US20060161049A1 - Surgical access port - Google Patents

Abstract

A device for retracting edges of an incision in a surface to form an opening including: a flexible, tubular skirt having an upper end, a lower end, and a channel therebetween; a ring connected to the lower end of the skirt for maintaining the lower end in an open configuration and defining an exit opening to the channel; and an inflatable collar connected to the skirt and surrounding the upper end. The ring is designed to fit through the incision and remain under the surface when it is oriented parallel to surface. The collar, when inflated, maintains the upper end in an open configuration and defines an entry opening to the channel. During use, the ring is inserted through the incision and the collar is inflated while remaining outside of the incision, thereby drawing the skirt against the edges of the incision and retracting the edges of the incision to form the opening. The retracting device can be included in a surgical access port, which further includes a flexible sleeve connected to at least one of the inflatable collar and the skirt, extending the channel from the exit opening of the skirt to an open end of the flexible sleeve distal to the skirt. The device can include a light source in the vicinity of the exit opening.

Description

BACKGROUND OF THE INVENTION
• This invention relates to the field of surgical devices. More particularly, the invention relates to a surgical access port, which provides a gas-tight seal for a hand or instrument to be inserted through the opening into a patient's body cavity.
• Abdominal surgery typically involves an incision in the abdominal wall large enough to accommodate a surgeon's hands, multiple instruments, and illumination of the body cavity. While large incisions simplify access to the body cavity during a surgery, they also increase trauma, require extended recovery time, and can result in unsightly scars. In response to these drawbacks, minimally invasive surgical methods have been developed.
• In minimally invasive abdominal surgery, several smaller incision are made into the abdominal wall. One of the openings is use to inflate the abdominal cavity with gas, which lifts the abdominal wall away from underlying organs and provides space to perform the desired surgery. This process is referred to as insufflation of the body cavity. Additional openings can be used to accommodate instruments for illuminating and viewing the cavity, as well as instruments involved in actually performing the surgery, e.g., instruments to manipulate, cut, or resect organs and tissue. While minimally invasive surgical methods overcome certain drawbacks of traditional methods, there are still various disadvantages. In particular, there is limited tactile feedback from the manipulated tissue to the surgeon hands. Also, tissue that is to be removed from the body cavity must be removed in pieces that are small enough to fit through one of the incisions.
• Recently, new surgical methods have been developed that combine the advantages of the traditional and minimally invasive methods. In these new methods, small incisions are still used to inflate, illuminate, and view the body cavity, but in addition, an intermediate incision is made into the abdominal wall to accommodate the surgeon's hand. The intermediate incision must be properly retracted to provide a suitable-sized opening, and the perimeter of the opening is typically protected with a surgical drape to prevent bacterial infection. A sealing mechanism is also required to prevent the loss of insufflation gases while the surgeon's hand is either inserted into or removed from the body cavity though the retracted incision.
SUMMARY OF THE INVENTION
• The invention features a surgical access port that allows a surgeon's hand or instrument to access a patient's body cavity through a sealed opening. The access port includes two parts, a wound retractor and a sealing sleeve. The wound retractor is designed to retract the edges of an incision made into a body cavity into an opening, and to seal around the edges of the opening, thereby forming a gas-tight connection between the body cavity and the interior of the access port. The sealing sleeve connects to the wound retractor external to the body cavity and provides a path for a surgeon to insert his hand through the opening formed by the wound retractor. The sealing sleeve seals around a surgeon's arm or a surgeon's glove, when the surgeon's hand is inserted into the body cavity, and seals the opening when the surgeon's hand is removed from the access port. Thus, the port provides hand access to the body cavity, and prevents gases in the body cavity, such as insufflation gases, from escaping into the surroundings.
• In general, in one aspect, the invention features a device for retracting edges of an incision in a surface to form an opening. The device includes: a flexible, tubular skirt having an upper end, a lower end, and a channel therebetween; a ring connected to the lower end of the skirt for maintaining the lower end in an open configuration and defining an exit opening to the channel; and an inflatable collar connected to the skirt and surrounding the upper end. The ring is designed to fit through the incision and remain under the surface when it is oriented parallel to the surface. The collar, when inflated, maintains the upper end in an open configuration and defines an entry opening to the channel. During use, the ring is inserted through the incision and the collar is inflated while remaining outside of the incision, thereby drawing the skirt against the edges of the incision and retracting the edges of the incision to form the opening.
• The retracting device can include the following features. The collar when fully inflated has an inner aperture having a diameter greater than the length of the incision. The device can also include a light source, such as an optic fiber or fiber optic cable, connected to the lower end of the skirt. The skirt can include a hem-shaped pocket that encloses the ring. The ring can be formed by filling a pocket with at least one of a gas and a liquid. The ring can have a substantially elliptical shape. The device can also include a second ring adjacent to an outer perimeter of the inflatable collar for reinforcing the entry opening, as well as a detachable cap, adapted to be received by the second ring, for sealing the entry opening. Furthermore, the device can include an inflatable cuff connected to an inner wall of the skirt and surrounding the entry opening for sealing around a surgeon's arm inserted into the channel, as well as a detachable plug, adapted to be received by the inflatable cuff, for covering the entry opening.
