Abstract:
A surgical portal assembly includes a portal member adapted for positioning within a tissue tract and defining a longitudinal axis with leading and trailing ends. The portal member includes at least one longitudinal port for passage of an object. The portal member comprises a compressible material adapted to transition between a first expanded condition to facilitate securing of the portal within the tissue tract and in substantial sealed relation with tissue surfaces defining the tissue tract, and a second compressed condition to facilitate at least partial insertion of the portal within the tissue tract. The portal assembly also includes an elongated member extending through the at least one longitudinal port and mechanically couplable to the portal member adjacent the leading end thereof. The elongated member is adapted to move through the at least one longitudinal port in a trailing direction to exert a compressive force at least adjacent the leading end to cause the portal member to transition toward the compressed condition.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
     The present application claims the benefit of and priority to U.S. Provisional Application Ser. No. 61/164,971 filed on Mar. 31, 2009, the entire contents of which are incorporated herein by reference. 
    
    
     BACKGROUND 
     1. Technical Field 
     The present disclosure relates generally to ports for use in minimally invasive surgical procedures, such as endoscopic and/or laparoscopic procedures, and more particularly, relates to an access port and an associated introducer mechanism to assist in deploying the port within a tissue tract of a patient. 
     2. Description of Related Art 
     Minimally invasive surgery is a type of surgery performed through one or more small incisions in a patient&#39;s body, usually less than an inch in dimension. Some advantages of minimal invasive surgery is that patients have less trauma to the body, lose less blood, have smaller surgical scars, and need less pain medication. 
     During a typical minimally invasive procedure, surgical objects, such as surgical access devices, e.g., trocar and cannula assemblies, or endoscopes, are inserted into the patient&#39;s body through the incision in tissue. In general, prior to the introduction of the surgical object into the patient&#39;s body, insufflation gasses are used to enlarge the area surrounding the target surgical site to create a larger, more accessible work area. Accordingly, the maintenance of a substantially fluid-tight seal is desirable so as to prevent the escape of the insufflation gases and the deflation or collapse of the enlarged surgical site. 
     To this end, various ports with valves and seals are used during the course of minimally invasive procedures and are widely known in the art. However, a continuing need exists for an access pot and associated introducer mechanism which can position the access port with relative ease and with minor inconvenience for the surgeon. 
     SUMMARY 
     Accordingly, in accordance with one embodiment of the present disclosure, a surgical portal assembly includes a portal member adapted for positioning within a tissue tract and defining a longitudinal axis with leading and trailing ends. The portal member includes at least one longitudinal port for passage of an object. The portal member comprises a compressible material adapted to transition between a first expanded condition to facilitate securing of the portal within the tissue tract and in substantial sealed relation with tissue surfaces defining the tissue tract, and a second compressed condition to facilitate at least partial insertion of the portal within the tissue tract. An elongated member extends through the at least one longitudinal port and is mechanically couplable to the portal member adjacent the leading end thereof. The elongated member is adapted to move through the at least one longitudinal port in a trailing direction to exert a compressive force at least adjacent the leading end to cause the portal member to transition toward the compressed condition. The portal member may include first and second longitudinal ports having respective first and second elongated members extending therethrough and being attachable to the portal member adjacent the leading end thereof. The first and second elongated members are adapted to move through the respective first and second longitudinal ports in the trailing direction to cause the portal member to transition toward the compressed condition. The portal may include a third longitudinal port with a third elongated member extending therethrough and being attachable to the portal member adjacent the leading end thereof. The third elongated member is adapted to move through the third longitudinal port in the trailing direction to cause the portal member to transition toward the compressed condition. 
