The present disclosure relates generally to surgical apparatuses for use in minimally invasive surgical procedures, such as endoscopic and/or laparoscopic procedures, and more particularly, the present disclosure relates to a surgical apparatus including a specimen retrieval bag assembly and a vacuum tube for accessing the bag assembly and collecting body tissue(s) and/or body fluid(s) during these procedures.
Minimally invasive surgery, such as endoscopic surgery, reduces the invasiveness of surgical procedures. Endoscopic surgery involves surgery through body walls, for example, viewing and/or operating on the ovaries, uterus, gall bladder, bowels, kidneys, appendix, etc. There are many common endoscopic surgical procedures, including arthroscopy, laparoscopy, gastroentroscopy and laryngobronchoscopy, just to name a few. In these procedures, trocars are utilized for creating incisions through which the endoscopic surgery is performed. Trocar tubes or cannula devices are extended into and left in place in the abdominal wall to provide access for endoscopic surgical tools. A camera or endoscope is inserted through a trocar tube to permit the visual inspection and magnification of the body cavity. The surgeon can then perform diagnostic and/or therapeutic procedures at the surgical site with the aid of specialized instrumentation, such as forceps, graspers, cutters, applicators, and the like, which are designed to fit through additional cannulas. To protect the opening from accidental penetration by the surgical instruments, wound retractors are often placed across the opening.
When removing certain tissues from the body cavity, for example tumor tissue, it is important that the tumor tissue does not come into contact with healthy or uninvolved tissue, so as in this way to avoid metastasis and avoid harming the patient. Minimally invasive surgical procedures, however, may be limited where large size tumors or large masses of tissue have to be removed from a body cavity. If tumor tissue or tissue parts have to be removed, they may be introduced into an “extraction bag,” also referred to herein as a “specimen bag,” at the site where the tumor or diseased tissue has been detached from the surrounding tissue, after which the specimen bag is withdrawn from the body, normally through a trocar or similar device, thereby minimizing contact of the diseased tissue with healthy tissue.
Improved wound retractors and specimen bags, including those capable of use with a vacuum source, for use in minimally invasive surgical procedures remain desirable.
The present disclosure is directed to surgical apparatuses and kits for use in minimally invasive surgery. The surgical apparatus includes a wound retractor having a specimen bag attached thereto, for placement of diseased tissue therein. In embodiments, the kit of the present disclosure includes the surgical apparatus and a vacuum tube for assisting in removing tissue specimens from the body.
In some embodiments, a kit of the present disclosure includes a wound retractor and specimen bag assembly including a wound retractor and a specimen bag. The wound retractor includes a proximal ring, a distal ring, and a film disposed between the proximal ring and the distal ring, with the specimen bag attached to the distal ring of the wound retractor. The kit also includes a vacuum tube.
In embodiments, the proximal ring of the wound retractor defines a generally circular opening and is deformable.
In some embodiments, the distal ring of the wound retractor defines a generally circular opening and is deformable.
In embodiments, a length of the film of the wound retractor between the proximal ring and the distal ring is adjustable.
In other embodiments, the specimen bag is attached to the distal ring of the wound retractor by a method such as adhesive bonding, welding, heat-sealing, and combinations thereof.
In some embodiments, the wound retractor includes a tether.
In embodiments, the vacuum tube includes a distal portion defining a generally circular opening, a narrower proximal portion defining a narrower, generally circular opening, and an elongate shaft defining a lumen between the distal portion and the narrower proximal portion.
In some embodiments, the vacuum tube includes a valve.
In other embodiments, the kit of the present disclosure further includes a vacuum source adapted to communicate with the vacuum tube. In some embodiments, the vacuum source includes a syringe.
In yet other embodiments, a kit of the present disclosure includes a wound retractor and specimen bag assembly including a wound retractor and a specimen bag, the wound retractor including a proximal ring, a distal ring, and a film disposed between the proximal ring and the distal ring, the specimen bag being attached to the distal ring of the wound retractor. In embodiments, the kit also includes a vacuum tube, and a vacuum source including a syringe adapted to communicate with the vacuum tube.
In some embodiments, the proximal ring of the wound retractor defines a generally circular opening and is deformable. The distal ring of the wound retractor may also define a generally circular opening and is deformable.
