US20120109064A1 - Port fixation with interlocking structure - Google Patents

Abstract

The present disclosure relates to a surgical access system that includes a cannula assembly adapted for removable positioning within a percutaneous tissue tract, and an obturator assembly removably positionable within the cannula assembly. The cannula assembly includes a cannula housing, a cannula sleeve, and first engagement structure, and the obturator assembly includes an obturator housing, an obturator sleeve, and second engagement structure. The first engagement structure and the second engagement structure are correspondingly dimensioned such that rotation of the obturator assembly in a first direction effectuates corresponding rotation of the cannula assembly to facilitate advancement of the cannula assembly through tissue.

Description

CROSS-REFERENCE TO RELATED APPLICATION
• The present application is a divisional of U.S. patent application Ser. No. 12/487,071, filed Jun. 18, 2009, which claims the benefit of, and priority to, U.S. Provisional Patent Application Ser. No. 61/081,466, filed Jul. 17, 2008, now expired, the entire contents of each application being incorporated by reference herein.
BACKGROUND
• 1. Technical Field
• The present disclosure relates to surgical devices. More particularly, the present disclosure relates to surgical access systems and methods of using the same during minimally invasive surgical procedures.
• 2. Background of the Related Art
• Minimally invasive surgical procedures, which include both endoscopic and laparoscopic procedures, permit surgery to be performed on target tissue, such as organs, vessels, or the like, at a surgical worksite removed from an opening in the patient's tissue. Such procedures are typically performed through a surgical access system including, among other things, a cannula assembly and an obturator assembly positionable therein.
• Generally, in laparoscopic procedures, the surgical worksite is first insufflated to provide increased access to the target tissues. Subsequently, the obturator assembly, which typically includes a distal end adapted to penetrate the patient's tissue, is inserted into the cannula assembly and is used to create a temporary tissue tract. The cannula assembly is subsequently advanced through the tissue tract, thereafter remaining in place, and the obturator assembly is removed such that additional instrumentation can be inserted through the cannula assembly to carry out the remainder of the procedure.
• Known surgical access systems are usually pushed through the tissue tract by applying an axial, distally directed force to the surgical access system. Advancing the surgical access system in this manner, however, may unnecessarily stress, stretch, or deform the patient's tissue. Accordingly, it would be desirable to provide a surgical access system that can be advanced through a patient's tissue in a less traumatic manner.
SUMMARY
• In one aspect of the present disclosure, a surgical access system is disclosed that includes a cannula assembly adapted for removable positioning within a percutaneous tissue tract, and an obturator assembly removably positionable within the cannula assembly. The cannula assembly includes a cannula housing, a cannula sleeve, and first engagement structure, and the obturator assembly includes an obturator housing, an obturator sleeve, and second engagement structure. The first engagement structure and the second engagement structure are correspondingly dimensioned such that rotation of the obturator assembly in a first direction effectuates corresponding rotation of the cannula assembly to facilitate advancement of the cannula assembly through tissue. It is envisioned that the first engagement structure may depend proximally from the cannula housing and that the second engagement structure may depend distally from the obturator housing.
• In one embodiment of the surgical access system, the first engagement structure includes a first plurality of teeth and the second engagement structure includes a second plurality of teeth. The first plurality of teeth is configured and dimensioned for engagement with the second plurality of teeth in an interlocking arrangement. Specifically, each tooth in the first plurality of teeth includes a first inner surface and a first outer surface, and each tooth in the second plurality of teeth includes a second inner surface and a second outer surface, wherein the first outer surface is configured and dimensioned to engage the second inner surface, and the first inner surface is configured and dimensioned to engage the second outer surface. The first outer surface and the second inner surface are each substantially planar such that rotation of the obturator assembly relative to the cannula assembly is substantially restricted in the first direction, and the first inner surface and the second outer surface are correspondingly chamfered such that the obturator assembly is permitted to rotate relative to the cannula assembly in a second direction that is opposite to the first direction.
