Implantable subcutaneous injection ports have been used primarily for the purpose of vascular access. The devices are generally implanted beneath the skin of a patient near the upper chest. The injection port exhibits a silicon membrane overlying a chamber which is, in turn, connected to tubing and catheter usually entering the internal jugular or subclavian vein. The chamber is accessed by puncturing the overlying skin with a Huber point needle, then puncturing the self sealing silicon membrane of the port. This allows the repeated injection of medicines or the drawing of blood with low risk of infection at the same time preserving the integrity of the skin. Various injection ports are commercially available. By way of example is the injection port available under the brand name of Port-A-Cath® Implantable Venous Access Systems.
The onlay access port exhibited here represents an advance in the design of subcutaneous medical access devices. This is especially true for applications where the access port is placed on the abdominal fascia, and where the tubing egress route is through the abdominal musculature and into the peritoneal cavity. Such an application is laparoscopic adjustable gastric banding. Ports currently used in laparoscopic adjustable gastric banding borrow their design from those traditionally used as venous access devices placed on the chest wall. Traditional venous access ports exhibit tubing exiting from the side of the port which is advantageous in these applications where a length of tubing will initially track more or less horizontally, parallel to the chest wall then entering a large vein. Venous access applications present minimal opportunity for the tubing to be routed at sharp angles and consequently less opportunity for kinking and resulting obstruction. Use of venous access ports in procedures such as laparoscopic adjustable gastric banding where it requires the routing of tubing through the abdominal fascia and into the peritoneal cavity instead of routing the tubing horizontally along the chest wall. This often requires the tubing to be routed at sharper angles. This results in the most common complications in laparoscopic adjustable gastric banding which are the occlusion of tubing due to kinking and the loss of integrity of the tubing wall by cracking due to angulation stresses. The onlay port described here shows an exit directly beneath and at the bottom of the onlay access port allowing direct vertical penetration of the abdominal fascia by the tubing which exits the port at right angles to the horizontal orientation of the onlay port.
This new design also reduces the possibility of puncturing the tubing during needle access to the port and reduces the possibility of port to become malpositioned or rotated due to the horizontal fixed tubing which eliminates all but one axis of freedom about which it can rotate. Additionally the onlay access port will be easier to place at surgery. Direct placement over a trochar site allow the tubing to be inserted through a smaller incision immediately below the only access port. This further enhances the stability of the port installation and reduces the need for fixation to the muscular fascia by suturing or other fixative technique. The only access port will be manufactured of titanium and silicone or other suitable materials that are inert and well tolerated by the body
Alternative embodiments of the port utilizing u-joint and ball joint connectors, will add additional flexibility in the catheter attachment allowing the patent greater freedom of movement with lessened risk of dislodging the access port.
Turn now to
Another embodiment of the onlay port is exhibited in
The joining pockets and the joining inserts may be configured in such a way that when joining insert is disposed within the joining pocket, it is retained therein by means of an expanded lip 18A on second joining insert 18 which is retained by a narrowed lip retainer 19A in joining pocket 19. Alternatively joining pockets and joining inserts could be smooth-walled and would be joined by an appropriate adhesive.
As mentioned earlier, the appropriate routing of catheter 13 is to avoid kinking which is a significant complication in the use of these devices in laproscopic adjustable gastric banding.
Injection chamber bottom aperture 25 need not be centrally located but may be located in any position such that fluid may pass from the injection chamber 12. It should also be noted that the first shield aperture 30 need not be confined to any particular location on first shield 26.
The invention is applicable to laparoscopic adjustable gastric banding surgery or any surgical procedure where the implantation of an access port with the characteristics of the above described invention would be desirable.
This application is the National Stage of International Application No. PCT/US2009/000142, filed 9 Jan. 2009.
Number | Date | Country | |
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20120179120 A1 | Jul 2012 | US |
Number | Date | Country | |
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Parent | PCT/US09/00142 | Jan 2009 | US |
Child | 13135537 | US |