Endoscopic aspiration instrument

An endoscopic aspiration instrument suitable for use with a trocar sheath in laparoscopic surgical procedures is disclosed for aspirating fluid from an ovarian cyst without leakage of the fluid into the peritoneal cavity. The endoscopic instrument comprises a elongated suction tube member having a needle guide positioned within the passageway thereof. The suction tube and needle guide are connected at the proximal ends thereof with the use of a three access port connector. The first access port connects to the proximal end of the suction tube. The proximal end of the needle guide tube is extended through the first port and connected to the second port of the T-type connector. An aspiration needle is inserted through a sealing cap positioned over the second access port and into the passageway of the needle guide tube. A centering device comprising a sleeve and a plurality of radially extending arms is positioned about the distal end of the needle guide tube for centering the needle guide tube within the passageway of the suction tube. The centering device is also located a predetermined distance from the distal end of the suction tube for preventing the ovarian cyst from being drawn too far into the suction tube. The connector also includes a third side port for connection to suction equipment for providing a vacuum in the suction tube to engage the ovarian cyst.

TECHNICAL FIELD 
This invention relates to medical instruments and particularly to an 
endoscopic medical instrument for aspirating biological tissue such as an 
ovarian cyst. 
BACKGROUND OF THE INVENTION 
A number of endoscopic medical and surgical instruments are available for 
aspirating fluid during a minimally invasive laparoscopic surgical 
procedure. One such endoscopic instrument is an aspiration needle for 
puncturing and aspirating fluid from, for example, an ovarian cyst. 
Another endoscopic instrument is an aspiration tube for aspirating fluid 
from the peritoneal cavity. One problem with the aspiration needle is that 
fluid leaks from around the shaft of the needle when the it punctures the 
cyst. Likewise, an aspiration tube allows fluid draining into the 
peritoneal cavity to come in contact with healthy tissue before and during 
removal. The problem of fluid leaking or draining into the peritoneal 
cavity is particularly heightened when the fluid contains malignant cells. 
The leakage of fluid with malignant cells to surrounding tissue 
significantly changes the morbidity and prognosis of the patient. 
When a protein marker test produces a positive result indicating that an 
ovarian cyst is malignant, an invasive procedure is typically employed to 
remove the ovary and fallopian tube associated with the malignant cyst. As 
a result, the patient experiences a four to five day hospital stay with 
three to six weeks of post-operative recovery. 
When the protein marker test produces a negative result indicating that the 
ovarian cyst may be benign, a minimally invasive, endoscopic 
close-chambered ovarian cyst removal technique is preferred. This 
minimally invasive procedure permits the patient to be discharged from the 
hospital within a 24 hour period with a normal post-operative recovery 
period lasting from three to five days. Typically, the patient is back to 
work or performing normal activity within five to eight days of this 
procedure. However, a negative protein marker test result is accurate only 
about 80% of the time. Consequently, the surgeon wants to prevent fluid 
leakage from the cyst. Should the ovarian cyst contain fluid having 
malignant cells, the morbidity and prognosis of the patient is 
significantly changed when the fluid is allowed to leak and come in 
contact with other healthy tissue within the peritoneal cavity. As a 
result, the morbidity and prognosis of the patient is typically worse than 
that of the invasive procedure where the malignant cells can be contained 
from further migration. 
The prevention of fluid leakage to healthy tissue during endoscopic 
aspiration will not effect the morbidity or prognosis of the patient even 
though the fluid contains malignant cells. A pathological report of the 
aspirated fluid indicating that malignant cells are present would then 
indicate the need for the invasive surgical procedure where healthy tissue 
exposure to the malignant fluid is eliminated or contained. However, 
leakage of the malignant fluid during the minimally invasive procedure 
would significantly worsen the morbidity or prognosis of the patient even 
though the invasive procedure would be subsequently employed. 
SUMMARY OF THE INVENTION 
The foregoing problems are solved and a technical advance is achieved with 
an illustrative endoscopic instrument with particular applications to 
laparoscopic or pelviscopic procedures for aspirating a cyst without fluid 
leakage to other tissue within the peritoneal cavity. This endoscopic 
instrument is advantageously utilized as a pelviscopic instrument for 
aspirating an ovarian cyst during a close-chambered ovarian cyst drainage 
procedure. The endoscopic instrument comprises an elongated member such as 
a suction tube having a first longitudinal passageway extending between 
the distal and proximal ends of the tube, whereby the distal end of the 
tube is inserted through a trocar sheath. The proximal end includes first 
and second access ports of which the first access port is accessible to 
the passageway. A vacuum is applied to the first access port and 
passageway to engage and maintain purchase of the ovarian cyst with the 
distal end of the suction tube. The instrument also includes a positioning 
or centering device positioned within the suction tube passageway a 
predetermined distance from the distal end. The centering device has a 
passageway for receiving and centering an aspiration needle that is 
inserted advantageously through the second access port. 