• The retracting device can be included in a surgical access port, which further includes a flexible sleeve connected to at least one of the inflatable collar and the skirt, extending the channel from the exit opening of the skirt to an open end of the flexible sleeve distal to the skirt. In some embodiments, the flexible sleeve can be removed and reattached to the device, or it can be permanently affixed. The access port can include a light source connected to the skirt in the vicinity of the exit opening, and the flexible sleeve can include an iris valve.
• In one embodiment of the access port, the flexible sleeve includes an inner sleeve and an outer sleeve forming a chamber therebetween, and an inlet port for inflating the chamber, whereby inflating the chamber compresses together a central portion of the inner sleeve, thereby sealing the channel. A pair of drawstrings can be attached to opposite sides of the central portion of the inner sleeve and pull the sides in opposite directions toward the outer sleeve, thereby collapsing the central portion of the inner sleeve into two flattened portions contacting each other to form a seal. Furthermore, the central portion of the inner sleeve can include two sealed regions opposite one another in which immediately adjacent portions of the inner sleeve are welded together, thereby dividing the central portion into two substantially flattened portions extending along the length of the channel adjacent to one another.
• In another embodiment, the access port includes a flap valve that connects to the open end of the flexible sleeve and extends into the channel. The flap valve seals the channel when there is a positive pressure differential between the channel and the surroundings. A pair of drawstrings can be attached to opposite ends of the flap valve and pull the ends in opposite directions to enhance the sealing ability of the flap valve.
• In a further embodiment, the access port includes an inflatable cuff attached to an inner surface of the sleeve for sealing around a surgeon's arm. The inflatable cuff can be surrounded by a backing of a substantially non-expandable material. Furthermore, a second ring can be connected to the sleeve and surround the open end of the sleeve. To seal the open end, a detachable cap adapted to be received by the second ring can be used.
• In another embodiment, the access port can include a sealing collar attached to the sleeve and surrounding the open end, and a glove having a flange at the open end of the glove. The sealing collar can have a groove along its inner perimeter that mates with or engages the flange and seals the channel when inserted into the groove.
• In a related embodiment, the access port includes a sealing collar attached to the sleeve and surrounding the open end, and a glove having an enlarged cuff. The sealing collar including an inwardly expanding inflatable bladder that mates with the enlarged cuff and seals the opening when the glove is inserted into the sleeve.
• In another related embodiment, the access port includes a sealing collar attached to the sleeve and surrounding the open end, a bracelet having a fixed diameter, and a surgical glove. The sealing collar has a groove along its inner perimeter that mates with the bracelet. During use, the bracelet is worn by a surgeon underneath the surgical glove and is mated to the sealing collar so that a portion of the glove is held within the groove by the bracelet, thereby sealing the channel.
• In another aspect, the invention features a surgical access port, for use with a surgical glove, including a device for retracting the edges of a surgical incision to form an opening into a patient's body cavity, a sealing sleeve attached to the device external to the body cavity, and a semi-rigid bracelet having a fixed diameter. The sealing sleeve includes a flexible sleeve providing a channel from its open end distal to the retracting device through to the opening, and a sealing collar attached to the sleeve and surrounding the open end that mates with the bracelet. During use, the bracelet is worn by a surgeon underneath the surgical glove and is mated to the sealing collar, thereby fastening a portion of the glove to the sealing collar and sealing the channel. In some embodiments, the access port further includes the surgical glove.
• The invention also features a method of using the new access ports. The steps include: placing the bracelet around an arm of the surgeon; placing the glove over a hand of the surgeon so that the glove extends over the bracelet; inserting the gloved hand into the access port; and attaching the portion of the inserted glove to the access port by mating the bracelet with the sealing collar of the access port.
• In further aspects, the invention features a surgical access port including a device for retracting the edges of a surgical incision to form an opening into a patient's body cavity and a sealing sleeve attached to the device external to the body cavity. The sealing sleeve includes a flexible sleeve providing a channel from its open end distal to the retracting device through to the opening and a mechanism for sealing the channel. The mechanism includes drawstrings.
• In one embodiment, the sealing sleeve further includes an outer sleeve surrounding the flexible sleeve and forming a chamber therebetween, and an inlet port for inflating the chamber. Inflating the chamber compresses together a central portion of the flexible sleeve, thereby sealing the channel. The drawstrings attach to opposite sides of the central portion of the flexible sleeve, pulling the sides in opposite directions toward the outer sleeve, thereby imparting a preferred flattened geometry to the central portion of the inner sleeve and enhancing the seal.
• In another embodiment, the mechanism further includes a flap valve that connects to the open end of the flexible sleeve and extends into the channel. The flap valve seals the channel when there is a positive pressure differential between the channel and the surroundings. The drawstrings attach to opposite ends of the flap valve, pulling the ends in opposite directions, enhancing the sealing ability of the flap valve.
• Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. Although methods and materials similar or equivalent to those described herein can be used in the practice or testing of the present invention, suitable methods and materials are described below. All publications, patent applications, patents, and other references mentioned herein are incorporated by reference in their entirety. In case of conflict, the present specification, including definitions, will control. In addition, the materials, methods, and examples are illustrative only and not intended to be limiting.
• The invention has the following advantages.
