WO1993008867A2

WO1993008867A2 - Apparatus for laparoscopic and endoscopic surgery

Info

Publication number: WO1993008867A2
Application number: PCT/US1992/009354
Authority: WO
Inventors: Naomi L. Nakao; Peter J. Wilk
Original assignee: Nakao Naomi L; Wilk Peter J
Priority date: 1991-11-05
Filing date: 1992-11-03
Publication date: 1993-05-13
Also published as: WO1993008867A3; AU3058992A

Abstract

An instrument assembly for use in laparoscopic or endoscopic surgery comprises a laparoscope or endoscope and a surgical instrument. The laparascope or endoscope includes a tubular member (82) for insertion into a patient's body, the tubular member (82) being flexible at least in a region about a distal end thereof. The tubular member includes an elongate channel (80) extending longitudinally therethrough, the channel having a characteristic diameter. A control element (92) is provided on the laparoscope or endoscope for controlling a bending type motion of the tubular member in the flexible region at the distal end of the instrument. The surgical instrument has an elongate body portion with a diameter smaller than the characteristic diameter of the laparoscope or endoscope channel, whereby the surgical instrument is insertable into the channel. The elongate body portion of the surgical instrument is flexible at least in an area about a distal end of the instrument.

Description

METHOD AND APPARATUS FOR USE IN APAROSCOPIC AND ENDOSCOPIC SURGERY

Field of the Invention

This invention relates to a method and apparatus for use in laparoscopic and endoscopic surgery. More particularly, this invention relates to a surgical instrument which may be used separately in conjunction with a laparoscope or endoscope or as an integral part of a laparoscope or endo¬ scope. This invention also relates to a method for performing surgery using such an instrument. Background of the Invention

Laparoscopy involves the piercing of the abdominal wall and the insertion of a tubular port member through the perforation. Various instruments may be inserted through the tubular member to perform surgical operations inside the abdomen.

Generally, upon the disposition of the first tubular member so that it traverses the abdominal wall, the abdominal cavity is pressurized to distend the abdominal wall and pro¬ vide a safety region between the wall and the body organs inside the cavity. Moreover, several perforations are made. One perforation receives a laparoscope which enables visual monitoring of organs and surgical activities inside the abdominal cavity. Other perforations serve for the insertion of different surgical instruments.

Laparatomic surgery provides several advantages over conventional incision-based surgery. The laparotomic perfora¬ tions, in being substantially smaller than the incisions made during conventional operations, are less traumatic to the patient and provide for an accelerated recovery and convales¬ cence. Hospital stays are minimized. Concomitantly, laparo¬ scopic surgery is less time consuming and less expensive than conventional surgery for correcting the same problems.

Generally, laparatomic surgery is performed with rigid instruments, the distal end portions of which are inserted into the patient's abdominal cavity through one or more tubular port members inserted in perforations formed in the abdominal wall. To enable the different laparotomic surgical instruments to reach different locations within the abdominal cavity, the tubular port members are tilted or pivoted. In a more recent development, the distal terminal portions of some laparoscopes are flexible and bendable under control of the surgeon by the manipulation of actuator members outside the patient. As in endoscopic surgery, surgical instruments such as biopsy forceps, graspers, trocars, suction devices, irrigators, scissors, cautery devices, staplers, suture applicators and clamps, may be inserted through one or more longitudinal channels in the laparoscopes or endoscopes. These instruments are at least partially flexible to enable them to flex with the bending type motions of the laparoscopes or endoscopes in which they are inserted.

In laparoscopic or endoscopic surgical operations, it occasionally occurs that a site of interest inside a patient is located on an underside of an organ. Such loca¬ tions are difficult to reach with conventional laparoscopic or endoscopic instruments. There is, therefore, a long-felt need in the field of laparoscopic or endoscopic surgery to provide a means for facilitating such operations. Objects of the Invention

An object of the present invention is to provide a method and an associated apparatus for facilitating access to internal body tissues of a patient in laparoscopic or endo¬ scopic operations.

Another, more particular, object of the present invention is to provide such a method and apparatus which facilitates the performance of surgical operations on internal body tissues which are located on sides of organs away from a laparoscope or endoscope.