• The cannula sleeve may include a threaded portion that is configured and dimensioned to engage the tissue as the cannula assembly is rotated in the first direction to thereby facilitate advancement of the cannula assembly through the tissue. Additionally, or alternatively, the obturator assembly may include a handle that is configured and dimensioned for manual engagement to facilitate rotation of the obturator assembly.
• In one embodiment of the surgical access system, the first engagement structure is defined by an internal configuration of a non-circular opening extending through the cannula housing, and the second engagement structure is defined by an outer configuration of the obturator sleeve. In this embodiment, at least a portion of the obturator sleeve defines a cross-sectional configuration corresponding to the cross-sectional configuration of the opening in the cannula housing such that relative rotation between the obturator assembly and the cannula assembly is substantially restricted.
• In an alternative embodiment of the surgical access system, the first engagement structure is defined by an internal configuration of the cannula sleeve and the second engagement structure is defined by an outer configuration of the obturator sleeve. In this embodiment, at least a portion of the obturator sleeve defines an outer cross-sectional configuration that corresponds to an internal cross-sectional configuration of the cannula sleeve, wherein the outer cross-sectional configuration of the obturator sleeve and the internal cross-sectional configuration of the cannula sleeve are non-circular such that relative rotation between the obturator assembly and the cannula assembly is substantially restricted.
• In another embodiment of the surgical access system, the first engagement structure includes a rack and the second engagement structure includes a pawl. The pawl is configured and dimensioned for engagement with the rack to permit ratcheting movement of the obturator assembly relative to the cannula assembly. The rack and the pawl may be positioned in any suitable location. For example, the rack may be positioned on an inner wall of the cannula housing, depending inwardly therefrom, and the pawl may be positioned in mechanical cooperation with the obturator sleeve.
• The rack includes a plurality of teeth each having a first planar surface and a first chamfered surface, and the pawl includes a second planar surface and a second chamfered surface. The first planar surface of the rack is configured and dimensioned to engage the second planar surface of the pawl such that rotation of the obturator assembly relative to the cannula assembly is substantially restricted in a first direction, and the first chamfered surface of the rack is configured and dimensioned to engage the second chamfered surface of the pawl such that the obturator assembly is permitted to rotate relative to the cannula assembly in a second direction that is opposite to the first direction. The obturator assembly may further include a biasing mechanism connected to the pawl to facilitate reciprocal movement of the pawl in the first and second directions.
• In an alternate aspect of the present disclosure, a method of establishing percutaneous access to a surgical worksite is disclosed. The method includes the steps of providing a cannula assembly adapted for removable positioning within a tissue tract, providing an obturator assembly removably positionable within the cannula assembly, positioning the obturator assembly within the cannula assembly, and rotating the obturator assembly in a first direction. The cannula assembly includes first engagement structure and the obturator assembly includes second engagement structure. The first engagement structure corresponds in configuration to the second engagement structure such that rotation of the obturator assembly in the first direction effectuates corresponding rotation of the cannula assembly to facilitate advancement of the cannula assembly through tissue.
• These and other features of the surgical access system disclosed herein, and methods of using the same, will become more readily apparent to those skilled in the art from the following detailed description of various embodiments of the present disclosure.
BRIEF DESCRIPTION OF THE DRAWINGS
• Various embodiments of the present disclosure are described herein below with references to the drawings, wherein:
