surgical access device

专利摘要:
SURGICAL ACCESS DEVICE. The present invention relates generally to methods and devices for removing fluid from a surgical instrument. Surgical access devices and sealing systems to create a closed system between the external environment and the environment in which the surgical access device is being inserted. System devices may also include a fluid remover in the form of a sorbent element, a scraper element, a capital effect absorbing element, or any combination thereof that is configured to remove fluid from an operating channel of the device or system and / or a surgical instrument inserted through it.
公开号:BR112013009059B1
申请号:R112013009059-6
申请日:2011-10-12
公开日:2020-11-17
发明作者:Patrick J. Minnelli；Kevin M. Montgomery
申请人:Ethicon Endo-Surgery, Inc.；
IPC主号:

专利说明:

CROSS REFERENCE TO RELATED ORDERS
[0001] This application is a part-continuation of US patent application No. 12 / 533,590, filed on July 31, 2009 and entitled "Surgical Access Devices with Sorbents", which is a part-continuation of: US patent application No. 12 / 110,724, filed April 28, 2008 and entitled "Absorbing Fluids in a Surgical Access Device"; US patent application No. 12 / 110,727, filed on April 28, 2008 and entitled "Scraping Fluid Removal in a Surgical Access Device"; US patent application No. 12 / 110,742, filed on April 28, 2008 and entitled "Wicking Fluid Management in a Surgical Access Device" and US patent application No. 12 / 110,755, filed on April 28, 2008 and entitled " Fluid Removal in a Surgical Access Device ", all of which are incorporated herein, by reference, in their entirety. FIELD OF THE INVENTION
[0002] The present invention relates to methods and devices for performing surgical procedures and, in particular, methods and devices for maintaining visibility during surgical procedures. BACKGROUND OF THE INVENTION
[0003] During laparoscopic surgery, one or more small incisions are formed in the abdomen and a trocar is inserted through the incision to form a route that provides access to the abdominal cavity. The trocar is used to introduce various instruments and tools into the abdominal cavity, as well as to provide insufflation to elevate the abdominal wall above the organs. During such procedures, a visualization device, such as an endoscope or laparoscope, is inserted through one of the trocars to allow a surgeon to see the field of operation on an external monitor attached to the visualization device.
[0004] Visualization devices are commonly inserted and removed through a trocar several times during a single surgical procedure, and during each insertion and removal they can find fluid that can adhere to the lens of the devices and totally or partially prevent visibility through the lens. In addition, a device can pull fluid from inside the patient's body and into the trocar, where fluid can be deposited until the device or other instrument is reinserted through the trocar. Upon reinsertion, the fluid can adhere to the lens of the devices. The device lens therefore needs to be cleaned to restore visibility, commonly several times during a single surgical procedure. With limited access to just one device on the body, each lens cleaning may require removing the device from the body, cleaning the lens fluid from the device, and reintroducing the device into the body. Such lens cleaning is a lengthy procedure that also increases the chances of complications and contamination through repeated insertion and removal of the device.
[0005] Consequently, there is a need for methods and devices to maintain clear visibility through a lens of a viewing device during a surgical procedure. SUMMARY OF THE INVENTION
[0006] The present invention in general provides methods and devices for preventing fluid from being deposited on and / or for removing fluid from a surgical instrument. In one embodiment, a surgical access device is provided and may include a compartment that defines an operating channel sized and configured to receive a surgical instrument. An insufflation port can be formed in the compartment and can be configured to deliver an insufflation gas to the operating channel. In addition, a seal can be arranged inside the compartment and can be positioned proximal to the inflation port. In some embodiments, the seal can be configured to receive a surgical instrument that has passed through the operating channel.
[0007] A fluid remover can be placed inside the compartment and can be positioned distally to the inflation port. The fluid remover can have many configurations, for example, the fluid remover can have an external perimeter mounted inside the compartment and a central opening configured to receive surgical instruments through it. In some embodiments, the outer perimeter may be in a sealing fit with the compartment. The fluid remover can be configured to allow the insufflation gas to pass through when an instrument obstructs the central opening. The fluid remover can be, for example, a scraper configured to scrape fluid from inserted surgical instruments through the central opening.
[0008] In some embodiments, the scraper may include a capillary-absorbing element formed therefrom and configured to absorb fluid capillarity away from the central opening in the scraper. The capillarity-absorbing element can have many different configurations, for example, the capillarity-absorbing element can be in the form of a plurality of channels formed on a distal surface of the scraper and extending radially out of the central opening of such so that the scraped fluid from a surgical instrument can flow into the channels. The fluid remover may also include a sorbent disposed distal to the scraper and configured to receive fluid scraped by the scraper. In one embodiment, the fluid remover may include a hole formed therein and positioned at a distance from the central opening and external doperimeter. The orifice can be configured to allow the insufflation gas to pass through it.
[0009] As will be understood by the individual of ordinary skill in the art, the compartment can have many configurations. In one embodiment, the compartment may include a proximal compartment portion and a distal compartment portion that has a cannula extending distally thereto. The proximal and distal compartment portions can be arranged around an inner retainer, and the operating channel can extend through the inner retainer and cannula. The outer perimeter of the fluid remover may be in a sealing fit with the inner retainer and the distal compartment portion. In some embodiments, the seal can be captured between the inner retainer and the proximal compartment portion.
[00010] The distal cannula may include an angled distal surface that has a more distal point and a more proximal point. In some embodiments, the most distal point may be aligned with the insufflation port, although it may have any angular orientation as desired. The surgical access device can also include at least one opening formed in an external wall of the compartment that can be configured to receive a suture.
[00011] In other respects, a surgical access device is provided and may include a compartment and a cannula extending distally from the compartment. The compartment and cannula may have an operating channel extending therethrough between a proximal opening formed at a proximal end of the compartment and a distal end of the cannula. The operating channel can be sized and configured to receive a surgical instrument. An insufflation port can be attached to the compartment and configured to receive and distribute an insufflation gas to the operating channel. In addition, a seal can be arranged inside the compartment and configured to substantially prevent the passage of an insufflation gas from the insufflation port to the proximal opening when no surgical instrument is disposed through it.
[00012] In some embodiments, a fluid remover can be disposed inside the compartment and can be positioned distally to the seal. The fluid remover may have an outer perimeter in a sealing fit with the housing. The fluid remover may also have a central opening formed through it positioned to receive a surgical instrument that has passed through the operating channel. In addition, the fluid remover may include a hole formed there between the central opening and the outer perimeter that is configured to allow the inflation gas to pass from the inflation port to the cannula when an instrument is disposed through and obstructs the central opening in the fluid remover.
[00013] Although the fluid remover can have many configurations, in one embodiment, the fluid remover can be a scraper configured to scrape fluid from a surgical instrument that has passed through the opening. The surgical access device may also include a sorbent disposed within the compartment at a location distal to the scraper. The sorbent can be configured to sip fluid removed by the scraper. In some embodiments, the surgical access device may additionally include a capillary-absorbing element formed in the scraper and configured to capillarily absorb fluid from the central opening in the scraper. The sorbent can have, for example, a central opening formed through it and can be axially aligned with the central opening in the scraper. In one embodiment, the central opening in the sorbent may have a diameter greater than the diameter of the central opening in the scraper. The inflation port can be positioned anywhere inside the compartment, for example, the inflation port can be positioned proximal to the fluid remover.
[00014] Although the compartment can have many configurations, in one embodiment, the compartment can include a portion of a proximal compartment and a portion of the distal compartment arranged around an internal retainer. The operating channel can extend through the inner retainer, and the outer perimeter of the fluid remover can be in a sealing fit with the inner retainer. The proximal opening can be formed in the proximal compartment. In some embodiments, the internal retainer can be captured between the proximal and distal compartment portions.
[00015] In additional aspects, methods are also presented. For example, a method for removing fluid from a surgical access device is provided and may include inserting a surgical access device through the tissue such that the surgical access device provides an operating channel extending through the tissue and into a body cavity. In addition, a surgical instrument can be inserted through the operating channel of the surgical access device in such a way that a central opening formed in a scraper disposed inside the operating channel engages a circumference of the surgical instrument. The method may additionally include distributing an insufflation gas through an insufflation port on the surgical access device to inflate the body cavity. The insufflation gas can pass through a hole formed in the scraper.
[00016] In some embodiments, inserting a surgical instrument through the operating channel of a surgical access device may include inserting a surgical instrument through a seal in an operating channel of a surgical access device that extends into a body cavity. The seal can move from a closed position in which the operating channel is sealed to an open position while the surgical instrument passes through. In addition, a fluid remover disposed distal to the seal can scrape fluid from the surgical instrument and invert proximally to transfer the fluid away from the surgical instrument. The fluid scraped by the scraper can be transferred to a sorbent.
[00017] In other respects, a method for reprocessing a surgical access device is provided and includes removing a scraper from a surgical access device, cleaning the scraper, treating a surface of the scraper with a surfactant, and replacing the scraper on the device surgical access. In some embodiments, the surfactant may be sodium dodecyl benzene sulfonate or sodium dodecyl sulfate. In other embodiments, the scraper may be formed from a hydrophobic material such as a polyisoprene.
[00018] Still in additional aspects, a method for reprocessing a surgical access device is provided and includes removing a first sorbent from a surgical access device, treating a second sorbent with a surfactant, and replacing the first sorbent with the second sorbent in the surgical access device. In some embodiments, the surfactant may be sodium dodecyl benzene sulfonate or sodium dodecyl sulfate.
[00019] In another aspect, a fluid remover for use in a surgical access device is provided and may include a compartment that defines an operating channel sized to receive a surgical instrument, an insufflation port arranged in the compartment, and a seal proximal to the deflation port. In some embodiments, the fluid remover may include a fluid removal member that has an outer perimeter and a central opening formed therein to receive and seal around a surgical access device. The fluid removal member can also have an orifice disposed radially out of the central opening and radially into the outer perimeter and can be configured to allow the insufflation gas to pass through it. BRIEF DESCRIPTION OF THE DRAWINGS
[00020] The invention will be more fully understood from the following detailed description, taken in conjunction with the accompanying drawings, in which:
[00021] Figure 1A is a perspective view of an embodiment of a trocar;
[00022] Figure 1B is an exploded view of the trocar in Figure 1 A;
[00023] Figure 1C is a cross-sectional view of a portion of the trocar in Figure 1A;
[00024] Figure 1D is a bottom perspective view of an instrument seal assembly for use with the trocar in figure 1A;
[00025] Figure 1E is an exploded view of the instrument sealing assembly of figure 1D;
[00026] Figure 1F is a perspective view of a trocar seal in Figure 1A;
[00027] Figure 1G is a bottom perspective view of an embodiment of a scraper for a fluid removal set for use with the trocar of figure 1 A;
[00028] Figure 1H is a perspective view of an embodiment of a sorbent wick of a fluid removal set for use with the trocar in figure 1A;
[00029] Figure 11 is a perspective view of a sorbent element of a fluid removal assembly for use with the trocar of Figure 1 A;
[00030] Figure U is a perspective view of a structure for housing the sorbent element of Figure 11;
[00031] Figure 1K is a perspective view of a cap portion of a fluid removal assembly for use with the trocar in Figure 1A;
[00032] Figure 2A is a cross-sectional view of a proximal portion of another embodiment of a trocar;
[00033] Figure 2B is an exploded view of the trocar in figure 2A;
[00034] Figure 3A is an exploded view of a portion of a trocar that has a drop in fluid assembly;
[00035] Figure 3B is an exploded view of the drop-in fluid removal assembly of figure 3A;
[00036] Figure 3C is a cross-sectional view of a trocar in figure 3A;
[00037] Figure 4A is an exploded view of an embodiment of a scraper assembly for scraping fluid;
[00038] Figure 4B is a bottom perspective view of the scraper assembly of figure 4A;
[00039] Figure 4C is a top perspective view of the scraper assembly of figure 4A;
[00040] Figure 5A is a perspective view of another embodiment of a fluid removal assembly that has a scraper nested within a sorbent element;
[00041] Figure 5B is a top view of the fluid removal assembly of figure 5A;
[00042] Figure 5C is a cross-sectional view of the fluid removal assembly of Figure 5A disposed within a trocar compartment;
[00043] Figure 6A is a cross-sectional view of a trocar that has the modality of a scraper to scrape fluid from a surgical instrument that passes through it;
[00044] Figure 6B is a cross-sectional view of a trocar that has another modality of a scraper for scraping fluid from a surgical instrument that passes through it;
[00045] Figure 6C is a cross-sectional view of a trocar that has yet another modality of a scraper for scraping fluid from a surgical instrument that passes through it;
[00046] Figure 7 is a cross-sectional view of another embodiment of a trocar compartment that has sorbent membrane doors positioned adjacent to a zero closing seal;
[00047] Figure 8 is a cross-sectional view of yet another modality of a trocar compartment that has capillary absorption fingers attached to a sorbent reservoir;
[00048] Figure 9 is a cross-sectional view of an embodiment of a trocar compartment that has a sorbent element disposed therein;
[00049] Figure 10A is a cross-sectional view of an embodiment of a zero-closing seal that has extension members for absorption by capillary fluid effect;
[00050] Figure 10B is a transparent perspective view of the seal in Figure 10A;
[00051] Figure 11 is an exploded view of another type of fluid removal assembly that has a sorbent element nested between the first and the second zero closing seal;
[00052] Figure 12A is a cross-sectional view of yet another embodiment of a sorbent element that has two sorbent bars arranged within a zero closing seal;
[00053] Figure 12B is a transparent perspective view of the sorbent element and the seal of figure 12A;
[00054] Figure 13 is an exploded view of an embodiment of a trocar compartment that has a scraper for scraping fluid from a surgical instrument that passes through it;
[00055] Figure 14 is a cross-sectional view of an embodiment of a trocar cover that has a scraper for scraping fluid from a surgical instrument that passes through it;
[00056] Figure 15A is a top view of a trocar cover that has another embodiment of a scraper for scraping fluid from a surgical instrument that passes through it;
[00057] Figure 15B is a side perspective view of the trocar cover of figure 15A;
[00058] Figure 16 is an exploded view of an embodiment of a multilayer seal that has a sorbent element disposed between the layers;
[00059] Figure 17 is a bottom perspective view of an embodiment of a trocar cover that has a sorbent element disposed thereon;
[00060] Figure 18A is a bottom perspective view of an embodiment of a capillary absorption element formed in a portion of a seal protector to create between the seal protector and a seal;
[00061] Figure 18B is a top perspective view of the seal protector portion of figure 18A;
[00062] Figure 19A is a top view of a multilayer protective member that has ribs of flesh;
[00063] Figure 19B is a top view of a layer of the protective member of Figure 19A;
[00064] Figure 20A is a side perspective view of a deep cone instrument seal that has capillary absorption tabs formed on an external surface;
[00065] Figure 20B is a top perspective view of another embodiment of a deep cone instrument seal that has capillary effect absorption tabs formed on an internal surface;
[00066] Figure 21 is a perspective view of a multilayer protective element that has holes formed therein to receive fluid;
[00067] Figure 22A is an exploded view of a multilayer protective element;
[00068] Figure 22B is a cross-sectional view taken through line B-B of one of the protective elements of figure 22A;
[00069] Figure 23A is a side view of an embodiment of a seal that has an hourglass configuration for scraping fluid from a surgical instrument;
[00070] Figure 23B is a side view of the seal in Figure 23A showing an instrument passed through it;
[00071] Figure 24A is the cross-sectional view of an embodiment of a trocar cannula that has overlapping scrapers and a sorbent disposed therein;
[00072] Figure 24B is an enlarged view of one of the scrapers and sorbents in Figure 24A;
[00073] Figure 25 is a perspective view of another embodiment of a scraper for scraping fluid from a surgical instrument shown passed through it;
[00074] Figure 26 is a perspective view of another modality of a device for scraping fluid from a surgical instrument;
[00075] Figure 27A is an exploded view of a trocar and removable cover for scraping fluid from a surgical instrument;
[00076] Figure 27B is a side view mounted from a distal end of the trocar and the removable tip of figure 27A;
[00077] Figure 27C is a perspective view of the removable point and distal end of the trocar in figure 26B;
[00078] Figure 28 is a partially transparent side view of an embodiment of the capillary absorption element that has an hourglass shape;
[00079] Figure 29 is a perspective view of a trocar that has a cannula with grooves formed in it for absorption by capillary fluid effect from the cannula;
[00080] Figure 30A is a perspective view of another embodiment of a trocar that has a proximal compartment and a distal cannula;
[00081] Figure 30B is a side view in cross section of the trocar in figure 30A;
[00082] Figure 30C is a perspective view of an instrument seal assembly, a channel seal, a fluid removal assembly and a trocar insufflation port of figure 30A;
[00083] Figure 30D is a side view in cross section of the fluid remover and the inflation port of figure 30C;
[00084] Figure 30E is a perspective view of a fluid remover of figure 30C;
[00085] Figure 30F is an exploded view of the fluid remover of figure 30E showing a cap, scraper, crown and sorbent;
[00086] Figure 30G is a bottom perspective view of a scraper in Figure 30F showing channels formed therein;
[00087] Figure 30H is a cross-sectional view of one of the scraper channels in Figure 30G;
[00088] Figure 301 is a top view of a cover of figure 30F;
[00089] Figure 30J is a bottom view of the cover of figure 33I; and
[00090] Figure 31 is a bottom view of another embodiment of a cap for use with a fluid removal assembly;
[00091] Figure 32A is a perspective view of another embodiment of a trocar;
[00092] Figure 32B is a side perspective view of an instrument seal, a channel seal, a fluid remover and a trocar insufflation port of figure 32A;
[00093] Figure 32C is a side view of the fluid remover and the inflation port of figure 32B;
[00094] Figure 32D is a side perspective view of the fluid remover of figure 32C;
[00095] Figure 33A is a perspective view of another embodiment of a trocar that has a fluid removal system provided therein;
[00096] Figure 33B is a cross-sectional view of the trocar in Figure 33A showing an example sealing system and fluid removal system;
[00097] Figure 34A is a perspective view of an embodiment of a proximal compartment of the trocar in figure 33A;
[00098] Figure 34B is another perspective view of the proximal compartment of figure 34A;
[00099] Figure 35A is a perspective view of a modality of a distal compartment of the trocar in figure 33A;
[000100] Figure 35B is a perspective cross-sectional view of the distal compartment of figure 35A;
[000101] Figure 36 is an exploded view of the sealing system and the fluid removal system of the trocar in Figure 33A;
[000102] Figure 37A is a perspective view of an exemplary seal retainer for the trocar in Figure 33A;
[000103] Figure 37B is a cross-sectional view of the seal retainer of Figure 37A;
[000104] Figure 37C is a perspective view of another exemplary seal retainer for use in the trocar in figure 33A;
[000105] Figure 38A is a bottom view of an example scraper and capillarity absorber for use in the trocar in Figure 33A;
[000106] Figure 38B is a top view of the scraper of figure 38A;
[000107] Figure 38C is a top view of the scraper of Figure 38A seated inside an exemplary distal compartment; and
[000108] Figure 39 is a perspective view of an exemplary sorbent for use in the trocar in figure 33A. DETAILED DESCRIPTION OF THE INVENTION
[000109] Certain exemplary modalities will now be described to provide a general understanding of the principles of structure, function, manufacture and use of the devices and methods described here. One or more examples of such modalities are illustrated in the attached drawings. Those skilled in the art will understand that the devices and methods specifically described and illustrated in the accompanying drawings are exemplary non-limiting embodiments, and that the scope of the present invention is defined only by the claims. The characteristics illustrated or described in connection with an exemplary modality can be combined with the characteristics of other modalities. It is our intention that such modifications and variations are within the scope of the present invention.
[000110] The present invention in general provides methods and devices for maintaining clear visibility through a display device during surgical procedures, and in particular, methods and devices are provided for removing fluid from an access device and / or surgical instrument passed, for example, inserted and / or removed, through an access device, and / or to prevent fluid from being transferred in a display device that passes through an access device. In certain exemplary embodiments, the methods and devices are effective for removing fluid from an access device and / or surgical instrument as the instrument is being removed from the access device, thereby preventing fluid from being deposited in an instrument being inserted through the device access. However, methods and devices can be configured to remove fluid prior to and / or during insertion and / or removal.
