Tissue Isolator
Field of the Invention
The present invention relates, in general, to the field of biomedical devices used in surgical
procedure and, in particular, to a tissue isolator designed to isolate tissue for morcellation and
prevent seeding of benign or potentially cancerous tissue during the morcellation procedure. The
present invention further prevents accidental damage to the surrounding healthy tissue.
Background of the Invention
In the prior art, various types of pouches or bags have been developed to allow for the removal
of tissue through a small opening, orifice, or port in an surgical procedure such as laparoscopic
procedure. Tissue bags have also been considered for the morcellation of tissue inside the bag for
its safe removal. Unfortunately, many surgical techniques using bags for morcellation are
difficult to accomplish due to various constraints present in the bags such as the shape, material
and difficulty in placing the bag in the abdomen. The insertion and removal of the bag inside the
abdomen requires -special skill of usage of the bag by the user and thus requires special
techniques to be used as per the design of the bag by the user. Various evidences of spillage of
blood and tissue have occurred during morcellation. There are bags having single openings used
in the prior art such as in US20040097960, which provides a bag for use in a laparoscopic
surgery, having at its one end an opening through which extracted interna! organ is put in and
drawn from, and having at its other end a tubular organ storage portion with a closed bottom, of
which bore diameter is smaller than that of the opening. This invention cannot be used in
conjunction with power morcellation.
In US20140236167 to Shibley et al., the cap is placed on the bag mounted to the retractor after
the rim of the single port bag is removed out through the incision and the cap is used as an access
device for an instrument for morcellation or a surgeon's hand/arm. According to FIG. 24,
piercing of the bag is done by trocar to create a port on the bag after the bag is inserted inside the
abdomen, in which situation there are high chances of leakage of blood and tissue during
removal of the bag from the abdomen. According to FIG. 94, the bag contains a small port with a
valve. The disadvantage in such bags is that the location of the port becomes difficult. These
bags with small ports can limit the size of tissue to be inserted inside the bag.
In US20140236168 to Shibley et al., the body portion of the bag has a length and width greater
than a length and width of the neck portion used for morcellation. FIGS. 160, 161 show creation
of the ports during surgery, thereby the chance of leakage is greater in such bags.
In US20130184536 to Shibley et al., the bag has an exit port and an entrance port.
In US6752822, the bag is everted over the severed tissue once the receiving tips have grasped the
tissue, and the enclosed tissue and bag may be safely removed from the patient.
However these prior arts have been unable to tackle various issues related to tissue morcellation
and insertion in the abdomen and removal of the bag from the abdomen.
Summary of the Invention
The present invention relates, in general, to the field of biomedical devices used i a surgical
procedure and, in particular, to a tissue isolator designed to isolate and extract moreellated tissue
while preventing seeding of benign/ potentially cancerous tissue during the morcellation
procedure.
The present invention provides a tissue isolator comprising two or more openings designed to
isolate and extract moreellated tissue during a laparoscopic morcellation procedure wherein
present invention is so designed to suit any number of abdominal port preparation/ usage during
laparoscopic surgery using the tissue isolator for isolation and extraction of moreellated tissue.
Thus, the user does not have to create any opening during the procedure. This further limits
leakage and the opening may be closed as per requirement by the user. The present isolator
allows larger tissues to be inserted into it. It also prevents spillage during tissue morcellation and
facilitates insertion in the abdomen and removal of the isolator from the abdomen.
In an embodiment the tissue isolator is made of specific shape to enhance the usability and util ity
of the tissue isolator during the surgical procedure. Various markings for identification and
positioning of isolator inside the peritoneum to further enhance the usability of the isolator are
also disclosed.
In an embodiment the isolator optionally comprises atieast one sealing element to seal the
isolator during use.
In an embodiment the isolator optionally comprises atieast one closure element to close the
isolator after use and before removing it from the patient body.
The tissue isolator provides a method of isolating and extracting tissue from the body.
In an embodiment, introducer is disclosed which can be used to assist the user in using the said
isolator.
In an embodiment, a deployer is provided to assist the user in using the said isolator.
The foregoing objects and other advantages and features of the invention may now be more
readily ascertained from the following detailed description of a preferred embodiment thereof,
taken in conjunction with the accompanying drawings.
Brief Description of Drawings
FIGS. 1 to 3 illustrate a tissue isolator of the present invention.
FIGS. 4 to 6 illustrate various embodiments of the tissue isolator of the present invention.
FIG. 7 illustrates an inflated isolator.
FIGS. 8 to 1 illustrate flexible element of the tissue isolator of the present invention.
FIGS. 12 to 13 illustrate an identification mark on the tissue isolator of the present invention.
FIG . 14 illustrates a one or more layer structure of the tissue isolator of the present invention.
FIGS. 15 to 20 illustrate variants of two or more openings of the tissue isolator of the present
invention.
FIGS. 2 1 and 22 illustrate channels or lumens in the opening of the isolator of the present
invention.
FIGS. 23 and 24 illustrate mechanism to inflate the isolator of the present invention.
FIGS. 25 to 33 illustrate sealing element used in the present invention.
FIGS. 34 to 38 illustrate closure element used in the present invention.
FIGS. 39 and 40 illustrate various embodiments of the present invention .
FIG. 4 1 illustrates introducer of the present invention
FIGS. 42 to 48 illustrate a method of using tissue isolator with optional introducer of the present
invention.
FIGS. 49 to 56 illustrate various embodiments of pulling elements.
