Abstract:
A method for performing a surgical procedure includes the steps of: accessing a surgical site with an access member, the access member having proximal and distal ends, and defining a longitudinal axis, the access member having an elongated element operatively connected thereto; transitioning the access member from a first condition having a first dimension orthogonal to the longitudinal axis to a second condition having a second dimension orthogonal to the longitudinal axis greater than the first dimension by drawing the elongated element in a proximal direction; anchoring the access member within a tissue passage leading to the surgical site when in the second condition thereof; and introducing a surgical object through a longitudinal opening of the access member to perform a surgical task.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
       [0001]    The present application is a continuation of copending U.S. patent application Ser. No. 12/641,906 filed on Dec. 18, 2009, which claims the benefit of and priority to U.S. Provisional Application Ser. No. 61/153,078 filed on Feb. 17, 2009 (now expired), the entire contents of which are incorporated herein by reference. 
     
    
     BACKGROUND 
       [0002]    1. Technical Field 
         [0003]    The present disclosure relates to surgical access apparatus for positioning within an opening formed in a patient&#39;s tissue. More particularly, the present disclosure relates to surgical access apparatus that are repositionable to facilitate anchoring within a percutaneous opening, and capable of removably receiving one or more surgical instruments. 
         [0004]    2. Background of the Related Art 
         [0005]    In contemporary medical practice, many surgical procedures are performed through small incisions formed in the skin, as compared to the larger incisions typically required in traditional procedures, in an effort to reduce both patient trauma and recovery time. Generally, such procedures are referred to as “endoscopic,” unless performed in the patient&#39;s abdomen, in which case the procedure is referred to as “laparoscopic,” or on a joint, ligament, or the like, in which case the procedure is referred to as “arthroscopic.” Throughout the present disclosure, “endoscopic,” “laparoscopic,” and “arthroscopic” procedures may be collectively referred to as “minimally invasive” procedures. 
         [0006]    Typically, a minimally invasive surgical procedure will include the use of a surgical access apparatus or portal member to facilitate entry into a surgical worksite positioned beneath the patient&#39;s tissue with surgical instrumentation, e.g., endoscopes, obturators, staplers, and the like. A typical surgical access apparatus defines a passageway or lumen through which the surgical instrumentation is inserted and the procedure is carried out. 
         [0007]    While many varieties of surgical access apparatus are known in the art, a continuing need exists for a surgical access apparatus that may be releasably and reliably secured within the patient&#39;s tissue throughout the course of a minimally invasive procedure. 
       SUMMARY 
       [0008]    In one aspect of the present disclosure, a method for performing a surgical procedure, includes the steps of: 
         [0009]    providing a surgical access apparatus comprising:
       a housing having proximal and distal ends and being configured to removably receive at least one surgical instrument;   a tubular member extending distally from the housing, the tubular member being adapted to removably receive the at least one surgical instrument and repositionable between a first position, in which the tubular member is configured for at least partial insertion into an opening in the tissue, and a second position, in which the tubular member is configured to facilitate anchoring of the tubular member within the tissue;   a connective member secured to the tubular member;   at least one filament secured to the connective member and extending proximally therefrom; and   at least one manual member secured to the at least one filament, the at least one manual member being configured and dimensioned for grasping by a clinician such that the at least one filament is movable in a proximal direction to facilitate selective repositioning of the tubular member from the first position to the second position;       
 
         [0015]    advancing the tubular member distally into an opening in the tissue while in the first position; and 
         [0016]    moving the at least one manual member in a proximal direction to cause corresponding movement of the connective member to thereby reposition the tubular member from the first position to the second position to anchor the surgical access apparatus within the tissue. 
         [0017]    The housing may include locking structure in which the method includes the step of engaging the locking structure with one or more of the at least one filament and the at least one manual member to maintain the tubular member in the second position. The step of repositioning the tubular member from the first position to the second position may cause a portion of the tubular member to lie in a plane substantially parallel to the tissue. 
         [0018]    The tubular member may include a mesh of braided fibers and, wherein during the step of moving the at least one manual member, the mesh is adapted for radial expansion to facilitate passage of the surgical instrument into the lumen of the tubular member. The method may further include the step of introducing a surgical instrument through the surgical access apparatus and optionally the step of establishing a substantially fluid-tight seal about the surgical instrument with the connective member. The mesh of braided fibers may include a substantially elastic material such that during the step of introducing the surgical instrument through the surgical access apparatus, the axial length of the tubular member changes. In the alternative, the mesh of braided fibers may include a substantially inelastic material such that during the step of introducing the surgical instrument through the surgical access apparatus, the axial length of the tubular member remains substantially constant. 
