Patent Publication Number: US-2005119685-A1

Title: Expandible surgical access device

Description:
CROSS REFERENCE TO RELATED APPLICATIONS  
      The present application claims the benefit of priority of U.S. Provisional Patent Application Ser. No. 60/512,389, filed on Oct. 17, 2003, the entire contents of which are hereby incorporated by reference herein. 
    
    
     BACKGROUND  
      1. Technical Field  
      The present disclosure relates generally to surgical access devices, and, in particular, relates to an access device having an anchoring arrangement to securely engage the abdominal wall thereby minimizing the potential of inadvertent removal of the access device from the tissue site.  
      2. Background of Related Art  
      Minimally invasive surgical procedures including both endoscopic and laparoscopic procedures permit surgery to be performed on organs, tissues and vessels far removed from an opening within the tissue. These procedures typically employ a surgical instrument introduced into the body through a cannula which provides access to the underlying tissues within the tissue site. The cannula often incorporates a seal assembly adapted to provide a fluid tight seal about the instrument to minimize the leakage of insufflation gases from the body cavity.  
      While minimally invasive surgical procedures have proven to be quite effective in surgery, several disadvantages remain. The cannula may have a tendency to back out of the incision in the abdominal wall particularly during manipulation of the instruments through the cannula seal.  
     SUMMARY  
      Accordingly, the present disclosure relates to an access device for facilitating access to a surgical site. The access device includes an access member defining a longitudinal axis and having proximal and distal ends. The access member includes an inner member and an outer member disposed about the inner member. The inner member defines an opening therethrough to permit access to a surgical site. The inner member and outer member are moveable relative with respect to one another. The access device also includes a deployment member associated with the inner member and the outer member. The deployment member is adapted to be deployed in at least a radial outward direction relative to the longitudinal axis upon movement of the inner member and outer member relative to one another, to thereby be positioned to engage body tissue to facilitate retention of the access member within a patient&#39;s body. The deployment member comprises a deployment collar engaged with the inner member at a first end portion and the outer member at a second end portion of the collar.  
      The collar is desirably disposed adjacent a distal end of the inner member. In certain embodiments, the collar is disposed between the inner member and the outer member.  
      The deployment member preferably includes at least one deployment segment adapted to deflect in at least a radial outward direction relative to the longitudinal axis. The at least one deployment segment may include at least one hinge whereby the deployment segment pivots along the hinge to deflect in at least a radial outward direction. In certain embodiments, the at least one deployment segment comprises a plurality of bendable segments arranged so as to deflect in a radial outward direction upon movement of the inner member and the outer member with respect to each other in an axial direction.  
      In certain embodiments, the outer member defines an axial slot in an outer wall portion thereof, the at least one deployment segment being disposed inwardly of the outer member, and the axial slot permitting the bendable segment of the at least one deployment segment to pass therethrough upon deployment thereof.  
      The outer member desirably includes at least one thread portion on an exterior surface thereof, where the at least one thread portion is dimensioned for engaging tissue and cooperating with the deployment means so as to retain the apparatus in tissue. The at least one thread portion may comprise a plurality of thread portions arranged in interrupted manner about the exterior surface of the outer member.  
      In certain embodiments, the access apparatus further comprises a cam member in operative engagement with the inner member or the outer member. The cam member is moveable to drive the inner member or outer member in an axial direction to cause deployment of the at least one deployment segment. The cam member is desirably adapted for rotational movement. In certain embodiments, the cam member is in operative engagement with an inner housing attached to a proximal end of the inner member and an outer housing attached to a proximal end of the outer member, whereby rotational movement of the cam member causes movement of the inner member and the outer member with respect to one another in an axial direction and deployment of the at least one deployment segment. Desirably, at least one of the inner housing and the outer housing includes a cam slot and the cam member is in operative engagement with the cam slot to cause deployment of the deployment means. The cam member may be rotatably attached to the inner housing and the outer housing may have the cam slot so that rotation of the cam member advances the outer member in a distal direction.  
      In certain embodiments, the access apparatus includes a lever mechanism having a lever rotatably mounted to the inner member and in operative engagement with the outer member. The lever member is desirably rotatable to drive the outer member to cause deployment of the deployment means.  
      In certain embodiments, the access apparatus includes a rotatable control knob rotatably mounted to the inner member and in operative engagement with the outer member. The lever member is desirably rotatable to drive the outer member to cause deployment of the deployment means. The collar may be disposed outwardly from the inner member.  
