CA2081927C - Safety trocar - Google Patents

Safety trocar Download PDF

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Publication number
CA2081927C
CA2081927C CA002081927A CA2081927A CA2081927C CA 2081927 C CA2081927 C CA 2081927C CA 002081927 A CA002081927 A CA 002081927A CA 2081927 A CA2081927 A CA 2081927A CA 2081927 C CA2081927 C CA 2081927C
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CA
Canada
Prior art keywords
trocar
cannula
fully extended
safety
extended position
Prior art date
Legal status (The legal status 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 status listed.)
Expired - Lifetime
Application number
CA002081927A
Other languages
French (fr)
Other versions
CA2081927A1 (en
Inventor
Julian F. Borgia
William J. Allen
Jeffrey A. Stein
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Covidien AG
Original Assignee
Sherwood Service AG
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Filing date
Publication date
Application filed by Sherwood Service AG filed Critical Sherwood Service AG
Publication of CA2081927A1 publication Critical patent/CA2081927A1/en
Application granted granted Critical
Publication of CA2081927C publication Critical patent/CA2081927C/en
Anticipated expiration legal-status Critical
Expired - Lifetime legal-status Critical Current

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34Trocars; Puncturing needles
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34Trocars; Puncturing needles
    • A61B17/3494Trocars; Puncturing needles with safety means for protection against accidental cutting or pricking, e.g. limiting insertion depth, pressure sensors
    • A61B17/3496Protecting sleeves or inner probes; Retractable tips
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08Accessories or related features not otherwise provided for
    • A61B2090/0801Prevention of accidental cutting or pricking
    • A61B2090/08021Prevention of accidental cutting or pricking of the patient or his organs

Abstract

A safety trocar instrument, for piercing the wall of an anatomical cavity to provide communication with the inside of the cavity, includes a tubular cannula and an elongate trocar having a sharp piercing point. The 2trocar is mounted for axial reciprocal movement within the cannula. In a withdrawn rest position, the point is received within and shielded by the distal end of the cannula. A retraction spring biases the trocar to its withdrawn position.

