CA2121231C

CA2121231C - Multifunctional probe for minimally invasive surgery

Info

Publication number: CA2121231C
Application number: CA002121231A
Authority: CA
Inventors: Harold J. Walbrink; Paul P. Burek; William J. Bowers; Donald L. Emmons
Original assignee: Birtcher Medical Systems Inc
Current assignee: Birtcher Medical Systems Inc
Priority date: 1991-10-18
Filing date: 1992-10-13
Publication date: 1998-11-24
Anticipated expiration: 2012-10-13
Also published as: AU2809892A; JPH07500041A; EP0608318A1; US5449356A; WO1993007821A1; CA2121231A1; EP0608318A4

Abstract

A probe (20) for use in minimally invasive surgery incorporates a handle (50), a body tube (60) and an electrosurgical (120) extending through the probe to the distal end (46) thereof. The probe includes a port (56) to a passageway through the body tube (60) for achieving evacuation, irrigation or aspiration at the surgical site controlled by a fluid flow control device (54). Additional devices, such as a video monitor (40) and inflation pump (28), may be utilized in association with the probe (20).

Description

~ wo g3~07~2~ _1 2 1 2 1 2 3 1 P~r/usg2/al~7~6 MUL~ u~CTIONAL PROBE FOR ~INIMALLY INVASI~E SURGERY

This invention relates to a new and improved probe usef~l in minimally inva~ive ~urgery. The new and ~mproved probe allows multiple di~ferent ~urgical procedures to be performed during an operation without removal of the probe ~rom ~h~Q
patient. Tho~e procedures include gas assist~d ~leuL~urgical coagulation, standard electrosurgical coagulation and cutting, laser coagulation and cutting, aqua dis~ection, irrigati~n, aspiration, evacuation, and m~chanical procedure~.

Backqround of the Invention At the present time, on~ of the ~ost rapidly o~es~i~g areas in surgical ~reatmen~ o~ patien~s is minimally invasi~e surgery, exe~plified by lapaxos~opic surgery. Laparoscopic surg~ry, which is t~pically used ~or surgical treatment within the ~bdo~in~l ~avity, involves co~ducting the surgical pro~ e by us~ of a probe which is insert2d through th~ abdominal wall. The probe del~vers the surgical capability i~to the abdominal c~vityO
Since only a ~mall incision nee~ to be made in the abdominal wall to insert the probe and gain access to the interior organs and tis~ues, the pro~ re is r~garded as~ ~nimally in~asiv~0 o g~ Ac~e~ to the abdominal cavity, the ~abdominal~ wàll is penètrated wi~h a dé~ice called a . : , . . . . . . . . .
trocar. Th~:t~ocar is att~h~to a ~n~llla or ~h~ath. After pen@tratiQn the trocar is withdrawn thr~ugh the ~n~1-1a. m~ abdomin~l ca~ity is then ' ' pre~surized by~a~flow of ga~ deIiver~d fro~ an : inflation pum~ through the r~nmlla~ and th~
abdo~inal wall ~rAn~ away from the internal organs and ti~U~~. ~he ~Y~n~ion of the abdominal wall WCl 93/07821 ~ PCS/USg2/08706 212123i o~curs ~;lowly and care~ lly so as not to damage any 3f~ the interior organs or tiscuet;. A pre6~;ure ~ensor on the inflation pump senses the kac:k pres~ure f rom the ~bdcaminal cavity and terminates . the delivery o~ ga~3 ollce the pr2ssure reaahes an upper limit. The amount o~ abdominal wall e~n~ion provide~; good access ~o the interior organs.
After inf lation, the probes and other surgical in~;truments sre in~erted into the abdo~inal cavilty through a hollow ~nt~rior of the cannula. A s~al on the interior of the c~n~ a c:ontaats th~3 probe to prevent the escape of ga~s f rom th~ abdominal cavity .
The probes can then be manipulated from sids to ~;ide due to the flexibility of the abdominal wall wher~
the cannula penetrates it. It is typical to inser~
two or three ~z~n-lul a~ in strategic loczltions to provide adequate ac~ and triangulation to the inflated abdominal cavity for the surgical procedure .
A combin~d lig~t sourc~ and ~ideo camera device is ill~e~ed lthrough one o~ the ~nrll~l as. The iJlterior of th~ abdo~inal cavity i5 illuminated and the images received by the video came~a are -displayed on a videcl ~onitor which is vi ible to the surgeon. As~ a re~ult o~ viewing the video monitor the s~aly20il is able to manipulate the pxob~s to accomplish the ~de . ired surgical efi~ec:t.
After co~pl~it3n Df :the ~urgical p ~ re, th~
~ ~ prs:~bes arad ~nr~ are rem~ved and th~ s~ll ~ni n~s m~de in the abd~miraal wall are clo~ed. The a~unt of trauma èxperi~n~ lby the pati~rlt i consid~rably reduced with mini3llally i~rasive surg~ry, ompared to the mor~ traditional type o~
op@n ~urgexy.
~ varl~y of pr~Yious probes are availa~l~ fox u~;e in minimally inYasive ~urg~ry. ~owev~r, most of YYO g3/07~21 2 1 2 :1 2 3 1 P~/USg2/087~

thes~ prior probes are capable of only ~ single u~e or type of functionality, for example, standard ele~LL~rgical cuttins or coa~ulation. A ~ew prior art probes may be ~ hle o~ limit~d multlple S ~unctions, such as ~ AArd electrosurgical cutting and coagulation as well a~ me~h~n~Gal cutting or biopsy col~ection. Since many di~erent typ88 Og ~urgical func ions are typically acaompl~ch~ duri~g the minimally invasive suxgery, the surgeo~ is u~ually r~uired t~ remove one probe ~rom the ~An~ a and in ert a different ~xo~ at ~arious different stages of the pro~ e in ord~r to complete the minimally invasive su~yery.
Removal of on~ probe and ~nsertion of another probe may have ~erious cQ~ nce~ to the patient and may, as well, create some tP~hni cal difficulties. For example, if an ar~ery or vein i8 cut eith~r inten ionally or accidentally during the ~04~.~re, a con~iderable amount of bl~ may ~ L into ~ e abdominal cavity d~ring the ti~e while a cutti~g probe is r~ov~d and a ~nA~rd ele~t~ iaal coagulating ~bL2 i8 in. Qxt~d~ I~
~h~ blood flow is ~ignifica~t, th~ a~ou~t o~ blood pooling may beaome ~ub~tantial e.,4~-.31~ to obscure th~
~ita wher~ ~h~ bl~e~ o~ Ling~ thereby ~aki~g it di~ficuit or impo~sibl~ for th~ surg~on to loGat~
the~bl~ site with the n~wly in~ert~d ~LO~_~
. ~ r~her~ore tho blood pool ~ay c~ L or ~hort circuit:~he~electrieal ener~y appli~d during 30 ~t~n~rd~ el~tro~urg~ry away ~rom the t~58ue and a~ the creat~on ~nd adherence o~ an ~r~h~r or ~aab ~n~ ~:he ~ r~l?~ rhe ~E-c'h~r cr~a~ t~
: h~o8ta~i~ 0r eoa~ul~tion to ~top the ~l~w of blood.
-~ Other difficu~:tie o~ a si~ilar natur~ exist with 3 5 r~ t to other ~ypC~ of function whic~ mu~t be WO 93/07821 ~ - PCr/US92/08706 21212~1 4 '~
accompl ~ che~l with single function prob~s used during a minimally in~ sive surgery It is with re~pect to this bacl~ ulld in~o~mation, as well as other in~orma~ion not ~pecifically ~ rc~ here~ that he present significant impro~e~ents and adv~naements have-evolved in the ~ia~d l~f probes for mi~imally in~rasive ç :urgery .

