# Patent

## Title
Implantable access port device having a safety cap

## Abstract

A system for attaching an access port to bodily tissue includes an access port assembly and including an access port having a generally central axis. The access port assembly further includes an attachment mechanism structured to enable the access port to be attached, for example, to an abdominal muscle of a patient. The system includes a safety cap which lies substantially flush against the anchor base to provide no space for movement of the anchors. The safety cap prevents the anchors from deploying prematurely.

## Background
RELATED APPLICATIONS
This application is a divisional of U.S. patent application Ser. No. 12/750,565, filed Mar. 30, 2010, which is a continuation-in-part of U.S. patent application Ser. No. 12/426,057 filed on Apr. 17, 2009, which claims the benefit of U.S. Provisional Patent Application No. 61/045,890 filed on Apr. 17, 2008, the entire disclosure of each of these applications being incorporated herein by this specific reference.


BACKGROUND
The present invention generally relates to medical implants and more specifically relates to an implantable access port device and an attachment mechanism for attaching such an access port device to tissue.
Medical implants for performing therapeutic functions for a patient are well known. Such devices include pace makers, vascular access ports, injection ports (such as used with gastric banding systems) and gastric pacing devices. Such implants need to be attached, typically subcutaneously, in an appropriate place in order to function properly. It is desirable that the procedure to implant such devices be quick, easy and efficient and require as small of an incision as possible.
SUMMARY OF THE INVENTION
The present invention is directed to a system including an implantable access port, for example, but not limited to, an implantable access port for use in inflating and deflating an inflatable portion of a gastric band. Generally, the system includes an access port configured to be connected, for example, by means of a fluid conduit, to an inflatable portion of a gastric band. Access ports for use with gastric bands are well known and are described, for example, in U.S. patent application Ser. No. 10/562,964, filed on Sep. 15, 2004; U.S. patent application Ser. No. 10/562954, filed on Jan. 21, 2005; U.S. patent application Ser. No. 11/472,902, filed on Jun. 22, 2006; U.S. patent application Ser. No. 11/444,702, filed on May 31, 2006 and U.S. patent application Ser. No. 11/540,177, filed on Sep. 29, 2006, the entire disclosure of each of these patent applications being incorporated herein by this specific reference.
In one aspect of the invention, a system for attaching an access port to bodily tissue is provided.
The system generally comprises an access port assembly including an access port and an access port housing generally containing the access port. The access port may be structured for holding, receiving and enabling passage of a fluid between the access port assembly and a patient or into another implanted device in a patient, for example, a gastric band.
For example, the access port includes a bottom, a sidewall and a needle penetratable septum. The needle penetratable septum is spaced apart from the bottom and lies in a plane approximately parallel therewith. The sidewall, the bottom and the septum define a space for holding fluid. The access port assembly has a generally central axis extending through the bottom, the septum and the space for holding fluid. The sidewall generally surrounds this axis and is radially spaced therefrom.
The access port assembly further includes an attachment mechanism, including, for example, a plurality of rotatable anchors having a deployed position and an undeployed position. When in the deployed position, the anchors fix the access port to bodily tissue. In the case where the system is used in conjunction with a gastric band, the access port assembly may be secured, by means of the anchors, to the rectus muscle fascia.
In some embodiments, the attachment mechanism is reversible, allowing the implantable medical device to be detached from tissue.
In another embodiment, a safety cap may be removably fixed to an anchor base of the access port housing. The safety cap lies flush against the anchor base to provide no space for movement of the anchors. The safety cap prevents the anchors from deploying prematurely. The safety cap also prevents the anchors from being partially deployed.
In a specific embodiment, each of the anchors is made of wire, for example, a bent, stainless steel wire having round cross section and a multi-faceted, sharp distal tip.
In one embodiment, the plurality of anchors comprises four anchors spaced apart about the access port. Each anchor includes a main body, for example, a curved distal portion, which engages tissue, and a pivotal proximal portion which is rotatably connected to the access port housing. In some embodiments, the pivotal proximal portion is substantially perpendicular with the curved distal portion, or more specifically, substantially perpendicular with a plane in which the curved distal portion rotates when the anchors are moved into the deployed position. In some embodiments, each anchor may include a generally spiral distal portion and a straight proximal portion substantially perpendicular with the spiral distal portion. A cam system may be used as a means for actuating deployment of the anchors, for example, upon rotation of a rotating activator of the access port housing. In one embodiment, the anchor may comprise a main body and a shaft. The main body, which is generally a curved or arcuate shape, may be formed separately from the shaft or, alternatively, may be integrally formed therewith. In one embodiment, the main body is formed through a metal stamping process and the shaft formed separately, for example, through a milling process and is press fit into an aperture in the main body. Other means of forming the anchors are described in greater detail elsewhere herein. In another embodiment, the system further comprises a delivery tool structured to facilitate attachment of the access port assembly to bodily tissue. The tool includes a handle having a generally longitudinal axis and a distal portion structured to couple with or engage the access port assembly. The tool further includes an activation mechanism for activating deployment of the attachment mechanism. In some embodiments, the tool is configured such that the generally longitudinal axis of the handle is spaced apart from the generally central axis of the access port when the delivery tool is so engaged with the access port assembly. For example, the delivery head of the tool is offset from the tool handle. For example, the tool has a generally, non-linear, or curved, configuration with the delivery head being located forward of, or extending away from, the handle.
In another aspect of the invention, the activation mechanism of the tool comprises a cable mechanism, for example, two cables extending from a proximal end of the tool along the tool handle to the delivery head. In a specific embodiment, the cable mechanism comprises two opposingly movable cables. Longitudinal displacement of the cable mechanism causes rotational movement of the anchors when the tool is engaged to the access port assembly. The cables may be made of tungsten, or a tungsten material. Generally, each cable includes a substantially straight proximal portion extending along the handle of the tool and a curved distal portion connected to a rotating element of the delivery head.
Each and every feature described herein, and each and every combination of two or more of such features, is included within the scope of the present invention provided that the features included in such a combination are not mutually inconsistent.



