# Patent

## Title
Tissue manipulation devices

## Abstract

Tissue manipulation and retraction devices. In various forms, the manipulation devices include a cannula that is insertable through the abdominal wall. A plurality of independently controllable manipulation members extend through the cannula and are attachable to various forms of surgical tools. The surgical tools may be manipulated and controlled by a surgeon from a position outside of the patient.

## Background
CROSS-REFERENCE TO RELATED APPLICATIONS
This non-provisional patent application claims the benefit of and priority from U.S. Provisional Patent Application Ser. No. 61/452,432, filed Mar. 14, 2011, entitled “Surgical Stapling Instruments”, the entire disclosure of which is hereby incorporated by reference.


FIELD OF THE INVENTION
The present invention generally relates to surgical devices for temporarily retaining and supporting tissues and organs in a desired orientation during surgery, and more particularly, to devices for retracting tissue that may be inserted through a single port during laparoscopic surgery.
BACKGROUND
Minimally invasive surgical procedures are typically conducted through one or more small ports that are inserted through relatively small incisions. Laparoscopic surgery, for example, may involve infusing a gas into a portion of the patient through a small port to facilitate visual access and operating space within the patient. Surgeons may perform various procedures laparoscopically where bodily structures must be separated or retracted from surrounding tissue. Although the insufflation gas expands the abdomen to permit the surgeon to view the surgical site, it is often necessary to manipulate the internal organs or tissues to provide a clear path to the surgical objective. Conventionally, small, thin, long instruments are used to perform surgery and retract tissue structures, vessels, and organs. Such devices are disclosed, for example, in U.S. Pat. No. 4,190,042 to Sinnreich, U.S. Pat. No. 4,654,028 to Suma, U.S. Pat. No. 4,744,363 to Hasson, U.S. Pat. No. 4,909,789 to Taguchi et al., U.S. Pat. No. 5,195,505 to Josefsen, U.S. Patent Application Publication No. US 2008/0154299 A1 to Livneh, and U.S. Patent Application Publication No. US 2008/0242939 A1 to Johnston.
One major challenge to employing laparoscopic surgical techniques is the ability to move all of the unrelated or non-involved tissue out of the surgical site to permit better physical and visual access to the target tissue or organ. In an open procedure, large metal retractors are commonly used to pull the masses of small intestines away and then pack them off with surgical sponges. A dedicated separation of adjacent tissue structures is often desirable but can be technically difficult due to the limits of instruments that must fit through the working ports.
When performing various laparoscopic colorectal surgical procedures, the surgeon often must manipulate the surgical instruments through a pile or collection of bowel to open up a sufficient arena in which to perform the necessary surgical steps. This is often complicated by the need to move through several quadrants of bowel and otherwise vary the retraction states of tissue over the course of the procedure. These challenges are further exacerbated when performing single port access surgery (SILS) where all of the access devices are clustered through in a single incision. For example, when multiple retraction devices are passed through a single abdomen position, triangulation of the direction of retraction can be very critical and challenging.
Thus, the need exists for devices that provide multiple selectively guidable retraction means that are inserted through a single access port.
The foregoing discussion is intended only to illustrate some of the shortcomings present in the field of the invention at the time, and should not be taken as a disavowal of claim scope.
BRIEF SUMMARY
In connection with general aspects of various embodiments of the present invention, there is provided a tissue manipulation device that, in at least one embodiment, includes a hollow cannula that has a distal and a proximal end. The device further includes a plurality of manipulation members wherein each manipulation member has a manipulation distal end. An adjustment assembly is coupled to the proximal end of the hollow cannula and operably interfaces with each of the plurality of manipulation members to selectively apply separate actuation motions thereto. At least one surgical tool is removably coupled to at least one of the manipulation members. Each surgical tool is configured to at least initially pass through the cannula.
In connection with yet another general aspect of one form of the present invention, there is provided a tissue manipulation device that comprises a body portion that has a hollow cannula coupled thereto. The hollow cannula has a distal end that is configured to puncture tissue. A first manipulation cable extends through the hollow cannula and is coupled to a first rotatable disc assembly that is operably supported by the body portion such that by rotating the first rotatable disc assembly in a first deployment direction, a first portion of the first manipulation cable is deployed in a first distal direction relative to the distal end of the hollow cannula. By rotating the first rotatable disc assembly in a first actuation direction, the first portion of the first manipulation cable is moved in a first proximal direction relative to the distal end of said cannula. A first releasable lock member interfaces with the first rotatable disc assembly to selectively prevent rotation of the first rotatable disc assembly. A second manipulation cable extends through the hollow cannula. The second manipulation member is coupled to a second rotatable disc assembly that is operably supported by the body portion such that by rotating the second rotatable disc assembly in a second deployment direction, a second portion of the second manipulation cable is moved in a second distal direction relative to the distal end of the hollow cannula. By rotating the second rotatable disc assembly in a second actuation direction, the second portion of the second manipulation cable is moved in a second proximal direction toward the distal end of the cannula. A second releasable lock member interfaces with the second rotatable disc assembly to selectively prevent rotation of the second rotatable disc assembly. A third manipulation cable extends through the hollow cannula. The third manipulation member is coupled to a third rotatable disc assembly that is operably supported by the body portion such that by rotating the third rotatable disc assembly in a third deployment direction, a third portion of the third manipulation cable is moved in a third distal direction relative to the distal end of the hollow cannula. By rotating the third rotatable disc assembly in a third actuation direction, the third portion of the third manipulation cable is moved in a third proximal direction toward the distal end of the cannula. A third releasable lock member interfaces with the third rotatable disc assembly to selectively prevent rotation of the third rotatable disc assembly. At least one surgical tool is removably couplable to a distal end of at least one of the first, second and third manipulation cables. The surgical tool is selected from a group of surgical tools comprising a grasping device and a substantially flexible tissue-retaining net.
In accordance with still another general aspect of one form of the present invention, there is provided a surgical procedure comprising installing a cannula through a patient's abdominal wall such that a distal end of the cannula protrudes into the patient's abdomen. The cannula has a plurality of manipulation cable assemblies protruding out of the distal end thereof into the patient's abdomen. Each of the manipulation cable assemblies are independently selectively actuatable relative to each other. The method further includes coupling a first surgical tool to an end of one of the manipulation cable assemblies and coupling a second surgical tool to another end of another one of the manipulation cable assemblies. In addition, the method comprises applying an actuation motion to the first surgical tool through the one manipulation cable assembly coupled thereto and applying another actuation motion to the second surgical tool through the another one of the manipulation cable assemblies attached thereto.



