WOUND RETRACTOR SPECIMEN BAG
20170325798 · 2017-11-16
Inventors
Cpc classification
A61B17/0293
HUMAN NECESSITIES
A61B17/3423
HUMAN NECESSITIES
A61B2017/320024
HUMAN NECESSITIES
International classification
Abstract
A surgical apparatus for positioning within a tissue incision to access an underlying body cavity and remove a tissue specimen therefrom includes a wound retractor having a specimen bag attached thereto. The wound retractor includes a proximal ring, a distal ring, and a film extending therebetween defining a longitudinal passage therethrough. The specimen bag is attached to the distal ring of the wound retractor and permits placement of a tissue specimen to be removed from the body therein.
Claims
1. A surgical apparatus, comprising: a wound retractor including: a proximal ring, a distal ring, and a film disposed between the proximal ring and the distal ring; and a specimen bag attached to the distal ring of the wound retractor.
2. The surgical apparatus of claim 1, wherein the proximal ring of the wound retractor defines a generally circular opening and is deformable.
3. The surgical apparatus of claim 1, wherein the distal ring of the wound retractor defines a generally circular opening and is deformable.
4. The surgical apparatus of claim 1, wherein the film of the wound retractor defines an adjustable length between the proximal ring and the distal ring.
5. The surgical apparatus of claim 1, wherein the specimen bag is attached to the distal ring of the wound retractor by a method selected from the group consisting of adhesive bonding, welding, heat-sealing, and combinations thereof.
6. The surgical apparatus of claim 1, wherein the proximal ring, the distal ring, or both, possess a tether thereon.
7. A kit comprising: a surgical apparatus including a wound retractor including: a proximal ring, a distal ring, a film disposed between the proximal ring and the distal ring; and a specimen bag attached to the distal ring of the wound retractor; and a morcellating trocar.
8. The kit of claim 7, further including a cannula.
9. The kit of claim 7, wherein the proximal ring of the wound retractor defines a generally circular opening and is deformable.
10. The kit of claim 7, wherein the distal ring of the wound retractor defines a generally circular opening and is deformable.
11. The kit of claim 7, wherein the film of the wound retractor defines an adjustable length between the proximal ring and the distal ring.
12. The kit of claim 7, wherein the specimen bag is attached to the distal ring of the wound retractor by a method selected from the group consisting of adhesive bonding, welding, heat-sealing, and combinations thereof.
13. The kit of claim 7, wherein the proximal ring, the distal ring, or both, possess a tether thereon.
14. The kit of claim 7, wherein the morcellating trocar includes a proximal portion, a distal portion, and an elongate shaft between the proximal portion and the distal portion, the elongate shaft having blades on an interior surface at the distal portion projecting into a lumen of the elongate shaft, and the proximal portion of the elongate shaft possessing a rotation knob for rotating the elongate shaft.
15. A method comprising: introducing into a body opening a surgical apparatus including a wound retractor having a proximal ring, a distal ring, a film disposed between the proximal ring and the distal ring, and a specimen bag attached to the distal ring of the wound retractor; inserting the surgical apparatus through the body opening into a body cavity; passing a tissue specimen through the proximal ring, the film and the distal ring of the surgical apparatus into the specimen bag; removing the proximal ring from the body cavity through the body opening so that the film is adjacent tissue encompassing the body opening; pulling the proximal ring away from the distal ring such that the distal ring is brought into abutment with an inner surface of the tissue surrounding the body opening; rolling the proximal ring about itself such that the film is furled about the proximal ring and tensioned; rolling the proximal ring to retract the incision and bring the proximal ring into abutment with an outer surface of the tissue; and removing the tissue specimen from the specimen bag.
16. The method of claim 15, further including breaking up the tissue specimen prior to removing the tissue specimen from the specimen bag.
17. The method of claim 15, further including: introducing a cannula through the proximal ring, the film, and the distal ring into the specimen bag prior to removing the tissue specimen from the specimen bag; introducing a morcellating trocar through the cannula into the specimen bag; introducing a grasping element through the morcellating trocar into the specimen bag and grasping the tissue specimen therein; proximally pulling the grasping element while activating the morcellating trocar to break up the tissue specimen as it is removed from the specimen bag.
18. The method of claim 17, wherein the cannula possesses an anchoring balloon which is inflated to anchor the cannula in the body opening.
19. The method of claim 17, further comprising inflating the specimen bag prior to removal of the tissue specimen therefrom.
