Surgical access instruments for use with delicate tissues

Abstract

One or more surgical instruments provide access to delicate tissue, such as brain tissue or breast tissue, through a transcutaneous incision, for a variety of reasons, such as to access a surgical site for providing a working channel for accessing delicate tissue by surgical instruments, to provide access to insert an inflatable prosthesis, or for providing an external buttress channel for supporting tissue thereon. The surgical instrument assembly includes an interleaved combination of an open sleeve hollow retractor and a tapered tipped wedge introducer. The wedge introducer is introduced into an area adjacent to the hollow sleeve. The distal tip of the wedge introducer extends beyond a distal end of the hollow retractor, forward of a distal end of the hollow retractor, so that the wedge introducer traverses delicate tissue ahead of the distal end of the hollow retractor, guiding the hollow retractor into place to the delicate tissue.

1 . An apparatus providing access to delicate tissue through a transcutaneous incision comprising: 
 an interleaved combination of an open sleeve hollow retractor and a tapered tipped wedge introducer;    said wedge introducer being introduced into an area adjacent to said hollow sleeve;    a distal tip of said wedge introducer extending beyond a distal end of said hollow retractor, at a location region forward of a distal end of said hollow retractor, so that said wedge introducer traverses the delicate tissue ahead of said distal end of the hollow retractor, guiding said hollow retractor into place to the delicate tissue; and,    said tapered tipped wedge introducer being removable from said open sleeve of said hollow retractor adjacent the delicate tissue, leaving the delicate tissue exposed to a said open sleeve of said hollow retractor.    
   
   
       2 . The apparatus providing access into delicate tissue as in  claim 1  further comprising: 
 said hollow retractor having an open sleeve having a diameter of at least one arc of a curve having a decreasing curved cross sectional diameter;    said tapered tipped wedge introducer having a diameter of at least one arc of a curve having a decreasing curved cross sectional diameter;    said tapered tipped wedge introducer retractor having a length exceeding a predetermined length of said hollow retractor, providing an advancing member extending forward of a distal end of said hollow retractor;    said tapered tipped wedge introducer having an exterior surface corresponding to an interior surface of said hollow sleeve;    said tapered tipped wedge introducer having a diameter with an arc of a decreasing curved cross section approximating said arc of said curved cross section of said open sleeve;    said hollow retractor and said tapered tipped wedge introducer being insertable adjacent to the delicate tissue; and,    said hollow retractor and said tapered tipped wedge introducer being advanced together to the delicate tissue.    
   
   
       3 . The apparatus as in  claim 1  wherein said hollow retractor provides access for at least one surgical instrument to a surgical site within the delicate tissue.  
   
   
       4 . The apparatus for providing access to delicate tissue as in  claim 1  wherein the hollow retractor and the interleaved tapered tipped wedge introducer spread a portion of delicate tissue apart from another portion of delicate tissue toward the surgical site.  
   
   
       5 . The apparatus for providing access to delicate tissue as in  claim 1  wherein the hollow retractor and the interleaved tapered tipped wedge introducer intersect transversally into a portion of delicate tissue at the surgical site.  
   
   
       6 . The apparatus as in  claim 1  wherein said hollow retractor supports the delicate tissue thereupon.  
   
   
       7 . The apparatus as in  claim 1  wherein said apparatus provides access for at least one inflatable prosthetic member into the delicate tissue and inflating the inflatable member.  
   
   
       8 . The apparatus as in  claim 1  wherein said hollow retractor includes a handle attachable to a clamp.  
   
   
       9 . The apparatus as in  claim 1  wherein said hollow retractor and said tapered tipped wedge introducer include a lock temporarily locking said tapered tipped wedge introducer adjacent to said hollow retractor.  
   
   
       10 . The apparatus for providing access to delicate tissue as in  claim 2  wherein said at least one arc of said curve of said diameter of said hollow retractor is a closed plane curve.  
   
   
       11 . The apparatus for providing access to delicate tissue as in  claim 2  wherein said at least one arc of said curve of said diameter of said hollow retractor is an arc of a portion of a closed plane curve.  
   
   
       12 . The apparatus as in  claim 1  wherein a distal end of said tapered introducer has a small opening at a distal end thereof, allowing for removal of small portions of tissue from a surgical site.  
   