BRIEF DESCRIPTION OF THE FIGURES
The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention, and, together with the general description of the invention given above, and the detailed description of the embodiments given below, serve to explain the principles of the present invention.
FIG. 1 is a perspective view of a tissue manipulation device embodiment with an installation sheath attached thereto;
FIG. 2 is a cross-sectional view of a portion of the tissue manipulation device of FIG. 1 taken along line 2-2 in FIG. 1;
FIG. 3 is another view of the tissue manipulation device of FIG. 1 installed through the abdominal wall of a patient and wherein a conventional grasping instrument is used to manipulate one of the manipulation cables thereof;
FIG. 4 is a cross-sectional view of one of the manipulation cables shown in FIG. 3 taken along line 4-4 in FIG. 3;
FIG. 5 is a perspective view of a portion of a manipulation cable and a collection of surgical tool embodiments of the present invention;
FIG. 6 is a partial perspective view illustrating use of a grasping instrument to install a surgical tool embodiment onto a distal end of a manipulation cable;
FIG. 7 is a partial end view of a portion of a surgical tool embodiment in a rolled-up configuration for installation through a cannula;
FIG. 8 is a partial cross-sectional view of another tissue manipulation embodiment of the present invention;
FIG. 9 is a partial perspective view of a portion of the tissue manipulation device embodiment of FIG. 8;
FIG. 10 is another is a partial perspective view of a portion of the tissue manipulation device embodiment of FIG. 8;
FIG. 11 is a perspective view illustrating one method of using at least one of the tissue manipulation device embodiments of the present invention during a surgical operation;
FIG. 12 is a side view of a portion of another tissue manipulation device embodiment of the present invention;
FIG. 13 is a perspective view of the portion of the tissue manipulation device depicted in FIG. 12;
FIG. 14 is an exploded assembly view of an adjustment wheel assembly embodiment of the present invention;
FIG. 15 is another exploded assembly view of the adjustment wheel assembly of FIG. 14;
FIG. 16 is an enlarged exploded assembly view of a portion of the adjustment wheel assembly of FIGS. 14 and 15;
FIG. 17 is a top cross-sectional view of a portion of the tissue manipulation device of FIGS. 12 and 13;
FIG. 18 is a top perspective view of another surgical tool embodiment of the present invention with the movable jaws thereof in an open position;
FIG. 19 is a bottom perspective view of the surgical tool embodiment of FIG. 18;
FIG. 20 is an exploded assembly view of the surgical tool of FIGS. 17 and 18;
FIG. 21 is a partial cross-sectional view of the surgical tool of FIGS. 17-20;
FIG. 22 is a rear exploded assembly view of the surgical tool of FIGS. 17-21;
FIG. 23 is a cross-sectional side view of the surgical tool of FIGS. 17-22 prior to attachment of a manipulation cable thereto;
FIG. 24 is another cross-sectional side view of the surgical tool of FIG. 23 after the distal end of the manipulation cable has been attached to the surgical tool; and
FIG. 25 is another cross-sectional side view of the surgical tool of FIG. 24 in a closed position.



