Multi-head repository for use with a surgical device

Devices and methods for organizing a plurality of end effectors and selectively delivering them through surgical trocars are described herein. In one embodiment, a surgical end effector loading device is provided that includes at least one mating element to interface with a surgical trocar, a deployment lumen positioned to align with a working channel of a surgical trocar, an end effector repository having a plurality of end effector lumens formed therein to receive end effectors, the repository being configured to selectively align any of the plurality of end effector lumens with the deployment lumen, and an advancer coupled to the repository and configured to advance an end effector from the repository through the deployment lumen.

FIELD OF INVENTION

This disclosure relates generally to surgical instruments and, more particularly, to devices that deliver end effectors to a surgical site.

BACKGROUND

Surgical procedures are used to treat and cure a wide range of diseases, conditions, and injuries. Surgery often requires access to internal tissue through open or minimally invasive surgical procedures. The term “minimally invasive” refers to all types of minimally invasive surgical procedures, including endoscopic, laparoscopic, arthroscopic, natural orifice intraluminal, and natural orifice transluminal procedures. Minimally invasive surgery can have numerous advantages compared to traditional open surgical procedures, including reduced trauma, faster recovery, reduced risk of infection, and reduced scarring.

In many minimally invasive procedures, the abdominal cavity is insufflated with carbon dioxide gas to provide adequate space to perform a procedure. The insufflated cavity is generally under pressure and is sometimes referred to as being in a state of pneumoperitoneum. Surgical access devices are often used to facilitate surgical manipulation of internal tissue while maintaining pneumoperitoneum. For example, during a surgical procedure the abdominal wall can be pierced and a cannula or trocar (such as the trocar shown inFIGS. 1A-2) can be inserted into the abdominal cavity. The trocar can provide a port through which other surgical instruments can be passed into a patient's body to perform a variety of procedures.

Development in minimally invasive surgery has resulted in increasingly complex procedures that require multiple instruments and precise manipulations within the body. Because of the limited access space afforded by a trocar and the relatively larger wound size associated therewith, one solution has been the use of percutaneous surgical instruments inserted directly into a body cavity and used to supplement instruments introduced through one or more trocars. For example, procedures have been developed that involve additional percutaneous instruments to aid in retracting organs and structures. In some procedures, one or more percutaneous instruments having removable end effectors are utilized in combination with a trocar that can accommodate the passage of various end effectors for connection with the instrument in vivo. Inserting surgical instruments percutaneously, i.e., passing directly through tissue without an access device, can further reduce trauma and scarring to the patient by reducing the size of the wound created. Additional details on such instruments can be found, for example, in U.S. Patent Application Publication No. 2011/0087267 to Spivey et al., entitled “Method For Exchanging End Effectors In Vivo,” which is hereby incorporated by reference.

The increasing use of percutaneously-inserted surgical instruments is not without challenges, however. For example, the use of percutaneously-inserted surgical instruments can require a large operating staff to simultaneously manipulate the percutaneously-inserted instrument, the trocar providing access to pass an end effector, and a loading device used to deliver the end effector through the trocar and attach it to the distal end of the instrument. The complexity of this operation is compounded when several end effectors are used in sequence to accomplish different tasks (e.g., grasping, cutting, etc.). In such a case, a surgeon or other user is forced to juggle the plurality of end effectors along with at least one loading device, trocar, and percutaneous instrument.

In addition, it can be difficult to successfully attach or remove an end effector from a percutaneously-inserted instrument inside a patient's body. There are a number of reasons for this, not the least of which is the confined and remote environment in which the instrument shaft and end effector are being manipulated. Surgeons can struggle to ensure that the straight shaft of the surgical trocar and the straight shaft of the percutaneous instrument are in alignment when coupling or decoupling an end effector. Moreover, it can be difficult in this confined environment to determine when an end effector is completely and successfully coupled to a percutaneous instrument and/or a loading device. Making this determination can be important, however, because prematurely releasing an end effector from one instrument before coupling it to another can drop the end effector within the body cavity, necessitating further time and action to retrieve it.

One attempted solution to these challenges has been to utilize the trocar as a means for passing the distal end of a percutaneously-inserted instrument back out of a patient's body in order to exchange end effectors. Passing the instrument (either with or without an end effector attached) through the trocar in the “wrong” direction (i.e., from its distal end toward its proximal end) can damage the one or more seals present in the trocar that help maintain pneumoperitoneum. This is because trocar seals are often designed with a “duckbill” or other shape that is oriented for proximal-to-distal instrument passage.

Accordingly, there is a need for improved devices and methods that assist users in managing a number of modular surgical end effectors and passing them into a patient's body for attachment to a surgical instrument positioned inside the body. There is also a need for improved devices and methods that provide better feedback to a user regarding the coupling (or lack thereof) between an end effector and another instrument.

SUMMARY OF THE INVENTION

The present invention generally provides devices and methods for managing and delivering surgical end effectors into a patient's body for attachment to another surgical instrument in vivo. The devices and methods described herein can reduce the complexity of this type of operation by providing a loading device having an end effector repository capable of housing a plurality of end effectors and selectively deploying any such end effector into a patient's body. Further, the devices and methods described herein can couple to a surgical trocar in the same manner that an obturator is typically coupled to a trocar. This coupling can effectively combine the loading device and trocar into a single component that can be more easily manipulated by a user. This single component provides for organizing and deploying a plurality of surgical end effectors. The devices and methods described herein can also include features designed to ease the process of aligning and coupling an end effector to a percutaneous instrument, such as the ability to pivot an end effector within the patient's body for easier alignment, or the inclusion of one or more features that provide feedback when an end effector is securely coupled or not.

In one aspect, a surgical end effector loading device is provided that includes at least one mating element configured to interface with at least one complementary mating element of a surgical trocar to restrict movement of the loading device relative to the trocar, as well as a deployment lumen formed in a distal end of the loading device and positioned to align with a working channel of the surgical trocar when the at least one mating element is interfaced with the at least one complementary mating element of the trocar. The device further includes an end effector repository having a plurality of end effector lumens formed therein that are each configured to receive a surgical end effector, the end effector repository being further configured to selectively align any of the plurality of end effector lumens with the deployment lumen. The device also includes at least one advancer coupled to the end effector repository and configured to advance a surgical end effector from an end effector lumen of the end effector repository through the deployment lumen.

