Directivity gas flow accessory for supplying gas to patient and discharging gas from patient

Abstract

To provide a cannula and / or a medical instrument accessory configured to locally inject gas to a lumen for surgery of a patient (pneumoperitoneum or the like) or discharge the gas from the patient.SOLUTION: A medical instrument accessory includes a body that can be mounted over at least a part of a medical instrument shaft, the body having an inner lumen, a proximal end part, and a distal end part. The distal end part includes an opening, and the distal end part is arranged at an operation end part of the medical instrument or arranged adjacent to it when in use. An outer wall and the lumen of the medical instrument shaft define a gas flow passage. Gas or fluid is released or introduced to the gas flow passage at the distal end part and adjacent to the end part of the medical instrument shaft.SELECTED DRAWING: Figure 3B

Description

[Technical Field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims priority from U.S. Provisional Patent Application No. 62 / 976,993, filed February 14, 2020, the contents of which are incorporated by reference.

[0002] The present disclosure relates generally to medical instrument accessories and components of medical instrument accessories, particularly such accessories configured to direct gases to and / or evacuate gases from a patient during a medical procedure. [Background technology]

[0003] A variety of medical procedures require the provision of a gas, typically carbon dioxide, to a patient during the procedure. For example, two broad categories of medical procedures that often require the provision of a gas to a patient are closed medical procedures and open medical procedures.

[0004] In closed medical procedures, an insufflator is placed to deliver gas to a patient's body cavity during the procedure to inflate the cavity and / or prevent it from collapsing. Examples of such medical procedures include laparoscopy and endoscopy, although insufflators may be used with any other type of medical procedure as needed. Endoscopic procedures allow a physician to visualize a body cavity by inserting an endoscope or the like through one or more natural orifices, one or more small punctures, or one or more incisions to generate images of the cavity. In laparoscopic procedures, a physician generally inserts medical instruments through natural orifices, one or more small punctures, or one or more incisions to perform a medical procedure within the body cavity. In some cases, an initial endoscopic procedure is performed to evaluate the body cavity, followed by laparoscopy to operate on the body cavity. Such procedures are widely used, for example, in the peritoneal cavity or during thoracoscopy, colonoscopy, gastroscopy or bronchoscopy.

[0005] In open medical procedures, such as open surgeries, gas is used to fill the surgical cavity, with excess gas spilling out through the opening. Gas may also be used to provide a layer of gas over exposed body parts, including internal body parts where there is no discernible cavity. In these procedures, gas may not serve to inflate a cavity, but may be used to prevent or reduce desiccation and infection by covering exposed internal body parts with a layer of heated, humidified, sterile gas.

[0006] Devices for delivering gas during these medical procedures may include an insufflator arranged to connect to a remote pressurized gas source, such as a hospital gas supply system. The device may be operable to control the pressure and / or flow of gas from the gas source to a suitable level for delivery to the body cavity, typically through a cannula or needle connected to the device and inserted into the body cavity, or through a diffuser arranged to diffuse the gas above and into the wound or surgical cavity.

[0007] The body temperature of a human patient is generally approximately 37°C. It may be desirable for the temperature of the gas delivered from the device to match as closely as possible the body temperature of a typical human. It may also be desirable to deliver gas above or below body temperature, e.g., anywhere between 1 and 10°C, 15°C, or at a temperature more or less above or below body temperature, i.e., a range including any two of the aforementioned values. It may also be desirable to deliver gas at a desired fixed or variable humidity and / or a desired fixed or variable temperature. Gas at a desired gas temperature and / or humidity (also referred to herein as standard) may be, for example, a dry cooling gas, a dry hot gas, a humidified cooling gas, or a humidified hot gas. Furthermore, gas delivered into the patient's body may be relatively dry, which may cause damage to the body cavity, including, for example, cell desiccation, cell death, and / or adhesions. Often, a humidifier is operably coupled to the insufflator. A controller of the device can activate a heater in a humidifier located in the gas flow path to deliver a humidifying fluid to the gas stream before it enters the patient's body cavity. The humidifying fluid can be water.

[0008] The humidified gas may be delivered to the patient via further tubing, which may also be heated. The injector and humidifier may be located in separate housings connected together by suitable tubing and / or electrical connections, or may be located in a common housing arranged to be connected to a remote gas supply via suitable tubing.

[0009] Due to the difference in temperature between a medical instrument and the temperature inside the human body, condensation can form on the surface of the instrument when it is introduced into the body. When condensation forms on the viewing surface of a medical instrument, such as the lens of a camera or scope, it causes a fogging effect, impairing visibility through the viewing surface. When condensation forms on the instrument, it can coalesce into droplets. This can occur directly on the viewing surface or on another surface and then migrate to or deposit on the viewing surface. Therefore, as used herein, condensation and / or fogging refers to condensation generally, and in some cases specifically to condensation (i.e., fogging) on ​​the viewing surface.

[0010] When operating a medical instrument within the body, bodily fluids, tissue, or debris may obstruct the vision through the instrument's viewing surface. For example, the viewing surface may be exposed to blood, smoke, and / or bone fragments, which may block the view through the viewing surface.

[0011] Any discussion of documents, acts, materials, devices, articles or the like which has been included in this specification should not be taken as an admission that any or all of such matters form part of the prior art or were common general knowledge in the art to which this disclosure pertains by virtue of existing prior to the respective priority dates of the appended claims. Summary of the Invention [Problem to be solved by the invention]

[0012] Condensation occurs when the temperature of a gas drops below the dew point temperature for the level of humidity the gas contains and / or when there is a surface below the dew point temperature. The human body is a warm, moist environment, having a temperature of approximately 37°C. When a cold (e.g., at or below typical room temperature and / or below typical human body temperature) camera, scope, or other medical instrument is inserted into this environment, condensation can cause droplets to form on the lens or elsewhere on the scope, which can drip onto the lens area. Similarly, condensation can form droplets on the inner walls and / or shaft of the cannula upper housing and drip onto the lens area. When such fluid collects on the lens area, it inhibits light transmission through the lens, thus impairing the scope operator's field of vision. Additionally, while humidifying and heating the insufflation gases can reduce damage to the patient's tissue within the surgical cavity, the humidification and temperature of the gases can adversely affect the ability of condensation to build up on and / or around the lens of the scope.

[0013] During a medical procedure, various other substances may come into contact with the lens of a scope, inhibiting light transmission through the lens. For example, the lens may come into contact with bodily fluids or tissue, or debris or particles created by the procedure, e.g., surgical smoke. Any such substance or debris on the lens may obstruct the view of, for example, a surgeon or other medical personnel participating in the medical procedure (e.g., surgery). If the lens becomes contaminated by particles, fluid droplets, or the like, it may be necessary to remove the camera and / or other medical instruments and wipe it (or them) to remove the contaminants. However, removal of the medical instruments from the surgical cavity causes them to cool below the patient's body temperature. As a result, when the instruments are inserted into the body, further condensation may form, which may again obstruct the operator's view through the lens. Past approaches to resolving this include pre-warming the medical instruments and / or using a light or heat source at the end of the camera to warm the lens. Such interventions generally require additional steps and can adversely affect the workflow and efficiency of the procedure. Additionally, repeated heating of the instrument, or parts thereof, such as with a heating element adjacent to the lens, may affect the structure of the instrument and / or increase the complexity of sterilization of the instrument. [Means for solving the problem]

[0014] The present disclosure provides examples of directional gas flow cannulas and / or medical instrument accessories, or medical instruments configured to direct gas flow toward the end of the cannula / instrument. In particular, the disclosed examples are suitable for localizing fluid infusion or evacuation near the distal end of the medical instrument, or for localizing / directing fluid flow around and / or across the distal end of the medical instrument. The disclosed cannula and / or medical instrument accessory examples are operable to move fluid and / or debris across and / or away from the end of the cannula / instrument and / or to heat the end, thereby preventing condensation from forming droplets at the end of the cannula / instrument and / or otherwise removing material from the end. If the instrument is a scope, this may maintain or increase light transmission through the lens at the end of the scope, widening the field of vision. Some disclosed examples may direct gas to flow around the scope / medical instrument to affect the lens and / or the environment at or near the medical instrument. Other disclosed examples may direct insufflation gas to dissipate smoke, condensation, or other unwanted media from the instrument.

[0015] According to one disclosed aspect, a medical instrument accessory for localizing fluid injection or evacuation near a distal end of a medical instrument is provided. The medical instrument accessory may include a body mountable over at least a portion of a shaft of the medical instrument. The body has an inner lumen, a proximal end, and a distal end, and the distal end includes an opening. The distal end is configured to be disposed at or adjacent to the distal end of the medical instrument during use. The outer wall of the medical instrument shaft and the inner lumen define a fluid flow path for fluid to flow into and / or out of the fluid flow path at or adjacent to the distal end of the medical instrument shaft.

[0016] The medical instrument accessory described in any of the preceding paragraphs may further include one or more of the following features: The body may be elongate. The body may be generally cylindrical. The lumen may be shaped to at least partially surround the instrument shaft. The fluid flow path may be defined at least in part by an inner wall of the body and an outer wall of the medical instrument shaft. The body may be configured to attach to the distal end of a cannula or other medical instrument. The body may be at least partially flexible and / or may include an extendable element configured to attach to the distal end of a cannula. The body may be movable between a retracted position and an extended position.

[0017] The body may be configured to attach to a medical instrument at its proximal end via a fitting. The fitting may be a sealing fitting. The fitting is configured to create a fluid-tight seal. The proximal end of the body may be in fluid communication with a fluid source and / or a vent. The body may have a first portion, the inner lumen of which has a first diameter substantially the same as the diameter of the outer wall of the medical instrument, and a second portion, the inner lumen of which has a second diameter larger than the diameter of the outer wall of the medical instrument, and the body has at least one aperture in fluid communication with the fluid flow path. The diameter of the lumen may transition from the first diameter to the second diameter. The at least one aperture may be located at the transition between the first diameter and the second diameter.

[0018] The medical instrument may be a laparoscope, and the fluid flow path may be configured such that fluid exits or enters a fluid flow path adjacent to the lens of the laparoscope. Additionally or alternatively, the fluid flow path may be configured such that fluid exits or enters a fluid flow path parallel to the lens of the laparoscope. The body may define a protruding portion, such as a shoulder portion or a ring portion, disposed at a distal end. The protruding portion may define at least one aperture. The protruding portion may define an inner diameter that is smaller than an outer diameter of the medical instrument. The medical instrument may be an electrocautery tool. The body may have a length dimensioned substantially equal to the length of the medical instrument, such that a distal end of the body is disposed adjacent to the distal end of the medical instrument.

[0019] In some cases, a medical instrument accessory for confining or directing fluid flow around a distal end of a medical instrument can include a body configured to fit over at least a portion of a shaft of the medical instrument. The body can include a lumen with an inner wall, a proximal end, an open distal end, and at least one structure configured to position the medical instrument shaft within the lumen during use so that a fluid flow path is defined between the inner lumen wall and the medical instrument shaft. The body can further direct fluid into or out of the open distal end. The body can also direct fluid around the end of the medical instrument.

[0020] The medical instrument accessory described in any of the preceding paragraphs may further include one or more of the following features: The at least one structure may be on an inner wall of the accessory. The body may be configured to over-fit onto at least a portion of the medical instrument shaft. The proximal end of the body may be in fluid communication with a fluid source or a vent. The at least one structure may include multiple structures. The at least one structure may hold the medical instrument shaft substantially concentrically within the lumen.

[0021] At least one structure may include one or more substructures, such as surfaces, protrusions, or ribs, extending inward from the inner wall. The one or more substructures may extend along substantially the entire length of the inner wall. The one or more substructures may be located at least partially around the open distal end. The one or more substructures may be located adjacent the proximal end. The one or more substructures may be located adjacent the proximal end and the distal end. At least one structure may include one or more protrusions extending inward from the inner wall of the lumen. The one or more protrusions may be located at the proximal end, the distal end, and / or intermediately along the length of the lumen. The one or more substructures or protrusions may be substantially uniformly spaced around the diameter of the lumen. The one or more substructures or protrusions may be non-uniformly spaced. The one or more substructures or protrusions may at least partially define multiple fluid flow paths, and in some embodiments, the flow paths may define different shapes and / or sizes.

[0022] The at least one structure may include one or more fins extending inward from the inner wall of the lumen. The one or more fins may be arranged in a substantially spiral configuration. The at least one structure may include one or more flexible members extending from the open distal end. The at least one structure may include a movable tip located at the distal open end, the movable tip having a flexible portion and a solid edge from which one or more protrusions extend radially inward. The solid edge may be laterally movable and substantially parallel to the open distal end. The solid edge may be configured to engage with an end of a medical instrument. The lumen may have a cross-sectional shape that is different from that of the medical instrument shaft. The cross-sectional shape of the lumen may be substantially elliptical. The at least one structure may include one or more channels defined in the inner wall of the lumen. The one or more channels may extend substantially the entire length of the lumen.

[0023] In some cases, a medical instrument accessory for directing fluid flow to, e.g., around and / or across, a distal end of a medical instrument can include a body configured to fit over at least a portion of a shaft of the medical instrument to at least partially surround the shaft. The body can include a lumen with an inner wall, a proximal end, an open distal end, and a stop that can be located at or adjacent the open distal end. The body defines a longitudinal axis between the ends.

[0024] The medical instrument accessory described in any of the preceding paragraphs may further include one or more of the following features: The stop may be configured to position the distal end of the medical instrument a predetermined distance from the open distal end of the body during use. The medical instrument accessory may further include one or more structures, such as ribs or protrusions, disposed on the inner wall of the lumen. The ribs or protrusions may be disposed substantially concentrically around the inner wall of the lumen.

