HK1191202A - Tissue retractor assembly - Google Patents

Abstract

An intracorporeal surgical tissue retractor is provided having an anchor selectively deployable in a first tissue not to be retracted and a grasper selectively deployable on a second tissue to be retracted. A longitudinally selectively movable support is threadable through the anchor and attached at a substantially distal end of the movable support to the grasper. A deployment user interface is couplable to the movable support and has a proximal end manipulable by a user extracorporeally and a distal end releasably attachable to both the anchor and the grasper, adapted to intracorporeally deploy the anchor into the first tissue and the grasper onto the second tissue. The user interface includes a first actuator having an anchor positioning tool enabling selective deployment of the anchor in the first tissue, and a second actuator enabling selective opening and closing of the jaws of the grasper.

Description

Tissue retractor assembly

RELATED APPLICATIONS

The present application claims priority, based on U.S. provisional application No. 61/502,178 filed on 28/6/2011 entitled "tissue retractor assembly". The contents of this application are incorporated by reference into the present application.

Technical Field

The present invention relates generally to tissue retractor assemblies and, more particularly, to tissue retractor assemblies for single incision laparoscopic surgery.

Background

Single-incision laparoscopic surgery is a surgical procedure that may provide less risk, less patient trauma, and/or reduced procedure time. In a typical single incision procedure, for example, a single incision is introduced through the umbilicus to gain access to internal organs and/or desired anatomical regions. Generally, retraction of the gallbladder or other organ is required during a single incision. However, retraction for single incision access is difficult because the incision site is typically caudal to the organ and provides limited access for additional retraction tools.

Therefore, there is a need for an organ retraction system that can be used for both single-incision and small-incision procedures (e.g., gallbladder, appendix, colon procedures; bariatric procedures, hysterectomy, etc.) that can be performed with minimal invasive means, e.g., through one or more 5mm (or greater) laparoscopic ports, without requiring additional abdominal incisions to facilitate introduction of the organ retraction system. There is also a need for a non-invasive organ retraction system, for example, that reduces the risk of organ injury and/or the risk of punctures associated with tissue engagement and/or retraction. Reducing these risks is important because, among other things, tissue trauma and/or puncture may lead to infection, for example, the release of bile from the gallbladder may lead to infection in the peritoneal space and aggravate the risk to the patient. There is a further need for an organ retraction system for single or small incision surgery in which organ tension or distraction can be adjusted extracorporeally during the procedure, e.g., without the need to remove and/or reintroduce the delivery device. Still further, there is a need for an organ retraction system that can grasp the changing structures of a target organ. These and other needs are addressed by the components of the present disclosure.

Disclosure of Invention

In accordance with embodiments of the present disclosure, the disclosed tissue retractor assembly is used in single or low incision laparoscopic surgical procedures or similar procedures, and has significant advantages. In general, the disclosed tissue retractor assemblies are laparoscopic surgical aids that assist in retracting various organs and/or structures within the body. In an exemplary embodiment, the tissue retractor is a multi-component device configured and dimensioned to be passed through a 5mm (or larger) laparoscope or similar incision and to provide an atraumatic means for grasping and holding organs or other anatomical structures (e.g., the gallbladder).

In accordance with embodiments of the present disclosure, the disclosed example tissue retractor assemblies are adapted to retract organs or other anatomical structures by preventing cooperative interaction between the injury grasper and the anchored guide/suture, e.g., a suture passed through an anchor placed or otherwise fixed in a fixed position (e.g., the abdominal wall). More particularly, the disclosed tissue retractor assembly may operate by: (i) positioning or securing the anchor relative to an anatomical structure (e.g., the abdominal wall), (ii) linking the suture to the anchor (either before or after securing the anchor relative to the anatomical structure), (iii) engaging, attaching and/or securing the deployable, trauma-preventing grasper relative to an organ, tissue or other anatomical structure, and (iv) manipulating/manipulating the suture attached or otherwise secured relative to and through the grasper, thereby allowing the organ/tissue/anatomical structure to be retracted, moved or otherwise manipulated, e.g., by pulling the suture. Obviously, the suture is advantageously passed through the abdominal wall, e.g. through an incision, and is typically manipulated by the surgeon/user from an external location.

In an exemplary embodiment, the tissue retractor assembly is adapted for introduction and use through the abdominal wall (through a 5mm incision) and includes a cannula defining an axis and a distal end. A grasper and an anchor are removably secured to the distal end of the cannula. The suture is cooperatively linked to the grasper and the anchor for moving/maneuvering the grasper relative to the anchor. The grasper is generally configured and dimensioned to be axially extendable from the cannula and includes first and second legs/jaws for grasping organs, tissues and/or other structures. The grasper further includes a tubular member that moves axially so that the legs/jaws of the grasper can move relative to one another, e.g., by pinching or camming action. The tubular member may function or cooperate with a locking mechanism configured and dimensioned to be advanced/pushed distally to grasp and lock the first and second leg/jaws in engagement with a target structure (e.g., organ, tissue, and/or other structure).

The anchor is generally configured and dimensioned to be deployed by the distal end of the cannula. The anchor may advantageously be fixed to an anatomical location/structure within the abdominal cavity, e.g., the anchor may be attached to the abdominal wall adjacent to an organ, tissue or other desired structure. The anchor is generally defined by a body (e.g., a cylinder) and at least two prongs extending therefrom. Preferably, the anchor comprises more than two legs, more preferably the anchor comprises four such legs. The sharp leg may advantageously be adapted to be positioned along the axis of the cannula (or substantially along the axis), for example, to facilitate introduction through the abdominal wall. In the illustrated embodiment, the sharp legs are constructed of a resilient material, such as nitinol or stainless steel, and are shaped to be resiliently movable between first and second positions/configurations. More particularly, the legs are advantageously configured so as to be movable between a first, relatively straightened, generally aligned-axis configuration (e.g., during abdominal introduction) and a second, curved configuration (after deployment through a cannula within the abdominal cavity) to provide suitable anchoring. In this way, at least two legs (preferably four legs) may be automatically deployed into the abdominal wall, for example in a generally crossed configuration or, in the case of the preferred embodiment, in an outwardly curved configuration, to effectively secure the anchor relative to the abdominal wall. The pointed ends of the legs assist in tissue penetration and the preferred outwardly bowed configuration of the legs upon deployment prevents inadvertent withdrawal of the anchor from the abdominal wall. In accordance with the present disclosure, a suture may be introduced into the abdominal cavity, for example, through a cannula, and passed through (i) the anchor body (or through an extension connected to the body) and (ii) a cooperating aspect of the grasper. Typically, the suture is pre-tied to the grasper and anchor prior to abdominal introduction. The suture may be manipulated by the surgeon/user from a position outside the abdominal cavity, and a desired level of tension and/or directional force may be transferred to the grasper based on passing through the anchor. Thus, in an exemplary implementation, the position of the grasper relative to the anchor may be adjusted remotely by manipulating the suture, for example, by introducing an additional length of suture into the abdominal cavity or withdrawing a length of suture from the abdominal cavity.

Therefore, the disclosed tissue retractor assembly includes anchors that provide a stable attachment to the desired substrate (e.g., peritoneal structures associated with the abdominal wall, which cannot use non-piercing anchors). Additionally, the disclosed tissue retractor assemblies may be used to transmit force to a grasper located within the abdominal cavity, for example, by manipulating a length of suture or fiber extending from the abdominal cavity, thereby enabling a surgeon/user to tighten and/or reposition the grasper relative to a generally fixed point defined by the anchor. In an exemplary implementation, sutures/fibers are passed through the incision to enable and/or support a minimally invasive surgical procedure. The assembly thus disclosed enables the introduction and manipulation of advantageous graspers through minimally invasive access points (e.g., 5mm incisions).

According to further embodiments of the present disclosure, the first and second legs/jaws of the grasper are constructed of stainless steel or other material that provides the necessary strength/resilience. The leg/nip is generally formed in an initial shape. At least one of the first and second legs/jaws of the grasper may further include serrations at its distal end to better grasp and/or capture tissue. Additionally, at least one of the first and second legs/jaws may further define an angled or arched portion that enables the grasper to be spread wide enough to assist in grasping organs, tissues, and/or other desired anatomical elements. The locking mechanism associated with the grasper may be defined by a ring, or more preferably, an elongated and/or short tubular member configured and dimensioned to be pushed or otherwise advanced distally relative to the grasper to pass over/around the proximal ends of the first and second legs/jaws to cause the first and second legs/jaws to clamp tissue, organs, or other anatomical structures, e.g., a camming action triggered by a distal pusher ring/tubular member.

According to further embodiments of the present disclosure, one or both of the first and second legs/jaws of the grasper may include rubber or other coating (in whole or in part) applied to its distal end to better grasp and/or capture tissue in an atraumatic manner.

In accordance with further embodiments of the present disclosure, the disclosed exemplary tissue retractor assemblies are adapted to (i) deploy anchors having retractable tips and retractable barbs to the abdominal wall or other anatomical structure, (ii) deploy a wire member to grasp tissue or other structure to be retracted or manipulated, and (iii) help manage sutures attached to or otherwise secured to the wire member and passed through the anchors, which allows the organ/structure to be retracted or manipulated by suture pulling. In particular, an exemplary tissue retractor assembly includes a cannula configured and dimensioned to encase or otherwise removably secure an anchor, a wire member, and optionally a grasper. The anchor is configured and dimensioned to be deployed by the cannula and attached to the abdominal wall adjacent to the organ or other desired structure.

The anchor may be defined by an outer tube and a central shaft, and may further include at least two barbs configured and dimensioned to be deployed when the central shaft is pulled axially. The wire element may be defined by a coil spring configured and dimensioned to be deployed out of the distal end of the cannula and extend distally such that the wire element may be secured and adjusted relative to the anchor by a length of suture or fiber. According to a further embodiment of the present disclosure, the wire element further comprises surface roughness or barbs along the inner surface of the wire element to enhance the grip of the organ. A grasper configured and dimensioned to extend out of the distal end of the cannula and through the wire member may be provided, such grasper being effective to grasp tissue and retract it into the wire member.

Therefore, when using known medical techniques and existing laparoscopic techniques, the disclosed tissue retractor assembly advantageously provides an anchor that can be used to transmit forces transmitted from locations outside the abdominal cavity. This force may be transmitted by manipulating a length of suture or fiber relative to the anchor, allowing the surgeon/user to pull or otherwise manipulate the grasper located within the abdominal cavity through the suture. Indeed, in accordance with the present disclosure, the surgeon may maneuver the grasper relative to anchor points established on the peritoneal wall or other locations within the abdominal cavity.

In accordance with embodiments of the present disclosure, the disclosed example tissue retractor assemblies may function to deploy sutures around organs or other anatomical structures, e.g., in a circular fashion. The tissue retractor assembly may be further adapted to (i) deliver anchors having angled tips to the abdominal wall, and (ii) manage sutures attached to the looped suture and passed through the anchors, which allows the organ/structure to be retracted by pulling of the suture, e.g., through an incision through the abdominal wall. In particular, an exemplary tissue retractor assembly includes a cannula housing an anchor and a grasper. The grasper is defined by a suture loop configured and dimensioned to be released/advanced distally by the cannula, and a one-way catch configured and dimensioned for grasping and retracting and tightening around the organ/structure.

According to further embodiments of the present disclosure, the loop structure may include small notches or barbs to increase the friction of the suture loop with the organ, thereby reducing the likelihood of slippage therebetween. The one-way catch may be defined by a molded plastic part that allows the suture loop to be pulled in one direction, but prevents loosening of the suture loop. Additionally, the anchor may be defined by a generally symmetrical structure.

