Soft tissue retractor and method for providing surgical access

• US 5,810,721 A
• Filed: 03/04/1996
• Issued: 09/22/1998
• Est. Priority Date: 03/04/1996
• Status: Expired due to Term

• Current Assignee: Edwards Lifesciences LLC (Edwards Lifesciences Corporation)
• Original Assignee: Heartport, Inc. (Johnson & Johnson)
• Inventors: Flom, James R., Peters, William S., Boyd, Stephen W., Mueller, Richard L., Mangosong, Lorraine F.
• Primary Examiner(s): FLANAGAN, BEVERLY MEINDL
• Application Number:
  US08/610,619
• Time in Patent Office: 932 Days
• Field of Search: 600/201, 600/204, 600/206, 600/208, 600/210, 600/215, 600/209, 600/227, 600/231, 600/233, 600/235, 600/245
• US Class Current: 600/206
• CPC Class Codes: A61B 17/02 for holding wounds open; Tractors specula A61B1/32 ; drainage appliances for wounds A61M27/00
• CPC Class Codes: A61B 17/0206 with antagonistic arms as supports for retractor elements
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/0293 with ring member to support retractor elements
• 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 17/3423 Access ports, e.g. toroid shape introducers for instruments or hands access sites for liquids A61M39/0247
• CPC Class Codes: A61B 17/3431 being collapsible, e.g. made of thin flexible material A61B17/3423 takes precedence
• 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 17/3468 for implanting or removing devices, e.g. prostheses, implants, seeds, wires devices for implanting seeds A61M37/0069
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/3427 for intercostal space
• CPC Class Codes: A61B 2017/3482 inside
• CPC Class Codes: A61B 2090/306 using optical fibres

Abstract

The present invention provides a retractor for providing surgical access through a passage in tissue, together with methods for its use and deployment. The retractor comprises an anchoring frame having an upper surface, a lower surface, and an opening therethrough which defines an axial axis. A flexible tensioning member is attached to the frame, and is extendable from the frame out of the body through the passage when the frame is positioned through the passage and into a body cavity. This tensioning member is selectively tensionable to spread the tissue radially outwardly from the axial axis. Hence, it is the tension imposed on the flexible liner which effects retraction of the tissue, rather than relying on the structural integrity of an artificial lumen.

Claims

1. A retractor for providing surgical access into a body cavity by widening a passage surgically formed in tissue, said retractor comprising:

an anchoring frame having an upper surface, a lower surface, and an opening therethrough which defines an axial axis, the anchoring frame having an axial length and a width wherein the axial length is less than the width, the anchoring frame being positionable through the passage into the body cavity; and

a flexible tensioning member attached to the anchoring frame and extendible from the anchoring frame out of the body cavity through the passage when the anchoring frame is in the body cavity, said tensioning member being selectively tensionable to widen the passage by retracting tissue radially outwardly away from the axial axis.

2. A retractor as claimed in claim 1, wherein the anchoring frame is ring-shaped.

3. A retractor as claimed in claim 1, wherein the flexible tensioning member is configured to compress the tissue adjacent the passage against the upper surface of the anchoring frame.

4. A retractor as claimed in claim 1, wherein the anchoring frame has a narrow profile configuration for insertion through the passage and is deployable into a wide profile configuration while inside the body cavity, the width of the anchoring frame across the upper surface in the wide profile configuration being wider than the passage.

5. A retractor as claimed in claim 4, wherein the anchoring frame comprises a resilient material which may be collapsed into the narrow profile configuration and which expands to the wide profile configuration when released in the body cavity.

6. A retractor as claimed in claim 4, wherein the frame comprises a deployment mechanism for mechanically expanding the frame from the narrow profile configuration to the wide profile configuration.

7. A retractor as claimed in claim 1, wherein the tensioning member comprises a plurality of flexible tabs which are axially extendable from the frame on opposing sides of the opening.