To further guide and center the aspiration needle, the endoscopic 
instrument includes a second elongated member such as a tubular needle 
guide having a second longitudinal passageway between distal and proximal 
ends thereof. The tubular needle guide is positioned within the suction 
tube passageway with the proximal end thereof being connected to the 
second access port. The second access port has access to the passageway of 
the tubular needle guide for inserting and guiding the aspiration needle 
therethrough. 
A sealing cap is positioned over the second access port for maintaining 
purchase of the ovarian cyst when a vacuum is applied to the first access 
port of the suction tube. The aspiration needle is advantageously inserted 
through the sealing cap, second access port and extendable through the 
needle guide and beyond the distal end of the suction tube to puncture and 
aspirate the ovarian cyst without permitting any leakage of fluid within 
the peritoneal cavity. 
Should any fluid leak from about the shaft of the aspiration needle, fluid 
from the cyst held in purchase with pelviscopic instrument for aspirating 
an ovarian cyst during a close-chambered ovarian cyst drainage procedure. 
The endoscopic instrument comprises an elongated member such as a suction 
tube having a first longitudinal passageway extending between the distal 
and proximal ends of the tube, whereby the distal end of the tube is 
inserted through a trocar sheath. The proximal end includes first and 
second access ports of which the first access port is accessible to the 
passageway. A vacuum is applied to the first access port and passageway to 
engage and maintain purchase of the ovarian cyst with the distal end of 
the suction tube. The instrument also includes a positioning or centering 
device positioned within the suction tube passageway a predetermined 
distance from the distal end. The centering device has a passageway for 
receiving and centering an aspiration needle that is inserted 
advantageously through the second access port. 
To further guide and center the aspiration needle, the endoscopic 
instrument includes a second elongated member such as a tubular needle 
guide having a second longitudinal passageway between distal and proximal 
ends thereof. The tubular needle guide is positioned within the suction 
tube passageway with the proximal end thereof being connected to the 
second access port. The second access port has access to the passageway of 
the tubular needle guide for inserting and guiding the aspiration needle 
therethrough. 
A sealing cap is positioned over the second access port for maintaining 
purchase of the ovarian cyst when a vacuum is applied to the first access 
port of the suction tube. The aspiration needle is advantageously inserted 
through the sealing cap, second access port and extendable through the 
needle guide and beyond the distal end of the suction tube to puncture and 
aspirate the ovarian cyst without permitting any leakage of fluid within 
the peritoneal cavity. 
Should any fluid leak from about the shaft of the aspiration needle, fluid 
from the cyst held in purchase with the suction tube is aspirated through 
the suction tube and out of the first access port. 
The instrument also includes a one-way check valve connected to the 
proximal end of the aspiration needle for preventing loss of purchase of 
the cyst within the suction tube as well as preventing any fluid within 
the aspiration needle from being drawn out of the distal end of the needle 
and through the suction tube. This also prevents loss of purchase of the 
suction tube with the cyst. 
The outer surface of the suction tube includes a matte or non-glare finish 
for reducing, if not eliminating, the reflection of light from the suction 
tube during the endoscopic procedure. This significantly reduces annoying 
and fatiguing conditions to the attending physician. 
Alternatively, the endoscopic instrument includes the suction tube with the 
first and second access ports at the proximal end thereof and the second 
elongated member, such as the tubular needle guide, positioned within the 
first passageway of the suction tube. The proximal end of the needle guide 
is connected to the second access port thereby allowing the second access 
port direct access to the passageway of the needle guide. The instrument 
further includes a positioning device attached about the proximal end of 
the needle guide tube and positioned within the first passageway of the 
suction tube a predetermined distance from the distal end thereof. 
To facilitate reuse and cleaning, the endoscopic aspiration instrument 
utilizes a T-type connector having three access ports for interconnecting 
the suction tube and the tubular needle guide. Two ports of the connector 
are directly opposite from one another with the proximal end of the 
suction tube being connectable to the first port. The second or side port 
has access through the connector and to the passageway of the suction 
tube. The second elongated member is positioned through the first port and 
connected to the third port directly opposite therefrom. The passageway of 
the elongated tubular needle guide is accessible through this third port. 
The instrument further includes a positioning or centering device attached 
about the distal end of the tubular needle guide which is positionable 
within the passageway of the suction tube when connected to the three port 
connector. The positioning device includes a sleeve and a plurality of 
arms extending radially therefrom and toward the inner surface of the 
suction tube. The positioning device is advantageously positioned a 
predetermined distance from the distal end of the suction tube to prevent 
the ovarian cyst from being drawn too far into the suction tube. 
