Methods and devices for laparoscopic surgery

Two part laparoscopic tools and surgical methods using such tools are presented. The tools and methods enable use of multiple surgical tools each having wide tool heads to be used in a body cavity using a single wide trocar and one or more narrow incisions, thereby reducing surgical risk and enhancing patient comfort and shortening recovery time. Additional instruments for facilitating laparoscopic surgery are also presented.

FIELD AND BACKGROUND OF THE INVENTION

The present invention, in some embodiments thereof, relates to devices and methods for performing laparoscopic surgery.

Laparoscopic surgery (one form of minimally invasive surgery (MIS), also known as band-aid surgery, keyhole surgery, or pinhole surgery) is a modern surgical technique with many advantages over traditional open surgical methods. The first use of this approach in order to perform a cholecystectomy was in 1987. Since that time, the procedure has gained popularity and is now regularly used in many different operations within the abdominal and pelvic cavities as well as for thoracoscopic and orthopedic surgery.

In existing laparoscopic methods, a variety of different instruments are used, including graspers, scissors, coagulation devices, harmonic scalpels, needle holders, cameras, suction devices and so on. A plurality of such instruments may be required in a single procedure, with each instrument requiring its own trocar, which both acts as an entry port and facilitates manipulation of the devices within the abdominal cavity or other operative site. In general, laparoscopic operations are usually performed by inserting 2-6 trocars (ports) into the abdominal cavity, each through an incision in the skin.

The trocars usually range in size from 5 mm to 12 mm in diameter, each serving as an introduction channel for one or more surgical tools. However, the use of trocars carries risks during both insertion and removal. The risks include:damage to blood vessels in the abdominal walls (particularly in overweight patients);damage to fascial tissues;extended and painful recovery period;visible scarring;relatively high cost;time consuming; andpost-operative ventral hernia (POVH), particularly when the larger trocars are used.

Most of the aforementioned risks and disadvantages are associated with the relatively large size of the incision required for trocar insertion.

SUMMARY OF THE INVENTION

The present invention, in some embodiments thereof, relates to devices and methods for performing laparoscopic surgery. More specifically, the present invention provides two-part laparoscopic tools which may be inserted into the body using fewer and/or smaller incisions than those used according to methods of prior art, and other tools for facilitating laparoscopic surgery. Embodiments of the invention significantly reduce surgical risks, simplify surgical procedures, and facilitate rapid patient recovery.

The methods include performing laparoscopic interventions using one or more multi-part instruments, wherein each instrument comprises a shaft (optionally with handle) and one or more operating tools (also called “operating heads” and “operating tool heads”) attachable to that shaft. The shafts have a cross-section considerably smaller than most laparoscopic tools of prior art and are designed for direct insertion into the body cavity by puncture penetration or through a relatively small incision, rather than through a conventional laparoscopic port. The handles comprise a screw thread or other attaching mechanism at their distal ends, suitable for attaching an operating head thereto.

In the following the term “wide trocar” refers to a trocar wide enough to enable passage of an operating tool. A typical internal diameter of a wide trocar would be 4 mm or larger, though that size is not to be considered limiting. In the following the term “narrow trocar” refers to a trocar only wide enough to enable passage of a shaft to which an operating tool may be attached. A typical internal diameter of a “narrow trocar” would be 3 mm or less, though that size should not be considered limiting.

Various embodiments presented herein enable providing a plurality of operating tools each connected to an individual shaft and able to be operated independently, using only a single wide trocar, by introducing a plurality of operating tools into the body cavity through the wide trocar, and introducing shafts for those operating tools either through narrow trocars or by using a shaft (optionally with an inserted stiffener) to directly puncturing the cavity wall, thereby creating openings substantially similar in size to the diameter of the shaft. Such openings are considerably smaller than the opening required for a wide trocar, and consequently are less damaging and provide fewer complications, shortened recovery time and less bleeding and less scarring.

