U.S. patent application number 15/866973 was filed with the patent office on 2018-07-19 for apparatus for inserting a surgical device at least partially through a wound opening.
This patent application is currently assigned to ATROPOS LIMITED. The applicant listed for this patent is ATROPOS LIMITED. Invention is credited to Frank BONADIO, John BUTLER, Catherine DEEGAN, Shane J. MacNALLY, Trevor VAUGH.
Application Number | 20180199929 15/866973 |
Document ID | / |
Family ID | 36130174 |
Filed Date | 2018-07-19 |
United States Patent
Application |
20180199929 |
Kind Code |
A1 |
BUTLER; John ; et
al. |
July 19, 2018 |
APPARATUS FOR INSERTING A SURGICAL DEVICE AT LEAST PARTIALLY
THROUGH A WOUND OPENING
Abstract
An apparatus (650) for inserting a distal ring (9) of a wound
retractor device (2) through a wound opening comprises a bladeless
tip (641) for creating the wound opening by forcing tissue apart,
and a conveying device (5) for conveying the distal ring (9)
through the wound opening. The conveying device (5) comprises a
hook element (6) for engaging the distal ring (9) to convey the
distal ring (9) through the wound opening, and a receiver housing
(651) for receiving a seal (652) and a proximal ring (653) of the
wound retractor device (2) to hold the seal (652) and the proximal
ring (653) externally of the wound opening, and thus maintain a
sleeve portion of the wound retractor device (2) in tension, during
conveying of the distal ring (9) through the wound opening.
Inventors: |
BUTLER; John; (County Mayo,
IE) ; VAUGH; Trevor; (County Offaly, IE) ;
BONADIO; Frank; (County Wicklow, IE) ; DEEGAN;
Catherine; (Dublin, IE) ; MacNALLY; Shane J.;
(County Wicklow, IE) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
ATROPOS LIMITED |
County Wicklow |
|
IE |
|
|
Assignee: |
ATROPOS LIMITED
County Wicklow
IE
|
Family ID: |
36130174 |
Appl. No.: |
15/866973 |
Filed: |
January 10, 2018 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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15076086 |
Mar 21, 2016 |
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15866973 |
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13894172 |
May 14, 2013 |
9301808 |
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15076086 |
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11347803 |
Feb 6, 2006 |
8465494 |
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13894172 |
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60650197 |
Feb 4, 2005 |
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60724775 |
Oct 11, 2005 |
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60740634 |
Nov 30, 2005 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 17/3476 20130101;
A61B 2017/320044 20130101; A61B 18/1487 20130101; A61B 17/3431
20130101; A61B 2090/08021 20160201; A61B 2017/3443 20130101; A61B
2017/3484 20130101; A61B 17/29 20130101; A61B 17/3415 20130101;
A61B 17/0218 20130101; A61B 18/04 20130101; A61B 2017/06042
20130101; A61B 17/3423 20130101; A61B 2017/00353 20130101; A61B
17/0293 20130101; A61B 17/3417 20130101; A61B 2017/00473 20130101;
A61B 2090/036 20160201; A61B 17/06109 20130101; A61B 17/3421
20130101; A61B 2017/0225 20130101; A61B 2017/3492 20130101; A61B
34/70 20160201; A61B 17/3496 20130101; A61B 17/32093 20130101; A61B
17/3468 20130101 |
International
Class: |
A61B 17/02 20060101
A61B017/02; A61B 17/34 20060101 A61B017/34; A61B 17/06 20060101
A61B017/06; A61B 34/00 20160101 A61B034/00 |
Claims
1-171. (canceled)
172. A kit for retracting a wound opening, the kit comprising: a
wound retractor including: a proximal ring, a distal ring, and a
retracting sleeve extending between the proximal ring and the
distal ring for engaging the wound opening; and an introducer
including a holder and a movable member, the holder including a
distal portion having a distal opening, and the movable member
coupled to the holder and movable relative to the holder between a
retracted position and an extended position, wherein when the
introducer is in use with the wound retractor, with the movable
member in the retracted position, a sidewall of the distal portion
of the holder extends about a chamber for receiving the distal
ring, and moving the movable member distally to the extended
position exerts a force on the distal ring for ejecting the distal
ring from the chamber.
173. The kit of claim 172, wherein the chamber includes a proximal
end and a distal end, and the movable member includes a
distal-facing surface, and wherein the distal-facing surface
defines the proximal end in the retracted position of the movable
member.
174. The kit of claim 173, wherein the distal-facing surface is at
the distal end of the chamber in the extended position of the
movable member.
175. The kit of claim 173, wherein a width of the chamber is less
than a diameter of the distal ring, such that the distal ring is
compressed by the sidewall of the distal portion of the holder when
received in the chamber.
176. The kit of claim 172, wherein at least a portion of the
movable member has a cross-sectional shape complementary to a
cross-sectional shape of the chamber.
177. The kit of claim 172, wherein a distal portion of the
retracting sleeve is coupled to the distal ring, and in the
retracted position of the movable member, when the introducer is in
use with the wound retractor, the chamber receives the distal
portion of the retracting sleeve and the distal ring.
178. The kit of claim 177, wherein the holder includes an opening
through the sidewall for receiving the distal portion of the
retracting sleeve.
179. A kit for retracting a wound opening, the kit comprising: a
wound retractor including: a proximal ring, a distal ring, and a
retracting sleeve extending between the proximal ring and the
distal ring for engaging the wound opening; and an introducer
including a holder and a movable member, the holder including a
distal portion, the distal portion including: a distal opening, a
sidewall surrounding the distal opening, the sidewall defining a
chamber for receiving the distal ring, and the chamber having an
oval cross-sectional shape, and the movable member coupled to the
holder and movable relative to the holder between a retracted
position and an extended position, wherein in the retracted
position, the chamber is configured to receive the distal ring, and
in the extended position, the chamber is configured to receive the
movable member.
180. The kit of claim 179, wherein the distal portion of the holder
includes a slot in the sidewall.
181. The kit of claim 180, wherein in the retracted position of the
movable member, when the introducer is in use with the wound
retractor, the slot receives a distal portion of the retracting
sleeve, and the chamber receives the distal portion of the
retracting sleeve and the distal ring.
182. The kit of claim 179, wherein the oval-cross-sectional shape
has a diameter less than a diameter of the distal ring, such that
the distal ring is compressed by the sidewall when received in the
chamber.
183. The kit of claim 179, wherein at least a portion of the
movable member has a cross-sectional shape complementary to the
oval cross-sectional shape of the chamber.
184. The kit of claim 179, wherein the chamber includes a proximal
end and a distal end, and the movable member includes a
distal-facing surface, wherein the distal-facing surface defines
the proximal end of the chamber in the retracted position of the
movable member.
185. The kit of claim 184, wherein the distal-facing surface of the
movable member is at the distal end of the chamber in the extended
position of the movable member.
186. A kit for retracting a wound opening, the kit comprising: a
surgical device for insertion into the wound opening; and a holder
including: a distal portion having a distal opening, and a sidewall
extending proximally from the distal portion of the holder; a
movable member coupled to the holder and movable relative to the
holder between a retracted position and an extended position, the
movable member including a shaft having a distal-facing surface,
wherein retracting the movable member until the movable member
abuts a distal-facing surface of the holder places the movable
member in the retracted position, in which a portion of the
sidewall distal to the distal-facing surface defines a chamber for
receiving the surgical device via the distal opening, and wherein
extending the movable member until the movable member abuts a
proximal-facing surface of the holder places the movable member in
the extended position, and during extension of the movable member
the shaft fills the chamber as the distal-facing surface moves
toward the distal opening for deploying the surgical device from
the distal opening.
187. The kit of claim 186, wherein at least a portion of the
movable member has a cross-sectional shape complementary to a
cross-sectional shape of the chamber.
188. The kit of claim 186, wherein the holder includes a slot in
the sidewall, and the distal-facing surface of the holder is at a
proximal end portion of the slot.
189. The kit of claim 188, wherein the movable member includes a
projection projecting from a lateral surface of the movable member,
and the projection extends into the slot for selectively engaging
the distal-facing surface of the holder.
190. The kit of claim 186 wherein a width dimension of the chamber
is greater than a height dimension of the chamber.
191. The kit of claim 190, wherein the chamber has an oval
cross-sectional shape.
Description
INTRODUCTION
[0001] This invention relates to an apparatus for inserting a
surgical device at least partially through a wound opening, and to
a method of inserting the surgical device at least partially
through the wound opening.
STATEMENTS OF INVENTION
[0002] According to the invention there is provided an apparatus
for inserting a surgical device at least partially through a wound
opening, the apparatus comprising:-- [0003] a conveying device
insertable at least partially through a wound opening to convey a
surgical device at least partially through the wound opening.
[0004] In one embodiment of the invention the conveying device is
configured to engage a surgical device to couple the surgical
device to the conveying device. The conveying device may comprise a
hook element to engage a surgical device. A concave portion of the
hook element may face distally. The hook element may be provided in
the region of a distal end of the conveying device. The conveying
device may comprise a body portion, and the hook element may be
movable relative to the body portion.
[0005] In one embodiment the conveying device comprises a retaining
element to retain a surgical device in engagement with the
conveying device. The conveying device may comprise a passageway to
facilitate location of a surgical device in engagement with the
conveying device. The passageway may facilitate location of at
least part of a surgical device in the concave portion of the hook
element. The retaining element may be configured to selectively
obstruct at least part of the passageway.
[0006] In one case the retaining element is movable between an
obstructing configuration obstructing at least part of the
passageway and a passage configuration facilitating passage of a
surgical device through the passageway. The retaining element may
be pivotably movable between the obstructing configuration and the
passage configuration. The retaining element may be biased towards
the obstructing configuration. The retaining element may comprise a
resilient arm. The conveying device may comprise a control element
to control movement of the retaining element between the
obstructing configuration and the passage configuration.
[0007] In one embodiment the apparatus is configured to insert a
surgical device at least partially through a wound opening with at
least part of the surgical device in a low-profile configuration.
The apparatus may comprise a holder element for holding at least
part of a surgical device in a low-profile configuration. The
holder element may be movable relative to the conveying device
between a holding configuration in which at least part of a
surgical device is held in a low-profile configuration and a
release configuration in which the surgical device is released. The
holder element may be mounted to the conveying device. The holder
element may be concentrically mounted around the conveying
device.
[0008] In one case the apparatus is configured to hold a first part
of a surgical device externally of a wound opening during conveying
of a second part of the surgical device through the wound opening.
The apparatus may be configured to maintain part of a surgical
device in tension. The apparatus may comprise a receiver portion
for receiving a first part of a surgical device to hold the first
part. The receiver portion may comprise a slot. The receiver
portion may comprise a housing portion. The receiver portion may be
provided at a proximal end of the conveying device.
[0009] In another embodiment the conveying device comprises a
housing portion for receiving at least part of a surgical device to
couple the surgical device to the conveying device. The housing
portion may have an exit opening to facilitate ejection of at least
part of a surgical device from within the housing portion. The
housing portion may have an entry opening to facilitate insertion
of at least part of a surgical device into the housing portion. The
housing portion may have an opening which acts as both the exit
opening and the entry opening. The exit opening and/or the entry
opening may be provided at a distal end of the housing portion. The
exit opening and/or the entry opening may face distally.
[0010] The exit opening and/or the entry opening may be provided
along at least part of a sidewall of the housing portion. In one
case the exit opening and/or the entry opening faces laterally.
[0011] In one case the apparatus comprises a closure element to
selectively close the exit opening and/or the entry opening.
[0012] The housing portion may have a sleeve opening to facilitate
a part of a surgical device extending out of the housing portion.
The sleeve opening may be provided along at least part of the
sidewall of the housing portion. The sleeve opening may face
laterally.
[0013] In one case the housing portion has an opening which acts as
both the sleeve opening and the exit opening. The housing portion
may have an opening which acts as both the sleeve opening and the
entry opening.
[0014] In a further case the conveying device comprises an ejector
element to assist ejection of at least part of a surgical device
from within the housing portion. The ejector element may comprise a
plunger.
[0015] The housing portion may be substantially non-circular in
cross-section. The housing portion may be substantially oval-shaped
in cross-section.
[0016] In another embodiment the conveying device comprises an
insertion element insertable at least partially through a wound
opening and a drawing element to couple a surgical device to the
insertion element for drawing of the surgical device at least
partially through the wound opening. The drawing element may be
substantially flexible. The drawing element may comprise a length
of string. The insertion element may have an opening through which
the drawing element extends to couple the drawing element to the
insertion element. The opening may be provided in the region of a
distal end of the insertion element.