• FIG. 1 is a perspective view of a surgical access system in accordance with the principles of the present disclosure shown in a disassembled condition and including an obturator assembly removably positionable within a cannula assembly;
• FIG. 2 is an enlarged, side view of the surgical access system ofFIG. 1 shown in an assembled condition and illustrating a plurality of teeth formed on each of the obturator and cannula assemblies;
• FIG. 3 is an enlarged, side view of the surgical access system ofFIG. 1 shown in an assembled condition with the plurality of teeth formed on the obturator and cannula assemblies interlocked such that the obturator and cannula assemblies are in secure engagement;
• FIG. 4 is a bottom view of the obturator assembly seen inFIG. 1 taken through line4-4;
• FIG. 5 is a top view of the cannula assembly seen inFIG. 1 taken through line5-5;
• FIG. 6 is a side view of the surgical access system ofFIG. 1 in an assembled condition and inserted within tissue;
• FIG. 7 is a side view of an alternate embodiment of the surgical access system ofFIG.1 including a handle connected to the obturator assembly;
• FIG. 8 is a side view of another embodiment of the surgical access system ofFIG. 1 shown in a disassembled condition;
• FIG. 9 is a bottom view of the obturator assembly seen inFIG. 8 taken through line9-9;
• FIG. 10 is a top view of the cannula assembly seen inFIG. 8 taken through line10-10;
• FIG. 11 is a perspective view of another embodiment of the surgical access system in accordance with the principles of the present disclosure shown in a disassembled condition and including a ratcheting mechanism including a rack associated with the obturator assembly that is engagable with a pawl associated with the obturator assembly; and
• FIG. 12 is a top, cross-sectional view taken through the ratcheting mechanism upon assembly of the surgical access system seen inFIG. 11 illustrating the engagement of the rack and the pawl.
DETAILED DESCRIPTION OF THE EMBODIMENTS
• In the drawings and in the description which follows, in which like reference numerals identify substantially similar or identical elements, the term “proximal” will refer to the end of the presently disclosed surgical access system which is closest to the clinician during use, while the term “distal” will refer to the end which is furthest from the clinician, as is traditional and known in the art.
• Referring now to the drawings,FIG. 1 illustrates asurgical access system1000 in general accordance with the principles of the present disclosure.Surgical access system1000 includes anobturator assembly100 positionable within acannula assembly200.
• Obturator assembly100 includes anobturator housing102 and anelongate obturator sleeve104. Theobturator housing102 may include agripping portion106 to facilitate manual manipulation of theobturator housing102 by a clinician. Referring now toFIGS. 2-3 as well, theobturator housing102 further includes a plurality ofteeth108 depending downwardly (distally) from adistal wall110. Each of the plurality ofteeth108 includes aninner surface112 and a chamferedouter surface114 connected by a substantially planardistal surface116. The respective inner andouter surfaces112,114 of theteeth108 are each connected to thedistal wall110 of theobturator housing102, and in the particular embodiment seen inFIGS. 2-3, theinner surface112 extends from thedistal wall110 in substantially orthogonal relation while theouter surface114 extends from thedistal wall110 such that an acute angle .PHI. is defined therewith.
• Theobturator sleeve104 is coupled to, and extends distally from theobturator housing102 along a longitudinal axis “A”. In one embodiment, as seen inFIGS. 1 and 4, theobturator sleeve104 defines a substantially circular cross-section along its entire length. However, in alternate embodiments, theobturator sleeve104 may define a cross-section having other geometrical configurations, as discussed in further detail below.
• Theobturator sleeve104 includes adistal end118 that is adapted to penetrate tissue. In the embodiment of thesurgical access system1000 illustrated inFIG. 1, thedistal end118 of theobturator sleeve104 defines a substantially blunt, conical configuration such that theobturator assembly100 is employable to enlarge apre-existing tissue tract10 formed in a patient's tissue “T”, such as incision created through the use of a scalpel. In alternate embodiments, however, thedistal end118 of theobturator sleeve104 may be substantially incisive such that theobturator assembly100 may be used to create thetissue tract10.
• Theobturator housing102 and/or theobturator sleeve104 may be fabricated from any suitable biocompatible material including metals or polymers, and in alternate embodiments, may be wholly or partially formed of materials that are transparent to permit the visualization of the tissue “T” therethrough during insertion.