8. A retractor as claimed in claim 7, wherein the tabs comprise adhesive strips.

9. A retractor as claimed in claim 1, wherein the tensioning member comprises a sheet of material, and wherein the sheet is manually tensionable in a plurality of directions relative to the frame.

10. A retractor as claimed in claim 1, further comprising an attachment mechanism on an extremity of the tensioning member spaced apart from the frame for attachment outside of the body cavity to hold the tissue in a retracted position and maintain tension on the tensioning member.

11. A retractor as claimed in claim 10, wherein the attachment mechanism is an adhesive disposed on the tensioning member.

12. A retractor as claimed in claim 1, further comprising an outer frame structure coupled to the tensioning member and having a plurality of suture retainers.

13. A retractor as claimed in claim 1, further comprising an illuminating device coupled to at least one of the frame and tensioning member for conducting light into the body cavity.

14. A retractor as claimed in claim 1, wherein the anchoring frame comprises a superelastic material.

15. A retractor as claimed in claim 1, wherein the axial length of the anchoring frame is less than about 20 mm.

16. A retractor for providing surgical access into an opening surgically formed in a patient, the retractor comprising:

an anchoring frame having an upper surface, a lower surface, and an opening therethrough, the frame being movable from a collapsed position to an expanded position; and

a flexible tensioning member attached to the frame on at least two opposing sides of the opening in the frame, the tensioning member extendible out of a patient when the frame is within the chest cavity and in the expanded position, said tensioning member having first and second selectively tensionable portions, the first and second selectively tensionable portions being configured to be tensioned in substantially opposing directions by an amount sufficient to retract tissue away from the opening so as to widen the opening in the patient.

17. A retractor as claimed in claim 16, further comprising an attachment mechanism on an extremity of the tensioning member spaced apart from the anchoring frame to hold the tissue in a retracted position and maintain tension on the tensioning member.

18. A retractor as claimed in claim 17, wherein the attachment mechanism comprises adhesive.

19. A retractor as claimed in claim 16, wherein the tensioning member is configured to exert tension outwardly from the frame in a plurality of radially opposed directions.

20. A retractor as claimed in claim 16, wherein the anchoring frame is ring-shaped.

21. A retractor as claimed in claim 16, wherein the opening has a radial dimension of between about 10 mm and 9 cm.

22. A retractor as claimed in claim 16, wherein the tensioning member comprises a plurality of flexible manually tensionable tabs.

23. A retractor as claimed in claim 22, wherein the tabs comprise an elastomeric material.

24. A retractor as claimed in claim 22, wherein the tabs comprise an absorbent material.

25. A retractor as claimed in claim 16, further comprising an illuminating device coupled to at least one of the frame and the tensioniong member for conducting light into the body cavity.

26. A method for retracting tissue to temporarily widen a surgically-formed penetration into a body cavity, the method comprising:

positioning an anchoring frame against a tissue surface within the body cavity adjacent to a surgically-formed penetration so that an opening in the frame is aligned with the penetration; and

manually tensioning a first flexible tissue restraining portion extending from the frame and out of the body cavity through the penetration so as to urge the tissue adjacent to the penetration outwardly and widen the penetration;

securing the first flexible tissue restraining portion after the tensioning step to maintain tension on the first flexible tissue restraining portion;

manually tensioning a second flexible tissue restraining portion extending from the frame and out of the body cavity through the pentration so as to urge the tissue adjacent to the penetration outwardly and widen the pentration; and

securing the second flexible tissue restraining portion after the tensioning step to maintain tension on the second flexible tissue restraining portion.

27. A method as claimed in claim 26, wherein the first and second tensioning steps apply tension in radial outward direction relative to the frame.

28. A method as claimed in claim 26, wherein the first and second tensioning steps apply tension to the first and second tissue restraining portions in substantially opposite directions.

29. A method as claimed in claim 26, further comprising surgically accessing a body cavity through the penetration and the opening in the frame while maintaining the tension.