      In certain embodiments, the deployment collar includes tabs and the outer member includes slots. The tabs are received in the slots. The apparatus may include a locking collar having a recess for engaging the distal end of the deployment collar. The locking collar is attached to the inner member.  
      In a further aspect of the present invention, an access apparatus for facilitating access to a surgical site comprises an access member defining a longitudinal axis and having an inner member and an outer member disposed about the inner member. The inner member defines an opening therethrough to permit access to a surgical site. The inner member and the outer member are movable with respect to one another in the axial direction. The apparatus includes a collar having a proximal end and a distal end, the proximal end being attached to the outer member and the distal end being attached to the inner member. The collar has deployment segments arranged to deflect in a radial outward direction upon movement of the inner member and outer member with respect to one another. A cam member is attached to one of the inner member and the outer member for engaging a surface on the other of the inner member and the outer member so that rotation of the inner member or the outer member moves the inner member and the outer member with respect to one another in the axial direction.  
      The inner member desirably has a groove for engaging the distal end of the collar. The deployment segments may have a proximal hinge and a distal hinge and may be arranged to bow outwardly at a central area of the deployment segments. The deployment segments may be arranged to bow outwardly at a central area of the deployment segments. The deployment segments may have a third hinge at the central area.  
      In certain embodiments, the collar is disposed inwardly of the outer member and the outer member defines axial slots. The deployment segments may extend through the axial slots after deployment. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
      The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the disclosure and, together with a general description of the disclosure given above, and the detailed description of the embodiment(s) given below, serve to explain the principles of the disclosure, wherein:  
       FIG. 1  is a perspective view of the apparatus in accordance with an embodiment of the present disclosure;  
       FIG. 1A  is an enlarged perspective view of the distal end of the apparatus in accordance with the embodiment of  FIG. 1 ;  
       FIG. 2  is another perspective view of the apparatus in accordance with the embodiment of  FIGS. 1 and 1 A;  
       FIG. 3  is a perspective view of the apparatus in accordance with the embodiment of  FIGS. 1-2 , showing a trocar mounted thereto;  
       FIG. 4  is an enlarged exploded view of the apparatus in accordance with the embodiment of  FIGS. 1-3 , showing parts separated illustrating the various components;  
       FIG. 5  is an enlarged perspective view of the deployment member of the apparatus in accordance with the embodiment of  FIGS. 1-4 ;  
       FIG. 6  is an enlarged perspective view of the outer sheath of the apparatus in accordance with the embodiment of  FIGS. 1-5 ;  
       FIG. 7  is a cross-sectional view of the apparatus in accordance with the embodiment of  FIGS. 1-6 ;  
       FIG. 8  is an enlarged sectional view of the distal end of the apparatus in accordance with the embodiment of  FIGS. 1-7 ;  
       FIG. 9  is a view in cross-section illustrating an apparatus in accordance with the embodiment of  FIGS. 1-8 , showing a trocar positioned within the apparatus and penetrating tissue;  
       FIG. 10  is a cross-sectional view in accordance with the embodiment of  FIGS. 1-9 , illustrating the deployment member in a deployed condition;  
       FIG. 11  is an enlarged isolated cross-sectional view of the distal end of the apparatus in accordance with the embodiment of  FIGS. 1-10 , further illustrating the relationship of the deployment member with the inner and outer sheath of the apparatus;  
       FIG. 12  is a perspective view of the apparatus in accordance with the embodiment of  FIGS. 1-11 , further illustrating the deployment member in a deployed condition; and  
       FIG. 13  is a cross-sectional view of the apparatus in accordance with the embodiment of  FIGS. 1-12 , showing the trocar removed to permit access to the underlying body cavity.  