Description

2o$~~z~
SAFETY TROCAR
The present invention relates to a surgical instrument, commonly called a "trocar instrument" or "device," or simply a "trocar," that is used to pierce the wall of an anatomical cavity thereby forming a passageway providing communication with the inside of the cavity.
Other medical instruments such as endoscopes, arthoscopes, and operating instruments can thereafter be inserted through the passageway to perform various medical procedures within the anatomical cavity.
Surgical techniques using trocar devices to pierce anatomical cavity walls have recently gained great favor in the expanding field known as "least invasive surgery." Such techniques have been widely employed, for example, in gall bladder surgery and their use for other types of operations is actively being explored and implemented. These methods are desirable because the passageway formed by the trocar is small and neat.
Therefore, the major trauma associated with large surgical incisions, used to perform certain operations in the past, can be avoided.
The present invention provides an improved safety trocar instrument that is well suited to least invasive surgical techniques. By its design the safety trocar instrument of the present invention not only avoids the trauma that results when large incisions are made in an anatomical cavity wall, but also reduces the chance that unintended and unwanted trauma will result particularly after the instrument penetrates the wall.
In its elemental form, a trocar is a device comprising an elongated shaft of, for example, surgical steel having a sharpened blade or point. Typically, least invasive surgery using such a device is performed first by inserting a fine surgical or "Veress" needle through the cavity wall and thereafter injecting a fluid into the cavity to insufflate it and separate the cavity wall, including muscle and the peritoneum in the case of the abdomen, from other internal organs like the heart, stomach, and major blood vessels. The sharpened point of the tracar is then placed against the cavity wall and urged to pierce it by manually applying pressure to the proximal end of the shaft. An outer sleeve or "cannula" may be slid over the shaft through the wound created by the sharp point. The sleeve permits the shaft to be withdrawn from the cavity wall and:snaintains the passageway into the cavity:
Observation and surgical instruments can then be introduced into the cavity through the sleeve.
Safety trocars described in the prior art have certain inherent drawbacks. First, because the piercing tip of the trocar blade is generally shielded when the instrument is placed against the anatomical cavity wall, it is necessarily shielded from the surgeon's view. Therefore, the surgeon cannot be certain that the tip will puncture the wall at the precise location desired. Moreover, after the piercing tip has ~0~~~~~
penetrated the cavity wall, it must protrude a further substantial distance into the anatomical cavity before the inner sleeve or shield is released again to cover the tip. Thus, a substantial period remains during which the tip is exposed and may injure internal organ structures. Since the inner sleeve or shield and outer sleeve may remain in the cavity after the trocar is removed, they often project a substantial distance into the cavity. Thus the available space in the cavity within which the surgeon can work is reduced.
Therefore, still additional improvement to safety trocar instrument design would be greatly beneficial to the surgical community.
It is a principal object of the present invention to provide an improved safety trocar instrument that mitigates the problems associated with prior art devices and has a safety shield that projects forwardly to surround a sharp trocar point after the point and distal end of the shield penetrate an anatomical cavity wall.
It is an additional principal object of the present invention to provide a self-contained, mechanically actuated safety trocar instrument in which a sharp a trocar point is retracted into a surrounding sleeve when the sharp point has penetrated an anatomical cavity wall. The invention thereby results in a substantial improvement over known prior art devices.
These and other objects are achieved by the present invention, which includes a main body that supports an outer sleeve or cannula.
In the first alternative embodiment, the main body is configured to mate with a trocar subassembly that includes a plunger head and a main housing having a trocar. The trocar has a sharp point.
The safety trocar instrument in accordance with the first alternative this preferred embodiment is assembled by mating the main body-cannula subassembly with the trocar subassembly such that the trocar is received coaxially within the cannula. The trocar is urged by a retraction spring to a withdrawn rest position with the point surrounded by the distal end of the cannula. , In the first alternative embodiment, the instrument is armed to pierce an anatomical cavity wall by manually pressing the plunger head of the trocar subassembly into the main body until the sharp trocar point projects beyond the distal end of the cannula with the trocar in a fully extended position. The trocar is initially held in such attitude by an internal latching mechanism residing in the plunger head and main housing of the trocar subassembly. However, the trocar is linked to the latching mechanism through a lost-motion coupling that permits it to be urged backwardly into the housing and plunger head, to an intermediate retracted position, against the force of a pressure spring. The point is nevertheless exposed when the trocar is in the intermediate position.
Once armed, the trocar of the first alternative embodiment is used to pierce an anatomical cavity wall by pressing the exposed point of the trocar against the wall at precisely the desired location. During this operation, pressure against the trocar point urges the trocar backwardly through the lost-motion coupling to the intermediate position in a first stage to prepare a trip mechanism for disarming the latching mechanism.
When the cavity wall has been completely penetrated, pressure on the trocar point is relieved permitting it again to be returned through the lost-motion coupling by the pressure spring to its fully extended position.
The return of the trocar point causes the trip mechanism to fully disarm the latch mechanism thereby releasing the trocar and permitting it to be retracted to its rest position by the retractor spring with its sharp point surrounded by the distal end of the cannula. The trocar subassembly can then be removed leaving the cannula in the anatomical cavity wall to provide communication with the inside of the cavity.
In the second alternative embodiment, the main body is configured to mate with a trigger sleeve and trocar subassembly that includes a main housing and a plunger head in which a trigger sleeve is axially reciprocally mounted. The trigger sleeve is urged to a rest position projecting outwardly from the main housing. A
trocar having a sharp point is coaxially received within the trigger sleeve for reciprocal movement and is urged to a retracted rest position with the sharp point surrounded by the distal end of the sleeve.
The safety trocar instrument in accordance with the second alternative embodiment is assembled by mating the:-main body-cannula subassembly with the~triggerw -sleeve-trocar subassembly with the inner sleeve and trocar received coaxially within the cannula.
The second alternative embodiment the instrument is armed to pierce an anatomical cavity wall by manually pressing the plunger head of the trigger sleeve-trocar subassembly into the main body until the distal end of the trigger sleeve projects slightly beyond the distal end of the cannula and thereafter the sharp trocar point projects beyond the distal end of the trigger sleeve. The trocar is latched in such attitude by an .
:internal latching mechanist x-e,~3.ding i.rn t~m~ plunger head and main housing of the trigger sleeve-troear subassembly, but i~he trigger sleeve remains fx°ee t.o rec. pr~acate by being urged back into the r,;.~anmul.a . 'T'he t:rc:car :,instrument is then used to pierce an anatomical cavity wa:~ ':I ~::>~~ pressing the exposed point of the trc>car ~.g<~ir-~st t'&~N w~a~ 1. at: precisely t:he desired location. After tire point begins to penetrate tshe wal l , the distal end of the t.rigge r s;J.~=eve encounters the outer surface of the wa:l~... 'fhe r~::~ist:ance of: the wal:L
t-hereafter causes the triggezw Sleeve t.o be urged inwardly into the cannula to a retracted posa.t.i.can ::a,r~ a first stage preparatory to disa:rr~ring tile l.~tc:hing c~cAec~~z~nism. When the cavity wail has been completely penetrated pressure on the trigger sleeve is relieved permitting ~t ~:~aain to be urged back t.o its rest position. 'I"he returta of the trigger sleeve then fully disarms the latch mechanism th~::reby releasing the t.rocar shaft and permitting its t~:~ be retrG~c~t:ed to it:s rest position with its sharp point ~;urrounded key the trigger ~;leeve and cannula, The trocar_ shaft. a.nd trigger ~~ubassemb:l.y can then be x-emovec.~ l.eavir~c:~ t~~e cannu.l.a in. the anatomical cavity wall to prc>vide com~~~ur~i~atian with the inside of the cavity.
Therefore, according to a brc_~ad aspect of th.e invention, there i.s provided a safety trTo~.ar instrurnent for piercing the wall of an anatoma.cal cavity to provide communication with the inside 1:7f the c4~~rit::.,; , said trocar instrument comprising: (a) a tubular canruula; (b) an elongate trocar, having a sharp piercing ~aoint, mounted for axial reciprocal movement with_i.x~r said c~anz:u.,~la between a withdrawn rest position in which said point is received within and shielded by the distal end. of :;aid consuls, a fully extended po:>ition in whir~h ;said poi.r~tT is expo;~ed beyond the distal end of said cannula, anc~ an intermediate - E:; a _.
position retracted toward the nest pc>s:ita.orfzwom the fu:Lly extended position in which said point is a~.so exposed beyond th.e distal end of said cannula; (c) nueans i'o:~ biasing said trocar to its withdrawn positi.ozu; (d) la:yel~ means for latching said trocar, in opposition to ;~;~:~:i.c:~ biasing means, fcr reciprocal movement between the ful:l.y extended position and the intermediate positi.can; arid Vie) t::r::iL::~ means coupling said trocar to said latch means when said t:.rocar moves from the fully extended position tc~ t::.~~e ir:te:r.~rnectiate position, anal tripping said latch means wfiezl said tirc~~oar returns tcward said fully extended posit:ic,~~n t.a r.arly;~.tch said trocar and thereby permit said trocar to be moved to the withdrawn rest position by said biasing oa~:~:aras .
According to another aspect of t't~e invention, there is provided a safety t=.roc~a:r instr~xrne~~ut for piercing the wall of an anatomical cavity to provide communication with the irnside of the cavi.t:.yy, .7ai.d t.zw~.:~:~r ~. nstrument.
comprising: (a) a tubular cannula; (b) an elongate trocar, having a sharp piercing po:i.:GO.t, mounted fear a~i.al reciprocal movement within said cannula between a wit~ndrawn rest pcsi.tion irn which said pc:i.nt is rr-__~ce:i.ved w~tthin and shielded by the distal end of said cannula and a fua.ly extended position iru which said point i s expi~~-~E:d i~e~:rc~r~d the distal end of said cannula; (c) means for biasing said trocar to its withdrawn position; (d) l.atcwh means l:oa:~ 7.atching said trocar in opposition t.o said biasing means; and (e) trip means for tripping said latcri mE=ans too ~.~mlc~tch said t~rocar and thereby permit said trocar too be moved to its withdrawn rest positi..on by s<~id biasing mc:ar~s; arac.~ ( t:~ ) lost-mot::ic~n coupling means coupling said trip means to said trocar and permitting said trocar°, when ~.at:cheri by sa:~d latch means, to reciprocate between the fully extended pos:it:ion and an intermediate retracted position ire wrdic::~~ s~:~a.ci troc~ar point - ~b -i~; also exposed beyond true distal end of: said cannula., said trocar arming said trip means wivera mcaved to the intermediate retracted position and actua,tin~~ Said trip means to trip said latch means when returned toward the fully extended position.
According to a further broad asp~:ct of the invention, there is provided a Vafet~~ t r~s~c:~~z instrument for piercing the wall of an anatomical cavity t:o provide ccmmunication with the inside of:: the cavity, said trocar instrument comprising: (a) a me~a.r~t body-~~~au:c.nula subaQ~sembly including: (1) a m<~in body; (2) 5:~ tt..rbu:ld:~r~ ~:::~aranula ;projecting from the main body; a:~d (b) a tr:wcax- suk.;~,:as;~:~,embly formed to mate with said maim body-c:annulr~ uk~a; serrib l y and including °:
( 1 ) a housing; (2 ) an elongate 2:rocar, ~uawing a sharp piercing point, mournted for axial reciprocal moverrrent relative to said housing between a withdrawn. rest position, a fully extended position, and an int:.ermed~.a~e position retracted from the fu3_ly extended posita.on toward the withdrawn position, said trocax- beirzc~ F~.Sr-rnc::d. t.o be: coaxially received ire said cannula with said pc:~:int_, exposed beyond the=_ distal end thereof in the fully e;~tendea;~ axed intermediate positions, and with said point withdrawn iruto and shielded by the distal end of said cannula in tile wa_thdrawn position;
(3) means for biasing said trocar toward it:.s withdrawn position; (4) plunger means with which said trocar subassembly can be manually urged toward said main body-ca:nnula subassembly t:c~s an armed stagce trv~ mc:~ve said trocar ;:o its fully extended position; (5) :Lat.c:h rnear:°~s~ for latching said trocar, in oppo:~ition. to sa.i.c~ r.,rias:irrg rr:!eans, for reciprocal movement between the fully exterrc~ed position and the intermediate position when the irrstrurnent is in the armed stage; and (6) trip means coupling said trocar to said latch means when said trocar moves from the fully extended _ ~ c .-position to the intermediate posi.ti.on ire, tune armed stage, said trip means thereafter t.r_i.pping said. la~t:..<~h means when said trocar returns toward the fully extended position from the intermediate position thereby to pezmi~~= said trocar to bEa 'urged to its withdrawn pos~~..t:ioz~. by said i<~a.asing means.
Thus the present invexxtion prw~vic~E:~s a safety trocar instrument in which the sharp point cf the trocar is retracted into a surrounding shield structw~e. Since retraction occurs immediat:el.y t.zinon entry o:fi the troc<~r point into the anatomical cavity, there is a x-educed likelihood of injury to internal organs. MUreover, since retraction occurs promptly at that tame, :l_a.tt~le c:~f thq:a device remains in the cavity after penet:rat..i.can to i.nfring~~~ upon the surgeon's work area. Sti.il further, the trocar point is e~:posed to the surgeon's view at the st~:~x°t c:~f penetration so that the surgeon can prec:~.sel~~ posit:i.on. it at the desired cavity wall ~~Ri~~~
location. Thus the safety trocar instrument of the present invention is a substantial improvement over designs of the type disclosed in the prior art.
The present invention is also entirely self-contained and mechanically actuated. Therefore, it is not affected by electrical power failures or interruptions nor does it depend on cumbersome ancillary electrical equipment. And since no wire connections to such ancillary equipment are required, they are not present to interfere with the. surgeon's work.
These and other objects, aspects, features, and advantages of the present invention will become apparent from the following detailed description taken in conjunction with the accompanying drawings.
FIRST EMBODIMENT DRAWINGS
Figures 1A to 1F are a sequence of perspective views of the preferred embodiment of the safety trocar instrument of the present invention showing it at various stages during use;
Figure 2 is a vertical cross-sectional view of the safEty trocar instrument of the present invention shown in its assembled rest condition;
Figures 3A to 3D are a sequence of vertical croas-sectional views of the safety trocar instrument of the present invention showing it being armed and operated through initial piercing of an anatomical cavity wall;
and Figures 4A to 4D are a sequence of vertical cross-sectional views of the safety trocar instrument of the present invention showing the trocar retraction _ g _ operation and the trocar subassembly being removed from the main body-cannula assembly.
DESCRIPTION OF THE FIRST EMBODIMENT
Figures 1A though 1F diagrammatically show the safety trocar instrument in accordance with first alternative embodiment of the present invention as it appears in various stages of use. More particularly, this safety trocar instrument, generally indicated at 10. includes a main body 12 having an outer tubular sleeve or cannula 14 projecting from it. The main body-cannula subassembly, generally indicated at 16, is configured to mate with a trocar subassembly generally indicated at 18, that includes a sleeve 20, mounted in a housing 22, and an elongate trocar 24, having a sharp point 26 and being mounted for axial reciprocal movement in the sleeve 20 but being urged to a retracted position therein.
In the assembled rest position of the instrument 10 shown in Figure 1A, in which the sleeve 20 and cannula 14 are partly broken away to show the location of the trocar point 26, the trocar subassembly 18 is mated with the main body-cannula subassembly 16 such that the coaxially.arranged trocar 22 and sleeve 20 are in turn received coaxially within the cannula 14. As can be seen, in this rest position the distal end of the sleeve resides entirely within the distal end of the cannula and the sharp point 26 of the trocar resides within the distal end of the sleeve 20. Thus, in the rest position the sleeve and cannula 14 shield the trocar point 26.
The assembled instrument is armed, as shown in Figure 1B, to pierce an anatomical wall 28 by manually squeezing the trocar subassembly 18 into the main body-_ g _ cannula subassembly 16. This operation causes the sharp trocar point 26 to project beyond the distal ends of both the sleeve 20 and cannula 14. The trocar is latched in this fully extended position by an internal latching mechanism but is permitted partially to retract from the fully extended position by a lost-motion coupling. Both the latching mechanism and lost-motion coupling will be described in detail below.
Thus the trocar point is exposed in preparation for puncturing the cavity wall 28.
As shown in Figures 1B and 1C, the trocar point 26 is visible to a surgeon so that it can be precisely positioned at the desired location on an anatomical cavity wall 28 for the intended puncture wound. As the point begins penetration, counterforce exerted by the wall 28 urges the trocar 24 back toward, but not withdrawn into, the distal end of the cannula to an intermediate retracted position as permitted by the lost-motion coupling. In this intermediate position, a trip mechanism is prepared to disarm the internal latching mechanism.
Figure 1D shows the state of the trocar instrument 10 in which both the trocar point 26 and the distal ends of the sleeve 20. and cannula 14 have cleared the inside surface of the wall 28. Accordingly, the counterforce exerted by the wall on the trocar is relieved permitting it again to be projected to its fully extending position. This action causes the trip mechanism to disarm the internal latch mechanism permitting the trocar to be retracted to its rest position with the trocar point 26 shielded within the sleeve 20 and cannula 14 distal ends, as shown in Figure 1E. In Figure 1E the sleeve 20 and cannula 14 are shown partly broken away for clarity as in Figure 1A.

