CN101856245A - 具有可拆卸可更换元件的外科进入装置 - Google Patents
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3498—Valves therefor, e.g. flapper valves, slide valves
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00477—Coupling
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
- A61B2017/3445—Cannulas used as instrument channel for multiple instruments
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
- A61B2017/3445—Cannulas used as instrument channel for multiple instruments
- A61B2017/3447—Linked multiple cannulas
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3462—Trocars; Puncturing needles with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals
- A61B2017/3466—Trocars; Puncturing needles with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals for simultaneous sealing of multiple instruments
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
- A61B2017/3482—Means for supporting the trocar against the body or retaining the trocar inside the body inside
Abstract
本发明提供了用于在进行外科手术的过程中以改进的方式进入外科部位的方法和装置。在一个示例性实施例中，提供的外科进入装置具有套管、套管基座和牵开器。套管基座能够将其连接到牵开器和套管，从而实现进入外科部位。套管可以可拆卸地并且可更换地连接到套管基座。可任选地，套管基座可以可拆卸地并且可更换地连接到牵开器。根据需要，可以将套管与套管基座脱开连接，这样可以使得能够从外科部位取出物体和/或使得套管或者另一个套管能够附连到保持在适当位置的套管基座，从而保持进入到外科部位。本发明还提供了用于进入外科部位的示例性方法。
Description
技术领域
本发明涉及进入外科部位的方法和装置，更具体地讲，涉及将多个器械通过单个切口引入体腔的方法和装置。
背景技术
微创外科技术(例如，内窥镜和腹腔镜)通常优于传统的开放式外科，这是因为微创外科技术通常康复时间较短，疼痛较轻，且手术相关并发症较少。在许多腹腔镜手术中，将二氧化碳气体充入腹腔，使压力达到约15mm Hg。刺穿腹腔壁，在腹腔中插入直径约5至10mm的套管或套针。通常，将多个套管或套针插入并置于外科部位，从而可以同时使用多个器械(例如，腹腔镜、抓紧器、解剖器、手术剪、牵开器等)。尽管也已经开发出腹腔镜手术的小型版本，但是这些手术所用的器械通常更加昂贵而易碎，并且通常仍需要使用多个直径约2至3mm的器械或通道。
由于微创外科越来越受欢迎，手术以及这些手术中使用的器械得以显著发展。例如，在一些手术中，肚脐处的单个切口可足以进入外科部位。这是因为在腹腔镜手术中，肚脐是进入腹腔的优选部位。肚脐切口可以容易地扩大，而不会明显影响术后美观，也不会显著增加伤口并发症的几率，从而允许多个器械能够通过单个切口被引入。然而，会发生“筷子”效应，“筷子”效应会导致外科医生的手与器械之间发生干扰。这种干扰会大大降低外科医生进行所需手术的能力。
已开发出一些外科进入装置来尝试减小“筷子效应”。例如，装置可包括具有多个分开的密封通道的室，所述密封通道被构造用于进入外科位置。每一密封通道能够容纳器械，并可将外科位置相对于外部环境密封。然而，目前被设计用于减小“筷子效应”的装置有其自身独特的问题。这些组件的构造会导致这样的问题，例如组织在形成在套管中的通道周围塌陷(collapse)。例如，当在腹部手术中结合使用套管时，在通道周围腹部的筋膜层(fascia layer)会塌陷。通道会是经常设置器械的工作通道，因此塌陷的组织会限制和阻碍设置在套管中的器械的独立运动。随着通过套管设置的器械的数量增加，这一问题经常会加重。
另外，由于充气通常被用作腹腔镜手术的一部分，所引起的力施加到套管上，导致套管被不期望地沿脱离身体的方向推动，就像加压的液体瓶中的软木塞一样。尽管这些组件通常可被缝合就位，但是这些组件的保持性和稳定性能力较弱。另外，由于将套管缝合到组织，所以在外科过程中移除套管既困难，也不方便。因此，外科医生通常无法容易地将对象从外科部位移除，或者无法在单个手术过程中使用不同类型的套管。
因此，需要在腹腔镜手术过程中进入外科部位的改进的方法和装置。另外，还需要在外科过程中允许套管被容易地从外科部位移除、被更换或被再次附连的方法和装置。
发明内容
本发明提供的这些方法和装置总体上用于在进行外科(例如，腹腔镜手术)的过程中使外科医生以改进的方式进入身体内。在一个实施例中，外科进入装置包括套管；套管基座，所述套管基座能够可拆卸地并且可更换地座置所述套管；牵开器，所述牵开器被连接到所述套管基座并且从所述套管基座向远侧延伸。所述套管具有与多个分离的和不同的远端通道相连的近端开口。在一个实施例中，所述套管基座和所述牵开器固定地相互连接。在另一个实施例中，可以从所述牵开器移除所述套管基座，因此可以用(例如)另一个套管基座来更换所述套管基座。当所述套管基座和所述牵开器连接在一起时，可以形成流体密封的构型。在一个实施例中，所述牵开器比所述套管基座更加柔性。所述牵开器能够形成穿过组织的通道，并且在一个实施例中，它可以包括远端环。所述远端环的直径可以大于所述牵开器的近侧部分的直径。在另一个实施例中，多个套管能够可拆卸地并且可更换地连接到所述套管基座。
可以按多种方式来实现套管针对所述套管基座的可拆卸和可更换的性质，但是优选地，在这两个组件之间形成流体密封性配合连接。例如，套管可以包括能够与套管基座上的螺纹部分配合的螺纹部分。这种构造将使得套管和套管基座能够可拆卸并且可更换地连接。该配合构造的另一个实例包括具有至少一个接纳部分的套管基座和具有至少一个凸起的套管。套管的凸起能够延伸到套管基座的接纳部分中并且与之接合。这种构造还会造成套管和套管基座可拆卸并且可更换地连接。这些配合技术以及本领域已知的各种其他技术可以同样用于可拆卸地并且可更换地配合牵开器和套管基座。