• Since the edges of the incision are retracted by simply inflating the collars, the wound retractor is easy to use. Furthermore, the wound retractor provides a seal around the perimeter of a retracted wound, from the inner abdominal wall to the surface of the skin. The seal prevents infection and provides a gas-tight connection between the body cavity and the remainder of the access port.
• In the sealing sleeve portion of the access port, the flap valve and the inner sleeve, which is compressed by the inflatable chamber, provide a gas-tight seal around a surgeon's arm when the surgeon's hand is inserted into a patient's body cavity. This seal prevents insufflation gases from escaping. The effectiveness of this seal is improved by the drawstrings.
• A light source connected to the base of the wound retractor can be used to illuminate the body cavity, making additional incisions for endoscopic illuminating means unnecessary.
• Other features and advantages of the invention will be apparent from the following detailed description, and from the claims.
BRIEF DESCRIPTION OF THE DRAWING
• FIG. 1 is a cross-sectional view of a surgical access port.
• FIGS. 2A to2E illustrate the steps in using the wound retractor portion of the access port ofFIG. 1.
• FIG. 3 is a cross-sectional view of a another embodiment the surgical access port ofFIG. 1.
• FIG. 4 is a cross-sectional view of a another embodiment of a surgical access port.
• FIG. 5 is a schematic of a modular surgical access port.
• FIGS. 6A and 6B are schematic views of an iris valve in open and closed configurations, respectively.
• FIGS. 7A and 7B are a cross-sectional views of another embodiment of a surgical access port.
• FIG. 8 is a cross-sectional view of an embodiment of a wound retractor.
• FIG. 9 is a cross-sectional view of another embodiment of a wound retractor.
• FIG. 10 is a perspective view of an embodiment of the access port employing a glove.
• FIG. 11 is a perspective view of another embodiment of the access port employing a glove.
• FIG. 12 is a perspective view of a further embodiment of the access port employing a glove.
• FIG. 13 is a schematic of a wound retractor having a light source for illuminating the body cavity.
DETAILED DESCRIPTION
• The surgical access port is best described as having two parts, a wound retractor and a sealing sleeve.
• The wound retractor includes a flexible tubular skirt having a first end reinforced with a stiff ring so that the first end is maintained in an open orientation, and a second end surrounded by one or more inflatable collars. The reinforced first end is inserted into the body cavity through an incision, providing a channel through the skirt from the outside to the inside of the body cavity. During use, the collars are inflated, thereby drawing out skirt within the incision and pulling the reinforced first end of the skirt tight against the inner wall of the patient's skin. As a result, the edges of the incision are retracted into an opening and the skirt seals around the perimeter of the opening along the inner abdominal wall to the outer surface of the skin.
• A sealing sleeve is attached to the wound retractor portion above the inflatable collars. The sealing sleeve has an entry opening distal to the collars and extends the channel provided by the skirt. Within the sealing sleeve, a gas-tight seal is provided for conforming to the shape of an object (e.g., a hand or instrument) inserted through the channel into the body cavity.
• Alternatively, the sealing sleeve can include means for attaching a surgeons glove to the entry opening of the sleeve. In these cases, the exterior of the glove seals the channel while a surgeon's hand can be inserted into the interior of the glove and access the body cavity.
• Surgical Access Ports
• As shown inFIG. 1,surgical access port62 is a sleeve-like device having anentry opening12 and anexit opening18. During use, a surgeon inserts a hand into theentry opening12 and accesses a patient's body cavity throughexit opening18, after the access port is inserted into the body cavity through an incision, and prevents gases used to insufflate the body cavity from escaping through the incision. Aflexible skirt66 surroundsexit opening18 and has a hem-like pocket63 at its end proximal to exitopening18.Pocket63 encloses aring64 so that the skirt andexit opening18 are maintained in an open, substantially circular or elliptical orientation.Skirt66 extends upward from exit opening18 towards one or moreinflatable collars68 and69 that surroundskirt66. The upper end ofskirt66 is connected to theupper-most collar69, from the inner circumference ofcollar69 to the top ofcollar69. Each of theinflatable collars68 and69 respectively enclose an annular region. The annular regions may or may not be in fluid contact with one another, but they are isolated from the rest of the sleeve, body cavity, and surrounding. Thecollars68 and69 are inflated through one ormore inlet ports11. Whencollars68 and69 are in fluid communication with one another, only asingle inlet port11 is required.
• Anouter sleeve10 is attached to the upper end ofskirt66 and extends upward towards entry opening12.Outer sleeve10 encloses anupper chamber16, which is in fluid contact with gases from the body cavity whenexit opening18 is inserted through an incision into the body cavity.Outer sleeve10 is inverted at theentry opening12 forming aflap valve14, which sealsupper chamber16 from the surroundings external toentry opening12.
• The lower portion ofaccess port62, which includesring64,skirt66, andinflatable collars68 and69, form the wound retractor. During use, anincision50, e.g., in the shape of a slit (FIG. 2A) is first made in the patient'sabdominal wall52.Ring64 and the attached portion ofskirt66 are then inserted into the body cavity throughincision50 withcollars68 and69 being uninflated and remaining external to incision50 (FIG. 2B). Ifring64 is circular and has a diameter less than the length ofincision50, it is inserted perpendicular toabdominal wall52. Alternatively, ifring64 is circular and its diameter is greater than the length ofincision50,ring64 must be flexible enough to fit throughincision50 in a deformed state. Most preferably,ring64 is rigid and has an elliptical shape with a maximum diameter longer than the length ofincision50 and a minimum diameter shorter than the length ofincision50. In this case,rigid ring64 is inserted into the body cavity by orienting its minimum diameter parallel toincision50.
