U.S. patent application number 15/376731 was filed with the patent office on 2017-03-30 for thoracic access port including foldable anchor.
The applicant listed for this patent is Covidien LP. Invention is credited to David Gregory Ahern, Robin Craig Cocker.
Application Number | 20170086881 15/376731 |
Document ID | / |
Family ID | 45888012 |
Filed Date | 2017-03-30 |
United States Patent
Application |
20170086881 |
Kind Code |
A1 |
Ahern; David Gregory ; et
al. |
March 30, 2017 |
Thoracic Access Port Including Foldable Anchor
Abstract
A surgical access device includes a body having a first member
and a second member relatively movable between open and closed
configurations. Each member is positionable within an opening in
tissue to provide access to an interior space of a patient. Each
member includes a top surface, a bottom surface, a leading end, and
a trailing end. The top surfaces are positioned in close
cooperative alignment when the first and second members are in the
closed configuration. The trailing ends are positioned in close
cooperative alignment when the first and second members are in the
open configuration. In the open position, the first and second
members define a passage therethrough to permit access to the
interior space for passage of a surgical instrument
therethrough.
Inventors: |
Ahern; David Gregory;
(Cambridgeshire, GB) ; Cocker; Robin Craig;
(Lancashire, GB) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Covidien LP |
Mansfield |
MA |
US |
|
|
Family ID: |
45888012 |
Appl. No.: |
15/376731 |
Filed: |
December 13, 2016 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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|
14835774 |
Aug 26, 2015 |
9549722 |
|
|
15376731 |
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|
13397896 |
Feb 16, 2012 |
9119665 |
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14835774 |
|
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|
61454684 |
Mar 21, 2011 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 17/0218 20130101;
A61B 2017/3427 20130101; A61B 17/0293 20130101; A61B 17/3423
20130101; A61B 2017/3484 20130101 |
International
Class: |
A61B 17/34 20060101
A61B017/34; A61B 17/02 20060101 A61B017/02 |
Claims
1. A method of accessing an internal surgical work site,
comprising: positioning a surgical access device at least partially
within an opening in tissue to provide access to an internal space,
the surgical access device including a first member and a second
member; engaging a moveable element of an insertion device with the
first member of the surgical access device; moving the movable
element of the insertion device from a first position to a second
position to cause at least one of the first member or the second
member of the surgical access device to move between a first
configuration where the first member and the second member define a
passage therebetween, the passage configured to permit access of a
surgical instrument to the internal space, and a second
configuration where top surfaces of the first member and the second
member are positioned in close cooperative alignment, wherein the
movable element is substantially aligned with a longitudinal axis
defined by a shaft of the insertion device when the movable element
is in the first position, and the movable element is substantially
aligned with an axis transverse to the longitudinal axis when the
movable element is in the second position.
2. The method according to claim 1, wherein moving the movable
element from the first position to the second position includes
pivoting the movable element with respect to the shaft of the
insertion device.
3. The method according to claim 1, further comprising engaging a
protuberance of the movable element with an aperture of the first
member of the surgical access device.
4. The method according to claim 3, further comprising moving the
protuberance from a larger portion of the aperture to a smaller
portion of the aperture to help secure the movable member with
respect to the first member of the surgical access device.
5. The method according to claim 1, further comprising applying
force to a cord secured to at least one of the first member or the
second member to allow at least one of the first member or the
second member to move toward the second configuration.
6. The method according to claim 1, wherein moving the movable
element of the insertion device from the first position to the
second position causes at least one of the first member or the
second member of the surgical access device to rotate about 90
degrees relative to a central axis defined through the passage.
7. The method according to claim 1, wherein moving the movable
element of the insertion device from the first position to the
second position causes each of the first member and the second
member of the surgical access device to rotate about 90 degrees
relative to a central axis defined through the passage.
8. The method according to claim 1, further comprising disengaging
the moveable element of the insertion device from the first member
of the surgical access device.
9. A method of accessing an internal surgical work site through an
intercostal space defined between a patient's ribs comprising:
providing a surgical access device including a body having a first
member and a second member, each of the first member and the second
member including a top surface, a bottom surface, a leading end,
and a trailing end; providing an insertion device including a
housing having a shaft extending from the housing, at least one
movable element extending from a distal end of the shaft, and an
actuator operably coupled to the at least one movable element and
operable to move the at least one movable element between a first
position and a second position; coupling the at least one movable
element to at least one of the first member or the second member;
selectively moving the first member and the second member between a
closed configuration, where the top surfaces of the first member
and the second member are positioned in close cooperative
alignment, and an open configuration; positioning the first member
and the second member relative to the intercostal space with the
insertion device; and uncoupling the at least one movable element
from at least one of the first member or the second member.
10. The method according to claim 9, further comprising removing
the surgical access device from the intercostal space by pulling at
least one cord operably coupled to the surgical access device.
11. The method according to claim 9, further comprising rotating
the insertion device after uncoupling the at least one movable
element of the insertion device from the first member and the
second member of the surgical access device in order to permit
removal of the insertion device through a passage defined through
the first member and the second member of the surgical access
device.
12. The method according to claim 9, further comprising engaging a
protuberance of the at least one movable element with an aperture
of the first member of the surgical access device.
13. The method according to claim 12, further comprising moving the
protuberance from a larger portion of the aperture to a smaller
portion of the aperture to help secure the at least one movable
member with respect to the first member of the surgical access
device.
