Pneumatic system for deployment of articulating arms for an access port

A surgical apparatus for positioning within a tissue tract accessing an underlying body cavity is adapted to articulate instruments inserted therein. The surgical apparatus includes an anchor member configured to form a sealing relation with a tissue, a balloon member and a plurality of articulating arms extending distally from the anchor member. Inflating and/or deflating the balloon member effectuate articulation of the articulating arms.

BACKGROUND

1. Technical Field

The present disclosure relates generally to surgical instruments for use with a seal anchor member. More particularly, the present disclosure relates to articulating surgical instruments usable with a seal anchor member that provides multiple instrument access through a single incision in a minimally invasive surgical procedure.

2. Description of Related Art

Increasingly, many surgical procedures are performed through small incisions in the skin. As compared to the larger incisions typically required in traditional procedures, smaller incisions result in less trauma to the patient. By reducing the trauma to the patient, the time required for recovery is also reduced. Generally, the surgical procedures that are performed through small incisions in the skin are referred to as endoscopic. If the procedure is performed on the patient's abdomen, the procedure is referred to as laparoscopic. Throughout the present disclosure, the term minimally invasive is to be understood as encompassing both endoscopic and laparoscopic procedures.

During a typical minimally invasive procedure, surgical objects, such as surgical access devices (e.g., trocar and cannula assemblies) or endoscopes, are inserted into the patient's body through the incision in tissue. In general, prior to the introduction of the surgical object into the patient's body, insufflation gas is used to enlarge the area surrounding the target surgical site to create a larger, more accessible work area. Accordingly, the maintenance of a substantially fluid-tight seal is desirable so as to inhibit the escape of the insufflation gas and the deflation or collapse of the enlarged surgical site. In response to this, various access devices with sealing features are used during the course of minimally invasive procedures to provide an access for surgical objects to enter the patient's body. Each of these devices is configured for use through a single incision or a naturally occurring orifice (i.e. mouth, anus, or vagina) while allowing multiple instruments to be inserted through the device to access the working space beyond the device.

During procedures employing multiple surgical instruments through a single incision access device, it is advantageous to coordinate the positioning of the end effectors of each surgical instrument. In situations where one or more of the surgical instruments is an articulating surgical instrument, manipulating the articulating surgical instrument or instruments to coordinate the positions of the end effectors is desirable.

Typically, in the prior art, mechanisms that enable articulation of the surgical instruments employ links, screws, cams or cable systems with drawbacks such as difficult placement and cumbersome use.

Hence, a continuing need exists for coordinating the end effectors of articulating surgical instruments used with an access device that permits multiple instruments to be used through a single incision.

SUMMARY

Disclosed herein is a surgical apparatus for positioning within a tissue tract accessing an underlying body cavity. The surgical apparatus includes an anchor member defining a longitudinal axis, a proximal end and a distal end; a balloon member extending distally from the distal end of the anchor member; and an articulating arm extending distally from the distal end of the anchor member, and defining one longitudinal lumen to receive a surgical instrument therethrough.

The articulating arm defines a linear position and an articulated position. The articulating arm transitions between the linear position and the articulated position during inflation and/or deflation of the balloon member. The balloon member is configured to expand in a radial dimension upon inflation.

The articulating arm includes a flexible cable disposed within the articulating arm. Additionally, the articulating arm includes at least one rigid member and at least one flexible member, and the flexible member defines a gooseneck or accordion configuration.

In one embodiment, the articulating arm includes three rigid members and two flexible members, each flexible member intermittently disposed between each pair of adjacent rigid members. The two flexible members include a proximal flexible member defining a first rotational limit, and a distal flexible member defining a second rotational limit. The second rotational limit is greater than the first rotational limit.

The surgical apparatus may include a plurality of articulating arms circumferentially arranged with respect to the balloon member.

The surgical apparatus may also include an inflation system to inflate and deflate the balloon member. In some embodiments, the inflation system includes a piston therein configured to move in a proximal direction, and the proximal movement of the piston articulates the articulating arm.

Also disclosed is a method of articulating a surgical instrument positioned within a tissue tract accessing an underlying body cavity. The method includes positioning a surgical apparatus within the tissue tract. The surgical apparatus includes an anchor member defining a longitudinal axis, a proximal end and a distal end; a balloon member extending distally from the distal end of the anchor member; and an articulating arm extending distally from the distal end of the anchor member. The method further includes inserting the surgical instrument into the articulating arm, and introducing an inflation medium to the balloon member to articulate the articulating arm.