The anchor is defined by the rear crossover, the torsion spring, and an axial connection between the rear crossover and the torsion spring. The anchor may further include two prongs configured and dimensioned for deployment by the distal end of the cannula. The grasper may be adjusted and/or manipulated relative to the anchor by a length of suture passed through the anchor. Therefore, when using known medical techniques and existing laparoscopic techniques, the disclosed tissue retractor assembly provides spring clip anchors that allow penetration of abdominal tissue with a reduced probability of medical injury, and that can be used to transmit forces from a location outside the abdominal cavity. A length of suture or fiber may be used to enable pulling of the tissue grasper, such suture/fiber passing through the anchor point and ultimately through the abdominal wall, e.g., through an incision. The disclosed delivery system may advantageously facilitate introduction through a 5mm incision and allow interaction of the grasper and anchor to achieve the medical results described herein. Generally, the disclosed system assists and manages and routes the suture from the delivery incision and allows/assists removal of the clip from the abdominal wall.

In accordance with embodiments of the present disclosure, exemplary tissue retractor assemblies are disclosed that sequentially emit deployed 5mm Raney clips. The Raney clip may be adapted to exit the end of the cannula and thereby project axially, as opposed to the conventional transverse approach. A Raney clip may be atraumatically applied to an organ or structure according to the present disclosure, and a second clip may be applied as a function of an anchor on the abdominal wall. The suture may be attached to the grasper and passed through a second clip/anchor, which allows the organ/tissue to be retracted by the pulling of the suture, e.g., by an external location based on the suture passing through the abdominal wall, e.g., through an incision.

In particular, in an exemplary embodiment, the tissue retractor assembly can include a cannula housing a first grasper and a second grasper. The first grasper is defined by a first clip configured and dimensioned to be axially deployable by the distal end of the cannula and to be defined by the C-shaped piece after deployment by the cannula 501. The second grasper may be defined by a second clip configured and dimensioned to be axially deployable by the distal end of the cannula and to be defined by the C-shaped piece upon deployment by the cannula. The first grasper is advantageously adapted to be secured and adjusted relative to the second grasper by a length of suture.

According to further embodiments of the present disclosure, the first clip and the second clip may be metal, plastic, or a combination of metal and plastic. The first and second clips are further defined by teeth located at the open ends or inner surfaces of the first and second clips to assist in grasping tissue. The first and second clips may further include a rubber coating to help atraumatically grasp tissue.

Therefore, the disclosed tissue retractor assembly provides attachment to the organ and anchor using the same kind of clamping and deployment technique. The tissue retractor assembly thus disclosed allows deployment of multiple clips when advantageous to the procedure, the anchor may be used to transmit force, a length of suture or fiber used to enable traction of the organ through the anchor point by the grasper, and a delivery system used to enable introduction through a 5mm incision. The disclosed system allows both the grasper and the anchor to be attached/secured within the abdominal cavity and allows the surgeon/user to manage/operate the grasper through interaction with a suture passing through the abdominal wall (e.g., through a delivery incision). In addition, the disclosed tissue retractor assembly allows the clip/anchor to be removed from the abdominal wall when needed.

Additionally, anchor retrieval tools are also contemplated as part of the tissue retractor assemblies of the present invention. The positioning ring protrudes from the end of the tool and functions to enable easy positioning of the anchor in the body. The positioning ring is looped around a suture attached to the anchor, and the retrieval tool is guided directly to the anchor along the suture. The central shaft is disposed in the body of the retrieval tool, and the distal end of the central shaft includes a ramp portion that terminates in a shoulder or flange. The shoulder preferably interacts with at least one (preferably more than one) flexible stop tab that cuts into and angles inward toward the body of the anchor. When the distal end of the central shaft enters the interior of the anchor, the stop tabs catch under the shoulder or flange, thereby preventing the anchor from disengaging from the distal end of the shaft.

According to the present invention, there is provided an intracorporeal surgical tissue retractor having a) an anchor selectively deployable to a first tissue to be unretracted; b) a grasper selectively deployable to a second tissue to be retracted; c) a selectively longitudinally movable support attachable to the grasper through the anchor and at a substantially distal end of the movable support; and d) a deployment user interface coupleable to the movable support and having a proximal end operable by a user from outside the body and a distal end releasably connected to the anchor and the grasper, adapted to deploy the anchor to the first tissue and the grasper to the second tissue inside the body. The second tissue is selectively retracted when the grasper is deployed to the second tissue and the movable support is selectively moved proximally. The more the movable support is selectively moved proximally, the more the second tissue is retracted, thereby enabling dynamic retraction of the second tissue.

In one embodiment, the anchor preferably comprises a plurality of distally projecting legs and a generally proximally disposed body. Preferably, the legs of the anchor are bent outwardly and are constructed of a resilient material. The user interface further includes an outer cannula or tube and an anchor positioning tool attached to the distal end of the user interface and relatively retractable into the distal end of the outer cannula. As the anchor positioning tool is relatively retracted into the outer cannula, the outer cannula forces the legs of the anchor releasably secured to the anchor positioning tool into a substantially straightened configuration. When the legs are in a generally straightened configuration, the anchor can be deployed into tissue that will not be retracted.

Preferably, the anchor positioning tool is attachable to the distal end of the user interface and releasably attachable to the body of the anchor. One of the body of the anchor and the anchor positioning tool includes a flange and the other of the body of the anchor and the anchor positioning tool includes a plurality of arms releasably secured to the flange. The user interface includes an outer cannula and a middle cannula, the middle cannula being disposed within the outer cannula, the anchor positioning tool being attached to a distal end of the middle cannula. In such an embodiment, the arms are preferably disposed on the anchor positioning tool and are biased radially outwardly by the middle cannula, wherein the arms are forced radially inwardly by the outer cannula when the middle cannula is relatively withdrawn from the outer cannula.

The legs of the anchor are preferably outwardly curved and are constructed of a resilient shape memory material wherein the outer cannula urges the legs of the anchor into a generally straightened configuration as the middle cannula is relatively withdrawn into the outer cannula. The proximal end of the user interface preferably includes a first actuator coupled to the middle cannula, actuating the first actuator in a first motion causing the middle cannula to move in a distal direction to deploy the anchor to the first tissue. Preferably, actuating the first actuator in a second motion moves the middle cannula in a proximal direction to retract the anchor from the first tissue.

In one embodiment, the body of the anchor preferably includes a shoulder region that is releasably attachable to an anchor positioning tool that is attached to the distal end of the user interface. The shoulder region includes a slot and the anchor positioning tool includes a plurality of arms releasably securable in the slot. As described above, the user interface includes an outer cannula and a middle cannula, the middle cannula being disposed within the outer cannula, the anchor positioning tool being attached to the distal end of the middle cannula. The arms of the anchor positioning tool are biased radially outwardly by the middle cannula and are forced radially inwardly by the outer cannula to engage the slots of the anchor when the middle cannula is relatively withdrawn from the outer cannula. The body of the anchor preferably further comprises at least one notch formed at the distal end of the body, the notch being adapted to receive the movable support when the anchor is deployed to the first tissue.

The resilient material of the anchor preferably has different curvatures at different temperatures, wherein the material has a lower curvature at body temperature than at room temperature.

In one embodiment, the grasper includes a pair of arms forming a pair of jaws at respective distal ends of the arms, the jaws being adapted to be securely attached to the second tissue; and a biasing mechanism attached to the arm biasing the jaws toward the closed position. Preferably, the grasper further comprises a pair of corresponding holes, one formed on each arm, through which the movable support is arrangeable. As the movable support is selectively moved proximally, additional force is applied to the jaws by the movable support passing through the apertures in the grasper arm, further creating a tendency for the jaws to close to a closed position.

In one embodiment, as described above, the user interface includes an outer tube or cannula, and the grasper is relatively retractable at least partially inside and outside the outer cannula; when at least one of the outer cannula and the grasper is moved relative to the other of the outer cannula and the grasper to cause the grasper to be at least partially retracted into the outer cannula, the distal end of the outer cannula bears against the proximal ends of the arms of the grasper and forces the jaws open against the biasing mechanism. Preferably, the user interface comprises a longitudinally movable outer cannula and a substantially stationary grasper support disposed within the outer cannula and attached to the grasper, the grasper being at least partially retractable into and out of the outer cannula. When the outer cannula is moved relative to the grasper to cause the grasper to be at least partially retracted into the outer cannula, the distal end of the outer cannula bears against the proximal ends of the arms of the grasper and forces the jaws open against the biasing mechanism.

In another embodiment, the user interface includes an outer cannula having a distal rim, and the grasper has a proximal end at least partially abuttable against the distal rim of the outer cannula. When at least one of the outer cannula and the grasper is moved relative to the other of the outer cannula and the grasper, the distal edge of the outer cannula bears against the proximal end of the grasper and forces the jaws open against the biasing mechanism. In this embodiment, preferably the user interface comprises an elongated, movable outer cannula having a distal edge and a grasper support disposed within the outer cannula and attached to the grasper. In each case, the proximal end of the grasper preferably includes an outer diameter portion that bears against the distal edge of the outer cannula; movement of the grasper relative to the outer cannula forces the jaws open due to abutment of the distal edge against the outer diameter portion.

In one embodiment, according to the present invention, the user interface includes a first actuator disposed at a proximal end of the user interface and mechanically coupled to the anchor positioning tool such that the anchor positioning tool is selectively longitudinally movable and such that the anchor is deployable to the first tissue. The user interface preferably further includes a second actuator disposed at a proximal end of the user interface and mechanically coupled to one of the outer cannula or the grasper such that the grasper is selectively movable longitudinally relative to the outer cannula to selectively open and close the jaws of the grasper. Preferably, the second actuator is disposed at a proximal end of the user interface and is mechanically coupled to the outer cannula such that the outer cannula is selectively longitudinally movable relative to the grasper to selectively open and close the jaws of the grasper. The user interface preferably further comprises a third actuator disposed at a proximal end of the user interface and mechanically coupled to the grasper support such that the grasper support can be selectively moved longitudinally to free the grasper from movement relative to the user interface and to deploy the grasper to the second tissue. The biasing mechanism of the grasper preferably includes a coil spring disposed at a proximal end of the grasper, and the grasper support preferably includes a hook formed at a distal end of the grasper support, the hook being hookable through the coil spring. The hook is preferably sized to fit within the body of the anchor to assist in retrieval of the deployed anchor. The user interface preferably further comprises a substantially immovable grip for providing a counter force to the movement of the first and/or second actuator.

Optionally, the invention includes an anchor retrieval tool having a body and a central shaft disposed within the body, the central shaft having a proximal end and a distal end, the distal end of the central shaft including a ramp portion, the ramp portion terminating in a shoulder-like feature, the shoulder-like feature matingly engageable with at least one flexible stop tab cut into the body of the anchor and angled inwardly toward the body of the anchor. When the distal end of the central shaft enters the interior of the body of the anchor, the tabs snap under the shoulder-like features of the central shaft, thereby preventing the anchor from disengaging from the distal end of the central shaft and thereby assisting in the retrieval of the anchor from the first tissue. The anchor retrieval tool may further comprise a positioning ring extending from the distal end of the body of the tool, the positioning ring being capable of being looped around the movable support through which the movable support passes such that the anchor retrieval tool may be guided directly to the anchor along the movable support. The positioning ring is preferably coupled to a ring tightener adapted to selectively tighten the positioning ring around the movable support.

