FIELD OF THE INVENTION
The present invention generally relates to surgical devices for temporarily retaining and supporting tissues and organs in a desired orientation during surgery, and more particularly, to devices for retracting portions of the bowel during surgery.
BACKGROUND
One major challenge to employing laparoscopic colorectal techniques is the ability to move all of the unrelated or non-involved tissue out of the surgical site to permit better physical and visual access to the target tissue or organ. In an open procedure, large metal retractors would be used to pull the masses of small intestines away and then pack them off with surgical sponges. When performing various colorectal surgical procedures, the surgeon often must manipulate the surgical instruments through a pile or collection of bowel to open up a window to operate in.
Thus, the need exists for devices that can be used to support portions of the bowel during laparoscopic colorectal operations in unobtrusive orientations to provide better physical and visual access to the portion of the bowel to be operated on.
The foregoing discussion is intended only to illustrate some of the shortcomings present in the field of the invention at the time, and should not be taken as a disavowal of claim scope.
BRIEF SUMMARY
In connection with general aspects of various embodiments of the present invention, there is provided a bowel retractor device that, in various forms, comprises an elastic body that is configurable from a first collapsed position wherein the elastic body is insertable through an opening in a patient's body to a second expanded position wherein a portion of the patient's bowel may be supported by a central portion of the elastic body in a desired orientation.
In connection with yet another general aspect of one form of the present invention, there is provided a bowel retractor device that includes a central portion that has a first plurality of flexible first arms protruding therefrom in a first direction. The plurality of first flexible arms defines a first opening between each adjacent flexible arm. A second plurality of flexible second arms protrude from the central portion in a second direction wherein each flexible second arm protrudes from the central portion at positions opposite from the first openings and wherein the flexible second arms are spaced from each other to form a second opening therebetween.
In accordance with still another general aspect of one form of the present invention, there is provided a bowel retractor device that includes a selectively inflatable ring that has a textured annular surface that defines an interior area. A supply conduit is coupled to the selectively inflatable ring and a source of pressurized medium.
In accordance with other general aspects of various forms of the present invention, there is provided a method for performing laparoscopic bowel surgery on a target portion of a patient's bowel. In one form of the present invention, the method includes inserting at least one bowel retractor device through an opening in the patient. Each of the bowel retractor devices comprises a body that is configurable from a first collapsed position wherein the body is insertable through the opening to a second expanded position. The method further includes engaging a corresponding non-target portion of the bowel with a central portion of each of the at least one bowel retractor devices when in the second expanded position and positioning the at least one bowel retractor device to locate the corresponding non-target bowel portion engaged thereby in non-obtrusive positions to thereby provide physical and visual access to the target portion of the bowel.
BRIEF DESCRIPTION OF THE FIGURES
The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention, and, together with the general description of the invention given above, and the detailed description of the embodiments given below, serve to explain the principles of the present invention.
FIG. 1 is a view of a portion of a patient's abdomen and bowel segment with two trocars installed through the abdominal wall and one of the bowel retraction device embodiments of the present invention with non-target portions of the patient's bowel installed therein;
FIG. 2 is a perspective view showing a conventional trocar installed through the abdominal wall of a patient and being used to pass a bowel retractor embodiment of the present invention into a surgical area within the abdomen;
FIG. 3 is a view of a bowel retractor embodiment of the present invention inserted in a twisted orientation into a cannula of a trocar;
FIG. 4 is a top view of a bowel retractor device embodiment of the present invention;
FIG. 5 is a top view of another bowel retractor device embodiment of one form of the present invention;
FIG. 6 is a perspective view of another bowel retractor device embodiment with non-target portions of a patient's bowel supported therein;
FIG. 7 is another perspective view of a bowel retractor device located inside a patient's abdomen and wherein the surgeon is using a grasping device to pull non-target portions of the patient's bowel through an opening in the bowel retractor device;
FIG. 8 is a top view of another bowel retractor device embodiment of the present invention;
FIG. 9 is a perspective view of the bowel retractor device of FIG. 8 supporting non-target portions of a patient's bowel therein;
FIG. 10 is a front perspective view of another bowel retractor device embodiment of the present invention;
FIG. 11 is a perspective view of the bowel retractor device of FIG. 10 supporting non-target portions of a patient's bowel therein and wherein the tether portion thereof has be inserted through the cannula of a trocar;
FIG. 12 is a top view of another bowel retractor device embodiment of the present invention;
FIG. 13 is a perspective view of the bowel retractor device of FIG. 12 supporting non-target portions of a patient's bowel therein and wherein the tether portion thereof has be inserted through the cannula of a trocar;
FIG. 14 is a perspective view of another bowel retractor device embodiment of the present invention;
FIG. 15 is a perspective view of the bowel retractor device of FIG. 14 supporting non-target portions of a patient's bowel therein and wherein retractor manipulation needles have been inserted through the abdominal wall to engage portions of the bowel retractor device;
