SURGICAL RETRACTION DEVICE AND PROCEDURE

Abstract

The present invention provides a retraction device comprising, a shaft, a plurality of arms supported by the shaft, the arms being configured to be moveable between a first orientation in which the device assumes an insertion profile for passage of the device through a surgical incision, and a second orientation in which the device assumes a retraction profile. At least one of the plurality of the arms is adapted to be adjustable between a first length and a second length.

Claims

1. A retraction device comprising: a shaft, a plurality of arms supported by the shaft and being configured to be moveable between a first orientation in which the device assumes an insertion profile for passage of the device through a surgical incision, and a second orientation in which the device assumes a retraction profile, and in which at least one of the plurality of the arms is adapted to be adjustable between a first length and a second length.

2. The retraction device as in claim 1, in which the at least one arm is a telescopic arm.

3. The retraction device as in claim 1, in which the second length is longer than the first length.

4. The retraction device as in claim 3, in which the second length is at least 1.5 times longer than the first length.

5. The retraction device as in claim 1, in which the device further comprises a slidably moveable member capable of movement relative to the shaft, in which relative movement of the slidably moveable member in a first direction radially collapses the arms causing the retraction device to assume the insertion profile, and in which relative movement of the slidably moveable member in a second direction radially expands the arms causing the retraction device to assume the retraction profile.

6. The retraction device as in claim 1, in which the device further comprises a clamp mounted and arranged on the shaft in a manner such that a contact surface of the clamp contacts an exterior surface of the skin of the subject.

7. The retraction device claim 6, in which the clamp includes a flange extending radially from a distal end thereof, a lower surface of said flange making contact with the surface of the skin.

8. The retraction device in claim 7, in which the flange is annular.

9. The retraction device as in claim 6 which the clamp is slidably mounted on the shaft.

10. The retraction device as in claim 9, in which the clamp includes a guide channel configured for receipt of the shaft, the channel guiding movement of the clamp along the shaft.

11. The retraction device as in claim 10, in which the guide channel is a bore.

12. The retraction device as in claim 11, in which the clamp includes a first member having a first channel and a second member having a counterpart second channel, the bore being formed by the mating of the first channel with the second channel.

13. The retraction device as in claim 12, in which the first member and second member are pivotally connected.

14. The retraction device as in claim 1, in which the shaft has a perimeter and the plurality of arms are arranged about the perimeter such that in the insertion profile a longitudinal edge of a first arm is in contact with a longitudinal edge of a neighbouring arm.

15. (canceled)

16. (canceled)

17. The retraction device as in any preceding claim, in which the plurality of arms are arranged about substantially all of said perimeter and extend therefrom.

18. (canceled)

19. (canceled)

20. The retraction device as in claim 1, in which at least one of the plurality of arms comprises a magnetic material providing at least one point for magnetic anchorage.

21. The retraction device as in claim 20, in which the magnetic material comprises a plurality of magnetic or electromagnetic elements, thereby providing multiple points for magnetic anchorage.

22. The retraction device as in claim 20, in which the magnetic material is embedded within the at least one arm in order to avoid direct contact with tissue.

23. (canceled)

24. (canceled)

25. (canceled)

26. (canceled)

27. (canceled)

28. (canceled)

29. (canceled)

30. (canceled)

31. (canceled)

32. (canceled)

33. (canceled)

34. (canceled)

35. (canceled)

36. (canceled)

37. (canceled)

38. (canceled)

39. (canceled)

40. (canceled)

41. (canceled)

42. (canceled)

43. (canceled)

44. (canceled)

45. (canceled)

46. A kit for use during a surgical procedure, the kit comprising a retraction device as in claim 1, and at least one of the group consisting of: i) an access means through which the retraction device may be passed; ii) a flexible attachment means configured to secure the retraction device to a rigid support means; iii) a clamp configured for mounting on a shaft of the retraction device; iv) a restraining means for attachment to at least one of the plurality of arms of the device, the restraining means being configured for restraining a tissue or organ; v) a restraining means deployment tool.