• Oncering64 is within the body cavity, it is oriented so that it is parallel to the abdominal wall52 (FIGS. 2C and 2D).FIGS. 2C and 2D are cross-section views along the length and width, respectively, ofincision50, withcollars68 and69 remaining uninflated. In this configuration, the diameter and stiffness ofring64 are sufficient to prevent it from being pulled back throughincision50. Thecollars68 and69, which have diameters equal to or greater than the length ofincision50, are then inflated thoughinlet port11.Collars68 and69 initially rest aboveabdominal wall52 aroundincision50. Ascollars68 and69 are inflated, they expand upward and their inner circumferences expand radially outwardly (FIG. 2E). Since the upper end ofskirt66 is connected to the inner circumference of theupper-most collar69,skirt66 is also drawn upwards and radially outward, thereby drawingring64 tightly against the inner surface ofabdominal wall52. As a result, the intermediate portion ofskirt66 is drawn tightly against the edges ofincision50, retracting the adjacent tissue and producing an opening into the body cavity and a gas-tight seal between the body cavity and the remainder ofaccess port62.FIG. 2E illustrate a cross-sectional view ofincision50 withcollars68 and69 being inflated.
• Once the wound retractor ofaccess port62 has provided a gas-tight seal aroundincision50, the body cavity is inflated with gas. The gas also expands intoupper chamber16, inflating the upper portion ofaccess port62. The pressure withinupper chamber16seals flap valve14, which prevents gas from escaping throughentry opening12. The portion offlap valve14 distal toentry opening12 has a preferred flattened orientation formed by heat sealingside portions15aand15bof flap valve14 (FIG. 3). As the flap valve extends upward towards entry opening12, it opens into an approximately circular geometry. During use, the surgeon inserts his hand intoupper chamber16 through entry opening12 andflap valve14. Insertion of the surgeon's hand momentarily breaks the seal betweenside portions15aand15bofflap valve14, but thereafter the pressure within upper chamber sealsflap valve14 around the surgeon's arm. The loss of insufflation gases is thereby minimized during insertion and subsequent removal of the surgeon's hand. Since these gas losses are small, they can be compensated for easily by known pumping means used for inflating and regulating pressure in the body cavity.
• To preventflap valve14 from everting as a result of positive pressure in the upper chamber, the portion of the access port extending from the upper portion ofouter sleeve10 towardflap valve14 along entry opening12 can be reinforced with additional material to stiffen the access port in this region, and to maintain the preferred orientation, i.e., to prevent eversion.
• In addition or alternatively, heat-sealedside portions15aand15bcan be provided witheyelet openings20aand20bthrough which drawstring22aand22bare attached (FIG. 3).Drawstrings22aand22bextend in opposite directions such that tension placed upon them pulls the two walls offlap valve14 into close approximation. The drawstrings pass through the walls ofouter sleeve10 viadrawstring ports24aand24b.Drawstring ports24aand24bform a friction fit arounddrawstrings22aand22bsealingupper chamber16 from the surroundings and fixing the respective lengths of the drawstrings inupper chamber16. Tension ondrawstrings22aand22bcan be increased by pulling on the drawstrings from the outside ofouter sleeve10, even asaccess port62 is in use. In certain embodiments,drawstring ports24aand24bcan further include one-way releasable locking mechanisms so that tension on the drawstrings can be increased and decreased from the outside ofouter sleeve10. The drawstrings prevent the inversion offlap valve14 whenupper chamber16 is inflated and enhance the effectiveness of the flap valve seal, with and without insertion of a surgeon's hand.
• In an alternative embodiment,drawstrings22aand22bare made of an elastic material and fixedly attached to the inner wall ofouter sleeve10. In this embodiment, the drawstrings do not extend outward throughouter sleeve10 and so the tension on them is not adjustable. Instead, the drawstrings are cut to a specific length to provide a preset tension on the flap valve opening when the upper chamber is fully expanded.
• FIG. 4 shows another embodiment ofhand access port62, which differs from the embodiments described previously in the following way.Flap valve14 is replaced with a flexible and expandableinner sleeve30 that extends from entry opening12 and attaches to skirt66 near the upper-most collar. As a result,upper chamber32 is completely isolated from the body cavity and the surroundings. Instead of being inflated by insufflation gases from the body cavity,upper chamber32 is inflated separately throughinlet port34.
• The interior ofinner sleeve30 provides a channel from entry opening12 to the wound retractor. Whenupper chamber32 is inflated, the positive pressure inupper chamber32 collapses together the walls of expandableinner sleeve30, thereby sealing the channel, or alternatively, sealinginner sleeve30 around the arm of a surgeon.
• Inner sleeve30 includes a central portion having a flattened orientation formed by heat sealingside portions38aand38b.Hence, the circumference ofinner sleeve30 begins substantially circular near entry opening12, becomes elongate in the vicinity ofside portions38aand38b,and becomes substantially circular again in the vicinity ofcollars68 and69. As described previously, the access port can also includeeyelet openings40aand40binside portions38aand38b,through whichdrawstrings42aand42bare attached, respectively. The drawstrings extend outwardly throughdrawstring ports44aand44b.Whenupper chamber32 is inflated to a pressure greater than the pressure in the body cavity and the surroundings, the positive pressure collapses together the walls ofinner sleeve30 betweenside portions38aand38b,sealing the body cavity fromentry opening12. As a result ofdrawstrings42aand42b,this seal is enhanced.
• During use of this embodiment, the wound retractor portion ofaccess port62 is implemented as described previously (and shown inFIGS. 2A-2E).Upper chamber32 is then inflated, sealing the body cavity from the surroundings. Following this step, the body cavity is insufflated. If the pressure in the body cavity is greater than pressure inupper chamber32, the seal will leak insufflation gas to the surroundings, otherwise the seal will be maintained. In this way, the isolatedupper chamber32 insures that the insufflation pressure in the body cavity will remain below the pressure in the upper chamber. As the surgeon inserts his hand throughaccess port62 and into the body cavity, the positive pressure fromupper chamber32 will forceinner sleeve30 to conform to the shape of the surgeon's arm, thereby maintaining the seal. As mentioned before, any loss of insufflation gas during the insertion and removal of the surgeon's hand can be compensated for by the insufflation pump.