Su~ary of the TnventioTI
An important a~pect of the probe of the pre~ent inv~ntion is a nozzl~ and ~lectrode assembly at a di~tal snd of the probs. The nozzle and ~lectrode a~sembly provides gas assi~ted ele~ urgical coagulation or electro-fulguration. By incorporating th~ nozzle and electrode as~embly in the probe, gas assi~ted el2s:tro-fulguration i~
iDediately av~ hle for ~ulguration of bleç~l;7 g ~urfaces without the n~ ity of remo~ing s)ne probe ~nd inzerl:ing ~nother probe., Gas a~;~isted el@c:tro-fulguration ha~ rant ad~antage :in coagulation, b~aause it u5e8 ga~ flow to clear th~ ~3urgical ~ite o~ ~ozins~ and a~gre~i~ely ~lowing blood. Thu~ th~
surface or ~;tro~aa of the t~ ~n~ i~; exposed to the el~ ::tric~l en~rs~y carried within the gas j et to allow the~ electrioal energy to inte:ract with th0 and create ~an eff~ctive and ad~aerent 6~ r.
The ~blood or fluid clearing e~fec:t o~E th~ sta~3 jet:
al~o k~eI~: the: ~;urgical ~;ite ~risible, whiah i8 very 30~ant for the surgeon und~ar the~ ~;om~what dif~ic:ult and arti~Ei cial cirs~umsltanc o~E conAl1cti~g ~e PLV~t~ e by viewing a video ~oni~r~ By ild~;v~csrating :the nozzle: and ~e~ectr~de a~ ~bly for : ~ as ;~ssia~ted ~le~ro-fu~guration in the di tal end of the ~z c~e, th~ ~urgeon can: i32~a~dliat~ly achie~e thi5 2;uperior type of h~mo~ta~is ~ withc~ut WO 93/07821 . 2 1 2 1 2 3 1 PCI~/VS92/~8706 ,., S
substantial bl~ i ng occurring be~ore an electro-coaguïation probe is inserted and po~itioned in the abdominal cavity or before the ble~ i n~ has become so sub~itantial as to obscure the surgical site~
~other a~pec~ of th~ probl3 of th~ present in~ention is the pro~vision fvr a ~nultiplicity o~
different types o~ surgieal functions within a single probe. In accor~ c~ with this a~pect, a separat~ c~hZ~n~~l exten,d~3 through a tube at the di~;tal end of the probe. The ch~r~rlel is adapted to r~c~iv~3 and retain an auxiliary surgical instrument, 8u5:h as a st~n~rd electrosurgical cutting or coagulation electrode, a laser ~iber optic ç:onduit by which to achieve laser cutting or coagulation, an aqua dissec~ion conduit, or a mer~ ni cal tool ~uch as a knife or biopsy collection device. Preferably, one auxiliary surgisal in~;trument can be removed fro~ the probe and a different on~ i~serted without L~ov~l of ~he probe fro~ the i~sufflator.
Px~erably, a ~lider or re~inin~ member is located at a ~ at a proximal end of the pr~be to allow adjustment of th~ location and po~ition of the iary surgical in tr~ment Aur;n~ the pro~e~tlre~
Another ~cr~ ~of the prob~ of the pre.ent inven~ion i8 at;l~a t one fluid communication r~s~geway ext~n~in~ ~hrough th~ tube of th~ ~lobe by which to~irrigat~ ~luid to;the ~urgi~al site, or . to a~pi~ate~fluid~from the ~ite, or evacuate fluid fr ~ wi~hin th@ abdQmi~al cavity. Preferably, the irrigatioa, a$piration or evacuatio~ r~ way '-exi~tfi in addition to the ~h~n~l for ~he auxilia~y ~urgical instrument~ and/or in addition to the ~' nozzle and:~electrode as~mbly for gas as~i~t~d el~ o ~ulguration. A~ i n ~ the probe ne~d not be ~: 35 :removed to achieve irrigation, aspiration or evacuation of ~he abdominal cavity after or before W~93/07821 .. s P~/U$92/087~-~
~ . , 2121231 6 ~
the procedure conducted with one of the other curgical functions available from the probe.
The capability to xeadily ~Y~ ge different auxiliary surgical instrument~ ~or U8~ in the probe without removing the probe from ~he cannula, and the ability to achieve multiple different ~urgical--functions from a single probe, contribute to th~
acco~plishment of the proc~dure and the recovery o~
the patient. The amount o~ time to accompli~h the urgery may be reduced if le s tim~ is consumed in ~h~nging probe~. The multiple ~unction~ achieved by the single probe may reduce the number o~
~AnmllaS which the surgeon is requir~d to insert in the patient to acco~plish the minimally inva~ive surgery. Of course, fewer incisions made in the patient should ~nh~nGe and contribute to the patient's recovery ~ollowing the ~urgery.
Lastly t a further aspect o~ the probe of the present invention i5 the inco~ oration of a pre ~ure reli~f ~alve in comm ~ ication with the p~ geway ae a part of th~ probe. Ths pr~s~ure rzlief valve proYides a ~argin o~ protection against t~e unintentional o~er~inflation o~ the abd~inal cavit~ r inflation is of particular concern ~h~n using gas assisted electro-~ulguration in the abdomlnal cavity, bec~u e previous pro~ res did not admit additional ~as into ~he abdomînal caviky.
The~baok~:p~e aure ~ r of ~he inflation pump was ~ r~ y ~ te in ~o~,~Lolling ~h~ abdo~inal ~ . in~la~ion pre sure becau~e any slight: OE mo~e~tary over-inflation would inher~ntly l~ak betw~en the ~h~in~l wall and ~he c~nnl-lA at ~he incision.
.. Ho~v~r, the use of gas assisted ~le~5 LO ~ulgur~tion - .. creat~ a ~ituation where~he ga~ d~livered du~ing el~L~o fulguration aould caus~ a ~riou-~ over-in~lation &ituation ~hat eould not be rectifi~d .

WO 93/07821 PCr/US92/08706 ..
, 1 7 qui~kly enough ~rom ~his inherent leakage. Th~
pressure relief val~fe is important because typically there i~ no ~eans to quickly relieve over~ lation.
~he pre~sure relie~ valve of the probe i al o a back up sa~ety m~rhAn~ sm ~or the pressure sen~or of thQ inflation pu~p. ~
A more complete appreciation o~E the pre~ent in~rention and its ~cope can be obtA; ~ rom under&~An-l i nq the accompanying drawings t which are briefly summarized below, the ~ollowing dlatailed description o~ a presentl y pre f erred ~mh~ ment o~
the inventiorl, and the aprenAP~l c:laims.

Brief Desc~l ption of th~ D~awings Fig. 1 is a block, schematic and perspective i}lustration 8howi~ng th probe o~ ~he ~
invention ill uce in an abdominal cav~ty in - ~ro~iatio~ with variou~ o'cher equipme~t by which a minimally illvasive ~urgical PL~ e i~ v~ cted.
~ig . 2 i an lon~itl~; nZ~ l cro~;fi-~;ection o~ a h~n~le of the probe ~-3 ~l l. in Fig. 1 at a proxi~l end o~ the probe.
: Fig. 3 is ara~enlarged lon5i~ n~ CF~~
~;ection of a tube o~ the prob~ S~OWTl in Fig~ 1 at a di~tal e~d of ~ probç~. ~
Fig. :4: is~: a p~L~ ive ~ w o~ a nozzle and elec:trode a~Eu3mbly ~t the di~;tal 6~nd of the probe shown in Fig. ~ 3 0 Fig. ~ 5 i~ ~ cros~ Lion view takell ~ub tantially ~ in t:he ~plane oî line 5; 5 o~ Fig. 3.
~ Fig. 6 is a ~ L5 ~~_~ ion vi~w takell ub tantially~ in;~ t~8 plane o~line 6 6 of Fig, 3.
- - Fig. 7 19 a ~s:ross~~;ectis~ w talcen E~ulsstanti Ily in the plane of line 7-7 of Fig. 3.
: : :

WO g3/~7821 . ~ PCI/llS92/08706 9~ 8 Fig . 8 is an enlarged cross-2 ;ectional vi~w o~
only the tube o~ the probe, similar to the ~riew~; of the tube shown irl Figs. 5, 6 and 7.
Fig. 9 is an ~~nlarged view of ~ portio2 o~ the h~-ll e of ~he probe shown in Fi.g. 2 illu~3trating detalls o~ a ~lider member. ~
Fig. 10 is a c:ross-sectional view taken ~;ubstantially in the lin~ o~ plane 10-10 in Fig. 9.
Fig. 11 is an enlarged vi~w 4~E a E~eal located within the h;~ e of the probe ~;hown in Fig. 2.

