Note: Descriptions are shown in the official language in which they were submitted.
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SURGICAL HAND ACCESS APPARATUS
This application is a division of Canadian Patent No. 2,560,154 filed
April 5, 2005,
BACKGROUND
I. Field of the Disclosure
The present disclosure relates generally to surgical devices for facilitating
sealed access across a body wall and into a body cavity and, more
particularly, to a
surgical access apparatus adaptable to provide selective retraction of an
incision to permit
the sealed insertion of either the surgeon's hand and/or surgical instruments
during
laparoscopic and endoscopic surgical procedures.
2. Description of the Related Art
Minimally invasive surgical procedures including both endoscopic and
laparoscopic procedures permit surgery to be performed on organs, tissues and
vessels far
removed from an opening within the tissue. Laparoscopic and endoscopic
procedures
generally require that any instrumentation inserted into the body be sealed,
i.e. provisions
must be made to ensure that gases do not enter or exit the body through the
incision as,
e.g., in surgical procedures in which the surgical region is insufflated.
These procedures
typically employ surgical instruments which are introduced into the body
through a
cannula. The cannula has a seal assembly associated therewith. The seal
assembly
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provides a substantially fluid tight seal about the instrument to preserve the
integrity of
the established pneumoperitoneum.
Minimally invasive procedures have several advantages over traditional
open surgery, including less patient trauma, reduced recovery time, reduced
potential for
infection, etc... However, despite its recent success and overall acceptance
as a preferred
surgical technique, minimally invasive surgery, such as laparoscopy, has
several
disadvantages. In particular, surgery of this type requires a great deal of
surgeon skill in
order for the surgeon to manipulate the long narrow endoscopic instruments
about a
remote site under endoscopic visualization. In addition, in laparoscopic
surgery
involving the intestinal tract, it is often preferable to manipulate large
sections of the
intestines to perform the desired procedure. These manipulations are not
practical with
current laparoscopic tools and procedures accessing the abdominal cavity
through a
trocar or cannula.
To address these concerns, recent efforts have focused on hand-assisted
laparoscopic techniques and procedures. These procedures incorporate both
laparoscopic
and conventional surgical methodologies. The hand assisted technique is
performed in
conjunction with a hand access seal which is an enlarged device positionable
within the
incision in, e.g., the insufflated abdominal cavity. The device includes a
seal for forming
a seal about the surgeon's arm upon insertion while permitting surgical
manipulation of
the arm within the cavity. However, known hand access seals are quite
cumbersome,
incorporate elaborate sealing mechanisms and are incapable for selective
retraction of an
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incision. Moreover, these hand access seals are incapable of conversion for
use with
laparoscopic instruments.
SUMMARY
Accordingly, the present disclosure relates to a surgical access apparatus
adaptable to pennit the sealed insertion of either the surgeon's hand and/or
surgical
instruments during laparoscopic and endoscopic surgical procedures. In one
preferred
embodiment, the surgical access apparatus includes an inner member adapted for
insertion through an opening within body tissue for positioning within the
body, at least
one tensioning element extending from the inner member and. an outer member
for
positioning outside the body. The outer member includes a first element and a
second
element. The second element is operatively connected to the at least one
tensioning
element and adapted for rotational movement relative to the first member to
cause
retraction of the tissue defining the opening within the body. The at least
one tensioning
element is preferably connected to the inner member, and is adapted to
displace the inner
member toward the outer member upon rotation of the second element.
Preferably, a plurality of tensioning elements is provided. The second
member is adapted to rotate relative to the first member to reduce effective
lengths of the
tensioning elements to displace the inner member toward the outer member into
engagement with an internal body wall and to retract the tissue defining the
opening. A
liner member may be connected to the inner member and dimensioned to extend
from the
inner member through the opening within the body tissue and defining a
passageway
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therethrough for permitting passage of an object. The tensioning elements may
be
embedded within the liner member and are movable relative to the liner member.
The second element of the outer member is adapted to be secured at a
predetermined angular orientation relative to the first element to selectively
tension the at
least one tensioning element. Preferably, the second element is adapted to be
secured at a
plurality of predetermined angular relationships relative to the first member.
Means may
be provided for selectively securing the first and second elements at a
plurality of relative
angular relationships. One preferred means for selectively securing includes a
ratchet
and pawl mechanism associated with the first and second elements.
