Single port laparoscopic access with laterally spaced virtual insertion points

Abstract

A system for performing single port laparoscopic procedures includes a transcutaneous seal and a plurality of tools. The tools comprise a substantially rigid tubular seal having a core which is translatably and rotatably disposed in the sleeve. The handle at the proximal end of the tool controls an end effector at the distal end of the tool. The sleeves of the tools are locked in the transcutaneous seals so that they remain in a fixed geometric relationship which prevents the tools from interfering with each other during laparoscopic procedures.

1 . A laparoscopic tool comprising
 a substantially rigid tubular sleeve having (a) a proximal region defining an axis, (b) a middle region having a proximal end attached to and extending from the proximal region, a distal end, and at least one curve between the proximal and distal ends, and (c) a distal region extending from the middle region and a central passage therethrough;   a core disposed in the sleeve and having a proximal section extending from the proximal region of the sleeve and a distal section extending from the distal region of the sleeve, wherein the core can be rotated and axially extended and retracted relative to the sleeve;   an effector at the distal end of the core; and   a handle at the proximal end of the core, wherein the handle can extend, retract, and rotate the core within the sleeve and is operatively coupled through the core to the effector.   
     
     
         2 . A tool as in  claim 1 , wherein at least a portion of the proximal region of the sleeve is substantially straight. 
     
     
         3 . A tool as in  claim 2 , wherein the entire proximal region of the sleeve is substantially straight. 
     
     
         4 . A tool as in  claim 2 , wherein at least a portion of the distal region of the sleeve is substantially straight. 
     
     
         5 . A tool as in  claim 3 , wherein the entire distal portion is substantially straight. 
     
     
         6 . A laparoscopic tool as in  claim 1 , wherein the middle region of the tubular sleeve first curves away from the axis and then curves back toward the axis. 
     
     
         7 . A tool as in  claim 1 , wherein the middle region of the sleeve has an S-shaped geometry with a proximal curve in one direction followed by a distal curve in the opposite direction. 
     
     
         8 . A tool as in  claim 7 , wherein the proximal curve has a radius in the range from 3 cm to 12 cm and the distal curve has a radius in the range from 3 cm to 12 cm. 
     
     
         9 . A tool as in  claim 1 , wherein the middle region of the tubular sleeve has a C-shaped geometry. 
     
     
         10 . A tool as in  claim 9 , wherein the proximal and distal regions of the tubular sleeve extend coaxially from the middle region along a single line. 
     
     
         11 . A tool as in  claim 9 , wherein the proximal and distal regions of the tubular sleeve extend along parallel, spaced-apart lines from the middle region. 
     
     
         12 . A tool as in  claim 7 , wherein the sleeve has a length in the range from 18 cm to 35 cm, the proximal region has a length in the range from 4 cm to 12 cm, the middle region has a length in the range from 10 cm to 20 cm, and the distal region has a length in the range from 4 cm to 12 cm. 
     
     
         13 . A tool as in  claim 1 , wherein the effector comprises mechanically displaceable components. 
     
     
         14 . A tool as in  claim 13 , wherein the effector comprises jaws. 
     
     
         15 . A tool as in  claim 13 , further comprising a drive cable coupled at a proximal end to the handle, passing through a central passage of the core, and coupled at a distal end to the mechanically displaceable components. 
     
     
         16 . A tool as in  claim 15 , wherein the drive cable comprises a Bowden cable. 
     
     
         17 . A tool as in  claim 16 , wherein the handle comprises a trigger coupled to the Bowden cable. 
     
     
         18 . A tool as in  claim 15 , wherein the core comprises a tubular body which is received in the central passage of the tubular sleeve, wherein at least a central section of the body which is disposed within the sleeve is flexible to allow the body to be advanced and retracted within the curves of the middle region of the sleeve. 
     
     
         19 . A tool as in  claim 18 , wherein the proximal and distal sections of the core are substantially rigid. 
     
     
         20 . A tool as in  claim 19 , wherein the central section comprises nested elements which are coupled to transmit torque but permit bending. 
     
     
         21 . A tool as in  claim 20 , wherein the cable passes through aligned openings in the nested elements. 
     