In embodiments, a length of the film of the wound retractor between the proximal ring and the distal ring is adjustable.
In some embodiments, the specimen bag is attached to the distal ring of the wound retractor by a method such as adhesive bonding, welding, heat-sealing, and combinations thereof.
In other embodiments, the wound retractor includes a tether.
In embodiments, the vacuum tube includes a distal portion defining a generally circular opening, a narrower proximal portion defining a narrower, generally circular opening, and an elongate shaft defining a lumen between the distal portion and the narrower proximal portion.
In other embodiments, the vacuum tube includes a valve.
Methods of the present disclosure are also provided. In embodiments, a method of the present disclosure includes inserting a wound retractor and specimen bag assembly including a wound retractor having a proximal ring, a distal ring and a film disposed between the proximal ring and the distal ring, and a specimen bag attached to the distal ring, into a body cavity through a body opening; passing a tissue specimen through an opening defined by the proximal ring, the film and the distal ring of the wound retractor into the specimen bag; removing the proximal ring from the body cavity through the body opening so that the film is adjacent tissue encompassing the body opening; pulling the proximal ring away from the distal ring such that the distal ring is brought into abutment with an inner surface of the tissue surrounding the body opening; rolling the proximal ring about itself such that the film is furled about the proximal ring to bring the proximal ring into abutment with an outer surface of the tissue; introducing a vacuum tube through the proximal ring into the specimen bag; attaching a vacuum source to the vacuum tube; drawing a vacuum through the vacuum tube to draw a portion of the tissue specimen within the specimen bag into the distal portion of the vacuum tube; and removing the vacuum tube possessing the portion of the tissue specimen from the wound retractor.
In embodiments, the method of the present disclosure further includes rolling the proximal ring to retract the incision and bring the proximal ring into abutment with an outer surface of the tissue.
Various embodiments of the presently disclosed wound retractor and specimen bag assembly are described herein with reference to the drawings wherein:
The present disclosure provides a wound retractor and specimen bag assembly and vacuum tube for use in minimally invasive surgical procedures. As used herein with reference to the present disclosure, minimally invasive surgical procedures encompass laparoscopic procedures and endoscopic procedures, and refer to procedures utilizing scopes or similar devices having relatively narrow operating portions capable of insertion through or a small incision in the skin.
The aspects of the present disclosure may be modified for use with various methods for retrieving tissue specimens during minimally invasive surgical procedures, sometimes referred to herein as minimally invasive procedures. Examples of minimally invasive procedures include, for example, cholecystectomies, appendectomies, nephrectomies, colectomies, splenectomies, and the like.
As used herein, the term distal refers to that portion of a wound retractor and specimen bag assembly which is farthest from the user, while the term proximal refers to that portion of the wound retractor and specimen bag assembly of the present disclosure which is closest to the user.
The wound retractor and specimen bag assembly of the present disclosure includes a wound retractor with a specimen bag affixed thereto. The wound retractor component includes a sleeve member possessing at least two rings, including a proximal ring and a distal ring, with a film extending between the two rings. The specimen bag component is attached to the distal ring of the wound retractor. In use, the specimen bag assembly is passed through an incision and placed within a body cavity, and tissue to be removed therefrom, referred to in embodiments as a “tissue specimen”, is passed through the wound retractor component and placed within the specimen bag. The proximal ring of the wound retractor component is then removed from the body cavity and placed adjacent the skin on an outside surface of the body adjacent the incision, with the distal ring of the sleeve member and the specimen bag remaining within the body, so that the film extends through the incision and is adjacent the tissue encompassing the incision. The presently disclosed wound retractor and specimen bag assembly is suitable for use in any procedure where access to the interior of the body is limited to one or more relatively small incisions, as in minimally invasive procedures.
Kits of the present disclosure include both the wound retractor and specimen bag assembly described above, as well as a vacuum tube assembly. The vacuum tube assembly permits removal of tissue specimens from the specimen bag without the need for breaking up the tissue, sometimes referred to herein as morcellation of tissue, with a scalpel or some other morcellation device.
Embodiments of the present disclosure will now be described in detail with reference to the drawings, in which like reference numerals designate identical or corresponding elements in each of the several views. In the following description, well-known functions or constructions are not described in detail to avoid obscuring the present disclosure in unnecessary detail.