在外科进入装置的另一个实施例中，所述装置包括套管，所述套管具有在所述套管的远端和近端之间延伸穿过所述套管的开口；以及支撑基座，所述支撑基座能够可拆卸地座置所述套管。所述套管可以包括从所述近端向远侧延伸并且穿过所述外科进入装置的牵开器的多个细长柔性通道。每个通道具有延伸穿过所述通道并且与延伸穿过所述套管的开口连通的开口。牵开器可以从支撑基座向远侧延伸。支撑基座可以可任选地可拆卸地并且可更换地连接到牵开器。当套管基座和牵开器连接在一起时，可以形成流体密封的构型。在一个实施例中，支撑基座和套管中的任一个包括凸形锁定机构，所述凸形锁定机构能够与支撑基座和套管中的另一个上设置的凹形锁定机构连接。这样可以使得支撑基座和套管能够可拆卸地并且可更换地连接。在另一个实施例中，支撑基座和牵开器中的任一个包括凸形锁定机构，所述凸形锁定机构能够与支撑基座和牵开器中的另一个上设置的凹形锁定机构连接。这样可以使得支撑基座和牵开器能够可拆卸地并且可更换地连接。在一个实施例中，牵开器可以包括远端环，所述远端环的直径大于牵开器的近侧部分的直径。
在用于进入外科部位的方法的一个实施例中，牵开器被设置成穿过组织中的开口，以使得牵开器形成延伸到体腔内的工作通道。套管可以座置在套管基座中，从牵开器的近端向近侧延伸。这样可以使得在套管和套管基座之间能够形成密封。可以将器械插入并穿过套管并且插入并穿过多个分离的并且插入不同的密封通道中的一个，所述密封通道从套管向远侧延伸。这样可以使得器械的远端能够设置在体腔内。在一个实施例中，牵开器的近侧部分和远侧部分接合环绕近侧部分和远侧部分之间的开口的组织。在另一个实施例中，套管基座中的至少一部分设置在组织中的开口内。可任选地，可以从套管基座移除套管，并且可以将第二套管座置在套管基座中。这样可以使得在第二套管和套管基座之间能够形成密封。将套管座置在套管基座中的步骤可以按各种方式执行，例如通过将套管与套管基座通过螺纹连接。所述方法还可以包括将第二器械插入并穿过多个密封通道中的另一个，以允许第二器械的远端能够进入体腔。在一个实施例中，所述方法还包括移除套管，并且通过牵开器和套管基座从体腔移除物体。
本发明具体涉及：
(1)一种外科进入装置，包括：
套管，所述套管具有与多个分离的和不同的远端通道相连通的近端开口；
套管基座，所述套管基座能够可拆卸地并且可更换地座置所述套管；以及
牵开器，所述牵开器被连接到所述套管基座并且从所述套管基座向远侧延伸。
(2)如第(1)项所述的外科进入装置，其中所述套管基座和所述牵开器固定地相互连接。
(3)如第(1)项所述的外科进入装置，其中所述套管基座和所述牵开器可拆卸地并且可更换地连接。
(4)如第(3)项所述的外科进入装置，其中所述套管基座和所述牵开器当连接在一起时形成流体密封的构型。
(5)如第(1)项所述的外科进入装置，其中所述牵开器比所述套管更加柔性。
(6)如第(1)项所述的外科进入装置，其中所述套管包括能够与所述套管基座上的螺纹部分配合的螺纹部分，以使所述套管可拆卸地并且可更换地连接到所述套管基座。
(7)如第(1)项所述的外科进入装置，其中所述套管基座包括至少一个接纳部分，所述套管包括至少一个凸起，所述至少一个凸起能够延伸到所述至少一个接纳部分中并且与之接合，以使所述套管可拆卸地并且可更换地连接到所述套管基座。
(8)如第(1)项所述的外科进入装置，其中所述牵开器包括远端环，所述远端环的直径大于所述牵开器的近侧部分的直径。
(9)如第(1)项所述的外科进入装置，还包括多个套管，所述多个套管能够可拆卸地并且可更换地连接到所述套管基座。
(10)一种外科进入装置，包括：
套管，所述套管具有在所述套管的远端和近端之间延伸穿过所述套管的开口和从所述近端向远侧延伸的多个细长柔性通道，每个所述通道具有延伸穿过所述通道并且与延伸穿过所述套管的开口连通的开口；以及
支撑基座，所述支撑基座具有从其向远侧延伸的牵开器，所述支撑基座中能够可拆卸地座置所述套管，使得所述多个细长柔性通道延伸穿过所述牵开器。
(11)如第(10)项所述的外科进入装置，其中所述支撑基座可拆卸地并且可更换地连接到所述牵开器。
(12)如第(11)项所述的外科进入装置，其中所述套管基座和所述牵开器当连接在一起时形成流体密封的构型。
(13)如第(10)项所述的外科进入装置，其中所述支撑基座和所述套管中的一个包括凸形锁定机构，所述凸形锁定机构能够与所述支撑基座和所述套管中的另一个的凹形锁定机构连接，以使所述套管可拆卸地并且可更换地连接到所述支撑基座。
(14)如第(10)项所述的外科进入装置，其中所述牵开器和所述支撑基座中的一个包括凹形锁定机构，所述凹形锁定机构能够与所述支撑基座和所述牵开器中的另一个的凸形锁定机构连接，以使所述支撑基座可拆卸地并且可更换地连接到所述牵开器。
(15)如第(10)项所述的外科进入装置，其中所述牵开器还包括远端环，所述远端环的直径大于所述牵开器的近侧部分的直径。
(16)一种进入外科部位的方法，包括：
将牵开器设置成穿过组织中的开口，使得所述牵开器形成延伸到体腔内的工作通道；
将套管座置在套管基座中并从所述牵开器的近端向近侧延伸，使得在所述套管和所述套管基座之间形成密封；以及
将器械插入穿过所述套管并穿过多个分离的和不同的密封通道中的一个，使其从所述套管向远侧延伸，以将所述器械的远端设置在所述体腔内。
(17)如第(16)项所述的方法，其中所述牵开器的近侧部分和远侧部分接合环绕所述近侧部分和所述远侧部分之间的开口的组织。
(18)如第(16)项所述的方法，其中所述套管基座中的至少一部分设置在组织中的开口内。
(19)如第(16)项所述的方法，还包括从所述套管基座移除套管，并且将第二套管座置在所述套管基座内以在其间形成密封。
(20)如第(16)项所述的方法，其中所述将套管座置在套管基座中的步骤包括将所述套管与所述套管基座通过螺纹连接。
(21)如第(16)项所述的方法，还包括将第二器械插入并穿过所述多个密封通道中的另一个密封通道，以将所述第二器械的远端设置在所述体腔内。
(22)如第(16)项所述的方法，还包括移除所述套管，并且通过所述牵开器和所述套管基座从所述体腔移除物体。
附图说明
由下文的“具体实施方式”并结合附图，可更加完整地理解本发明。现将各附图说明如下：
图1是外科进入装置的一个示例性实施例的侧面剖视图；
图2是图1的外科进入装置的基座的透视图；
图3是外科进入装置的另一个实施例的侧面透视图；
图4是外科进入装置的另一个实施例的顶部透视图；
图5是外科进入装置的另一个实施例的侧面透视图；
图6是外科进入装置的另一个实施例的顶部透明透视图，所述外科进入装置所具有的牵开器包括至少一个用于容纳器械的钩部；
图7是外科进入装置的另一个实施例的顶部透明透视图，所述外科进入装置所具有的套管包括至少一个用于容纳器械的钩部；
图8是外科进入装置的另一个实施例的顶部透视图，所述外科进入装置所具有的套管具有轮廓漏斗设计；
图9是外科进入装置的一个实施例的侧面剖视分解图，其中，套管和基座具有螺纹部分并且未连接；
图10是图9的外科进入装置的侧面剖视图，其中，套管和基座连接；
图11是外科进入装置的另一个实施例的侧面剖视图，其中，套管和基座具有螺纹部分，并且在基座的远端设置有密封件；
图12是外科进入装置的另一个实施例的侧面剖视图，其中，套管和基座具有螺纹部分，并且在套管上设置有密封件；
图13是外科进入装置的一个实施例的侧面剖视分解图，其中，套管包括至少一个销，基座包括至少一个切割部分，所述切割部分被构造用于容纳所述至少一个销；
图14是图13的外科进入装置的透视局部剖面分解图；
图15是外科进入装置的一个实施例的顶部透视图，其中，套管包括至少一个凸块，基座包括至少一个闩锁，所述闩锁被构造用于容纳所述至少一个凸块；
图16是图15的外科进入装置的侧面剖视图，其具有设置在组织中的牵开器；
图17是外科进入装置的另一个实施例的顶部透视图，其中，套管包括环形凸缘，基座包括至少一个闩锁，所述闩锁被构造用于容纳所述环形凸缘；