• Referring still toFIG. 1, thecannula assembly200 will be discussed. Thecannula assembly200 includes acannula housing202 and anelongate cannula sleeve204. As seen inFIG. 5, thecannula housing202 defines anopening206 therethrough that is configured and dimensioned to permit the passage of one or more surgical instruments, including but not limited to theobturator assembly100, an endoscope, and/or a surgical fastener applying apparatus. In the embodiment seen inFIGS. 1 and 5, theopening206 defines a substantially circular configuration, e.g., to accommodate the substantially circular cross-sectional configuration of theobturator sleeve104. However, in alternate embodiments, theopening206 may define other geometrical configurations, as discussed in further detail below.
• To prevent the passage of insufflation gas through thecannula assembly200, e.g., through theopening206 in thecannula housing202, thecannula housing202 may include aseal assembly208 with an internal seal or valve (not shown) that is adapted to close in the absence of a surgical instrument and to form a substantially fluid-tight seal therewith upon insertion, such as a duck-bill or other zero closure valve, to substantially prevent the escape of insufflation gases through thecannula assembly200. An example of one such internal seal or valve is disclosed in commonly assigned U.S. Pat. No. 5,820,600 to Carlson, et al., which issued Oct. 13, 1998, the entire contents of which are incorporated by reference herein. The present disclosure contemplates that theseal assembly208 may be either releasably of fixedly connected to thecannula housing202. Means for releasably connecting theseal assembly208 to thecannula housing202 may include a bayonet coupling, threaded connection, latch, friction fit, tongue and groove arrangements, snap-fit, etc.
• Referring now toFIGS. 1-3, thecannula housing202 further includes a plurality ofteeth210 that are configured and dimensioned to engage theteeth108 of theobturator assembly100 such that theobturator assembly100 is selectively engagable with, and disengageable from, thecannula assembly200.
• Eachtooth210 depends upwardly (proximally) from aproximal wall212 of thecannula housing202 and includes anouter surface214 and a chamferedinner surface216 connected by a substantially planarproximal surface218. The respective outer andinner surfaces214,216 of theteeth210 are each connected to theproximal wall212 of thecannula housing202, and in the particular embodiment seen inFIGS. 2-3, theouter surface214 extends from theproximal wall212 in substantially orthogonal relation while theinner surface216 extends from theproximal wall212 to define the acute angle .PHI. therewith, i.e., the same acute angle .PHI. defined between theouter surface114 of eachtooth108 formed on theobturator housing102 and thedistal wall110 thereof.
• Thecannula sleeve204 of thecannula assembly200 extends distally from thecannula housing202 and defines an internallongitudinal lumen220 that corresponds in configuration to theobturator sleeve104 of theobturator assembly100. Accordingly, in the embodiment of the surgical access system seen inFIG. 1, thecannula sleeve204, and thus thelumen220, also defines a circular cross-sectional configuration. Thelumen220 is dimensioned such that theobturator assembly100, as well as additional surgical instruments including but not being limited to endoscopes and/or surgical fastener applying apparatus, may be positioned therein. In general, thelumen220 will define an internal dimension substantially within the range of about 4.5 mm to about 15 mm, although acannula sleeve204 having a substantially larger or smaller internal dimension is also within the scope of the present disclosure. Thecannula sleeve204 terminates in an opendistal end222 to permit theobturator assembly100 and/or the additional surgical instruments to pass through thecannula assembly200.
• Referring now toFIGS. 1 and 6, in one embodiment, thecannula sleeve204 includes anouter wall224 with a threadedportion226. The threadedportion226 includes a plurality ofthreads228 arranged to define a pitch “P” that facilitates engagement of the threadedportion226 and the patient's tissue “T”. Engagement of the threadedportion226 with the tissue “T” facilitates advancement of thecannula assembly200 through thetissue tract10 in the manner discussed in further detail below. An embodiment of thecannula assembly200 having acannula sleeve204 with a substantially smoothouter wall224, e.g., anouter wall224 that is devoid of the threadedportion226 seen inFIGS. 1 and 5, however, is not beyond the scope of the present disclosure, however.