• Access port62 may further include a one-way relief valve46, such as a duck-billed relief valve, betweenupper chamber32 and a region withininner sleeve30 proximal toinflatable collars68 and69. A duck-billed relief valve is a one-way valve that opens when there is a sufficient pressure differential between opposite sides of the valve. In this embodiment,relief valve46 would begin to leak if the pressure inupper chamber32 became too large. For example, when the surgeon's arm is withininner sleeve30, the volume ofupper chamber32 becomes compressed, thereby increasing the pressure withinupper chamber32 and against the surgeon's arm. This may be uncomfortable for the surgeon. Advantageously,relief valve46 would optimize the effectiveness of the seal around the surgeon's arm and the comfort of the surgeon by releasing gas fromupper chamber32 to the body cavity. The insufflation pump used to inflateupper chamber32 could compensate for any loss of gas fromupper chamber32 that may be required to maintain an effective seal once the surgeon removes his hand.
• Relief valve46 also allows the body cavity to be insufflated with the same pump used to inflateupper chamber32. Once the pressure inupper chamber32 reaches a preset value, gas will leak throughrelief valve46 insufflating the body cavity. The seal between the entry opening and the body cavity will be maintained since the pressure in upper chamber will remain larger than the pressure in the body cavity. In a further embodiment, the access port includes a second one-way relief valve extending frominflatable collars68 and69 to the upper chamber. Thus, a single pumping means could be used to first inflatecollars68 and69, then inflateupper chamber32, and finally inflate the body cavity. The relief valves would require that the pressure incollars68 and69 is greater than the pressure inupper chamber32, which is greater than the pressure in the body cavity.
• A relief valve may also be positioned betweenupper chamber32 and a region ofinner sleeve30 proximal toentry opening12. In this case gas will leak for the upper chamber into the surroundings.
• Access Port Variations
• In another embodiment, the access port described above having an inner and outer sleeve can also include a second pair of drawstrings for imparting a second region of the inner sleeve with a preferred flattened geometry. Thus, when the seal formed by the first flattened region is broken during the insertion or removal of a surgeon's hand, pressure from the inflated upper chamber provides a second seal at the second flattened region, or vice-versa.
• Alternatively, for any of the embodiments described previously, a flap valve can be connected to the skirt and extend into the wound retractor, thereby providing a second seal on the surgeon's arm. Thus, when the surgeon's hand breaks either seal, the remaining seal prevents the escape of insufflation gases.
• In a further embodiment, the surgical access port can be modular as shown inFIG. 5, comprising a wound retractor200 (as described above) and a sealingsleeve202. Depending on the particular embodiment, the sealing sleeve could, for example, include an outer sleeve having a flap valve seal within an entry opening (e.g., the embodiment shown inFIG. 1) or an inflatable chamber formed between an inner and outer sleeve (e.g., the embodiment shown inFIG. 4). For surgical procedures that do not require insufflation of the body cavity, the wound retractor can be used on its own for retracting an incision to make an opening into the body cavity. When insufflation of the body cavity is necessary, the sealing sleeve is attached to the wound retractor using a reusable gas-tight attachment means204, such as a zip-lock seal. Alternatively, for example, the attachment means can include a compression or threaded fit between a pair of semi-rigid collars attached to the sealing sleeve and wound retractor, respectively. Otherwise, the surgical access port is structured and functions similarly to the embodiments described above.
• In other embodiments, the wound retractors described herein can be used with other types of sealing sleeves. In particular, rather than sealing means based on inflation, mechanical sealing means well known in the art can be provided. For example, as shown inFIGS. 6A and 6B, the sealing sleeve can include aniris valve76 attached to the upper end of the skirt above the inflatable collars. The iris valve is formed from twostiff rings70 and72 attached to opposite ends of atubular piece74 of elastic material (FIG. 6A). In this configuration,iris valve76 is open. To seal the opening, or alternatively, to seal around a surgeon's arm inserted through the opening, theupper ring72 is rotated relative to thelower ring70, as a result tubular piece ofelastic material74 becomes twisted and the opening through the tubular piece contracts (FIG. 6B). To lock the relative positions of the upper and lower rings, the rings are attached to one another using aclasping mechanism78 and80, e.g., a latch.
• Alternatively, for example, the lower ring can be provided with upright pegs evenly spaced around its circumference. The upright pegs fit into corresponding openings in the upper ring, so that when the upper ring is placed on the lower ring the rotational position of the rings relative to one another is fixed.
• Another embodiment of a sealing sleeve101 is shown inFIGS. 7A and 7B. Thetop end108 ofsleeve10 is maintained in an open configuration by its connection to arigid ring110. Just belowrigid ring110, the inner wall ofsleeve100 is connected to aninflatable cuff112, which is made out of an expanding, elastomeric material (e.g., rubber). Surroundinginflatable cuff112 on the outside ofsleeve10 is astiff backing100 of a close-fitting non-expanding material (e.g., a nylon weave). Since backing100 is non-expanding,cuff112 will expand inward when inflated, thereby sealing around a surgeon's arm when the surgeon's hand is inserted through the channel formed bywound retractor106. Furthermore, since there is a region of flexible material betweencuff112 and woundretractor106, the surgeon can easily alter the angle of his arm and the penetration depth of his hand, without jeopardizing the seal formed bycuff112. When the surgeon's hand is removed from the access port,cuff112 can be inflated further to completely seal the channel.
• Alternatively, to seal the channel when the surgeon's hand is removed,rigid ring110 can receive a snap-on cap114 (FIG. 7B), which covers the opening at thetop end108 ofsleeve100. The cap is made of a semi-flexible material, which includes, for example, hard rubber, polyvinyl chloride (PVC), and foam.Cap114 includes agroove117, above a lowerinner lip116, that mates withrigid ring110. The mechanical pressure created by a slight undersizing of the diameter ofgroove117 aboveinner lip116 relative to the diameter ofrigid ring110 forms a tight seal.Cap114 can also includeinstrument ports118 and120, which provide gas-tight sealable openings into the body cavity for surgical instruments (e.g., trocars, cannulas, and endoscopes).