The method may also include introducing the inflation medium to the balloon member to expand the balloon member in a radial dimension. The same process may also transition the articulating arm from a linear configuration to an articulated configuration. By analogy, the reverse process, i.e., withdrawing the inflation medium from the balloon member, transitions the articulating arm from the articulated configuration to the linear configuration.

The surgical apparatus used in the method may include a piston configured to articulate the articulating arm. Introducing the inflation medium drives the piston in a proximal movement to articulate the articulating arm.

DETAILED DESCRIPTION

The present disclosure describes a surgical apparatus and methods of deploying articulating arms of a surgical apparatus into a triangulated position with the use of a fluid system such as a pneumatic or hydraulic balloon.

Particular embodiments of the present disclosure will be described herein with reference to the accompanying drawings. As shown in the drawings and as described throughout the following description, and as is traditional when referring to relative positioning on an object, the term “proximal” or “trailing” refers to the end of the apparatus that is closer to the user and the term “distal” or “leading” refers to the end of the apparatus that is farther from the user. In the following description, well-known functions or constructions are not described in detail to avoid obscuring the present disclosure in unnecessary detail.

One type of minimal invasive surgery described herein employs a device that facilitates multiple instrument access through a single incision. This is a minimally invasive surgical procedure, which permits a user to operate through a single entry point, typically the patient's navel. Additionally, the presently disclosed device may be used in a procedure where a naturally occurring orifice (e.g. vagina or anus) is the point of entry to the surgical site. The disclosed procedure involves insufflating the body cavity and positioning a portal member within, e.g., the navel of the patient. Instruments including an endoscope and additional instruments such as graspers, staplers, forceps or the like may be introduced within a portal member to carry out the surgical procedure. An example of such a surgical portal is disclosed in U.S. patent application Ser. No. 12/244,024, Pub. No. US 2009/0093752 A1, filed Oct. 2, 2008, the entire contents of which are hereby incorporated by reference herein.

Referring now to the drawings, in which like reference numerals identify identical or substantially similar parts throughout the several views,FIG. 1illustrates a surgical apparatus10adapted for insertion within a tissue tract20, e.g., through the abdominal or peritoneal lining in connection with a laparoscopic surgical procedure. The surgical apparatus10has an anchor member100for securing the surgical apparatus10with respect to the tissue tract20. The surgical apparatus10further includes a balloon member110and at least one articulating arm120distally connected to the anchor member100.

FIG. 2is an exploded view of the surgical apparatus10. For clarity purposes, only one articulating arm120is shown. As illustrated inFIG. 2, the anchor member100defines a central longitudinal axis “A,” a proximal end104, a distal end106, and defines at least one longitudinal passage108extending between the proximal end104and the distal end106.

The anchor member100may include a plurality of longitudinal passages108, such as four longitudinal passages108shown inFIG. 2. The longitudinal passages108may have uniform dimensions or different dimensions. It is envisioned that at least one longitudinal passage108is dimensioned to receive the balloon member110. It is also envisioned that at least one longitudinal passage108is dimensioned to receive the articulating arm120.

The anchor member100has a longitudinal length “L1,” greater than or equal to the minimum length required to anchor the surgical apparatus10within any type of tissue tract20. The anchor member100may define a generally cylindrical configuration. However, it is contemplated that the anchor member100may define other configurations both prior and subsequent to insertion within the tissue tract20.

The anchor member100may be made from a semi-resilient, disposable, compressible, and flexible type material, for example, but not limited to, a suitable foam, gel material, or soft rubber having sufficient compliance to establish a sealing relation with the tissue tract20. In one embodiment, the foam includes a polyisoprene material.

As shown inFIG. 2, the balloon member110extends distally from the distal end106of the anchor member100. The balloon member110defines a deflated state as illustrated inFIG. 2and an inflated state as illustrated inFIG. 3. In one embodiment, the balloon member110is coaxially aligned with respect to the central longitudinal axis “A,” as shown inFIG. 2. In an alternate embodiment, the balloon member110may be positioned off the central longitudinal axis “A.”

