« PreviousContinue »
SURGICAL ACCESS APPARATUS WITH
CROSS REFERENCE TO RELATED
The present application claims the benefit of and priority to U.S. Provisional Application Ser. No. 60/931,768 filed on May 24, 2007, the entire contents of which are incorporated herein by reference. 10
1. Technical Field
The present disclosure relates to a surgical portal for 15 accessing underlying body tissue to permit the introduction of surgical objects in conjunction with a medical procedure. More particularly, the present disclosure relates to a surgical portal including a centering mechanism for facilitating the alignment of a surgical instrument with an axis of the surgical 20 portal, to thereby assist in the maintenance of the seal about the instrument and/or the minimize lateral movement of the instrument within the portal.
2. Discussion of Related Art
Surgical portals are employed in various minimally inva- 25 sive procedures including laparoscopic or endoscopic procedures. Such portals are inclusive of trocar cannulas, catheters, or, in the event of a minimally invasive hand assist procedures, hand access devices. Surgical portals typically incorporate a seal mechanism to form a fluid tight seal about an 30 instrument or hand passed through the portal. The seal mechanisms, however, often are limited by their ability to sustain a seal when an instrument, particularly, a smaller diameter instrument, is moved off-axis relative to a central axis of the portal. Moreover, the seal mechanisms are also 35 limited by their ability to sustain their integrity when the surgical instrument is angulated. Such extreme ranges of motion of smaller diameter surgical instruments within the portal can create a "cat eye" or crescent shaped gap about the instrument resulting in fluid loss (e.g., insufflation gas loss). 40
Accordingly, the present disclosure is directed to a surgical access apparatus including a housing member and a portal 45 member extending from the housing member and defining a longitudinal axis. The housing member and the portal member define a longitudinal passage therethrough dimensioned to permit passage of an elongated object. A centering mechanism is mounted relative to the housing member. The center- 50 ing mechanism includes an annular element mounted for rotational movement within the housing member and about the longitudinal axis and first and second arm elements mounted to the annular element and extending radially inwardly relative to the longitudinal axis. The first and second 55 arm elements are each positioned to intersect the longitudinal passage and are adapted to pivot relative to the housing member. The first and second arm elements are operatively connected whereby pivotal movement of the first arm element upon engagement with the elongated object causes the annu- 60 lar element to rotate in response thereto and effect corresponding pivotal movement of the second arm element. A seal may be disposed within the housing member. The seal is adapted to establish a substantial sealing relation with the elongated object. The first and second arm elements may be 65 normally biased to urge the instrument toward a generally aligned position with respect to the longitudinal axis.
The centering mechanism may include a third arm element. The first, second and third arm elements may be generally coaxially arranged with respect to the longitudinal axis.
The annular element may include an outer element with the first and second arm elements being connected to the outer element. The first and second arm elements are adapted to pivot about respective pivotal axes upon rotation of the outer element.
In an alternate embodiment, the annular element may include an inner element. The first and second arm elements are adapted to pivot upon rotation of the inner element. An outer mount may be provided where the first and second arm elements being pivotally mounted to the outer mount. The outer mount is fixed with respect to the housing member. The first and second arm elements may be each pivotally mounted to the outer mount through a living hinge.
In another embodiment, the surgical access apparatus includes a housing member, a portal member extending from the housing member and defining a longitudinal axis with the housing member and the portal member defining a longitudinal passage therethrough dimensioned to permit passage of an elongated object and at least three arm elements pivotally mounted relative to the housing member and extending radially inwardly relative to the longitudinal axis. The at least three arm elements are each positioned to intersect the longitudinal passage. The at least three arms have camming structure to operatively connect the at least three arms in a manner whereby pivotal movement of a first arm element upon engagement with the elongated object causes corresponding pivotal movement of the remaining arm elements. A seal may be disposed within the housing member. The seal is adapted to establish a substantial sealing relation with the elongated object. The at least three arm elements may be pivotally mounted relative to the housing member about living hinges. Each of the at least three arm elements may include cam slots for receiving corresponding cam pins of adjacent arm elements. The at least three arm elements may be adapted to normally bias the elongated object in a generally aligned position with respect to the longitudinal axis.
BRIEF DESCRIPTION OF THE DRAWINGS
Preferred embodiments of the present disclosure will be better appreciated by reference to the drawings wherein:
FIG. 1 is a perspective view of the surgical access apparatus in accordance with the principles of the present disclosure;
FIG. 2 is a perspective view with parts separated of the surgical access apparatus of FIG. 1 illustrating the housing member, portal member and the centering mechanism;
FIG. 3 is a side cross-sectional view of the housing member and the centering mechanism;
FIG. 4 is a top plan view of the centering mechanism illustrating the annular element and the centering arms extending inwardly from the annular element and having a small diameter instrument positioned therein;
FIG. 5 is a top plan view similar to the view of FIG. 4 illustrating a large diameter instrument positioned within the centering mechanism;
FIG. 6 is a top plan view of an alternate embodiment of the centering mechanism illustrating an outer element, an inner element and centering arms connected to the inner element;
FIG. 7 is a top plan view similar to the view of FIG. 6 illustrating the centering mechanism with a large diameter instrument positioned therein;
FIG. 8 is a top plan view of an alternate embodiment of the centering mechanism illustrating an outer element, centering
arms connected to the inner element and having a camming mechanism for causing movement of the centering arms; and FIG. 9 is a top plan view similar to the view of FIG. 8 illustrating the centering mechanism with a large diameter instrument positioned therein. 5
DETAILED DESCRIPTION OF THE
The access apparatus of the present disclosure is capable of io accommodating objects of varying diameters, e.g., including instruments from about 4.5 millimeter (mm) to about 15 millimeter (mm), during a minimally invasive surgical procedure. Moreover, the access apparatus contemplates the introduction and manipulation of various types of instrumen- 15 tation adapted for insertion through a trocar and/or cannula assembly while maintaining a fluid tight interface about the instrumentation to prevent gas and/or fluid leakage from the established pneumoperitoneum so as to preserve the atmospheric integrity of a surgical procedure. Specifically, the 20 access apparatus includes a centering mechanism which while permitting angular manipulation of the surgical instrument normally biases the instrument into an aligned position with respect to the axis of the cannula. This feature of the present disclosure desirably minimizes the entry and exit of 25 gases and/or fluids to/from the body cavity.