• In another embodiment, shown inFIG. 8, the wound retractor described previously can further include arigid ring210 surrounding the outer perimeter ofinflatable collars68 and69. For example,skirt66 can extend over, and connect to, the outer perimeter ofinflatable collars68 and69, enclosingrigid ring210 between these collars. Alternatively, for example, one of the inflatable collars can include additional material for enclosingrigid ring210 around the outer perimeter of that collar.Rigid ring210 will help preventcollars68 and69 from deforming in response to forces from the retracted opening when inflated, and will provide structure to the top part of awound retractor212 whencollars68 and69 are uninflated. Furthermore,rigid ring210 allows snap-oncap114 to directly cover the channel provided bywound retractor212.Cap114 is mounted ontoring210 by a compression fit. The diameter ofrigid ring210 is slightly larger than the diameter ofgroove117 abovelower lip116, thereby forming a tight seal.
• As shown inFIG. 9, woundretractor224 can further include aninflatable cuff220 attached directly to skirt66 of the wound retractor adjacent to the inner perimeter ofinflatable collars68 and69. In this case, woundretractor224 includes a sealing means for the channel into the body cavity (i.e., cuff220) and a sealing sleeve is unnecessary.Cuff220 is made of an expandable, elastomeric material and will expand inward when inflated, sealing around a surgeons arm that is inserted through the channel formed bywound retractor224. When the surgeon's arm is removed,cuff220 can either be inflated to completely seal the channel, or alternatively,cuff220 can receive a sealingplug230. Afterplug230 is inserted intowound retractor224,inflated cuff220, when inflated, fits securely within recessedgroove232, thereby sealing the channel. As withcap114, sealingplug230 can include one or moresealable instrument ports234 for inserting instruments into the body cavity throughwound retractor224.
• Access Port Variations Using a Glove
• In another series of embodiments shown inFIGS. 10-12, a seal is made between the cuff of a glove worn by the surgeon and the opening of the sealing sleeve. Awound retractor300 of anaccess port302 provides an opening through anabdominal wall304 into abody cavity306. A flexibletubular sleeve310 is attached to woundretractor300 external tobody cavity306, extending the channel formed bywound retractor300 to anentry opening312 ofsleeve310. A sealingcollar314 is connected tosleeve310 surroundingentry opening312.Sealing collar314 is for mating to anenlarged cuff317 of aglove316 worn by a surgeon, thereby sealing the channel from the surroundings.
• Sleeve310 can be provided with a means for closing the channel along anintermediate portion318 ofsleeve310 to seal the opening tobody cavity306. For example, along acircumference322 ofintermediate portion318,sleeve310 can attach to adrawstring320, which can be drawn up external to sleeve310 (FIG. 10). When drawstring320 is drawn up,circumference322 contracts until the channel intobody cavity306 is completely covered bysleeve310. In another embodiment, shown inFIG. 11,intermediate portion318 can be closed by a “bear-trap”clamp330 comprising two hingedarcuate bands332 and334 connected to the base ofsleeve310. Whenbands332 and334 extend away from one another, they surround the base ofsleeve310 and the channel remains open. Asbands332 and334 are brought together abovewound retractor300, they force together opposite inner surfaces ofsleeve310, thereby closing the channel and sealing the opening tobody cavity306.
• In a further embodiment, shown inFIG. 12, inner surfaces ofintermediate portion318 ofsleeve310 include a zip-lock seal340 for sealing the opening tobody cavity306. In other embodiments, a separate mechanical clamp can be used to hold inner surfaces ofintermediate portion318 together, thereby closing the channel.
• During use, the closing means is used to seal the opening intobody cavity306 formed bywound retractor300.Body cavity306 is then insufflated, with the closing means preventing the escape of insufflation gases into the surroundings.Cuff317 of surgeon'sglove316 is then mated with sealingcollar314 and the closing means is released so that the surgeon's gloved hand can accessbody cavity306. The open end ofsleeve310 is sealed toenlarged cuff317, preventing the escape of insufflation gases even though the closing means surroundingintermediate portion318 is not in use. The length offlexible sleeve310 provides the surgeon's arm with a sufficient movement range. When the surgeon brings his gloved hand aboveintermediate portion318, the closing means can be reset, thereby resealing the opening tobody cavity306. Thereafter,enlarged cuff317 is detached from sealingcollar314 and the surgeon's gloved hand is removed fromaccess port302.
• In one embodiment,enlarged cuff317 includes a radially-outwardly extendingflange350 that mates with aninner groove352 within sealingcollar314.Flange350 is made of a semi-rigid material (e.g., plastic or rubber) that is sufficiently deformable forflange350 to be inserted into sealingcollar314 and mate with groove352 (FIG. 10).
• In the above embodiment,glove316 can be a standard surgical glove andflange350 can be formed by placing a bracelet over the surgeon's gloved hand and mounting the bracelet to the wrist portion of the glove using an adhesive material. In order to seal the channel, the bracelet is designed to mate withgroove352.
• Alternatively, abracelet360 can be worn underneath glove316 (FIGS. 11-12). Again,glove316 is a standard surgical glove, which is typically made of a flexible and semi-elastic material (e.g., latex, natural rubber, or polymeric materials). In this case, the surgeon places abracelet360 around his wrist and then pullsglove316 over his hand and the bracelet.Glove316 conforms to the shape ofbracelet360, thereby formingenlarged cuff317, which completely surrounds the wrist of the surgeon and can mate with sealingcollar314.
• In these embodiments,bracelet360 is made of a substantially rigid or semi-rigid material (e.g., an o-ring made of hard rubber) and has a fixed diameter.Sealing collar314 can comprise aninflatable bladder364 for expanding against and mating with enlarged cuff317 (FIG. 11).Sealing collar314 can also be made of a semi-compressible material (e.g., foam or a gel-filled bladder), which provides an interference fit withenlarged cuff317. Alternatively,bracelet360 can have a cross-sectional shape designed to fit with aninner groove370 of sealing collar314 (FIG. 12). Glove material pressed between fittedcollar314 andbracelet360 functions as a gasket, enhancing the effectiveness of the seal.
