Abstract:
A surgical portal apparatus includes a portal member defining a longitudinal axis and having a longitudinal opening therethrough for receiving a surgical object, an adjustable seal disposed within the longitudinal opening and having inner seal portions adapted to permit passage of the surgical object in substantial sealed relation therewith and an adjustment member mounted within the portal member and operatively connected to the adjustable seal. The adjustment member is positioned to intersect the longitudinal passageway to engage the surgical object and move relative to the portal member to thereby cause corresponding relative displacement of the inner seal portions of the adjustable seal and facilitate passage of the surgical object through the adjustable seal. The inner seal portions of the adjustable seal are adapted for relative movement between a first generally approximated position and a second generally displaced position upon movement of the adjustment member. The inner seal portions of the adjustable seal may be dimensioned to substantially prevent passage of fluids when in the first generally approximated position. In one arrangement, the adjustable seal includes first and second seal elements which define the inner seal portions.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
   The present application claims the benefit of and priority to U.S. Provisional Application Ser. No. 60/931,244 filed on May 22, 2007, the entire contents of which are incorporated herein by reference. 

   BACKGROUND 
   1. Technical Field 
   The present disclosure relates generally to a surgical portal apparatus for accessing the body, and more particularly, relates to a surgical portal apparatus having variable seal adjustment capabilities for receiving endoscopic instruments of various diameters. 
   2. Background of Related Art 
   Trocar assemblies and other surgical portal apparatuses are used by surgeons to operate on a patient without having to create large incisions that may become infected and may cause major scaring. Portal apparatuses are known in the art, as are the instruments inserted therethrough for operating within the body cavity. Typically a surgical portal apparatus comprises two major components, a trocar sleeve including a housing and a cannula, and an obturator. 
   Accessing the body cavity using a surgical portal apparatus is a multi-step process. An incision is initially made in the skin using a scalpel or other cutting instrument. Some trocar assemblies may include a cutting blade or sharpened distal end for performing this function. The obturator, having been inserted into the sleeve of the trocar cannula, is directed through the incision in the skin. The obturator is then used to penetrate the skin and access the body cavity. By applying pressure against the proximal end of the obturator, the sharpened point of the obturator is forced through the skin until it enters the body cavity. The cannula is inserted through the perforation made by the obturator and the obturator is withdrawn, leaving the cannula as an access way to the body cavity. 
   In order to provide a greater space in which a surgeon may operate and to increase visibility of the tissue being operated on, the body cavity is generally insufflated. To avoid gas leakage from within the cavity prior to or during insertion of an instrument through the cannula, and as instruments are being removed and replaced, various seal members have been developed. Conventional access systems generally include one or more seals configured for use with endoscopic instruments of the same or similar diameters. In this manner, the instruments inserted through the system must be of substantially similar diameter; otherwise a proper seal will not form between the instrument and the housing. An improper seal may result in leakage of insufflation gas. 
   However, not all endoscopic instruments have similar diameters. An instrument for performing a procedure may have a different diameter from a second instrument for performing the same procedure, just as instruments for performing various procedures may also have different diameters. Successful completion of a procedure may require the use of various instruments throughout the procedure. Thus, completing a procedure using multiple endoscopic instruments may require the use of multiple access systems, wherein system is configured for receiving an instrument of different diameter. 
   Therefore, it would be beneficial to have a surgical portal apparatus that is configured to sealingly receive endoscopic instruments of different diameters. 
   SUMMARY 
   Accordingly, a surgical portal apparatus includes a portal member defining a longitudinal axis and having a longitudinal opening therethrough for receiving a surgical object, an adjustable seal disposed within the longitudinal opening and having inner seal portions adapted to permit passage of the surgical object in substantial sealed relation therewith and an adjustment member mounted within the portal member and operatively connected to the adjustable seal. The adjustment member is positioned to intersect the longitudinal passageway to engage the surgical object and move relative to the portal member to thereby cause corresponding relative displacement of the inner seal portions of the adjustable seal and facilitate passage of the surgical object through the adjustable seal. The inner seal portions of the adjustable seal are adapted for relative movement between a first generally approximated position and a second generally displaced position upon movement of the adjustment member. The inner seal portions of the adjustable seal may be dimensioned to substantially prevent passage of fluids when in the first generally approximated position. In one arrangement, the adjustable seal includes first and second seal elements which define the inner seal portions. 
