Natural orifice surgery system

Abstract

To provide a surgical access port system that comprises a retractor that is adapted for being coupled to a cap and that is particularly useful in natural orifice surgery.SOLUTION: A retractor 6100 comprises: an outer ring 6120 which is configured to be disposed proximate the natural orifice of a patient and substantially surround the orifice; a tubular body 6130; and various stabilizing mechanisms surrounding the tubular body 6130, sized and configured to stabilize and retain the retractor 6100 within the orifice. The stabilizing embodiments described herein are useful in all natural orifices and are of particular use in the vaginal surgery.SELECTED DRAWING: Figure 6E

Description

[Technical field]

[0001] FIELD OF THE DISCLOSURE This application relates generally to surgical instruments, particularly cap access instruments useful in single port surgical procedures for natural orifices, and particularly useful in vaginal surgical procedures.

[0002] Description of Related Applications This application is a claim of U.S. Patent Application No. 62 / 038,082, filed Aug. 15, 2014, the disclosure of which is incorporated herein by reference in its entirety. [Background technology]

[0003] Access devices are commonly used in surgery to facilitate the introduction of various surgical instruments into the natural biological ducts, ducts, openings, cavities, and other interior areas of the body. These access devices include, for example, instruments that facilitate the introduction of needles into blood vessels and trocars that facilitate the introduction of laparoscopic instruments into the abdominal region of the body.

[0004] Some of these access devices are introduced into a region containing a fluid or gas under pressure. In the case of a needle access device, the pressure may be from a liquid, e.g., blood. In the case of a trocar, the pressure may be from a gas, e.g., insufflation gas. In either case, it is desirable to allow the introduction of a surgical instrument into the cavity without allowing the escape of the pressurized fluid or gas.

[0005] In the case of a trocar, a cannula at the distal end of the trocar is typically connected to a seal housing at the proximal end of the trocar. Together, the cannula and housing form a working channel through which various instruments can be inserted to access the cavity. A seal mechanism is typically provided within the housing, including a septum valve that seals the working channel when an instrument is in place and a zero-closure valve that seals the working channel when an instrument is removed. Summary of the Invention [Problem to be solved by the invention]

[0006] Current surgical access ports allow for the access of a single instrument through each port or multiple instruments through a rigid cannula. Some instruments, such as transanal endoscopic microsurgery (TEMS) units, require that the instruments be attached to the operating table to support the weight of the instruments and to locate the position of the instruments relative to the patient. These instruments do not provide the surgeon with flexibility in selecting the size of the instruments, and they limit the movement of the instruments with their rigid cannulas. Additionally, surgeons are performing laparoscopic surgical procedures through a single or limited number of access ports. These surgical procedures may be performed through a single 2-centimeter incision at the umbilicus, or in certain cases, transvaginally or transanally. There is a need for a system that meets the needs of these new procedures or techniques and facilitates flexible movement of laparoscopic instruments through a single or limited number of ports, while preventing the escape of pressurized fluids or gases and allowing the removal of large specimens. There is a particular need for an access system that can be deployed within a natural body cavity, such as the vagina, that provides a sealed system for insufflation and a platform that allows for the introduction of multiple surgical instruments of various sizes, while maintaining sufficient stability to anchor the access system within the cavity without damaging the cavity wall. [Means for solving the problem]

[0007] The present invention relates to a surgical access port system for performing a surgical procedure at a natural orifice, the surgical access port system including an outer ring configured to be positioned near the natural orifice of a patient, a tubular body having a longitudinal axis, a proximal end and a distal end, a funnel segment extending between and joining the outer ring and the proximal end of the tubular body, the funnel segment providing a reduction between the outer ring and the tubular body, the surgical access port system further including a flange disposed about the tubular body, the flange having a circular ridge surrounding a channel, the flange adapted to secure a retractor within the body orifice, the flange being disposed about the distal or proximal end of the tubular body.

[0008] Optionally, the surgical access port system further includes a removable gel cap having a gel pad and a cap ring coupled to the gel pad, the cap ring being engageable with the outer ring.

[0009] In another embodiment, a surgical access port system includes an outer ring configured to be positioned near a patient's natural orifice, a tubular body having a longitudinal axis, a proximal end and a distal end, and a funnel segment extending between and connecting the outer ring and the proximal end of the tubular body, the funnel segment providing a reduction between the outer ring and the tubular body, the surgical access port system further including a frusto-conical bolster disposed about the tubular body, the bolster having a first diameter at the distal end and a second diameter at the proximal end, the second diameter being greater than the first diameter, the bolster adapted to externally occlude the natural orifice.

[0010] In some embodiments, the bolster is comprised of at least one of a thermosetting polymer and a thermoplastic elastomer. In some embodiments, the bolster is secured about the proximal end of the tubular body. Optionally, the surgical access port system further includes a flange disposed about the tubular body distal to the bolster and / or an inflatable balloon disposed about the tubular body distal to the bolster. In some embodiments, the bolster slidably engages the tubular body.

[0011] In another embodiment, a surgical access port system includes an outer ring configured to be positioned near a patient's natural orifice, a tubular body having a longitudinal axis, a proximal end and a distal end, and a funnel segment extending between and joining the outer ring and the proximal end of the tubular body, the funnel segment providing a reduction between the outer ring and the tubular body, the surgical access port system further includes a mechanical balloon disposed about the tubular body, the mechanical balloon having a series of arms disposed along the longitudinal axis of the tubular body, each arm having a proximal end attached to a first ring and a distal end attached to a second ring, the second ring being secured to the tubular body, and the surgical access port system further includes a third ring disposed about the tubular body proximal to the first ring, the third ring adapted to move along the tubular body to engage the first ring and urge it toward the distal end of the tubular body, thereby applying a load to the arms, which flare out from the tubular body. Mechanical balloons can also be used in combination with compression flanges or bolster cones.

[0012] Optionally, the arms are made of a semi-rigid material. In some embodiments, each of the arms further comprises an articulating joint along the length of the arm.

[0013] In another embodiment, a surgical access port system includes an outer ring configured to be positioned near a patient's natural orifice, a tubular body having a longitudinal axis, a proximal end and a distal end, and a funnel segment extending between and joining the outer ring and the proximal end of the tubular body, the funnel segment providing a reduction between the outer ring and the tubular body, and the surgical access port system further includes an inflatable saddle balloon disposed about the tubular body, the saddle balloon having a first crest and a second crest, the second crest being offset from the first crest along the longitudinal axis of the tubular body. In some embodiments, the saddle balloon upon inflation compresses tissue of the natural orifice between the first crest and the second crest, thereby occluding the natural orifice.

[0014] In another embodiment, a surgical access port system includes an outer ring configured to be positioned near a patient's natural orifice, a tubular body having a longitudinal axis, a proximal end and a distal end, and a funnel segment extending between and connecting the outer ring and the proximal end of the tubular body, the funnel segment providing a reduction between the outer ring and the tubular body, the surgical access port system further includes a retaining sleeve having a longitudinal axis, a proximal end, a distal end, and a lumen, the tubular body disposed within the lumen for movement along the longitudinal axis of the retaining sleeve, and the surgical access port system further includes at least two arms, each arm coupled to a distal end of the retaining sleeve by an articulating hinge, the arms movable from a closed position to an open position when the distal end of the tubular body engages the arms.

[0015] Optionally, each arm further includes an angled lead disposed near the articulating hinge, the lead positioned to engage a distal end of the tubular body as the tubular body is moved through the retaining sleeve. In some embodiments, the surgical access port system further includes male threads wrapped around the exterior of the tubular body and female threads wrapped around an interior surface of the lumen of the retaining sleeve, the male threads adapted to engage with the female threads. In other embodiments, the surgical access port system further includes a plurality of teeth disposed along an exterior surface of the tubular body and a plurality of detents disposed along an interior surface of the lumen of the retaining sleeve, the teeth adapted to engage the detents to facilitate unidirectional movement of the tubular body through the lumen of the retaining sleeve. [Brief description of the drawings]

[0016] [Figure 1] FIG. 1 is a side view of a patient during surgery, positioned on the abdomen, illustrating an embodiment of an access device in use. [Diagram 2] 1 is a cross-sectional view of an embodiment of an access device with a retractor or surgical wound retractor dilating the patient's vagina and a gel cap sealing the opening of the retractor. [Diagram 3] 1 is a front view showing an embodiment of an access device deployed at a patient's mouth and in use. [Figure 4] FIG. 1 is a plan view showing a patient in a prone position with an embodiment of an access device deployed at the patient's anus in use. [Figure 5A] 1 is a pictorial illustration of components of an access device system useful in natural orifice surgery. [Figure 5B] FIG. 5B is a perspective view of the retractor of FIG. 5A. [Figure 6A] FIG. 13 is a perspective view of an embodiment of a natural orifice retractor with an occlusion flange. [Figure 6B] FIG. 6B is a cut-away side view of the natural orifice retractor of FIG. 6A. [Figure 6C]FIG. 13 is a side view of an embodiment of a natural orifice retractor with compression flanges. [Figure 6D] FIG. 6D is a cut-away side view of the natural orifice retractor of FIG. 6C. [Figure 6E] FIG. 13 is a perspective view of an embodiment of a natural orifice retractor with a bolster cone. [Figure 6F] FIG. 1 is a side view of an embodiment of a natural orifice retractor with a mechanical balloon shown in an uncompressed state. [Figure 6G] FIG. 6F is a side view of the natural orifice retractor of FIG. 6F shown in a compressed or expanded state. [Figure 6H] FIG. 13 is a perspective view of an embodiment of a natural orifice retractor with a balloon. [Figure 6I] FIG. 13 is a perspective view of an embodiment of a natural orifice retractor with a saddle balloon. [Figure 6J] FIG. 13 is a perspective view of an alternative embodiment of a retractor with an inflatable member. [Figure 6K] FIG. 13 is a cutaway side view showing the check valve and channels provided within the tubular body of the retractor. [Figure 6L] FIG. 13 is a perspective view of an embodiment of a natural orifice retractor with a balloon and bolster. [Figure 6M] FIG. 1 is a perspective view of an embodiment of a natural orifice retractor adapted to allow retraction and access shown in an open configuration without insufflation. [Figure 6N] FIG. 6C is a cross-sectional view of an embodiment of the natural orifice retractor of FIG. 6M. [Figure 6O] FIG. 13 is an enlarged side view of the retaining sleeve and threads disposed about the tubular body of the retractor. [Figure 6P] FIG. 6C is a cross-sectional view of the embodiment of FIG. 6M shown in a closed configuration. [Figure 6Q] FIG. 13 is an enlarged side view of the ratchet drive mechanism that attaches the retaining sleeve to the tubular body of the retractor. [Figure 7A]FIG. 1 is a perspective view of an obturator adapted to facilitate introduction of a natural orifice retractor into a body orifice, such as the vagina. [Figure 7B] FIG. 7B is a side view of the obturator of FIG. 7A. [Figure 7C] FIG. 1 is a perspective view of an obturator having a straight shaft piece adapted to facilitate introduction of a natural orifice retractor into a body orifice, such as the vagina. [Figure 7D] FIG. 7D is a perspective view of a retractor provided on the obturator of FIG. 7C. [Figure 7E] FIG. 6C is a perspective view of an obturator modified with a recess that provides clearance for the inflation port shown in FIGS. 6I and 6J to facilitate introduction of a natural orifice retractor into a body orifice, such as the vagina. [Figure 8A] FIG. 5B is a side view of the natural orifice access device of FIG. 5A. [Figure 8B] FIG. 5B is a plan view of the natural orifice access device shown in FIG. 5A. [Figure 8C] FIG. 5B is a perspective view of the natural orifice access device shown in FIG. 5A. [Figure 9A] 1 is a perspective view of an embodiment of a natural orifice access device having a cap with multiple ports disposed therethrough. [Figure 9B] 1 is an exploded view of an embodiment of a port and optional obturator that are components of some embodiments of the access device system. FIG. [Figure 10A] FIG. 1 is a top perspective view of an embodiment of a gel cap. [Figure 10B] FIG. 13 is a bottom view of an embodiment of a cap ring. [Figure 11A] FIG. 1 is a top view of an embodiment of a gel cap having multiple access ports embedded within a gel pad. [Figure 11B] FIG. 11B is a top perspective view of the gel cap shown in FIG. [Figure 11C] FIG. 11B is a bottom perspective view of the gel cap shown in FIG. 11A. [Figure 11D] FIG. 11B is a top perspective view of the gel cap shown in FIG. 11A with instruments inserted into two of the access ports. [Figure 11E] FIG. 11E is a bottom perspective view of the gel cap and device shown in FIG. [Figure 11F] FIG. 11E is a side view of the gel cap and device shown in FIG. [Figure 11G] FIG. 13 is a top perspective view of an embodiment of a gel cap having a fixed camera or laparoscopic port. [Figure 12] 1 is a cutaway perspective view of an embodiment of an access instrument system including a gel cap that snaps onto a retractor. FIG. [Figure 13] FIG. 2 is an exploded view of an embodiment of a trocar. [Figure 14A] FIG. 1 is a side view of an embodiment of a trocar having a fixed cannula in an insertion configuration. [Figure 14B] FIG. 13 is a side view of an embodiment of a trocar having a fixed cannula in a fixed configuration. [Figure 15] FIG. 13 is a side view of another embodiment of a trocar having a fixed cannula. [Figure 16A] FIG. 13 is a side view of another embodiment of a trocar having a fixed cannula. [Figure 16B] FIG. 16B is a perspective view of an embodiment of a bolster suitable for use with the trocar shown in FIG. 16A. [Figure 17A] FIG. 13 is a side view of another embodiment of a trocar having a fixed cannula. [Figure 17B] FIG. 17B is a perspective view of an embodiment of a bolster suitable for use with the trocar shown in FIG. 17A. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0017] Throughout the figures, identical components are labeled with the same reference numbers.

