Patent Publication Number: US-9883912-B2

Title: Suspension system for minimally invasive surgery

Description:
CROSS REFERENCE TO RELATED APPLICATION 
     The present application is a continuation of U.S. patent application Ser. No. 13/209,529, filed Aug. 15, 2011, and claims the benefit of and priority to U.S. Provisional Application Ser. No. 61/411,515, filed on Nov. 9, 2010, the entire contents of which are incorporated herein by reference. 
    
    
     TECHNICAL FIELD 
     This application generally relates to the field of minimally invasive surgery. More particularly, the present disclosure relates to a system for supporting a plurality of instruments for minimally invasive surgery. 
     RELATED ART 
     Laparoscopy is a minimally invasive surgical procedure performed in the abdominal cavity. It has become the treatment of choice for several routinely performed interventions. 
     However, known laparoscopy technologies are limited in scope and may be unduly complex due in part to 1) mobility restrictions resulting from using rigid tools inserted through access ports, and 2) limited visual feedback. That is, long rigid laparoscopic tools inserted through small incisions in the abdominal wall or other regions of laparoscopic surgery limit the surgeon&#39;s range of motion and therefore may increase the complexity of the surgical procedures being performed. Similarly, using a 2-D image from a typically rigid laparoscope inserted through a small incision limits the overall understanding of the surgical environment. Further, in many current surgical procedures, an additional port is required to accommodate a laparoscope (camera), and a port is required for each instrumentation insertion, requiring an additional incision which increases the risk of infection and lengthens patient recovery time. Single port laparoscopic surgery can have restricted instrument mobility. 
     There is a continuing need in the art for improved surgical methods, systems, and devices for laparoscopic and other minimally invasive surgery. 
     SUMMARY 
     The present disclosure pertains to a suspension system for supporting surgical instruments for use inside a body cavity in a minimally invasive surgical procedure, and particularly in a laparoscopic procedure. The suspension system comprises an external frame having a first support and a second support, a plurality of elongated members extending from the external frame and into the body cavity, and an internal platform located inside the body cavity. The internal platform includes a plurality of links reconfigurable from a first elongated position wherein the links are substantially aligned along a longitudinal axis for insertion to a second position wherein the links are angled with respect to one another to form a non-linear configuration. The first support is movable with respect to the second support to thereby move the internal platform. 
     In one embodiment, the first support includes an elongated arm pivotably attached to the second support for movement toward and away from the body cavity. In another embodiment, the first support includes an elongate arm rotatably attached to the second support for rotation about a longitudinal axis of the second support. 
     The external frame can include first attachment structure for connecting the elongated members at the proximal portion and the links can include second attachment structure to receive the distal portion of the elongated members. The links can having mounting structure for mounting a surgical device thereto and can be pivotally attached to one another. One of the links can have tool attachment structure for detachable connection to an insertion tool. 
     In one embodiment, the first support is pivotable from a position substantially horizontal to overlie the patient to a position substantially vertical with respect to the patient. 
     In another aspect, the present disclosure provides a suspension system for supporting surgical devices inside a patient&#39;s body cavity comprising an external frame having a first plurality of holes extending therethrough and attached to a support for movement toward and away from the body cavity, a plurality of rods extending from the frame sized to at least partially extend through one of the plurality of holes, and an internal platform including a series of interconnecting links having at least one hole sized to receive one of the rods therethrough. 
     The links can include an attachment structure located along the body thereof. The system may further comprise a pod having a complementary attachment structure to an attachment structure of the links. In some embodiments, the external frame is pivotably connected to the rigid support. 
     Preferably, the links are insertable into the body cavity in a generally elongated position and are reconfigured to an angular position within the body cavity. 
     The present disclosure also provides in another aspect a suspension system for supporting surgical devices inside a patient&#39;s body cavity comprising a substantially rigid external frame positioned outside the body and movably connected to a support for movement with respect to the body cavity, a plurality of elongated connectors extending from the external frame into the body cavity, and an internal support located inside the body cavity and attached to the elongated connectors. The elongated connectors are movable to apply a retraction force on a portion of the internal support to change the plane of the portion with respect to other portions of the support. 
