Abstract:
In laparoscopic or thorascopic surgery, a trocar is used to provide an passage into the body cavity of a patient for injecting an inert gas to inflate it. A laparoscope or thorascope is passed through a sealing membrane of the trocar so the patient may be observed without releasing a large quantity of the inert gas. If the scope lens is clouded with body liquids or tissue, the scope is removed from the trocar and its lens cleaned. The trocar cannula is cleaned by running a swab through the sealing membrane into the cannula and removing body liquids, tissue and/or check valve lubricant from the inside of the cannula. The swab includes radiopaque markers on the sorbent end, measuring marks on the swab handle and an enlargement on the swab handle. The enlargement is positioned so it may be grasped and the swab pushed into the cannula a distance which is insufficient to push the sorbent end out of the end of the cannula.

Description:
[0001]    This application is based on Provisional Application Ser. No. 60/996,124, filed Nov. 1, 2007 on which priority is claimed. 
         [0002]    This invention relates to an accessory for assisting in the performing of laparoscopic or thorascopic surgery and a method of its use and more particularly to a method and apparatus for cleaning an laparoscopic or thorascopic trocar. 
     
    
     BACKGROUND OF THE INVENTION 
       [0003]    One of the great advances in surgery in the recent past has been the development of remote viewing surgery where the surgeon looks through or uses some type remote viewing instrument to see the site of the procedure. Laparoscopic, thorascopic, arthroscopic or endoscopic surgery are species of remote viewing surgery and involve the introduction of a viewing scope into the interior of a patient where a surgical procedure is to be performed. In the case of endoscopic surgery, an endoscope is inserted through a natural body opening. In the case of arthroscopic surgery, an incision is made near the joint where the procedure is to be done and a trocar inserted through the incision through which a viewing scope is inserted. In the case of all versions of remote viewing surgery except endoscopic surgery, a trocar is inserted through an incision in the patient&#39;s skin and a viewing scope and/or other instruments are passed through the trocar. 
         [0004]    In the case of thorascopic surgery, a series of incisions are made in the chest wall to insert a variety of implements into the chest cavity. The only major difference between a thorascopic trocar and a laparoscopic trocar is the length of the cannula, i.e. the thorascopic trocars have cannulas which are several inches shorter than laparoscopic trocars. In the case of laparoscopic surgery, several small incisions are made in the patient&#39;s abdominal wall to insert a variety of implements into the patient&#39;s abdomen. A series of trocars are inserted into the abdomen through the incisions to provide one or more pathways for a laparoscope and/or other surgical instruments. After removing a piercing implement or obturator from the trocar, the abdomen or chest is distended by injecting an inert gas, typically carbon dioxide, through the cannula of the trocar thereby providing some room to perform a surgical procedure. Each trocar includes a sealing membrane having an opening therein for passing the laparoscope or other surgical implements into the patient&#39;s abdomen while largely preventing the escape of the inert gas from the patient&#39;s abdomen or chest cavity. In addition, some trocar embodiments include a check valve of some type to prevent the escape of the inert gas from the patient&#39;s abdomen when the laparoscope or other surgical implement is removed. Some trocar models include a flapper type check valve while others include a slit diaphragm but both have the function of reducing or preventing gas escape from the patient&#39;s abdomen or chest cavity when the laparoscope or surgical implement is removed. The number and placement of the incisions and the particular type of laparoscope and surgical instruments depends, of course, on the type and extent of surgery to be performed. 
         [0005]    In the case of thorascopic surgery, one or more small incisions are made in the patient&#39;s chest cavity. One or more trocars are inserted into the chest cavity so a thorascope and/or other surgical instruments may be inserted into the patient. So far as is relevant for purposes of this invention, the laparoscopic and thorascopic procedures are essentially the same. As used herein, the word torso is used as a generic term to include the abdomen and the chest cavity. 
         [0006]    Periodically, the lens on the forward end of the laparoscope may be obscured or partly obscured by body liquids, tissue or lubricant on the check valve. In current practice, the surgeon withdraws the laparoscope from the cannula, cleans the lens and reinserts the laparoscope through the cannula of the trocar. Occasionally, the interior wall of the cannula collects body liquids, tissue or check valve lubricant, meaning that the lens may become clouded or obscured when reinserted through the cannula. Currently, the cannula is attempted to be cleaned with surgical gauze. 
         [0007]    It has been proposed in the prior art to provide for in situ cleaning of laparoscope lenses or to provide lens washing nozzles on laparoscopes as shown and discussed in U.S. Pat. No. 5,392,766. Although these approaches may theoretically be workable, they have not been accepted, for whatever reasons, by general surgeons in normal every day surgery. 
