Methods for the prevention of surgical site infections

• US 9,084,594 B2
• Filed: 01/08/2013
• Issued: 07/21/2015
• Est. Priority Date: 01/10/2012
• Status: Active Grant

• Current Assignee: Board of Trustees of the Leland Stanford Junior University (Stanford Management Co.)
• Original Assignee: Board of Trustees of the Leland Stanford Junior University (Stanford Management Co.)
• Inventors: Suh, Insoo, Coe, Jonathan, Gnanashanmugam, Swaminadhan, Koehler, Jeremy, Welton, Mark
• Primary Examiner(s): Robert, Eduardo C
• Assistant Examiner(s): JOHANAS, JACQUELINE T
• Application Number:
  US13/736,875
• Publication Number:
  US 20130178709A1
• Time in Patent Office: 924 Days
• Field of Search: 600201-246, 604/513, 604/73, 604/103.01, 604/102, 604/164.01, 604/174, 604/28, 604/19, 604/27, 604/35, 604 43- 48
• US Class Current: 1/1
• 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 17/0293 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 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 2017/00539 hydraulically
• CPC Class Codes: A61B 2017/00544 pneumatically
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/0225 flexible, e.g. fabrics, meshes, or membranes
• CPC Class Codes: A61B 2017/3437 with means for removing or absorbing fluid, e.g. wicks or absorbent pads
• CPC Class Codes: A61B 2017/3492 against the outside of the body
• CPC Class Codes: A61B 2217/005 with suction drainage system
• CPC Class Codes: A61B 2217/007 with irrigation system

Abstract

Several methods to reduce surgical site infections include inserting a surgical access device into an incision, retracting tissue, and introducing fluid into the surgical access device such that the fluid exits the surgical access device and irrigates a surgical site. Other methods do not include introducing fluid into a surgical access device but include suctioning a fluid into the surgical access device and removing the fluid from the body.

Claims

1. A method for retracting tissue in a surgical site in a body, the method comprising:

inserting at least a portion of a surgical access device into an incision, wherein the surgical access device comprises a first retention member, a second retention member, a pliable membrane comprising an inner layer and an outer layer with a space therebetween, the pliable membrane coupled to the first retention member and the second retention member, and a fluid delivery inlet configured to be placed in fluid communication with the pliable membrane;

advancing the first retention member into the body through the incision;

placing the second retention member outside the body;

retracting the tissue using the pliable membrane;

introducing fluid into the fluid delivery inlet such that the fluid flows through the space and exits an opening in a lateral surface of a first portion of the pliable membrane and the introduced fluid contacts a wall of the surgical site; and

suctioning at least a portion of the fluid after the fluid contacts the wall of the surgical site through a second portion of the pliable membrane not in direct fluid communication with the first portion, wherein the suctioned fluid enters the pliable membrane at a location disposed between the first and the second retention members.

2. The method of claim 1, wherein a fluid conduit member is coupled to the first retention member and the method further comprises suctioning the fluid into the fluid conduit member and removing the fluid from the body.

3. The method of claim 1, wherein the fluid comprises an antibiotic fluid.

4. The method of claim 1, wherein the fluid comprises a saline solution.

5. The method of claim 1, wherein the fluid comprises a diagnostic or therapeutic agent.

6. The method of claim 1, wherein the fluid exits the pliable membrane at a location disposed between the first and second retention members.

7. The method of claim 1, wherein the surgical access device comprises a plurality of fluid delivery regions and a plurality of fluid removal regions, and wherein the plurality of fluid delivery regions and the plurality of fluid removal regions are disposed between the first and the second retention members.

8. The method of claim 1, wherein the inner layer and the outer layer are joined together at a plurality of locations thereby forming a quilted pattern which prevents billowing of the pliable membrane.

9. The method of claim 1, wherein a porous material is disposed in the space.

10. The method of claim 1, wherein the pliable membrane comprises a plurality of perforations disposed between the first and second retention members, the plurality of perforations disposed away from the first and second retention members, and wherein the fluid exits at least some of the plurality of perforations and contacts the wall of the surgical site.

11. A method for retracting tissue in a surgical site in a body, the method comprising:

inserting at least a portion of a surgical access device into an incision, wherein the surgical access device comprises a first retention member, a second retention member, a pliable membrane coupled to the first retention member and the second retention member, and a fluid removal conduit coupled to the first retention member;

advancing the first retention member into the body through the incision;

placing the second retention member outside the body;

retracting the tissue using the pliable membrane;

introducing a fluid into the surgical access device such that the fluid exits a first section of the pliable membrane and wherein the introduced fluid flows out of the surgical access device into the body before being suctioned back into the surgical access device,

suctioning the fluid from the body into the surgical access device, wherein the fluid flows from the body through a second section of the pliable membrane not in direct fluid communication with the first section, and wherein the fluid enters the pliable membrane at a location disposed between the first and the second retention members; and

removing the fluid from the body.

12. The method of claim 11, further comprising coupling a suction device to the fluid removal conduit.

13. The method of claim 11, wherein the surgical access device comprises a plurality of fluid delivery regions and a plurality of fluid removal regions, and wherein the plurality of fluid delivery regions and the plurality of fluid removal regions are disposed between the first and the second retention members.

14. The method of claim 11, wherein the pliable membrane comprises an inner layer and an outer layer joined together at a plurality of locations thereby forming a quilted pattern which prevents billowing of the pliable membrane.

15. The method of claim 14, wherein a porous material is disposed in a space between the inner layer and the outer layer.

16. A method for retracting tissue in a surgical site in a body, the method comprising:

inserting a retraction device into an incision;

retracting tissue;

introducing fluid into the retraction device; and

forcing the fluid out of the retraction device into the surgical site, wherein the retraction device comprises a pliable membrane comprising an inner layer and an outer layer with a space therebetween, and wherein the fluid exits an opening in a lateral surface of a first section of the pliable membrane, and wherein the fluid flows through the space, wherein the introduced fluid contacts a wall of the surgical site; and

suctioning at least a portion of the fluid after said fluid contacts the wall of the surgical site in through a lateral surface of a second section of the pliable membrane not in direct fluid communication with the first section of the pliable membrane.

17. The method of claim 16, wherein forcing the fluid out of the retraction device comprises forcing the fluid through a channel system that substantially circumscribes the retraction device.

18. The method of claim 16, wherein forcing the fluid out of the retraction device comprises forcing the fluid through a porous material.

19. The method of claim 16, wherein the retraction device comprises an upper portion and a lower portion that are not in direct fluid communication, wherein forcing the fluid out of the retraction device comprises forcing the fluid out of the upper portion and suctioning the fluid from the surgical site comprises suctioning the fluid into the lower portion.

20. The method of claim 16, wherein the inner layer and the outer layer are joined together at a plurality of locations thereby forming a quilted pattern which prevents billowing of the pliable membrane.

21. The method of claim 16, wherein a porous material is disposed in the space.

22. The method of claim 16, wherein the retraction device comprises first and second retention members, and the pliable membrane comprises a plurality of perforations disposed between the first and second retention members, the plurality of perforations disposed away from the first and second retention members, and wherein the fluid exits at least some of the plurality of perforations and contacts the wall of the surgical site.