Trocar with beveled needle insertion aperture and coplanar obturator

Abstract

A surgical access device includes a cannula and a housing assembly coupled to a proximal end of the cannula. A working channel defined by a cannula lumen and a housing interior extends between a proximal end and a distal end of the surgical access device along a central axis of the surgical access device. The working channel is configured to receive a surgical instrument, and an insufflation port is configured to direct insufflation fluid into the working channel. First and second needle ports open to the working channel through respective first and second side portions of the surgical access device. The first needle port is diametrically opposed from the insufflation port. Each of the first and second needle ports is configured to direct a suture passer needle to pass through the surgical access device across the working channel at an oblique angle relative to the central axis.

Description

Background Technology

[0001] Surgical procedures may require clinicians to access cavities or other desired surgical sites within a patient's body. To perform such procedures, an incision is made through the patient's tissue to enter the cavity. Some routine surgical procedures involve using a scalpel, such as a surgical knife, to create the incision, while some minimally invasive surgeries, such as laparoscopic and endoscopic surgeries, utilize a cannula assembly for access to the cavity. A conventional cannula assembly typically includes a cannula occluder housed within a cannula cannula. In use, the clinician guides the cannula occluder and cannula through the tissue to access the cavity at the desired surgical site. Once inside, the clinician withdraws the cannula occluder from the cannula cannula, making the cannula available for introducing surgical instruments into the cavity for further processing.

[0002] The following patents provide examples of cannula assemblies, their components, and other types of surgical access devices and wound closure devices: U.S. Patent 7,981,092, entitled "Vibratory Trocar," published July 19, 2011; U.S. Patent 8,226,553, entitled "Access Device with Insert," published July 24, 2012; U.S. Patent 8,251,900, entitled "Surgical Access Devices and Methods Providing Seal Movement in Predefined Paths," published August 28, 2012; U.S. Patent 8,579,807, entitled "Absorbing Fluids in a Surgical Access Device," published November 12, 2013; U.S. Patent 8,568,362, entitled "Surgical Access Device with Sorbents," published October 29, 2013; and U.S. Patent 8,568,362, entitled "Surgical Access Device with Sorbents," published January 28, 2014. U.S. Patent 8,636,686 entitled “Device”; U.S. Patent 8,690,831 entitled “Gas Jet Fluid Removal in a Trocar” published on April 8, 2014; U.S. Patent Publication 2008 / 0200950 entitled “Surgical Hook” published on August 21, 2008; U.S. Patent Publication 2015 / 0038793 entitled “Devices, Systems, and Methods for Providing Surgical Access and Facilitating Closure of Surgical Access Openings” published on February 5, 2015; U.S. Patent Publication 2015 / 0038994 entitled “Devices, Systems, and Methods for Providing Surgical Access and Facilitating Closure of Surgical Access Openings” published on February 5, 2015; and U.S. Patent Publication 2015 / 0038994 entitled “Wound Closure Device including Mesh” published on April 2, 2015. U.S. Patent Publication 2015 / 0094741, concerning “Barrier”, is cited herein by reference.

[0003] Surgical instruments used with such surgical access devices may have a distal end effector (e.g., an endoscopic cutter, gripper, scalpel, suturer, applicator, access device, drug / gene therapy delivery device, and energy delivery device using ultrasonic vibration, RF, laser, etc.) for engaging tissue in various ways through the access device to achieve diagnostic or therapeutic effects. Laparoscopic and endoscopic surgical instruments may include an axis located between the end effector and a handle portion manipulated by the clinician. Such an axis allows insertion to a desired depth and rotation about the longitudinal axis of the axis, thereby facilitating the positioning of the end effector within the patient's cavity. Positioning of the end effector may be further facilitated by including one or more articulation joints or features, allowing the end effector to selectively articulate or otherwise deflect relative to the longitudinal axis of the axis.

[0004] Although various surgical instruments, including surgical access devices and end effectors, and other associated components have been manufactured and used, it is believed that no one has manufactured or used the invention described in the appended claims prior to one or more inventors. Attached Figure Description

[0005] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention and, together with the general description of the invention given above and the detailed description of the embodiments given below, serve to explain the principles of the invention.

[0006] Figure 1 A perspective view of an exemplary cannula assembly is shown;

[0007] Figure 2 It shows Figure 1 A partially exploded side front view of a cannula assembly having a cannula housing, a cannula cannula, and an occluder.

[0008] Figure 3A It shows having Figure 1 A side cross-sectional view of the patient tissue of the cannula assembly, which passes through the tissue and is manipulated by a clinician.

[0009] Figure 3B It shows Figure 3A A side sectional view of the tissue and cannula assembly, in which Figure 1 The cannula assembly is inserted through the tissue and received within the patient's cavity;

[0010] Figure 3C It shows Figure 3AA side sectional view of the tissue and cannula assembly, wherein the occluder is withdrawn from the cannula for entry into the cavity via a working channel through the cannula and the cannula housing.

[0011] Figure 3D It shows Figure 3C A side sectional view of the tissue and cannula assembly, showing the cannula housing and cannula insert being removed from the patient's cavity and tissue;

[0012] Figure 4A It shows the removal Figure 1 After the cannula assembly Figures 3A to 3D The diagram shows another sectional view of the tissue, which has an opening through the tissue and a suture introduced into a portion of the tissue for closing the opening.

[0013] Figure 4B It shows Figure 4A A lateral sectional view of the tissue, in which a suture is introduced through another part of the tissue and pulled through the tissue;

[0014] Figure 4C It shows Figure 4A A lateral sectional view of the tissue, wherein the sutures are tightened and knotted to at least partially close the opening;

[0015] Figure 4D It shows Figure 4A A lateral sectional view of the tissue, wherein the tissue has additional sutures for further closure of the opening;

[0016] Figure 5 A perspective view of an exemplary cannula needle having a housing assembly, a cannula, and a needle orifice is shown;

[0017] Figure 6 It shows Figure 5 Exploded perspective view of the cannula;

[0018] Figure 7 It shows Figure 5 A side sectional view of the cannula shows an exemplary suture needle guide that extends through the cannula along an exemplary first suture path oriented obliquely relative to the central axis of the cannula.

[0019] Figure 8 It shows Figure 5 Top front view of the cannula, with the proximal shell of the shell assembly omitted;

[0020] Figure 9 A top front view of another exemplary cannula is shown;

[0021] Figure 10A perspective view of another exemplary cannula with a rotating collar is shown; and

[0022] Figure 11 It shows Figure 10 A perspective view of the disassembled rotating collar of the cannula and the distal housing.

[0023] The accompanying drawings are not intended to be limiting in any way, and various embodiments of the invention can be conceived to be implemented in many other ways, including those not necessarily shown in the drawings. The drawings, which are incorporated in and constitute a part of this specification, illustrate several aspects of the invention and, together with the description, serve to explain the principles of the invention; however, it should be understood that the invention is not limited to the explicit arrangements shown. Detailed Implementation

[0024] The following description of certain examples of the invention is not intended to limit the scope of the invention. Other examples, features, aspects, embodiments, and advantages of the invention will be apparent to those skilled in the art from the following description, which is shown by way of example, and a preferred mode is contemplated for carrying out the invention. It will be appreciated that the invention can have other different and obvious aspects, all of which are not departing from the invention. Therefore, the drawings and descriptions should be regarded as substantially illustrative and not restrictive.

[0025] I. Exemplary Surgical Access Device

[0026] Figures 1-2 An exemplary surgical access device is shown in the form of a first exemplary cannula assembly (10), which includes a cannula cannula (12) and a cannula occluder (14). The cannula occluder (14) passes through the cannula housing (16) of the cannula cannula (12) and is removably received within the cannula cannula (12). Figure 1 As shown, with the cannula occluder (14) positioned within the cannula cannula (12), the clinician inserts the cannula assembly (12) through the patient's tissue (17) at the desired surgical site (see [reference]). Figure 3A ) so as to enter the cavity inside the patient's body (18) (see Figure 3A By way of example only, the cannula assembly (10) can be inserted into the patient's abdominal cavity between two ribs or at other sites. The end (20) of the cannula occluder (14) protrudes distally from the cannula cannula (12) to puncture tissue (17) (see...). Figure 3A ) so that the distal end portion of the cannula (12) can be introduced into the cavity (18) (see Figure 3B In the cannula (12), the clinician withdraws the cannula occluder (14) proximally, creating a cavity (18) within the patient's body (see...). Figure 3CThe cavity (18) is connected to the surgical environment via a cannula (12). The clinician can then introduce fluids such as gas through the cannula (12) to facilitate the filling of the cavity (18) (see [link to relevant documentation]). Figure 3A The end effector of the surgical instrument is expanded and / or introduced through a cannula (12) for use in joining tissue (17) to achieve diagnostic or therapeutic effects.