       FIG. 14  is a perspective view of an apparatus in accordance with another embodiment of the disclosure;  
       FIG. 15  is cross-sectional view of the apparatus taken along the lines  15 - 15  of  FIG. 14 ;  
       FIG. 16  is an exploded view of the apparatus in accordance with the embodiment of  FIGS. 14-15 , with parts separated;  
       FIG. 16A  is an enlarged isolated view of the locking groove of the inner sheath in accordance with the embodiment of  FIGS. 14-16 ;  
       FIG. 16B  is an enlarged isolated view illustrating the locking tabs of the deployment member in accordance with the embodiment of  FIGS. 14-16A ;  
       FIG. 17  is a cross-sectional view of the apparatus in accordance with the embodiment of  FIGS. 14-16B ;  
       FIG. 17A  is an enlarged sectional view of the apparatus in accordance with the embodiment of  FIGS. 14-17 , illustrating the relationship of the cam member and the housing of the inner member;  
       FIG. 18  is a side perspective view of the base of the outer member of the apparatus in accordance with the embodiment of  FIGS. 14-17A ;  
       FIG. 18A  is an enlarged view illustrating further details of the base in accordance with the embodiment of  FIGS. 14-18 ;  
       FIG. 19  is a perspective view of the cam member in accordance with the embodiment of  FIGS. 14-18A ;  
       FIG. 19A  is an enlarged view illustrating further details of the cam member in accordance with the embodiment of  FIGS. 14-19 ;  
       FIG. 20  is a perspective view of the proximal end of the apparatus in accordance with the embodiment of  FIGS. 14-19A ;  
       FIG. 21  is a cross-sectional view of the apparatus taken along lines  21 - 21  of  FIG. 20 ;  
       FIG. 22  is a perspective view similar to the view of  FIG. 20  prior to mounting of the outer member to the inner member;  
       FIG. 23  is an enlarged sectional view of the distal end of the apparatus in accordance with the embodiment of  FIGS. 14-22 ;  
       FIG. 24  is a view similar to the view of  FIG. 15  illustrating the cam member actuated to deploy the deployment member;  
       FIG. 25  is a side view of the apparatus in accordance with the embodiment of  FIGS. 14-24 , illustrating advancement of the outer member upon actuation of the cam member;  
       FIG. 26  is a cross-sectional view of the apparatus in accordance with the embodiment of  FIGS. 14-25 , illustrating the deployment member fully deployed;  
       FIG. 27  is a perspective view of the apparatus in accordance with the embodiment of  FIGS. 14-26 , further illustrating the deployment member in a deployed condition;  
       FIG. 28  is a cross-sectional view of the apparatus in accordance with the embodiment of  FIGS. 14-27 , showing the apparatus deployed within body tissue;  
       FIGS. 29-32  are views of another alternate embodiment of the present disclosure; and  
       FIGS. 33-36  are views of yet another embodiment of the present disclosure. 
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS  
      Preferred embodiment(s) of the apparatus of the present disclosure will now be described in detail with reference to the drawings wherein like reference numerals identify similar or like elements throughout the several views. As used herein, the term “distal” refers to that portion which is further from the user, while the term “proximal” refers to that portion which is closest to the user.  
      Referring initially to  FIGS. 1-3 , there is illustrated an apparatus in accordance with an embodiment of the present disclosure. Apparatus  10  is intended to permit access to body tissue, particularly, a body cavity, to permit the introduction of an object therethrough for performing various surgical procedures on internal organs within the cavity. The object may be a surgical instrument such as a laparoscopic or endoscopic clip applier, stapler, forceps, dissector, retractor, electro-surgical device or the like. Alternatively, the object may be the surgeon&#39;s arm or hand, e.g., when used during procedures where the hand is introduced within the body, such as the abdominal cavity, to directly assist in the required surgery. Apparatus  10  includes a mechanism which upon deployment secures the apparatus within the body tissue thereby minimizing the potential of the apparatus being unintentionally dislodged from its location.  
      With reference to  FIG. 4 , in conjunction with  FIGS. 1-3 , apparatus  10  generally includes three components, namely, first or inner member  12 , second or outer member  14  coaxially mounted relative to inner member  12  about longitudinal axis “a” and deployment member  16  adjacent the distal ends of inner and outer members  12 ,  14 . Inner member  12  includes housing  18  and inner sheath  20  extending distally from the housing  18 . Similarly, outer member  14  includes base  22  and outer sheath  24  extending from the base  22 . In the assembled condition of apparatus  10 , inner member  12  is disposed within outer member  14  with housing  18  residing within base  22  and inner sheath  20  positioned within outer sheath  24 . An elastomeric seal  26  may be positioned within base  22  to seal the interface between the base  22  and housing  18 . Inner member  12  is axially movable relative to outer member  14  to deploy deployment member  16  as will be appreciated from the description provided hereinbelow.  