DETAILED DESCRIPTION
The assignee of the present application also owns the following applications which were contemporaneously filed herewith and which are each herein incorporated by reference in their respective entireties:

    U.S. patent application Ser. No. 13/181,779, filed Jul. 13, 2011, entitled “Multiple Part Anvil Assemblies For Circular Surgical Stapling Devices”;
    U.S. patent application Ser. No. 13/181,798, filed Jul. 13, 2011, entitled “Modular Surgical Tool Systems”;
    U.S. patent application Ser. No. 13/181,801, filed Jul. 13, 2011, entitled “Specimen Retraction devices and Methods”;
    U.S. patent application Ser. No. 13/181,807, filed Jul. 13, 2011, entitled “Modular Tool Heads For Use With Circular Surgical Instruments”;
    U.S. patent application Ser. No. 13/181,768, filed Jul. 13, 2011 entitled “Collapsible Anvil Plate Assemblies For Circular Surgical Stapling Devices”;
    U.S. patent application Ser. No. 13/181,786, filed Jul. 13, 2011, entitled “Circular Stapling Devices With Tissue-Puncturing Anvil Features”;
    U.S. patent application Ser. No. 13/181,774, filed Jul. 13, 2011 entitled “Anvil Assemblies With Collapsible Frames For Circular Staplers”;
    U.S. patent application Ser. No. 13/181,842, filed Jul. 13, 2011, entitled “Rectal Manipulation Devices”;
    U.S. patent application Ser. No. 13/181,836, filed Jul. 13, 2011, entitled “Surgical Access Devices With Anvil Introduction and Specimen Retrieval Structures”; and
    U.S. patent application Ser. No. 13/181,827, filed Jul. 13, 2011, entitled “Surgical Bowel Retractor Devices”.


