U.S. patent application number 12/030590 was filed with the patent office on 2009-08-13 for compression expanded cannula.
This patent application is currently assigned to DePuy Mitek, Inc.. Invention is credited to Jason Hamilton, Gary McAlister, Gregory R. Whittaker.
Application Number | 20090204081 12/030590 |
Document ID | / |
Family ID | 40601146 |
Filed Date | 2009-08-13 |
United States Patent
Application |
20090204081 |
Kind Code |
A1 |
Whittaker; Gregory R. ; et
al. |
August 13, 2009 |
COMPRESSION EXPANDED CANNULA
Abstract
Various methods and devices are provided for accessing an
interior surgical site using an access portal which can be inserted
and removed with minimal tissue damage and which can form a seal
with tissue while inserted. Generally, a device is provided having
a rigid elongate surgical access member with a lumen extending
therethrough that is configured to receive a surgical tool. The
device can also include a flexible sleeve having a lumen extending
therethrough that is configured to receive the elongate surgical
access member. A substantially rigid collar is provided disposed
adjacent to a proximal end of the flexible sleeve and having a
lumen extending therethrough that is configured to receive the
elongate surgical access member. In an exemplary embodiment, the
collar is movable relative to the elongate surgical access member
to selectively configure the flexible sleeve in a relaxed condition
in which the flexible sleeve has a relatively smooth outer
tissue-contacting surface and a compressed condition in which the
flexible sleeve has a plurality of protrusions formed on the outer
tissue-contacting surface that are configured to create a seal
between the outer tissue-contacting surface and tissue.
Inventors: |
Whittaker; Gregory R.;
(Stoneham, MA) ; McAlister; Gary; (Franklin,
MA) ; Hamilton; Jason; (Dartmouth, MA) |
Correspondence
Address: |
NUTTER MCCLENNEN & FISH LLP
WORLD TRADE CENTER WEST, 155 SEAPORT BOULEVARD
BOSTON
MA
02210-2604
US
|
Assignee: |
DePuy Mitek, Inc.
Raynham
MA
|
Family ID: |
40601146 |
Appl. No.: |
12/030590 |
Filed: |
February 13, 2008 |
Current U.S.
Class: |
604/264 |
Current CPC
Class: |
A61B 17/3421 20130101;
A61B 17/3439 20130101; A61B 2017/3458 20130101; A61B 2017/0225
20130101; A61B 17/0218 20130101; A61B 2017/3435 20130101; A61B
2017/3484 20130101; A61B 17/3423 20130101; A61B 2017/349 20130101;
A61B 2017/3419 20130101 |
Class at
Publication: |
604/264 |
International
Class: |
A61M 25/00 20060101
A61M025/00 |
Claims
1. A surgical access device, comprising: an elongate surgical
access member having a lumen extending therethrough that is
configured to receive a surgical tool; a flexible sleeve member
having a lumen extending therethrough that is configured to receive
the elongate surgical access member; and a substantially rigid
collar member disposed adjacent to a proximal end of the flexible
sleeve and having a lumen extending therethrough that is configured
to receive the elongate surgical access member, the collar member
being movable relative to the elongate surgical access member to
selectively configure the flexible sleeve in a relaxed condition in
which the flexible sleeve has a relatively smooth outer surface and
a compressed condition in which the flexible sleeve has a plurality
of protrusions formed on the outer surface that are configured to
create a seal between the outer surface and tissue, wherein the
flexible sleeve is normally in the relaxed condition and is
configured to receive a compressive force to be configured in the
compressed condition.
2. The device of claim 1, wherein the plurality of protrusions are
configured to increase an outer diameter of the flexible sleeve in
the compressed condition.
3. The device of claim 1, wherein the plurality of protrusions are
one of threads and ribs.
4. The device of claim 1, wherein the collar member includes
threads formed on an interior surface thereof which are configured
to mate to corresponding threads formed on an exterior surface of
the elongate surgical access member.
5. The device of claim 4, wherein the collar member is configured
to rotate via the mated threads and move in a distal direction to
move the flexible sleeve distally into the compressed
condition.
6. The device of claim 1, wherein the device further comprises at
least one camming member in communication with the rigid collar
member.