Embodiments presented herein include methods for attaching an operating tool to shaft and optionally also to a manipulating handle, including:

a) introducing a distal portion of a shaft into a body cavity, for example by puncturing a wall of the cavity or by introducing the handle through the wall by means of a narrow trocar, introducing an operating tool into the body cavity through a wide trocar, and connecting tool to shaft within the body cavity,

b) introducing a distal portion of a shaft into a body cavity, for example by puncturing a wall of the cavity or by introducing the handle through the wall by means of a narrow trocar, extending the distal shaft portion towards and into a wide trocar, advancing the distal shaft portion through the wide trocar so that the distal shaft portion exits the body cavity through the wide trocar, attaching an operating tool to that distal shaft portion while the distal shaft portion is outside the body, and then withdrawing the shaft so that the attached operating tool is retracted into the body cavity where it can be used, and

c) attaching an operating tool to a shaft, the shaft optionally having a sharp proximal end, introducing the shaft into a wide trocar, extending it towards an inner portion of a body cavity wall, causing the shaft to traverse to body cavity wall so that the proximal shaft extends outside the body cavity, connecting a handle to the shaft portion which is external to the body cavity, and withdrawing the shaft far enough from the body so that the operating tool is drawn through the wide trocar and into the body cavity, where it can be used.

The operating tools (also called “operating heads” herein) may be any surgical tools, including (but not limited to) graspers, scissors, coagulation devices, harmonic scalpels, LigaSure, needle holders, ligatures, cameras and suction devices. The operating heads may optionally have shaft diameters similar to, or larger than, those of conventional laparoscopic tools. According to some embodiments of methods of use, a plurality of these operating heads may be inserted into the body (e.g. sequentially, through a single trocar port of conventional design, or Gastro-Colonoscopically using a Natural Orifice Transluminal Endoscopic Surgery (NOTES) instrument) and may be mated with and attached to their shafts within the body cavity. In alternative embodiments one or more of such shafts may be inserted into the body cavity, extended out of the body cavity (e.g. sequentially) through a single trocar or a reduced number of trocars, attached to an operating head outside the body, and thence drawn back into the body cavity through the trocar. With either of these methods, the result is a plurality of narrow shafts penetrated into the body cavity through punctures or insertions which are smaller than typical trocar diameters, each shaft mated to an operating head, which may be any conventional surgical tool of normal diameter and capabilities. Additional operating heads may be introduced into the body cavity and operating heads may be switched and exchanged, all within the body cavity, during the course of an operation. A plurality of surgical tools are thereby made available for manipulation and use within a body cavity, though a only a reduced number of trocars (optionally only one) have been used.

Some embodiments of the present invention further comprisetools for managing a plurality of operating heads within the body cavity, comprising a plurality of connecting elements each able to hold an operating head, and further comprising a penetrating element operable to penetrate a body wall from within the body cavity, and to extend beyond the body where it may be grasped and immobilized from outside the body;tools for inserting operating heads into the body cavity and/or for removing operating heads from a body cavity, optionally implemented as a sheath adaptable over a camera assembly introduced into a body through a trocar;tools for removing body tissues or other objects from the body cavity during an intervention, comprising a sheath (optionally adaptable over a camera assembly introduced into the body through a trocar) and a rolled or folded bag which may be introduced into the body cavity through the sheath, unrolled or unfolded within the body cavity, filled with materials to be extracted, and then withdrawn from the body through the trocar;tools for stabilizing and/or immobilizing and/or positioning body organs or other tissues during a surgical intervention comprising a narrow shaft having a distal portion insertable into the body cavity and connectable to an operating head, and a stabilizing/positioning mechanism connected proximal portion of the shaft outside the body and designed to stabilize the shaft in a selected position; andseveral grasper designs with detachable heads, some including a head mechanism presenting advantages over head mechanisms known to prior art.

