Abstract:
A surgical system is adapted and configured for use in a minimally invasive surgical procedure. The surgical system includes surgical instruments that are configured and adapted to be inserted into an underlying body cavity in a first configuration and to transition to a second configuration within the body cavity to provide improved manipulation and visualization of internal body structures. A method of using the surgical system is also disclosed.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
       [0001]    The present application claims the benefit of and priority to U.S. Provisional Application Ser. No. 61/480,073, filed on Apr. 28, 2011, the entire contents of which are incorporated herein by reference. 
     
    
     BACKGROUND 
       [0002]    1. Technical Field 
         [0003]    The present disclosure relates generally to a surgical device for use in a minimally invasive surgical procedure. More particularly, the present disclosure relates to instrumentation for use in a minimally invasive surgical procedure that facilitate both the placement and use of the instruments within the surgical site. 
         [0004]    2. Background of Related Art 
         [0005]    A minimally invasive surgical procedure is one in which a surgeon enters a patient&#39;s body through one or more small openings in the patient&#39;s skin or a naturally occurring opening (e.g., mouth, anus, or vagina). As compared with traditional open surgeries, minimally invasive surgical procedures have several advantages and disadvantages. Minimally invasive surgeries include arthroscopic, endoscopic, laparoscopic, and thoracic surgeries. Advantages of minimally invasive surgical procedures over traditional open surgeries include reduced trauma and recovery time for patients. 
         [0006]    However, some disadvantages include a lack of direct visualization of the surgical site and reduced dexterity of instruments, as compared to traditional open surgeries. In particular, the simultaneous manipulation of the viewing instrument and surgical instruments that are inserted into the opening may be complicated. One complication arises from the difficulty in visualizing surgical instruments on a monitor that is operably coupled to the viewing instrument. 
         [0007]    One surgical technique used to increase the ability of the surgeon to visualize and access critical anatomy is triangulation. Triangulation is a principle in which the surgical instrument and the viewing instrument are held so that their tips form the apex of an imaginary triangle. In particular, the viewing instruments may be in the middle of the surgical field, and the surgical instruments may be angled with respect to the viewing instrument as to form an imaginary triangle. 
         [0008]    In minimally invasive surgical procedures through a single opening, straight and rigid surgical instruments are inserted through a single incision. To control the instruments, a surgeon often crosses his hands. The lack of triangulation makes visualization and access of critical anatomy potentially difficult. Furthermore, it is desirable to coordinate the positions of end effectors of the surgical instruments. 
         [0009]    Consequently, a continuing need exists for improved minimally invasive surgical devices. 
       SUMMARY 
       [0010]    Disclosed herein is a surgical system for use during a minimally invasive surgical procedure. In particular, a minimally invasive surgical triangulation system is disclosed. The minimally invasive surgical triangulation system includes a seal anchor member that is transitionable between a first condition and a second condition. 
         [0011]    The seal anchor member includes a leading portion, a trailing portion, and an intermediate section positioned between the leading and trailing portions. At least two ports extend longitudinally through the intermediate section. Each port defines a longitudinal axis through which a surgical instrument is placed. 
         [0012]    The surgical instrument includes a shaft that is rotatable about the longitudinal axis of the port. By rotating the shaft of the surgical instrument within the port, the orientation of the surgical instrument is transitioned between first and second orientations. When the surgical instruments have the first orientation, the triangulation system is in a first condition. Conversely, the triangulation system is in the second condition when the surgical instruments are in the second orientation. 
         [0013]    Moreover, the minimally invasive surgical triangulation system defines a width that corresponds to the orientation of the shaft of the surgical instrument within the port. In an embodiment, the shaft of the surgical instrument defines a contour that is generally S-shaped. Depending on the orientation of the shafts of the surgical instruments within the ports, the shafts of the surgical instruments collectively define either a bulb shape or a coiled, helical shape. When the shafts define a bulb shape, the greatest distance between any two points along the surface of the shafts is greater than when the shafts define a coiled or helical shape. Consequently, the width of the triangulation system is greater in the second condition in which the shafts define a bulb shape than when the triangulation system is in the first condition and the shafts define a coiled or helical shape. 
         [0014]    Placement of the triangulation system within a body opening defined within tissue is facilitated when the triangulation system is in the first condition as compared to when it is in the second condition. Once placed inside the body opening, the surgical instruments are triangulated with respect to one another by rotating the shafts of the surgical instrument and transitioning the shafts to define the bulb shape. Once the desired surgical procedure is performed, the triangulation system is transitioned back to the first condition to facilitate removal of the triangulation system from the body opening. 
         [0015]    Methods of using the triangulation system are also disclosed including providing the triangulation system, placing the triangulation system while in the first condition having the reduced profile or width into a body opening to access an underlying body cavity. Once within the triangulation system is placed within body opening, the surgical instruments are triangulated with respect to one another by actuating the surgical instruments, thereby transitioning the triangulation system to the second condition. Once the triangulation system is the second condition, a desired surgical procedure is performed. Upon completion of the desired surgical procedure, the triangulation system is transitioned back to the first condition to facilitate the removal of the triangulation system from the surgical site. 