图18是外科进入装置的另一个实施例的顶部视图，其中，套管包括环形凸缘，该环形凸缘能够被基座的至少一个闩锁容纳；
图19是图18的外科进入装置的侧面剖视图，其具有设置在组织中的牵开器以及处于锁定位置的至少一个闩锁；和
图20是图19的外科进入装置的一部分的侧面剖视图，其中，所述至少一个闩锁处于解锁位置。
具体实施方式
现在将描述一些示例性实施例以提供对本文公开的器械和方法的结构、功能、制造和使用原理的全面理解。这些实施例中的一个或多个实施例在附图中示出。本领域的技术人员将理解，本文具体描述并在附图中示出的器械和方法是非限制性示例性实施例并且本发明的范围仅由权利要求书限定。结合一个示例性实施例示出或描述的特征可以与其他实施例的特征组合。这些修改和变型旨在被包括在本发明的范围内。本领域技术人员也将认识到，在一定程度上，就相对于半径或直径(通常用于描述圆形或圆柱形元件)描述本文中公开的尺寸而言，可容易地确定具有不同几何形状的部件的等同量度。同样，本领域技术人员将认识到，在一定程度上，就讨论具有特定性质(例如，刚性或柔性)的特定材料而言，也可使用其他材料，并且可根据需要按照特定方式处理材料以使其更刚性或更柔性。
外科进入装置通常用于微创外科，例如腹腔镜外科。外科进入装置可被设置在身体内，以允许从身体外部进入外科部位。所述装置通常能够通过该装置接纳一个或多个器械，从而能够使用所述器械进行所需手术。所述装置可具有多个不同的部件，但是在图1所示的示例性实施例中，装置10包括牵开器20、套管基座40和套管60。在该实施例中，牵开器20能够设置在穿过组织102形成的切口104中，以形成延伸穿过组织102并进入体腔的工作通道。套管基座40可连接到牵开器20，套管60可连接到套管基座40。可通过套管60(也就是通过套管基座40和牵开器20)实现进入身体。
在外科进入装置10的示例性实施例中，套管60和套管基座40可以可拆卸可更换地连接，从而套管60可以根据需要附连到套管基座40或与套管基座40分离，和/或其他套管可根据需要被附连和分离。在其他实施例中，套管基座40和牵开器20可以按照相似的方式可拆卸可更换地连接。理想的是，将外科进入装置10设计为使得套管基座40可拆卸可更换地与套管60和牵开器20连接。在示例性实施例中，所有配合连接形成液密密封。作为另一种选择或除此之外，可以将配合的两个部件与一个或多个密封件结合使用。本文中所公开的实施例可提高外科进入装置10的保持性，从而装置10可以更容易保持在所需位置并抵抗试图使装置10从切口104离开的力(例如，由于充气引起的力)。
外科进入装置10的每一部件可具有多种构型。牵开器20通常能够设置在穿过组织102形成的切口104内，以形成延伸到体腔中的工作通道。尽管至少部分地取决于牵开器20将被设置于其中的切口的尺寸、将设置在组织中的牵开器20的量、将使用牵开器20进行的外科的类型、以及装置10的吻合部件的形状，牵开器20可具有多种形状，但是在一个示例性实施例中，牵开器20为细长中空圆柱形构件，具有近侧部分22和远侧部分24，近侧部分22能够与套管基座40连接，远侧部分24能够将组织102牵离切口104。在一些实施例中，牵开器可被完全设置在组织内，但是在其他实施例中，仅牵开器20的部分可被设置在组织内，而其他部分在组织表面之上和/或之下延伸。牵开器20能够大致柔性的，因此可由柔性材料(例如，聚合物)制成。可用于形成牵开器的柔性材料的例子包括聚异戊二烯、聚氨酯(Dolyurthethane)和有机硅。不止一种材料可用于形成牵开器20，牵开器20可包括比其他部分更刚性的部分。例如，牵开器的更刚性的部分可以由诸如聚碳酸酯、聚酯、聚醚酰亚胺材料或不锈钢材料制成，而更柔性的部分可由诸如聚异戊二烯、聚氨酯和有机硅的材料制成。在与本申请同时提交的Fred Shelton和Chris Widenhousea的名称为“Retractor with Flexible Sleeve”(具有柔性袖套的牵开器)的共同待审专利申请中公开了牵开器的一个示例性实施例，据此该申请的全部内容以引用方式合并于此。
牵开器20还可以是多种形状和尺寸，这可至少部分地取决于将设置牵开器20的切口的尺寸、将设置在组织中的牵开器20的量、将使用牵开器20进行的外科的类型、以及装置10的吻合部件的形状。例如，远侧部分24能够与位于切口104的远端105处的组织102接合，并将组织102牵离切口104，以形成通路。通过使牵开器20的至少一部分完全穿过切口104，外科进入装置10受套管周围的组织的潜在塌陷影响的可能性较少，其中，所述套管连接到牵开器20或者连接到与牵开器20连接的套管基座。因此，穿过套管的器械受任何潜在组织塌陷影响的可能性也较小。例如，如果牵开器20穿过腹腔壁设置，则筋膜层可被牵开，从而防止套管60周围的筋膜塌陷。
牵开器20在近侧部分22和远侧部分24处的尺寸也可不同，或者作为另一种选择，近侧部分22和远侧部分24中的每一个的尺寸可基本相似。在图1所示的实施例中，近侧部分22具有恒定直径，而远侧部分24向外径向地伸展，以形成最大直径大于近侧部分22的直径的凸缘。这是因为在该实施例中，牵开器20没有被完全设置在组织102内。具体地讲，近侧部分22在切口104内终止，而远侧部分24恰好延伸超过组织102的内表面，使得径向凸缘紧靠组织的内壁并与组织的内壁接合。在示例性实施例中，牵开器20的近侧部分22和远侧部分24的直径可大约在0.5至5cm的范围内。在一个示例性实施例中，远侧部分24的凸缘的最大直径大约是近侧部分22的直径的两倍。然而，牵开器20的任何部分的尺寸或者外科进入装置10(在这方面)的任何其他部分的尺寸可至少基于装置10的预期用途而调节。
如图1中进一步示出的，牵开器的远侧部分24还可包括帮助将牵开器20保持在所需位置以及提供装置在切口104内的稳定性的结构。例如，远侧部分24可包括直径大于牵开器20的近侧部分22的直径的环。远侧部分24的所述环可与径向凸缘一体地形成，或者被设置在径向凸缘的最大直径之内。
牵开器20的近侧部分22可以按照多种方式构造，但是通常能够与具有不同构型的多种套管基座(例如，套管基座40)配合。将在下面更详细地描述牵开器20与套管基座40的配合。近侧部分22还可以是可调节的，并且能够例如在牵开器20被设置在组织切口中时控制牵开器20的深度。近侧部分22还可在例如牵开器20被设置在腹腔壁中时，防止牵开器20在组织壁中受到完全挤压。
牵开器20可与套管基座40连接，以形成延伸到体腔中的工作通道。套管基座40通常可被构造用于在其中容纳套管，而套管又可用于进入外科部位。套管基座40可具有多种形状和尺寸，并且可由多种材料制成。在示出的实施例中，套管基座40的近侧部分42大致为漏斗形，远侧部分44大致为圆柱形。套管基座40的近侧部分42的形状通常能够与套管60的近侧部分62的形状配合，而套管基座40的远侧部分44的形状通常能够与牵开器20的近侧部分22的形状配合。因此，套管基座40的尺寸通常可吻合牵开器20和套管60之一或其二者的尺寸。在一个示例性实施例中，近侧部分42的最大直径大约在2至5cm范围内，更具体地大约在3至4cm范围内，而远侧部分44的最大直径大约在0.5至2.5cm范围内。当然，套管基座40的任何部分的尺寸可至少基于装置10的预期用途而调节。