It is noted embodiments of the present invention include (and are not limited to) the above-listed components and embodiments used both separately and/or in concert, and further include additional components and embodiments as detailed below. It is further noted that the “wide” and “narrow” tools described in detail below may be used individually or in sets of several such tools used individually and/or in concert, and that one or more “wide” tools may be used alone or in concert with one or more “narrow” tools. It is further noted that the invention is not limited to the specific exemplary uses described for the disclosed devices, and that the invention is also not limited to the specifically described exemplary tool examples described as being used to perform the disclosed methods.

DESCRIPTION OF SPECIFIC EMBODIMENTS OF THE INVENTION

The present invention, in some embodiments thereof, relates to devices and methods for performing laparoscopic surgery. More specifically, the present invention provides two-part laparoscopic tools which may be inserted into the body using fewer and/or smaller incisions than those used according to methods of prior art, and other tools for facilitating laparoscopic surgery. Embodiments of the invention significantly reduce surgical risks, simplify surgical procedures, and facilitate rapid patient recovery.

It is expected that during the life of a patent maturing from this application many relevant laparoscopic tools will be developed and the scope of the terms “laparoscopic tool”, “operating tool” and “operating head” are intended to include all such new technologies a priori.

The term “consisting of means “including and limited to”.

According to some embodiments of the invention there is presented a method for inserting and removing surgical instruments during a laparoscopic procedure in the body cavity of a subject, comprisinginserting a surgical instrument (a grasper, for example) constructed of two separate parts, a distal operating head inserted into a body cavity through a conventional laparoscopic port, by use of a Natural Orifice Transluminal Endoscopic Surgery (NOTES) instrument, or by some similar method, and a proximal shaft directly inserted into a body cavity through a stab incision made in the wall of the body cavity;connecting the two parts of the instrument;use of the instrument within the body cavityseparation of the two parts following their use;withdrawal of the shaft through its stab incision; andwithdrawing of the distal operating head through the port, NOTES instrument, or similar device.

Connecting and separating distal and proximal portions of the device may be performed with the assistance of a conventional grasper inserted through a trocar.

In some embodiments of the invention a surgical kit comprises a “wide tool” and one or more “narrow tools”.

FIG. 1Apresents an exemplary embodiment of a wide tool99, comprising a shaft100with a sharp distal end110capable of penetrating a body wall, and a detachable head200.FIG. 1Bshows a wide tool with detachable head200attached.

In some embodiments the shaft of the wide tool is inserted into a body cavity through the cavity wall, and the distal head of the wide tool is inserted into the body cavity through a trocar and connected to the wide tool shaft by manipulation by a grasper or other tool inserted through a trocar. In other embodiments the distal portion of the wide tool may be caused to traverse a portion of the body cavity, and exit the cavity through a trocar, where the wide tool head can be connected to the wide tool shaft, which is then retracted into the body cavity. In yet other embodiments the wide tool with head attached may be inserted into the body cavity through a trocar.

Once the wide tool head is connected to the wide tool shaft and positioned in the body cavity, the wide tool can be used as described below to connect additional operating heads to additional tools having shafts introduced (by puncture or very small incisions) into the body cavity. These may be additional wide tools and/or “narrow tools” as described below.

As may be seen in the exemplary embodiment shown inFIG. 1, the shaft of the wide tool may be implemented with a proximal handle300shaped similarly to a scissor, with one leg of the scissor attached to the outside of the shaft, and a second leg attached on an actuating rod or actuating cord passing the length of the shaft and providing means for manipulating an operating head when attached thereto by pulling or pushing on the actuating rod or cord and causing it to move backward or forward with respect to the body of the shaft.

FIG. 2shows a portion of a distal part of such a shaft, showing at “A” a passageway120for such an actuating cord125or rod127, at “B” a connector130for fluid (e.g. irrigation or suction), and at “C” a passageway140for a stiffening rod150.FIG. 3shows such a stiffening rod150positioned alongside the shaft100of a wide tool99, andFIG. 4shows the stiffening rod150inserted therein. Such a stiffening rod can be inserted in the shaft100to stiffen and reinforce the shaft, for example when the shaft is caused to penetrate by force through a body wall or other tissue. The stiffening rod can then be removed, leaving an empty passageway140through which fluids can be caused to flow (e.g. for suction or irrigation), or which may be used for other purposes such as passing objects therethrough.

