CN100384382C - wound retractor device - Google Patents

Abstract

A wound protector and retractor device (1) comprising a sleeve (2), a distal member formed by a distal ring (3) of elastic material, and a proximal member Formed by the proximal loop (4). The sleeve (2) surrounds the distal ring (3) and freely moves axially relative to the distal ring (3) in the manner of a pulley. The proximal ring (4) is fixed to the sleeve (2), in this case at its proximal inner end. The sleeve (2) terminates in a handle or grip part, in this case reinforced by a grip ring (15). The sleeve extends from the proximal ring (4) and the distal ring (3) is accommodated between the inner and outer layers (2a, 2b) of the sleeve (2). The elastic distal ring (3) is tightened and inserted through the incision (6). Then, pull the sleeve (2) upwards. After the sleeve (2) is pulled up, the outer layer (2b) is pulled up and the inner layer (2a) is pulled around the end ring (3). This results in a shortening of the axial length between the proximal ring (4) and the distal ring (3), tensioning the sleeve and exerting traction on the edges of the cutout (6). Since the cut is pulled, the edge is also protected by the sleeve. After traction, a portal is created, eg, for the surgeon to insert his hand and/or instruments for treatment. The device can be used as a retractor in open surgery, or as a base for a valve/seal to allow use in manual assisted laparotomy, or for instrument passage or hand passage.

Description

wound retractor device

technical field

The invention relates to a retractor. In particular, the present invention relates to a retractor for retracting the edges of an incision or natural body opening to produce maximum exposure of an organ or body structure for inspection and/or access during a surgical procedure, At the same time, it provides protection for the exposed side of the incision tissue.

Background technique

Various retractors are known. Some known retractors are difficult and cumbersome and/or expensive to use. Additionally, certain known retractors are defined for specific size incisions and specific patient anatomy.

The present invention seeks to provide an improved wound retractor which will overcome at least some of these problems and additionally provide a measure of wound protection during surgical procedures.

Contents of the invention

According to the present invention, there is provided a wound protector and retractor device comprising:

vertical axis;

remote member;

the proximal member; and

a sleeve extending between at least the distal member and the proximal member,

The sleeve has a proximal grip portion for pulling the sleeve upwardly thereby shortening the axial length between the distal member and the proximal member.

In this device, the shortened axial length between the distal and proximal members remains substantially unchanged after release of the gripping portion without the need for additional locking means.

In one embodiment, the proximal gripping portion is provided at the proximal portion of the sleeve. The gripping portion can be reinforced by reinforcing means such as gripping rings. The grab ring can be mounted to the sleeve.

In one embodiment, the sleeve is secured to the proximal member at a first end and is movable past the proximal member at a second end. The sleeve is axially slidable over the proximal member at the second end.

In another embodiment, the second end of the sleeve is slidably received on a portion of the proximal member to allow relative movement between the sleeve and the proximal member, thereby shortening the distance between the distal member and the proximal end of the sleeve. Axial length between members. The portion of the proximal member that slidably receives the sleeve may comprise an exterior of the proximal member. The second end of the sleeve may be biased against the proximal member.

In one embodiment, the proximal member is located within the sleeve.

The proximal member may form part of a fixation device configured to substantially fix the axial length of the sleeve between the distal member and the proximal member at a desired length.

The sleeve may extend from the proximal member around the distal member and have a return portion on the outside of the proximal member that provides the proximal gripping portion.

In one embodiment, the distal member includes a distal ring which may be an O-ring.

The distal ring can be made of elastic material.

In one embodiment, the proximal member includes a proximal ring which may be an O-ring.

The proximal ring may be relatively stiff compared to the distal ring.

In one embodiment, the sleeve is made of a flexible material.

The wound protector and retractor device may include guide members for the proximal portion of the sleeve.

The sleeve can extend between the guide member and the proximal member.

The guide member may include a receiver for the proximal member. For example, the guide member may have an inwardly facing groove for defining a receptacle for the proximal member. In one instance, the proximal member comprises a proximal ring and the groove has a shape complementary to the proximal ring, for example the groove may be substantially C-shaped in cross-section.

In another embodiment, a lock may be provided for locking the guide member to the proximal member. The guide member can cooperate with the proximal member to form the lock.

In some cases, the guide member can have an interference fit with the proximal member.

In one embodiment, after retracting the incision, the sleeve defines an excess sleeve portion extending between the proximal member and the grasping portion.

This excess sleeve portion can be removed. Alternatively, the redundant sleeve portion is inserted through the retractor and in this case may define an organ holder.

Optionally, the excess sleeve portion is configured to form a seal such as a forearm seal or appliance seal.

The seal may comprise an iris valve.