Referring also to
The wound retractor 100 includes a proximal ring 120, a distal ring 140, and a generally cylindrical film 130 disposed therebetween. The wound retractor and specimen bag assembly 10 further defines a longitudinal axis “L” shared by the proximal ring 120, the distal ring 140, and the film 130, as well as the specimen bag 200. It is envisioned that the proximal ring 120 and the distal ring 140 may each be detachably coupled or permanently attached to a proximal end portion 132 and a distal end portion 134, respectively, of the film 130 by any means within the purview of those skilled in the art, e.g., glue, suture, impulse welding, chemical or mechanical bonding, an over molding process, etc. In some embodiments, the proximal ring 120, film 130, and distal ring 140 are monolithically integrated such that the wound retractor 100 is a unitary structure. Attachment of the film 130 to the rings 120, 140 can be continuous around the rings 120, 140 or may be discontinuous, provided the rings 120, 140 are sufficiently secured to the film 130 to allow the film 130 to be rolled about the proximal ring 120 as described below.
The proximal ring 120 and the distal ring 140 are axially aligned along longitudinal axis “L” with the film 130 disposed therebetween, as noted above. The proximal ring 120 has a generally circular configuration that defines a circular opening 122 (see
It is envisioned that the proximal ring 120 and the distal ring 140 may be fabricated from resilient materials such that the proximal ring 120 and the distal ring 140 may temporarily deform into a generally oblong configuration during insertion of the wound retractor 100 through an incision “I” while reverting to a generally circular configuration during use. For example, thermoplastic polyurethanes sold under the name PELLETHANE®, offers flexibility and a wide range of hardnesses. The proximal ring 120, for example, may be fabricated from PELLETHANE® 2363-80A, PELLETHANE® 2363-90A, a 50/50 composition of PELLETHANE® 2363-80A and PELLETHANE® 2363-90A, or any alternatives known in the art. The distal ring 140 may be fabricated from, for example, PELLETHANE® 2363-90A for the extra small and small size, PELLETHANE® 2363-55D for the medium and large size, a 50/50 composition of PELLETHANE® 2363-90A and PELLETHANE® 2363-55D for the large size, or any alternatives within the purview of those skilled in the art. The proximal ring 120 and the distal ring 140 may be fabricated from the same or different materials.
The film 130 defines a generally cylindrical shape to form a lumen between the proximal ring 120 and the distal ring 140. The circular configuration of the proximal and distal rings 120 and 140, respectively, maintains the film 130 in an expanded state to maintain the lumen in a non-collapsed state. The film 130 is coupled to the proximal ring 120 at the proximal end portion 132 and is coupled to the distal ring 140 at the distal end portion 134, such that the film 130 does not slide or move relative to a surface of either the proximal ring 120 or the distal ring 140. The film 130 may be fabricated from a clear, non-elastomeric material, e.g., a polyurethane. Alternately, it is envisioned that the film 130 may be formed from a variety of materials including opaque and clear materials.
The length “X” (
It is envisioned that the wound retractor 100 may come in a variety of sizes to appropriately fit and accommodate a range of incision diameters. For example, for an extra small wound retractor, the outer diameter of the proximal ring 120 and the distal ring 140 may be about 2.5 inches; for a small wound retractor, the outer diameter of the proximal ring 120 and the distal ring 140 may be about 3.9 inches; for a medium sized wound retractor, the outer diameter of the proximal ring 120 and the distal ring 140 may be about 5.1 inches; for a large wound retractor, the outer diameter of the proximal ring 120 and the distal ring 140 may be about 7.5 inches; and for an extra-large wound retractor, the outer diameter of the proximal ring 120 and the distal ring 140 may be about 9.4 inches.
Specimen bags of the present disclosure are made of flexible and durable materials within the purview of those skilled in the art, in embodiments, polymeric materials. The specimen bags are inflatable and capable of allowing a surgeon to introduce cutting devices into the specimen bag to reduce the size of the tissue specimen therein, thereby facilitating removal of the specimen bag from the body. Materials used to form the specimen bags are antistatic, pyrogen-free, non-toxic and sterilizable. In embodiments, materials used to form the film portion of the wound retractor described above may be used to form the specimen bag. In other embodiments, the specimen bag is formed of materials that are different from those used to form the film of the wound retractor. The specimen bag may be opaque or clear.
