US20160135839A1 - Surgical introducer and access port assembly - Google Patents
Surgical introducer and access port assembly Download PDFInfo
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- US20160135839A1 US20160135839A1 US15/003,126 US201615003126A US2016135839A1 US 20160135839 A1 US20160135839 A1 US 20160135839A1 US 201615003126 A US201615003126 A US 201615003126A US 2016135839 A1 US2016135839 A1 US 2016135839A1
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- Prior art keywords
- port
- surgical
- elongated introducer
- introducer
- surgical apparatus
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
- A61B17/3423—Access ports, e.g. toroid shape introducers for instruments or hands
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/32—Devices for opening or enlarging the visual field, e.g. of a tube of the body
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
- A61B17/3423—Access ports, e.g. toroid shape introducers for instruments or hands
- A61B2017/3429—Access ports, e.g. toroid shape introducers for instruments or hands having a unitary compressible body, e.g. made of silicone or foam
Definitions
- the present disclosure relates to surgical access ports, and, more particularly, relates to an introducer and associated compressible port adapted to facilitate positioning of the port within tissue in connection with a laparoscopic surgical procedure
- Single Port Access (SPATM) surgery also known as Single Incision Laparoscopic Surgery (SILSTM) or One Port Umbilical Surgery (OPUS) or Natural Orifice TransUmbilical Surgery (NOTUS)
- SPATM Single Port Access
- LIMSTM Single Incision Laparoscopic Surgery
- OPUS One Port Umbilical Surgery
- NOTUS Natural Orifice TransUmbilical Surgery
- Surgical procedures of this type are like many laparoscopic surgeries in that the patient is under general anesthesia, insufflated and laparoscopic visualization is utilized.
- the port is inserted through an incision (e.g., 20 mm incision) via a surgical instrument, e.g., a port introducer device in the form of a Kelly clamp.
- the Kelly clamp method involves spreading, separating, and dividing subcutaneous tissue dissection).
- a surgeon's ability to properly place a port e.g., a SILSTM port, may present practical challenges due to the limited length of the Kelly clamp's arm and handle.
- a SILSTM port may present practical challenges due to the limited length of the Kelly clamp's arm and handle.
- the device is held in the palm of a surgeon's hand, sufficient visibility may not be possible using this technique without overly dilating the incision and compromising the seal.
- a SILSTM port challenging using the Kelly clamp method, but removal of the Kelly clamp after successful installation may also be difficult.
- improper loading of the Kelly clamp may result in the clamp's metal tips coming into unintentional contact with the surgical area, which may result in injury including scarring, pain, and/or longer convalescence.
- a surgical apparatus for permitting access to tissue includes an elongated introducer and a surgical port.
- the introducer includes an outer wall segment defining a longitudinal axis and a longitudinal port passage extending therethrough.
- the outer wall segment has a longitudinal slot in communication with the port passage.
- the elongated introducer is dimensioned for at least partial introduction within an opening in tissue.
- the surgical port includes a port body having leading and trailing ends, an intermediate segment disposed between the leading and trailing ends and at least one passageway for reception and passage of a surgical instrument.
- the port body is mounted to the elongated introducer with one of the leading and trailing ends disposed within the port passage and with the intermediate segment extending through the longitudinal slot and the other of the leading and trailing end external of the elongated introducer.
- the port body is dimensioned to be advanced within the port passage for deployment through the opening in the tissue as generally directed by the elongated introducer.
- the port body comprising a compressible material and is adapted to transition from a compressed state when mounted to the elongated introducer to a released state when deployed from the elongated introducer.
- the surgical elongated introducer may define introducer leading and trailing ends, and farther includes a retractor segment adjacent the introducer leading end.
- the retractor segment is dimensioned and configured to retract tissue surrounding the opening.
- the retractor segment may define an arcuate profile.
- the outer wall segment of the elongated introducer is substantially arcuate along a major portion of the length thereof.
- the retractor segment may define a general hook-shape and is arranged in oblique relation with the longitudinal axis.
- a pusher member may be at least partially disposed within the longitudinal port passage of the elongated introducer.
- the pusher member may be adapted for longitudinal advancement to engage and deploy the port body from the introducer and within the opening in tissue.
- the elongated introducer may include a handle mounted to the outer wall segment dimensioned for engagement by the user.
- the elongated introducer may be substantially rigid, flexible or include both rigid and flexible portions. At least a portion of the longitudinal slot is coated with a lubricious material.
- the outer wall segment of the elongated introducer may include first and second movable segments.
- Thee first and second movable segments may be adapted for movement between a generally open position and a generally approximated position, wherein, when in the open position, the one of the leading and trailing ends of the port body is positionable within the port passage, and, when in the approximated position, the port body is moved to the compressed state with the one of the leading and trailing ends disposed within the port passage, the intermediate segment extending through the longitudinal slot and the other of the leading and trailing end external of the elongated introducer.
- the first and second movable segments may be adapted for pivotal movement relative each other.
- the elongated introducer may include a substantially flexible portion and a rigid portion.
- the substantially flexible portion may be movable between a first position for securing the port therein to a second position for facilitating removal of the elongated introducer from the opening in the tissue.
- the substantially flexible portion may be dimensioned to extend substantially the length of the rigid portion.
- a retrieval structure may be operably coupled to the distal end of the elongated introducer.
- the retrieval structure may be selected from the group consisting of a suture, string and filament.
- FIG. 1A is a perspective view of a port and port introducer in accordance with an embodiment of the present disclosure
- FIG. 1A -1 is a cross-sectional view taken along line segment “ 1 A -1 - 1 A -1 ” of FIG. 1A ;
- FIG. 1B is a perspective view illustrating the port being loaded into the port introducer depicted in FIG. 1A ;
- FIG. 1C is a perspective view illustrating the port introducer accessing tissue and the port loaded within the port introducer
- FIG. 1D is a perspective view illustrating the port securely positioned within tissue of a patient
- FIG. 2A is a perspective view of a port and port introducer in accordance with an alternate embodiment of the present disclosure
- FIG. 2B is a perspective view illustrating the port being loaded into the port introducer mechanism depicted in FIG. 2A ;
- FIG. 2C a perspective view illustrating the port introducer accessing tissue and the port loaded within the port introducer
- FIG. 2D a perspective view illustrating the port securely positioned within tissue of a patient
- FIG. 3A is a perspective view illustrating a port and port introducer in accordance with an another embodiment of the present disclosure
- FIG. 3B is a front view of the port introducer depicted in FIG. 3A ;
- FIG. 3C is a perspective view illustrating the port introducer accessing tissue and the port loaded within the port introducer
- FIG. 3D is a perspective view illustrating the port securely positioned within tissue and the port introducer extracted from tissue;
- FIG. 4A is a perspective view of a port and port introducer in accordance with an embodiment of the present disclosure
- FIG. 4A -1 is a cross-sectional view taken along line segment “ 4 A -1 - 4 A -1 ” of FIG. 4A ;
- FIG. 4B is a side view of a rigid portion associated with the port introducer depicted in FIG. 4A ;
- FIG. 4C is a top elevational view of the rigid portion depicted in FIG. 4B ;
- FIG. 4D is a perspective view illustrating the port being loaded into the port introducer depicted in FIG. 4A ;
- FIG. 4E is a perspective view illustrating the port introducer accessing tissue and the port loaded within the port introducer
- FIG. 4F is a perspective view illustrating the port securely positioned within tissue of a patient
- FIG. 4G is a perspective view illustrating the port removed from tissue and the introducer being extracted from tissue
- FIG. 4H is a perspective view of a port introducer in accordance with an embodiment of the present disclosure.
- FIG. 4H -1 is a cross-sectional view taken along line segment “ 4 H -1 - 4 H -1 ” of FIG. 4H ;
- FIG. 4I is a side view of a rigid portion associated with the port introducer depicted in FIG. 4H ;
- FIG. 4J is a top elevational view of the rigid portion depicted in FIG. 4I .