Deta ~ 1 ed Descr i ~t .i on A presently preferxed e~odiment and best mode pr6~sently known for practicing the present invention is a probe 2 0 shown in Fis~ . ~ . q~h~ pro}:~e 2 0 is shown a~ it would typically be us~d in a mini~- lly invasive ~urgic:al p~o~ re in an abd~minal c~ity 22~ The probe 20 is ince~lad itltO th~ ab~ominal ~avity ~rough a ~A~ l a 24 which ha~i; pre~riou~:ly b~en r~ through th~ abdominal wall 2 6 . An in:f~lation pump ~8 force~ pr~ urizQd and s~erile ga~ uc:h as c~rb~n di~Y~e, th~o~ he c~nr~ a 24 i~to the~abdo~ninal cavity ~2. A~; a ~ t, the ~h~ inAl wall 26 e~ away ~ro2~ the interior t; rr~ and abdominal organ~; 30. A pres~ure ~m~~or ~ of th~ inflation pllmp 28 ~o-lLLvls the operation of the pump .28 to ~ it the amount of pressur~ within ~e~a~dominal ca~ity 22 and th~reby limit the ~ount of~ ~~n~ion o~ the Z~ Al wall 26. A
~- r ~ n~ a 34, and po~3E;ibly other8 as deter~ined 30 : l~y the ~ on, ~i al~o pe~E;itioned in1:h~ abdominal ~rall 2~, b~ the~ addi~ional c~n7ll7l as are not r-r~rily attach~d to the ln~lation pump 28.
A Yid~o:camera and lig~t sv~ d~vic:e 36 is ~4~ ted to a wand-like device 38. The ~and~lilce d~ice 38 is insert@d into the abslominal cavity 22 2 1 2 1 2 3 1 PCT/U592~8706 through th~ n~t7l a 34 . The light ~ourcQ o~ the deviae 3 6 illuminates the interis~r tissue~; and organ~; 30, and the video camera o~ the d~vice 36 tran~mits video images to a video monitor 40. By viewing the interior organs 3 0, the surgeon is able to manipulate the probe 2 0 to achieve a de irea surgical e~fect.
The probe 2 0 is connected to a gas as~ ted electro-fulgur~ltion device 42. The gas ~sist~d la ele~L~o fulguration device 42 is Le~;2~el-ted by the type of equipment descril~ed in U. S . Patsnt No .
-4 ~ 781,175 granted November 1, 1988 ~or 'IEle~ L. ~ical Conductive Gas Stxeam Technique of Achieving Improved ~:ch~r fs:~r Coagulation" which is owned by the assignee hereo~ . Oth~r U. S . patent2;
and applit:ation8 pertinent to gac assisted ele~iLi o f~ulguratior~ includle Patent No. 4, gOl t 720 gralnted February 20, 1990 for "Power Co~ g ol Ior Beam-Type }:lectrosurgic:al Unit,'l Patent No. 4,901,719 granted February 20,~ 1990 for ~Ele~;~L~ rgical ~c~n~ ctive ~as Stream Equipm~nt~l and application Serial No.
592,810~ fiIed Oatober 4, 19~0, ~or 'l~le~L~ lrgical ~nAri~c~ In-,~ }ating ~Blade and c~cn~ tlve Ga Functiona1ity. 1~ ~
In general, ~ :gas assist~d el~ o fulguration involve~ the deliYe~y o~ a stream or jet of inerg gas~to th~ tic~ at:a~ urgical site ~7hile imult~o~ y transmitting eI~c:triaal ~ Ly~ as arc~ in ionized ~n~ Gtlve pa~hway~ in the flo~ g ~a~- jet. The interac~i on oP the ga~; flow and t~e . ~ - e:L~c:triGal arc~ achie~ve a ~;uperior coagulativ~ or . ~ ~ h~mostatic eff~ct on bl~ n~ ~t~ e ~;urfac~s. G;a~
a~isted-ele.;L~o fulgura~ion i~ part:ic:ulalrly u~fu and e~ectiv on a~ nively ble~ urface~
35 hec~l~RQ tha ~a~:is ~ble to hold O~e~ and displace the blood from the surface of the ti ~u~ to allow the W~ g3/07821 ; PC~/l)Sg2/0~706 2121231 lo -~
arc:s of electric:al energy carried in the gas to interact more thoroughly and e~fecti~rely with the P. A more ef~ective eschar is creat~d which is le~s ~usceptible to floating away due to a lack o~
adherence to th~ underlying tissue. The gas as~isted electro fulguration de~Jice 42 shown i~ Fig.
1 is both the source of gas and the ~~ource of electrical en~rgy, and both the gas and th~
electrical energy i~ supplied to the probe 20 at a ga~ electrosurgical port 44~ The eleatro-~ulguration effect is created at a front or di~tal end 4 6 of the probe 2 0 .
The probe 2 0 also n~ers the c~pahillty of accepting and u*ilizing a variety of auxiliary surgical instruments 48, such as a st~n~l~rd ele~LLG-~urgical cutting and coagulation elec::trode, a la~er fiber optic con~; t for cut~ng and roagulation, an ~aqua dissection ~ollA~ t, mechAT~ical tools ~uch as a knife or a biop y collee:tiorl de~ice, and othsr types of ~urgical equipm~nt~ The a ~Y~ ;urgit:al inEt~ents can be i~;erted into ~h~ ~r~l~¢: 20 :fro~n its re r or proxi~al end 50, or when ~ the ~ probe is xeDIlovQd ~ro~ l:he ~n~ r~DI the distal end 46. ~ "~r~ on tha type of auxiliary surgical inst~ument 48 used with th~ probe 20, the L ~ent 4~8: Dlay need ~o b~3 ~o~r~o~t~d to ~ L
~quipm~nt 52 ~y ~which to u~e th~ a~iliary ~urgiaal ia~ ment ~48 . ~ For ~xample,~ if th~ . ingtrum~nt 48 is .a st~ rd ~le~ ical electrode, th~ ort 30 ~ . .equip~ent~ will be a 5t;~nA:~rd el~atrosurgical - gQner~or . Wh~n a laser f iber optic ~-~J~ t is ~~~d a~;~the auxiliary surgic~ L~ nt with the probe 20, the la~ iber :~ptic: ç:onduit will b~ nn~ted to a~ la~sar~bea~ ~device. When an aqua ~ e~-tion ~ t is used as th~ auxi~iary ~urgical in~stnJment, the ~aqua tli ~fiection con~ t will b~
i W~ 93/0782~ 2 1 2 1 2 3 1 P~/I~S92/~87~6 connected to a f ltlid pressure and f lo~7 generation device. Of cour~:e, if a me~hA~ical tool is used as the auxiliary urgical instrument, it may or may no~
be connected to ~~u~ort Pquipment, since manual co~ll,Lol oP many me~n; c:al tool~; by the surg~on will operate the2ll without additic)nal ~u~ LL equipx~nt.
~nother feature of the multifunctional probe 20 is the capability to achieve irrig~tion, a~piration or evacuation within ~he abdominal ca~rity f rom the distal end 46 of lthe probe. A~ ~rill be under~:tood more c~mpletely from the ~ollowing de~criptîon, the irrigation, axpiration or eva¢uation is achiQved by fluid fl~w to or ~rom the di~tal ~nd 46 of the probe 20. A fluid flow control device 54 i8 co~ nec:ted to î5 a fluid flow port 56 o~ the probe ~0 ~o achieve the irrigation, a~;piration or evacllation~
As a ~ 1 t of the i~ages on the video mon~ kor 40 obt~in6~ from the video ca~ra o~ the devic::e 36, the ~;urg~on can gr~sp a h~n~31 e 58 of the probe 20 2 0 and manipulate ~ conne~cted tub~ 60 o~ the probe 2 0 . . ~ tu po~ition ~ di~tal :~nd J.6 at the d~;irsd .~ location to achieve the de~ired ~urgic:al effect on the tissue~ or organ~; 30. ~ ~h~ probe is pivoted als3ng with the c~n~ la 24 at the point where both extend through th@ a~sd;:~minal walI to mo~e the di~tal end 46 to: the desired lo~ation.
The ~n~lle ~58 and t:he tub~ 60 ~re p~x~an~ntly :: ~ c~7~neGted togeth~r ~a~ a urlitary struc:ture by an he~ or ~th@ like~ an~l ~he ~ Al~ 58 and t~e! tu~e ~ 60 are th0 two ma~or: elements; of th~ probe ~0., Pre~rably the h~n~l e ~ and ~h~ t7~bf3 60 arld all ~f ~- the compoTlent . AR~o!:~lat~d with~ the~3e elemQnt~; other than t~e m~t~llic ~nd eIas;~omeric com~onents are for~d of pla~3tic, - to obtain a relati~r~ly ~ iv~ and di~cpo~:~hle probe 20. Of cour~;e, th~
probe 20 could al o ba formed of me~re long las~ing , W093/07~21 PCr/US92/087~6 and durabl~ materials which are capable of repeated sterilizations, in order to allow the probe 20 ~o be used repeatedly before disposal.
Mor~ detail~ concerning the gas assi~ted S electro-fulguration aspects of the ~obe 20 are illu~rated in Figs. 2 through a. A cylindricâi ~ ;t 62 extend~ longitudinally completely through the tube 60 from the handle 58 to th~ distal end 46, a~ is understood from Figs~ 1, 2 and 3. With the tube 60 attached to the hA~le 58, the conAl~;t 62 fits o~er a ~ r sleeve 64 ~o ~ ed in the-forward end of the h~l e 58. A diYider or wall 66 wi~hin a hollow interior 68 of the handle 58 de~ine~ a co~muni~ation pathway 70 between the conduit 62 and the gaR electro~lyical port 44~ An electrical ~o~ tor 72 extend~ through the ~o~ t 62, th~
pathway 70 and out of the port 44 to the gas as~i~ted electro-ful~uration device 420 Electrical energy for ~lectro-fulguration is supplied to the probe 2Q over the ~ t~qtor 72. A ~l~xible tubing 74 i~ c~n~ted from the port 44 to th~ ga a~sisted el~L ~agula ion device 42 by ~-h~ ~ gas for electro-fulguration is ~upplied to ~he p~o~e 20 and the conduit:62.
At thq~ di~tal end 46 of the probe, a no~z}e and electrode~a~embly 76 is retai~ed in ~he c~n~lit 62, - : a~:iC ~hown in-Fig~. 3 and 4. The ~ tor 72 e~tend ~the length o~ the ~o~ t 62 ~nd i~
~ el~ctrically ~n~cted by~a con~ector 78 to ~he rear 30 : . ~nd of an:~lon~g,a~ed ~lectrode 80 sf the as~e~bly 76.
: The rear end o~ ~he electrode 80 is ret~n~ in the a~sem~ly 76 by~a ~u~.~ stru~ e 82. Due to the retention of the~electrode 80 at the r~ar end th~reof, tha ~lectrode proj~cts ~orward in a 3S cantilever ~u~orted manner. ~ r~ar porti~n 84 o~
~e ~ oLL structure.82 is generally rectangularly W0 93/07821 2 1 21 2 3 1 PCT/US92~08706 shaped, and the rectangularly shaped portion 84 f its within the conduit ~2 a~ is ~hown in Figs. 4 and 5.
A midsection 86 o~ the ~ structure ~2 is generally tubularly shaped, hollow and integral with S the rectangularly shaped portion 84. At the forward end of the rectangular portion 84, slcrt:5 88 are foL..._~ transversely through the portion 84 to a~hieve a pathway into the hollow interior of the ~ubular midsection 86 and to ~c~e the electrode 80, as is shown in Fig. 6. A ~ l acle portion 87 extends forward ~r~m the m~ ?ction 86. A hollow slee~r~ 90 i8 partially r~ceived within th~
receptacle portion 87, but the sleeve is of sufficient length to extend forward beyond the end of th~3 receptacle portion 874 The midsection 86 and the cleeve 90 UL~O~ (1S the e~sed ~orward proj ~acting por1:ion of the electrode 8 0 . Both the ~leeve 90 and the ~orward tip of the electrode 80 terminate at approximately the same location as 2û s~own~ or alternati~ely, khe electrode tip i5 slightly r~ce~~d within the ~;leeve 90.
Pr~ferably, the L~l~~ oxt stru~;LuL~ 82 is :Eormed of plastic, the electrode 80 i~~ metallic such as l_u~ en~ and the sleeve 9Q is ceramic~ Pre~erably the elec:trode 80 and the sleeve 90 are ins~rt molded during the ~ormation o~ the pla~;tic ~ L
structure 820 The noz21e and ~lc~v-le a~3sembly 76 re~Aine~ within the o~ t 62 due to a friction i~it, but an ~ ive may al~;o be employ~d to conn~ct 30 ~- ~he a~s~mbly to the tube ~0. If the ~leeve 90 is not insert molded to the receptacle ~37p an Ar~h~C:ive may be used to hold thes~ elements ~og~ther~ In ~- 80311e r:ira~ms~ es; it may ba po~ ible to el;~ t~
the receptac:le 87 and raly on th~ retentio~a of the ~i~~'~ 1, tructure 82 and a portion of the sle~ve W093/07821 . ~ ,~ PCI/US92/~87~6 ~
2121231 ' ~

