Illuminated surgical access system

Abstract

To provide an illuminated surgical access system. [Solution] A lighting surgical access system is provided, comprising an annular retractor / protector and a photo-emitter system attached thereto. The annular retractor / protector retracts and protects the patient's body opening while the photo-emitter system illuminates the internal surgical site, body cavity, or body opening.

Description

Technical Field

[0001] [Cross - Reference to Related Applications] This application claims priority and the benefit thereof to U.S. Provisional Patent Application No. 63 / 089,486, filed Oct. 8, 2020, and No. 63 / 248,319, filed Sep. 24, 2021, both of which are hereby incorporated by reference in their entirety.

[0002] This application generally relates to systems and methods for illuminating a surgical site, and more particularly to a lighted annular protector - trocar and its system and method for illuminating an internal surgical site.

Background Art

[0003] Proper illumination of the surgical site assists the surgeon or medical personnel in positioning and operating surgical instruments within the limited spatial boundaries of the patient's body cavity, facilitating the surgical procedure. Overhead surgical lamps are ubiquitous in the operating room but are limited in providing effective illumination mainly due to their positioning far outside the surgical site (e.g., incision or patient aperture). Also, light enters from limited directions, e.g., only 1 or 2 directions, making it difficult to avoid casting shadows that limit the visibility of the surgical site. In addition, the illuminated area is not precisely focused, causing glare around the site and reducing visual contrast. The amount of light that can illuminate anatomical structures or surgical sites within the body is also restricted by the size of the incision or aperture, and it becomes extremely difficult to achieve sufficient illumination when the size of the incision or aperture is small. The convenience of the overhead lamp is further reduced by the need for frequent readjustment to find the proper angle, especially when the surgical procedure requires repositioning of the patient.

Summary of the Invention

Problems to be Solved by the Invention

[0004] Surgical headlamps share many of the same drawbacks, including the problem of shadows cast by unidirectional light, glare around the incision, and limited light entering the incision or opening. Such lamps can also be inconvenient, as they are often bulky or require continuous concentration to maintain properly directed light. Illuminated single-point retractors aim to solve some of the problems caused by the ineffectiveness of overhead lights and headlamps, but they sacrifice some convenience because they must be held by hand. These illuminated retractors also fail to provide annular illumination to the surgical site. Furthermore, such devices often provide unidirectional light without being able to illuminate deep inside the patient's cavity. In addition, the direction of the light beam is often not adjustable without losing traction. Other illumination systems fail to address or overcome the challenge of shielding from surrounding tissue or the device itself, along with thermal, luminous output, or other similar performance, manufacturing, and procedural issues. [Means for solving the problem]

[0005] Various embodiments provide an illuminated surgical access system. The illuminated surgical access system comprises an annular protective body and an optical emitter system. In various embodiments, the annular protective body comprises an outer ring, an inner ring, a sheath, or a combination thereof. In various embodiments, the optical emitter system comprises a light-emitting diode, a plastic optical fiber, an optical fiber, or a light emitter that can be connected to a laparoscope.

[0006] In various embodiments, the illuminated surgical access system further comprises a light skirt that can be attached to the sheath, the light skirt comprising a hoop circumferentially arranged around the outer edge of the sheath and movable longitudinally relative to the sheath. In various embodiments, at least one elongated light strand is arranged to extend from the hoop and emit light away from the inner ring.

[0007] In various embodiments, the illuminated surgical access system further comprises a flexible hoop that can be attached to the outer ring. In various embodiments, at least one flange extends from the flexible hoop. In various embodiments, the illuminated surgical access system further comprises a curved support that can be attached only to a section of the outer ring, leaving each portion along the outer ring in the absence of any such support. In various embodiments, at least one flange is connected to the curved support and extendable therefrom. In various embodiments, the illuminated surgical access system further comprises a cap or flange that can be detachably connected to the outer ring and a plurality of optical emitters, each optical emitter being adjustable in position relative to the cap or flange and independently adjustable relative to one another.

[0008] In various embodiments, the illuminated surgical access system further comprises optical clips detachably attached to the outer and / or inner rings. In various embodiments, a flexible neck is arranged to be bendable and extendable from the optical clips. In various embodiments, the illuminated surgical access system further comprises a cap detachably connected to the outer ring, the cap including one or more openings through which one or more optical bands pass and extend distally toward the inner ring. In various embodiments, the illuminated surgical access system further comprises an inner curved support or optical clip detachably connected to the inner ring, the inner curved support comprising light-emitting diodes incorporated within the inner curved support. In various embodiments, the illuminated surgical access system further comprises a mesh illuminator extending across the access channel and attached to the inner ring. In various embodiments, the illuminated surgical access system further comprises an inflatable balloon attached to the sheath or inner ring, the optical emitter system being attached to or integrated within the balloon. In various embodiments, the illuminated surgical access system further comprises an instrument guard, and the light emitter system is mounted on or integrated within the instrument guard.

[0009] In various embodiments, an illuminated surgical access system comprises an outer ring, an inner ring, and a sheath having a proximal end connected to the outer ring positioned outside the body cavity or externally to an internal surgical site, and a distal end connected to the inner ring positioned inside the body cavity or proximal to an internal surgical site. The sheath defines the boundary of an access channel extending from the outer ring to the inner ring. The illuminated surgical access system comprises a light emitter comprising a light-emitting diode, a light emitter, and a POF. The light emitter can be connected to a POF, a laparoscope, or both. Light is provided by an optical emitter system comprising one or more light sources, carriers, or emitters, etc., including light boxes, LEDs, POFs, and various equivalents or combinations thereof, which are connected to and integrated with or mounted thereto, in various embodiments.

[0010] Many of the incidental features of the present invention will be more readily apparent, as they will be better understood by referring to the above and below descriptions and considering them together with the accompanying drawings.

[0011] The present invention can be understood by referring to the following description together with the accompanying drawings, in which reference numerals throughout the drawings indicate similar parts. [Brief explanation of the drawing]

[0012] [Figure 1] This is a perspective view of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 2] This is a bottom view of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 3] This is a side view of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 4] This is a side view of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 5] This is a top view of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 6] This is a perspective view of various parts of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 7] This is a perspective view of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 8] This is a perspective view of various parts of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 9] This is a perspective view of various parts of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 10] This is a perspective view of various parts of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 11] This is a perspective view of various parts of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 12] This is a bottom perspective view of each part of an activated state illuminated surgical access system located within an internal surgical site and illuminating it, according to various embodiments of the present invention. [Figure 13] These are top views of various parts of an activated state illuminated surgical access system for illuminating an internal surgical site, according to various embodiments of the present invention. [Figure 14] This is a perspective view of various parts of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 15] This figure shows a graphic representation of a plastic optical fiber illustrating the cuts made to incident light and internal surgical sites according to various embodiments of the present invention. [Figure 16] This figure shows a graphic representation of a plastic optical fiber illustrating the cuts made to incident light and internal surgical sites according to various embodiments of the present invention. [Figure 17] This is a side view of multiple cuts or notches in a plastic optical fiber according to various embodiments of the present invention. [Figure 18] This is a top perspective view of multiple cuts or notches in a plastic optical fiber according to various embodiments of the present invention. [Figure 19]Side view of an adapter according to various embodiments of the present invention. [Figure 20] Side view of an adapter according to various embodiments of the present invention. [Figure 21A] Diagram of the end profile or cap of a plastic optical fiber according to various embodiments of the present invention. [Figure 21B] Diagram of the end profile or cap of a plastic optical fiber according to various embodiments of the present invention. [Figure 21C] Diagram of the end profile or cap of a plastic optical fiber according to various embodiments of the present invention. [Figure 21D] Diagram of the end profile or cap of a plastic optical fiber according to various embodiments of the present invention. [Figure 22] Cross-sectional side view of a lighted surgical access system according to various embodiments of the present invention. [Figure 23] Perspective view of a lighted surgical access system according to various embodiments of the present invention. [Figure 24] Cross-sectional side view of a lighted surgical access system according to various embodiments of the present invention. [Figure 25] Cross-sectional side view of a lighted surgical access system according to various embodiments of the present invention. [Figure 26] Cross-sectional side view of a lighted surgical access system according to various embodiments of the present invention. [Figure 27] Cross-sectional side view of a lighted surgical access system according to various embodiments of the present invention. [Figure 28] Cross-sectional side view of a lighted surgical access system according to various embodiments of the present invention. [Figure 29] Cross-sectional side view of a lighted surgical access system according to various embodiments of the present invention. [Figure 30] Cross-sectional side view of a lighted surgical access system according to various embodiments of the present invention. [Figure 31] Cross-sectional side view of a lighted surgical access system according to various embodiments of the present invention. [Figure 32] This is a cross-sectional side view of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 33] This is a perspective side view of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 34] This is a perspective side view of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 35] This is a perspective side view of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 36A] This is a cross-sectional side view of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 36B] This is a cross-sectional side view of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 36C] This is a perspective side view of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 37] This is a cross-sectional side view of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 38] This is a cross-sectional side view of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 39A] This is a cross-sectional side view of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 39B] These are perspective top views of various parts of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 40A] These are cross-sectional side views of various parts of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 40B] These are cross-sectional side views of various parts of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 41] This is a cross-sectional side view of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 42] This is a cross-sectional side view of a lighting-type surgical access system according to various embodiments of the present invention. [Figure 43]This is a cross-sectional side view of a lighting-type surgical access system according to various embodiments of the present invention. [Modes for carrying out the invention]

[0013] Various embodiments provide illuminated surgical access systems, and various embodiments and diagrams of exemplary illuminated surgical access systems are shown in Figures 1 to 43. In various embodiments, the illuminated surgical access system includes a protector / retractor 3 (hereinafter referred to as the “retractor”) that provides annular or 360-degree protection and / or retraction of a patient’s opening or orifice. The illuminated surgical access system provides unobstructed, illuminated access to the patient’s body or cavity. The retractor comprises an outer ring or outer support 5 and an inner ring or inner support 7. The inner and outer rings are connected by a film, fiber, thin film, or sheath 9. The retractor is length-adjustable by wrapping the sheath around the outer ring, and such adjustments can apply traction or radial force to retract or enlarge an opening in the patient. In various embodiments, the retractor is length-adjustable or otherwise adjustable to accommodate various patient body types or body wall thicknesses. In various embodiments, the retractor has a fixed or predetermined length and / or cannot be adjusted in length by winding an outer ring or other similar arrangement. The outer ring 5 is configured to be positioned outside the patient to facilitate access, adjust traction, and accommodate the arrangement of an illuminated surgical access system. In various embodiments, the sheath defines an operating channel or access channel extending from its proximal end to its distal end, and the illuminated surgical access system provides unobstructed illuminated access along and / or within the access channel defined by the sheath 9.

[0014] The retractor has sufficient flexibility to remain intact when deployed through the patient's orifice or otherwise placed and positioned within the orifice. In various embodiments, the outer diameter or circumference of the retractor when activated and / or deployed is defined or not greater than the outer diameter of the inner and / or outer rings. In various embodiments, the sheath 9 is made of an elastic or nonmetallic material to remain intact when the retractor is activated or deployed through the patient's orifice or otherwise placed and positioned within the orifice. In various embodiments, the sheath is made of one or more layers of material and, in various embodiments, is anisotropic, for example, stretchable or elongable in the longitudinal direction but hardly stretchable in the radial direction, and is made of or includes one or more layers of fiber or similar material having such anisotropy.

[0015] A light carrier, such as a plastic optical fiber (POF) 11, is connected to the distal portion of the retractor sheath 9. In various embodiments, the POF 11 is an elongated tube or tubular structure and / or has a core covered or wrapped with an outer cladding. The POF 11 has a distal portion attached to the distal portion of the sheath, which for ease of reading is referred to herein as the “POF tail” 16. Furthermore, the POF 11 has a proximal portion configured to extend from the POF tail 16 or an intermediate portion which is between the POF tail 16 and the proximal portion. The proximal portion of the POF is referred to herein as the “POF tip” 14 for ease of reading. The POF tail or each of its portions is coupled to the sheath 9 of the retractor. In various embodiments, the POF tail or each of its portions is coupled to the sheath 9 by a sleeve 8.

[0016] As shown in the illustration, in various embodiments, the POF 11 is attached to the retractor sheath 9 through a sleeve 8. In various embodiments, the sleeve 8 surrounds all or at least a portion of the outer edge of the distal portion of the sheath. The sleeve is configured to house the POF or the distal portion of the POF tail 16 and, in various embodiments, provides a channel through which the POF extends. In various embodiments, the sleeve 8 is fused over the proximal and distal portions of the sheath with respect to the longitudinal axis that encloses and surrounds the POF. The sleeve 8 creates a barrier to prevent blood or other foreign matter from entering the sleeve, obstructing the POF, and / or absorbing light emitted from the POF. In various embodiments, the sleeve 8 helps to fix the POF to the retractor sheath 9, thereby preventing the POF from detaching from the sheath or being released elsewhere. In various embodiments, the sleeve 8 fixes the POF so that it does not move independently along the sheath or longitudinally, or at least not beyond the boundaries of the sleeve. Therefore, in various embodiments, the arrangement of the sheath determines the arrangement of the sleeve, and thus the arrangement of the POF.

