U.S. patent application number 13/920366 was filed with the patent office on 2013-10-24 for surgical hand access apparatus.
The applicant listed for this patent is Covidien LP. Invention is credited to Robert C. Smith, Thomas Wenchell.
Application Number | 20130281786 13/920366 |
Document ID | / |
Family ID | 35125631 |
Filed Date | 2013-10-24 |
United States Patent
Application |
20130281786 |
Kind Code |
A1 |
Smith; Robert C. ; et
al. |
October 24, 2013 |
SURGICAL HAND ACCESS APPARATUS
Abstract
A surgical access apparatus adaptable to permit the sealed
insertion of either the surgeon's hand and/or surgical instruments
during laparoscopic and endoscopic surgical procedures includes an
access housing defining a longitudinal axis and having a first
internal passageway configured and dimensioned to permit passage of
at least one of a hand and an arm of a surgeon, and a base
mountable to the access housing. The base may include a liner
member positionable within an incision of a patient to at least
partially line the incision. The liner member may have a first end
for positioning within the body and a second end for positioning
external of the body. A displacement member may be operatively
connected to the access housing and to the second end of the liner
member. The displacement member is adapted for movement to cause
corresponding displacement of the second end of the liner member
relative to the access housing whereby the liner member engages
tissue forming the incision to at least partially retract the
incision.
Inventors: |
Smith; Robert C.;
(Middlefield, CT) ; Wenchell; Thomas; (Durham,
CT) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Covidien LP |
Mansfield |
MA |
US |
|
|
Family ID: |
35125631 |
Appl. No.: |
13/920366 |
Filed: |
June 18, 2013 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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12706780 |
Feb 17, 2010 |
8485971 |
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13920366 |
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11102446 |
Apr 5, 2005 |
7717847 |
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12706780 |
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60559548 |
Apr 5, 2004 |
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Current U.S.
Class: |
600/207 ;
600/208 |
Current CPC
Class: |
A61B 17/0218 20130101;
A61B 2017/3464 20130101; A61B 2017/00477 20130101; A61B 2017/00265
20130101; A61B 17/3423 20130101; A61B 17/3462 20130101 |
Class at
Publication: |
600/207 ;
600/208 |
International
Class: |
A61B 17/02 20060101
A61B017/02 |
Claims
1. A surgical access apparatus, which comprises: an access housing
defining a central longitudinal axis and having a longitudinal
opening extending therethrough for passage of a surgeon's hand, the
access housing positionable with respect to body tissue; a trocar
adapter releasably mounted to the access housing, the trocar
adapter including: a trocar sleeve positioned for reception within
the longitudinal opening of the access housing when the trocar
adapter is mounted to the access housing, the trocar sleeve having
an internal passageway for passage of a surgical instrument; and an
instrument valve having inner valve portions dimensioned and
configured to receive a surgical instrument in fluid tight relation
therewith; and a seal mounted to the access housing, the seal
having internal seal portions dimensioned and configured to
establish a sealing relation with the surgeon's arm or with the
trocar sleeve when the trocar adapter is mounted to the access
housing in the absence of the surgeon's arm.
2. The surgical access apparatus according to claim 1 wherein the
trocar adapter includes a zero closure valve adapted to open to
permit passage of the surgical instrument and substantially close
in the absence of the surgical instrument.
3. The surgical access apparatus according to claim 1 including a
flexible liner operatively connected to the access housing for
positioning within an incision in the body tissue to engage tissue
portions defining the incision.
4. The surgical access apparatus according to claim 3 wherein the
flexible liner has a first end for positioning through the incision
and a second end for positioning external of the tissue
portions.
5. The surgical access apparatus according to claim 4 including a
displacement member operatively coupled to the second end of the
flexible liner, the displacement member actuable to exert a
tensional force on the flexible liner to cause the liner to draw
the tissue portions laterally outwardly thereby retracting the
incision.