within th~ conduit 62 ~not shown~ to hold thef~e elements together.
Two oppositely oriented D-shaped c~pening~ 92 re~ult on the o~ite sides oP the rectangularly ~haped portion B4 when i~ is in~rted in the conduit 62, as is shown irl Figs. 5 and 6. It is through the~e D-shaped open; n~ 92 that gas is conducted ~rom the conduit 62 into ~he !310~8 88 and into a cylindrical cen~er orani n~ 94 formed ~r the interior~: o~ the hollow m~ ation 86 and khe ~;leeve gO, as i hown in Figs. 3 and 7. Th~ cyli~drical center op~n; n~ 94 i~ pre~3rably concerltric with the electrode 80. The center opening thL~uyh the sleeve . ~0 forms a nozzle for the gas ~o e~cit the As~~m}~ly 76. Before exitirlg the nozzle, the gas ~Ul ounds the ex~ d elec:trode 80 and become~ ioniz~d a~ it traYerse~ through the nozzle ~5 a ~ E ~ t of the electrical p~t~ntial applied on the ele~ e 80 from the e~nA~etor 72. The ionized gas eonAl~t~ the elel:trieal ener~ fro~ the electrod~ 8~ in are~
within the gas Ilowing from the nozzle to the ~ e to aehieve ele~L~o ful~uration.
In addiltion to the e~ t 62, the tube 60 2leo ineludla~ an in trument e~n~el 100 w~ich ~xtend~
par~llel~ tQ th~ ~or~ t 62 along the l~n~h of the tube . q he instrument ~h~n~o~ 100 eoD~unieat~s direc:tly with; the ' interior 68 o~ the h~ e 58 above d~rid@r ~ wall ~4, a~ i8 shown in ~ig. ~ . Tbe : Ghannel 100 ~extend~ eontin~ y and longit~ 1y 30 ~ through the - pr~e 2 0 -from the i distal end 46 at the tube 60 to 1:he prc~ximal end 5~ at the h~ l e 58. It is thrtaugh ~ c~n~l 100 that the variou~
auxiliary~ ~urgical instrum~Ilt are utilized in c03 junction with ~he probe 20~
The: ~-7Y;liary surgical instrument C~ollld be generally elongated and have an exterior cyl indrical WO 93/07821 2 1 2 1 2 3 1 PCr/U~92/08706 -shape to f it within the c-~nn~l 100 . As is shown in Fig. B, a cross ~ecti onal view of the ~h~nr~el 100 reveals a crescent haped conf iguration . ~ inner cylindrical wall 102 o~ thQ ~ub~ 60 is generally parallel ~o the outer cylindrical wall 104 c f the tube ~S0. An inner partition 106 within th~ t~be pxoj~cts radially inward from both points at wh:Lch the ilmer cylindrical wall 102 te~inates. The partition 106 separates th~ nc~ t 62 from t~e chArmel 100 along with the l~ngt~2 of the tube 60.
The partition 106 ha a cylindrically cunr~d support ~;ur~ace 108 which fac~s rA~ y outward. The inner ~08t location of conca~ity e~f the ~;upport surface 108 i~ at t~e central axi~ 110 o~ the tube 60. ~h~ curvature of the ~ ~o~ L ~;urface 108 is defined by an equal lens~th radius from i~ point 112 which is midway b~twe~n lthe axis 110 of the tube and the inner cylindrical wall 102. The point 112 i~
located at the lonsJit~ axi~ of the auxiliary 2 0 2i~urgical ~nstn~ent .
Having the shap~s thuE; de crib~ad, a longit~3; n~l auxiliary ~urgical in ~ru~ent having a diameter slightIy le~ than the di~;tanae betweQn t:he axis 110 and the wall 102 will f it within th~
instru31ent ch~nr~ 100 and be~ ol l,ed by and r~tP~ in position when it r~sts on tha ~u~ort :~ ~;urface 108 ane~ the inl:erior ~uri~ac~ 102, a~ i8 . ~hc~n in Fig~;:. 3, ;S, 6 a!md :7. ~he longit~ axi~
: - of the i,-aL~-lment c~ n~l 100 becom~2~ the ~ame a the lon~ ~~l ~xis of th@~: auxiliary $urgical in~;t~ent, and both ax~s are located at the point ~- ~ 112.:~ ~cau~ the ~u~o~ ~ urfac:e 108 ~ e~
~; r~ ly olltward frc~m ~e aa~i~ llO o~ ~he tube 60 and toward the interior cylindrical wal~ 102, the cylindrically ~h;~ urgical instrwilen~ will be prevera~d from moving :trarl~v~rsely within the WO 93/07821 3r t ~ PCr/US92/08706 ~

