U.S. patent application number 10/902756 was filed with the patent office on 2004-12-30 for hand access port device.
Invention is credited to Caldwell, Martin, Cummins, Christopher.
Application Number | 20040267096 10/902756 |
Document ID | / |
Family ID | 26320257 |
Filed Date | 2004-12-30 |
United States Patent
Application |
20040267096 |
Kind Code |
A1 |
Caldwell, Martin ; et
al. |
December 30, 2004 |
Hand access port device
Abstract
An access port device is provided which enables hand access to a
patient's body cavity while retaining pneumoperitoneum by
minimizing gas leakage through the access port device. The access
port device comprises a sleeve of flexible material including a
proximal end and a distal end, and forming an access opening
positionable in an incision in a patient's body, an outer annular
sealing device attached to the proximal end of the sleeve to secure
the access port device externally to a patient, an inner annular
sealing device attached to the distal end of the sleeve to secure
the access port device internally to the patient, and an access
component removably connected to the outer annular sealing device,
the access component including a flexible ring removably engaging
the outer annular sealing device. The access component may include
a sleeved glove, an access sleeve of flexible material, the access
sleeve including an integral glove for receiving a surgeon's hand,
and the access sleeve and glove having a length sufficient to
extend from the flexible ring through the access opening. In
another aspect, the outer annular sealing device includes an
annular groove for receiving the flexible ring. The annular groove
may be formed in an outer peripheral surface of the outer annular
sealing device. The access component may further include an access
sleeve of flexible material positioned adjacent to the sleeve, the
device further including an inflatable chamber formed between the
sleeve and the access sleeve.
Inventors: |
Caldwell, Martin; (Ranelagh
Dublin, IE) ; Cummins, Christopher; (Tullamore,
IE) |
Correspondence
Address: |
APPLIED MEDICAL RESOUCES CORPORATION
22872 Avenida Empresa
Rancho Santa Margarita
CA
92688
US
|
Family ID: |
26320257 |
Appl. No.: |
10/902756 |
Filed: |
July 29, 2004 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
10902756 |
Jul 29, 2004 |
|
|
|
10052297 |
Jan 18, 2002 |
|
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Current U.S.
Class: |
600/213 |
Current CPC
Class: |
A61B 2017/00265
20130101; A61B 17/3423 20130101; A61B 90/40 20160201 |
Class at
Publication: |
600/213 |
International
Class: |
A61B 001/32 |
Foreign Application Data
Date |
Code |
Application Number |
Jul 30, 1999 |
IE |
S990660 |
Sep 24, 1999 |
IE |
990660 |
Claims
1-13. (Cancelled without prejudice).
14. An access port device for use in surgery, comprising: a sleeve
of flexible material including a proximal end and a distal end, and
forming an access opening positionable in an incision in a
patient's body; an outer annular sealing device attached to said
proximal end of said sleeve to secure the access port device
externally to a patient; an inner annular sealing device attached
to said distal end of said sleeve to secure the access port device
internally to the patient; an access component removable connected
to said outer annular sealing device, said access component
including a flexible ring removable engaging said outer annular
sealing device.
15. An access port device as claimed in claim 14, wherein said
access component includes a sleeved glove.
16. An access port device as claimed in claim 14, wherein said
access component includes an access sleeve of flexible material,
said access sleeve including an integral glove for receiving a
surgeon's hand, said access sleeve and glove having a length
sufficient to extend from said flexible ring through said access
opening.
17. An access port device as claimed in any of claims 14 to 16,
wherein said outer annular sealing device includes an annular
groove for receiving said flexible ring.
18. An access port device as claimed in claim 17, wherein said
annular groove is formed in an outer peripheral surface of said
outer annular sealing device.
19. An access port device as claimed in claim 14, wherein said
access component further includes an access sleeve of flexible
material positioned adjacent to said sleeve, the device further
including an inflatable chamber formed between said sleeve and said
access sleeve.
20. An access port device as claimed in claim 19, wherein said
outer annular sealing device further includes a flexible annular
extension extending radially inwardly from said outer annular
device, said annular extension including a inner annular biasing
surface facing outwardly from the patient's body.
21. An access port device as claimed in claim 20, wherein said
annular extension includes a circumferentially unsupported annular
floating edge.
22. An access port device as claimed in claim 20 or claim 21,
further including a gas chamber positioned adjacent said inner
annular biasing surface to collect gas leaking between said sleeve
and the patient's body.
23. An access port device as claimed in claim 20, wherein said
flexible annular extension is generally flat.
24. An access port device as claimed in claim 22, wherein said
outer annular sealing device includes an upper annular overhang
positioned opposite and spaced from said flexible annular
extension, said gas chamber being positioned between said upper
annular overhang and said flexible annular extension.
25. An access port device as claimed in claim 20, said outer
annular sealing device further including an outer biasing surface
facing said inflatable chamber to cause gas pressure in said
inflatable chamber to apply a gas pressure sealing force against
said outer biasing surface to bias said outer annular sealing
device into abutment with the patient's outer surface.
26. An access port device for use in surgery, comprising: a first
sleeve of flexible material including a proximal end and a distal
end, and forming an access opening positionable in an incision in a
patient's body; and a leakage minimizing means for minimizing gas
leakage from between said first sleeve and the patient's body, said
leakage minimizing means including an outer annular sealing device
attached to said proximal end of said first sleeve, an inner
annular sealing device attached to said distal end of said first
sleeve for abutting and sealingly engaging an inner surface of a
body cavity of the patient, and a sealing force applying means for
causing leakage gas between said first sleeve and the patient's
body to apply a sealing force against said outer annular sealing
device to bias said outer annular sealing device toward the
patient.
27. An access port device as claimed in claim 26, further including
a second sleeve of flexible material positioned adjacent to said
first sleeve and an inflatable chamber formed between said first
sleeve and said second sleeve.
28. An access port device as claimed in claim 27, wherein said
sealing force applying means includes a flexible annular extension
extending radially inwardly from said outer annular sealing device
and an inner biasing surface facing outwardly away from the
patient's body.
29. An access port device as claimed in claim 28, wherein said
annular extension includes a circumferentially unsupported annular
floating edge.
30. An access port device as claimed in any of claims 26 to 29
wherein said sealing force applying means further includes a
leakage gas chamber means positioned adjacent said outer annular
sealing device for collecting gas leakage between said first sleeve
and the patient's body.