7. The device of claim 6, wherein the at least one camming member
is rotatable to configure the flexible sleeve in a compressed
condition.
8. The device of claim 1, wherein the elongate surgical access
member comprises a cage member coupled between the rigid collar
member and a distal ring.
9. The device of claim 8, wherein the rigid collar member is
effective to move the cage member proximally to configure the
flexible sleeve in a compressed condition.
10. A surgical access device, comprising: a body defining a central
longitudinal axis; and a deformable surgical access member
configured to be in communication with the body, the deformable
surgical access member defining an outer tissue-contacting surface,
wherein the deformable surgical access member is configured to
receive a compressive force to effect an increase in an outer
diameter thereof to configure the outer tissue-contacting surface
in a condition effective to form a seal with tissue.
11. The device of claim 10, wherein the outer tissue-contacting
surface contains threads configured to form a seal with tissue when
a compressive force is applied to the deformable surgical access
member.
12. The device of claim 10, wherein the deformable surgical access
member is disposed between a substantially rigid band disposed
adjacent to a proximal end of the deformable surgical access member
and a substantially rigid distal ring.
13. The device of claim 12, wherein the substantially rigid band
includes threads formed on an interior surface thereof and
configured to mate with corresponding threads formed on an exterior
surface of the body.
14. The device of claim 13, wherein the substantially rigid band is
configured to rotate via the mated threads to move the
substantially rigid band distally and cause the outer
tissue-contacting surface of the deformable surgical access member
to form a seal with tissue.
15. The device of 13, wherein the body comprises a cage member, and
the substantially rigid band is configured to rotate via the mated
threads to move the cage member proximally to cause the outer
tissue-contacting surface of the deformable surgical access member
to form a seal with tissue.
16. A method for providing instrument access within a patient,
comprising: providing a cannula assembly including an elongate
surgical access member with a bore formed therethrough configured
to receive a surgical tool; inserting the cannula assembly into an
incision in a patient in an insertion condition in which the
flexible sleeve has a relatively smooth exterior surface; and
applying a compressive force to the flexible sleeve to move the
flexible sleeve from the insertion condition to a compressed
condition in which the exterior surface of the flexible sleeve
includes surface features which extend radially outward from the
elongate surgical access member to form a seal with tissue.
17. The method of claim 16, wherein an outer diameter of the
flexible sleeve is greater in the compressed condition than in the
insertion condition.
18. The method of claim 16, further comprising inserting at least
one surgical tool through the bore in the member to effect a
surgical procedure.
19. The method of claim 16, wherein the compressive force is
applied by sliding a member distally relative to the elongate
surgical access member.
20. The method of claim 16, wherein the compressive force is
applied by rotating a threaded member along complimentary threads
on the elongate surgical access member.
21. The method of claim 16, wherein the compressive force is
applied by rotating at least one camming member.
22. The method of claim 16, wherein the compressive force is
applied by withdrawing a surgical tool from the elongate surgical
access member and the flexible sleeve.
23. The method of claim 22, wherein the compressed condition is the
natural state of the flexible sleeve 114.
Description
FIELD
[0001] The present invention generally relates to methods and
devices for providing access portals through which surgical
instruments can be inserted. More particularly, the invention
relates to devices which can be inserted into and removed from a
patient with minimal tissue damage.
BACKGROUND
[0002] Arthroscopic, or more generally, minimally invasive surgical
procedures rely on obtaining percutaneous access to an internal
surgical site using small-diameter openings to gain access to the
desired surgical site. In many cases, access tubes are placed
through the opening to allow a variety of elongated instruments to
be passed through the access tubes to gain access to an internal
surgical work site without the need for large incisions. As a
result, patient trauma and recovery time are typically reduced.
[0003] Very often, these access tubes, which are often called
cannulas, must be left in an incision for an extended period of
time, without significant movement, as instruments are inserted and
removed. This typically requires rigid surface features on the
exterior of the cannula, such as corrugations or threads, to engage
the tissue surrounding the cannula. These rigid surface features,
however, can cause tissue damage as the cannula is inserted and
usually do not result in the most secure fit once in place due to
tissue trauma surrounding the cannula. The cannula can also be
difficult to remove once inserted due to the rigid surface
features, possibly leading to further tissue damage during
removal.