20. The method of claim 17, wherein the morcellating trocar includes a proximal portion, a distal portion, and an elongate shaft between the proximal portion and the distal portion, the elongate shaft having blades on an interior surface at the distal portion projecting into a lumen of the elongate shaft, and the proximal portion of the elongate shaft possessing a rotation knob for rotating the elongate shaft, and activating the morcellating trocar includes rotating the elongate shaft so that the tissue specimen is cut by the blades as the tissue specimen passes through the morcellating trocar.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
[0020] Various embodiments are described herein with reference to the drawings wherein:
[0021]
[0022]
[0023]
[0024]
[0025]
[0026]
[0027]
[0028]
[0029]
[0030]
[0031]
[0032]
[0033]
DETAILED DESCRIPTION
[0034] The present disclosure provides a surgical apparatus for use in minimally invasive procedures. As used herein with reference to the present disclosure, minimally invasive surgical procedures encompass laparoscopic procedures and endoscopic procedures, and refer to procedures utilizing scopes or similar devices having relatively narrow operating portions or a small incision in the skin.
[0035] The aspects of the present disclosure may be modified for use with various methods for retrieving tissue specimens during minimally invasive procedures. Examples of minimally invasive procedures include, for example, cholecystectomies, appendectomies, nephrectomies, colectomies, splenectomies, and the like.
[0036] As used herein, the term distal refers to the portion of a surgical apparatus, including a wound retractor and specimen bag of the present disclosure, which is farthest from the user, while the term proximal refers to that portion of the surgical apparatus of the present disclosure which is closest to the user.
[0037] The surgical apparatus of the present disclosure includes a wound retractor with a specimen bag affixed thereto. The wound retractor component includes a sleeve member possessing at least two rings, including a proximal ring and a distal ring with a film between the two rings. The specimen bag component is attached to the distal ring of the wound retractor. In use, the entire surgical apparatus is passed through an incision and placed within the body, and tissue to be removed therefrom, referred to in embodiments as a “tissue specimen”, is passed through the wound retractor component and placed within the specimen bag. The proximal ring of the wound retractor component is then removed from the body cavity and placed adjacent the skin on the outside of the body adjacent the incision, with the distal ring of the sleeve member and specimen bag remaining within the body, so that the film extends through the incision and is adjacent the tissue encompassing the incision into the body. These apparatuses are suitable for use in any procedure where access to the interior of the body is limited to one or more relatively small incisions, as in minimally invasive procedures.
[0038] Kits of the present disclosure include both the surgical apparatus described above, as well as a manual morcellating trocar. The manual morcellating trocar may be placed through the wound retractor of the surgical apparatus and introduced into the specimen bag containing the tissue specimen, whereby the manual morcellator is activated to break up the tissue specimen within the specimen bag permitting removal of the tissue specimen from the body through the wound retractor. Kits of the present disclosure may also include an optional cannula for introducing the morcellating trocar into the specimen bag.
[0039] Embodiments of the present disclosure will now be described in detail with reference to the drawings, in which like reference numerals designate identical or corresponding elements in each of the several views. In the following description, well-known functions or constructions are not described in detail to avoid obscuring the present disclosure in unnecessary detail.
[0040]
[0041] The surgical apparatus 10, including the wound retractor 100 and the specimen bag 200, is adapted for insertion into wound “W” through an incision “I” (as illustrated in
[0042] Turning to
[0043] The proximal ring 120 and the distal ring 140 are axially aligned along longitudinal axis “L” with the film 130 disposed therebetween, as noted above. The proximal ring 120 has a generally circular configuration that defines a circular opening 122 (see
[0044] It is envisioned that the proximal ring 120 and the distal ring 140 may be fabricated from resilient materials such that the proximal ring 120 and the distal ring 140 may temporarily deform into a generally oblong configuration during insertion of the wound retractor 100 through an incision “I” (
[0045] The film 130 defines a generally cylindrical shape to form a lumen between the proximal ring 120 and the distal ring 140. The circular configuration of the proximal and distal rings 120 and 140, respectively, maintains the film 130 in an expanded state to maintain the lumen in a non-collapsed state. The film 130 is coupled to the proximal ring 120 at the proximal end portion 132 and is coupled to the distal ring 140 at the distal end portion 134, such that the film 130 does not slide or move relative to a surface of either the proximal ring 120 or the distal ring 140. The film 130 may be fabricated from a clear, non-elastomeric material, e.g., a polyurethane.