[0017] The conveying device may be configured to convey a surgical
device arranged concentrically with respect to a longitudinal axis
of the conveying device. The conveying device may be configured to
convey a surgical device arranged offset with respect to a
longitudinal axis of the conveying device.
[0018] In one case the conveying device has a wound extending
portion with a maximum transverse dimension of between 3 mm and 35
mm. The maximum transverse dimension of the wound extending portion
may be between 5 mm and 12 mm.
[0019] In one case a distal end of the conveying device is
substantially blunt. In another case a distal end of the conveying
device is substantially rounded.
[0020] In one embodiment the apparatus comprises an opening device
to create a' wound opening.
[0021] The opening device may comprise an incising device. The
incising device may be configured to create a wound opening by
cutting tissue. The incising device may comprise a substantially
sharp tip. The incising device may comprise a blade element. The
incising device may comprise an electrocautery scalpel.
[0022] The opening device may be configured to create a wound
opening by forcing tissue apart. The opening device may comprise a
substantially blunt tip. The opening device may comprise a
substantially bladeless tip.
[0023] The opening device may be mounted to the conveying device.
The conveying device may comprise a lumen extending therethrough
and the opening device may be extendable through the lumen to mount
the opening device to the conveying device. The opening device may
be mounted substantially concentrically with respect to a
longitudinal axis of the conveying device.
[0024] The opening device may be attached to the conveying device.
In one case the opening device is releasably attached to the
conveying device. The apparatus may be configured to create a wound
opening and convey a surgical device at least partially through the
wound opening in a single step.
[0025] The opening device may be provided at a distal end of the
conveying device.
[0026] In one case the opening device is movable relative to the
conveying device between an extended configuration and a retracted
configuration. The opening device may be manually movable relative
to the conveying device between the extended configuration and the
retracted configuration. The opening device may comprise a handle
portion to facilitate manual movement of the opening device. The
opening device may be biased towards the retracted configuration.
The opening device may be biased towards the extended
configuration.
[0027] In another case the opening device is detached from the
conveying device.
[0028] The apparatus may be configured to create a wound opening in
an opening step and to convey a surgical device at least partially
through the wound opening in a separate conveying step. In one
embodiment the conveying device is configured to be inserted at
least partially through a wound opening after the opening device
has been removed from the wound opening. In another embodiment the
conveying device is configured to be inserted at least partially
through a wound opening while the opening device remains in
position extending through the wound opening. In the retracted
configuration a distal end of the opening device may be covered. In
the retracted configuration a distal end of the opening device may
be housed within the conveying device. The opening device may have
a wound extending portion with a substantially flattened
cross-section. The conveying device may have a wound extending
portion with a substantially flattened cross-section.
[0029] In a further embodiment the opening device comprises a
cutting element for creating a wound opening and a shield element
for shielding the cutting element. The shield element may be
movable relative to the cutting element between a cutting
configuration and a shielding configuration. The opening device may
be biased towards the shielding configuration. The opening device
may comprise a locking element to releasably lock the opening
device in the shielding configuration.
[0030] The cutting element may be fixed to the conveying device.
The shield element may be mounted to the conveying device. The
shield element may be concentrically mounted around the conveying
device.
[0031] In one case the opening device comprises a support element,
the cutting element being fixedly attached to the support element
and the shield element being movably attached to the support
element.
[0032] In another case the opening device comprises a support
element, the shield element being fixedly attached to the support
element and the cutting element being movably attached to the
support element.
[0033] In a further embodiment the opening device comprises a
cutting element for creating a wound opening and a support element,
the cutting element being releasably attached to the support
element.
[0034] In one case the apparatus comprises a limiting element to
limit the extent of passage of the opening device through tissue.
The limiting element may comprise an abutment member for abutting
an external surface of tissue adjacent a wound opening. The
limiting element may be mounted to the opening device. The position
of mounting of the limiting element on the opening device may be
adjustable.
[0035] The limiting element may be movable relative to the opening
device between a retracted configuration and an extended
configuration. The limiting element may be biased towards the
retracted configuration.
[0036] The opening device may have a wound extending portion with a
maximum transverse dimension of between 3 mm and 35 mm. The maximum
transverse dimension of the wound extending portion may be between
5 mm and 12 mm.
[0037] In another embodiment the apparatus comprises a guide device
insertable at least partially through a wound opening to maintain
the patency of the wound opening.
[0038] The guide device may be substantially flexible. The guide
device may comprise a length of string.
[0039] The guide device may be substantially rigid. In one case the
guide device is substantially tubular. The guide device may have a
substantially flattened, oblong cross-section. The guide device may
have a slot extending along a sidewall of the guide device.
[0040] The guide device may be mountable to the conveying device
and/or to the opening device.
[0041] The guide device may have a wound extending portion with a
maximum transverse dimension of between 3 mm and 35 mm. The maximum
transverse dimension of the wound extending portion may be between
5 mm and 12 mm.
[0042] In another case the apparatus comprises a removal device to
assist in removal of a surgical device from a wound opening. The
removal device may be detached from a surgical device. The removal
device may be configured to engage a surgical device to assist in
removal of the surgical device from a wound opening. The removal
device may be configured to engage a distal portion of a surgical
device.
[0043] The removal device may comprise a hook element to engage a
surgical device. A concave portion of the hook element may face
proximally. The hook element may be provided in the region of a
distal end of the removal device.
[0044] The removal device may comprise a gripping portion which may
be gripped.
[0045] In one case the removal device comprises a connector element
extendable at least partially through a wound opening. The
connector element may be substantially flexible. The connector
element may comprise a length of string.
[0046] The guide device and the removal device may be provided by a
single device.
[0047] In another aspect of the invention there is provided a
surgical assembly comprising:-- [0048] a surgical device; and
[0049] an apparatus of the invention for inserting the surgical
device at least partially through a wound opening.
[0050] The surgical device may comprise a wound retractor device.
The wound retractor device may comprise a distal retaining element
for location distally of a wound opening to retain the wound
retractor device in position retracting the wound opening.
[0051] In a further aspect, the invention provides a method of
inserting a surgical device at least partially through a wound
opening, the method comprising the steps of:-- [0052] providing a
surgical device; [0053] creating a wound opening; and [0054]
conveying the surgical device at least partially through the wound
opening.
[0055] The wound opening may be created and the surgical device may
be conveyed at least partially through the wound opening in a
single step.
[0056] In one embodiment the wound opening is created using an
opening device, and the surgical device is conveyed at least
partially through the wound opening using a conveying device. The
method may comprise the step of moving the opening device relative
to the conveying device between an extended configuration and a
retracted configuration. The opening device may be moved relative
to the conveying device from the extended configuration to the
retracted configuration after the wound opening has been created.
The opening device may be moved relative to the conveying device
from the extended configuration to the retracted configuration
before the surgical device has been conveyed fully through the
wound opening.
[0057] In one case the opening device is manually moved relative to
the conveying device between the extended configuration and the
retracted configuration. The opening device may be pulled
proximally relative to the conveying device from the extended
configuration to the retracted configuration. The opening device
may be moved relative to the conveying device from the extended
configuration to the retracted configuration by a biasing element.
The opening device may be moved while the conveying device remains
in a fixed position.
[0058] The wound opening may be created in an opening step and the
surgical device may be conveyed at least partially through the
wound opening in a separate conveying step. In one case the wound
opening is created using an opening device, and the surgical device
is conveyed at least partially through the wound opening after the
opening device has been removed from the wound opening. In another
case the wound opening is created using an opening device, and the
surgical device is conveyed at least partially through the wound
opening while the opening device remains in position extending
through the wound opening.
[0059] The surgical device may be conveyed at least partially
through the wound opening by engaging the surgical device and
pushing the surgical device distally. In one embodiment the method
comprises the step of retaining the surgical device in engagement
with a conveying device during the step of conveying at least
partially through the wound opening.
[0060] The surgical device may be conveyed at least partially
through the wound opening with at least part of the surgical device
in a low-profile configuration. The method may comprise the step of
holding at least part of the surgical device in the low-profile
configuration during the step of conveying at least partially
through the wound opening. The method may comprise the step of
releasing the surgical device after conveying at least partially
through the wound opening.
[0061] In one case the method comprises the step of holding a first
part of the surgical device externally of the wound opening during
conveying of a second part of the surgical device through the wound
opening. Part of the surgical device may be maintained in
tension.
[0062] The surgical device may be conveyed at least partially
through the wound opening with at least part of the surgical device
received in a housing portion of a conveying device. The method may
comprise the step of inserting at least part of the surgical device
into the housing portion before conveying at least partially
through the wound opening. The method may comprise the step of
ejecting at least part of the surgical device from within the
housing portion after conveying at least partially through the
wound opening.
[0063] The surgical device may be conveyed at least partially
through the wound opening by drawing the surgical device
distally.
[0064] In one case the wound opening is created by cutting tissue.
In another case the wound opening is created by forcing tissue
apart.
[0065] The wound opening may be created by advancing an opening
device substantially distally through tissue. The wound opening may
be created by rotating an opening device. The opening device may be
rotated about an axis substantially parallel to the longitudinal
axis of the wound opening.
[0066] In a further case the method comprises the steps of:--
[0067] providing a guide device; and [0068] inserting the guide
device at least partially through the wound opening to maintain the
patency of the wound opening.
[0069] The wound opening may be created using an opening device,
and the method may comprise the step of limiting the extent of
passage of the opening device through tissue.
[0070] The wound opening may be created using an opening device,
and the method may comprise the step of shielding a cutting element
of the opening device after the wound opening has been created. The
cutting element may be shielded before the surgical device has been
conveyed fully through the wound opening. The method may comprise
the step of exposing the cutting element to create the wound
opening.
[0071] In one case the method comprises the step of removing the
surgical device from the wound opening. The method may comprise the
step of engaging the surgical device to remove the surgical device
from the wound opening. A distal portion of the surgical device may
be engaged.
[0072] The maximum transverse dimension of the wound opening is
preferably between 3 mm and 35 mm. The maximum transverse dimension
of the wound opening may be between 5 mm and 12 mm.
[0073] The invention also provides in another aspect a guide device
insertable at least partially through a wound opening to maintain
the patency of the wound opening.
[0074] In another aspect the invention provides a removal device to
assist in removal of a surgical device from a wound opening.
[0075] According to another aspect the invention provides an
opening device comprising a cutting element for creating a wound
opening and a support element, the cutting element being releasably
attached to the support element.
[0076] In a further aspect the invention provides an opening device
to create a wound opening, the opening device comprising a limiting
element to limit the extent of passage of the opening device
through tissue.
[0077] According to another aspect the invention provides an
opening device comprising a cutting element for creating a wound
opening and a shield element for shielding the cutting element.
BRIEF DESCRIPTION OF THE DRAWINGS
[0078] The invention will be more clearly understood from the
following description of some embodiments thereof, given by way of
example only, with reference to the accompanying drawings, in
which:--
[0079] FIG. 1 is a side view of an apparatus for inserting a
surgical device at least partially through a wound opening
according to the invention;
[0080] FIG. 2 is an end view of the apparatus of FIG. 1;
[0081] FIGS. 3 to 5 are partially cross-sectional, side views of
the apparatus of FIG. 1, in use;
[0082] FIG. 6 is a side view of another apparatus for inserting a
surgical device at least partially through a wound opening
according to the invention;
[0083] FIGS. 7 to 9 are partially cross-sectional, side views of
the apparatus of FIG. 6, in use;
[0084] FIG. 10 is a side view of another apparatus for inserting a
surgical device at least partially through a wound opening
according to the invention and a surgical device;
[0085] FIG. 11 is a partially cut-away, side view of the apparatus
and surgical device of FIG. 10;
[0086] FIGS. 12 to 15 are partially cross-sectional, side views of
the apparatus of FIG. 10, in use;
[0087] FIGS. 16 to 21 are partially cross-sectional, side views of
another apparatus for inserting a surgical device at least
partially through a wound opening according to the invention, in
use;
[0088] FIGS. 21(a) to 21(f) are views similar to FIGS. 10 to 15 of
a further apparatus for inserting a surgical device at least
partially through a wound opening according to the invention;
[0089] FIG. 21(g) is a cross-sectional, side view of another
apparatus for inserting a surgical device at least partially
through a wound opening according to the invention;
[0090] FIGS. 21(h) to 21(k) are partially cross-sectional, side
views of the apparatus of FIG. 21(g), in use;
[0091] FIGS. 21(l) to 21(p) are views similar to FIGS. 21(g) to
21(k) of another apparatus for inserting a surgical device at least
partially through a wound opening according to the invention;
[0092] FIG. 21(q)(i) is a side view of another apparatus for
inserting a surgical device at least partially through a wound
opening according to the invention;
[0093] FIG. 21(q)(ii) is a perspective view of an opening device of
the apparatus of FIG. 21(q)(i);
[0094] FIGS. 21(r)(i) to 21(v)(ii) are views similar to FIGS.