- proximal refers to the end of the device that is closer to the user and the term “distal” refers to the end of the apparatus that is further from the user.
- the port introducers according to the present disclosure are configured to facilitate the introduction of an access port, e.g., a foam port, within a surgical incision of a patient. It is envisioned that the port introducers may be used in connection with other surgical procedures utilizing natural or formed openings in a body cavity of a patient. Embodiments of the present disclosure are illustrated in FIGS. 1A-4J .
- port introducer 10 includes an introducer assembly 100 that is suitable for use with a surgical foam port 200 .
- the port introducer 10 and foam port 200 may he manufactured and sold separately or provided as a kit.
- Introducer assembly 100 includes a substantially rigid elongated introducer or housing 102 dimensioned for at least partial introduction within an opening in tissue.
- housing 102 is of a unitary construction formed by any suitable manufacturing methods including but not limited to injection molding, overmolding, etc.
- Housing 102 may be formed from any suitable biocompatible material including rigid such as stainless steel, titanium, polymeric material and/or a resilient elastomeric material.
- housing 102 , or portion thereof, may be coated with or formed from a lubricious material 104 . More particularly, in the embodiment illustrated in FIGS.
- an internal surface 106 is coated with a layer of one or more types of fluoropolymers including without limitation, polytetrafluoroethylene (a.k.a. PTFE or Teflon®, manufactured by the E.I. du Pont de Nemours and Co. of Wilmington, Del., USA), see FIG. 1A , for example.
- a lubricious material 104 decreases the coefficient of kinetic friction ( ⁇ k) between the internal surface 106 and the port 200 and, thus, facilitates movement of the port 200 through housing 102 .
- the lubricious material 104 may be selected from the group consisting of polytetrafluoroethylene (PTFE), perfluoroalkoxy polymer (PFA), fluorinated ethylene-propylene (FEP).
- Housing 102 is configured to receive, compress and releasably secure the port 200 therein.
- housing 102 includes an outer wall segment 102 a defining a longitudinal axis “A-A” and a surgical port 200 passageway therethrough.
- Outer wall segment 102 a includes a slotted tube configuration with open proximal (or trailing) and distal (or leading) ends 108 and 110 , respectively.
- Housing 102 includes a proximal face 150 and a distal face 152 .
- the proximal end 108 may be closed.
- a longitudinal slot 114 is disposed adjacent the proximal face 150 and may extend at least partially along a length of the housing 102 . In the embodiment illustrated in FIGS.
- the longitudinal slot 114 extends along the length of the housing 102 from the proximal end 108 to the distal end 110 such that the housing 102 includes a generally “C” like configuration (see FIG. 1A -1 ).
- a pair of top edges 114 a and 114 b extend along the length of the longitudinal slot 114 and run parallel to the longitudinal axis “A-A” (see FIG. 1A -1 in conjunction with FIG. 1B ),
- the longitudinal slot 114 facilitates loading and unloading of the port 200 into the distal end 110 of the housing 102 .
- the longitudinal slot 114 is proportioned to move the port 200 toward a compressed state as the port 200 is pushed within the longitudinal slot 114 from the distal end 110 of the housing 102 toward the proximal end 108 of the housing 102 .
- Distal end 110 includes a leading edge 116 that is angled or slanted with respect to top edges 114 a and 114 b. More particularly, the leading edge 116 extends from a distal portion of the top edges 114 a and 114 b at an angle culminating at a distal insertion tip 118 .
- the angled leading edge 116 and distal tip 118 facilitate loading and unloading of the port 200 into the housing 102 and positioning the housing 102 into a tissue tract.
- distal tip 118 includes a retractor having a generally “hook” like shape 124 (or other suitable structure), see FIG. 1B .
- the retractor 124 may be employed to retract tissue, such as, for example, prior to insertion of the housing 102 into the tissue tract ( FIG. 1C ).
- Retractor 124 includes a generally arcuate or curved configuration and extends distally from the distal end 110 of the housing 102 in a generally oblique relation with the longitudinal axis “A-A.”
- the retractor 124 may be a separate structure operably coupled to the housing 102 at the distal end 110 thereof, or the retractor 124 may be monolithically formed with the distal tip 118 .
- a portion, e.g., the distal face 152 , of the distal tip 118 may curve toward the proximal end 108 forming the hook 124 .
- a gripping device or handle assembly may be operably coupled to the proximal end 108 .
- proximal end 108 includes a handle assembly 112 .
- Handle assembly 112 may operably couple to the proximal end 108 by any suitable means.
- handle assembly 112 may be monolithically formed with the proximal end 108 or may be removably attached to the proximal end via a press or friction fit.
- Handle 112 assembly includes a generally “C” like configuration when viewed in cross-section.
- Handle assembly 112 includes proximal and distal ends 132 and 134 , respectively, each having a respective flange 136 and 138 .
- a circular recess 140 is defined between the flanges 136 and 138 .
- the recess 140 is configured to receive one or more fingers of a user.
- the recess provides additional leverage for the user and, thus, facilitates a user pushing the port 200 through the longitudinal slot 114 and from the housing 102 . While the drawings depict the longitudinal slot 114 extending through the handle assembly, it is within the purview of the present disclosure to have the longitudinal slot not extend through the handle assembly 112 .
- a surgical instrument 120 may be employed to push out, i.e., deploy the surgical port 200 from the distal end 110 of the housing 102 when the housing 102 is positioned within a tissue tract or an incision of the patient ( FIG. 1D ).
- a surgical instrument in the form of push rod 120 or the like is receivable within the handle assembly 112 and movable within at least a portion of the housing 102 .
- the push rod 120 includes a guide pin 122 that is configured to move within the longitudinal slot 114 .
- the recess provides additional leverage to the user and, thus, allows a user to deploy the surgical port 200 from the distal end 110 of the housing 102 with one hand.
- port introducer assembly 100 is suitable for use with a surgical foam port 200 .
- Port 200 is of the foam type and is adapted to transition from a normally non-compressed or relaxed state or condition ( FIGS. 1A and 1D ) for affixing the port 200 within an incision or opening of a patient to a compressed condition ( FIG. 1C ) when mounted to the housing 102 for inserting the port 200 within the incision of a patient.
- Port 200 may be formed from any suitable bio-compatible material, such as, for example, a thermoplastic elastomer.
- Port 200 is configured to receive one or more types of surgical instruments, e.g., laparoscopic and/or endoscopic instruments.
- port 200 includes a port body 211 and may include one or more passageways or openings 202 that extend from a proximal (or trailing) end 204 of the foam port 200 to the distal (or leading) end 206 of the foam port 200 .
- Openings 202 may have any suitable geometric configuration. As shown in the representative drawings, openings 202 have a generally circular configuration. Trailing end 204 includes a generally circumferential configuration and includes a flange 208 that is configured to contact an outer surface of an abdominal wail of a patient ( FIG. 1D ). Likewise, leading end 206 includes a generally circumferential configuration and includes a flange 210 that is configured to contact an inner surface of an abdominal wall of a patient ( FIG. 1D ).
- This configuration of flanges 208 , 210 maintains the port 200 in a substantially fixed position when the port 200 is positioned within an incision of a patient.
- a port 200 is disclosed in commonly assigned U.S. patent application Ser. No. 12/244,024 filed, Oct. 2, 2008 the entire contents of which are hereby incorporated by reference herein.
- port 200 may be inserted into the open end of the distal end 110 and pushed into the longitudinal slot 114 toward the proximal end 108 ( FIG. 1B ), Once port 200 is inserted into the longitudinal slot 114 , housing 102 may then be inserted into an opening or incision made within a tissue “T” of a patient ( FIG. 1C ). After housing 102 is properly positioned into the incision, the port 200 may be disengaged from the housing 102 and into the incision where the port 200 will return to its non-compressed condition such that the port 200 is securely positioned within the incision ( FIG. 1D ).
