A SURGICAL ACCESS SYSTEM.

Abstract

A surgical access system (1) adapted to facilitate access to a surgical site through an incision in a patient's body upon opening the incision comprises a support ring (2), a radially adjustable saddle-shaped retractor (3, 17) configured to grasp and manually retract a section of abdominal tissue into the incision, and coupling elements (20) configured to adapt each of the radially adjustable saddle-shaped retractors to the support ring in a tissue retraction position. The system (1) is adapted to facilitate access to a neonate through a cesarean section incision in the patient's abdomen.The support ring is sized to allow the delivery of a neonate through the ring and comprises a non-adjustable saddle-shaped retractor (7) fixed to the support ring and an outward-projecting handle (8) fixed to the support ring adjacent to the fixed saddle-shaped retractor (7). The non-adjustable saddle-shaped retractor is a pelvic region retractor configured to cover and retain the woman's bladder during a cesarean section. The coupling element for the radially adjustable saddle-shaped retractor comprises a first formation disposed on the upper portion of the support ring and a corresponding second formation on the retractor configured to engage with the first formation, wherein the formations are configured to allow the retractor to tilt and / or rotate relative to the support ring when the retractor is fitted to the ring in a tissue retraction position.

Description

A SURGICAL ACCESS SYSTEM FIELD OF INVENTION The present invention relates to a surgical access system and, in particular, to a surgical access system for use in a cesarean section operation. BACKGROUND OF THE INVENTION A cesarean section is a surgical procedure to deliver a newborn through an open abdominal incision (laparotomy) and an incision in the uterus (hysterotomy). There are several techniques a surgeon can use to perform a cesarean delivery. One such technique is the Pfannenstiel-Kerr approach. The Pfannenstiel skin incision is slightly curved and located approximately 3 centimeters above the patient's pubic symphysis. The surgeon then makes an incision through the subcutaneous layer, which can vary from 2 to 5 centimeters in thickness, depending on the patient's BMI, until reaching the fascia. An incision is then made in the fascia, and the underlying rectus abdominis muscle is separated along the midline to access the peritoneum. Entry into the peritoneal cavity is achieved by opening the peritoneum. In a pregnant woman, the uterus is often located at this point upon entering the abdomen. Typically, it is at this point in the procedure that a handheld metal retractor is used to assist in the manipulation of the abdominal tissues. A retractor, such as the Doyen retractor, often called a bladder knife, is inserted into the open abdominal cavity. It is positioned at the lower end of the incision, just above the pubic symphysis, and is used to protect the bladder from accidental injury during the procedure. Typically, additional manual metal retractors are also used to retract abdominal wall tissue to access and visualize the uterus. Once the uterine incision is made and the neonate is delivered, the surgeon must repair the uterus. The time from when the surgeon accesses the peritoneal cavity until the neonate is delivered and the uterine is subsequently repaired typically ranges from 20 to 40 minutes. Delivery of the neonate often occurs within the first 5 minutes of this time. During this time, it is important to maintain good visualization and access to the uterus within the abdominal cavity to ensure a successful outcome for the patient. The use of manual metal retractors to keep the incision space open has several disadvantages. Each retractor requires an assistant to retract the tissue. With the duration of tissue retraction, typically 20 to 40 minutes, the assistant experiences fatigue and strain, which is exacerbated when dealing with a patient with a high BMI. Additional assistants are typically required for a high BMI patient, but there is limited space for them to work, due to the primary surgeon standing on one side of the operating table and the primary assistant on the opposite side. Another disadvantage of manual metal retractors is that they cannot be used to keep the incision open during delivery of the newborn due to the risk of injury to the infant. Therefore, they must be removed and replaced by the assistant's hands during delivery. The manual metal retractors are then reinserted into the abdominal cavity for uterine repair. This constant movement in and out of the manual metal retractors, along with the assistant's hands in the abdominal cavity, leads to an increased risk of bacterial transfer to the incision site and, subsequently, increases the risk of the patient acquiring a surgical site infection (SSI) as a result of the procedure. In the case of a high BMI or an obese patient, additional medical staff are often called in to use their hands to remove and hold abdominal tissue out of the way of the performing surgeon, as needed. This can provide immediate effectiveness for the surgeon, but it costs the additional staff time and money and causes physical strain and fatigue, as they are often placed in awkward positions to handle abdominal tissue while simultaneously staying out of the way of the primary surgeon and senior assistant. With the increased number of assistant hands inside the patient's abdominal cavity, there is a proportional increase in the risk of transferring bacteria to the incision site and, subsequently, an increased risk of the patient acquiring a surgical site infection (SSI) as a result of the procedure. Self-retaining metal retractors, such as the Balfour or Collins retractor, are also available, but these are not typically used for cesarean sections because they are unsuitable for delivery of the newborn through them when deployed on the patient. They also take time to position and are designed for use in standard abdominal surgery, not cesarean sections. An alternative to manual, self-retaining metal retractors are disposable double-ring plastic retractors, which consist of an inner and outer ring joined by a flexible, transparent film hammock that protects the wound edge. The main competitors in this area are SurgiSleeve (from Medtronic), the Alexis O Retractor (from Applied Medical), and OB / Mobius (from Cooper Surgical). All of these competitors achieve surgical space retraction in a similar manner. However, these products are adapted from other surgical procedures, and therefore none address the specific clinical and ergonomic needs of cesarean section surgery. In the disposable double-ring retractor, retraction is achieved by inserting the inner ring fully into the abdominal cavity and then tightening the outer ring against the patient's abdomen. The resulting opening depends on how tightly the outer ring can be twisted to create sufficient tension in the transparent, flexible hammock material between the inner and outer rings to retain the abdominal wall at the incision site. Disposable double-ring retractors maintain the incision site open symmetrically and are safe for childbirth; however, they become less effective in obese patients or those with a high BMI because they cannot effectively contain a dense wall of abdominal tissue.This is because the retraction forces required to retain the abdominal wall in a high BMI or obese patient are difficult to achieve with the double-ring method. The inner ring has a higher risk of slipping out of the abdominal cavity due to the degree of tension required between the rings to achieve good visualization of the uterus. Another disadvantage of the disposable double-ring retractor is that it also hinders the surgeon if, during the procedure, the surgeon needs to access the underlying abdominal tissue, for example, to cauterize a bleeding vessel or to lengthen an incision in the fascia. In this scenario, the surgeon would have to completely remove the double-ring retractor and then reinsert it, which would increase the procedure time and the risk of transferring bacteria to the incision site. Another disadvantage of self-retaining metal retractors and disposable double-ring retractors is that neither addresses the problem of managing protruding pannus, which is a particular issue in obese patients or those with a high BMI. In certain obese or high-BMI patients, protruding abdominal pannus can invade the surgical incision site during the procedure. This leads to an increased risk of bacterial transfer to the incision site and, subsequently, increases the risk of the patient developing a surgical site infection (SSI) as a result of the procedure. The protruding pannus at the surgical incision site also hinders the requirement for good visualization of the uterus and, therefore, must be retained during the procedure. Some techniques employed to achieve this involve taping the pannus to the patient's chest or otherwise anchoring the pannus to the operating table, toward the patient's head, to keep the surgical incision site clear. US patent 4,421,107 describes a self-retaining metal surgical retractor comprising a support ring and a plurality of radially adjustable retractor paddles attached to the ring at defined positions. During use, the retractor is placed over the incision, and the paddles engage the incision before retracting radially to open the incision while attached to the ring. The circumferential position of the paddles on the ring cannot be adjusted during surgery. US patent 6,582,364 describes a disposable double-ring surgical retractor such that the inner ring is inserted into the abdominal cavity through the incision site and the flexible, tubular connecting material is tensioned between the inner and outer rings to achieve retraction of the incision site. Surgical access systems, including those for abdominal surgery, are described in documents US2011 / 021879, US2019 / 254651, US2473266, WO2011158046, and WO2018 / 119473. Many of the described systems feature support rings and tissue retraction arms configured for adjustable attachment to the support ring. Many of the devices employ long, metal retraction blades that would be unsuitable for a cesarean section and the delivery of a newborn. Furthermore, the mechanisms for attaching the blades to the support ring are complex and require two hands to operate. Additionally, in all the devices, the retraction blades are securely fastened to the support ring. The challenges described above regarding cesarean delivery in obese patients with a high BMI are not addressed by current devices on the market. These challenges must be overcome to improve surgical outcomes for the female patient, ensure the safe delivery of the newborn, and improve the ergonomics of the procedure for both the surgeon and the assistant. The object of the invention is to overcome these challenges by providing a device and method of use that will facilitate positive outcomes for the patient and improve the ergonomics of the cesarean delivery procedure for the surgeon. Existing devices do not adequately address these challenges. It is an object of the invention to overcome at least one of the problems mentioned above. qa Lcnn / zznz / E / YiAi SUMMARY OF THE INVENTION The applicant addressed the problems of the prior art by providing a surgical access system that has a support ring and one or more detachable, self-retaining retractors that can be mounted on the ring. In one aspect, the support ring comprises a non-adjustable retractor and an adjacent handle that are typically integrally formed with the support ring, where the non-adjustable retractor is configured to cover and retain the woman's bladder during the procedure.The combination of the non-adjustable retractor and handle allows the surgeon to easily and partially anchor the support ring to the patient on one pelvic side of the incision. The non-adjustable retractor covers the woman's bladder. The removable retractor is then used to grasp a section of tissue on one abdominal side of the incision and manually retract the tissue before attaching it to the ring in a tissue-retracted position, thus fully anchoring the ring to the open incision. Additional removable retractors can then be used to further open the incision. In one aspect, coupling elements are provided to attach the detachable retractor(s) to the ring. These elements are configured to allow a degree of play between the retractor and the ring when joined together in a tissue retraction position, particularly by permitting tilting and / or rotation of the retractor. This has been found to be highly beneficial in the context of a cesarean section procedure, where the retractors are configured to fix radially. This allows the incision to be securely secured in an open orientation while simultaneously permitting controlled tilting and rotation of the retractors during the procedure. This enables positional adjustment of the retractors during delivery of the neonate and minimizes the risk of trauma to the neonate. In another aspect, the retractors have an upward-hanging proximal flange configured to deflect the panniculus of a woman, especially an obese woman. In a first aspect, the invention provides a surgical access system adapted to facilitate access to a surgical site through an incision in a patient's body by opening the incision, comprising: a support ring; at least one retractor configured to manually grasp and retract a section of abdominal tissue at the incision; and coupling elements configured to fit the or each retractor to the support ring in a tissue retraction position. In any configuration, the system is adapted to facilitate access to a newborn through a cesarean incision in the patient's abdomen, and the support ring is sized to allow delivery of a newborn through the ring. The system can be adapted to perform other surgeries, especially abdominal surgeries. In any modality, the or each retractor is a saddle-shaped retractor. In any modality, the retractor or each retractor is a radially adjustable retractor. In any embodiment, the system comprises a non-adjustable saddle-shaped retractor fixed (e.g., integrally formed) to the support ring and, optionally, an outward-projecting handle fixed to the support ring adjacent to the fixed saddle-shaped retractor. In any configuration, the fixed retractor and the handle are positioned facing each other on the ring. In any modality, the non-adjustable saddle-shaped retractor is a pelvic region retractor configured to cover and retain the woman's bladder during a cesarean section. In any embodiment, the coupling element for the or each retractor comprises a first formation disposed in the support ring and a corresponding second formation in the retractor configured to couple with the first formation. In any modality, the first formation is located on an upper surface of the retractor with its back to the patient's skin during use. In any configuration, the first formation can be detachably attached to the support ring (for example, it can be configured to snap onto the support ring, typically at any point along the ring). In either configuration, the first assembly is integrally formed with the support ring. In both configurations, the first and second arms are designed to allow the retractor to tilt and / or rotate relative to the support ring when attached to the ring in a tissue retraction position. This allows the retractor, when attached to the ring, to be positionally adjusted during a surgical procedure to adjust the size and shape of the surgical site access. This is especially useful during a cesarean section when delivering a newborn through the cesarean incision, as the retractors' ability to adjust positionally relative to the support ring reduces the risk of trauma to the newborn during delivery. In any mode, the coupling element formations are configured to allow the retractor to tilt and rotate relative to the support ring when the retractor is fitted to the ring in a tissue retraction position. In either mode, the coupling element formations are configured to allow the retractor to tilt outwards up to 10° or 15°. In any mode, the coupling element formations are configured to allow the retractor to tilt inwards up to 500 10°. In any mode, the coupling element formations are configured to allow the retractor to rotate + / - 45°. In any mode, the coupling element formations are configured to allow the retractor to roll relative to the support ring when the retractor is fitted to the ring in a tissue retraction position. In