Preferably, the movable support described above comprises a suture comprising a proximal end, the proximal end of the suture being wound on and optionally off an ingot disposed at the proximal end of the deployment user interface. The suture is preferably threaded through the user interface to the distal end of the user interface. The user interface preferably includes a wire positioning loop selectively extendable from a distal end of the user interface and mechanically coupled to a fourth actuator disposed at a proximal end of the user interface and adapted to capture and retract the movable support into the user interface to enable positioning of the deployed anchor and grasper.

Additional features, functions and benefits of the disclosed tissue retractor assembly will be apparent from the detailed description set forth below, particularly when read in conjunction with the figures.

Drawings

Fig. 1 is a perspective view of an exemplary tissue retractor cannula housing a grasper and an anchor.

Figures 2A-C are perspective views of an exemplary tissue retractor in a working stage of grasping a tissue or organ.

Fig. 3 is a perspective view of an exemplary grasper in an open position.

Fig. 4 is a side view of the exemplary grasper in an open position.

Fig. 5 is a side view of an exemplary grasper in an initial closed position.

Fig. 6 is a side view of an exemplary grasper in a final closed position.

Fig. 7 is a perspective view of an exemplary anchor in a released position.

Fig. 8 is a perspective view of an exemplary anchor in a released position having a different configuration.

Fig. 9 is a perspective view of an exemplary grasper and anchor in operation.

Fig. 10 is a perspective view of an exemplary tissue retractor cannula housing an anchor, a wire member, and a grasper.

Figures 11A-C are perspective views of an exemplary tissue retractor in a working stage of anchor deployment.

Figures 12A-E are perspective views of an exemplary tissue retractor in a working stage of deploying a wire element.

Fig. 13 is a perspective view of an exemplary anchor and wire element in operation.

Fig. 14 is a perspective view of an exemplary tissue retractor cannula housing an anchor and grasper.

Fig. 15 is a partial cross-sectional view of an exemplary tissue retractor cannula housing an anchor and grasper.

Figures 16A-D are perspective views of an exemplary tissue retractor in a working stage for grasping an organ or tissue.

Figures 17A-D are perspective views of an exemplary tissue retractor in a working stage of anchor deployment.

Fig. 18 is a perspective view of an exemplary anchor and grasper in operation.

Fig. 19 is a partial cross-sectional view of an exemplary tissue retractor cannula housing a first grasper and a second grasper.

Figures 20A-E are perspective views of an exemplary tissue retractor in an operational stage of deploying a first grasper and a second grasper.

Fig. 21 is a perspective view of an exemplary first and second graspers in operation.

Fig. 22 is a perspective view of an exemplary anchor retrieval tool according to the present invention.

Fig. 23 is a perspective view of the distal end of the exemplary anchor retrieval tool of fig. 22.

Fig. 24A is a broken perspective view of the distal end of the exemplary anchor retrieval tool of fig. 22-23 associated with an exemplary anchor according to the present disclosure.

Fig. 24B is a partial cross-sectional view of the proximal end of the example anchor retrieval tool of fig. 22-23.

Fig. 25A is a perspective view of the distal end of the example anchor retrieval tool of fig. 22-24 secured to the example anchor of fig. 24A.

Fig. 25B is a cross-sectional view of the distal end of the exemplary anchor retrieval tool according to the present invention of fig. 22-24 secured to the exemplary anchor of fig. 24A.

Fig. 26A-B are cross-sectional views of the distal end of the exemplary anchor retrieval tool of fig. 22-25 with the anchor removed from tissue (not shown).

Fig. 26C is a cross-sectional view of the proximal end of the example anchor retrieval tool of fig. 22-25 illustrating removal of the anchor.

Figure 27A is a perspective view of a tissue retractor assembly according to the present invention.

Fig. 27B is a perspective view of the tissue retractor assembly of fig. 27A with a cover of the user interface removed for clarity.

Figures 28A-B are perspective views of a tissue retractor grasper according to the present invention.

Figures 28C-D are perspective views of the tissue retractor grasper of figures 28A-B interacting with a cannula according to the present invention.

Fig. 29A-B are perspective views of anchors for retraction of tissue in vivo according to the present invention.

Fig. 30A is a perspective view of a proximal end of a user interface of the tissue retractor assembly of fig. 27A with a cover of the user interface removed for clarity.

Fig. 30B is a perspective end view of the distal end of the user interface of the tissue retractor assembly of fig. 27A-B with the grasper and anchor removed for clarity.

Fig. 30C is a side cross-sectional view of the distal end of the user interface of the tissue retractor assembly of fig. 27A-B with the grasper removed for clarity.

Fig. 31 is a perspective view of an anchor clamping sleeve according to the present invention.

Fig. 32A-C are rear perspective views of the hook actuating assembly of the tissue retractor assembly of fig. 27A-B with one of the sliding handles removed for clarity.

Figures 33A-G are a series of perspective views of the distal end of the tissue retractor assembly of figures 27A-B in operation.

Detailed Description

In accordance with embodiments of the present disclosure, the disclosed tissue retractor assemblies generally relate to tissue retractors for use in single-incision or low-incision laparoscopic or similar procedures. In particular, the tissue retractor assembly is a laparoscopic surgical assist device capable of facilitating in vivo retraction of a variety of organs or tissues. Generally, the tissue retractor assembly is in the form of a multi-component device configured and dimensioned to be delivered through the abdominal wall, for example, through a laparoscopic incision or similar port (e.g., 5 mm), and to provide an atraumatic device that grasps and holds organs or other anatomical tissue/structures (e.g., gallbladder). In general, the dimensional characteristics of the disclosed tissue retractor assembly/system are adapted for use through a 5mm cannula, which is typically found in the use and operation of laparoscopic surgical tools.

This will be described with reference to fig. 1-33. It is to be understood that these drawings are merely exemplary in nature and are in no way intended to limit the scope of the invention. The scope of the invention is defined by the appended claims.

Referring to fig. 1, an exemplary embodiment of a tissue retractor assembly according to the present disclosure is shown in the form of a tissue retractor assembly 100. Tissue retractor assembly 100 includes a tube or cannula 101, tube or cannula 101 housing a grasper 102 and an anchor 103. The grasper 102 is configured and dimensioned to be axially extended from the distal end of the cannula 101 and includes a first leg 102a and a second leg 102b for grasping tissue. The first leg 102a and the second leg 102b may be constructed of flat metal or plastic plates. Further, the first and second legs 102a and 102b may optionally be rubber coated, having surface features or shapes that facilitate grasping of the organ without damaging the organ. The grasper 102 further includes a locking ring 104, the locking ring 104 being configured and dimensioned to be pushed distally through an inner cannula (not shown), grasping and locking the first and second legs 102a, 102b about the organ or tissue. The locking ring 104 may be constructed of a short tube or ring-shaped member.

Tissue retractor assembly 100 further includes an anchor 103, anchor 103 being configured and dimensioned to be deployed by cannula 101 and attached to the abdominal wall in front of the organ. The anchor 103 is further defined by a cylinder 105, the cylinder 105 being attached to at least two pointed thin legs 106a and 106b, respectively, the thin legs 106a and 106b lying along an axis 115 of the cylinder 103. The at least two pointed thin legs 106a and 106b are preformed into a preformed shape such that when the anchor 103 is deployed through the cannula 101, the at least two pointed thin legs 106a and 106b return to the preformed shape to increase the pullout force of the anchor 103.

Referring to fig. 2A-C, tissue retractor assembly 100 is shown in progressive steps of grasping an organ or tissue 107 after tissue retractor assembly 100 has been introduced into an incision (not shown). With particular reference to fig. 2A, the tissue retractor assembly 100 is shown with the grasper 102, the grasper 102 having been loaded into the cannula 101 for introduction into the incision, and the first and second legs 102A, 102b having been extended out of the distal end of the cannula 101. Once in the incision and on the organ 107 to be grasped, the grasper 102 is pushed out of the distal end of the cannula 101 by a hook (not shown) attached to the proximal end of the grasper 102. Generally, the clinician has a multi-purpose 5mm grasper at the surgical site during the procedure of treating the tissue of the organ in question. As shown in fig. 2A, the first and second legs 102A, 102b of the grasper 102 have been extended out of the distal end of the cannula 101 and are used to encircle the organ 107 to be grasped.

Referring to fig. 2B, the grasper 102 has been placed in a position sufficiently surrounding the organ 107 to be grasped, and the locking ring 104 is used to lock the grasper 102 in position surrounding the organ 107. In particular, the locking ring 104 is pushed distally through an inner cannula (not shown) while the inner hook holds the grasper 102 in place. In this way, locking mechanism 104 clamps first leg 102a and second leg 102b in position around organ 107.

Referring to fig. 2C, once the grasper 102 is locked, the cannula 101 is retracted and lifted to release the hook, wherein the hook is pushed distally, allowing the grasper 102 to be deployed from the cannula 101. As shown in fig. 2C, tissue retractor assembly 100 further includes a suture (stitch) 108, suture 108 securing and allowing adjustment of grasper 102 relative to anchor 103. In particular, a suture 108 is attached to the top ends of the first and second legs 102a and 102b, respectively, and the cannula 101 pulls the suture from the distal end.

Turning now to fig. 3-6, another embodiment of the present invention is shown as grasper 110 and provides a sufficiently wide opening for grasping an organ or tissue. Referring to fig. 3, the grasper 110 is shown in an "expanded" position and includes first and second legs 112a, 112b and a sleeve 111. The first and second legs 112a and 112b may be constructed of stainless steel wire and formed. Distal ends 113a and 113b are preferably both formed into a loop, thus providing a more spread out and therefore more stable area for grasping tissue or organs. Additionally, at least one of the first and second legs 112a and 112b may have a surface feature, i.e., serrations, located at the distal end 113a of the first leg or the distal end 113b of the second leg. Additionally, the first leg 112a may additionally include an angled region 114, the region 114 being located between the distal end 113a of the first leg and the distal end of the lock sleeve 111. In particular, the angled region 114 includes an angled bend upward and downward relative to the surface of the first leg 112a, wherein the angled bend may be about 45 ° so as to allow for a sufficiently large opening for the grasper. With further reference to FIG. 3, in lieu of the locking collar described above with reference to FIG. 2, FIG. 3 shows a locking sleeve 111, preferably configured as an elongated tube, to provide a stronger locking force, to slide more easily without cocking relative to the sliding axis, and to provide better ergonomics for a proximally located user.

Referring to fig. 4, another side view of the preferred grasper 110 in the "expanded" position is shown for providing a clearer view of the angled region 114. The second leg 112b may be formed in a straight manner or may include a curve to provide a stronger or more stable grasp on the organ or tissue when the first and second legs 112a, 112b are secured.

Referring to fig. 5, the grasper 110 is shown in a "closed" position. The first leg 112a and the second leg 112b are cinched as the lock sleeve 111 is pushed distally through the cannula 101 in the direction of the distal ends of the first and second legs (113 a and 113b, respectively).

Referring to fig. 6, the grasper 110 is shown in a "closed" position, in which the lock sleeve 111 has been pushed distally through the cannula 101 to the furthest possible point. As will be appreciated by those skilled in the art, as the sleeve 111 is pushed proximate the distal ends 113a and 113b of the first and second legs, respectively, the first leg 112a and the second leg 112b may be pushed together with increasing force, thereby providing the clinician with a range of forces that may be applied by the grasper 110 to adequately grasp an organ or tissue.

