US20060149306A1 - Sealed surgical access device - Google Patents

Abstract

A surgical access device is adapted to facilitate access through an incision in a body wall having an inner surface and an outer surface, and into a body cavity of a patient. The device includes first and second retention members adapted to be disposed in proximity to the outer surface and the inner surface of the body wall, respectively. A membrane extending between the two retention members forms a throat which is adapted to extend through the incision and form a first funnel extending from the first retention member into the throat, and a second funnel extending from the second retention member into the throat. The throat of the membrane has characteristics for forming an instrument seal in the presence of an instrument and a zero seal in the absence of an instrument. The first retention member may include a ring with either a fixed or variable diameter. The ring can be formed in first and second sections, each having two ends. Couplings can be disposed between the ends to accommodate variations in the size of the first retention member. The first retention member can also be formed as an inflatable toroid, a self-expanding foam, or a circumferential spring. A plurality of inflatable chambers can also provide the surgical access device with a working channel adapted for disposition across the body wall. A first retention member with a plurality of retention stations functions with a plurality of tethers connected to the membrane to change the shape of the membrane and the working channel. A stabilizing platform can be used to support the access device generally independent of any movement of the body wall.

Description

CROSS REFERENCE TO RELATED APPLICATIONS
• This is a non-provisional application claiming the priority of provisional application Ser. No. 60/241,953 filed on Oct. 19, 2000, entitled “Hand-Assisted Laparoscopy Apparatus and Method”, as well as the PCT application serial no. PCT/US01/29682, filed on Sep. 21, 2001, and entitled “Surgical Access Apparatus and Method,” both of which are fully incorporated herein by reference.
BACKGROUND OF THE INVENTION
• 1. Field of Invention
• This invention relates generally to surgical access devices, and more specifically to access devices adapted for use in minimal invasive surgery to provide sealed instrument access across a body wall and into a body cavity.
• 2. Discussion of Related Art
• Surgical access to a body cavity, such as the abdominal cavity, is referred to as “open laparotomy” or “closed laparoscopy.” An open procedure involves an incision of sufficient size to allow a surgeon to place hands and instruments within the surgical site. In addition, the site must be open enough for the surgeon to clearly see what he or she is doing. There is often a need for multiple retractors, clamps, and sponges. All of these devices compete for room within the surgical site.
• Laparoscopic or closed surgery eliminates many of the issues surrounding open laparotomy. In a typical pressurized laparoscopy, the abdominal wall is punctured and at least one trocar is inserted into the peritoneum. Gas is introduced into the abdominal cavity and to elevate the abdominal wall away from the internal organs. This results in a large, clear operating field. Additional trocars can be inserted as needed for various procedures. A laparoscope is used to provide visualization of the surgical site. The instrumentation for laparoscopic procedures has developed prolifically in recent years and the surgeons have become comfortable with a “remote-control” approach to various aspects of surgery. Cutting, dissecting, cauterizing, stapling and suturing have all been addressed by laparoscopic device manufacturers.
• Despite the many advantages of laparoscopic surgery, there remain a few complex procedures that make laparoscopy difficult or risky. In some of these cases, a hybrid procedure makes the most sense. If one could have the visibility and open field of a laparoscopic procedure and the control of an open procedure, one would truly have it all. However, the two modalities tend to obviate each other. Indeed, there are some who would argue that the advances of laparoscopy would be in vane if an open procedure were added as a default.
• In recent years, a few enterprising surgeons have advanced a method that they call “hand-assisted” laparoscopy or “handoscopy.” This involves placing one of the surgeon's hands inside the patient through an enlarged incision, while under laparoscopic visualization. With no protruding instrumentation normally used in closed laparoscopy, it is not required to perform overly challenging maneuvers
• The challenge now facing the surgeon in this procedure is providing an adequate sealing means within the enlarged incision. The surgeon's hand must be comfortable, properly placed and free to move with a normal range of motion. In addition, the surgeon should be able to remove and replace his/her hand into the abdominal cavity without loss of pneumoperitoneum.