instrument ~ nn~l 100 . The ~ ol l, sur~ace 108 and the interior sur~ace 10~ are one escample of means f or ~;upport;ing the auxil iary surgiaal lnstmment in -- the ~ntlel 100, however other t~,rpes and con~iguratiorls o~ ~;U~ )l 1, means, either int~gral with the tube 60 or ~;eparate components, may bë u~3ed a~; alternative~.
Although a ~ariety o~ di~ferellt typ~s o~
auxiliary surgicsal in~trum~nt whi¢h have the n~c~Q~ry outer diamet~r and the general cylindrical ~h~E~e can be u~ed with the probe 20, a ~:t~rlA~rd elec~L~ Yyical coa~ulation and cutting electrode 120 i~3 illu trated in Figs. 1, 2, 3, 5 allnd 6. The electrosurgic:al electrode 12 0 is ~ormed ~rom a hollow metallic tube 122 upon which an exterior layer of in~;ulating ~aterial 124 ~uch as heat 2;hri~ak tubing i8 C ~ GC~tlai~. The tube 12~ i~; pr~Perably ~or~ed r~o~ stainle~s ~te~l or al umiallum. At the ~proximal end ~ of th~ electrode 120, a metallic te~inal snd 126 ~Fig. 1) i~; ~er~An; cally and el6~ctrically ~ ed to ~he tube 122., The ter~; ~ e~d 126 allows am elec:trical ~onA~ tor n~oted to a corl~entional el~ctroE~urgic~l gen~rator t~ be ~o~n~ct~d to th~ ctrode 120 a~
th~ ~u~olL~ equipment 52 (Fig. 1~. At ~he di~tal e~d of the electrode 120 a m2tallic op~rating t~p 128 is ~e~l cally and el~ctrically c~nn~cted to - . ~ the tub~122. ~ e tip 128 may be o~E a Yari~ty of coalfi~ura~ions adapt~d for th~ partic:ular urgic~l 30 ~ L~ which t:he ~ul~3e~ de ires to ae:c:omplish.
So 1 ong as t~e tip 1~8 eactend3; no i~urt~r tran~er~3ely olltwilrd at any ~ ocation than the e;cterior ~ur ac:e of the: electrode 120, th~ el~c~rode 120 can be in~ert~d ~nd r~mov~d ~rt~ th¢ ch~ 100 from the proximal end of the probe ~0, ~hile t~e prs:~be i$ in place in th~ ahdominal c~a~ity 22 ~F~g.

WO ~3/07821 2 1 2 1 2 ~ 1 P~rtUSg2/08706 ~
....

1). If the operating ~ip 128 is larg~ar ~han the exterior ~ur~ace of the electrode 120, the auxiliary surgical instr~ment ~ust be in~erted in the instrum~nt ch~nnel 100 be~ore the prs~be i.8 inserted in khe c:~n~ l a 24 (Fig. 1) .
To allow the surgeon to control the extension and retraction o~ the AllY'i ~l iary surgical instrument 4 8, ~;uch as the electrode 12 0, without moYing the probe within the cAnr~ a 24 SFig. 1), the probe 20 includes a ~;lider m~mber 130, which i~ shown in Fig~ 2, 9 ~nd 10. The slider member 130 is mo~lrably ret~ i ~D~ within the interlor 68 oP th~a h:-n~l e 58, to allc~w longit~lA i rl~ 1 movement along the instxument c~-nns~ 100. The auxlliary surgical in~trument 48 extend~ through a ~;lot 134 in the slider member 130 and a lock roller me~ber 132 applie~ frictional retaining force by which to ~ ctively :retain the lider member to the auxiliary surgical i,l~L~ment 48. Once the ~;lider ~ember ancl the auxiliary ~;urgical in~truDlent are ret~ e~l together, ls~ngitl~d;rlal mov~m~nt o~ ~he ~ èr m~mber extends or retracts the distal end of the auxiliary ~;urgi ::al in~trument fro~ thQ ~nd of the instn~ent ~h~n~l at the dis~al end 46 of the probe-20.
2S: The slo~134 ~ the slider m~mber 130 in which th~ auxiliary surgical in~tru~nt i~; ret~ i n~ has a U-~h~pe~ll aonfigura~icsn whic ~extend~ continuously ongitl~A~ y ~along and~forms a part of th~
- ~ in~trument~h~r~ 100. i~ ner cylindrioal ~ ~urfag:e ~of the U~ re~ 810t:~ 13~ is 0~ o~
radiu~; ~rom~the instrument ax~ ig. 10). The -' traight~ :leg~ portion~e~ o~he;U~ re~ slot 134 i ntegrally~ conrl~c~ to a ~ase~ port:ion 136 of the lider Dember 130.:~ Th~ ~ase portioll 136 extend. th~
35 ~ length of ~the~ slider ~ber 130. A transver~ely een~er~ point on th~ bottom surface o~ t~ae ba3e , WO 93/07821 '. ~; PCI~US~2/08706 ~
2121231 18 r~, portion 13 6 is locate.d at approximately the sam¢
distance from the instrument axis 112 as the curved ~urface o~ the U-shaped ~lot 134, thus allowing the ~ auxil~ary surgical instrument to closely ~it within the U-shaped 810t 134.
At a middle longit~ l location along the length of the slider member l3n~ a pair of wing portions 138 extend upward from oppo~ite transverse ~ides of the ba~e portion 136. The wing portion~
138 each have an op~n~n~ 140 formed therein ~or receiving a rotational ax~ e 142 of the lock xoller 132. The axle 142 of the lock roller 132 is snapped into he openings 140 by ~;lightly spreAfl1~g th~ wing portions î38 a~nd sliding the loclc roll~r 132 betwe~n them until the axl~ ~42 enters the orR~nin~s: 140. The resiliency of the wing portioale .s thsm to ~he original position to hold the lock roller in position. As an alternative, the axle may not be made integral with the lock rc~ller, but in~tead, a hole ~not shown) may b6~ fonned through the lock ~roller at the loGation of the axle.
A:bras~ or ~olther t~e o~:pi~ ~all;o not shown) will :
be insert:ad ~through thi~; hol~ and th~ or~n;n~F 140 to hold the ~lcsok roller~ in a pivotably ~n~ected 25 : c:ondition tc:3 th6~ wing~ portions~ Use of the separate pin avoid ~the~ ne~P~:~ity to ob~ain sufficient : re~ilience ~from the wing lportions to allow them the ac:cept: - the lntegral ~ axl~ ~as; ~ho~. . ~
Th~ lock~:roller 132: includes an upp~r ~urface 3Q ~ ~ 144 which-ex~en~-abo~re the wing por~ -138. q~e upp~r surface 14 4 ~as tran~;vsr~3e ~;lot~ or ot:h~r ~: type~ of ri~e~;or~1n~rtie~n~ fo~med kherein by : ~
whic~ the ~u~o~ can ~ tely friction~lly ~ e :the sur~ac:e 144 :a~ad~rota e the lock rolï~r 132 about th~ axl~ l420 ~ ~

,' .