- the push rod 120 may be employed to push the port 200 through the longitudinal slot 114 and from the open distal end 110 .
- one or more types of surgical instruments e.g., endoscope, may be inserted through the one or more apertures 202 .
- port introducer 300 includes an introducer assembly 400 that is suitable for use with part 200 .
- the components of port introducer 300 may be formed from any of the hereinbefore disclosed materials.
- Introducer assembly 400 is substantially similar to the introducer assembly 100 described above. So as not to obscure the present disclosure with redundant information, only those features unique to introducer assembly 400 will described hereinafter.
- housing 402 Unlike the housing 102 , a portion of an elongated introducer or housing 402 is movable between a first or generally open position for receiving at least a portion of the port 200 to a second or generally approximated position for securing and moving the port 200 to a compressed state.
- the housing 402 includes proximal and distal faces 450 and 452 , respectively, and defines a longitudinal axis “A-A.”
- Housing 402 includes a slotted tube configuration defined by two pivotably coupled outer wall segments 402 a and 402 b.
- a hinge 406 operably couples the outer wall segments 402 a and 402 b to each other.
- hinge 406 facilitates movement of the housing 402 between the first and second positions.
- Hinge 406 may be any suitable type of hinge, e.g., living, pinned, strap, and so forth.
- hinge 406 is a living hinge 406 that extends the length of the housing 402 along the distal face 450 a thereof.
- one or more locking members 420 may operably couple to or be operably associated with the housing 402 .
- the locking member(s) may be configured to allow the outer wall segments 402 a and 402 b to selectively move between the first and second positions and substantially maintain the hinge 406 in the first position during insertion of the housing 402 into an incision.
- the locking member 420 is disposed along the proximal face 450 adjacent a medial portion of the housing 402 , see FIG. 2A .
- a drawstring 422 is operably disposed on outer wall segment 402 a and receivable within a corresponding receiving structure 424 operably disposed on the outer wall segment 402 b.
- the drawstring 422 is threaded through the receiving structure 424 and manipulated by a user to substantially maintain the hinge 406 in the first position during insertion of the housing 402 into an incision.
- the housing 402 may be devoid of a locking member 420 and during insertion of the housing 402 into an incision a user may simply grasp each of the outer wail segments 402 a and 402 b such that the hinge 406 is substantially maintained in the first position.
- outer wall segments 402 a and 402 b may be in the first position ( FIG. 2A ). With housing segments 402 a and 402 b in the first position, port 200 may be positioned between the outer wall segments 402 a and 402 b, and the outer wall segments 402 a and 402 b may be moved to the second position. Once port 200 is inserted into the housing, the housing 402 may then be inserted into an opening or incision made within a tissue “T” of a patient ( FIG. 2C ). After housing 402 is properly positioned into the incision, the port 200 may be disengaged from the housing 402 and into the incision where the port 200 will return to its non-compressed condition such that the port 200 is securely positioned within the incision ( FIG.
- the outer wall segments 402 a and 402 b may be moved back to the first position after the housing is positioned into the tissue to facilitate disengaging the port 200 from the housing 402 .
- the push rod 120 may be employed to push the port 200 through the longitudinal slot 414 and from the open distal end 410 .
- one or more types of surgical instruments e.g., endoscope, may be inserted through the one or more apertures 202 .
- port introducer 500 includes an introducer assembly 600 that is suitable for use with port 200 .
- the components of port introducer mechanism 500 may be formed from any of the hereinbefore disclosed materials.
- Introducer assembly 600 includes an elongated introducer or housing 602 configured to receive, compress and releasably secure the port 200 therein.
- housing 602 includes an outer wall segment 606 defining a longitudinal axis “A-A.”
- Housing 602 including outer wall segment 606 includes a ‘shoe horn” like configuration.
- housing 602 includes open (or trailing) proximal and distal (or leading) ends 608 and 610 , respectively.
- a relatively flat distal face 652 extends along a length of the housing 602 .
- a longitudinal channel or slot 614 is disposed adjacent a proximal face 650 and extends along the length of the housing 602 from the proximal end 608 to the distal end 610 such that the housing 602 includes an oval, generally “C” like configuration (see FIG. 3B , for example).
- a pair of top edges 614 a and 614 b extend along the length of the longitudinal slot 614 and run parallel to the longitudinal axis “A-A” (see FIG. 3A in conjunction with FIG. 3B ).
- the longitudinal slot 614 facilitates loading and unloading of the port 200 into the distal end 610 of the housing 102 .
- the longitudinal slot 614 is proportioned to move the port 200 toward a compressed state as the port 200 is pushed within the longitudinal slot 614 from the distal end 610 of the housing 602 toward the proximal end 608 of the housing 602 .
- a handle section 620 operably couples to the proximal end 608 .
- Handle section 620 may operably couple to the proximal end 608 of the housing by any suitable means.
- handle section 620 is monolithically formed with the housing 602 .
- handle section 620 may be joined to housing 602 via welding, soldering, brazing, and so forth.
- handle section 620 may operably couple to the housing 620 via a rivet, bolt, screw, and so forth.
- the handle section 620 includes a “ladle” like configuration with one or more curved surfaces.
- handle section 620 includes a generally arcuate or curved (e.g., convex) proximal end 622 and a generally arcuate or curved (e.g., concave) distal end 625 .
- a portion 626 of the proximal end 622 serves as surface for a user to grip.
- a portion 628 of the distal end 624 serves as a shoulder that pushes against the port 200 and maintains the port 200 within the housing 602 , such as, for example, during insertion the housing 602 into the tissue tract.
- port 200 may be positioned within the housing 602 ( FIG. 3A ). Once port 200 is inserted into the housing 602 , the housing 602 may then be inserted into an opening or incision made within a tissue “T” of a patient ( FIG. 3C ). After housing 602 is properly positioned into the incision, the port 200 may be disengaged from the housing 602 and into the incision where the port 200 will return to its non-compressed condition such that the port 200 is securely positioned within the incision ( FIG. 3D ). In an embodiment, the push rod 120 may be employed to push the port 200 through the longitudinal slot 614 and from the pen distal end 610 . Once the port 200 is securely positioned within the incision, one or more types of surgical instruments, e.g., endoscope, may be inserted through the one or more apertures 202 .
- surgical instruments e.g., endoscope
- port introducer 700 includes an introducer assembly 800 that is suitable for use with port 200 .
- the components of port introducer mechanism 700 may be formed from any of the hereinbefore disclosed materials.
- Introducer assembly 800 includes an elongated introducer or housing 802 .
- housing 802 is of a unitary construction formed by any of the aforementioned manufacturing methods and from any of the aforementioned materials.
- housing 802 is formed from one or more elastomeric materials, such as, for example, polypropylene, polyethylene, etc.
- a portion (e.g., a rigid portion 804 ) of the housing 802 may be formed from a material that is substantially rigid and a portion (e.g., a flexible portion 806 ) of the housing 802 may be formed from a material that is substantially flexible (e.g., polyethylene).
- housing 802 having substantially rigid and flexible portions 804 and 806 , respectively, described in greater detail below.
- housing 802 may be coated with or formed from any of the aforementioned lubricious materials 104 .
- Housing 802 is configured to receive, compress and releasably secure the port 200 therein.
- housing 802 includes a substantially rigid portion 804 and supporting a flexible portion 806 forming an outer wall segment ( FIG. 4A-1 ).
- Rigid portion 804 extends the length of the housing 802 and includes a generally “banana” like configuration (see FIGS. 4A and 4B , where FIG. 4B illustrates the rigid portion 804 separated from the flexible portion 806 ).
- Rigid portion 804 forms a distal end 810 of housing 802 ( FIGS. 4A, 4B and 4C , where FIG. 4C illustrates the rigid portion 806 separated from the flexible portion 804 ).
- Rigid portion 804 defines and/or includes a rigid “backbone” 812 that extends at least partially along the length of the rigid portion 804 (as best seen in FIG. 4C ).