[0025] The medical instrument accessory may further include at least one deflection structure, such as a shelf, shoulder, or ledge, arranged to extend partially across the open distal end to receive and deflect fluid flowing through the lumen, e.g., laterally relative to the longitudinal axis. The or each deflection structure may extend radially inward and may be arranged to extend from an edge, side, or rim of the open distal end. The deflection structure may include multiple deflection surfaces arranged to direct the fluid into respective multiple streams transverse to the longitudinal axis. The deflection structure may be separate from and attachable to the accessory, e.g., the accessory shaft. The deflection structure may extend substantially perpendicular from the edge of the open distal end and may be defined by a ring structure. The deflection structure may define a surface area that is a segment of a circle. The stop may be positioned within the lumen axially spaced from the deflection structure or at least partially on the deflection structure.

[0026] The medical instrument accessory may further include a protruding portion, such as a flange, extending longitudinally from the open distal end to enable fluid flow direction. The protruding portion may extend from an edge or rim of the distal end to partially surround the opening. The protruding portion may define a free end, and the deflection structure may extend radially inward from the free end of the protruding portion.

[0027] The body may include at least one second lumen configured to convey fluid through the body and outwardly therefrom, for example, to channel insufflation gases into the surgical cavity. The body may include at least one exhaust lumen configured to receive fluid and convey it through the body, for example, to exhaust fluid from the surgical cavity. The at least one exhaust lumen may have an inlet disposed within the body. The open distal end may be angled relative to the longitudinal axis of the body.

[0028] In some cases, a medical instrument accessory for heating a medical instrument can include a body that can be configured to fit over at least a portion of the medical instrument. The body can include a heating device that can directly or indirectly heat the medical instrument during use.

[0029] The medical instrument accessory described in any of the preceding paragraphs may further include one or more of the following features: The body may have a lumen with an inner wall. The inner wall may be configured to contact the surface of the medical instrument. The inner wall may be configured to be spaced from the surface of the medical instrument during use. The body may define a length that is shorter than the length of the shaft of the medical instrument. The heating device may include one or more selected from the group consisting of: a heating coil, a resistive material, a flexible PCB, chemical heating, an insulating material, and vaporization. The heating device may be powered by one or more of an external unit, an associated cannula, a battery, a tubing set, tubing, and wireless power transmission. The heating device may provide heating along substantially the entire length of the shaft of the medical instrument. The heating device may be configured to provide graduated heating along the shaft of the medical instrument. The heating device may be configured to provide heating that is localized to a portion of the shaft of the medical instrument.

[0030] In some cases, a medical instrument accessory for confining or directing fluid flow about a distal end of a medical instrument can include a body configured to fit over at least a portion of a shaft of the medical instrument. The body can have at least one structure configured to position the medical instrument shaft within the cannula lumen during use to define a fluid flow path between the wall of the cannula lumen and the medical instrument shaft.

[0031] The medical instrument accessory described in any of the preceding paragraphs may further include one or more of the following features: The fluid flow path may be configured to direct fluid toward, around, and / or across the distal end of the medical instrument. The at least one structure may include a plurality of structures. The at least one structure may be configured to abut or adjacent an exterior surface of the medical instrument during use.

[0032] In some cases, medical instruments used in laparoscopic surgical procedures may include a shaft configured to direct fluid flow relative to the instrument shaft, for example, over or adjacent to the distal end of the shaft.

[0033] The medical instrument described in any of the preceding paragraphs may further include one or more of the following features: The shaft may have a lumen for directing fluid flow through the shaft and out at or adjacent the distal end of the shaft. The lumen may be concentric with the shaft. The medical instrument may include an inwardly extending deflection structure for directing fluid flow from the lumen across the distal end of the shaft. The deflection structure may be ring-shaped. The lumen may be offset from the axis of the shaft. The deflection structure may extend inward from a rim at the distal end of the shaft.

[0034] The surface of the shaft may have one or more protrusions extending radially outward. The one or more protrusions may be configured to contact the inner wall of the cannula during use to define a fluid flow path between the shaft and the cannula. The one or more protrusions may be ribs extending at least partially along the shaft. The ribs may extend along substantially the entire length of the shaft. The one or more protrusions may be substantially uniformly distributed around the circumference of the shaft. The one or more protrusions may be non-uniformly distributed around the circumference of the shaft. The one or more protrusions may be different sizes and may be located around the circumference of the shaft, where the one or more protrusions of different sizes are configured to create various gas path sizes. The one or more protrusions may include spiral fins. The shaft may have a cross-sectional shape different from the cross-sectional shape of the cannula. The shaft of the medical instrument may include a heating device.

[0035] According to another disclosed aspect, a medical instrument accessory for localizing fluid injection or evacuation from a distal end of a medical instrument having a shaft is provided. The medical instrument accessory includes a body configured to be attached to the medical instrument. The body defines an inner lumen dimensioned to receive at least a portion of the shaft, a proximal end, a distal end, and a longitudinal axis therebetween. The distal end defines an opening and is configured to be disposed at or adjacent the distal end of the medical instrument during use. The inner lumen is shaped to define a fluid flow path such that, during use, fluid can flow into and / or out of the fluid flow path through the opening.

[0036] The medical instrument accessory described in any of the preceding paragraphs may further include one or more of the following features. The accessory may include at least one deflecting structure arranged to receive fluid flowing through the inner lumen and direct the received fluid to flow transversely to the longitudinal axis. The at least one deflecting structure may be arranged to direct the fluid to flow outwardly from the opening. The at least one deflecting structure may be configured such that, during use, the or each deflecting structure directs the received fluid to flow substantially transversely to the distal end of the medical instrument. The at least one deflecting structure may be configured such that, during use, the received fluid directs the received fluid to flow substantially parallel to the distal end of the medical instrument. The at least one deflecting structure may be arranged to direct the received fluid to flow substantially perpendicular to the longitudinal axis. The at least one deflecting structure may be arranged to direct the received fluid into a plurality of separate streams. The at least one deflecting structure may be arranged such that at least two of the streams are directed to intersect with each other. The at least one deflecting structure may be arranged to direct each of at least two of the streams radially toward the longitudinal axis. The at least one deflecting structure may be arranged to direct at least two of the streams parallel to one another. The at least one deflecting structure may be arranged to direct at least two of the streams diverging away from one another. The at least one deflecting structure may be arranged to direct the streams across two or more planes axially spaced from one another. The or each deflecting structure may be arranged to extend from half of the inner lumen. The or each deflecting structure may be arranged to cover equal to or less than half of the opening defined by the distal end.

[0037] The inner lumen may define two portions, the first portion defining a first diameter and the second portion defining a second diameter greater than the first diameter. The or each deflection structure may extend partially across the opening from the second portion. The first diameter may be dimensioned to be substantially equal to an outer diameter of the medical instrument, such that the first portion fits snugly with the medical instrument during use. The body may include a shaft and an end cap removably securable to the shaft, and the at least one deflection structure is defined by the end cap.

[0038] The medical instrument accessory described in any of the preceding paragraphs may include an alignment feature defining a recess shaped to at least partially receive a portion of the medical instrument, and the recess is positioned to prevent relative rotation of the medical instrument and the accessory. The alignment feature may be located at or adjacent to the proximal end of the body. The recess may be configured to be an open slot configured to extend along the longitudinal axis. The recess may be defined by a pair of spaced elongated members. The recess may be defined by a shroud shaped to complement and at least partially surround a portion of the medical instrument. The body may include a shaft and an end cap removably securable to the shaft, and the alignment feature may extend from the end cap. The alignment feature may be removably securable to the end cap.

[0039] The medical instrument accessory described in any of the preceding paragraphs may include a locking mechanism operable to retain the medical instrument within the accessory. The locking mechanism may include a cam rotatable about an axis between an open position and a locked position, in which the cam is positioned to interfere with the medical instrument during use. The locking mechanism may be disposed at or adjacent to the proximal end of the body. The body may define a first slot and a second slot extending perpendicular to and intersecting the first slot, and the cam may include a shaft, and each slot may be dimensioned to receive the shaft. The cam may include a protrusion at each end of the shaft, and the first slot may be dimensioned to receive the shaft and the protrusion, and the second slot may be dimensioned to receive only the shaft, with the protrusion disposed outside the second slot to engage the cam with the body.

[0040] It should be recognized that references herein to "proximal" and "distal" are in accordance with the conventional meaning of these terms in the art, as they relate to the operator or user of the device. For example, the distal end of a medical instrument is generally the end located away from the operator, which is generally within or in contact with the patient during use.

[0041] Throughout this specification the word "comprise" or variations such as "comprises" or "comprising" will be understood to imply the inclusion of a stated element, integer or step, or group of elements, integers or steps, but not the exclusion of any other element, integer or step, or group of elements, integers or steps.

[0042] These and other features, aspects, and advantages of the present disclosure will be described with reference to drawings of several embodiments, which are intended to schematically illustrate several embodiments and are not intended to limit the scope of the present disclosure. In some cases, "slices" are shown for clarity in several cross-sectional and transverse views of three-dimensional cannulas, sheaths, or accessories. Those skilled in the art will recognize that these drawings show slices of three-dimensional cannulas, sheaths, or accessories. In some cases, protruding surfaces are not shown for clarity. For example, the surfaces of protruding holes are hidden in some drawings. [Brief explanation of the drawings]

