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EP-4368234-B1 - DEVICES FOR PERFORMING MINIMALLY INVASIVE SURGERY HAVING FOAM SUPPORT HOUSING

EP4368234B1EP 4368234 B1EP4368234 B1EP 4368234B1EP-4368234-B1

Inventors

  • KLEYMAN, GENNADY
  • AUGELLI, MICHAEL J.
  • KANE, MICHAEL J.

Dates

Publication Date
20260506
Application Date
20180924

Claims (15)

  1. An access device (300) for surgical procedures comprising: an end cap including a rigid body (304) with a flexible support (306) sealingly mounted to the rigid body (304) with at least one separate access port (40) for accommodating introduction of individual surgical instruments into a body of a patient, the at least one access port (40) sealingly attached to the flexible support (306) and extending in a proximal direction therefrom, wherein the flexible support (306) is of a material more flexible than those of the rigid body (304) and the at least one access port (40) to provide for relative angular movement of the at least one access port (40) to provide flexibility for positioning surgical instruments introduced through the at least one access port (40), wherein each access port (40) includes an axially opposed pair of gripping rims (321) with a portion of the flexible support (306) gripped between the gripping rims (321), characterized in that : the flexible support (306) includes a flexible foam material including at least one of a rubber material, a rubber-like material, and/or a foam material made from a gel or gel-like material, wherein the flexible support (306) has a respective receptacle groove (325) defined therein for receiving each of the gripping rims (321).
  2. The access device as recited in claim 1, wherein the foam material is at least one of a closed-cell foam and/or an open-cell foam with an air tight coating for providing sealing to prevent gas flow therethrough.
  3. The access device as recited in claim 1, wherein the at least one access port (40) is mounted to a distal surface of the flexible support (306) and extends proximally through respective bores in the flexible support (306) to extend proximally from the flexible support (306).
  4. The access device as recited in claim 1, wherein there are a plurality of access ports (40) extending proximally from the end cap, evenly spaced circumferentially about the end cap.
  5. The access device as recited in claim 4, wherein each access port (40) extends from a respective planar facet (225) of the flexible support (306).
  6. The access device as recited in claim 5, wherein each access port (40) extends normal from the respective facet (225) of the flexible support (306).
  7. The access device as recited in claim 5, wherein the respective facets (225) meet at facet junctures (227), wherein the facet junctures (227) meet each other at an apex of the flexible support (306), in particular wherein each facet (225) is angled at an angle α from a circumferential plane of the end cap, in particular wherein the angle α is larger than 0° and less than or equal to 60°.
  8. The access device as recited in claim 1, wherein the rigid body (304) defines a complete circumferential ring (313, 314) and wherein the flexible support (306) is mounted within and spans the circumferential ring (313, 314) forming a complete circumferential seal between the rigid body (304) and the flexible support (306).
  9. The access device as recited in claim 8, wherein the flexible support (206; 306) is adhered to an inward facing surface of the circumferential ring (313, 314).
  10. The access device as recited in claim 8, wherein the circumferential ring (313, 314) includes a proximal ring portion (313) and a distal ring portion (314), wherein the flexible support (206; 306) is squeezed between the proximal and distal ring portions, in particular wherein the flexible support (206; 306) defines a respective ring groove (315) for receiving the proximal and distal ring portions.
  11. The access device as recited in claim 1, further comprising: a bottom body (230) having a distally extending tubular body (202) with an access channel (9) defined therethrough for accommodating surgical instruments from the access ports (40) into a rectal cavity, or natural orifice of a patient.
  12. The access devise as recited in claim 11, wherein the bottom body (230) includes an gas inlet in fluid communication with the access channel (9), in particular wherein the one or more access ports (40) are configured to form a mechanical seal for insufflation gas for when instruments are inserted through the access ports (40) and when no instruments are inserted through the access ports (40).
  13. The access device as recited in claim 11, wherein the tubular body (202) is configured for trans-anal introduction and/or wherein the end cap is configured for complete 360° axial rotation relative to the bottom body (230) and/or wherein the tubular body (202) is mounted to a main ring portion (207) of the bottom body (230), and wherein the tubular body (202) is of a less rigid material than that of the main ring portion (207) and/or wherein the rigid body (204; 304) includes at least one flexible tab (216) configured to engage and disengage the bottom body (230) to selectively permit or prevent relative axial rotation of the multiport end cap and bottom body (230).
  14. The access device as recited in claim 1, wherein each of the access ports (40) includes a respective seal configured to seal against gas flow when no surgical instrument is introduced therethrough, and to seal around surgical instruments introduced therethrough.
  15. The access device as recited in claim 1, wherein a respective main seal (406) is suspended at a proximal end of each of the at least one access port (40) wherein a distal end of the at least one access port (40) is sealingly attached to the flexible support (306).

