Surgical access system

Abstract

The invention is directed to a hand access system that provides hand access to a surgical area while maintaining pneumoperitoneum during laparoscopic surgery. The hand access system comprises a sheath retractor adapted to dilate a wound stretchable to a desired diameter, the sheath retractor includes a first ring being adapted for disposition interiorly of the wound, a second ring being adapted for disposition exteriorly of the wound, and a sheath being disposed in a generally cylindrical form between the first ring and the second ring and operable to exert a radial retraction force on the wound. The hand access system further comprises a detachable hand seal adapted to be removable from the second ring of the sheath retractor. The sheath retractor may be formed of an elastomeric material, and the hand seal may be formed of a gel material and includes a slit providing an instrument seal in the presence of an instrument or hand and a zero seal in the absence of the instrument or hand. In another aspect, there is disclosed a surgical access device adapted for disposition relative to an incision in a patient comprising a valve including a plurality of overlapping sheets defining an access channel, and a ring having an inner diameter for holding the valve by fixing each of the overlapping sheets along a portion of the perimeter, the access channel extends into communication with the incision in the patient. Each of the overlapping sheets includes a portion of the perimeter that is not fixed to the inner diameter of the ring, which provide open edges defining the access channel. The open edges slightly overlap at the center of the ring. The open edges may have different shapes including at least one of a straight edge, concave, convex and a cross-configuration. The hand access device may further comprise a septum seal formed at the proximal and distal ends of the ring.

1 . A hand access system, comprising: 
 a sheath retractor adapted to dilate a wound stretchable to a desired diameter, the sheath retractor comprising 
 a first ring being adapted for disposition interiorly of the wound;  
 a second ring being adapted for disposition exteriorly of the wound; and  
 a sheath being disposed in a generally cylindrical form between the first ring and the second ring and operable to exert a radial retraction force on the wound; and  
   a detachable hand seal adapted to be attached and detached from the second ring of the sheath retractor.    
     
     
         2 . The hand access system of  claim 1 , wherein the hand seal can be detached from the sheath retractor to convert the hand access system from laparoscopic surgery to open surgery.  
     
     
         3 . The hand access system of  claim 1 , wherein at least one of the first ring, the second ring and the sheath is formed from an elastomeric material.  
     
     
         4 . The hand access system of  claim 1 , wherein the hand seal is formed of a gel material and includes a slit providing an instrument seal in the presence of an instrument or hand and a zero seal in the absence of an instrument or hand.  
     
     
         5 . The hand access system of  claim 1 , wherein the first ring has a first diameter and the second ring has a second diameter, and the first and second diameters are greater than the desired diameter of the wound.  
     
     
         6 . The hand access system of  claim 1 , wherein the sheath retractor further comprises a third ring disposed circumferentially of the sheath and moveable between a plurality of positions between the first ring and the second ring, each of the positions being associated with a different retraction force, the third ring being adapted for disposition exteriorly of the wound.  
     
     
         7 . The hand access system of  claim 6 , wherein the sheath retractor further comprises means for retaining the third ring at one of the plurality of positions in order to provide the desired radial retraction force associated with that position.  
     
     
         8 . The hand access system of  claim 7 , wherein the retaining means comprises a fourth ring adapted to interlock with the third ring to fix the sheath at the desired position.  
     
     
         9 . The hand access system of  claim 8 , wherein the retaining means further comprises a wedge disposed between the third ring and the fourth ring.  
     
     
         10 . The hand access system of  claim 1 , further comprising an adapter having a first adapter cavity for releasably attaching to the ring of the retractor sheath and a second adapter cavity for releasably attaching to the hand seal.  
     
     
         11 . The hand access system of  claim 10 , wherein the first adapter cavity has a first diameter and the second adapter cavity has a second diameter less than or equal to the first diameter.  
     
     
         12 . The hand access system of  claim 1 , wherein the hand seal includes a cavity to receive the second ring of the sheath retractor after installation of the hand seal.  
     
     
         13 . The hand access system of  claim 6 , wherein the hand seal further comprises a latch on an inner diameter for latching the third ring.  
     
     
         14 . The hand access system of  claim 13 , wherein the access sheath may be placed inside or outside of the hand seal after attachment of the hand seal and the seal retractor.  
     