6. The surgical access apparatus according to claim 5 including a
first member coupled adjacent the first end of the liner member,
the first member dimensioned to move between a contracted condition
to pass through the incision and an expanded condition engaging
tissue underlying the incision to thereby retain the first end of
the liner relative to the incision.
7. The surgical access apparatus according to claim 6 wherein the
first member is normally biased to the expanded condition.
8. The surgical access apparatus according to claim 7 wherein the
first member is substantially annular.
9. The surgical access apparatus according to claim 5 wherein the
displacement member includes an expandable member.
10. The surgical access apparatus according to claim 9 wherein the
expandable member is adapted to expand upon introduction of fluids
therein.
11. The surgical access apparatus according to claim 10 wherein the
expandable member is a balloon member.
12. The surgical access apparatus according to claim 9 wherein the
access housing is dimensioned to accommodate the expandable
member.
13. The surgical access apparatus according to claim 12 including a
housing mount mounted to the access housing and positioned adjacent
the expandable member, the housing mount operatively coupled to the
second end of the liner member and movable relative to the access
housing upon expansion of the expandable member to exert the
tensional force on the liner member.
14. The surgical access apparatus according to claim 13 wherein the
housing mount is dimensioned to move in a longitudinal direction
relative to the longitudinal axis of the access housing.
Description
CROSS-REFERENCE TO RELATED APPLICATION(S)
[0001] This application is a divisional application of U.S. patent
application Ser. No. 12/706,780, filed Feb. 17, 2010, which is a
continuation of co-pending U.S. patent application Ser. No.
11/102,446, filed Apr. 5, 2005, which claims benefit to U.S.
Provisional Application No. 60/559,548, filed Apr. 5, 2004. The
entire contents of both applications are hereby incorporated herein
by reference.
BACKGROUND
[0002] 1. Field of the Disclosure
[0003] The present disclosure relates generally to surgical devices
for facilitating sealed access across a body wall and into a body
cavity and, more particularly, to a surgical access apparatus
adaptable to permit the sealed insertion of either the surgeon's
hand and/or surgical instruments during laparoscopic and endoscopic
surgical procedures.
[0004] 2. Description of the Related Art
[0005] Minimally invasive surgical procedures including both
endoscopic and laparoscopic procedures permit surgery to be
performed on organs, tissues and vessels far removed from an
opening within the tissue. Laparoscopic and endoscopic procedures
generally require that any instrumentation inserted into the body
be sealed, i.e. provisions must be made to ensure that gases do not
enter or exit the body through the incision as, e.g., in surgical
procedures in which the surgical region is insufflated. These
procedures typically employ surgical instruments which are
introduced into the body through a cannula. The cannula has a seal
assembly associated therewith. The seal assembly provides a
substantially fluid tight seal about the instrument to preserve the
integrity of the established pneumoperitoneum.
[0006] Minimally invasive procedures have several advantages over
traditional open surgery, including less patient trauma, reduced
recovery time, reduced potential for infection, etc. However,
despite the recent success and overall acceptance of minimally
invasive procedures as a preferred surgical technique, minimally
invasive surgery, such as laparoscopy, has several disadvantages.
In particular, surgery of this type requires a great deal of
surgeon skill in order for the surgeon to manipulate the long
narrow endoscopic instruments about a remote site under endoscopic
visualization. In addition, in laparoscopic surgery involving the
intestinal tract, it is often preferable to manipulate large
sections of the intestines to perform the desired procedure. These
manipulations are not practical with current laparoscopic tools and
procedures accessing the abdominal cavity through a trocar or
cannula.
[0007] To address these concerns, recent efforts have focused on
hand-assisted laparoscopic techniques and procedures. These
procedures incorporate both laparoscopic and conventional surgical
methodologies. The hand assisted technique is performed in
conjunction with a hand access seal which is an enlarged device
positionable within the incision in, e.g., the insufflated
abdominal cavity. The device includes a seal for forming a seal
about the surgeon's arm upon insertion while permitting surgical
manipulation of the arm within the cavity. However, known hand
access seals are quite cumbersome and incorporate elaborate sealing
mechanisms. Moreover, these hand access seals are incapable of
conversion for use with laparoscopic instruments.