[0017] In various embodiments, the sleeve is embedded in or integrated with the sheath 9 of the retractor. In various embodiments, the sheath comprises at least two walls, e.g., an inner wall and an outer wall, and the POF tail portion 16, the sleeve 8, and / or each portion thereof are positioned between these walls of the sheath. To prevent foreign matter from entering, an opening for accessing and positioning the POF tail portion between these walls can be sealed by heat or otherwise closed. In various embodiments, a seal 24 is positioned at one end of the sleeve 8 to prevent foreign matter from entering the seal, and in various embodiments, the seal is positioned between the POF tail portion 16 and the POF tip portion 14. To fix the POF so that it does not move independently along the sheath in the longitudinal or longitudinal direction, or at least not beyond the boundaries of the sleeve, the above and / or the following heat melting, etc., can be used. The heat-sealed seal may extend around the sheath or only along one or more portions thereof. In various embodiments, the sleeve is manufactured from one or more layers of material. In various embodiments, the light output can be increased by covering the posterior portion of the POF with a reflective material 22. The reflective material reflects the leaked light back into the POF. In various embodiments, the reflective material is positioned between the sleeve 8 and the sheath 9 or between each portion thereof. In various embodiments, the reflective material is integrated into the sleeve 8 or each portion thereof, for example, the upper portion, to reflect light further into the internal surgical site in a downward or distal direction.

[0018] In various embodiments, a light emitter or light source can be connected to the POF. In various embodiments, the light emitter or light source is an optical box 40 or tower configured to be connected to a laparoscope or endoscope. The endoscope can be connected to the optical tower through an optical cable 30, in which case one end 31 is connected to the optical tower and the other end 32 is connected to the endoscope. Thus, the optical cable is configured to be connectable to an optical tower or similar light source configured to supply light to a surgical laparoscope or endoscope. In various embodiments, the light source is supplied by the surgical laparoscope or endoscope, and / or the light source of these endoscopes is connected to the light source. In various embodiments, the light source has a power source or power supply, and / or a controller for adjusting the optical output of the light source.

[0019] Light sources, which are sources that supply light to endoscopes and laparoscopes, are often advantageously available in most surgical environments, thus providing advantages to the user and facilitating the operation of illuminated surgical access devices. Furthermore, such sources can also be positioned away from the surgical site, and the light output of the light source can be adjusted, thus providing the advantage of adjusting the POF connected to the light source. However, it must be acknowledged that other sources of light can be provided to supply light to the POF or connected to other illuminated surgical access devices. Therefore, such light sources described are not limiting and should be interpreted as examples of light sources for POFs. However, any light source, either by itself or through other connections, adapters, or amplifiers, etc., will supply sufficient lumens or light output to illuminate the internal surgical site and / or access channel through the connected POF. In various embodiments, the light source is a xenon light source, a 300-watt light source, one that produces at least 1500 lumens of light output, or any combination thereof. In various embodiments, the light source consists of one or more light-emitting diodes (LEDs). In various embodiments, a light source, such as one or more LEDs, can be connected via an optical cable, connector, adapter, POF, or a combination thereof. In various embodiments, the light source is battery-powered.

[0020] In various embodiments, the illuminated surgical access system comprises one or more adapters or adapter 21 and / or connector 12 configured to provide continuity between the POF and the light source, optical cable, and / or the intermediate connection between the light source and / or optical cable. This continuity minimizes optical loss by ensuring that light is transmitted directly from the optical cable, source, and / or repeater to the POF without gaps or cavities, for example, and reduces the temperature experienced by the adapter and / or connector. In various embodiments, continuity is provided by a flush or nearly flush contact or similar connection that minimizes or eliminates gaps or cavities between the POF and the light source, optical cable, and / or the intermediate connection between the light source and / or optical cable. In various embodiments, the illuminated surgical access system comprises one or more adapters or adapter 21 and / or connector or connector 12 configured to provide flush or nearly flush contact between the POF and the light source, optical cable, and / or the intermediate connection between the light source and / or optical cable.

[0021] In various embodiments, the adapter and / or connector is manufactured from a plastic or metal with high heat dissipation properties. In various embodiments, the adapter and / or connector is manufactured from or covered with insulating material arranged to minimize heat transfer to other components, the user, and / or the patient.

[0022] In various embodiments, the adapter provides the user with the ability to swap adapter connection types on demand and / or swap available optical cables, light sources, and / or intermediate connections. In various embodiments, the adapter is a replaceable adapter and / or a double-sided adapter. For example, as shown in Figure 19, adapter 21c is a double-sided adapter having one side 25 having an interface arranged to engage with and secure a first one or more predetermined type of connection to an optical cable and / or light source, and the opposite or reversed side 27 having an interface arranged to engage with and secure a second or different one or more predetermined type of connection to an optical cable and / or light source. Both sides 25, 27 of adapter 21c are arranged to engage with and secure the connector 12 of POF 11. In various embodiments, the sides 25, 27 connect and secure the adapter to the respective connection by screw threads, clips, snap fasteners, keyways, bayonets, or various other interfaces or joining features. In various embodiments, the adapter connects to a fixed ACMI adapter using screw threads or snap fastener features. In various embodiments, the connector and / or adapter, for example, adapter 21d, includes a lever or arm, for example, arm 29, configured to expand or contract its inner diameter or opening to open / close or clamp around a light source, a connection or end of an optical cable, and / or an intermediate connection, for example, an adapter or additional cable. In various embodiments, one end of the adapter and / or connector has an adjustable opening or crimp interface, for example, adapter 21d, as shown in Figure 20, and in other various embodiments, the adapter and / or connector has adjustable openings or crimp interfaces at both ends. In various embodiments, the adapter 21 can be integrated into the connector 12 as a monolithic structure or permanently mounted elsewhere, or can replace or be used in place of the connector 12.

[0023] In various embodiments, the end of the optical cable is configured to be detachably attached to a connector of a laparoscope or illuminated surgical access device. In various embodiments, the connector and / or adapter is configured to be detachably connected directly to a light source. In various embodiments, the connector and / or adapter is configured to be detachably connected to the optical cable. In various embodiments, the connector is provided to connect only to a specific connection given to the end of the optical cable. In various embodiments, the connector and / or adapter is customizable or adjustable to accept one or more different types of connectors or connection given or provided to the end of the optical cable. In various embodiments, the connector and / or adapter is connectable to and / or compatible with industry standard surgical optical cables.

[0024] In various embodiments, the connector 12 has snap-on connectors arranged so that one or more adapters, for example, adapters 21a, 21b, snap onto the open end of the connector 12. In various embodiments, the connector 12 includes one or more O-rings or snap-on rings having corresponding grooves or channels configured to seal and engage with the inner diameter portion of the adapter and further improve the connection between the two. In various embodiments, the connector 12 and / or adapter 21 have one or more flanges extending radially from their outer surfaces over the connector 12 and / or adapter 21 to prevent or restrict the movement or extension of the adapter or the connection of the connector to the adapter. In various embodiments, the adapter has multiple ends of similar connection types. For example, adapter 21a has a snap-on connector at one end and a snap-on connector at the opposite end. In various embodiments, the adapter has multiple ends of dissimilar connection types. For example, adapter 21b has a snap-on connector at one end and a screw-on connector at the opposite end. In various embodiments, the connector 12 is used without adapter 21.

[0025] In various embodiments, the adapter is positioned to be press-fitted onto the outer surface of various types of optical cables. In various embodiments, the adapter is positioned to connect or secure the connector and / or optical cable by magnetic connection. In various embodiments, the adapter features a friction-utilizing push-lock that connects and secures the optical cable to the adapter by inserting the optical cable into an internal opening and subsequently releasing the optical cable. In various embodiments, the adapter is positioned to connect directly to a connector on an optical box or light source. In various embodiments, the adapter consists of a clamshell-like component positioned to crimp and secure the optical cable and POF together. In various embodiments, the clamshell further includes compressible foam or similar material or has steps of various diameters to mate with and secure optical cables and / or their connectors or other repeaters that bring them together, of various sizes or dimensions and / or shapes. In various embodiments, the proximal end of the POF includes a preloading or biasing mechanism, such as a spring or O-ring, which is arranged to engage with the distal end of the optical cable and / or adapter to compress a spring, for example, in order to bias the optical cable and / or adapter to a flush contact position when the optical cable is connected to the adapter. In various embodiments, the adapter includes one or more lenses arranged to focus light from the optical cable into the POF, and / or in various embodiments, the connector includes one or more lenses arranged to focus light from the adapter into the connector and / or light from the connector into the POF.

[0026] In various embodiments, the adapter and / or connector includes a heat sink or other heat sink and / or insulator to reduce or minimize thermal effects that may occur due to non-facial contact with the optical cable, adapter, and / or connector. In various embodiments, the adapter and / or connector includes an insulating sleeve positioned to reduce thermal effects and / or thermal diffusion that may potentially adversely affect the user, patient, and / or the device or other surrounding devices or components.

[0027] In various embodiments, the POF tip 14 transmits or transmits light from the proximal end or connector 12 to the POF tail 16 in various embodiments, and further ultimately to an internal surgical site, body cavity, or body orifice. In various embodiments, the POF tip is an elongated tube, tubular, or cylindrical structure.

[0028] In various embodiments, the POF tip 14 is covered with a heat-shrinkable material to eliminate glare, reduce bending, and / or to join or connect a connector and / or sleeve to the POF. The heat-shrinkable material or another opaque material acts as a barrier to prevent light from leaking out of the tip and causing glare. In various embodiments, the heat-shrinkable material has an opaque color and / or contains or is made of a non-transparent material.

[0029] In various embodiments, the POF tip 14 and / or POF tail 16 are provided with a heat-shrinkable material that provides a layer of material that narrows the POF and prevents sharp bends. Sharp bends within the POF can cause a considerable amount of light loss. In various embodiments, heat shrinkage is used to help to fix or seal connectors, adapters, and / or sleeves to the POF. It should be noted that heat shrinkage eliminates glare, reduces bends, and joints adapters and / or connectors with the POF, solving multiple problems at once. In various embodiments, the POF can be painted or coated to eliminate glare, stress-relieving material can be used to reduce bends, and / or clamps can be used to reinforce heat shrinkage or bring the task to a separate or individual joint or connection with the adapter, connector, or sleeve.

[0030] In various embodiments, the POF tip 14 is configured to maintain flexibility, allowing the user to manipulate the POF to avoid tissue trauma to the incision wall or interference with the retractor sheath. In various embodiments, the POF tip is configured to prevent the POF from detaching or shifting, thereby maintaining optimal light output or throughput between the light source and the POF. In various embodiments, the POF tip is configured to block emission from the POF until light reaches the POF output site, thereby maximizing illumination or reduction of light delivered or transmitted to this site. In various embodiments, the POF tip comprises an opaque, e.g., black film or backing, which may or may not be a heat-shrinkable material that provides flexibility and light shielding. In various embodiments, a selection of the opaque film, sleeve, wrap, or backing, e.g., a proximal and / or distal portion or end, is heat-shrinkable over the tube of the POF tip. In other embodiments, the POF tip is, e.g., white, with a less opaque film or backing, which may or may not be a heat-shrinkable material that provides flexibility. In various embodiments, the POF tip comprises a heat-shrinkable body with a black adhesive backing that provides flexibility and resistance to tensile forces or detachment of the POF tip, and provides light shielding. In various embodiments, the light output can be increased by wrapping the POF tip with a reflective material before applying heat shrinkage. The reflective material reflects the leaked light back to the POF.

[0031] In various embodiments, the POF tip includes cuts, slits, and / or notches that function as cooling notches to reduce or dissipate a portion of the light energy incident on the POF before such energy reaches the POF tail. In various embodiments, the cooling notches are provided beneath an opaque film, sleeve, wrap, or backing that is heat-shrinkable over the POF tip, for example, a heat-shrinkable body with a black adhesive backing. In various embodiments, the opaque film, sleeve, wrap, or backing is heat-shrinkable over the POF tip, for example, a heat-shrinkable body with a black adhesive backing, allowing light to be absorbed through the cooling notches, thereby dissipating the thermal energy over a larger area along the POF and preventing it from concentrating at the POF tail 16 and / or its distal or furthest end.

