Patent Publication Number: US-10314612-B2

Title: Surgical tool introducer

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a divisional patent application of U.S. patent application Ser. No. 14/188,095, filed on Apr. 24, 2014, which claims priority to U.S. Provisional Patent Application No. 61/768,846, filed Feb. 25, 2013, the disclosures of which are incorporated by reference in their entirety. 
    
    
     FIELD OF THE INVENTION 
     The present invention generally relates to systems and methods for surgeries preparations, and more specifically to methods and devices for assembling laparoscopic surgical instrumentation in a patient&#39;s body cavity. 
     BACKGROUND OF THE INVENTION 
     In laparoscopic surgery, several relatively small ports are made in the abdomen for allowing introduction of different types of instrumentation and accessories into the abdominal cavity for different surgical interventions (usually performed under endoscopic vision). Although usually considered superior in several aspects to open surgery, the use of a plurality of 5 to 15 mm ports still leads to local pain, scars, and possibly port related complications such as hernia in scars and the need for one or two assistants in addition to the surgeon. A known concept which aims at relieving some of such disadvantages includes the use of a single port for introducing regular sized surgical heads which are interchangeably connectable to manipulators extendable into the abdominal cavity via small sized entry points, usually 3 mm or less. The manipulators usually includes an elongated slender shaft being 3 mm or less in diameter, emerging from a robotic or handheld actuator part provided outside patient body, and they are introduced into the abdominal cavity either percutaneous (if having sharp distal end, for example) or through a minimal invasive laparoscopic port. Prior publications describing relevant techniques and instrumentation include: U.S. Pat. Nos. 5,352,219, 5,441,059, 5,593,402, 6,723,043, 7,666,181 and 8,133,254. 
     Nevertheless, assembling any two parts projecting from remote entry points in a body cavity still possesses certain challenges that should be answered in further improvement of currently proposed means and methods. One challenge is to safely engage and then assemble these two parts, even under laparoscopic vision, without possibly harming nearby tissues and organs and of course without dropping any of these parts before or during engagement and/or assembly in the body cavity. Second challenge is to locate, engage and assemble the two parts easily and rapidly so that no significant burden will be added to surgeon&#39;s work. 
     SUMMARY OF THE INVENTION 
     The present invention generally relates to systems and methods for surgeries preparations, and more specifically to methods and devices for assembling and/or disassembling laparoscopic surgical instrumentation in a patient&#39;s body cavity. 
     In an aspect of some embodiments, there is provided a tool introducer which comprises or is configured for introduction in an elongated body comprising a tubular body, for example a straight tube. In some embodiments, the tube encloses a tube lumen opened at its distal end with a tube opening. Optionally, the tube is sized and shaped for introducing in a body cavity via a laparoscopic port. In some embodiments, the tube is extendable through and from the laparoscopic port by at least 5 cm, optionally by at least 10 cm, optionally by at least 15 cm, optionally by at least 20 cm, or higher, or lower, or by any intermediate value. 
     Optionally, the elongated body includes an enlarged portion sized and/or shaped for barricading by the laparoscopic port. In some embodiments, a seal member is provided in or proximal to the lumen for sealing gas flow therefrom from a distal environment (such as the body cavity) to a proximal environment (such as an outer environment to the body cavity). 
     In some embodiments, the tool introducer includes locking means configured to selectively lock or unlock an interchangeable surgical tool to the tube from displacing axially and/or rotationally in the tube lumen. Optionally, the locking means are configured such that, at locking, a tool connector of the tool projects towards the tube opening and distanced therefrom by at least 3 cm, optionally by at least 5 cm, optionally by at least 10 cm, optionally by at least 20 cm, or higher, or lower, or any intermediate value. Optionally, the locking means are selectively introducible in the lumen, optionally as part of a plug member, and fixedly connectable to the tube. The locking means may include at least two opposing teeth selectively movable from an inward position when at locking to an outward position when at unlocking. Optionally, the locking means are normally locking. Optionally, the locking means are manually operational with a button provided at or adjacent the enlarged portion. 
     In some embodiments, the tool introducer includes visualization means or allows introduction of such via the lumen. Optionally and additionally, the tool introducer includes lighting means or allows introduction of such via the lumen. 
     In some embodiments, the tool is connectable with the tool connector to a fitting portion of a tool manipulator. Optionally, the fitting portion is located at a distal end of an elongated shaft. In some embodiments, the elongated shaft has a maximal diameter equal or smaller than 3 mm, optionally equal or smaller than 2 mm. In some embodiments, the tool manipulator and/or elongated shaft are introducible into the body cavity via an entry point remote to tool introducer entry. Optionally, the entry point is maintained by a second laparoscopic port or is made by percutaneous progression of the elongated shaft through a body cavity wall enclosing the body cavity. 
