US3384087A

US3384087A - Tracheotome

Info

Publication number: US3384087A
Application number: US322819A
Authority: US
Inventors: Brummelkamp Reindert
Original assignee: Individual
Current assignee: Individual
Priority date: 1962-11-12
Filing date: 1963-11-12
Publication date: 1968-05-21
Anticipated expiration: 1985-05-21
Also published as: NL108491C; GB1058910A; CH397148A; DE1224875B

Description

y 21, 1968 R. BRUMMELKAMP 3,384,087

TRACHEOTOME Filed Nov. 12, 1965 4 Sheets-Sheet 1 IN vroz RE/NDERT BRUMMEL K/IMP TTORNEY.

May 21, 1968 R. BRUMMELKAMP TRACHEOTOME 4 Sheets-Sheet 2 Filed Nov. 12, 1963 //v VEN TOR Ramos/e7 BRUMMBLKAMP 3 ATTo/e/vm y 1968 R. BRUMMELKAMP 3,384,087

TRACHEOTOME Filed Nov. 12, 1963 .4 Sheets-Sheet I;

Q I I FIG.7.

//v VENTOI? REM/MR7" BRuMMEL/mMP A TTORNE v.

May 21, 1968 R. BRUMMELKAMP TRACHEOTOME 4 Sheets-Sheet 4 Filed Nov. 12, 1965 FIG. 8

FIG.9

INVENTOR REINDERT BRUMMELKAMP United States Patent 0 3,384,087 TRACHEOTGME Rcindert Brummelkamp, Groenlosewsg l, Winterswijlr, Netherlands Filed Nov. 12, 1963, Ser. No. 322,819 Claims priority, application Netherlands, Nov. 12, 1962, 285,391; Nov. 1, 1963, 300,008 8 Claims. (Cl. 128305) The invention relates to a so-called tracheotome, therefore to an instrument for performing the tracheotomy.

The invention aims at providing an instrument which is very simple to handle and can be used entirely safely and quickly. There is a very great need of such an instrument especially since medical science has realized that asphyxiation is a complication inducing one of the most frequent causes .of death. The consequences of so-called asphyxiation manifest themselves only after some time after e.g. a traffic accident or in the battle-field and experience teaches that the shortage of oxygen and the excess of carbonic acid to which the body is temporarily exposed, lead to a progressive acidosis with all its deleterious consequences. One thing and another often results in death and there is an urgent need of a possibility to feed oxygen to the lungs as quickly as possible. For such purpose a tracheotomy with a tracheotome can be applied. Cleaning of the deeper bronchial tubes can be facilitated by it, whereas the so-called wet lung can be prevented from arising. The so-called dead space of the bronchial tubes is diminished by about 100 cc. and reduced to about 50 cc. by a tracheotomy so that also in restrained respiration oxygen may still enter the lungs.

Performing a tracheotomy with the existing apparatus on the spot of an accident or for example in the battlefield is fairly difiicult especially with a view to the prevailing conditions. The use of known tracheotomes requires a great carefulness so that the medical man prefers not to use said instrument on the spot of the accident but to first transport the patient to the hospital. The time required for transporting the patient may however cause and also mostly causes an increased asphyxiation.

Now the object of the invention is to provide a tracheotome with which, should the case arise, not only an experienced surgeon but even a less skilled family doctor can perform the required operation quickly and without danger of undesired consequences of its use.

Propositions have already been made for tracheotomes, with which by way of first aid with less danger for the patient tracheotomy can be performed. In fact a tracheotome is already known the object of which is to simplify Y tracheotomy, however the dangers of complications and failures are removed by it to a still insufiicient extent.

The known tracheotome, corresponding in certain respects with the tracheotome as per the invention, consists a.o. of a bent cannula provided at one end with a supporting-plate having fixing means, a correspondingly bent trocar, slidably fitting in said cannula, said trocar being of such length that the knife protrudes from said cannula along a determinate length outside the end averted from the supporting-plate as the removable trocar is fixed near said supporting-plate and of a needle provided with a sharp point. As initial operation in a tracheotomy said needle is inserted into the trachea.

Said straight needle has sideways a guiding in the form of a groove for a ball-shaped end of a bent trocar. T he purpose of the guiding is that in it the ball-shaped end of the trocar is introduced after the needle has been inserted in the trachea in place. The incision of the trocar enlarges the initial opening caused by the needle and enables a larger diameter tube concentrically encompassing the rear end of the trocar, the so-called trachea cannula, to be inserted in the trachea through the incision made.