[0018] Embodiments of the surgical instrument access device system are useful, for example, for single incision, single port and / or limited port laparoscopic surgical procedures or procedures, such as abdominal (FIG. 1), transvaginal (FIG. 2), oral (FIG. 3) and transanal (FIG. 4) procedures. Various surgical instrument access devices are described in U.S. Patent Application Publication No. 2009 / 0187079, filed Jan. 22, 2009, entitled SURGICAL INSTRUMENT ACCESS DEVICE, and U.S. Patent No. 7,727,146, entitled WOUND RETRACTOR WITH GEL CAP, both of which are incorporated by reference in their entireties.

[0019] FIG. 5A shows an embodiment of an access device system including a retractor 6100, an introducer 6400 shown inserted into the retractor as if it could be placed in the body opening, a cap 6200, one or more ports 6310, and an obturator 6600 as in single port and / or limited port procedures. The retractor 6100 is placed and / or positioned in, across and / or through a surgical incision and / or body opening to enlarge, reshape and / or isolate the surgical incision or body opening. The cap 6200 provides an artificial body wall through which instruments penetrate through the port 6310 to access the interior of the patient's body, e.g., a body cavity. The retractor 6100 can be introduced into the opening using the introducer 6400, and the port 6310 can be placed through the gel cap using the obturator 6600. The components of the access device are made of any suitable biologically compatible material.

[0020] With the gel cap 6200 attached to the retractor 6100, the access device system allows the user to insufflate an opening, such as the vaginal canal. The dilation of the vaginal canal caused by insufflation improves visualization of the anatomy (e.g., compared to a traditional vaginal hysterectomy) and eliminates the need for the use of rigid mechanical retractors that may cause damage to soft tissue. The gel cap is removable at any point during the surgical procedure to allow for specimen removal.

[0021] The retractor 6100 is made of a semi-flexible thermoplastic elastomer or thermosetting polymer. It will suit a range of anatomies with lengths of about 4 cm to 7 cm and diameters of about 3 cm to 5 cm for use in vaginal procedures. The retractor retracts and occludes the vagina. A suture knot 6160 at the proximal end 6152 and / or a flange 6110 along the tubular body allows the retractor to be prevented from being removed once in place. The gel cap 6200 can be attached with the aid of a lever 6135 that locks under the proximal ring 6120 of the retractor 6100. This creates a pressure resistant seal and allows insufflation through an insufflation port 6145 in the gel cap. Smoke can be evacuated through the port not used for insufflation. An instrument port 6310 can be placed in the gel cap 6200 to allow the use of various laparoscopic instruments. The gel cap can then be removed and the specimen can be removed through the retractor 6100.

[0022] 5B, the outer ring 6120 is located proximal to the funnel section 6140. In the illustrated embodiment, the outer ring 6120 has a substantially circular footprint. As described further herein, the outer ring 6120 can be sized and shaped to sealingly couple to a cap or other access device provided thereon. In some embodiments, one or more suture points 6160 can be provided on the retractor 6100 adjacent the outer ring 6120. The two suture points 6160 are generally diametrically opposed relative to the generally circular profile of the outer ring 6120. In other embodiments, the retractor can have three or more suture points or one provided at various locations relative to the outer ring 6120.

[0023] With continued reference to FIG. 5B, the tubular body 6130 has a generally circular profile that defines a generally cylindrical passageway 6150. The generally cylindrical passageway is desirably large enough to accommodate two or more laparoscopic instruments therethrough, thus allowing access to multiple surgical instruments within a body cavity using a single native orifice access device. Additionally, the generally cylindrical passageway is desirably large enough to allow multiple surgical instruments positioned therethrough to be translated or rotated relative to one another, thereby allowing the surgeon to manipulate the instruments as desired during a surgical procedure. The generally cylindrical passageway extends between a proximal end 6152 of the retractor 6100 adjacent the outer ring 6120 and a distal end 6154 of the retractor 6100 adjacent the flange 6110. In FIGS. 5A and 5B, the tubular body 6130 has a circular cross-section. In other embodiments, the tubular body 6130 has another shape, such as an oval cross-section, an octagonal cross-section, or a multi-shape, so that it can be appropriate for the natural orifice of interest. Some embodiments of the tubular body 6130 have one or more coatings that provide additional functionality, such as an antimicrobial coating.

[0024] In the illustrated embodiment, the funnel segment 6140 provides a reduction in diameter between the relatively large diameter of the outer ring 6120, which is sized to be removably coupled to an access device, e.g., a cap, and the relatively small diameter of the passageway 6150, which is sized to fit within the native orifice in its minimally expanded state. The funnel segment 6140 has an inner surface that can provide a bearing surface for an obturator or introducer used to advance the retractor 6100 into the body cavity. In some embodiments, the funnel segment can have a substantially linear taper between the relatively large and relatively small diameters such that the inner surface is a frusto-conical segment. In other embodiments, the funnel segment 5 can have a curved profile between the relatively large and relatively small diameters. In some embodiments, no funnel section is provided, such as when a tubular body is directly coupled to the outer ring.

[0025] It may be desirable for the outer ring 6120 to be relatively stiff as compared to the relatively flexible tubular body 6130 of the retractor 6100 such that the outer ring 6120 can sealingly engage an access device, e.g., a cap. Referring to FIG. 5B, a perspective view of the retractor is shown with the outer ring 6120 partially cut away. In the illustrated embodiment, the outer ring 6120 has an annular groove 6122 formed therein with a reinforcing member 6124 disposed therein. In some embodiments, the reinforcing member 6124 can comprise a metallic member, e.g., a wire, formed into the shape of a ring. For example, in some embodiments, the reinforcing member 6124 can comprise a stainless steel ring that is placed in the groove 6122 during manufacture of the retractor 6100. In other embodiments, the reinforcing member 6124 can comprise an injectable non-metallic member. For example, in some embodiments, a glass filled polymer or polycarbonate material can be injected into the groove 6122 during manufacture of the retractor 6100.

[0026] While the illustrated embodiment of the retractor 6100 includes reinforcing members to increase the stiffness of the outer ring 6120, in other embodiments, the retractor 6100 may be formed in a multiple shot molding process. For example, in some embodiments, the inner segment of the retractor, comprised of the tubular body 6130 and the inner ring 6110, is made from a soft material in one molding operation, and the outer segment of the retractor 6100, comprised of the funnel segment 6140 and the outer ring 6120, is made from a relatively harder material, such as a polycarbonate material or other suitable material, in a separate molding operation.

[0027] 5B, the illustrated embodiment has a continuous, generally annular groove. In other embodiments, a plurality of non-contiguous recesses can each receive a respective one of a plurality of reinforcing members. Additionally, in some embodiments, the outer ring can have two or more concentric, generally annular grooves, each receiving a corresponding reinforcing member.

[0028] Various types of flanges can be used to help secure the retractor within the body orifice. One embodiment of a natural orifice access device retractor 6100 shown in FIG. 6A can be configured for use in transvaginal surgical procedures. The retractor 6100 has an occlusion flange 6111, an outer or proximal ring 6120, and a tubular body 6130 and a funnel segment 6140 extending between and connected to the occlusion flange 6111 and the outer ring 6120. The occlusion flange 6111 is semi-rigid and is approximately 2 inches (5.08 cm) to 4 inches (10.16 cm) in diameter. When inserted into an orifice, such as the vagina, the flange receives pressure from the walls of the vaginal canal, thereby creating a seal that helps maintain insufflation. In some embodiments, the occlusion flange is "cup-shaped" with a circular ridge 6109 surrounding the channel 6107, providing sufficient flexibility to allow the flange 6111 to flex to accommodate various anatomical structures while still maintaining a seal.

[0029] Referring to FIG. 6C, a side view of a retractor 6100 for use in a natural orifice access device system with a different flange embodiment is shown. In this embodiment, the retractor 6100 is shown with a compression flange 6112. The compression flange 6112 is approximately 2 inches (5.08 cm) to 4 inches (10.16 cm) in diameter and is provided around the retractor distal to an outer or proximal ring 6120. The distance between the compression flange and the outer ring is designed to be less than the thickness of the tissue with the natural orifice. For a vaginal orifice, this distance is approximately 0.1 inches (0.254 cm) to 0.5 inches (1.27 cm). This creates a compression force that is applied to the tissue between the flange of the retractor and the outer ring. This force and the "cup-like" geometry of the flange (see FIG. 6D) help to occlude the vagina and prevent dislodgement. A suture knot 6160 can be used to reduce the tendency to dislodge.

[0030] Referring to FIG. 6E, a perspective view of a retractor 6100 for use in a natural orifice access device system with yet another flange embodiment is shown. In this embodiment, the retractor 6100 is shown with a bolster cone 6113. A bolster cone made of a soft thermoset polymer or thermoplastic elastomer, tapered with a maximum diameter of about 2 inches (5.08 cm) to 4 inches (10.16 cm) for use in the vagina, can be added to the retractor. In use, the retractor is advanced into a body orifice, such as the vagina, while the bolster cone acts as a stop to externally occlude the vagina. The bolster cone can be fixed or movable along the tubular body 6130 of the retractor 6100. A suture knot 6160 prevents the retractor from slipping out and maintains the bolster cone compression against the orifice. This design can optionally include flanges similar to others described herein.

[0031] Referring to Figures 6F and 6G, a side view of a retractor for use in a natural orifice access device system with different flange embodiments is shown. In this embodiment, the retractor is shown with a mechanical expansion feature ("mechanical balloon") 6114. The mechanical balloon has a series of arms 6105 that extend circumferentially around the channel 6130, which are attached to a first ring 6103 and a second ring 6101. The first ring is movable along the length of the channel, and the second ring is fixed at or near the distal end of the channel. A sliding third ring 6102, which is mounted around the tubular channel proximal to the first ring, can be advanced toward the distal end of the channel, thereby placing the arms under a load that causes them to flare outward and assume the balloon-like shape shown in Figure 6G. The arms exert a force on the anatomy of the natural orifice, thereby anchoring the retractor in place without damaging the surrounding tissue.

