US20130217973A1 - Wound retraction apparatus and method - Google Patents
Wound retraction apparatus and method Download PDFInfo
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- US20130217973A1 US20130217973A1 US13/765,278 US201313765278A US2013217973A1 US 20130217973 A1 US20130217973 A1 US 20130217973A1 US 201313765278 A US201313765278 A US 201313765278A US 2013217973 A1 US2013217973 A1 US 2013217973A1
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- ring
- wound
- sheath
- retractor
- rings
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/32—Devices for opening or enlarging the visual field, e.g. of a tube of the body
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0293—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors with ring member to support retractor elements
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
- A61B17/3423—Access ports, e.g. toroid shape introducers for instruments or hands
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
- A61B17/3431—Cannulas being collapsible, e.g. made of thin flexible material
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
- A61B2017/3482—Means for supporting the trocar against the body or retaining the trocar inside the body inside
- A61B2017/3484—Anchoring means, e.g. spreading-out umbrella-like structure
Definitions
- This invention relates generally to wound retraction and more specifically to wound retraction in a laparoscopic surgical procedure.
- Wound retraction in accordance with the present invention allows the surgeon to easily locate a retractor and to provide a solid base for an instrument or hand seal.
- This retractor removes the tissue pressure from the wrist during hand-assisted laparoscopic surgery. It can also protect the tissue at the wound site, for example, from abrasion, bacteria or other contaminants organs, such as donor kidneys to be removed with minimal risk or damage.
- the retractor also opens the wound providing greater access to the operative site for instruments, such as the hand of the surgeon.
- a surgical retractor is adapted to adjust to a variety of body wall thicknesses and to dilate a wound in the body wall to a desired diameter.
- the retractor includes a first ring having a diameter greater than the desired diameter of the wound and is adapted for disposition interiorly of the wound.
- a second ring having a diameter greater than the desired diameter of the wound is adapted for disposition exteriorly of the wound.
- a tubular sheath with a first end and a second end, is coupled to the first ring at the first end.
- a retaining means is disposed on the second ring, adapted to detachably attach to the tubular sheath, wherein the tension of the sheath between the first ring and the second ring maintains the wound in an open configuration.
- the retaining means comprise hooks.
- the retaining means comprise clamps.
- the surgical retractor includes a first ring having a diameter greater than the desired diameter of the wound and being adapted for disposition interiorly of the wound, a second ring having a diameter greater than the desired diameter of the wound and being adapted for disposition exteriorly of the wound, and a cylindrical sheath with a center, a first end and a second end, the first end coupled to the first ring and the second end coupled to the second ring, with at least one intermediate ring coupled to the sheath.
- the intermediate ring is coupled to the interior surface of the sheath.
- the intermediate ring is coupled to the center of the sheath.
- the surgical retractor in another aspect of the invention, includes a first ring having a diameter greater than the desired diameter of the wound and being adapted for disposition interiorly of the wound, a second ring having a diameter greater than the desired diameter of the wound and being adapted for disposition exteriorly of the wound, and a cylindrical sheath with a center, a first end and a second end, the first end coupled to the first ring and the second end coupled to the second ring, with at least two intermediate rings coupled to the sheath.
- the intermediate rings are coupled to the exterior surface of the sheath.
- a surgical retractor is adapted to dilate a wound in the body wall to a desired diameter.
- the retractor includes a first ring having a diameter greater than the desired diameter of the wound and being adapted for disposition interiorly of the wound, a second ring having a diameter greater than the desired diameter of the wound and being adapted for disposition exteriorly of the wound, a tubular sheath with a first end and a second end, the first end coupled to the first ring and the second end coupled to the second ring, a compartment disposed around the sheath between the first ring and the second ring, proximate to the second ring, the compartment adapted to be operatively disposed exteriorly of the body wall, a valve attached to the compartment, operatively adapted to adjust the compartment between an open state and a sealed state, and a foam annulus disposed within the compartment.
- the foam annulus is adapted to expand when the compartment is in a open state to thereby elevate the second ring above the body wall and tension the sheath to provide retraction of the wound.
- the wound retractor includes a sealing cap, wherein the sealing cap is detachably attached to the second ring.
- FIG. 1 is a perspective view of one embodiment of the present invention
- FIG. 2 is a perspective axial cross section view of the embodiment illustrated in FIG. 1 ;
- FIG. 3 is a perspective view of an additional embodiment of the invention including multiple retraction elements
- FIG. 4 is a perspective view of an additional embodiment of the invention including an elastomeric sheath and multiple retention elements secured onto hook features;
- FIG. 5 having a sheath attached to an outer ring with clamps
- FIG. 6 is a perspective view of a further embodiment of the invention including multiple ladders with rungs providing a sheath with desired tension;
- FIG. 7A is a perspective view of a further embodiment of the invention including retention elements in the form of zip ties with detents;
- FIG. 7B is an enlarged perspective view of a detent adapted for use in the embodiment of FIG. 7A ;
- FIG. 8A is a perspective view of an additional embodiment of the invention wherein the retention elements include a series of ropes with enlargements or knots operable relative to a window in the outer ring;
- FIG. 8B is an enlarged perspective view of a window configuration adapted for use with the embodiment of FIG. 8A ;
- FIG. 9 is an axial cross section view of a further embodiment of the invention including a threaded second ring and a threaded third ring operable with a sealing cap;
- FIG. 10 is an axial perspective view of a further embodiment including a moveable third ring
- FIG. 11A is an axial schematic view showing the FIG. 10 embodiment in a natural state
- FIG. 11B is an axial schematic view showing the FIG. 10 embodiment in a retraction state
- FIG. 12-FIG . 15 are axial perspective views showing steps in a preferred method for operating the FIG. 10 embodiment
- FIG. 12 is an axial perspective view showing the second ring being rolled over the third ring to create a circumferential retainer
- FIG. 13 is an axial perspective view showing the third ring being rolled over the second ring to move the circumferential retainer to a desired position;
- FIG. 14 is an axial view showing the step of FIG. 12 with the retractor operatively disposed
- FIG. 15 is an axial cross section view of the step illustrated in FIG. 13 showing the retractor operatively disposed;
- FIG. 16 is an axial perspective view of a further embodiment including a clip for retaining the third ring at a desired position between the second ring and the first ring;
- FIG. 17 is an axial perspective view showing multiple loops each disposed at a particular distance from the first ring and adapted to alternatively receive the third ring at a desired distance from the first ring;
- FIG. 18 is an axial perspective view of an embodiment including tracks and a third ring with a mating groove
- FIG. 19 is an axial perspective view of an embodiment including a fourth ring for clamping the sheath between the third ring and the fourth ring;
- FIG. 20 is an axial perspective view of a further embodiment including a series of third rings for forming the retention roll at different positions between the first and second rings;
- FIG. 21 is an axial perspective view of an embodiment including unidirectional interlocking rings in a separated state
- FIG. 22 is an axial perspective view of the unidirectional interlocking rings in a proximate clamping state
- FIG. 23A is a cross sectional view showing a unidirectional mechanism with a third ring, fourth ring, and associated cap ring including a wedge;
- FIG. 23B shows the rings of FIG. 23A operatively disposed to wedge the sheath between the second and fourth rings
- FIG. 24 is an axial cross section view showing an embodiment of a unidirectional retention member, including a one-way roller;
- FIG. 25 is an axial cross section view showing a unidirectional retention member in the form of a ratchet
- FIG. 26 is an axial cross section view of a further embodiment wherein the third ring is expandable to adjust the distance between the third ring and the first ring;
- FIG. 27 is an axial cross section view showing the embodiment FIG. 26 with the third ring including foam in an expanded state;
- FIG. 28 is an axial cross section view of an embodiment showing a second ring being rolled into an inverted retention ring
- FIG. 29 is an axial cross section view showing the FIG. 28 embodiment with the rolled ring held by the retainer.