In one embodiment, the device includes a guide member for the proximal portion of the sleeve, and the excess sleeve material is mounted to the guide member. The excess sleeve material, together with the guide member, may define a chamber. The chamber may have an inflation port. In one instance, after inflation, the chamber defines a seal against an object such as a surgeon's forearm or an instrument shaft.

In one embodiment, the device includes a first proximal mounting member and a second proximal mounting member with at least a portion of the sleeve extending therebetween. The first and second mounting members are movable relative to each other.

The mounting members are axially movable relative to each other and/or the mounting members are rotatable relative to each other.

In one configuration, the mounting members are movable relative to each other to form a seal with at least a portion of the proximal end portion of the sleeve. The mounting member is movable to twist the sleeve to form an iris.

In one embodiment, the device includes a biasing member for biasing the seal into a desired state, such as a closed state.

The biasing member may be a spring such as a coil spring.

In one embodiment, the device further comprises a lock for locking the first and second mounting members together.

The second mounting member may cooperate with the first mounting member to form the lock. The lock may be formed by a snap fit between the mounting members. Optionally, one mounting member is an interference fit with the other mounting member to form the lock.

In one instance, the sleeve extending between the mounting members is a proximal portion of a retraction sleeve.

In another instance, extending between the mounting members is a coupling sleeve separate from the retraction sleeve.

The first mounting member may include a ring member.

The second mounting member may comprise a ring member.

In one embodiment, the wound protector and retractor device further includes a valve. The valve can be connected to the retractor device.

In one instance, the valve is attached to the proximal portion of the sleeve.

In another case, a connector is provided between the device and the valve. The connector may include a connector sleeve. The connector sleeve may have a substantially fixed length.

In one embodiment, a flexible joint is provided between the valve and the device.

In another embodiment, a malleable joint is provided between the valve and the device. In this case, the valve may be offset relative to the longitudinal axis of the wound retractor.

In one embodiment, the extensible joint is formed by an extensible connecting sleeve portion. The extendable connecting sleeve portion may have a corrugated structure.

In one embodiment, the valve is a lip seal.

Optionally, the valve is a diaphragm seal.

The valve can be a forearm seal or an instrument seal.

In one embodiment, the device includes release means for releasing the device from the retracted state. The release means may comprise pulling means. The pulling device may be coupled to the distal member. The pulling means may comprise a drawstring or strap.

In another aspect, the invention provides a wound protector and retractor device comprising:

vertical axis;

remote member;

the proximal member; and

a sleeve extending between at least the distal member and the proximal member,

After retracting the incision, the sleeve defines a redundant sleeve portion extending from the vicinity of the proximal member.

In one embodiment, the redundant sleeve portion is configured to form a seal such as a forearm seal or an instrument seal. The seal may include a diaphragm valve.

In another aspect, the present invention provides a wound protector and retractor device comprising:

vertical axis;

remote member;

the proximal member; and

a sleeve extending between at least the distal member and the proximal member,

The device also includes a first proximal mounting member and a second proximal mounting member with at least a portion of the sleeve extending therebetween.

The first and second mounting members are slidable relative to each other. The mounting members are axially movable relative to each other and/or the mounting members are rotatable relative to each other. In one aspect, the mounting members are movable relative to each other to form a seal with at least a portion of the proximal end portion of the sleeve. The mounting member is movable to twist the sleeve to form a diaphragm. The device may include a biasing member for biasing the seal into a desired state, such as a closed state.

In another aspect, the present invention provides a surgical device comprising a wound retractor, a valve and a connector between the wound retractor and the valve, the wound retractor comprising:

vertical axis;

remote member;

the proximal member; and

A sleeve extends at least between the distal member and the proximal member.

The connector may include a connector sleeve, which may have a substantially fixed length. The connector may comprise a flexible joint between the valve and the retractor. Optionally, the connector includes a malleable joint between the valve and the retractor. The valve may be offset relative to the longitudinal axis of the wound retractor. The extensible joint is formed by an extensible connecting sleeve portion. The extensible connecting sleeve portion may have a corrugated structure.

In another aspect, the present invention provides a method for retracting an incision, comprising the steps of:

make an incision on the patient;

providing a wound retractor comprising a longitudinal shaft, a distal member, a proximal member and a sleeve extending at least between the distal member and the proximal member, the sleeve having a proximal grabbing part;

inserting the distal member through the incision such that the sleeve extends through the incision and the proximal member is outside the incision;

Grab the grip portion of the sleeve and pull the sleeve upwardly to shorten the axial length of the sleeve between the distal and proximal members.

In one embodiment, the shortened axial length of the sleeve between the distal member and the proximal member remains substantially unchanged after the gripping portion is released.

The sleeve may be secured to the proximal member at a first end and extend beyond the proximal member at a second end, and the method includes pulling the sleeve upwardly to position the sleeve between the distal member and The axial length between the proximal members is shortened, moving the sleeve past the proximal members. The method may include the step of moving the sleeve relative to the proximal member, including sliding a portion of the sleeve against a radially outer portion of the proximal member.

