WO2001080725A1 - Surgical access device - Google Patents

Surgical access device Download PDF

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Publication number
WO2001080725A1
WO2001080725A1 PCT/US2000/010898 US0010898W WO0180725A1 WO 2001080725 A1 WO2001080725 A1 WO 2001080725A1 US 0010898 W US0010898 W US 0010898W WO 0180725 A1 WO0180725 A1 WO 0180725A1
Authority
WO
WIPO (PCT)
Prior art keywords
side member
lateral
leg
carriage
length
Prior art date
Application number
PCT/US2000/010898
Other languages
French (fr)
Inventor
James D. Segermark
Christopher J. Herman
Original Assignee
Viamedics, Llc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Viamedics, Llc filed Critical Viamedics, Llc
Priority to DE10085461T priority Critical patent/DE10085461T1/en
Priority to AU2000244839A priority patent/AU2000244839A1/en
Priority to PCT/US2000/010898 priority patent/WO2001080725A1/en
Publication of WO2001080725A1 publication Critical patent/WO2001080725A1/en

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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0206Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors with antagonistic arms as supports for retractor elements
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0293Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors with ring member to support retractor elements

Definitions

  • the present invention provides an improved surgical access device of the type used to gain access to an internal cavity of a patient's body.
  • Coronary bypass surgery typically involves the coronary arteries on the caudal side of the heart (i.e., the apical side of the heart). Because coronary bypass surgery usually does not require access to the cranial parts of the chest cavity, a lesser amount of retraction is ideally required toward the cranial regions of the chest cavity than is required toward the caudal regions of the chest cavity. Other procedures, such as open heart valve replacement or repair, require a greater amount of retraction across the entire chest cavity, to expose both the cranial and caudal regions of the heart.
  • the intercostal space When performing surgical procedures in the thoracic cavity, access is gained by making an incision between the ribs. This area is referred to as the intercostal space.
  • the ribs are attached posteriorly to the spine and anteriorly to the sternum. This creates a bowing of the rib and non-uniformity of the distance of the intercostal space.
  • a procedure in which a section of a lung, or the entire lung is removed may require non- parallel retraction of the ribs to address the bowing of the ribs and variance of the intercostal space. Ideally, this retraction is minimized to lessen trauma, specifically the breakage or removal of ribs.
  • Non-parallel retraction is presently only performed by the use of two surgical retractor devices placed at opposite ends of the intercostal incision and opened independently of each other.
  • a surgical device for accessing a body cavity comprises first and second longitudinally opposed side members, each of the side members having first and second ends.
  • a first lateral member adjustably connects the first end of the first side member to the second end of the second side member, with at least one of the side member ends being moveable along a length of the first lateral member, thereby permitting adjustment of the lateral distance between the first end of the first side member and second end of the second side member.
  • a second lateral member adjustably connects the second end of the first side member to the first end of the second side member, with at least one of the side member ends being moveable along a length of the second lateral member, thereby permitting adjustment of the lateral distance between the second end of the first side member and first end of the second side member.
  • At least one transversely extending repositionable flange is releasably attached to each side member.
  • the Present Invention also comprises the first and second side members being pivotably articulated to the first and second lateral members by a bayonet hinge mechanism.
  • Fig. 1 shows a perspective view of an embodiment of the invention in parallel retracting configuration.
  • Fig. 2 shows a perspective view of the first side member shown in Figs. 1 and 19.
  • Fig. 3 shows a perspective view of the second side member shown in Figs. 1 and 19.
  • Fig. 4 shows a plan view of the lower surface of the lower plate of the first side member.
  • Fig. 5 shows a plan view of the lower surface of the lower plate of the second side member.
  • Fig. 6 shows a plan view of the upper surface of the first lateral member shown in Figs. 1 and 19.
  • Fig. 7 shows a plan view of the upper surface of the second lateral member shown in Figs. 1 and 19.
  • Fig. 8 shows a plan view of the lower surface of the first lateral member.
  • Fig. 9 shows a plan view of the lower surface of the second lateral member.
  • Fig. 10 shows a perspective view from the lower surface of the first carriage.
  • Fig. 11 shows a perspective view from the lower surface of the second carriage.
  • Fig. 12 shows an end view of the first carriage.
  • Fig. 13 shows an end view of the second carriage.
  • Fig. 14 shows a disassembled perspective view of the mating gear assembly.
  • Fig. 15 shows an assembled perspective view of the first mating gear assembly.
  • Fig. 16 shows an assembled perspective view of the second mating gear assembly.
  • Fig. 17 shows a perspective view of a tissue engaging flange.
  • Fig. 18 shows a side view of a tissue engaging flange.
  • Fig. 19 shows a perspective view of the assembled surgical access device configured for non-parallel retraction.
  • Body Hinge refers to the pivoting articulation between a side member and a carriage and the pivoting articulation between a side member and a lateral member.
  • the carriage has an essentially perpendicular extension terminating in a hook.
  • the hook defines a slot extending into the body of the extension, the slot terminating at a concavity facing toward the opening of the slot.
  • a peg extends perpendicularly away from the hook a distance less than the width of the hook.
  • the hook of the carriage is designed to articulate with and form a hinge capable of pivoting against a side member. Both end portions of each side member comprise a cylindrical post extending between upper and lower plates.
  • a beam perpendicularly disposed between the plates forms an "I" configuration if viewed from an end perspective separates upper and lower plates.
  • the length of the beam is less than the length of the upper and lower beams, to allow for the post to extend between the plates.
  • the upper plate is solid and raised proximally (i.e., extends away from the patient's body) when the surgical access device is in use by the physician.
  • the lower plate is parallel and distal to the upper plate and has an arcuate channel extending partially around the lower plate. To complete articulating the channel with the side member requires first placing the hook around the post, with the carriage and side member disposed in parallel planes to each other.
  • the raised peg on the perpendicular extension of the carriage is aligned with and fits into the arcuate channel and guides the carriage in a pivoting motion with respect to the side member, while maintaining the carriage and side member in a parallel planar disposition to each other.
  • the lateral members utilize a similar configuration as the carriage to articulate with the side member.
  • the lateral member is essentially a bar having a first leg with an extended length and a second leg of shorter length attached to one end of the first leg at approximately a right angle.
  • the second leg is configured in a similar manner to the perpendicular extension of the carriage ( . e., the hook and peg arrangement is designed to articulate with the post and arcuate channel of the side member to provide a pivoting arrangement).
  • Kit refers to a set of elements in unassembled form, which when assembled forms a surgical access device.
  • Outside refers to the space outside the area created by the articulated and assembled surgical access device and bounded by the first side member, second side member, first carriage, second carriage, first lateral member and second lateral member.
  • FIGs 1 and 19 illustrate an embodiment of the present invention.
  • the assembled surgical access device 100 defines an access port 22 which extends therethrough.
  • This access port 22 can take any desired shape or dimension to achieve a particular clinical objective.
  • the access port 22 can be circular, elliptical, rectangular, or deltoid.
  • the access port 22 is shown as being rectangular, while in Figure 19, the access port 22 is shown as being deltoid.
  • the dimensions of the access port 22 vary significantly depending on the body cavity being accessed and the reason for such access. If the surgeon is attempting to gain access to a patient's thoracic cavity through an incision through the intercostal space, typical dimensions of the access port 22 for an adult patient will be on the order of 2.5 inches (about 6.3 cm) long by 1.5 inches wide.
  • typical dimensions of the access port 22 for an adult patient will be on the order of 6 inches long by 1.5 to 6 inches wide (to provide an asymmetric incision). The dimensions would decrease proportionately for a child.
  • one embodiment of the Present Invention comprises first 140a and second 140b longitudinally extending opposed side members, each having a first end 142a, 144a and a second end 142b, 144b.
  • the first end 142a of the first side member 140a is pivotably attached to the first lateral member 190a by means more fully discussed below.
  • the first lateral member 190a extends through the first carriage 200a in a slidable manner more fully discussed below.
  • An extension 204 extends perpendicularly from the first carriage 200a and is pivotably attached to the second end 144b of the second side member 140b.
  • first end 144a of the second side member 140b is pivotably attached to the second lateral member 190b by means more fully discussed below.
  • the second lateral member 190b extends through the second carriage 200b in a slidable manner more fully discussed below.
  • An extension 204 extends perpendicularly from the second carriage 200b and is pivotably attached to the second end 142b of the first side member 140a.
  • the assembled Present Invention presents mirror images of itself. The mirror image nature of the Present Invention is further reflected in that similar parts are identical and therefore completely interchangeable.
  • the first 140a and second 140b side members are identical as are first 190a and second 190b lateral members.
  • first 200a and second 200b carriages are also identical with each other and interchangeable as are first 300a and second 300b mating gear assemblies.
