Abstract:
A surgical support assembly is disclosed, including a plurality of tissue penetrating support members, a plurality of position controlling members through which the plurality of tissue penetrating support members are inserted, and an imaging member attached at the vertex of the plurality of tissue penetrating support members. Also disclosed is a method of assembling and using a surgical support assembly in conjunction with minimally invasive surgical procedures.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
       [0001]    The present application claims the benefit of and priority to U.S. Provisional Application Ser. No. 61/602,103, filed on Feb. 23, 2012, the entire contents of which are incorporated herein by reference. 
     
    
     BACKGROUND 
       [0002]    1. Technical Field 
         [0003]    This application generally relates to the field of minimally invasive procedures. More particularly, the present disclosure relates to a surgical support assembly for positioning and securing a camera or projector inside the body in the proximity of a surgical site. 
         [0004]    2. Background of Related Art 
         [0005]    Today, many surgical procedures are performed through small incisions in the skin, as compared to the larger incisions typically required in traditional procedures, in an effort to reduce both trauma to the patient and recovery time. Generally, such procedures are referred to as endoscopic, unless performed on the patient&#39;s abdomen, in which case the procedure is referred to as laparoscopic. Throughout the present disclosure, the term minimally invasive should be understood to encompass both endoscopic and laparoscopic procedures. During a typical minimally invasive procedure, surgical objects, such as surgical access ports (e.g., trocar and/or cannula assemblies), endoscopes, or other instruments, are inserted into the patient&#39;s body through the incision in tissue. Prior to the introduction of the surgical object into the patient&#39;s body, insufflation gases may be used to enlarge the area surrounding the target surgical site to create a larger, more accessible work area. 
         [0006]    As surgical objects are inserted into the patient&#39;s body, the problem of visibility of the insufflated workspace arises. Due to the nature of minimally invasive procedures, the relatively small incisions into tissue do not afford an operator much direct visibility into an insufflated workspace. Surgical imaging equipment is thus increasingly relied upon to visualize an insufflated workspace during minimally invasive procedures. 
         [0007]    However, the presence of multiple tissue layers and surgical objects can obscure the field of view for an operator using surgical imaging equipment inserted through tissue. Further, imaging equipment that is inserted into a body cavity may be forced out of alignment due to the interactions of surgical objects and tissue within the insufflated workspace. Therefore, it is desirable to have imaging equipment that can be attached to a portion of a body cavity to view a surgical site above or below the equipment. Accordingly, a need exists for a device that can support imaging equipment in an insufflated workspace with the ability to adapt to changing conditions at the minimally invasive surgical site. 
       SUMMARY 
       [0008]    The present disclosure is directed toward a support assembly for an imaging member above a surgical site. The support assembly includes a plurality of support members that penetrate a layer of tissue and extend into a body cavity below. The support members may be rigid or resilient rods having a variety of shapes and cross-sectional profiles. In embodiments, the support members may be hollow to receive wires or other equipment. 
         [0009]    Disposed on the surface of the layer of tissue through which the support members are inserted are position control members which control the depth of insertion of the support members. The position control members are generally flat members that receive the support members. The position control members may additionally control the degree to which the support members may be pivoted within the position control members. In embodiments, the position control members may include a rotatable member or other structure to assist the support members in pivoting relative to the position control member. 
         [0010]    In other embodiments, the position control members may be flat pads through which the support members are inserted. The flat pads frictionally engage the outer surface of the support members and inhibit the amount of axial translation of the support members into an internal body cavity. 
         [0011]    The position control members may incorporate a locking mechanism to secure the support members in place. The locking member may be a set screw or a latching element that engages a side surface of a support member to hold the support member in place to inhibit axial translation of the support member and may additionally inhibit the support member from pivoting within the position control member. In embodiments, separate locking mechanisms may be present for inhibiting axial translation and pivoting of the support members. 
         [0012]    An imaging member, which may include a camera, a projector or an illuminator or a combination thereof, is attached at the distal portions of the support members to at a vertex of the support members. The secure attachment of the imaging element to the support members may include a threaded connection. In other embodiments, the coupling of the imaging member to the support members may be formed with an interference fit, tongue-and-groove, or bayonet-type connection. The imaging member collects images from the surgical site below. In embodiments, the imaging element may incorporate a projector, with collected or stored images projected onto a surface such as the interior surface of a tissue wall. 
