Patent Publication Number: US-2021161557-A1

Title: Surgical access device and sleeve stops for use therewith

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     This application is a divisional of U.S. patent application Ser. No. 16/237,788, filed on Jan. 2, 2019, the entire contents of which being incorporated by reference herein. 
    
    
     BACKGROUND 
     Technical Field 
     The present disclosure relates to a surgical access device. More particularly, the present disclosure relates to sleeve stops for use with a surgical access device. 
     Background of the Related Art 
     Endoscopic and laparoscopic minimally invasive procedures have been used for introducing medical devices inside a patient and for viewing portions of the patient&#39;s anatomy. To view a desired anatomical site, a surgeon may insert a rigid or flexible endoscope inside the patient to render images of the anatomical site. 
     Typically, a trocar assembly includes a cannula and an obturator. The cannula remains in place for use during the laparoscopic procedure, and the obturator includes a tip for penetrating body tissue. In endoscopic surgical procedures, surgery is performed in any hollow organ or tissue of the body through a small incision or through a narrow endoscopic tube (e.g., a cannula) inserted through a small entrance wound in the skin. In laparoscopic procedures, surgical operations in the abdomen are performed through small incisions (usually about 0.5 to about 1.5 cm). Laparoscopic and endoscopic procedures often require the surgeon to act on organs, tissues and vessels far removed from the incision. 
     Accordingly, it may be helpful to provide a sleeve stop that is usable with trocar assemblies and is configured to help prevent over-insertion or over-travel of the trocar assembly within a surgical site. 
     SUMMARY 
     The present disclosure relates to a surgical access device including a cannula and a sleeve stop. The cannula includes a housing and an elongated portion extending distally from the housing. The elongated portion defines a channel extending therethrough. A distal portion of the elongated portion is configured for engaging tissue. The sleeve stop is configured for selective engagement with the elongated portion of the cannula and is configured to limit distal advancement of the cannula with respect to tissue. The sleeve stop is a unitary structure and includes a body portion having a first section and a second section. The first section and the second section are interconnected by a living hinge. The first section is configured to selectively engage the second section. 
     In disclosed embodiments, the first section of the body portion of the sleeve stop may include a finger, and the second section of the body portion of the sleeve stop may include a receptacle configured for slidingly receiving the finger. It is further disclosed that the finger and the receptacle may include a plurality of teeth. In embodiments, engagement between the plurality of teeth of the finger and the plurality of teeth of the receptacle may help maintain a size of an aperture defined between the first section of the body portion of the sleeve stop and the second portion of the body portion of the sleeve stop. 
     It is also disclosed that the sleeve stop may be made from a single material, such as plastic. 
     It is further disclosed that the surgical access device may include a stopping block positionable on the elongated portion of the cannula and distally of the sleeve stop. The stopping block may be configured to contact tissue and to prevent the sleeve stop from contacting tissue. 
     The present disclosure also relates to a surgical access device including a cannula and a sleeve stop. The cannula includes a housing and an elongated portion extending distally from the housing. The elongated portion defines a channel extending therethrough, and a distal portion of the elongated portion is configured for engaging tissue. The sleeve stop is configured for selective engagement with the elongated portion of the cannula, and is configured to limit distal advancement of the cannula with respect to tissue. The sleeve stop includes an adjustable member and a body portion having a first section and a second section. The first section is pivotable relative to the second section about a pivot. The first section and the second section define an aperture therebetween for slidable reception of the cannula. The adjustable member is configured to threadably engage a threaded aperture of the first section of the sleeve stop and a threaded aperture of the second section of the sleeve stop. 
     In disclosed embodiments, rotation of the adjustable member in a first direction relative to the first section of the sleeve stop may cause a diameter of the aperture to increase, and rotation of the adjustable member in a second direction relative to the first section of the sleeve stop may cause the diameter of the aperture to decrease. 
     It is also disclosed that the adjustable member may include a wing nut. 
     It is further disclosed that the first section of the sleeve stop may include a semi-circular portion and an extension portion, and the second section of the sleeve stop may include a semi-circular portion and an extension portion. In embodiments, the threaded aperture of the first section of the sleeve stop may be on the extension of the first section, and the threaded aperture of the second section of the sleeve stop may be on the extension of the second section. 
