Abstract:
A surgical access assembly including a base and an elongated member extending from the base. The bass defines a central axis and has an opening for receipt, of a surgical instrument. The elongated member defines a passageway for passage of at least a portion of the surgical instrument and is adapted to assume a substantially rolled configuration in a normal unstressed condition thereof When in the rolled configuration, the elongated member is rolled transverse to the central axis.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
       [0001]    The present application is a continuation application of U.S. patent application Ser. No. 12/467,433, filed on May 18, 2009, which claims the benefit of and priority to U.S. Provisional Patent Application Ser. No. 61/075,521, filed on Jun. 25, 2008, the entire disclosure of each application is incorporated herein by reference. 
     
    
     BACKGROUND 
       [0002]    1. Technical Field 
         [0003]    The present disclosure relates to assemblies for accessing a body cavity, and more particularly, to an access assembly having a low profile, 
         [0004]    2. Background of Related Art 
         [0005]    Trocar and other access assemblies are used by surgeons to operate on a patient without having to create large incisions that may become infected and may cause major scaring. Access assemblies are known in the art, as are the instruments inserted therethrough for operating within the body cavity. Typically, an access assembly includes a housing, and a tubular member or cannula affixed to the housing and configured for insertion into a body cavity. These assemblies generally include a zero closure seal mounted within the housing to prevent the escape of insufflation gas and an instrument seal also within the housing for forming a seal about the instrument. 
         [0006]    The cannula of conventional access assemblies are limited in that they reduce the type and configuration of instruments that may be inserted into a body cavity. A curved or otherwise bent instrument may not be inserted through a conventional cannula. In addition. manipulation of the inserted instrument is limited by the dimensioning of the cannula. Even further, the housing and a conventional cannula incorporates both the instrument and zero closure seal, and, as a result, presents a relatively large profile encompassing a significantly larger area within the operative field. 
         [0007]    Therefore, it would be beneficial to have art access assembly including a low profile housing and capable of permitting offset manipulation of the instrument. 
       SUMMARY 
       [0008]    In accordance with one embodiment of the present disclosure, a surgical access assembly includes a base defining a central axis and having an opening for receipt of a surgical instrument and an elongated member extending from the base. The elongated member may define a passage for passage of the surgical instrument. The elongated member is adapted to assume a substantial rolled configuration in a normal unstressed condition thereof The elongated member may be adapted to substantially seal the passage when in the rolled configuration thereof. As a further feature, the elongated member may be adapted to establish a substantial sealed relation with the surgical instrument received, within the passage. In one embodiment, the elongated member may include an elastomeric material which is adapted to permit angulated movement of the surgical instrument relative to the central axis. The elongated member may include a leading end portion which is substantially closed in the absence of the surgical instrument to substantially seal the passage. 
         [0009]    The elongated member may include a coating for facilitating the insertion and removal of an endoscopic instrument, and is configured to receive endoscopic instruments of varying diameters. The elongated member may be configured to receive a endoscopic instrument having a curved length. 
         [0010]    The base may include an adhesive ring for selectively sealing the base to a patient. In the alternative, the base may include one or more suture tie down members. The suture tie down members each may include a recess formed about the perimeter of the base. Alternatively, the suture tie down members may include labs extending from the perimeter of the base. The base may include a substantially disc-shaped member having a low profile, and may be devoid of a seal. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS  
         [0011]    The foregoing summary, as well as the following detailed description will be better understood when read in conjunction with the appended figures. For the purpose of illustrating the present disclosure, a preferred embodiment is shown. It is understood, however, that the present disclosure is not limited to the precise arrangement and instrumentalities shown. 
           [0012]      FIG. 1  is a side view of an access assembly according to aspects of the present disclosure in an initial or pre-stretched: and roiled condition; 
           [0013]      FIG. 2  is a side view of the access assembly of  FIG. 1  in a stretched and extended condition; 
           [0014]      FIG. 3  is a top view of the access assembly of  FIGS. 1 and 2 ; 
           [0015]      FIG. 4  is a cross-sectional view of the access assembly of  FIGS. 1-3  taken along line  4 - 4  of  FIG. 1 . 
           [0016]      FIG. 5  is a side view of the access assembly of  FIGS. 1-4  illustrating an endoscopic instrument positioned within the access assembly; 
           [0017]      FIG. 6  is a side view of the access assembly of  FIGS. 1-5  illustrating the endoscopic instrument manipulated within the access assembly; 
           [0018]      FIG. 7  is a side view of the access assembly of  FIGS. 1-6  illustrating a curved endoscopic instrument positioned within the access assembly. 
           [0019]      FIG. 8  is a side cross-sectional view of an alternate embodiment of an access assembly according to the present disclosure; 
           [0020]      FIG. 9  is a top view of the access assembly of  FIG. 8 ; and 
           [0021]      FIG. 10  is side view of the access assembly of  FIGS. 8 and 9  illustrating an endoscopic instrument positioned within the access assembly. 