[0043] [Figure 1] 1 illustrates a schematic representation of an exemplary medical gas delivery system in use during surgery. [Figure 2] 1 illustrates a schematic representation of an exemplary medical gas delivery system. [Figure 3A] 1A-1C show schematic diagrams of an embodiment of a cannula configured to direct gas flow into a surgical cavity. [Figure 3B] 1A-1C show schematic diagrams of an embodiment of a cannula configured to direct gas flow into a surgical cavity. [Figure 3C] 1A-1C show schematic diagrams of an embodiment of a cannula configured to direct gas flow into a surgical cavity. [Figure 3D] 1A-1C show schematic diagrams of an embodiment of a cannula configured to direct gas flow into a surgical cavity. [Figure 4] 10 illustrates the effect on the field of view within the surgical cavity by using localized infusion and / or localized evacuation. [Figure 5A] 10 illustrates the effect on the field of view within the surgical cavity by using localized infusion and / or localized evacuation. [Figure 5B] 10 illustrates the effect on the field of view within the surgical cavity by using localized infusion and / or localized evacuation. [Figure 6A]10 shows an extendable element on a cannula that can be secured to a medical instrument and that releases or vents gas to the distal end of the medical instrument. [Figure 6B] 10 shows an extendable element on a cannula that can be secured to a medical instrument and that releases or vents gas to the distal end of the medical instrument. [Figure 6C] 10 shows an extendable element on a cannula that can be secured to a medical instrument and that releases or vents gas to the distal end of the medical instrument. [Figure 6D] 10 shows an extendable element on a cannula that can be secured to a medical instrument and that releases or vents gas to the distal end of the medical instrument. [Figure 6E] 10 shows an extendable element on a cannula that can be secured to a medical instrument and that releases or vents gas to the distal end of the medical instrument. [Figure 6F] 10 shows an extendable element on a cannula that can be secured to a medical instrument and that releases or vents gas to the distal end of the medical instrument. [Figure 7A] 1 shows an extension of a cannula for venting or evacuating gas at the distal end of a medical instrument. [Figure 7B] 1 shows an extension of a cannula for venting or evacuating gas at the distal end of a medical instrument. [Figure 8A] 1 illustrates a medical instrument accessory that can be attached to a medical instrument. [Figure 8B] 1 illustrates a medical instrument accessory that can be attached to a medical instrument. [Figure 9A] 1 illustrates a medical instrument accessory that can be positioned within a cannula and positioned around a medical instrument. [Figure 9B] 1 illustrates a medical instrument accessory that can be positioned within a cannula and positioned around a medical instrument. [Figure 9C] 1 illustrates a medical instrument accessory that can be positioned within a cannula and positioned around a medical instrument. [Figure 9D] 1 illustrates a medical instrument accessory that can be positioned within a cannula and positioned around a medical instrument. [Figure 10A]1 illustrates a medical instrument accessory that can be positioned within a cannula and positioned around a medical instrument. [Figure 10B] 1 illustrates a medical instrument accessory that can be positioned within a cannula and positioned around a medical instrument. [Figure 11] 1 illustrates directional gas flow directed around a medical instrument within a medical instrument accessory. [Figure 12A] 1 shows ribs installed on the inner surface of a medical instrument accessory. [Figure 12B] 1 shows ribs installed on the inner surface of a medical instrument accessory. [Figure 13A] 10 illustrates ribs that may be positioned at a distal end of a medical instrument accessory that define gas flow paths between the ribs. [Figure 13B] 10 illustrates ribs that may be positioned at a distal end of a medical instrument accessory that define gas flow paths between the ribs. [Figure 14A] 10 illustrates a protrusion that may be positioned on the distal end of a medical instrument accessory. [Figure 14B] 10 illustrates a protrusion that may be positioned on the distal end of a medical instrument accessory. [Figure 15A] 10 illustrates a rib that can be positioned at a first location on the distal end of the medical instrument accessory and at a second spaced apart location on the proximal end of the medical instrument accessory. [Figure 15B] 10 illustrates a rib that can be positioned at a first location on the distal end of the medical instrument accessory and at a second spaced apart location on the proximal end of the medical instrument accessory. [Figure 15C] 10 illustrates a rib that can be positioned at a first location on the distal end of the medical instrument accessory and at a second spaced apart location on the proximal end of the medical instrument accessory. [Figure 16] 10 illustrates a spiral structure that may include spiral fins positioned along the interior wall of a medical instrument accessory. [Figure 17] 1 illustrates a flexible, flared tip that may be positioned at the distal end of a medical instrument accessory. [Figure 18A] 10 illustrates a flexible section that may be positioned at the distal end of a medical instrument accessory. [Figure 18B]10 illustrates a flexible section that may be positioned at the distal end of a medical instrument accessory. [Figure 19A] 10 illustrates unevenly spaced ribs that may be positioned on the distal end of a medical instrument accessory. [Figure 19B] 10 illustrates unevenly spaced ribs that may be positioned on the distal end of a medical instrument accessory. [Figure 20A] 10 illustrates ribs of different widths that may be spaced around the distal end of a medical instrument accessory. [Figure 20B] 10 illustrates ribs of different widths that may be spaced around the distal end of a medical instrument accessory. [Figure 21A] 10 illustrates cutouts that may be positioned along the body of the accessory. [Figure 21B] 10 illustrates cutouts that may be positioned along the body of the accessory. [Figure 22A] 1 illustrates an accessory for a medical instrument that may have a non-circular shape, thereby allowing gas flow around the medical instrument. [Figure 22B] 1 illustrates an accessory for a medical instrument that may have a non-circular shape, thereby allowing gas flow around the medical instrument. [Figure 23] 1 illustrates a directional gas flow directed across a medical instrument within a cannula. [Figure 24A] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 24B] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 24C]The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 24D] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 24E] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 25A] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 25B] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 25C] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 25D]The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 25E] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 26A] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 26B] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 26C] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 26D] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 26E]The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 27A] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 27B] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 27C] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 27D] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 27E] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 28A]The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 28B] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 28C] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 28D] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 28E] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 29A] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 29B]The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 29C] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 29D] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 29E] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 30A] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 30B] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 30C]The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 30D] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 30E] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 31A] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 31B] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 31C] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 31D]The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 31E] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 32A] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 32B] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 32C] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 32D] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 32E]The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 33A] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 33B] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 33C] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 33D] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 33E] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 34A]The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 34B] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 34C] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 34D] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 34E] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 35A] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 35B]The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 35C] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 35D] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 35E] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 36A] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 36B] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 36C]The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 36D] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 36E] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 37A] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 37B] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 37C] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 37D]The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 37E] The medical instrument accessory may include a body that may be positioned over at least a portion of the shaft of the medical instrument and a stop portion at or adjacent the distal open end, and the stop portion may position the end of the medical instrument shaft adjacent the open distal end of the medical instrument accessory. [Figure 38] 1 illustrates a heating device that may be used with any of the directional gas flow cannulas or medical instrument accessories described herein. [Figure 39] 1 illustrates a heating device that may be used with any of the directional gas flow cannulas or medical instrument accessories described herein. [Figure 40A] 1 illustrates a heating device that may be used with any of the directional gas flow cannulas or medical instrument accessories described herein. [Figure 40B] 1 illustrates a heating device that may be used with any of the directional gas flow cannulas or medical instrument accessories described herein. [Figure 40C] 1 illustrates a heating device that may be used with any of the directional gas flow cannulas or medical instrument accessories described herein. [Figure 41A] 1 illustrates various heating methods that may be incorporated into the medical instrument accessories described herein. [Figure 41B] 1 illustrates various heating methods that may be incorporated into the medical instrument accessories described herein. [Figure 41C] 1 illustrates various heating methods that may be incorporated into the medical instrument accessories described herein. [Figure 41D] 1 illustrates various heating methods that may be incorporated into the medical instrument accessories described herein. [Figure 41E] 1 illustrates various heating methods that may be incorporated into the medical instrument accessories described herein. [Figure 41F]1 illustrates various heating methods that may be incorporated into the medical instrument accessories described herein. [Figure 42A] 1 illustrates various power options for providing power to the heating device. [Figure 42B] 1 illustrates various power options for providing power to the heating device. [Figure 42C] 1 illustrates various power options for providing power to the heating device. [Figure 42D] 1 illustrates various power options for providing power to the heating device. [Figure 42E] 1 illustrates various power options for providing power to the heating device. [Figure 42F] 1 illustrates various power options for providing power to the heating device. [Figure 42G] 1 illustrates various power options for providing power to the heating device. [Figure 43A] 10 shows a variation of how heat can be transferred to a gas stream passing by or through a medical instrument accessory. [Figure 43B] 10 shows a variation of how heat can be transferred to a gas stream passing by or through a medical instrument accessory. [Figure 43C] 10 shows a variation of how heat can be transferred to a gas stream passing by or through a medical instrument accessory. [Figure 44A] 1 illustrates gas delivery options that may be used with any of the cannulas, medical instrument accessories, or medical instruments described herein. [Figure 44B] 1 illustrates gas delivery options that may be used with any of the cannulas, medical instrument accessories, or medical instruments described herein. [Figure 45] 1 illustrates gas delivery options that may be used with any of the cannulas, medical instrument accessories, or medical instruments described herein. [Figure 46] 1 illustrates gas delivery options that may be used with any of the cannulas, medical instrument accessories, or medical instruments described herein. [Figure 47]1 illustrates gas delivery options that may be used with any of the cannulas, medical instrument accessories, or medical instruments described herein. [Figure 48] 10 shows mounting options for incorporating medical instrument accessories and securing any cannula, medical instrument accessory, or device that may be used with the medical instrument. [Figure 49A] 10 shows mounting options for incorporating medical instrument accessories and securing any cannula, medical instrument accessory, or device that may be used with the medical instrument. [Figure 49B] 10 shows mounting options for incorporating medical instrument accessories and securing any cannula, medical instrument accessory, or device that may be used with the medical instrument. [Figure 50A] 10 shows mounting options for incorporating medical instrument accessories and securing any cannula, medical instrument accessory, or device that may be used with the medical instrument. [Figure 50B] 10 shows mounting options for incorporating medical instrument accessories and securing any cannula, medical instrument accessory, or device that may be used with the medical instrument. [Figure 51A] 10 shows mounting options for incorporating medical instrument accessories and securing any cannula, medical instrument accessory, or device that may be used with the medical instrument. [Figure 51B] 10 shows mounting options for incorporating medical instrument accessories and securing any cannula, medical instrument accessory, or device that may be used with the medical instrument. [Figure 52A] 10 shows mounting options for incorporating medical instrument accessories and securing any cannula, medical instrument accessory, or device that may be used with the medical instrument. [Figure 52B] 10 shows mounting options for incorporating medical instrument accessories and securing any cannula, medical instrument accessory, or device that may be used with the medical instrument. [Figure 52C]10 shows mounting options for incorporating medical instrument accessories and securing any cannula, medical instrument accessory, or device that may be used with the medical instrument. [Figure 52D] 10 shows mounting options for incorporating medical instrument accessories and securing any cannula, medical instrument accessory, or device that may be used with the medical instrument. [Figure 52E] 10 shows a locking mechanism at the proximal end of a medical instrument accessory shaft. [Figure 52F] 10 shows a locking mechanism at the proximal end of a medical instrument accessory shaft. [Figure 53A] 1 shows a cannula with a gas flow path between the cannula lumen and the medical instrument. [Figure 53B] 1 shows a cannula with a gas flow path between the cannula lumen and the medical instrument. [Figure 54A] Medical device accessories: Indicates a medical device with a mounting part. [Figure 54B] Medical device accessories: Indicates a medical device with a mounting part. [Figure 55A] Refers to a medical device in which two or more medical device accessories are attached to the medical device. [Figure 55B] Refers to a medical device in which two or more medical device accessories are attached to the medical device. [Figure 56] 1 shows a medical device with a medical device accessory attached to the medical device. [Figure 57A] 1 shows a medical instrument with a medical instrument accessory. [Figure 57B] 1 shows a medical instrument with a medical instrument accessory. [Figure 58A] 1 shows a medical instrument with a medical instrument accessory. [Figure 58B] 1 shows a medical instrument with a medical instrument accessory. [Figure 59A] 1 shows a medical instrument with a medical instrument accessory. [Figure 59B] 1 shows a medical instrument with a medical instrument accessory. [Figure 60A]1 shows a cannula with a gas flow path between the cannula lumen and the medical instrument. [Figure 60B] 1 shows a cannula with a gas flow path between the cannula lumen and the medical instrument. [Figure 61A] 1 illustrates an embodiment of a medical device having a lumen for directing gas flow through the medical device. [Figure 61B] 1 illustrates an embodiment of a medical device having a lumen for directing gas flow through the medical device. [Figure 61C] 1 illustrates an embodiment of a medical device having a lumen for directing gas flow through the medical device. [Figure 62A] 1 illustrates an embodiment of a medical device having a lumen for directing gas flow through the medical device. [Figure 62B] 1 illustrates an embodiment of a medical device having a lumen for directing gas flow through the medical device. [Figure 62C] 1 illustrates an embodiment of a medical device having a lumen for directing gas flow through the medical device. [Figure 63A] 1 shows protrusions evenly spaced around the circumference of the shaft of a medical instrument to direct flow concentrically around the instrument. [Figure 63B] 1 shows protrusions evenly spaced around the circumference of the shaft of a medical instrument to direct flow concentrically around the instrument. [Figure 64A] Two sets of protrusions are shown evenly spaced around the circumference of the instrument shaft to direct flow concentrically around the instrument. [Figure 64B] Two sets of protrusions are shown evenly spaced around the circumference of the instrument shaft to direct flow concentrically around the instrument. [Figure 65] The projections are shown in a spiral arrangement around the circumference of the shaft of the medical instrument to direct flow concentrically around the medical instrument. [Figure 66A] 1 shows protrusions that are non-uniformly spaced around the circumference of the shaft of a medical instrument to direct flow concentrically around the medical instrument. [Figure 66B] 1 shows protrusions that are non-uniformly spaced around the circumference of the shaft of a medical instrument to direct flow concentrically around the medical instrument. [Figure 67A] Protrusions of unequal widths are shown around the shaft of the medical instrument to direct flow concentrically around the medical instrument. [Figure 67B] Protrusions of unequal widths are shown around the shaft of the medical instrument to direct flow concentrically around the medical instrument. [Figure 68A] 1 shows a medical instrument having a shaft with a non-circular cross section. [Figure 68B] 1 shows a medical instrument having a shaft with a non-circular cross section. [Figure 69A] Indicates a medical device with a ledge. [Figure 69B] Indicates a medical device with a ledge. [Figure 69C] Indicates a medical device with a ledge. [Figure 70A] 1 shows a medical instrument with a ledge on one side of the instrument to direct gas across the lens. [Figure 70B] 1 shows a medical instrument with a ledge on one side of the instrument to direct gas across the lens. [Figure 70C] 1 shows a medical instrument with a ledge on one side of the instrument to direct gas across the lens. [Figure 71A] 10 shows a medical instrument with a circular ledge around the angled medical instrument that directs gas across the lens in all directions in the plane of the ledge. [Figure 71B] 10 shows a medical instrument with a circular ledge around the angled medical instrument that directs gas across the lens in all directions in the plane of the ledge. [Figure 71C] 10 shows a medical instrument with a circular ledge around the angled medical instrument that directs gas across the lens in all directions in the plane of the ledge. [Figure 72A]1 illustrates an angled medical instrument with a ledge on one side of the angled medical instrument that directs gas across the lens. [Figure 72B] 1 illustrates an angled medical instrument with a ledge on one side of the angled medical instrument that directs gas across the lens. [Figure 72C] 1 illustrates an angled medical instrument with a ledge on one side of the angled medical instrument that directs gas across the lens. [Figure 73A] 1 illustrates an embodiment of power options for a heating device for a medical instrument. [Figure 73B] 1 illustrates an embodiment of power options for a heating device for a medical instrument. [Figure 73C] 1 illustrates an embodiment of power options for a heating device for a medical instrument. [Figure 73D] 1 illustrates an embodiment of power options for a heating device for a medical instrument. [Figure 73E] 1 illustrates an embodiment of power options for a heating device for a medical instrument. [Figure 74A] 1 illustrates an embodiment of a medical instrument accessory that includes a deflection structure configured to direct fluid flow toward a distal end of the accessory. [Figure 74B] 1 illustrates an embodiment of a medical instrument accessory that includes a deflection structure configured to direct fluid flow toward a distal end of the accessory. [Figure 74C] 1 illustrates an embodiment of a medical instrument accessory that includes a deflection structure configured to direct fluid flow toward a distal end of the accessory. [Fig. 74D] 74A-74C illustrate an alternative embodiment of an accessory for the medical instrument shown in FIGS. [Figure 74E] 74A-74C illustrate an alternative embodiment of an accessory for the medical instrument shown in FIGS. [Figure 74F] 74A-74C illustrate an alternative embodiment of an accessory for the medical instrument shown in FIGS. [Figure 74G] 74A-74C illustrate an alternative embodiment of an accessory for the medical instrument shown in FIGS. [Figure 74H]74A-74C illustrate an alternative embodiment of an accessory for the medical instrument shown in FIGS. [Figure 74I] 74A-74C illustrate an alternative embodiment of an accessory for the medical instrument shown in FIGS. [Figure 75] 1 shows an accessory for a medical instrument having a sealing element at the proximal end of the accessory shaft to prevent gas from exiting or leaking at the proximal end. [Figure 76A] 10 illustrates an embodiment of an alignment feature configured to prevent relative rotation between a medical instrument and an accessory for the medical instrument. [Figure 76B] 10 illustrates an embodiment of an alignment feature configured to prevent relative rotation between a medical instrument and an accessory for the medical instrument. [Figure 76C] 10 illustrates an embodiment of an alignment feature configured to prevent relative rotation between a medical instrument and an accessory for the medical instrument. [Figure 76D] 10 illustrates an embodiment of an alignment feature configured to prevent relative rotation between a medical instrument and an accessory for the medical instrument. [Figure 77A] 10 illustrates an embodiment of a locking mechanism operable to secure an accessory for a medical instrument to the medical instrument. [Figure 77B] 10 illustrates an embodiment of a locking mechanism operable to secure an accessory for a medical instrument to the medical instrument. [Figure 77C] 10 illustrates an embodiment of a locking mechanism operable to secure an accessory for a medical instrument to the medical instrument. [Figure 77D] 10 illustrates an embodiment of a locking mechanism operable to secure an accessory for a medical instrument to the medical instrument. [Figure 77E] 10 illustrates an embodiment of a locking mechanism operable to secure an accessory for a medical instrument to the medical instrument. [Figure 77F] 10 illustrates an embodiment of a locking mechanism operable to secure an accessory for a medical instrument to the medical instrument. DETAILED DESCRIPTION OF THE INVENTION

[0044] While several embodiments and examples are described below, it should be recognized that the present disclosure encompasses obvious modifications and equivalents thereof, not just the disclosed embodiments and / or uses. The scope of the present disclosure is not intended to be limited to any particular embodiment described below. While some features may be disclosed in connection with one or more embodiments and other features may be disclosed in connection with one or more other embodiments, it should be recognized that combining these features together into one or more additional embodiments is within the scope of the present disclosure. Thus, it is understood that any combination of the disclosed features of either the medical instrument accessory or the instrument itself is within the scope of the present disclosure.

