Surgical Apparatus

The present invention relates generally to apparatus for use in surgery, and more particularly to improvements in surgical apparatus suitable for maintaining a sterile aseptic environment while performing open or minimum invasive surgery.

Laparoscopic surgery has become a procedure of choice for certain abdominal operations because of the relatively small incisions involved and the minimal trauma and shortened healing time for the patient. However, not all surgeons have the highly specialized training and experience needed to perform the required critical surgical tasks with trocar and cannula assemblies while observing a remote TV image of the abdominal cavity under conditions of pneumoperitoneum.

A modified or hybrid form of laparoscopic surgery, more adaptable to surgeons trained only in conventional surgical techniques, is now possible with a surgical apparatus especially developed for hand-assisted minimum invasive laparoscopic surgery while still maintaining pneumoperitoneum. The mere presence of one hand of the surgeon in the abdominal cavity together with a laparoscope enables the trocar and cannula assemblies to be precisely and safely moved about by feel as well as by sight on a TV monitor.

Such an apparatus is disclosed in pending U.S. patent application Ser. No. 08/300,346 filed Sep. 2, 1994 by the inventors of the present invention. A flexible sleeve with an entry opening at the proximal end is sealed by an adjustable cuff around the surgeon's forearm when his/her hand is inserted into the sleeve, and an exit opening on one side near the distal end of the sleeve is sealed by an adhesive flange around an incision through which the surgeon's hand may pass into the abdominal cavity. A duckbill check valve located between the entry and exit openings defines an antechamber along the forearm which prevents loss of pneumoperitoneum while the hand is being inserted or removed from the sleeve during a surgical procedure such as when retrieving various surgical instruments.

However, the apparatus does not permit the surgeon or other operating room personnel to introduce or remove instruments directly into the sleeve at the site of the incision during an operation, or to store these instruments within the sleeve where they can be easily grasped by the surgeon; nor will the apparatus enable the surgeon to use both hands, or the hand of an assistant, within the sleeve.

Furthermore, brief interruptions in the course of an operation may not be feasible where the surgeon needs to withdraw his/her arm from the sleeve from time to time.

Accordingly, it is an object of the present invention to provide a surgical apparatus suitable for open or minimum invasive surgery while maintaining a sterile aseptic environment at the operating site.

Another object of the invention is to provide a gas-impervious sleeve for hand-assisted surgery in which conventional instruments can be inserted under conditions of pneumoperitoneum within easy reach of the surgeon's hand.

Still another object of the invention is to provide a surgical apparatus which is suitable for hand-assisted surgery under conditions of pneumoperitoneum, and which can be quickly disconnected and reconnected around the site of an incision to accommodate brief interruptions in the course of an operation.

A still further object of the invention is to provide a surgical apparatus suitable for maintaining a sterile aseptic environment in the immediate vicinity of a wound during a surgical procedure initiated under emergency conditions at a field station and subsequently while the patient is being transported to a more fully equipped aseptic operating room environment where the surgical procedure can be completed.

These and other objects and novel features of the invention are accomplished with a surgical apparatus in which a flexible sleeve includes an exit opening near a distal end for adhesively sealing around an incision in a patient, and sealable hand and instrument entry openings for maintaining an isolated and aseptic environment in the immediate vicinity of the incision. One preferred embodiment includes access ports with duckbill check valves in the sleeve near the incision which allow laparoscopic and other surgical instruments to be introduced or removed from the sleeve without losing pneumoperitoneum or sterile integrity at the site. In a second embodiment, two sleeves communicate with a transparent dome-shaped envelope for receiving both hands. The envelope is completely closed except for an opening in the bottom side which adhesively seals to the patient around the operating site, and access ports with duckbill check valves extending into the top of the envelope for instruments to be passed in and out during surgery. A third embodiment includes a short sleeve with a quick-disconnect ring and an adhesive flange at a distal end opening which seal around the outer end of a wound protector emplaced in the incision. A cuff at the proximal end opening seals the sleeve around the arm of the surgeon, and instrument access ports with duckbill check valves maintain pneumoperitoneum and sterile integrity at the incision while the sleeve is connected to the wound protector during surgery.

The foregoing and other objects, novel features, and advantages of the invention will become more apparent from the following description when taken in conjunction with accompanying drawings wherein:

FIG. 1 is a perspective view of one preferred embodiment of a surgical apparatus according to the invention suitable for minimum invasive abdominal surgery;

FIG. 2 is an exploded isometric view in flat layout of principal components of the surgical apparatus of FIG. 1;

FIG. 3 is a longitudinal cross-sectional view of the distal end of the surgical apparatus of FIG. 1 taken along the line 3--3;

FIG. 4 is a view partially in cross-section of another preferred embodiment of the surgical apparatus according to the invention which is especially suitable for use with both hands or under emergency field conditions;

FIG. 5 is a view partially in cross-section of still another preferred embodiment of the surgical apparatus according to the invention having a quick-disconnect sleeve.