[0027] It should be understood that terms such as “proximal” and “distal” used herein are relative to the clinician’s grasp of the cannula housing (16). Thus, the tip (20) is located distally relative to the more proximal cannula housing (16). It should also be understood that, for convenience and clarity, spatial terms such as “vertical” and “horizontal” are used in the diagrams herein. However, surgical instruments are used in many orientations and locations, and these terms are not intended to be restrictive or absolute. Additionally, in some instances, the term “component” is used interchangeably with and not interchangeably with the term “assembly” (e.g., cannula and cannula assembly). There is no specific intention to use terms referring to different components. Similarly, terms such as “instrument” and “device” are used interchangeably.

[0028] A. An exemplary cannula assembly with a cannula and an occluder

[0029] Figures 1 to 2 The trocar assembly (10) includes a cannula (12) extending distally from the trocar housing (16). In this example, the trocar housing (16) has a generally cylindrical shape and a proximal removable cap (22) on top of the distal housing chamber (not shown). The cap (22) can be selectively attached to or removed from the housing chamber. The trocar housing (16) includes a housing sidewall (24) extending circumferentially about a central longitudinal axis (26) through the trocar assembly (10) and thus along the trocar cannula (12). The trocar housing (16) also includes a central lumen (27) extending from a proximal housing end opening (28) to a distal housing end opening (not shown). As shown, the cover (22) selectively engages with the housing sidewall (24) via a distal engaging member (not shown) and also includes a proximal engaging member, such as a slot (not shown), configured to be removably connected to a pair of inserts (32) extending distally from a portion of the closure (14). However, it should be understood that alternative structures and devices may also be removably connected to the cover (22) during use.

[0030] The cannula (12) extends distally from the cannula housing (16) and is generally also defined by a cannula sidewall (33) extending circumferentially around a central longitudinal axis (26). The cannula sidewall (33) extends distally to a beveled end (34) such that the cannula sidewall (33) and the beveled end (34) are configured to be inserted through tissue (17) (see See Figure 3A ) so as to enter the cavity (18) (see Figure 3A This will be discussed in more detail below. For this purpose, the cannula (12) typically has a smaller diameter than the cannula housing (16), which is configured to remain in the tissue (17) (see...). Figure 3C The cannula (12) defines an internal lumen (35) having a proximal cannula end opening (not shown) and a distal cannula end opening (36) extending through a beveled end (34). In this example, the distal housing end opening (not shown) of the cannula housing (16) is fluidly connected to the proximal cannula end opening (not shown), such that the central lumen (27) of the cannula housing (16) and the internal lumen (35) of the cannula (12) define a working channel (38). Thus, the working channel (38) extends from the proximal housing end opening (28) to the distal cannula end opening (36) and is configured to receive one or more surgical instruments passing through it for access to the lumen (18).

[0031] Furthermore, the blow-in port (40) is operatively connected to the cannula housing (16) to control the flow of blow-in fluid, such as carbon dioxide, through a portion of the cannula (12) and into the cavity (18). More specifically, the blow-in port (40) includes a piston valve (42) and a stopcock stem (44), which work together to allow and / or prevent blow-in fluid from passing through the cannula housing (16) into the passage (not shown) and into the cannula cannula (12). The cannula housing (16) and the cannula (12) have a proximal sealing assembly and a distal sealing assembly (not shown) respectively located within a central lumen (27) and an inner lumen (35) of the working channel (38). In this example, the proximal sealing assembly is an instrument seal (not shown), while the distal sealing assembly (not shown) is a zero-closure seal, such as a duckbill seal (not shown). An instrument seal (not shown) is held within the cap (22) and is configured to provide a fluid seal for surgical instruments extending through the working channel (38). In contrast, when no instrument is positioned to pass through the working channel (38), a duckbill seal (not shown) is configured to form a seal within the working channel, thereby preventing leakage of blown-in fluid during use. It should be understood, of course, that alternative sealing assemblies may be positioned within the working channel (38) to prevent such leakage of blown-in fluid.

[0032] The duckbill seal is also configured to be manipulated to provide an opening to the working channel (38) larger than the corresponding opening provided by the instrument seal. This larger opening provided by the duckbill seal facilitates the aspiration of body tissue through the cannula housing (16) during surgical procedures. Specifically, the cap (22) and the proximal instrument seal can be removed to expose the duckbill seal, thereby allowing the surgeon to aspirate body tissue proximally through the opening of the duckbill seal that would otherwise be too large to be aspirated proximally through the opening of the instrument seal.

[0033] As briefly discussed above, the occluder (14) is used in conjunction with the cannula (12) for inserting the cannula assembly (10) into a patient. The occluder (14) of this example includes a shank head (46) having a cylindrical shaft (48) extending distally therefrom to a distal end (20), the distal end typically configured to puncture tissue (17) (see [link to relevant documentation]). Figure 3A The handle head (46) is configured to be gripped by a clinician during use and optionally includes a movable insert (32) that extends distally to be removably engaged with the cannula housing (16) for selective fixation. A shaft (48) is received through the working channel (38) such that an end (20) extends distally from a beveled end (34). Of course, the occluder (14) can be selectively removed from the cannula (12) and the cannula housing (16) to release the working channel (38) for use. While the cannula assembly (10) of this example has an occluder (14), it should be understood that in some examples the cannula (12) can be inserted without the occluder (14), or alternatively configured to facilitate insertion without the use of the occluder (14).

[0034] B. Exemplary methods for entering a patient's internal cavity

[0035] Figures 3A to 3D The cannula assembly (10) described above is shown penetrating tissue (17) into a cavity (18). More specifically, the tissue (17) in this example has a relatively outward superficial layer and a relatively inward deep layer. The superficial layer typically comprises an outer skin layer (52) and an inner fat layer (54); while the deep layer comprises a fibrous and flexible fascia layer (56) with relatively higher tensile strength than the superficial layer. Figure 3AAs shown, with the occluder (14) received within the cannula (12) and connected to the cannula housing (16), the clinician manipulates the cannula assembly (10) to press the end (20) of the occluder (14) against the skin (52) and inward toward the cavity (18), while simultaneously rotating the cannula assembly (10) back and forth. Arrows (49) and (50) indicate this inward movement and rotatable movement, respectively. Continued inward pressing of the cannula assembly (10) further guides the end (20) and beveled end (34) of the cannula (12) through the fat layer (54) and fascia layer (56) and into the cavity (18), as... Figure 3B As shown. The clinician then disconnects the occluder (14) from the cannula housing (16) and withdraws the occluder (14) from the cannula (12) to establish a pathway from the outside of the tissue (17) into the cavity (18) via the working channel (38), as shown. Figure 3C As shown, this is for use with another surgical instrument (not shown) to achieve a diagnostic or therapeutic effect. Once the diagnostic or therapeutic effect is achieved, the clinician withdraws the cannula (12) and the cannula housing (16) for removal from the tissue (17), as shown. Figure 3D As shown.