SUMMARY
[0008] Accordingly, the present disclosure relates to a surgical
access apparatus adaptable to permit the sealed insertion of either
the surgeon's hand and/or surgical instruments during laparoscopic
and endoscopic surgical procedures. The surgical access apparatus
includes an access housing defining a longitudinal axis and having
a first internal passageway configured and dimensioned to permit
passage of at least one of a hand and an arm of a surgeon, and a
base mountable to the access housing. The base may include a liner
member positionable within an incision of a patient to at least
partially line the incision. The liner member may have a first end
for positioning within the body and a second end for positioning
external of the body. A displacement member may be operatively
connected to the access housing and to the second end of the liner
member. The displacement member is adapted for movement to cause
corresponding displacement of the second end of the liner member
relative to the access housing whereby the liner member engages
tissue forming the incision to at least partially retract the
incision.
[0009] The surgical access apparatus may include a seal mounted to
the access housing across the first internal passageway. The seal
may be adapted to receive the hand and/or the arm of the surgeon in
a substantial fluid-tight relation. One seal comprises a gel
material.
[0010] The surgical access apparatus further may include a trocar
adapter releasably mountable to the access housing in the absence
of the at least one of the hand and the arm. The trocar adapter
includes a trocar sleeve having a second internal passageway
dimensioned to permit passage of a surgical instrument. The trocar
adapter may include an instrument valve disposed relative to the
second internal passageway. The instrument valve may be adapted to
establish a substantial fluid tight relation with the instrument.
The seal of the access housing may be adapted to form a substantial
fluid tight seal about the trocar sleeve of the trocar adapter.
[0011] The displacement member may include an expandable member.
The access housing may include an outer trough for at least partial
reception of the expandable member.
[0012] The base may include a housing mount mounted to the access
housing and positioned adjacent the expandable member. The housing
mount is operatively coupled to the second end of the liner member
and is movable relative to the access housing upon expansion of the
expandable member to displace the second end of the liner member.
The base also may include first and second substantially annular
members connected adjacent respective first and second ends of the
liner member. The second substantially annular member may be
operatively coupled to the housing mount. The first annular member
may comprise a resilient material.
[0013] In another embodiment, a surgical access apparatus includes
an access housing having a housing passageway for receiving an
object, a seal mounted to the access housing across the housing
passageway, and a base mountable to the access housing. The seal is
adapted to receive the at least one of the hand and the arm in
substantial fluid-tight relation. The base includes a flexible
liner member which is positionable within an incision of a patient
to at least partially line the incision and has a first end for
positioning within the body to engage an inner surface of the body
and a second end for positioning external of the body; a
substantially annular housing mount mounted with respect to the
access housing and operatively coupled to the second end of the
liner member and a substantially annular expandable member in
operative engagement with the housing mount. The expandable member
is expandable to displace the housing mount and the second end of
the liner member whereby the liner member engages tissue forming
the incision to at least partially retract the incision. The base
may include first and second substantially annular members
connected adjacent respective first and second ends of the liner
member. The housing mount may be in operative engagement with the
second member. The access housing may include an outer trough with
the expandable member being at least partially accommodated in the
outer trough.
[0014] A trocar adapter may be releasably mountable to the access
housing in the absence of the at least one of the hand and the arm.
The trocar adapter includes a trocar sleeve having a sleeve
passageway dimensioned to permit passage of a surgical instrument
and an instrument valve adapted to establish a substantial fluid
tight relation with the instrument.