14. The method according to claim 9, further comprising rotating
the at least one movable member about 90 degrees relative to a
central axis defined through a passage defined through the first
and second members of the surgical access device.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a divisional of U.S. patent application
Ser. No. 14/835,774 filed Aug. 26, 2015, which is a divisional of
U.S. patent application Ser. No. 13/397,896 filed Feb. 16, 2012,
now U.S. Pat. No. 9,119,665, which claims the benefit of and
priority to U.S. Provisional Patent Application No. 61/454,684,
filed Mar. 21, 2011, the entire disclosure of which is incorporated
by reference herein.
BACKGROUND
[0002] 1. Technical Field
[0003] The present disclosure relates generally to devices and
techniques for performing surgical procedures. More particularly,
the present disclosure relates to an access device for minimally
invasive surgery.
[0004] 2. Background of the Related Art
[0005] In an effort to reduce trauma and recovery time, many
surgical procedures are performed through small openings in the
skin, such as an incision or a natural body orifice. For example,
these procedures include laparoscopic procedures, which are
generally performed within the confines of a patient's abdomen, and
thoracic procedures, which are generally performed within a
patient's chest cavity.
[0006] Specific surgical instruments have been developed for use
during such minimally invasive surgical procedures. These surgical
instruments typically include an elongated shaft with operative
structure positioned at a distal end thereof, such as graspers,
clip appliers, specimen retrieval bags, etc.
[0007] During minimally invasive procedures, the clinician creates
an opening in the patient's body wall, oftentimes by using an
obturator or trocar, and thereafter positions an access assembly
within the opening. The access assembly includes a passageway
extending therethrough to receive one or more of the
above-mentioned surgical instruments for positioning within the
internal work site, e.g. the body cavity.
[0008] During minimally invasive thoracic procedures, an access
assembly is generally inserted into a space located between the
patient's adjacent ribs that is known as the intercostal space, and
then surgical instruments can be inserted into the internal work
site through the passageway in the access assembly.
[0009] In the interests of facilitating visualization, the
introduction of certain surgical instruments, and/or the removal of
tissue specimens during minimally invasive thoracic procedures, it
may be desirable to spread the tissue adjacent the ribs defining
the intercostal space and/or the ribs. Additionally, during these
procedures, firm, reliable placement of the access assembly is
desirable to allow the access assembly to withstand forces that are
applied during manipulation of the instrument(s) inserted
therethrough. However, reducing patient trauma during the
procedure, discomfort during recovery, and the overall recovery
time remain issues of importance. Thus, there exists a need for
thoracic access ports which minimize post operative patient pain
while enabling atraumatic retraction of tissue and which do not
restrict access to the body cavity. There also exists a need to
facilitate insertion of such thoracic ports into the body
cavity.
SUMMARY
[0010] According to one aspect of the present disclosure, a
surgical access device is provided which includes a body that
includes a first member and a second member. Each member includes a
top surface, a bottom surface, a leading end, and a trailing end.
The first and second members are relatively movable between open
and closed configurations and are positionable within an opening in
tissue to provide access to an interior space of a patient. The
first and second members in the open configuration define a passage
therethrough. The passage is dimensioned to permit access to the
interior space of the patient for passage of a surgical instrument
therethrough.
[0011] Preferably, the trailing ends are positioned in close
cooperative alignment when the first and second members are in the
open configuration and the top surfaces are positioned in close
cooperative alignment when the first and second members are in the
closed configuration.
[0012] In some embodiments, in the open configuration, the leading
ends of the first and second members are diametrically opposed and
the top and bottom surfaces of the first member are substantially
aligned with the top and bottom surfaces of the second member along
an axis substantially transverse to a central axis defined through
the passage. In some embodiments, in the closed configuration, the
leading and trailing ends of the first member are substantially
aligned with the leading and trailing ends of the second member and
the bottom surfaces of the first and second members are disposed in
substantially mirrored relation.
[0013] In some embodiments, one or both of the first and second
members include one or more flaps extending into the passage.
[0014] In some embodiments, one or both of the first and second
members define one or more apertures dimensioned to facilitate the
positioning of the first and the second members into the open
configuration. The apertures can include a first portion and a
second portion wherein the first portion is smaller than the second
portion. Each of the first and second members can include a surface
feature defined along the top surface thereof wherein each
respective surface feature can be in contact with the other surface
feature when the first and second members are in the closed
configuration. One or more of the surface features may include a
tapered portion.
[0015] In some embodiments, a first arm extends from one of the
first and second members and a second arm extends from the other of
the first and second members. In such embodiments, the first arm
can define a channel dimensioned to receive the second arm such
that the first arm and the second arm are engaged in close
geometric fit when the first and second members are positioned in
the open configuration so that the first and second members are
secured in the open configuration.
[0016] In some embodiments, one or more cords may be secured to one
or both of the first arm and the second arm wherein when the first
and second members are secured in the open configuration, the one
or more cords are actuable upon the application of a predetermined
amount of force to disengage the first and second arms from a close
geometric fit so that the first and second members are no longer
secured in the open configuration. An opening may be defined within
the first arm and/or the second arm through which the one or more
cords may be secured.
[0017] According to another aspect, a surgical access system is
provided and includes a surgical access device and an insertion
device. The surgical access device includes a body that includes a
first member and a second member. Each member is movable between
open and closed configurations and is positionable within an
opening in tissue to provide access to an internal space of a
patient. The first and second members in the open configuration
define a passage therethrough. The passage is dimensioned to permit
access to the internal space of a patient for passage of a surgical
instrument therethrough.
