Abstract:
An access device for use in a minimally invasive surgical procedure is disclosed. The access device is configured and adapted to be placed within a body opening to provide access to an underlying body cavity. The access device provides protection to the opening and minimizes contamination and the risk of possible infection.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
     The present application claims the benefit of and priority to U.S. Provisional Application Ser. No. 61/615,494, filed on Mar. 26, 2012, the entire contents of which are incorporated herein by reference. 
    
    
     BACKGROUND 
     1. Technical Field 
     The present disclosure relates to an access device for use in a minimally invasive surgical procedure. In particular, the access device is placed within a tissue tract to provide access to an underlying body cavity while providing protection to the tissue tract. 
     2. Background of Related Art 
     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 an incision or a naturally occurring bodily orifice (e.g., mouth, anus, or vagina) in tissue. To facilitate access to an underlying body cavity, access devices are placed within the within the incision or the naturally occurring bodily orifice. Surgical instruments are placed through the access device. 
     While it is desirable to minimize the size of an incision or to access internal body structures through a naturally occurring orifice, adequate anatomical exposure is needed to facilitate access to the surgical site. Achieving adequate anatomical exposure can be achieved by separating the walls of the incision or the naturally occurring body orifice. Various retraction devices have been developed to facilitate access to underlying body structures. 
     As with any surgical procedure, care must be taken to inhibit the possibility of infection that may result if exposed healthy tissue comes in contact with infected or malignant tissue. For example, the spillage of tumor cell clusters may spur the growth of malignant tumors in previously unaffected areas of a patient&#39;s body in a process known as tumor seeding. In particular, the sides of a wound a susceptible to infection resulting from contamination. Various wound protection devices have been developed to protect a wound or body orifice during a surgical procedure. 
     There is a continuing need for new surgical devices that will facilitate access to a surgical site through an incision or naturally occurring bodily orifice while inhibiting contamination of surrounding tissue during the procedure. 
     SUMMARY 
     The present disclosure discloses a surgical access device that includes an outer sleeve and one or more inner sleeves that are inwardly disposed of the outer sleeve. The one or more inner sleeves are removable, one at a time, from the surgical access device such that a clean, unused sleeve can be provided without necessitating removal of the surgical access device from the surgical site. 
     In an embodiment, the surgical access device includes a proximal ring and a distal ring. The outer sleeve is operably coupled to the proximal and distal rings. The proximal and distal rings can function to draw the outer sleeve taut to create a tension in the material of the outer sleeve. This tension may facilitate maintenance of the generally tubular shape of the outer sleeve when the surgical access device is placed within the body opening within the tissue. 
     The inner sleeves are removably secured to one another and to the outer sleeve. During use, an adhesive layer between the inner sleeves and the outer sleeve can facilitate maintenance of the inner and outer sleeves in a given position relative to one another. A drawstring may be operatively coupled to each of the inner sleeves to facilitate removal of the inner sleeves by proximally translating the drawstring thereby moving the inner sleeve in a corresponding direction. 
     A method of using the surgical access device is also disclosed. During use, the surgical access device is provided and placed into a body opening. The outer sleeve of the surgical access device facilitates maintaining the body opening in an open state to facilitate access to underlying body structures through the lumen of the surgical access device. As the inner sleeves defining the lumen become contaminated with bodily debris and fluid, the inner sleeves are removed from within the lumen, thereby exposing a previously unexposed inner sleeve and providing the lumen of the surgical access device with a clean surface. Once the desired surgical procedure is completed, the surgical access device is removed from the body opening. 