[0032] In various embodiments, the posterior tail portion 16 of the POF is configured to be located or positioned inside the surgical site. In various embodiments, the posterior tail portion of the POF is an elongated tube, tubular, or cylindrical structure. In various embodiments, the posterior tail portion of the POF comprises one or more notches, notches, or recesses 18. In various embodiments, the notches 18 are angled to a predetermined or pre-defined angle, for example, 45 degrees or near thereto, to ensure internal total internal reflection with respect to more than half of the light encountering the notches. In various embodiments, the notches or notches are angled to an angle 180 with respect to the axis 181, between 42 and 45 degrees, for example, as shown in Figures 15-16. When light reaches the other side of the POF, the light is refracted out of the POF because the angle between the ray and the surface of the POF is large enough that it leaks out instead of being reflected inside the POF. Reflecting light to the other side of the POF is advantageous because the cylindrical POF wall helps to diffuse the light. The cuts are positioned so that refracted light is directed towards the anatomical structures within the body.

[0033] In various embodiments, the period and number of the slits 18 are predetermined or set in advance to produce uniform light extraction and dispersion near the distal end of the sheath and / or at the internal surgical site. Each slit extracts light and reduces the amount of light traveling through the POF, thereby causing attenuation at subsequent slits. To compensate for or address this attenuation, the period / number of slits are predetermined in various embodiments to ensure uniform light extraction throughout. In various embodiments, one or more slits are predetermined or set in advance to produce uniform light extraction and dispersion near the distal end of the sheath and / or at the internal surgical site.

[0034] In various embodiments, the notches are present on the surface or punched into the POF. Circular holes through the POF can achieve a similar result to notches. In various embodiments, the POF is notched to increase the brightness and / or light output at the surgical site by about 10 times compared to an unprocessed or unnotched POF. In addition to or instead of this, the POF is notched to reduce the power required to generate the desired light output and / or brightness, reducing the required power by 50 to 60 percent compared to the power required by an unprocessed or unnotched POF in various embodiments.

[0035] In various embodiments, the notches of the POF11 can be modified in period and / or depth to change the optical output, focus, and / or direction of light at the surgical site, for example, by illuminating or focusing on a certain portion with respect to the orientation of a retractor and a POF attached thereto.

[0036] For example, as shown in Figures 21A to 21D, the distal end 17 of the POF 11 may have a predetermined or fixed end profile, cover, and / or cap. In various embodiments, the distal end 17 of the POF 11 may have a flat end, profile, or shape, e.g., a flat end 17a, and / or a cap, cover, or lens of the flat end, shape, or profile. The flat end 17a is configured to direct light from the POF 11 outwards from the distal end 17 of the POF in a linear or longitudinal direction along the central axis of the POF. Thus, the light from the POF is emitted without being obstructed and is not reflected back into the POF. In various embodiments, the distal end 17 of the POF 11 may have an angled end, shape, or profile, e.g., an angled end 17d, and / or a cap, cover, or lens of the angled or inclined end, shape, or profile. The angled end 17d is oriented so as to direct the light from the POF 11 perpendicular or oblique to the central axis or longitudinal axis of the POF, and / or so as to be offset or parallel to the central axis of the POF.

[0037] In various embodiments, the terminal profile of the POF 11 is tapered or rounded to refract light radially. In various embodiments, the distal end 17 of the POF 11 has a tapered or rounded end, profile, or shape, and / or a cap, cover, or lens of the tapered or rounded end, shape, or profile, for example, having a tapered end 17b or a rounded end 17c. For example, in various embodiments, light is dispersed radially instead of leaking parallel to the POF 11, thereby illuminating anatomical structures within the body. In various embodiments, inside the POF 11, light travels at ±25 degrees with respect to the central axis of the POF. To extract all of this light radially, the terminal profile is tapered at ±23 degrees. In various embodiments, the tapered profile of the POF extracts light radially. In various embodiments, the distal portion or distal end of the POF has a different profile or shape from the distal end or distal portion of the cap, cover, or lens of the POF. In various embodiments, the distal end 17 of the POF 11 has a different shape other than flat, for example, a round or prism-shaped end, profile, or shape, and / or has a cap, cover, or lens over such end, shape, or profile, in order to direct or diffuse light toward or toward high illumination, to minimize optical interference, and / or to reduce thermal energy or thermal energy.

[0038] In various embodiments, the distal end 17 of the POF 11 has a predetermined profile or shape, and / or a cap, cover, or lens of a predetermined shape or profile, to facilitate the diffusion or rerouting of light into anatomical structures within the body and to facilitate more even distribution of light / thermal energy. In various embodiments, the distal end 17 of the POF 11 is provided with a coating, cover, or otherwise configured to facilitate the diffusion or rerouting of energy or light emitted from the distal portion or distal end of the POF 11. In various embodiments, the cap, cover, or lens is integrated into the distal portion or distal end 17 of the POF 11 to form a monolithic structure. In various embodiments, the cap, cover, or lens, for example, the cap 171 shown in Figures 5 and 14, is friction-fitted, bonded, or otherwise attached to the distal portion or distal end 17 of the POF 11. In various embodiments, the cap, cover, or lens has an inner diameter that matches or is somewhat larger than the outer diameter of the distal portion or distal end of the POF for friction fitting to or attachment to the distal portion or distal end of the POF. In various embodiments, the cap, cover, or lens has an outer diameter that is larger than the outer diameter of the distal portion or distal end of the POF. In various embodiments, the cap, cover, or lens has an inner concentric tube or cylinder and / or one or more projections, and the outer surface of the inner tube, cylinder, or projections is configured to attach or connect to the inner surface of the distal portion or distal end of the POF to further secure the cap, cover, or lens to the distal portion or distal end of the POF. In various embodiments, the cap, cover, or lens has one or more indentations or cavities along or within the outer surface or end face of the cap, cover, or lens to facilitate its own attachment and / or removal, and / or to direct the energy or light of the POF.

[0039] In various embodiments, the cap, cover, or lens includes a reflective film, coating, or backing to facilitate the reflection of some of the light energy back into the POF tail section, thereby increasing the light intensity instead of being reflected back into the body cavity and / or completely absorbed by the cap, cover, or lens. In various embodiments, a disc of mirror-like reflective film may be placed on, for example, inside the cap, cover, or lens, or bonded to the end portion of the POF tail section, where the disc of reflective film is configured to reflect light back into the POF, increasing the brightness of the light emitted into the body cavity, and to reduce the heat absorbed by the cap, cover, lens, or end portion of the POF tail section, thereby lowering or reducing the temperature they experience. In various embodiments, the cap or cover is positioned on the most distal end of the POF tail section, and both the cap or cover and the distal end are positioned within a sleeve, and in various embodiments, the cap, sleeve, and / or sheath insulate the outer or annular area from the heat generated by light at the end of the POF tail section. In various embodiments, the cap is positioned to minimize the temperature of its exterior. For example, the cap has an outer shell that creates an insulating gap between the core or inner portion at the distal end of the POF tail and / or the inner shell or inner portion of the cap connected thereto. In various embodiments, the POF and / or POF tail and / or cap, cover, or lens has a wall thickness, coating, covering, and / or material configured to prevent the temperature of the POF tail and / or cap, cover, or lens from being lower than or equal to a predetermined temperature, e.g., 43°C, or within a range, e.g., 40-45°C, or 43°C.

[0040] In various embodiments, the illuminated surgical access system comprises two inner and outer thermoplastic polyurethane (TPU) rings, a TPU film forming a sheath between these rings, a plastic optical fiber (POF) made from methyl methacrylate, a polyolefin heat-shrinkable tubing material covering a portion of the POF, and / or connectors and / or adapters for adapting to industry-standard surgical optical cables.

[0041] In various embodiments, illuminated surgical access devices or systems are provided to eliminate the shortcomings of current surgical illumination technologies. In various embodiments, illuminated surgical access devices or systems illuminate internal surgical sites, cavities, incisions, or openings while enabling hands-free 360-degree retraction and / or protection. Thus, illuminated surgical access devices or systems are configured to provide annular, intact retraction and illumination of internal surgical sites, cavities, incisions, or openings to achieve maximum exposure within the patient's cavities, incisions, and / or openings.

[0042] In various embodiments, the illuminated surgical access system places the illumination element below the incision or patient opening, which eliminates the problem of glare and / or shadow around the incision, as well as the problem of insufficient light entering through a small incision or opening. In various embodiments, the POF is positioned above the inner ring and / or mounted there on the sheath, thereby avoiding or reducing shielding by the inner ring, not interfering with the function of the inner ring fixed in the patient cavity, and / or not reducing the flexibility of the inner ring when positioned through the patient opening, while still aligning the light output within the internal surgical site.

[0043] In various embodiments, a portion of the POF configured to seat below the incision or opening of the patient has notches or slits that help disperse light from the POF to illuminate the internal surgical site or internal surgical space, body cavity, incision, or opening. The POF tip or each portion thereof that exits through the incision or opening is, in various embodiments, shielded to prevent light leakage and terminated with connectors and / or adapters for connection to a standard surgical lighting unit or surgical lighting source. The light-emitting portion of the illuminated surgical access system is positioned below the incision or opening so as not to cause glare above the incision or opening, maintaining visual contrast of the internal surgical site or internal surgical space. Furthermore, since the light is delivered by the POF into the incision or opening, the amount of light that can illuminate the surgical space is not limited by the size of the incision or opening.

[0044] In various embodiments, the hoop or semicircular shape of the POF contributes to the illumination effect of the illuminated surgical access device or system. In various embodiments, the exposed portion of the plastic optical fiber is mounted around the sheath to follow the path or outline of the sheath or inner ring, and the light is emitted evenly around the circumference of the inner ring's sheath. Thus, the light emitted from the system is evenly distributed and / or omnidirectional rather than originating from a single point, thereby eliminating the problem of shadows being cast within the surgical field. For example, if the surgeon's hand or instrument is inserted into an incision or opening, thereby blocking the light or parts thereof from one side of the ring, the other half of the ring will continue to illuminate the area, preventing disruptive shadows. The evenly distributed and / or omnidirectional nature of the light also solves the problems of frequent repositioning (e.g., commonly required with overhead lamps) and keeping the light in the correct direction (e.g., generally difficult with headlamps). When light is positioned at the incision or opening and can enter or disperse from all angles, the need to adjust the positioning or angle of the light to provide sufficient illumination is minimized or eliminated, even when the patient needs to be repositioned.

[0045] When the POF is integrated with a self-holding retractor or attached to another device, it is possible to make the illuminated surgical access device completely hands-free during use. This solves the problems and / or inconveniences of other illuminated retractors that require a member of the surgical team to constantly hold the retractor in place. In various embodiments, when activated, the illuminated surgical access device is positioned in the incision by crushing the inner ring and inserting it through the incision or opening, where it then expands and locks into place. The outer ring pulls the sheath and is turned inside out and lowered to open the incision. At this point, the illuminated surgical access device or illuminated surgical access system will continue to open the incision or opening hands-free without requiring any further adjustments. When the POF is attached to the sheath or otherwise mounted above or at a distance from the distal portion or end of the inner ring or sheath, the addition of the POF does not alter or interfere with the opening operation or procedure and / or the fixation of the inner ring, and the illuminated surgical access device or illuminated surgical access system can be used hands-free after initial positioning. In various embodiments, when the POF is attached to the sheath or otherwise mounted above or at a distance from the distal portion of the inner ring or sheath, optical interference by the distal portion of the inner ring or sheath can be avoided or eliminated, and / or the positioning of the POF can be facilitated and / or optimized.

[0046] In various embodiments, the POF is one or more plastic optical fibers. In various embodiments, a bundle of plastic optical fibers is used, which improves the flexibility of the POF and, in various embodiments, has an equal diameter. In various embodiments, the POF is a plurality of plastic optical fibers that, when bundled together, form the boundary of a circle or cylinder having a diameter of about 5 mm. In various embodiments, the plurality of plastic optical fibers are joined at a connection between the POF tip and POF tail, located in or around the sheath 9, sleeve 8, and / or inner ring 5. In various embodiments, a plurality of smaller POF fibers from the POF tip terminate at different points along or around the distal end of the inner ring 5 and / or sheath, dispersing the light to these selected points. In various embodiments, the POF comprises a plurality of plastic optical fibers having different lengths and / or diameters to disperse the light to various points and / or to adjust the flexibility of the POF in different parts of the POF. In various embodiments, the POF is a single plastic optical fiber having a diameter of about 5 mm. In various embodiments, the POF has a diameter equal to or greater than the diameter of the optical cable. In various embodiments, the POF is elongated and tubular, and in various embodiments, comprises one or more elongated and tubular plastic optical fibers. In various embodiments, the tip of the POF or each portion thereof that aligns with the patient's opening or incision has a thinned, reduced, or smaller profile, for example, having an elliptical, rectangular, or similar shape, to prevent obstruction and / or interference with the retractor and / or the patient's body opening and / or incision.

[0047] In various embodiments, the POF or each portion thereof is or comprises an end-emitting optical fiber that reduces optical loss. In various embodiments, the POF comprises various types of plastic optical fibers. For example, in various embodiments, the POF tip comprises an end-emitting POF and transitions to a side-emitting POF at a predetermined connection point in or near the sheath. In various embodiments, the POF tip comprises an end-emitting POF and the POF tail comprises a side-emitting POF. In various embodiments, a coupler, such as a T-coupler, is provided where the POF tip terminates in or around an inner ring, and the T-coupler is positioned between the POF tip and one or more side-emitting POFs to connect them, for example, the POF tail comprises one or more side-emitting POFs. In various embodiments, the POF or each portion thereof is molded into an arc-shaped or circular shape with one or more bubbles embedded within to disperse light away from the outer ring and towards an internal surgical site or area of ​​interest.

