Devices and methods for protecting tissue at a surgical site

• US 20050283050A1
• Filed: 06/22/2004
• Published: 12/22/2005
• Est. Priority Date: 06/22/2004
• Status: Active Grant

• Current Assignee: DePuy Synthes Products LLC (Johnson & Johnson)
• Original Assignee: DePuy Synthes Products LLC (Johnson & Johnson)
• Inventors: Smith, Matthew, Gundlapalli, RamaRao, Heldreth, Mark
• Granted Patent: US 8,857,440 B2
• Time in Patent Office: Days
• US Class Current: 600/208
• CPC Class Codes: A61B 17/0293 with ring member to support retractor elements
• CPC Class Codes: A61B 17/3423 Access ports, e.g. toroid shape introducers for instruments or hands access sites for liquids A61M39/0247
• CPC Class Codes: A61B 2046/205 Adhesive drapes
• CPC Class Codes: A61B 2090/08021 of the patient or his organs
• CPC Class Codes: A61B 46/00 Surgical drapes

Abstract

A tissue protector is adapted to be positioned on the skin surrounding an incision. The tissue protector provides a load bearing surface for surgical tools and instruments to prevent blunt force and pressure trauma to the skin and soft tissues within the incision. In one embodiment, the tissue protector is a sheet of wear-resistant material having an opening corresponding to the incision and expandable as the incision is retracted. In another embodiment, a tissue protector device includes a continuous expandable arrangement of interconnected L-shaped links. In still another embodiment, a one-piece tissue protector includes a flexible panel supported on the skin and a flexible sleeve extending into the incision. Yet another embodiment of the invention resides in a track that is supported about the incision. An instrument support platform is slidably mounted to the track to support a surgical tool relative to the incision.

Claims

1. A method for protecting tissue at an incision for minimally invasive surgery comprising the steps of:

making an incision at the surgical site;

applying an abrasion-resistant sheet of material around the incision; and

retracting the tissue and the sheet of material at the incision to access the surgical site.

2. The method for protecting tissue of claim 1, wherein the step of applying a sheet of material includes adhering the sheet of material to the skin or a betadiene layer surrounding the incision.

3. The method for protecting tissue of claim 1, further comprising the step of supporting a surgical tool on the abrasion-resistant sheet while manipulating the tool.

4. The method for protecting tissue of claim 1, further comprising the step of providing an anti-infection compound to the sheet of material.

5. A tissue protector for use in minimally invasive surgery comprising:

a sheet of abrasion-resistant material defining an elongated opening for access to a tissue incision, said sheet having an adherent facing surface adapted to be applied to the surgical site surrounding the incision.

6. The tissue protector of claim 5, wherein said sheet further includes a bead defined around at least a portion of said opening, said bead arranged to support a surgical tool or instrument extending into the incision when the sheet is applied to the surgical site.

7. The tissue protector of claim 5, wherein said sheet of material is an isotropic.

8. The tissue protector of claim 7, wherein said sheet of material exhibits greater resistance to stretching along an axis parallel to the length of said elongated opening than along an axis perpendicular to said length.

9. The tissue protector of claim 5, wherein said sheet includes an expandable portion spanning said elongated opening at opposite ends thereof.

10. The tissue protector of claim 9, wherein said expandable portion includes a pleat.

11. The tissue protector of claim 9, wherein said expandable portion is configured to expand less toward the terminal ends of the opening.

12. The tissue protector of claim 5 wherein said sheet includes reinforcements at the opposite ends of said elongated opening.

13. The tissue protector of claim 5, wherein said sheet is dosed with an anti-infection compound.

14. A tissue protector device for use in minimally invasive surgery, comprising:

a plurality of generally L-shaped links, each sized for contacting a portion of a surgical incision; and

means for connecting adjacent links of said plurality of links to permit expansion of the distance between said plurality of links.

15. The tissue protector device of claim 14, wherein said plurality of links includes:

a first set of links;

a second set of links alternatingly disposed between links of said first set; and

said means for connecting includes a sliding connection between links of said first set and links of said second set to permit relative movement therebetween.

16. The tissue protector device of claim 15, wherein said sliding connection includes a male-female connection between links of said first set and links of said second set.

17. The tissue protector device of claim 16, wherein said male-female connection includes a channel defined in links of said first set of links, said channel configured to slidably receive links of said second set of links therein.

18. The tissue protector device of claim 17, wherein said links of said first set of links are tubular.

19. The tissue protector device of claim 15, wherein said sliding connection includes a slot defined in links of said first set of links and a protrusion connected to links of said second set of links and extending into said slot to slide within said slot.

20. The tissue protector device of claim 19, wherein said slot includes a detent at the opposite ends of said slot, each said detent offset from said slot so that said protrusion is prevented from sliding within said slot when said protrusion is disposed within said detent.

21. The tissue protector device of claim 14, wherein said plurality of links are connected to form a continuous circle.

22. The tissue protector device of claim 21, wherein said means for connecting is operable to permit expansion of said continuous circle from a first diameter to a larger second diameter.

23. The tissue protector device of claim 22, wherein said means for connecting is operable to permit expansion of said continuous circle to infinite diameters between said first and second diameters.

24. The tissue protector device of claim 14, wherein said plurality of links are connected to form at least two opposing arc segments.