31. An access port device as claimed in claim 28, wherein said
sealing force applying means further includes a gas chamber
positioned adjacent said inner biasing surface to collect gas
leaking between said first sleeve and the patient's body.
32. An access port device as claimed in claim 31, wherein said
flexible annular extension is generally flat.
33. An access port device as claimed in claim 32, wherein said
outer annular ring includes an upper annular overhang positioned
opposite and spaced from said flexible annular extension, said gas
chamber being positioned between said upper annular overhang and
said flexible annular extension.
34. An access port device as claimed in claim 26, wherein said
leakage minimizing means includes sizing said first sleeve to fit
closely to the patient's cavity wall to cause a sealing force to
bias said outer annular sealing device into sealing engagement with
the patient's skin.
35. An access port device as claimed in claim 33, wherein sealing
force applying means further includes an outer biasing surface
formed on said overhang and adapted to receive gas pressure biasing
forces tending to bias said overhang into abutment with the
patient's outer surface.
36. An access port device for use in surgery, comprising: a sleeve
of flexible material including a proximal end and a distal end, and
forming an access opening positionable in an incision in a
patient's body; a non adhesive outer annular sealing device
attached to said proximal end of said sleeve and adapted to create
a non adhesive, substantially gas-tight seal adjacent the patient's
body to prevent gas flow from the patient's body; an inner annular
scaling device attached to said distal end of said sleeve to secure
the access port device internally to the patient; and an access
component sealingly mounted on said outer annular sealing device
and extendable into said access opening.
37. An access port device as claimed in claim 36, wherein said
access component is removably mounted on said outer annular sealing
device.
38. The access port device of claim 37, wherein said non adhesive
outer annular sealing device includes a flexible annular extension
extending radially inwardly and an inner biasing surface formed on
said flexible annular extension and facing outwardly away from the
patient's body.
39. An access port device as claimed in claim 38, wherein said
annular extension includes a circumferentially unsupported annular
floating edge.
40. An access port device as claimed in claim 38, further including
a gas chamber positioned adjacent said inner biasing surface to
collect gas leaking between said sleeve and the patient's body.
41. An access port device as claimed in claim 37, wherein said
flexible annular extension is generally flat.
42. (Cancelled without prejudice).
43. A surgical device for use in minimally invasive surgery of the
type using an inflated body cavity accessible to a surgeon through
an incision, the device being formed to define a sleeve access port
for insertion into the incision and having: mounting means for
locating and securing the device in position on a patient; sealing
means to prevent substantial leakage of gas from the body cavity;
and a retractor to limit contact between the sleeve and the
incision when in use.
44. A surgical device as claimed in claim 43 wherein the retractor
is provided as a deformed tube.
45. A surgical device as claimed in claim 44 wherein the tube has
at opposing ends a proximal ring and a distal ring.
46. A surgical device as claimed in claim 45 wherein the proximal
and distal rings are formed for substantially airtight engagement
with the sleeve and with the patient's abdomen.
47. A surgical device as claimed in claim 46 wherein the ring
incorporates an adhesive portion for fixing the ring in
position.
48. A surgical device as claimed in any of claims 45 to 47 wherein
the distal ring is formed for substantially airtight engagement
with the sleeve and with the patient's internal abdominal wall.
49. A surgical device as claimed in claim 45 wherein engagement
between the proximal ring and sleeve is provided by a skirt carried
on the sleeve and having a rim formed for releasable engagement to
the ring.
50. A surgical device as claimed in claim 49 wherein the ring and
skirt are integrally formed.
51. A surgical device as claimed in claim 49 or 50 wherein the
skirt has an integrally formed glove for receiving a surgeon's
hand.
52. A surgical device as claimed in claim 49 wherein the skirt has
an integrally formed pocket for receiving a surgical
instrument.
53. A surgical device as claimed in claim 49 wherein the skirt has
a recessed receiver formed for engagement with a ring.
54. A surgical device as claimed in claim 49 wherein the skirt has
a recessed receiver formed for engagement with a surgeon's
glove.
55. A surgical device as claimed in claim 45 wherein the proximal
ring incorporates a flexible gas retaining ring extending down from
the proximal ring and formed for engagement against a patient's
skin when in position to define a gas retention chamber.
56. A surgical device as claimed in claim 55 wherein the gas
retaining ring is inflatably movable between an insertion position
and an in use position.
57. A surgical device as claimed in claim 55 or 56 wherein the gas
retaining ring is provided by a collapsible bellows ring.
58. A surgical device as claimed in claim 45 wherein the device
incorporates a retractor-positioning device.
59. A surgical device as claimed in claim 45 wherein the
retractor-positioning device has means for releaseably engaging the
proximal ring and the distal ring.
60. A surgical device as claimed in claim 58 wherein the means for
engaging the proximal ring and the distal ring are movable between
a retracted position and a locating position.
61. A surgical device as claimed in claim 58 or claim 59 wherein
the means for engaging the proximal ring and the distal ring are
telescopically movable.
62. A surgical device as claimed in claim 45 wherein the proximal
ring supports a flexible web, said web in turn defining a hole for
receiving the sleeve.
63. A surgical device as claimed in wherein the device incorporates
a collapsible support scaffold, the scaffold being formed for
supporting the device in an operative state and collapsible to
provide a surgeon free access to the incision.
Description
[0001] The present invention relates to an improved hand access
port, which enables hand access during laproscopic surgery while
retaining pneumoperitoneum.
[0002] Minimally invasive surgery is surgery carried out by causing
a minimum amount of trauma by incision in a patient's body. This
type of surgery almost invariably involves deliberately introducing
gas into a patient's peritoneal cavity to cause
pneumoperitoneum.
[0003] Accordingly, surgical sleeves have been developed to prevent
gas from escaping from the patient's body cavity while allowing the
surgeon to operate using minimally invasive surgery techniques.
These sleeves create a controlled pressurized environment within
the sleeve while allowing the surgeon's arm to ass through the
sleeve. For example, U.S. Pat. Nos. 5,803,921 and 5,899,208 both
disclose an access port device having an inner sleeve, an outer
sleeve, an exit opening sealing feature for preventing substantial
leakage of gas from the patient's body in the region of an exit
opening and an entry opening sealing, feature substantially
preventing gas leakage around the surgeon's arm at the entry
opening. A lower annular edge of the outer sleeve is sealingly
secured, for example by adhesive, either to wrapping material
applied to the patient or directly to the patient's skin. The exit
opening sealing feature includes a pair of arcuate bands positioned
to bring the opposing faces of the sleeve into contact to form an
initial seal. The arcuate bands are passed through the incision
into the abdomen. During pressurization, the arcuate bands also
function to prevent the tendency of the inner sleeve to invert
under pressure since the bands cannot pass back through the
incision. The entry opening sealing feature includes an inflatable
chamber formed between the sleeves to cause the walls of the inner
sleeve to contact and form an entrance seal.