多种不同的材料可用于形成套管基座40。在一个实施例中，套管基座40的近侧部分42为大体刚性的，以提供用于容纳套管60的坚固基座。套管基座40的某些部分可以比其他部分更柔韧。例如，远侧部分44可以比近侧部分42更柔韧，以有助于插入牵开器中。在一些实施例中，套管基座40可以由多种材料制成，以允许套管基座40的各部分具有不同的特性。例如，近侧部分42可以由大体刚性的材料制成，而远侧部分44可由更柔性的材料制成。在一个示例性实施例中，近侧部分42由更刚性的材料(例如，聚碳酸酯、聚酯、聚醚酰亚胺材料或不锈钢)制成，而远侧部分44由更柔性的材料(例如，聚异戊二烯、聚氨酯或有机硅)制成。在其他实施例中，整个套管基座40由例如聚碳酸酯、聚酯、聚醚酰亚胺材料或不锈钢的材料制成。在其他实施例中，整个套管基座40由在近侧部分42处提供足够刚性的聚合物制成。
除了被构造用于容纳套管之外，套管基座40的近侧部分42还可被构造用于帮助牵开器20提供外科装置10的保持性和稳定性。例如，近侧部分42可帮助控制套管基座40的插入深度(当牵开器20连接到套管基座40时，也就是牵开器20的插入深度)，从而防止牵开器20和套管基座40中的任一个在组织壁中受到完全挤压。在一个实施例中，近侧部分42包括凸缘58，凸缘58能够与切口104的近端103处的组织的外表面接合。凸缘58可包括抓紧结构，所述抓紧结构使得套管基座40附连到组织102，而不需要外部部件(例如，缝合线)的帮助。抓紧结构的一些非限制性实例包括浮雕区域、纹理区域以及它们的组合。在可供选择的实施例中，可使用外部部件(例如，一根或多根缝合线)来帮助将套管基座40附连到组织104。图3以及图5至图7(将在稍后更详细地描述)示出了可使用缝合线作为套管60或套管基座40的一部分的实施例。
套管60可设置在由套管基座40和牵开器20形成的工作通道中，可通过套管60提供进入外科部位的通道。与外科进入装置10的其他部件类似，套管60可具有很多种构型、形状和尺寸，这些构型、形状和尺寸通常与装置10的其他部件的构型、形状和尺寸吻合。在套管的一个示例性实施例中，如图1所示，套管60的近侧部分62大致为漏斗形，并且直径向远侧减小，套管60的远侧部分64包括一个或密封通路或通道70，通道70向远侧朝着外科部位延伸。设置在套管60的近侧部分62和远侧部分64之间的可以是连接区63，连接区63被构造用于帮助将套管60连接到套管基座40或者在某些实施例中连接到牵开器20。如图所示，连接区63大致为圆柱形。
套管60的近侧部分62的形状通常能够吻合套管基座40的近侧部分42的形状。套管60的连接区63的形状通常能够吻合配合部件(例如，根据需要，套管基座40和/或牵开器20)的配合结构。套管60的远侧部分64的形状通常能够允许进入外科部位。在一个示例性实施例中，近侧部分62的直径大约在3至5cm范围内，连接区的直径和远侧部分的直径(在图1中，后者被定义为距离d)大约在0.5至2cm范围内。与装置的其他部件类似，套管60的任何部分的尺寸可至少基于装置10的预期用途而调节。
套管60可由多种材料制成，所述材料包括任何数量的聚合物，所述聚合物包括(但不限于)聚碳酸酯、聚酯、聚醚酰亚胺材料和不锈钢。另外，与套管基座40类似，可使用多种不同的材料来形成套管60和套管60的多个部分，甚至是各个通道70本身也可由不同的材料制成。在一个实施例中，聚四氟乙烯加劲管被设置在至少一个通道70中，以提供强度和刚度并减小摩擦。然而，外科装置10的部件还可帮助提高套管60的性能。例如，当使用装置10时，牵开器20和套管基座40可帮助防止组织在套管60的通道70周围塌陷。当外科装置10被设置在腹部中时，牵开器20可防止筋膜层在通道70周围(也就是器械周围)塌陷，从而避免对器械运动的限制和阻碍。
套管60的近侧部分62可包括开口66，开口66被构造用于容纳一个或多个外科器械。近侧部分62还可包括凸缘72，在某些实施例中，凸缘72可以按照与套管基座40的凸缘58类似的方式形成。例如，凸缘72可包括抓紧结构(例如，浮雕区域、纹理区域及其他抓紧结构)，所述抓紧结构帮助与组织接合，而不需要外部部件(例如，缝合线)。近侧部分62的开口66可以与远侧部分64的通道70或通路连通。图示实施例包括三个通道70，但是仅两个通道可见。在其他实施例中，套管60可具有一个、两个、三个或三个以上分开的不同通道70。
通道70的尺寸和形状可至少部分地基于将与套管60结合使用的各种器械而有差别。通道70可被构造用于接纳将在外科部位处使用的一个或多个器械。在一个实施例中，通道70是柔性的、沿远端方向延伸的细长通道。尽管通道可具有多种尺寸，但是在一个实施例中，通道70的直径大约在5至10mm范围内。通道70可包括密封件，该密封件被构造用于防止流体在外科部位和套管60之间通过。可使用多种密封件类型。例如，密封件可被设置在通道70内部。或者，通道70的远端可包括狭缝，该狭缝在器械周围形成密封。本领域技术人员将认识到，密封件可形成于和/或设置于通道70内或通道70周围的任何地方。存在多种密封元件，但是在一个实施例中，每一通道70包括：器械密封件，所述器械密封件在设置在其中的器械周围形成密封，但是在没有器械设置在其中时不形成密封；通道密封件，所述通道密封件在其中没有插入器械时形成密封；或者组合密封件，所述组合密封件既在其中没有插入器械时密封通道，也在插入其中的器械周围形成密封。作为非限制性实例，示例性密封件包括鸭嘴形密封件、锥形密封件、挡板阀、凝胶密封件、隔膜密封件、唇形密封件、光圈密封件、等等。本领域技术人员还将理解，本发明所公开的任何实施例可包括密封件的任何组合。
不仅特定通道能够具有特定密封件，而且特定通道还能够容纳特定类型的器械。例如，在一个实施例中，一个通道可具有较大直径，使得该通道被构造用于接纳内窥镜，而另两个通道可具有更宽、更深的入口空间，以用于接纳其他外科器械。更宽、更深的入口空间可增加插入其中的任何器械的运动范围，并且可使得使用多个器械的工作更容易。在Voegele等人于2006年11月2日提交的名称为“Multi-port Laparoscopic Access Device”(多口腹腔镜进入装置)的美国专利申请No.2006/0247673以及Widenhouse等人于2008年9月30日提交的名称为“Surgical Access Device”(外科进入装置)的美国专利申请序列No.12/242,765中描述了套管的通道以及能够并入套管及其通道中的结构(例如，排气口和充气口)的非限制性实例，所述申请的全部内容以引用方式合并于此。
外科进入装置10的三个主要部件，即牵开器20、套管基座40和套管60可以按照多种方式配合。如图所示，牵开器20的近侧部分22能够与套管基座40的远侧部分44连接。尽管牵开器20和套管基座40可使用多种连接技术连接在一起，但是在图示实施例中，牵开器20的近侧部分22可通过搭扣配合与套管基座40的远侧部分44接合。更具体地讲，套管基座40可包括凹槽48，凹槽48被构造用于容纳牵开器20的近侧部分22的凸缘23，以在两者间形成密封配合连接。另外，或作为另一种选择，近侧部分22的尺寸可略大于套管基座40的远侧部分44的尺寸，以允许近侧部分22被设置在远侧部分44上方，从而提供过盈配合。在其他实施例中，如上面所指出的，套管基座40能够与牵开器20一体地形成，以形成单个套管支撑单元。另外，下面关于套管基座40和套管60讨论的多种连接机构也可用于牵开器20和套管基座40。