A further particular object of the present invention is to provide such an instrument assembly which is easy to use. Summary of the Invention

An instrument assembly for use in laparoscopic or endoscopic surgery comprises, in accordance with the present invention, a laparoscope or endoscope and a surgical or operating instrument. The laparoscope or endoscope includes a tubular member for insertion into a patient's body, the -tubular member being flexible at least in a region about a distal end thereof. The tubular member includes an elongate channel extending longitudinally therethrough, the channel having a characteristic diameter. A control element is pro¬ vided on the laparoscope or endoscope for control-ling a bend¬ ing type motion of the tubular member in the flexible region at the distal end of the instrument. The surgical instrument has an elongate body portion with a diameter smaller than the characteristic diameter of the laparoscope or endoscope chan¬ nel, whereby the surgical instrument is insertable into the channel. The elongate body portion of the surgical instrument is flexible at least in an area about a distal end of the instrument. An actuator is provided on the surgical instru¬ ment for controlling a bending type motion of the elongate body portion of the instrument in the flexible area at the distal tip of the instrument. The actuator is operable inde¬ pendently of the bending control element for the laparoscope or endoscope.

Pursuant to another feature of the present inven¬ tion, the surgical instrument has an operative component on the elongate body portion at a distal end thereof for implementing a surgical type operation on internal body tis¬ sues of the patient. The operative component may take the form of a scissors, a grasping forceps, a biopsy forceps, a clamp, a stapler, a suture applicator, an irrigation or suc¬ tion port, a scissors, a cautery device or any other device for performing surgical type operations on internal body tis¬ sues. The surgical instrument also has an actuator element on the elongate body portion which is coupled to the operative component for enabling a surgeon to use the operative com¬ ponent for performing the respective surgical operation. The actuator for the bending type motion of the surgical instru¬ ment is operable separately from the actuator for the opera¬ tive component.

The present invention is therefore directed in part to a surgical instrument for use in conjunction with a rigid or partially flexible laparoscope or an endoscope. As dis¬ cussed above, the surgical instrument comprises an elongate body portion which is flexible at least in an area about a distal end of the elongate body portion of the surgical instrument. The surgical instrument also comprises an opera- tive component on the elongate body portion at the distal end thereof for implementing a surgical type operation on internal body tissues of the patient. A first actuator is provided on the elongate body portion of the surgical instrument and is operatively connected to the operative component for enabling a surgeon to use the operative component for performing the surgical type operation. A second actuator is provided on the surgical instrument for controlling a bending type motion of the elongate body portion in the flexible area about the dis¬ tal end of the surgical instrument. This bending is imple¬ mented independently of any bending motion of the laparoscope or endoscope. Moreover, the actuator for bending the surgical instrument's distal end portion is operable separately from the actuator for working the operative component (forceps, clamp, stapler, etc.).

In the event that the surgical instrument is used inside a biopsy or other channel of a laparoscope or endo¬ scope, the diameter of the elongate body portion of the surgi¬ cal instrument is smaller than a characteristic diameter of the laparoscopic or endoscopic biopsy channel, so that the surgical instrument is insertable into that channel.

In the event that the surgical instrument is utilizable separately and distinctly from a laparoscope or endoscope, the surgical instrument has the structure defined above, except that the diameter of the elongate body portion need not be smaller than the biopsy channel of a laparoscope or endoscope. In this case, the surgical instrument is inserted separately, for example, into a patient's abdomen. The surgical instrument may be inserted through one incision, while the laparoscope is inserted through a different inci¬ sion.

A method for use in laparoscopic or endoscopic surgery, comprises, in accordance with the present invention, the steps of (a) inserting through an opening into a patient a laparoscope or endoscope having an elongate channel, (b) using the laparoscope or endoscope to locate a desired surgical site inside the patient, (c) longitudinally shifting through the elongate channel of the laparoscope or endoscope a surgical instrument so that an operating tip at a distal end portion of the instrument is ejected from the laparoscope or endoscope and inserted into the patient, and (d) manipulating the surgi¬ cal instrument from outside the patient so that the distal end portion bends independently of any bending motion of the laparoscope or endoscope. The surgical instrument is then manipulated so that the operating tip engages internal body tissues of the patient at the surgical site.