The balloon member110may have a composite construction. Specifically, the balloon member110may have a first member112and a second member114. The first member112exhibits a generally cylindrical configuration elongated along the central longitudinal axis “A.” The second member114exhibits a generally ovoid or bladder configuration. It is also envisioned that the first and second members112,114may exhibit other configurations.

In one embodiment, the second member114is made of an inflatable, elastic material and configured to expand in a radial dimension “R” upon inflation. The first member112, on the other hand, is made of a relatively rigid material and maintains the same physical dimension during inflation. In an alternate embodiment, the second member114is configured to expand in the longitudinal dimension “A,” or configured to expand in both the longitudinal dimension “A” and the radial dimension “R” upon inflation. In another alternate embodiment, the first member112is also made of an inflatable, elastic material, and configured to expand in either the longitudinal dimension “A” or the radial dimension “R”, or both dimensions, upon inflation.

The first member112of the balloon member110defines a channel116therein. In one embodiment, the channel116is coupled to an inflation system40, illustrated inFIGS. 4A-B, to deliver an inflation medium to the second member114. Details regarding the inflation system40are described later.

In one embodiment, the balloon member110may expand radially only to a specific maximum volume. Additional inflation pressure will not increase the volume of the balloon member110. To achieve the above effect, the balloon member110may be used in conjunction with a net, such that the net envelops the balloon member110to prevent expansion of the balloon member110once the balloon member110reaches the specific maximum volume.

The balloon member110is connected to the anchor member100. In one embodiment, a portion of the first member112of the balloon member110is disposed within a longitudinal passage108of the anchor member110, and the remaining portion of the first member112together with the second member114are disposed distally with respect to the longitudinal passage108. The first member112may be releasably connected to the longitudinal passage108via frictional engagement, and the first member112can be repositioned along the longitudinal passage108until a desired position has been reached. When the first member112frictionally engages the longitudinal passage108, a substantial sealing relation is established therebetween. The first member112may also be permanently attached to the longitudinal passage108via adhesives, welding or by an overmolding process.

In an alternate embodiment, the balloon member110is distally attached to the distal end106of the anchor member100. Specifically, a proximal end of the first member112abuts the distal end106of the anchor member100. The first member112is coaxially aligned with respect a longitudinal passage108. The longitudinal passage108is operatively connected to the inflation system40. The longitudinal passage108and the channel116defined by the first member112together define a continuous longitudinal passage to deliver inflation medium from the inflation system40to the second member114. The balloon member110may be permanently attached to the distal end106of the anchor member100by adhesives, welding, or by an overmolding process.

The surgical apparatus10further includes at least one articulating arm120extending distally from the anchor member100. The articulating arm120defines a linear configuration, as illustrated inFIG. 2, in which the articulating arm120is generally aligned along a longitudinal axis parallel to the central longitudinal axis “A.” In its linear configuration, the articulating arm120defines a longitudinal length “L2.” In one embodiment, the longitudinal length “L2” of the articulating arm120is substantially larger than the longitudinal length “L1” of the anchor member100. The articulating arm120also defines an articulated configuration, as shown inFIG. 3, in which the articulating arm120is curled or clenched.

The articulating arm120includes at least one rigid member130and at least one flexible member140. The articulating arm120may include a plurality of rigid members130and a plurality of flexible members140intermittently disposed among the plurality of rigid members130. In one embodiment as shown inFIG. 2, the articulating arm120includes three axially disposed rigid members130: a proximal rigid member130a, a middle rigid member130band a distal rigid member130c. Each rigid member130exhibits a generally cylindrical configuration. The articulating arm120further includes two flexible members140: a proximal flexible member140aand a distal flexible member140b, which are intermittently disposed between each pair of adjacent rigid members130. Each flexible member140has a gooseneck or accordion-like configuration. InFIG. 2, the rigid members130and the flexible members140are arranged from the proximal end to the distal end of the articulating arm102in the following order: the proximal rigid member130a, the proximal flexible member140a, the middle rigid member130b, the distal flexible member140b, and the distal rigid member130c.

The rigid members130and the flexible members140together form a circular wall150extending along the length “L2” of the articulating arm120. The circular wall150defines a longitudinal lumen152at the center thereof. The longitudinal lumen152also has a length of “L2.” The longitudinal lumen152is dimensioned to receive a surgical instrument30as shown inFIG. 3. The surgical instrument30could be any surgical instrument such as grasper, stapler, forceps or the like.