• Several devices have been proposed in an attempt to satisfy the requirements of the “handoscopist.” They generally involve an elastomeric seal that fits through an incision and is held in place by retention means on either or both sides of the abdominal wall. The devices are generally complex and require several steps to place. One of the devices requires an adhesive to be placed on the exterior abdominal wall (skin) as the seal is adhered to the skin. This requires not only application of the adhesive but also a drying time. Allergic reactions and other complications must be considered when using this product. Another device makes use of a “toroidal balloon” that inflates to position the device and seal the incision. The surgeon must overcome the friction and sealing pressure of this device when inserting and withdrawing his/her hand from the surgical site. A further device involves the use of a built-in glove or sleeve. This arrangement diminishes the range of motion and the tactile sensation of the hand.
• U.S. Pat. No. 5,848,992 discloses a surgical access device that allows the conversion of an open procedure to a laparoscopic procedure. In addition, the '992 patent discloses the use of such a device in a case where a large organ is to be removed. In this instance, an incision of adequate size is made initially and sealed with the device at the same time the trocars are being inserted
• Notwithstanding these proposed devices, there remains a continuing need for a surgical access device that provides a flexible, simple and complete seal within an incision of adequate size for introduction of a human hand.
SUMMARY OF THE INVENTION
• The present invention satisfies the requirements of a surgical access device for use with surgical instruments including the surgeon's hand. With this access device, “hand-assisted” laparoscopy is greatly facilitated within a closed surgical environment.
• The present invention makes use of an internal retention member and an external retention member connected by a flexible, lubricious material. At least one of the retention members is tensionable to provide adequate stability to the incision site.
• The present invention also provides a sealing portion that allows the largest range of hand motion without leakage of insufflation gas. The seal is formed of a material that responds well to the presence of glove material such as Natural Latex, Poly-isoprene, Nitrile, Vinyl or Polyurethane.
• In one aspect of the invention, the surgical access device is adapted to facilitate access through an incision in a body wall having an inner surface and an outer surface, and into a body cavity of a patient. The device includes a first retention member configured to surround the incision in proximity to the outer surface of the body wall. A second retention member is configured to surround the incision in proximity to the inner surface of the body wall. A membrane extending between the first retention member and second retention member forms a throat adapted for disposition through the incision. A first funnel extends from the first retention member into the throat and a second funnel extends from the second retention member into the throat. The throat of the membrane has characteristics for forming an instrument seal in the presence of an instrument, any zero seal in the absence of an instrument.
• In another aspect of the invention, the first retention member comprises a ring having a first section with a first end and a second end, and a second section with a third end moveable relative to the first end to the first retention member and a fourth end moveable relative to the second end of the first retention member. A coupling is disposed between the first end of the first retention member and the third end of the second retention member. This coupling is operable to vary the distance separating the first end and the third end to control the shape of a working channel formed by the membrane. A second coupling or a hinge may be provided between the second end of the first retention member and the fourth end of the second retention member.
• In a further aspect of the invention, the first retention member has a shape that is variable to control the shape of the working channel formed by the membrane. The first retention member can be formed as an inflatable structure such as a toroid. The first retention member may also include self expanding foam for a circumferential spring.
• In still a further aspect of the invention, a surgical access device can include a plurality of inflatable chambers each extending in a plane passing through the axis of the device. These chambers collectively define a working channel that is adapted for disposition across the body wall. The chambers may have a straight or U-shaped configuration.
• In another aspect of the invention, the device includes a first retention member including a ring with a plurality of retention stations. The membrane is attached to a plurality of tethers that can be coupled to the ring at an associated one of the retention stations to provide the membrane with a desired shape.
• In still a further aspect of the invention, a stabilizing platform is proposed to support the access device generally independent of any movement associated with the body wall.