- FIG. 30 is an axial cross section view illustrating an embodiment with two end rings and at least one intermediate ring.
- FIG. 1 The basic concept of retracting and protecting a wound site is illustrated in the prospective view of FIG. 1 wherein a wound 10 is formed in an abdominal wall 11 .
- a retractor 12 uses two rings 14 and 16 which are fixed to an elastic sheath 18 .
- the sheath 18 has a generally cylindrical configuration and is disposed along an axis 21 .
- the rings 14 and 16 are disposed in respective planes which extend radially of the axis 21 .
- the sheath 18 has elastomeric properties, but in its natural, unstretched state the two rings 14 and 16 are separate by a natural distance.
- the lower ring 14 is placed interiorly of the abdominal wall 11 and the upper ring 14 is stretched beyond the natural distance away from the lower ring.
- the upper ring 16 is placed on the surface of the skin.
- the rings 14 , 16 Since the diameters of the rings 14 , 16 are greater than that desired for the wound site 10 , they will have sufficient footing to maintain this tension between the two rings 14 , 16 . This tension is created by the elastic material that has been stretched and retained at a distance greater than the natural distance. It will be appreciated that in many embodiments, the sheath 18 can be formed of a non-elastic sheathing material. In a similar manner, the rings 14 and 16 may be provided with a rigid configuration or alternatively may be formed of an elastromeric material.
- FIG. 2 shows a simple schematic of the ring dynamics illustrated in FIG. 1 , with the retractor 12 operatively disposed across the abdominal wall 11 .
- the elastic sheet sheath 18 acts as a circumferential spring 23 around the wound site 10 that evenly distributes the tension between the two rings 14 and 16 , as represented by arrows 25 & 27 .
- the elastic sheeting provides a radial retraction force 30 around the wound to enlarge the wound site 10 in order to facilitate the passage of instruments, such as the hand of the surgeon.
- the amount of tension force between the two rings 14 and 16 can be controlled by the elastomeric proportion of the elastic sheath 18 .
- a material with a higher elasticity can be chosen to allow for greater stretch.
- FIG. 3 illustrates the “sandwiching” of the abdominal wall between the two rings 14 , 16 using elastic tensioners, such as rubber bands 36 .
- elastic tensioners such as rubber bands 36 .
- the use of elastic tensioners allows for a greater range of wall thicknesses because the tensions can be selected at the time of application. For instance, the user would make an incision and measure the actual abdominal wall thickness. He would then choose the appropriate rubber bands providing the desired tensions for the given application. In this case the rubber bands 36 could be secured by hooks 38 provided on one or both of the rings 14 and 16 . This gives the user more versatility with the device.
- FIG. 4 is a different embodiment which provides even further versatility. This design is not limited by the fixed distance between the rings 14 , 16 of the retractor 12 . Instead, the inner ring 14 will be fixed to the sheath 18 , and the upper ring 16 will comprise a separate assembly. Initially, the inner ring 14 is placed into the peritoneum cavity. Then the elastic material is pulled taut and secured onto hook features 41 located on the outer ring 16 . This allows the user to fix the retractor 12 to an abdominal wall of any size.
- FIG. 5 shows an additional embodiment wherein the sheath 18 is attached to the outer ring 16 using clamps 43 .
- FIG. 6 illustrates another embodiment wherein the sheath 18 is attached to the outer ring 16 using ladders 45 with rungs 46 , that may be connected to the external surface of the sheath 18 . Once the preferred tension of the sheath 18 has been attained, the user simply hooks an appropriate rung 46 onto an associated hook 47 located on the outer ring 16 .
- FIG. 7A shows a structure which sandwiches the abdominal wall 11 between the two rings 14 , 16 using zip ties 50 .
- the ties 50 can be pulled tight through associated holes 54 to fix the rings 14 , 16 relative to the abdominal wall 11 .
- the zip ties 50 may be formed with a plurality of grooves 52 which extend traverse or perpendicular to the length of the tie 50 .
- the tie 50 is threaded through the hole 54 in the upper ring 16 where one of the grooves 52 is engaged by a tongue 56 which prevents movement of the tie 50 back through the hole 54 .
- FIG. 8A shows a method of sandwiching the abdominal wall between the two rings 14 , 16 using a series of ropes 58 , each having a plurality of knots 61 .
- the ropes 52 can be tensioned and one of the knots 61 secured into an associated holder located on the outer ring 16 .
- each rope 58 is drawn upwardly through an associated window 63 in the outer ring 16 .
- This window 63 will typically be provided with portion 65 larger than the knots 61 , and portion 67 smaller than the knots 61 as illustrated in FIG. 8B .
- FIG. 9 An additional embodiment of the wound retractor 12 is illustrated in FIG. 9 where elements of structure similar to those previously described are designated by the same reference numeral followed by the lower case letter “a.”
- the device includes the sheath 28 a which lines the wound 10 to prevent or limit the risk of portsite metastasis, and the outer ring 16 a .
- the outer ring 16 a also includes a sealing surface 72 at its base which is designed to seal against the exterior surface of the abdominal wall 11 .
- the device further comprises the thin film sheath 28 a with a ring 74 , having external threads 76 , which is attached to the proximal end of the sheath 28 a , and with the inner ring 14 a attached to the distal end of the sheath 28 a .
- the inner ring 14 a is designed to be placed inside the wound 10 while the rings 16 a and 74 remain external to the wound 10 .
- the outer ring 16 a can be rotated clockwise relative to the inner ring 14 a .