FIG. 16 is a perspective view of another bowel retractor device embodiment of the present invention;
FIG. 17 is another perspective view of the bowel retractor device embodiment of FIG. 16 with a non-target portion of a patient's bowel being supported thereby;
FIG. 18 is a cross-sectional view of the bowel retractor device embodiment of FIG. 16;
FIG. 19 is a partial perspective view of another bowel retractor device embodiment of the present invention;
FIG. 20 is a side view of another bowel retractor device embodiment of the present invention;
FIG. 21 is a perspective view of the bowel retractor device embodiment of FIG. 20 with portions of a patient's bowel supported therein;
FIG. 22 is a top view of another bowel retractor device embodiment of the present invention;
FIG. 23 is a perspective view of the bowel retractor device embodiment of FIG. 22 inside a portion of a patient's abdomen and supporting a non-target bowel portion therein;
FIG. 24 is a perspective view of another bowel retractor device embodiment of the present invention;
FIG. 25 is a perspective view of another bowel retractor device embodiment of the present invention;
FIG. 26 is a perspective view of another bowel retractor device embodiment of the present invention;
FIG. 27 is a perspective view of a trocar device inserted through the abdominal wall of a patient with a bowel retractor device embodiment being passed through the trocar cannula;
FIG. 28 is a perspective view of a portion of a patient's colon with four bowel retractor device embodiments of the present invention supporting non-target bowel portions;
FIG. 29 is a partial perspective view of another bowel retractor device embodiment of the present invention being supported in an expanded position by an installation tool embodiment of the present invention;
FIG. 30 is another perspective view of the bowel retractor device embodiment of FIG. 29 supporting a bowel portion therein with the installation tool removed therefrom;
FIG. 31 is a perspective view of a portion of a patient's colon with four other bowel retractor device embodiments of the present invention supporting non-target bowel portions;
FIG. 32 is a perspective view of another bowel retractor device embodiment of the present invention in an open position and supported by a grasping instrument;
FIG. 33 is another perspective view of the bowel retractor device embodiment of FIG. 32 and supporting a bowel portion therein;
FIG. 34 is a partial perspective view of a trocar device inserted through a portion of a patient's abdominal wall with the bowel retractor device of FIGS. 32 and 33 being inserted through the trocar cannula;
FIG. 35 is a top view of the bowel retractor device embodiment of FIGS. 32-34 in a collapsed or rolled-up position wherein the retractor device may be inserted through a trocar cannula or other opening in a patient's body;
FIG. 36 is a perspective view of three bowel retractor device embodiments of FIGS. 32-35 inside a portion of a patient's abdomen;
FIG. 37 is a perspective view of a patient's abdomen and bowel retractor device embodiments of the present invention supporting portions of the patient's bowel therein;
FIG. 38 is a perspective view of a patient's abdomen and bowel retractor device embodiments of the present invention supporting portions of the patient's bowel therein;
FIG. 39 is a top view of one of the bowel retractor devices depicted in FIG. 38 in a closed position;
FIG. 40 is another top view of the bowel retractor device of FIGS. 38 and 39 in an open position;
FIG. 41 is a partial perspective view of another bowel retractor device embodiment of the present invention supporting a portion of a patient's bowel therein;
FIG. 42 is a partial perspective view of another bowel retractor device embodiment of the present invention supporting a portion of a patient's bowel therein;
FIG. 43 is a perspective view of a portion of another bowel retractor device embodiment of the present invention in an uninflated state;
FIG. 44 is another perspective view of the portion of bowel retractor device embodiment of FIG. 43 in an inflated state;
FIG. 45 is a partial perspective view of a portion of a patient's abdomen supporting the bowel retractor device embodiment of FIG. 43 therein in an uninflated state; and
FIG. 46 is another partial perspective view of a portion of a patient's abdomen containing the bowel retractor device embodiment of FIG. 44 therein and supporting a portion of the patient's bowel therein.
DETAILED DESCRIPTION
The assignee of the present application also owns the following applications which were contemporaneously filed herewith and which are each herein incorporated by reference in their respective entireties:
U.S. patent application Ser. No. ______, filed ______, entitled “Multiple Part Anvil Assemblies For Circular Surgical Stapling Devices”, Attorney Docket No. END6926USNP2/110014;
U.S. patent application Ser. No. ______, filed ______, entitled “Modular Surgical Tool Systems”, Attorney Docket No. END6921USNP/110019;
U.S. patent application Ser. No. ______, filed ______, entitled “Specimen Retraction Devices and Methods”, Attorney Docket No. END6930USNP/110012;
U.S. patent application Ser. No. ______, filed ______, entitled “Modular Occlusion and Tissue Acquisition Mechanisms For Circular Stapling Devices”, Attorney Docket No. END6932USNP/110010;
U.S. patent application Ser. No. ______, filed ______, entitled “Tissue Manipulation Devices”, Attorney Docket No. END6924USNP/110018;
U.S. patent application Ser. No. ______, filed ______, entitled “Collapsible Anvil Plate Assemblies For Circular Surgical Stapling Devices”, Attorney Docket No. END6926USNP/110016;
U.S. patent application Ser. No. ______, filed ______, entitled “Circular Stapling Devices With Tissue-Puncturing Anvil Features”, Attorney Docket No. END6926USNP3/110013;
U.S. patent application Ser. No. ______, filed ______, entitled “Anvil Assemblies With Collapsible Frames For Circular Staplers”, Attorney Docket No. END6926USNP1/110015;
U.S. patent application Ser. No. ______, filed ______, entitled “Rectal Manipulation Devices”, Attorney Docket No. END6931USNP/110011; and
U.S. patent application Ser. No. ______, filed ______, entitled “Surgical Access Devices With Anvil Introduction and Specimen Retrieval Structures”, Attorney Docket No. END6925USNP/110017.
