Patent Publication Number: US-2017360423-A1

Title: Removable medical retractor tip

Description:
RELATED APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 13/783,570, filed Mar. 4, 2013, which claims the benefit of priority from U.S. Provisional Application No. 61/651,803, filed May 25, 2012, and titled “Removable Medical Retractor Tip”, the contents of which is incorporated herein by reference. 
    
    
     TECHNICAL FIELD 
     The present invention relates to medical devices and more specifically, instruments used in conjunction with laparoscopic surgery. 
     BACKGROUND 
     Laparoscopic surgical procedures generally involve inflating a bodily cavity with a gas, such as the abdomen, to provide better visibility of the surgical site. Such gasses may include carbon dioxide. After the surgical site is insufflated, the bodily cavity may be punctured using a trocar device for the purposes of inserting surgical tools such as a laparoscopic camera, cutting and manipulating tools, etc. For example, when performing laparoscopic surgery in the abdominal area, the trocar device is utilized to puncture the peritoneum. Thereafter, a laparoscopic retractor may be inserted through the puncture site and directed to the targeted anatomy to assist in retracting and holding certain bodily organs and tissue, thereby exposing the surgical field for the procedure. Maintaining adequate vision of the target or surgical field during laparoscopic procedures is critical to a successful laparoscopic procedure, as inadequate ability to visualize anatomical structures is a common complication of laparoscopic procedures, and can lead to conversion from a laparoscopic to an open procedure. 
     Laparoscopic surgery has many advantages over traditional open surgery in that it generally takes less time to complete, the patient is likely to experience less severe post-operative pain, and the incisions leave less noticeable scarring as compared to open surgery. Additionally, hospital recovery time and costs are generally reduced. 
     Despite the benefits of laparoscopic surgery, such surgery is often difficult to perform due to the effort required to arrive at adequate exposure of the surgical field. This is especially true in the case of inserting a retractor into a larger patient due to, for example, the distribution of adipose tissue over the preferred insertion site. For example, after the initial insertion is made, the retractor must be navigated through numerous layers of materials, including the skin, adipose tissue, etc. to reach the abdominal cavity and from there the target anatomy site. The materials through which the retractor is navigated are malleable and flexible, and accordingly, the incision does not remain fixed relative to the skin, adipose tissue, etc. Thus, inserting the retractor through the layers of material, especially when the patient has a thicker layer of adipose tissue over the insertion site, is difficult and results in a phenomenon called “tenting”, wherein the retractor becomes stuck in the layers of material that have moved relative to the insertion point. This delays the procedure until the end of the retractor finally locates the incision into the abdominal cavity. Because laparoscopic retractors typically have a rounded end to facilitate easy insertion though the skin and into the abdominal cavity, the length of the end dictates how much adipose tissue can be accommodated. The more the adipose layers must be compressed to insert the insertion end, the more likely the incision path becomes difficult to navigate. Although the insertion end of the retractor could be lengthened, a long retractor end impedes the medical procedure once it has been inserted, particularly in surgical areas having space constraints such as the pelvic area. Accordingly, present retractors do not provide an adequate solution to performing efficient laparoscopic surgery on those patients with additional adipose tissue over the preferred insertion site. 
     BRIEF SUMMARY 
     In a first aspect, a removable tip is provided comprising a substantially conical-shaped body comprising a proximal body portion and a distal body portion, wherein the proximal body portion comprises a substantially hollow portion and is configured for receiving a distal portion of a medical retractor, and wherein the distal body portion is atraumatic. 
     In a second aspect, a medical retractor system is provided, comprising a removable tip having a substantially conical-shaped body comprising a proximal body portion and a distal body portion, wherein the proximal body portion comprises a substantially hollow portion and is configured for receiving a distal portion of a medical retractor, and wherein the distal body portion is atraumatic; a disengagement means in communication with the substantially conical-shaped body configured to disengage the substantially conical-shaped body from a distal portion of a medical retractor; and a medical retractor having a proximal portion and a distal portion, wherein the distal portion is connected to the removable tip. 
     In a third aspect, a method for using a medical retractor system is provided, comprising the steps of providing a medical retractor comprising a proximal portion and a distal portion; and providing a removable tip comprising a substantially conical-shaped body comprising a proximal body portion and a distal body portion, wherein the proximal body portion comprises a substantially hollow portion and is configured for receiving the distal portion of the medical retractor, and wherein the distal body portion is atraumatic. 
    
    
     
       BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS 
       The embodiments will be further described in connection with the attached drawing figures. It is intended that the drawings included as a part of this specification be illustrative of the exemplary embodiments and should in no way be considered as a limitation on the scope of the invention. Indeed, the present disclosure specifically contemplates other embodiments not illustrated but intended to be included in the claims. Moreover, it is understood that the figures are not necessarily drawn to scale. 
