Patent Application
20100168522
1. Technical Field
The present disclosure relates generally to devices and techniques for performing minimally invasive surgical procedures. More particularly, the present disclosure relates to a device that is configured and dimensioned for positioning within an intercostal space to facilitate access to an internal surgical work site with one or more surgical instruments.
2. Background of the Related Art
In an effort to reduce trauma and recovery time, many surgical procedures are performed through small openings in the skin, such as an incision or a natural body orifice. For example, these procedures include laparoscopic procedures and thoracic procedures, such as those that are performed to investigate, diagnose, and treat diseases. Throughout the present disclosure, the term “minimally invasive” should be understood to encompass any and all such procedures.
Specific surgical instruments have been developed for use during minimally invasive surgical procedures, and typically include a shaft with an end effector, or operating portion, that is positioned at a distal end thereof. Dependent upon the requirements of the particular procedure, the end effector may include, for example, graspers, clip appliers, staplers, and the like.
During the minimally invasive procedure, the clinician often creates an opening through the patient's body wall using an obturator or trocar, and thereafter, positions an access assembly, such as a cannula assembly, within the opening. The access assembly typically includes an elongate access sleeve that is configured and dimensioned to receive one or more of the above-mentioned surgical instruments such that the end effector can be positioned within an internal work site adjacent the tissue that is the subject of the procedure.
Unlike laparoscopic surgery, which requires insufflation of the abdominal cavity to provide an operative region for the clinician, thoracic surgery does not require the introduction of insufflation gas into the thoracic cavity. Thus, the design of access assemblies intended for use during thoracic surgery can be simplified since the presence of a seal, or valve, is not essential.
In minimally invasive thoracic surgeries, the access assembly is generally inserted into a space located between adjacent ribs that is known as the intercostal space. After penetration of the patient's body wall is accomplished, the obturator can be removed from the access assembly, and one or more surgical instruments can be inserted into the internal work site therethrough.
In the interests of facilitating visualization, the introduction of certain surgical instruments, and/or the removal of tissue specimens during minimally invasive thoracic procedures, it may be desirable to spread the adjacent ribs defining the intercostal space. Additionally, during these procedures, firm, reliable placement of the access assembly is also desirable in order to allow the access assembly to withstand forces that are applied during manipulation of the instrument(s) inserted therethrough. However, reducing patient trauma during the procedure, discomfort during recovery, and the overall recovery time remain issues of importance.
In one aspect of the present disclosure, a surgical access assembly is disclosed that is configured and dimensioned for positioning within an opening in tissue which provides access to an intercostal space defined between a patient's adjacent ribs in order to facilitate the passage of a surgical instrument into an internal work site. The body portion has an inner liner formed from a first material and defining an internal space that is configured and dimensioned to removably receive the surgical instrument, and an outer liner that is positioned about the inner liner. The outer liner is formed from a second material having a lower durometer than the first material such that the outer liner is resiliently deformable to facilitate conformity with the intercostal space to minimize the application of force to the patient's tissue upon insertion and removal of the access assembly and manipulation of the surgical instrument within the internal space.
In one embodiment of the disclosed access assembly, the body portion may include a substantially rectangular cross-sectional configuration. The body portion may include sidewalls that are substantially planar and/or arcuate in configuration.
The surgical access assembly may include a body portion with a proximal portion that defines a first transverse dimension, and a distal portion that defines a second, smaller transverse dimension. The configuration and dimensions of the proximal portion facilitate engagement with the patient's tissue to prevent passage of the access assembly entirely into the internal work site.
In another aspect of the present disclosure, a surgical access assembly is disclosed that is configured and dimensioned to facilitate access to an internal work site through an intercostal space defined between a patient's adjacent ribs. The surgical access assembly includes a body portion having a proximal portion and a distal portion, and defines an internal space that is configured and dimensioned to receive a surgical instrument. The body portion incorporates an inner membrane and an outer membrane defining a cavity. The inner membrane and the outer membrane are formed from a biocompatible material that is substantially impermeable such that the cavity is capable of retaining a fluid therein.
The surgical access assembly is repositionable between deflated and inflated conditions upon communication of the fluid to and from the cavity such that the access assembly is resiliently deformable to thereby facilitate conformity with the intercostal space in order to minimize the application of force to the patient's tissue upon insertion and removal of the access assembly and manipulation of the surgical instrument within the internal space.
The access assembly may include proximal and distal portions, wherein the proximal portion is configured and dimensioned to prevent the access assembly from passing entirely into the internal work site, e.g., the proximal portion may define a first transverse dimension, whereas the distal portion may define a second, smaller transverse dimension.
As with the surgical access assembly discussed in connection with the aforedescribed aspect of the present disclosure, in one embodiment, it is envisioned that the body portion may include a substantially rectangular cross-sectional configuration. The body portion may include sidewalls that are substantially planar and/or arcuate in configuration.