The outer member may include a seal mounted relative to the passageway
of the liner member. The seal is adapted to form a fluid tight seal about an
object
inserted therethrough. The outer member may also include a zero closure valve
mounted
relative to the liner member and adapted to form a fluid tight seal in the
absence of an
object positioned therethrough. The zero-closure valve may be a duck bill
valve.
In another preferred embodiment, the surgical access apparatus includes a
liner base and an access housing for positioning outside the body. The liner
base includes
an inner member adapted for insertion through an opening within body tissue
for
positioning within the body, a sleeve member connected to the inner member and
dimensioned to extend from the inner member through the opening within the
body
tissue, and a plurality of tensioning elements connected to the inner member
and
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associated with the sleeve member to impart a tensioning effect on the sleeve
member.
The access housing includes a first element and a second element. The second
element is
operatively connected to the tensioning elements and adapted for rotational
movement
relative to the first member to cause the tensioning elements to displace the
inner member
toward the access housing and to cause the sleeve member to engage and retract
tissue
defining the opening within the body. The tensioning members are adapted to
move
relative to the sleeve member upon rotation of the second element and may be
embedded
within the sleeve member. A seal is preferably mounted to the access housing
and is
adapted to form, a fluid tight seal about an object inserted tlaerethrough. A
zero closure
valve may also be mounted relative to the liner member for forming a fluid
tight seal in
the absence of an object positioned therethrough. The second member of the
access
housing is adapted to be selectively secured at a predetermined rotational
relationship
with respect to the first member to provide for selective tensioning of the
tensioning
elements and selective retraction of tissue.
BRIEF DESCRIPTION OF THE DRAWINGS
Preferred embodiments of the present disclosure will be better appreciated
by reference to the drawings wherein:
FIG. I is a perspective view of the hand access apparatus in accordance
with the principles of the present disclosure illustrating the access housing
and the liner
base;
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FIG. 2 is a perspective view with parts separated illustrating the
components of the access apparatus in accordance with the embodiment of FIG.
1;
FIG. 3 is a side cross-sectional view of the access housing;
FIG. 4 is a top cross-sectional view of the access housing;
FIG. 5 is a perspective view of the outer base of the access housing;
FIG. 6 is an isolated view illustrating the ratchet arm of the outer base;
FIG. 7 is an isolated view illustrating the suture receiving slots of the
ratchet ring of the access housing;
FIG. 8 is an isolated view illustrating the ratchet teeth of the ratchet ring
of
the access housing;
FIG. 9 is a side cross-sectional view of the liner base of the access housing
illustrating the liner sleeve, upper and lower rings and the suture tensioning
members;
FIG. 10 is a perspective view of the upper ring of the liner base;
FIG. 11 is an isolated view illustrating the annular grooves and suture slots
within the upper ring;
FIGS. 12-13 are isolated views illustrating mounting of the suture
tensioning members of the liner base to the ratchet ring;
FIG. 14 is a cross-sectional view taken along the lines 14-14 of FIG. 13
further illustrating the relationship of the tensioning members and the
ratchet ring;
FIGS 15-16 are views illustrating positioning of the hand access apparatus
of FIG. 1 within an incision;
FIGS. 17-18 are isolated views illustrating the orientation of the suture
tensioning members before and subsequent to rotation of the outer base;
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FIG. 19 is a top view illustrating retraction of the incision subsequent to
rotation of the outer base;
FIG. 20 is a side cross-sectional view similar to the view of FIG. 3 further
illustrating retraction of the incision;
FIG_ 21 is a view illustrating insertion of a hand through the access
apparatus;
FIGS. 22-23 are perspective views of a trocar adapter for use with the
access apparatus in accordance with the embodiment of FIG. 1;
FIG. 24 is a side cross-sectioned view taken along the lines 24-24 of FIG.
23;
FIG. 25 is a perspective view of an alternate embodiment of the outer base
of the access housing;
FIG. 26 is a cross-sectional view taken along the lines 26-26 of FIG. 25
illustrating the suture forks of the outer base of the embodiment of FIG. 25;
FIG. 27 is a perspective view of an alternate embodiment of the access
housing of the access apparatus of FIG. 1;
FIG. 28 is a perspective view of a gear wheel of the access housing of the
embodiment of FIG. 27;
FIG. 29 is a bottom view of the gear ring of the access housing of FIG. 27;
FIGS. 30 is a perspective view with parts separated of the access housing
of FIG. 27; and
FIG. 31-32 are side cross-sectional view illustrating operation of the gear
wheels during rotation of the gear ring of the access housing of FIG. 27.