[0004] Accordingly, there is a need for improved devices and
methods that provide access portals which can be inserted into and
removed from an incision with minimal tissue damage and can
effectively engage tissue while within the incision.
SUMMARY OF THE INVENTION
[0005] The present invention generally provides access portals
through which surgical procedures can be performed and that can be
inserted and removed with minimal tissue damage to form a seal with
tissue while inserted. In one embodiment, a surgical access device
is provided having an elongate surgical access member with a lumen
extending therethrough that is configured to receive a surgical
tool. The surgical access device can also include a flexible sleeve
having a lumen extending therethrough that is configured to receive
the elongate surgical access member. A substantially rigid collar
member can be disposed adjacent to a proximal end of the flexible
sleeve having a lumen extending therethrough that is configured to
receive the elongate surgical access member. In an exemplary
embodiment, the collar member is movable relative to the elongate
surgical access member to selectively configure the flexible sleeve
in a relaxed condition in which the flexible sleeve has a
relatively smooth outer tissue-contacting surface and a compressed
condition in which the flexible sleeve has a plurality of
protrusions formed on the outer tissue-contacting surface that are
configured to create a seal between the outer tissue-contacting
surface and tissue. The flexible sleeve is normally in the relaxed
condition and is configured to receive a compressive force to be
configured in the compressed condition.
[0006] In an exemplary embodiment, the plurality of protrusions are
configured to increase an outer diameter of the flexible sleeve in
the compressed condition and can be threads and/or ribs. In
addition, the collar member can include threads formed on an
interior surface thereof which are configured to mate to
corresponding threads formed on an exterior surface of the elongate
surgical access member. In one exemplary embodiment, the collar
member is configured to rotate via the mated threads and to move
the flexible sleeve distally into the compressed condition. The
surgical access device can further include at least one camming
member in communication with the rigid collar member where the
camming member is rotatable to configure the flexible sleeve in a
compressed condition. In another exemplary embodiment, the elongate
surgical access member can be a cage member coupled between the
rigid collar member and a distal ring, where the rigid collar
member is effective to move the cage member proximally to configure
the flexible sleeve in a compressed condition.
[0007] In a further embodiment, a surgical access device is
provided having a body defining a central longitudinal axis and a
deformable surgical access member configured to be in communication
with the body. The deformable surgical access member can define an
outer tissue-contacting surface such that the deformable surgical
access member is configured to receive a compressive force to
effect an increase in an outer diameter thereof to configure the
outer tissue-contacting surface in a condition effective to form a
seal with tissue. In one exemplary embodiment, the outer
tissue-contacting surface can contain threads configured to form a
seal with tissue when a compressive force is applied to the
deformable surgical access member.
[0008] In an embodiment, the deformable surgical access member is
disposed between a substantially rigid band disposed adjacent to a
proximal end of the deformable surgical access member and a
substantially rigid distal ring. The substantially rigid band can
include threads formed on an interior surface thereof which are
configured to mate with corresponding threads formed on an exterior
surface of the body. The substantially rigid band can be configured
to rotate via the mated threads to move the substantially rigid
band distally and to cause the outer tissue-contacting surface of
the deformable surgical access member to form a seal with tissue.
In another embodiment, the elongate surgical access member can be a
cage member and the substantially rigid band can be configured to
rotate via the mated threads to move the cage member proximally to
cause the outer tissue-contacting surface of the deformable
surgical access member to form a seal with tissue.
[0009] Methods are also provided relating to instrument access
within a patient and include providing a cannula assembly having a
elongate surgical access member with a bore formed therethrough
configured to receive a surgical tool. The method can also include
inserting the cannula assembly into an incision in a patient in an
insertion condition in which the flexible sleeve has a relatively
smooth exterior surface and applying a compressive force to the
flexible sleeve to move the flexible sleeve from the insertion
condition to a compressed condition in which the exterior surface
of the flexible sleeve includes surface features which extend
radially outward from the elongate surgical access member to form a
seal with tissue. In an embodiment, an outer diameter of the
flexible sleeve is greater in the compressed condition than in the
insertion condition.