Certain exemplary embodiments will now be described to provide an overall understanding of the principles of the structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those of ordinary skill in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments and that the scope of the various embodiments of the present invention is defined solely by the claims. The features illustrated or described in connection with one exemplary embodiment may be combined with the features of other embodiments. Such modifications and variations are intended to be included within the scope of the present invention.
Reference throughout the specification to “various embodiments,” “some embodiments,” “one embodiment,” or “an embodiment”, or the like, means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment. Thus, appearances of the phrases “in various embodiments,” “in some embodiments,” “in one embodiment”, or “in an embodiment”, or the like, in places throughout the specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments.
The terms “proximal” and “distal” are used herein with reference to a clinician manipulating the handle portion of the surgical instrument. The term “proximal” referring to the portion closest to the clinician and the term “distal” referring to the portion located away from the clinician. It will be further appreciated that, for convenience and clarity, spatial terms such as “vertical”, “horizontal”, “up”, and “down” may be used herein with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.
FIG. 1 illustrates an embodiment of a tissue manipulation device 10 that has been inserted through the abdominal wall 2 into the abdomen 4 of a patient. More specifically, in one form, the tissue manipulation device 10 includes a body 12 that has a hollow cannula 14 protruding therefrom. The cannula 14 has a proximal end 16 that is attached to the body 12 and an open distal end 18. In at least one embodiment, a removable sheath 20 is configured to be slidably received on the distal end 18 of the cannula 14. In various embodiments, the removable sheath 20 has a distal end 22 that is configured to puncture through tissue. Thus, as will be discussed in further detail below, the removable sheath 20 is initially installed on the cannula 14 to facilitate insertion of the distal end 18 of the cannula 14 into the patient's abdomen 4. The removable sheath 20 may, for example, be temporarily retained on the cannula 14 by shrink wrap material or similar material (not shown). The shrink-wrap material may be perforated to facilitate easy removal once the cannula 14 has been inserted through the abdominal wall 2. Once the cannula 14 has been inserted through the abdominal wall 2, the sheath 20 may be removed therefrom by a conventional grasping instrument 25 inserted into the patient's abdomen 4 through another access opening such as through a conventional trocar device (not shown).
As can be seen in FIGS. 1 and 2, an embodiment of the tissue manipulation device 10 includes a plurality of manipulation members 30. In various embodiments, each of the manipulation members 30 are substantially identical and include a wire cable or core 32 that has a distal end portion 34 with an attachment member or attachment slug 36 attached thereto. The core 32 extends through a cable sheath 38. In at least one embodiment, at least one of, and preferably all of, the manipulation members 30 are substantially ductile. That is, for example, the core 32 may be fabricated from a substantially ductile material that will, at least to some extent, hold an angle. Thus, as shown in FIG. 3, once a manipulation member 30 has been deployed into a patient's abdomen 4, the surgeon may configure the manipulation member 30 with a grasping device 25 to bend it into a desirable configuration. Such ability enables the surgeon to broaden or further distance the pull or manipulation location from the initial puncture site.
As can also be seen in FIGS. 1 and 3, the body 12 operably supports an adjustment assembly, generally designated as 40. In at least one embodiment, the adjustment assembly 40 comprises a plurality of actuation members 42 in the form of rotatable wheel assemblies 50 that are rotatably supported on a common shaft 52. Each wheel assembly 50 is independently rotatable relative to the other rotatable wheel assemblies 50 journaled on the common shaft 52. In at least one embodiment, each rotatable wheel assembly 50 has at least one manipulation cable 30 operably attached thereto. In the illustrated embodiment, two manipulation cables 30 are attached to each rotatable wheel assembly 50. The rotatable wheel assemblies 50 are configured such that rotation of the wheel assembly 50 in a first direction “pays out” or moves the manipulation cable(s) 30 attached thereto in the distal direction “DD” relative to the open distal end 18 of the cannula 14. Rotation of a wheel assembly 50 in an opposite second direction retracts or moves the manipulation cable(s) 30 attached thereto in a proximal direction “PD” relative to the open distal 18 of the cannula 14. Also in various embodiments, each of the rotatable wheel assemblies 50 has a series of dimples 54 formed around its circumference that are configured to interact with a corresponding spring-biased detent 56 mounted in the body 12 as shown in FIGS. 1 and 3. It will be understood that, when the corresponding detent 56 engages a dimple 54 in a the rotatable wheel assembly 50, the rotatable wheel assembly 50 is retained in that position and prevents the rotatable wheel assembly 50 from being inadvertently rotated which may move the corresponding manipulation members 30 operably coupled thereto. Other releasable wheel locking arrangements may be employed.
As can be seen in FIGS. 3 and 5, various embodiments of the present invention include a collection of surgical tools 60, 70, 80 that may be removably attached to a distal end 34 of any of the manipulation cables 30. For example, the surgical tool 60 comprises a grasping device that comprises a pair of movable jaws 62, 64 that are coupled to an attachment portion 66. In at least one embodiment, the jaws 62, 64 are biased to an open position (shown in phantom lines in FIG. 5) by a spring or other biasing member (not shown). As will be discussed in further detail below with respect to other surgical tool embodiments, the attachment portion 66 is configured to be attached to the distal end 34 of a manipulation cable 30 such that when the surgeon applies a tension force to the cable core 32, the movable jaws 62, 64 are pulled to a closed position as shown in FIG. 5. In alternative embodiments, the movable jaws 62, 64 may be biased to the closed position and when tension is applied to the manipulation cable 30 attached thereto, the jaws 62, 64 are moved to the open position.
As can also be seen in FIG. 5, the surgical tool 70 comprises an atraumatic grasping device that includes a pair of movable jaws 72, 74 that are coupled to an attachment portion 76 that is configured to be attached to the distal end 34 of a manipulation cable 30. In at least one embodiment, the jaws 72, 74 are biased to an open position as shown by a spring or other biasing member (not shown). As will be discussed in further detail below with respect to other surgical tool embodiments, the attachment portion 76 is configured to be attached to the distal end 34 of a manipulation cable 30 such that when the surgeon applies a tension force to the cable core 32, the movable jaws 72, 74 are pulled to a closed or tissue clamping position. In alternative embodiments, the movable jaws 72, 74 may be biased to the closed position and when tension is applied to the manipulation cable 30 attached thereto, the jaws 72, 74 are moved to the open position. In various embodiments, the movable jaws 72, 74 each comprise an elastomeric pad that can be rolled up to a collapsed position to facilitate insertion of the surgical tool 70 through a cannula. FIG. 7 illustrates the surgical tool 70 in a rolled-up or collapsed position for insertion through a cannula. Jaw 74 has been stippled to enable the reader to distinguish it from jaw 72. The surgical tool 70 may be retained in the rolled-up configuration by shrink-wrap material 75 that may have a perforated portion to facilitate easy removal once the surgical tool 70 has been inserted into the body. Once the shrink-wrap material 75 has been removed, the elastic jaws 72, 74 relax to their expanded, substantially planar configurations as shown in FIG. 5. FIG. 6 illustrates the attachment of a surgical tool 60 to a manipulation cable 30 by use of a conventional grasping device 25.
