Surgical instrument support and method of using the same

I claim:

1. A surgical instrument support comprising:

a base having a flat surface facing in a first direction for placement against a tissue,

said base defining a seat with a concave surface,

there being one piece defining at least a portion of each of the flat and concave base surfaces;

connector having a convex surface to abut to and move universally relative to the concave base surface;

sleeve defining a passage through which a surgical instrument can be directed;

means for connecting the connector to the sleeve so that the sleeve follows universal movement of the connector relative to the base; and

first means cooperating between the connector and base for maintaining the connector and base in an operative position in which the convex surface on the connector resides adjacent to a plane within which the flat base surface resides and does not project significantly in the first direction beyond the flat base surface,

said flat base surface defining the furthestmost extension of the support in the first direction,

whereby the flat base surface can be pressed sealingly against a tissue through which an incision is to be made to allow a surgical instrument to be directed through the sleeve passage into an incision around which the flat base surface seals,

wherein the first cooperating means comprises means for snap fitting the connector and sleeve into the operative position.

2. A surgical instrument support comprising:

a base having a flat surface facing in a first direction for placement against a tissue,

said base defining a seat with a concave surface,

there being one piece defining at least a portion of each of the flat and concave base surfaces;

a connector having a convex surface to abut to and move universally relative to the concave base surface;

a sleeve defining a passage through which a surgical instrument can be directed;

means for connecting the connector to the sleeve so that the sleeve follows universal movement of the connector relative to the base; and

first means cooperating between the connector and base for maintaining the connector and base in an operative position in which the convex surface on the connector resides adjacent to a plane within which the flat base surface resides and does not project significantly in the first direction beyond the flat base surface,

said flat base surface defining the furthestmost extension of the support in the first direction,

whereby the flat base surface can be pressed sealingly against a tissue through which an incision is to be made to allow a surgical instrument to be directed through the sleeve passage into an incision around which the flat base surface seals,

wherein the sleeve has an axial extent and an outer surface, there being second means on the sleeve selectively positionable between a) a first position wherein the second means defines an axially facing shoulder that projects radially beyond the outer surface of the sleeve and b) a second position wherein the second means does not project significantly radially beyond the outer surface of the sleeve, and third means cooperating between the sleeve and at least one of the connector and base for selectively mounting the sleeve and base in first and second different relative positions, with the shoulder of the second means being spaced axially from the flat base surface a first distance with the base and sleeve in said first relative position and the connector and sleeve in an operative relationship and the second means being spaced axially from the flat base surface a second distance with the base and sleeve in said second relative position and the connector and sleeve in an operative relationship.

3. The surgical instrument support according to claim 2 wherein the third means includes fourth means for releasably fixing the relative position of the connector and sleeve and fifth means for releasably fixing the relative positions of the connector and base.

4. The surgical instrument support according to claim 3 wherein at least one of the fourth and fifth means comprises a set screw that is extendable in a line transversely to a line perpendicular to the plane of the flat base surface.

5. The surgical instrument support according to claim 2 wherein the second means comprises a bladder that is selectively inflatable and deflatable to be placed in its first and second positions, respectively.

6. A surgical instrument support comprising:

base having a flat surface facing in a first direction for placement against a tissue,

said base defining a seat with a concave surface,

there being one piece defining at least a portion of each of the flat and concave base surfaces;

a connector having a convex surface to abut to and move universally relative to the concave base surface;

a sleeve defining a passage through which a surgical instrument can be directed;

means for connecting the connector to the sleeve so that the sleeve follows universal movement of the connector relative to the base; and

first means cooperating between the connector and base for maintaining the connector and base in an operative position in which the convex surface on the connector resides adjacent to a plane within which the flat base surface resides and does not project significantly in the first direction beyond the flat base surface,

said flat base surface defining the furthestmost extension of the support in the first direction,

whereby the flat base surface can be pressed sealingly against a tissue through which an incision is to be made to allow a surgical instrument to be directed through the sleeve passage into an incision around which the flat base surface seals,

wherein said convex surface is part of a spherical outer surface on the connector and a line tangent to said spherical outer surface at a right angle to the plane within which the flat base surface resides intercepts the flat base surface

wherein each of the connector and flat base surface has a diameter and the diameter of the flat base surface is at least two times the diameter of the connector.