     Additionally, it is disclosed that the surgical access device may include a stopping block positionable on the elongated portion of the cannula and distal of the sleeve stop. The stopping block may be configured to contact tissue and to prevent the sleeve stop from contacting tissue. 
    
    
     
       BRIEF DESCRIPTION OF FIGURES 
       Various embodiments of the present disclosure are illustrated herein with reference to the accompanying drawings, wherein: 
         FIG. 1  is a perspective view of a trocar assembly including a cannula and an obturator; 
         FIG. 2  is a perspective view of a first embodiment of a sleeve stop for use with the cannula of  FIG. 1 ; 
         FIG. 3  is an assembly view of the trocar assembly of  FIG. 1 , the first embodiment of the sleeve stop of  FIG. 2 , and a stopping block; 
         FIG. 4  is a perspective view of the trocar assembly of  FIGS. 1 and 3  including the first embodiment of the sleeve stop of  FIGS. 2 and 3  and the stopping block of  FIG. 3  engaged with tissue; 
         FIG. 5  is a top view of a second embodiment of a sleeve stop; 
         FIG. 6  is a perspective view of a third embodiment of a sleeve stop; 
         FIG. 7  is a side view of the third embodiment of the sleeve stop of  FIG. 6 ; 
         FIGS. 8 and 9  are side views of a fourth embodiment of a sleeve stop; and 
         FIGS. 10 and 11  are perspective views of a fifth embodiment of a sleeve stop. 
     
    
    
     DETAILED DESCRIPTION 
     Embodiments of the presently disclosed surgical access device and sleeve stops are described in detail with reference to the drawings, wherein like reference numerals designate corresponding elements in each of the several views. 
     As used herein, the term “distal” refers to that portion of the instrument, or component thereof which is farther from the user while the term “proximal” refers to that portion of the instrument or component thereof which is closer to the user. 
     Various embodiments of a surgical access device are described herein. Generally, the surgical access device includes a trocar assembly which may be employed during surgery (e.g., laparoscopic surgery) and may, in various embodiments, provide for the sealed access of laparoscopic surgical instruments into an insufflated body cavity, such as the abdominal cavity. As will be described in additional detail below, the trocar assemblies of the present disclosure include a cannula and an obturator insertable therethrough. The cannula and obturator are separate components but are capable of being selectively connected together. For example, the obturator may be inserted into and through the cannula until the handle of the obturator engages, e.g., selectively locks into, a proximal housing of the cannula. In this initial position, the trocar assembly is employed to tunnel through an anatomical structure, e.g., the abdominal wall, either by making a new passage through the structure or by passing through an existing opening through the structure. Once the trocar assembly has tunneled through the anatomical structure, the obturator is removed, leaving the cannula in place in the structure, e.g., in the incision created by the trocar assembly. The proximal housing of the cannula may include seals or valves that prevent the escape of insufflation gases from the body cavity, while also allowing surgical instruments to be inserted into the body cavity. Further details of a surgical access device including a cannula and an obturator are described in U.S. Pat. No. 10,022,149 to Holsten et al., issued on Jul. 17, 2018, and U.S. Patent Application Publication No. 2018/0085145 to Okoniewski et al., filed on Nov. 13, 2017, the entire content of each of which being incorporated by reference herein. 
     With initial reference to  FIG. 1 , a surgical access device  100  is shown. Surgical access device  100  includes a cannula  200 , and an obturator  300 . The obturator  300  is insertable through a channel  210  defined by an elongated portion  220  of cannula  200 . Additionally, obturator  300  is selectively engageable with or attachable to cannula  200 . More particularly, a proximal portion  302  of obturator  300  is selectively engageable with or attachable to a proximal portion or housing  202  of cannula  200 . In use, when obturator  300  is engaged with cannula  200 , a distal end  310  of obturator  300  is advanced into tissue “T” to create or enlarge an incision or opening in tissue “T” ( FIG. 4 ). Alternatively, a distal end  230  of cannula  200  can be used to create or enlarge an opening in tissue “T,” without the use of an obturator, for instance. In either situation, it may be important to limit or control the insertion depth of cannula  200  with respect to the tissue “T” to help provide optimal access to the target tissue, and to minimize accidental contact between portions of cannula  200  or obturator  300  with tissue located distally of the target tissue. The present disclosure includes various embodiments of sleeve stops that are positionable on cannula  200 , and which are configured to limit the distance cannula  200  can be advanced with respect to the tissue “T.” 
