WO2011144920A1 - Seal for a surgical instrument - Google Patents

Seal for a surgical instrument Download PDF

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Publication number
WO2011144920A1
WO2011144920A1 PCT/GB2011/050913 GB2011050913W WO2011144920A1 WO 2011144920 A1 WO2011144920 A1 WO 2011144920A1 GB 2011050913 W GB2011050913 W GB 2011050913W WO 2011144920 A1 WO2011144920 A1 WO 2011144920A1
Authority
WO
WIPO (PCT)
Prior art keywords
tubular member
flexible tubular
seal
lumen
flexible
Prior art date
Application number
PCT/GB2011/050913
Other languages
French (fr)
Inventor
Michael John Mcmahon
Michael White
Original Assignee
Surgical Innovations Limited
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Surgical Innovations Limited filed Critical Surgical Innovations Limited
Publication of WO2011144920A1 publication Critical patent/WO2011144920A1/en

Links

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34Trocars; Puncturing needles
    • A61B17/3462Trocars; 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
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34Trocars; Puncturing needles
    • A61B17/3498Valves therefor, e.g. flapper valves, slide valves

Definitions

  • the present invention relates to a seal for a surgical instrument, an in particular to a seal for sealing a shaft of a surgical instrument between a pressurised human or animal body cavity and the atmosphere.
  • the body cavity in which the procedure takes place is often insufflated.
  • the insufflation causes the body cavity to be at a higher pressure than the external atmosphere.
  • Seals for use with minimally invasive surgical instruments are known.
  • One example is the system sold under the trade name Yelloport, which is commercially available from
  • the Yelloport system provides a trocar system with a seal.
  • a typical seal 2 used in the Yelloport system is depicted in Figure 1.
  • the seal 2 comprises an annular sealing member 4. Adjacent the annular sealing member 4 are two flaps 6.
  • the flaps 6 are manufactured from a resilient material. When an instrument is not present in the seal the resilience of the flaps 6 presses them together. This creates a seal that prevents insufflation gas from escaping.
  • the flaps 6 are formed of a material with relatively high Shore hardness, for example a Shore hardness of 50 to 71.
  • Shore hardness for example a Shore hardness of 50 to 71.
  • the flaps 6 must also define a slit larger than the diameter of the instrument, so that they can be opened by inserting an instrument. These factors combine to require an increase in the size of the seal. It would be desirable for the seal to be smaller, particularly for use in systems where multiple instruments enter a body cavity through a single incision.
  • the high resilience required also increases the friction on the shaft of the instrument during insertion and removal.
  • the present invention provides a seal comprising an annular sealing member and a flexible tubular member extending from the annular sealing member.
  • the flexible tubular member is configured to be substantially closed to the passage of gas through the seal in the absence of an internal force.
  • a flexible tubular member can still form an effective valve against the passage of gas through the seal when an instrument is not present to open the tubular member.
  • the annular sealing member forms a seal on the shaft of the instrument.
  • the tubular shape of the flexible tubular member enables the size of the seal can be reduced compared to prior art seals using flaps. A further advantage is reduced friction on insertion and removal of the instrument.
  • a seal for sealing an opening in a pressurised body cavity from the atmosphere comprising:
  • a flexible tubular member extending from to the annular member, the flexible tubular member having a first end and a second end and defining a lumen therebetween; wherein the flexible tubular member is configured such that the lumen is closed in the absence of an internal force within the lumen
  • the flexible tubular member is configured so that the lumen is closed in the absence of a surgical instrument, which will provide an internal force to open the lumen as it is inserted. This forms a seal against gas escaping through the seal when no instrument is present. Closure of the lumen can be accomplished in various ways, some of which are described in more detail below.
  • the flexible tubular member is sufficiently flexible that the higher pressure around the walls of the flexible hollow member cause it close under the pressure.
  • the flexible annular member provides a seal around a shaft of the instrument.
  • the flexible tubular member can be affixed directly to the flexible annular member. In other embodiments, such as embodiments where the seal is in a housing, it may be spaced apart from the flexible annular member, provided that the lumen follows on from the opening.
  • the flexible hollow member comprises a material with a Shore hardness less than 50, more preferably less than 5.
  • the flexible hollow member may have a thickness less than 1mm, more preferably, less than 0.15 mm.
  • the flexible tubular member may have a frustoconical shape.
  • the reference to a frustoconical shape should be interpreted broadly to include all forms which are generally conical or pyramid-like with a cross-sectional area decreasing along an axis.
  • a frustoconical portion may not have smooth sides, for example the sides may include creases or pleats providing the overall cross sectional area decreases along an axis.
  • the frustoconcial shape can assist in closure of the lumen in the absence of an internal force.
  • the valve further comprises a gas inlet port adapted for connection to a source of pressurised gas, and wherein the gas inlet port is configured to divert inflowing gas towards the outside of the flexible tubular member thereby increasing air pressure outside the lumen of the flexible tubular member.
  • the gas inlet port can therefore provide a source of additional pressure to cause the lumen of the flexible tubular member to close.