The circular wall150further defines at least one channel, e.g.154a,154b, or154c, of a length “L2” positioned circumferentially about the longitudinal lumen152. The circular wall150may define a plurality of channels, e.g.154a-c, therein. In one embodiment as illustrated inFIG. 2, the circular wall150defines three channels154a-c. The channels154a-cmay be symmetrically disposed. Alternately, as shown inFIG. 5, which is a cross-sectional view of the articulating arm120, two of the channels154a-bare disposed on an x-axis, and the third channel154cis disposed on a y-axis. Each of the channels154a-cis dimensioned to receive a flexible cable or wire therein. The flexible cable is used to facilitate stabilization and articulation of the articulating arm120.

The articulating arm120may be connected to the anchor member100in a manner similar to the way the balloon member110connected to the anchor member100. In one embodiment, a portion of the articulating arm120is disposed within a longitudinal passage108of the anchor member100, and the remaining portion of the articulating arm120extends distally beyond the longitudinal passage108. The articulating arm120may be releasably connected to the longitudinal passage108via frictional engagement, and the articulating arm120can be repositioned along the longitudinal passage108until a desired position has reached. When the articulating arm120frictionally engages the longitudinal passage108, a substantial sealing relation is established therebetween. The articulating arm120may also be permanently attached to the longitudinal passage108via adhesives or other similar mechanisms.

The articulating arm120is positioned relative to the balloon member110in a manner such that inflation and deflation of the balloon member110would transition the articulating arm120between its linear configuration and its articulated configuration. In one embodiment, as shown inFIG. 1, the middle rigid member130band the second member114of the balloon member110are disposed distally with respect to the distal end106to the same extent.

It is envisioned that the articulating arm120remains in contact with the balloon member110during inflation and deflation. InFIG. 1, the articulating arm120contacts the deflated balloon member110at one contact point160, which is the same point where the second member114of the balloon member110meets the middle rigid member130bof the articulating arm120. The contact point160may be anywhere along the length of the middle rigid member130band anywhere along the length of the second member114. In one embodiment as inFIG. 1, the contact point160is about one third way down the length of the middle rigid member130b, and about half way down the longitudinal length of the second member114.

In another embodiment, as illustrated inFIG. 1A, the second member114may be securely attached to the middle rigid member130bat the contact point160via a hoop162. The hoop162circumferentially surrounds the middle rigid member130. The second member114includes a protrusion164defining an opening166which allows the hoop162to travel therethrough.

Details regarding articulation of a single articulating arm120are illustrated inFIGS. 6A-C. As illustrated inFIG. 6A, the proximal flexible member140aincludes a plurality of proximal links142, including a first proximal link142aconnected to the proximal rigid member130a, and a last proximal link142bconnected to the middle rigid member130b. Similarly, the distal flexible member140bincludes a plurality of distal links144, including a first distal link144aconnected to the middle rigid member130b, and a last distal link144bconnected to the distal rigid member130c.

In one embodiment, as illustrated inFIG. 6A, each proximal link142defines a conical proximal end142cand a flat distal end142d. When the proximal links142are arranged in a linear configuration, each proximal link142has a rotational limit of θ1in both clockwise and counterclockwise directions. Further, the rotational limit θ1corresponds to a gap “a” between adjacent proximal links142. Similarly, the middle rigid member130balso has a rotational limit of θ1in both clockwise and counterclockwise directions from its linear position, and has a gap “a” with respect to the last proximal link142b.

The distal links144are arranged in a similar fashion as the proximal links142, except that the each distal link144has a rotational limit θ2corresponding to a gap “b.” The rotational limit θ2is greater than the rotational limit θ1. For that reason, the gap “b” is also larger than the gap “a.” Likewise, the distal rigid member130calso defines a rotational limit θ2, and has a gap “b” with respect to the last distal link144b.

Due to the above configuration, the middle rigid member130bcan be pivoted with respect to the proximal rigid member130aabout the proximal flexible member140a, and simultaneously varying the gap “a” defined in the proximal links142. Similarly, the distal rigid member130ccan be pivoted with respect to the middle rigid member130babout the distal flexible member140b, and simultaneously varying the gap “b” defined in the distal links144.

