Instrument System For Minimally Invasive Surgery In A Patient's Tissue

An instrument system for minimally invasive surgery in the tissue of a patient, with an instrument shaft, having a distal end that can be inserted in the body of the patient and a proximal end that remains outside the body, with an inner channel extending axially and continuously in the instrument shaft, with at least one working channel extending axially and continuously in the instrument shaft, and with an obturator which can accommodate an optical system coaxially and can be inserted into the inner channel in such a manner that its transparent distal tip projects out from the beveled distal front end of the instrument shaft. The system can include a valve block at the proximal end of the instrument shaft, closing the inner channel and enabling sealed passage of the obturator or an optical system.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to German Patent Application No. 10 2017 111 821.7, filed May 30, 2017, which is incorporated by reference in its entirety.

BACKGROUND

The present application relates to an instrument system for minimally invasive surgery in the tissue of a patient.

SUMMARY

Minimally invasive surgery in natural body cavities, for example in the abdominal cavity, is performed using trocars, which consist of a trocar obturator and a trocar sleeve. The trocar obturator is used to pierce the tissue surrounding the body cavity in order to insert the trocar sleeve. Gas is insufflated into the body cavity to expand the cavity and create an adequate surgical field. The obturator is then withdrawn and the trocar sleeve remains, to provide access to the surgical field for an endoscopic optical system and for surgical instruments.

In the case of minimally invasive surgery in the tissue of a patient, for example, surgical removal of a tumor embedded in the tissue, a problem exists in that no natural cavity is present for the surgical procedure. Therefore, US 2015/0051495 A1 describes a method for minimally invasive surgery in the tissue of a patient, e.g., for removing a tumor in the female breast, in which a trocar with an optical obturator is made to pierce into the tissue under visual observation until the distal tip of the trocar reaches the tumor to be dissected. Then pressurized gas is insufflated through the trocar to force the tissue apart and create an artificial cavity for the surgery to be performed. Instruments can be introduced through the working channel of the trocar sleeve to perform the steps of the surgery in front of the distal tip of the trocar.

A trocar with an obturator, a trocar sleeve and an endoscopic optical system is known from DE 10 2011 107 615 A1.

The present disclosure is based on the task of providing an instrument system for minimally invasive surgery in the tissue of a patient, which allows the dissection of an artificial surgical cavity for the surgical procedure.

According to the present disclosure, this task is accomplished using an instrument system having the features and structures recited herein.

Advantageous embodiments of the present disclosure are further recited herein.

The instrument system according to the present disclosure has an elongated instrument shaft of stable form, which is introduced into the body of the patient. The distal end of the instrument shaft then enters intracorporeally into the target area of the tissue, while the proximal end of the instrument shaft remains outside of the body. The instrument shaft has an inner channel extending axially in a continuous, straight line from the proximal to the distal end. Into this inner channel, an obturator can be inserted, which has a distal transparent tip and can accommodate an optical system by which during the penetration of the tissue, the tissue adjacent to the transparent tip can be visualized to observe the penetration and positioning of the distal tip. Furthermore the instrument shaft has at least one working channel, which is likewise formed axially, extending continuously from the proximal to the distal end. Semi-flexible instruments can be introduced through the working channels in such a manner that their distal working elements emerge distally from the working channel and can be used in front of the distal tip of the instrument shaft, while the operating elements disposed at the proximal end of the instrument remain outside of the body. Furthermore, a pressurized gas can be insufflated through a working channel to create an artificial cavity for the surgical operation to be performed. In addition, if necessary, irrigation fluid can be introduced through a working channel and/or blood and tissue fluid can be suctioned off.

At the proximal end of the inner channel, a valve block is disposed on the instrument shaft. The valve block provides sealed closure for the inner channel when no instrument is introduced into the inner channel. When the obturator is introduced into the inner channel, the valve block seals the obturator in the inner channel at its outer circumference. When the obturator is withdrawn after positioning of the distal tip in the channel, in place of the obturator an endoscopic optical system can be introduced into the inner channel so that the surgical procedure can be performed under direct view. In this case the endoscopic optical system is also sealed off by the valve block in the inner channel.