BRIEF DESCRIPTION OF THE DRAWINGS
The invention may be better understood with reference to the following Detailed Description and Drawings of which:
FIG. 1 is a simplified perspective view of an access port assembly of a system of the invention as implanted in a patient and being used for inflation and deflation of a conventional gastric band for treating obesity;
FIGS. 2 and 3 are perspective views of a conventional gastric band useful in conjunction with the system of the present invention, the gastric band being shown in a deflated state and an inflated state, respectively;
FIG. 4 is a perspective view of a system in accordance with the present invention, including an access port assembly and a delivery tool for applying the access port assembly to bodily tissue;
FIG. 5 is a perspective view of the access port assembly and a delivery head of the tool separated from the access port assembly, of the system shown in FIG. 4;
FIG. 6 is an exploded view of the access port assembly shown in FIG. 5;
FIG. 6A is a cross-sectional view of the access port assembly coupled with the delivery head;
FIG. 7 is a partial cross-sectional side view of the system shown in FIG. 4;
FIGS. 8A and 8B are cross-sectional side views of the proximal portion of the tool showing an activation mechanism in an unlocked state and a locked state, respectively;
FIG. 9 is a side view of the distal portion of the tool;
FIG. 10 is a cross-sectional view of the distal portion of the tool and the access port assembly of the system of the invention;
FIGS. 11, 12 and 13 show a cut-away view of the access port with an anchor thereof in an undeployed state, a partially deployed state and a fully deployed state, respectively;
FIG. 14 shows a cross-sectional view of a top of the tool taken along line 14-14 of FIG. 12;
FIG. 15 is a cross-sectional view taken along lines 15-15 of FIG. 13;
FIG. 16 is a cross-sectional view taken along lines 16-16 of FIG. 14;
FIG. 17 is a cross-sectional view taken along lines 17-17 of FIG. 15;
FIG. 18 is a perspective view of the main body of the anchor and the shaft prior to assembly;
FIG. 19 is a perspective view of the main body of the anchor and the shaft after assembly;
FIG. 20 is a perspective top view of the access port housing with a safety cap fixed thereon;
FIG. 21 is a perspective top view of the access port housing with a safety cap removed;
FIG. 22 is a side view of the access port housing with a safety cap fixed thereon;
FIG. 23 is a perspective bottom view of the access port housing with a safety cap fixed thereon;
FIG. 24 is a perspective bottom view of the access port housing with a safety cap removed;
FIG. 25 is a perspective bottom view of an alternative embodiment of the safety cap;
FIG. 26 is a perspective bottom view of an alternative embodiment of the safety cap; and
FIG. 27 is a perspective bottom view of an alternative embodiment of the safety cap.