     The internal support preferably includes a plurality of links reconfigurable from a first elongated position wherein the links are substantially aligned along a longitudinal axis for insertion to a second position wherein the links are angled with respect to one another to form a non-linear configuration for attachment to the elongated connectors. 
     Preferably, the internal support has instrument receiving structure to mount surgical instruments thereto. 
     In another aspect, the present disclosure provides a method for providing a platform for surgical instruments for performing minimally invasive surgery, the method comprising the steps of:
         providing an external frame;   inserting the elongated members into a body cavity of a patient;   connecting elongated members to the external frame;   inserting through a different site an internal platform configured in a substantially linear configuration;   reconfiguring the internal platform inside the body cavity to a non-linear configuration;   joining the elongated members and the platform inside the body cavity; and   moving the external frame to move the internal platform within the body cavity.       

     The step of reconfiguring the platform can include the step of pivoting a series of links with respect to one another. The method may further comprise the step of placing a pod within the body cavity and attaching the pod to one of either the internal platform and one of the elongated members. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings, which are incorporated in and form part of the specification, illustrate the present disclosure when viewed with reference to the description, wherein: 
         FIG. 1  is a perspective view of a suspension system in accordance with the principles of the present disclosure, illustrating an external frame structure, a plurality of rods, and an internal platform; 
         FIG. 2  is an exploded view of the external frame structure and the plurality of rods; 
         FIG. 3  is an exploded view of the internal platform and an insertion tool for the platform: 
         FIG. 4  is a side cross-sectional view of the suspension system of  FIG. 1  taken along section line  4 - 4  of  FIG. 1 ; 
         FIG. 5  is a perspective view of the internal platform in a fully extended (elongated) position for insertion to the body cavity; 
         FIG. 6  is a perspective view of the internal platform in a partially angled (pivoted) position; 
         FIG. 7  is a partially cut away view of the suspension system illustrating insertion of the internal platform inside a body cavity; and 
         FIG. 8  is a partially cut away view of the suspension system including a camera and an illumination source attached to the internal platform. 
         FIG. 8  A is a partially cut away view of an alternate embodiment of the suspension system illustrating pivoting of the external frame structure and showing insertion of the internal platform inside a body cavity; 
         FIG. 9  illustrates movement of the external frame structure to a vertical position; 
         FIG. 10  is a partially cut away view of an alternate embodiment of the suspension system illustrating a swivel attachment of the external frame to rotate the external frame away from the patient. 
         FIG. 11  is a partially cut away view of another alternate embodiment the suspension system including a camera and an illumination source attached to the internal platform and showing in phantom movement (exaggerated for clarity) of the connecting rods; and 
         FIG. 12  is a partially cut away view of the suspension system of  FIG. 11  including a camera and an illumination source attached to the internal platform and showing pivoting of the external frame. 
     
    
    
     Other features of the present disclosure will become apparent from the following detailed description, taken in conjunction with the accompanying drawings, which illustrate, by way of example, the principles of the present disclosure. 
     DETAILED DESCRIPTION OF THE EMBODIMENTS 
     Embodiments of the presently disclosed suspension system are described in detail with reference to the drawings, in which like reference numerals designate identical or corresponding elements in each of the several views. As used herein, the term “distal” refers to that portion of the suspension system, or component thereof, further from the user while the term “proximal” refers to that portion of that portion of the suspension system or component thereof, closer to the user. 
     Referring now to the drawings, wherein like reference numerals identify similar structural elements of the subject system, there is illustrated in  FIG. 1  a suspension system, designated generally by reference numeral  10  which forms a stable rigid platform for surgical devices. The suspension system also enables pivoting movement of the surgical devices in the manner described below. 
     The suspension system  10  includes an external frame structure  20 , a plurality of elongated members or rods  40 , and an internal platform  60 . As shown in  FIG. 7 , the external frame structure  20  has a clamp  23 , a vertical arm  21 , and a horizontal arm  22 . The clamp  23  is located at a lower end  24  of the vertical arm  21 . The clamp is preferably configured to mount to the rail R of the operating table. The arms  21 ,  22  can be monolithic/integral or separate attached components. The horizontal arm  22  extends from an upper end  25  of the vertical arm  21  to overlie the patient. 
     In alternate embodiments, instead of vertical and horizontal arms, the arms can be curved. Additionally, a single curved or angled arm could alternatively be provided. 