   The adjustment member may be operatively connected to the first seal element, whereby movement of the adjustment member upon engagement with the surgical object causes corresponding movement of the first seal element. The first seal element may be adapted for lateral movement relative to the longitudinal axis during movement between the first generally approximated position and the second generally displaced position. The adjustment member may be adapted for pivotal movement relative to the portal member. A gear member may be operatively connected to the adjustment member and to the first seal element. The gear member is adapted to translate movement of the adjustment member to corresponding movement of the first seal element. 
   The adjustment member may be adapted for movement between an initial position and an activated position. The initial position and the activated position correspond to the first generally approximated position and the second generally displaced position of the inner portions of the adjustable seal. The adjustment member includes a zero closure seal adapted to substantially close the longitudinal opening when in the first position of the adjustment member. 
   A secondary seal may be mounted to the portal member. The adjustable seal may be adapted to form a substantial seal about a surgical object having a first cross-sectional dimension and the secondary seal is adapted to form a substantial seal about a surgical object having a second cross-sectional dimension. The second cross-sectional dimension is greater than the first cross-sectional dimension. The adjustable seal may be adapted to form a seal about a surgical object having a diameter ranging from about 4 mm to about 6 mm, and wherein the secondary seal member is adapted to form a seal about a surgical object having a diameter ranging from about 9 mm to about 13 mm. The adjustable seal may be mounted distal to the secondary seal member. 
   The portal member may include a portal housing and a portal sleeve extending from the portal housing. 

   
     BRIEF DESCRIPTION OF THE DRAWINGS 
     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, various embodiments are shown. It is understood, however, that the present disclosure is not limited to the precise arrangement and instrumentalities shown. 
       FIG. 1  is a side perspective view of a surgical portal apparatus according an embodiment of the present disclosure; 
       FIG. 2  is a front perspective view of the surgical portal apparatus of  FIG. 1 ; 
       FIG. 3  is a side cross-sectional view of the surgical portal apparatus of  FIGS. 1 and 2  illustrating the adjustment member, gear mechanism and the seal member with the adjustment member, in a first or initial condition; 
       FIG. 4  is a side cross-sectional view similar to the view of  FIG. 3  illustrating an endoscopic instrument having a small diameter inserted therethrough; 
       FIG. 5  is a side cross-sectional view of the surgical portal apparatus illustrating the adjustment member in a second condition up insertion of an endoscopic device having a large diameter; 
       FIG. 6  is a view illustrating the adjustment member within the housing; 
       FIG. 7A  is a side view of the adjustment member; 
       FIG. 7B  is a top view of the adjustment member; 
       FIG. 8A  is a top view of the second seal member; 
       FIG. 8B  is a side view of the second seal member; 
       FIG. 9  is a view illustrating the adjustment member in the initial condition; 
       FIG. 10  is a view illustrating the adjustment member in an intermediate position; 
       FIG. 11  is a view of the adjustment member in an activated position; and 
       FIGS. 12-14  are cross-sectional views of a surgical portal apparatus according to another embodiment of the present disclosure, in a first or sealed condition ( FIG. 12 ), in an intermediary condition ( FIG. 13 ), and in an open condition ( FIG. 14 ). 
   

   DESCRIPTION OF PREFERRED EMBODIMENTS 
   Referring now to the drawings wherein like reference numerals illustrate similar components throughout the several views, there is illustrated the surgical portal apparatus  100  in accordance with the principles of the present disclosure. 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. 
   Referring initially to  FIGS. 1 and 2 , surgical portal apparatus  100  is shown in the form of a cannula assembly. Surgical portal apparatus  100  includes a housing or portal member  102  and a cannula sleeve  104  extending distally from housing  102 . Surgical portal apparatus  100  may be configured for use with any known endoscopic or laparoscopic instrument. Cannula sleeve  104  is configured to be inserted through the skin into a body cavity with the aid of an obturator (not shown). Cannula sleeve  104  may instead include a blade or piercing tip for penetrating through the skin and into a body cavity. Cannula sleeve  104  may be integral formed with housing  102 . Alternatively, cannula sleeve  104  may be configured for selectable engagement with housing  102 . 