[0004] Although the devices disclosed in the '921 and '208 patents
operate effectively in many applications, improvements are
desirable. For example, in the certain applications, the arcuate
bands of the exit opening sealing means tend to shift outwardly
from the abdomen through the incision thereby adversely affecting
the seal. Also, when a surgeon extends a hand through the entrance
seal formed by the inner walls of the sleeve, the inner walls may
not effectively contact and seal around the entire outer annular
surface of the wrist/arm. As a result, an excessive amount of gas
is leaked from the patient's body cavity. In addition, improvements
in sealing the lower edge of the outer sleeve to prevent leakage
would be advantageous.
[0005] Another known sleeve is shown in PCT Patent Application No.
PCT/IE94/00045 entitled "Apparatus for use in surgery". The access
port sleeve shown is used to create a controlled pressurized
environment within the sleeve while allowing a surgeon's arm to
pass through the sleeve. During surgery, gas is pumped into the
body cavity around the surgery site and the sleeve prevents gas
escaping while allowing the surgeon to operate using minimally
invasive surgery techniques. The application shows a sleeve having
a flange at a distal end provided with adhesive for adhering the
device to a patient's body or alternatively a mounting ring to
surround the incision in a patient's body. While providing a
suitable apparatus for performing such surgery the device described
suffers from the principle disadvantage that in use, the sleeve
protrudes upwardly from the patient and may interfere with the
surgical team's activities. Additionally, the sleeve must be sealed
against the surgeon's upper forearm by clamping the device to the
arm sufficiently tightly to avoid gas leak around the area of the
seal. This presents the surgeon with a problem both in sealing the
sleeve and in subsequent mobility.
[0006] A further problem associated with the use of sleeves of the
kind described is that a phenomenon known as "tenting" may occur.
"Tenting" means that when the sleeve is adhered to the patient's
skin or to a surgical drape and gas is induced into the patients
abdominal cavity, there is a tendency for the sleeve to fill with
gas and to pull away from the patient. A still further problem
associated with the use of such sleeves is that repeated insertion
of surgical devices or the surgeons hand can cause unacceptably
high trauma levels around the incision. This is particularly
problematic when a surgeon attempts to remove an intact specimen or
a hard organ.
[0007] Therefore, there is a need for an improved access port
device for more effectively preventing gas from escaping from the
patient's body while allowing the surgeon to effectively operate
using minimally invasive surgery techniques.
[0008] Therefore, it is an object of the present invention to
overcome the disadvantages of the prior art and to provide an
access port device capable of permitting effective surgery while
permitting body cavity pressure to be easily maintained.
[0009] It is another object of the present invention to provide an
access port device capable of minimizing leakage of gas from the
body cavity between the access port device and a surgeon's hand/arm
in a simple manner without limiting the movement of the hand.
[0010] It is yet another object of the present invention is to
provide an access port device, which effectively prevents
inadvertent retraction of a sleeve of the device from a body
cavity.
[0011] Yet another object of the present invention is to provide an
access port device capable of creating a gas tight seal between the
access port device and patient's body.
[0012] Still another object of the present invention is to provide
an access port device capable of effectively minimizing gas leakage
from a body cavity through the space between the access port device
and the patient's body.
[0013] A further object of the present invention is to provide an
access port device, which creates an effective seal without the use
of adhesive.
[0014] These and other objects of the present invention are
achieved by providing an access port device for use in surgery,
comprising a first sleeve of flexible material including a proximal
end and a distal end, a securing device attached to the distal end
of the first sleeve to secure the access port device externally to
the patient and a second sleeve of flexible material attached to
the proximal end of the first sleeve. The second sleeve includes an
entry opening adjacent the proximal end of the first sleeve and an
exit opening positioned a spaced distance from the entry opening.
An inflatable chamber is formed between the first and second
sleeves. The access port device further includes a third sleeve of
flexible material attached to at least one of the first and second
sleeves wherein the third sleeve includes an annular elastic band
positioned between the entry and the exit openings of the second
sleeve to sealingly engage a surgeon's arm extending through the
third sleeve. The third sleeve is preferably formed of a sufficient
length to be positioned adjacent the exit opening and extends along
a substantial portion of the second sleeve. Also, the third sleeve
may be attached to the second sleeve at a first attachment location
adjacent the entry opening, and at a second attachment location a
spaced distance along the second sleeve from the first attachment
location. The elastic band is preferably positioned at a distal end
of the third sleeve.
[0015] The access port may include an elongated exit opening seal
mounted on the second sleeve at the exit opening. The exit opening
seal is positioned along an exit opening seal plane extending
through the entry opening, and the exit opening of the second
sleeve. A second sleeve retraction prevention device may be
included for preventing inadvertent retraction of the second sleeve
from an incision in a patient's body. The second sleeve retraction
prevention device includes at least one transverse wing extending
transverse to the exit opening seal plane. The at least one
transverse wing includes at least one first wing positioned on a
first side of the exit opening and at least one second wing
positioned on a second side of the exit opening. Each of the at
least one first wings and the at least one second wings may include
a pair of wings. The wings may be integrally formed on the
elongated exit opening seal. The elongated exit opening seal may
include a pair of opposed bands biased together while the
transverse wing may be integrally formed on at least one band of
the opposed bands. The first pair of wings may be located at a
first end of the pair of opposed bands while the second pair of
wings is located at a second end of the pair of opposed bands. One
wing of each pair of wings extends from the bands in a first
transverse direction while the other wing extends from the other
band in a second transverse direction opposite to the first
direction.
