U.S. patent application number 11/841758 was filed with the patent office on 2008-04-24 for surgical device for retracting and/or sealing an incision.
This patent application is currently assigned to Atropos Limited. Invention is credited to Frank BONADIO, Ronan Bernard MCMANUS, Shane Joseph MCNALLY, Alan REID, Derek William YOUNG.
Application Number | 20080097162 11/841758 |
Document ID | / |
Family ID | 26320227 |
Filed Date | 2008-04-24 |
United States Patent
Application |
20080097162 |
Kind Code |
A1 |
BONADIO; Frank ; et
al. |
April 24, 2008 |
Surgical Device for Retracting and/or Sealing an Incision
Abstract
A wound protector retractor comprises an inner O-ring for
insertion through a wound opening and a connecting sleeve extending
between the O-ring and outer mounting means. The outer means are
provided by rings between which the sleeve is led. The rings are
rotated relative to each other and the inner ring to form a
centralised lumen of reduced cross section and to shorten the axial
extent of the sleeve. A wound is both retracted and protected.
Inventors: |
BONADIO; Frank; (Bray,
IE) ; MCNALLY; Shane Joseph; (Dublin, IE) ;
MCMANUS; Ronan Bernard; (Bray, IE) ; YOUNG; Derek
William; (County Dublin, IE) ; REID; Alan;
(Dublin, IE) |
Correspondence
Address: |
FINNEGAN, HENDERSON, FARABOW, GARRETT & DUNNER;LLP
901 NEW YORK AVENUE, NW
WASHINGTON
DC
20001-4413
US
|
Assignee: |
Atropos Limited
|
Family ID: |
26320227 |
Appl. No.: |
11/841758 |
Filed: |
August 20, 2007 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10995117 |
Nov 24, 2004 |
7300399 |
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11841758 |
Aug 20, 2007 |
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|
10133979 |
Apr 29, 2002 |
6846287 |
|
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10995117 |
Nov 24, 2004 |
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09801826 |
Mar 9, 2001 |
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10133979 |
Apr 29, 2002 |
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PCT/IE99/00122 |
Dec 1, 1999 |
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09801826 |
Mar 9, 2001 |
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Current U.S.
Class: |
600/208 |
Current CPC
Class: |
A61B 2017/00557
20130101; A61B 17/0293 20130101; A61B 2017/3482 20130101; A61B
17/3423 20130101; A61B 17/3431 20130101 |
Class at
Publication: |
600/208 |
International
Class: |
A61B 1/32 20060101
A61B001/32 |
Foreign Application Data
Date |
Code |
Application Number |
Dec 1, 1998 |
IE |
980997 |
Feb 15, 1999 |
IE |
990111 |
Claims
1. A surgical device comprising: an inner mounting means for
insertion through a wound opening; a first outer mounting means for
mounting external of a wound opening; and connecting means
extending between the inner and outer mounting means; the
connecting means being movable to shorten the axial extent of the
connecting means.
2. A surgical device as claimed in claim 1 wherein the outer
mounting means is movable relative to the inner mounting means to
twist the connecting means to form a lumen of reduced cross section
and to shorten the axial extent of the connecting means.
3. A device as claimed in claim 2 wherein the outer mounting means
is rotatable relative to the inner mounting means to twist the
connecting means.
4. A device as claimed in claim 1, wherein the connecting means is
a sleeve of pliable material extending between the inner and outer
mounting means.
5. A device as claimed in claim 1, including a second outer
mounting means, the connecting means extending between the first
outer mounting means, the inner mounting means, and the second
outer mounting means.
6. A device as claimed in claim 5 wherein the first and second
outer mounting means are rotatable relative to one another to twist
the connecting means and to draw the inner mounting means towards
the outer mounting means.
7. A device as claimed in claim 5 wherein the inner mounting means
is an O-ring.
8. A device as claimed in claim 7 wherein the connecting means is a
sleeve which is led from the first outer mounting means to the
O-ring and from the O-ring to the second outer mounting means.
9. A device as claimed in claim 5 including locking means for
locking the first outer mounting means relative to the second outer
mounting means.
10. A device as claimed in claim 5 wherein one of the outer
mounting means is located or locatable within the other outer
mounting means.