DETAILED DESCRIPTION
Turning now to FIG. 1, a simplified perspective view of an access port assembly 10 of a system of the invention is shown. The access port assembly 10 is shown as it is being penetrated by a needle 2 of a manually operable syringe 3. By passing fluid into the access port assembly 10, or removing fluid by means of the access port assembly 10, as will be described in greater detail hereinafter, the needle 2 and syringe 3 provide a convenient means for inflating and/or deflating a conventional gastric band 4, thereby enabling adjustment of a size of a stoma or a level of restriction on a patient's stomach 5. The gastric band 3 is shown in a deflated state in FIG. 2 and an inflated state in FIG. 3, and is not considered, in itself, to make up an embodiment of the present invention.
Turning now to FIG. 4, a system 20 in accordance with one embodiment of the invention is shown. The system 20 generally includes an implantable access port assembly 10 and a tool 30 for fixing the access port assembly 10 to bodily tissue. The access port assembly 10 is configured to be connected, for example, by means of a fluid line 6 (see FIG. 1) to an inflatable portion of a gastric band 4.
Referring now to FIG. 5, the access port assembly 10 generally comprises an access port 34 having a septum 36, a chamber 37 (shown in FIG. 6A) and an inlet/outlet connector 38 in communication with the chamber 37. The access port 34 is structured for holding, receiving and enabling passage of a fluid between inlet/outlet connector 38 and fluid line 6.
In the shown embodiment, the access port assembly 10 includes accommodations for facilitating suturing thereof to the patient, in the event that the use of the tool 30 to attach the access port assembly 10 is not desired. For example, suturing holes 40 are provided. Needle clearance regions 41 may also be provided to facilitate suturing.
The access port assembly 10 is shown in detail in FIGS. 6 and 6A. The access port 34 includes an access port bottom 42, a substantially cylindrical access port sidewall 44 and needle penetratable septum 36. The access port 34 further includes passage, for example, outlet barb 48, extending from chamber 37, which makes up a part of an inlet/outlet connector 38 coupleable to fluid line 6.
Inlet/outlet connector 38 may comprise a strain relief element 50 which locks into a coupler 51 of housing sidewall 56 and protects fluid line 6 from folding, kinking, rotating or torquing where line 6 connects to the access port assembly 10. Further strain relief may be provided by flexible sleeve 51a. Flexible sleeve 51a may be made of a puncture-resistant material, and, along with strain relief element 50, provides protection against accidental needle puncture to line 6.
The septum 36 is spaced apart from the access port bottom 42 and lies in a plane approximately parallel therewith. The septum 36 may be made of any suitable needle penetratable material, for example—a self sealing, needle penetratable material. The access port sidewall 44, access port bottom 42 and septum 36 define a chamber 37, or space, for holding fluid. The access port bottom 42 and access port sidewall 44 may be integral components of a substantially unitary structure made of a biocompatible metallic material, for example, titanium. Outlet barb 48 may also be made of the same material.
The access port assembly 10 has a generally central axis, indicated by line 52 in FIG. 6, extending through the access port bottom 42, the septum 36 and the chamber 37. The access port sidewall 44 generally surrounds the generally central axis 52 and is radially spaced apart therefrom. It should be appreciated that when the access port assembly 10 is implanted for use in a patient, the generally central axis 52 is generally perpendicular to the surface of the tissue or muscle to which the access port assembly is attached.
The access port assembly 10 further includes a housing 54 including a housing sidewall 56 substantially surrounding the access port sidewall 44, and an actuator assembly. Actuator assembly is made up of an actuator cap 58 and actuator element 62 which are rotatable (as indicated by arrows 64 on actuator cap and actuator element 62) with respect to the housing sidewall 56. The actuator element 62 includes a plurality of force protrusions 112 extending out from the surface of the actuator element 62. The housing 54 further includes an anchor base 66 including tracks 68 for receiving actuator element 62.
The access port assembly 10 further includes an attachment mechanism 70. The attachment mechanism 70 is structured to anchor or fix the access port assembly 10 to the patient. The attachment mechanism 70 may comprise, for example, a plurality of rotatable anchors 74 which are movable between an undeployed position and a deployed position. The rotatable anchors 74 are driven by the force protrusions 112 between the undeployed position and the deployed position.
In the shown embodiment, the plurality of rotatable anchors 74 comprises four anchors 74. The anchors 74 are generally spaced apart for example, substantially equidistantly spaced apart, about a circumference of the access port 34. When in the undeployed position, the anchors 74 are substantially concealed and contained between the actuator element 62 and the housing sidewall 56. During deployment, the anchors 74 rotate and travel out of their contained, substantially concealed position to an exposed position, by sliding through apertures 75 in anchor base 66.
Each anchor 74 may be made of a wire, for example, stainless steel wire. The anchor 74 may comprise a bent wire having a generally round cross-section and a sharp distal tip 76.
The anchor tip 76 is structured to penetrate and enter bodily tissue as the anchor 74 rotates into the deployed position. In some embodiments, the anchor tip 76 includes one or more flat faces. For example, the tip 76 may have a single facet, or may be multi-faceted. For example, the tip 76 may have two facets or three or more facets.
In a specific embodiment, the anchors 74 are a bent stainless steel wire have a generally arc shape having an arc diameter of slightly less than about 0.5 inch and a constant circular cross section of about 0.023 inch diameter.
Each anchor 74 includes a main body, for example, a curved distal portion 80, which engages tissue and a pivotal proximal portion 82 which is rotatably connected to the anchor base 66 of the port housing. In the shown embodiment, the pivotal proximal portion 82 is substantially perpendicular with the curved or spiral distal portion 80, or more specifically, substantially perpendicular with a plane in which the curved distal portion moves when the anchors 74 are rotated into the deployed position.