[0010] The method can further include inserting at least one
surgical tool through the bore in the elongate surgical access
member to effect a surgical procedure. In an embodiment, the
compressive force is applied by sliding a member distally relative
to the elongate surgical access member. In another embodiment, the
compressive force is applied by rotating at least one camming
member. In addition, the compressive force can be applied by
withdrawing a surgical tool from the elongate surgical access
member and the flexible sleeve, where the compressed condition is
the natural state of the flexible sleeve.
BRIEF DESCRIPTION OF THE DRAWINGS
[0011] The invention will be more fully understood from the
following detailed description taken in conjunction with the
accompanying drawings, in which:
[0012] FIG. 1A is a front view of one embodiment of a surgical
access device in a relaxed condition;
[0013] FIG. 1B is a front view of the device of FIG. 1A, in a
compressed condition;
[0014] FIG. 1C is an exploded view of the device of FIG. 1A;
[0015] FIG. 2A is a front view of another embodiment of a surgical
access device in the relaxed condition;
[0016] FIG. 2B is a front view of the device of FIG. 2A, in the
compressed condition;
[0017] FIG. 2C is an exploded view of the device of FIG. 2A;
[0018] FIG. 3A is a further embodiment of a surgical access device
in the relaxed condition;
[0019] FIG. 3B is a cross-section of the device of FIG. 3A, showing
the compressed condition;
[0020] FIG. 3C is an exploded view of the device of FIG. 3A;
[0021] FIG. 4A is a front view of an exemplary embodiment of a
surgical access device having a body and a flexible sleeve; and
[0022] FIG. 4B is a front view of the device of FIG. 4B, in the
compressed condition.
DETAILED DESCRIPTION
[0023] Certain exemplary embodiments will now be described to
provide an overall understanding of the principles of the
structure, function, manufacture, and use of the devices and
methods disclosed herein. One or more examples of these embodiments
are illustrated in the accompanying drawings. Those skilled in the
art will understand that the devices and methods specifically
described herein and illustrated in the accompanying drawings are
non-limiting exemplary embodiments and that the scope of the
present invention is defined solely by the claims. The features
illustrated or described in connection with one exemplary
embodiment may be combined with the features of other embodiments.
Such modifications and variations are intended to be included
within the scope of the present application.
[0024] The present application provides methods and devices useful
for accessing an interior surgical site using an access portal
which can be inserted and removed with minimal tissue damage and
which can form a seal with tissue while inserted. In an embodiment
illustrated in FIGS. 1A-1C, a surgical access device 100 is
provided having an elongate surgical access member 102 with a
generally cylindrical body and a bore formed therethrough
configured for receiving a surgical tool or other device. A
proximal most end of the elongate surgical access member 102 can
include two flange portions, a first flange portion 104 and a
second flange portion 106, each of which have a larger diameter
that the elongate surgical access member 102. As will be
appreciated by those skilled in the art, the elongate surgical
access member 102 and the first and second flanges 104, 106 can be
configured to seat and receive surgical tools, valve systems,
trocars, obturators, vacuum systems and any other devices that may
aid in a surgical procedure. Threads 108 can be formed on an
exterior surface of the elongate surgical access member 102, and
while the threads 108 can be formed at any location along a length
of the elongate surgical access member 102, in the illustrated
embodiment, they are formed on a proximal portion of the elongate
surgical access member 102 situated at a distance below the second
flange 106. The threads 108 are configured to mate with
corresponding threads on a substantially rigid collar, as will be
described in detail below. A tapered portion 110 can be formed on a
distal most end of the elongate surgical access member 102. As will
be appreciated by a person skilled in the art, the size of the
tapered portion 110 and the amount of tapering can vary depending
on the surgical tools expected to be received by the device. A
proximal portion of the tapered portion 110 can also include a lip
112 which has a diameter greater than a diameter of the elongate
surgical access member 102. In an exemplary embodiment, the lip 112
can seat and/or mate to a distal portion of a deformable surgical
access member or flexible sleeve 114 as will be described in detail
below. As will be appreciated by those skilled in the art, the
elongate surgical access member 102 can be rigid, flexible, and/or
semi-rigid and can be formed from a variety of biocompatible
materials, including but not limited to polycarbonate, ABS,
polyetheretherketone (PEEK), polyetherimide, polystyrene,
polyvinylchloride,polyester, polypropelene, polyethelene,
polyurethane. One of ordinary skill in the art will appreciate that
other polymers or blends thereof may be used to achieve similar
properties.
