Surgical port for stay sutures and system and methods thereof

A surgical port is disclosed. The surgical port has a cannular channel. The surgical port also has one or more suture slots in communication with the cannular channel. The surgical port further has a pair of cam grips for each of the one or more suture slots, each pair of cam grips comprising opposing gripping arms configured to allow suture to be pulled through the opposing gripping arms in a direction away from the cannular channel and to resist suture movement in a direction towards the cannular channel.

FIELD

The claimed invention relates to surgical devices, and more specifically to surgical ports.

BACKGROUND

Laparoscopic, endoscopic, and other types of minimally invasive surgical procedures often rely on percutaneous introduction of surgical instruments into an internal region of a patient where the surgical procedure is to be performed. As part of many minimally invasive surgical procedures, stay sutures may be placed in various tissue and then tensioned either to pull the tissue out of the way or to move the tissue to a more convenient position for the surgeon to reach through a minimally invasive incision. Surgeons continue to find it desirable to utilize smaller and smaller access incisions in order to minimize trauma and reduce patient recovery times. Unfortunately, in some situations, the minimally invasive access incision is so narrow that it does not provide a suitable angle for stay sutures to pull tissue away from the access channel afforded by the minimally invasive incision. Therefore, it would be desirable to have an improved device for routing the stay sutures separately from a main surgical access point while enabling convenient adjustment of the stay suture tensions.

SUMMARY

A surgical port is disclosed. The surgical port has a cannular channel. The surgical port also has one or more suture slots in communication with the cannular channel. The surgical port further has a pair of cam grips for each of the one or more suture slots, each pair of cam grips comprising opposing gripping arms configured to allow suture to be pulled through the opposing gripping arms in a direction away from the cannular channel and to resist suture movement in a direction towards the cannular channel.

It will be appreciated that for purposes of clarity and where deemed appropriate, reference numerals have been repeated in the figures to indicate corresponding features, and that the various elements in the drawings have not necessarily been drawn to scale in order to better show the features.

DETAILED DESCRIPTION

FIG. 1illustrates one embodiment of a surgical port20having one embodiment of a needle22installed therein. The tip of the needle22can be seen extending from a cannular channel24of the surgical port20. The needle22has a handle26which is sized to prevent the handle26from passing through the cannular channel24. The cannular channel24is coupled to a flange28.

In practice, the needle22is installed in the surgical port20when it is desired to place the surgical port20into a patient. Alternatively, the needle22may come pre-installed in the surgical port20as shown inFIG. 1. The cannular channel24may be flexible, and if so, the inserted needle22provides some stiffness to the cannular channel24. As configured inFIG. 1, the needle may be used to pierce through the skin, which tends to be tougher to pass through than the tissues beneath the skin. When the skin is just pierced and the distal end30of the cannular channel24has passed through the skin, the needle22may be removed from the surgical port20by pulling on the needle handle26and holding the flange28steady. If the cannular channel24is stiff enough, the flange28may be used to push the distal end30of the cannular channel24through internal tissue, for example, muscle tissue until the flange28rests on the outer surface of the patient. Alternately, and especially if the cannular channel24is not rigid, a blunt obturator (not shown inFIG. 1) may be inserted into the cannular channel24in place of the needle22. The distal tip of such a blunt obturator could extend past the distal end of the cannular channel24and could be used to insert the cannular channel24of the surgical port through the tissue below the skin. The blunt obturator would tend to avoid harming the tissue through which it passed.

Once the cannular channel24reaches a desired position, the obturator (if used) could be removed. The access opening created by the cannular channel24can be on the order of 1-2 mm or smaller, creating very little trauma to the patient.

With the surgical port20in place, a snare or hook sized to fit within the cannular channel24may be inserted into the patient through the cannular channel24in order to capture stay suture ends which have been stitched through tissue. The stay suture stitches would typically have been placed via access from the main minimally invasive incision. It is desirable, however, to be able to pull the stay sutures at an angle different from that provided by the minimally invasive incision. Therefore, if the stay suture ends are captured by a hook or snare placed through the cannular channel24of the surgical port20, the stay suture ends may be pulled through the cannular channel24and out of the surgical port20.

In this embodiment, the flange28is made from an upper flange cover32and a lower flange34(which is not visible in the view ofFIG. 1). The flange28defines multiple suture slots36A,36B.

FIGS. 2A, 2B, 2C, 2D, 2E, and 2Fare front, left side, right side, rear, top, and bottom elevational views, respectively, of the upper flange cover32. The upper flange cover32defines tab receiving openings38A and38B which are visible in the front and rear views, respectively, ofFIGS. 2A and 2D. The tab receiving openings38A,38B are configured to attach to corresponding tabs on the lower flange34(not visible inFIGS. 2A-2F). In this embodiment, the upper flange cover32also defines three cam pockets40A,40B,40C, the features of which will be discussed in more detail later in this specification. The upper flange cover32also defines an opening42which works in conjunction with a similar opening in the lower flange to couple and communicate with the cannular channel.

