Patent Publication Number: US-2019183527-A1

Title: Laparoscopic guide

Description:
FIELD 
     The invention relates to a laparoscopic guide for use in the field of laparoscopic surgery and to a method of guiding a laparoscopic surgical instrument or the like. 
     BACKGROUND 
     Laparoscopic surgery is a form of keyhole surgery in which operations are performed at an operation site, generally in the abdominal cavity or pelvic cavity of a patient, via one or more small incisions that are located some distance from the operation site. A laparoscope is used to relay an image of the operation site to a display screen so that the surgeon performing the laparoscopic surgery can view the operation site as he conducts the surgery. The surgeon typically manipulates the laparoscope and a number of laparoscopic surgical instruments, tools or the like, through the incisions for use in performing the surgery at the operation site. The instruments and tools are each engaged through a trocar that is positioned in an incision and which provides a means of holding the instrument or tool in place in the incision and in the abdominal or pelvic cavity. In general, the trocar comprises a trocar port at a proximal end and a cannula extending distally therefrom. During surgery, the trocar port rests above the incision and provides access for the instrument and/or tool into the cannula which extends to the operation site. 
     Laparoscopic surgery is increasing in popularity due to the advantages it can provide to the patient in terms of a smaller post-surgical physical scar, pain reduction and swifter recovery time in comparison with open surgery. However, the surgeon has to manipulate one or more of the laparoscopic surgical instruments and tools during the surgery, which requires dexterity and precision, particularly when it is required to remove one instrument from the trocar and replace it with another instrument or tool. The surgeon must watch the operation site on a display screen associated with the laparoscope whilst simultaneously removing or engaging a surgical instrument quickly and efficiently. The laparoscopic surgical instruments and tools typically include surgical scissors, forceps and suckers/irrigators that are elongate and narrow in their general shape. The trocar port typically has a small aperture in which the instruments and tools are received. Although it is important for instruments and tools to be inserted in the trocar port in a timely and efficient manner during surgery, it can be difficult to quickly find the small aperture of the trocar port with the instrument or tool. The trocar port also has a tendency to move as the laparoscopic surgical instrument is removed therefrom, meaning that the surgeon must reposition it to continue the surgery. This creates further inefficiency in the surgical procedure. 
     Laparoscopic techniques are improving, however increasingly challenging cases are being faced by surgeons in terms of body habitus (fat) and pathology (larger, more inflamed cases). There is therefore also a need to improve the ease of surgical procedure and the outcome for challenging cases. 
     OBJECT OF INVENTION 
     It is the object of the present invention to substantially overcome or at least ameliorate one or more of the above disadvantages or to substantially meet the above need. 
     SUMMARY OF INVENTION 
     According to a first aspect of the invention, there is disclosed herein a laparoscopic guide comprising a hollow body having a longitudinal mid-plane and a cross sectional area that tapers from a proximal end to a distal end thereof, the distal end having a distal end face being oriented substantially perpendicular to the longitudinal mid-plane, the distal end face being adapted for communication with an inlet of a trocar port, and the proximal end being adapted for receiving a laparoscopic surgical instrument or the like therein prior to the laparoscopic surgical instrument passing through the trocar port, wherein the proximal end has an open end face that is arranged obliquely relative to the distal end face. 
     The obliquely oriented open end face is thus advantageously larger than would be the case if the opening was parallel to the distal end face, providing a large area into which the surgical instrument or tool can be engaged. The tapering of the hollow body towards the distal end easily guides the surgical instrument into the trocar and the surgeon is able to manipulate the surgical instrument through a wide range of movement at the proximal open end face to achieve the desired positioning of the surgical instrument at the operation site. Furthermore, the oblique slant of the open end face of the laparoscopic guide maximises access to the trocar without limiting the reach of the surgeon when engaging the surgical instrument into the trocar. 
     Preferably, the hollow body has a generally conical or part conical shape. In an embodiment, the hollow body is radially symmetrical about a longitudinal axis thereof. In an alternative embodiment, the hollow body is radially asymmetrical about the longitudinal axis. 
     Preferably, the longitudinal mid-plane is a horizontal mid-plane and an angle subtended by a plane defined by the open end face of the proximal end and the horizontal mid-plane is 45 degrees or less. More preferably, the angle is 30 degrees or less. In an embodiment, the angle is 5 degrees or less. 
     Preferably, the distal end of the laparoscopic guide is engageable with an inlet portion of a trocar port. In an embodiment, the distal end is engageable by a push fit with the inlet end of the trocar port. Alternately, the distal end is engageable with the inlet of the trocar port via a quick release mechanism, for example a simple releasable clip and recess mechanism. 
     In an alternative embodiment, the distal end of the laparoscopic guide is formed integrally with an inlet portion of the trocar port. 
     According to a second aspect of the invention, a method of guiding a laparoscopic surgical instrument or the like into an inlet of a trocar port comprises engaging the laparoscopic surgical instrument or the like into the open end face of the proximal end of a laparoscopic guide as described above and thereafter engaging the laparoscopic surgical instrument or the like into the trocar port. 
    