  • the feature of identical similar parts adds to the simplicity of the design by eliminating any ambiguity following sterilization when reassembling the surgical access device 100 prior to use.
  • the first 140a and second 140b side members which are identical in all respects and completely interchangeable with each other, comprise an upper plate 152 having a length, a width, a first end 142a, 144a, a second end 142b, 144b an upper surface 154 and a lower surface 156.
  • a lower plate 160 is attached to the upper plate 152 in a generally parallel planar manner.
  • the lower plate 160 has an upper surface 162 and a lower surface 164.
  • a first post 158 extends in a generally perpendicular manner between the upper surface 162 of the lower plate 160 and the lower surface 156 of the upper plate 152 proximate the first end 142a, 144a of the first and second side member 140a, 140b.
  • a second post 168 extends in a generally perpendicular manner between the upper surface 162 of the lower plate 160 and the lower surface 156 of the upper plate 152 proximate the second end 142b, 144b of the first 140a and second 140b side members.
  • a first arcuate channel 172 and a second arcuate channel 174 extend into the lower plate 160 from the upper surface 162.
  • the first 172 and second 174 arcuate channels extend completely through the lower plate 160 for simplicity of manufacture and more importantly, improved sterilizability.
  • the first 172 and second 174 arcuate channels could also comprise a groove extending into but not through the lower plate 160 from the upper 162 or lower 164 surface as design contingencies dictate.
  • the first arcuate channel 172 is concentric with the first post 158 and begins at the first end 142a, 144a of the first 140a and second 140b side members and arcs toward the inside edge 138a, 138b of the first 140a and second 140b side members.
  • the second arcuate channel 174 is concentric with the second post 168 and begins at the second end 142b, 144b of the first 140a and second 140b side member and arcs toward the inside edge 138a, 138b of the first 140a and second 140b side member.
  • a plurality of longitudinally arranged apertures 150 designed to hold and secure one or more tissue engaging flanges 400 during use of the surgical access device 100 are defined proximate the inside edge 138a, 138b of the first 140a and second 140b side member.
  • Each aperture 150 defines an associated shelf 151 that is attached to the lower plate 160 and terminates toward the first 138a or second 138b inside edge of the first 140a or second 140b side member, respectively.
  • the upper plate 152 defines a substantially consistent thickness along its length. This permits the surgeon to attach a plurality of surgical accessories (not shown) to the surgical access device 100 during surgery. This greatly increases the efficiency of the surgical team during an operation by permitting the surgical accessories (not shown) to be fixed in place during the operation, thus freeing up space and allowing fewer personnel in the immediate operating area.
  • Such devices include suction/irrigation probes (suckers), beating heart stabilizers, malleable instrument arms, diaphragm retractors, valve instrument retractors (primarily for mitral valve), cautery pencil holders, illumination probes and sternal approximators. Suture pads (not shown) can also be attached to the upper plate 152.
  • the suture pads give the physician the ability to suture to the tissue and then suture or re-suture anywhere along the length of the suture pad to achieve the appropriate retraction.
  • the suture pads By being able to have sutures attached at any location along the length of the first 140a and second 140b side members, the suture pads essentially provide an infinite number of connection locations, enabling a physician to reorient the sutured tissue by moving the suture to a different location on the pad to alter the direction the suture is pulling.
  • the physician will pass the suture through the patient's tissue and through one of the suture pads or may tie a knot at each end to hold the suture in place, as is conventional.
  • first 190a and second 190b lateral members comprise a first leg 250 and a second leg 252, and have an upper surface 186 and a lower surface 188 and a width 191.
  • First lateral member 190a and second lateral member 190b are identical in all respects and are thus completely interchangeable.
  • First leg 250 has a longitudinal dimension and a terminal end 254.
  • Second leg 252 has a longitudinal dimension and a terminal end 256.
  • first leg 250 defines a greater longitudinal dimension than does second leg 252. It is possible, however, that uses for the surgical access device 100 may exist wherein the second leg 252 would need to be longer than the first leg 250.
  • first 190a and second 190b lateral members have a first leg 250 longer than the second leg 252.
  • combinations of various lengths of the first leg 250 and second leg 252 are contemplated and within the scope of the invention.
  • Veterinary applications on large animals such as horses and cattle require lateral members having greater dimensions than would a human application.
  • pediatric applications in human beings would require smaller sized lateral members than would adults.
  • the first 250 and second 252 legs are fixedly attached to each other at an approximate angle of ninety degrees. Other angles, however, would also work and are contemplated by and within the scope of the Present Invention.
  • a plurality of regularly spaced teeth 192 are disposed along the length of the first leg 250.
  • the teeth 192 are sized to mate with first 300a and second 300b mating gear assemblies as shown in Figs. 15 and 16.
  • a hook 270 is disposed proximate the terminal end 254 of the second leg 252.
  • the hook 270 defines a slot 272 that in a preferred embodiment extends toward, is substantially parallel with the first leg 250 and terminates at a closed end 273 facing away from the terminal end 254 of the first leg 250.
  • peg 274 extends perpendicularly from the lower surface 188 of the first 190a and second 190b lateral members.
  • the peg 274 extends from the lower surface 188 of the first 190a or second 190b lateral member so as to be received by the first arcuate channel 172 in an essentially parallel planar relationship with the first end 142a, 144a of the first side member 140a or second side member 140b.
  • the tolerance between the first 190a or second 190b lateral member and first 140a or second 140b side member, guided in an arcing motion by the peg 274 extending into the first arcuate channel 172 results in a pivotable hinge between the first 190a or second 190b lateral member and the first end 142a, 144a of the first 140a or second 140b side member.
  • an off-center trough 276 is defined on the lower surface 188 of the first 190a and second 190b lateral members and runs parallel with the longitudinal dimension of the first 190a and second 190b lateral member.
  • First 200a and second 200b carriages are identical in all aspects and therefore completely interchangeable with each other.
  • First 200a and second 200b carriages comprise a body 202 having a top side 216, a bottom side 218, an upper surface 220 and a lower surface 222.
  • a channel 206 extends through the body 202 and is configured and arranged to slidably accept the first leg 250 of the first 190a or second 190b lateral member.
  • a bearing 210 is defined by the body 202 and is configured and arranged to receive a first 300a or second 300b mating gear assembly as will be discussed in greater detail below.
  • An off-center projection 208 runs the length of and is in parallel alignment with the channel 206.
  • An extension 204 extends from the top side 216 of the body 202 in a perpendicular manner and has a terminal end 212.
  • a hook 214 is defined at the terminal end 212 of the extension 204.
  • a slot 224 runs substantially parallel with the top side 216 of the body 202 and terminates at a closed end 217 facing the bearing 210.
  • a peg 226 proximate the closed end 217 of the slot 224 extends perpendicularly toward the lower surface 222 of the carriage 200a, 200b.
  • extension 204, slot 224 and peg 226 enable the carriage 200a, 200b to be removably and pivotably hinged to the second post 168 proximate the second end 142b, of the first side member 140a, or to the second post 168 proximate the second end 144b of the second side member 140b in only one way. Put another way, it is impossible to attach the first 200a or second 200b carriage to the second end 142b, 144b of the first 140a or second ,140b side member in any way other than a pivotable parallel planar way.
  • the channel 206 is positioned to slidably receive the first leg 250 of the first 190a or second 190b lateral member due to the off-center alignment of the trough 276 and projection 208. This allows the slot 272 of the first 190a or second 190b lateral member to attach to the first end 142a, 144a of the first 140a or second 140b side member with the first leg 250 extending toward the opposing side member 140a or 140b.
  • the length of the extension 204 is similar to the length of the second leg 252 of the first 190a and second 190b lateral members.
  • Similarity of length of the second leg 252 ensures the ability of the assembled surgical access device 100 to be able to perform parallel retraction, if desired. It is contemplated by and therefore within the scope of the invention to have the length of the extension 204 of the first carriage 200a be different than the length of the extension 204 of the second carriage 200b. It is also contemplated by and therefore within the scope of the invention to have different lengths for each of the extensions 204 of the first 200a and second 200b carriages and each of the second legs 252 of the first 190a and second 190b lateral members.
  • Fig. 14 shows the disassembled first 300a and second 300b mating gear assemblies.
  • the first 300a and second 300b mating gear assemblies comprise a mating gear 302 defining an upper disc 304 and a lower disc 306.
  • Two gear teeth 308 sized and spaced to mate with the teeth 192 on the first 190a and second 190b lateral members are disposed between and separate the upper disc 304 and lower disc 306.
  • the distance defined by the length of the gear teeth 308 is of a length slightly greater than the width
  • a raised portion 310 extends from the upper disc 304 and defines an aperture 312 therethrough.
  • the outer diameter of the upper disc 304 and lower disc 306 is slightly smaller than the inner diameter of the bearing 210 defined by the body 202 of the first 200a or second 200b carriage.
  • a gear handle 314 defines a free end 315 and an attached end 317.
  • a pair of centered projections 316 extend longitudinally from the attached end 317 and define apertures 318.
  • Figs. 15 and 16 show the assembled first 300a and second 300b mating gear assemblies.
  • the first 300a and second 300b mating gear assemblies are identical in all aspects and therefore completely interchangeable with each other.