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DETAILED DESCRIPTION OF THE PREFERRED EMBODEVIENTS
The surgical access apparatus of the present disclosure provides a
substantial seal between the body cavity of a patient and the outside
atmosphere before,
during and after insertion of an object through the apparatus. Moreover, the
access
apparatus of the present invention is adapted for positioning within an
incision and is
capable of selectively retracting the tissue defining the incision to permit
access to the
underlying tissue. The access apparatus is particularly adapted for
accommodating the
hand and/or arm of a surgeon during a hand assisted laparoscopic procedure and
establishing a gas tight seal with the arm when inserted. However, the access
apparatus
may be adapted to receive other objects, such as surgical instruments. The
access
apparatus is further adapted to substantially close in the absence of the
object to maintain
the integrity of the insnfflated peritoneal cavity.
Although the specific focus of this disclosure will be on a preferred
laparoscopic procedure, it will be noted that laparoscopic surgery is merely
representative
of a type of operation wherein a procedure can be performed in a body cavity
with access
through a body wall.
In the following description, as is traditional the term "proximal" refers to
the portion of the instrument closest to the operator, while the term "distal"
refers to the
portion of the instrument remote from the operator.
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Referring now to the drawings, in which like reference numerals identify
identical or substantially similar parts throughout the several views, FIGS. 1
- 4 illustrate
the access apparatus of the present disclosure. Access apparatus 100 generally
includes
two main components, namely, access housing 102 defining longitudinal axis "a"
and
liner base 104 which extends from the housing 102. Housing 102 includes
several
components which, when assembled, provide a unit which is postionable against
the body
of the patient. Specifically, housing 102 includes outer base 106, ratchet
ring 108
disposed within the outer base 106 and ratchet hub 110. Each of outer base
106, ratchet
ring 108 and ratchet hub 110 are preferably annular or ring-like in
configuration defining
a central aperture to permit access within housing 102.
With reference to FIGS. 5-6, in conjunction with FIGS. 1-4, outer base
106 will be discussed. Outer base 106 serves as the peripheral element
enclosing the
remaining components of housing 102. Outer base 106 includes a plurality
(e.g., two) of
ratchet arms 112 peripherally spaced adjacent its lower surface 114. Each
ratchet arm
112 is spring biased radially inwardly relative to longitudinal axis "a" and
defines a
locking shelf 116 for engagement with components of ratchet ring 108. (See
FIGS. 4-6)
In one preferred arrangement, outer base 106 is monolithically formed of a
plastic
resilient material whereby ratchet arms 112 are normally biased inwardly but
are capable
of deflecting outwardly to accommodate a ratcheting action or movement of the
arms
112. The lower surface 114 of outer base 102 further includes a plurality of
depending
contact posts 118 peripherally spaced about the surface 114. Outer base 106 is
adapted
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for rotational movement about longitudinal axis "a" relative to ratchet ring
108 and
ratchet hub 110 in the direction depicted by the directional arrow "B" in FIG-
. 4.
Referring now to FIGS. 7-8, in view of FIGS. 2-4, ratchet ring 108 and
ratchet hub 110 are disposed around a lower end of the outer bass 106. Ratchet
ring 108
includes a plurality of external ratchet teeth 120 which cooperate with
ratchet arms 112 of
outer base 106 to selectively lock the relative position of outer base 106 and
ratchet ring
108. Ratchet ring 108 further includes a plurality of upwardly extending tabs
122 (FIGS.
2 and 7) which are received within correspondingly positioned apertures 124
(FIG. 2) of
ratchet hub 110. Tabs 122 may include locking shelves 126 which engage ratchet
hub
110 to secure the ratchet ring 108 and ratchet hub 110. In alternative
embodiments, the
ratchet ring 108 and ratchet hub 110 are integrally formed in a single
structured. In a
preferred embodiment, ratchet ring 108 and ratchet hub 110 are stationary.
Ratchet ring
108 further includes a plurality of slots 128 within inner peripheral wall 130
and aperture
132 in outer peripheral wall 134. Ratchet ring 108 further defines u-shape
trough 136
(FIG. 3) which contacts the skin of the patient during use.