Similarly, the alternative endoscopic instrument includes an aspiration 
needle that is insertable through the third port and passageway of the 
needle guide and extendable beyond the distal end of the suction tube to 
puncture and aspirate the ovarian cyst. A check valve is also connected to 
the proximal end of the aspiration needle to prevent suction of fluid 
within the aspiration needle from being drawn therefrom and through the 
passageway of the suction tube. A sealing cap is likewise positioned about 
the third port for maintaining purchase of the ovarian cyst and suction 
tube prior to and during insertion of the aspiration needle. The 
endoscopic instrument further includes a suction tube connectable to the 
second port for maintaining a vacuum within the suction tube. A clamp 
positioned about the connecting tube regulates the vacuum through the 
connecting and suction tube.

DETAILED DESCRIPTION 
Depicted in FIG. 1 is endoscopic instrument 100 such as a pelviscopic cyst 
aspirator for aspirating fluid 101 from an ovarian cyst 102. The 
instrument includes an elongated member 103 such as a stainless steel 
suction tube which is passed through the passageway of trocar sheath 104 
and into the peritoneal cavity 105 of patient 106. The trocar sheath is 
inserted through the abdominal wall 107 of a patient for performing a 
minimally invasive laparoscopic or pelviscopic procedure usually 
associated with the reproductive organs of a female patient. The distal 
end 108 of the elongated suction tube member is positioned to engage the 
outer wall of the ovarian cyst and maintain purchase of the cyst by a 
vacuum introduced via suction connecting tube 109 attached to side port 
110 of connector 111 and a vacuum source (not shown) attached to connector 
112 of the connecting tube. T-type connector 111 has three ports 110, 113, 
and 114 of which the proximal end 115 of suction tube 103 is connected to 
access port 114. A well-known regulating clamp 116 is positioned about 
suction connecting tube 109 and regulates the amount of vacuum maintained 
on cyst 102. Aspiration needle 117 is inserted through sealing cap 118, 
access port 113, and suction tube 103 to puncture and aspirate the ovarian 
cyst. When inserted into the cyst, another source of vacuum is applied to 
the proximal end of the aspiration needle through one-way check valve 119 
to aspirate fluid 101 without leaking into peritoneal cavity 105. 
Depicted in FIG. 2 is a cross-sectional view of endoscopic instrument 100 
with aspiration needle 117 positioned for insertion through sealing cap 
118 and into access port 113. Endoscopic instrument 100 basically 
comprises elongated suction tube member 103, connector 111, and a second 
elongated needle guide member 120 interconnected as shown. By way of 
example, elongated suction tube member 103 comprises a type 302 stainless 
steel tube approximately 31 cm in length. The suction tube includes a 
hollow passageway 121 approximately 3/8" in diameter and wall 122 
approximately 0.035" in thickness. Distal end 108 of the tube engages and 
maintains purchase of the ovarian cyst with the aid of a vacuum applied 
through passageway 121 and connector 111. Proximal end 115 of the suction 
tube is connected to the first port 114 of the connector with the aid of a 
well-known threaded interconnection. 
Second elongated member 120, referred to as an aspiration needle guide, is 
centrally positioned within passageway 121 of suction tube 103. By way of 
example, needle guide 120 is approximately 40 cm long and comprises a 15 
gauge thin wall tube having an outside diameter of approximately 0.072" 
and an internal passageway having an inside diameter of 0.059" between 
distal end 124 and proximal end 125. The proximal end 125 extends 
centrally through first access port 114 of connector 111 and connects to 
second access port 113 as shown with the use of well-known silver solder 
to secure the proximal end to the access port. Positioning device 126 is 
positioned about the distal end of the needle guide to center the needle 
guide within passageway 121 of the suction tube. 
Depicted in FIG. 3 is an end view of suction tube 103, needle guide 120, 
and positioning device 126 taken along the line 3--3 of FIG. 2. 
Positioning device 126 comprises a hollow sleeve 127 connected to distal 
end 124 of needle guide 120 using, for example, well-known silver solder. 
A plurality of arms 128 extends radially from sleeve 127 for centering 
needle guide 120 within passageway 121 of the suction tube. The ends of 
the arms make contact with the inside surface of tubular wall 12 to center 
needle guide 120 within passageway 121 of the suction tube. This allows 
the suction tube to be removed from the connector for cleaning. The 
positioning device is also located a predetermined distance from the 
distal end 108 of suction tube 103 for preventing the engaged ovarian cyst 
from being drawn too far into the suction tube. 