• In any of the embodiments using the bracelet and glove, the seal is maintained without constricting the surgeons arm, which can be a source of discomfort. The surgeon's arm is not constricted becausebracelet360 has a fixed diameter and need only fit loosely around the surgeon's arm. However, by mating with sealingcollar314,bracelet360 securely attachesglove316 to entry opening312 ofsleeve300, sealing the opening to the body cavity, and allowing access to the body cavity viaglove316.
• Preventing the constriction of a surgeon's arm can be further achieved by an embodiment in which the cross-sectional diameter ofbracelet360 along the length of the surgeons arm is slightly larger than the corresponding dimension ofgroove370. Hence, an interference fit between the mating components is provided along a direction parallel to the surgeon's arm, andbracelet360 is not compressed along a direction that will constrict a surgeon's arm.
• In some embodiments, it is desirable for the diameter ofbracelet360, and the glove itself, to be large enough that the surgeon can remove his hand fromglove316 without detachingglove316 fromsleeve310. In this case,access port300,glove316 andbracelet360 combine to form a detachable glove box, in which, during use, the surgeon can insert and remove his hand from the body cavity at will (via glove316) with no loss of insufflation gas, and when the procedure is completed,glove316 can be detached fromaccess port300.
• It is worth pointing out, however, that the diameter ofbracelet360 should not be too large to prevent a surgeon's range of movement. In particular, the diameter ofenlarged cuff317 formed bybracelet360 should be smaller than the diameter of the retracted incision. As a result, the surgeon can completely insert his gloved hand and arm, includingenlarged cuff317, through the retracted opening into the body cavity. Alternatively, the glove and cuff can be designed such that the glove extends up to, for example, a surgeon's elbow, and the cuff fits around the surgeon's upper forearm or elbow to provide the surgeon a sufficient reach inside the body cavity.
• In other embodiments, a separate mechanical or elastic clamp can be used to attachglove316 to the entry opening312 ofsleeve310. Furthermore, in any of the above embodiments, additional mechanical or elastic, clamping or tightening means (e.g., elastic bands, drawstrings, or incremental tightening rings) can be used to enhance the seal provided by the connection ofenlarged cuff317 to sealingcollar314.
• Inclusion of a Light Source
• In further embodiments, any of the embodiments described previously can include a light source connected to a portion of the wound retractor inserted into and facing the body cavity. For example, referring toFIG. 13, awound retractor130 includesinflatable collar132 surrounding anentry opening133 external to a patient'sabdominal wall135, askirt134 extending fromuppermost collar132 through an incision into abody cavity138, and aring136 reinforcing the substantially circular opening of the end ofskirt134 distal touppermost collar132. Encased withinskirt134 is a plurality ofoptical fibers142 extending along the length ofskirt134 towardring136. The optical fibers can also be adhered to the inner or outer walls ofskirt134. The ends offiber optic cables142 face into the body cavity and extend around the perimeter of exit opening140 adjacent to ring136. Theoptical fibers142 pass throughskirt134 to the outer perimeter of entry opening133 where they are bundled together and connected to an externallight source144.
• Other light sources can also be used. For example the ring could be luminescent and the skirt pocket transparent. In particular, the ring could be electroluminescent, so that when a current or a voltage is applied, the ring emits light. Wire used to pass current or voltage into the ring could be encased in the skirt as was described above for fiber optic cables. In another embodiment, the ring material is phosphorescent and is “charged-up” by it exposing it to light, e.g., ultraviolet light, prior to use. In a further embodiment, the ring could enclose chemiluminescent material. In this case, a seal within the ring is ruptured immediately prior to use, thereby mixing a plurality of materials that react with one another and emit light from the ring.
• Materials and Manufacture
• In the above embodiments, a gas-tight, flexible, and partially elastic material, such as a plastic or a rubber, is used for the skirt, collars, and the inner and outer sleeves. For example, polyethylene, polypropylene, urethane, natural rubber, or latex can be used. The material for the ring provides stiffness to the lower end of the skirt. In particular, the ring should be stiff enough that it will not pass through the incision when it is initially parallel to the inner wall of a patient's skin and a force is drawing it tight against the inner wall. The ring can be made of, e.g., metals, polyvinyl chloride (PVC), hard rubber, and foam. Alternatively, the hem-shaped pocket could be gas-tight and the ring pneumatic, with the pocket being filled with a gas, liquid, or gel. During use, the pocket is filled prior to the insertion of the exit opening into the body cavity. Methods of molding or heating-sealing together flexible plastic materials into prescribed medically-approved objects are well known in the art and can be carried out by commercial entities (e.g., Dielectrics Industries, Chicopee, Mass.).
Other Embodiments
• It is to be understood that while the invention has been described in conjunction with the detailed description thereof, that the foregoing description is intended to illustrate and not limit the scope of the invention, which is defined by the scope of the appended claims. For example, the surgical access port can also be used and adapted for insertion of a surgical tool rather than, or in addition to, a surgeon's hand. Moreover, the sealing sleeve can be provided with a plurality of access openings to simultaneously accommodate a plurality of hands and/or instruments that are be inserted into the body cavity. Also, the rings, collars and entry and exit openings, are not limited to substantially circular shapes, instead they could, for example, have an elliptical shape to better accommodate the inserted object and provide the desired retraction of the incision. Furthermore, the length of the sealed side portions in the sealing sleeve can also be optimized to more effectively seal the inserted object.
• The retractor and sealing sleeve are not limited to surgical applications. They can be used in any application in which the edges of an incision into a surface is retracted into an opening, and where appropriate, a seal is used to prevent the escape of gases through the opening.
• Other aspects, advantages, and modifications are within the scope of the following claims.