FIG. 6 is an exploded perspective view of another embodiment of the invention; and

FIG. 7 is a view showing the FIG. 6 embodiment in use.

Referring now to the drawings wherein like reference characters denote like or corresponding parts throughout the several views, there is shown in FIGS. 1, 2 and 3 a surgical apparatus, indicated generally by the numeral 10, adhering to a patient's abdominal wall L. Of course, if a surgical drape were first applied to the operating site, flange 18 would adhere as well to the upper surface of the drape around a wound W.

Apparatus 10 includes a gas-impermeable, flexible sleeve 12 having a distal end 12a with an exit opening 14 in a bottom panel 12c around wound W sized to pass a surgeon's hand through, and a proximal end 12b with an entry opening 16 remote from the site sized to pass the surgeon's hand through and receive the forearm. A flange 18, fixed to panel 12c around exit opening 14, is coated on the bottom exposed side with an adhesive 19 for adhering to the abdominal wall L. A release or peel-strip backing (not shown) completely covers the adhesive prior to use. A non-toxic, biocompatible adhesive found especially suitable for hypersensitive skin is an acrylate polymer, such as IT8-59-A by Tolas Health Care Packaging of Feasterville, Pa., having a thickness of 0.002 in., peel adhesion 8 to 10 lb/sq. in., shear resistance of 1.2 hrs. at 1 kg/sq.in., and tack 1250 g/sq. cm. around wound W. An adjustable cuff 20 in entry opening 16 clamps around the forearm to form a chamber in sleeve 12 communicating with the abdominal cavity. An inner gas-lock or duckbill check valve 22 biased normally closed by a bias stay 23, defines an antechamber in sleeve 12 with cuff 20 around the surgeon's arm to minimize loss of insufflation under conditions of pneumoperitoneum when cuff 20 is breached. Sleeve 12, valve 22 and cuff 20 are preferably constructed of 3-mil polyolefin with flange 18 of 4-mil polyolefin materials and in the manner such as disclosed in patent application Ser. No. 08/300,346, supra, the disclosure of which is incorporated by reference herein.

Access ports 24 and 26, located near exit opening 14 in a top panel 12d of sleeve 12 allow instruments or the like to be inserted during surgery while maintaining pneumoperitoneum. As best seen in FIG. 2, port 24 defines an opening 24a located approximately coaxial with exit opening 14 and includes a duckbill check valve 24b extending into sleeve 12. An external snap-on cap 24c covers opening 24a when not in use. Access port 26 defines a slot 26a transverse to the length of sleeve 12 between port 24 and distal end 12a and includes a duckbill check valve 26b extending into sleeve 12. A grommet 26c fixed around slot 26a provides stiffening and tear resistance, and a strip 26d coated on one side with a peelable adhesive 26e sealingly adheres to the exposed surface of grommet 26c. On account of the width of duckbill check valve 26a, tension is applied between the opposite sides thereof by a U-shaped stay 26f made of a thin strip of resilient material, such as a high density polyethylene plastic, in order to maintain valve 26a in a normally closed position. Port 24 is sized to pass slender instruments such as lumens and trocars, whereas port 26 is sized to pass wider instruments such as clamps and forceps. The duckbill configuration of the check valve 24 and 26 comprises two flexible flat panels joined to each other on opposite sides and around the respective specimens 24a and 26a.

A wound protector 28, such as disclosed in patent application Ser. No. 8/300,346, supra, and incorporated by reference herein emplaced in exit opening 16 and extending through abdominal wall L and peritoneum P, protects wound W from exposure to diseased tissue and non-sterile material passing through the wound during surgery.

Referring now to FIG. 4, there is shown a surgical apparatus, indicated generally by the numeral 30, which is especially suitable for obtaining an asceptic environment in the immediate vicinity of wound W for performing emergency abdominal surgery such as at a mobile field hospital. Apparatus 30 comprises a flexible enclosure 32 made of a generally flat bottom panel 32a covered by a dome-shaped top panel 32b. An exit opening 34 in bottom panel 32a includes an adhesive flange for sealing to surgical drape D around an aforedescribed wound protector 28 emplaced in wound W. A distal end of flexible left and right sleeves 38a and 38b, respectively, communicate with the interior of enclosure 32 through openings in top panel 32b on generally opposite sides thereof. Entry openings 40 at proximal ends of sleeves 38a and 38b each includes an aforedescribed adjustable cuff 20 which tightens around the surgeon's forearms and completely isolates wound W from ambient conditions.

Top panel 32b of enclosure 32 includes access ports 44 constructed like access port 24 of FIG. 2 for passing instruments through to the surgeon. The size of the port is determined according to the size and shape of the instruments. In addition, pockets 46 affixed to the interior of top panel 32b are provided for storing instruments and other devices at easily accessible locations. The shape of the pockets depend on the type of device stored.