[0018] The insertion device includes a housing having a shaft
extending from the housing. At least one movable element extends
from a distal end of the shaft. An actuator is operably coupled to
at least one movable element and is operable to move at least one
movable element between first and second positions. The at least
one movable element is releasably engageable with at least one of
the first and second members of the surgical access device such
that movement of at least one movable element between the first and
second positions repositions the first and second members of the
surgical access device between open and closed configurations when
at least one movable element is engaged with at least one of the
first and second members of the surgical access device.
[0019] In some embodiments, the at least one movable element is
substantially aligned with a longitudinal axis of the insertion
device in the first position and substantially aligned with an axis
transverse to the longitudinal axis of the insertion device in the
second position.
[0020] The passage defined through the first and second members in
the open configuration may in some embodiments be substantially
elliptical and define a plane including major and minor axes. In
some embodiments, when the one or more movable elements are
positioned in the second position, the one or more movable elements
are prevented from crossing the plane defined by a substantially
elliptical passage of the surgical access device when the one or
more movable elements are not substantially aligned with the major
axis defined by the substantially elliptical passage of the
surgical access device.
[0021] In some embodiments, each member includes a top surface, a
bottom surface, a leading end, and a trailing end, wherein the top
surfaces are positioned in close cooperative alignment when the
first and second members are in the closed configuration and the
trailing ends are positioned in close cooperative alignment when
the first and second members are in the open configuration and in
the closed configuration.
[0022] In some embodiments, the first member and/or the second
member of the surgical access device define one or more apertures
and the one or more movable elements of the insertion device
include one or more protuberances extending therefrom wherein the
one or more apertures and the one or more protuberances are
releasably engagable with each other. The one or more apertures can
have a first portion and a second portion wherein the first portion
is smaller than the second portion such that the one or more
protuberances of the one or more movable elements are dimensioned
to engage the smaller portion of the one or more apertures in a
tight geometric fit and the larger portion in a loose geometric fit
such that the one or more protuberances remain substantially
secured to the smaller portion of the one or more apertures when
engaged therewith and are substantially freely movable relative to
the larger portion of the one or more apertures when engaged
therewith.
[0023] According to yet another aspect, the present disclosure is
directed to a method of accessing an internal surgical work site
relative to an intercostal space defined between a patient's ribs.
The method includes the step of providing a surgical access device
including a body having a first member and a second member, each
member including a top surface, a bottom surface, a leading end,
and a trailing end. The method includes providing an insertion
device including a housing having a shaft extending from the
housing, at least one movable element extending from a distal end
of the shaft, and an actuator operably coupled to the at least one
movable element and operable to move the at least one movable
element between first and second positions. The method includes the
steps of coupling the at least one movable element to one or both
of the first and second members, selectively positioning the first
and second members between a closed configuration, where the top
surfaces of first and second members are positioned in close
cooperative alignment, and an open configuration. The method
further includes positioning the first and second members relative
to the intercostal space with the insertion device and uncoupling
the at least one movable element from at least one of the first and
second members.
[0024] The method may include the step of removing the surgical
access device from the intercostal space by pulling one or more
cords operably coupled to the surgical access device. The method
may include the step of rotating the insertion device after
uncoupling the one or more movable elements of the insertion device
from the first and second members of the surgical access device in
order to permit removal of the insertion device through a passage
defined through the first and second members of the surgical access
device.
BRIEF DESCRIPTION OF THE DRAWINGS
[0025] Various exemplary embodiments of the present disclosure are
described herein below with reference to the drawings, wherein:
[0026] FIG. 1 is a perspective view of the inner member of a
surgical access assembly in accordance with the present disclosure
shown in a closed configuration mounted to an insertion device with
the membrane removed for clarity;
[0027] FIG. 2 is a perspective view of the inner member of the
surgical access assembly of FIG. 1 shown in an open configuration
on the insertion device with the membrane removed for clarity;
[0028] FIG. 3 is a front view illustrating a patient's skeletal
structure with one embodiment of the presently disclosed surgical
access device of the presently disclosed surgical access assembly
of FIGS. 1 and 2 positioned within the intercostal space defined
between adjacent ribs;
[0029] FIG. 4 is an enlarged, perspective view of the surgical
access device of FIG. 1 shown in the open configuration;
[0030] FIG. 5 is an enlarged, perspective view of the distal end of
the surgical access assembly of FIGS. 1 and 2;
[0031] FIG. 6 is an enlarged, perspective view of the distal end of
the surgical access assembly of FIGS. 1 and 2 shown in the closed
configuration;
[0032] FIG. 7 is an enlarged, partial perspective view of the
surgical access device of FIG. 4 shown disposed between open and
closed configurations;
[0033] FIG. 8 is a side, cross-sectional view of the insertion
device of the surgical access assembly of FIGS. 1 and 2, the
insertion device shown in the closed configuration;
[0034] FIG. 9 is an enlarged, side, cross-sectional view of the
distal end of the insertion device of the surgical access assembly
of FIGS. 1 and 2, the distal end of the insertion device shown in
the closed configuration;
[0035] FIGS. 10-12 are progressive views of the insertion device of
the presently disclosed surgical access assemblies showing the
insertion device being repositioned between open and closed
configurations;
[0036] FIG. 13 is a perspective view of another embodiment of the
surgical access device in accordance with the present
disclosure;
[0037] FIG. 14 is a perspective view of the base of the surgical
access device of FIG. 13;
[0038] FIG. 15 is a perspective view of the body of the surgical
access device of FIG. 13;
[0039] FIG. 16 is a front illustrative view of the surgical access
device of FIG. 13 shown in the closed configuration;
[0040] FIG. 17 is front illustrative view of the surgical access
device of FIG. 13 shown in the open configuration; and
[0041] FIG. 18 is a front, perspective view, in partial
cross-section of another embodiment of the surgical access device
in accordance with the present disclosure.