Referring again to FIG. 2, connector 111 resembles a T-type fitting having 
three access ports 110, 113, and 114. The main body 129 of the connector 
is approximately 11/2" in length between directly opposed access ports 113 
and 114. The outside diameter of the main body near first access port 114 
is approximately 0.625". The main body also includes an inside cylindrical 
passageway 130 approximately 0.312" in diameter. Proximal end 115 and 
access port 114 are threaded to provide ready interconnection of the two 
components. Passageway 130 tapers to a diameter of 0.111" at the proximal 
end thereof for receiving the proximal end of needle guide 120. Similarly, 
the outside diameter of the main body of the connector reduces to an 
outside diameter of approximately 0.375". The proximal end of the main 
body includes a circular flange 131 for well-known sealing cap 118 to 
engage and provide an air-tight seal. Sealing cap 118 is commercially 
available from Cook Urological, Inc., Spencer, Ind. Proximal end 125 of 
needle guide 120 is connected to access port 113 using well-known silver 
solder. 
Side access port 110 opens into main connector passageway 130 via 
connecting tube adaptor 132 having an outside diameter of approximately 
0.495" and an internal passageway 133 having a diameter of approximately 
0.250". Connecting tube adaptor 132 is either silver-soldered or press-fit 
into the main body of connector 111. Vacuum connecting tube 109 connects 
between adaptor 132 and vacuum suction equipment (not shown) to provide 
vacuum and aspiration through access port 110 and passageway 121 of 
suction tube 103. Well-known connecting cap 134 secures connecting tube 
109 to adaptor 132 and access port 110. 
When the suction tube 103 is placed next to an ovarian cyst wall, suction 
applied through connecting tube 109 and passageway 121 draws the ovarian 
cyst wall into the end of suction tube 103 up to positioning device 126. 
In addition, the ovarian cyst wall is engaged against the distal end 124 
of needle aspiration guide 120. 
Aspiration needle 117 is a well-known aspiration needle approximately 40 cm 
in length and is comprised of either a 14 or 17 gauge metal tube with a 
hub connector 135 at the proximal end thereof. A standard lancet bevel is 
provided at the distal end 136 of the tube. A well-known one-way check 
valve 137 is connected to the proximal end of the hub typically with a 
well-known Luer lock connector. A second source of vacuum or suction is 
applied to proximal end 138 for providing suction to aspirate fluid from 
the ovarian cyst through the tube of the aspiration needle. 
To briefly describe the procedure utilized with the cyst aspiration 
instrument, the aspirating needle 117 is inserted through sealing cap 118, 
access port 113, and into passageway 123 of the needle guide 120. Suction 
is applied to the distal end 138 of the check valve. The instrument is 
then inserted into the peritoneal cavity through the trocar sheath 104 as 
shown in FIG. 1. Suction via connecting tube 109 is applied to passageway 
121 of suction tube 103, which engages the outside wall of the ovarian 
cyst. Sufficient purchase is maintained to manipulate the cyst and the 
ovary, if necessary. Well-known regulating clamp 116 is in a generally 
full open position for maximum purchase. The aspiration needle is then 
extended through the needle guide to puncture the wall of the cyst. Fluid 
from the cyst is drawn through the aspiration needle to aspirate and 
deflate the cyst. A saline lavage is also utilized with the aspirating 
needle to further aspirate or evacuate the cystic contents. The one-way 
check valve 137 prevents fluid from flowing back through the needle and 
into suction tube 103. Should any fluid leak from about the outer wall of 
the aspiration needle, suction tube 103 aspirates any emerging fluid. 
The aspiration needle is removed, and the cyst is fully deflated by 
aspiration through suction tube 103. Purchase of the cyst wall is 
maintained within suction tube 103 and positioning device 128. The surgeon 
then employs a well-known tying off technique of the ruptured cyst end, 
and the cyst is removed using well-known surgical techniques. 
Suction is maintained while the aspirating instrument is withdrawn from the 
cavity. This is done to prevent any backward draining or leakage of fluid 
down the shaft. The aspiration instrument is then removed without any 
leakage or drainage of possibly malignant cells into the peritoneal 
cavity. As a result, the leakage of possibly malignant cyst fluid into the 
peritoneal cavity during a minimally invasive pelviscopic procedure is 
minimized if not completely eliminated. 
It is to be understood that the above-described medical instrument for 
aspirating a cyst without fluid leakage is merely an illustrative 
embodiment of the principles of this invention and that other apparatus 
may be devised by those skilled in the art without departing from the 
spirit and scope of this invention. In particular, the endoscopic 
instrument is comprised of basically three components consisting of a 
suction tube, a needle guide and a connector with three access ports. 
Alternatively, the suction tube can be provided with a single, side access 
port and a second access port at the proximal end for inserting the 
aspiration needle therethrough. The centering device may be attached to 
the distal end of the suction tube without the need for the needle guide. 
In this embodiment, the aspiration needle is inserted through the sealing 
cap and the second access port at the proximal end of the suction tube and 
centered by the physician for insertion into the cyst through positioning 
device 128. Although described for aspirating an ovarian cyst, the 
aspiration instrument may also be utilized to aspirate bile from the 
gallbladder, fluid from kidney cysts, or fluid from other cavities of the 
body.