7. A support for a surgical instrument, said support comprising:

a base having a substantially flat surface facing in a first direction for placement against a tissue;

a connector having a spherical outer surface and a through bore; and

first means cooperating between the base and connector for snap fitting the base and connector together in an operative position in which the connector is universally movable relative to the base and the spherical outer surface of the connector resides adjacent to a plane within which the flat base surface resides and does not project significantly in the first direction beyond the flat base surface.

8. A support for a surgical instrument, said support comprising:

a base having a substantially flat surface facing in a first direction for placement against a tissue;

a connector having a spherical outer surface and a through bore;

first means cooperating between the base and connector for snap fitting the base and connector together in an operative position in which the connector is universally movable relative to the base and the spherical outer surface of the connector resides adjacent to the plane of the flat base surface and does not project significantly in the first direction beyond the flat base surface; and

second means cooperating between the base and connector for fixing the base and connector selectively in a plurality of different positions.

9. The surgical instrument support according to claim 8 wherein the second means comprises a set screw.

10. A support for a surgical instrument, said support comprising:

a base having a substantially flat surface facing in a first direction for placement against a tissue;

a connector having a spherical outer surface and a through bore;

first means cooperating between the base and connector for snap fitting the base and connector together in an operative position in which the connector is universally movable relative to the base and the spherical outer surface of the connector resides adjacent to a plane within which the flat base surface resides and does not project significantly in the first direction beyond the flat base surface; and

second means mounted to at least one of the base and connector for defining a first shoulder facing the flat base surface to captively hold a tissue between the first shoulder and the flat base surface.

11. The surgical instrument support according to claim 10 wherein the second means comprises a sleeve with a flexible bladder thereon that defines said first shoulder.

12. A support for a surgical instrument, said support comprising:

a base having a substantially flat surface fitting in a first direction for placement against a tissue;

a connector having a spherical outer surface and a through bore:

first means cooperating between the base and connector for snap fitting the base and connector together in an operative position in which the connector is universally movable relative to the base and the spherical outer surface of the connector resides adjacent to a plane within which the flat base surface resides and does not project significantly in the first direction beyond the flat base surface,

wherein the flat base surface has one of a square and rectangular shape as viewed at a right angle to the plane of the flat base surface.

13. A method of defining a passageway through a tissue to accommodate a surgical instrument, said method comprising the steps of:

making an incision in the tissue;

placing a base with an opening therethrough against the tissue so that the incision is exposed at the base opening;

directing a sleeve through the base opening and tissue so that a portion of the sleeve is in a cavity bounded by the tissue;

defining a first shoulder on the portion of the sleeve in the cavity;

drawing the sleeve out of the incision to bear the shoulder on the sleeve portion against the tissue;

providing a connector on the sleeve and sliding the connector along the sleeve to bear the connector against the base at a location adjacent to the tissue and thereby bring the first shoulder and base firmly against the tissue to captively hold the tissue; and fixing the connector relative to the sleeve.

14. The method of defining a passageway through a tissue according to claim 13 including the step of fixing at least one of the connector and sleeve to the base.

15. A method of defining a passageway through a tissue to accommodate a surgical instrument, said method comprising the steps of:

making an incision in the tissue;

placing a base with an opening therethrough against the tissue so that the incision is exposed at the base opening;

directing a sleeve through the base opening and tissue so that a portion of the sleeve is in a cavity bounded by the tissue;

defining a first shoulder on the portion of the sleeve in the cavity;

drawing the sleeve out of the incision to bear the first shoulder on the sleeve portion against the tissue;

providing a connector on the sleeve and sliding the connector along the sleeve to bear the connector against the tissue to thereby firmly hold the tissue between the connector and first shoulder; and

guiding pivoting movement of the connector on the base.

16. The method of defining a passageway through a tissue according to claim 15 including the step of fixing the connector, sleeve, and base, each relative to the other.