         [0019]    In another aspect, a method for performing a surgical procedure includes the steps of: 
         [0020]    accessing a surgical site with an access member, the access member having proximal and distal ends ends, and defining a longitudinal axis, the access member having an elongated element operatively connected thereto; 
         [0021]    transitioning the access member from a first condition having a first dimension orthogonal to the longitudinal axis to a second condition having a second dimension orthogonal to the longitudinal axis greater than the first dimension by drawing the elongated element element in a proximal direction; 
         [0022]    anchoring the access member within a tissue passage leading to the surgical site when in the second condition thereof; and 
         [0023]    introducing a surgical object through a longitudinal opening of the access member to perform a surgical task. 
         [0024]    The method may further include the step of securing the elongated element to substantially maintain the access member in the second condition thereof. A connective member may be positioned within the longitudinal opening of the access member and connected to the access member and the elongated element, whereby during the step of transitioning, the elongated member draws the connective member in a proximal direction to cause segment of the access member to be displaced in a radial outward direction relative to the longitudinal axis. The method may further include the step of establishing a substantial seal about the surgical object with the connective member. 
         [0025]    The access member may include a tubular braided mesh, and wherein, during the step of transitioning, mesh segments of the braided mesh are displaced in the radial outward direction relative to the longitudinal axis to engage tissue adjacent the tissue passage. The tubular braided mesh may comprise elastic material, whereby, during the step of transitioning, reduction of a longitudinal length of the tubular braided mesh is substantially minimized or remains substantially constant. 
         [0026]    These and other features of the surgical access apparatus disclosed herein will become more readily apparent to those skilled in the art through reference to the detailed description of various embodiments of the present disclosure that follows. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0027]    Various embodiments of the present disclosure are described herein below with references to the drawings, wherein: 
           [0028]      FIG. 1  is a side, schematic view of a surgical access apparatus including a housing and a tubular member in accordance with one embodiment of the present disclosure, wherein the tubular member is shown in a first position; 
           [0029]      FIG. 2  is a side, schematic view of the surgical access apparatus shown in  FIG. 1  illustrating the tubular member in a second position within a tissue tract formed in a patient&#39;s tissue; 
           [0030]      FIG. 3  is a side, schematic view of an alternative embodiment of the surgical access apparatus shown in  FIG. 1 ; 
           [0031]      FIG. 4  is a side, cross-sectional view of one embodiment of locking structure for use with the surgical access apparatus shown in  FIG. 1  illustrating the locking structure in a locked condition; 
           [0032]      FIG. 5  is a side, cross-sectional view of the locking structure shown in  FIG. 4  illustrating the locking structure in an open condition; and 
           [0033]      FIGS. 6 and 7  are side, schematic views of another embodiment of the surgical access apparatus shown in  FIG. 1  including a membrane disposed about the tubular member, the tubular member being respectively shown in the first and second positions thereof. 
       
    
    
     DETAILED DESCRIPTION OF THE EMBODIMENTS 
       [0034]    In the drawings, and in the following description, like references numerals will identify similar or identical elements. Throughout the following description, the term “proximal” will refer to the end of the presently disclosed surgical access apparatus, or component thereof, that is closest to the clinician during proper use, while the term “distal” will refer to the end that is furthest from the clinician. Additionally, the term “tissue tract” should be understood as referring to any opening in a patient&#39;s tissue, whether formed by the clinician or pre-existing. 
         [0035]    With reference to  FIGS. 1 and 2 , a surgical access apparatus  10  is disclosed that is removably positionable within a tissue tract or opening  12  formed in a patient&#39;s tissue “T.” The surgical access apparatus  10  is employable during the course of a surgical procedure, e.g., a minimally invasive procedure, to facilitate access to a surgical worksite “W,” such as a patient&#39;s underlying cavities, tissues, organs, or the like, with one or more surgical instruments “I.” In one aspect of the present disclosure, the surgical access apparatus  10  includes a housing  100 , a tubular member  200 , a connective member  300 , one or more filaments  400 , and at least one manual member  500 . 