In a specific embodiment shown in FIGS. 18 and 19, the anchor 74 may comprise a main body 149 and a separately formed shaft 152 immovably fitted thereto. For example, the main body 149 includes an aperture 154 at a proximal end thereof, for receiving the shaft 152, an inner curve portion 156, a locking bend portion 158, and an outer curve portion 160. In the shown embodiment, the main body 149 may be formed by cutting from a sheet of material. For example, the main body may be stamp cut, forming a stamp cut portion 150 of the anchor 74. The main body 149, alternatively, may be made from any other suitable means, for example, the main body 149 may be laser cut or chemically etched from a sheet of material. Alternatively still, the main body may be a wire form or injection molded.
The outer curve portion 160 of the main body 149 terminates at a tip portion 162, located at a distal end of the main body 149. The main body 149 may have rounded, radiused edges 164. The aperture 154 has a shape suitable for receiving the shaft 152, for example, the aperture 154 may have a substantially circular or other shape and an inner diameter 166 that corresponds to a diameter 168 of the shaft 152 such that the shaft is immovably fitted to the main body 149. For example, the aperture 154 may have an oval, rectangular, triangular, or other configuration.
It is to be appreciated that anchor 74 may be molded, for example, injection molded, as a single component, rather than being made from a main body 149 and separate shaft 152.
The inner curve portion 156 of main body 149 has a shape that allows the force protrusions 112 to glide along the surface of the inner curve 156 to operate as shown in FIGS. 11, 12 and 13. The locking bend portion 158 has a sharp curve shape designed to stop the motion of the force protrusions 112, as shown in FIG. 13. The outer curve portion 160 has a generally arc shape with an arc diameter of slightly less than about 0.5 inch. The outer curve 160 may be manufactured with the intent to maintain a substantially constant cross-section similar to that of a bent wire form. No part of the inner curve portion 156 directly engages the outer curve portion 160, except through the locking bend portion 158. In an alternative embodiment, the outer curve portion may have a varied diameter that still allows the anchors 74 to effectively penetrate bodily tissue.
The shaft 152 comprises an axle portion 170, a friction portion 172, and a head 174. The shaft 152 defines an axis of rotation 176 for the main body 149. The shaft 152 is substantially cylindrical in shape. Each portion of the shaft may have an associated diameter 168, 178, 180. The shaft 152 has a first shaft diameter 178 and a second shaft diameter 168 different from the first shaft diameter 178. For example, the axle portion 170 has a first diameter 178 and a second diameter 168, wherein the first diameter 178 is smaller than second diameter 168. First shaft diameter 178 is smaller than the diameter 166 of the aperture 154, thereby allowing the axle portion 170 to pass through the aperture 154 and engage with the anchor proximal end. The friction portion 172 has a diameter 168 approximately equal to the diameter 166 of the aperture 154. The approximately equal diameter 168 allows the friction portion 172 to immovably fit to the aperture 154 with a friction force. The head 174 has a diameter 180 larger than diameter 166 of the aperture 154. The larger diameter 180 allows the head 174 to abut against the side of the main body 149 when the shaft 152 is inserted through the aperture 154. The head 174 prevents the main body 149 from rotating in a direction perpendicular to the axis of rotation 176. In an alternative embodiment, the head 174 may have any shape that abuts the side of the main body 149, including a triangular, rectangular, oval, or other shape, with a diameter of the head 174 larger than the diameter 166 of the aperture 154.
In one embodiment, the main body 149 is made of stainless steel, for example, 316 stainless steel, and is formed or shaped through a stamping process. In a more specific embodiment, the main body 149 is formed or shaped through a progressive stamping process.
In one embodiment, the main body 149 is formed by the steps of initially stamp cutting a general shape of the main body, for example, inner curve portion 156, locking bend portion 158, and outer curve portion 160 using an appropriately shaped die/punch from a sheet of material, and subsequently forming, for example, cutting, for example, stamp cutting, a faceted distal tip into the precut general shape.
In one embodiment, the anchor is formed or shaped by an initial stamp cutting of the main body general shape, and a subsequent stamp cutting of the distal tip, and no further post processing steps, for example, no further subsequent sharpening or polishing steps, for example, prior to assembly of the port and prior to clinical use thereof. In other words, the progressive stamp cutting of the anchor, in accordance with the invention, provides a work hardened, high strength anchor with a sharp distal tip requiring no additional tip sharpening or tip polishing.
A stainless steel sheet may be used as a stock, which is then stamped in the desired form on a press using dies and punches. In one embodiment, the stamping process initially produces a generally rectangular shaped stamp cut portion 150 with squared edges and a substantially uniform cross-section. The stamp cut portion 150 may be then subsequently cut, ground or stamped to form the sharp distal tip 162. The stamp cut portion 150 may be abraded and polished, for example, using conventional means, for example, in a tumbler with an abrasion chemical, to produce the radiused edges 164 shown in FIGS. 18 and 19.
The tip 162, which may include two, three or more facets, may be formed by grinding, cutting, polishing, or any other suitable means. In one embodiment, the tip is a ground tip, for example, is produced by means of a grinding wheel or other suitable conventional grinding mechanism. Alternatively or additionally, the tip 162 may be cut, for example, stamp cut, laser cut or chemically etched, into the distal end of the main body 149. In some embodiments, the tip is stamp cut during or subsequent to the stamp-cutting of the main body 149. In other embodiments, the tip is formed by any suitable combination of cutting, grinding and/or polishing. In one embodiment, the tip 162 is cut during the initial stamp cutting of the main body 149, and the anchor is then subjected to post cutting steps such as polishing. In other embodiments the tip 162 is cut, for example, stamp cut, into the pre-cut main body after polishing and abrading procedures.