      Base  22  of outer member  14  has a scalloped arrangement on its proximal surface  23  defined by a series of undulations or interconnected locking recesses  28 . Base  22  further includes a pair of diametrically opposed enlarged indentations  30  also within its proximal surface. Housing  18  of inner member  12  includes boss  32  ( FIG. 3 ) extending radially outwardly from its outer surface. Boss  32  is adapted to be received within one of locking recesses  28  of base  22  to lock deployment member  16  in the deployed position. Housing  18  further includes insufflation port  34  in diametrical opposed relation to boss  32 . Insufflation port  34  defines a neck  36  which is also correspondingly dimensioned to be received in one of locking recesses  28  to facilitate retention of deployment member  16  in the deployed position. Insufflation port  34  permits passage of fluids into the body, such as insufflation of the abdominal cavity.  
      Inner sheath  20  of inner member  12  is a tube-like element and is secured to housing  18  by conventional means including adhesives, cements, welding and any other method known in the art. Alternatively, inner sheath  20  and housing  18  may be monolithically formed as a single unit. Outer sheath  24  is also tube-like and is mounted to permit rotational and axial movement of the outer sheath  24  relative to base  22 . Outer sheath  24  defines an interrupted threaded configuration on the outer surface  23  of the outer sheath  25 , having a series of partial threads  38 , which assist in advancing the apparatus  10  within the surgical site through rotational movement, or in retaining the apparatus in tissue. As best depicted in  FIG. 6 , outer sheath  24  also includes a plurality of longitudinally extending axial slots  40  adjacent the distal end of the sheath  24  extending through the sheath  24  in a longitudinal direction of the outer sheath  24 . A corresponding locking slot  42  is formed in outer sheath  24  adjacent each axial slot  40 , proximal of the axial slots  40 . The axial slots  40  and locking slots  42  cooperate to mount deployment member  16  and permit the deployment member  16  to assume the deployed position.  
      The threads formed in the outer sheath may comprise one or more continuous threads, or interrupted threads on the outer sheath  24 . In further embodiments, the threads comprise one or more protrusions formed on the outer sheath, or may be omitted.  
      The components of inner member  12  and outer member  14  may be formed from any suitable rigid biocompatible material including, e.g., stainless steel, titanium, aluminum or a polymeric material including acrylics, styrene, carbonates and polymers thereof. Any suitable medical grade material may be used. Inner member  12  and outer member  14  may be opaque or transparent in whole or in part.  
      Referring now to FIGS.  1 A and  4 - 6 , deployment member  16  will be discussed. Deployment member  16  is part of a deployment means which secures apparatus  10  within the tissue site. Deployment member  16  includes deployment collar  44  which is shown in perspective view in  FIG. 5 . Deployment collar  44  includes first and second rings  46 ,  48  at respective proximal and distal ends of the collar  44  and interconnected by a plurality of deployment segments or tabs  50 . Deployment segments  50  are radially spaced about collar  44  and define openings  45 . Although four segments  50  are shown, the number of segments  50  may be greater or less than four. Deployment segments  50  each define a plurality of axially spaced hinge lines or joints  52 . A first pair of hinge joints  52   a ,  52   b  is disposed adjacent respective first and second rings  46 ,  48  and a third hinge joint  52   c  is disposed at the approximate midpoint of deployment segment  50 . Deployment segments  50  flex along hinge joints  52  to a radial outward position upon actuation of deployment member  16  to secure the apparatus  10  within the tissue of the body cavity (See  FIG. 10 ). In further embodiments, the third hinge joint  52   c  may be omitted. Deployment segments  50  may bow at the approximate mid-point, without third hinge joint  52   c.    
      With continued reference to FIGS.  1 A and  4 - 8 , deployment collar  44  is mounted to inner and outer sheaths  20 ,  24  in the following manner. First and second rings  46 ,  48  each include a plurality of proximal and distal tabs  54  equidistantly disposed about their respective peripheries and extending outwardly from the rings  46 ,  48 . Proximal tabs  54   a  are correspondingly dimensioned and arranged to be received within locking slots  42  of outer sheath  24  to secure first ring  46  with respect to the outer sheath  24 . With this arrangement, deployment segments  50  are aligned with axial slots  40  of outer sheath  24  thereby permitting the deployment segments  50  to bow outwardly through the axial slots  40  during deployment. In one preferred embodiment, inner sheath  20  includes locking collar  56  mounted at its distal end. Locking collar  56  preferably includes an internal annular recess  58  which accommodates the distal end of inner sheath  20  as depicted in  FIG. 8 . Inner sheath  20  is secured to locking collar  56  adjacent internal annular recess  58  by conventional means including the use of adhesives, welding, or any other methods known in the art. Locking collar  56  further defines beveled end  60  which extends from the distal end of outer sheath. Beveled end  60  facilitates insertion of apparatus  10  within tissue. The proximal end of locking collar  56  abuts second ring  48  of deployment collar  44 . Thus, as inner sheath  20  is retracted relative to outer sheath  24 , locking collar  56  forces second ring  48  in a corresponding proximal or retracting direction. Such movement causes deployment segments  50  to flex outwardly along hinge joints  52  to a deployed condition. Distal tabs  54   b  ride within axial slots  40  of outer sheath  24  during the retracting movement.  