[000111] A person skilled in the art will realize that the term fluid, for use in the present invention, is intended to include any substance that, when in a surgical instrument, may adversely affect the operation of the instrument or the ability of a surgeon to use it. Fluids include any type of body fluid, such as blood, and any type of fluid introduced during a surgical procedure, such as saline. Fluids also include fluid / solid mixtures or fluids with particles (such as pieces of fabric) suspended or located therein, as well as viscous materials and gases. A person skilled in the art will also realize that the various concepts presented in the present invention can be used with various surgical instruments during various procedures, however in certain exemplary embodiments the invention is particularly useful during laparoscopic procedures, and more particularly during procedures in which a device visualization, such as a laparoscope or endoscope, passes through a surgical access device, such as a trocar, which provides a route from an incision in the skin to a body cavity. As previously explained, during such procedures the repeated insertion and removal of the visualization device can deposit fluid within the access device, thus causing the fluid to be transferred back to the distal visualization end of the visualization device on reinsertion through the same. Various methods and exemplifying devices are provided here to prevent such an occurrence.
[000112] In certain exemplary embodiments, the methods and devices presented here use a fluid remover that is effective for removing fluid from an access device and / or surgical instrument passed through it. While the fluid remover can have multiple configurations and can work in various ways to remove fluid, exemplary fluid removers include scrapers for scraping fluids, sorbents for absorbing fluid and capillary absorption elements for redirection or capillary fluid absorption , for example, by capillary action. Any combination of fluid removers can be provided, and fluid removers can be arranged in multiple locations on an access device to remove fluid from portions of the access device and / or surgical instruments, such as visualization devices, passed through the access device. The particular location of the fluid removers may depend on the particular configuration of the access device and / or surgical instrument.
[000113] In certain exemplary embodiments, the fluid remover may include one or more sorbents. The sorbent can be any insoluble (or at least partially insoluble) material or mixture of materials that are capable of absorbing fluids or capturing fluids through a process of either or both absorption and adsorption. A sorbent material or element can therefore include any or a combination of absorbent materials and / or adsorbent elements and materials and / or elements. In certain exemplary embodiments, the sorbent is formed from a hydrophilic material and / or includes a hydrophilic material to facilitate fluid reception. For example, the sorbent can be coated using known coating techniques during manufacture to make one or more portions of the sorbent hydrophilic. In one embodiment, the sorbent can be formed by any extrusion process in which, for example, the fibers can all extend longitudinally in a direction generally parallel to a longitudinal axis of the cylindrical tube, as shown in figure 30F. The fibers will thus form a generally cylindrical hollow tubular member, which can subsequently be cut to form a plurality of sorbents. A gap or cutout in the side wall can also be made to form a C-shaped sorbent, or the sorbent can be formed to have a C-shaped configuration without the need to make any additional cuts. Exemplary formats and configurations for the sorbent will be discussed in more detail below. A hydrophilic surfactant can be applied to the sorbent, either before or after the sorbent is cut. A person skilled in the art will realize that a variety of techniques can be used to coat the sorbent or portions thereof with a hydrophilic material and / or to form the sorbent or portions thereof from a hydrophilic material. The particular hydrophilic material used may also vary, and exemplary materials will be discussed in more detail below in relation to the scraper. The same hydrophilic materials used with the scraper can also or alternatively be used with the sorbent.
[000114] In general, sorbents that are absorbent remove fluid through an absorption process, similar to a sponge, in which a liquid diffuses into the volume and / or structure of the absorbent and becomes a part of that volume and / or structure. For example, the sorbent can capture and retain a liquid distributed through its molecular structure, causing the absorbent to swell. The liquid can cause the solid structure to swell by 50% or more. Typical absorbers are at least 70% insoluble in excess fluid. Absorbents can have any shape, size and shape known in the art as needed to stand alone and / or fit inside, around or through any component of a fluid remover and / or trocar. Certain exemplifying modalities of absorbents include, but are not limited to, crushed wood pulp fluff, cellulose fibers, polymeric gelling agents, hydrophilic nonwoven, cellulose, sodium polycrylate, cotton, polyethylene terephthalate, polyethylene, polypropylene, chloride polyvinyl, ABS, polyamide, polystyrene, polyvinyl alcohol, polycarbonate, ethylene methacrylate copolymer and polyacetal.
[000115] Sorbents that are adsorbent, on the other hand, remove fluid through an adsorption process by retaining a liquid on its surfaces, including pores and capillaries. The liquid accumulates on the surface of an adsorbent by the formation of a film of molecules or atoms that are retained therein as a consequence of surface energy. In some embodiments, an adsorbent material may include one or more insoluble (or at least partially insoluble) materials that can be coated with a liquid on their surfaces. For example, the adsorbent can be a structure formed of insoluble fibers. The structure can be porous, since empty spaces or spaces can be located between the individual fibers. In this way, liquid can accumulate on the surface of the fibers, thus filling the voids between the fibers. Typical adsorbents will absorb fluid without swelling more than 50% in excess liquid. The adsorbents can have any shape, size and shape known in the art as needed to act independently and / or fit inside, around or through any component of a fluid remover and / or trocar. In an exemplary embodiment, the adsorbent is shaped to have a predetermined shape and size. Certain exemplifying adsorbent materials include, but are not limited to, compounds containing carbon-based compounds and / or polymer-based compounds, among others. For example, adsorbent materials can include silica gel, alumina, zeolites, activated carbon, graphite, cellulose, porous polymer matrices, perlite, metal hydroxides, butyrate and nitrate and metal oxide cellulose acetate, polyamide, polysulfone, vinyl polymers, polyesters, polyolefins and PTFE, as well as porous glass or glass ceramics, graphite oxide, polyelectrolyte complexes, alginate gel, etc.
[000116] Although the fluid removers disclosed in the present invention can be used with various surgical access devices known in the art, in certain exemplary embodiments a trocar is provided that has one or more fluid removers arranged therein to remove fluid from portions of the trocar and / or an instrument, such as a visualization device, passed through it. A person skilled in the art will realize that a trocar is shown for illustration purposes only, and that virtually any type of access device, including cannulas, ports, etc., can be used. Figures 1A to 1Cilustrate an exemplary embodiment of a trocar 2. As shown, trocar 2 is generally in the form of a compartment 6 that has a proximal portion (also referred to in the present invention as a proximal compartment) that can accommodate one or more sealing elements and a distal cannula 8 that extends distally from the proximal compartment 6. Trocar 2 defines an operating channel 4 that extends through it to introduce various instruments into a body cavity. Numerous configurations are available for the proximal compartment 6. In the illustrated embodiment, the proximal compartment 6 has a generally cylindrical shape with a removable lid portion 5 and an inner side wall 3. An opening 7 can be formed within the proximal end of compartment 6 , so that the opening 7 extends through the removable cover 5 and through the remainder of the compartment 6 and is coaxial with the operating channel 4 that extends through the cannula 8. The cannula 8 can also have several configurations, and can include several characteristics known in the art. In the illustrated embodiment, the cannula 8 has a generally elongated cylindrical shape and includes a series of annular ridges 9 formed on an external surface 10 thereof. The opening 7 extending through the proximal compartment 6 and the cannula 8 defines the operating channel 4 which is sized and configured to receive a surgical instrument. One skilled in the art will appreciate that compartment 6 and cannula 8 can be formed as a unitary structure or as two separate components that are paired with each other. The compartment 6 may also include other features, such as a stop-cock regulating valve 13 to allow and prevent the passage of an insufflation fluid, for example, carbon dioxide, through the trocar 2 and into a body cavity.
[000117] In use, the distal cannula 8 can be inserted through an incision in the skin and through the tissue to position a more distal end within a body cavity. The proximal compartment 6 can remain external to the body cavity, and several instruments can be inserted through the operating channel 4 and into the body cavity. Typically, during surgical procedures in a body cavity, such as the abdomen, insufflation is provided through trocar 2 to expand the body cavity to facilitate the surgical procedure. Thus, in order to maintain insufflation within the body cavity, most trocars include at least one seal arranged there to prevent air leakage. Various seal configurations are known in the art, but trocar 2 typically includes an instrument seal that forms a seal around an instrument disposed therethrough, but otherwise does not form a seal when no instrument is disposed through it; a channel seal (also referred to in this document as a zero closing seal) that seals the operating channel 4 when no instrument is disposed through it; or a combination of instrument seal and channel seal that is effective both for forming a seal around an instrument disposed therethrough and for forming a seal on the operating channel 4 when no instrument is disposed through it. In the embodiment shown in figures 1A to 1C, trocar 2 includes an instrument seal 14 and a separate channel or zero closure seal 24. However, a person skilled in the art will realize that several other seals known in the art can be used including , for example, membrane valves, gel seals, diaphragm seals, etc.
[000118] In an exemplary embodiment, as shown in figures 1C to 1E, the seal of the instrument 14 is generally in the form of a multilayer conical seal 16 and a multilayer protection member 18 disposed on a proximal surface 15 of the seal 16. As it is best shown in figure 1E, the multilayer conical seal 16 may include a series of overlapping seal segments 20 which are mounted in an interlaced arrangement to provide a complete seal body. The sealing segments 20 can be stacked on top of each other or interlocked together in an overlapping manner to form the multilayer seal 16 which has a central opening 17 therein. The sealing segments 20 can be produced from any number of materials known to those skilled in the art, but in an exemplary embodiment, the sealing segments 20 are formed from an elastomeric material. The seal segments 20 can also be shaped so that they have a variable thickness along the seal profile 16. Varying the thickness along the seal profile 16 can be effective in minimizing leakage and reducing drag forces on the instrument . The multilayer protection member 18 can similarly be formed from a series of overlapping segments 22 which are placed close to the overlapping sealing segments 20 and which are configured to protect the sealing segments 20 from damage caused by surgical instruments passing through the opening 17 in the seal 16. The protective member 18 can also be formed from various materials, but in certain exemplary embodiments the protective member 18 is formed of a molded thermoplastic polyurethane elastomer, such as Pellethane ™. The segments 20 and 22 forming the seal 16 and the protective member 18 can be joined using various techniques known in the art. As shown in figures 1D and 1E, segments 20 and 22 are held together by several ring members that pair to engage segments 20 and 22 between them. In particular, the protective member 18 is meshed between a crown 26 and a trim ring 28, and the seal 16 is meshed between the trim ring 28 and a retainer ring 30. Pins 32 are used to pair the members of the ring 26 and 28 and to extend through and engage the seal segments 16 and the protective member 18.
[000119] When fully assembled, the instrument seal 14 can be arranged in several places within the trocar 2. In the illustrated embodiment, the instrument seal 14 is arranged in the cover 5 of the trocar 2 in a location exactly distant from the proximal opening 7 and proximal to a channel seal, as discussed in more detail below. In use, an instrument can pass through the center of the seal assembly and the seal segments 20, 22 can engage and form a seal around an outer surface of the instrument to thereby prevent fluid from passing through the seal 14. When no instrument is disposed through it, the opening will not form a seal in the operating channel 4, however, other configurations in which a seal is formed when no instrument is placed through it are also conceivable. Exemplary instrument seal configurations are described in more detail in US publication No. 2004/0230161 entitled "Trocar Seal Assembly", filed March 31, 2004, and in US application No. 10 / 687.502, entitled "Conical Trocar Seal ", filed on October 15, 2003, which are incorporated herein by reference in their entirety.
[000120] The zero closing seal in the illustrated embodiment is shown in more detail in figure 1F, and as shown the illustrated zero closing seal is in the form of a duckbill seal 24. Seal 24 is configured to form a seal on the operational channel 4 when no instrument is placed through it to avoid leakage of insufflation gases distributed through trocar 2 into the body cavity. As shown, the duckbill seal 24 has a generally circular flange 34 with a side wall 36 extending distally thereto. The shape of the side wall 36 can vary, but in the illustrated embodiment, the side wall 36 includes opposite flaps 35 that extend at an angle towards each other in a distal direction and that join at one distal end to form a face. seal 38. Opposite flaps 35 are movable relative to each other to allow the seal face 38 to move between a closed position, in which no instrument is disposed through it, and the seal face 38 seals the operating channel 4 of trocar 2, and an open position in which an instrument is arranged through it. The seal may include several other features, as described in detail in US application No. 11 / 771,263, entitled "Duckbill Seal with Fluid Drainage Feature", filed on June 29, 2007, which is incorporated herein in its entirety for reference .
[000121] According to the present disclosure the general structure of the seals, as well as the trocar, generally does not form part of the present invention. As such, a person skilled in the art will certainly realize that various seal configurations, as well as several trocars, can be used without departing from the spirit of the invention presented in the present invention.
[000122] As indicated above, a fluid remover can be placed inside trocar 2 to remove fluid from a seal and / or a surgical instrument that extends through the seal. As best shown in figures 1B and 1C, the illustrated trocar2 includes a fluid removal assembly 40 that is disposed within the proximal compartment 6 of trocar 2 at a location distal from the duckbill seal 24. The fluid removal assembly 40 includes a scraper for scraping fluid from a surgical instrument that passes through operating channel 4 in trocar 2, and a sorbent to absorb the fluid removed. The scraper may also include a capillary absorption characteristic to absorb capillary fluid from the opening in the scraper, and / or the sorbent may include a capillary absorption characteristic to absorb capillary fluid from the scraper.
[000123] The components of the fluid removal set 40 are shown in more detail in figures 1G to 1K, and as shown, the set generally includes a cover 42 (figure 1K), a scraper 44 (figure 1G), a sorbent wick 46 (figure 1H), sorbent cartridges 48 (figure 11), and a housing or frame 50 (figure 1J). When fully assembled, fluid removal set 40 is configured to scrape fluid from surgical instruments that pass through operating channel 4 of trocar 2, to capillarly remove scraped fluids and to sip them, thus preventing fluids from being redeposited in the instrument through reinsertion through the operational channel.
[000124] Referring first to figure 1G, the scraper 44 can have a variety of configurations, however in an exemplary mode, as shown, the scraper has a generally flat configuration with a circular shape. A central opening 52 is formed through a central portion thereof and is sized and configured to receive a surgical instrument through it. In use, the central opening 52 can be coaxial with the openings in the instrument and the channel seals. Scraper 44 can be formed from various materials, but in an exemplary embodiment, the scraper is formed from polyisoprene to allow scraper 44 to engage and scrape fluid from any instrument passed through it. As further shown in Figure 1G, a distal face surface 54 of the scraper 44 can include a plurality of channels 56 formed therein and extending radially outward from the central opening 52, or from a location exactly radially outward, but adjacent to the opening central 52. The channels 56 can be configured so that the scraped fluid from an instrument through the central opening 52 will flow into the channels 56 and thus be removed by capillarity of the opening 52.
[000125] As indicated above, the fluid removal assembly 40 may also include a sorbent wick 46. As shown in figure 1H, in an exemplary embodiment the sorbent wick 46 has a generally flat circular portion 62 with a central opening 58 formed therethrough. . The central opening 58 can have a diameter slightly larger than a diameter of the central opening 52 in the scraper 44, and it can be configured to be coaxially positioned with the opening 52 in the scraper 44. As additionally shown in figure 1H, the sorbent wick 46 it may also include one or more side walls 60 extending from the planar circular portion 62. The illustrated side walls 60 extend proximally, however they may extend distally depending on the particular configuration of the wick 46. The side walls 60 may configured to fit within the inner side wall 3 of the trocar compartment 6. In use, the sorbent wick 46 can absorb by capillarity and sip fluid from the central opening 52 inside the scraper 44, and it can distribute the fluid to the sorbent cartridges 48, as discussed in more detail below. The sorbent wick 46, as well as several other sorbent members shown in the present invention, can be formed from a variety of sorbent materials as described above.
[000126] The sorbent cartridges 48 are shown in more detail in figure 11, and as shown, each of the cartridges 48 has a generally semicircular shape with a width, as measured from an inner surface 64 to an outer surface 66, which decreases in a proximal to distal direction to form wedge-shaped members 68. Together, the cartridges 48 can have an annular configuration. In use, cartridges 48 can absorb fluid from the sorbent wick 46, thus storing the fluid away from any instrument that passes through operating channel 4. Cartridges 48 can be contained within trocar 2 by a housing or frame 50, as shown in figure 1J. The structure 50 may have a generally cylindrical configuration with an opening 68 extending through it, and a plurality of ridges 70 projecting radially outwardly and extending axially along an outer surface 72 thereof. Each sorbent cartridge 48 can be mounted between two ridges. In use, structure 50 can be particularly advantageous, since it can protect the sorbent from coming into contact with instruments that pass through the operating channel.
[000127] When totally together, the scraper 44 can be seated inside the sorbent wick 46, which can rest on the top of the structure 50 that holds the sorbent cartridges 48. The cover 42, shown in figure 1K, can be seated on the top of the scraper 44 and within the sorbent wick 46, and the cap 42 can lock on the structure 50, thus holding the fluid remover assembly 40 together. With reference to figure 1C, the whole as a whole 40 can rest within the proximal compartment 6 of the trocar 2 exactly distal from the duckbill seal 24. As a result, when an instrument, such as a visualization device, passes through the operating channel 4 of trocar 2, any fluid in the instrument will be removed from the side walls of the instrument by scraper 44. The fluid will flow through channels 56 and / or be removed by capillary opening 52 through the sorbent wick 46, which distributes the fluid to the cartridges sorbents 48. As a result, when the instrument is removed, for example, the fluid will be prevented from being deposited on the seal of the instrument 14, thus preventing the fluid from being transferred from the seal of the instrument 14 back into the instrument by reinsertion.
[000128] Figures 2A and 2B illustrate yet another embodiment of a fluid removal assembly 80 that is similar to the embodiment shown in figure 1A. In this embodiment, the proximal compartment 79 of the trocar has a structure 82 which is molded into the internal side wall 81 of compartment 79 for the direct placement of a sorbent, a scraper and a lid, thus eliminating the need for a structure 50 of figure 1J . A single sorbent element 86 is also provided, instead of a separate sorbent wick and sorbent cartridges. In particular, the sorbent element 86 in this embodiment has a generally cylindrical configuration with a distal portion 88 that tapers inwardly to an outer surface 87 thereof to conform with the inner surface 81 of the proximal compartment 79 of the trocar. A recess 90 can be formed around an inner surface 92 of a proximal end 93 of the sorbent element 86 to seat a scraper 94, which can have a configuration that is the same or similar to the scraper 44 described above with reference to figure 1G. The recess 90 can engage an outer perimeter 96 of the scraper 94 so that the channels 56 in the scraper 94 can distribute fluid away from the opening 52 inside the scraper 94 to the sorbent element 86 surrounding the scraper 94. A cap 98 can sit on top of the scraper 94 and may include a flange 99 that extends around the proximal end 93 of the sorbent element 86. The cap 98 can engage the inner side wall 81 of the proximal compartment 79 of the trocar to retain the scraper 94 and the sorbent element 86 in the same in a location exactly distant from the duckbill seal 24. In use, the instruments that pass through the operating channel 4 of the trocar will be engaged by the scraper 94, which scrapes fluid from the external surface of the instrument. The fluid is removed by capillarity of the opening 52 inside the scraper 94 through the channels 56, which distribute the fluid to the sorbent element 86 surrounding the scraper 94. In this way, similarly to the modality of figure 1A, when the instrument is removed, for example, it will be prevented that the fluid is deposited on the seals and, in particular, the seal of the instrument 14, thus preventing fluid from being transferred from the seal of the instrument 14 back into the instrument by reinsertion.
[000129] A person skilled in the art will realize that fluid removal sets 40 and 80 can have a variety of other configurations. Figures 3A and 10B illustrate additional exemplary modalities of fluid removers, for example, scrapers, sorbents and capillary absorption elements, or combinations thereof. In these modalities, the fluid removers are all located distally from the channel seal, for example, duckbill seal or other zero closing seal, and distal from the instrument seal 14. However, a person skilled in the art will realize that the The particular location of the fluid remover can vary and fluid removers can be positioned anywhere within the trocar.