         [0013]    These and other embodiments of the present disclosure will be described in greater detail below with reference to the appended figures. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0014]    The accompanying drawings, which are incorporated in and form part of the specification, illustrate the present disclosure when viewed with reference to the description, wherein: 
           [0015]      FIG. 1  is a perspective view of a surgical support assembly including three support members, three position control members, and an imaging member; 
           [0016]      FIG. 2  is a partial assembly view of the surgical support assembly as shown in  FIG. 1 , with the support members inserted through the position control members and separate from the imaging member; 
           [0017]      FIG. 3A  is a side cross-sectional view of a position control member before a support member is inserted therethrough; 
           [0018]      FIG. 3B  shows the side cross-sectional view of  FIG. 3A , with a support member partially inserted therethrough and pivoted relative to the position control member; 
           [0019]      FIG. 3C  shows the side cross-sectional view of  FIG. 3A , with a support member fully inserted therethrough at an angle and locked into position; 
           [0020]      FIG. 3D  shows the side cross-sectional view of  FIG. 3C , further including a passageway through which a set screw may directly engage the support member; 
           [0021]      FIG. 4  is a cross-sectional view of the surgical support assembly of  FIG. 1 , fully assembled and disposed in a body cavity; 
           [0022]      FIG. 5  is a side perspective view of an embodiment of a position control member as a flat pad, with a support member inserted therethrough; 
           [0023]      FIG. 6  is a side cross-sectional view of partial assembly view of a surgical support assembly having two support members, with one support member securely attached to the imaging element with an interference fit, and another support member inserted into position in the body cavity prior to attachment to the imaging element; and 
           [0024]      FIG. 7  is a bottom perspective view of an embodiment of a surgical support assembly having an imaging element incorporating a projector to display an image inside a body cavity. 
       
    
    
       [0025]    Other features of the present disclosure will become apparent from the following detailed description taken in conjunction with the accompanying drawings, which illustrate, by way of example, the principles of the present disclosure. 
       DETAILED DESCRIPTION OF EMBODIMENTS 
       [0026]    The present disclosure will now describe in detail embodiments of a surgical support assembly with reference to the drawings in which like reference numerals designate identical or substantially similar parts in each view. Throughout the description, the term “proximal” will refer to the portion of the assembly closest to the operator, whereas the term “distal” will refer to the portion of the assembly farthest from the operator. 
         [0027]    Referring initially to  FIG. 1 , a surgical support assembly  100  is shown fully assembled. The surgical support assembly  100  includes a plurality of support members  110  that penetrate a layer of tissue  500  ( FIG. 4 ). The support members may have tips configured and dimensioned to cut through tissue (not shown), or may be inserted into pre-formed incisions in tissue. The support members  110  are generally elongate members that have a cylindrical cross-sectional profile. Other shapes with different cross-sectional profiles are contemplated for the support members  110 . The support members  110  may be solid or hollow. 
         [0028]    The support members  110  are inserted through respective position control members  120 . Position control members  120  generally include a flat underside  120   b  that contacts a body surface  500   a  ( FIG. 4 ). Underside  120   b  of position control members  120  may be otherwise shaped or curved to accommodate a variety of body surface conditions. Position control members  120  also include a receiving portion  122  that may be a neck or other protruding shape from the flat profile of position control member  120 . At the proximal end  120   a  of the position control member  120  is an aperture  120   c  ( FIG. 3A ) that defines a passage  120   d  ( FIG. 3A ) through the position control member  120  through which a support member  110  may be inserted. 
         [0029]    Position control members  120  may also include a locking mechanism  124  that affects movement of the support members  110  at least axially through the position control member  120  and layer of tissue  500 . Locking mechanisms  124  can be used to maintain position control members  124  at a desired depth in a layer of tissue  500 . The position control members  120  may also control the degree to which the support members  110  are free to pivot relative to the position control members  120 , as will be described further below. 
         [0030]    Attached to the distal portions  110   a  ( FIG. 2 ) of the support members  110  is an imaging member  130 . Imaging member  130  may have a pod-like shape as shown, though other shapes and profiles are contemplated for imaging member  130 . The imaging member  130  incorporates an imaging aperture  132  (shown in phantom view) for collecting or projecting images in an internal body cavity  500   b  ( FIG. 4 ). The imaging aperture  132  may be include a camera, a light pipe with polished ends, a fiber optic element, or a projector. The imaging member  130  is attached at the distal portions  110   a  of the support members  110  such that it forms an apex of the support members  110 . The imaging aperture  132  is disposed on or embedded in a side surface of imaging member  130  such that it has a substantially unobstructed view of a surgical site. The positioning of the support members  110  and the imaging member  130  may also be inverted such that the imaging member is at a distal vertex and the imaging member looks proximally toward the abdominal wall, for example in a hernia operation. 