17. A support for a surgical instrument, said support comprising:

a base having a flat surface facing in a first direction for placement against a tissue,

said base defining a seat with a concave surface;

a connector having a convex surface to abut to and move universally relative to the concave base surface;

a sleeve defining a passage through which a surgical instrument can be directed;

means for connecting the connector to the sleeve so that the sleeve follows universal movement of the connector relative to the base; and

first means cooperating between the connector and base for maintaining the connector and base in an operative position in which the convex surface on the connector resides adjacent to a plane within which the flat base surface resides and does not project significantly in the first direction beyond the flat base surface, said first cooperating means comprising means for snap fitting the connector and sleeve into the operative position.

18. A support for a surgical instrument, said support comprising:

a base having a flat surface facing in a first direction for placement against a tissue,

said base defining a seat with a concave surface; a connector having a convex surface to abut to and move universally relative to the concave base surface;

a sleeve defining a passage through which a surgical instrument can be directed;

means for connecting the connector to the sleeve so that the sleeve follows universal movement of the connector relative to the base; and

first means cooperating between the connector and base for releasably fixedly maintaining the connector and base in an operative position in which the convex surface on the connector resides adjacent to a plane within which the flat base surface resides and does not project significantly in the first direction beyond the flat base surface,

said first cooperating means comprising means for snap fitting the connector and sleeve into the operative position.

Description Submit all comments and votes

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates to surgical instruments and, more particularly, to a support for a laparoscopic surgical instrument to maintain a desired orientation of the instrument relative to a tissue through which the instrument extends.

2. Background Art

In performing laparoscopic surgery, an incision is made in a patient to admit a cannula which serves as a conduit for the introduction of selected surgical instruments into a body cavity. The body cavity in which the operation is performed is filled with a gas to distend the surrounding tissue to create a suitably sized operating space.

The inventor herein has designed structures to maintain the gas in the body cavity while allowing freedom of tilting movement for the surgical instrument. One such structure is shown in U.S. Pat. No. 5,002,557. This particular structure utilizes an elongate sleeve having an inflatable bladder at its distal end which is passed through the tissue into the body cavity. A collar with a conical sealing surface is slidable lengthwise of the sleeve. The distal end of the sleeve is passed through the tissue with the bladder deflated. Inflation of the bladder creates an annular shoulder which can be drawn up sealingly against the inside tissue surface. The collar is pressed into the tissue towards the bladder shoulder so that the bladder shoulder and collar captively embrace the tissue to thereby hold the sleeve in an operative position. The conical collar surface and bladder maintain a seal at the tissue incision even with the sleeve reoriented in use.

While the above structure affords a high integrity seal through a wide range of movement for the sleeve, it has one limitation. The basic instrument in U.S. Pat. No. 5,002,557 does not have any structure for maintaining a desired orientation of the sleeve. This feature is desirable to perform many conventional procedures. It is common to align the sleeve opening with a site at which more than one procedure is to be performed. The surgeon is usually required to remove and reinsert the same or different instruments. In the absence of some type of aligning structure for the sleeve, the surgeon is required to constantly manipulate the sleeve to access the same site. This is an inconvenience and time consuming. Further, certain procedures require the use of multiple instruments directed through separate incisions into a body cavity. The freely movable sleeves may reposition to cause interference between the various instruments therewithin. Furthermore, the conical structure limits the degree to which the sleeve can be tilted as the large end of the cone impinges on the opposing surface of the skin on the side to which the instrument is tilted.

The inventor herein has also developed certain guide structures in the form of adjustable jigs that can cooperate with an instrument. Exemplary structures are shown in my U.S. Pat. No. 5,201,742, entitled "Support Jig for a Surgical Instrument".

While the jig disclosed in U.S. Pat. No. 5,201,742 is was highly effective in terms of its versatility and stability, it has one drawback; that being that the tissue is required to flex significantly as the instrument is repositioned, due to the fact that the pivot point for the instrument is spaced a substantial distance away from the tissue.

SUMMARY OF THE INVENTION

The present invention is specifically directed to overcoming the above-enumerated problems in a novel and simple manner.

