WO2001013804A1

WO2001013804A1 - Laparoscopic surgical instrument and method

Info

Publication number: WO2001013804A1
Application number: PCT/US2000/023022
Authority: WO
Inventors: Randy S. Haluck
Original assignee: The Penn State Research Foundation
Priority date: 1999-08-24
Filing date: 2000-08-22
Publication date: 2001-03-01
Also published as: AU6796100A

Abstract

A surgical instrument (10) is provided for use in performing endoscopic procedures having a handle (24, 26) and an elongate tubular member (14) having a proximal end coupled with the handle for being disposed externally of the anatomical cavity and a distal end for being disposed within the anatomical cavity. The distal end further includes a pair of opposed, relatively movable jaws (18, 20) that form a grasping portion operable by manipulation of the handle to releasably grasp a releasable trocar (83). The releasable trocar (83) has a complementarily shaped shank (87), a relatively sharp tip (92) and may include a pair of blunt-edge tissue separators (94) that project outwardly from the outer surface of the trocar (83). In an alternative embodiment, the relatively movable jaws (118, 120) define (i) a grasping portion operable by manipulation of the handle (24, 26) to grasp or cut objects; and (ii) a pair of blunt-edge tissue separators (124) that project outwardly from the outer surface of the jaws (118, 120) so that when the jaws are in a closed position they may be used as a trocar.

Description

Laparoscopic Surgical Instrument And Method

Field Of The Invention

The present invention relates generally to medical instruments and

procedures and more particularly, to an instrument for use in laparoscopic or

endoscopic surgical procedures.

Background Of The Invention

Endoscopic and minimally invasive medical procedures, such as

laparoscopy, have become widely accepted for surgery and illness diagnosis.

This is due to reduced trauma to the patient and reduced hospitalization time.

Other techniques exist for creating a working space within the abdominal cavity,

but the vast majority of laparoscopic operations worldwide are performed using

the technique of pneumoperitoneum.

At the beginning of all laparoscopic cases, a small incision is made,

followed by a small (1cm) hole in the remaining layers of the abdominal wall so

as to gain access to the peritoneal cavity. An alternative method of gaining

access to the peritoneal cavity is to insert a small needle through the abdominal

wall and to instill C0₂ through this needle into the peritoneal cavity. The

peritoneal cavity is usually inflated to a pressure of about 14cm H₂0. The

pressure of the pneumoperitoneum must be maintained at all times during the

operation. An automatic insufflation pump keeps C0₂ flowing to maintain a

preset working pressure. If pressure is lost, the working space collapses,

nothing can be seen, via a video system, and the operation comes to a halt. This

working pressure must be maintained despite the need to introduce and remove

cameras, instrumentation, and the like through the abdominal wall during the operat on.

The solution to this problem has been the development of laparoscopic

ports. These devices, in their simplest form, consist of tubes which penetrate the

abdominal wall to provide a path for the introduction, removal, and exchange of

instruments, etc. Prior art ports must be inserted through the abdominal wall.

This is usually done by the use of a sharp spike, known in the art as a "trocar,"

which is positioned within the lumen of the port, and inserted into the abdominal

wall so as to pierce it. The trocar is then removed from the lumen of the port.

Prior art ports also incorporate some type of valve or seal mechanism to create

an airtight seal around an instrument as it is slid through the port and into the

abdominal cavity. This is to prevent leakage from the pressurized

pneumoperitoneum. The seals must be efficient, as even seemingly small leaks

can exceed the maximum insufflation rate of C0₂ pump.

Most laparoscopic operations use pneumoperitoneum and a separate

port for each instrument. For example, for gallbladder removal (laparoscopic

cholecystectomy), two instruments are required for retraction, while another is

required for dissection, then often requiring three ports. An additional port is

required for the video camera bringing the total number of ports required to four

for performing a laparoscopic cholecystectomy. Instruments may be exchanged

through any of the ports at any time. Other common laparoscopic operations

including hernia repair, appendectomy, stomach surgery, and gynecologic

surgery require from three to five ports for performing each operation. Such

procedures commonly involve performing a number of individual acts or functions

within the anatomical cavity including grasping, cutting, coagulating, irrigating,

aspirating, puncturing, injecting, dissecting, cauterizing, ligating, suturing, illuminating, visua izing and/or co ect ng spec mens or opsy. Endoscop c instruments are often designed to perform only one of the above functions,

requiring several incisions for placement of multiple portals to accommodate a

suitable number of endoscopic instruments for performing the required functions

or necessitating frequent withdrawal and replacement of individual endoscopic

instruments through a single incision. In some instances, an endoscopic

instrument may be inserted into the abdomen of the patent and not removed until

the procedure is completed. Here, no instrument exchange is required, even

though a port is in place.