     
         15 . The hand access system of  claim 6 , wherein the third ring comprises at least one hook to latch the hand seal as the hand seal is attached to the sheath retractor.  
     
     
         16 . The hand access system of  claim 1 , further comprising a conformable gasket to facilitate sealing of the peritoneum.  
     
     
         17 . The hand access system of  claim 16 , wherein the conformable gasket is attached to the first ring or to the sheath of the sheath retractor.  
     
     
         18 . The hand access system of  claim 16 , wherein the conformable gasket floats unattached to the sheath and interiorly of the wound.  
     
     
         19 . A hand access system, comprising: 
 a sheath retractor adapted to dilate a wound stretchable to a desired diameter, the sheath retractor comprising 
 a first ring being adapted for disposition interiorly of the wound;  
 a second ring being adapted for disposition exteriorly of the wound; and  
 a sheath being disposed in a generally cylindrical form between the first ring and the second ring and operable to exert a radial retraction force on the wound; and  
   an iris seal adapted to be attached and detached from the sheath retractor.    
     
     
         20 . The hand access system in  claim 19 , wherein the iris seal comprises: 
 a first iris ring;    a second iris ring coaxially attached to the first iris ring; and    a cylindrical elastic member connected to the first and second iris rings and having an opening,    wherein the first and second iris rings operate to rotate relative to one another in either direction to open or close the opening of the cylindrical elastic member.    
     
     
         21 . The hand access system in  claim 20 , wherein the first and second iris rings are rotated in opposite directions to create an airtight constriction in the middle of the elastic member.  
     
     
         22 . The hand access system in  claim 21 , wherein at least one of the first and second iris rings is de-rotated to loosen or enlarge the constriction of the elastic member.  
     
     
         23 . The hand access system in  claim 21 , wherein each of the iris rings comprises a plurality of tracks to allow the iris rings to be relatively rotated at predetermined angles.  
     
     
         24 . The hand access system in  claim 20 , wherein the sheath retractor further comprises a third ring disposed circumferentially of the sheath and moveable between a plurality of positions between the first ring and the second ring, each of the positions being associated with a different retraction force, the third ring being adapted for disposition exteriorly of the wound.  
     
     
         25 . The hand access system in  claim 24 , wherein the sheath retractor further comprises means for retaining the third ring at one of the plurality of positions in order to provide the desired radial retraction force associated with that position.  
     
     
         26 . The hand access system in  claim 25 , wherein the retaining means comprises a fourth ring adapted to interlock with the third ring to fix the sheath at the desired position.  
     
     
         27 . The hand access system in  claim 26 , wherein the retaining means further comprises a wedge disposed between the third ring and the fourth ring.  
     
     
         28 . The hand access system in  claim 24 , wherein the third ring comprises at least one hook to latch the hand seal as the hand seal is attached to the sheath retractor.  
     
     
         29 . The hand access system in  claim 20 , further comprising a spring connecting the first and second iris rings to further facilitate a complete opening, a partial constriction or an airtight constriction of the opening of the elastic member.  
     
     
         30 . The hand access system in  claim 29 , wherein the spring automatically pulls and rotates the iris rings after de-rotation.  
     
     
         31 . The hand access system in  claim 29 , wherein the spring is formed from an elastomeric material.  
     
     
         32 . The hand access system in  claim 29 , wherein as an object is withdrawn from the iris seal, the spring contracts and causes the sheath constriction to tighten automatically.  
     
     
         33 . The hand access system in  claim 29 , wherein the amount the spring stretches and contracts is determined by the length of the spring.  
     
     
         34 . The hand access system in  claim 29 , wherein each of the iris springs comprises a hollow frame and a plurality of interlocking tracks.  
     
     
         35 . The hand access system in  claim 34 , wherein the interlocking tracks operate to encase the spring to prevent the spring from crossing into an instrument or hand passage area within the iris rings.  
     
     
         36 . The hand access system in  claim 35 , wherein the interlocking tracks operate to open and close the seal at predetermined angles.  
     