[0032] In some embodiments, the sliding third ring has threads along its inner surface that engage with threads around the channel, see Figure 6G. In other embodiments, a ratchet drive mechanism can be used to move the sliding third ring along the channel.

[0033] The sliding ring may be made of any rigid or semi-rigid material, plastic or metal, and the arms may be made of a semi-rigid metal or plastic that is flexible enough to flare outwardly under load. Alternatively, the arms may be made of a rigid material, with an articulated joint located approximately mid-length of each arm to facilitate similar flaring.

[0034] The mechanical balloon has a diameter of about 2 inches (5.08 cm) to about 4 inches (10.16 cm), and is disposed around the tubular body at the distal end of the retractor. The mechanical balloon may be coated with a non-porous, flexible material that allows for occlusion upon expansion and prevents dislodgement, or may be uncoated to serve only to allow fixation. The amount of expansion may be variable to accommodate different anatomies. This feature is initially unexpanded for easy insertion and then expanded as needed.

[0035] In some embodiments, a mechanical balloon can be used in combination with a compression flange as shown in Figure 6C. In this embodiment, a compression flange is provided around the tubular body proximal to the mechanical balloon, which compression flange helps seal the retractor within the natural orifice. In an alternative embodiment, the mechanical balloon can be used in combination with a bolster cone as shown in Figure 6E. The bolster cone acts to seal the retractor within the orifice with the mechanical balloon helping to anchor the retractor.

[0036] In another embodiment shown in Figures 6H-6J, the flange may include an inflatable member 6132, e.g., an annular balloon coupled to a gas or fluid source, that can be selectively inflated and deflated between a deflated, relatively small diameter state for insertion and transection and an inflated, relatively large diameter state for retention within the body cavity. An inflation port 6134, e.g., a check valve, attached to the funnel portion 6140 of the retractor is connected to the inflatable member 6132 through a channel 6136 in the wall of the tubular body 6130. Fluid or gas introduced through the inflation port flows through the channel and into the inflatable member, thereby inflating the inflatable member.

[0037] The channel 6136 extends through the tubular body generally parallel to the longitudinal axis of the tubular body and includes a proximal opening that interfaces with the inflation port 6134 and a distal opening 6139 that opens into the exterior surface of the tubular body at the inflatable member. In one aspect, the inflation port 6134 can include a normally closed check valve with a spring loaded plunger. In another aspect, the check valve can include a luer lock. It is envisioned that other inflation ports known in the art can be used.

[0038] In this embodiment, the tubular body 6130 is preferably constructed of a relatively rigid material, such as polycarbonate. The tubular body has an inflatable member located at its distal end, which may be made of a heat shrinkable polyolefin tube around the exterior of the tubular body. The distal end of the body / tube assembly is then heated for approximately 30-40 seconds, then placed into a mold, and air is injected into it, giving the inflatable member the annular balloon shape shown in FIG. 6H, or any other desired shape, depending on the shape of the mold. The inflatable member 6132 should be sufficiently impermeable to substantially prevent the inflation gas or fluid from penetrating the wall of the inflatable member.

[0039] In one embodiment, the inflatable member 6132 can have a substantially donut-shaped shape (see FIG. 6H) when inflated. In another embodiment, the inflatable member can have a disk shape when inflated. In another embodiment, the inflatable member 6132 can be a pleated balloon. In yet another embodiment, the inflatable member is a saddle-shaped balloon 6116 as shown in FIG. 6I. For use in vaginal procedures, the saddle-shaped balloon is tapered with a maximum diameter of about 2 inches (5.08 cm) to about 4 inches (10.16 cm) in this embodiment. The balloon can be initially deflated to facilitate entry into the vagina and then inflated with fluid through an inflation port 6134 at the proximal end of the retractor. The vaginal opening fits into the low point of the saddle and is compressed between the peaks of the saddle when the balloon is inflated. This occludes the vagina from both the inside and outside to prevent dislodging. The balloon also distributes the force applied during the procedure over a larger area, thereby reducing the risk of tissue damage. Suture knots can also be used to reduce the tendency for dislodgement. The balloon is then deflated upon completion of the procedure for easy removal. Those skilled in the art will envision other shapes suitable for a particular natural orifice.

[0040] In use, after the retractor is placed in the natural orifice, the inflatable member can be inflated by inserting a syringe or injector into a valve 6134 located at the proximal end 6138 of the channel in the tubular body (see FIG. 6K). As shown in FIGS. 6J and 6K, a port leads into the channel 6136, allowing fluid or gas from the syringe to travel to the inflatable member 6132. Alternatively, a bulb pump or other source of gas or fluid can be used to inflate the inflatable member.

[0041] In yet another embodiment, a bolster cone as described herein may be combined with an inflatable member as shown in FIG. 6L. In this embodiment, the retractor has a balloon 6132 at the distal end and a bolster cone 6113 at the middle of the channel. For use in vaginal procedures, the balloon has a diameter of about 2 inches (5.08 cm) to about 4 inches (10.16 cm) and the bolster cone is tapered with a maximum diameter of about 2 inches (5.08 cm) to about 4 inches (10.16 cm). The balloon 6132 may be initially deflated to facilitate entry into the vagina and then inflated through a port 6134 at the proximal end of the retractor. The amount of inflation may be variable to accommodate different anatomies. When inflated, the balloon occludes the vagina, preventing the retractor from falling out while causing compression of the bolster cone against the vaginal opening to further occlude. The bolster cone distributes the force applied during the procedure over a larger area, thereby reducing the potential for damage to the tissue. Suture knots can also be used to reduce the tendency for dislodgement, while the balloon can be deflated upon completion of the procedure to facilitate removal.

[0042] Another embodiment of a natural orifice access device system configured to allow retraction and access without insufflation gas is shown in Figures 6M-6P. In some natural orifices, such as the vagina, pressure from a standard gas insufflator may be insufficient to maintain a visible stable surgical workspace due to leakage and large surges caused by surges from the gas insufflator. In this embodiment, the retractor 6100 has a proximal ring 6120 and a tubular body 6130 adapted to engage a retaining sleeve 6143. The retaining sleeve has a lip 6144 at its proximal end and at least two retracting arms 6146 at its distal end. The retracting arms are connected to the retaining sleeve by an articulating hinge 6147 that allows the arms to move between a closed position (Figure 6P) where the distal ends of the arms are close together, and an open position (Figures 6M, 6N) where the distal ends of the arms are moved away from each other. Optionally, the retractable arm may have an angled lead 6148 located near the hinge 6147 .

[0043] In the embodiment of Figures 6M-6P, the tubular body has external threads 6149 wrapped around the exterior of the tubular body that are adapted to engage internal threads 6151 provided around the surface of the inner lumen of the retaining sleeve 6143. See Figure 6O.

[0044] In an alternative embodiment, a ratchet drive mechanism including teeth 6153 and a series of pawls 6155 may be used in place of the female and male threads (see FIG. 6Q). The ratchet drive mechanism allows the retractor to be advanced relatively easily through the lumen of the retaining sleeve, while resisting rearward movement until the side of the tubular body of the retractor is manually depressed to release the ratchet drive mechanism.

[0045] In use, the tubular body 6130 of the retractor 6100 is advanced forward through the lumen of the retaining sleeve 6143 until contact is made with the retracting arm 6146. An angled lead 6148 on the retracting arm allows the opening to occur at a stepwise rate to accommodate various anatomical structures. A lip 6144 on the retaining sleeve prevents the proximal end of the lumen from entering the opening and provides a retention point in the front body of the retractor. As seen in Figures 6M and 6N, the fully advanced channel exerts pressure on the retracting arms, which flare outward to hold the vaginal canal open. With the tissue of the vaginal canal retracted, direct access to the cervix and surrounding tissue is possible. In Figure 6P, the retractor is pulled back, releasing the retracting arms so that they can collapse onto each other. This position facilitates access through the opening.

[0046] In some embodiments, the natural orifice access system can include a retractor 6100 and an optional obturator 6400 (FIGS. 7A and 7B). The obturator can have a proximal bearing surface 6410 sized and shaped to abut against the inner surface 6142 of the funnel segment 6140 and a distal flaring surface 6420 sized and shaped to expand the natural orifice to allow passage of the retractor 6100. Thus, during insertion of the retractor 6100 into the natural orifice, the flaring surface 6420 expands a pathway to the surgical site within the body cavity while the obturator abuts against the inner surface 6142 of the funnel segment 6140, thereby advancing the retractor 6100 into position at the surgical site. Additionally, in some embodiments, the obturator may have a handle 6430 at its proximal end to facilitate selective twisting or rotation of the obturator about its longitudinal axis during insertion.

[0047] In an alternative embodiment shown in Figure 7C, the obturator 6405 has a straight shaft piece 6425 located between the distal expansion surface 6420 and the proximal bearing surface 6410 to facilitate expansion of the natural orifice prior to insertion of the retractor. This obturator can then be combined with a retractor 6100 to aid in easy insertion, as shown in Figure 7D.

[0048] In embodiments where the inflatable member is provided on the retractor, the optional obturator 6400 may be modified with a recess 6139 to provide clearance for the inflation port, as shown in FIG. 7E.

[0049] Referring to FIG. 8A, a side view of a natural orifice access device is shown having a cap 6200 removably coupled to a retractor 6100. In the illustrated embodiment, the cap 6200 has a sealable access surface 6210, e.g., a gel pad surface, as described in further detail herein. In certain embodiments, the cap 6200 may further include at least one gas or fluid port 6220, 6230. In the illustrated embodiment, the cap 6200 has two gas or fluid ports 6220, 6230, such that one port can be used for insufflation and the other port can be used for venting, e.g., when performing electrosurgery through the access device. In certain embodiments, at least one of the gas or fluid ports 6220, 6230 has a valve, e.g., a stopcock valve, to selectively control the flow rate of fluid therethrough.

[0050] 8B, a plan view of a natural orifice access device is shown. The sealable access surface 6210 can be surrounded and constrained by an annular frame 6240, e.g., a split ring having a clamp 6250. The clamp 6250 can be movable between an open configuration in which the cap 6200 is selectively removable from the retractor 6100 and a clamped configuration in which the cap 6200 can be secured to the retractor 6100. For example, the annular frame 6240 can be positioned circumferentially about the outer ring 6120 with the clamp 6250 in the open configuration, and the clamp can be moved to the clamped configuration to sealingly secure the cap 6200 to the retractor 6100. Thus, the cap 6200 can be easily removed during a surgical procedure to facilitate removal of resected tissue from the surgical site through the retractor 6100.

[0051] 8C, a perspective view of a natural orifice access device is shown. In the illustrated embodiment, the clamp 6250 can have a distal flange 6252 positioned to interface with the outer ring 6120 of the retractor when the clamp is in the clamped configuration. As shown, the clamp 6250 engages a distal surface of the outer ring 6120 of the retractor 6100. In some embodiments, the annular frame 6240 can further include at least one distal flange sized and positioned to interface with the retractor. In the illustrated embodiment, the annular frame 6240 has a distal flange 6260 positioned to engage a distal surface of the outer ring 6120 of the retractor. As shown, the flange 6260 is generally diametrically opposite the distal flange of the clamp 6250. In other embodiments, the annular frame 6240 may have two or more distal flanges positioned substantially equally spaced around the circumference of the annular frame 6240 or irregularly spaced around the circumference of the annular frame.

[0052] 9A, another embodiment of a natural orifice access device is shown with a cap 6300 removably coupled to a retractor 6100. In the illustrated embodiment, the cap 6300 has multiple ports 6310 disposed through its access surface 6320. Advantageously, the multiple ports 6310 allow for easy placement and manipulation of multiple laparoscopic instruments into a surgical site through a single natural orifice.

[0053] 9A , the port 6310 has a relatively low profile, i.e., it minimally protrudes above the access surface 6320 and / or below the distal surface of the cap 6300. The port 6310 is therefore shorter than the length of a typical trocar, with the port having a seal assembly disposed above the access surface 6320 and a cannula extending through the gel pad of the cap 6300. Reducing the length of the port 6310 allows for increased angular or rotational movement for instruments extending therethrough, as well as allowing for the use of curved and / or angled instruments.