any mode, the coupling element formations are configured to allow the retractor to roll on each side up to 2°. In all configurations, the support ring has an elliptical profile. Other profiles include circular and oval. In any configuration, the system comprises at least two radially adjustable saddle-shaped retractors. In any configuration, the system comprises at least three radially adjustable saddle-shaped retractors. In any configuration, the system comprises at least one and preferably two, three or four retractors, each of which is radially and circumferentially adjustable. In any configuration, the system is set up to attach a radially adjustable retractor to the support ring at a position on the ring diametrically opposite the fixed retractor. Therefore, when the fixed retractor is positioned at 180°, the system can be configured to attach the radially adjustable retractor at 0°. In any configuration, the system is designed to attach radially adjustable retractors to the support ring at positions flanking a point on the ring that is diametrically opposite the fixed retractor. Therefore, when the fixed retractor is positioned at 180°, the system can be configured to attach radially adjustable retractors at 10 o'clock (or anywhere between 270° and 330°) and 60° (or anywhere between 30° and 90°). In any mode, the system is configured for the attachment of a radially adjustable retractor to the support ring in a central position on the ring diametrically opposite the fixed retractor and the attachment of radially adjustable retractors to the support ring in positions flanking the central position. It will be observed that when the first formations on the support ring are integrally formed with the ring, the position of the formations will determine the circumferential position of the retractors on the ring. Thus, in one embodiment, the ring has a first central formation located on the ring diametrically opposite the fixed retractor and optionally first lateral formations arranged on the ring on each side of the first central formation. In another embodiment, the ring has first lateral formations arranged on the ring on each side of a point on the ring diametrically opposite the fixed retractor. In any modality, the radially adjustable saddle-shaped retractor comprises an upward-hanging flange configured to deflect the panniculus of an obese woman away from the surgical site during use. The flange is disposed at a proximal end of the retractor. In any modality, at least two of the radially adjustable saddle-shaped retractors comprise an upward-hanging flange configured to deflect the panniculus of an obese woman away from the surgical site during use. In any modality, the upward-hanging flange extends to a height of at least 5.08, 7.62, 10.16, 12.7, or 15.24 cm (2, 3, 4, 5, or 6 inches), for example, 5.08–25.04, 5.08–20.32, 5.08–15.24, 5.08–10.16, 7.62–20.32, 7.62–15.24, 7.62–10.16 cm (2–10, 2–8, 2–6, 2–4, 3–8, 3–6, or 3–4 inches) above the patient's abdomen when the retractor engages the incision. The flange length may vary depending on the patient. Therefore, for obese patients with a larger panniculus, a larger (or more rigid) deflector rim may be used. In any configuration, the rim is rigid. In any modality, the rim is semi-rigid to allow some degree of rim deflection during use while keeping the panniculus away from the operating field. In any configuration, a lateral profile of the deflector rim is S-shaped. In any configuration, the hairline deflector element is adjustablely attached to the retractor and configured for positional adjustment relative to it. For example, the flange can be hinged to the retractor. The flange can be adjusted from an initial configuration (for example, typically parallel to a plane of the support ring) to a fully extended hairline deflector configuration. qa Lcnn / zznz / E / YiAi In any configuration, the hairline deflector element is detachably attached to the retractor. This allows for a modular system where the flange can be selected according to the woman's hairline and attached to the retractors. Therefore, the invention also relates to a system comprising a plurality of hairline flanges of different shapes and / or dimensions configured for detachable attachment to a retractor. In any configuration, the deflector element of the hairline is shape-adjustable. The element may include a spring to allow it to jump from one configuration (e.g., hanging downwards) to a second configuration (hanging upwards). The element may comprise a thin, malleable metal core, integrated within the element itself, which would allow for a degree of shaping by the user. Other methods for incorporating shape-adjustability will be obvious to a person skilled in the art. In any configuration, the retractor comprises a top panel, a bottom panel, and a back panel and is configured to wrap around a section of tissue. In any modality, the retractor generally has a U-shaped profile. In any modality, the panniculus deflector rim is arranged on (or may be attached to) a proximal end of the upper wall of the retractor. In any modality, the posterior wall has a convex curvature to accommodate the curvature of an open incision (cesarean section). In any modality, the lower wall has a curved profile to adapt to the curvature of the lower abdominal wall of a pregnant woman. In either configuration, the top panel of the saddle-shaped adjustable retractors is open outwards and away from the incision. In any configuration, the top panel of the retractable screen generally has a trapezoidal shape. In any modality, when the retractor has a rim that deflects the panniculus, the transition between the upper wall and the rim is a smooth curve. In any configuration, when the system comprises at least two retractors, the upper walls of the retractors are sized to fit together when placed side by side on the ring in a retracted position. In any configuration, the retractors are rigid. In any configuration, the retractors are semi-rigid. In any modality, the retractors are sufficiently elastically deformable to allow a user to grasp and hold the tissue with the retractor. qa Lcnn / zznz / E / YiAi In any mode, the system is configured to allow circumferential adjustment of at least one of the ring retractors. In one embodiment, the system comprises a coupling element configured to attach to the ring at a plurality of different circumferential positions on the ring. The coupling element may comprise a ring coupling portion and a retractor coupling portion. In any configuration, the coupling element is integrally formed with the retractor. In any configuration, the coupling element is configured to snap into the support ring. In any embodiment, the retractor comprises a plurality of integral coupling elements that are radially separated to allow radial adjustment of the retractor on the ring. In either embodiment, the support ring and saddle-shaped retractors are made of polymer. In another embodiment, the ring and / or retractors are made of metal or composite materials. In either configuration, the support ring and retractors are single-use, disposable parts. In another configuration, the ring and / or retractors are reusable. In any modality, the first formation on the support ring is a protruding lug. In any modality, the second corresponding formation in the retractor is a lug-receiving slot. In any modality, the retractor is radially adjustable and comprises a plurality of radially separated second formations (e.g., radially separated lug receiving slots). In any configuration, each lug-receiving slot is an incoming slot. This means that the slot is sized to receive the lug and then hold the lug in place during lug movement relative to the slot (usually transverse movement of the retractor relative to the lug). In any embodiment, the lug-receiving slot comprises an inwardly radially oriented slot portion sized to receive the lug and an outwardly radially oriented slot portion configured to snap-fit ​​with the lug. In any embodiment, the lug comprises a stem portion sized to snap into place with the radially outwardly facing groove portion and a head portion that is Lcnn / zznz / E / YiAi oversized in relation to the radially outward grooved portion, but sized to fit snugly through the radially inward grooved portion. The stem may have a circular or oval profile and may be tapered or tapered inwards or outwards. In any configuration, the radially inward portion of the groove is oversized relative to the lug head portion, allowing the lug to be easily received in the groove portion. In any configuration, the radially inward portion of the groove is sized to receive the lug head portion when the head portion is misaligned with the radially inward groove by up to 10° in the direction of rotation. In any modality, the ear is generally T-shaped and comprises an elongated head portion. In any configuration, the elongated head portion is aligned with a circumference of the support ring. In any modality, the plurality of first radially separated formations is arranged in a proximal section of the upper wall of the retractor. In any modality, one of the formations in the support ring is arranged on the support ring diametrically opposite the non-adjustable saddle-shaped retractor. In any modality, the support ring comprises two formations arranged on one side of the support ring opposite the saddle-shaped fixed retractor. In any modality, the first formation in the support ring is a cavity, for example, a channel, and the corresponding second formation in the retractor is a cavity or projection that couples to the channel. In any configuration, the channel is at least partially embedded in the support ring. In either configuration, the channel is a radial channel and the channel coupling projection is a radially extending rail element arranged on the underside of the upper wall of the retractor and configured to couple (and typically engage) with the channel and typically allow sliding radial movement of the rail in the channel. In any mode, the lane is formed integrally with the retractor. In any modality, the radial channel in the support ring has a longitudinal axis that extends radially inwards and downwards towards a plane of the support ring. In any modality, the channel has an elliptical profile. Other profiles include circular or oval shapes. In any configuration, the rail element and radial channel are sized for a firm but sliding fit so that tilting the retractor relative to the support ring effects friction locking of the rail element to the channel. In any modality, the first or each formation in the support ring is formed integrally with the support ring. In any configuration, the or each formation on the support ring can be detachably mounted on the support ring. In any modality, the first detachable formation comprises a body with a lower part having a channel configured to snap-fit ​​to the support ring and an upper part comprising a formation configured to snap to a corresponding second formation in the retractor. In any modality, the upper body training comprises a channel or projection that attaches to the rail. In any modality, the formation on the upper part of the body comprises a channel for coupling to the rail with an opening configured to allow contact between the rail and the support ring. In either configuration, the body is designed to allow a portion of the support ring to project into the rail's mating channel. The contact between the rail and the support ring can act as a friction locking mechanism to secure the retractor in position over the support ring. In any embodiment, a lower portion of the rail element has a plurality of radially spaced teeth. In any embodiment, an upper surface of the support ring has an elongated circumferential groove configured to receive any of the plurality of radially spaced teeth across the opening when the body is coupled with the support ring and retractor rails. In either mode, the teeth and slot are configured to lock into place when the retractor is in a first tilting orientation and to disengage when the retractor is in a second tilting orientation. In any mode, the first tilt orientation is an inward tilt orientation. qa Lcnn / zznz / E / YiAi In any form, the teeth have a sawtooth profile (flat or curved sawtooth profile). In any configuration, each tooth extends laterally, at least partially, through the rail. In any configuration, the channel on the underside of the body has an elliptical profile designed to allow a limited amount of rotation of the body on the support ring while preventing full rotation. The limited rotation can be, for example, 5 to 40°, 5 to 30°, or 5 to 20° in a clockwise and / or counterclockwise direction. In any configuration, the support ring is flat. In any configuration, the support ring is not flat. In any mode, the support ring curves upwards and away from the handle. In any modality, the support ring has a first upward curved flex and a second downward curved flex. In any modality, the system comprises a deflector element of the panniculus configured to fit the support ring. In any embodiment, the deflector element of the panicle comprises an elongated curved panel and a connection means for connecting the panel to the support ring in a panicle deflector orientation. In any configuration, the curvature of the panel follows the curvature of the support ring. In any configuration, the connection means comprise a plurality of radial arms configured to snap together with the support ring. In any configuration, the elongated curved panel has a width that is at least 50%, 60%, 70%, 80%, or 90% of the widest dimension of the support ring. When the ring is circular, the widest dimension will be the diameter of the ring. In any modality, the retractor comprises a functional material. In any modality, the retractor comprises an antimicrobial material. In any modality, the retractor is formed from a transparent material. In any modality, an external surface of the paddle, especially the inflection curve that joins the back wall with the upper and / or lower walls, has a smooth surface. In any modality, an external surface of the paddle, especially the inflection curves that join the back wall with the upper and lower walls, comprises a hydrophilic surface. qa Lcnn / zznz / E / YiAi A hydrophilic coating is a very thin, transparent coating typically used on catheters. A typical procedure involves immersing the item in a container of the liquid hydrophilic coating. When the item is removed from the container, it is wet with the hydrophilic coating and typically requires curing to bond the coating to the item's surface. This curing can be done with heat in an oven or UV curing in a specialized UV chamber. The finished coating is dry to the touch, but when wet, it absorbs water at a rate of 300 to 400% of its own weight, making the surface feel very slippery, like a bar of soap. In any embodiment, an internal surface of the paddle, especially the back wall and the inflection curves that join the back wall to the upper and lower walls, comprises a rough surface that optionally comprises notches or projections on the surface. In any configuration, the lower wall is slightly inclined upwards towards the upper wall, for example, up to 10°, for example 2-10°, 2-7° or approximately 5°. In any procedure, the posterior wall is sized according to the thickness of the woman's abdominal wall. The posterior wall typically has a height of 2-10 cm, or 5-10 cm or 5-7 cm for an obese woman, and 2-3 cm for a non-obese woman. In any modality, the transition from the top wall to the back wall and / or the transition from the back wall to the bottom wall is curved. In any modality, the transition from the top wall to the back wall curves upwards and around the back wall to provide a skin strain relief pocket. In any modality, the edges of the posterior wall and / or the lower wall have a smooth, atraumatic profile. In any modality, the edges of the back wall and / or the bottom wall comprise a soft, flexible rim, covering or edge that is optionally formed by a soft elastomer or silicone material. In any configuration, the soft, flexible flange / cover or edge is bonded to the retractor's edge via an overmolding process. Other methods include adhesive bonding or other joining processes, such as laser welding or ultrasonic bonding. In any configuration, the support ring is designed to emit light. Therefore, it can incorporate lights and a battery, or it can incorporate chemicals that, when activated, react to emit light, for example, luminescent light. The invention