Referring again to FIGS. 1-4, access housing 102 further includes valve
support 138, duck bill valve 140 and septum seal 142. Valve support 138 is an
elongated
annular collar which extends within outer base 106. The upper surface 144 of
valve
support 138 defines a plurality of upwardly extending posts 146 peripherally
spaced
about the upper surface 144. Duck bill valve 140 is mounted to valve support
138. The
duckbill valve 140 preferably comprises an elastomeric material. Specifically,
duck bill
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valve 140 includes circumferential flange 148 having a plurality of apertures
150.
Apertures 150 are dimensioned to receive correspondingly positioned posts 146
of valve
support 138 to fix the valve 140 relative to the valve support 138_ Duck bill
valve 140
further includes lower or distal flange 152 which is positioned between the
lower surface
154 of the valve support 138 and an interior ledge 156 of ratchet hub 110.
(FIG. 3) Duck
bill valve 140 defines a pair of interior walls 158 obliquely arranged
relative to the
longitudinal axis and terminating in adjacent relation to define a slit 160.
Slit 160 opens
to permit passage of an object by deflection of walls 158 and closes in the
absence of the
object as facilitated by the pressure of insufflation gases within the cavity,
i.e., duck bill
seal is a zero-closure seal. Alternatively, other zero closure seals may also
be
incorporated within apparatus 100.
With continued reference to FIGS. 1-4, septum seal 142 is positioned
adjacent duck bill valve 140. Septum seal 142 includes a peripheral seal area
162
surrounding central aperture 162a. Peripheral area 162 includes a plurality of
openings
164 which receive the upper ends of posts 146 of valve support 112 to fix the
septum seal
142 within housing 102. Seal 142 is adapted to form a substantial seal about
an object
inserted through aperture 162a and may stretch to accommodate larger size
objects.
Septum seal 142 is preferably formed of an elastomeric material. Although
described as
a septum seal, it is appreciated that seal 142 could be a slit valve, balloon
valve, gel seal
or any other seal available in the art_ In one embodiment, seal 142 preferably
comprises a
gel material such as a soft urethane gel, silicon gel, etc. and preferably has
compressible
characteristics to permit the seal 142 to conform and form a seal about the
outer surface
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of a surgeon's hand and/or arm. during insertion and manipulation about the
operation
site.
In an alternate preferred embodiment, seal 142 is fabricated from a
resilient material, e.g., polyisoprene, and has at least one layer of fabric
material
positioned adjacent the resilient material. The seal 142 may be fabricated
from ari
elastomeric material molded with a fabric manual. A. friction resisting
coating may be
applied to seal 142. This seal is disclosed in commonly-assigned U.S. Patent
No.
6,702.787. Other valve types are also contemplated including zero-closure
valves,
septum valves, slit valves, double-slit valves, inflatable bladders, other
foam or gel
valve arrangements, etc.
With continued reference to FIGS. 1-4, housing 102 further includes cover
166 which is positioned over septum seal 142 to substantially enclose valve
support 138,
duck bill valve 140 and septum seal 142. Cover 166 includes an aperture 168 to
permit
access to the interior of housing 102. Preferably, cover 166 incorporates
structure to
engage a corresponding surface or structure of ratchet ring 108 or ratchet hub
110 to
secure the cover 166 within housing 102. For example, cover 166 may include a
plurality
of tabs I 66a on its exterior surface which lock into corresponding recesses -
within ratchet
ring 108 or ratchet hub 110. Other means for connecting cover 102 within
housin.c. 102
are also envisioned. The cover 166, outer base 106, ratchet ring 108 and
ratchet hub 110
are desirably formed from a relatively rigid polymeric material such as
polycarbonate.
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Referring now to FIGS. 1-3 and 9-11, liner base 104 will be discussed.
Liner base 104 is intended for positioning within the incision of the patient
to line the
incision and/or retract the tissue defming the incision thereby enhancing
access to the
underlying body cavity. Liner base 104 includes sleeve 168, lower ring 170 and
upper
ring 172 connected to respective ends of the sleeve 168. Sleeve 168 may be a
sheet of
flexible material including, for example, polyethylene, polypropylene, etc.,
arranged in a
tubular configuration. Preferably, sleeve 168 is double walled as shown in
FIG. 9 and
defines enlarged ring-like areas 174 to accommodate lower and upper rings 170,
172.