     In an aspect of some embodiments, there is provided a method, comprising at least one of the following steps (not necessarily in same order): 
     positioning a surgical tool introducer such that a distal portion thereof projects in a body cavity. Optionally, the tool introducer comprises or is being introduced into a straight tube, such as an engager or trocar, enclosing a tube lumen opened at its distal end with a tube opening. Optionally, the tool introducer includes locking means provided in the tube lumen to selectively lock or unlock an interchangeable surgical tool to the tube from displacing axially and/or rotationally. Optionally, the tool includes a tool connector projecting towards the tube opening and distanced therefrom by at least 3 cm. Optionally, the tool introducer positioning includes telescopic introduction through a laparoscopic port; 
     penetrating, either percutaneously, or through a trocar, with an elongated shaft of a tool manipulator in the body cavity via an entry point remote to the tool introducer. In some embodiments, the elongated shaft includes a fitting portion connectable with the tool connector of the tool. Optionally, the elongated shaft is sized and shaped to advance in the tube lumen at least until an adjoining of the fitting portion and the tool connector is applicable; 
     manipulating and/or extending the tool introducer to reach and engage the elongated shaft; 
     inserting the elongated shaft in the tube lumen via the tube opening; 
     advancing the elongated shaft in the tube lumen so that the elongated shaft and tool substantially aligns. Optionally, the fitting portion is also positioned in direct contact with the tool connector. In some embodiments, the advancing is preceded by positioning an interchangeable surgical tool in the tube lumen such that the tool connector projects towards the tube opening and distanced therefrom by at least 3 cm; 
     connecting the tool to the elongated shaft, optionally by adjoining the tool connector and the fitting portion; and 
     withdrawing the elongated shaft from the tube lumen, optionally following unlocking the tool. 
     In some embodiments, the step of manipulating and/or the step of extending is preceded by at least one of introducing visualization means in the tube lumen and applying the visualization means to locate the elongated shaft in the body cavity. In some embodiments, the visualization means are removed before performing the positioning. 
     Optionally, at least one of the manipulating, extending and inserting is visually monitored. 
     In some embodiments, the method also includes removing of the tool. Optionally the tool removal includes at least one of the following steps: 
     re-inserting the elongated shaft in the tube lumen via the tube opening; 
     re-advancing the elongated shaft with the tool in the tube lumen so that the elongated shaft and tool substantially aligns and optionally becomes in contact with the locking means; 
     disconnecting the tool from the elongated shaft by dispatching the tool connector and the fitting portion. Optionally, disconnecting is preceded by shifting the locking means to unlocking mode. Optionally, the unlocking is followed by returning the locking means to locked mode and locking the tool to the tube; and 
     withdrawing the elongated shaft from the tube lumen. 
     In an aspect of some embodiments, there is provided a system which includes an elongated tube, comprising a tube proximal opening, a tube distal opening, a tube lumen extending between the tube proximal opening and the tube distal opening. In some embodiments, the elongated tube has a proximal segment and distal segment, and optionally the proximal segment has a larger outer diameter than the distal segment. Optionally, a seal provided in the the lumen, optionally a zero seal and/or an instruments seal. In some embodiments, the system also includes a tool holder which includes locking means to selectively lock or unlock an interchangeable surgical tool from displacing axially and/or rotationally in the tube lumen. In some embodiments, the elongated tube is telescopically introducible at a port proximal end, through a port lumen and bypassing a seal mechanism of a laparoscopic port interconnecting a body cavity and an outer environment. In some embodiments, the tool holder is adapted to be inserted through the tube proximal opening to be deployed in the tube lumen and thereby projecting a tool connector of the tool towards the tube distal opening and in a distance of at least 3 cm therefrom. 
     In some embodiments, the tool holder comprises a holder distal opening, a sealed proximal end and a holder lumen extending at least partially therebetween. 
     In some embodiments, the holder lumen is adapted to receive an end portion of a needle system when the needle entering the tube distal opening via the port distal opening. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Some embodiments of the invention are herein described, by way of example only, with reference to the accompanying drawings. With specific reference now to the drawings in detail, it is stressed that the particulars shown are by way of example and for purposes of illustrative discussion of embodiments of the invention. In this regard, the description taken with the drawings makes apparent to those skilled in the art how embodiments of the invention may be practiced. 
       In the drawings: 
         FIG. 1  schematically illustrates a cut view representing a tool introducer, in accordance with an exemplary embodiment of the present invention; 
         FIGS. 2A-D  schematically illustrate cut views representing different stages of deploying a laparoscopic surgical tool, in accordance with an exemplary embodiment of the present invention; 
         FIGS. 3A-B  schematically illustrate cut views representing use of an exemplary tool introducer for aligning between a surgical head and a manipulator distal end in a safe environment, in accordance with an exemplary embodiment of the present invention; 
         FIGS. 4A-B  schematically illustrate cut views representing two exemplary tool introducers with different visualization means, in accordance with an exemplary embodiment of the present invention; 
         FIG. 5  schematically illustrates a cut view representing an exemplary system for introducing a surgical tool in a body cavity via a laparoscopic port and for engaging with, aligning and assemble the surgical tool to a tool manipulator in the body cavity, in accordance with an exemplary embodiment of the present invention; 
         FIG. 6  schematically illustrates a cut view representing an exemplary tool holder member of the exemplary system represented in  FIG. 5 , in accordance with an exemplary embodiment of the present invention; 
         FIGS. 7A-K  schematically illustrate cut views representing different stages of deploying a laparoscopic surgical tool using the exemplary system represented in  FIG. 5 , in accordance with an exemplary embodiment of the present invention; 
         FIG. 8  schematically illustrates a cut view representing a tool introducer introducible in a laparoscopic port, in accordance with an exemplary embodiment of the present invention; and 
         FIG. 9  schematically illustrates a cut view representing a tool introducer with powered tool deployer, in accordance with an exemplary embodiment of the present invention. 