• Thecannula housing202 and/or thecannula sleeve204 may be fabricated from any suitable biocompatible material including metals or polymers, and in alternate embodiments, may be wholly or partially formed of materials that are transparent to permit the visualization of the tissue “T” therethrough during insertion.
• Referring now toFIGS. 1-3 and6, a method of using thesurgical access system1000 to provide percutaneous access to a surgical worksite “W” through a patient's tissue “T” will be discussed. Initially, thesurgical access system1000 is assembled by inserting theobturator assembly100 into thecannula assembly200. As seen inFIG. 6, theobturator assembly100 is dimensioned such that thedistal end118 thereof extends beyond thedistal end222 of thecannula sleeve204 upon insertion.
• Theobturator assembly100 is then rotated in the direction of arrow1 to ensure that therespective teeth108,210 formed on the obturator andcannula assemblies100,200 are interlocked such that theobturator assembly100 and thecannula assembly200 are securely engaged. Interlocking of theteeth108,210 can be seen in transition betweenFIGS. 2 and 3. When theteeth108,210 are interlocked, the inner andouter surfaces112,114 of eachtooth108 formed on theobturator housing102 respectively engage the outer andinner surfaces214,216 ofadjacent teeth210 formed on thecannula housing202.
• Thedistal end118 of theobturator sleeve104 of theobturator assembly100 is then positioned within thetissue tract10 to enlarge the opening defined thereby and thus facilitate insertion of the assembledsurgical access system1000 into the tissue “T”.
• The engagement between theinner surfaces112 of theteeth108 and theouter surfaces214 of theteeth210 prohibits relative rotation between theobturator assembly100 and thecannula assembly200 in the direction of arrow1. However, the engagement between the chamferedouter surfaces114 of theteeth108 and the chamferedinner surfaces216 of theteeth210 creates a camming effect by which theouter surfaces114 of theteeth108 traverse theinner surfaces216 of theteeth210, thereby permitting relative rotation between theobturator assembly100 and thecannula assembly200 in the direction ofarrow2. Consequently, rotation of theobturator assembly100 in the direction of arrow1 effectuates corresponding rotation of thecannula assembly200. In contrast, however, as theobturator assembly100 in rotated in the direction ofarrow2, the position of thecannula assembly200 remains substantially constant. This facilitates manipulation of the assembledsurgical access system1000 in a ratcheting manner in which rotation of theobturator assembly100, and consequently, rotation of thecannula assembly200, is alternated between the directions indicated byarrows1 and2.
• As thecannula assembly200 rotates in the direction of arrow1, the threadedportion226 of thecannula sleeve204 engages the adjacent tissue portions T.sub.1, T.sub.2 (FIG. 6) defining thetissue tract10 formed in the tissue “T”, thereby advancing thesurgical access system1000 into the tissue “T”. Accordingly, thesurgical access system1000 is advanced into and through the tissue “T” solely through the rotation of theobturator housing100, thereby obviating the need to apply what would be an otherwise requisite axial force in the distal direction and substantially minimizing any unnecessary stressing, stretching, or deformation of the tissue “T”.
• While a clinician may choose to manipulate thesurgical access system1000 in the ratcheting manner described above, alternating rotation of theobturator assembly100 between the directions indicated byarrows1 and2, in an another method of use, the clinician may choose to simply rotate theobturator assembly100, and thus thecannula assembly200, continuously in the direction of arrow1.
• After thecannula assembly200 has passed through thetissue tract10 and been securely positioned within the tissue “T”, theobturator assembly100 is withdrawn therefrom such that additional surgical instrumentation can be subsequently inserted through thecannula assembly200 and into the surgical worksite “W” (FIG. 6) to carry out the remainder of the minimally invasive surgical procedure.
• It should be appreciated that, while the above-described methods relate to the insertion of anobturator assembly100 having a substantially bluntdistal end118 into apre-existing tissue tract10 formed in the tissue “T”, alternate methods of using thesurgical access system1000 are also contemplated in which theobturator assembly100 includes a substantially incisivedistal end118 that is employable to create thetissue tract10.
• Referring now toFIG. 7, another embodiment of the surgical access system, referred to generally byreference number2000 will be described. Thesurgical access system2000 is substantially similar to thesurgical access system1000 discussed above with respect toFIGS. 1-6, and accordingly, will only be discussed with respect to its differences therefrom.