   
       13 . The apparatus for providing access to delicate tissue as in  claim 2  wherein said at least one arc of said curve of said diameter of said hollow retractor is an arc of a portion of a closed plane curve wherein the closed plane curve is generated by a point moving in such a way that the sums of its distances from two fixed points is a constant.  
   
   
       14 . The apparatus for providing access to delicate tissue as in  claim 2  wherein said at least one arc of said curve of said diameter of said hollow retractor is an arc of a portion of a closed plane curve wherein the closed plane curve is an elliptical oval-shaped plane section of a circular cone that is a not perpendicular to an axis of the cone.  
   
   
       15 . The apparatus for providing access to delicate tissue as in  claim 14  wherein said at least one arc of said curve of said diameter of said hollow retractor is an arc of a portion of a closed plane curve wherein the closed plane curve is an elliptical oval.  
   
   
       16 . The apparatus for providing access to delicate tissue as in  claim 2  wherein said arc of said hollow retractor is a portion of a continuous arc.  
   
   
       17 . The apparatus for providing access to delicate tissue as in  claim 2  wherein said arc of said hollow retractor is a continuous arc.  
   
   
       18 . The apparatus for providing access to delicate tissue as in  claim 2  wherein said arc of said tapered tipped wedge introducer is a portion of a continuous arc.  
   
   
       19 . The apparatus for providing access to delicate tissue as in  claim 2  wherein said arc of said tapered tipped wedge introducer is a continuous arc.  
   
   
       20 . The apparatus for providing access to delicate tissue as in  claim 2  wherein said closed plane curve is flared outward at a proximal end.  
   
   
       21 . A method of providing access into delicate tissue for at least one surgical instrument assembly comprising the steps: 
 making an incision into delicate tissue;    providing a hollow retractor having an open sleeve having a diameter of at least one arc of a curve having a decreasing curved cross sectional diameter;    providing a tapered tipped wedge introducer having a diameter of at least one arc of a curve having a decreasing curved cross sectional diameter introducing said tapered tipped wedge introducer into an area adjacent to said hollow sleeve having said at least one arc of a curve having a decreasing curved cross sectional diameter;    said closed end tipped wedge introducer having an exterior surface corresponding to an interior surface of said hollow sleeve;    said closed end tipped wedge introducer having a diameter with an arc of a decreasing curved cross section approximating said arc of said curved cross section of said open sleeve;    placing said hollow retractor and said tapered tipped wedge introducer into the delicate tissue;    advancing said hollow retractor and said tapered tipped wedge introducer through said delicate tissue to a surgical site therein;    retracting said tapered tipped wedge introducer from said open sleeve of said hollow retractor adjacent the tissue; and,    accessing at least one surgical instrument to the surgical site within the delicate tissue.    
   
   
       22 . A method of providing access into delicate tissue for at least one surgical instrument comprising the steps: 
 making an incision into delicate tissue;    providing a hollow retractor having an open sleeve having a diameter of at least one arc of a curve having a decreasing curved cross sectional diameter;    providing a tapered tipped wedge introducer having a diameter of at least one arc of a curve having a decreasing curved cross sectional diameter introducing said tapered tipped wedge introducer into an area adjacent to said hollow sleeve having said at least one arc of a curve having a decreasing curved cross sectional diameter;    said closed end tipped wedge introducer having an exterior surface corresponding to an interior surface of said hollow sleeve;    said closed end tipped wedge introducer having a diameter with an arc of a decreasing curved cross section approximating said arc of said curved cross section of said open sleeve;    placing said hollow retractor and said tapered tipped wedge introducer into the delicate tissue;    advancing said hollow retractor and said tapered tipped wedge introducer through said delicate tissue to a surgical site therein;    retracting said tapered tipped wedge introducer from said open sleeve of said hollow retractor adjacent the tissue; and,    supporting the delicate tissue thereupon.    
   