[0015] In a still further embodiment, the surgical access apparatus
may include an access housing defining a central longitudinal axis
and having a longitudinal opening extending therethrough for
passage of a surgeon's hand. A retractor base may be mounted to the
access housing. The retractor base may include a flexible liner for
positioning within the incision to engage tissue portions defining
the incision. A trocar adapter may be releasably mounted to the
access housing. The trocar adapter may include a trocar sleeve
positioned for reception within the longitudinal opening of the
access housing when the trocar adapter is mounted to the access
housing, the trocar sleeve having an internal passageway for
passage of a surgical instrument. An instrument valve having inner
valve portions dimensioned and configured to receive a surgical
instrument in fluid tight relation therewith. A zero closure valve
adapted to open to permit passage of the surgical instrument and
substantially close in the absence of the surgical instrument. A
seal mounted to the access housing, the seal having internal seal
portions dimensioned and configured to establish a sealing relation
with the surgeon's arm or with the trocar sleeve when the trocar
adapter is mounted to the access housing in the absence of the
surgeon's arm.
[0016] In another embodiment, a surgical access apparatus includes
an access housing defining a central longitudinal axis and having a
longitudinal opening extending therethrough for passage of a
surgeon's hand, a retractor base mounted to the access housing and
having a flexible liner for positioning within the incision to
engage tissue portions defining the incision, a trocar adapter
releasably mounted to the access housing, and a seal mounted to the
access housing. The trocar adapter includes a trocar sleeve
positioned for reception within the longitudinal opening of the
access housing when the trocar adapter is mounted to the access
housing and having an internal passageway for passage of a surgical
instrument, an instrument valve having inner valve portions
dimensioned and configured to receive a surgical instrument in
fluid tight relation therewith and a zero closure valve adapted to
open to permit passage of the surgical instrument and substantially
close in the absence of the surgical instrument. The seal mounted
to the access housing has internal seal portions dimensioned and
configured to establish a sealing relation with the surgeon's arm
or with the trocar sleeve when the trocar adapter is mounted to the
access housing in the absence of the surgeon's arm.
[0017] Methods for performing hand assisted and instrument assisted
laparoscopic surgical procedures are also envisioned.
[0018] These and other embodiments of the present disclosure will
be described herein below in greater detail.
BRIEF DESCRIPTION OF THE DRAWINGS
[0019] Preferred embodiments of the present disclosure will be
better appreciated by reference to the drawings wherein:
[0020] FIG. 1 is a top view of the hand access apparatus in
accordance with the principles of the present disclosure
illustrating the access housing, trocar adapter and retractor
base;
[0021] FIG. 2 is a cross sectional view of the access apparatus in
accordance with the embodiment of FIG. 1 taken along lines 2-2 of
FIG. 1;
[0022] FIG. 3 is a partial cross-sectional view of the access
apparatus in accordance with the embodiment of FIG. 1 taken along
lines 3-3 of FIG. 1;
[0023] FIG. 4 is a top plan view of the expandable member of the
retractor base of the access apparatus in accordance with the
embodiment of FIG. 1;
[0024] FIG. 5 is a side cross-sectional view of the expandable
member in accordance with the embodiment of FIG. 1 taken along
lines 5-5 of FIG. 4;
[0025] FIG. 6 is a top plan view of the flexible liner of the
retractor base of the access apparatus in accordance with the
embodiment of FIG. 1; and
[0026] FIG. 7 is a side cross-sectional view of the flexible liner
in accordance with the embodiment of FIG. 1 taken along lines 7-7
of FIG. 6.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0027] The surgical access apparatus of the present disclosure
provides a substantial seal between the body cavity of a patient
and the outside atmosphere before, during and after insertion of an
object through the apparatus. The apparatus has a flexible liner
and an expandable member so that the apparatus can be used to line
the incision and to retract the incision, providing access to a
surgical site.
