WO1994014497A1

WO1994014497A1 - Adjustable valve for surgical applications

Info

Publication number: WO1994014497A1
Application number: PCT/US1993/012283
Authority: WO
Inventors: Kenneth H. Mollenauer; George D. Hermann; Thomas A. Howell; Michelle Y. Monfort
Original assignee: Fogarty, Thomas, J.
Priority date: 1992-12-17
Filing date: 1993-12-16
Publication date: 1994-07-07
Also published as: US5514109A; US5338313A; US5556387A

Abstract

An adjustable surgical valve has a sealing body (106) with an axial passage extending through it, a toroidal body (111) axially aligned with the sealing body, and a device (110, 120) that selectively changes the relative axial positions of the sealing body and the toroidal body. The sealing body and the toroidal body have mating surfaces which radially compress the axial passage of the sealing body when the relative axial positions of the sealing body and the toroidal body are changed. This causes the axial passage to seal with an instrument (c) inserted into it, or to seal with itself if no instrument is inserted. Alternatively, or additionally, the sealing body may include a braided sleeve (138) coaxial with the axial passage and extending from the sealing body, and a device that selectively changes the relative axial positions of the sealing body and the extended part of the braided sleeve to elongate the braided sleeve. This causes the braided sleeve to contract radially, which compresses the axial passage of the sealing body radially. The sealing body is made of an elastomeric foam or an encapsulated gel. In a method of making a surgical valve, a sealing body is attached inside one end of a braided sleeve, the other end of which is threaded through the bore of a toroidal body, and the braided sleeve, toroidal body, and sealing body are inserted into the bore of a substantially cylindrical valve body.

Description

ADJUSTABLE VALVE FOR SURGICAL APPLICATIONS

Field of the Invention

The invention relates to adjustable valves for surgical valves, in particular to valves capable of accommodating large-diameter cathethers or multiple catheters without leaking.

Background of the Invention In cardiac, vascular, urology, laparoscopic cholecystectomy and other medical procedures using catheters, there has been an increasing need for large-diameter valves. These procedures use catheters having a wide range of diameters. These procedures may also use multiple catheters.

Current surgical valves fall into two basic categories, passive and active. A passive valve relies on the deformation of a resilient part by the catheter to form the required fluid-tight seal with the catheter. A recent example of a passive valve is described in United States Patent No. 4,909,798, in which the valve has a longitudinally extended valve housing with a first opening and a central longitudinal passage communicating with an opposite second opening. A one-piece seal located in the longitudinally extended valve housing has a sealing neck having a relatively small opening that communicates with a sealing chamber. On the opposite side of the sealing chamber are sealing exit lips that are readily expansible to a diameter less than that of the valve housing when a catheter is inserted. This surgical valve does not accommodate a wide range of catheter diameters. A seal that exerts enough lateral pressure to seal around a small-diameter catheter applies too much friction when sealing a large-diameter catheter. Moreover, the lip-type seals tend not to seal uniformly around all of the circumference of the catheter.

An active surgical valve includes a mechanism that moves a seal into contact with the catheter when the catheter is in place in the valve. A common feature of such valves is a tube of a flexible material through which the catheter is inserted. A mechanism moves the flexible material into contact with the catheter.

Some valves, such as the valves shown in United States Patent Nos. 3,977,400 and 4,243,034, use a simple vise-like arrangement with opposing jaws to bring the flexible material into contact with the catheter. With such an arrangement, the contact pressure between the flexible material and the catheter is very non-uniform around the circumference of the catheter. A development of this arrangement uses two pairs of opposing jaws perpendicular to one another to produce a more uniform contact pressure.

United States Patent No. 3,970,089 describes a tube of a flexible material surrounded by an annular vessel into which a fluid can be pumped to apply pressure to the outer wall of the tube, and hence to move the inner wall of the tube into contact with the catheter. This arrangement provides a uniform contact pressure between the tube and the catheter, but the range of catheters that can be sealed without the wall of the tube buckling, and providing a leakage path, is limited.

United States Patent No. 4,580,573 shows an arrangement in which a flexible tube has a rigid tube connected to each end. The catheter passes through the rigid tubes and the flexible tube. By rotating one of tie rigid tubes axially relative to the other a twist is imposed on the flexible tube, which reduces the internal diameter of the flexible tube such that the inner wall of the flexible tube forms a seal with the catheter.

Current surgical valves have a tendency to leak, especially if multiple catheters are used. Additionally, current surgical valves can only be used with catheters having a relatively narrow range of diameters. Current large diameter surgical valves do not close completely and require that the catheter be left in place to maintain a seal. Current surgical valves require constant manipulation to maintain a seal around the catheter without excessive friction.

Objects and Summary of the Invention An adjustable surgical valve according to a first aspect of the invention comprises a sealing body that has an axial passage extending through it, a toroidal body that is axially aligned with the sealing body, and a device that selectively changes the relative axial positions of the sealing body and the toroidal body. The sealing body and the toroidal body have mating surfaces which radially compress the axial passage of the sealing body when the relative axial positions of the sealing body and the toroidal body are changed. Radially compressing the axial passage causes the axial passage to seal with an instrument inserted into it; or to seal with itself if no instrument is inserted into the axial passage.

An adjustable surgical valve according to a second aspect of the invention comprises a sealing body that has an axial passage extending through it. The sealing body includes a braided sleeve that is coaxial with the axial passage and that extends from the sealing body. The valve also comprises a device that selectively changes the relative axial positions of the sealing body and part of the braided sleeve remote from the sealing body. Changing the relative axial positions of the sealing body and the remote part of the braided sleeve elongates the braided sleeve, which causes the braided sleeve to contract radially, and compresses the axial passage of the sealing body radially. Radially compressing the axial passage causes the axial passage to seal with an instrument inserted into it; or to seal with itself if no instrument is inserted into the axial passage.

In a first practical embodiment of an adjustable surgical valve according to the invention, the mating surface of the sealing body is its outer surface and the mating surface of the toroidal body is its inner surface. In the plane perpendicular to the axis defined by the axial passage in the sealing body ("the axis"), the distance of the outer surface of the sealing body from the axis is substantially constant. In tiie same plane, the distance of inner surface of the toroidal body from the axis decreases along the axis from greater than the distance of the outer surface of the sealing body from the axis to less than the distance of the outer surface of the sealing body from the axis. The sealing body is located in a substantially fixed axial position by a braided sleeve, and the means for selectively changing the relative axial positions of the sealing body and the toroidal body moves the toroidal body axially relative to the sealing body. When the valve is in its open (non-sealing) position, the mating surfaces of the sealing body and the toroidal body are substantially disengaged. The valve is closed by moving the toroidal body axially into engagement with the sealing body such that, as the toroidal body is moved, the distance from the axis of the inner surface of the toroidal body engaged with a given point on the sealing body progressively decreases. The rigid inner surface of the toroidal body thus deforms the compliant outer surface of the sealing body radially towards the axis. The toroidal body additionally elongates the braided sleeve. The resulting compression of the sealing body compresses the axial passage and forms the required seal.

The valve is opened by moving the toroidal body axially relative to the sealing body in the opposite direction, i.e., such that the distance from the axis of the inner surface of the toroidal body engaged with a given point on the sealing body progressively increases. This reduces the radial deformation of the outer surface of the sealing body and the elongation of the braided sleeve, which reduces the deformation of the axial passage, and releases the seal. The means for changing the relative positions of the sealing body and the toroidal body in the first practical embodiment of the valve includes a ratchet mechanism.