     The arm(s) can be attached to the rail of the operating table, mounted to the floor, or mounted to other structure. 
     It is also contemplated that the arms  21  and  22  (or other alternate arms) could be pivotally or hingedly joined to one another. It will be understood that throughout this specification such joints between various members could be joints with additional degrees of rotational or translational freedom such as ball joints, telescoping joints and the like. This would enable the external platform  27  of the external frame structure  20  to be positioned at various angles with respect to the patient. For example, the platform  27  could be positioned generally horizontal with respect to the patient as shown in  FIG. 7  as well as pivoted to acute angles or even pivoted to the side of the patient to a vertical position. Examples of systems with such movement are described below with reference to  FIGS. 8A-12 . Such adjustability would increase the versatility of the system. Locking mechanisms could also be provided to lock the arm in the desired angular position. 
     Referring back to  FIGS. 1, 2 and 7 , a plurality of threaded through holes  26  are formed in platform (mounting region  27 ) of horizontal arm  22  which is located at an opposite end from the vertical arm  21 . Note that platform  27  can be pivotally or hingedly attached to arm  22  or can be integral/monolithic with arm  22 . The platform  27  forms an external support. As shown, platform  27  is a substantially triangular region which supports the internal platform  60  in a substantially triangular configuration to support and maneuver surgical devices in the manner described below. Although shown as substantially triangular, other configurations are also contemplated, e.g. circular, oval, rectangular and other polygons. 
     Each of the plurality of threaded holes  26  of the region  27  are sized to provide passage of one of the rods (elongated members)  40  therethrough which secure the internal platform  60  ( FIG. 1 ). As shown, the holes  26  are spread apart and preferably positioned at the vertices of the triangular region  27 . Positioning in other areas is also contemplated as are a fewer or greater number of holes  26  to accommodate a different number of rods  40  if desired. 
     With reference to  FIG. 2 , each rod  40  includes a proximal portion  42 , a distal portion  41 , and a rod body  43  therebetween. Attached to the proximal portion  42  of the rod  40  is a knob  50  that mates with a restricted (reduced diameter) section  45  of the rod  40 . The knob  50  may have a gripping surface  51  that increases the surface area and creates a leverage point for rotational interaction. For clarity, only one of the three rods  40  is fully labeled. Rotation of the knob  50  threading!}′ (and removably) attaches the rod  40  to the internal platform  60  via engagement of threads  46  on the distal end of the rod  40  with the platform openings as described below. 
     A circumferential groove  44  is located in an intermediate region of the rod body  43 , i.e. distal of the knob  50  and proximal of the distal portion  41 . The groove  44  is sized to accept a retaining ring  30 . The combination of the knob  50  and the retaining ring  30  restricts axial movement of the rod body  43  within a central aperture  56  of screw  55 , while allowing rotational movement. Rod  43  is rotated to thread into the internal platform  60  in the manner described below. 
     Each screw  55  has external threads  57  that mate with one of the plurality of internally threaded holes  26  in the external platform region  27  of frame structure  20 . The screw  55  preferably includes knurls  58  to provide rotational interaction for threading the screw  55  into the holes  26 . Screw  55  can be used to advance or retract the rod  40  which moves the internal platform  60  as described in detail below. That is, rotation of screw  55  in a first direction, presses knob  50  in an upward direction to lift the associated (connected) region of the internal platform  60 . Rotation of screw  55  in an opposite direction presses retaining ring  30  in a downward direction to return the associated (connected) region of the internal platform  60  to its original position. Thus, the range of movement in this embodiment is defined as a distance between these components which in one embodiment can be about 0.5 inches, although other distances are also contemplated. This adjustment allows a microadjustment of the platform position by warping any or all of the rods  40 . 
     Now referring to  FIGS. 3, 5, and 6 , the internal platform  60  includes a series of interconnecting links  61  having a first mating end  62 , a second mating end  63 , and a link body  64  therebetween. These links form a rigid support inside the patient&#39;s body cavity. In the illustrated embodiment, three links  61  are provided to form a substantially triangular region. However, a different number of links can be provided and the links can be arranged in different shapes, e.g. circular, oval, rectangular or other shapes including other polygonal shapes. Each end  62  of link  61  is connectable with the end  63  of another of the series of links  61 . Each of the series of interconnecting links  61  has a pair of holes  65 . One of the pair of holes  65  is located at each end of the link  61 , e.g. in the end  63  and end  62 . Each of the pair of holes  65  provides passage of the threaded section  46  of the rod  40  therethrough to enable the rod  40  to be removably attached to the platform  60  and enable the rod  40  to be rotated to change the plane of the associated link  61  and thereby change the plane of the internal platform  60 . 
