Surgical access device system and methods of use

Abstract

A surgical access device can include a plurality of retractor members that together define a lumen having a first cross-sectional dimension. Each of the plurality of retractor members can be moved radially outward to at least a second cross-sectional dimension to create a surgical access passage. The surgical access device, systems and kits comprising the surgical access device, and methods of using the surgical access device can include a mechanism for inserting an elongate member from exterior the body to the surgical she, a mechanism for moving the retractor members radially outward, a mechanism for guiding the radially outward movement of the retractor members, a mechanism for securing each of the retractor members in a range of positions, and a mechanism for illuminating the surgical site. Variations of the devices, systems, kits, and methods are useful for creating and maintaining a surgical access passage for performing minimally invasive surgery.

1 . A device, comprising:
 an elongate member comprising a proximal end, a distal end, and a plurality of retractor members each having an inner surface that together define a lumen of the elongate member, the lumen having a first cross-sectional dimension,   each of the plurality of retractor members being moveable radially outward to a second cross-sectional dimension for creating a surgical access passage capable of receiving instruments, and   a retainer ring comprising a plurality of retractor member guide channels opening through inner and outer edges of the retainer ring and configured for placement at the proximal end of and concentric to the plurality of retractor members, each retractor member including an arm in a respective one of the guide channels when the retractor members are positioned to define the lumen in the first cross-sectional dimension and the arms are slidable the respective guide channel as the retractor member is moved radially outward to the second cross-sectional dimension.   
     
     
         2 . The device of  claim 1 , wherein the surgical access passage further comprises a substantially constant cross-sectional dimension between the proximal end and the distal end. 
     
     
         3 . The device of  claim 1 , wherein the surgical access passage further comprises a direct access to a surgical site. 
     
     
         4 . The device of  claim 1 , further comprising:
 a retractor member arm extending outwardly from the proximal end of each retractor member in the respective guide channel, wherein the retractor member arm and guide channel each include a T-shaped cross-section.   
     
     
         5 . The device of  claim 4 , further comprising a mechanism for securing each of the plurality of retractor members in a first position comprising the first cross-sectional dimension and in a second position comprising the second cross-sectional dimension. 
     
     
         6 . The device of  claim 5 , wherein the mechanism for securing each of the plurality of retractor members comprises a wheel lock threaded through a wheel lock guide in the retainer ring into each retainer member guide channel and into adjustable contact with the retainer member arm in that guide channel. 
     
     
         7 . The device of  claim 1 , further comprising a stylet comprising a pointed tip and a guide wire bore extending through the stylet, the stylet insertable into the lumen for guiding the elongate member over a guide wire to a surgical site. 
     
     
         8 . The device of  claim 1 , further comprising a mechanism insertable into the lumen and actuatable to apply a radially outward force to move the retractor members. 
     
     
         9 . The device of  claim 8 , wherein the mechanism for moving the retractor members comprises an expandable body. 
     
     
         10 . The device of  claim 9 , the plurality of retractor members having a length, wherein the expandable body comprises a length that approximates the length of the retractor members. 
     
     
         11 . The device of  claim 9 , the plurality of retractor members having a length, wherein the expandable body comprises a length less than the length of the retractor members. 
     
     
         12 . The device of  claim 8 , the mechanism for moving the retractor members further comprising a hydraulic mechanism. 
     
     
         13 . The device of  claim 8 , die mechanism for moving the retractor members further comprising a mechanical mechanism. 
     
     
         14 . The device of  claim 4 , the surgical access passage further comprising one cross-sectional dimension from a range of cross-sectional dimensions between the first cross-sectional dimension of the lumen and a cross-sectional dimension equal to an inside diameter of the retainer ring. 
     
     
         15 . The device of  claim 1 , the surgical access passage having a cross-sectional dimension comprising a diameter in the range of ¾ inch to 1¼ inch. 
     
     
         16 . The device of  claim 1 , the surgical access passage further comprising a non-circular cross-sectional configuration. 
     
     
         17 . The device of  claim 1 , one or more of the retractor members further comprising a hollow region for transferring material to and from a surgical site. 
     
     
         18 . The device of  claim 1 , further comprising a light source for illuminating a surgical site. 
     
     
         19 . A device, comprising:
 an elongate member comprising a proximal end, a distal end, and a plurality of retractor members each having an inner surface that together define a lumen of the elongate member, the lumen having a first cross-sectional dimension,   each of the plurality of retractor members being moveable radially outward to a second cross-sectional dimension for creating a surgical access passage capable of receiving instruments, further comprising a light source for illuminating a surgical site and a retainer ring configured for placement at the proximal end of and concentric to the plurality of retractor members,   a rotatable arm rotatably mounted on the retainer ring, and   a curved insertion member attachable to the rotatable arm, having the light source at a distal tip of the insertion member, and being capable of percutaneous insertion of the light source to a periphery of the surgical site.   
     