     
    
    
     DETAILED DESCRIPTION 
     The present invention generally relates to systems and methods for surgeries preparations, and more specifically to methods and devices for assembling laparoscopic surgical instrumentation in a patient&#39;s body cavity. 
     In an aspect of some embodiments, there is provided a device or a “tool introducer” for introducing surgical tools into a patient&#39;s body cavity, such as an abdominal cavity. Surgical tools according to present disclosure may include any surgical tool known to art having outer diameter generally being equal or smaller than 20 mm, or equal or smaller than 10 mm, or in some exemplary embodiments being substantially between 3 mm to 5 mm in outer diameter. As such, surgical tools according to present disclosure may include but not be limited to graspers, coagulators, hooks, staplers, scalpels, suturing means, heat or light sources, surgical monitoring devices, scissors, needle holders, retractors, clip applicators or others. In some embodiments, surgical tools according to present disclosure are surgical heads connectable to manipulators, which may be either manually or robotically operable. In some embodiments, surgical heads according to present disclosure are interchangeable in the sense that different surgical heads can be connected, sequentially, onto a single manipulator. Manipulators according to present disclosure generally include an elongated shaft, optionally needle like, with means to connect to and actuate the surgical head. Connection between surgical head and elongated shaft may include any type of connection means such as but not limited to snap locking, elastic teeth, threading, bayonet locking, clamp/chuck connection, ball and socket, magnet, friction, expandable portion (e.g., balloon member), or others. In some embodiments, such elongated shafts are generally 5 mm or less in diameter, optionally 3 mm or less, optionally 2 mm or less, or higher, or lower, or in any intermediate value. 
     In some embodiments, the tool introducer includes or is introducible in an elongated sleeve or tubular member (optionally, though not necessarily, cylindrical) in which the elongated shaft may be inserted for assembling or disassembling with the surgical heads positionable and lockable therein. In some embodiments, surgical tool docking and/or locking position in the tool introducer is distant enough from its distal opening therefore forcing the elongated shaft of the manipulator to align at least partially so that easier assembling condition is met. In some such embodiments, distance from distal opening may be at least 3 cm, optionally at least 5 cm, optionally at least 10 cm, optionally at least 20 cm. In some embodiments, assembling or disassembling is possible in the body cavity, optionally and alternatively outside patients body, or optionally anywhere in between. 
     Reference is made to  FIG. 1  which schematically illustrates a cut view representing a tool introducer  100 , in accordance with an exemplary embodiment of the present invention. Tool introducer  100  includes an elongated body comprising a straight tube  110 , the tube enclosing a tube lumen  160  opened at its distal end with a tube opening  130 . Tool introducer  100  also includes locking means  170  which are provided in tube lumen  160  to selectively lock or unlock an interchangeable surgical tool  200  to tube  110  from displacing axially and/or rotationally. 
     In some embodiments, the locking means are configured such that, at locking, a tool connector  210  of the tool  200  projects towards tube opening  130  and distanced with a distance d 1  therefrom being at least 3 cm, or optionally by at least 5 cm, or optionally by at least 10 cm, or optionally by at least 20 cm, or higher, or lower, or any intermediate value. 
     Tool introducer  100  includes a seal member  150  provided in or proximal to lumen  160  for sealing gas flow therefrom from a distal environment to a proximal environment, so, for example, inflation gas (normally CO2) will not escape abdominal cavity during tool introduction and/or assembly/disassembly. Seal member  150  may be permanent or selectively removable, may be firm or pliable (e.g., a valve) or have any form as known in the art. Tool  200  may be readily provided in lumen  160  or can be introducible thereto via tube&#39;s proximal opening  140 , optionally with or without locking means  170 . 
     Tool introducer  100  may be deliverable into the body cavity via a premade cut or puncture, or it may be introduced in a percutaneous fashion while penetrating and piercing through tissues from the outer environment and into the inner environment enclosed in the body cavity. Optionally and alternatively, tool introducer  100  is introducible via a laparoscopic port so, optionally, tube  110  is sized and shaped for introducing in a body cavity via a laparoscopic port. In some embodiments, and as shown in  FIG. 1 , tool introducer  100  includes an enlarged portion  120  sized and/or shaped for barricading by a laparoscopic port. 