     These and other features of the present disclosure will be more fully described with reference to the appended figures. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       By way of description only, embodiments of the present disclosure will be described with reference to the accompanying drawings, in which: 
         FIG. 1  is a cross-sectional view of a surgical access device in accordance with the present disclosure positioned within a tissue tract and shown in a first condition; 
         FIG. 2  is a cross-sectional view of the surgical access device of  FIG. 1  shown in a second condition; 
         FIG. 3  is a top view of an embodiment of a surgical access device in accordance with the present disclosure; 
         FIG. 4A  is a perspective view of an embodiment of a surgical access device in accordance with the present disclosure and shown in a first condition; 
         FIG. 4B  is a partially cutaway view of the surgical access device of  FIG. 4A ; 
         FIG. 5A  is a perspective view of the surgical access device of  FIG. 4A  shown relative to tissue and in an intermediate condition; 
         FIG. 5B  is the surgical access device as shown in  FIG. 5A  in a second condition; is a front view of a surgical access device in accordance with the present disclosure; 
         FIG. 6A  is a front view of an introducer device; and 
         FIG. 6B  is a front view of the introducer device of  FIG. 6A  shown placed within the surgical access device of  FIG. 1 . 
     
    
    
     DETAILED DESCRIPTION 
     Particular embodiments of the present disclosure will be described herein with reference to the accompanying drawings. In the figures and in the description that follows, in which like reference numerals identify similar or identical elements, the term “proximal” will refer to the end of the apparatus that is closest to the operator during use, while the term “distal” will refer to the end that is farthest from the operator during use. 
     A first embodiment of a surgical access device will now be described with reference to  FIGS. 1 and 2 . The surgical access device  10  is configured and adapted to be placed within a body opening “O”, e.g., a naturally occurring bodily orifice (e.g., mouth, anus, or vagina) or an incision or wound within a patient&#39;s skin “S”. The surgical access device  10  is configured and adapted to provide access to underlying body cavity “C” while providing protection to the surfaces of the body opening “O”. 
     The surgical access device  10  includes a trailing or proximal portion  5  and a leading or distal portion  3 . The proximal portion  5  of the surgical access device  10  includes a proximal ring  2 . The distal portion  3  of the surgical device  10  includes a distal ring  4 . An intermediate section  7  is positioned between the proximal portion  5  and the distal portion  3 . As shown in  FIGS. 1 and 2 , the intermediate section  7  includes an outer sleeve  8  and one or more inner sleeves  6 . The intermediate section  7  defines a lumen  11  longitudinally extending along longitudinal axis “X”. 
     The outer sleeve  8  is fixed to the proximal ring  2  and the distal ring  4 . The outer sleeve  8  may be formed from a length of flexible material that is drawn taut by spacing the proximal ring  2  apart from the distal ring  4  along longitudinal axis “X”. In embodiments, the outer sleeve  8  may be formed from a rigid, semi-rigid, or compressible material to facilitate anchoring of the seal anchor member  10  within the body opening “O”. 
     Disposed within and removably coupled to the outer sleeve  8  are one or more inner sleeves  6 . The one or more sleeves  6  are positioned between and are removably coupled to the proximal and distal rings  2 ,  4 . The one or more sleeves  6  may each be removably coupled to the proximal ring  2  at fixation point  16  and to the distal ring  4  at fixation point  14 . The one or more inner sleeves  6  may be formed from a flexible material that is drawn taut by the proximal and distal ring  2 ,  4 . Each inner sleeve  6  may be removably coupled to fixation points  14 ,  16  by an adhesive. When drawn taut, the one or more inner sleeves  6  are tensioned and will resist deformation, thereby maintaining a generally cylindrical shape. 
     In an embodiment, as shown in  FIG. 3 , the inner sleeves  6  and the outer sleeve  8  may form a single structure. Micro-perforations  6   a  between each inner sleeve  6  and the outer sleeve  8  facilitate separation of individual inner sleeves  6  from each other and the outer sleeve  8  upon the application of a force F upon an inner sleeve  6 . 
     As shown in  FIGS. 1 and 2 , a drawstring  12  may be secured to a distal end of each inner sleeve  6 . Upon application of force F to the inner sleeve  6  ( FIG. 2 ) in the proximal direction, the inner sleeve  6  separates from the fixation point  14 . Continued application of force F to the inner sleeve  6  results in separation of the inner sleeve  6  from fixation point  16  and the removal of the inner sleeve  6  from the lumen  11 . 