21(q)(i) and 21(q)(ii) of further apparatus for inserting a
surgical device at least partially through a wound opening
according to the invention;
[0095] FIGS. 22 to 24 are partially cross-sectional, side views of
a further apparatus for inserting a surgical device at least
partially through a wound opening according to the invention, in
use;
[0096] FIG. 24(a) is an end view of another apparatus for inserting
a surgical device at least partially through a wound opening
according to the invention;
[0097] FIG. 24(b) is a side view of the apparatus of FIG.
24(a);
[0098] FIGS. 24(c) and 24(d) are views similar to FIGS. 24(a) and
24(b) of the apparatus of FIG. 24(a) and a surgical device;
[0099] FIGS. 24(e) to 24(j) are partially cut-away, perspective
views of the apparatus of FIG. 24(a), in use;
[0100] FIG. 24(k) is a perspective view of another apparatus for
inserting a surgical device at least partially through a wound
opening according to the invention;
[0101] FIGS. 24(l) and 24(m) are perspective views of the apparatus
of FIG. 24(k) and a surgical device;
[0102] FIGS. 25 to 30 are partially cross-sectional, side views of
another apparatus for inserting a surgical device at least
partially through a wound opening according to the invention, in
use;
[0103] FIGS. 31 to 36 are partially cross-sectional, side views of
another apparatus for inserting a surgical device at least
partially through a wound opening according to the invention, in
use;
[0104] FIGS. 37 to 43 are partially cross-sectional, side views of
a further apparatus for inserting a surgical device at least
partially through a wound opening according to the invention, in
use;
[0105] FIGS. 43(a) to 43(f) are partially cut-away, perspective
views of the apparatus of FIGS. 24(a) to 24(j), in use;
[0106] FIGS. 44 to 49 are partially cross-sectional, side views of
another apparatus for inserting a surgical device at least
partially through a wound opening according to the invention, in
use;
[0107] FIG. 50 is a perspective view of a guide device of another
apparatus for inserting a surgical device at least partially
through a wound opening according to the invention;
[0108] FIGS. 51 and 52 are perspective views of a guide device and
an incising device of another apparatus for inserting a surgical
device at least partially through a wound opening according to the
invention;
[0109] FIGS. 53 to 58 are perspective views of the apparatus, in
use;
[0110] FIGS. 58(a) to 58(d) are perspective views of another
apparatus for inserting a surgical device at least partially
through a wound opening according to the invention, in use;
[0111] FIGS. 58(e) to 58(h) are perspective views of another
apparatus for inserting a surgical device at least partially
through a wound opening according to the invention, in use;
[0112] FIGS. 58(i) to 58(n) are partially cut-away, perspective
views of another apparatus for inserting a surgical device at least
partially through a wound opening according to the invention, in
use;
[0113] FIGS. 59 to 61 are side views of incising devices of other
apparatus for inserting a surgical device at least partially
through a wound opening according to the invention;
[0114] FIGS. 62 and 63 are partially cross-sectional, side views of
the incising device of FIG. 61, in use;
[0115] FIGS. 64 and 65 are partially cross-sectional, side views of
another apparatus for inserting a surgical device at least
partially through a wound opening according to the invention, in
use;
[0116] FIG. 66 is a side view of an incising device of another
apparatus for inserting a surgical device at least partially
through a wound opening according to the invention;
[0117] FIGS. 67 and 68 are partially cross-sectional, side views of
the incising device of FIG. 66, in use;
[0118] FIG. 69 is a side view of a further apparatus for inserting
a surgical device at least partially through a wound opening
according to the invention;
[0119] FIG. 70 is an end view of the apparatus of FIG. 69;
[0120] FIG. 71 is a partially cross-sectional, side view of the
apparatus of FIG. 69 in an extended configuration;
[0121] FIG. 72 is a partially cross-sectional, side view of the
apparatus of FIG. 69 in a retracted configuration;
[0122] FIGS. 73 to 75 are partially cross-sectional, side views of
the apparatus of FIG. 69, in use;
[0123] FIGS. 75(a) and 75(b) are views similar to FIGS. 71 and 72
of another apparatus for inserting a surgical device at least
partially through a wound opening according to the invention;
[0124] FIGS. 75(c) to 75(g) are partially cross-sectional, side
views of the apparatus of FIGS. 75(a) and 75(b), in use;
[0125] FIG. 75(h) is a side view of a distal end of another
apparatus for inserting a surgical device at least partially
through a wound opening according to the invention in an
obstructing configuration;
[0126] FIG. 75(i) is a side view of the apparatus of FIG. 75(h) in
a passage configuration;
[0127] FIGS. 75(j) and 75(k) are views similar to FIGS. 75(h) and
75(i) of a distal end of a further apparatus for inserting a
surgical device at least partially through a wound opening
according to the invention;
[0128] FIGS. 75(k)(i) and 75(k)(ii) are side views of part of
another apparatus for inserting a surgical device at least
partially through a wound opening according to the invention;
[0129] FIG. 75(k)(iii) is a front view of another apparatus for
inserting a surgical device at least partially through a wound
opening according to the invention in an obstructing
configuration;
[0130] FIG. 75(k)(iv) is a side view of the apparatus of FIG.
75(k)(iii) in the obstructing configuration;
[0131] FIGS. 75(k)(v) and 75(k)(vi) are views similar to FIGS.
75(k)(iii) and 75(k)(iv) of the apparatus of FIG. 75(k)(iii) in a
passage configuration;
[0132] FIGS. 75(k)(vii) and 75(k)(viii) are views similar to FIGS.
75(k)(iii) and 75(k)(iv) of the apparatus of FIG. 75(k)(iii) in the
obstructing configuration and a surgical device;
[0133] FIG. 75(l) is a perspective view of another apparatus for
inserting a surgical device at least partially through a wound
opening according to the invention in an extended
configuration;
[0134] FIG. 75(m) is a side view of the apparatus of FIG. 75(l) in
the extended configuration;
[0135] FIG. 75(n) is a partially cross-sectional, side view of the
apparatus of FIG. 75(l) in the extended configuration;
[0136] FIG. 75(o) is a plan view from below of the apparatus of
FIG. 75(l) in the extended configuration;
[0137] FIGS. 75(p) and 75(q) are views similar to FIGS. 75(m) and
75(n) of the apparatus of FIG. 75(l) in a retracted
configuration;
[0138] FIG. 75(r) is a side view of a conveying device of the
apparatus of FIG. 75(l);
[0139] FIG. 75(s) is a cross-sectional, side view of the conveying
device of FIG. 75(p);
[0140] FIG. 75(t) is a perspective view of an incising device of
the apparatus of FIG. 75(l);
[0141] FIGS. 75(u) to 75(y) are partially cross-sectional, side
views of the apparatus of FIG. 75(l), in use;
[0142] FIGS. 76 to 81 are partially cross-sectional, side views of
an incising device of another apparatus for inserting a surgical
device at least partially through a wound opening according to the
invention, in use;
[0143] FIGS. 82 and 83 are perspective views of another apparatus
for inserting a surgical device at least partially through a wound
opening according to the invention;
[0144] FIGS. 84 to 88 are partially cross-sectional, side views of
the apparatus of FIGS. 82 and 83, in use;
[0145] FIG. 89 is a perspective view of another apparatus for
inserting a surgical device at least partially through a wound
opening according to the invention with a holder element in a
release configuration and with an incising device in a retracted
configuration;
[0146] FIG. 90 is a front view of the apparatus of FIG. 89;
[0147] FIG. 91 is a front view of the apparatus of FIG. 89 with the
holder element in a holding configuration and with the incising
device in the retracted configuration;
[0148] FIG. 92 is a perspective view of the apparatus of FIG. 89
with the holder element in the holding configuration and with the
incising device in an extended configuration;
[0149] FIG. 93 is a front view of the apparatus of FIG. 92;
[0150] FIGS. 94 to 102 are partially cross-sectional, front views
of the apparatus of FIG. 89, in use;
[0151] FIG. 103 is a perspective view of another apparatus for
inserting a surgical device at least partially through a wound
opening according to the invention;
[0152] FIGS. 104 to 107 are partially cut-away, perspective views
of the apparatus of FIG. 103, in use;
[0153] FIG. 108 is a perspective view of a further apparatus for
inserting a surgical device at least partially through a wound
opening according to the invention in a shielding
configuration;
[0154] FIGS. 109 and 110 are perspective views of the apparatus of
FIG. 108 in a cutting configuration;
[0155] FIG. 111 is a view along line A-A in FIG. 110;
[0156] FIGS. 112 to 115 are partially cut-away, perspective views
of the apparatus of FIG. 108, in use;
[0157] FIG. 116 is a perspective view of another apparatus for
inserting a surgical device at least partially through a wound
opening according to the invention in a retracted configuration;
and
[0158] FIG. 117 is a perspective view of the apparatus of FIG. 116
in an extended configuration.
DETAILED DESCRIPTION
[0159] Referring to the drawings and initially to FIGS. 1 to 5
thereof, there is illustrated an apparatus 1 according to the
invention suitable for inserting a surgical device, such as a wound
retractor device 2, at least partially through a wound opening 3.
Together the apparatus 1 and the wound retractor device 2 form a
surgical assembly.
[0160] The apparatus 1 comprises an incising device 4 for creating
the wound opening 3, and a conveying device 5 insertable through
the wound opening 3 to convey the wound retractor device 2 through
the wound opening 3.
[0161] In this case the wound retractor device 2 has a distal
retaining ring 9 for locating distally of the wound opening 3 to
retain the wound retractor device 2 in position retracting the
wound opening 3. However it will be appreciated that the apparatus
1 is suitable for conveying a variety of surgical devices at least
partially through a wound opening 3. For example, the surgical
device may be of any suitable construction such as the wound
retractor devices described in US patent application published
under No. 2001/0037053A, and/or U.S. Pat. No. 6,582,364, and/or
U.S. patent application Ser. No. 10/678,653, the relevant contents
of which are incorporated herein by reference.
[0162] In this case the incising device 4 is provided in the form
of a sharpened blade element fixedly attached to the distal end 7
of the conveying device 5.
[0163] The conveying device 5 has a hook element 6 in the region of
the distal end 7 for engaging a portion of the wound retractor
device 2 to couple the wound retractor device 2 to the conveying
device 5. As illustrated in FIG. 1, the concave portion of the hook
element 6 faces distally.
[0164] The hook element 6 opens to a side of the conveying device
5. The wound retractor device 2 is therefore arranged offset with
respect to the longitudinal axis A-A of the conveying device 5.
[0165] In use, the wound retractor device 2 is coupled to the
conveying device 5 by engaging the distal ring 9 of the wound
retractor device 2 with the hook element 6 (FIG. 3). The apparatus
1 is then passed through tissue 8 with the blade element 4 as the
leading end to create the wound opening 3, and is advanced through
the wound opening 3 to convey the wound retractor device 2 through
the wound opening 3 by passing the distal ring 9 distally (FIG. 4).
Thus the apparatus 1 may be used to create the wound opening 3 and
convey the wound retractor device 2 through the wound opening 3 in
a single step. The apparatus 1 may then be withdrawn from the wound
opening 3 leaving the wound retractor device 2 in position
extending through the wound opening 3 and with the distal ring 9
distally of the wound opening 3 (FIG. 5).
[0166] The maximum transverse dimension of the wound opening 3 is
between 3 mm and 35 mm, preferably between 5 mm and 12 mm.
[0167] The maximum transverse dimension of the incising device 4
and of the portion of the conveying device 5 which extends through
the wound opening 3 is between 3 mm and 35 mm, preferably between 5
mm and 12 mm.
[0168] In FIGS. 6 to 9 there is illustrated another apparatus 11
according to the invention, which is similar to the apparatus 1 of
FIGS. 1 to 5, and similar elements in FIGS. 6 to 9 are assigned the
same reference numerals.
[0169] In this case the incising device 12 is provided in the form
of an electrocautery scalpel fixedly attached to the distal end 7
of the conveying device 5. The electrocautery scalpel 12 has a
power connection lead 13 for connecting to a power supply.
[0170] FIGS. 10 to 15 illustrate a further apparatus 21 according
to the invention, which is similar to the apparatus 1 of FIGS. 1 to
5, and similar elements in FIGS. 10 to 15 are assigned the same
reference numerals.
[0171] In this case the conveying device 5 comprises a housing
portion 22 for receiving the distal ring 9 of the wound retractor
device 2. In this manner the wound retractor device 2 is coupled to
the conveying device 5.
[0172] An entry/exit opening 23 is provided at the distal end of
housing portion 22 facing distally. The opening 23 facilitates
insertion of the distal ring 9 into and ejection of the distal ring
9 from within the housing portion 22.