FIG. 5 further illustrates another surgical tool 80 that may be employed with many of the tissue manipulation device embodiments disclosed herein. As can be seen in that FIG., the surgical tool 80 comprises a substantially flexible tissue-restraining net member 84. The net member 84 is coupled to an attachment portion 82 that is configured to be attached to the distal end 34 of a manipulation cable 30. In use, the surgical tool 80, in a collapsed state may be inserted into the body through a cannula. The surgeon may then attach the surgical tool 80 to a manipulation cable 30 using a conventional grasping device 25. The surgeon may then fasten a portion of the net 84 to a portion of the abdominal wall 2 or other tissue. The surgeon may use the net structure 84 to manipulate and restrain tissue “T” in a desirable location to open up the surgical site and to provide better access to the target tissue or organ. See FIG. 11.
FIG. 8 illustrates another embodiment of a tissue manipulation device 100. In at least one form, the tissue manipulation device 100 includes a body portion 102 that has a hollow cannula 104 attached thereto. The hollow cannula 104 has a proximal end 106 that is attached to the body portion 102 and an open distal end 108. The device 100 further includes a plurality of manipulation members 130. In various embodiments, each of the manipulation members 130 are substantially identical and include a wire cable or core 132 that has a distal end portion 134 with an attachment member or slug 136 attached thereto. The core 132 extends through a sheath 138. In at least one embodiment, at least one of, and preferably all of, the manipulation members 130 are substantially ductile. That is, for example, the core 132 may be fabricated from a substantially ductile material that will, at least to some extent, hold an angle.
An adjustment assembly, generally designated as 140, is operably supported on the cannula 104. In at least one embodiment, the adjustment assembly 140 comprises a plurality of actuation members 142 in the form of rotatable wheel assemblies 150 that are rotatably supported on the cannula 104 or other common shaft. Each wheel assembly 150 is independently rotatable relative to the other rotatable wheel assemblies 150 journaled on the cannula 104 or common shaft. In at least one embodiment, each rotatable wheel assembly 150 has at least one manipulation cable 130 operably attached thereto. In the illustrated embodiment, two manipulation cables 130 are attached to each rotatable wheel assembly 150. The rotatable wheel assemblies 150 are configured such that rotation of the wheel assembly 50 in a first direction “pays out” or moves the manipulation cable(s) 130 attached thereto in the distal direction “DD” relative to the open distal end 108 of the cannula 104. Rotation of a wheel assembly 150 in an opposite second direction retracts or moves the manipulation cable(s) 130 attached thereto in a proximal direction “PD” relative to the open distal 108 of the cannula 104. The body portion 102 may be configured with detents 56 (described above) for preventing the wheel assemblies 150 from inadvertently rotating. Other wheel locking arrangements may also be employed.
As can also be seen in FIGS. 8 and 9, the tissue manipulation device 100 further includes an umbrella-like assembly 160 that may be selectively opened and closed. In at least one form, the umbrella-like assembly 160 is moved from a substantially collapsed position to an open position by an actuation member 162. In one form, the actuation member 162 comprises a shaft 164 that extends through the cannula 104 and terminates in a proximal end 166. A spreader member 170 is attached to the distal end of the shaft 164. During insertion of the device 100 through the abdominal wall, the shaft 164 is axially positioned to move the spreader member to its distal-most position (illustrated in phantom lines in FIGS. 9 and 10) to permit the umbrella-like member 160 to be collapsed. Once the cannula 104 has been inserted through the abdominal wall 2, the surgeon may pull the shaft 164 in the proximal direction “PD” which thereby draws the spreader member 170 into spreading contact with the umbrella-like member 160 to move it to the open position illustrated in FIG. 10. As the manipulation cables 130 hang over the edges of the umbrella-like member 160, they are spread into a radial pattern which may allow each manipulation cable 130 to have a wider triangulation vector to the surgical site.
FIG. 11 illustrates one method of using the tissue manipulation device 100 in connection with resecting a portion of a patient's colon. More specifically, the cannula 104 may be inserted through the abdominal wall 2 into the abdomen 4 with a removable sheath 20 of the type and construction described above. Once the removable sheath and cannula 104 have been inserted through the abdominal wall 2, the perforated shrink-wrap material retaining the removable sheath on the cannula 104 is removed from the cannula 104 by a conventional grasping device 25. FIG. 11 depicts the device 100 after the cannula 104 has been inserted through the abdominal wall 2 and the sheath has been removed therefrom. As can be seen in that FIG., the umbrella-like member 160 has been expanded to further spread the manipulation cables 130. As shown, a surgical tool 80 is attached to one of the manipulation cables 130 and is being used to retain a “non-target” portion 6 of the patient's colon away from the surgical site. In addition, the surgical tool 70 is attached to another manipulation cable 30 and is being used to grasp and manipulate another portion 7 of the patient's colon. FIG. 11 illustrates use of a conventional laparoscopic tissue cutting device 27 and grasper 25 to cut the colon specimen 9 from colon portions 7 and 8.
FIGS. 12 and 13 illustrate a portion of another tissue manipulation device embodiment 200 of at least one form of the present invention. As can be seen in those FIGS., the tissue manipulation device 200 includes a body 202 that has a hollow cannula 204 protruding therefrom. The cannula 204 has a proximal end 206 that is attached to the, body portion 202. The cannula also has an open distal end (not shown) that is configured to be inserted into the patient in the various manners described above. As can be seen in FIG. 17, an embodiment of the tissue manipulation device 200 includes a plurality of manipulation members 230. In various embodiments, each of the manipulation members 230 are substantially identical and include a wire cable or core 232 that has a distal end portion 234 with an attachment member or attachment slug 236 attached thereto as was described above. The core 232 extends through a cable sheath 238. In at least one embodiment, at least one of, and preferably all of, the manipulation members 230 are substantially ductile. That is, for example, the core 232 may be fabricated from a substantially ductile material that will, at least to some extent, hold an angle.
As can also be seen in FIGS. 12 and 13, the body 12 operably supports an adjustment assembly, generally designated as 240. In at least one embodiment, the adjustment assembly. 240 comprises a plurality of actuation members 242 in the form of rotatable wheel assemblies 250 that are rotatably supported on a common shaft 252. Each wheel assembly 250 is independently rotatable relative to the other rotatable wheel assemblies 250 journaled on the common shaft 252. In at least one embodiment, each rotatable wheel assembly 250 has a pair of manipulation cables 230 operably attached thereto. In various embodiments, a wheel assembly 250 comprises a mounting wheel 254 and a tension wheel 270. Each mounting wheel 254 has a mounting hub portion 256 that has mounting slots 258 therein. The mounting slots 258 are configured to mountingly receive therein a proximal attachment slug 237 that is attached to a proximal end 235 of the cable core 232. The slots 258 communicate with a transverse arcuate slot 260 that is configured to receive therein a cable tension block 262 that has sockets 253 for receiving the slugs 239 therein. As will become further apparent as the present Detailed Description proceeds, the length of the arcuate slot 260 will define the amount of travel of the proximal end portion 235 of the cable core 232 relative to the proximal end 239 of the corresponding cable sheath 238. Thus, a manipulation cable 230 is attached to the mounting wheel by inserting the proximal end portion 235 of the cable core 232 into a corresponding mounting slot 258. Proximal end 239 of the cable sheath 238 does not extend into the mounting slot 258 but abuttingly engages a retention ledge 257 formed in the mounting hub portion 256. Such arrangement enables the cable core 232 to be pushed and pulled relative to the cable sheath 238. See FIG. 15.
