SURGICAL ACCESS DEVICES WITH INTEGRATED WOUND CLOSURE FEATURES

• US 20170281154A1
• Filed: 04/01/2016
• Published: 10/05/2017
• Est. Priority Date: 04/01/2016
• Status: Active Grant

• Current Assignee: Cilag Gmbh International (Johnson & Johnson)
• Original Assignee: Ethicon Endo-Surgery LLC (Johnson & Johnson)
• Inventors: Hess, Christopher J., Shelton, IV, Frederick E., Morgan, Jerome R., Bledsoe, Ryan A., Withers, Douglas E., Gates, Craig T.
• Granted Patent: US 10,299,785 B2
• Time in Patent Office: Days
• CPC Class Codes: A61B 17/0057 Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• CPC Class Codes: A61B 17/3417 Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating syringe needles A61M5/32; dilators A61M29/00
• CPC Class Codes: A61B 17/3421 Cannulas
• 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 17/3439 with means for changing the inner diameter of the cannula, e.g. expandable A61B17/3423, A61B17/3431 take precedence; catheters A61M25/0662
• CPC Class Codes: A61B 17/3462 with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals expandable cannulas A61B17/3417
• CPC Class Codes: A61B 2017/00637 for sealing trocar wounds through abdominal wall
• CPC Class Codes: A61B 2017/00663 the implement being a suture
• CPC Class Codes: A61B 2017/0225 flexible, e.g. fabrics, meshes, or membranes
• CPC Class Codes: A61B 2017/3441 with distal sealing means
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments catheters A61B2017/22072
• CPC Class Codes: A61B 2017/3464 with means acting on inner surface of valve or seal for expanding or protecting, e.g. inner pivoting fingers
• CPC Class Codes: A61M 39/04 having pierceable self-sealing members

Abstract

Surgical access devices having wound closure features incorporated as part of the device are provided. The devices allow suture to be inserted directly into the device and operated to close an opening through which the device is disposed as or shortly after the device is removed from the surgical site. Further, the wound closure features allow for various orientations of wound closure to be achieved by adjusting an angle at which the suture enters tissue surrounding the opening to be closed. Some of the wound closure features provided for include openings formed in both the housing and cannula of the surgical access device, multiple openings formed in one or both the housing and cannula, locations of the openings being adjustable or otherwise movable, and various flexible seals. Other features, as well as methods of closing an opening through which the surgical access device was disposed, are also provided.

Claims

1. A surgical access device, comprising:

a housing having a central lumen extending therethrough and a sidewall disposed around the central lumen, the sidewall having at least one opening extending therethrough, the at least one opening having an opening seal associated therewith;

a cannula extending distally from the housing and in fluid communication with the central lumen to define a working channel that is sized and configured to receive a surgical instrument, the cannula having at least one sealed opening extending through a sidewall thereof; and

a seal disposed within the working channel and configured to seal the working channel when no surgical instrument is disposed therethrough,

wherein the at least one opening extending through the sidewall of the housing and the at least one sealed opening extending through the sidewall of the cannula are configured to form a suture path such that a suture can be passed from an outside environment, through the at least one opening of the housing, through the at least one sealed opening of the cannula, and to a surgical site.

2. The device of claim 1, wherein the at least one opening extending through the sidewall of the housing and the at least one sealed opening extending through the sidewall of the cannula are configured such that an angle formed between a central longitudinal axis extending through the cannula and an axis extending between the at least one opening extending through the sidewall of the housing and the at least one sealed opening extending through the sidewall of the cannula is adjustable.

3. The device of claim 2,

wherein the at least one opening extending through the sidewall of the housing comprises a plurality of openings extending through the sidewall of the housing, each opening having a seal associated therewith, and

wherein the angle is adjustable as a result of the axis extending between the at least one opening extending through the sidewall of the housing and the at least one sealed opening extending through the sidewall of the cannula having a first position at which the axis extends between a first opening of the plurality of openings extending through the sidewall of the housing and an opening of the at least one sealed opening extending through the sidewall of the cannula, and a second position at which the axis extends between a second opening of the plurality of openings extending through the sidewall of the housing and the opening of the at least one sealed opening extending through the sidewall of the cannula.

4. The device of claim 2,

wherein the at least one sealed opening extending through the sidewall of the cannula comprises a plurality of sealed openings extending through the sidewall of the cannula, and

wherein the angle is adjustable as a result of the axis extending between the at least one opening extending through the sidewall of the housing and the at least one sealed opening extending through the sidewall of the cannula having a first position at which the axis extends between an opening of the at least one opening extending through the sidewall of the housing and a first sealed opening of the plurality of sealed openings extending through the sidewall of the cannula, and a second position at which the axis extends between the opening of the at least one opening extending through the sidewall of the housing and a second sealed opening of the plurality of sealed openings extending through the sidewall of the cannula.