DETAILED DESCRIPTION OF THE EMBODIMENTS
[0042] Various embodiments of the presently disclosed access
assembly, and methods of using the same, will now be described in
detail with reference to the drawings wherein like references
numerals identify similar or identical elements. In the drawings,
and in the following description, the term "proximal" should be
understood as referring to the end of the access assembly, or
component thereof, that is closer to the clinician during proper
use, while the term "distal" should be understood as referring to
the end that is farther from the clinician, as is traditional and
conventional in the art. Additionally, use of the term "tissue"
herein below should be understood to encompass both the patient's
ribs, and any surrounding tissues. It should also be understood
that the term "minimally invasive procedure" is intended to include
surgical procedures through small openings/incisions performed
within a confined space such as the thoracic cavity or abdominal
cavity.
[0043] Referring now to the drawings, FIGS. 1-12 illustrate one
embodiment of the presently disclosed surgical access assembly that
is generally referred to by reference numeral 10, in use for a
minimally invasive thoracic surgical procedure. The various
components of the surgical access assembly 10 may be formed from
any suitable biocompatible material, including, but not limited to,
polymeric materials. With particular reference to FIGS. 1-2, the
surgical access assembly 10 includes a surgical access device 100
and an insertion device 200. The surgical access device (access
port) 100 is depicted as a thoracic access device configured and
dimensioned for insertion by the insertion device 200 into the
intercostal space "S" (FIG. 3), thereby providing on access port
for the insertion of one or more surgical instruments (not shown)
therethrough for manipulation within the thoracic cavity "T" (FIG.
3). The intercostal space "S" is located between a patient's
adjacent ribs "R" through an opening or incision in tissue. A
membrane (not shown in FIGS. 1 and 2) as described below preferably
also forms part of the access device 100.
[0044] With reference to FIGS. 4-7, the surgical access device 100
includes a body 102 that includes a first member 110 and a second
member 120. The first member 110 includes a top surface 110a, a
bottom surface 110b, a leading end (or outer end or edge) 110c, and
a trailing end (or inner end or edge) 110d. The second member 120
includes a top surface 120a, a bottom surface 120b, a leading end
(or outer end or edge) 120c, and a trailing end (or inner end or
edge) 120d. The first and second members 110, 120 are each movable
between open (FIGS. 4 and 5) and closed (FIG. 6) configurations and
are positionable within the opening in tissue to provide access to
the intercostal space "S" (FIG. 3) defined between a patient's
adjacent ribs "R" (FIG. 3). As best shown by the arrows "A" and "B"
in FIGS. 4-6, one or both of the first and second members 110, 120
may rotate as the first and second members 110, 120 move between
the open and closed configurations. For example, each of the first
and second members 110, 120 may rotate from between about 45
degrees to about 135 degrees between the open and closed
configurations. Other degrees of rotation are also contemplated. As
illustrated in FIGS. 5 and 6, each of the first and second members
110, 120 are shown rotating about 90 degrees between the open and
closed configurations. The first and second members 110, 120 define
a passage 130 therethrough when positioned in the open
configuration. The passage 130 is dimensioned to permit access to
the intercostal space "S" (FIG. 3) for passage of one or more
surgical instruments into an internal work site of a thoracic
cavity "T" (FIG. 3). As best shown in FIG. 4, the passage 130 may
be substantially rectangular with rounded sides (or considered as
substantially elliptical with two substantially parallel straight
sides), and define a place including a major axis "M" and a minor
axis "N." The passageway can also be of other shapes.
[0045] In the open configuration (FIGS. 4 and 5), the leading ends
110c, 120c are in substantially spaced relation across the major
axis "M" at spaced positions along minor axis "N" as they form
outer ends of the device 100. The trailing ends 110d, 120d are in
substantial abutting mirrored relation across the major axis "M"
and at close proximal positions along minor axis "N" as the inner
edges are adjacent. Also in the open configuration, the leading
ends 110c, 120c and the trailing ends 110d, 120d are substantially
in the same plane, e.g., substantially similarly longitudinally
positioned along longitudinal axis "L." In the closed configuration
(FIG. 6), the leading ends 110c, 120c and the trailing ends 110d,
120d are in closer proximity and preferably in substantial abutting
relation across the major axis "M" and in close proximal positions
along minor axis "N." In addition, the leading ends 110c, 120c are
at spaced longitudinal positions relative to the trailing ends
110d, 120d along the longitudinal axis "L" in the closed
configuration. Thus, as can be appreciated leading ends 110c, 120c
are on the exterior sides of the access device 100 in the open
configuration shown in FIG. 4 and are moved adjacent one another in
the closed configuration of FIG. 6.
[0046] With continued reference to FIG. 4, the first member 110 may
include one or more flaps 112 extending into the passage 130 and
the second member 120 may include one or more flaps 122 extending
into the passage 130. The flaps 112, 122 may be positioned relative
adjacent ribs "R" (FIG. 3). Note that during the surgical
procedure, surgical tools might be inserted through the access port
and torque applied can result in pressure on and damage to tissues
including nerves running along the ribs. The flaps 112, 122 are
designed to spread point loads and thus reduce such trauma to the
tissue during the procedure.