Finally, as shown in Figure 1F, the trocar subassembly 18 can be withdrawn from the main body-cannula subassembly 16 with the cannula 14 remaining in the puncture wound in the wall 28. The cannula thus provides a passage through the cavity wall into the cavity interior.
The specific structure of the safety trocar instrument in accordance with a preferred embodiment of the 10 present invention will now be described with reference to Figure 2, which is a vertical cross-sectional view thereof. The trocar device includes the main body 12 having the cannula 14 extending therefrom. The main body 12 is formed with an intermediate partition 30, an upwardly projecting stop 32 on the partition 30, and a captured compression spring 34. The main body 12 is also formed with a generally rectangularly shaped socket 36 projecting upwardly from the partition 30.
The trocar subassembly 18 is configured to mate with main body-cannula subassembly 16 and includes a main housing 38 having an integrally formed plunger head 40, and the sleeve 20, which has a radial flange 42 at its proximal end and is mounted for reciprocal movement within the housing 38. The bottom of the main housing 38-:ice rectangularly.shaped to be telescopically received in the socket 36.
The trocar 24 is mounted for axial reciprocal movement within the trocar subassembly and includes a shaft 52 having radially projecting upper and lower flanges 54 and 55 near its proximal end and the sharp point 26 at its distal end. The trocar shaft 52 is coaxially received within the sleeve 20. A stop plate 50 is received about the trocar shaft 52 between the upper and lower flanges 54 and 55 and is urged upwardly into contact with the upper radial flange 54 by a pressure N ~~