[0046] The length “X” between the proximal ring 120 and the distal ring 140 is adjustable. More specifically, the length “X” can be decreased by rolling the proximal ring 120 towards the distal ring 140 to furl the film 130 about the proximal ring 120. Similarly, the length “X” can be increased by rolling the proximal ring 120 away from the distal ring 140 to unfurl the film 130 from about the proximal ring 120. As discussed above, as the proximal ring 120 is rolled towards or away from the distal ring 140, the film 130 furls or unfurls about the proximal ring 120. It should be appreciated that as the film 130 is furled about the proximal ring 120, it reduces the length “X” of the film 130, so the tension in the film between the proximal ring 120 and distal ring 140 is increased to provide a radially outward force within the incision “I”.
[0047] It is envisioned that the wound retractor 100 may come in a variety of sizes to appropriately fit and accommodate a range of incision diameters. For example, for an extra small wound retractor, the outer diameter of the proximal ring 120 and the distal ring 140 may be about 2.5 inches; for a small wound retractor, the outer diameter of the proximal ring 120 and the distal ring 140 may be about 3.9 inches; for a medium sized wound retractor, the outer diameter of the proximal ring 120 and the distal ring 140 may be about 5.1 inches; for a large wound retractor, the outer diameter of the proximal ring 120 and the distal ring 140 may be about 7.5 inches; and for an extra-large wound retractor, the outer diameter of the proximal ring 120 and the distal ring 140 may be about 9.4 inches.
[0048] Specimen bags of the present disclosure are made of flexible and durable materials within the purview of those skilled in the art, in embodiments, polymeric materials. The specimen bags are inflatable and capable of allowing a surgeon to introduce cutting devices into the specimen bag to reduce the size of the tissue specimen therein, thereby facilitating removal of the specimen bag from the body. Materials used to form the specimen bags are antistatic, pyrogen-free, non-toxic and sterilizable. In embodiments, materials used to form the film portion of the wound retractor described above may be used to form the specimen bag. In other embodiments, the specimen bag is formed of materials that are different from those used to form the film of the wound retractor. The specimen bag may be opaque or clear.
[0049] As depicted in
[0050] Both the proximal ring 120 and the distal ring 140 may be collapsed from the generally circular configuration to a generally oblong configuration (not shown) for insertion, along with the specimen bag 200, through incision “I”. More specifically, as the practitioner squeezes opposing sides of the proximal ring 120 and the distal ring 140 radially inwards, the generally circular openings of the proximal ring 120 and the distal ring 140 are deformed from the generally circular configuration to a generally oblong configuration (not shown) such that the proximal ring 120 and the distal ring 140 assume a smaller profile for ease of insertion through incision “I”. Once inserted, the practitioner releases the proximal ring 120 and distal ring 140 and the resiliency of the material urges the proximal ring 120 and the distal ring 140 towards their generally circular configurations.
[0051] In embodiments, where the tissue specimen “T” within the specimen bag 200 is too large to pass through the wound retractor 100 (
[0052] Referring to
[0053] Kits of the present disclosure also include an optional cannula 400 for introducing the morcellating trocar 300 through the wound retractor 100 and into the specimen bag 200. Turning to
[0054] The anchoring balloon 440 at the distal portion 412 of the elongate shaft 410 of the cannula 400 may be inflated with any medical grade fluid, such as saline, CO.sub.2, or any other fluid. The anchoring balloon 440 may be inflated using a syringe, mechanically or manually operated pump, or other means. The inflation port 420 for inflating the anchoring balloon 440 may be used with one-way valves, check valves, or any other valve arrangement for inflating the anchoring balloon 440.
[0055] Once the anchoring balloon 440 has been inflated to secure the distal portion 412 of the cannula 400 within a body cavity and within the specimen bag 200, the specimen bag 200 can be inflated. In order to inflate the specimen bag 200, a source of inflation pressure is releasably attached to the inflation port 430 and pressurized fluid is introduced through the inflation port 430 and communicated along axis 3-3 (as depicted in
[0056]
[0057] With reference to
[0058] Once tissue specimen “T” has been introduced into the specimen bag 200, the surgeon then collapses and deforms the proximal ring 120 using a forceps, grasper, or similar instrument. In other embodiments, the proximal ring 120 has a tether thereon (not shown), which may be pulled proximally by the surgeon to remove the proximal ring 120 from the body cavity.