[0048] In various embodiments, the POF and / or sleeve are configured to not exceed a predetermined temperature, for example, 40-45°C or 43°C. In various embodiments, the POF and / or sleeve configured in this way comprises one or more layers, coatings, films, or thermal or heat dissipation or reduction insulators. In various embodiments, an additional or second sleeve is provided and attached to the sheath. The second sleeve wraps around or covers the leading end of the POF. In various embodiments, the second sleeve is oriented perpendicular or obliquely to the longitudinal axis and access channel of the sheath. In various embodiments, the second sleeve is oriented laterally to the sleeve containing the tail portion of the POF. In various embodiments, the second sleeve and the sleeve containing the tail portion of the POF are joined or integrally formed to provide a single-structure sleeve. In various embodiments, all or part of the POF and / or sleeve includes or is integrated with a reflective film, coating, or cover to reflect light back into the POF and reduce light loss. In various embodiments, a cable management device or cable management system is attached to or integrated with the POF to adjust, control, or distribute the desired length of the POF for surgical use, while keeping any excess portion of the POF in a managed state, such as coiled or wrapped, to prevent shielding by the excess portion of the POF.

[0049] During surgery, surgical dehiscence is achieved by first compressing the inner ring and inserting it into the incision or opening, seating it beneath the desired fixation tissue. Next, the outer ring is turned inside out or rolled up by the user, thereby stretching the sheath and applying outward pressure to the wound or opening, substantially dehiscence the tissue. The placement of the POF around and / or spaced away from the most distal portion of the inner ring or sheath positions the POF beneath the fixation tissue and / or incision or opening within the internal surgical site and / or access channel. The illuminated surgical access system is sealed on the sheath above the inner ring and illuminates the internal surgical site and / or access channel by transmitting light through the POF from inside the incision or opening to the outside of the sterile field. The light is supplied from a surgical light source and transmitted through a surgical optical cable. The optical cable is connected to one of the system's adapters. Once the surgical procedure is complete or if necessary, the user can disconnect the optical cable from the adapter and / or connector and remove the illuminated surgical access device from the surgical site.

[0050] In various embodiments, the POF is kept separate from the sheath and later attached to the sheath for surgical use. In various embodiments, the POF is incorporated, fitted, or positioned within the sleeve of the sheath for surgical use during the procedure or in anticipation of the surgical procedure. In various embodiments, the sheath has a pocket into which the POF is incorporated or positioned within the sheath for surgical use during the procedure or in anticipation of the surgical procedure. In various embodiments, the POF is contained between the inner ring and the sheath, with or without the sleeve, for example, by turning the inner ring attached to the sheath inside out and covering the POF. In various embodiments, a buffer or impact barrier, such as rubber or elastic buffer, is provided attached to or connected to the POF, sheath, and / or sleeve to isolate or protect the body or surgical opening from the pressure acted upon by the operation or the POF during surgical use. In various embodiments, the buffer or impact barrier is positioned between the posterior tail of the POF, the posterior tip of the POF, and / or both, and the opening and / or incision of the body. In various embodiments, the POF tail section, the POF tip section, or both are placed between a cushioning material and / or an impact barrier and / or a sheath and / or sleeve.

[0051] In various embodiments, a lighted surgical access system may comprise a retractor and a POF connected to or otherwise attached thereto. In various embodiments, a lighted surgical access system may comprise a light source, a retractor, and a POF connected to the retractor and the light source. In various embodiments, the POF is detachably connected to the light source and / or the retractor. In various embodiments, a lighted surgical access system may include an optical cable connecting the light source to the POF. In various embodiments, a lighted surgical access system may comprise a surgical access device and a POF connected to or otherwise attached thereto. In various embodiments, the surgical access device may be or include a retractor, cannula, or trocar, etc., that provides access, a channel, or a pathway into the patient's body cavity, and / or may be flexible enough to be bent, and / or may allow a portion of itself to be deformed or compressed by tissue, etc.

[0052] In various embodiments, the illuminated surgical access system may include a retractor of adjustable length to accept 360-degree hands-free protection and / or openings within the patient, depending on the anatomical structure of the patient. In various embodiments, the retractor may not include an outer ring, an inner ring, or both. In various embodiments, the illuminated surgical access system may include a surgical access device, a POF, and / or a light source. In various embodiments, the illuminated surgical access system includes a POF. In various embodiments, the POF is spaced apart and separated from the inner ring and / or from the most distal portion, most distal component, or most distal end of the sheath or surgical access device. In various embodiments, the POF is fixed to the sheath or otherwise constrained longitudinally or lengthwise along or relative to the sheath. In various embodiments, one or more POFs may be attached to the sheath, and one or more POFs may extend around the sheath or along each portion thereof. In various embodiments, the inner ring or inner support or each of its parts is manufactured in whole or in one or more parts of one or more of it from one or more POFs, such as molded POFs and / or side-emitting POFs. Thus, in various embodiments, the one or more POFs described throughout this application can be used in place of or function as the inner ring. In various embodiments, the sheath or each of its parts is arranged to function as a light curtain that delivers light to or toward the internal surgical site under the body wall or patient opening. In various embodiments, a skirt, drape, and / or second sheath is attached to the distal end of the sheath and / or the inner ring, and / or extends therefrom, and functions as a light curtain that delivers light to or toward the internal surgical site under the body wall or patient opening.

[0053] In various embodiments, the POF comprises a POF tip and / or a POF tail. In various embodiments, an optical cable and / or a repeater thereto is directly connected to the POF tail, and the POF tip is removed, for example. In various embodiments, the POF comprises a core and a cladding surrounding or encasing it. In various embodiments, the outer layer of the POF cladding is modified, such as by adding surface roughness, to facilitate light scattering. In various embodiments, the outer cladding layer or each portion thereof is removed, and for example, one or more portions of the POF, such as the POF tail or one or more sections of the core of each portion thereof, are exposed beneath the incision or internal surgical site. In various embodiments, the optical emitter system comprises one or more POFs or each portion thereof.

[0054] In various embodiments, the POF and / or POF tail portion comprises one or more cuts, protrusions, projections, or other points, portions, or areas of deflection and / or reflection that are shaped, sized, or otherwise dimensioned to modulate the light scattering of the POF. In various embodiments, the POF and / or POF tail portion comprises one or more cuts, protrusions, projections, or other points, portions, or areas of deflection and / or reflection for partially directing light in one or more specific directions. In various embodiments, the specific directions are toward the internal surgical site or internal surgical area and / or away from or opposite to the outside of the patient or the outside portion of the surgical access system. In various embodiments, one or more cuts, protrusions, projections, or other points, portions, or areas of deflection and / or reflection allow or permit incident light to travel along any of the remaining portions of the POF or further along a portion of it in the opposite direction to its propagation. In various embodiments, one or more cuts, protrusions, projections, or other points, portions, or areas of deflection and / or reflection are, for example, holes, channels, grooves, or openings angled perpendicular to or less than 45 degrees to the POF or optical cable. In various embodiments, the POF and / or POF tail section comprises one or more cuts, protrusions, projections, or other points, portions, or areas of deflection and / or reflection that are molded or otherwise pre-formed in predetermined shapes, sizes, and / or dimensions to adjust or provide optimal light scattering or dispersion. In various embodiments, the POF and / or POF tail section comprises one or more cuts, protrusions, projections, or other points, portions, or areas of deflection and / or reflection above or away from the internal surgical site or internal surgical area. In various embodiments, light travels to the end of the POF, encountering other points or areas of deflection, reflection, or refraction along the way. In various embodiments, the end portion of the POF includes a specific profile and / or end cap or cover that deflects, reflects, or refracts incident light in one or more specific directions, and allows the incident light to travel through the end portion of the POF formed by such end profile or cap without obstruction as it is emitted.In various embodiments, the POF comprises a connector, a POF tip, a POF tail, a terminal cap, and / or any combination thereof.

[0055] Referring to Figures 22-23, illuminated surgical access systems 3 in various embodiments are shown, comprising an outer ring 5 and an inner ring 7 together with a sheath 9 connecting these rings. The length of the sheath 9 is adjustable by winding or wrapping the sheath around the outer ring. In various embodiments, a light skirt 201 is attached to the inner ring 7. The skirt comprises one or more light strands, light strings, light strips, light bands, or light drapes 202 extending from a hoop or semicircular ring 203 attached to the outer surface of the sheath above the inner ring. In various embodiments, the hoop 203 has a width or diameter smaller than the diameter of the outer ring, the inner ring, or both thereof. One or more strands, strings, strips, bands, or drapes hang down from and extend through the inner ring to illuminate the internal surgical site or internal surgical space. Light is supplied by the skirt and / or one or more strands, strings, strips, bands, or drapes, or supplied to these skirts and / or one or more strands, strings, strips, bands, or drapes by a light emitter system connectable thereto, the light emitter system comprising one or more light sources, light carriers, or light emitters, including but not limited to integrated or mounted light boxes, LEDs, POFs, and various equivalents or combinations thereof. In various embodiments, the skirt is made movable, removable, and / or adjustable, and can therefore be positioned to change the position of one or more light sources. In various embodiments, one or more light sources are adjustable, removable, and / or repositionable, and can therefore be positioned to change the illumination by changing the position of one or more light sources toward each other and / or the skirt, and to reduce potential occlusion and / or glare by one or more light sources. It should be acknowledged that it is conceivable that an additional one or more light sources may be provided to adjust or change the illumination and / or potential physical or visual occlusion.

[0056] In various embodiments, the size, shape, and / or dimensions of the strands, strings, strips, bands, or drapes 202 can be modified relative to each other and / or to the skirt. In various embodiments, the strands, bands, or drapes 202 extend substantially along the longitudinal direction or are aligned with the longitudinal axis of the sheath and extend distally from the skirt and / or the inner ring. In various embodiments, the strands, strings, strips, bands, or drapes have a width less than their length. In various embodiments, the strands, strings, strips, bands, or drapes have a width less than the width or height of the outer ring 5 or the inner ring 7, and / or a length greater than the width or height of the outer ring 5 or the inner ring 7.

[0057] In various embodiments, a flexible semicircular, circular, arc-shaped section, curved support, or hoop 205 can be removably attached to the outer ring 5, as illustrated in Figures 24-25. The outer ring 5, with the curved support or flexible hoop 205 attached, secures the flexible hoop to the outside of the patient's opening. In various embodiments, the hoop 205 has or is defined to have a larger diameter or width than the outer ring, and in various embodiments, the hoop is more flexible than the outer ring. One or more curved flanges 206 extend from the hoop, which are stretchable, expandable, flexible, and / or deformable to fit the patient's opening. In various embodiments, light is supplied to the distal end of the flange to illuminate the internal surgical site. Light is supplied by one or more curved supports or hoops 205 and / or flanges 206, or supplied to these curved supports or hoops 205 and / or flanges 206 by an optical emitter system connectable thereto, the optical emitter system comprising one or more light sources, optical carriers, or optical emitters, including but not limited to integrated or mounted optical boxes, LEDs, POFs, and various equivalents or combinations thereof. In various embodiments, these curved flanges 206 can be clamped together toward insertion, and then, in the positioned state, the curved flanges 206 can be rebent toward the contour of the incision. In various embodiments, one or more flanges and / or hoops can be provided without a sheath, an outer ring, and / or an inner ring. In various embodiments, one or more flanges and / or hoops can be made movable and / or adjustable and thus positioned to change the position of one or more light sources. In various embodiments, one or more flanges can be bent toward insertion through an access channel defined by a sheath. In various embodiments, one or more light sources connectable to one or more flanges and / or hoops are adjustable and / or repositionable, and can therefore be arranged to change the position of one or more light sources relative to each other and / or the flanges.

[0058] In various embodiments, the size, shape, and / or dimensions of one or more flanges 206 can be varied relative to each other and / or the hoop 205. In various embodiments, one or more flanges 206 extend substantially longitudinally or are aligned with the longitudinal axis of the sheath and extend distally away from the hoop 205 and / or the outer ring. In various embodiments, one or more flanges have a width less than their length. In various embodiments, one or more flanges have a width less than the width or height of the hoop, outer ring, and / or inner ring, and / or a length greater than the width or height of the hoop, outer ring, or inner ring.