[0036] like Figure 4A As shown, removal of the cannula (12) from the tissue (17) typically results in a tissue opening (58), also known as a tissue orifice or tissue wound, which the clinician closes to promote healing of the tissue (17). While some tissue openings may close adequately due to the tissue (17) gathering together, others, such as tissue openings (58), are sutured using sutures (60). Figures 4A to 4D In one example shown, the suture (60) is removably connected to the needle (62) to guide the suture (62) through the tissue (17) as the clinician manipulates the needle (62). More specifically, as Figure 4B As shown, the clinician guides the needle (62) downward through the fascia (56) on one side of the tissue opening (58), and then upward through the fascia (56) on the other side of the tissue opening (58) as the needle (62) has completely passed through the tissue (17). It is noteworthy that the clinician guides the needle (62) distally through the fascia (56) from the tissue opening (58) a desired distance to be relatively closer to the tissue opening (58); while also passing a sufficient distance to provide enough fascia (56) to anchor the suture (60). Additionally, the clinician angles the tip of the needle (62) at an appropriate angle away from the central axis of the opening (58) to achieve sufficient "interlocking" when the suture (60) is anchored within the fascia (56). Figure 4CAs shown, the sutures (60) from the corresponding sides of the tissue opening (58) are brought together and pulled to similarly pull the tissues (17) together and at least partially close the tissue opening (58). The clinician then knots the sutures (60) to secure the tissues (17) together and fully closes the tissue opening (58) using the formed suture (64), as... Figure 4D As shown. Additional sutures (64) may be placed along the tissue (17) to further close the tissue opening (58) and promote the healing of the tissue (17).

[0037] Although shown Figures 4A-4D The above-mentioned suturing technique is used when using a cannula assembly (10) (see...) Figure 1 This is an exemplary procedure for closing a tissue opening (58) with a suture (60), but other exemplary procedures and devices may be used alternatively to close such tissue openings. By way of example, U.S. Patent Application 15 / 088,723, filed April 1, 2016, entitled “Surgical Access Devices with Integrated Wound Closure Features,” describes alternative cannula assemblies and suturing techniques, the entire contents of which are incorporated herein by reference. Clinicians may use alternative cannula assemblies and suturing techniques in any combination as needed.

[0038] II. Exemplary surgical access device with wound closure features

[0039] A. An exemplary cannula needle having a needle opening and a blow-in opening in a first arrangement.

[0040] Figures 5-8Another exemplary surgical access device in the form of a cannula (100) is shown. For example, although not shown, those skilled in the art will recognize that the cannula (100) can be used in conjunction with any suitable cannula occluder, such as the occluder (14) described above. The cannula (100) generally includes a housing assembly (102) and a cannula (104) coupled to the housing assembly (102) and extending distally from the housing assembly along the central longitudinal axis of the cannula (100). The housing assembly (102) includes a proximal housing (106), a housing cover (108), a latching ring (110), and a distal housing (112). The proximal housing (106) has a proximal housing head (114) and a proximal housing base (116). The proximal housing (106) is coupled to and selectively released from the remainder of the cannula (100) via the housing cover (108) and the latching ring (110). As described in more detail below, the cannula (100) also includes a plurality of needle entry orifices (150) and needle exit orifices (152), which define corresponding plurality of suture paths extending obliquely through the cannula (100) across the central axis of the cannula. In this example, at least one of the needle entry orifice (150) and the corresponding needle guide structure (154) is positioned in a coplanar relationship opposite to the blow-in orifice (134) of the cannula (100) along its diameter.

[0041] like Figure 6 As shown, the cannula (104) includes a proximal hub (118), a distal end (120), and a cylindrical body (122) extending between the proximal hub and the distal end along the central axis of the cannula (100). The proximal hub (118) flares out radially outward from the cylindrical body (122) in a proximal direction and defines a proximal opening to the cannula lumen (124), while the distal end (120) defines a distal opening to the cannula lumen (124). The distal end (120) itself is inclined and includes a chamfered edge (126) configured to facilitate insertion of the distal end (120) through tissue into the patient's body cavity during surgical procedures. The outer surface of the cylindrical body (122) may be provided with a plurality of tissue engagement ribs (128) or similar features adapted to frictionally engage the inner wall of the tissue opening through which the cannula (104) is received into the body cavity.

[0042] like Figure 7As shown, the cannula lumen (124) is in fluid communication with the interior (130) of the housing assembly (102) to jointly define a working channel (132) that extends through the cannula (100) along its central axis. A distal opening to the working channel (132) is defined by the distal end (120) of the cannula (104), and a proximal opening to the working channel (132) is defined by the proximal housing head (114). When the proximal housing (106) separates from the remainder of the cannula (100), the proximal opening to the working channel (132) is defined by the housing cover plate (108). For example, the working channel (132) is configured to receive one or more surgical instruments, such as various endoscopic surgical instruments, to enter a patient's body cavity and observe and / or treat palpable tissue therein.

[0043] like Figure 6 and Figure 7 As shown, the blow-in port (134) (or “piston”) is operatively connected at fitting (136) to the proximal hub (118) of the cannula (104). The blow-in port (134) includes an internal valve (137) and a valve stem (138) and may be integrally formed with fitting (136) or alternatively coupled to fitting (136) during cannula (100) assembly. A blow-in conduit (not shown) is coupled to the inlet of the blow-in port (134) and directs blow-in fluid (such as carbon monoxide) from a fluid source into the blow-in port (134), which then directs the fluid distally through the working channel (132) into the patient's body cavity. The valve stem (138) is configured to rotate the internal valve (137) between an open and closed position to control the flow of blow-in fluid through the blow-in port (134).

[0044] Similar to the cannula assembly (10), the cannula (100) may include a proximal (or "external") sealing assembly and / or a distal (or "internal") sealing assembly, each disposed within a working channel (132). In this example, the cannula (100) includes a distal sealing assembly in the form of an instrument seal (140) disposed within a tapered portion of a proximal hub (118). The distal instrument seal (140) includes a central opening (142) configured to receive a surgical instrument passing through it and configured to seal the outer surface of the surgical instrument to prevent proximal advancement of bodily fluids and / or tissue into the housing assembly interior (130). In an exemplary configuration, the instrument seal (140) may be configured to absorb bodily fluids or otherwise remove bodily fluids from the outer surface of the surgical instrument as the surgical instrument retracts proximally through the instrument seal (140).

[0045] Those skilled in the art will recognize that the cannula (100) may include proximal and / or distal sealing assemblies of various suitable configurations, such as those disclosed in U.S. Patent Application 15 / 088,723, which is incorporated herein by reference above. For example, although not shown, the cannula (100) may include a proximal sealing assembly in the form of an instrument seal disposed within a proximal housing (106), and / or a distal sealing assembly in the form of a zero-closure seal (such as a duckbill seal) disposed within a proximal hub (118) of the cannula (104). As described above with reference to the cannula assembly (10), such zero-closure seals are generally configured to form a fluid-impermeable seal in the working channel (132), thereby maintaining a blow-in even when no surgical instrument is present in the working channel (132). In addition, the distal zero-closure seal can be manipulated to provide an opening to the distal portion of the working channel (132), such that the opening is large enough to allow tissue to be retrieved proximally through it, particularly when the proximal housing (106) is separated from the cannula (100) to provide an entrance to the distal zero-closure seal.

[0046] like Figure 6 As shown, the cannula (100) also includes a plurality of needle openings formed in selected side portions of the cannula (104). As described in more detail below, each needle opening is configured to guide a suture threader needle (or simply "suture threader") across the working channel (132) of the cannula (100) at an angle relative to the central axis of the cannula (100), thereby establishing an oblique suture path extending through the cannula (100) and adjacent tissues. As used herein, the term "oblique" means neither parallel nor perpendicular to a reference axis, such as the central axis of the cannula (100).

[0047] In this example, the cannula (100) includes a pair of needle entry orifices (150) and a corresponding pair of needle exit orifices (152) disposed distal to the needle entry orifices (150). Each needle entry orifice (150) is defined by a corresponding needle guide structure, shown in the form of a needle guide tube (154), which is integrally formed with the proximal hub (118) and protrudes obliquely outward from the proximal hub at a corresponding side portion of the cannula (104). The needle entry orifices (150) extend through the proximal hub (118) and into the cannula lumen (124), as shown. Figure 7 To best illustrate. For example... Figure 5-7As best shown, each needle exit orifice (152) extends through the cylindrical body (122) of the cannula (104) and opens into the cannula lumen (124) at a position substantially diametrically opposite to the needle entry orifice (150) and its corresponding needle guide (154). In this example, each needle exit orifice (152) is substantially elongated along the central axis of the cannula needle (100), but in alternative examples, the needle exit orifice (152) may be formed to have various other shapes.