         FIG. 1A  illustrates a perspective view of an exemplary retractor attached to an exemplary removable tip; 
         FIG. 1B  illustrates a perspective view of the exemplary retractor detached from the exemplary removable tip illustrated in  FIG. 1A ; 
         FIG. 1C  illustrates a perspective view of a portion of the exemplary retractor detached from the exemplary removable tip illustrated in  FIG. 1B  at the circle  1 C; 
         FIG. 2A  illustrates a perspective view of an exemplary retractor attached to another exemplary removable tip; 
         FIG. 2B  illustrates a bottom perspective view of the exemplary removable tip illustrated in  FIG. 2A ; 
         FIG. 2C  illustrates a perspective view of the exemplary removable tip illustrated in  FIG. 2A  just prior to disengagement from the exemplary retractor; 
         FIG. 2D  illustrates a perspective view of the exemplary removable tip illustrated in  FIG. 2A  disengaged from the distal-most portion of the exemplary retractor; 
         FIG. 2E  illustrates a perspective view of the exemplary removable tip illustrated in  FIG. 2A  being removed through an incision; 
         FIG. 3A  illustrates a perspective view of an exemplary retractor attached to another exemplary removable tip; 
         FIG. 3B  illustrates a perspective view of the exemplary removable tip illustrated in  FIG. 3A  in the process of disengagement from the distal-most portion of the exemplary retractor; 
         FIG. 3C  illustrates a perspective view of the exemplary removable tip illustrated in  FIG. 3A  being disengaged from the distal-most portion of the exemplary retractor; 
         FIG. 3D  illustrates a perspective view of the exemplary removable tip illustrated in  FIG. 3A  being removed through an incision; 
         FIG. 4A  illustrates a perspective partial cross-sectional view of an exemplary retractor attached to another exemplary removable tip; 
         FIG. 4B  illustrates a perspective view of the exemplary removable tip illustrated in  FIG. 4A ; 
         FIG. 4C  illustrates a perspective view of the exemplary removable tip illustrated in  FIG. 4A  just prior to disengagement from the exemplary retractor; 
         FIG. 4D  illustrates a perspective view of the exemplary removable tip illustrated in  FIG. 4A  disengaged from the exemplary retractor; 
         FIG. 5A  illustrates a perspective view of an exemplary retractor attached to another exemplary removable tip; 
         FIG. 5B  illustrates a perspective view of the exemplary removable tip illustrated in  FIG. 5A  disengaged from the exemplary retractor; 
         FIG. 6A  illustrates a perspective view of an exemplary retractor attached to another exemplary removable tip; 
         FIG. 6B  is a cross-sectional view of the removable tip taken along line  6 A- 6 A in  FIG. 6A ; 
         FIG. 6C  illustrates a perspective view of the exemplary removable tip illustrated in  FIG. 6A  disengaged from the exemplary retractor; 
         FIG. 7A  illustrates a perspective view of an exemplary retractor attached to another exemplary removable tip; 
         FIG. 7B  illustrates a perspective view of the exemplary removable tip illustrated in  FIG. 7A  disengaged from the exemplary retractor; 
         FIG. 8A  illustrates a perspective view of an exemplary retractor attached to another exemplary removable tip; 
         FIGS. 8B-8E  illustrate a perspective view of the exemplary removable tip illustrated in  FIG. 8A  partially or fully disengaged from the exemplary retractor; 
         FIG. 9A  illustrates a perspective view of an exemplary retractor attached to another exemplary removable tip; 
         FIG. 9B  illustrates a perspective view of the exemplary removable tip illustrated in  FIG. 9A  in a collapsed configuration; 
         FIGS. 9C-9E  illustrate cross-sectional views of the exemplary removable tip illustrated in  FIG. 9A  showing the collapsing mechanism; 
         FIG. 10A  illustrates a perspective view of an exemplary retractor attached to another exemplary removable tip; 
         FIG. 10B  illustrates a perspective view of the exemplary removable tip illustrated in  FIG. 10A  in a retracted position; 
         FIGS. 10C-10E  illustrate cross-sectional views of the exemplary removable tip illustrated in  FIG. 10A  comprising various retracting mechanisms; 
         FIG. 11A  illustrates a perspective view of an exemplary retractor attached to another exemplary removable tip; 
         FIG. 11B  illustrates a perspective view of the exemplary removable tip illustrated in  FIG. 11A  in a deflated configuration; 
         FIGS. 11C-11D  illustrate cross-sectional views of the exemplary removable tip illustrated in  FIG. 11A  further comprising an inflation mechanism; 
         FIG. 12A  illustrates a perspective view of an exemplary retractor attached to another exemplary removable tip; 
         FIG. 12B  illustrates a perspective view of the exemplary removable tip illustrated in  FIG. 12A  in a partially retracted configuration; 
         FIG. 13A  illustrates a perspective view of an exemplary retractor attached to another exemplary removable tip; 
         FIG. 13B  illustrates a perspective view of the exemplary removable tip illustrated in  FIG. 13A  disengaged from the exemplary retractor; 
         FIG. 14A  illustrates a perspective view of an exemplary retractor attached to another exemplary removable tip; 
         FIG. 14B  illustrates a perspective view of the exemplary removable tip illustrated in  FIG. 14A  in a retracted configuration; 
         FIG. 15A  illustrates a perspective view of an exemplary retractor attached to another exemplary removable tip; 
         FIG. 15B  illustrates a perspective view of the exemplary removable tip illustrated in  FIG. 15A  in a shortened configuration; 
         FIG. 16A  illustrates a perspective partial cross-sectional view of an exemplary retractor attached to another exemplary removable tip; 
         FIG. 16B  illustrates a perspective side view of the distal end of the exemplary removable tip illustrated in  FIG. 16A ; 
         FIG. 16C  illustrates a perspective view of the exemplary removable tip illustrated in  FIG. 16A  disengaged from the exemplary retractor; and 
         FIG. 17  illustrates a method of use of an exemplary retractor-removable tip system, such as those illustrated herein and equivalents thereto. 
     
    
    
     DETAILED DESCRIPTION OF PRESENTLY PREFERRED EMBODIMENTS 
     The exemplary embodiments illustrated provide the discovery of systems, methods, and apparatuses used in conjunction with laparoscopic surgery to improve efficiency and navigation to the target anatomy while maintaining adequate exposure of the target anatomy. 