- the ring 74 is drawn proximally stretching the sheath 28 a .
- This opens the wound 10 and draws both the outer ring 16 a and the inner ring 14 a toward the abdominal wall 11 .
- a primary seal is created between the inner ring 14 a and the abdominal wall 11 , while a secondary seal is formed between the surface 72 of the outer ring 16 a and the exterior surface of the abdominal wall 11 .
- a sealing cap 81 can then be attached to the proximal end of the outer ring 16 a to permit insufflation and otherwise facilitate a laparoscopic procedure. The sealing cap 81 can be removed at any time to allow conversion from laparoscopic surgery to open surgery.
- the device enables a surgeon to retract and protectively line an abdominal wall incision, while being able to easily adjust the retractor 12 a to accommodate variations from patient to patient in the thickness of the abdominal wall 11 .
- the device effectively seals around the interior and exterior of the wound 10 , which allows the sealing cap 81 to be attached to seal the abdominal cavity and enable a laparoscopic procedure to be performed.
- FIGS. 10-14 Another embodiment of the retractor 12 is illustrated in FIGS. 10-14 where elements of structure similar to those previously discussed are designated with the same reference numeral followed by the lower case letter “b.”
- the retractor 12 b includes the thin film sheath 28 b which lines the wound to prevent or limit the risk of portsite metastasis.
- the inner and outer rings, 14 b and 16 b respectively, are attached to opposing ends of the sheath 28 b in the manner previously described.
- a third ring 83 is fixed to the sheath 28 b between the rings 14 b and 16 b.
- the inner ring 14 b is positioned interiorly of the abdominal wall 11 as illustrated in FIG. 11A . Then the sheath 28 b is pulled outwardly through the wound 10 , tensioning the sheath 28 b and causing the abdominal wall 11 to retract or open as illustrated in FIG. 11B .
- the ring 16 b can be moved distally over the ring 83 .
- the ring 16 b is stretched circumferentially outwardly of the ring 83 to form the bundle 85 .
- This formation is further illustrated in the cross section schematic view of FIG. 14 where the bundle 85 of elastomeric rings presses against the outer surface of the abdominal wall 11 to maintain tension on the sheath 28 b .
- the ring bundle 85 can be further rotated to move the third ring 83 outwardly and distally of the ring 16 b as required to produce and maintain the desired tension on the sheath 28 b.
- retraction is achieved by positioning the ring 83 above the ring 16 b , and pulling the sheath 28 b upwardly from the wound 10 ( FIG. 12 ).
- the sheath is prevented from pulling back into the incision by stretching the ring 83 out, around, and under the ring 16 b.
- the degree of retraction or how much the sheath is pulled upwardly is depended on the height of the ring 83 about the abdominal wall 11 .
- This height can be adjusted in the embodiment of FIG. 16 wherein elements of structure similar to those previously described are designated with the same reference numeral followed by the lower case letter “c.”
- the ring 83 c can be disconnected from and moved relative to the sheath 28 c .
- the ring 83 c can be fixed to the sheath 28 c , for example by a clip 87 .
- Clamps or clips may be used to lock the movable ring at the appropriate height as shown in FIG. 16 .
- a series of open loops 88 ( FIG. 17 ) or tracks 89 ( FIG. 18 ) can be fixed to the sheath 28 c at different distances from the inner ring 14 c to hold the ring 83 c at different heights.
- the moveable ring 83 can be formed as two complimentary rings.
- the outer ring 16 b can be disposed outwardly of the sheath 28 c and a fourth ring 90 can be disposed inwardly of the sheath 28 c .
- These two rings 14 c and 90 function to clamp the sheath 28 c so that the ring 83 c is maintained in a fixed position by the complimentary locking ring 90 .
- the inner locking rings 83 c and 90 of the FIG. 19 embodiment provide for simple operation of the retractor 12 .
- These interlocking rings 83 and 90 can be pushed down so that they rest on the outer surface of the abdominal wall 11 .
- any tendency of this sheath 28 c to move back into the wound site merely tightens the interlocking relationship of the rings 83 c and 90 .
- the desired degree of tension is maintained on the sheath 28 c until it is again pulled to release the locking ring 90 from the ring 83 c.
- FIG. 20 In still a further embodiment, illustrated in FIG. 20 , several intermediate rings, 92 , 94 , 96 and 98 can be provided between the inner ring 14 c and the outer ring 16 c .
- the rings such as the ring 16 c , 92 and 94 , disposed outwardly of the abdominal wall 11 can be rolled into the ring bundle 85 c to maintain the desired tension on the sheath 28 c .
- the rings 96 and 98 which are not included in the ring bundle 85 c , contact the abdominal wall 11 to provide increased friction and perhaps increased retraction at the wound site.
- a further advantage of these embodiments is that they enable the surgeon to retract and protectively cover the wound 10 while permitting adjustment of the retractor 12 c to variations in thickness of the abdominal wall 11 .
- These devices provide an airtight seal around the wound 10 , thus allowing an airtight cap or access port to be attached to enable laparoscopic surgery. Furthermore, usage of these devices is simple in that retraction can be achieved with one motion by grasping the proximal ring 16 c and pulling it up from the wound 10 and then merely releasing it.
- the one-way characteristics of the interlocking rings 83 c and 90 are illustrated in the progressive views of FIGS. 21 and 22 . With reference to these figures, it can be seen that retraction is maintained by preventing the sheath 28 c from pulling back into the wound 10 by means of the one-way operation of the interlocking rings 83 c and 90 .
- the sheath 28 c slides easily through the interlocking rings 83 c and 90 in the upper direction, but is prevented from sliding through the rings 83 c and 90 in the downward direction.
- One-way mechanisms can be formed, for example, with a wedge 93 as illustrated in FIGS. 23A and 23B , a one-way roller 95 as illustrated in FIG. 24 , or a one-way ratchet 97 as illustrated in FIG. 25 .
- Bumps, over-braid, threads or coatings on the sheath 28 can be added for additional traction using these one-way mechanisms.
- features such as indentations or protrusions on the sheath 28 can permit it to pass in only one direction.
- FIGS. 26 and 27 A further embodiment of the wound retractor 12 is illustrated in FIGS. 26 and 27 wherein elements of structure are similar to those previously described or designated with the same reference numeral followed by the lower case letter “d.”
- These embodiments include an expandable foam annulus 101 which is disposed in a compartment 103 sealed by a valve 104 .
- This compartment 103 is formed between the rings 14 d and 16 d , and proximate the outer ring 16 d . In this location, the compartment 103 is operatively disposed exteriorly of the abdominal wall 11 .