Turning now to fig. 7, an exemplary embodiment of an anchor 103 is shown. Tissue retractor assembly 100 is used to deploy anchors 103 to the abdominal wall. The anchor 103 may be comprised of a preformed shape memory nitinol nail (staple) that may be formed from a single wire or cut from tubing. The basic structure of the anchor 103 is a cylinder 105, the cylinder 105 being attached to at least two pointed thin legs 106a and 106b, the thin legs 106a and 106b lying along the axis 115 of the cylinder 105. At least two pointed thin legs 106a and 106b are pointed to allow penetration of tissue. The preformed nature of the at least two prong thin legs 106a and 106b allows the at least two prong thin legs 106a and 106b to return to their preformed shape to increase the anchor pull out force. As shown in fig. 1, the anchor 103 is initially loaded onto a "D" shaped or specially shaped cannula 101, the cannula 101 helping to restrain the thin legs 106a and 106b of the at least two prongs and allowing the anchor 103 to be deployed by a single tube through a tube pushing mechanism. Referring to fig. 7, anchor 103 is shown in a "release" position, in which at least two pointed thin legs 106a and 106b are preformed to fold toward axis 115 and the center of cylinder 106.

Referring to fig. 8, another embodiment of an anchor 203 of the present invention is shown. Unlike anchor 103 in fig. 7, anchor 203 in fig. 8 includes at least two (preferably four) pointed thin legs 206a, 206b, 206c and 206d, pointed thin legs 206a, 206b, 206c and 206d being preformed to curve outwardly from axis 208 and the center of cylinder 205. As shown in fig. 7, the anchor 203 of fig. 8 also has a cylinder 205 as a basic structure of the anchor 203, and the cylinder 205 is attached to or integrally formed with the at least two pointed thin legs 206a, 206b, 206c and 206 d. The anchor 203 may also include a slot or notch 207 on the cylinder 205, the slot or notch 207 serving the purpose of guiding the suture 108, as will be further explained in connection with fig. 9.

Referring to fig. 9, the anchor 103 or 203 is attached by positioning the distal end of the cannula 101 over the abdominal wall 109, the clinician's hand is typically palpated outside the abdominal wall 109, and the cannula 101 pushes the anchor 103 or 203 axially away from the cannula 101 while the anchor 103 or 203 penetrates the tissue 109. As the anchor 103 or 203 is released from the cannula 101, the at least two pointed thin legs 106a, 106b or 206a, 206b, 206c and 206d bend inward or outward from the center of the cylinder 105 or 205 and thereby provide sufficient pullout force while protecting the clinician from injury.

Fig. 9 further illustrates the exemplary grasper 102 and anchor 103 in operation. In particular, the grasper 102 grips the organ 107 and is locked in place by the locking mechanism 104. In addition, the anchor 103 is released from the cannula 101 and the preformed at least two pointed thin legs 106a and 106b return to the preformed shape to provide sufficient extraction force. It should be noted that grasper 102 is movably secured to anchor 103 by suture 108. The cannula 101 pulls the suture 108 back out of the incision, the suture 108 keeping all parts tethered and allowing the clinician to retract the organ 107 by increasing the tension on the suture 108. The suture 108 may be secured outside the incision using a clamp or other suitable tool. After the procedure is complete, the grasper 102 will be removed from the organ 107 (during a cholecystectomy or other resection procedure). The anchor 103 may be removed by grasping with a 5mm grasper (not shown) and pulling along the axis of the anchor 103 to remove it from the abdominal wall. The components of tissue retractor assembly 100 are removable through an abdominal incision created by the introduction port. The operation of the preferred grasper 110 of fig. 3-6 is generally similar to that described above in connection with fig. 9.

Referring now to fig. 10, an alternative tissue retractor assembly 300 according to the present disclosure is shown. In the embodiment shown in fig. 10, tissue retractor assembly 300 includes a cannula 301 housing an anchor 302, a wire 303, and a grasper 304. The anchor 302 is configured and dimensioned to be deployed by the cannula 301 and attached to the abdominal wall in front of the organ. Anchor 302 includes an outer tube 314 and a central shaft 309, central shaft 309 further including at least two barbs 308a and 308B, shown in fig. 11B, barbs 308a and 308B configured to be deployed from outer tube 314 when central shaft 309 is pulled axially. In addition, anchor 302 includes a retractable tip 306, and when central shaft 309 is pulled axially to deploy at least two barbs 308a and 308b, tip 306 retracts into outer tube 314. The wire (wire) 303 may be configured as a coil spring configured and dimensioned to be deployed out of the distal end of the cannula 301 and extend axially. Further, the wire member 303 is secured and adjusted relative to the anchor 302 by a length of suture 311. Finally, grasper 304 is configured and dimensioned to extend beyond the distal end of cannula 301 and to be passed through wire 303, grasp tissue 313 (as shown in fig. 13) and retract into the distal end of cannula 301 to draw tissue 313 into wire 303. The grasper 304 may be a pediatric grasper with a specialized jaw (jaw) 305.

Still referring to fig. 10, tissue retractor assembly 300 is based on a 5mm cannula 301, 5mm cannula 301 being commonly used in the design of laparoscopic surgical tools. Cannula 301 includes an anchor 302 and a wire 303 for grasping an organ or tissue 313. The components of the cannula 301 are arranged coaxially with the anchor 302 with a fully functional 3mm grasper 304 in the centre, the grasper 304 being adjacent to the anchor 302. With the cannula wall 316 spaced apart, the wire member 303 is compressed into the annular member 316, the annular member 316 being surrounded by the outer cannula wall 317.

The anchor 302 is constructed in two pieces, an outer tube 314 forming the body of the anchor 302, and a central shaft 309 located inside the outer tube 314, the central shaft 309 including a retractable tip 306 and at least two barbs 308a and 308b integrated, the at least two barbs 308a and 308b being deployable by pulling on the central shaft 309 of the anchor 302 adjacent the retractable tip 306. The anchor 302 may be constructed of metal or plastic.

Referring to fig. 11A-C, the tissue retractor assembly 300 is shown in progressive steps securing the anchor 302 to the abdominal wall 312 after the tissue retractor assembly 300 is introduced into a sil incision (not shown). First, the distal end of the cannula 301 is placed on the abdominal wall 312. The clinician's hands are typically palpated outside the abdominal wall 312. A specially designed 3mm grasper 304, typically used in pediatric laparoscopic procedures, is used to push the anchor 302 axially distally to penetrate the tissue 312. As shown in fig. 11A and 11B, the 3mm grasper 304 is then retracted to retract the tip 306 and deploy at least two barbs 308a and 308B. In particular, at least two barbs 308a and 308b are deployed through openings 307a and 307b, the openings 307a and 307b being located on the outer tube 314 of the anchor 302. The at least two barbs 308a and 308b significantly increase the retention of the anchor 302 on the abdominal wall 312. As shown in fig. 11C, the anchor 302 further has a suture 311, the suture 311 being attached to the proximal end and the cannula 301 pulling the suture 311 from the distal end. Wire 311 may be attached to the proximal end of central shaft 309 of anchor 302 by a ring 310 or similarly shaped member.

Referring to fig. 12A-E, tissue retractor assembly 300 is shown in progressive steps grasping organ 313 after tissue retractor assembly 300 is introduced into the incision and anchor 302 is secured to abdominal wall 312. Typically, in this procedure, the clinician has a multi-purpose 5mm grasper (not shown) at the surgical site. In grasping the organ, a 5mm grasper is responsible for the tissue of the organ in question. The wire 303 is essentially a specially designed coil spring that may have features such as surface roughness or barbs along the inner wire surface to enhance gripping of the organ 313. As shown in fig. 12A, wire 303 is pushed out of the distal end of cannula 301 and radially expanded to achieve a large diameter profile that can contain more tissue of organ 313. The 3mm grasper 304 is then extended out of the distal end of the cannula 301 to reach through the wire 303, grasp the organ 313 and is retracted back to the distal end of the cannula 301 to pull the tissue of the organ 313 into the wire 303, which will grasp the organ 313 due to the forces generated between the wire 303 and the surface of the organ 313. Referring to fig. 12E, once wire 303 is secured around organ 313, wire 303 is secured and can be adjusted relative to anchor 203 by the length of suture 311. In particular, as shown in fig. 11C, the length of suture 311 is attached to the wire 303, extends to the loop 310 of the anchor 302, and is attached to the cannula 301.

Referring to fig. 13, an exemplary wire 303 and anchor 302 are shown in operation. Once the wire 303 and anchor 302 are attached to the organ 313 and abdominal wall 312, respectively, the cannula 301 is withdrawn from the aperture pulling a length of suture 311, which keeps all components in a chain and allows the clinician to retract the organ 313 by increasing the tension on the length of suture 311. A length of suture 311 may be secured outside the aperture using a clamp or other suitable tool (not shown). After the procedure is over, grasper 303 will be removed (in a cholecystectomy) along with organ 313. Removal of the anchor 302 would require re-introduction of the cannula 301, the cannula 301 including the 3mm grasper 304. A 5mm grasper may be used to grasp the outer tube 314 of the anchor 302, while a 3mm grasper 304 is used to attach to the central shaft 309 of the anchor 302 and push distally to retract the at least two barbs 308a and 308b to allow the anchor 302 to be removed from the abdominal wall 312. The anchor 302 may be withdrawn into the cannula 302, or removed through a 5mm incision, respectively. Since the components are chained together by a length of suture 311, the components of cannula 301 can also be removed through the abdominal incision created when the port is introduced.

Turning now to fig. 14 and 15, an alternative tissue retractor assembly 400 according to the present disclosure is shown. Fig. 15 provides a partial view of an alternative tissue retractor assembly 400 to more conveniently show the internal components of the tissue retractor assembly 400. In the embodiment shown in fig. 14 and 15, tissue retractor assembly 400 includes a cannula 401, cannula 401 housing an anchor 405 and a grasper 403. Grasper 403 is comprised of a suture loop 403a having a one-way catch (toggle) 402, the one-way catch 402 being configured and dimensioned to be released distally by cannula 401. In particular, suture loop 403a is configured and dimensioned for grasping tissue of organ 406, retracting to the distal end of cannula 401, and tightening around the tissue of organ 406. The anchor 405 includes a rear crossover (back span) 412, a torsion spring 409, and an axial connection between the rear crossover 412 and the torsion spring 409. The anchor 405 further includes two prongs 405a and 405b, the prongs 405a and 405b configured and dimensioned for distal deployment from the cannula 401. The grasper 403 is fixed and adjustable relative to the anchor 405 by a length of suture 411.

With further reference to fig. 14 and 15, the tissue retractor assembly 400 is based on a 5mm cannula 401, the 5mm cannula 401 typically being used in the design of laparoscopic surgical tools. Cannula 401 includes grasper 403 and anchor 405 for attachment to organ 406, and a system for deploying grasper 403 and anchor 405. The components of cannula 401 are arranged along the axis of cannula 401 with grasper 403 and anchor 405, with grasper 403 below anchor 405, grasper 403 may be comprised of a spring clip. The cannula 401 may also include a slot to allow deployment of the suture loop 403 a. Cannula 401 may further include features to aid in the delivery, use, and deployment of grasper 403 and anchor 405.

Referring to fig. 16A-D, tissue retractor assembly 400 is shown in progressive steps of grasping organ 406 after tissue retractor assembly 400 is introduced into an orifice (not shown). Grasper 403 is a suture-based organ grasper, including a suture loop 403a and a one-way catch 402. The one-way catch 402 may be constructed of a small molded plastic part that allows the suture loop 403a to be pulled in one direction, but prevents loosening of the suture loop 403 a. The suture loops 403a may also be ribbons or similar structures to increase friction or to more evenly distribute forces. Additionally, the suture loop 403a may have surface features on its diameter, such as small indentations or barbs, to increase the friction of the suture loop 403a with the organ 406 and reduce the likelihood of slippage. The suture loop 403a is held flat in the cannula 401 by the hook 404, the hook 404 being located in the suture loop 403a and maintaining tension in the suture loop 403a in the cannula 401.

