Access Device

Abstract

Various devices and methods are provided with respect to inserting multiple surgical instruments through a single surgical access device. A medical device including a flexible tissue retractor a releasable insert having multiple instrument openings, and a member such as a sleeve is disclosed. The insert can be in the form of an insert assembly including multiple components. The sleeve can support the insert with respect to the retractor such that the insert and sleeve can be removed together with the retractor remaining in the incision. A method of using the insert is also described.

What is claimed: 
     
         1 . A medical device comprising:
 a flexible tissue retractor having an outer surface for engaging a body incision and an inner surface defining a passageway;   a sleeve, at least a portion of the sleeve positionable within the passageway; and   an insert comprising at least one instrument opening, wherein the insert is adapted to be releasably supported in the passageway.   
     
     
         2 . The medical device of  claim 1  wherein at least a portion of the sleeve is disposed between a portion of inner surface of the flexible tissue retractor and a portion of the insert. 
     
     
         3 . The medical device of  claim 1  wherein the sleeve comprises a generally cylindrical portion sized to be positioned within the passageway between a portion of the flexible member and a portion of the insert. 
     
     
         4 . The medical device of  claim 1  wherein the insert and sleeve are removable together from the passageway of the flexible tissue retractor. 
     
     
         5 . The medical device of  claim 1  wherein sleeve is removably positionable in the passageway of the flexible tissue retractor, and wherein removal of the sleeve from the tissue retractor is operable to remove the insert from the passageway. 
     
     
         6 . The medical device of  claim 1  wherein the sleeve is positionable in the passageway between an outer surface of the insert and a portion of the inner surface of the flexible member, and wherein the sleeve comprises a material having a hardness less than the hardness of the outer surface of the insert. 
     
     
         7 . The medical device of  claim 1 , wherein the sleeve comprises a first portion positionable within the passageway of the flexible tissue retractor, and second portion positionable outside the passageway. 
     
     
         8 . The medical device of  claim 1  wherein the second portion is adapted to be grasped by a user to withdraw the sleeve and insert together from the passageway. 
     
     
         9 . The medical device of  claim 1  wherein the sleeve comprises a first portion positionable within the passageway of the flexible tissue retractor, and a second portion extending radially from the first portion and positionable outside the passageway of the flexible tissue retractor. 
     
     
         10 . The medical device of  claim 1  wherein the sleeve comprises a ledge for restricting axial movement of the insert through the sleeve. 
     
     
         11 . A medical device comprising:
 a flexible tissue retractor having an outer surface for engaging a body incision and an inner surface for defining a body access passageway;   an insert releasably supported within the body access passageway, the insert comprising:
 a plurality of instrument openings; 
 at least one seal associated with each instrument opening; and 
   a removable sleeve disposed intermediate the insert and at least a portion of the passageway of the flexible tissue retractor.   
     
     
         12 . The device of  claim 11  wherein the sleeve and insert are adapted to be removed together from the passageway. 
     
     
         13 . The medical device of  claim 11  wherein the sleeve and insert are adapted to be inserted together into the passageway. 
     
     
         14 . The medical device of  claim 11  wherein the sleeve has an axial length greater than an axial length of the insert. 
     
     
         15 . The medical device of  claim 11  wherein the sleeve has an axial length greater than an axial length of the passageway. 
     
     
         16 . A medical device comprising:
 a flexible tissue retractor having an outer surface for engaging a body incision and an inner surface defining a passageway;   a member having a portion releasably positionable within the passageway of the flexible tissue retractor; and   an insert comprising at least one instrument opening;   wherein the member is adapted to releasably support the insert with respect to the passageway of the flexible tissue retractor.   
     
     
         17 . The medical device of  claim 16  wherein the member comprises a sleeve. 
     
     
         18 . The medical device of  claim 16  wherein member and insert are configured to be removed together from the passageway of the flexible tissue retractor. 
     
     
         19 . The medical device of  claim 18  wherein the member and insert are configured to be removed together from the flexible tissue retractor without removing the tissue rectractor from a body incision. 
     
     
         20 . The medical device of  claim 16  wherein the member comprises a retention feature for preventing the insert from being pushed through the member and into a body cavity.