The specimen bag 200 may be joined to the distal ring 140 of the wound retractor at the distal portion 134 of the film 130 by methods within the purview of those skilled in the art, including, but not limited to, adhesive bonding, welding, heat-sealing, combinations thereof, and the like. Alternatively, the specimen bag 200 can be integrally formed with the film 130, in embodiments of the same material.
As discussed above, both the proximal ring 120 and the distal ring 140 may be collapsed from the generally circular configuration to a generally oblong configuration (not shown) for insertion, along with the specimen bag 200, through incision “I”. More specifically, as the practitioner squeezes opposing sides of the proximal ring 120 and the distal ring 140 radially inwards, the generally circular openings of the proximal ring 120 and the distal ring 140 are deformed from the generally circular configuration to a generally oblong configuration (not shown) such that the proximal ring 120 and the distal ring 140 assume a smaller profile for ease of insertion through incision “I”. Once inserted, the practitioner releases the proximal ring 120 and distal ring 140 and the resiliency of the material urges the proximal ring 120 and the distal ring 140 towards their generally circular configurations.
In embodiments, where there is concern that the tissue specimen “TS” within the specimen bag 200 is diseased, for example cancerous, and it is desired to minimize contact of the tissue specimen “TS” with healthy tissue, but morcellation or other means for breaking up the tissue within the specimen bag 200 are not feasible or desired (for fear of damaging the specimen bag 200 and/or the wound retractor 100), a vacuum tube 300 may be inserted through the lumen of the wound retractor 100 into the specimen bag 200 to remove tissue specimen “TS” from the body cavity “BC”.
The kit (
The vacuum tube 300 may be formed of hard, rigid materials. Suitable materials for forming the vacuum tube include, for example, polyolefins such as polyethylene (including ultra high molecular weight polyethylene) and polypropylene including atactic, isotactic, syndiotactic, and blends thereof; polyethylene glycols (PEGs); polyethylene oxides; copolymers of polyethylene and polypropylene; polyisobutylene and ethylene-alpha olefin copolymers; fluorinated polyolefins such as fluoroethylenes, fluoropropylenes, fluoroPEGs, and polytetrafluoroethylene; polyamides; polyamines; polyimines; polyesters such as polyethylene terephthalate, polyethylene naphthalate, polytrimethylene terephthalate, and polybutylene terephthalate; polyethers; polybutester; polytetramethylene ether glycol; 1,4-butanediol; polyurethanes; acrylic polymers; methacrylics; vinyl halide polymers and copolymers such as polyvinyl chloride; polyvinyl alcohols; polyvinyl ethers such as polyvinyl methyl ether; polyvinylidene halides such as polyvinylidene fluoride and polyvinylidene chloride; polychlorofluoroethylene; polyacrylonitrile; polyaryletherketones; polyvinyl ketones; polyvinyl aromatics such as polystyrene; polyvinyl esters such as polyvinyl acetate; copolymers of vinyl monomers with each other and olefins such as ethylene-methyl methacrylate copolymers; acrylonitrile-styrene copolymers; acrylonitrile butadiene styrene resins; ethylene-vinyl acetate copolymers; alkyd resins; polycarbonates; polyoxymethylenes; polyphosphazines; polyimides; epoxy resins; aramids; silicones; and copolymers and combinations thereof.
The kit of the present disclosure also includes a vacuum source, in embodiments a syringe 400, for drawing a vacuum through the vacuum tube 300, thereby removing the tissue specimen “TS” from the specimen bag 200 by drawing the tissue specimen “TS” into the distal portion 312 of the vacuum tube 300. Other possible sources for drawing a vacuum include, for example, a mechanically or manually operated pump (not shown), a simple electric vacuum pump (not shown), or other similar means. The narrower proximal portion 316 of the vacuum tube 300 is couplable to the vacuum source, in embodiments the syringe 400. Means for coupling the narrower proximal portion 316 of the vacuum tube 300 to the vacuum source, in embodiments the syringe 400, are within the purview of those skilled in the art and include, for example, friction fitting, the use of seals within the lumen of circular opening 318 of the narrower proximal portion 316 of the vacuum tube 300, a luer-type coupling, combinations thereof, and the like.