[0045] Exemplary Medical Gas Delivery System An exemplary surgical system is shown in FIGS. 1 and 2, which illustrate an insufflation system 1 during a medical procedure. In some embodiments, the system may include a fluid source, e.g., a gas source 9, and a medical instrument configured to be inserted into a surgical cavity within a patient 2 via a cannula 15. The gas source 9 may include any suitable supply of gas, such as a canister, a wall source, or a generator, such as a blower. It should be appreciated that fluid, as referred to herein, may refer to any gas or liquid. A humidifier, e.g., a passover humidifier comprising a humidification chamber 5 holding a quantity of humidified fluid 8, may be installed between the gas source and the surgical cavity. The system may have functionality for aspiration and / or evacuation of surgical smoke, debris, and the like. This functionality may include one or more evacuation cannulas 22. The system 1 may include monitoring equipment for use with the system. For example, a surgical scope (hereinafter "scope") including a camera, such as a laparoscope, may be used with or be part of a medical instrument, allowing images recorded by the scope to be displayed on an external monitor. Optionally, gas may be delivered via delivery tubes 10, 13, which may heat or cool the gas as it travels between the gas source and the surgical cavity.

[0046] Cannula 15 may be used to deliver gases to the surgical cavity. Cannula 15 may include one or more passageways for introducing gases and / or one or more medical instruments 20 into the surgical cavity. The medical instruments may be any suitable instrument for use within the surgical cavity, such as a scope, an electrocautery tool, an electrosurgical tool, an energy, or laser cutting and / or cauterizing tool, etc.

[0047] As described herein, a proximal direction with respect to a cannula, medical instrument, or medical instrument accessory generally refers to the top operable end of the cannula, instrument, or accessory, while a distal direction with respect to a cannula, instrument, or accessory generally refers to the bottom operable end of the cannula, instrument, or accessory. The bottom operable end is generally configured to be the first end inserted into a surgical cavity. More detailed examples of directional gas flow cannulas and medical instrument accessories are described below. Reference numbers for the same or substantially the same features may have the same last two digits.

[0048] Examples of medical equipment accessories Condensation occurs when the temperature of a gas drops below the dew point for the level of humidity it contains. This can be caused by the gas contacting a surface that is at a temperature below the dew point. Medical instruments intended to be inserted into the surgical cavity via cannula 15, such as a camera and / or surgical scope, are generally at a lower temperature than the human body. Therefore, humidified gas can condense on the instrument, forming droplets on the lens and / or elsewhere on the instrument, which can drip onto the lens. Similarly, the instrument lens can collect other debris and / or fluids, such as bodily fluids and / or tissue, or can become fogged by smoke or other debris. If fluids and / or debris collect on or near the lens, this can obstruct the view of the instrument operator, e.g., the surgeon, or other medical personnel participating in the procedure. This may require removing the instrument from the surgical cavity and cleaning the lens, which can extend the duration of the surgical procedure. Additionally, when the instrument is removed from the cavity, this can cause the temperature of the instrument to drop, which can cause further fogging and / or condensation when reintroduced into the cavity.

[0049] This disclosure provides examples of medical instrument accessories that may be used with the cannula 15 of a medical gas delivery or laparoscopic system. The medical instrument accessories can be configured to deliver gas to a medical instrument, such as a scope, which may reduce or prevent fluid droplets or debris from collecting on the instrument and / or allow fluid or debris to be removed from the instrument.

[0050] The exemplary medical instrument accessories disclosed herein can be retrofitted to existing surgical systems, such as insufflation systems, without the need for customization. Thus, the exemplary medical instrument accessories disclosed herein can enhance the optical clarity of the scope lens and / or maintain a clear field of view during use. This can help minimize surgical duration and post-operative complications (e.g., pain, adhesions, and / or other) and / or allow medical personnel, such as surgeons, to easily navigate the cannula during a medical procedure.

[0051] Delivering a gas flow near or across the distal end of a medical instrument, e.g., a scope, can heat the end of the instrument and / or apply a force to the end. This can inhibit the formation of condensation by affecting the environment immediately surrounding the scope lens. Additionally or alternatively, this can drive fluid and / or debris away from the end. This can be achieved by manipulating fluid flow, temperature, and / or humidity in the environment. This can advantageously maintain the temperature of the scope lens (or other instrument components, e.g., sensors) above the dew point of the gas in a zone adjacent to the scope lens. Medical instrument accessories can be single-use (disposable) or reusable. Alternatively, multiple portions of a medical instrument accessory can be single-use (disposable) or reusable. Medical instrument accessories can be made of biocompatible and / or sterilizable materials.

[0052] It is recognized that disclosed embodiments of medical instrument accessories may include any of the features and / or integers disclosed herein or that may be indicated individually or collectively herein, and that any and all combinations of two or more of the disclosed features are within the scope of the present disclosure.

[0053] An exemplary directional gas flow cannula may have any of the features of cannula 15. For example, the directional gas flow cannula may have a cannula body 102 connectable to an elongate shaft 104. The elongate shaft 104 optionally has a pointed end to simplify insertion of the cannula 100 into the surgical cavity. In some cases, the cannula's elongate shaft 104 may be used in combination with an obturator that functions as a trocar. A trocar may include a cannula and an obturator. The cannula body 102 may have guide features that aid in the insertion of a medical instrument into the cannula. As used herein, the terms guiding element, guiding feature, guide element, and / or guide feature may be used interchangeably herein to refer to features that aid in insertion or that are used to support or position a medical instrument within a cannula.

[0054] A surgical, e.g., insufflation system for supplying insufflation gases to a surgical cavity, such as any of the surgical, e.g., insufflation systems disclosed herein, may incorporate any of the exemplary medical instrument accessories disclosed herein. As described above, the system may include a gas source configured to provide insufflation gas, a humidifier in fluid communication with the gas source and configured to humidify the insufflation gas received from the gas source. A gas delivery tube may extend between and be in fluid communication with the humidifier and the cannula.

[0055] During laparoscopic surgery, there is typically some form of electrosurgery / electrocautery / ultrasound or laser instrumentation to cause cutting or coagulation within the insufflated surgical cavity. This can produce surgical smoke, which can concentrate within the cavity, especially in the absence of significant gas leakage or suction / irrigation. High concentrations of smoke within the insufflated cavity, or plumes of smoke moving toward the lens of the scope within the cavity, can significantly obstruct the optical clarity and field of view of the scope operator, e.g., the surgeon or other members of the surgical team. In the absence of evacuation or suction, the surgeon typically vents all or a portion of the gas from within the cavity and then re-inflates.

[0056] Directing the gas flow toward the lens of the scope can advantageously mitigate the effects of smoke concentrating within the insufflated cavity by affecting the environment immediately adjacent to the lens. For example, this can direct smoke away from the scope, improving visibility and expanding the surgeon's field of vision. This can also prevent plumes of smoke from contacting medical instruments.

[0057] FIG. 3A schematically illustrates a surgical cavity, showing a cannula 100 extending into an insufflated cavity CA, such as within a pneumoperitoneum, and a scope lens C at the distal end of a scope inserted through the cannula 100. Surgical smoke S is shown surrounding the scope lens C. FIG. 3B schematically illustrates the surgical cavity scenario of FIG. 3A with a directional gas flow, indicated by arrows, moving the smoke S away from the scope lens C. As shown, the scope is held concentric with the cannula 100, and the gas can be directed to be substantially concentric and coaxial with the instrument. As the gas travels through the cannula 100, it is directed around and past the scope. FIG. 3C schematically illustrates that the cannula can include one or more features, as described in detail below, to create a control zone Z where smoke, fluids, or other unwanted media are directed away from the medical instrument. In other words, a gas barrier or gas envelope, also referred to herein as a gas shroud, gas sheath, protective zone, or temperature and humidity controlled region, may be formed by directing gas flow through the cannula 100, causing gas to flow from an opening, through the lumen of the cannula 100, and out one or more exit ports. FIG. 3D schematically illustrates the scenario of FIGS. 3A-3C, showing the directional gas flow cannula 100 used in combination with a second cannula 300. In some cases, a first medical instrument may include a scope lens C and may be inserted through the second cannula 300, and a directional gas flow may be introduced through the directional gas flow cannula 100. As shown in FIG. 3D, the directional gas flow cannula 100 may provide a directional gas flow, indicated by the arrow, within the insufflated cavity CA to move smoke S away from the scope lens C inserted through the second cannula 300. Optionally, directional gas flow cannula 100 may also support a second medical instrument 301 that may be inserted through directional gas flow cannula 100, as shown in FIG. 3D.

[0058] The directional gas flow cannula 100 can be configured to produce a gas envelope that extends distally beyond the end of an associated medical instrument and / or onto or past a portion of the medical instrument, such as an endoscope lens, sensor, or other element. The formed gas envelope may have any number of potential benefits, including, but not limited to, one or more of the following: maintaining the temperature of the instrument above the dew point; preventing or reducing fogging and / or condensation from forming on the instrument; reducing or preventing smoke, debris, or other unwanted media from contacting or collecting on the instrument; directing smoke, debris, or other unwanted media away from the instrument and / or lumen outlet so that the gas envelope dissipates the rising smoke; substantially surrounding a portion of the instrument (or substantially the entirety of the instrument portion positioned within the surgical cavity and / or cannula shaft); surrounding the instrument concentrically within the shaft and / or distally beyond the shaft outlet; extending a predetermined or calculated distance beyond the outlet in a desired direction; and maintaining a temperature, humidity, and / or pressure controlled environment around the shaft (e.g., the distal end of the shaft) and the outlet of an elongated shaft, for example, maintaining a temperature above the dew point within the envelope.

[0059] The gas flow leaves the scope surface and diverges a distance from the exit of the cannula 100. The distance and jet divergence angle do not necessarily depend on the scope insertion depth. The distance the flow diverges away from the scope can decrease proportionally with increasing flow rate. In some embodiments, the extent of the gas envelope can be controlled to extend up to about, at least about 10 mm, 25 mm, 50 mm, 75 mm, or 100 mm or less, or more or less past the distal end of the medical instrument and / or lumen exit, or a range inclusive of any two of the aforementioned values. In some forms, the gas envelope can extend any distance from about 10 mm to about 100 mm beyond the distal end and / or lumen exit. In some forms, the gas envelope can extend no more than about 100 mm past the distal end of the medical instrument and / or lumen exit. The distance the envelope extends can be based on the flow rate of the delivered gas.

[0060] Surgical systems, e.g., insufflation systems, can be configured to deliver gas at an intermittent (e.g., periodic) and / or constant flow. In some embodiments, a constant flow provides a more stable envelope. In other embodiments, an intermittent or periodic flow allows for the formation of an envelope that evaporates droplets on the scope. The flow rate of the delivered gas can be sufficient to maintain a pressurized surgical cavity. The flow rate can be, for example, at least about 2 liters per minute (lpm). In one example, the flow rate provided is at least about 6 lpm. In one example, the flow rate provided is at least about 7 lpm. In another example, the flow rate is at least about 10 lpm, or between about 10 lpm and about 12 lpm, or about, at least about 2, 4, 6, 8, 10, 12, 14, 16, 20, 30, 40, 50, 60, or less, or more or less lpm, or a range including any two of the foregoing values. The flow rate may be any suitable flow rate. In one example, the flow rate may reach or exceed approximately 40 L / min to approximately 50 L / min. Furthermore, the flow rate limit may be based on the pressure within the surgical cavity. The surgical cavity pressure may be defined, for example, by regulatory standards established in clinical practice, and may be, for example, up to approximately 50 mmHg in some cases. The exemplary flow rates listed above may be continuous flow rates. If an intermittent flow rate is delivered, the flow rate may vary between and including the limits listed for continuous flow rates. When an instrument is positioned concentrically with the cannula 100, this may enhance the insufflation gas being distributed around and / or against the instrument, e.g., the lens of a scope. This may also allow the instrument to defog. Generally, increasing the flow rate of insufflation gas may decrease the time required for defogging. The cool, dry gas provided to the cannula 100 while the instrument is held concentrically may also aid in defogging the lens C. Defogging can be improved by warming the gas. This can be achieved using a humidifier, such as the SH870 humidifier from Fisher & Paykel Healthcare (Auckland, NZ), which can further humidify the gas. Humidifying the gas has the advantage of reducing cell / tissue damage.As the scope is inserted beyond the cannula, a greater flow rate is achieved over a longer distance until the envelope covers the scope. The distance between the end of the shaft and the distal end of the scope may be referred to as the insertion depth. The insertion depth may be, for example, from about 20 mm to about 100 mm. The insertion depth may be, for example, up to about 80 mm. The defog time may be longer when the insertion depth extends beyond a threshold distance, for example, 100 mm in some cases. The flow rate from the gas source 9, e.g., an injector, may be controlled to vary the length of the envelope. The flow may be controlled by the injector, or there may be a flow control device positioned in the gas path, or the humidifier may include a device or structure for controlling the flow rate delivered to the cannula.