The inner channel follows a straight line in the instrument shaft up to its proximal end, so that the essentially rigid straight obturator and the optics can be introduced into this inner channel. On the other hand, at their proximal end region, which remains outside of the body during surgery, the working channels are bent or curved away from the axis of the instrument shaft toward the outside, resulting in an ergonomically advantageous position for operating the instruments inserted in the working channel.

Such a bent shape of the working channels is possible through the use of semi-flexible instruments. At the proximal ends of the working channels as well, valves are disposed that allow the instruments to be introduced while maintaining a tight seal and allow the working channels to be closed with a seal when no instruments are introduced in the working channel. These valves also allow for the insufflation of the pressurized gas.

Furthermore, at the proximal end of the instrument shaft, two hand grips are preferably molded on, which facilitate the controlled advancement and movement of the instrument shaft by the surgeon. It is advantageous if the proximal ends of the working channels are spatially disposed relative to one another so that operator, using only one hand, can hold a hand grip and at the same time operate an instrument disposed in the corresponding working channel.

The distal end of the instrument shaft is beveled such that the plane of the distal front end of the instrument shaft deviates from the axis of the instrument shaft at an angle different from 90°.

When the obturator is inserted in the instrument shaft, its penetrating distal tip projects beyond the distal end face of the instrument shaft to allow penetration of the tissue. Here, the distal end of the obturator is seated with its external circumference closely fitted in the internal diameter of the inner channel to prevent penetration of tissue and the like into the inner channel when the distal tip is being advanced.

In this process, the end face of the instrument shaft preferably passes continuously into the circumferential curved surface area of the tip of the obturator, so that the tissue penetrated by the tip of the obturator can undergo further blunt dissection by the subsequent distal end of the instrument shaft.

The axial position of the obturator in the instrument shaft can be accurately maintained by suitable fixing aids. As soon as the distal tip is positioned in the surgical target area, the obturator is withdrawn. The optical system is introduced into the inner channel until its distal end is positioned at the distal outlet of the inner channel. Thus the optical system allows direct view into the surgical field. The optical system can also be fixed in its position in the instrument shaft with an optical system clamp. Since penetration of the tissue is no longer occurring in this stage, the distal end of the optical system need not be seated with a tight seal in the inner channel. Therefore it is possible to use the same endoscopic optical system inserted in the obturator for observing the surgical field even without the obturator. To prevent penetration of tissue, fluid and the like into the distally open working channels during penetration, the working channels may also be closed by an inserted stylet if desired.

During penetration into the tissue, the tissue is penetrated by the distally projecting tip of the obturator, while the beveled distal end of the instrument shaft performs blunt dissection of the penetrated tissue. As soon as the distal tip has reached the surgical target area, the instrument shaft can be rotated around its longitudinal axis, as a result of which, because of the beveled tip of the instrument shaft and the eccentric arrangement of the obturator tip, an annular cavity is dissected in the tissue, enabling the insufflation of pressurized gas.

The instrument shaft is preferably manufactured as a one-piece plastic article.

DETAILED DESCRIPTION

In the embodiments shown, the instrument system has an instrument shaft10, which is designed as an elongated, straight cylinder with an approximately oval cross-section. The distal anterior face12of the instrument shaft10is beveled such that its plane forms an angle differing from 90° with the axis of the instrument shaft10; this is preferably between 30° and 60° and in the embodiment shown is 45°.

Through the instrument shaft10in the axial longitudinal direction thereof, an inner channel14passes, which preferably has a circular cross-section and proceeds in a continuous straight line from the proximal end to the distal end of the instrument shaft10. The inner channel14proceeds in the cross-section of the oval instrument shaft10, preferably eccentric to the middle axis of the instrument shaft10. As a result, the inner channel14at the distal end emerges in the further distally located surface of the beveled end face. A valve block16is located at the proximal end of the inner channel14. The valve block16preferably has an internal valve flap and a lip seal. The valve flap closes the inner channel14airtight and can be opened to permit the passage of an instrument. When an instrument is introduced into the inner channel14and the valve flap is opened, the lip seal abuts against the circumference of the instrument introduced and thus closes off the inner channel14.