         [0016]    These and other features of the current disclosure will be explained in greater detail in the following detailed description of the various embodiments. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0017]    Various embodiments of the present disclosure are described hereinbelow with reference to the drawings, wherein: 
           [0018]      FIG. 1  is a front perspective view of a seal anchor member shown positioned relative to tissue; 
           [0019]      FIG. 2  is a front perspective view of a triangulation system including the seal anchor member of  FIG. 1  shown with surgical instruments placed therein in a first condition; 
           [0020]      FIG. 3  is a front perspective view of the triangulation system of  FIG. 2  shown in a second condition; 
           [0021]      FIG. 4A  is a cross-sectional view of the triangulation system of  FIG. 2  taken along section line shown in the first condition; 
           [0022]      FIG. 4B  is a bottom view of the triangulation system of  FIG. 2  shown in the first condition; 
           [0023]      FIG. 4C  is a schematic view illustrating movement of the surgical instruments; 
           [0024]      FIG. 5A  is a cross-sectional view of the triangulation system of  FIG. 2  shown in a second condition; and 
           [0025]      FIG. 5B  is a bottom view of the triangulation system of  FIG. 2  shown in the second condition. 
       
    
    
     DETAILED DESCRIPTION OF THE EMBODIMENTS 
       [0026]    Particular embodiments of the present disclosure will be described herein with reference to the accompanying drawings. As shown in the drawings and as described throughout the following descriptions, and as is traditional when referring to relative positioning on an object, the term “proximal” will refer to the end of the apparatus that is closest to the clinician during use, and the term “distal” will refer to the end that is farthest from the clinician during use. 
         [0027]    With reference to  FIG. 1 , a seal anchor member  10  for use in a minimally invasive surgical procedure will now be described. The seal anchor member  10  defines a longitudinal axis X and has respective trailing (or proximal) and leading (or distal) ends  12 ,  14 , and an intermediate portion  16  disposed between the trailing and leading ends  12 ,  14 . Seal anchor member  10  includes one or more ports  18   a - c , which extend longitudinally between trailing and leading ends  12 ,  14 , respectively. Each of the ports  18   a - c  defines a longitudinal axis S. A centrally disposed lumen  19  may be positioned among the one or more ports  18   a - c . The lumen  19  longitudinally extends through seal anchor member  10  and is configured and adapted to receive a viewing instrument  30  ( FIG. 2 ) therethrough. 
         [0028]    The trailing end  12  of the seal anchor member  10  defines a first diameter D 1 , and the leading end  14  of the seal anchor member  10  defines a second diameter D 2 . The intermediate portion between the trailing and leading ends  12 ,  14  defines a radial dimension R. The radial dimension R may be less than the first and second diameters D 1 , D 2  of the trailing and leading ends  12 ,  14 , respectively, and may vary along length L of the seal anchor member  10  to define a substantially hour-glass configuration. 
         [0029]    The seal anchor member  10  is insertable within tissue tract I defined within body opening I of tissue T. The hour-glass configuration of the intermediate section  16  of the seal anchor member  10  may facilitate anchoring of the seal anchor member  10  within the body opening I. Furthermore, the seal anchor member  10  is configured and adapted to establish a sealing relation with the tissue T. An example of such a seal anchor member  10  is illustrated in U.S. Pat. Pub. 2009/0093752, the entire contents of which are hereby incorporated by reference. 
         [0030]    A triangulation system  100  will now be described with respect to  FIGS. 2-5B . The triangulation system  100  includes the seal anchor  10  and at least two surgical instruments  20  placed within the one or more ports  18   a - c  of the seal anchor member  10 . A viewing instrument  30  may be placed within the centrally disposed lumen  19  and centered between the surgical instruments  20  that are placed within ports  18 . The viewing instrument  30  includes a viewing portion  35 , e.g., lens, and a monitor or eyepiece  37  for remotely viewing the surgical site within body cavity C. 
         [0031]    The triangulation system  100  is configured and adapted to transition between a first condition as shown in  FIGS. 2 ,  4 A-B and a second condition as shown in  FIGS. 3 ,  5 A- 5 B. Each surgical instrument  20  of the triangulation system  100  includes a specially shaped shaft  24  to facilitate the transition between the first and second conditions. As shown best in  FIGS. 4A and 5A , the shafts  24  of the surgical instrument  20  are generally S-shaped. As will be described below, the S-shaped configuration of the shafts  24  facilitate transitioning of the triangulation system  100  between the first condition and the second condition. In the first condition, the triangulation system  100  has a relatively narrower profile as compared to when the triangulation system  100  is in the second condition. 