[000130] Figures 3A to 3C illustrate one embodiment of a fluid removal set 100 having a scraper and a sorbent. In particular, as best shown in figure 3B, fluid removal set 100 may include a stabilizing cup 106 coupled to a flange 108. The stabilization cup 106 can be formed of an absorbent material and the flange 108 can seat the cup 106 within the proximal compartment 6 of the trocar 2, as shown in figure 3C. A scraper element in the form of a scraper disk 102 can be positioned between the flange 108 and the stabilization cup 106, and a sorbent ring 104 can be coupled to a distal surface 103 of the scraper disk 102. The scraper disk 102 can have a central opening 105 that extends through it and configured to scrape fluid from surgical instruments that pass through operating channel 4 of trocar 2. As an instrument passes through operating channel 4, fluid can be scraped by the scraper disk 102 and absorbed by the ring sorbent, as well as the stabilization cup. As can be seen in figure 3B, each of the flange 108, scraper disk 102 and the sorbent ring 104 can optionally include cuts 110 to fit around the stop-cock regulator 13 associated with the trocar 2. In use, the set fluid remover 100 can be formed as a drop-in unit that fits inside proximal compartment 6 of trocar 2. As shown in figure 3C, assembly 100 can be accommodated in a distal portion of proximal compartment 6 in a location exactly distant from the duckbill seal 24. The fluid removal assembly 100 will thus remove fluid from the instruments that have passed through operating channel 4 of the trocar, thus preventing fluid from being deposited on the seals, and in particular , in the seal of the instrument 14, and / or redeposited in instruments passed through the operational channel 4.
[000131] Figures 4A to 4C illustrate another embodiment of a fluid removal assembly 114 that is similar to the assembly shown in figures 3A to 3C, however in this embodiment the assembly 114 does not include a stabilizing cup. As shown, the fluid removal assembly includes a substantially planar circular scraper disk 116 which has a central opening 115 for receiving a surgical instrument. The scraper disk 116 can be accommodated within a flange or retainer ring 118 configured to be positioned within the proximal compartment of a trocar. A sorbent ring 120 can be positioned adjacent to a distal surface 117 of the scraper disk 116 and it can act to absorb any fluid that is scraped from instruments passing through the scraper disk 116. When disposed within a trocar, flange 118 can act as a support structure to secure the scraper disk 116 and the sorbent ring 120 in a fixed position within the proximal compartment. Although the position may be distal to the duckbill seal, as indicated above, the assembly may be located in several other portions within the trocar, including between the duckbill seal and the instrument seal, proximal to the instrument seal or within any portion of the cannula.
[000132] In another embodiment, shown in figures 5A to 5C, a fluid removal assembly 122 is provided and may have a generally tapered configuration with a scraper 124 that has a generally proximal planar flange 125 and a tapered body 126 extending distally thereof and defining a central opening 128. The tapered body 126 may have a plurality of slits 127 that extend proximally from a distal end thereof and designed to reduce the forces of insertion and withdrawal in a surgical instrument passing through it. Conical body 126 can be surrounded by a conical sorbent element 130 so that conical body 126 is nested within conical sorbent element 130. When assembled and disposed within a trocar, as shown in figure 5C, flange 125 can be placed inside of the proximal compartment 6 just below the duckbill seal 24 and it can pair with or engage the inner side wall of the compartment 6 to retain the fluid removing assembly therein. In use, as an instrument passes through the operating channel, the scraper 124 can engage and remove fluid from the instrument and the sorbent element 130 can absorb the fluid. A person skilled in the art will realize that any number of geometries can be used in a similar way. Also, a flange size or diameter can be adjusted as needed, or the flange can be removed, to seat the fluid removal assembly in other locations within the trocar.
[000133] Figures 6A to 6C illustrate additional modalities of conical scrapers 132a, 132b and 132c that are similar to the scraper 124 described above and shown in figures 5A to 5C. As with the previous embodiment, scrapers 132a, 132b and 132c in figures 6A to 6C are positioned distally to the duckbill seal 24. Such a configuration can prevent fluid in the instruments from being inserted and / or removed from being deposited in the bill seal. duck, as well as the instrument seal located in a more proximal position 14. In an exemplary embodiment, each scraper 132a, 132b and 132c can be made of a flexible material and can include at least one slot formed in it and configured to allow scrapers 132a, 132b and 132c expand radially. Slots are available in a variety of configurations. In the embodiment shown in figure 6A, a single slot 134 extends diagonally around scraper 132a so that slot 134 follows the shape of the cone. In another embodiment shown in Figure 6B, the multiple slits 137 extend proximally from the distal end of the cone and terminate at a location 139 logodistal to the proximal end. Such a configuration may provide a scraper having multiple scraping segments 138. As additionally shown in Figure 6B, each scraping segment 138 may also include a notch or cutout 140 formed on an outer surface at the distal end thereof to allow segment 138 expand and contact as instruments are passed through. Figure 6C illustrates another exemplary embodiment of a cone shaped scraper 132c. Similar to scraper 132b shown in Figure 6B, scraper 132c includes several slits 142 which extend proximally from its distal end. In this embodiment, however, the slots 142 increase in width in a distal to proximal direction so that each scraping element 143 has a distal end 144 with a width that is greater than the width of a proximal end 145 thereof. As indicated above, in use the slots 134, 137 and 142 formed in the scrapers 132a, 132b and 132c allow the scrapers to expand radially as a surgical instrument is passed through, thus accommodating instruments of various sizes, while still being effective to scrape fluid from the instruments.
[000134] Figure 7 illustrates another embodiment of a fluid remover positioned immediately distal from a channel seal, for example, duckbill seal 150, in a proximal compartment of a trocar. In this embodiment, the fluid remover is in the form of servant membrane ports 152. Membrane ports 152 can have various shapes and sizes, and they can be formed from any number of components. For example, membrane doors 152 can be in the form of two side walls 153 that are movable with each other. The side walls153 may have a profile that is similar to the profile of the duckbill seal 150. In other embodiments, the membrane doors 152 may have a shape that corresponds to the shape of the duckbill seal 150. A person skilled in the art you will notice that several configurations are possible. The membrane doors 152 can be placed inside the proximal compartment 6 and attached to the compartment 6 by any means of attachment known in the art, including by mechanical means, adhesives, etc. The membrane doors 152 can define an opening 154 between them to receive a surgical instrument, and the opening 154 can be positioned just distal from the sealing face 151. In use, the membrane doors 152 can move from a closed position or substantially closed to an open position as an instrument is passed through the duckbill seal 150 and the membrane port 152. Ports 152 can come into contact and engage the surgical instrument as it is passed through them to absorb fluids from the instrument . The membrane ports 152 can also absorb any excess fluid that is scraped from the instrument by the duckbill seal 150 and which is distally from the duckbill seal 150.
[000135] In a similar embodiment, shown in figure 8, the fluid remover can be in the form of an element of absorption by capillary effect instead of a sorbent. In the illustrated embodiment, the capillary absorption element is in the form of first and second capillary absorption fingers 160a and 160b which are coupled to the opposite outer edges 162 of the sealing face 161 on the duckbill seal 163. The capillary-absorbing fingers 160a and 160b can be in the form of elongated elements that follow the natural shape of the inner side wall 165 of the proximal compartment 6 of trocar 2 so that fluid will flow naturally through fingers 160a and 160b. Capillary-absorbing fingers 160a and 160b may also include a sorbent reservoir 164 disposed on a distal end thereof. In the illustrated embodiment, the sorbent reservoir 164 on each finger 160a and 160b is in the shape of a ring placed inside the proximal compartment 6 and effective to absorb the fluids absorbed by the capillary seal 163 by the capillary effect fingers 160a and 160b. The sorbent reservoir 164 may, however, have several other configurations, such as ring segments. In use, as fluids are deposited on the duckbill seal 163 by instruments passing through, the fluid will naturally flow to the outer edges of the seal face 161. The difference in surface between the absorption fingers by capillary effect 160a and 160b and the duckbill seal 24 will cause fluid to flow from seal 163 to fingers 160a and 160b and fingers 160a and 160b into the sorbent reservoir 164. As will be perceived by those skilled in In the technique, capillary-absorbing fingers 160a and 160b can be integrally formed with the duckbill seal 163 or they can simply be in close contact with the sealing face 161 of the duckbill seal 163.
[000136] Figure 9 illustrates another embodiment of a fluid remover that is positioned distal from a zero closing seal. Similar to the embodiment shown in figure 7, the fluid remover is in the form of a sorbent. However, in this embodiment the sorbent is a sorbent insulating ring 172. The insulating ring 172 can have a generally circular or conical configuration with an opening 173 formed through it, as shown, but it can have any number of other geometries to facilitate the passage of an instrument through it. Insulating ring 172 may also include multiple slots 174 formed therein and extending radially outwardly from opening 173 to reduce the forces of insertion and withdrawal in an instrument being passed through it. In use, the insulating ring 172 can be placed inside a distal portion of the proximal compartment 6 of the trocar, just distant from the duckbill seal 166, and the opening 173 can be positioned coaxially with the operating channel 4. According to a surgical instrument passes through it, the insulating ring 172 will contact the instrument and sip any fluid in the instrument. Insulating ring 172 can also absorb any fluid that drips from the duckbill seal 166 as seal 166 scrapes the instrument.
[000137] In other embodiments, the zero closing seal itself can be modified to include a fluid remover. For example, figures 10A and 10B illustrate another embodiment of a duckbill seal 176 in which the sealing face 168 extends distally and is expanded in width to cause the outer ends of the sealing face 168 to come into contact with the inner side wall 169 of the proximal compartment 6 of the trocar, thus forming an absorption element by capillary effect. In use, when an instrument passes through the duckbill seal 176, the sealing face 168 will scrape off the instrument fluid. The fluid will naturally move out towards the outermost edges of the sealing face 168. Since the outer edges are in contact with the inner side wall 169 of the proximal compartment 6, the fluid will be removed by capillary effect from the sealing face 168 and internal side wall 169 of compartment 6. Although not shown, compartment 6 can optionally include a sorbent disposed therein to absorb the fluid removed by absorption by capillary effect of the seal.
[000138] Figure 11 illustrates another embodiment of a modified zero-closing seal 186. In this embodiment, a sorbent element 180 is nested within the duckbill seal 177, and a second duckbill seal 178 is nested within the sorbent element 180. The nested sorbent 180 and the nested duckbill seal 178 can have two sealing walls, 182 and 184 similar to the duckbill seal 177, which are on a sealing face that is configured to form a seal when no instruments are disposed of and that are configured to open when a surgical instrument passes through. The nested sorbent body 180 and the nested duckbill 178 may each have a profile similar or identical to the duckbill seal 177, except smaller in size for all to fit a nested configuration. Components 177, 178 and 180 can be merely sealed within each other, or they can be attached to each other using various clamping mechanisms known in the art, including adjusting the press, glue, etc. In use, the sealing face of all three components will come in contact with a surgical instrument as it passes through the sealing assembly. The sorbent 180 will thus absorb any fluid in the instrument, as well as scraped fluid from the instrument by the duckbill seal 177 and the nested duckbill seal 178.
[000139] Figures 12A and 12B illustrate another embodiment of a modified zero closing seal 190. In this embodiment, the duckbill seal 191 includes two sorbent bars 192 arranged therein and extending therethrough. The sorbent bars 192 can be positioned to extend substantially parallel to the sealing face 193, or to extend substantially perpendicular as shown. The seal 190 may also include a sorbent ring 194 positioned around an inner side wall 193 of the duckbill seal 191 and in contact with the sorbent bars 192. The sorbent ring 194 can provide a reservoir for the fluid collected by the sorbent bars 192 In use, the sorbent bars 192 will contact and engage a surgical instrument as it passes through the duckbill seal 191, and will thus remove fluid by sorption from the surgical instrument.
[000140] As indicated above, the various fluid removing modalities presented in the present invention can be located anywhere within a trocar or other access device, including distal from a channel seal, between a channel seal and a gasket seal. instrument, or proximal to an instrument seal. A position of the fluid remover can also vary in relation to an inflation port, as will be discussed in more detail below. Fluid removers can also be formed integrally with the seal (s) and / or portions of the compartment, and any combination of fluid removers can be used. Figures 13 to 22B illustrate several exemplary modalities of fluid removers that are integrally formed or incorporated into an instrument seal, or located adjacent to an instrument seal and, thus, proximal to a channel seal.
[000141] Turning first to figure 13, in this embodiment the fluid remover 200 is in the form of a combination of scraper and sorbent. In particular, the fluid remover 200 includes a generally flat circular scraper disk 202 that has an opening 204 formed therethrough and configuration to be positioned coaxially with the operating channel 4 in the trocar 2. The opening 204 can be sized and configured to form sealing around an instrument passed through it. Fluid remover 200 can also include a sorbent disk 206 arranged concentrically around opening 204 in scraper 202. In use, scraper 202 will scrape fluid from instruments passing through it, and sorbent 206 will sip off scraped fluid . The fluid remover 200 can be arranged inside the proximal compartment 6 of the trocar 2 using various techniques, but as shown in figure 13, the fluid remover 200 is configured to be engaged between the removable cover 5 and the distal portion of the proximal compartment 6 of trocar 2. As a result, scraper 202 and sorbent 206 will be positioned in alignment with operating channel 4 extending through compartment 6, and will also be positioned between the proximal instrument seal and the distal channel seal.
[000142] Figure 14 illustrates another embodiment of a fluid remover 210 that has a combination of scraper and sorbent, however, in this embodiment the fluid remover 210 is completely disposed within the removable cover 5 containing the seal of the instrument. As shown, a scraper 212 can be cone shaped and can be positioned perfectly distal from the instrument seal. In other embodiments, the scraper 212 may be flat. The scraper 212 can also replace or act as the seal for the instrument. A sorbent ring 214 can be positioned concentrically around and in contact with an opening 216 at the distal end of the conical scraper 212. As a result, the sorbent ring 214 will sip off any fluid by scraping a surgical instrument extending through scraper 212.
[000143] In yet another embodiment, shown in figures 15A and 15B, the fluid remover can be in the form of a scraper that is part of the seal of the instrument 218. As shown, the seal of the instrument 218 is a multilayer seal that has the protector disposed on a proximal surface thereof, as previously described in relation to figure 1E. The scraper may be in the form of a second protector 222 which is disposed distal to the segments of the multilayer seal. The second protector 222 can have the same configuration as the protector in figure 1E, however, the second protector 222 can define an opening 224 that is configured to contact and engage a surgical instrument that passes through the seal 218. Consequently, in In use, the second protector 222 can engage and scrape fluid from instruments that pass through seal 218.
[000144] In another embodiment, shown in figure 16, the fluid remover may be in the form of a multilayer sorbent that is positioned between the multiple layers 20 of the seal 16, as shown, or that is positioned between the multiple layers 22 of the seal protector 18. The sorbent may be in the form of multiple sorbent sheets 232 which are layered between the layers of the seal 16 (or seal protector 18). Thus, in use, when an instrument passes through the instrument seal, the sheets 232 will absorb any fluids removed by scraping the instrument through the seal 14, thus preventing fluid from accumulating around the seal opening 14 and being reapplied to a surgical instrument as it is reinserted through it. Sorbent sheets 232 can be effective for sipping fluid, as well as for interrupting surface tension and / or capillary action between the seal and the protector. Thus, there should be no fluid in or near the sealing opening and / or opening of the protector that will be able to touch or collect an instrument being passed through it.
[000145] Figure 17 illustrates another embodiment of a sorbent fluid remover. In this embodiment, the sorbent is in the form of an insulating ring 242 that has a configuration similar to the insulating ring 172 previously described in relation to figure 9. However, in this embodiment, the insulating ring 242 is positioned adjacent to a distal surface 244 of the instrument seal 14, instead of zero closing seal 24. In particular, as shown in figure 17, the insulating ring 242 can be placed concentrically around a distal opening 246 formed in the removable cover 5, so that instrument passing through the sealing of the instrument 14 they will come in contact with the insulating ring 242, which will remove sorption fluids from the instrument. Insulating ring 242 can also absorb any fluid that is scraped from or drips from the seal of the instrument 14.
[000146] In another embodiment shown in figures 18A and 18B, a capillary-absorbing element is integrally formed with the multilayer seal protector 18 previously described with reference to figure 1E. As previously explained, the multilayer seal 16 may have a natural shape that is slightly tapered and it may include an opening dimensioned to receive an instrument through it. The protector 18, similarly, has an opening, however, in the modality shown in figures 18A and 18B, the length of a protector 240 decreases, thus increasing the diameter of the opening defined by protector 18. As a result, protector 240 it will have an opening that is larger than the opening in seal 16 to create a flattened profile against the conical shape of seal 16, thus creating a gap between protector 240 and seal 16. As surgical instruments are removed from the trocar, the gap will prevent fluids from being collected between layers 20 of seal 16 and will allow protector 240 to absorb fluids due to the capillary effect of seal opening 16. Thus, if fluid is deposited on seal 16, there will be no capillary action to retain fluid between the seal 16 and protector 240, thus allowing fluids to drain. In addition, when an instrument is passed through protector 240 and seal 16, the gap created between seal 16 and protector 18 will prevent fluid from being squirted from between seal 16 and protector 240 and into an instrument.
[000147] In another embodiment shown in figures 19A and 19B, the multilayer seal protector 248 has a capillary absorption element in the form of flesh ribs 250 arranged on a surface of each individual protective layer 249 so that the ribs 250 create pockets between layers to remove by capillary absorption and retain fluid removed by scraping the instruments through the instrument seal. In the illustrated embodiment, the ribs 250 are offset by 90 degrees, although other geometries are possible as will be understood by those skilled in the art. In one embodiment, the ribs 250 can be arranged on a top or proximal surface of the protector. In this way, as a surgical instrument is passed through the instrument seal 14, the instrument will come into contact with the ribs 250 in order to open the protector 248 and the seal with meat, preventing the surgical instrument from coming into contact with the surface of the instrument. protector 248 and / or the seal. In another embodiment, the ribs 250 can be arranged on a bottom or distal surface of the protector, thus creating a gap between the protector 248 and the seal to prevent capillary action and the capture of fluid between the seal and the protector 248.
[000148] Figures 20A and 20B illustrate another embodiment of an instrument seal 254 that has ribs to absorb fluid by capillary effect away from an opening in seal 254. In this embodiment, the seal of instrument 254 is in the form of a seal deep-cone having a flange 260 with a conical side wall 262 extending distally thereto. A distal portion 264 of the tapered side wall 262 tapers inwardly to define an opening 258 at the distal end 264 of the seal 254. In the embodiment shown in figure 20A, the side wall 262 may include one or more ribs 266 formed on an outer surface 261 and extending between the proximal and distal ends of the side wall 262, ending at opening 258. External ribs 266 can be effective to absorb fluid by capillarity away from opening 258 in seal 254. In the form shown in figure 20B, ribs 266 are formed on the inner surface 268 of side wall 262 and extend between the proximal and distal ends of side wall 262, ending at opening 258. Ribs 266 will therefore have a fleshy effect, causing any instrument inserted through seal 254 contact ribs 266 to cam seal 254, instead of coming into contact with an internal surface 2 68 of seal 254.
[000149] In another embodiment, shown in figure 21, the multilayer seal protector 269 may include a plurality of holes 270 formed in the individual layers 271 of protector 269 to form a capillary absorption element to absorb capillary fluid from the capillary effect. seal. As the fluid is trapped between protector 269 and the seal when an instrument is passed through the seal of the instrument, the holes 270 act to remove by capillary effect the fluid from the seal and the opening in the seal. The fluid can be trapped inside the holes 270 by surface tension so that an instrument passed through the seal will not come in contact with the fluid trapped in the holes 270.
[000150] Various other modifications can also be made to the multilayer seal protector previously described in figure 1E to remove fluid from the seal or from instruments passed through the seal. In another embodiment, shown in figures 22A and 22B, the protective segments 272 may include surface characteristics, such as a crimped surface 276, formed on the distal surface thereof. As shown in figure 22B, when the protective segments 272 are positioned against the sealing segments 20, the crimped surface 276 will create a gap that separates the protector 273 from the seal, thereby providing a path for the fluid to be removed by capillary absorption. opening in the seal and between protector 273 and the seal.