Pursuant to another feature of this method in accordance with the present invention, the laparoscope or endoscope has a flexible end portion and means for controlling bending of the flexible end portion, the step of manipulating the surgical instrument comprising the step of using the means for controlling so that bending type motions of the laparo¬ scope or endoscope are independent of bending motions of the distal end portion of the surgical instrument.

Pursuant to another feature of the present inven¬ tion, the step of manipulating the surgical instrument com¬ prises the step of moving an actuator member located on the surgical instrument.

This method may comprise the further steps of remov¬ ing the surgical instrument from the laparoscopic or endo¬ scopic channel, inserting therein an additional surgical instrument, manipulating the additional surgical instrument from outside the patient so that a distal end portion of the additional surgical instrument bends independently of bending type motions of the laparoscope or endoscope, and actuating the additional surgical instrument so that an operating tip connected to a distal terminus of the distal end portion of the additional surgical instrument engages internal body tis¬ sues of the patient.

Another method, in accordance with the present invention, for use in laparoscopic surgery comprises the steps of (i) forming at least one opening in a patient's abdominal wall, (ii) , inserting a separate tubular port member into each abdominal-opening or incision to prevent each opening from closing and to provide access to an abdominal cavity of the patient, (iii) partially inserting a laparoscope into the patient's abdominal cavity, via a tubular port member, (iv) partially inserting a surgical instrument into the patient's abdominal cavity, via the same or another tubular port member, so that an operating tip at a distal end portion of the instrument is inserted into the patient body cavity, and (v) manipulating the surgical instrument from outside the patient so that the distal end portion bends independently of bending type motions of the laparoscope. The surgical instrument is actuated so that the operating tip engages internal body tis¬ sues of the patient.

A surgical instrument in accordance with the present invention facilitates access to internal body tissues of a patient in laparoscopic or endoscopic operations. More spe¬ cifically, a method and apparatus in accordance with the pres¬ ent invention facilitates the performance of surgical opera¬ tions on internal body tissues which are located on sides of organs away from a laparoscope or endoscope. Brief Description of the Drawing

Fig. 1 is a schematic side elevational view of a surgical instrument for use in laparoscopic or endoscopic surgery, in accordance with the present invention.

Fig. 2 is a schematic side elevational view of a modification of the surgical instrument of Fig. 1, in accord¬ ance with the present invention.

Fig. 3 is a schematic side perspective view of a portion of the surgical instrument of Fig. 1 or 2, in accord¬ ance with the present invention, inserted in a biopsy channel of a laparoscope or endoscope.

Fig. 4 is a schematic side perspective view of a portion of another kind of surgical instrument, in accordance with the present invention, inserted in a biopsy channel of a laparoscope or endoscope.

Fig. 5 is a schematic side cross-sectional view of a patient's abdomen during a laparoscopic procedure utilizing the surgical instrument of Fig. 1 or 2, in accordance with the present invention.

-Fig. 6 is a schematic side cross-sectional view of a patient's abdomen during a laparoscopic procedure utilizing the surgical instrument of Fig. 3 or 4, in accordance with the present invention. Detailed Description As illustrated in Fig. 1, a surgical instrument 20 for use in laparoscopic or endoscopic surgical procedures includes a body portion 22 in the form of an elongate tubular member. At a distal end, elongate body portion 22 is provided with an operative component 24. Operative component 24 may take the form of virtually any laparoscopic or endoscopic surgical tool and is schematically illustrated to have a pair of jaws 26a and 26b. Such jaws would be found in such instru¬ ments as biopsy forceps, graspers, scissors, staplers, suture applicators and clamp applicators. However, as discussed hereinafter with reference to Fig. 4, the operative component of the surgical instrument may alternatively be a trocar, a suction device, an irrigator, a cautery device, or other instrument which does not have jaws.

Operative component 24 is mechanically connected to a manually operable actuator 28 at a proximal end of surgical instrument 20. Actuator 28 may exemplarily take the form of a pair of handle members 30a and 30b which are movable rela¬ tively towards and away from one another, as indicated by arrows 32a and 32b, for alternatively opening and closing jaws 26a and 26b, as indicated by phantom lines 33a and 33b.