FIG. 57 illustrates embodiment for shape of isolator.
FIGS. 58, 59 illustrate various embodiments for method of tissue insertion inside isolator.
FIGS. 60 to 62 illustrate various embodiments of the deployer of tissue isolator of the present
invention.
FIGS. 63 to 65 illustrate various embodiments for configuration for packing of isolator.
DESCRIPTION OF THE INVENTION
The description below provides various embodiments of the tissue isolator of the present
invention and use thereof.
The present invention provides a tissue isolator designed for isolation and extraction of
morcellated tissue during a surgical procedure such as a laparoscopic procedure. Referring to
FIGS. , 2 and 3, a tissue isolator 1 of the present invention is provided, which is biocompatible
and comprising two or more openings 2, 3 designed to prevent dissemination of potentially
cancerous tissue during morcellation or surgery. FIG. 1 shows the isolator 1 inside the abdomen
with openings 2, 3 with tissue 4 placed inside the isolator. The said isolator 1 is biocompatible
for safe use during surgery. The isolator 1 has two or more openings 2, 3 and can be suitable for
use with any number of abdominal port preparation/ usage during laparoscopic surgery.
An opening is a lumen, which extends outwards and which allows access to the interior space of
the isolator. A port is a self-sealing structure to prevent fluid loss from the pressurized body.
FIG. 2 describes the isolator with at least two openings. In the said isolator, a central body
portion 10 forming an interior space configured to receive a tissue, said central body portion
having a top section 11. Further a neck 12 integrally formed with said central body portion, said
neck having a proximal end extending outward from the said top section of said central body
portion and a distal end 13. An opening 2 formed at the distal end of said neck, said opening and
said neck configured to receive a first surgical instrument or tissue. Further the said isolator
comprises of a neck 14 integrally formed with said central body portion, said neck having a
proximal end extending outward fro the said top section of said central body portion and a
distal end 15. An opening 3 formed at the distal end of said neck, said opening and said neck
configured to receive the tissue or instrument.
In one of the embodiments shown in FIG 3 opening 3 and neck 14 are substantially larger than
opening 2 and neck 12. Further the openings may be located toward the top section 11 or on the
upper side prevent spillage since both openings are located higher than the central body portion
10. Further one of the opening 2 is small enough that it seals itself on the instrument to avoid gas
leakage once an instrument passes through it.
In another embodiment as shown in FIG. 3, the diameter of opening 3 may be larger than neck
14 of the isolator 1, so that tissue can be easily inserted into it. Once inserted, when the user pulls
the opening out of the abdominal port, the tissue may easily slip through its neck 1 section and
pass into the central body portion 10 due to flexibility of the material of construction.
When a tissue collection bag, disclosed in the prior art, is punctured to provide an additional
port, it creates a risk for tissue spillage. Hence in the isolator 1 of the present invention, a second
opening is provided prior to insertion into the body and can be completely brought out of the
body. Thus, the tissue is completely isolated.
In one of the embodiments, the opening 2 can be in the range of 1 to 50 mm in diameter to
accommodate various size instruments. The opening 3 can be in the range of 30 to 300 mm in
diameter to accommodate the tissue of 20 to 300 mm diameter. The connecting neck can be
either of similar size to its opening or it can be smaller than the opening e.g, neck size can be 2%
to 50% smaller than the opening. A higher opening to neck ratio can prevent the isolator from
slipping back into the abdomen once the opening is taken out of the abdomen. The neck 12 or 14
may have sudden bulge to avoid wrinkles at that section when isolator is inflated. Any one of the
openings is used for the passage of trocar through it, so that laparoscope 7 (F G. 1) can pass
through the trocar and seals the opening section. The other opening can be used to accept power
morcellator 5 (FIG. 1). The central body portion of the isolator may have volume in the range of
from 300ml to 8000 ml. When the trocar passes through the opening 2, due to its elastic property,
it can stretch and allow the trocar to pass through it by sealing around it. This can provide a
natural sealing around the trocar, thereby preventing gas leakage from around the trocar. This
also minimizes crumpled material around the port and enables good visualization. Further
optionally, the tail 20 of the isolator 1, as represented in FIG. 3, is made in such a way that user
ca hol the tail 20 while insertion of the trocar through it.
The bags described in the prior art, have a single opening and a rectangular or conical shape.
During surgery, the rectangular shaped bags have more material to be inserted inside the
abdomen. Thus after insertion of such bags inside the abdomen, when inflated the bag tries to
take its natural rectangular shape, but due to the natural sphere like shape of the abdomen, the
ends of the bag try to accumulate at its corners. This accumulated material of the bag may cause
difficulties in morcellation such as occluded vision, twisting and Such like.
Thus to overcome these issues the isolator is made in unique and innovative shapes like being
substantially curved as shown in FIG. 3, shape as shown in FIG. 4 or L shape as shown in FIG.
5 or J Shape as shown in FIG. 6. The U shape is provided to suit the morcellation through
umbilicus port and suprapubic port. One opening may come out of the suprapubic port and the
other opening may come out through the umbilicus port. The L shape as shown in FIG. 5 and J
shape as shown in FIG. 6 are made for port positions at the sides of the abdomen, where one
opening may co e out of the umbilicus port and the other opening may come out of the left oi¬
right side port.
The central body portion when inflated is made to contain tissue for morcellation. The central
body portion is designed to conform to the shape of the inflated abdomen. Further, the central
body portion is made in the disclosed unique shape to easily accommodate different tissue sizes.
