Abstract:
A method of retracting and/or manipulating tissue is provided. The method includes providing access to a body cavity, providing a retractor including a elongated body portion, a needle formed on a proximal end of the elongated body portion and an anchor means formed on a distal end of the elongated body portion, directing the needle of the retractor through a section of tissue to be retracted, drawing the retractor though the tissue until the anchor means engages the tissue, and pulling the body portion of the retractor to manipulate the tissue.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims the benefit of and priority to U.S. Provisional Patent Application No. 61/104,102, filed Oct. 9, 2008, the entire disclosure of which is incorporated by reference herein. 
    
    
     BACKGROUND 
     1. Technical Field 
     The present disclosure relates to single incision or laparoscopic surgery. More particularly, the present disclosure relates to tissue retractors for use during laparoscopic surgery. 
     2. Background of Related Art 
     Methods for performing single incision or laparoscopic surgical procedures are known and are becoming more widely used. Operating through a single incision or port permits a surgeon to perform an extensive array of procedures with minimal scarring and faster recovery time for a patient. Smaller, more precise instruments and other advances in medicine have brought about an increase in the number of procedures that may be performed laparoscopically. The reduced space in which a surgeon has to insert instruments within a patient limits the number of instruments that may be received in a patient at any given time. 
     When operating in the abdominal cavity, a surgeon may find the need to retract or move one or more organs or other tissue to better access a target site with the cavity. Conventional retractors tend to be long and rigid, and therefore, not suitable for laparoscopic use. Furthermore, inserting a conventional retractor through the incision or port may require a larger incision or port. When a port assembly is used, insertion of a conventional retractor through one of the ports of the assembly occupies that port for the duration of the procedure and eliminates the use of the port with another instrument. 
     Therefore, a continuing need exists for a tissue retractor and method of retracting tissue that is more suitable for use during laparoscopic procedures. 
     SUMMARY 
     Accordingly, method of retracting tissue is provided. The method includes the steps of providing laparoscopic access to a body cavity, providing a retractor including a elongated body portion, a needle formed on a proximal end of the elongated body portion and an anchor means formed on a distal end of the elongated body portion, directing the needle of the retractor through a section of tissue to be retracted, drawing the retractor though the tissue until the anchor means engages the tissue, and pulling the body portion of the retractor to manipulate the tissue. The method may further include the step of withdrawing the proximal end of the retractor from the body cavity. The method may also include the step of anchoring the proximal end of the retractor exterior of the body cavity. The anchor means may include a pledget. 
     The retractor of the provided method may be completely received within the body cavity of a patient, or instead the proximal end of the retractor may extend from the body cavity. The needle of the retractor may be directed through a wall of the body cavity or instead may be partially directed through the wall of the body cavity. The elongated body portion of the retractor may include multiple body portions. The elongated body portion of the retractor may include multiple needles. The anchor means may include proximally extending barbs. 
     Another method of retracting tissue is provided. The method includes the steps of providing laparoscopic access to a body cavity, providing a retractor including a elongated body portion and a needle formed on a proximal end, wherein the proximal end of the elongated body portion further includes barbs for engaging tissue, directing the needle of the retractor through a section of tissue to be retracted, drawing the retractor though the tissue until the barbs formed thereon engage the tissue, and pulling on a distal end of the retractor to set the barbs in the tissue. The distal end of the retractor may remain external of the body cavity. The distal end of the retractor may be anchored external of the body cavity. The method may further include the step of pulling on the distal end of the retractor to manipulate the tissue. 
     Still another method of retracting tissue is provided. The method includes the steps of providing laparoscopic access to a body cavity, providing a retractor including a elongated body portion including a needle and barbs formed on a first end and a support member having a first end integrally formed with a second end of the body portion, the support member including a fastener on a second end thereof for selectively securing the second end of the support member to the elongated body portion, placing the support member of the retractor around a section of tissue to be retracted, engaging the fastener formed on the second end of the support member to the elongated body portion of the retractor, directing the needle of the retractor through the skin of a patient, and drawing the needle though the tissue until the barbs formed thereon engage the skin. The fastener formed on the support member may be one of a hook and a clip. The support member may form a sling. The support member may be configured to support the tissue in a hammock-like manner. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the disclosure and, together with a general description of the disclosure given above, and the detailed description of the embodiment(s) given below, serve to explain the principles of the disclosure, wherein: 
         FIGS. 1-4  illustrate of a method of retracting tissue using an tissue retractor according to an embodiment of the present disclosure; 
         FIGS. 5-7  illustrate another method of retracting tissue using another tissue retractor according to the present disclosure; 
         FIGS. 8-11  illustrate yet another method of retracting tissue using yet another tissue retractor according to the present disclosure; 
         FIGS. 12 and 13  illustrate still another method of retracting tissue using the tissue retractor illustrated in  FIGS. 8-11 ; 
         FIG. 14  illustrates yet another method of retracting tissue using still yet another tissue retractor according to the present disclosure; 
         FIG. 15  illustrates still yet another method of retracting tissue using still yet another tissue retractor according to the present disclosure; and 
         FIG. 16  illustrates still yet another method of retracting tissue using still yet another tissue retractor according to the present disclosure. 
