DE102011012055A1 - Surgical access system for surgical instrument used for minimally invasive surgery, has closure element that includes A covering membrane for covering tubular element so that open cross-section of tubular element is sealed - Google Patents

Abstract

The surgical access system (10) has a resilient ring (12) made of rubber or silicone material, and a silicone-made thin-walled tubular element (14) which is connected to the ring circumferentially. A closure element (16) is connected to an end of the distal portion of the tubular element. The closure element includes silicone A covering membrane (18) for covering the tubular element so that open cross-section of the tubular element is sealed.

Description

The invention relates to a surgical access system for receiving and performing one or more surgical instruments for minimally invasive surgery in a body wall of a patient.

In minimally invasive surgery, the body wall of the patient typically uses so-called trocars, which allow the insertion of surgical instruments and endoscopes, as well as their removal or removal of tissue materials.

When working with multiple surgical instruments, trocars have typically been used in the past at various locations in the patient's body, such as, for example, surgical procedures. B. in the context of 16 and 17 in the EP 1 323 389 A2 is described.

More recently, there is a growing tendency to make do with only one openings in the body wall of the patient to be made with a cut, and to insert and operate the multiple instruments into the body of the patient in a common surgical access system.

The solutions proposed so far are sometimes complex and in particular laborious to position on the patient's body and partly do not allow the use of instruments with larger diameter, which require trocars with diameters of, for example, 13 mm.

The object of the invention is therefore to propose a surgical access system of the type described in the introduction that is simple in design and inexpensive to deliver.

This object is achieved by a surgical access system with the features of claim 1.

The elastically deformable frame part of the surgical access system according to the invention allows the surgical access system with its inside to be arranged end by a relatively small incision, especially in the region of the navel through the body wall (in the present example, the abdominal wall) to introduce into the body cavity, where it Resiliency returns to its original shape and holds the attached thin-walled hose member at its lying in the body cavity end in the open state.

Since the access system according to the invention does not require complex production means and / or expensive materials, it can be designed as a one-way system.

On the other hand, the reuse of the elastically deformable first frame part is possible, as well as parts of the closure element. In these so-called hybrid systems, at least the thin-walled tubular element and the membrane are then exchanged for each new use.

The length of the tubing member is preferably sized so that the same surgical access system can find application in patients with different thicknesses of the abdominal wall, with the excess length of tubing remaining on the body surface without having to be separated from the fully assembled surgical access system.

The closure element belonging to the surgical access system according to the invention is, after the elastically deformable first frame part has been brought into contact with the thin-walled and therefore flexible tube element or its first end in the interior of the body, sealingly connected to the outer tubular element section and thus leads to a substantially tight completion of the incision.

The fact that the closure element with the hose element is not firmly connected from the outset, but depending on the thickness of the abdominal wall of the patient in different positions at a distance from the first end of the tubular element can be fixed, the length of the surgical access system can be exactly to the thickness of the abdominal wall adapt to the patient.

This is an important advantage over the prior art access systems, which often offer only one or more fixed sizes and thus can not provide a proper fitment of the internal and surface elements of the access system.

Thus, at the same time a secure fit of the surgical access system according to the invention is achieved on the abdominal wall of the patient, which is advantageous for the desired dense connection or the tight seal, created with an incision body opening in the body wall, z. B. represents the abdominal wall.

The tightness achieved with the invented system of this invention for sealing the incision-formed opening in the body wall of the patient is sufficient to be that of the inside of the body built gas pressure can be kept in a minimally invasive surgery.

Preferably, an elastomeric material, in particular a rubber material or a silicone material is used for the first frame part, which ensures sufficient elastic deformability, so that the first frame member can be tightly compressed by a relatively small opening of the body wall, for example, on the navel of a patient introduced into the interior of the body , Since the hose element is designed to be deformable as a thin-walled element and therefore flexibly and without force, no larger opening must be provided when dimensioning the incision for the hose element. The body opening to be created rather depends on the need for the respective operation and the instruments to be used.

This is another advantage of the present invention in that the inventive access surgical system can be used for accesses of different sizes in the body wall of a patient. Again, then eliminates the provision of a variety of different sized systems that would otherwise be kept depending on the number of instruments to be used.

Preferably, the hose member is made of a transparent or at least translucent material, so that a simple control of the seat of the outer portion of the hose member relative to the closure element is possible.

With regard to the externally introduced multiple instruments, a large area is typically required on the outboard portion of the surgical access system, such that with simultaneous use of multiple surgical instruments, they can be positioned and manipulated without physical constraint.

In a preferred configuration of the hose element, this is designed with a widening diameter toward the free end lying far away from the first end, so that too tight a tensioning of the hose through the closure element is avoided.

The membrane of the closure element is designed so that trocars are inserted through these in a simple manner and sealed by the membrane, so that compared to the previously offered solutions in the prior art, if necessary, the appropriate instruments for the respective trocars can be used and none for the Different application situations different closure elements must be kept.