Certain exemplary embodiments will now be described to provide an overall understanding of the principles of the structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those of ordinary skill in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments and that the scope of the various embodiments of the present invention is defined solely by the claims. The features illustrated or described in connection with one exemplary embodiment may be combined with the features of other embodiments. Such modifications and variations are intended to be included within the scope of the present invention.
Reference throughout the specification to “various embodiments,” “some embodiments,” “one embodiment,” or “an embodiment”, or the like, means that a particular feature, structure, or characteristic described in connection with the embodiment is included . in at least one embodiment. Thus, appearances of the phrases “in various embodiments,” “in some embodiments,” “in one embodiment”, or “in an embodiment”, or the like, in places throughout the specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments.
The terms “proximal” and “distal” are used herein with reference to a clinician manipulating the handle portion of the surgical instrument. The term “proximal” referring to the portion closest to the clinician and the term “distal” referring to the portion located away from the clinician. It will be further appreciated that, for convenience and clarity, spatial terms such as “vertical”, “horizontal”, “up”, and “down” may be used herein with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.
FIG. 1 illustrates a portion of a patient's abdominal wall 2 and portions of the patient's bowel or colon 4. More specifically, a bowel retractor device 20 embodiment of the present invention is employed to support/retract non-target bowel portions 8 from target bowel portions 6. As used herein, the term “target bowel portion(s)” refers to that portion or portions of the bowel on which the surgical procedure is to be performed. The term “non-target bowel portions” refers to those portions of the bowel that are not the subject of the surgical procedure and which often obscure physical and/or visual access to the target portions. In the depicted Figure, two conventional trocar devices 10 have been inserted through the abdominal wall 2. Such trocar devices 10 include a cannula 12 that is configured to form of a passage through the abdominal wall 2 through which surgical instruments 14 may be inserted. A variety of styles and sizes of trocars are known. In general, the trocars are sized based on the inner diameter of their respective cannula.
In various non-limiting embodiments, the bowel retractor device 20 comprises an elastic body portion 22 that is configurable from a first collapsed orientation that permits the elastic body portion 22 to be inserted through a trocar cannula 12 to a second expanded position wherein a non-target portion or portions 8 of a patient's bowel 4 are supported by a central portion 24 of the bowel retractor device 20. In various embodiments, the central portion 24 may comprise a substantially flexible film such as for example silicone or neoprene film having a thickness ranging from, for example, 0.020 inches to 0.120 inches that has a collar or flexible outer ring 26 formed therearound. The flexible outer ring 26 may comprise for example in at least one embodiment, an embedded stainless steel wire or titanium wire. In at least one embodiment, when the retractor device 20 is in the first or collapsed position, it is in a twisted configuration such as those shown in FIGS. 2 and 3. When the retractor device 20 is in the second or expanded position, the retractor device 20 may assume the positions shown in FIGS. 1, 4, and 5. The flexible central portion 24 has a first amount of elasticity and the flexible outer ring 26 has a second amount of elasticity. In some embodiments, the second amount of elasticity is less than the first amount of elasticity. That is the outer ring 26 may be more rigid that the flexible central portion 24.
As can be seen in FIGS. 4 and 5, the central portion 24 of the bowel retractor device 20 has at least one opening 28 therein. The size, shape, number, and orientation(s) of such opening(s) may vary. For example, in FIG. 4, the opening 28 comprises an elongated slot and the opening 28 in FIG. 5 has a multiple-pointed star shape.
The retractor devices 20 may be used as follows in connection with one exemplary method of the present invention. To commence the surgical process, at least two trocars 10 are installed through the patient's abdominal wall 2 in a known manner. One of the trocars 10 may be initially used to pass the retractor device or devices 20 therethrough. The other trocar 10 may be used to enable the surgeon to pass a conventional surgical instrument such as a grasper 14 to grab the retractor device 20 and position it over the non-target bowel portions 8. Once the retractor device 20 has exited the trocar cannula 12, the surgeon may also use that trocar 10 to pass a second grasper 14 therethrough to assist in drawing the non-target portions 8 of bowel through the opening(s) 28 in the retractor device 20. Such arrangement enables the non-target bowel portions 8 to be retained away from the target bowel portions 6. By introducing three or four of the retractor devices 20, for example, multiple quadrants of non-target bowel portions 8 could be tucked away and easily movable to clear the surgical site. The coupled group could be pulled en masse to one side or the other of the target bowel portion(s) 6 making it very easy to negotiate the multiple bowel quadrants to perform the surgical procedure on the target bowel portions 6. In various embodiments, the surgeon may pull one section 8 of bowel 4 multiple times through the opening 26 to bunch up and constrain that non-target portion 8 of the bowel 4.