4 3,384,087 Ce Patented May 21, 1968 The mentioned trachea-cannula as well as the portion of the trocar encompassed by it are bent and corresponding with the said bend the trachea-cannula is then inserted after the needle has been removed. Said insertion goes so far as to make a supporting-plate fixed at the end of the trachea-cannula touch the skin. With the aid of a string fixed around the patients neck and passing through apertures in the supporting-plate said supporting-plate is fixed with respect to the neck and also so the tracheacannula with respect to the trachea. Through the central aperture in said supporting-plate and after removal of the trocar access is obtained to the lumen of the trachea.

It will be clear that first of all already the insertion of the straight needle requires some skill and handiness since the danger exists that when such a needle is inserted in the front of the trachea the point of the needle will perforate or damage the opposite side of the trachea. It is even imaginable that the needle to be inserted along its full thickness will also perforate the gullet lying behind the trachea. Further it can also hardly be prevented that the trocar initially guided in the groove of the needle will eventually nevertheless damage the back of the trachea or worse.

The object of the invention is to provide a simplified and more safely to handle tracheotome in which also a known bent cannula, a trocar and a needle are applied.

According to the invention for such purpose the needle is also so bent that it fits slidably in the hollow trocar and in service condition protrudes with its sharp point end along an adjustable length outside the end of the trocar, a knife protruding outside the circumference of the trocar, said knife being guided in longitudinal grooves of the cannula, the trocar being provided with a traverse projection serving as a stop against the skin and equally guided by said longitudinal grooves, said traverse projection restraining the insertion of the knife into the trachea. Thereby the knife may form one whole with the trocar, said knife being fixed to its wall or to the needle within the trocar such that the cutting edges of the knife protrude through sideways grooves of the trocar and said knife is displaced together with said needle.

Preferably the tracheotome according to the invention is so executed that also a removable stop traversely positioned with respect to the instrument is provided between the point of the trocar and its traverse protrusion such that the initial insertion of the point of the needle can be restrained in that in the insertion said stop comes to abut against the skin.

An efficient form of embodiment is that in which the trocar is provided with a leaf-shaped knife meeting a blunt end of said trocar, said knife enlarging V-shapedly as from said blunt end, said knife together with traverse protrusions located in the same plane behind said knife being guided by two opposite longitudinal grooves in the cannula.

In order to achieve an easy retraction of the trocar it is recommendable to have the knife narrow at the side turned away from the point and to provide it also with a cutting edge at said side lying in front of the protrusion, in consequence of which in the rearward movement the skin can be cut.

The end of the trocar turned away from the knife may be provided with a coupling element being able to easily detachably cooperate with an operatively associated coupling element of the supporting plate of the cannula.

For being able to restrain the insertion depth of the needle in its initial insertion one or more traverse grooves may be applied in the knife-provided end of the tubular trocar through which grooves extends an eye of a tongue provided with a traverse protrusion, said tongue being movably guided by means of a guiding piece in a groove applied in the cannula. By applying more than one groove one attains that the intrusion depth may be adjusted from case to case dependent on the patients nature.

A further adjustment of the insertion depth of the needle proper can be obtained in that at the end of the needle a cylindrical screw-threaded organ is provided with which a nut cooperates, said nut hitting against the supporting-plate and/or the end of the trocar turned away from the knife.

For easily completely disassembling the apparatus which is not only important in operating the apparatus but also for properly cleaning it, the construction is preferably so executed that the groove Within which the movable tongue is guided possesses a local enlargement through which said guiding piece of said tongue can so be introduced as to enable sideways grooves in the guiding piece to cooperate with the edge of the remaining portion of the groove.

When the cannula has been provided with longitudinal grooves in the mentioned way or possibly extra longitudinal grooves have still been applied, the composing parts of the tube wall of the cannula are nevertheless properly linked up with the supporting-plate. Owing to the presence of the grooves the cannula, if so desired, can be symmetrically widened or narrowed.

When the knife is fixed to the needle a removable traverse protrusion serving as a stop can be fixed to the trocar whereby the cutting edges of the knife can be received then in grooves of said traverse protrusion. The construction may also be so executed that a thickened end of the trocar can be fixed in various positions in a handle of the instrument. It may be recommendable to apply yet an extra narrower knife to the needle between the point of the needle and the knife.