     Other embodiments and a method of use of the portal assembly are also envisioned. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The above and other aspects, features, and advantages of the present disclosure will become more apparent in light of the following detailed description when taken in conjunction with the accompanying drawings in which: 
         FIG. 1A  is a perspective view of an surgical portal assembly in accordance with the principles of the present disclosure illustrating the portal member and the elongated constraining members extending through the portal member; 
         FIG. 1B  is a longitudinal cross-sectional view of the surgical portal assembly of  FIG. 1A  illustrating the portal member in a first expanded condition; 
         FIG. 1C  is a longitudinal cross-sectional view of the surgical portal assembly of  FIGS. 1A and 1B  illustrating the portal member in a second compressed condition and being inserted within a tissue tract of a patient; 
         FIG. 2A  is a longitudinal cross-sectional view of a surgical portal assembly in accordance with another embodiment of the present disclosure illustrating the portal member in a first expanded condition; 
         FIG. 2B  is a longitudinal cross-sectional view of the surgical portal assembly of  FIG. 2A  showing the surgical portal assembly being deployed within a tissue tract of a patient illustrating the portal member in a second compressed condition and being inserted within a tissue tract of a patient; and 
         FIG. 2C  is a longitudinal cross-sectional view of the surgical portal assembly of  FIGS. 2A and 2B  illustrating the portal member deployed within a tissue tract; 
         FIG. 3A  is a perspective view of another embodiment of the surgical portal assembly in accordance with another embodiment of the present disclosure illustrating the portal member in a normal expanded condition; 
         FIG. 3B  is a perspective view of the surgical portal assembly of  FIG. 3B  with at least the leading end of the portal member in a compressed condition; 
         FIG. 3C  is a longitudinal cross-sectional view of the surgical portal assembly of  FIG. 3A ; 
         FIGS. 4A-4B  are views of the constraining member of the surgical portal assembly of  FIG. 3A ; and 
         FIGS. 5A-5B  are views of another embodiment of the surgical portal assembly illustrating the portal member in respective expanded and contracted conditions. 
     
    
    
     DETAILED DESCRIPTION 
     Particular embodiments of the present disclosure will be described herein with reference to the accompanying drawings. As shown in the drawings and as described throughout the following description, and as is traditional when referring to relative positioning on an object, the term “proximal” or “trailing” refers to the end of the apparatus that is closer to the user and the term “distal” or “leading” refers to the end of the apparatus that is further from the user. In the following description, well-known functions or constructions are not described in detail to avoid obscuring the present disclosure in unnecessary detail. 
     One type of minimal invasive surgery described herein is referred to as a single-incision laparoscopic surgery (SILS). SILS is an advanced minimally invasive surgical procedure which would permit a surgeon to operate through a single entry point, typically the patient&#39;s navel. The disclosed SILS procedure involves insufflating the body cavity and positioning a port within, e.g., the navel of the patient. Instruments including an endoscope and additional instruments such as graspers, staplers, forceps or the like may be introduced within the port to carry out the surgical procedure. 
     The port assembly in the SILS procedure may be introduced into an incision with a Kelly clamp. However, the Kelly clamp may limit the surgeon&#39;s ability to properly place a SILS port due to the limited length of the Kelly clamp&#39;s arm and handle. Furthermore, visibility may become an issue due to the presence of the clamp and the surgeon&#39;s hand holding the clamp. Removal of the Kelly clamp subsequent to placement of the port may also present undesired obstacles. 
     Referring now to the drawings, in which like reference numerals identify identical or substantially similar parts throughout the several views,  FIGS. 1A and 1B  illustrate a port assembly  100  in accordance with the principles of the present disclosure. Port assembly  100  includes a portal member  102  having including at least one longitudinal port  108 , possibly, a plurality of longitudinal ports  108  extending along the axis “k” of the portal member  102 . One or more elongated constraining members  120  extend through the longitudinal ports  108 . At least one or more inner longitudinal ports  108  are dimensioned to receive a surgical object (not shown) therethrough. The portal member  102  has a proximal trailing end  104  having a first dimension D 1  and a distal leading end  106  having a second dimension D 2  when the portal member  102  is in a normal expanded condition. The portal member  102  may be made from a disposable, compressible, and/or flexible type material, for example, but not limited to, a suitable foam or gel material having sufficient compliance to form a seal about one or more surgical objects, shown generally as surgical object, and also establish a sealing relation with the tissue. The foam is preferably sufficiently compliant to accommodate off axis motion of the surgical object. In one embodiment, the foam includes a polyisoprene material. Suitable portal members are disclosed in commonly assigned U.S. patent application Ser. No. 12/244,024, filed Oct. 2, 2008, the entire contents of which is hereby incorporated by reference herein. 
     Each elongated member  120  has a first end  122  and a second end  124 . Elongated member  124  spans the length of the portal member  102 . The first end  122  of the elongated member  120  is positioned at the proximal trailing end  104  of the portal member  102 , while the second end  124  of the elongated member  120  is attached to the distal leading end  106  of the portal member  102 . The elongated member  120  may be attached to the distal leading end  106  of the portal member  102  by any suitable attaching technique, such as for example, gluing, stapling and suturing. Further, the elongated member  120  may be made from any suitable material, for example, but not limited to, plastic, metal, and shape-memory alloy. 
