Abstract:
A surgical portal system for a surgical procedure incorporating the use of one or more sutures includes a portal housing and a portal sleeve extending from the portal housing. The portal housing includes an internal wall. The portal housing and the portal sleeve define a longitudinal axis and has a longitudinal opening for passage of a surgical instrument and one or more sutures. The portal sleeve is dimensioned for insertion within tissue to provide access to an underlying body site. A seal is mounted to the internal wall of the portal housing and arranged to intersect the longitudinal axis. The seal comprises a conformable material dimensioned and configured to substantially conform about the surgical instrument upon passage of the surgical instrument through the longitudinal opening, to establish a substantial seal thereabout and to displace in at least a radial direction to contact the internal wall of the portal housing to engage one or more sutures extending through the longitudinal opening and to establish a substantial sealing relation with the internal housing wall in the presence of the one or more sutures.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims priority to and the benefit of, U.S. Provisional Application Ser. No. 61/260,485, filed on Nov. 12, 2009, the entire contents of which are incorporated herein by reference. 
     
    
     BACKGROUND 
       [0002]    1. Technical Field 
         [0003]    The present disclosure relates to a portal apparatus, and, more particularly, relates to a portal apparatus incorporating a conformable cup-shaped seal adapted to secure one or more sutures in a predefined orientation while also potentially maintaining a substantial sealed relation with the interior of the portal apparatus. 
         [0004]    2. Description of the Related Art 
         [0005]    Trocars and other surgical portal apparatii are known, as are a myriad of procedures that may be preformed using such apparatii. Many of the minimally invasive procedures performed through portals necessitate or are simplified by the use of one or more sutures passing through the surgical portal apparatus. Sutures extending into a body cavity through a surgical portal may be used to, for example, temporarily retain tissue, manipulate tissue, anchor tissue or operate peripheral devices. 
         [0006]    In an attempt to reduce the number of incision sites required to complete a given surgical procedure, a single surgical portal apparatus may be used to pass one or more sutures into a body cavity, in addition to providing access for one or more devices. A single anchor device (e.g., bone anchor) may have numerous suture ends extending from the surgical site and through the portal passage. The sutures, however, are subject to potential entanglement or confusion of receptive suture ends. Another concerns the ability to establish or maintain a seal within the portal in the presence of the suture and/or surgical instrument to prevent insufflation fluids or irrigant fluids from escaping through the portal. 
       SUMMARY 
       [0007]    Accordingly, a surgical portal system for a surgical procedure incorporating the use of one or more sutures includes a portal housing and a portal sleeve extending from the portal housing. The portal housing includes an internal wall. The portal housing and the portal sleeve define a longitudinal axis and a longitudinal opening for passage of a surgical instrument and one or more sutures. The portal sleeve is dimensioned for insertion within tissue to provide access to an underlying body site. The portal seal is mounted to the internal housing wall of the portal housing. The portal seal includes a proximal seal wall arranged to intersect the longitudinal axis and a peripheral seal wall depending from the proximal seal wall in an at least axial direction. The portal seal is adapted to deflect during passage of the surgical instrument through the longitudinal opening whereby wall segments of the peripheral seal wall are displaced in at least a radial direction to contact the internal housing wall of the portal housing to engage one or more sutures extending through the longitudinal opening. The peripheral seal wall of the portal seal may be dimensioned whereby during passage of the surgical instrument the wall segments of the peripheral seal wall conform to secure the one or more sutures in general fixed relation against the internal housing wall. Alternatively, or additionally, the peripheral seal wall may be dimensioned whereby during passage of the surgical instrument the wall segments of the peripheral seal wall establish a substantial sealing relation with the internal housing wall against the one or more sutures. 
         [0008]    The peripheral seal wall may be obliquely arranged with respect to the longitudinal axis when in an initial condition thereof. The portal seal may be in the general shape of a frustum. As a further embodiment, the portal seal defines an open cavity or a cavity which is open adjacent to or leading toward the portal sleeve. 
         [0009]    The proximal seal wall of the portal seal may be devoid of a seal passage. The portal seal may be mounted to the internal housing wall with a hinge, and be adapted for pivotal movement about the hinge. The portal seal may comprise a conformable material adapted to conform about the surgical instrument to establish a substantial sealed relation therewith. The portal seal may comprise a conformable material adapted to conform about the one or more sutures to establish a substantial sealed relation therewith and the internal housing wall. 
