the surgical access apparatus of the present disclosure provides a substantial seal between the body cavity of a patient and the outside atmosphere before , during and after insertion of an object through the apparatus . moreover , the access apparatus of the present disclosure is adapted for positioning within an incision and may retract the tissue defining the incision to permit access to the underlying tissue . the access apparatus is particularly adapted for accommodating the hand and / or arm of a surgeon during a hand assisted laparoscopic procedure and establishing a gas tight seal with the arm when inserted . however , the access apparatus may be adapted to receive other objects , such as surgical instruments . the access apparatus is further adapted to substantially close in the absence of the object to maintain the integrity of the insufflated peritoneal cavity . although the specific focus of this disclosure will be on a preferred laparoscopic procedure , it will be noted that laparoscopic surgery is merely representative of a type of operation wherein a procedure can be performed in a body cavity with access through a body wall . in the following description , as is traditional the term “ proximal ” refers to the portion of the instrument closest to the operator , while the term “ distal ” refers to the portion of the instrument remote from the operator . referring now to fig1 - 2 , hand access apparatus 10 includes two main components , namely , access housing 12 and liner base 14 which is mounted to the access housing 12 . access housing 12 is positioned external to the body , preferably , in contact with the outer skin of the body and consists of outer frame or housing member 16 , seal support 18 disposed within the housing member 16 and first and second seals 20 , 22 . housing member 16 preferably defines outer flange 24 dimensioned for engagement by the surgeon and lower u - shaped flange 26 . u - shaped flange 26 contacts the skin of the patient upon application of access apparatus 10 . u - shaped flange 26 also serves to mount liner base 14 . housing member 16 defines housing axis “ a ” and internal longitudinal passageway 28 extending through the housing member 16 . housing member 16 may be a single piece component or alternatively incorporate multiple pieces assembled together by conventional means . in one preferred embodiment , housing member 16 incorporates two components 16 a , 16 b as depicted in fig2 . housing component 16 b serves as a cover for enclosing first and second seals 20 , 22 and is connected to housing component 16 a in fixed relation . seal support 18 of access housing 12 is an elongated annular collar which extends at least partially within housing member 16 . the upper surface 30 of seal support 18 includes a plurality ( two are shown ) of upstanding posts 32 peripherally spaced about the periphery of the upper surface 30 . referring now to fig3 - 4 , in conjunction with fig1 - 2 , first seal 16 includes outer seal portion 34 and inner seal portion 36 . outer seal portion 34 defines a plurality of apertures 38 which receive corresponding posts 32 of seal support 18 to mount first seal 20 to the seal support 18 . outer seal portion 34 also includes a plurality of ribs 40 radially displaced about the outer seal portion 34 . ribs 40 define an undulating arrangement as shown in fig4 . the undulating arrangement permits expansion of outer seal portion 34 particularly during offset manipulation of the object relative to housing axis “ a ”. ribs 40 are each preferably arranged along a line of intersection “ b ” with housing axis “ a ” to permit uniform expansion and movement of first seal 20 . ribs 40 may take other shapes and forms such as , for example , a sinusoidal configuration , pyramidal , convex , concave etc . . . . inner seal portion 36 defines internal aperture or opening 42 . aperture 42 is arranged about first seal axis “ c ” ( fig2 ) which is preferably radially offset from housing axis “ a ”. aperture 42 may be any suitable geometrical shape including circular , elliptical , square , rectangular , or any other polygonal arrangement . in the preferred embodiment , aperture 42 is generally d - shaped . inner seal portion 36 is adapted to radially move upon insertion of an object though aperture 42 as facilitated by ribs 40 to permit the aperture 42 to assume a position in general alignment with housing axis “ a ”. with reference to fig5 , in conjunction with fig1 - 2 , second seal 22 includes outer seal portion 44 and inner seal portion 46 . outer seal portion 44 also includes apertures 48 disposed about its periphery for reception of posts 32 of seal support 18 to mount the second seal 22 within housing member 16 . inner seal portion 46 defines opening or aperture 50 which may be of any geometrical shape , but , preferably , is generally d - shaped . aperture 50 is arranged to be a mirror image of aperture 42 of first seal 20 . aperture 50 is arranged about second seal axis “ d ” which is radially offset from housing axis “ a ”. alternatively , as depicted in fig5 a , aperture 50 may be centrally located within second seal 22 with second seal axis “ d ” coincident with axis “ a ” of housing member 16 . this arrangement may minimize the degree of movement required by first seal 20 and also positions the object in the center of housing member 16 during use . second seal 22 may optionally include expansible ribs of the type aforedescribed in connection with first seal 20 . first and second seals 20 , 22 are each adapted to form a substantial seal about an object inserted through their apertures 42 , 50 and may stretch to accommodate larger size objects . first and second seals 20 , 22 are preferably in juxtaposed contacting relation . first and second seals 20 , 22 may be formed of an elastomeric material including commercially available monoprene ™. in one preferred embodiment , seals 20 , 22 are fabricated from a resilient material , e . g ., polyisoprene , with each having at least one layer of fabric material positioned adjacent the resilient material . seals 20 , 22 may be fabricated from an elastomeric material molded with a fabric material . a friction resisting coating may be applied to seals 20 , 22 . such seal is disclosed in commonly - assigned u . s . patent application ser . no . 10 / 165 , 373 filed jun . 