套管基座40和牵开器20之间的连接通常可形成液密(即，密封)构型，以限制或防止流体从两者间通过。在可供选择的实施例中，套管基座40和牵开器20可以一体地形成，以形成单个套管支撑单元，所述套管支撑单元被构造用于容纳并支撑套管60。在非一体形成的实施例中，可在套管基座40和牵开器20之间形成多种不同的密封构型，下面将相对于各种实施例更详细地描述这些密封构型中的一些。如图1所示，相对于切口104，在牵开器20仅部分地设置在延伸穿过组织的切口中的实施例中，套管基座40可被设置在组织切口的剩余部分中。换言之，牵开器20位于组织102中的部分的长度可小于组织102的厚度，使得牵开器20没有延伸穿过组织102的整个厚度。然而，套管基座40可延伸穿过组织102的剩余厚度，从而牵开器20和套管基座40组合形成延伸穿过组织102的整个厚度的通路。
可包括多种结构来帮助套管基座40插入牵开器20中。例如，如图2所示，远侧部分44可包括能够提供柔性的多个锯齿或轴向切口50。远侧部分44还可包括斜截部分52，斜截部分52使得套管基座40更容易插入牵开器20中。在图示实施例中，远侧部分44还包含环54，环54设置在套管基座的远侧部分44的内表面56上。环54可用作帮助套管60与套管基座40配合的结构，这将在稍后更详细地描述。尽管在图示实施例中，套管基座40的整个远侧部分44延伸到牵开器20的近侧部分中，但是在其他实施例中，仅套管基座的最远端或者仅套管基座的远侧部分44的一部分可连接到牵开器20。
尽管套管基座40能够连接到部分或全部设置在组织中的牵开器20，但是在牵开器20完全穿过组织设置的一些实施例中，套管基座40能够在腔外部连接到牵开器20的近侧部分22。稍后参照图16和图19更详细地描述这些类型的实施例的实例。在这样的实施例中，先前描述的有助于将套管基座40插入牵开器20中的结构(例如，锯齿、轴向切口和/或斜截部分)可用于帮助将套管60插入到牵开器20中。即使在能够完全位于切口外部时，套管基座40仍能够可拆卸可更换地连接到牵开器20和套管60中的每一个，并且同样能够使得在套管基座40与牵开器20和套管60中的每一个之间可形成或包括密封。
套管基座40还能够与套管60配合。具体地讲，套管60可以可拆卸、可更换地连接到套管基座40。如将在稍后更详细描述的，套管60的配合结构可以是多种形式，包括如本文中参照图示实施例描述的，过盈配合、搭扣配合和/或凹凸结构(例如，螺纹部分、销和容纳部分、凸块和容纳部分以及环形凸缘和容纳部分)。套管60和套管基座40之间的连接通常可形成液密(即，密封)构型，或者可在套管60和套管基座40之间包括或形成密封。密封件可限制或防止流体从套管基座40和套管60之间通过。
将参照本文中示出的各种实施例描述多种不同的密封构型。在图1所示的实施例中，形成两种不同的密封。如图所示，套管60的远侧部分64包括凹槽76，凹槽76与套管基座40的环54协作，以在套管60和套管基座40之间形成密封过盈配合。这种构型使得套管60能够扣入套管基座40中和从套管基座40分离。在可供选择的实施例中，套管60和套管基座40可一体地形成，以形成单个套管单元。在这样的实施例中，套管单元可以可拆卸可更换地连接到牵开器20。还在近侧部分42的内表面46与套管60的近侧部分62之间形成密封。内表面46基本上是平的，并与套管60的外表面68配合以在两者间形成密封。在可供选择的实施例中，套管基座40的内表面46可包括凸起或凹入结构，所述凸起或凹入结构与套管60的外表面68的凹入或凸起结构配合，以在两者间形成密封。内表面46还可被构造用于阻挡套管60，使得套管60在所需停止位置处不能继续向远侧方向D移动。可通过例如使套管基座40与套管60的几何形状相应地吻合来产生这种阻挡效果。
牵开器20、套管基座40和套管60的可拆卸可更换性质使得不同构型的相同部件能够连接到相同的配合部件。因此，一种或多种构型的套管基座能够连接到相同的牵开器，或者相同的套管基座能够与多种牵开器连接。同样，一种或多种构型的套管能够与相同套管基座连接，或者相同套管能够与多种构型的套管基座连接。如将在稍后更详细描述的，套管基座40的配合结构以及牵开器20和套管的配合结构可以是无数种形式。在图示实施例中，可拆卸可更换结构包括过盈配合、搭扣配合和凸凹配合(例如，螺纹部分、销和切口部分、凸块和容纳部分以及环形凸缘和容纳部分)。本领域技术人员将理解，所述配合结构可在外科进入装置10的各个部件之间交换使用。
在图3至图8中公开了外科进入装置的另外的实施例。图3至图5示出了用于外科进入装置的套管160、160′、160″的实施例，其中，从它们的远侧部分166、166′、166″延伸的通道170、170′、170″被构造为当器械被从通道170、170′、170″移除时防止倒转。具体地讲，图3至图5中的套管160、160′、160″的通道170、170′、170″中的每一个包括厚度不均匀的壁。所述厚度可以在整个套管160、160′、160″上均是变化的，或者作为另一种选择，所述厚度可仅在套管160、160′、160″的一些部分(例如，仅在通道170、170′、170″中的一个或多者中)是变化的。如图3至图5中的每个所示，通道170、170′、170″包括提供按照期望变化的壁厚度的结构。在图3中，通道170包括轴向延伸部分180，该轴向延伸部分180的厚度不同于通道170的其余部分的厚度。通道170可包括任何数量的轴向延伸部分180，轴向延伸部分180可围绕通道170按照任何距离彼此径向间隔开。在图4中，通道170′包括节182，节182的厚度不同于通道170′的其余部分的厚度。具体地讲，节182比通道170′的其他部分薄。在图5中，通道170″包括窗口部分184，窗口部分184的厚度不同于通道170″的其余部分。具体地讲，窗口部分184比通道170″的其余部分薄。在一些实施例中，部分180、182和184可总体上比通道170、170′、170″的其余部分薄，而在其他实施例中，部分180、182和184可总体上比通道170、170′、170″的其余部分厚。本领域技术人员将认识到，也可使用形成不均匀壁厚的其他构型。
另外，图3和图5均示出了一根或多根缝合线186、186″，所述缝合线186、186″可与套管160、160″结合使用，以帮助保持套管160、160″和/或与其相关的外科进入装置的位置。图3示出了缝合线186环绕套管160的近侧部分183上的凸块181的实施例。图5示出了缝合线186″穿过套管160″的近侧部分183″上的孔185的实施例。本领域技术人员将认识到，一根或多根缝合线同样可与套管基座和/或牵开器结合使用，以帮助保持套管基座、牵开器和/或与其相关的外科进入装置的位置。
图6和图7示出了外科进入装置的两个其他实施例210、210′。如图所示，外科进入装置210、210′包括一个或多个钩部290、290′，所述钩部290、290′被构造用于容纳器械208、208′。在图6中，钩部290设置在牵开器220的内表面226上，而在图7中，钩部290′设置在套管260′的近侧部分262′上并可从该近侧部分262′向近侧延伸。图7还示出一个或多个钩部290′可设置在牵开器220′的远侧部分224′上并可从该远侧部分224′向远侧延伸。本领域技术人员将进一步认识到，钩部290、290′可相对于外科装置210、210′设置在各种其他位置上，包括作为套管基座的一部分。
图6和图7还示出一根或多根缝合线286、286′，它们可与套管260、260′结合使用，以帮助保持套管260、260′的位置。图7进一步示出了在外科进入装置210′中包括一个或多个伸展肋292′。如图所示，肋292′设置在牵开器220′和套管260′之间，并在两者间沿轴向延伸。可使用任何数量的肋292′，这些肋可根据需要伸展和收缩，或者可在将装置210′设置到组织切口中之前被适当地确定尺寸。当被设计为伸展和收缩时，可使用远程装置来促使肋292′伸展和收缩。肋292′可用于较厚的组织。肋292′可提供附加的长度以及稳定性。
