Trocar insertion apparatus

Abstract

Apparatus for forming and enlarging a percutaneous penetration are disclosed. The apparatus includes an elongate dilation member including a radially expandable member having a first cross-sectional area; and an elongate expansion member including a tubular element having a second cross-sectional area which is larger than the first cross-sectional area. The apparatus further includes an advancing apparatus having a first arm with a first engaging feature for engaging the handle of the dilation member; a second arm with a second engaging feature for engaging the handle of the expansion member; and an operation member; the first arm and the second arm being connected so that operation of the operation member approximates the first engaging feature and the second engaging feature together.

1 . An insertion apparatus for use in connection with an expandable member insertable into an opening in a patient's tissue and a dilation member removably positionable with the expandable member to enlarge the opening, the insertion apparatus comprising:
 a first arm extending along a longitudinal axis that is configured and dimensioned to receive the expandable member such that axial movement of the expandable member is restricted with respect to the tissue following insertion of the expandable member to thereby minimize trauma upon repositioning of the dilation member; and   a second arm operatively connected to the first arm, the second arm being configured and dimensioned to receive the dilation member to establish and maintain relative axial alignment between the expandable member and the dilation member.   
     
     
         2 . The insertion apparatus of  claim 1 , further including a first engaging feature coupled to the first arm and a second engaging feature coupled to the second arm, the first engaging feature being configured and dimensioned to retain the expandable member and the second engaging feature being configured and dimensioned to retain the dilation member. 
     
     
         3 . The insertion apparatus of  claim 2 , wherein the first engaging feature includes a first pair of legs spaced axially from a second pair of legs to define a gap therebetween, the gap being configured and dimensioned to receive the expandable member such that relative axial movement between the expandable member and the first engaging feature is substantially prevented. 
     
     
         4 . The insertion apparatus of  claim 2 , further including an operation member operatively connected to at least one of the first and second arms to effectuate relative axial movement between the first and second arms upon actuation of the operation member. 
     
     
         5 . The insertion apparatus of  claim 4 , wherein the operation member is attached to the second arm. 
     
     
         6 . The insertion apparatus of  claim 4 , wherein the first arm is slidably received by the second arm such that actuation of the operation member effectuates approximation of the first engaging feature and the second engaging feature. 
     
     
         7 . The insertion apparatus of  claim 4 , wherein the operation member includes a first handle and a second handle, the second handle being fixedly positioned relative to the first arm and substantially aligned with the longitudinal axis defined thereby. 
     
     
         8 . The insertion apparatus of  claim 7 , wherein the first handle is movably relative to the second handle to actuate the operation member. 
     
     
         9 . The insertion apparatus of  claim 8 , wherein the first handle is pivotably connected to the second handle for repositioning between an open position, in which the first handle is misaligned with the longitudinal axis, and a closed position, in which the first handle is substantially aligned with the longitudinal axis, wherein movement of the first handle from the open position to the closed position actuates the operation member. 
     
     
         10 . A method of forming and enlarging an opening in tissue comprising the steps of:
 providing an expandable member removably positionable within the opening;   providing a dilation member positionable within and movable through the expandable member;   providing an insertion apparatus having proximal and distal ends and including a first arm movably connected to a second arm, the first arm being configured and dimensioned to receive the expandable member such that axial movement of the expandable member is restricted with respect to the tissue following insertion of the expandable member to thereby minimize trauma upon repositioning of the dilation member, the second arm being configured and dimensioned to receive the dilation member to establish and maintain relative axial alignment between the expandable member and the dilation member:   connecting the expandable member and the first arm of the insertion apparatus;   connecting the dilation member and the second arm of the insertion apparatus;   positioning the expandable member within the opening in the tissue; and   effectuating relative movement between the first arm and the second arm of the insertion apparatus to move the dilation member through the expandable member to thereby enlarge the opening in the tissue.   
     
     
         11 . The method of  claim 10 , wherein the step of providing an insertion apparatus includes providing an insertion apparatus further including a first engaging feature coupled to the first arm for retaining the expandable member and a second engaging feature coupled to the second arm for retaining the dilation member. 
     
     
         12 . The method of  claim 11 , wherein the step of providing an insertion apparatus includes providing an insertion apparatus wherein the first engaging feature includes a first pair of legs spaced axially from a second pair of legs to define a gap therebetween for receiving the expandable member so as to substantially prevent relative axial movement between the expandable member and the first engaging feature. 
     
     
         13 . The method of  claim 11 , wherein the step of providing an insertion apparatus includes providing an insertion apparatus further including an operation member operatively connected to at least one of the first and second arms for controlling relative axial movement between the first and second arms. 
     
     
         14 . The method of  claim 13 , wherein the step of effectuating relative movement between the first and second arms includes manipulating the operation member to cause approximation of the first engaging feature and the second engaging feature and distal advancement of the dilation member. 
     
     
         15 . A kit for providing access to a surgical site within tissue, the kit comprising:
 an expandable member insertable into an opening in the tissue;   an expansion assembly removably positionable with the expandable member to enlarge the opening; and   an insertion apparatus comprising:
 a first arm configured and dimensioned to receive the expandable member such that axial movement of the expandable member is restricted with respect to the tissue following insertion of the expandable member to thereby minimize trauma upon repositioning of the dilation member; and 
 a second arm operatively connected to the first arm, the second arm being configured and dimensioned to receive the expansion assembly to establish and maintain relative axial alignment between the expandable member and the expansion assembly. 
   
     
     
         16 . The kit of  claim 15 , wherein the expandable member includes a radially expandable sleeve with a lumen extending therethrough that is configured and dimensioned to receive the dilation member. 
     
     
         17 . The kit of  claim 16 , wherein the sleeve of the expandable member includes a tubular braid formed from an inelastic material. 
     
     
         18 . The kit of  claim 15 , further including a needle for use in creating the opening in the tissue. 
     
     
         19 . The kit of  claim 18 , wherein the expandable member is configured and dimensioned to receive the needle. 
     
     
         20 . The kit of  claim 15 , wherein the expansion assembly includes a tubular member defining a lumen therethrough and an obturator with a distal end configured and dimensioned to separate tissue, the obturator being removably positionable within the lumen of the tubular member to facilitate distal advancement of the tubular member.