In some embodiments, the outer ring or collar 26 may be bendable as opposed to being purely elastic. For example, in some embodiments, the collar 26 may comprise a bendable metal wire or cable that is encapsulated in a flexible material such as silicone, neoprene, etc. In such arrangement, the surgeon may bend or twist the collar or outer ring 26 into a desired configuration and the metal wire will retain it in that configuration. Once the retractor device 20 has been fully inserted into the patient, the surgeon may bend the retractor device 20 into whatever restraining form that would be most useful to keep the clump of non-target bowel 8 out of the working space. For example, the retractor device 20 may be folded or bent and then lodged up behind the trocar cannula 12 or held back with a grasping instrument 14, whichever is more convenient. The flexible fit holds the non-target bowel portion 8 together without strangulating it or interfering with the peristalsis which might cause swelling. The fit between the non-target portion(s) 8 pulled through the opening(s) is such that the non-target bowel portion(s) would not slip back out of the opening 28.
FIGS. 6 and 7 illustrate bowel retractor devices 20 with alternative opening arrangements. In particular, the openings 28 comprises a plurality of slots and perforations 29. The perforations 29 are aligned off of each end of the slots 28 as shown and enable the flexible center portion 24 to rupture to enable the slots 28 to enlarge or expand as needed as the bowel portions 8 are pulled therethrough. In FIGS. 7 and 8, those slots that have expanded are designated as slots “28E”.
FIG. 8 illustrates another retractor device 30 embodiment of the present invention that includes a body portion 32 that is configurable from a first collapsed orientation that permits the body portion 32 to be inserted through a trocar cannula or other opening in a patient's body to a second expanded position wherein a non-target portion or portions 8 of a patient's bowel 4 are supported by a central portion 34 of the bowel retractor device 30. In various embodiments, the central portion 34 may comprise a substantially flexible film such as, for example, a silicone or neoprene film having a thickness ranging from, for example, 0.020 inches to 0.120 inches that has a collar or flexible outer ring 36 formed therearound. As can be seen in FIG. 8, the outer collar 36 is formed with a plurality of spaced radially outwardly extending tabs 38. Each tab 38 has a hole 40 therethrough that is configured to receive a cinchable member 42 such as, for example, a vectran, nylon, polyglycolic acid (PGA), catgut, or polypropylene cable to be woven therethrough as shown. The end portions 43, 44 of the cinchable member 42 pass through a grommet portion 39 of the collar 36. By applying tension “T” to the end portions 43, 44 will cause the bowel retractor 30 to be cinched around the non-target bowel portions 8 pulled through an opening 35 in the central portion 34. The cinchable member 42 may also be used to manipulate the retractor 30 and retrain it in a desired position.
In FIG. 9, the bowel retractor device 50 is substantially similar to the bowel retractor device 30, except that the bowel retractor device 50 lacks the cinchable member. Instead a flexible tether 52 extends from the device 50. The tether has a manipulation ring 54 attached thereto as shown. The outwardly extending tabs 38 form portions of the device 50 that may be easily grasped with a grasping instrument to facilitate the installation, manipulation and positioning of the bowel retractor device 50.
FIGS. 10 and 11 illustrate another bowel retractor device embodiment 60 of the present invention. The bowel retractor 60 includes an elastic body portion 62 that comprises a flexible plate member 63 that has a plurality of openings 64, 66, 68 therethrough. In various embodiments, the flexible plate member 63 may comprise, for example, a silicone or neoprene film having thicknesses that range from 0.020 inches to 0.150 inches. In the illustrated embodiment, three different sizes of openings are shown. In other embodiments, all of the openings may have the same size and/or have different shapes. The scope of this embodiment of the present invention is intended to cover embodiments with a variety of differently-shaped openings and different arrangements of openings—having the same size and having different sizes. As can be further seen in FIGS. 10 and 11, a tether 70 is attached to other otherwise formed with the body portion 62 such that it protrudes therefrom. In addition, a retention tab or portion 72 is also formed on or attached to the body portion 62. In the illustrated embodiment, the body portion 62 is substantially square-shaped and the tether 70 and retention tab 72 are formed on opposite corners of the plate member 63.
The bowel retractor device 60 may be used as follows. After the device 60 has been inserted through the trocar 10 or otherwise located at the surgical site, the surgeon may use graspers or other surgical instruments to draw the non-target portions 8 of the patient's bowel 4 through one or more of the openings 64, 66, 68 in the body portion 62 in the manner described above. Once the non-target bowel portion(s) 8 have been drawn through one or more of the openings 64, 66, 68 the surgeon may loop the tether 70 through an opening 74 in the retention tab 72 and extend the tether 70 back through the trocar cannula 12 to enable the surgeon to retain, manipulate and/or position the retractor device 60 and retained non-target bowel portion(s) 8 from outside of the patient.
FIGS. 12 and 13 illustrate another bowel retractor device embodiment 80 of the present invention. As can be seen in FIG. 12, in at least one embodiment, the device 80 comprises a plurality of (four are shown) of flexible plate members 82 that are interconnected by flexible straps 84. Each plate member 82 has at least one (two are shown) openings 83 therein. The openings 83 shown have a multiple pointed star shape. The number, shape and orientation of openings 83 may vary. One or more plate members 82 may have different numbers of differently shaped openings in arrangements that differ from the openings and arrangements in one or more other plate members 82. In still other embodiments, at least one plate member 82 has at least one opening 83 therethrough. As can also be seen in FIG. 12, a tether 86 is attached to, or is other otherwise formed with, one of the plate members 82 such that it protrudes therefrom In addition, a retention strap 88 is attached to, or is otherwise formed with, another plate member 82. In the illustrated embodiment, the four plate members 82 are shown and the tether 86 and retention strap 72 are formed on the corners of opposite plate members 82.