         [0008]    It has been proposed in the prior art to clean the inside of arthroscopes used in non-abdominal surgery with a swab as shown in U.S. Pat. Nos. 5,029,573; 5,318,582 and 5,356,419. 
         [0009]    Other disclosures of some interest relative to this invention are found in U.S. Pat. Nos. 3,133,538; 3,205,518; 3,376,867; 4,626,251; 5,928,176; 6,045,623 and D401,326 along with Printed Patent Application 2005/0267,421. 
       SUMMARY OF THE INVENTION 
       [0010]    In this invention, the inside of a cannula of a laparoscopic or thorascopic trocar is cleaned with a swab in the middle of surgery to remove body liquids, tissue or check valve lubricant from the inside of the cannula. Typically, the laparoscope lens becomes clouded and the laparoscope is removed from the cannula and cleaned. Before the laparoscope is reinserted through the cannula, the swab of this invention is run through the cannula to remove any body liquids, tissue or check valve lubricant thereby allowing the lens to generate clear pictures to the monitor being watched by the surgeon. 
         [0011]    The swab is of unusual design and includes a handle of sufficient size to seal against the sealing membrane opening of the cannula to thereby prevent the escape of gas from the patient&#39;s abdomen or chest cavity when the swab is being used to clean the inside of the cannula. The swab handle includes depth markings to the end of the sorbent patch on the handle end and/or a shoulder or enlargement at a location where the swab is fully inserted into the cannula. In effect, the enlargement acts as a depth gauge to minimize the potential of dislodging the sorbent patch from the handle and leaving the sorbent patch inside the patient. Radiopaque elements on the sorbent swab end allow the swab end to be located by x-ray or fluoroscope. 
         [0012]    It is an object of this invention to provide an improved method and apparatus for cleaning a laparoscopic or thorascopic cannula during abdominal surgery or thoracic surgery. 
         [0013]    A further object of this invention is to provide an improved swab for cleaning a laparoscopic or thorascopic cannula during surgery. 
         [0014]    A more specific object of this invention is to provide an improved swab having a handle providing an enlargement to minimize the possibility of the swab being inserted past the end of the cannula. 
         [0015]    These and other objects and advantages of this invention will become more apparent as this description proceeds, reference being made to the accompanying drawings and appended claims. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0016]      FIG. 1  is an exploded isometric view of a conventional arthroscopic trocar; 
           [0017]      FIG. 2  is an exploded cross-sectional isometric view of a conventional arthroscopic trocar; 
           [0018]      FIG. 3  is an exploded isometric view of a conventional laparoscopic trocar; 
           [0019]      FIG. 4  is an exploded cross-sectional isometric view of a conventional laparoscopic or thorascopic trocar; 
           [0020]      FIG. 5  is an enlarged exploded view of the trocar of  FIG. 3 , many of the long components being cut off for purposes of illustration; 
           [0021]      FIG. 6  is a pictorial view of one embodiment of a swab of this invention; 
           [0022]      FIG. 7  is a pictorial view of another embodiment of a swab of this invention. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0023]    Referring to  FIGS. 1-2 , a conventional arthroscopic trocar  10  comprises a cannula  12  into which is inserted a piercing implement or obturator  14 . In use, an incision is made in the patient, as on the back of the hand as shown in U.S. Pat. Nos. 5,029,573; 5,318,582 and 5,356,419 and the trocar  10  inserted into the incisions. The trocar  10  is advanced into the patient&#39;s body by pushing on an end  16  of the piercing element so the point  18  burrows its way through the patient&#39;s flesh to reach the desired location where a surgical procedure is to be conducted. The obturator  14  is then removed, leaving the cannula  12  in place. A series of the trocars  10  may be placed in the patient, depending on the type and extent of surgery to be performed. The arthroscopic trocar  10  will be seen to be quite simple and the cannula  12  is of small internal diameter. Although there may be some variation in the size of the passage  20  through the cannula  12 , they are very small and usually are in the 4 millimeter range. 
         [0024]    Referring to  FIGS. 3-5 , a conventional laparoscopic trocar  30  comprises, as major components, a cannula  32 , a sealing section  34  and a piercing element or obturator  36 . In some embodiments, the cannula  32  may comprise an elongate exteriorly ribbed conduit  38  having a bulbous end  40  housing a slit diaphragm type check valve  42 , a port  44  having a valve  46  for delivering and withdrawing inert gas to and from the patient&#39;s abdomen and a latching mechanism  48  for securing the sealing section  34  to the cannula  32 . The slit diaphragm  42  conveniently includes a single slot  50  through which the laparoscope (not shown) extends. When the laparoscope is removed, the size and shape of the diaphragm  42  closes to prevent flow of the inert gas out of the patient. 