  • the flexible tubular member comprises a shape memory material and is shaped such that in the absence of an internal force acting outwardly on the walls of the lumen, the lumen is closed, preventing flow of gas through the lumen.
  • a material with a preformed shape in which the lumen is closed can be used, such as a shape which is configured to roll up at the second or distal end.
  • Various materials can be used, including shape memory polymers.
  • the seal may further comprise a housing.
  • the annular member is mounted at a first end of the housing.
  • the second end of the flexible tubular member is mounted at a second end of the housing. In this embodiment the flexible tubular member is not attached directly to the annular member.
  • Figure 1 is a diagrammatic representation of a prior art seal
  • Figure 2 is a diagrammatic representation of a seal according to an embodiment of the present invention.
  • Figures 3 A and 3B are cross sections showing diagrammatic representations of the operation of the seal of Figure 2 both with and without a surgical instrument present;
  • Figure 4 is a diagrammatic representation of a perspective view of the seal of Figure 2 without a surgical instrument present
  • Figure 5 is a diagrammatic representation of a cross section of another embodiment of the present invention.
  • Figure 6 is a diagrammatic representation of a perspective view of a further embodiment of the invention.
  • Figure 7 is a diagrammatic representation of a perspective view of another embodiment of the invention.
  • Figure 2 depicts perspective view of a seal 10 according to an embodiment of the present invention shown with an open lumen for clarity.
  • the seal 10 comprises a flexible annular member 12 and flexible hollow member 14 extending from the flexible annular member 12.
  • the flexible annular member 12 has an inner surface which defines an opening 16 with a diameter slightly smaller than the shaft of a surgical instrument. Typical surgical instrument shaft diameters include 5mm, 10mm, 12mm and 16mm.
  • the seal 10 can be formed in a number of different sizes and the appropriate size selected.
  • Extending from and attached to the flexible annular member 12 is the flexible tubular member 14.
  • the flexible tubular member 14 has a frustoconical shape in this embodiment.
  • the frustoconial shape defines an internal diameter that decreases along axis 15.
  • this can enable part of the flexible tubular member 14 to have a diameter smaller than the diameter of the instrument shaft so that a second seal can be formed with the instrument shaft.
  • This second seal is not essential to the invention.
  • the flexible annular member 12 is made of Silicone or TPE and the flexible tubular member 14 is made of Ripstop Nylon or Polythene, with a Shore Hardness of 5 or less.
  • the flexible tubular member is 0.15 mm or less thick.
  • the seal 10 of this embodiment will be combined with other components of a port system to provide a seal between a pressurised body cavity and the outside atmosphere.
  • the seal of the invention may be used with the Yelloport system. The operation of the seal will now be explained with reference to Figures 3 A and 3B.
  • Figure 3 A depicts the seal 10 with a shaft 18 of a surgical instrument in place. It can be seen how the flexible annular member 12 forms a first seal on the shaft 18, and the flexible tubular member 14 forms an optional second seal on the shaft 18.
  • Figure 3B depicts how the seal 10 prevents gas escaping from the pressurised body cavity.
  • the action of pressure on the outside of the flexible tubular member 14 causes it to collapse, closing the lumen within it so that gas cannot pass through the flexible hollow member 14.
  • Figure 4 is a perspective view of the seal in this closed state.
  • Figure 5 depicts another embodiment of a seal 20 according to the present invention. It shows a diagrammatic cross section of the seal 20 with a shaft 21 of a surgical instrument in place. The construction is the same as the first except as described below.
  • the flexible tubular member 22 is not directly attached to the flexible annular member 24.
  • This embodiment further comprises a housing 26, which to which both the flexible annular member 24 and the flexible tubular member 22 are attached.
  • both first and second ends of the flexible tubular member 22 are attached to the housing 26.
  • the flexible tubular member comprises an additional portion as well as the frustoconical portion of reducing diameter.
  • Figure 6 depicts a diagrammatic representation of a further embodiment of the invention, which is the same as the first except as described below.
  • the flexible tubular member 28 is formed into a shape which closes the lumen in the flexible tubular member 28.
  • the material properties of the flexible tubular member 28 cause it to assume a closed shape, such as the partially rolled up shape shown in Figure 6.
  • the flexibility of the flexible tubular member 28 causes it to unroll and the lumen to open.
  • Figure 7 depicts a diagrammatic representation of a further embodiment of the invention, which is the same as the first except as described below.
  • the flexible tubular member 30 defines a tube of substantially constant diameter.
  • the tubular member 30 is shown in an open position for clarity.
  • the tubular member 30 of this embodiment is configured to close in the absence of an internal force using any of the methods described in conjunction with other embodiments.
  • the seal may further comprise a port for a gas supply.
  • the gas flow through the port can be configured to increase the air pressure around the outside of the flexible tubular member, assisting its closure.
  • the present invention provides a seal which can have a reduced profile because of the use of a flexible tubular member. This can still form an effective seal and allows the use of material with a lower Shore hardness and consequent smaller size of the seal. An additional advantage is reduced friction during inserting and removal of a surgical instrument.