[0047] Referring again to FIGS. 4-6, in the open configuration, the
leading ends 110c, 120c of the first and second members 110, 120
are diametrically opposed and the top and the bottom surfaces 110a,
110b of the first member 110 are substantially aligned with the top
and bottom surfaces 120a, 120b of the second member 120 along an
axis substantially transverse to a central axis "X" defined through
the passage 130. As best shown in FIG. 5, the central axis "X" may
be substantially aligned with a longitudinal axis "L" of the
insertion device 200. The trailing ends 110d, 120d are positioned
in close cooperative alignment when the first and second members
110, 120 are in the open configuration. In the closed (e.g. folded
or collapsed) configuration, the leading and trailing ends 110c,
110d of the first member 110 are substantially aligned with the
leading and trailing ends 120c, 120d of the second member 120 and
the bottom surfaces 110b, 120b of the first and second members 110,
120 are disposed in substantially mirrored relation. The top
surfaces 110a, 120d are positioned in close cooperative alignment
when the first and second members 110, 120 are in the closed
configuration. That is, as the device 10 is folded, the top
surfaces 110a, 120d are folded toward each other to the position of
FIG. 6, where the leading ends 110c, 120c are moved adjacent one
another. Bottom surfaces 120, 120b then form the outer sides of the
device 100.
[0048] With continued reference to FIG. 4, the first member 110
defines one or more apertures 114 and the second member 120 defines
one or more apertures 124. The apertures 114, 124 are dimensioned
to facilitate the positioning of the first and the second members
110, 120 into the open configuration. The aperture 114 includes a
first portion 114a and a second portion 114b. Similarly, the
aperture 124 includes a first portion 124a and a second portion
124b. The first portions 114a, 124a are smaller than the second
portions 114b, 126a.
[0049] The first member 110 includes a surface feature 116 defined
therealong. The surface feature 116 may include one or more tapered
portions 116a. Similarly, the second member 120 includes a surface
feature 126 defined therealong. The surface feature 126 may include
one or more tapered portions 126a. The surface features 116, 126
are in contact with each other when the first and second members
110, 120 are in the closed configuration. The tapered portions
116a, 126a of the first and second members 110, 120 may have
complementary mating surfaces with at least a portion of the
surface feature 116, 126 of the other respective member 110, 120.
In this manner, the tapered portions 116a, 126 enable the surface
features 116, 126 to engage each other in close cooperative
alignment.
[0050] As best shown in FIG. 7, a first arm 118 extends from the
first member 110. A second arm 128 extends from the second member
120. The first arm 118 defines a channel 118a dimensioned to
receive the second arm 128 such that the first arm 118 and the
second arm 128 are engaged in close geometric fit when the first
and second members 110, 120 are positioned in the open
configuration so that the first and second members 110, 120 are
secured in the open configuration. One or more cords 140 may be
secured to one or both of the first arm 118 and the second arm 128.
When the first and second members 110, 120 are secured in the open
configuration, the one or more cords 140 are actuable, upon the
application of a predetermined amount of force, to disengage the
first and second arms 118, 128 from the close geometric fit so that
the first and second members 110, 120 are no longer secured in the
open configuration. An opening 118b may be defined within one or
more of the first arm 118 and the second arm 128 through which the
one or more cords 140 may be secured.
[0051] Referring now to FIGS. 8-12, the insertion device 200, which
may be disposable, includes a housing 202 having a shaft 204
extending from the housing 202 and a movable assembly 210 at a
distal end of shaft 204. A lumen 201 is defined through the housing
202 and the shaft 204. One or more movable elements 210a, 210b
extend from a distal end of the shaft 204 and are pivotally coupled
to the distal end thereof via pins 203. In particular, first and
second movable elements 210a, 210b may be secured on opposed ends
of the distal end of the shaft 204 via pins 203a, 203b so that they
pivot in opposite directions. An actuator 206 is operably coupled
to the movable elements 210a, 210b and is operable to move the
movable elements 210a, 210b between first and second positions. As
best illustrated in FIG. 9, the distal end of the actuator 206 may
be pivotally connected via pin 203c to extensions 211 extending
from each respective movable element 210a, 210b. Extension 211a of
first movable element 210d enables the first movable element 210d
to rotate about both pins 203a and pin 203c when the actuator 206
is longitudinally translated. Similarly, the extension (not shown
but identical to extension 211a and disposed on the opposed side in
substantially mirrored relation) of second movable element 210b
enables the second movable element 210b to rotate about both pins
203b and pin 203c when the actuator 206 is longitudinally
translated. In this respect, each of the extensions 211 of the
first and second movable elements 210a, 210b pivots and
longitudinally translates, simultaneously, in response to the
longitudinal actuation of the actuator 206. In addition, both the
extensions 211 of the first and second movable elements 210a, 210b
also simultaneously longitudinally translate with respect to each
other; however, each movable element 210a, 210b pivots in opposed
direction about pin 203c with respect to the other, as discussed
above. Specifically, movable elements 210a, 210b pivot away from
one another when being positioned in an open configuration and away
from one another when being positioned in a closed
configuration.