图8示出套管360的一个实施例，该套管360具有扇形顶表面394。具体地讲，轮廓或漏斗形区域围绕每一进入口396，以帮助将器械引导到进入口396中，从而到达工作通道中的所需位置。因此，特别是当用户无法看到套管360时，所述轮廓能够帮助用户朝着所需进入口396引导。在图示实施例中，所述轮廓使得三个分开的进入口396能够被容易地确定。
图9至图20的实施例示出了外科进入装置的部件能够可拆卸可更换地连接的多种不同的方式。本说明书中始终被相似编号的部件通常具有相似的特征。本领域技术人员将认识到，尽管将仅相对于两个部件(例如，套管和套管基座)来描述实现可拆卸可更换连接的一些结构，但是如果需要，这些结构可以容易地应用于其他部件，例如套管基座与牵开器或者套管与牵开器。同样，尽管一个部件可能被描述成具有凸结构，与之配合的部件可能被描述成具有凹结构，但是本领域技术人员将认识到，凸结构和凹结构的位置可颠倒。类似地，虽然图9至图20的实施例具有用于形成液密连接或密封的不同结构，但是本领域技术人员将认识到，这些结构中的每一种均可应用于外科装置的任何实施例和任何部件。
图9和图10示出了外科进入装置410的一个实施例，该外科进入装置410具有套管460、套管基座440和牵开器420。如图所示，套管基座440包括凹连接机构，套管460包括凸连接机构。更具体地讲，套管基座440的远侧部分444包括内部螺纹部分443，套管460的远侧部分464包括外部螺纹部分463。套管460与套管基座440可以通过各自的螺纹部分463、443进行螺纹连接。通过将套管460与套管基座440脱开螺纹连接，可以从套管基座440上卸下套管460。虽然螺纹部分443、463之间的相互作用可以产生流体密封性密封，但是在一个实施例中，如图9和图10所示，在套管460周围设置O形环471，从而得到套管460和套管基座440之间的额外密封。
也可以使用其它密封件。例如，图11示出外科进入装置410′的实施例，该外科进入装置410′具有通过螺纹连接的套管基座440′和套管460′，其中，图示为环形脊471′的密封件一体地形成为套管基座440′的一部分。在图示实施例中，环形脊471′在螺纹部分443′的下方一体地形成在套管基座440′的远侧部分444′上，用于限制或防止流体经过套管460′和套管基座440′之间并由此进入到与之连接的牵开器420′的开口中。环形脊471′与图9和图10中的O形环471具有类似的功能并且按类似的方式作用。与图9和图10中的实施例类似地，套管460′与套管基座440′可以通过各自的螺纹部分463′、443′进行螺纹连接。
在具有螺纹连接的套管基座440″和套管460″的外科进入装置410″的又一个实施例(图12所示)中，密封件471″一体地形成为套管460″的一部分。如图所示，密封件471″一体地形成在套管460″的漏斗形部分上，并且能够限制或防止流体从套管基座440″的外部进入套管基座440″的远侧部分444″并由此进入与之连接的牵开器420″的开口。与环形脊471′类似，密封件471″与O形环471具有类似的功能并且按类似的方式作用。另外，密封件471″还可以用作阻挡件，用于防止套管460″沿着远端方向D′向着套管基座440″进一步的远端运动。密封件471″可以被设置成将套管460″阻挡在所需位置上，以使得套管460″和套管基座440″之间能够存在所需的连接构造。
图13和图14示出外科进入装置510的另一个实施例，该外科进入装置510具有套管560、套管基座540和牵开器520。如图所示，套管基座540包括凹连接机构，套管560包括凸连接机构。更具体地讲，套管基座540的远侧部分544包括一个或多个接纳部分(例如，键切口部分(keyed cut-out portion)545)，其用于接纳套管560的一个或多个凸起。套管560的凸起可以设置在其远侧部分564上并且可以是一个或多个销565或开口。在图示实施例中，存在四个销565和四个切口部分545，尽管也可以使用任意数量的销565和切口部分545。销565可以接合切口部分545并且附连到其中，以将套管560连接到套管基座540。按照使销565与切口部分545接合的步骤相反的步骤，通过将销565移到切口部分545之外，可以移除套管560。虽然在销565和切口部分545之间的相互作用可以产生密封，但是在图示实施例中，在套管560周围设置O形环571形式的密封件，从而在外部环境和套管基座540之间形成额外的密封，由此在外部环境和牵开器520的开口之间得到额外的密封。另外，图14还示出套管560的凸缘572上的抓握结构577，所述凸缘572参照以上图1中的凸缘72进行描述。
图15和图16示出外科进入装置610的又一个实施例，该外科进入装置610具有套管660、套管基座640和牵开器620。如图所示，套管基座640包括凹连接机构，套管660包括凸连接机构。更具体地讲，套管基座640的近侧部分642包括闩锁647形式的一个或多接纳部分，用于接纳套管660的凸块667形式的一个或多个凸起。套管660的凸块667可以设置在套管660的外表面668上。在图示实施例中，存在三个凸块667和三个闩锁647(只有两个是可见的)，尽管也可以使用任意数量的凸块667和闩锁647。凸块667可以按各种方式滑动到闩锁647中。在图示实施例中，使凸块667与闩锁647位于近似的平面，然后将套管660沿着顺时针方向C弯曲以对齐凸块667和闩锁647。可以在套管基座640的近侧部分642上设置一个或多个阻挡件641，以协助对齐凸块667和闩锁647。阻挡件641的设置方式可以使得当凸块667与阻挡件641接触时，凸块667大致对齐并且完全位于闩锁647内。在图示实施例中，每个接纳部分647都包括与之相邻的阻挡件641，尽管在其他实施例中也可以使用任意数量的阻挡件641(包括仅一个阻挡件641)。
可以通过将套管660弯曲成不对齐状态(如图所示沿着逆时针方向CC)使得凸块667不与闩锁647对齐来卸下套管660。作为另外一种选择或除此之外，闩锁647可以是柔性的，使得沿着向下方向R按压闩锁647的松开件649时，可以使松开件649沿着方向S枢转从而离开套管660，由此将闩锁647与套管660的凸块667脱离。因此，可以卸下套管660。虽然凸块667和闩锁647之间的相互作用可以严生密封，但是在图示实施例中，在套管基座640的内表面646和套管660的外表面668之间形成近端密封件671。这在图16中尤为明显，在图16中，示出了牵开器620穿过组织702完全位于切口704内。
如图16所示，牵开器620的近端622与位于切口704的近侧部分703处的组织702接合，牵开器620的远端624与位于切口704的远侧部分705处的组织接合。套管基座640因此能够通过如图所示的过盈配合方式连接到内腔704外部的牵开器620。更具体地讲，牵开器620的近端622的直径更近似于远端624的直径。虽然在图示实施例中，近端622的直径略小于远端624的直径，但是在其他实施例中，近端622和远端624具有基本上相同的直径，或者，近端622的直径大于远端624的直径。牵开器620的中部621可以在它们之间延伸，其尺寸配合切口704，因此其直径小于近端622的直径和远端624的直径中的任一个。近端622可以包括轴向延伸的壁，该壁在套管基座640周围延伸，以接合套管基座640。虽然在图示实施例中，牵开器620和套管基座640之间的连接是过盈配合，但是在其他实施例中，它可以是搭扣配合和凸凹连接或者用于将组件连接在一起的其他连接。