- the rigid “backbone” 812 provides additional structural integrity for the housing 802 .
- Flexible portion 806 operably couples to the rigid portion 804 .
- flexible portion 806 is overmolded to the rigid portion 804 ( FIG. 4A -1 ) and substantially encases the rigid portion 804 .
- Flexible portion 806 extends substantially the length of the rigid portion 804 .
- Flexible portion 806 is movable between a first position for securing the port 200 therein (see FIG. 4A-1 in combination with FIG.
- flexible portion 806 includes two generally upright collapsible outer sidewalls 814 and 816 laterally spaced apart from each other and culminating adjacent the distal end 810 .
- the outer sidewalls 814 and 816 are configured to collapse when the port 200 is not positioned within the housing 802 and a force is applied to the outer sidewalls 814 and 816 , such as, for example, when the housing 802 is being removed from a tissue tract.
- the flexible member 806 including outer sidewalls 814 and 816 form a longitudinal slot 818 extending at least partially the length of the housing 802 .
- Longitudinal slot 818 functions in a maimer similar to that of the previously described slots, e.g., longitudinal slot 114 .
- Each of the outer sidewalls 814 and 816 includes relatively curved top edges 840 and 842 , respectively. Curved top edges 840 and 842 facilitate loading of the port 200 within the housing 802 .
- Flexible member 806 including outer sidewalls 814 and 816 together with rigid portion 804 define a proximal end 820 that includes an opening 822 dimensioned to securely receive a portion (e.g., a distal end 206 ) of the surgical port 200 .
- Proximal end 820 is dimensioned to move the port 200 toward a compressed state as the port 200 is pushed from the proximal end 820 of the housing 802 toward the distal end 810 of the housing 802 .
- Distal end 810 includes a relatively blunt tip 824 .
- distal end 810 may include a relatively sharp tip configuration (not explicitly shown).
- a retrieval structure 828 operably couples the distal end 810 ( FIG. 4A ).
- Retrieval structure 828 couples to an aperture 830 located adjacent tip 824 .
- the retrieval structure 828 may be any suitable structure including but not limited suture, string, filament, and so forth.
- retrieval structure is a suture 828 including an end 834 that is looped through the opening 830 and subsequently knotted.
- suture 828 may be operably coupled to housing 802 by other suitable coupling means, e.g., adhesives, over-molding, and so forth.
- Suture 828 may have any suitable length. In the embodiment illustrated in FIGS.
- suture 828 includes a length that allows the suture 828 to remain outside the tissue tract after the housing 802 is pushed into and completely through the tissue tract, such that the suture 828 may be employed to pull the housing 802 out of and from the tissue tract, described in greater detail below.
- surgical instrument may be employed to disengage the housing 802 from the surgical port 200 when the housing 802 is positioned within a tissue tract or an incision of the patient.
- a surgical instrument the form of a push rod 120 or the like is receivable within one or more of the openings 202 of the port 200 .
- the port 200 may be positioned within the proximal end 820 of the housing 802 .
- distal end 810 of housing 802 may then be inserted into an opening or incision made within a tissue “T” of a patient ( FIG. 4E ).
- the port 200 is disengaged, e.g., via a twisting action of the housing 802 , from the housing 802 , where the port 200 will return to its non-compressed condition such that the port 200 is securely positioned within the incision (see FIG. 4F ).
- the housing 802 is completely inserted through the incision as shown in FIG.
- the housing 802 may be disengaged from the port 206 via one or more surgical instruments, e.g., a push rod 120 .
- the suture 832 may be employed to retrieve the housing 802 ( FIG. 4G ).
- the collapsible walls 814 and 816 will collapse or “fold” to the second position, shown in phantom in FIGS. 4A -1 and 4 G, facilitating removal of the housing from the tissue tract.
- Port introduce 700 a is substantially similar to port introducer 700 . So as not to obscure the present disclosure with redundant information only those features unique to port introducer 700 a will be described herein.
- an elongated introducer or housing 802 a includes one or more rigid supports or fingers 875 configured to provide added structural integrity to housing 802 a and/or a flexible portion 806 a, e.g., collapsible outer sidewalls 814 a and 816 a, operably associated with the housing 802 a.
- housing 802 a includes a pair of fingers 875 . Fingers 875 operably couple to a distal end 810 a of a rigid portion 804 a and extend proximally toward a proximal end 820 a of rigid portion 804 a.
- fingers 875 are disposed above a rigid backbone 812 a and encased by flexible member 806 a, see FIG. 4I in combination with FIG. 4H-1 . More particularly, fingers 875 are in spaced apart relation relative to each other and are laterally disposed on opposite sides of a rigid backbone 812 a, see FIG. 4H-1 in combination with FIG. 4J . Operation of introducer 800 a including fingers 875 is substantially similar to that of introducer 800 .
- One distinguishing feature of the introducer 800 a when compared to introducer 800 is that the fingers 875 of housing 802 a add an amount of predetermined rigidity to the collapsible walls 814 a and 816 a.
Abstract
A surgical apparatus for permitting access to tissue includes an elongated introducer and a surgical port. The introducer includes an outer wall segment defining a longitudinal axis, a longitudinal port passage extending therethrough and a longitudinal slot in communication with the port passage. The introducer is dimensioned for at least partial introduction within an opening in tissue. The surgical port includes a port body mounted to the introducer with one of its leading and trailing ends disposed within the port passage and with the intermediate segment extending through the longitudinal slot and the other of the leading and trailing end external of the elongated introducer. The port body is dimensioned to be advanced within the port passage for deployment through the opening in the tissue and is adapted to transition from a compressed state to a released state.
Description
- The present application claims the benefit of and priority to U.S. Provisional Application Ser. No. 61/604,644, filed on Feb. 29, 2012, the entire contents of which are incorporated herein by reference.
- 1. Technical Field
- The present disclosure relates to surgical access ports, and, more particularly, relates to an introducer and associated compressible port adapted to facilitate positioning of the port within tissue in connection with a laparoscopic surgical procedure
- 2. Related Art
- Single Port Access (SPA™) surgery, also known as Single Incision Laparoscopic Surgery (SILS™) or One Port Umbilical Surgery (OPUS) or Natural Orifice TransUmbilical Surgery (NOTUS), is an advanced minimally invasive surgical procedure in which a clinician operates almost exclusively through a single entry point, typically a port positioned in a patient's navel. Surgical procedures of this type are like many laparoscopic surgeries in that the patient is under general anesthesia, insufflated and laparoscopic visualization is utilized. Typically, the port is inserted through an incision (e.g., 20 mm incision) via a surgical instrument, e.g., a port introducer device in the form of a Kelly clamp.
- Once a skin incision is made inferior to a patient's umbilicus, the patient is typically prepared for laparoscopic surgery using the Kelly clamp method. The Kelly clamp method involves spreading, separating, and dividing subcutaneous tissue dissection). A surgeon's ability to properly place a port, e.g., a SILS™ port, may present practical challenges due to the limited length of the Kelly clamp's arm and handle. Furthermore, since the device is held in the palm of a surgeon's hand, sufficient visibility may not be possible using this technique without overly dilating the incision and compromising the seal. Not only is proper placement of a SILS™ port challenging using the Kelly clamp method, but removal of the Kelly clamp after successful installation may also be difficult. In addition, improper loading of the Kelly clamp may result in the clamp's metal tips coming into unintentional contact with the surgical area, which may result in injury including scarring, pain, and/or longer convalescence.