[000151] Figures 23A and 23B illustrate another embodiment of a seal 280 that is configured to remove fluid. In this embodiment, seal 280 has an hourglass configuration so that seal 280 is a combination of trocar and instrument seal. In other words, seal 280 is effective both for forming a seal within the trocar operating channel when no instrument is disposed through it and for forming a seal around an instrument disposed therethrough. The hourglass shape of seal 280 allows a central portion 282 of seal 280, which in a natural state is in a closed configuration as shown in figure 23A, to open and engage an instrument passed through it, as shown in figure 23B, and thus scrape any fluid from the instrument. Due to the curvature in the inner side walls 284 of the seal 280, the removed fluid will flow away from the central portion, thereby preventing the fluid from being redeposited in an instrument reinserted through it. The hourglass configuration of seal 280 is also advantageous in that it will accommodate instruments of various sizes. The central portion 282 can also move or float with respect to the central axis of the operating channel in the trocar, thereby accommodating off-axis instruments.
[000152] Figures 24A to 29 illustrate several other exemplary embodiments of fluid removers. Although certain modalities are described as being arranged or formed in the cannula, a person skilled in the art will realize that, as with the previous modalities, the modalities of figures 24A to 29 can similarly be arranged at various locations within a trocar. and that various combinations of fluid removers can be used.
[000153] In the embodiment shown in figures 24A and 24B, the fluid remover is in the form of a plurality of scraper elements that extend at least partially through the operating channel 4 of the cannula 8. The scraper elements can be relatively thin and can assume the shape and shape of cloths 292, as is best shown in figure 24B, which will scrape or dry the fluid from a surgical instrument passed through the cannula 8. Cloths 292 can be fixedly or articulated coupled to an internal side wall 294 of the cannula 8, and they can be flexible to accommodate instruments of various sizes, and to allow for both insertion and removal of instruments. The cannula 8 can also include any number of cloths 292, and the cloths 292 can be spaced from each other, or they can be in a stacked configuration. Cloths 292 can have a conical configuration so that each cloth 292 extends around the entire inner diameter of the cannula 8. Alternatively, cloths 292 can be formed into individual segments that are positioned at a distance from each other, for example , approximately 90 degrees apart within the inner surface 294 of the cannula 8. The segments can be layered within the cannula 8 so that different parts of the surgical instrument come into contact with the cloths 292 at different heights as the instrument is being passed through of this. Cloths 292 may also be in contact with a sorbent element 296, or include a sorbent portion, so that the collected fluid drips into or is absorbed by capillarity within the sorbent material and away from possible contact with a reinserted instrument. As shown in figures 24A and 24B, the sorbent element 296 is located adjacent to the inner side wall 294, and thus radially out of the wiper body 292. The sorbent elements 296 can be formed within a cannula wall 8, so that the cannula 8 is partially formed from the sorbent elements 296. The sorbent elements 296 can also be formed within the grooves in the cannula wall and / or can be adhered directly to the cannula wall by any fastening mechanism known in the art, for example example, a fixing ring 297. In use, as an instrument is passed through the cannula 8, the instrument will be scraped on all sides simultaneously by the plurality of cloths 292. The fluid will drain out where it will be absorbed by the sorbent element 296 .
[000154] Figure 25 illustrates another exemplary embodiment of a scraper 300. In this embodiment, the scraper 300 is substantially conical in shape increasing in diameter in a distal direction. A proximal end 302 of the scraper 300 includes an opening 304 formed therethrough, and a fluid collecting member is formed at a distal end 306 thereof and extends inwardly. The fluid collecting member can have a variety of configurations and can generally be configured to collect scraped fluid by the scraper 300. In an exemplary embodiment, as shown, the fluid collecting member can be in the form of a substantially C-shaped rim. 308 extending inwardly from the distal end 306 of the scraper 300. At least a portion of the fluid collecting member can also optionally be sorbent, thus allowing the fluid collecting member to both collect and absorb scraped fluid through the scraper. The scraper 300 can be formed from a flexible material, so that it can radially expand to engage a surgical instrument extending through it. In use, the narrow proximal end of the scraper 300 can engage a surgical instrument passed through it to thereby scrape fluid from the instrument. The fluid removed by scraping the instrument will travel to an internal surface 310 of scraper 300 and be collected and / or absorbed by the fluid collecting member disposed at distal end 306 of scraper 300. Although scraper 300 is generally indicated as being disposed in cannula 8, scraper 300 can similarly be disposed anywhere within trocar 2, including in the proximal compartment 6.
[000155] Figure 26 illustrates another exemplary embodiment of a scraper 312. In this embodiment, scraper 312 includes the first and second rotating members 314a and 314b that are configured to rotate and engage a surgical instrument as the instrument is passed through it. . The first and second rotating members 314a and 314b can have a variety of shapes and sizes. In the illustrated embodiment, the first and second rotating members 314a and 314b are in the form of a spool. The spools can be configured so that the geometry of the second element 314b complements that of the first member 314a. As shown, the first member 314a includes a substantially spherical shaped central portion 316 that corresponds with a concave cut 318 in the second element 314b. The geometry of the spools can have several shapes, including, but not limited to, straight cylindrical, C-shaped and toothed cylindrical. The first and second rotating members 314a and 314b can be positioned at a variety of locations in the cannula, or within the proximal compartment of a trocar, and they can be formed from a variety of materials including, but not limited to, the rigid, flexible and sorbent materials. In use, the rotating members 314a and 314b can rotate and engage a surgical instrument that passes through it to thereby scrape and optionally remove fluid sorption from the instrument.
[000156] Figures 27A to 27C illustrate another embodiment of a fluid remover in the form of a removable tip or sleeve 322 that can be removable coupled to a distal end 324 of the cannula 8. As shown, sleeve 322 is under the shape of a generally cylindrical compartment with a tapered distal end 326, similar to the distal end 324 of the cannula 8. A proximal end 328 of the sleeve 322 can be sized to fit over and engage the distal end of the cannula 8, for example, by interference fit, and the distal end of the compartment may include an opening 330 formed therein and sized to receive a surgical instrument therethrough. Sleeve 322, or at least a portion of sleeve 322 surrounding opening 330 at distal end 326, can be formed from a malleable or expandable material to allow the opening in sleeve 322 to expand radially as an instrument is passed through the same. Exemplary malleable materials include, but are not limited to, polyisoprene, pelatan and silicone. In use, as a surgical instrument is passed through opening 330 in sleeve 322, opening 330 will scrape fluid from the instrument, thus preventing the fluid from being pulled into the trocar and deposited on the seals.
[000157] In another embodiment shown in figure 28, an hourglass seal 340 is provided, similar to seal 280 described in relation to figures 23A and 23B, however, seal 340 includes a capillary absorption element under the in the form of one or more cuts or slits 342 formed in the central reduced diameter portion 344. Similar to seal 280 previously described with reference to figures 23A and 23B, the hourglass shape will allow the central portion 344 to scrape or wipe fluid from an instrument surgical procedure passed through it. The cuts or slits 342 will allow the scraped fluid to be absorbed by capillarity through the slits 342 to an outer surface 346 of the seal 340.
[000158] In another embodiment shown in figure 29, the capillary absorption element can take the form of a plurality of slits 350 formed in the operating channel 4 of a cannula 352. Slits 350 can be of any size and shape sufficient to the transfer of fluid disposed on an inner surface of the cannula 352 to an outer surface 354 of the cannula 352. Thus, as an instrument is passed through the cannula 352, any fluid that drips to the inner surface of the cannula 352 will be transferred to the surface 354 of the cannula 352 through the slots 350.
[000159] Figures 30A to 30J illustrate another embodiment of a trocar 400 that has a fluid remover 430 disposed there. As shown, trocar 400 has a proximal compartment 402 and a distal cannula 404 with an operating channel 408 formed through and extending between the proximal and distal ends 400a, 400b thereof. The compartment 402 may include one or more seals that are effective for sealing the operating channel 408, that is, to prevent insufflation leakage, when no instrument is disposed through it and / or when an instrument is disposed through it. As shown in figures 30B and 30C, compartment 402 includes a proximal instrument seal in the form of a multilayer seal 412, which is effective for forming a seal around an instrument inserted therethrough, and a distal channel seal, as a duckbill seal 410, which is effective for sealing the operating channel when no instrument is inserted through it. An exemplary embodiment of a duckbill seal 410 that can be used with the present invention is presented in US Patent Application Serial No. 11 / 771,263 filed June 29, 2007 and entitled "Duckbill Seal With Fluid Drainage Feature" , by Paul T. Franer and Thomas A. Gilker. Such a duckbill is particularly useful since it has a low profile and has fluid draining characteristics that can assist in the further prevention of fluid redeposition in instruments inserted through the seals. A person skilled in the art will realize that any number, type and configuration of channel and / or instrument seals can be positioned within compartment 402 in various locations. The compartment may also include an inflation port 406 which is formed in compartment 402 to supply an insufflation gas to operating channel 408.
[000160] As indicated above, compartment 402 may include a fluid remover 430 positioned therein and configured to remove fluid from a surgical instrument inserted therethrough. The fluid remover 430 may have an opening 470 formed through a central potion thereof, in axial alignment with the operating channel 408, to receive a surgical instrument. Opening 470 can be effective for removing fluid from a surgical instrument upon insertion and / or withdrawal therethrough. In an exemplary embodiment, fluid remover 430 is preferably positioned distally to seals 412 and 410 so that fluid collected in the instrument when disposed in a body cavity can be removed from the surgical instrument before being removed through seals 412 and 410, thereby preventing the fluid from being deposited in the seals and, consequently, deposited in an instrument inserted in the trocar. In order to position fluid remover 430 distally from seals 412 and 410, fluid remover 430 will be positioned close to, distal to or in the path of the inflation port. When fluid remover 430 is positioned in the path of or distal to the insufflation port, it is preferably configured so that it does not block the path of an insufflation gas from the port through the distal cannula 404. During many surgical procedures with the use of a trocar, insufflation is used to expand the body cavity into which the trocar extends. The trocars can therefore have an insufflation port, such as port 406 shown in figures 30A to 30C, which is positioned distally from seals 412 and 410, so that the seals are effective to prevent gas from flowing out of the proximal compartment 402. In this way, a constant flow of gas is maintained through the distal cannula 404 and into the body cavity. Since port 406 is positioned distally from seals 412 and 410, in an exemplary embodiment, in order to maintain a low profile compartment and the position of fluid remover 430 away from the seals, fluid remover 430 can be positioned adjacent to or distal to port 406. As such, fluid remover 430 is preferably configured to allow air to pass through and / or around it so that it does not block the flow of insufflation gas from the port 406 to cannula 404 when an instrument is inserted through opening 470 in fluid remover 430. In other words, fluid remover 430 can have a configuration that allows insufflation gas to pass from port 406 to distal cannula 404 even when an instrument is disposed through fluid remover 430. Figures 30A to 30J illustrate such an embodiment of fluid remover 430 which is in the gas flow path from port 406 to cannula 404. In this fashion a cut or route is provided on a portion of fluid remover 430 to allow gas to pass through port 406 to cannula 404, as will be discussed in more detail below. Fluid remover 430 may also include other features to facilitate the passage of gas through it, as will be discussed in more detail below.
[000161] The fluid remover 430 can have several configurations and it can include any one or more of a capillary absorption element, a sorbent and a scraper. Figures 30C to 30F illustrate an embodiment of fluid remover 430 that is positioned distally from seals 412 and 410 and close to supply port 406. Fluid remover 430 generally includes a sorbent 414 disposed within the compartment and disposed in the around a crown 420, a scraper 422 positioned on a proximal surface of the crown 420 and a lid 418 positioned against a proximal surface of the scraper 422.
[000162] As shown in more detail in figures 30F and 30G, the scraper 422 of fluid remover 430 can have many shapes and configurations, however in the illustrated embodiment the scraper 422 is in disk format and has an opening 424 formed through a central portion of it. Scraper 422 can be configured to remove fluid from a surgical instrument by passing through opening 424 through the contact of the surgical instrument and scraping and / or wiping its circumference. In an exemplary embodiment, scraper 422 is formed from a flexible and resilient material to allow opening 424 of scraper 422 to expand around and engage an external wall of an instrument passed through it.
[000163] Scraper 422 may also include features to direct the flow of fluids. For example, as shown in figure 30G, the scraper can include one or more channels 422c formed on a distal surface thereof and extending radially out of aperture 424, so that the fluid removed by scraping an instrument being withdrawn through the opening 424 will flow through the channels and radially away from opening 424. As additionally shown in figures 30F and 30G, scraper 422 may also include one or more holes 422 formed through it to receive pins formed in crown 420, as will be discussed in more detail below. The holes 422h allow the scraper 422 to rest on a proximal surface of the crown 420 and to be captured between the crown 420 and the cap 418. The holes 422h can also be of a size that allows air to pass through it when the crown pins 420 are arranged in it. Such a configuration can help prevent fluid remover 430 from functioning as a seal, as will be discussed in more detail below. In some embodiments, however, scraper 422 can also be formed as an instrument seal and / or as a scraper for smaller diameter surgical instruments and a seal for larger diameter surgical instruments.
[000164] In certain exemplary embodiments, in order for the 422 aspirator to effectively absorb capillary fluid radially out of the opening and towards the sorbent, all or portions of the scraper may be formed of or may include a hydrophilic material. For example, the scraper can be formed of a hydrophilic material, such as nylon, and / or the scraper can be spray-coated, dip-coated, plasma-etched or otherwise coated using various coating techniques known, with a surfactant coating that makes the scraper or portions thereof hydrophilic. In an exemplary embodiment, where the scraper is formed from a hydrophobic material, such as a polyisoprene, a hydrophilic coating is applied to the scraper to make the scraper hydrophilic. The coating can be applied to any one or more of the scraper surfaces, and it can be applied at any stage during manufacturing. In one embodiment, the scraper can be soaked in a surfactant bath during manufacture to make the entire scraper hydrophilic. Exemplary coating materials include, by way of non-limiting example, sodium dodecyl benzene sulfonate (SDBS) and sodium dodecyl sulfate (SDS). The coating is preferably one that remains stable during sterilization, such as gamma and thermal radiation sterilization.
[000165] A person skilled in the art will realize that several factors can be changed to facilitate the absorption action by capillary effect of the scraper. For example, the contact angle of a drop of fluid on a hydrophilic surface of the scraper can be optimized, so that fluid will spread on contact with the surface. In certain exemplifying embodiments, the hydrophilic material may have a low contact angle, such as 90 degrees or less. Other factors that can affect the scraper's ability to absorb fluid by capillarity away from the opening include the smooth surface, the geometry of the capillary absorption channels and the surface tension of the fluid being applied. For example, the channel geometry can be designed to provide the capillary forces necessary to direct fluid to a minimum capillary height so that the fluid will expand just after the outer wall of the crown 420 to reach the sorbent 414. The geometry of the channel can be changed to obtain the desired capillary height. Figure 30H illustrates an exemplary modality of channel geometry that is optimized to facilitate the capillary action of the channel. As shown, the channel has a cross-sectional shape, generally U-shaped, with the inner corners located at the base of the channel, being rounded and having a radius of curvature r1, and the outer corners, located at the opening of the channel, being rounded and having a radius of curvature r2. The channel can also have a width w at the base, as measured between the opposite side walls of the channel, which differ from the width w1 in the opening, as measured between the rounded outer corners and which also differs from a maximum width w2 as measured from the outermost ends of the channel at the opening. The difference between width w and width w1 is indicated by reference x. The channel can additionally have a maximum height h, as measured from the base to the outermost ends of the channel at the opening, which differs from a height h1, as measured from the base to the outer rounded corners. The particular dimensions of the channel may vary. For example, the radius of curvature r1 at the base of the channel may be less than the radius of curvature r2 at the opening of the channel, and the width w at the base of the channel is less than the width w1 at the opening, which, in turn, is smaller than the maximum width w2 so that the channel width gradually increases from the base towards the opening. In an exemplary embodiment, however, the width w at the base of the channel is preferably equal to or greater than the width w1 at the opening. The dimensions and cross-sectional shape of the channel may also vary over the entire length of the channel. For example, the channel may have a height and / or width that radially increases or decreases outward, so that the channel height and / or width near the central opening in the scraper is either less than or greater than the height and width of the scraper. channel close to the outer perimeter of the scraper. Each channel can also reach a maximum height and / or width at a certain distance from the central opening, and the height and / or width can then remain constant throughout the rest of the channel extending radially out of that location. A person skilled in the art will realize that the channel can be modified to obtain a desired capillary height in order to cause the fluid to be directed from the scraper opening, through the crown and into the sorbent.
[000166] As indicated above, other modifications can be made to obtain an optimal capillary effect. In another embodiment, the scraper and the sorbent can both be configured to have a surface energy gradient, so that the surface energy increases as the fluid moves from the opening inside the scraper, along the channels and to inside the sorbent.
[000167] Fluid remover 430 may also include a scraper crown 420, shown more clearly in figure 30F, which can extend distally from a distal surface of scraper 422 and which can help assemble scraper 422 and sorbent 414 inside the compartment. The scraper crown 420 can have several configurations, however in the illustrated mode it has a ring-shaped body 434 with multiple pins 436 extending in a similar manner. The pins 436 can extend through the corresponding holes 422h formed in the scraper 422 and inside of the holes 418h formed in the cap 418, as shown in figure 30J. Crown 420 and cap 418 can be paired together using various techniques, such as a snap fit or interference fit, adhesive or welding, etc. When interconnecting scraper 422 between cover 418 and crown 420, scraper 422 may have an outer diameter that is less than an inner diameter of compartment 402, so that a gap G is provided between scraper 422 and compartment 402, as shown in figure 30D. The gap G will allow air to flow proximally after the scraper 422.
[000168] As additionally shown in figure 30F, the scraper crown 420 can also include a cutout 426 formed in a side wall thereof. One or more flange members 440 may extend radially out of a side wall of the scraper crown 420 on each side of the cut 426 formed through the crown 420 to define a route. The flange members 440 can be positioned to align axially with the cut formed in the sorbent 414 and a cut formed in the cap 418, as will be discussed in greater detail below, to form a complete route that allows the insufflation gas flow from the port of inflation 406 through the cuts, and to the operating channel 408 into the distal cannula 404. This allows the inflation to be distributed through the cannula, while an instrument is passed through the fluid remover 430 and occludes the operating channel. The flange portions 440 can be positioned on either side of an opening 442 of the inflation port 406, through which the inflation gas flows. As a result, a pressure on each side of the fluid remover will be equalized.
[000169] The molded scraper cover 418 is shown in more detail in figures 30I and 30J, and it can have a generally circular or ring-shaped configuration that is proximal to the scraper. In use, cover 418 can serve to protect the proximal surface 432 of scraper 422 from the insertion of acute surgical instruments by acting as a guide or funnel for the surgical instrument within opening 424 of scraper 422. As indicated above, the scraper cover 418 may include one or more holes 418 formed on a distal surface thereof to receive pins 436 formed on the crown 420. The scraper cover 418 may also include an opening 418 through which a surgical instrument can extend that is in axial alignment with the opening 424 formed in the scraper 422, and a cut 448 formed in a side wall or perimeter of the scraper cover 418 which aligns with the cut 446 formed in the scraper crown 420 and the sorbent 414.
[000170] As shown in figure 30J, in one embodiment the scraper cover 418 may also include a circular microsphere or compaction ridge 450 projecting in a distal position in addition to a more distal surface thereof, so that the ridge extends towards and presses against the proximal surface of the scraper 422 to secure the scraper 422 in the controlled compression between the compaction ridge 450 in the cap 20 and the proximal surface of the crown 420. The compaction ridge 450 can also function to remove by sealing and prevent fluid from seeping back towards the scraper 422 opening.