5. The device of claim 2,

wherein the at least one opening extending through the sidewall of the housing comprises an elongate opening having an elongate length that extends substantially parallel to the central longitudinal axis, the elongate opening comprising an adjustable entry point movable along the elongate length to adjust the angle formed between the central longitudinal axis extending through the cannula and the axis extending between the elongate opening and the at least one sealed opening extending through the sidewall of the cannula.

6. The device of claim 2,

wherein the housing comprises:

a first rotary disc having a first opening of the at least one opening extending through the sidewall of the housing disposed thereon, the first rotary disc being configured to rotate about the central longitudinal axis extending through the cannula; and

a second rotary disc disposed distal of the first rotary disc and having a second opening of the at least one openings extending through the sidewall of the housing disposed thereon, the second rotary disc being configured to rotate about the central longitudinal axis extending through the cannula, and

wherein the first and second openings are movable to adjust the angle formed between the central longitudinal axis extending through the cannula and the axis extending between the at least one opening extending through the sidewall of the housing and the at least one sealed opening extending through the sidewall of the cannula.

7. The device of claim 6, wherein the first and second openings are configured to be moved to an alignment position in which the first and second openings are aligned to form an elongate opening having an elongate length that extends substantially parallel to the central longitudinal axis, the elongate opening being configured to allow for multiple entry points of a surgical instrument to thereby provide the adjustable angle formed between the central longitudinal axis extending through the cannula and the axis extending between the at least one opening extending through the sidewall of the housing and the at least one sealed opening extending through the sidewall of the cannula.

8. The device of claim 2, further comprising a rotary dial configured to move the at least one opening extending through the sidewall of the housing to adjust the angle formed between the central longitudinal axis extending through the cannula and the axis extending between the at least one opening extending through the sidewall of the housing and the at least one sealed opening extending through the sidewall of the cannula.

9. The device of claim 2, wherein the angle is adjustable approximately between values of about 15 degrees to about 60 degrees.

10. The device of claim 1, wherein the at least one sealed opening extending through the sidewall of the cannula comprises a seal having a patterned guide surface facing towards the working channel and configured to direct a surgical instrument through one or more pre-defined resealable openings of the seal.

11. The device of claim 10, wherein the patterned guide surface provides a slidable, floating instrument entrance that allows an angle formed between a central longitudinal axis extending through the cannula and an axis extending between the at least one opening extending through the sidewall of the housing and the at least one sealed opening extending through the sidewall of the cannula to be adjustable.

12. The device of claim 1,

wherein a proximal portion of the cannula has a portion of the sidewall that is thinner than surrounding portions of the sidewall of the cannula, the thinner portion having the at least one sealed opening extending therethrough, and

wherein the device further comprises a sealing sleeve sized to be disposed over the thinner portion such that an outer diameter of the combination of the thinner portion of the sidewall and the sealing sleeve is substantially similar to an outer diameter of the surrounding portions of the sidewall of the cannula, the sealing sleeve providing the sealable nature of the at least one sealed opening.

13. A surgical access device, comprising:

a housing;

a cannula extending distally from the housing, the housing and the cannula defining a working channel extending therethrough that is sized and configured to receive a surgical instrument;

a seal disposed within the working channel and configured to seal the working channel when no instrument is disposed therethrough;

at least one entry port disposed in or proximate to the housing, the at least one entry port having a seal associated therewith; and

at least one sealed exit port extending through a sidewall of the cannula,

wherein the at least one entry port and the at least one sealed exit port are configured such that an angle formed between a central longitudinal axis extending through the cannula and an axis extending between the at least one entry port and the at least one sealed exit port is adjustable.

14. The device of claim 13, wherein the angle is adjustable approximately between values of about 15 degrees to about 60 degrees.

15. The device of claim 13,

wherein the at least one entry port comprises a plurality of entry ports disposed in or proximate to the housing, each entry port having a seal associated therewith, and

wherein the angle is adjustable as a result of the axis extending between the at least one entry port and the at least one sealed exit port having a first position at which the axis extends between a first entry port of the plurality of entry ports and a sealed exit port of the at least one sealed exit port, and a second position at which the axis extends between a second entry port of the plurality of entry ports and the sealed exit port of the at least one sealed exit port.

