Abstract:
A surgical device is provided including an access port having a tubular member with a first ring secured at a proximal end and a second ring secured at a distal end; an articulation structure having an outer tube and an inner tube; and a control mechanism coupled to one end of the inner tube for advancing the inner tube through the outer tube; wherein the outer tube includes at least one rigid section and at least one flexible section and the inner tube includes at least two pre-bent sections.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a divisional of U.S. patent application Ser. No. 13/735,075 filed Jan. 7, 2013, which claims benefit of U.S. Provisional Application No. 61/584,713 filed Jan. 9, 2012, and the disclosures of each of the above-identified applications are hereby incorporated by reference in their entirety. 
     
    
     BACKGROUND 
       [0002]    1. Technical Field 
         [0003]    The present disclosure relates to an apparatus and method for accessing a body cavity. More particularly, the present disclosure relates to a surgical device including an access assembly in operative association with at least one pre-bent tube. 
         [0004]    2. Background of Related Art 
         [0005]    Today, many surgical procedures are performed through small incisions in the skin, as compared to the larger incisions typically required in traditional procedures, in an effort to reduce both trauma to the patient and recovery time. Generally, such procedures are referred to as “endoscopic,” unless performed on the patient&#39;s abdomen, in which case the procedure is referred to as “laparoscopic.” Throughout the present disclosure, the term “minimally invasive” should be understood to encompass both endoscopic and laparoscopic procedures. 
         [0006]    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. 
         [0007]    To this end, various 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 a seal anchor member that can be inserted directly into the incision in tissue and that can accommodate a variety of surgical objects while maintaining the integrity of an insufflated workspace. 
       SUMMARY 
       [0008]    Accordingly, an improved surgical apparatus is provided. The surgical apparatus includes an access port having a tubular member with a first ring secured at a proximal end and a second ring secured at a distal end. The surgical apparatus further includes an articulation structure having an outer tube and an inner tube and a control mechanism coupled to one end of the inner tube for advancing the inner tube through the outer tube. The outer tube includes at least one rigid section and at least one flexible section and the inner tube includes at least two pre-bent sections. 
         [0009]    The inner tube is configured to slidably engage and advance through the outer tube. The inner tube and the outer tube are coaxial. The inner tube defines at least one channel for receiving at least one surgical instrument. 
         [0010]    In another exemplary embodiment, the inner tube includes at least two channels. One of the at least two channels is used for smoke evacuation from a surgical site. 
         [0011]    In another exemplary embodiment, at least one pre-bent section of the inner tube causes a like direction bend of the flexible section of the outer tube, when the at least one pre-bent section engages the flexible section. Additionally, at least one pre-bent section of the inner tube causes the flexible section of the outer tube to bend in any direction based on rotation of the control mechanism, when the at least one pre-bent section engages the flexible section. 
         [0012]    The control mechanism is configured to rotate the inner tube 360° degrees. 
         [0013]    In yet another exemplary embodiment, the outer tube has two rigid sections of substantially equal length separated by the flexible section. Additionally, the outer tube has two rigid sections separated by the flexible section, at least one of which is substantially equal in length to a length of the flexible section. 
         [0014]    In another exemplary embodiment, an improved surgical apparatus is provided. The surgical apparatus includes an access port having a tubular member with a first ring secured at a proximal end and a second ring secured at a distal end and an instrument guide device including (i) an outer member having a proximal end and a distal end, the proximal and distal ends being rigid sections connected to each other via a flexible section and (ii) an inner member having at least two rigid bends and at least one channel extending therethrough. The inner member is adapted to be inserted through and slidably engage the outer member such that at least one rigid bend of the inner member engages the flexible section of the outer member. 