         [0010]    The portal system may include an instrument seal. The instrument seal has inner surfaces adapted to establish a substantial sealed relation with the surgical instrument. The portal system further may include a zero closure valve adapted to substantially close the longitudinal opening in the absence of the surgical instrument. 
         [0011]    A method for performing a surgical procedure is also disclosed. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0012]    Various embodiments of the present disclosure are described herein with reference to the drawings wherein: 
           [0013]      FIG. 1  is a side cross-sectional view of an portal apparatus including a housing with an portal seal according to an embodiment of the present disclosure; 
           [0014]      FIG. 2  is a partial cross-sectional view of a proximal end of the portal apparatus and the portal seal of  FIG. 1 ; and 
           [0015]      FIGS. 3A-3C  is respective side views of the housing and the portal seal of  FIGS. 1 and 2  shown prior to, during and after insertion of the surgical instrument. 
       
    
    
     DETAILED DESCRIPTION 
       [0016]    The apparatus and system herein disclosed may be configured for use in various surgical procedures, including laparoscopic, endoscopic, arthroscopic and orthopedic surgery. The apparatus provides passage between a subject&#39;s body cavity and the outside atmosphere and is capable of receiving surgical instruments of various sizes and configurations. Embodiments of the presently disclosed suture management systems are configured to receive, for example, clip appliers, graspers, dissectors, retractors, staplers, laser probes, photographic devices, suture anchor installation devices, endoscopes and laparoscopes, tubes, and the like. Such instruments are collectively referred to herein as “instruments” or “instrumentation.” 
         [0017]    In addition to the instruments, the apparatus incorporates a seal which may conform about a surgical object while maintaining a seal within the apparatus interior even in the presence of sutures during, e.g., in an endoscopic procedure, laparoscopic procedure or arthroscopic procedure. The seal may also secure the sutures in a fixed position relative to the apparatus, which may facilitate organization of the suture ends. The seal may also be used to maintain the one or more sutures in a taut condition even in the presence of insufflation gases and/or saline fluids introduced within the operative site during, e.g., an arthroscopic procedure. 
         [0018]    Referring now to the drawings wherein like reference numerals illustrate similar components throughout the several views, there is illustrated a surgical portal apparatus in accordance with the principles of the present disclosure. In the following description, the term “proximal” refers to the portion of the portal apparatus that is closest to the clinician, whereas the term “distal” refers to the portion of the portal apparatus that is farthest from the clinician. As used herein, the term “subject” refers to a human patient or other animal. The term “clinician” refers to a physician, nurse or other care provider and may include support personnel. 
         [0019]    Referring to  FIGS. 1-3 , and initially with reference to  FIG. 1 , a portal seal  10  configured for use with a portal apparatus designated  100  is shown. Apparatus  100  and operative components associated therewith may be formed from any suitable material, e.g., a biocompatible material. Portal apparatus  100  defines a longitudinal axis “A” and includes a housing  110  and an access or portal member  120 . A proximal end  111  of housing  110  includes an opening  115  and portal member  120  defines a longitudinal passageway  112 . Opening  115  and longitudinal passageway  112  are generally aligned with respect to the longitudinal axis “A” to permit passage of surgical objects such as instruments “I” and/or sutures “S” utilized in connection with the procedure. Housing  110  includes outer and inner walls  118  and  122 , respectively. Inner wall  122  includes a tapered segment, e.g., a generally frustoconical segment  122   a  having a first average or median diameter “D 1 ” and a cylindrical distal segment  122   b  having second diameter “D 2 ”, wherein the first diameter “D 1 ” is less than second diameter “D 2 ”. This frustoconical configuration when combined with portal seal  10  may provide a substantially fluid tight seal about the proximal end  111  in the presence or absence of a surgical instrument within portal apparatus. Additionally, the relatively long sloped surfaces associated with the frustoconical configuration may assist to reduce the escape of insufflation gases when one or more type of sutures “S” is present between the inner wall  122  of the housing  110  and the portal seal  10 , such as, for example, during an arthroscopic surgery. 