Abstract

A seal is provided for sealing an opening in a pressurised body cavity from the atmosphere. The seal comprises a flexible annular member and a flexible tubular member. The flexible tubular member extends from the annular member, has a first end and a second end and defines a lumen between the first end and the second end. The flexible tubular member is configured such that the lumen is closed in the absence of an internal force within the lumen.

Description

SEAL FOR A SURGICAL INSTRUMENT
The present invention relates to a seal for a surgical instrument, an in particular to a seal for sealing a shaft of a surgical instrument between a pressurised human or animal body cavity and the atmosphere.
During minimally invasive surgical procedures the body cavity in which the procedure takes place is often insufflated. The insufflation causes the body cavity to be at a higher pressure than the external atmosphere. There is therefore a need to seal instruments inserted into the body cavity at the interface between the body cavity and the outside atmosphere (typically the abdominal wall) to prevent loss of the insufflation gas.
Seals for use with minimally invasive surgical instruments are known. One example is the system sold under the trade name Yelloport, which is commercially available from
Surgical Innovations Ltd. The Yelloport system provides a trocar system with a seal. A typical seal 2 used in the Yelloport system is depicted in Figure 1. The seal 2 comprises an annular sealing member 4. Adjacent the annular sealing member 4 are two flaps 6. The flaps 6 are manufactured from a resilient material. When an instrument is not present in the seal the resilience of the flaps 6 presses them together. This creates a seal that prevents insufflation gas from escaping.
When an instrument is inserted into the seal 2, it passes first through the seal 2 which forms a seal against the shaft of the instrument. As the instrument is inserted further it acts against the flaps 6 to open them and enter the body cavity. The seal 2 then prevents the insufflation gas from escaping, not the flaps 6.
In order to provide sufficient resilience to form a gas-tight seal in the absence of a surgical instrument the flaps 6 are formed of a material with relatively high Shore hardness, for example a Shore hardness of 50 to 71. In addition a reasonably large amount of material must be used to provide sufficient sealing in the absence of an instrument. The flaps 6 must also define a slit larger than the diameter of the instrument, so that they can be opened by inserting an instrument. These factors combine to require an increase in the size of the seal. It would be desirable for the seal to be smaller, particularly for use in systems where multiple instruments enter a body cavity through a single incision. The high resilience required also increases the friction on the shaft of the instrument during insertion and removal.
Accordingly the present invention provides a seal comprising an annular sealing member and a flexible tubular member extending from the annular sealing member. The flexible tubular member is configured to be substantially closed to the passage of gas through the seal in the absence of an internal force. Surprisingly, a flexible tubular member can still form an effective valve against the passage of gas through the seal when an instrument is not present to open the tubular member. When an instrument is present the annular sealing member forms a seal on the shaft of the instrument. The tubular shape of the flexible tubular member enables the size of the seal can be reduced compared to prior art seals using flaps. A further advantage is reduced friction on insertion and removal of the instrument.
According to a first aspect of the present invention, there is provided a seal for sealing an opening in a pressurised body cavity from the atmosphere, the seal comprising:
a flexible annular member; and
a flexible tubular member extending from to the annular member, the flexible tubular member having a first end and a second end and defining a lumen therebetween; wherein the flexible tubular member is configured such that the lumen is closed in the absence of an internal force within the lumen The flexible tubular member is configured so that the lumen is closed in the absence of a surgical instrument, which will provide an internal force to open the lumen as it is inserted. This forms a seal against gas escaping through the seal when no instrument is present. Closure of the lumen can be accomplished in various ways, some of which are described in more detail below. In one embodiment the flexible tubular member is sufficiently flexible that the higher pressure around the walls of the flexible hollow member cause it close under the pressure. In use with a surgical instrument, the flexible annular member provides a seal around a shaft of the instrument.