Top panel 32b is preferably made of a thin transparent plastic film to give the surgeon a clear view of the operating site. Apparatus 30 being made of flexible material allows the surgeon in a field emergency situation to close wound W temporarily and roll up sleeves 38a and 38b, as shown in broken outline, thereby sealing enclosure 32 for transporting the patient to another facility with apparatus 30 attached where the surgery can be completed under better conditions. Elastic bands or clips, not shown, may be applied to keep the sleeves from unrolling.

Referring now to FIG. 5, there is shown a surgical apparatus, indicated generally by the numeral 50, for hand-assisted minimum invasive surgery under conditions of pneumopentoneum which can be readily connected and disconnected by the surgeon during the operation. Apparatus 50 comprises a sleeve 52 having an entry opening 54 at a proximal end which is tightened around a surgeon's forearm by an adjustable cuff 20 as described in FIG. 1. An elastic ring 56 at the distal end of sleeve 52 defines an annular lip 56a with an interference fit with an exposed O-ring 28a of a wound protector 28 which has been emplaced in wound W in the manner described in patent application Ser. No. 08/300,346, supra, the disclosure of which is incorporated by reference herein. Protector 28 includes a flexible tube 28b secured around one end of O-ring 28a and around an O-ring 28c at the opposite end. An adhesive-coated flange 58 about ring 56 adheres to surgical drape D to sealingly enclose sleeve 52 about the wound.

Ports 60 and 62 provide direct access for instruments to be inserted into sleeve 52 without losing insufflation pressure, if any is present. Port 60 is constructed with check valves 60b and snap-on cap 60c in the same manner as port 24 of FIG. 1. Port 62 is preferably constructed of a semi-rigid sleeve 62a communicating at one end through an opening 62b in sleeve 52. A duckbill valve 62c extends toward opening 62b from an O-ring 62d secured around the other end of sleeve 62a.

The method of using the several disclosed embodiments of the surgical apparatus are similar. Basically, the abdomen is routinely prepared with anteseptics and dried, and an incise drape D is applied to the operating site. An incision with a scalpel is made at the site of sufficient size for a surgeon's hand to pass through. A wound protector 28 corresponding in size with the incision is placed in the wound by squeezing one O-ring into a tight ellipse and inserting it lengthwise through the incision until it expands inside the peritoneum and the O-ring on the other end overlaps the exposed drape D around wound W. With the surgeon's hand extending into the abdominal cavity through the wound protector 28, trocars/cannulas may be guided into place and the hand removed in order to attach one of the above-described surgical apparatus 10, 30, or 50. The hand is then reinserted through the openings of the apparatus for drawing outer O-ring through opening 14 and allowing it to expand inside sleeve 12 around the opening, and the cavity insufflated. Instruments and other materials may then be inserted within easy reach of the surgeon's hand through the various ports, or may be stored in pockets within the apparatus.

Another simplified embodiment is illustrated in FIG. 6. As seen therein, a surgical apparatus 200 similar in construction to apparatus 100 of FIGS. 3-17 in Applicants' incorporated by reference copending application Ser. No. 300,346, now U.S. Pat. No. 5,640,977 is provided, except that a first flange 251 is integral with a proximal end 204 of a sleeve 202, and a second flange member 252 is integral with a surgeon's glove 253 having a hand and finger receiving portion 253a and an elongate gauntlet portion 253b mounting the second flange 252 in the region of the open end thereof. When the surgeon's arm with glove 253 passes into sleeve 202, flanges 251 and 252 are sealingly interengaged. FIG. 7 illustrates the embodiment of FIG. 6 in use in surgery. As seen therein, the inner glove 253 extends interiorily of the sleeve 202 and is connected thereto at the sleeve proximal end 204 to afford a range of arm movement of the surgeon relative to the patient under insufflation conditions of the patients's cavity. An adhesive coated ring 211, as described heretofore, and in the parent application, extends around the wound W for effecting a sealed gastight connection of the outer sleeve 202 onto the patient over which a conventional surgical drape D is installed.

Some of the many advantages and novel features of the invention should now be readily apparent. For example, a surgical apparatus is provided which is especially suitable for open or minimum invasive surgery while maintaining a sterile asceptic environment at the operating site. Ports with duckbill check valves are provided in the apparatus which allow instruments of various shapes and sizes to be inserted under conditions of pneumoperitoneum and within easy reach of the surgeon's hand. The apparatus can be quickly disconnected and reconnected around the site of an incision to accommodate brief interruptions in the course of an operation. In one of the disclosed embodiments, the apparatus can remain attached to the patient while being transferred from a field hospital to a more complete operating room facility where the surgery can be completed.

It will be understood, of course, that various changes in the details, materials, steps and arrangement of parts, which have been herein described and illustrated in order to explain the nature of the invention may be made by those skilled in the art within the principal and scope of the invention as expressed in the appended claims.