The majority of laparoscopic ports used are disposable. Reusable,

sterilizable ports are available, but have several drawbacks. In order to

purchase sufficient reusable ports to accommodate a moderate sized operating

room facility several thousands of dollars in capital expenditure is required by the

hospital. Known reusable ports are also somewhat difficult to maintain. Rubber

seals and valves crack and break with repeated use and sterilization.

Maintaining and replacing small seals and parts requiring disassembly of the

port is tedious and often results in lost or damaged parts. Also, the trocar

portion of the apparatus often becomes dull after several uses. Using a port that

is not sharp, or that leaks is frustrating for the surgeon and potentially dangerous

to the patient.

Summary Of The Invention

In one embodiment of present invention, a surgical instrument for use in

performing endoscopic procedures within an anatomical cavity is provided

comprising a handle and an elongate member having a proximal end coupled w e an e or e ng spose ex erna y o e ana om ca cav y an a s a end for being disposed within the anatomical cavity. The distal end further

includes a pair of opposed, relatively movable jaws that form a grasping portion

operable by manipulation of the handle to releasably grasp a releasable trocar.

The releasable trocar comprises a shank that is adapted for grasping, a

relatively sharp tip and may include a pair of blunt-edge tissue separators that

project outwardly from the outer surface of the trocar.

In an alternative embodiment, the relatively movable jaws define (i) a

grasping portion operable by manipulation of the handle to grasp; and (ii) a pair

of blunt-edge tissue separators that project outwardly from the outer surface of

the jaws so that when the jaws are in a closed position they may be used for

tissue penetration.

In another alternative embodiment of the invention, a portal tube is

sealingly positioned on the elongate member and is operative to move between

(i) a first position in which the portal is in a proximal location on the elongate

member and in spaced relation to the anatomical cavity, and (ii) a second

position in which the portal is in a distal location on the elongate member and in

sealed communication with said anatomical cavity.

In a further embodiment of the invention the optional portal may be used

with either the releasable trocar or the jaw trocar.

A method is provided for gaining access to an anatomical cavity

comprising the steps of providing a surgical instrument formed according to any

one of the foregoing embodiments of the invention. Manipulating the handles of

the instrument so as to close the jaws, and then pressing the jaws against the

tissue of the wall of the anatomical cavity so as to separate the tissue. The jaws are t en move to an operat ve s te w t n t e anatom ca cav ty. e orego ng method may include the step of positioning a portal between the separated

tissue while maintaining the jaws at the operative site, and may also be

performed with either the releasable trocar or the jaws having a pair of blunt-

edge tissue separators.

Brief Description Of The Drawings

These and other features and advantages of the present invention will be

more fully disclosed in, or rendered obvious by, the following detailed description

of the preferred embodiments of the invention, which are to be considered

together with the accompanying drawings wherein like numbers refer to like

parts and further wherein:

Fig. 1 is a perspective view an endoscopic instrument according to one

embodiment of the present invention;

Fig. 2 is a partially broken away, elevational view of the endoscopic

instrument shown in Fig. 1 ;

Fig. 3 is a partially broken away, elevational view of the endoscopic

instrument shown in Fig. 1 , showing a graspable trocar bit just prior to

engagement with the jaws of the instrument;

Fig. 4 is a perspective view of an endoscopic instrument according to an

alternative embodiment of the present invention;

Fig. 5 is an elevational view of an endoscopic instrument according to

another alternative embodiment of the present invention including an optional

use portal sleeve; FIG. 6 is a cross-sectional view of the optional use portal sleeve shown in Fig. 5, as taken along line 6-6 in Fig. 5; and

Fig. 7 is an elevational view of an endoscopic instrument according to a

further alternative embodiment of the present invention.