     Reference is now made to  FIGS. 2A-D  which schematically illustrate cut views representing different stages of deploying surgical tool  200 , in accordance with an exemplary embodiment of the present invention. In the suggested method, tool  200  is introduced from outer environment OE into body cavity BC through body cavity wall CW so that it can be connected while in body cavity BC to a distal end portion  315  of a manipulator  300 . As shown in  FIG. 2A , a laparoscopic port  400  is provided in body cavity wall CW, through a first entry point E 1 , thereby creating a selectively sealed passage between body cavity BC and an outer environment OE. Laparoscopic port  400  may be of any type known to art, a trocar, a sheath or other, with means to connect to a gas pressurizing source and to seal gas backflow therethrough. In some embodiments, laparoscopic port  400  allows passing therethrough of objects (such as tools and instruments) that if aligned with its elongated axis has external boundaries of about 20 mm or less in diameter, or optionally about 10 mm or less in diameter or optionally about 5 mm or less in diameter. In some embodiments, laparoscopic port  400  is the largest laparoscopic port provided in cavity wall CW during surgery to introduce large or normal size surgical tools in body cavity BC. Optionally and alternatively, laparoscopic port  400  is the single laparoscopic port used during surgery hence other means (e.g., manipulators) may be introduced in body cavity BC otherwise, such as by percutaneous penetration through cavity wall CW. In some embodiments, if body cavity BC is an abdominal cavity, first entry point E 1  may be the umbilicus. Laparoscopic port  400  introduction and setting may be done as commonly practiced in laparoscopic surgery. 
     Before, after or in parallel to providing laparoscopic port  400  in first entry point E 1 , tool manipulator  300  is introduced as well and deployed in body cavity BC. Tool manipulator  300  includes an elongated shaft  310  ending distally with end portion  315  and with a proximal handheld part  320  having at least one actuating member  325 . Elongated shaft  310  penetrates into body cavity BC through a second entry point E 2 , being substantially remote to first entry point E 1 . In some embodiments, end portion  315  is sharp such that it can be used to pierce through a percutaneous passage through body cavity wall CW at second entry point E 2 . Elongated shaft  310  comprises a fitting portion (not shown) connectable with a tool connector of a surgical tool (such as tool connector  210  of tool  200 ). Elongated shaft  310  is sized and shaped such so it can be advanced in a tube lumen (such as lumen  160  of tool introducer  100 ), at least until an adjoining fitting portion and tool connector is applicable. 
     As shown in  FIG. 2A , tool introducer  100  equipped with tool  200  is passed via laparoscopic port  400  such that tube  110  projects in body cavity BC and tube opening  130  is opened to body cavity BC. Before, during or after such passing of tool introducer  100  through laparoscopic port  400 , visualization means (not shown) can be used in order to trace elongated shaft  310  and/or its distal end  315 . Such visualization means may include any of a laparoscope, endoscope, optical fiber, and a camera, optionally accompanied with illumination means, and these may be provided as an integral part of tool introducer  100  or laparoscopic port  400 , or can be inserted as a separate device via tool introducer  100  or laparoscopic port  400 . Tool introducer  100  is then manipulated and/or extended, under vision or blindly, in order to reach and engage elongated shaft  310  and/or its distal end  315 . In some embodiments, tube  110  is extendable through and from laparoscopic port  400  by at least 5 cm, optionally by at least 10 cm, optionally by at least 15 cm, optionally by at least 20 cm. Optionally and alternatively (not shown), the visualization means are introduced from a separate entry point into body cavity BC and can be used to survey engagement and connection of the system components as described below, from the side. 
     As shown in  FIG. 2C , elongated shaft  310  is inserted in tube lumen  160  via tube opening  130  and then advanced therein so that elongated shaft  310  and tool  200  substantially aligns, optionally forced to align by bounded geometries of elongated shaft  310  in tube  110 . Elongated shaft is advanced until assembly with tool  200  is possible, optionally when the fitting portion of elongated shaft  310  is in direct contact with tool connector  210 . Tool  200  may then be connected to elongated shaft  310  by adjoining tool connector and fitting portion. As shown in  FIG. 2D , manipulator  300  may then be withdrawn so that elongated shaft  310  is removed from tube lumen  160 , and the assembled surgical instrument can be applied for surgery as needed. Optionally, tool  200  is first unlocked from tool introducer  100  before manipulator  300  can be withdrawn. Tool introducer  100  may be kept in laparoscopic port  400  or removed therefrom (as shown), optionally replaced with a second tool introducer equipped with another tool for connecting to a second manipulator (not shown). 
     Reference is made to  FIGS. 3A-B  which schematically illustrate cut views representing use of an exemplary tool introducer  1100  in a laparoscopic system  1000  for aligning between a surgical head  1200  and a manipulator distal end  1300  in a safe environment, in accordance with an exemplary embodiment of the present invention. Tool introducer  1100  includes an elongated tubular body  1110  having an enlarged portion  1120  ending with a sealed proximal end  1140 , and a distal end  1130  opened to inner lumen  1160 . In lumen  1160  with distance d 2  from distal opening  1130  there is a docking portion  1150  which selectively locks to surgical head  1200  shown nests therein. Docking portion  1150  opens distally with an angle α for allowing centering of incoming slender artifacts sliding therein until reaching and arriving in direct contact with connector  1210  of surgical head  1200 . Manipulator  1300  includes an inner member  1320  and an outer member  1310  which may be fixed or rotatable and/or slidable on with the other. At least inner member  1320  includes a fitting portion at its distal tip, namely thread  1325  that can be threaded in connector  1210  having mating thread for bolt-and-nut type connection. Distance d 2  is chosen such to achieve a maximally allowed angle of attack β when thread  1325  is adjacent docking portion  1150  entry, in order to assist in accurate positioning therein. In some embodiments, angle β is equal or smaller than about 45°, optionally equal or smaller than about 30°, optionally equal or smaller than about 15°, optionally equal or smaller than about 5°, or higher, or lower, or of any intermediate value. In some such embodiments, angle β depends on distance d 2  as well as in geometrical ratios between lumen  1160  size and manipulator outer boundaries dimensions. In some embodiments, distance d 2  is at least 3 cm, optionally at least 5 cm, optionally at least 10 cm. In some embodiments, lumen  1160  diameter distal to docking portion  1150  is between 10 mm and 1 mm, optionally between 7 mm and 2 mm, optionally between 5 mm and 3 mm. In some embodiments, outer diameter of manipulator distal end  1300  is equal to or smaller than about 3 mm, optionally equal to or smaller than 2 mm, optionally about 1.5 mm. 
