The present invention relates generally to the field of steerable channel devices for minimally invasive surgical procedures, and more particularly to reinforcements for minimizing unintended deflection of the shafts flexible instruments steered by steerable channel devices during use.
Surgery in the abdominal cavity is frequently performed using open laparoscopic procedures, in which multiple small incisions or ports are formed through the skin and underlying muscle and peritoneal tissue to gain access to the peritoneal site using the various instruments and scopes needed to complete the procedure. The peritoneal cavity is typically inflated using insufflation gas to expand the cavity, thus improving visualization and working space. Further developments have led to systems allowing such procedures to be performed using fewer ports, and in some cases only a single port.
Some instrument access devices or ports suitable for use in single port procedures and other laparoscopic procedures are described in co-pending U.S. application Ser. No. 11/804,063 (US Publication 2007-0299387) filed May 17, 2007 and entitled SYSTEM AND METHOD FOR MULTI-INSTRUMENT SURGICAL ACCESS USING A SINGLE ACCESS PORT, U.S. application Ser. No. 12/209,408 (US Publication 2009-227843) filed Sep. 12, 2008 and entitled MULTI-INSTRUMENT ACCESS DEVICES AND SYSTEMS, and U.S. application Ser. No. 12/511,043 (US Publication 2011-0060183) filed Jul. 28, 2009, entitled MULTI-INSTRUMENT ACCESS DEVICES AND SYSTEMS, and U.S. application Ser. No. 12/846,788 (US Publication US 2011-0184231), entitled DEFLECTABLE INSTRUMENT PORTS, filed Jul. 29, 2010, and U.S. application Ser. No. 13/651,278 (Attorney Docket: TRX-2620), entitled Deflectable Instrument Shafts, filed Oct. 12, 2012, each of which is incorporated herein by reference. The aforementioned patent applications describe access systems incorporating at least one and in some cases multiple steerable instrument channel devices.
Referring to
The medical instrument is one having a flexible shaft 240 and an end effector 250 on the distal end of the flexible shaft. The medical instrument may further include a handle (not shown) on the proximal end of the shaft. The handle may include an actuator used for actuating the end effector, such as by opening/closing jaws, applying a staple or other fastener etc, or features for energizing an electrosurgical element.
In use, the distal portion of the flexible instrument is passed through the steerable instrument channel such that the end effector 250 exits the distal end of the steerable instrument channel. Deflection or steering of the flexible instrument is carried out by actively steering or deflecting the distal portion of the steerable instrument channel. The flexible instrument is removably received within the lumen of the steerable instrument channel so that it may be interchanged with other medical instruments during the course of the procedure.
In some instances, a portion of the medical instrument's flexible shaft 240 may be positioned distal to the distal end of the steerable instrument channel, and thus may undesirably flex within the body. For example, the flexible instrument shaft may flex as the end effector is engaged with tissue, contacts or advances against tissue, or is used for tissue manipulation. Such flexion may occur during times when the instrument channel is actively steered and also when the user is not actively steering the channel. The present application describes a feature that may be used at the distal end of a steerable instrument channel to minimize such unintended flexion of the flexible instrument shaft.
This application describes reinforcing elements positioned at a distal end of an instrument channel device through which the distal ends of medical instruments are delivered to an operative site within a body cavity. The reinforcing elements are disclosed as positioned at the end of an instrument channel device having a steerable distal portion, although they might instead be used on other types of instrument channel devices.
The proximal shaft portion may be a flexible, rigid, semi-rigid, or rigidizable tubular shaft. Examples are found in the co-pending patent applications referenced in the Background section above.
Telescoping reinforcement 104 is formed of a plurality of telescoping members 108a-108e having a collapsed position as shown in
Members 108a-108d include longitudinally extending slots or cutouts 110 in their side walls. Each member may include more than one such slots. For example, in the illustrated embodiment each member includes a pair of longitudinally extending slots 110 spaced 180° from one another. In the drawings the slots 110 in members 108a and 108c are shown off-set 90° from the slots 110 in members 108b and 108d. Different (or no) offsets may be used in other embodiments. Each slot has a distal end as shown.
Detents 112 (best seen in
Prior to insertion of a medical instrument through the lumen 106, the members 108a-108e are arranged in the nested configuration shown in
In alternate embodiments, magnetic features at the proximal end of the telescoping reinforcement are used to retain the members 108a-108e in the proximal, nested, configuration by engaging with magnetic material disposed on the distal member 108e.
In other alternate embodiments, elastomeric materials including, but not limited to, silicone or extension springs 107 may be terminally attached to distal member 108e such that extension of the telescoping members is opposed by a spring force exerted by the elastomeric member.