FIG. 5presents an additional embodiment where similar elements are presented in a slightly different configuration. It is noted that the small passage120, described above as used for passage of an actuating rod127or cord125, can be used for other purposes, such as for passage of an electrical connection129. Additional conduits within the shaft may be supplied as well.

The wide tool may be provided with a solid grasper head, or with a grasper head210comprising hollow portions220which can be used as conduits for fluids. Such a head210, comprising a hollow220, is shown inFIG. 6A, and a detail view of the hollow portion of such a head is shown inFIG. 6B. This hollow portion220can be made continuous with the passage140shown inFIG. 2, or with another conduit in the shaft, to enable irrigation, suction, or some similar fluid-related activity. It is noted that although a grasper head with a hollow portion is shown in the figures in the context of tools with detachable heads as described above, graspers and similar surgical tools which comprise hollow portions and are capable of implementing suction activity or irrigation activity in addition to grasping may also be implemented in surgical instruments wherein the grasper head is permanently attached to its shaft.

FIGS. 6C,6D, and6E show successive stages of fluid flow in the case of suction being applied at point “B” ofFIG. 2.

Optionally the wide tool may comprise an electrical power connection, and portions of the shaft may be constructed of insulating materials or may be covered by insulating materials, as appropriate. Electrical tools270may be positioned at the operating head or may be incorporated in the shaft. An example is provided inFIG. 7, which presents a wide tool configured as a coagulator272.

FIG. 8presents a partial view of a “narrow tool”101, one or more of which are supplied together with at least one “wide tool” to form a kit, in some embodiments of the present invention. A narrow tool is similar to a wide tool in that it comprises a shaft which comprises a distal end sharp enough to penetrate tissue, a separable operating head useful for performing a useful function during a surgical procedure, and an attachment configuration (for example, screw threads) enabling to attach and the operating head to a distal portion of the shaft, and to detach it therefrom. In some embodiments the narrow tube comprises a conduit through which a wire and/or an activating rod or cord may be passed, which wire or rod or cord may be used to control or activate the operating head or a portion thereof. Such a conduit is seen positioned in an upper portion of that part of a narrow tool shaft pictured inFIG. 8.

It is an advantage of the narrow tool that it may be made extremely thin: in some embodiments the diameter of a narrow tool is between 1 and 3 mm. (Note that these dimensions are given by way of example, and are not to be considered limiting.) Thin shafts of such narrow dimensions can be caused to penetrate through an abdominal wall (or into any other body cavity) with a minimum of damage to tissues through which they pass. In an exemplary method of use, a wide tool is introduced into a body cavity as described above, an operating head for a narrow tool is introduced into a body cavity through a trocar, and the wide tool is used to grasp the detached narrow-tool head and to attach it to the narrow tool shaft. In this manner one or many narrow tools can be introduced into the body cavity and used within the cavity with only minimal damage to the cavity walls. Narrow tools so introduced are similar to standard laparoscopic tools and can be used by a surgeon with little or no special training.

In some embodiments the operating head is constructed of two parts, a base part connected to the shaft (e.g. to a wide tool shaft or to a narrow tool shaft), and a second moveable part connected to an activating rod positioned in a conduit within the shaft. Moving the activating rod forward and backward has the effect of moving the moveable head part with respect to the base head part, for example opening and closing a grasper as shown inFIG. 9.

In an alternative construction shown inFIG. 10, two moveable parts each connected to a common activating rod are also connected to a fixed part of a shaft. Forward and backward movement of the activating rod with respect to the shaft has the effect of closing and opening the moveable portions of the grasper, as shown in the Figure.