[0052] Referring now to FIGS. 4 and 10-12, the movable elements
210a, 210b are substantially aligned with a longitudinal axis "L"
of the insertion device 200 in the first position and substantially
aligned with an axis "Z" that is transverse to the longitudinal
axis "L" of the insertion device 200 in the second position. The
movable elements 210a, 210b of the insertion device 200 are
releasably engagable with one or both of the first and second
members 110, 120 of the surgical access device 100 such that
movement of the movable elements 210a, 210b between the first and
second positions repositions the first and second members 110, 120
of the surgical access device 100 between open and closed
configurations when the movable elements 210a, 210b) are engaged
with one or both of the first and second members 110, 120 of the
surgical access device 100. As best shown in FIG. 5, when the
movable elements 210a, 210b are positioned in the second position,
the movable elements 210a, 210b are prevented from crossing the
plane defined by the substantially elliptical passage 130 of the
surgical access device 100 when the movable elements 210a, 210b are
not substantially aligned with the major axis "M" (FIG. 4) defined
by the substantially elliptical passage 130 of the surgical access
device 100.
[0053] With reference to FIGS. 4-5, the movable elements 210a, 210b
of the insertion device 200 include one or more protuberances 212
extending therefrom. The apertures 114, 124 of the surgical access
device 100 and the protuberances 212 of the insertion device 200
are engagable. The protuberances 212 are dimensioned to engage the
smaller first portions 114a, 124a of the apertures 114, 124 in a
tight geometric fit and the larger second portions 114b, 124b in a
loose geometric fit such that the one or more protuberances 212
remain substantially secured to the first portions 114a, 124a of
the apertures 114, 124 when engaged therewith and are substantially
freely movable relative to the second portions 114b, 124b of the
apertures 114, 124 when engaged therewith.
[0054] With reference now to FIGS. 13-17, an alternative embodiment
of the presently disclosed surgical access device will be
discussed. The embodiment disclosed herein below is similar to the
surgical access device 100 discussed above, and accordingly, will
only be discussed to the extent necessary to describe the
differences in structure and operation thereof.
[0055] FIG. 13 illustrates an embodiment of the presently disclosed
surgical access device that is identified by the reference numeral
300. The surgical access device 300 includes a base 310 and a body
320 operably couplable to the base 310. As best shown in FIG. 14,
the base 310 includes a support 312, a first wing 314a, and a
second wing 314b. The first and second wings 314a, 314b are
substantially identical and are secured to opposite ends of the
support 312. The first and second wings 314a, 314b each include a
planar surface 315 on which the body 320 is positioned. The support
312 defines a passage 312a that is substantially elliptical and
defines a major axis "M" and a minor axis "N." The first and second
wings 314a, 314b each include first and second elements 316a, 316b.
The first and second elements 316a, 316b are pivotable between a
folded condition, where the first and second elements 316a, 316b
are substantially aligned with a central axis "C" defined through
the passage 312a, and an unfolded condition, where the first and
second elements 316a, 316b are substantially aligned with minor
axis "N," which is transverse to the central axis "C." The first
and second elements 316a, 316b each define a contoured surface
318a, 318b. The contoured surfaces 318a, 318b are dimensioned to
engage complimentary mating surfaces (not shown) defined on the
bottom surface of the body 320 of the surgical access device 300
such that pivoting, e.g. folding, of the first and second elements
316a, 316b folds the connected body 320 as described below.
[0056] Referring now to FIG. 15, the body 320 includes a first
member 322 and a second member 324. The first member 322 includes a
top surface 322a, a bottom surface 322b, a leading end 322c, and a
trailing end 322d. The second member 324 includes a top surface
324a, a bottom surface 324b, a leading end 324c, and a trailing end
324d. The first and second members 322, 324 are each movable
between (open) unfolded (FIG. 17) and (closed) folded (FIG. 16)
configurations and are positionable within the opening in tissue to
provide access to the intercostal space "T" (FIG. 3) defined
between a patient's adjacent ribs "R." One or both of the first and
second members 322, 324 may rotate as the first and second members
322, 324 move between the unfolded and folded configurations. As
illustrated in FIGS. 16-17, each of the first and second members
322, 324 are shown rotating about 90 degrees between the unfolded
and folded configurations, although other degrees of rotation are
also contemplated. As best shown in FIG. 13, the first and second
members 322, 324 define a passage 330 therethrough when positioned
in the unfolded configuration. The passage 330 is substantially
aligned with the passage 312a when the first and second members
322, 324 are in the unfolded configuration so that passages 312a
and 330 are dimensioned to permit access to the intercostal space
"T" (FIG. 3) for passage of one or more surgical instruments into
an internal work site. Each passage 312a and 330 may be
substantially rectangular with rounded ends and define a plane
including a major axis "M" and a minor axis "N." Each of the
passages 312a, 330 are substantially similar to passage 130
discussed above. Other shapes of the passage are also
contemplated.
[0057] The access device 300 can be composed of several components
to facilitate the use of different material properties in different
areas of the device 300. Since the base 310 is designed to flex it
can be made of a material such as polypropylene. Since body 320 is
attached, e.g. welded or bonded, to a membrane, it is composed of a
material that is compatible with the material of the membrane. It
is also envisioned that various molding techniques can be utilized
to manufacture device 300 to allow different materials to be used
in different regions of a component.