     Diseases and conditions contemplated for treatment include, but are not limited to, those involving the pelvic region as well as any other bodily region or field benefiting from improved navigation to a target site. 
     The present invention is not limited to those embodiments illustrated herein, but rather, the disclosure includes all equivalents including those of different shapes, sizes, and configurations. The systems, devices, and methods may be used in any field benefiting retractors or devices to aid in the navigation to a target site. Additionally, the devices and methods are not limited to being used with human beings; others are contemplated, including but not limited to, animals. 
     Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art. In case of conflict, the present document, including definitions, will control. Preferred methods and materials are illustrated below, although apparatuses, methods, and materials similar or equivalent to those illustrated herein may be used in practice or testing. All publications, patent applications, patents and other references mentioned herein are incorporated by reference in their entirety. The materials, methods, and examples disclosed herein are illustrative only and not intended to be limiting. 
     The terms “comprise(s),” “include(s),” “having,” “has,” “can,” “contain(s),” and variants thereof, as used herein, are intended to be open-ended transitional phrases, terms, or words that do not preclude the possibility of additional acts or structures. The present disclosure also contemplates other embodiments “comprising,” “consisting of” and “consisting essentially of,” the embodiments or elements presented herein, whether explicitly set forth or not. 
     The term “proximal,” as used herein, refers to a direction that is generally towards a physician during a medical procedure. 
     The term “distal,” as used herein, refers to a direction that is generally towards a target site within a patient&#39;s anatomy during a medical procedure. 
     A more detailed description of the embodiments will now be given with reference to  FIGS. 1A-17 . Throughout the disclosure, like reference numerals and letters refer to like elements. The present disclosure is not limited to the embodiments illustrated; to the contrary, the present disclosure specifically contemplates other embodiments not illustrated but intended to be included in the claims. 
       FIG. 1A  illustrates a perspective view of exemplary retractor  102  attached to exemplary removable tip  100 ,  FIG. 1B  illustrates a perspective view of exemplary retractor  102  detached from exemplary removable tip  100 , and  FIG. 1C  illustrates a perspective view of a portion of exemplary retractor  102  detached from exemplary removable tip  100  illustrated in  FIG. 1B  at the circle  1 C. Referring to  FIG. 1A , exemplary retractor  102  includes proximal portion  102   a  and distal portion  102   b.  The distal-most portion of retractor  102  has been modified to receive a female proximal portion  100   a  of removable tip  100 . Retractor  102  is designed for insertion through a laparoscopic incision or port and is preferably used to aid in the positioning and or holding of organs or tissues during a diagnostic, exploratory, or therapy procedure. For example, retractor  102  may be used to help position organs and tissues during, for example, rectal dissections, pelvic floor grafting, uterine procedures, and bowel procedures. Moreover the use of two or more retractors  102  having removable tips  100  are contemplated. 
     The distal-most end of retractor  102  is atraumatic, pinched, and tapered. Proximal portion  100   a  of removable tip  100  is substantially hollow to receive retractor  102  via a snap fit or other attachment means, including but not limited to, a friction fit. A screw/threaded attachment means may also be used, recognizing that such an attachment means may be more difficult to disengage when in use due to the space constraints of the working environment. 
     Removable tip  100  is a substantially conical-shaped removable piece configured for attachment to distal portion  102   b  of retractor  102  to improve retractor  102  insertion, especially in the case of patients having large amounts of adipose tissue. Distal portion  100   b  of removable tip  100  is tapered and atraumatic for ease of insertion and navigation through an incision and to prevent damaging organs and tissue. Although removable tip  100  is illustrated as being configured to receive retractor  102  therein, retractor  102  may be configured to receive removable tip  100  therein. In other words, retractor  102  may be configured with a female distal end  102   b  into which a male proximal end  100   a  of removable tip  100  may be inserted and affixed thereto. In any event, in either configuration, it is generally preferred, although not required, that a medical retractor be free from numerous crevasses or other surface features that may make sterilization for reuse difficult. 
     The additional overall length provided by removable tip  100  makes it easier for retractor  102  to be inserted through the incision during a laparoscopic procedure. The longer the removable tip  100 , the more adipose tissue can be accommodated. In other words, fashioning removable tip  100  to have a longer dimension will allow it to accommodate thicker skin, fat, and muscle layers. However, because removable tip  100  is removable from retractor  102  after retractor  102  is inserted, the space constraints addressed by a retractor  102  having a minimized overall size may be achieved. 
     Referring to  FIGS. 1B and 1C , removable tip  100  is illustrated as disengaged from retractor  102  by being pulled distally from retractor  102 , using, for example, an instrument such as endo grippers. Once removable tip  100  is disengaged from retractor  102 , retractor  102  alone is of a sufficient length to perform its retracting functions. The distal-most portion of retractor  102  includes a tapered atraumatic portion  104  for ease of insertion through an incision or port that will not damage tissue or organs once disengaged from removable tip  100 . 
     Removable tip  100  is approximately 5 cm long but other lengths are contemplated depending upon the amount of tissue needed through which to introduce retractor  102 . For example, removable tips  100  having a variety of lengths may be manufactured to accommodate various amounts of adipose or other tissues and could be provided as part of a kit. For example, a first removable tip  100  may have a length of 5 cm, a second may have a length of 8 cm, and a third may have a length of 10 cm. Accordingly, the user may choose the most appropriately-sized removable tip  100  for attachment to retractor  102  based on the clinical facts and circumstances. In some cases, if the material through which retractor  102  needs to be inserted is sufficiently thin, removable tip  100  may not be needed. 