         [0015]    Also provided is an articulation method. The method includes the steps of providing an access port having a tubular member with a first ring secured at a proximal end and a second ring secured at a distal end and providing an articulation mechanism including: an outer member having a proximal end and a distal end, the proximal and distal ends being rigid sections connected to each other via a flexible section and an inner member having at least two rigid bends and at least one channel extending therethrough. The inner member is adapted to be inserted through and slidably engage the outer member such that at least one rigid bend of the inner member engages the flexible section of the outer member. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0016]    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: 
           [0017]      FIG. 1  is a front perspective view of a surgical apparatus in accordance with the present disclosure shown in an expanded condition illustrating a seal anchor member positioned relative to the tissue; 
           [0018]      FIGS. 2A-2C  are side views of the outer tube shown in straight and bent configurations, in accordance with the present disclosure; 
           [0019]      FIG. 3  is a side view of the inner tube having two pre-bent portions, in accordance with the present disclosure; 
           [0020]      FIG. 4A  is a front perspective view of the seal anchor member shown in the expanded condition and subsequent to its insertion into the incision, in accordance with the present disclosure; 
           [0021]      FIG. 4B  is a front perspective view of the seal anchor member shown in the expanded condition and subsequent to its insertion into the incision, with the inner and outer tubes inserted therethrough, in accordance with the present disclosure; 
           [0022]      FIG. 4C  is a front perspective view of the seal anchor member shown in the expanded condition and subsequent to its insertion into the incision, with the inner tube inserted entirely therethrough such that a distal end of the inner tube exits the seal anchor member, in accordance with the present disclosure; 
           [0023]      FIG. 5A  is a cross-sectional view of the tube configuration depicting an outer tube, a single inner tube slidably engaging the outer tube, and a surgical instrument inserted therethrough, in accordance with the present disclosure; and 
           [0024]      FIG. 5B  is a cross-sectional view of the tube configuration depicting an outer tube, a double slot inner tube slidably engaging the outer tube, and surgical instruments inserted therethrough, in accordance with the present disclosure. 
       
    
    
     DETAILED DESCRIPTION 
       [0025]    The access ports of the present disclosure, either alone or in combination with a cannula assembly, provide a substantially fluid-tight seal between a body cavity of a patient and the outside atmosphere. The access ports, or seal assemblies, of the present disclosure are configured to receive surgical instruments of varying diameter. Various surgical procedures contemplated include laparoscopic and arthroscopic surgical procedures. 
         [0026]    The access ports of the present disclosure contemplate the introduction of various types of instrumentation adapted for insertion through a trocar and/or cannula assembly while maintaining a substantially fluid-tight interface about the instrument to help preserve the atmospheric integrity of a surgical procedure from gas and/or fluid leakage. Examples of instrumentation include, but are not limited to, clip appliers, graspers, dissectors, retractors, staplers, laser probes, photographic devices, endoscopes and laparoscopes, tubes, and the like. Such instruments will collectively be referred to as “instruments” or “instrumentation.” 
         [0027]    Embodiments of the presently disclosed apparatus will now be described in detail with reference to the drawings, in which like reference numerals designate identical or corresponding elements in each of the several views. As used herein, the term “distal” refers to that portion of the tool, or component thereof which is further from the user while the term “proximal” refers to that portion of the tool or component thereof which is closer to the user. While the use of the access assembly is often described herein as engaging an incision, it should be recognized that this is merely exemplary and is not intended to limit the use of the assembly in any way, but rather it should be recognized that the present disclosure is intended to be useable in all instances in situations in which the access assembly engages an incision, a naturally occurring orifice, or any other suitable opening. The port is usable through an incision or through a naturally occurring orifice. 
         [0028]    Referring to  FIGS. 1-4B , a surgical apparatus  10  for use in a surgical procedure, e.g., a minimally invasive procedure is illustrated. Surgical apparatus  10  includes seal anchor member  100  (or access assembly or access port) defining a longitudinal axis “A” and having respective trailing (or proximal) and leading (or distal) ends  102 ,  104  and an intermediate portion  106  disposed between the trailing and leading ends  102 ,  104 . Seal anchor member  100  includes one or more ports  108  that extend longitudinally between trailing and leading ends  102 ,  104 , respectively, and through seal anchor member  100 . 
         [0029]    Seal anchor member  100  is preferably formed from a suitable foam material having sufficient compliance to form a seal about one or more surgical objects, and also establish a sealing relation with the tissue, “T.” 