[0058] In the open configuration (FIG. 17), the leading ends (or
outer ends) 322c, 324c are in substantially spaced relation across
the major axis "M" at spaced positions along minor axis "N" and the
trailing ends (or inner ends) 322d, 324d are in adjacent (or in
some embodiments abutting) mirrored relation across the major axis
"M" and at close proximal positions along minor axis "N." Also, in
the open configuration, the leading ends 322c, 324c and the
trailing ends 322d, 324d are substantially in the same plane, e.g.,
substantially similarly longitudinally positioned along
longitudinal axis "L." In the closed configuration (FIG. 16), the
leading ends 322c, 324c and the trailing ends 322d, 324d are in
substantial mirrored relation across the major axis "M" and in
close proximal positions along minor axis "N." In addition, the
leading ends 322c, 324c are at spaced longitudinal positions
relative to the trailing ends 322d, 324d along the longitudinal
axis "L" in the closed configuration.
[0059] With reference now to FIG. 18, another alternative
embodiment of the presently disclosed surgical access device will
be discussed. The embodiment disclosed herein below is similar to
the surgical access device 100 discussed above, and accordingly,
will only be discussed to the extent necessary to describe the
differences in structure and operation thereof.
[0060] FIG. 18 illustrates another embodiment of the presently
disclosed surgical access device that is identified by the
reference numeral 400. Surgical access device 400 includes a
membrane assembly 410 extending from body 102', which is identical
to body 102 of FIG. 1 (except for the membrane attachment). Body
102' can be inserted into the patient using the insertion device
200 in the same manner body 102 is inserted. The membrane assembly
includes a flexible membrane 412 and a ring 414. The flexible
membrane 412 includes proximal and distal ends 412a, 412b. The
distal end 412b of the flexible member 412 may be coupled to and
extend proximally from the internally positioned body 102 of the
surgical access device 400. The flexible membrane 412 is generally
funnel shaped and protects and isolates tissue surrounding the
surgical access device 400 from the passage 130 extending
therethrough, thus reducing the risk of tissue damage and/or
infection during the surgical procedure. The flexible membrane 412
may be configured for soft tissue retraction and may be of
sufficient elasticity to permit retraction of a wide range of
tissue thicknesses since there may be a wide range of tissue
thicknesses among different patients. Furthermore, the flexible
membrane 412 is formed of a material of sufficient strength to
prevent accidental tearing and/or puncture by surgical
instrumentation inserted through the surgical access device 400.
Additionally, the flexible membrane 412 may be made from a
bio-compatible material to reduce the incidents of adverse reaction
by a patient upon contact with the patient's tissue. Flexible
membrane 412 may also be made of a transparent material to allow
the surgeon to better visualize the surgical site and surrounding
tissue.
[0061] The continuous ring 414 is coupled to the proximal end 412a
of flexible membrane 412 outside the patient. Ring 414 may be
disposed through a loop 416 formed at the proximal end 412a of
flexible membrane 412. Proximal end 412a of flexible membrane 412
may be folded back onto and adhered to flexible membrane 412 to
define loop 416 therebetween, or, alternatively, proximal end 412a
of flexible membrane 412 may be engaged to ring 414 via any other
suitable mechanism. Ring 414 may be made from a flexible or a
semi-rigid material. The ring 414 may be sufficiently rigid to
retain membrane 412 in an open, tensioned configuration, while
being somewhat flexible such that ring 414 may be rotated about a
circumference thereof to roll, or wind-up flexible membrane 412
therearound, as shown by arrows 420. Thus, as ring 414 is rotated
in the direction of arrows 420, membrane 412 is rolled-up around
ring 414 and tensioned, thereby flexing the surgical access device
400 further outwardly to retract tissue and/or to expand the
passage 130 extending through the surgical access device 400.
[0062] With continued reference to FIGS. 1-18, use and operation of
the presently disclosed surgical access assembly 10 will be
discussed during the course of a minimally invasive surgical
procedure. While the surgical access assembly 10 will be discussed
in the context of a thoracic procedure, it should be appreciated
that the following discussion of the surgical access assembly 10 is
applicable to other minimally invasive surgical procedures.
[0063] Initially, the opening is made in the outer tissue wall of
the thoracic cavity "T" (FIG. 3). Thereafter, if not already having
been coupled to one of the presently disclosed surgical access
devices, the insertion device 200 is coupled thereto. As best shown
in FIG. 5, the movable elements 210a, 210b of the insertion device
200 are coupled to one or both of the first and second members of
one of the presently disclosed surgical access devices. In this
manner, the protuberances 212 of the movable elements 210a, 210b
are positioned within the larger second portions 114b, 124b of the
apertures 114, 124. Then, the movable elements 210a, 210b of the
insertion device 200 are rotated so that the protuberances 212
couple with the smaller first portions 114a, 124a in close
geometric fit, whereby the protuberances 212 are substantially
secured to the first portions 114a, 124a. As such, the insertion
device 200 is enabled to reposition the surgical access device
between open (FIGS. 2, 13 and 17) and closed (FIGS. 1, 6 and 16)
configurations upon the actuation (e.g., longitudinal translation)
of the actuator 206. In the closed configuration, the surgical
access device is in an approximated position such that the surgical
access device assumes a reduced profile defining a smaller
transverse dimension than in the open configuration. The reduced
transverse dimension facilitates atraumatic insertion and removal
of the surgical access device.
[0064] With the insertion device 200 maintaining the surgical
access device in the closed configuration (FIGS. 1 and 6), the
clinician, with the insertion device 200, inserts the surgical
access device into the opening and positions the surgical access
device in the intercostal space between adjacent ribs "R" into
desired placement for providing the clinician access to the
thoracic cavity "T" (FIG. 3). Specifically, the insertion device
200, with reference to FIGS. 10-12, is actuated via the actuator
206 in order to reposition the surgical access device into the open
position so that the surgical access device may be positioned
between adjacent ribs "R."