  • the gear handle 314 is pivotably attached to the raised portion 310 of the mating gear 302 by means of a pin 320 extending through the gear handle projection 316 apertures 318 and through the raised portion aperture 312.
  • the rack and pinion system defined by the first 190a and second 190b lateral members, and first 300a and second 300b mating gear assemblies provides a mechanism for increasing the mechanical advantage of a force applied to the first 200a and second 200b carriage to move it along the first 190a or second 190b lateral members.
  • the gear handle 314 will move the carriage 200a, 200b laterally along the lateral member 190a, 190b, with the gear ratio of the mating gear 302 and teeth 192 determining the mechanical advantage.
  • the two cylindrical gear teeth 308 provide a locking mechanism wherein in the position of the first 200a or second 200b carriage can be locked in a desired position on the first 190a or second 190b lateral member.
  • the 200a or second.200b carriage is locked into position when the gear teeth 308 are aligned with the teeth 192 of the first 190a or second 190b lateral member with the gear handle 314 at an angle so as to extend parallel with the first 190a or second 190b lateral member.
  • this geometry results in a locked position every 180 degrees, or a linear movement of the pitch of the gear (in this embodiment 0.26" along the travel of the teeth
  • the assembled surgical access device 100 is configured and arranged to receive and hold a plurality of tissue engaging flanges 400.
  • the flange 400 comprises an upper end 402, a lower end 404, a length 406 and a width 408.
  • the distal end 404 defines a portion 405 extending in the direction of retraction.
  • the upper end 402 defines an offset portion 403 that extends in the direction of retraction. The offset portion 403 is sized so as to be received within an aperture 150. When the flange 400 is inserted into the aperture 150, the offset portion 403 will rest against the upper surface 153 of the shelf 151.
  • the length 406 of the flanges 400 can be varied to accommodate the needs of a particular surgeon or surgical procedure. While in one embodiment the flanges 400 are releasably attached to the side members 140a, 140b by the alignment of the offset portion 403 and the shelf 151, other methods (not shown) for attachment are also contemplated by and therefore within the scope of the invention.
  • a stainless steel flange (not shown) could also be used that would be repositionably fastenable to several positions along the inside edge 138a, 138b of the first 140a and second 140b side members using a fastener mechanism, such as a screw (not shown).
  • An additional mechanism comprises a clamping mechanism (not shown).
  • First 140a and second 140b side members, first 190a and second 190b lateral members, first 200a and second 200b carriages, and first 300a and second 300b mating gear assemblies are preferably constructed from 17-4 PH metal injection molded stainless steel. 17-4 stainless steel is preferred due to its resistance to corrosion, surface hardness (wear resistance), and strength. In an alternate embodiment, first 140a and second 140b side members, first 190a and second 190b lateral members, first 200a and second 200b carriages, and first 300a and second 300b mating gear assemblies could also be machined from stainless steel. Stainless steel offers the advantages of relatively low cost, great strength, biocompatibility and endurance.
  • first 140a and second 140b side members, first 190a and second 190b lateral members, first 200a and second 200b carriages, and first 300a and second 300b mating gear assemblies could also be made of various plastics such as polycarbonate and ABS provided the first 190a and second 190b lateral members are reinforced with stainless steel to resist bending.
  • the flanges 400 are preferably made from injection molded polycarbonate plastic with a barium sulfate load for radiopacity. Radiopacity is a desirable characteristic in the flanges 400 in the event one remains behind in the patient following completion of surgery. Other plastic materials such as ABS with a barium sulfate load are also suitable and therefore contemplated by and within the scope of the invention.
  • the flanges are disposable and come ready to use in a sterilized package.
  • first and second parts are identical to and interchangeable with each other. Assembly of the components as described below need not take place in any particular order, thus the order to be described should be regarded as exemplary and not limiting the scope of the invention.
  • the first lateral member 190a and first side member 140a are placed in similar planar positions.
  • the slot 272 of the first lateral member 190a is aligned so as to engage the first post 158 proximate the first end 142a of the first side member 140a.
  • the first lateral member 190a is slid toward the first post 158 until the closed end of the slot 273 contacts the first post 158.
  • the peg 274 of the first lateral member 190a is simultaneously slid into the first arcuate channel 172.
  • the first lateral member 190a can now be pivoted toward the inside edge 138a of the first side member 140a so' that the first leg 250 of the first lateral member 190a extends away from the inside edge 138a of the first side member 140a.
  • the first carriage 200a is fitted with the first mating gear assembly 300a and aligned with the upper surface 220 facing the assembler so that the slot 224 faces away from the first lateral member 190a.
  • the channel 206 is aligned with the free end 196 of the first lateral member 190a and the first mating gear assembly 300a rotated until the gear teeth 308 mesh with the teeth 192 on the first lateral member 190a.
  • the first mating gear assembly 300a is continued to be rotated until the first carriage 200a rests at a position on the first leg 250 of the first lateral member 190a where at least the free end 196 of the first leg 250 extends from the first carriage 200a.
  • the second post 168 at the second end 144b of the second side member 140b is aligned with the slot 224 of the first carriage 200a, simultaneously aligning the peg 226 of the first carriage 200a with the second arcuate channel 174 of the second side member 140b.
  • the second side member 140b is slid toward the second post 168 until the closed end of the slot 217 contacts the second post 168.
  • the second side member 140b is now pivoted toward the inside edge 138a of the first side member 140a.
  • the second lateral member 190b is aligned with the first post 158 proximate the first end 144a of the second side member 140b.
  • the second lateral member 190b is slid toward the first post 158 of the second side member 140b until the closed end 273 contacts the first post 158, while simultaneously aligning the peg 274 of the second lateral member 190b with the second arcuate channel 174 of the second side member 140b.
  • the second lateral member 190b is pivoted toward the inside edge 138b of the second side member 140b until it is substantially perpendicular to the second side member 140b.
  • the second carriage 200b is aligned with the second end 142b of the first side member 140a so that the second post 168 at the second end 142b of the first side member 140a is aligned with the slot 224 of the second carriage 200b, simultaneously aligning the peg 226 of the second carriage 200b with the second arcuate channel 174 of the first side member 140a.
  • the second carriage 200b is fitted with the second mating gear assembly 300a and aligned with the upper surface 220 facing the assembler so that the slot 224 faces toward the second lateral member 190b.
  • the channel 206 is aligned with the free end 196 of the second lateral member 190b and the second mating gear assembly 300b rotated until the gear teeth 308 mesh with the teeth 192 on the second lateral member 190b.
  • the second mating gear assembly 300b is continued to be rotated until the second carriage 200b rests at a position on the first leg 250 of the second lateral member 190b where at least the free end 196 of the first leg 250 extends from the second carriage 200b.
  • At least one flange 400 is attached to each of the first side member 140a and second side member 140b.
  • the placement of the flanges 400 is symmetrical (i.e., equal numbers of flanges 400 are placed at the mirror image aperture 150 on the opposite side member 140a or 140b). This completes assembly of the surgical access device 100.
  • an incision is made into the patient.
  • tissue will normally need to be incised to gain access to the anatomical site where the operation is to occur.
  • the sterilized, assembled surgical access device 100 is carefully inserted into the incision. It is important that the length 406 of the flange 400 is sufficiently long that the lower end 404 of the flange 400 extends into the body at a point deeper than the tissue to be retracted.
  • the first 300a and second 300b mating gear assemblies are rotated by the surgeon or technician causing retraction only to the minimum extent required.
  • the illustrated design permits the first end 142a of the side member 140a to be moved away from or toward the second end 144b of the second side member 140b along the first lateral member 190a without requiring any movement of the second end 142b of the first side member 140a toward the first end 144a of the second side member 140b.
  • the second end 142b of the first side member 140a can be moved with respect to the first end 144a of the second side member 140b along the second lateral member 190b without requiring any movement of the previously discussed half of the surgical access device 100.
  • the surgical access device 100 may be initially deployed with both carriages 200a, 200b locked as described above against movement with respect to the associated lateral member 190a, 190b and with the side members 140a, 140b positioned immediately adjacent another in a parallel manner.
  • the gear handle 314 of the first carriage 200a can be lifted upwardly from the locked position and rotated to move the first carriage 200a with respect to the first lateral member 190a.
  • the first end 142a of the first side member 140a will pivot with respect to the second leg 252 of the first lateral member 190a about the first post 158 of the first side member 140a.
  • the second end 144b of the second side member 140b will pivot with respect to the terminal end 212 of the carriage extension 204 about the second post 168 of the second side member 140b.
  • the gear handle 314 may be pushed downwardly toward the substantially parallel planar position to lock the carriage 200a in place on the first lateral member 190a. Due to the mirror image nature of the invention, the procedure described above works equally well when applied to the other side of the surgical access device 100 (i.e., second end 142b of first side member 140a toward first end 144a of second side member 140b).