• These and other features and advantages of the invention will become more apparent with a description of preferred embodiments in reference to the associated drawings.
DESCRIPTION OF DRAWINGS
• FIG. 1 is a side view drawing of a surgical patient in a laparoscopic procedure;
• FIG. 2 is a front view drawing of a surgical patient in a “hand-assisted” surgical procedure;
• FIG. 3 is a front view drawing of a preferred embodiment of the present invention in place;
• FIG. 4 is an oblique view drawing of the present invention showing two retention members;
• FIG. 5 is an oblique view drawing of the invention in an alternate embodiment;
• FIG. 6 shows the present invention having an alternate exterior retention member;
• FIG. 7A illustrates a folded retention member of the present invention in a closed condition;
• FIG. 7B illustrates the folded member in an opening condition;
• FIG. 7C shows the folded member in a half open condition;
• FIG. 7D shows the folded member in a fully open condition with the seal material tensioned;
• FIG. 8A illustrates an alternate embodiment of the folded retention member closed;
• FIG. 8B illustrates the alternate embodiment partially open;
• FIG. 8C shows the half open retention member having a transverse seal opening;
• FIG. 8D shows the transverse seal opening fully tensioned along its length;
• FIG. 9 shows an adjustable external retention member opening the seal portion;
• FIG. 10 shows the adjustable retention member with a seal portion under minimum tension;
• FIG. 11 illustrates an adjustable retention having a hinge and jackscrew combination;
• FIG. 12 shows the hinge and jackscrew placing opening tension on the seal member;
• FIG. 13 shows the retention member having two jackscrew adjustments and having the seal member in a transverse position and under minimum tension;
• FIG. 14 shows the retention member where the seal member is under maximum tension;
• FIG. 15 illustrates an embodiment of the retention member wherein the tensioning of the seal member is provided by detente folding spacers;
• FIG. 16 shows the detente spacers in an over-center or locked position and applying tension to the seal member;
• FIG. 17 is an oblique view of the external retention member having a ratchet for holding the seal member at a preferred tension;
• FIG. 18 illustrates an alternate embodiment of the present invention wherein the external retention member is an un-inflated but inflatable or fillable hollow torrus;
• FIG. 19 shows the inflatable retention member fully inflated and tensioning the sealing member to provide sealing pressure;
• FIG. 20 illustrates the present invention having two un-inflated but inflatable retention members and the seal member at minimum tension;
• FIG. 21 shows the two inflatable retention members fully inflated and the seal member fully tensioned;
• FIG. 22 illustrates an alternate embodiment of the present invention where the un-inflated retention members and the seal portion are integrally formed of connected tubular segments;
• FIG. 23 shows the alternate embodiment in an inflated condition and shaped as would be the case if the device were inserted within a surgical incision;
• FIG. 24 illustrates an alternate embodiment wherein the external retention member is a coil spring;
• FIG. 25 illustrates the alternate embodiment wherein the external and the internal retention members are coil springs;
• FIG. 26 illustrates an alternate embodiment of the present invention wherein a strap is used to maintain a position over a surgical incision;
• FIG. 27 illustrates an embodiment of the present invention wherein preferred embodiments of the retention member and the seal member are held in place by a strap;
• FIG. 28 illustrates an additional preferred embodiment of the present invention wherein the sleeve/membrane has tensioning tethers in a first condition;
• FIG. 29 illustrates the tethers in a second condition;
• FIG. 30 illustrates the tethers in an irregular, non-uniform configuration;
• FIG. 31 illustrates the tethers in a regular, uniform configuration; and
• FIG. 32 is a perspective view of an access device in combination with a stabilizing platform.
DESCRIPTION OF PREFERRED EMBODIMENTS AND BEST MODE OF THE INVENTION
• InFIG. 1, a patient is illustrated in a prone or supine position and designated by thereference numeral10. Thepatient10 has an abdomen12 which includes a body orabdominal cavity16 defined by anabdominal wall18. A plurality oftrocars20,21, and22 are placed so as to provide surgical access to theabdominal cavity16.Various instruments23,24,25 are illustrated for use through thetrocars20,21, and22.