         [0025]    The latching mechanism  48  may be of any suitable type and conveniently includes openings  52  for receiving prongs on the sealing section  34 . An actuator  54  rotates a spring biased ring (not shown) to release the prongs in order to separate the sealing section  34  and the cannula  32 . 
         [0026]    In some embodiments, the sealing section  34  may comprise a housing  56  having finger prongs  58  received in the openings  52  to secure the sealing section  34  and the cannula  32  together. One or more guide pins  60  may be provided on the sealing section  34  to be received in guide openings (not shown) to align the sealing section  34  and the cannula  32 . 
         [0027]    In some embodiments, the sealing section  34  also comprises a floating ring  62  carrying a series of sealing elements  64  providing a central opening through which the piercing element  36  extends. The sealing elements  64  comprise a series of rubber flaps that act much like the iris of an eye to spread apart when the obturator  36  passes through them thereby sealing on the periphery of the obturator  36 . The sealing section  34  also comprises openings  66  for latching onto the obturator  36 . 
         [0028]    The obturator  36  comprises an elongate shaft  68  having a pointed end  70  which is sharp enough to penetrate tissue below the skin of the patient. The obturator  36  includes a dome shaped end  72  which can be easily grasped by the surgeon and pushed through the abdominal wall of the patient. One or more latches  74  align with and enter the openings  66  of the sealing section  34  for securing the obturator  36  to the sealing section  34 . The latches  74  may be retracted by pressing on buttons  76 . Laparoscopic trocars typically have cannulas of considerably larger internal diameter in order to pass cameras, surgical implements and the like which are necessitated by laparoscopic surgery. While the internal diameters of laparoscopic cannulas may vary from 5-15 millimeters, the vast majority of laparoscopic cannulas have internal diameters of 8-12 millimeters. Those skilled in the art will recognize the trocar  30  to be a conventional trocar made by Ethicon Endo-Surgery of Somerville, N.J., and known as an Endopath XCEL, size 12, which means it is twelve millimeters outside diameter. 
         [0029]    Use of the laparoscopic trocar  30  should now be apparent. After the surgeon makes the necessary incision in the patient&#39;s skin, the pointed end  70  of the assembled trocar  30  is inserted through the incision and pushed to pass through the patient&#39;s abdominal wall. When the trocar  30  has been inserted to the appropriate location, the obturator  36  is removed by pressing on the buttons  76  and unlatching the obturator  36  from the sealing section  34 . The surgeon then inflates the patient&#39;s abdomen by connecting a source of pressurized inert gas to the port  44  and opening the valve  46 . When the patient&#39;s abdomen has been distended sufficiently, the surgeon closes the valve  46  thereby disconnecting the source of pressurized inert gas. Depending on the nature of the surgical procedure being conducted, the surgeon may make other incisions in the patient&#39;s abdomen and position additional trocars at strategic locations to assist in the conduct of the surgical procedure. 
         [0030]    Sooner or later, the surgeon passes a laparoscope through one of the trocars and views the operation site on a monitor in the operating room. Surgical steps are taken by inserting implements through others of the trocars and the surgical procedure is conducted, depending on the nature and extent of the procedure. Occasionally, the lens on the laparoscope will become clouded by body liquids, tissue and/or check valve lubricant. The surgeon may remove the laparoscope from the trocar  30  and clean the lens with any available sorbent material. Occasionally, detritus such as body liquids, tissue and/or check valve lubricant accumulates on the inside of the cannula  38  so reinsertion of the laparoscope through the cannula  38  may again cause the lens to be fouled so the picture on the monitor being watched by the surgeon is not clear. Those skilled in the art will recognize the laparoscopic procedure, as described above, to be conventional. 
         [0031]    In the event the cannula  38  has accumulated body liquids, tissue and/or check valve lubricant which may cloud the laparoscope lens, a swab  80  is provided that is designed to clean the inside of the cannula  38  as shown in  FIG. 6 . The swab  80  comprises a handle  82  and an sorbent end  84 . The handle  82  is of substantial diameter, both to support the weight of the sorbent end  84  and to seal against the sealing elements  64  to inhibit the loss of the inert gas from the patient&#39;s abdomen. Typically, the handle  82  has an outer diameter of 3-4 millimeters although it will be understood that any diameter which is strong enough to be relatively inflexible, support the load of the sorbent end  84  and seal against the sealing elements  64  will be operative in this invention. 