The distal terminus 34 of body portion 22 is flexi¬ ble and may be bent, as indicated by phantom lines 36a and 36b, in different directions to increase the effective range and angles of approach of operative component 24. Surgical instrument 20 is provided with another manually operable actuator 38 comprising a pair of finger rings 40a and 40b which are mechanically linked to opposite sides of terminus 34 via respective cables 42a and 42b. Cables 42a and 42b extend longitudinally along opposite sides of body portion 22 and are guided through respective pluralities of eyelets 44a and 44b. It is to be noted, however, that cables 42a and 42b could be housed in respective channels (not shown) along body portion 22 so that the cables would not be visible to the unaided eye.

Pulling actuator ring 40a in the direction indicated by an arrow 46a causes terminus 34 to bend so that operative component 24 assumes the position indicated by phantom lines 36a, while pulling actuator ring 40b in the direction indi¬ cated by an arrow 46b causes terminus 34 to bend so that operative component 24 assumes the position indicated by phantom lines 36b.

As depicted in Fig. 2, another surgical instrument 50 for use in laparoscopic or endoscopic surgical procedures includes an elongate essentially tubular body portion 52. At a distal end, body portion 52 is provided with an operative component 54 having a pair of jaws 56a and 56b. As discussed above with reference to Fig. 1, operative component 54 may be an instrument such as a biopsy forceps, graspers, scissors, staplers, suture applicators and clamp applicators. Alterna¬ tively, operative component 54 be a trocar, a suction device, an irrigator, a cautery device, or other instrument which does not have jaws.

Operative component 54 is mechanically connected to a manually operable actuator 58 at a proximal end of surgical instrument 50. Actuator 58 may exemplarily take the form of a pair of handle members 60a and 60b which are movable rela¬ tively towards and away from one another, as indicated by arrows 62a and 62b, for alternatively opening and closing jaws 56a and 56b, as indicated by phantom lines 63a and 63b.

The distal terminus 64 of body portion 52 is flexi¬ ble and may be bent, as indicated by phantom lines 66a and 66b, in different directions to increase the effective range and angles of approach of operative component 54. Surgical instrument 50 is provided with a manually operable actuator 68 comprising a single finger ring which is mechanically linked to opposite sides of terminus 64 via cables 72a and 72b. Cables 72a and 72b extend longitudinally along opposite sides of body portion 52 and are guided through respective pluralities of eyelets 74a and 74b. Of course, cables 72a and 72b may be alternatively housed in respective channels (not illustrated) along body portion 52.

Pushing actuator ring 68 in the direction indicated by an arrow 76a causes terminus 64 to bend so that operative component^" 54 assumes the position indicated by phantom lines 66a_r while pulling actuator ring 70b in the direction indi¬ cated by an arrow 76b causes terminus 64 to bend so that operative component 54 assumes the position indicated by phantom lines 66b. Body portions 22 and 52 of surgical instruments 20 and 50 may have a sufficiently small diameter that they can be inserted into the biopsy channel 80 of a laparoscope or endo¬ scope 82, as illustrated in Fig. 3. Laparoscope or endoscope 82 is provided at a distal end with an aperture or lens 84 for emitting light, as well as an aperture or lens 86 for collect¬ ing light.

As shown in Fig. 4, a surgical instrument 88 pro¬ vided with a distal end portion 90 which bends in response to the manipulation or activation of a bend actuator device 92 takes the form of a tubular member such as a suction or irrigation tube, or a cautery device. Accordingly, at a proximal end, surgical instrument 88 is operatively coupled to a vacuum source, a supply or irrigant, or an electrical power source (not shown) . Surgical instrument 88 is slidably inserted through the biopsy channel 94 of a laparoscope or endoscope 96. Laparoscope or endoscope 96 may have a flexible distal end portion which bends under the control of an actuator device 97 and is provided at its distal end with an aperture or lens 98 for emitting light, as well as an aperture or lens 100 for collecting light.

Fig. 5 shows the use of surgical instrument 20 of Fig. 1 (or surgical instrument 50 of Fig. 2) in laparotomic surgery separately from a laparoscope 102. An abdominal wall AW of a patient P is pierced at two locations to form a pair of openings or incisions through which respective laparotomic tubular port members 104 and 106 are inserted. Laparoscope 102 is inserted through one tubular port member 104 partially into the abdominal cavity AC of patient P. A distal end por¬ tion 108 of laparoscope 102 may be flexible, as indicated by phantom lines 110. Surgical instrument 20 is partially inserted into abdominal cavity AC through the other tubular port member 106. Actuator 28 (or 58) is manipulated by a surgeon to bend terminus 34 (or 64) , thereby extending the reach and increasing the maneuverability of operative com¬ ponent 24 (or 54) . This increase in maneuverability and effective range of surgical instrument 20 (or 50) is attained without the necessity of pivoting the tubular port member 106 through which surgical instrument 20 (or 50) is inserted into the abdominal cavity AC of patient P.