In the accompanying drawings the invention as well as some embodiments and details of it are explained and elucidated.

FIG. 1 shows a longitudinal section of a tracheotome as per the invention in assembled condition.

FIG. 2 up to and inclusive FIG. give a perspective view of the various composing parts.

FIG. 6 shows in longitudinal section another embodiment of a tracheotome as per the invention.

FIG. 7 shows a top view of it.

FIG. 8 shows a side view.

FIG. 9 shows a portion of the needle with the knife.

The instrument as per FIGS. 1-5 has, just like known tracheotomes, a trachea cannula 1, open at both ends, said cannula remaining in the trachea once the tracheotomy has been completed. Then the supporting-plate 2 rests against the patients neck and a fixing string is passed in a known Way through eyes 3 in the supportingplate by which string the supporting-plate is retained against the patients neck.

In assembled condition of said instrument a tube 4 executed as a trocar and bent according to the same radius of curvature as the cannula is located inside the cannula 1. Said tube bears a knife 5 at its end protruding outside the cannula 1. Said fiat knife provided on both sides with a cutting edge tapers towards the end of the trocar or tube 4 and this preferably such that the edge of said knife at its beginning has the same width as the blunt end 6 of the tube 4.

Since the cannula 1 on the larger portion of its length is provided with opposite longitudinal grooves 7 and the cannula 1 and the tube 4 have the same radius of curvature, the knife 5, in moving the tube 4 inside the cannula 1, can follow said movement. Thereby the edge of the knife 5 extends outside the grooves 7 then. In practice the width of the knife 5 is such that at its broadest portion the edge protrudes on both sides about 2% mm. outside the grooves. At the front side of the tube the grooves 7 are fully open so that the knife 5 is not stopped by the grooves. At 9 the knife, for reasons to be mentioned later, preferably also provided at that 4 place with a cutting edge, tapers and it leads to or near the wall of the tube 4.

Further the tube 4 at short distance from the broader part of the knife 5 has a broad wing-shaped stop 10. Said stop has such a thickness that in moving the tube 4 inside the cannula 1 the stop is moved in the grooves 7. The greatest width of the stop 10 is preferably greater than the greatest width of the knife 5. At its front side 11 the stop is blunt. The rear end of the tube 4 is provided with means, such as a bayonet joint 12, to be temporarily fixed to the supporting-plate 2 and for example thereby hooks behind a cam 13 connected to said supporting-plate.

Inside the tube 4 in assembled condition an also correspondingly bent needle 14 is movable. Said needle may be considered a thick injection needle and has at one end a sharply whetted point 15. Said point-shaped end protrudes in operative condition of the apparatus along a certain distance, e.g. 2 cm. outside the tube 4. The other end of the needle holds a threaded cylinder 16 on which a nut 17 is rotatable. Since said nut 17 abuts the head 18 of the tube 4, which head 18 in turn rests against the supporting-plate, in turning the nut 17, the point 15 of the needle 14 may be taken further or less far outside the tube 4 and so also outside the cannula 1.

In the wall of the tube 4 near the end 6

traverse grooves

19, 28*, 21 are provided. Through said grooves an eye 22 can be passed and this such that the needle 14 may freely pass through said eye. Said eye is fixed to a resilient tongue 23 provided with a handle knob 24. Said knob 24 has a guiding piece 26 with sideways grooves 27. Said grooves 27 are so bent that the edges 29 of a groove 28 in said cannula 1 can be received in the grooves 27 so that the handle knob 24 with the guiding piece 26 can move to and fro with respect to groove 28. In order to make the guiding piece with its grooves cooperate with the edges of groove 28 said groove has been widened at 30 so as to allow the guiding piece 26 to be correctly positioned in front of said edges. In moving the knob 24 forward with the guiding piece 26 the grooves 27 receive the edges 29. Now the eye 22 can be introduced in one of the

traverse grooves

19, 20 or 21 and such deeply into the tube 4 that the needle 14 passes through the eye 22 so that said eye with the tongue 23 and the guiding piece 26 are retained. So the needle 14 may as yet freely move to and fro inside the tube 4 in the way described.

Near the eye 22 there is a collar 31, protruding on both sides, in the form of a traverse bar.