     Another embodiment of a surgical access device will now be described with reference to  FIGS. 4A and 4B . A surgical access device  20  includes a series of tubular structures  21 ,  22 ,  23  that are frictionally engaged with one another. The tubular structures  21 ,  22 ,  23  may be formed from a rigid or semi-rigid material to resist the biasing force of the body opening O to maintain the tubular shape of the tubular structures  21 ,  22 ,  23 . Although shown as including three tubular structures  21 ,  22 ,  23 , the surgical access device  20  may include a greater or lesser number of such tubular structures. The outermost tubular structure  21  forms an intermediate section  28  that interacts with the walls of the body opening O. An hour-glass configuration of the intermediate section  28  may facilitate securement of the surgical access device  20  within the body opening O. The proximal and distal ends  27 ,  29  of the surgical access device  20  may be flanged to facilitate securing of the surgical access device  20  within the body opening O. 
     As shown best in  FIG. 4B , the surfaces  21   a ,  22   a ,  23   a  of the tubular structures  22 ,  23  may include an adhesive layer to inhibit movement of the tubular structures with respect to one another. A drawstring  13  may be coupled to the tubular structures  21 ,  22 ,  23  to facilitate removal of each tubular structure  22 ,  23  from the surgical access device  20 . When one of the tubular structures  21 ,  22 ,  23  (i.e., the structure having an exposed surface) becomes contaminated, the tubular structure can be removed while maintaining the surgical access device  20  within the body opening O. As shown in  FIGS. 5A and 5B , a surgeon H may proximally translate tubular structure  23  in the direction indicated by arrows A, thereby leaving behind the remaining unused tubular structures  21 ,  22 . 
     An introducer device  50  may be used to facilitate placement of the surgical access device  10 . As shown in  FIG. 6A , the introducer device  50  includes a tapered distal end  56 , and elongated tubular structure  54 , and a flanged proximal end  52 . As shown in  FIG. 6B , the introducer device is configured and adapted to be placed within the lumen  11  of the surgical access device  10 , and the proximal end  52  of the introducer device  50  is configured and adapted to engage the proximal end  5  of the surgical access device  10  such that distal translation of the introducer device  50  pushes the surgical access device into the body opening O of tissue T. In addition, the tapered distal end  56  of the introducer device  50  facilitates placement of the introducer device  50  into the lumen  11  of the surgical access device. Furthermore, the tapered distal end  56  of the introducer device  50  may facilitate the creation or enlargement of the body opening O within the skin S of tissue T. 
     A method of using the surgical access devices described herein will now be discussed with respect to surgical access device  10 . First, introducer  50  may be placed within lumen  11  of the surgical access device  10 . The surgical access device  10  is then placed into the body opening O of tissue T by inserting the introducer  50  along with the surgical access device  10  into the body opening O. The tapered distal end  56  facilitates insertion of the surgical access device  10  and helps stretch the body opening O to accommodate reception of the surgical access device  10 . The surgical access device  10  is then anchored within the body opening O. The shape, e.g., an hour-glass configuration, of the surgical access device  10  facilitates the anchoring of the surgical access device  10  within the body opening O. 
     Once the surgical access device  10  is placed within the body opening O, the desired surgical procedure is performed. During the course of the surgery, it may be advantageous to remove inner sleeves  6  as they become contaminated to facilitate maintaining a clean working environment. Removal of the inner sleeves  6  is accomplished by translating each inner sleeve  6  proximally out from the lumen  11 . Applying force F in a proximal direction to the drawstring  12  results in separation of the inner sleeve  6  from the surgical access device, and the exposure of the surface of the next remaining inner sleeve  6  or the inner surface of the outer sleeve  8 . Once the desired surgical procedure is completed, the surgical access device  10  is removed from the body opening O. 
     It will be understood by those skilled in the art that various modifications and changes in form and detail may be made to the present disclosure without departing from the scope and spirit of the same. Therefore, the above description should not be construed as limiting, but merely as exemplifications of particular embodiments. While several embodiments of the disclosure have been shown in the drawings, it is not intended that the disclosure be limited thereto. Rather, the disclosure is intended to be read as broadly in scope as the art will allow.