[0173] A sleeve opening 25 is also provided through which a sleeve
portion of the wound retractor device 2 may extend from the distal
ring 9 proximally out of the housing portion 22. The sleeve opening
25 is provided along a part of the sidewall of the housing portion
22 and faces laterally.
[0174] The blade element 4 is hingeably attached to the housing
portion 22. In this way the blade element 4 acts as a closure
element to selectively close the opening 23 (FIG. 11) or
selectively open the opening 23 (FIG. 14).
[0175] The conveying device also includes a plunger 24 which may be
depressed to assist ejection of the distal ring 9 from within the
housing portion 22 (FIG. 14).
[0176] In use, the wound retractor device 2 is coupled to the
conveying device 5 by inserting the distal ring 9 into the housing
portion 22 through the opening 23 and moving the blade element 4
across to close the opening 23. The sleeve portion of the wound
retractor device 2 extends proximally out through the sleeve
opening 25. The apparatus 21 is then passed through tissue 8 with
the blade element 4 as the leading end to create the wound opening
3, and is advanced through the wound opening 3 to convey the wound
retractor device 2 through the wound opening 3 (FIGS. 12 and 13).
The plunger 24 is then depressed to push the distal ring 9 distally
to engage against the blade element 4, and thus move the blade
element 4 across to open the opening 23. Further depression of the
plunger 24 ejects the distal ring 9 from within the housing portion
22 through the opening 23 (FIG. 14). The apparatus 21 may then be
withdrawn from the wound opening 3 leaving the wound retractor
device 2 in position extending through the wound opening 3 and with
the distal ring 9 distally of the wound opening 3 (FIG. 15).
[0177] Referring to FIGS. 16 to 21 there is illustrated another
apparatus 31 according to the invention, which is similar to the
apparatus 21 of FIGS. 10 to 15, and similar elements in FIGS. 16 to
21 are assigned the same reference numerals.
[0178] In this case the housing portion 22 has an entry opening 32
in the form of an elliptical slot along a proximal part of the
sidewall of the housing portion 22, and has an exit opening 33 in
the form of an elliptical slot along a distal part of the sidewall.
The slots 32, 33 face laterally. A narrow slot 34 joins the entry
opening 32 to the exit opening 33. The narrow slot 34 allows the
sleeve portion of the wound retractor device 2 to pass into the
body (FIG. 20).
[0179] The blade element 4 is fixedly attached to the housing
portion 22 in this case.
[0180] In use, the wound retractor device 2 is coupled to the
conveying device 5 by inserting the distal ring 9 into the housing
portion 22 through the proximal opening 32 (FIGS. 16 and 17). The
apparatus 31 is then passed through tissue 8 with the blade element
4 as the leading end to create the wound opening 3, and is advanced
through the wound opening 3 to convey the wound retractor device 2
through the wound opening 3 (FIGS. 18 and 19). The plunger 24 is
depressed to eject the distal ring 9 from within the housing
portion 22 through the exit opening 33 (FIG. 20). The sleeve of the
wound retractor device 2 passes along the narrow slot 34. The
apparatus 31 may then be withdrawn from the wound opening 3 leaving
the wound retractor device 2 in position extending through the
wound opening 3 and with the distal ring 9 distally of the wound
opening 3 (FIG. 21).
[0181] FIGS. 21(a) to 21(f) illustrate another apparatus 230
according to the invention, which is similar to the apparatus 31 of
FIGS. 16 to 21, and similar elements in FIGS. 21(a) to 21(f) are
assigned the same reference numerals.
[0182] In this case the housing portion 22 has a single opening
231, which faces laterally, along the distal portion of the
sidewall. The opening 231 acts as the entry opening to facilitate
insertion of the distal ring 9 of the wound retractor device 2 into
the housing portion 22 (FIGS. 21(a) and 21(b)), and acts as the
exit opening to facilitate ejection of the distal ring 9 from
within the housing portion 22 (FIG. 21(e)). The opening 231 also
acts as the sleeve opening to facilitate extension the sleeve of
the wound retractor device 2 out of the housing portion 22 during
conveying through the wound opening 3 (FIGS. 21(c) and FIG.
21(d)).
[0183] The method of using the apparatus 130 includes the following
steps: [0184] Compress the distal ring 9 of the wound retractor
device 2; [0185] Load the distal ring 9 through the cut-out 231 in
the cannula 22 with the sleeve trailing out (FIGS. 21(a) and
21(b)); [0186] Pierce the skin 8 with the blade 4 and advance the
introducer 230 until the cut-out 231 is inside the abdomen (FIGS.
21(c) and 21(d)); [0187] Depress the ejector plunger 24 to push out
the distal ring 9 (FIG. 21(e)); [0188] Remove the injector
introducer 230 from the incision 3, leaving the distal ring 9
inside the abdomen (FIG. 21(f)).
[0189] Referring to FIGS. 21(g) to 21(k) there is illustrated
another apparatus 600 according to the invention, which is similar
to the apparatus 230 of FIGS. 21(a) to 21(f), and similar elements
in FIGS. 21(g) to 21(k) are assigned the same reference
numerals.
[0190] In this case the apparatus 600 comprises the conveying
device 5 and an opening device 601 for creating the wound opening 3
by forcing the tissue 8 apart. The opening device 601 is provided
in this case in the form of a substantially blunt, solid bladeless
tip fixedly attached to the distal end 7 of the conveying device
5.
[0191] In use the wound opening 3 is created by advancing the
opening device 601 distally through the tissue 8 while
simultaneously rotating the opening device 601 in a reciprocating
clockwise--counter clockwise manner about an axis substantially
parallel to the longitudinal axis of the wound opening 3 (FIGS.
21(h) and 21(i)).
[0192] FIGS. 21(g) to 21(k) show the ejector system 600. The
`O`-ring 9 is loaded through the side opening 231 of the shaft 22.
This allows the tip 601 to be more substantial in size.
[0193] At the intersection of the housing portion 22 and the
opening device 601 at the distal end 7 of the conveying device 5,
there is provided a ramp 602 to facilitate ejection of the `O`-ring
9. In use, the `O`-ring 9 is pushed outwards with the ramp system
602 (FIG. 21(j)).
[0194] FIGS. 21(l) to 21(p) illustrate another apparatus 610
according to the invention, which is similar to the apparatus 600
of FIGS. 21(g) to 21(h), and similar elements in FIGS. 21(l) to
21(p) are assigned the same reference numerals.
[0195] In this case the opening device 601 is provided in the form
of a substantially blunt, hollow bladeless tip fixedly attached to
the distal end 7 of the conveying device 5.
[0196] A sleeve opening 611 is provided in the sidewall of the
housing portion 22 facing laterally to facilitate a sleeve portion
of the wound retractor device 2 to extend out of the housing
portion 22 while the distal ring 9 of the wound retractor device 2
is housed within the housing portion 22 (FIGS. 21(m) and
21(n)).
[0197] FIGS. 21(l) to 21(p) show the ejector type introducer 610
which is loaded from the front. The introducer 610 features the
blunt, hollow, bladeless tip 601.
[0198] The buttonhole distal ring 9 is loaded up through the hollow
bladeless tip 601, and subsequently ejected through the tip 601
(FIG. 21(o)). A back and forward motion together with a downwards
pressure is employed to create the wound opening 3 (FIGS. 21(m) and
21(n)). The rod 24 is pushed down to eject the `O`-ring 9, and as a
result the `O`-ring 9 is pushed downwards (FIG. 21(o)).
[0199] It will be appreciated that the blunt, bladeless tip opening
device may have a variety of different configurations. For example,
in the apparatus 620 according to the invention the opening device
621 comprises a winged tip configuration (FIGS. 21(q)(i) and
21(q)(ii)), in the apparatus 622 according to the invention the
opening device 623 comprises an asymmetrical tip configuration
(FIGS. 21(r)(i) and 21(r)(ii)), in the apparatus 624 according to
the invention the opening device 625 comprises a four wing
configuration (FIGS. 21(s)(i) and 21(s)(ii)), in the apparatus 626
according to the invention the opening device 627 comprises a flap
tip configuration (FIGS. 21(t)(i) and 21(t)(ii)), in the apparatus
628 according to the invention the opening device 629 comprises a
spiral tip configuration (FIGS. 21(u)(i) and 21(u)(ii)), in the
apparatus 630 according to the invention the opening device 631
comprises a series of protrusions (FIGS. 21(v)(i) and
21(v)(ii)).
[0200] In the embodiments described previously with reference to
FIGS. 21(g) to 21(p), the blunt, bladeless tip opening device was
employed with a conveying device 5 in which the distal ring 9 of
the wound retractor device 2 is received within the housing portion
22. In the embodiments described previously with reference to FIGS.
21(q)(i) to 21(v)(ii), the blunt, bladeless tip opening device was
employed with a conveying device 5 in which the distal ring 9 of
the wound retractor device 2 may be engaged by the hook element 6.
It will be appreciated that for any of the embodiments disclosed in
this patent specification in which the wound opening is created by
an incising device which creates the wound opening by cutting
tissue, a blunt, bladeless tip opening device may be employed in
place of the incising device to create the wound opening by forcing
tissue apart instead. It will also be appreciated that for any of
the embodiments disclosed in this patent specification in which the
wound opening is created by a blunt, bladeless tip opening device
which creates the wound opening by forcing tissue apart, an
incising device may be employed in place of the blunt, bladeless
tip opening device to create the wound opening by cutting tissue
instead.
[0201] In FIGS. 22 to 24 there is illustrated another apparatus 41
according to the invention, which is similar to the apparatus 21 of
FIGS. 10 to 15, and similar elements in FIGS. 22 to 24 are assigned
the same reference numerals.
[0202] In this case the incising device 42 is provided in the form
of a sharpened blade element extending concentrically through the
conveying device 5.
[0203] The housing portion 43 of the conveying device 5 comprises a
flexible sleeve 44 and an inner tubular member 45 with a proximal
spring 46. The distal end of the sleeve 44 is releasably attached
to the distal end of the tubular member 45 with the distal ring 9
of the wound retractor device 2 housed between the sleeve 44 and
the tubular member 45 (FIG. 22). The wound retractor device 2 is
arranged concentrically with respect to the longitudinal axis A-A
of the conveying device 5.
[0204] In use, the apparatus 41 is passed through tissue 8 with the
blade element 42 as the leading end to create the word opening 3,
and is advanced through the wound opening 3 to convey the wound
retractor device 2 through the wound opening 3 (FIGS. 22 and
23).
[0205] The apparatus 41 is inserted as a normal trocar. The distal
ring 9 and sleeve portion of the wound retractor device 2 are held
close to the tubular member 45 by the retaining sleeve 44, which
may be made out of a plastic film material/stretchable film
material, or woven material.
[0206] The attachment of the distal end of the sleeve 44 to the
distal end of the tubular member 45 is then released. In
particular, when the distal ring 9 is within the abdomen, the
sleeve 44 is released at the distal end by a release mechanism
within the tubular member 45.
[0207] The apparatus 41 is then withdrawn from the wound opening 3
leaving the wound retractor device 2 in position extending through
the wound opening 3 and with the distal ring 9 distally of the
wound opening 3 (FIG. 24). In particular, the piercing introducer
42 and retaining sleeve 44 are pulled proximally, leaving the wound
retractor device 2 in position to be deployed and secured.
[0208] Referring to FIGS. 24(a) to 24(j) there is illustrated
another apparatus 640 according to the invention, which is similar
to the apparatus 1 of FIGS. 1 to 5, and similar elements in FIGS.
24(c) to 24(j) are assigned the same reference numerals.
[0209] In this case the apparatus 640 comprises an opening device
641 in the form of a blunt, bladeless tip similar to the tip 621
described previously with reference to FIGS. 21(q)(i) and
21(q)(ii).
[0210] The conveying device 5 comprises a receiver slot 642 at the
proximal end 643 of the conveying device 5. The sleeve portion of
the wound retractor device 2 may be received in the slot 642 to
hold the sleeve portion externally of the wound opening 3, and thus
maintain the sleeve portion in tension, during conveying of the
distal ring 9 of the wound retractor device 2 through the wound
opening 3.
[0211] In use the wound opening 3 is created by advancing the
opening device 641 distally while rotating the opening device 641
in a reciprocating clockwise--counter clockwise manner to force the
tissue 8 apart (FIGS. 24(f) to 24(i)), in a manner similar to that
described previously with reference to FIGS. 21(g) to 21(p).
[0212] The slot 642 holds the sleeve portion of the wound retractor
device 2 in tension externally of the wound opening 3, and thus
maintain the sleeve portion in tension, during conveying of the
distal ring 9 of the wound retractor device 2 through the wound
opening 3 (FIGS. 24(e) to 24(i)).