The devices and methods described herein can have a number of additional features and/or variations, all of which are within the scope of the present disclosure. In some embodiments, for example, the end effector repository can be a rotatable carousel. In such an embodiment, the carousel can rotate to align any of a plurality of end effector lumens formed therein with a deployment lumen of the loading device and/or a working channel of a surgical trocar. In other embodiments, however, the end effector repository can have alternative shapes, such as a rectangular cartridge that translates to align various end effector lumens with a deployment lumen and/or trocar working channel. Regardless of its shape, the end effector repository can have any number of end effector lumens formed therein and, in certain embodiments, can have three or more end effector lumens.

In some embodiments, the end effector repository can include a plurality of viewing ports positioned to permit visualization of the contents of each end effector lumen. Such ports can permit a user to quickly determine which end effector lumens have end effectors loaded therein and what type of end effector is in each lumen.

In certain embodiments, the at least one advancer can be slidably disposed within an end effector lumen of the end effector repository and configured to translate the surgical end effector along a longitudinal axis of the end effector lumen. In addition, the at least one advancer can be coupled to an actuator that extends beyond an outer diameter of the end effector lumen. In such an embodiment, a user can advance an end effector by translating the actuator distally along a length of the loading device.

Other configurations of the at least one advancer are possible as well. For example, in some embodiments the at least one advancer can include a worm drive mechanism to effect movement of an end effector along a longitudinal axis of the device. The worm drive mechanism can include, for example, an end effector retainer that couples to an end effector and translates along a length of the loading device as the worm drive mechanism is rotated. Note that in some embodiments a combination of a translating advancer and a worm drive mechanism or other configuration can be employed together, e.g., with one advancer carrying the end effector over a first distance and another advancer carrying the end effector over a second distance.

As noted above, in certain embodiments the loading device can include an end effector retainer disposed within the deployment lumen and configured to couple to a surgical end effector. The end effector retainer can, in some embodiments, pivot relative to the loading device in order to pivot the end effector relative to the loading device after the end effector is advanced through the deployment lumen. Pivoting the end effector in this manner can aid in aligning the end effector with a percutaneously-inserted surgical instrument to ease the coupling process.

In still other embodiments, the end effector retainer or other portion of the loading device can include one or more features to indicate when an end effector is coupled thereto. These can include, for example, pivoting or pop-up/out indicators that are actuated by an end effector mating completely with the end effector retainer. These indicators can provide helpful feedback to a user.

In another aspect, a surgical instrument kit is provided that includes a loading device having at least one mating element, a deployment lumen formed in a distal end thereof, an end effector repository having a plurality of end effector lumens formed therein, the end effector repository being configured to selectively align any of the plurality of end effector lumens with the deployment lumen, and at least one advancer coupled to the end effector repository. The kit further includes a trocar having a proximal end, a distal end, at least one mating element, and a working channel extending therethrough from the proximal end to the distal end, as well as a plurality of surgical end effectors. Further, the plurality of surgical end effectors are received within the plurality of end effector lumens of the end effector repository, the at least one mating element of the loading device interfaces with the at least one mating element of the trocar, and the deployment lumen of the loading device aligns with the working channel of the trocar.

As with the device described above, a number of variations and additional features are possible. For example, in some embodiments the end effector repository can be a rotatable carousel. Moreover, in certain embodiments the end effector repository can include a plurality of viewing ports positioned to permit visualization of the contents of each end effector lumen.

Also similar to the device described above, in some embodiments the at least one advancer can be slidably disposed within an end effector lumen of the end effector repository and configured to translate the surgical end effector along a longitudinal axis of the end effector lumen. Further, the at least one advancer can be coupled to an actuator that extends beyond an outer diameter of the end effector lumen.

In certain embodiments, the loading device of the kit can further include an end effector retainer positioned within the deployment lumen and configured to selectively couple to one of the plurality of surgical end effectors. Moreover, in some embodiments the end effector retainer can pivot relative to the loading device in order to pivot a surgical end effector coupled thereto relative to the loading device after the surgical end effector is advanced through the deployment lumen.

In another aspect, a surgical method is provided that includes coupling a loading device with a surgical trocar such that a deployment lumen formed in the loading device coaxially aligns with a working channel of the surgical trocar and complementary mating features on the loading device and the surgical trocar restrict relative motion therebetween. The method further includes actuating an end effector repository of the loading device to align one of a plurality of end effector lumens formed therein with the deployment lumen of the loading device, and advancing a surgical end effector housed within the end effector lumen through the deployment lumen of the loading device and the working channel of the surgical trocar.

In some embodiments, advancing the surgical end effector can include rotating a worm drive mechanism to effect distal advancement of the surgical end effector. In other embodiments, however, advancing the surgical end effector can include translating an advancer distally within the end effector lumen. In still other embodiments, advancing the surgical end effector can include a combination of translating and rotating various components of the loading device.

In certain embodiments, the method can further include pivoting the surgical end effector relative to the loading device after the end effector has been advanced through the working channel of the surgical trocar. This can, for example, ease the process of aligning the end effector with a surgical instrument for coupling thereto.

Any of the features or variations described above can be applied to any particular aspect or embodiment of the invention in a number of different combinations. The absence of explicit recitation of any particular combination is due solely to the avoidance of repetition in this summary.

DETAILED DESCRIPTION OF THE INVENTION

Additionally, to the extent that linear or circular dimensions are used in the description of the disclosed devices and methods, such dimensions are not intended to limit the types of shapes that can be used in conjunction with such devices and methods. A person skilled in the art will recognize that an equivalent to such linear and circular dimensions can easily be determined for any geometric shape. Further, sizes and shapes of the devices, and the components thereof, can depend at least on the anatomy of the subject in which the devices will be used, the size and shape of components with which the devices will be used, and the methods and procedures in which the devices will be used.

Surgical devices and methods are described herein that provide for improved organization and delivery of surgical instrument end effectors into a patient's body through a surgical trocar. The devices and methods provided for include an end effector repository capable of housing a plurality of modular end effectors and selectively delivering any of the end effectors through a deployment lumen. Furthermore, features are included for mating an end effector loading device to a surgical trocar such that a surgeon or other user no longer needs to manipulate two devices separately. By combining an end effector loading device and a surgical trocar into a single device, and providing the capability to organize and deploy a plurality of end effectors, complexity of procedures involving the end effectors can be significantly reduced. Moreover, certain embodiments of the devices and methods described herein can provide other features, such as the ability to pivot an end effector relative to the loading device or coupling feedback indicators, to further improve a surgical procedure.