       
    
    
     DETAILED DESCRIPTION  
       [0022]    Referring now to the drawings wherein like reference numerals illustrate similar components throughout the several views. As shown in the drawings and as described throughout the following description, as is traditional, when referring to relative positioning on an object, the term “proximal” refers to the end of the apparatus which is closer to the user and the term “distal” refers to the end of the apparatus which, is further from the user. 
         [0023]    With reference to  FIGS. 1-5 , an embodiment of an access assembly in accordance with the aspects of the present disclosure is shown generally as access assembly  100 . Access assembly  100  Includes base  102  and elongated member  110  extending from the base  102  and defining a longitudinal axis “y”. Access assembly  100  defines a longitudinal passageway Kit extending through the base  102  and elongated member  310 , and is adapted for receiving an endoscopic instrument. 
         [0024]    Base  102  of access assembly  100  may define a substantially flat circular member having proximal and distal surfaces  102   a,    102   b.  Base  102  includes opening  103  which forms part of longitudinal passageway  101 . Base  102  is constructed of plastic, metal or any other suitable material. As will be discussed in further detail below, base  102  is scented to elongated member  110 . Base  102  may include an adhesive ring  104  circumscribing opening  103  on distal surface  102   b.  Adhesive ring  104  may be adapted to selectively secure base  102  to a patient during an endoscopic procedure. Adhesive ring  104  may include any biocompatible adhesive suitable far selectively affixing base  102  to a patient. Adhesive ring  104  may form a seal between the patient and base  102  to prevent she escape of insufflation gas from within the cavity of the patient. It is envisioned, however, that distal surface  102   b  of base  102  may include a second ring (not shown) configured to form a seal between base  102  and the patient. 
         [0025]    Elongated member  110  includes a flexible tapered sleeve  111  having substantially open proximal end  110   a,  and distal end  110   b  which is capable of assuming an open or closed position in the presence or absence of a surgical instrument, respectively. Tapered sleeve  111  is substantially tapered along a length thereof. Proximal end  110   a  is securely affixed to distal surface  102   b  of base  102  in any suitable manner, including, but not limited to, welding, adhesives and mechanical fasteners. Elongated member  110  is constructed from an elastomeric material that is capable of stretching to receive an endoscopic instrument therethrough, in one embodiment, elongated member  110  may include a tubular fabric coated or impregnated with an elastomeric material, This arrangement is disclosed in commonly assigned U.S. patent application Ser. No. 10/067,056, bled Oct. 15, 2004, the entire contents of which is incorporated herein by reference. Elongated member  110  may be fabricated from any material which is capable of receiving a surgical instrument “I” and radially expanding to permit passage of the surgical instrument “I” in sealed relation. Some suitable materials include medical grade polymers and metals. In an exemplary embodiment, elongated member  110  includes a braided material of inelastic filaments covered by an elastomeric membrane of, e.g., urethane, or any elastomeric material or as generally disclosed in commonly assigned U.S. Pat. Nos. 5,431,676 and 6,245,052, the entire contents of each being incorporated herein by reference. Elongated member  110  is adapted to form, a seal about the endoscopic instrument to substantially prevent the egress or release of insufflation gases or fluids about the instrument. Elongated seal member  110  may receive instruments of different and varying diameters and/or instruments having curved or bent lengths. Due to its resilient characteristics, elongated member  110  further permits greater manipulation of endoscopic instrument “I” within the elongated member  110  providing a large degree of off-axis or angulated movement of the instrument relative to conventional inflexible cannulas. 
         [0026]    With particular reference to  FIG. 1 , in an initial or pre-stretched condition, elongated member  110  defines a roiled or spiraled configuration about an axis “z” that is transverse to longitudinal axis “y”. This arrangement may assist in establishing a seal within longitudinal passageway  101  of access member  100 . In addition, distal end  110   b  of elongated member  110  may be adapted to form a zero closure seal, such that in the absence of an endoscopic instrument, distal end  110   b  is sealed. Thus, the spiraled or rolled, configuration of elongated member  110 , in conjunction with the ability of distal end  110   b.  to close, provides a substantial seal within access assembly  100  when access assembly  100  is not in use receiving an endoscopic instrument and increases the integrity of the seal defined within access assembly  100 . Alternatively, distal end  110   b  of elongated member  110  may be partially open, whereby the roiling of elongated member  110  establishes the seal within access assembly  100 .  FIG. 2  illustrates elongated member  111  in the stretched or unrolled position which is assumed upon introduction of the surgical instrument. This rolled configuration may be preset during manufacture, e.g., set in the robed configuration during curing of the elastomer. In the alternative, elongated member  110  may be a shape memory material adapted to assume the rolled configuration upon exposure to a predefined temperature, e.g. body temperature. Such shape memory materials capable of performing in this manner are appreciated by one skilled in the art. 