[0048] As used herein with reference to various first and second structures or reference points, the term "diameter-opposite" encompasses, but is not limited to, configurations in which the reference structures or reference points are positioned at the same longitudinal location along the central axis of the cannula (100). For example, in this example, each needle entry orifice (150) is spaced proximally from its corresponding needle exit orifice (152), but the orifices (150, 152) are still understood to be diameter-opposite to each other along the same axially extending plane containing the central axis of the cannula (100). Of course, in an alternative form of the cannula (100), the needle entry orifice (150) may be located in a first plane containing the central axis of the cannula, while the corresponding needle exit orifice (152) may be located in a second plane containing the central axis of the cannula and offset from the first plane, such that the needle entry orifice and exit orifice (150, 152) are not diameter-opposite to each other.

[0049] like Figure 7 As best illustrated, each needle entry port (150) and its corresponding needle guide (154) are configured to cooperate with the opposing needle exit port (152) to guide the suture threader needle (156) along a corresponding suture path extending obliquely relative to the central axis of the cannula (100). Specifically, the needle entry port (150) and its corresponding needle guide (154) on the first side portion of the cannula (104) cooperate with the needle exit port (152) on the second side portion of the cannula (104) to define a first oblique suture path. Additionally, the needle entry port (152) and its corresponding needle guide (154) on the second side portion of the cannula (104) cooperate with the needle exit port (152) on the first side portion of the cannula (104) to define a second oblique suture path.

[0050] Each needle exit orifice (152) is spaced distally from its corresponding needle entry orifice (150) by a distance suitable for achieving the desired suture path angle (or "tissue occlusion angle") measured between the central axis of the resulting suture path and the cannula (100). In this example, each needle exit orifice (152) is spaced distally by the same axial distance from its corresponding needle entry orifice (150), such that the resulting suture path exhibits the same suture path angle. However, in other examples, the needle exit orifices (152) may be spaced distally by different axial distances from their respective needle entry orifices (150) to achieve different suture path angles.

[0051] Although the needle guide structure in this example is shown as a needle guide tube (154) integrally formed with the cannula (104), those skilled in the art will recognize that various other configurations and structures suitable for guiding the suture threader needle (156) along an oblique suture path of the cannula (100) can be implemented. For example, the cannula (100) may be provided with a needle guide tube integrally formed with or otherwise defined by the distal housing (112), as disclosed, for example, in U.S. Application No. END8139USNP, entitled “Trocar with Oblique Needle Insertion Port and Perpendicular SealLatch,” filed on the same day as this application, the disclosure of which is incorporated herein by reference. In other examples, such outwardly projecting needle guide structures may be omitted from the cannula (100).

[0052] like Figure 6 and Figure 7 As shown, each needle orifice (150, 152) of the cannula (100) is provided with a punctureable seal configured to assist in maintaining the blow-in when the suture guide needle (156) is guided through the cannula (100) along the suture path and / or when the suture guide needle (156) is withdrawn from the cannula (100). In this example, each needle entry orifice (150) is provided with an entry seal, which is shown in the form of a sealing cap (158) received within the entry end of the corresponding needle guide tube (154). Furthermore, each needle exit orifice (152) is provided with an exit seal, which is shown in the form of an elongated protrusion (162) projecting radially inward from the inner surface of the cannula (160). Figure 5 and Figure 6As shown, the cannula (160) is received above the narrowed region of the cylindrical body (122) of the cannula (104) and has an outer diameter similar to that of the distal portion of the cylindrical body (122) located distal to the tissue engagement rib (128). In an exemplary configuration, the sealing cap (158) and the cannula (160) (including the protrusion (162)) may be formed of an elastomeric material. Alternatively, the cannula (160) and / or the sealing cap (158) may be formed, for example, by an overlay injection molding process.

[0053] like Figures 5-7 As shown, the distal housing (112) is in the form of a generally annular shell, which is shaped to receive and surround the proximal hub (118) of the cannula (104). The distal housing (112) includes a pair of diametrically opposed flanks (164) that a surgeon can grasp when the cannula (100) is introduced through patient tissue. The distal housing (112) also includes an incision (166) sized and shaped to accommodate a blow-through orifice (134) therethrough, and a pair of axially extending slots (168) sized and shaped to accommodate a needle guide (154) therethrough. In this example, the distal housing (112) is oriented relative to the cannula (104) and the needle guide (154) such that the slots (168) are arranged in corresponding sidewall portions extending between the flanks (164). In an alternative configuration, the distal housing (112) may be oriented such that the slot (168) is arranged in the wing (164) or in various other parts of the distal housing (112).

[0054] The proximal housing (106), defined by the combination of the proximal housing head (114) and the proximal housing base (116), is configured to engage and selectively disengage from the remaining distal portion of the cannula (100) via an operating latch ring (110) relative to the housing cover plate (108). Figure 6 and Figure 7 As shown, the proximal housing head (114) includes a central opening (170) that defines the proximal end of the working channel (132) of the cannula (100) when the proximal housing (106) is engaged with the cannula (104). The proximal housing head (114) also includes a pair of slots (172) configured to receive a corresponding pair of blades extending distally from the proximal head of the occluder, such as... Figure 2The insert (32) of the occluder (14) shown is designed to releasably connect the occluder to the cannula (100). The proximal housing head (114) is supported by or connected to the proximal housing base (116), for example, via a snap-fit ​​connection. Although not shown, a proximal sealing assembly (such as an instrument seal) may be arranged between the proximal housing head (114) and the proximal housing base (116). Such a proximal sealing assembly can mate with the aforementioned distal sealing assembly (140) to ensure a sealed engagement between the cannula (100) and surgical instruments inserted through the cannula (100).

[0055] The proximal housing base (116) includes a plurality of distally extending mating features configured to facilitate attachment and release of the proximal housing (106) to the housing cover (108) and the latching ring (110). Specifically, as Figure 6 As shown, the underside of the proximal housing base (116) includes a pair of distally extending latching tabs (174) and a pair of distally extending latching pins (176). The housing cover (108) includes a pair of tab slots (178) configured to receive the latching tabs (174) passing through therethrough and a pair of pin holes (180) configured to receive the latching pins (176) passing through therethrough. The housing cover (108) also includes a plurality of distally extending connecting pins (182) configured to be received by corresponding plurality of connecting holes (184) formed on the distal housing (112) to connect the housing cover (108) to the distal housing (112), for example by press-fit or snap-fit ​​engagement.

[0056] A latching ring (110) is arranged on the distal side of the housing cover (108), and is received radially inward of the sidewall of the housing cover (108) at the upper proximal end of the latching ring (110) and radially inward of the distal housing (112) at the lower distal end of the latching ring (110). Figure 6 As shown, the latch ring (110) includes a user engagement feature in the form of an outwardly projecting knob (186). The latch ring (110) also includes a plurality of inwardly projecting latch features in the form of a pair of latch arms (188) and a pair of cam ramps (190) circumferentially spaced between the latch arms (188).

[0057] A latching ring (110) is rotatable about the central axis of the cannula (100) between a latched position and an unlatched position. In the latched position, the latching feature of the latching ring (110) engages the distally extending feature of the proximal housing base (116). In the unlatched position, the latching feature of the latching ring (110) releases the distally extending feature of the proximal housing base (116), thereby allowing proximal separation of the proximal housing (106). More specifically, in the latched position, a latching arm (188) engages with a latching post (176), and a cam ramp (190) engages with a latching tab (174). In the unlatched position, the latching arm (188) disengages from the latching post (176), and the cam ramp (190) disengages from the latching tab (174), thereby releasing the proximal housing (106) from the remaining distal portion of the cannula (100). The latching ring (110) can be rotated between a latched position and an unlocked position by a knob (186) that protrudes radially through a circumferential slot (not shown) formed in the sidewall of the housing cover (108).

[0058] The components of the housing assembly (102), including the proximal housing (106), housing cover (108), and latching ring (110), may be further constructed and operated in accordance with one or more of the teachings of the U.S. application [Agent Reference No. END8139 USNP], which is incorporated above by reference. For example, in various examples, the cannula (100) may be configured such that the latching ring knob (186) remains circumferentially spaced (or “offset”) from each needle guide (154) throughout the entire permissible range of rotation of the latching ring (110) relative to the housing cover (108), thereby ensuring unobstructed access to the needle guides (154) during suturing procedures performed with the cannula (100).