   Cannula sleeve  104  forms a substantially tubular member having proximal and distal ends  104   a ,  104   b . Cannula sleeve  104  may be composed of plastic, metal, polymers or the like. Cannula  104  may be disposable, or in the alternative, reusable. Cannula sleeve  104  may be solid, or alternatively, cannula sleeve  104  may be flexible. Distal end  104   b  of cannula sleeve  104  may be open. Distal end  104   b  may instead be configured to include one or more seal members (not shown). Cannula sleeve  104  may be of any configuration and of any length or diameter. Thus, it is appreciated that the embodiments of the present disclosure are not limited by the configuration of cannula sleeve  104  and may be configured for use with any conceivable cannula assembly configuration. 
   Referring now to  FIGS. 3-5 , housing  102  of surgical portal apparatus  100  defines a passageway  101  therethrough configured for receiving endoscopic instruments of various diameters. Housing  102  includes a first seal member  110 , a second seal member  120  and an adjustment member  130  therebetween. As will be described below, adjustment member  130  is operably connected to second seal member  120  such that movement of adjustment member  130  causes movement of second seal member  120 . 
   First seal member  110  extends about an inner surface of housing  102 , preferably about a proximal end  102   a  of housing  102 . However, it is envisioned that first seal member  110  may be disposed anywhere along the length of passageway  101 . First seal member  110  may comprise any known seal configurations. First seal member  110  may include one or more seal surfaces  112 . First seal member  110  is configured for sealably receiving an endoscopic instrument  10  having a large diameter. Seal surface  112  may be formed of rubber, plastic, polymer or the like. An instrument contacting end  112   a  of seal surface  112  may be tapered to facilitated sealing about endoscopic instrument  10 . Preferably, first seal member  110  is configured for sealably receiving an endoscopic instrument having the largest diameter capable of being inserted through passage  101 . 
   Still referring to  FIGS. 3-5 , adjustment member  130  defines a substantially planar base  132 . Base  132  includes a first end  132   a  configured for pivotal engagement with housing  102  and a second end  132   b  configured to be pivotally biased within passageway  101 . First end  132   a  of base  132  defines an opening  133  therethrough for pivotally receiving a bearing pin  136  ( FIG. 6 ). Opening  133  includes first and second portions  133   a ,  133   b . First portion  133   a  of opening  133  is configured to receive a first end  136   a  of bearing pin  136 . Second portion  133   b  of opening  133  is larger than first portion  133   a  and is configured to receive a spring  138  about a second end  136   b  of bearing pin  136 . A shoulder  137  ( FIG. 7A ) may be formed between first and second portions  133   a ,  133   b  of opening  133 . Shoulder  137  defines an opening  137   a  therein for receiving a first end  138   a  of spring  138 . Second end (not shown) of spring  138  is received within a slot  116   c  formed in second end  136   b  of bearing pin  136 . Bearing pin  136 , including spring  138  received about second end  116   b , is inserted through opening  133  and is securely mounted to housing  102 . The configuration of spring  138  within first end  132   a  of base  132  causes second end  132   b  thereof to be biasedly received within passageway  101  formed in housing  102 . 
   Still referring to  FIG. 7A , first end  132   a  of base  132  further includes a geared portion  135  radially extending at least partially about opening  133 . Geared portion  135  includes gears  135   a . Geared portion  135  is configured to engage a geared portion  125  formed in a base  122  of second seal member  120  ( FIGS. 8A-8B ). In this manner, geared portion  125  of second seal member  120  forms the rack to the pinion of geared portion  135  formed on adjustment member  130 . As with all rack and pinion gears, rotational movement of the pinion gear causes lateral movement of the rack. Geared portion  135  may extend the width of first end  132   a  of base  132 . Alternatively, geared portion  135  may comprise one or more rows of gears  135   a  for engaging one or more rows of gears  125   a  formed on first end  122   a  of base  122  ( FIGS. 8A and 8B ). 