• As seen inFIG. 7, theobturator assembly300 includes ahandle320 connected to theobturator housing302 to facilitate rotation thereof. Thehandle320 may be integrally formed with theobturator housing302, as illustrated inFIG. 7, or alternatively, thehandle320 may be releasably connectable with theobturator housing302 through the employ of corresponding attachment and receipt structure.
• After positioning thedistal end318 of theobturator assembly300 within thetissue tract10 formed in the tissue “T”, the clinician uses thehandle320 to rotate theobturator assembly300, either alternating between the directions indicated byarrows1 and2, or continuously in the direction of arrow1, as described above with respect toFIGS. 1-6.
• Referring now toFIGS. 8-10, another embodiment of the surgical access system, referred to generally byreference number3000 will be described. Thesurgical access system3000 is substantially similar to thesurgical access system1000 discussed above with respect toFIGS. 1-6, and accordingly, will only be discussed with respect to its differences therefrom.
• In contrast to theobturator assembly100 seen inFIGS. 1 and 4, for example, in which theobturator sleeve104 defines a substantially circular cross-sectional configuration along its entire length, at least a portion of theobturator sleeve404 of theobturator assembly400 defines a non-circular, e.g., polygonal, cross-sectional configuration. In the particular embodiment illustrated inFIGS. 8 and 9, theobturator sleeve404 defines a square cross-sectional configuration along its entire length. However, in alternate embodiments, only a portion of theobturator sleeve404, e.g., a proximal portion thereof, may define the non-circular cross-sectional configuration. Additionally, in alternate embodiments, various other non-circular geometric configurations are contemplated for thesleeve404, including but not limited to hexagonal and triangular configurations.
• As seen inFIG. 10, theopening506 extending through thecannula housing502 of thecannula assembly500 also defines a non-circular, e.g., polygonal, configuration that corresponds to the cross-sectional configuration defined by theobturator sleeve404. As such, in the embodiment seen inFIGS. 8 and 10, theopening506 extending thorough thecannula housing502 defines a square configuration. Optionally, thelumen520 extending through thecannula sleeve504 may also define a non-circular, e.g., polygonal, configuration corresponding to that of theobturator sleeve404. Upon insertion of theobturator assembly400 into thecannula assembly500, the corresponding configurations of theobturator sleeve404 and theopening506 substantially prevent rotation of theobturator assembly400 relative to thecannula assembly500. Accordingly, rotation of theobturator assembly400 effectuates corresponding rotation of thecannula assembly500, thereby obviating the need for theteeth108,210 respectively formed on the obturator andcannula assemblies100,200 of thesurgical access system1000 discussed above with respect toFIGS. 1-6.
• Referring now toFIGS. 11-12, still another embodiment of the surgical access system, referred to generally byreference number4000 will be described. Thesurgical access system4000 is substantially similar to thesurgical access system1000 discussed above with respect toFIGS. 1-6, and accordingly, thesurgical access system4000 will only be discussed with respect to its differences therefrom.
• Thesurgical access system4000 incorporates a ratcheting mechanism600 including arack602 associated with thecannula assembly700 and apawl604 associated with theobturator assembly800. Therack602 and thepawl604 are engagable in the manner described below to facilitate selective engagement and disengagement of theobturator assembly800 and thecannula assembly700 comprising thesurgical access system4000.
• In the embodiment of the ratcheting mechanism600 discussed below with respect toFIGS. 11-12, therack602 is formed on aninner wall606 of thecannula housing702 and thepawl604 is illustrated in mechanical cooperation with theobturator sleeve804. However, it should be appreciated that therack602 and thepawl604 may be positioned in any manner suitable to permit the engagement thereof. As an illustrative example, the present disclosure contemplates that thepawl604 may alternatively be positioned on thedistal wall810 of theobturator housing802.