     With particular reference to  FIGS. 2-4 , a first embodiment of a sleeve stop is shown and is indicated by reference character  500 . Sleeve stop  500  is a spring-loaded clamp, and includes a ring portion  510 , and two extensions  520 ,  522 . Ring portion  510  defines an aperture  512  therethrough which is sized to engage an outer circumference of elongated portion  220  of cannula  200 . Extensions  520 ,  522  extend from and are an integral part of ring portion  510 . In embodiments, ring portion  510  and extensions  520 ,  522  are a unitary structure. As shown, sleeve stop  500  may be formed of a single wire formed into the illustrated shape or a similar shape. 
     When extensions  520 ,  522  are moved toward one another (e.g., by squeezing them together), the diameter of aperture  512  changes from a first, smaller diameter to a second, larger diameter. Extensions  520 ,  522  are biased (e.g., spring-loaded) away from each other, thereby biasing aperture  512  towards its first, smaller diameter. 
     In its initial, biased position, aperture  512 , defined by ring portion  510  of sleeve stop  500 , is configured to fixedly or non-slidingly engage elongated portion  220  of cannula  200 . In its second, non-biased position, aperture  512  is at least slightly larger than an outer diameter of elongated portion  220  of cannula  200  thereby enabling sleeve stop  500  to be repositioned along elongated portion  220  of cannula  200 . 
     Additionally, as shown in  FIGS. 3 and 4 , a stopping block  550  is also positionable on elongated portion  220  of cannula  200 , and distal of sleeve stop  500 . Stopping block  550  is configured to contact tissue, and is configured to prevent sleeve stop  500  from contacting tissue, for example. Stopping block  550  includes an aperture  560  having a larger diameter than an outer diameter of elongated portion  220  of cannula  200 , thereby allowing stopping block  550  to slidingly engage elongated portion  220  of cannula  200 . 
     In use, a user moves extensions  520 ,  522  of sleeve stop  500  toward each other to enlarge aperture  512 , slides sleeve stop  500  to a desired position along elongated portion  220  of cannula  200 , and releases extensions  520 ,  522  to decrease the size of aperture  512  such that sleeve stop  500  is fixedly or non-slidingly positioned on elongated portion  220  of cannula  200 . With particular reference to  FIGS. 3 and 4 , when distal end  230  of cannula  200  (and/or obturator  300 ) is inserted into tissue “T,” a distal face  552  of stopping block  550  contacts the tissue “T,” and a distal face  501  of sleeve stop  500  contacts a proximal face (not visible in  FIG. 3 or 4 ) of stopping block  550 . This engagement between the tissue “T” and stopping block  550 , and between stopping block  500  and sleeve stop  500  helps prevent further insertion of cannula  200  with respect to the tissue “T.” Following the surgical procedure, for instance, sleeve stop  500  and/or stopping block  550  can be removed from cannula  200 , sterilized, and re-used. 
     Referring now to  FIG. 5 , a second embodiment of a sleeve stop is shown and is indicated by reference character  600 . Sleeve stop  600  is configured to engage elongated portion  220  of cannula  200 , and is usable with stopping block  550 , as discussed above. Sleeve stop  600  includes a body portion  610  defining an aperture  620 , a lever  630 , and a link  640  interconnecting body portion  610  and lever  630 . Body portion  610  includes a first section  610   a  that is pivotably connected to a second section  610   b  with a first pivot  612 . Together, first section  610   a  and second section  610   b  define aperture  620  therebetween, which is sized to engage an outer circumference of elongated portion  220  of cannula  200 . 
     Link  640  includes a slot  642  configured to slidingly engage a pin  614  of second section  610   b  of body portion  610 . Link  640  is pivotably engaged with lever  630  by a second pivot  635 . Lever  630  is pivotable about second pivot  635  in the general direction of arrow “A” in  FIG. 5  when transitioning from a first position (shown) to a second position (not shown), and in the general direction of arrow “B” in  FIG. 5  when transitioning from the second position to the first position. As lever  630  pivots, link  640  slides relative to second section  610   b  of body portion  610  (i.e., pin  614  of second section  610   b  slides within slot  642  of link  640 ), such that the diameter defined by aperture  620  changes. When lever  630  is in its first position (shown), the diameter defined by aperture  620  is relatively small such that sleeve stop  600  is configured to fixedly or non-slidingly engage elongated portion  220  of cannula  200 . When lever  640  is in its second position, the diameter defined by aperture  620  is relatively large (i.e., larger than an outer diameter of elongated portion  220  of cannula  200 ) such that sleeve stop  600  is configured to be repositioned along elongated portion  220  of cannula  200 . 