[0059] like Figure 8As best illustrated in this example, the first needle guide tube (154) and its needle entry orifice (150) are arranged diametrically opposite to the blow-in orifice (134). Therefore, the first needle guide tube (154), its needle entry orifice (150), the corresponding needle exit orifice (152), and the blow-in orifice (134) are arranged in a first plane (P1) extending axially along the central axis of the cannula needle (100). The second needle guide tube (154) and its needle entry and exit orifices (150, 152) are arranged in a second axially extending plane (P2) encompassing the central axis of the cannula needle (100). Thus, the first and second suture paths defined by the needle orifices (150, 152) and the needle guide tube (154) intersect at the central axis. The knob (186) of the latching ring (110) is arranged in a third axially extending plane (P3) encompassing the central axis. It should be understood that the third plane (P3) may correspond to the midpoint of the circumferential path along which the knob (186) travels when the latching ring (110) rotates relative to the rest of the cannula (100).

[0060] In this example, the second plane (P2) is offset from the first plane (P1) such that the first needle tube and the second needle tube (154) are positioned in a non-diameter-relative relationship, and the resulting first and second suture paths lie in different planes. More specifically, in some examples, the second plane (P2) may be offset from the first plane (P1) by approximately 17 degrees. Furthermore, in this example, the third plane (P3) extends perpendicular to the first plane (P1) such that the knob (186) is circumferentially offset from each of the first needle guide tube (154) and the blow-in orifice (134). Thus, in this example, the needle guide tube (154), the blow-in orifice (134), and the latching ring knob (186) are circumferentially offset from each other. Additionally, the knob (186) remains circumferentially offset from each needle guide tube (154) and the blow-in orifice (134) throughout the entire permissible range of rotation of the latching ring (110) about the central axis of the cannula needle (100). This configuration ensures unobstructed access to the needle guide tube (154) during use of the cannula (100).

[0061] It should be understood that in other examples, the axially extending planes (P1, P2, P3) can be arranged in various other configurations. In this respect, the second plane (P2), which includes the second needle guide tube (154) and its needle entry orifice (150), can be offset from the first plane (P1) by more or less than 17 degrees. Furthermore, the third plane (P3), which includes the latch ring knob (186), can not be perpendicular to the first plane (P1). For example, the third plane (P3) can be oriented such that the knob (186) is circumferentially offset from the blow-in orifice (134) or the first needle guide tube (154) by more or less than 90 degrees. Moreover, although the cannula (100) of this example is shown and described as providing two suture paths oriented in a particular arrangement, each suture path defined by a corresponding needle entry orifice (150) and needle exit orifice (152), other forms of the cannula (100) can be suitably configured to provide alternative numbers and arrangements of suture paths. For example, the cannula (100) can be configured to provide three or more suture paths.

[0062] B. An exemplary cannula needle having a pinhole and a blow-in port in a second arrangement.

[0063] Figure 9 Another exemplary surgical access device in the form of a cannula (200) is shown, wherein the same reference numerals denote the same features described above in conjunction with the cannula (100). Except as described below, the cannula (200) is substantially similar to the cannula (100). Specifically, the cannula (200) includes a pair of needle guide tubes (202) and corresponding needle entry ports (204), which are arranged in a diametrically opposed relationship along a first axially extending plane (P1) containing the central axis of the cannula (200). A second axially extending plane (P2) extends through the central cannula axis and the latching ring knob (186), and a third axially extending plane (P3) extends through the central cannula axis and the blow-in port (134). In various examples, the second plane (P2) may extend through the path endpoint or path midpoint of the knob (186).

[0064] In this example, the second plane (P2) extends perpendicular to the third plane (P3), causing the latch ring knob (186) to be circumferentially offset by 90 degrees from the blow-in orifice (134). Additionally, the first plane (P1) is angularly offset from both the second and third planes (P2 and P3), causing the needle guide tube (202) and needle inlet (204) to be circumferentially offset from the knob (186) and the blow-in orifice (134). In this example, the first plane (P1) is angularly offset from the second plane (P2) by approximately 17 degrees. Alternative configurations of the cannula needle (200) may exhibit an angular offset of greater than or less than 17 degrees between the first plane (P1) and the second plane (P2).

[0065] C. An exemplary cannula needle having a needle opening arranged on a rotating collar.

[0066] During suturing procedures to close tissue openings using cannulas (such as one or both of the cannulas (100, 200) described above) that define one or more suture paths for entry and exit, it may be desirable to adjust the rotational position of one or more suture paths about the central axis of the cannulas in situ without rotating the cannulas relative to the patient as a whole. This adjustment may be desired, for example, to better accommodate certain anatomical structures of the patient and achieve better “occlusion” of the orthotopically sutured fascia. Exemplary cannulas features described below enable such adjustments.

[0067] Figure 10 An exemplary cannula (210) is shown, which is configured to selectively rotate about its central axis to adjust its suture path. The cannula (210) is similar to the cannula (100) in that it includes a housing assembly (212) and a cannula (214) coupled to and extending distally from the housing assembly along the central axis of the cannula. The housing assembly (212) includes a proximal housing (216) having a proximal housing head (218) and a proximal housing base (220), a housing cover (222), a latching ring (not shown) similar to a latching ring (110), and a distal housing (224). Except for the aspects described below, the components of the cannula (210) are substantially similar in structure and function to the corresponding components of the cannula (100) described above.

[0068] Unlike the housing assembly (102) of the cannula (100), the housing assembly (212) of the cannula (210) includes a rotating collar (226) disposed between a housing cover (222) and a distal housing (224). The rotating collar (226) supports a pair of needle guides (228), each guide (228) defining a needle entry orifice (232) communicating with a working channel (230) of the cannula (210). The rotating collar (226) is configured to selectively rotate one or both of the needle guides (228) and their respective suture paths about the central axis of the cannula (210) relative to the rotational fixing components of the cannula (210), including a pair of needle exit orifices (234) formed in the cannula (214). For example, in this example, the needle guides (228) are fixed relative to the rotating collar (226), and the rotating collar (226) is configured to rotate about the central axis of the cannula. Therefore, the first and second needle guide tubes (228) rotate together about the central axis of the cannula. In other examples, the rotating collar (226) may be fixed relative to the cannula (214), while the first and second needle guide tubes (228) or other needle guide structures are configured to rotate independently or in relation to each other about the central axis of the cannula, for example, along one or more circumferentially extending tracks (not shown) formed in the rotating collar (226).

[0069] The rotating collar (226) is configured to rotate relative to the cannula (214) between a first end position and a second end position, such as Figure 10 The reference numerals (A, B) in the accompanying drawings indicate this. The first end position and the second end position (A, B) are offset from each other circumferentially by any suitable angle, for example, approximately 30-45 degrees. Furthermore, a rotating collar (226) is mounted to the cannula needle (210) such that when the rotating collar (226) is in its first end position (A), the first needle guide tube (228) is circumferentially offset from the blow-in orifice (236) by a selected angle, for example, approximately 17 degrees. Thus, in an exemplary configuration in which the rotating collar (226) rotates between the first end position and the second end position (A, B) within a 45-degree range, the first needle guide tube (228) can be moved from the first end position to the second end position, in which the guide tube (228) is offset from the blow-in orifice by 17 degrees, and in the second end position, the needle guide tube (228) is offset from the blow-in orifice (236) by 57 degrees. In various examples, the cannula (210) may include one or more pawl mechanisms or other rotation limiting mechanisms (not shown) configured to releasably hold the rotating collar (226) in one or more predetermined rotational positions relative to the cannula (214).

[0070] like Figure 10As shown, needle exit orifices (234) are formed in the proximal cylindrical portion of the cannula (214). Each exit orifice (234) extends circumferentially about the central axis of the cannula, with a circumferential dimension sufficient to allow a corresponding needle guide tube (228) to be aligned with the needle exit orifice (234) throughout the entire range of rotation of the rotating collar (226) between its first end position and its second end position (A, B). Additionally, each needle exit orifice (234) has an axial dimension sufficient to accommodate suture paths with various suture path angles passing through it. In an alternative example, the cannula (210) may include a plurality of needle exit orifices arranged circumferentially about the central axis of the cannula at positions corresponding to predetermined rotational positions of the rotating collar (226). Each needle exit orifice (234) includes a puncturable seal (238) configured to help retain the airflow during surgical procedures, similar to the seal (162) of the cannula (100). Each needle guide tube (228) may also include a puncture-proof seal (not shown), such as a sealing cap (not shown) similar to the sealing cap (158) of the cannula needle (100).