FIGS. 1A-2illustrate one embodiment of a surgical trocar100known in the art that can be used in connection with the devices and methods described herein. The illustrated trocar100is similar to trocars sold under the trade name ENDOPATH XCEL® by Ethicon Endo-Surgery, Inc. of Cincinnati, Ohio, though any other trocar known in the art can also be employed with, or easily adapted to be employed with, the devices and methods described herein. The trocar100generally includes a distal trocar sleeve102that is coupled to a proximal trocar housing104.

The trocar100can have a lumen or working channel106extending therethrough and one or more seals (seeFIG. 2) can be disposed across the working channel between the distal sleeve102and proximal housing104. Further, an insufflation port108can be included to permit the introduction of insufflating gas, such as carbon dioxide, to help maintain pneumoperitoneum during a procedure.

The trocar housing104can include a proximal surface110configured to couple with, for example, an obturator (not shown) that can be utilized to help pass the trocar100through tissue. The trocar housing104can also include at least one mating element configured to aid in coupling the obturator to the trocar100. In the illustrated embodiment, for example, the at least one mating element includes a plurality of recesses112configured to receive corresponding protrusions formed on the obturator (not shown). Further details on an exemplary coupling between an obturator and a trocar can be found in U.S. Pat. No. 8,034,032 to Voegele et al., entitled “Multi-Angled Duckbill Seal Assembly,” which is hereby incorporated by reference.

Trocars are made in a variety of sizes and are typically denoted by a diameter of the working channel106. This measure represents the largest width or diameter instrument that can be passed into a patient's body through the trocar. In the case of ENDOPATH XCEL® trocars, for example, the working channel is typically 5 mm or 12 mm in diameter. The smaller of the two sizes is typically utilized to introduce end effectors and other surgical instruments, while a visual scope is often introduced through the larger size working channel. Of course, these are not limitations on the size and intended use of a trocar, but merely examples.

Beyond the basic components described above, the various seals of a trocar are important for maintaining pneumoperitoneum and can be somewhat complex.FIG. 2illustrates an exploded view of the trocar100including its various internal components in this non-limiting exemplary embodiment. From the proximal end of the trocar100, a first instrument seal202is shown. The instrument seal202commonly has a round aperture in its center that is coaxially aligned with the working channel106. The instrument seal202is configured to form a seal around, for example, a round-shape scope or instrument being passed through the trocar working channel. In some embodiments, when no instrument is present the aperture can remain open, i.e., it does not completely collapse to seal off proximal and distal portions of the working channel106.

The instrument seal202can be located proximal to a “duckbill” seal204that is configured to seal the working channel106when no instrument is present. The shape of the duckbill seal204, having opposed sidewalls that form a straight lip, can be effective to seal the channel in the absence of an instrument, but often fails to form a tight seal around an instrument. This is one reason for including two seals in series that have different shapes and purposes. Of course, a number of other seal shapes, numbers, and configurations are known in the art and can be employed with the devices and methods described herein.

The illustrated trocar100also includes an insufflation port valve206and inner housing208that surrounds the seals202,204. Finally, the illustrated embodiment includes a fluid remover assembly formed by a scraper210and a sorbent member212. The fluid remover assembly is configured to remove bodily or other fluids that might be present on an instrument as it is retracted back through the working channel of the trocar proximally. In particular, the scraper210, which can be formed from a molded polyisoprene and has a central opening coaxially aligned with the working channel106, presses against an instrument and removes fluid as the instrument is moved relative thereto. The scraper210can include a series of radial channels (not shown) formed therein and extending from the central opening. The channels will have a capillary effect and allow fluid to flow radially outward away from the central opening of the scraper210. This fluid will then be absorbed by the sorbent member212that is in contact with an outer portion of the scraper210. The sorbent member212can be formed from, e.g., a polyolefin or other sorbent material.

As noted above, the trocar100and other embodiments thereof are often used during minimally invasive procedures to provide a means of accessing the interior of a patient's body. Further, they are commonly used in connection with percutaneously-inserted instruments in order to pass modular end effectors into the patient's body. These end effectors can then be coupled to the narrow distal end of the percutaneous instrument to allow the instrument to perform a variety of tasks. For example, one embodiment of a modular end effector can include a pair of jaws that can be actuated by relative movement of two concentric shafts of a percutaneously-inserted instrument. The shafts can easily be passed through tissue without the use of a trocar or other access device, and the jaws can be coupled thereto in vivo to turn the shafts into a useful tool for grasping and manipulating tissue.

Challenges with using these types of instruments typically arise in connection with the process of coupling, decoupling, or exchanging the modular end effectors with the distal end of the percutaneously-inserted instrument. The process typically involves a separate loading device that grasps the end effector and is used to introduce the end effector into the patient's body by passing it through the working channel of the trocar100. The loading device and instrument must then be properly aligned to insert the shaft of the instrument into a socket formed in the end effector. Completing this coupling process can require manipulating the loading device, the trocar it is passed through, and the percutaneously-inserted instrument simultaneously. Moreover, as the number of end effectors used increases, so does the complexity of the procedure and demands on the surgical team, as the end effectors must be tracked and organized, and each exchange requires the simultaneous manipulation of the components listed above.

Beyond the difficulty of manipulating multiple components simultaneously or managing a set of modular end effectors, it can also be difficult to achieve a desired alignment between the various components or to discern when a modular end effector is coupled to a given component (and can therefore be released from another component) in the confined and remote environment where the procedure takes place. In an attempt to address these issues, some surgeons and other users opt to pass the percutaneously-inserted instrument back out of the body through the trocar100. This can allow the surgeon to directly manipulate the end effector and distal end of the instrument. However, passing the instrument through the trocar100from its distal end to its proximal end can damage the trocar seals. As shown inFIG. 2, the trocar seals (as well as the fluid removal assembly if present) are designed to accept instruments moving in a proximal-to-distal direction. Retraction of instruments initially passed in this manner is not problematic because the instrument shaft maintains the seal in an open position and prevents inadvertent deformation of the seals during proximal retraction. When an instrument is initially passed in a distal-to-proximal direction, however, the instrument can deform or destroy the trocar seals202,204.