         [0030]    Proximal end  102  of seal anchor member  100  defines a first diameter D 1  and distal end  104  defines a second diameter D 2 . In one embodiment of seal anchor member  100 , the respective first and second diameters D 1 , D 2  of the proximal and distal ends  102 ,  104  are substantially equivalent, as seen in  FIG. 1 , although an embodiment of seal anchor member  100  in which diameters D 1 , D 2  are different is also within the scope of the present disclosure. As depicted in  FIG. 1 , proximal and distal ends  102 ,  104  define substantially planar surfaces. However, embodiments are also contemplated herein in which either or both of proximal and distal ends  102 ,  104 , respectively, define surfaces that are substantially arcuate to assist in the insertion of seal anchor member  100  within a tissue tract  12  defined by tissue surfaces  14  and formed in tissue “T,” e.g., an incision, as discussed in further detail below. 
         [0031]    Intermediate portion  106  defines a radial dimension “R” and extends longitudinally between proximal and distal ends  102 ,  104 , respectively, to define an axial dimension or length “L.” The radial dimension “R” of intermediate portion  106  varies along the axial dimension, or length, “L” thereof. Accordingly, seal anchor member  100  defines a cross-sectional dimension that varies along its length “L,” which facilitates the anchoring of seal anchor member  100  within tissue “T,” as discussed in further detail below. However, an embodiment of seal anchor member  100  in which the radial dimension “R” remains substantially uniform along the axial dimension “L” thereof is also within the scope of the present disclosure. 
         [0032]    The radial dimension “R” of intermediate portion  106  is appreciably less than the respective diameters D 1 , D 2  of proximal and distal ends  102 ,  104  such that seal anchor member  100  defines an “hour-glass” shape or configuration to assist in anchoring seal anchor member  100  within tissue “T,” as discussed in further detail below. However, in an alternate embodiment, the radial dimension “R” of intermediate portion  106  may be substantially equivalent to the respective diameters D 1 , D 2  of proximal and distal ends  102 ,  104 . In cross section, intermediate portion  106  may exhibit any suitable configuration, e.g., substantially circular, oval or oblong. 
         [0033]    Referring now to  FIGS. 1 and 4A , seal anchor member  100  is adapted to transition from an expanded condition to a compressed condition so as to facilitate the insertion and securement thereof within tissue tract  12  in tissue “T.” In the expanded condition, seal anchor member  100  is at rest and the respective radial dimensions D 1 , D 2  of the proximal and distal ends  102 ,  104  of seal anchor member  100 , as well as the radial dimension R of the intermediate portion  106  are such that the seal anchor member  100  cannot be inserted within tissue tract  12 . However, in the compressed condition, proximal and distal ends  102 ,  104  of seal anchor member  100 , as well as intermediate portion  106  are dimensioned for insertion into tissue tract  12 . 
         [0034]    Seal anchor member  100  may be formed of a biocompatible compressible material that facilitates the resilient, reciprocal transitioning of seal anchor member  100  between the expanded and compressed conditions thereof. In one embodiment, the compressible material is a “memory” foam. An external force may be applied to seal anchor member  100  to cause the seal anchor member  100  to assume the compressed condition. The external force may be directed inwardly and when seal anchor member  100  is subjected thereto, e.g., when seal anchor member  100  is squeezed, seal anchor member  100  undergoes an appreciable measure of deformation, thereby transitioning into the compressed condition. 
         [0035]    Referring again to  FIG. 1 , one or more positioning members  114  may be associated with either or both of trailing (or proximal) end  102  and distal (or leading) end  104  of seal anchor member  100 . Positioning members  114  may be composed of any suitable biocompatible material that is at least semi-resilient such that positioning members  114  may be resiliently deformed and may exhibit any suitable configuration, e.g., substantially annular or oval. 