In a second practical embodiment of an adjustable surgical valve according to the invention, the mating surface of the sealing body is its outer surface and the mating surface of the toroidal body is its inner surface. In the plane perpendicular to the axis, the distance of the inner surface of the toroidal body from the axis is substantially constant. In the same plane, the distance of the outer surface of the sealing body increases along the axis, from less than the distance of the inner surface of the toroidal body from the axis to greater than the distance of the inner surface of the toroidal body from the axis. The sealing body includes a braided sleeve. The toroidal body has a fixed position and the means for selectively changing the relative axial positions of the sealing body and the toroidal body moves the sealing body axially relative to the sealing body.

When the valve is in its open (non-sealing) position, the mating surfaces of the sealing body and of the toroidal body are substantially disengaged. The valve is closed by moving the sealing body axially to bring its outer surface into engagement with the inner surface of the toroidal body such that, as the sealing body is moved, the distance from the axis of the outer surface of the sealing body engaged with a given point on the inner surface of the toroidal body progressively increases. Because the inner surface of the toroidal body is rigid, it deforms the outer surface of the sealing body radially towards the axis. The axial motion of the sealing body also elongates the braided sleeve. The resulting compression of the sealing body compresses the axial passage and forms the required seal.

The valve is opened by moving the sealing body axially relative to the toroidal body in the opposite direction, i.e., such that the distance from the axis of the outer surface of the sealing body engaged with a given point on the inner surface of the toroidal body progressively decreases. This reduces the radial compression applied to the sealing body and releases the seal. The means for changing the relative positions of the sealing body and the toroidal body in the second practical embodiment of the hemostasis valve according to the invention includes a mechanism that translates a twisting motion to an axial motion.

Practical embodiments of an adjustable surgical valve according to the invention employ both mating surfaces and axial stressing of a braided sleeve to apply a uniform radial compression to the axial passage in the sealing body. It is an object of the invention to provide an adjustable surgical valve that can be adjusted to seal around instruments having a wide range of diameters without leaking.

It is a further object of the invention to provide an adjustable surgical valve that provides a seal that is both liquid-tight and gas-tight.

It is a further object of the invention to provide an adjustable surgical valve that provides good tactile feedback without leaking.

It is a further object of the invention to provide an adjustable surgical valve that seals around multiple instruments.

It is a further object of the invention to provide an adjustable surgical valve that can easily be adjusted using one hand. It is a further object of the invention to provide an adjustable surgical valve that, once adjusted to seal around a given instrument, does not require further adjustment to maintain the seal.

It is a further object of the invention to provide an adjustable surgical valve that is self-sealing when the instrument is withdrawn.

In a first method of manufacturing an adjustable surgical valve according to the invention, a sealing body is attached inside the one end of a braided sleeve, the other end of the braided sleeve is threaded through the bore of a toroidal body, and the braided sleeve, toroidal body, and sealing body are inserted into the bore of a substantially cylindrical valve body. In a variation on the first method, the sealing body is attached to the braided sleeve by molding it in place in the braided sleeve.

In a second method of manufacturing an adjustable surgical valve according to the invention, a braided sleeve is inserted into the bore of a collar and the collar is attached to the braided sleeve part-way along the length of the braided sleeve. An elastomeric foam sealing body is molded along the length of, coaxial with, and surrounding the braided sleeve, and the sealing body is inserted into a cylindrical valve body.

Brief Description of the Drawings Figure 1A is a longitudinal cross sectional view of the sealing mechanism of an adjustable surgical valve according to the first aspect of the invention in its open (non-sealing) position.

Figure IB is a longitudinal cross sectional view of the sealing mechanism of an adjustable surgical valve according to the first aspect of the invention in its closed (sealing) position.

Figure 2A is a transverse cross-sectional view of the sealing mechanism of an adjustable surgical valve according to the first aspect of the invention sealed around an instrument inserted into the axial passage of the valve.

Figure 2B is a transverse cross-sectional view of the sealing mechanism of an adjustable surgical valve according to the first aspect of the invention sealed after the instrument has been withdrawn.

Figure 3 is a transverse cross-sectional view of the sealing mechanism of an adjustable surgical valve according to the first aspect of the invention sealed around two instruments.

Figure 4A is a perspective view of the sealing mechanism of an adjustable surgical valve according to the second aspect of the invention in its open (non-sealing) position.

Figure 4B is a perspective view of the sealing mechanism of an adjustable surgical valve according to the second aspect of the invention in its closed (sealing) position. Figure 4C is a perspective view of an alternative form of the sealing mechanism of an adjustable surgical valve according to the second aspect of the invention in its open (non-sealing) position.

Figure 5A is a longitudinal cross sectional view of a more complete embodiment of an adjustable surgical valve according to the second aspect of the invention in its open (non-sealing) position.

Figure 5B is a longitudinal cross sectional view of a more complete embodiment of an adjustable surgical valve according to the second aspect of the invention in its closed (sealing) position.

Figure 6 is a perspective view of a first practical embodiment of an adjustable surgical valve according to the invention.

Figure 7 is a longitudinal cross-sectional view of the first practical embodiment of an adjustable surgical valve according to the invention in its open (non-sealing) position. Figure 8 is a longitudinal cross-sectional view of the first practical embodiment of an adjustable surgical valve according to the invention in its closed (sealing) position sealed around an instrument inserted into the axial passage of the valve.

Figure 9 is a longitudinal cross-sectional view of the first practical embodiment of an adjustable surgical valve according to the invention in its closed _^(sealing) position with the instrument removed. Figure 10 is a perspective view of a second practical embodiment of an adjustable surgical valve according to the invention.

Figure 11 is a longitudinal cross-sectional view of the second practical embodiment of an adjustable surgical valve according to the invention in its open (non-sealing) position.

Figure 12 is a longitudinal cross-sectional view of the second practical embodiment of an adjustable surgical valve according to the invention in its closed (sealing) position. Detailed Description of the Invention

The basic sealing mechanism of an adjustable surgical valve according to a first aspect of the invention is illustrated in Figures 1A and IB. Figure 1A shows the valve in its open (non-sealing) position. The adjustable surgical valve 1 has a sealing body 6, a toroidal body 11 , and a mechanism (not shown) for changing the axial position of at least one of the sealing body 6 and the toroidal body 11 relative to the other.

The sealing body has an outer surface 36 that is its mating surface. The sealing body has an axial passage 16 through which one or more instruments, such as the catheter C, can be passed from the proximal end 21 of the sealing body to the distal end 26, in the direction indicated by the arrow 31. Sealed to the distal end 26 of the sealing body is the introducer sleeve S through which the catheter C passes into the body (not shown). The catheter C is shown throughout as an example of an instrument that is inserted into the axial passage of the valve. The valve can be used with instruments other than catheters, however.

The sealing body 6 is preferably formed of a resilient elastomeric foam material that is compliant, but is sufficiently strong in compression to enable a substantially uniform radial deformation of the outer surface 36 of the sealing body towards the axis to move the wall of the axial passage 16 radially towards the axis to contact, and to form a seal with, the catheter C, or, if no catheter is in the axial passage, to contact itself and to seal the axial passage. The sealing body 6 may alternatively be formed of an encapsulated medical silicone gel, such as Dow Corning Q7-2147. The preferred encapsulation material is RTV, such as G.E. 118.