• InFIG. 2, a “hand-assisted” laparoscopic procedure is shown. Thepatient10 is supine and theabdominal cavity16 is insufflated. In addition to thetrocars20,21, and22, there is an additionalsurgical access device50 that has been placed relative to asurgical incision100. Thisaccess device50 is adapted to receive ahand160 of a surgeon, as it is placed through theaccess device50 and into theabdominal cavity16 of thepatient10. The surgeon is able to use the insertedhand160 to perform tasks that are too difficult or not safe for the instruments normally used in laparoscopy. Theaccess device50 provides a gas tight seal so that the insufflated, pressurized abdomen atcavity16 does not collapse. Theaccess device50 may also accommodate large, contaminated specimens or diseased organs or tissue. Furthermore, instrumentation or tools that might otherwise be too large for a trocar may be introduced through theaccess device50 and subsequently attached to device drivers operated through thetrocars20,21, and22. Specimen bags that are introduced through a trocar may be removed through theaccess device50 when fully burdened.
• Theaccess device50 is placed through thesurgical incision100,FIG. 3, and retained against the external abdominal wall17 by a first retention member orretainer55, and against the internalabdominal wall18 by a second retention member orretainer65. The external,first retainer55 supports a gas tight sleeve ormembrane75 at afirst end76. The internal,second retainer65 supports the gas tight sleeve ormembrane75 at the second,opposite end86. The two opposing ends76 and86 maintain a communicatingsurface77 that passes through theincision100. The material of thesurgical access device50 provides a durable and non-permeable surface against the incised tissue defining theincision100.
• With particular reference toFIGS. 4, 5,6, a preferred embodiment of theaccess device50 has afirst end51, asecond end52 and a communicatingmiddle portion53. Thefirst end51, in a preferred embodiment, is external to abody cavity16 and comprises an enlarged andadjustable portion55. The exact shape of thefirst end portion55 may be circular, ovoid, rectangular, square, triangular or the like. Thefirst end portion55 is sized and configured to be adjustable in area so that asurface77 of a sleeve ormembrane75 is appropriately stretched or tensioned.
• A preferred embodiment of theaccess device50 employs an overlappingleaf spring56 that is biased to the open condition. As opposing ends57,58 of thespring56 spread apart, appropriate tension is exerted upon the sleeve/membrane75. The applied tension causes a pulling force to be exerted through the communicatingmiddle portion53. This force approximates the second, internal, ordistal end52 of theaccess device50 to the inner surface of theabdominal wall18.
• Thesecond retaining portion65 is preferably constructed of a flexible material that allows it to be inserted into thesurgical incision100 in a folded form or reduced profile. Thesecond retaining portion65 is preferably self-deploying or, at least, has sufficient memory to return to a preferred, somewhat circular, or pre-determined shape or condition without manipulation. The material choices for such a configuration may include flexible vinyl, rubber, silicone, or other elastomeric. The materials may also include rigid materials like rigid plastic or metal with a hinged or flexible portion.
• In addition, the construction of either the first orsecond retention members55 and65, respectively, may include the use of elastomeric components that have been fitted with or have been molded to include shape memory metals, such as Nickel-Titanium (NiTinol). In any case, thesecond retention member65 is easily deformable to a condition or shape that facilitates introduction into the smallest possiblesurgical incision100. It must be kept in mind that thesecond retention member65 must be sized and configured to retain theaccess device50 in place during the rigors of an active surgical procedure, and do so without causing tissue damage such as tissue necrosis or abrasion. A preferred embodiment of thesecond retention member65 comprises aring66 of soft silicone or vinyl with an internal, encapsulated or insert molded Nickel-Titanium support ring. This embodiment may be introduced in a very deformed condition and will subsequently recover the preferred shape and size upon completion of introduction into thebody cavity16.
• As an alternative, the super-elastic and shape-memory properties of Nickel-Titanium may be drawn from temperature transition properties of the alloy. For instance, thesecond retention member65 may be cooled to a temperature where thering66 is easily, deformable to a high degree, then, as the alloy warms to body temperature, theretention member65 returns to a programmed shape, size or configuration.
• The sleeve/membrane portion75 is shaped by the tension between thefirst retention member55 and thesecond retention member65. The sleeve/membrane75 may initially define anorifice78 which may be a slit or a hole or the like that communicates between the exterior and the interior of thebody cavity16 through alumen80. Thelumen80 exhibits a first condition when the sleeve/membrane75 is not under tension and a second condition when the sleeve/membrane75 is under tension.
• In a preferred embodiment, the tensioning of the sleeve/membrane75 adjusts thelumen80 to a preferred size and configuration. Such a configuration might be the creation of the radiused, funnel-shapedorifice78 transitioning to the smaller diameter in themiddle portion53 and again transitioning to a funnel-shapedenlargement67 distally at thesecond retention member65.
