Abstract:
A trocar sleeve that isolates the surgical device or movement thereof to inhibit or prevent an established non-jet streaming condition from becoming a jet streaming condition and a method of inhibiting or preventing a jet streaming condition from occurring due to instrument obstruction.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a continuation of U.S. Patent application Ser. No. 12/658,086 filed Feb. 2, 2010, which is a continuation of U.S. Patent application Ser. No. 11/058,435 filed Feb. 15, 2005 now U.S. Pat. No. 7,722,558. 
     
    
     FIELD OF THE INVENTION 
       [0002]    This invention relates to the field of medical devices, and more specifically to a trocar sleeve for delivery of an insufflation fluid in a non jet-streaming condition regardless of whether instruments are present in the trocar sleeve. 
       STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
       [0003]    None 
       REFERENCE TO A MICROFICHE APPENDIX 
       [0004]    None 
       BACKGROUND OF THE INVENTION 
       [0005]    A physician can use a trocar device to deliver fluid into a body cavity during specific medical procedures or treatments. The purpose of using such a device is to inflate or distend the body cavity to allow the surgeon (1) exploration of the area in which the surgery will be performed and (2) to provide a view of the site to be treated or observed. Insufflation is used in many common procedures including endoscopic surgical procedures, laparoscopic procedures performed on the abdominal cavity and thoracoscopic procedures performed on the chest cavity. 
         [0006]    At the beginning of the procedure, the surgeon cuts an incision to traverse the skin and tissue layers until the body cavity is opened. A Verres need is inserted to start insufflation. A Verres needle may be used, however a trocar can be placed directly without use of a needle to enter the body cavity. An external, pressurized fluid source is connected to the needle. The fluid flows from the proximal end of the needle to a distal end thereof from which the fluid exits and is delivered into the body cavity. This causes the tissue layers to distend, a process known as insufflation. Carbon dioxide gas is commonly used for insufflation and other substances, which may include drugs and anesthetics may be mixed with the carbon dioxide gas and administered simultaneously. 
         [0007]    After satisfactory insufflation, the needle is removed and a trocar sleeve may be inserted through the incision and into the body cavity. Trocar sleeves are sized and shaped to pass through the incision and tissue layers of a body so that the sleeve penetrates at least partially into the body cavity. Cameras and/or surgical devices may be inserted into the sleeve to provide the surgeon with a view of the surgical site or to allow the surgeon to treat the area. 
         [0008]    My U.S. Pat. No. 6,733,479 discloses, a trocar sleeve with a plurality of apertures that address the problem of the “jet streaming effect” and is hereby incorporated by reference. The “jet streaming effect” is known to damage tissues and/or organs of the body because as the fluid contacts those surfaces, the lining of the body cavity and the surfaces of the organs housed therein undergo severe heat loss. The effect is more fully described in U.S. Pat. No. 6,733,479 and references cited therein. To eliminate or reduce the “jet streaming effect” my prior patent discloses a series of apertures located along the trocar sleeve to effectively distribute the gases at velocities, which are below the threshold of the “jet streaming effect”. While the perforated trocar greatly reduces or eliminates the “jet streaming effect” there can be transient conditions when an instrument can periodically obstruct the trocar sleeve and therefore temporarily affect the fluid flow through the trocar sleeve and possibly cause localized regions on the trocar sleeve where the “jet streaming conditions” could occur. For example, a manipulation of an instrument such as surgical device within the trocar sleeve or the insertion of an irregular shaped instrument might block off a substantial portion of the trocar sleeve thereby increasing velocity at other regions of the trocar sleeve until the jet streaming velocity is exceeded. Since this condition is most likely to occur in a localized area and might be only a temporary condition the user might not even know that a “jet streaming condition” is occurring at some of the apertures in the trocar sleeve. 
         [0009]    The present invention provides a solution to the problem of transient conditions that can produce localized “jet streaming conditions” by providing a trocar sleeve that does not produce a “jet streaming condition” even though different size and shape instruments are inserted into the trocar sleeve. Furthermore, the instruments can be manipulated in the trocar sleeve without fear of inducing a localized “jet streaming condition”. A further embodiment of the invention eliminates the “jet streaming condition” through eliminating of instruments in the trocar sleeve that is used to deliver fluids to a body cavity. 