Description

CROSS-REFERENCE TO RELATED APPLICATION This application claims the benefit of priority to U. S Patent Application Serial No. 15/790,582 filed October 23, 2017. BACKGROUND OF THE INVENTION 1. Field of the Invention The subject invention is directed to surgical access devices, and more particularly, to multi-port access devices for minimally invasive surgical procedures. 2. Description of Related Art Laparoscopic or "minimally invasive" surgical techniques are becoming commonplace in the performance of procedures such as cholecystectomies, appendectomies, hernia repair and nephrectomies. Benefits of such procedures include reduced trauma to the patient, reduced opportunity for infection, and decreased recovery time. Such procedures commonly involve filling or "insufflating" the abdominal (peritoneal) cavity with a pressurized fluid, such as carbon dioxide, to create what is referred to as a pneumoperitoneum. The insufflation can be carried out by a surgical access device equipped to deliver insufflation fluid, or by a separate insufflation device, such as an insufflation (veress) needle. CONMED Corporation of Utica, New York, USA has developed unique surgical access devices that permit ready access to an insufflated surgical cavity without the need for conventional mechanical seals, and it has developed related gas delivery systems for providing sufficient pressure and flow rates to such access devices, as described in whole or in part in U.S. Patent No. 7,854,724 and U.S. Patent No. 8,795,223. During typical laparoscopic procedures, a surgeon makes three to four small incisions, usually no larger than about twelve millimeters each. Typically the surgical access device is inserted into an incision using a separate inserter or obturator placed therein. Following insertion, the inserter is removed, and the trocar allows access for instruments to be inserted into the abdominal cavity. A variety of larger access devices are also known in the art for accessing a surgical site through a single relatively large incision to perform minimally invasive procedures, rather than through multiple small incisions. Examples of such devices are disclosed in U.S. Patent Application Publication No. 2013/0012782. Trans-anal minimally invasive surgery (TAMIS) is a specialized minimally invasive approach to removing benign polyps and some cancerous tumors within the rectum and lower sigmoid colon. The benefit of TAMIS is that it is considered an organ-sparing procedure, and is performed entirely through the body's natural opening, requiring no skin incisions to gain access to a polyp or tumor. This scar-free recovery provides a quick return to normal bowel function. Unlike traditional surgery where a major portion of the large intestine is removed, with TAMIS the surgeon will precisely remove the diseased tissue, leaving the rest of the natural bowel lumen intact to function normally. Traditional surgery often requires a large incision and a hospital stay ranging from a few days to more than a week. A TAMIS procedure may only require an overnight stay in the hospital or can be performed as an outpatient procedure, often permitting patients an immediate return to an active lifestyle. TATMe (Trans-anal Total Mesorectal Excision) is a more significant trans-anal procedure. US 2010/228092 A1 discloses a surgical access device, comprising a housing having a central axis and a working channel extending therethrough; a seal member disposed in the housing and configured to seal the working channel; and a plurality of sealing elements disposed in the seal member, each sealing element being configured to receive and form a seal around an instrument inserted therethrough and into the working channel, the plurality of sealing elements including at least one movable sealing element that is movable independent of the other sealing elements within a predetermined path. US 2010/081880 A1 discloses a surgical access device, comprising a retractor having an opening extending therethrough for forming a pathway through tissue into a body cavity; a housing coupled to the retractor and defining a longitudinal axis extending therethrough, the housing having a plurality of rigid sealing ports in communication with the opening in the retractor, each sealing port having a sealing element therein and having a central axis that forms an angle with the longitudinal axis of the housing that is greater than zero. WO 2010/082722 discloses a trocar which makes a small puncture in the abdominal wall of a patient to perform laparoscopic surgery without making an abdominal incision. More particularly, it relates to a multi-channel trocar having an attachable/detachable sealing member, in which one trocar can be equipped with various types of surgical instruments to perform laparoscopic surgery with a minimized abdominal incision and relieve the cost burden on the patient, and in which the sealing member for preventing the inflow/outflow of air to/from the trocar is