     As shown in  FIG. 3A , manipulator distal end  1300  advances in lumen  1160  and reaches docking portion  1150 . Lumen boundaries imposed by tubular body  1110  are rigid yet smooth enough so that manipulator  1300  would not stuck or cling in-place, while providing a tracked passage thereinside while preventing possible harm to organs or tissues outside tubular body  1110  which may potentially happen in case the surgeon would target manipulator distal end  1300  directly to a small opening such as of surgical head connector  1210 . After manipulator distal end  1300  is advanced in lumen  1160  and forced to align thereto, connection with surgical head  1200  can then be made, as shown in  FIG. 3B . In some embodiments, entire manipulator end portion  1300  or only inner member  1320  revolves so that thread  1325  threads into connector  1210 . 
       FIGS. 4A-B  schematically illustrate cut views representing two exemplary tool introducers  1400  and  1500  with different visualization means, in accordance with an exemplary embodiment of the present invention. As shown in  FIG. 4A , tool introducer  1400  includes an elongated tubular body  1410  having an enlarged portion  1420  ending with a sealed proximal end  1440 , and a distal end  1430  opened to inner lumen  1460 . A docking portion  1450  is provided in lumen  1460  which can selectively lock to a surgical head (not shown). Tubular body  1410  at its distal end around opening  1460  encloses at least one visual capture device  1470  (e.g., digital camera head) and at least one illumination source  1480  (e.g., LED illumination) which may be operational wired or wirelessly to power source and/or image recording unit provided outside patient&#39;s body. As shown in  FIG. 4B , tool introducer  1500  includes an elongated tubular body  1510  having an enlarged portion  1520  ending with a selectively sealed proximal end  1540 , housing a valve  1570 , and a distal end  1530  opened to inner lumen  1560 . A docking portion  1550  is provided in lumen  1560  which can selectively lock to a surgical head (not shown). An optical fiber  1600  is shown when introduced through lumen  1560  that is configured to transfer image and light from its tip  1610  backwards to image capture and recording means (not shown) provided outside patient&#39;s body. 
     In some embodiments, a tool introducer is provided as a system or a kit which comprises an elongated tubular member (tube) or sleeve for reaching and engaging a distal end of a tool manipulator, and a separate drawer and/or tool locking means that can be inserted from a proximal opening of the tube and deliver a tool therein to a predefined position having a minimal distance from tube&#39;s proximal opening, as previously described. As such, systems or kits according to the present disclosure may include locking means that are selectively introducible in tube&#39;s lumen, optionally as part of a plug member, and fixedly connectable to the tube. In some such embodiments, locking means may include at least two opposing teeth selectively movable from an inward position at locking to an outward position at unlocking. Optionally, the locking means are normally locking. Optionally, the locking means are manually operational with a button mechanism. Optionally, the tube is sized and configured for passing through a laparoscopic port, such as a commercially available laparoscopic port having inner diameter between 3 mm and 20 mm, or optionally between 5 mm and 10 mm. 
     Reference is now made to  FIG. 5  which schematically illustrates a cut view representing an exemplary system  2000  for introducing a surgical tool in a body cavity via a laparoscopic port  2100  and for engaging with, aligning and assemble the surgical tool to a tool manipulator (not shown) in the body cavity, in accordance with an exemplary embodiment of the present invention. System  2000  includes an engager  2200  and a tool holder  2300 . In  FIG. 5 , tool holder  2300  is shown equipped with an interchangeable grasper  2400  and provided in and assembled to engager  2200 ; and both are provided in and through laparoscopic port  2100 . 
     System  2000  may be sold or provided to the surgical team as a kit comprising at least one engager  2200  (shown in detail in  FIG. 7B ) and at least one tool holder  2300  (shown in detail in  FIG. 6 ). The kit may also include laparoscopic port  2100  (shown in detail in  FIG. 7A ) or be configured to work with commercially available ports. The kit may also include at least one surgical tool, optionally including but not limited to interchangeable grasper  2400  (shown in detail in  FIG. 7D ). The kit may also include at least one tool loader, optionally including but not limited to a grasper loader  2600  (shown in detail in  FIGS. 7D-E ). The kit may also include at least one manipulator comprising a needle portion, optionally including but not limited to needle  2700  (shown in detail in  FIG. 71 ). 