[000171] Although there may be many configurations for fluid remover 430, in the embodiment shown in figures 30B to 30E, fluid remover 430 also includes a sorbent 414 positioned circumferentially around scraper crown 420 and configured to absorb scraped fluid by scraper 422. As shown in figure 30F, sorbent 414 can be configured to be positioned around scraper crown 420, and thus can have a cut 444 formed in it that aligns with cut 426 formed in crown 420. The ends terminals of sorbent 414 will thus be in a boundary position with flange 440 in crown 420. As a result, sorbent 414 will be substantially C-shaped. Cutting 444 in sorbent 414 will also allow air to flow everywhere around the outside of scraper 422, due to the gap G between the outer perimeter of scraper 422 and the compartment. The cut in sorbent 414 will therefore continue to allow air to pass through and around scraper 422 in the event that sorbent 414 is obstructed. This is particularly advantageous since air forced to flow through sorbent 414 could potentially push fluid out of sorbent 414. Sorbent 414 can be attached around scraper crown 420 using any method known in the art including, for example, example, an adhesive or simply by an interference fit between an inner wall of compartment 402 and the scraper crown 420. As will be understood by those skilled in the art, sorbent 414 can have a solid ring shape, or any other shape, and it can be made up of multiple individual portions as needed.
[000172] Although sorbent 414 preferably has a shape that corresponds to the shape of crown 420, sorbent 414 can be configured to be compressed between crown 420, scraper 422 and compartment 402. Thus, sorbent 414 it can have a shape in the initial cross section that is more square and it can deform in a shape that is more triangular. The sorbent 414 can be formed from various materials that allow it to be compressed, while still allowing sorbent 414 to sip fluid. The sorbent 414 can also be permeable, so that it can flow through it.
[000173] The particular size of the sorbent 414 may also vary, but in an exemplary embodiment the sorbent 414 has an internal diameter that is greater than an opening diameter 424 in the scraper, so that sorbent 414 will only contact scraper 422 in a location radially out of aperture 424. This will allow fluid to flow from the aperture, through channels 422c, and then be absorbed by the sorbent. In an exemplary embodiment, the sorbent is positioned radially out of the holes 422h formed in the scraper, since it allows the sorbent 414 to be positioned around the crown 420.
[000174] As indicated above, when fluid remover 430 is fully assembled, it can rest within a distal portion of proximal compartment 402. Sorbent 414 can be positioned in contact with an inner surface of compartment 402, crown 420 can be arranged inside the sorbent 414, the scraper 422 can be in the crown 420 and be positioned in contact with the sorbent, and the cap can be positioned in the scraper 422 and be paired with the crown 420. The cap 418 can optionally be welded by ultrasound or otherwise be fixedly paired with compartment 402 to secure fluid remover 430 therein. As shown in figure 30F, sorbent 414 may include surface features, such as longitudinally extending grooves 415 formed on an internal surface thereof and configured to align with and receive pins 436 in the scraper crown 420.
[000175] When disposed inside compartment 402, fluid remover 430 will be positioned in the inflation path. In particular, referring again to figures 30C and 30D, the inflation port 406 has a lumen 460 extending through it. The lumen 460 defines a longitudinal axis LA and has a cylindrical inner surface with a more proximal inner surface 462 and a more distal inner surface 464. Fluid remover 430 is generally positioned within the lumen route 460 and, more particularly, it it is positioned so that the innermost surface 462 of the lumen 460 is positioned distally to the scraper 422 and the longitudinal axis LA extends through a median portion of the sorbent 414. In other words, the sorbent 414 is positioned in the path of the flow of the inflation port 406 gas to the distal cannula. A person skilled in the art will realize that the various components of fluid remover 430 can be positioned at various locations in relation to the inflation port 406. Since the portions of fluid remover 430 in the illustrated embodiment are positioned in the flow path of the air from the inflation port 406 to the distal cannula, cuts 426 and 444 in crown 420 and sorbent 414 will allow air flow to pass through it and into the distal cannula.
[000176] In use, a surgical instrument can be inserted through seals 412 and 410 and through opening 470 into fluid remover 430 as needed in a particular procedure. With the use of insufflation port 406, insufflation gas can be introduced into operating channel 408 of trocar 400 so that insufflation is achieved distally to seals 412 and 410 and fluid remover 430. Insufflation gas can be move along the route defined by the flange portions 440, through the cuts 426 and 444 in the crown 420 and sorbent 414, respectively, and within the operating channel 408 of the distal cannula 404. In this way, the fluid remover 430 can be distal to the seals 412 and 410 to remove fluid from instruments being removed, while allowing insufflation gas to flow into the distal cannula. As a surgical instrument is removed from operating channel 408, the fluid scraped from the surgical instrument by scraper 422 flows radially outward and is absorbed by sorbent 414, thereby keeping the fluid away from any instrument that can be reinserted into operating channel 408. The fluid remover 430 thus allows the removal of fluid from a surgical instrument in a position distal to seals 412 and 410, while also allowing the introduction of insufflation gas distal to both seals 412, 410. A person skilled in The technician will realize the possible variations for the positioning of seals and fluid removers to allow distal insufflation to both.
[000177] Figure 31 illustrates another embodiment of a cap 418 'for use with a fluid remover. In this embodiment, instead of including a cutout 448 formed in a side wall of the lid 418 to allow air to pass through the lid 418 in a proximal direction in the direction of the seals, the lid 418 'includes a plurality of holes or openings 448' formed therein. and positioned radially around a perimeter of the lid 418 '. The lid 418 'can include numerous holes in any location and be of any size. The holes 448 'are merely configured to prevent the fluid remover from forming a seal, if not necessary, since it may be desirable to maintain a zero pressure differential through the fluid remover to prevent air from forcing the fluid outward of the sorbent.
[000178] Figures 32A to 32D illustrate yet another embodiment of a trocar 500 that has a fluid remover 530 disposed thereon. As shown, the trocar 500 has a proximal compartment 502 and a distal cannula 504 with an operating channel 508 formed through and extending between the proximal and distal ends thereof. As shown in figure 32B, compartment 502 can include an instrument seal, such as a deep cone seal 512 (only a proximal flap is shown), positioned within a channel seal, like a duckbill seal 510. One person skilled in the art will realize that any number, type and configuration of channel and / or instrument seals can be positioned within compartment 502. The compartment may also include an inflation port 506 that is formed in compartment 502 to provide an insufflation gas to operating channel 508.
[000179] In this embodiment, fluid remover 530 differs from fluid remover 430 described above by the fact that it is positioned more distally in relation to the inflation port. In general, fluid remover 530 has an opening 570 formed through a central portion thereof, in axial alignment with operating channel 508, for receiving a surgical instrument. Opening 570 can be effective for removing fluid from a surgical instrument upon insertion and / or withdrawal therethrough. Fluid remover 530 is positioned distally to seals 512 and 510 so that fluid can be removed from the surgical instrument before it is drawn through seals 512 and 510 in order to prevent fluid from depositing on the seals. As with fluid remover 430, fluid remover 530 may have a configuration that allows insufflation gas to pass from port 506 to distal cannula 504 even when an instrument is disposed through fluid remover 530. In particular, in this embodiment the fluid remover 530 is generally positioned in the lumen route 560 of the inflation port 506 and, more particularly, it is positioned so that the longitudinal axis LA of the lumen 560 extends through a substantially central portion of the scraper cover 518. The most proximal inner surface 562 of the door is thus generally aligned with a wall at the top 556 of the scraper cover 518. As shown in figure 32B, the scraper 522 is thus positioned distal to the longitudinal axis LA of the lumen 560 and can generally be positioned in alignment with the innermost surface 564 of lumen 560. In other embodiments, scraper 522 can be positioned fully distal or close 1 to the innermost surface 564 of the lumen 460. A person skilled in the art will appreciate that the fluid remover 530 can be positioned in any number of ways in relation to the lumen 560.
[000180] Since the cap portion 518 and the scraper 522 are positioned in the inflation path, the cap 518 and scraper 522 in this embodiment can each have a cut 548 and 546 that is positioned within the gas route insufflation to allow gas to flow into operating channel 508, as shown in figure 32D. The cuts 548 and 546 can align with the corresponding cuts 526 and 544 in crown 520 and sorbent 514, respectively, similar to crown 420 and sorbent 414 discussed above. As is further shown in figure 32D, the scraper cover 518 may also include a flap or flange 550 extending around a proximal portion thereof and located proximal to the cut 548 formed on the side wall of the scraper cover 518. As a result , the notch 546 is not a complete cut, but it is defined on three sides by two side walls with opposing notches 552a and 552b and a top wall 556 and thus the top wall 556 can optionally serve as a sealed proximal contour for the insufflation gas route that will be described below. In an exemplary embodiment, the top wall 556 can be positioned in alignment with the most proximal interior surface 562 of the lumen 560 within the insufflation port.
[000181] Another exemplary embodiment of a trocar is illustrated in figures 33A-39. As shown in figure 33A, a surgical access device or trocar 600 is provided. Although trocar 600 can have many configurations, it can generally include a compartment 602 with a cannula 604 extending distally thereto. The compartment 602 and the cannula 604 can define an operating channel 606 extending longitudinally through a center thereof to receive a surgical instrument. An inflation port 612 can be coupled to one side of compartment 602 to provide inflation to trocar 600. In some embodiments, a fluid removal system that may include a scraper, a capillary-absorbing element and / or a sorbent, can be arranged inside compartment 602. Although the inflation port 612 can be arranged in many places in compartment 602, in this particular embodiment, the inflation port 612 is positioned proximal to the fluid removal system and displaced from the operating channel 606 in such a way. so that the inflation gas introduced into the compartment through the inflation port 612 passes distally through the fluid removal system to inflate the cannula 604 and the body cavity when a surgical instrument is disposed inside the operating channel. A sealing system can also be arranged inside compartment 602 to prevent leakage of insufflation gas.
[000182] The trocar 600 is illustrated in more detail in figure 33B. In some embodiments, compartment 602 and, optionally, cannula 604, may be a single integrally formed component, as in many of the embodiments described above. In other embodiments, such as that illustrated in figure 33B, compartment 602 can include a proximal compartment 608 and a separate distal compartment 610 that couple to form compartment 602. The proximal compartment 608 and distal compartment 610 can confine the various components of the trocar 600, such as the sealing system and the fluid removal system. For example, the proximal and distal compartments 608, 610 can confine a sealing system that can generally include a zero-closing seal and an instrument seal, for example, a duckbill seal 616 and a deep cone seal 618, respectively. The sealing system may additionally include an internal seal retainer 626 to retain and form a seal with the various internal components, as will be described in more detail below.
[000183] The proximal and distal compartments 608, 610 can also confine the fluid removal system, which can be arranged distally to the inflation port 612. As noted above and as shown in figures 33B and 38A, the fluid removal system it can generally include a scraper 620 for scraping fluid from a surgical instrument inserted therethrough, a capillarity absorbing element 622 disposed in the scraper (shown in figure 38A) for transferring scraped fluid from the surgical instrument and / or a sorbent 624 to retain fluid away from the surgical instrument. Since the inflation port 612 can be arranged inside compartment 602 at a location proximal to the fluid removal system, in general, the fluid removal system can have an inflation path formed through it, indicated by the arrow A in figure 33B, to allow insufflation gas to pass from a proximal portion of trocar 600 to a distal portion of it so that the area below the sealing system, including the cannula 604 and the body cavity, can be pressurized. The path can be moved from operating channel 606 so that the insufflation gas can pass through the fluid removal system even when a surgical instrument is disposed inside and obstructing operating channel 606 of trocar 600. These and other aspects will be described in detail below .
[000184] The components of compartment 602 are illustrated in more detail in figures 34A-35, and the proximal compartment 608 is shown in detail in figures 34A and 34B. The proximal compartment 608 can, in general, be a substantially rigid hollow component designed to confine and retain the sealing system and to receive the inflation port 612 and the cock 614. The proximal compartment 608 can have many configurations, but illustrated embodiment, it has a proximal end wall 632 with a side wall 633 extending substantially orthogonally and distally thereto. The proximal compartment 608 can be generally opened distally, without a distal end wall, to allow the distal end to correspond to the distal compartment. A cavity formed in the proximal compartment can accommodate the various internal components of the trocar 600 when the proximal compartment 608 is combined with the distal compartment 610.
[000185] In some embodiments, the proximal end wall 632 may include an opening 628 for receiving a surgical instrument through it and for defining the operating channel 606 extending along a central longitudinal axis of the trocar 600. A central lumen substantially rigid cylindrical 630 can extend from the opening 628 a distance to the proximal compartment 608 to define the operating channel 606. The central lumen 630 can also serve to guide a surgical instrument to the sealing system. One or more corresponding elements 648 can be formed on the proximal end wall 632 of the proximal compartment 608 to fit a plug to insert the trocar 600 into the tissue.
[000186] The proximal end wall 632 and the side wall 633 of the proximal compartment 608 can have an outer surface 635 and an inner surface 634 that can be of any shape as desired to provide the necessary internal space. Sidewall 633 can optionally include an arcuate or stretched portion 636 that has an opening or cutout 638 for receiving inflation port 612. Sidewall 633 can also include a distal rim 641 that is configured to fit a proximal rim corresponding 664 (shown in figure 35A) of distal compartment 610. The proximal ring 664 and distal ring 641 can correspond using any technique known in the art, including, but not limited to, interference fit, pressure fit, adhesive , clasp, etc. For example, the proximal compartment 608 can include one or more coupling members 640 to fit into distal compartment 610. The illustrated embodiment includes four coupling members 640 each extending from a coupling lumen 642. Lumens 642 can be integrally formed with and / or rigidly coupled to the inner surface 634 of the sidewall 633, and the coupling members 640 may extend distally therefrom. Coupling members 640 can be components similar to substantially rigid elongated pins that are configured to be arranged within corresponding coupling lumens 666 (shown in figure 35A) of distal compartment 610. When coupling members 640 are fitted to lumens 666 , a secure coupling can be formed between the proximal and distal compartments 608, 610 by means of, for example, an interference fit, a pressure fit, or an adhesive. An individual of ordinary skill in the art will observe the variety of ways that the proximal and distal compartments 608, 610 can be joined together.
[000187] In one embodiment, each coupling lumen 642 may have a protrusion or rib 643 extending radially outwardly thereto, as shown in figure 34B. Although the ribs 643 can have many configurations, in the illustrated embodiment, the ribs 643 are protrusions with a rectangular shape that generally extend along a length of the coupling lumen 642. Two of the ribs 643 located on one side of the cutout 638 they can be oriented towards each other and the other two ribs 643 located on the opposite side of the cutout 638 can be oriented towards each other, as shown in figure 34B. The ribs 643 can be configured to engage shims 693 formed on a flange 691 of the internal retainer 626 (shown in figures 36 and 37A). The ribs 643 can prevent the internal retainer 626 from floating inside the proximal and distal compartment 608, 610 and can thus ensure proper compaction of the seals 616, 618 and the scraper 620 maintaining the pneumatic seal. In particular, the ribs 643 can ensure that the gap between a proximal sealing flange 644 of the proximal compartment 608 and a proximal retaining ring 680 of the retainer 626 has an appropriate height to provide the desired compaction of the seals 616, 618 arranged inside of the gap. For example, when the proximal compartment 608 is fully seated in and seated in the distal compartment 610, a distal end 637 of each rib 643 is contiguous with and engages a corresponding pants 693 on the flange 691 of the inner retainer 626. The distance between the distal end 637 of each rib 643 and the proximal sealing flange 644 of the proximal compartment 608 can adjust the gap between the proximal sealing flange 644 and the proximal retaining ring 680 of the retainer 626 (described in more detail below). In this way, the amount of compression on the seals 616, 618 seated together can be predicted. Similarly, the length of the ribs 643 can also adjust between the inner retainer 626 and the distal compartment 610, thereby controlling the amount of compaction of the scraper 620, also described in more detail below.
[000188] Proximal compartment 608 may also include details for retaining and sealing against seals 616, 618. For example, in some embodiments, proximal compartment 608 may include a proximal sealing flange 644 formed on an inner surface 646 of the wall. proximal end 632, as shown in figure 34B. The 644 proximal sealing flange can be a substantially rigid cylindrical member that has a diameter greater than a central lumen diameter 630, but less than a width of the proximal compartment 608. In general, the proximal sealing flange 644 can act as the retainer seal 626 in order to retain and form a seal with the duckbill seal 616 and the deep cone seal 618, as will be described in detail below.
[000189] The distal compartment 610 can also have many configurations and a modality is shown in more detail in figures 35A and 35B. Similar to the proximal compartment 608, the distal compartment 610 can, in general, be a substantially rigid hollow component designed to confine and retain the fluid removal system and to receive the inflation port 612. The distal compartment 610 can have many configurations, but, in the illustrated embodiment, it has a distal end wall 652 with side wall 654 extending substantially orthogonally and proximally thereto. The distal compartment 610 can, in general, be opened proximally, without a proximal end wall, and the side wall 654 can define a cavity produced for the compartment of the various internal components of trocar 600 when the distal compartment 610 is combined with the proximal compartment 608.
[000190] The distal compartment 610 can also, in general, be configured to receive a surgical instrument through it and can be configured to fit the inflation port 612 and the proximal compartment 608. For example, the distal compartment 610 can include an opening 650 formed in its distal end wall 652 to receive a surgical instrument through it and to define the operating channel 606 extending to the cannula 604. In some embodiments, the distal end wall 652 and the side wall 654 may have a outer surface 656 and inner surface 658 and can be any shape as desired that provides the necessary internal space. Sidewall 654 can optionally include an arcuate or extended portion 660 that includes an opening or cutout 662 to receive inflation port 612. Sidewall 654 can also include a proximal rim 664 that is configured to fit a rim corresponding distal 641 (shown in figure 34B) of proximal compartment 608. Proximal bezel 664 and distal bezel 641 can be fitted using any technique known in the art, including, but not limited to, interference fit, pressure fit , adhesive, closure, etc. For example, the proximal compartment 610 may include one or more coupling lumens 666 to fit into the proximal compartment 608. The illustrated embodiment includes four coupling lumens 666 each integrally formed with and / or rigidly coupled to the inner surface 658 of the sidewall 656. The Coupling lumens 666 can be substantially rigid hollow components that are configured to receive corresponding coupling members 640 (shown in figure 34B) of the proximal compartment 608 to securely fit the proximal and distal compartments 608, 610 together, as described above.
[000191] The distal compartment 610 may also include details for retaining and sealing against the scraper 620. For this purpose, the distal compartment 610 may include a distal sealing flange 668 formed in the distal end wall 652. The distal sealing flange 668 it can be a substantially rigid cylindrical member that has a diameter greater than an aperture diameter 650, but less than a width of the distal housing 610. In general, the distal sealing flange 668 can act with the sealing lip 626 to retain and form a seal with the fluid removal system, as will be described in detail below. In addition, the distal compartment 610 can include a plurality of ridges 651 which are designed to seat and engage the scraper 620 as will be described in detail below. The ridges 651 can be formed integrally with a proximal surface of a wall 736 extending from the floor of the distal compartment 610, and can have high and low portions that define each ridge 651.
[000192] A cavity 670, shown in figure 35A, can be formed between the opening 650 and the distal sealing flange 668 to seat the sorbent 624. The cavity can have one or more ridges, for example, a plurality of ridges 672 formed around an inner surface of the distal sealing flange 668 to provide friction engagement with the sorbent 624. Cavity 670 can also include a plurality of details, for example, four projections 671 that extend proximally to the floor of cavity 670 and which are designed to engage sorbent 624 and compress sorbent 624 into engagement with scraper 620 as will also be described in more detail below. As will be understood by those skilled in the art, any type of detail sufficient to compress the sorbent 624 into an engagement with the scraper 620 can be used inside cavity 670. The protrusions 671 can be formed integrally with the distal compartment 610 or can be attached to it by an adhesive or other fixation mechanism.
[000193] Distal compartment 610 can optionally be integrally formed with cannula 604. Cannula 604 can extend distally from distal compartment 610 and can end distally in an angled portion that forms a distal piercing tip 605 that facilitates entry through the tissue in a bodily cavity. In some embodiments, a point further away from the angled distal tip 605 of the cannula 604 can be oriented in relation to the distal compartment 610 such that it is aligned with the inflation port 612, although it may have any desired orientation. Distal compartment 610 may also have one or more suture loops or other suture tie features 675 formed around an outer perimeter of an outer surface 656 thereof. Each 675 suture tie feature can define an opening or trajectory formed through it to receive a suture in order to help, in a more satisfactory way, to secure trocar 600 when it is disposed in the tissue. The suture strapping feature 675, shown in figure 33A, can have any angular orientation in relation to the distal angled tip 605 of the cannula 604, but, in one embodiment, at least one strapping feature 675 is displaced 90 degrees from the most away from the distal angled drilling tip 605. In other embodiments, the 675 suture tie feature can be positioned in line with the distal angled tip 605 of the cannula 604, or shifted 180 degrees from that.