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
       Preferred embodiments of the present invention will now be described, by way of examples only, with reference to the accompanying drawings, wherein: 
         FIG. 1  is a schematic cross-sectional representation of a laparoscopic guide attached to a trocar in situ at an operation site; 
         FIG. 2  is a side view of a typical trocar comprising a trocar port and cannula; 
         FIG. 3  is a schematic cross-sectional view of the trocar port and cannula of  FIG. 2 ; 
         FIG. 4  is a schematic enlarged view of the laparoscopic guide fitted to the trocar port of  FIG. 2 or 3 ; 
         FIG. 5  is an enlarged view of an embodiment of the laparoscopic guide fitted to the trocar port of  FIG. 2 or 3  with a push fit attachment; 
         FIGS. 6 a  to 6 c    show schematic cross-sectional views of embodiments of the laparoscopic guide of  FIG. 1 ; 
         FIG. 7  is an enlarged view of a further embodiment of the laparoscopic guide fitted to the trocar port with a quick release attachment; and 
         FIG. 8  is a schematic representation of a still further embodiment of a laparoscopic guide that is formed integrally with the trocar port. 
     
    
    
     DESCRIPTION OF EMBODIMENTS 
     Throughout the disclosure herein, as is traditional when referring to relative positioning on a surgical instrument, the term “proximal” refers to the end which is closer to the surgeon and the term “distal” refers to the end which is further away from the surgeon. 
       FIG. 1  shows a schematic representation of a laparoscopic surgery taking place at an operation site  5  in the abdominal cavity  1  of a patient. An incision  10  has been made in the patient&#39;s abdomen. A trocar  20  is engaged into the abdominal cavity  1  via the incision  10 . The trocar  20  has a trocar port  25  at a proximal end thereof and an elongate cannula  21  extending distally therefrom. As shown in  FIG. 1 , the trocar port  25  rests above the incision  10  and the cannula  21  extends into the abdominal cavity  1 . The trocar port  25  is shown more clearly in  FIGS. 2 and 3 . The trocar port  25  has a plastic body having a central conduit  26  extending from an inlet end  27  to an outlet end  28  thereof. The conduit  26  includes a valve (not shown) therein that is designed to create a seal around a laparoscopic surgical instrument or the like, for example surgical scissors  40 , engaged into the trocar port  25  during a surgical procedure. The valve seals the outlet end  28  of the port  25  from the atmosphere during the laparoscopic surgical procedure. The trocar port  25  includes a shallow plastic inlet portion  23  at a proximal end thereof, having a concaved surface  23   a  that includes an inlet aperture  24  at a centre thereof. The inlet aperture  24  is in communication with the conduit  26  for admission of the surgical scissors  40  or the like into the trocar port  25 , through the valve and thereafter into the trocar cannula  21  and into the abdominal cavity  1 . 
     A CO 2  port  33  extends from one side of the trocar port  25 . The CO 2  port  33  is in fluid communication with a CO 2  conduit  34  that extends from the CO 2  port  33  and through the plastic body of the trocar port  25  to the outlet end  28  thereof. The CO 2  conduit  34  is also in fluid communication with the trocar cannula  21 . During a laparoscopic procedure, a CO 2  supply  29  is connected to the CO 2  port  33  for providing CO 2  to the abdominal cavity  1 . The abdominal cavity  1  is insufflated with the carbon dioxide gas in order to maintain the abdominal cavity wall away from the operation site  5 . This creates a working and viewing area around the operation site  5  within the abdominal cavity  1 , remote from the incision  10 . The valve, in sealing the outlet end  28  of the trocar port  25  from the atmosphere, prevents the egress of CO 2  gas from the trocar port  25  to the atmosphere during the laparoscopic surgical procedure. 
     A laparoscopic guide  50  is attached to the inlet portion  23  of the trocar port  25  for guiding the surgical scissors  40  or other surgical instrument or laparoscopic tool into the inlet aperture  24  of the concaved surface  23   a  of the trocar port  25  and through the cannula  21 . In the embodiments of  FIGS. 1 and 4 to 8  shown herein, the laparoscopic guide  50  has a generally conical, or funnel, shaped elongate hollow body  52 . The hollow body  52  tapers from the proximal end  55  to a distal end  60  thereof. The distal end  60  is cylindrical in shape and is adapted to push fit over the inlet portion  23  of the port  25  for attachment thereto. 