[0016] In another embodiment, the access port device of the present
invention comprises a sleeve of flexible material including a
proximal end and a distal end, and forming an access opening
positionable in an incision in a patient's body. The device further
includes an outer annular sealing device attached to the proximal
end of the sleeve to secure the access port device externally to a
patient and an inner annular sealing device attached to the distal
end of the sleeve to secure the access port device internally to
the patient. Moreover, the access port device includes an access
component removably connected to the outer annular sealing device
and including a flexible ring removably engaging the outer annular
sealing device. The access component may include an access sleeve
of flexible material, which may include an integral glove for
receiving a surgeon's hand. The access sleeve and glove have a
length sufficient to extend from the flexible ring through the
access opening. The outer annular scaling device may include an
annular groove for receiving the flexible ring and the groove may
be formed in an outer peripheral surface of the outer annular
sealing device. An inflatable chamber may be formed between the
sleeve and the access sleeve. The outer annular sealing device may
include a flexible annular extension extending radially inwardly
from the outer annular scaling device wherein the annular extension
includes an inner annular biasing surface facing outwardly from the
patient's body. The annular extension may include a
circumferentially unsupported annular floating edge. The device may
further include a gas chamber positioned adjacent the inner annular
biasing surface to collect gas leaking between the sleeve and the
patient's body. Preferably, the flexible annular extension is
generally flat. The outer annular sealing device may include an
upper annular overhang positioned opposite and spaced from the
flexible annular extension so that the gas chamber is positioned
between the upper annular overhang and the flexible annular
extension. The outer annular sealing, device may further include an
outer biasing surface facing the inflatable chamber.
[0017] Thus, the present invention provides an access port device
comprising a first sleeve of flexible material including a proximal
end and a distal end and forming an access opening positionable in
an incision in a patient's body. The access port device also
includes a leakage-minimizing feature for minimizing gas leakage
from between the first sleeve and the patient's body. The leakage
minimizing feature includes an outer annular sealing device
attached to the proximal end of the first sleeve, an inner annular
sealing device attached to the distal end of the first sleeve for
abutting and sealingly engaging an inner surface of a body cavity
of the patient, and a seal force applying device for causing
leakage gas between the first sleeve and the patient's body to
apply a sealing force against the outer annular sealing device to
bias the outer annular sealing device toward the patient. The
access port device may further include a second sleeve of flexible
material positioned adjacent the first sleeve and an inflatable
chamber formed between the first and second sleeves. The sealing
force applying device may further include the flexible annular
extension and the inner biasing surface. The sealing force applying
device may further include sizing the first sleeve to fit closely
to the patient's cavity wall to cause a sealing force to bias the
outer annular sealing device into scaling engagement with the
patient's skin. The sealing force applying device may further
include the annular overhang, gas chamber and outer biasing
surfaces mentioned hereinabove.
[0018] The present invention also provides an access port device
for use in surgery which comprises a sleeve of flexible material, a
non adhesive outer annular sealing device attached to a proximal
end of the sleeve and adapted to create a non adhesive,
substantially gas tight seal adjacent the patient's body to prevent
gas flow from the patient's body and an inner annular sealing
device attached to the distal end of the sleeve to secure the
access port device internally to the patient. In this case, the
access component is sealingly mounted on the outer annular sealing
device and extendable into the access opening. The access component
may be removably mounted on the outer annular sealing device, which
may, in turn, include the flexible annular extension.
[0019] According to one aspect of the invention there is provided a
surgical device for use in minimally invasive surgery of the type
using an inflated body cavity accessible to a surgeon through an
incision, the device being formed to define a sleeve access port
for insertion into the incision and having:--
[0020] mounting means for locating and securing the device in
position on a patient;
[0021] sealing means to prevent substantial leakage of gas from the
body cavity; and
[0022] a retractor to limit contact between the sleeve and the
incision when in use.
[0023] Thus, contact with the incision is limited thereby reducing
patient trauma and greatly improving the ease with which
instruments or a surgeon's hand may be inserted.
[0024] In one arrangement, the retractor is provided as a
deformable tube.
[0025] Preferably, the tube has at opposing ends a proximal ring
and a distal ring.
[0026] Preferably, the proximal and distal rings are formed for
substantially airtight engagement with the sleeve and with the
patient's abdomen.
[0027] In one arrangement the or each ring incorporates an adhesive
portion for fixing the ring in position.
[0028] Preferably, the distal ring is formed for substantially
airtight engagement with the sleeve and with the patient's internal
abdominal wall.
[0029] Ideally engagement between the proximal ring and sleeve is
provided by a skirt carried on the sleeve and having a rim formed
for releasable engagement to the ring.
[0030] In one arrangement the ring and skirt are integrally
formed.
[0031] In one arrangement the skirt has an integrally formed glove
or pocket for receiving a surgeons hand or surgical instrument.
[0032] In one arrangement the skirt has a recessed or undercut
receiver formed for engagement with a ring or a surgeons glove.
[0033] In a preferred embodiment, the proximal ring incorporates a
flexible gas retaining ring extending down from the proximal ring
and formed for engagement against a patients skin when in position
to define a gas retention chamber.
[0034] Preferably, the gas retaining ring is inflatably movable
between an insertion position and an in use position.
[0035] In one arrangement, the gas retaining ring is provided by a
collapsible bellows ring.
[0036] In a particularly preferred embodiment, the device
incorporates a retractor-positioning device.
[0037] Ideally, the retractor-positioning device has means for
releaseably engaging the proximal ring and the distal ring.
[0038] Preferably, the means for engaging the proximal ring and the
distal ring are movable between a retracted position and a locating
position.
[0039] Ideally, the means for engaging the proximal ring and the
distal ring are telescopically movable.
[0040] According to another aspect of the invention the proximal
ring supports a flexible web, said web in turn defining a hole for
receiving the sleeve.
[0041] According to a further aspect of the invention the device
incorporates a collapsible support scaffold, the scaffold being
formed for supporting the device in an operative state and
collapsible to provide a surgeon free access to the incision.