[0054] 9B is an exploded view of one embodiment of the port 6310 and an optional obturator 6600 that is a component of some embodiments of the access device system. In the illustrated embodiment, the obturator 6600 has a sharp piercing tip 6610.

[0055] The port 6310 has a proximal end, a distal end and a longitudinal axis. The port 6310 has a cannula 6620 extending along the longitudinal axis. A seal 6630 is provided at the proximal end of the cannula 6620 housed within a housing 6640. A retainer 6650 is provided at the distal end or tip of the cannula 6620.

[0056] The cannula 6620 has a tubular body dimensioned to receive one or more instruments therethrough. In the illustrated embodiment, the cannula 6620 is a substantially cylindrical tube that penetrates the cap 6300 during use. In the illustrated embodiment, the cannula 6620 is relatively short because it only needs to extend across the cap 6300 (FIG. 9A), which has a known and consistent thickness, and not the body wall. Thus, some embodiments of the cannula 6620 are about 2 times or less longer than the thickness of the gel pad, about 1.5 times or less longer, about 1.2 times or less longer, or about 1.1 times or less longer. In some embodiments, the cannula 6620 is about 20 mm or less shorter, about 10 mm or less shorter, or about 5 mm or less shorter than the thickness of the gel pad. In some embodiments, the cannula 6620 is of a length dimension approximately the same as the thickness dimension of the gel pad. In other embodiments, the cannula 6620 has a different length, for example, a length typical for a cannula used to traverse a body wall. A shorter cannula length allows for increased angular freedom for an instrument passing therethrough. Shorter cannula embodiments also allow for the use of curved instruments. The cannula 6620 is made of any suitable biocompatible material. In some embodiments, the cannula 6620 is made of a soft or flexible material.

[0057] The illustrated seal 6630 includes an instrument or diaphragm seal 6660 and a zero seal 6670. Optionally, a shield 6680 may be provided within the instrument seal 6660. The instrument seal 6660 seals against instruments passing therethrough, thereby maintaining a pressurized state within the body cavity, e.g., a pneumoperitoneum or retroperitoneal pneumoperitoneum state. The zero seal 6670 provides a seal when no instruments are passing through the seal 6630. The instrument seal 6660 and zero seal 6670 are received within a housing 6640 provided at the proximal end of the cannula 6620 and secured therein by a seal cover 6690.

[0058] The retainer 6650 is disposed at or near the distal end of the cannula 6620. In some embodiments, the retainer 6650 and the cannula 6620 are integral, while in other embodiments, the retainer 6650 and the cannula 6620 are not integral. In the illustrated embodiment, the proximal end of the retainer 6650 has a flange 6655 that is generally flat and perpendicular to the longitudinal axis, and the distal end is tapered and narrows toward the distal end of the cannula 6620. The flange 6655 reduces the risk of accidental or inadvertent removal of the port 6310 from the cap. Some embodiments of the proximal face of the flange 6655 have additional fastening features, such as barbs, spikes, ridges, textures, etc., configured to pierce or bite into the distal face of the cap 6300. In some embodiments, the diameter of the flange 6655 is about 1.2 to about 2.5 times larger or about 1.5 to about 2.0 times larger than the outer diameter of the cannula 6620. Some embodiments of the port 6310 are 5 mm trocars, where the outer diameter of the cannula 6620 is about 7 mm to about 8 mm.

[0059] The tapered end of the retainer 6650 facilitates either insertion of the port 6310 into the cap on its own or insertion of the port 6310 into the cap upon assembly with the obturator 6600 passing through the port 6310. For example, in some embodiments, the retainer 6650 is inserted into a pre-formed opening in the cap 6300.

[0060] In some embodiments where the retainer 6650 and the cannula 6620 are not integrated, i.e., separate components, the retainer 6650 is secured to the cannula 6620 after the cannula 6620 is inserted through the cap. In some embodiments, the cannula 6620 and the retainer 6650 are secured mechanically, e.g., with a latch, threads, clip, locking ring, ratchet, etc. In some embodiments, the cannula 6620 and the retainer 6650 are secured adhesively. In some embodiments, the position of the retainer 6650 is adjustable, e.g., to accommodate caps of different thicknesses. In some embodiments, the cannula 6620 and / or the retainer 6650 are secured to the cap, e.g., by adhesive.

[0061] 10A illustrates in perspective view an embodiment of a cap or cover 10500, which is a surgical access device that allows access to the body cavity from outside the body cavity while sealing an opening between the body cavity and an area located outside the body cavity. Specifically, the illustrated cap 10500 releasably and sealingly couples to the outer ring 6120 (FIG. 5) of a surgical wound retractor. The cap 10500 has a cap ring 10510 sized and shaped to be coupleable to the outer ring 6120 of the surgical wound retractor and a pad 10530 coupled to the cap ring 10510. An embodiment of the cap 10500 provides an artificial body wall with consistent properties, such as thickness, compliance, stiffness, uniformity, etc., as compared to a natural body wall.

[0062] The illustrated cap or cover 10500 is substantially circular. In other embodiments, the gel cap 10500 has another shape or footprint, such as an oval, elliptical, paraboloid, square, rectangular, or another suitable curved or polygonal shape. In some embodiments, the outer ring 6120 of the retractor and the cap ring 10510 of the cap can have the same overall shape or footprint. In other embodiments, the outer ring 6120 of the retractor and the cap ring 10510 of the cap can have substantially different shapes, such as a generally circular outer ring 6120 and an oval cap ring 10510, respectively. In these embodiments, the outer ring 6120 can be distorted or reshaped to be bondable to the cap ring 10510, such as by compressing opposing sides of the outer ring 6120. For example, non-circular shapes are useful for procedures where space is limited. As discussed above, dilating a long straight incision with an oval or elongated retractor requires less force than a similar procedure using a circular retractor.

[0063] In some embodiments, the pad 10530 is comprised of gel. In such embodiments, the pad 10530 is referred to as a "gel pad" and the cap 10500 is referred to as a "gel cap." The descriptions of the gel pad and gel cap generally apply to embodiments in which the pad 10530 is not comprised of gel unless otherwise specified. In some embodiments, there are no preformed access channels in the gel pad 10530, for example for instrument access. An instrument can be inserted directly through the gel pad 10530 to penetrate the gel pad 10530, thereby forming an access channel or portion in the gel pad 10530. Each access portion forms an instrument seal in the presence of an instrument inserted therethrough and a zero seal when no instrument is inserted therethrough. The gel provides an airtight seal around instruments of various shapes and sizes inserted through the access channel. Some embodiments of the gel pad 10530 also allow for trocar access directly therethrough, thereby also allowing instrument access into the body cavity. Embodiments of the gel pad 10530 have a working diameter of about 40 mm to about 120 mm, which is the diameter of a portion of the gel pad 10530 through which instruments and / or trocars can be inserted. Embodiments of the gel cap 10500 are typically about 10 mm to 50 mm wider than the working diameter.

[0064] Thus, embodiments of the gel cap 10500 maintain a pressurized state, e.g., pneumoperitoneum or retroperitoneum, within a body cavity during multiple instrument exchanges and substantially prevent inadvertent reduction of pressurization. Embodiments of the gel cap 10500 also provide substantially continuous access and visibility during a surgical procedure. Embodiments of the gel cap 10500 have a small profile that allows for use in procedures with limited surgical space.

[0065] In some embodiments, the gel is an Ultragel, which is characterized by an ultimate elongation of about 1000 percent or more and a Shore A hardness of about 5 or less durometer. Some embodiments of Ultragels comprising KRATON® and mineral oil exhibit an ultimate elongation of greater than about 1500 percent and improved sealing properties, e.g., sealing with a wider size range of instruments than other seal materials. In some embodiments, a seal comprised of Ultragel also forms a zero seal when an instrument is removed therefrom. Thus, in some embodiments of a seal comprised of Ultragel, a single seal acts as both an instrument seal and a zero seal.

[0066] Some embodiments of the cap ring 10510 have a substantially cylindrical ring with a proximal portion, a distal portion, and a longitudinal axis extending from the proximal portion to the distal portion. In other embodiments, the cap ring 10510 is of another shape or footprint, such as an oval. As best seen in FIG. 10B, which is a bottom view of the cap ring 10510, in the illustrated embodiment, the proximal portion of the cap ring 10510 has a plurality of holes 10512 distributed around its circumference. The holes 10512 extend through a wall 10514 located at the proximal portion of the cap ring. In other embodiments, the holes 10512 are provided in at least one member extending longitudinally inward or longitudinally outward from the wall 10514 of the cap ring. In the illustrated embodiment, the gel pad 10530 is provided at a proximal portion of the cap ring 10510, and portions of the gel pad 10530 extend through the holes 10512, thereby forming an interlocking structure between the cap ring 10510 and the gel pad 10530, thereby mechanically locking the cap ring 10510 and the gel pad 10530 to one another.

[0067] The distal portion of the cap ring 10510, in the illustrated embodiment, is substantially cylindrical and sized and shaped to receive the outer ring 6120 (FIG. 5) of the wound retractor. The cap ring 10510 has a latch mechanism 10516 that releasably couples the cap ring 10510 to the outer ring 6120. As will be appreciated by those skilled in the art, other mechanisms are also useful for coupling the cap ring 10510 to the outer ring 6120 of the wound retractor, such as, for example, a protruding lip, a lever, a clip, a latch, a tongue, a groove, a thread, a bayonet mount, a screw, a friction fit, a compression fit, a snap cap, and the like. In the illustrated embodiment, when the outer ring 6120 of the wound retractor is received within the distal portion of the cap ring 10510, the outer ring 6120 of the wound retractor contacts and embeds within a portion of the gel pad 10530 provided at the distal portion of the cap ring 10510, thereby displacing a portion of the gel to form a seal between the gel pad 10530 and the outer ring 6120 and tubular body 6130 of the wound retractor. Thus, the distal portion of the gel pad 10530 is in apposition with the incision or body opening. In other embodiments, the cap ring 10510 is permanently coupled or secured to the outer ring 6120.

[0068] The cap ring 10510, in some embodiments, is comprised of a polymer. Examples of suitable polymers include polyethylene (PE), low density polyethylene (LDPE), high density polyethylene (HDPE), ultra-high molecular weight polyethylene (UHMWPE), polycarbonate, thermoplastic elastomers (DYNAFLEX® from GLS Co., KRATON® from Kraton Polymers), polyphenylene oxide (PPO), polystyrene, and the like. The polymer component of the cap ring may be fabricated by any suitable method, including injection molding, melt casting, blow molding, and the like.

[0069] Some embodiments of the process for casting the gel pad 10530 into the cap ring 10510 include steps carried out at temperatures above about 130° C. for several hours, such as about 3 to about 4 hours. Thus, in some of these embodiments, the cap ring 10510 does not deform under these conditions.