Abstract

A surgical access device (100) utilizing two side members (140a, 140b) carrying repositionable tissue engaging flanges (400) and two lateral members (190a, 190b) that are pivotably hinged to the side members by a bayonet hinge mechanism that allows variable amounts of retraction at either end of the retractor.

Description

SURGICAL ACCESS DEVICE
FIELD OF THE INVENTION
The present invention provides an improved surgical access device of the type used to gain access to an internal cavity of a patient's body.
BACKGROUND OF THE INVENTION
Surgeons frequently need to gain access to patients' body cavities to perform various procedures. One way to gain access to such a cavity is to perform invasive surgery where the cavity is opened fairly widely from the exterior to allow the surgeon ready access to the interior of the cavity. For example, in most traditional heart surgery, the patient's sternum is split and the overlying tissue is cut back to allow the surgeon to place both hands in the chest cavity. Such procedures traditionally employ a retractor to maintain the incision in an open configuration during surgery.
A wide variety of surgical retractors are known in the art. Most surgical retractors are intended to allow a surgeon to forcibly urge tissue out of the way to enable unfettered access to the underlying anatomical structures. For example, United States Patent No. 4,765,311 issued to Kulik et al. (the teachings of which are hereby incorporated by reference), shows a "wound retractor" that comprises a split tube. Each of the two tube halves are carried on holders which can be moved apart from one another to retract the tissue and provide access to the abdominal cavity. United States Patent No. 1,157,202 issued to Bates, teaches a retractor which is used to retract the sides, of an incision in the abdominal wall. The retractor includes four separate retractile elements which are arranged about an oval frame. The tissue can be pulled apart to expand the size of the opening of the incision by pulling the retractile elements away from one another.
United States Patent No. 5,125,396 issued to Ray (the teachings of which are incorporated herein by reference), suggests a surgical retractor which comprises two separate arcuate blades. A separate ring carries each of these arcuate blades. By turning these two rings with respect to one another, one can move the blades with respect to one another to open a generally cylindrical passageway through the patient's tissue.
When opening up the chest cavity for performing coronary bypass surgery, following the typical incision through the sternum, it is desirable to retract the layers of tissue to the minimum degree possible. Minimal retraction causes less trauma to other areas of the patient's body, resulting in less pain and faster overall healing time. Coronary bypass surgery typically involves the coronary arteries on the caudal side of the heart (i.e., the apical side of the heart). Because coronary bypass surgery usually does not require access to the cranial parts of the chest cavity, a lesser amount of retraction is ideally required toward the cranial regions of the chest cavity than is required toward the caudal regions of the chest cavity. Other procedures, such as open heart valve replacement or repair, require a greater amount of retraction across the entire chest cavity, to expose both the cranial and caudal regions of the heart.
When performing surgical procedures in the thoracic cavity, access is gained by making an incision between the ribs. This area is referred to as the intercostal space. The ribs are attached posteriorly to the spine and anteriorly to the sternum. This creates a bowing of the rib and non-uniformity of the distance of the intercostal space. A procedure in which a section of a lung, or the entire lung is removed may require non- parallel retraction of the ribs to address the bowing of the ribs and variance of the intercostal space. Ideally, this retraction is minimized to lessen trauma, specifically the breakage or removal of ribs. Non-parallel retraction is presently only performed by the use of two surgical retractor devices placed at opposite ends of the intercostal incision and opened independently of each other.
Thus, what is needed is a single surgical retractor allowing for non-parallel retraction when required, and parallel retraction in other instances.
SUMMARY OF THE INVENTION
The Present Invention contemplates both a surgical access device and a method of gaining surgical access to a body cavity. In accordance with one embodiment of the invention, a surgical device for accessing a body cavity comprises first and second longitudinally opposed side members, each of the side members having first and second ends. A first lateral member adjustably connects the first end of the first side member to the second end of the second side member, with at least one of the side member ends being moveable along a length of the first lateral member, thereby permitting adjustment of the lateral distance between the first end of the first side member and second end of the second side member. Likewise, a second lateral member adjustably connects the second end of the first side member to the first end of the second side member, with at least one of the side member ends being moveable along a length of the second lateral member, thereby permitting adjustment of the lateral distance between the second end of the first side member and first end of the second side member. At least one transversely extending repositionable flange is releasably attached to each side member.
In another embodiment, the Present Invention also comprises the first and second side members being pivotably articulated to the first and second lateral members by a bayonet hinge mechanism.
BRIEF DESCRIPTION OF THE DRAWINGS
Fig. 1 shows a perspective view of an embodiment of the invention in parallel retracting configuration.
Fig. 2 shows a perspective view of the first side member shown in Figs. 1 and 19.
Fig. 3 shows a perspective view of the second side member shown in Figs. 1 and 19.
Fig. 4 shows a plan view of the lower surface of the lower plate of the first side member.
Fig. 5 shows a plan view of the lower surface of the lower plate of the second side member. Fig. 6 shows a plan view of the upper surface of the first lateral member shown in Figs. 1 and 19.
Fig. 7 shows a plan view of the upper surface of the second lateral member shown in Figs. 1 and 19.
Fig. 8 shows a plan view of the lower surface of the first lateral member.
Fig. 9 shows a plan view of the lower surface of the second lateral member.
Fig. 10 shows a perspective view from the lower surface of the first carriage.
Fig. 11 shows a perspective view from the lower surface of the second carriage.
Fig. 12 shows an end view of the first carriage.
Fig. 13 shows an end view of the second carriage.
Fig. 14 shows a disassembled perspective view of the mating gear assembly.
Fig. 15 shows an assembled perspective view of the first mating gear assembly.
Fig. 16 shows an assembled perspective view of the second mating gear assembly.
Fig. 17 shows a perspective view of a tissue engaging flange.
Fig. 18 shows a side view of a tissue engaging flange.
Fig. 19 shows a perspective view of the assembled surgical access device configured for non-parallel retraction. DETAILED DESCRIPTION OF THE INVENTION INCLUDING A BEST MODE
Definitions
"Bayonet Hinge" as used herein, unless otherwise defined, refers to the pivoting articulation between a side member and a carriage and the pivoting articulation between a side member and a lateral member. The carriage has an essentially perpendicular extension terminating in a hook. The hook defines a slot extending into the body of the extension, the slot terminating at a concavity facing toward the opening of the slot. A peg extends perpendicularly away from the hook a distance less than the width of the hook. The hook of the carriage is designed to articulate with and form a hinge capable of pivoting against a side member. Both end portions of each side member comprise a cylindrical post extending between upper and lower plates. A beam perpendicularly disposed between the plates forms an "I" configuration if viewed from an end perspective separates upper and lower plates. The length of the beam is less than the length of the upper and lower beams, to allow for the post to extend between the plates. The upper plate is solid and raised proximally (i.e., extends away from the patient's body) when the surgical access device is in use by the physician. The lower plate is parallel and distal to the upper plate and has an arcuate channel extending partially around the lower plate. To complete articulating the channel with the side member requires first placing the hook around the post, with the carriage and side member disposed in parallel planes to each other. The raised peg on the perpendicular extension of the carriage is aligned with and fits into the arcuate channel and guides the carriage in a pivoting motion with respect to the side member, while maintaining the carriage and side member in a parallel planar disposition to each other. The lateral members utilize a similar configuration as the carriage to articulate with the side member. The lateral member is essentially a bar having a first leg with an extended length and a second leg of shorter length attached to one end of the first leg at approximately a right angle. The second leg is configured in a similar manner to the perpendicular extension of the carriage ( . e., the hook and peg arrangement is designed to articulate with the post and arcuate channel of the side member to provide a pivoting arrangement). "Caudal" as used herein, unless otherwise defined, refers to the inferior or lower part of the human body (i. e., toward the feet).
"Cranial" as used herein, unless otherwise defined, refers to the superior or upper part of the human body (/. e., toward the head).