11. A device as claimed in claim 4 wherein the inner diameter of
the sleeve is greater than or equal to the axial length of the
sleeve.
12. A device as claimed in claim 11 wherein the inner diameter of
the sleeve is greater than the axial length of the sleeve by an
amount which is less than the thickness of an average abdominal
wall.
13. A device as claimed in claim 12 wherein a substantially gas
tight seal is formed between the outer mounting means on shortening
of the length of the sleeve.
14. A device as claimed in claim 13 wherein the sleeve extending
between the first and second outer mounting means defines an
inflatable space.
15. A device as claimed in claim 14 wherein the device includes a
port for connection to an inflation means.
16-22. (canceled)
23. A device as claimed in claim 1 wherein the connecting means is
translated to shorten the axial extent of the connecting means.
24. A device as claimed in claim 23 wherein the connecting means
comprises a sleeve which is translated by a drawstring
mechanism.
25. A device as claimed in claim 24 wherein the connecting means
comprises a plurality of straps attached to the inner mounting
means, the straps being pulled upwardly to shorten the axial extend
of the connecting means.
26. A device as claimed in claim 25 including an iris diaphragm
connected to the straps.
27. A device as claimed in claim 1 wherein the outer mounting means
includes a holder for holding a surgical instrument.
28-37. (canceled)
Description
BACKGROUND OF THE INVENTION
[0001] The present invention relates to a surgical device. More
specifically, the invention relates to devices for retraction of an
incision or natural bodily opening during surgery and for
protecting the edges of incisions from infection or tumour seeding
during surgery.
Wound Retraction
[0002] Adequate anatomical exposure is required in modern surgical
procedures to allow procedures to be safely and effectively
performed. Anatomical exposure is achieved by separating the walls
of a natural orifice or spreading apart the margins of a surgical
incision. A difficult surgical procedure can be simplified by
adequate retraction whereas a relatively simple procedure can be
made more difficult or even dangerous by the lack of adequate
retraction. Exposure is maximised with correct incision placement
and well directed retraction.
[0003] Retraction can be achieved in several different ways. The
most common method of surgical wound retraction is by the use of
hand held retractors. These may be made of metal or thermoplastics
and allow an operator to apply a retraction force to the wound
edges. They are disposable or reusable and come in a variety of
shapes and sizes to satisfy the requirements of different surgical
procedures.
[0004] Another type of retractor are Frame mounted retractor
devices are also known. Such devices consist of a rigid circular or
horseshoe-shaped frame on which multiple, detachable and movable
paddle retractors are attached. The device may be mounted to an
operating table to provide secure anchorage. Retraction may be
applied in required directions. Typically such retractors are made
of stainless steel to facilitate cleaning and sterilisation for
reuse. Some of the more complex retractors need to be taken apart
before sterilisation and reassembled before use. These devices
always apply retraction at a few specific locations on the wound.
This is a disadvantage of such devices as it can lead to regional
ischaemia on parts the wound edge.
[0005] A wound retractor and protector is disclosed in U.S. Pat.
No. 5,524,644 (Crook). This device consists of an open-ended sleeve
of polymeric material with a flexible ring at each end. One ring is
inserted into the incision and the sleeve is manually rolled up
around the other ring to apply tension to the polymeric material to
achieve retraction. The device is often difficult to use because of
the manual dexterity required, especially when the surgeons hands
are wet. In addition, the device is incrementally adjustable. This
restricts the efficiency of the device across all abdominal wall
thicknesses.
[0006] U.S. Pat. No. 5,545,179 (Williamson IV) describes a device
having an elastomeric sealing element and a tubing conduit. The
device protects the edges of the wound from contamination. However,
the device is specifically for laparoscopic instruments and is not
suitable for hand assisted surgery because the wound opening is not
sufficiently retracted.
[0007] WO-A-96/36283 Mollenauer) describes a trocar device for
retracting and sealing an incision and providing a sealed access
port for surgical instruments. Whilst this incision and providing a
sealed access port for surgical instruments. Whilst this device
provides both retraction and protection to the wound edge is not
suitable for use in hand assisted surgery due to size limitations.