Advantageously, the metal stamping process is believed to enhance overall anchor strength, particularly when the material used to form the anchor is 316 stainless steel. This process of stamping appears to produce a “work hardening” effect on the metallurgy of this material. This produces a stainless steel anchor that has a higher strength then a wrought stainless steel material.
In addition, the stamping process described herein further allows for greater part uniformity than possible with the bent wire embodiment of the anchor 74. Further still, the presently described stamping process produces a main body 149 which has a highly uniform, constant cross-section, which may enhance tissue penetration. The resulting mechanical properties of the stamp cut are similar to a bent wire made from stainless steel. The higher strength provides a rigidity to a constant cross section for optimal penetration.
It is to be appreciated that other types of materials, for example, metals other than stainless steel, or other types of stainless steel, for example, other than 316 stainless steel, may be used to form anchors suitable as components of the present invention. Appropriate shaping, polishing and/or other processing steps may be utilized to produce an anchor having the desired properties and specifications, depending upon the type of material of which the anchor is made. Such steps will be known to those of ordinary skill in the art.
The shaft 152 may be formed in any suitable manner. In one embodiment, the shaft 152 is formed through a milling process. The shaft 152 is press-fit into the aperture 154 of the main body 149, using a fixture and a press. After the shaft 152 and main body 149 are combined, the assembly is washed and cleaned in a cleaning chemical bath.
Turning briefly to FIG. 4, the access port assembly 10 may further comprise a removable safety cap 83 to protect a physician's or medical personnel's hands and fingers from accidental anchor sticks. The safety cap 83 mounts to the bottom of the access port housing 54 by a press-on fit. The color of the safety cap 83 may be an easily distinguishable color from the port housing color.
The safety cap 83 is further illustrated in FIG. 20. The safety cap 83 is a generally flat disc with an inner surface 186, shown in FIG. 21, and an outer surface 198, shown in FIGS. 23 and 24. The safety cap 83 is removably fixed to the access port housing 54. The safety cap 83 is fixed to the access port housing 54 through columns 182 located on the safety cap 83 that connect to the suturing holes 40 located on the anchor base 66. The safety cap 83 may be made of a plastic material. The columns 182 enter through the suturing holes 40 to provide a friction fit with the inner surface of the suturing holes 40. The columns 182 or suturing holes 40 may have varied shapes or mechanisms that removably fix the safety cap 83 to the anchor base 66. In one embodiment, magnets could be used to removably fix the safety cap 83 to the anchor base 66.
FIG. 20 illustrates a plurality of legs 184 protruding from an outer surface of the safety cap 83. The plurality of legs 184 have a generally half-disc shape and are positioned to balance the safety cap 83 evenly when standing on a table or a flat surface. The plurality of legs 184 elevate the safety cap 83 off a surface, allowing a user to more easily grab and lift the access port assembly 10 off the surface.
FIG. 21 illustrate the safety cap 83 removed from the anchor base 66, displaying the inner surface 186 of the safety cap 83. In operation, when the safety cap 83 is fixed to the anchor base 66, the inner surface 186 of the safety cap 83 is flush with a surface 196 of the anchor base 66, shown in FIG. 24. The anchors 74 have no space for movement because the inner surface 186 of the safety cap 83 prevents downward motion of the anchors 74 through the apertures 75 in the anchor base 66 (see also FIG. 22). Hence, the safety cap 83 prevents any and all movement of the anchors 74.
FIG. 21 also illustrates that the safety cap 83 has an outer rim portion 188, a tab portion 190, and an indent portion 192. The outer rim portion 188 defines an outer extent of the safety cap 83. The outer rim portion 188 of the safety cap 83 has a substantially circular shape. The outer rim portion 188 of the safety cap 83 extends outward only as far as an outer rim portion 194 of the anchor base 66. The outer rim portion 188 does not extend over the outer rim portion 194 of the anchor base 66 to assure the access port assembly 10 can fit within the sidewall 101 of the delivery head 96. If the outer rim portion 188 extended over the outer rim portion 194 of the anchor base 66, the safety cap 83 may disrupt the fit of the safety cap 83 within the delivery head 96. In addition, the outer rim portion 188 does not extend in a direction up along a side of the housing sidewall 56 or any portion of the housing 54, to similarly assure the access port assembly 10 can fit within the sidewall 101 of the delivery head 96. The tab portion 190 of the safety cap 83 extends outward from the safety cap 83, beyond the outer rim portion 194 of the anchor base 66. The tab portion 190 provides a grip that allows a user to grip and remove the safety cap 83 from the anchor base 66. The tab portion 190 further includes a friction surface 195 that provides an increased grip surface. The friction surface 195 may include one or more curved protrusions (e.g., three). The indent portion 192 is located substantially within the center of the safety cap 83 and comprises a depression or lowered area of the safety cap 83. The indent portion 192 has a shape that conforms to a shape of the access port bottom 42, illustrated in FIG. 24. The indent portion 192 allows the safety cap 83 to avoid interference from the access port bottom 42, assuring the inner surface 186 of the safety cap 83 remains flush with the anchor base 66.
FIG. 21 additionally illustrates an offset triangular position of the columns 182 on the inner surface 186 of the safety cap 83. The offset triangular position corresponds to a similar offset triangular position of the suturing holes 40. The offset triangular position assures that the safety cap 83 can only align in one position relative to the anchor base 66 when the safety cap 83 is fixed thereon. In the embodiment shown in FIG. 21, the safety cap 83 is aligned such that the tab portion 190 extends in a direction away from the coupler 51 (see also FIG. 21). This configuration assures a user's hand will not interfere with the coupler 51 when attempting to reach for the tab portion 190.