[0065] With continued reference to FIGS. 10-12, when actuation is
desired, the clinician translates the actuator 206 in the distal
direction. The actuator 206 longitudinally translates so that each
movable element 210a, 210b moves from the closed configuration to
the open configuration, whereby the surgical access device coupled
thereto also moves from the closed configuration to the open
configuration. In order to secure the surgical access device in the
open configuration, the actuator 206 is translated to a distal-most
position. With particular regard to surgical access device 100, the
first and second arms 118, 128 of the first and second members 110,
120 engage in close geometric fit in order to maintain the surgical
access device 100 in the open configuration when positioned between
the adjacent ribs "R."
[0066] Referring now to FIG. 18, in embodiments that include the
membrane assembly 410, the flexible membrane 412 may be positioned
proximally of the opening so that it protects and isolates the
surrounding tissue. In addition, the flexible membrane 412 may be
tensioned, e.g., via the ring 414, by pulling the ring 414 or
rotating the membrane 412 about the ring 414, to realize the
desired positioning. In some embodiments, the ring 414 can be
expandable by sliding first and second ring components away from
each other to tension the membrane.
[0067] With reference again to FIG. 5, the insertion device 200 may
then be uncoupled from surgical access device in order to permit
removal of the insertion device 200. In particular, the one or more
movable elements 210a, 210b are rotated so that the protuberances
212 move into the second portions 114b, 124b, thereby enabling the
movable elements 210a, 210b to be uncoupled.
[0068] After uncoupling the movable elements 210a, 210b of the
insertion device 200 from the surgical access device, the insertion
device 200 can then be repositioned into the closed configuration
upon the proximal translation of the actuator 206 (FIG. 12). In the
closed configuration, the insertion device 200 assumes a reduced
profile defining a smaller transverse dimension than in the open
configuration. The reduced transverse dimension facilitates
atraumatic insertion and removal of the insertion device 200. Once
positioned in the closed configuration, the insertion device 200
may be atraumatically removed through the passage of one of the
presently disclosed surgical access devices.
[0069] After removal of the insertion device 200, the clinician
carries out the remainder of the surgical procedure by passing one
or more surgical instruments through the passage of one of the
presently disclosed surgical access devices. However, it should be
appreciated that some instruments may be passed through the passage
while the insertion device 200 is coupled to the surgical access
device.
[0070] The surgical instrument(s) inserted through one of the
presently disclosed surgical access devices may be any surgical
instrument(s) configured and dimensioned to pass through one of the
passages of the presently disclosed surgical access devices, and
adapted to perform a surgical, diagnostic, or other desired
procedure. For example, suitable surgical instruments may include
an endoscopic apparatus, which perform a variety of functions such
as the application of surgical clips or other such fasteners, the
cutting of body tissue, and/or specimen retrieval for removing an
internal tissue sample.
[0071] In order to facilitate passage of the surgical instrument(s)
into the thoracic cavity "T," and/or removal of the surgical
instrument(s) therefrom, it is envisioned that surgical
instrument(s), and or the insertion device 200, and/or any of the
presently disclosed surgical access devices, may be partially, or
entirely, coated with a biocompatible, lubricous material.
[0072] Following completed use of the surgical instrument(s), the
instrument(s) are withdrawn from the surgical access device. The
surgical access device may then be returned to the closed
configuration, via reinsertion and coupling of the insertion device
200 as described above. After coupling the insertion device 200 to
the surgical access device as described above, the actuator 206 is
then proximally translated so that one or more movable elements
210a, 210b reposition the surgical access device into the closed
configuration for facilitating removal of the surgical access
device from between the adjacent ribs "R." In this respect, the
reduced profile of the surgical access device in the closed
configuration allows for atraumatic removal of the surgical access
device from the intercostal space "S."
[0073] Alternatively, the surgical access device may be
repositioned into the closed configuration for removal upon the
application of a predetermined amount of force to the one or more
cords 140 as best illustrated in FIG. 7. The one or more cords 140
impart a force upon the surgical access device that enables the
surgical access device to approximate the closed configuration for
facilitating removal of the surgical access device from the
intercostal space "S." With particular regard to the surgical
access device 100, the predetermined force causes the first and
second arms 118, 128 to become disengaged, thereby enabling the
first and second members 110, 120 to be repositioned such that they
approximate towards the closed configuration for facilitating
removal of the surgical access assembly 100 from between the
adjacent ribs "R." In this respect, the reduced profile of the
surgical access device 100 in the closed configuration allows for
atraumatic removal of the surgical access device 100 from the
intercostal space "S."
[0074] Persons skilled in the art will understand that the
structures and methods specifically described herein and
illustrated in the accompanying figures are non-limiting exemplary
embodiments, and that the description, disclosure, and figures
should be construed merely exemplary of particular embodiments. It
is to be understood, therefore, that the present disclosure is not
limited to the precise embodiments described, and that various
other changes and modifications may be effected by one skilled in
the art without departing from the scope or spirit of the
disclosure. Additionally, it is envisioned that the elements and
features illustrated or described in connection with one exemplary
embodiment may be combined with the elements and features of
another without departing from the scope of the present disclosure,
and that such modifications and variations are also intended to be
included within the scope of the present disclosure. Accordingly,
the subject matter of the present disclosure is not to be limited
by what has been particularly shown and described.
* * * * *