Preferably, the hose member is also made of a silicone material, wherein the first frame part and the hose member can also be made in one piece.

It is also conceivable that a hose element is used, which is folded back on itself, wherein in the region of the folding then the first frame part is arranged. This can optionally be firmly connected to the hose member or even loosely inserted, as already by the over the closure element to be effected fixing the hose member at its free ends in itself a sufficient fixation of the first frame member relative to the hose member is possible.

Preferably, the closure element is formed so that it can be detachably connected to the hose element.

The closure element is preferably made dimensionally stable, wherein the dimensional stability can be ensured in different ways.

On the one hand, the closure element can be manufactured in several parts and comprise a second frame part, which can be connected to the section of the tube element. After connecting the second frame part with the hose element, the membrane can then be applied to the second frame part.

This is preferably done by the membrane being held on a membrane frame and the membrane being positioned and secured to the membrane frame on the second frame part.

Alternatively, the membrane can be positioned separately on the second frame part so as to overlap the open cross-section of the tubular element and then the membrane frame can be non-positively and / or positively connected to the second frame part, the wall of the tubular element and the membrane sealingly lying on one another between the second frame part and the diaphragm frame.

In a multi-part construction, on the one hand, the second frame part can be designed to be dimensionally stable and / or the membrane frame can bring about the dimensional stability or even a connection of the second frame part and membrane frame can lead to the desired dimensional stability.

The connection of the second frame part and membrane frame can be positive and / or non-positive happen, so that in turn arise for the connection of the second frame part and membrane frame manifold possibilities.

On the one hand, it is conceivable that the second frame part has a receiving groove for the membrane frame and this is inserted into the second frame part in a positive and / or non-positive fit.

Alternatively, the membrane frame can have a receiving groove for the second frame part and the second frame part can be received positively and / or non-positively in the groove of the membrane frame.

Another possibility is to make the membrane or at least its edge of an elastic material that can be stretched over the second frame part and so holds the membrane on the second frame part.

In this regard, the second frame part may have on its radially outer surface a receiving groove or recess into which the membrane edge or frame engages positively.

The membrane itself is also preferably made of a silicone material, as z. B. is also used for the manufacture of surgical gloves or balloon systems.

In this case, the membrane is preferably likewise transparent, so that the field or volume lying directly below the membrane can be viewed from the outside.

The above-described construction of the multi-part closure element has an advantage that the membrane can be exchanged as needed during surgery, for example, when in very complex operations, the instruments changed several times and thus different trocars must be used.

In addition, in the membrane of the access system according to the invention, the corresponding connection elements for acting on the inside of the body can be accommodated with pressure or suction via the possibly occurring in the treatment of the patient vapors (for example, in the thermal sealing of wound parts) can be sucked off or drained.

These and other advantages of the invention are explained in more detail below with reference to the drawings. They show in detail:

1 An exploded view of a surgical access system according to the invention;

2 to 5 applying a surgical access system to an incision-created body opening of a patient;

6A to 6D various variations of the connection of a closure element of an access system according to the invention; and

7 a partially broken view of a patient-mounted surgical access system.

1 shows a surgical access system according to the invention 10 in an exploded view.

The surgical access system according to the invention comprises an elastic ring made of a silicone material 12 as elastically deformable first frame part on which a transparent hose element 14 is formed with a first end.

Alternatively, the elastic ring 12 be made of a rubber material which is very well sterilizable and thus usable for multiple use in so-called hybrid systems.

Furthermore, the surgical access system includes 10 the present invention, a closure element 16 , which is formed in two parts and a dimensionally stable second frame part 20 as well as a membrane frame 22 with a membrane 18 includes.

On the membrane frame 22 are tabs 24 . 25 formed with which the membrane frame together with the membrane in a once mounted state of the second frame part 20 remove again and thus remove and replace if necessary.

In the 2 to 5 becomes the placement of the surgical access system in an opening created by an incision 33 in an abdominal wall 32 Of course, the surgical access system can also be arranged on other body walls of a patient.

The term patient means both animal and human patients in the context of the description of the present invention.

The flexible ring 12 is preferably with a surgical forceps 30 compressed like this in the 2 is shown.

The flexible ring 12 becomes together with the thin-walled hose element 14 attached to the flexible ring 12 is molded with the surgical forceps 30 in an opening 33 the abdominal wall 32 in and out. Then the surgical forceps 30 from the passage opening 33 taken again, the flexible ring 12 unfolds due to its elastic properties back to its original shape and lies, as soon as train on the hose element 14 applied from the outside, at the bottom of the abdominal wall 32 at. This situation of the already introduced ring 12 with the hose element adjoining thereto 14 is in 3 shown.