FIG. 3A-3Cillustrate one embodiment of a surgical end effector loading device300that addresses these and other challenges. The device300generally includes a housing302with a distal portion303that is configured to abut against a proximal end of a surgical trocar. The device300also includes at least one mating element304that is coupled to the housing302and configured to interface with a complementary mating element of a surgical trocar (e.g., mating elements112of trocar100) to restrict movement of the housing relative to the trocar. A deployment lumen306extends from the distal portion303of the housing302and is configured to align with and extend into a working channel of a surgical trocar. Proximal to the deployment lumen306is an end effector repository308that includes a plurality of end effector lumens formed therein that can house a modular surgical end effector. The repository308in the illustrated embodiment is a carousel that can be rotated to align any of the end effector lumens with the deployment lumen306. An advancer310can then be used to move a surgical end effector from the repository308into the deployment lumen306for delivery into a patient's body through a surgical trocar.

FIGS. 4A and 4Billustrate views of the loading device300coupled to the trocar100. As shown in the figures, the distal-facing first portion303of the housing302can abut against the proximal surface110of the trocar100. Further, the deployment lumen306can extend through the working channel106of the trocar100such that a surgical end effector can be delivered out of a distal end of the trocar sleeve102. Although a distal end of the deployment lumen306is shown extending from a distal end of the working channel106of the trocar100, other configurations are possible in which the distal end of the deployment lumen306remains proximal of the working channel distal end, or extends farther distally than shown.

The loading device300can be coupled to the trocar100via one or more mating elements formed on the device that interface with complementary mating elements formed on the trocar.FIGS. 4C-4Dillustrate the coupling between the loading device300and the trocar100in more detail. As shown in the detail view of the mating element304inFIG. 5, the mating element can be in the form of a U-shaped frame500having hooks, barbs, or clips502formed on distal ends thereof. The U-shaped frame500can also include a central lumen503formed therein that is configured to receive the deployment lumen306. The mating element304can be formed from a resilient material, such as an elastically deformable polymer or metal, and can be biased away from a longitudinal axis L of the mating element304, and of the loading device300. This biasing can aid the mating element304in interfacing with a recess formed in the trocar100. The mating element304can also include opposed actuating surfaces504that can be depressed by a surgeon or other user in order to selectively decouple or release the loading device300from the trocar100when desired. The actuating surfaces504can include ridges or other surface features formed thereon to aid a user in grasping and depressing them. While the mating element304is illustrated as a single U-shaped frame500with opposed distal end features502, in other embodiments a plurality of separate mating elements can be employed at various positions around the deployment lumen306that is configured to extend into a working channel of the surgical trocar100, or a differently-shaped frame can be employed, e.g., a T-shaped or cross-shaped frame having four distal mating features.

Referring back to the cross-sectional and partially transparent views ofFIGS. 4C and 4D, the interaction between the mating element304of the loading device300and the complementary mating elements112of the trocar100can be observed. In particular, the hooks502formed at the distal ends of the U-shaped mating element304extend into the recesses112formed in the proximal surface110of the trocar100. Further, due to the outward bias of the mating element304, the hooks502engage an underside of the proximal surface110of the trocar100and prevent the loading device300from being drawn away from the trocar axially (i.e., along a longitudinal axis L). In addition, the generally rectangular cross-sectional shape of the mating element304can substantially fill the generally rectangular recesses112, thereby preventing the loading device300from rotating or otherwise moving radially relative to the longitudinal axis L. Accordingly, the mating element304of the loading device300can be configured to restrict movement of the loading device300relative to the trocar100in all degrees of freedom.

To release the loading device300from the trocar100(e.g., at the conclusion of a surgical procedure, or if a different loading device with a different set of surgical end effectors is to be passed through the trocar working channel106), a surgeon or other user can depress the opposed actuating surfaces504of the mating element304in order to move the distal hooks502against any biasing force towards the longitudinal axis L. This movement of the hooks502can allow the hooks to disengage from the underside of the proximal surface110of the trocar100and pass through the recesses112formed therein. Accordingly, the loading device300can be selectively coupled to the trocar100.

The illustrated mating element304is just one embodiment of a mating element, however, and a variety of other configurations are also possible. For example, the configuration of distally-protruding hooks502on the loading device300and recesses112formed in the trocar100can be reversed such that hooks protruding from the trocar proximal surface can be received within recesses formed in a distal-facing portion303of the loading device housing302. In still other embodiments, the bias and orientation of the hooks502can be reversed such that they are biased radially inward toward a longitudinal axis L, rather than radially outward as shown. Moreover, the hooks502can be positioned on an outer surface of the loading device300and configured to engage with recesses, shelves, or other surface features formed on an outer surface of a proximal portion of the trocar100. There are a variety of other known coupling mechanisms in the art that can also be employed. Regardless of the particular configuration of the mating elements, the loading device300can include at least one mating element that is complementary to at least one mating element formed on the trocar100. In many cases, the at least one mating element on the trocar can be pre-existing and utilized to attach other trocar accessories, such as an obturator.

Still further, certain embodiments of the at least one mating element304can be configured to permit at least some relative movement between the loading device300and the trocar100. For example, in some embodiments the at least one mating element304can include at least one cylindrical rod or other projection that extends into a recess formed in the trocar100without utilizing a hook or other feature to positively latch on to the trocar. In such an embodiment, the loading device300can be prevented from moving radially with respect to, or rotating about, a longitudinal axis L, but can be permitted to move axially relative to the longitudinal axis L. In still other embodiments, a distal-facing portion303of the loading device housing302can include an outer wall configured to extend over a proximal portion of the trocar100, and one or more splines can be formed on both the loading device300and trocar100to prevent relative rotation or radial movement with respect to the longitudinal axis L. In still other embodiments, rotation about the longitudinal axis L can be permitted while movement in other directions can be restricted. Of course, any combination of various mating elements can be utilized as known in the art, and need not conform to the specific examples provided herein.