     Laparoscopic port  2100  includes an elongated tubular member or tube  2110  enclosing a lumen  2120  and having a proximal enlarged handheld portion  2130 . Handheld portion allows introduction of objects therethrough into body cavities when deployed via proximal port opening  2140  and includes at least one seal such as port seal  2150  to prevent gas escape. Pressure inlet  2160  allows connection to a pressurized gas source. Laparoscopic surgery involves insufflation of a gas (usually carbon dioxide) into the abdominal/peritoneal cavity producing a pneumoperitoneum. This causes an increase in intra-abdominal pressure (IAP). Carbon dioxide is commonly insufflated into the peritoneal cavity for example at a rate of 4-6 liter/min to a pressure of 10-20 mm Hg, for example. The pneumoperitoneum may be maintained for example by a constant gas flow of 200-400 ml/min. 
     Engager  2200  includes an elongated tubular body  2210  opened at a proximal end  2240  and at a distal end  2270  with a lumen  2220  extending therebetween. According to the present disclosure, elongated tube  2200  includes at least one seal provided in lumen  2220  such as a zero seal  2260  (configured to prevent gas passage at least when it is absent from any object extending therethrough) and an instruments seal  2250  (configured to prevent gas at least when objects having outer diameter of a certain diameter range extends therethrough). Optionally and as shown, at its distal end  2270  there is provided an expandable funnel, optionally and as shown, an asymmetrical funnel component  2212 . In some embodiments, funnel  2212  is a self-expandable partially (or, alternatively, fully) conic structure, expandable from and re-collapsible to a substantially tubular form. At its tubular form, funnel  2212  can be passed at both directions through laparoscopic port lumen  2120 . At its expanded conic form, funnel  2212  has a substantially greater span which increases covering area around any intruding slender objects, such as a distal end portion of a manipulator longitudinal shaft. Furthermore, the expanded funnel  2212  facilitates a more smoother introduction and accommodation of a nonaligned shaft (e.g., projecting at an angle between 100-180° of any coordinate axis with respect to engager tube&#39;s longitudinal axis) so that instead of impinging and even penetrating through the funnel, the needle can gently slide over the curved walls of the funnel until aligning with its longitudinal axis. With its configuration, including a tapered edge and having a first closed side and a second substantially opened side, funnel  2212  allows a continuous accurate visualization and monitoring using an endoscope or a camera projected forward. Such a design further allows a faster and easier recollapsing of funnel  2212 . As shown in  FIG. 5  and in  FIG. 7B , tube body  2210  is telescopically introducible at proximal end  2140  of laparoscopic port  2100 , through lumen  2120  and bypassing seal  2150 , yet maintaining sealed passage to gas passage therein (with seals  2250  and/or  2260 ) or between its outer boundaries and seal  2150 . 
     Tool holder  2300  includes an inner sleeve member  2320  slidable in an outer sleeve member  2310 . Outer sleeve member  2310  has an enlarged proximal end portion  2312  with a concavity fitted for a push-button  2330 . Button  2330  is connected to proximal end of inner sleeve member  2320  and is interconnected with compression spring  2332  to outer sleeve member  2310  so that is normally pulled back with respect to outer sleeve member  2310  when not pushed in. Tool holder  2300  includes locking means  2326  to selectively lock or unlock an interchangeable surgical tool from displacing axially and/or rotationally in engager tube lumen  2220 . In some embodiments and as shown, locking means  2326  include a distal portion of inner sleeve member  2320  that is slitted partially along its length with slits  2324  so that to create a plurality of teeth  2322  configured to extend outwardly from longitudinal axis when emerging out of outer sleeve member  2310  (when button  2330  is pushed). When button  2330  is at backward position (pulled back) teeth  2322  are inwardly compressed and nest within the boundaries imposed by outer sleeve member  2310 , so that in case an surgical tool is housed in tool holder  2300  (as shown for example in  FIG. 7G ) the inwardly compressed teeth locks the tool in-place. In some embodiments, and as shown in  FIG. 5  and in  FIG. 7G , tool holder  2300  is adapted to be inserted through engager&#39;s proximal opening  2240  to be deployed in lumen  2220  and thereby projecting a tool connector (such as connection threads  2422  and  2424  of interchangeable grasper  2400 ) towards engager&#39;s distal opening  2270 . In some embodiments, a surgical tool, such as interchangeable grasper  2400 , when placed with tool holder  2300  in and assembled with engager  2200 , has its distal-most face distanced by at least 3 cm from distal end  2270  of engager  2200 . 
     Interchangeable grasper  2400  includes a grasper portion  2410  and a connector portion  2420 . Grasper portion  2410  includes a first jaw  2412  and a second jaw  2414  pivotally connected with a joint  2416 . Connector portion  2420  includes an inner member comprising a first female thread  2422  slidable in an outer member comprising a second female thread  2424 , larger in diameter than first female thread  2422 . Relative distance between threads  2422  and  2424  determine relative distance between jaws  2412  and  2414  or magnitude of compression force developed therebetween. A compression spring  2426  keeps threads  2422  and  2424  in a nominal distance such that jaws  2412  and  2414  are kept closed (in-contact) yet with negligible compression. 