If the isolator is made in a straight tubular shape, the tissue may slip out of the other opening
when the one of the openings is pulled out. The unique shape provided prevents the tissue from
slipping out of the opening.
FIG. 7 shows the inflated isolator 1 in the abdomen. Power morcellator 5 is inserted through one
of the openings, preferably the opening 3. Trocar 22 is inserted through the other opening,
preferably the opening 2.
Another disadvantage of prior art is that during surgery, the surgeon may be unable to easily
separate the two surfaces of the opening to insert tissue through it. The two surfaces may stick to
the tissue and create difficulty in insertion of tissue into the isolator. To overcome this problem,
in accordance with one of the preferred embodiment of the invention, to make the tissue insertion
inside the isolator easier, any or all of the openings 2, 3 of the isolator can open, itself after
entering inside the abdomen. As shown in FIG. 8, the openings 2, 3 may optionally include a
flexible element. The flexible element can be an integral part of the opening or an elastomeric
ring 25 attached to the opening. In preferred embodiment, as shown in FIG 9, the flexible
element may be a wire or loop 27 made of super elastic material such as nitinol, to reduce the
amount of material, and may be attached to the opening 3. The said wire may be attached b
passing through the tubular pocket 26 created at the opening of the isolator. The flexible element
can be deformed to any shape but once released takes its natural shape. The flexible element 25
and 27 as shown in FIG. 8 and FIG. 9 respectively will preferably have a cross-section in the
approximate range of 0.1 mm to 10 mm in diameter. As shown in FIG. 9, the flexible element 27
may be enclosed in a tubular pocket 26 "provided at the opening, so that flexible element 27 will
not be exposed. The tubular pocket 26 can be created by folding the distal end of the opening
back downward and fastening it to the isolator 1 such as by sewing, heat sealing or the like.
According to an embodiment of the invention as illustrated by FIG. 10, the opening may have
nitinol or spring steel wire formed in zig-zag form 28 that is positioned at the opening. In a
relaxed condition, it is opened by its shape memory or flexible characteristic and it can be
compressed.
In another embodiment as shown in FIG 11, the flexible element may be in the form of inflatable
ring 29. The action of opening of the isolator may be made easy by having an inflatable ring 29
around the opening of the isolator. The said inflatable ring can be inflated from outside by
pumping in air or liquid. Inflation of the ring can open the opening of the isolator to facilitate
tissue insertion by the surgeon.
According to an embodiment of the invention, magnetic strips may be embedded within the
opening of the isolator. There can be two or more strips with same polarity embedded facing one
another. As both edges of the opening come closer to each other; due to repulsion the edges of
the opening will repel each other and will remain open. Thus after inserting isolator inside the
inflated abdomen, the opening of the isolator opens itself.
In prior art, the inventions provided do not have appropriate markings to guide the user during
different procedures of morcellation. Since the isolator is transparent, semi-transparent or
opaque, the user may find it difficult to distinguish between the isolator and tissue or different
sides of the isolator or edge of the isolator. Further it may take more time to locate the openings
of the isolator. While inserting the tissue inside the isolator, the user may be confused between
the inner and outer side of the isolator. Even during insertion of trocar through one of the
opening, it may be difficult to locate the opening and thus user can puncture hole at any
undesirable location at opening. To make the isolator easy to use and also save procedural time,
the isolator may be made in various colors or markings. Further to reduce chances of user error,
markings may be provided on the isolator.
Some of the representative markings are disclosed herein. In an embodiment as shown in FIG.
12, arrow markings 30 may be provided on the upper side or end of the opening 3. The arrow
mark may be visible from inside as well as outside of the isolator. This marking indicates
grasping location while pulling out the opening 3 through the abdominal port. Arrow marking 3 1
is an indication of the opening 2. Line 32, preferably thick, at opening indicates the location for
knot formation or placement of closure element, provided below in the disclosure. There may be
vertical lines 33 on the neck portion of the openings which indicate any twisting of the isolator at
the opening, i.e. the surgeon will be aware of twisting while pulling out both ends of isolator
through their respective abdominal ports. There may be prints 34 on the band 38 wherein theband
38 can be colored such as blue color. These prints are to indicate the inner side of the
isolator at the opening and differentiate it from the outside of the isolator. In one embodiment,
the print is visible only from the inside of the isolator and not from the outside. This helps the
user to easily identify the inner side of the isolator, while inserting tissue inside the isolator.
Lining 35 is provided preferably on the shorter edge 39 of the isolator to distinguish it from the
longer edge 40 of the isolator. There may be directional markings 36 to indicate the direction of
the openings. These directional markings 36 may be an arrow shaped or of representative shape
of the isolator itself. This helps the surgeon to locate the openings of the isolator after insertion
of the isolator inside the abdomen and while viewing with a laparoscope. A colored filled or
unfilled circle 41 can be provided around the opening 2 wherein this marking may help in easy
identification of the opening of the isolator while insertion of the trocar through it. Marking 3
may run across the length of the isolator body. Such marking may help the user to distinguish the
isolator body inside the abdomen from surrounding tissue 6 (FIG. 1).
n accordance to yet another embodiment of the invention, the isolator may be colored, opaque
or transparent; there may be marking/ indicators. This color indicator /marking will help the user
i easy identification of the opening inside the abdomen. There may be any colored arrows or
markings for indication of positioning and to prevent twisting. There may be colored lining on
the isolator openings, it may be any color such as blue, green or the device may have outer and
inner surface in two different colors such as outer surface in light blue and inner surface in light
green or the isolator outer surface ma have a plurality of colored lines that extend
circumferential ly around the entire isolator parallel to one another like zebra lining 45 or in any
other pattern as shown in FIG. 13.