When the instrument is assembled in the way described the point 15 of the needle 14 can be inserted in the trachea under a tracheal ring. The point 15 can reach the lumen of the trachea. The traverse bar 31 prevents the sharp point of the needle 14 from further and undesired intrusion. When in said way the initial small opening has been made the needle '14 can be removed by retracting it from the tube 4. So also the sharp point is removed and the danger of damaging the rear Wall of the trachea as well.

In retracting the needle 14 its point 15 will come out of the eye 22 which in consequence of the resilient action of the spring-tongue 23 will rise and out of the

apertures

19, 20 or 21. Before inserting the point 15 in the trachea the user has determined how far, dependent on the thickness of the neck and the skin, the point 15 should intrude; so in what distance from the front end the traverse bar 31 should be positioned, so whether the eye 22 should be received in

groove

19, 20 or 21.

Once the eye 22 released from the needle 14, which can be pulled out completely, also the knob 24 with the guiding piece 26, the spring-tongue 23 and the traverse bar 31 can be pushed back and if so desired be removed from the apparatus.

The blunt end 6 of the tube 4 has reached the lumen of the trachea and the tracheotome can without difliculty be pressed inside through the small opening made. Thereby the skin and the trachea are more widely incised in traverse direction by the edges of the knife 5. Once the broader portion 9 of the knife 5 having passed the skin, the skin contracts around the trachea at the location of the narrowing of the knife 5 and the wing-shaped stop 10. Thereby said stop prevents the knife from being too far inserted. The incision made is large enough now to introduce the bent cannula into the trachea. This is possible after the

coupling

12, 13 has been released whereafter the cannula is pushed along the knife 5. Thereby the stop remains keeping the knife 5 in place.

Since only the cannula should remain in the trachea, the tube 4 has to be removed with the knife 5 after the cannula is at its location. As this is the case the tube 4 is withdrawn. Thereby the contracted skin extant between the back of the knife 5 and the stop 10 can be intersected by the back (at 9) of the knife, said back also being provided with a cutting edge.

When the cannula has been put in place in the way described, the lumen of the trachea, if so desired, can still be widened by making the slightly resilient tube wall parts budge apart. Via the cannula a rubber tube with cuff can be introduced in the usual way and oxygen can be artificially fed to the patient.

When as indicated in FIGURES 6 to and inclusive 9 the trocar consists of a trocar tube and detached from it a knife connected to the needle, said trocar tube and needle forming together the trocar, some advantages are obtained. The construction is simplified which has advantages in manufacturing.

The last mentioned tracheotome is easily hand operable. Since the needle point has to be whetted sharply and for such purpose should consist of appropriate steel, it is more efficient to have the knife form one whole with the needle and therefore have it consist of the same whettable material. To said needle a second narrower knife may be applied then as will be further described.

Also the tracheotome according to FIGS. 69 has a trachea-cannule 1, open on both sides, which remains behind in the trachea after the tracheotomy as well as a supporting-plate 2 with eyes 3 by which the supportingplate is retained against the patients neck.

Inside the cannula 1 and in assembled condition of the instrument the trocar 4 is located. Said trocar carries a wing-shaped stop 32 at short distance from the broadest portion of the knife 33.

The knife 33 consists of two blades protruding sideways outside the trocar 4 and in the present case fixed to the bent needle 14. The knife-blades protrude from grooves 8 extending from the free end up to the stop 32 in which grooves the knife 33 is movable in displacing the needle 14. On both sides the knife 33 is provided with a cutting edge and the knife tapers towards the free end 6 of the trocar 4.

Since the cannula 1 is provided with longitudinal grooves 7 and the cannula 1 and the trocar 4 and the needle 14 have the same radius of curvature the knife 33 can follow the movement of the needle when the latter is displaced within the cannula 1.

The needle 14 has at one end a sharply whetted poi t 15. In service condition of the instrument the pointshaped needle end partly protrudes outside the trocar 4. The other needle end carries a block 45 to which a release trigger 34 is fixed which can be controlled by a release button 35.