The bowel retractor device 80 may be used as follows. After the device 80 has been inserted through the trocar 10 or otherwise located at the surgical site, the surgeon may use graspers or other surgical instruments to draw the non-target portions 8 of the patient's bowel 4 through one or more of the openings 83 in the plate members 82 in the manner described above. Once the non-target bowel portion(s) 8 have been drawn through one or more of the openings 83, the surgeon may loop the tether 86 through an opening 90 in the retention strap 88 and extend the tether 86 back through the trocar 10 to enable the surgeon to retain, manipulate and/or position the device and retained non-target bowel portion(s) 8 from outside of the patient.
FIGS. 14 and 15 illustrate another bowel retractor embodiment 100 of the present invention. The bowel retractor 100 includes a body portion 102 that comprises a flexible mesh portion that has a plurality of openings 104 therethrough. In various embodiments, the body portion may be fabricated from, for example, silicone, neoprene, etc. In the illustrated embodiment, openings 104 may be are arranged in a grid-like fashion. In other embodiments, the openings may have different sizes. The scope of this embodiment of the present invention is intended to cover embodiments with a variety of differently-shaped openings and different arrangements of openings—having the same size and having different sizes. As can be further seen in FIGS. 14 and 15, at least one manipulation formation 106 is formed on the body portion 102. In the illustrated embodiment, the device 100 is substantially square-shaped and a manipulation formation 106 is formed on each corner thereof. Each manipulation formation 106 has a hole 108 therethrough to enable a manipulation tool to engage and manipulate the device 100. The manipulation tool may comprise a grasper or other surgical instrument. In the illustrated embodiment, two needle-like hook members 110 are inserted through the patient's abdominal wall and serve to hook the openings 108 in the manipulation formations 106.
The bowel retractor device 100 may be used as follows. After the device 100 has been inserted through the trocar 10 or otherwise located at the surgical site, the surgeon may use graspers or other surgical instruments to draw the non-target portions 8 of the patient's bowel 4 through one or more of the openings 104 in the body portion 102 in the manner described above. Once the bowel portions 8 have been drawn through one or more of the openings 104, the surgeon may insert one or more of the needle-like hook members 110 through the abdominal wall 2 to hookingly engage one or more of the manipulation formations 106 to position and or retain the device 100 in a desired orientation.
FIG. 16 illustrates another bowel retractor device embodiment 120 of the present invention. The bowel retractor device 120 includes a body portion 122 that comprises a flexible annular ring 124 that has a flexible central portion 126 attached thereto. In at least one embodiment, the flexible central portion 126 comprises a plurality of interwoven flexible ribbon-like members 128. In various embodiments, the flexible annular ring may be fabricated from, for example, Polypropylene, Santoprene, etc. The interwoven ribbon members 128 will have weave tightness that permits non-target portion(s) 8 of the patient's bowel to be pulled therethrough without damaging the bowel, yet retain the non-target bowel portion(s) in position. To assist the surgeon with the manipulation and support of the device 120, a manipulation formation 129 may be formed on the annular ring 124 as shown.
The bowel retractor device 120 may be used as follows. After the device 120 has been inserted through the trocar 10 or otherwise located at the surgical site, the surgeon may use graspers or other surgical instruments to draw the non-target portions 8 of the patient's bowel 4 between the ribbons 128 in the manner described above. Once the bowel portions 8 have been drawn between the ribbons 128, the surgeon may use a grasper or other surgical instrument to engage the manipulation formation 129 to position and or retain the device 120 in a desired orientation.
FIG. 17 illustrates another bowel retractor device embodiment 130 of the present invention. The bowel retractor device 130 includes a body portion 132 that comprises a flexible annular ring 134 that has a flexible central portion 136 attached thereto. In at least one embodiment, the flexible central portion 136 comprises a plurality of interwoven flexible strips 138. In various embodiments, the flexible annular ring 134 may be fabricated from, for example, Santoprene, polypropylene, etc. In at least one embodiment, the interwoven flexible strips 138 have a substantially circular cross-sectional shape. The interwoven strips 138 define a plurality of openings 139 and will have weave tightness that permits non-target portion(s) 8 of the patient's bowel 4 to be pulled through one or more of the openings 139 without damaging the bowel, yet retain the bowel in position. To assist the surgeon with the manipulation and support of the device 120, a manipulation formation (not shown) may be formed on the annular ring 134 as shown.
The bowel retractor device 130 may be used as follows. After the device 130 has been inserted through the trocar 10 or otherwise located at the surgical site, the surgeon may use graspers or other surgical instruments to draw the non-target portions 8 of the patient's bowel 4 through one or more of the openings 139 in the manner described above. Once the non-target bowel portion(s) 8 have been drawn between the flexible strips 138, the surgeon may use a grasper or other surgical instrument to engage the manipulation formation to position and or retain the device 130 in a desired orientation.