Still referring to fig. 16A-D, to attach the suture loop 403a to the organ 406, the cannula 401 will be introduced through the aperture and placed in proximity to the attachment point. The suture loop 403a will be moved distally to create slack in the suture loop 403 a. Typically, in this procedure, the clinician has a multi-purpose 5mm grasper 413 at the surgical site. In grasping the organ 406, the 5mm grasper 413 is responsible for the tissue of the organ 406 in question. A5 mm grasper 513 could be used to pull tissue of organ 406 through suture loop 403 a. The delivery portion of the cannula 401 can pull the free end of the suture loop 403a through the one-way catch 402 to cinch the suture loop 403a around the tissue of the organ 406. The one-way latch 402 and grasper 403 assembly may be released from the cannula 401 by retracting the hook 404 and retracting the cannula 401. The free end of the suture loop, a length of suture 411, can be pulled out of the distal end of the cannula 401 while approaching the attachment point for attaching the anchor 405 to the abdominal wall 410.

Referring to fig. 17A-D, tissue retractor assembly 400 is shown in progressive steps of securing anchor 405 to abdominal wall 410 after tissue retractor assembly 400 is introduced into an aperture (not shown) and after grasper 403 is secured around organ 406. The anchor 405 may be constructed from a wire piece constructed from a single piece of wire. The wire is in the form of a substantially symmetrical structure including the rear crossover 412, torsion spring 409 and the axial connections between the elements. The anchor 405 has a structure similar to the normally closed spring used in typical structures of clothing pins. The anchor 405 further includes two prongs 405a and 405b, the prongs 405a and 405b not connected by a cross member and being pointed to assist in penetrating tissue. Anchor 405 is generally closed and is positioned in a tray 413 or similar structure in cannula 401 for deployment.

Still referring to fig. 17A-D, deployment of anchor 405 requires a device inside cannula 401 to push anchor 405 distally sufficiently so that a detachment (ripping) feature 407 on cannula 401 can wedge under both sharp legs 405a and 405b of anchor 405. The tray 413 is then withdrawn proximally, which causes the two prongs 405a and 405b of the anchor 405 to be positioned to penetrate the abdominal wall 410. In particular, cannula 401 includes a disengagement feature 407 and two slits 408a and 408b, the two slits 408a and 408b being sized and configured to allow the two prongs 405a and 405b of anchor 405 to be deployed from the distal end of cannula 401 through an internal retraction mechanism when anchor 405 is partially deployed from the distal end of cannula 401. Therefore, when the anchor 405 is normally closed in the tray 413, the two prongs 405a and 405b may be deployed by the cannula 401 through the two slits 408a and 408b to properly penetrate and attach to the abdominal wall 410.

With further reference to fig. 17A-D, the distal end of the cannula 401 is positioned adjacent the abdominal wall 410. The clinician's hands are typically palpated outside the abdominal wall 410. The clinician may push the leading cannula while pulling cannula 401 and anchor 405 proximally. This will cause the two sharp legs 405a and 405b of the anchor 405 to hook (snag) and penetrate the abdominal wall 410. The anchor 405 may then be released from the cannula 401 by retracting the cannula 401 and pushing the tray 413 distally. The closing action of the anchor 405 and the direction of tension applied through a length of suture 411 will increase the retention force of the anchor 405.

Referring to fig. 18, an exemplary anchor 405 and grasper 403 are shown in operation. The cannula 401 pulls a length of suture 411 back out of the aperture, the length of suture 411 keeping all components in a chain and allowing the clinician to retract the organ 406 by increasing the tension on the length of suture 411. A length of suture 411 may be secured outside the aperture using a clamp or other suitable tool. After the procedure is over, the grasper 403 will be removed (in a cholecystectomy) along with the organ 406. The grasper 413 shown in fig. 16C may be further used to grasp the rear crossover 412 of the anchor 405 and push in a direction opposite to the direction of entry, allowing the anchor 405 to be easily removed. The normally closed nature of the anchor 405 allows the two prongs 405a and 405b to safely enter the abdominal cavity. The anchor 405 and grasper 403 of the tissue retractor assembly 400 may also be removed through the abdominal incision created when the port is introduced, as both are chained by sutures.

Turning now to fig. 19, an alternative tissue retractor assembly 500 according to the present disclosure is shown. In the exemplary embodiment of fig. 19, tissue retractor assembly 500 includes a cannula 501, cannula 501 housing a first grasper 502 and a second grasper 503. The first grasper 502 may be comprised of a first clip configured and dimensioned to be axially deployable by the distal end of the cannula 501 and defined by a C-shaped piece upon deployment by the cannula 501. The second grasper 503 may be comprised of a second clip configured and dimensioned to be axially deployable by the distal end of the cannula 501, and also defined by the C-shaped piece after deployment by the cannula 501. The first grasper 502 is further secured and adjusted relative to the second grasper 503 by a length of suture 504, which suture 504 is advanced through the first and second graspers 502 and 503 and into the cannula 501.

The tissue retractor assembly 500 shown in fig. 19 is based on a 5mm cannula 501, the 5mm cannula 501 typically being used in the design of laparoscopic surgical tools. The cannula 501 deploys the first and second graspers 502 and 503 by sequentially pushing the first and second graspers 502 and 503 out of the distal end of the cannula 501. The first and second graspers 502 and 503 can be pushed forward by a force applied through an axially sliding rod or cannula 501 using a threaded or gear drive mechanism (not shown). The first and second graspers 502 and 503 may be constructed of metal, plastic, or a combination of materials that form a generally closed C-shape or U-shape, such as a Raney-type clip. First and second graspers 502 and 503 may have first and second rear crossovers 505 and 506, respectively, for guiding or attaching a length of suture 504. The first and second graspers 502 and 503 may additionally have grasping features 502a, 502b, 503a, and 503b, i.e., teeth, points, V-shapes, located at the open end or inner surface to assist in grasping tissue. The first and second graspers 502 and 503 for the organ 507 may be further coated with rubber, having surface features or shapes that facilitate grasping of the organ without damaging the organ 507. In addition, the second grasper 503 to be attached to the abdominal wall 509 may have more protruding gripping features 503a and 503b, i.e., more protruding teeth or sharp points, to attach to the abdominal wall 509. However, the first grasper 502 used to grasp the organ 507 may have atraumatic teeth on the grasping features 502a and 502b to prevent injury to the organ 507.

Still referring to fig. 19, and with further reference to fig. 20A-E, tissue retractor assembly 500 is shown in progressive steps of securing first grasper 502 to organ 507 and second grasper 503 to abdominal wall 509 after tissue retractor assembly 500 is introduced into an orifice (not shown). The first and second graspers 502 and 503 located in the insertion tube 501 will be fully opened so that they are nearly straight. The first and second graspers 502 and 503 are loaded into the cannula 501 for the purpose of introduction into the orifice. Once inside the ostium and at the organ to be grasped, the first and second graspers 502 and 503 may be deployed. Generally, as shown in fig. 20A, in this procedure, the clinician has a multi-purpose 5mm grasper 508 at the surgical site. The 5mm grasper 508 is responsible for the tissue of the organ 507 in question. The distal end of the cannula 501 is placed in proximity to the organ 507 and the first grasper 502 is pushed distally out of the cannula 501 by a rod or shaft driven by a screw or gear mechanism (not shown). The first grasper 502 will be pushed out approximately half way to allow the clinician to position the first grasper 502, and then the first grasper 502 will be deployed. The shape of the cannula 501 and the characteristics of the end can help manage the dynamic nature of the deployment of the first grasper 502. This design also provides the possibility of deploying multiple graspers (not shown) on the organ 507 if necessary. The cannula 501 pulls a length of suture 504 and the suture 504 is tied to a first grasper 502 placed on the organ 507.

With further reference to fig. 20A-E, a second grasper 503 is then deployed to allow the organ 507 to be retracted. The second grasper 503 may have the same overall shape and function as the first grasper 502. The second grasper 503 may have more protruding features on the grasping features 503a and 503b of the inflated abdominal wall 509. The gripping features 503a and 503b may also be pointed, thereby forming a penetrating feature. The cannula 501 is advanced to the abdominal wall 509 and a conventionally used 5mm grasper 508 is used to take care of the tissues of the abdominal wall 509. The second grasper 503 is deployed in a substantially similar way as the first grasper 502, which is attached to the organ 507.

Referring to fig. 21, an exemplary first grasper 502 and second grasper 503 are shown in operation. The cannula 501 pulls a length of suture 504 back out of the orifice, the length of suture 504 keeps all components in a chain and allows the clinician to retract the organ 507 by increasing the tension on the length of suture 504. A length of suture 504 may be secured outside of the aperture using a clamp or other suitable tool. After the procedure is over, the first grasper 502 on the organ 507 will be removed together with the organ 507 (in a cholecystectomy procedure). Depending on the geometry of the second grasper 503, removal of the second grasper 503 may require a specific tool, which may be integrated into the cannula 501 or a separate tool. If integrated into the cannula 501, the tool can be reintroduced to engage the second grasper 503 for removal without damaging the tissues of the abdominal wall 509. The first and second graspers 502 and 503 may be removed through an abdominal incision made when introducing the port.

Once the surgical procedure using the assembly of the present invention is completed, the assembly must be removed, at least partially. While biodegradable anchors (and thus not required to be removed) are contemplated as within the scope of the present invention, preferred embodiments of the anchor 203 are made of a non-degradable material, such as nitinol. In this way, the anchor is preferably removed from the patient after the procedure is completed.

To this end, the present invention may also include an anchor retrieval tool 600, as shown in fig. 22-26. The retrieval tool 600 has a generally elongated shape with a distal end 600A and a proximal end 600B. The body 601 is preferably generally tubular in shape and is adapted to pass through a surgical incision.

Fig. 23 shows a detail view of the distal end 600A. A retaining ring 602 extends from the extreme end of the distal end 600A. The positioning ring 602 is made of wire, suture-like thread, or other flexible thin material, and functions to enable easy positioning of anchors in the body. For example, the positioning ring 602 is sleeved around a suture attached to the anchor 203; the clinician may then direct the retrieval tool along the suture directly to the anchor 203 where the anchor 203 is embedded, for example, in the abdominal wall. One or both ends of the ring 602 are attached to a pull tab 604, the pull tab 604 serving to tighten the ring 602 around the suture as desired. As shown in fig. 23, when the pull tab 604 is pulled along the body 601 in the direction of arrow a, the loop 602 is retracted into the body 601 and tightened in the direction of arrow B. The loop 602 thus tightened is shown in dashed lines in fig. 23. Other loop tightening mechanisms (e.g., levers) are contemplated as being within the scope of the present invention.

A shaft 606 is disposed in the body 601, the shaft 606 having a hollow bore 607, the bore 607 adapted to receive a suture (not shown). As best shown in fig. 23 and 24A, the distal-most end of the shaft 606 includes a beveled portion 608, the beveled portion 608 terminating in a shoulder or flange 610 (discussed below). As best shown in fig. 24B, the proximal end of the shaft 606 passes through a handle portion 616 of the body 601, the handle portion 616 including a handle flange 620. An enlarged bore 618 is formed in the handle portion 616, the handle portion 616 being sized to receive a wider proximal end 622 of the shaft 606, the proximal end 622 terminating in a rounded end or handle 624. The bottom 619 of the bore 618 preferably acts as a stop mechanism to prevent over-insertion of the handle and, thus, over-extension of the distal end of the shaft 606 (which may cause injury to the patient).