In one embodiment, the portion of the sleeve between the distal and proximal members comprises two layers of material. The sleeve may be wrapped around the distal member to form two layers of material.

The method may include sealing the wound retractor, for example by attaching a seal to the wound retractor, by releasably mounting a seal to the wound retractor. A seal can be mounted to the proximal end of the wound retractor. A seal can be mounted on the proximal end of the sleeve.

In one aspect, the retractor includes a mounting member and the seal is attached to the mounting member.

In one embodiment, the seal is attached to the proximal end of the wound retractor with a connector.

The connector may be a connecting sleeve. The connector may be at least partially made of a flexible material. Optionally, the connector is at least partially an extensible material, and the method may include the step of manipulating the connector into a desired state. In one instance, the desired state is a state where the seal is offset from the longitudinal axis of the wound retractor.

In one embodiment, the method includes pulling upwardly on the sleeve to form an excess sleeve portion extending adjacent the wound retractor. In one aspect, the method includes the step of partially cutting away the excess sleeve. In another instance, the method includes the step of inserting the excess sleeve portion through the retractor. This excess sleeve material can be inserted through the retractor to provide an organ retainer.

In another aspect, the method includes the step of manipulating the excess sleeve portion to form a seal.

In one embodiment, the retractor includes a proximal mounting member, and the redundant sleeve portion is connected to the mounting member.

In another embodiment, the excess sleeve portion forms a cavity with the mounting member. The chamber may have an inflation port, and the method includes inflating the chamber with gas to form a seal.

The seal may be a lip seal or a diaphragm seal.

In one embodiment, the wound retractor is sealed with a forearm seal.

In another embodiment, the wound retractor is sealed with an instrument seal.

In one instance, the incision is sized to accommodate an instrument when retracted.

In another case, the incision is sized to accommodate the forearm when retracted.

In yet another instance, the incision is sized to provide an open surgical site when retracted.

According to the present invention, there is provided a medical device comprising:

a retractor member comprising a distal portion for insertion through an incision in the patient and a proximal portion for extending from the incision into the patient's body;

a distal member connected to the distal portion of the retractor member;

a proximal member connected to the proximal portion of the retractor member;

The retractor member is axially movable relative to the distal member to draw the proximal and distal members toward each other thereby shortening the axial length of the retractor between the proximal and distal members.

In one embodiment, the retractor member includes a sleeve member. The sleeve member preferably extends around the distal member.

In one embodiment, the distal member is an annular member such as an elastic ring, eg an O-ring.

In one embodiment, the proximal member is connected to a retractor member. The proximal member may be an annular member.

In one embodiment, the sleeve member is a flexible material.

In one configuration, the sleeve extends from the proximal member around the distal member and has a return portion outside the proximal member.

The return portion may have a handle member such as a ring member.

In one embodiment, the device includes a guide member.

The retractor member can extend between the guide member and the proximal member.

The guide member may include a receiver for the proximal member.

The guide member may include a guide ring receiving member.

The sleeve return portion may be configured to provide an integral valve member. In this case, the sleeve return can be twisted to form a diaphragm valve.

In another embodiment, the sleeve return is mounted to the guide member.

The sleeve return portion may extend into the opening defined by the sleeve member.

The device may include a lock for locking the guide member to the proximal member. Typically, the guide member cooperates with the proximal member to form the lock.

The guide member can be an interference fit with the proximal member.

In one embodiment of the invention, the device comprises a valve, such as a valve of the diaphragm type.

In one embodiment, the device includes a biasing member for biasing the valve to a desired position, such as a closed position.

In one configuration, the device includes a guide member positioned adjacent the proximal member, and biasing means is disposed between the proximal member and the guide member. The biasing means may comprise a spring such as a coil spring.

In one embodiment, a sleeve portion extends between the proximal member and the guide member, and the biasing means is disposed around the sleeve. The sleeve member may be an extension of the retractor member.

In one embodiment, the device includes a release member for releasing the device from the incision. The release member may comprise an elongate member extending from the distal end of the device, such as a drawstring or a spring.

The release member may extend from the distal member.

In one embodiment, the valve is or can be located near the proximal member. A flexible material may be disposed between the valve and the proximal member. The flexible material may comprise a proximal extension of the retractor member.

In one embodiment, the flexible material includes a sleeve portion.

In another embodiment, the valve is a lip seal.

The present invention also provides a method for retracting the incision, comprising the steps of:

A device is provided comprising a retractor member, a distal member and a proximal member, the retractor member having a distal portion and a proximal portion, the distal member being connected to the distal portion, the proximal member being connected to the proximal The end part is connected;

inserting the distal end member and the distal portion of the retractor member through the incision in the patient; and

pulling the retractor member axially relative to the distal member to draw the proximal and distal members closer to each other, thereby shortening the axial length of the retractor member between the proximal and distal members and retracting incision.