- Accordingly, a surgical apparatus for permitting access to tissue includes an elongated introducer and a surgical port. The introducer includes an outer wall segment defining a longitudinal axis and a longitudinal port passage extending therethrough. The outer wall segment has a longitudinal slot in communication with the port passage. The elongated introducer is dimensioned for at least partial introduction within an opening in tissue. The surgical port includes a port body having leading and trailing ends, an intermediate segment disposed between the leading and trailing ends and at least one passageway for reception and passage of a surgical instrument. The port body is mounted to the elongated introducer with one of the leading and trailing ends disposed within the port passage and with the intermediate segment extending through the longitudinal slot and the other of the leading and trailing end external of the elongated introducer. The port body is dimensioned to be advanced within the port passage for deployment through the opening in the tissue as generally directed by the elongated introducer. The port body comprising a compressible material and is adapted to transition from a compressed state when mounted to the elongated introducer to a released state when deployed from the elongated introducer.
- The surgical elongated introducer may define introducer leading and trailing ends, and farther includes a retractor segment adjacent the introducer leading end. The retractor segment is dimensioned and configured to retract tissue surrounding the opening. The retractor segment may define an arcuate profile. The outer wall segment of the elongated introducer is substantially arcuate along a major portion of the length thereof. The retractor segment may define a general hook-shape and is arranged in oblique relation with the longitudinal axis.
- A pusher member may be at least partially disposed within the longitudinal port passage of the elongated introducer. The pusher member may be adapted for longitudinal advancement to engage and deploy the port body from the introducer and within the opening in tissue. The elongated introducer may include a handle mounted to the outer wall segment dimensioned for engagement by the user. The elongated introducer may be substantially rigid, flexible or include both rigid and flexible portions. At least a portion of the longitudinal slot is coated with a lubricious material.
- The outer wall segment of the elongated introducer may include first and second movable segments. Thee first and second movable segments may be adapted for movement between a generally open position and a generally approximated position, wherein, when in the open position, the one of the leading and trailing ends of the port body is positionable within the port passage, and, when in the approximated position, the port body is moved to the compressed state with the one of the leading and trailing ends disposed within the port passage, the intermediate segment extending through the longitudinal slot and the other of the leading and trailing end external of the elongated introducer. The first and second movable segments may be adapted for pivotal movement relative each other.
- The elongated introducer may include a substantially flexible portion and a rigid portion. The substantially flexible portion may be movable between a first position for securing the port therein to a second position for facilitating removal of the elongated introducer from the opening in the tissue. The substantially flexible portion may be dimensioned to extend substantially the length of the rigid portion.
- A retrieval structure may be operably coupled to the distal end of the elongated introducer. The retrieval structure may be selected from the group consisting of a suture, string and filament.
- Embodiments of the disclosure will be described with reference to the accompanying drawings in which:
-
FIG. 1A is a perspective view of a port and port introducer in accordance with an embodiment of the present disclosure; -
FIG. 1A -1 is a cross-sectional view taken along line segment “1A-1-1A-1” ofFIG. 1A ; -
FIG. 1B is a perspective view illustrating the port being loaded into the port introducer depicted inFIG. 1A ; -
FIG. 1C is a perspective view illustrating the port introducer accessing tissue and the port loaded within the port introducer; -
FIG. 1D is a perspective view illustrating the port securely positioned within tissue of a patient; -
FIG. 2A is a perspective view of a port and port introducer in accordance with an alternate embodiment of the present disclosure; -
FIG. 2B is a perspective view illustrating the port being loaded into the port introducer mechanism depicted inFIG. 2A ; -
FIG. 2C a perspective view illustrating the port introducer accessing tissue and the port loaded within the port introducer; -
FIG. 2D a perspective view illustrating the port securely positioned within tissue of a patient; -
FIG. 3A is a perspective view illustrating a port and port introducer in accordance with an another embodiment of the present disclosure; -
FIG. 3B is a front view of the port introducer depicted inFIG. 3A ; -
FIG. 3C is a perspective view illustrating the port introducer accessing tissue and the port loaded within the port introducer; -
FIG. 3D is a perspective view illustrating the port securely positioned within tissue and the port introducer extracted from tissue; -
FIG. 4A is a perspective view of a port and port introducer in accordance with an embodiment of the present disclosure; -
FIG. 4A -1 is a cross-sectional view taken along line segment “4A-1-4A-1” ofFIG. 4A ; -
FIG. 4B is a side view of a rigid portion associated with the port introducer depicted inFIG. 4A ; -
FIG. 4C is a top elevational view of the rigid portion depicted inFIG. 4B ; -
FIG. 4D is a perspective view illustrating the port being loaded into the port introducer depicted inFIG. 4A ; -
FIG. 4E is a perspective view illustrating the port introducer accessing tissue and the port loaded within the port introducer; -
FIG. 4F is a perspective view illustrating the port securely positioned within tissue of a patient; -
FIG. 4G is a perspective view illustrating the port removed from tissue and the introducer being extracted from tissue; -
FIG. 4H is a perspective view of a port introducer in accordance with an embodiment of the present disclosure; -
FIG. 4H -1 is a cross-sectional view taken along line segment “4H-1-4H-1” ofFIG. 4H ; -
FIG. 4I is a side view of a rigid portion associated with the port introducer depicted inFIG. 4H ; and -
FIG. 4J is a top elevational view of the rigid portion depicted inFIG. 4I . - Particular embodiments of the present disclosure will be described herein with reference to the accompanying drawings. In the following description, well-known functions or constructions are not described in detail to avoid obscuring the present disclosure in unnecessary detail. As shown in the drawings and as described throughout the following descriptions, and as is traditional when referring to relative positioning on an object, the term “proximal” refers to the end of the device that is closer to the user and the term “distal” refers to the end of the apparatus that is further from the user.
- The port introducers according to the present disclosure are configured to facilitate the introduction of an access port, e.g., a foam port, within a surgical incision of a patient. It is envisioned that the port introducers may be used in connection with other surgical procedures utilizing natural or formed openings in a body cavity of a patient. Embodiments of the present disclosure are illustrated in
FIGS. 1A-4J . - With reference to
FIGS. 1A-1D , and initially with reference toFIG. 1A , an embodiment of aport introducer 10 is shown. In the embodiment illustrated inFIGS. 1A-1D ,port introducer 10 includes anintroducer assembly 100 that is suitable for use with asurgical foam port 200. Theport introducer 10 andfoam port 200 may he manufactured and sold separately or provided as a kit. -
Introducer assembly 100 includes a substantially rigid elongated introducer orhousing 102 dimensioned for at least partial introduction within an opening in tissue. In the embodiment illustrated inFIG. 1A-1D ,housing 102 is of a unitary construction formed by any suitable manufacturing methods including but not limited to injection molding, overmolding, etc.Housing 102 may be formed from any suitable biocompatible material including rigid such as stainless steel, titanium, polymeric material and/or a resilient elastomeric material. In embodiments,housing 102, or portion thereof, may be coated with or formed from alubricious material 104. More particularly, in the embodiment illustrated inFIGS. 1A-1D , aninternal surface 106 is coated with a layer of one or more types of fluoropolymers including without limitation, polytetrafluoroethylene (a.k.a. PTFE or Teflon®, manufactured by the E.I. du Pont de Nemours and Co. of Wilmington, Del., USA), seeFIG. 1A , for example. Coatinginternal surface 106 ofhousing 102 with alubricious material 104 decreases the coefficient of kinetic friction (μk) between theinternal surface 106 and theport 200 and, thus, facilitates movement of theport 200 throughhousing 102. In embodiments, thelubricious material 104 may be selected from the group consisting of polytetrafluoroethylene (PTFE), perfluoroalkoxy polymer (PFA), fluorinated ethylene-propylene (FEP). -