Additionally, as illustrated inFIG. 6A, each articulating arm120includes at least one cable170running through one of the small channels154a-cdefined in the circumference of the articulating arm120. For clarity purposes,FIG. 6Aonly shows one cable170without showing the small channels154a-c. The cable170has a flexible nature allowing it to be easily conformed to the configuration of the articulating arm120.

The cable170defines a constant length, and includes a first portion172passing through the proximal flexible member140a, and a second portion174passing through the distal flexible member140b, and a remaining portion176that is disposed in the rigid members130a-c. Since the rigid members130a-chave a relatively constant dimension compared to the flexible members140a-b, the length of the remaining portion176of the cable170that is disposed in the rigid members130a-cremains constant.

Accordingly, a change in length of the first portion172is compensated by a change in length of the second portion174, and vice versa. For instance, an increase in gap “a” in the proximal flexible member140aresults an increase in length of the first portion172of the cable170, which inevitably demands a decrease in length of the second portion174of the cable170. Reduction in length of the second portion174causes a decrease in gap “b” in the distal flexible member140b. For these reasons, as shown inFIG. 6B, any pivotal motion of the middle rigid member130bin a counterclockwise direction with respect to the proximal rigid member130athat increases the gap “a” in the proximal flexible member140awould inevitably require pivotal motion of the distal rigid member130cin a clockwise direction with respect to the middle rigid member130cto decrease the gap “b” in the distal flexible member140b.

With reference toFIG. 3, during inflation of the balloon member110, the second member114of the balloon member110expands radially outwardly and pushes the middle rigid member130bof the articulating arm120outwardly via the contact point160. As a result of the inflation, the articulating arm120exhibits a curled or claw configuration. More specifically, the middle rigid member130bpivots with respect to the proximal rigid member130aabout the proximal flexible member140auntil the proximal links142in the proximal flexible member140areach their rotational limit θ1. During this process, the distal rigid member130cwould also pivot inwardly.

Similarly, deflation of the balloon member110would cause reverse behavior of the articulating arm120, and resumes the articulating arm120from its articulated position shown inFIG. 3to its linear configuration as shown inFIG. 1. In one embodiment, the cable170has a resilient material with a resilient nature that tends to resume its original linear configuration in the absence of any biasing force. The biasing force could be the force applied by the balloon member110which increases as the balloon member110inflates and decreases as the balloon member110deflates. In an alternate embodiment, the articulating arm120includes other spring mechanisms, parallel to the cable170, that tends to resume the articulating arm120to its linear configuration as the balloon member110deflates.

In one embodiment, when the balloon member110reaches its maximally inflated state, the proximal links142in the proximal flexible member140awould have also reached their rotational limit θ1, as illustrated inFIG. 6B. When each proximal link142reaches its rotational limit θ1, each distal link144would pivot for an extent less than its rotational limit θ2. For instance, adjacent distal links144in the distal flexible member140bstill have a gap “d” defined therebetween. It is envisioned that the distal flexible member140bmay be further rotated to reach their rotational limit θ2by pulling the cable170in a proximal direction.

With reference toFIG. 4A, the inflation system40includes a rotatable knob402to selectively control the amount of inflation and deflation. For instance, a clockwise rotation “C1” of the knob402introduces inflation medium to the balloon member110thereby inflating the balloon member110. A counterclockwise rotation “C2” of the knob402withdraws inflation medium from the balloon member110thereby deflating the balloon member110. The inflation system40may be a hydraulic system or a pneumatic system.

In a certain embodiment, the inflation system40may include mechanisms configured to provide additional articulation to the articulating arm120after the balloon member110reaches its maximum inflated state. For instance, as illustrated inFIG. 4A, the inflation system40may include a cylinder404which includes a spring loaded piston406therein. The cylinder404could be an air cylinder. The cylinder404is fluidly coupled to the balloon member110. A spring408is positioned between the piston406and the proximal end410of the cylinder404. The spring408exerts a distal pressure upon the piston406and presses the distal end412of the piston406against the distal end414of the cylinder404. The proximal end178of the cable170is securely attached to the distal end412of the spring loaded piston406.

The piston406remains still against the distal end414of the cylinder404until the inflation pressure within the balloon member110reaches a certain level that overcomes the spring pressure by the spring408.