As the proximal attachment slugs 237 are inserted through the mounting slots 258, the attachment slugs 237 are seated in the sockets 263 in the cable tension block 260. As can be seen in FIG. 15, the cable tension block 262 is received in the arcuate slot 260 and protrudes outwardly therefrom. As shown in FIG. 14, the end of the cable tension block 262 is configured to extend into an opening 272 provided in the corresponding tension wheel 270. Thus, rotation of the tension wheel 270 relative to the corresponding mounting wheel 254 will result in the application of a tension force “T” to the cable core 232 relative to its corresponding cable sheath 238 when the tension wheel 270 is rotated in a first direction “FD” to draw the distal end 234 of the cable core 232 toward the distal end 239′ of the cable sheath 238. Rotation of the tension wheel 270 in a second direction “SD” will result in the application of a compression force “CP” to the cable core 232 relative to the cable sheath 238 to ultimately move the distal end portion 234 of the manipulation cable 230 distally away from the distal end 239′ of the cable sheath 238. Also in various embodiments, to provide the surgeon with tactile feedback during the rotation of the tension wheel 270 relative to the mounting wheel 254, a detent assembly 280 is employed.
In at least one embodiment, the detent assembly 280 comprises a piston cap 282 that is attached to a ball 284 that is biased toward the mounting wheel 254 by a spring 286. A cavity 273 provided through the tension wheel 270 and a mounting cap 275 are provided for installation purposes. When installed, the piston cap 282 is configured to engage the series of dimples 288 formed in the mounting hub 256. Thus, as the tension wheel 270 is rotated relative to the mounting wheel 254, the piston cap 282 will snap into a corresponding one of the dimples 288 thereby providing the surgeon with a tactile indication of an amount of rotation achieved. In addition, when the piston cap 282 is engaged with a dimple 288, inadvertent rotation of the tension wheel 270 relative to the mounting wheel 254 may be prevented.
Various embodiments of the tissue manipulation device 200 further comprise a locking system 290 for selectively and independently locking each mounting wheel 254 in position to prevent inadvertent rotation thereof after the surgeon has moved the corresponding manipulation cables 230 into their desired positions. In at least one embodiment, the locking system 290 comprises a locking switch 292 that corresponds to each one of the mounting wheels 254. As can be seen in FIGS. 12 and 13, each locking switch 292 has a locking portion 294 formed thereon that is configured to lockingly engage a portion of the corresponding mounting wheel 254. Each locking switch 292 is slidably mounted within a corresponding slot 295 formed in the body portion 202. The locking switch 292 may be sized relative to its corresponding slot 295 to establish friction therebetween such that the friction generated therebetween will retain the switch 292 in the locked or engaged position as well as in the unlocked position. In various embodiments, each locking switch 292 may be formed with a release trigger 293 to facilitate the retraction of the locking switch 292 from the locked position to the unlocked position.
FIGS. 18-22 illustrate a surgical tool 300 that may be effectively used in connection with any of the tissue manipulation devices described herein. As can be seen in FIGS. 18 and 19, for example, the surgical tool 300 comprises a grasping device that has two movable jaws 302, 304. As can be seen in FIG. 20, each of the movable jaws 302, 304 are pivotally coupled to an attachment clevis 310 by a pivot shaft 312. A spring 306 serves to bias the jaws 302, 304 away from each other to an open position. The mounting clevis 310 further has a cable attachment portion 314 that has a slotted aperture configured to receive a distal attachment slug 236 and distal end 234 of the cable core 232 of a corresponding mounting cable 230. The attachment clevis 310 is movably received within an attachment housing 320. The attachment housing 320 has a slotted hole 322 therein to enable the distal end 234 and distal attachment slug 236 to be inserted therethrough into the attachment portion 314 of the mounting clevis 310. When attached, the distal end 239′ of the cable sheath 238 abuts the end wall 321 of the attachment housing 320. Thus, when the surgeon moves the tension wheel 270 as described above, the distal end 234 of the cable core 232 will move relative to the distal end 239′ of the cable sheath 238.
The cable attachment portion 314 is biased in the distal direction “DD” within the attachment housing 320 by a pair of springs 334 that are mounted on mounting pins 332 within the attachment housing 320. The springs 334 serve to maintain the slot 316 in the mounting clevis 310 out of alignment with the slot 322 in the attachment housing 320 to prevent inadvertent detachment of the manipulation cable 230 from the tool 300. To affix the manipulation cable 230 to the surgical tool 300, the user biases the attachment clevis in the proximal direction “PD” until the slots 316, 322 are aligned. See FIG. 21. The distal end 234 and distal attachment slug 236 are then inserted into the aligned slots 322, 316 and the attachment clevis 310 is then released to permit the springs 234 to bias the attachment clevis 310 distally thereby locking the surgical tool 300 to the manipulation cable 230. To detach the manipulation cable 230 from the surgical tool 300, the user simply biases the attachment clevis 310 in the distal direction “DD” until the slot 316 therein is in alignment with slot 322 in the attachment housing 320. The user may then insert a pin or other member through a hole 325 provided in the attachment housing 320 to urge the distal cable portion 234 and distal attachment slug 236 out of the slots 316 and 322.
To close the jaws 302, 304, the surgeon applies a tension force “T” to the cable core 232 by rotating the tension wheel 270 as was discussed above. As the cable core 232 is pulled in the proximal direction “PD”, the attachment clevis 310 is moved in the proximal direction “PD” within the attachment housing 320. As the attachment clevis 310 moves in the proximal direction “PD”, the jaws 302, 304 contact the attachment housing 320 and are pivoted to the closed position. See FIG. 25. As the jaws 302, 304 close on tissue, they apply a compressive closure force thereto. In this embodiment, the compressive closure force will increase as the surgeon increases with the amount of tension force “T” applied to the manipulation cable core 232. Stated another way, the movable jaws 302, 304 close harder on the tissue as the cable core 232 is pulled harder.
Those of ordinary skill in the art will appreciate that the various embodiments of the present invention represent a vast improvement over prior tissue retraction systems. Such embodiments offer improved methods of triangulating tissue retraction tools during laparoscopic surgery. In addition, various embodiments comprise a trocar-like device that can be installed through the abdominal wall without the need of other surgical installation instruments or conventional trocar devices. The individually attached surgical tools can be coupled to the various manipulation cables to provide large organ support and retraction. Such arrangements may afford the surgeon with a sufficient level of tissue retraction and manipulation while only requiring a single puncture to be made through the abdominal wall for installation and deployment purposes. The various surgical tools disclosed herein may be sized to at least initially extend through the device cannula. In other embodiments, the surgical tools may be installed into the body through another opening and then attached to the manipulation cables using conventional grasping devices. Moreover, various forms of the present invention afford the surgeon with the ability to adjust the retraction over the course of the surgical procedure.
Any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated materials does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.
The invention which is intended to be protected is not to be construed as limited to the particular embodiments disclosed. The embodiments are therefore to be regarded as illustrative rather than restrictive. Variations and changes may be made by others without departing from the spirit of the present invention. Accordingly, it is expressly intended that all such equivalents, variations and changes which fall within the spirit and scope of the present invention as defined in the claims be embraced thereby.