FIG. 22 provides a side view of the access port assembly 10, illustrating the inner surface 186 of the safety cap 83 being flush with the anchor base 66. The safety cap 83 provides no space for movement of the plurality of rotatable anchors 74 when the safety cap 83 is fixed to the anchor base 66. The anchors 74 can not rotate down through the apertures 75. The safety cap 83 lies flush with the anchor base 66 to prevent the anchors 74 from dislodging from the access port assembly 10, and prevents the anchors 74 from disengaging with the actuator element 62. The safety cap 83 additionally prevents the attachment mechanism 70 from deploying prematurely.
FIGS. 23 and 24 illustrate an outer surface 198 of the safety cap 83 with a plurality of legs 184 protruding therefrom. FIG. 24 illustrates the anchor base 66 has a substantially flat bottom 197. The inner surface 186 of the safety cap 83 lies flush with this substantially flat bottom 197 of the anchor base 66. FIG. 24 also illustrates the bottom surface 196 of the anchor base 66 may define a plane 199. The safety cap 83 prevents the anchors 74 from rotating through the plane 199 when the safety cap 83 is fixed to the anchor base 66.
FIG. 25 illustrates an alternative embodiment of the safety cap 83 without legs. The embodiment provides a low-profile safety cap 83 with a reduced chance of interference between the safety cap 83 and other surfaces. The embodiment also allows a reduction in material used to form the safety cap 83. FIG. 26 illustrates another embodiment of the safety cap 83 with cylindrically shaped legs 200. In general, the legs may be structured or positioned in various manners to elevate the safety cap 83 above a surface. For example, FIG. 27 further illustrates a safety cap 83 with three legs 184, positioned to balance the safety cap 83 on a flat surface or table.
Referring back now to FIG. 6, the access port assembly 10 may include one or more locator elements 84, for example, at least one or two or more radio opaque markers 86 that are clearly visible under an x-ray. These may be secured in port housing 54 and spaced apart from the access port 34 so as not to hide the marker image with an image of the access port 34. In a specific embodiment, two markers 86 are provided, each having dimensions of about 0.075′′×0.200′′ in length a separation distance from the access port 34 of at least about 0.100′′ in. The markers can be used to facilitate identification of the type of gastric band or other useful information to be identified by an X-ray image of the access port assembly 10, for example, by using varied configurations of markers 86.
As shown in FIG. 7, the tool 30 includes a handle 90 having a generally longitudinal axis (indicated by line 92) and a distal portion 96 structured to be removably and functionally coupled to the access port assembly 10.
In the shown embodiment, the tool 30 is configured such that the generally longitudinal axis of the handle 90 is spaced apart from, or not aligned with, the generally central axis 52 of the access port 34 when the tool 30 is coupled with the access port assembly 10. In other words, the delivery head 96 of the tool 30 which engages the access port assembly 10 is offset from the tool handle 90, i.e., the portion of the tool 30 that is handled by an operator thereof. In some embodiments, the generally central axis of the access port 34 and the longitudinal axis of the handle are offset a distance of at least about one inch to about two inches or more.
For example, the tool 30 has a generally curved, scoop shaped, L-shaped, or similar “offset” configuration such that the delivery head 96 is located forward with respect to, or extending away from, the handle 90. This configuration enables the tool 30 to be used to implant the access port assembly 10 using a relatively small incision, for example, in comparison to a conventional applier or tool that is substantially unilinear in configuration, or requires the tool to be substantially entirely aligned with a central axis of a similarly sized access port during surgical implantation. During implantation of the access port assembly 10, a physician inserts the delivery head 96 into an incision that is somewhat offset from the implantation site, that is, the target location where the access port is attached.
Turning now as well to FIGS. 8A and 8B, the tool 30 includes an activation mechanism 98. The activation mechanism 98 enables automatic deployment of the attachment mechanism 70, for example, by a physician using the system 10 to attach the access port assembly 10 to a patient. The activation mechanism 98 will be described in greater detail elsewhere herein.
FIG. 9 shows a side view of the delivery head 96 of the tool 30. The delivery head 96 includes top 100 and sidewall 101. When the tool 30 is coupled with the access port assembly 10, the top 100 extends over at least a portion of the access port 34 and the actuator cap 58 (see FIG. 5) and the sidewall 101 extends around and the clips to at least a portion of the housing sidewall 56.
Turning back to FIGS. 8A and 8B, in this exemplary embodiment, the activation mechanism 98 comprises a cable mechanism 102 coupled to a trigger mechanism 104.
The cable mechanism 102 comprises two opposingly movable cables 106 made of tungsten or similar material. The cables 106 extend from the trigger mechanism 104 along the tool handle 90 to the delivery head 96 of the tool 30. The trigger mechanism 104 includes a manually compressible trigger 104a and a trigger release button 104b. 
Generally, each cable 106 includes a substantially straight proximal portion extending along the handle of the tool 30 and a curved distal portion connected to the rotating element 108 of the delivery head 96 (see FIG. 5). Suitable structure, for example, the cable anchor 107 is provided to secure the cables 106 in place. The cables 106 are movable in mutually opposing directions upon rotation of the wheel 132.