FIG. 6illustrates various components that can form a surgical instrument kit according to the teachings of the present disclosure. The kit can include a modular surgical end effector602(or a plurality thereof), an end effector loading device604similar to the device300described above, and a surgical trocar606similar to the trocar100described above. In use, one or more surgical end effectors602can be loaded within an end effector repository of the loading device604. Loading the end effectors in this manner can aid in keeping the end effectors organized for easy selection and deployment during a surgical procedure. To this end, the walls of the end effector repository can be formed from a transparent material, or can include one or more viewports formed therein, to allow a user to observe which end effector lumens of the repository have end effectors loaded therein, and what type of end effector is available for deployment. The loaded end effector loading device604can then be coupled to the surgical trocar606in the same manner as an obturator or other trocar accessory. The end result is a single device that can be easily manipulated with one hand during a procedure (as opposed to a more traditional set-up where a separate trocar and loading device have to be simultaneously manipulated using at least two hands). Further, the end effector repository can selectively align any of its end effector lumens with a main deployment lumen in order to deliver any loaded end effector into a patient's body through the trocar606. In the illustrated embodiment, this can be accomplished by rotating the carousel repository until the desired end effector lumen is aligned with the deployment lumen. Of course, the procedure can be reversed as well to return an end effector into an empty end effector lumen after use.

FIGS. 7A-7Dillustrate the various components of the loading device300discussed above in greater detail. As shown in the figures, the housing302and deployment lumen306are an integrally formed component in this embodiment. This need not be the case in every embodiment. Moreover, the deployment lumen306can have any desired length and, in some embodiments, may be just a through-hole formed in the housing302or distal-facing portion303. The at least one mating element304is sandwiched between the proximal housing302and the distal-facing portion303, and the deployment lumen306passes through the central lumen503formed therein. At a proximal end of the device, the end effector repository308is coupled to the housing302. The illustrated repository308is in the form of a rotatable carousel having three end effector lumens formed therein. An advancer310is slidably positioned within each end effector lumen of the repository and can be used to move an end effector from within the end effector lumen into the deployment lumen306and, ultimately, out a distal end thereof into a patient's body. Each advancer310can include an actuator701coupled thereto that extends beyond an outer diameter of the end effector lumen and can be directly manipulated by a user to control advancement of an end effector. Finally, a button702is included in housing302that can be used to selectively block the deployment lumen306and prevent any end effector from being advanced therethrough.

FIGS. 7C and 7Dillustrate the coupling between the housing302and the end effector repository308in greater detail. As shown inFIG. 7C, the housing302includes a cut-out704sized to receive the repository308and permit its rotation about a central axis. The deployment lumen306extends through the housing302such that it can be selectively aligned with any of the end effector lumens of the repository308. Also illustrated in greater detail is the button702, which includes a projection706that can fill the opening of the deployment lumen306to block the passage of any end effector therethrough. The button702is biased to an open position by biasing element708and, as a result, requires actuation to block the deployment lumen passage.

FIG. 7Dillustrates the housing302and repository308from an alternative angle and shows the three end effector lumens710of the illustrated embodiment. As noted above, each lumen can have a longitudinal axis and can include a slidable advancer310configured to translate along the longitudinal axis of the lumen it is disposed within. Alternatively, a single advancer310can be configured to be used with all of the end effector lumens710by, for example, removably inserting the advancer into the desired end effector lumen. As noted above, the end effector repository308in the illustrated embodiment is in the form of a rotatable carousel having three end effector lumens710. This is merely an exemplary embodiment, however, as repositories with a larger or smaller number of end effector lumens are possible. In addition, repositories with different shapes and mechanisms for selectively aligning a given end effector lumen with a deployment lumen are also possible. For example, an end effector repository with a rectangular shape can have a plurality of end effector lumens placed adjacent to one another along a single dimension thereof, and the repository could be configured to translate along that dimension to selectively align any of the end effector lumens with a deployment lumen.

The advancer310illustrated and described above includes an elongate shaft disposed within an end effector lumen710such that movement of the actuator701by a user can advance an end effector through the deployment lumen306to a distal end of the loading device300. As noted above, however, the deployment lumen306can have any desired length, including a very short length. In such an embodiment, it can be desirable to include an advancer of much shorter length as well. In addition, some embodiments can employ a second advancer mechanism to control advancement of an end effector through the deployment lumen, as described in more detail below. In such embodiments, a shorter advancer within the end effector repository can also be desirable.FIG. 8illustrates one embodiment of such a loading device and advancer. The loading device800can similarly include a housing802and end effector repository804. Further, the repository804can include a plurality of end effector lumens806that can each receive a modular surgical end effector602. In the illustrated embodiment, however, the advancer808is much shorter, such that the end effector602is closer to the actuator810that controls the position of the advancer808. Accordingly, when the actuator810is moved to a distal-most position the end effector602will be positioned at a proximal end of the deployment lumen (not shown).

FIGS. 9A-17illustrate another embodiment of an end effector loading device900that includes separate advancer mechanisms for controlling movement of an end effector within the end effector repository and within the deployment lumen. The device900includes several components that are similar to the devices described above, including a housing902, distal-facing portion903, at least one mating element904, deployment lumen906, end effector repository908, and slidable advancer910. In addition, the device900couples with a surgical trocar, such as trocar100described above, in a similar manner as the device300. The device900, however, also includes a worm drive mechanism914that controls advancement of an end effector916through the deployment lumen906.

The exploded view ofFIG. 11illustrates the components of the device900in greater detail. The construction of the housing902,903, mating element904, and end effector repository908are similar to the device300described above. In addition, the device900also includes a button1102for selectively blocking the passage of end effectors into the deployment lumen906. Further, the advancer910is similar to the embodiment illustrated inFIG. 8and described above. The worm drive mechanism914includes the deployment lumen906, a translating end effector retainer1108, and an end effector retainer guide1110. The end effector retainer guide1110sits within the deployment lumen906and is rotationally fixed relative to the device900, while the end effector retainer1108slides along the guide1110as the deployment lumen906is rotated. Moreover, female threads1204(seeFIG. 12) can be formed on an inner sidewall of the deployment lumen906to guide movement of the end effector retainer1108as the deployment lumen is rotated.

FIG. 12illustrates the deployment lumen906in greater detail. The deployment lumen906of the device900can rotate freely with respect to the housing902, and includes an enlarged flange1202to allow a user to grasp the deployment lumen and control its rotation. The flange1202can include features formed on an outer surface thereof to enhance a user's grip.

FIGS. 13A and 13Billustrate the end effector guide1108. The guide1108can be a generally ring-shaped component1302sized to slide within the deployment lumen and allow passage of an end effector through an inner lumen formed therein. The outer surface of the component1302can include one or more projections1304configured to be received by the female threads1204formed in the inner sidewalls of the deployment lumen906, as well as one or more recesses1306configured to receive a portion of the end effector retainer guide1110.