[0028] Moreover, the access apparatus of the present invention is
capable of accommodating the hand and/or arm of a surgeon and is
convertible to receive surgical instruments of varying diameters,
which may range from 5 mm to 15 mm, for example, and establishing a
gas tight seal with the arm and each instrument when inserted. The
access apparatus is further adapted to substantially seal the body
cavity in the absence of the object to maintain the integrity of
the insufflated peritoneal cavity.
[0029] Generally, the access apparatus is convertible between a
first operative condition to permit introduction and manipulation
of a surgeon's hand or arm in sealed relation therewith and a
second operative condition to permit introduction and manipulation
of a laparoscopic or endoscopic surgical instrument also in sealed
relation.
[0030] Although the specific focus of this disclosure will be on a
preferred laparoscopic procedure, it will be noted that
laparoscopic surgery is merely representative of a type of
operation wherein a procedure can be performed in a body cavity
through an access apparatus through a body wall.
[0031] In the following description, as is traditional the term
"proximal" refers to the portion of the instrument closest to the
operator, while the term "distal" refers to the portion of the
instrument remote from the operator.
[0032] Referring now to the drawings, in which like reference
numerals identify identical or substantially similar parts
throughout the several views, FIGS. 1 and 2 illustrate the access
apparatus of the present disclosure. Access apparatus 100 includes
two main components, namely, access housing 102 and retractor base
104. The apparatus also desirably includes trocar adapter 106,
which is releasably mounted to the access housing 102. Access
housing 102 is intended for positioning adjacent (preferably, in
contact with) the external area of the body, e.g., the abdominal
cavity. Access housing 102 defines central longitudinal axis "a"
and longitudinal opening or passageway 108 extending along the
central axis "a". Longitudinal passageway 108 is dimensioned to
permit passage of the surgeon's hand and/or arm. Access housing 102
further includes an outer circumferential U-shaped flange or trough
110 and an internal vertical support wall 112. Although vertical
support wall 112 is shown as having an inner and outer wall, a
single wall may be used. Vertical support wall 112 defines
longitudinal passageway 108. Access housing 102 may be made from
any suitable biocompatible polymeric material including
polycarbonate, polystyrene, etc. Alternatively, access housing 102
may be fabricated from biocompatible metals such as stainless steel
or titanium and their alloys.
[0033] Referring still to FIGS. 1-2, access housing 102 preferably
includes a seal 114 which is mounted across longitudinal passageway
108. Seal 114 may comprise one or more seals, such as septum seals,
flapper valves, duckbill seals, etc., arranged to provide a
substantial seal around a surgeon's arm, or surgical instruments,
or in the presence of such object. The embodiment of FIGS. 1-7 has
a gel material such as a soft urethane gel, silicon gel, etc. and
preferably has compressible characteristics to permit the seal 114
to conform and form a seal 114 about the outer surface of a
surgeon's hand and/or arm during insertion and manipulation about
the operation site. Seal 114 preferably includes a V-shaped
entrance opening 116 which extends to slit 118 within the seal 114.
V-shaped opening 116 converges inwardly toward slit 118 to
facilitate insertion and passage of an object such as a surgeon's
hand and/or adapter 106 through seal 114. Moreover, seal 114 opens
to permit passage of the object whereby the internal gel portions
defining slit 118 engage this object in fluid tight relation
therewith. Seal 114 is further adapted to assume a substantially
closed position in the absence of the hand or adapter 106, i.e., to
form a zero seal, thus preventing the escape of insufflation gases
through access housing 102 when objects have been removed from the
passageway 108 of access apparatus 100. Slit 118 of seal 114 may be
a generally linear orientation, t-shaped, tricuspid, or x-shaped,
or other shape when viewed in plan. Seal 114 is connected to the
interior of access housing 102 through conventional means such as
being molded therewith or connected therewith by an adhesive.