[0070] Some embodiments of the gel pad 10530 are comprised of an elastomeric gel. Examples of such gels are described in U.S. Patent Application Serial No. 10 / 381,220, filed March 20, 2003, which is incorporated by reference herein in its entirety. Examples of gels are prepared by mixing at least one triblock copolymer with a solvent, which dissolves the midblock of the triblock copolymer. The mixture is typically a slurry. The endblocks typically comprise a thermoplastic, such as styrene, and the midblock typically comprises a thermoset elastomer, such as ethylene / butylene, isoprene, or butadiene. Examples of triblock copolymers include styrene-ethylene / butylene-styrene (SEBS), styrene-isoprene-styrene (SIS), and styrene-butadiene-styrene (SBS). In some embodiments, the solvent is an oil, such as mineral oil. When the triblock copolymer mixture or slurry is heated, the midblock melts in the mineral oil, resulting in a network of insoluble endblocks. The resulting network has enhanced elastomeric properties compared to the parent and child polymers. In some embodiments, the triblock copolymer used is KRATON® G1651, which has a styrene to rubber ratio of 33 / 67. Once formed, the gel is substantially permanent and, depending on the nature of the endblocks, can be processed as a mixed thermoplastic elastomer. The mixture or slurry has a minimum temperature at which it becomes a gel, which is called the minimum gelation temperature (MGT). This temperature typically corresponds to a few degrees above the glass transition temperature of the thermoplastic endblocks. For example, the MGT for a mixture of KRATON® G1651 and mineral oil is about 120°C. Once the slurry reaches the MGT and the transition to the gel state occurs, the gel becomes more transparent, thereby providing a visual indicator confirming the complete transition of the slurry to the gel state, after which the gel can be cooled. Some embodiments of the gel include a diblock copolymer instead of or in addition to the triblock copolymer.An embodiment of a diblock copolymer includes a thermoplastic first end block, such as styrene, and a thermoset elastomeric second end block, such as ethylene / butylene, isoprene, or butadiene. One example of a suitable diblock copolymer is styrene-ethylene / butylene (SEB).

[0071] For a given mass of slurry that will form a complete gel, the entire mass of slurry is heated to or above the MGT and held at or above the MGT for a sufficient time for the end blocks to form an interconnected network or matrix. The slurry will continue to form a gel at temperatures between the MGT and the temperature at which the components of the slurry / gel begin to decompose and / or oxidize. For example, if the slurry / gel is heated to a temperature above 250° C., the mineral oils in the slurry / gel will begin to volatilize and oxidize. Oxidation may cause the gel to turn brown and become oily.

[0072] The rate at which a given amount of slurry forms a gel is determined by the rate at which the slurry loses mass to the MGT, and at the high temperature of the MGT gel, the endblock network forms and disperses quickly, thereby hastening gel formation.

[0073] Various base gel formulations can be mixed or alloyed together to produce gels with various intermediate properties. For example, KRATON® G1701X is a mixture of 70% SEB and 30% SEBS with an overall styrene to rubber ratio of 28 / 72. As will be appreciated by those skilled in the art, an almost unlimited number of combinations, alloys and styrene to rubber ratios can be formulated, each formulation resulting in an embodiment exhibiting one or more advantages, such as low durometer, high elongation and good tear strength.

[0074] Some embodiments of the gel material further include polymers, such as silicones, soft urethanes, and hard plastics, which, together with the foaming agent, improve the sealing properties of the gel. Examples of suitable silicones include silicones used in electronic encapsulation. Examples of suitable hard plastics include polyvinyl chloride (PVC), isoprene, KRATON® neat and other KRATON® / oil mixtures. For KRATON® / oil mixtures, suitable oils include vegetable oils, petroleum and silicone oils, and mineral oils.

[0075] Some embodiments of the gel include one or more additives that provide one or more desirable properties, such as at least one of enhanced lubricity, enhanced appearance, and wound protection. The additives are mixed directly into the gel and / or added as surface treatments. In some embodiments, other compounds are added to the gel to modify its physical properties and / or to aid in subsequent modification of the surface by providing binding sites and / or surface charge. Additionally, oil-based colorants are added to the slurry, which in some embodiments results in gels of different colors.

[0076] Some embodiments of the gel pad 10530 have a layer of polyethylene on at least one surface. The polyethylene is dissolved in mineral oil and the solution is applied to one or more surfaces of the gel pad 10530. The mineral oil does not evaporate but rather is absorbed into the gel pad over time, leaving behind the polyethylene as a layer on the surface of the gel pad.

[0077] In some embodiments, the triblock copolymer / solvent mixture / slurry used to manufacture the gel pad 10530 includes about 90% by weight mineral oil and about 10% by weight KRATON® G1651. From a thermodynamic standpoint, this mixture behaves similarly to mineral oil. Mineral oil has a relatively high heat capacity, so it may take about 3 to about 4 hours to convert 1 pound of slurry to a homogenous gel at about 130° C. Once formed, it should be cooled as quickly as possible without any apparent adverse effect on the gel. In some embodiments, the gel is cooled by cold water immersion. In other embodiments, the gel is air-cooled. Other cooling techniques are used in other embodiments, as will be recognized by those skilled in the art.

[0078] Certain properties of the KRATON® / oil gel will vary with the weight ratio of the components. In general, a higher percentage of mineral oil will result in a softer gel, and a higher percentage of KRATON® will result in a harder gel. Gels that are too soft will exhibit excessive tenting or doming of the gel cap 10500 during surgery when the patient's body cavity is insufflated. Some embodiments of gels that are too soft will also provide an adequate instrument seal and / or zero seal. However, the gel needs to be soft enough to provide an adequate seal with or without the presence of an instrument.

[0079] Upon sitting or standing for an extended period of time or for an extended period of time, the copolymer, e.g., KRATON®, and the solvent, e.g., mineral oil, in the slurry may separate. The slurry may be mixed, e.g., with a high shear mixer, to achieve high homogeneity. However, mixing the slurry may introduce or add air to the slurry. To remove air from the slurry, the slurry may be degassed. In some embodiments, the slurry is degassed under vacuum, e.g., in a vacuum chamber. In some embodiments, the applied vacuum is about 0.79 meters (about 29.9 inches) of mercury or about 1 atmosphere. Optionally, the slurry may be stirred or mixed under vacuum to facilitate removal of air. During degassing under vacuum, the slurry typically expands, then foams, and then reduces in volume. When foaming has substantially ceased, the vacuum is typically discontinued. Degassing the slurry under vacuum reduces the volume of the slurry by about 10%. Degassing the slurry also reduces oxidation of the finished gel in some embodiments.

[0080] Degassing the slurry tends to result in a stiffer gel: a gel made with a degassed slurry containing about 91.6% mineral oil and about 8.4% KRATON® G1651 in an 11 to 1 ratio by weight has about the same stiffness as a gel made with a slurry that was not degassed and contained about 90% mineral oil and about 10% KRATON® G1651 in a 9 to 1 ratio by weight.

[0081] Since mineral oil is typically less dense than KRATON®, the two components will separate after mixing, with the less dense mineral oil rising to the top of the vessel. This phase separation typically occurs as the quiescent slurry converts to a gel state over a period of hours. As a result, the resulting gel is non-homogeneous, with a higher concentration of mineral oil at the top and a lower concentration at the bottom. The rate of separation is a function of the depth or head height of the slurry being heated. Factors related to the relative homogeneity of the gel include the mass of the slurry, the head height, the temperature at which the gel sets, and the rate at which energy is transferred to the gel.

[0082] The gel pad 10530 or gel cap 10500 is sterilized by gamma radiation in some embodiments, which is relatively and / or relatively easy to qualify compared to other sterilization processes, such as ethylene oxide. However, gamma radiation sterilization may result in large bubbles in the gel pad, which are cosmetic and / or aesthetic problems in sterilization equipment. Since the bubbles typically contain more than 99% room air, the dissolved air is advantageously removed from the slurry prior to converting the slurry to a gel. For example, the slurry may be degassed under vacuum as described above, and then gelled by heating. Some bubbles may still form in the gel during gamma radiation sterilization, but typically disappear over a period of about 24 hours to about 72 hours. Typically, mineral oil contains about 10% dissolved gas at room temperature. As described above, removing the air from the gel causes the gel to harden. However, this effect is countered during gamma sterilization by the softening of the gel by gamma radiation.

[0083] In some embodiments where the gel pad 10530 is gamma sterilized, the gel comprises about 90% mineral oil and about 10% KRATON® by weight. As discussed above, degassing the slurry causes the gel to harden. However, the counteracting softening caused by gamma radiation results in a gel with substantially the same hardness as a gel comprising about 90% mineral oil and about 10% KRATON® by weight that has not been degassed and has not been gamma sterilized.

[0084] In some embodiments, the gel pad 10530 is coupled, attached, formed with, or integral with the cap ring 10510 to provide an airtight seal between the cap ring 10510 and the tubular body 6130 (FIG. 5). The gel pad 10530 covers and seals the entire opening in the cap ring 10510 and also covers the entire wound or opening as an opening. As discussed above, the gel pad 10530 provides an airtight seal around instruments of various shapes and sizes inserted therethrough.

[0085] Embodiments in which the gel pad support structure of the cap ring 10510 comprises a thermoplastic elastomer, such as DYNAFLEX® or KRATON®, and the gel pad 10530 comprises a similar thermoplastic elastomer, such as KRATON®, exhibit improved adhesion between the gel pad 10530 and the cap ring 10510. The polystyrene component of KRATON® in the gel pad 10530 improves adhesion with polypropylene oxide (PPO), polystyrene, and other similar polymers.

[0086] In some embodiments where the cap ring 10510 is made of polycarbonate, the polycarbonate component of the cap ring 10510 will not bond to the gel pad 10530 at 130° C., which is a typical manufacturing temperature for a gel pad 10530 made of KRATON®. However, during casting, the gel pad 10530 is bonded to the cap ring 10510 by raising the temperature to about 150° C. for several minutes. It is believed that a bond can be formed between the gel pad 10530 and the cap ring 10510 by simultaneously heating the gel's polystyrene component and the polycarbonate to a temperature above their melting points. In other embodiments, the uncured gel and the cap ring 10510 are heated to a temperature at or near the glass transition temperature of the polycarbonate in the cap ring 10510, thereby bonding the gel pad 10530 to the cap ring 10510.

[0087] In some embodiments, the gel includes mineral oil and the cap ring 10510 includes a polymer that is soluble in mineral oil under manufacturing conditions, such as polyethylene (PE), low density polyethylene (LDPE), high density polyethylene (HDPE), ultra-high molecular weight polyethylene (UHMWPE). Using polyethylene (PE) as an example, PE has a higher molecular weight than mineral oil and is soluble in mineral oil at temperatures used to cast the gel pad 10530. Thus, a bond is created between the PE in the cap ring 10510 and the gel pad 10530 because a portion of the PE in the cap ring 10510 melts into the mineral oil in the gel pad 10530 at processing temperatures, such as temperatures above about 130° C.

[0088] In an embodiment of a method of making a gel cap, the cap ring 10510 is placed into a mold that, together with the cap ring 10510, has a space that is a negative of the desired shape of the gel pad, and uncured gel is added to the mold. Sufficient gel in an uncured state is then added to the mold to cover and fill the holes 10512. The uncured gel flows through, fills, and resides within the holes. Also, in some embodiments, the mold is filled with enough uncured gel to extend into the distal portion of the cap ring 10510. After the gel has cured, the gel in the holes connects and bonds to the gel on a first side of each hole 10512 to the gel on the second side of the hole, thereby mechanically locking the gel pad 10530 to the cap ring 10510.

[0089] Some embodiments include other methods of bonding the gel pad 10530 to the cap ring 10510 in addition to or in place of the mechanical interlock described above. Such methods are useful, for example, for bonding a separately formed gel pad or gel slug 10530 to the cap ring 10510. Some embodiments bond the gel pad 10530 to the cap ring 10510 using a glue or adhesive, such as a cyanoacrylate (SUPERGLUE® or KRAZY GLUE®). The glue is believed to bond to the rubber or styrene component of the triblock copolymer, and the bond is often stronger than the gel material itself. Some embodiments utilize welding (solvent bonding), where a solvent dissolves the plastic in the cap ring 10510 and dissolves the polystyrene in the gel pad 10530. The solvent is applied to the gel pad 10530 and cap ring 10510 by any suitable method, such as spraying and / or dipping. In effect, the solvent dissolves the plastic of the cap ring 10510 and the polystyrene in the gel pad 10530, thereby forming a bond between the two that remains intact even after the solvent evaporates.

[0090] In an embodiment for manufacturing the gel cap 10500, the gel pad 10530 is cast into the cap ring 10510 to form the gel cap 10500. The cap ring 10510 is positioned or placed into a mold cavity of a casting mold. An embodiment of the mold cavity includes a support for the annular wall of the cap ring 10510. An embodiment of the mold is made of a material with sufficient heat dissipation properties, such as at least one of aluminum, copper, and brass. As one skilled in the art will recognize, other mold materials with lesser heat dissipation properties will produce acceptable parts in some embodiments. Additionally, some embodiments of the mold include active cooling elements, such as channels for pumping a coolant.