- a sealing cap 105 can be disposed over the outer ring 16 d to facilitate laparoscopic surgery.
- the valve 104 can be opened to permit air into the cavity 103 . This also permits the foam annulus 101 to expand as illustrated in FIG. 27 thereby elevating the ring 16 d above the abdominal wall 11 and tensioning the sheath 28 d.
- annular foam 101 expands to a high profile state, seals are formed on both sides of the wall 11 around the sheath 28 d .
- the wall 11 is retracted from the wound 10 .
- the surgeon simply opens the valve 104 and pulls the inner ring 14 d out through the wound 10 . While an expandable foam is described for this embodiment, additional materials could be utilized which expand upon contact with the inlet air.
- the device enables a surgeon to quickly retract and protectively line an abdominal wall incision while being able to easily accommodate variations from patient to patient in the thickness of the abdominal wall.
- the device effectively seals around the interior and exterior of the incision, and allows a sealing cap to be attached to seal the abdominal cavity and to enable a laparoscopic procedure to be performed.
- FIGS. 28 and 29 A wound retractor with an inverting ring 107 is illustrated in FIGS. 28 and 29 where elements of structure similar to those previously disclosed are designated with the same reference numeral followed by the lower case letter “e.”
- the device includes the sheath 28 e which lines the wound 10 to prevent or limit the risk of portsite metastasis.
- the device includes base 110 with a sealing ring 14 on its distal end, which is designed to seal against the exterior abdominal wall 11 of the patient.
- the device includes a thin film sheath 28 e with the inverting ring 107 configured to lock into the base 110 which is attached to the proximal end of the sheath 28 .
- the sealing ring 14 e is designed to be placed inside the incision while the external inverting ring 107 remains external to the incision.
- the base 110 is configured to move freely between the rings 14 e and 107 .
- the external ring can then be pushed into a recess 114 in the base 110 which is configured to lock the ring in position and thereby maintain the tension on the sheath 28 e .
- a primary seal is created between the peritoneal ring 14 e and the anterior abdominal wall, and a secondary seal is created between the sealing ring 112 of the base 110 and the exterior abdominal wall.
- a sealing cap 116 can then be attached to the proximal end of the base and the patient can be insufflated with carbon dioxide to allow a laparoscopic procedure such as a gastric bypass to be performed.
- the sealing cap can be removed at any time to allow conversion from laparoscopic surgery to open surgery.
- a most significant advantage associated with this embodiment is that the device enables a surgeon to retract and protectively line an abdominal wall incision while being able to easily adjust the device to accommodate variations from patient to patient in the thickness of the abdominal wall.
- the device effectively seals around the interior and exterior of the incision, which allows a sealing cap to be attached to seal the abdominal cavity ad enable laparoscopic procedure to be performed.
- FIG. 30 A further embodiment of the wound retractor is, illustrated in FIG. 30 , where elements of structure similar to those previously disclosed are designated with the same reference numeral followed by the lower case letter “f.”
- This embodiment includes three separate rings 16 f , 14 f , and 83 f .
- the device has a tubular sheath 28 f which lines the incision to prevent or limit the risk of portsite metastasis.
- the device includes the external ring 16 f attached to the proximal end of the sheath 28 f , the intermediate ring 83 f attached to the center of the sheath, and a peritoneal ring attached to the distal end of the sheath 28 f .
- the peritoneal ring is designed to be placed inside the incision while the eternal ring 16 f remains external to the incision.
- the intermediate ring 83 f may remain external to the incision or may lie within the incision itself depending upon how the three rings are oriented.
- This wound retractor has four different fixed lengths to accommodate abdominal walls of four different thicknesses.
- the first length which is the longest, is achieved by simply placing the peritoneal ring 14 f into the incision.
- the tension of the sheath between the external ring 16 f and the peritoneal ring 14 f maintains the incision in an open configuration. If the thickness of the abdominal wall 11 is less than the distance between the eternal ring 16 f and the peritoneal ring 14 f , then a shorter length can be selected.
- the second length which is less than the first length, is achieved by simply placing the peritoneal ring 14 f into the incision, and then pulling the sheath 28 f upwards until the intermediate ring 83 f is external to the incision.
- the tension of the sheath 28 f between the intermediate ring 83 f and the peritoneal ring 14 f maintains the incision in an open configuration. If the thickness of the abdominal wall 11 is less than the distance between the intermediate ring 83 f and the peritoneal ring 14 f then a shorter length can be selected.
- the third length which is less than the second length, is achieved by inserting the peritoneal ring 14 f into the incision and then pulling the intermediate ring 83 f over the external ring 16 f .
- the tension of the sheath between the peritoneal ring and the combination of the external ring and the intermediate ring maintains the incision in an open configuration. If the thickness of the abdominal wall is less than the third length, then the fourth length will have to be selected.
- the fourth length which is less than the third length, is achieved by first pulling the intermediate ring 83 f through the external ring 16 f , and then pulling the intermediate ring 83 f over the external ring 16 f .
- the tension of the sheath 28 f between the peritoneal ring 14 f and the combination of the external ring 16 f and the intermediate ring 83 f maintains the incision in an open configuration.
- This 3-ring retractor can therefore be positioned to effect four different lengths to accommodate variations in the thickness of the abdominal wall from patient to patient.
- a most significant advantage associated with this embodiment is that the device enables a surgeon to retract and protectively line an abdominal wall incision while being able to easily adjust the device to accommodate variations from patient to patient in the thickness of the abdominal wall.
- the device is also very low in cost since it includes only four components, 3 rings 14 f , 16 f , and 83 f , and a tubular sheath 28 f.
Abstract
Description
- This application is a continuation of U.S. patent application Ser. No. 12/108,400 filed Apr. 23, 2008, which is a continuation of U.S. patent application Ser. No. 11/755,305, filed on May 30, 2007, now U.S. Pat. No. 7,377,898, which is a continuation of U.S. patent application Ser. No. 11/218,412, filed on Sep. 1, 2005, now U.S. Pat. No. 7,238,154, which is a continuation of U.S. patent application Ser. No. 10/399,209, filed on Aug. 22, 2003, now U.S. Pat. No. 6,958,037, which claims benefit of PCT application serial no. PCT/US01/50742, filed on Oct. 20, 2001, which claim priority to provisional application No. 60/241,958 filed Oct. 19, 2000, and entitled “Wound Retraction Apparatus and Method,” the disclosures of which are hereby incorporated by reference as if set forth in full herein.
- 1. Field of Invention
- This invention relates generally to wound retraction and more specifically to wound retraction in a laparoscopic surgical procedure.