     
         20 . A device, comprising:
 an elongate member comprising a proximal end, a distal end, and a plurality of retractor members each having an inner surface that together define a lumen of the elongate member, the lumen having a first cross-sectional dimension,   each of the plurality of retractor members being moveable radially outward to a second cross-sectional dimension for creating a surgical access passage capable of receiving instruments, further comprising a light source for illuminating a surgical site and a retainer ring configured for placement at the proximal end of and concentric to the plurality of retractor members,   a retainer ring arm extending laterally from the retainer ring and comprising an angled guide slot, and   a straight insertion member having the tight source at a distal tip of the insertion member and being capable of guided percutaneous insertion through the guide slot so that the light source is positionable at a periphery of the surgical site.   
     
     
         21 . The device of  claim 20 , the straight insertion member further comprising indicia for indicating a distance the insertion member has been inserted toward the surgical site. 
     
     
         22 . The device of  claim 18 , further comprising the light source at a distal end of at least one of the plurality of retractor members. 
     
     
         23 . A device, comprising:
 an elongate member comprising a proximal end, a distal end, and a plurality of retractor members each having an inner surface that together define a lumen of the elongate member, the lumen having a first cross-sectional dimension,   each of the plurality of retractor members being moveable radially outward to a second cross-sectional dimension for creating a surgical access passage capable of receiving instruments, further comprising a light source for illuminating a surgical site and a stabilization ring positionable inside and near the distal end of the retractor members when the retractor members are in a position comprising the second cross-sectional dimension, wherein the stabilization ring comprises the light source and the stabilization ring rigidly supports inside surfaces of the plurality of retractor members.   
     
     
         24 . A device, comprising:
 an elongate member comprising a proximal end, a distal end, and a plurality of retractor members each having an inner surface that to ether define a lumen of the elongate member, the lumen having a first cross-sectional dimension,   each of the plurality of retractor members being moveable radially outward to a second cross-sectional dimension for creatin a surgical access passage capable of receiving instruments, further comprising a light source for illuminating a surgical site and a retainer ring configured for placement at the proximal end of and concentric to the plurality of retractor members, wherein the retainer ring includes one or more recesses in a bottom side thereof between adjacent retractor members and the light source is housed in the one or more recesses near an inside edge of the retainer ring.   
     
     
         25 . The device of  claim 1 , further comprising a barrier material between at least two of the retractor members. 
     
     
         26 . The device of  claim 1 , further comprising a barrier material between each pair of adjacent retractor members. 
     
     
         27 . The device of  claim 1 , wherein the surgical access passage is in a human or an animal. 
     
     
         28 . The device of  claim 1 , wherein the surgical access passage comprises access to a spine. 
     
     
         29 . The device of  claim 1 , wherein the surgical access passage comprises access to a joint. 
     
     
         30 . A device, comprising:
 an elongate member comprising a proximal end, a distal end, and a plurality of retractor members each having an inner surface that together define a lumen of the elongate member, the lumen having a first cross-sectional dimension;   a retractor member arm extending outwardly from the proximal end of each retractor member;   a lower retainer ring comprising a plurality of retractor member guide channels and configured for placement at the proximal end of and concentric to the plurality of retractor members, each retractor member arm slidable within one of the guide channels; and   an upper retainer ring engageable with and slidingly rotatable relative to the lower retainer ring; and   each of the plurality of retractor members being moveable radially outward to a second cross-sectional dimension when the upper and lower retainer rings are rotated relative to each other for creating a surgical access passage capable of receiving instruments.   
     
     
         31 . The device of  claim 30 , wherein
 the lower retainer ring comprises a lower retainer ring slot located above and parallel to each guide channel;   the upper retainer ring comprises an upper retainer ring slot having a center aligned with a center of the lower retainer ring slot and angled relative to the longitudinal axis of the lower retainer ring slot; and   each retractor member arm comprises a peg extending upward through the lower and upper retainer ring slots,   such that when the upper and lower retainer rings are rotated relative to each other, the upper retainer ring slot presses against the peg, causing the retractor member to move radially.   
     
     
         32 . The device of  claim 30 , further comprising a mechanism for securing the upper and tower retainer rings in a desired position relative to each other. 
     
     
         33 . The device of  claim 30 , further comprising a mechanism for securing each of the plurality of retractor members in a first position comprising the first cross-sectional dimension and in a second position comprising the second cross-sectional dimension. 
     
     
         34 . The device of  claim 30 , further comprising a light source for illuminating a surgical site. 
     
     
         35 . The device of  claim 30 , wherein the surgical access passage further comprises a substantially constant cross-sectional dimension between the proximal end and the distal end. 
     
     
         36 . The device of  claim 30 , wherein the surgical access passage further comprises a direct access to a surgical site. 
     