spring 57. The stop plate 50, pressure spring 57, and flanges 54 and 55 constitute a lost-motion coupling, the function of which will be described in further detail below.
The trocar 24 is urged to a retracted rest position by a retractor spring 56 compressed between the lower side of the stop plate 50, which engages the upper flange 54, and the sleeve flange 42. The trocar 24 is also stopped in this retracted rest position by a pair of .
pivotable pushers 58 mounted in the plunger head 40 that, when closed in the radial direction, engage the proximal end 59 of the trocar shaft 52, which has a reduced diameter. The pivotable pushers 58 each have a downwardly, radially outwardly tapered outer cam surface 60 that is engaged by an inner aperture in an embracing ring 62 mounted in the plunger head 40. The ring 62 is urged downwardly by a plunger spring 64 that is compressed between it and the inner surface of the top 65 of the plunger head 40. The embracing ring 62, which thus constitutes a cam driver, urges the pivotable pushers 58 radially together by engaging the tapered outer pusher surfaces 60.
In addition, the trocar subassembly incorporates a 'lath mechanism the function of which was generally described above. Now, in detail, this latch mechanism includes latch means in the form of a pawl 68 mounted for pivoted movement on the sleeve flange 42, and an upstanding tab 76 projecting upwardly from the intermediate partition 30 in the main body through a hole in the bottom of the main housing. The pawl 68 is formed with a hook 72 at its upper end, which can override and engage an upper edge of the stop plate 50, and a foot 78 at its lower end that can engage a catch 79 at the upper end of the tab 76.

A trip mechanism for the latch mechanism, comprising the tab 76 and pawl 68, includes an arm 74 pivotably mounted in the plunger head. The arm 74 has a tab 71, which can be engaged by the lower edge of the lower flange 55 to cause the arm 74 to pivot in the counterclockwise direction, and a finger 73, which can engage the foot 78 of pawl 68. It is these latch and trip mechanisms, in cooperation with the trocar flanges 54 and 55 and the stop plate 50, that determine the sequence of operations of the trocar instrument described above with reference to Figures 1A to 1F.
More particularly, Figures 3A through 3D show the sequence of movements of the various elements of the safety trocar instrument described above from the rest position to arming of the instrument, and, in turn, to initial penetration of the anatomical cavity wall.
In the initial rest position shown in Figure 3A, which is substantially the same as Figure 2, the trocar subassembly 18 is inserted into the main body-cannula subassembly 16 with the sleeve 20 and trocar shaft 52 coaxially received within the cannula 14. The distal ends of the sleeve 20 and cannula 14 terminate at nearly the same axial location, with the main housing 38 b-e~ng urged outwardly from the main body 12 to its rest position by the relaxed compression spring 34.
When the device is to be used, the trocar subassembly 18 is manually squeezed into main body-cannula subassembly 16 thereby compressing the captured spring 34, until the catch 79 of the tab 76 catches the foot 78 of the pawl 68 with the sleeve flange 42 abutting the stop 32, which projects through holes in the bottom of the main housing 38. At this stage, the trocar shaft is moved downwardly a small distance by the ~~~:~~~'l pushers 58, but the trocar point 26 remains within both the sleeve 20 and cannula 14, as shown in Figure 3B.
Further depression of plunger head 40 relative to the main housing 38 causes the pivotable pushers 58 to push the trocar shaft 54 axially downwardly further until the hook 72 of the pawl 68 overrides and catches the edge of the stop plate 50 thereby compressing the retractor spring 56. At this stage the trocar point 26 projects to a fully extended position beyond the distal ends of both the sleeve 20 and cannula 14, as shown in Figure 3C. Those distal ends also become substantially coextensive.
Ultimately, complete depression of plunger head 40 causes the sidewall of the embracing ring 62 to engage the periphery of the sleeve flange 42, which as noted has come to rest on the top of a stop 32 projecting upwardly from the intermediate partition 30.
Therefore, further downward movement of the plunger head 40 causes the embracing ring 62 to move upwardly relative to the pushers 58, which are then permitted to spread radially outwardly and release the proximal end 59 of the trocar shaft 52. In this configuration, shown in Figure 3C, the trocar instrument is armed and rea3y to pierce an anatomical cavity wall: .
The instrument can then create a puncture wound by pressing the point 26 of the trocar 24 against the cavity wall. As the point begins its entry, resistance or counterforce exerted by the wall causes the trocar shaft 52 to be urged inwardly into cannula 14 and sleeve 20, against the force of the pressure spring 57, to an intermediate retracted position until the edge of the lower flange 55 overrides the tab 71 of arm 74, as shown in Figure 3D. The upper and lower flanges 54 and ~~8~~~'~

