fig1 illustrates an embodiment of a surgical access device 10 of the present invention shown applied to a patient 12 . the surgical access device 10 has a flexible base 14 for removable attachment to a portion of skin 16 and a hollow stem 18 extending outwardly from the base 14 . the flexible base 14 is generally large enough to cover a surgical incision 20 ( not seen in fig1 ) as well as covering sufficient skin 16 to insure adequate adhesion . a peripheral edge 22 surrounds the flexible base 14 . an operative instrument 24 is shown passing through an operative passageway 26 in the hollow stem 18 . referring now to fig2 - 3 , the surgical access device 10 will be described in greater detail . the base 14 is preferably a thin planar sheet of flexible material . the base 14 may be of any shape but preferably is of sufficient surface area to provide secure adhesion to the skin 16 of the patient 12 such that the surgical access device 10 is not moved or removed during the surgical procedure . the peripheral edge 22 provides a transition from the flexible base to the skin 16 . in this way the peripheral edge 22 may be smooth and may even taper downwardly towards the skin 16 to prevent the base 14 from being pulled up or otherwise off of the skin 16 . the flexible base has an opening 28 for isolating a surgical incision 20 . the opening 28 is preferably of the same or a slightly larger size than the incision 20 to provide isolation of the incision 20 as well as for maintaining an incision 20 in an open state . the opening 28 may be cut or otherwise provided in the flexible base 14 prior to attachment to the patient 12 or may be directly made in the flexible base 14 by a surgeon after attachment to the patient 12 . in this way , the surgical incision 20 and the opening 28 may be made simultaneously . typically , this may be done using a surgical blade or other device as is known to those of skill in the art of surgical incisions . the opening 28 is preferably centrally located on the surface of the flexible base 14 . the hollow stem 18 extends outwardly from the flexible base 14 and away from the patient 12 . the hollow stem 18 is preferably a flexible member and may be integral with the flexible base 14 such that the two comprise a single molded piece . however , the hollow stem 18 may also be attached to the base using an adhesive or any other method as is known in the art of joining surgical elastic materials . the hollow stem 18 is centered over the opening 28 such that the operative passageway 26 provides a direct path to the incision 20 . by being flexible , the hollow stem 18 allows for increased maneuverability of an operative device or instrument 24 passing through the operative passageway 26 . an instrument seal 30 is attached across the hollow stem 18 . in this way , a seal is created around an operative instrument 24 inserted through the hollow stem 18 . in a preferred embodiment , the instrument seal 30 comprises a flexible sheet of elastic material 32 extending across the hollow stem 18 to form a centrally disposed opening 34 . this opening 34 is elastically expandable for sealed contact against the exterior walls of an inserted instrument 24 . a highly elastic material is desirable since this minimizes the necessity to provide different instrument seals 30 having different disposed opening diameters 34 . the flexible sheet of elastic material 32 preferably extends across an upper end 36 of the hollow stem 18 . this allows for the flexible base 14 , the hollow stem 18 and the instrument seal 30 to all be made from a single integral piece . however , the instrument seal 30 may be attached most anywhere across the hollow stem 18 . an adhesive or any other method as is known in the art , may be used to attach the instrument seal 30 to the inner walls of the operative passageway 26 . an operative valve 38 may also be attached within said hollow stem 18 . the operative valve 38 provides a penetrable seal across the operative passageway 26 within the hollow stem 18 and may also be used to maintain an inflated or distended peritoneum . in this fashion , the instrument seal 30 is preferably placed outwardly from the flexible base 14 in relation to the operative valve 38 such that an operative instrument 24 inserted into the hollow stem 18 is sealed across the instrument seal 30 prior to penetrating the gas - tight barrier of the operative valve 38 . the operative valve 38 may be attached to the interior wall of the hollow stem 18 and extend across the operative passageway 26 . however , the operative valve 38 may also be attached to or an integral part of the flexible base 14 . attachment of the operative valve 38 is similar to that described for the instrument seal 30 . a plurality of flexible flaps 40 allow penetration through the valve 38 while maintaining a gas - tight barrier when not penetrated . in a preferred embodiment , the operative valve 38 may be a duck - bill valve 42 such as the duck - bill valve described in u . s . pat . no . 