• The material of a preferred embodiment of the sleeve/membrane75 may include a non-distensible or non-elastic material such as polyethylene, polyurethane or reinforced elastomeric. The choice of polyethylene for the sleeve/membrane75 provides thesurface77 with nearly friction-free characteristics against most glove materials. Since the polyethylene material is non-elastic, the sleeve/membrane75 will fold into discrete “fan-fold”segments79. Such a condition will allow the material of the sleeve/membrane75 to be compressed radially by the adjacent body tissue so that it forms athroat90 or nearly occludedmiddle portion53 when no hand or instrument is present within thelumen80 of thedevice50. Thus, in the absence of the hand or instrument, the throat functions as a zero seal. When a hand or instrument is present within thelumen80, the fan-folded material at thethroat90 of the sleeve/membrane75 yields to the size and shape of the inserted hand or instrument yet forms an occlusive instrument seal. Bearing in mind that the normal pneumoperitoneum is about 0.18 to 0.28 psi, thethroat90 of the present invention is adequate to form both the zero seal and the instrument seal.
• The embodiment ofFIG. 5 is similar to that ofFIG. 4 except that themembrane75 in proximity to thefirst retention member55 has the configuration of a septum. In this case, theorifice78 is formed as a slit which transitions into thethroat90 of the device.Fan-fold segments79 extend to the ends of the slit ororifice78 in this embodiment ofFIG. 5. Thesefan-fold segments79 are absent in the embodiment ofFIG. 6.
• With reference to FIGS.7A-D, a preferred embodiment of thesurgical access device50 of the present invention comprises afirst retention member155 that is folded so that it resembles a taco. The folding of thefirst retention member155 relaxes themember75, allowing thesecond retention member65 to be easily inserted into a surgical incision100 (FIG. 2). The subsequent unfolding of thefirst retention member155, for example, by forcing apart a pair ofseparable members156,157, results in a stretching of the sleeve/membrane75. In this position, the twomembers156,157 of thefirst retention member155 are locked in a single plane or flattened condition with the sleeve/membrane75 in tension.
• In a preferred embodiment of the foldedfirst retention member155 theorifice78 is elongate and in line with afold159 of the sleeve/membrane75 as well as a pair of hingedportions158 of thefirst retention member155. In an alternative embodiment illustrated inFIGS. 8A-8D, theorifice78 that is elongate and transverse to both thefold159 of the sleeve/membrane75 and the hingedportions158 of thefirst retention member155.
• With reference toFIGS. 9-17, asurgical access device50 is shown with thefirst retention member155; however, in this case themember155 is adjustable in area or circumference. In this embodiment, the twoseparable members156,157 of thefirst retention member155 may be separated along a common plane by a pair of actuating adjustingsleeves200,220 operating against adjustingscrews210,230. This action will place the sleeve/membrane75 under tension so as to prepare theorifice78 for use. There may be a several of the adjustingmembers200,220, for example, two, three, four, or more, that cooperate to stretch the sleeve/membrane75. This stretching may be uniform or non-uniform.
• Specifically referring toFIGS. 11, 12, a further embodiment of thesurgical access device50 is shown to have at least onehinge260 that permits theseparate members156,157 to pivot on each other in opposing directions upon application of a spreading force. In this case, the spreading force is applied by rotation of a jackscrew and thumb-wheel combination265. The resulting non-uniform spreading force causes theorifice78 to assume a preferred condition.
• With reference toFIGS. 13, 14, there is shown another embodiment of thesurgical access device50 according to the present invention wherein theelongate orifice78 is positioned so as to be stretched along itslengthwise midline278. This configuration causes theorifice78 to assume a more closed natural condition than would be the case wherein theelongate orifice78 is transverse to the stretching moment. A combination of in-line and transverse stretching of the sleeve/membrane75 and theorifice78 can result in a more symmetrical or uniform opening of theorifice78.
• Referring now toFIGS. 15, 16, another embodiment of thesurgical access device50 is shown, according to the present invention. In this embodiment theseparable members156 and157 are moveable in a single plane between an expanded position illustrated inFIG. 15 and a contracted position illustrated inFIG. 16. In this case, theseparable member156 has ends161 and163 while theseparable member157 has ends160 and162. Foldedseparation members285 and296 are disposed between theends160,161, and theends162,163, respectively. In the compressed state of theseparable members156,157, theseparable members285 and296 are in a folded condition with the first ends160 and162 abutting theends161 and163, respectively. When theseparable members156 and157 are spread to the expanded state illustrated inFIG. 15, theseseparation members285 and296 are moved to an unfolded, flattened or over-centered condition as illustrated inFIG. 16. In this condition, theseparation members285 and295 maintain theseparable members156 and157 in the expanded state thereby stretching the membrane175.