[0213] In use, the sleeve is tensioned and passed through the slot
641 in the handle to keep the sleeve taut and to keep the ring 9 on
the hook 6 (FIG. 24(c)). The distal ring 9 is fixed on the hook 6
due to the sleeve being in tension (FIG. 24(d)). An incision 644 is
made in the skin 8 using a scalpel. The depth of the incision 644
is just sufficient to break the skin surface (FIG. 24(e)). The
introducer 5 is twisted back and forth as it advances through the
abdominal wall 8. The blunt tip 641 passes through the skin layers
dissecting as it goes (FIG. 24(f)). The opening device 641 is
twisted and advanced (FIG. 24(g)) until the bladeless tip 641
enters the abdominal cavity (FIG. 24(h)). Because the tip 641 is
blunt, the procedure is therefore particularly safe. In particular
the risk of damage to internal organs due to inadvertent contact
with the tip 641 is minimised. The introducer 5 is further advanced
until all of the distal ring 9 is inside the abdomen (FIG. 24(i)).
The sleeve is unhooked from the slot 642 in the introducer handle
and the introducer 5 is removed leaving the distal ring 9 in the
abdomen (FIG. 24(j)).
[0214] In FIGS. 24(k) to 24(m) there is illustrated a further
apparatus 650 according to the invention, which is similar to the
apparatus 640 of FIGS. 24(a) to 24(j), and similar elements in
FIGS. 24(k) and 24(m) are assigned the same reference numerals.
[0215] In this case the conveying device 5 comprises a receiver
housing portion 651 at the proximal end 643 of the conveying device
5. A seal portion 652 and a proximal ring portion 653 of the wound
retractor device 2 may be received in the housing portion 651 (FIG.
24(m)) to hold the seal portion 652 and the proximal ring portion
653 externally of the wound opening 3, and thus maintain the sleeve
portion of the wound retractor device 2 in tension, during
conveying of the distal ring 9 of the wound retractor device 2
through the wound opening 3.
[0216] FIG. 24(k) illustrates the introducer 650 which includes a
slot 654 for the excess sleeve portion at the proximal top end of
the buttonhole device 2, a reception space 655 for part of the
buttonhole device 2, and the hook 6 for the distal ring 9.
[0217] In use, the distal ring 9 is attached to the hook 6 (FIG.
24(l)).
[0218] The seal portion 652 and the proximal ring portion 653 of
the buttonhole device 2 are inserted into the housing 651 at the
proximal top end of the introducer 650, and the excess sleeve
material is passed out through the slot 654 in the top of the
buttonhole device housing 651 (FIG. 24(m)). The sleeve portion is
now kept in tension.
[0219] It will be appreciated that the apparatus according to the
invention, as disclosed in this patent specification, may be
employed to insert a variety of different types of surgical devices
at least partially through a wound opening. The apparatus according
to the invention may be employed to insert a variety of different
types of wound retractor devices at least partially through a wound
opening, for example the wound retractor devices disclosed in
International patent application No. PCT/IE2003/000141 the relevant
contents of which are incorporated herein by reference, and/or the
wound retractor devices disclosed in International patent
application No. PCT/IE2005/000113 the relevant contents of which
are incorporated herein by reference.
[0220] FIGS. 25 to 30 illustrate a further apparatus 51 according
to the invention, which is similar to the apparatus 1 of FIGS. 1 to
5, and similar elements in FIGS. 25 to 30 are assigned the same
reference numerals.
[0221] In this case the incising device 4 comprises a sharpened
blade element 57 fixedly attached to the distal end 52 of an
elongate member 53. The incising device 4 remains detached from the
conveying device 5.
[0222] In this case the conveying device 5 has a rounded/blunt
distal end 7.
[0223] The apparatus 51 further comprises a guide device 54
insertable through the wound opening 3. The guide device 54 is
provided in this case in the form of a length of flexible
string/ribbon 55 with a hook element 56 attached to a distal end of
the string 55. The concave portion of the hook element 56 faces
proximally.
[0224] The string 55 and the hook element 56 also act as a removal
device to assist in removal of the wound retractor device 2 from
the wound opening 3. The hook element 56 is engagable with the
distal ring 9 of the wound retractor device 2, and the string 55
extends proximally through the wound opening 3 for actuation by a
user. In this manner the string 55 connects the hook element 56 to
the user.
[0225] In use, the incising device 4 and the guide device 54 are
passed through the tissue 8 with the blade element 57 as the
leading end to create the wound opening 3 in an incision step (FIG.
25). The incising device 4 is then withdrawn from the wound opening
3 leaving the guide device 54 in position extending through the
wound opening 3 and with the hook element 56 distally of the wound
opening 3 (FIG. 26). Because the guide device 54 extends through
the wound opening 3, this arrangement ensures that the patency of
the wound opening 3 is maintained even when the incising device 4
has been withdrawn. In particular the string 55 ensures that the
various layers of fat/muscle/fascia stay aligned as a straight
incision.
[0226] The wound retractor device 2 is coupled to the conveying
device 5 by engaging the distal ring 9 with the hook element 6
(FIG. 26). The conveying device 5 is then advanced though the wound
opening 3 to convey the wound retractor device 2 through the wound
opening 3 in a conveying step (FIG. 27).
[0227] Thus the incising device 4 of the apparatus 51 is used to
create the wound opening 3 in an incision step (FIG. 25), and the
conveying device 5 of the apparatus 51 is used to subsequently
convey the wound retractor device 2 through the wound opening 3 in
a conveying step (FIG. 27). These two steps are distinct and
separate.
[0228] The conveying device 5 may be withdrawn from the wound
opening 3 leaving the wound retractor device 2 in position
extending through the wound opening 3 and with the distal ring 9
distally of the wound opening 3 (FIG. 28).
[0229] To assist in removal of the wound retractor device 2 from
the wound opening 3, the hook element 56 may be engaged with the
distal ring 9 and pulled proximally by pulling the string 55
proximally (FIG. 30). The wound retractor device 2 may thus be
removed from the wound opening 3.
[0230] The string 55 and hook element 56 remain detached from the
wound retractor device 2. This enables the string 55 and hook
element 56 to be inserted into the wound opening 3 before insertion
of the wound retractor device 2, and thus enables the string 55 and
hook element 56 to act as the guide device. The hook element 56
contacts the distal ring 9 to aid removal of the wound retractor
device 2, but remains detached from the distal ring 9.
[0231] The maximum transverse dimension of the portion of the
incising device 4 which extends through the wound opening 3 is
between 3 mm and 35 mm, preferably between 5 mm and 12 mm.
[0232] Referring to FIGS. 31 to 36 there is illustrated another
apparatus 61 according to the invention, which is similar to the
apparatus 51 of FIGS. 25 to 30, and similar elements in FIGS. 31 to
36 are assigned the same reference numerals.
[0233] In this case the guide device 54 comprises a loop 62 in the
string 55 at the distal end of the string 55.
[0234] As illustrated in FIGS. 35 and 36, to assist in removal of
the wound retractor device 2, the loop 62 may be gripped by a
grasping instrument 63 and pulled proximally while also pulling the
string 35 proximally. In this case the loop 62 and string 35 are
not required to contact the distal ring 9 to effect removal of the
wound retractor device 2.
[0235] In FIGS. 37 to 43 there is illustrated another apparatus 71
according to the invention, which is similar to the apparatus 51 of
FIGS. 25 to 30, and similar elements in FIGS. 37 to 43 are assigned
the same reference numerals.
[0236] In this case the blade element 57 is releasably attached to
the distal end 52 of the elongate member 53, and the blade element
57 is fixedly attached to the distal end of the string 55. A
proximal side of the blade element 57 has a hook formation 72.
[0237] In use, the incising device 4, with the blade element 57
attached to the elongate member 53, and the string 55 are passed
through tissue 8 with the blade element 57 as the leading end to
create the wound opening 3 in an incision step (FIG. 38). The blade
element 57 is detached from the elongate member 53 (FIG. 39), and
the elongate member 53 is withdrawn from the wound opening 3
leaving the string 55 extending through the wound opening 3 and
with the blade element 57 distally of the wound opening 3 (FIG.
40).
[0238] To assist in removal of the wound retractor device 2 from
the wound opening 3, the hook formation 72 of the blade element 57
may be engaged with the distal ring 9 and pulled proximally by
pulling the string 55 proximally (FIG. 43).
[0239] It will be appreciated that a surgical device, such as the
wound retractor device 2, may be inserted at least partially
through the wound opening 3 with the wound opening 3 being created
and the wound retractor device 2 being conveyed at least partially
through the wound opening 3 in a single step, or alternatively with
the wound opening 3 being created in an opening step and with the
wound retractor device 2 being conveyed at least partially through
the wound opening 3 in a separate conveying step.
[0240] For example, with reference to FIGS. 24(e) to 24(j), the
apparatus 640 is described and illustrated creating the wound
opening 3 and conveying the wound retractor device 2 at least
partially through the wound opening 3 in a single step. With
reference to FIGS. 43(a) to 43(f), the apparatus 640 may
alternatively be employed to create the wound opening 3 in an
opening step (FIGS. 43(a) to 43(c)), and to subsequently convey the
distal ring 9 of the wound retractor device 2 through the wound
opening 3 is a separate conveying step (FIGS. 43(d) to 43(f)).
[0241] To create the wound opening 3, the opening device 641 is
advanced distally while the opening device 641 is rotated in a
reciprocating clockwise--counter clockwise manner about an axis
substantially parallel to the longitudinal axis of the wound
opening 3 (FIGS. 43(a) to 43(c)).
[0242] To convey the distal ring 9 through the wound opening 3, the
conveying device 5 is advanced distally without rotating the
conveying device 5 (FIGS. 43(d) and 43(e)). It will be appreciated
that the conveying device 5 may alternatively be rotated in a
reciprocating clockwise--counter clockwise manner about an axis
substantially parallel to the longitudinal axis of the wound
opening 3 while advancing distally through the wound opening 3 to
convey the distal ring 9 through the wound opening 3. By rotating
the conveying device 5 in this manner, this may assist in
overcoming frictional resistance to passage of the distal ring 9
through the wound opening 3.
[0243] In FIGS. 43(a) to 43(f), the bladeless introducer 640 is
employed to create the incision 3 prior to loading of the
buttonhole distal ring 9 and delivery of the distal ring 9 through
to the abdomen.
[0244] In use, the skin incision 644 is pre-made with a scalpel
(FIG. 43(a)). The conveying device 641 is twisted back and forth
and advanced (FIG. 43(b)). The blunt tip 641 enters the abdomen,
and thus the incision 3 is created (FIG. 43(c)).
[0245] The introducer 640 is withdrawn, the buttonhole distal ring
9 is loaded on to the hook 6 and the sleeve is tensioned to keep
the wound retractor device 2 fixed in position (FIG. 43(d)). The
distal ring 9 is passed into the abdominal cavity (FIG. 43(e)). The
sleeve is released, by untensioning the sleeve, from the introducer
640 which is then removed leaving the distal ring 9 in the abdomen
(FIG. 43(f)). The buttonhole device 2 is now ready to be
deployed.
[0246] FIGS. 44 to 49 illustrate a further apparatus 81 according
to the invention, which is similar to the apparatus 71 of FIGS. 37
to 43, and similar elements in FIGS. 44 to 49 are assigned the same
reference numerals.
[0247] In this case the incising device 4 is provided in the form
of the blade element 57 releasably attached to the distal end 7 of
the conveying device 5.
[0248] The distal end 7 of the conveying device 5 is rounded and
blunt for added safety. The rounded/blunt distal end minimises the
possibility of damage being caused to internal organs should the
distal end 7 contact internal organs.
[0249] In use, the wound retractor device 2 is coupled to the
conveying device 5 by engaging the distal ring 9 of the wound
retractor device 2 with the hook element 6 (FIG. 44). The apparatus
81, with the blade element 57 attached to the conveying device 5,
is passed through tissue 8 with the blade element 57 as the leading
end to create the wound opening 3, and is advanced through the
wound opening 3 to convey the wound retractor device 2 through the
wound opening 3 (FIG. 45). Thus the apparatus 81 may be used to
create the wound opening 3 and convey the wound retractor device 2
through the wound opening 3 in a single step.
[0250] In this case the string 55 and the blade element 57 are
employed as the removal device 54 only, and not as the guide
device. Because the wound opening 3 is created and the wound
retractor device 2 is conveyed through the wound opening 3 in a
single step, there is no requirement for a guide device in this
case.
[0251] When the wound retractor device 2 is deployed to retract the
wound opening 3, the blade element 57 remains distally of the wound
opening 3 and the string 55 extends through the retracted wound
opening 3 (FIG. 48).