In one form of the invention, a support is provided for a surgical instrument, which support has: a base that defines a seat with a concave surface and has a flat surface facing in a first direction for placement against tissue: a connector having a convex surface to abut to and move universally relative to the concave base surface; a sleeve defining a passage through which a surgical instrument can be directed; structure for connecting the connector to the sleeve so that the sleeve follows universal movement of the connector relative to the base; and cooperating structure on the connector and base for maintaining the connector and base in an operative position in which the convex surface on the connector resides adjacent to the plane of the flat base surface and does not project significantly in the first direction beyond the flat base surface.

Because the convex surface is adjacent to the point of connection of the support to tissue, pivoting of an instrument on the support can occur with a relatively small incision without significantly stretching the tissue around the incision.

To facilitate connection between the connector and sleeve, a snap-fit arrangement can be provided.

The sleeve has an axial extent and an outer surface. Structure is provided on the sleeve that can be placed selectively in a) a first position to define an axially facing shoulder and b) a second position wherein it does not project significantly radially beyond the outer surface of the sleeve. The sleeve cooperates between at least one of the connector and base to selectively mount the sleeve and base in first and second different relative positions. In the first relative position, the shoulder is a first distance away from the flat base surface. In the second position, the shoulder is a second distance away from the flat base surface.

The shoulder can be defined by a bladder that is selectively inflatable and deflatable to be placed in its first and second positions.

With this arrangement, the surgical support can positively capture tissue to afford a stable support for an instrument.

The base establishes a significant contact area between the instrument support and tissue on which it is carried and thereby resists tipping of the support. The tissue engaging surface can be square, rectangular, round, or other suitable shape. Preferably, the effective diameter of the surface, which contacts the tissue, is between 4 and 9 cm, although other dimensions are contemplated.

The instrument support can be maintained in a number of different positions. The connector and sleeve can be selectively fixed as can the connector and base. This can be accomplish through a set screw, or other suitable structure.

In one form, the convex surface is part of a spherical outer surface on the connector and a line tangent to the spherical outer surface at a fight angle to the plane of the flat base surface intercepts the flat base surface. This arrangement affords a substantial contact area between the base and tissue.

In one form of the invention, the diameter of the spherical outer surface is at least two times the diameter of the sleeve.

In another form of the invention, a support is provided for a surgical instrument, which support has: a base with a substantially flat surface facing in a first direction for placement against tissue; a connector having a spherical outer surface and through bore; and cooperating structure on the base and connector for mounting the base and connector in an operative position in which the connector is universally movable relative to the base and the spherical outer surface of the connector resides adjacent to the plane of the flat base surface and does not project significantly in the first direction beyond the flat base surface.

The invention further contemplates a method of defining a passageway through a tissue to accommodate a surgical instrument, which method includes the steps of making an incision in the tissue, placing a base with an opening therethrough against the tissue so that the incision is exposed at the base opening, directing a sleeve through the base opening and tissue so that a portion of the sleeve is in a cavity bounded by the tissue, defining a first shoulder on the portion of the sleeve in the cavity, drawing the sleeve out of the incision to bear the shoulder on the sleeve portion against the tissue, providing a connector on the sleeve and sliding the connector along the sleeve to bear the connector against the base at a location adjacent to the tissue to thereby bring the first shoulder and base firmly against the tissue to captively hold the tissue; and fixing the connector relative to the sleeve.

The sleeve can be preassembled to the base so that the sleeve and base are movable as a unit as the sleeve is directed through the incision. Alternatively, the base, by itself, can be pre-applied on the tissue.

At least one of the connector and sleeve can be fixed as desired to the base.

The invention further contemplates a method, as described above, wherein the connector is slid along the sleeve to bear the connector against the tissue to thereby firmly hold the tissue between the connector and first shoulder. The connector can thus be used to perform a sealing function and at the same time guide movement of the sleeve associated therewith relative to the base.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a sectional elevational view of a surgical instrument support according to the present invention in operative relationship to a tissue;

FIG. 2 is a view as in FIG. 1 and showing a modified form of surgical instrument support according to the present invention;

FIG. 3 is a schematic plan view of a surgical instrument support according to the present invention utilizing three extensible members for maintaining the orientation of a sleeve for an instrument on the support;

FIG. 4 is a fragmentary, partial cross-sectional view of a universal connection for an end of one of the extensible members;