[0034] In an alternate preferred embodiment, seal 118 is fabricated
from a resilient material, e.g., polyisoprene, and has at least one
layer of fabric material positioned adjacent the resilient
material, or molded with the resilient material. A friction
resisting coating may be applied to seal 118. Seals such as those
disclosed in certain embodiments of commonly-assigned U.S. patent
application Ser. No. 10/165,373 filed Jun. 6, 2002, the contents of
which are incorporated in its entirety by reference, may be used.
Other valve types are also contemplated including zero-closure
valves, septum valves, slit valves, double-slit valves, inflatable
bladders, other foam or gel valve arrangements, etc.
[0035] Referring now to FIGS. 1-3, retractor base 104 will be
discussed. Retractor base 104 is intended for positioning within
the incision of the patient to line the incision and/or retract the
tissue defining the incision thereby enhancing access to the
underlying body cavity. Retractor base 104 includes liner 120,
annular mount 122 at the wall end of retractor base 104 and
expandable member 124 disposed in the u-shaped through 110 of
access housing 102. With reference to FIGS. 4-5, in conjunction
with FIGS. 1-3, liner 120 includes tubular sheath or flexible liner
member 126, first member 128 connected to other end of the liner
member 126 and second member 130 connected to the remaining end of
the liner member 126. Liner member 126 may be a sheet of flexible
material including, for example, polyethylene, polypropylene, etc.,
arranged in a tubular configuration. Liner member 126 may also
include an elastomeric material and may incorporate rigid runners
embedded within the material to increase its rigidity. Although in
the preferred embodiment, liner member 126 is tubular, it is
envisioned that the liner member 126 may incorporate several
pieces, e.g., individual tabs or the like. Liner member 126 may or
may not be impervious to fluids. Liner member 126 is desirably
adapted to line the incision so as to prevent contamination of the
incision by any tissue which may be removed through the access
apparatus, or in the course of the surgery. Generally, liner member
126 serves to retract the incision during placement of the
retractor base 104, so that the patient's skin, fascia, and other
tissue are drawn back, allowing access to the surgical site.
[0036] First member 128 of liner 120 is adapted for positioning
through the incision and beneath the abdominal wall to engage the
interior abdominal wall portions to thereby secure retractor base
104 relative to the incision. First member 128 is preferably
flexible to facilitate passage through the incision and possesses
sufficient resiliency to return to its original configuration upon
entering the abdominal cavity. First member 128 is preferably
annular or ring-like in configuration and may be fabricated from a
resilient or elastomeric material. First member 128 may be fixedly
secured to the end of liner member 126 through conventional means
such as welding, adhesives, etc . . .
[0037] Second member 130 is also annular or ring-like in
configuration and is attached to the other end of liner member 126
by conventional means such as welding, adhesives, etc . . . Second
member 130 preferably possesses a more rigid characteristic than
first member 128, and may be formed of a suitable biocompatible
polymeric material or a biocompatible metal. Alternatively, second
member 130 may be fabricated from an elastomeric material.
Alternatively, the first member 128 and second member 130 may be
formed integrally with the liner member 126. The second member 130
may be omitted.
[0038] As best depicted in FIGS. 2-3, annular mount 122 of
retractor base 104 is coaxially mounted about access housing 102.
Annular mount 122 is adapted to move relative to access housing 102
in a longitudinal direction relative to longitudinal axis "a" and
preferably slides along the outer surface of the vertical support
wall of the access housing 102 adjacent vertical support wall 112.
Annular mount 122 is adapted to connect to second member 130 in a
manner which secures the second member 130 to the annular mount
122. Any suitable means to connect second member 130 to annular
mount 122 are envisioned including adhesives, cements etc.
Alternatively, a snap-fit or ridge for receiving the second member
130 may be used. Annular mount 122 and second member 130 may
incorporate corresponding structure to securely mount the two
components. Such structure may be a tongue and groove arrangement,
tab and slot etc . . . In one preferred embodiment, second member
130 is pulled over to be received within inner channel 132 of
annular mount 122 and may be retained within the channel 132
through a friction fit, the resiliency of the second member, or the
like. Alternatively, the upper end of the liner member 126 may be
wrapped around annular mount 122.