## Claims

1. A tissue manipulation device, comprising:
a hollow cannula having a distal end and a proximal end;
a plurality of manipulation members, each said manipulation member having a manipulation distal end;
an adjustment assembly coupled to said proximal end of said hollow cannula and operably interfacing with each of said plurality of manipulation members to selectively apply separate actuation motions to each of said plurality of manipulation members, wherein each of said plurality of manipulation members is moveable independently from others of said plurality of manipulation members in response to said separate actuation motions, wherein each of said plurality of manipulation members is extendable beyond said distal end of said hollow cannula;
at least one surgical tool removably coupled to at least one of said plurality of manipulation members, wherein each said surgical tool is at least initially configured to pass through said cannula, wherein said adjustment assembly is operably supported on a body coupled to said proximal end of said hollow cannula and wherein said adjustment assembly comprises:
a plurality of actuator members operably supported on said body, wherein each of said actuator members comprises a rotatable wheel, wherein each of said rotatable wheels operably interfaces with a corresponding one of said plurality of manipulation members; and
locking means interfacing with said plurality of actuator members for selectively locking said actuator members in unactuatable positions.

2. The tissue manipulation device of claim 1 wherein each of said plurality of manipulation members comprises a substantially ductile manipulation cable.

3. The tissue manipulation device of claim 1 further comprising a locking assembly interfacing with said adjustment assembly to selectively prevent actuation of said adjustment assembly.

4. The tissue manipulation device of claim 1 further comprising a removable sheath supported on said distal end of said hollow cannula and configured to pierce through tissue, wherein said removable sheath is removably couplable to said hollow cannula.

5. The tissue manipulation device of claim 1 wherein at least one of said plurality of manipulation members has a distal end configured to be removably attached to said surgical tool.

6. The tissue manipulation device of claim 5 wherein said at least one said manipulation member comprises a manipulation cable having an attachment member on said distal end thereof and wherein said surgical tool comprises a pair of movable jaws selectively movable between an open position and a closed position.

7. The tissue manipulation device of claim 6 wherein said pair of movable jaws further comprises:
a first jaw;
a second jaw;
a biasing member interacting with said first and second jaws to bias said first and second jaws to said open position; and
an attachment portion movably supporting said first and second jaws and configured to interact with said attachment member such that upon application of an actuation motion thereto by said attachment member, said first and second jaws move toward each other.

8. The tissue manipulation device of claim 7 wherein said application of said actuation motion comprises applying a tension force to a portion of said manipulation cable.

9. The tissue manipulation device of claim 8 wherein said first and second jaws apply a closure force to tissue received therebetween during said application of said tension force to said manipulation cable and wherein said attachment portion is configured such that said closure force increases as said tension force increases.

10. The tissue manipulation device of claim 5 wherein said surgical tool comprises a flexible tissue-retaining net structure.