55 in cooperation with the pressure spring 57 permit this lost trocar motion relative to the stop plate 50.
Figures 4A to 4D show the sequence of movement of the various elements of the safety trocar instrument as the cavity wall is penetrated and retraction of the trocar point 26 is subsequently triggered. As depicted in Figure 4A, counterforce against the point 26 of the trocar shaft 52 is relieved when the trocar and cannula 14 clear the inner surface of the cavity wall.
Therefore, the pressure spring 57 may urge the trocar shaft 52 downwardly again from the intermediate position toward the fully extended position. This motion of the trocar causes the arm 74 to be pivoted in the counterclockwise direction by engagement of the edge of the lower flange 55 with the tab 71. The extreme end of the arm 74 then depresses the foot 78 of pawl 68 causing it also to pivot in the counterclockwise direction to disengage its hook 72 from the edge of the stop plate 50, thereby releasing the stop plate 50. The retractor spring 56 compressed between the flange 42 and the stop plate 50 then urges the trocar shaft 52 upwardly into the sleeve 20 and cannula 14 to its 'withdrawn rest position with the point shielded within the distal ends of both, as degzcted in Figure ~4B.
When the plunger head 40 is thereafter manually released, it may move upwardly within the main housing 38 under the influence of compressed spring 34, disengaging the sidewall of the embracing ring 62 from the periphery of the sleeve flange 42. The ring 62 may then be urged downwardly to embrace the pushers 58 and urge them together. The pushers may then again grip the proximal end 59 of the trocar shaft 52, as shown in Figure 4C. As can also be seen there, the pawl 68 can swing about its pivot so that the foot 78 can be disengaged from the catch 79 of the leg 76.
Thereafter the trocar subassembly may be removed from the main body-cannula subassembly such that the cannula remains in the anatomical cavity wall to provide communication with the cavity interior.
It should be noted that the sleeve 20 in the trocar subassembly is long enough in the preferred embodiment to shield the trocar point, particularly when the trocar subassembly is in its rest condition and removed from the main body-cannula subassembly. However, the sleeve 20 may be eliminated if desired since it, by itself, is not necessary to retraction of the trocar point into the distal end of the cannula. If the sleeve is eliminated, the cannula will shield the trocar point after it is retracted following cavity penetration.
SFCOrID EL~ODIMENT DRAWINGS
Figures 5A to 5F are a sequence of perspective views of the preferred embodiment of the safety trocar instrument of the present invention showing it at various stages during use;
Figure 6 is a vertical cross-sectional view of the safety trocar instrument of the present invention shown in its assembled rest condition;
Figures 7A to 7D are a sequence of vertical cross-sectional views of the safety trocar instrument of the present invention showing it being armed and operated through initial piercing of an anatomical cavity wall;
and IJ

Figures 8A to 8D are a sequence of vertical cross-sectional views of the safety trocar instrument of the present invention showing the trocar retraction operation and the trigger sleeve-trocar subassembly being removed from the main body-cannula assembly.
DESCRIPTION OF THE SECOND EMBODIMENT
Figures 5A though 5F diagrammatically show the safety trocar instrument in accordance with the second alternative embodiment of the present invention as it appears in various stages of use. More particularly, this safety trocar instrument, generally indicated at 110, includes a main body 112 having an outer tubular sleeve or cannula 114 projecting from it. The main body-cannula subassembly, generally indicated at 116, is configured to mate with a trigger sleeve-trocar subassembly generally indicated at 118, that includes a tubular trigger sleeve 120, mounted for reciprocal movement in a housing 122 and urged to an outwardly extending position therefrom, and an elongate trocar 124, having a sharp point 126 and being mounted for axial reciprocal movement in the trigger sleeve 120 but being urged to a retracted position therein.
In.the'assembled rest position-.of the instrument 110 shown in Figure 5A, in which the trigger sleeve 120 and cannula 114 are partly broken away to show the location of the trocar point 126, the trigger sleeve-trocar subassembly 118 is mated with the main body-cannula subassembly 116 such that the coaxially arranged trocar 122 and trigger sleeve 120 are in turn received coaxially within the cannula 114. As can be seen, in this rest position the distal end of the trigger sleeve resides substantially entirely within the distal end of the cannula and the sharp point 126 of the trocar resides within the distal end of the trigger sleeve 2~~~.~~~1 120. Thus, in the rest position the trigger sleeve shields the trocar point 126.
The assembled instrument is armed, as shown in Figure 5B, to pierce an anatomical wall 128 by manually squeezing the trigger sleeve-trocar subassembly 118 into the main body-cannula subassembly 116. This operation causes the distal end of the trigger sleeve 220 to project beyond the distal end of the cannula 114 and causes the sharp trocar point 126 to project beyond the distal end of the. trigger sleeve 120. The trocar is latched in this projecting position by an internal latching mechanism to be described in detail below.
Thus the trocar point is exposed in preparation for puncturing the cavity wall 128.
As shown in Figures 5B and 5C, the trocar point 126 is visible to a surgeon so that it can be precisely positioned at the desired location on an anatomical cavity wall 128 for the intended puncture wound. As the point begins penetration, counterforce exerted by the wall 128 urges the distal end of the trigger sleeve 120 back into the distal end of the cannula to a first position. In this first retracted position, the trigger sleeve is prepared to disarm the internal latch mechanism holding the trocar in its extended position:
Figure 5D shows the state of the trocar instrument 110 in which both the trocar point and the distal ends of the trigger sleeve and cannula have cleared the inside surface of the wall 128. Accordingly, the counterforce exerted by the wall on the trigger sleeve is relieved permitting it again to be projected to its extended position with its distal end protruding beyond the distal end of the cannula. This action of the trigger sleeve disarms the internal latch mechanism permitting the trocar to be retracted to its rest position with N