[0039] With reference now to FIGS. 6-7, in conjunction with FIGS.
1-3, expandable member 124 of retractor base 104 is preferably in
the form of a balloon having an annular or ring like dimension
correspondingly arranged to be received and confined within outer
trough 110 of access housing 102. Expandable member 124 includes a
fluid supply line 134 which is in communication with the interior
of the expandable member 124 to provide fluid to, and selectively
inflate, the expandable member 124. Expandable member 124 may be
selectively filled with a fluid such as water, saline, etc. or a
gas such as air or CO.sub.2. In the assembled condition of
apparatus 100, the upper surface of expandable member 124 contacts
annular mount 122. Accordingly, upon expansion of expandable member
124, annular mount 122 is displaced in a proximal direction away
from the abdominal cavity. Similarly, second member 130 attached to
annular mount 122 also moves proximally away from first member 128.
Such movement causes liner member 126 to become tensioned, thereby
drawing the tissue surrounding the incision laterally outwardly to
at least partially retract the incision. Liner member 126 is
tensioned so as to retract the incision, without requiring the
surgeon to pull on the liner member 126, or arrange the liner
member 126 and fix the liner member 126 in position. As
appreciated, as liner member 126 is tensioned, first member 128 may
be also pulled in a proximal direction to bring the first member
128 into contact with the interior wall of the abdominal cavity.
This activity effectively secures retractor base 104 within the
incision and seals against the leakage of gas around the
sleeve.
[0040] Referring again to FIGS. 1-2, trocar adapter 106 of access
apparatus 100 will now be described. Trocar adapter 106 includes
adapter base 136 and valve assembly 138 which is mounted to the
adapter base 136. Adapter base 136 includes cannula sleeve 140,
inner wall 142 extending from the sleeve 140 and peripheral flange
144. Cannula sleeve 140 is a tube-like structure having a
longitudinal opening 146 dimensioned for passage of surgical
instrumentation. The proximal end of cannula sleeve 140 extends
beyond inner wall 142 for attachment to valve assembly 138 as will
be discussed. Adapter base 136 is preferably monolithically formed
as a single unit and may be fabricated from a suitable
biocompatible polymeric material through injection molding
techniques, or using other known techniques. Alternatively, adapter
base 136 may be formed of a suitable biocompatible metal material
like stainless steel, titanium, titanium alloys etc.
[0041] Adapter base 106 is preferably releasably mounted to access
housing 102. In one preferred arrangement, adapter base 106
includes peripheral rib 146 extending radially inwardly relative to
longitudinal axis "a". Peripheral rib 146 is received within
annular groove 148 of access housing 102 in snap-fit relation
therewith to releasably connect the two components. Other means for
releasably connecting adapter base 106 to access housing 102 are
also envisioned including a bayonet coupling, friction fit, tongue
and groove, etc. Adapter base 106 may also be tethered to access
housing 102 to provide a flip-top arrangement.
[0042] Valve assembly 138 may be any conventional trocar seal
system adapted for mounting to a cannula sleeve and forming a fluid
tight seal about an endoscopic instrument ranging in diameter from
about 3 mm to about 15 mm. In one preferred embodiment, valve
assembly 138 is of the type available from United States Surgical
Corporation of Norwalk, Conn. under the tradename, VERSAPORT.TM.
PLUS. The VERSAPORT.TM. PLUS seal includes a valve housing 150, a
semicircular or hemispherical gimbal valve 152 mounted within the
housing and a zero-closure or duck-bill valve 154 extending from
the valve housing 150 and toward cannula sleeve 140. Gimbal valve
152 is adapted to swivel or rotate within valve housing 150 about a
central axis of rotation to accommodate offset manipulation of the
instrument inserted through valve assembly 138. Gimbal valve 152
includes a mounting that is rotatably secured in the valve housing
150 and a resilient valve member for forming a seal with the
instrument. Duck bill valve 154 is adapted to open in the presence
of an instrument and close to function as a zero closure seal in
the absence of an instrument. Valve housing 150 is connected to the
proximal end of cannula sleeve 140 through any conventional means
including adhesives, bayonet coupling, etc. Other valve assemblies
for incorporation into adapter 106 are also envisioned such as the
valve assemblies disclosed in commonly assigned U.S. Pat. Nos.