     Removable tip  100  is made from plastic, such as polypropylene, although other materials are contemplated, including but not limited to TPE (thermoplastic elastomers), polycarbonate, polystyrene, an elastomeric material capable of stretching over the distal-most portion of retractor  102 , molded silicone, and metal. Removable tip  100  may be configured from two or more materials, including those having different properties, characteristics or features, including but not limited to, one material having a different hardness from the other. For example, distal portion  100   b  of removable tip  100  may be configured from a harder material than, for example, proximal portion  100   a  of removable tip  100 . The harder material may provide the distal portion  100   b  with an improved ability to pass through the tissue during placement, whereas the softer material may provide the proximal portion  100   a  with an improved ability to engage with the distal end  102   b  of the retractor  102 . 
     Removable tip  100  preferably is disposable, low-cost, and is intended for single use, although it may be configured to be reusable. Retractor  102  is preferably also low-cost and may be manufactured for either single use or for multiple uses. 
       FIG. 2A  illustrates a perspective view of exemplary retractor  202  attached to exemplary removable tip  200 ,  FIG. 2B  illustrates a bottom perspective view of removable tip  200 ,  FIG. 2C  illustrates a perspective view of removable tip  200  just prior to disengagement from retractor  202 ,  FIG. 2D  illustrates a perspective view of removable tip  200  disengaged from the distal-most portion of retractor  202 , and  FIG. 2E  illustrates a perspective view of removable tip  200  being removed through an incision. Referring to  FIGS. 2A-2B , retractor  202  is similar to the retractor embodiment discussed above in connection with  FIGS. 1A-1C . The distal-most end of retractor  202  is atraumatic and rounded. For example, retractor  202  is designed for insertion through a laparoscopic incision or port and is preferably used to aid in the positioning and or holding of organs or tissues during a diagnostic, exploratory, or therapy procedure. For example, retractor  202  may be used to help position organs and tissues during, for example, rectal dissections, pelvic floor grafting, uterine procedures, and bowel procedures. Although only a single retractor  202  is illustrated, the use of two or more retractors  202  having removable tips  200  is also contemplated. 
     Removable tip  200  is a substantially conical-shaped removable piece configured for attachment to distal portion  202   b  of retractor  202  to improve the insertion capability of retractor  202 , especially in the case of patients having large amounts of adipose tissue. Distal portion  200   b  of removable tip  200  is tapered and atraumatic for ease of insertion and navigation through an incision, as well as to prevent causing damage to organs and tissue. Proximal portion  200   a  of removable tip  200  is substantially hollow so as to receive retractor  202  therein. As will be explained below, removable tip  200  is configured to be disengaged from retractor  202  by breaking the removable tip  200  at snap point  204 . For example, referring to  FIG. 2C , an instrument, such as a forceps or endo gripper E is positioned at and grabs distal portion  200   b  of removable tip  200 . Endo gripper E is then moved in the direction of arrow A to cause distal portion  200   b  of removable tip  200  to break from supporting neck  206  at snap point  204 , thereby releasing the engagement of removable tip  200  with retractor  202 . Removable tip  200  includes supporting neck  206  that maintains, at least temporarily, communication with retractor  202  even after distal portion  200   b  of removable tip  200  is broken at snap point  204 . 
     Referring to  FIG. 2D , an instrument, such as endo grippers E is used to back feed removable tip  200  proximally along retractor  202  in the direction of arrow B such that removable tip  200  is able to be removed from the area of the laparoscopic procedure. Referring to  FIG. 2E , removable tip  200  continues to be back-thread proximally along retractor  202  in the direction of arrow C such that it is pushed through the incision point at the skin and the abdominal cavity, and is subsequently removed from the procedure. Once removable tip  200  is disengaged from retractor  202 , retractor  202  alone is of a sufficient length to perform its retracting functions. 
     Removable tip  200  is approximately 5 cm long but other lengths are contemplated depending upon the amount of tissue through which retractor  202  is to be introduced. For example, multiple removable tips  200  each having a variety of lengths may be manufactured to accommodate various amounts of adipose or other tissues. For example, a first removable tip  200  may have a length of 5 cm, a second may have a length of 8 cm, and a third may have a length of 10 cm. The removable tips  200  having various lengths may be included in a kit supplied with retractor  202 . Accordingly, the user may choose the most appropriately-sized removable tip  200  for attachment to retractor  202  based on the clinical facts and circumstances. In some cases, the material through which retractor  202  needs to be inserted may be sufficiently thin such that removable tip  200  may not be needed. 
     Removable tip  200  is made from plastic, such as polypropylene, although other materials are contemplated, including but not limited to TPE (thermoplastic elastomers), polycarbonate, polystyrene, nylon, and molded silicone. Removable tip  200  may be configured from two or more materials, including those having different properties, characteristics or features, including but not limited to, one having a different hardness from the other. For example, distal portion  200   b  of removable tip  200  may be configured from a harder material than, for example, proximal portion  200   a  of removable tip  200 . 
     Removable tip  200  preferably is disposable, low-cost, and is intended for single use, although it may be configured to be reusable. Retractor  202  is preferably also low-cost and may be manufactured for single use or for multiple uses. 
     One advantage of the configuration of removable tip  200 , among many, is that removable tip  200  is never completely disengaged from the retractor  202  while within the patient. Accordingly, there is very little risk of removable tip  200  becoming lost or forgotten within the patient. 