[0091] The mold cavity and cap ring 10510 assembly is then filled with a desired amount of triblock copolymer / mineral oil slurry so that the slurry contacts the cap ring 10510. In some embodiments, the slurry is preheated, for example to about 125° F., which facilitates complete filling of the mold cavity with the slurry, thereby reducing the likelihood of voids in the gel. Preheating the slurry to a temperature lower than the MGT reduces the viscosity of the slurry, allowing it to flow more easily. As discussed above, some embodiments of the slurry are degassed in a vacuum prior to casting. In some embodiments, the slurry is degassed even after it is filled into the mold cavity, which removes any air that may be introduced during filling of the mold cavity and facilitates the flow of the slurry into the voids in the mold. The mold, cap ring, and slurry are heated, for example in an oven, until the slurry reaches a temperature of about 150° C. As discussed above, the slurry gels at about 120° C., but at 150° C., the gel bonds to the polycarbonate cap ring 10510. Depending on the material used in the cap ring 10510, bonding may occur at temperatures other than about 150° C. In embodiments in which the cap ring 10510 is made of MGT, a material having a melting point below 120° C., for example, the gel pad 10530 is molded separately as a gel slug, and then the gel slug is bonded to the cap ring 10510 as described above.

[0092] Once the conversion of the slurry into a gel is complete, for example when the temperature of the gel pad reaches about 150° C., the gel cap 10500 is cooled, for example by air cooling, cold water immersion, or another suitable method. At 150° C., the gel pad 10530 is soft and easily deformed. Any deformations in the gel pad 10530 that occur during cooling are solidified after cooling. Thus, in some embodiments, the gel cap 10500 is cooled in a mold, thereby reducing the risk of deformation of the gel pad 10530. Factors that affect the cooling time include the size and shape of the mold, the amount of gel, the temperature and amount of the cooling medium, the properties of the cooling medium, and the mold material. As an example, the cooling time for a particular gel cap 10500 may be about 2 hours for air cooling and about 15 minutes for water cooling. Whether air or water cooling, the final properties of the gel are substantially the same. The gel cap 10500 is typically cooled to about ambient room temperature, but may be cooled to a lower temperature if desired. At about 0° C., the gel hardens, which is useful, for example, in a secondary operation, such as bonding a separately manufactured gel pad 10530 and cap ring 10510 together. The gel cap 10500 can be removed from the mold at any time after the gel has hardened.

[0093] Upon removal from the mold, the gel pad 10530 typically has a sticky surface. By coating the gel pad 10530 with a powder, such as cornstarch, the tackiness of the gel pad 10530 after curing is substantially reduced or eliminated.

[0094] As discussed above, in some embodiments, the gel pad 10530 is molded separately from the cap ring 10510 and bonded to the cap ring 10510 by a secondary operation, e.g., bonding. In some embodiments, the gel pad 10530 is molded as a gel slug with an outer perimeter less than the perimeter of the inner cylindrical wall of the cap ring 10510 and a height greater than the height of the cap ring 10510. Because the gel pad 10530 is molded separately from the cap ring 10510, it is only necessary to heat the slurry to the MGT, e.g., about 120° C., which completes the conversion of the slurry to a gel, after which the gel becomes substantially clear. As discussed above, the gel slug can be cooled, e.g., to about 0° C., and then placed within the inner cylindrical wall of the cap ring 10510.

[0095] In some embodiments, the gel slug is bonded to the cap ring 10510 by compression molding, which compresses the gel slug longitudinally, thereby expanding the periphery of the gel slug and forcing the gel slug against the inner cylindrical wall of the cap ring 10510. The compressed gel slug and cap ring 10510 are then heated to a temperature sufficient for the polystyrene in the gel and the polymer of the cap ring 10510 to form a bond therebetween. Molding the gel slug separately from the cap ring 10510 and then bonding the gel slug to the cap ring is particularly useful in embodiments where the cap ring 10510 is made of a material that has a lower melting point than the MGT of the gel. In such situations, it is useful to mold the gel slug separately and heat bond it to the cap ring 10510 without melting the cap ring 10510.

[0096] Described above in detail are embodiments of a method for enlarging an incision or body opening using the retractor 6100. As a result of this method, the outer ring 6120 of the retractor is in substantial contact with the outer surface of the body wall. A gel cap 10500 is then coupled to the outer ring 6120 of the retractor, thereby sealing the opening between the body cavity and an area outside the cavity, and the surgeon can then insufflate the cavity.

[0097] As discussed above, embodiments of the gel cap 10500 do not include preformed access channels in the gel pad 10530. In use, an instrument can be inserted directly through the gel pad 10530, thereby creating an access channel through the gel pad 10530. Each access channel created in the gel cap creates an instrument seal when an instrument is passed therethrough, as the gel provides an airtight seal around instruments of various geometries. When the instrument is removed from the gel pad 10530, the channel created in the gel pad by the instrument closes to form a zero seal.

[0098] Some embodiments of the cap use access devices, such as trocars, inserted into the gel pad 10530 for instrument access, particularly where the access channel is subject to repeated manipulation of an instrument, such as repeated insertion, removal, advancement, expansion, rotation, and / or other manipulation. Each trocar inserted into the gel pad 10530 allows for repeated introduction, removal, and / or manipulation of an instrument therethrough.

[0099] In some embodiments, the gel cap 10500 does not initially include an access channel, allowing the surgeon the freedom to determine the placement of instruments therethrough. Additionally, the surgeon has unlimited flexibility with respect to placement and repositioning of ports within the confines of the gel cap 10500 as well as the option to select different trocar sizes for various clinical procedures. Being removable, the gel cap 10500 allows for the removal of large specimens. Once removed, the gel cap 10500 can be reattached to the outer ring 6120 of the retractor, thereby restoring the seal and allowing the surgeon to re-insufflate the body cavity.

[0100] Additionally, gel embodiments can deform without losing physical integrity while maintaining a substantially airtight instrument seal with an instrument penetrating them and an airtight zero seal for the access channel without an instrument penetrating them. Thus, gel cap 10500 embodiments allow for translational or positional and angular or rotational "float" or degrees of freedom for an instrument through the gel pad 10530. This float allows for movement of the instrument relative to both the cap ring 10510 and other instruments. In contrast, other single or limited port systems do not allow for one or both of translational or angular float for the instrument.

[0101] FIG 11A is a top view of an embodiment of a gel cap 11500 having multiple access ports, seals or sealing valves disposed within the gel pad. FIG 11B is a top perspective view of the gel cap 11500 attached to a retractor. FIG 11C is a bottom perspective view of the gel cap 11500 attached to a retractor. The gel cap 11500 has a cap ring 11510 and a gel pad 11530 that are generally identical to the cap ring and gel pad of the previous embodiments.

[0102] The gel cap 11500 further includes a number of access ports 11540, at least a portion of which are disposed or embedded within the gel pad 11530. In the illustrated embodiment, the access ports 11540 have a low profile (low profile), i.e., they do not or only minimally protrude above the proximal surface of the gel pad 11530 and / or below the distal surface of the gel pad 11530. Thus, the length of the access ports 11540 is approximately the thickness of the gel pad 11530, which is less than the length of a typical trocar inserted into the gel pad 11530, which has a seal assembly disposed above the gel pad 11530 and a cannula passing through the gel pad 11530. The reduced length of the access ports 11540 allows for increased angular or rotational movement of the instruments passing therethrough and allows for the use of curved and / or angled instruments. In the illustrated embodiment, the access ports 11540 are substantially permanent or non-removable under the conditions of use of the gel cap 11500. Additionally, trocars can be inserted through the gel pad 11530 if additional ports are desired.

[0103] Each port 11540 has a longitudinal axis extending from proximal to distal of the gel pad 11530, a first seal 11542 disposed proximal to the gel pad 11530, and a second seal 11544 disposed proximal to the first seal 11542. Looking at each of the ports or seals 11540, one can see that a hole is provided through the gel pad 11530, and the line of sight is aligned with the longitudinal axis. In the illustrated embodiment, the first seal 11542 forms an instrument seal when an instrument is passed therethrough, and the second seal 11544 forms a zero seal when no instrument is passed therethrough.

[0104] In the illustrated embodiment, the first seal 11542 comprises a septum seal. A hole 11546 is provided through each septum seal, the hole being slightly smaller than the cross section of the smallest instrument to be inserted therethrough. The holes 11546 in the septum seal are substantially aligned with the longitudinal axis of the holes and ports 11540 provided through the gel pad. When an instrument is inserted through the holes 11546 in the septum seal, the holes 11546 expand to engage the outer surface of the instrument, thereby forming a seal with the outer surface. The septum seal is comprised of an elastomeric material that presses against the hole against an instrument inserted therethrough. As will be appreciated by those skilled in the art, other types of instrument seals are used in other embodiments.

[0105] In the illustrated embodiment, the second seal 11544 includes a double duckbill valve that functions as a zero closure seal that provides a zero seal in the absence of an instrument inserted therethrough. As will be appreciated by those skilled in the art, the second seal may include other types of seals, such as duckbill valves, flap valves, etc. The double duckbill valve is comprised of an elastomeric material. In some embodiments, the first seal 11542 and the second seal 11544 each independently include at least one of an elastomeric material, such as rubber, synthetic rubber, silicone, ethylene propylene diene monomer (EPDM), ethylene-propylene copolymer (EP rubber), polyisoprene, polybutadiene, polyurethane, styrene-butadiene, ethylene vinyl acetate (EVA), polychloroprene (NEOPRENE®), perfluoroelastomer (KALREZ®), etc.

[0106] Thus, in use, the septum seal provides an instrument seal when there is an instrument inserted therethrough, and the duckbill valve provides a zero seal when there is no instrument inserted therethrough. The illustrated embodiment has ports or seals 11540 provided in the gel pad of different sizes. Each size of port 11540 sealably accommodates a different instrument size range to be inserted therethrough. The size of the port is typically given as the diameter of the largest instrument that the port will accommodate, e.g., 5 mm, 11 mm, or 12 mm. Figures 11D, 11E, and 11F are top perspective, bottom perspective, and side views of a thin instrument 11550a and a thick instrument 11550b inserted through the small port 11540a and the large port 11540b, respectively, of the embodiment of the gel cap 11500 shown in Figures 11A-11C.

[0107] 11G is a top perspective view of an embodiment of the gel cap 11500 further having a fixed port location, for example, for a camera or laparoscope. The fixed port 11560 has a locking mechanism 11562 that maintains the position of a camera or laparoscope inserted therethrough. In some embodiments, one of the ports 11540 further has a stopcock and / or gas fitting that is used as a gas inlet and / or outlet port for insufflating, depressurizing, and / or venting the body cavity. In some embodiments, the gas inlet / outlet ports are provided in the cap ring 11510.

[0108] 12 is a cutaway perspective view of an embodiment of an access device system 12000 including a retractor 12100 and a cap or cover 12500 similar to the retractor and gel cap embodiments described above. The retractor 12100 has an inner ring 12110, an outer ring 12120, and a sleeve 12130 extending between the inner ring 12110 and the outer ring 12120. In the illustrated embodiment, the cap 12500 is a gel cap having a proximal side, a distal side, a cap ring 12510, and a gel pad 12530. In the illustrated embodiment, the cap ring 12510 has a tubular ring sized to receive the outer ring 12120 of the retractor in a stowed position. The distal side of the cap ring 12510 has an annular slot 12520 that is sufficiently radially deformable to allow the outer ring 12120 to reversibly pass therethrough. Thus, the illustrated embodiment of the cap ring 12510 secures the cap 12500 to the outer ring 12120 via a snap or friction fit.