[000194] Although the sealing system and fluid removal system arranged inside compartment 602 can have many different configurations, an exemplary embodiment of these systems is shown in more detail in figure 36. As noted above, the illustrated sealing system includes a duckbill channel seal 616, a deep cone instrument seal 618, and an internal seal retainer 626 to secure the sealing elements within the trocar 600. As will be understood by the person of ordinary skill in the art, any A suitable seal combination can be used inside compartment 602 which is effective in maintaining inflation of the cannula 604 and the body cavity during use. In this way, the seal combination can, in general, include both a zero-closing seal and an instrument seal and / or a single seal that has the ability to zero-seal and seal around an instrument. In the illustrated embodiment, the deep cone seal 618 is arranged inside the duckbill seal 616 in such a way that an instrument inserted into the operating channel 606 through opening 628 in the proximal compartment 608 finds the deep cone seal 618 first. Since this is positioned proximal to the duckbill seal 616, the deep cone seal 618 will form a seal around the surgical instrument before the surgical instrument finds and opens the duckbill seal 616. In this way, insufflation can be maintained during instrument insertion in trocar 600.
[000195] Although there are several ways to retain the seals inside the compartment 602, in the illustrated embodiment, the seals 616, 618 are arranged inside and coupled to the seal retainer 626. The seal retainer 626 and the proximal and distal compartments 608, 610 can generally work together to seal operating channel 606 by compressing and sealing against a perimeter of seals 616, 618. In particular, as shown in figures 36-37B, sealing lip 626 can be a substantially rigid cylindrical component which defines a portion of operating channel 606 and seals operating channel 606 with respect to a region in compartment 602 outside and / or surrounding retainer 626. Sealing retainer 626 fits inside compartment 602 and may have a proximal end 706 and a distal end 702. The proximal end 706 may have an opening 700 that has substantially the same diameter as an outer diameter of retainer 626, although may have any diameter necessary to accommodate seals 616, 618. The distal end 702 may include a distal end wall 708 with an opening 704 extending therethrough. Opening 704 can have any required diameter, for example, a diameter that is less than the outside diameter of retainer 626, but at least large enough to receive a surgical instrument. The retainer 626 may have a side wall 711 extending between its proximal and distal ends 706, 702. In some embodiments, the distal end wall 708 may include a plurality of ribs 707 extending radially from aperture 706, as shown in figure 37C. The ribs 707 can be configured to maintain positive contact between the scraper 620 and the sorbent 624.
[000196] As noted above, in some embodiments, seals 616, 618 can be retained by and sealed between sealing lip 626 and sealing flange 644 of proximal compartment 608. In particular, lip 626 may have a proximal lip ring 680 which can engage a distal surface 682 of a flange 684 formed on the duckbill seal 616. The proximal sealing flange 644 of the proximal compartment 608 can engage the proximal surface 686 of the flange 688 on the deep cone seal 618. As shown in most evident in figure 33B, when the carrier 600 is mounted, the proximal retaining ring 680 and the proximal sealing flange 644 together compress around the outer perimeter of flanges 684, 688 and form a seal against it in such a way that the operating channel 606 is sealed for insufflation purposes. Proximal rim 680 and sealing flange 644 can also retain seals 616, 618 inside compartment 602. As noted above, the amount of spacing between distal end 637 of ribs 643 in proximal compartment 608 and proximal sealing flange 644 of the proximal compartment 608 can be used, at least in part, to predict and control the amount of compaction of seals 616, 618.
[000197] As also noted above, at least a portion of the fluid removal system can be retained by and sealed between the seal retainer 626 and the seal flange 668 of the distal compartment 610. In particular, the seal retainer 626 can include a distal retainer ring 690 that can engage with a proximal surface 692 of scraper 620. In addition, distal sealing flange 668 in distal compartment 610 can engage with distal surface 694 of scraper 620. When the trocar 600 is mounted, the distal retainer ring 690 and the distal sealing flange 668 together compress around the outer perimeter of the scraper 620 to form a seal against it in such a way that the operating channel 606 is sealed for insufflation purposes. Distal rim 690 and sealing flange 668 can also retain scraper 620 inside compartment 602.
[000198] As shown in figures 33B, 36 and 37A, the sealing lip 626 may additionally include a median flange 691 extending radially out of the lip 626 and arranged around an outer circumference thereof. The middle flange 691 can, in general, be arranged anywhere along a length of retainer 626, but, in the embodiment illustrated, it is arranged close to a middle portion of retainer 626. The middle flange 691 can be configured to engage on an inner side wall of the proximal and distal compartments 608, 610 at a point where the proximal and distal compartments 608, 610 fit. In this way, retainer 626 can be retained and secured inside compartment 602. As noted above, flange 691 can also include a plurality of shims 693 configured to engage ribs 643 with proximal compartment 608. The length of ribs 643 can be used to predict and control the compression of seals 616, 618 and scraper 620. In some embodiments, the middle flange 691 may have a portion 710 that curves or sinks distally to accommodate the structure of the proximal and distal compartments 608, 610 near the coupling point for inflation port 612.
[000199] In some embodiments, the seal retainer 626 may also include a port 696 for receiving the inflation port 612. An opening 706 may be formed in a distal end wall 708 of retainer 626 in order to allow gas from insufflation flows from port 696 and through the distal end wall 708 to inflate cannula 604 and body cavity.
[000200] As noted above, the trocar 600 may include a fluid removal system configured, in general, to remove fluid from a surgical instrument and transfer and store the fluid in a location away from operating channel 606 and any surgical instrument inserted through the same. The fluid removal system can have many configurations, but, as shown in figure 36 and as noted above, it can include the scraper 620 that has the capillarity absorbing element 622 formed in it (shown in figure 38A) and the sorbent 624 positioned adjacent to aspirator 620 to absorb fluids absorbed by capillarity by capillary absorption element 622.
[000201] Scraper 620 is shown in more detail in figures 38A-38C and can have any of the same or different features and configurations previously described. The scraper 620 can be a substantially circular component having a proximal surface 722 and a distal surface 694. An opening 712 can be formed through a center of the scraper 620 to receive a surgical instrument therethrough. Aperture 712 can have a diameter substantially equal to, or slightly less than, a diameter of a surgical instrument inserted through it so that aperture 712 scrapes along the outside of a surgical instrument while traversing it in order to remove fluid of this. As noted in the previous embodiments, the scraper 620 can be formed of a flexible material and can therefore invert proximally while a surgical instrument is extracted through and scraped through opening 712.
[000202] There are many ways in which scraper 620 can be retained inside compartment 602. As noted above, in one embodiment, scraper 620 can be retained by and disposed between the distal retainer ring 690 of retainer 626 and the flange sealing ring 668 from distal compartment 610. Due to the fact that scraper 620 can be formed of a flexible and / or compressible material, while rim 690 and flange 668 engage the outer perimeter of scraper 620, the outer perimeter of the scraper 620 can be compacted between them and a seal can be formed between the scraper 620, the rim 690 and the flange 668. As noted above, the amount of spacing between the distal end 637 of the ribs 643 in the proximal compartment 608 and the rim of distal retainer 690 can be used, at least in part, to provide control of the amount of compaction of scraper 620. The outer perimeter of the scraper can optionally include a shoulder 724 extending from m proximal way of the proximal surface 722. The rim 690 and the flange 668 can compact the scraper 620 in a location radially into the rim 722, as can be seen in figure 33B.
[000203] In some embodiments, the scraper 620 may include features to assist in holding scraper 620 inside compartment 602. For example, the outermost perimeter of scraper 620 may include one or more indentations, for example, four indentations 714 for receive protrusions 716 in distal compartment 610. Protrusions 716 are coupled to and / or integrally formed with lumens 666 and serve to additionally stabilize scraper 620 inside distal compartment 610. Scraper 620 can also include an opening or hole 718 which can be aligned with the opening 706 formed in the retainer 626 to allow the insufflation gas to flow through it. Orifice 718 can be of any size or shape known in the art that is sufficient to allow insufflation gas to flow through it. In the illustrated embodiment, orifice 718 is substantially rectangular and has a size to correspond to aperture 706. Orifice 718 can be displaced from aperture 712 such that an axis extends through the center of orifice 718 which is parallel to the longitudinal axis the trocar 600 is moved a distance from the longitudinal axis of the trocar 600.
[000204] As noted above, scraper 620 may also include features formed thereon, such as capillary absorption element 622, to absorb fluid capillarity away from operating channel 606. Although capillary absorption element 622 may take any suitable shape to absorb fluid capillary away from opening 712, in the illustrated embodiment, capillary absorber 622 may be one or more channels 720 formed on distal surface 694. Channels 720 may partially extend to distal surface 694 of scraper 620 and may have an adequate depth to contain and transfer fluid away from opening 712. Channels 720 may start at opening 712 and extend radially out of it, or they may start at a radial distance away from opening 712 and extend radially outward addition, as shown in figures 38A and 38C. Similarly, channels 720 may extend the entire length to the outermost circumference of scraper 620, or may stop a distance away from the outermost circumference, as shown in figure 38A. One skilled in the art will observe the variety of possible configurations for the 720 channels.
[000205] There can also be numerous channels 720 formed in the scraper 620 as desired and they can be arranged around the scraper 620 with equal spacing between them and / or with irregular spacing between them. In the illustrated embodiment, a plurality of channels 720 are formed in scraper 620 and most of them are, in general, evenly spaced around scraper 620. However, channels 720 near orifice 718 may differ in spacing. For example, four of the channels 720 near orifice 718 are not equally spaced from the other channels 720. Instead, two channels 720 on one side of orifice 718 and two channels 720 on the other side of orifice 718 are spaced closer to each other. in order to provide space for orifice 718 and to ensure that fluid is directed away from orifice 718. As noted above, scraper 620 can be seated on ridges 621 formed in wall 736 of distal compartment 610. In particular, ridges 621 they can engage a narrow circumference of the scraper 620 that is closer to the central opening 712 than the outermost circumference, for example, about a quarter to a third of the distance along the length of the channels 720, although any configuration is possible. This narrow hitch circumference allows the scraper 620 to be seated within the distal compartment 610 without causing the channels 720 to sag or collapse, as would likely happen with a wider hitch area. The channels 720 can be aligned with the ridges 621, as shown in figure 38C, such that each channel 720 is aligned to the lower portion or valley of the ridges 621 to ensure that the fluid flows through the channel 720. Each raised portion or peak of the ridges 621 extends proximally between channels 720. Channels 720 can be adjacent to and be in contact with sorbent 624 to absorb capillary fluid to sorbent 624.
[000206] The sorbent 624 can also have any shape and configuration, as noted in detail above. In the embodiments illustrated in figures 36 and 39, the sorbent 624 may have a substantially C-shaped and / or substantially circular shape with a cutout 730 on one side. A central opening 727 of the sorbent 624 may have a diameter that is greater than a diameter of the operating channel 606 of the cannula 604 and / or the opening 712 formed in the scraper 620. The sorbent 624 may have a proximal surface 726 and a distal surface 728, as well as an outer surface 732 and an inner surface 734. The sorbent 624 may, in general, have a rectangular cross section with a width W and a height H, and in some embodiments, the width W may be less than a height H In other embodiments, sorbent 624 may have a circular cross section, a triangular cross section, etc. The sorbent 624 can, in general, be of a size suitable to be positioned inside the cavity 670 formed inside the distal compartment 610. The cutout 730 can have any width and configuration, and, in the illustrated embodiment, has a width similar to, but greater than the size of the orifice 718 in the scraper 620 and the opening 706 in the retainer 626. For example, the cutout 730 may be wider than the parallel walls 677 inside the distal compartment 610 which defines an inflation path 674 through the compartment distal 610. The hole 718 in the scraper 620 and the opening 706 in the retainer 626 can have a width substantially equal to the width of the walls 677 in the distal compartment 610. The larger width of the cutout 730 compared to the width of the hole 718 and the opening 706 should ensure that the inflation path remains free of any fluid retained in sorbent 624. In use, cutout 730 is preferably aligned with hole 718 and opening 706.
[000207] As noted above, the sorbent 624 can be seated inside the cavity 670 and on top of the projections 671. The projections 671 can engage the distal surface 728 of the sorbent 624 and can raise the sorbent 624 in order to tilt the sorbent 624 forming engagement with scraper 620. In particular, the proximal surface 726 of sorbent 624 can be compressed forming engagement with distal surface 694 of scraper 620. In some embodiments, there may be a compaction force that results in an interference contact between the surfaces 726, 694 in the range of about 0.0254 (1 / 1,000) to about 0.457 mm (18 / 1,000 inches) to ensure sufficient contact between the two surfaces 726, 694 without blocking channels 720 and preventing transfer of fluids. The engagement between the two surfaces 726, 694 provided by the projections 671 results in an efficient transfer of fluid from channels 720 of the capillary absorption element 622 to the sorbent 624. The fluid scraped by opening 712 can travel radially outward opening 712 through the channels 720, go through the ridges 621, and get in contact with the sorbent 624 to be sipped in this way.
[000208] When the trocar is assembled, all the holes, openings and paths through the various components of the fluid removal system can be aligned to form an inflation path through the fluid removal system, as shown by the arrow A in the figure 33B. More particularly, the sorbent 624 can be positioned inside the cavity 670 inside the distal compartment 610. The ridges 672 can engage the outer surface 732 of the sorbent 624, although the inner surface 734 engages a wall 736 defining the opening 650 that extends to the cannula 604. The opposite sides 738a, 738b of the cutout 730 can be positioned on the side of the channel or path 674 extending from the opening 650 inside the distal compartment 610. The path 674 can be aligned with the door 696 retainer 626 to allow insufflation gas to flow through it. The scraper 620 can be positioned on top of or proximal to the sorbent 624 in such a way that the outer perimeter of the scraper 620 rests on the distal sealing flange 668 of the distal compartment 610, and such that the capillary absorbing element 622 is adjacent to and in contact with sorbent 624. Thus, the fluid scraped by scraper 620 will be absorbed by capillarity along channels 720 and sorbent by sorbent 624. Sorbent 624 will retain the fluid away from operating channel 606, and thus away from any instrument inserted through the operating channel 606. The hole 718 in the scraper 620 can be aligned with the path 674 in the distal compartment 610 and the cutout 730 in the sorbent 624 in order to allow the insufflation gas flow through it.
[000209] Additionally, the seal retainer 626 can be positioned proximal to the scraper 620 in such a way that the distal rim 690 is positioned on the proximal surface in contact with the outer perimeter of the scraper 620 and forms a seal against it with the sealing flange. distal 668. Opening 706 in retainer 626 can also be aligned with hole 718 in scraper 620, cutout 730 in sorbent 624 and path 674 in distal compartment 610 to form the inflation path to allow the flow of insufflation through it . Thus, the insufflation gas of port 696 passes from an area in the distal compartment 610 that is proximal to the fluid removal system through the path created by opening 706, through hole 718, through cutout 730 and through path 674 and to an area distant to the fluid removal system. The insufflation gas can therefore pass to the cannula 604 and the body cavity through the fluid removal system even when a surgical instrument occludes the opening 712 in the scraper 620.
[000210] In use, since trocar 600 is inserted into a body cavity, inflation port 612 can be used to introduce inflation gas into compartment 602 through port 696 on seal retainer 626. In other embodiments, gas insufflation valve can be inserted into compartment 602 before an instrument is inserted through it. The gas can flow to channel 740 at retainer 626 near the distal end of the duckbill seal 616 shown in figure 33B, and to the inflation path created through the fluid removal system as described above, as well as through the operating channel 606. When an instrument is disposed through trocar 600, the deep cone seal 618 forms a seal around the instrument to maintain distal inflation of seal 618. Additionally, the surgical instrument occludes opening 712 in scraper 620, preventing the flow of gas through operating channel 606. The inflation path that extends through the fluid removal system is displaced relative to operating channel 606, so that the inflation gas can flow through the inflation path in the direction of arrow A shown in figure 33B, as described above.
[000211] As a surgical instrument is removed from trocar 600, it is pulled through opening 712 in scraper 620. Opening 712 can scrape fluid from the outside of the surgical instrument. The fluid can travel through the capillarity absorption channels 720 and be absorbed by capillarity away from the opening 712. The channels 720 can transfer the fluid to the sorbent 624, where it is kept away from the opening 712 so that any surgical instrument subsequently inserted is not contaminated by the fluid. It will be understood by the individual of common skill in the technique that the order of use and / or method steps are not important and, therefore, can be performed in any order.
[000212] In another embodiment, all of the fluid removal modes described above can be formed into a single "inlet" unit, as needed. The inlet unit may include sorbent elements, scraper elements, capillary absorption elements and / or combinations thereof. These elements can be combined as needed in an externally configured unit that can be placed in an existing trocar system as needed. In this way, the inlet unit will fit in and around any seals and components disposed within the proximal compartment, including the removable cover, and / or inside the cannula. For example, the input unit can be configured to fit below or distal to one or more sealing elements and / or it can be configured to fit above or proximal to one or more sealing elements. Alternatively or in addition, the entry unit can be configured to have components that fit above, below or between the sealing elements. The inlet unit can also include the seals in it, so that the entire unit can be placed inside an empty trocar compartment. The input unit can also be removable as needed, and the unit, or portions thereof, can be reusable.
[000213] Methods for removing fluid from a surgical instrument are also generally provided. In an exemplary embodiment, a surgical instrument can be passed through an access device and a fluid remover in the access device can remove any fluid in the instrument, or fluid deposited in a seal within the access device by the instrument. In an exemplary embodiment, a fluid remover can engage a surgical instrument that has passed through an access device, such as a trocar, by removing the instrument to thereby remove fluid from the instrument, thereby preventing fluid from accumulating in the s ) fence / seals and / or to be redeposited in instruments passing through it. As indicated above, the fluid remover can be formed from any combination of one or more sorbent, scraping and capillary absorption elements. A person skilled in the art will realize that virtually any combination of sipping, scraping and capillary absorption elements can form the fluid remover resulting in a variety of methods for removing fluid that can include any combination of sipping, scraping and absorbing fluid. by capillary effect away from a surgical instrument and / or a seal or other portion of a trocar or other access device.
[000214] Those skilled in the art will additionally appreciate that the present invention has applications in conventional open endoscopic and surgery instruments as well as applications in robotic aid surgery.
[000215] The devices described here can be designed to be discarded after a single use, or they can be designed for use multiple times. In either case, however, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of steps to disassemble the device, followed by cleaning or replacing particular parts, and subsequent reassembly. In particular, the device can be disassembled, and any number of particular parts or parts of the device can be selectively exchanged or removed, in any combination. As a non-limiting example, the scraper and / or sorbent can be removed, cleaned, re-coated with a hydrophilic material, sterilized and reused. After cleaning and / or changing private parts, the device can be reassembled for subsequent use in a reconditioning facility or by a surgical team immediately before a surgical procedure. Those skilled in the art will appreciate that the reconditioning of a device can use a variety of techniques for disassembly, cleaning or replacement, and reassembly. The use of such techniques, and the resulting refurbished device are all within the scope of the present application.
[000216] Preferably, the devices described here will be processed before surgery. First, a new or used instrument is obtained and, if necessary, cleaned. The instrument can then be sterilized. In a sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK pouch. The container and its contents are then placed in a radiation field that can penetrate the container, such as gamma radiation, X-rays, or high-energy electrons. The radiation kills bacteria on the instrument and the container. The sterile instrument can then be stored in a sterile container. The sterile container keeps the instrument sterile until it is opened at the medical facility.
[000217] It is preferable that the device is sterilized. This can be accomplished in any number of ways known to those skilled in the art including beta or gamma radiation, ethylene oxide or vapor.
[000218] An individual skilled in the art will appreciate other aspects and advantages of the invention based on the modalities described above. Accordingly, the invention should not be limited by what has been particularly shown and described, except as indicated by the appended claims. All publications and references cited herein are hereby expressly incorporated, by reference, in their entirety.