WO 93/07821 2 1 212 3 ~ PC~/USg2/0$786 ~ c:am ~;urface 146 is eccQntrically positioned relative to the axle 142 at the ls:~wer end of the lock roller 132. By rotzlking the lock roller 132 in a clockwi~e direct~ OJl as illustrated in Figs ~ 2 and 9, the cam surf ace 14 6 appl ie~: lat~ral .~orce on the auxiliary ~urgic:al in~trument 48 located within the V~ 3d Clot 134 of the slider memb~r 130. Upon a ::hisving a prsdeterrn~ n~l rotational po~;ition, a flat urface 148 of the cam ~lar~ac~ cc~ntact~ th¢
outer exterior of the auxiliary surgical instrum~nt 48 and cau6e~ the locJc roller 132 to be retained in po~3ition.
The amount of ec ~,e ~ Lric allovem4~nt of the c:~
surface 146 and the ~lat surface 148 is su~ficient to frictionally retain the auxiliary ~urgical instrument in th~ U-~h~e~ ~410t 134 80 t;hat the in3s~n~ment 48 ~c~ve~ in corljunction with the ~;lid~r ~e~ber 130. T~us, the exten~iorl t~d retrzlction of the operat~ ng tip of the auxiliary ~;urgical 2 o i~ ~en~ at the di~tal ~d o~ the prob~ i6 ~chieved by mov~ng th~ ~;lid~r member 130 forward and backward. A~~ hown in Fig 2 and 9, an o~r i n~
150 is formed in the housing 58 ~o allow th~ lock roller 132 and wing portic~n~ 138 to mo~e forward and r~arwardlly on ~h~ rior o~ the hZ~ e 58.
The lock roller 132 is one of Dlany alternative exa~ples of ~a retz~inins ~eans ~or selec~i~e~y r~t~in~ the ~ auxiliary surgical i~,~Ll~ent to the slider Do~ber. Virtually any type of controllable retAin~n~ device ~Ahle of aehieving a suf~icient ~r~ctional engagacent with the auxiliary surgic:al ii.~L~ent to ¢ause it to ~ove wi~h the slidex ~e~b~r ~ill ~u~ic~ a~ an alternativ~ ts: the loc:k rc~ r 132.
~houl d th~ ~uLy~n de~ire to ~ix ths ~lider ~ember 13 0 in a ~ingle loca~ion relativ~ to ~he WO 93/07821 . P~/US92/08711~
~121231 ~o hou~:ing 58, th~ forward lower end of ~he U-c~reA
~lot 134 has form~d therein a notch 152 wh~ ch i~
adapted to receive a ridge 15~ of a re~ilient tang 156 located. within the interior 68 o~ ~h~ h2mdle 58, S as i5 ~:hown in Figs~ 2 and 9. ~he xe8ilient tang 156 deflect~ toward and away from the ~lidex m~i~ber arld tran~versely wi~h re~pQct to the in~trument ch~n~el 100, to allow the ridge 154 to ~;nap within the notch 152 when the slid~r m~mber 130 iE~ moved to ~0 the forward po8ition within t:he opening 150~ With the ridge 154 engaged in the notch 15Z, th~ slider member 130 and the re~;ne~l auxiliary surgical instrumen~ 48 are held in a ~ix~d posit~ on relative to the h~A1 e 58 of the probe 20. This ~eature allow~ the surgeon to fix the desired amount of extension o~ the ;~llY'i ~ ty l~;urgical iL~ ment from tlle dist;ll end 46 of th~ ., By releasing the loek roller 132, adjusting the position o~ the ?llYi 1 ia~ urgieal in~;trument by gra~;ping i~ from ~0 the rear en~ of the hou~iing 58, and then rotating the loek roller 132 ~ae~6 into ~che retAinin~
po~;ition, the po~ition of tha a~lY~ ry surgieal il-ffl.~ume~ in t:he ~,ol~e 20 is eh~
Al~ernatively, t~e surgeon c:an eixte~d and retraet : 25 the auxiliary ~urgie~l ins~ ent by long~ ;n~l mo~rement of the slider ~ er 130, provided ~ha~ t:he - ~ ; slid~r-me~er i8 not mov~d ~orward to th~ re~;n~
A."j :",.' i ,, pca~ition.:
is preferred to arrange the eam surfaee 146 30~ .: and the ~lat :sur~aeei, 148 to aehieY e retention ~: between t~e~slider mem~er and the auxiliary ; el~etrode due to s::lookwise move~ent of the loc:k rollex as ~shc~m in ~Pigs. 2 :and 3. Clockwise ovement of th~ lock roller re ult~ fr~m finger :~ : 35 : ~ force which ~ha~ a: component lt~n~;n~ to move the :: ~ slider ~e~ber rearward. Since a rearward component wo g3/0782~ 2 1 2 ~ 2 3 :1 PCI/US92/08706 .

of ~inger force is required to overcome the force of the tang 156 to move the ~:lider member rearward from the forward~ost po~:ition, the lock roll~r will not rotate to ~ccidentally rel~a~i;e the re~ i ni rl~
posltion will not result in accid~ tally releas-ing the auxiliary surgic:al instrument whQn the 61id8r member i~ mov~d rearward ~rom the f or~rard po~:itisn .
In order to irrigate, aspirate and ~vacuate fluid (ga~ or li~uid) from within the abdominal cavity and at the surs~ical site, the probe includes a~ lea~t one pAFI~-geway extenA; n~ through the tube 60 to the di~:tal end 46. The embodimsnt of the probe 2û shown actually includes two r~ geways 160 a~ is shown in Figs. 5, 6 and 7. The p~~geway~
i60 eartend thlou~l, the tube 160 on each ~ide of ths ~UYi 1 iary ~3urgical in ~rument ~8, ~L~3ented ~r the elec:trode 120, and communicate with a chamber 162 formed in the interior 68 of the ~n~l e S8, a~ ~hown in Fig. 2. The xear erld of the chamber 162 i~3 alo~ed l:~y a seal 164. Th~ divider 66 ~er~at~; th~
chamber 162 ~ro~ the pathway 70. The c:h~mber 162 . . .
communicates with the ~luid *low port 56. ~A
~tAn~ ~d~ ~uer ~itting 166 is ~o.,l-ected to the ~nd o~
th~ por~ 56, and a ho~e or other tubular ~o.~ t connects the fluid flow co~atrol device 54 (Fig. 1 to the probe 20 at the luer ~ting.
7~8 i~ ~hawn 'in Fig~;. 5, 6 an~l 7, a longitu~lin~
al is~ ë~tabli~F~ between ~e a~ urgical 1nstru~t and the interior surface 102 and the ~U~OL L ~ur~ace 108 . This seàl is maihtA i n~ during the~ linëar ~aovement of the auxiliary ~urgical instr~ment: within t he~ c~ n~l 100. r~nr~è~llently~
the remai n~r~ of the ~r~re within the chan~l 100 ~ not ~ ied ~y the: auxiliary ~iurgical in~tru~ent becom26 1the r~ geway 160. It i~ thricsugh these p~ ge~ays:~ 160 that the ~luid flow derive~l iErom the W093/07821 v ~ PCT/US~2/087~
2 1 2 ~ 2 3 1 22 ~low control d~vice 54 (Fig. 1) achie~es irrigation, aspiration, and evacua~ion within the abdominal cavity.
~he seal 164 is one example of a ~ealin~ ~ans for providing a fluid seal between the auxiliary surgical instrument 48 and ~he interior 6~ of t~e hA~le 58. Consequently, the fluid within the abdominal cavity, whether it b~ liquid or gas, i~
confi~ed within the interior chamber 162 for communication into and out o~ the fluid ~low port 56. The ~eal 164 prev~nts the fluid from entering the other portion~ o~ the hA~le 58 and inter~eri~g with the movement of the slider member 72, for example.
The seal 164 is illustrated in Fig~ 11 to incIude an outer r¢latively thick edge 168 from which there extends inward~y a relati~ely thin ~embra~e 170. The edge 1~8 fi~s wi*hin a ret~ntion : ~ receptacle 172 formed within ~he interior o~ the h~n~l e 58, a~ i~ hown in Fig. 2. A pla~tic ring 169 Gontact~ the edge 168 and eyr~n~ the edge 16 outward to hold th~seal in po~ition in the receptacle 1720 At the center 4f the m~brane 170, a circular opening 174 is formed for the purpose of receiving the generally circular ~xterior : con~i~uration of the auxiliary surgical i.~LL~ment~
48. The ore~ng 174 i~ located at the axial center 112 of the auxilia~y surgical in~trument and th~
~h~nn~l 100. The seal 164 is preferably formed of a 30 ~ resilient elastomeriG material, a~d the de~lection~
xibility and re ilience o~ the membra~ 170 ~chieve~ ~he fluid tight seal against the ~xterior ~urface of the auxiliary surgical in~trume~
~hown in Fig. 2. The membrane 170 ~hus resi~ts ~he ; 35 r~ ge of the fluid into or out o~ the in~erior chamber 162 from aroun~ the auxiliary sur~ical :