Furthermore, at least one working channel is formed in the instrument shaft10. In the embodiment shown, three working channels18are provided.

The working channels18travel in a direction parallel to the axis alongside the inner channel14in the instrument shaft10and open distally in the end face12in the surface area thereof, located further proximally. As is shown inFIG. 5, the three working channels18are disposed in a triangle in the cross-section of the instrument shaft10beneath the inner channel14.

The working channels18travel in a straight line parallel to the axis in the instrument shaft10to the proximal end of the instrument shaft10. At the proximal end of the instrument shaft10, the working channels18proceed toward the longitudinal access of the instrument shaft10bent toward the outside, so that with the axis of the instrument shaft10they form a proximally opening angle preferably between 15° and 45°, and in the embodiment shown about 30°. The angled proximal end region of the working channels18in each case is formed by a tubular appendage20, in each case formed in one piece on the proximal end of the instrument shaft10. The tubular appendages20that enclose the working channel18extend in the proximal direction beyond the proximal end of the instrument shaft10and the valve block16. In the embodiment shown, two appendages20.1and20.2with the respective working channels18.1and18.2are disposed in a plane that encloses the axis of the instrument shaft10. The third appendage20.3with the working channel18.3is bent downward from this plane.

At the proximal end of the appendage20in each case a valve22is disposed, which seals off the respective end of the working channel18and allows sealed introduction of an instrument as is explained above for the valve block16.

In addition at least one hand grip24is integrally formed at the proximal end of the instrument shaft10. In the embodiments shown, two hand grips24are present. The hand grips24are designed as integrally formed rods that are angled against the axis of the instrument shaft10and form with the axis of the instrument shaft10a proximally opening angle of about 15° to 45°, preferably of about 30°. As is especially recognizable fromFIG. 3, the two hand grips24are essentially below the appendages20.1and20.2.

At the proximal end of the instrument shaft10, a bracket is also integrally formed, preferably extending in an arc shape from the appendages20.1and20.2. On the bracket26a connector28is integrally formed for fastening the instrument shaft10to a stand or the like.

The instrument system also has an obturator30. The obturator30is designed as a hollow cannula with a transparent distal tip32. The tip32may be designed in a sharp or blunt conical shape. An endoscopic optical system is slid into the obturator30. The optical system is designed in a manner known in and of itself and therefore is not shown in the drawing and will not be described in further detail. As is shown inFIGS. 6 and 7, the obturator30is slid through the valve block16into the inner channel14of the instrument shaft10. With suitable fixing means34the obturator30introduced into the inner channel14is fixed onto the valve block, so that its axial position in the instrument shaft10is defined and maintained. The distal tip32of the obturator30in this position projects distally beyond the front face12of the instrument shaft10, asFIG. 9shows.

The outer diameter of the obturator30is adapted to the inner diameter of the inner channel14in such a way that the obturator30fits tightly in the inner channel14at the front face12. This ensures that tissue cannot penetrate into the inner space of the interior channel14. When the obturator30is inserted, the outer circumference of the projecting tip32merges continuously into the front face12, as shown inFIG. 9. In the proximally located region (FIG. 9, bottom) this is apparent from the oblique position of the front face12. In the distally located area (FIG. 9, top) the outer edge of the front face12between the outlet opening of the inner channel14and the circumference of the instrument shaft10is bordered by a bevel36in such a way that here also a continuous transition is achieved. The front face12thus merges across the entire circumference of the obturator tip32, in a distally acute angle of 45° in the example shown, with the outer circumference of the obturator30.

After removal of the obturator30from the instrument shaft10, the endoscopic optical system can be withdrawn from the obturator30and can also be passed through the valve block16into the inner channel14of the instrument shaft10and fixed in the inner shaft10in its axial position. If the optical system alone is introduced into the instrument shaft10and especially fixed with a clamp38for the optical system, the distal end of the optical system lies in the plane of the front face12of the instrument shaft10.