         [0031]    Turning to  FIG. 2 , the surgical support assembly  100  is shown partially assembled, with the support members  110  inserted through the position control members  120 , but separate from the imaging member  130 . The imaging member  130  contains threaded receiving apertures  134  and the distal portions  110   a  of the support members  110  are threaded such that the support members  110  and the imaging member  130  threadably engage upon inserting and rotating the support members  110  into the respective threaded receiving apertures  134 . It is also contemplated that the support members  110  and the imaging element  130  may be attached with a press or interference fit, a spline configuration, or a bayonet-type connection. It should be noted that support members  110  may be considerably more slender than depicted, for example the members may be 2-5 mm in diameter allowing for small incisions or needle like placement of the members. Imaging element  130  may be placed through a separate larger incision or trocar intended as the primary surgical incision. Thus, a separate incision for visualization is not necessary and the risk of incisional hernia is reduced. 
         [0032]    Referring to  FIGS. 3A-3C , insertion of a support member  110  into a position control member  120  and the subsequent locking in position of a support member  110  is shown. As seen in the cross-sectional view of  FIG. 3A , position control member  110  may include a rotatable element  126 , which rotates, pivots or otherwise moves within receiving portion  122 . Rotatable element  126  may be seated in position control member  120  in a ball-and-socket configuration. Other configurations are contemplated to allow support members  110  to pivot within position control members  120 , such as a movable structure of rods, levers, and/or cuffs. Rotatable element  126  may also extend into the position control member  120  below the receiving portion  122 . Rotatable element  126  includes a passage  126   a  therethrough that aligns with the passage  120   d  through the receiving member  122 . Adjacent to the rotatable member  126  is locking mechanism  124 , which is shown as a screw  124   a  that advances through a threaded passage  122   a  in a portion of receiving member  122 . Other locking mechanisms are contemplated for use in the position control member  120 , such as a knob or button lock, or a clamping collar. 
         [0033]    Turning now to  FIG. 3B , a support member  110  is shown partially inserted through the passage  120   d  and the passage  126   a . Rotatable member  126  allows for support member  110  to pivot within position control member  120 . As the support member  110  is free to translate through the passages  120   d ,  126   a  and pivot relative to the passage  120   d , the position control member  120  is in an unlocked position, as shown with the screw  124   a  backed out of the threaded passage  122   a . With the screw  124   a  spaced from the rotatable member  126  and support member  110 , the screw  124   a  does not inhibit the motion of support member  110  through the position control member  120 . 
         [0034]    Referring to  FIG. 3C , the position control member  120  is shown in a locked position, with the screw  124   a  advanced through the threaded passage  122   a  and in contact with the rotatable member  126 . As the screw  124   a  frictionally engages the outer surface of rotatable member  126 , support member  110 , inserted therethrough, is prevented from further pivoting within the passage  120   d . The rotatable member  126  may exert a compressive force on the support member  110  disposed through the passage  126   a , inhibiting it from further translating axially through the position control member  120 . 
         [0035]    As shown in  FIG. 3D , the rotatable member  126  may also include a passage  126   b  through which the screw  124   a  may advance to directly contact the support member  110 . The screw  124   a  is advanced through passage  126   b  until direct contact with support member  110  is made, and maintains the desired depth of insertion of the support member  110  through the passages  120   d ,  126   a . The screw  124   a  also prevents the support member  110  from pivoting relative to the position control member  120  by bracing it against the passages  120   d ,  126   a.    
         [0036]    Alternatively, the passage  126   a  may be dimensioned such that the support member  110  frictionally engages the rotatable member  126  upon insertion. The frictional engagement of the support member  110  and rotatable member  126  ensure that the support member is maintained at a desired depth in the body cavity  500   b . The axial depth of the support member  110  may be changed by additional forces exerted by an operator. Still further, position control member  120  may incorporate a separate locking mechanism to inhibit the axial translation of support member  110  (not shown). 
         [0037]    Turning now to  FIG. 4 , a full assembly view of surgical access assembly  100  is shown. In use, an operator will place position control members  120  on a body surface  500   a  to designate the points of insertion for the support members  110  through a tissue layer  500 . The support members  110  are then inserted into the respective position control members  120 , through the tissue layer  500 , and into a body cavity  500   b . Support members  110  are positioned to a desired axial depth and pivoted to a desired degree within position control members  120 . Imaging member  130  is inserted through the layer of tissue  500  either through a separate incision, or an appropriately sized incision through which one of the support members  110  may also be inserted. Graspers, forceps, or other instruments may be used to hold the imaging member  130  in place in the body cavity  500   b  prior to assembly of the surgical support assembly  100 . The threaded distal portions  110   a  of the support members  110  are then attached to the threaded receiving apertures  134  of the imaging member  130 . With the imaging member  130  positioned above the surgical site in the internal body cavity  500   b , the position control members  120  are locked such that the support members  110  are maintained in their desired axial and angular positions. Locking of the position control members  120  is accomplished by advancing the set screw  124   a  through the threaded passage  122   a . The imaging aperture  132  of the imaging member  130  is then securely positioned to collect images from the surgical site below. When minimally invasive procedures are completed, the position control members  120  are unlocked, and the support members may be detached from the imaging member  130  and removed from the tissue layer  500  and the position control members  120 . The imaging member  130  then may also be removed from the body cavity  500   b  and the position control members  120  removed from the body surface  500   a.    