     
    
    
     DETAILED DESCRIPTION 
     Although the embodiments of the present disclosure will be described as relates to use in single incision or laparoscopic surgery, the aspects of the present disclosure may be modified for use in procedures other than those performed through a laparoscopic port. For example, the embodiments of the present disclosure may be modified for use in open surgery and endoluminally through a natural orifice. 
     With reference now to  FIGS. 1-4 , a first method for retracting an organ is illustrated. Referring initially to  FIG. 1 , using known surgical techniques, a laparoscopic port  100  is inserted through skin “S” of a patient to access a body cavity “C”. A tissue retractor  110  is then inserted through laparoscopic port  100  and is received within body cavity “C”. 
     With reference still to  FIG. 1 , tissue retractor  110  includes a substantially elongated body portion  111  having a needle  112  on a proximal end  110   a  and a pledget  113  formed on a distal end  110   b . Body portion  111  of retractor  110  may be formed from any known material, including absorbable and non-absorbable thread. Pledget  113  may be formed from plastic, polymer or other biocompatible material. Pledget  113  may be integrally formed with body portion  110 . In an alternative embodiment, pledget  113  may instead be securely affixed to distal end  110   b  of retractor  110  using adhesive, glue, mechanical fasteners, welding or other suitable technique. In one embodiment, pledget  113  is composed of an absorbable material for use with an absorbable suture. In this manner, pledget  113  may remain with body cavity “C” following completion of a procedure. 
     Still referring to  FIG. 1 , needle  112  of retractor  110  is first grasped within jaw members  52  of a laparoscopic instrument  50 . Turning to  FIG. 2 , instrument  50  is then externally manipulated by a surgeon using known techniques to direct needle  112  of retractor  110  through a section of tissue “T” to be retracted. Although shown as a section of small/large intestine, tissue “T” may include any tissue or organ within the body. Once a proximal end of needle  112  is visible through tissue “T”, needle  112  is released from within jaw members  52  and the exposed end of needle  112  is regrasped within jaw members  52 . 
     Turning to  FIG. 3 , as instrument  50  is pulled distally through laparoscopic port  100 , retractor  110  is drawn through tissue “T” until pledget  113  formed on distal end  110   b  of retractor  110  engages tissue “T”. Retractor  110  may need to be released and regrasped one or more times to draw body portion  111  through tissue “T” and to engage pledget  113 . Once pledget  113  of retractor  110  has engaged tissue “T”, any further manipulation of retractor  110  causes movement of tissue “T”. For example, continued withdrawal of retractor  110  from laparoscopic port  100  causes retraction of tissue “T”, in the direction of arrow “A” ( FIG. 4 ) 
     With reference now to  FIG. 4 , laparoscopic instrument  50  may be completely withdrawn from laparoscopic port  100  along with proximal end  110   a  of retractor  110 . In this manner, proximal end  110   a  of retractor  110  is accessible to a surgeon. Alternatively, proximal end  110   a  of retractor  110  may be retained within body cavity “C” for further manipulation using instrument  50 . In one embodiment, laparoscopic port  100  may include an anchor (not shown) on which proximal end  110   a  of retractor  110  may be tied. Alternatively, once received through passage “P” of laparoscopic port  100 , proximal end  110   a  may be continually grasped by a surgeon for further manipulation of tissue “T”, or instead, proximal end  110   a  may otherwise be selectively anchored outside of body cavity “C”. By suspending tissue “T” within body cavity “C” from flexible retractor  110 , tissue “T” may freely move within body cavity “C”. Thus, if tissue “T” is incidentally contacted by an instrument (not shown) during a laparoscopic procedure, the trauma to tissue “T” from the contact is minimized. When retractor  110  is received through passageway “P” in laparoscopic port  100 , there is sufficient room within passageway “P” for an additional instrument (not shown) to be inserted therethrough. In this manner, a single passageway of laparoscopic port  100  may be used for multiple purposes. In one embodiment, laparoscopic port  100  includes a groove or slot (not shown) extending along passageway “P” configured to receive retractor  110  such that other instruments (not shown) may be inserted through passageway “P” without engaging retractor  110 . 