     
         22 . A tool as in  claim 1 , wherein the effector comprises an electrode which is connected to an electrical conductor which passes through a central passage of the core. 
     
     
         23 . A tool as in  claim 1 , further comprising a coupling tube slidably disposed over the curve of the middle region of the rigid tubular sleeve. 
     
     
         24 . A tool as in  claim 23 , wherein the middle region has a C-shaped curve and the coupling tube has a similar but shorter curve so that the sleeve can slide within the tube. 
     
     
         25 . A tools as in  claim 23 , wherein the tube has a pivotal coupler which can be removably attached to another pivotal coupler on another coupling tube. 
     
     
         26 . A laparoscopic system comprising:
 a first tool having a proximal handle segment, a middle segment, and a distal effector segment;   a second tool having a proximal handle segment, a middle segment, and a distal effector segment; and   a transcutaneous seal having a first tube for removably receiving the first tool and a second tube for receiving the second tool;   wherein the tubes are coupleable to maintain the first and second tools in a predetermined relative orientation and wherein the handles can be used to translate and rotate the distal effector segments while the tools remain in the seal.   
     
     
         27 . A system as in  claim 26 , wherein the transcutaneous seal is adapted to be placed in an umbilicus. 
     
     
         28 . A system as in  claim 27 , wherein the transcutaneous seal comprises a polymeric block with passages for removably receiving the first and second tools. 
     
     
         29 . A system as in  claim 26 , further comprising individual locks for securing each tool in the receiving tube. 
     
     
         30 . A system as in  claim 26 , wherein the tools are free to slide and rotate within the tubes. 
     
     
         31 . A system as in  claim 26 , wherein the tubes are fixedly coupled to each other. 
     
     
         32 . A system as in  claim 26 , wherein each tool comprises:
 a substantially rigid tubular sleeve having a proximal region defining an axis, a middle region extending from the middle region first curving away from the axis and then curving back toward the axis, a distal region extending from the middle region, and a central passage therethrough;   a core disposed in the sleeve and having a proximal section extending from the proximal region of the sleeve and a distal section extending from the distal region of the sleeve, wherein the core can be rotated and axially extended and retracted relative to the sleeve;   an effector at the distal end of the core; and   a handle at the proximal end of the core, wherein the handle can extend, retract, and rotate the core and is operatively coupled through the core to the effector.   
     
     
         33 . A system as in  claim 26 , wherein the tubes are pivotally attachable to each other to allow the tools to pivot relative to each other about a horizontal axis. 
     
     
         34 . A system as in  claim 33 , wherein the transcutaneous seal comprises first and second semi-circular tubes which slidably receive similar semi-circular middle regions of the sleeves of the first and second tools, respectively, allowing the tools to be manipulated as if they were straight tools passing through virtual insertion points at laterally spaced-apart centers of the semi-circles. 
     
     
         35 . A transcutaneous seal comprising:
 an elastomeric seal body adapted to be positioned in a transcutaneous penetration; and   at least a first shapeable tube extending axially through the elastomeric seal body, said first tube having a central passage for removably receiving a laparoscopic tool having a non-linear geometry.   
     
     
         36 . A transcutaneous seal as in  claim 35 , further comprising a second shapeable tube extending axially through the elastomeric seal body, said second shapeable tube having a central passage for removably receiving a laparoscopic tool, wherein said first and second shapeable tubes are fixedly attached to each other at one location along their lengths. 
     
     
         37 . A transcutaneous seal as in  claim 36 , wherein each of the first and second shapeable tubes includes a lock for axially securing a laparoscopic tool within the respective tube. 
     
     
         38 . A transcutaneous seal as in  claim 36 , wherein each shapeable tube comprises a lubricious polymer. 
     
     
         39 . A transcutaneous seal as in  claim 36 , wherein each shapeable tube comprises a peripheral opening along an axial line to allow preferential bending in a single plane. 
     
     
         40 . A transcutaneous seal as in  claim 36 , wherein the first and second shapeable tubes are attached at locations peripherally opposite to the axial lines of the openings so that both tubes preferentially bend in the same plane.