• Therack602 includes a plurality ofteeth608 depending radially inward from thecannula housing702, i.e., away from theinner wall606 towards the opening (not shown) extending through thecannula housing702. In the particular embodiment of the ratcheting mechanism600 seen inFIGS. 11-12, eachtooth608 includes afirst surface610 and a second, chamferedsurface612 connected by anend surface614. However, alternate configurations for theteeth608 are also within the scope of the present disclosure. Thefirst surface610 extends radially inward from theinner wall606 while thesecond surface612 extends from theinner wall606 such that an acute angle a is defined therewith.
• Thepawl604 defines aradial portion616 that includes afirst surface618 and a second, chamferedsurface620 connected by anend surface622, each of which corresponds in configuration and dimensions to the respective first, second, and endsurfaces610,612,614 of theteeth608 comprising therack602. Thepawl604 is in mechanical cooperation with a biasingmember624 to facilitate reciprocal displacement of thepawl604 relative to theobturator sleeve804 in the directions indicated byarrows1 and2. While the biasingmember624 is illustrated as aspring626 disposed about theobturator sleeve804, in alternate embodiments, thebiasing mechanism624 may constitute any mechanism suitable for the intended purpose of biasing thepawl604 towards a normal position thereof, which can be seen inFIG. 12, positionable in any suitable location.
• In the normal position, the first andsecond surfaces618,620 of thepawl604 respectively engage the first andsecond surfaces610,612 ofadjacent teeth608. Due to this engagement, rotating theobturator assembly800, and thus, thepawl604 in one direction endeavors to displace thepawl604 in the opposite direction. Specifically, rotating theobturator assembly800 in the direction of arrow1 endeavors to displace thepawl604 in the direction ofarrow2, and rotating theobturator assembly800, and thus, thepawl604 in the direction ofarrow2 endeavors to displace thepawl604 in the direction of arrow1. However, displacement of thepawl604 from the normal position in the direction ofarrow2 is substantially proscribed such that movement of thepawl604 in the direction ofarrow2 is limited to movement facilitated by the influence of the biasingmember624 as thepawl604 is returned to the normal position following displacement of thepawl604 in the direction of arrow1, as described in further detail below.
• Prohibiting displacement of thepawl604 from the normal position in the direction ofarrow2 prohibits relative rotation between theobturator assembly800 and thecannula assembly700 in the direction of arrow1. Accordingly, rotating theobturator assembly800, and thus, thepawl604 in the direction of arrow1 effectuates corresponding rotation of thecannula assembly700 through the engagement of thepawl604 with theteeth608 of therack602. By contrast, displacement thepawl604 in the direction of arrow1 is unrestricted such that rotation of theobturator assembly800 relative to thecannula assembly700 in the direction ofarrow2 is permitted. As theobturator assembly800, and thus, thepawl604 is rotated in the direction ofarrow2, thesecond surface612 of eachtooth608 traverses thesecond surface620 of thepawl604. This causes displacement of thepawl604 in the direction of arrow1 and allows the clinician to rotate theobturator assembly800 in the direction ofarrow2 without causing corresponding rotation of thecannula assembly700. Subsequently, thepawl604 is urged back towards the normal position by the biasingmember624, thereby facilitating manipulation of thesurgical access system4000 in a ratcheting manner in which rotation of theobturator assembly800 can be alternated between the directions indicated betweenarrows1 and2.
• As thecannula assembly700 is rotated in the direction of arrow1, the threadedportion726 of thecannula sleeve704 engages the patient's tissue “T”, causing advancement of thesurgical access system4000 therethrough, as discussed above with respect toFIGS. 1-6.
• While the clinician may choose to manipulate thesurgical access system4000 in the ratcheting manner described above, alternating rotation of theobturator assembly800 between the directions indicated byarrows1 and2, alternatively, the clinician may choose to simply rotate theobturator assembly800, and thus, thecannula assembly700 continuously in the direction of arrow1.
• Persons skilled in the art will understand that the systems and methods specifically described herein and illustrated in the accompanying drawings are intended to be construed as non-limiting, exemplary embodiments, and that the features illustrated or described in connection with one exemplary embodiment may be combined with the features of other embodiments. Additionally, one skilled in the art will appreciate further features and advantages of the disclosure based on the above-described embodiments. As such, the disclosure is not to be limited by what has been particularly shown and described, except as indicated by the appended claims.