     Turning now to  FIG. 1C , the second dimension D 2  defined by distal leading end  106  is configured to decrease, to a shorter diameter or length D 2 ′. This occurs when the first end  122  of each elongated member  120  is pulled in a proximal trailing direction, depicted by directional arrow A, by a clinician, thereby also pulling second end  124 . In this manner, the distal leading end  106  is pulled towards the center of the portal member  102 , which movement is depicted by a directional arrow B, since the second end  124  of the elongated member  120  is attached to the distal leading end  106 . 
       FIG. 1A  illustrates, in an exemplary embodiment, the surgical portal assembly  102  having three (3) elongated members passed through each respective longitudinal port  108 . However, one skilled in the art will appreciate that any number of elongated members and longitudinal ports may be used and implemented with the surgical portal assembly  100 . Thus, the surgical portal assembly  100  may further include one or more outer longitudinal ports  108  that are defined within the portal member  102  and are configured to contain one or more elongated members  120 . As discussed above, the elongated member may be coupled to an outer portion of the distal leading end  124  of the portal member  102 . Any means for coupling elongated member  120  to portal member  102  are envisioned including cements, adhesives, welding or the like. It is also envisioned that elongated member  120  may be releasably connected to portal member  102  whereby pulling on the elongated member  120  to exert a force which exceeds a predetermine value will cause release of the elongated member  120  from the portal member  102 . Instruments may be introduced within longitudinal ports  108  when the elongated members  120  are removed. As a further alternative, an instrument may be positioned within a longitudinal port  108  in the presence of an elongated member  120 . The compressive material of fabrication of portal member  102  will ensure that a seal is established and maintained about the instrument. 
     Portal member  102  may include a substantially annular ring  140  of spring material, such as stainless steel or a shape memory material. Annular ring  140  may deform or compress when distal leading end  206  of portal member  202  is compressed, and returns to its normal annular shape upon release of the first end  122  of elongated member  120 , thus biasing distal leading end  106  to its normal state of  FIG. 1B . Annular ring  140  may be embedded within or attached to portal member  102  during manufacture. 
     In accordance with the present disclosure, a method of introducing a surgical portal assembly is provided. Referring back to  FIGS. 1A-1C , in an initial step of the method, a surgical portal assembly, as described above, is provided to a surgical site. In a next step, the first end  122  of each elongated member  120  is pulled in a proximal trailing direction, as depicted by directional arrow A, such that the second dimension D 2  of the distal leading end  106  compresses and decreases to a smaller dimension D 2 ′. Thereafter, the surgical portal assembly  100  is deployed into a tissue tract T of a patient, which has been previously prepared by a clinician. In a following step, the first end  122  of the elongated member  120  is released by a user such that the smaller second dimension D 2 ′ of the distal leading end  106  increases to a larger second dimension D 2 , i.e., the portal member returns to its normal expanded condition with distal leading end  106  expanding to substantially secure the surgical portal assembly  100  at a desired surgical location within a tissue tract T. The presence of annular ring  140  may facilitate this transformation as discussed hereinabove. 
     In another exemplary embodiment, shown in  FIGS. 2A-2C , one or more elongated members may continuously run along the length of an outer surface of the portal member  202  and back up through a respective longitudinal ports  230  of the portal member. In this configuration, each first and second ends  222 ,  224  of respective elongated members  220  is adjacent to proximal trailing end  204  of a portal member  202 . In disclosed embodiments, each elongated member  220  may have an irregular surface or grip portion  226  that may mechanically couple to a distal leading end  206  of the portal member  202 . For example, the grip portion  226  of the elongated member  220  may contain a barbed texture, a hook and loop fastener, or any suitable irregularly surfaced material. 