         [0032]    The triangulation system  100  may be placed within the body opening I with the surgical instruments  20  placed within the ports  18   a - c  such that the triangulation system  100  is in the first condition. Alternatively, the surgical instruments  20  may be inserted into the ports  18   a - c  subsequent to the placement of the seal anchor member  10  into the body opening I. In particular, once the seal anchor member  10  is placed within the body opening I, the surgical instruments  20  may be placed within the ports  18   a - c  such that the triangulation system  100  is in the first condition. Removal of the triangulation system  100  may be accomplished by removing the entire triangulation system  100  with the surgical instruments  20  placed within the ports  18   a - c  such that the triangulation system  100  is in the first condition. Alternatively, the surgical instruments  20  may be removed from the ports  18   a - c  prior to the removal of the seal anchor member  10 . 
         [0033]    In the first condition, the shafts  24  of the surgical instruments  20  collectively form a generally helical or coiled configuration with each of the shafts  24  in a first orientation with respect to the longitudinal axis S of the ports  18   a - c  in which the shafts  24  are positioned. As shown best in  FIG. 2 , when the triangulation system  100  is in the first condition, the shafts  24  of the surgical instruments  20  collectively define a generally helical or coiled configuration, which minimizes the profile or width of the triangulation system  100 . In the first condition, the distance D 3 , defining the greatest distance between any two points on the surfaces of the shafts  24  is minimized to facilitate placement of the triangulation system within body opening I of tissue T. In particular, an elongated generally straight section  24   a  of the shaft  24  is inwardly oriented such that the shaft  24  does not extend past the leading end  14  of the seal anchor member  10 . 
         [0034]    As shown in  FIGS. 2 ,  3 ,  4 A, and  5 A, each of the surgical instruments  20  includes an actuation mechanism  21  including a handle  21  and an actuator or trigger  22 . Actuation of the actuation mechanism  21  by depressing the trigger  22  causes actuation of the end effectors  40  of the surgical instruments  20 . The surgical instruments are rotatable within ports  18   a - c  of the seal anchor member  10 . In particular, a surgeon may rotate shafts  24  of the surgical instruments  20  within the ports  18   a - c  along bi-directional arrow Y ( FIGS. 3 and 4C ). Due to the shape of the shafts  24 , depending on the orientation of the shafts  24 , the rotation of the shafts  24  in a first direction will cause either an increase or a decrease in the distance between the farthest two points on the surfaces of any two of the shafts  24 . 
         [0035]    Transition of the triangulation system  100  to the second condition, as shown in  FIGS. 3 and 4C , is accomplished by rotating surgical instruments  20  in the direction of arrow Y about longitudinal axis S of the ports  18  in which the surgical instruments  20  are placed. In the second condition, the shafts  24  of the surgical instruments collectively define a bulb or bulbous shape. In particular, the greatest distance between the farthest two points on the surfaces of the shafts  24  defines a distance D 4  that is greater than distance D 3 . The generally S-shaped contour of the shaft  24 , which includes an elongated generally straight section  24  facilitates the transition between the first and second conditions of the triangulation system. In an embodiment, as shown in  FIG. 3 , by rotating the shaft  24  of the surgical instrument  20 , the shaft  24  is outwardly oriented such that a portion of the shaft  24  extends past the leading end  14  of the seal anchor member  10 . 
         [0036]    As shown in  FIGS. 3 ,  5 A, and  5 B when the triangulation system is in the second condition, the end effectors  40  of the surgical instruments  20  are triangulated with respect to one another. As shown in  FIG. 3 , by triangulating the end effectors  40  with respect to each other, visualization of the positioning of the end effectors  40  is facilitated by bringing the end effectors within the field of view of the viewing portion  35  of the viewing instrument  30 . 
         [0037]    A method of using the triangulation system  100  will now be described. The triangulation system  100  is provided and is placed in the body opening I of tissue T to access the body cavity C. It is advantageous that the profile or width of the triangulation system  100  be as small as possible such that the triangulation system  100  can be placed within a relatively small body opening I without necessitating increasing the size of the body opening I. To this end, the triangulation system  100  is inserted into the body opening I while in the first condition in which the shafts  24  of the surgical instruments  20  collectively define a generally coiled or helical configuration ( FIG. 2 ). 
         [0038]    Once placed, shafts  24  of the surgical instrument  20  are placed in the body cavity C, the surgical instrument  20  can be actuated to cause triangulation of the end effectors  40  with respect to one another and the viewing portion  35  of viewing instrument  30 . By actuating the surgical instruments  20 , the shafts  24  of the surgical instruments  20  are rotated along bi-directional arrow Y as shown in  FIGS. 3 and 4C , thereby transitioning the triangulation system  100  to the second condition in which the shafts  24  of the surgical instrument  20  collectively define an uncoiled, bulbous shape. In the second condition, visualization of the surgical site is facilitated since the end effectors  40  of the surgical instruments are triangulated with respect to one another and the viewing portion  35  of the viewing instrument  30 . 
         [0039]    Although the illustrative embodiments of the present disclosure have been described herein with reference to the accompanying drawings, the above description, disclosure, and figures should not be construed as limiting, but merely as exemplifications of particular embodiments. It is to be understood, therefore, that the disclosure is not limited to those precise embodiments, and that various other changes and modifications may be effected therein by one skilled in the art without departing from the scope or spirit of the disclosure.