[0059] In various embodiments, a flexible cap or flange 210 is removably connected to the outer ring 5, as illustrated in Figure 26. The flange is circular, semicircular, or has an arc-shaped section, and light is supplied by one or more photoemitters, e.g., lamps 212, which extend proximal to the flange and distally toward the inner ring and / or directed toward or oriented into the patient's orifice. Light is supplied by one or more flanges or lamps, or to these one or more flanges or lamps by a photoemitter system connectable thereto, the photoemitter system comprising one or more light sources, photocarriers, or photoemitters, including but not limited to integrated or mounted photoboxes, LEDs, POFs, and various equivalents or combinations thereof. In various embodiments, one or more flanges and / or caps have or define an inner diameter or width smaller than the inner diameter of the outer ring and an outer diameter larger than the outer diameter of the outer ring. In various embodiments, one or more flanges and / or caps are more flexible than the outer ring. In various embodiments, the cap and / or flange are movable, for example, rotatable or slidable, relative to the outer ring. In various embodiments, one or more flanges are made movable and / or adjustable, and thus can be positioned to change the position of one or more light sources. In various embodiments, one or more light sources and / or light emitters connectable to the flanges are adjustable and / or repositionable, and thus can be positioned to change the position of one or more light sources relative to each other and / or the flanges. In various embodiments, one or more light emitters are adjustable in position relative to the cap, flange, and / or each other, and are independently adjustable relative to the cap, flange, and / or each other. In various embodiments, one or more flanges include channels arranged to snap onto or connect to the outer ring 5. In various embodiments, the channels include one or more ledges, projections, snaps, and / or other connecting features for securing the flange 210 to the outer ring.In various embodiments, one or more flanges 210 may be provided to change the position of one or more light sources, to reduce potential external occlusion of any of the one or more light sources, and / or to enhance illumination to a specific section or side along the flange or outer ring. In various embodiments, each of the light emitters may be adjustable to change the illumination or direction of light of the light emitter to various directions or heights as needed, for example, on a swivel, adjustable arm, ball and socket, and ratchet. In various embodiments, one or more light emitters may be removable from the flange to change the illumination and reduce potential occlusion and / or glare caused by one or more light emitters. In the illustrated embodiment, three lamps 212 are shown. It should be acknowledged that it is conceivable that one or more additional lamps may be provided to adjust or change illumination and / or potential physical or visual occlusion. In various embodiments, one or more lamps 212 may extend vertically away from the flange and then be angled distally toward the patient's opening or internal surgical site.

[0060] In various embodiments, as illustrated in Figures 27-28, one or more optical clips 216 are removablely attached to the outer ring 5, for example, by clipping. The optical clips are movable, for example, slidable and / or repositionable along the length around the outer ring. In various embodiments, the optical clip comprises a clip 217 and one or more adjustable or flexible necks 218, the clip being attached to the outer ring, and the neck being bendable and extendable from the clip toward the inner ring through the patient opening or access channel of the sheath 9. In various embodiments, light is emitted from the distal portion or distal end of the neck 218, for example, the magnified end 219. Light is supplied by one or more clips, necks, and / or expanding ends, or supplied to these one or more clips, necks, and / or expanding ends by an optical emitter system connectable thereto, the optical emitter system comprising one or more light sources, optical carriers, or optical emitters, including but not limited to integrated or mounted optical boxes, LEDs, POFs, and various equivalents or combinations thereof. In various embodiments, for example as shown in Figure 28, the flexible or adjustable neck and / or clip of the optical clip is positioned or positionable to remain outside the patient's orifice so that light can be emitted distally from outside the patient's orifice, and in addition to or instead of this, it is bent to be positioned within the patient's orifice and / or access channel of the retractor to and / or inside the inner ring. In various embodiments, as in Figure 28, one or more necks and / or clips of the optical clip are, instead of or in addition to, detachably attached to the inner ring and bendable, for example, to pass further beyond the distal end of the retractor and be positioned deep into the patient's openings, body cavities, and / or inaccessible and / or parts of the patient's internal organs or tissues where additional or stronger illumination is desired. In various embodiments, one or more necks and / or clips of the optical clip are bendable from the inner ring above and / or along the access channel of the retractor.

[0061] In various embodiments, the size, shape, and / or dimensions of one or more necks 218 can be varied relative to each other and / or the clip 217. In various embodiments, one or more necks 218 extend substantially longitudinally or are aligned with the longitudinal axis of the sheath and extend distally away from the clip 217 and / or the outer ring 5. In various embodiments, one or more necks have a width less than their length. In various embodiments, one or more necks have a width less than the width or height of the clip, outer ring, and / or inner ring, and / or a length greater than the width or height of the clip, outer ring, or inner ring.

[0062] For example, as shown in Figure 29, in various embodiments, a cap 220 is removably connected to the outer ring 5. The cap has one or more openings, holes, or slots 221 through which one or more optical bands or optical tubes 222 can extend distally toward the inner ring 7. In various embodiments, the cap can cover the entire opening of the outer ring, thereby sealing or blocking the access channel of the sheath 9. In various embodiments, the cap covers a portion of the opening defined or bounded by the outer ring, sealing or blocking a portion of the access channel defined or bounded by the sheath 9, thereby restricting or constraining the optical tube to a specific portion or area relative to the outer ring and / or the sheath. In various embodiments, the cap comprises a gel, ultragel, and / or elastic material. In various embodiments, the cap comprises a penetrable and sealable material, such as a gel, configured to seal in contact with the inserted instrument and / or optical tube and / or to provide a seal in the absence of the instrument inserted through the cap. In various embodiments, the cap seals the access channel of the sheath across the entire opening of the outer ring. In various embodiments, the cap covers only a portion of the opening defined by the outer ring. In various embodiments, the cap comprises an elastic material through which the opening and / or the optical tube or optical band extends. One or more optical bands or optical tubes are bendable and stretchable through the patient opening or sheath access channel from the cap toward the inner ring. Light is emitted from the distal portion or distal end of one or more optical tubes. Light is supplied to these optical bands or optical tubes by an optical emitter system supplied by or connectable to them, the optical emitter system comprising one or more light sources, optical carriers, or optical emitters, including but not limited to integrated or mounted optical boxes, LEDs, POFs, and various equivalents or combinations thereof. In various embodiments, one or more of the one or more optical bands or optical tubes may be POFs, LED strings, or LED strips, etc.

[0063] In various embodiments, the size, shape, and / or dimensions of one or more optical bands or optical tubes 222 can be varied relative to each other. In various embodiments, one or more optical bands or optical tubes 222 are aligned with the longitudinal axis of the sheath so as to extend substantially longitudinally or distally away from the outer ring 5. In various embodiments, one or more optical bands or optical tubes 222 have a width smaller than their length. In various embodiments, one or more optical bands or optical tubes have a width smaller than the width or height of the outer ring and / or inner ring, and / or a length larger than the width or height of the outer ring or inner ring. In various embodiments, one or more optical bands or optical tubes 222 have greater flexibility than the outer ring 5.

[0064] As illustrated in Figure 30, in various embodiments, a semicircular, circular, arc-shaped, or curved inner support or inner hoop 226 can be detachably connected to the inner ring 7. The curved support or hoop 226 of the inner section is configured to partially seat or position between the inner ring and the patient's inner cavity or tissue. In various embodiments, the curved support or hoop of the inner section is flexible enough to be folded or deformed for insertion into the patient's opening and / or access channel of a retractor. In various embodiments, the curved support or hoop 226 has or defines a distal diameter or distal width greater than the diameter of the inner ring and is more flexible than the outer ring in various embodiments. In various embodiments, the inner curved support or hoop has a diameter greater than the diameter of the inner ring and / or a diameter smaller than the outer diameter of the outer ring. In various embodiments, the inner curved support or hoop is more flexible than the outer ring. In various embodiments, the inner curved support or hoop has a channel positioned to snap onto the inner ring. In various embodiments, the inner curved support or hoop has an L-shaped cross-section. In various embodiments, the entire inner curved support or hoop is positioned outside the access channel. In various embodiments, the inner curved support or hoop is transparent or translucent. In various embodiments, the inner curved support or hoop has a transparent or translucent underside that faces away from the inner ring. In various embodiments, the inner curved support or hoop has one or more apertures and / or lenses through which light is emitted. The light is emitted from the distal portion or distal end of the inner section or inner hoop. The light is supplied by the curved support or hoop of the inner section or supplied to the curved support or hoop of these inner sections by an optical emitter system connectable thereto, the optical emitter system comprising one or more light sources, optical carriers, or optical emitters, including but not limited to integrated or mounted optical boxes, LEDs, POFs, and various equivalents or combinations thereof.In various embodiments, one or more sections, curved supports, or hoops include channels arranged to snap into or otherwise connect to the inner ring 7. In various embodiments, the channels include one or more ledges, projections, snaps, and / or other connecting features for securing the section or hoop 226 to the inner ring. In various embodiments, one or more sections, curved supports, or hoops may be provided to change the position of one or more light sources, to reduce potential external occlusion of any of the one or more light sources, and / or to enhance illumination to a particular section or side along these sections, hoops, or inner ring.

[0065] For example, in Figure 31, in various embodiments, one or more optical clips 228 can be detachably mounted on the inner ring, for example, by clipping or snapping. The optical clips are movable, for example, slidable, and / or repositionable along the length around the inner ring. Light is supplied to these optical clips by an optical emitter system supplied by or connectable to the optical clips, the optical emitter system comprising one or more light sources, optical carriers, or optical emitters, including but not limited to integrated or mounted optical boxes, LEDs, POFs, and various equivalents or combinations thereof. Light is emitted from the distal portion or distal end of the optical clip. In various embodiments, the optical clips are dimensioned, flexible, and / or molded to be fitted through the patient opening and / or access channel of the retractor and attachable to the inner ring. In various embodiments, one or more clips are arranged to snap or otherwise connect to the inner ring 7. In various embodiments, the channel comprises one or more ledges, projections, snaps, and / or other connecting features for securing the clip 228 to the inner ring. In various embodiments, one or more clips are provided to change the position of one or more light sources, to reduce the potential external occlusion of any of the one or more light sources, and / or to enhance illumination to these sections, hoops, or specific sections or sides along the inner ring. In various embodiments, the light clips are transparent or translucent. In various embodiments, the light clips cover a portion of the underside of the inner ring and / or have a U-shaped cross-section. In various embodiments, the light clips have a first upper portion in contact with the surface of the inner ring facing the access channel, a second upper portion in contact with the surface of the inner ring facing the access channel, and a lower portion connecting the first upper portion to the second upper portion. In various embodiments, the light clips have a channel having a width and length smaller than the inner diameter of the inner ring and / or positioned to snap onto the inner ring.

[0066] In various embodiments, for example, as shown in Figures 32-33, the sheath 9 or each portion thereof, for example, the distal portion of the sheath, includes a reflective sheet and / or a glossy sheet, coating, or film embedded in or attached to the sheath. The reflective sheet, coating, film, or any combination thereof, for example, a reflective film 191, reflects light from POFs, LEDs, and various equivalents or combinations thereof toward the internal cavity away from the outer ring. In various embodiments, a glossy sheet, coating, film, or any combination thereof, for example, a glossy film 192, absorbs direct and / or reflected light from an external light source such as an overhead surgical light and emits light toward the internal cavity away from the outer ring. In various embodiments, the sheath includes pockets positioned to temporarily hold or enclose adapters, optical cables, and / or portions of the POF toward removal from and connection to each component for use in surgical procedures.

[0067] In various embodiments, one or more LED strips or LED strings, or POFs, etc., can be mounted inside or integrated into a sheath. In various embodiments, for example as shown in Figure 34, one or more LED strips or LED strings, POFs, such as side-emitting POFs and / or end-emitting POFs, and / or any combination thereof, e.g., LED231, can be arranged circumferentially around or inside the sheath, and / or stacked or spaced apart from one another. In various embodiments, for example as shown in Figure 35, one or more LED strips or LED strings, POFs, such as side-emitting POFs and / or end-emitting POFs, and / or any combination thereof, e.g., POF232, can be arranged so as to extend longitudinally from the proximal to the distal portion of the sheath, and circumferentially around or inside the sheath and / or spaced apart from one another. In various embodiments, one or more LED strips or LED strings, side-emitting POFs, etc., and / or any combination thereof can be arranged longitudinally and transversely, e.g., horizontally.

[0068] In various embodiments, as shown in Figures 36A to 36C, for example, one or more LEDs, LED strips or LED strings, POFs, or other photoemitters and / or photocarriers, such as LED 233, may be mounted or integrated only within the distal portion of the sheath and / or the inner ring. For example, in Figure 36A, LED 233 is mountable or integrated on the distal end of the sheath. In the exemplary embodiment shown in Figure 36B, LED 233 is mounted or integrated on the inner surface or inner area of ​​the inner ring, and in Figure 36B, it is mounted or integrated on the outer surface or outer area of ​​the inner ring. In various embodiments, combinations of arrangements of one or more LEDs, LED strips or LED strings, POFs, or other photoemitters and / or photocarriers may be mounted or integrated on the distal portion of the sheath and / or the inner ring. For example, one or more LEDs may be arranged on one or more inner surfaces, outer surfaces, and bottom surfaces of the sheath and / or inner ring. In various embodiments, one or more LEDs, LED strips or LED strings, POFs, or other light emitters and / or light carriers are positioned or arranged as a curtain, grid, or column of light, positioned or arranged in a configuration that is continuous and / or alternating or overlapping with respect to each other vertically. In various embodiments, the curtain, grid, or column of light is positioned above and / or on the inner ring and / or on the distal end or distal portion of the sheath. In various embodiments, the curtain, grid, or column of light extends into the internal surgical site past the distal end or distal portion of the sheath and / or the inner ring. In various embodiments, a portion of the curtain, grid, or column of light is positioned above and / or on the inner ring and / or the distal end or distal portion of the sheath, and a portion of the curtain, grid, or column of light is positioned below or past the distal end or distal portion of the inner ring and / or the sheath.

