SURGICAL APPARATUS

摘要

Instruments (200A, 510, 610, 600A, 800A) for performing medical procedures in an interior portion, e.g., an insufflated abdomen (10), of the body of a living being from outside the body of the being via a small percutaneous incision or puncture (16, 514, 614, 2140). The instruments each include a distal portion having a working head in the form of a pair of jaws (210, 212, 530, 532, 630, 632, 230A, 232A, 610, 612, 610', 612', 610A, 612A), whose free end is sufficiently blunt as to not pose a danger to tissue within the abdomen. An extendable/retractable piercing device (300, 400, 620, 200C, 400A, 500A, 7000, 1000) which either forms a portion of the instrument or is separate therefrom is mounted on the distal end of the instrument and arranged to be extended to pierce through the skin to enable the working head to be passed through the skin and underlying tissue into the abdomen without the use of a trocar or other introducing device. A flange (408A, 4080, 1004) is provided in some embodiments to control the depth of penetration of the device. The instruments also include a proximal portion (202, 604A, 606A) arranged to be held outside the body of the being when the working head is located at the desired position. The piercing device is retractable from the instrument so that it doesn't pose a danger to internally located tissue. The instrument's jaws are opened or closed by manipulation of the proximal portion of the instrument to perform the procedure. After that is done the instrument is removed from the percutaneous incision or puncture, whereupon it seals itself.