"Lower" as used herein, unless otherwise defined, refers to the direction toward the interior of the patient's body.
"Inside" as used herein, unless otherwise defined, refers to the space defined by the articulated and assembled surgical access device and bounded by the first side member, second side member, first carriage, second carriage, first lateral member and second lateral member.
"Kit" as used herein, unless otherwise defined, refers to a set of elements in unassembled form, which when assembled forms a surgical access device.
"Upper" as used herein, unless otherwise defined, refers to the direction away from the interior of the patient's body.
"Outside" as used herein, unless otherwise defined, refers to the space outside the area created by the articulated and assembled surgical access device and bounded by the first side member, second side member, first carriage, second carriage, first lateral member and second lateral member.
Nomenclature
22 Access Port 100 Surgical Access Device
138a Inside Edge of First Side Member
138b Inside Edge of Second Side Member
140a First Side Member
140b Second Side Member 142a First End of First Side Member
142b Second End of First Side Member
144a First End of Second Side Member
144b Second End of Second Side Member 150 Aperture
151 Shelf
152 Upper Plate
153 Upper Surface of Shelf
154 Upper Surface of Upper Plate 156 Lower Surface of Upper Plate
158 First Post
160 Lower Plate
162 Upper Surface of Lower Plate
164 Lower Surface of Lower Plate 168 Second Post
172 First Arcuate Channel
174 Second Arcuate Channel
186 Upper Surface of Lateral Member
188 Lower Surface of Lateral Member 190a First Lateral Member
190b Second Lateral Member
191 Width of Lateral Member
192 Teeth on Lateral Member 196 Free End of Lateral Member 200a First Carriage
200b Second Carriage
202 Body of Carriage
204 Extension
206 Channel 208 Projection
210 Bearing
212 Terminal End of Carriage Extension
214 Hook on Carriage
216 Top Side of Carriage 217 Closed End of Slot
218 Bottom Side of Carriage
220 Upper Surface of Carriage
222 Lower Surface of Carriage
224 Slot (Carriage)
226 Peg (Carriage) 250 First leg of Lateral Member
252 Second Leg of Lateral Member
254 Terminal End of First Leg
256 Terminal End of Second Leg
270 Hook (Lateral Member)
272 Slot (Lateral Member)
273 Closed End of Slot
274 Peg (Lateral Member)
276 Trough
300a First Mating Gear Assembly
300b Second Mating Gear Assembly
302 Mating Gear
304 Upper Disc
306 Lower Disc
308 Gear Teeth
310 Raised Portion of Mating Gear
312 Aperture in Raised Portion
314 Gear Handle
315 Free End of Gear Handle
316 Projections On Gear Handle
317 Attached End of Gear Handle
318 Apertures in Gear Handle Projections
320 Pin
400 Flange
402 Upper End of Flange
403 Offset Portion of Flange
404 Lower End of Flange
405 Portion Extending in Retraction Direction 406 Length of Flange
408 Width of Flange
410 Leading Edge of Flange
Construction
Figures 1 and 19 illustrate an embodiment of the present invention. The assembled surgical access device 100 defines an access port 22 which extends therethrough. This access port 22 can take any desired shape or dimension to achieve a particular clinical objective. For example, the access port 22 can be circular, elliptical, rectangular, or deltoid. In Figure 1, the access port 22 is shown as being rectangular, while in Figure 19, the access port 22 is shown as being deltoid. The dimensions of the access port 22 vary significantly depending on the body cavity being accessed and the reason for such access. If the surgeon is attempting to gain access to a patient's thoracic cavity through an incision through the intercostal space, typical dimensions of the access port 22 for an adult patient will be on the order of 2.5 inches (about 6.3 cm) long by 1.5 inches wide. If the surgeon is attempting to perform a sternotomy, typical dimensions of the access port 22 for an adult patient will be on the order of 6 inches long by 1.5 to 6 inches wide (to provide an asymmetric incision). The dimensions would decrease proportionately for a child.
As shown in Fig. 1, one embodiment of the Present Invention comprises first 140a and second 140b longitudinally extending opposed side members, each having a first end 142a, 144a and a second end 142b, 144b. The first end 142a of the first side member 140a is pivotably attached to the first lateral member 190a by means more fully discussed below. The first lateral member 190a extends through the first carriage 200a in a slidable manner more fully discussed below. An extension 204 extends perpendicularly from the first carriage 200a and is pivotably attached to the second end 144b of the second side member 140b. In a similar manner the first end 144a of the second side member 140b is pivotably attached to the second lateral member 190b by means more fully discussed below. The second lateral member 190b extends through the second carriage 200b in a slidable manner more fully discussed below. An extension 204 extends perpendicularly from the second carriage 200b and is pivotably attached to the second end 142b of the first side member 140a. Viewed from any side of itself, the assembled Present Invention presents mirror images of itself. The mirror image nature of the Present Invention is further reflected in that similar parts are identical and therefore completely interchangeable. For example, the first 140a and second 140b side members are identical as are first 190a and second 190b lateral members. Finally, the first 200a and second 200b carriages are also identical with each other and interchangeable as are first 300a and second 300b mating gear assemblies. The feature of identical similar parts adds to the simplicity of the design by eliminating any ambiguity following sterilization when reassembling the surgical access device 100 prior to use.
As shown in Figs. 2 and 3, the first 140a and second 140b side members, which are identical in all respects and completely interchangeable with each other, comprise an upper plate 152 having a length, a width, a first end 142a, 144a, a second end 142b, 144b an upper surface 154 and a lower surface 156. A lower plate 160 is attached to the upper plate 152 in a generally parallel planar manner. The lower plate 160 has an upper surface 162 and a lower surface 164. A first post 158 extends in a generally perpendicular manner between the upper surface 162 of the lower plate 160 and the lower surface 156 of the upper plate 152 proximate the first end 142a, 144a of the first and second side member 140a, 140b. In a similar manner a second post 168 extends in a generally perpendicular manner between the upper surface 162 of the lower plate 160 and the lower surface 156 of the upper plate 152 proximate the second end 142b, 144b of the first 140a and second 140b side members. A first arcuate channel 172 and a second arcuate channel 174 extend into the lower plate 160 from the upper surface 162. In a preferred embodiment, the first 172 and second 174 arcuate channels extend completely through the lower plate 160 for simplicity of manufacture and more importantly, improved sterilizability. In an alternate embodiment, however, the first 172 and second 174 arcuate channels could also comprise a groove extending into but not through the lower plate 160 from the upper 162 or lower 164 surface as design contingencies dictate. As best shown in Fig. 4, the first arcuate channel 172 is concentric with the first post 158 and begins at the first end 142a, 144a of the first 140a and second 140b side members and arcs toward the inside edge 138a, 138b of the first 140a and second 140b side members. In a similar manner (as best shown in Fig. 5), the second arcuate channel 174 is concentric with the second post 168 and begins at the second end 142b, 144b of the first 140a and second 140b side member and arcs toward the inside edge 138a, 138b of the first 140a and second 140b side member. In one embodiment, a plurality of longitudinally arranged apertures 150 designed to hold and secure one or more tissue engaging flanges 400 during use of the surgical access device 100 are defined proximate the inside edge 138a, 138b of the first 140a and second 140b side member. Each aperture 150 defines an associated shelf 151 that is attached to the lower plate 160 and terminates toward the first 138a or second 138b inside edge of the first 140a or second 140b side member, respectively.
The upper plate 152 defines a substantially consistent thickness along its length. This permits the surgeon to attach a plurality of surgical accessories (not shown) to the surgical access device 100 during surgery. This greatly increases the efficiency of the surgical team during an operation by permitting the surgical accessories (not shown) to be fixed in place during the operation, thus freeing up space and allowing fewer personnel in the immediate operating area. Such devices (not shown) include suction/irrigation probes (suckers), beating heart stabilizers, malleable instrument arms, diaphragm retractors, valve instrument retractors (primarily for mitral valve), cautery pencil holders, illumination probes and sternal approximators. Suture pads (not shown) can also be attached to the upper plate 152. The suture pads give the physician the ability to suture to the tissue and then suture or re-suture anywhere along the length of the suture pad to achieve the appropriate retraction. By being able to have sutures attached at any location along the length of the first 140a and second 140b side members, the suture pads essentially provide an infinite number of connection locations, enabling a physician to reorient the sutured tissue by moving the suture to a different location on the pad to alter the direction the suture is pulling. In use, the physician will pass the suture through the patient's tissue and through one of the suture pads or may tie a knot at each end to hold the suture in place, as is conventional.