[0069] In various embodiments, a mesh illuminator is detachably mounted on an inner or outer ring. The mesh light comprises one or more LEDs, LED strips or LED strings, POFs, or other light emitters and / or light carriers arranged in a predetermined pattern and detachably mounted on the inner or outer ring. The spacing of the multiple lights provides access for fixtures and / or hands through them and through access channels in the sheath. The multiple lights are provided in a grid pattern with rectangular, square, diamond-shaped, or other similar spacings or openings that provide access for fixtures and / or hands through them. In various embodiments, the multiple lights are arranged in a row or column-only pattern to enlarge these spacings. In various embodiments, each part of the mesh illuminator is movable relative to other parts of the mesh illuminator to provide access for fixtures or hands through it. For example, a row of light emitters and an adjacent row of light emitters are movable relative to each other, or one is fixed and the other is movable so that spacing is provided between rows of light emitters to allow unobstructed access for fixtures and / or hands through it. In various embodiments, the movable portion of the mesh illuminator is biased and / or elastic, thereby moving to a different position and then returning to its initial position. In various embodiments, the movable portion of the mesh illuminator is provided with a shape memory material or the like, thereby keeping each part of the illuminator in the position it was last moved to. The mesh illuminator provides illumination above and / or below along the sheath and / or its access channels.

[0070] In various embodiments, one or more power sources, such as batteries, and / or switches or buttons to control the power source and / or one or more LEDs, may be mounted or integrated only within the distal portion of the sheath and / or the inner ring. For example, as shown in Figure 37, in various embodiments, a push button 242 is connected to a battery 241 enclosed within, positioned within, or mounted on the outer surface of the inner ring 7, and one or more LEDs 234 enclosed within, or positioned within or along the outer surface of the inner ring. The push button is configured to turn one or more LEDs on and off individually or in groups. For example, as shown in Figure 38, in various embodiments, one or more photocarriers 236 are optically connected to one or more LEDs 235 to transmit light from one or more LEDs toward the body cavity and / or circumferentially around the inner ring 7. In various embodiments, a power source is provided to power one or more LEDs, an LED strip or LED string, or other similar photoemitters. In various embodiments, the power supply is embedded in or attached to the sheath, for example, located in a pocket on the sheath, or in various embodiments, located outside or to the outside of an internal surgical site, body cavity, and / or opening.

[0071] In various embodiments, one or more openings, grooves, channels, slots, or openings are provided within the inner and / or outer rings for connecting or mounting one or more POFs or LEDs to the respective inner and / or outer rings. For example, as shown in Figure 39A, in various embodiments, one or more openings, grooves, channels, slots, or openings within the inner ring provide a through-hole, snap-fit ​​connection, or friction-fit connection between one or more POFs, e.g., the distal end or distal portion of POF251, and the inner ring 7. In various embodiments, one or more openings, grooves, channels, slots, or openings within the inner ring are tapered or have different diameters inside or at different ends, allowing one or more POFs or LEDs to enter but not to come out of the openings, grooves, channels, slots, or openings within the inner ring. In various embodiments, the inner ring 7 has, for example, one or more grooves, channels, or slots, each having an opening guided toward the center of the sheath and arranged to attach to or capture a longitudinally extending POF, e.g., POF252, on its side. In various embodiments, the inner ring 7 has, for example, one or more circumferential grooves, channels, or slots, each having an opening guided toward the center of the sheath or access channel and arranged to attach to or capture a circumferentially or radially extending POF, e.g., POF253, on its side. In various embodiments, the inner ring 7 has, for example, one or more circumferential grooves, channels, or slots, each having an opening guided toward the center of the sheath or access channel and arranged to attach to or capture a circumferentially or radially extending POF, e.g., POF253, on its side. In various embodiments, the inner ring has one or more openings or openings through which a POF, for example, a portion of a longitudinally extending POF, is attached or captured and / or extends through it.

[0072] In various embodiments, the inner ring or its components may be inflatable. In various embodiments, for example, as shown in Figure 41, a balloon 271 is attached to or integrated with the inner ring 7. In various embodiments, the balloon is provided as a separate component from the inner ring but can still be located near the inner ring and / or the distal end of the sheath. In various embodiments, the balloon can be located next to and / or below the inner ring. In various embodiments, the balloon can be an inflatable disk, torus, ring, or one or more inflatable curved sections that are inflated by air or fluid, etc. The POF or its distal section, for example, POF 255, in various embodiments may be integrated with or attached to the balloon, the inflatable inner ring, or its components, and the inflation of such a section can selectively adjust the positioning of the POF or its components, and thus the dispersion of light from each component of the POF, relative to the longitudinal axis of the sheath. In various embodiments, the balloon or inflatable inner ring is molded or sized to position the POFs toward each other, individually, or in groups in a specific direction, for example, horizontally, vertically, or obliquely to or toward the internal cavity. In various embodiments, the balloon or each of its parts is expandable toward and / or toward the inner ring. In various embodiments, each of the balloon and / or inflatable inner ring is selectively inflatable and has a separate isolated inflatable section and / or inflatable light source. In various embodiments, one or more valves, tubes, and / or pumps are provided to inflate the balloon, inner ring, and / or each of its parts or any combination thereof. In various embodiments, other light sources, photocarriers, photoemitters, such as LEDs, can be integrated into or attached to the balloon, inflatable inner ring, or each of its parts instead of or in addition to the POFs.

[0073] In various embodiments, the inner ring or support may include one or more rings or curved portions adjacent to and / or stacked with each other. In various embodiments, the inner ring or support may comprise one or more rings or curved portions, in which case a POF, e.g., a POF tail portion, and / or other photoemitters or photocarriers, etc., may be placed in or attached to one or more of these rings of the inner ring. In various embodiments, for example, as shown in Figure 42, the inner ring or support may comprise an upper ring 275 and a lower ring 276, in which case the POF tail portion is placed in the upper ring 275 and the lower ring 276 separates the POF tail portion from the internal body cavity. In various embodiments, the inner ring or support or each portion thereof may include one or more lumens, slots, or grooves arranged to receive a POF or its distal portion. In various embodiments, one or more lumens, slots, or grooves are molded or dimensioned to position the POFs toward each other, individually, or in groups in a specific direction, e.g., horizontal, vertical, or oblique to or toward the internal cavity. In various embodiments, the inner ring or support or each part thereof is filled with an activated, chemiluminescent material that emits light toward the internal cavity when agitated, in addition to or instead of the POFs or other light emitters. In various embodiments, the inner ring or support or each part thereof is transparent, translucent, reflective, and / or otherwise manufactured or comprises a material that allows or facilitates the emission of light from the POFs and / or other light sources toward the internal cavity, or that minimally obstructs this light. In various embodiments, the inner ring or support or each part thereof, all or one or more parts thereof, are manufactured with one or more side-emitting POFs. In various embodiments, each part of the inner ring and / or outer ring or sheath includes, for example, a removable mounting portion having a hook-and-loop fastener face or connector, to which one or more power supplies, light sources, and / or photocarriers having corresponding hook-and-loop fastener faces or connectors can be detachably mounted.

[0074] In various embodiments, one or more optical fibers are mounted or integrated within a sheath, arranged to carry light from an external light source to illuminate an internal cavity and / or access channel, extending from the proximal end or proximal portion of the sheath to the distal portion or distal end of the sheath. In various embodiments, one or more optical fibers may be provided externally as an optical fiber bundle and then separated individually or in groups and arranged around the sheath. In various embodiments, the optical fiber bundle carries light from a single light source and is separated as individual or group optical fibers dispersed around the sheath. The light is emitted from the distal end and / or along one or more of the dispersed optical fibers.

[0075] In various embodiments, one or more optical conductors are provided to capture and / or transmit light on the outside. In various embodiments, for example, as shown in Figure 43, one or more optical conductors 281, 282 extend from the outer ring 5 along the sheath 9 to the inner ring 7. In various embodiments, one or more optical conductors are integrated with the outer ring and / or the inner ring or are otherwise attached. The proximal ends of one or more optical conductors are connected to one or more openings, slots, channels, or apertures in the outer ring, and the distal ends of one or more optical conductors are connected to one or more openings, channels, slots, or apertures in the inner ring. Each portion of one or more optical conductors can be embedded in and / or between the walls of the sheath or otherwise attached. Furthermore, separate covers or sleeves can be attached to the sheath over one or more optical conductors and, in various embodiments, may include reflective material to assist in further illumination of internal surgical sites and / or openings. In various embodiments, one or more optical conductors may be arranged within the access channel of the sheath. In various embodiments, one or more optical conductors may include notches or notches to direct light further in a specific direction, for example, into the internal surgical site and / or access channel. In various embodiments, in addition to one or more optical conductors, other light sources, optical carriers, optical emitters, such as LEDs and POFs, may be integrated into or mounted on the sheath and / or ring described herein.

[0076] In various embodiments, guards, such as instrument guards and / or shredding guards, can be provided, positioned to protect the sheath and / or surrounding body wall. POFs or other optical emitters described throughout this application can be mounted within or integrated into the guard. For example, in various embodiments, one or more optical emitters are embedded within or mounted within the shredding / instrument guard. The guard is radially adjustable to adjust the diameter by which its boundary is defined. In various embodiments, a retractor can be attached to or provided on the guard. In various embodiments, the guard is provided independently or used without a retractor. In various embodiments, the guard has higher puncture resistance and / or tear resistance than the sheath, and is manufactured from, for example, a highly puncture-resistant and / or highly tear-resistant material. In various embodiments, the guard has higher rigidity than the sheath and / or is positioned to maintain a stationary hourglass shape. In various embodiments, the sheath is inserted through an opening defined or bounded by the guard. In various embodiments, the guard is insertable through the access channel of the sheath and / or biased to abut against or radially press against the sheath. Light is emitted from the distal end of the light emitter and / or the distal end or distal portion of the guard. In various embodiments, the light is supplied by a light emitter system connectable to these distal ends or distal portions, the light emitter system comprising one or more light sources such as LEDs, POFs, or light carriers. In various embodiments, a guard may be provided to the various embodiments of the retractor and corresponding light sources, light carriers, and light emitters described herein, or these embodiments may be integrated into or attached to the guard, in order to further assist in the illumination of the internal surgical site, the patient's anatomical structures, and / or the access channel.

[0077] In various embodiments, a metal retractor or a point retractor can be provided, to which one or more photoemitters can be integrated or attached. In various embodiments, one or more LEDs are mounted on the outer surface of the point retractor, and in various embodiments, one or more LEDs are magnetically connected to the magnetically compatible surface of the point retractor. For example, one or more LEDs may include one or more magnets mounted on one side thereof, with the other side of the magnets attached to the point retractor. In various embodiments, one or more LEDs are magnetically connected to the magnets, and their magnetized or magnetically compatible outer surfaces are positioned outward. For example, an externally positioned power supply or controller for one or more LEDs may include a magnetic surface or magnetic part attached to the LED or a magnetic surface magnetically connected to a part of the LED. In various embodiments, one or more photoemitters and / or photocarriers and / or each of their parts or accessories may be integrated or attached to surgical instruments such as gripping forceps or scalpels and / or auxiliary devices such as surgical gloves. In various embodiments, point retractors and / or instruments are provided in various embodiments of the retractors and corresponding light sources, light carriers, and light emitters described herein to further assist in illuminating internal surgical sites, patient anatomical structures, and / or access channels, or these embodiments can be integrated or attached to point retractors and / or instruments.