the trocar point within the trigger sleeve distal end, as shown in Figure 5E. In Figure 5E the trigger sleeve and cannula are shown partly broken away for clarity as in Figure 5A.
Finally, as shown in Figure 5F, the trigger sleeve-trocar subassembly 118 can be withdrawn from the main body-cannula subassembly 116 with the cannula 114 remaining in the puncture wound in the wall 128. The cannula thus provides a passage through the cavity wall into the cavity interior.
The specific structure of the safety trocar instrument 110 in accordance with a preferred embodiment of the present invention will now be described with reference to Figure 6, which is a vertical cross-sectional view thereof. The trocar device includes the main body 112 having the cannula 114 extending therefrom. The main body 112 is formed with an intermediate partition 130, an upwardly projecting stop 132 on the partition 130, and a captured compression spring 134. The main body 112 is also formed with a generally rectangularly shaped socket 136 projecting upwardly from the partition 130.
The=trigger sleeve-trocar subassembly 118 is configured to mate with main body-cannula subassembly 116 and has a main housing 138, a plunger head 140, and the trigger sleeve 120, which is reciprocally mounted within housing 138. The bottom of the main housing 138 is rectangularly shaped to be telescopically received in the socket 136. The plunger head 140 is mounted for reciprocal telescoping movement relative to the housing 138 and the two elements are prevented from disengaging from one another by suitable means (not shown).

The trigger sleeve 120 has a rest position relative to the main housing 138 in which a radial flange 142 at its proximal end is supported by a retainer 144 on the bottom 146 of the housing 138. The trigger sleeve is urged to this rest position by a motion spring 148 compressed between the radial trigger sleeve flange 142 and the underside of an inner horizontal partition 150 formed within housing 138.
The trocar 124 is also mounted for axial reciprocal movement within the trigger sleeve-trocar subassembly and includes a shaft 152 having catch means in the form of a radial flange 154 near its proximal end and the sharp point 126 at its distal end. The trocar shaft 152 is coaxially received within the trigger sleeve 120. The trocar 124 is urged to a retracted rest position by a retractor spring 156 compressed between the upper side of the horizontal partition 150 and the radial flange 154. The trocar 124 is also stopped in ~20 this retracted rest position by a pair of pivotable pushers 158 mounted in the plunger head 110 that, when closed in the radial direction, engage the proximal end 159 of the trocar shaft 152, which has a reduced diameter. The pivotable pushers 158 each have a downwardly, radially outwardly tapered outer cam surface 160 that is engaged by an inner aperture in an embracing ring 162 mounted in the plunger head 140.
The ring 162 is urged downwardly by a plunger spring 164 that is compressed between it and the inner surface of the top 165 of the plunger head 140. The embracing ring 162, which thus constitutes a cam driver, urges the pivotable pushers 158 radially together by engaging the tapered outer pusher surfaces.
In addition, the trigger sleeve-trocar subassembly incorporates a latch mechanism, indicated generally at 166, the function of which was generally described 2~~~~~'~

above. Now, in detail, this latch mechanism 166 includes latch means in the form of a pawl 168 mounted for pivoted movement on a stand 170 projecting upwardly from the inner partition 150 within the housing 138.
The pawl 168 is formed with a hook 172 that can engage the top of the flange 154 on the trocar shaft 152. A
sidewardly projecting arm 174 is formed on the pawl 168 and carries pivotably mounted trip means in the form of a leg 176 that projects downwardly through the partition 150 and has an enlarged foot 178 at its lower free end. This foot is configured to engage the head 182 of an upstanding tab 180 projecting from the partition 130 in the main body through a hole in the bottom 146 of the housing 138. It is this latch mechanism, in cooperation with the trocar flange 154 and the trigger sleeve flange 142, that determines the sequence of operations of the trocar instrument described above with reference to Figures 5A to 5F.
More particularly, Figures 7A through 7D show the sequence of movements of the various elements of the safety trocar instrument described above from the rest position to arming of the instrument, and, in turn, to initial penetration of the anatomical cavity wall.
In the initial rest position shown in Figure 7A, which--is substantially the same as Figure 6, the trigger sleeve-trocar assembly 118 is inserted into the main body-cannula subassembly 116 with the trigger sleeve 120 and trocar shaft 52 coaxially received within the cannula 114. The distal ends of trigger sleeve 120 and cannula 114 terminate at about the same axial location, with the main housing 138 being urged outwardly from the main hody 112 to its rest position by the relaxed compression spring 134.

2~~~.~~~

When the device is to be used, the trigger sleeve-trocar subassembly 118 is manually squeezed into main body-cannula subassembly 116 thereby compressing the captured spring 134, until the bottom wall 146 of housing 138 abuts the stop 132. In this position, shown in Figure 7B, the foot 178 of the leg 176 is caught under the head 182 of the tab 180. The distal end of the trigger sleeve 120 projects slightly beyond on the distal end of the cannula 114, but the point 126 of the trocar 124 remains within both trigger sleeve .
120 and cannula 114.
Further depression of plunger head 140 relative to the main housing 138 causes the pivotable pushers 158 to push the trocar shaft 154 axially downwardly until the hook 172 of the pawl 168 overrides the flange 154 on the shaft 152. The point 126 of the trocar 124 then projects beyond the distal ends of both the trigger sleeve 120 and cannula 114, as shown in Figure 7C.
Ultimately, complete depression of plunger head 140 causes the periphery 183 of the embracing ring 162 to engage the upper extreme 184 of the housing 138 thereby stopping relative embracing ring-main housing movement.
Further downward movement of the plunger head 140 .. causes the embracing ring 162 to move. upwardly relative to the pushers 158 which are then permitted to spread radially outwardly and release the proximal end 159 of the trocar shaft 152. In this configuration, shown in Figure 7C, the trocar instrument is armed and ready to pierce an anatomical cavity wall.
The instrument can then create a puncture wound by pressing the point 126 of the trocar 124 against the cavity wall. After the point begins its entry, the distal end of the trigger sleeve encounters the cavity wall. Resistance or caunterforce exerted by the wall 2~~19~'~

causes the trigger sleeve 120 to be urged inwardly into cannula 114, against the force of the motion spring 148, until the edge of the radial trigger sleeve flange 142 overrides the foot 178 of the leg 176, as shown in Figure 7D.
Figures 8A to 8D show the sequence of movement.of the various elements of the safety trocar instrument as the cavity wall is penetrated and retraction of the trocar point is subsequently triggered. As depicted in Figure BA, counterforre against the distal end of the trigger sleeve 120 is relieved when the trigger sleeve and cannula 114 clear the inner surface of the cavity wall so that the motion spring 148 may urge the trigger sleeve 120 downwardly again toward its rest position.
This motion of the sleeve causes the radial flange 142 to pull the leg 176 downwardly thereby pivoting the pawl 168 so that it hook 172 is disengaged from the radial flange 154 on the trocar shaft.