       FIG. 3A  illustrates a perspective view of exemplary retractor  202  attached to exemplary removable tip  300 ,  FIG. 3B  illustrates a perspective view of removable tip  300  in the process of disengagement from the distal-most portion of retractor  202 ,  FIG. 3C  illustrates a perspective view of removable tip  300  being disengaged from the distal-most portion of retractor  202 , and  FIG. 3D  illustrates a perspective view of removable tip  300  being removed through an incision. Although a single retractor  202  is illustrated, the use of two or more retractors  202  each having removable tips  300  is contemplated. 
     Removable tip  300  includes proximal portion  300   a  and distal portion  300   b . Removable tip  300  is a substantially conical-shaped removable piece configured for attachment to distal portion  202   b  of retractor  202  to improve retractor insertion, especially in the case of patients having large amounts of adipose tissue. Referring to  FIG. 3A , proximal portion  300   a  of removable tip  300  is substantially hollow and configured for receiving distal portion  202   b  of retractor  202 , via, for example, a snap fit or other attachment means, including but not limited to a friction fit. Distal portion  300   b  of removable tip  300  is tapered and atraumatic for ease of insertion and navigation through an incision and to prevent damaging organs and tissue. In this particular embodiment, removable tip  300  includes pull cord  302  connected to ring  304  that when pulled, breaks removable tip  300  at perforations  308 , thereby causing removable tip  300  to release its grip on retractor  202  such that removable tip  300  may be removed. Ring  304  or other retaining means is intended to remain outside patient while retractor  202  equipped with removable tip  300  is being inserted into a patient. 
     Referring to  FIGS. 3B and 3C , ring  304  is pulled proximally in the direction of arrow F thereby causing perforations  308  (illustrated in  FIG. 3A ) to break and create break flap  306  in the direction of arrow D. The entirety of tip  300  is then pulled proximally along retractor  202  in the direction of arrow G. Referring to  FIG. 3D , removable tip  300  continues to be back-thread proximally along retractor  202  in the direction of arrow H such that it is pushed through the incision point at skin and the abdominal cavity and is able to be removed from the procedure. Once removable tip  300  is disengaged from retractor  202 , retractor  202  alone is of a sufficient length to perform its retracting functions. 
     Removable tip  300  is approximately 15 cm long but other lengths are contemplated depending upon the amount of tissue needed through which to introduce retractor  202 . For example, multiple removable tips  300  having a variety of lengths may be manufactured to accommodate various amounts of adipose or other tissues. For example, a first removable tip  300  may have a length of 15 cm, another may have a length of 18 cm, and another may have a length of 20 cm. Accordingly, the user may choose the most appropriately-sized removable tip  300  for attachment to retractor  202  based on the clinical facts and circumstances. In some cases, if the material through which retractor  202  needs to be inserted is sufficiently thin, removable tip  300  may not be needed. 
     Removable tip  300  is made from plastic, such as polypropylene, although other materials are contemplated, including but not limited to TPE (thermoplastic elastomers), polycarbonate, polystyrene, nylon, and molded silicone. Removable tip  300  may be configured from two or more materials, including those having different characteristics or features, including but not limited to, one having a different hardness from the other. For example, distal portion  300   b  of removable tip  300  may be configured from a harder material than, for example, proximal portion  300   a  of removable tip  300 . 
     Removable tip  300  preferably is disposable, low-cost, and is intended for single use, although it may be configured to be reusable. One advantage of the configuration of removable tip  300 , among many, is that removable tip  300  is never completely disengaged from retractor  202  while within the patient. Accordingly, there is very little risk of removable tip  300  becoming lost or forgotten within the patient. 
       FIG. 4A  illustrates a perspective partial cross-sectional view of exemplary retractor  102  attached to exemplary removable tip  400 ,  FIG. 4B  illustrates a perspective view of removable tip  400 ,  FIG. 4C  illustrates a perspective view of removable tip  400  just prior to disengagement from the exemplary retractor, and  FIG. 4D  illustrates a perspective view of removable tip  400  disengaged from the exemplary retractor. The use of two or more retractors  102  having removable tips  400  are contemplated. 
     Referring to  FIGS. 4A and 4B , removable tip  400  includes proximal portion  400   a  and distal portion  400   b . Removable tip  400  is a substantially conical-shaped removable piece configured for attachment to distal portion  102   b  of retractor  102  to improve retractor insertion, especially in the case of patients having large amounts of adipose tissue. Distal portion  400   b  of removable tip  400  is tapered and atraumatic for ease of insertion and navigation through an incision and to prevent damaging organs and tissue. Proximal portion  400   a  of removable tip  400  is substantially hollow and configured for receiving distal portion  102   b  of retractor  102 , via, for example, a snap fit or other attachment means, including but not limited to a friction fit. In the particular embodiment illustrated, the distal portion  102   b  of the retractor  102  comprises one or more grooves or indentations that are configured to receive one or more ridges or protrusion on the inside of removable tip  400  to facilitate engagement between therebetween. Removable tip  400  includes pull tab  402  that when pulled, breaks removable tip  400  at perforations  404 , thereby causing removable tip  400  to release its grip on retractor  102  such that removable tip  400  may be removed. 
     Referring to  FIGS. 4C and 4D , an instrument, such as a forceps or an endo gripper E is positioned at and grasps pull tab  402 . The endo gripper E pulls pull tab  402  in the direction of arrow J away from removable tip  400 , thereby causing perforations  404  to break until perforation stop  406  such that removable tip  400  remains one piece. Removable tip  400  is disengaged from retractor  102  and can be removed through any incision or port, or after the procedure is complete. Once removable tip  400  is disengaged from retractor  102 , retractor  102  alone is of a sufficient length to perform its retracting functions. 