Detailed Description Of The Preferred Embodiment

The following description of the preferred embodiments of the invention

are intended to be read in connection with the foregoing drawings and are to be

considered a portion of the entire written description of this invention. As used in

the following description, terms such as, "horizonal", "vertical", "left", "right", "up",

and "down", as well as adjectival and adverbial derivatives thereof (e.g.,

"horizontally", "rightwardly", "upwardly", etc.) simply refer to the orientation of the

structure of the invention as it is illustrated in the particular drawing figure when

that figure faces the reader. Similarly, the terms "inwardly" and "outwardly"

generally refer to the orientation of a surface relative to its axis of elongation, or

axis of rotation, as appropriate. Also, the terms such as "connected" and

"interconnected," when used in this disclosure to describe the relationship

between two or more structures, means that such structures are secured or

attached to each other either directly or indirectly through intervening structures,

and includes pivotal connections. The term "operatively connected" means that

the foregoing direct or indirect connection between the structures allows such

structures to operate as intended by virtue of such connection.

The endoscopic instrument of the present invention can be utilized in any

type of anatomical cavity. Accordingly, while the invention is described

hereinafter for use with laparoscopy procedures, the invention can be used with catheters and other small or large diameter tubular or hollow, cylindrical members providing access to small cavities, such as veins and arteries as well

as large cavities, such as the abdomen.

Referring to Figs. 1-3, an endoscopic instrument 10 formed in

accordance with the present invention, includes a housing 12, an outer tubular

member 14 extending distally from the housing 12, an inner tubular member 16

telescopically fitted within the outer tubular member and terminating distally in a

pair of opposed jaws 18 and 20, and a handle portion formed of a fixed handle

24 and a movable handle 26.

More particularly, housing 12 includes longitudinally spaced front and rear

walls 28 and 30 that are oriented perpendicular to a longitudinal axis of

endoscopic instrument 10. A top wall 32 is disposed in substantially parallel

relation to the longitudinal axis. A bottom wall 34 includes a concave forward

portion 36 that curves downwardly from front wall 28 to connect with an upper

end of fixed handle 24. A rearward portion 38 of housing 12 extends proximally

at an angle relative to the longitudinal axis of endoscopic instrument 10 from an

upper end of handle 24 to rear wall 30. A lower end of fixed handle 24 is

configured as an elongate finger loop 40 to accommodate one or more fingers

of a user. Movable handle 26 is pivotally mounted on a pin 42 proximally spaced

from fixed handle 24 and secured internally to a wall or walls of housing 12. A

lower end of handle 26 is configured as a finger loop 44 to accommodate one or

more fingers of the user, and a pair of arcuate mating protrusions, shown by

broken lines at 46 and 48 in FIG. 2, can optionally be carried in opposed relation

on finger loops 40 and 44 for ratcheting engagement during use. Movable

handle 26 includes an arcuate end portion 50 disposed within housing 12 and defining a plurality of gear teeth 52 on a side of pin 42 opposite finger loop 44. Outer tubular member 14 is open at both ends and extends distally from

housing 12 through an opening in front wall 28. Distal end 54 of outer tubular

member 14 can be blunt as shown, tapered, beveled, slotted or chamfered as

desired or have any other suitable distal configuration. Preferably, outer tubular

member 14 comprises a cylindrical cross-section along its length, and is formed

from a substantially rigid material, such as stainless steel or other biocompatible

metal or polymer material. Proximal end 56 of outer tubular member 14 is

movably disposed within housing 12, and carries a rack 58 in spaced relation to

toothed end portion 50 of handle 26. A pinion gear 60 engages rack 58, and is

mounted on the same shaft as a reduction gear 62 which meshingly engages

toothed end portion 50 of handle 12 to convert relatively small rotary or pivotal

movement of handle 12 into significantly larger linear movement of rack 58.

It will be appreciated that counterclockwise rotation of handle 26 about

pin 42 results in proximal movement of outer tubular member 14 relative to

housing 12 and that clockwise rotation of handle 26 about pin 42 results in distal

movement of outer tubular member 14 relative to housing 12. In a preferred

embodiment, movable handle 26 is biased in a clockwise direction toward fixed

handle 24, for example by use of a torsion spring (not shown) coiled around pin

42 and connected between movable handle 26 and fixed handle 24 and/or

housing 12.