     
         37 . A surgical access device adapted for disposition relative to an incision in a patient, comprising: 
 a valve including a plurality of overlapping sheets defining an access channel; and    a ring having an inner diameter for holding the valve by fixing each of the overlapping sheets along a portion of the perimeter,    wherein the access channel extends into communication with the incision in the patient.    
     
     
         38 . The hand access device in  claim 37 , wherein each of the overlapping sheets includes a portion of the perimeter that is not fixed to the inner diameter of the ring.  
     
     
         39 . The hand access device in  claim 38 , wherein the non-fixed portions provide open edges defining the access channel.  
     
     
         40 . The hand access device in  claim 39 , wherein the open edges slightly overlap at the center of the ring.  
     
     
         41 . The hand access device in  claim 40 , wherein the overlap is about 0.25″.  
     
     
         42 . The hand access device in  claim 37 , further comprising a septum seal formed at the proximal end of the ring and having a hole at the center of the seal.  
     
     
         43 . The hand access device in  claim 42 , further comprising a second septum seal formed at the distal end of the ring and having a hole at the center of the second septum seal.  
     
     
         44 . The hand access device in  claim 39 , wherein the open edges of the non-fixed portions may have different shapes including at least one of a straight edge, concave, convex, and a cross-configuration.  
     
     
         45 . A surgical access device adapted for disposition relative to an incision in a patient, comprising: 
 a plurality of septum layers each having a hole at the center of the septum layer and a first diameter;    a ball sandwiched between the septum layers and having a second diameter greater than the first diameter; and    a ring having an inner diameter for affixing the plurality of septum layers along the perimeter.    
     
     
         46 . A surgical access device facilitating a sealing relationship with an instrument or an arm of a surgeon extending through the device and into an incision in a patient, the access device comprising: 
 a valve structure including a plurality of overlapping sheets defining an access channel,    the valve in a first state forming a zero seal in the absence of the instrument or the arm of the surgeon extending through the valve structure,    the valve in a second state forming an instrument seal in the presence of the instrument or the arm of the surgeon extending through the valve structure, and    the access channel extends into communication with the incision in the patient.    
     
     
         47 . The hand access device in  claim 46 , further comprising a rigid or semi-rigid ring having an inner diameter for holding the valve structure by fixing each of the overlapping sheets along a portion of the perimeter.  
     
     
         48 . The hand access device in  claim 46 , wherein the zero seal and the instrument seal have properties for inhibiting the escape of liquids and gases through the valve structure.  
     
     
         49 . The hand access device in  claim 46 , wherein each of the overlapping sheets includes a portion the perimeter that is not fixed to the inner diameter of the ring.  
     
     
         50 . The hand access device in  claim 49 , wherein the non-fixed portions provide open edges defining the access channel.  
     
     
         51 . The hand access device in  claim 50 , wherein the open edges slightly overlap at the center of the ring.  
     
     
         52 . The hand access device in  claim 47 , further comprising a septum seal formed at the proximal end of the ring and having a hole at the center of the seal.  
     
     
         53 . The hand access device in  claim 52 , further comprising a second septum seal formed at the distal end of the ring and having a hole at the center of the second septum seal.  
     
     
         54 . The hand access device in  claim 50 , wherein the open edges of the non-fixed portions may have different shapes including at least one of a straight edge, concave, convex, and a cross-configuration.  
     
     
         55 . A surgical access system facilitating a sealing relationship with a robotic device or an arm of surgeon extending through the access system and into an incision in a patient, comprising: 
 a sheath retractor adapted to dilate a wound stretchable to a desired diameter, the sheath retractor comprising 
 a first ring being adapted for disposition interiorly of the wound;  
 a second ring being adapted for disposition exteriorly of the wound; and  
 a sheath being disposed in a generally cylindrical form between the first ring and the second ring and operable to exert a radial retraction force on the wound; and  
   a detachable instrument seal adapted to be attached and detached from the second ring of the sheath retractor.    
     
     
         56 . The surgical access system of  claim 55 , wherein at least one of the first ring, the second ring and the sheath is formed from an elastomeric material.  
     
     
         57 . The surgical access system of  claim 55 , wherein the instrument seal is formed of a gel material and includes a slit providing an instrument seal in the presence of the robotic device or hand and a zero seal in the absence of the robotic device or hand.