The trocar shaft 152 is thereby released so that its point 126 is once again retracted into the trigger sleeve 120 and cannuTa 114 by the force of the retractor spring 156, as depicted in Figure 8B.
When~plunger head 140 is thereafter manually released, it may move upwardly within the main housing 138, under the influence of plunger spring 164, permitting the' periphery 183 of the embracing ring 162 to clear the upper extreme of the housing 138 and again embrace the outer tapered sides 160 of pivotable pushers 158 to urge the pushers 158 together. The pushers may then again grip the proximal end 159 of the trocar shaft 152, as shown in Figure 8C. As can also be seen there, the leg 176 can swing about its pivot on the arm 174 so that the foot 178 carp be disengaged from both the trigger-sleeve flange 142 and the head 182 of the tab 180. Appropriate biasing means for the latch can be provided to ensure disengagement.
Thereafter the trigger sleeve-trocar subassembly may be removed from main body-cannula subassembly such that the cannula remains in the anatomical cavity wall to provide communication with the cavity interior.
Accordingly, it will be appreciated that the present invention provides an improved safety trocar instrument that retracts a sharpened trocar point into a shielding trigger sleeve as soon as the distal end of the sleeve penetrates an anatomical cavity wall. The instrument may be self-contained and is mechanically actuated.
Therefore, reliable operation does not depend on external power supplies or electrical triggering mechanisms.
Although specific embodiments of the present invention have been described above in detail, it will be understood that this description is merely for purposes of illustration. Various modifications of and equivalent structures corresponding to the disclosed aspects of the preferred embodiments in addition to those described above may be made by those skilled in the=art without departing from the spirit.of the present invention which is defined in the following claims, the scope of which is to be accorded the broadest interpretation so as to encompass such modifications and equivalent structures.

Claims (24)