A further alternative construction is presented inFIG. 11, which shows a configuration in which an external activating rod connects to an external portion of an operating head, and an internal activating rod, able to advance and retract within the external portion, connects to an internal portion of the operating head. Advancing and retracting the internal rod with respect to the external portion causes opening and closing of the jaws of the grasper. Also of interest in the Figure: note the form of the distal portion of the shaft100inFIGS. 11A and 11D, which distal portion is pointed (102) to facilitate penetration of tissues, but which also comprises screw threads104enabling connection between shaft and head. Note also the matching screw threads103on outer and inner portions of the operating head, as shown inFIGS. 11B and 11D.

Surgical Support Tools:

Physical Support Structure:

In some embodiments of the invention there is provided a support structure500which enables to physically support or hold organs or parts of organs or other tissues in particular positions, to enable surgical work to proceed on those organs or tissues, or on organs or tissues in their vicinity.FIG. 12provides a view of an embodiment where a wide or more typically a narrow tool is used for this purpose. The distal portion of the tube is made to penetrate into the body cavity, the operating head200is attached as described above, and the operating head200(in the form of a grasper or other tool) is made to seize and hold a portion of the organ or tissues whose support or immobilization is desired. As shown in the figure, an external support device500surrounding or otherwise connected to a proximal portion of the tool shaft100, outside the body cavity, is adjustable and may be adjusted to maintain that proximal portion at a desired position and angle with respect to the body. (In the exemplary embodiment shown in the figure, a tripod502or multi-legged shape504with adjustable-length legs506is used.) Fixing the position of the proximal portion, external to the body, also fixes the position of the distal portion internal to the body, and thereby fixes also the position of the tissue or organ grasped by the head.

Tool for Removal of Operating Heads:

FIGS. 13-15present a tool for removal of operating heads from within the body cavity.FIG. 13shows the head removal tool in the form of a sleeve600formed to fit on a camera or other visualization device610introducible into a body cavity through a trocar620. At the end of the operation or whenever desired, the visualization device may be withdrawn from a trocar, a sleeve “E” added to the device as shown inFIG. 13, and the device reinserted. In use sleeve E may be extended beyond the visualization device. A wide or narrow tool is used to detach an operating head200from a tool, and to position it within or attach it to sleeve600as shown inFIG. 14. The visualization device610together with sleeve600and the attached operating head200can then be removed through the trocar as shown inFIG. 15.

Device for Extracting Tissues:

During the course of an operation it is often necessary to provide for removing from a body cavity organs or tissues which have been excised, or to provide from removing devices introduced into the cavity during the operation.FIGS. 16-18present a device for doing this.

As shown inFIG. 16, a sleeve600is provided which is sized and shaped to be adapted to a visualization device610insertable into the body through a trocar620or other port. An appropriately sized bag630is rolled or folded and stored within the sleeve.

When deployment of the bag is desired, the bag630may be unrolled or unfolded using a manipulation device (such as narrow or wide tool with grasper head) present in the body cavity. The deployed removal bag630is shown inFIG. 17.

In an alternative embodiment, the removal bag may be provided with flexible straps640as shown inFIG. 18. The straps may be manipulated to open the bag for use, and the bag may be removed from the body cavity by pulling on the straps, which extend beyond the trocar and may be grasped from outside the body of the patient.

Tool for Managing Operating Heads:

According to a further aspect of embodiments of the invention, there is provided a tool for managing a plurality of operating heads within the body of a patient.

As described above, operating heads may be inserted into a body cavity (e.g. through a trocar) and there may be attached to one or more tool shafts. In some cases it may be desired to have a plurality of operating heads (e.g. a plurality of tools of different types) present within a body cavity, and to alternate use of various heads by attaching and disconnecting them from one or more tool shafts, which shafts remain in place and need not be removed from the cavity nor reinserted therein.

To facilitate this process a tool organizing device is provided, as shown inFIGS. 19-21.