As illustrated in Fig. 6, the laparoscopic surgical assembly of Fig. 3 (or 4) is insertable through a single tubular port member 112 traversing an opening in a patient's abdominal wall AW. Upon the making of an incision or opening in abdominal wall AW, the insertion of tubular port member 112 into the opening, and the insertion of laparoscope 82 or 96 through the tubular port member 112 at least partially into body cavity AC, the terminus 34 (64) of surgical instrument 20 (50) or the distal end portion 90 of surgical instrument 88 (Fig. 4) is bent independently of any bending type motions of the distal end portion of laparoscope 82 or 96.

In a laparoscopic surgical procedure utilizing the instrument assembly of Fig. 6, laparoscope 82 is used in a conventional manner to locate a desired surgical site inside the patient P. Upon the detection of the desired surgical site, elongate body portion 22 (or 52) of surgical instrument 20 (or 50 or 88) is longitudinally shifted through the elongate channel 80 (94) of the laparoscope so that operative component 24 at a distal end portion of the instrument is ejected from the laparoscope and inserted into the patient. Of course, other necessary steps are implemented in performing the laparotomic surgery, such as the pressurization or other distension of the abdomen.

Although the invention has been described in terms of particular embodiments and applications, one of ordinary skill in the art, in light of this teaching, can generate additional embodiments and modifications without departing from the spirit of or exceeding the scope of the claimed invention. For example, other, alternative, structures may be provided for bending the distal end of a laparoscopic or endo¬ scopic surgical instrument under the control of a surgeon from outside the patient. More specifically, bending might be effectuated through hydraulic means rather than mechanical cables. Accordingly, it is to be understood that the drawings and descriptions herein are proferred by way of example to facilitate comprehension of the invention and should not be construed to limit the scope thereof.

Claims

CLAIMS:

1. An instrument assembly for use in laparoscopic or endoscopic surgery, comprising: a laparoscope or endoscope having a tubular member for insertion into a patient's body, said tubular member being flexible at least in a region about a distal end thereof, said tubular member including an elongate channel extending longi¬ tudinally therethrough, said channel having a characteristic diameter; control means on said laparoscope or endoscope for controlling a bending type motion of said tubular member in said region; a surgical tool having an elongate body portion with a diameter smaller than said characteristic diameter, whereby said surgical tool is insertable into said channel, said elongate body portion of said surgical tool being flexible at least in an area about a distal end thereof; and actuator means on said surgical tool for controlling a bending type motion of said elongate body portion in said area, said actuator means being operable independently of said control means.

2. The instrument assembly defined in claim 1 wherein said surgical tool has operational means on said elongate body portion at a distal end thereof for implementing a surgical type operation on internal body tissues of the patient, said surgical tool also having means on said elongate body portion and operatively connected to said operational means for enabling a surgeon to use said operational means for performing said surgical type operation, said actuator means being operable separately from said means for enabling.

3. A surgical instrument for use in conjunction with a laparoscope or endoscope having a tubular member for inser¬ tion into^" a patient, said tubular member including an elongate channel extending longitudinally therethrough, said channel having a characteristic diameter, said surgical instrument comprising: an elongate body portion with a diameter smaller than said characteristic diameter, whereby the surgical instrument is insertable into the channel of the laparoscope or endoscope, said elongate body portion being flexible at least in an area about a distal end thereof; operational means on said elongate body portion _,at the distal end thereof for implementing a surgical type opera¬ tion on internal body tissues of the patient; irst actuator means mounted to said elongate body portion and operatively connected to said operational means for enabling a surgeon to use said operational means for per¬ forming said surgical type operation; and second actuator means on said surgical instrument for controlling a bending type motion of said elongate body portion in said area independently of any bending motion of the laparoscope or endoscope, said second actuator means being operable separately from said first actuator means.