         [0038]    Referring to  FIG. 5 , an embodiment of a position control member  220  is shown with a support member  110  inserted therethrough. Position control member  220  is shown as a flat pad to be disposed on a body surface  500   a . Any number of shapes and layered configurations are contemplated for position control member  220 . Position control member  220  may additionally be treated with an adhesive on its underside  220   b  (not shown) to aid in the attachment of position control member  220  to a body surface  500   a  (not shown). Position control member  220  is formed of a material suitable to frictionally engage an outer surface of support member  110  when the support member  110  is inserted therethrough, such as fabric or rubber. The frictional engagement of position control member  220  and support member  110  allows an operator to position the support member  110  at a desired depth, without unintended axial translation of the support member  110 . This position control also maintains the angular position at which the support member  110  is inserted though the layer of tissue  500 . Position control member  110  may be formed of various thicknesses to provide a desired degree of position control. 
         [0039]    Turning now to  FIG. 6 , a partial assembly view of an embodiment of a surgical access assembly  300  is shown. Surgical access assembly  300  includes at least two support members  310 . Support members  310  are substantially similar to support members  110  of the previous embodiments, but support members  310  contain a passage  310   a  extending the length of support member  310  through which equipment such as wires  336  may be passed. Wires may supply power or control signals to an imaging element  330  or may send or receive images between the imaging element  330  and another device. 
         [0040]    Surgical access assembly  300  also incorporates position control members  320 . Position control members  320  are substantially similar to position control members  120  discussed above, but do not include a rotatable member. Position control members  320  are disposed on a body surface  500   a  such that the support members  110  are inserted at desired angles relative to a body cavity  500   b . Surgical access assembly  300  may be utilized on surgical sites with uneven or irregular body surface geometries. Position control members  320  include a receiving portion  322  extending from the flat profile of the position control member  320 . The receiving portion  322  defines a passage  322   a  through which the support member  310  is inserted. A support member  310  may frictionally engage a position control member  320 , or may be free to translate within the passage  322   a . A latching member  324  may be present to lock the support member  310  in position in the position control member  320 . The latching member  324  is a lever that rotates and causes an end  324   b  to frictionally engages an outer surface of the support member  310 . 
         [0041]    Surgical access assembly  300  includes imaging member  330 . Imaging member  330  includes an imaging aperture  332  and receiving apertures  334 . Distal portions  310   b  of support members  310  frictionally fit within receiving apertures  334 . Other couplings between support members  310  and imaging member  330  are contemplated, including a threaded connection, tongue-and-groove connection, or bayonet-type coupling. With the support members  310  securely attached to the imaging member  330 , the imaging aperture  332  faces body cavity  500   b  such that it can collect images from a surgical site below. 
         [0042]    Referring to  FIG. 7 , an embodiment of a surgical access assembly  400  is shown. Surgical access assembly  400  incorporates support members  110 , position control members  120 , and an imaging member  430 . Imaging member  430  incorporates an imaging aperture  432 , and an image projecting element  436 . Image projecting element  436  projects an image collected from imaging aperture  430  onto a portion of body cavity  500   b . The projected image may be projected laterally, proximally or distally to display on any suitable surface in the body cavity  500   b  such as a tissue wall, on an implant, such as a hernia mesh or on a separate screen inserted into the body cavity  500   b  (not shown). The projected image allows an operator or surgeon to view the received image from a surgical site in situations where the field of view for an operator might be obscured, but where the image receiving element  432  is able to access. Alternatively, the image projecting element  436  may project images other than those from the image receiving element  432 , such as images stored in memory or those externally transmitted to the imaging element  430 . For example, he projected image may provide a target or project a preplanned template for an eventual configuration of tissue or project a go/no-go region. 
         [0043]    In further embodiments, equipment such as wires or fiber optic cables may serve as position control members, and suspend an imaging member above a body cavity for use during minimally invasive procedures. In still further embodiments, a position control member may be inserted into a body cavity, extend through the body cavity, and exit a portion of the body cavity, with an imaging member mounted to the portion of the position control member mounted in the body cavity. 
         [0044]    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 embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the present disclosure.