Other alternate embodiments may include a retention mechanism that may be released by rotation or other actuation means perpetrated by the distal end of the instrument shaft or end effector. In these embodiments, extension of members 108a-108e is impeded by a mechanical stop that must be engaged by the instrument end effector to be released.
The steerable portion 102 of the instrument shaft 100 may take one of many forms suitable for use in constructing a steerable instrument shaft, including flexible tubing, vertebrae segments, slotted tubing (e.g. laser cut tubing) etc.
Pull elements (not shown) employed to steer the steerable portion 102 extend through guides 124 disposed on the exterior surface of the ball segment 120. As described in the prior applications incorporated herein, the distal ends of the pull elements are coupled to the distal end of the steerable instrument channel, and the proximal ends are coupled to an actuator that applies/releases tension on the pull elements to steer the portion 102. Examples of actuators that may be used to engage the pull elements are disclosed in the incorporated prior applications.
The number of guides 124 used preferably corresponds to the number of pull elements that are to be used to steer the steerable portion 102. Four guides 124 are shown spaced at 90 degree intervals, corresponding to the use of two or four pull elements.
The vertebrae segments include anti-rotation features to prevent the segments 120, 122 from axially rotating relative to one another. As one example, anti-rotation members on one segment are engaged by anti-rotation features on the adjacent segments. In the drawings, the ball segments 120 have anti-rotation posts 126 that are received in corresponding receivers 128 extending proximally and distally from the socket segments 122.
Other deflectable shaft features that used in combination with the telescoping tip described herein are described in U.S. application Ser. No. 13/651,278, entitled Deflectable Instrument Shafts, filed Oct. 12, 2012, which is incorporated herein by reference. For example, a tubular liner of PTFE or other material may extend longitudinally through the lumen to form a smooth passageway for movement of instruments through the shaft. A skin formed of a thin flexible membrane or material may cover the segments to prevent surrounding body tissue or other material from passing into the spaces between adjacent segments, or from being pinched or captured between adjacent segments. The skin is preferably loose enough that it will not resist deflection of the shaft when the pull elements are actuated.
During use of the first embodiment, the tip of the medical instrument (e.g. the end effector 250) is inserted into the proximal end of the lumen of instrument channel device 100, advanced through the steerable portion 102 and into the telescoping reinforcement 104 which is in the nested configuration shown in
Features may be included for retracting the members 108b-108e in a proximal direction upon withdrawal of the instrument tip or end effector 250 from the telescoping reinforcement 104. In one embodiment, a feature on the end effector 250 or clevis engages with a corresponding feature within member 108e, such that withdrawing the end effector in a proximal direction withdraws member 108e and then sequentially causes withdrawal of each of the more proximal members 108d-108b. In one embodiment, the engaging features are magnetic elements. For example, the stop within the distal end of member 108e may be a magnetic ring, and a component (e.g. a collar) on the instrument's clevis 251 is formed of a material that will magnetically engage with the magnetic ring.
An alternative arrangement for withdrawing the telescoping reinforcement 104 utilizes a flat wire coil (or a circular cross-section extension spring) wound in a tubular configuration and having a first end coupled to the member 108e and a second end coupled more proximally, such as to member 108a. The coil may be positioned in the lumen of the telescoping reinforcement, or around the telescoping reinforcement's outer surface. In this embodiment, the coil is stretched when the telescoping reinforcement 104 is in the expanded position. When the end effector is withdrawn from the telescoping reinforcement 104, the coil retracts and draws the members 108b-108e proximally into the collapsed position. It should be pointed out that the coil may apply sufficient retention forces to the members 108b-108e to prevent undesired expansion of the telescoping reinforcement 104, thus eliminating the need for the deflecting members 114 described above.
A flat wire coil of the type described in the prior paragraph may itself serve as a telescoping reinforcement, thus providing a telescoping reinforcement that will self-retract following withdrawal of the end effector, and that will remain biased in the nested configuration. As shown in
While certain embodiments have been described above, it should be understood that these embodiments are presented by way of example, and not limitation. It will be apparent to persons skilled in the relevant art that various changes in form and detail may be made therein without departing from the spirit and scope of the invention. This is especially true in light of technology and terms within the relevant art(s) that may be later developed. Moreover, features of the various disclosed embodiment may be combined in a variety of ways to produce additional embodiments.
Any and all patents, patent applications and printed publications referred to above, including for purposes of priority, are incorporated herein by reference.
This application claims the benefit of U.S. Provisional Application No. 61/728,296, filed Nov. 20, 2012, and U.S. Provisional Application No. 61/801,781, filed Mar. 15, 2013, each of which is incorporated herein by reference.
Number | Date | Country | |
---|---|---|---|
61728296 | Nov 2012 | US | |
61801781 | Mar 2013 | US |