Housing 102 is configured to receive, compress and releasably secure theport 200 therein. With this purpose in mind,housing 102 includes anouter wall segment 102 a defining a longitudinal axis “A-A” and asurgical port 200 passageway therethrough.Outer wall segment 102 a includes a slotted tube configuration with open proximal (or trailing) and distal (or leading) ends 108 and 110, respectively.Housing 102 includes aproximal face 150 and adistal face 152. In an embodiment, theproximal end 108 may be closed. Alongitudinal slot 114 is disposed adjacent theproximal face 150 and may extend at least partially along a length of thehousing 102. In the embodiment illustrated inFIGS. 1A-1D , thelongitudinal slot 114 extends along the length of thehousing 102 from theproximal end 108 to thedistal end 110 such that thehousing 102 includes a generally “C” like configuration (seeFIG. 1A -1). A pair oftop edges longitudinal slot 114 and run parallel to the longitudinal axis “A-A” (seeFIG. 1A -1 in conjunction withFIG. 1B ), Thelongitudinal slot 114 facilitates loading and unloading of theport 200 into thedistal end 110 of thehousing 102. Thelongitudinal slot 114 is proportioned to move theport 200 toward a compressed state as theport 200 is pushed within thelongitudinal slot 114 from thedistal end 110 of thehousing 102 toward theproximal end 108 of thehousing 102.Distal end 110 includes aleading edge 116 that is angled or slanted with respect totop edges leading edge 116 extends from a distal portion of thetop edges distal insertion tip 118. The angledleading edge 116 anddistal tip 118 facilitate loading and unloading of theport 200 into thehousing 102 and positioning thehousing 102 into a tissue tract. One or more types ofstructure 124 configured to manipulate tissue may be operably associated with thedistal end 110. More particularly,distal tip 118 includes a retractor having a generally “hook” like shape 124 (or other suitable structure), seeFIG. 1B . In this instance, theretractor 124 may be employed to retract tissue, such as, for example, prior to insertion of thehousing 102 into the tissue tract (FIG. 1C ).Retractor 124 includes a generally arcuate or curved configuration and extends distally from thedistal end 110 of thehousing 102 in a generally oblique relation with the longitudinal axis “A-A.” Theretractor 124 may be a separate structure operably coupled to thehousing 102 at thedistal end 110 thereof, or theretractor 124 may be monolithically formed with thedistal tip 118. For example, a portion, e.g., thedistal face 152, of thedistal tip 118 may curve toward theproximal end 108 forming thehook 124. - In an embodiment, a gripping device or handle assembly may be operably coupled to the
proximal end 108. In the embodiment illustrated inFIGS. 1A-1D ,proximal end 108 includes ahandle assembly 112.Handle assembly 112 may operably couple to theproximal end 108 by any suitable means. For example, handleassembly 112 may be monolithically formed with theproximal end 108 or may be removably attached to the proximal end via a press or friction fit. Handle 112 assembly includes a generally “C” like configuration when viewed in cross-section.Handle assembly 112 includes proximal anddistal ends respective flange circular recess 140 is defined between theflanges recess 140 is configured to receive one or more fingers of a user. The recess provides additional leverage for the user and, thus, facilitates a user pushing theport 200 through thelongitudinal slot 114 and from thehousing 102. While the drawings depict thelongitudinal slot 114 extending through the handle assembly, it is within the purview of the present disclosure to have the longitudinal slot not extend through thehandle assembly 112. - In the embodiment illustrated in
FIGS. 1A-1D , asurgical instrument 120 may be employed to push out, i.e., deploy thesurgical port 200 from thedistal end 110 of thehousing 102 when thehousing 102 is positioned within a tissue tract or an incision of the patient (FIG. 1D ). To this end, a surgical instrument in the form ofpush rod 120 or the like is receivable within thehandle assembly 112 and movable within at least a portion of thehousing 102. In the embodiment illustrated inFIGS. 1A-1D , thepush rod 120 includes aguide pin 122 that is configured to move within thelongitudinal slot 114. When thepush rod 120 is employed to push out, i.e., deploy thesurgical port 200 from thedistal end 110 of thehousing 102, the recess provides additional leverage to the user and, thus, allows a user to deploy thesurgical port 200 from thedistal end 110 of thehousing 102 with one hand. - As noted above,
port introducer assembly 100 is suitable for use with asurgical foam port 200. A brief description of asurgical port 200, and operative features associated therewith, now follows. -
Port 200 is of the foam type and is adapted to transition from a normally non-compressed or relaxed state or condition (FIGS. 1A and 1D ) for affixing theport 200 within an incision or opening of a patient to a compressed condition (FIG. 1C ) when mounted to thehousing 102 for inserting theport 200 within the incision of a patient.Port 200 may be formed from any suitable bio-compatible material, such as, for example, athermoplastic elastomer. Port 200 is configured to receive one or more types of surgical instruments, e.g., laparoscopic and/or endoscopic instruments. With this purpose in mind,port 200 includes aport body 211 and may include one or more passageways oropenings 202 that extend from a proximal (or trailing) end 204 of thefoam port 200 to the distal (or leading)end 206 of thefoam port 200.Openings 202 may have any suitable geometric configuration. As shown in the representative drawings,openings 202 have a generally circular configuration. Trailingend 204 includes a generally circumferential configuration and includes aflange 208 that is configured to contact an outer surface of an abdominal wail of a patient (FIG. 1D ). Likewise, leadingend 206 includes a generally circumferential configuration and includes aflange 210 that is configured to contact an inner surface of an abdominal wall of a patient (FIG. 1D ). This configuration offlanges port 200 in a substantially fixed position when theport 200 is positioned within an incision of a patient. One example of aport 200 is disclosed in commonly assigned U.S. patent application Ser. No. 12/244,024 filed, Oct. 2, 2008 the entire contents of which are hereby incorporated by reference herein. - In use,
port 200 may be inserted into the open end of thedistal end 110 and pushed into thelongitudinal slot 114 toward the proximal end 108 (FIG. 1B ), Onceport 200 is inserted into thelongitudinal slot 114,housing 102 may then be inserted into an opening or incision made within a tissue “T” of a patient (FIG. 1C ). Afterhousing 102 is properly positioned into the incision, theport 200 may be disengaged from thehousing 102 and into the incision where theport 200 will return to its non-compressed condition such that theport 200 is securely positioned within the incision (FIG. 1D ). In an embodiment, thepush rod 120 may be employed to push theport 200 through thelongitudinal slot 114 and from the opendistal end 110. Once theport 200 is securely positioned within the incision, one or more types of surgical instruments, e.g., endoscope, may be inserted through the one ormore apertures 202. - With reference to
FIGS. 2A-2D , and initially with reference toFIG. 2A , an embodiment of aport introducer 300 is shown in the embodiment illustrated inFIGS. 2A-2D ,port introducer 300 includes anintroducer assembly 400 that is suitable for use withpart 200. The components ofport introducer 300 may be formed from any of the hereinbefore disclosed materials. -
Introducer assembly 400 is substantially similar to theintroducer assembly 100 described above. So as not to obscure the present disclosure with redundant information, only those features unique tointroducer assembly 400 will described hereinafter. - Unlike the
housing 102, a portion of an elongated introducer orhousing 402 is movable between a first or generally open position for receiving at least a portion of theport 200 to a second or generally approximated position for securing and moving theport 200 to a compressed state. With this purpose in mind, thehousing 402 includes proximal anddistal faces Housing 402 includes a slotted tube configuration defined by two pivotably coupledouter wall segments FIGS. 2A-2D , ahinge 406, or the like, operably couples theouter wall segments hinge 406 facilitates movement of thehousing 402 between the first and second positions.Hinge 406 may be any suitable type of hinge, e.g., living, pinned, strap, and so forth. In the embodiment illustrated inFIGS. 2A-2D , hinge 406 is aliving hinge 406 that extends the length of thehousing 402 along the distal face 450 a thereof. - In an embodiment, one or