[0078] In various embodiments, one or more photocarriers or photoemitters, such as LED strings or LED strips, or transparent needles or embolusers, may be provided separately from the sheath and / or POF, and such photocarriers or photoemitters may illuminate different parts of the internal cavity. In various embodiments, such photocarriers or photoemitters may be positioned, for example, freely or without restriction, relative to the sheath to illuminate a specific area or part of the internal cavity. In various embodiments, to further aid in the illumination of the internal surgical site, the patient's anatomical structure, and / or access channels, such photocarriers or photoemitters may be provided in various embodiments of the retractor and corresponding light source, photocarrier, or photoemitter described herein, or these embodiments may be integrated or mounted on such photocarriers or photoemitters. In various embodiments, one or more magnified distal portions or magnified distal ends of one or more photocarriers or photoemitters, or one or more magnified photocarriers or magnified photoemitters, such as photoballs, may be provided to illuminate the internal cavity or a specific area or part thereof. In various embodiments, one or more tethers, straps, or connectors can be provided to assist in the placement, positioning, and / or removal of one or more optical emitters and / or optical carriers that are not otherwise attached to or integrated with the sheath and / or inner ring. For example, in various embodiments, one or more tethers, straps, or connectors can be attached to one or more optical emitters, optical carriers, and / or associated power supplies that are not otherwise attached to or integrated with the sheath and / or inner ring. In various embodiments, one or more optical emitters and / or optical carriers or each part or accessory thereof can be positioned or configured to emit omnidirectional and / or focused light, for example, downward and / or circumferentially directed light.In various embodiments, light is supplied by the various embodiments or by an optical emitter system connectable to these embodiments, the optical emitter system comprising one or more light sources, optical carriers, or optical emitters, including but not limited to integrated or mounted optical boxes, LEDs, POFs, and various equivalents or combinations thereof.

[0079] The above description is provided to enable those skilled in the art to manufacture and use the devices or systems described herein, and to carry out the methods, and illustrates what the inventors consider to be the best mode of carrying out the invention. However, various modifications will remain obvious to those skilled in the art. These modifications are intended to be within the disclosure of the invention. Different embodiments or aspects of such embodiments may be illustrated and described in various figures throughout this specification. It should be noted that each embodiment and its aspects, while illustrated or described separately, can be combined with one or more of the other embodiments and their aspects unless otherwise explicitly stated. The reason for not explicitly listing each combination is solely to facilitate the reading of this specification.

[0080] Although the present invention has been described in certain specific embodiments, many additional modifications and variations will be apparent to those skilled in the art. Therefore, it should be understood that the present invention can be implemented in ways other than those specifically described, including various changes in size, shape, and materials, without departing from the scope and spirit of the invention. In other words, the embodiments of the present invention should be considered illustrative and not limiting in all respects. [Explanation of Symbols]

[0081] 3. Illuminated Surgical Access System 5. Outer ring 7. Inner ring 9 Sheath 203 Hoop or semicircular ring

Claims

1. A lighting-type surgical access system that illuminates the body cavity internally, An outer ring positioned to be placed outside the body cavity, An inner ring positioned to be placed inside the body cavity, A sheath having a proximal end connected to the outer ring and a distal end connected to the inner ring, the sheath defining the boundary of an access channel extending from the outer ring to the inner ring, Optical emitter system, A system characterized by comprising the following features.

2. The optical emitter system is characterized by comprising a light-emitting diode, as described in claim 1.

3. The optical emitter system is characterized by comprising a plastic optical fiber, as described in claim 1.

4. The optical emitter system is characterized by comprising an optical fiber, as described in claim 1.

5. The optical emitter system is characterized by comprising a light emitter that can be connected to a laparoscope, as described in claim 1.

6. The optical emitter system is characterized by comprising an optical skirt that can be attached to the sheath, as described in claim 1.

7. The system according to claim 6, characterized in that the optical skirt comprises hoops arranged circumferentially around the outer edge of the sheath and movable longitudinally relative to the sheath.

8. The system according to claim 7, characterized in that the hoop is rotatable relative to the sheath.

9. The system according to claim 8, further comprising a plurality of light-emitting diodes connectable to the hoop.

10. The system according to claim 8, further comprising at least one elongated light strand extending from the hoop, wherein the at least one elongated light strand is arranged to emit light away from the inner ring.

11. The system according to claim 10, characterized in that the at least one elongated optical strand comprises at least one plastic optical fiber.

12. The system according to claim 10, characterized in that the at least one elongated optical strand comprises at least one light-emitting diode.

13. The system according to any one of claims 7 to 12, characterized in that the hoop has an outer circumference smaller than the inner circumference of the inner ring.

14. The system according to any one of claims 7 to 13, characterized in that the hoop has an outer circumference smaller than the outer circumference of the inner ring.

15. The system according to claim 1 or 12, further comprising a flexible hoop that can be attached to the outer ring.

16. The system according to claim 15, characterized in that the flexible hoop has a diameter larger than the diameter of the outer ring.

17. The system according to claim 15 or 16, characterized in that the flexible hoop is arranged to be repositionable along the circumference of the outer ring.

18. The system according to claim 17, further comprising at least one flange extending from the flexible hoop.

19. The system according to claim 18, characterized in that the at least one flange or flexible hoop is connectable to the optical emitter system.

20. The system according to claim 19, characterized in that the optical emitter system comprises at least one of a light-emitting diode, a plastic optical fiber, an optical fiber, or a light-emitting device.

21. The system according to claim 19, further comprising a light-emitting diode connected to the distal portion of at least one flange.

22. The system according to claim 19, further comprising a light-emitting diode connected to the flexible hoop.

23. The system according to claim 1 or 12, further comprising a curved support which can be attached only to the section of the outer ring, leaving each portion along the outer ring in the absence of any such support.

24. The system according to claim 23, further comprising at least one flange connected to the curved support and extendable therefrom.

25. The system according to claim 24, characterized in that at least one flange is bendable so as to be inserted through the access channel.

26. The system according to claim 25, characterized in that the at least one flange or curved support is connectable to the optical emitter system.

27. The system according to claim 26, characterized in that the optical emitter system comprises at least one of a light-emitting diode, a plastic optical fiber, an optical fiber, or a light-emitting device.

28. The system according to claim 25, further comprising a light-emitting diode connected to the distal portion of at least one flange.

29. The system according to claim 25, further comprising a light-emitting diode connected to the curved support.

30. The system according to claim 18, 19, 25, or 26, characterized in that the at least one flange comprises a plurality of flanges having different dimensions relative to each other.

31. The system according to claim 18, 19, 25, or 26, characterized in that the at least one flange comprises a first flange having a length shorter than the length of the second flange.

32. The system according to claim 1, 6, 12, 18, 19, 25, or 26, further comprising a cap that can be detachably connected to the outer ring.

33. The optical emitter system is characterized by comprising an optical emitter that is separated from the cap and extends above the outer ring, as described in claim 32.

34. The system according to claim 33, characterized in that the optical emitter can be directed downward and toward the inner ring.

35. The system according to claim 33, characterized in that the optical emitter is adjustable in position relative to the cap and is adjustable independently of the cap.

36. The system according to claim 33, wherein the optical emitter comprises a plurality of optical emitters, and each optical emitter is adjustable in position relative to the cap and is adjustable independently of each other.

37. The system according to any one of claims 33 to 36, characterized in that the optical emitter comprises a light-emitting diode.

38. The system according to claim 33 or 37, characterized in that the cap is movable relative to the outer ring.

39. The system according to claim 33 or 37, characterized in that the cap is rotatable relative to the outer ring.

40. The system according to claim 1, 6, 12, 18, 19, 25, or 26, further comprising a flange that can be detachably connected to the outer ring.

41. The optical emitter system is characterized by comprising an optical emitter that extends away from the flange and above the outer ring, as described in claim 40.

42. The system according to claim 41, characterized in that the optical emitter can be directed downward and toward the inner ring.

43. The system according to claim 41, characterized in that the optical emitter is adjustable in position with respect to the flange and is adjustable independently with respect to the flange.

44. The system according to claim 41, wherein the optical emitter comprises a plurality of optical emitters, each optical emitter being adjustable in position with respect to the flange and independently adjustable with respect to one another.

45. The system according to any one of claims 41 to 44, characterized in that the optical emitter comprises a light-emitting diode.

46. The system according to claim 41 or 45, characterized in that the flange is movable relative to the outer ring.

47. The system according to claim 41 or 45, characterized in that the flange is rotatable with respect to the outer ring.

48. The system according to claim 41 or 45, characterized in that the flange is slidable along the outer surface of the outer ring.

49. The system according to claim 41 or 45, characterized in that the flange has an inner surface that is in contact with the outer surface of the outer ring.

50. The system according to claim 41 or 45, characterized in that the flange has a channel that defines a snap-type connection portion to the outer ring.

51. The system according to claim 50, characterized in that the channel has a lower ledge that can be detachably connected to the lower outer edge of the outer ring.

52. The system according to claim 50 or 51, characterized in that the channel has an inner lower ledge that is removablely connectable to the lower inner edge of the outer ring.

53. The system according to claim 33, 37, 41, or 45, characterized in that the optical emitter is height-adjustable.

54. The system according to claim 33, 37, 41, or 45, characterized in that the optical emitter is rotatable.

55. The system according to claim 1, 12, 18, 19, 25, or 26, further comprising an optical clip detachably attached to the inner ring.

56. The system according to claim 55, characterized in that the optical clip is movable relative to the inner ring.

57. The system according to claim 55, characterized in that the optical clip is slidable along the circumference of the inner ring.

58. The system according to claim 1, 6, 12, 18, 19, 25, 26, or 55, further comprising an optical clip detachably attached to the outer ring.

59. The system according to claim 58, characterized in that the optical clip is movable relative to the outer ring.

60. The system according to claim 58, characterized in that the optical clip is slidable along the circumference of the outer ring.

61. The system according to claim 55 or 58, further comprising a flexible neck that is bendable and is arranged to be extendable from the optical clip.

62. The system according to claim 61, characterized in that the distal end of the flexible neck has an enlarged end.

63. The system according to claim 61 or 62, characterized in that the flexible neck is bendable so as to be inserted into the access channel.

64. The system according to claim 61 or 62, characterized in that the flexible neck is bendable to move away from the inner ring or the outer ring.

65. The system according to any one of claims 61 to 64, characterized in that the flexible neck or the optical clip is connectable to the optical emitter system.

66. The system according to claim 65, characterized in that the optical emitter system comprises at least one of a light-emitting diode, a plastic optical fiber, an optical fiber, or a light-emitting device.

67. The system according to claim 65, further comprising a light-emitting diode connected to the distal end of the flexible neck.

68. The optical clip further comprises a light-emitting diode connected to the optical clip, The aforementioned flexible neck is equipped with an optical fiber. The system according to 65, characterized in that it is as described above.

69. The system according to claim 65, characterized in that the flexible neck has a length greater than its width.

70. The system according to claim 65, characterized in that the flexible neck has a width smaller than the width of the optical clip.

71. The outer ring is further equipped with a cap that is detachably connected to it. The cap includes one or more openings through which one or more optical bands pass and which extend distally toward the inner ring, The system according to claim 1, claim 6, claim 12, claim 18, claim 19, claim 25, claim 26, claim 55, or claim 65.

72. The system according to claim 71, wherein the cap covers the entire opening of the outer ring to seal the access channel of the sheath.

73. The system according to claim 71, characterized in that the cap covers a portion of the opening defined by the outer ring.

74. The system according to claim 71, wherein the cap further comprises an elastic material including the one or more openings.

75. The cap further comprises a penetrable and sealable material configured to seal against the outer surface of the instrument through which it is inserted, The aforementioned permeable and sealable material includes the one or more openings, The system according to feature 71.

76. The system according to any one of claims 71 to 75, characterized in that the one or more optical bands are bendable and positioned within the access channel and away from the outer ring.

77. The system according to claim 76, characterized in that the one or more optical bands have different sizes relative to each other.

78. The system according to claim 76, characterized in that the one or more optical bands have a length greater than their width.

79. The system according to claim 76, characterized in that the one or more optical bands extend in a direction aligned with the longitudinal axis of the sheath and distally away from the outer ring.

80. The system according to claim 76, characterized in that the one or more optical bands are tubular.

81. The system according to claim 76, characterized in that the one or more optical bands have higher flexibility than the outer ring.

82. The system according to any one of claims 76 to 81, characterized in that the one or more optical bands are connectable to the optical emitter system.

83. The system according to claim 82, characterized in that the optical emitter system comprises at least one of a light-emitting diode, a plastic optical fiber, an optical fiber, or a light-emitting device.

84. The system according to 82, characterized in that the optical emitter system comprises at least one light-emitting diode connected to the one or more optical bands.

85. The system according to claim 1, 6, 12, 18, 19, 25, 26, 55, 65, or 71, further comprising an inner curved support removablely connected to the inner ring.

86. The system according to 85, characterized in that the inner curved support is flexible and foldable so as to be inserted through the access channel.

87. The system according to claim 85 or 86, characterized in that the inner curved support has an upper flange that can be attached to the upper portion of the inner ring.

88. The system according to claim 85, 86, or 87, characterized in that the inner curved support is formed as an inner hoop.

89. The system according to 88, characterized in that the inner hoop has a diameter larger than the diameter of the inner ring.

90. The system according to 88, characterized in that the inner loop has a diameter smaller than the outer diameter of the outer ring.

91. The system according to 88, characterized in that the inner hoop is more flexible than the outer ring.

92. The system according to claim 91, characterized in that the inner hoop has a channel that is arranged to snap onto the inner ring.