WO~3/07~21 ~ 1 21 2 ~ I PCT/US92/0~7 instru~ent, and con~ine~ all fluid flow through the port 56. By ori~nting the seal 164 with the edge 168 projecting ~orwardly, the interior pressure within the chamber 162 ~orces the edg~ ~68 radially outward, ther~by providing a more e~feckive seal of the edges 168 against the retention L~_e~LacIe 172.
The ring 169 is preferably formed of more rigid plasti~ material. Other type~ of ~ealing means which provide the equiv~lent functionality for confining the fluid in the interior chamber 162 might serve a~ alterna~ives to the ~eal 168 d~scribed abov~.
Another important feature of th~ probe 20 is the provision o~ a pressure relief valve 180 connected in fluid communication wîth the interior : chamber lS2. The pressure relief val~e lRO i~
retAinD~ in a receptacle 182 ~ormed in the hA~le ~8, and is operative to ven~ pressurized ~luid within th~ interior chamber 162 to the exterior of the h~n~le upon the pressure of the fluid ~ceQ~
. a predetermined l~vel:. The pressure relie~ valve : ~ 180 is p~rticularly usQPul in ~i~v~ ing ov~r inflation:of the~abdomin~l cavity during gas a~ ted ele~Llo:fulgurati:on. The gas A~e~ to the ~A~rinAl~cavit~during electro-~ulguratiOn aontribut@s to the~pressure in the abdominal caYi~y.
lthough~the back:pressure:~n~rr ~f the inflation pu~p (28,~ Fig.~ ~ay termina~e ~he delivery of gas fr~:the inflation pump-to the abdominal cavi~y, the : 30 -' gas from the~:gas as~isted e}ec~r~-~ul~urat~on may~
continue to~Yr~ the abdo~inal wall. The limited nting~fro~ the~in~ ion around the a~nUla i~
: typically not sufficient to prevent ov~r~
~: pres~urization~during:ga~ a~si~ted electroo :: 35 coagulatio~ but the pressure ~eli~f valve 180 will rel ieY~ thi additional pressure once it ~Y~ the ~: :

WO 93/07821 ~ PClr/US92/0~70~ 1 ~1~1231 24 release point oP the pressure relief valv~ 1804 Since the interior chamber 162 communicate~~ with the abdominal cavity 22 (Fig. 1) through the passayeways 160 (Fig~ . 5-7 ), the pres~ure relie:E ~ralve 180 act~
a~ an auxiliary or back up for the ~ r functionality of the back pre~;~ure ~en~or a~ ociated with the inflation p~amp 28 (Fig. 1). The incorporatio~ of the pres~ure relief valve 180 in th~ probe 20 thus increase~ the measur-3 oP ~af~ty lo against the as~cidental over pre~ urization of the abdominal cavity during a minimally invasive surgery. The gerleral natur~ o~ pres~ure relief valves is well known.
By providing a cyl irldrical cros~ sectional çh~nnl?l exten~ from one end of the probe to the other along the in~trument f !h~qnn~l 100 ~ it i8 apparent that the ~ eol~ may e~ n~e or sub~;titute one auxilia~ surgical instrum~nt 48 for ano~her by releasing the lock rolï~r 132 and withdrawing the instnamen~ during the ~vc~ e. 0~ course/ for the slight amount of time during which o~e ~uxiliary su~gical instrum~nt i withdrawn and ~e~ore another can be inse~ed in the E~robe, ~hers will be a slighlt le~k of gas through the relati~ely ~mall opening 174 in the seal 168. This ~ ht leak e~f gaE; over a relatively short duration o~:time ~ ld not be uf~ iént ~o resul~; in an:y ~ignific:ant r~duction in th~ ncion of ~he abdominal ~all, p~rticul~rly sinc~ the in~lation pump 28 ~Fig, 1) ~ho~lld b~co~~~