权利要求:
Claims (10)
[0001]
1. Surgical access device (600), comprising: a compartment (602) that defines an operating channel (606) dimensioned and configured to receive a surgical instrument, an insufflation port (612) formed in the compartment (602) and configured for distributing insufflation gas to the operating channel (606); a sealing device (616, 618) disposed inside the compartment (602) and positioned proximal to the insufflation port (612), the seal (616, 618) being configured to receive a surgical instrument passed through the operating channel (606); and a fluid remover (620, 622, 624) disposed inside the compartment (602), the fluid remover having an external perimeter mounted in the compartment (602) and a central opening configured to receive surgical instruments through it; characterized by fact that the fluid remover (620, 622, 624) is positioned distally to the supply port (612), where the supply port (612) is configured to deliver the supply gas to the portion of the operating channel (606 ) distal to the seal (616, 618) and proximal to the fluid remover (620, 622, 624), and the fluid remover (620, 622, 624) is configured to allow the insufflation gas to pass through it when an instrument obstructs the central opening.
[0002]
2. Surgical access device (600) according to claim 1, characterized in that the fluid remover (620, 622, 624) comprises a scraper (620) configured to remove fluid from the inserted surgical instruments through the opening central.
[0003]
3. Surgical access device (600), according to claim 2, characterized by the fact that the scraper (620) includes an absorption element (622) by capillary effect formed in it and configured to absorb fluid from the central opening in the scraper (620).
[0004]
Surgical access device (600) according to claim 3, characterized in that the absorption element (622) comprises a plurality of channels (720) formed on a distal surface (694) of the scraper (620) and extending radially outwardly from the central opening so that fluid removed from a surgical instrument can flow into the channels (720).
[0005]
5. Surgical access device (600) according to claim 2, characterized in that the fluid remover (620, 622, 624) includes a sorbent (624) disposed distally to the scraper (620) and configured to receive fluid removed by the scraper (620).
[0006]
6. Surgical access device (600) according to claim 1, characterized in that the fluid remover (620, 622, 624) includes an orifice (718) formed in it and positioned at a certain distance from the opening central and the outer perimeter of the orifice (718) being configured to allow insufflation gas to pass through it.
[0007]
Surgical access device (600) according to claim 1, characterized in that the compartment (602) comprises a portion of the proximal compartment (608) and a portion of the distal compartment (608) having a cannula (602) ) extending distally from it, the proximal and distal portions of the compartment being arranged around an internal retainer (626), the operating channel (606) extends through the internal retainer (626) and the cannula (602), and the outer perimeter of the fluid remover (620, 622, 624) is in a sealing fit with the inner retainer (626) and the distal compartment portion (610).
[0008]
8. Surgical access device (600) according to claim 7, characterized by the fact that the seal (616, 618) is captured between the internal retainer (626) and the proximal compartment portion (610).
[0009]
9. Surgical access device (600), according to claim 7, characterized by the fact that the distal cannula (602) includes an angled distal surface (605) having a more distal and a more proximal point, with the most distal point is aligned with the inflation port (612).
[0010]
10. Surgical access device (600), according to claim 1, characterized by the fact that it still comprises at least one opening (675) formed in the external wall of the compartment (602) and configured to receive a suture.

