Patent Publication Number: US-2023149640-A1

Title: Systems and methods for conducting smoke evacuation during laparoscopic surgical procedures

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims priority to U.S. Provisional Patent Application No. 61/826,088 filed May 22, 2013 and to U.S. Provisional Patent Application No. 61/728,608 filed Nov. 20, 2012, each of which is incorporated by reference herein in its entirety. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The subject invention is directed to laparoscopic surgery, and more particularly, to systems and methods for conducting smoke removal and evacuation from the abdominal cavity of a patient during a laparoscopic surgical procedure utilizing a dual lumen cannula. 
     2. Description of Related Art 
     Laparoscopic or “minimally invasive” surgical techniques are becoming commonplace in the performance of procedures such as cholecystectomies, appendectomies, hernia repair and nephrectomies. Benefits of such procedures include reduced trauma to the patient, reduced opportunity for infection, and decreased recovery time. Such procedures within the abdominal (peritoneal) cavity are typically performed through a device known as a trocar or cannula, which facilitates the introduction of laparoscopic instruments into the abdominal cavity of a patient. 
     Additionally, such procedures commonly involve filling or “insufflating” the abdominal (peritoneal) cavity with a pressurized fluid, such as carbon dioxide, to create what is referred to as a pneumoperitoneum. The insufflation can be carried out by a surgical access device, e.g., a cannula or trocar, equipped to deliver insufflation fluid, or by a separate insufflation device, such as an insufflation (veress) needle. Introduction of surgical instruments into the pneumoperitoneum without a substantial loss of insufflation gas is desirable, in order to maintain the pneumoperitoneum. 
     During typical laparoscopic procedures, a surgeon makes three to four small incisions, usually no larger than about twelve millimeters each, which are typically made with the surgical access devices themselves, typically using a separate inserter or obturator placed therein. Following insertion, the inserter is removed, and the trocar allows access for instruments to be inserted into the abdominal cavity. Typical trocars often provide means to insufflate the abdominal cavity, so that the surgeon has an open interior space in which to work. 
     The trocar must provide a means to maintain the pressure within the cavity by sealing between the trocar and the surgical instrument being used, while still allowing at least a minimum freedom of movement of the surgical instruments. Such instruments can include, for example, scissors, grasping instruments, and occluding instruments, cauterizing units, cameras, light sources and other surgical instruments. Sealing elements or mechanisms are typically provided on trocars to prevent the escape of insufflation gas. Sealing elements or mechanisms typically include a duckbill-type valve made of a relatively pliable material, to seal around an outer surface of surgical instruments passing through the trocar. 
     Further, in laparoscopic surgery, electrocautery and other techniques (e.g. harmonic scalpels) create smoke and other debris in the surgical cavity, reducing visibility by fogging the view from, and coating surfaces of endoscopes and the like. A variety of surgical insufflation systems and smoke evacuation systems are known in the art. 
     Additionally, SurgiQuest, Inc., Milford, Conn. USA has developed surgical access devices that permit access to an insufflated surgical cavity without conventional mechanical seals, and has developed related systems for providing sufficient pressure and flow rates to such access devices, as described in whole or in part in U.S. Pat. No. 7,854,724. 
     While the systems and methods described above have generally been considered satisfactory for their intended purpose, there is an ongoing need for improved functionality in insufflation systems and related techniques. 
     SUMMARY OF THE INVENTION 
     The subject disclosure is directed to a new and useful surgical gas delivery system for use during laparoscopic surgical procedures, e.g., in an abdominal cavity of a patient, and more particularly, to an insufflation and smoke evacuation system that includes a pump for circulating pressurized gas within the system and a dual lumen cannula configured to provide access to the abdominal cavity of a patient, which includes a first lumen communicating with the source of insufflation fluid and a second lumen communicating with the pump. 
     In one embodiment of the subject invention, the dual lumen cannula includes a first lumen communicating with the source of insufflation fluid and a pressure side of the pump for delivering pressurized gas and insufflation fluid to the abdominal cavity, and a second lumen communicating with a suction side of the pump for removing gas from the abdominal cavity. 
     In another embodiment of the subject invention, the dual lumen cannula includes a first lumen communicating with the source of insufflation fluid and a second lumen communicating with a pressure side of the pump for delivering pressurized gas to the abdominal cavity. In addition, the system includes a second cannula which has a single lumen communicating with a suction side of the pump for removing gas from the abdominal cavity. 
     In certain embodiments of the subject invention, a bypass valve is operatively associated with the pump for controlling a gas circulation rate within the system. In addition, a mechanical seal is operatively associated with the second lumen to maintain abdominal pressure, and the first lumen serves as a sense line for sensing abdominal pressure. A filter device is also provided for filtering gas circulating through the system to remove smoke and debris therefrom. 