     The internal platform  60  includes two different sized bushings: a longer bushing  67  and a shorter bushing  68 . The longer bushing  67  connects the ends  62  and  63  of at least two links  61  together by an interference fit to form the series of links  61  in a non-linear configuration, such as the illustrated substantially triangular configuration. The shorter bushing  68  extends only through the initial hole  65  in the series of links  61 . Each of the bushings  67  and  68  may have a complementary thread to that of the threaded section  46  of the rod  40  that allows the rod  40  to be secured to the internal platform by rotation of the knob  50 . Alternatively, it is also contemplated that the bushings  67  and  68  be unthreaded and that a separate nut (not shown) is used to secure the platform  60  to the rod  40 . Further contemplated are the use of snap together links (not shown). 
     Each of the links  61  can include a slot  66  located along the link body  64  thereof, and extending longitudinally along the link  61 , which can accommodate a pull cable for pivoting the links. 
     The suspension system  10  includes a pod  110  ( FIG. 8 ) with a complementary attachment structure  115  that provides attachment to the links  61 . The attachment structure can include a threaded structure, a snap on feature, one or more magnets, or other structure. The pod  110  may include a surgical instrument that is a visualization device such as a camera  111  or an illumination source  112 . Other surgical instruments that are contemplated include, but are not limited to, a grasper, a retractor, and a sensor. 
     Now referring to  FIG. 4 , at least one of the rods  40  may contain an electrical conduit  101  that may be connected with a second electrical conduit  102  located in at least one of the links  61 . Each of the conduits  101 ,  102  has an electrical connector  103  on each end of the conduit. The connectors  103  may be either internal to the components  40 ,  61 , or the connectors may be located external to the components  40 ,  61 . The electrical conduits  101 ,  102 , in combination with the electrical connector  103 , provide communication between a remote control unit (not shown) and instruments coupled to the internal platform  60 . Specifically, these electrical connections may provide one or more of the following: (a) electrical power; (b) control signals; and (c) optical information (e.g. light and/or video signals). 
     Other arrangements of the electrical connectors are also contemplated. For example, the connectors can be coaxially positioned in a single rod, they can be positioned in separate rods, or can be positioned parallel within a non-conductive rod. 
     At least one of the links  61  preferably has a tool receiving section  70  (FIGS,  5  and  6 ) for placing the internal platform  60  within the body cavity. The insertion tool receiving section  70  may have cither internal or external threads  71  that mate with the end of a tool or driver  200  for placement of the internal platform  60  through a cannula  105 , as shown in  FIG. 7 . Alternatively, other disengagable retention structure for tool  70  and link  61  can be provided such as a bayonet lock. 
     For delivery, the links  61  are in an elongated position, substantially aligned with the longitudinal axis passing through the series of links. In this substantially linear position, they can be delivered through a trocar or access port inside the body cavity (see e.g. cannula  105  of  FIG. 7 ). Once delivered, the links  61  are manipulated to a second position, wherein the links  61  are pivoted to an angular or non-linear position, and preferably form a substantially triangular configuration. This region preferably corresponds to the region  27  of arm  22  of external frame structure  20 . In this manner, the openings  65  in the links  61  are substantially aligned with holes  26  of platform region  27  for reception of elongated rods  40 . 
     The links  61  can be pivoted by the delivery tool  200  in a hinge like manner to form the triangular shape (or other shapes). Alternatively, a pull wire (not shown) can be provided within a slot  66  in the links which is tensioned to pivot the links to their angled mounting position. In another variation, the links are spring loaded to a substantially triangular or other non-linear position and a wire extending through the links maintains the links in an elongated position. As the wire is retracted from the links, the links return to their spring biased position. 