• Anelongate orifice78 may be orientated either in-line or transverse to the direction of stretch. An additional embodiment of thesurgical access device50 may comprise a plurality of thefoldable separation members285,296 wherein the stretching of the sleeve/membrane75 is more or less uniform. Thefoldable separation members285,295 may be constructed of metal, with or without a discrete hinge, or plastic having either discrete or “living” hinges.
• FIG. 17 depicts a further embodiment of thesurgical access device50 according to the present invention. In this case, thefirst retention member155 comprises a length of rigid or semi-rigid material formed into a hoop orcoil290. Thiscoil290 has opposing ends291 and292 as well as anouter surface293 and aninner surface294. When the ends291,292 are spread relative to each other, thecoil290 assumes a larger diameter and area so that the tension upon the attached sleeve/membrane75 is increased.
• The position of the coil ends291 and292 can be maintained by a series ofratchet teeth295 and an associatedratchet pawl296. In the illustrated embodiment, theratchet teeth295 are formed on theouter surface293 and theratchet pawl296 is formed on theend292. Alternatively, a second series of ratchet teeth can be formed on theinner surface294, and an associated second ratchet pawl can be formed on theend291. This double-ended, double-sided ratchet configuration results in a very large distention potential for thefirst retention member155 and, concomitantly, the sleeve/membrane75.
• In this embodiment, thefirst retention member155, as well as theratchet teeth295, and theratchet pawl296, are preferably constructed of a rigid plastic material such as polycabonate, ABS, PBC or other filled or non-filled material. In a further embodiment, thefirst retention member155 may be formed from a metal so that it is sterilizable and reusable. Such an embodiment may still include the disposable sleeve/membrane75 and thesecond retention member65.
• With reference now toFIGS. 18, 19,20,21, asurgical access device50 according to the present invention is shown having an inflatable or fillablefirst retention member300, and a malleable, foldable or otherwise deformablesecond retention member65. In a preferred embodiment, the inflatable orfillable retention member300 comprises a closed,hollow structure310 which may be circular or toroidal. Thehollow structure310, when un-inflated or un-filled exerts very little, if any, stretching or tensioning force upon the sleeve/membrane75. When thehollow structure310 is inflated, however, it assumes a larger diameter and area which results in the desired stretching or tensioning of the sleeve/membrane75. Preferred embodiments of thehollow structure310 can be formed from either elastic or non-distensible materials.
• Similarly, the sleeve ormembrane75 can be formed from an elastic material although in a preferred embodiment themembrane75 is non-distensible. In this embodiment, expansion of thehollow structure310 also stretches the sleeve/membrane75 so that thethroat90 of theaccess device50 is also placed under tension. This tensioning ofthroat90 which connects thefirst retention member300 and thesecond retention member65, causes thesecond retention member65 to be appropriately drawn into sealing engagement with the interior surface of the abdominal wall18 (FIG. 1). This will result in a gas-tight seal around theaccess device50. In the embodiment ofFIG. 19, themembrane75 is in the form of a septum.
• With attention drawn specifically toFIGS. 20, 21, there is shown asurgical access device50 according to the present invention wherein afirst retention member300 includes the inflatable orfillable structure310, and asecond retention member365 also includes an inflatable orfillable structure375. Thesecond retention member365, when un-inflated or un-filled may be easily inserted through anincision100 into abody cavity16 and subsequently inflated or filled to assume a more-or-less rigid or definite shape and configuration within thebody cavity16. Thefirst retention member300 may then be inflated or filled to provide the external retention and the concurrent stretching or tensioning of the sleeve/membrane75. Although it is apparent that the sleeve/membrane75 can also be formed with a double wall structure that is inflatable, this is not the case with the embodiments ofFIGS. 20 and 21. In these illustrated embodiments, the sleeve/membrane75 that connects the two inflatable orfillable retention members300,365, is formed of a single layer or thickness of non-dispensable or non-elastic material. With this construction, themembrane75 is not inflatable and relies on a minimum of intrusive material along the middle portion orthroat90 and through theincision100. At thisthroat90 of theaccess device50, the sleeve/membrane75 remains smooth, lubricious, thin, and non-bulky.