         [0036]    The housing  100  includes respective proximal and distal ends  102 ,  104 , and may be fabricated from any suitable biocompatible material including moldable polymeric materials, stainless steel, titanium, or the like. The housing  100  is configured for manual engagement by a clinician and includes an opening  106  extending therethrough that is configured for the reception and passage of the surgical instrument “I,” which defines an outer transverse dimension “D|.” The housing  100  includes an outer wall  108  defining a flange  110  with a distal surface  112 , and may optionally include an internal seal or valve (not shown), such as a duck-bill or zero-closure valve, that is adapted to close in the absence of the surgical instrument “I”. Examples of suitable internal seals or valves are discussed in commonly assigned U.S. Pat. Nos. 5,820,600 to Carlson, et al. and 6,702,787 to Racenet et al., which issued on Oct. 13, 1998 and Mar. 9, 2004, respectively, the entire contents of which are incorporated by reference herein. The housing  100  further includes locking structure  600 , which will be discussed in detail below. 
         [0037]    The tubular member  200  extends distally from the housing  100  along a longitudinal axis “A” a length “L,” and includes a proximal end  202  and a distal end  204 . The tubular member  200  is configured as a braid  206  formed by a mesh of biocompatible fibers  208 , and defines an axial lumen  210  therethrough that is configured for the reception and passage of the surgical instrument “I”. Specifically, the lumen  210  of the tubular member  200  defines an internal transverse dimension “Dr” that is less than the outer transverse dimension “Di” of the surgical instrument “I.” Consequently, insertion of the surgical instrument “I” into the lumen  210  of the tubular member  200  will cause the tubular member  200  to expand outwardly along an axis “B” that is transverse, e.g., orthogonal, in relation to the longitudinal axis “A.” In one embodiment of the tubular member  200 , the fibers  208  may be formed from a substantially elastic material, which allows the length “L” of the tubular member  200  to remain substantially constant during outward expansion. However, in an alternative embodiment, the fibers  208  comprising the braid  206  may be formed from a substantially inelastic material, e.g., polyamide fiber, stainless steel, or the like, such that tubular member  200  experiences a measure of shortening along the longitudinal axis “A” upon the introduction of surgical instrument “ 1 ”, further details of which may be obtained through reference to U.S. Pat. No. 5,431,676 to Dubrul et al., the entire contents of which are incorporated by reference herein. The fibers  208  comprising the braid  206  may be of any suitable configuration, including but not limited to round, flat, ribbon-like, or square. 
         [0038]    With continued reference to  FIGS. 1 and 2 , the connective member  300  will be discussed. The connective member  300  may be formed from any suitable biocompatible material, including but not limited to polymeric materials or rubber. Desirably, the connective member  300  is formed from a resilient, substantially non-rigid material such that the connective member  300  is capable of deformation, e.g., compression, to facilitate insertion of the tubular member  200  into the tissue tract  12 . In one specific embodiment of the present disclosure, the connective member  300  is formed from an expandable material such that the connective member  300  is deformed radially as the surgical instrument “I” is passed therethrough. In this embodiment, the connective member  300  forms a substantially fluid-tight seal with the surgical instrument “I” to inhibit the escape of fluid, e.g., insufflation gas in the case of a laparoscopic surgical procedure or an irrigant solution in the case of an arthroscopic surgical procedure, from the surgical worksite “W” about the tubular member  200 . 
         [0039]    The connective member  300  is secured to the tubular member  200 , and may be positioned at any suitable location along the length “L” thereof. For example, the connective member  300  may be positioned adjacent the distal end  204  of the tubular member  200 , as shown in  FIGS. 1 and 2 . The connective member  300  may positioned either within the lumen  210  ( FIGS. 1 and 2 ), or alternatively, the connective member  300  may be positioned externally of the tubular member  200 , i.e., the connective member  300  may be secured to an outer surface  212  of the tubular member  200  ( FIG. 3 ). 
         [0040]    Referring again to  FIGS. 1 and 2 , the surgical access apparatus  10  is illustrated as including a pair of filaments  400 . In alternative embodiments of the present disclosure, however, the filaments  400  may be included in either greater or fewer numbers. The filaments  400  are secured to the connective member  300  such that the filaments  400  extend proximally therefrom, i.e., towards the housing  100 , and may be secured to the connective member  300  in any suitable manner, such as through the use of adhesives or heat staking, for example. The filaments  400  are used to reposition the tubular member  200  from a first (initial) position ( FIG. 1 ) to a second (activated) position ( FIG. 2 ), and may be any members suitable for this intended purpose, including but not limited to surgical sutures, tape, etc. 
         [0041]    In the first position, the tubular member  200  defines an initial outer dimension “D|” that is substantially uniform along the length “L.” The length “L” of the tubular member  200  in the first position may vary depending on the intended usage of the surgical access apparatus  10 , but in general, will lie substantially within the range of about 10 cm to about 25 cm. However, a tubular member  200  that is substantially longer or shorter is not beyond the scope of the present disclosure. The initial outer dimension “D|” of the tubular member  200  is smaller than the dimensions of the tissue tract  12  such that the tubular member  200  can be inserted and advanced distally through tissue tract  12  will little or no resistance when the tubular member is in the first position. 