The flexible tubular member can be affixed directly to the flexible annular member. In other embodiments, such as embodiments where the seal is in a housing, it may be spaced apart from the flexible annular member, provided that the lumen follows on from the opening.
Preferably, the flexible hollow member comprises a material with a Shore hardness less than 50, more preferably less than 5. The flexible hollow member may have a thickness less than 1mm, more preferably, less than 0.15 mm.
In some embodiments, the flexible tubular member may have a frustoconical shape. The reference to a frustoconical shape should be interpreted broadly to include all forms which are generally conical or pyramid-like with a cross-sectional area decreasing along an axis. A frustoconical portion may not have smooth sides, for example the sides may include creases or pleats providing the overall cross sectional area decreases along an axis. The frustoconcial shape can assist in closure of the lumen in the absence of an internal force. In one embodiment, the valve further comprises a gas inlet port adapted for connection to a source of pressurised gas, and wherein the gas inlet port is configured to divert inflowing gas towards the outside of the flexible tubular member thereby increasing air pressure outside the lumen of the flexible tubular member. The gas inlet port can therefore provide a source of additional pressure to cause the lumen of the flexible tubular member to close.
In another embodiment, the flexible tubular member comprises a shape memory material and is shaped such that in the absence of an internal force acting outwardly on the walls of the lumen, the lumen is closed, preventing flow of gas through the lumen. This can be achieved in various ways. For example, in one embodiment a material with a preformed shape in which the lumen is closed can be used, such as a shape which is configured to roll up at the second or distal end. Various materials can be used, including shape memory polymers. In other embodiments, the seal may further comprise a housing. The annular member is mounted at a first end of the housing. Preferably, the second end of the flexible tubular member is mounted at a second end of the housing. In this embodiment the flexible tubular member is not attached directly to the annular member.
Embodiments of the invention will now be described by way of example with reference to the accompanying drawings, in which: Figure 1 is a diagrammatic representation of a prior art seal;
Figure 2 is a diagrammatic representation of a seal according to an embodiment of the present invention;
Figures 3 A and 3B are cross sections showing diagrammatic representations of the operation of the seal of Figure 2 both with and without a surgical instrument present;
Figure 4 is a diagrammatic representation of a perspective view of the seal of Figure 2 without a surgical instrument present;
Figure 5 is a diagrammatic representation of a cross section of another embodiment of the present invention;
Figure 6 is a diagrammatic representation of a perspective view of a further embodiment of the invention;
Figure 7 is a diagrammatic representation of a perspective view of another embodiment of the invention.
Figure 2 depicts perspective view of a seal 10 according to an embodiment of the present invention shown with an open lumen for clarity. The seal 10 comprises a flexible annular member 12 and flexible hollow member 14 extending from the flexible annular member 12.
The flexible annular member 12 has an inner surface which defines an opening 16 with a diameter slightly smaller than the shaft of a surgical instrument. Typical surgical instrument shaft diameters include 5mm, 10mm, 12mm and 16mm. The seal 10 can be formed in a number of different sizes and the appropriate size selected. Extending from and attached to the flexible annular member 12 is the flexible tubular member 14. The flexible tubular member 14 has a frustoconical shape in this embodiment. The frustoconial shape defines an internal diameter that decreases along axis 15.