FIG. 14illustrates the end effector retainer guide1110that can be rotationally fixed relative to the device900(e.g., fixed to the housing902at a proximal end thereof) and can guide the proximal/distal translation of the end effector retainer1108as the deployment lumen906is rotated. The guide1110can include a proximal retaining ring1402and a distal retaining ring1404, as well as one or more longitudinally extending rails1406. The rails1406can be fixed to the proximal and distal retaining rings1402,1404and can be sized to be received within the one or more recesses1306formed in the end effector retainer1108. Given that the guide1110cannot rotate relative to the housing902, the interplay of the rails1406and the recesses1306can prevent the end effector retainer1108from rotating as well.

FIG. 15illustrates the end effector retainer guide1110disposed within the deployment lumen906. Visible in the figure is the distal retaining ring1404(the proximal retaining ring1402is not shown and can be affixed to the housing902), longitudinally-extending rails1406, and female threads1204formed on an inner sidewall of the deployment lumen906. The end effector retainer1108can translate proximally and distally along the rails1406as the deployment lumen906is rotated because the projections1304will ride along the female threads1204formed in the deployment lumen sidewall while the rails prevent any rotation of the end effector retainer1108.

FIG. 16illustrates the end effector916, sometimes referred to as an end effector assembly, in greater detail to show one embodiment of a mechanism for coupling the end effector to the end effector retainer1108. The end effector916can include a distal portion1602configured to perform a particular task (e.g., opposed grasping jaws in the illustrated embodiment), as well as a socket1604formed at a proximal end thereof for receiving a distal end of a percutaneous surgical instrument shaft. In a middle portion of the end effector916, one or more mating features1606can be formed that are configured to interface with the end effector retainer1108. For example, in the illustrated embodiment a series of ridges define an annular-shaped depression around the end effector916that can receive the ring-shaped member1302of the end effector retainer1108. The sizes of the mating features1606and end effector retainer1108can be controlled such that a desired interference fit is achieved that is sufficiently secure but also can be overcome when desired to either couple or decouple the end effector916from the end effector retainer1108.

The illustrated end effector retainer1108is just one possible embodiment and a number of variations or alternatives can be employed. For example, the illustrated configuration can be reversed to provide an end effector mating feature1606having radially-outward-biased protrusions formed thereon that are configured to fit into recesses formed on an inner sidewall of the end effector retainer1108. Alternatively, any of a variety of other latching mechanisms can be utilized to couple the end effector916to the end effector retainer1108. Certain embodiments of an end effector retainer1108can allow for rotation of the end effector916when coupled (and permit coupling of the end effector in any rotational orientation), such as the illustrated annular depression, or can prevent such rotation (e.g., if separate hemispherical recesses were employed in place of the annular recess).

FIG. 17illustrates the interplay of the various components of the worm drive mechanism914in greater detail. In the cross-sectional view of the figure, the end effector retainer1108can be seen seated within the annular depression1606formed in the central portion of the end effector916. This selectively locks the end effector916to the end effector retainer1108. Moreover, the projections1304extending from an outer surface of the end effector retainer1108can be seen riding within the female threads1204formed on the inner sidewall of the deployment lumen906. As a result of these interactions, along with the interaction between the end effector retainer1108and guide1110, the end effector916can be carried along the length of the deployment lumen906by a user rotating the lumen via the flange1202.

When the end effector916reaches a distal end of the deployment lumen906, a percutaneous surgical instrument shaft can be inserted into the exposed socket1604at the proximal end of the end effector to couple the end effector to the instrument. The instrument can then be withdrawn and the force exerted on the end effector can overcome the interference fit between the end effector retainer1108and the end effector mating feature1606, thereby freeing the end effector from the loading device900. This procedure can be reversed to return the end effector916to the loading device900after the procedure is complete, or when one end effector needs to be exchanged for another.

In addition to providing the ability to manage and selectively deploy any of a plurality of modular end effectors from a single device, the devices and methods described herein also provide for easier alignment of an end effector with a percutaneous surgical instrument that is to be coupled thereto, as well as improved feedback regarding the status of such coupling. These features can be beneficial because they allow a surgeon or other user to perform an end effector coupling or decoupling in vivo with less difficulty.

Easier alignment of end effectors and surgical instruments can be accomplished in some embodiments by utilizing an end effector retainer that permits pivoting an end effector relative to a loading device once the end effector has been advanced through the working channel of a surgical trocar.FIGS. 18A-18Cillustrate one embodiment of an end effector loading device1800with this type of end effector retainer1802. In the perspective and cross-sectional views ofFIGS. 18A and 18B, respectively, an advancer1804is positioned at an intermediate point between its proximal-most and distal-most positions, and the end effector retainer1802is accordingly partially extended from a distal end of the trocar100. As the advancer1804continues to be moved distally relative to the device1800, the end effector retainer1802will extend fully from the distal end of the trocar100, as shown inFIG. 18C(indicated by arrow1). Once the end effector retainer1802is fully extended, a portion thereof can pivot relative to a longitudinal axis L of the device1800to change the orientation of the end effector1806attached to the retainer1802(indicated by arrow2). This change in orientation of the end effector1806can make it easier to align a percutaneously-inserted surgical instrument for coupling to the end effector. The pivoting motion can be controlled in a number of ways. For example, a control cable can be routed down the end effector retainer1802from a proximal end of the device and utilized to control pivoting motion. In other embodiments, the pivoting motion can be made part of the distal advancement of the end effector retainer1802using a cam mechanism, such that the final portion of distal travel of the advancer1804causes the pivoting motion. Such a configuration can have the advantage of minimizing complexity and ensuring that end effector1806is sufficiently advanced out of the distal end of the trocar100before beginning the pivoting motion. Regardless of configuration utilized, any desired amount of pivoting can be provided. In embodiments utilizing a cam mechanism, a maximum amount of pivoting can be, in some cases, about 100°.

FIGS. 19-22illustrate the end effector retainer1802in more detail. As noted above, the end effector retainer1802can be disposed at a distal end of a plunger component1902of the advancer1804and can be configured to selectively couple to an end effector1806. The end effector retainer can include a housing1906, as well as a pivoting end cap1908and retention clip1910. The illustrated end effector retainer1802can ease the process of aligning an end effector with a percutaneously-inserted surgical instrument by allowing the end effector to pivot relative to the retainer, in contrast to, for example, the end effector retainer1108that requires an instrument to align with a longitudinal axis L of the loading device900.