The device retracts and protects due to the inflation of one or one
or more balloons and because these close the lumen when inflated it
is not possible to visualize the contents of the abdomen through
the device.
[0008] WO-A-98/48724 discloses a device for use in hand assisted
laparoscopic surgery. The device has a wound retractor/protector
component and a component for sealing around the wrist of the
surgeon. The wound protector component consists of an inner ring
and two outer inflatable doughnut-shaped rings mounted vertically
on top of another. The inner and outer rings are linked by an
elastomeric sleeve. Inflation of the two outer rings causes
retraction of the elastomeric sleeve. This device provides wound
retraction and protection but it is not suitable for device has a
large vertical profile due to the outer rings. This restricts reach
into the incision and extends the fulcrum of any instruments used
in such a way that their effective reach and breath of lateral
movement would be severely restricted.
Wound Protection
[0009] The sides of an open wound are susceptible to infection and
cross contamination if they are touched by contaminated material
such as body parts or fluids as they pass through the opening of a
wound. Serious problems can also result from cancerous material
coming into contact with the wound edge. It is well known that
cancerous cells may become seeded in wound areas, especially at
trocar sites.
[0010] To avoid such problems great care is taken to protect the
edges of an incision using drapes that are impervious to liquids.
An incision liner is disclosed in U.S. Pat. No. 3,397,692
(Creager). This linear comprises a sheet of polymeric material. The
sheet has a hole cut out in the centre and the edges of the hole
are reinforced using a semi-rigid ring. This ring can be inserted
into the incision allowing a surgical procedure to proceed through
the ring while the material attached to the ring protects the edges
of the incision from contaminants in the wound site. These device
marketed as "Steridrape" by 3M Corporation and comes in a variety
of sizes for different wound sizes. However such devices do not
adequately retract an incision.
[0011] In general known devices are of either complex construction,
do not effectively seal a wound and/or are difficult to
operate.
[0012] There is therefore a need for an improved surgical device
that will overcome at least some of these problems.
STATEMENTS OF INVENTION
[0013] According to the invention there is provided a surgical
device comprising: [0014] an inner mounting means for insertion
through a wound opening; [0015] a first outer mounting means for
mounting eternal of a wound opening; and [0016] connecting means
extending between the inner and outer mounting means; [0017] the
connecting means being movable to shorten the axial extent of the
connecting means.
[0018] In a particularly preferred embodiment of the invention the
outer mounting means is movable relative to the inner mounting
means to twist the connecting means to form a lumen of reduced
cross section and to shorten the axial extent of the connecting
means.
[0019] Most preferably the outer mounting means is rotatable
relative to the inner mounting means to twist the connecting
means.
[0020] In a particularly preferred embodiment of the invention the
connecting means is a sleeve of pliable material extending between
the inner and outer mounting means.
[0021] In one aspect the device includes a second outer mounting
means, the connecting means extending between the first outer
mounting means, the inner mounting means, and the second outer
mounting means.
[0022] In this case preferably the first and second outer mounting
means are rotatable relative to one another to twist the connecting
means and to draw the inner mounting means towards the outer
mounting means. The outer rings also rotate relative to the inner
mounting means.
[0023] In a particularly preferred embodiment the inner mounting
means is an O-ring. Preferably the connecting means is a sleeve
which is led from the first outer mounting means to the O-ring and
from the O-ring to the second outer mounting means.
[0024] In a preferred embodiment of the invention the device
includes locking means for locking the first outer mounting means
relative to the second outer mounting means.
[0025] In one arrangement one of the outer mounting means is
located or locatable within the other outer mounting means.
[0026] Preferably the inner diameter of the sleeve is greater than
or equal to the axial length of the sleeve.
[0027] In a preferred arrangement the inner diameter of the sleeve
is greater than the axial length of the sleeve by an amount less
than the thickness of an average abdominal wall, which is typically
2 to 6 cm. This assists in achieving a retraction force.
[0028] Preferably a substantially gas tight seal is formed between
the outer mounting means on shortening of the length of the sleeve.
Ideally, the sleeve extending between the first and second outer
mounting means defines an inflatable space.
[0029] In one embodiment of the invention the device includes a
port for connection to an inflation means.