more locking members 420, e.g., clamp, latch, drawstring, etc., may operably couple to or be operably associated with thehousing 402. The locking member(s) may be configured to allow theouter wall segments hinge 406 in the first position during insertion of thehousing 402 into an incision. In the embodiment illustrated inFIGS. 2A-2D , the lockingmember 420 is disposed along theproximal face 450 adjacent a medial portion of thehousing 402, seeFIG. 2A . More particularly, adrawstring 422 is operably disposed onouter wall segment 402 a and receivable within a corresponding receivingstructure 424 operably disposed on theouter wall segment 402 b. In use, thedrawstring 422 is threaded through the receivingstructure 424 and manipulated by a user to substantially maintain thehinge 406 in the first position during insertion of thehousing 402 into an incision. - Alternatively, the
housing 402 may be devoid of a lockingmember 420 and during insertion of thehousing 402 into an incision a user may simply grasp each of theouter wail segments hinge 406 is substantially maintained in the first position. - In use,
outer wall segments FIG. 2A ). Withhousing segments port 200 may be positioned between theouter wall segments outer wall segments port 200 is inserted into the housing, thehousing 402 may then be inserted into an opening or incision made within a tissue “T” of a patient (FIG. 2C ). Afterhousing 402 is properly positioned into the incision, theport 200 may be disengaged from thehousing 402 and into the incision where theport 200 will return to its non-compressed condition such that theport 200 is securely positioned within the incision (FIG. 2D ). In an embodiment, theouter wall segments port 200 from thehousing 402. Alternatively, or in combination therewith, thepush rod 120 may be employed to push theport 200 through the longitudinal slot 414 and from the open distal end 410. Once theport 200 is securely positioned within the incision, one or more types of surgical instruments, e.g., endoscope, may be inserted through the one ormore apertures 202. - With reference to
FIGS. 3A-3E , and initially with reference toFIG. 3A , an embodiment of aport introducer 500 is shown. In the embodiment illustrated in FIGS. 3A-3E,port introducer 500 includes anintroducer assembly 600 that is suitable for use withport 200. The components ofport introducer mechanism 500 may be formed from any of the hereinbefore disclosed materials. -
Introducer assembly 600 includes an elongated introducer orhousing 602 configured to receive, compress and releasably secure theport 200 therein. With this purpose in mind,housing 602 includes anouter wall segment 606 defining a longitudinal axis “A-A.”Housing 602 includingouter wall segment 606 includes a ‘shoe horn” like configuration. More particularly,housing 602 includes open (or trailing) proximal and distal (or leading) ends 608 and 610, respectively. A relatively flatdistal face 652 extends along a length of thehousing 602. A longitudinal channel orslot 614 is disposed adjacent aproximal face 650 and extends along the length of thehousing 602 from theproximal end 608 to thedistal end 610 such that thehousing 602 includes an oval, generally “C” like configuration (seeFIG. 3B , for example). A pair oftop edges longitudinal slot 614 and run parallel to the longitudinal axis “A-A” (seeFIG. 3A in conjunction withFIG. 3B ). Thelongitudinal slot 614 facilitates loading and unloading of theport 200 into thedistal end 610 of thehousing 102. Thelongitudinal slot 614 is proportioned to move theport 200 toward a compressed state as theport 200 is pushed within thelongitudinal slot 614 from thedistal end 610 of thehousing 602 toward theproximal end 608 of thehousing 602. - A
handle section 620 operably couples to theproximal end 608.Handle section 620 may operably couple to theproximal end 608 of the housing by any suitable means. In the embodiment illustrated inFIGS. 3A-3D ,handle section 620 is monolithically formed with thehousing 602. In embodiments, handlesection 620 may be joined tohousing 602 via welding, soldering, brazing, and so forth. Alternatively, handlesection 620 may operably couple to thehousing 620 via a rivet, bolt, screw, and so forth. Thehandle section 620 includes a “ladle” like configuration with one or more curved surfaces. More particularly,handlesection 620 includes a generally arcuate or curved (e.g., convex)proximal end 622 and a generally arcuate or curved (e.g., concave) distal end 625. Aportion 626 of theproximal end 622 serves as surface for a user to grip. Aportion 628 of thedistal end 624 serves as a shoulder that pushes against theport 200 and maintains theport 200 within thehousing 602, such as, for example, during insertion thehousing 602 into the tissue tract. - In use,
port 200 may be positioned within the housing 602 (FIG. 3A ). Onceport 200 is inserted into thehousing 602, thehousing 602 may then be inserted into an opening or incision made within a tissue “T” of a patient (FIG. 3C ). Afterhousing 602 is properly positioned into the incision, theport 200 may be disengaged from thehousing 602 and into the incision where theport 200 will return to its non-compressed condition such that theport 200 is securely positioned within the incision (FIG. 3D ). In an embodiment, thepush rod 120 may be employed to push theport 200 through thelongitudinal slot 614 and from the pendistal end 610. Once theport 200 is securely positioned within the incision, one or more types of surgical instruments, e.g., endoscope, may be inserted through the one ormore apertures 202. - With reference to
FIGS. 4A-4G , and initially with reference toFIG. 4A , an embodiment of aport introducer 700 is shown. In the embodiment illustrated inFIGS. 4A-4G ,port introducer 700 includes anintroducer assembly 800 that is suitable for use withport 200. The components ofport introducer mechanism 700 may be formed from any of the hereinbefore disclosed materials. -
Introducer assembly 800 includes an elongated introducer orhousing 802. In the embodiment illustrated inFIG. 4A-4G ,housing 802 is of a unitary construction formed by any of the aforementioned manufacturing methods and from any of the aforementioned materials. In embodiments,housing 802 is formed from one or more elastomeric materials, such as, for example, polypropylene, polyethylene, etc. In the embodiment illustrated inFIGS. 4A-4D , a portion (e.g., a rigid portion 804) of thehousing 802 may be formed from a material that is substantially rigid and a portion (e.g., a flexible portion 806) of thehousing 802 may be formed from a material that is substantially flexible (e.g., polyethylene). The significance ofhousing 802 having substantially rigid andflexible portions housing 802, or portion thereof, may be coated with or formed from any of the aforementionedlubricious materials 104. -
Housing 802 is configured to receive, compress and releasably secure theport 200 therein. With this purpose in mind,housing 802 includes a substantiallyrigid portion 804 and supporting aflexible portion 806 forming an outer wall segment (FIG. 4A-1 ).Rigid portion 804 extends the length of thehousing 802 and includes a generally “banana” like configuration (seeFIGS. 4A and 4B , whereFIG. 4B illustrates therigid portion 804 separated from the flexible portion 806).Rigid portion 804 forms adistal end 810 of housing 802 (FIGS. 4A, 4B and 4C , whereFIG. 4C illustrates therigid portion 806 separated from the flexible portion 804).Rigid portion 804 defines and/or includes a rigid “backbone” 812 that extends at least partially along the length of the rigid portion 804 (as best seen inFIG. 4C ). The rigid “backbone” 812 provides additional structural integrity for thehousing 802.Flexible portion 806 operably couples to therigid portion 804. In the embodiment illustrated inFIGS. 4A-4G ,flexible portion 806 is overmolded to the rigid portion 804 (FIG. 4A -1) and substantially encases therigid portion 804.Flexible portion 806 extends substantially the length of therigid portion 804.Flexible portion 806 is movable between a first position for securing theport 200 therein (seeFIG. 4A-1 in combination withFIG. 4D , for example) to a second position for facilitating removal of thehousing 802 from a tissue tract (shown phantomly inFIG. 4A -1). With this purpose in mind,flexible portion 806 includes two generally upright collapsibleouter sidewalls distal end 810. Theouter sidewalls port 200 is not positioned within thehousing 802 and a force is applied to theouter sidewalls housing 802 is being removed from a tissue tract. Theflexible member 806 includingouter sidewalls longitudinal slot 818 extending at least partially the length of thehousing 802.Longitudinal slot 818 functions in a maimer similar to that of the previously described slots, e.g.,longitudinal slot 114. Each of theouter sidewalls top edges top edges port 200 within thehousing 802.Flexible member 806 includingouter sidewalls rigid portion 804 define aproximal end 820 that includes anopening 822 dimensioned to securely receive a portion (e.g., a distal end 206) of thesurgical port 200.Proximal end 820 is dimensioned to move theport 200 toward a compressed state as theport 200 is pushed from theproximal end 820 of thehousing 802 toward thedistal end 810 of thehousing 802.Distal end 810 includes a relativelyblunt tip 824. Alternatively,distal end 810 may include a relatively sharp tip configuration (not explicitly shown). - A
