Abstract:
A surgical portal apparatus for use in surgical procedures incorporating at least one suture is provided. The surgical portal apparatus includes a portal member defining a longitudinal axis and having a longitudinal opening therethrough for receiving a surgical object, and a suture retaining insert configured to be selectively received in the portal member. The suture retaining insert may include a base and a plurality of spaced projections extending radially outward from the base, the projections being radially spaced whereby adjacent projections define a suture receiving passage adapted to accommodate a suture.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
       [0001]    The present application claims the benefit of and priority to U.S. Provisional Application Ser. No. 61/162,756 filed on Mar. 24, 2009, the entire contents of which are incorporated herein by reference. 
     
    
     BACKGROUND 
       [0002]    1. Technical Field 
         [0003]    The present disclosure relates to trocars and other surgical portal apparatus, and more particularly, relates to a suture management system for surgical portal apparatus that includes a slotted ring. 
         [0004]    2. Background of Related Art 
         [0005]    Trocars and other surgical portal apparatus are known, as are myriad procedures that may be preformed using such assemblies. Many of the minimally invasive procedures performed through access assemblies necessitate or are simplified by the use of one or more sutures passing through the surgical portal apparatus. Sutures extending into a body cavity through a surgical portal apparatus may be used to, for example, temporarily retain tissue, manipulate tissue, anchor tissue or operate peripheral devices. In an attempt to reduce the number of incision sites required to complete a given surgical procedure, a single surgical portal apparatus may be used to pass one or more sutures into a body cavity, in addition to providing access for one or more devices. A single anchor device may have numerous suture ends that extend therefrom and through the surgical portal apparatus. The sutures extending through the surgical portal apparatus may become tangled as each is manipulated or as one or more instruments are inserted and withdrawn from the assembly. Also, a surgeon may confuse the suture ends during the course of a surgery. Tangling or confusion of the suture ends may unnecessarily complicate the procedure and increase time necessary to complete the procedure. 
         [0006]    Therefore, it would be beneficial to have a suture management system for use with surgical portal apparatus. 
       SUMMARY 
       [0007]    Accordingly, a surgical portal apparatus for use in surgical procedures incorporating at least one suture is provided. The surgical portal apparatus includes a portal member defining a longitudinal axis and having a longitudinal opening therethrough for receiving a surgical object, and a suture retaining insert configured to be selectively received in the portal member. The suture retaining insert may include a base and a plurality of spaced projections extending radially outward from the base. The projections are radially spaced whereby adjacent projections define a suture receiving passage adapted to accommodate a suture. 
         [0008]    The suture retaining insert may include at least three projections. The at least three projections are arranged to define at least two suture receiving slots between adjacent projections. The portal member may include an internal shelf adjacent the internal opening for supporting the suture retaining insert. The base of the insert may include an opening for receiving a surgical object therethrough. The base may be generally annular in configuration. The surgical portal apparatus may further include a seal member disposed along the longitudinal opening of the portal member for forming a substantial seal about the surgical object. 
         [0009]    In another aspect, the surgical portal apparatus includes a portal member defining a longitudinal axis and having a longitudinal opening therethrough for receiving a surgical object and proximal and distal ends and a plurality of individual suture retaining members positioned adjacent the proximal end of the portal member. The suture retaining members each include inner portions defining a slot for receiving a suture extending though the longitudinal opening in the portal member. The suture retaining members may each be generally C-shaped. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0010]    The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the disclosure and, together with a general description of the disclosure given above, and the detailed description of the embodiment(s) given below, serve to explain the principles of the disclosure, wherein: 
           [0011]      FIG. 1  is a perspective side view of a surgical portal apparatus according to an embodiment of the present disclosure; 
           [0012]      FIG. 2  is a top view of the surgical portal apparatus of  FIG. 1 ; 
           [0013]      FIG. 3  is a top view of an alternate embodiment of a surgical portal apparatus according to the present disclosure; 
           [0014]      FIG. 4A  is a top view of an insert according to an alternate embodiment of the present disclosure; 
           [0015]      FIG. 4B  is a side views of the insert of  FIG. 4A ; 
           [0016]      FIG. 5A  is a top view of an insert according to another embodiment of the present disclosure; 
           [0017]      FIG. 5B  is a side view of the insert of  FIG. 5A ; 
           [0018]      FIG. 6  is a top view of a surgical portal apparatus according to another embodiment of the present disclosure; 
           [0019]      FIG. 7A  is a top view of a suture retainer of  FIG. 6 ; 
           [0020]      FIG. 7B  is a side view of the suture retainer of  FIG. 7A ; and 
           [0021]      FIG. 8  is a top view of a surgical portal apparatus according to an alternate embodiment of the present disclosure. 
