Abstract:
A surgical portal apparatus for use in a surgical procedure incorporating one or more sutures is provided. The surgical portal apparatus includes a portal member defining a longitudinal axis and having a longitudinal opening therethrough, and a suture management device operably connected to the portal member. The suture management device includes a first member and a second member mountable to the first member. The first member and the second member have cooperating surfaces adapted to selectively secure the at least one suture in a predetermined relation with respect to the portal member.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
       [0001]    The present application claims the benefit of and priority to U.S. Provisional Application Serial No. 61/148,470 filed on Jan. 30, 2009, the entire contents of which are incorporated herein by reference. 
     
    
     BACKGROUND 
       [0002]    1. Technical Field 
         [0003]    The present disclosure relates to a trocar and other surgical portal apparatus, and more particularly, relates to a suture management apparatus for surgical portal apparatus that includes an interlocking cap. 
         [0004]    2. Background of Related Art 
         [0005]    Trocars and other surgical portal apparatus are known, as are myriad procedures that may be preformed using such assemblies. Many of the minimally invasive procedures performed through access assemblies 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 apparatus may be used to, for example, temporarily retain tissue, manipulate tissue, anchor tissue or operate peripheral devices. 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 may have numerous suture ends that extend therefrom and through the surgical portal apparatus. The sutures extending through the surgical portal apparatus may become tangled as each is manipulated or as one or more instruments are inserted and withdrawn from the assembly. Also, a surgeon may confuse the suture ends during the course of a surgery. Tangling or confusion of the suture ends may unnecessarily complicate the procedure and increase time necessary to complete the procedure. 
         [0006]    Therefore, it would be beneficial to have an apparatus for use with a surgical portal apparatus for managing sutures. 
       SUMMARY 
       [0007]    A surgical portal apparatus for use in a surgical procedure incorporating one or more sutures includes a portal member defining a longitudinal axis and having a longitudinal opening therethrough and a suture management device operably connected to the portal member. The suture management device includes a first member and a second member mountable to the first member. The first member and the second member have cooperating surfaces adapted to selectively secure the at least one suture in a predetermined relation with respect to the portal member. The first member may include at least one suture retaining slot. The second member includes at least one depending rib dimensioned for at least partial reception within the at least one slot of the first member. The at least one slot and the at least one rib may extend radially outwardly relative to the longitudinal axis. 
         [0008]    In one embodiment, the first member may include a plurality of slots and the second member may include a plurality of ribs. The ribs are dimensioned and arranged to be partially received within respective slots to thereby releasably secure a plurality of sutures. The respective slots and recesses of the first and second members may be arranged in predetermined radial spaced relation. 
         [0009]    The first member and the second member each define a longitudinal opening sized to receive a surgical object. The portal member may include a housing segment and an elongated segment extending from the housing segment. The suture management device is adapted to releasably engage the housing segment. Alternatively, the suture management device is integrally formed with the housing segment. 
         [0010]    In another aspect, a suture management device includes an insert member configured to be operably connected to a portal member. The insert member includes a plurality of radially outward extending slots. A cap member includes a plurality of radially outward extending ribs configured to engage in the slots of the insert member, wherein engagement of the ribs in the slots securely retains at least one suture therein. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0011]    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: 
           [0012]      FIG. 1  is a perspective side view of a surgical portal apparatus including a suture management apparatus according to an embodiment of the present disclosure; 
           [0013]      FIG. 2  is a perspective side view of the cap member of the suture management apparatus of  FIG. 1 ; 
           [0014]      FIG. 3  is a perspective side view of the insert member of the suture management apparatus of  FIG. 1 ; and 
           [0015]      FIG. 4  is a perspective side view of a surgical portal apparatus including a suture management system according to another embodiment of the present disclosure; 
       
    
    
     DETAILED DESCRIPTION 
       [0016]    The surgical portal apparatus herein disclosed may be configured for use in various surgical procedures, including laparoscopic, endoscopic, arthroscopic and orthopedic surgery. The access assembly 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. An embodiment of the presently disclosed access assembly is configured to receive, for example, clip appliers, graspers, dissectors, retractors, staplers, laser probes, photographic 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 access assembly also allows the passage of one or more sutures therethrough, e.g., during an arthroscopic procedure. When several sutures are introduced into the subject&#39;s body through the access assembly, the sutures might tangle with each other or be confused by a surgeon. Suture tangle and/or confusion may, at the very least, inconvenience the clinicians conducting the surgical procedure. To minimize the possibility of sutures tangling with one another or a surgeon from confusing the sutures, the access assembly incorporates a suture retaining member for holding the one or more suture in place. The suture retaining member may also be used to maintain the one or more suture in a taut condition. 