Preferably, the outer surface 36 of the sealing body intersects a plane perpendicular to the axis defined by the axial passage 16 ("the axis") to form a circle, but can form other suitable shapes such as a square, a rectangle, a hexagon, an octagon, etc.

The toroidal body 11 is axially aligned with the sealing body 6, and has a proximal end 41 and a distal end 46. The toroidal body 11 is formed of a relatively rigid material, such as plastic or metal. The mating surface of the toroidal body 11 is its inner surface 51. The intersection of the inner surface 51 of the toroidal body with a plane perpendicular to the axis preferably forms the same shape as the outer surface 36 of the sealing body, i.e., a circle, but can form other suitable shapes such as a square, a rectangle, a hexagon, an octagon, etc. In Figure 1 A, the distance from the axis of the outer (mating) surface 36 of the sealing body is shown as progressively decreasing from the proximal end 21 of the sealing body to the distal end 26, and the distance from the axis of the inner (mating) surface 51 of the toroidal body is also shown as progressively decreasing from the proximal end 41 of the toroidal body to the distal end 46. However, if the distance from the axis of the outer surface 36 of the sealing body progressively decreases between the proximal end 21 and the distal end 26, die distance from the axis of the inner surface 51 of the toroidal body may be substantially constant along the axis. Alternatively, if the distance from the axis of the inner surface 51 of the toroidal body progressively decreases between the proximal end 41 and the distal end 46, the distance from the axis of the outer surface 36 of the sealing body may be substantially constant along d e axis. In any of the three cases just stated, the distance from the axis of the inner surface 51 at the proximal end 41 of the toroidal body should be less than the distance from the axis of the outer surface 36 at the proximal end 21 of the sealing body, and greater than the distance of the outer surface 51 at the distal end 26 of the sealing body.

The toroidal body 11 can be made considerably shorter in the axial direction than shown in Figure 1A. A ring with a square, rectangular, circular, or other suitable cross section in the plane of the axis can be used for the toroidal body 11. Alternatively, the toroidal body 11 can comprise a plurality of substantially spherical or cylindrical beads on a substantially circular axis in the plane perpendicular to die axis. Such an arrangement reduces friction by providing the toroidal body 11 with an inner surface mat rolls over die outer surface 36 of the sealing body instead of sliding.

Figure 1A shows the adjustable surgical valve 1 according to the invention in its open (non-sealing) position. The sealing body 6 and the toroidal body 11 are axially positioned such that the inner surface

51 of the toroidal body is disengaged from the outer surface 36 of the sealing body. The toroidal body

11 thus exerts no radial compression on the sealing body 6, the axial passage 16 in die sealing body is fully open, which allows the catheter C to be freely inserted or withdrawn.

Figure IB shows d e adjustable surgical valve according to the invention in its closed (sealing) position. The relative axial positions of the sealing body 6 and the toroidal body 11 have been changed in die direction shown by the arrow 56 to engage die inner surface 51 of the toroidal body widi die outer surface 36 of the sealing body. This change in the relative axial positions is brought about by a suitable mechanism (not shown) that moves the sealing body relative to die toroidal body, or moves die toroidal body relative to die sealing body, or moves die sealing body and die toroidal body relative to one anotfier. The rigid inner surface 51 of the toroidal body deforms radially towards die axis the part of the outer surface 36 of the sealing body with which it is engaged. This applies a uniform radial compression to the sealing body. The material of the sealing body transmits the uniform radial compression applied by the deformation of the outer surface of the sealing body to d e part of the axial passage 16 substantially opposite d e deformed outer surface. The uniform radial compression deforms the axial passage radially inwards. Figure IB shows die axial passage deformed sufficiently to bring the wall of the axial passage into contact with, and to seal, die catheter C.

Widi the relative positions of the sealing body 6 and die toroidal body 11 adjusted to bring the wall of the axial passage 16 into sealing contact widi die catheter C, the cadieter is sealed by a relatively large area of the compliant material of the sealing body. This provides a leak-proof seal using a relatively small radial force between die sealing body and die cadieter. The resulting small frictional force between the sealing body and die catheter gives excellent "feel" when die catheter is inserted or adjusted. In this adjustment condition, die catheter can be adjusted or wididrawn without having to adjust die relative positions of the sealing body and die toroidal body. This adjustment condition will be called die "minimum friction-no leakage" condition. Further change in die relative axial positions of the sealing body 6 and die toroidal body 11 in die direction shown by die arrow 56 increases the uniform radial compression on me sealing body. This causes further deformation of the axial passage 16. The axial passage is deformed over more of its length, and d e radial force between the wall of the axial passage 16 and die instrument, such as die cadieter C, is increased. This increases the friction between die sealing body and die catheter C, but further reduces die possibility of leakage. Further change in die relative axial positions of d e sealing body and die toroidal body in the direction shown by die arrow 56 enables die valve to seal with a smaller diameter cadieter, or to seal widi no cadieter.

Using an elastomeric foam or an encapsulated silicone gel to form the sealing body 6 enables die valve to accommodate a large diameter cadieter and to seal widiout leaking when die large diameter catheter is wididrawn. The sealing body 6 also enables die valve to be self-sealing when the catheter is wididrawn. Figures 2A and 2B show cross sections of the valve in die plane perpendicular to die axis to illustrate die self-sealing action of the valve. In Figure 2A, die relative axial positions of the toroidal body 11 and die sealing body 6 have been adjusted to deform die axial passage 16 such that its wall seals with die cadieter C. Figure 2B shows die valve after the cadieter has been wididrawn. When die cadieter is withdrawn, the resilience of the sealing body moves die wall of the axial passage further towards die axis, so that die wall seals widi itself.

With a relatively small diameter cadieter, die relative axial positions of the toroidal body 11 and die sealing body 6 can be adjusted to die minimum friction-no leakage position after the catheter is inserted, and die valve will be self-sealing wkhout the need to re-adjust it when die cadieter is withdrawn. In Figure 2B, which shows the valve after the catheter has been wididrawn, die diameter of the outer surface 36 is the same as in Figure 2A, which indicates diat the relative positions of the toroidal body and die sealing body were not changed when die cadieter was wididrawn.

Wi± a larger diameter cadieter, die relative positions of die toroidal body and the sealing body must be adjusted to produce a radial force on the axial passage 16 diat is greater than die radial force for minimum friction for die valve to be self-sealing when me cadieter is wididrawn.

Using an elastomeric foam that is also compliant, or an encapsulated silicone gel, to form the sealing body 6 enables die surgical valve according to die invention to seal around two or more catiieters inserted into the axial passage 16. This is illustrated in Figure 3, which shows a cross-section of the valve in die plane perpendicular to die axis with two catheters Cl and C2 inserted into the axial passage 16. When die outer surface 36 of the sealing body 6 is radially deformed by die toroidal body 11 , the resulting radial compression of the sealing body forces part of the sealing body to fill the narrow cusp between die two catheters, and achieves the desired seal.

Figures 4A through 4C show perspective views of die basic sealing mechanism of an adjustable surgical valve according to a second aspect of the invention. The adjustable surgical valve according to die second aspect of the invention is similar to me adjustable surgical valve according to die first aspect of the invention, but the uniform radial compression is applied to me sealing body in a different way.