     In use, a user moves lever  630  of sleeve stop  600  in the general direction of arrow “A” away from first section  610   a  of body portion  610  thereby enlarging aperture  620 , slides or repositions sleeve stop  600  to a desired position along elongated portion  220  of cannula  200 , and moves lever  630  in the general direction of arrow “B” toward first section  610   a  of body portion  610  to decrease the size of aperture  620  such that sleeve stop  600  is fixedly or non-slidingly positioned on elongated portion  220  of cannula  200 . Sleeve stop  600  is also usable with stopping block  550  in a similar manner as shown herein and described above with regard to sleeve stop  500 . Accordingly, the use of sleeve stop  600  helps prevent further insertion of cannula  200  with respect to the tissue “T.” Following the surgical procedure, for instance, sleeve stop  600  and/or stopping block  550  can be removed from cannula  200 , sterilized, and re-used. 
     Referring now to  FIGS. 6 and 7 , a third embodiment of a sleeve stop is shown and is indicated by reference character  700 . Sleeve stop  700  is configured to engage elongated portion  220  of cannula  200 , and is usable with stopping block  550 , as discussed above. Sleeve stop  700  includes a body portion  710  having a first section  710   a  and a second section  710   b , which are pivotable with respect to each other about pivot  711 , and which together define an aperture  720  that is sized to engage an outer circumference of elongated portion  220  of cannula  200 . Sleeve stop  700  also includes an adjustable member  730  (e.g., a wing nut) rotatably engageable with first section  710   a  and second section  710   b  of body portion  710 . 
     Adjustable member  730  includes a threaded portion (hidden from view in the figures), which is configured to engage corresponding threaded sections of respective extensions  712   a ,  712   b  of first section  710   a  and second section  710   b  of body portion  710 . As adjustable member  730  is rotated in a first direction (e.g., clockwise) relative to body portion  710 , extension  712   a  of first section  710   a  moves toward extension  712   b  of second section  710   b  (about pivot  711 ), thereby reducing the size of aperture  720  such that sleeve stop  700  fixedly or non-slidingly engages elongated portion  220  of cannula  200  and is unable to slide relative thereto. As adjustable member  730  is rotated in a second direction (e.g., counter-clockwise) relative to body portion  710 , extension  712   a  of first section  710   a  moves away from extension  712   b  of second section  710   b  (about pivot  711 ), thereby increasing the size of aperture  720  such that sleeve stop  700  is repositionable along elongated portion  220  of cannula  200 . 
     In use, a user rotates adjustable member  730  of sleeve stop  700  in the second direction, for instance, to thereby enlarge aperture  720 , slides sleeve stop  700  to a desired position along elongated portion  220  of cannula  200 , and rotates adjustable member  730  in the first, opposite direction, for instance, to decrease the size of aperture  720  such that sleeve stop  700  is fixedly or non-slidingly positioned on elongated portion  220  of cannula  200 . Sleeve stop  700  is also usable with stopping block  550  in a similar manner as shown herein and described above with regard to sleeve stop  500 . Accordingly, the use of sleeve stop  700  helps prevent further insertion of cannula  200  with respect to the tissue “T.” Following the surgical procedure, for instance, sleeve stop  700  and/or stopping block  550  can be removed from cannula  200 , sterilized, and re-used. 
     Referring now to  FIGS. 8-9 , a fourth embodiment of a sleeve stop is shown and is indicated by reference character  800 . Sleeve stop  800  is configured to engage elongated portion  220  of cannula  200 , and is usable with stopping block  550 , as discussed above. Sleeve stop  800  is a unitary structure and includes a body portion  810  having a first section  810   a  and a second section  810   b  interconnected by a living hinge  820 . It is envisioned that an entirety of sleeve stop  800  is made from a single material, e.g., plastic. Together, first section  810   a  and second section  810   b  define an aperture  812 . First section  810   a  of body portion  810  includes a finger  830  having a plurality of teeth  832 . Second section  810   b  of body portion  810  includes a receptacle  840  having a plurality of teeth  842  for slidingly receiving finger  830 . 