      In further embodiments, the deployment means comprises an inflatable membrane, or expandable sponge on the inner sheath, outer sheath or a collar associated with the inner and/or outer sheath. In further embodiments, the deployment segments  50  may be provided on outer sheath  24 . In further embodiments, the deployment means is integrally formed with the inner sheath  20 .  
      The operation of apparatus  10  will now be discussed. In a laparoscopic surgery, the peritoneal cavity is insufflated to raise the cavity wall to provide greater access to the tissue and organs within. With reference to  FIG. 9 , a trocar  100  is placed within apparatus  10  and advanced to extend the distal penetrating tip  102  into the tissue. The trocar  100  is used to puncture the abdominal wall as is conventional in the art. The trocar may then be removed if desired. Thereafter, inner member  12  is moved relative to outer member  14  in a proximal or retracted direction in the direction of directional arrows “z” as depicted in  FIG. 10 . Proximal movement of inner sheath  20  moves locking collar  56  proximally. Proximal movement of locking collar  56  causes second ring  48  of deployment collar  44 , which is seated on the locking collar  56 , to move proximally. This movement causes deployment segments  50  to bow outwardly along hinges  52  and extend through axial slots  40  of outer sheath  24  to the arrangement shown in  FIG. 1 . In this position, deployment segments  50  engage the inner wall of the peritoneal cavity thus preventing the apparatus from inadvertent withdrawal from the operative site. Alternatively, deployment segments  50  may be manipulated to engage the tissue surrounding the opening, preventing apparatus  10  from being pulled out of the abdomen. Desirably, a collar is frictionally or otherwise engaged with outer sheath and is used to engage the outer surface of the abdominal wall, and cooperating with deployment member  16  to fix apparatus  10  in position.  FIG. 12  illustrates deployment collar  44  in the fully deployed position. Apparatus  10  is then secured in the deployed position by rotating housing  18  of inner member  12  in the direction of directional arrow “y” of  FIG. 12 . Inner sheath  20  and locking collar  56  rotate together with respect to deployment collar  44 , as deployment collar  44  is not attached to locking collar  56 . Alternatively, the inner sheath  20  is engaged with housing  18  so as to allow such rotation. Boss  32  and neck  36  of insufflation port  34  are then positioned in respective recesses  28  of base  22  of outer member  14 . The boss  32  may be omitted in other embodiments. In this position, inner member  12  is secured in the retracted position thereby maintaining deployment collar  44  in the deployed condition.  FIG. 13  illustrates apparatus with deployment member fully deployed and trocar removed to permit access to internal organs within the body cavity. Thereafter, an object such as a surgical instrument is introduced within the apparatus to perform the desired surgery. In further embodiments, the apparatus  10  is sized to receive a surgeon&#39;s hand, which is inserted into the body cavity.  
      It is contemplated that apparatus  10  may have a valve or seal assembly which may be mountable to housing  18 , or incorporated into housing  18  and/or base  22 . The preferred valve or seal assembly may include at least one valve or seal element adapted to form a seal about the inserted object to prevent release of insufflation gases through the apparatus  10 . The valve or seal assembly may also include a zero-closure valve (e.g., a flapper or duck bill valve) to close the axial opening of the apparatus in the absence of the object. One valve assembly suitable for this purpose is disclosed in commonly assigned U.S. Pat. No. 5,603,702 to Smith et al., the contents of which are hereby incorporated herein by reference. The &#39;702 patent discloses, in certain embodiments, a valve assembly that may be adapted to mount to housing  18  through a detachable connection or the like including a bayonet coupling, friction fit, threaded connection or any other suitable connection known in the art. The valve assembly may be incorporated in the housing  18 , base  22 , or both.  
      In further embodiments, the trocar  100  is eliminated and a blunt obturator is used within the inner sheath  20 . The apparatus  10  and obturator are advanced into the body after making an incision in the body tissue.  