[0025] In the embodiment illustrated in FIGS. 1A-1C, the
substantially rigid collar is in the form of a two-part rotatable
bushing 120 divided into a ring 122 and a nut 124. The ring 122 can
include threads formed on an interior surface thereof which are
configured to mate with the corresponding threads 108 formed on the
exterior surface of the proximal portion of the elongate surgical
access member 102, as described above. The ring 122 can also be
configured to mate with the nut 124 by way, for example, of a press
fit or sliding fit, so that the ring 122 can be rotated with
respect to the nut 124. The nut 124 can include a proximal male
portion 126 configured to seat the ring 122 and a distal male
portion 128 configured to mate with a flange 116 formed on a
proximal end of the flexible sleeve 114. In this way, the ring 122
can be rotated via the mated threads with respect to both the nut
124 and the flexible sleeve 114. As noted above, the bushing 120
can be substantially rigid and can be formed from a variety of
biocompatible materials, including but not limited to
polycarbonate, ABS, polyetheretherketone (PEEK), polyetherimide,
polystyrene, polyvinylchloride, polyester, polypropelene,
polyethelene, polyurethane. One of ordinary skill in the art will
appreciate that other polymers or blends thereof may be used to
achieve similar properties.
[0026] The flexible sleeve 114 can be a substantially tubular
member which can be configured to receive the elongate surgical
access member 102 within a bore formed therein. In one embodiment,
illustrated in FIGS. 1A-1C, a distal most end 118 of the flexible
sleeve 114 rests on the lip 112 of the elongate surgical access
member 102 and is mated thereto so that the distal most end 118 of
the flexible sleeve 114 cannot be moved relative to the elongate
surgical access member 102. The flange 116 on the proximal most end
of the flexible sleeve 114 can be coupled to the distal male
portion 128 of the bushing 120, and can be configured to be movable
with the bushing 120 relative to the elongate surgical access
member 102. The flexible sleeve 114 is deformable and can be formed
from a variety of biocompatible materials, including but not
limited to polyvinylchloride, polyurethane, silicone,
polyetherimide, polyeetherester, thermoplastic polyolefins. One of
ordinary skill in the art will appreciate that other polymers or
blends thereof may be used to achieve similar properties.
[0027] The flexible sleeve is designed to be selectively configured
in a relaxed condition and in a compressed condition. In the
relaxed condition, which is the normal or natural state of the
flexible sleeve 114, an outer tissue-contacting surface 132 of the
flexible sleeve 114 has a relatively smooth surface, as shown in
FIG. 1A, with a first diameter D1. While the flexible sleeve 114
can be configured in many different ways, in one embodiment, in the
relaxed condition, the flexible sleeve 114 is configured to fit
relatively tightly around an outer tissue-contacting surface of the
elongate surgical access member 102. Accordingly, in one exemplary
embodiment, in the relaxed condition, the difference between the
outer diameter of the elongate surgical access member 102 and the
first diameter of the flexible sleeve 114 is essentially the
thickness of the flexible sleeve 114 itself.
[0028] In an embodiment in which the flexible sleeve 114 is
configured to be in the compressed condition, a plurality of
protrusions 130 can form on the outer surface of the flexible
sleeve 114. In the illustrated embodiment, the plurality of
protrusions 130 are in the form of threads which are disposed on a
distal portion of the flexible sleeve 114. A person skilled in the
art will appreciate, however, that the protrusions 130 can also be
ridges, threads, ribs or other surface irregularities which can be
formed over the entire outer surface of the flexible sleeve 114, or
over only a very particular area of the outer surface 132.
Therefore, if the flexible sleeve 114 is configured in a compressed
condition, the outer surface 132 of the flexible sleeve 114 has a
second diameter D2 shown in FIG. 1B, measured from the outermost
boundary of the protrusions 130, which is greater than the first
diameter D1. In an exemplary embodiment, the first diameter D1 in
the relaxed condition can be in the range of about 1 to 5 mm, and
more preferably in the range of about 2 to 3 mm. In the compressed
condition, the second diameter D2 can be in the range of about 2 to
10 mm, and more preferably in the range of about 4 to 6 mm. A
person skilled in the art will appreciate that the device 100 can
have any first and second diameter necessary for a particular
procedure, or to accommodate any size surgical tool as needed. The
protrusions 130 can engage and form a seal with tissue when the
device 100 is in the compressed condition.