FIG. 18 illustrates another bowel retractor device embodiment 140 of the present invention which is substantially similar to the bowel retractor device 130 described above except that the central portion 136′ comprises a plurality of layers 142 of interwoven flexible strips 138. The bowel portions 8 may be drawn through the openings 139 in one or more of the layers 142. FIG. 19 illustrates another bowel retractor device embodiment 150 of the present invention which is substantially similar to the bowel retractor device 140 described above, except that one of the layers 142 comprises a plurality of interwoven ribbons 128 and another layer 142 comprises a plurality of interwoven flexible strips 138.
FIG. 20 illustrates another bowel retractor device embodiment 150 of the present invention. The bowel retractor device 150 includes a body portion 152 that comprises a flexible endless collar member 154 that defines an inner area 156. In various embodiments, the flexible endless collar member 154 is elongated and is sized to be passed down through a trocar cannula 12 or other opening through the abdominal wall 2. The flexible endless collar member 154 may be fabricated from, for example, Santoprene, polypropylene, etc. The device 150 further includes a plurality of flexible fingers 156, 160 that protrude inwardly from the endless collar member 154. In at least one embodiment, the flexible fingers 158 extend between fingers 160 and have a cross-sectional size that differs from a cross-sectional size of fingers 160. Also in various embodiments, each of the fingers 158 have a ball-shaped member 159 formed on the end thereof and each of the fingers 160 have a ball-shaped member 162 formed on the end thereof. In at least one embodiment, each of the ball-shaped members 159 have a diameter that differs from the diameter of the ball-shaped members 162.
The bowel retractor device 150 may be used as follows. After the device 150 has been inserted through the trocar 10 or otherwise located at the surgical site, the surgeon may use graspers or other surgical instruments to draw the non-target portions 8 of the patient's bowel 4 through the central area 156. Once the non-target bowel portions 8 have been drawn between the flexible fingers 158, 160, the surgeon may use a grasper or other surgical instrument to engage the manipulation formation 166 formed on the endless collar member 154 to position and or retain the device 150 in a desired orientation.
FIG. 22 illustrates another bowel retractor device embodiment 170 of the present invention. The bowel retractor device 170 includes a body portion 172 that comprises a flexible endless collar member 174 that defines an inner area 176. In various embodiments, the flexible endless collar member 174 is elongated and is sized to be passed down through a trocar cannula 12 or other opening through the abdominal wall 2. The flexible end less collar member 174 may be fabricated from, for example, Santoprene, polypropylene, etc. The device 170 further includes a plurality of flexible fingers 177, 178 that protrude inwardly from the endless collar member 174. In at least one embodiment, the flexible fingers 178 extend between fingers 177. The flexible fingers 178 have a length that is shorter than the length of fingers 177. Also in various embodiments, each of the fingers 177, 178 have a ball-shaped member 179 formed on the end thereof. In at least one embodiment, the fingers 177, 178 lie along a common plane. Also in one embodiment, a manipulation formation 175 is formed on the endless collar member 174 to enable the device 170 to be easily manipulated with a surgical instrument such as a grasping instrument.
The bowel retractor device 170 may be used as follows. After the device 170 has been inserted through the trocar 10 or otherwise located at the surgical site, the surgeon may use graspers or other surgical instruments to draw the non-target portions 8 of the patient's bowel 4 through the central area 176. Once the non-target bowel portions 8 have been drawn between the flexible fingers 177, 178, the surgeon may use a grasper or other surgical instrument to engage the manipulation formation 175 formed on the endless collar member 174 to position and or retain the device 170 in a desired orientation.
FIG. 24 illustrates a bowel retractor device 170′ that is substantially identical in construction and use as bowel retractor device 170 except that device 170′ only has fingers 177 that all have a common length. FIG. 25 illustrates a bowel retractor device 180 that is substantially identical in construction and use as bowel retractor device 170′, except that fingers 177 protrude out of the inner area 176. In particular, the endless collar 174 defines a reference plane “RP” and each of the fingers 177 extend transversely to reference plane RP. The bowel retractor device embodiment 180 depicted in FIG. 25 is substantially identical to bowel retractor device 170′, except that fingers 177 all taper away from the endless collar 174 in a general frusto-conical configuration. That is, each of the fingers 177 extend along an axes that will ultimately intersect at a common point. The bowel retractor device 180′ in FIG. 26 is substantially identical in construction and use as bowel retractor device 180 except that the fingers 177 extend out of the open area such that they are substantially perpendicular to the reference plane RP and are substantially parallel to each other. The bowel retractor device 180″ in FIG. 27 is substantially identical to the bowel retractor device 180′ except that the fingers 177 have different lengths. The bowel retractor devices 170′, 180, 180′, 180″ may all be used in the various manners described above.
FIG. 28 illustrates the use of four bowel retractor devices 190 for supporting the non-target bowel portions 8 in each of four quadrants involved in the surgical procedure. In at least one embodiment, each bowel retractor device 190 comprises a flexible pouch 192 that has an opening 194 therein. In one embodiment, the opening is surrounded by a collar member 196 in the form of an elastic band. The pouches 192 may be rolled up into a first collapsed position to enable them to be inserted through a trocar cannula 12. Once the pouches 192 have been inserted into the surgical area, the surgeon may open each pouch 192 and install it over a portion of non-target bowel 8. Once the pouches have been installed over the various non-target bowel portion(s) 8, they may be separated into quadrants which provide the surgeon with physical and visual access to the target bowel portion. Those of ordinary skill of the art will understand that various numbers of pouches 192 may be employed as needed.