     Engagement between plurality of teeth  832  of finger  830  and plurality of teeth  842  of receptacle helps maintain a desired portion of finger  830  within receptacle  840 , which corresponds to a desired size of aperture  812 . When aperture  812  is larger than an outer diameter of elongated portion  220  of cannula  200  (e.g.,  FIG. 8 ), sleeve stop  800  is able to be repositionable along elongated portion  220  of cannula  200 . When aperture  812  is equal to or smaller than the outer diameter of elongated portion  220  of cannula  200  (e.g.,  FIG. 9 ), sleeve stop  800  fixedly engages elongated portion  220  of cannula  200  and is unable to slide relative thereto. 
     In use, a user is able to position sleeve stop  800  around elongated portion  220  of cannula  200  when sleeve stop  800  is in an open position ( FIG. 8 ), slide sleeve stop  800  to a desired position along elongated portion  220  of cannula  200 , and insert at least a portion of finger  830  into receptacle  840  to decrease the size of aperture  812  and to maintain the position of first section  810   a  of body portion  810  relative to second section  810   b  of body portion  810  ( FIG. 9 ) such that sleeve stop  800  is fixedly or non-slidingly positioned on elongated portion  220  of cannula  200 . Sleeve stop  800  is also usable with stopping block  550  in a similar manner as shown herein and described above with regard to sleeve stop  500 . Accordingly, the use of sleeve stop  800  helps prevent further insertion of cannula  200  with respect to the tissue. Following the surgical procedure, for instance, sleeve stop  800  and/or stopping block  550  can be removed from cannula  200 , sterilized, and re-used. 
     Referring now to  FIGS. 10-11 , a fifth embodiment of a sleeve stop is shown and is indicated by reference character  900 . Sleeve stop  900  is configured to engage elongated portion  220  of cannula  200 , and is usable with stopping block  550 , as discussed above. Sleeve stop  900  includes a body portion  910  having a first section  910   a  and a second section  910   b  interconnected by a living hinge  920 . Together, first section  910   a  and second section  910   b  define an aperture  912 . First section  910   a  of body portion  910  includes a finger  930  having a lip  932 . Second section  910   b  of body portion  910  includes a receptacle  940  for receiving lip  932  of finger  930 . 
     Engagement between lip  932  of finger  930  and receptacle  940  helps maintain first section  910   a  and second section  910   b  of body portion  910  in a closed position ( FIG. 11 ), which corresponds to a desired size of aperture  912 . When first section  910   a  and second section  910   b  of body portion  910  are in an open position ( FIG. 10 ), aperture  912  is larger than an outer diameter of elongated portion  220  of cannula  200  such that sleeve stop  900  is able to be repositionable along elongated portion  220  of cannula  200 . When first section  910   a  and second section  910   b  of body portion  910  are a closed position ( FIG. 11 ), aperture  912  is equal to or smaller than the outer diameter of elongated portion  220  of cannula  200  such that sleeve stop  900  fixedly engages elongated portion  220  of cannula  200  and is unable to slide relative thereto. 
     In use, a user is able to position sleeve stop  900  around elongated portion  220  of cannula  200  when sleeve stop  900  is in an open position ( FIG. 10 ), slide sleeve stop  900  to a desired position along elongated portion  220  of cannula  200 , and insert lip  932  of finger  930  into receptacle  940  to decrease the size of aperture  912  and to maintain the position of first section  910   a  of body portion  910  relative to second section  910   b  of body portion  910  ( FIG. 11 ) such that sleeve stop  900  is fixedly or non-slidingly positioned on elongated portion  220  of cannula  200 . Sleeve stop  900  is also usable with stopping block  550  in a similar manner as shown herein and described above with regard to sleeve stop  500 . Accordingly, the use of sleeve stop  900  helps prevent further insertion of cannula  200  with respect to the tissue. Following the surgical procedure, for instance, sleeve stop  900  and/or stopping block  550  can be removed from cannula  200 , sterilized, and re-used. 
     While the above description contains many specifics, these specifics should not be construed as limitations on the scope of the present disclosure, but merely as illustrations of various embodiments thereof. Therefore, the above description should not be construed as limiting, but merely as exemplifications of various embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.