[0061] Examples of localized flow of injection or discharge In some cases, a localized flow of gas for injection or evacuation near the field of view of the scope lens may be used to clear stagnation zones and debris, including, but not limited to, smoke. For example, during laparoscopic surgery, some form of electrosurgery or electrocautery will typically be used within the surgical cavity. This can result in, for example, surgical smoke, which can concentrate within the cavity, especially when there is no significant gas leakage or aspiration. High concentrations of smoke within the surgical cavity, or plumes of smoke moving toward the scope lens within the cavity, can significantly obstruct optical clarity and the field of view for the scope operator. In some cases, the surgeon may inject clean gas into the cavity, allowing evacuation or using suction to draw out fumed gases and / or reduce the concentration of smoke.

[0062] In some cases, localized gas insufflation adjacent to the lens of the scope can reduce or eliminate stagnant zones of gas flow around the scope. This can help move gas into the field of view and / or dilute smoke with clean insufflation gas, both of which can increase optical clarity. This can force clean insufflation gas into the field of view.

[0063] In some cases, localized exhaust adjacent to the lens of the scope can effectively remove smoky gases by venting the gases from near the source of the smoke, allowing the gases to be removed from or near the field of view.

[0064] 4-5B illustrate localizing gas transmission and evacuation to the distal end of the medical instrument, e.g., adjacent the scope. This can advantageously allow for the environment directly surrounding the lens to be affected regardless of the depth of insertion of the medical instrument into the cavity and beyond the distal end of the cannula. In some embodiments, the system can be configured to position the medical instrument concentrically with respect to the attachment. Additionally, some embodiments are configured to direct gas toward the lens, such as across or at the lens. Other embodiments are configured to direct gas in front of and / or away from the lens.

[0065] Figure 4 shows a surgical cavity without intervention. Figure 5A shows the use of a first medical instrument accessory 510 to provide localized insufflation to the distal end of a medical instrument 511, including a scope or camera. Figure 5B shows the use of a first medical instrument accessory 510 to provide localized evacuation to the distal end of a medical instrument 511.

[0066] Figures 6A-6F show a medical instrument accessory including an extendable element 620 removably attached to a cannula 600 configured to deliver gas to a distal end of a medical instrument 610. Figures 6A and 6B show the cannula 600 and the extendable element 620 delivering exhaled gas from a distal end 608 adjacent the distal end of the instrument 610 past the instrument 610, the gas being indicated by a unidirectional arrow. Figures 6D and 6E show the cannula 600 and the extendable element 620 receiving gas at the distal end 608 and delivering the gas past the instrument 610, the gas being indicated by a unidirectional arrow.

[0067] FIG. 6A shows the body 604 of the extendable element 620 in a compressed configuration retracted toward the elongate shaft 602 of the cannula 600. The body 604 is dimensioned to at least partially receive the shaft of a medical instrument 610. The body 604 may define one or more lumens. In the illustrated embodiment, the body 604 defines an inner lumen 606. The one or more lumens may extend from and be in fluid communication with an opening or outlet defined by the distal end 608 of the body 604. The lumen 606 is defined by an inner sidewall 612 of the body 604. FIG. 6B shows the extendable element 620 and the cannula 600 receiving the medical instrument 610, such as a scope or camera. The instrument 610 has an elongate shaft 614 disposed within the lumen 606 of the body 604. In the illustrated embodiment, the distal end 608 is perpendicular to the axis of the body 604 and the shaft 602. In other embodiments, the distal end 608 is angled relative to the axis of the body 604, for example, to accommodate an angled scope. The cannula 600 may include a gas port 616 that can be configured to allow gas to enter or exit the cannula 600. The gas inlet port 616 may be connected to a gas source, for example, a gas delivery tube of an insufflation system (such as any of the systems described herein). In some embodiments, the shaft 602 of the cannula 600 is elongate and may be cylindrical, generally cylindrical, or otherwise tubular. In some embodiments, the gas flow path may be defined, at least in part, by an inner wall of the shaft 602 and an outer wall of the shaft of the medical instrument 610. An extendable element 620 may be removably attached to the distal end of the cannula 600, as shown in FIGS. 6A-6F. In other embodiments, the extendable element 620 and the cannula 600 are unitary. The extendable element 620 is deformable, at least partially flexible, and can be deformed between a retracted position shown in Figure 6A and an extended position shown in Figure 6B. In some embodiments, the retracted position is the default or rest position of the extendable element 620.

[0068] In some cases, medical instrument 610 may be a laparoscope, and fluid is directed through cannula 600 and / or extendable element 620 to and / or from a fluid flow path adjacent the lens of the laparoscope. In other cases, the medical instrument may be an electrocautery tool.

[0069] The extendable element 620 may define an abutment structure, such as a ring 621, at its distal end, allowing it to abut against the distal end of the instrument 610. It should be appreciated that molding the abutment structure as a ring 621 is exemplary, and the structure may be alternatively configured, such as including alternative shelves, shoulders, or other surfaces. In the illustrated embodiment, the ring 621 is sized to partially receive the end of the instrument 610 and may include a catch or a mechanism that is removably securable to the medical instrument 610. Securing the extendable element 620 to the instrument 610 allows the element 620 to extend as the medical instrument 610 passes through the lumen 606. This allows the extendable element 620 to extend in proportion to the insertion depth of the instrument 610.

[0070] FIG. 6C shows a cross section through line 6C-6C of FIG. 6B , illustrating the distal end of extendable element 620 with ring 621. Ring 621 defines opening 622 to allow light access to medical instrument 610. Ring 621 may be dimensioned to prevent medical instrument 610 from passing through opening 622. Ring 621 may define additional apertures 623. In the illustrated embodiment, these apertures 623 are arranged in a circumferentially spaced annular array around opening 622. In other embodiments, ring 621 defines some of apertures 623. During use, apertures 623 may allow gas to pass through ring 621 and exit body 604 into the surgical cavity or to escape from the surgical cavity into body 604.

[0071] 6D-6E show a cannula 600 and an extendable element 620 that are used to vent gas from the surgical cavity through a distal end 608 and out a gas port 616.

[0072] 7A and 7B illustrate a medical instrument accessory including an extension 720 that can be secured to a cannula 700 to allow gas to be exhaled or vented adjacent the distal end of a medical instrument 710 inserted through the cannula 700. FIG. 7A shows a body 704 of the extension 720 attached to the distal end of the cannula 700. The cannula 700 can include an elongate shaft 702. The body 704 can be attachable to or positioned over at least a portion of the shaft 702. The body 704 can define one or more lumens, such as an inner lumen 706 shown in FIGS. 7A and 7B. The one or more lumens can extend from and be in fluid communication with an opening defined in a distal end 708 of the body 704. The lumen 706 is defined by a sidewall 712 of the body 704. Lumen 706 is configured to receive at least a portion of elongate shaft 714 of medical instrument 710. Body 704 defines a free end disposed perpendicular to the axis of body 704. In other embodiments, the free end is disposed at an angle relative to the axis. Cannula 700 may include a gas port 716 disposed to route gas into or out of cannula 700. Port 716 is connectable to a gas source, for example, a gas delivery tube of an insufflation system (such as any of the systems disclosed herein). FIG. 7A shows cannula 700 and extension 720 disposed to allow gas to be expelled adjacent the distal end of medical instrument 710, as indicated by the arrow extending from distal end 708, indicating the gas flow path.

[0073] Extension 720 may be attached or fixed to the end of cannula 700. Extension 720 may enable a focused flow of gas to be delivered to a region of interest, such as within the field of view of medical instrument 710.

[0074] FIG. 7B shows cannula 700 and extension 720 being used to evacuate gases from the surgical cavity, as indicated by the inwardly pointing arrow at distal end 708.

[0075] Distal end 708 of extension 720 can be disposed at or adjacent to the distal end of medical instrument 710. In some embodiments, extension 720 is cylindrical or otherwise shaped to fit cannula 700 and / or complementarily shaped to instrument 710, e.g., inner wall 712 configured to be offset a specified distance from one or more outer surfaces of instrument 710. In some cases, a gas flow path can be defined, at least in part, by the inner wall of extension 720 and the outer wall of the shaft of medical instrument 710. Extension 720 is configured to attach to the distal end of cannula 700, as shown in FIGS. 7A-7B .

[0076] Examples of medical equipment accessories for directional gas flow 8A and 8B show a medical instrument accessory 800 that can be positioned around a medical instrument 810. The medical instrument accessory 800 and medical instrument 810 can be positioned within a cannula 890. The medical instrument accessory 800 can be secured to the medical instrument 810, allowing the accessory 800 and instrument 810 to be connected prior to insertion into the cannula 890, and allowing gas to be injected and released directly adjacent the tip of the medical instrument 810, regardless of the depth of insertion into the cannula 890.

[0077] The medical instrument accessory 800 includes a body 804 dimensioned to be positioned within a lumen of a cannula 890 when attached to a medical instrument 810, such as a scope. The body 804 may include an elongate shaft 802 defining one or more lumens. In the illustrated embodiment, the shaft 802 defines an inner lumen 806 dimensioned to at least partially receive a shaft 814 of the medical instrument 810. The one or more lumens may extend from and be in fluid communication with an opening or outlet defined at a distal end of the body 804. The lumen 806 is defined at least in part by an inner sidewall 812 of the body 804. The body 804 may include a gas port 816 configured to allow gas to enter and / or exit the body 804. The port 816 may be connected to a gas source, such as a gas delivery tube of an insufflation system (such as, for example, any of the systems disclosed herein). FIG. 8A shows a medical instrument accessory 800 that can be attached to a medical instrument 810 to direct gas parallel to and / or away from the distal end of the shaft 814, creating a gas flow path as shown by the arrows. In the illustrated embodiment, gas is delivered into the accessory 800 through a port, configured as a gas inlet port 816 in this illustrated embodiment. In other embodiments, the proximal end of the body 804 can be in fluid communication with a gas source. The accessory 800 can be attached to the medical instrument 810 to prevent leakage of gas between the accessory 800 and the instrument 810. In some cases, the accessory 800 includes a sealable attachment mechanism to sealingly secure the accessory 800 to the instrument 810. The accessory 800 can be dimensioned to extend to or beyond the distal end of the medical instrument 810 and can be secured to release gas to the end of the medical instrument 810 regardless of the depth of the medical instrument 810. Fitting 800 allows for the delivery of a focused gas flow closer to the target area. As shown in FIG. 8A, fitting 800 can emit gas closer to the field of view of medical instrument 810. In some cases, body 804 can have a length that extends to or beyond the distal end of medical instrument 814, such that the distal end of body 804 is adjacent to or extends beyond the distal end of the medical instrument, as shown in FIGS. 8A-8B.

[0078] Figure 8B shows medical instrument accessory 800 configured to vent gas at any insertion depth of medical instrument 810 near the field of view, as indicated by the inward-pointing arrow at the distal end of accessory 800. Figure 8B shows a port configured as a gas vent port 821 to allow gas to be vented from the assembly.

[0079] 9A-9D show a medical instrument accessory 900 that can be positioned around a medical instrument 910. The medical instrument accessory 900 and medical instrument 910 can be positioned within a cannula 990. The medical instrument accessory 900 can be attached to the medical instrument 910 prior to insertion into the cannula 990. The medical instrument accessory 900 provides channeling insufflation at and / or beyond the distal end of the medical instrument to allow for the release of gas. The medical instrument accessory 900 can extend to the distal end of the medical instrument as shown in FIGS. 9A-9B.

[0080] FIG. 9A shows a medical instrument accessory 900 that may include a body 904. As shown in FIGS. 9A-9B, the medical instrument accessory 900 may be positioned within a lumen of a cannula 990. The body 904 may include an elongate shaft 902. One, two, or more lumens may be present in the body 904, e.g., an inner lumen 906. The one, two, or more lumens may extend from and be in fluid communication with an opening or outlet at or near the distal end 908 of the body 904. The lumen 906 may be defined by a sidewall, e.g., an inner sidewall 912 of the body 904. An elongate shaft 914 of a medical instrument 910 may be positioned within the lumen 906 of the body 904. The cannula 990 may include a gas inlet port 916 that may be connected to, for example, a gas delivery tube of a surgical insufflation system (such as any of the systems disclosed herein).

[0081] 9A shows a medical instrument accessory 900 within which a medical instrument 910 is mounted, allowing for the release of gas and gas flow at the distal end of a medical instrument shaft 914, as indicated by the arrows. The accessory 900 may be secured or attached to the proximal end of the medical instrument 910 to prevent gas from escaping the proximal end and release gas at the distal end of the accessory 900. In some cases, the attachment may be a seal. In some cases, the attachment may prevent fluid loss at the attachment. Gas may enter the cannula 990 through a gas inlet port 916.