[0109] 13 is an exploded view of an embodiment of a trocar 13800 and an optional obturator 13900 that is a component of some embodiments of the access device system. In the illustrated embodiment, the obturator 13900 has a sharp piercing tip 13910. In embodiments in which the trocar 13800 and obturator 13900 are inserted through the gel pad 10530 rather than through the body wall, potential damage to the underlying tissue from contact with the tip 13910 is reduced because the gel pad 10530 serves as an artificial body wall spaced apart from the underlying tissue as described above. In other embodiments, the obturator tip 13910 has another shape, such as a blunt and / or non-bladed shape, which, for example, reduces the risk of damage to other components of the access system, such as the expanding sheath of a retractor.

[0110] The trocar 13800 has a proximal end, a distal end and a longitudinal axis. The trocar 13800 has a cannula 13810 extending along the longitudinal axis. A trocar seal 13820 is provided at the proximal end of the cannula 13810. A retainer 13830 is provided at the distal end or tip of the cannula 13810. In the illustrated embodiment, the distal end or tip of the cannula 13810 is not angled, i.e., is not beveled. Other embodiments have an angled or beveled distal end or tip of the cannula 13810. The illustrated embodiment of the trocar 13800 does not include an insufflation gas inlet. As a result, the trocar 13800 is typically used in procedures where the body cavity is not insufflated or where insufflation is performed via a separate instrument. Other embodiments of trocars are disclosed in U.S. patent application Ser. No. 11 / 677,994, filed Feb. 22, 2007, the disclosure of which is incorporated by reference herein.

[0111] The cannula 13810 has an elongated tubular cannula body 13812 sized to accommodate one or more instruments received therethrough. The cannula body 13812 is a substantially cylindrical tube that, in use, passes through the gel pad 10530. In the illustrated embodiment, the cannula body 13812 extends from a proximal end of the cannula 13810 to which a trocar seal 13820 is coupled, the proximal end having a larger outer diameter than the cannula body 13812.

[0112] In some embodiments, the cannula 13810 is relatively short because the cannula body 13812 only needs to traverse the gel pad 10530 (FIG. 10A) which has a known and consistent thickness and not the body wall. Thus, some embodiments of the cannula body 13812 are about 2 times or less longer than the thickness of the gel pad, about 1.5 times or less longer, about 1.2 times or less longer, or about 1.1 times or less longer. In some embodiments, the cannula body 13812 is about 20 mm or less longer, about 10 mm or less longer, or about 5 mm or less longer than the thickness of the gel pad. In some embodiments, the cannula body 13812 is about the same length as the thickness of the gel pad. In other embodiments, the cannula body 13812 has a different length, for example, a length typical for a cannula used to traverse a body wall. A shorter length of the cannula body allows for increased angular freedom for instruments passing therethrough. Shorter cannula body embodiments also accommodate curved instruments. The cannula 13810 is made of any suitable biocompatible material. In some embodiments, the cannula 13810 is made of a soft material.

[0113] The illustrated trocar seal 13820 includes an instrument or septum seal 13822 and a zero seal 13824. The instrument seal 13822 seals against instruments passing therethrough, thereby maintaining a pressurized state within the body cavity, e.g., a pneumoperitoneum or retroperitoneal pneumoperitoneum state. The zero seal 13824 provides a seal when no instruments are passing through the trocar seal 13820. The instrument seal 13822 and zero seal 13824 are received within a housing 13826 at the proximal end of the cannula 13810 and secured therein by a seal cover 13828.

[0114] The retainer 13830 is disposed at or near the distal end of the cannula 13810. In the illustrated embodiment, the distal end of the cannula 13810 is generally perpendicular or not angled to its longitudinal axis. Other embodiments have an angled or beveled distal end or tip. In some embodiments, the retainer 13830 and the cannula 13810 are integral, while in other embodiments, the retainer 13830 and the cannula 13810 are not integral. In the illustrated embodiment, the proximal end of the retainer 13830 has a flange 13832 that is generally flat and perpendicular to the longitudinal axis, and the distal end is tapered and narrows toward the distal end of the cannula 13810. The flange 13832 reduces the risk of accidental or inadvertent removal of the trocar 13800 from the cap. Some embodiments of the proximal face of the flange 13832 include at least one additional fastening feature, such as barbs, spikes, ridges, texture, etc., configured to pierce or bite into the distal face of the gel pad 10530. In some embodiments, the diameter of the flange 13832 is about 1.5 to about 2.5 times larger or about 2.0 to about 2.2 times larger than the outer diameter of the cannula body 13812. Some embodiments of the trocar 13800 are 5 mm trocars, where the outer diameter of the cannula body 13812 is about 7 mm to about 8 mm.

[0115] The tapered end of the retainer 13830 facilitates either insertion of the trocar 13800 into the gel pad by itself or insertion of the trocar 13800 into the gel pad upon assembly with the obturator 13900 passing through the trocar 13800. For example, in some embodiments, the retainer 13830 is inserted into a preformed opening in the gel pad 10530. Because the gel material embodiments of the gel pad 10530 have a high value for elongation as discussed above, the retainer 13830 can be inserted through a relatively small opening in the gel pad 10530 while still resisting inadvertent back-out as discussed above.

[0116] In some embodiments where the retainer 13830 and the cannula 13810 are not integrated, i.e., separate components, the retainer 13830 is secured to the cannula 13810 after the cannula 13810 is inserted through the cap. In some embodiments, the cannula 13810 and the retainer 13830 are secured mechanically, e.g., with a latch, threads, clip, locking ring, ratchet, etc. In some embodiments, the cannula 13810 and the retainer 13830 are secured adhesively. In some embodiments, the position of the retainer 13830 is adjustable, e.g., to accommodate caps of different thicknesses. In some embodiments, the cannula 13810 and / or the retainer 13830 are secured to the cap, e.g., by adhesive.

[0117] 14A is a side view of another embodiment of a trocar 14800 suitable as a component of the single port surgical access system described above, the trocar including, for example, a gel pad 10530 and a retractor. Some embodiments of the access system include a plurality of trocars 14800. The trocar 14800 is generally identical to the trocar 13800 described above, and the trocar 14800 includes a cannula 14810, a trocar seal assembly 14820, and a retainer 14830, which are generally the same as the corresponding features described above. The illustrated embodiment of the trocar 14800 further includes a bolster 14840 and a locking component 14850. The illustrated embodiment of the cannula 14810 is also referred to as a "fixation cannula," as will become apparent from the following description.

[0118] In the illustrated embodiment, the bolster 14840 is torus or donut shaped. The cannula body 14812 passes through an opening in the bolster 14840. The diameter of the opening in the bolster 14840 is sufficiently larger than the outer diameter of the cannula body 14812 to allow free movement along the cannula body 14812. The illustrated embodiment of the bolster 14840 is made of a deformable material, such as a polymeric resin and / or elastomer, as described in more detail below. Examples of suitable materials include rubber, natural rubber, synthetic rubber, polyisoprene, styrene-butadiene rubber, silicone rubber, ethylene-propylene copolymer, ethylene-propylene-diene monomer rubber, polybutadiene, polychloroprene, polyurethane, and the like. Some embodiments of the bolster 14840 have an anti-friction layer or coating in the area or regions that contact the cannula 14810 to facilitate movement along the cannula 14810.

[0119] The outer diameter of some embodiments of the bolster 14840 is about 0.8 to about 2 times or about 1 to about 1.5 times the diameter of the flange 14832 of the retainer 14830. The thickness of the bolster is about 3 mm (0.12 inches) to about 10 mm (0.4 inches) or about 4 mm (0.16 inches) to about 6 mm (0.24 inches). In some embodiments, the distal face 14844 of the bolster is concave, thereby providing additional clamping or fixation force on the gel pad 10530 and conforming to gel pads 10530 having different and / or non-uniform thicknesses. The particular dimensions of the bolster 14840 are selected based on the properties of the bolster and gel materials and the dimensions of the cannula body 14812, the locking component 14850 and the gel pad 10530.

[0120] The locking component 14850 is disposed on the cannula body 14812 proximal to the retainer 14830 and has a lip 14852 located proximal to the expanding section 14854. The lip 14852 extends radially from the cannula body 14812 with a diameter greater than the diameter of the opening of the bolster 14840. The elastomeric material of the bolster 14840 allows the bolster 14840 to be pushed over and through the lip 14852. In the illustrated embodiment, the lip 14852 has a ratchet sized to facilitate sliding the bolster 14840 distally and resist sliding the bolster 14840 proximally. Also, in the illustrated embodiment, the lip 14852 is a continuous structure that surrounds the cannula body 14812. In other embodiments, the lip 14852 is comprised of a plurality of structures disposed about the cannula body 14812 .

[0121] The flared section 14854 is generally cylindrical and has a diameter approximately the same as or slightly larger than the diameter of the opening of the bolster 14840 such that the bolster 14840 frictionally engages the flared section. In the illustrated embodiment, the flared section 14854 has a length dimension greater than a thickness dimension of the bolster 14840. In the illustrated embodiment, the flared section 14854 does not extend to or contact the flange 14832 of the retainer 14830, thereby not reducing the surface area of ​​the proximal face of the flange 14832 and increasing the removal resistance of the flange 14832. In other embodiments, the flared section 14854 extends to the retainer 14830. Other embodiments do not include a flared section.

[0122] The distance between the distal end of the lip 14852 and the proximal face of the flange 14832 is equal to or slightly less than the sum of the thickness of the bolster 14840 and the thickness of the gel pad 10530. In some embodiments, the gel pad is about 5 mm (about 0.4 inches) to about 30 mm (about 1.2 inches) thick or about 13 mm (about 0.5 inches) to about 25 mm (about 1 inch) thick.

[0123] The trocar 14800 has at least two configurations: a first or insertion configuration shown in FIG. 14A and a second or fixation configuration shown in FIG. 14B.

[0124] In an embodiment of a method of using the trocar 14800, the trocar 14800 is placed in an insertion configuration in which the bolster 14840 is first positioned on the cannula body 14812. The trocar 14800 is placed within the artificial body wall before and / or after the artificial body wall is joined to the patient's body.

[0125] In the embodiment shown in FIG. 14A, the bolster 14840 is disposed at the proximal end of the cannula body 14812, where the bolster 14840 frictionally engages a distal portion of the cannula level 14814, which is an enlarged portion at the proximal end of the cannula 14810 to which the seal assembly 14820 is coupled.

[0126] The distal end of the trocar 14800 is positioned over the artificial body wall, for example a gel pad 10530, and then the retainer 14830 is inserted through the gel pad 10530. In some embodiments, the obturator 13900 (FIG. 13) is first inserted through the seal assembly 14820 at the proximal end of the trocar, with the tip 13910 extending from the distal end of the trocar prior to this step. In other embodiments, an opening is first made in the artificial body wall using a separate instrument. In other embodiments, the distal end of the trocar 14800 is pushed through the artificial body wall, thereby making the opening in the process.

[0127] 14B by sliding the bolster 14840 down along the cannula body 14812 and over the lip 14852 and along the enlarged section 14854. In the illustrated configuration, the artificial body wall is captured and compressed between the flange 14832 of the retainer and the bolster 14840. The lip 14852 locks the bolster 14840 in place preventing the bolster from moving proximally, thereby securing or locking the trocar 14800 to the artificial body wall.

[0128] In the fixation configuration, the trocar 14800 is fixed relative to the localized portion of the artificial body wall with which it is engaged. However, as discussed above, embodiments of the artificial body wall exhibit high elongation. Thus, as the artificial body wall is deformed, the trocar 14800 can translate and / or rotate relative to its original position and orientation.

[0129] In embodiments using the obturator 13900, the obturator is removed. The trocar 14800 serves as an access port for one or more instruments during a surgical procedure.

[0130] If desired, the trocar 14800 is removed from the artificial body wall, for example, by first disengaging the bolster 14840 from the locking component 14850 and then withdrawing the retainer 14830 from the artificial body wall. In some embodiments, the trocar 14800 and the artificial body wall are not disengaged and are disposed of as a unit. In some embodiments, the bolster 14840 is not detachable from the locking component 14850.