   Base  132  of adjustment member  130  includes a second end  132   b  defining an instrument contacting surface  134 . Second end  132   b  of base  132  is configured extend within passageway  101 . As will be described below, second end  132   b  is configured to engage an endoscopic instrument  10 ,  20  as it is inserted through passageway  101  if the diameter of the instrument is larger then the opening formed in second seal member  120 . As seen in  FIGS. 4 and 5 , contacting surface  134  of second end  132   b  may be rounded to prevent contact with endoscopic instrument  20  with the smaller diameter or facilitate engagement with endoscopic instrument  20  with the larger diameter. 
   Although as described, base  132  is biased received within passageway  101  by spring  138 , it is envisioned that base  132  may be biased with any known means including, but not limited to, a hydraulic or pneumatic piston, flexible plate or the like. 
   Referring now to  FIGS. 8A and 8B , second seal member  120  includes a base  122  having a first end  122   a  and a second end  122   b . First end  122   a  of base  122  includes a substantially rectangular body including a geared portion  125 . Geared portion  125  includes gears  125   a . Gears  125   a  of geared portion  125  are configured to selectively engage gears  135   a  of geared portion  135  formed on first end  132   a  of base  132 . As will be described below, geared portions  135 ,  125  are configured to such that second seal members  120  is opened as base  132  of adjustment member  130  is moved. Second end  122   b  of base  122  further defines one or more grooves  123  for slidably securing base  122  within housing  102 . Housing  102  may define corresponding rails or tracks (not shown) configured to be received within grooves  123  formed in base  122 . 
   Second end  122   b  of base  122  includes a substantially planar member defining a semi-circular opening  123 . Second end  122   b  is configured to be received within a slot  105  formed in housing  102  ( FIGS. 3-5 ). A seal surface  124  extends about opening  123 . Seal surface  124  may comprise one or more layers. Seal surface  124  may be formed from rubber, plastic, polymer or the like. As will be described in detail below, second end  122   b  of base  122  is configured to operably engage slot  105  formed in housing  102  to form an adjustable opening  106   a  ( FIG. 9A ),  106   b  ( FIG. 9B ),  106   c  ( FIG. 9   c ) for receiving endoscopic instruments of various diameters therethrough. 
   With reference to  FIGS. 9-11 , housing  102  defines a semi-circular opening  106  corresponding to opening  123  defined by base  122  of second seal member  120 . Opening  106  includes a seal surface  107  extending thereabout for operable engagement with seal surface  124  of opening  123  to selectively form openings  106   a - 106   c  as adjustment member  130  is activated in the manner described below. Seal surfaces  124 ,  107  are configured to sealingly receive endoscopic instruments of increasing diameter as second seal member  120  is slidingly withdrawn from slot  105  formed in housing  102 . Seal surfaces  124 ,  107  may alternatively include a flap or other means for sealing opening  106  with or without an endoscopic instrument  10 ,  20 ,  30  inserted therethrough. 
   With reference now to  FIGS. 3-5 , surgical portal apparatus  100  will be described as relates to the operation of first and second seal members  110 ,  120  and adjustment member  130 . Referring initially to  FIGS. 3 and 4 , in a first or initial condition, base  132  of adjustment member  130  is pivotally biased within housing  102 . Base  132  is configured and positioned such that endoscopic instrument  20  ( FIG. 4 ) may pass through passageway  101  without engaging contacting surface  134  of second end  132   a . In this manner, although geared portion  135  formed on base  132  engages geared portion  125  formed on base  122 , base  122  remains slidingly received within slot  105  formed in housing  102  even as endoscopic instrument  20  is inserted past base  132 . Endoscopic instrument  20  may incidentally contact seal surface  112  of first seal member  110 , however, no sealing action is expected from this contact. In an alternate embodiment, seal surface  112  may be configured to sealingly receive endoscopic instrument  20 . 
   With reference now to  FIG. 9 , in this first or initial condition, opening  106   a  is formed by semi-circular openings  106 ,  123  formed in housing  102  and base  122 , respectively, and between seal surfaces  107 ,  124 , respectively, for sealably receiving endoscopic instruments  10 ,  20 ,  30  therethrough. Alternatively, and as discussed above, in this first or initial condition, opening  106   a  may be sealed prior to insertion of instrument  20  therethrough. 