     Removable tip  400  is approximately 5 cm long but other lengths are contemplated depending upon the amount of tissue needed through which to introduce retractor  102 . For example, multiple removable tips  400  having a variety of lengths may be manufactured to accommodate various amounts of adipose or other tissues. For example, a first removable tip  400  may have a length of 5 cm, another may have a length of 8 cm, and another may have a length of 10 cm. Accordingly, the user may choose the most appropriately-sized removable tip  400  for attachment to retractor  102  based on the clinical facts and circumstances. In some cases, if the material through which retractor  102  needs to be inserted is sufficiently thin, removable tip  400  may not be needed. 
     Removable tip  400  is made from plastic, such as polypropylene, although other materials are contemplated, including but not limited to TPE (thermoplastic elastomers), polycarbonate, polystyrene, nylon, and molded silicone. Removable tip  400  may be configured from two or more materials, including those having different characteristics or features, including but not limited to, one having a different hardness from the other. For example, distal portion  400   b  of removable tip  400  may be configured from a harder material than, for example, proximal portion  400   a  of removable tip  400 . Removable tip  400  preferably is disposable, low-cost, and is intended for single use, although it may be configured to be reusable. 
       FIG. 5A  illustrates a perspective view of exemplary retractor  202  attached to exemplary removable tip  500 , and  FIG. 5B  illustrates a perspective view of removable tip  500  disengaged from exemplary retractor  202 . The use of two or more retractors  202  having removable tips  500  are contemplated. 
     Removable tip  500  includes proximal portion  500   a  and distal portion  500   b . Removable tip  500  is a substantially conical-shaped removable piece configured for attachment to distal portion  202   b  of retractor  202  to improve retractor insertion, especially in the case of patients having large amounts of adipose tissue. Distal portion  500   b  of removable tip  500  is tapered and atraumatic for ease of insertion and navigation through an incision and to prevent damaging organs and tissue. Proximal portion  500   a  of removable tip  500  is substantially hollow and configured for receiving distal portion  202   b  of retractor  202 . 
     Removable tip  500  includes pull cord  502  connected to ring  506  that when pulled, breaks removable tip  500  at spiral perforations  504  disposed about removable tip  500 , thereby causing removable tip  500  to unwind and release its grip on retractor  202  such that removable tip  500  may be removed. Ring  506  or other retaining means is intended to remain outside patient while retractor  202  equipped with removable tip  500  is being inserted into a patient. 
     Ring  506  is pulled proximally in the direction of arrow K, thereby causing perforations  504  to break and unravel tip  500 . The entirety of tip  500  is then pulled out of the way from the area of retractor  202 . For example, ring  506  or any portion of pull cord  502  may be taped, clipped, or adhered, to an article such as the skin&#39;s surface, to maintain the placement of removable tip  500 . Once removable tip  500  is disengaged from retractor  202 , retractor  202  alone is of a sufficient length to perform its retracting functions. After retractor  202  is removed from the incision site, removable tip  500  is likewise able to be removed from the incision site. 
     One advantage of the configuration of removable tip  500 , among many, is that removable tip  500  is always connected to retractor  202  or the outside surface of the patient during the procedure. Accordingly, there is very little risk of removable tip  500  becoming lost or forgotten within the patient. 
     Removable tip  500  is approximately 15 cm long but other lengths are contemplated depending upon the amount of tissue needed through which to introduce retractor  202 . For example, multiple removable tips  500  having a variety of lengths may be manufactured to accommodate various amounts of adipose or other tissues and provided with retractor  202  as a kit. For example, a first removable tip  500  may have a length of 15 cm, another may have a length of 18 cm, and another may have a length of 20 cm. Accordingly, the user may choose from the kit the most appropriately-sized removable tip  500  for attachment to retractor  202  based on the clinical facts and circumstances. In some cases, if the material through which retractor  202  needs to be inserted is sufficiently thin, removable tip  500  may not be needed. 
     Removable tip  500  is made from plastic, such as polypropylene, although other materials are contemplated, including but not limited to TPE (thermoplastic elastomers), polycarbonate, polystyrene, nylon, and molded silicone. Removable tip  500  may be configured from two or more materials, including those having different properties, characteristics or features, including but not limited to, one having a different hardness from the other. For example, distal portion  500   b  of removable tip  500  may be configured from a harder material than, for example, proximal portion  500   a  of removable tip  500 . Removable tip  500  preferably is disposable, low-cost, and is intended for single use, although it may be reusable. 
       FIGS. 6A-6C  illustrate another embodiment of a removable tip  600  for use with retractor  202 . In this particular embodiment, the removable tip  600  comprises a pair of break lines  610  disposed longitudinally along the distal portion thereof. The break lines  610  are configured to break apart as the removable tip  600  is pulled in a proximal direction to thereby allow the removable tip  600  to be retracted in a proximal direction along the retractor  202 . Pull tabs may be provided on the proximal end of the removable tip  600  to facilitate the application of the breaking force and removal of the removable tip  600 . 
       FIGS. 7A-7B  illustrate another embodiment of a removable tip  700  for use with retractor  202 . In this particular embodiment, the removable tip  700  includes a pull cable  710  attached to the distal end the removable tip  700 . Once the retractor  202  is position, the user pulls on the pull cable  710  with sufficient force to separate and remove the removable tip  700  from the retractor  202 . The distal end of the pull cable  710  may include a loop to facilitate grasping thereof. 