类似技术:

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公开号 | 公开日 | 专利标题

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BR112013009059B1|2020-11-17|surgical access device

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BR112012002041B1|2021-05-04|fluid remover for use in a surgical access device

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JP5653590B2|2015-01-14|Fluid removal in surgical access devices

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JP5478933B2|2014-04-23|Absorption of fluids in surgical access devices

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CA2664867C|2016-07-12|Scraping fluid removal in a surgical access device

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CA2664838C|2017-06-20|Wicking fluid management in a surgical access device

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US11235111B2|2022-02-01|Surgical access device

同族专利:

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公开号 | 公开日

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CA2814501A1|2012-04-19|

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EP2627269B1|2018-02-28|

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RU2582869C2|2016-04-27|

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US20110046449A1|2011-02-24|

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EP2627269A1|2013-08-21|

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US8636686B2|2014-01-28|

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US9827383B2|2017-11-28|

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CN103249367A|2013-08-14|

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PL2627269T3|2018-07-31|

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US20140121465A1|2014-05-01|

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JP2013544555A|2013-12-19|

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AU2011316659A1|2013-05-02|

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AU2011316659B2|2015-07-23|

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CA2814501C|2018-09-11|

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USD878606S1|2020-03-17|

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WO2012051253A1|2012-04-19|

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BR112013009059A2|2016-07-19|

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CN103249367B|2016-08-10|

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JP5931074B2|2016-06-08|

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USD735852S1|2015-08-04|

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RU2013119987A|2014-11-20|

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法律状态:
2018-12-26| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|

---

2020-02-18| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

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2020-07-21| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

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2020-11-17| B16A| Patent or certificate of addition of invention granted [chapter 16.1 patent gazette]|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 12/10/2011, OBSERVADAS AS CONDICOES LEGAIS. |

优先权:

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申请号 | 申请日 | 专利标题

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US12/902,265|2010-10-12|

---

US12/902,265|US8636686B2|2008-04-28|2010-10-12|Surgical access device|

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PCT/US2011/055905|WO2012051253A1|2010-10-12|2011-10-12|Surgical access device|

---