      In certain embodiments, the deployment means is associated with the inner sheath and may comprise a portion of the inner sheath formed interally therewith or a separate collar mounted at a distal end of the inner sheath. The outer sheath has slots formed therein to accommodate the deployment of the deployment means, or the outer sheath is dimensioned to allow deployment of deployment means. The distal end of the inner sheath may be connected to the outer sheath so that upon distal movement of the inner sheath, the deployment segments extend through axial slots in outer sheath.  
      Referring to  FIGS. 14-17 , another embodiment of the apparatus of the present disclosure is illustrated. Apparatus  120  includes first or inner member  122 , second or outer member  124  coaxially mounted relative to inner member  122  about longitudinal axis “a,” and deployment member  126  adjacent the distal end of inner and outer members  122 ,  124 . Inner member  122  includes housing  128  and inner sheath  130  extending distally from the housing  128 . Similarly, outer member  124  includes base  132  and outer sheath  134  extending from the base  132 . In the assembled condition of apparatus  120 , inner member  122  is disposed within outer member  124  with housing  128  residing within base  132  and inner sheath  130  positioned within outer sheath  134 . Apparatus further includes cam member  136  which is positioned within base  132 , between housing  128  and base  132 . Cam member  136  forms part of a cam mechanism which acts to deploy deployment member  126 . Generally, cam member  136  is rotatable to axially move inner member  122  and outer member  124  relative to each other to deploy deployment member  126 . The details and operation of cam member  136  will be discussed in greater detail hereinbelow.  
      In the embodiment shown, outer sheath  134  does not include threads, like those shown in  FIG. 1 . However, in further embodiment, continuous or interrupted threads maybe included.  
      Apparatus  120  further includes an adapter  138  which is positioned adjacent the proximal end of inner member  122  and mounted on housing  128 . Adapter  138  mounts an elastomeric duck bill or zero seal  140 . Such seal  140  closes in the absence of an object inserted into apparatus  120  to prevent passage of insufflation gases through the apparatus. Various means for mounting adapter  138  are envisioned including, e.g., a bayonet coupling, a snap fit arrangement, threaded arrangement, adhesives etc. Apparatus  120  further includes an insufflation port  142  attached to housing  128  for introduction of insufflation fluids necessary to insufflate the abdominal cavity. A valve  144  is incorporated into insufflation port  142  as is known in the art.  
      Referring to  FIG. 18 , in conjunction with  FIGS. 14-17 , housing  128  of inner member  122  includes a recessed area or arc portion  146  in its outer surface and a circumferential rib  148  adjacent the distal portion of the housing  128 . Circumferential rib  148  defines an annular or circumferential recess  150  which facilitates mounting of cam member  136  relative to housing  128 . The proximal end of housing  128  has an enlarged flange  152 . Flange  152  defines a support surface for supporting adapter  138 . As appreciated, adapter  138  may be secured to flange  152  with the use of adhesives, etc. if desired. The distal end of housing  128  includes a reduced diameter section  154 .  
      Referring now to  FIGS. 19-22 , in conjunction with  FIGS. 17-18 , cam member  136  will be described. Cam member  136  includes annular portion  156  and manually manipulative leg  158  extending from the annular portion  156 . Annular portion  156  defines an opening  160  for coaxial mounting about reduced diameter section  154  of housing  128 . Annular portion  156  further defines internal groove  162 , a plurality of tabs  164  which extend radially inwardly adjacent the groove  162  and an internal rib  166  ( FIGS. 19 and 19 A). In the assembled position of cam member  136  on housing  128 , tabs  164  are received within internal groove  150  of housing  128  with internal rib  166  of the cam member  136  in sliding contact relation with the reduced diameter portion  154  of housing  128 .  FIGS. 17 and 17 A depict the relationship of these components in detail. Thus, as appreciated cam member  136  is free for rotational movement relative to housing  128 , by virtue of the relationship of tabs  164  of cam member  136  and internal groove  150  of the housing  128 , but is axially fixed to the inner member  122 . Preferably, tabs  164  are sufficiently flexible to flex during assembly of the components to thereby permit the tabs  164  to flex to be received within internal groove  150  in general snap fit relation. Tabs  164  preferably include beveled surfaces  168  to facilitate this assembly process. Tabs  164  are arranged in spaced relation about annular portion  156 .  