[0029] In one embodiment, the protrusions 130 in the flexible
sleeve 114 can be pre-formed in the material of the flexible sleeve
114 so that the outer surface 132 remains relatively smooth in the
relaxed condition, and threads, ribs, or other surface
irregularities will form when the flexible sleeve 114 is configured
in the compressed condition. A person skilled in the art will
appreciate the various ways that the protrusions 130 can be
pre-formed in the flexible sleeve 114.
[0030] In an exemplary embodiment, in use, the device 100 can be
inserted into an incision in a patient in an insertion condition in
which the flexible sleeve 114 is in a relaxed condition such that
the outer surface 132 of the flexible sleeve 114 is relatively
smooth. After the device 100 is inserted and positioned as needed
within the patient, the ring 122 can be rotated, for example, in a
clockwise direction, via the mated threads to configure the
flexible sleeve in a compressed condition as the nut 124 and the
flexible sleeve 114 are moved in a distal direction. As this action
moves the flexible sleeve 114 in a distal direction, the flexible
sleeve 114 is compressed between the nut 124 and the lip 112 formed
on the tapered portion 110 of the elongate surgical access member
102 so as to cause protrusions 130 to form in the outer surface 132
of the flexible sleeve 114. The protrusions 130 can be configured
to engage tissue to prevent pullout and/or movement and to form a
seal with the surrounding tissue. Surgical instruments can be
inserted and removed through the bore in the elongate surgical
access member 102 to perform surgical procedures as needed. At a
point in time when the device 100 is no longer needed within the
patient, the ring 122 can be rotated in an opposite direction, for
example, counter-clockwise, via the mated threads to cause the nut
124 and the flexible sleeve 114 to move in a proximal direction. As
the flexible sleeve 114 is moved proximally, the protrusions 130 in
the flexible sleeve 114 disengage from sealing contact with the
surrounding tissue and essentially disappear as the compression is
removed from the flexible sleeve 114 so that the outer surface 132
of the flexible sleeve 114 is relatively smooth and in the relaxed
or insertion condition. The device 100 can then be removed from the
incision with minimal tissue damage.
[0031] In another embodiment, shown in FIGS. 2A-2C, an access
device 200 is provided having the rigid elongate surgical access
member 102 and flexible sleeve 114 as described above. In addition,
the device 200 can include an activation mechanism for configuring
the flexible sleeve 114 in the relaxed condition and the compressed
condition. The activation mechanism can include a slider member 220
having a bore formed therethrough for receiving the elongate
surgical access member 102 and at least one camming member. In the
illustrated embodiment, the activation mechanism includes two
camming members 230. The slider member 220 can include a proximal
flange 222, a base portion 224, and a male mating portion 226
configured to mate with the flange 116 formed on the proximal end
of the flexible sleeve 114. The slider member 220 can be configured
in many ways, but in the illustrated embodiment, the slider member
220 is adapted to slide relative to the elongate surgical access
member 102. In an exemplary embodiment, the camming members 230 are
rotatable members coupled to a proximal portion of the elongate
surgical access member 102 and are configured to rotate via pins
232 or other connection means known in the art. The camming members
230 are disposed adjacent to the proximal flange 222 of the slider
member 220 and are adapted to act upon the proximal flange 222 when
the activation mechanism is activated to configure the flexible
sleeve 114 in a relaxed condition or a compressed condition, as
will be described below.