In the preferred embodiment, the isolator- may be made from thin elastic film such as
Thermoplastic Polyurethane with thickness in the preferable range of 10 to 500 microns. This
material should be thin that it can be easily placed in the introducer or can be passed through the
10-30 mm abdominal port. This material can possess high strength and can be stretchable. Thus
even if sharp devices press against the film, it can resist rupture to a great extent. Due to this
strength and elasticity, the chances of the isolator getting ruptured are minimized.
In yet another embodiment, the isolator may be made of material such as Nylon thin film, which
can provide strength to the isolator making it cut resistant. The isolator may also be made from
one or more layers of similar or dis-similar materials or a composite material to prevent tearing
and better performance of the device during its use in the procedure.
Surface finish of the isolator may be matted, to avoid reflection of light. In one of the
embodiment, the surface of the isolator may be coated with anti-microbial coating or nano-silver
coating.
According to another embodiment of the invention, the isolator may be made from any of the cut
resistant woven or non-woven material like CARBON FIBER, GLASS FIBER, J VLAR®,
SPECTRA®, Cut-Tex® PRO, ATA, Dyneema, TWARON®, HexArmor® etc, and elastomeric
or plastic coating may be done on one or both side to fill invisible pores, so that no fluid can
come out from the isolator. The isolator can achieve flexibility and can be expandable to take the
area of the abdomen or peritoneum. Also, morcellator or any instrument cannot cut the inflated
isolator during insertion of the morcellator or such instruments and while morcellating or cutting
the tissue. The isolator can thus achieve cut resistant properties with flexibility.
In yet another embodiment of the invention, the isolator may be made in at least two layers,
where inner layer is made of cut resistant woven material and outer layer is made anti leak layer
from any of these materials such as thin plastic or elastomer like PU, silicone, nitrile. Both the
layers may be joined to each other.
In accordance with yet another embodiment of the invention, the isolator may be made of
composite material wherein the inside layer is made of mesh (e.g. nitinol, steel or any strong
material etc.), which is resistant to cutting from sharp objects or instruments. The pore size of the
mesh can be carefully selected so that the smallest arc of the cutter tip does not penetrate through
the mesh. The mesh can be covered by a thin elastic membrane to avoid leakage of the tissues or
blood. Further the mesh should keep the isolator supple and flexible during its introduction and
removal from the abdominal cavity.
In accordance with yet another embodiment of the invention, the isolator may be made by
attaching rip-stop lining 46 at one or both the openings up to the neck section of the isolator as
illustrated in FIG. 14. This rip-stop lining 46 at the inner side helps in avoiding cut or tear of
isolator during use of sharp instruments (e.g. trocar) through it. The rip-stop lining 46 may be
made from Nylon or any suitable material that resists tearing.
In another embodiment, the inner layer of the isolator may be made from slippery material or i
may have a coating of slippery material. The slippery material can be lubricious or hydrophilic or
hydrophobic or gel. The coefficient of friction () of hydrophilic coatings may range from 0.01
to 0.3. The inner layer may also be so slippery so as to prevent the sharp instrument from cutting
the isolator. Further the slippery material may help to place the tissue with ease into the isolator.
Further, it may help in free rotation of the tissue during morcellation or cutting inside the
isolator.
In accordance with yet another embodiment of the invention, the isolator can be made of more
than one layer of membrane. A liquid or gel material may be filled in between at least two layers.
In case the layer is cut, the fluid can spill out indicating the user to stop or change the plan of
surgery. I one of the variations, the inner layer may be opaque white and the fluid/ gel may be
blue or any other color so that as soon as the layer is cut, it can give a visual indication of the cut.
In accordance with yet another embodiment of the invention, the isolator can be made of
alternate variable thickness material with first thickness region and second thickness region.
Thick section can provide strength and shape to the isolator.
n accordance with yet another embodiment of the invention, the isolator may have two or more
openings as shown in FIG. , FIG. 16 and FIG. 17. In one of the embodiment one of the
openings 50 will be along the top section and rest of the openings will be on the top section or on
the Upper side of the isolator. After placement of tissue 4 inside the isolator, any or all the
openings may be exteriorized from the incisions on the abdomen. A or any one of these
openings may be sealed by trocar, through which grasper or laparoscope can be passed. Trocar
may be used to pass gas inside the isolator to inflate it.
In one embodiment of the invention, shown in FIG. 16, the isolator may also be used having two
or more openings. All or any of the openings (except for the openings being used) can be closed
by purse string 51 or a closure element such as the one shown and described in FIG. 5 or closed
in various other ways and can be opened by the user as and when needed. All the openings
coming out of the abdominal ports may be held in place by the friction between isolator neck
section and abdominal wall. Alternatively the opening can be tied by sutures to the outer
abdominal wall with the help of structure 77 as shown in FIG. 28.
In another embodiment of the invention, shown in FIG. 17, some openings may optionally be in a
closed state 52 while other openings may be in open state 53 or all openings may optionally be in
closed state 52. The open state openings can be used to place the tissue into the isolator. The
closed state opening may be used when instruments such as laparoscopic graspers or morcellator
needs to be passed to aid in the morcellation procedure. As illustrated in FIG. 18, FIG. 19 and
FIG. 20, instrument such as piercing tools can create an incision in the closed opening so that the
required instrument can pass through it. On passage of the instrument, the incision may create a
leak-proof seal around the periphery of the instrument due to material property of the isolator.