         [0020]    Portal seal  10  may be configured to provide a substantial seal between a body cavity of a patient and the outside atmosphere both during and subsequent to insertion of a surgical instrument “I” and or sutures “S” through the portal member  120 . Portal seal  10  may accommodate instruments of varying diameter while providing a substantially fluid tight seal within the portal apparatus  100 . Portal seal  10  may minimize egress of insufflation gases or irrigant fluids (e.g., in an arthroscopic procedure) through portal apparatus  10  during the procedure. It is also envisioned that a second seal such as a zero-closure seal  130  or duck bill seal can be used in conjunction with portal seal  10 . The zero closure seal  130  may close in the absence of an object. The versatility of the presently disclosed portal seal  10  facilitates endoscopic surgery, wherein a variety of instruments having different diameters are often needed during a single surgical procedure. 
         [0021]    The portal seal  10  may comprise a conformable material and may be configured to establish a seal within portal housing  110  during insertion and manipulation of a surgical object thereof. Suitable conformable materials include elastomeric synthetic and natural materials such as polyisoprene, natural rubber, butyl rubber, copolymers of isobutylene and isoprene, polybutadiene, polyurethane. The portal seal may include the fabric and elastomeric seal disclosed in commonly assigned U.S. Pat. No. 6,702,787 to Racenet, the entire contents of such disclosure being hereby incorporated by reference herein. 
         [0022]    Portal seal  10  may conform to the internal surfaces of the wall  122  of the portal housing  110 . More particularly, the portal seal  10  may be formed from any material that allows the portal seal  10  to transition between an initial condition in the absence of the surgical instrument “I” to an activated condition, wherein segments of the portal seal  10  are configured to deflect or deform when the surgical instrument “I” is inserted through the housing  110  and engage one or more sutures “S” extending through the portal apparatus  10  to secure the sutures in fixed relation, and, potentially, establish an internal seal within the portal housing and/or about the surgical instrument “I”. 
         [0023]    Referring now to  FIGS. 3A-3C , in conjunction with  FIGS. 1-2 , portal seal  10  includes proximal seal wall  12  arranged to intersect the longitudinal axis “A-A” and outer peripheral wall  14  depending from the proximal seal wall  12  in an axial direction. In embodiments, proximal seal wall  12  is substantially planar and is arranged in orthogonal relation with the longitudinal axis “A-A”. Proximal seal wall  12  may be substantially solid, i.e., devoid of an aperture. Outer peripheral wall  14  is obliquely arranged with respect to the longitudinal axis “A-A”. In one embodiment, outer peripheral wall  14  and tapered segment  122   a  of inner wall  122  defines a substantially equivalent angle relative to the longitudinal axis “A-A”. In one embodiment, portal seal  10  defines a general hollow cup-shape or may be in the shape of a frustum. Outer peripheral wall  14  defines an open cavity  16  within the confines of the wall  14  which opens in the direction of portal sleeve  120 . 
         [0024]    In one embodiment, a slight annular space  119  may be provided between portal seal  10  and inner wall  122  of housing  110  in the absence of the surgical instrument. The annular space  119  may permit passage of the sutures “S” utilized during the procedure. In another embodiment, portal seal  10  engages the inner wall  122  including frusto-conical segment  122   a  and/or cylindrical segment  122   b  in substantial sealed relation in the absence of the surgical instrument “I”. In this embodiment, the frustoconical configuration when combined with the frustoconical configuration of inner wall  122  of the housing  110  may provide a substantially fluid tight seal about the proximal end  111  when a surgical instrument “I” is not inserted within the housing  110 . Additionally, the relatively long sloped surfaces associated with the frustoconical configuration helps to reduce the escape of insufflation gases or saline when one or more type of sutures “S” is present between the inner wall  122  of the housing and the portal seal  10 , such as, for example, when the portal apparatus  100  is used during an arthroscopic surgery. 
         [0025]    In embodiments, portal seal  10  is connected to housing  110  through hinge  132  Hinge  132  may be any suitable type of hinge. Hinge  132  is configured to prevent the portal seal  10  from detaching from the inner wall  122  of the housing  110  when the surgical instrument “I” is being inserted through and removed from the housing  110 . Hinge  132  may also permit portal seal  10  to pivot or flex during insertion and/or manipulation of the surgical instrument. 