FIG. 20illustrates the end effector retainer housing1906in greater detail. The housing1906can include a proximal end2002configured to be coupled to a distal end of the plunger component1902of the advancer1804. A distal end of the housing1906can include opposed arms2004having recesses2006formed therein that are configured to couple with pivot pins2102(seeFIG. 21) of the pivoting end cap1908. The housing1906can have a lumen2008formed therein and can include a cut-out2010from a portion of a sidewall thereof. The lumen2008can be configured to receive an end effector1806and the sidewall cut-out2010can be sized to allow the end effector1806to pivot away from, or into, the housing1906when attached to the pivoting end cap (seeFIG. 18C).

The pivoting end cap1908can include, as mentioned above, a proximal end having opposed pivot pins2102configured to be received within recesses formed in a distal end of the end effector retainer housing1906. As shown inFIG. 21, the pivoting end cap1908can have a generally cylindrical shape having an inner lumen2106formed therein for receiving an end effector1806. A distal portion2104can include a sidewall cut-out2108sized to receive the retention clip1910.

The retention clip1910, as shown inFIG. 22, can be a resilient U-shaped component, such as a snap ring or spring clip. The retention clip1910can be configured to be received within the sidewall cut-out2108formed in the pivoting end cap1908such that it resiliently extends into the inner lumen2106of the pivoting end cap. The retention clip1910can have a variety of shapes, sizes, and rigidities, and in some embodiments can include a two-color body arranged to provide a visual indication of end effector coupling to a surgeon or other user, as described in more detail below. In one embodiment, for example, an outer circumference2202of the retention clip1910can have a different color from an inner portion2204thereof.

FIGS. 23A-24Billustrate one exemplary embodiment of coupling an end effector1806with the end effector retainer1802. InFIGS. 23A and 23B, the end effector1806is aligned with, but a distance away from, the pivoting end cap1908of the end effector retainer1802. As shown best in the side view ofFIG. 23B, before the end effector1806is inserted into the pivoting end cap1908, the resilient retention clip1910extends into the inner lumen2106of the pivoting end cap. To couple the end effector1806to the end effector retainer1802, the end effector can be advanced into the configuration shown inFIGS. 24A and 24B. In this configuration, the insertion of the end effector1806into the lumen2106of the pivoting end cap1908can press the retention clip1910radially outward relative to a longitudinal axis L of the end cap. The biasing force of the retention clip1910can grasp the end effector1806and prevent it from falling away from the end effector retainer1802. Further, in some embodiments the end effector1806can be inserted such that a recess or other feature, such as the annular depression1606described above, aligns with the retention clip1910. Seating the retention clip1910in the depression1606can increase the strength of the coupling between the end effector1806and the retainer1802.

In addition, the use of a multi-colored retention clip1910can provide a visual indication to a surgeon or other user when an end effector is sufficiently inserted into the end effector retainer1802. For example, in the configuration ofFIG. 23A, the retention clip1910is seated such that only the outer circumference surface2202is visible. However, in the configuration ofFIG. 24A, wherein the end effector1806is grasped by the retention clip1910, the different-colored inner portion2204is visible. Seeing this different-colored surface can serve as an indication that end effector1806is coupled to the end effector retainer1802and can be, for example, safely released from the distal end of a percutaneously-inserted surgical instrument.

In some embodiments, it can be desirable to provide an indication regarding the status of coupling between an end effector and a loading device at a location more easily visible by a user. In the embodiment ofFIGS. 25A and 25B, for example, a loading device2500can include a button2502positioned along a proximal portion of the device (e.g., the device housing) to provide such an indication. The button2500can, for example, be connected to an end effector retainer, such as the retainer1802described above, via a mechanical linkage such that the button is pressed outward against a biasing force when an end effector is coupled to the retainer (as shown inFIG. 25B). Similar to the dual-color retention clip1910described above, the button2502can include a portion2504having a different color that is only visible when the button is urged outward against the biasing force. Accordingly, the position and visible color of the button can provide an easily observable indication of the coupling status of a retainer and an end effector.

FIGS. 26-30Billustrate still another embodiment of a coupling status indicator that can be employed on both the end effector (to indicate coupling status of an end effector and a percutaneous surgical instrument) and a loading device (to indicate coupling status of an end effector and the loading device).FIG. 26illustrates the basic components of a percutaneous surgical instrument2602and a more traditional loading device2610, though the same principles can be applied to the multi-head loading devices described herein. The percutaneous surgical instrument2602includes an actuator2604(e.g., a handle in the case of a hand-operated instrument), a shaft2606configured to percutaneous insertion through tissue, and an end effector2608. The loading device2610similarly includes an actuator2612and shaft2614, as well as an end effector retainer2616.

FIGS. 27A-28Billustrate the end effector retainer2616of the loading device2610in greater detail. As shown in the figures, the end effector retainer2616can be coupled to the shaft2614by an articulating joint2702and the retainer can house a modular end effector2708. The end effector retainer2616can also include a pivoting coupling indicator2704that extends upward from the outer surface of the end effector retainer2616when an end effector2708is coupled to the retainer. As with the retention clip1910and button2502described above, the indicator2704can include a portion2706that has a different color and is only visible when the indicator is popped up above the surface of the retainer2616. The indicator2704can thereby provide the same type of easily observable indication of coupling status as the retention clip1910and button2502described above.

FIGS. 28A and 28Bin particular illustrate the actuation of the indicator2704as an end effector2708is inserted into the end effector retainer2616. InFIG. 28A, for example, the indicator2704remains in a retracted configuration as the end effector2708is initially inserted into the retainer2616(shown by arrow1). This can be because the indicator2704is biased toward the configuration illustrated inFIG. 28A, i.e., biased toward an inner lumen2707of the end effector retainer2616. As the end effector2708is fully inserted into the inner lumen2707, however, it can urge the indicator2704outward into the configuration shown inFIG. 28B. In this extended configuration the differently-colored portion2706can be visible to a user (shown by arrow2), thereby providing feedback of successfully coupling between the end effector2708and the end effector retainer2616.