[0082] As shown in FIG. 9B , the accessory 900 may include one or more apertures 992 in the body that allow gas to pass from the cannula 990 into the lumen 906 of the accessory 900. The gas may be channeled through the accessory apertures 992. The gap between the inner wall of the cannula 990 and the outer wall of the accessory 900 may be narrow enough so that the gas may be channeled through the accessory 900, as shown in FIG. 9A . The gas may be released at the distal end of the accessory 900 at or adjacent to the field of view of the medical instrument 910. The accessory 900 may be inserted into the cannula lumen, and the at least one aperture 992 preferably does not extend past the distal end of the cannula 915 to allow a desired or suitable flow of gas through the lumen 906. In some cases, the location of the apertures 992 defines the length of the working range of the shaft. The accessory 900 can have a longitudinal length such that the open distal end of the accessory 900 can be positioned at or adjacent to the distal end of the medical instrument 910 and can release gas at the end of the medical instrument 910, regardless of the depth within the surgical cavity.

[0083] As shown in FIGS. 9A and 9C, the body can have a first portion 994 at the proximal end of the attachment 900 with a lumen of a first diameter comparable to the diameter of the medical device outer wall. The body can have a second portion 996 at the distal end of the attachment 900 with a lumen of a second diameter greater than the diameter of the medical device outer wall. The body can have at least one aperture 992 in fluid communication with a gas flow path. FIG. 9B shows a cross section through line 9A-9A in FIG. 9A at the aperture 992. FIG. 9B shows an aperture in the medical instrument attachment 900 that allows gas to enter the attachment, thereby channeling the gas into the lumen of a nearby medical instrument attachment by the medical instrument. As shown in FIGS. 9A and 9C, the diameter of the lumen can transition from a first diameter to a second diameter. The diameter transition can occur at or adjacent to the aperture in the body. In some cases, placing aperture 992 at the transition may deflect gas flow into aperture 992 and through the gas flow path between the body and medical instrument 910 .

[0084] FIG. 9C illustrates a medical instrument accessory 900 for venting gas near the field of view, as indicated by the arrows showing the direction of flow. The accessory 900 illustrated in FIG. 9C is similar to the medical instrument accessory 900 illustrated in FIG. 9A , except that the medical instrument accessory 900 vents gas near the field of view of the medical instrument 910 and includes an exhaust port 921. The medical instrument accessory 900 can be placed on any medical instrument to vent gas near the field of view. For example, electrocautery cutting can produce smoke, which can cause vision problems. Therefore, when the medical instrument accessory is placed on a cutting tool, any smoke generated can be blown away, or vented, before it can cause problems, such as vision impairment. Gas can be vented near the field of view and can pass through the lumen of the accessory 900. As indicated by the arrows in FIG. 9C , gas can enter the cannula through an aperture 992 in the accessory 900 and flow out the exhaust port 921. Figure 9D shows a cross section of medical instrument accessory 900 taken along line 9C-9C of Figure 9C at aperture 992. Figure 9D shows the aperture in medical instrument accessory 900 that allows gas to enter cannula 990 from accessory 900.

[0085] 10A-10B show a medical instrument accessory 1000 that can be positioned around a medical instrument 1010. The medical instrument accessory 1000 and the medical instrument 1010 can be positioned within a cannula 1090. The medical instrument accessory 1000 can be attached to the medical instrument 1010 prior to insertion into the cannula 1090. The medical instrument accessory 1000 can be positioned on the medical instrument 1010 to channel gas through the medical instrument accessory 1000. As shown in FIGS. 10A-10B, the distal end of the medical instrument accessory 1000 can be positioned at or adjacent to the distal end of the medical instrument 1010 during use. In some cases, a portion of the medical instrument 1010 can be positioned outside the open distal end of the accessory. In some cases, both can be introduced into the cannula 1090 after the medical instrument 1010 is positioned within the accessory.

[0086] FIG. 10A shows a medical instrument accessory 1000 that may include a body 1004. The medical instrument accessory 1000 may interact with or be secured to a medical instrument 1010. The assembly of the medical instrument accessory 1000 and the medical instrument 1010 may be positioned within a cannula 1090. As shown in FIGS. 10A-10B, the accessory 1000 may be positioned within a lumen of the cannula 1090. One, two, or more lumens may be present within the body 1004, e.g., an inner lumen 1006. The one, two, or more lumens may be in fluid communication with an opening or outlet at or near a distal end 1008 of the body 1004. The lumen 1006 may be defined by a sidewall, e.g., an inner sidewall 1012 of the body 1004. In other embodiments, a medical instrument 1010, such as an electrocautery instrument, or an endoscope or camera or other scoping instrument, may be received within the lumen 1006 of the body 1004, including, for example, the elongate shaft 1014 of the medical instrument 1010.

[0087] The accessory 1000 may include a gas inlet port 1016. The gas inlet port 1016 may be connected to a gas delivery tube of a surgical, e.g., insufflation system (such as any of the systems disclosed herein). FIG. 10A shows the medical instrument accessory 1000 with a medical instrument 1010 inserted into the accessory 1000 to allow for the release of gas from the distal end of the medical instrument shaft 1014, as indicated by the gas flow path indicated by the arrow extending from the distal end of the accessory 1000. The medical instrument accessory 1000 may be positioned within a cannula 1090. The accessory 1000 may be secured to the proximal end of the medical instrument 1010. A sealing means or element may be provided to prevent gas from escaping from the proximal end and to release gas at the distal end of the accessory 1000. Gas may enter the body 1004 of the accessory 1000 through the gas inlet port 1016. The accessory 1000 may enable delivery of the gas flow closer to the target area. The accessory 1000 may emit gas near the distal end of the medical instrument 1010 or near the target area. The accessory 1000 may be placed on any medical instrument 1010. For example, electrocautery cutting may produce smoke, which may cause visibility problems. Therefore, when the accessory 1000 is engaged with a cutting instrument, the generated smoke may be vented before it causes any problems.

[0088] Figure 10B shows a medical instrument accessory 1000 that allows gas to enter near the distal end or target area of ​​the medical instrument, as indicated by the arrow pointing toward the distal end of accessory 1000. Figure 10B shows a medical instrument accessory 1000 similar to medical instrument accessory 1000 shown in Figure 10A, except that medical instrument accessory 1000 allows gas to enter near the distal end or target area of ​​the medical instrument 1010 and includes an exhaust port 1021.

[0089] The accessory 1000 can vent gases near the field of view. The accessory 1000 can be placed on any instrument. For example, electrocautery cutting can produce smoke and vision problems. Therefore, if the accessory 1000 is placed on a cutting instrument, any smoke generated can be vented before it causes any problems. The gases can be vented near the field of view and pass through the lumen of the accessory 1000. As shown by the arrows in FIG. 10B, the gases can pass through the lumen of the accessory 1000 and exit through the exhaust port 1021.

[0090] Example of directional gas flow around a medical device with medical device accessories To overcome some of the challenges of condensation, fogging, or other factors that can reduce visibility, it may be desirable to create a controlled microenvironment around the lens or working end of the instrument. A directional gas flow around the medical instrument may allow for a controlled microenvironment to be created around the lens or working end of the instrument. This environment may isolate the lens from the warm, moist environment of the pneumoperitoneum. The medical instrument with the lens may be held either concentrically or off-axis and surrounded by a gas passageway. This may allow the insufflation gas to conform to and substantially surround the medical instrument. The gas may thus coat the lens of the medical instrument and, to some extent, form a barrier between the lens and the surrounding environment. If the conditions of the delivered gas are controlled, this may affect the environment around the medical instrument.

[0091] FIG. 11 illustrates directional gas flow around a medical instrument 1110 within a medical instrument accessory 1100.

[0092] In some cases, the medical instrument accessory may include at least one structure or guide element for positioning the medical instrument relative to the lumen, such as concentric with or offset from a longitudinal axis defined by the lumen, such that a gas flow path is defined between the inner lumen wall and the medical instrument shaft. More detailed examples of guide elements or structures that may be used in combination with or in addition to those described herein are described in International Application No. PCT / NZ2019 / 050100, filed August 16, 2019, (“DIRECTED GAS FLOW SURGICAL CANNULA FOR PROVIDING GASES TO A PATIENT”), the entire disclosure of which is incorporated herein by reference.

[0093] In some cases, the structure or guide element may be disposed on an inner wall of the accessory, e.g., defined by the inner wall or mountable on or adjacent to the inner wall. For example, the structure or guide element may be in the form of one or more members that are separate from and affixable to the shaft of the accessory and disposed on the inner wall. The structure or guide element may extend inward relative to the inner wall, and during use, the structure or guide element is positioned between the inner wall and the medical instrument. In some cases, the medical instrument accessory may have multiple structures. The proximal end of the body of the medical instrument accessory may be in fluid communication with a gas source or vent. Gas may be directed around the end of the medical instrument, outward from the open distal end of the accessory. In some embodiments, at least one structure or guide element is formed by one or more ribs. FIG. 12A shows a longitudinally (axially) extending rib 1220 defined by the inner wall of a medical instrument accessory 1200. The ribs 1220 are positioned to concentrically position the attachment 1200 around a medical instrument (not shown). FIG. 12B shows a cross section of the medical instrument attachment 1200 taken along line 12A-12A in FIG. 12A. As shown in FIG. 12B, the ribs 1220 can form a circumferentially spaced annular array around the inner wall to retain the medical instrument substantially concentrically within the medical instrument attachment 1200. FIGS. 12A and 12B show the ribs 1220 extending partway along the longitudinal length of the inner wall of the attachment 1200. It should be appreciated that the ribs 1220 can be positioned adjacent only one or both of the proximal and distal ends of the attachment 1200, either continuously between the ends, or discontinuously spaced apart between the ends. The ribs 1220 are positioned to allow gas to flow through the attachment 1200, between the ribs 1220, and around the medical instrument. 12B, ribs 1220 may extend inwardly from the interior wall of medical instrument accessory 1200. Furthermore, configuring instrument support structures or guide elements as ribs 1220 is exemplary, and it will be recognized that these structures may be configured in other shapes, such as dimples, fins, splines, grooves, or channels.

[0094] As shown in FIG. 13A , ribs 1320 may be positioned at or adjacent the open distal end of the medical instrument accessory 1300. The ribs 1320 may define a gas passageway for gas to travel around the periphery or circumference of the medical instrument. The ribs 1320 may hold the medical instrument substantially concentrically within the lumen of the medical instrument accessory. In some cases, the ribs may not contact the medical instrument during use, but may function as a limit or stop to prevent the medical instrument from contacting the interior sidewall of the medical instrument accessory shaft. FIG. 13B shows a cross-section of the medical instrument accessory 1300 taken along line 13A-13A in FIG. 13A . As shown in FIG. 13B , the ribs may extend radially to encourage centering of the medical instrument within the medical instrument accessory 1300, and gas flow may pass between the sidewall 1321 of the ribs 1320 around the medical instrument and the outer wall of the medical instrument (not shown). In some cases, the ribs 1320 can be axially and / or longitudinally spaced at regular or irregular intervals along the inner circumference of the medical instrument accessory 1200 .

[0095] In some cases, at least one structure or guide element may include protrusions, such as bumps or indentations, on the medical instrument accessory to direct gas flow concentrically around the medical instrument. The protrusions may extend inward from the inner wall of the medical instrument lumen. The protrusions may be located anywhere along the body of the medical instrument accessory to direct flow concentrically around the medical instrument. The protrusions may be located at the proximal end, distal end, or intermediate portion along the length of the accessory's lumen. As shown in FIG. 14A, protrusions 1420 may be positioned at the open distal end of the medical instrument accessory 1400, and gas may pass concentrically between the protrusions 1420 around the medical instrument (not shown). FIG. 14B shows a cross-section of the medical instrument accessory 1400 taken along line 14A-14A in FIG. 14A. 14B, the protrusions 1420 may diverge radially to hold the medical instrument concentrically within the medical instrument accessory 1400, and gas flow may pass between the protrusions 1420 around the medical instrument. In some cases, the protrusions may be evenly (or substantially evenly) spaced around the diameter of the accessory lumen. In other embodiments, the protrusions may be non-uniformly spaced around the diameter of the accessory lumen, creating gas flow paths of different sizes.

[0096] In some cases, at least one structure may include two or more sets of ribs on the medical instrument accessory to direct gas flow concentrically around the medical instrument. The two or more sets of ribs may be located anywhere along the body of the medical instrument accessory to direct flow concentrically around the medical instrument. As shown in FIG. 15A, rib 1520 may be positioned at a first location at the distal end of medical instrument accessory 1500. Rib 1522 may be positioned at a second location on medical instrument accessory 1500 proximal to the first location. Gas may pass between ribs 1520 and 1522 concentrically around the medical instrument (not shown). FIG. 15B shows a cross-section of medical instrument accessory 1500 taken along line 15A-15A in FIG. 15A through rib 1522. Figure 15C shows a cross section of medical instrument accessory 1500 taken along line 15B-15B in Figure 15A through rib 1520. As shown in Figures 15B and 15C, ribs 1520 and 1522 may diverge radially at two locations to concentrically retain the medical instrument within medical instrument accessory 1500, and gas flow may pass between ribs 1520 and 1522 around the medical instrument. In some cases, ribs 1520 and 1522 may be positioned any number of times and at any number of locations along the accessory. In some cases, the ribs may be located adjacent the proximal end of the medical instrument accessory.

[0097] The at least one structure may include one or more fins extending inward from the inner wall of the accessory. The one or more fins may be in a spiral configuration on the medical instrument accessory to direct gas flow in a vortex pattern around the medical instrument. The spiral configuration may be located anywhere along the body of the medical instrument accessory to direct flow in a vortex pattern around the medical instrument. As shown in FIG. 16 , the spiral configuration may include spiral fins 1620 positioned along the inner wall of the medical instrument accessory 1600. The spiral fins 1620 may direct flow as well as hold the medical instrument concentrically within the medical instrument accessory 1600.