         [0010]    The present invention is a trocar sleeve for insufflating the body cavity without damaging a tissue in the body cavity due to transient flow conditions. More specifically, the invention includes a trocar having a fluid flow chamber that delivers an insufflating fluid at a velocity below a jet streaming velocity whether or not an instrument such as a camera or a surgical device is in the lumen in the trocar sleeve. In one embodiment a double walled trocar sleeve is used to inhibit or prevent the “jet streaming condition” and in another embodiment a blind trocar sleeve is used to inhibit or prevent the “jet streaming condition”. In both embodiments, the invention provides a fluid flow condition that is not affected by instruments. 
       BRIEF SUMMARY OF THE INVENTION 
       [0011]    Briefly, one embodiment of the invention comprises a trocar sleeve having an inner wall that isolates an instrument in the trocar sleeve from the insufflation fluid and in another embodiment a blind trocar sleeve is used for insufflations purposes while a conventional trocar sleeve is used for the surgical procedures but not for introducing the insufflating fluid. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0012]      FIG. 1  is a side view of the trocar sleeve; 
           [0013]      FIG. 2  is a cross-sectional view of the trocar sleeve taken along lines  2 - 2  of  FIG. 1  illustrating the flow of fluid; 
           [0014]      FIG. 3  is side view of the alternate embodiment blind trocar sleeve; and 
           [0015]      FIG. 3A  is a cut away and enlarged view of a portion of the alternative embodiment the blind trocar sleeve of  FIG. 3 . 
       
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENT 
       [0016]    Referring to  FIG. 1  and to  FIG. 2  the present invention provides a trocar sleeve  10  for insufflating a body cavity while minimizing or eliminating damage to a tissue in the body cavity that can occur proximate the cylindrical member  11  of trocar sleeve  10 . Typically, the trocar sleeve is inserted into the body cavity  13  of an animal or human by creating an opening within the body that extends through many layers of tissue  20 , which include skin, fat, muscle, and pre-pleural or pre-peritoneal in either the thoracic or abdominal cavities, respectively. 
         [0017]      FIG. 1  shows trocar  10  that addresses the problem of transient “jet streaming conditions” that can occur because of partial obstructions within the lumen caused by the insertion of an instruments such as a surgical device through the trocar sleeve  10 . Such obstructions, which reduce the diameter of the lumen, can result in high-pressure fluid delivery to the body cavity at localized region proximate the trocar sleeve  10  and thus cause damage to the tissues and/or organs of the body. 
         [0018]      FIG. 1  shows trocar sleeve sleeve  10  in a partial cut away view. The trocar sleeve includes a housing  16 . Attached to the housing is an inlet port  15 . A cylindrical member or tube  11  is attached to the housing and is formed about a central longitudinal axis A x  of the trocar sleeve. The cylindrical member  11  has a proximal end  12  and spaced distally therein is a distal end  14 . A spaced plurality of apertures  19  is defined within the exterior of the body surface of the cylindrical member  11 . The plurality of apertures  19  are regularly spaced from one another and extend at least partially from the distal end  14  toward the proximal end  12  of the trocar sleeve. The plurality of apertures  19  can extend the entire length of the trocar sleeve if so desired, or for any desired length along the trocar sleeve. It is anticipated that although the respective apertures may extend along the entire length of the trocar sleeve if so desired, the apertures will preferably be spaced from the proximal ends. 
         [0019]    Within the cylindrical member  11  and attached to the housing  16  is a cylindrical member or tube  22  having a sidewall  22   a  which is impervious or substantially impervious to fluid flow therethrough. 
         [0020]      FIG. 2  shows a cross section view revealing the outer elongated tube or cylindrical member  11  having the apertures  19  therein. Located concentrically within cylindrical member  11  is a further elongated tube or cylindrical member  22  having the sidewall  22   a  impervious to fluid flow with sidewall  22   a  spaced from inner sidewall  11   a  of tube  11  to form an annular chamber  30  for fluid to flow therethrough. Positioned within lumen  31  of cylindrical member  22  is the instrument comprising trocar  21 , which is shown occupying a central portion of the lumen  31 . In use, the trocar  21  might occupy more or less of the lumen  31 . The lumen  31  is used for manipulating the instruments and is isolated from the annular chamber  30 . That is, the lumen  31  is not used to deliver the insufflation gas to the patient any consequently manipulation of the surgical device  21  within the lumen  31  does not have any effect on the flow through the annular chamber  30  and hence through the radial apertures  19 . Thus, once a “non jet streaming condition” is established at apertures  19  any changes in the position of the instrument or the type of instrument in the lumen  31  will not have any effect on the velocity of the fluids escaping from the apertures since the flow through the apertures is isolated from the instruments located in the lumen  31  of the trocar sleeve  10 . Thus, the present invention is well suited for those applications where the instruments inserted through the trocar sleeve are of different size or shape since the size, shape or the position of the instrument does not effect the flow through the trocar sleeve  11 . In addition, any repositioning of the instruments in the lumen  31  will not have any effect on flow conditions through the trocar sleeve since the fluid flow is independent of conditions in lumen  31 . 