       FIGS. 8A-8E  illustrate another embodiment of a removable tip  800  for use with a retractor  202 . In this particular embodiment, the removable tip  800  comprises a foldable distal portion  810  that may be folded to either permit removal or reduce the overall length thereof. Referring to  FIG. 8B , a forceps or endo grasper E is used to fold the distal portion  810 . As show in  FIG. 8C , the folding of the distal portion  810  exposes an opening in the removable tip  800 , thereby permitting the removable tip  800  to be retracted proximally along the retractor  202 . In the variation illustrated in  FIGS. 8D-8E , the foldable distal portion  810  is folded and secured alongside the remaining portion of the removable tip  800 , thereby reducing the overall length thereof. 
       FIGS. 9A-9E  illustrate another embodiment of a removable tip  900  for use with a retractor  202 . In this particular embodiment, the removable tip  900  comprises a collapsing mechanism  910  that permits the overall length of the removable tip  900  to be reduced. In particular, and as best seen in  FIGS. 9C-9E , the collapsing mechanism  910  comprises a plurality of interior supports that are secured to telescoping portions of the removable tip  900 . A button or other activation device on the removable tip  900  is depressed to break the interior supports, thereby allowing the telescoping sections to be collapsed, as shown in  FIG. 9B . 
       FIGS. 10A-10E  illustrate another embodiment of a removable tip  1000  for use with a retractor  202 . In this particular embodiment, the removable tip  1000  comprises a retracting mechanism that permits the overall length of the removable tip  1000  to be reduced. With reference to  FIGS. 10A-10C , the retracting mechanism includes a screw thread disposed on the outer surface of proximal portion  1010  which is configured to mate with a screw thread on the internal surface of distal portion  1012 . Rotation of the distal portion  1012  relative to the proximal portion  1010  causes the distal portion to move in a proximal direction relative to the retractor  202 , thereby allowing the overall length of the removable tip  1000  to be reduced.  FIGS. 10D-10E  illustrate an alternative arrangement wherein a bayonet connection is used in lieu of the screw connection. In the particular embodiments illustrated, the proximal portion  1010  is a separate component that is affixed to the distal end of the retractor  202 . However, it should be understood that the proximal portion  1010  could be integrally formed with or a formed into the distal end of the retractor  202 . 
       FIGS. 11A-11D  illustrate another embodiment of a removable tip  1100  for use with a retractor  202 . In this particular embodiment, the removable tip  1100  comprises an inflatable balloon tip  1110  that is filled with saline. The saline is removed from the balloon tip  1110  to deflate and collapse the balloon tip  1110 , thereby reducing the overall length of the removable tip  1100 . With reference to  FIG. 11B , the balloon tip  1110  is cut or punctured to allow the saline to escape. With reference to  FIGS. 11C-11D , the removable tip  1100  further includes an inflation mechanism  1112  for delivering saline to or removing saline from the balloon tip  1110 . The balloon tip  1110  could comprise multiple chambers to allow removable tip  1100  to be inflated to various lengths or configuration. 
       FIGS. 12A-12B  illustrate another embodiment of a removable tip  1200  for use with a retractor  202 . In this particular embodiment, the removable tip  1200  comprises a deformable and/or compressible material. As shown in  FIG. 12A , a pull cable  1210  is attached the distal end of the removable tip  1200 . The pull cable  1210  passes proximally through a lumen or hollowed out portion of the removable tip  1200 , and then proximally through a lumen of the retractor  202 . Once the retractor  202  is in position, the used pulls the pull cable  1210  to invert the distal end of the removable tip  1200 . The distal end of the removable tip  1200  is then pulled back into the lumen or hollowed out portion of the removable tip  1200 , thereby reducing the overall length of the removable tip  1200 . In the particular embodiment illustrated, the distal portion of the removable tip  1200  is also pulled into the lumen of the retractor  202 . If the removable tip  1200  comprises a sufficiently compressible material, the removable tip may be pulled completely into the lumen of the retractor  202 . 
       FIGS. 13A-13B  illustrate another embodiment of a removable tip  1300  for use with retractor  202 . In this particular embodiment, the removable tip  1300  includes a grasping mechanism  1310  attached to the distal end the removable tip  1300 . Once the retractor  202  is position, the user grasps the grasping mechanism  1310  with a forceps or endo grasper E with sufficient force to separate and remove the removable tip  1300  from the retractor  202 . In the particular embodiment illustrated, the grasping mechanism  1310  comprises a port in the distal end of the removable tip  1300 . However, other grasping mechanisms are contemplated, such a wire ring or suture loop. 
       FIGS. 14A-14B  illustrate another embodiment of a removable tip  1400  for use with a retractor  202 . In this particular embodiment, the removable tip  1400  comprises a spring loaded retracting mechanism that permits the overall length of the removable tip  1400  to be reduced. In particular, the removable tip  1400  comprises a distal portion  1410  that is slidably coupled to a proximal portion  1412 , wherein a coil spring is disposed therebetween. Once the retractor  202  is in position, pressure is applied to the distal portion  1410  to cause the distal portion  1410  to move in a proximal direction relative to the proximal portion  1412  and the retractor  202 , thereby allowing the overall length of the removable tip  1400  to be reduced, as illustrated in  FIG. 14B . A detent or similar mechanism may be provided between the distal portion  1410  and the proximal portion  1412  to secure the removable tip  1400  in a collapsed configuration. In the particular embodiments illustrated, the proximal portion  1412  is a separate component that is affixed to the distal end of the retractor  202 . However, it should be understood that the proximal portion  1412  could be integrally formed with or a formed into the distal end of the retractor  202 . 