5 , 443 , 452 , to hart et al ., is incorporated herein fully by reference . however , any type of valve or seal which is penetrable by an operative instrument 24 and which can maintain a gas - tight barrier across the operative passageway 26 within the hollow stem 18 may be utilized . an adhesive coating 44 may be applied to the flexible base 14 or the skin 16 surrounding the surgical incision 20 to positively secure the surgical access device 10 the patient 12 . the adhesive 44 may be formed of any suitable non - tissue reactive adhesive material such as , for example , hollister medical adhesive , manufactured by hollister , inc ., or elastoplast , manufactured by biersdorf , inc . a release sheet ( not shown ) may be supplied when the adhesive coating 44 is applied to the flexible base 14 prior to attachment to the skin 16 . the release sheet may be formed of any suitable paper or plastic material allowing the release sheet to be manually pealed away from the layer to expose the adhesive coating 44 . in addition to an adhesive coating 44 , the surgical access device 10 may also be attached to a patient 12 in other ways . for example , the natural adhesion of the material , securing straps and devices or any other method of attaching a flexible sheet of material to the skin . the use of securing straps advantageously allows the flexible base to be tightened against the skin , maintaining an open incision 20 . fig4 shows the surgical access device 10 having a plurality of hollow stems 18 attached to the base 14 . in this fashion , the surgical access device 10 provides access into an operative region ( not shown ) through almost any number of differing locations . the use of multiple access devices 10 also allows the use of multiple surgical or other operable instruments 24 each of which may be passed through an individual operative passageway 26 within each hollow stem 18 . in addition , each of the hollow stems 18 may be provided with differing size and types of instrument seals 30 and / or operative valves 38 . the flexible base 14 may also be used to support various sizes of openings 28 to be covered by the hollow stems 18 . this greatly increases the flexibility of the surgical procedures available within the operative region . referring now to fig5 - 6 , an alternative embodiment of a surgical access device 50 constructed in accordance with the principles of the present invention will be described . in this embodiment , like features to those of the previous embodiment are designated by like reference numerals , succeeded by the letter &# 34 ; a &# 34 ;. the surgical access device 50 includes a flexible base 14a having a peripheral edge 22a as described in the previous embodiment . however , in this embodiment , the hollow stem 18a comprises a plurality of flexible concentric rings 52 made from an elastic material . these flexible rings 52 may be hollow concentric tubes which are stacked on top of each other . however , the rings 52 may also be made from folds of material . the flexible rings 52 may be made of any cross - sectional shape such as circular , oval or any other shape which facilitates access for various surgical instruments 24a within the patient 12a . the instrument seal 30a may be made from one of the concentric rings 52 of elastic material . in this fashion , the instrument seal 30a is a flexible ring 52 having a flexible sheet of elastic material 32a extending across the operative passageway 26a as previously described . however , the instrument seal 30a may also be comprised of a flexible ring 52 which extends inwardly to form a smaller diameter than the remaining concentric rings 52 . thus , the instrument seal 30a which is preferably an elastic material , is expandable such that it surrounds an inserted operative instrument 24a to provide the desired seal . this seal is made as the inner diameter of the seal 30a forms a continuous contact against the exterior wall of the instrument 24a . an operative valve 38a may be disposed across the operative passageway 26a to provide a gas - tight barrier as previously described . referring now to fig7 - 10 , a second alternative embodiment of a surgical access device constructed in accordance with the principles of the invention will be described . in this embodiment , like features to those of previous embodiments are designated by like reference numerals , succeeded by the letter &# 34 ; b &# 34 ;. the surgical access device 60 includes a flexible base 14b and a hollow stem 18b which is oriented at an angle . this embodiment allows for an angled access which may be an oblique entrance into an operable region 62 which may otherwise be impossible . in particular , a surgical procedure , such as a vein harvesting procedure , requires a relatively shallow access adjacent the surgical incision 20b . this type of procedure is generally not possible utilizing a trocar which prevents the angled access . the hollow stem 18b may be provided at any angle which orients up from the flexible base 14b . however , an angle of between approximately 20 degrees and 60 degrees is found preferable . when performing a procedure , such as a vein harvesting procedure within the leg of a patient 12b , it is often necessary to create an anatomical cavity 64 within the operative region 62 without the use of insufflation . to create this anatomical cavity 64 , the surgical access device 60 is first attached to a portion of skin 16b using an adhesive coating 44b . a pull tab 66 attached to the flexible base 14b is used to pull the flexible base outwardly away from the patient 12b . in this way , the skin 16b attached to the flexible base 14b is pulled away , exposing an operative region 62 and creating an anatomical cavity 64 . any number of pull tabs 66 or other devices which allow the surgical access device 60 to be drawn outwardly away from the patient 12b may be utilized . the pull tabs 66 may be of a size or shape that facilitates a strong grip with a gloved hand . the pull tabs 66 may even comprise hoops or rings made from a plastic or metal . fig1 illustrates a third alternative embodiment of a surgical access device constructed in accordance to the principles of the present invention . in this embodiment , like features to those embodiments are designated by like reference numerals succeeded by the letter &# 34 ; c &# 34 ;. the surgical access device 70 includes a flexible base 14c having a centrally