The handle portion of the endoscopic instrument shown and described

herein is exemplary of the types of conventional handle mechanisms suitable for

performing the function of actuating the jaws; accordingly, the handles can have

any configuration to actuate the jaws including, but not limited to, configurations employing a pair of pivotally connected arms, one fixed and one pivoted arm, a pistol grip with a movable trigger, or resilient U-shaped handle members.

Further, the handle portion of the instrument can be configured to rotate relative

to a pivot axis oriented perpendicular to the longitudinal axis of the instrument so

that, for example, in one position the handles will extend laterally from the

instrument or at a substantially perpendicular angle relative to the longitudinal

axis; while, in another position, the handles will extend proximally from the

instrument like scissor handles.

Inner member 16 includes a tubular portion 64 telescopically fitted within

outer tubular member 14, and defining a lumen or channel 66 through

endoscopic instrument 10. The proximal end of inner member 16 extends

through the proximal end of outer tubular member 14 within housing 12. The

distal end of tubular portion 64 is bifurcated or split longitudinally to form integral

one-piece jaws 18 and 20 in opposed relation, the jaws being normally biased

apart as shown in FIG. 3. Tubular body 64 is preferably formed with jaws 18 and

20 as a single unitary part using a resilient biocompatible material such as, for

example, a spring steel or an elastomehc polymer material having suitable

elastic properties for normally biasing the upper and lower jaws apart while

permitting the jaws to be moved toward one another in response to forces acting

on the outer jaw surfaces and/or cams as a result of relative axial movement

between outer tubular member 14 and inner member 16.

In a first embodiment of the present invention, jaws 18 and 20 cooperate

to define a grasping portion at a distal end having opposed inner surfaces 80

and 82. Jaws 18 and 20 include means 81 for grasping a releasable trocar 83.

More particularly, grasping means 81 may include a combination of indentation, recess, protrusions or teeth that are arranged for securely holding releasable trocar 83 when closed. Releasable trocar 83 preferably comprises a conical

profile to facilitate the penetration or dissection of tissue, and includes a shank

87, a base 90, and an apex 92. Shank 87 comprises a relatively elongate shaft

that projects outwardly from the center portion of base 90, and includes a series

of indentations, recesses, protrusions or teeth that are arranged in a

complementary pattern corresponding to opposed inner surfaces 80 and 82 of

jaws 18 and 20. Base 90 has a diameter substantially equivalent to that of inner

member 16. Apex 92 is pointed so as to be capable of piercing or separating

tissue without inflicting severe trauma. In some cases, a pair of blunt-edged

blades 94, or tissue separators, are positioned on the outer conical surface of

trocar 83. Blunt-edged blades 94 are arranged in circumferentially spaced

relation to one another, and project outwardly from the conical surface of trocar

83 to facilitate the penetration or .

Instrument 10 is used in connection with the foregoing first embodiment of

the invention in the following manner. Since inner member 16 is fixed relative to

housing 12 actuation of jaws 18 and 20 is controlled by moving outer tubular

member 14 relative to inner member 16. If closed, jaws 18 and 20 can be

opened by moving outer tubular member 14 proximally relative to inner member

16. Movement of outer tubular member 14 over inner member 16 is controlled by

operation of movable handle 26. Counterclockwise rotation of handle 26 about

pin 42 results in clockwise rotation of reduction gear 62 which, in turn, causes an

equal angular rotation of pinion 60. Pinion 60 is of greater diameter than

reduction gear 62 so that, for equal angles of rotation, pinion 60 will produce

greater circumferential displacement. Pinion 60 engages the gear teeth of rack 58 to cause proximal movement of outer tubular member 14 relative to jaws 18 and 20 thereby permitting the jaws to move resiliently to the open position,

shown in FIG. 3. In the open position, jaws 18 and 20 are biased apart such that

grasping means 81 are angularly spaced from one another allowing shank 87 of

trocar 83 to be positioned between jaws 18 and 20. Clockwise rotation of

handle 26 about pin 42 results in counterclockwise rotation of reduction gear 62

and pinion 60 causing distal movement of rack 58 and outer tubular member 14

relative to the jaws so that distal end 54 of outer tubular member 14 will slide

over the jaws in an axial direction causing the jaws to be cammed inwardly from

the open position to a closed position. As the jaws move from the open position

to the closed position, grasping means 81 rotate toward one another to grasp

shank 87. More particularly, the complementary indentations, recesses,

protrusions or teeth engage one another to securely clamp trocar 83 between

jaws 18 and 20. It will be understood that arcuate mating protrusions 46 and 48

latched together to maintain handle 26 in position related to fixed handle 24, and

thereby maintain jaws 18 and 20 in gripping relation with shank 87 of trocar 83.