25. The tissue protector device of claim 24, wherein said opposing arc segments are elliptical.

26. The tissue protector device of claim 24, further comprising a hinge connecting at least one end of each of said opposing arc segments.

27. The tissue protector device of claim 26, wherein said hinge is resiliently biased to pivot said opposing arc segments away from each other.

28. The tissue protector device of claim 14, wherein each of said plurality of links is arcuate.

29. A tissue protector for use in minimally invasive surgery, comprising:

a flexible panel having a facing surface adapted to be supported on the skin adjacent an incision, said panel defining an opening for alignment over said incision when the panel is supported on the skin; and

a flexible sleeve substantially coextensive with said opening and connected to said facing surface of said flexible panel to extend into the incision when said facing surface is supported on the skin.

30. The tissue protector of claim 29, wherein said flexible sleeve and said flexible panel are integral.

31. The tissue protector of claim 29, wherein said flexible sleeve includes an upper edge integral with said flexible panel at said opening and a lower edge flared outwardly relative to said upper edge.

32. The tissue protector of claim 29, wherein said flexible panel is anisotropic.

33. The tissue protector of claim 29, wherein said opening is elongated in a generally oval shape.

34. The tissue protector of claim 33, wherein said flexible panel is stiffer along an axis perpendicular to the axis of said elongated opening than along an axis parallel to the axis of said elongated opening.

35. The tissue protector of claim 29, wherein said flexible panel has an upper surface opposite said facing surface, said upper surface defining at least one continuous rib concentrically disposed about said opening.

36. The tissue protector of claim 35, wherein said upper surface defines at least three concentrically disposed ribs.

37. The tissue protector of claim 29, wherein said flexible sleeve includes an interior surface, said interior surface defining at least one circumferential rib spaced apart from said opening.

38. The tissue protector of claim 37, wherein said interior surface of sad flexible sleeve defines at least three spaced apart circumferential ribs.

39. The tissue protector of claim 29, wherein said facing surface includes an adhesive adapted to adheres to the surgical site adjacent the incision.

40. A tissue protector device for minimally invasive surgery comprising:

a track configured to encircle at least a portion of an incision at a surgical site;

an instrument platform having an upper surface for supporting an instrument and an opposite lower surface; and

means between said lower surface and said track for slidably mounting said instrument platform on said track with said upper surface aligned with the incision.

41. The tissue protector device of claim 40, further comprising means for fixing the location of said track relative to the incision.

42. The tissue protector device of claim 41, wherein said means for fixing includes a panel attached to said track, said panel including an adherent facing surface adapted to be applied to the surgical site surrounding the incision and defining an opening for access to the incision.

43. The tissue protector device of claim 40, further comprising a panel attached to said track, said panel including an adherent facing surface adapted to be applied to the surgical site surrounding the incision and defining an opening for access to the incision.

44. The tissue protector device of claim 40, wherein said means for slidably mounting permits pivoting of said instrument platform relative to said track.

45. The tissue protector device of claim 40, wherein said means for slidably mounting includes a bracket projecting from said lower surface, said bracket defining a notch configured to engage said track.

46. The tissue protector device of claim 45, wherein:

said track includes an upper ring having a substantially circular cross-section; and

said notch is substantially circular to engage said upper ring.

47. The tissue protector device of claim 40, wherein said upper surface defines a channel for receiving the instrument.

48. The tissue protector device of claim 47, wherein said channel includes an elongate arcuate surface.

49. The tissue protector device of claim 40, wherein said instrument platform includes a deflector panel at an end of said upper surface, said deflector panel being oblique to said upper surface.

50. The tissue protector device of claim 40, wherein said track is flexible so that said track can be configured to correspond to the shape of the perimeter of the incision.

51. A device for protecting body tissues at an incision, comprising:

a first portion configured to be supported on body tissues surrounding the incision; and

a second portion associated with said first portion and configured to cover body tissues within the incision.

52. The device for protecting body tissues of claim 51, wherein:

said first portion includes a flexible panel having a facing surface adapted to be supported on the body tissues surrounding the incision, said panel defining an opening for alignment over the incision; and

said second portion includes a flexible sleeve connected to said first portion and substantially coextensive with said opening and projecting from said facing surface to extend into the incision to cover body tissues within the incision.

53. The device for protecting body tissue of claim 52, wherein said first portion is integral with said second portion.

54. The device for protecting body tissues of claim 51, wherein said first portion and said second portion are integral to form an L-shaped body, said first portion supported on the body tissues surrounding the incision and the second portion extending into the incision to cover body tissues within the incision.

55. A device for protecting body tissues at an incision, comprising:

a first portion configured to be supported on body tissues surrounding the incision; and

means carried by said first portion for dissipating forces applied thereon by a surgical tool or instrument introduced into the incision.

56. The device for protecting body tissues of claim 55, wherein:

said first portion includes a sheet of material defining an elongated opening for access to the incision; and

said means for dissipating forces includes a bead defined on said sheet adjacent and around said elongated opening.

57. The device for protecting body tissues of claim 56, further comprising a second portion integral with said first portion and substantially coextensive with said opening and projecting from said first portion to extend into the incision to cover body tissues within the incision

58. The device for protecting body tissues of claim 55, wherein said means for dissipating forces includes a second portion integral with said first portion to form an L-shaped body configured to engage the incision.