         [0018]    Referring now to the drawings wherein like reference numerals illustrate similar components throughout the several views, there is illustrated a suture management system in accordance with the principles of the present disclosure. In the following description, the term “proximal” refers to the portion of the access assembly that is closest to the clinician, whereas the term “distal” refers to the portion of the access assembly 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 initially to  FIG. 1 , a suture management system according the present disclosure is shown as suture management system  100 . Suture management system  100  includes a surgical portal apparatus  110  and a suture management device  120 . 
         [0020]    Surgical portal apparatus  110  includes a portal member  112  and a sleeve  114  extending distally from portal member  112 . Although the following discussion of suture management device  120  will be with respect to surgical portal apparatus  110 , the aspects of the present disclosure should not be read as limited to the embodiments herein disclosed. Suture management device  110  may be modified for use with any surgical portal apparatus. 
         [0021]    Still referring to  FIG. 1 , portal member  112  defines a substantially cylindrical housing having an open proximal end  112   a  and a substantially open distal end  112   b . Open proximal end  112   a  is configured to engage insert  120 . Distal end  112   b  of portal member  112  may be integrally formed with sleeve  114 . Alternatively, portal member  112  may be configured for selectable engagement with sleeve  114 . Portal member  112  may be construction of plastic, polymer or other like material. Portal member  112  may be disposable, or in the alternative, reusable. Portal member  112  may be rigid, or alternatively, substantially flexible. Portal member  112  may include one or more seal members (not shown) having any seal arrangement for receiving a surgical object in a sealing manner. Portal member  112  may further include one or more anchors (not shown) or other suture securing means for securing one or more suture “S” extending through surgical portal apparatus  110 . Portal member  112  may further include an insufflation valve or port (not shown) configured to fill the body cavity of a patient with insufflation gas, saline or other suitable fluid. 
         [0022]    Sleeve  114  is configured to be inserted through the skin into a body cavity with the aid of an obturator (not shown), or may instead, include a blade or piercing tip for penetrating through the skin and into a body cavity. Sleeve  114  forms a substantially tubular member having proximal and distal ends  114   a ,  114   b  and defining a first longitudinal passage  113  extending therebetween. Sleeve  114  may be composed of plastic, metal, polymers or the like. Sleeve  114  may be disposable, or in the alternative, reusable. Sleeve  114  may be rigid, or alternatively, sleeve  114  may be flexible. Sleeve  114  may be open, or instead, may be configured to include one or more seal members (not shown) having any seal arrangement along the length thereof. 
         [0023]    With reference now to  FIGS. 1-3 , suture management device  120  includes a substantially cylindrical assembly configured to be received on proximal or housing end  112   a  of portal member  112 . Suture management device  120  defines a longitudinal passage  123  configured for receipt of endoscopic, laparoscopic or other elongated instrument of various diameters. Suture management apparatus  120  includes an insert or first member  130  and a cap or second member  140  configured to engage insert member  130 . Although suture management apparatus  120  is preferably used with a surgical portal apparatus having one or more seal members for receiving an instrument in a sealed fashion, it is envisioned that suture management apparatus  120  may include one or more seal members (not shown). 
         [0024]    Referring now to  FIG. 3 , insert member  130  defines a substantially cylindrical body  132  having proximal and distal ends  132   a ,  132   b  and defining a longitudinal passage  133  extending therebetween. Distal end  132   b  includes a flanged or recessed portion  134  configured to be received in proximal end  112   a  of portal member  112 . As shown, insert member  130  is configured to frictionally engage proximal end  112   a  of portal member  112 ; however, it is envisioned that insert member  130  and portal member  112  may be mechanically coupled, i.e. threaded engagement. Although shown as being received within proximal end  112   a  of portal member  112 , it is further envisioned that insert member  130  may be configured to be received about portal member  112 . Proximal end  132   a  of insert member  130  includes a plurality of radial extending slots  136 . Slots  136  are spaced about proximal end  132   a  and extend outwardly from longitudinal passage  133 . Insert member  130  may include any number of slots  136 . Slots  136  may be of varying widths. Each of slots  136  is configured to receive at least one suture  10  ( FIG. 1 ). As shown, each of slots  136  may include markings  138  to assist in identifying sutures  10  received therein. Markings  138  may be letters, numbers, symbols, colors or other identifying feature. As will be discussed in further detail below, markings  138  may also assist in aligning cap member  140  with insert member  130 . 