         [0036]    Prior to the insertion of seal anchor member  100 , positioning members  114  are deformed in conjunction with the respective proximal and distal ends  102 ,  104  of seal anchor member  100  to facilitate the advancement thereof through tissue tract  12  ( FIG. 4A ). Subsequent to the insertion of seal anchor member  100  within tissue tract  12 , the resilient nature of positioning members  114  allows positioning members to return to their normal, substantially annular configuration, thereby aiding in the expansion of either or both of the respective proximal and distal ends  102 ,  104  and facilitating the transition of seal anchor member  100  from its compressed condition to its expanded condition. Positioning members  114  also may engage the walls defining the body cavity to further facilitate securement of seal anchor member  100  within the body tissue. For example, positioning member  114  at leading end  104  may engage the internal peritoneal wall and positioning member  114  adjacent trailing end  102  may engage the outer epidermal tissue adjacent the incision  12  within tissue “T.” In another embodiment of seal anchor member  100 , one or more additional positioning members  114  may be associated with intermediate portion  106 . 
         [0037]    In use, the peritoneal cavity (not shown) is insufflated with a suitable biocompatible gas such as, e.g., CO 2  gas, such that the cavity wall is raised and lifted away from the internal organs and tissue housed therein, providing greater access thereto. The insufflation may be performed with an insufflation needle or similar device, as is conventional in the art. Either prior or subsequent to insufflation, a tissue tract  12  is created in tissue “T,” the dimensions of which may be varied dependent upon the nature of the procedure. 
         [0038]    Prior to the insertion of seal anchor member  100  within tissue tract  12 , seal anchor member  100  is in its expanded condition in which the dimensions thereof prohibit the insertion of seal anchor member  100  into tissue tract  12 . To facilitate insertion, the clinician transitions seal anchor member  100  into the compressed condition by applying a force “F” thereto, e.g., by squeezing seal anchor member  100 . As best depicted in the surgical apparatus  400 A of  FIG. 4A , subsequent to its insertion, distal end  104 , positioning member  114  and at least a section  112  of intermediate portion  106  are disposed beneath the tissue “T.” Seal anchor member  100  is caused to transition from the compressed condition to the expanded condition by removing force “F” therefrom. 
         [0039]    After successfully anchoring seal anchor member  100  within the patient&#39;s tissue “T,” one or more surgical objects may be inserted through ports  108 .  FIG. 4A  illustrates a surgical object introduced through one of ports  108 . As previously discussed, prior to the insertion of surgical object, port  108  is in its first state in which port  108  defines an initial dimension, in one embodiment, is a longitudinal slit. Accordingly, prior to the escape of insufflation gas through port  108 , in the absence of surgical object is minimal, thereby preserving the integrity of the insufflated workspace. 
         [0040]    Additionally, one or more surgical objects are inserted through a tube configuration, including an outer tube and an inner tube, as described with reference to  FIGS. 2A-2C  and  3 . 
         [0041]      FIGS. 2A-2C  illustrate an outer tube  200 .  FIG. 2A  illustrates the outer tube  200  in a first configuration  200 A being a straight configuration.  FIG. 2B  illustrates the outer tube  200  in a second configuration  200 B being a first bent configuration.  FIG. 2C  illustrates the outer tube  200  in a third configuration  200 C being a second bent configuration.  FIGS. 2A-2C  illustrate how the outer tube  200  may bend or flex either to the left ( FIG. 2B ) or to the right ( FIG. 2C ). Outer tube  200  includes a proximal end  210 , a distal end  220 , and a middle portion  230 . The middle portion  230  is a bendable or flexible portion. Outer tube  200  may have a diameter, D A . In one embodiment, it is contemplated that the proximal end  210  and the distal end  220  are rigid or semi-rigid sections or portions. It is also contemplated that the proximal portion  210 , the distal portion  220 , and the middle portion  230  are of substantially equal length. Therefore, the outer tube  200  may have two rigid sections  210 ,  220  of substantially equal length separated by the flexible section  230 . However, one skilled in the art may contemplate a number of different lengths for the proximal portion  210 , the distal portion  220 , and the middle portion  230 . For example, the middle portion  230  may be smaller that the rigid portions  210 ,  220 . 