       
    
    
     DETAILED DESCRIPTION 
       [0022]    The suture management apparatus and systems herein disclosed may be configured for use in various surgical procedures, including laparoscopic, endoscopic, arthroscopic and orthopedic surgery. The suture management systems provides passage between a subject&#39;s body cavity and the outside atmosphere and is capable of receiving surgical instruments of various sizes and configurations. Embodiments of the presently disclosed suture management systems are configured to receive, for example, clip appliers, graspers, dissectors, retractors, staplers, laser probes, photographic devices, endoscopes and laparoscopes, tubes, and the like. Such instruments are collectively referred to herein as “instruments” or “instrumentation.” 
         [0023]    In addition to the instruments, the suture management systems also allows the passage of one or more sutures therethrough, e.g., during an arthroscopic procedure. When several sutures are introduced into the subject&#39;s body through the suture management system, the sutures might tangle with each other or be confused by a surgeon. Suture tangle and/or confusion may, at the very least, inconvenience the clinicians conducting the surgical procedure. To minimize the possibility of sutures tangling with one another or a surgeon from confusing the sutures, the suture management system incorporates a suture retaining member for retaining the one or more sutures. 
         [0024]    Referring now to the drawings wherein like reference numerals illustrate similar components throughout the several views, there are illustrated embodiments of surgical portal apparatus according the principles of the present disclosure. As shown in the drawings and as described throughout the following description, as is traditional when referring to relative positioning on an object, the term “proximal” refers to the end of the apparatus which is closer to the user and the term “distal” refers to the end of the apparatus which is further from the user. 
         [0025]    Referring initially to  FIG. 1 , an embodiment of a surgical portal apparatus according to the present disclosure is shown generally as surgical portal apparatus  100 . Surgical portal apparatus  100  includes a portal member  102 , a sleeve  104  extending distally from portal member  102 , and a suture management apparatus  110  configured to engage portal member  102 . Surgical portal apparatus  100  may be configured for use with any known endoscopic or laparoscopic instrument. 
         [0026]    Portal member  102  defines a substantially cylindrical member having an open proximal end  102   a , a substantially open distal end  102   b  and defining a passage  103  therebetween. Distal end  102   b  of portal member  102  may be integrally formed with sleeve  104 . Alternatively, portal member  102  may be configured for selectable engagement with sleeve  104 . Portal member  102  may be constructed of plastic, polymer or other like material. Portal member  102  may be disposable, or in the alternative, reusable. Portal member  102  may be rigid, or alternatively, substantially flexible. Portal member  102  may include one or more anchors  106  or other suture securing means for securing one or more sutures  10  extending through surgical portal apparatus  100 . Portal member  102  may further include one or more seal members (not shown) having any seal arrangement for receiving an instrument in a sealed manner. As will be discussed in further detail below, proximal end  102   a  of portal member  102  is configured to receive suture management apparatus  110 . 