诸如O形环673的密封件可以设置在牵开器620和套管基座640之间，以限制或防止流体从其间经过。套管660连接并穿过套管基座640，套管660的外表面668接合牵开器620的内表面626。如图所示，可以在两个表面668、626之间形成密封，或者可以将密封件置于其间。另外，如图所示，套管660的远侧部分664可以包括斜面675，该斜面675可以有助于将套管660插入牵开器620。套管660的通道670可以延伸超过牵开器620的远端624进入体腔。
图17示出外科进入装置710的又一个实施例，该外科装置710具有套管760、套管基座740和牵开器720。如图所示，套管基座740包括凹连接机构，套管760包括凸连接机构。更具体地讲，套管基座740的近侧部分742包括闩锁747形式的一个或多个接纳部分，用于接纳套管760的角凸缘769。凸缘769可以设置在套管760的外表面768上。在图示实施例中，存在三个闩锁747(两个是可见的)，尽管也可以使用任意数量的闩锁747。为了接合凸缘769，闩锁747上的松开件749可以是柔性的，使得沿着向下方向R′按压松开件749可以使松开件749沿着方向S′而离开套管760。然后，可以将凸缘769置于合适的位置，在此处，当沿着向下方向R′的力被释放时，闩锁747可以与凸缘769接合。至少参照图15和图16以及作为一个整体的整个申请所描述的任意数量的密封件可以与该实施例结合使用。凸缘769和接纳部分747之间的相互作用还可以产生密封。套管760的通道770可以延伸超过牵开器720的远侧部分724。
图18至图20示出外科进入装置810的另一个实施例，该外科进入装置810具有套管860、套管基座840和牵开器820。牵开器820与图15和图16中的牵开器620类似，这是因为牵开器820能够完全位于组织902内。与图15和图16中的外科进入装置610的实施例类似，套管基座840能够通过过盈配合的方式连接到牵开器820的近侧部分822，并且诸如O形环873的密封件可以设置在牵开器820和套管基座840之间，以限制或防止流体从其间经过。
套管860的构造方式与外科进入装置610的套管660的构造方式的不同之处在于，套管860包括一个或多个入口896而不是包括用于在其中设置器械的通道670。入口896均可以包括与套管基座840中的开口839连通的开口，由此牵开器820中的开口819通向外科部位。与通道670类似，入口896被密封以防止流体从其经过(例如当器械插入套管860或者将器械从套管860取出时)。在图示实施例中，使用了鸭嘴密封件874，但是在其他实施例中，可以使用任意数量或任意类型的密封件，包括以上针对通道70讨论的密封件。如图所示，套管860能够座置于套管基座840上。虽然可以基于套管860与套管基座840的连接来形成密封连接，但是在图示实施例中，诸如O形环877的单独的密封件可以设置在其间，用于限制或防止流体从套管860和套管基座840之间经过。当将外科进入装置810设置在组织902中时，其构造与针对外科进入装置610描述的构造类似。牵开器820贯穿组织902的厚度，因此套管基座840连接到组织902外部的牵开器820。
图18至图20中使用的连接机构与图17中的连接机构类似。凹连接机构包括设置在套管基座840的近侧部分842上的闩锁847形式的一个或多个接纳部分(如图所示为三个)，凸连接机构包括设置在套管860的外表面868上的环形凸缘869。环形凸缘869和闩锁847之间的相互作用与图17中的凸缘769和接纳部分747的相互作用类似。因此，沿着向下方向R″施加力(如图19所示)可以使得闩锁847能够沿着方向S″枢转而离开套管860(如图20所示)，使得套管860可以与套管基座840接合(图19)和从套管基座840上脱离(图20)。
在应用时，外科进入装置可以使得用户能够进入外科部位并且在外科部位进行工作，而不需要与之前类型的外科进入装置相关的许多空间、保持物和稳定性组织。为了方便起见，当讨论使用外科进入装置的各种方法(而不详述手术外科进入装置和它们相关组件的各种实施例中的每个)时，将参照图1中的外科进入装置10。当讨论特定类型的可拆卸可更换的连接结构时，可以参照特定的外科进入装置和与之相关的附图。本领域的技术人员将认识到的范围是，在各个实施例之间，这些特征中的一些特征是可互换的，这些方法的各个步骤中的一些步骤同样也是可互换的。
切口104可以形成在身体的组织102中。例如，切口104可以形成在组织102(例如，腹壁)中。为了使得外科进入装置10可以进入切口104，可以在切口104中设置牵开器20。牵开器20可以形成从身体外部通向外科部位的工作通道。更具体地讲，牵开器20可以接合环绕开口的组织102并且牵开组织102(当外科部位例如是腹部时，组织102包括筋膜层)以使其位于切口104形成的路径外。在一些实施例中，牵开器20可以部分设置在切口104中，使得牵开器20的远侧部分24是切口104的远端，并且牵开器20的近侧部分22终止于组织内(例如，图1和图9-13)，然而，在其他实施例中，牵开器20完全贯穿组织的厚度，使得远侧部分24是切口104的远端并且近端部份22终止于切口104的近端(例如，图16和图19)。虽然牵开器可以按多种方式设置在切口中，但是在一个实施例中，牵开器20被叠起或折叠并且插入并穿过切口104。牵开器20的远侧部分24可以接合组织102的内表面，可以将牵开器20的剩余部分穿过组织102拉回，以确保牵开器20至少部分接合在切口104内。
套管基座40可以连接到牵开器20。在一个实施例中，在将套管基座40和牵开器20中的任一个插入切口104之前，将套管基座40连接到牵开器20(或者套管基座40与牵开器20一体形成)，但是在另一个实施例中，在牵开器20至少部分固定到切口104中之后，将套管基座40连接到牵开器20。套管基座40可以连接到牵开器20的近侧部分22，使得其从牵开器20起沿着近端方向延伸。通常，当牵开器20没有完全贯穿组织时，套管基座40可以设置在切口104的剩余部分中，因此将终止于切口104的近侧部分103的近端。在这类实施例中，凸缘58可以在近侧部分103接合组织的外表面，从而有助于稳定地进入外科部位(例如，图1和图9-13)。在牵开器20完全贯穿组织的实施例中，套管基座40仍然可以连接到牵开器20，如图16和图19所示。将套管基座40连接到牵开器20的步骤可以按任意数量的方式实现，包括通过针对图9-20描述的用于将套管60连接到套管基座40的任意连接构件。因此，套管基座40和牵开器20可以至少通过过盈配合、搭扣配合(通过螺纹部分、销和接纳部分、凸块或环形凸缘和接纳部分以及其它类型的凸凹机构的方式)来连接。将套管基座40连接到牵开器20可以在其间形成流体密封性密封。
套管60可以连接到套管基座40。在一个实施例中，在套管基座40连接到牵开器20之前，套管60连接到套管基座40，然而在另一个实施例中，在套管基座40连接到牵开器20之后，套管60连接到套管基座40。如针对图9-20描述的，套管60和套管基座40可以按任意方式连接，这些方式包括(但不限于)过盈配合、搭扣配合(通过螺纹部分、销和接纳部分、凸块或环形凸缘和接纳部分以及其它类型的凸凹机构的方式)。将套管60连接到套管基座40可以在其间形成流体密封性密封。