As shown in Figs. 6 and 7, the first 190a and second 190b lateral members comprise a first leg 250 and a second leg 252, and have an upper surface 186 and a lower surface 188 and a width 191. First lateral member 190a and second lateral member 190b are identical in all respects and are thus completely interchangeable. First leg 250 has a longitudinal dimension and a terminal end 254. Second leg 252 has a longitudinal dimension and a terminal end 256. In one embodiment, first leg 250 defines a greater longitudinal dimension than does second leg 252. It is possible, however, that uses for the surgical access device 100 may exist wherein the second leg 252 would need to be longer than the first leg 250. Accordingly, it is not critical that first 190a and second 190b lateral members have a first leg 250 longer than the second leg 252. Thus, combinations of various lengths of the first leg 250 and second leg 252 are contemplated and within the scope of the invention. Veterinary applications on large animals such as horses and cattle require lateral members having greater dimensions than would a human application. Likewise, pediatric applications in human beings would require smaller sized lateral members than would adults. In a preferred embodiment, the first 250 and second 252 legs are fixedly attached to each other at an approximate angle of ninety degrees. Other angles, however, would also work and are contemplated by and within the scope of the Present Invention. A plurality of regularly spaced teeth 192 are disposed along the length of the first leg 250. The teeth 192 are sized to mate with first 300a and second 300b mating gear assemblies as shown in Figs. 15 and 16. A hook 270 is disposed proximate the terminal end 254 of the second leg 252. The hook 270 defines a slot 272 that in a preferred embodiment extends toward, is substantially parallel with the first leg 250 and terminates at a closed end 273 facing away from the terminal end 254 of the first leg 250. As best shown in Figs. 8 and 9, peg 274 extends perpendicularly from the lower surface 188 of the first 190a and second 190b lateral members. The peg 274 extends from the lower surface 188 of the first 190a or second 190b lateral member so as to be received by the first arcuate channel 172 in an essentially parallel planar relationship with the first end 142a, 144a of the first side member 140a or second side member 140b. The tolerance between the first 190a or second 190b lateral member and first 140a or second 140b side member, guided in an arcing motion by the peg 274 extending into the first arcuate channel 172 results in a pivotable hinge between the first 190a or second 190b lateral member and the first end 142a, 144a of the first 140a or second 140b side member. As best shown in Figs. 8 and 9, an off-center trough 276 is defined on the lower surface 188 of the first 190a and second 190b lateral members and runs parallel with the longitudinal dimension of the first 190a and second 190b lateral member.
As best shown in Figs. 10 and 11, first 200a and second 200b carriages are identical in all aspects and therefore completely interchangeable with each other. First 200a and second 200b carriages comprise a body 202 having a top side 216, a bottom side 218, an upper surface 220 and a lower surface 222. A channel 206 extends through the body 202 and is configured and arranged to slidably accept the first leg 250 of the first 190a or second 190b lateral member. A bearing 210 is defined by the body 202 and is configured and arranged to receive a first 300a or second 300b mating gear assembly as will be discussed in greater detail below. An off-center projection 208 runs the length of and is in parallel alignment with the channel 206. An extension 204 extends from the top side 216 of the body 202 in a perpendicular manner and has a terminal end 212. A hook 214 is defined at the terminal end 212 of the extension 204. A slot 224 runs substantially parallel with the top side 216 of the body 202 and terminates at a closed end 217 facing the bearing 210. A peg 226 proximate the closed end 217 of the slot 224 extends perpendicularly toward the lower surface 222 of the carriage 200a, 200b. The particular configuration and arrangement of the extension 204, slot 224 and peg 226 enable the carriage 200a, 200b to be removably and pivotably hinged to the second post 168 proximate the second end 142b, of the first side member 140a, or to the second post 168 proximate the second end 144b of the second side member 140b in only one way. Put another way, it is impossible to attach the first 200a or second 200b carriage to the second end 142b, 144b of the first 140a or second ,140b side member in any way other than a pivotable parallel planar way. When the first 200a or second 200b carriage is attached to the second end 142b, 144b of the first 140a or second 140b side member, the channel 206 is positioned to slidably receive the first leg 250 of the first 190a or second 190b lateral member due to the off-center alignment of the trough 276 and projection 208. This allows the slot 272 of the first 190a or second 190b lateral member to attach to the first end 142a, 144a of the first 140a or second 140b side member with the first leg 250 extending toward the opposing side member 140a or 140b. Finally, in a preferred embodiment, the length of the extension 204 is similar to the length of the second leg 252 of the first 190a and second 190b lateral members. Similarity of length of the second leg 252 ensures the ability of the assembled surgical access device 100 to be able to perform parallel retraction, if desired. It is contemplated by and therefore within the scope of the invention to have the length of the extension 204 of the first carriage 200a be different than the length of the extension 204 of the second carriage 200b. It is also contemplated by and therefore within the scope of the invention to have different lengths for each of the extensions 204 of the first 200a and second 200b carriages and each of the second legs 252 of the first 190a and second 190b lateral members.
Fig. 14 shows the disassembled first 300a and second 300b mating gear assemblies. The first 300a and second 300b mating gear assemblies comprise a mating gear 302 defining an upper disc 304 and a lower disc 306. Two gear teeth 308 sized and spaced to mate with the teeth 192 on the first 190a and second 190b lateral members are disposed between and separate the upper disc 304 and lower disc 306. The distance defined by the length of the gear teeth 308 is of a length slightly greater than the width
191 of the first 190a and second 190b lateral members. A raised portion 310 extends from the upper disc 304 and defines an aperture 312 therethrough. The outer diameter of the upper disc 304 and lower disc 306 is slightly smaller than the inner diameter of the bearing 210 defined by the body 202 of the first 200a or second 200b carriage. A gear handle 314 defines a free end 315 and an attached end 317. A pair of centered projections 316 extend longitudinally from the attached end 317 and define apertures 318.
Figs. 15 and 16 show the assembled first 300a and second 300b mating gear assemblies. The first 300a and second 300b mating gear assemblies are identical in all aspects and therefore completely interchangeable with each other. The gear handle 314 is pivotably attached to the raised portion 310 of the mating gear 302 by means of a pin 320 extending through the gear handle projection 316 apertures 318 and through the raised portion aperture 312. The rack and pinion system defined by the first 190a and second 190b lateral members, and first 300a and second 300b mating gear assemblies provides a mechanism for increasing the mechanical advantage of a force applied to the first 200a and second 200b carriage to move it along the first 190a or second 190b lateral members. Turning of the gear handle 314 will move the carriage 200a, 200b laterally along the lateral member 190a, 190b, with the gear ratio of the mating gear 302 and teeth 192 determining the mechanical advantage. The two cylindrical gear teeth 308 provide a locking mechanism wherein in the position of the first 200a or second 200b carriage can be locked in a desired position on the first 190a or second 190b lateral member. The 200a or second.200b carriage is locked into position when the gear teeth 308 are aligned with the teeth 192 of the first 190a or second 190b lateral member with the gear handle 314 at an angle so as to extend parallel with the first 190a or second 190b lateral member. Put another way, this geometry results in a locked position every 180 degrees, or a linear movement of the pitch of the gear (in this embodiment 0.26" along the travel of the teeth
192 of the first 190a or second 190b lateral member.
As explained in greater detail below, the assembled surgical access device 100 is configured and arranged to receive and hold a plurality of tissue engaging flanges 400. As best shown in Figs. 17 and 18, the flange 400 comprises an upper end 402, a lower end 404, a length 406 and a width 408. In one embodiment, the distal end 404 defines a portion 405 extending in the direction of retraction. In a further embodiment, the upper end 402 defines an offset portion 403 that extends in the direction of retraction. The offset portion 403 is sized so as to be received within an aperture 150. When the flange 400 is inserted into the aperture 150, the offset portion 403 will rest against the upper surface 153 of the shelf 151. This ensures that during retraction the flange 400 will lever against the upper surface 153 of the shelf 151, enabling the leading edge 410 of the flange 400 to firmly exert force against the retracted tissue without becoming dislodged. Finally, it is contemplated by and within the scope of the invention that the length 406 of the flanges 400 can be varied to accommodate the needs of a particular surgeon or surgical procedure. While in one embodiment the flanges 400 are releasably attached to the side members 140a, 140b by the alignment of the offset portion 403 and the shelf 151, other methods (not shown) for attachment are also contemplated by and therefore within the scope of the invention. For example, a stainless steel flange (not shown) could also be used that would be repositionably fastenable to several positions along the inside edge 138a, 138b of the first 140a and second 140b side members using a fastener mechanism, such as a screw (not shown). An additional mechanism comprises a clamping mechanism (not shown).