         [0027]    Sleeve  104  is configured to be inserted through the skin into a body cavity with the aid of an obturator (not shown), or may instead, include a blade or piercing tip for penetrating through the skin and into a body cavity. Sleeve  104  forms a substantially tubular member having proximal and distal ends  104   a ,  104   b  and defining a first longitudinal passage  103  extending therebetween. Sleeve  104  may be composed of plastic, metal, polymers or the like. Sleeve  104  may be disposable, or in the alternative, reusable. Sleeve  104  may be rigid, or alternatively, sleeve  104  may be flexible. Sleeve  104  may be open, or instead, may be configured to include one or more seal members (not shown) along the length thereof. In an alternate embodiment, proximal end  104   a  of sleeve  110  may be configured for operable engagement with suture management device  110 . 
         [0028]    Suture management apparatus  110  defines a suture retaining insert  112  configured for operable engagement with portal member  102 . Insert  112  may be composed of plastic, polymer, metal or any other suitable material. Insert  112  includes a substantially annular base  114  and a plurality of projections or partitions  116  radial spaced thereabout. Annular base  114  defines an opening  113  configured for receipt of elongated objects therethrough. Opening  113  may be of varying diameters and may include a seal member (not shown) for receiving an instrument in a sealed manner. Projections  116  may be integrally formed with base  112 . Alternatively, projections  116  may be securely affixed to and/or selectively removable from base  114 . As shown, projections  116  include substantially triangular-shaped members; however, alternate configurations are envisioned. 
         [0029]    With reference still to  FIGS. 1 and 2 , portal member  102  includes a plurality of cut-outs  105  configured to receive insert  112 . Cut-outs  105  are formed in proximal end  102   a  of portal member  102  about passage  103 . Cut-outs  105  correspond in number and placement to projections  116  of insert  112 . Cut-outs  105  are configured to receive projections  116  of insert  112  as insert  112  is received in proximal end  102  of portal member  102 . As shown, cut-outs  105  are configured to loosely receive projections  116 ; however, cut-outs  105  and/or projections  116  may be configured such that insert  112  frictionally engages proximal end  102   a  of portal member  102 . In an alternate embodiment, cut-outs  105  may be configured to selectively receive projections  116  in a locking manner. For example, one or more of cut-outs  105  may include a lip (not shown) configured such that rotation of insert  112  once projections  116  are received in cut-outs  105  would cause a portion of projection  116  to engage the lip, thereby securing insert  112  within proximal end  102   a  of portal member  102 . Rotation of insert  112  in an opposite direction would cause projections  116  to disengage the lip, thereby releasing insert  112  from portal member  102 . 
         [0030]    In operation, surgical portal apparatus  100  operates in a manner similar to conventional access assemblies. Sleeve  104  is inserted through tissue, either with a piercing tip (not shown) or with the aid of an obturator (not shown). Once received through the tissue, surgical portal apparatus  100  may receive instruments through passage  103  in the absence of insert  112 , or instead, through opening  113  formed in insert  112 . Prior to receipt of one or more sutures “S” through surgical portal apparatus  100 , insert  112  is removed from passage  103 . One or more sutures “S” are then received through passage  103  of surgical portal apparatus  100  in any conventional manner. Sutures “S” are then extended radially outward from passage  103  over proximal end  102   a  of portal member  102  between cut-outs  105  ( FIG. 1 ). A surgeon may then place insert  112  within passage  103 , thereby retaining sutures “S” in an outer perimeter of passage  103  closer to portal member  102  ( FIG. 2 ). Once insert  112  is in place, elongated objects may be passed through opening  113  without causing the tangling of sutures “S”. Insert  112  may be removed as necessary to add, remove and/or relocate sutures “S” within passage  103 . 