[0042] The invention will now be described more particularly with
reference to the accompanying drawings, which show, by way of
example only, some embodiments of a surgical device in accordance
with the invention, in which:--
[0043] FIG. 1 is a perspective view of a first embodiment of the
access port device of the present invention;
[0044] FIG. 2 is a perspective view of the bottom of the first
embodiment of FIG. 1;
[0045] FIG. 3 is a plan view of the opposed bands of the exit
opening seal;
[0046] FIG. 4 is a perspective view of one of the bands of the exit
opening seal;
[0047] FIG. 5 is a cross sectional side view of the access port of
the first embodiment as applied to a patient prior to access
during, surgery;
[0048] FIG. 6 is a cross sectional side view similar to FIG. 5
during use with access by a surgeon's arm;
[0049] FIG. 7 is a cross sectional view of a second embodiment of
the present invention in use;
[0050] FIG. 8 is a cross sectional view of a third embodiment of
the present invention including a seal force applying feature;
[0051] FIG. 9 is a cross sectional view of the device of FIG. 8
during use but without showing an access component attached;
[0052] FIG. 10 is a sectional view of a surgical device in
accordance with the invention in position on a patient;
[0053] FIG. 11 is front view of a sleeve forming part of the
invention;
[0054] FIG. 12 is a perspective view of a retractor forming part of
the invention;
[0055] FIG. 13 is a front view of a retractor-positioning device
forming part of the invention;
[0056] FIG. 14 is a sectional view of another embodiment of a
surgical device in accordance with the invention in position on a
patient;
[0057] FIG. 15 is a sectional view of the device of FIG. 14 with a
surgeon's hand inserted;
[0058] FIG. 16 is a sectional view of a further embodiment of a
surgical device in accordance with the invention in position on a
patient;
[0059] FIG. 17 is a sectional view of the device of FIG. 16 with a
surgeons hand inserted;
[0060] FIG. 18 is a sectional view of another surgical device in
accordance with the invention in position on a patient;
[0061] FIG. 19 is a sectional view of a further surgical device in
accordance with the invention in position on a patient;
[0062] FIG. 20 is a top view of the surgical device of FIG. 19;
[0063] FIG. 21 is a sectional view of another surgical device in
accordance with the invention in an insertion position on a
patient; and
[0064] FIG. 22 is a sectional view of the surgical device of FIG.
21 in an operating position on a patient.
[0065] Referring to FIGS. 1-6, there is shown a first embodiment of
the access port device of the present invention, indicated
generally at 10, for permitting access to a patient's body cavity
during surgery while maintaining body cavity pressure. Access port
device 10 generally includes a first sleeve 12 of flexible material
including a proximal end 14 and a distal end 16, a securing device
18 attached to the distal end 16 of first sleeve 12, a second
sleeve 20 attached to proximal end 14 of first sleeve 12 and a
third sleeve 22 of flexible material attached to at least one of
the first sleeve 12 and second sleeve 20. As described hereinbelow,
this arrangement can be effectively and sealingly attached to a
patient's body surrounding an incision to permit the insertion of a
hand into a patient's body cavity while simply and effectively
maintaining pneumoperitoneum as desired throughout a laproscopic
surgery procedure.
[0066] Referring to FIGS. 1 and 5, both first sleeve 12 and second
sleeve 20, extend annularly with second sleeve 20 positioned inside
first sleeve 12. Second sleeve 20 is preferably integrally formed
at proximal end 14 of first sleeve 12, i.e. second sleeve 20 is an
integral extension of first sleeve 12 turned inwardly onto itself.
Securing device 18 includes a flange 24 extending transversely from
distal end 16 for connection to either the patient's skin or
wrapping material covering the patient's skin. Preferably, the
flange 24 includes an adhesive, such as a solid or a liquid
adhesive, for adhering to the wrapping material or skin to securely
and sealingly affix the access port device 10 to the patient. Both
first sleeve 12 and second sleeve 20 may each be formed from
opposing sheets of flexible material fused together along opposite
edges 26 and 28, respectively, with edges 26 being positioned
outwardly from edges 28. As shown in FIG. 5, an inflatable chamber
30 (FIG. 5) is positioned between first sleeve 12 and second sleeve
20 for receiving pressurized gas via an inlet valve 32 (FIG. 1).
Inlet valve 32 is provided on first sleeve 12 so that inflatable
chamber 30 can be inflated prior to the insertion of a surgeon's
hand into the device as shown in FIG. 5. The gas pressure in
inflatable chamber 30 is maintained by gas flowing from the body
cavity of the patient during pneumoperitoneum. Thus, after the
inflation of chamber 30 through valve 32, valve 32 is closed.
[0067] Referring to FIG. 5, the second sleeve 20 forms an entry
opening 34 positioned adjacent the proximal end 14 of first sleeve
12 and an exit opening 36 positioned a spaced distance from entry
opening 34. Second sleeve 20 has a length sufficient to extend
through first sleeve 12 and through an incision 2 formed in a
patient's body 4 so as to be positioned in the patient's body
cavity when access port device 10 is applied to the patient as
shown in FIG. 5. Access port device 10 further includes an
elongated exit opening seal 38 mounted on second sleeve 20 and
extending across exit opening 36. Elongated exit opening seal 38 is
positioned along an exit opening seal plane, indicated at 40, which
extends through entry opening 34 and exit opening 36 of second
sleeve 20. Elongated exit opening seal 38 includes a pair of
resilient opposed bands 42 as clearly shown in FIGS. 2, 3 and 5.
Each band 42 is positioned in a respective elongated cuff 44 formed
in the distal end of second sleeve 20. Bands 42 are formed of a
resilient flexible material, i.e. plastic, which permits the bands
to be flexed outwardly to create an exit opening for receiving a
surgeon's hand and/or an instrument. Each of the bands 42 may also
include a cushioning strip made from, for example, foam, to provide
more comfort to the surgeon's hand/wrist during use. In the relaxed
state, the bands 42 are biased together bringing the opposing faces
of second sleeve 20 into mutual contact and hence forming an exit
opening seal. The geometry of bands 42 is such that, when presented
at right angles to the incision 2, it is possible for the bands to
pass through the incision. Once in position within the patient's
body cavity, bands 42 align themselves nominally parallel to the
abdominal wall as shown in FIG. 5. Thus, elongated exit opening
seal 38 functions to form an initial seal preventing the escape of
gas from the body cavity to the atmosphere via the exit opening, 36
of second sleeve 20.
[0068] Access port device 10 also includes a second sleeve
retraction prevention feature, indicated generally at 46, for
preventing inadvertent retraction of second sleeve 20 from incision
2. It has been found that during use of conventional access port
devices, the insulflation pressure in the patient's body cavity
acts to undesirably invert the inner sleeve and move the inner
sleeve outwardly through the incision. Second sleeve retraction
prevention feature 46 of the present invention effectively prevents
elongated exit opening seal 38, and thus the distal end of second
sleeve 20, from passing outwardly through incision 2 under the
force of the insulflation pressure. As shown in FIGS. 2-5, second
sleeve retraction feature 46 includes at least one transverse wing
48 extending from the distal end of second sleeve 20 transverse to
exit opening seal plane 40 (FIG. 5). Specifically, in the preferred
embodiment, second sleeve retraction prevention feature 46 includes
a transverse wing 48 formed at each end of each of the opposed
bands 42 as clearly shown in FIG. 3. Transverse wings 48 are
integrally formed on opposed bands 42 and extend transversely
generally parallel to the under surface of the patient's body
defining the body cavity. The transverse wings 48 extend through
respective slits formed in the cuff 44 of second sleeve 20 thereby
securing bands 42 within cuff 44. During use, once the distal end
of second sleeve 20 has been inserted through incision 2 into the
patient's body cavity, transverse wings 48 will prevent inadvertent
movement of elongated exit opening seal 38 through incision 2 by
abutting the under surface of the patient's body forming the body
cavity as shown in FIG. 6. Even prior to insertion of a surgeon's
arm into the access port device 10, when insulflation pressure
causes movement of exit opening seal 38 toward incision 2,
transverse wings 48 will abut the incision and prevent exit opening
seal 38 from passing through incision 2. As a result, second sleeve
retraction prevention feature 46 creates a more reliable and
effectively usable access port device, which can be easily and
simply utilized without subsequent repositioning of second sleeve
20 after initial setup.