     The hollow body  52  flares outwardly towards the proximal end  55  and terminates in an open end face through which the surgical scissors  40  are received during the laparoscopic surgical procedure. The hollow body  52  has a longitudinal mid-plane X-X that extends from the proximal end  55  to the distal end  60  of the hollow body  52  as shown in  FIGS. 6 a -6 c    and includes a longitudinal axis of the hollow body  52 . The distal end is defined by a distal end face  60  that, in this embodiment, is an open end face. The distal end face  60  is therefore adapted to communicate with the inlet aperture  24  of the trocar port  25 . The open end face at the proximal end  55  is arranged obliquely relative to the distal end face  60  of the hollow body, as best seen in  FIGS. 6 a -6 c   . In  FIGS. 6 a -6 c   , the longitudinal mid-plane is a horizontal mid-plane and an angle θ subtended by a plane defined by the open end face of the proximal end  55  and the horizontal mid-plane that will depend on the requirement of the particular surgery. For example, it is envisaged that the angle θ could be more than 45 degrees in some instances, or it may be very low e.g. 10 degrees or less such that the guide takes the form of a shallow scoop, or any suitable angle in between. The oblique open end face of the proximal end  55  is thus larger than would be the case if the opening was parallel to the distal end face  60 . The smaller the angle θ, the larger the opening at the open end face. Consequently, a large area is provided into which the surgical scissors  40  or other instrument or tool can be engaged therein. The tapering of the hollow body  52  towards the distal end  60  quickly guides the surgical scissors into the inlet aperture  24  of the concaved surface  23   a  of the trocar port  25 . The skilled person will note that the surgeon is able to manipulate the surgical scissors  40  through a wide range of movement at the open end face of the proximal end  55  to achieve the desired positioning of the surgical scissors  40  at the operation site  5 . Furthermore, the oblique slant of the open end face of the proximal end  55  of the laparoscopic guide  50  maximises access to the trocar port  25  without limiting the reach of the surgeon when engaging the surgical scissors  40  into the trocar port  25 . 
     The ease of insertion of the surgical scissors  40  into the laparoscopic guide  50  and thereby into the trocar port  25  and trocar cannula  21  allows the surgeon to quickly change instruments and tools without spending valuable time aligning the instruments and tools with the inlet aperture  24  of the trocar port  25 . The surgical scissors  40  can be engaged and removed from the trocar port  25  and cannula  21  in a stable manner. 
     In variations of the laparoscopic guide  50 , the hollow body  52  may have an asymmetrical cross-sectional area as shown schematically in  FIG. 6 a    or other suitably shaped cross-sectional area without departing from the scope of the claimed invention. Furthermore, a shallower angle θ will provide a larger open end face of the proximal end  55  than will a larger angle θ, improving the reach of the surgeon relative to the trocar port  25 . The hollow body  52  can be as long or as short as necessary to stably guide specific surgical instruments into the concaved surface  23   a  of the trocar port  25 . 
     In other variations of the laparoscopic guide  50 , the hollow body  52  may be fully or partially formed from a semi translucent material and internally illuminated by a light source disposed therein such that the surgeon is able to readily locate the hollow body  52  during surgery, especially in the dark. This allows the surgeon to easily insert the surgical scissors  40  or other surgical instrument or laparoscopic tool into the laparoscopic guide  50  and thereby into the trocar port  25  and trocar cannula  21 . In other variations of the laparoscopic guide  50 , the hollow body  52  may be fully or partially formed from a flexible material. 
     In an alternative embodiment of the laparoscopic guide shown in  FIG. 7 , the distal end face  60  of the laparoscopic guide  150  has a pair of quick release clips thereon that releasably clip into corresponding recesses  65  arranged in a proximal surface  67  of the trocar port  125 . The skilled person will appreciate that other suitable means of attaching the laparoscopic guide  150  to the port  125  are also possible. 
     In a further alternative embodiment shown in  FIG. 8 , the laparoscopic guide  250  is formed integrally with the trocar port  225  such that the interior of the hollow body  252  communicates directly with the conduit  226  of the trocar port  225  and the open distal end face  60  is integral with the trocar port  225 . 
     Persons skilled in the art will appreciate that the above specific embodiments described are merely examples of the present disclosure. Persons skilled in the art will appreciate that the various features described in relation to different embodiments may be used in combination or as alternatives. Persons skilled in the art will also appreciate various other modifications and alternatives to the embodiments described.