         [0042]      FIG. 3  illustrates an inner tube  300  having two pre-bent portions. For example, inner tube  300  may include a proximal portion  310 , a distal portion  320 , a first bend  330 , and a second bend  340 . Thus, it is contemplated that the inner tube  300  has an “S” shaped configuration and reinforced with a rigid sleeve located between the pre-bent portions  330 ,  340 . Additionally, the inner tube  300  may be configured to slidably engage and advance through the outer tube  200  (see  FIGS. 2A-2C ). As such, the inner tube  300  and the outer tube  200  may be coaxial. 
         [0043]    Moreover, as seen in  FIGS. 5A-5B , the inner tube  300  may define at least one channel  512  for receiving at least one surgical instrument  510  as shown in  FIG. 5A  as a first configuration  500 A.  FIG. 5B  illustrates an inner tube  300  having at least two channels  522 ,  532  for receiving two surgical instruments  520 ,  530 , as shown in a second configuration  500 B. It is contemplated that at least one of the two channels  522 ,  532  shown in  FIG. 5B  may be used for smoke evacuation from the surgical site. 
         [0044]    Referring back to  FIGS. 2A-2C  and  3 , at least one pre-bent section  330 ,  340 , of the inner tube  300  may cause a like direction bend of the flexible section  230  of the outer tube  200 , when the at least one pre-bent section  330 ,  340  engages the flexible section  230 . Additionally, at least one pre-bent section  330 ,  340  of the inner tube  300  may cause the flexible section  230  of the outer tube  200  to bend in any direction based on rotation of a control mechanism  350 , when the at least one pre-bent section  330 ,  340  engages the flexible section  230  of the outer tube  200 . The control mechanism  350  may be configured to rotate the inner tube  300  by 360° degrees. 
         [0045]    In operation, when the inner tube  300  is in a retracted configuration (i.e., outside the outer tube  200 ), an instrument is also located in a straight configuration. After insertion of the instrument into the inner tube  300 , the inner tube  300  may be pushed through the outer tube  200  by a control mechanism  350 . When the inner tube  300  is extended therethrough, the pre-bent section  330  moves forward and makes a left turn of articulation (see surgical apparatus  400 B of  FIG. 4B ). At the same time, the second pre-bent section  340  moves through the flexible section  230  of the outer tube  200 , thus making a right turn of articulation. In effect, the instrument is triangulated in the form of an “S” shape. In  FIG. 4C , the inner tube is pushed further such that the distal portion  320  exits the distal end of the outer tube  200 . The second pre-bent section  340  is shown exiting the distal end of the outer tube  200 , thus changing the orientation of the flexible section  230 . 
         [0046]    When the inner tube  300  is retracted, the instrument straightens and may be removed from the outer tube  200 . As such, the inner tube  300  may be easily inserted and removed to and from the outer tube  200  at any articulated positions. As a result, the motion of articulation may be determined by extending or retracting the inner tube  300  and by rotating the outer tube  200  for a 360° triangulation. 
         [0047]    Therefore, in summary, the surgical apparatus may include an instrument guide device including (i) an outer member having a proximal end and a distal end, the proximal and distal ends being rigid sections connected to each other via a flexible section and (ii) an inner member having at least two rigid bends and at least one channel extending therethrough. The inner member is then adapted to be inserted through and slidably engage the outer member such that at least one rigid bend of the inner member engages the flexible section of the outer member. As such, at least one rigid bend of the inner member may cause a like direction bend of the flexible section of the outer member, when the at least one rigid bend engages the flexible section. Additionally, at least one rigid bend of the inner member may cause the flexible section of the outer member to bend in any direction based on rotation of a control mechanism, when the at least one rigid bend engages the flexible section. The inner member may also be connected to a control mechanism for controlling articulation of the inner member. 
         [0048]    While several embodiments of the disclosure have been shown in the drawings, 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 presently disclosed embodiments. Thus the scope of the embodiments should be determined by the appended claims and their legal equivalents, rather than by the examples given. 
         [0049]    Persons skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments. 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 disclosure. As well, one skilled in the art will appreciate further features and advantages of the present disclosure based on the above-described embodiments. Accordingly, the present disclosure is not to be limited by what has been particularly shown and described, except as indicated by the appended claims.