In order to deploy the anchors 74, an operator presses the trigger 104a as indicated in FIG. 8A. Compression of the trigger 104a causes compression of the spring 130, rotation of the wheel 132 and longitudinal displacement of the cable 106. The trigger latch 134 is biased against the wheel 132, for example, by means of a spring (not shown). Once the trigger 104a is fully compressed as shown in FIG. 8B, the trigger latch 134 engages the wheel 132 at the detent notch 132a (the detent notch 132a may be more clearly seen in FIG. 8A) and locks the trigger mechanism 104. When the trigger 104a is fully compressed, trigger release button 104b is “out” as shown in FIG. 8B. In order to cause the anchors 74 to retract, an operator presses trigger release button 104b, which disengages trigger latch 134 from the detent notch 132a and load on the spring 130 causes reverse rotation of the wheel 132.
Turning as well, briefly to FIGS. 5 and 6, longitudinal displacement of cable 106, activated by manually pressing trigger 104a, causes rotation of the rotating element 108 and reciprocal rotation of the actuator cap 58. Rotation of the actuator cap 58 causes reciprocal rotation of the actuator element 62 and deployment of the anchors 74.
Rotation of actuator element 62 causes rotation of each anchor 74.
FIGS. 11, 12 and 13 illustrate deployment of an anchor 74 from a retracted, undeployed, position, through a rotating, deploying, position, to an actuated position, respectively.
Referring now to FIGS. 5 and 10, the distal portion of tool 30 is coupled to access port assembly 10 by inserting access port assembly 10 between sidewall 101 of distal portion 30. When tool 30 is engaged to access port assembly 10, protrusions 113 of rotating element 108 are fixed in receiving ports 114 of actuator cap 58 and clips 116 of distal portion sidewall 101 engage undercuts 118 of housing sidewall 56.
Turning briefly to FIGS. 11, 12 and 13, access port assembly 10 is shown in partial cross-sectional view, as it is being stapled or fixed to an abdominal muscle fascia 120.
FIGS. 11-17 show different views of the access port assembly 10 and delivery head 96 during anchor deployment.
More particularly, FIG. 11 shows attachment mechanism 70 prior to deployment of anchor 74.
FIGS. 12, 14 and 16 show delivery head 96 and access port assembly 10 during deployment of anchor 74. As shown in FIG. 16, during deployment and prior to full deployment, clip 116 of delivery head 96 secures to undercut 118 of housing sidewall 56.
As shown in FIGS. 13, 15, and 17, when the activation mechanism 98 is fully deployed, structure, for example, berm 142 of rotating element 108, forces clip 116 outward and out of engagement with undercut 118, thereby decoupling access port assembly 10 from delivery heard 96.
EXAMPLE
Use of the System
The following example describes one manner of using the presently shown and described system 20 of the invention to attach the access port assembly 10 to a gastric banding patient.
Referring generally to the Figures, the physician threads the strain relief element 50 over soft tubing 6 leaving about 2 cm. of the tubing extending beyond locking end of strain relief element 50.
The tubing is then coupled to barb 48 until flush with housing sidewall 56 of port housing 54. The strain relief element 50 is then pushed into and locked onto coupler 51.
The physician checks that the trigger mechanism 104 is in a fully opened position such as shown in FIG. 7.
The physician inserts the access port assembly 10 into the delivery head 96 of the tool 30 by placing the access port assembly 10 on a table with the safety cap 83 in contact with the table (FIG. 4), and pressing delivery head 96 against access port assembly 10 in a direction along axis 52 of FIG. 7. This causes the access port assembly 10 to snap into delivery head 96. The safety cap 83 is then manually removed from the access port assembly 10. At this point, the anchors 74 are positioned as shown in FIG. 11.
The physician places tubing from the gastric band into the abdomen. The access port assembly 10 is placed lateral to a trocar opening and a pocket is created for the access port assembly 10 so that it is placed far enough from the trocar path to avoid abrupt kinking of the tubing. The tubing path is placed such that that the tubing will form a straight line with a gentle arching transition into the abdomen. The tubing is placed perpendicular to the midline of the patient.
The physician verifies that the fat has been fully cleared and the rectus muscle fascia is visible. The delivery head 96 of the tool 30 with access port assembly 10 coupled thereto is placed into a dissected pocket in an angled position to facilitate insertion. The access port assembly 10 is place flat against the fascia to ensure that all anchors 74 will fully engage the fascia and/or muscle tissue. The physician applies finger pressure to the top 100 of delivery head 96 to insure the access port assembly 10 is flat against the fascia and the tool 30 is steadied for firing.
The physician firmly squeezes the trigger mechanism 104 until it is fully closed thereby deploying the anchors 74 into the underlying fascia. At this point, the activation mechanism 98 is locked in a closed position as shown in FIG. 8B and the anchors 74 are fully deployed as shown in FIGS. 13, 15 and 17.
In order to disengage the tool 30 from the access port assembly 10, the physician slides the delivery head 96 away from the access port assembly 10 for example, horizontally or laterally, and lifts the tool 30 out of the incisional site. The physician ensures that the anchors 74 are fully engaged into fascia by running a finger around the base of the access port assembly.
In the event the access port assembly 10 is to be disengaged from the fascia and repositioned, the trigger release button is pressed which unlocks the latch mechanism from the position shown in FIG. 8B which releases the trigger mechanism 104. Once the trigger is fully open the stainless steel anchors will be completed retracted back into the access port assembly 10. The access port assembly 10 can then be redeployed using tool 30 as described hereinabove, in a different, for example, more desirable location.
Numerous benefits have been described which result from employing the concepts of the present invention. The foregoing description of one or more embodiments of the invention has been presented for purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise form disclosed. Modifications or variations are possible in light of the above teachings and are considered to be within the scope of the invention. The one or more embodiments were chosen and described in order to illustrate the principles of the invention and its practical application to thereby enable one of ordinary skill in the art to utilize the invention in various embodiments and with various modifications as are suited to the particular use contemplated.