In another aspect of the present disclosure, a method of facilitating access to an internal work site beneath a patient's tissue is disclosed. The method includes the steps of (i) forming an opening in the patient's tissue; (ii) advancing an access assembly through the opening in a deflated condition such that the access assembly is positioned within an intercostal space defined between the patient's adjacent ribs; (iii) inflating the access assembly via communication of a fluid into a cavity defined between inner and outer membranes of the access assembly, whereby the access assembly conforms to the intercostal space to facilitate secured positioning thereof; (iv) inserting the surgical instrument into the internal work site through the access assembly; and (v) performing a surgical procedure utilizing the surgical instrument.
The step of inflating the access assembly may include causing a proximal portion thereof to define a first transverse dimension greater than a second transverse dimension defined by a distal portion thereof such that the proximal portion is configured and dimensioned for engagement with the patient's tissue to prevent passage of the access assembly entirely into the internal work site.
Upon inflation, the body portion of the surgical access assembly may be caused to realize a substantially rectangular cross-sectional configuration to facilitate conformity with the intercostal space. The body portion may be caused to define substantially planar sidewalls to maximize available surface area for contact with the patient's tissue, and/or at least one pair of arcuate sidewalls.
In still another aspect of the present disclosure, a method of facilitating access to an internal work site beneath a patient's tissue is disclosed. The method includes the steps of (i) forming an opening in the patient's tissue; (ii) advancing an access assembly through the opening into an intercostal space defined between the patient's adjacent ribs such that an outer liner of the access assembly is resiliently deformed to facilitate conformity with the intercostal space; (iii) inserting a surgical instrument into the internal work site through the access assembly; and (iv) performing a surgical procedure utilizing the surgical instrument.
The surgical access assembly may include a body portion with an inner liner positioned in contact with the outer liner, wherein the inner liner is formed from a first material, and the outer liner is formed from a second material having a lower durometer than the first material. Upon positioning within the opening, the inner liner may establish a passageway to the internal work site that extends longitudinally therethrough. It is envisioned that the proximal portion of the access assembly may be caused to abut the patient's tissue to prevent passage of the access assembly entirely into the internal work site.
Various exemplary embodiments of the present disclosure are described herein below with reference to the drawings, wherein:
Various embodiments of the presently disclosed access assembly, and methods of using the same, will now be described in detail with reference to the drawings wherein like references numerals identify similar or identical elements. In the drawings, and in the following description, the term “proximal” should be understood as referring to the end of the access assembly, or component thereof, that is closer to the clinician during proper use, while the term “distal” should be understood as referring to the end that is farther from the clinician, as is traditional and conventional in the art. Additionally, use of the term “tissue” herein below should be understood to encompass both the patient's ribs, and any surrounding tissues.
The access assembly 100 is configured and dimensioned to extend into the thoracic cavity “T” (
As best seen in
In one embodiment of the access assembly 100, the distal portion 108 of the body portion 102 includes a cross-sectional configuration defining a first transverse dimension “X1” that extends along a first transverse axis “X,” and a second, smaller transverse dimension “Z1” that extends along a second transverse axis “Z,” as best seen in
The distal portion 108 of the body portion 102 includes a pair of first sidewalls 116 (
In an alternative embodiment of the access assembly 100, it is envisioned that both the pair of first sidewalls 116 and the pair of second sidewalls 118 may be substantially planar in configuration such that the cross-sectional configuration of the body portion 102 is substantially rectangular.
The specific configuration and dimensions of the access assembly 100 may be varied in alternative embodiments of the present disclosure based on such factors as the anatomy of the patient to be treated, and the surgical instruments to be used in conjunction therewith. As such, it is further envisioned that both pairs of sidewalls 116, 118 may include arcuate profiles in order to further facilitate spreading of the patient's ribs, as well as maximization of the internal space 112 (
With continued reference to
As mentioned above, it is envisioned that the body portion 102 (
Referring now to
Following completed use of the surgical instrument “I,” the instrument “I” can be withdrawn from the access assembly 100, and the access assembly 100 can be removed from the intercostal space.