6,482,181, 5,820,600, U.S. Pat. Reissue No. 36,702 and U.S. patent
application Ser. No. 09/706,643, filed Nov. 6, 2000, the entire
contents of each are hereby incorporated by reference herein.
[0043] Other details of trocar adapter 106 may be ascertained by
reference to the commonly assigned U.S. Pat. No. 7,393,322, which
is incorporated herein in its entirety by reference.
Operation
[0044] The use of the access apparatus 100 in connection with a
hand assisted laparoscopic surgical procedure will be discussed.
Generally, the peritoneal cavity is insufflated using e.g., a
trocar, and an incision is made to provide access to the cavity as
is conventional in the art. Thereafter, retractor base 104 is
introduced within the incision by contracting first member 128 and
advancing the first member 128 through the incision and into the
body cavity. First member 128 is released to permit the first
member 128 to return to its normal condition (under the influences
of its inherent resiliency) within the cavity. Liner member 126
extends from first member 128 through the incision to line the
incision as previously discussed.
[0045] The procedure is continued by positioning access housing 102
(without adapter 106 being attached to access housing 102) adjacent
the external side of the abdominal wall. If not already connected,
second member 130 is connected to annular mount 122 by positioning
the second member 130 within channel 132 of annular mount 122.
Thereafter, expandable member 124 which is received within outer
trough 110 of access housing 102 is expanded by introduction of
fluids through supply line 134. During expansion, annular mount 122
(through its contact with expandable member 124) is displaced from
the patient to slide proximally along the vertical support wall 112
of access housing 102 to thereby also displace second member 130 of
liner 120 in a proximal direction. This movement causes any excess
slack in liner member 126 to be removed and draws first member 128
into further engagement with the internal abdominal wall thereby
securing retractor base 104 relative to the body tissue. As
appreciated, liner member 126 may also expand the size of the
incision upon movement of second member 130.
[0046] With access apparatus 100 in its first operative condition,
hand assisted surgery may then be effected by advancement of the
surgeon's hand and arm through seal 114 of access housing 102 and
into the body cavity. Seal 114 forms a fluid tight seal about the
arm. The desired hand assisted procedure may then be performed.
[0047] When it becomes desirable to convert hand access apparatus
100 for use with laparoscopic instrumentation (i.e., to convert
access apparatus 100 to its second operative condition), trocar
adapter 106 is mounted to access housing 102 in the aforedescribed
manner. Once mounted, trocar sleeve 140 extends through slit 118 of
seal 114. Seal 114 forms a fluid-tight seal about the outer surface
of trocar sleeve 140. Instrumentation is introduced through valve
assembly 138 and trocar sleeve 140 to carry out the desired
procedures. As mentioned, gimbal valve 140 of valve assembly 138
forms a fluid tight seal about the instrument and permits
manipulation of the instrument within the operative site.
[0048] Thus, access apparatus 100 may be utilized in conjunction
with hand-assisted laparoscopic procedures and more conventional
instrument-assisted laparoscopic procedures. This flexibility and
adaptability significantly reduces the number of incisions required
within the abdominal cavity thus minimizing patient trauma and
infection, and improving recovery time.
[0049] It will be understood that various modifications may be made
to the embodiments disclosed herein. Therefore, the above
description should not be construed as limiting, but merely as
exemplifications of preferred embodiments. Those skilled in the art
will envision other modifications within the scope and spirit of
the claims appended hereto.
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