     The elongated rods  40  are attached to the internal platform region  27  of the external frame  20  as described above. Consequently, at least the distal portions of the rods  40  extend within the body cavity. As shown, the rods  40  extend substantially parallel to one another as they extend into the body cavity, although the internal platform  60  could alternatively enable mounting of the instruments in angled positions. 
     With the rods  40  extending into the body cavity, when the links  61  are delivered, the opening in the distalmost link  61  is mated with the distal threaded portion  46  of a rod  40 . The insertion tool  200  is then manipulated to pivot the intermediate link  61   b  with respect to the distalmost link  61  and then attached to a second rod  40 . The proximal link  61  is then pivoted with respect to the intermediate link, for attachment to the third elongated rod  40 , thus forming the aforedescribed substantially triangular shape. The insertion tool  200  can then be withdrawn through the cannula  105 , leaving the cannula  105  free for insertion of other instruments. A laparoscopic imaging device, e.g. a camera, wired or cordless, can then be inserted for example through cannula  105  and attached to the internal platform  60  as described above. An illumination device can also be inserted through the cannula  105  and attached to the internal platform  60 . This is shown in  FIG. 8 . A third device can be inserted through cannula  105  and attached to the internal frame as well. Note that instruments other than or in addition to the camera and illuminator can be inserted and attached to the internal frame  60 . In embodiments with additional attachment structure, more devices can be inserted and attached. 
     Once mounted, the instruments can be maneuvered by manipulation of the rods  40 . More specifically, rotation of the screw  55  in a first direction will cause retraction of the rod  40  which in turn will cause retraction of the link  61  to which it is attached. As the links are connected in a substantially triangular region, such retraction causes the respective vertex of the internal platform  60  to retract as the other vertices remain stationary, thereby lifting a portion of the internal platform  60  out of the plane. As can be appreciated, any one of the vertices can be moved with respect to the other two, as well as two of the vertices can be moved with respect to the other vertices, thus providing a conical shaped range of movement. In this manner, maneuverability of the instruments is achieved while maintaining a stable and substantially rigid suspension system as the internal platform  60  is connected to the external platform  27  which is mounted to the operating table (or the floor). 
     In embodiments wherein the external platform  27  is movably, e.g. pivotably, mounted to an external supporting frame, the screws  55  can be used for fine adjustment of internal platform  60  and the pivotal movement of the external platform  27  used for coarse adjustment as the pivotal movement will move the respective rod(s)  40  which in turn will move the internal platform  60 . Such pivotable mounting is illustrated in  FIGS. 8A-12 . 
       FIGS. 8A-12  illustrate embodiments of the suspension system providing for pivotable or rotatable movement of the external frame, or portion thereof. Turning first to  FIG. 8A , the suspension system  110  is identical to the suspension system  10  of  FIG. 1  except for the attachment of the platform. More specifically, the suspension system  210 , like suspension system  10 , includes an external frame structure  220 , a plurality of elongated members or rods  240  with knobs  250  and screws  255 , and an internal platform  260 . The internal platform  260  includes a series of interconnecting links  261  identical to links  60  of the embodiment of  FIG. 1 . For brevity, details of the structure and function of these components of  FIG. 8A  will not be repeated herein as they are identical to that described above in the embodiment of  FIGS. 1-8 . Only the differences between the embodiment of  FIG. 8A  and  FIG. 1  will be discussed. The difference is in the attachment of horizontal arm  222  to vertical arm  221 . 
     More specifically, horizontal arm  222  is pivotably attached to vertical arm  221  at hinge  223 . This enables the horizontal arm  222  to pivot in the direction of the arrow of  FIG. 8A  which in turn moves the external platform  227 . One such pivoted position is illustrated in phantom in  FIG. 8A , it being understood that preferably various angled positions can be achieved. Further, as previously discussed, the hinge may be a ball and socket joint allowing additional angular adjustments. Preferably the hinged structure maintains the external platform  227  in the selected angled position. However, mechanisms to lock the external platform  227  in a selected position are also contemplated. Movement of the external platform  227  moves the connected rods  240  which in turn move the connected internal platform (links  260 ) to change the angle of the instrumentation attached to the internal platform. 
     The foregoing structure can also be provided such that the horizontal arm  222  can be pivoted from a horizontal position overlying the patient&#39;s incision to a vertical position, substantially aligned with a longitudinal axis of the vertical arm  221  as shown in  FIG. 9 . This can move the system away from the patient and out of the way of the surgeon until positioning over the patient is desired. 