       FIGS. 15A-15B  illustrate another embodiment of a removable tip  1500  for use with a retractor  202 . In this particular embodiment, the removable tip  1500  comprises a distal end portion  1510  that is removable. In particular, the distal end portion  1510  is cut and removed from the removable tip  1500  once the retractor  202  is in position. The distal end portion  1510  may also be snapped off and removed. To aid in the removal of the distal end portion  1510 , the removable tip  1500  may comprise a weakened area configured to facilitate removal of the distal end portion  1510 . Once removed, a forceps or endo grasper E may be used to remove the distal end portion  1510  from the surgical site. 
       FIGS. 16A-16C  illustrate another embodiment of a removable tip  1600  for use with retractor  102  and is similar to the embodiment discussed above in connection with  FIGS. 4A-4D . Specifically,  FIG. 16A  illustrates a perspective partial cross-sectional view of exemplary retractor  102  attached to exemplary removable tip  1600 ,  FIG. 16B  illustrates a perspective view of the distal end portion of the removable tip  1600 , and  FIG. 16C  illustrates a perspective view of removable tip  1600  disengaged from the exemplary retractor. 
     Referring to  FIGS. 16A and 16B , removable tip  1600  includes proximal portion  1600   a  and distal portion  1600   b . Removable tip  1600  is a substantially conical-shaped removable piece configured for attachment to distal portion  102   b  of retractor  102  to improve retractor insertion, especially in the case of patients having large amounts of adipose tissue. As best seen in  FIG. 16 , distal portion  1600   b  of removable tip  1600  comprises a flattened end portion having a reduced cross-section for ease of insertion and navigation through an incision and to prevent damaging organs and tissue. The reduced cross-section also facilitates grasping by a forceps or other device. Distal portion  1600   b  may also include a opening for the attachment of a suture or pull wire. 
     Referring to  FIG. 16A , proximal portion  1600   a  of removable tip  1600  is substantially hollow and configured for receiving distal portion  102   b  of retractor  102 , via, for example, a snap fit or other attachment means, including but not limited to a friction fit. In the particular embodiment illustrated, the distal portion  102   b  of the retractor  102  comprises one or more grooves or indentations that are configured to receive one or more ridges or protrusion on the inside of removable tip  1600  to facilitate engagement between therebetween. 
     As illustrated in  FIG. 16C , removable tip  1600  includes pull tab  1602  that when pulled, breaks removable tip  1600  at perforations  1604 , thereby causing removable tip  1600  to release its grip on retractor  102  such that removable tip  1600  may be removed. As explained above in connection with the embodiment of  FIGS. 4C-4D , the pull tab  1602  can be grasped with a forceps or endo gripper, and then pulled away from removable tip  1600  to thereby cause perforations  1604  to break. Removable tip  1600  can then be disengaged from the retractor  102  and removed through an incision or port, or after the procedure is complete. Once removable tip  1600  is disengaged from retractor  102 , retractor  102  alone is of a sufficient length to perform its retracting functions. 
       FIG. 17  illustrates a method  1700  of use of an exemplary retractor-removable tip system, such as those illustrated herein and equivalents thereto. At block  1702 , a retractor is provided, such as those illustrated in  FIGS. 1A-16C  or equivalents thereto. At block  1704 , a removable tip is provided, such as those illustrated in  FIGS. 1A-16C  or equivalents thereto. At block  1706 , the removable tip is attached to the retractor forming an assembly. Attachment means include, but are not limited to a snap fit, friction fit, and a screw/threaded attachment. At block  1708  the assembly is inserted through an incision or a port. At block  1710 , the removable tip is disengaged from the retractor by a disengagement means, such as those illustrated in  FIGS. 1A-16C , including but not limited to, pulling the removable tip distally from the retractor, snapping a distal portion of the tip breaking the supporting neck, pulling a pull cord or pull tab causing the removable tip to break at perforations. At block  1712  the removable tip is removed from the incision or port, which may be the same incision or port illustrated at block  1608 . The removable tip may be removed before or after removing the retractor from an incision or port. Means for removing the removable tip from an incision or a port include, but are not limited to, those illustrated in  FIGS. 1A-16C  and equivalents thereto, including but not limited to, back-threading the removable tip proximally along the retractor out through the incision or port, removing the retractor through a first incision or port and then removing the removable tip through the first incision or port, and removing the removable tip through a first incision or port and then removing the retractor through a second incision or port. 
     From the foregoing, the discovery of systems, apparatuses, and methods of removable tips for use in conjunction with medical instruments, including but not limited to, medical retractors in laparoscopic surgery improve the efficiency and navigation to the target anatomy while maintaining adequate exposure to the target anatomy. It can be seen that the embodiments illustrated and equivalents thereto as well as the methods of manufacturer may utilize machines or other resources, such as human beings, thereby reducing the time, labor, and resources required to manufacture the embodiments. Indeed, the discovery is not limited to the embodiments illustrated herein, and the principles and methods illustrated herein may be applied and configured to any retractor and equivalents. 
     Those of skill in the art will appreciate that embodiments not expressly illustrated herein may be practiced within the scope of the present discovery, including that features illustrated herein for different embodiments may be combined with each other and/or with currently-known or future-developed technologies while remaining within the scope of the claims presented here. It is therefore intended that the foregoing detailed description be regarded as illustrative rather than limiting. It is understood that the following claims, including all equivalents, are intended to define the spirit and scope of the discovery. Furthermore, the advantages illustrated above are not necessarily the only advantages of the discovery, and it is not necessarily expected that all of the illustrated advantages will be achieved with every embodiment of the discovery.