also relates to a surgical access system according to invention qa Lcnn / zznz / E / YiAi for use in a method for performing surgery on a subject, wherein the system is used to retract tissue and maintain the retracted tissue in a retracted position. The subject may be male or female. The surgery may be abdominal surgery. The abdominal surgery may be a cesarean section procedure on a pregnant woman. The pregnant woman may be obese, wherein the method may include a step of deflecting the panniculus of the obese pregnant woman away from the surgical site with the panniculus deflector flange. In another aspect, the invention provides a method for facilitating access to a neonate through a cesarean section incision in the woman's abdomen by opening the incision, comprising the steps of: providing a support ring sized to allow delivery of a newborn through the ring and comprising a non-adjustable pelvic region retractor and a handle attached to the support ring; articulate the support ring to insert the non-adjustable pelvic region retractor into the incision to cover and retain the woman's bladder with the support ring positioned over the woman's abdomen; insert a first adjustable saddle-shaped retractor into the incision to grasp a first section of abdominal tissue on one abdominal side of the incision; Attach the first adjustable saddle-shaped retractor to the support ring while holding the first section of abdominal tissue in a first position separate from the non-adjustable pelvic region retractor to anchor the support ring to the woman and partially open the incision. Insert a second adjustable saddle-shaped retractor into the incision to grasp a second section of abdominal tissue; and attach the second adjustable saddle-shaped retractor to the support ring while grasping the second tissue section in a second position on the separate support ring of the non-adjustable pelvic region retractor to further open the incision. In any modality, the first adjustable saddle-shaped retractor is attached to the support ring at a ring position diametrically opposite to the non-adjustable pelvic region retractor. In any modality, the method includes the following stages: insert a third adjustable saddle-shaped retractor into the incision to grasp a third section of abdominal tissue; and attach the third adjustable saddle-shaped retractor to the support ring while grasping the third tissue section in a third position separate from the non-adjustable pelvic region retractor to further open the incision, wherein the first adjustable saddle-shaped retractor is attached to the support ring at a ring position diametrically opposite the non-adjustable pelvic region retractor, and the second and third adjustable saddle-shaped retractors are attached to the support ring at positions flanking and adjacent to the first adjustable saddle-shaped retractor In any embodiment, the coupling elements are used to join the first saddle-shaped retractor to the support ring in a tissue retraction position, wherein the coupling elements are configured to allow the retractor to tilt and / or rotate relative to the support ring when the retractor is fitted to the ring in a tissue retraction position, wherein the method comprises adjusting the tilt and / or rotation of the first saddle-shaped retractor during delivery of the neonate. In any embodiment, at least one of the adjustable saddle-shaped retractors comprises an upward-hanging flange configured to deflect the panniculus of an obese woman away from the surgical site during use; the method comprises a step in which the panniculus deflector flange deflects the woman's panniculus away from the surgical site while the adjustable saddle-shaped retractors maintain the incision in an open configuration. In any embodiment, the self-locking coupling elements are used to attach the adjustable saddle-shaped retractor to the support ring in a tissue retraction position, wherein the self-locking coupling elements can be actuated to lock the retractor to the support ring in response to radially inward forces exerted on the retractor by the abdominal tissue when the retractor is in a tissue retraction position, wherein the method comprises manually attaching the adjustable saddle-shaped retractor to the support ring in a tissue retraction position by means of the self-locking coupling elements and releasing the retractors where the retractor is pulled radially inward to actuate the self-locking coupling elements. In any embodiment, the self-locking coupling elements comprise a projection in the support ring and a projection-receiving incoming groove in the retractor, wherein the incoming groove is configured to receive the projection and lock the projection to the groove to the inward radial movement of the groove relative to the projection, wherein the method comprises the steps of coupling the projection and the incoming groove, and releasing the retractor, wherein the retractor is pulled radially inward to lock the projection in the incoming groove. In any embodiment, coupling elements are used to attach the saddle-shaped retractor to the support ring in a tissue retraction position, wherein the coupling elements comprise a radially extending rail disposed on the retractor and a channel in the support ring configured to receive the rail in a sliding engagement, wherein the method comprises attaching a tissue section with the retractor, engaging the rail of the retractor with the channel of the support ring, retracting the retractor by sliding the rail radially outward in the channel, and locking the rail to the channel in the radially outward position. In any modality, the rail and channel are configured to engage by friction when the retractor is positioned relative to the ring at a first tilt and to unlock when the retractor is positioned relative to the ring at a second tilt, wherein the method comprises orienting the retractor relative to the support ring at the second tilt, retracting the retractor while held at the second tilt, and then adjusting the tilt of the retractor relative to the support ring to the first tilt to lock the retractor to the ring and release the retractor. In any embodiment, the coupling elements are used to attach the saddle-shaped retractor to the support ring in a tissue retraction position, wherein the coupling elements comprise a formation on the retractor configured to snap directly onto an external aspect of the ring, wherein the method comprises a step of retracting the retractor until the formation is facing an external aspect of the ring and moving the formation partially radially inward to engage the external aspect of the ring. In any embodiment, coupling elements are used to join the saddle-shaped retractor to the support ring in a tissue retraction position, wherein the coupling elements comprise a first formation on the support ring and a corresponding second formation on the adjustable saddle-shaped retractor configured to couple with the first formation, wherein the method comprises coupling the saddle-shaped retractor to the support ring by coupling the first formation with the corresponding second formation. qa Lcnn / zznz / E / YiAi In any embodiment, the saddle-shaped adjustable retractor comprises a plurality of corresponding second formations radially separated in the retractor, wherein the method comprises: Insert the adjustable saddle-shaped retractor into the incision to grasp a first section of abdominal tissue on one abdominal side of the incision; attach the adjustable saddle-shaped retractor to the support ring by coupling the first formation with one of the corresponding second formations; hold the retractor attached to the ring for a period of time; separate the retractor from the ring; and attach the retractor to the support ring in a second retraction position by coupling the first formation with another of the corresponding second formations to further retract the first tissue section. In any embodiment, the method includes a step of adjusting the radial position of the adjustable saddle-shaped retractor to a less retracted position after delivery of the neonate. In another aspect, the invention provides a method for facilitating access to a surgical site through an incision in a patient's body by opening the incision, comprising the steps of: inserting a first adjustable saddle-shaped retractor into the incision to grasp a first section of tissue; attach the first saddle-shaped adjustable retractor to a support ring while holding the first tissue section; Insert a second adjustable saddle-shaped retractor into the incision to grasp a second tissue section; and attach the second tissue retraction paddle to the support ring while grasping the second tissue section to keep the incision open. In either modality, the incision is a cesarean section incision and the tissue comprises abdominal tissue, and in which the support ring is sized to allow the delivery of a neonate through the ring. In any modality, the method may employ a system of the invention. In any embodiment, the support ring comprises a saddle-shaped retractor fixed to the ring (e.g., integrally formed), wherein the method comprises an initial step of inserting the fixed saddle-shaped retractor into the incision to grasp a section of abdominal tissue. In one embodiment, the fixed retractor is a pelvic region retractor, and the method comprises inserting the retractor into the incision to grasp or make contact with a section of abdominal tissue above the subject's bladder and to cover and retain the bladder. In any modality, the method comprises an additional step of adjusting the radial position of the first or second tissue retraction retractor with respect to the support ring, optionally while attaching to the support ring. In any embodiment, the retractor comprises a plurality of radially separate formations, each configured to attach to the support ring. The formation may be configured to attach directly to the ring, to a connector that detachably connects to the ring, or to a corresponding formation integrally formed on the ring (e.g., a projection such as a lug). In any modality, the method comprises the following stages: hold a first section of tissue with the retractor; attach the retractor to the support ring in a first retraction position by using a first of the radially separated formations to partially retract the first tissue section; Hold the retractor attached to the ring in the first retraction position; separate the retractor from the ring; attach the retractor to the support ring in a second retraction position by using a second of the radially separated formations to further retract the first tissue section; Hold the retractor attached to the ring in the second retraction position; and optionally, repeat the separate, join, and hold step to further retract the tissue section. In any modality, the retractor formations comprise formations configured to snap into the ring or an intermediate connector. In any modality, the formation in the retractor is a groove and the support ring comprises a lug, and the method comprises coupling the groove and the lug. In any modality, the slot is an inward-facing slot configured to receive the lug and lock the lug in the slot with the inward radial movement of the slot relative to the lug, wherein the method comprises the steps of coupling the inward-facing slot and lug, and allowing the retractor to be pulled radially inward by the forces exerted by the open incision to lock the slot to the lug. qa Lcnn / zznz / E / YiAi In any embodiment, the retractor's formation is a radially extending rail integrally formed, and the ring comprises a channel configured to receive the rail in a sliding coupling, wherein the method comprises grasping a tissue section with the retractor, coupling the retractor's rail with the channel of the support ring, and retracting the retractor by sliding the rail radially outward in the channel, and locking the rail to the channel in the radially outward position. In any modality, the rail and channel are configured to engage by friction when the retractor is positioned relative to the ring at a first tilt and to unlock when the retractor is positioned relative to the ring at a second tilt, wherein the method comprises orienting the retractor relative to the support ring at the second tilt, retracting the retractor while held at the second tilt, and then adjusting the retractor stage relative to the support ring to the first tilt to lock the retractor to the ring and release the retractor. In any modality, the formation in the retractor is configured to snap into place directly on an external aspect of the ring, wherein the method comprises a step of retracting the retractor until the formation is facing an external aspect of the ring and moving the formation partially radially inward to snap into place on the external aspect of the ring. In any modality, the method comprises an additional step of adjusting the circumferential position of the first or second tissue retraction paddle with respect to the support ring while attached to the support ring. In any modality, the method comprises additional steps of inserting a third adjustable saddle-shaped retractor into the incision and clamping a third section of abdominal tissue with the retractor, and attaching the third retractor to the support ring to further open the incision. In any modality, the method comprises a step of adjusting the height of at least one of the adjustable saddle-shaped retractors before or after it clamps a section of tissue. In another aspect, the invention provides a method for facilitating access to a woman's uterus through a cesarean section incision in the woman's abdomen by opening the incision, comprising the steps of: providing a support ring sized to allow delivery of a neonate through the ring and comprising a saddle-shaped pelvic region retractor and a Lcnn / zznz / E / YiAi handle fixed to the support ring; Insert the saddle-shaped fixed pelvic retractor into the incision to hold a first section of abdominal tissue over the woman's bladder; insert a first adjustable saddle-shaped retractor into the incision to hold a second section of abdominal tissue; attach the first adjustable saddle-shaped retractor to the support ring in a separate position from the fixed saddle-shaped pelvic region retractor to open the incision; Insert a second adjustable saddle-shaped retractor into the incision to grasp a third section of abdominal tissue with the retractor; and attach the second adjustable tissue retraction paddle to the support ring to further open the incision. In any modality, the method comprises additional steps of inserting a third adjustable saddle-shaped retractor into the incision and clamping a fourth section of abdominal tissue with the retractor and attaching the third adjustable saddle-shaped retractor to the support ring to further open the incision. In any modality, the method comprises an additional step of adjusting the radial position of at least one of the adjustable saddle-shaped retractors with respect to the support ring while attaching to the support ring. In any configuration, the support ring comprises a coupling element that is configured to allow radial adjustment of the adjustable retractor in the support ring from a first retraction position to a second retraction position. In any embodiment, the adjustable retractor comprises a radial groove, and the coupling element comprises a lug configured for sliding engagement in the groove and a brake that can be actuated to lock the adjustable tissue retraction paddle to the coupling element. In one embodiment, the brake is self-locking. In any modality, the method comprises an additional step of adjusting the circumferential position of at least one of the saddle-shaped adjustable retractors on the support ring, typically while attaching it to the support ring. In any modality, the coupling element is configured to move along the support ring from a first circumferential position to a second circumferential position, wherein the method comprises a circumferential adjustment stage of the retractor on the support ring. In any embodiment, the coupling element comprises a carriage that can move along the ring and comprises braking means for fixing the carriage in a position along the ring. In any modality, the method comprises a step of adjusting the height of the saddle-shaped adjustable retractor before or after it clamps the tissue. In any embodiment, an upper wall of at least one of the saddle-shaped adjustable retractors comprises an upward-hanging panniculus