Materials
First 140a and second 140b side members, first 190a and second 190b lateral members, first 200a and second 200b carriages, and first 300a and second 300b mating gear assemblies are preferably constructed from 17-4 PH metal injection molded stainless steel. 17-4 stainless steel is preferred due to its resistance to corrosion, surface hardness (wear resistance), and strength. In an alternate embodiment, first 140a and second 140b side members, first 190a and second 190b lateral members, first 200a and second 200b carriages, and first 300a and second 300b mating gear assemblies could also be machined from stainless steel. Stainless steel offers the advantages of relatively low cost, great strength, biocompatibility and endurance. In a further embodiment, the first 140a and second 140b side members, first 190a and second 190b lateral members, first 200a and second 200b carriages, and first 300a and second 300b mating gear assemblies could also be made of various plastics such as polycarbonate and ABS provided the first 190a and second 190b lateral members are reinforced with stainless steel to resist bending. The flanges 400 are preferably made from injection molded polycarbonate plastic with a barium sulfate load for radiopacity. Radiopacity is a desirable characteristic in the flanges 400 in the event one remains behind in the patient following completion of surgery. Other plastic materials such as ABS with a barium sulfate load are also suitable and therefore contemplated by and within the scope of the invention. In one embodiment, the flanges are disposable and come ready to use in a sterilized package.
Assembly
As explained in detail above, the design of the Present Invention ensures that the various components can be articulated together in only one way. While the following description of the assembly process discusses the process in terms such as "first side member 140a being attached to first lateral member 190a", etc. it should be remembered that in all cases regarding the intended articulation of the various components of the invention, where first and second parts are specified, the first and second parts are identical to and interchangeable with each other. Assembly of the components as described below need not take place in any particular order, thus the order to be described should be regarded as exemplary and not limiting the scope of the invention.
The first lateral member 190a and first side member 140a are placed in similar planar positions. The slot 272 of the first lateral member 190a is aligned so as to engage the first post 158 proximate the first end 142a of the first side member 140a. The first lateral member 190a is slid toward the first post 158 until the closed end of the slot 273 contacts the first post 158. The peg 274 of the first lateral member 190a is simultaneously slid into the first arcuate channel 172. The first lateral member 190a can now be pivoted toward the inside edge 138a of the first side member 140a so' that the first leg 250 of the first lateral member 190a extends away from the inside edge 138a of the first side member 140a. The first carriage 200a is fitted with the first mating gear assembly 300a and aligned with the upper surface 220 facing the assembler so that the slot 224 faces away from the first lateral member 190a. The channel 206 is aligned with the free end 196 of the first lateral member 190a and the first mating gear assembly 300a rotated until the gear teeth 308 mesh with the teeth 192 on the first lateral member 190a. The first mating gear assembly 300a is continued to be rotated until the first carriage 200a rests at a position on the first leg 250 of the first lateral member 190a where at least the free end 196 of the first leg 250 extends from the first carriage 200a. Next, the second post 168 at the second end 144b of the second side member 140b is aligned with the slot 224 of the first carriage 200a, simultaneously aligning the peg 226 of the first carriage 200a with the second arcuate channel 174 of the second side member 140b. The second side member 140b is slid toward the second post 168 until the closed end of the slot 217 contacts the second post 168. The second side member 140b is now pivoted toward the inside edge 138a of the first side member 140a. Following this step, the second lateral member 190b is aligned with the first post 158 proximate the first end 144a of the second side member 140b. Next, the second lateral member 190b is slid toward the first post 158 of the second side member 140b until the closed end 273 contacts the first post 158, while simultaneously aligning the peg 274 of the second lateral member 190b with the second arcuate channel 174 of the second side member 140b. At this point, the second lateral member 190b is pivoted toward the inside edge 138b of the second side member 140b until it is substantially perpendicular to the second side member 140b. The second carriage 200b is aligned with the second end 142b of the first side member 140a so that the second post 168 at the second end 142b of the first side member 140a is aligned with the slot 224 of the second carriage 200b, simultaneously aligning the peg 226 of the second carriage 200b with the second arcuate channel 174 of the first side member 140a. The second carriage 200b is fitted with the second mating gear assembly 300a and aligned with the upper surface 220 facing the assembler so that the slot 224 faces toward the second lateral member 190b. The channel 206 is aligned with the free end 196 of the second lateral member 190b and the second mating gear assembly 300b rotated until the gear teeth 308 mesh with the teeth 192 on the second lateral member 190b. The second mating gear assembly 300b is continued to be rotated until the second carriage 200b rests at a position on the first leg 250 of the second lateral member 190b where at least the free end 196 of the first leg 250 extends from the second carriage 200b. At least one flange 400 is attached to each of the first side member 140a and second side member 140b. In a preferred embodiment, the placement of the flanges 400 is symmetrical (i.e., equal numbers of flanges 400 are placed at the mirror image aperture 150 on the opposite side member 140a or 140b). This completes assembly of the surgical access device 100. Use
For purposes of illustration, the following discussion is based on retraction as would be used in performing open-chest heart surgery.
Following preoperative procedures, an incision is made into the patient. Several layers of tissue will normally need to be incised to gain access to the anatomical site where the operation is to occur. When all tissue layers are incised, the sterilized, assembled surgical access device 100 is carefully inserted into the incision. It is important that the length 406 of the flange 400 is sufficiently long that the lower end 404 of the flange 400 extends into the body at a point deeper than the tissue to be retracted. To minimize trauma to the patient, the first 300a and second 300b mating gear assemblies are rotated by the surgeon or technician causing retraction only to the minimum extent required.
As shown Fig. 19, the illustrated design permits the first end 142a of the side member 140a to be moved away from or toward the second end 144b of the second side member 140b along the first lateral member 190a without requiring any movement of the second end 142b of the first side member 140a toward the first end 144a of the second side member 140b. Alternatively, the second end 142b of the first side member 140a can be moved with respect to the first end 144a of the second side member 140b along the second lateral member 190b without requiring any movement of the previously discussed half of the surgical access device 100.
For example, the surgical access device 100 may be initially deployed with both carriages 200a, 200b locked as described above against movement with respect to the associated lateral member 190a, 190b and with the side members 140a, 140b positioned immediately adjacent another in a parallel manner. The gear handle 314 of the first carriage 200a can be lifted upwardly from the locked position and rotated to move the first carriage 200a with respect to the first lateral member 190a. The first end 142a of the first side member 140a will pivot with respect to the second leg 252 of the first lateral member 190a about the first post 158 of the first side member 140a. The second end 144b of the second side member 140b will pivot with respect to the terminal end 212 of the carriage extension 204 about the second post 168 of the second side member 140b. Once the carriage 200a has been moved the desired distance toward the free end 196 of the first lateral member 190a, the gear handle 314 may be pushed downwardly toward the substantially parallel planar position to lock the carriage 200a in place on the first lateral member 190a. Due to the mirror image nature of the invention, the procedure described above works equally well when applied to the other side of the surgical access device 100 (i.e., second end 142b of first side member 140a toward first end 144a of second side member 140b). Differential retraction at each end of the surgical access device 100 is thus possible, resulting in a wide variety of retraction possibilities. Following completion of the surgical procedure, the gear handles 314 are unlocked, and the surgical access device 100 re-retracted to the insertion configuration, and removed from the patient.