[0252] Referring to FIGS. 51 to 58 there is illustrated another
apparatus 91 according to the invention, which is similar to the
apparatus 51 of FIGS. 25 to 30, and similar elements in FIGS. 51 to
58 are assigned the same reference numerals.
[0253] In this case the guide device 92 is provided in the form of
a rigid tubular member 93. The tubular member 93 has a
substantially circular cross-section. A slot 94 extends
longitudinally along a sidewall of the tubular member 93.
[0254] As illustrated in FIG. 52, the tubular member 93 is
mountable to the incising device 4. In this case the elongate
member 53 of the incising device 4 has an elongate protrusion 95
for mating with the slot 94 in the tubular member 93.
[0255] In use the guide device 92 is mounted to the incising device
4 (FIG. 52), and the incising device 4 and the guide device 92 are
passed through tissue 8 with the blade element 57 as the leading
end to create the wound opening 3 in an incision step (FIG. 53).
The incising device 4 is then withdrawn from the wound opening 3
leaving the guide device 92 in position extending through the wound
opening 3 (FIG. 54).
[0256] The wound retractor device 2 is coupled to the conveying
device 5 by engaging the distal ring 9 with the hook element 6
(FIG. 55). The conveying device 5 is then advanced through the
wound opening 3 to convey the wound retractor device 2 through the
wound opening 3 in a conveying step (FIG. 56). The conveying device
5 and the guide device 92 may be withdrawn from the wound opening 3
leaving the wound retractor device 2 in position extending through
the wound opening 3 and with the distal ring 9 distally of the
wound opening 3 (FIGS. 57 and 58).
[0257] The open slot 94 of the guide device 92 facilitates removal
of the guide device 92 over the sleeve portion of the wound
retractor device 2.
[0258] The maximum transverse dimension of the portion of the guide
device 92 which extends through the wound opening 3 is between 3 mm
and 35 mm, preferably between 5 mm and 12 mm.
[0259] The guide device 92 does not act as a removal device to
assist in removal of the wound retractor device 2 from the wound
opening 3, in this case.
[0260] In an alternative embodiment the tubular member 93 may have
a substantially flattened, oblong cross-section, as illustrated in
FIG. 50. The flattened, oblong cross-section of the tubular member
93 may in certain cases be easier to accommodate in the wound
opening 3, and/or may in certain cases be able to accommodate the
squeezed distal ring 9 more easily.
[0261] FIGS. 58(a) to 58(d) illustrate another apparatus 161
according to the invention, which is similar to the apparatus 51 of
FIGS. 25 to 30, and similar elements in FIGS. 58(a) to 58(d) are
assigned the same reference numerals.
[0262] In this case both the incising device 4 and the conveying
device 5 have substantially flattened cross-sections. The flattened
incising device 4 is particularly easy to introduce compared to
conventional trocar blades.
[0263] In use, the incising device 4 is passed through tissue 8
with the blade element 57 as the leading end to create the wound
opening 3 in an incision step (FIG. 58(a)).
[0264] The wound retractor device 2 is coupled to the conveying
device 5 by engaging the distal ring 9 with the hook element 6. The
conveying device 5 is advanced through the wound opening 3 to
convey the wound retractor device 2 through the wound opening 3 in
a conveying step, while the incising device 4 remains in position
extending through the wound opening 3 (FIG. 58(b)).
[0265] Because both the incising device 4 and the conveying device
5 have flattened cross-sections, both may be accommodated extending
through the wound opening 3 at the same time. The elasticity of the
tissue 8 and of the distal ring 9 facilitate introduction of the
distal ring 9 through the wound opening 3 while the incising device
4 remains in position extending through the wound opening 3.
[0266] Because the incising device 4 is not removed from the wound
opening 3 before insertion of the conveying device 5, there is no
requirement for a separate guide device in this case. The incising
device 4 effects the function of maintaining the patency of the
wound opening 3.
[0267] Both the incising device 4 and the conveying device 5 may
then be withdrawn from the wound opening 3 leaving the wound
retractor device 2 in position extending through the wound opening
3 and with the distal ring 9 distally of the wound opening 3 (FIG.
58(d)).
[0268] Referring to FIGS. 58(e) to 58(h) there is illustrated
another apparatus 171 according to the invention, which is similar
to the apparatus 1 of FIGS. 1 to 5, and similar elements in FIGS.
58(e) to 58(h) are assigned the same reference numerals.
[0269] In this case the conveying device 5 comprises an insertion
element 174 insertable through the wound opening 3, and a drawing
element 172, provided in this case in the form of a length of
flexible string. The string 172 is attached to the distal ring 9 of
the wound retractor device 2 by means of a hook and extends through
an opening 173 in the distal end 7 of the insertion element 174. In
this manner the string 172 couples the distal ring 9 to the
insertion element 174, and can be used to draw the distal ring 9
distally through the wound opening 3.
[0270] The blade element 4 is fixedly attached to the distal end 7
of the insertion element 174.
[0271] In use, the insertion element 174 is passed through tissue 8
with the blade element 4 as the leading end to create the wound
opening 3 (FIG. 58(e)). The string 172 is then pulled proximally
(FIG. 58(g)). Because the string 172 is looped through the opening
173, the string 172 acts as a pulley to draw the distal ring 9
distally through the wound opening 3. The insertion element 174 may
then be withdrawn from the wound opening 3 leaving the wound
retractor device 2 in position extending through the wound opening
3 and with the distal ring 9 distally of the wound opening 3 (FIG.
58(h)).
[0272] The string 172 may be left in position extending through the
wound opening 3. The string 172 may be subsequently used to assist
in removal of the wound retractor device 2.
[0273] In FIGS. 58(i) to 58(n) there is illustrated another
apparatus 660 according to the invention, which is similar to the
apparatus 640 of FIGS. 43(a) to 43(f), and similar elements in
FIGS. 58(i) to 58(n) are assigned the same reference numerals.
[0274] In this case the conveying device 5 comprises a body portion
661 and the hook element 6 is slidably moveable along the body
portion 661.
[0275] In use, the distal ring 9 of the wound retractor device 2 is
coupled to the hook element 6 by engaging the hook element 6 with
the distal ring 9 (FIG. 58(j)). The wound opening 3 is created in
an opening step by advancing the opening device 641 distally while
rotating the opening device 641 in a reciprocating
clockwise--counter clockwise manner to force the tissue 8 apart
(FIGS. 58(k) and 58(l)). The distal ring 9 remains externally of
the wound opening 3 during the step of creating the wound opening
3.
[0276] The distal ring 9 is then conveyed through the wound opening
3 in a separate conveying step by sliding the hook element 6
distally along the body portion 661 of the conveying device 5 (FIG.
58(m)). During the step of conveying the distal ring 9 through the
wound opening 3, the opening device 641 remains within the wound
interior and the body portion 661 of the conveying device 5 remains
extending through the wound opening 3.
[0277] The apparatus 660 is then removed from the wound opening 3
to leave the distal ring 9 within the wound interior and the sleeve
portion extending proximally out through the wound opening 3 (FIG.
58(n)).
[0278] The apparatus 660 comprises the proximal handle 643, the
hook 6 on the sliding member, and the bladeless introducer tip 641
(FIG. 58(i)).
[0279] The distal ring 9 is attached to the sliding hook 6, which
is initially positioned away from the dissecting, leading edge 641
of the introducer 660 (FIG. 58(j)). This ensures that the ring 9
will not interfere with the twisting motion required by the
bladeless tip 641.
[0280] The twisting motion advances the bladeless tip 641 through
the abdominal wall 8 (FIG. 58(k)). The distal ring 9 does not
interfere with the creation of the incision 3. In FIG. 58(l), the
bladeless tip 641 has entered the abdomen.
[0281] The sliding hook member 6 is then advanced down the shaft
661 of the introducer 660 to pass the distal ring 9 through the
incision 3 (FIG. 58(m)). The introducer 660 is removed, leaving the
distal ring 9 in the abdomen ready for deployment (FIG. 58(n)).
[0282] In FIG. 59 there is illustrated an incising device 101 of
another apparatus according to the invention, which is similar to
the incising device 4 of FIGS. 25 to 30, and similar elements in
FIG. 59 are assigned the same reference numerals.
[0283] In this case the incising device 101 has an abutment member
102 fixedly mounted to the elongate member 53. The abutment member
102 is suitable for abutting an external surface of tissue 8
adjacent the wound opening 3. In this manner the abutment member
102 acts as a limiting element to limit the extent of passage of
the incising device 101 through tissue 8. In particular the
abutment member 102 prevents any sudden "jump-through" when the
tissue 8 is pierced.
[0284] FIG. 60 illustrates a further incising device 111 of another
apparatus according to the invention, which is similar to the
incising device 101 of FIG. 59, and similar elements in FIG. 60 are
assigned the same reference numerals.
[0285] In this case the abutment member 102 is mounted to the
elongate member 53 by means of a coiled spring 112. The coiled
spring 112 extends between the abutment member 102 and the proximal
end 113 of the elongate member 53. The abutment member 102 is thus
movable relative to the elongate member 53 between a retracted
configuration (FIG. 60) and an extended configuration, in which the
spring 112 is compressed. The spring 112 acts to bias the abutment
member 102 away from the proximal end 113 of the elongate member 53
towards the retracted configuration.
[0286] Referring to FIGS. 61 to 63 there is illustrated another
incising device 121 of another apparatus according to the
invention, which is similar to the incising device 101 of FIG. 59,
and similar elements in FIGS. 61 to 63 are assigned the same
reference numerals.
[0287] In this case the abutment member 102 is mounted to the
elongate member 53 by means of a screw-thread arrangement 122. This
arrangement facilitates adjustment of the position of mounting of
the abutment member 102 on the elongate member 53. Thus the
abutment member 102 is adjustable to accommodate different abdomen
thickness.
[0288] The abutment member 102 prevents the blade element 57
entering too far into the abdomen (FIG. 63).
[0289] In FIGS. 64 and 65 there is illustrated another apparatus
131 according to the invention, which is similar to the apparatus 1
of FIGS. 1 to 5, and similar elements in FIGS. 64 and 65 are
assigned the same reference numerals.
[0290] In this case the apparatus 131 has the abutment member 102,
similar to that described previously with reference to FIG. 59,
fixedly mounted to the conveying device 5.
[0291] FIGS. 66 to 68 illustrate a further incising device 141 of
another apparatus according to the invention, which is similar to
the incising device 111 of FIG. 60, and similar elements in FIGS.
66 to 68 are assigned the same reference numerals.
[0292] In this case the coiled spring 112 extends between the
abutment member 102 and the distal end 52 of the elongate member
53. The abutment member 102 is thus movable relative to the
elongate member 53 between a retracted configuration (FIG. 67) and
an extended configuration (FIG. 68), in which the spring 112 is
extended. The spring 112 acts to bias the abutment member 102
towards the distal end 52 of the elongate member 53 towards the
retracted configuration.
[0293] In order to fully pierce the tissue 8, the spring 112 must
be stretched. Hence the piercing operation is a controlled one. In
this manner, the possibility of sudden "jump-through" when the
blade element 57 breaks through is minimised.
[0294] Referring to FIGS. 69 to 75 there is illustrated another
apparatus 151 according to the invention, which is similar to the
apparatus 1 of FIGS. 1 to 5, and similar elements in FIGS. 69 to 75
are assigned the same reference numerals.
[0295] In this case the blade element 4 is attached to the
conveying device 5 by means of a spring 152 extending between the
blade element 4 and the proximal end 153 of the conveying device 5.
The blade element 4 is movable relative to the conveying device 5
between an extended configuration (FIG. 71) and a retracted
configuration (FIG. 72), in which the spring 152 is compressed. The
spring 152 acts to bias the blade element 4 away from the proximal
end 153 towards the extended configuration.
[0296] When the apparatus 151 pierces the tissue 8, the blade
element 4 retracts into the conveying device 5 for safety (FIG.
74).
[0297] FIGS. 75(a) to 75(g) illustrate another apparatus 200
according to the invention, which is similar to the apparatus 151
of FIGS. 69 to 75, and similar elements in FIGS. 75(a) to 75(g) are
assigned the same reference numerals.
[0298] In this case the blade element 4 is detached from the
conveying device 5. The blade element 4 is mounted to the conveying
device 5 by extending the blade element 4 through a lumen 201 in
the conveying device 5. A handle portion 202 is provided at the
proximal end of the blade element 4 to facilitate gripping of the
blade element 4 and manual movement of the blade element 4 relative
to the conveying device 5 between the extended configuration (FIG.
75(a)) and the retracted configuration (FIG. 75(b)). In the
retracted configuration, the distal end of the blade element 4 is
housed within the distal end 7 of the conveying device 5 to safely
cover the distal end of the blade element 4.