Description of drawings

The invention will be more clearly understood from the following description of some embodiments given by way of example with reference to the accompanying drawings, in which:

Figure 1 is a perspective view of a retractor according to the present invention;

Figure 2 is a cross-sectional view of the device of Figure 1;

Figures 3 and 4 are perspective views illustrating the manner in which the device of Figures 1 and 2 is formed;

Figures 5 and 6 are cross-sectional views of Figures 3 and 4, respectively;

7 and 8 are perspective views illustrating the use of the device;

9 and 10 are cross-sectional views showing the method of use of the device;

Figure 11 is a cross-sectional view of another device according to the present invention in a ready-to-use state;

12 is a perspective view of the device of FIG. 11 with the distal portion inserted through an incision;

13 is a cross-sectional view of the device of FIG. 11 with the distal portion inserted through an incision;

Figure 14 is a cross-sectional view of the device of Figure 11 in use with a retracted incision;

Figure 15 is a perspective view of the device in the form shown in Figure 14;

Figure 16 is a perspective view of the device in its original position with excess sleeve portions removed;

Figure 17 is a cross-sectional view of the device in the original position with the excess sleeve portion extending rearwardly into the incision;

Figure 18 is a perspective view of the device in its original position with the excess sleeve portion distorted;

Figure 19 is a perspective view similar to Figure 18 with the excess sleeve portion further twisted to provide a diaphragm valve;

Figure 20 is a cross-sectional view of another device according to the present invention in a home position;

Figure 21 is a cross-sectional view of the device of Figure 20, wherein the redundant sleeve portion is mounted on a guide member;

Figure 22 is a cross-sectional view of the device of Figure 21, wherein the excess sleeve portion is expanded to provide an integrally everted channel portion;

Figure 23 is a perspective view of another retractor of the present invention combined with a release device,

Figure 24 is a cross-sectional view of the retractor of Figure 23;

Figure 25 is a perspective view illustrating the manner in which the device of Figure 23 is formed;

Figure 26 is a cross-sectional view of the device in the configuration shown in Figure 25;

Figure 27 is a sectional view of the retractor of Figures 23 to 26 in use;

Figure 28 is a cross-sectional view of the retractor of Figures 23 to 27, illustrating the operation of a release device;

Figure 29 is a perspective view of another device according to the present invention in an inserted configuration;

Figure 30 is a perspective view of the device of Figure 29 in an incision;

Figure 31 is another perspective view of the device of Figure 30;

Figure 32 is another view of the device of Figure 31 with the exterior cut away and forming a valve;

Figure 33 is a view of the device of Figure 32 with the valve closed;

Figure 34 is a perspective view of another device similar to that of Figures 29-33, with a valve closed;

Figure 35 is a cross-sectional view of the device of Figure 34;

Figure 36 is a perspective view of another device similar to that of Figures 29-33 incorporating a biasing means in an inserted configuration;

Figure 37 is another perspective view of the device of Figure 36 in a retracted state;

Figure 38 is another perspective view of the device of Figure 37 in another configuration with the excess sleeve removed;

Figure 39 is a perspective view of the device of Figure 38 with the valve closed;

Figure 40 is a perspective view of the device of Figure 39 with the valve partially open;

Figure 41 is a perspective view of the device of Figure 39 with an object inserted into the valve;

Figure 42 is a perspective view of another device according to the present invention;

Figure 43 is a cross-sectional view of the device of Figure 42 in a cutout;

Figure 44 is a cross-sectional view of the device of Figure 43 with an object extending therethrough;

Figure 45 is a sectional view similar to Figure 44 with an object offset from the longitudinal axis of the device;

Figure 46 is a cross-sectional view of another device inserted into an incision according to the present invention;

Figure 47 is a cross-sectional view of the device of Figure 46 with a retracted incision;

Figures 48 and 49 are cross-sectional views of the device of Figure 47 showing the formation of a diaphragm valve;

Figure 50 is a cross-sectional view of another channel opening;

Figure 51 is a cross-sectional view of the port of Figure 50 with an instrument in place;

Figures 52-55 are cross-sectional views of another channel opening;

Figures 56 and 57 are cross-sectional views of yet another channel opening;

Figures 58 and 59 are cross-sectional views of another channel opening;

Figures 60 to 62 are cross-sectional views of yet another channel opening;

Figures 63 to 66 are cross-sectional views of another channel opening;

67-72 are cross-sectional views of another port of the present invention.