Sleeve 168 may also include an elastomeric material. Although in the preferred
embodiment, sleeve 168 is tubular, it is envisioned that the sleeve 168 may
incorporate
several pieces, e.g., individual tabs or the like. Sleeve 168 may or may not
be impervious
to fluids, but preferably protects an incision through tissue from
contamination.
Lower ring 170 is adapted for positioning through the incision and beneath
the abdominal wall to engage the interior wall portions to thereby secure
sleeve 168
relative to the incision. Lower ring 170 is preferably flexible to facilitate
passage through
the incision and possesses sufficient resiliency to return to its original
configuration upon
entering the abdominal cavity. Lower ring 170 includes a plurality of
longitudinal
openings 176 and annular grooves 178 as depicted in FIGS. 10 and 11. Grooves
178
facilitate collapsing of lower ring 170 upon itself when passing through the
incision. In
alternative embodiments, the ring 170 may be flexible enough to deform while
being
inserted through an incision, without incorporating grooves 178. Lower ring
178 is
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preferably annular or ring-like in configuration and may be fabricated from an
elastomeric material. Lower ring 170 is accommodated within the enlarged ring-
like area
174 of sleeve 168.
Referring now to FIGS. 2 and 9, upper ring 172 of liner base 104 is
substantially identical in configuration to lower ring 170. As best depicted
in FIG. 3,
upper ring 172 is accommodated within the enlarged ring-like area 174 of
sleeve 168. In
the assembled condition, upper ring 172 is received within u-shape trough 136
of ratchet
ring 108 and is secured between the trough 136 and lower surface 180 of
ratchet hub 110
(FIG. 3).
õ
Liner base 104 further includes a plurality of tensioning members 182
which extend within the doubled wall of sleeve 168. Tensioning members 182 are
secured to lower ring 170 and extend out from sleeve 168 through openings 184
provided
in upper ring 172. Tensioning members 182 may comprise strings, tabs or the
like,
including sutures. In one embodiment, the ends 182a of tensioning members 182
are
secured within lower ring 170 with suture ferrules 186. Other means to connect
the
suture ends 182a to lower ring 170 are also envisioned. Tensioning members 182
move
within sleeve 168 upon rotation of outer base 106 of access housing 102 to
displace lower
ring 170 toward upper ring 172 and access housing 102.
As depicted in FIGS. 12-14, the outer ends 182b of tensioning members
180 are accommodated within receiving slots 128 of ratchet ring 108 and extend
through
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openings 186 of outer wall 134 of the ratchet ring 108. Tensioning members 182
are
secured within openings 186 of ratchet ring 108 by conventional means
including with
the use of suture ferrules 188, or anchors, knots, etc. Tensioning members 182
are
adapted to slide within sleeve 168 upon rotation of outer base 106 to displace
lower ring
170 toward upper ring 172 so as to bring the lower ring 170 into engagement
with the
inner body wall. By rotation of outer base 106, the effective lengths of
tensioning
members 182 are reduced. Such motion also imparts a tensioning and retracting
effect on
sleeve 168 to cause the sleeve 168 to engage and retract tissue defining the
incision.
Tensioning members 182 may be any suitable flexible member including sutures,
cables,
drawstrings or the like.
In further embodiment, the sleeve incorporates tensioning members in a
wall of the sleeve or extending from an upper end of the sleeve so that the
tensioning
members and sleeve are integral with one another.
Operation
The use of the access apparatus 100 in connection with a hand assisted
laparoscopic surgical procedure will be discussed. The peritoneal cavity is
insufflated
and an incision is made within the cavity, with e.g., a trocar, to provide
access to the
cavity as is conventional in the art. Thereafter, as depicted in FIGS. 15-16,
liner base 104
is introduced within the incision.. Specifically, lower ring 170 is passed
through the
incision and placed within the body cavity. As noted, lower ring 170 may be
contracted
upon itself to facilitate passage through the incision and then released to
permit the lower
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ring 170 to return to its noinial condition (under the influences of its
inherent resiliency)
within the cavity. Liner sleeve 168 extends from lower ring 170 through the
incision to
line the incision as previously discussed.