     
         37 . A device, comprising:
 an elongate member comprising a proximal end, a distal end, and a plurality of retractor members each having an inner surface that together define a lumen of the elongate member, the lumen having a first cross-sectional dimension;   a threaded retractor member arm rotatably connected to and extending outwardly from the proximal end of each retractor member;   a retainer ring comprising a plurality of matingly threaded retractor member guide channels and configured for placement at the proximal end of and concentric to the plurality of retractor members, each threaded retractor member arm rotatable within one of the guide channels; and   each of the plurality of retractor members being moveable radially outward to a second cross-sectional dimension when the threaded retractor member arm is rotated for creating a surgical access passage capable of receiving instruments.   
     
     
         38 . The device of  claim 37 , wherein each threaded retractor member arm is fixedly inserted through a rotation wheel adjacent to the exterior of the retainer ring, and wherein rotation of the rotation wheel causes the connected retractor member to move radially. 
     
     
         39 . The device of  claim 37 , further comprising a mechanism for securing each of the plurality of retractor members in a first position comprising the first cross-sectional dimension and in a second position comprising the second cross-sectional dimension. 
     
     
         40 . The device of  claim 37 , further comprising a light source for illuminating a surgical site. 
     
     
         41 . The device of  claim 37 , wherein the surgical access passage further comprises a substantially constant cross-sectional dimension between the proximal end and the distal end. 
     
     
         42 . The device of  claim 37 , wherein the surgical access passage further comprises a direct access to a surgical site. 
     
     
         43 . A kit, comprising:
 an elongate member comprising a proximal end, a distal end, and a plurality of retractor members each having an inner surface that together define a lumen of the elongate member, the lumen having a first cross-sectional dimension, each of the plurality of retractor members being moveable radially outward to a second cross-sectional dimension for creating a surgical access passage; and   a retainer ring comprising a plurality of retractor member guide channels in the ring opening through inner and outer edges of the ring and configured for placement at the proximal end of and concentric to the plurality of retractor members, each retractor member slidable within one of the guide channels as said retractor member is moved radially outward.   
     
     
         44 . The kit of  claim 43 , wherein the surgical access passage further comprises a substantially constant cross-sectional dimension between the proximal end and the distal end. 
     
     
         45 . The kit of  claim 43 , further comprising a stylet comprising a pointed tip and a guide wire bore extending through the stylet, the stylet insertable into the lumen for guiding the elongate member over a guide wire to a surgical site. 
     
     
         46 . The kit of  claim 43 , further comprising a mechanism for moving the retractor members radially outward, the mechanism being insertable into the lumen and actuatable to apply a radially outward force to move the retractor members. 
     
     
         47 . The kit of  claim 43 , further comprising a light source for illuminating the surgical site. 
     
     
         48 . A system, comprising:
 a plurality of inter-connected retractor members each having an inner surface that together define a lumen, the lumen having a first cross-sectional dimension, each of the plurality of retractor members being moveable radially outward to a second cross-sectional dimension for creating an access passage, wherein each of the retractor members includes a length between a proximal end and a distal end thereof; and   a mechanism configured to control movements of the plurality of inter-connected retractor members, wherein the mechanism includes a balloon at a distal end of a cannula, the balloon having a length approximating the length of the retractor members between the proximal end and the distal end of the retractor members, the balloon being insertable into the lumen when the lumen has the first cross-sectional dimension and the balloon being expandable in the lumen to apply a force to the inner surfaces of the retractor members to move the proximal and distal ends of the plurality of retractor members radially outward to the second cross-sectional dimension.   
     
     
         49 . The system of  claim 48 , wherein the access passage further comprises a proximal end and a distal end and a substantially constant cross-sectional dimension between the proximal end and the distal end. 
     
     
         50 - 52 . (canceled) 
     
     
         53 . The system of  claim 48 , further comprising
 a retractor member arm extending outwardly from a proximal end of each retractor member; and   a retainer ring comprising a plurality of retractor member guide channels and configured for placement at the proximal end of and concentric to the plurality of retractor members, each retractor member arm slidable within one of the guide channels.   
     
     
         54 . The system of  claim 48 , further comprising a mechanism for securing each of the plurality of retractor members in a first position comprising the first cross-sectional dimension and in a second position comprising the second cross-sectional dimension. 
     
     
         55 . The system of  claim 48 , further comprising a stylet comprising a pointed tip and a guide wire bore extending through the stylet, the stylet insertable into the lumen for guiding the elongate member over a guide wire to a surgical site. 
     
     
         56 . The system of  claim 53 , the access passage further comprising one cross-sectional dimension from a range of cross-sectional dimensions between the first cross-sectional dimension of the lumen and a cross-sectional dimension equal to an inside diameter of the retainer ring. 
     
     
         57 . The system of  claim 48 , further comprising a light source for illuminating a surgical site. 
     
     
         58 . The system of  claim 48 , further comprising a barrier material between at least two of the retractor members. 
     
     
         59 . The system of  claim 48 , further comprising a barrier material between each pair of adjacent retractor members. 
     
     
         60 - 74 . (canceled)