This same type of indicator can be utilized on the end effector itself to provide an indication of coupling status with a percutaneous surgical instrument2602. As shown inFIGS. 29A-30B, for example, the end effector2608that couples to the shaft2606of the instrument2602can include a pivoting coupling indicator2902similar to the indicator2704described above. That is, the indicator2704can be configured to move between a retracted configuration when the instrument2602is not coupled (or only partially coupled) to the end effector2608, and an extended configuration when the instrument and end effector are fully coupled. Further, the indicator2902can include a differently-colored portion2904that is only visible in the extended configuration to provide an easily observable indication of coupling status.

FIG. 29Billustrates one exemplary mechanism for coupling the end effector2608to the remainder of the instrument2602. As noted above, the end effector2608can include a socket2906formed at a proximal end thereof that can receive a distal end of the instrument shaft2606. The shaft2606can include multiple concentric shafts housed therein, including an inner shaft2908and an intermediate shaft2910. With the inner shaft2908retracted proximally, opposed arms of the intermediate shaft2910can deflect inward to pass through a collar2912of the end effector2608. The inner shaft2908can then be advanced distally to prevent the arms of the intermediate shaft2910from deflecting inward, thereby locking the end effector2608to the instrument. Further relative motion between the various shafts2606,2908, and2910can produce movement of, e.g., jaws or other implements of the end effector2608. Further information on exemplary coupling mechanisms for an end effector and percutaneous instrument can be found in U.S. Patent Publication No. 2011/0087267 to Spivey et al., entitled “Method for Exchanging End Effectors In Vivo,” which is hereby incorporated by reference.

FIGS. 30A and 30Billustrate the operation of the indicator2902, which is similar to the operation of the indicator2704shown inFIGS. 28A and 28Band described above. In particular, the indicator2902of the end effector2608can be biased inward toward an inner lumen of the socket2906such that it sits in the position shown inFIG. 30A. As the shafts2606,2908, and2910are inserted into the socket2906(as shown by the arrow1inFIG. 30A), they can contact the indicator2902and urge it into the extended configuration shown inFIG. 30B. In such a configuration, the differently-colored portion2904can be visible to a user, thereby providing feedback that the end effector2608has been coupled to the instrument2602.

While the various embodiments described above may have only subset of the features described herein, the various components and functionalities described can be combined in a variety of manners, all of which are considered within the scope of the present invention. For example, a loading device could include both the translating advancer and worm drive mechanism of the device900, as well as the pivoting end effector retainer of the device1800.

The devices described herein can be utilized in a variety of surgical procedures. In general, a method of using the devices described herein can include coupling a loading device with a surgical trocar such that a deployment lumen formed in the loading device coaxially aligns with a working channel of the surgical trocar and complementary mating features on the loading device and the surgical trocar restrict relative motion therebetween. Coupling the loading device to the trocar can occur after loading one or more surgical end effectors into the loading device, or the loading device can come pre-installed with one or more surgical end effectors, or the loading device can be inserted without an end effector in anticipation of receiving one from a percutaneously-inserted surgical instrument (e.g., at the conclusion of a procedure). As mentioned above, the coupling of the loading device and the trocar can make use of pre-existing mating features formed on or in the trocar for attachment of other accessories, such as an obturator.

Methods of using the devices described herein can further include actuating an end effector repository of the loading device to align one of a plurality of end effector lumens formed therein with the deployment lumen of the loading device. Actuating the end effector repository can include, for example, rotating a carousel-type repository to align a desired end effector lumen with the deployment lumen. The desired end effector lumen can be determined in a number of manners, including by reading labels on the outside of the repository, observing the contents of each end effector lumen through a viewport formed therein, etc.

Methods of using the devices described herein can further include advancing a surgical end effector housed within the end effector lumen through the deployment lumen of the loading device and the working channel of the surgical trocar. Advancing the end effector can be accomplished using a variety of mechanisms, including slidable plunger-type advancers disposed in the end effector lumen, worm gear or other drive mechanisms coupled to the device, combinations thereof, etc.

Once an end effector is advanced through the deployment lumen, further steps can be performed, such as pivoting the end effector relative to the loading device, e.g., to better align with a percutaneous surgical instrument, and selectively releasing the end effector from the loading device, e.g., after the end effector has been coupled to a distal end of the percutaneous surgical instrument.

Any of the components and devices known in the art and/or described herein can be provided as part of a kit including any of a loading device, a trocar, and one or more surgical end effectors, as described herein, as well as other components with which such components are typically used, e.g., an obturator. The loading device can be configured to be removably coupled to the trocar using one or more complementary mating features or elements present on the trocar and the loading device. The trocar can be any particular model or configuration of trocar known in the art. Further, the end effectors provided in the kit can perform different functions, including but not limited to the functions described herein, and/or can be included together in a single kit to perform a particular function, such as a kit specifically tailored for stretching and stapling tissue. Further, one or more other ports or surgical instruments, including cameras and other viewing instruments, can be provided to assist in performing a given procedure.

The devices disclosed herein can be formed from a variety of materials and can have a variety of different sizes and shapes. For example, loading devices and trocars can be formed from various polymers and/or metals. Furthermore, particular components can be formed from a different material than other components. By way of further example, a loading device housing can be formed from a polymer material, (e.g., polycarbonate), while an end effector retainer (e.g., the pivoting end effector retainer1206) can be formed from a metal, such as surgical grade stainless steel (e.g., 17-4), other 300 and 400 series stainless steels, titanium, and aluminum, perhaps to take advantage of greater rigidity. Of course, these are just non-limiting examples of possible material combinations. Device sizes can also vary greatly, depending on the intended use and surgical site anatomy. As mentioned above, the devices described herein can commonly be used in connection with trocar diameters on the order of 5 mm, though any particular size could be constructed. Further, a variety of lengths could be employed at any particular diameter to accommodate various end effector sizes, surgical site locations, etc.

The devices described herein can be processed before use in a surgical procedure. First, a new or used instrument can be obtained and, if necessary, cleaned. The instrument can then be sterilized. In one sterilization technique, the instrument can be placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and its contents can then be placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high-energy electrons. The radiation can kill bacteria on the instrument and in the container. The sterilized instrument can then be stored in the sterile container. The sealed container can keep the instrument sterile until it is opened in the medical facility. Other forms of sterilization known in the art are also possible. This can include beta or other forms of radiation, ethylene oxide, steam, or a liquid bath (e.g., cold soak). Certain forms of sterilization may be better suited to use with different portions of the device due to the materials utilized, the presence of electrical components, etc.