     These and other features of the system of the subject invention and the manner in which it is manufactured and employed will become more readily apparent to those having ordinary skill in the art from the following enabling description of the preferred embodiments of the subject invention taken in conjunction with the several drawings described below. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       So that those skilled in the art to which the subject invention appertains will readily understand how to make and use the subject invention without undue experimentation, preferred embodiments thereof will be described in detail herein below with reference to certain figures, wherein: 
         FIG.  1    is cross-sectional view of the upper portion of a dual lumen cannula constructed in accordance with a preferred embodiment of the subject invention, which includes, among other things a mechanical duckbill seal; 
         FIG.  2    is a schematic drawing of an embodiment of the insufflation and smoke evacuation system of the subject invention, which employs the dual lumen cannula shown in  FIG.  1   , as well as an additional single lumen cannula; 
         FIG.  3    is s schematic drawing of an embodiment of the insufflation and smoke evacuation system of the subject invention, which employs the dual lumen cannula shown in  FIG.  1   ; and 
         FIG.  4    is a schematic drawing of yet another embodiment of the insufflation and smoke evacuation system of the subject invention, which employs a tri-lumen cannula, as well as an additional single lumen cannula. 
     
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
     Reference will now be made to the drawings wherein like reference numerals identify similar structural features or aspects of the subject disclosure. For purposes of explanation and illustration, and not limitation, a partial view of an exemplary embodiment of an insufflation and smoke evacuation system in accordance with the disclosure is shown in  FIG.  1    and is designated generally by reference character  10 . Other embodiments of insufflation and smoke evacuation systems in accordance with the disclosure, or aspects thereof, are provided in  FIGS.  2 - 4   , as will be described. It is to be appreciated that the systems, devices and methods presented herein may be used for surgical gas delivery, including insufflation, smoke evacuation, and/or recirculation in connection with suitable surgical devices, and in applicable surgical procedures. 
     The present invention relates to multimodal systems, and related devices and methods, capable of performing multiple surgical gas delivery functions, including insufflation to standard or specialized surgical access devices or other instruments, such as veress needles and the like, smoke evacuation through standard or specialized surgical access devices, and specialized functions, such as recirculation and filtration of insufflation fluids, such as with the above-mentioned surgical access devices described for example in U.S. Pat. No. 7,854,724; as well as those in U.S. Pat. Nos. 7,182,752; 7,285,112; 7,413,559 or 7,338,473; each of which is incorporated by reference herein in its entirety. 
     Use of a single multimodal system such as those described herein reduces costs by requiring purchase of only one system while achieving multiple functions, and also thereby reduces the amount of equipment needed in an operating room, thus reducing clutter and allowing space for other necessary equipment. 
     The present invention is particularly suited for minimizing the amount of equipment needed in a surgical operating room, in that the subject systems are capable of performing multiple functions, and therefore also allow flexibility of surgical technique. It is envisioned that the gas delivery system disclosed herein can be used in general laparoscopic procedures including but not limited to laparoscopic cholecystectomy, laparoscopic appendectomy, laparoscopic hernia repair, Nissen-Y and Lap Nephrectomy. 
     Those skilled in the art will readily appreciate that systems described in U.S. Pat. No. 7,854,724, for example, provide pressurized gas to and remove depressurized gas from specialized surgical access devices, which penetrate into a surgical cavity, such as a patient&#39;s abdominal cavity. These access devices are adapted and configured to form a pressure bather to inhibit the loss of insufflation gas to the atmosphere. 
     An example of an access device constructed in accordance with a preferred embodiment of the subject invention is illustrated in  FIG.  1    and is designated generally by reference numeral  10 . Access device  10  is configured as a dual lumen cannula. That is, it includes a proximal housing  12 , an outer cannula  14  and an inner cannula  16 . The inner cannula  16  defines a central or inner lumen  18  and an annular or outer lumen  20  is formed between the outer cannula  14  and the inner cannula  16 . 
     The housing  12  includes a first flow port  28  communicating with the central lumen of the inner cannula  16  and a second flow port  30  communicating with the annular passage  20 . A main access port  32  is provided in the end cap  34  of the housing  12 , and a duckbill seal  36  is supported within the housing  12  to prevent the egress of pressurized gas from the device through the access port  32 . 
     As discussed in more detail below with reference to  FIG.  2   , during use gas from the abdomen, e.g., pneumoperitoneum  116 , interchanges with gas coming from the access device  10 , a portion of which is collected and recycled through the system, and is re-pressurized along the way, passing through one or more filters, e.g., filter  123  described below. During this recycling process, smoke and/or other circulating debris, such as atomized fluids, are removed by the filters, improving visibility within the surgical cavity, thus aiding in the surgical procedure. An example of a filter that can be utilized with the subject invention is disclosed in U.S. Pat. No. 8,088,189, the disclosure of which is herein incorporated by reference in its entirety. 