Claims (20)

1: A surgical access system comprising:

a cannula assembly including an opening extending therethrough, and being adapted for removable positioning within a percutaneous tissue tract; and

an obturator assembly removably positionable within the opening extending through the cannula assembly, at least a portion of the obturator assembly including a configuration corresponding to that of the opening such that relative rotation between the obturator assembly and the cannula assembly is substantially inhibited, whereby rotation of the obturator assembly effectuates corresponding rotation of the cannula assembly to facilitate advancement of the cannula assembly through tissue.

2: The surgical access system ofclaim 1, wherein the opening is non-circular in configuration, and at least a portion of the obturator assembly positionable within the opening has a non-circular configuration.

3: The surgical access system ofclaim 2, wherein the opening is polygonal in configuration, and at least a portion of the obturator assembly positionable within the opening has a polygonal configuration.

4: The surgical access system ofclaim 1, wherein the cannula assembly includes a cannula housing, and a cannula sleeve extending distally from the cannula housing.

5: The surgical access system ofclaim 4, wherein the cannula sleeve includes a threaded portion configured and dimensioned to engage the tissue as the cannula assembly is rotated to thereby facilitate advancement of the cannula assembly through the tissue.

6: The surgical access system ofclaim 1, wherein the obturator assembly includes an obturator housing, and an obturator sleeve extending distally from the obturator housing.

7: The surgical access system ofclaim 6, wherein the obturator housing includes a handle configured and dimensioned for manual engagement to facilitate rotation of the obturator assembly.

8: The surgical access system ofclaim 6, wherein the obturator sleeve includes a distal end configured and dimensioned to penetrate tissue.

9: The surgical access system ofclaim 8, wherein the distal end of the obturator sleeve has a blunt configuration.

10: A surgical access system comprising:

a cannula assembly comprising:

a cannula housing including an opening extending therethrough having a non-circular cross-sectional configuration; and

a cannula sleeve extending distally from the cannula housing; and

an obturator assembly engagable with the cannula assembly, the obturator assembly including:

an obturator sleeve configured and dimensioned for insertion into the opening extending through the cannula housing, at least a portion of the obturator sleeve having a non-circular cross-sectional configuration corresponding to that of the opening extending through the cannula housing such that relative rotation between the obturator assembly and the cannula assembly is substantially inhibited, whereby rotation of the obturator assembly effectuates corresponding rotation of the cannula assembly to facilitate advancement of the cannula assembly through tissue.

11: The surgical access system ofclaim 10, wherein the opening extending through the cannula housing is polygonal in configuration, and at least a portion of the obturator sleeve has a polygonal configuration.

12: The surgical access system ofclaim 11, wherein the opening extending through the cannula housing is substantially square in configuration, and at least a portion of the obturator sleeve has a substantially square configuration.

13: The surgical access system ofclaim 10, wherein the cannula sleeve includes a threaded portion configured and dimensioned to engage the tissue as the cannula assembly is rotated to thereby facilitate advancement of the cannula assembly through the tissue.

14: The surgical access system ofclaim 10, wherein the obturator assembly further includes an obturator housing secured to a proximal end of the obturator sleeve.

15: The surgical access system ofclaim 14, wherein the obturator housing includes a handle configured and dimensioned for manual engagement to facilitate rotation of the obturator assembly.

16: The surgical access system ofclaim 10, wherein the obturator sleeve includes a distal end configured and dimensioned to penetrate tissue.

17: The surgical access system ofclaim 16, wherein the distal end of the obturator sleeve has a blunt configuration.

18: A method of establishing percutaneous access to a surgical worksite comprising the steps of:

positioning a cannula assembly within a tissue tract;

positioning an obturator assembly within an opening in the cannula assembly to cause engagement between an external surface of the obturator assembly and an internal surface of the opening in the cannula assembly such that relative rotation between the obturator assembly and the cannula assembly is substantially inhibited;

rotating the obturator assembly to effectuate corresponding rotation of the cannula assembly, and facilitate advancement of the cannula assembly through tissue; and

advancing the obturator assembly and the cannula assembly distally through the tissue tract.

19: The method ofclaim 18 further including the step of withdrawing the obturator assembly from the cannula assembly, whereby the cannula assembly remains positioned within the tissue tract.

20: The method ofclaim 19 further including the step of inserting a surgical instrument into the surgical worksite through the cannula assembly.

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