[0030] The invention also provides a surgical device comprising:--
[0031] an inner mounting means for insertion through a wound
opening; [0032] a first outer mounting means; [0033] a second outer
mounting means; and [0034] a sleeve of pliable material extending
from the second outer mounting means to the inner mounting means
and from the inner mounting means to the first outer mounting
means.
[0035] Preferably one or both of the first and second outer
mounting means are movable relative to one another to adjust the
diameter of the lumen defined by a twist in the sleeve extending
therebetween.
[0036] Ideally, the first and second outer mounting means are
rotatable relative to one another.
[0037] In one embodiment of the invention the sleeve is releasably
mounted to the second outer mounting means for adjustment of the
length of the sleeve.
[0038] Preferably the second mounting means comprises a receiver
and the sleeve is mounted or mountable to a ring which is
releasably mounted to the receiver.
[0039] In another embodiment of the invention the inner mounting
means is configured to reduce the size thereof for ease of
insertion into a wound opening.
[0040] Typically in this case the inner mounting means comprises a
ring which includes a hinge means for reducing the size of the
ring.
[0041] A device as claimed in claim 1 wherein the connecting means
is translated to shorten the axial extent of the connecting
means.
[0042] A device as claimed in claim 23 wherein the connecting means
comprises a sleeve which is translated by a drawstring
mechanism.
[0043] A device as claimed in claim 24 wherein the connecting means
comprises a plurality of straps attached to the inner mounting
means, the straps being pulled upwardly to shorten the axial extend
of the connecting means.
[0044] Typically the outer mounting means includes a holder for
holding a surgical instrument.
[0045] The surgical device may form a wound retractor, a wound
protector or a wound protector retractor.
BRIEF DESCRIPTION OF DRAWINGS
[0046] The invention will be more clearly understood from the
following description thereof given by way of example only with
reference to the accompanying drawings, in which:--
[0047] FIG. 1 is a perspective view of a surgical device according
to the invention;
[0048] FIG. 2 is a cross sectional view of the device of FIG.
1;
[0049] FIG. 3 is a cross sectional view of the device in one
position of use;
[0050] FIG. 4 is a cross sectional view of the device in another
position of use;
[0051] FIG. 5 is a top plan view of the device in the position of
FIG. 4;
[0052] FIGS. 6 and 7 are respectively perspective and cross
sectional views illustrating a method of forming the device of
FIGS. 1 to 5;
[0053] FIG. 8 is a perspective view of another surgical device
according to the invention;
[0054] FIG. 9 is a cross sectional view of the device of FIG. 8 in
one position of use;
[0055] FIG. 10 is a cross sectional view of the device of FIG. 8 in
another position of use;
[0056] FIGS. 11 and 12 are cross sectional views of another
surgical device according to the invention in different positions
of use;
[0057] FIG. 13 is a plan view of the device of FIG. 11;
[0058] FIG. 14 is a cross sectional view of a further surgical
device according to the invention;
[0059] FIGS. 15A and 15B are cross sectional views of the device of
FIG. 14, in use;
[0060] FIG. 16 is plan view of the device of FIG. 14;
[0061] FIG. 17 is a cross section view of another surgical device
of invention;
[0062] FIG. 18 is a plan view of the device of FIG. 17;
[0063] FIG. 19 is a cross sectional view of another surgical device
of the invention;
[0064] FIG. 20 is a plan view of the device of FIG. 19;
[0065] FIG. 21 is a cross sectional view of a further surgical
device of the invention;
[0066] FIG. 22 is a cross sectional view of a still further
surgical device of the invention;
[0067] FIG. 23 is plan view of the device of FIG. 22;
[0068] FIG. 24 is a perspective view of another surgical device of
the invention;
[0069] FIG. 25 is a perspective view of the device of FIG. 24 being
adjusted;
[0070] FIG. 26 is a side, partially cross sectional view of the
device of FIGS. 24 and 25;
[0071] FIG. 27 is a view similar to FIG. 26 of the device partially
disassembled;
[0072] FIG. 28 is a view similar to FIG. 26 with the device of FIG.