FIGS. 3A, 3B, 3C, 3D, 3E, and 3Fare front, left side, right side, rear, top, and bottom elevational views, respectively, of the lower flange34. The lower flange has tabs44A,44B which are configured to correspond and couple to tab receiving openings38A,38B for coupling the lower flange34to the upper flange cover. The lower flange34also has a plurality of cam stops46, the features of which will be discussed in more detail later in the specification. The lower flange34also defines an opening48which is configured to receive a portion of the cannular channel.

FIGS. 4A-4Dare exploded views illustrating the assembly of one embodiment of a surgical port. As shown inFIG. 4A, one or more cam grips50A,50B,52A,52B are set into the cam pockets40A,40B,40C of the upper flange cover32. Specifically in this embodiment, cam grip50A is set into cam pocket40C; cam grip50B and then cam grip52B are set into cam pocket40B; and cam grip52A is set into cam pocket40A. Each cam grip has a gripping arm54. The gripping arms54of cam grips50A and50B face each other, while the gripping arms54of cam grips52A and52B face each other. The pair of gripping arms54on cam grips50A and50B are aligned to lie in substantially the same plane. Similarly, the pair of gripping arms54on cam grips52A and52B are aligned to lie in substantially the same plane. In this particular embodiment, all of the gripping arms54will lie in substantially the same plane. Since cam grips50B and52B are both installed in the same cam pocket40B, all of the gripping arms54are made to lie in the same plane by making cam pockets40A,40B deeper than cam pocket40C, and also by extending the gripping arms54of cam grips52A and50B higher than the gripping arms54of cam grips50A and52B. In other embodiments, the pairs of gripping arms may lie in different planes.

As shown inFIG. 4B, the distal end30of the cannular channel24is inserted into the upper side of the opening48in the lower flange34. In this embodiment, the cannular channel24has a stepped proximal end56which corresponds to the shape of opening48and is configured to prevent the proximal end56from passing all the way through opening48in the lower flange34. These components may be held together until further assembly, or they may be coupled together using a variety of techniques, including, but not limited to gluing, ultrasonic welding, press fitting, and heat bonding.

As shown inFIG. 4C, the resultant assembly ofFIG. 4Bhas been turned upside-down and is being aligned with and installed into the resultant assembly ofFIG. 4A. The tabs44A,44B will be snapped into the tab receiving openings38A,38B. The opening42in the upper flange cover32is sized to communicate with the cannular channel opening in the proximal end of the cannular channel (not visible in this view). When attached to the upper flange cover32, the lower flange34also is configured to keep the cam grips52A,52B,50B (not easily visible in this view because it is partially beneath cam grip52B), and50A from falling out of cam pockets40A,40B,40C.

As shown inFIG. 4D, the needle22may be inserted into the cannular channel24of the fully assembled surgical port20through the opening in the flange28. Alternatively, an obturator58may be inserted into the cannular channel24. As discussed above, the obturator would have a blunt tip60which would be sized to extend past the distal end30of the cannular channel24. The obturator58may also have a handle62for ease of use and to prevent the obturator58from passing all the way through the cannular channel24and into a patient.

FIG. 5is a partially exposed view of a surgical port20through which the ends64A,64B of a stay suture66have been drawn. This may be done by using a hook or a snare as described above. The stay suture66is shown looping out of the distal end30of the cannular channel24for simplicity, however, it should be understood that such a stay suture66would be stitched through a desired tissue when in actual use. The stay suture ends64A,64B are pulled up through the cannular channel24and then down into the suture slots36A,36B, respectively. Suture slot36B is not visible in this partially exposed view, allowing us to see more clearly how the suture may be engaged with the cam grips52A,52B. In particular, it can be seen that the suture leading to suture end64B has been drawn through the opposing gripping arms54of cam grips52A,52B. As schematically illustrated inFIGS. 6A-6C, the cam grips52A,52B,50A,50B are able to rotate slightly within a small range defined by the cam pocket and the cam stops (not shown in this view). The broken line positions inFIG. 6Cillustrates one end of the range of motion, while the solid line positions inFIG. 6Cillustrates the other end of the range of motion for the cam grips52A,52B,50A,50B. This motion allows suture64A,64B to be drawn in-between respective pairs of gripping arms54. The gripping arms54are configured to resist motion of the suture64A,64B in a backwards direction68while allowing the suture to be pulled to a desired tension in a forwards direction70. The opposing pairs of gripping arms54may be configured to hold a single suture or multiple suture strands. In this way, stay sutures snared or hooked back through the surgical port20may be held in place by pulling the suture ends down into one or more suture slots36A,36B. The gripping arms54will hold the suture at the set tension.