[0059] As shown in
[0060] With the distal ring 140 in abutment with the inner surface 8 of wound “W”, the proximal ring 120 is rolled distally towards the distal ring 140 and the outer surface 4 of wound “W” to a desired position, such that the film 130 is furled about the proximal ring 120 (not shown) and thereby tensioned.
[0061] Once the wound retractor 100 and the specimen bag 200 are in position, surgical tools and instruments may pass through the wound retractor 100 with the distal ring 140 in abutment to the inner surface 8 of wound “W”, and the proximal ring 120 rolled to a desired position and/or brought into abutment to the outer surface 4 of wound “W”. The wound retractor 100 may be tensioned further to provide retraction of incision “I”, increasing the incision diameter.
[0062] Where the tissue specimen “T” in the specimen bag is too large to be removed through the incision, the morcellating trocar 300 may be introduced through the wound retractor 100 into the specimen bag 200. While the morcellating trocar 300 may be introduced directly through the wound retractor 100 into the specimen bag 200, in embodiments, as depicted in
[0063] Upon inflation of the specimen bag 200, the morcellating trocar 300 is introduced through the cannula 400 into the specimen bag 200. (
[0064] As depicted if
[0065] The anchoring balloon 440 on the cannula 400 helps stabilize the tissue specimen “T” during removal of the tissue specimen “T” from the specimen bag 200. As the forceps 500 are pulled proximally (indicated by arrows “Y” in
[0066] Pulling tissue specimen “T” through the distal end 312 of the morcellating trocar 300 will bring tissue specimen “T” to be removed from the specimen bag 200 into contact with the blades 320, 330. Rotating the elongate shaft 310 with the proximal rotation knob 340 as tissue specimen “T” is pulled proximally into contact with the blades 320, 330 within the lumen 314 of the elongate shaft 310 of the morcellating trocar 300 will continually cut the tissue specimen “T” into a double helical pattern to allow it to fit through the smaller diameter of the elongate shaft 310. The cut tissue specimen may thus pass through the elongate shaft 310 of the morcellating trocar 300 as it is removed from the specimen bag 200. In embodiments, if tissue specimen “T” to be removed separates and portions thereof remain in the specimen bag 200 as tissue specimen “T” is cut by the blades 320, 330, the surgeon may grab those additional pieces of tissue with a forceps or other grasper, and/or use a vacuum source for removal of any remaining portion of the tissue specimen “T” from the specimen bag 200. In other embodiments, the volume of the tissue specimen “T” in the specimen bag 200, as well as any fluids from the tissue specimen “T”, may be reduced to a point that specimen bag 200, with any remaining tissue and/or fluids therein, may pass through incision “I” without need for any further morcellation.
[0067]
[0068] In other embodiments, not shown, power morcellators may be used with the wound retractor/specimen bag of the present disclosure.
[0069] Once a sufficient amount of tissue specimen “T” is removed from the specimen bag 200 to facilitate removal of the specimen bag 200 through incision “I”, the inflation gases are withdrawn from the specimen bag 200, and from the anchoring balloon 440. The surgeon then collapses and deforms the distal ring 140 using a forceps, grasper, or similar instrument. In other embodiments, the distal ring 140 has a tether thereon (not shown), which may be pulled proximally by the surgeon to remove the distal ring 140 from the body cavity.
[0070] The film 130, distal ring 140, and specimen bag 200 are then removed from the body cavity through incision “I”.
[0071] After the specimen bag 200 is removed, any tissue remaining therein can be removed from the specimen bag 200 for further examination or the specimen bag 200 can be discarded.
[0072] The specimen bags of the present disclosure provide safe tissue extraction at the end of minimally invasive surgical procedures. Diseased tissue may be removed from the body without seeding of spilled tissue cells inside the abdomen. The design of the wound retractor/specimen bags of the present disclosure, with the morcellating trocar described above, allows for the surgeon to break up tissue without tearing the specimen bag and possibly releasing tissue contents back into the body of the patient. It is further envisioned that the methods of using the specimen bags of the present disclosure may be modified to accommodate needs of a given procedure and/or the preferences of the surgeon. It is further envisioned that the embodiments disclosed herein may be used to remove any tissue or object from the body.
[0073] It will be understood that various modifications may be made to the embodiments disclosed herein. For example, other methods for introducing specimen bags of the present disclosure into the body of a patient may be used. Additionally, other specimen bag shapes may be used. Further, the terminology of similar components with the various embodiments should not be construed as specific to any particular embodiment. Thus, the above description should not be construed as limiting, but merely as exemplifications of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.