located opening 28c for isolating a superfascial incision 20c within a portion of skin 16c of a patient 12c . an adhesive coating 44c may be applied between the flexible base 14c and the skin 16c to insure adequate attachment of the access device 70 to the patient 12c . however , alternative securing devices 72 may be used alone or in conjunction with the adhesive coating 44c . the securing device 72 may include a rigid or flexible strap which extends around the patient 12c securing the surgical access device 70 to the skin 16c . however , any form of securing device 72 such as bands , hooks or any other device for securing a flexible planar base 14c to the patient 12c may be utilized . by cinching down on the securing device 72 , the planar base 14c is advantageously stretched . in this fashion , the opening in the base 14c is forced open as is the isolated incision 20c . thus , the incision 20c may be maintained open during a surgical procedure . the surgical access device 70 is also advantageously designed such that the opening 28c may be made simultaneously with the surgical incision 20c . in this fashion , the surgical access device 70 is secured to the skin 16c and the opening 28c along with the surgical incision 20c are made together . the securing device 72 may then be cinched somewhat tighter to maintain both the opening 28c and the surgical incision 20c open . a removable hollow stem 18c , having an instrument seal 30c and an operative valve 38c may be attached to the surgical access device 70 such that an operative passageway 26c is provided through the hollows stem 18c and into the surgical incision 20c . by providing a removable hollow stem 18c , both laparoscopic and open surgical techniques can be utilized during a single surgical procedure and utilizing a single surgical incision 20c . fig1 shows a fourth alternative embodiment of a surgical access device constructed in accordance with the principles of the present invention . in this embodiment , like features to those of previous embodiments are designated by like reference numerals succeeded by the letter &# 34 ; d &# 34 ;. the surgical access device 80 includes an elastomeric sleeve 82 for surrounding a distended anatomical cavity 84 . typically , the distended cavity will be an abdominal cavity , but the principles also apply to other regions such as a leg . a rib is attached to the sleeve 82 , such that it surrounds the distended anatomical cavity 84 while supporting the shape of the distended attached sleeve 82 . the surgical access device 80 is used to maintain a distended anatomical cavity 84 by first securing the sleeve 82 to at least a portion of skin 88 surrounded by the sleeve 82 . an adhesive coating 44d may preferably be utilized since the skin 88 must remain attached to the sleeve 82 . prior to securing the sleeve 82 to the skin 88 , the anatomical cavity 84 is preferably fully distended . this may be accomplished by insufflating the cavity 84 using a positive pressure as is known to those of skill in the art . alternatively , the sleeve 82 may be adhered to the skin 88 without first distending the cavity and the sleeve pulled outwardly as previously described . a rib 86 is then secured to the sleeve 82 to support and maintain the sleeve 82 in the distended position . in this way , the skin 88 surround the distended anatomical cavity 84 is secured to the sleeve 82 which is structurally supported by the rib 86 . additional ribs or other structurally supporting members 86 may be attached to the sleeve 82 to further support and maintain the distended anatomical cavity 84 . access within the anatomical cavity 84 may be accomplished by attaching a hollow stem 18d , including an instrument seal 30d and an operative valve 38d as previously described . a surgical incision 20d may be made prior to securing the surgical access device 80 to the patient 12d . alternatively , an incision may be made through both the sleeve 82 and the patient 12 in a similar fashion to that described with the base 14 . in this fashion , the surgical access device 80 acts to maintain the distended anatomical cavity 84 as well as providing superfascial access at any desired location along the sleeve 82 . in addition , insufflation may be used to maintain the distended anatomical cavity 84 . the sleeve 82 which is preferably a sheet of elastomeric material may be provided as a continuous sleeve or alternative as a single sheet which is wrapped around the anatomical cavity 84 and secured to itself . while this invention has been described with respect of various specific examples and embodiments , it is to be understood that the invention is not limited thereto and that it can be variously practiced within the scope of the following claims .
a surgical access device for providing gas tight communication to an anatomical cavity which facilitates the insertion and use of surgical instruments while maintaining the anatomical cavity . the access device allows for the use of laparoscopic instruments in tight surgical locations without the need for a trocar or other supportive device . in addition , the surgical access device allows the use of non - laparoscopic instruments in a laparoscopic setting to add flexibility and improved sterility to an open surgery . increased surgical instrument access and mobility within the anatomical cavity is achieved with a reduced need for insufflation . the access surgical device includes a flexible planer base with an integral opening for isolating and maintaining an open surgical incision . a hollow stem having an instrument seal is attached to the base over the incision . the stem also includes a valve for maintaining a positive gas pressure within the anatomical cavity .