Detailed ways

Referring to the drawings, and initially to Figures 1 to 10, there is shown a device 1 comprising a retractor member formed by a sleeve 2, a distal The member is formed by a distal ring 3 of elastic material, such as an O-ring, and the proximal member is formed by a proximal ring 4, which may also be an O-ring.

The sleeve 2 may be made of any suitable material, such as a flexible plastic film material, and comprises a distal portion 5 for insertion through an incision 6 and a proximal portion 8, in this example, The incision 6 is made in the abdominal cavity 7 of the patient, and the proximal portion 8 is adapted to extend from the incision 6 and out of the patient's body.

In this example, the distal ring 3 is not fixed to the sleeve 2 , but the sleeve surrounds the ring 3 and is free to move axially relative to the distal ring 3 to a certain extent in the manner of pulleys. A proximal ring 4 is fixed to the sleeve 2 and in this case at its proximal inner end. The sleeve 2 ends in a handle or grip, which in this case is reinforced by a grip ring 15 .

To construct the traction device according to the invention, the sleeve 2 is firstly provided with a grasping ring 15 fixed at one end and a proximal ring 4 fixed at the other end ( FIGS. 3 , 5 ). Then, the distal ring 3 is placed on the sleeve 2, as shown in FIGS. 4 and 6 . The grab ring 15 is then used to manipulate the sleeve 2 so that the sleeve 2 is folded back on itself into the configuration shown in Figures 1 and 2 with the grab ring 15 at the uppermost end. The sleeve extends from a proximal ring 4 and a distal ring 3 is accommodated between the inner and outer layers 2a, 2b of the sleeve 2 . The unit is now ready to use.

The elastic distal ring 3 is tightened and the distal end 5 of the sleeve 2 is inserted through the incision 6, as shown in FIG. 4 . Then, the sleeve 2 is pulled up in the direction of arrow A in FIGS. 8 to 10 . After the sleeve 2 is pulled up, the outer layer 2b is pulled up, while the inner layer 2a is pulled around the proximal ring 3 . This results in a shortening of the axial length between the proximal ring 4 and the distal ring 3 , tensioning the sleeve and exerting a retracting force on the edges of the incision 6 . The system exhibits a self-locking phenomenon because the rings 3, 4 remain in place and apply the retracting force when tension is applied to the sleeve 2 and the pulling force is released. The friction fit between the various layers of the sleeve in this construction may contribute to this self-locking.

As the incision is retracted, its edges are also protected by the sleeve. After retraction, a portal is created to allow, for example, a surgeon to insert his hand and/or instruments to perform the procedure. The device can be used as a retractor in open surgery, or as a seat for a valve/seal to allow it to be used for manual assisted laparotomy, or for passage of instruments or hands.

The excess sleeve part 20 outside the cutout can eg be cut off.

The retractor is suitable for a range of incision sizes and is easy to produce. It is also relatively easy to manipulate in use. It not only retracts but also protects the incision.

Referring now to Figures 11 to 19, there is shown another apparatus 50 of the present invention which is similar to that described above with reference to Figures 1 to 10 and like parts are designated by like reference numerals. In this example, the device comprises a guide member 51 for the proximal ring 4 . The guide member 51 is in the form of an annular ring member with an inwardly facing C-shaped groove 52 sized to accommodate the ring 4 shown. The outer layer of the sleeve 2 is disposed between the ring 4 and the guide member 51 to further control the pulling of the sleeve and thus the application of traction. This guide member 51 also contributes to stabilizing the proximal ring 4 . The use of the device 50 shown in Figures 12 to 15 is similar to that described above.

Any suitable guide member such as ring 51 may help to hold/stabilize the proximal ring 4 in the desired position during pulling up on the sleeve to retract the incision. The guide member may be located proximally of the ring 4 .

The guide member is provided with a monitoring member to which a device such as a valve can be connected.

Referring to Figure 16, it will be noted that in one instance, the excess sleeve portion 20 may be cut away.

Referring to Figure 17, in this case the excess sleeve portion 60 is folded back into the cutout. In this configuration, it could act as an organ retractor, or provide an open channel for surgeons to work inside.

Referring to Figures 18 and 19, in this case the excess sleeve portion is twisted to form a diaphragm valve (iris diaphragm valve) 65.

In the embodiment shown in FIGS. 20 to 22 , the device 70 of the invention has an integral seal/valve 71 . The device 70 is similar to that described above with reference to Figures 11 to 19, and like parts are given like reference numerals. In this case, the guide member 50 has an external groove 75 to accommodate the grab ring 15 shown in FIG. 21 . The redundant sleeve portion 20 is folded outwards and downwards, and the grip ring 15 engages into the groove 75 to provide an airtight seal. In this configuration, the excess sleeve can be inflated through the inflation port 76 ( FIG. 22 ) to provide an integral access valve 71 . The valve can be used to sealably engage hands, instruments or the like passing through it. The portion of the expansion sleeve defining the valve can be everted onto objects passing therethrough.