         [0042]    Upon the application of a force to the filaments  400  in the direction of arrow  1  ( FIG. 1 ), e.g., by pulling or drawing the filaments  400  proximally, the tubular member  200  is shortened along the longitudinal axis “A”, thereby transitioning into the second position ( FIG. 2 ). In the second position, the tubular member  200  defines a length “L 2 ” that is considerably less than the initial length “L” defined by the tubular member  200  in the first position. Additionally, in the second position, the tubular member  200  defines a tissue engaging portion  214  having an outer dimension “D 2 ” that is considerably greater than the outer dimension “Di” defined by the tubular member  200  in the first position. The tissue engaging portion  214  contacts the patient&#39;s tissue “T” about the tissue tract  12  and, in conjunction with the flange  110  of the housing  100 , facilitates anchoring of the surgical access apparatus  10 . It is envisioned that the tissue engaging portion  214  may also act to at least partially form a seal with the patient&#39;s tissue “T” to substantially reduce the likelihood that any fluids present within the surgical worksite “W,” such as insufflation gasses or irrigant solutions, will escape around the surgical access apparatus  10 . 
         [0043]    With continued reference to  FIGS. 1 and 2 , the aforementioned manual members  500  are secured to the filaments  400 , and are configured and dimensioned for engagement by the clinician to assist the clinician in transitioning the tubular member  200  from the first position ( FIG. 1 ) to the second position ( FIG. 2 ). Although illustrated as ring-shaped, it should be understood that the manual members  500  may be configured and dimensioned in any manner suitable for this intended purpose. Generally, the number of manual member  500  included as part of the surgical access apparatus  10  will correspond to the number of filaments  400 . For example, as seen in  FIGS. 1 and 2 , the surgical access apparatus  10  includes a pair of filaments  400  connected to a pair of manual members  500 . It is also envisioned, however, that each of the filaments  400  may be secured to the same manual member  500 . 
         [0044]    As previously indicated, the housing  100  of the surgical access apparatus  10  includes locking structure  600 , which acts to maintain the tubular member  200  in the second position ( FIG. 2 ). As seen in  FIGS. 1 and 2 , in one embodiment, the locking structure  600  includes one or more channels  602  that are formed in the housing  100 , as well as one or more engagement members  604 . The channels  602  extend at least partially through the housing  100  to one or more egresses  114  ( FIG. 2 ) formed either in a proximal-most surface  116 , as shown, or an outer wall  108  of the housing  100 . In the illustrated embodiment, the filaments  400  extend through the channels  602  for grasping by the clinician, e.g., via the manual members  500 , to thereby transition the tubular member  200  into the second position ( FIG. 2 ). Upon repositioning of the tubular member  200  from the first position ( FIG. 1 ) to the second position ( FIG. 2 ), either or both of the filaments  400  and the manual members  500  are secured about the engagement members  604 , e.g., by tying. The engagement members  604  may be any structure suitable for the intended purpose of releasably securing the filaments  400 , such as the illustrated hook, for example. 
         [0045]    Referring now to  FIGS. 4 and 5 , in an alternative embodiment, the locking structure  600  includes the aforementioned channels  602  and a locking mechanism  606 . The locking mechanism  606  includes a locking member  608  having an aperture  610  formed therein, a handle portion  612 , and a biasing member  614 . The aperture  610  is configured to receive the filaments  400 , and the handle portion  612  is configured for manual engagement by the clinician to facilitate transitioning of the locking mechanism  606  between a locked condition ( FIG. 4 ) and an open condition ( FIG. 5 ). In the locked condition, the aperture  610  is in misalignment with the channel  602  such that a portion of the filaments  400  is disposed between the housing  100  and the locking member  608 , effectively prohibiting any movement of the filaments  400  and thereby maintaining the second position of the tubular member  200  ( FIG. 2 ). When the locking mechanism  606  is in the open condition, however, at least a portion of the aperture  610  is aligned with the channel  602  such that the filaments  400  may freely extend therethrough. The biasing member  614  urges the locking mechanism  606  towards the locked condition and may be comprised of any structure or mechanism suitable for this intended purpose, e.g., a spring. 
         [0046]    In alternative embodiments, the locking mechanism  606  may comprise a single locking member  608  and a single biasing member  614 , as shown in  FIGS. 4 and 5 , or a plurality of locking members  614  engagable with one or more biasing members  620 . 