93. The system according to claim 91, characterized in that the inner hoop has an L-shaped cross-section.

94. The system according to claim 91, characterized in that the entire inner hoop is positioned outside the access channel.

95. The system according to claim 85, 86, 87, 88, or 90, characterized in that the inner curved support is transparent or translucent.

96. The system according to claim 85, 86, 87, 88, or 90, characterized in that the inner curved support has a lower surface facing away from the inner ring, and the lower surface is transparent or translucent.

97. The system according to claim 85, 86, 87, 88, or 99, characterized in that the inwardly curved support is connectable to the optical emitter system.

98. The system according to 97, characterized in that the inwardly curved support has a distal end from which light is emitted.

99. The optical emitter system is characterized by comprising a light-emitting diode incorporated within the inwardly curved support, as described in claim 97.

100. The system according to 97, characterized in that the inner curved support has an aperture through which light is emitted.

101. The system according to 97, characterized in that the inwardly curved support has a lens through which light is emitted.

102. The optical emitter system is characterized by comprising a plastic optical fiber having one or more slits that can be connected to the inwardly curved support, as described in 97.

103. The system according to claim 102, characterized in that the one or more cuts are arranged on the upper surface of the plastic optical fiber facing toward the outer ring.

104. The system according to claim 97, characterized in that the inner curved support is movable relative to the inner ring.

105. The system according to claim 1, 6, 12, 18, 19, 25, 26, 55, 65, or 71, further comprising an optical clip detachably attached to the inner ring.

106. The system according to claim 105, characterized in that the optical clip is transparent or translucent.

107. The system according to claim 105 or 106, characterized in that the optical clip covers a portion of the lower surface of the inner ring.

108. The system according to claim 105, 106, or 107, characterized in that the optical clip has a U-shaped cross-section.

109. The optical clip is characterized by having a first upper portion in contact with the surface of the inner ring facing away from the access channel, a second upper portion in contact with the surface of the inner ring facing toward the access channel, and a lower portion connecting the first upper portion to the second upper portion, as described in claim 105, 106, or 107.

110. The system according to claim 105, 106, or 107, characterized in that the optical clip has a width and length smaller than the inner diameter of the inner ring.

111. The system according to claim 105, 106, or 107, characterized in that the optical clip has a channel arranged to snap onto the inner ring.

112. The system according to any one of claims 105 to 111, characterized in that the optical clip is connectable to the optical emitter system.

113. The optical emitter system is characterized by comprising a light-emitting diode incorporated within the optical clip, as described in claim 112.

114. The system according to 112, characterized in that the optical clip is movable relative to the inner ring.

115. The system according to any one of claims 1 to 114, characterized in that the sheath has a reflective portion.

116. The system according to any one of claims 1 to 115, further comprising a reflective sheet attached to the sheath.

117. The system according to any one of claims 1 to 116, characterized in that the sheath has a luminous portion.

118. The system according to any one of claims 1 to 117, further comprising a luminous sheet attached to the sheath.

119. The system according to any one of claims 1 to 118, characterized in that the sheath has a distal portion and a reflective sheet disposed on the distal portion of the sheath.

120. The system according to any one of claims 1 to 119, characterized in that the sheath has a distal portion and a glossy coating disposed on the distal portion of the sheath.

121. The system according to any one of claims 1 to 120, wherein the sheath further comprises a pocket arranged to hold one of a power supply, a plastic optical fiber, an optical cable, or an adapter.

122. The system according to claim 1, characterized in that the optical emitter system is arranged circumferentially along the circumference of the sheath.

123. The optical emitter system is arranged longitudinally along the sheath, as described in claim 1.

124. The optical emitter system is characterized in that it extends from the proximal portion of the sheath to the distal portion of the sheath, as described in claim 1.

125. The optical emitter system is characterized by comprising a light-emitting diode, as described in claim 122, 123, or 124.

126. The optical emitter system is characterized by comprising a plastic optical fiber, as described in claim 122, 123, or 124.

127. The optical emitter system is characterized by comprising a first plastic optical fiber arranged along the sheath in a first direction and a second plastic optical fiber arranged along the sheath in a second direction transverse to the first direction.

128. The optical emitter system is characterized by comprising a first optical fiber arranged along the sheath in a first direction and a second optical fiber arranged along the sheath in a second direction transverse to the first direction, as described in claim 1.

129. The optical emitter system comprises a first light-emitting diode string extending from the proximal portion of the sheath to the distal portion of the sheath, and a second light-emitting diode string spaced apart from the first light-emitting diode, wherein the second light-emitting diode string extends from the proximal portion of the sheath to the distal portion of the sheath, as described in claim 1.

130. The optical emitter system is characterized by comprising a first light-emitting diode string extending along the sheath in a first direction and a second light-emitting diode string extending in a second direction different from the first direction, as described in claim 1.

131. The system according to claim 1, characterized in that the optical emitter system is attached to the distal portion of the sheath.

132. The system according to claim 1, characterized in that the optical emitter system is attached to the inner ring.

133. The system according to claim 1, characterized in that the optical emitter system is attached to the inner edge of the inner ring facing the access channel.

134. The system according to claim 1, characterized in that the optical emitter system is attached to the outer edge of the inner ring facing away from the access channel.

135. The system according to claim 1, characterized in that the optical emitter system is attached to the lower surface of the inner ring.

136. The optical emitter system is characterized in that it is angled with respect to the access channel, as described in claim 1.

137. The system according to claim 1, characterized in that the optical emitter system is aligned with the longitudinal axis of the access channel.

138. The system according to claim 1, characterized in that the optical emitter system is integrated into the inner ring.

139. The system according to claim 1, characterized in that the optical emitter system is integrated into the distal portion of the sheath.

140. The system according to claim 1, characterized in that the optical emitter system is fixed in a groove within the inner ring.

141. The system according to claim 1, characterized in that the optical emitter system comprises a plurality of light-emitting diodes arranged in a pattern and extending from the distal portion of the sheath.

142. The system according to claim 141, characterized in that the pattern is a grid pattern.

143. The system according to claim 141, characterized in that the pattern is a series of consecutive rows.

144. The system according to claim 141, characterized in that the pattern is an overlapping grid pattern.

145. The optical emitter system is characterized in that it extends beyond the inner ring, as described in claim 1.

146. The optical emitter system is characterized in that it does not extend beyond the inner ring, as described in claim 1.

147. The optical emitter system is characterized by comprising a light-emitting diode, as described in any one of claims 131 to 146.

148. The optical emitter system is characterized by comprising a plastic optical fiber, as described in any one of claims 131 to 146.

149. The system according to claim 1, 6, 12, 18, 19, 25, 26, 55, 65, or 71, further comprising a mesh illuminator extending across the access channel and attached to the inner ring.

150. The system according to 149, wherein the mesh illuminator is arranged in a pattern having spacing between light-emitting diodes, and the spacing is such that it provides access for a tool or hand through it.

151. The system according to claim 149 or 150, characterized in that each part of the mesh illuminator is movable relative to each other part of the mesh illuminator to provide access for an instrument or hand through it.

152. The system according to claim 149, characterized in that the mesh illuminators are arranged in a grid pattern.

153. The system according to claim 149, characterized in that the mesh illuminators are arranged in a series of rows or columns.

154. The system according to claim 151, wherein the mesh illuminator returns to its initial position after being moved.

155. The system according to claim 151, characterized in that the mesh illuminator remains in the position to which it has been moved.

156. The system according to claim 1, claim 6, claim 12, claim 18, claim 19, claim 25, claim 26, claim 55, claim 65, claim 71, or claim 149, further comprising one or more power sources.

157. The system according to claim 1, 6, 12, 18, 19, 25, 26, 55, 65, 71, or 149, further comprising one or more controllers arranged to start or stop the optical emitter system.

158. The system according to claim 1, 6, 12, 18, 19, 25, 26, 55, 65, 71, or 149, further comprising one or more controllers arranged to adjust the illumination or focus of the light emitter system.

159. The system according to claim 1, 6, 12, 18, 19, 25, 26, 55, 65, 71, or 149, further comprising one or more controllers arranged to control the connection between the optical emitter system and the one or more power supplies.

160. The system according to claim 1, 6, 12, 18, 19, 25, 26, 55, 65, 71, or 149, further comprising one or more controllers arranged to selectively start or stop a selected portion of the optical emitter system.

161. The system according to claim 1, 6, 12, 18, 19, 25, 26, 55, 65, 71, or 149, further comprising one or more controllers arranged to selectively adjust the illumination or focus of a selected portion of the light emitter system.

162. The system according to any one of claims 157 to 161, characterized in that the controller comprises a switch.

163. The system according to any one of claims 157 to 161, characterized in that the controller includes user-accessible buttons.

164. The system according to any one of claims 157 to 161, characterized in that the controller is mounted inside or integrated with the sheath.

165. The system according to any one of claims 157 to 161, characterized in that the controller is mounted inside or integrated with the inner ring.

166. The system according to any one of claims 157 to 161, characterized in that the controller is mounted inside or integrated with the outer ring.

167. The system according to any one of claims 157 to 161, characterized in that the controller is located outside and separated from the retractor.

168. The system according to any one of claims 157 to 161, characterized in that the controller is attached only to or integrated with the distal portion of the sheath.

169. The system according to 156, characterized in that the power supply is mounted inside or integrated into the sheath.

170. The system according to 156, characterized in that the power supply is mounted inside or integrated with the inner ring.

171. The system according to 156, characterized in that the power supply is mounted inside or integrated into the outer ring.

172. The system according to claim 156, characterized in that the power supply is located outside the retractor and is separated from it.

173. The system according to 156, characterized in that the power supply is attached only to or integrated with the distal portion of the sheath.

174. The inner ring is expandable, The optical emitter system is mounted on or integrated within the expandable inner ring. The system according to claim 1, claim 6, claim 12, claim 18, claim 19, claim 25, claim 26, claim 55, claim 65, claim 71, or claim 149.

175. Each portion of the inner ring is selectively expandable, The optical emitter system is mounted on or integrated within the selectively expandable inner ring. The system according to claim 1, claim 6, claim 12, claim 18, claim 19, claim 25, claim 26, claim 55, claim 65, claim 71, or claim 149.

176. The inflatable balloon is further attached to the sheath or the inner ring, The optical emitter system is attached to or integrated within the balloon. The system according to claim 1, claim 6, claim 12, claim 18, claim 19, claim 25, claim 26, claim 55, claim 65, claim 71, or claim 149.

177. The system according to claim 176, characterized in that the balloon is positioned next to the inner ring.

178. The system according to 176, characterized in that the balloon is positioned below the inner ring.

179. The system according to 176, characterized in that the balloon is expandable so as to move away from the inner ring.

180. The system according to 176, characterized in that the balloon is expandable so as to move away from the inner ring and downward therefrom.

181. The system according to claim 176, characterized in that each part of the balloon is selectively expandable.

182. The system according to claim 1, 6, 12, 18, 19, 25, 26, 55, 65, 71, or 149, wherein the inner ring comprises a first inner ring and a second inner ring, and the optical emitter system is mounted within or integrated with the first inner ring.

183. The system according to 182, characterized in that the first inner ring is positioned next to the second inner ring.

184. The system according to claim 182 or 183, characterized in that the second inner ring comprises a reflective material.

185. The system according to claim 182 or 183, characterized in that the second inner ring is transparent or translucent.

186. The system according to claim 1, 6, 12, 18, 19, 25, 26, 55, 65, 71, or 149, characterized in that the inner ring comprises a chemiluminescent material.

187. The system according to claim 1, 6, 12, 18, 19, 25, 26, 55, 65, 71, or 149, characterized in that the inner ring comprises a reflective material.

188. The system according to claim 1, 6, 12, 18, 19, 25, 26, 55, 65, 71, or 149, characterized in that the sheath comprises a chemiluminescent material.

189. The system according to claim 1, 6, 12, 18, 19, 25, 26, 55, 65, 71, or 149, characterized in that the inner ring is entirely made of a plastic optical fiber.

190. The optical emitter system is characterized by comprising a bundle of optical fibers, as described in claim 1, 6, 12, 18, 19, 25, 26, 55, 65, 71, or 149.

191. The optical emitter system is characterized by comprising an optical conductor arranged to passively capture light from outside the retractor, as described in claim 1, 6, 12, 18, 19, 25, 26, 55, 65, 71, or 149.

192. Equipped with additional equipment guards, The optical emitter system is mounted inside or integrated into the fixture guard. The system according to any one of claims 1 to 191, characterized by...

193. The system according to claim 192, characterized in that the device guard is adjustable.

194. The system according to claim 192 or 193, characterized in that the device guard has higher rigidity than the sheath.

195. The system according to claim 192, 193, or 194, characterized in that the device guard has higher tear resistance than the sheath.

196. The system according to any one of claims 192 to 195, characterized in that the instrument guard has an hourglass shape and is insertable into the access channel of the sheath.

197. The system according to any one of claims 192 to 196, characterized in that the sheath is insertable through an opening defined by the instrument guard.

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