The procedure is continued by positioning access housing 102 adjacent the
external body tissue with the outer surface of trough 136 of ratchet ring 108
engaging the
tissue surrounding the incision. Thereafter, when it comes desirable to
increase the size
of the incision, outer base 106 is rotated in the direction of directional
arrow "B" of
FIG. 4. As outer base 106 rotates, engaging posts 118 of outer base 106 engage
tensioning members 182 to deflect the tensioning members 182 from the
arrangement
shown in FIG. 17 to the arrangement shown in FIG. 18. During this movement,
the
tensioning members 182 draw lower ring 170 of liner base 104 toward upper ring
172.
Simultaneously, a tensioning effect is imparted to sleeve 168 which causes the
sleeve 168
to retract tissue. As appreciated, the amount of deflection of tensioning
members 182
through rotation of outer base 106 is selectively controllable through the
associated
ratchet mechanism. In addition, the sleeve 168 is tensioned and the tissue is
retracted
without requiring the surgeon to pull on or otherwise arrange the sleeve 168.
Outer base
106 may be rotated relative to ratchet ring 108 sufficiently to draw the lower
ring 170 of
liner base 104 into engagement with the interior wall of the body cavity. FIG.
20
=
illustrates lower ring 170 engaged with the inner wall of the body cavity with
sleeve 168
retracting tissue "t" defining the incision.
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With access apparatus 100 in this position of FIG. 20, hand assisted
surgery may then be effected by advancement of the surgeon's hand and arm
through
seals 142, 140 of access housing 102 and into the body cavity (FIG. 21). Seal
142 forms
a fluid tight seal about the arm. The desired hand assisted procedure may then
be
performed.
One other salient feature of access apparatus 100 is the ability to convert
hand access apparatus 100 for use with laparoscopic instrumentation. In this
regard; and
with reference to FIGS. 22-24, a trocar adapter 200 is provided. Trocar
adapter 200
includes adapter base 202 and valve assembly 204 which is -mounted to the
adapter base
202. Adapter base 202 includes trocar sleeve 206, inner wall 208 extending
from the
sleeve 206 and peripheral flange 210. Trocar sleeve 206 is a tube-like
structure having a
longitudinal opening defining an internal dimension suitable for passage of
surgical
instrumentation. The proximal end of trocar sleeve 206 extends beyond inner
wall 208
for attachment to valve assembly 204. Adapter base 202 is preferably
monolithically
formed as a single unit and may be fabricated from a suitable polymeric
material through
injection molding techniques. Alternatively, adapter base 202 may be formed of
a
suitable biocompatible metal material like stainless steel, titanium, titanium
alloys etc.
Adapter base 202 is preferably releasably mounted to access housing 102.
In one preferred arrangement, adapter base 202 includes peripheral tabs 212
depending
from its lower surface which engage recesses 166a of cover 166 to secure the
base 202 to
the cover. Other means for releasably connecting adapter base 202 to access
housing 102
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are also envisioned including a bayonet coupling, friction fit, tongue and
groove, etc.
Adapter base 202 may also be tethered to access housing 102 to provide a flip-
top
arrangement.
Valve assembly 204 may be any conventional trocar seal system adapted
for mounting to a trocar sleeve and forming a fluid tight seal about an
endosconic
instrument ranging in diameter from about 3mm to about 15mrn. In one preferred
embodiment, valve assembly 204 is of the type available from United States
Surgical
Corporation of Norwalk. Connecticut under the tradensrne, VERSAPORTPLUSTm. The
VERSATORTPLUSTm seal includes a valve housing 214, a gimbal valve 216 mounted
within the housing and a zero-closure or duck-bill valve 218 extending from
the valve
housing 214 and into trocar sleeve 206. Gimbal valve 216 is adapted to swivel
or rotate
within valve housing 214 about a central axis of rotation to accommodate
offset
manipulation of the instrument inserted through valve assembly 204. Duck bill
valve 218
is adapted to open in the presence of an instrument and. close to function as
a zero closure
seal in the absence of an instrument. Valve housing 214 is connected to the
proximal end .
of trocar sleeve 200 through any conventional means including adhesives,
bayonet
coupling, etc. Other valve assemblies for incorporation into adapter 200 are
also
envisioned such as the valve assemblies disclosed in commonly assigned U.S.
Patent Nos. 6.482.] 81, 5,820,600, RE 36,702 and U.S. Patent No. 6,942,671.
Once mounted, trocar sleeve 206 extends through aperture 162a of seal 142.
Seal 142 forms a fluid-tight seal about the outer surface of trocar sleeve
206.