30. A method as claimed in claim 29, wherein the surgically accessing step comprises directly observing tissues within the body cavity through the opening in the frame.

31. A method as claimed in claim 29, wherein the surgically accessing step comprises optically observing tissues within the body cavity through the opening in the frame from outside the body using magnification optics.

32. A method as claimed in claim 26, further comprising the step of expanding the frame from a narrow profile to a large profile while inside the body cavity, wherein the frame retains the large profile during the tensioning steps.

33. A method as claimed in claim 32, wherein the expanding step comprises releasing the frame and allowing it to expand resiliently.

34. A method as claimed in claim 32, further comprising inserting the frame through the passage into the body cavity in the narrow profile.

35. A method as claimed in claim 34, wherein the inserting step comprises introducing the frame angled edgewise through the passage.

36. A method as claimed in claim 26, wherein the securing steps comprise adhesively attaching the first and second tissue restraining portions, respectively, to an external surface of the patient'"'"'s body.

37. A method for retracting tissue, comprising the steps of:

forming an incision in a patient'"'"'s body;

inserting an anchoring frame into the incision so that at least a portion of the frame is disposed beneath an interior surface of the patient'"'"'s body; and

applying tension to a first flexible tab extending out of the patient and coupled to the frame to retract tissue and widen the incision.

38. The method of claim 37, further comprising the step of:

applying tension to a second flexible tab extending out of the patient and coupled to the frame, the second tab extending in a substantially opposite direction relative to the first flexible tab.

39. The method of claim 38, wherein:

the inserting step is carried out in an intercostal space between adjacent ribs; and

the tensioning steps are carried out to retract tissue along a length of the intercostal space.

40. The method of claim 37, further comprising the step of:

coupling an illuminating device to at least one of the anchor and first flexible tab; and

lighting a portion of the patient'"'"'s body with the illuminating device for visualization through the incision.

41. The method of claim 37, further comprising the step of:

restraining the first flexible tab after the tensioning step to maintain tension on the first flexible tab.

42. The method of claim 37, wherein:

the inserting step is carried out with the anchor being mounted on a holder which releases the anchor.

43. A method for retracting tissue, comprising the steps of:

providing an anchoring frame and a tensioning member coupled to the anchoring frame, the anchoring frame having a collapsed position and an expanded position, the anchoring frame being mounted on a holder which holds the anchoring frame in the collapsed position;

inserting the anchoring frame into a patient'"'"'s body through an incision using the holder, the anchoring frame being in the collapsed position;

releasing the anchoring frame from the holder after the inserting step; and

applying tension to the tensioning member thereby retracting tissue around the incision.

44. The method of claim 43, wherein:

the providing step is carried out with the tensioning member being a manually tensionable strap.

45. A retractor for providing surgical access into a body cavity through a passage in tissue, said retractor comprising:

an anchoring frame having an upper surface, a lower surface, and an opening therethrough which defines an axial axis, wherein the anchoring frame is positionable through the passage into the body cavity;

a flexible tensioning member attached to the anchoring frame and extendable from the anchoring frame out of the body cavity through the passage when the anchoring frame is in the body cavity, said tensioning member being selectively tensionable to spread the tissue radially outwardly from the axial axis; and

an outer frame structure coupled to the tensioning member, the outer frame having a plurality of suture retainers.

46. A retractor as claimed in claim 45, wherein the anchoring frame comprises nitinol.

47. A retractor for providing surgical access into a body cavity through a passage in tissue, said retractor comprising:

an anchoring frame having an upper surface, a lower surface, and an opening therethrough which defines an axial axis, wherein the anchoring frame comprises a superelastic material and is positionable through the passage into the body cavity; and

a flexible tensioning member attached to the anchoring frame and extendable from the anchoring frame out of the body cavity through the passage when the anchoring frame is in the body cavity, said tensioning member being selectively tensionable to spread the tissue radially outwardly from the axial axis.