After completion of tissue morcellation, those openings may be closed by purse string or a
closure element to lock it, so that tissue or blood or fluid does not leak out during removal of
isolator. In another embodiment of the invention, the unused closed openings may be left inside
the abdomen during surgery.
In yet another embodiment of the invention, there may be two or more openings placed in an
orderly manner or in a random manner. Any of these openings may have sealing element.
In accordance to yet another embodiment of the invention as shown in FIG. 2 , the isolator has
two or more openings. At least one of the openings optionally includes two or more channels 55
for passage of laparoscopic instruments. All or any of these channels 55 may contain valves for
sealing and gas inlet. Alternatively, all or any of the channels may be closed and the user can
puncture the closed end to access the central body portion of the isolator.
In yet another embodiment of the invention, shown in FIG. 22, at least one opening of the
isolator optionally includes multiple extruded channels 56 extending out. The extruded channels
56 help in using the isolator in a single opening laparoscopic surgery with multiple working
channels. In similar way there may be multiple extruded channels 56 connected at the edge of
the opening to prevent the entanglement of the extruded channels with one another during
passage of the isolator into or removal of the isolator from the abdominal cavity.
The isolator is inserted inside the abdomen and it may be inflated. In an embodiment, a separate
tubular structure 57 meant for C02 or gas passage may be attached to the wall of the isolator as
shown in FIG.23. The tubular structure 57 may be attached to the inner wall of the isolator by
methods such as adhesive bonding or heat sealing. The tubular structure 57 may be outside or
may be inside the isolator. The tubular structure 57 can be removable from the isolator in one of
the embodiments. In yet another embodiment, the tubular structure 57 niay be made integral to
the isolator.
In accordance to yet another embodiment of the invention, illustrated by FIG. 24, the isolator
may have a network of tubular channels 60 on its body. All of them are connected to an annular
chamber 62 at the openings of the isolator. The annular chamber has a one way valve to retain
C02/ gas/ fluid inside the tubular channels. The isolator can have water proof elastic or nonelastic
sheath 61 between the networks of annular channels to prevent spillage of fluid out of the
isolator. Tissue may be placed inside the isolator through one of the openings. Optionally tissue
can be placed inside through the flap 63 with or without a valve. This embodiment may not
require insufflation of the abdominal cavity as the network of annular channels can provide the
required reinforcement and make a clear working area available within the isolator.
In the embodiments described below, the tissue isolator optionally comprises at least one sealing
element to seal the opening of the isolator so that the isolator can be inflated in the body. These
scaling elements may be in attachable form or releasably attachable or the opening itself may act
as seal when morcellator or instruments are passed or when the opening is not in use. Various
sealing elements mentioned below may be used together or separately during the procedure.
I another variant embodiment of the invention as shown in FIG. 25, the opening of the isolator
may have a pre-attached sealing element 71 such as a sealing valve with insufflation port 70. The
sealing valve of the said sealing element can be like the seal valve of a trocar with insufflation
port. The embodiment serves a dual purpose of isolator and trocar and hence a separate trocar is
not required to be passed through the opening of the isolator.
In another embodiment as shown in FIG. 26, the whole sealing element with insufflation port 70
similar to the sealing element 7 1 (FIG. 25) may be made as reusable and releasably attachable
part 69 which can be attached to seal connector 72 by means of different locking mechanisms
such as snap lock, twist lock, thread lock.
In another embodiment of the invention,' shown in FIG. 27, a lock ri 74 may be used as sealing
element for locking and sealing the opening on the abdomen. The lock rim 74 may have a curved
feature at its edges in which the flexible element such as flexible element 25 (FIG. 8) of the
isolator opening can be rolled or wrapped. Thus, the flexible element can be held in the circular
hook 73 at the periphery of the lock rim 74. Due to the elastic property of the lock rim 74 the
said flexible element can be held in the lock rim. The inner area of the lock rim may have a valve
feature 75. The lock rim 74 may be of a size preferably larger than the size of the abdominal port
so as to prevent the isolator from sliding into the body. In an embodiment shown in FIG. 28, the
lock rim 74 may have at least one tab 77 with hole through which, sutures 76 can be passed o
secure the lock rim onto the abdomen.
In another embodiment, as shown in FIG. 29, the lock rim may be divided into two parts, upper
rim 78 with valve 75 and bottom rim 7 . The upper rim 78 and bottom rim 79 can have mating
locking features such as threading or snap fit to releasably attach the upper rim 78 with bottom
rim 79. The bottom rim can have a holding feature 80 to hold the flexible element of the isolator
in place as shown in FIG. 30. The outer periphery of the bottom rim may have features such as
the tab 77 with hole, described in FIG. 28, which can be used to fix the rim in its position on the
abdomen. The upper rim 78 can be removed to access the abdominal port and it may be attached
to bottom rim 79 to seal the abdominal port if the abdominal post is not in use.
In yet another embodiment of the invention, illustrated by FIG. 31, the isolator opening such as
isolator opening 2 can be taken out from an abdominal port and a mini trocar 81 like device or
cap with universal seal as sealing element may be releasably attached to the opening of the
isolator. This can prevent leak and act as an access port. This mini trocar can be used to provide
the passage for the morcellator or for laparoscopic instruments into the isolator in such a manner
that the tip of the morcellator or instruments do not come in contact with the isolator thereby
preventing any damage to the isolator.