In one embodiment, the balloon member110may expand radially due to inflation to a specific maximum volume or a maximum inflated state. When the balloon member110reaches its maximum inflated state, additional inflation will continuously increase the inflation pressure within the balloon member110, but will not increase the volume of the balloon member110. It is envisioned that once the balloon member110reaches its maximum inflated state, any additional inflation pressure within the balloon member110will overcome the spring pressure of the spring408, thus inducing movement of the piston406. Accordingly, in this embodiment, upon inflation, the inflation medium first inflates the balloon member110until the balloon member110reaches its maximum inflated state, at which point all the proximal links142of the proximal flexible member140aare locked by their rotational limit θ1as shown inFIG. 6B. Any further inflation thereafter actuated by continuous rotation of the knob402in the clockwise direction “C1,” as shown inFIG. 4B, overcomes the spring pressure exerted by the spring408and drives the piston406in a proximal direction. Proximal movement of the piston406simultaneously pulls the cable170attached thereto in a proximal direction. Proximal movement of the cable170causes the distal links144to rotate further until each distal link144reaches its rotational limit θ2, as illustrated inFIG. 6C. InFIG. 6C, both the proximal and distal flexible members140aand140breach their rotational limits. The distal rigid member130cas shown inFIG. 6Chas an additional inward articulation compared to that inFIG. 6B.

The surgical apparatus10may comprise a plurality of articulating arms120, such as three or four articulating arms120. The embodiment illustrated inFIG. 1shows that the surgical apparatus10includes three articulating arms120. The plurality of articulating arms120may be symmetrically and circumferentially arranged about the balloon member110. For instance, the plurality of articulating arms120may be spaced equidistant from the balloon member110and spaced equally from one another. Alternately, the distance between each articulating arm120and the balloon member110may vary. The distance between adjacent articulating arms120may also vary.

It is envisioned that inflation of the balloon member110causes simultaneous articulation of the plurality of articulating arms120. If surgical instruments30are disposed within each of the articulating arm120, as illustrated inFIG. 3, inflation of the balloon member110triangulates the end effectors32of the surgical instruments30to focus on a target zone. Continuous inflation causes the surgical instruments30to reduce their focus by gradually reducing the dimension of the target zone. For similar reasons, deflation causes the surgical instruments30to enlarge their focus by increasing the dimension of the target zone.

In operation, the surgeon first introduces the surgical apparatus10into the tissue tract20until all the articulating arms120are beneath the tissue tract20. At that point, the anchor member100forms a substantial sealing relation with the tissue tract20. Next, the surgeon introduces surgical instruments30into each articulating arm120. It is also envisioned that the surgical instruments30may be inserted into each arm120before advancing the surgical apparatus10into the tissue tract20. Then, the surgeon activates the rotatable knob402of the inflation system40to inflate the balloon member110. Expansion of the balloon member110pivots the middle rigid member130bof the articulating arm120outwardly about the proximal flexible member140a, which, in turn, causes the distal rigid member130cto pivot inwardly about the distal flexible member140b. Once the balloon member110reaches its maximum inflated state, any inflation thereafter drives the cable170in a proximal direction to effectuate additional articulation of the articulating arm120. During inflation, the articulating arms120clench inwardly, triangulate the end effectors32of the surgical instruments30to focus on a target zone. The surgeon may continue rotating the knob402to articulate the arms120until the surgical instruments30reduce their focus to a desired dimension.

To reset the articulating arms120to their linear configuration, the surgeon simply rotates the knob402in a reverse direction to effectuate deflation. As discussed earlier, the cables170may comprise a resilient material, which, in turn, assist the articulating arms120to resume their original linear configuration during deflation. Alternately, the articulating arm120incorporates other spring mechanisms with resilient nature, such as elastic wires placed into the channels154a-cofFIG. 5.

The surgical apparatus10and method of its operation as disclosed herein provides significant benefits to the surgeon during surgical procedures. The surgical apparatus10allows the surgeon to triangulate the surgical instruments30and fine-tune the articulation of the surgical instruments30, and enables the surgeon to easily control the amount of triangulation of surgical instruments30with a single action, i.e., rotation of the knob402. As a result, the deployment and triangulation of the surgical instruments30is effortless, intuitive, and can be handled by a single hand in a single action.

While several embodiments of the disclosure have been shown in the drawings and/or discussed herein, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Therefore, the above description should not be construed as limiting, but merely as exemplifications of particular embodiments. Different embodiments of the disclosure may be combined with one another based on the particular needs of the surgical procedures. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.