Referring to Figures 23 to 28, there is shown another retractor 80 of the present invention which is similar to the retractor described above and like parts are designated by like reference numerals. In this case, the retractor 80 has a release mechanism formed in this case by a release cord or strap 81 connected at one end 82 to the inner ring 3 and terminating at The outer free end 83 can be grasped by the user. After assembly, this release strip 81 is guided through the gap between the proximal ring 4 and the outer guide member 51 , thereby being positioned between the proximal ring 4 and the guide member. The release strap 81 facilitates the release of the self-locking sleeve in use in the cutout. Pulling on the release strap 81 will pull the inner ring 3 to allow release of the inner ring 3 from the inner wall of the incision, thereby releasing the device. The flexibility of the inner ring 3 facilitates this movement.

An advantage of this configuration is that the user can easily release the device from its self-locking retraction configuration.

Referring to Figures 29 to 33, there is shown another apparatus 90 of the present invention, in which parts similar to those of the apparatus described above are designated by the same reference numerals. In this case, the device 90 has a lower guide ring 51 for the proximal ring 4 and an outer guide assembly formed by an upper guide ring 91 and a second proximal ring 92 on which the sleeve 2 is located. Guided between the proximal rings. In all relevant embodiments, an upper guide such as upper guide ring 91 may have a second mounting member located adjacent to a first guide member such as guide ring 51 that also has a mounting member. member. The device is first used to retract the incision as described above. This external guide assembly is conveniently located outside the guide member 51 and the proximal ring 4 during this phase. In fact, it can be completely detached from the sleeve 2 and subsequently attached to the sleeve 2 at an appropriate stage, eg when the incision is retracted as shown in FIG. 30 . The outer guide assembly is then moved downward toward the cutout shown in FIG. 31 . This can be achieved by pulling the sleeve 2 upwards at the same time. When the guide is adjacent to the guide member 51, the excess sleeve portion can be cut off as shown in FIG. 32 . By twisting the guide assembly relative to the guide member 51 , the sleeve 2 is twisted, thereby closing the inner cavity of the sleeve 2 and forming a diaphragm-type access valve 95 as shown in FIG. 33 . In this way, a sealed access opening is provided for passing hands and/or instruments through the incision.

It will be appreciated that although it has been described with reference to an incision made by a surgeon, the device of the present invention may also be used for retraction of any opening, such as a body opening.

Referring to Figures 34 and 35, there is shown another retractor device 100 of the present invention which is similar to the device of Figures 29 to 33 and like parts are designated by like reference numerals. In this case, a releasable lock is provided for keeping the access valve 95 closed. For interlocking, in this case the upper guide ring 91 is an interference fit with the lower guide ring 51 . Various other locking structures may also be used, such as threaded or bayonet type fits, magnets, clips and the like.

Referring to Figures 36 to 41, there is shown another retractor device 110 of the present invention which is similar to the device of Figures 29 to 33 and like parts are designated by like reference numerals. In this case, the device incorporates a biasing means to bias an integral valve into the closed position. This biasing means is formed in this case by a helical spring 111 situated around the sleeve between the guide rings 51 , 91 . In use, the device is used in a similar manner to Figures 29 to 33, except that during the downward movement of the upper guide ring 91 the spring 111 also moves downwards towards the lower guide ring 51, initially to the position shown in Figure 38 . During this stage, excess sleeve material can be removed. The spring 111 is tensioned with the rotation of the upper guide ring 91 while pushing the upper guide ring 91 downward. The sleeve material between the two guide rings 51 , 91 is twisted to form a diaphragm type valve 112 as shown in FIG. 39 . In order to open the valve 112 for passage of eg an instrument, hand, arm or the like, a downward force may be applied to push the upper guide ring 91 towards the lower guide ring 51 against the biasing force of the spring. This configuration is shown in FIG. 40 . When an object is inserted, the upper guide ring member 91 is released allowing the valve to close around the object. The operation of device 110 is evident in Figures 41(a) to 41(d). In Fig. 41(a), the valve 112 is in a closed rest state. FIG. 41( b ) shows application of downward force to open valve 112 . Insertion of an object such as instrument 113 through open valve 112 is shown in FIG. 41(c). In FIG. 41( d ), the downward pressure on the upper guide ring 91 is released, allowing the valve 112 to close around the object 113 .

Referring now to Figures 42 to 45, there is shown another apparatus 120 of the present invention which is similar in some respects to the apparatus of Figures 11 to 18 and like parts are designated by like reference numerals. In this case, the device has a lip seal 121 . The lip seal 121 is formed by a membrane with a central hole 122 through which an object 123 such as an instrument passes. This lip seal 121 is located adjacent to the guide ring 51 on the sleeve 2 forming a proximal flexible sleeve portion 125 . The sleeve portion 125 is very useful in assisting the offset movement of the object 123 as shown in FIG. 45 . The sleeve portion 125 accommodates movement of the object 123 while maintaining a sealing fit between the lip seal 121 and the object 123 . It will be appreciated that this feature, like the others described above, may be used with other configurations of wound protector/retractor and channel members than those shown in the figures.