The adjustable surgical valve according to the second aspect of die invention is shown in its open (non-sealing) state in Figure 4A. The adjustable surgical valve 2 comprises a substantially cylindrical sealing body 7. The sealing body includes a substantially cylindrical axial passage 12, through which one or more instruments, such as the cadieter C, can be passed.

The sealing body 7 is formed from the same type of elastomeric foam material or encapsulated silicone gel as the sealing body 6 (Figure 1) of the first embodiment of die invention. As wim the sealing body of the first embodiment of the invention, me sealing body 7, when subject to a radial compression, forms a fluid-tight seal with one or more instruments passed dirough d e axial passage 12. Details of the material of the sealing body 7 and of its sealing action are similar to those of the sealing body 6 (Figure 1), and dierefore will not be repeated.

The sealing body 7 preferably has a circular cross section in the plane normal to the axial passage. Unlike the sealing body of the first embodiment of the invention, die area of the circular cross section of the sealing body 7 is substantially constant along die lengtii of the sealing body.

The sealing body 7 occupies part of the bore of die braided sleeve 17. The braided sleeve may be attached to die surface of the sealing body 7 widi a suitable adhesive, or the sealing body may be molded inside the braided sleeve, widi the braided sleeve providing die outer surface of the braided sleeve/sealing body assembly, as shown in Figure 4A. Alternatively, die braided sleeve 17A may be incorporated widiin die sealing body 7A, as shown in Figure 4C.

In Figure 4A, die braided sleeve 17 is a hollow cylinder widi a circular cross section diat, when elongated, exerts a uniform radial compression. Anydiing placed inside me braided sleeve, such as d e sealing body 7, is subject to die uniform radial compression when the braided sleeve is elongated. Thus, die braided sleeve subjects die sealing body to a uniform radial compression similar to that produced by die mating surfaces of the first embodiment of me invention. The braided sleeve 17 is preferably made of a loosely-woven fabric, such as polyester, nylon, or polypropylene. To enable e braided sleeve to generate a uniform radial compression when elongated, the warp threads of the fabric are arranged at an angle relative to die longitudinal axis of die braided sleeve. Alternatively, die braided sleeve may be made of a knitted material. In Figure 4A, die sealing body 7 occupies part of the lengtfi of die braided sleeve 17. The braided sleeve is shown in its normal (non-elongated) state, and die sealing body 7 is not deformed. An instrument, such as the cadieter C, placed in die axial passage 12 of the sealing body moves freely within die axial passage.

The effect of elongating die braided sleeve 17 on die sealing body 7 is illustrated in Figure 4B, which shows die adjustable surgical valve 2 in its closed (sealing) state. Axially moving me part 27 of the braided sleeve distal from the sealing body relative to die sealing body in die direction shown by die arrow 32 elongates die braided sleeve and causes the braided sleeve to exert a uniform radial compression on the sealing body. The sealing body transmits die uniform radial compression exerted by e braided sleeve against its outer surface to the axial passage 12. The uniform radial compression deforms me axial passage, and causes it to seal widi die cadieter C. The magnitude of the radial compression is adjusted by changing die relative axial positions of the distal part 27 of the braided sleeve and die sealing body.

As an alternative to axially moving the distal part 27 of the braided sleeve relative to die fixed sealing body to elongate die braided sleeve 17, d e distal part 27 of the braided sleeve can be fixed, and die sealing body 7 can be moved axially in die direction opposite to die direction indicated by die arrow 32. As a further alternative, bodi the sealing body and die distal part of the braided sleeve can be moved to elongate the braided sleeve.

Cross sections of a more complete embodiment of an adjustable surgical valve according to die second aspect of the invention are shown in Figures 5 A and 5B. The sealing body 7 of valve 52 is formed inside die proximal part of the braided sleeve 17. The braided sleeve/sealing body assembly is mounted in me bore of the cylindrical valve body 37. The proximal part 22 of the braided sleeve/sealing body assembly is attached to the bore. The distal part 27 of the braided sleeve is attached to die inner surface 42 of die toroidal actuator 47.

The toroidal actuator 47 is free to slide axially widiin die bore of die valve body 37. A mechanism (not shown), attached to die toroidal actuator, adjusts die axial position of the toroidal actuator in the bore, and hence die elongation of the braided sleeve 17. Mechanisms of the type to be discussed below, or some other suitable mechanism, can be used to adjust die axial position of the toroidal actuator in die bore of die valve body.

Figure 5 A shows die adjustable surgical valve 52 in its open (non-sealing) state. The braided sleeve 17 is shown in its normal (non-elongated) state, and die sealing body 7 is not deformed. An instrument, such as the cadieter C, placed in the axial passage 12 of the sealing body moves freely within me axial passage.

Figure 5B shows die adjustable surgical valve 52 in its closed (sealing) state. The mechanism (not shown) has moved die toroidal actuator 47 in the bore of the valve body 37 in the direction of die arrow 57. This elongates die braided sleeve 17 and causes die braided sleeve to exert a uniform radial compression on the sealing body 7. The sealing body transmits the uniform radial compression exerted by the braided sleeve against its outer surface to the axial passage 12, which deforms the axial passage and causes it to seal widi die cadieter C. The magnitude of the radial compression is adjusted by changing the axial position of die toroidal actuator 47 in die bore of the valve body 37. Practical embodiments of an adjustable surgical valve according to die invention employ both mating surfaces and elongation of a braided sleeve to apply a uniform radial compression to the axial passage in the sealing body.

Figure 6 shows a perspective view of the first practical embodiment of an adjustable surgical valve 101 according to die invention. The introducer sleeve S is attached to the distal end of die surgical valve 101, and passes dirough an incision or puncture I into the body B. A catheter C passes through die valve 101 and die introducer sleeve S into die body B.

The valve body 100 of the surgical valve is a hollow, substantially cylindrical plastic molding, preferably of polycarbonate. The bore of the valve body 100 has a circular cross section. A longitudinal slot 105 is molded or cut in the valve body 100. The pillar 115 passes through the slot 105 and is attached to die toroidal body (see Figure 7). The end of the pillar distal from the toroidal body is inserted and glued into a small bore in the pawl 110. The pawl, which is preferably a polycarbonate molding, pivots by bending the pillar. The axis of the bore in the pawl is at an acute angle relative to die longitudinal axis of d e pawl to bias die pawl into engagement with die ratchet 120. Alternatively, die pillar and pawl, or the pillar, pawl, and toroidal body can be molded as an integral unit.

The pawl 110, pillar 115, and ratchet 120 provide die preferred way of changing the relative axial positions of the sealing body 106 and die toroidal body 111 (Figure 7) and of changing e elongation of d e braided sleeve 138 (Figure 7). This mechanism has a small number of parts, can be adjusted precisely, and can be operated widi one hand. Alternative mechanisms can be used to change die relative axial positions of the sealing body and die toroidal body, and die elongation of die braided sleeve. For example, die twist mechanism to be described below in connection widi Figures 10, 11, and 12 can be adapted to diis purpose.

Pressure applied radially to die protrusion 125 on die pawl 110 disengages the pawl from the ratchet 120. The protrusion also facilitates axially sliding die pawl widi die ±umb to adjust die valve. The ratchet 120 is a metal stamping attached to die outer surface of the valve body 100 by gluing, preferably widi an epoxy adhesive. Alternatively, the ratchet can be molded as an integral part of die valve body molding.