[0069] Importantly, access port device 10 of the present invention
also includes the third sleeve 22 positioned within, and attached
to, second sleeve 20. In the preferred embodiment, third sleeve 22
extends from entry opening 34 of second sleeve 20 to a location
adjacent exit opening 36. Third sleeve 22 is attached to, or
integrally formed on, second sleeve 20 at a first attachment 50
adjacent entry opening 34. First attachment 50 extends annularly to
prevent gas from escaping from the space between second sleeve 20
and third sleeve 22. Third sleeve 22 is also attached to second
sleeve 20 at a second attachment 52 located a spaced distance from
first attachment 50 along third sleeve 22. Second attachment 52
occurs at a point close to a distal end of third sleeve 22 so as to
maintain the distal end in the inner space of second sleeve 20. For
example, second attachment 52 may be in the form of two separate
weld lines positioned on opposite sides of third sleeve 22. An
inflatable gas chamber 60 is formed between second sleeve 20 and
third sleeve 22, which captures gas leaking by elongated exit
opening seal 38. The inflation of chambers 30 and 60 create an
entry opening seal 62 by forcing the opposing surfaces of third
sleeve 22 into abutment prior to use as shown in FIG. 5. Thus the
combination of exit opening seal 38 and entry opening seal 62
effectively minimizes gas leakage through access port device 10 so
as to retain pneumoperitoneum.
[0070] Importantly, third sleeve 22 includes an annular elastic
band 54 for sealingly engaging a surgeon's hand, wrist or arm
positioned in third sleeve 22 as shown in FIG. 6. In the preferred
embodiment, annular elastic band 54 is positioned at the distal end
of third sleeve 22. Annular elastic band 54 is sized and designed
with sufficient elasticity so as to permit insertion of hands and
arms of varying sizes while ensuring a substantially gas tight seal
between elastic band 54 and the arm. It will be understood that the
size and elasticity of the access port and elastic band 54 can be
varied to accommodate, for instance only one finger rather than the
entire hand and arm of the surgeon. Also, the size and elasticity
of the access port and elastic band 54 may be designed to
accommodate instruments of various sizes while still substantially
preventing leakage from the patient's body cavity through the
access port device 10. It should be noted that the various sleeves
of access port device 10 may be manufactured from any flexible, gas
impermeable, sterilizable, biocompatible material, for instance
polyethylene.
[0071] Reference is now made to FIG. 7 which discloses a second
embodiment of the present invention directed to an access port
device 100 including a first sleeve of flexible material 102 having
a proximal end 104 for positioning external to a patient and a
distal end 106 for positioning in a patient's body cavity. Access
port device 100 includes an outer annular sealing device 110
attached to proximal end 104 of first sleeve 102 and an inner
annular sealing device 112 attached to distal end 106 of first
sleeve 102. Both outer and inner annular sealing devices 110 and
112 are sized and shaped to extend in an annular fashion around a
given incision and, therefore, may be provided in a variety of
sizes depending on the length of the incision. Outer annular
sealing device 110 includes a biasing surface 114 facing, outwardly
away from the patient's body 4. Proximal end 104 of first sleeve
102 is sealingly attached to biasing surface 114 around the entire
circumference of outer annular sealing device 110. Likewise, the
distal end 106 of first sleeve 102 is sealingly attached to inner
annular scaling device 112 in any conventional manner creating a
secure sealed connection. Inner annular sealing device 112 may be a
ring formed of any flexible, resilient material. Biasing surface
114 is preferably formed on a flexible annular extension 116 of
outer annular sealing device 1 10.
[0072] Access port device 100 also includes an access component 1
18 sealingly engaging outer annular sealing device 110 and
extendable into the access opening formed by first sleeve 102.
Preferably, access component 1 18 includes a flexible ring 120
designed for removable mounting in an annular groove 122 formed in
outer annular sealing device 1 10. Flexible ring 120 is preferably
formed of an elastic, resilient material to permit the ring to be
stretched and moved into groove 122 and, if desired, expanded for
removal from groove 122. Of course, flexible ring 120 is designed
with a circumference and sized relative to the size of outer
annular sealing device 1 10 such that stretching of the ring is
required for engaging annular groove 122 so that the ring is biased
into sealing engagement with outer annular sealing device 110 in
annular groove 122. In the present embodiment, access component 118
also includes a sleeve of flexible material 124 extending from
flexible ring 120 and having a length sufficient to extend through
the access opening formed by first sleeve 102 and inner annular
sealing device 112 as shown in FIG. 7. In the embodiment shown, the
sleeve of flexible material 124 may include an integrated glove to
form a sleeved glove 126 for receiving a surgeon's hand/arm. As
shown in FIG. 7, an inflatable chamber 128 is formed between first
sleeve 102 and the sleeve of flexible material 124 for containing
gas flowing through the gap between sleeved glove 126 and first
sleeve 102 thereby retaining pneumoperitoneum.
[0073] The first sleeve 102 is sized to permit inner annular
sealing device 112 to be effectively positioned underneath the
patient's cavity wall 4 and outer annular sealing device 1 10 to be
positioned on the outer surface of the patient while first sleeve
102 fits closely to the patient's cavity wall. As a result, inner
annular sealing device 1 10 is biased tightly against the inner
surface of the patient's body cavity wall 4 while first sleeve 102
exerts a downward force on outer annular sealing device 110. In
addition, since biasing surface 1 14 faces outwardly away from the
patient's body cavity wall 4, gas pressure in the inflatable
chamber creates gas pressure sealing forces acting on biasing
surface 1 14 which tends to bias outer annular sealing device 1 10
against the patient. Consequently, an effective seal is achieved
between outer annular sealing device 1 10 and the patient's body.