可以将一个或多个器械插入并穿过外科进入装置10来执行任意次数的手术。在套管60包括多个通道70的实施例中，每个套管70能够根据所需的用途或手术在其内接纳一个或多个器械。在某些情况下，某些通道70可以被专门设计成用于特定用途。也可以从外科进入装置10取出器械。将密封件设置在通道70中，以有助于限制或防止当将器械插入外科进入装置10或者从外科进入装置10取出器械时不必要的流体进入或流出外科部位。
在进行外科手术的过程中，不仅可以插入器械，而且在进行外科手术的过程中可以插入和取出外科进入装置10自身的组件。例如，因为套管60可拆卸地并且可更换地连接到套管基座40，所以套管60可以与套管基座40脱开连接并且第二套管可以连接到套管基座40。根据所需的用途，第二套管可以具有与第一套管60类似或不同的构造。同样可以移除第二套管，并且包括初始套管60的其他套管可以可拆卸地并且可更换地连接到套管基座40。或者，在移除第一套管60之后，可以从外科部位取出诸如组织样本的物体、肿瘤或者位于外科部位的其他物体或样本，然后，第一套管60或任意其他套管可以连接到套管基座40。由套管和套管基座之间的可拆卸和可更换的性质造成可以生成具有多个套管的套件，这多个套管包括类似和/或不同的构造。不同的套管可以具有不同尺寸的通道和/或密封件，以在不同尺寸的器械周围形成密封。单个套管可以具有不同尺寸的通道，和/或单个套管可以具有相同尺寸的通道，并且多个套管可以协同地用于手术。套件中的套管式的套管能够可更换地用于外科进入装置。
同样，套管基座40也可以可拆卸地并且可更换地与牵开器20相连，其相连方式与以上针对套管60和套管基座40描述的相连方式类似。相同或者额外的套管基座可以与牵开器20连接和脱开连接。可以移除套管基座40，从外科部位取出物体，然后可以将套管基座40或者另外的套管基座连接到牵开器20。因此，可以生成具有多个套管基座的套件，这多个套管基座包括类似和/或不同的构造，并且该套件可以可任选地与具有多个套管的套件组合起来。套件中的套管基座使得套管基座能够可更换地用于外科进入装置。本领域的技术人员将认识到，这类套件还可以包括多个牵开器，包括类似和/或不同的牵开器。
本领域的技术人员将会知道，本发明可应用于常规内窥镜手术和开放性手术器械，也可应用于机器人辅助手术。
本文所公开的器械可被设计为单次使用后丢弃，或者它们可被设计为可使用多次。然而无论是哪种情况，该器械都可在至少使用一次后经过修复再行使用。修复可包括以下步骤的任何组合：拆卸器械，然后清洗或更换特定零件，以及重新组装。具体地讲，可拆卸该装置，并且可按照任何组合选择性地更换或拆下器械的任何数量的特定零件或部件。清洗和/或更换特定部件后，可到修理厂或在临外科前由外科组人员将器械重新装配，以供后续使用。本领域的技术人员将会知道，修复器械时可利用多种技术进行拆卸、清洗/更换和重新组装。这些技术的使用以及所得的经修复的装置均在本发明的范围内。
优选地，在手术之前对本文所描述的装置进行处理。首先，获取新的或用过的器械，并根据需要进行清洗。然后对器械进行消毒。在一种消毒技术中，将器械置于闭合并密封的容器中，例如塑料或TYVEK口袋中。然后将容器及其容纳物置于可穿透该容器的辐射场，例如γ辐射、X射线或高能电子。辐射将杀死器械上和容器中的细菌。然后可将消毒后的器械保存在消毒容器中。该密封容器将器械保持在无菌状态，直到在医疗设备中打开该容器。
优选对装置进行消毒。这可以通过本领域技术人员已知的任何多种方式进行，包括β或γ辐射、环氧乙烷、蒸汽灭菌。
本领域技术人员根据上述各实施例，会认识到本发明的更多特征和优点。因此，本发明不受已具体示出和描述的内容所限制，而是由所附权利要求书限定。本文引述的所有出版物和参考文献都明确地以引用方式全文并入本文中。
Claims (10)
1.一种外科进入装置，包括：
套管，所述套管具有与多个分离的和不同的远端通道相连通的近端开口；
套管基座，所述套管基座能够可拆卸地并且可更换地座置所述套管；以及
牵开器，所述牵开器被连接到所述套管基座并且从所述套管基座向远侧延伸。
2.根据权利要求1所述的外科进入装置，其中所述套管基座和所述牵开器固定地相互连接。
3.根据权利要求1所述的外科进入装置，其中所述套管基座和所述牵开器可拆卸地并且可更换地连接。
4.根据权利要求3所述的外科进入装置，其中所述套管基座和所述牵开器当连接在一起时形成流体密封的构型。
5.根据权利要求1所述的外科进入装置，其中所述牵开器比所述套管更加柔性。
6.根据权利要求1所述的外科进入装置，其中所述套管包括能够与所述套管基座上的螺纹部分配合的螺纹部分，以使所述套管可拆卸地并且可更换地连接到所述套管基座。
7.根据权利要求1所述的外科进入装置，其中所述套管基座包括至少一个接纳部分，所述套管包括至少一个凸起，所述至少一个凸起能够延伸到所述至少一个接纳部分中并且与之接合，以使所述套管可拆卸地并且可更换地连接到所述套管基座。
8.根据权利要求1所述的外科进入装置，其中所述牵开器包括远端环，所述远端环的直径大于所述牵开器的近侧部分的直径。
9.根据权利要求1所述的外科进入装置，还包括多个套管，所述多个套管能够可拆卸地并且可更换地连接到所述套管基座。
10.一种外科进入装置，包括：
套管，所述套管具有在所述套管的远端和近端之间延伸穿过所述套管的开口和从所述近端向远侧延伸的多个细长柔性通道，每个所述通道具有延伸穿过所述通道并且与延伸穿过所述套管的开口连通的开口；以及
支撑基座，所述支撑基座具有从其向远侧延伸的牵开器，所述支撑基座中能够可拆卸地座置所述套管，使得所述多个细长柔性通道延伸穿过所述牵开器。
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| AU (1) | AU2010201083A1 (zh) |
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| CN105581814A (zh) * | 2014-11-12 | 2016-05-18 | 柯惠Lp公司 | 用于与手术进入装置联用的附接件 |
| CN105581814B (zh) * | 2014-11-12 | 2021-04-27 | 柯惠Lp公司 | 用于与手术进入装置联用的附接件 |
| CN105769256A (zh) * | 2015-01-12 | 2016-07-20 | 上海林超医疗设备科技有限公司 | 用于建立手术通道的器具 |
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Also Published As
| Publication number | Publication date |
|---|---|
| US20100262080A1 (en) | 2010-10-14 |
| US8419635B2 (en) | 2013-04-16 |
| AU2010201083A1 (en) | 2010-10-28 |
| KR20100112091A (ko) | 2010-10-18 |
| CA2699143A1 (en) | 2010-10-08 |
| EP2238932A2 (en) | 2010-10-13 |
| EP2238932A3 (en) | 2011-12-07 |
| JP2010240437A (ja) | 2010-10-28 |
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Application publication date: 20101013 |