     Needle  2700  of manipulator (which is not shown in full) includes an inner rod member  2730  slidable in cylindrical member  2720 . Inner rod member  2730  has a distal dull tip  2734  and a first male thread  2732  adjacent thereto. Cylindrical member  2720  includes a second male thread  2722  provided at its distal end. In some embodiments, needle  2700  is operable to create a percutaneous penetration path hence includes sharp means to puncture and cut through soft tissues. In some such embodiments, and as shown, needle  2700  includes an outer cover  2710  with sharp distal end in which cylindrical member  2720  may slide backwards along with inner rod member  2730  until fully retracted therein, so that needle  2700  acts similarly to a veress needle as needed. 
     Reference is now made to  FIGS. 7A-K  which schematically illustrate cut views representing different stages of deploying interchangeable grasper  2400  using system  2000 , in accordance with an exemplary embodiment of the present invention. As shown in  FIG. 7A , laparoscopic port  2100  is introduced into body cavity BC through body cavity wall CW using known surgical practiced techniques. Body cavity BC may then be insufflated via pressure inlet  2160 . As shown in  FIG. 7B , engager  2200  is then passed in laparoscopic port  2100  bypassing its seal  2150  yet keeping a sealed environment using zero seal  2260 . As shown in  FIG. 7C , a laparoscope  2500  is introduced into body cavity BC via engager  2200  with its distal end  2510  peeping partially beneath and in funnel  2212 , or upward or backward thereto. Laparoscope  2500  can be used to trace end portion of a manipulator (such as needle  2700  shown in  FIGS. 7H-K ) and visualize approaching and reaching it with funnel  2212 . Once manipulator emerges into engager&#39;s lumen  2220 , optionally while laparoscope  2500  is partially withdrawn, the laparoscope can be removed and further steps can optionally be made blindly. 
     Before, after or in parallel to the above-mentioned steps, interchangeable grasper  2400  may optionally be loaded in tool holder  2300  (in case it is not preloaded) using loader  2600 . As shown in  FIG. 7D , loader  2600  is bolted (optionally manually, using its enlarged end portion  2610 ) with a threaded portion  2620  into second female thread  2424  of interchangeable grasper  2400 . Alternatively and optionally, loader may be plugged in into a recess such as second female thread  2424  of interchangeable grasper  2400  without threading. With loader  2600 , interchangeable grasper  2400  is then pushed into tool introducer  2300  while its button  2330  is pushed so that teeth  2322  extend out from outer sleeve member  2310  and outwardly, so that to allow such loading (as shown in  FIG. 7E ) until interchangeable grasper  2400  is fully nesting in-position (as shown in  FIG. 7F ). Button  2330  may then be released to pop out, and loader unbolted and removed. 
     Afterwards, the loaded tool introducer  2300  is inserted (e.g., plugged-in or bolted) in engager  2200  via its proximal opening  2240 , optionally instead of laparoscope  2500 . Needle  2700  may then advance forward in engager lumen  2210  until reaching distal portion of interchangeable grasper  2400  ( FIG. 7H ). Connection is made possible, for example, if both inner rod member  2730  and cylindrical member  2720  revolves (e.g., clockwise) until first male thread  2732  is bolted in first female thread  2422  and second male thread  2734  is bolted in second female thread  2424  ( FIG. 7J ). Only then, button  2330  can be pushed and needle  2700 , now equipped with interchangeable grasper  2400 ) can be withdrawn from tool holder  2300  and engager  2200  and be used in surgery as needed. 
     In some embodiments, different or similar tools can be loaded in same or different tool holder, using same or different loader, so same or different needles/manipulators. Tool holder  2300  can be removed and replaced with laparoscope  2500  for visualizing the surgical procedure. 
     Disassembly of interchangeable grasper  2400  from needle  2700  (or of other likewise instrumentation) can be done similarly in reverse fashion, for example by first using engager  2200  equipped with laparoscope  2500  to locate, reach and engage interchangeable grasper  2400 . Then inserting the interchangeable grasper partially in engager  2200  and removing laparoscope  2500 . Then inserting unloaded tool holder  2300  in engager  2200  and pushing interchangeable grasper thereto until contacting teeth  2322 . In some embodiments, verification of correct contact is made (optionally, visually and/or tactilely and/or electronically or otherwise). In some embodiments, the pushing ends with preliminary locking such as by snap-locking means. Then, button  2330  is pushed and interchangeable grasper  2400  can be pushed further to nest in tool introducer  2300  and allow proper release of button  2330 . Afterwards, the needle  2700  can be unbolted from interchangeable grasper  2400  and all instruments may be removed from patient&#39;s body or replaced as needed. 