   
       23 . A method of providing access into delicate tissue for at least one surgical instrument comprising the steps: 
 making an incision into delicate tissue;    providing a hollow retractor having an open sleeve having a diameter of at least one arc of a curve having a decreasing curved cross sectional diameter;    providing a tapered tipped wedge introducer having a diameter of at least one arc of a curve having a decreasing curved cross sectional diameter introducing said tapered tipped wedge introducer into an area adjacent to said hollow sleeve having said at least one arc of a curve having a decreasing curved cross sectional diameter;    said closed end tipped wedge introducer having an exterior surface corresponding to an interior surface of said hollow sleeve;    said closed end tipped wedge introducer having a diameter with an arc of a decreasing curved cross section approximating said arc of said curved cross section of said open sleeve;    placing said hollow retractor and said tapered tipped wedge introducer into the delicate tissue;    advancing said hollow retractor and said tapered tipped wedge introducer through said delicate tissue to a surgical site therein;    retracting said tapered tipped wedge introducer from said open sleeve of said hollow retractor adjacent the tissue; and,    accessing at least one inflatable prosthetic member into the delicate tissue and inflating the inflatable member.    
   
   
       24 . An apparatus providing access to delicate tissue through a transcutaneous incision comprising: 
 an interleaved combination of an open sleeve hollow retractor and a tapered tipped wedge introducer;    said open sleeve hollow retractor being tapered;    said open sleeve hollow retractor having a decreasing elliptical cross section;    said wedge introducer being tapered;    said wedge introducer having a decreasing elliptical cross section;    said wedge introducer being introduced into an area adjacent to said hollow sleeve;    a distal tip of said wedge introducer extending beyond a distal end of said hollow retractor, at a location region forward of a distal end of said hollow retractor, so that said wedge introducer traverses the delicate tissue ahead of said distal end of the hollow retractor, guiding said hollow retractor into place to the delicate tissue;    said tapered tipped wedge introducer being removable from said open sleeve of said hollow retractor adjacent the delicate tissue, leaving the delicate tissue exposed to a said open sleeve of said hollow retractor;    said tapered tipped wedge introducer having an exterior surface corresponding to an interior surface of said hollow sleeve;    said hollow retractor and said tapered tipped wedge introducer being insertable adjacent to the delicate tissue;    said hollow retractor and said tapered tipped wedge introducer being advanced together to the delicate tissue;    said hollow retractor providing access for at least one surgical instrument to a surgical site within the delicate tissue;    said hollow retractor including a handle attachable to a clamp;    said handle having a base where said handle is attached to said hollow retractor, said handle merging with said base in a cascading shape, interrupting the continuous curve of the proximal end of the hollow retractor, said cascading dip providing easier finger access into a working channel of said hollow retractor; and,    said hollow retractor and said tapered tipped wedge introducer including a lock temporarily locking said tapered tipped wedge introducer adjacent to said hollow retractor.    
   
   
       25 . An apparatus providing access to delicate tissue through a transcutaneous incision comprising: 
 an interleaved combination of an open sleeve hollow retractor and a tapered tipped wedge introducer;    said open sleeve hollow retractor being tapered;    said open sleeve hollow retractor being arch shaped, having a decreasing arched cross section;    said wedge introducer being tapered;    said wedge introducer being arch shaped, having a decreasing arch shaped cross section;    said wedge introducer being introduced into an area adjacent to said hollow sleeve;    a distal tip of said wedge introducer extending beyond a distal end of said hollow retractor, at a location region forward of a distal end of said hollow retractor, so that said wedge introducer traverses the delicate tissue ahead of said distal end of the hollow retractor, guiding said hollow retractor into place to the delicate tissue;    said tapered tipped wedge introducer being removable from said open sleeve of said hollow retractor adjacent the delicate tissue, leaving the delicate tissue exposed to a said open sleeve of said hollow retractor;    said tapered tipped wedge introducer having an exterior surface corresponding to an interior surface of said hollow sleeve;    said hollow retractor and said tapered tipped wedge introducer being insertable adjacent to the delicate tissue;    said hollow retractor and said tapered tipped wedge introducer being advanced together to the delicate tissue;    said hollow retractor providing access for at least one surgical instrument to a surgical site within the delicate tissue;    said hollow retractor including a handle attachable to a clamp;    said handle having a base where said handle is attached to said hollow retractor, said handle merging with said base in a cascading shape, interrupting the continuous curve of the proximal end of the hollow retractor, said cascading dip providing easier finger access into a working channel of said hollow retractor; and,    said hollow retractor and said tapered tipped wedge introducer including a lock temporarily locking said tapered tipped wedge introducer adjacent to said hollow retractor.