Claims (25)

1-33. (canceled)

34. A surgical access port comprising:

a retracting device comprising an upper portion configured to overlie tissue surrounding an incision into a patient, a lower portion insertable through the incision and configured to underlie the tissue surrounding the incision, and a flexible, gas-impermeable skirt having an upper end connected to the upper portion and a lower end connected to the lower portion, wherein the lower portion is configured to be drawn tightly against an inner surface of the tissue and to maintain the lower end in an open configuration, and wherein the skirt, upper portion, and lower portion define an open channel extending through the incision; and

a seal removably secured to the upper portion of the retracting device and configured to selectively seal an upper end of the channel or to seal around an object inserted through the seal.

35. The surgical access port ofclaim 34, wherein the skirt comprises rubber.

36. The surgical access port ofclaim 34, wherein the lower portion comprises a ring.

37. The surgical access port ofclaim 36, wherein the skirt includes a hem-shaped pocket that encloses the ring.

38. The surgical access port ofclaim 36, wherein the ring is formed by filling a pocket with at least one of a gas, a liquid, and a gel.

39. The surgical access port ofclaim 36, wherein the ring comprises a metal, plastic, hard rubber, or foam.

40. The surgical access port ofclaim 36, wherein the ring is circular.

41. The surgical access port ofclaim 36, wherein the ring is elliptical.

42. The surgical access port ofclaim 34, wherein the seal comprises a valve.

43. The surgical access port ofclaim 34, wherein the seal comprises an iris valve.

44. The surgical access port ofclaim 34, wherein the seal comprises a cap that seals the upper end of the channel.

45. The surgical access port ofclaim 44, wherein the cap comprises hard rubber, plastic, or foam.

46. A method of using the surgical access port ofclaim 34, the method comprising:

inserting the lower portion through the incision; and

using the flexible skirt to draw the lower portion tight against an inner surface of the tissue, the lower portion forming a seal around a perimeter of the incision along the inner surface of the tissue.

47. A surgical access port comprising:

a retracting device comprising an upper portion configured to overlie tissue surrounding an incision into a patient, a lower portion insertable through the incision and configured to underlie the tissue surrounding the incision, and a flexible, gas-impermeable skirt having an upper end connected to the upper portion and a lower end connected to the lower portion, wherein the lower portion is configured to be drawn tightly against an inner surface of the tissue and to maintain the lower end in an open configuration, and wherein the skirt, upper portion, and lower portion define an open channel extending through the incision; and

a mechanical sealing means secured to the upper portion of the retracting device and configured to selectively seal the upper end of the channel or to seal around an object inserted through the mechanical sealing means.

48. The surgical access port ofclaim 47, wherein the lower portion comprises a ring having a circular or elliptical shape.

49. The surgical access port ofclaim 48, wherein the skirt includes a hem-shaped pocket that encloses the ring.

50. The surgical access port ofclaim 48, wherein the ring is formed by filling a pocket with at least one of a gas, a liquid, and a gel.

51. The surgical access port ofclaim 48, wherein the ring comprises a metal, plastic, hard rubber, or foam.

52. The surgical access port ofclaim 47, wherein the mechanical sealing means comprises at least one of a valve, an iris valve, and a cap.

53. The surgical access port ofclaim 52, wherein the cap comprises hard rubber, plastic or foam.

54. A method, comprising:

inserting a lower portion of a flexible, gas-impermeable skirt of a retracting device through an incision in a surface of a tissue in a patient and orienting the lower portion to underlie an inner surface of tissue surrounding the incision;

orienting an upper portion of the skirt to overlie an outer surface of tissue surrounding the incision; and

using the flexible skirt to draw the lower portion tight against the inner surface of tissue surrounding the incision to form a seal around a perimeter of the incision along the inner surface, and to further retract the incision into an opening and provide a channel through the incision.

55. The method ofclaim 54, further comprising sealing the channel by attaching to the upper portion at least one of a valve, an iris valve, and a cap.

56. The method ofclaim 54, further comprising releasably attaching to the upper portion a gas-impermeable sleeve in order to extend the channel away from the incision.

57. A method of performing minimally invasive surgery, the method comprising:

extending the channel away from the incision using the method ofclaim 56; and

accessing an interior of the patient through the channel.

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