Semi-flexible instruments can be introduced to the working channels18. Such semi-flexible instruments are known in and of themselves, so they need not be described in further detail here.

The semi-flexible instruments have a flexible, pliable shaft, stable against tensile and compression forces. The instruments can be introduced through the respective working channel18, wherein because of the flexible shaft they can follow the curvature of the working channels18. Once the instrument is introduced into the respective working channel18, its distal working element projects distally out of the end face12of the instrument shaft10. The proximal operating elements of the instrument remain proximally outside of the working channel18and its valve22. The instrument is sealed off by the valve22. Semi-flexible instruments used may be any of a plurality of instruments known in and of themselves with correspondingly designed working elements and operating elements. These can be, for example, cutting, clamping, grasping, or coagulating instruments or suction-irrigation instruments or biopsy forceps, etc.

In addition, in particular, pressurized gas can be insufflated through the working channels18or the inner channel14. It is also possible to introduce liquids through the working channels and suction it off, for example to rinse the surgical field and suction off blood and tissue fluid.

A minimally invasive surgical procedure in the tissue of a patient is conducted in the following way using the instrument system according to the present disclosure:

First the obturator30is placed in the instrument shaft10and fixed in its axial position in the instrument shaft10in such a way that the distal tip32projects distally out of the front face12of the instrument shaft10. The instrument shaft10is introduced into the tissue through a skin incision if necessary.

In this process the distal tip32of the obturator penetrates the tissue. The advancement of the distal end in the tissue can be observed using the optical system through the transparent tip32of the obturator30. The tissue penetrated by the tip32further undergoes blunt dissection by the continuously following distal end of the instrument shaft10. Since the obturator30at the distal end is tightly enclosed in the inner channel14and the distal end of the instrument shaft10, during this penetration of the tissue, no tissue can intrude into the inner channel14. The distal openings of the working channels18if necessary can be closed by a suitable stylet, so that also no tissue can penetrate into the working channels18.

The instrument shaft10is guided under visualization via the transparent tip32of the obturator30through the tissue until the distal end of the instrument shaft10is positioned in the surgical target area. Delicate introduction and maneuvering of the instrument shaft10is made easier for the operator by means of the hand grips24. Once the distal end of the instrument shaft10is positioned in the area of the surgery, the instrument shaft10is rotated around its longitudinal axis, which is ideally facilitated by grasping the instrument on the bracket26. When the instrument shaft10is rotated, the distal end of the instrument shaft10, because of its beveling and the eccentric arrangement of the obturator30, creates an annular cavity in the tissue. Pressurized gas can now be insufflated into this initially produced cavity though one of the working channels18or the inner channel14, so that the tissue is forced aside and the initially artificially created gap is dilated to form a cavity.

Into this artificial cavity now created in front of the distal end of the instrument shaft10, the semi-flexible instruments can be introduced through the working channels18to perform surgical steps in the surgical area. For this purpose the obturator30is withdrawn from the instrument shaft10since further penetration of the tissue is no longer necessary. In place of the obturator30an endoscopic optical system is now introduced into the inner channel14, positioned in this inner channel14, and fixed with the clamp38for the optical system. The optical system previously disposed in the obturator30can preferably be used for this purpose. The optical system used and positioned allows a direct view into the artificial cavity created by the gas insufflation, so that the surgical steps can be performed under unimpeded direct view through the optical system. In this way a surgical site is produced, similar to that in a preformed body cavity during laparoscopic surgery.

The mutual arrangement of the appendages20and the hand grips24in this process allows ergonomically advantageous handling of the instrument system by the operator. The operator can grasp one of the hand grips24with one hand and hold it using the ring finger and the little finger, while simultaneously operating the actuation elements of an instrument in the adjacent appendage20.1or20.2with the same hand. By means of the bracket26and the connecting piece28the instrument system can also be held on a suitable stand to hold the instrument shaft10in its appropriate position during the surgical operation.

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