         [0032]    The handle  82  preferably includes a variety of unusual features. In some embodiments, a series of distance measuring marks or indicia  86 ,  86 ′ can be provided to indicate the distance from the far or distal end of the sorbent end  84  to the mark  86 ,  86 ′. Preferably, the marks  86  are located at distances from the sorbent end  84  corresponding to the lengths of cannula that are compatible with the particular swab  80 . This may be used to prevent the surgeon from inserting the swab  80  so far into the cannula  38  that the sorbent end  84  passes out of the end of the cannula  38 . This is not desirable because it creates the possibility that the sorbent end  84  may become detached from the handle  82  requiring it to be retrieved from inside the patient. For example, the Ethicon Endo-Surgery Model Endopath XCEL, size 12 discussed above, the distance from the proximate end of the sealing section  34  to the distal end of the cannula  38  is approximately nineteen centimeters. For use with this particular trocar, the mark  86 ′ is preferably slightly less than nineteen centimeters from the end of the sorbent end  84 . 
         [0033]    In some embodiments, the handle  82  can include a tactile distance device or indicator  88  such as a shoulder or enlargement  90  to indicate the distance from the sorbent end  84  to the mark  86 ′. In some embodiments, the enlargement  90  is permanently fixed to the handle  82  at the time of manufacture. The enlargement  90  may be used to prevent the surgeon from inserting the swab  80  so far into the cannula  38  that the sorbent end  84  passes out of the end of the cannula  38 . For use with the Ethicon Endo-Surgery Model Endopath XCEL described above, the mark  86 ′ is preferably about nineteen centimeters from the end of the sorbent end  84 . In use, the surgeon can grasp the enlargement  90  and push the swab  80  through the cannula  38  and confidently realize that the sorbent end  84  will not pass out of the cannula  38 . 
         [0034]    The sorbent end  84  may be of any suitable type to remove debris or detritus from the inside of the cannula  38  and can be either adsorbent or absorbent materials. Materials, such as natural or polymer fibers, foam or the like are preferable. There is some tendency for fibers from the sorbent end  84  to be pulled loose when passed through the sealing elements  64  and/or the check valve  42 . Accordingly, some care in the manufacture of the sorbent end  84  from fibers is preferably done to minimize pulling fibers from the sorbent end. In some embodiments, one or more radiopaque threads  92  are incorporated into the sorbent end  84  so the location of the sorbent end  84  may be determined by x-ray or fluoroscope in the unlikely event it becomes detached from the handle and is inside the patient. 
         [0035]    Referring to  FIG. 7 , another embodiment of a swab  94  is illustrated. The swab  94  includes a handle  96  and sorbent end  98  having similar characteristics to the handle  82  and sorbent end  84  although the end  98  is illustrated as being foam rather than fiber. In the swab  94 , a tactile distance indicator  100  can be attached to the handle  96  in the operating room by one of the operating room personnel, such as a surgical technician, nurse or surgeon. To determine the location of the indicator  100 , the swab  94  is inserted into the cannula  38  until the sorbent end  98  begins to exit the end of the cannula  38  and the indicator  100  is attached to the handle  96 . To this end, the indicator  100  can be an adhesive backed tape  102  and, depending on the thickness of the tape, can be wound multiple times around the handle  96  to provide the desired thickness. 
         [0036]    By applying the indicator  100  at or near the time of surgery, one can significantly reduce the number of models of the swab of this invention in order to accommodate cannulas of significantly different length and diameter. For example, the sorbent end  98  can be made the same size to clean cannulas  38  having internal diameters between 5-15 millimeters and, by applying the indicator  100  in the operating room or near the time of surgery, only one size swab is needed. If the indicator  100  were permanently attached to the handle  96  at the time of manufacture, every model trocar would have to have a swab made specifically for it. 
         [0037]    It is estimated there are about 35,000 surgeons in the United States who routinely do remote viewing surgery of all types. It is estimated that these surgeons currently do an average of 100 remote viewing surgeries per year for a total of about 3,500,000. Although remote viewing surgery has been increasing in popularity, it would not be surprising to learn that  30 , 000 , 000  remote viewing surgeries have been conducted in the United States in the last ten years. 
         [0038]    It will accordingly be seen that the same cleaning operations conducted during laparoscopic procedures conducted in the abdomen of the patient may be conducted during thorascopic procedures conducted in the chest cavity of the patient. 
         [0039]    The method of cleaning a laparoscope or thorascope as described has not been previously known. It is the spirit and scope of this invention to provide a new method and apparatus for cleaning laparoscopic and/or thorascopic trocars. 
         [0040]    Although this invention has been disclosed and described in its preferred forms with a certain degree of particularity, it is understood that the present disclosure of the preferred forms is only by way of example and that numerous changes in the details of operation and in the combination and arrangement of parts may be resorted to without departing from the spirit and scope of the invention as hereinafter claimed.