     Referring now to  FIG.  2   , there is illustrated an insufflation and smoke evacuation system constructed in accordance with the subject invention and designated generally by reference numeral  100  that includes a recirculation pump  112  for circulating pressurized gas within the system. The system  100  includes a dual lumen cannula  10  as illustrated in  FIG.  1   . In this embodiment of the invention, the dual lumen cannula  10  includes a first or outer lumen  20  communicating with a source of insufflation fluid  114  through a conduit  115  connected to the flow port  30  in housing  12 . The source of insufflation fluid  114  maintains pressure within pneumoperitoneum  116 . The outer lumen  20  of dual lumen cannula  10  also serves as a sense line for sensing and controlling abdominal pressure within the system  100 . 
     The dual lumen cannula  10  of system  100  further includes a second or central lumen  18  communicating with a pressure or supply side of the recirculation pump  112  through a conduit  117  connected to the flow port  28  in housing  12  for delivering pressurized gas to the abdominal cavity, e.g., for recirculation as described below. 
     In addition, the system  100  includes a second cannula  150  which has a single lumen that communicates with a suction side of the recirculation pump  112  through a conduit  119 , e.g., by way of a luer connection, for removing gas from the abdominal cavity. System  100  further includes a bypass valve  125  that is operatively associated with the recirculation pump  112  through a conduit  121  connecting conduit  117  to conduit  119  to control the gas circulation rate within the system  100 . When bypass valve  125  is closed, pump  112  recirculates gas through connecting conduit  117 , central lumen  18 , pneumoperitoneum  116 , second cannula  150 , and conduit  119 , which includes a filter  123 . Filter  123  can remove smoke, particles, moisture, and the like from the insufflation gas circulating through pneumoperitoneum  116 . Bypass valve  112  can be opened and adjusted as needed to reduce the flow of recirculation through pneumoperitoneum  116 . 
     Referring now to  FIG.  3   , there is illustrated another insufflation and smoke evacuation system constructed in accordance with the subject invention and designated generally by reference numeral  200  that includes a recirculation pump  212  for circulating pressurized gas within the system. The system  200  further includes a dual lumen cannula  10  as illustrated in  FIG.  1   . 
     In this embodiment of the invention, the dual lumen cannula  10  includes a first annular lumen  20  communicating with a source of insufflation fluid  214  and a high pressure side (or supply side) of the pump  212  through a conduit  217  connected to the flow port  30  in housing  12 . The annular lumen  20  of dual lumen cannula  10  also serves as a sense line for sensing abdominal pressure within the system  200 . 
     In system  200 , the dual lumen cannula  10  further includes a second lumen  18  communicating with the suction side of the recirculation pump  212  through a conduit  219  connected to the flow port  28  of housing  12  for removing gas from the abdominal cavity, e.g. pneumoperitoneum  116  of  FIG.  1   . In this embodiment, second lumen  18  has only one line, namely conduit  219 , which is a suction line, i.e., there is no sense/insufflation line for second lumen  18 . System  200  further includes a bypass valve  225  that is operatively associated with the recirculation pump  212  through a conduit  221  connecting conduit  217  to conduit  219  to control the rate of gas circulation within the system  200 . Bypass valve  225  can be used to control the amount of recirculation flow through dual lumen cannula  10  as described above. Filter  223  operates as described above with respect to filter  123 . 
     Referring to  FIG.  4   , there is there is illustrated yet another insufflation and smoke evacuation system designated generally by reference numeral  300 . System  300  includes a source of insufflation gas  314 , pump  312 , bypass valve  325 , second cannula  350 , and filter  323 , and is substantially identical to the system  100  shown in  FIG.  2   , except that system  300  includes a tri-lumen cannula  320  and a communication line  360  that extends between the inner bowl area of the cannula  320  and the vacuum line  319 . As a result, if the tri-lumen cannula  320  is used as an access port for a laparoscope, smoke will exit the abdominal cavity in an area that is located away from the distal end of the scope so as not to adversely impact visibility through the scope. 
     While shown and described in the exemplary context of insufflation of a peritoneum space, those skilled in the art will readily appreciate that any suitable space can be insufflated with the systems and methods described herein without departing from the scope of this disclosure. 
     While the subject invention has been shown and described with reference to preferred embodiments, those skilled in the art will readily appreciate that various changes and/or modifications may be made thereto without departing from the spirit and scope of the subject invention as defined by the appended claims.