Referring to Figures 46 to 48, there is shown another apparatus 130 of the present invention having some features similar to those of Figures 11 to 15, and like parts are designated by like reference numerals. In this case, the sleeve has a proximal portion outside the wound when the device is in the retracted configuration. The proximal sleeve portion includes a first portion 131 extending from the guide ring 51 and a second portion 132 extending from the first portion 131 . The second portion 132 is defined between two spaced diaphragm rings 134, 135 (iris rings). It will be noted that the diaphragm rings 134, 135 have mating features such as protrusions and grooves for internal fit during assembly. This diaphragm ring 134 also has cooperating elements, which in this case are formed by grooves 137, for cooperating in assembly with corresponding cooperating elements of the guide ring 51, which in this case are formed by Protrusions 138 are formed.

As mentioned above, the device is adapted to retract a wound with the first and second sleeve portions 131, 132 extending proximally. The first sleeve portion 131 is redundant and can be removed or crimped after the first diaphragm ring 134 is assembled on the guide ring 138, as shown in FIG. 48 . The second or upper diaphragm ring 135 is then rotated to twist the sleeve portion 132 to form a diaphragm-type seal as shown in FIG. 49 . The diaphragm ring 135 mates with the diaphragm ring 134 as shown to keep the valve closed.

In some of the embodiments described above, a valve 829 is mounted directly to a retractor base 811 . A flexible coupling may be provided between retractor 811 and valve 829 . For example, as shown in FIGS. 93 and 94 , such a flexible link is formed by a length of flexible sleeve 830 extending between retractor 811 and valve 829 . The flexible sleeve 830 may be formed by excess retractor sleeve material attached to the valve 829 .

In another embodiment of the invention shown in Figures 52 to 57, a valve 860 may be attached to the retractor 811 in a manner that facilitates a flexible joint therebetween. For example, a fixed length sleeve 862 may extend between the outer proximal ring 863 of the retractor 811 and the valve 860 . Excess sleeve material 864 from retractor 811 may pass through valve 860 . The valve 860 can be pushed down and the excess sleeve pulled up to lock the retractor base 811 tightly in the incision. Excess sleeve material 864 can be cut away and removed, if desired. This flexible sleeve 864 allows the instrument to tilt without affecting the seal of the valve to the shaft of the instrument/object 814 as shown in FIG. 57 .

As shown in FIGS. 58 and 59 , for more controllable flexibility, a spring 867 can be positioned between the valve 860 and the retractor proximal ring 863 .

Referring now to Figures 60-62, another modular system is described in which a valve 870 is releasably mounted to a retractor 811. The retractor 811 may have a proximal ring 871 with a groove 872 that accommodates a valve 870 . The instrument shaft 814 can easily pass through the valve 870 and the retractor 811. At least portion 873 of shaft 814 can be bent or turned against the distal end of the retractor.

Referring now to FIGS. 63-66 , any suitable valve 880 may be coupled to the retractor 811 via sleeve material 881 that protrudes from the retractor 811 . The valve 880 can be pulled upwards to deploy the retractor base 811 . This excess sleeve material 881 is provided with a flexible neck which facilitates easy introduction of objects such as instruments 883, even objects with curved shafts (Fig. 119). This configuration also facilitates access to the auxiliary instrument by allowing the valve 880 to move closer to the retractor base 811 as shown in FIG. 120 .

Referring to Figures 67 to 72, another access port comprising a wound protector and retractor device 811 and a valve 900 is depicted. This valve 900 is connected to the outer guide ring 901 of the retractor device 811 by means of a sleeve 902, which in this case is made of a malleable material in a corrugated structure, shaped like a bendable drinking straw. Wrinkles in a way that bends the hinged sections. Sleeve 902 may be pre-shaped to be offset from the longitudinal axis of the retractor to facilitate easy insertion of instruments or the like. The corrugated sleeve 902 may be compressed as shown in FIG. 68 to provide a lower profile to help delineate any excess retractor sleeve as shown in FIGS. 69 and 70 . Thus, the corrugated sleeve 902 can be extended/extended and easily manipulated into a desired configuration. Since the sleeve 902 is malleable, it will maintain the desired curved shape even when the abdomen is pressurized. Any excess retractor sleeve material 905 may be cut away as shown or as used above.

In this context, the term "extendable" is used to denote an element which can be manipulated into a desired position and/or orientation and which, when used in a patient for its intended purpose, for example when inserted between laparoscopic instrument parts, can be The manipulated position and/or orientation is maintained under typical applied stresses and strains.