In another embodiment of the invention, shown in FIG. 32, the attached structure 82 at the
isolator opening may have metal ball 83 as sealing element and elastomeric pad 84 at its side.
The metal ball 83 can seal the opening when there is no device passing through the opening.
During insertion of device through the opening, the device can press and move the metal ball 83
to one side by pressing onto the elastomeric pad 84.
In yet another embodiment of the invention, shown in FIG. 33, the opening of the isolator can
have a locking feature 86 such as threading, snap fit that can be releasably locked onto a mating
locking feature 85 on the morcellator 5. This can help in avoiding spillage and the isolator need
not be outside the body.
In embodiment of the invention described below, the tissue isolator optionally comprises at least
one closure element supplied with the isolator to close the opening of the isolator in a leak-proof
manner so that the isolator can be safely removed from the body after morcellation is completed.
These closure elements may be in attachable form or releasably attachable form or may be
movable upwards and/or downwards along the isolator during use or it can be integral part of the
isolator itself or it can formed as a procedural step. The following embodiments explain the
closure of the isolator using closure element for removal from the body without spillage of blood
and tissue after morcellation. Various closure elements mentioned may be used together or
separately during the procedure.
In an embodiment of the invention, illustrated by FIG. 34, one of the openings of the isolator can
be tied into the knot 90 acting as a closure element so that it can be removed outside from the
body by pulling it as shown in the FIG. 34. The knot 90 may be tied at particular points or at
particular identification marks, even above or below any identification mark so that it provides
proper closure for the removal. The knot may be tied below line 32 as shown in FIG. 12 for
removal of the isolator.
In a preferred embodiment as shown in FIG. 35 and FIG 36, closure elements 91 or 96
respectively, may be provided as a separate component. After completion of the morcellation
procedure, the closure element can be opened, positioned approximately around the opening of
the isolator and locked thereby sealing the opening to avoid any kind of fluid leakage.
Closure elements shown in FIG. 35 and FIG. 36, may have at least one rib 92, with optional
protruded features 95 to press onto the isolator and completely close the area above an below
the opening thereby preventing any fluid from coming out of the opening. The closure elements
can further have locking snap 94 to hold the closure element in locked position. The two sections
of the closure element may be connected by living hinge 93. The closure element may be open
from both the ends, so that isolator opening can pass through it.
In yet another embodiment as shown in FIG. 37, closure element 107 may contain at least two
parts - the body 97 and latch section 99. The body of the closure element may have a lock snap
98 and hinge pin 100. The latch may have locking /sealing teeth 103, hinge pin 100 to assemble
with the body and a locking dimple feature 102 to lock with snap 98 in the body 97. The isolator
opening can be compressed between latch teeth 103, hood feature 101 and the body surface to
seal the opening. The lock snap 98 can hold the latch 99 tightly to complete the closing
procedure.
In another embodiment of the invention, shown in FIG. 38, the isolator can be twisted around at
least one closure element which is a clamp 104. The clamp can be elongated with a frame formed
by two sides, a top support member, middle member and bottom member extending transverse to
create two openings 105, and the isolator weaving through the openings and around the top and
bottom support members. On placement of the isolator in the clamp, it can be pressed into a lock
106 thereby closing the opening of the isolator.
In another embodiment of the invention, at least one adhesive tape/sticker may be provided with
the isolator as closure element. User can remove peel-off paper from the adhesive tape and apply
on the opening to permanently seal it. This can also avoid reusing of isolator.
Various other embodiments are described herewith for tissue insertion, morcellation and
extraction using the isolator.
In one embodiment of the invention, illustrated by FIG. 39, the isolator may have a rod 110
attached to the center or off center of the isolator with a sharp tip 111 meant for piercing the
tissue. The central rod can have a stopper 112 on it to prevent any tissue from sliding down
towards the isolator once the tissue is mounted on the rod. The stopper can maintain a safe
distance between the tissue and the isolator body and keep the morcellator blade away from the
isolator body thereby preventing damage to the isolator. The morcellator may optionally have an
external guide tube, which can be guided over the rod to cut tissue 4 without damaging the
isolator.
In accordance to yet another embodiment of the invention, illustrated by FIG. 40, the isolator
may be made up of two disjoint layers. The outer layer may be made of an elastic material and
the inner layer may be made of wire mesh 113. Tissue 4 can be placed inside the inner wire
mesh 113. The isolator opening can be then taken out through the abdominal port. Before
morcellation, gas can be passed into the outer layer to inflate it. The morcellator 5 can be passed
into the mesh 113 to morcellate the tissue 4. Morcellation of tissue inside the inner mesh can
avoid accidental cut or damage of the isolator by the morcellator or instrument. Wire mesh can
act as a pushing/ pulling element to aid in morcellation of the tissue. Thus it can avoid spillage of
the small cut tissue fro the isolator.
As illustrated in FIG. 41, an optional introducer may be supplied with the isolator for easy
introduction of the isolator inside the body. The introducer 120 may be an elongated member. t
may have a slit 121 on its body for placement of the isolator 1 in a folded condition.
The distal end 122 of the introducer 120 may be beveled or tapered so as to minimize the force
required during insertion. The proximal end 124 may have a gripping feature which may be a
single tail 123 like feature or it may have multiple tails to easily hold and pull it out once the
isolator 1 is delivered inside the body cavity. Optionally the introducer may have markings for
easy identification during use.