4. A surgical instrument at least partially insert¬ able into a patient separately and distinctly from a laparo¬ scope or endoscope, comprising: an elongate body portion flexible at least in an area about a distal end thereof; operational means on said elongate body portion at the distal end thereof for engaging internal body tissues of a patient upon insertion of said elongate body portion into a cavity of the patient and for effectuating a surgical opera¬ tion on the internal body tissues of the patient; first actuator means on said elongate body portion and operatively connected to said operational means for actuating said operational means for perform said surgical operation; and second actuator means on said surgical instrument for controlling a bending type motion of said elongate body portion in said area.

5. A method for use in laparoscopic or endoscopic surgery, comprising the steps of: inserting through an opening into a patient a laparoscope or endoscope; using said laparoscope or endoscope to locate a desired surgical site inside the patient, said laparoscope or endoscope having an elongate channel; longitudinally shifting through said elongate chan¬ nel a surgical instrument so that an operating tip at a distal end portion of said instrument is ejected from said laparo¬ scope or endoscope and inserted into the patient; manipulating said surgical instrument from outside the patient so that said distal end portion bends independ¬ ently of any bending motion of said laparoscope or endoscope; and actuating said surgical instrument so that said operating tip engages internal body tissues of the patient at the surgical site.

6. The method defined in claim 5 wherein said laparoscope or endoscope has a flexible end portion and means for controlling bending of said flexible end portion, said step of manipulating being implemented so that said distal end portion of said surgical instrument is bent independently of bending motion of said laparoscope or endoscope induced by said means for controlling.

7. The method defined in claim 5 wherein said step of manipulating comprises the step of moving an actuator mem¬ ber located on said surgical instrument.

8. The method defined in claim 5, further comprising the steps of removing said surgical instrument from said chan¬ nel, inserting therein an additional surgical instrument, manipulating said additional surgical instrument from outside the patient so that a distal end portion of said additional surgical instrument bends independently of bending type motions of said laparoscope or endoscope, and actuating said additional surgical instrument so that an operating tip con¬ nected to a distal terminus of the distal end portion of said additional surgical instrument engages internal body tissues of the patient.

9. A method for use in laparoscopic surgery, com¬ prising the steps of: forming at least one opening in a patient's abdominal wall; inserting a separate tubular port member into each said opening to maintain each said opening from closing and to provide access to an abdominal cavity of the patient; partially inserting a laparoscope into the patient's abdominal cavity, via a said tubular port member; partially inserting into the patient's abdominal cavity, via a said tubular port member, a surgical instrument so that an operating tip at a distal end portion of said instrument is inserted into the patient's body cavity; manipulating said surgical instrument from outside the patient so that said distal end portion bends independ¬ ently of bending type motions of said laparoscope; and actuating said surgical instrument so that said operating tip engages internal body tissues of the patient.

10. A surgical instrument at least partially insert¬ able into a patient separately and distinctly from a laparo¬ scope or endoscope, comprising: an elongate body portion including rigid shaft at a proximal end of the instrument and a continuously flexible area at a distal end of the instrument; operational means on said elongate body portion at the distal end thereof for engaging internal body tissues of a patient upon insertion of said elongate body portion into a cavity of the patient and for effectuating a surgical opera¬ tion on the internal body tissues of the patient; first actuator means on said elongate body portion and operatively connected to said operational means for actuating said operational means for perform said surgical operation; and

-second actuator means on said surgical instrument for controlling a bending type motion of said elongate body portion in said area.

11. A surgical method comprising the steps of: using a trocar to form a perforation in an external body surface of a patient; disposing a trocar sleeve in said perforation; inserting an elongate instrument through said trocar sleeve so that a distal end of said instrument protrudes into a body cavity of the patient while a proximal end of said instrument remains outside said patient; initially manipulating said proximal end of said instrument, from outside the patient, to bend a distal end portion of said instrument continuously along a disal end seg¬ ment thereof; also manipulating said said proximal end of said instrument, from outside the patient, to maneuver an operative tip of said instrument into juxtaposition with selected inter¬ nal body tissues of the patient; and additionally manipulating said proximal end of said instrument, from outside the patient, to pivot an element of said operative tip relative to said segment and to move said element of said operative tip into engagement with the selected internal body tissues.