[0032] In an exemplary embodiment, in use, the device 200 can be
inserted into an incision in a patient in an insertion condition in
which the flexible sleeve 114 is in a relaxed condition such that
the outer surface 132 of the flexible sleeve 114 is relatively
smooth, as shown in FIG. 2A. After the device is inserted and
positioned as needed within the patient, the camming members 230
can be rotated, such as by ninety degrees, as shown in FIG. 2B to
cause the slider member 220 to move in a distal direction. As the
slider member 220 moves in a distal direction, the proximal end of
the flexible sleeve 114 is also moved distally so as to compress
the flexible sleeve 114 between the slider member 220 and the lip
112 formed on the tapered portion 110 of the elongate surgical
access member 102 and configure the flexible sleeve 114 in a
compressed condition. As the flexible sleeve 114 is compressed,
protrusions 130 form on the outer surface 132 of the flexible
sleeve 114 to engage and form a seal with the surrounding tissue,
thereby preventing movement and pullout of the device 200 from the
incision. Surgical instruments can be inserted and removed through
the bore in the elongate surgical access member 102 to perform
surgical procedures as needed. At a point in time when the device
is no longer needed within the patient, the camming members 230 can
be rotated ninety degrees in the opposite direction, as shown in
FIG. 2A, to cause the slider member 220 and the proximal end of the
flexible sleeve 114 to move in a proximal direction. As the
flexible sleeve 114 is moved proximally, the protrusions 130 in the
flexible sleeve 114 disengage with the surrounding tissue and
disappear as the compression is removed from the flexible sleeve
114 so that the outer surface 132 of the flexible sleeve 114 is
relatively smooth and in the relaxed condition. The device 200 can
be removed from the incision with minimal tissue damage.
[0033] In a further embodiment, shown in FIGS. 3A-3C, a device 300
is provided having a cage member 310 coupled to a receiver body
320. The cage member 310 can include a proximal ring 312 that can
be rigidly mated with an interior surface of the receiver body 320
by any means known in art, for example a snap fit, press fit, or
adhesive. The receiver body 320 and the cage member 310 can have a
bore formed therethrough for receiving a surgical tool or other
instrument. In an exemplary embodiment, the receiver body 320 can
include a proximal flange 322 and a threaded male portion 324
adapted to mate with a corresponding threaded female portion 328 of
a substantially rigid collar 326. The rigid collar 326 can have a
bore formed therethrough that is configured to receive the cage
member 310 when the rigid collar 326 is threadedly mated with the
receiver body 320. The cage member 310 can also include about 2 to
10, and more preferably about 4 to 6, vertical bars 316 extending
from the proximal ring 312 to a distal ring 314 to form the
cage-like structure of the cage member 310. The distal ring 314 of
the cage member 310 can be configured to mate with a distal
compression member 330 by any means known in the art such as a
press fit, a snap fit, or adhesive. A flexible sleeve 114 is
disposed between a distal end of the rigid collar 326 and a
proximal surface of the distal compression member 330 and includes
a bore formed therethrough for receiving the cage member 310.
[0034] In an exemplary embodiment, in use, the device 300 can be
inserted into an incision in a patient in an insertion condition in
which the flexible sleeve 114 is in a relaxed condition such that
the outer surface 132 of the flexible sleeve 114 is relatively
smooth, as shown in FIG. 3A. After the device 300 is inserted and
positioned as needed within the patient, the receiver body 320 can
be rotated via the mated threads "out" of the rigid collar 326 to
move in a proximal direction. As the receiver body 320 is moved
proximally, the cage member 310 and the distal compression member
330 are both pulled proximally, thereby compressing the flexible
sleeve 114 between the rigid collar 326, which is not moving, and
the distal compression member 330. As the flexible sleeve 114 is
compressed, protrusions 130 form on the outer surface 132 thereof
to engage and form a seal with the surrounding tissue, thereby
preventing movement and pullout of the device 300 from the
incision. Surgical instruments can be inserted and removed through
the bore in the elongate surgical access member 102 to perform
surgical procedures as needed. At a point in time when the device
300 is no longer needed within the patient, the receiver body 320
can be rotated via the mated threads back "into" the rigid collar
326 to move in a distal direction, thereby moving the cage member
310 and the distal compression member 330 distally. As the distal
compression member 330 is moved distally, the flexible sleeve 114
disengages from a seal with the surrounding tissue and returns to
the insertion or relaxed condition as the compression is removed to
have a relatively smooth outer surface 132. The device 300 can then
be removed from the incision with minimal tissue damage.