[0071] Figure 11 Additional details of exemplary features of the swivel collar (226) and the distal housing (224) are shown. The swivel collar (226) includes a generally annular body (240) and an outer wall (242) supporting needle guides (228). Each needle guide (228) is supported by a shoulder element (244) projecting radially outward from the annular body (240), and the needle guides (228) are arranged at diametrically opposed positions on the annular body (240). In other examples, the needle guides (228) may be arranged in various other configurations, such as those described above in conjunction with cannulated needles (100, 200). Alternatively, the needle guides (228) and / or shoulder elements (244) may be omitted and replaced by various other forms of needle guiding structures, such as structures integrated within the annular body (240) of the swivel collar (226). The rotating collar (226) also includes a pair of downwardly hanging L-shaped legs (246) configured to engage the rotating collar (226) with the distal housing (224) and guide rotation of the rotating collar (226) relative to the distal housing (224), as described below. In this example, the legs (246) are diametrically opposed to each other and circumferentially equidistant between the needle guide tubes (228).

[0072] The distal housing (224) of this example includes a generally annular body (248) having an upper wall (250). A pair of circumferentially extending slots (252) are arranged in the upper wall (250) and configured to receive downwardly hanging legs (246) of a rotating collar (226). A pair of circumferentially extending sealing openings (254) are also arranged in the upper wall (250) and configured to receive suture threader needles (not shown) passing through them. The slots (252) and sealing openings (254) are arranged in a circumferentially alternating manner such that each slot (252) is configured to align with a corresponding leg (246) and each sealing opening (254) is configured to align with the distal end of a corresponding needle guide tube (228). Each slot (252) has a radially enlarged opening (256) configured to receive a radially projecting distal foot (258) of a corresponding leg (246) when the rotating collar (226) is assembled with the distal housing (224). Each slot (252) also includes an elongated channel (260) extending circumferentially from the enlarged opening (256) and configured to hold and guide the leg (246) along a circumferential path as the rotating collar (226) rotates relative to the distal housing (224). The circumferential length of the slot (252) defines the permissible range of rotation of the rotating collar (226) relative to the distal housing (224) and can be appropriately sized to provide any desired range of rotation.

[0073] Each circumferentially extending sealing opening (254) has a circumferential length sufficient to allow the distal end of the corresponding needle guide tube (228) to be aligned with the sealing opening (254) throughout the entire permissible range of rotation of the rotating collar (226) relative to the distal housing (224). Each sealing opening (254) is provided with a punctureable seal (262) configured to be puncturable by a suture threader needle guided distally through the corresponding needle guide tube (228). In various examples, each punctureable seal (262) may include a circumferentially extending slit (not shown) configured to facilitate distal insertion of the suture threader needle through the punctureable seal (262) and to facilitate rotation of the rotating collar (226) relative to the distal housing (224) as the suture threader needle extends through the punctureable seal (262). Each sealing opening (254) is configured to guide the suture threader needle into the working channel (230) and toward the corresponding needle exit orifice (234) on the cannula (214). In addition, each sealing opening (254) has a radial dimension sufficient to accommodate suture paths with various different suture path angles passing through it.

[0074] Each of the aforementioned exemplary cannulas (100, 200, 210) is configured to function as a suture guiding mechanism for guiding a suture guide needle and a suture carried by the suture guide needle distally through the tissue and into the tissue at a predetermined suture path angle, so as to close an opening formed in the patient's body with sutures via cannulation. Any of the cannulas (100, 200, 210) can be implemented in conjunction with the general steps of an exemplary suturing procedure disclosed, for example, in U.S. application [Attorney General's Reference No. END8139 USNP], which is incorporated herein by reference above. Furthermore, the teachings presented herein regarding the cannula (100, 200, 210) can be further combined with various teachings from any one or more of the following applications: U.S. Application No. END8137USNP entitled "Needle Guide Instrument with Traverse Suture Capture Feature," the disclosure of which is incorporated herein by reference; U.S. Application No. END8138USNP entitled "Suture Grasping Instrument," filed on the same day as this application, the disclosure of which is incorporated herein by reference; U.S. Application No. END8141USNP entitled "Suture Passing Instrument with Puncture Site Identification Feature," filed on the same day as this application, the disclosure of which is incorporated herein by reference; U.S. Application No. END8142USNP entitled "Trocar Obturator with Transverse Needle Ports," filed on the same day as this application, the disclosure of which is incorporated herein by reference; and U.S. Application No. END8142USNP entitled "Surgical Port with Wound," filed on the same day as this application. The disclosure of U.S. application “ClosureChannels” [Attorney-in-charge reference number END8143USNP], filed on the same day as this document, is incorporated herein by reference; the disclosure of U.S. application “Trocar Obturator with Detachable Rotary Tissue Fastener” [Attorney-in-charge reference number END8144USNP], filed on the same day as this document, is incorporated herein by reference; the disclosure of U.S. application “Method of Suturing a Trocar Patch Incision” [Attorney-in-charge reference number END8153USNP], filed on the same day as this document, is incorporated herein by reference; and / or other patent and patent application publications incorporated herein by reference.

[0075] III. Exemplary Combinations

[0076] The following examples illustrate various non-exhaustive ways in which the teachings herein can be combined or applied. It should be understood that the following examples are not intended to limit the scope of any claims that may be provided at any time in this patent application or any subsequent filing thereof. No disclaimer is intended. The following examples are provided merely for illustrative purposes. It is contemplated that the various teachings herein may be arranged and applied in a variety of other ways. It is also contemplated that some variations may omit certain features mentioned in the following examples. Therefore, none of the aspects or features mentioned below should be considered definitive unless otherwise expressly indicated, for example, by the inventor or a successor of the inventor's interests at a later date. If any claim set forth in this patent application or any subsequent filing relating to this patent application includes additional features beyond those mentioned below, such additional features should not be presumed to have been added for any reason related to patentability.

[0077] Example 1

[0078] A surgical access device includes: (a) a cannula having a proximal end, a distal end, and a cannula lumen extending between the proximal end and the distal end; (b) a housing assembly coupled to the proximal end of the cannula, wherein the housing assembly defines a housing interior communicating with the cannula lumen; and (c) a working channel extending along a central axis of the surgical access device from the proximal end of the surgical access device to the distal end of the surgical access device, wherein the working channel is defined by the cannula lumen and the housing interior, and wherein the working channel is configured to receive passages therethrough. The surgical instrument; (d) a blow-in port configured to direct blow-in fluid into the working channel; (e) a first needle port opening into the working channel via a first side portion of the surgical access device, wherein the first needle port is diametrically opposed to the blow-in port; and (f) a second needle port opening into the working channel via a second side portion of the surgical access device, wherein each of the first and second needle ports is configured to guide a suture threader needle through the surgical access device at an angle relative to the central axis across the working channel.

[0079] Example 2

[0080] According to the surgical access device of Embodiment 1, the second needle orifice is circumferentially offset from the blow-in orifice.

[0081] Example 3

[0082] According to the surgical access device of Embodiment 2, the second needle orifice is circumferentially offset from the blow-in orifice by at least 17 degrees.

[0083] Example 4

[0084] According to any one or more of the surgical access devices described in the foregoing embodiments, the housing assembly includes a proximal housing and a latching ring configured to releasably engage the proximal housing with the cannula, wherein the latching ring includes a user engagement feature actuable to release the proximal housing from the cannula, wherein the user engagement feature is circumferentially offset from the inlet orifice throughout its permissible range of motion.

[0085] Example 5

[0086] According to the surgical access device of Embodiment 4, the latching ring is movable to a position where the user engagement feature is circumferentially offset by at least 90 degrees from the inlet orifice.