47. (canceled)

48. (canceled)

49. The kit as in claim 46, in which the restraining means comprises a magnetic material, and in which the restraining means is magnetically attachable to at least one of a plurality of arms comprising a magnetic material.

50. (canceled)

51. (canceled)

52. (canceled)

53. (canceled)

54. (canceled)

55. (canceled)

56. (canceled)

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0078] Constructions of the invention are further described herein with reference to the accompanying drawings in which:

[0079] FIG. 1 is a side view of the retraction device.

[0080] FIG. 2 is an end view of the distal end of the retraction device.

[0081] FIG. 3 shows the retraction device in the insertion profile as it is being inserted through the surgical incision.

[0082] FIG. 4 shows a detailed views of the clamp.

[0083] FIG. 5 shows assembly of the clamp onto the shaft of the retraction device.

[0084] FIG. 6 shows the clamp in its final position on the retraction device.

[0085] FIG. 7 shows the mechanism for the deployment of the retraction device from the insertion profile to the retraction profile.

[0086] FIG. 8 is a schematic of the retraction device in the retraction profile within a body cavity.

[0087] FIG. 9 shows the mechanism for extending the length of the arms of the retraction device.

[0088] FIG. 10 is a schematic of the retraction device shown in FIG. 9 within a body cavity.

[0089] FIG. 1 shows a side view of the retraction device 10. The device is deployed to/from an insufflated abdominal cavity through a small incision (similar in size to that made by a 12 mm laparoscopic camera port). This minimises access trauma. The device is designed to be located at the central laparoscopic access point, typically the umbilicus. The device is inserted/removed from the incision in the same way as a conventional laparoscopic port or trocar. The device may be used in conjunction with an access means, such as a trocar, but this is not necessary. The device includes a shaft 20, a plurality of arms 30 located at or near the distal end of the shaft, a plunger 40 located at the opposing proximal end and a collar 50 positioned about the shaft.

[0090] An end view of the retraction device 10 is shown in FIG. 2. The illustrated device includes three retraction arms 30a, 30b and 30c and one stabilisation arm 30d. The longitudinal edges of each of the arms are in contact with the longitudinal edges of the neighbouring arms. This minimises the cross-sectional size of the device and provides a smooth insertion profile. The proximal end of each arm has a tapered curve. This results in the distal-most end of each arm converging to a central point. This shaping also facilitates the insertion of the device through a surgical incision.

[0091] FIG. 3 is a schematic of the retraction device partly inserted through a surgical incision within the abdominal wall 60. The abdominal wall is shown in cut-away. The retraction device is shown in the insertion profile. Whilst the diameter of the device in the insertion profile is variable, it is constrained by the size of the surgical incision. The device must fit snuggly within the surgical incision. In the illustrated embodiment the diameter of the device is about 19 mm.

[0092] FIG. 4 shows the clamp 70 which is used to support the retraction device within the abdominal cavity. The use of the clamp obviates the need for the retraction device to be connected to a rigid support means, such as an operating table. The clamp is in the form of a collar that the surgeon positions about the shaft 20 of the device.

[0093] The clamp 70 comprises a first member 80a and a second member 80b that are pivotally connected via a hinge 90. Each member includes a semi-circular shaped flange 100a, 100b. An upstanding curved wall 110a, 110b is provided on the straight edge of the semi-circular flange. Each curved wall 110a, 110b provides a semi-circular guide channel 120a, 120b on each member. The guide channels 120a, 120b are located in corresponding positions on the first and second members so that when the two members are pivotally brought together into a closed relationship the guide channels 120a, 120b form a bore 130. The depth of the guide channels 120a, 120b is selected such that the final diameter of the bore 130 is only slightly larger than diameter of the shaft 20.

[0094] When the first and second members 80a, 80b are in the closed positioned the semi-circular flanges 100a, 100b form an annular flange.

[0095] The shaft 20 is provided along its length with a plurality of horizontally orientated grooves 140. Teeth 150 arranged on one end of each curved wall 110a, 110b are engagable with the grooves 140. This improves the attachment of the clamp to the shaft.