         [0025]    With reference now to  FIG. 2 , cap member  140  defines a substantially frustro-conical body  142  having proximal and distal ends  142   a ,  142   b  and defining a longitudinal passage  143  therebetween. Distal end  142  of cap member  140  includes a distal extension  144  extending therefrom. Distal extension  144  defines a distal end of longitudinal passage  143  and is configured to be received within longitudinal passage  133  of insert member  130 . Cap member  140  further includes a plurality of ribs  146  extending radially outward from distal extension  144 . Ribs  146  correspond in number and placement to slots  136  formed in proximal end  132   a  of insert member  130 . Each of ribs  146  is configured to be received within a corresponding slot  136  of insert member  130 . Ribs  146  may be over-sized, include a coating (not shown), or otherwise be configured to frictionally engage slot  136  and/or sutures  10 . Distal end  142   b  of cap member  140  may also include markings  148  corresponding to markings  138  on insert member  130 . Marking  148  may assist in aligning ribs  146  with slots  136  and/or, in lieu of markings  138  on insert member  130 , to identify sutures  10  within slots  136 . 
         [0026]    Depending on the configuration of surgical portal apparatus  110  and/or the preference of the user, insert member  130  of suture management apparatus  120  may be attached to surgical portal apparatus  110  during manufacture, by a surgeon prior to insertion of surgical portal apparatus  110  into a body cavity or following insertion of the surgical portal apparatus  110  into the body cavity. Cap member  140  may be provided separate from insert member  130 , or alternatively, cap member  140  may be engaged with insert member  130 . As discussed above, sleeve  114  of surgical portal apparatus  110  may be of the self-piercing type or may instead be inserted with the assistance of an obturator (not shown). Prior to receipt of sutures  10  ( FIG. 1 ) within slots  136  of insert member  130 , surgical portal apparatus  110  functions as a traditional access assembly. A seal member (not shown) disposed within portal member  112 , sleeve  114  and/or suture management apparatus  120  may operate to receive instrument “I” in a sealed manner. 
         [0027]    In operation, cap member  140  of suture management apparatus  120  is disengaged from insert member  130  in order to permit one or more sutures  10  to be received within slots  136  of insert member  130 . The sutures  10  may be used to manipulate tissue or in conjunction with, e.g. an orthopedic procedure to connect tissue. The sutures  10  may extend from the operative site through sleeve  114  of portal apparatus  110 . Once one or more sutures  10  are received within slots  136 , cap member  140  is engaged with insert member  130  such that ribs  146  engage slots  136  formed in insert member  130 . Sutures  10  are thus frictionally retained within slot  146  by ribs  136 . Alternatively, or additionally, distal extension  144  of cap member  140  frictionally engages sutures  10  against an inner surface of insert member  130 . Cap member  140  may be disengaged and reengaged from insert member  130  as necessary to add, remove and/or relocate sutures  10  within slots  136 . In using suture management system  100  during a surgical procedure, sutures  10  that would otherwise become tangled, misplaced and/or confused, are instead securely retained by suture management device  120  and maintained separate from instrument “I”. 
         [0028]    Turning now to  FIG. 4 , an alternate embodiment of a suture management system is shown generally as suture management system  200 . Suture management system  200  is substantially similar in form and function to suture management system  100  described hereinabove. Suture management device  220  includes a suture management apparatus  220  and a surgical portal apparatus  210 . Suture management apparatus  220 , and insert member  230  in particular, is integrally formed with surgical portal apparatus  210 . In this manner, insert member  230  and surgical portal apparatus  210  cannot accidentally become separated during a procedure. 
         [0029]    Although the illustrative embodiments of the present disclosure have been described herein with reference to the accompanying drawings, it is to be understood 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.