The port of the present invention can be used in several ways. In one approach, using a retractor as described above, the distal inner guide ring is inserted into the incision and the outer guide ring is slid to controllably radially expand the incision. The retractor is then locked in this position. If necessary, the outer guide ring can be moved further down to create a larger incision.

In some configurations, an instrument can be manually bent outside the body, the bent instrument delivered through the port for easy access to the surgical site.

In another embodiment, an instrument is inserted into the portal, and the surgeon bends the instrument with the abdominal wall itself, and then inserts the curved portion further into the abdominal cavity.

In each case, the sleeve can be grasped by grasping a valve or other element mounted on it.

The port of the present invention has at least some of the following advantages:

Controlled Radial Expansion

1. Use smaller incisions to get larger channels

2. Ability to vary incision size as needed (e.g. sample removal during E. coli elimination)

Stronger sealing ability

1. There will be no leakage of gas from the wound edge

2. Will not accidentally pull out from the cutout

3. Can seal any incision, and does not require auxiliary sealing methods (suture, Hansen mouth, etc.)

Eliminate the inner contour of the abdomen

1. Provide greater operating space in the abdominal cavity (very critical in pelvic surgery)

2. Access to the perineum during surgery such as radical prostatectomy.

Protect wounds from infection and cancer

1. Tight seal does not produce "chimney" effect

2. After removal, all potentially contaminated areas are isolated from the cutout

Lowered outer abdominal contour

1. Will increase the effective working length of the device

2. Has a large working area outside the abdominal cavity

Increased freedom of movement over traditional abdominal instruments

The invention is not limited only to the above-described embodiments given with reference to the drawings, which may vary in structure and detail.

Claims (17)

1. Wound protection device and retractor device comprise:

The longitudinal axis;

Distal end members;

Proximal structure;

At least the sleeve that between this distal end members and this proximal structure, extends, and

The ways that is used for this telescopic proximal part;

This sleeve extends, extends, extends from this distal end members at nearside around this distal end members to this distal end members from this proximal structure in the distally, and has a returning part, this returning part extends between this ways and this proximal structure at nearside, this sleeve is fixed on this proximal structure at the first end place, and can axially slip over this proximal structure at this returning part place, this returning part provides a near-end gripping portion, being used for, thereby shorten axial length between this distal end members and this proximal structure with the upwards pulling of this sleeve.

2. Wound protection device according to claim 1 and retractor device; it is characterized in that; discharge after this near-end gripping portion, under the situation that does not need other locking device, the axial length of the shortening between this distal end members and this proximal structure remains unchanged substantially.

3. Wound protection device according to claim 1 and 2 and retractor device is characterized in that, this near-end gripping portion is arranged on this telescopic close end office.

4. Wound protection device according to claim 1 and 2 and retractor device is characterized in that, this near-end gripping portion can be strengthened by stiffening device.

5. Wound protection device according to claim 1 and 2 and retractor device; it is characterized in that; this proximal structure forms the part of a fixture, and this fixture is configured for the axial length basic fixed of this sleeve between this distal end members and this proximal structure is expection length.

6. Wound protection device according to claim 1 and 2 and retractor device is characterized in that this distal end members comprises distal loop.

7. Wound protection device according to claim 1 and 2 and retractor device is characterized in that this proximal structure comprises proximal loop.

8. Wound protection device according to claim 1 and 2 and retractor device is characterized in that this sleeve is made by flexible material.

9. Wound protection device according to claim 1 and 2 and retractor device is characterized in that, after retracting otch, this sleeve limits a unnecessary sleeve part, and extend between this proximal structure and this near-end gripping portion this unnecessary sleeve part.

10. Wound protection device according to claim 1 and 2 and retractor device is characterized in that, also comprise a valve.

11. Wound protection device according to claim 1 and 2 and retractor device is characterized in that, this device comprises that one is used for this device from retracting the releasing device that state discharges.

12. Wound protection device according to claim 1 and 2 and retractor device is characterized in that, after retracting otch, this sleeve limits near a unnecessary sleeve part from extending this proximal structure.

13. Wound protection device according to claim 12 and retractor device is characterized in that, this unnecessary sleeve part is configured to define a sealing member.

14. a surgery device comprises Wound protection device according to claim 1 and 2 and retractor device, valve and the adapter between this Wound protection device and retractor device and this valve.

15. surgery device according to claim 14 is characterized in that, this adapter comprises a connector sleeve.

16. surgery device according to claim 14 is characterized in that, this adapter comprises the flexible joint between this valve and this Wound protection device and retractor device.

17. surgery device according to claim 14 is characterized in that, this adapter comprises the extending joint between this valve and this Wound protection device and retractor device.

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