[0299] As illustrated in FIG. 75(a) the blade element 4 is mounted
substantially concentrically with respect to the longitudinal axis
of the conveying device 5. In this concentric arrangement the
longitudinal axis of the blade element 4 is substantially parallel
to the longitudinal axis of the conveying device 5. The centre axis
of the blade element 4 may be offset in the radial direction by a
relatively small distance from the centre axis of the conveying
device 5, in particular to accommodate the hook element 6 and a
recess in the sidewall of the conveying device.
[0300] As illustrated in FIG. 75(b), the distal end 7 of the
conveying device 5 is blunt and rounded for safety.
[0301] As illustrated in FIG. 75(b), lifting the blade element 4 by
means of retraction of the handle 202 causes the blade 4 to move up
into the body of the hook introducer 5.
[0302] In use, the apparatus 200 with the blade element 4 in the
extended configuration is pushed distally through the tissue 8
until the blade element 4 has passed through the tissue 8 to create
the wound opening 3 (FIG. 75(d)). The blade 4 creates the incision
3 and the hook 6 drags the distal ring 9 through the incision 3.
The pushing force is stopped once the blade 4 is seen entering the
abdomen. The handle portion 202 of the blade element 4 is then
gripped, and the blade element 4 is manually pulled proximally
while the conveying device 5 remains in a fixed position to move
the blade element 4 from the extended configuration to the
retracted configuration (FIG. 75(e)). The blade retracting handle
202 is pulled up to hide the blade 4 in the introducer body 5 to
result in a safe blunt introducer 5. It is noted that the wound
retractor device 2 has only been conveyed partially through the
wound opening 3 at the point where the blade element 4 is retracted
into the conveying device 5.
[0303] The conveying device 5 is then pushed further distally
through the wound opening 3 until the distal ring 9 of the wound
retractor device 2 has passed fully through the wound opening 3
into the abdomen (FIG. 75(f)). The introducer 5 is advanced until
the distal ring 9 is fully inside the abdomen. The apparatus 200 is
then withdrawn from the wound opening 3 leaving the wound retractor
device 2 mounted in the wound opening 3 (FIG. 75(g)). The
introducer 5 is removed to leave the distal ring 9 in the abdomen
and the wound retractor device 2 ready to be used.
[0304] In FIGS. 75(h) and 75(i) there is illustrated another
apparatus 210 according to the invention, which is similar to the
apparatus 200 of FIGS. 75(a) to 75(g), and similar elements in
FIGS. 75(h) and 75(i) are assigned the same reference numerals.
[0305] In this case the conveying device 5 comprises a resilient
arm 211 which extends across the passageway 212 between the concave
portion 213 of the hook element 6 and externally of the conveying
device 5. The arm 211 is movable between an obstructing
configuration in which the arm 211 extends across to obstruct part
of the passageway 212 (FIG. 75(h)) and a passage configuration in
which the arm 211 is bent back to facilitate passage of the distal
ring 9 of the wound retractor device 2 through the passageway 212
into and out of the concave portion 213 of the hook element 6 (FIG.
75(i)). In the obstructing configuration, the arm 211 retains the
distal ring 9 in engagement with the hook element 6 during
insertion of the wound retractor device 2 through a wound opening
3. The resilient nature of the arm 211 biases the arm 211 towards
the obstructing configuration.
[0306] The soft rubber distal ring retainer 211 has enough strength
to hold the distal ring 9 in place during delivery through the
abdominal wall 8, but bends out of the way to deposit the ring 9 in
the abdomen when the hook introducer 5 is being withdrawn.
[0307] As illustrated in FIG. 75(i), the soft rubber distal ring
retainer 211 collapses to either load or deposit the distal ring 9
into/from the hook 213.
[0308] Referring to FIGS. 75(j) and 75(k) there is illustrated a
further apparatus 220 according to the invention, which is similar
to the apparatus 210 of FIGS. 75(h) and 75(i), and similar elements
in FIGS. 75(j) and 75(l) are assigned the same reference
numerals.
[0309] In this case the arm 211 is substantially rigid and is
pivotably attached to the body of the conveying device 5 by means
of a hinge 221. The arm 211 is pivotably movable between the
obstructing configuration (FIG. 75(j)) and the passage
configuration (FIG. 75(k)).
[0310] The pivot hook 211 is moved to (i) load the distal ring 9
into the concave position 213, or (ii) allow the distal ring 9 to
be removed from the concave portion 213. The addition of the pivot
hook 211 ensures that the distal ring 9 is fully held in the hook
213 of the introducer 5. When required the arm 211 is moved out of
the way to load or deliver the distal ring 9.
[0311] FIGS. 75(k)(i) and 75(k)(ii) illustrate another apparatus
670 according to the invention, which is similar to the apparatus
220 of the FIGS. 75(j) and 75(k), and similar elements in FIGS.
75(k)(i) and 75(k)(ii) are assigned the same reference
numerals.
[0312] In this case the apparatus 670 comprises an opening device
671, in the form of a blunt, bladeless tip, fixedly attached to the
distal end 7 of the conveying device 5. The tip 671 is similar to
the tip 621 described previously with reference to FIGS. 21(q)(i)
and 21(q)(ii).
[0313] FIGS. 75(k)(i) and 75(k)(ii) show the hook introducer 670
with the mechanical clasp 211 to hold the `O`-ring 9 in place. The
clasp 211 could be spring loaded or controlled via a lever.
[0314] FIGS. 75(k)(i) and 75(k)(ii) show the blunt tip 671 with two
wings for serration of the tissue.
[0315] Referring to FIGS. 75(k)(iii) to 75(k)(viii) there is
illustrated a further apparatus 680 according to the invention,
which is similar to the apparatus 670 of FIGS. 75(k)(i) and
75(k)(ii), and similar elements in FIGS. 75(k)(iii) to 75(k)(viii)
are assigned the same reference numerals.
[0316] In this case the conveying device 5 comprises a rigid arm
681 movable, under the control of a thumbswitch 682, between the
obstructing configuration in which the arm 681 obstructs part of
the passageway 212 (FIGS. 75(k)(iii) and 75(k)(iv)), and the
passage configuration in which the arm 681 is moved distally to
facilitate passage of the distal ring 9 of the wound retractor
device 2 through the passageway 212 into and out of the concave
portion 213 of the hook element 6 (FIGS. 75(k)(v) and
75(k)(vi)).
[0317] The locking bar feature 681 may be employed to secure the
distal ring 9 to the hook 6. The apparatus 680 comprises the
proximal handle 683, the shaft 5, the thumbswitch 682, the hook 6,
the locking bar 681, and the bladeless tip 671. The thumbswitch 682
is spring-loaded towards the obstructing position, in which the
locking bar 681 is moved proximally (FIGS. 75(k)(iii) and
75(k)(iv)).
[0318] In FIG. 75(k)(vi), the thumbswitch 682 is pushed down
distally. This causes the locking bar 681 to move down distally
also. The distal ring 9 may now be fitted onto the hook 6 (FIGS.
75(k)(vii) and 75(k)(viii)).
[0319] After the buttonhole distal ring 9 is placed on to the hook
6, the thumbswitch 682 is released. This causes the locking bar 681
to lock the ring 9 in place (FIGS. 75(k)(vii) and 75(k)(viii)). To
release the ring 9, for example in the abdomen, the thumbswitch 682
may be pressed distally down again.
[0320] In FIGS. 75(l) to 75(y) there is illustrated a further
apparatus 310 for inserting a surgical device at least partially
through a wound opening according to the invention, which is
similar to the apparatus 200 of FIGS. 75(a) to 75(g), and similar
elements in FIGS. 75(l) to 75(y) are assigned the same reference
numerals.
[0321] In this case the blade element 4 is biased towards the
retracted configuration by means of a compression spring 313. The
spring 313 is located between and engaging against an internal
ledge 314 in the lumen 201 of the conveying device 5 and a
laterally protruding handle 312 on the blade element 4 (FIG.
75(n)). In the extended configuration the spring 313 is compressed
(FIG. 75(n)), and in the retracted configuration the spring 313 is
in an uncompressed, at-rest state (FIG. 75(q)).
[0322] The blade element 4 is moved relative to the conveying
device 5 from the retracted configuration to the extended
configuration by manually pushing the handle 312 distally, for
example using a thumb. To move the blade element 4 relative to the
conveying device 5 from the extended configuration to the retracted
configuration, the handle 312 is released and the biasing force of
the spring 313 pushes the blade element 4 proximally.
[0323] A recess 311 is provided at a lateral side of the conveying
device 5 to minimise the profile of the distal ring 9 during
conveying through the wound opening 3 (FIGS. 75(u) to 75(x)).
[0324] In use, the distal ring 9 of the wound retractor device 2 is
hooked onto the introducer handle 5 by means of the hook 6 (FIG.
75(u)). The blade 4 is exposed by the surgeon depressing the thumb
switch 312. The introducer 5 is advanced until the surgeon sees the
blade 4 appearing through abdominal wall 8 on his monitor (FIG.
75(v)).
[0325] The surgeon removes his thumb from the thumb switch 312. The
spring 313 extends, causing the blade 4 to retract safely into the
introducer handle 5 (FIG. 75(w)). There is thus provided a safe,
blunt introducer 5 which the surgeon advances into the abdomen
until the distal ring 9 is fully inside (FIG. 75(x)).
[0326] The introducer 5 is withdrawn from the incision 3 leaving
the distal ring 9 in the abdomen and the wound retractor device 2
is ready to be deployed to retract the incision 3 (FIG. 75(y)).
[0327] In FIGS. 76 to 81 there is illustrated a further incising
device 181 of another apparatus according to the invention, which
is similar to the incising device 4 of FIGS. 25 to 30, and similar
elements in FIGS. 76 to 81 are assigned the same reference
numerals.
[0328] In this case the incising device 181 comprises a support
element 182, a cutting element 183 for creating the wound opening 3
fixedly attached to the support element 182, and a shield element
184 for shielding the cutting element 183 movably attached to the
support element 182 by means of two springs 185. The shield element
184 is movable relative to the cutting element 183 between an
extended shielding configuration (FIGS. 76, 78, 79, 81) and a
retracted cutting configuration (FIGS. 77 and 80). The springs 185
act to bias the shield element 184 towards the extended shielding
configuration.
[0329] As illustrated in FIGS. 79 to 81, the shield element 182 has
a cantilever arm 186 with a radially inwardly protruding finger 187
at a proximal end of the arm 186. The finger 187 is engageable in a
recess 188 in the cutting element 183 to releasably lock the shield
element 182 in the extended shielding configuration (FIG. 81).
[0330] In use, the incising device 181 is configured with the
shield element 184 in the extended shielding configuration and with
the finger 187 disengaged from the recess 188 (FIGS. 76 and 79).
The incising device 181 is then moved distally towards the tissue 8
so that the cutting element 183 and the shield element 184 engage
the tissue 8. Further movement of the incising device 181 distally
causes the shield element 184 to move proximally relative to the
cutting element 183 against the biasing force of the springs 185
due to the frictional resistance of the tissue 8 (FIGS. 77 and 80).
The proximal movement of the shield element 184 exposes the cutting
element 183. The sharpened cutting element 183 passes through the
tissue 8 to create the wound opening 3 (FIG. 77).
[0331] The cutting element 183 breaks through to the distal side
189 of the tissue 8, and the shield element 184 then reaches the
distal side 189 of the tissue 8. When the shield element 184
reaches the distal side 189, there is no further frictional
resistance to advancement of the shield element 184 and thus the
shield element 184 moves distally relative to the cutting element
183 to the extended shielding configuration under the biasing force
of the springs 185 (FIG. 78). As the shield element 184 moves
distally, the finger 187 engages the recess 188 to lock the shield
element 184 in the extended shielding configuration (FIG. 81).
[0332] In this extended shielding configuration, the shield element
184 shields the cutting element 183 and thus prevents the sharpened
cutting element 183 from inadvertently contacting and potentially
damaging any internal organs or tissue.
[0333] It will be appreciated that in an alternative embodiment of
the invention, the shield element may be fixedly attached to the
support element, and the cutting element may be movably attached to
the support element, for example by means of springs.
[0334] FIGS. 82 to 88 illustrate another apparatus 300 for
inserting a surgical device at least partially through a wound
opening according to the invention, which is similar to the
apparatus 230 of FIGS. 21(a) to 21(f), and similar elements in
FIGS. 82 to 88 are assigned the same reference numerals.
[0335] In this case the apparatus 300 comprises a shield element
184 attached to the housing portion 22 by means of two compression
springs 185, in a manner similar to that described previously with
reference to FIGS. 76 to 81.