The flanged proximal and distal ends of the valve, 130 and 135, respectively, enable die valve to be gripped in die fingers of the hand while adjusting die position of the pawl widi die thumb. The flanged ends are preferably integral parts of the valve body molding, but can be separate polycarbonate moldings glued to die valve body 100 widi a cyanoacrylate or other suitable adhesive. The flanged end 135 must molded separately and later attached if die pawl, pillar and toroidal body are molded as an integral unit.

Figure 7 shows a longitudinal cross-sectional view of surgical valve shown in Figure 6. The sealing body 106 and die toroidal body 111 are mounted in me bore of the valve body 100. In die plane perpendicular to d e axis defined by die axial passage 116 ("die axis"), die sealing body has a circular cross section. The diameter of the sealing body, i.e., die distance of the outer (mating) surface 136 of the sealing body from the axis, is substantially constant along die leng i of die sealing body. The diameter of the sealing body is reduced near its distal end 126 to enable die sealing body to engage smootiily with the toroidal body. The toroidal body 111 is a polycarbonate molding widi inner and outer circular cross sections in the plane perpendicular to die axis. Its outer diameter is slightly smaller than the diameter of the bore of the valve body 100, and is substantially constant along its lengdi. This enables die toroidal body to slide freely within die bore of die valve body. The inner diameter of the toroidal body progressively decreases from the proximal end 141 of the toroidal body to about half-way along die toroidal body, and remains substantially constant from about half-way along e toroidal body to die distal end 146. If the pawl. pillar, and toroidal body are not molded as an integral unit, a small radial bore is provided in the toroidal body to receive the pillar 115, which is glued in place widi a suitable adhesive.

The sealing body 106 is formed by molding or extruding a suitable silicone foam. The axial passage 116 is formed in die molding or extruding process. In e preferred embodiment, die sealing body is molded using Type 762 silicone foam from General Electric. The outer (mating) surface 136 of the sealing body is provided by ie braided sleeve 138. The braided sleeve is a substantially cylindrical piece of woven polyester material that preferably is sealed with a silicone sealant, such as Type Q7-2213 sealant, manufactured by Dow Chemical Co.

The braided sleeve 138, after sealing, is placed in a mold and die silicone foam is injected into the mold inside the braided sleeve. When the completed sealing body/braided sleeve assembly is removed from the mold, die braided sleeve is firmly attached to the foam of the sealing body. Part of the braided sleeve forms the outer surface 136 of the sealing body. Alternatively, die foam can be molded separately and glued in place inside the braided sleeve using a silicone RTV or odier suitable adhesive.

Using part of the sealed braided sleeve 138 for the outer (mating) surface 136 of the sealing body 106 provides a surface that is smoother and more durable man would be provided by die silicone foam alone. This provides lower friction between the sealing body and die toroidal body 111, which makes it easier to adjust die axial position of the toroidal body, and enables die valve to be opened simply by releasing die pawl 110.

The part of the braided sleeve 138 extending distally from the sealing body 106 is called die sleeve extension 140. The sleeve extension passes through die bore of die toroidal body 111, and is attached to die valve body 100 by trapping it between the large luer hub 145 and die distal end 135 of die valve body. The large luer hub is preferably glued into die distal end of die valve body.

The braided sleeve 138 provides die sealing body 106 with tensile strengtii and locates die sealing body axially so diat die sealing body can withstand the axial force applied to it by die toroidal body 111. The braided sleeve also provides a uniform radial compression to on die sealing body. The axial force exerted by the toroidal body 111 as it is advanced over d e sealing body axially displaces die sealing body, and dius elongates the braided sleeve. The elongation of the braided sleeve provides a radial compression to the sealing body in addition to die radial compression provided by the juxtaposition of die mating surfaces 136 and 151 of the sealing body and die toroidal body, respectively. The braided sleeve extension 140, being sealed widi silicone sealant, provides a fluid-tight passage between die distal end 135 of the valve body and die distal end 126 of the sealing body.

Figure 7 shows die surgical valve according to the invention in its open (non-sealing) position. The proximal end 141 of the toroidal body is slightly engaged wiώ die distal end 126 of the sealing body; but die diameter of the outer surface 136 of the sealing body at distal end 126 is slightly reduced, so die toroidal body 111 does not deform the sealing body 106. Nor does the toroidal body 111 cause any elongation of the braided sleeve 138. Consequently, die axial passage 116 is not deformed, and no seal is formed with die cadieter C in the axial passage.

Figure 8 shows die surgical valve of Figure 7 adjusted to form a minimum friction-no leakage seal widi the cadieter C. This adjustment can be carried out using only one hand. The valve body 100 is gripped in die fingers, and die pawl 110 is pulled by die thumb in the direction indicated by die arrow 156. The axial position of the pawl, and hence of the toroidal body 111 , is adjusted to provide a seal that does not leak, yet imposes minimum friction on die cadieter, and hence resistance to die movement of the cadieter C. The low friction offered by the surgical valve according to die invention when adjusted in its minimum friction-no leakage positions provides maximum tactile feedback to die surgeon when inserting or adjusting an instrument, such as the catheter C, through die valve. Moving die pawl 110 in die direction indicated by die arrow 156 moves die toroidal body 111 in the same direction and engages die inner surface 151 of the toroidal body widi the outer surface 136 of die sealing body. The inner surface 151 deforms the outer surface 136 of the sealing body, moving it radially towards die axis. In addition, die axial movement of the toroidal body 111 moves die sealing body axially, which elongates die braided sleeve 138. The deformation of the outer surface 136 togemer widi die elongation of the braided sleeve causes die wall of the axial passage 116 to move uniformly towards, and to seal widi, die cadieter C. The sealing body exerts an axial force on the toroidal body 111 in die direction opposite to diat indicated by die arrow 156, but die toroidal body is prevented from moving by the pawl 111 engaged in the ratchet 120. To release die valve completely, me valve body 100 is gripped in die fingers, and pressure is applied to die protrusion 125 widi die diumb to release the pawl 110 from the ratchet 120. The axial force exerted by the sealing body 106 against the toroidal body 111 and die low friction between die braided sleeve 138 on die outer surface 136 of the sealing body and die inner surface 151 of the toroidal body makes the valve self-releasing. No axial pressure from me thumb is required to release the valve. To release die valve partially, die same procedure is used, except diat the motion of die pawl is controlled, preferably by the thumb, and die pawl is re-engaged in die ratchet after the adjustment has been made.

Figure 9 shows die surgical valve 101 according to die invention in its fully closed position, i.e. , widi no cadieter inserted into e axial passage 116. The pawl 110, and hence the toroidal body 111, are moved further in the direction indicated by the arrow 156. This engages die inner surface 151 of the toroidal body still further widi die outer surface 136 of the sealing body, and also increases the elongation of the braided sleeve 138. The increased radial deformation of the outer surface 136 of the sealing body further towards the axis and d e increased elongation of the braided sleeve togedier cause die wall of the axial passage 116 to move radially towards the axis, to seal with itself. The material of the sealing body 106 is sufficiently compliant to allow die wall of the axial passage to seal with itself under moderate radial pressure. The pawl 110 and ratchet 120 hold die toroidal body 111 in its set axial position until die pawl is released.