FIG. 5 is a fragmentary, partial cross-sectional view of one form of extensible member that is normally biased to a predetermined length;

FIG. 6 is a fragmentary, perspective view of a modified form of universal connection for an end of one of the extensible members;

FIG. 7 is a sectional view of a prior art surgical instrument support in operative relationship to a tissue;

FIG. 8 is a cross-sectional view of a modified form of surgical instrument support, according to the present invention, being attached to a tissue, with a surgical instrument directed therethrough;

FIG. 9 is a cross-sectional view of a connector on the instrument support being snap-fit into its operative position with respect to a base;

FIG. 10 is a fragmentary, partial cross-section view of a modified form of connection between a base and connector, according to the present invention;

FIG. 11 is a view as in FIG. 10 of a further modified form of connection between a base and connector;

FIG. 12 is a cross-sectional view of a further modified form of connection between a base and connector;

FIG. 13 is a cross-sectional view of a still further modified form of connection between a base and connector;

FIG. 14 is a schematic representation of the bottom cross-section of a tissue-engaging surface on a base on the support; and

FIG. 15 is a view as in FIG. 14 showing a modified form of base.

DETAILED DESCRIPTION OF THE DRAWINGS

In FIG. 7, a prior art surgical instrument support is shown at 10. The support 10 has a sleeve 12 and housing 14 which cooperatively define a passageway 16 for a surgical instrument through a body tissue 18 into a cavity 20. A spike 22 with a sharpened distal end 24 is directed through the passageway 16 until an enlarged head 26 thereon abuts a shoulder 28 at the top of the housing 14. In this position, the sharpened distal end 24 protrudes from the free end 30 of the sleeve 12. The projecting, sharpened distal end 24 facilitates insertion of the instrument support 10 through a small incision 32 in the tissue 18.

The free end 30 of the sleeve 12 is advanced through the tissue 18 sufficiently that a bladder 34 thereon is fully exposed within the cavity 20. The bladder 34 is in a collapsed state as the sleeve 12 is directed through the tissue 18. Thereafter, the bladder 34 is inflated to the FIG. 7 configuration by fluid from a pressurized supply 36 which communicates through a passageway 38 integrally formed with the sleeve 12. The inflated bladder 34 defines an annular shoulder 40 which bears on the inside surface 42 of the tissue 18 to thereby prevent withdrawal of the sleeve 12 from the incision 32.

A collar 44 surrounds the sleeve 12 and is guided along the outer surface 46 thereof for movement lengthwise of the sleeve 12. The collar has a conical sealing surface 48 that can be pressed into the tissue 18. The surface 48 and surface 40 capture the tissue 18 and provide an effective seal around the incision 32. A set screw 50 can be tightened to lock the collar 44 to thereby maintain the instrument 10 in its operative position.

Once the collar 44 is locked, the spike 22 can be withdrawn. A gas, from a supply 52, can be introduced into the cavity 20 through the passageway 38 to distend the cavity 20 and define a suitable working area in the cavity 20. A hinged door 54 is abuttable to an annular shoulder 56 to seal the passageway 38. The door 54 is normally biased by a spring 58 into its sealing position. Entry of an instrument automatically pivots the door 54 into its open position shown in FIG. 7.

With the collar 44 locked in position, an effective seal is maintained by the sealing surface 48 and shoulder 40. This seal is maintained even as the sleeve 12 is tilted through a substantial angle, as indicated by the reference .alpha.. However, due to the resilience of the tissue 18, there is nothing to effectively stabilize the orientation of the support 10 in any one position. This problem is solved by the inventive instrument support shown at 60 in FIG. 1.

The instrument support 60 consists of a sleeve 62 having a through bore 64 defining a passageway for the introduction of an instrument from externally of a tissue 66 therethrough into a cavity 68. The sleeve 62 has an integrally formed means 70 for stabilizing the position of the sleeve 62 relative to the tissue 66. The means 70 is in the form of an annular plate 72 having an annular, flat surface 74 for facially engaging the tissue 66 with the support in an operative position. The surface 74 may be home directly against a tissue surface 76 or, alternatively, an adhesive layer 78 can be interposed between the surface 74 and tissue 66 to releasably hold the plate 72 in a desired position relative to the tissue 66. The plate has a diameter that is preferably at least 1 inch and a thickness of at least 1/8 inch.