The proximal and distal end configurations of the shaft 606 described above enable the clinician to position and remove the anchor from the patient's body at the end of the procedure or procedure. For use of such an exemplary retrieval tool 600, it is preferred to use a slightly adjusted anchor 203 ', such as the anchor 203' shown in fig. 24A. Anchor 203 ' is similar to anchor 203, having a cylinder 205 ' and four legs 206 '. However, the anchor 203 'also includes at least one (and preferably a plurality of) flexible stop (depth) tabs 612 cut into the cylinder 205'. The stop tabs 612 are angled inwardly toward the center of the body 205'. As the distal end of the shaft 606 enters the interior of the anchor 203', the ramped surface 608 pushes against the stop 612 causing the stop 612 to flex outwardly as the ramped surface 608 slides past the stop 612. Subsequently, as shown in fig. 25A-B, when the narrow neck 611 of the shaft 606 is substantially adjacent the tab 612, the tab 612 springs back to its original position/configuration and snaps under the shoulder 610, thereby preventing removal of the anchor 203' from the distal end of the shaft 606. As shown in fig. 26C, the clinician retracts handle 624 in the direction shown by arrow C and the distal end of shaft 606 pulls anchor 203' out of the tissue and down into body 601, thus exiting the patient.

A preferred embodiment of tissue retractor assembly 700 includes grasper 710, anchor 730, and universal user interface 740, tissue retractor assembly 700 being shown in various views and stages of deployment in fig. 27-33.

28A-B, tissue grasper 710 is adapted to contact and secure a tissue or organ to be retracted. The grasper 710 includes opposable upper and lower arms 712 and 714, each having a distal end 713 and a proximal end 715. The inner opposing surfaces of distal end 713 form the actual tissue grasping jaws 716, typically by a structure that creates a high coefficient of friction between grasper 710 and the organ to be retracted. In a preferred embodiment, the nip 716 includes a contoured face having peaks or teeth 716A and troughs 716B. As shown in fig. 28A, the teeth 716A of one of the arms 712 and 714 preferably cooperatively engage the slots 716B of the other of the arms 712 and 714 in a staggered manner. Preferably, the nip 716 is substantially smooth and free of sharp or jagged edges (i.e., the teeth 716A are rounded) to avoid tearing or other damage to the tissue to be retracted. Other gripping surface embodiments are also contemplated.

The proximal ends 715 of the arms 712 and 714 are connected by a coil spring 718 and a linear strut 720. A spring 718 biases the proximal ends 715 apart, thereby biasing the distal ends 713 together and closed (thereby biasing the nip 716). To open the nip 716, a force is applied to the proximal ends 715 of the arms 712 and 714, urging the proximal ends 715 together. In one embodiment, this is accomplished by relative retraction of the grasper 710 into the tube or cannula 750, the tube or cannula 750 having an inner diameter or similar dimension that is less than the width of the proximal end 715 when the grasper is in the closed configuration shown in fig. 28A. The opposite retraction of the grasper into tube 750 (i.e., either grasper 710 is pulled into tube 750 or tube 750 is pushed onto grasper 710) causes the tube to clamp proximal ends 715 together, thereby opening nip 716.

In a preferred embodiment of the grasper 710, as shown in fig. 28A-D, the proximal ends 715 of the arms 712, 714 are provided with a tapered diameter such that only a portion of the proximal end 715 is located and retained in the tube. In a preferred embodiment, the proximal end 715 is provided with at least two sections: a narrower section 719A that fits within outer tube 750, and a wider protruding section 719B that cannot fit within outer tube 750 (see fig. 28C). When the outer tube 750 is moved forward (or when the grasper is pulled rearward), the distal edge or face of the tube pushes against the projection 719B, which causes the projection 719B to pivot generally about the axis of the coil spring 718. Thus, as shown in fig. 28D, the proximal ends 715 of the arms 712, 714 are pushed together and the distal ends 713 are spread apart, ready to grasp tissue in the nip 716.

As previously described in connection with the previous embodiments, when the grasper 710 is secured to the organ to be retracted, the user will pull on the suture attached thereto. If pulled with sufficient force, such pulling can at least partially overcome the biasing force of the coil spring 718 and loosen the grip of the jaws 716 on the retracted tissue. To enhance the grip of the nip, holes 717 are provided in the arms 712 and 714 away from the pivot point of the arms. A suture (not shown) to which the grasper and anchor are attached is passed through hole 717. Thus, when the user pulls on the suture to retract tissue secured in the nip 716, tension on the suture is transferred through the hole 717 to the arms 712 and 714 and tends to further close the nip 716, thereby further securing the retracted tissue. The harder (to a reasonable extent) the user pulls, the greater the "closing force" will be transferred to the nip 716 by the suture passing through hole 717.

A preferred anchor 730 of tissue retractor assembly 700 is shown in fig. 29A-B. Anchor 730 includes a body 732 having a slotted or necked down partially formed slot 734 generally at its proximal end. Additionally or alternatively, body 732 may be substantially straight and provided with a proximal flange 735, flange 735 having a larger diameter than body 732. In either case, an anchor securing mechanism (described below) catches either the slot 734 or the flange 735.

The body 732 also includes at least one notch 736, the notch 736 preferably being formed longitudinally on the body 732. The notch 736 receives a suture or other movable support that passes through the anchor (and is attached to the grasper 710) such that when the anchor 730 is deployed, longitudinal movement of the suture does not abrade abdominal wall tissue that is in contact with the distal edge 732A of the body 732. In addition, the gap 736 allows for easier movement of the clinician-operated suture, as the suture does not rub against abdominal wall tissue nor get caught between the abdominal wall tissue and the distal edge 732A.

The distal end of anchor 730 is provided with a plurality of legs 738. Preferably, four such legs are provided. Anchor 730 is made of a resilient, preferably shape memory metal such as nitinol. As shown in fig. 29A, in its natural configuration, the legs 738 are bent outward by the body 732. As shown in fig. 29B, when anchor 730 is deployed or retracted into a confined space (e.g., outer tube 750), the tube flattens legs 738 such that they are generally straight as shown in fig. 29B. That is, anchor 730 is shown in fig. 29B in a "ready to deploy" configuration (i.e., in tube 750), and anchor 730 is shown in fig. 29A in a deployed configuration (i.e., secured to the abdominal wall).

The nitinol or other shape memory material of anchor 730 can be selected to have different bending properties at different temperatures. In a preferred embodiment, the formulation or alloy is selected to be more flexible at room temperature (about 20 ℃) than at body temperature (about 37 ℃). In this case, when legs 738 are ready to be inserted into the abdominal wall, legs 738 are more easily deployed from their straight, tube-in-tube configuration. Subsequently, after being placed on the abdominal wall, the temperature of legs 738 rises to about body temperature and legs 738 become less likely to buckle. In this way, anchor 730 becomes more firmly deployed on the abdominal wall with less likelihood of being inadvertently or accidentally removed when removal is not required.

As shown in perspective view in fig. 27A and fig. 27B with the housing removed for clarity, all of the components of the tissue retractor assembly can be controlled by a user through a universal user interface 740. Generally, interface 740 has a distal end 741A and a proximal end 741B, distal end 741A being in direct contact with and interacting with grasper 710 and anchor 730, and fig. 30A is an enlarged view of proximal end 741B. Figure 30B is an enlarged end view of the distal end 741A with the grasper removed for clarity and figure 30C is a cross-sectional view of the distal end 741A.

The opening and closing of the grasper 710 is controlled by a trigger 752, the trigger 752 being mechanically coupled to the outer cannula barrel 750 by a connection 754. Trigger 752 is biased to the position shown in fig. 30A by spring 756. When a user moves the trigger 752 in the direction of arrow a in fig. 30A (e.g., by squeezing the trigger 752 using the knob 744 as a counter force), the link 754 moves the outer tube 750 in a distal direction (to the left in the figure). As described above, the distal edge of the outer tube 750 abuts against the projections 719B of the arms 712, 714 of the grasper, forcing the jaws 716 apart. When the user releases his grip on the trigger 752, the trigger 752 returns to the initial position shown in fig. 30A, since the trigger 752 is biased by the spring 756, the outer tube 750 moves proximally away from the grasper 710, and the jaws 716 reclose due to the biasing force of the coil spring 718. In this manner, by squeezing and releasing the trigger 752, the user can easily open and close the grasper 710 to secure it to the tissue or organ to be retracted.

Deployment of anchor 730 is accomplished by operation of trigger 762, which trigger 762 is mechanically connected to intermediate sleeve tube 760 by connector 764. Trigger 762 is biased in the position shown in fig. 30A by spring 766. In a preferred embodiment, anchor 730 is secured to the distal end of middle tube 760 by a clamping sleeve 770, which will be described below. When the user moves the trigger 762 in the direction of arrow B in fig. 30A (e.g., by squeezing the trigger 762 using the circular stem 744 as a counter force), the link 764 moves the middle tube 760 in a distal direction (to the left in the drawing). First, as shown in fig. 30C, anchor 730 is disposed in outer tube 750 in the straight leg configuration of fig. 29B. As the user squeezes trigger 762, middle tube 760 pushes anchor 730 distally. As the legs 738 are extended out from the distal end of the outer tube 750, the legs 738 are rolled back to their natural, flexed configuration as shown in FIG. 29A. If the distal end of the outer tube 750 is pressed against tissue (e.g., the abdominal wall), the legs 738 penetrate and hook into the tissue, firmly securing the anchor thereto. When it is desired to remove anchor 730 from the abdominal wall, anchor 730 is reattached to the distal end of middle tube 760, as when the anchor is deployed, middle tube 760 is pushed out of outer tube 750 by operating trigger 762. When the anchor is re-secured to middle tube 760, the user loosens his grip on trigger 762, and middle tube 760 retracts into outer tube 750, pulling anchor 730 back. The distal and inner surfaces of outer tube 750 pull anchor legs 738 to straighten out away from the abdominal wall tissue and into the straight leg configuration of fig. 29B.

As shown in the perspective view of fig. 31 and the overall assembly view in fig. 30B, 30C and 27A (dashed lines), the preferred structure for securing the anchor 730 to the middle tube 760 and for positioning the anchor at a desired location on the abdominal wall is a clamping sleeve 770. Clamping sleeve 770 is a relatively short tubular structure having a proximal section 772 of the body, which proximal section 772 is preferably welded or otherwise secured to or over the distal end of middle tube 760. Extending from the distal end of the clamping sleeve 770 are a plurality of arms 774, each arm 774 terminating in an inwardly directed generally vertical tab (tab) or tooth 776. As shown in fig. 30C, for example, teeth 776 are configured to penetrate into slots 734 (and/or onto flanges 735) of anchor 730 to retain anchor 730 on the distal end of middle tube 760. The arms 774 are normally biased outwardly, preferably at least at the fold point 778 (as shown in phantom in fig. 31); the teeth 776 only penetrate into the slot 734 when both the anchor and the clamping sleeve are arranged in the outer tube 750. As the middle tube 760 is pushed distally out of the outer tube 750 by operating the trigger 762, the arms 774 are biased radially outward and the teeth 776 move outward out of engagement with the slots 734. Since the legs 738 of the anchor 730 dig into the abdominal wall tissue when this occurs, the anchor exits the clamping sleeve 770 and remains secured to the abdominal wall.

So far, a description has been given of how to open and close the grasper jaw 716 by operating the user interface 740 (specifically, the trigger 752). Once the grasper is secured to the tissue to be retracted, it must be disengaged from the overall assembly 700. In a preferred embodiment, the grasper 710 is connected to the user interface 740 by a hook 780, as best shown in fig. 30B-C. Preferably, the loop portion 718A of the coil spring 718 is initially mounted to the distal end of the hook 780 prior to use of the assembly 700. As the grasper jaws are opened and closed about the tissue to be retracted, for example, as shown in fig. 27A, the grasper 710 remains secured to the distal end 741A of the actuator 740. At this time, as shown in fig. 30C, the hook 780 is completely inserted into the outer tube 750, and the coil spring 718 is caught between the hook 780 and the outer tube 750. The hook 780 is preferably disposed in an inner tube 783 (see fig. 30B-C), the inner tube 783 preferably not moving at all and keeping the orientation of the hook 780 constant, which enables keeping the orientation of the grasper 710 constant relative to the actuator and other parts of the assembly.

