Instrument access device

Abstract

An instrument access device ( 500 ) comprises a distal O-ring ( 11 ) for insertion into a wound interior, a proximal member for location externally of a wound opening and a sleeve ( 12 ) extending in two layers between the distal O-ring ( 11 ) and the proximal member. The proximal member comprises an inner proximal ring member ( 25 ) and an outer proximal ring member ( 24 ) between which the sleeve ( 12 ) is led. A seal housing ( 300 ) is mounted to the inner proximal ring member ( 25 ). A gelatinous elastomeric seal ( 302 ) with a pinhole opening ( 303 ) therethrough is received in the housing ( 300 ). An instrument may be extended through the seal ( 302 ) to access the wound interior through the retracted wound opening in a sealed manner. [ FIG. 58( a )( i ) ]

1 . An instrument access device comprising:
 a distal anchoring member for insertion into a wound interior;   an elongate member extending proximally from the distal anchoring member to retract laterally the sides of a wound opening; and   an instrument working channel through which an instrument may extend to access the wound interior.   
     
     
         2 . An access device as claimed in  claim 1  wherein the device comprises a proximal member for location externally of a wound opening. 
     
     
         3 . An access device as claimed in  claim 2  wherein the proximal member comprises a ring member. 
     
     
         4 . An access device as claimed in  claim 2  wherein the proximal member comprises a proximal inner element and a proximal outer element. 
     
     
         5 . An access device as claimed in  claim 4  wherein the elongate member is led between the proximal inner element and the proximal outer element. 
     
     
         6 . An access device as claimed in  claim 4  wherein the proximal inner element and/or the proximal outer element comprises a ring element. 
     
     
         7 . An access device as claimed in  claim 4  wherein the proximal outer element is mounted to the proximal inner element. 
     
     
         8 . An access device as claimed in  claim 7  wherein the proximal outer element is demountable from the proximal inner element. 
     
     
         9 - 98 . (canceled) 
     
     
         99 . A method of accessing a wound interior with an instrument, the method comprising the steps of:
 inserting a distal anchoring member through an incision, the distal anchoring member having an elongate member attached thereto;   presenting an instrument working channel member to the incision;   pulling the elongate member upwardly relative to the instrument working channel member to at least partially insert the instrument working channel member into the incision; and   inserting an instrument through the incision.   
     
     
         100 . A method as claimed in  claim 99  wherein the elongate member lies at least in part between the instrument working channel member and the walls of the incision. 
     
     
         101 . A method as claimed in  claim 99  wherein the incision is a laparoscopic incision. 
     
     
         102 . A method as claimed in  claim 101  wherein the sides of the incision are retracted to a diameter of less than 40 mm. 
     
     
         103 . A method as claimed in  claim 102  wherein the sides of the incision are retracted to a diameter of between 3 mm and 35 mm. 
     
     
         104 . A method as claimed in  claim 103  wherein the sides of the incision are retracted to a diameter of between 5 mm and 12 mm. 
     
     
         105 . A method as claimed in  claim 99  wherein the sides of the incision are retracted to a diameter substantially equal to a diameter of the instrument working channel member. 
     
     
         106 . A method as claimed in  claim 99  wherein the sides of the incision are at least partially retracted by insertion of the instrument working channel member into the incision. 
     
     
         107 - 118 . (canceled) 
     
     
         119 . A method of retracting a wound opening, the method comprising the steps of:
 inserting a distal anchoring member through a wound opening into a wound interior;   locating a proximal member externally of the wound opening with an elongate member extending at least between the distal anchoring member and the proximal member;   locating a guide member externally of the wound opening;   moving the guide member and the proximal member relative to the elongate member to retract laterally the sides of the wound opening; and   removing the guide member while the distal anchoring member, the proximal member and the elongate member remain in position retracting the wound opening.   
     
     
         120 . A method as claimed in  claim 119  wherein the elongate member is led between the proximal member and the guide member. 
     
     
         121 . A method as claimed in  claim 119  wherein the elongate member extends in two layers between the proximal member and the distal anchoring member. 
     
     
         122 . A method as claimed in  claim 119  wherein the proximal member is moved by pushing the guide member which engages the proximal member. 
     
     
         123 - 140 . (canceled)