[0096] The clamp 70 is also secured in place about the shaft by a tab 160 provided on the straight edge of the first member 80a being snap-fitted into a slot 170 provided on a straight edge of the second member 80b.

[0097] FIG. 5 illustrates the clamp 70 being positioned about the shaft 20 of the retraction device. The retraction device is shown in the retraction profile, with the plurality of arms in the second orientation. The abdominal wall 60 (shown in cut-away) is sandwiched between the lower surface of the annular flange, and the upper surfaces of each of the retraction arms 30a-30c. The clamp is shown in the closed position in FIG. 6. The clamp is positioned along the longitudinal axis of the shaft 20 so that the lower surface of the annular flange (formed by semi-circular flanges 110a and 110b) is in contact with the exterior surface of the skin of the patient. In this arrangement the clamp 70 can apply a compressive force downwardly onto the skin, thereby providing a sealing function. This helps to prevent gas leaking from the insufflated abdominal cavity.

Deployment of the Device

[0098] The deployment of the device from the insertion profile to the retraction profile is described below as a two-step process. The first step is referred to as the arm opening step. The second step is referred to as the arm lengthening step. The second step is optional.

First Step Of Device Deploymentthe Arm Opening Step.

[0099] In this step the retraction arms 30a-30c and the stabilisation arm 30d are moved to their second orientation in which they become angled (>0) relative to the longitudinal axis shaft 20. This mechanism for moving the arms is illustrated in FIG. 7. The surgeon depresses the plunger 40 which in turn moves a cam-like mechanism past each arm.

[0100] FIG. 8 illustrates the arms 30a-30d in the second orientation, in which the arms are locked at an angle of about 90 with respect to the longitudinal axis of the shaft 20. In this second orientation the upper surface of the arms lie against the inner surface of the abdominal wall. The angle between the arms 30a and 30b is about 70 and the angle between the arms 30b and 30c is about 70. It is contemplated that the angle between the arms 30a and 30b and the angle between the arms 30b and 30c can be lesser or greater than about 70. It is also contemplated that the angle between the arms 30a and 30b can be different from the angle between the arms 30b and 30c.

Second Step of Device Deploymentthe Arm Lengthening Step.

[0101] FIG. 9 illustrates the mechanism for extending the length of the retraction arms 30a-30c. In the device illustrated the stabilisation arm 30d is not extendable, but it is envisaged that it could be in other constructions. Each retraction arm includes a first portion 180a that is pivotally connected to the shaft 20 and a second portion 180b that is slidably connected to the first portion. A tensionable cord 190 extends along the length of the shaft and along the first and second portions of the arm. When the arm is configured to have its first length, the cord is not held under tension and the proximal end of the second portion lies underneath the first portion. When the surgeon puts the cord under tension, by sliding the collar 50 upwardly along the shaft 20 towards the plunger 40 (as indicated by the arrow A), the second portion 180b of the arm is caused to slide in a direction away from the first portion 180a (as indicated by Arrow B), thereby extending the overall length of the arm.

[0102] FIG. 10 illustrates the device with fully extended arms 30a-30c. Retraction of tissues is achieved using a system of tensile restraints 170 which are composed of a clip to grasp the desired tissue or organ which in turn is anchored to the lower surface of the retraction arms 30a-30c using mechanical fixings. Suitable mechanical fixings, include magnets, hooks or loops provided on the clip. Optionally, a compliant cord element joins the clip to the retraction arm.

[0103] After the completion of the surgical procedure the device 10 is removed from the abdominal cavity by reversing the deployment steps 1 and 2. The device assumes the original insertion profile, and can be removed from the abdominal cavity, once the clamp has been moved out of contact with the exterior surface of the skin of the patient.

[0104] It is envisaged that the reversal of the deployment steps can be performed in either order. That is to say, the arms can be shortened and then moved to the first orientation, or the arms can be moved to the first orientation and then shortened.

[0105] For example, the surgeon can slide the collar 50 downwardly along the shaft 20 to shorten the length of the arms 30a-30c. The plunger 40 is then moved upwardly to move the arms 30a-30d from the second orientation into the first orientation.