[0087] Example 6

[0088] According to one or more of embodiments 4 to 5, the surgical access device includes an outwardly protruding knob in the user engagement feature.

[0089] Example 7

[0090] According to one or more of the surgical access devices described in Embodiments 4 to 6, the latching ring is rotatable about the central axis relative to the proximal housing.

[0091] Example 8

[0092] According to any one or more of the surgical access devices described in the foregoing embodiments, the cannula includes a proximal hub configured to engage with the housing assembly, wherein the first pinhole and the second pinhole extend through the proximal hub.

[0093] Example 9

[0094] According to any one or more of the surgical access devices described in the foregoing embodiments, the first needle port includes a first needle inlet port, and the second needle port includes a second needle inlet port, wherein the surgical access device further includes a first needle outlet port disposed distal to the first needle inlet port and a second needle outlet port disposed distal to the second needle inlet port, wherein the first needle inlet port and the first needle outlet port together define a first suture path extending obliquely across the central axis of the surgical access device, wherein the second needle inlet port and the second needle outlet port together define a second suture path extending obliquely across the central axis of the surgical access device.

[0095] Example 10

[0096] According to the surgical access device of Embodiment 9, the cannula includes a proximal hub and a cylindrical portion extending distally from the proximal hub, wherein the first needle exit port and the second needle exit port communicate with the working channel via the cylindrical portion.

[0097] Example 11

[0098] According to one or more of the surgical access devices described in Embodiments 9 to 10, the first needle inlet and the second needle inlet, as well as the first needle outlet and the second needle outlet, are arranged such that the first suture path and the second suture path extend through the central axis of the surgical access device.

[0099] Example 12

[0100] The surgical access device according to any one or more of Embodiments 9 to 11 further includes a first needle guide structure configured to guide a suture threader needle through the first needle orifice along the first suture path, and a second needle guide structure configured to guide a suture threader needle through the second needle orifice along the second suture path.

[0101] Example 13

[0102] According to the surgical access device of Embodiment 12, the first needle guide structure and the second needle guide structure include a first needle guide tube and a second needle guide tube.

[0103] Example 14

[0104] According to any one or more of the surgical access devices described in Embodiments 9 to 13, wherein the first needle exit orifice is diametrically opposite to the first needle entry orifice, and wherein the second needle exit orifice is diametrically opposite to the second needle entry orifice.

[0105] Example 15

[0106] According to any one of embodiments 9 to 14, the surgical access device wherein the first needle inlet, the first needle outlet, and the blow-inlet are located in a plane extending axially through the surgical access device along the central axis of the surgical access device.

[0107] Example 16

[0108] A surgical access device includes: (a) a cannula having a proximal hub, a distal end, and a cannula lumen extending between the proximal hub and the distal end; (b) a housing assembly coupled to the proximal hub of the cannula, wherein the housing assembly defines a housing interior communicating with the cannula lumen; (c) a working channel extending along a central axis of the surgical access device from a proximal end of the surgical access device to a distal end of the surgical access device, wherein the working channel is defined by the cannula lumen and the housing interior, wherein the working channel is configured to receive surgical instruments passing through it; (d) a blow-in port configured to direct blow-in fluid into the working channel; and (e) a needle port passing through the proximal hub of the cannula to the working channel, wherein the needle port is diametrically opposed to the blow-in port, wherein the needle port is configured to guide a suture threader needle through the working channel at an angle relative to the central axis.

[0109] Example 17

[0110] The surgical access device according to Embodiment 16 further includes a second needle port extending through the proximal hub of the cannula to the working channel, wherein the second needle port is circumferentially offset from the blow-in port.

[0111] Example 18

[0112] A surgical access device includes: (a) a cannula having a proximal end, a distal end, and a cannula lumen extending between the proximal end and the distal end; (b) a housing assembly coupled to the proximal end of the cannula, wherein the housing assembly defines a housing interior communicating with the cannula lumen; (c) a working channel extending along a central axis of the surgical access device from the proximal end of the surgical access device to the distal end of the surgical access device, wherein the working channel is defined by the cannula lumen and the housing interior, wherein the working channel is configured to receive surgical instruments passing through it; (d) a blow-in port configured to guide blow-in fluid into the working channel; (e) a first needle entry port extending through a side portion of the surgical access device into the working channel; and (f) a first needle exit port extending through a side portion of the surgical access device into the working channel, wherein the first needle entry port extends through a side portion of the surgical access device into the working channel; A needle exit orifice communicates with a first needle entry orifice to define a first needle channel, the first needle channel being configured to guide a suture threader needle through the working channel at an angle relative to the central axis of the surgical access device; (g) a second needle orifice, the second needle orifice extending through a side portion of the surgical access device into the working channel; and (h) a second needle exit orifice, the second needle exit orifice extending through a side portion of the surgical access device into the working channel, wherein the second needle exit orifice communicates with the second needle entry orifice to define a second needle channel, the second needle channel being configured to guide a suture threader needle through the working channel at an angle relative to the central axis of the surgical access device into the surgical access device, wherein at least one of the first needle entry or the second needle entry orifice and its corresponding needle exit orifice is located in an axial plane extending axially through the surgical access device along the central axis of the surgical access device, wherein the axial plane is offset from the blow-in orifice.

[0113] Example 19

[0114] According to the surgical access device of Embodiment 18, the first needle inlet, the first needle outlet and the blow-in outlet are located in a first axial plane extending axially through the surgical access device along the central axis of the surgical access device, wherein the second needle inlet and the second needle outlet are located in a second axial plane extending axially through the surgical access device along the central axis of the surgical access device, wherein the second axial plane is offset from the first axial plane.

[0115] Example 20

[0116] According to the surgical access device of Embodiment 18, each of the first needle access orifice and the second needle access orifice is circumferentially offset from the blow-in orifice.

[0117] IV. Miscellaneous

[0118] It should be understood that any one or more of the teachings, expressions, embodiments, examples, etc., described herein can be combined with any one or more of the other teachings, expressions, embodiments, examples, etc., described herein. Therefore, the aforementioned teachings, expressions, embodiments, examples, etc., should not be considered in isolation from each other. Various suitable ways in which the teachings herein can be combined will be apparent to those skilled in the art upon reference to the teachings herein. Such modifications and variations are intended to be included within the scope of the claims.

[0119] It should be understood that any patent, patent publication, or other public material allegedly incorporated herein by reference, whether in whole or in part, is incorporated only to the extent that the incorporated material does not conflict with the existing definitions, statements, or other public materials set forth in this disclosure. Therefore, and to the extent necessary, the disclosures expressly listed herein replace any conflicting material incorporated herein by reference. Any material, or part thereof, allegedly incorporated herein by reference that conflicts with the existing definitions, statements, or other public materials listed herein will be incorporated only to the extent that the incorporated material does not conflict with the existing public materials.