The additional adjustment of the axial position of die toroidal body shown in Figure 9 is only necessary when a large-diameter catheter is to be wididrawn from the surgical valve 101. In practice, when a large-diameter catheter is to be wididrawn from the valve, the valve is left set in die minimum friction-no leakage position shown in Figure 8 until die cadieter is almost completely withdrawn. The position of the pawl 110, and hence of the toroidal body 111 , is uien adjusted towards die position shown in Figure 9. This increases friction, but still allows the cadieter to be wididrawn. When die cadieter disengages from the compressed part of the sealing body 106, die resilience of the sealing body 106 causes me part of the axial passage 116 under compression from the toroidal body 111 and die braided sleeve 138 to collapse radially towards the axis, and seal widi itself. Depending on me diameter of the cadieter C, die diameter of the sealing body 106, and die axial position of die toroidal body when die cadieter is wididrawn, die pawl 110, and hence die toroidal body 111, may have to be moved further in the direction indicated by die arrow 156 to cut off residual leakage after die cadieter has been withdrawn. With a smaller-diameter catheter, die valve adjusted to die minimum friction-no leakage position shown in Figure 8 is self sealing, and no adjustment is necessary when die catheter is wididrawn.

Figures 10 and 11 show a perspective view and a longitudinal cross section, respectively, of a second practical embodiment of the surgical valve 201 according to die invention. In Figure 10, the introducer sleeve S is sealed into die distal end of die surgical valve 201, and passes dirough an incision or puncture I in me body B. A cadieter C passes through the valve 201 and die introducer sleeve S into die body B. The valve 201 has an outer valve body 202 and an inner valve body 207. The outer valve body 202 and the inner valve body 207 togedier form the toroidal body of the valve.

The outer valve body 202 is a hollow, substantially cylindrical polycarbonate plastic molding. The bore of the outer valve body 202 has a circular cross section, and is stepped towards the axis at its proximal end to form die shoulder 212, which provides a first dirust bearing for the inner valve body 207, as shown in Figure 11. The distal end 217 of the outer valve body provides a second thrust bearing for the inner valve body 207. The bore of the outer valve body flares outwards proximally from die shoulder 212 to provide a first part of die inner surface 251 A of the toroidal body of die valve. A longitudinal slot 218 is molded or cut in e outer valve body 202. The inner valve body 207 is a hollow, substantially cylindrical polycarbonate plastic molding. The outer diameter of the inner valve body 207 is slightly smaller than the diameter of die bore of the outer valve body 202 so diat die inner valve body can rotate freely within the outer valve body. The bore of die inner valve body provides a second part 25 IB of the inner surface of die toroidal body of die valve. A spiral slot 222, shown as a broken line in Figure 10, is cut or molded in die wall of die inner valve body 207.

The proximal end 227 of die inner valve body mates with die shoulder 212 of die outer valve body to provide die first dirust bearing. The distal end of die inner valve body has a flange 232 diat mates with the distal end 217 of the outer valve body to provide die second dirust bearing. Attached to the radially remote part of d e flange 232 and coaxial with the inner valve body 207 is die twist ring 237. The twist ring 237 enables die inner valve body 207 to be gripped when die valve is adjusted.

A large luer hub 242 is attached to die distal end of the inner valve body 207, preferably by gluing with a suitable adhesive. Alternatively, and preferably, the large luer hub 242 can be an integral part of die inner valve body molding. The sealing tube 247 passes through die boss of d e large luer hub coaxial to the inner valve body. The sealing tube is preferably an integral part of the inner valve body molding, but it can be a separate tube of metal, for example, stainless steel, or plastic.

In die second practical embodiment of the invention, die collar 252 longitudinally divides the sealing body 206 into a proximal part 206 A and a distal part 206B, and divides die axial passage 216 into a proximal part 216A, which is in die proximal part 206A of the sealing body, and a distal part 216B. The proximal part 206 A of the sealing body provides the main sealing action of the valve. The outer surface of die proximal part 206A of the sealing body provides d e outer surface 236 of the sealing body. The distal part 206B of the sealing body 206B provides die required secondary seal between die static part of die valve, i.e., die sealing tube 247, and die moving part of the valve, i.e., the sealing body 206.

The diameter of the distal part 216B of the axial passage is slightly smaller than die outer diameter of the sealing tube 247, which allows die axial passage to form a fluid-tight seal widi the sealing tube. The diameter of the proximal part 216A of the axial passage is about die same as the diameter of the bore of die sealing tube 247, and is dius smaller than die diameter of the distal part 216B of d e axial passage.

In die plane perpendicular to the axis, the proximal part 206A of die sealing body has a circular cross section. Adjacent to d e collar 252, die diameter of the proximal part 206 A of the sealing body is slightly smaller man die diameter of die bore of die inner valve body 207. The diameter of the proximal part of the sealing body progressively increases in die direction proximal to die collar 252. The rate of increase of diameter is similar to die rate of increase of diameter of the inner surface 251 A of the outer valve body 202.

In the plane perpendicular to die axis, the distal part 206B of die sealing body has a circular cross section widi a substantially constant diameter. The outer diameter of the distal part of the sealing body is slightly smaller than the diameter of the bore of the inner valve body 207, so that d e distal part of the sealing body can freely slide axially in e bore of the inner valve body.

The collar 252 is a plastic molding, preferably of polycarbonate. The outside diameter of the collar is slightly smaller than the diameter of the bore of die inner valve body 207, so that the collar can slide freely in the bore of the inner valve body. The bore of the collar is preferably larger than the outer diameter of the sealing tube 247. A radial hole is drilled and tapped in die side of the collar to receive the screw 257. The screw passes through die linear slot 218 in the outer valve body 202 and the spiral slot 222 in die inner valve body. A pin glued into die radial hole in me collar can be substituted for the screw. Twisting die outer valve body relative to die inner valve body in die direction shown by die arrow 262 (Figure 10) moves the collar axially in the direction indicated by the arrow 256.

The sealing body 206 is formed by attaching a braided sleeve 240, which is preferably a substantially cylindrical piece of woven polyester material, to the bore of the collar 252, preferably by gluing with a cyanoacrylate adhesive. The collar and braided sleeve are dien placed in a mold, and a suitable elastomeric foam is injected radially on both sides of die braided sleeve, and axially on both sides of the collar. Alternatively, the foam can be extruded around die braided sleeve and collar. The axial passage 216 is formed in the molding or extruding process. In die preferred embodiment, d e sealing body is molded from Type 762 silicone foam manufactured by General Electric Co. Alternatively, the foam can be molded around die braided sleeve in a mold that provides a waisted area to receive the collar. The collar can tiien be attached to the exposed braided sleeve in the waisted area, preferably by gluing. The braided sleeve provides die elastomeric foam forming e sealing body widi tensile strengdi, positively attaches the foam of die sealing body to the collar, and, when elongated, radially compresses the sealing body.