Once trocar 83 is installed, instrument 10 may be guided, by hand, to the

wall of an anatomical cavity. Instrument 10 is advanced distally through the

abdominal wall with jaws 18 and 20 disposed in a tightly closed configuration

around shank 87 of trocar 83. Once the abdominal wall has been pierced by

trocar 83, the instrument can be manipulated externally of the body to position

the jaws so that trocar 83 may be released and removed from the operative site,

via a retrieval tool that has been positioned within the abdomen through a portal.

Various grasping and cutting functions can be performed at the operative site

using different tools that have been affixed to jaws 18 and 20, via a similarly arranged shank 87, and by operating the handles of the instrument to open and close the jaws as required.

Movable handle 26 is preferably proximally spaced from fixed handle 24

as shown so that the user can maintain one or more fingers on the stationary

handle 24 while operating the movable handle 26 with the thumb and/or other

fingers of the hand. Movable handle 26 is preferably biased in a clockwise

direction, looking at FIG. 3, toward stationary handle 24 so that, when the

movable handle is released, outer tubular member 14 will be automatically

moved over jaws 18 and 20 to close the jaws together to hold trocar 83 between

the jaws.

Referring to Fig. 4 in an alternative embodiment of the present invention

an instrument 100 is provided with a pair of jaws 118 and 120 comprising a pair

of blunt-edged blades 124, or tissue separators, that are positioned on the outer

surface of jaws 118 and 120. Blunt-edged blades 124 are arranged in

circumferentially spaced relation to one another, and project outwardly from the

outer surface of each jaw 118 and 120. The respective tip portion 126 of jaws

118 and 120 may be complementarily conically shaped so that when jaws 118

and 120 are disposed in a closed position they form a substantially sharp

obturator tip to facilitate the penetration or dissection of tissue. It will be

understood that other profile shapes for jaws 118 and 120 may be used in

connection with the invention, e.g., square, rhomboidal, or any other combination

of flat surfaces and angled corners capabable of tissue penetration.

In use, instrument 100 is guided to the wall of an anatomical cavity, with

jaws 118 and 120 in a closed position. Instrument 100 is advanced distally

through the abdominal wall with jaws 118 and 120 acting as a trocar to pierce and separate the tissue of the abdominal wall. Once the abdominal wall has been pierced by instrument 100, the instrument can be manipulated externally of

the body to position jaws 118 and 120 adjacent to an operative site. Various

grasping and/or cutting functions can be performed at the operative site using

different portions of the jaws and by operating the handles of the instrument to

open and close the jaws. It will be understood that the inner surfaces of jaws 118

and 120 may include blades, teeth, indentations, or the like that are adapted for

use in laparoscopic surgical procedures. It will also be understood that both

laparoscopic instruments 10 and 100 allow for easier axial manipulation, and at

shallower angles relative to the surface of the anatomical cavity, than with prior

art laparoscopic instruments. Further, the axial movement of instruments 10 and

100 is enhanced due to the low coefficient of friction between the outer surface

of outer tubular member 14 and the edges of the incision.

Referring to Figs. 5 and 6, a further alternative embodiment of the present

invention provides an optional portal 200 that is slidably and sealingly positioned

over a portion of outer tubular member 14 of instrument 210. More particularly,

portal 200 comprises an elongate cannula 215, a frusto-conical tip 218, and a

hub 221. Cannula 215 is formed from a relatively rigid, biocompatible metal or

polymer material, and defines a distal opening 224, a proximal opening 227,

and a longitudinally extending lumen 230 that communicates with both openings.

Frusto-conical tip 218 is formed on the distal end of cannula 215 and surrounds

distal opening 224. Hub 221 projects radially outwardly from the proximal end of

cannula 215 to form an annular shoulder 233. An o-ring seal 236 is positioned

within lumen 230, adjacent to proximal opening 227, and in concentric relation to

hub 221. O-ring seal 236 comprises an inner diameter that is smaller than the diameter of outer tubular member 14, and is securely fastened to the inner surface of cannula 215 so as to be fixed in place.