     Upon completion of a laparoscopic procedure, all, a portion or none of retractor  110  may removed from body cavity “C”. When retractor  110  is removed from body cavity “C” a surgeon grasps pledget  113  and draws retractor  110  back through tissue “T”. Needle  112  is separated from retractor  110  prior withdrawal to facilitate withdrawal of retractor  110 . The surgeon may elect to cut retractor  110  along body portion  111  to limit the amount of retractor  110  that must be drawn through tissue “T”. Once retractor  110  is no longer engaged with tissue “T”, retractor  110 , or the pieces that once formed retractor  110  are removed from body cavity “C” through laparoscopic port  100 . In an alternative method, the portion of retractor  110  extending from laparoscopic port  100  is cut and the remaining portion of retractor  110  is left within body cavity “C” to be absorbed. 
     With reference now to  FIGS. 5-7 , an alternative method of retracting tissue “T” according to the present disclosure is illustrated. Referring initially to  FIG. 5 , laparoscopic port  100  is inserted through skin “S” to access body cavity “C”. A needle  212  on a proximal end  210   a  of a tissue retractor  210  according to another embodiment of the present disclosure is grasped within jaws  52  of a laparoscopic instrument  50  and is received through passageway “P” formed in laparoscopic port  100 . Tissue retractor  210  further includes a plurality of barbs  214  formed on proximal end  210   a  thereof distal of needle  212 . During the procedure, a distal end  210   b  of retractor  210  remains outside of body cavity “C”. 
     Turning to  FIG. 6 , instrument  50  is used to direct needle  212  through a section of tissue “T”. Once a proximal end of needle  212  is visible through tissue “T”, needle  212  is released from within jaw members  52  and the exposed end of needle  212  is regrasped within jaw members  52 . Proximal end  210   a  of retractor  210  is then drawn through tissue “T” a sufficient length to engage barbs  214  formed on proximal end  210   a . Once barbs  214  have engaged tissue “T”, needle  212  is released from jaw members  52 . 
     With reference now to  FIG. 7 , retraction of distal end  210   b  of retractor  210  through laparoscopic port  100  causes barbs  214  to bite into tissue “T”, thereby engaging tissue “T” and permitting retraction thereof through external manipulation of retractor  210 . As with the method of retraction described above, passageway “P” formed through laparoscopic port  100  may be used to receive an additional instrument (not shown). 
     Removal of retractor  210  from within body cavity “C” may be accomplished by grasping needle  212  and continuing to draw retractor  210  through tissue “T”. To limit the amount of retractor  210  that must be drawn through tissue “T”, retractor  210  may be cut anywhere along the length thereof distal of tissue “T”. 
     Turning now to  FIGS. 8-11 , another method of retracting tissue “T” according to the present disclosure is illustrated. With reference initially to  FIG. 8 , laparoscopic port  100  is inserted through skin “S” and a tissue retractor  310  according to an alternative embodiment of the present disclosure is received within body cavity “C”. Tissue retractor  310  includes a needle  312  formed on a proximal end  310   a  thereof and a pledget  313  formed on a distal end  310   b  thereof. In an alternative embodiment, distal end  310   b  of retractor  310  may include barbs (not shown) formed extending proximal towards needle  312 . In this manner, the barbs formed on distal end  310   b  of retractor  310  would act as an end effector, thereby preventing retractor  310  from being pulled through tissue “T”. Proximal end  310   a  of retractor  310  includes barbs  314 . Needle  312  of retractor  310  is then received within jaw members  152  of laparoscopic instrument  150 . 