Optionally, this can enable part of the flexible tubular member 14 to have a diameter smaller than the diameter of the instrument shaft so that a second seal can be formed with the instrument shaft. This second seal is not essential to the invention.
In this embodiment the flexible annular member 12 is made of Silicone or TPE and the flexible tubular member 14 is made of Ripstop Nylon or Polythene, with a Shore Hardness of 5 or less. The flexible tubular member is 0.15 mm or less thick.
In use, the seal 10 of this embodiment will be combined with other components of a port system to provide a seal between a pressurised body cavity and the outside atmosphere. For example the seal of the invention may be used with the Yelloport system. The operation of the seal will now be explained with reference to Figures 3 A and 3B.
Figure 3 A depicts the seal 10 with a shaft 18 of a surgical instrument in place. It can be seen how the flexible annular member 12 forms a first seal on the shaft 18, and the flexible tubular member 14 forms an optional second seal on the shaft 18.
Figure 3B depicts how the seal 10 prevents gas escaping from the pressurised body cavity. The action of pressure on the outside of the flexible tubular member 14 causes it to collapse, closing the lumen within it so that gas cannot pass through the flexible hollow member 14. Figure 4 is a perspective view of the seal in this closed state.
Figure 5 depicts another embodiment of a seal 20 according to the present invention. It shows a diagrammatic cross section of the seal 20 with a shaft 21 of a surgical instrument in place. The construction is the same as the first except as described below. In this embodiment the flexible tubular member 22 is not directly attached to the flexible annular member 24. This embodiment further comprises a housing 26, which to which both the flexible annular member 24 and the flexible tubular member 22 are attached. In this embodiment both first and second ends of the flexible tubular member 22 are attached to the housing 26. In order for the second end to be attached to the housing 26 the flexible tubular member comprises an additional portion as well as the frustoconical portion of reducing diameter.
So that the flexible tubular member can still close under the action of air pressure additional material must be provided given that both first and second ends are attached to the housing and held open. This additional material is depicted by the undulations in the flexible tubular member 22 visible in Figure 5 and may be provided by pleating or folding the flexible tubular member 22.
Figure 6 depicts a diagrammatic representation of a further embodiment of the invention, which is the same as the first except as described below. Here the flexible tubular member 28 is formed into a shape which closes the lumen in the flexible tubular member 28. When no shaft is present the material properties of the flexible tubular member 28 cause it to assume a closed shape, such as the partially rolled up shape shown in Figure 6. When a surgical instrument shaft is present in the seal, the flexibility of the flexible tubular member 28 causes it to unroll and the lumen to open.
Figure 7 depicts a diagrammatic representation of a further embodiment of the invention, which is the same as the first except as described below. In this embodiment the flexible tubular member 30 defines a tube of substantially constant diameter. As depicted in Figure 7 the tubular member 30 is shown in an open position for clarity. However, the tubular member 30 of this embodiment is configured to close in the absence of an internal force using any of the methods described in conjunction with other embodiments.
In other embodiments (not illustrated) the seal may further comprise a port for a gas supply. The gas flow through the port can be configured to increase the air pressure around the outside of the flexible tubular member, assisting its closure. Thus, the present invention provides a seal which can have a reduced profile because of the use of a flexible tubular member. This can still form an effective seal and allows the use of material with a lower Shore hardness and consequent smaller size of the seal. An additional advantage is reduced friction during inserting and removal of a surgical instrument.