Portal 200 is positioned on the outer surface of outer tubular member 14

by simply orienting instrument 210 so that the jaws are positioned in coaxial

confronting relation with proximal opening 227. Once in this position, instrument

210 is moved toward portal 200 so that the jaws enter proximal opening 227 and

lumen 230. As this occurs, o-ring seal 236 sealingly engages outer tubular

member 14, and slides along its surface as portal 200 is slid onto instrument

210.

If, during a laparoscopic procedure, a surgeon determines that a portal is

required, he need only push on hub 221 with sufficient force to cause portal 200

to sealingly slide along outer tubular member 14 until frusto-conical tip 218

enters the abdominal wall through the previously created incision. O-ring seal

236 prevents gas leaking from the pneumoperitoneum through cannula 215. The

outer surface of portal 200 is preferably textured to enhance engagement with

the edges of the incision so as to promote the ceiling and anchoring of portal

200 within the pneumoperitoneum. Portal 200 allows for easy instrument

exchange by the surgeon.

Figures 5 and 7 show embodiments of the present invention wherein a

releasable trocar 83 or a pair of jaws 118 and 120 forming a pair of blunt-edged

blades or tissue separators are combined with a portal 200.

It is to be understood that the present invention is by no means limited

only to the particular constructions herein disclosed and shown in the drawings,

but also comprises any modifications or equivalents within the scope of the claims.

Claims

What Is Claimed Is:

1. A surgical instrument for use in performing endoscopic procedures

within an anatomical cavity comprising:

a handle; and

an elongate member having a proximal end coupled with said handle for

being disposed externally of the anatomical cavity and a distal end for being

disposed within the anatomical cavity and carrying a pair of opposed, relatively

movable jaws, said jaws defining a grasping portion operable by manipulation of

said handle to releasably grasp a trocar.

2. A surgical instrument according to claim 1 wherein said releasable

trocar includes at least one tissue separator that projects outwardly from the

outer surface of said trocar.

3. A surgical instrument according to claim 1 wherein said jaws

cooperate to define a grasping portion at a distal end having opposed inner

surfaces including means for grasping said releasable trocar said grasping

portion operable by manipulation of said handle to releasably grasp and

securely clamp said trocar for penetration of the wall of said anatomical cavity

with said surgical instrument.

4. A surgical instrument according to claim 3 wherein said grasping

means includes a combination of indentations that are arranged in a pattern on

said inner surfaces of said jaws for securely holding said releasable trocar when

said jaws are disposed in a closed position.

5. A surgical instrument according to claim 4 wherein said releasable trocar comprises a conical profile to facilitate the penetration and dissection of

tissue, and includes a shank, a base, and an apex wherein said shank includes

an elongate shaft projecting outwardly from a center portion of said base and

having a plurality of indentations that are arranged in a complementary pattern

corresponding to said inner surfaces of said jaws.

6. A surgical instrument according to claim 5 wherein said base has

a diameter substantially equivalent to that of said elongate member.

7. A surgical instrument for use in performing endoscopic procedures

within an anatomical cavity comprising:

a handle; and

an elongate tubular member having a proximal end coupled with said

handle for being disposed externally of the anatomical cavity and a distal end for

being disposed within the anatomical cavity and carrying a pair of opposed,

relatively movable jaws;

said jaws defining (i) a grasping portion operable by manipulation of said

handle to grasp objects; and (ii) a pair of blunt-edge tissue separators that

project outwardly from the outer surface of said jaws.

8. A surgical instrument for use in performing endoscopic procedures

within an anatomical cavity comprising:

a handle; and

an elongate member having a proximal end coupled with said handle for

being disposed externally of the anatomical cavity and a distal end for being disposed within the anatomical cavity and carrying a pair of opposed, relatively movable jaws;

said jaws defining (i) a grasping portion operable by manipulation of said

handle to releasably grasp and securely clamp a trocar for penetration of the wall

of said anatomical cavity with said surgical instrument; and

a portal tube sealingly positioned on said elongate tubular member and

operative thereon to move between (i) a first position in which said portal is in a

proximal location on said elongate tubular member and in spaced relation to

said anatomical cavity, and (ii) a second position in which said portal is in a

distal location on said elongate member and in sealed communication with said

anatomical cavity.