[0098] At least one structural or guide element may include a flexible or semi-flexible flared tip at the distal end of the medical instrument accessory to direct gas flow concentrically around the medical instrument and to concentrically position the medical instrument within the accessory. The flexible flared tip may be located at the distal end of the body of the medical instrument accessory to direct flow concentrically around the medical instrument. As shown in FIG. 17 , a flexible flared tip 1720 may be positioned at the distal end of the medical instrument accessory 1700. The flared tip 1720 may be made of a thin plastic or another semi-flexible material at the distal end of the accessory 1700. The flexible flared tip 1720 may flare out when a medical instrument (not shown) is pushed past the flared tip 1720. The flexible flared tip can push back on the medical instrument to hold it concentrically within the medical instrument accessory 1700 .

[0099] At least one structure or guide element may include a flexible section at the distal end of the medical instrument accessory to direct gas flow concentrically around the distal end of the medical instrument. The flexible section may be located at the distal end of the body of the medical instrument accessory to direct flow concentrically around the medical instrument and retain the medical instrument within the medical instrument accessory. As shown in FIGS. 18A-18B, a flexible section 1820 may be positioned at the distal end of the medical instrument accessory 1800. In some cases, the flexible section 1820 may include a flexible bellows. The flexible section may be made of a flexible material 1822 attached to the body of the medical instrument accessory 1800 and may have a non-flexible tip or edge 1824 that attaches to the medical instrument. The flexible section 1820 may have a movable tip that moves with the medical instrument and can maintain flow around the lens of the medical instrument, as shown in FIG. 18B. 18A-18B, the movable tip can have a flexible material 1822 and a solid tip or edge 1824 with one or more protrusions extending radially inward. The solid tip or edge 1824 can be laterally movable and substantially parallel to the open distal end of the attachment. The solid tip or edge 1824 can engage the end of the medical instrument.

[0100] At least one structure may include ribs or channels at the distal end of the medical instrument accessory to direct gas flow concentrically around the medical instrument. The ribs or channels may be similar to those described with reference to FIGS. 12A-16. The ribs or channels may be located at the distal end of the body of the medical instrument accessory to direct flow concentrically around the medical instrument and retain the medical instrument within the medical instrument accessory. In some cases, the ribs and channels may be uniformly sized ribs spaced unevenly around the accessory. One or more ribs may create gas flow channels between adjacent ribs. As shown in FIGS. 19A-19B, ribs 1920 may be positioned at the distal end of the medical instrument accessory 1900. The ribs 1920 may be unevenly spaced around the attachment 1900 to deflect contaminants or water droplets away from the lens or to promote evaporation of condensation / cloudiness that forms on the lens, as indicated by the arrows at the distal end of the attachment 1900 in FIG. 19A . The ribs 1920 may be located at any point along the attachment 1900 or along the entire length of the attachment 1900. The ribs 1920 may be unevenly spaced around the attachment 1900 to direct gas entrainment over the top side of the medical instrument. The uneven spacing of the ribs 1920 may create channels of different sizes around the inner wall of the attachment 1900. The differently sized channels may result in different gas velocities, creating a pressure differential at the distal end of the attachment 1900. FIG. 19B shows a cross section taken along line 19A-19A in FIG. 19A , illustrating the uneven spacing of the ribs 1920 around the inner wall of the attachment 1900. The ribs 1920 may hold the scope substantially concentrically within the attachment 1900 .

[0101] In some cases, the ribs and channels may be ribs of different sizes spaced around the attachment. One or more ribs may define gas flow channels between adjacent ribs. As shown in FIGS. 20A-20B , ribs 2020 may be positioned at the distal end of the medical instrument attachment 2000. The ribs 2020 may have different sizes that cover different portions of the circumference of the inner sidewall of the medical instrument attachment 2000. The ribs 2020 may be different sizes and spaced around the attachment 2000 to entrain gas flow over the top side of the medical instrument, as shown by the arrow at the distal end of the attachment 2000 in FIG. 20A . Flow across the lens may advantageously deflect contaminants or water droplets away from the lens or promote evaporation of condensation / cloudiness that has formed on the lens. The ribs 2020 may be placed at any point along the attachment or along the entire length of the attachment. Different size channels may be created by ribs of different widths around the inner wall of the attachment. Channels of different sizes have different gas velocities and can create pressure differentials at the distal end of the device. As shown in Figure 20B, which is a cross section taken along line 20A-20A in Figure 20A, ribs 2020 can be of different widths spaced around the inner wall of the attachment and can hold the scope concentrically within the attachment. Although the ribs are shown at the distal end, the ribs can be of any length.

[0102] At least one structure may include a cutout or channel in the inner wall of the medical instrument accessory body to direct gas flow concentrically around the medical instrument. The cutout or channel in the medical instrument accessory body may define a channel for gas flow regardless of where the medical instrument is positioned within the accessory. Depending on the axial position of the medical instrument within the accessory, the gas either flows concentrically around the medical instrument or is jetted over its upper side. As shown in FIGS. 21A-21B, the cutout or channel 2120 may be positioned along substantially the length of the accessory's body. As shown in FIG. 21B, which is a cross-section taken along line 21A-21A in FIG. 21A, the cutout or channel 2120 allows gas to continue to flow around the medical instrument 2110, even when the medical instrument 2110 is pressed into the inner wall of the accessory 2100. Although the cutouts or channels 2120 are shown as being evenly spaced and extending through most of the body of the accessory, the cutouts or channels may be of any length and may be evenly or unevenly spaced. In some cases, the cutouts or channels may extend the entire length or substantially the entire length of the lumen of the accessory.

[0103] At least one structure may include a non-circular cross-section in the body of the medical instrument accessory. The medical instrument may have a circular or substantially circular shaft. Therefore, gas can flow through the accessory regardless of the position of the medical instrument within the medical instrument accessory. As shown in FIGS. 22A-22B, the medical instrument accessory 2200 may have a non-circular shape, thereby allowing gas to flow around the medical instrument. Depending on the axial position of the scope, gas may either flow concentrically around the medical instrument or be jetted over the top of the medical instrument. FIG. 22B shows a cross-section of the body of the medical instrument accessory 2200 taken along line 22A-22A in FIG. 22A. As shown in FIG. 22B, the non-circular shape of the accessory 2200 allows gas to flow around the medical instrument at any position. Although the non-circular cross-section of the accessory body is shown as elliptical, the non-circular cross-section of the accessory body may be any non-circular shape.

[0104] Example of directional gas flow across a medical device with medical device accessories FIG. 23 illustrates a medical instrument accessory 2300 configured to direct fluid flow across the distal end of a medical instrument 2310 disposed within the medical instrument accessory 2300.

[0105] In some applications, it may be useful to control the microenvironment surrounding the lens or working end of a medical instrument to mitigate problems caused by condensation, smoke, or debris collecting near or across the lens / working end. Directed gas flow across the lens or working end of a medical instrument can help control the microenvironment by affecting the zone around the lens / working end, e.g., by manipulating fluid flow, temperature, and / or humidity. For example, directing a gas or other fluid around the lens can maintain the lens temperature above the dew point of the gas in the local environment, preventing the formation of condensation. Also, if moisture or debris collects on the lens, it can be at least partially removed by directing a fluid, such as an unsaturated gas, across the lens. Some disclosed embodiments described below are configured to position the medical instrument concentrically or off-axis and direct a gas flow across the lens. The medical instrument can be positioned relative to the distal end of the assembly described herein to direct a flow across the lens at the distal end of the medical instrument shaft.

[0106] 24A-37E show example embodiments of medical instrument accessories having similar features to the embodiments shown in FIGS. 6A-22B. These embodiments also include a stop disposed at or adjacent to the distal open end. The stop can assist in positioning the distal end of the medical instrument, such as the lens of a scope, relative to the distal end of the accessory, for example, adjacent to or a predetermined distance from the open distal end of the accessory. During use, the stop can include any feature that positions the end of the medical instrument shaft a predetermined distance away from the open distal end.

[0107] 24A-24E illustrate a medical instrument accessory 2400 including a stop 2426 and a deflection structure configured to redirect fluid traveling longitudinally through the accessory 2400 to travel at least partially radially, as indicated by the single-headed arrow. In this embodiment, the deflection structure is configured as an annular ledge 2420 disposed at or adjacent to the distal end of the accessory 2400 and defines a distal end opening. In other embodiments, the deflection structure includes one or more distinctly angled and / or positioned surfaces defined by one or more other structures. The annular ledge 2420 defines a plane and can direct gas across a lens of a medical instrument placed within the accessory 2400 in all directions of the plane. As indicated by the arrows in FIGS. 24A-24C, gas can be directed down the lumen and across the lens simultaneously to exit directly into the surgical cavity. In this embodiment, the ledge 2420 extends radially inward from the edge or rim of the distal end. The ledge 2420 may be substantially perpendicular to the edge of the distal end of the attachment 2400. The attachment 2400 may also include one or more protrusions, in this embodiment in the form of ribs 2422, arranged to position the medical instrument within the attachment 2400. The ribs 2422 may also direct fluid flow through channels defined between the ribs 2422, the medical instrument, the inner wall of the attachment, and the ledge 2420. The ribs 2422 may have longitudinal rib portions 2424 arranged to maintain the position of the medical instrument relative to the longitudinal axis of the attachment 2400, and / or radial rib portions 2426 (positioned on the ledge 2420) that function as stops and maintain the position of the medical instrument relative to the distal end of the attachment 2400. The ribs 2422 may be arranged on the inner wall of the lumen of the attachment 2400. Figure 24D, a cross section taken along line 24D-24D in Figure 24C, shows the annular arrangement of ribs 2422 around the inner wall. Figure 24E, a cross section taken along line 24E-24E in Figure 24C, shows the distal end of medical instrument accessory 2400 and annular ledge 2420.

[0108] 25A-25E show a medical instrument accessory 2500 including a deflection structure positioned to direct fluid flow toward the distal end of the accessory 2500; in this embodiment, the deflection structure, in the form of a shelf 2520, extends partway across an opening defined in the distal end of the accessory 2500. In some cases, the medical instrument accessory 2500 can accommodate a medical instrument that is centered or offset relative to its longitudinal axis and has a flat or angled lens. The medical instrument accessory 2500 can provide better control of the medical instrument. The shelf 2520 can direct gas across the lens of the medical instrument. As shown by the arrows in FIGS. 25A-25C, gas can be directed down the lumen and deflected by the shelf 2520 to travel across the lens as the gas exits the distal end into the surgical cavity. The accessory 2500 may include a shelf 2520 that extends partway across the distal opening of the accessory 2500. In some cases, the shelf 2520 may be a segment that extends partially across the distal opening and may define an area less than half of the opening. For example, the straight edge of the shelf 2520 may be less than the diameter of the open distal end. The shelf 2520 may extend radially inward from the edge of the open distal end. The accessory 2500 may also include one or more protruding ribs 2522 positioned adjacent to or against the medical instrument to enable support of the instrument during use. The ribs may be positioned on the inner wall of the accessory's lumen. The ribs may be positioned concentrically or substantially concentrically around the inner wall of the accessory's lumen. One or more protruding ribs 2522 may direct flow across the lens and through a channel created by the protruding ribs 2522, the medical instrument (not shown), the interior wall of the accessory, and the shelf 2520. The ribs 2522 may be concentric around the scope, directing gas flow directly into the body cavity and across the lens. The protruding ribs 2522 on the ledge allow the medical instrument to rest on the ribs, and the ledge may direct flow across and past the lens and the distal end of the shaft of the medical instrument. FIG. 25D shows a cross section taken along line 25D-25D of FIG. 25C extending through the medical instrument accessory 2500.Figure 25D shows a rib 2522 within the medical instrument accessory. Figure 25E shows a cross section taken along line 25E-25E in Figure 25C, which passes through the distal end of the medical instrument accessory 2500. Figure 25E shows a shelf 2520 covering one side of an opening in the medical instrument accessory 2500. As shown in Figure 25E, the shelf 2520 can be semicircular or approximately semicircular in shape. In other embodiments, the shelf 2520 can define a crescent shape or one or more other shapes, depending on the requirements for directing fluid flow toward the distal end of the accessory 2500.

[0109] 26A-26E show a medical instrument accessory 2600 having a deflection structure configured similarly to the above-described embodiments, such that a ledge 2620 is disposed on one side of the distal end of the accessory 2600. A protruding portion extends longitudinally from the distal end to form a wall, configured in this embodiment as a flange 2624. The ledge 2620 may extend partway across the distal opening of the accessory 2600 to direct gas across the lens of the medical instrument as it exits the accessory 2600 into the body cavity. The flange 2624 may be located substantially opposite the ledge 2620, as shown in FIGS. 26A-26B. Gas may pass through the lumen and be directed against the ledge 2620 across the distal end of the medical instrument, as shown by the arrows in FIGS. 26A-26C, and then be directed against the flange 2624 away from the accessory 2600 into the surgical cavity. The ledge 2620 can be located on one side of the distal end of the attachment 2600 and the flange 2624 on the opposite side. The ledge 2620 can extend radially inward from the edge of the open distal end opposite the flange 2624. The ledge 2620 can be on the opposite side of the attachment 2600 from the flange 2624. The flange 2624 can extend the length of a first side of the attachment 2600. As shown in FIG. 26B , the second, opposite side of the attachment 2600 can be shorter than the first side and terminate in the ledge 2624.