deflector flange, wherein the upward-hanging flange deflects the woman's panniculus away from the incision when attached to the support ring. Other aspects and preferred embodiments of the invention are defined and described in the other claims set forth below. BRIEF DESCRIPTION OF THE FIGURES Figures 1A and 1B are perspective views of a support ring that is part of a surgical access system according to an embodiment of the invention and that has a fixed saddle-shaped retractor. Figures 2A and 2B are perspective views of a first modality of an adjustable saddle-shaped retractor that forms part of a surgical access system according to the invention. Figures 3A and 3B are perspective views of a second modality of an adjustable saddle-shaped retractor that is part of a surgical access system according to the invention and that has a panniculus deflector flange. Figure 4 is a perspective view of a coupling element that is part of a surgical system according to the invention. Figure 5 is a perspective view of a surgical system according to one embodiment of the invention with the retractors attached to the support ring in a partially retracted configuration. Figure 6 is a perspective view of the surgical system in Figure 5 with the retractors shown in a fully retracted configuration suitable for providing access to the uterus during a cesarean section procedure. Figures 7A and 7B are perspective views from above of a support ring that is part of a surgical access system according to an embodiment of the invention and that has a saddle-shaped fixed retractor and first formations (T-shaped projecting legs) integrally formed with the projecting ring, including a central lug arranged diametrically opposite the fixed retractor and side lugs on each side of the fixed retractor. Figure 8 is a perspective view of the support ring of Figures 7A and 7B showing a radially adjustable saddle-shaped retractor having a series of corresponding second formations (slots) spaced radially apart with the retractor attached to the ring by coupling between the T-shaped lug of the ring and the radially outward-facing slot of the retractor. Figure 9 is a perspective view of the support ring of Figures 7A and 7B showing two radially adjustable saddle-shaped retractors, each of which has a series of corresponding radially spaced second formations (slots). The retractors are attached to the ring by coupling between the ring's T-shaped side lugs and the retractor's second slots. In this position, the retractors are retracted further than the retractor shown in Figure 8. Figure 10A is a perspective view of the support ring of Figures 7A and 7B showing three radially adjustable saddle-shaped retractors, each of which has a series of corresponding radially spaced second formations (slots), with the retractors attached to the ring by coupling between the center and T-shaped side lugs of the ring, wherein the center retractor is attached to the center lug by means of its radially outermost slot and the side retractors are attached to the side lugs by means of their second slots. Figure 10B is a view of the system in Figure 9 showing two additional saddle-shaped retractors attached to the ring flanking the fixed retractor. Figures 11 and 12 are a perspective and top view of a section of the support ring showing the first three formations (central and lateral T-shaped lugs) integrally formed with the ring at 0°, 48°, and 312° (where the fixed retractor is located on the ring at 180°). Figure 12 illustrates how the T-shaped lug head is aligned with the ring. Figure 13 is a perspective view from below of the support ring and a radially adjustable retractor located adjacent to the ring with the second slot aligned with the central T-shaped lug and the retractor straddling the support ring with the back wall 23 qa Lcnn / zznz / E / YiAi of the retractor projecting downwards into the support ring Figure 14 is a perspective view from above of the support ring showing a rear side of the fixed retractor and handle. Figures 15, 16, and 17 illustrate the configuration of the incoming groove in the retractor and how it engages with the T-shaped lug. Figure 15 shows a radially adjustable retractor engaging with the support ring, with the T-shaped lug of the support ring seated in the radially inward portion of the groove. Figure 17 is a top plan view of the T-shaped lug seated in the oversized portion of the groove. Figure 16 shows the retractor after it has been moved radially inward relative to the support ring, with the lug stem frictionally locked to the smaller, radially outward portion of the groove. Figures 18 and 19 are top plan views showing the lug coupled with the incoming slot, showing how the radially outward portion of the slot is oversized to accommodate and tolerate a ±8° misalignment of the user, with respect to the T-shaped head of the lug that facilitates alignment of the lug and slot in the pressurized environment of a surgical procedure. Figure 20 is a top plan view of two radially adjustable retractors attached to a support ring, illustrating how the coupling elements allow rotational movement of the retractors when locked in the ring. It will be seen that the forces acting on the retractors when in a tissue retraction position are a radially inward force, which locks the lug in the radially outward portion of the incoming groove, while allowing side-to-side rotational movement of the retractors relative to the support ring. Figures 21A and 21B are side elevation views of a radially adjustable retractor attached to a ring showing how the coupling means allow the retractor to be tilted inwards (Figure 21A) and outwards (Figure 2IB) relative to the support ring. Figures 22 and 23 are perspective views of radially and circumferentially adjustable retractors that have a series of separate, radially formed second formations integrally incorporated into the underside of the retractor's upper panel, configured to snap-fit ​​onto the support ring. A proximal end of the upper panel includes an upward-hanging hairline deflector flange approximately equal in height to the height of the retractor's rear panel. qa Lcnn / zznz / E / YiAi Figures 24 and 25 are perspective views of the radially and circumferentially adjustable retractors of Figures 22 and 23 but without the panniculus deflector flange. Figure 26 is a perspective view from below of the retractors of Figures 24 and 25 attached to a support ring on each side of the fixed retractor. Figure 27 is a plan view from above of the retractors in Figures 24 and 25 showing how the coupling elements at the bottom of the retractor allow both circumferential and radial adjustment of the retractors on the ring. Figures 28 and 29 illustrate one embodiment of the system of the invention with a support ring having a fixed saddle-shaped retractor, three circumferentially and radially adjustable retractors (one diametrically opposite the fixed retractor), and two radially adjustable retractors flanking the central retractor. Figures 30 and 31 illustrate another embodiment of the system of the invention with a support ring with a saddle-shaped fixed retractor, three radially adjustable retractors (one diametrically opposite the fixed retractor) and two radially and circumferentially adjustable retractors flanking the fixed retractor. Figure 32 is a side elevation profile view of a retractor showing the curved bend between the top panel and the flange, and between the back panel and the top and bottom panels. This view also illustrates the S-shape of the deflector flange and how the bottom panel projects slightly upward toward the top panel (approximately 5°). Figures 33 and 34 are top views of a radially adjustable retractor showing the convex curvature of the posterior wall that allows it to follow the curved shape of an open abdominal incision. Figures 35 and 36 are lateral elevation views looking radially inward from a proximal end of a radially adjustable retractor and show the curvature of the upper and lower walls that allows them to adapt to the curvature of the abdominal tissue in a pregnant woman. Figures 37A-37F illustrate the use of one modality of the surgical access system of the invention in a cesarean section procedure, in which: Figure 37A is an illustration of a pregnant woman with a cesarean section incision located approximately 3 centimeters above the patient's pubic symphysis; Figure 37B shows a support ring located on the woman's abdomen with the saddle-shaped fixed retraction paddle inserted into the cesarean incision covering the woman's bladder retention; Figure 37C shows a radially adjustable retractor (which has a panniculus deflector flange) that grasps a section of tissue on the abdominal side of the incision and retracts and attaches to the support ring via a lug on the support ring diametrically opposite the fixed retractor. Once the retractor is fixed to the support ring in a tissue retraction position, the support ring is anchored to the woman and does not need to be held by a surgeon or assistant. Figure 37D shows two more radially adjustable retractors, each of which grasps a section of abdominal tissue and retracts to open the incision. These retractors attach to the support ring in positions that flank and align with the first radially adjustable retractor. At this stage, all three radially adjustable retractors attach to the ring by their outermost radial slots and are therefore in their least retracted position. Figure 37E shows two radially adjustable retractors flanking each other, repositioned radially after separating and being repositioned through a second slot (i.e., further retracted). Figure 37F shows the three radially adjustable retractors repositioned radially after detaching and reattaching to the ring (the central retractor does not connect via its second slot, and the lateral retractors connect via their third slots). Two radially and circumferentially adjustable retractors are also shown retracting the sides of the incision and attaching to the ring in positions flanking the fixed retractor. In this configuration, the cesarean incision is fully open, and the cesarean procedure can continue. Figure 38 shows a radially adjustable retractor according to an alternative embodiment of the invention. Figure 39 is a perspective view from below of the retractor of Figure 38 attached to a support ring that includes first formations (embedded radial channels) configured to receive a corresponding second formation (rail element) at the bottom of the upper panel of the retractor. Figure 40 is a perspective view from above of the system in Figure 39. Figures 41 and 42 are perspective views from below (Figure 41) and above (Figure 42) of the system in Figure 39 and include two additional radially adjustable retractors from Figure 38 attached to the support ring in positions flanking the first retractor. Figure 43 is a side elevation view, partially in perspective, of the system in Figure 26 qa Lcnn / zznz / E / YiAi 39. Figures 44 and 45 are perspective views of the retractor in Figure 38 and include a viewing window at a proximal end of the upper wall adjacent to the deflector ridge of the panniculus. Figures 46 and 47 are perspective views of early alternative configurations (detachable connectors) designed to couple the retractor of Figure 38 to a support ring. The connectors have a body with a ring receiving channel on the underside and a rail coupling channel formed on the top of the body. This upper channel is generally orthogonal to the ring receiving channel, so that an axis of the rail coupling channel projects radially inward. The ring receiving channel is sized for a press fit on the support ring. The rail application channel is sized to engage with the retractor rail in a sliding relationship. Figures 48 and 49 are perspective views of early alternative configurations (detachable connectors) designed to couple the retractor of Figure 38 to a support ring. The connectors are similar to those in Figures 46 and 47, except that the rail engagement groove is recessed into the body and communicates with the ring's engagement groove. In use, this allows a portion of the connecting ring to protrude into the rail engagement groove. This enables the rail and support ring to make contact with each other, functioning as a friction-locking mechanism to secure the rail to the support ring. Figure 50 is a side elevation perspective view of a support ring having a detachable connector (Figures 46 and 47) press-fitted into the ring and a radially adjustable retractor (Figure 38) approaching the detachable connector. This shows how the use of this connector allows both radial and circumferential adjustment of the retractor's position on the connecting ring. Figure 51 is a detailed view of the system in Figure 50 with AA section lines. Figure 52 is a cross-sectional view of the support ring and connector taken along section lines AA of Figure 51. Figures 53 to 55 are cross-sectional views similar to Figure 52, showing how the elliptical shape of the ring's mating channel allows limited tilting movement of the connector within the ring. In Figures 54 and 55, the connector tilts outward and inward, resulting in frictional locking between the ring and the channel at defined friction points. Figure 56 is a side elevation cross-section view of the radially adjustable retractor connected qa Lcnn / zznz / E / YiAi to the ring via the detachable connector of Figures 48 and 49 and showing the ring in contact with the rail when the connector is tilted inwards. Figures 57 and 58 are perspective views of a radially adjustable retractor according to an alternative embodiment of the invention, wherein the rail on the underside of the upper panel of the retractor has a series of teeth extending radially along the rail. Each tooth extends laterally across the top of the rail, and in Figure 57 the teeth have a straight sawtooth profile, while in Figure 58 the teeth have a curved sawtooth profile. Figure 59 is a perspective view from below of a system of the invention showing two radially adjustable retractors with an integrated rail connected to the support ring via detachable connectors. Figure 60 is a perspective view from above of part of the system in Figure 59. Figures 61 to 63 are views of the system in Figure 59 showing how the teeth on the retractor rail engage and lock with a groove formed on the top of the support ring when the connector is attached to the rail and support ring. Figures 64 and 65 are cross-sectional views showing the connector attached to the support ring and the rail. In Figure 64, the connector is rotated (i.e., tilted inward) relative to the ring, and the teeth do not engage. In Figure 65, the connector is not rotated (no tilt), and a tooth on the rail engages in the groove of the support ring, locking the rail, connector, and support ring in position. This lock can be released by adjusting the tilt of the retractor relative to the ring. Figures 66 and 67 are perspective views of another detachable connector of the invention configured to snap-fit ​​to the support ring and having a protruding T-shaped lug configured to engage in an incoming groove in a retractor. Figure 68 is a view of a system of the invention incorporating a detachable connector of Figures 66 and 67 and showing how the detachable connector is connected. circumferentially adjustable around the ring and how the connector allows radial adjustment of the retractor relative to the ring. Figure 69 is a perspective view of a radially adjustable retractor attached to a support ring with the detachable connector of Figures 66 and 67, where the retractor is attached to the connector's T-shaped lug through its innermost radial groove and thus with maximum retraction. qa Lcnn / zznz / E / YiAi Figures 70 and 71 are perspective and elevation side views of a support ring according to an alternative embodiment of the invention, wherein the support ring has a curved profile. Figures 72 to 75 are side elevation views of the support rings of the invention. Figures 76 and 77 are perspective views from below of a system of the invention comprising a curved support ring and showing how the system can follow the patient's curvature indicated by the arrows. Figures 78 and 79 are elevation views of a system according to an alternative embodiment of the invention that incorporates a detachable elongated panniculus deflector flange configured to join the outer ring and curved around a section of the ring opposite the fixed retractor. Figures 80 and 81 are perspective views of a radially adjustable retractor without a hairline deflector