With reference to
Once tissue specimen “TS” has been introduced into the specimen bag 200, the surgeon then collapses and deforms the proximal ring 120 using a forceps, grasper, or similar instrument and withdraws the proximal ring 120 through the incision “I”. In other embodiments, the proximal ring 120 has a tether 124 thereon (shown in phantom in
As shown in
With the distal ring 140 in abutment with the inner surface 8 of wound “W”, the proximal ring 120 is rolled distally towards the distal ring 140 and the outer surface 4 of wound “W” to a desired position, such that the film 130 is furled about the proximal ring 120 (not shown) and thereby tensioned.
Referring to
Referring briefly to
Where the syringe 400 is used as the vacuum source, the plunger 410 of the syringe 400 may first be pushed distally (indicated by arrows “P” in
As shown in
As depicted in
In use, the plunger 410 of the syringe 400 is pushed distally (indicated by arrows “P” in
For example, the plunger 410 of the syringe 400 is pushed down at least a second time to repeat the cycle (indicated by arrows “P” in
Once the tissue specimen “TS” is pulled into the distal end portion 312 of the vacuum tube 300, the vacuum tube 300 may be removed from the wound retractor 100. In embodiments, if the tissue specimen “TS” to be removed separates and portions thereof remain in the specimen bag 200 as tissue specimen “TS” is pulled into the distal end portion 312 of the vacuum tube 300, the surgeon may grab those additional pieces of tissue with a forceps or other grasper, and/or use a vacuum source for removal of any remaining portion of the tissue specimen “TS” from the specimen bag 200. In other embodiments, the volume of the tissue specimen “TS” in the specimen bag 200, as well as any fluids from the tissue specimen “TS”, may be reduced to a point that specimen bag 200, with any remaining tissue and/or fluids therein, may pass through incision “I” without need for any further vacuum.
In embodiments, once the vacuum tube 300 is removed from the wound retractor 100, a pin (not shown) or some similar means may be used to lift the ball 320 so that it no longer blocks the distal opening 326 of the narrower proximal portion 316 of the vacuum tube 300, to let air into the vacuum tube 300, and assist in releasing the tissue specimen “TS” from the vacuum tube 300. Alternatively, as depicted in
Once the vacuum tube 300 has been removed from the wound retractor 100, the surgeon then collapses and deforms the distal ring 140 of the wound retractor 100 using a forceps, grasper, or similar instrument and the distal ring 140 and specimen bag 200 are withdrawn through the incision “I”. In other embodiments, the distal ring 140 has a tether thereon (not shown), which may be pulled proximally by the surgeon to remove the distal ring 140 and the specimen bag 200 from the body cavity “BC”.
After the specimen bag 200 is removed from the body cavity “BC”, any tissue remaining therein can be removed from the specimen bag 200 for further examination or the specimen bag 200 can be discarded.
The kits and specimen bags of the present disclosure provide safe tissue extraction at the end of minimally invasive surgical procedures. Diseased tissue may be removed from the body without seeding of spilled tissue cells inside the abdomen. The design of the wound retractor/specimen bags of the present disclosure, with the vacuum tube described above, allows for the surgeon to remove tissue from the body without the need for morcellators or other mechanical devices that otherwise could tear the specimen bag and possibly release tissue contents back into the body of the patient. It is further envisioned that the methods of using the specimen bags of the present disclosure may be modified to accommodate needs of a given procedure and/or the preferences of the surgeon. It is further envisioned that the embodiments disclosed herein may be used to remove any tissue or object from the body.
It will be understood that various modifications may be made to the embodiments disclosed herein. For example, other methods for introducing specimen bags of the present disclosure into the body of a patient may be used. Additionally, other specimen bag shapes may be used. Further, the terminology of similar components with the various embodiments should not be construed as specific to any particular embodiment. Thus, the above description should not be construed as limiting, but merely as exemplifications of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.
This application claims the benefit of and priority to U.S. Provisional Patent Application No. 62/621,189 filed Jan. 24, 2018, the entire disclosure of which is incorporated by reference herein.
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