FIGS. 29 and 30 illustrate another bowel retractor device 190′ that is substantially identical to bowel retractor device 190, except that the collar member comprises an elastic band 196′ that may be expanded from a non-expanded or collapsed state to an expanded state by inserting a selectively expandable and contractible installation head 193 of an installation tool 191 into the opening 194. When the installation head 193 is expanded, the elastic collar or band 196′ is retained in the expanded state to permit the non-target bowel portions 8 to be inserted into the pouch 192 through the opening 194. Once the non-target bowel portion 8 has been inserted into the pouch, the installation head 193 is moved to the contracted position and removed from the elastic collar 196′ which lightly contracts around the non-target bowel portions 8 protruding through the opening 194 to retain the non-target bowel portion 8 within the pouch 192 without damaging the non-target bowel portion 8 protruding therefrom.
The bowel retractor device 190″ in FIG. 31 is substantially identical in construction and use as bowel retractor device 190 except that the collar 196″ is a cinchable member. For example, the collar 196″ may comprise an expandable belt-type member that may be expanded to form a desired opening and then locked in position by a lock screw 197. Thus, the surgeon may release the lock screw 197 to enable the opening to be expanded for installation over a portion of the non-target bowel portion 8 and thereafter cinched in and locked with locking screw 197 to retain the pouch 192 on the non-target bowel portion 8 captured therein.
FIGS. 32-36 illustrate another form of bowel retractor device 200 embodiment of the present invention. In various forms, the bowel retractor device 200 comprises a body portion 202 in the form of a pouch 204. In various embodiments, the pouch 204 may have a cinchable opening 206 therein. In at least one embodiment, a closure member 208 is attached to the pouch 204 such that it extends around the opening 206. The closure member 208 may be configured with two diametrically opposed hinge portions 210 that facilitates movement of the closure member 208 from a collapsed or closed position (FIG. 33) to an open position (FIG. 32). As illustrated in FIG. 32, the closure member 208 may be moved to the open position by applying opposing forces “F1” on the hinge portions 210 as well as applying opening forces “F2” in opposite directions to the closure member 208. The bowel retractor device 200 may be inserted into the patient through a trocar 10 as shown in FIG. 34. To facilitate insertion of the retractor device 200 through the trocar cannula 12, the device 200 may be rolled up as shown in FIGS. 34-36. FIG. 37 illustrates another bowel retractor device 200′ that is substantially identical in construction and use as bowel retractor device 200 except that the closure member 208′ is substantially spring-loaded. Such spring loading may be created by the configuration of the closure member itself or be assisted with one or more spring members (not shown) embedded therein. FIGS. 38-40 illustrate another bowel retractor embodiment 200″ that is essentially the same as the bowel retractor 200, except that the closure member 208″ has four hinge portions 210″.
The closure members 208, 208′, 208″ of the bowel retractor devices 200, 200′, 210″, respectively are designed in their normal state to be biased to a closed position or state. When in the closed state, however, the closure members 208, 208′, 208″ may be designed to limit the closure force exerted onto the portion of the bowel received therein to minimize the risk of occlusion of blood flow to the captured bowel portion as well as to allow peristalsis to continue. Such closure bias is designed to immediately immobilize the non-target portions 8 of the bowel placed in the pouch so that it does not slip back out. The hinge portions 210, 210′, 210″ enable the closure members 208, 208′, 210″ to be forced open for the entire loading period, or more preferably, the closure member could be opened only as bowel segments are pulled in. The closure portions then maintain the opening in a closed position while the surgeon moves to grasp the next section of bowel to be introduced into the pouch. Thus, use of the biased closed temporary bowel retractor devices 200, 200′, 200″ improve the ease of introducing bowel portions therein as the closure portions thereof can automatically close itself to keep the non-target bowel portion from slipping back out of the pouch. The maximum cinching load also prevents inadvertent damage to the non-target bowel during retraction. In use, the surgeon may insert several of the devices 200, 200′, and/or 200″ through a trocar, trocars or other openings in the patient at the beginning of the surgical procedure. Lengths of the non-target bowel portions 8 would be placed into a pouch and then when the pouch became sufficiently full, the closure member thereof would be “snapped” shut. This procedure may be repeated with other bowel retractor devices 200, 200′, 200″ as needed. These loaded pouches could then be easily moved from one position to another in the abdomen cavity during the procedure. The surgeon is able to easily grasp and move en masse sections of the bowel 4 to move it out of the way. Additionally, the pouches could be temporarily clipped or pinned to different abdomen wall structures to facilitate more retraction. Also, the various pouch-type bowel retractor devices disclosed above may include a grasper access hole through the bottom of the pouch to enable a grasper instrument to be inserted therethrough and out through the pouch opening to grasp bowel portions to draw them into the pouch. Such arrangement serves to facilitate easy introduction of the bowel portions into the pouch. The hinge arrangements also serve to bias the closure members closed around the bowel portions as they are drawn into the pouch.