6 , 2002 , the contents of which are incorporated in its entirety by reference . fig6 illustrates in plan view the arrangement of first and second seals 20 , 22 ( with second seal 22 shown in phantom ) prior to insertion of an object within the apertures 42 , 50 of the seals 20 , 22 . as shown , apertures 42 , 50 of first and second seals 20 , 22 are in non - overlapping relation , and arranged so that the respective apertures of the first and second seal do not overlap . with this arrangement and with first and second seals 20 , 22 in contacting relation , the seals 20 , 22 substantially seal longitudinal passageway 28 of housing member 16 to prevent escape of insufflation gases through access housing 12 . referring again to fig1 - 2 , liner base 14 of access apparatus 10 will be discussed . liner base 14 is intended for positioning within the incision of the patient to line the incision and / or retract the tissue defining the incision thereby providing access to the underlying body cavity . liner base 14 includes liner member 52 , and lower ring 54 and upper ring 56 mounted to respective ends of liner member 52 . liner member 52 may be a sheet of flexible material including , for example , polyethylene , polypropylene , etc ., arranged in a tubular or sleeve - like configuration . liner member 52 may also include an elastomeric material and may incorporate rigid runners embedded within the material to increase its rigidity . although in the preferred embodiment , liner member 52 is tubular , it is envisioned that the liner member 52 may incorporate several pieces , e . g ., individual tabs or the like . liner member 52 may or may not be impervious to fluids . liner member 52 is adapted to line the incision so as to prevent contamination of the incision by any tissue which may be removed through the access apparatus , or in the course of the surgery . generally , liner member 52 may also serve to retract the incision during placement of the liner base 14 , so that the patient &# 39 ; s skin , fascia , and other tissue are drawn back , allowing access to the surgical site . lower ring 54 of liner member 52 is adapted for positioning through the incision and beneath the abdominal wall to engage the interior wall portions to thereby secure liner base 14 relative to the incision . lower ring 54 is preferably flexible to facilitate passage through the incision and possesses sufficient resiliency to return to its original configuration upon entering the abdominal cavity . lower ring 54 is preferably annular or ring - like in configuration and may be fabricated from a resilient or elastomeric material . lower ring 54 may be fixedly secured to the end of liner member 52 through conventional means . upper ring 56 is substantially identical to lower ring 54 , i . e ., upper ring 56 is also annular or ring - like in configuration and is attached to the other end of liner member 52 by conventional means . upper ring 56 is received within u - shaped flange 26 of access housing 12 and is secured between the flange 26 and lower surface 58 of seal support 18 to secure liner base 14 to access housing 12 . other means for attaching upper ring 56 to access housing 12 are also envisioned . in further embodiments , seal support 18 discussed above in connection with fig1 - 9 is mounted to a different base for retracting the incision and preferably lining the incision . for example , the base 14 may comprise a flexible sleeve for lining the incision and an inflatable member at a proximal end of the sleeve for tensioning the sleeve . other structures for the base 14 may be used as appreciated by those of ordinary skill in the art . the access apparatus 10 discussed above may also include an additional seal for sealing around the object inserted through the apparatus , such as a septum seal . the use of the access apparatus 10 in connection with a hand assisted laparoscopic surgical procedure will be discussed . the peritoneal cavity is insufflated and an incision is made within the cavity , with e . g ., a trocar , to provide access to the cavity as is conventional in the art . thereafter , as depicted in fig7 - 8 , liner base 14 is introduced within the incision . specifically , lower ring 54 is passed through the incision “ i ” and placed within the body cavity . as noted , lower ring 54 may be contracted upon itself to facilitate passage through the incision “ i ” and then released to permit the lower ring 54 to return to its normal condition ( under the influences of its inherent resiliency ) within the cavity . liner member 52 extends from lower ring 54 through the incision to line the incision as previously discussed . with reference to fig9 , the procedure is continued by positioning access housing 12 adjacent the external body tissue with the outer surface of u - shaped flange 26 engaging the tissue surrounding the incision . thereafter , an object such as the surgeon &# 39 ; s hand or arm “ o ” is introduced within access housing 12 and advanced through aperture 42 of first seal 20 . as noted , inner seal portion 36 of first seal 20 moves radially as facilitated by expansion of ribs 40 to permit aperture 42 to at least partially overlap with aperture 50 of second seal 22 thereby permitting the surgeon to continue advancing his arm through access housing 12 and liner base 14 . the surgeon continues to advance his arm though aperture 50 of second seal 22 and within the abdominal cavity . with access apparatus 10 in this position of fig9 , hand assisted surgery may then be effected by continued advancement of the surgeon &# 39 ; s hand and arm through seals 20 , 22 of access housing 12 and into the body cavity . seals 20 , 22 form a fluid tight seal about the arm . the desired hand assisted procedure may then be performed . it will be understood that various modifications may be made to the embodiments disclosed herein . therefore , the above description should not be construed as limiting , but merely as exemplifications of preferred embodiments . those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto .
a surgical access apparatus adaptable to permit the sealed insertion of either the surgeon &# 39 ; s hand and / or surgical instruments during laparoscopic and endoscopic surgical procedures includes an access member having a passageway therethrough and first and second seal members mounted across the passageway . the first and second seal members each has an aperture in non - overlapping relation to each other in the absence of the object positioned therein . the outer seal portion of the first seal member may include a plurality of expansible ribs and corresponding recesses arranged along respective lines of intersection with the axis of the first seal member .