Therefore, by sizing first sleeve 102 appropriately and utilizing
biasing surface 1 14, the present access port device 100 creates an
effective seal for minimizing gas leakage from the patient's body
cavity through the space between access port device 100 and the
patient's body cavity wall 4.
[0074] FIGS. 8 and 9 disclose a preferred embodiment of an access
port device indicated generally at 150, which is similar to the
access port device disclosed in the embodiment of FIG. 7 except for
a modified outer annular sealing device 152, which creates a more
effective seal against a patient's body in many applications.
Similar to the embodiment of FIG. 7, access port device 150 may
include an access component (not shown), such as the sleeved glove
126 of the previous embodiment, which can be sealingly mounted in
annular groove 154 of outer annular sealing device 152. Also,
access port device 150 includes an inner annular sealing device or
ring 156 and flexible sleeve 158 forming an access opening, 160
similar to the embodiment of FIG. 7. However, in the present
embodiment, access port device 150 includes a leakage minimizing
device 153 for minimizing gas-leakage from between sleeve 158 and
the patient's body, which includes a sealing force applying feature
159 including outer annular sealing device 152 and a leakage gas
chamber 162 for receiving leakage gas leaking between access port
device 150 and the patient. In addition, outer annular sealing
device 152 includes a flexible annular extension 164 having a
generally flat shape and extending radially inwardly to form a
circumferentially unsupported annular floating edge 166. Flexible
annular extension 164 also includes an inner biasing surface 168
facing outwardly from the patient and exposed to gas in the gas
chamber 162. The outer annular sealing device 152 further includes
an overhang 170, which in part forms gas chamber 162 and includes
an outer biasing surface 172. The sleeve 158 is sealingly attached
to outer biasing surface 172. Therefore, gas chamber 162 is formed
between flexible annular extension 164 and overhang 170. It should
be noted that overhang 170 may be designed with a sufficient length
so as to abut the patient's skin when placed on the patient as
shown in FIG. 9.
[0075] When applied to a patient's body as shown in FIG. 9, the
sealing force applying feature 159 effectively minimizes leakage
between access port device 150 and the patient's body in the
following manner. When the device is attached to the patient, inner
annular sealing device 156 lies tight against the inner surface of
the patient's body cavity, i.e. abdomen. The flexible sleeve 158 is
sized, as discussed hereinabove with respect to the embodiment of
FIG. 7, so as to exert a downward force on outer annular sealing
device 152 causing compression of flexible annular extension 164
against the patient's skin or an intermediate material. The access
component of FIG. 7 may then be attached to annular groove 154 by
stretching flexible ring 120 around outer annular sealing device
152 so as to position ring 120 in groove 154. If the access
component is in the form of sleeved glove 126, the surgeon would
place the glove on his hand by inserting his arm into the sleeved
glove prior to mounting the access component on outer annular
sealing device 152. After placing the glove on his hand, flexible
ring 120 would then be placed in annular groove 154 while the
surgeon's arm is extended through access opening 160. Also, before
attaching the sleeve glove 126 to outer annular sealing device 152,
the overall length of the sleeve glove 126 may be adjusted by
rolling or unrolling the flexible ring 120 to thereby take-up or
release the flexible material from ring 120.
[0076] During use, with the patient's body cavity deliberately
pressurized by introducing gas as shown in FIG. 9, any leakage gas
from the patient's body cavity, leaking between inner annular
sealing device 156 and the patient, will flow in the space between
sleeve 158 and the patient toward gas chamber 162. This leakage gas
will be trapped in gas chamber 162. Gas pressure induced biasing
forces are then generated on inner biasing surface 168 so as to
bias flexible annular extension 164 into sealing abutment against
the patient's skin thereby creating an enhanced seal between
flexible annular extension 164 and the patient. The greater the gas
pressure in gas chamber 162, the greater the sealing force between
flexible annular extension 164 and the patient's skin. As a result,
increased leakage into gas chamber 162 not only maintains but tends
to enhance the seal between outer annular sealing device 152 and
the patient's skin. In the event flexible annular extension 164
lifts away from the patient's skin, inner annular sealing device
156 will remain in contact with the patient's skin thereby
maintaining a seal. Also, the gas pressure in the inflatable
chamber formed between sleeve 158 and the access component imparts
gas pressure induced forces on outer biasing surface 172 tending to
bias overhang 170 into abutment with the patient's skin thereby
further assisting in sealing against leakage. When it is desired to
remove the sleeved glove 126, the surgeon's hand may simply be
pulled outwardly and removed from sleeved glove 126 or the flexible
ring 120 may be first released from outer annular sealing devices
110, 152. Preferably, the seal created between outer annular
sealing device 110 due to the effect of leakage minimizing device
153 is sufficient to avoid the use of adhesive between device 153
and the patient, thereby creating a non adhesive sealed access
port. If an adhesive is used, which is more likely in the
embodiment of FIG. 7, a liquid adhesive may be applied.
[0077] Referring to FIGS. 10 to 13 there is illustrated a surgical
device according to the invention, indicated generally by the
reference numeral 2001. The surgical device 2001 is formed for use
in minimally invasive surgery of the type using an inflated body
cavity indicated generally by the reference numeral 2002. The
cavity 2002 is accessible to a surgeon through an access port,
defined by a sleeve 2004, which passes through an incision in a
patient's abdominal wall 2003. The sleeve 2004 is connected to a
retractor indicated generally by the reference numeral 2005 which
atraumatically retracts the incision. The retractor 2005 is pressed
against the incision to protect it from contact as a surgeon
introduces or withdraws a hand, surgical device or body tissue. The
retractor 2005 is inserted using a retractor-positioning device
indicated generally as 2006, which will be described in more detail
below.
[0078] Referring now to FIG. 11, sealing means is provided for the
device 2001 by the sleeve 2004, which is in this case of the type
known and marketed by Medtech Ltd., as an INTROMIT R sleeve. The
sleeve 2004 has an entrance opening 2041. A flexible elongate inner
sleeve 2042 extends downwardly from the opening 2041 and terminates
away from the opening with a taut valve 2043. A feathered valve
2044 is also suspended from the opening inside the inner sleeve
2042. The sleeve 2004 also has a skirt 2045 extending downwardly
from the opening 2041 outside the inner sleeve 2042. The skirt 2045
has a flexible rim 2046 for connection in an airtight manner to the
retractor 2005.