• An additional embodiment of theaccess device50 of the present invention is shown inFIGS. 22, 23 wherein an open-ended, generallycylindrical sleeve450 is constructed of a plurality of axially aligned, communicating, hollow, inflatable,fillable members455. The communicatingmembers455 are inflatable or fillable by means of aninflation tube458. Particularly when uninflated, the generally cylindrical shape (FIG. 23) of theaccess device450 may be easily distorted so that adistal end460 may be placed through thesurgical incision100 and theabdominal cavity16. As theaccess device450 is inflated or filled, it assumes an “hour-glass” shape, and develops afirst retention portion470 and asecond retention portion480 joined by amiddle section490.
• A non-distensible or non-elastic material is also stipulated for use in this preferred embodiment so that friction is minimized, and so that the material of themiddle section490 does not gather or fold as a gloved hand or large instrument is repeatedly inserted and withdrawn through theaccess device450.
• In the illustrated embodiment, the individual inflatable orfillable members455 form axial chambers andabutments495 which prevent material motion and also minimize surface contact between a gloved hand and the material which forms the seal with theabdominal wall18. The lumen of themiddle section490 may be lubricated with a thick or viscous material which can be stored along the seams of the abutting or adjoining inflatable orfillable members455. The lubricating product may also function to perfect the instrument seal in the present of a gloved hand or instrument, or to perfect the zero seal in the absence of the gloved hand or instrument.
• With reference toFIG. 24, asurgical access device50 according to the present invention is shown wherein a compressiblehelical coil member500 forms afirst retention member550. Thecoil member500 may be deformed so as to minimize the tension upon an attached sleeve/membrane75 and amiddle portion560 thereof. Asecond retention member565 may be deformed and placed within thesurgical incision100, so that upon release or decompression of thecoil500 of the first retainingmember550 thesecond retaining member565 is appropriately approximated to the interior wall of a body cavity. For packaging and shipping, thecoil500 of the first retainingmember550 may be maintained within a containment pouch, bag, box, or the like (not shown) in its most-compact condition. In this condition, the first retainingmember550 will exert a minimum of tension upon the attached sleeve/membrane75.
• In a similar embodiment illustrated inFIG. 25, asecond retaining member563 is also provided with a secondretention coil member565. This secondretaining coil member565 may be introduced through theincision100 in a compact configuration and subsequently released to assume an enlarged diameter. This provides theaccess device50 with an increased area of contact at the inner surface of theabdominal wall18. As thesecond retention coil565 is released to assume its enlarged diameter, it also functions to stretch or tension the attached sleeve/membrane75.
• With reference toFIGS. 26, 27, there is shown asurgical access device50 according to the present invention that is adapted to be held in position over thesurgical incision100 by, a strap orbelt600 which surrounds theabdomen12 of the patient10 (FIG. 1). In this embodiment, theaccess device50 may include the strap orbelt600 and associated closure members or buckles610. Theaccess device50 in the embodiment ofFIG. 26 is illustrated as aseptum seal615. In the embodiment ofFIG. 27, the access device is similar to that described with reference toFIG. 19 and designated with thereference numeral300.
• Turning now toFIGS. 28 and 29, thesurgical access device50 is shown with amembrane75 extending between thefirst retention member55 and thesecond retention member65. In this embodiment, thefirst retention member55 includes a solid,rigid ring700 that is disposed in a plane generally perpendicular to the axis of theaccess device50. On the side of thering700 opposite the second retainingportion65, a plurality ofslits710 are provided which extend radially of thering700. In this embodiment, a plurality oftethers715 are attached to themembrane75 at different radial locations. Thetethers715 are attached to themembrane75 at aninner end16 and are provided with anenlargement feature717 at anouter end718. In this embodiment, theslits710 of thering700 are sized and configured to engage and confine at least one of thetethers715. In such an embodiment, the enlargement features715 can act to prevent thetethers715 from being drawn back through theslits710. Theenlargement feature717 can also function as handles facilitating engagement of each of thetethers717, as it is drawn outwardly through the associated slit710 to tension themembrane75.