flange and for use with a system comprising a detachable hairline deflector flange. Figure 82 is a perspective view of the system in Figure 79 with the radially adjustable paddle of Figure 80 attached to the ring by an integrally formed T-shaped lug. Figures 83 and 84 are perspective views of the system in Figure 82 shown with additional radially adjustable retractors attached to the support ring. Figures 85 and 86 are perspective views of a radially adjustable retractor with a soft hydrophilic surface configured to absorb water and make the surface slippery to facilitate the passage of a neonate during delivery. Figures 87 and 88 are a perspective view of a radially adjustable retractor with parts of the tissue-engaging surface of the retractor incorporating a rough surface to improve grip on the tissue. Figure 89 is a side elevation view of a retractor showing how the lower panel tapers upward and away from the incision, which helps the retractor to hold the abdominal tissue in place during use. Figure 90 shows how the height of the retractor's back panel can be varied to accommodate patients with abdominal tissue of different thicknesses. Figures 91A and 91B are perspective views of a radially adjustable paddle having an extended panniculus deflector element and a skin incision strain relief pocket forming at the bend point between the top and back panels. Figures 92 and 93 are cross-sectional views of a retractor without a tension relief pocket that engages and grasps abdominal tissue through an incision. The rectangular shape represents a cross-section through the abdominal wall. The arrow in Figure 92 indicates the direction of movement as the paddle grasps and lifts the abdominal incision. With the pivoting paddle retracting abdominal tissue under load (as would also be the case with standard retractors), the edges of the abdominal tissue experience a greater degree of compression due to the paddle's internal profile (areas of greater tissue compression are indicated by the arrows in Figure 93).Higher levels of tissue compression are experienced, especially in the outer layers of the skin, where compression can compromise blood flow within the tissue layers and subsequently increase the risk of tissue necrosis, depending on the duration of compression. Figures 94 and 95 are cross-sectional views of a retractor that includes a strain relief pocket that engages and secures abdominal tissue through an incision. The strain relief element of this paddle provides a pocket for the tissue edge, thus significantly reducing the level of tissue compression due to the paddle's geometric shape. This reduction in tissue compression therefore reduces the risks associated with restricted blood flow and resulting tissue damage. The upper arrow in Figure 93 represents the outer layers of the epidermis, where the greatest benefit from the strain relief feature will be obtained. The lower arrow would still be under the same degree of compression as the retractor in Figure 93; however, the inner layers do not present the same risk of necrosis.An additional strain relief feature could be incorporated for the inner edge of the tissue, if deemed appropriate. Figures 96 and 97 are elevation and section views of a radially adjustable retractor with silicone or soft elastomer edges. Figure 98 is a side elevation view of the retractor in Figure 96. Figure 99 is a side elevation view of a retractor without the soft elastomeric or silicone rim. Figures 100 and 101 are perspective and side elevation views of a radially adjustable retractor (for reference). Figures 102 and 103 are perspective and side elevation views of a radially adjustable retractor with an adjustable, user-moldable panniculus deflector flange. Figures 104 and 105 are perspective views of the retractor in Figure 103 with the panniculus deflector flange formed in two different shapes. qa Lcnn / zznz / E / YiAi Figures 106 and 107 are perspective views of the retractor in Figure 103 before it is attached to a support ring. Figures 108 and 109 are perspective views of the retractor in Figure 104 attached to a support ring. Figure 110 is a perspective view of a system of the invention with several vanes, each of which has an adjustable panniculus deflector flange that unfolds upward on three of the retractors and folds downward on two of the retractors. Figure 111 illustrates the use of a system of the invention to contain the panniculus of an obese woman during a cesarean section procedure. DETAILED DESCRIPTION OF THE INVENTION All publications, patents, patent applications, and other references mentioned in this description are incorporated by reference in their entirety for all purposes, as if each individual publication, patent, or patent application were specifically and individually indicated to be incorporated by reference and their contents quoted in full. General definitions and preferences When used in this description and unless otherwise specifically indicated, the following terms are intended to have the following meanings in addition to any broader (or narrower) meanings the terms may have in the art: Unless the context otherwise requires, the use of the singular in this description should be construed as including the plural and vice versa. The term "a" used in relation to an entity should be read as referring to one or more of that entity. As such, the terms "a," "one or more," and "at least one" may be used interchangeably in this description. As used in this description, the term "comprises" or variations thereof, such as "comprises" or "comprising," should be read to indicate the inclusion of any enumerated integer (e.g., a feature, element, property, method / process step, or constraint) or group of integers (e.g., elements, features, properties, method / process steps, or constraints), but not the exclusion of any other integer or group of integers. Therefore, as used in this description, the term "comprising" is inclusive or open-ended and does not exclude additional unenumerated integers or method / process steps. qa Lcnn / zznz / E / YiAi As used in this description, the term disease is used to define any abnormal condition that impairs physiological function and is associated with specific symptoms. The term is broadly used to encompass any disorder, illness, abnormality, pathology, ailment, condition, or syndrome in which physiological function is impaired, regardless of the nature of the etiology (or, indeed, whether the etiological basis of the disease is established). It thus includes conditions resulting from infection, trauma, injury, surgery, radiological ablation, age, intoxication, or nutritional deficiencies. As used in this description, the term treatment or treat refers to an intervention (e.g., the administration of an agent to a subject) that cures, improves, or reduces the symptoms of a disease or eliminates (or lessens the impact of) its cause (e.g., the reduction in the accumulation of pathological levels of lysosomal enzymes). In this context, the term is used synonymously with the term therapy. Additionally, the terms treatment or treat refer to an intervention (e.g., the administration of an agent to a subject) that prevents or delays the onset or progression of a disease or reduces (or eradicates) its incidence within a treated population. In this case, the term treatment is used synonymously with the term “prophylaxis.” As used herein, an effective amount or a therapeutically effective amount of an agent is defined as an amount that can be administered to a subject without excessive toxicity, irritation, allergic response, or other problems or complications, consistent with a reasonable risk / benefit ratio, but sufficient to provide the desired effect, e.g., treatment or prophylaxis manifested by a permanent or temporary improvement in the subject's condition. The amount will vary from subject to subject, depending on the individual's age and general condition, the route of administration, and other factors. Therefore, although it is not possible to specify an exact effective amount, those skilled in the art will be able to determine an appropriate effective amount in any individual case through routine experimentation and general background knowledge.A therapeutic outcome in this context includes the eradication or reduction of symptoms, the reduction of pain or discomfort, prolonged survival, improved mobility, and other markers of clinical improvement. A therapeutic outcome does not necessarily have to be a complete cure. Improvements in biological / molecular markers, clinical improvements, or observational improvements may be observed. In a preferred embodiment, the methods of the invention are applicable to humans, large racehorses (horses, camels, dogs), and domestic companion animals (cats and dogs). qa Lcnn / zznz / E / YiAi In the context of treatment and effective quantities as defined above, the term subject (which should be read to include individual, animal, patient, or mammal when context permits) defines any subject, particularly a mammalian subject, for whom treatment is indicated. Mammalian subjects include, but are not limited to, humans, domestic animals, farm animals, zoo animals, sport animals, pets such as dogs, cats, guinea pigs, rabbits, rats, mice, horses, camels, bison, cattle, and cows; primates such as apes, monkeys, orangutans, and chimpanzees; canids such as dogs and wolves; felines such as cats, lions, and tigers; equids such as horses, donkeys, and zebras; food animals such as cows, pigs, and sheep; ungulates such as deer and giraffes; and rodents such as mice, rats, hamsters, and guinea pigs. In preferred modalities, the subject is a human being.As used herein, the term equine refers to mammals of the family Equidae, which includes horses, donkeys, asses, kiangs, and zebras. The system and method of the invention are primarily for use in human surgery but can be readily adapted for use with large mammals, such as equines, bovines, supines, ovines, and porcines. A support ring refers to a ring-shaped support structure, usually a closed ring, onto which tissue retractors can be attached and held in a tissue retraction position. The ring is generally circular, but it can also be oval, elliptical, or triangular. It is typically sized to be approximately the same size as, or slightly larger than, the desired size of the open incision. When the system is used in a cesarean section, the ring is sized to allow delivery of a neonate through it and is usually circular or oval. The ring may be curved (with a single bend or multiple bends). The ring may also have a round or elliptical cross-section.The latter was found to be useful in the context of coupling and locking a connecting element to the ring, as the connecting element can be provided from a channel configured to press-fit with the ring where the channel has a profile that provides limited clearance between the channel and the ring to allow limited (but not complete) rotational movement of the coupling element on the ring, for example, a rotation of up to approximately + / - 20° or 30°. The limited rotational movement allows the retractor to tilt inwards and / or outwards. “Saddle-shaped retractor” or “tissue-holding retractor” refers to a tissue retraction paddle shaped to hold a section of an incision in the body of a coupling having a lug configured to slide into a groove of the retractor. In one embodiment, the coupling element comprises a component configured to snap into the support ring. The embodiments described herein include carriage-like coupling elements (e.g., detachable connectors) configured to snap into the support ring at numerous positions along the ring. In one embodiment, the carriage is configured to permit circumferential movement of the carriage on the ring while preventing or inhibiting rotational movement of the carriage on the ring.In another embodiment, the retractor includes an integral coupling element configured for direct coupling with the support ring, for example, a groove sized and positioned to press-fit into the support ring. A plurality of integral coupling elements may be provided in the retractor to allow attachment to the support ring at different radial positions relative to the ring. The integral coupling elements are typically radially spaced on a lower side of the retractor's upper panel. The coupling element often comprises a channel element configured to press-fit into the ring. The channel element may be configured to face at least partially radially inward so as to interact with a radially outward aspect of the ring.This means that, during use, when the retractor grasps an incision and retracts, the forces acting on the retractor will pull it radially inward. When the channel element faces at least partially radially inward, this will result in the channel being secured to the ring. Figure 26 illustrates this and shows a 51A channel element in the retractor facing radially inward. The connecting elements can also be a projection (e.g., a lug) on ​​the ring, usually arranged on a top aspect of the ring, and a projection-receiving slot in the retractor. Generally, a plurality of radially spaced slots are provided on the underside of the top panel of the retractor. The slot can be an inward-facing slot.The incoming groove can be configured to freely receive the projection in a first radial position relative to the projection and then lock the groove with the projection in a second radial position relative to the projection. Generally, the second groove position is radially inward of the first position. Such an incoming groove allows the retractor to grasp a section of the incision and be manually retracted so that the groove is in the first position relative to the projection, by placing the retractor over the projection and then allowing the retractor to be pulled radially inward under the forces exerted by the open incision where the groove will lock with the projection. Figures 18 and 19 illustrate an incoming groove in the retractor.The projection can also be configured to prevent up-and-down movement (moving away from and toward the patient) of the retractor when it is in a locked position. For example, the projection may have a head and a stem where the head is larger than the stem, and the groove may have an inwardly oriented radial portion sized to receive the head portion and an outwardly oriented radial portion that is too small to receive the head portion. Figure 7B shows an example of a projection for use with an inward-facing groove, and Figures 18 and 19 show an example of a slow inward-facing groove. The coupling (connecting) element can also be a connector that can be detachably mounted on the support ring and include a formation configured to join a corresponding formation on a retractor.The formation on the detachable connector can be a projection as described above. The formation on the detachable connector can also be configured as a channel to receive the channel-coupling formation on the retractor. The channel-coupling formation on the retractor can be a rail element configured to engage and be retained within the channel, typically in a sliding relationship. The rail element can extend radially along the retractor (generally extending radially along at least a portion of the underside of the retractor's top panel). The rail element and channel can have complementary profiles configured to engage in coupling with the channel. The channel can be partially or fully recessed in the support ring. The channel generally extends radially through the support ring. This embodiment is shown in Figure 41.The rail may have a series of radially spaced teeth. The support ring may have a circumferential groove. The connector may be configured to engage with the rail and support ring, allowing one of the rail teeth to mesh with the groove in the support ring to lock the retractor to the ring and prevent rotation of the connector within the ring. The connector may be configured to unlock the locking mechanism when the retractor is tilted inward or outward and the locking mechanism has zero or low tilt. This is illustrated in Figures 64 and 65. The coupling element of the invention may be self-locking. Self-locking applied to the coupling element means that the coupling element locks the retractor into the ring once the user positions and releases it. An example is the use of a lug and groove arrangement described below, where once the groove of the retractor engages with the lug, the forces exerted on the retractor by the open incision cause the lug and groove to lock into position and remain there until