11. A tissue manipulation device, comprising:
a hollow cannula having a distal end and a proximal end;
a plurality of manipulation members, each said manipulation member having a manipulation distal end;
an adjustment assembly coupled to said proximal end of said hollow cannula and operably interfacing with each of said plurality of manipulation members to selectively apply separate actuation motions thereto; and
at least one surgical tool removably coupled to at least one of said plurality of manipulation members, wherein each said surgical tool is at least initially configured to pass through said cannula, wherein said adjustment assembly is operably supported on a body coupled to said proximal end of said hollow cannula, wherein said adjustment assembly comprises:
a plurality of actuator members operably supported on said body, wherein each of said actuator members comprises a rotatable wheel, wherein each of said rotatable wheels operably interfaces with a corresponding one of said plurality of manipulation members; and
locking means interfacing with said plurality of actuator members for selectively locking said actuator members in unactuatable positions, wherein each of said plurality of manipulation members comprises a manipulation cable and wherein each of said rotatable wheels is configured to selectively windup and pay out said corresponding manipulation cable attached thereto, and wherein said locking means comprises a movable locking switch associated with each said rotatable wheel for selectively immobilizing said rotatable wheel independently from other of said rotatable wheels.

12. A tissue manipulation device, comprising:
a hollow cannula having a distal end and a proximal end;
a plurality of manipulation members, each said manipulation member having a manipulation distal end;
an adjustment assembly coupled to said proximal end of said hollow cannula and operably interfacing with each of said plurality of manipulation members to selectively apply separate actuation motions thereto; and
at least one surgical tool removably coupled to at least one of said plurality of manipulation members, wherein each said surgical tool is at least initially configured to pass through said cannula, wherein at least one of said plurality of manipulation members has a distal end configured to be removably attached to the at least one surgical tool, wherein said at least one said manipulation member comprises a manipulation cable having an attachment member on said distal end thereof and wherein said surgical tool comprises a pair of movable jaws selectively movable between an open position and a closed position, wherein said movable jaws are each configurable from a rolled up orientation to a substantially planar orientation.

13. The tissue manipulation device of claim 12 further comprising a selectively rupturable member extending around at least a portion of said movable jaws to temporarily retain said movable jaws in said rolled up orientation.

14. A tissue manipulation device comprising:
a body portion;
a hollow cannula coupled to said body portion and having a distal end configured to puncture tissue;
a first manipulation cable extending through said hollow cannula, said first manipulation cable coupled to a first rotatable disc assembly operably supported by said body portion such that by rotating said first rotatable disc assembly in a first deployment direction, a first portion of said first manipulation cable is deployed in a first distal direction relative to said distal end of said hollow cannula and by rotating said first rotatable disc assembly in a first actuation direction, said first portion of said first manipulation cable is moved in a first proximal direction relative to said distal end of said cannula;
a first releasable lock member interfacing with said first rotatable disc assembly to selectively prevent rotation of said first rotatable disc assembly;
a second manipulation cable extending through said hollow cannula, said second manipulation cable coupled to a second rotatable disc assembly operably supported by said body portion such that by rotating said second rotatable disc assembly in a second deployment direction, a second portion of said second manipulation cable is moved in a second distal direction relative to said distal end of said hollow cannula and by rotating said second rotatable disc assembly in a second actuation direction, said second portion of said second manipulation cable is moved in a second proximal direction toward said distal end of said cannula;
a second releasable lock member interfacing with said second rotatable disc assembly to selectively prevent rotation of said second rotatable disc assembly;
a third manipulation cable extending through said hollow cannula, said third manipulation cable coupled to a third rotatable disc assembly operably supported by said body portion such that by rotating said third rotatable disc assembly in a third deployment direction, a third portion of said third manipulation cable is moved in a third distal direction relative to said distal end of said hollow cannula and by rotating said third rotatable disc assembly in a third actuation direction, said third portion of said third manipulation cable is moved in a third proximal direction toward said distal end of said cannula;
a third releasable lock member interfacing with said third rotatable disc assembly to selectively prevent rotation of said third rotatable disc assembly; and
at least one surgical tool removably couplable to a distal end of at least one of said first, second and third manipulation cables, said at least one surgical tool selected from a group of surgical tools comprising:
a grasping device; and
a substantially flexible tissue-retaining net.

15. The tissue manipulation device of claim 14 wherein at least a portion of at least one of said first, second and third manipulation cables is substantially ductile.

16. The tissue manipulation device of claim 14 wherein said grasping device comprises:
a first jaw;
a second jaw;
a biasing member interacting with said first and second jaws to bias said first and second jaws to an open position; and
an attachment portion movably supporting said first and second jaws and configured to interact with said one of said first, second and third manipulation cables such that upon application of an actuation motion thereto, said first and second jaws move toward each other.

17. The tissue manipulation device of claim 15 wherein said application of said actuation motion comprises applying a tension force to said one of said first, second and third manipulation cables attached to said attachment portion.

18. The tissue manipulation device of claim 17 wherein said first and second jaws apply a closure force to tissue received therebetween during said application of said tension force to said one of said first, second and third manipulation cables and wherein said attachment portion is configured such that said closure force increases as said tension force increases.