Claims

What is claimed is:
1. A surgical device for accessing a body cavity, comprising:
(a) first and second longitudinally extending opposed side members, each of the side members having a first end and a second end;
(b) a first lateral member adjustably connecting the first end of the first side member to the second end of the second side member, at least one of the side member ends being moveable along a length of the first lateral member, thereby permitting adjustment of the lateral distance between the first end of the first side member and second end of the second side member;
(c) a second lateral member adjustably connecting the second end of the first side member to the first end of the second side member, at least one of the side member ends being moveable along a length of the second lateral member, thereby permitting adjustment of the lateral distance between the second end of the first side member and first end of the second side member; and
(d) at least one transversely extending repositionable flange releasably attached to each side member.
2. The surgical access device of claim 1 wherein the first and second side members are pivotably articulated to the first and second lateral members by a bayonet hinge mechanism.
3. The surgical access device ofclaim 2 wherein pivotable articulation between the first and second side members and the first and second lateral members occurs in substantially a single plane.
4. The surgical access device ofclaim 1 wherein a first carriage attaches the first lateral member to the second end of the second side member and a second carriage attaches the second lateral member to the second end of the first side member.
. A surgical device for accessing a body cavity, comprising:
(a) first and second opposed side members, each of the side members having a first end and a second end;
(b) a first lateral member adjustably connecting the first end of the first side member to the second end of the second side member, at least one of the side member ends being moveable along a length of the first lateral member, thereby permitting adjustment of the space between the first end of the first side member and the second end of the second side member;
(c) a second lateral member adjustably connecting the second end of the first side member to the first end of the second side member, at least one of the side member ends being moveable along a length of the second lateral member, thereby permitting adjustment of the space between the second end of the first side member and the first end of the second side member; and (d) wherein the first and second side members are pivotably attached to the first and second lateral members by a bayonet hinge mechanism.
6. The surgical access device ofclaim 5 wherein pivotable articulation between the first and second side members and first and second lateral members occurs in substantially a single plane.
7. The surgical access device ofclaim 5 further including at least one transversely extending repositionable flange releasably attached to each side member.
8. The surgical access device ofclaim 5 wherein a first carriage attaches the first lateral member to the second end of the second side member and a second carriage attaches the second lateral member to the second end of the first side member.
9. The surgical device ofclaim 2 or 5 wherein the bayonet hinge mechanisms permit operable attachment of each end of the side members to only one end of the lateral members.
0. A surgical device for accessing a body cavity, comprising:
(a) first and second opposed mirror image side members, each side member having a first end, a second end, an inside edge and an outside edge, comprising; (i) an upper plate having a length, a width, a first end, a second end, and upper and lower surfaces, (ii) a lower plate having a length, a width, an inner edge, an outer edge, an upper surface, a lower surface, the lower plate a plurality of apertures disposed along the length of the lower plate proximate the inner edge adapted to releasably receive and hold tissue engaging flanges, (iii) a first post attaching the lower surface of the upper plate and the upper surface of the lower plate in spaced relationship proximate the first ends of the upper and lower plates, (iv) a second post attaching the lower surface of the upper plate and the upper surface of the lower plate in spaced relationship proximate the second ends of the upper and lower plates, (v) a first arcuate channel in each side member, concentric with the first post, portside to a point greater than a quarter turn around the post; and
(vi) a second arcuate channel in each side member, concentric with the second post, portside to a point greater than a quarter turn around the post;
(b) a first lateral member adjustably connecting the first end of the first side member to the second end of the second side member, at least one of the ends being moveable along a length of the first lateral member, thereby permitting adjustment of the space between the first end of the first side member and the second end of the second side member, the first lateral member comprising; (i) a bar having a first leg with a length and a terminal end and a second leg with a length having a terminal end, the first and second legs being disposed to each other at an angle, (ii) a plurality of regularly spaced gear teeth disposed along the length of the first leg, (iii) an off-center linear trough or projection disposed on an upper or lower surface of the first leg extending along at least a portion of the length of the first leg,
(iv) a hook defining a slot disposed proximate the terminal end of the second leg, and
(v) a peg protruding from an upper or lower surface of the second leg proximate the slot;
(c) a second lateral member adjustably connecting the second end of the first side member to the first end of the second side member, at least one of the ends being moveable along a length of the first lateral member, thereby permitting adjustment of the space between the second end of the first side member and the first end of the second side member, the second lateral member comprising;
(i) a bar having a first leg with a length and a terminal end and a second leg with a length having a terminal end, the first and second legs being disposed to each other at an angle, (ii) a plurality of regularly spaced gear teeth disposed along the length of the first leg, (iii) an off-center linear trough or projection disposed on an upper or lower surface of the first leg extending along at least a portion of the length of the first leg, (iv) a. hook defining a slot disposed proximate the terminal end of the second leg, and (v) a peg protruding from an upper or lower surface of the second leg proximate the slot;
(d) a first carriage, comprising;
(i) a carriage body having a length, a channel extending through the length of the body, configured and arranged to accept the first leg of the first lateral member therethrough, and a bearing with an off- center trough or projection within the channel mated to the trough or projection of the first leg of the first lateral member, whereby only a single spatial orientation of the first lateral member relative to the first carriage allows passage of the first leg of the first lateral member through the channel in the first carriage, and (ii) a perpendicular extension terminating in a hook, defining a slot disposed proximate a terminal end of the extension; (e) a second carriage, comprising;
(i) a carriage body having a length, a channel extending through the length of the body, configured and arranged to accept the first leg of the .second lateral member therethrough, and a bearing with an off-center trough or projection within the channel mated to the trough or projection of the first leg of the second lateral member, whereby only a single spatial orientation of the second lateral member relative to the second carriage allows passage of the first leg of the second lateral member through the channel in the second carriage, and (ii) a perpendicular extension terminating in a hook, defining a slot disposed proximate a terminal end of the extension; (f) a first mating gear disposed in the bearing in the first carriage for mating with the teeth disposed on the first leg of the first lateral member whereby the lateral position of the first lateral member with regard to the side member can be varied when the gear is rotated; and (g) a second mating gear disposed in the bearing of the second carriage for mating with the teeth disposed on the first leg of the second lateral member whereby the lateral position of the second lateral member with regard to the side member can be varied when the gear is rotated.
11. The surgical access device ofclaim 10 wherein the lower plate of the first and second members further comprises a plurality of apertures, the apertures defining recessed portions extending from the lower plate so as to provide a shelf extending in the inside direction, coplanar and continuous with the lower surface of the lower plate and terminating so as to provide an opening through the lower plate.
12. The surgical access device ofclaim 10 wherein the tissue engaging flange comprises an extended finger defining proximal and distal ends, a longitudinal dimension, a thickness and a width, the distal end having portions angled toward the outside edge, the proximal end defining a portion angled to the outside edge of the lower plate when inserted in the lower plate and having a lesser thickness and a narrower width than the width of the aperture so as to be insertable through the selected aperture from the outer surface of the lower plate, wherein upon insertion the proximal end rests against the shelf such that when retraction force is applied to the inserted flange, the flange is firmly secured to the side member by being levered against the shelf.
13. A kit assemblable to form a surgical access device for accessing a body cavity, comprising: (a) a first longitudinally extending side member having a first end and a second end;
(b) a second longitudinally extending side member having a first end and a second end;
(c) a first lateral member; (d) a second lateral member;
(e) at least one transversely extending repositionable flange releasably attachable to each side member;
(f) wherein the first lateral member is configured and adapted to pivotably attach to the first end of the first side member and the second end of the second side member, with at least one of the first end or the second end being movable along a length of the first lateral member, thereby permitting adjustment of the lateral distance between the first end of the first side member and the second end of the second side member; and
(g) wherein the second lateral member is configured and adapted to pivotably attach to the second end of the first side member and the first end of the second side member, with at least one of the first end or the second end being movable along a length of the second lateral member, thereby permitting adjustment of the lateral distance between the second end of the first side member and the first end of second side member.
14. The kit ofclaim 13 wherein the first and second side members can be pivotably articulated to the first and second lateral members by a bayonet hinge mechanism when assembled.
15. The kit of claim 14 wherein pivotable articulation between the first and second side members and the first and second lateral members can occur in substantially a single plane when assembled.
16. The kit of claim 13 wherein a first carriage can attach the first lateral member to the second end of the second side member and a second carriage can attach the second lateral member to the second end of the first side member.
17. A kit assemblable to form a surgical access device for accessing a body cavity, comprising:
(a) a first side member having a first end and a second end;
(b) a second side member having a first end and a second end;
(c) a first lateral member;
(d) a second lateral member; (e) at least one transversely extending repositionable flange releasably attachable to each side member; (f) wherein the first lateral member is configured and adapted when assembled to pivotably attach to the first end of the first side member and the second end of the second side member, with at least one of the first end or the second end being movable along a length of the first lateral member, thereby permitting adjustment of the lateral distance between the first end of the first side member and the second end of the second side member; (f) wherein the second lateral member is configured and adapted when assembled to pivotably attach to the second end of the first side member and the first end of the second side member, with at least one of the first end or the second end being movable along a length of the second lateral member, thereby permitting adjustment of the lateral distance between the second end of the first side member and the first end of second side member; and (g) wherein the first and second side members are pivotably attachable to the first and second lateral members by a bayonet hinge mechanism when assembled.
18. The kit of claim 17 wherein pivotable articulation between the first and second side members and the first and second lateral members can occur in substantially a single plane when assembled.
19. The kit of claim 17 wherein a first carriage can attach the first lateral member to the second end of the second side member and a second carriage can attach the second lateral member to the second end of the first side member when assembled.
PCT/US2000/010898 2000-04-21 2000-04-21 Surgical access device WO2001080725A1 (en)

Priority Applications (3)

Application Number Priority Date Filing Date Title
DE10085461T DE10085461T1 (en) 2000-04-21 2000-04-21 Surgical access device
AU2000244839A AU2000244839A1 (en) 2000-04-21 2000-04-21 Surgical access device
PCT/US2000/010898 WO2001080725A1 (en) 2000-04-21 2000-04-21 Surgical access device

Applications Claiming Priority (1)

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US7594888B2 (en) 2004-10-29 2009-09-29 Depuy Spine, Inc. Expandable ports and methods for minimally invasive surgery
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US8517935B2 (en) 2006-01-04 2013-08-27 DePuy Synthes Products, LLC Surgical retractors and methods of minimally invasive surgery
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US8550995B2 (en) 2006-01-04 2013-10-08 DePuy Synthes Products, LLC Surgical access devices and methods of minimally invasive surgery
US9254126B2 (en) 2006-01-05 2016-02-09 DePuy Synthes Products, Inc. Non-rigid surgical retractor
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US11596394B2 (en) 2018-09-17 2023-03-07 Board Of Regents, The University Of Texas System Adjustable locking surgical retractor

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Cited By (16)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8038611B2 (en) 2003-12-18 2011-10-18 Depuy Spine, Inc. Surgical methods and surgical kits
US10869657B2 (en) 2003-12-18 2020-12-22 DePuy Synthes Products, Inc. Surgical retractor systems and illuminated cannulae
US7594888B2 (en) 2004-10-29 2009-09-29 Depuy Spine, Inc. Expandable ports and methods for minimally invasive surgery
US8550995B2 (en) 2006-01-04 2013-10-08 DePuy Synthes Products, LLC Surgical access devices and methods of minimally invasive surgery
US8517935B2 (en) 2006-01-04 2013-08-27 DePuy Synthes Products, LLC Surgical retractors and methods of minimally invasive surgery
US9254126B2 (en) 2006-01-05 2016-02-09 DePuy Synthes Products, Inc. Non-rigid surgical retractor
US9675332B2 (en) 2012-01-13 2017-06-13 Aesculap Ag Surgical retractor
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CN108601518A (en) * 2015-08-10 2018-09-28 德克萨斯大学系统董事会 Adjustable locking operation retractor
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AU2016306486B2 (en) * 2015-08-10 2021-05-27 The Board Of Regents Of The University Of Texas System Adjustable locking surgical retractor
US11228235B2 (en) 2015-08-10 2022-01-18 Board Of Regents, The University Of Texas System Adjustable locking surgical retractor
US11596394B2 (en) 2018-09-17 2023-03-07 Board Of Regents, The University Of Texas System Adjustable locking surgical retractor

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