With reference now to
The proximal portion 204 includes respective first and second pairs of sidewalls 210, 212 that extend in substantially parallel relation such that the proximal portion 204 defines a substantially rectangular configuration. However, it should be appreciated that alternative configurations for the proximal portion 204, such as oval, are not beyond the scope of the present disclosure. The configuration and dimensions of the proximal portion 204 facilitates the insertion into, and the removal of the surgical instrument(s) “I” (
The intermediate portion 208 extends distally from the proximal portion 204 and can be integral (monolithic) with the distal portion 206 and/or the proximal portion 204 or alternatively can be a separate element connected to the distal portion 206 and/or the proximal portion 204. The intermediate portion 208 includes respective first and second pairs of sidewalls 214, 216 corresponding to the sidewalls 210, 212 of the proximal portion 204. The first pair of sidewalls 214 taper in a distal direction inwardly towards the longitudinal axis “Y.” The inward taper of the first pair of sidewalls 214 guides the surgical instrument(s) “I” upon insertion into the access assembly 200 to facilitate passage into the thoracic cavity “T”, and provides a surface that is configured and dimensioned for abutment with the patient's tissue to prevent the surgical access assembly 200 from passing entirely into the internal work site, e.g. the thoracic cavity. Additionally, the tapered configuration of the first pair of sidewalls 214 provides increased internal space for manipulation of surgical instrument(s), e.g. instrument “I” of
In the embodiment of the access assembly 200 illustrated in
The distal portion 206 extends distally from the intermediate portion 208, and includes a wall 218 of a substantially cylindrical configuration defining an opening that extends therethrough. It should be appreciated, however, that the distal portion 206 may include other geometrical configurations, e.g., rectangular, in alternative embodiments of the present disclosure. The opening in wall 218 is configured and dimensioned to facilitate passage of surgical instrument(s), e.g. instrument “I” of
The access assembly 300 includes a body portion 302 that is formed from the aforementioned compliant material, e.g., PU foam. The incorporation of such a material allows the body portion 302 of the access assembly 300 to better conform to the shape of the intercostal space defined between the patient's adjacent ribs “R.” Additionally, the compliant material minimizes the force “F” (
While illustrated as including a body portion 302 with a substantially rectangular in cross-sectional configuration, in alternative embodiments of the access assembly 300, it is envisioned that the body portion 302 may assume other geometrical configurations, e.g., oval. Also, the entire body portion 302 can be formed from compliant material, or alternatively, only portions thereof.
Whereas the inner liner 404 is formed from a substantially rigid material, the outer liner 406 is formed from a substantially compliant material, e.g., a material having a lower durometer than the material comprising the inner liner 404, either partially or wholly. By way of example, the outer liner can be formed from a biocompatible gel. Consequently, during use of the access assembly 400, the compliant outer liner 406 provides a cushioned contact area between the body portion 402 and the patient's tissue, e.g., the patient's ribs “R” (
Although the access assembly 400 is illustrated as including respective first and second pairs of first sidewalls 408, 410 that are substantially planar in configuration, whereby the body portion 402 includes a substantially rectangular cross-sectional configuration, alternative geometrical configurations for the access assembly 400 are not beyond the scope of the present disclosure. For example, it is envisioned that at least one of the respective first and second pairs of sidewalls 408, 410 may have an arcuate profile such that the cross-sectional configuration of the body portion 402 is substantially oval.
With reference now to
The body portion 502 includes an inner membrane 510 and an outer membrane 512 which collectively define a cavity 514. The respective inner and outer membranes 510, 512 may be formed from any suitable biocompatible material that is capable of retaining a fluid, e.g., air, water, or saline, within the cavity 514, i.e., a substantially impermeable material. During use of the access assembly 500, the cavity 514 is filled with the aforementioned fluid in order to transition the access assembly 500 between a deflated condition (not shown) and an inflated condition (
Inflating the access assembly 500 provides a measure of resiliency and deformability that cushions the patient's tissue during the course of the surgical procedure, and evenly distributes any applied forces, e.g., during insertion, removal, and/or manipulation of the surgical instrument(s), e.g. instrument “I” of
Although the access assembly 500 is illustrated as including a substantially circular cross-sectional configuration, alternative geometrical configurations for the access assembly 500 are not beyond the scope of the present disclosure. For example, it is envisioned that the access assembly 500 may include substantially planar and/or arcuate sidewalls such that the cross-sectional configuration of the access assembly 500 is substantially rectangular.
Although described for use in thoracic procedures, it should also be understood that the access assemblies described herein can be used in other surgical procedures, including, but not limited to the replacement or reparation of a diseased or damaged valve, such as the repair and replacement of mitral, aortic, and other heart valves, repair of atrial and ventricular septal defects, pulmonary thrombectomy, treatment of aneurysms, electrophysiological mapping and ablation of the myocardium, and any other procedure in which interventional devices are introduced into the interior of the heart or a great vessel, as well as annuloplasty, quadrangular resection, commissurotomy, shortening mitral or tricuspid valve chordae tendonae, reattachment of severed mitral or tricuspid valve chordae tendonae or papillary muscle tissue, decalcification of valve and annulus tissue, and the like. The term “minimally invasive” as used herein also includes such procedures.
Persons skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying figures are non-limiting exemplary embodiments, and that the description, disclosure, and figures should be construed merely exemplary of particular embodiments. It is to be understood, therefore, that the present disclosure is not limited to the precise embodiments described, and that various other changes and modifications may be effected by one skilled in the art without departing from the scope or spirit of the disclosure. Additionally, it is envisioned that the elements and features illustrated or described in connection with one exemplary embodiment may be combined with the elements and features of another without departing from the scope of the present disclosure, and that such modifications and variations are also intended to be included within the scope of the present disclosure. Accordingly, the subject matter of the present disclosure is not to be limited by what has been particularly shown and described, except as indicated by the appended claims.
This application claims the benefit of U.S. Provisional Patent Application No. 61/107,749, filed on Oct. 23, 2008, the entire contents of which are incorporated by reference herein.
| Number | Date | Country | |
|---|---|---|---|
| 61107749 | Oct 2008 | US |