9. A surgical instrument according to claim 8 wherein said portal is

slidably positioned over a portion of said elongate member.

10. A surgical instrument according to claim 8 wherein said portal

comprises an elongate cannula having a distal opening, a proximal opening,

and a longitudinally extending lumen that communicates with both openings, a

frusto-conical tip formed on a distal end of said cannula and surrounding said

distal opening, and a hub projecting radially outwardly from a proximal end of

said cannula, and including an o-ring seal positioned within said lumen, adjacent

to said proximal opening, and in concentric relation to said hub, said o-ring

defining an inner diameter that is smaller than the diameter of said elongate

member.

11. A surgical instrument according to claim 8 wherein said releasable trocar includes a pair of blunt-edge tissue separators that project outwardly from

the outer surface of said trocar.

12. A surgical instrument according to claim 8 wherein said jaws

include inner surfaces comprising a combination of indentations that are

arranged in a pattern for securely holding said releasable trocar when said jaws

are disposed in a closed position.

13. A surgical instrument according to claim 12 wherein said

releasable trocar comprises a conical profile to facilitate the penetration and

dissection of tissue, and includes a shank, a base, and an apex wherein said

shank includes an elongate shaft projecting outwardly from a center portion of

said base and having a plurality of indentations that are arranged in a

complementary pattern corresponding to said inner surfaces of said jaws.

14. A surgical instrument according to claim 13 wherein said base has

a diameter substantially equivalent to that of said elongate member.

15. A surgical instrument for use in performing endoscopic procedures

within an anatomical cavity comprising:

a handle; and an elongate member having a proximal end coupled with said handle for being disposed externally of the anatomical cavity and a distal end for being

movable jaws;

said jaws defining (i) a grasping portion operable by manipulation of said

handle to grasp objects; and (ii) a pair of blunt-edge tissue separators that

project outwardly from the outer surface of said jaws; and

a portal tube sealingly positioned on said elongate member and

proximal location on said elongate member and in spaced relation to said

anatomical cavity, and (ii) a second position in which said portal is in a distal

location on said elongate member and in sealed communication with said

anatomical cavity.

16. A method for gaining access to an anatomical cavity comprising

the steps of:

(A) providing a surgical instrument for use in performing endoscopic

procedures within an anatomical cavity having a handle and carrying a pair of

opposed, relatively movable jaws that are operatively interconnected to said

handle;

(B) manipulating said handle so as to close said jaws;

(C) pressing said jaws against the tissue of the wall of said anatomical

cavity so as to separate said tissue; and

(D) positioning said jaws within said anatomical cavity at an operative

site.

17. The method of claim 16 including the step of: (E) positioning a portal between said separated tissue while maintaining

said jaws at said operative site.

18. A method for gaining access to an anatomical cavity comprising

the steps of:

(A) providing a surgical instrument for use in performing endoscopic

procedures within an anatomical cavity having a handle and an elongate

member and carrying

(i) a pair of opposed, relatively movable jaws at an end of said

elongate member that are operatively interconnected to said handle; and

(ii) a portal tube sealingly and slidingly positioned on said elongate

tubular member between said handle and said jaws;

(B) manipulating said handle so as to close said jaws;

(C) pressing said jaws against the tissue of the wall of said anatomical

cavity so as to separate said tissue;

(D) positioning said jaws within said anatomical cavity at an operative

site;

(E) sliding said portal to a distal position on said elongate member so as

to be in sealed communication with said anatomical cavity.

19. A method for gaining access to an anatomical cavity comprising

the steps of:

(A) providing a surgical instrument for use in performing endoscopic

procedures within an anatomical cavity having a handle and carrying a pair of

opposed, relatively movable jaws that are operatively interconnected to said

handle;

(B) manipulating said handle so as to securely clamp a trocar between

said jaws;

(C) moving said surgical instrument toward the wall of said anatomical

cavity so as to position said trocar against said tissue and so as to separate

said tissue; and

(D) positioning said jaws within said anatomical cavity at an operative

site.

20. The method of claim 19 including the step of:

(E) positioning a portal between said separated tissue while maintaining

said jaws at said operative site.