In this second embodiment, die braided sleeve 240 does not form the outer surface of the sealing body 206, as it does in the first embodiment. In me second embodiment, which lacks die pawl and ratchet arrangement of the first embodiment, some friction between die outer surface 236 of die sealing body and die inner surface 251 A and 25 IB of the toroidal body is desirable to maintain the sealing body and the toroidal body in their desired relative axial positions. Because of this friction, die valve is not self- releasing: the outer valve body 202 must be twisted relative to d e inner valve body 207 in die direction opposite to diat indicated by me arrow 262 to release the valve. Alternatively, the friction between the outer surface of the sealing body and die inner surface of the toroidal body can be reduced, and the valve provided widi a rotational pawl and ratchet or similar arrangement. Other mechanisms for changing the relative axial positions of the sealing body and die toroidal body can also be used in die second embodiment. For example, die linear pawl and ratchet arrangement of the first embodiment can be adapted for use in the second embodiment of the valve. Figure 11 shows die surgical valve according to die invention in its open (non-sealing) position. The inner surface 251 A of the toroidal body lightly contacts die outer surface 236 of die sealing body such mat the inner surface the toroidal body does not deform the outer surface of sealing body. Moreover, the inner surface of the toroidal body applies no axial stress to die sealing body, so mere is no elongation of the braided sleeve 240. Thus, die axial passage 216A is not deformed. Figure 12 shows the surgical valve of Figure 11 adjusted to its fully sealing condition. The valve can be adjusted using only one hand. The gripping ring 237 is gripped by wrapping the middle finger around it and die proximal end of die outer valve body 202 is gripped between die diumb and forefinger. To seal the valve, the diumb and forefinger are moved relative to die middle finger to twist the outer valve body 202 in the direction indicated by die arrow 262. This causes die collar 252, and hence the sealing body 206, to move in the direction indicated by the arrow 256. The collar 252 moving in die direction indicated by the arrow 256 draws the outer surface 236 of the sealing body into engagement with the inner surface 251 A and 25 IB of me toroidal body. The rigid inner surface 251 A and 25 IB of the toroidal body deforms the outer surface 236 of die sealing body moving it radially towards die axis. In addition, die toroidal body applies an axial stress to the sealing body, which elongates the braided sleeve 240. The deformation of the outer surface of the sealing body and the elongation of the braided sleeve together cause die wall of die axial passage 216A to move towards die axis, and, when die sealing body has been drawn far enough into die toroidal body, to seal with itself.

Drawing the sealing body further into die toroidal body increases die deformation of the outer surface of die sealing body and the elongation of die braided sleeve. This increases die length of the sealed part of the axial passage 216A and die inward radial pressure on die wall of the axial passage.

Like d e first practical embodiment, the second practical embodiment of the surgical valve according to die invention can be adjusted to provide a "minimum friction-no leakage" seal around one or more cadieters. Also, like die first practical embodiment, me second practical embodiment is self sealing from die minimum friction-no leakage position with a smaller-diameter catheter, and from a higher friction position widi a larger-diameter catheter. The second practical embodiment of the valve can provide manual sealing of the valve, which the first practical embodiment cannot provide. When the second practical embodiment of the valve is in its open (non-sealing) position, die proximal end of the sealing body 206 projects proximally from the proximal end of die outer valve body 202, as shown in Figure 11. The exposed part of the sealing body can therefore be gripped by an opposed thumb and finger, or by forceps, to provide manual sealing.

Claims

ClaimsWe claim:

1. A surgical valve comprising: a sealing body having an axial passage extending thered rough, die axial passage defining an axis, die sealing body having a position on the axis; a toroidal body, axially aligned widi die sealing body, and having a position on die axis, the sealing body and die toroidal body having mating surface means whereby changing the position of one of the sealing body and die toroidal body relative to the odier compresses the axial passage of die sealing body; and a position changing means for selectively changing the position of one of die sealing body and die toroidal body relative to the other.

2. The surgical valve of claim 1, wherein the position changing means moves the toroidal body relative to the sealing body.

3. The surgical valve of claim 1, wherein the means position changing means moves the sealing body relative to die toroidal body.

4. The surgical valve of claim 1, wherein: die mating surface means of the sealing body is of a cross section that increases along die axis from a minimum to a maximum; and the mating surface means of the toroidal body is of a substantially constant cross section that is less than die maximum cross section of the mating surface means of the sealing body.

5. The surgical valve of claim 4, wherein: die mating surface means of the sealing body is of a substantially circular cross section; and die mating surface means of the toroidal body is of a substantially circular cross section.

6. The surgical valve of claim 1, wherein: die mating surface means of the sealing body is of a substantially circular cross section; and die mating surface means of die toroidal body is of a substantially circular cross section.

7. The surgical valve of claim 1, wherein: die mating surface means of the sealing body is of a cross section that increases along the axis from a minimum to a maximum; and the mating surface means of the toroidal body is of a cross section diat increases along the axis from a minimum to a maximum in the same direction as die direction in which the cross section of the mating surface means of the sealing body increases.

8. The surgical valve of claim 7, wherein: the mating surface means of the sealing body is of a substantially circular cross section; and the mating surface means of die toroidal body is of a substantially circular cross section.

9. The surgical valve of claim 1, wherein: me mating surface means of d e toroidal body is of a cross section diat increases along the axis from a minimum to a maximum; and the mating surface means of the sealing body is of a substantially constant cross section diat is greater dian the minimum cross section of me mating surface means of the sealing body.

10. The surgical valve of claim 9, wherein: e mating surface means of the sealing body is of a substantially circular cross section; and die mating surface means of die toroidal body is of a substantially circular cross section.

11. The surgical valve of claim 1 , wherein the sealing body includes a braided sleeve disposed coaxially wid die axial passage; and die position changing means is additionally for axially elongating die braided sleeve, d e axial elongation causing the braided sleeve to contract radially.

12. The surgical valve of claim 1, wherein the position changing means includes a pawl and ratchet.

13. The surgical valve of claim 1, wherein the position changing means includes a means for translating rotational motion about die axis into longitudinal motion along die axis.

14. The surgical valve of claim 1, wherein the sealing body comprises an elastomeric foam.

15. The surgical valve of claim 1, wherein the sealing body comprises an encapsulated gel.

16. A surgical valve comprising: a sealing body, the sealing body: having an axial passage extending tiieredirough, the axial passage defining an axis, die sealing body having a position on the axis, and including a braided sleeve coaxial with die axial passage, die braided sleeve extending from the sealing body to provide a remote part, the remote part having a position on die axis; and a position changing means for selectively changing die position of one of the sealing body and die remote part of the braided sleeve relative to the odier to elongate die braided sleeve axially, diereby radially compressing the axial passage of the sealing body.

17. The surgical valve of claim 16, wherein me position changing means includes a toroidal body attached to die remote part of die braided sleeve.

18. The surgical valve of claim 17, wherein: die sealing body has an outer surface; the braided sleeve has an inner surface and an outer surface; the toroidal body has an inner surface; the sealing body is mounted widiin d e braided sleeve widi die outer surface of the sealing body attached to the inner surface of the braided sleeve; and die outer surface of die braided sleeve is attached to die inner surface of the toroidal body.

19. The surgical valve of claim 17, wherein: me surgical valve additionally comprises a cylindrical valve body having a bore; die sealing body is attached to me bore of the valve body; and die toroidal body is slidably mounted within the bore of die valve body.

20. The surgical valve of claim 16, wherein: the surgical valve additionally comprises a cylindrical valve body having a bore; the sealing body is slidably mounted wimin me bore of the valve body; and die remote part of the braided sleeve is attached to the bore of the valve body.

21. The surgical valve of claim 16, wherein: the surgical valve additionally comprises a cylindrical valve body having a bore; the braided sleeve extends from the sealing body in a first direction to provide a first remote part; ie braided sleeve additionally extends from the sealing body in a second direction, opposite to die first direction, to provide a second remote part; d e sealing body and die braided sleeve are mounted widiin the bore of the valve body; die position changing means is attached to die first remote part of the braided sleeve; and die second remote part of the braided sleeve is attached to die bore of die valve body.