- 2. Discussion of the Related Art
- During laparoscopic surgery, it is desirable to inflate the abdominal cavity in order to increase the volume of the working space. This is accomplished with an insufflation gas which must be maintained at a pressure sufficient to inflate the abdomen. Maintaining the pressure of the insufflation gas is difficult when it is also desirable to insert instrumentation through the abdominal wall. If the surgeon is interested in inserting his or her hand in a hand-assisted laparoscopic procedure, the maintenance of insufflation pressure is even more difficult. Currently, several devices exist that accomplish this surgical need although they suffer from drawbacks such as difficult placement and cumbersome use. Thus, it is desirable that the wound be retracted, protected, and fixed while maintaining an insufflation seal.
- Wound retraction in accordance with the present invention allows the surgeon to easily locate a retractor and to provide a solid base for an instrument or hand seal. This retractor removes the tissue pressure from the wrist during hand-assisted laparoscopic surgery. It can also protect the tissue at the wound site, for example, from abrasion, bacteria or other contaminants organs, such as donor kidneys to be removed with minimal risk or damage. The retractor also opens the wound providing greater access to the operative site for instruments, such as the hand of the surgeon.
- In one aspect of the invention, a surgical retractor is adapted to adjust to a variety of body wall thicknesses and to dilate a wound in the body wall to a desired diameter. The retractor includes a first ring having a diameter greater than the desired diameter of the wound and is adapted for disposition interiorly of the wound. A second ring having a diameter greater than the desired diameter of the wound is adapted for disposition exteriorly of the wound. A tubular sheath with a first end and a second end, is coupled to the first ring at the first end. A retaining means is disposed on the second ring, adapted to detachably attach to the tubular sheath, wherein the tension of the sheath between the first ring and the second ring maintains the wound in an open configuration. In one embodiment, the retaining means comprise hooks. In another embodiment, the retaining means comprise clamps.
- In another aspect of the invention, the surgical retractor includes a first ring having a diameter greater than the desired diameter of the wound and being adapted for disposition interiorly of the wound, a second ring having a diameter greater than the desired diameter of the wound and being adapted for disposition exteriorly of the wound, and a cylindrical sheath with a center, a first end and a second end, the first end coupled to the first ring and the second end coupled to the second ring, with at least one intermediate ring coupled to the sheath. In one embodiment, the intermediate ring is coupled to the interior surface of the sheath. In another embodiment, the intermediate ring is coupled to the center of the sheath.
- In another aspect of the invention, the surgical retractor includes a first ring having a diameter greater than the desired diameter of the wound and being adapted for disposition interiorly of the wound, a second ring having a diameter greater than the desired diameter of the wound and being adapted for disposition exteriorly of the wound, and a cylindrical sheath with a center, a first end and a second end, the first end coupled to the first ring and the second end coupled to the second ring, with at least two intermediate rings coupled to the sheath. In one embodiment, the intermediate rings are coupled to the exterior surface of the sheath.
- In another aspect of the invention, a surgical retractor is adapted to dilate a wound in the body wall to a desired diameter. The retractor includes a first ring having a diameter greater than the desired diameter of the wound and being adapted for disposition interiorly of the wound, a second ring having a diameter greater than the desired diameter of the wound and being adapted for disposition exteriorly of the wound, a tubular sheath with a first end and a second end, the first end coupled to the first ring and the second end coupled to the second ring, a compartment disposed around the sheath between the first ring and the second ring, proximate to the second ring, the compartment adapted to be operatively disposed exteriorly of the body wall, a valve attached to the compartment, operatively adapted to adjust the compartment between an open state and a sealed state, and a foam annulus disposed within the compartment. The foam annulus is adapted to expand when the compartment is in a open state to thereby elevate the second ring above the body wall and tension the sheath to provide retraction of the wound. In one embodiment, the wound retractor includes a sealing cap, wherein the sealing cap is detachably attached to the second ring.
- These and other features and advantages of the invention will become more apparent with a description of preferred embodiments and reference to the associated drawings.
-
FIG. 1 is a perspective view of one embodiment of the present invention; -
FIG. 2 is a perspective axial cross section view of the embodiment illustrated inFIG. 1 ; -
FIG. 3 is a perspective view of an additional embodiment of the invention including multiple retraction elements; -
FIG. 4 is a perspective view of an additional embodiment of the invention including an elastomeric sheath and multiple retention elements secured onto hook features; -
FIG. 5 having a sheath attached to an outer ring with clamps; -
FIG. 6 is a perspective view of a further embodiment of the invention including multiple ladders with rungs providing a sheath with desired tension; -
FIG. 7A is a perspective view of a further embodiment of the invention including retention elements in the form of zip ties with detents; -
FIG. 7B is an enlarged perspective view of a detent adapted for use in the embodiment ofFIG. 7A ; -
FIG. 8A is a perspective view of an additional embodiment of the invention wherein the retention elements include a series of ropes with enlargements or knots operable relative to a window in the outer ring; -
FIG. 8B is an enlarged perspective view of a window configuration adapted for use with the embodiment ofFIG. 8A ; -
FIG. 9 is an axial cross section view of a further embodiment of the invention including a threaded second ring and a threaded third ring operable with a sealing cap; -
FIG. 10 is an axial perspective view of a further embodiment including a moveable third ring; -
FIG. 11A is an axial schematic view showing theFIG. 10 embodiment in a natural state; -
FIG. 11B is an axial schematic view showing theFIG. 10 embodiment in a retraction state; -
FIG. 12-FIG . 15 are axial perspective views showing steps in a preferred method for operating theFIG. 10 embodiment; -
FIG. 12 is an axial perspective view showing the second ring being rolled over the third ring to create a circumferential retainer; -
FIG. 13 is an axial perspective view showing the third ring being rolled over the second ring to move the circumferential retainer to a desired position; -
FIG. 14 is an axial view showing the step ofFIG. 12 with the retractor operatively disposed; -
FIG. 15 is an axial cross section view of the step illustrated inFIG. 13 showing the retractor operatively disposed; -
FIG. 16 is an axial perspective view of a further embodiment including a clip for retaining the third ring at a desired position between the second ring and the first ring; -
FIG. 17 is an axial perspective view showing multiple loops each disposed at a particular distance from the first ring and adapted to alternatively receive the third ring at a desired distance from the first ring; -
FIG. 18 is an axial perspective view of an embodiment including tracks and a third ring with a mating groove; -
FIG. 19 is an axial perspective view of an embodiment including a fourth ring for clamping the sheath between the third ring and the fourth ring; -