         [0027]    Elongated member  110  thus can serve its both the zero closure seal and the instrument seal for access assembly  100 , and removes the necessity of positioning these seals within housing or base  102 . As a consequence, base  102  may be reduced in height. This reduced height or profile will increase the operating area available above the patient to improve instrument maneuverability, thereby potentially facilitating completion of the surgical procedure. 
         [0028]    Access assembly  100  will be discussed in the terms of use of the assembly  100  in a laparoscopic surgery. The abdominal cavity is insufflated with a suitable gas, e.g., CO 2  gas, as is conventional and in the art. In one method, a Veress needle may be introduced within access assembly  100  and advanced through longitudinal passage  101  to cause elongated member to unroll from the condition depicted in  FIG. 1  to the condition depicted in  FIG. 2 . Thereafter, (he Veress needle with mounted access assembly  100  is advanced within the abdominal cavity. The Veress needle is flu idly coupled to a source insufflation gases to insufflate the body cavity. The Veress needle is removed leaving elongated member  110  of access assembly  100  in position accessing the body cavity. Upon removal, of the Veress needle, elongated member  110  assumes the coiled or roiled configuration of  FIG. 1 . In this condition, elongated member  110  is substantially sealed preventing escape of gases through access assembly  100 . Thereafter, a surgical instrument is advanced through longitudinal passage  101  of access assembly  100  causing elongated member to assume the substantially linear condition of  FIG. 2 . Elongated member  110  establishes a seal about the instrument.  FIG. 5  illustrates surgical instrument “I” positioned within access assembly  100 . 
         [0029]    Due to its elastomeric characteristics, surgical Instrument may be angulated relative to longitudinal axis “y” of seat housing during performance of the procedure. The degree of angulation is significantly greater than inflexible cannula assemblies.  FIG. 6  illustrates lateral offset movement of the surgical instrument. As appreciated, this tea turn permits access to tissue remote from access assembly  100  thereby potentially reducing the number of cannula assemblies required to perform the procedure. During angulation, elongated member  110  maintains a seal about the surgical instrument. 
         [0030]    With reference now to  FIGS. 5-7 , when an endoscopic instrument “I” is inserted into opening  103  of base  102 , elongated member  110  unrolls and stretches radially to accommodate instrument “I”. Once received within elongated member  110 , instrument “I” may be manipulated as desired. The low profile of base  102  and the configuration of elongated member  110  permit instrument “I” to be manipulated to a greater degree than an instrument inserted through a convention access assembly. The internal surface of elongated member  110  and/or the external surface of instrument “I” may be coated with silicone or other suitable substance to facilitate insertion and removal of instrument “I” from within elongated member  110 . Removal of instrument “I” causes elongated member  110  to return to the initial, pre-stretched condition wherein the elongated member  110  rolls upon itself to create a seal. Access assembly  100  may be installed using a veress needle or standard obturator. 
         [0031]    Referring now to  FIGS. 8-10 , an alternate embodiment of an access assembly according to the present disclosure is shown generally as access assembly  200 . Access assembly  200  is substantially similar to access assembly  100  described hereinabove, and will only be described as relates to the differences therebetween. Access assembly  200  includes a base  202  and elongated member  210 . 
         [0032]    With continued reference to  FIGS. 8-10 , base  202  includes proximal and distal surfaces  202   a.    202   b  and defines opening  203  sized to receive an endoscopic instrument. Opening  203  may includes sloped edges for assisting in receipt of instrument “I” and/or for increasing the range of manipulation of endoscopic instrument “I”. Base  202  includes sealing ring  205  mounted on distal surface  202   b  and about opening  203  for maintaining a seal between the patient and access assembly  200 , Base  202  may alternately or further include adhesive pads  204  spaced about distal surface  202   b  for selectively securing base  202  to a patient. Base  202  further includes suture tie down members  206 . Suture tie down members  206  may include recesses  208  and/or tabs  209 . Recesses  208  are formed in and extend about the perimeter of base  202  and include openings  208   a  therein for receiving sutures. In this manner, a surgeon may secure access assembly  200  to a patient utilizing sutures placed through openings  208   a  in recesses  208 . Alternatively, suture tie down members  206  may include tabs  209 . Tabs  209  function in a manner similar to recess  208 , permitting a surgeon to secure base  202  to a patient with sutures. 
         [0033]    With reference to  FIGS. 8 and 10 , seal member  210  may include one or more support members  215  extending the length thereof. Support member  215  may include a flexible metal wire, plastic strip or other suitable material. Support member  215  is securely attached to elongated member  210  and may alternately be integrally formed therewith. Support member  215  may be configured to roll elongated member  210  upon itself in the absences of endoscopic instrument “I” being inserted therethrough. In this manner, support member  215  ensures that elongated member  210  creates a seal. Support member  215  may further be configured to prevent the inversion of elongated member  210  as endoscopic instrument “I” is removed horn access assembly  200 . 
         [0034]    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.