Examples of instrumentation contemplated for use with the access apparatus include clip appliers, graspers, dissectors, retractors, staplers, laser probes, photographic devices, endoscopes and laparoscopes, tubes, and the like. Such instru- 30 ments will be collectively referred to herein as "instruments or instrumentation".
In the following discussion, the term "proximal" will refer to the portion of the access apparatus nearest to the clinician during operation while the term "distal" will refer to that 35 portion of the access apparatus most remote to the clinician.
Referring now to the drawings, in which like reference numerals identify identical or substantially similar parts throughout the several views, FIGS. 1-2 illustrate the access apparatus 100 ofthe present disclosure. Access apparatus 100 40 may be any member suitable for the intended purpose of accessing a body cavity and typically defines a passageway permitting introduction of instruments or the clinician's hand therethrough. Access apparatus 100 is particularly adapted for use in laparoscopic surgery where the peritoneal cavity is 45 insufflated with a suitable gas, e.g., C02, to raise the cavity wall from the internal organs therein. Access apparatus 100 is typically used with an obturator assembly (not shown) which may be blunt, a non-bladed, or a sharp pointed instrument positionable within the passageway of the access apparatus 50 100. The obturator assembly is utilized to penetrate the abdominal wall to introduce the access apparatus 100 through the abdominal wall, and then subsequently is removed from the access apparatus 100 to permit introduction of the surgical instrumentation utilized to perform the procedure through the 55 passageway.
Access apparatus 100 includes housing member 102 and portal member 104 connected to the housing member 102 and extending therefrom. Portal member 104 defines a longitudinal axis "k" extending along the length of the portal member 60 104. Housing member 102 and portal member 104 further define internal longitudinal passage 106 dimensioned to permit passage of surgical instrumentation. Portal member 104 may be formed of any suitable medical grade material, such as stainless steel or other rigid materials, including polymeric 65 materials, such as polycarbonate, or the like. Portal member 104 may be transparent or opaque. The diameter of portal
member 104 may vary, but typically ranges from about 4.5 millimeters (mm) to about 15 millimeters (mm).
Housing member 102 may include a number of components assembled together to define the outer housing shown in the drawings. For example, housing member 102 may include main housing 108 and centering assembly 110. Centering assembly 110 may or may not be a component of housing member 102. In one embodiment, centering assembly 110 may be selectively releasably mountable to main housing 108. In another embodiment, centering assembly 110 is an integral part of main housing 108. Centering assembly 110 will be discussed in greater detail hereinbelow. Main housing 108 is attached to the proximal end of portal member 104, specifically, to portal flange 112 of portal member 104. In one method, main housing 108 is connectable to portal flange 112 through a bayonet coupling consisting of radially spaced tongues 114 on the exterior of portal flange 112 and corresponding recesses 116 within the interior of main housing 108, which are arranged to receive the tongues 114. Thereafter, portal flange 112 and main housing 108 are rotated to securely lock tongues 114 within recesses 116. Other conventional means, e.g., a threaded connection, snap fit, ultrasonic welding or any other means envisioned by one skilled in the art including, e.g., adhesive means, may be utilized to connect portal flange 112 and main housing 108. Main housing 108 further includes diametrically opposed housing grips 118 dimensioned and arranged for gripping engagement by the fingers of the user. Additionally or alternatively, suture anchors may extend from main housing. Portal flange 112 and main housing 108 may be integrally formed with portal member 104.
Main housing 108 further includes valve 120. Valve 120 may be a zero-closure valve such as duck-bill valve having a slit which is adapted to close in the absence of a surgical object and/or in response to insufflation gases of the pressurized cavity. In the alternative, valve 120 may be a gel seal, balloon valve, or a flapper valve.
Referring now to FIGS. 1-3, centering assembly 110 includes centering housing, generally identified as reference numeral 122, centering mechanism 124 and seal 126 which are each disposed within the centering housing 122. Centering housing 122 defines central housing axis "m" which is preferably parallel to the axis "k" of portal member 104, and, more specifically, coincident with the axis "k" of the portal member 104. Centering housing 122 incorporates three housing components, namely, first, second and third housing components 128,130, 132, respectively, which, when assembled together, form the centering housing 122. Assembly of housing components 128,130,132 may be affected by any of the aforementioned connection means discussed with respect to main housing 108. Although shown and described as three components, it is appreciated that centering housing 122 may be a single component having centering mechanism 124 and seal 126 mounted therein. In the assembled condition of housing components 128,130,132, internal seal chamber 134 and internal centering chamber 136 are defined within the walls of centering housing 122.
Centering assembly 110 includes seal 126 disposed within internal seal chamber 134. Seal 126 may include annular support collar 138 and seal element 140 which is mounted within, or attached to, the support collar 138. Support collar 138 is adapted to reciprocally slide in the direction of directional arrows "c" (FIG. 3) within internal seal chamber 134 in general transverse relation to central housing axis "m". Support collar 138 may comprise a plastic, metallic or elastomer material and may be monolithically formed with seal element 140. Support collar 138 may comprise a two-part ring assem