FIG. 20 is an axial perspective view of a further embodiment including a series of third rings for forming the retention roll at different positions between the first and second rings; -
FIG. 21 is an axial perspective view of an embodiment including unidirectional interlocking rings in a separated state; -
FIG. 22 is an axial perspective view of the unidirectional interlocking rings in a proximate clamping state; -
FIG. 23A is a cross sectional view showing a unidirectional mechanism with a third ring, fourth ring, and associated cap ring including a wedge; -
FIG. 23B shows the rings ofFIG. 23A operatively disposed to wedge the sheath between the second and fourth rings; -
FIG. 24 is an axial cross section view showing an embodiment of a unidirectional retention member, including a one-way roller; -
FIG. 25 is an axial cross section view showing a unidirectional retention member in the form of a ratchet; -
FIG. 26 is an axial cross section view of a further embodiment wherein the third ring is expandable to adjust the distance between the third ring and the first ring; -
FIG. 27 is an axial cross section view showing the embodimentFIG. 26 with the third ring including foam in an expanded state; -
FIG. 28 is an axial cross section view of an embodiment showing a second ring being rolled into an inverted retention ring; -
FIG. 29 is an axial cross section view showing theFIG. 28 embodiment with the rolled ring held by the retainer; and -
FIG. 30 is an axial cross section view illustrating an embodiment with two end rings and at least one intermediate ring. - The basic concept of retracting and protecting a wound site is illustrated in the prospective view of
FIG. 1 wherein awound 10 is formed in anabdominal wall 11. In this embodiment, aretractor 12 uses tworings elastic sheath 18. Thesheath 18 has a generally cylindrical configuration and is disposed along anaxis 21. Therings axis 21. - The
sheath 18 has elastomeric properties, but in its natural, unstretched state the tworings lower ring 14 is placed interiorly of theabdominal wall 11 and theupper ring 14 is stretched beyond the natural distance away from the lower ring. Once theelastic sheath 18 has been stretched to a distance greater than the abdominal wall thickness, theupper ring 16 is placed on the surface of the skin. - Since the diameters of the
rings wound site 10, they will have sufficient footing to maintain this tension between the tworings sheath 18 can be formed of a non-elastic sheathing material. In a similar manner, therings -
FIG. 2 shows a simple schematic of the ring dynamics illustrated inFIG. 1 , with theretractor 12 operatively disposed across theabdominal wall 11. Theelastic sheet sheath 18 acts as acircumferential spring 23 around thewound site 10 that evenly distributes the tension between the tworings arrows 25 & 27. In addition, the elastic sheeting provides aradial retraction force 30 around the wound to enlarge thewound site 10 in order to facilitate the passage of instruments, such as the hand of the surgeon. - The amount of tension force between the two
rings elastic sheath 18. In order to accommodate a larger range of abdominal wall thicknesses, a material with a higher elasticity can be chosen to allow for greater stretch. -
FIG. 3 illustrates the “sandwiching” of the abdominal wall between the tworings rubber bands 36. The use of elastic tensioners allows for a greater range of wall thicknesses because the tensions can be selected at the time of application. For instance, the user would make an incision and measure the actual abdominal wall thickness. He would then choose the appropriate rubber bands providing the desired tensions for the given application. In this case therubber bands 36 could be secured byhooks 38 provided on one or both of therings -
FIG. 4 is a different embodiment which provides even further versatility. This design is not limited by the fixed distance between therings retractor 12. Instead, theinner ring 14 will be fixed to thesheath 18, and theupper ring 16 will comprise a separate assembly. Initially, theinner ring 14 is placed into the peritoneum cavity. Then the elastic material is pulled taut and secured onto hook features 41 located on theouter ring 16. This allows the user to fix theretractor 12 to an abdominal wall of any size. -
FIG. 5 shows an additional embodiment wherein thesheath 18 is attached to theouter ring 16 usingclamps 43.FIG. 6 illustrates another embodiment wherein thesheath 18 is attached to theouter ring 16 usingladders 45 withrungs 46, that may be connected to the external surface of thesheath 18. Once the preferred tension of thesheath 18 has been attained, the user simply hooks anappropriate rung 46 onto an associatedhook 47 located on theouter ring 16. -
FIG. 7A shows a structure which sandwiches theabdominal wall 11 between the tworings inner ring 14 has been placed, theties 50 can be pulled tight through associatedholes 54 to fix therings abdominal wall 11. As illustrated inFIG. 7B , the zip ties 50 may be formed with a plurality ofgrooves 52 which extend traverse or perpendicular to the length of thetie 50. In operation, thetie 50 is threaded through thehole 54 in theupper ring 16 where one of thegrooves 52 is engaged by atongue 56 which prevents movement of thetie 50 back through thehole 54. -
FIG. 8A shows a method of sandwiching the abdominal wall between the tworings ropes 58, each having a plurality ofknots 61. After thering 14 has been placed, theropes 52 can be tensioned and one of theknots 61 secured into an associated holder located on theouter ring 16. In this embodiment, eachrope 58 is drawn upwardly through an associatedwindow 63 in theouter ring 16. Thiswindow 63 will typically be provided withportion 65 larger than theknots 61, andportion 67 smaller than theknots 61 as illustrated inFIG. 8B . - An additional embodiment of the
wound retractor 12 is illustrated inFIG. 9 where elements of structure similar to those previously described are designated by the same reference numeral followed by the lower case letter “a.” - This embodiment is adapted for opening the
wound 10 in theabdominal wall 11 and for maintaining thewound 10 in the open configuration to allow access into the abdominal cavity. The device includes thesheath 28 a which lines thewound 10 to prevent or limit the risk of portsite metastasis, and theouter ring 16 a. Theouter ring 16 a also includes a sealingsurface 72 at its base which is designed to seal against the exterior surface of theabdominal wall 11. The device further comprises thethin film sheath 28 a with aring 74, havingexternal threads 76, which is attached to the proximal end of thesheath 28 a, and with theinner ring 14 a attached to the distal end of thesheath 28 a. Theinner ring 14 a is designed to be placed inside thewound 10 while therings wound 10. - Once the
inner ring 14 a is placed inside thewound 10 and into the peritoneal cavity, theouter ring 16 a can be rotated clockwise relative to theinner ring 14 a. As the internal thread 70 on theouter ring 16 a engage theexternal threads 76 on thering 74, thering 74 is drawn proximally stretching thesheath 28 a. This opens thewound 10 and draws both theouter ring 16 a and theinner ring 14 a toward theabdominal wall 11. A primary seal is created between theinner ring 14 a and theabdominal wall 11, while a secondary seal is formed between thesurface 72 of theouter ring 16 a and the exterior surface of theabdominal wall 11. A sealingcap 81 can then be attached to the proximal end of theouter ring 16 a to permit insufflation and otherwise facilitate a laparoscopic procedure. The sealingcap 81 can be removed at any time to allow conversion from laparoscopic surgery to open surgery. - Perhaps the most significant advantage associated with this embodiment is that the device enables a surgeon to retract and protectively line an abdominal wall incision, while being able to easily adjust the retractor 12 a to accommodate variations from patient to patient in the thickness of the