A handle 36 is fixed to the trocar 4 and is provided with some, e.g. two

stops

37, 38. When the release trigger takes the normal position the block 45 cannot pass the stops and so is stopped by one stop 37 respectively the other 38 and so takes a fixed position. After pressing the release button the block can be transferred to the other position. In order to prevent the front side of the instrument from penetrating initially too far a removable stop 39 is provided which traversely protrudes outside the diameter of the cannula I. Said stop is prefer- .ably fixed to the handle 36 by a retaining chain or such like 40. The stop 39 is retained to the trocar 4 on the one side by a pin 41 into an aperture 42 of the trocar 4 and on the other hand in that the blades of the knife 33 reach into grooves 43 of the flat shaped stop which e.g. may consist of a plastic element.

In using said tracheotome the sharp point 15 of the needle 14 is introduced between the rings of the trachea. The initial cut is widened somewhat by the small knife blades 44 so that the point of the trocar 4 can penetrate. A too far penetration is prevented by the stop 39 which abuts against the skin of the neck.

As the release button 35 is pressed the release trigger 34 is disengaged whereafter the block 45 can be transferred from the drawn position into the position between the

stops

37 and 38 whereupon the release button no longer pressed. In the last mentioned position the sharp point 15 of the needle 14 in retracted position is behind the free end of the trocar 4. By the displacement of the blades of the knife 33 the same are removed from the grooves 43 of the stop 39. Said stop 39 can then be pushed aside by one finger or be removed from the trocar 4 by pulling the chain 40. Then the tracheotome is further pressed into the trachea by exerting pressure onto the handle 36. The trocar 4 penetrates into the trachea and at said movement the knife 33 makes a Wider out until the stop 32 abuts the skin. Since the knife 33 tapers towards the rear side at 9 the skin relaxes so that the cannula can easily penetrate.

As last step of the operation the cannula 1 is passed over the trocar 4 in forward direction until the supporting-plate 2 contacts the skin. Thereafter the remaining parts of the instrument are retracted so that only the cannula 1 remains behind in the trachea.

In order to facilitate the retraction of the parts to be removed especially as to the needle 14 with the knife 33 said knife at its rear side at 9 is also provided with a cutting edge so that it can as well :cut in the retracting movement.

I claim:

1. A tracheotome comprising,

(a) a bent cannula having an end portion adapted to be inserted into a trachea, said cannula having a longitudinal groove extending therealong,

(b) a correspondingly bent tubular trocar slidably disposed in said cannula,

(c) said trocar having an end portion adapted to extend beyond the end of said cannula inserted into the trachea,

(d) a knife means connected to the extended end of said trocar whereby said knife means protrudes laterally through said groove of said cannula along a predetermined length of said end portion of said cannula,

(e) a correspondingly bent hollow needle disposed within said trocar,

(f) said needle being adjustably disposed within said trocar, and said needle having a sharp point protruding beyond the end of said trocar.

2. The invention as defined in claim 1 and including means for limiting the penetration of said needle into the trachea.

3. The invention as defined in claim 1 and including adjusting means for effecting longitudinal adjustment of said needle relative to said trocar.

4. The invention as defined in claim 2 wherein said adjusting means includes a threaded connector disposed on the end of said needle opposite said point, and an adjusting nut threaded to said connector whereby said needle is axially adjusted relative to said trocar depending upon the direction of rotation of said adjusting nut.

5. The invention as defined in claim 2 and including means for effecting adjustment of said limiting means.

6. A tracheotome comprising,

a bent cannula having an end portion adapted to be inserted into a trachea,

a correspondingly bent tubular trocar slidably disposed in said cannula,

said trocar having an end portion adapted to extend beyond the end of said cannula inserted into the trachea,

a knife means connected to the extended end of said trocar whereby said knife means protrudes laterally of said cannula along a predetermined length of said end portion of said cannula,

a correspondingly bent hollow needle disposed within said trocar,

said needle having adjustment means and being adjustably disposed within said trocar, and said needle having a sharp point protruding beyond the end of said trocar,

said adjusting means including a threaded connector disposed on the end of said needle opposite said point, and

an adjusting nut threaded to said connector whereby said needle is axially adjusted relative to said trocar depending upon the direction of rotation of said adjusting nut,

and including means for effecting adjustment of said limiting means,

wherein said latter means includes a spring tongue adjustably mounted on said cannula, an eye plate mounted on the end of said tongue, and said cannula having a series of spaced slots adapted to receive said eye plate.