the user adjusts the retractor's position. Other methods of self-locking coupling elements could include pinion and ratchet-type mechanisms, or snap-fit ​​coupling elements configured to frictionally adjust the retractor and the support ring in relative position. Outward-facing direction applied to the arrangement of the retractor and support ring means that the retractor, when attached to the support ring, faces outward to grasp and hold a section of the incision in an open configuration. “Fixed saddle-shaped retractor” refers to a retractor that is part of the support ring and is not configured to fit or separate from the support ring during surgery. When the system is for cesarean section surgery, the fixed retractor is typically a retractor of the type designed to retain the bladder during a cesarean section (also known as a Doyen retractor). It should be understood that the radial adjustment applied to the retractor or coupling element means the movement of the retractor to open or close the incision, that is, from a position inside the ring to a periphery of the ring, or vice versa. The movement does not have to be exactly radial. Providing a coupling element that allows easy radial adjustment of the retractor's position relative to the support ring provides the flexibility to allow the incision to be opened (or closed) further after the retractor is attached to the ring. Circumferential adjustment applied to the coupling element means that the coupling element is configured to allow movement of the retractor between at least two circumferential positions along the support ring. In one embodiment, the coupling elements comprise a carriage configured for sliding movement along the support ring and may include braking means for fixing the position of the coupling element relative to the support ring or for self-locking when a user attaches and releases them. “Obese” in the context of the patient means a BMI greater than 25, 30 or typically greater than 35. This, in one aspect, in the invention refers to a system and method for use with obese patients, and especially with obese pregnant women. EXEMPLIFICATION The invention will now be described with reference to specific examples. These are merely illustrative and for illustrative purposes only: they are not intended to limit in any way the scope of the claimed monopoly or the described invention. These examples represent the best means currently contemplated for implementing the invention. With reference to the drawings, and initially to Figures 1A to 4, a surgical access system of the invention is illustrated, generally indicated by reference number 1, comprising a support ring 2, an adjustable saddle-shaped retractor 3, and a coupling element 20 for adapting the adjustable retractor 3 to the support ring 2 in a desired position. In more detail, and with reference to Figures 1A and 1B, the support ring 2 is circular and has a circumference large enough to allow the delivery of a neonate through the ring. Therefore, this ring is slightly larger than the head of a neonate. The ring 2 includes a saddle-shaped retractor 7 attached to the ring in an outward-facing position, and an outward-projecting handle 8 positioned over the fixed retractor 7. The retractor 7 is generally U-shaped and has an upper wall 7A, a lower wall 7B, and a rear wall 7C that have a convex curvature matching and aligned with the curvature of the support ring 2. All corners 8 of the retractor are curved and do not include any sharp corners or edges. With reference to Figures 2A and 2B, the adjustable saddle-shaped retractor 3 is shown in more detail and includes a U-shaped top wall 10, a bottom wall 11, and a rear wall 12, with the top and bottom walls slightly separated outwards. The rear wall 12 has a convex curvature. The top wall 10 is longer than the bottom wall 11 and is trapezoidal in shape, widening from the rear wall 12 to a free end 15 and including an elongated inward groove 16. With reference to Figures 3A and 3B, a modified adjustable saddle-shaped retractor 17 is illustrated, in which the parts identified with reference to the previous modality are assigned the same reference numbers. In this modality, the upper wall 10 is longer and has an upward-hanging flange 18 that functions to deflect abdominal tissue away from the open incision. With reference to Figure 4, a coupling element 20 for adapting a retractor 3, 17 to a support ring 2 is illustrated. It comprises a carriage 21 with a groove 22 having an elliptical profile on its lower surface, dimensioned to engage the support ring 2 in a tight but sliding arrangement. The use of a groove having an elliptical profile helps prevent rotation of the carriage on the support ring. A lug 23 is provided that engages the groove on its upper surface and is dimensioned to engage the incoming groove 38 16 of the upper wall 10 of the retractor 3, 17. With reference to Figure 5, a surgical system of the invention 1 is illustrated with the retractors 3, 17 attached to the support ring 2 in an outward-facing and partially retracted configuration. The modified retractors 17 with the panniculus deflector flange 18 are attached to the ring 2 opposite the fixed retractor 7, and the other two retractors 3 are attached to the ring on each side of the fixed retractor. Figure 6 illustrates the same surgical system with two additional retractors 3, and after the retractors 3, 17 are radially adjusted outward to an illustrated fully retracted position. It can be seen in Figure 6 how the upper walls of the retractors are sized to fit when placed side by side on the ring in a fully retracted position. With reference to Figure 7A, a support ring 2 is illustrated, forming part of a surgical access system according to one embodiment of the invention, wherein the parts described with reference to the prior embodiments are assigned the reference numerals in the name. In this embodiment, the coupling elements include three T-shaped lugs 40 integrally formed on an upper surface 41 of the ring, including a central lug 40A arranged diametrically opposite the fixed retractor 7 and lateral lugs 40B, 40C on each side of the central lug 40A. With reference to Figure 7B, each lug 40 has a cylindrical stem portion 42 projecting upward from the upper surface of the ring 2 and a T-shaped head 43 aligned with the ring. Figure 8 shows the support ring 2 with a radially adjustable saddle-shaped retractor 3 attached to the ring. The retractor 3 includes a plurality of radially spaced slots 44 along the upper panel 10 of the retractor, configured to engage with a T-shaped lug 40. Each slot 44 is an inward-facing slot, the details of which will be described in more detail below. In the image shown, the T-shaped lug engages with the first slot 44A (the outermost radially). Figure 9 shows the support ring 2 of Figures 7A and 7B with two radially adjustable saddle-shaped retractors 3 attached, each retractor connected to the ring by coupling between the T-shaped lugs 40B, 40C flanking the ring and the second slots 44 of the retractor. In this position, the retractors are retracted further than the retractor shown in Figure 8. Figure 10A shows the support ring of Figures 7A and 7B with three radially adjustable saddle-shaped retractors 3 attached to the ring by coupling between the central and lateral T-shaped lugs of the ring, wherein the central retractor is attached to the central lug 40A by means of its radially outermost groove 44A and the lateral retractors are attached to the lateral lugs 40B, 40C by means of their second grooves 44B. Figure 10B is a view of the system in Figure 9 showing two additional saddle-shaped retractors 3B attached to the ring flanking the fixed retractor. Figures 11 and 12 show a section of the support ring 2, revealing the central and lateral T-shaped lugs 40A to 40C integrally formed with the ring at 0°, 48°, and 312° (with the fixed retractor positioned on the ring at 180°). Figure 12 illustrates how the T-bar head 43 of lug 40 is aligned with ring 2. Figure 13 shows a radially adjustable paddle 3 straddling the support ring 3, with the second slot 44B located above the central T-shaped lug 40A. The T-shaped lug is also shown in more detail, with the upright stem 42 and the T-shaped bar head 43 at the top. A panniculus deflector flange 18 extending upward in a slightly curved S-shape from a distal end of the upper panel 10 of the retractor 3 is also shown. Figure 14 shows the support ring 2, which displays a rear view of the fixed retractor 7 and handle 8. The fixed retractor is integrally formed with ring 2 and is located diametrically opposite the center lug 40A. Figures 15, 16, and 17 illustrate the configuration of the inward-facing groove 44 in the retractor and how it engages with the T-shaped lug 40. As illustrated in these figures, the inward-facing grooves 44 have a radially inward-facing groove portion 46 that is oversized relative to the T-shaped head 43 and a radially outward-facing groove portion 47 that is smaller than the T-shaped head but sized for friction fit with the lug stem 42. Figure 15 shows a radially adjustable retractor 3 engaging with the support ring 2 with the T-shaped head 43 protruding through the radially inward-facing portion 46 of the groove. Figure 16 shows the retractor moved radially inward, forcing the lug stem 42 into friction fit with the radially outward-facing portion 47 of the groove 44. Figures 18 and 19 show the lug 40 fitting into the incoming groove 44, and show how the radially inward portion 46 of the groove is oversized to accommodate and tolerate a ±8° misalignment of the user, with respect to the T-shaped head 43 of the lug that facilitates alignment of the lug and groove in the pressurized environment of a surgical procedure. Figure 20 shows two radially adjustable retractors 3 attached to a support ring 2, which 40 Lcnn / zznz / E / YiAi illustrates how the coupling elements allow the retractors 3 to rotate relative to the ring when locked to the ring (rotation arrows). It will be seen that the forces acting on the retractors when they are in a tissue retraction position are a radially inward force (arrow A), which serves to lock the lug in the radially outward portion of the incoming groove while allowing the retractors to rotate side-to-side relative to the support ring. Figures 21A and 21B show the radially adjustable retractor 3 attached to a ring 2, illustrating how the coupling means allow inward (Figure 21A) and outward (Figure 2IB) tilting movement (arrow A) of the retractor relative to the support ring. The degree of tilting can be controlled by the height of the stem 42. Figures 22 and 23 illustrate another embodiment of a radially adjustable retractor in which the parts identified with reference to the preceding embodiments are assigned the same reference numbers. In this embodiment, the retractor, generally designated by reference number 50, has a series of three radially spaced hooks 51 integrally formed on a lower side of the upper wall 10 and configured to attach directly to the support ring. A proximal end of the upper panel 10 includes an S-shaped flange 18 that deflects the upward-hanging hairline and is approximately as high as the rear panel of the retractor. Figures 24 and 25 show a similar embodiment of the retractor in Figures 22 and 23 but without the hairline deflecting flange. Figure 26 illustrates two of the retractors 50 attached to a support ring 2 on each side of the fixed retractor 7 by means of the central hook 51A.Figure 27 is a plan view from above of the retractors in Figures 24 and 25 showing how the hooks on the bottom of the retractor allow circumferential and radial adjustment of the retractors 50 on ring 2. Figures 28 and 29 illustrate a system of the invention with a support ring 2 and a fixed, integrally formed saddle-shaped retractor 7, three circumferentially and radially adjustable retractors 50 (a retractor 50A diametrically opposed to the fixed retractor) that are attached to the ring 2 by snap coupling between hooks 51A and the ring, and two radially adjustable retractors 3 that have slots 44 flanking the central retractor and coupled to the ring by coupling between lugs 40B and 40C and the corresponding slots 44 in the retractors 3. Figures 30 and 31 illustrate another embodiment of the system of the invention that is identical to the system illustrated in Figures 28 and 29 with the exception that the retractor mounted on the ring diametrically opposite the fixed retractor 7 is a radially adjustable retractor that is attached to the ring qa Lcnn / zznz / E / YiAi by coupling between the mounting lug 40A and the slot 44 on the retractor (as described above). Figure 32 is a side elevation profile view of a retractor showing the curved bend between the top panel 10 and the flange 18, between the rear panel 12 and the top panel 10, and between the rear panel 12 and the bottom panel 11. This view also illustrates the S-shape of the deflector flange of the panniculus 18, and how the bottom panel 11 projects slightly upward toward the top panel 10 (approximately 5°). The dotted line indicates the profile shape of the retractor. Figures 33 and 34 are top views of a radially adjustable retractor 3 showing the convex curvature of the posterior wall 12, which allows it to follow the curved shape of an open abdominal incision. The dotted line indicates the curvature relative to the retractor's back panel, providing a curve that follows the curvature of an abdominal incision opening and thus minimizes stress concentration points at the edges. If the posterior wall 12 were not curved as illustrated in the rectangular representation in Figure 34, stress concentration points would occur at the positions indicated by arrows A. Figures 35 and 36 are side elevation views looking radially inward from the proximal end of a radially adjustable retractor 3, showing the curvature of the upper wall 10 and lower wall 11 that allows them to adapt to the curvature of the abdominal tissue in a pregnant woman. The dotted line indicates the curvature relative to the upper panel 10. The curvature follows the natural dome shape of the pregnant maternal abdomen, thus minimizing stress concentration points at the edges of the paddles. If the upper wall 10 were not curved as illustrated in the rectangular representation in Figure 36, stress concentration points would occur at the positions indicated by arrows A. With reference to Figures 37A-37F, the use of the surgical access system of the invention in a cesarean section procedure is described, in which the parts identified with respect to the preceding modalities are assigned the same reference numbers. It will be appreciated that the following represents one method of using the system of the invention for surgical access and that, in practice, some of the steps may be performed in a different order. Furthermore, the incision and the manual adjustment of the retractors before attachment to the support ring are not illustrated in the following description, although they are described. Figure 37A is an illustration of a pregnant woman with a cesarean section incision located approximately 3 centimeters above the patient's pubic symphysis. qa Lcnn / zznz / E / YiAi Figure 37B shows a support ring 2 located on the woman's abdomen with the saddle-shaped fixed retractor 7 inserted into the cesarean incision covering and retaining the woman's bladder. Figure 37C shows a radially adjustable retractor 3 (having a panniculus deflector flange 18) that grasps a tissue section on the abdominal side of the incision and retracts and attaches to the support ring 2 via a lug 40A on the support ring diametrically opposite the fixed retractor 7. Once the retractor is attached to the support ring 2 in a tissue retraction position, the support ring is anchored to the woman and does not need to be held by a surgeon or assistant. Figure 37D shows two additional radially adjustable retractors 3', each of which grasps a section of abdominal tissue and retracts to open the incision and attaches to the support ring 2 in positions that flank and fit with the first radially adjustable retractor 3. At this stage, all three radially adjustable retractors are attached to the ring by the outermost radially 44A slots and thus in the least retracted position. Figure 37E shows two radially adjustable lateral retractors 3', radially relocated after separating and rejoining through a second slot 44B in retractor 3 (i.e., further retracted). Figure 37F shows the three radially adjustable retractors repositioned radially after separating and reattaching to the ring (the central