abdominal wall 11. The device effectively seals around the interior and exterior of thewound 10, which allows the sealingcap 81 to be attached to seal the abdominal cavity and enable a laparoscopic procedure to be performed. - Another embodiment of the
retractor 12 is illustrated inFIGS. 10-14 where elements of structure similar to those previously discussed are designated with the same reference numeral followed by the lower case letter “b.” In this embodiment, the retractor 12 b includes thethin film sheath 28 b which lines the wound to prevent or limit the risk of portsite metastasis. The inner and outer rings, 14 b and 16 b, respectively, are attached to opposing ends of thesheath 28 b in the manner previously described. However, in this embodiment, athird ring 83 is fixed to thesheath 28 b between therings - In order to achieve the desired retraction, the
inner ring 14 b is positioned interiorly of theabdominal wall 11 as illustrated inFIG. 11A . Then thesheath 28 b is pulled outwardly through thewound 10, tensioning thesheath 28 b and causing theabdominal wall 11 to retract or open as illustrated inFIG. 11B . - At this point, it is desirable to maintain the retraction by preventing the
sheath 28 b from pulling back into thewound 10. This maintenance of tension on thesheath 28 b is addressed in a unique manner with the embodiment ofFIG. 10 wherein therings - In the manner illustrated in
FIG. 12 , thering 16 b can be moved distally over thering 83. This creates a circumferential retainer orring bundle 85 which is illustrated in the perspective view ofFIG. 13 . In this process, thering 16 b is stretched circumferentially outwardly of thering 83 to form thebundle 85. This formation is further illustrated in the cross section schematic view ofFIG. 14 where thebundle 85 of elastomeric rings presses against the outer surface of theabdominal wall 11 to maintain tension on thesheath 28 b. With reference toFIG. 15 , it will be appreciated that thering bundle 85 can be further rotated to move thethird ring 83 outwardly and distally of thering 16 b as required to produce and maintain the desired tension on thesheath 28 b. - With the embodiment of
FIG. 10 , retraction is achieved by positioning thering 83 above thering 16 b, and pulling thesheath 28 b upwardly from the wound 10 (FIG. 12 ). The sheath is prevented from pulling back into the incision by stretching thering 83 out, around, and under thering 16 b. - The degree of retraction or how much the sheath is pulled upwardly, is depended on the height of the
ring 83 about theabdominal wall 11. This height can be adjusted in the embodiment ofFIG. 16 wherein elements of structure similar to those previously described are designated with the same reference numeral followed by the lower case letter “c.” In this embodiment, thering 83 c can be disconnected from and moved relative to thesheath 28 c. At a desired location above theinner ring 14 c, thering 83 c can be fixed to thesheath 28 c, for example by aclip 87. - Clamps or clips may be used to lock the movable ring at the appropriate height as shown in
FIG. 16 . Also, a series of open loops 88 (FIG. 17 ) or tracks 89 (FIG. 18 ) can be fixed to thesheath 28 c at different distances from theinner ring 14 c to hold thering 83 c at different heights. - Alternatively, as illustrated in
FIG. 19 , themoveable ring 83 can be formed as two complimentary rings. Theouter ring 16 b can be disposed outwardly of thesheath 28 c and afourth ring 90 can be disposed inwardly of thesheath 28 c. These tworings sheath 28 c so that thering 83 c is maintained in a fixed position by thecomplimentary locking ring 90. - The inner locking rings 83 c and 90 of the
FIG. 19 embodiment provide for simple operation of theretractor 12. These interlocking rings 83 and 90 can be pushed down so that they rest on the outer surface of theabdominal wall 11. As thesheath 28 c is drawn upwardly to achieve the proper degree of tension, it is easily moved between therings sheath 28 c to move back into the wound site merely tightens the interlocking relationship of therings sheath 28 c until it is again pulled to release the lockingring 90 from thering 83 c. - In still a further embodiment, illustrated in
FIG. 20 , several intermediate rings, 92, 94, 96 and 98 can be provided between theinner ring 14 c and theouter ring 16 c. With this embodiment, the rings, such as thering abdominal wall 11 can be rolled into thering bundle 85 c to maintain the desired tension on thesheath 28 c. In this case, therings ring bundle 85 c, contact theabdominal wall 11 to provide increased friction and perhaps increased retraction at the wound site. - A further advantage of these embodiments is that they enable the surgeon to retract and protectively cover the
wound 10 while permitting adjustment of the retractor 12 c to variations in thickness of theabdominal wall 11. These devices provide an airtight seal around thewound 10, thus allowing an airtight cap or access port to be attached to enable laparoscopic surgery. Furthermore, usage of these devices is simple in that retraction can be achieved with one motion by grasping theproximal ring 16 c and pulling it up from thewound 10 and then merely releasing it. - The one-way characteristics of the interlocking rings 83 c and 90 are illustrated in the progressive views of
FIGS. 21 and 22 . With reference to these figures, it can be seen that retraction is maintained by preventing thesheath 28 c from pulling back into thewound 10 by means of the one-way operation of the interlocking rings 83 c and 90. Thesheath 28 c slides easily through the interlocking rings 83 c and 90 in the upper direction, but is prevented from sliding through therings sheath 28 c by pulling it proximally thereby unlocking therings ring 83 c to be removed from thesheath 28 c in order to remove theretractor 12 from the wound site. - Other one-way mechanisms can be formed, for example, with a
wedge 93 as illustrated inFIGS. 23A and 23B , a one-way roller 95 as illustrated inFIG. 24 , or a one-way ratchet 97 as illustrated inFIG. 25 . Bumps, over-braid, threads or coatings on the sheath 28 can be added for additional traction using these one-way mechanisms. Alternatively, features such as indentations or protrusions on the sheath 28 can permit it to pass in only one direction. - A further embodiment of the
wound retractor 12 is illustrated inFIGS. 26 and 27 wherein elements of structure are similar to those previously described or designated with the same reference numeral followed by the lower case letter “d.” These embodiments include anexpandable foam annulus 101 which is disposed in acompartment 103 sealed by avalve 104. Thiscompartment 103 is formed between therings outer ring 16 d. In this location, thecompartment 103 is operatively disposed exteriorly of theabdominal wall 11. As in any of the embodiments previously disclosed, a sealingcap 105 can be disposed over theouter ring 16 d to facilitate laparoscopic surgery. After theretractor 12 d is operatively disposed as illustrated inFIG. 27 , thevalve 104 can be opened to permit air into thecavity 103. This also permits thefoam annulus 101 to expand as illustrated inFIG. 27 thereby elevating thering 16 d above theabdominal wall 11 and tensioning thesheath 28 d. - As the
annular foam 101 expands to a high profile state, seals are formed on both sides of thewall 11 around thesheath 28 d. In addition, thewall 11 is retracted from thewound 10. To remove thewound retractor 12 from the patient, the surgeon simply opens thevalve 104 and pulls theinner ring 14 d out through thewound 10. While an expandable foam is described for this embodiment, additional materials could be utilized which expand upon contact with the inlet air. - One advantage associated with this embodiment is that the device enables a surgeon to quickly retract and protectively line an abdominal wall incision while being able to easily accommodate variations from patient to patient in the thickness of the abdominal wall. In addition, the device effectively seals around the interior and exterior of the incision, and allows a sealing cap to be attached to seal the abdominal cavity and to enable a laparoscopic procedure to be performed.