• In such an embodiment, it may be desirable to form theslits710 so that they are tapered toward the bottom of theslit710. This will facilitate compression of the associatedtether715 to increase the frictional engagement between thetether715 and thering700. In this manner, thetethers715 can be collectedly adjusted to provide themembrane75 with the desired shape and seal characteristics. Themembrane75 can be released from thering700 by merely lifting thetethers715 to disengage their associatedslits710. InFIG. 30, thetether715 is tensioned non-uniformly to provide themembrane715 with an irregular shape. This configuration can be compared with that illustrated inFIG. 31 wherein the tethers are tensioned uniformly to provide themembrane75 with a uniform configuration.
• InFIG. 32, theaccess device50 is illustrated in combination with a stabilizingplatform800. Initially, it will be noted that theaccess device50 which is illustrated, is that described generally with reference toFIGS. 28-31. However, it will be apparent that the stabilizingplatform800 can be adapted to receive and function with any of the foregoing embodiments of theaccess device50, in order to achieve the advantageous discussed below.
• In this embodiment, the stabilizingplatform800 includes a base having a generally planer configuration with a pair ofsupport flanges805 and807 extending perpendicular on opposing sides of thebase803. A pair of upstanding arms110 and112 are pivotally, and perhaps releasably attached to the associatedflanges805 and807. Across member814 is pivotally and perhaps releasably connected between thearms810 and812. Thiscross member814 in a preferred embodiment is perpendicular to thearms810 and812 and parallel to the plane of thebase803. Theaccess device50 is supported by thecross member814, with its axis816 generally perpendicular to thecross member814. With this orientation, the first retention member855, represented by thering700, is disposed in a plane which may be pivoted relative to theupstanding arms810,812, as well as thebase803.
• In operation, thebase803 is disposed beneath the patient10 (FIG. 1) in contact with the back of thepatient10. Theupstanding arms810 and812 can then be mounted to theflanges805 and807, respectively, on either side of thepatient10. Thecross member814 can then be attached to thearms810 and812.
• Thesupport platform800 can be of considerable advantage in a hand-assisted laparoscopic procedure which requires that a human hand being inserted and withdrawn several times while maintaining the abdominal pressure or pneumoperitoneum. As noted, the sealing port or throat90 (FIG. 4) of theaccess device50 must tightly fit around the wrist or arm of the surgeon. When the hand of the surgeon is removed, thethroat90 must close tightly to form a zero seal. This closed sealing attachment to the hand or arm of the surgeon can cause the abdominal wall18 (FIG. 1) to change in shape and particularly in elevation as the hand is inserted and removed. If theaccess device50 is directly attached to theabdominal wall18, this movement of thewall18 can result in movement of theaccess device50 causing other surgical instruments, such as a laparoscope, to be moved or displaced. It is the purpose of the stabilizingplatform800 to support theaccess device50 independently of theabdominal wall18. With this stabilization, movement of the surgeon's hand through theabdominal wall18 will be less apt to move theaccess device50. This greatly stabilizes the surgical field and particularly the instruments inserted through theaccess device50. Appropriate pivoting of thecross member814 and thearms810 and812 enable theaccess device50 to be swiveled to a position appropriate to patients of various size and weight. In an alternative embodiment, the base may be formed as part of a surgical table with at least one support member, such as thearms810,812, extending from one or both sides of the patient to support thecross member814.
• Given the many embodiments disclosed herein for theaccess device50, many other embodiments will now become apparent with changes in structure or materials. For that reason, one is cautioned not to limit the scope of the invention only to the disclosed embodiments, but only with reference to the following claims.

Claims (6)

1-23. (canceled)

24. A combination for facilitating a surgical procedure on a patient supported on a surgical table, comprising:

an access device including a membrane defining a working channel adapted for disposition across a body wall of the patient to provide instrument access into a body cavity of the patient;

a stabilizing platform supporting portions of the access device generally independent of any movement of the body wall; and

the stabilizing platform having a base in a fixed relationship with the surgical table, and a cross member in a fixed relationship with the portions of the access device.

25. The combination recited inclaim 24, further comprising:

at least one arm extending between the base and the cross member.

26. The combination recited inclaim 25, wherein at least one arm has a pivotal relationship with the base.

27. The combination recited inclaim 26, wherein the cross member has an axis and is rotatable on its axis relative to the arm.

28. The combination recited inclaim 25 wherein at least one arm is releasably attached to the base.

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