A means at 80 connects the plate 72 to the sleeve 62. The connecting means 80 is preferably integrally formed with the sleeve 62 and plate 72 from a rubber, or other deformable material. The connecting means 80 has a reduced thickness to produce a universal-type hinge 82 between the sleeve 62 and plate 72. This hinge 82 allows the This hinge 82 allows the sleeve 62 shown in phantom lines in FIG. 1.

The invention further contemplates a means at 84 for maintaining the sleeve 62 and plate 72 in a desired relationship. The maintaining means 84 is in the form of an elongate, extensible member/rod having a first end 86 connected to the plate 72 through a connecting means 88 and a second end 90 connected to the sleeve 62 through a connecting means 92.

The extensible rod 84 is defined by first and second cooperating parts 94, 96, respectively. A mounting sleeve 98 has a through bore 100 to accept both the first rod part 94 and second rod part 96. The second rod part 96 is suitably fixed to the mounting sleeve 98, as by welding. The other rod part 94 is freely slidable in and out of the through bore 100 so as to thereby vary the effective length of the extensible rod 84. A set screw 102 fixes the rod part 94 relative to the mounting sleeve 98 to maintain a desired effective length for the rod 84.

The connecting means 88 includes a socket 104 for reception of a ball 106 integrally formed at the end of the rod part 94. The rod end 86 is thus free to move universally relative to the plate 72.

The connecting means 92 includes a collar 108 which surrounds the outer surface 110 of the sleeve 62. The collar 108 has a socket 112 therein to receive a ball 114 on the rod end 90 to allow universal pivoting of the rod end 90 relative to the collar 108. The collar 108 is slidable axially relative to the sleeve 62 and can be fixed in a desired position by a set screw 116.

Once the plate 72 is abutted to the tissue 66, the sleeve 62 can be reoriented to align the passageway 64 defined thereby with a site at which a procedure is to be performed. This adjustment is permitted with the set screw 102 loosened. When the desired orientation of the sleeve 62 is arrived at, the set screw 102 is tightened to thereby fix the effective length of the mounting rod 84. For purposes of stability, at least two additional, similarly constructed mounting rods 84', 84" are provided as shown in FIG. 3. This arrangement produces a tripod support which adds significant stability to the sleeve 62.

To further stabilize the sleeve 62, a set screw 118 is provided to lock the ball 114 in the socket 112 to thereby prevent inadvertent movement of the rod end 90. The rod end 86 can be suitably fixed using a modified form of connecting means 120 as shown in FIG. 4. The connecting means 120 includes a socket 122 for reception of the ball 106 and a set screw 124 to lock the ball 106 in the socket 122. A similarly locking mechanism can be provided on one or both of the additional rods 84', 84".

Additional versatility is afforded by providing a movable base 126 as part of the connecting means 88, as shown in FIGS. 3 and 4. The base 126 has an L-shaped leg 128 which is received in a guide slot 130 in a plate 72'. The slot 130 extends circumferentially about the plate 72' to allow the relative circumferential position of the base 126 to be selected relative to the plate 72'. The set screw 132 associated with each base 126 allows the position of each base 126 relative to the plate 72' to be fixed. Similar legs 128 can be provided on the other rods 84', 84".

Another aspect of the invention is the provision of a sealing surface 134 formed integrally with the sleeve 62 to provide a seal at the tissue incision. The sealing surface 134, which may have a reduced diameter or be slightly tapered to penetrate the tissue 6, performs a function similar to the sealing surface 48 on the collar 44 on the prior art support 10 in FIG. 7.

To enhance the seal of the sealing surface 134, an inflatable bladder 136 is provided at the distal end 138 of a cylindrical guide sleeve/cannula 140 that can be made part of or fit within the sleeve 62. The bladder 136 is collapsible against the peripheral surface 142 of the cannula 140 and inflatable by a fluid from a supply 144 through an appropriate conduit 146. The inflatable bladder 136 defines an annular shoulder 148 which, in conjunction with the sealing surface 134, captively holds the tissue 66