retractor 3 now attaches via its second slot 44B and the lateral retractors 3' attach via their third slots 44C). Also shown are two radially and circumferentially adjustable retractors 50 that retract the sides of the incision and are attached to ring 2 in positions flanking the fixed retractor. In this configuration, the cesarean incision is fully open and the cesarean procedure can continue. Figure 38 shows a radially adjustable retractor according to an alternative embodiment of the invention and generally indicated by reference number 60. In this embodiment, the retractor 60 has a radially extending rail 61 integrally formed with a lower portion of the upper panel 10 and having an inverted T-shaped profile configured to engage and slide in a corresponding formation on the ring. Figures 39 and 40 show the retractor 60 attached to a support ring 2 having a series of partially recessed channels 62 circumferentially spaced on an upper surface of the ring 2. The channels 62 are sized to receive the retractor rails 61 in a sliding and retaining relationship that provides radial adjustment of the retractor 60 with respect to the ring 2. The channels have a profile that partially embraces the rail head 65 and retains the rail in the channel. Figures 41 and 42 show a system of the invention having three radially adjustable retractors 60 attached to the support ring 2. Figure 43 is a side elevation view, partially in perspective, of the system in Figure 39, showing anchor points A1 and A2. Where the retractor interacts with the ring, the sliding channel 62 becomes a locking mechanism once the user's hand is removed. This occurs due to the offset planes from which the abdominal forces B act on the paddle, relative to the point where the paddle interacts with the ring (anchor point A1). This results in a torsional or bending force being applied to the retractor. The resulting retraction moment applies a friction locking property, which secures the retractor's position. This locking mechanism is released when the user places their hand on the retractor and moves it in the opposite direction of the applied moment, releasing the friction lock and allowing the user to reposition the retractor. Figures 44 and 45 are perspective views of the retractor 60 of Figure 38 and include a viewing window 66 at a proximal end of the upper wall adjacent to the deflector ridge of the panniculus. Figures 46 and 47 are perspective views of first alternative configurations (detachable connector 70) designed to couple the retractor 60 to a support ring. The connector 70 comprises a body with a ring receiving channel 71 on the underside of the body and a rail coupling channel 72 formed on the upper portion of the body that is generally orthogonal to the ring receiving channel, such that an axis of the rail coupling channel 72 projects radially inward relative to the ring when attached to it. The ring receiving channel 71 has an elliptical profile sized for press-fit engagement with the support ring. The rail application channel is sized to receive the rail in a retaining and sliding relationship. In use, the connector 70 can be attached at any point around the circumference of the ring. The connector allows radial adjustment of the retractor over the ring by sliding the retractor relative to the connector, where release of the retractor results in locking the retractor rail to the connector and locking the connector to the support ring. Figure 50 is a perspective elevation side view of a support ring 2 having a detachable connector 70 press-fitted into the ring and a radially adjustable retractor 60 with a rail 61 approaching the detachable connector. These arrows R and C show how the use of this connector allows both radial (R) and circumferential (C) adjustment of the retractor's position on the connecting ring. Figure 51 is a detailed view of connector 70 attached to a support ring 2 with section lines AA, and Figure 52 is a sectional view of the support ring and connector taken along section lines AA in Figure 51, showing the small gap between the elliptical ring 2 and the elliptical ring coupling channel 71. The retraction moment, due to the forces acting on it from use in the patient, will cause the gap between ring 2 and the coupling channel of ring 71 to decrease to the point where the parts make frictional contact, thus creating a circumferential positioning locking mechanism. The elliptical shape facilitates this, while also providing an anti-rotation function, and thus limits the actual momentary degree of rotation, indicated by M. Figures 53 to 55 are cross-sectional views similar to Figure 52, showing how the elliptical shape of the ring's mating channel allows limited tilting movement of the connector within the ring. In Figures 54 and 55, the connector tilts outward and inward, resulting in frictional locking between the ring and the channel at defined friction points. These illustrations demonstrate how the elliptical shape permits a degree of tilting movement while preventing full rotation. This tilting movement results in frictional contact points, preventing circumferential movement of the coupling. Figures 48 and 49 show a detachable, circumferentially adjustable connector similar to that in Figures 46 and 47, generally indicated by reference number 80, in which the parts described with reference to the previous embodiment are assigned the same reference numbers. In this embodiment, the ring coupling channel 71 is recessed into the body and has an opening 81 between channel 72 and channel 71, so that when channel 71 is coupled to ring 2, the upper part of the ring is positioned in the rail coupling channel and makes contact with the rail. This is illustrated in Figure 56, which shows a cross-sectional view of ring 2, connector 80, and rail 61, and shows the ring in contact with the rail when the connector is tilted inward. Figures 57 and 58 are perspective views of a radially adjustable retractor according to an alternative embodiment of the invention, generally indicated by reference number 90, wherein the parts identified with reference to the prior embodiments are assigned the same reference numbers. In this embodiment, the head 65 of the rail 61 on the underside of the upper panel 10 of the retractor has a series of teeth 91 arranged radially along the rail. Each tooth 91 extends laterally across the top of the rail. In Figure 57, the teeth 91 have a straight sawtooth profile, and in Figure 58, the teeth 91 have a curved sawtooth profile. Figure 59 is a perspective view from below of a system of the invention showing two radially adjustable retractors 90 with integrated rail 61 and teeth 91 connected to the support ring 2 via the detachable connector 80. Figure 60 is a perspective view from above of part of the system of Figure 59 and showing a connecting ring 2 with a groove 93. Figures 61 to 63 are views of the system of Figure 59 showing how a tooth 91 on the rail 61 of the retractor 90 engages and locks with the groove 93 formed on the top of the support ring 2 when the connector 80 is attached to the rail 61 and the support ring 2. This is further illustrated in Figures 64 and 65, which are cross-sectional views showing the connector engaged with the support ring and the rail.In Figure 64, the connector 80 and rail rotate (i.e., tilt inward) relative to ring 2, resulting in teeth 91 being separated and not engaging with groove 93 in ring 2. This is an unlocked configuration that allows the rail and retractor to slide along channel 71 to radially adjust the retractor's position relative to the ring. In Figure 65, the connector does not rotate (little or no tilting, which occurs when the user releases the retractor), and a tooth 91 on the rail engages with groove 93 in the support ring, resulting in the rail, connector, and support ring being locked in position. This lock can be released by adjusting the retractor's tilt relative to the ring. Figures 66 and 67 are perspective views of another detachable connector of the invention, generally designated by reference number 100, wherein the parts identified with reference to the prior embodiments are assigned the same reference numbers. In this embodiment, the detachable connector 100 is configured to snap-fit ​​onto the support ring 2 as previously described and is engaged with the retractor by means of a protruding T-shaped lug 101 configured to engage an incoming groove 44 in the retractor. The lug and T-slots are substantially the same as those previously described and function in the same manner. Figure 68 shows a system of the invention incorporating a detachable connector 100 and shows how the detachable connector is circumferentially adjustable around ring 46 qa Lcnn / zznz / E / YiAi (arrow C) and how the connector allows radial adjustment of the retractor 3 relative to ring 2 (arrow R). Figure 69 shows a radially adjustable retractor 3 attached to a support ring 2 with the detachable connector 100, where the retractor is attached to the connector's T-shaped lug 40 through its radially innermost groove 44D (full retraction). Figures 70 and 71 are perspective and elevation side views of a support ring 2 according to an alternative embodiment of the invention, wherein the support ring has a curved profile. Figures 72 to 75 are side elevation views of the support rings of the invention. In Figures 72 and 73, the support ring 2 has a curved profile that curves upward from the fixed retraction end of the ring to the opposite end of the ring with the flange 18. In Figures 74 and 75, the curvature of the ring can have a first upward bend 105 and a second downward bend 106, as illustrated by the bold line 107. Figures 76 and 77 are perspective views from below of a system of the invention comprising a curved support ring and showing how the system can follow the patient's curvature indicated by the arrows. Figures 78 and 79 are elevation views of a system according to an alternative embodiment of the invention incorporating a detachable, elongated, panniculus deflector panel 110 configured to join the outer ring and curved around a section of the ring opposite the fixed retractor 7. In profile, the panel 110 has the same S-shaped profile as illustrated above for the integral flange 18, and has inwardly projecting radially connecting arms 111 with snap-fit ​​connectors 112 at a distal end of each arm configured to snap-fit ​​to the connecting ring 2. The panel 110 is shown before attachment to the ring 2 in Figure 78 and after attachment to the ring in Figure 79. Figures 80 and 81 are perspective views of radially adjustable retractors 3 without a hairline deflector flange and for use with a system comprising a detachable hairline deflector panel 110. Apart from the absence of an integrally formed hairline deflector flange 18, the retractors 3 are substantially the same as those described above. Figure 82 is a perspective view of the system in Figure 79 with the radially adjustable retractor 3 attached to ring 3 by means of an integrally formed T-shaped lug 40A that engages with the radially outermost slot 44A and the panniculus deflector panel 110 attached to ring 2 by arms 111 and connectors 112. qa Lcnn / zznz / E / YiAi Figures 83 and 84 are perspective views of the system in Figure 82 shown with additional radially adjustable retractors 3' and 50 attached to the support ring as described above. Figures 85 and 86 are perspective views of a radially adjustable retractor 3 with a hydrophilic surface coating 120 configured to absorb water and make the surface slippery to facilitate the passage of a neonate during delivery. Figures 87 and 88 are a perspective view of a radially adjustable retractor 3 with parts of the tissue-engaging retractor surface incorporating a rough surface 130 to improve grip when it comes into contact with abdominal tissue. Figure 89 is a side elevation view of a retractor showing how the lower panel 11 tapers upward and away from the incision, which helps the retractor grasp or hold the abdominal tissue during use. The retractor 3 is also sufficiently elastically deformable to allow the lower panel 11 to flex upward and downward during use (arrow A). Figure 90 shows how the height h of the retractor's back panel can be varied during manufacturing to accommodate patients who have abdominal tissue of different thicknesses. Figures 91A and 91B are perspective views of a radially adjustable paddle 3 having an extended panniculus deflector element 18 and a skin incision strain relief pocket 140 formed at the inflection point between the upper and rear panels 10, 12. Figures 92 to 94 show the configuration and technical effect of the strain relief pocket 140. First, Figures 92 and 93 are cross-sectional views of a retractor 3 without a strain relief pocket 140, which engages and secures the abdominal tissue 141 through an incision. The rectangular shape represents a cross-section through the abdominal wall. The arrow in Figure 92 represents the direction of movement when the retractor 3 grasps and lifts the abdominal incision.With the retractor 3, which retracts abdominal tissue under load (as would also be the case with standard retractors), the edges of the abdominal tissue experience a greater degree of compression due to the internal profile of the paddle (areas of greater tissue compression indicated by the arrows in Figure 93). Higher levels of tissue compression are experienced, especially in the outer layers of the skin, where compression can compromise blood flow within the tissue layers and subsequently increase the risk of tissue necrosis, depending on the duration of compression. Figures 94 and 95 are cross-sectional views of a retractor that includes a strain relief pocket that engages and secures abdominal tissue through an incision. The strain relief element of this paddle provides a pocket for the tissue edge, thus significantly reducing the level of tissue compression due to the paddle's geometric shape. This reduction in tissue compression therefore reduces the risks associated with restricted blood flow and resulting tissue damage. The upper arrow in Figure 93 represents the outer layers of the epidermis, where the greatest benefits of the strain relief feature will be obtained. The lower arrow would still be under the same degree of compression as the retractor in Figure 93; however, the inner layers do not present the same risk of necrosis.An additional strain relief feature could be incorporated for the inner edge of the tissue, if deemed appropriate. Figures 96 and 97 are cross-sectional elevation views of a radially adjustable retractor 3 without (Figure 96) and with (Figure 97) a soft elastomer or silicone rim. Figure 98 is a side elevation view of the retractor in Figure 96 with the rim, and Figure 99 is a side elevation view of a retractor without the soft elastomer or silicone rim. Figures 100 and 101 are perspective and side elevation views of a radially adjustable retractor without a panniculus deflector flange. Figures 102 and 103 are side elevation and perspective views of a radially adjustable retractor 3 with an adjustable, user-moldable hairline deflector flange 160. Figures 104 and 105 are perspective views of the retractor of Figure 102 with the hairline deflector flange formed in two different shapes. Figures 106 and 107 are perspective views of the retractor 3 before it is attached to a support ring, showing how the moldable flange 160 can take the shape of a panniculus before it is attached to ring 2. Figures 108 and 109 are perspective views of the retractor of Figure 104 attached to a support ring, and Figure 110 is a perspective view of a system of the invention with several retractors, each of which has an adjustable panniculus deflector flange 160 that unfolds upward on three of the retractors and folds downward on two of the retractors. Figure 111 illustrates the use of a system of the invention for containing the subcutaneous fat of an obese woman during a cesarean section procedure. The image shows the ring 3 anchored to the woman's abdomen by the fixed retractor 7 and the opposing retractor 3, and the subcutaneous fat deflector flange 18 that holds the woman's subcutaneous fat and keeps it out of the surgical field during the procedure. Equivalents The preceding description details current preferred embodiments of the present invention. It is expected that those skilled in the art will think of numerous modifications and variations in the practice thereof when considering these descriptions. It is intended that such modifications and variations are covered within the claims appended to this description.