FIG. 7illustrates one embodiment of a surgical port system72. The system72has a surgical port20, an obturator74, a hook76device, and a snare device78. The surgical port20has a flexible cannular channel24in this embodiment. The obturator74may be placed into the opening42of the surgical port20to enable the enable the flexible cannular channel24to be passed through tissue exposed by a small skin incision. The obturator74may then be removed from the surgical port20and either the hook device76or the snare device78may be placed into the opening42for capturing the ends of a stay suture and pulling them out of the surgical port20. The hook device76has a distal hook80with an atraumatic tip for grabbing the desired suture. The snare device78has a plastic target82at its distal end. The plastic target82is held by a snare loop84(not easily visible inFIG. 7, but visible inFIG. 10A). The snare loop84extends through a metal tube86where it is coupled to a curved metal handle88. The plastic target82can be removed from the snare device78to expose the snare loop84. The snare loop84and the end of the metal tube86near the snare loop84may be placed into the opening42and through the flexible cannular channel24of the surgical port20. A desired suture can be placed through the snare loop84, and the curved metal handle88and metal tube86can be simultaneously pulled away from the surgical port20to draw the suture in the snare loop84out of the opening42. The stay suture ends may be tensioned as desired and then pulled into suture slots36A,36B of the surgical port20. Each suture slot36A,36B can hold a pair of suture ends as described above, so each surgical port20may be used with at least two stay sutures.

FIGS. 8A-8Eillustrate one embodiment of a method for installing the surgical port ofFIG. 7in a patient. As illustrated inFIG. 8A, a small skin incision90is opened at a desired location on a patient for stay suture passage based on a surgeon's preference and experience. The obturator74is aligned with the opening42on the surgical port20and then placed92into the opening42until the handle94of the obturator74contacts the surgical port20as shown inFIG. 8B. As shown inFIG. 8C, the obturator74and cannular channel24of the surgical port20are inserted through the incision90. The obturator74can be worked carefully through the underlying tissue, taking care to avoid location of known blood vessels, nerves, and other sensitive structures and organs, until the surgical port20contacts the patient as shown inFIG. 8D. As shown inFIG. 8E, the obturator74may be removed96while the surgical port20is held against the patient.

FIGS. 9A-9Fillustrate one embodiment of a method for pulling a stay suture through the installed surgical port20using the hook device76. The distal end of the hook device76may be inserted into the opening42of the surgical port20as shown inFIG. 9A. As illustrated in the simulated endoscopic visualization view ofFIG. 9B, one or both strands of the desired stay suture98may be captured within the distal hook80of hook device76by manipulating the proximal handle100of the hook device76outside of the patient as shown inFIG. 9C. As shown inFIG. 9D, the hook device76may then be pulled102out of the patient while steadying the surgical port20to bring the stay suture98ends98A,98B out of the surgical port20. As shown inFIG. 9E, the stay suture ends98A,98B can be tensioned104per surgeon's discretion to position the tissue held by the stay suture98as desired. As shown inFIG. 9F, the stay suture ends98A,98B can be locked to maintain the desired tension by pulling106them down into one of the suture slots36B.

FIGS. 10A-10Jillustrate one embodiment of a method for pulling a stay suture through the surgical port ofFIG. 7using the snare device78. As shown inFIG. 10A, the plastic target82may be pushed108out of the snare loop84. As shown inFIG. 10B, the snare loop84may be folded back against the tube86of the snare device. As illustrated inFIG. 10C, the folded loop84end of the snare device may be inserted110into the opening42of the surgical port20. The tube86should be inserted far enough through the cannular channel for the snare loop84to exit the cannular channel24inside the patient as shown in the simulated endoscopic visualization view ofFIG. 10D. As illustrated in the simulated endoscopic visualization view ofFIG. 10E, the snare loop84may be placed over the sewing end of a suturing device114inside the patient. The suturing device114may be an automated suturing device or a needle grasping device. As illustrated inFIG. 10F, a stay suture116may be sewn into a desired suture location using the suturing device114. As schematically shown inFIG. 10G, the suturing device114may be withdrawn118back through the snare loop84(thereby pulling the stay suture through the snare loop84) and, outside of the patient, the stay suture ends116A,116B may be cut to separate them from the suturing device114or any needle caps or needles to which they might be attached. As shown inFIG. 10H, the snare device78may be pulled120out of the patient while steadying the surgical port20to bring the stay suture ends116A,116B out of the surgical port20. As shown inFIG. 10I, the stay suture ends116A,116B can be tensioned122per surgeon's discretion to position the tissue held by the stay suture116as desired. As shown inFIG. 10J, the stay suture ends116A,116B can be locked to maintain the desired tension by pulling124them down into one of the suture slots36B.

Various advantages of a surgical port for stay sutures have been discussed above. Embodiments discussed herein have been described by way of example in this specification. It will be apparent to those skilled in the art that the foregoing detailed disclosure is intended to be presented by way of example only, and is not limiting. Various alterations, improvements, and modifications will occur and are intended to those skilled in the art, though not expressly stated herein. These alterations, improvements, and modifications are intended to be suggested hereby, and are within the spirit and the scope of the claimed invention. The drawings included herein are not necessarily drawn to scale. Additionally, the recited order of processing elements or sequences, or the use of numbers, letters, or other designations therefore, is not intended to limit the claims to any order, except as may be specified in the claims. Accordingly, the invention is limited only by the following claims and equivalents thereto.