     Reference is made to  FIG. 8  which schematically illustrates a cut view representing a tool introducer  3100  introducible in a laparoscopic port  3300 , in accordance with an exemplary embodiment of the present invention. Laparoscopic port  3300  may be a commercially available device provided with or separate to tool introducer  3100 , from same or different vendor. Laparoscopic port  3300  may be a sheath or cannula of a laparoscopic trocar system having standard or non-standard sizes, for example an inner diameter of 5 mm, 8 mm, 11 mm, 12 mm or 15 mm, or higher, or lower, or intermediate size, and/or a length of 50 mm, 75 mm, 100 mm, 150 mm, 200 mm, or higher, or lower, or intermediate size. Laparoscopic port  3300  includes a hollow tubular body  3310  with a proximal wide portion  3320 , a proximal end  3340  and a distal end  3330 . A sealing mechanism  3350 , commonly comprising zero seal and/or instruments seal, is configured for sealing inner passage of tubular body  3310  if empty or if occupied with artifacts, such as tool introducer  3100 , passing therethrough. 
     Tool introducer  3100  includes an elongated body  3110  and locking means  3120  to selectively lock or unlock with an interchangeable surgical tool  3200  from moving or displacing axially and/or rotationally. Tool introducer  3100  also includes a handheld portion  3130  at its proximal end for manual actuation and/or maneuverability such as in and out laparoscopic port  3300 , and through it, in and out an internal body cavity if laparoscopic port  3300  is deployed in the body cavity wall. Tool introducer  3100  may be configured, such as sized and/or shaped, such that it can place tool  3200  in a certain predetermined position in laparoscopic port  3300  or at least in minimal distance to its distal end  3330 . In some such embodiments, handheld portion  3130  may be shaped and/or sized such as it can serve as a stopper for maximal projection of tool  3200  in tubular body  3310  inner passage. 
     In some embodiments, tool introducer  3100  is configured such that, at locking, a tool connector  3220  of the tool  3200  projects towards tube opening at distal end  3330  and distanced with a distance P there from being at least 3 cm, or optionally by at least 5 cm, or optionally by at least 10 cm, or optionally by at least 20 cm, or higher, or lower, or any intermediate value. 
     Tool  3200  may be readily provided in locking means  3120  and it can be introducible thereto via proximal opening at proximal end  3340  with tool introducer  3100 . 
       FIG. 9  schematically illustrates a cut view representing a tool introducer  4100  with a powered tool deployer  4400 , in accordance with an exemplary embodiment of the present invention. Tool introducer  4100  is similar in many respects to tool introducer  3100  and is meant for introduction in an elongated tubular member, such as laparoscopic port  4300 , and for positioning and/or locking a surgical tool such as tool  4200  thereinside, to a predetermined distance from a distal opening thereof being at least 3 cm in length. Tool introducer  4100  includes an elongated body comprising of a distal member  4120  with locking means adapted for selectively locking in tool  4200 , which is rotationally connected with a hollow proximal member  4130  starting with a handheld portion  4110 . At the intersection of distal member  4120  and proximal member  4130  there is a recess  4140  configured for interaction with a corresponding projecting portion  4462  of powered tool deployer  4400 , optionally having non-circular cross section, either symmetrical (such as hexagonal cross section) or not symmetrical (such as a rectangular slit). 
     Powered tool deployer  4400  is configured to couple with tool introducer  4100  (when, optionally, placed in laparoscopic port  4300 ) and rotate distal member  4120  about proximal member  4130 , thereby rotating tool  4200 , such that when a distal end of a tool manipulator elongated shaft, having a fitting portion configured to thread to corresponding portion in tool  4200 , is pressed thereto, then tool  4200  will connect to the tool manipulator, and vice versa. Powered tool deployer  4400  includes an elongated portion  4410  sized to fit and extend in the hollow proximal member  4130  of tool introducer  4100 , and a proximal handheld part  4420  containing the powering components, such as motor  4440 , controller  4450  and battery  4430 . Alternatively and optionally, the powering element may be a spring that is tensioned manually, and that may be released by an actuator to activate the tool deployer. Elongated portion  4410  houses a driver shaft  4460  ending with projecting portion  4462 . Driver shaft  4460  is connected to motor  4440  and controller  4450  is configured to determine timing for powering motor  4440  to revolve diver shaft  4460  and, optionally, other features (such as torque moment, velocity and others). Battery  4430  is optionally rechargeable. Motor  4440  operation may begin selectively upon operator&#39;s triggering (such as by pressing a trigger or a push button; not shown), or automatically, for example upon connection of tool  4200  with a corresponding fitting portion of a tool manipulator (not shown). Tool  4200  and manipulator fitting portion may include specific identification and compatibility means such that motor  4440  will not be ignited unless proper identification and/or compatibility are met. 
     Although the invention has been described in conjunction with specific embodiments thereof, it is evident that many alternatives, modifications and variations will be apparent to those skilled in the art. Accordingly, it is intended to embrace all such alternatives, modifications and variations that fall within the spirit and broad scope of the appended claims. 
     All publications, patents and patent applications mentioned in this specification are herein incorporated in their entirety by reference into the specification, to the same extent as if each individual publication, patent or patent application was specifically and individually indicated to be incorporated herein by reference. In addition, citation or identification of any reference in this application shall not be construed as an admission that such reference is available as prior art to the present invention. To the extent that section headings are used, they should not be construed as necessarily limiting.