The tool organizing device may be configured as a cartridge magazine, as a rack, as a shelf, as a set of hooks, or in any other convenient configuration.

FIG. 19shows an exemplary tool rack650(a tool organizer device650or “head storage tool” is configured as a set of connected hooks) is shown external to the body cavity.

InFIG. 20, the tool organizer device (head storage tool) has been inserted into the body cavity, e.g. through a trocar. To avoid multiplying large body openings, if a single trocar has been installed and is used for passage of a visualization device into a body cavity, passing the tool organizer (or tool operating heads, or other objects) into the cavity may be done, for example, by removing a visualization device from a trocar, passing the organizing device through the trocar into the cavity, and then replacing the visualization device in the trocar.

As shown in the Figure, the tool organizer comprises a penetrating point660long enough and sharp enough so that if the device is grasped by a tool within the cavity the penetrating point may be caused to pass from inside the cavity to the outside of the body, where it may be grasped and held by a surgical tool. This has the effect of immobilizing the tool organizer as shown inFIG. 21.

A plurality of operating heads may then be stored in or on the device during an operation, where they are accessible to being taken up by one of the available manipulating tools (e.g. wide tool or narrow tool), yet are kept in order and out of the way of on-going surgical manipulations. This situation is presented inFIG. 22.

Attention is now drawn toFIG. 23which shows a process whereby an operating head200may be attached to a penetrating tool100while outside the body, as was mentioned above. This procedure is convenient for attaching an operating head to a wide tool, which wide tool can then be used to attach operating heads to a plurality of narrow tools within the body cavity. However, for convenience, the procedure shown inFIG. 23can be used to attach heads to narrow tools as well.

As seen in the figure, a shaft100is caused to penetrate into a body cavity in which a trocar620or similar port has been inserted. The shaft is then directed towards and through the trocar (a visualization device using the trocar may be temporarily removed from it for this purpose), and becomes available outside the body, where the operating head may be attached. The shaft is then withdrawn through the trocar back into the body cavity, where it may be used. A similar procedure can be utilized to remove a head from a shaft before withdrawing the shaft from the body.

Example of a Surgical Procedure Using Tools Described in this Document: Removal of an Appendix.Insert standard trocar (e.g. trocar of 10 mm diameter) into a body cavity wall, e.g. in the navel;Insert a visualization modality (e.g. a camera), use it to survey the body cavity, locate the infected appendixInsert wide tool directly into lower bellyTemporarily remove visualization device, pass through the distal portion of wide tool so that it extends beyond the trocar and is outside the body.Affix operating head to wide tool.Withdraw wide tool through trocar into body cavity, replace visualization device.Introduce narrow tool into the lower belly above the pubis under guidance of visualization device.Remove visualization device from trocar, introduce operating head (e.g. dissector) through trocar, restore visualization device.Use wide tool to grasp dissector head and affix it to narrow tool shaft, under guidance of visualization toolRemove visualization device from trocar, introduce tool organizer, scissor tool, and a tool for immobilization of the intestine.Fix tool organizer in a place by holding with wide tool and causing its penetrating point to penetrate the body wall to a position outside the body, where it is grabbed by a standard surgical device, thereby immobilizing it.Mount spare operating heads on the organizing tool.Proceed with the operation, cutting, cauterizing, etc. according to standard surgical procedures as needed, using the various tools held in readiness by the tool organizer, and changing operating heads as needed. Appendix is disconnected from the body, bleeding is cauterized and/or tied. Scissor head mounted on one of the shafts and used to cut ligatures.Visualization tool removed, sleeve containing tissue bag is mounted on visualization device which is returned to place through the trocar.Bag is opened using narrow tool, appendix placed within bag, bag and visualization device removed from body through trocar. Visualization tool replaced in cavity.Operation site is irrigated through hollow portion of wide tool. Hemostasis checked.Body cavity is irrigated, cleaned, inspectedHead removal tool mounted on visualization tool and used to remove various operating tools, and (usually last) the tool organizerNarrow tool(s) withdrawn from body under observation by visualization tool. Generally no stitching of the penetration site is required.Removal of visualization device, then of the trocar. Closing of the opening through which the trocar was inserted.