Instrumentation is introduced through valve
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assembly 204 and trocar sleeve 206 to carry out the desired procedures. As
mentioned,
gimbal valve 216 of valve assembly 204 forms a fluid tight seal about the
instrument and
permits manipulation of the instrument within the operative site.
FIGS. 25-26 illustrate an alternate embodiment of the outer base 106 of
access housing 102. In accordance with this embodiment, the contact posts 118
which
engage tensioning members 182 during rotation of the outer base 106 are
replaced with
forks 190. Forks 190 depend downwardly from the lower suture of outer base 106
at an
oblique angle and capture the tensioning members 182 during rotation of outer
base 106.
In all other regards, access apparatus 100 operates in the same manner as that
described
in connection with the embodiment of FIG. 1.
FIGS. 27-32 illustrate another alternate embodiment of the present
disclosure. In accordance with this embodiment, access apparatus 300 includes
access
housing 302 having wheel mount 304, wheel hub 306 mounted to the wheel mount
304
and gear ring 308. Wheel mount 304 and hub 306 are secured to each other
through
corresponding engagement of tabs 310 of the wheel mount 304 and slots 312 of
the wheel
hub 306. Wheel mount 304 and wheel hub 306 are stationary. Wheel mount 304
includes a plurality of gear wheels 316 mounted about the periphery of the
wheel mount
304. Gear wheels 316 rotate about their respective individual axes. Any means
for
mounting gear wheels 316 to wheel mount 304 are envisioned. Each gear wheel
316
includes slotted opening 318 extending transverse to the axis of rotation of
the gear
wheels 316. Slotted openings 318 receive the ends of tensioning members 182 of
liner
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base 104. The extreme ends of tensioning members 182 are secured to wheel
mount 304
by secured engagement with suture mounts 320 disposed about the periphery of
wheel
mount 304.
Gear ring 308 includes a plurality of gear teeth 322 depending from its
lower surface (FIG. 29). Gear teeth 322 engage the teeth of gear wheels 316
during
rotation of gear ring 308 relative to wheel mount 304 and wheel hub 308. Gear
ring 308
a iso includes tab 324. Tab 324 may be spring biased radially inwardly and is
adapted to
be received within corresponding openings 326 of gear hub 306 upon rotation of
the gear
ring 308. In this manner, gear ring 308 may be selectively secured at desired
rotational
orientations relative to gear wheel 304 and gear hub 306.
Liner base 104 of access apparatus 300 is identical to the liner base 104
described in connection with FIG. 1.
FIGS. 31-32 illustrate operation of access apparatus 300. Subsequent to
positioning liner base 104 within the incision, gear ring 308 is rotated in
the direction of
the directional arrow shown in FIG. 32 to cause gear wheels 316 to rotate
about their
respective axes. This rotation causes displacement of tensioning members 182
in the
manner depicted in FIG. 32 to thereby impart a tensioning affect on the
tensioning
members 182. Desirably, the gear wheels 316 include an integral spool for
winding the
tensioning members. Inner ring 170 of liner base 104 is thus drawn upwardly
preferably
in engagement with the body cavity wall. In addition, such action causes
sleeve 168 of
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CA 02808281 2013-03-05
liner base 104 to retract tissue in the manner previously described in.
connection. with
FIG. 1. As noted, tab 324 of gear ring 308 selectively secures the gear ring
308 at a
desired rotational relationship relative to gear wheel 304 and gear 'nub 306.
If g,-reater
tension or retraction is required, gear ring may be further rotated to penlait
tab 324 to be
received in the next successive opening 326 of gear hub 306.
Thus, the access apparatus of the present disclosure provides for selective
retraction of tissue during a hand-assisted laparoscopic surgical technique.
Moreover, the
apparatus may be utilized in conjunction with hand-assisted laparoscopic
procedures and
more conventional instrument-assisted laparoscopic procedures. This
flexibility and
adaptability sigaificantly reduces the number of incisions required within the
abdominsi
cavity thus minimizing patient trauma and infection, and. improving recovery
time.
It will be understood that various modifications may be made to the
embodiments disclosed herein. Therefore, the above description should not be
construed
as limiting, but merely as exemplifications of preferred embodiments. The
scope of the
claims should not be limited by the preferred embodiments set forth herein_
but should
be given the broadest interpretation consistent with the description as a
whole.
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