Claims

1. A surgical access system (1) adapted to facilitate access to a surgical site through an incision in a patient's body upon opening the incision, comprising a support ring (2); a radially adjustable saddle-shaped retractor (3, 17) configured to manually grasp and retract a section of abdominal tissue into the incision; and coupling elements (20) configured to adapt each of the radially adjustable saddle-shaped retractors to the support ring in a tissue retraction position;characterized in that the system (1) is adapted to facilitate access to a neonate through a cesarean section incision in the patient's abdomen and in that the support ring is sized to allow delivery of a neonate through the ring and comprises an adjustable saddle-shaped retractor (7) fixed to the support ring and an outward-projecting handle (8) fixed to the support ring adjacent to the fixed saddle-shaped retractor (7), wherein the non-adjustable saddle-shaped retractor is a pelvic region retractor configured to cover and retain the woman's bladder during a cesarean section.

2. A system according to claim 1, wherein the coupling element for the radially adjustable saddle-shaped retractor comprises a first formation disposed on the top of the support ring and a corresponding second formation on the retractor configured to couple with the first formation, wherein the formations are configured to allow the retractor to tilt and / or rotate relative to the support ring when the retractor is fitted to the ring in a tissue retraction position.

3. A system according to claim 2, wherein the coupling element formations are configured to allow the retractor to tilt and rotate relative to the support ring when the retractor is fitted to the ring in a tissue retraction position.

4. A system according to claim 2 or 3, wherein the coupling element formations are configured to allow the retractor to roll relative to the support ring when the retractor is fitted to the ring in a tissue retraction position.

5. A surgical access system according to any preceding claim, comprising at least two radially adjustable saddle-shaped retractors.

6. A surgical access system according to any preceding claim, comprising at least three radially adjustable saddle-shaped retractors.

7. A surgical access system according to any preceding claim, wherein the radially adjustable saddle-shaped retractor comprises an upward-hanging flange configured to deflect the panniculus of an obese woman away from the surgical site during use.

8. A surgical access system according to claim 5 or 6, wherein at least two of the radially adjustable saddle-shaped retractors comprise an upward-hanging flange configured to deflect the panniculus of an obese woman away from the surgical site during use.

9. A surgical access system according to any preceding claim, wherein the radially adjustable saddle-shaped retractor comprises a top panel (10), a bottom panel (11), and a back panel (12) configured to hold a tissue section.

10. A surgical access system according to claim 9 having a U-shaped profile.

11. A surgical access system according to claim 9 or 10, wherein the upward-hanging flange is disposed at a proximal end of a radially adjustable saddle-shaped upper panel of the retractor and has an s-shaped profile.

12. A surgical access system according to any of claims 9 to 11, wherein the back panel has a convex curvature to match the curvature of an open incision. qa Lcnn / zznz / E / YiAi 13. A surgical access system according to any of claims 9 to 12, wherein the lower panel has a curved profile to adapt to the curvature of the lower part of the female abdominal wall.

14. A surgical access system according to any of the preceding claims, wherein the radially adjustable saddle-shaped retractors are sufficiently elastic to allow a user to grasp and hold the tissue when hand-held.

15. A surgical access system according to any preceding claim, comprising a circumferentially adjustable saddle-shaped retractor (3, 17) configured to manually grasp and retract a section of abdominal tissue into the incision, and a coupling element (20) configured to adapt the circumferentially adjustable saddle-shaped retractor to the support ring in a tissue retraction position.

16. A surgical access system according to claim 15, wherein the circumferentially adjustable saddle-shaped retractor includes an integral coupling element configured for direct coupling with the support ring (2) at a plurality of different circumferential positions along the ring.

17. A surgical access system according to claim 16, wherein the circumferentially adjustable saddle-shaped retractor comprises a plurality of integral coupling elements that are radially separated to allow radial adjustment of the retractor in the ring.

18. A surgical access system according to claim 16 or 17, wherein the integral coupling element comprises a ring-receiving formation configured to press-fit to the support ring, wherein the ring-receiving formation is oriented at least partially radially inward to engage with a radially outward aspect of the support ring.

19. A surgical access system according to any, wherein an upper panel (10) and / or a lower panel (11) of the saddle-shaped adjustable retractor (3, 17) opens outwards with a distal end of the panel that is wider than a proximal end of the panel.

20. A surgical access system according to any preceding claim comprising at least two radially adjustable saddle-shaped retractors wherein the upper panels (10) of the radially adjustable saddle-shaped retractors are sized to fit together when placed side by side in the ring in a fully retracted position.

21. A surgical access system according to any of the preceding claims, wherein the support ring (2) and the saddle-shaped retractors (3, 17) are made of polymer and are disposable.

22. A surgical access system according to claims 2 to 4, wherein the radially adjustable saddle-shaped retractor comprises a plurality of radially separated formations.

23. A surgical access system according to claims 2 to 4 or 22, wherein the formation in the support ring is a protruding lug and the formation in the retractor is a lug-receiving groove.

24. A surgical access system according to claim 23, wherein the lug-receiving slot is an incoming slot.

25. A surgical access system according to claim 24, wherein the lug-receiving slot comprises an inwardly radially oriented slot portion sized to receive the lug and an outwardly radially oriented slot portion configured to snap-fit ​​with the lug.

26. A surgical access system according to claim 24 or 25, wherein the lug comprises a stem portion sized to snap into the radially outward portion of the slot qa Lcnn / zznz / E / YiAi and a head portion that is oversized relative to the radially outward portion of the slot, but sized to fit snugly through the radially inward portion of the slot.

27. A surgical access system according to claim 26, wherein the inwardly radially oriented portion of the slot is dimensioned to receive the head portion when the head portion is misaligned with the inwardly radially oriented slot by up to 10° in the direction of rotation.

28. A surgical access system according to claims 23 to 27, wherein the lug is T-shaped and comprises an elongated head portion.

29. A surgical access system according to claims 23 to 28, wherein the elongated head portion is aligned with a circumference of the support ring.

30. A surgical access system according to claim 22, wherein the plurality of radially separated formations are arranged in a proximal section of the upper wall of the retractor.

31. A surgical access system according to claims 2 to 4, wherein one of the formations in the support ring is arranged in the support ring diametrically opposite the non-adjustable saddle-shaped retractor (7).

32. A surgical access system according to claims 2 to 4, wherein the support ring comprises two formations arranged on one side of the support ring opposite the fixed saddle-shaped retractor.

33. A surgical access system according to claims 2 to 4 or 22, wherein the formation on the support ring is a channel and the formation on the retractor is a projection that engages the channel. qa Lcnn / zznz / E / YiAi 34. A surgical access system according to claim 33, wherein the channel is embedded, at least partially, in the support ring.

35. A surgical access system according to claim 33 or 34, wherein the channel is a radial channel and the coupling projection of the channel is a rail element disposed on the underside of the upper wall of the retractor and configured to couple to the channel and allow sliding movement of the rail in the channel.

36. A surgical access system according to claim 31 or 32, wherein the radial channel has a longitudinal axis extending radially inwards and downwards towards a plane of the support ring.

37. Surgical access system according to claim 35 or 36, wherein the channel has an elliptical profile.

38. A surgical access system according to claims 35 to 37, wherein the rail element and radial channel are dimensioned for a tight but sliding fit, such that tilting the retractor relative to the support ring causes friction locking of the rail element in its position in the groove.

39. A surgical access system according to claims 2 to 4 wherein the or each formation in the support ring is integrally formed with the support ring.

40. A surgical access system according to claims 2 to 4 wherein the or each formation in the support ring can be detachably mounted on the support ring.

41. A surgical access system according to claim 40, wherein the detachable assembly comprises a connector with a lower portion having a ring receiving channel configured to snap-fit ​​onto the support ring and an upper portion comprising a formation configured to engage with the saddle-shaped retractor formation. qa Lcnn / zznz / E / YiAi 42. A surgical access system according to claim 41, wherein the upper body formation comprises a channel or projection that engages with the rail.

43. A surgical access system according to claim 42, wherein the upper body formation comprises a recessed channel that engages the rail with an opening configured to allow an upper portion of the support ring to project into the channel that engages the rail when the ring is received in the bell receiving channel.

44. A surgical access system according to claims 35 to 43, wherein the lower portion of the rail element has a plurality of radially spaced teeth and the upper portion of the support ring has an elongated circumferential groove configured to receive any of the plurality of radially spaced teeth through the opening.

45. A surgical access system according to claim 44, wherein the teeth and the slot are configured to allow locking between them when the retractor is in a first tilting orientation and unlocking when the retractor is in a second tilting orientation.

46. ​​A surgical access system according to claim 45, wherein the first tilt orientation is an inward tilt orientation.

47. A surgical access system according to claims 44 to 46 wherein the teeth have a sawtooth profile.

48. A surgical access system according to claims 41 to 47 wherein the ring receiving channel at the bottom of the connector has an elliptical profile configured to allow a limited amount of rotation of the connector in the support ring while preventing full rotation.

49. A surgical access system according to any of the preceding claims, wherein the support ring is flat. qa Lcnn / zznz / E / YiAi 50. A surgical access system according to claims 1 to 48, wherein the support ring is not flat.

51. A surgical access system according to claim 50, wherein the support ring curves upwards and away from the handle.

52. Surgical access system according to claim 51 wherein the support ring has a first upwardly curved bend and a second downwardly curved bend radially outward from the first upwardly curved bend.

53. A surgical access system according to any preceding claim, including a hairline deflector element configured to fit the support ring and comprising an elongated curved panel and connecting elements for connecting the panel to the support ring in a hairline deflector orientation wherein the elongated curved panel curves around an outer periphery of at least part of the support ring and projects upward relative to a plane of the support ring to deflect a woman's hairline away from the surgical site.

54. A surgical access system according to claim 53, wherein the elongated curved panel has a height that is at least equal to the height of the rear panel of the saddle-shaped retractor.

55. A surgical access system as claimed in claim 53 or 54, wherein the connecting elements comprise a plurality of radial arms configured to snap into the support ring.

56. A surgical access system according to claims 53 to 55, wherein the elongated curved panel has a width that is at least 50% of the widest dimension of the support ring.

57. A surgical access system according to any of the preceding claims, wherein the retractor comprises a functional material. qa Lcnn / zznz / E / YiAi 58. A surgical access system according to any of the preceding claims, wherein the retractor comprises an antimicrobial material.

59. A surgical access system according to any of the preceding claims, wherein the retractor is formed from a transparent material.

60. A surgical access system according to any preceding claim, wherein an external surface of the retractor, including the inflection curves joining the back wall to the upper and lower walls, has a smooth or hydrophilic surface.

61. A surgical access system according to any preceding claim, wherein the internal surface of the retractor, including the back wall and the bending curves joining the back wall to the upper and / or lower walls, comprises a rough surface that optionally comprises notches or projections on the surface.

62. A surgical access system according to any of the preceding claims, wherein the lower wall is slightly inclined upwards towards the upper wall, for example, up to 15°.

63. A surgical access system according to any of the preceding claims, wherein the posterior wall is dimensioned according to the thickness of the woman's abdominal wall.

64. A surgical access system according to any of the preceding claims, wherein the transition from the upper wall to the posterior wall and / or the transition from the posterior wall to the lower wall is curved.

65. A surgical access system according to any of the preceding claims, wherein the transition from the upper wall to the back wall comprises a pocket for skin relief.

66. A surgical access system according to claim 65, wherein the skin relief pocket comprises an outwardly curved transition section from the top wall to the back wall 67. A surgical access system according to any of the preceding claims, wherein the edges of the posterior wall and / or the lower wall have a smooth, atraumatic profile.

68. A surgical access system according to any of the preceding claims, wherein the edges of the posterior wall and / or the lower wall comprise a soft, flexible rim optionally formed from a silicone or soft elastomer material.

69. A surgical access system according to any of the preceding claims, wherein the soft, flexible rim is attached to the retractor rim by an overmolding process.

70. A surgical access system according to any preceding claim, wherein the panniculus deflector element is adjustablely attached to the retractor and configured for positional adjustment relative to the retractor.

71. A surgical access system according to any of the preceding claims, wherein the panniculus deflector element is detachably attached to the retractor.

72. A surgical access system according to any of the preceding claims, wherein the panniculus deflector element has an adjustable shape.

73. A surgical access system according to any preceding claim, comprising a viewing window disposed in an upper panel of the retractor.

74. A surgical access system according to any of the preceding claims, wherein the support ring has an elliptical profile.

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