      Annular portion  156  also includes first and second cam pins  170  arranged in general diametrical opposed relation and extending radially outwardly relative to the axis “a”. Cam pins  170  are received within cam slots  172  defined within base  132  of outer member  124  and traverse the slots  172  during rotational movement of cam member  136  to drive movement of the outer member  124  and inner member  122  with respect to one another in the axial direction. Manually manipulative leg  158  of cam member  136  is accommodated within recessed arc portion  146  of housing  128  as best depicted in  FIG. 21 . Manually manipulative leg  158  further defines an axial slot  175  ( FIGS. 16 and 22 ) dimensioned to receive a portion of the outer wall of base  132  when mounted to the base  132 .  FIG. 22  depicts cam member  136  mounted to housing  128  of inner member  122  prior to mounting of outer member  124 .  FIGS. 20 and 21  illustrate reception of the outer wall portion of base  132  within axial slot  174  of cam member  136  when outer member  124  is coaxially mounted about inner member  122 .  
      Referring now to  FIGS. 16 and 23 , deployment member  126  will be discussed. Deployment member  126  is part of a deployment means which secures apparatus  120  within the tissue site. Deployment member  126  includes deployment collar  174 , which is shown in perspective view in  FIG. 16 . Deployment collar  174  includes first and second rings  176 ,  178  at respective proximal and distal ends of the collar  174  and interconnected by a plurality of deployment segments  180  defining openings  181 . Deployment segments  180  are radially spaced about collar  174 . Although four segments  180  are shown, the number of segments  180  may be greater, e.g. five, six, or less than four. Deployment segment  180  each define a pair of axially spaced hinge lines or joints  182  disposed adjacent respective first and second rings  176 ,  178 . Deployment segments  180  flex along hinge joints  182  and bow outwardly adjacent its central area  183  to a radially outward position upon actuation of deployment member  126  to thereby secure apparatus  120  within the tissue of the body cavity.  
      Deployment collar  174  is mounted to inner and outer sheaths  130 ,  134  in the following manner. First ring  176  includes a plurality of pins  184  equi-distally disposed about its periphery and extending outwardly from the ring  176 . Pins  184  are correspondingly dimensioned and arranged to be received within locking openings  186  of outer sheath  134  in snap fit relation to secure first ring  176  to the outer sheath  74 . Second ring  178  includes a plurality of internal tabs  190  ( FIG. 23 ) equi-distally disposed within the internal region of the ring  178 . Tabs  190  are arranged to be received within groove  188  ( FIG. 16A ) of inner sheath  130  to secure second ring  178  to inner member  124 . With this arrangement, deployment collar  174  is axially fixed to inner and outer sheath  130 , 134  thereby permitting the deployment segments  180  to bow outwardly during deployment. In one preferred embodiment, deployment collar  174  includes beveled end  192  at its distal end which extends from the distal end of second ring  178  ( FIG. 23 ). Beveled end  192  facilitates insertion of apparatus  120  within tissue.  
      Referring again to  FIGS. 14 and 16 , apparatus  120  may further include a flexible slide ring or donut  194  coaxially mounted about outer sheath  74  of outer member  124 . Donut  194  is adapted to traverse the outer sheath  124  to be positioned against the tissue of the body cavity to cooperate with deployment member  126  to further facilitate securement of the apparatus  120  within the tissue. Donut  194  is frictionally engaged with outer sheath  74  and may have internal ribs  196  to facilitate frictional engagement about outer sheath  74 . Donut  194  preferably comprises an elastomeric material. In certain embodiments, the outer sheath includes threads on all or a portion of the outer surface of the outer sheath.  
      The operation of apparatus  120  will now be discussed. In a laparoscopic surgery, the peritoneal cavity is insufflated to raise the cavity wall to provide greater access to the tissue and organs within. A trocar is utilized to access the body cavity leaving apparatus  120  within the tissue site. With reference to  FIG. 24 , leg  158  of cam member  136  is moved in the direction of directional arrow “y”. During this movement, cam pins  170  traverse cam slots  172  of base  132  as depicted in  FIG. 25 . The inclined or oblique relation of cam slots  172  causes outer member  124  (including base  132  and outer sheath  134 ) to be driven axially relative to inner member  122  in the distal direction, illustrated by directional arrows “z”. As shown in  FIG. 26 , distal movement of outer sheath  134  causes first ring  176  of deployment collar  174  to move distally with respect to second ring  178 . This movement causes deployment segments  180  to bow outwardly along hinge joints  182  to the arrangement shown in  FIGS. 26 and 27 . In this position, deployment segments  180  engage the inner wall of the peritoneal cavity preventing the apparatus from inadvertent withdrawal from the operative site. As shown in  FIG. 26 , deployment segments  180  define a bowed arrangement, as no hinge joint is located in the central area  183 . The deployment segments  180  are desirably formed from a polymeric material, or other bendable material and sized so as to bend without a hinge joint in the central area  183 . In further embodiments, the deployment segments  180  include a hinge joint in the central area  183 , like joint  52   c  in  FIG. 5 . In further embodiments, the deployment segments are arranged to bend without any hinge joints. Desirably, deployment segments  180  have a curved shape in the bowed central area  183 , whereas joint  52   c  creates a pointed shape in the central area of deployment segment  50 . Alternatively, deployment segments  180  may be manipulated to engage the tissue surrounding the opening thus fixing the apparatus  120  within the incision.  