16. The device of claim 13,

wherein the at least one sealed exit port comprises a plurality of sealed exit ports extending through the sidewall of the cannula, and

wherein the angle is adjustable as a result of the axis extending between the at least one entry port and the at least one sealed exit port having a first position at which the axis extends between an entry port of the at least one entry port disposed in or proximate to the housing and a first sealed exit port of the plurality of sealed exit ports, and a second position at which the axis extends between the entry port of the at least one entry port and a second sealed exit port of the plurality of sealed exit ports.

17. The device of claim 13,

wherein the at least one entry port comprises an elongate opening having an elongate length that extends substantially parallel to the central longitudinal axis, the elongate opening comprising an adjustable entry point movable along the elongate length to adjust the angle formed between the central longitudinal axis extending through the cannula and the axis extending between the elongate opening and the at least one sealed exit port.

18. The device of claim 13,

wherein the housing comprises:

a first rotary disc having a first entry port of the at least one entry port disposed in or proximate to the housing disposed thereon, the first rotary disc being configured to rotate about the central longitudinal axis extending through the cannula; and

a second rotary disc disposed distal of the first rotary disc and having a second entry port disposed in or proximate to the housing disposed thereon, the second rotary disc being configured to rotate about the central longitudinal axis extending through the cannula, and

wherein the first and second entry ports are movable to adjust the angle formed between the central longitudinal axis extending through the cannula and the axis extending between the at least one entry port and the at least one sealed exit port.

19. The device of claim 18, wherein the first and second openings are configured to be moved to an alignment position in which the first and second openings are aligned to form an elongate opening having an elongate length that extends substantially parallel to the central longitudinal axis, the elongate opening being configured to allow for multiple entry points of a surgical instrument to thereby provide the adjustable angle formed between the central longitudinal axis extending through the cannula and the axis extending between the at least one entry port and the at least one sealed exit port.

20. The device of claim 13, further comprising a rotary dial configured to move the at least one entry port to adjust the angle formed between the central longitudinal axis extending through the cannula and the axis extending between the at least one entry port and the at least one sealed exit port.

21. The device of claim 13, wherein the at least one sealed exit port comprises a seal having a patterned guide surface facing towards the working channel and configured to direct a surgical instrument through one or more pre-defined resealable openings of the seal.

22. The device of claim 21, wherein the patterned guide surface provides a slidable, floating instrument entrance that allows the angle to be adjustable.

23. The device of claim 13,

wherein a proximal portion of the cannula has a portion of the sidewall that is thinner than surrounding portions of the sidewall of the cannula, the thinner portion having the at least one sealed exit port extending therethrough, and

wherein the device further comprises a sealing sleeve sized to be disposed over the thinner portion such that an outer diameter of the combination of the thinner portion of the sidewall and the sealing sleeve is substantially similar to an outer diameter of the surrounding portions of the sidewall of the cannula, the sealing sleeve providing the sealable nature of the at least one sealed exit port.

24. A surgical method, comprising:

passing a first filament tail through a first opening extending through a sidewall of a housing of a surgical access device

passing the first filament tail through a first opening extending through a sidewall of a cannula that extends distally from the housing;

passing the first filament tail through tissue adjacent to an opening in tissue;

passing a second filament tail through a second opening extending through the sidewall of the housing of the surgical access device;

passing the second filament tail through a second opening extending through the sidewall of the cannula;

passing the second filament tail through tissue adjacent to the opening in the tissue;

applying tension to at least one of the first and second filament tails to decrease a size of the opening in the tissue.

25. The method of claim 24, wherein at least one of the steps of passing the first filament tail through a first opening extending through a sidewall of the housing and passing a second filament tail through a second opening extending through the sidewall of the housing further comprises:

selecting one opening of a plurality of openings extending through the sidewall of the housing that are proximate to each other to be the respective first or second opening based on the desired angle at which the respective first or second filament tail is to passed through the tissue.

26. The method of claim 24, wherein at least one of the steps of passing the first filament tail through a first opening extending through a sidewall of the cannula and passing a second filament tail through a second opening extending through the sidewall of the cannula further comprises:

selecting one opening of a plurality of openings extending through the sidewall of the cannula to be the respective first or second opening based on the desired angle at which the respective first or second filament tail is to passed through the tissue.

27. The method of claim 24, wherein at least one of the first and second openings extending through the sidewall of the housing comprises an elongate opening having an elongate length that extends substantially parallel to a central longitudinal axis extending through the cannula and an adjustable entry point movable along the elongate length, the method further comprising:

moving the adjustable entry point longitudinally to adjust an angle at which the respective first or second filament tail is directed to enter the tissue.

28. The method of claim 24, further comprising:

moving at least one of the first and second openings extending through the sidewall of the housing to adjust an angle at which the respective first or second filament tail is directed to enter the tissue.