with reference to fig1 to 6 , a notes device of the present invention is shown . the device comprises a puncture needle 10 , a plurality of dilator sheaths 20 , a plurality of working sheaths 30 , and a tool member 40 . the puncture needle 10 comprises a puncture end 11 , a protruding safety stud 12 disposed substantially at a position of a middle section of the puncture needle 10 . the puncture needle 10 includes an elongated positioning projection 13 on an outer surface ( fig1 ). the puncture needle 10 is provided for puncturing into an internal wall of nature lumen at the beginning of the surgical procedure . the nature lumen wall can be a tracheal wall , or an internal wall of other natural orifices . in the present invention , an embodiment of the tracheal wall is used for the illustration . the dilator sheath 20 comprises a plurality of tapered first diameters ( or a series of different successively increasing diameters ), an insert member 21 at one end , and a limiting shoulder 22 at the other end opposite to the insert member 21 . each dilator sheath 20 is sheathed sequentially onto the puncture needle 10 . each dilator sheath 20 further includes an elongated positioning projection 23 on an outer surface and an elongated groove 24 on an inner surface , the groove 24 being disposed correspondingly to the positioning projection 23 ( fig2 ). the positioning projection 13 is partially , complementarily received in the groove 24 for guiding and positioning purposes when the puncture needle 10 is disposed in the dilator sheath 20 ( fig5 ). thus , the dilator sheath 20 and the puncture needle 10 can be sequentially slid in place . otherwise , tissues adjacent the bronchus may be damaged . the protruding safety stud 12 of the puncture needle 10 is stopped by the limiting shoulder 22 such that the insert member 21 will not exceed the puncture end 11 and will form a safety interval from the puncture end . the working sheaths 30 have a plurality of tapered second diameters ( or a series of different successively increasing diameters ), and each of the second diameters of the working sheaths 30 is slightly greater than each of the first diameters of the dilator sheaths 20 . the working sheath 30 comprises an elongated positioning projection 31 on an outer surface and an elongated groove 32 on an inner surface , the groove 32 being disposed correspondingly to the positioning projection 31 ( fig3 ). the positioning projection 23 is complementarily received in the groove 32 for guiding and positioning purposes when the dilator sheath 20 is disposed in the working sheath 30 . the working sheath 30 is used for inserting and retracting the dilator sheaths 20 and the puncture needle 10 after the dilator sheaths 20 have expanded a natural orifice . only the working sheath 30 is remained to form a space required for the surgical operation . thus , the working sheath 30 can be correctly guided along the dilator sheath 20 . in addition , a breathing apparatus can be connected when the working sheath 30 is used . as shown in fig4 a , a first configuration of the tool member 40 comprises an elongated , cylindrical shaft 41 and a steel cutting needle 42 releasably secured to the shaft 41 . the steel cutting needle 42 has an inclined surface with a v - shaped sharp end 421 . as shown in fig4 b , a second configuration of the tool member 40 comprises an elongated , cylindrical shaft 41 and a steel cutting needle 43 releasably secured to the shaft 41 . the steel cutting needle 43 has a trapezoidal end 431 as shown in fig4 c , a third configuration of the tool member 40 comprises an elongated , cylindrical shaft 41 and a steel cutting needle 44 releasably secured to the shaft 41 . the steel cutting needle 44 has a pointed end 441 . in each of the first to third configurations , an externally threaded extension is formed at one end of the shaft 41 and the other end of each of the steel cutting needles 42 , 43 and 44 is provided with an externally threaded hole for threadedly securing to the externally threaded extension of the shaft 41 . moreover , the tool member 40 further comprises a graduation 410 on an outer surface for measuring the location of damaged tissues and allowing an appropriate surgical instrument to perform a surgical procedure . the v - shaped sharp end 421 of the steel cutting needle 42 can be complimentarily disposed on an inclined surface for embedding and cutting a surgical thread at the end of the surgical procedure . further , the trapezoidal end 431 of another steel cutting needle 43 is used for outward deflecting the tissues in a surgical procedure . it is a physician &# 39 ; s choice of using one of the three steel cutting needles 42 , 43 and 44 in surgical procedure . the puncture needle 10 has a first length substantially equal to 70 cm . the dilator sheath 20 has a second length substantially equal to 33 cm . the safety interval is substantially equal to 2 cm . the plurality of first diameters can be equal to 5 mm , 7 mm , 9 mm and 11 mm respectively . in other words , the dilator sheaths 20 have diameters equal to 5 mm , 7 mm , 9 mm , and 11 mm sequentially for expanding an orifice . the plurality of second diameters can be equal to 7 mm , 9 mm , 11 mm , and 13 mm respectively . in other words , the plurality of working sheaths 30 can have diameters of 7 mm , 9 mm , 11 mm , and 13 mm respectively for maintaining the smoothness of the orifice during the operation . in general , the endoscope is entered from a trachea during a surgical operation , and a rigid ( or soft ) bronchoscopy is used for the surgical operation , and then the puncture needle 10 is inserted into the trachea , and the plurality of dilator sheaths 20 expand an orifice , and a working sheath 30 is used for maintaining the smoothness of the orifice during the surgical operation , and then a rigid bronchoscopy machinery ( a rigid one has been used clinically ) is used for a surgical operation , and the tool member also is disposed in the working sheath 30 in the surgical operation ( fig6 ). in addition , a method or procedure of the present invention comprises the steps of ( a ) creating a stable airway by a rigid bronchoscopy ; ( b ) selecting an appropriate puncture position ; ( c ) passing a surgical sheath from a tracheal sidewall situated at a position substantially 3 cm from the top of a tracheal carina and out of a trachea through a natural orifice ; ( c1 ) passing a puncture needle 10 out of the tracheal sidewall ; ( c2 ) passing a series of dilator sheaths 20 with tapered diameters along the puncture needle 10 sequentially to create an opening ; ( c3 ) preventing unnecessary damages by a design of a safety stud 12 which latches the dilator sheath 20 at a position substantially 2 cm from the tip of the puncture needle 10 ; ( c4 ) expanding the opening sequentially , and then retracting the dilator sheath 20 to a position of a sheath with one size smaller than the desired working sheath 30 ; ( c5 ) passing the working sheath 30 through the puncture needle 10 and the opening into a pleural space ; ( d ) using the rigid bronchoscopy machinery for the surgical operation after creating a working channel ; ( d1 ) exchanging air by the working sheath 30 of the rigid bronchoscopy during the surgical operation ; ( d2 ) prohibiting a removal of the sheath during the surgical operation ; ( e ) making sure that the oxygen level of an experimental animal or a patient reaches 100 % before removing the working sheath 30 ; ( f ) removing the working sheath 30 after the air exchange is terminated ; ( g ) immediately installing a tracheal stent after the working sheath 30 is removed ; ( g1 ) selecting the tracheal stent primarily by using a silicone stent ( which can be removed easily ), and evaluating the tracheal stent by a 3d ct before the surgical operation takes place ; ( g2 ) covering the opening of the trachea to avoid a pneumothorax ; ( g3 ) performing the endoscopic examination to confirm the position of the stent after the tracheal stent is disposed , wherein if the wound is smaller than one - third of the external circumference of the trachea , then the trachea will be healed automatically ; and ( h ) performing a rigid bronchoscopic examination after the surgical operation takes place , and performing a stent removal operation if the incision healing condition is good . in general , the tracheal stent is covered onto a wound orifice , and the tracheal stent can be removed after two weeks when the wound has been recovered naturally . in brief , the present invention provides a notes device that is disposed in a trachea to achieve the advantages of the notes , and the design of the device provides a user - friendly and easy operation for a scarless surgical operation without affecting a patient &# 39 ; s appearance . in addition , the present invention further includes a protruding safety stud disposed at a position substantially at a middle section of the puncture needle , such that the dilator sheath can be latched at a position substantially 2 cm from the tip of the puncture needle to prevent unnecessary damages . while the invention has been described in terms of preferred embodiments , those skilled in the art will recognize that the invention can be practiced with modifications within the spirit and scope of the appended claims .
a natural orifice translumenal endoscopic surgery device is provided with a puncture needle including a puncture end , an intermediate protruding safety stud , and a positioning projection on an outer surface ; dilator sheaths each including tapered first diameters , an insert member at one end , a limiting shoulder at the other end , a positioning protrusion on an outer surface , and a groove on an inner surface ; working sheaths each having a plurality of tapered second diameters and including a positioning protuberance on an outer surface and a trough on an inner surface ; and a tool member including a shaft having a graduation on an outer surface , and an operating head threadedly secured to the shaft .