27 re-assembled;
[0073] FIG. 29 is a diagrammatic perspective view of another
surgical device of the invention;
[0074] FIG. 30 is a perspective view of the device of FIG. 29 in a
wound inserting configuration;
[0075] FIGS. 31 and 32 are respectively diagrammatic perspective
and plan views of an inner ring part of the device of FIGS. 29 and
30;
[0076] FIG. 33 is a cross sectional view of two surgical devices
ready for assembly;
[0077] FIG. 34 is a cross sectional view of the devices of FIG. 33,
assembled;
[0078] FIG. 35 is a plan view of another surgical device according
to the invention;
[0079] FIG. 36 is a cross sectional view on the line A-A in FIG. 35
with the device in position in an incision;
[0080] FIG. 37 is a plan view of the device of FIGS. 35 and 36 in
another position of use; and
[0081] FIG. 38 is a cross sectional view on the line B-B of FIG.
37.
DETAILED DESCRIPTION
[0082] Referring to the drawings and initially to FIG. 1 to 7
thereof there is illustrated a surgical device, especially for use
in laparoscopic surgery. The device 1 in this case is used in
surgery involving an incision 2 in a wall 3 of a patients abdomen.
The wound is, in this case, both protected and retracted by the
device 1 of the invention. Thus, the invention in this case
provides a wound protector retractor.
[0083] The device 1 comprises an inner mounting means in the form
of an O-ring 10 of flexible material such as of elastomeric
material for insertion through the wound opening 2, an outer
mounting means for mounting external of the wound opening 2 and a
connecting means, in is case in the form of a sleeve 11 extending
between the inner 10 and outer mounting means. The outer mounting
means is movable, in this case rotatable, relative to the inner
O-ring 10 to twist the sleeve 11 to form a centralised lumen 12 of
reduced cross section and to shorten the axial extent of the sleeve
11. As the sleeve 11 is twisted the inner O-ring 10 is drawn
upwardly from the inserted position illustrated in FIG. 3 to the
in-use position illustrated in FIG. 4 in which the wound is sealed
and a radial retraction force is applied to the wound. A surgeon
inserts a sealed gloved hand/arm/instrument through the sealed and
retracted wound to perform a surgical procedure within the
abdomen.
[0084] In this preferred case the outer mounting means comprises a
first outer mounting means in the form of a first annular ring 20
and a second outer mounting means in the form of a second annular
ring 21. The sleeve 11 is of biocompatible pliable gas impermeable
plastics material and is attached at one end to the ring 20 and at
an opposite end to the ring 21. The sleeve 11 is connected to the
ring 20, led over the O-ring 10 and back up for attachment to the
ring 21 as best illustrated in FIG. 2.
[0085] In use, a surgeon makes an incision in the abdominal cavity
and the O-ring 10 is flexed and inserted through the incision as
illustrated in FIG. 3. The outer rings 20, 21 are then rotated
relative to one another in the direction of the arrows A and B in
FIG. 3. This relative rotation twists the sleeve 11 and shortens
the sleeve until the device is in the operative position of FIG. 4.
In this position the inner O-ring 10 is engaged against the inside
of the interior of the anterior abdominal wall and the rings 21 and
22 are external of the wound opening with the sleeve 11 shortened
in axial extent. The twisting of the sleeve 11 provides a central
lumen 12 of reduced size, which depends on the degree of twist A
full 180.degree. relative mist would result in closing down of the
lumen. The reduced lumen 12 provides access for instruments and/or
a surgeons arm while maintaining a wound seal.
[0086] Locking means of any suitable type may be provided to lock
the rings 20, 21 together. The locking means may, for example
comprise a releasable latching system such as a ratchet and pawl
arrangement or the like.
[0087] Preferably a gas tight seal is formed between the rings 20,
21 in use. The sleeve in this case provides an inflatable space 30
between the rings 20, 21 and the inner O-ring 10. An inflation
connection port may be provided in the device to facilitate
inflation. On inflation, a wound engaging section 11a of the sleeve
is pushed radially outwardly to provide a highly efficient wound
protector/seal and wound retractor. The inner sleeve section 11b is
inflated to further restrict the lumen 12 and provide highly
efficient sealing engagement with a surgeons forearm, a device or
an instrument inserted through the lumen.