     To introduce the portal member within the incision, e.g., in the navel, the first or inner end  222  of each elongated member  220  is pulled in a proximal trailing direction, depicted by directional arrow A, such that the second dimension D 2  of the distal leading end  206  decreases to smaller dimension D 2 ′. The surgical portal assembly is inserted into a tissue tract T of a patient. Thereafter, the second end  224  of each elongated member  220  is pulled in a proximal trailing direction, depicted by directional arrow A, such that the second smaller dimension D 2 ′ of the distal leading end  206  increases to a second larger dimension D 2 , thus the distal leading end  206  of the surgical portal assembly  200  is substantially secured in the tissue tract T of the patient. Instruments may be introduced within central passage  208  or any of the longitudinal ports  230  to perform the desired procedure. In this embodiment, portal member  202  may also comprises a malleable material such that distal leading end  206  returns to its normal uncompressed condition in response to movement of second ends  224 . Such malleable materials are inclusive of metals which may be embedded within the resilient compressible foam. In the alternative, portal member  202  be composed entirely of the malleable material. 
       FIGS. 3A-3B  illustrate an alternate embodiment of the present disclosure. In accordance with this embodiment, portal apparatus  300  includes portal member  302  having a plurality of longitudinal ports  304  for reception and passage of instrumentation in substantial fluid tight relation therewith and constricting element  306 . Constricting element  306  may be attached, secured, or embedded within leading end  308  of portal member  302  by conventional means. Constricting element  306  may define an annular shape either circumscribing or extending around a peripheral segment of leading end  308  of portal member  302 . Constricting element  306  further includes a lock  310  which secures the constricting element  306  in at least one defined annular or diametrical configuration. In one embodiment, constricting element may be secured via lock  310  to define a plurality of different sized annular loops. One suitable apparatus which may be adapted or modified for use with portal member  302  as a constricting element  306  and associated lock  310  is the serrated strap disclosed in commonly assigned U.S. Pat. No. 5,462,542 to Alesi, the entire contents of which are hereby incorporated in its entirety by reference herein. This serrated strap  350  is depicted in  FIGS. 4A and 4B . Strap  350  includes buckle  352  and strap member  354  extending from the buckle  352 . The buckle  352  includes base  356  and pawl  358  pivotally mounted and adapted to selectively engage pawl teeth  360  of strap member  354  as the strap member  354  is pulled through the buckle  352  while reducing the internal dimension of the loop created by the strap member  354 . As one modification to strap  350 , a release member  362  may be secured to pawl  358  of buckle  352  (see also  FIG. 3C ). Pawl  358  may be detachably connectable to base  356  within buckle  352  by, e.g., creating a zone or line of perforation  364  adjacent the location where the pawl  358  is connected to the base  356 . Thus, application of a force via release member  362  will cause pawl  358  to become detached from base  356  thereby releasing strap member  354  and permitting leading end  308  to assume its normal expanded condition. In the alternative, release member  362  may be permanently secured to pawl  358  whereby the release member  362  will cause release of the pawl  358  (in direction “y”) from pawl teeth  360  of strap member  354  without detachment of the pawl  358 , while still releasing strap member  354  and permitting leading flange to assume its normal expanded condition. 
       FIGS. 5A-5B  illustrate another embodiment of the portal apparatus of the present disclosure. Portal apparatus  400  includes portal member  402  of similar design to the aforedescribed portal members. Portal member  402  may include leading and trailing flanges  404 ,  406  which may secure the portal member  402  on opposed sides of a cavity wall, e.g., the peritoneal cavity wall. Flanges  404 ,  406  may be separate or monolithically formed with portal member  402 . Portal apparatus  400  further includes cinch member  408  attached, secured or otherwise embedded within leading flange  404  of portal member  402  around at least a portion of the leading flange  404 . At least one, e.g., two leads  410 , are connected to cinch member  408  with the free ends of the leads  410  extending through at least one longitudinal passageway  412  of portal member  402 . Leads  410  may be pulled in a proximal direction “z” away from cinch member  408  to reduce the effective diameter of the cinch member  408  and cause contraction of the annular configuration or shape of leading flange  404 . When in the contracted condition of  FIG. 5B , leading flange  404  is first introduced within the tissue tract followed by insertion of the portal member  402 . Once appropriately positioned relative to the tissue, e.g. abdominal wall, the free ends of leads  410  are released permitting leading flange  404  to expand to its normal condition of  FIG. 5A . In this position, leading flange  404  may abut the internal surface of peritoneal cavity and outer flange  406  may abut the dermal tissue segments. 
     While several embodiments of the disclosure have been shown in the drawings and/or discussed herein, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Therefore, the above description should not be construed as limiting, but merely as exemplifications of particular embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.