         [0047]    Referring again to  FIGS. 1 and 2 , the use and function of the surgical access apparatus  10  will be discussed during the course of a typical minimally invasive procedure subsequent to the formation of the tissue tract  12 . 
         [0048]    Prior to insertion of the surgical access apparatus  10 , the tubular member  200  is in the first position ( FIG. 1 ) to facilitate positioning of the tubular member  200  within the tissue tract  12 . It should be noted that the clinician may compress the connective member  300  radially, i.e., towards the longitudinal axis “A,” to further reduce the outer transverse dimension “D|” of the tubular member  200  at the distal end  204  to reduce the likelihood of trauma to the tissue “T” during insertion. After positioning the distal end  204  of the tubular member  200  within the tissue tract  12 , the clinician advances the surgical access apparatus  10  distally until the flange  110  abuts the patient&#39;s tissue “T.” Thereafter, the clinician draws the filaments  400  proximally towards the housing  100  to transition the tubular member  200  into the second position ( FIG. 2 ) and form the tissue engaging portion  214 . The clinician can then secure the filaments  400  to the locking structure  600  in order to maintain the second position of the elongated member  400 , thereby anchoring the surgical access apparatus  10  within the tissue tract  12 . The surgical instrument “I” can then be inserted into, and advanced distally through, the lumen  210  extending through the tubular member  200  to carry out the surgical procedure through the surgical access apparatus  10 . 
         [0049]    It should be noted that insertion of the surgical instrument “I” may expand the tubular member  200  outwardly along the transverse axis “B” into tight-fitting engagement with the patient&#39;s tissue “T,” thereby further securing the surgical access apparatus  10  and enhancing the quality of the seal formed by the engagement of the tissue “T” with the flange  110  and the tissue engaging portion  214  of the tubular member  200 . 
         [0050]    After completing the procedure and withdrawing the surgical instrument “I” from the tubular member  200 , the filaments  400  can be disengaged from the locking structure  600 , e.g., untied, such that the tubular member  200  can be returned to the first position ( FIG. 1 ). The surgical access apparatus  10  can then be withdrawn from the tissue tract  12 , and the tissue tract  12  can be closed. 
         [0051]    Referring now to  FIGS. 6 and 7 , in another embodiment, the surgical access apparatus  10  includes a membrane  700  that is disposed about the tubular member  200 . The membrane  700  may be composed of any suitable biocompatible material that is at least semi-resilient in nature and substantially impervious to fluids, e.g., insufflation gas or an irrigant solution. Incorporating the membrane  700  may facilitate the insertion and passage of one or more surgical instruments “I” into and through the lumen  210  of the tubular member  200 . The membrane  700  may be disposed about the tubular member  200  along its entire length, or in the alternative, the membrane  700  may be selectively disposed about individual sections of the tubular member  200 , e.g., about a proximal section  216 , an intermediate section  218 , and/or a distal section  220 . 
         [0052]    When disposed about the proximal section  216  of the tubular member  200 , the membrane  700  engages the patient&#39;s tissue “T” upon transitioning of the tubular member  200  from the first position ( FIG. 6 ) into the second position ( FIG. 7 ). Engagement of the membrane  700  with the patient&#39;s tissue “T,” in conjunction with the flange  110  of the housing  100 , creates a substantially fluid-tight seal about the tissue tract  12 , thereby substantially inhibiting the escape of any fluids from the surgical worksite “W” about the surgical access apparatus  10 . 
         [0053]    As previously discussed with respect to the surgical access apparatus  10  shown in  FIGS. 1 and 2 , introducing the surgical instrument “I” to the tubular member  200  may cause the tubular member  200  to expand outwardly along the transverse axis “B.” In the embodiment of the surgical access apparatus  10  seen in  FIGS. 6 and 7 , the membrane  700  would also be forced outwardly into engagement with the patient&#39;s tissue “T.” Accordingly, the membrane  700  may act to further anchor the surgical access apparatus  10  within the tissue “T,” and tighten the seal created therewith by the tissue engaging portion  214  and the flange  110 . 
         [0054]    The above description, disclosure, and figures should not be construed as limiting, but merely as exemplary of particular embodiments. It is to be understood, therefore, that the disclosure is not limited to the precise embodiments described, 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. Additionally, persons skilled in the art will appreciate that the features illustrated or described in connection with one embodiment may be combined with those of another, and that such modifications and variations are also intended to be included within the scope of the present disclosure.