[0336] The shield element 184 is movable relative to the blade
element 4 between an extended shielding configuration (FIG. 83) and
a retracted cutting configuration (FIG. 82). The springs 185 act to
bias the shield element 184 towards the extended shielding
configuration.
[0337] In use, the apparatus 300 is configured with the shield
element 184 in the extended shielding configuration (FIG. 84). The
apparatus 300 is then moved distally towards the tissue 8 so that
the blade element 4 and the shield element 184 engage the tissue 8.
Further movement of the apparatus 300 distally causes the shield
element 184 to move proximally relative to the blade element 4
against the biasing force of the springs 185 due to the frictional
resistance of the tissue 8 (FIG. 85). The proximal movement of the
shield element 184 exposes the blade element 4. The sharpened blade
element 4 passes through the tissue 8 to create the wound
opening.
[0338] The blade element 4 breaks through to the distal side of the
tissue 8, and the shield element 184 then reaches the distal side
of the tissue 8. When the shield element 184 reaches the distal
side, there is no further frictional resistance to advancement of
the shield element 184 and thus the shield element 184 moves
distally relative to the blade element 4 to the extended shielding
configuration under the biasing force of the springs 185 (FIG.
86).
[0339] In this extended shielding configuration, the shield element
184 shields the blade element 4 and thus prevents the sharpened
blade element 4 from inadvertently contacting and potentially
damaging any internal organs or tissue (FIG. 87). The distal ring 9
of the surgical device 2 may then be ejected from the housing
portion 22 (FIG. 88).
[0340] FIGS. 82 to 88 illustrate the spring shield system. The
springs 185 are configured so that the shield 184 is biased to
slide forward to cover the blade 4.
[0341] The shield system protects organs from stabbing or other
inadvertent damage due to introduction of the surgical device
2.
[0342] In FIG. 84 the protective shield 184 covers the blade 4 when
not in use. In FIG. 85, when the introducer 5 is pushed against the
skin, the shield 184 begins to retract exposing the blade 4. In
FIG. 86, as soon as the blade 4 passes through the abdomen wall,
the shield 184 springs back to cover the blade 4. In FIGS. 87 and
88, the introducer 5 can now be pushed further inside to release
the O-ring 9.
[0343] Referring to FIGS. 89 to 102 there is illustrated another
apparatus 500 for inserting a surgical device at least partially
through a wound opening according to the invention, which is
similar to the apparatus 310 of FIGS. 75(l) to 75(y), and similar
elements in FIGS. 89 to 102 are assigned the same reference
numerals.
[0344] In this case the apparatus 500 comprises a holder element
501 concentrically mounted around the conveying device 5. The
holder element 501 is suitable for holding the distal ring 9 of the
wound retractor device 2 in a low-profile configuration, in this
case an oval-shaped configuration (FIG. 95), during insertion of
the distal ring 9 through the wound opening 3.
[0345] The holder element 501 is longitudinally slidable relative
to the conveying device 5 between a holding configuration in which
the distal ring 9 is held in the low-profile, oval configuration
(FIG. 96), and a release configuration in which the distal ring 9
is released (FIG. 94).
[0346] In use the distal ring 9 of the wound retractor device 2 is
hooked onto the introducer handle 5 by means of the hook 6 (FIG.
94). The distal ring 9 is compressed into the low-profile, oval
configuration (FIG. 95), and the holder element 501 is slid
distally along the conveying device 5 from the release
configuration to the holding configuration to hold the distal ring
9 in the low-profile, oval configuration (FIG. 96). The blade 4 is
exposed by the surgeon depressing the thumb switch 312 (FIG. 97).
The introducer 5 is advanced until the surgeon sees the blade 4
appearing through the abdominal wall 8 on his monitor (FIG. 98).
The surgeon removes his thumb from the thumb switch 312. The spring
313 extends, causing the blade 4 to retract safely into the
introducer handle 5 (FIG. 99). There is thus provided a safe, blunt
introducer 5 which the surgeon advances into the abdomen until the
distal ring 9 in the low-profile, oval configuration is fully
inside (FIG. 100). The holder element 501 is slid proximally along
the conveying device 5 from the holding configuration to the
release configuration to release the distal ring 9 (FIG. 101). The
introducer 5 is withdrawn from the incision 3 leaving the distal
ring 9 in the abdomen and the wound retractor device 2 is ready to
be deployed to retract the incision 3 (FIG. 102).
[0347] In FIG. 89, the ring retainer 501 is fully retracted and the
blade 4 is fully retracted.
[0348] In FIG. 92 the ring retainer 501 is fully advanced and the
blade 4 is fully exposed.
[0349] In FIG. 97 the thumb switch 312 is pushed down to expose the
blade 4.
[0350] In FIG. 98 the introducer 500 easily advances through the
abdominal wall 8 because the distal ring 9 is compressed and does
not present any excess width. The blade 4 is seen on a laparoscope
to be just extending into the abdomen.
[0351] In FIG. 99 the surgeon removes his finger from the
thumbswitch 312. The internal spring now automatically retracts the
blade 4.
[0352] In FIG. 100 the introducer 500 can now be safely advanced
into the abdomen.
[0353] In FIG. 101, the ring retainer 501 is pulled back up. The
distal ring 9 is released and is no longer compressed.
Alternatively the distal ring 9 could be ejected instead of
withdrawing the holder element 501.
[0354] In FIG. 102, the introducer 500 is withdrawn from the
incision 3. The distal ring 9 simply falls off the hook 6 and
remains in the abdomen. The buttonhole device 2 is ready to be
fired.
[0355] In FIGS. 103 to 107, there is illustrated another apparatus
510 for inserting a surgical device at least partially through a
wound opening according to the invention, which is similar to the
apparatus 230 of FIGS. 21(a) to 21(l), and similar elements in
FIGS. 103 to 107 are assigned the same reference numerals.
[0356] In this case the blade element 4 is movable relative to the
housing portion 22 between an extended configuration (FIG. 104) and
a retracted configuration (FIG. 105). An actuator 511 is provided
extending through a slot 512 in the housing portion 22 to
facilitate movement of the blade element 4 between the extended
configuration and the retracted configuration.
[0357] In use, the distal ring 9 of the wound retractor device 2 is
compressed and inserted through the opening 231 into the housing
portion 22 with the sleeve of the wound retractor device 2
extending out of the housing portion 22 through the opening 231.
The apparatus 510 is extended through the tissue 8 with the blade
element 4 in the extended configuration to create the wound opening
3 (FIG. 104). When the blade element 4 has passed fully through the
tissue 8 and is located within the wound interior, the blade
element 4 is moved proximally to the retracted configuration by
means of the actuator 511 while the housing portion 22 is held in a
fixed position (FIG. 105). It is noted that the distal ring 9 has
been conveyed only partially through the wound opening 3 when the
blade element 4 is retracted.
[0358] The apparatus 510 is then advanced further through the wound
opening 3, and the plunger 24 is depressed to eject the distal ring
9 from within the housing portion 22 (FIG. 106). The apparatus 510
is withdrawn from the wound opening 3 leaving the wound retractor
device 2 in position extending through the wound opening 3 and with
the distal ring 9 distally of the wound opening 3 (FIG. 107).
[0359] The introducer 510 involves crushing the "O"-ring 9 down and
sliding it into a slot 231 in the shaft 22 of the introducer 510.
The slot 231 is at the distal tip of the shaft 22 so as to make
firing the distal ring 9 safer.
[0360] In FIG. 103, the "O"-ring 9 is compressed and slid inside
the shaft 22. The housing portion 22 may have an oval-shaped
cross-section.
[0361] In FIG. 104 the introducer 510 is pushed into the abdomen
wall 8. When the blade 4 is visible, the blade activation lever 511
is pulled up (FIG. 105) and the introducer 510 can be pushed in
further if needed.
[0362] In FIG. 106 the plunger activation lever 24 is pushed
downwards releasing the "O"-ring 9 and sleeve into the abdomen.
[0363] FIGS. 108 to 115 illustrate another apparatus 520 according
to the invention, which is similar to the apparatus 300 of FIGS. 82
to 88, and similar elements in FIGS. 108 to 115 are assigned the
same reference numerals.
[0364] In this case the blade element 4 is fixedly attached to the
distal end 7 of the housing portion 22. The shield element 184 is
provided in the form of a tubular element concentrically mounted
around the housing portion 22. The shield element 184 is manually
movable relative to the housing portion 22 between the extended
shielding configuration (FIG. 108) and the retracted cutting
configuration (FIG. 109).
[0365] A cut-out portion 521 is provided in the shield element 184
to facilitate access to the opening 231 in the housing portion
22.
[0366] In this case the housing portion 22 has a substantially
oval-shaped cross-section, as illustrated in FIG. 111. By
streamlining the distal ring 9 into a compressed, oblong
configuration, it may be easier to pass the distal ring 9 through
the incision 3.
[0367] In use, the distal ring 9 of the wound retractor device 2 is
compressed and inserted through the cut-away portion 521 in the
shield element 184 and through the opening 231 into the housing
portion 22 (FIGS. 108 and 109). The apparatus 520 is passed through
the tissue 8 with the shield element 184 in the retracted cutting
configuration to create the wound opening 3 through the tissue 8
(FIG. 112). When the blade element 4 has passed fully through the
tissue 8 and is located within the wound interior, the shield
element 184 is pushed distally while holding the housing portion 22
in a fixed position to move the shield element 184 to the extended
shielding configuration (FIG. 113). It is noted that the blade
element 4 is shielded before the distal ring 9 has been conveyed
fully through the wound opening 3.
[0368] The apparatus 520 is inserted further through the wound
opening 3 until the opening 231 is fully within the wound interior.
The plunger 24 is then depressed to eject the distal ring 9 out of
the housing portion 22 through the opening 231 and through the
cut-away portion 521 (FIG. 114). The apparatus 520 is removed from
the wound opening 3 leaving the distal ring 9 within the wound
interior and the wound retractor device 2 extending through the
wound opening 3 (FIG. 115).
[0369] The introducer 520 uses a system where the "O"-ring 9 and
the sleeve are encapsulated inside the shaft 22. The sliding sheath
184 holds the "O"-ring 9 in place inside the shaft 22 and pushes
forward to cover the blade 4 and release the "O"-ring 9.
[0370] The shaft 22 of the introducer 520 is oval in shape allowing
easier compression of the "O"-ring 9.
[0371] When the blade 4 is visible through the underside of the
abdomen wall 8, the sliding sheath 184 can be pushed forward to
cover the blade element 4 (FIG. 113).
[0372] When the blade 4 is protected, the introducer 520 can be
pushed in further if desired. When in far enough, the plunger 24
can be pushed down via the plunger lever to release the "O"-ring 9
and sleeve into the abdomen (FIG. 114).
[0373] FIGS. 116 and 117 illustrate another apparatus 700 according
to the invention, which is similar to the apparatus 310 of FIGS.
75(l) to 75(y), and similar elements in FIGS. 116 and 117 are
assigned the same reference numerals.
[0374] In this case the apparatus 700 comprises a receiver housing
portion 651 similar to that described previously with reference to
FIGS. 24(k) to 24(m). The apparatus 700 comprises the housing 651
for the outer proximal ring and seal of the wound retractor 2, the
hook 6 and the blade 4. In use the handle 312 may be pushed down to
expose the blade 4.
[0375] It will be appreciated that the apparatus of the invention
are suitable for inserting a variety of surgical devices at least
partially through a wound opening. For example the surgical device
could be a wound retractor device as described previously. A
sealing valve may be mounted to the wound retractor device. The
sealing valve could be at least partially of a gelatinous
elastomeric material. The sealing valve could be mounted to the
wound retractor device before insertion through the wound opening
or after insertion through the wound opening.
[0376] It will be appreciated that the apparatus of the invention
may comprise an incising device in any suitable form. For example,
the incising device may comprise a flat-tipped blade element or a
pyramid-tipped blade element, or any other suitable blade
element.
[0377] In the embodiments of the invention described above, the
cutting element/blade element of the conveying device is pushed
fully through the thickness of the tissue to create a wound
opening. However it will be appreciated that the invention also
provides a method of creating a wound opening in tissue in which
the cutting element/blade element is pushed through the tissue only
until the leading tip emerges on the interior side of the tissue.
The cutting element/blade element may then be withdrawn and the
distal ring of the surgical device pushed distally through the
partially created wound opening. As the distal ring is pushed
distally, the sides of the partially created wound opening are
forced apart to create a wound opening. This method results in a
smaller incision size and reduces the risk of herniation, by
relying on the elasticity of the tissue to create the wound opening
rather than relying on a larger incision size.
[0378] The invention is not limited to the embodiments hereinbefore
described, with reference to the accompanying drawings, which may
be varied in construction and detail.
* * * * *