   Referring now to  FIG. 5 , in a second condition, base  132  of adjustment member  130  is completely pivoted from within passageway  101  by endoscopic instrument  10 . Instrument  10  is initially inserted past first seal member  110  where it is sealingly engaged by seal surface  112 . As instrument  10  engages contacting surface  134  formed on second end  132   b  of base  132 , base  132  is pivoted from within passageway  101 . The pivoting of base  132  causes geared portion  135  formed on first end  132   a  thereof to engage geared portion  125  formed on base  122  of second seal member  120 . As base  132  of adjustment member  130  is pivoted geared portion  135  formed thereon engages geared portion  125  formed on base  122 . The engagement of gears  125   a ,  135   a  caused by the pivoting of adjustment member  130  results in a corresponding lateral movement of second seal member  120 . Downward pivoting of adjustment member  130  causes retraction or opening of second seal member  120 , while upward pivoting of adjustment member  130  causes advancement or closing of second seal member  120 . 
   With reference to  FIG. 11 , in the second condition, opening  106   c  formed by semi-circular openings  106 ,  123  and between seal surfaces  107 ,  124 , respectively, for sealably receiving endoscopic instrument  10  therethrough. Opening  106  may be sized to receive an endoscopic instrument having a diameter of a size as small as endoscopic instrument  20  and as large as endoscopic instrument  10 . Preferably, endoscopic instruments  10 ,  20 ,  30  measure 5 mm-12 mm in diameter, however, the aspects of the current disclosure may be modified to accommodate endoscopic instruments of larger and/or smaller diameter. 
   Referring now to  FIGS. 12-14 , an alternate embodiment of a surgical portal apparatus according to the present disclosure is shown generally as surgical portal apparatus  200 . Surgical portal apparatus  200  is similar to surgical portal apparatus  100  and will only be described as relates to the differences therebetween. Surgical portal apparatus  200  includes a housing or portal member  202  and a cannula sleeve  204 . Surgical portal apparatus  200  defines a passageway  201  therethrough for receiving endoscopic instruments of various diameters. A first seal member  210  is disposed about a proximal end of trocar housing  202 , an adjustment mechanism  230  is pivotally mounted within housing  202 , and a second seal member  220  is operably connected to adjustment mechanism  230 . 
   Still referring to  FIGS. 12-14 , adjustment mechanism  230  is similar to adjustment member  130 . Adjustment mechanism  230  differs from adjustment member  130  in the means by which adjustment mechanism  230  is operably connected to second seal member  220 . Unlike the engagement of geared portions  125 ,  135 , as described above, adjustment mechanism  230  is configured to lockingly receive an end of second seal member  220 . In this manner, as adjustment mechanism  230  is pivotally opened as described above, second seal member  220  wraps about an end of adjustment mechanism  230 , thereby retracting second seal member  220  from across passageway  201  formed in surgical portal apparatus  200 . 
   Second seal member  220  includes a substantially planar base  222 . Base  222  may comprise plastic, polymer, metal or the like. Base  222  includes first end  222   a  and a second end  222   b . First end  222   a  is configured to be lockingly received by adjustment mechanism  230 . Second end  222   b  is substantially similar in size and shape to second end  122   b  of base  122  described above. As discussed above, second seal member  220  is operably engaged with adjustment mechanism  230  such that downward pivotal movement of adjustment mechanism  230  causes lateral movement of second seal member from across passageway  201 . 
   Furthermore, unlike adjustment member  130 , second end  232   b  of base  232  may be configured to provide another sealing member  230 . Second end  232   b  of base  232  may include a seal surface  234 . Unlike in the previous embodiment, base  232  is completely biased across passageway  201 . In this manner, sealing surface  234  extends across and within passageway  201 , thereby forming a zero closure seal and effectively sealing passageway  201 . As an endoscopic instrument (not shown) is inserted through trocar housing  202 , base  232  of sealing member  230  is pivoted in the manner discussed above, thereby retracting second seal member  220 , and opening passageway  201  for insertion of an instrument therethrough. Withdrawal of the endoscopic instrument causes sealing member  230  to return to a biased position across passageway  201  and results in the advancement of second seal member  220 . 
   It will be understood that various modifications may be made to the embodiments disclosed herein. Therefore, the above description should not be construed as limiting, but merely as exemplifications of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims append hereto.