retrieval structure 828 operably couples the distal end 810 (FIG. 4A ).Retrieval structure 828 couples to anaperture 830 locatedadjacent tip 824. Theretrieval structure 828 may be any suitable structure including but not limited suture, string, filament, and so forth. In the embodiment illustrated inFIGS. 4A-4G , retrieval structure is asuture 828 including anend 834 that is looped through theopening 830 and subsequently knotted. In an embodiment,suture 828 may be operably coupled tohousing 802 by other suitable coupling means, e.g., adhesives, over-molding, and so forth. Suture 828 may have any suitable length. In the embodiment illustrated inFIGS. 4A-4G ,suture 828 includes a length that allows thesuture 828 to remain outside the tissue tract after thehousing 802 is pushed into and completely through the tissue tract, such that thesuture 828 may be employed to pull thehousing 802 out of and from the tissue tract, described in greater detail below. - In an embodiment, surgical instrument may be employed to disengage the
housing 802 from thesurgical port 200 when thehousing 802 is positioned within a tissue tract or an incision of the patient. To this end, a surgical instrument the form of apush rod 120 or the like is receivable within one or more of theopenings 202 of theport 200. - In use, the
port 200 may be positioned within theproximal end 820 of thehousing 802. Onceport 200 is secured to thehousing 802,distal end 810 ofhousing 802 may then be inserted into an opening or incision made within a tissue “T” of a patient (FIG. 4E ). Afterhousing 802 is inserted into the incision, theport 200 is disengaged, e.g., via a twisting action of thehousing 802, from thehousing 802, where theport 200 will return to its non-compressed condition such that theport 200 is securely positioned within the incision (seeFIG. 4F ). In an instance where, thehousing 802 is completely inserted through the incision as shown inFIG. 4F , for example), thehousing 802 may be disengaged from theport 206 via one or more surgical instruments, e.g., apush rod 120. In this instance, the suture 832 may be employed to retrieve the housing 802 (FIG. 4G ). During extraction of thehousing 802 from the incision, thecollapsible walls FIGS. 4A -1 and 4G, facilitating removal of the housing from the tissue tract. - With reference to
FIGS. 4H-4J an alternate embodiment of aport introducer 700 is shown designated 700 a. Port introduce 700 a is substantially similar toport introducer 700. So as not to obscure the present disclosure with redundant information only those features unique to port introducer 700 a will be described herein. - In the embodiment illustrated in
FIGS. 4H-4J , an elongated introducer orhousing 802 a includes one or more rigid supports orfingers 875 configured to provide added structural integrity tohousing 802 a and/or aflexible portion 806 a, e.g., collapsibleouter sidewalls housing 802 a. In the illustrated embodiment,housing 802 a includes a pair offingers 875.Fingers 875 operably couple to adistal end 810 a of arigid portion 804 a and extend proximally toward aproximal end 820 a ofrigid portion 804 a. In the embodiment illustrated inFIGS. 4H-4J ,fingers 875 are disposed above arigid backbone 812 a and encased byflexible member 806 a, seeFIG. 4I in combination withFIG. 4H-1 . More particularly,fingers 875 are in spaced apart relation relative to each other and are laterally disposed on opposite sides of arigid backbone 812 a, seeFIG. 4H-1 in combination withFIG. 4J . Operation ofintroducer 800 a includingfingers 875 is substantially similar to that ofintroducer 800. One distinguishing feature of theintroducer 800 a when compared tointroducer 800 is that thefingers 875 ofhousing 802 a add an amount of predetermined rigidity to thecollapsible walls - 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 an exemplification of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the present disclosure. Such modifications and variations are intended to come within the scope of the following claims.
Claims (21)
1-17. (canceled)
18. A surgical apparatus for permitting access to tissue, comprising:
an elongated introducer including opposing walls, the opposing walls transitionable between a closed position configured to facilitate insertion of the elongated introducer through an opening in the tissue, and an open position in which the opposing walls define a port passage therebetween; and
a surgical port transitionable between an expanded state and a compressed state, wherein the surgical port is configured to advance along the port passage of the elongated introducer when the opposing walls are in the open position.
19. The surgical apparatus according to claim 18 , wherein the elongated introducer includes a portion formed of a substantially rigid material.
20. The surgical apparatus according to claim 19 , wherein the opposing walls are urged inwardly in the closed position.
21. The surgical apparatus according to claim 19 , wherein the portion of the elongated introducer is interposed between the opposing walls.
22. The surgical apparatus according to claim 19 , wherein the opposing walls are biased toward the closed position.
23. The surgical apparatus according to claim 18 , wherein the elongated introducer includes proximal and distal ends, one of the proximal or distal ends defining an opening in communication with the port passage.
24. The surgical apparatus according to claim 23 , wherein the other one of the proximal or distal ends of the elongated introducer includes a blunt tip.
25. The surgical apparatus according to claim 24 , wherein the elongated introducer includes a retrieval structure coupled to the other one of the proximal or distal ends of the elongated introducer.
26. The surgical apparatus according to claim 18 , wherein at least one of the opposing walls includes a rigid support.
27. The surgical apparatus according to claim 18 , wherein at least a portion of the elongated introducer includes a lubricious material.
28. The surgical apparatus according to claim 18 , wherein the surgical port includes leading and trailing ends, one of the leading or trailing ends external to the elongated introducer when the surgical port is advanced along the port passage of the elongated introducer.
29. The surgical apparatus according to claim 18 , wherein at least a portion of the elongated introducer is formed of an elastomeric material.
30. A surgical apparatus for permitting access to tissue, comprising:
a surgical port formed of a compressible material, the surgical port defining a lumen configured to receive a surgical instrument therethrough; and
an elongated introducer including a flexible portion transitionable between an open position providing a port passage configured to advance the surgical port therealong, and a retracted position configured to facilitate insertion of the elongated introducer through an opening in the tissue.
31. The surgical apparatus according to claim 30 , wherein the flexible portion of the elongated introducer includes opposing walls laterally spaced apart in the open position.
32. The surgical apparatus according to claim 30 , wherein the elongated introducer includes a rigid portion extending along a length of the elongated introducer.
33. The surgical apparatus according to claim 32 , wherein the rigid portion of the elongated introducer is interposed between the opposing walls.
34. The surgical apparatus according to claim 31 , wherein the opposing walls are biased toward the retracted position.
35. The surgical apparatus according to claim 30 , wherein the elongated introducer includes proximal and distal ends, one of the proximal or distal ends defining an opening in communication with the port passage, the opening configured to receive the surgical port therethrough.
36. The surgical apparatus according to claim 30 , wherein the elongated introducer includes a retrieval structure coupled to the other one of the proximal or distal ends of the elongated introducer.
36. The surgical apparatus according to claim 30 , wherein at least one of the opposing walls includes a rigid support.
Priority Applications (1)
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US15/003,126 US20160135839A1 (en) | 2012-02-29 | 2016-01-21 | Surgical introducer and access port assembly |
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US13/755,244 US9271639B2 (en) | 2012-02-29 | 2013-01-31 | Surgical introducer and access port assembly |
US15/003,126 US20160135839A1 (en) | 2012-02-29 | 2016-01-21 | Surgical introducer and access port assembly |
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US13/755,244 Division US9271639B2 (en) | 2012-02-29 | 2013-01-31 | Surgical introducer and access port assembly |
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Also Published As
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US9271639B2 (en) | 2016-03-01 |
US20130225931A1 (en) | 2013-08-29 |
EP2633827B1 (en) | 2017-04-05 |
EP2633827A1 (en) | 2013-09-04 |
AU2013200889A1 (en) | 2013-09-12 |
CA2805209A1 (en) | 2013-08-29 |
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