      Cam member  136  may be secured in the deployed position by reception of cam pins  170  within recesses  198  of cam slots  172  ( FIG. 24 ). As cam pins  170  are advanced, they override shelf  199  of base  132  adjacent cam slot  172 . The shelf  199  defines the recess  198  of cam slot  172  so that the pin  170  is locked against the shelf  199  as shown in  FIG. 25 . It is envisioned that cam member  136  may be secured at a mid point position by provision of an additional shelf along the cam slot  172  in the central area of the slot  172 . Thereafter, donut  194  is advanced along outer sheath  134  to engage the outer wall of the patient thus fixing the apparatus  120  within the incision.  FIG. 28  illustrates apparatus  120  with deployment member  126  fully deployed with flexible donut  194  securely engaging the outer wall of the patient. Thereafter, an object such as a surgical instrument is introduced within the apparatus to perform the desired surgery. In further embodiments, the apparatus  120  is sized to receive a surgeon&#39;s hand, which is inserted into the body cavity.  
      Referring now to  FIGS. 29-32 , there is illustrated another embodiment of the present disclosure. This device  200  is substantially similar to the device of  FIGS. 14-28 , and includes inner and outer members having associated inner and outer sheaths, a housing  228  and a base  232 . However, with this embodiment, the cam mechanism is replaced with a lever mechanism  202  to drive outer member in the distal direction to deploy deployment member. Specifically, lever mechanism  202  includes manually engageable lever  204  which is mounted for rotational movement to housing  228  of inner member through lever pin  206 . Lever pin  206  is engageable with collar  208  and is rotatably received within an aperture  210  in the collar  208 . Collar  208 , in turn, is connected to outer sheath through conventional means. Lever pin  206  includes a helical groove  212  in its outer periphery which receives a corresponding transverse groove pin  214  associated with housing  228 . Consequently, rotation of lever  204  causes lever pin  206  to translate in the distal direction through traversing movement of helical groove  212  over groove pin  214 . The distal movement of lever pin  206  causes collar  208  and outer member to be driven distally to deploy the deployment member in the aforedescribed manner described. The deployment member  16  shown in  FIGS. 1-13 , or deployment member  126  of  FIGS. 14-28  may be used.  
      Referring now to  FIGS. 33-36 , there is illustrated another alternate embodiment of the present disclosure. This embodiment incorporates a rotatable control mechanism  300  to drive outer member to cause deployment of the deployment member. Rotatable control mechanism  300  includes rotatable knob  302  and pin  304  extending in the proximal direction from the knob  302 . Knob  302  is operatively connected to collar  306  by reception of a depending portion  308  of the knob  302  within a corresponding opening  310  in the collar  306 . Depending portion  308  is rotatable within opening  310 . Pin  304  extends through an internal bore  312  associated with housing  328  of inner member  122 . Pin  304  includes an external thread  314  which threadably engages internal thread  316  within the bore. Accordingly rotation of rotatable knob  302  causes corresponding rotation of pin  304  and thus corresponding axial movement of the knob  302  and pin  304  through the respective threaded arrangements to thereby drive the collar  306  and outer sheath to deploy the deployment member. Control knob  302  may include a scalloped outer surface  318  to facilitate engagement by the surgeon. It is noted that control knob  302  may be selectively rotated to cause partial deployment of the deployment member.  
      In the embodiments discussed above, the deployment member  16  or deployment member  126  carries a relatively thin elastomeric film on the deployment member to provide a seal with the tissue, to prevent the escape of insufflation gases during surgery.  
      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 appended hereto.