1. A safety trocar instrument far piercing the wall of an anatomical cavity to provide communication with the inside of the cavity, said trocar instrument comprising:
(a) a tubular cannula;
(b) an elongate trocar, having a sharp piercing point, mounted for axial reciprocal movement within said cannula between a withdrawn rest position in which said point is received within and shielded by the distal end of said cannula, a fully extended position in which said point is exposed beyond the distal end of said cannula, and an intermediate position retracted toward the rest position from the fully extended position in which said point is also exposed beyond the distal end of said cannula;
(c) means for biasing said trocar to its withdrawn position;
(d) latch means for latching said trocar, in opposition to said biasing means, for reciprocal movement between the fully extended position and the intermediate position; and (e) trip means coupling said trocar to said latch means when said trocar moves from the fully extended position to the intermediate position, and tripping said latch means when said trocar returns toward said fully extended position to unlatch said trocar and thereby permit said trocar to be moved to the withdrawn rest position by said biasing means.
2. The safety trocar instrument according to claim 1, further comprising means for urging said trocar from the intermediate position toward the fully extended position when said trocar is latched by said latch means.
3. The safety trocar instrument according to claim 1, wherein said trocar further comprises lost-motion coupling means for coupling said trocar to said latch means and including upper and lower flanges mounted in the region of the proximal end of said trocar and a stop plate mounted on said trocar for reciprocal movement between said upper and lower flanges.
4. The safety trocar instrument according to claim 3, further comprising a catch mounted in fixed position relative to said cannula, and wherein said latch means comprises a pawl for linking said catch and said stop plate when said trocar is moved to the fully extended position.
5, The safety trocar instrument according to claim 4, wherein said grip means comprises a trip arm mounted to engage said trocar when said trocar is moved from the fully extended position to the intermediate position and to unlink said pawl from said stop plate when said trocar is returned toward the fully extended position from the intermediate position.
6. The safety trocar instrument according to claim 1, further comprising plunger means for manually moving said trocar from the withdrawn rest position to the fully extended position.
7. The safety trocar instrument according to claim 6, wherein said plunger means comprises means for gripping a portion of said trocar remote from said piercing point when said trocar is in the withdrawn rest position and for releasing said remote portion when said trocar reaches the fully extended position.
8. The safety trocar instrument according to claim 7, wherein said plunger means further comprises a plunger head mounted for reciprocal movement relative to said trocar, and wherein said gripping means comprises at least one pusher element mounted in said plunger head, and means for driving sand pusher element to grip said trocar in a radial direction and to release said trocar.
9. The safety trocar instrument according to claim 8, wherein said trocar and said plunger head are mounted for reciprocal movement in the same axial direction;
wherein said pusher element has an outer cam surface and is mounted within said plunger head for pivoted movement into and out of gripping engagement with said trocar; and wherein said driving means comprises a cam driver mounted in said plunger head cooperating with said cam surface in a first position to hold said pusher element in gripping engagement with said trocar and is a second position to release said pusher element from gripping engagement with said trocar.
10. The safety trocar instrument according to claim 1, wherein said trocar, said biasing means, and said trip means constitute a trocar subassembly that is removable as a unit from said cannula.
11. A safety trocar instrument for piercing the wall of an anatomical cavity to provide communication with the inside of the cavity, said trocar instrument comprising:
(a) a tubular cannula;
(b) an elongate trocar, having a sharp piercing point, mounted for axial reciprocal movement within said cannula between a withdrawn rest position in which said point is received within and shielded by the distal end of said cannula and a fully extended position in which said point is exposed beyond the distal end of said cannula;
(c) means for biasing said trocar to its withdrawn position;
(d) latch means for latching said trocar in opposition to said biasing means; and (e) trip means for tripping said latch means to unlatch said trocar and thereby permit said trocar to be moved to its withdrawn rest position by said biasing means; and (f) lost-motion coupling means coupling said trip means to said trocar and permitting said trocar, when latched by said latch means, to reciprocate between the fully extended position and an intermediate retracted position in which said trocar point is also exposed beyond the distal end of said cannula, said trocar arming said trip means when moved to the intermediate retracted position and actuating said trip means to trip said latch means when returned toward the fully extended position.
12. The safety trocar instrument according to claim 11, wherein said trocar arms said trip means when said trocar is moved to the intermediate retracted position by counterforce on said trocar point and thereafter actuates said trip means to trip said latch means when counter force is relieved from said trocar point.
13. The safety trocar instrument according to claim 11, wherein said coupling means comprises means for urging said trocar toward the fully extended position from the intermediate retracted position when said trocar is latched by said latch means.
14. The safety trocar instrument according to claim 11, further comprising a housing in which said trocar is mounted for said reciprocal. movement, and a catch mounted in fixed position relative to said cannula, and wherein said latch means comprises a pawl pivot mounted within said housing to link said catch and said trocar together when said trocar is moved to the fully extended position.
15. The safety trocar instrument according to claim 14, wherein said trip means includes an arm pivotably mounted within said housing to be coupled to said trocar when said trocar is moved to the intermediate retracted position as permitted by said lost-motion coupling means, and to disengage said pawl from said catch when said trocar returns toward said fully extended position.
16. The safety trocar instrument according to claim 15, wherein said lost-motion coupling means comprises upper and lower flanges mounted is the region of the proximal end of said trocar and a stop plate mounted on said trocar for reciprocal movement between said upper and lower flanges, wherein send pawl includes a hook engageable with said stop plate when said trocar is moved to its fully extended position.
17. The safety trocar instrument according to claim 11, further comprising a housing, and a catch mounted in fixed position relative to said cannula, and wherein said latch means comprises a pawl pivotably mounted within said housing to link said catch and said trocar together when said trocar is moved to its fully extended position;
said trip means comprises an arm pivotably mounted within said housing to be coupled to said trocar when said trocar is moved to the intermediate retracted position as permitted by said lost-motion coupling means, and to disengage said pawl from said catch when said trocar is returned toward the fully extended position; and said lost-motion coupling means comprises upper and lower flanges mounted in the region of the proximal end of the trocar and a stop plate mounted on said trocar for reciprocal movement between said upper and lower flanges.
18. A safety trocar instrument according to claim 17, further comprising means for urging said trocar toward the fully extended position from the intermediate retracted position when said trocar is latched by said latch means.
19. The safety trocar instrument according to claim 11, further comprising plunger means for manually moving said trocar from the withdrawn rest position to the fully extended position.
20. The safety trocar instrument according to claim 19, wherein said plunger means comprises means for gripping a portion of said trocar remote from said piercing point when said trocar is in the withdrawn rest position and for releasing said remote portion when said trocar reaches the fully extended position.
21. The safety trocar instrument according to claim 20, wherein said plunger means further comprises a plunger head mounted for reciprocal movement relative to said trocar, and wherein said gripping means comprises at least one pusher element mounted in said plunger head, and means for driving said pusher element to grip said trocar in a radial direction and to release said trocar.
22. The safety trocar instrument according to claim 21, wherein acid trocar and said plunger head are mounted for reciprocal movement in the same axial direction; wherein said pusher element has an outer cam surface and is mounted within said plunger head for pivoted movement into and out of gripping engagement with said trocar; and wherein said driving means comprises a cam driver mounted in said plunger head cooperating with said cam surface in a first position to hold said pusher element in gripping engagement with said trocar and in a second position to release said pusher element from gripping engagement with said trocar.
23. The safety trocar instrument according to claim 21, wherein said trocar, said biasing means, and said trip means constitute a trocar subassembly that is removable as a unit from said cannula.
24. A safety trocar instrument for piercing the wall of an anatomical cavity to provide communication with the inside of the cavity, said trocar instrument comprising:
(a) a main body-cannula subassembly including:
(1) a main body;
(2) a tubular cannula projecting from the main body; and (b) a trocar subassembly formed to mate with said main body-cannula subassembly and including:
(1) a housing;
(2) an elongate trocar, having a sharp piercing point, mounted for axial reciprocal movement relative to said housing between a withdrawn rest position, a fully extended position, and an intermediate position retracted from the fully extended position toward the withdrawn position, said trocar being formed to be coaxially received in said cannula with said point exposed beyond the distal end thereof in the fully extended and intermediate positions, and with said point withdrawn into and shielded by they distal end of said cannula in the withdrawn position;
(3) means for biasing said trocar toward its withdrawn position;
(4) plunger means with which said trocar subassembly can be manually urged toward said main body-cannula subassembly to an armed stage to move said trocar to its fully extended position;
(5) latch means for latching said trocar, in opposition to said biasing means, for reciprocal movement between the fully extended position. and the intermediate position when the instrument is in the armed stage; and (6) trip means coupling said trocar to said latch means when said trocar moves from the fully extended position to the intermediate position in the armed stage, said trip means thereafter tripping said latch means when said trocar returns toward the fully extended position from the intermediate position thereby to permit said trocar to be urged to its withdrawn position by said biasing means.
CA002081927A 1991-11-04 1992-11-02 Safety trocar Expired - Lifetime CA2081927C (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US07/787,183 1991-11-04
US07/787,183 US5158552A (en) 1991-11-04 1991-11-04 Safety trocar instrument having a retractable trocar actuated by relief of pressure on the trocar point

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CA2081927A1 CA2081927A1 (en) 1993-05-05
CA2081927C true CA2081927C (en) 2004-01-06

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US (1) US5158552A (en)
EP (1) EP0540887B1 (en)
JP (1) JPH05208022A (en)
KR (1) KR930009572A (en)
AT (1) ATE195237T1 (en)
AU (1) AU653866B2 (en)
CA (1) CA2081927C (en)
DE (1) DE69231330T2 (en)
ES (1) ES2149766T3 (en)
MX (1) MX9206277A (en)
PL (1) PL296455A1 (en)
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ATE195237T1 (en) 2000-08-15
US5158552A (en) 1992-10-27
AU653866B2 (en) 1994-10-13
ZA928477B (en) 1993-05-06
EP0540887B1 (en) 2000-08-09
ES2149766T3 (en) 2000-11-16
TW235910B (en) 1994-12-11
EP0540887A1 (en) 1993-05-12
DE69231330D1 (en) 2000-09-14
AU2811192A (en) 1993-05-06
DE69231330T2 (en) 2001-01-25
JPH05208022A (en) 1993-08-20
MX9206277A (en) 1993-08-01
CA2081927A1 (en) 1993-05-05
KR930009572A (en) 1993-06-21
PL296455A1 (en) 1993-07-12

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