- A wound retractor with an
inverting ring 107 is illustrated inFIGS. 28 and 29 where elements of structure similar to those previously disclosed are designated with the same reference numeral followed by the lower case letter “e.” The device includes thesheath 28 e which lines thewound 10 to prevent or limit the risk of portsite metastasis. The device includesbase 110 with a sealingring 14 on its distal end, which is designed to seal against the exteriorabdominal wall 11 of the patient. The device includes athin film sheath 28 e with the invertingring 107 configured to lock into the base 110 which is attached to the proximal end of the sheath 28. - The sealing
ring 14 e is designed to be placed inside the incision while theexternal inverting ring 107 remains external to the incision. Thebase 110 is configured to move freely between therings ring 14 e is placed inside the incision and into the peritoneal cavity, theexternal ring 107 is continuously rolled or inverted, which draws the incision open and also draws both theexternal ring 107 and theperitoneal ring 14 e toward the abdominal wall. Once all of the slack in thesheath 28 e has been taken up by rolling or inverting theexternal ring 107, the external ring can then be pushed into a recess 114 in the base 110 which is configured to lock the ring in position and thereby maintain the tension on thesheath 28 e. With the proper amount of tension placed upon thesheath 28 e, a primary seal is created between theperitoneal ring 14 e and the anterior abdominal wall, and a secondary seal is created between the sealingring 112 of thebase 110 and the exterior abdominal wall. A sealingcap 116 can then be attached to the proximal end of the base and the patient can be insufflated with carbon dioxide to allow a laparoscopic procedure such as a gastric bypass to be performed. The sealing cap can be removed at any time to allow conversion from laparoscopic surgery to open surgery. - A most significant advantage associated with this embodiment is that the device enables a surgeon to retract and protectively line an abdominal wall incision while being able to easily adjust the device to accommodate variations from patient to patient in the thickness of the abdominal wall. The device effectively seals around the interior and exterior of the incision, which allows a sealing cap to be attached to seal the abdominal cavity ad enable laparoscopic procedure to be performed.
- A further embodiment of the wound retractor is, illustrated in
FIG. 30 , where elements of structure similar to those previously disclosed are designated with the same reference numeral followed by the lower case letter “f.” This embodiment includes threeseparate rings tubular sheath 28 f which lines the incision to prevent or limit the risk of portsite metastasis. The device includes theexternal ring 16 f attached to the proximal end of thesheath 28 f, theintermediate ring 83 f attached to the center of the sheath, and a peritoneal ring attached to the distal end of thesheath 28 f. The peritoneal ring is designed to be placed inside the incision while theeternal ring 16 f remains external to the incision. Theintermediate ring 83 f may remain external to the incision or may lie within the incision itself depending upon how the three rings are oriented. - This wound retractor has four different fixed lengths to accommodate abdominal walls of four different thicknesses. The first length, which is the longest, is achieved by simply placing the
peritoneal ring 14 f into the incision. The tension of the sheath between theexternal ring 16 f and theperitoneal ring 14 f maintains the incision in an open configuration. If the thickness of theabdominal wall 11 is less than the distance between theeternal ring 16 f and theperitoneal ring 14 f, then a shorter length can be selected. - The second length, which is less than the first length, is achieved by simply placing the
peritoneal ring 14 f into the incision, and then pulling thesheath 28 f upwards until theintermediate ring 83 f is external to the incision. The tension of thesheath 28 f between theintermediate ring 83 f and theperitoneal ring 14 f maintains the incision in an open configuration. If the thickness of theabdominal wall 11 is less than the distance between theintermediate ring 83 f and theperitoneal ring 14 f then a shorter length can be selected. - The third length, which is less than the second length, is achieved by inserting the
peritoneal ring 14 f into the incision and then pulling theintermediate ring 83 f over theexternal ring 16 f. The tension of the sheath between the peritoneal ring and the combination of the external ring and the intermediate ring maintains the incision in an open configuration. If the thickness of the abdominal wall is less than the third length, then the fourth length will have to be selected. - The fourth length, which is less than the third length, is achieved by first pulling the
intermediate ring 83 f through theexternal ring 16 f, and then pulling theintermediate ring 83 f over theexternal ring 16 f. The tension of thesheath 28 f between theperitoneal ring 14 f and the combination of theexternal ring 16 f and theintermediate ring 83 f, maintains the incision in an open configuration. This 3-ring retractor can therefore be positioned to effect four different lengths to accommodate variations in the thickness of the abdominal wall from patient to patient. - A most significant advantage associated with this embodiment is that the device enables a surgeon to retract and protectively line an abdominal wall incision while being able to easily adjust the device to accommodate variations from patient to patient in the thickness of the abdominal wall. The device is also very low in cost since it includes only four components, 3 rings 14 f, 16 f, and 83 f, and a
tubular sheath 28 f. - It will be understood that many other modifications can be made to the various disclosed embodiments without departing from the spirit and scope of the concept. For example, various sizes of the surgical device are contemplated as well as various types of constructions and materials. It will also be apparent that many modifications can be made to the configuration of parts as well as their interaction. For these reasons, the above description should not be construed as limiting the invention, but should be interpreted as merely exemplary of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the present invention as defined by the following claims.
Claims (10)
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Also Published As
Publication number | Publication date |
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US20080200767A1 (en) | 2008-08-21 |
US20050288558A1 (en) | 2005-12-29 |
US7238154B2 (en) | 2007-07-03 |
US7377898B2 (en) | 2008-05-27 |
US6958037B2 (en) | 2005-10-25 |
US20070225569A1 (en) | 2007-09-27 |
US20040049099A1 (en) | 2004-03-11 |
US8388526B2 (en) | 2013-03-05 |
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