Hook 780 is mechanically coupled to sliding handle 782 by connector 784 (see fig. 27A, 32A-C) and is biased into its neutral position within outer tube 750 by spring 786. Sliding of the sliding handle 782 distally in the distal direction as shown by arrow C in fig. 27A moves the hook 780 distally so that it protrudes from the distal end of the outer tube 750. This movement of the hook 780, in conjunction with it, urges the grasper 710 so that the grasper 710 is free to be removed from the hook 780 and remains attached to the tissue to which its jaws 716 are secured. When the user releases his grip or pressure on the handle 782, the spring 786 pulls the hook 780 proximally back into the outer tube 750.

Preferably, since grip 716 cannot be effectively controlled once grasper 710 is no longer in contact with outer tube 750, the hook actuation mechanism also includes a locking mechanism for preventing hook 780 from accidentally or inadvertently moving out of outer tube 750. Thus, the hook actuation mechanism also preferably includes a lock gate 787 connected to a connector 784 and a spring 789A. The locking gate 787 preferably includes a locking window 788, the locking window 788 being sized smaller than a corresponding locking tab 781 located at the proximal end of the hook 780. The lock gate 787 is preferably moved by the same action as the sliding handle 782; pushing handle 782 in a distal direction along arrow C (see fig. 27A) acts to lift lock gate 787 off of hook 780 and thereby disengage lock window 788 from hook locking tab 781.

The operation of the lock gate 787 is shown sequentially in fig. 32A-C. First, in FIG. 32A, the hook actuation assembly is in its initial, intermediate configuration, with the lock windows 788 of the lock gate 787 engaging the hooks 780 in the position of the locking tabs 781. Next, in fig. 32B, the sliding handle 782 is partially pushed distally in the direction of arrow C. The locking gate 787 is lifted slightly to disengage the locking window 788 from the locking flange 781. At this point, the hook 780 is free to move distally. Next, as shown in FIG. 32C, the sliding handle is pushed further in the direction of arrow C, and the hook 780 now extends out of the distal end of the outer tube 750. Grasper 710 may be removed therefrom and placed in position over the tissue to be retracted. Preferably, the user simply pushes the sliding handle 782 with a simple, smooth motion to first disengage the lock brake 787 and then move the hook 780 distally. However, other configurations of the link and hook locking mechanism are also contemplated as within the scope of the present invention, such as, for example, a two-step movement of the sliding handle 782 or similar actuator, a separate safety switch (not shown) controlling the operation of the lock brake 787 or similar structure, and the like.

In a preferred embodiment, three springs are included for maintaining the hook actuator assembly in the neutral position: a spring 786 biases the hook itself in a rearward proximal direction; a spring 789A biases the lock gate 787 downward to engage the locking lug 781 of the hook 780; and a spring 789B (adjacent to spring 789A and partially blocked by lock gate 787) is attached to and biases the distal end of connector 784. The present invention is intended to include other convenient biasing arrangements, e.g., more or fewer springs at the same or different locations, and the like.

Grasper 710 is deployed over the tissue to be retracted and anchor 730 is deployed over the abdominal wall so that the actual tissue retraction effecting structure is a movable support, preferably suture 800 (see fig. 30B). The suture 800 is preferably disposed distally within the inner tube 783, either above the hook 780 or below the hook 780. The proximal end of the suture 800 is preferably wrapped around a suture pig 802 (see fig. 32A-C) and, if desired, wrapped down. The distal end of suture 800 preferably passes through anchor 730 and is tied or otherwise secured to grasper 710 (e.g., through its coil spring 718 and through hole 717). When the user actuator 740 is retracted from the patient's body, the clinician may retract the tissue on the grasper 710 simply by pulling on the suture 800. The system behaves like a pulley as the suture 800 passes through the anchor 730, which is fixed to the abdominal wall. The more proximal the suture 800 is pulled away from the patient, the more the tissue is retracted. The present invention therefore allows for dynamic (i.e., variable and real-time) selection of how much retraction is provided to the tissue.

At some point at the end of the procedure, the user may wish to retrieve a variety of tools that are secured within the patient. The tool 600 may be retrieved using a separate anchor as described above; in the preferred assembly 700, however, the tool retrieval mechanism is incorporated and integrated into the user interface 740.

In particular, there is provided a wire loop 792 (see FIGS. 30B-C) disposed within catheter 790 within fixed inner tube 783. The distal end of the wire ring 792 selectively extends out of the distal end of the outer tube 750 by user actuation of the button 794, the button 794 being attached to the proximal end of the wire ring 792. A reinforcing structure (not shown) may be provided around part or all of the wire ring 792 to provide stability and prevent twisting of the wire ring 792 or to catch itself in any manner. Depressing the button 794 in the direction of arrow D (see fig. 30A) directly pushes the wire loop 792 out of the distal ends of the inner and outer tubes 783, 750. The clinician may then thread the suture 800 through the exposed wire loop and then release the button 794. Preferably, button 794 is spring biased by a spring (not shown) in a direction opposite to the direction of arrow D; thus, when button 794 is released, wire loop 792 will retract into inner tube 783 and restrain suture 800 therein. The clinician may then follow suture 800 down to anchor 730 and retrieve anchor 730 using clamping sleeve 770. Once anchor 730 is retrieved, the clinician may continue to follow suture 800 down to grasper 710 until the proximal end of grasper 710 abuts the distal edge of outer tube 750, causing grasper jaws 716 to open and release the retracted tissue. The handle 796 is then retracted proximally in the direction of arrow E (see fig. 30A) and the entire assembly is removed from the patient.

As shown in fig. 33A-G (with outer tube 750 removed for clarity in fig. 33A), in operation, tissue retractor assembly 700 is used in the following manner. In fig. 33A, the assembly 700 is in its pre-use configuration: the grasper jaws 716 are closed and the grasper 710 is secured to the hook 780 with the hook 780 being located just in the distal end of the outer tube 750. Hook 780 is biased proximally such that the proximal end of grasper 710 abuts the distal edge of outer tube 750, preferably with a narrower section 719A disposed in outer tube 750 and a wider projecting section 719B disposed immediately adjacent its distal edge. A suture (not shown in fig. 33A) is passed through holes 717 in the grasper arms 712, 714. The anchor 730 is secured in the outer tube 750 by the teeth 776 of the arms 774 of the clamping sleeve 770, the clamping sleeve 770 being substantially fully received in the outer tube 750. The user holds the universal user interface 740 with one hand, preferably with the knob 744 in the palm of his hand, just like a pistol.

After selecting the tissue, organ, or other body structure to be retracted, the user places grasper 710 at or near the tissue to be retracted. As shown in FIG. 30A, the user squeezes the trigger 752 in the direction of arrow A, preferably using a knob 744 as the counter force. Coupling 754 transmits a force from trigger 752 to outer tube 750 to move outer tube 750 distally. As previously described and as shown in fig. 28C, with the protruding section 719B abutting against the distal edge of the outer tube 750, distal movement of the outer tube 750 pushes the tube against the protruding section 719B, which force opens the jaws 716 of the grasper 710 (as shown in fig. 33B, where the outer tube 750 is transparent for clarity). The user can secure the grasper jaw 716 around the desired tissue and then release the trigger 752. Due to the biasing force of the spring 756, the trigger 752 and the outer tube 750 will return to their initial positions and the nip 716 will be securely closed around the tissue to be retracted.

Next, the user must release the grasper 710 from the user interface 740. To accomplish this, the user slides the sliding handle 782 in the direction of arrow C (see fig. 27A). This acts to unlock the lock gate 787 from the hook 780 and to push the hook 780 distally out of the distal end of the outer tube 750. When the jaws of the grasper are secured to the tissue to be retracted, a slight lateral movement causes the grasper coil spring 718 to release relative to the hook 780 and the distal end of the assembly is in the configuration shown in fig. 33C.

The user must then deploy anchor 730 into the abdominal wall or similar anatomy. As shown in fig. 33D, the device begins anchor deployment, wherein the distal end of outer tube 750 is pressed against tissue T. Thereafter, the user squeezes trigger 762 in the direction of arrow B (see fig. 30A), which causes intermediate tube 760 to move distally (via connection 764). As the middle tube 760 moves distally, and the anchor 730 clears the confines of the outer tube 750, the legs 738 gently penetrate the tissue T and return to their natural radially outward bowed configuration as shown in fig. 33E. The user completes the stroke of trigger 762 and arms 744 of clamping sleeve 770 naturally return to their radially outwardly biased configuration as shown in fig. 33F. In this way, the teeth 776 of the clamping sleeve disengage from the slots 734 of the anchor and the anchor remains firmly implanted in the tissue T. The assembly 700 can then be withdrawn by the patient and the suture 800 can be manipulated to provide greater or lesser retraction of tissue secured over the grasper jaws 716 as desired.

At the conclusion of the procedure, the user preferably must position the anchor and grasper for removal. First, button 794 is depressed in the direction of arrow D (see FIG. 30A), which causes wire loop 792 to extend out of catheter 790 and, thus, out of outer tube 750. The suture 800 is threaded through the wire loop 792 and the button 794 is released, causing the wire loop 792 to be withdrawn, securing the suture 800 in the catheter 790. The distal end 741 of the user interface 740 is then reinserted into the patient, thereby positioning the various components still attached to the distal end of the suture 800.

The first station along suture 800 is anchor 730. As shown in fig. 33G, since the hook 780 is fitted in the body 732 of the anchor 730, the user may extend the hook 780 to help find the anchor 730. The hook 780 helps align the anchor 730 with the distal end 741 of the user interface 740. The user then squeezes trigger 762 to extend middle tube 760 and thus clamp sleeve 770. As the clamping sleeve 770 is extended, its arms 774 are biased radially outward so that the teeth 776 can dig into the anchor slot 734 and/or catch on the anchor flange 735. The user loosens his grip on the trigger 762 and the middle tube 760 is withdrawn into the outer tube 750, first causing the arms 774 to clamp around the anchor slots 734/flanges 735, then pulling the anchor 730 proximally out of the tissue T. The anchor legs 738 eventually straighten out into the outer tube 750.

Next, the user follows suture 800 to grasper 710. The user extends the hook 780 by operating the sliding handle 782 in the direction of arrow C (fig. 27A). The user secures the hook 780 into the grasper coil spring 718 and then releases the sliding handle 782. Spring 786 retracts hook 780 into outer tube 750 while the proximal end of grasper 710 abuts the distal edge of outer tube 750. The user then squeezes trigger 752 to move outer tube 750 distally to push against protruding section 719B of grasper 710, forcing clip 716 to open and release the tissue retracted thereon. The trigger 752 is released and the nip 716 is closed. At this point the grasper is free of tissue and secured to the distal end of the user interface 740 and the entire device is removed from the patient.

The invention is not limited by the foregoing description. For example, a coil spring is shown in almost every case where a component is biased to a given position or configuration. However, for convenience and ease of manufacture, leaf springs or any other biasing mechanism may be employed. Additionally, although the figures illustrate various moving parts of the devices in particular configurations and couplings and mechanical connections between actuators, other connections are also contemplated. It is also contemplated that the preferred tissue retractor assembly of fig. 27-33 may be used with any of the embodiments shown in fig. 1-26. Additionally, as described above, the hook securing the grasper to the user interface is preferably secured by a grasper coil spring. However, the hook may be secured to other structure on the grasper, and the grasper may be provided with additional structure for this purpose.