[0079] The retractor 2005 as shown in FIG. 12 has a proximal ring
2051 for receiving the flexible rim 2046 and a distal ring 2052
connected to the proximal ring 2051 with a flexible incision
engaging retractor wall 2053. The proximal ring 2051 and the distal
ring 2052 are positioned on the patient using the
retractor-positioning device 6 as shown in FIG. 13. The
retractor-positioning device 2006 has means for engaging the
proximal ring 2051 provided by a pair of oppositely directed
telescopic arms 2061 carried on an introduction shaft 2063. The
shaft 2063 also carries means for engaging the distal ring provided
in this case by pivotally moveable distal arms 2063.
[0080] In use, an incision is made in the abdominal wall 2003. The
distal ring 2052 and the proximal ring 2051 are engaged on the
respective arms 2062, 2061 with the arms 2062, 2061 in a retracted
position (not shown) having the arms 2062, 2061 close to the shaft
2063. The proximal ring 2051 is then positioned on the patient by
telescopically extending the arms 2061. The distal arms 2062 and
portion of the shaft 2063 are then passed through the incision into
the cavity 2000. The distal ring 2052 is moved into position when
in the cavity 2002 by pivoting the oppositely directed arms 2062
away from the shaft 2063 so that the ring 2052 surrounds the
incision. The ring 2051 is disengaged from the arms 2061 causing it
to open against the abdomen wall. The arms 2062 are disengaged from
the ring 2052 by pulling upward. By positioning the retractor in
this way a variety of incision depths can be accommodated.
[0081] When the retractor 2005 has been positioned on the patient
the flexible rim 2046 is then deformed by the surgeon to engage on
and around the proximal ring 2051 in an airtight manner. The body
cavity is then inflated and when inflated the flexible elongate
inner sleeve 2042 is allowed to extend downwardly from the opening
2041 with the taut valve 2043 inserted into the body cavity. The
feathered valve 2044 is also suspended from the opening 2041 inside
the inner sleeve 2042 and above the incision. The gas pressure
within the cavity inflates the skirt 2045. The seal of the rim 2046
and the ring 2051 prevents air pressure from escaping. The surgeon
can then operate on the patient and the constant and controlled
distance between the sleeve and the retractor prevents unnecessary
contact with the incision thereby reducing overall patient trauma
and providing the surgeon with a greater range of movement
unencumbered by the incision wall.
[0082] Referring now to FIGS. 14 and 15 there is illustrated
another surgical device according to the invention, indicated
generally by the reference numeral 2100 in which parts similar to
those described in FIGS. 10 to 13 are identified by the same
reference numerals generally. In this embodiment, the device has an
extended proximal ring 2151. The proximal ring 2151 supports a
highly flexible web 2152 which in turn defines an opening through
which a sleeve 2153 passes. The sleeve 2153 is terminated in a taut
valve 2043 above the incision. The operation of this device is
similar to that described above. It will be appreciated that the
retractor may also be manually positioned on the operating site. By
providing the device in this way the taut valve is housed above the
incision thereby allowing a surgeon greater visibility as well as
eliminating the need to insert any valves within the body cavity.
Additionally, the valve will not travel with the surgeon's wrist
during insertion and as a low sealing force is required, the
surgeon suffers little compression on the arm during insertion.
[0083] Referring now to FIGS. 16 and 17 there is illustrated a
further surgical device according to the invention, indicated
generally by the reference numeral 700 in which parts similar to
those described in FIGS. 10 to 15 are identified by the same
reference numerals generally. In this embodiment the skirt 2045 is
supported by a collapsible scaffold structure 701. The scaffold
structure 701 is in turn carried on the proximal ring 2051.
[0084] In use, when the device 701 has been positioned on a patient
the skirt 2045 is supported by the structure 701 (See FIG. 16). As
a surgeon inserts a hand or instrument into the sleeve 2004 the
structure collapses (See FIG. 17) to provide free access and good
operating site visibility for the surgeon.
[0085] FIG. 18 illustrates another a surgical device according to
the invention, indicated generally by the reference numeral 1200.
In this embodiment a taut valve 1201 is formed from an elasticised
portion of a tapered sleeve 1204. Oppositely directed connecting
limbs 1202 extend outwardly from the valve 1201 and attach to a
proximal ring 1203. In use, the limbs 1202 stretch the sleeve 1204
causing the sleeve 1204 to narrow the taut valve 1201 and seal.
When a surgeon inserts a hand or surgical instrument the limbs 1202
are deflected to allow access. When the hand or instrument is
removed, the limbs re-establish the seal as before.
[0086] Referring now to FIGS. 19 and 20 there is illustrated
another surgical device according to the invention, indicated
generally by the reference numeral 1300 in which parts similar to
those described in FIGS. 10 to 18 are identified by the same
reference numerals generally. In this embodiment, the sleeve 2004
extends downwardly from an oval semi-rigid proximal ring 1301. The
ring 1301 in turn is carried on an inflatable ring 1302, which is
formed for inflation by an inflator 1303. In use, the device is
positioned on a patient and the ring 1302 is inflated. The degree
of retraction required is controlled by the pressure in the ring
1302 as greater pressure will force the sleeve 2004 against the
incision. As the proximal, distal and inflatable rings are oval
even pressure is applied at all points during retraction greatly
reducing patient trauma. The inflation of the ring 1302 draws the
sleeve 2004 against the incision and prevents loss of
pneumoperitoneum.
[0087] FIGS. 21 and 22 illustrate another surgical device according
to the invention indicated as 1500, which is similar in operation
to the embodiment shown in FIGS. 19 and 20. In this embodiment ring
1302 is replaced with a compressible bellows ring 1501. The bellows
ring 1501 has a one-way valve 1502. In use, the compressed bellows
ring 1501 is positioned on a patient. The ring is drawn up to allow
air to inflate the bellows ring 1501 through the valve 1502. This
inflation retracts the incision to the required degree and the
valve 1502 prevents the air from escaping and the incision from
closing. The incision can be released only by activation of the
valve 1502 by the surgeon.
[0088] Thus, by the relatively simple expedient of providing an
integrated wound or incision retractor in the access port, trauma
is reduced thereby greatly easing patient suffering and
accelerating postoperative recovery. Additionally, the invention
provides a greater range of movement to the surgeon allowing the
device to be used in a wider variety of surgical applications.
[0089] It will of course be understood that the invention is not
limited to the specific details described herein, which are given
by way of example only, and that various modifications and
alterations are possible within the scope of the apended
claims.
* * * * *