## Claims

1. An access port assembly comprising:
an access port having a generally central axis and including a bottom, a sidewall, and a needle penetrable septum;
an attachment mechanism structured to enable the access port to be attached to bodily tissue, the attachment mechanism comprising a plurality of rotatable anchors;
an access port housing having an anchor base, the access port housing defining a cavity to house the access port and the attachment mechanism, the anchor base having a plurality of holes; and
a safety cap removably fixed to the anchor base, the safety cap having an outer surface and an inner surface having a plurality of columns that are used to connect to the plurality of holes of the anchor base, the inner surface being flush with the anchor base to provide no space for movement of the plurality of rotatable anchors when the safety cap is fixed to the anchor base.

2. The access port assembly of claim 1, wherein the anchor base has a substantially flat bottom.

3. The access port assembly of claim 2, wherein the inner surface of the safety cap lies flush with the substantially flat bottom of the anchor base when the safety cap is fixed to the anchor base.

4. The access port assembly of claim 1, wherein a bottom surface of the anchor base defines a plane.

5. The access port assembly of claim 4, wherein the safety cap is structured to prevent the rotatable anchors from passing through the plane when the safety cap is fixed to the anchor base.

6. The access port assembly of claim 1, wherein the anchor base includes a plurality of apertures for the plurality of rotatable anchors to pass through.

7. The access port assembly of claim 6, wherein the safety cap is structured to prevent the rotatable anchors from passing through the plurality of apertures when the safety cap is fixed to the anchor base.

8. The access port assembly of claim 1, wherein the anchor base has an outer rim, the safety cap has an outer rim portion and a tab portion, the outer rim portion of the safety cap not extending beyond the outer rim of the anchor base.

9. The access port assembly of claim 1, wherein the plurality of columns are positioned on the inner surface of the safety cap to align the safety cap in only one position relative to the anchor base when the safety cap is fixed to the anchor base.

10. The access port assembly of claim 1, wherein the safety cap includes an outer rim portion, the plurality of columns are located substantially near the outer rim portion of the safety cap.

11. The access port assembly of claim 1, wherein the outer surface of the safety cap has a plurality of legs protruding therefrom.

12. The access port of claim 1, wherein the safety cap has an indent portion with a shape conforming to a shape of the access port bottom.