The following description provides for a method of isolation. FIG. 42 shows the isolator with
openings and an introducer 120. The isolator 1 in folded form or rolled form can be placed inside
the introducer such that a portion of the opening of the isolator may be exposed beyond the distal
end of the introducer as shown in FIG. 42. The introducer 120 with the folded isolator may then
be introduced inside the abdomen as shown in FIG. 43 and the abdomen can be filled with gas.
The isolator can be then be pulled out of the introducer 120 leaving the isolator completely inside
the body by pulling it with a grasper 126 that is inserted into the body from the other port 125, as
shown in FIG. 43. The introducer can then be removed from the body. The opening of the
isolator can be self-opening due to a flexible element such as flexible element 27 (FIG. 9). The
tissue 4 can then be placed inside the opening of the isolator with a grasper 126 as shown in FIG.
44. The opening can be grasped with a grasper 127 and pulled out of the body such that the tissue
4 is contained inside the isolator as shown in FIG. 45.
The openings are now outside the body as shown in FIG. 46. If there are more openings to the
isolator, all or any of the openings may be taken out of the body or may be left inside or the
openings may be closed state 52 (FIG. 17) to be formed later as per requirement. Orientation of
the openings of the isolator which are outside the body can be checked and twisting, if found,
can be removed by adjusting the orientation of the openings suitably as per the identification
mark 33 as shown in FIG. 12 . A trocar 125 can be passed through the opening as shown in FIG.
47 that seals the opening 2 of the isolator and the isolator can be insufflated. A laparoscope 7 can
be passed through the trocar 125 for visualization. A tissue morcellator can be passed through the
opening 3 of the isolator. Due to elasticity of the material or optional trocar, the gas leakage from
the isolator can be prevented thereby providing a clear work area to perform morcellation,
cutting or shredding of the tissue. The tissue 4 can be morcellated inside the isolator and the
morcellated pieces can be taken out of the body using grasper passed through the morcellator.
After morcellation is complete, the morcellator can be taken out from the opening, and the trocar
and laparoscope can be taken out from the other opening, the isolator can then be deflated and
the opening can be closed by closure element described above or by various other embodiments
as illustrated above. Closing of the opening ensures that residual tissue fragments and/or tissue
fluids and/or blood, if any, contained within the isolator after completion of morcellation will not
leak out into the body. The isolator can then be manually pulled out of the body by holding the
other opening.
The isolator in any of the embodiments may be supplied as pre-packaged within the introducer or
it may be folded and placed into the introducer at the time of surgery.
In another embodiment of the introducer, shown in FIG. 48, the isolator 1 may be contained
inside an introducer 120. A pusher 128 may be placed inside the introducer. The pusher 128 can
push the isolator into the body cavity. The pusher 128 may be releasably attached onto the
opening of the isolator. •
In another embodiment of the introducer, the introducer may have quick release live hinge
linearly for easy opening and closing. This may provide for easy insertion of isolator inside
introducer.
In various embodiments below, methods and device structures are described for pulling the
isolator.
In accordance to one embodiment of the invention, various pulling elements of the isolator
opening have been mentioned which may have at least one grasping feature such as holding ring,
hook or tab. which may be used to manipulate the isolator. As shown in FIG. 49, the opening
may have one or more staggered lips 130 extending outward from the top edge of the opening.
This may help ihe user to pick only one edge at a time using a grasper. Markings on the edges
may help to distinguish between the top edge and the underlying edge.
In yet another embodiment of the invention, the isolator may have at least one protruded
structure 1 made up of the same material bonded at critical points all over or in some parts
over its body. This may allow easy grasping and manipulation of the isolator within the
peritoneum. As shown in FIG. 50, the isolator may have one or multiple protruded structure 131,
which may help in easy holding of the isolator by grasper 127 and pulling out from abdominal
port.
In yet another embodiment of the invention, shown in FIG. 51, the isolator may have a thread
132 attached to its opening to help in identifying and pulling out the opening; the opening may
be used from any of the abdominal ports as required and the opening may be pu!ied from any of
the ports.
In yet another embodiment of the invention, shown in FIG. 52, the shape of the isolator may be
such that the tissue can be maintained tangential to the morcellator 5. The free end of the isolator
may have at least one attachment 133 to be pulled along the axis of the morcellator 5 during
morcellation so that the isolator forces the tissue to be always tangential to the morcellator and
the size of the isolator decreases with the decreasing size of the tissue. Advantage can be that, a
separate instrument may not be needed to manipulate the tissue as the isolator itself can be used
to manipulate the tissue.
There are various embodiments illustrated below for placement of tissue into the isolator and for
insertion of isolator into the abdomen.
In yet another embodiment of the invention, shown in FIG. 53, and FIG. 55 a pull thread 135
may be passed through support strips 134 attached to the isolator. Support strips are loop like
feature to receive the thread. Support strips may be part of the isolator or attached to the isolator.
The support strips may be continuous or intermittent. Optionally the pull thread 135 may be
attached at the opening of the isolator which forming a loop 136. As shown in FIG. 54, a grasper
126 may be introduced through the isolator and the pull thread 135 may be pulled to crumple 137
the isolator, which can help in easy exit of the grasper tip from the opening. There may be single
or multiple loops at the opening, the user can hold these loops with the grasper to stabilize the
opening while pulling the tissue 4 inside the isolator. The support strips, may he lp the isolator to
regain its shape when gas is passed into the isolator or otherwise. The support strips may be
placed along the edge of the isolator.