[0088] For efficient sealing engagement it is preferred that the
inner diameter (d) of the sleeve 11 is greater than or equal to the
axial length (l) of the sleeve 11 as illustrated in FIG. 7.
Preferably the inner diameter of the sleeve is greater than the
axial length of the sleeve by an amount which is less than the
thickness of an average abdominal wall. With this configuration on
twisting of the sleeve 11, sealing and retraction forces are
applied to the wound opening.
[0089] The surgical device 1 may be formed from a cylindrical
sleeve 50 of pliable plastic material attached to a pair of rings
20, 21 as illustrated in FIGS. 6 and 7. A flexible O-ring 10 is
fitted over the sleeve 50. The flexible sleeve 50 is then turned
over on itself so that the O-ring 10 is confined between inner and
outer sleeve sections 11a, 11b and the rings 20, 21 are in the
configuration illustrated in FIGS. 1 and 2.
[0090] The device of the invention applies a force to the wound
edges to achieve adequate exposure without causing ischaemic injury
to the wound edges. The device protects wound edges from cross
infection or seeding by cancerous or otherwise malignant cells.
Another advantage is that the device is sufficiently inexpensive
that it can be disposed of after a single use thereby obviating the
need for cleaning and sterilisation between use. In addition, the
device is simple to place into a desired position in a wound or
natural bodily opening and easy to remove, especially without
negating the benefits gained from use of the device as a wound
protector.
[0091] Referring to FIGS. 8 to 10 there is illustrated another
surgical device 60 according to the invention. The device 60 is
similar to the device 1 and like parts are assigned the same
reference numerals. In this case the sleeve 61 is a single wall
sleeve and there is only one outer mounting ring 62. On rotation of
the outer ring 62 relative to the inner ring 10 a twist is formed
in the sleeve which is shortened, drawing the inner ring 10
upwardly against the interior of the anterior abdominal wall as
illustrated in FIGS. 9 and 10.
[0092] It will be appreciated that the inner O-ring may be fixed,
for example, by adhesives to the sleeve of the surgical device. It
will also be appreciated that one or more of the mounting means may
be shaped to positively engage with tissue. For example, the
mounting means may include tissue-engaging projections to lock the
mounting means in position.
[0093] It will be appreciated that while for efficient retraction
and wound protection it is preferred that the connecting means
between the outer and inner mounting means is in the form of a
sleeve of pliable material, the connecting means may be
discontinuous. For example the sleeve may be in the form of
elongate strips or the like.
[0094] Referring to FIGS. 11 to 13 there is illustrated another
surgical device 70 according to the invention. In this case the
connecting means comprises a plurality of straps 71 which are drawn
upwardly to shorten the axial extent and to form a wound retractor.
The straps 71 are retained in the shortened configuration
illustrated by any suitable locking means such as by wedge elements
72. In is case an iris diaphragm type device 80 is provided in the
wound opening which is inflatable from the rest configuration
illustrated in FIG. 11 to the pressurised inflated configuration
illustrated in FIG. 12.
[0095] Referring to FIGS. 14 to 16 there is illustrated another
device 85 according to the invention in which the connecting means
is defined by a plurality of straps 86 which are movable between an
inner mounting ring 83 and an outer mounting ring 84 by buckle
devices 87 from the initial position illustrated in FIG. 15B to the
wound retracting position of FIG. 15 A. The inner ring 83 is first
inserted though the incision. The outer ring 82 is then brought
down to skin level by taking up the slack in the straps 86. To
achieve the retraction effect the straps 86 are pulled taut causing
the wound edge to be displaced out from the centrepoint of the
wound. The straps 86 may be adjusted until optimum retraction is
achieved. Tension in the straps 86 is maintained by the buckles 86
which may hold the strap 86 taut either by friction or using a
clasp mechanism.
[0096] Referring to FIGS. 17 and 18 another surgical device 90
similar to the device 85 is illustrated. In this case the inner and
outer mounting rings 82, 83 are of oval shape in transverse cross
section to smooth the movement of the straps 86. This device
operates in a similar manner to the device 85.