7. A tracheotome comprising a bent cannula provided on one end with a supporting-plate with fixing means, and in said cannula slidably fitting correspondingly bent trocar with a knife, said knife protruding from said cannula along a determinate length outside the end turned away from said supporting-plate as the trocar has been fixed near said supporting-plate, a hollow needle provided with a sharp point, said needle being so bent that it fits slidably in the hollow trocar, and in service position the sharp point end of said needle protrudes outside the trocar along an adjustable length, said knife being provided protruding outside the circumference of the trocar, said knife being guided in longitudinal grooves of said cannula, said trocar being provided with a traverse protrusion equally guided by said longitudinal grooves, said traverse protrusion in use restraining the penetration of said knife into the trachea, said knife having a leaf-shaped knife V- shaped cutting edges widening as from the blunt end of said trocar, said knife being guided by two opposite longitudinal grooves in said cannula, and a removable stop traversely positioned with respect to the instrument is provided between said point and said traverse protrusion at said trocar, restraining the penetration of the point of said needle and whereby in the end of said tube-shaped trocar provided with said knife, at least one traverse groove is applied, an eye of a tongue provided with a traverse protrusion reaching through said traverse groove, said tongue by means of a guiding piece being displaceably guided in a groove applied in said cannula.

8. A tracheotome comprising a bent cannula provided on one end with a supporting-plate with fixing means, and in said cannula slidably fitting correspondingly bent trocar with a knife, said knife protruding from said cannula along a determinate length outside the end turned away from said supporting-plate as the trocar has been fixed near said supporting-plate, a hollow needle provided with a sharp point, said needle being so bent that it fits slidably in the hollow trocar, in service position with its sharp point end protruding outside the trocar along an adjustable length, said knife being provided protruding outside the circumference of the trocar said knife being guided in lon itudinal grooves of said cannula, said trocar being provided with a traverse protrusion equally guided by said longitudinal grooves, said traverse protrusion in use restraining the penetration of the knife into the trachea, said knife being provided with a leaf-shap d knife V- shaped cutting edge Widening as from the blunt end of said trocar, said knife being guided by two opposite longitudinal grooves in said cannula, and a removable stop traversely positioned with respect to the instrument is provided between said point and said traverse protrusion at said trocar, restraining the penetration of the point of said needle and whereby in the end of said tube-shaped trocar provided with said knife, at least one traverse groove is applied, an eye of a tongue provided with a traverse protrusion reaching through said traverse groove, said tongue by means of a guiding piece being displaceably guided in a groove applied in said cannula, said groove, guiding the displaceable tongue, being provided with a local widening through which said guiding piece of said tongue can be passed, sideways grooves in said guiding piece being able to cooperate with the edges of the remaining portion of said groove.

References (Iited UNITED STATES PATENTS 2,865,374 12/1958 Brown et al. 1283()5 2,873,742 2/1959 Shelden' 128351 X 2,991,787 11/1961 Shelden et al. 128-305 X FOREIGN PATENTS 949,943 3/ 1949 France.

LOUIS G. MANCENE, Primary Examiner.

RICHARD A. GAUDET, Examiner.

G. E. MCNEILL, Assistant Examiner.

Claims

1. A TRACHEOTOME COMPRISING, (A) A BENT CANNULA HAVING AN END PORTION ADAPTED TO BE INSERTED INTO A TRACHEA, AND CANNULA HAVING A LONGITUDINAL GROOVE EXTENDING THEREALONG, (B) A CORRESPONDINGLY BENT TUBULAR TROCAR SLIDABLY DISPOSED IN SAID CANNULA, (C) SAID TROCAR HAVING AN END PORTION ADAPTED TO EXTEND BEYOND THE END OF SAID CANNULA INSERTED INTO THE TRACHEA, (D) A KNIFE MEANS CONNECTED TO THE EXTENDED END OF SAID TROCAR WHEREBY SAID KNIFE MEANS PROTRUDES LATERALLY THROUGH SAID GROOVE OF SAID CANNULA ALONG A PREDETERMINED LENGTH OF SAID END PORTION OF SAID CANNULA, (E) A CORRESPONDINGLY BENT HOLLOW NEEDLE DISPOSED WITHIN SAID TROCAR, (F) SAID NEEDLE BEING ADJUSTABLY DISPOSED WITHIN SAID TROCAR, AND SAID NEEDLE HAVING A SHARP POINT PROTRUDING BEYOND THE END OF SAID TROCAR.