[0131] 15 is a side view of another embodiment of a retention trocar 15800, which is generally similar to the embodiment shown in FIGURES 14A and 14B and described above. The trocar 15800 has an elongated tubular cannula 15810 with a proximal end, a distal end and a cannula body 15812, a seal assembly 15820 coupled to the proximal end of the cannula 15810, a retainer 15830 at the distal end of the cannula 15810, a bolster 14840 through which the cannula body 15812 passes, and a locking component 15850 on the cannula body proximal of the retainer 15830.

[0132] In the illustrated embodiment, the locking component 15850 has an enlarged diameter section 15854 having threads 15852. The bolster 15840 has threads that mate therewith such that the bolster 15840 is threadably engageable with the locking component 15850. The threading also allows the relative position of the bolster 15840 and the flange 15832 of the retainer to be adjusted in the fixation configuration of the trocar 15800, thereby allowing fixation to non-uniform and / or varying thicknesses of artificial body walls.

[0133] FIG 16A is a side view of another embodiment of a trocar 16800. FIG 16B is a perspective view of an embodiment of a bolster 16840 that can be used with the trocar 16800. The combination of the trocar 16800 and bolster 16840 is generally the same as the trocar embodiment shown in FIG 14A, FIG 14B, and FIG 15. The trocar 16800 has an elongated tubular cannula 16810 with a proximal end, a distal end, and a cannula body 16812, a seal assembly 16820 coupled to the proximal end of the cannula 16810, a retainer 16830 at the distal end of the cannula 16810, and a locking component 16850 on the cannula body proximal of the retainer 16830.

[0134] In the illustrated embodiment, the locking component 16850 has an enlarged diameter section 16854 with a plurality of annular rings 16852 extending radially from the cannula body 16812 defining a plurality of annular slots 16856. In the illustrated embodiment, the proximal edge of each ring 16856 is beveled, although some embodiments do not include beveled edges.

[0135] 16B illustrates an embodiment of a bolster 16840 in the form of a clip having a flat body 16842 with a notch 16844 having a semicircular portion. The notch 16844 is sized to engage with the slot 16856. The thickness of the body 16842 at the notch 16844 is also sized to engage with the slot 16856. The bolster 16840 has a grip 16846 extending perpendicularly from the body 16842 which provides a user grip for attaching and / or adjusting the bolster 16840. In other embodiments, the notch 16844 has another shape, such as a polygon, a rectangle, a portion of an octagon, etc.

[0136] In use, the trocar retainer 16830 is inserted into the artificial body wall as described above and secured therein by fitting the bolster 16840 into the annular slot 16856, thereby providing the desired fixation force. The degree of fixation is adjustable by selecting different slots.

[0137] In some embodiments, the bolster notch 16844 engages with a plurality of slots, thereby providing additional stability in the locking configuration. Other embodiments have a bolster through which the cannula body 16812 passes, similar to the embodiments described above. In some of these embodiments, the locking component 16850 acts as a ratchet. The bolster has one or more pawls that are optionally removable to allow for increased adjustability.

[0138] Figure 17A is a side view of an embodiment of a trocar 17800 having a fixation cannula, and Figure 17B is a perspective view of an embodiment of a bolster. The embodiment shown in Figures 17A and 17B is generally similar to the trocar embodiment shown in Figures 14A-16B and described above.

[0139] The trocar 17800 includes an elongated tubular cannula 17810 having a proximal end, a distal end and a cannula body 17812, a seal assembly 17820 coupled to the proximal end of the cannula 17810, a retainer 17830 on the cannula body 17812, and a locking component 17850 on the distal end of the cannula 17810. The illustrated embodiment of the trocar 17800 is similar to the embodiment shown in FIG. 16A, with the positions of the retainer 17830 and locking component 17850 reversed. In the illustrated embodiment, the flange 17832 of the retainer faces distally.

[0140] The locking component 17850 has an enlarged diameter section 17854 with a plurality of annular rings 17852 extending radially from the cannula body 17812 defining a plurality of annular slots 17856 .

[0141] 17B shows an embodiment of a bolster 17840 in the form of a clip having a flat body 17842 with a notch 17844 having a semicircular portion. The notch 17844 is sized to engage a slot 17856 in the locking component. Additionally, the thickness of the body 17842 at the notch 17844 is sized to engage the slot 17856. The illustrated embodiment of the bolster does not include a grip, while other embodiments do.

[0142] In some embodiments using the trocar 17800 embodiment, the cannula 17810 is secured to the artificial body wall, which is then coupled to the patient's body. For example, in some embodiments, one or more trocars 17800 are secured to the gel pad 10530 of the gel cap 10500 (FIG. 10A), which is then coupled to the retractor 6100.

[0143] While the present invention has been particularly shown and described with reference to exemplary embodiments thereof, it will be understood by those skilled in the art that various changes in form and detail of these embodiments can be made without departing from the spirit and scope of the invention as set forth in the appended claims.

Claims

1. 1. A surgical access port system for performing a surgical procedure at a patient's natural orifice, comprising: an outer ring, the outer ring configured to be placed proximate the natural orifice of the patient; and a tubular body having a longitudinal axis, a proximal end and a distal end, the proximal end of the tubular body being coupled to the outer ring; a retaining sleeve having a longitudinal axis, a proximal end, a distal end, and a lumen, the tubular body being disposed within the lumen for movement along the longitudinal axis of the retaining sleeve; at least two arms, each having a proximal end connected to the distal end of the retaining sleeve, and wherein when the distal end of the tubular body engages with the at least two arms, the at least two arms are movable from a closed position to an open position.

2. a male thread wound around the exterior of the tubular body and a female thread wound around the interior surface of the lumen of the retaining sleeve; The surgical access port system of claim 1 , wherein the male threads are adapted to engage the female threads to facilitate unidirectional movement of the tubular body through the lumen of the retaining sleeve.

3. 2. The surgical access port system of claim 1, further comprising a plurality of teeth along an outer surface of the tubular body and a plurality of detents along an inner surface of the lumen of the retaining sleeve, the plurality of teeth adapted to engage the plurality of detents to facilitate unidirectional movement of the tubular body through the lumen of the retaining sleeve toward the distal end.

4. 1. A surgical access port system for performing a surgical procedure at a patient's natural orifice, comprising: a tubular body having a longitudinal axis, a proximal end and a distal end; a retaining sleeve having a longitudinal axis, a proximal end, a distal end, and a lumen; the tubular body is disposed within the lumen of the retaining sleeve and is configured to move along the longitudinal axis of the retaining sleeve; A surgical access port system, wherein the tubular body includes a ratchet mechanism configured to move the tubular body in one direction along the longitudinal axis of the retaining sleeve.

5. Further comprising at least two arms, each of the at least two arms having a proximal end attached to the distal end of the retaining sleeve; The surgical access port system of claim 4 , wherein the at least two arms are movable from a closed position to an open position when the distal end of the tubular body engages the at least two arms.

6. the ratchet mechanism includes male threads wrapped around the exterior of the tubular body and female threads wrapped around the interior surface of the lumen of the retaining sleeve; The surgical access port system of claim 5 , wherein the male threads are adapted to engage the female threads to facilitate unidirectional movement of the tubular body through the lumen of the retaining sleeve.

7. the ratchet mechanism includes a plurality of teeth disposed along an exterior surface of the tubular body and a plurality of pawls disposed along an interior surface of the lumen of the retaining sleeve; The surgical access port system of claim 5 , wherein the plurality of tines are adapted to engage the plurality of pawls to facilitate unidirectional movement of the tubular body through the lumen of the retaining sleeve toward the distal end.

8. 8. The surgical access port system of claim 3, wherein the tines are disengageable from the pawls when pressure is applied, thereby permitting rearward movement of the tubular body within the lumen of the retaining sleeve, in a direction away from the distal end of the retaining sleeve.

9. The surgical access port system of claim 8 , wherein the release of the plurality of tines is effected by depression of the tubular body.

10. The surgical access port system of claim 1 or 5, wherein the at least two arms are configured to be foldable to facilitate insertion or removal of the surgical access port system from the natural orifice.

11. 10. The surgical access port system of claim 1 or 5, wherein the at least two arms are arranged in a flared manner to hold the natural orifice open when pressure is applied to the at least two arms.

12. 6. The surgical access port system of claim 1, wherein engagement of the distal end of the tubular body with the at least two arms corresponds to the tubular body advancing through the lumen of the retaining sleeve and applying pressure to the proximal ends of the at least two arms.

13. The surgical access port system of claim 12, wherein the tubular body is configured to move the at least two arms from the closed position to the open position when engaged with the at least two arms.

14. 6. The surgical access port system of claim 1, wherein the at least two arms have a first position in which the at least two arms are parallel to the longitudinal axis when in the closed position and are movable to a second position in which the at least two arms are angled relative to the longitudinal axis.

15. the retaining sleeve having a lip at the proximal end; The surgical access port system of claim 1 or 4, wherein the lip is configured to prevent the proximal end of the retaining sleeve from entering the natural orifice.

16. the tubular body is configured to receive an obturator; 6. The surgical access port system of claim 1, wherein the obturator comprises a proximal bearing surface sized and configured to support an inner surface of the tubular body and a distal expansion surface configured to expand the patient's natural orifice for passage of the tubular body through the natural orifice.

17. 17. The surgical access port system of claim 16, wherein the obturator comprises a handle configured to selectively twist and rotate the obturator relative to the longitudinal axis of the tubular body during insertion into the patient's natural orifice.

18. an outer ring configured to be positioned adjacent the natural orifice of the patient; The surgical access port system of claim 4 , wherein the proximal end of the tubular body is coupled to the outer ring.

19. It also has a removable cap, the removable cap is configured to be attached to the outer ring; The surgical access port system of claim 1 or 18, wherein the removable cap provides a sealable surface including a gel pad.

20. The surgical access port system of claim 1 or 4, further comprising a funnel segment at the proximal end of the tubular body.

21. a bolster disposed at the proximal end of the tubular body; The surgical access port system of claim 1 or 5, wherein the bolster is configured to externally occlude the natural orifice.

22. 6. The surgical access port system of claim 1, wherein each of the at least two arms further comprises an articulating hinge configured to facilitate movement of the at least two arms between the closed position and the open position.

23. the articulating hinge further comprises an inclined lead configured to allow the at least two arms to move at a small wiggle rate; The surgical access port system of claim 22 , wherein the angled lead is positioned to engage the distal end of the tubular body upon movement of the tubular body through the retaining sleeve.

24. a mechanical balloon disposed about the tubular body and attached to the first and second rings; the first ring is located away from the distal end of the tubular body; The surgical access port system of claim 1 or 4, wherein the second ring is fixed to the distal end of the tubular body.

25. the mechanical balloon includes a plurality of arms; The surgical access port system of claim 24, wherein each of the plurality of arms has a proximal end attached to the first ring and a distal end attached to the distal end of the tubular body.

26. The surgical access port system of claim 25, further comprising a balloon ratchet mechanism configured to unidirectionally move the first ring along the tubular body.

27. 27. The surgical access port system of claim 26, wherein the balloon ratchet mechanism is configured to resist non-unidirectional movement of the first ring until the ratchet mechanism is released.

28. 28. The surgical access port system of claim 27, wherein the balloon ratchet mechanism is releasable by depressing both sides of the tubular body.

29. 25. The surgical access port system of claim 24, wherein unidirectional movement of the first ring along the tubular body causes the mechanical balloon to flare.

30. a flange disposed about the tubular body; The surgical access port system of claim 1 or 4, wherein the flange has a circular ridge and includes a cup-shaped channel surrounding the tubular body.

31. the flange secures the surgical access port system at the natural orifice of the patient; the flange is compressible against a wall associated with the patient's natural orifice, thereby forming a seal to maintain infusion; 31. The surgical access port system of claim 30, wherein the cup-shaped channel of the flange is flexible, allowing the flange to flex to accommodate different anatomical structures and maintain the seal with respect to the different anatomical structures.

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