According to another embodiment of the invention, shown in FIG. 56, the isolator opening ma
have a split passage 139 for the purse string. This limited spilt passage 139 may decrease total
volume of the folded isolator thereby helping in easy passage of the isolator through the
abdominal port.
In an embodiment of the invention, shown in FIG. 57, to create more space for th working area
inside the abdomen, the isolator central body portion may be in the form of bellow 138. The.
bellow may be along the axis of the isolator or perpendicular to the axis of the isolator or circular
on either walls of the isolator. On inflating the isolator, these bellow type surfaces on both sides
of the central section can expand to create more space.
An alternative method is described below for performing the procedure of insertion, morcellation
and removal of isolator.
The isolator with openings may be passed into the abdomen filled with gas. A grasper or similar
instrument may be used to hold the opening and pass it through the abdominal port. Another
grasper is passed through another abdominal port may be used to pull the isolator inside the
abdomen wherein the other opening may or may not be pulled inside the abdomen. Thereafter,
one of the grasper 126 (FIG. 58) can hold the opening of the isolator to create clear passage for
separated tissue. A grasper 127 or similar instrument can be passed through another opening of
the isolator to grasp the tissue. The tissue 4 can then be pulled inside the isolator through the
opening as shown in FIG. 58. Thereafter, the grasper on the other side can pull the opening out
through the abdominal port as shown in FIG. 59. Supporting grasper 127 may be passed through
the opening of the isolator. Laparoscope 7 may be passed through other port in the abdomen.
After taking out opening of the isolator through another abdominal port, the morcellator can be
passed through it. Morcellation and subsequent steps of closing the isolator may be similar to as
described elsewhere in this disclosure.
In another embodiment of the invention, shown in FIG. 60, the deployer 145 may have a grasper
like tip 146 capable of holding onto the edge of the opening 147 of the isolator. The tip can
releasably latch onto the said edge of opening. It can remain latched until the deployer 145
pushes the isolator inside the body cavity. Once the isolator is inside the body cavity, the
deployer 145 can be triggered so as to release the opening of the isolator.
n another embodiment of the deployer, shown in FIG. 61, the deployer 145 may be flat shaped
made of metal or plastic, where its distal end may be curved fork 148 and proximal end may
have gripping handle.
In another embodiment of the deployer, shown in FIG. 62, the deployer 145 may have fork end
150 with linkages 151 controlled by the actuator or knob at the proximal end of deployer 145.
This embodiment may help in easy placement of tissue inside the isolator. Isolator with deployer
145 may be inserted inside the tube 149 and then pushed out as shown in FIG. 62.
In yet another embodiment of the invention, shown in FIG. 63, isolator may be packed in capsule
155 with at least two halves and passed through a trocar port into the abdominal cavity. Once the
cavity the two halves 156, 157 of the capsule can be separated from each other with the help of
two graspers, exposing the isolator as shown in FIG. 63. The two halves of the capsule 155 can
be taken outside the abdominal cavity as shown in FIG.64.
In yet another embodiment of the invention, illustrated by FIG. 65, the isolator 1 may be securely
packed inside the morcellator 5. This may help to supply isolator and morcellator together and
aid in ease of use. After separating tissue, the morcellator can be passed through preferably 0 to
8 mm port. The obturator 158 can push the isolator inside the abdomen for further use.
While the present invention has been illustrated by the description of the various embodiments
thereof, and while the embodiments have been described in considerable detail, it is not intended
to restrict or in any way limit the scope of the appended claims to such detail.
Additional advantages and modifications will readily appear to those skilled in the art. The
invention in its broader aspects is therefore not limited to the specific details, representative
apparatus and methods and illustrative examples shown and described. Accordingly, departures
may be made from such details without departing from the scope or spirit of applicant's general
inventive concept.
Claims
1. A tissue isolator for receiving tissue, said isolator comprising two or more openings.
2. The tissue isolator of claim 1, wherein the said tissue isolator is substantially curved shaped
to conform to an abdomen of the body.
3. The tissue isolator of claim 1, wherein at least one opening includes a flexible element.
4. The tissue isolator of claim 1, wherein the said tissue isolator comprises markings to identify
position and orientation of the isolator. ,
5. The tissue isolator of claim 1, wherein the said tissue isolator comprises at least one sealing
element.
6. The tissue isolator of claim 1, wherein the said tissue isolator comprises at least one closure
element.
7. The tissue isolator of claim 1 wherein at least one opening includes two o more channels.
8. The tissue isolator of claim 1, wherein the inner wall of the said tissue isolator has a slippery
coating.
9. An introducer for use in conjunction with the said tissue isolator of claim .
10. A deployer for use in conjunction with the said tissue isolator of claim 1.
11. A method of isolating and extracting tissue during a surgical procedure, comprising the steps
of:
(a) introducing a tissue isolator into an abdominal cavity;
(b) inserting the tissue inside the tissue isolator through the opening; and
(c) removing the tissue isolator out of the abdominal cavity.
12. The method of claim 1 , further comprises steps of:
(d) inflating the tissue isolator and morcellating the tissue inside the said tissue isolator
after step (b); and
(e) optionally closing the tissue isolator with at least one said closure element before
step (c).
13. The method of claim 11, wherein an introducer or deployer is used to facilitate insertion of
the isolator into the abdominal cavity.
14. The method of claim 11, wherein the tissue isolator is the tissue isolator of claim 1.