         [0021]      FIG. 2  illustrates the radial fluid flow through trocar sleeve  10 . An insufflating fluid, “F”, which may be gas, liquid containing drugs, anesthetic or other substances placed or mixed within a pharmaceutically acceptable carrier or any combination thereof. The fluid “F” is delivered under pressure from an external source via inlet port  15 , travels through the annular fluid flow chamber  30  and is discharged at below a “jet streaming velocity” through the plurality of apertures  19  as indicated by the arrows. Thus regardless of whether an instrument is present in lumen  31  or whether an instrument is manipulated in lumen  31  it will not have an effect on the fluid conditions through the apertures or fluid ports  19 . 
         [0022]      FIG. 3  illustrate an alternate embodiment  40  of the invention wherein a “non-jet streaming condition” can also be maintained. Specifically, the embodiment  40  includes a housing  46  and attached to the housing is an inlet port  45  and a tube or cylindrical member  41  having a proximal end  42  and spaced therefrom a distal end  44 . Along the exterior surface of the cylindrical member  41  is a plurality of fluid ports or apertures  49 . As can be seen in  FIG. 3  the arrows indicate an insufflation fluid is directed radially outward from the apertures  49  and is maintained at a non jet streaming velocity by control pressure conditions within cylindrical member  41 . Thus by having member  41  having a chamber  47  therein with  41  apertures sufficiently small to preclude insertions of instruments therethrough one ensures that instruments will not be inserted into trocar sleeve  40  and adversely affect the established non jet streaming conditions. 
         [0023]      FIG. 3A  is a partial cut away view of the cylindrical member  41  revealing an end member  48  blocking the end of cylindrical member  41  to provide a closed end of trocar sleeve  40  to prevent extension of an instrument or other device into plenum chamber  47 . This allows one to establish fluid flow conditions in plenum chamber  47  that produce fluid velocities through apertures  49  that are below a “jet streaming velocity” and will remain at below a “jet streaming velocity” since no instruments or other devices are inserted into the plenum chamber  47  to affect the velocity of the fluid discharged through apertures  49 . 
         [0024]      FIG. 3  and  FIG. 3A  show insufflating fluid flow delivered from within the blind trocar sleeve  40 . In operation fluid flows from an external source under pressure through the inlet port  45 , is carried through the cylindrical member  41  and flows into plenum chamber  47  and through the plurality of apertures  49  into the body cavity  43 . In the embodiment of  FIGS. 3 and 3A  because the trocar sleeve is blind no instrument can be inserted therethrough. Since no instrument can be inserted therein one need not be concerned with the size, shape or type of instrument as well as the position of the instrument affecting the fluid flow conditions proximate the cylindrical member  41 . Thus once the “non-jet streaming condition” is established in trocar sleeve  40  one can be assured that the non-jet streaming condition can be maintained proximate the trocar sleeve  40 . However, if a surgical instrument needs to be inserted into the body cavity it can be inserted into a companion or separate trocar sleeve that does not contain the insufflation gas. The end  48  may or may not have apertures  49  to allow fluid flow as well as from the side wall. 
         [0025]    Thus, the invention includes the method of insufflating a body cavity without damaging a tissue in the body cavity that can occur during transient conditions within the trocar sleeve by directing a fluid flow from a first chamber in a trocar sleeve through apertures in the trocar sleeve at a velocity less than a jet streaming velocity while inserting or manipulating an instrument in a further chamber that is isolated from the first chamber to prevent the instrument therein from affecting the flow of fluid from the first chamber to thereby maintain the velocity of the fluid at less than the jet streaming velocity.