Claims

1. A seal for sealing an opening in a pressurised body cavity from the atmosphere, the seal comprising:
a flexible annular member; and
a flexible tubular member extending from the flexible annular member, the flexible tubular member having a first end and a second end and defining a lumen therebetween;
wherein the flexible tubular member is configured such that the lumen is closed in the absence of an internal force within the lumen.
2. A seal according to claim 1, wherein the flexible tubular member comprises a material with a Shore Hardness less than 5.
3. A seal according to claim 1 or 2, wherein the flexible tubular member has a thickness less than 0.15 mm.
4. A seal according to claim 1 , 2 or 3, wherein the flexible tubular member has a frustoconical shape.
5. A seal according to any one of the preceding claims, wherein the valve further comprises a gas inlet port adapted for connection to a source of pressurised gas, and wherein the gas inlet port is configured to divert inflowing gas towards the outside of the flexible tubular member thereby increasing air pressure outside the lumen of the flexible tubular member.
6. A seal according to any one of the preceding claims, wherein the flexible tubular member comprises a shape memory material and is shaped such that in the absence of an internal force acting outwardly on the walls of the lumen, the lumen is closed, preventing flow of gas through the lumen.
7. A seal according to claim 6, wherein the flexible tubular member is configured to partially roll up at its distal end.
8. A seal according to any one of the preceding claims, further comprising a housing and wherein the annular member is mounted at a first end of the housing and the second end of the flexible tubular member is mounted at a second end of the housing.
PCT/GB2011/050913 2010-05-20 2011-05-12 Seal for a surgical instrument WO2011144920A1 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
GBGB1008385.5A GB201008385D0 (en) 2010-05-20 2010-05-20 Seal
GB1008385.5 2010-05-20

Publications (1)

Publication Number Publication Date
WO2011144920A1 true WO2011144920A1 (en) 2011-11-24

Family

ID=42341016

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/GB2011/050913 WO2011144920A1 (en) 2010-05-20 2011-05-12 Seal for a surgical instrument

Country Status (2)

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GB (1) GB201008385D0 (en)
WO (1) WO2011144920A1 (en)

Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5443452A (en) * 1992-07-02 1995-08-22 Applied Medical Resources Seal assembly for access device
US5662615A (en) * 1995-09-01 1997-09-02 Blake, Iii; Joseph W. Valve and valve cartridge for trocar
US5752970A (en) * 1995-02-03 1998-05-19 Yoon; Inbae Cannula with distal end valve
US5906577A (en) * 1997-04-30 1999-05-25 University Of Massachusetts Device, surgical access port, and method of retracting an incision into an opening and providing a channel through the incision
US6447489B1 (en) * 2000-01-18 2002-09-10 Ethicon Endo-Surgey, Inc. Laparoscopic access tool with gas seal
US20080171988A1 (en) * 2007-01-17 2008-07-17 Erblan Surgical, Inc. Double-cone sphincter introducer assembly and integrated valve assembly
US20100036323A1 (en) * 2007-02-20 2010-02-11 Smith Robert C Flexible cannula with seal

Patent Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5443452A (en) * 1992-07-02 1995-08-22 Applied Medical Resources Seal assembly for access device
US5752970A (en) * 1995-02-03 1998-05-19 Yoon; Inbae Cannula with distal end valve
US5662615A (en) * 1995-09-01 1997-09-02 Blake, Iii; Joseph W. Valve and valve cartridge for trocar
US5906577A (en) * 1997-04-30 1999-05-25 University Of Massachusetts Device, surgical access port, and method of retracting an incision into an opening and providing a channel through the incision
US6447489B1 (en) * 2000-01-18 2002-09-10 Ethicon Endo-Surgey, Inc. Laparoscopic access tool with gas seal
US20080171988A1 (en) * 2007-01-17 2008-07-17 Erblan Surgical, Inc. Double-cone sphincter introducer assembly and integrated valve assembly
US20100036323A1 (en) * 2007-02-20 2010-02-11 Smith Robert C Flexible cannula with seal

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