[0097] Referring to FIGS. 19 and 20 there is illustrated another
surgical device 93 which has single legged straps 94. This device
operates in a similar manner to devices 85 and device 90. In this
case straps 94 do not loop around the inner ring 83 but are
directly attached to it.
[0098] Referring to FIG. 21 there is illustrated a further surgical
device 95 having straps 96 which are locked in position by a
locking mechanism. The locking mechanism comprises a wedge 97
inserted into a hole through which the strop 96 passes to hold the
strap 96 in position by friction. A ratchet mechanism may also be
used or some other adjustable locking mechanism to hold the strap
in position.
[0099] The device 98 illustrated in FIGS. 22 and 23 is similar to
the device of FIG. 21 except that a different construction of wedge
or ratchet 99 is used to lock the straps in position.
[0100] Referring to FIGS. 24 to 26 there is illustrated another
surgical device according to the invention. In this case the
surgical device is a wound protector retractor 200 of similar
construction as that described above with reference to FIGS. 1 to
10. The device 1 comprises an inner mounting means in the form of a
first O-ring 201, a first outer mounting means in the form of a
second O-ring 202 mounted in a first receiver 203, and a second
mounting means in the form of a third O-ring 205 mounted in a
second receiver 206. The receivers 203, 206 are in his case
interconnectable as illustrated and a fourth O-ring 207 is provided
between the receivers 203, 206 on assembly.
[0101] A sleeve 210 of flexible pliable plastics material extends
from the second outer receiver 206 to the inner O-ring 201 and from
the inner O-ring 201 to the first outer receiver 203. The receivers
203, 206 are de-mountable as illustrated in FIG. 25 to facilitate
relative rotation therebetween in the direction of the arrows to
vary the degree of twist in the sleeve 210.
[0102] Referring to FIGS. 27 and 28 there is illustrated another
surgical device 220 which is similar to the device of FIGS. 24 to
26 and like parts are assigned the same reference numerals. In this
case the O-ring 205 is de-mountable from the receiver 206 to
facilitate length adjustment of the sleeve 210. On removal of the
O-ring 205 the sleeve 210 is adjusted to a desired length d. In
this way a single device 220 may be used for a variety of thickness
of abdomens. The lumen diameter defined by the twist does not need
to be changed to cater for a range of abdomen sizes. The excess
sleeve may be cut off or wound around the O-ring seal 205.
[0103] Referring now to FIGS. 29 to 32 there is illustrated part
230 of another surgical device according to the invention which is
similar to the devices of FIGS. 24 to 28 and like parts are
assigned the same reference numerals. An inner mounting means 231
is configured to reduce the size thereof for ease of insertion into
a wound opening. In this case the inner mounting means 231 is in
the form of a split ring which is hinged at 232 to facilitate a
reduction in the diameter of the ring 231 as illustrated. It will
of course be appreciated that the hinge may be integrally formed
and indeed, there may be a number of such hinges.
[0104] Referring to FIGS. 33 and 34 there is illustrated an
assembly of two surgical devices 250, 260. The device 250 is a
forearm seal and the device 260 is a wound protector retractor
which is assembled to an outer sealing device 250. The sealing
device 250 provides an outer sealed access port through which a
surgeon may insert his forearm or for insertion of an instrument or
the like.
[0105] Referring to FIGS. 35 to 38 there is illustrated another
surgical device 300 according to the invention. The device 300 is a
wound protector retractor similar to those described above. In this
case the wound protector retractor 300 comprises an inner ring 301
of semi-rigid elastomeric material and an outer ring 302 which is
of similar material. A sleeve 303 of pliable material extends
between the rings 301, 302. Drawstrings 305 are fitted to the
sleeve 303, the drawstrings being pulled outwardly in the direction
of the arrows to pull the sleeve 303 upwardly to tighten in the
incision and provide a wound protector and retractor.
[0106] Reference is also made to appropriate alternatives and
modifications which are outlined in our parallel applications
referenced ATRO1/C, ATRO2/C, ATRO14/C/, ATRO15/C, ATRO16/C/,
ATRO17/C, the entire contents of which are incorporated herein by
reference.
[0107] The invention is not limited to the embodiments hereinbefore
described which may be varied in construction and detail.
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