         [0026]    In embodiments, the entire portal seal  10  or a portion thereof may be coated with a material (e.g., polytetrafluoroethylene (PTFE) commercially available under the trademark TEFLON®) that provides the portal seal  10  with a relatively slippery surface to reduce laparoscopic instrument insertion forces. Alternatively, or in combination therewith, portal seal  10  may be made from a material that is not as lubricious. 
         [0027]    In use, portal member  120  with an obturator (not shown) positioned therein may be used to create an incision to gain access to an underlying body cavity. The underlying cavity may be filled with insufflation gases if used during a laparoscopic procedure. In an arthroscopic procedure, fluids may be used to expand a joint such as the knee, shoulder or the like. An anchor or screw may be passed through the portal member  120  and secured within hard tissue as is known in the art. One suitable anchor and installation tool is disclosed in commonly assigned U.S. Pat. Nos. 5,944,739 and 5,993,459, the entire contents of each disclosure being hereby incorporated by reference herein. The portal seal  10  may establish a seal about the installation tool as previously discussed. The installation tool may be removed leaving the anchor or screw with suture segments “S” extending therefrom. The suture ends or segments “S” may be passed about the portal seal  10  through, e.g., the annular space  119  and through the proximal end  111  of the housing  110 . In one embodiment, outer peripheral wall  14  of portal seal  10  may engage the sutures “S” to retain the sutures “S” in fixed relation within portal apparatus  10 . Another surgical instrument “I” may be inserted through opening  115  of housing  110 . Due to the conformable nature of the portal seal  10  and the lack of any seal passage through proximal seal wall  12 , the wall segments of peripheral wall  14  and proximal wall  12  of portal seal  10  will deflect or deform accompanied by some pivotal movement of seal  10  about hinge  132  to  1 ) conform and establish a substantially fluid tight seal about the periphery of the instrument “I” ( FIGS. 3B and 3C ) while also accommodating the outer diameter of the suture ends, and/or  2 ) secure the suture ends within the portal housing. Moreover, the introduction of the surgical instrument displaces seal portions of the portal seal  10  and forces the portal seal  10  (and suture ends “S”) against frusto conical segment  122   a  and/or cylindrical distal segment  122   b  of the inner wall  122 . While instrument “I” is disposed within the housing  110 , portal seal  10  may maintain a substantially fluid tight seal about the instrument “I” such that the fluids (e.g., insufflation gases or saline fluids) within the body cavity are substantially prevented from escaping through the access assembly. A surgical procedure or task may be performed with the instrument “I”. As noted above, the frustoconical configuration of the portal seal  10  and inner sidewall  122  of housing  110  reduces the escape of insufflation gas or irrigant fluid when the sutures “S” are present and positioned between the portal seal  10  and inner sidewall  122 . The sutures “S” are also retained in a predetermined relation within inner wall  122  of housing  110 , which may facilitate suture organization and identification and avoid entanglement. 
         [0028]    As a further alternative, portal seal  10  may include instrument seal  30  having a passage  32  adapted to establish a seal about the surgical instrument. A suitable instrument seal  30  may be the seal disclosed in the Racenet &#39;787 patent mentioned hereinabove. ( FIG. 1 ). The instrument seal  30  may be mechanically coupled to housing  110  in a manner to permit passage of sutures “S” therethrough, e.g., about the periphery of the instrument seal  30 . 
         [0029]    From the foregoing and with reference to the various drawings, those skilled in the art will appreciate that certain modifications can also be made to the present disclosure without departing from the scope of the same. For example, while portal seal  10  has been described herein as being fixedly secured to housing  110 , it is within the purview of the present disclosure to provide portal seal  10  detachably mountable to the proximal end  111  of housing  110 , e.g., for cleaning or disposal. In addition, portal seal  10  may be readily adapted for mounting to conventional cannulas of differing structures. The detachability of portal seal  10  from housing  110  may facilitate specimen removal through portal member  120 . 
         [0030]    While several embodiments of the disclosure have been shown in the drawings and/or discussed herein, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Therefore, the above description should not be construed as limiting, but merely as exemplifications of particular embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.