22. The surgical valve of claim 16, wherein the braided sleeve is made of a knitted material.

23. The surgical valve of claim 16, wherein die braided sleeve is made of a woven material, the woven material having a warp that is angularly offset relative to the axis.

24. The surgical valve of claim 16, wherein the sealing body comprises an elastomeric foam.

25. The surgical valve of claim 16, wherein the sealing body comprises an encapsulated gel.

26. A surgical valve comprising: a substantially cylindrical valve body having a bore; a sealing body fixed coaxially in the bore of die valve body, die sealing body having an axial passage extending theredirough; a toroidal body, axially aligned widi die sealing body, slidably mounted in die bore of the valve body, and having an axial position therein, die sealing body and die toroidal body having mating surface means whereby changing the axial position of the toroidal body compresses the axial passage of the sealing body; and means attached to the toroidal body for selectively changing die axial position of the toroidal body.

27. The surgical valve of claim 26, wherein: die mating surface means of the toroidal body is of a circular cross section; die cross section of the mating surface means of the toroidal body decreases along the axis in the direction away from e sealing body; the mating surface means of the sealing body is of a circular cross section; and the cross section of the mating surface means of the sealing body is substantially constant along the axis.

28. The surgical valve of claim 26, wherein: the sealing body includes a braided sleeve coaxial wid die axial passage; die braided sleeve extends from die sealing body to provide a remote part; and die remote part of the braided sleeve is attached to die valve body.

29. The surgical valve of claim 28, wherein die braided sleeve provides a sealed passage between die valve body and die sealing body.

30. The surgical valve of claim 28, wherein the means for selectively changing me axial position of die toroidal body is additionally for axially elongating me braided sleeve to contract die braided sleeve radially.

31. The surgical valve of claim 26, wherein: me valve body has an outer surface and includes a longitudinal slot; and die means for selectively changing die axial position of the toroidal body includes: a ratchet attached to die outer surface of the valve body, and a pawl attached to the toroidal body, passing dirough die longitudinal slot, and engaging with the ratchet.

32. The surgical valve of claim 26, wherein the sealing body comprises an elastomeric foam.

33. The surgical valve of claim 26, wherein the sealing body comprises an encapsulated gel.

34. A surgical valve comprising: a substantially cylindrical valve body having a bore; a sealing body slidably mounted coaxially in the bore of die valve body, and having an axial position therein, d e sealing body having an axial passage extending meredirough, the axial passage defining an axis, the valve body and die sealing body having mating surface means whereby changing the axial position of the sealing body compresses the axial passage of the sealing body; and a means attached to die sealing body for selectively changing me axial position of the sealing body.

35. The surgical valve of claim 34, wherein: me bore of the valve body provides the mating surface means of the valve body; die bore of die valve body is of a circular cross section that is substantially constant along die axis; and die mating surface means of die sealing body is of a substantially circular cross section diat increases along die axis in the direction away from the valve body.

36. The surgical valve of claim 34, wherein the sealing body includes a braided sleeve attached to me means for selectively changing die axial position of the sealing body.

37. The surgical valve of claim 36, wherein d e means for selectively changing e axial position of die sealing body is additionally for axially elongating die braided sleeve to contract die braided sleeve radially.

38. The surgical valve of claim 34, further comprising a sealing tube in die bore of the valve body, die sealing be being coaxial with the valve body, entering d e axial passage of die sealing body, and forming a seal therewidi.

39. The surgical valve of claim 34, wherein the valve body includes: a substantially cylindrical outer valve body having a bore; and a substantially cylindrical inner valve body rotatably mounted in d e bore of the outer valve body, and having a bore d at provides die bore of die valve body.

40. The surgical valve of claim 39, wherein: the inner valve body includes a spiral slot; die outer valve body includes a longitudinal slot; and die means attached to die sealing body for selectively changing die axial position of die sealing body includes: a collar attached to die sealing body, and a means, attached to me collar and engaging in the spiral slot and d e linear slot, for moving the sealing body axially when die outer valve body is rotated relative to die inner valve body.

41. The surgical valve of claim 34, wherein the sealing body comprises an elastomeric foam.

42. The surgical valve of claim 34, wherein the sealing body comprises an encapsulated gel.

43. A metiiod of rαanufacturing a surgical valve, comprising the steps of:

(a) providing:

(1) a substantially cylindrical braided sleeve having a first end and a second end,

(2) a sealing body having an axial passage, (3) a substantially cylindrical valve body having an outer surface and an inner bore, and

(4) a toroidal body having a tapered bore;

(b) inserting the sealing body into die braided sleeve;

(c) attaching the sealing body to the first end of die braided sleeve;

(d) threading the second end of the braided sleeve dirough die bore of the toroidal body, the diameter of the tapered bore of the toroidal body increasing towards die sealing body;

(e) inserting the braided sleeve, the toroidal body, and the sealing body into the bore of the valve body; and

(f) attaching the second end of the braided sleeve to the valve body.

44. The method of claim 43, wherein the steps of providing the sealing body having an axial passage, inserting the sealing body into the braided sleeve, and attaching the elastomeric foam sealing body to die first end of the braided sleeve are performed by the steps of: providing elastomeric foam; and molding me elastomeric foam into the first end of the braided sleeve to form the sealing body.

45. The method of claim 43, wherein:

(a) die method further comprises the step of providing an end plug; and

(b) die step of attaching die second end of the braided sleeve to die valve body includes the step of inserting die end plug into die bore of the valve body to secure die second end of die braided sleeve between die bore of die valve body and die end plug.

46. The method of claim 43, wherein:

(a) the step of providing a substantially cylindrical valve body provides a substantially cylindrical valve body including a longimdinal slot formed in die valve body;

(b) die providing step additionally provides: (1) a ratchet attached to the outer surface of the valve body, and

(2) a pawl;

(c) die method additionally comprises the step of attaching me pawl to the toroidal body dirough die longimdinal slot; and

(d) engaging the pawl in die ratchet.

47. The method of claim 43, further comprising the step of sealing the braided sleeve to provide a sealed passage between die valve body and the sealing body.

48. A method of manufacturing a surgical valve, comprising die steps of:

(a) providing:

(1) a substantially cylindrical braided sleeve,

(2) a substantially cylindrical collar having an axial bore, (3) a substantially cylindrical valve body having an axial bore, and

(4) elastomeric foam;

(b) inserting me braided sleeve into the axial bore of the collar;

(c) attaching die collar to the braided sleeve part-way along the lengdi of the braided sleeve;

(d) molding die elastomeric foam along me lengdi of, coaxial with, and surrounding die braided sleeve to form a sealing body; and

(e) inserting the sealing body, die braided sleeve, and die collar into die axial bore of the valve body.

49. The method of claim 48, wherein:

(a) die providing step additionally provides a pin;

(b) die step of providing a substantially cylindrical valve body provides a cylindrical valve body including: (1) a substantially cylindrical outer valve body having a bore and a longimdinal slot, and

(2) a substantially cylindrical inner valve body having a bore and a spiral slot;

(c) die step of providing a substantially cylindrical valve body additionally includes die step of inserting the inner valve body into die bore of the outer valve body such diat die longimdinal slot overlaps die spiral slot; and (d) the step of inserting d e sealing body into die axial bore of the valve body includes the steps of:

(1) inserting the pin dirough die longimdinal slot and die spiral slot, and

(2) attaching me pin to die collar.