[0035] In another embodiment, shown in FIGS. 4A and 4B, a device
400 is provided having a substantially rigid collar 420 disposed
adjacent to the flexible sleeve 114. The device 400 can also
include a distal ring 430 coupled to the distal end of the flexible
sleeve 114. A bore can be formed through the rigid collar 420, the
flexible sleeve 114, and the distal ring 430 adapted for receiving
a body 410. The body 410 can be any device or surgical tool known
in the art, and in the illustrated embodiment, the body 410 is an
obturator. In an exemplary embodiment, the body 410 can include a
flange 412 configured to be disposed adjacent to a proximal flange
422 on the rigid collar 420 when the body 410 is disposed within
the bore. The body 410 can have an outer diameter OD that is larger
than an inner diameter ID of the distal ring 430 so that the body
410 can be contained within the bore while being prevented from
passing through the distal ring 430. When the body 410 is contained
within the bore, the flexible sleeve 114 is stretched so that the
flexible sleeve 114 has a relatively smooth outer surface 132, as
shown in FIG. 4A. When the body 410 is removed from the bore, the
flexible sleeve 114 returns to its natural state in which it is
compressed between the distal ring 430 and the rigid collar 420,
causing protrusion 130 to form in the outer surface 132. In the
illustrated embodiment, the protrusions 130 are in the form of
threads.
[0036] In an exemplary embodiment, in use, the device 400 can be
inserted into an incision in a patient with the body 410 contained
within the bore. The body 410 causes the flexible sleeve 114 to be
stretched such that the outer surface 132 of the flexible sleeve
114 is relatively smooth in an insertion condition, allowing the
device 400 to be inserted with minimal tissue damage. After the
device 400 is placed as needed within the patient, the body 410 can
be removed from the bore, thereby causing the flexible sleeve 114
to be compressed between the proximal collar 420 and the distal
ring 430 in a compressed condition. As the flexible sleeve 114 is
compressed, protrusions 130 form on the outer surface 132 of the
flexible sleeve 114 to engage and form a seal with the surrounding
tissue. Surgical instruments can be inserted and removed through
the bore in the elongate surgical access member 102 to perform
surgical procedures as needed. At a point in time when the device
400 is no longer needed within the patient, the body 410 can be
inserted into the bore, thereby moving the distal ring 430 distally
and removing the compression from the flexible sleeve 114 so that
the protrusions 130 are removed from the outer surface 132. The
flexible sleeve 114 disengages from a seal with the surrounding
tissue as the compression is removed, and the device 400 can then
be removed from the incision with minimal tissue damage.
[0037] The devices disclosed herein can also be designed to be
disposed of after a single use, or they can be designed to be used
multiple times. In either case, however, the device can be
reconditioned for reuse after at least one use. Reconditioning can
include any combination of the steps of disassembly of the device,
followed by cleaning or replacement of particular pieces, and
subsequent reassembly. In particular, the device can be
disassembled, and any number of the particular pieces or parts of
the device can be selectively replaced or removed in any
combination. Upon cleaning and/or replacement of particular parts,
the device can be reassembled for subsequent use either at a
reconditioning facility, or by a surgical team immediately prior to
a surgical procedure. Those skilled in the art will appreciate that
reconditioning of a device can utilize a variety of techniques for
disassembly, cleaning and/or replacement, and reassembly. Use of
such techniques, and the resulting reconditioned device, are all
within the scope of the present application.
[0038] Preferably, the devices described herein will be processed
before surgery. First, a new or used device is obtained and if
necessary cleaned. The device can then be sterilized. In one
sterilization technique, the device is placed in a closed and
sealed container, such as a plastic or TYVEK bag. The container and
device are then placed in a field of radiation that can penetrate
the container, such as gamma radiation, x-rays, or high-energy
electrons. The radiation kills bacteria on the device and in the
container. The sterilized device can then be stored in the sterile
container. The sealed container keeps the device sterile until it
is opened in the medical facility. It is preferred that the device
is sterilized. This can be done by any number of ways known to
those skilled in the art including beta or gamma radiation,
ethylene oxide, or steam.
[0039] One skilled in the art will appreciate further features and
advantages based on the above-described embodiments. Accordingly,
the application is not to be limited by what has been particularly
shown and described, except as indicated by the appended claims.
All publications and references cited herein are expressly
incorporated herein by reference in their entirety.
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