[0120] The aforementioned devices can be applied to both traditional medical treatments and surgeries performed by medical professionals and robot-assisted medical treatments and surgeries. By way of example only, the various teachings herein can be readily incorporated into robotic surgical systems, such as the DAVINCI system from Intuitive Surgical, Inc. (Sunnyvale, California). TMSystem. Similarly, those skilled in the art will recognize that the various teachings herein are readily applicable in conjunction with the teachings of the following patents: U.S. Patent 5,792,135, entitled “Articulated Surgical Instrument For Performing Minimally Invasive Surgery With Enhanced Dexterity and Sensitivity,” published August 11, 1998, the disclosure of which is incorporated herein by reference; U.S. Patent 5,817,084, entitled “Remote Center Positioning Device with Flexible Drive,” published October 6, 1998, the disclosure of which is incorporated herein by reference; U.S. Patent 5,878,193, entitled “Automated Endoscope System for Optimal Positioning,” published March 2, 1999, the disclosure of which is incorporated herein by reference; and U.S. Patent 5,878,193, entitled “Robotic Arm DLUS for Performing Surgical,” published May 15, 2001. The disclosures of U.S. Patent 6,231,565, entitled "Tasks," are incorporated herein by reference; the disclosures of U.S. Patent 6,783,524, entitled "Robotic Surgical Tool with Ultrasound Cauterizing and Cutting Instrument," published on August 31, 2004, are incorporated herein by reference; the disclosures of U.S. Patent 6,364,888, entitled "Alignment of Master and Slave in a Minimally Invasive Surgical Apparatus," published on April 2, 2002, are incorporated herein by reference; the disclosures of U.S. Patent 7,524,320, entitled "Mechanical Actuator Interface System for Robotic Surgical Tools," published on April 28, 2009, are incorporated herein by reference; and the disclosures of U.S. Patent 7,691,098, entitled "Platform Link Wrist Mechanism," published on April 6, 2010, are incorporated herein by reference.The disclosures of U.S. Patent 7,806,891, entitled "Repositioning and Reorientation of Master / Slave Relationship in Minimally Invasive Telesurgery," published on October 5, 2010, are incorporated herein by reference; the disclosures of U.S. Patent 8,844,789, entitled "Automated End Effector Component Reloading System for Use with a Robotic System," published on September 30, 2014, are incorporated herein by reference; the disclosures of U.S. Patent 8,820,605, entitled "Robotically-Controlled Surgical Instruments," published on September 2, 2014, are incorporated herein by reference; the disclosures of U.S. Patent 8,616,431, entitled "Shiftable Drive Interface for Robotically-Controlled Surgical Tool," published on December 31, 2013, are incorporated herein by reference; and the disclosures of U.S. Patent 8,616,431, entitled "Surgical Stapling Instruments with...", published on November 5, 2013, are incorporated herein by reference. U.S. Patent 8,573,461, entitled “Cam-Driven Staple Deployment Arrangements,” the disclosure of which is incorporated herein by reference; U.S. Patent 8,602,288, entitled “Robotically-Controlled Motorized Surgical End Effector System with Rotary Actuated Closure Systems Having Variable Actuation Speeds,” published on December 10, 2013, the disclosure of which is incorporated herein by reference; and U.S. Patent 9,301,759, entitled “Robotically-Controlled Surgical Instrument with Selectively Articulatable End Effector,” published on April 5, 2016, the disclosure of which is incorporated herein by reference.U.S. Patent 8,783,541, entitled "Robotically-Controlled Surgical End Effector System," published on July 22, 2014, the disclosure of which is incorporated herein by reference; U.S. Patent 8,479,969, entitled "Drive Interface for Operably Coupling a Manipulatable Surgical Tool to a Robot," published on July 9, 2013, the disclosure of which is incorporated herein by reference; U.S. Patent 8,800,838, entitled "Robotically-Controlled Cable-Based Surgical End Effectors," published on August 12, 2014, the disclosure of which is incorporated herein by reference; and / or U.S. Patent 8,573,465, entitled "Robotically-Controlled Surgical End Effector System with Rotary Actuated Closure Systems," published on November 5, 2013, the disclosure of which is incorporated herein by reference.

[0121] Devices of the types described above may be designed for single-use and disposal, or they may be designed for multiple uses. In either or both cases, these types may be repaired for reuse after at least one use. Repair may include any combination of the following steps: disassembling the device, then cleaning or replacing specific parts, and subsequently reassembling. Specifically, some types of devices may be disassembled, and any combination may be used to selectively replace or remove any number of specific parts or portions of the device. While cleaning and / or replacing specific components, some types of devices may be reassembled at a repair facility or by the user prior to surgery for subsequent use. Those skilled in the art will appreciate that device repair can utilize a variety of techniques for disassembly, cleaning / replacement, and reassembly. The use of such techniques and the resulting repaired devices are within the scope of this application.

[0122] By way of example only, the types described herein can be sterilized before and / or after surgery. In one sterilization technique, the device is placed in a closed and sealed container such as a plastic bag or a TYVEK bag. The container and device can then be placed in a radiation field that can penetrate the container, such as gamma radiation, X-rays, or high-energy electrons. The radiation kills bacteria on the device and in the container. The sterilized device can then be stored in a sterile container for later use. Any other techniques known in the art can also be used to sterilize the device, including but not limited to beta or gamma radiation, ethylene oxide, or vapor.

[0123] Various embodiments of the invention have been shown and described, and further improvements to the methods and systems described herein can be achieved by suitable modifications made by those skilled in the art without departing from the scope of the invention. Several such possible modifications have been mentioned, and other modifications will be apparent to those skilled in the art. For example, the embodiments, implementations, geometries, materials, dimensions, ratios, steps, etc., discussed above are illustrative and not essential. Therefore, the scope of the invention should be considered in accordance with the following claims and should be understood as not being limited to the details of the structures and operations shown and described in the specification and drawings.

Claims

1. A surgical access device, comprising: (a) A cannula having a proximal end, a distal end, and a cannula lumen extending between the proximal end and the distal end; (b) A housing assembly coupled to the proximal end of the cannula, wherein the housing assembly defines an interior housing in communication with the lumen of the cannula; (c) A working channel extending along the central axis of the surgical access device from a proximal end of the surgical access device to a distal end of the surgical access device, wherein the working channel is defined by the cannula lumen and the interior of the housing, wherein the working channel is configured to receive surgical instruments passing through it. (d) A blow-in orifice, which is configured to guide blow-in fluid into the working channel; (e) A first needle port, the first needle port opening through a first side portion of the surgical access device to the working channel, wherein the first needle port includes a first needle entry port and a first needle exit port disposed distal to the first needle entry port, wherein the first needle entry port and the first needle exit port together define a first suture path extending obliquely across the central axis of the surgical access device; and (f) A second needle port, the second needle port opening through a second side portion of the surgical access device into the working channel, wherein the second needle port includes a second needle inlet port and a second needle outlet port disposed distal to the second needle inlet port, wherein the second needle inlet port and the second needle outlet port together define a second suture path extending obliquely across the central axis of the surgical access device, wherein the second needle port is circumferentially offset from the blow-in port. Each of the first and second needle openings is configured to guide the suture threader needle through the surgical access device at an angle relative to the central axis, traversing the working channel. The first needle entry port, the second needle entry port, the first needle exit port, and the second needle exit port are arranged such that the first suture path and the second suture path extend through the central axis of the surgical access device. The housing assembly includes a rotating collar that supports the first needle inlet and the second needle inlet. The rotating collar is configured to selectively rotate one or both of the first needle inlet and the second needle inlet, as well as the first suture path and the second suture path, about the central axis relative to the first needle exit and the second needle exit.

2. The surgical access device of claim 1, wherein, The second pinhole is offset circumferentially by at least 17 degrees from the blow-in port.

3. The surgical access device of claim 1, wherein, The housing assembly includes a proximal housing and a latching ring configured to releasably engage the proximal housing with the cannula, wherein the latching ring includes a user engagement feature actuable to release the proximal housing from the cannula, wherein the user engagement feature is circumferentially offset from the inlet orifice throughout its permissible range of motion.

4. The surgical access device of claim 3, wherein, The latching ring can be moved to a position where the user engagement feature is circumferentially offset by at least 90 degrees from the blow-in orifice.

5. The surgical access device of claim 3, wherein, The user engagement feature includes an outwardly protruding knob.

6. The surgical access device of claim 3, wherein, The latching ring is rotatable about the central axis relative to the proximal housing.

7. The surgical access device according to claim 1, wherein, The cannula includes a proximal hub configured to engage with the housing assembly, wherein the first pinhole and the second pinhole extend through the proximal hub.

8. The surgical access device of claim 1, wherein, The cannula includes a proximal hub and a cylindrical portion extending distally from the proximal hub, wherein the first needle exit port and the second needle exit port lead to the working channel via the cylindrical portion.

9. The surgical access device of claim 1, further comprising a first needle guide structure configured to guide a suture threader needle through the first needle orifice along the first suture path, and a second needle guide structure configured to guide a suture threader needle through the second needle orifice along the second suture path.

10. The surgical access device according to claim 9, wherein, The first needle guide structure and the second needle guide structure include a first needle guide tube and a second needle guide tube.

11. The surgical access device of claim 1, wherein, The first needle exit orifice is diametrically opposite to the first needle entry orifice, wherein the second needle exit orifice is diametrically opposite to the second needle entry orifice.

12. The surgical access device of claim 1, wherein, The first needle inlet, the first needle outlet, and the blow-in outlet are located in a plane extending axially through the surgical access device along its central axis.

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