     With reference now to  FIG. 9 , instrument  150  is then externally manipulated by a surgeon using known techniques to direct needle  312  of retractor  310  through a section of tissue “T” to be retracted. Once a proximal end of needle  312  is visible through tissue “T”, needle  312  is released from within jaw members  152  and the exposed end of needle  312  is regrasped within jaw members  152 . Retractor  310  is then drawn through tissue “T” until pledget  313  engages tissue “T”. In an alternative embodiment, retractor  310  is drawn through tissue “T” until barbs (not shown) formed on distal end  310   b  engage tissue “T”. 
     Turning to  FIG. 10 , laparoscopic instrument  152  is then manipulated to direct needle  312  of retractor  310  through skin “S”. With reference to  FIG. 11 , once needle  312  is received through skin “S”, a surgeon may grasp needle  312  external of body cavity “C” and continue to draw retractor  310  through skin “S”. Barbs  314  formed along proximal end  310   a  of retractor  310  prevent retractor  310  from being drawn back through skin “S”. Retractor  310  may be further drawn through skin “S” to further retract tissue “T”. 
     Alternatively, and with reference to  FIGS. 12 and 13 , needle  312  of retractor  310  may instead be directed through less than all the layers of skin “S” ( FIG. 12 ). Once a proximal end of needle  312  is visible through skin “S”, needle  312  is released from within jaw members  152  and the exposed end of needle  312  is regrasped within jaw members  152 . Retractor  310  may then be drawn through the layers of skin “S” to retract tissue “T”. Barbs  314  formed on proximal end  310   a  of retractor  310  prevent retractor  310  from being drawn back through the layers of skin “S”. 
     To remove retractor  310  from body cavity “C”, retractor  310  is cut distal of barbs  314  formed on proximal end  310   a  thereof. In one embodiment, this may be accomplished either within body cavity “C” or external thereof, depending on the location of needle  312 . Pledget  313  may then be retrieved from body cavity “C”. Alternatively, pledget  313  may remain in body cavity “C”. 
     Turning to  FIG. 14 , an alternative method of retracting tissue “T” using an alternative embodiment of the present disclosure is illustrated. A retractor  410  includes multiple body portions  411   a ,  411   b ,  411   c  extending from a pledget  413 . Each of body portions  411   a ,  411   b ,  411   c  include a needle  412   a ,  412   b ,  412   c , respectively. Each of body portions  411   a ,  411   b ,  411   c  may also include barbs  414   a ,  414   b ,  414   c . Retractor  410  may be used to retract tissue “T” in substantially the same manner as any of the methods described hereinabove, further including the step of directing second and third needles  412   b ,  412   c  of body portions  411   b ,  411   c , respectively, through tissue “T” and securing second and third body portions  412   b ,  412   c  to skin “S”. 
     With reference now to  FIG. 15 , another method of retracting tissue “T” using an alternative embodiment of the present disclosure is illustrated. A retractor  510  includes multiple body portions  511   a ,  511   b ,  511   c  formed on a first end and a single needle  512  formed on a second end. Each of body portions  511   a ,  511   b ,  511   c  include a needle  513   a ,  513   b ,  513   c , respectively, for directing respective body portions  511   a ,  511   b ,  511   c  through tissue “T”. Barbs  514   a ,  514   b ,  514   c  are formed along body portions  511   a ,  511   b ,  511   c  and are configured to engage tissue “T”. Barbs  514  are formed along body portion  511  to engage skin “S”. 
     Referring to  FIG. 16 , yet another method of retracting tissue “T” using another embodiment of the present disclosure is illustrated. A retractor  610  includes a sling or other suspension device  613  configured to support tissue “T”. Sling  613  may be formed of mesh or other support material to suspend tissue “T” in a hammock-like fashion. Sling  613  includes a first end  613   a  operatively connected to body portion  611   a  and a second end  613   b  including a hook, clip or other fixation means  615  for securing second end  613   b  of sling  613  to body portion  611   a . In this manner, sling  613  may be selectively received around tissue “T”. A proximal end of body portion  611   a  includes a needle  612   a  and may include barbs  614   a  for securing body portion  611   a  to or through skin “S”. Alternatively, and as shown in phantom, retractor  613  may include a second end  613   b  operatively connected to a second body portion  611   b . Second body portion  611   b  includes a second needle  612   b  and may include barbs  614   b  for securing second body portion  611   b  to or through skin “S”. 
     Although the illustrative embodiments of the present disclosure have been described herein with reference to the accompanying drawings, it is to be understood that the disclosure is not limited to those precise embodiments, and that various other changes and modifications may be effected therein by one skilled in the art without departing from the scope or spirit of the disclosure.