3 0 o~aerative i~ediately to add addiltional gas to the abdominal caYity to coun~era t the ~ ng ga~O
~he lo~ it~ n;~l arrange~ent o~ the in~tru~en~
~ ~ rl~:~nn~l in ~he marmer~ d~crlbed~ proYides t~
s~ tantial :advantag~ of the sur~eon not having to withdraw the probe ~rom the ~Ann~ to ~Yrh;3r~
auxiliary surgical i~ l.,~ants which have op~xating WO 93/0782~ - 2 1 2 1 2 3 1 ~Clr/US92/087Q6 tips that do not ~ce~e~l the out~;ide dim~nsions of the instrument . O~E coursa auxil iary ~urgical instruments which do have larger operatirltg tips can be inserted ~rom the distal end of the probe prior to insertion in the cAn~l7l a.
0~ cour~e, one of the substantial advanta~e~
offered by the probe 2û i~: the cA~hility o~
in~tantly obtaining gas a88i t~d ele~tro-fulguration when llec~~ry. The availability of ga~ a88i8tesl ele~;l,L~ fulguration greatly r~ r~f~ the rislc of immediate and serious ble~ bei~or~ th~ ~urgec)n is able to ~G~LLol it by oth~r conventional means. Of ~OUL e, a ~uf ~icient amount of bl~ i n~ can greatly ohstruct the surgical site and ; nh ~ hit the further plVyl7 ~3f of the proc~ re, p~rticularly if it become~ nece~ry lto remov~ onL~ prob~a, insert another probe to attempt to ~o~ ol the ble~
remove that prob, and in ert yet another probe to e~acuate 'che blood which ~ccumulated before t;he blD~ was controlled. With the probe og the p~s-~nt illv~Li~n, all of ~h~-~ functions c;~n be achieved by us~ of the single probe ill a r~lati~ly rapid mann~r tG contiml~ the ~y~ of th~
pr~ce~l~re without the substantial delayR or i~ediment~ which wer~ previou ly typis::al in minimally in~a~ive surgeries due tc~ the need to use rnr~rat~ surgical ~ S to achieve the multiplic:ity of ~;urgical fw~ation~ ;o~ ered.
A ~L.~-~?ntly pr~ferr~d em~ ent o~ t~e p~e~nt 3Q in~ention and ~any: of it i~provement5 have be~n !
A?s~ribed wit:h a degr~e of partic:ularity. Thi~
~~~Grip~ion ha~s b~er~ ~ad~ by way of pref~rr~d ~r~rle and: i8 t~ 3 on a p~ nt urlder~t~ ;n~ o~
kno~ledge: ~railable regarding the irl~ention. It should bç! under~;tood, howeYer, that th~ or)ç~ of thQ
pre~ent invPntion i5 ~ined l~y following clai~

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WO g3/07~21 Pcr/uss2/os7n6 2121231 2~
and not nes~ s~rily by the d~tail~d d~cription of the pref erred embodiment .

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Claims

What is claimed is:

1. A probe for performing minimally invasive surgery through a cannula extending through a body wall of a patient and into a body cavity where the surgery is performed, comprising:
a handle at a proximal end of the probe;
an elongated tube connected to the handle and extending to a distal end of the probe, the tube including a conduit and an electrical conductor which both extend along the length of the tube;
an assembly of a gas nozzle and an electrode positioned within the nozzle, the nozzle and electrode assembly connected to the tube at the distal end of the probe, the conduit communicating gas to the nozzle during gas assisted electro-fulguration, the electrical conductor connected to the electrode for conducting electrical energy to the electrode during gas assisted electro-fulguration; and the tube and the nozzle and electrode assembly having a predetermined configuration to permit the tube and the nozzle and electrode assembly to be inserted through the cannula and into the body cavity, the connection of the handle to the tube permitting the distal end to be positioned at a surgical site within the body cavity by manipulation of the handle.

2. A probe for performing minimally invasive surgery through a cannula extending through a body wall of a patient and into a body cavity where the surgery is performed, comprising:
a handle at a proximal end of the probe;
an elongated tube connected to the handle and extending to a distal end of the probe, the tube including a conduit and an electrical conductor which both extend along the length of the tube;
an assembly of a gas nozzle and an electrode positioned within the nozzle, the nozzle and electrode assembly retained in the conduit at the distal end of the probe, the conduit communicating gas to the nozzle during gas assisted electro-fulguration, the electrical conductor connected to the electrode for conducting electrical energy to the electrode during gas assisted electro-fulguration; and the nozzle and electrode assembly further comprises:
an elongated electrode;
a support structure connected to a rear end of the electrode and supporting the electrode in a forward projecting cantilever manner with a forward portion of the electrode exposed to gas flow therearound; and a hollow sleeve connected to the support structure and surrounding the forward exposed portion of the electrode, the interior of the hollow sleeve forming the nozzle.

3. A probe as defined in claim 2, wherein:
the support structure further includes an opening for conducting gas from the conduit into the interior of the sleeve.

4. A probe for performing minimally invasive surgery through a cannula extending through a body wall of a patient and into a body cavity where the surgery is performed, comprising:
a handle at a proximal end of the probe;
an elongated tube connected to the handle and extending to a distal end of the probe, the tube including a conduit and an electrical conductor which both extend along the length of the tube, and the tube having a predetermined configuration to permit the tube to be inserted through the canula and into the body cavity;
an assembly of a gas nozzle and an electrode positioned within the nozzle, the nozzle and electrode assembly connected to the tube at the distal end of the probe, the conduit communicating gas with the nozzle during gas assisted electro-fulguration, the electrical conductor connected to the electrode for conducting electrical energy to the electrode during gas assisted electro-fulguration; and the tube further comprises a passageway separate from the conduit and the nozzle, said passageway extending along the length of the tube and communicating fluid with the distal end of the probe during a procedure involving the application of at least one of evacuation, irrigation or aspiration during the surgery in which gas assisted electro-fulguration is applied from the nozzle and electrode assembly.

5. A probe as defined in claim 4, wherein:
the handle has a hollow interior;
the passageway extends into the hollow interior of the handle; and the handle includes a fluid flow port communicating with the hollow interior and with the passageway for establishing fluid communication between the fluid flow port and the passageway.

6. A probe as defined in claim 5, wherein:
the conduit communicates with the hollow interior of the handle;
the handle includes a gas electrosurgical port communicating with the hollow interior of the handle and with the conduit to establish gas communication from the gas electrosurgical port through the conduit to the nozzle and electrode assembly; and the hollow interior of the handle includes a divider to divide the interior of the handle into a first fluid communication pathway and a second fluid communication pathway, the first fluid communication pathway extending between the gas electrosurgical port and the conduit in the tube, and the second separate fluid communication pathway extending between the fluid flow port and the passageway, the first and second fluid communication pathways being separate of one another.

7. A probe as defined in claim 6, wherein:
the conductor extends through the conduit and the first fluid communication pathway and the gas electrosurgical port.

8. A probe for performing minimally invasive surgery through a cannula extending through a body wall of a patient and into a body cavity where the surgery is performed, comprising:
a handle at a proximal end of the probe;
an elongated tube connected to the handle and extending to a distal end of the probe, the tube including a conduit and an electrical conductor which both extend along the length of the tube;
an assembly of a gas nozzle and an electrode positioned within the nozzle, the nozzle and electrode assembly connected to the tube at the distal end of the probe, the conduit communicating gas with the nozzle during gas assisted electro-fulguration, the electrical conductor connected to the electrode for conducting electrical energy to the electrode during gas assisted electro-fulguration; and the tube further includes means for supporting an elongated auxiliary surgical instrument for longitudinal movement along the tube at the distal end of the probe.

9. A probe for performing minimally invasive surgery through a cannula extending through a body wall of a patient and into a body cavity where the surgery is performed, comprising:
a handle at a proximal end of the probe;
an elongated tube connected to the handle and extending to a distal end of the probe, the tube including a conduit and an electrical conductor which both extend along the length of the tube, and the tube having a predetermined configuration to permit the tube to be inserted through the cannula and into the body cavity;
an assembly of a gas nozzle and an electrode positioned within the nozzle, the nozzle and electrode assembly connected to the tube at the distal end of the probe, the conduit communicating gas to the nozzle during gas assisted electro-fulguration, the electrical conductor connected to the electrode for conducting electrical energy to the electrode during gas assisted electro-fulguration; and a channel extending longitudinally through the tube and into the handle, the channel adapted to accept an elongated auxiliary surgical instrument.

10. A probe as defined in claim 9, wherein the channel has a configuration for accepting an auxiliary surgical instrument selected from a group consisting of a standard electrosurgical electrode, a laser fiber optic conduit, an aqua dissection conduit, and a mechanical tool.

11. A probe as defined in claim 9, wherein:
the channel extends longitudinally through the tube and the handle between the proximal and distal ends of the probe to allow the replacement of one auxiliary surgical instrument with another auxiliary surgical instrument from the proximal end of the probe.

12. A probe as defined in claim 9, further comprising:
a slider member connected to the handle and moveable along the channel; and retaining means connected to the slider member and operative for selectively retaining an auxiliary surgical instrument to the slider member to achieve movement of the auxiliary surgical instrument with movement of the slider member.

13. A probe as defined in claim 12, wherein:
the slider member includes an elongated slot forming a part of the channel and adapted for receiving the auxiliary surgical instrument.

14. A probe as defined in claim 13, wherein the retaining means comprises:
a pivotable member pivotably connected to the slider member and having an eccentric surface moveable into the slot for contacting the auxiliary surgical instrument when the pivotable member is pivoted.

15. A probe as defined in claim 14, wherein:
the pivotable member comprises a lock roller, and the eccentric surface includes a flat surface to hold the lock roller in a retaining position against the auxiliary surgical instrument.

16. A probe as defined in claim 9, further comprising:
means connected to the tube for supporting and retaining an auxiliary surgical instrument within the channel to allow longitudinal sliding movement of the auxiliary surgical instrument along the channel.

17. A probe as defined in claim 16, wherein:
the handle has a hollow interior;
the tube further comprises a passageway extending along the length of the tube and communicating with the hollow interior of the handle; and the handle includes a fluid flow port communicating with the hollow interior and with the passageway for establishing fluid communication between the fluid flow port and the distal end of the probe through the passageway during a procedure involving the application of at least one of evacuation, irrigation or aspiration during the surgery.

18. A probe as defined in claim 17, wherein:
the channel defines the passageway extending along and parallel to an auxiliary surgical instrument which is retained and supported in the channel.

19. A probe as defined in claim 18, wherein:
the channel is defined by an interior surface of the tube;
the auxiliary surgical instrument is of a substantially cylindrical exterior configuration;
the means for supporting and retaining the auxiliary surgical instrument within the channel comprises a curved support surface which contacts the exterior cylindrical surface of the auxiliary surgical instrument; and the passageway exists between the exterior surface of the auxiliary surgical instrument and the interior surface of the tube.

20. A probe as defined in claim 19, wherein:
the support surface and the exterior cylindrical surface of the auxiliary surgical instrument have approximately the same curvature;
the auxiliary surgical instrument is supported between the curved support surface and the interior surface of the tube along a longitudinal contact position which is opposite the support surface; and the interior surface of the tube has a lesser degree of curvature than the exterior of the auxiliary surgical instrument along the longitudinal contact position.

21. A probe as defined in claim 20, wherein:
the support surface extends along substantially the full length of the tube.

22. A probe as defined in claim 21, wherein:
the longitudinal contact position extends along the length of the tube.

23. A probe as defined in claim 22, wherein:
the auxiliary surgical instrument establishes longitudinal seals with the interior surface of the tube along the longitudinal contact position and along the curved support surface; and the passageway is defined by the interior surface of the tube and the exterior surface of the auxiliary surgical instrument between the longitudinal seals.

24. A probe as defined in claim 23, wherein:
the passageway extends on both transverse sides of the auxiliary surgical instrument.

25. A probe as defined in claim 24, further comprising:
sealing means located within the interior of the handle and adapted for contacting the auxiliary surgical instrument and for confining fluid communication within the interior of the handle between the passageway and the fluid flow port.

26. A probe as defined in claim 25, wherein:
the sealing means comprises a resilient elastomer membrane having an opening formed therein through which the auxiliary surgical instrument is inserted and by which a seal is established against the exterior of the auxiliary surgical instrument.

27. A probe as defined in claim 26, further comprising:
pressure relief valve means connected to the handle and operative for releasing pressure communicated through the passageway to the interior of the handle.

28. A probe as defined in claim 27, wherein the handle further includes:
a gas electrosurgical port through which a supply of gas for delivery from the nozzle during gas assisted electro-fulguration is supplied; and a divider connected within the interior of the handle to divide the interior of the handle into one fluid communication pathway between the gas electrosurgical port and the conduit in the tube and into another separate fluid communication pathway between the fluid flow port and the passageway.

29. A probe for performing minimally invasive surgery through a cannula extending through a body wall of a patient and into a body cavity where the surgery is performed at a surgical site, comprising an elongated tube having a proximal end and a distal end, and a handle at the proximal end of said tube adapted for manipulation to position the distal end of the tube at the surgical site within the body cavity, said tube including a conduit and an electrical conductor both of which extend along the length of said tube; characterized by a gas nozzle connected to said tube at the distal end thereof, and an electrode positioned within said nozzle and connected to said electrical connector, said conduit communicating gas to said nozzle, said nozzle directing the gas from said conduit around said electrode and out of said nozzle in a directed jet toward the surgical site, said electrode delivering electrical energy as arcs into the jet gas to create gas assisted electro-fulguration at the surgical site, said tube, nozzle and electrode having a predetermined configuration to permit said tube, nozzle and electrode to be inserted through the cannula and into the body cavity.

30. A probe as defined in claim 1, further characterized by means in said tube supporting an elongated auxiliary surgical instrument for longitudinal movement along said tube and projection outwardly from the distal and thereof.