FIGS. 41 and 42 illustrate another bowel retractor device embodiment 220 of the present invention. Various embodiments include a substantially elastic body portion 222 that is insertable through an opening in a patient's body to a second expanded position wherein a portion of the patient's bowel may be supported thereby. In various embodiments, the body portion 222 includes a central portion 224 that has at least three flexible first arms 226 that protrude from the central portion 224 in a first direction. A first opening 228 is formed between each first arm 226. In at least one embodiment, each first opening has a shape that generally resembles a portion of an hourglass. In particular, each first opening 228 has a first neck portion 229 that is narrower than a first bottom portion 230. As can be further seen in FIGS. 41 and 42, the bowel retractor device 220 further comprises at least two flexible second arms 240 that protrude from a second side of the central portion 224 in a second direction. In one embodiment, each second arm 240 protrudes from the center portion 224 at positions opposite to the first opening 228. In other embodiments, the second arms 240 may be aligned with corresponding first arms 226. A second opening 242 is formed between each second arm 240. In at least one embodiment, each second opening 242 has a shape that generally resembles a portion of an hourglass. In particular, each second opening 242 has a second neck portion 244 that is narrower than a second bottom portion 246. In other embodiments, the first and second openings may be provided in other shapes.
Various embodiments of the bowel retractor device 220 are fabricated from a foam material or other elastic material. In other embodiments, each of the first and second arms 226, 240 have a bendable wire member or wire members (nitinal, spring steel, etc.) embedded therein to enable the arms 226, 240 to be advantageously bent in position to facilitate insertion of the retractor device 220 through a trocar or other opening. In still other embodiments, the center portion 224 may have a bendable wire portion therein. In other arrangements, bendable wires may be embedded in the center portion 224 and each of the first and second arms 226, 240. In other embodiments, at least one bendable wire is embedded in at least one of the center portion 224, a first arm 226 and/or a second arm 240. Such arrangements facilitate the bending of the device 220 in a position that facilitates its insertion through a trocar cannula. In other embodiments, however, the device 220 may be sized such that it can pass through a trocar cannula without having to be bent or collapsed.
In use, once the bowel retractor device 220 has been inserted into the patient through a trocar or other opening in the patient's body, the surgeon may grasp the retractor 220 with a grasping instrument and then pull non-target bowel portions 8 through the first and/or second openings 228, 242. The bowel portions 8 may be held in place by manipulating the formable arms 226, 240. In various embodiments, a suture drawstring 250 (FIG. 42) is provided to further support and tie down the retractors position. This step could be repeated several times creating a grouped clump of small bowel that can be moved around merely by moving the bowel retractor 220. Various embodiments of the retractor 220 can be bent into whatever restraining form would be most useful to keep the clump out of the working space. It could be lodged up behind a trocar cannula 12 or held back with a grasping instrument 14, whatever is convenient for the specific case. The flexible fit holds the small bowel together without strangulating it or interfering with the peristalsis causing swelling. The fit is tight enough to prevent the bowel from slipping right back out.
FIGS. 43-46 illustrate another bowel retractor device embodiment 260 of the present invention. In various embodiments, the retractor 260 comprises an inflatable ring 262 that defines an interior area 264. The inwardly facing surface 266 of the inflatable ring 262 is textured with, for example, dimples 269, etc. The ring 262 is supplied with a pressurized medium such as, for example, through a supply conduit 270 that is attached to a source of pressurized medium 272 located outside of the patient's body. See FIG. 45.
To use the bowel retractor device 260, the retractor 262 (in its collapsed or uninflated state) as well as the supply conduit may be inserted through a trocar 10 mounted in the abdominal wall 2 or it may be inserted into the surgical site through another opening 5 in the abdominal wall 2 as shown in FIG. 46. Once in position, the surgeon may then grasp non-target bowel portions 8 with one or more grasping instruments 14 to pull the non-target bowel portions 8 through the interior area 264. The surgeon may first inflate the ring 262 prior to pulling the non-target bowel portions 8 through the interior area 264 or the surgeon may pull the non-target bowel portions 8 through the interior area 264 prior to inflating the ring 262. Once inflated, the textured surface 266 retains the bowel portions in position. One or more retractors 260 may be used in the various methods described above to advantageously provide the surgeon with physical and visual access to the target tissue during the operation.
The various bowel retraction devices disclosed herein represent vast improvements over other retraction devices and methods commonly employed with performing operations on a patient's bowel. Many embodiments may be easily inserted into the patient through a common trocar cannula. The devices are easily manipulatable with common grasping instruments. Several of such devices may be used as necessary to advantageously locate non-target portion(s) of bowel in a desired position to provide the surgeon with physical and visual access to the target tissue. Once bunches of bowel have been gathered together, the bunches may be easily moved and positioned en masse to a desired location. The retractors may be easily clipped to portions of the abdomen to hold the retractor in position if necessary. While the various retractor devices disclosed herein have been described in detail for use in connection with bowel surgeries, it is conceivable that various embodiments of the present invention could also be employed to retract other forms of tissue/organs without departing from the spirit and scope of the present invention.
Any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated materials does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.
The invention which is intended to be protected is not to be construed as limited to the particular embodiments disclosed. The embodiments are therefore to be regarded as illustrative rather than restrictive. Variations and changes may be made by others without departing from the spirit of the present invention. Accordingly, it is expressly intended that all such equivalents, variations and changes which fall within the spirit and scope of the present invention as defined in the claims be embraced thereby.
Patent Application
20120238824