     In another alternate embodiment illustrated in  FIG. 10 , suspension system  310  is identical to suspension system  10  of  FIG. 1  except for the pivoting attachment of horizontal arm  322  to vertical arm  321 . Thus, the suspension system  310 , like suspension system  10 , includes an external frame structure  320 , a plurality of elongated members or rods  340  with knob  350  and screw  355 , and an internal platform  360 . The internal platform includes a series of interconnecting links  361  identical to links  60  of the embodiment of  FIG. 1 . For brevity, details of the structure and function of these components will not be repeated herein as they are identical to that described above in the embodiments of  FIGS. 1-8 . Only the differences between the embodiment of  FIG. 10  and  FIG. 1  will be discussed. The difference is in the attachment of horizontal arm  322  to vertical arm  321 . 
     Pivot fastener  329  enables the horizontal arm  322  to be rotated (swiveled) in the direction of the arrow to pivot about a longitudinal axis of the vertical arm  321 . Such pivotal movement of the external platform  327  moves the internal platform  360 , thereby changing the lateral position of the instruments attached to the internal platform  327 . As shown in  FIG. 10 , the horizontal arm  322  can be pivoted (swiveled) a sufficient amount to move the suspension system  210  out of the way of the surgeon. Rotation of 360 degrees or less is contemplated. The pivot can be configured so the horizontal arm  322  remains in the selected position. The pivot can also be configured so that the arm  322  can also move up and away from patient and down toward the patient. 
     The alternate embodiment of  FIGS. 11 and 12  are identical to  FIG. 1  except that the hinge  423  for enabling pivoting of the external platform  427  is at the end of the horizontal arm  422 . Otherwise, the suspension system  410  is identical to suspension system  10  and includes an external frame structure  420  with external platform  427 , a plurality of elongated members or rods  440  with knobs  450  and screws  455 , and an internal platform  460 . The internal platform  460  includes a series of interconnecting links  461  identical to links  60  of the embodiment of  FIG. 1 . For brevity, details of the structure and function of these components will not be repeated herein as they are identical to that described above in the embodiments of  FIGS. 1-8 . Only the differences between the embodiment of  FIG. 11  and  FIG. 1  will be discussed. The difference is in the attachment of external platform  427  to horizontal arm.  FIG. 11  illustrates in phantom a pivoted position of the elongated rods  440  (as a result of pivoting external platform  427 ) which in turn would pivot the internal platform  460  to change the position of the instruments extending therefrom. 
     The systems described herein also provide reference points to measure the position and orientation of the instrument. For example, measurement lines can be provided on the screw  55  to measure the lift or angle of the internal platform. A transducer at the screw  55  can also be used for measurement. 
     The present disclosure also relates to a method for providing a stable platform for surgical instruments for performing minimally invasive surgery, e.g. laparoscopic surgery. In the method, which by way of example describes the system of  FIG. 1 , it being understood that the other systems would be used in a similar manner, elongated members or rods  40  are connected to the external frame  20  and are inserted into a body cavity of a patient. The internal platform  60  is inserted through a different port site in a substantially straight position. The internal platform is then reconfigured inside the body cavity to a non-linear configuration and the elongated members (segments) arc joined to the platform inside the body cavity. 
     It is also contemplated that instead of having the elongated members linked together outside the body, they can be inserted one at a time through a port site and connected to each other in situ to form the desired internal platform shape. 
     The suspension system  10  may be provided in either kit form or as individual pieces. 
     After the selected instruments are coupled to the internal platform  60 , the physician performs the desired surgical procedure in the working space. Once the surgical procedure is completed, the physician removes the surgical instruments and the platform  60  by reversing the above-described installation technique. Note that the surgeon can pivot the external platform to change the position of the internal platform which in turn alters the angle of the surgical instrumentation if the systems of  FIGS. 8A-12  are utilized. 
     It will be understood that various modifications may be made to the embodiments disclosed herein. For example, the size, angles, curves, and/or attachment means of the component(s) surface(s) may be modified to better suit a particular surgical procedure. Therefore, the above description should not be construed as limiting, but merely as exemplifications of various embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.