Having described specific embodiments of the present invention, it is to be understood that the invention is not limited to the above description or the exemplary drawings. Rather, the scope of the invention is defined by the claims and includes any equivalents that occur to those skilled in the art.

Claims (44)

1. An intracorporeal surgical tissue retractor, comprising:

a) an anchor selectively deployable to a first tissue to be not retracted;

b) a grasper selectively deployable to a second tissue to be retracted;

c) a selectively longitudinally movable support attachable to the grasper through the anchor and at a substantially distal end of the movable support; and

d) a deployment user interface coupleable to the movable support and having a proximal end operable by a user from outside the body and a distal end releasably connected to the anchor and the grasper, adapted to deploy the anchor to the first tissue and the grasper to the second tissue inside the body.

2. An intracorporeal surgical tissue retractor according to claim 1, wherein when said grasper is deployed to said second tissue and said movable support is selectively moved proximally, said second tissue is selectively retracted.

3. An intracorporeal surgical tissue retractor according to claim 1, wherein when said anchor is deployed to said first tissue, said grasper is deployed to said second tissue and said movable support is selectively moved proximally, said second tissue is selectively retracted.

4. An intracorporeal surgical tissue retractor according to claim 2, wherein the more said movable support is selectively moved proximally, the more said second tissue is retracted, thereby enabling dynamic retraction of said second tissue.

5. An intracorporeal surgical tissue retractor according to claim 1, said anchor comprising:

a plurality of distally projecting legs; and

a body disposed generally proximally.

6. An intracorporeal surgical tissue retractor according to claim 5, said legs of said anchor being bent outwardly and comprised of an elastic material;

the user interface further comprising an outer cannula and an anchor positioning tool attached to a distal end of the user interface and relatively retractable into a distal end of the outer cannula,

wherein as the anchor positioning tool is relatively retracted into the outer cannula, the outer cannula forces the legs of the anchor releasably secured to the anchor positioning tool into a substantially straightened configuration.

7. An intracorporeal surgical tissue retractor according to claim 6, wherein said anchor is deployable into tissue not to be retracted when the legs are in said substantially straightened configuration.

8. An intracorporeal surgical tissue retractor according to claim 5, further comprising an anchor positioning tool attachable to a distal end of said user interface and releasably attached to said body of said anchor.

9. An intracorporeal surgical tissue retractor according to claim 8, wherein one of said body of said anchor and said anchor positioning tool comprises a flange and the other of said body of said anchor and said anchor positioning tool comprises a plurality of arms releasably secured to said flange.

10. An intracorporeal surgical tissue retractor according to claim 9, said user interface comprising an outer cannula and a middle cannula disposed within said outer cannula, said anchor positioning tool being attached to a distal end of said middle cannula.

11. An intracorporeal surgical tissue retractor according to claim 10, said arms being disposed on said anchor positioning tool and biased radially outwardly by said middle cannula, wherein said arms are forced radially inwardly by said outer cannula when said middle cannula is relatively retracted into said outer cannula.

12. An intracorporeal surgical tissue retractor according to claim 5, said legs of said anchor being curved outwardly.

13. An intracorporeal surgical tissue retractor according to claim 11, said legs of said anchor being outwardly curved and comprised of a resilient shape memory material, wherein said outer cannula urges said legs of said anchor into a generally straightened configuration as said middle cannula is relatively withdrawn into said outer cannula.

14. An intracorporeal surgical tissue retractor according to claim 13, said proximal end of said user interface comprising a first actuator coupled to said middle cannula, wherein actuation of said first actuator in a first motion causes said middle cannula to move in a distal direction to deploy said anchor to said first tissue.

15. An intracorporeal surgical tissue retractor according to claim 14, wherein actuating said first actuator in a second motion moves said middle cannula in a proximal direction to retract said anchor from said first tissue.

16. An intracorporeal surgical tissue retractor according to claim 3, said body further comprising a shoulder region releasably attached to an anchor positioning tool attached to said distal end of said user interface.

17. An intracorporeal surgical tissue retractor according to claim 16, said shoulder region comprising a slot and said anchor positioning tool comprising a plurality of arms releasably securable in said slot.

18. An intracorporeal surgical tissue retractor according to claim 17, said user interface comprising an outer cannula and a middle cannula disposed within said outer cannula, said anchor positioning tool being attached to a distal end of said middle cannula.

19. An intracorporeal surgical tissue retractor according to claim 18, said arms being biased radially outwardly by said middle cannula, wherein when said middle cannula is relatively retracted into said outer cannula, said arms are forced radially inwardly by said outer cannula to engage said slots of said anchor.

20. An intracorporeal surgical tissue retractor according to claim 5, said body of said anchor further comprising at least one notch formed at a distal end thereof, said notch adapted to receive said movable support when said anchor is deployed into said first tissue.

21. An intracorporeal surgical tissue retractor according to claim 1, said grasper comprising:

a pair of arms forming a pair of jaws at respective distal ends of the arms, the jaws adapted to be securely attached to the second tissue; and

a biasing mechanism attached to the arm biasing the jaws toward a closed position.

22. An intracorporeal surgical tissue retractor according to claim 21, said grasper further comprising a pair of corresponding holes formed respectively in each of said arms through which said movable support may be disposed.

23. An intracorporeal surgical tissue retractor according to claim 22, wherein when said movable support is selectively moved proximally, additional force is applied to said jaws by said movable support passing through said apertures in said grasper arm, further creating a tendency to close said jaws into said closed position.

24. An intracorporeal surgical tissue retractor according to claim 21, said user interface comprising an outer cannula, and said grasper being relatively retractable at least partially into and out of said outer cannula,

wherein when at least one of the outer cannula and the grasper is moved relative to the other of the outer cannula and the grasper to cause the grasper to be at least partially retracted into the outer cannula, a distal end of the outer cannula bears against a proximal end of the arm of the grasper and forces the jaws open against the biasing mechanism.

25. An intracorporeal surgical tissue retractor according to claim 21, said user interface comprising an elongated movable outer cannula and a generally stationary grasper support disposed within said outer cannula and attachable to said grasper, said grasper being at least partially retractable within and outside of said outer cannula,

wherein when the outer cannula is moved relative to the grasper to cause the grasper to be at least partially retracted into the outer cannula, the distal end of the outer cannula bears against the proximal ends of the arms of the grasper and forces the jaws open against the biasing mechanism.

26. An intracorporeal surgical tissue retractor according to claim 21, said user interface comprising an outer cannula having a distal rim and said grasper having a proximal end at least partially abuttable against said distal rim of said outer cannula,

wherein when at least one of the outer cannula and the grasper is moved relative to the other of the outer cannula and the grasper, the distal edge of the outer cannula bears against the proximal end of the grasper and forces the jaws open against the biasing mechanism.

27. An intracorporeal surgical tissue retractor according to claim 21, said user interface comprising a longitudinally movable outer cannula having a distal rim and a grasper support disposed within said outer cannula and attachable to said grasper, said grasper having a proximal end at least partially abuttable against said distal rim of said outer cannula,

wherein when the outer cannula is moved relative to the grasper, the distal end of the outer cannula bears against the proximal end of the grasper and forces the jaws open against the biasing mechanism.

28. An intracorporeal surgical tissue retractor according to claim 26, said proximal end of said grasper having an outer diameter portion abuttable against said distal rim of said outer cannula, wherein movement of said grasper relative to said outer cannula forces said jaws open as a result of abutment of said distal rim against said outer diameter portion.

29. An intracorporeal surgical tissue retractor according to claim 27, said proximal end of said grasper having an outer diameter portion abuttable against said distal rim of said outer cannula, wherein movement of said outer cannula relative to said grasper forces said jaws open as a result of abutment of said distal rim against said outer diameter portion.

30. An intracorporeal surgical tissue retractor according to claim 6, said user interface further comprising a first actuator disposed on said proximal end of said user interface and mechanically coupled to said anchor positioning tool, enabling selective longitudinal movement of said anchor positioning tool and deployment of said anchor to said first tissue.

31. An intracorporeal surgical tissue retractor according to claim 26, said user interface further comprising a second actuator disposed on said proximal end of said user interface and mechanically coupled to one of said outer cannula or said grasper such that said grasper is selectively relatively longitudinally movable relative to said outer cannula to selectively open and close said jaws of said grasper.

32. An intracorporeal surgical tissue retractor according to claim 27, said user interface further comprising a second actuator disposed on said proximal end of said user interface and mechanically coupled to said outer cannula such that said outer cannula is selectively longitudinally movable relative to said grasper to selectively open and close said jaws of said grasper.

33. An intracorporeal surgical tissue retractor according to claim 32, further comprising a third actuator disposed on said proximal end of said user interface and mechanically coupled to said grasper support such that said grasper support is selectively longitudinally movable to free said grasper of said user interface and to deploy said grasper to said second tissue.

34. An intracorporeal surgical tissue retractor according to claim 33, said biasing mechanism of said grasper comprising a coil spring disposed at said proximal end of said grasper and said grasper support comprising a hook formed at said distal end of said grasper support, said hook being hookable through said coil spring.

35. An intracorporeal surgical tissue retractor according to claim 34, wherein said hook is sized to fit within the body of said anchor to aid in retrieval of the deployed anchor.

36. An intracorporeal surgical tissue retractor according to claim 30, said user interface further comprising a substantially immovable grip for providing a counter force to the movement of said first actuator.

37. An intracorporeal surgical tissue retractor according to claim 32, said user interface further comprising a substantially immovable grip for providing a counter force to the movement of said second actuator.

38. An intracorporeal surgical tissue retractor according to claim 1, further comprising:

an anchor retrieval tool having a body and a central shaft disposed within the body, the central shaft having a proximal end and a distal end, the distal end of the central shaft including a ramp portion terminating in a shoulder matingly engageable with at least one flexible stop tab cut into and angled inwardly toward the body of the anchor,

wherein when the distal end of the central shaft enters the interior of the body of the anchor, the tab catches under the shoulder of the central shaft, thereby preventing the anchor from disengaging from the distal end of the central shaft, and thereby assisting in retrieving the anchor from the first tissue.

39. An intracorporeal surgical tissue retractor according to claim 38, said anchor retrieving tool further comprising a positioning ring extending from said distal end of said body of said tool, said positioning ring being configured to be looped around said movable support, said movable support passing through said anchor such that said anchor retrieving tool may be directed along said movable support directly to said anchor.

40. An intracorporeal surgical tissue retractor according to claim 39, said positioning ring being coupled to a ring tightener adapted to selectively tighten said positioning ring around said movable support.

41. An intracorporeal surgical tissue retractor according to claim 1, said movable support comprising a suture, said suture further comprising a proximal end, said proximal end of said suture wound on and selectively windable by a spindle disposed at said proximal end of said deployment user interface.

42. An intracorporeal surgical tissue retractor according to claim 41, said suture being threaded through said user interface to a distal end of said user interface.

43. An intracorporeal surgical tissue retractor according to claim 43, said user interface further comprising a wire loop selectively extendable from said distal end of said user interface and mechanically coupled to a fourth actuator disposed at said proximal end of said user interface and adapted to capture and retract said movable support into said user interface to enable positioning of said deployed anchor and said deployed grasper.

44. An intracorporeal surgical tissue retractor according to claim 6, wherein said elastic material of said anchor has different curvatures at different temperatures, wherein said metal has a smaller curvature at body temperature than at room temperature.