         [0031]    Turning to  FIG. 3 , an alternate embodiment of a suture management system of the present disclosure is shown generally as surgical portal apparatus  200 . Surgical portal apparatus  200  is substantially similar in form and function to surgical portal apparatus  100  described hereinabove, and therefore will only be described as relates to the differences therebetween. Surgical portal apparatus  200  includes a portal member  202  and an insert  212 . Insert  212  includes a plurality of projections  216  extending radially from annular base  214 . Annular base  214  defines an opening  213  for receipt of an elongated object. Projections  216  include markings  218  to assist in identifying one or more sutures “S” retained between projections  216 . Markings  218  may be letters, numbers, symbols, colors or other identifying feature. Alternatively, or in addition, markings (not shown) may be included on proximal end  202   a  of portal member  202 . Insert  212  is configured to be received within a proximal end  202   a  of portal member  202 . Proximal end  202   a  includes a recessed portion or shelf  205 . Shelf  205  is configured to engaging projections  216  of insert  212  as insert  212  is received within passage  203 . The configuration of insert  212  and portal member  202  permits insert  212  to be rotated within passage  203  while maintaining one or more sutures “S” between projections  216  and away from opening  213 . In this manner, insert  212  operates to prevent sutures “S” from becoming tangled and/or confused. Insert  212  further permits selective relocation of sutures “S” about passage  103  without removing insert  212  from portal member  202 . 
         [0032]    With reference now to  FIGS. 4A and 4B , an alternate embodiment of a suture retaining insert according to the present disclosure is shown generally as suture retainer insert  312 . Insert  312  is substantially similar in form and function to inserts  112 ,  212  described hereinabove. Insert  312  includes a plurality of projections  316  extending from an annular base  314 . Projections  316  are configured to retain a single suture “S” ( FIG. 1 ) therebetween. In this manner, sutures “S” may be maintained completely separate from one another. Portal members  102  ( FIGS. 2) and 202  ( FIG. 3 ) may be configured to receive insert  312 . 
         [0033]    Referring now to  FIGS. 5A and 5B , another embodiment of a suture retaining insert according to the present disclosure is shown generally as suture retaining insert  412 . Insert  412  is substantially similar to inserts  112 ,  212 ,  312  described hereinabove. Insert  412  includes a plurality of projections  416  extending from an annular base  414 . Annular base  414  defines an opening  413  configured for receiving an elongate object therethrough. Insert  412  further includes a distal extension  415  extending from base  414  and a seal member formed in opening  413 . Distal extension  415  is sized and dimensioned to be received within passage  103 ,  203  of access assemblies  100 ,  200  such that projections  416  engage cut-outs  105  or shelf  205 , respectively. A tapered deformable coating  415   a  extends about distal extension  415 . Deformable coating  415   a  is configured to frictionally engage proximal end  102   a ,  202   a  of portal member  102 ,  202 , respectively, as insert  412  is received within passage  103 ,  203 , respectively, thereby securely retaining suture “S” within passage  103 ,  203  against portal member  102 ,  202 . Furthermore, deformable coating  415   a  creates a seal between portal member  102 ,  202  and insert  412  thereby preventing escape of insufflation gas through surgical portal apparatus  100 ,  200 , respectively. Seal member  417  permits an instrument to be received through insert  412  in a sealed manner. 
         [0034]    Turning now to  FIG. 6 , an alternate embodiment of a surgical portal apparatus according to the present disclosure is shown generally as surgical portal apparatus or surgical portal apparatus  500 . Surgical portal apparatus includes a portal member  502  defining a passage  503  configured for receipt of an elongated object. Positioned about a proximal end  502   a  of portal member  502  is a plurality of suture retainers  505 . With particular reference to  FIGS. 7A and 7B , suture retainers include a substantially flat annular base  506  including a slot  506   a  for receiving one or more sutures “S”. Suture retainers  505  maintain suture “S” away from passage  503 , thereby preventing an instrument (not shown) inserted through surgical portal apparatus  500  from engaging and causing the entangling of sutures “S”. Suture retainers  505  may be integrally formed with, securely affixed to and/or removable attached to portal member  502 . In an alternate embodiment ( FIG. 8 ), suture retainers are positioned on a proximal end of sleeve  504 . 
         [0035]    Although the illustrative embodiments of the present disclosure have been described herein with reference to the accompanying drawings, it is to be understood that the disclosure is not limited to those precise embodiments, and that various other changes and modifications may be effected therein by one skilled in the art without departing from the scope or spirit of the disclosure.