Subsequently, as in 4 illustrates the free end of the hose member 14 through the second frame part 20 passed through, leaving this on the surface of the abdominal wall 32 can rest. The following is the free end of the hose element 14 over the second frame part 20 , which preferably also has ring shape and more preferably has a slightly larger diameter than the ring member 12 , as laid out in the 4 and 5 is indicated.

After the free end of the hose element 14 over the frame part 20 laid flat outwards, which is placed on a membrane frame 22 strained membrane 18 over the frame part 20 laid like this in 5 is shown.

In a final step then becomes the membrane frame 22 with the second frame part 20 positively and / or non-positively connected, so that a substantially tight closure of the opening 33 results.

Of the ones for the connection of the second frame part 20 and membrane frame 22 resulting different variants are exemplified four in the 6A to 6D shown in detail.

For one thing, the frame part 20 a circumferential groove 23 have in the one ring part 26 of the membrane frame 22 can be clipped positive and non-positive ( 6A ).

Over the tabs 24 . 25 can the membrane frame 22 with the membrane 18 again from the second frame part 20 solve and replace it if necessary.

Alternatively it can be provided that the membrane frame 22 a made of an elastic material edge 26 ' which extends over the dimensionally stable frame part 20 stretch, leaving it in the gusset between the frame part 20 and the abdominal wall 32 comes to rest, contracts and is held in a positive and positive manner ( 6B ).

A third alternative is in 6C shown in the membrane frame 22 ' a ring part 26 '' with a groove-shaped recess 27 has in the second frame part 20 ' can be clipped positive and form-fitting.

In the fourth in 6D shown variant are the membrane frame 22 '' and the second frame part 20 '' formed as concentric rings. First, the free end of the tube element on the abdominal wall 32 lying open second frame part and then spread the open cross-section of the hose member with the present here separated from the membrane frame membrane 18 covered. The membrane 18 stands together with the free end of the hose element 14 over the second frame part 20 '' out. Subsequently, the membrane frame 22 '' over the second frame part 20 '' pushed so that in between the hose element 14 and the membrane 18 be kept in sealing contact.

In cases where the membrane frame and the second frame part are positively and positively connected with each other, it is sufficient if the two elements are dimensionally stable in the interconnected state. Alternatively, each of the two components, namely membrane frame and frame part can be formed dimensionally stable. In further alternatives, either the membrane frame part or the second frame part is dimensionally stable, while this requirement is not required for the respective other component.

The dimensional stability is necessary because the hose element 14 on the closure element 16 must be kept sealed.

For removing the elastic ring 12 together with the hose element 14 out of the opening 33 it is an advantage if attached to the flexible ring 12 a thread-like element is attached (not shown), which together with the hose element 14 is led to the outside. At this thread element then the ring can be pulled out of the surgical wound in a simple manner.

7 now shows the inventive surgical access system 10 in fully assembled condition and with inserted small port 34 as well as a port 36 with a larger passage.

Finally shows 7 another opening 38 resulting from a direct insertion or piercing of the membrane 18 was created with an instrument.

This shows the versatility of the access system according to the invention 10 in the context of minimally invasive surgery.

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• EP 1323389 A2 [0003]

Claims (14)

A surgical access system for receiving and performing one or more surgical instruments for minimally invasive surgery in a body wall of a patient, comprising an elastically deformable first frame part, a thin-walled tubular element, which is peripherally connected to the first frame part at a first end, and a closure member connectable to the wall of the hose member at a portion of the hose member remote from the first end, the closure member including a membrane covering the open cross section of the hose member, and wherein in the connected condition of closure member and hose member, the closure member with the membrane is open Essentially tightly closes cross section of the hose member. Access system according to claim 1, characterized in that the first frame part is made of an elastomeric material, in particular a rubber material or a silicone material. Access system according to claim 1 or 2, characterized in that the hose element is transparent. Access system according to one of claims 1 to 3, characterized in that the hose element adjacent to the first frame part has a smaller diameter than in the section which can be connected to the closure element. Access system according to one of claims 1 to 4, characterized in that the distance between the first end of the hose member and the portion to which the closure element is connected is variable. Access system according to one of claims 1 to 5, characterized in that the hose member is made of a silicone material. Access system according to one of claims 1 to 6, characterized in that the closure element with the hose member is releasably connectable. Access system according to one of claims 1 to 7, characterized in that the closure element is dimensionally stable. Access system according to one of claims 1 to 8, characterized in that the closure element is made in several parts and comprises a second frame part, which is connected to the portion of the hose member. Access system according to claim 9, characterized in that the closure element comprises, in addition to the second frame part, a membrane frame on which the membrane is held. Access system according to claim 10, characterized in that the second frame part and the membrane frame non-positively and / or positively connected to each other. Access system according to one of claims 1 to 11, characterized in that the membrane is made of a silicone material. Access system according to claim 21, characterized in that the membrane is transparent. Access system according to one of claims 9 to 13, characterized in that the second frame part or the membrane frame has a groove into which the respective other part of the closure element is positively and / or non-positively engageable.

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