Attention is now drawn toFIGS. 24-29which show additional methods for providing a plurality of operating tools with wide heads within a body cavity having only a single wide opening.

FIG. 24shows an operating tool700with a wide head720and a narrow shaft710being inserted through a trocar620into a body cavity. Note that in the figure the wide operating-tool head720is positioned outside the body, and the narrow shaft710is inserted through the trocar into that body. IfFIG. 25the trocar, and the tool within it, is seen to be oriented so that the narrow shaft of the tool is aimed towards a selected portion of the outer wall of the body cavity.

FIG. 26shows the shaft (which may have a sharp end711) starting to puncture the cavity wall, moving from inside the body cavity towards the outside. A continuation of the process is shown inFIG. 27, in which the shaft has penetrated the cavity wall, and can be grasped from outside the patient's body. The shaft can then be draw sufficiently far outside the patient's body so that the opposite end of the tool, with operating head attached, can be drawn through the trocar and into the body cavity. In the situation shown inFIG. 28, the operating head and distal portion of the tool are within the body cavity, and the tool's shaft is outside the body cavity.FIG. 29shows a handle300attached to the tool, which is now read for surgical work within the body cavity. It the series of figures now described only one tool has been so inserted, but it is to be understood that a plurality of tools may be inserted into the body cavity in this manner, each having only a narrow-diameter puncture penetration of the body cavity wall and a wide operating tool head.

An optional additional embodiment is shown inFIG. 30, where a narrow trocar740, only slightly larger than the diameter of the tool shaft710, is positioned on the tool shaft prior to connection of handle300to shaft. The trocar can be slid down the shaft and into the puncture hole around the shaft, where it serves to facilitate free motion of the shaft during the surgical procedure and also serves to preserve gas pressure within the body cavity if the body cavity is inflated, as is often the case during surgical procedures.

Attention is now drawn toFIGS. 31-39, which present aspects of a surgical procedure whereby a treatment tool with narrow shaft and relatively wide treatment head can be introduced into a body cavity and manipulated through a narrow incision.

FIG. 31shows a surgical tool700partially introduced through a trocar into a body cavity, with shaft710in the body cavity and operating head720outside the cavity. A handle301which comprises an internal stiffener370having a sharp point372is shown inserted in the handle301, outside the body. (The stiffener is shown in dark color)

FIG. 32shows the handle301, with stiffener inserted, penetrating into the body cavity wall. InFIG. 33the stiffener370has been removed, the handle301remains penetrating the cavity wall. InFIG. 34, the shaft710of the tool700inserted through the trocar, and the handle301inserted through the cavity wall are oriented towards each other, inFIG. 35they approach each other and inFIG. 36they connect. Shaft and handle are provided with a connecting mechanism725such as matching screw threads (103,104) or any other attaching mechanism. A surgeon, manipulating both tools by their portions positioned outside the body, can connect them.

Once handle and tool are connect, the handle can be partially retracted from the body, pulling the operating tool head through the trocar and into the body cavity, as shown inFIG. 37. InFIG. 38the tool is shown with operating head within the body cavity and free to move, it's handle being outside the body where it can be manipulated by a surgeon.FIG. 39shows the tool approaching a surgical intervention site within the body cavity.

To remove the tool, the surgeon can use the handle to insert the operating head of the tool into the trocar, where he can grasp it from outside the body, and unscrew it or otherwise disconnect it from the handle. Thereafter both the tool and the handle can be removed from the body. The procedure can be used in introduce a plurality of such tools through a single trocar, enabling a surgeon to employ a plurality of tools with wide heads without needing a plurality of wide openings in the body cavity wall.