[0110] The accessory 2600 may also include one or more protruding ribs 2622 positioned to position a medical instrument within the accessory 2600. The ribs may be positioned on the inner wall of the accessory's lumen. The ribs may be positioned concentrically or substantially concentrically around the inner wall of the accessory's lumen. The one or more protruding ribs 2622 and ledge 2620 may direct flow across the lens through channels created between the ribs 2622, the medical instrument (not shown), the inner wall of the accessory, and the ledge 2620. The ribs 2622 may be concentric around the scope, directing gas flow directly into the body cavity and across the lens. The protruding ribs 2622 positioned on the ledge 2620 are positioned to support the medical instrument and allow fluid flow past the instrument to be deflected by the ledge and pass across the distal end of the medical instrument. Figure 26D, a cross-section taken along line 26D-26D in Figure 26C, shows one possible arrangement of ribs 2622 within attachment 2600. Figure 26E, a cross-section taken along line 26E-26E in Figure 26C, shows the distal end of medical instrument attachment 2600. Figure 26E shows a cross-section taken along line 26E-26E in Figure 26C and shows ledge 2620 extending partway across the distal opening of medical instrument attachment 2600. In some cases, ledge 2620 can be a segment that extends across the distal opening and spans less than half the opening. For example, in this embodiment, ledge 2620 defines a straight edge sized less than the diameter of the open distal end. It should be appreciated that the ledge 2620 may define one or more curved edges across the open distal end, or may be configured as a doubly curved (three-dimensionally curved) surface disposed partially across the distal end.

[0111] 27A-27E illustrate a medical instrument accessory 2700 including a protruding portion configured as a flange 2724 extending longitudinally from the distal end of the accessory 2700 and a deflecting structure configured as a ledge 270 extending from the flange 2724. The ledge 2720 may direct fluid flow toward the distal end, such as gas, across the distal end / lens of a medical instrument disposed within the accessory 2700. As shown in FIGS. 27A-27B, the ledge 2720 may extend radially inward from the end of the flange 2724. A notch may be defined on the opposite side of the distal end from the flange 2724 to allow fluid to exit the accessory 2700. The accessory 2700 may also include one or more protruding ribs 2722 positioned to position the medical instrument. The ribs may be positioned on the interior wall of the accessory's lumen. The ribs may be arranged concentrically or substantially concentrically around the inner wall of the lumen of the accessory. One or more protruding ribs 2722 and ledges 2720 may direct flow across the lens through a channel defined between the protruding ribs 2722, the medical instrument (not shown), the inner wall of the accessory, and the ledge 2720. The ribs 2722 may be concentric around the scope, directing gas flow directly into the body cavity and across the lens. The protruding ribs 2722 located on the ledges 2720 may support the medical instrument and allow fluid to flow around the instrument and pass across its distal end. Gas may pass down the lumen and be directed by the ledge 2720 across the distal end of the accessory 2600 and therefore across the medical instrument. As shown by the arrows in Figures 27A-27C, gas can also flow downward into the surgical cavity after exiting the distal end of the attachment 2700. Figure 27D, a cross section taken along line 27D-27D in Figure 27C, shows the arrangement of ribs 2722 within attachment 2700. Figure 27E, a cross section taken along line 27E-27E in Figure 27C, shows ledge 2720 as a segment of the distal opening of attachment 2700.

[0112] 28A-28E illustrate a medical instrument accessory 2800 having an interior sidewall defining a first longitudinal lumen. The accessory 2800 includes a deflection structure in the form of a ledge 2820 extending partway across the distal end of the accessory 2800. A second longitudinal lumen 2832 may be defined on one side of the accessory 2800 and may be in fluid communication with the first lumen. The ledge 2820 may be perpendicular to the interior sidewall. The ledge 2820 is positioned to direct gas flow toward the distal end, allowing the gas to flow across the optics of a medical instrument positioned within the first lumen. As shown in FIGS. 28A-28B, the ledge 2820 may extend radially inward from the end of the main or first lumen 2830. A medical instrument (not shown) may be positioned within the first lumen 2830. As shown by the arrows in FIGS. 28A-28C, gas may pass down the lumen and be directed across the distal end of the accessory by the ledge 2820, and will pass over the distal end of the medical instrument as it exits into the surgical cavity. The second lumen 2832 may channel insufflation gas directly into the surgical cavity. The accessory 2800 may also include one or more protruding ribs 2822 positioned to position the medical instrument within the first lumen. The ribs may be positioned on the inner wall of the accessory's first lumen 2830. The ribs may be positioned concentrically or substantially concentrically around the inner wall of the accessory's first lumen. The one or more protruding ribs 2822 and ledge 2820 may direct flow across the lens through a channel created by the protruding ribs 2822, the medical instrument (not shown), the inner wall of the accessory, and the ledge 2820. The ribs 2822 may be concentric around the scope, directing gas flow directly into the body cavity and across the lens. Protruding ribs 2822 located on ledge 2820 may help support the medical instrument during use and direct gas flow longitudinally around the instrument and across the distal end of the instrument. FIG. 28D, a cross section taken along line 28D-28D in FIG. 28C, shows ribs 2822 and first and second lumens 2830 and 2832 within attachment 2800. FIG. 28E is a view through the distal end of medical instrument attachment 2800.Figure 28E, a cross section taken along line 28E-28E in Figure 28C, shows ledge 2820 covering a portion of one side of the distal opening of first lumen 2830 of accessory 2800, with second lumen 2832 located on the opposite side from ledge 2820.

[0113] FIGS. 29A-29E show a medical instrument accessory 2900 including a deflecting structure in the form of a ledge 2920 on one side of the distal end of the accessory 2900 and an exhaust lumen 2932 terminating in a vent port 2934 defined on the opposite side of the accessory 2900. The ledge 2920 may direct gases across the lens of the medical instrument. The ledge 2920 may extend radially inward from the end of a main or first lumen 2930, as shown in FIGS. 29A-29B. A medical instrument (not shown) may be positioned within the first lumen 2930. As shown in FIGS. 29A-29B, gases may be directed across the distal end of the accessory by the ledge 2920 and will pass past the distal end of the medical instrument. The exhaust lumen 2932 may vent gases from the field of view to remove any smoke that may cause optical problems. The accessory 2900 may include a ledge 2920 extending radially inward from an edge of the distal end of the accessory 2900. The accessory 2900 may also include one or more protruding ribs 2922 arranged to position a medical instrument within the accessory 2900. The ribs may be arranged on the inner wall of the accessory's first lumen 2930. The ribs may be arranged concentrically or substantially concentrically around the inner wall of the accessory's first lumen. The one or more protruding ribs 2922 and ledge 2920 may direct flow through a channel created by the protruding rib 2922, the medical instrument (not shown), the accessory's inner wall, and the ledge 2920, and across the lens. The ribs 2922 may be concentric around the scope, directing gas flow directly into the body cavity and across the lens. Ribs 2922 located on ledge 2920 may act as stops to support the medical instrument and may enhance and direct fluid flow against ledge 2920 across the lens or distal end of the medical instrument. The interior wall of first lumen 2930 adjacent to exhaust lumen 2932 may have the same diameter as the medical instrument to allow gas to flow across the lens and hold the medical instrument in place within the accessory. The exhaust lumen 2932 allows gas to be exhausted from the surgical cavity through the accessory 2900. The exhaust lumen 2932 has an inlet 2934 in the outer wall of the body of the accessory 2900, as shown in FIG. 29A .Gases may pass down the lumen and may be directed across the distal end of the medical instrument by ledge 2920 as the gases exit into the surgical cavity and as the gases are exhausted through exhaust lumen 2932, as shown by the arrows in FIGS. 29A-29C. FIG. 29D, a cross section taken along line 29D-29D in FIG. 29C, illustrates the arrangement of ribs 2922 and first and second lumens 2930, 2932 within accessory 2900. FIG. 29E, a cross section taken along line 29E-29E in FIG. 29C, illustrates ledge 2920 covering a portion of one side of the distal opening of first lumen 2930 of accessory 2900. It should be appreciated that in other embodiments, accessory 2900 may include multiple exhaust lumens and two or more associated exhaust ports.

[0114] 30A-30E show a medical instrument accessory 3000 including a deflection structure configured as a ledge 3020 and an exhaust lumen 3032. The ledge 3020 is positioned to allow gas to be directed across the lens of a medical instrument positioned within the accessory 3000. As shown in FIGS. 30A-30B, the ledge 3020 can extend radially inward from the distal end of a main or first lumen 3030. A medical instrument (not shown) can be positioned within the first lumen 3030. As shown in FIGS. 30A-30B, gas can be directed across the distal end of the accessory 3000 by the ledge 3020 and will pass past the distal end of the medical instrument. The exhaust lumen 3032 can allow gas to exit the distal end of the accessory 3000 after passing across the medical instrument. In some cases, as shown in FIG. 30B, the exhaust lumen inlet 3034 can be positioned on the inner wall of the lumen 3030. FIGS. 30B-30C show a partial cross-sectional embodiment of the accessory 3000. The accessory 3000 can also include one or more protruding ribs 3022 positioned to position a medical instrument within the accessory. The ribs 3022 can be positioned on the inner wall of the first lumen 3030 of the accessory 3000. The ribs can be positioned concentrically or substantially concentrically around the inner wall of the first lumen 3030 of the accessory 3000. The one or more protruding ribs 3022 and ledge 3020 can direct flow through a channel created by the protruding ribs 3022, the medical instrument (not shown), the inner wall of the accessory 3000, and the ledge 3020, and across the lens. The ribs 3022 can be concentric around the scope, directing gas flow directly into the body cavity and across the lens. Protruding ribs 3022 located on ledge 3020 may support the medical instrument during use and provide space for fluid to flow around the instrument and be directed against ledge 3020 across the lens or distal end of the medical instrument. The inner wall of first lumen 3030 adjacent to exhaust lumen 3032 may have the same diameter as the medical instrument to allow gas to flow across the lens and hold the medical instrument in place within the attachment 3000. Gas may pass down the lumen and be directed by ledge 3020 across the distal end of the medical instrument.As shown by the arrows in Figures 30A-30C, the gas can then pass across the medical instrument and exit the distal end of the accessory 3000. Figure 30D, a cross section taken along line 30D-30D in Figure 30C, shows the arrangement of the ribs 3022, first lumen 3030, and second (exhaust) lumen 3032 within the accessory 3000. Figure 30E, a cross section taken along line 30E-30E in Figure 30C, shows the ledge 3020 extending over a portion of one side of the distal opening of the first lumen 3030 of the accessory 3000.

[0115] Figures 24A-30E show accessories that can be used with medical instruments, such as scopes, that have a flat (0°) end, such as defined by or containing a lens that is perpendicular to the longitudinal axis of the instrument. The accessories shown in Figures 31-37 can be used with medical instruments, such as scopes, that have lenses that are angled obliquely relative to the longitudinal axis of the instrument. Figures 31A-37E show medical instrument accessories similar to the embodiments described with respect to Figures 24A-30E. However, the medical instrument accessories of Figures 31A-37E have distal ends that are angled relative to the longitudinal axis of the accessory, resulting in geometries configured to provide one or more desired viewing angles. In some cases, the angled distal ends can provide viewing angles of about 1 degree to about 120 degrees. The angled distal end can be used to accommodate angled medical instruments, such as angled scopes, and the embodiments illustrated in Figures 31A-37E can be configured to direct gas across the lens of the angled medical instrument.

[0116] Figures 31A-31E are similar to Figures 24A-24E, and similar features are similarly numbered. Reference numbers for the same or substantially similar features have the same last two digits as those described in Figures 24A-24E. The deflection structure, in the form of an annular ledge 3120 in Figures 31A-31E, can be generally oriented at an angle between 1 and 89 degrees to accommodate angled-end medical instruments, such as angled surgical scopes, and can direct fluid across the end in all directions in the plane of the ledge. Gas can pass down the lumen and be directed by the ledge 3120 across the distal end of the medical instrument as it exits into the surgical cavity, as shown by the arrows in Figures 31A-31C.

[0117] Figures 32A-32E are similar to Figures 25A-25E, and similar features are similarly numbered. Reference numbers for the same or substantially similar features have the same last two digits as those described in Figures 25A-25E. The ledge 3220 on one side of the attachment 3200 in Figures 32A-32E can be angled to accommodate angled medical instruments and to direct gas across the lens in the plane of the ledge. Gas can pass down the lumen and be directed by the ledge 3220 across the distal end of the medical instrument as it exits into the surgical cavity, as shown by the arrows in Figures 32A-32C.

[0118] Figures 33A-33E are similar to Figures 26A-26E, and similar features are similarly numbered. Reference numbers for the same or substantially similar features have the same last two digits as those described in Figures 26A-26E. A ledge 3320 on one side of the attachment in Figures 33A-33E can be angled to accommodate angled medical instruments and direct gas across the lens. In some cases, the angled distal end can be positioned at an angle of about 1 degree to about 120 degrees. A flange 3324 extends from the opposite side of the opening of the attachment 3300 from the ledge and can direct gas flow directly down into the surgical cavity after the gas flow has passed over the medical instrument. Gas may pass down the lumen and be directed across the distal end of the medical instrument by ledge 3320 and down into the surgical cavity by flange 3320, as shown by the arrows in FIGS. 33A-33C.

[0119] Figures 34A-34E are similar to Figures 27A-27E, and similar features are similarly numbered. Reference numbers for the same or substantially similar features have the same last two digits as those described in Figures 27A-27E. In Figures 34A-34E, a ledge 3420 on one side of the attachment can accommodate angled medical instruments and direct gas across the lens. A flange 3424 extends on one side of the ledge and creates a cutout on the opposite side of the ledge to reduce the opportunity for gas deflection.

[0120] Figures 35A-35E are similar to Figures 28A-28E, and similar features are similarly numbered. Reference numbers for the same or substantially similar features have the same last two digits as those described in Figures 28A-28E. In Figures 34A-34E, the distal end and a ledge 3520 on either side of the open end of the attachment can be angled to accommodate angled medical instruments and direct gases across the lens. A second lumen 3532 in the medical instrument attachment 3500 can channel insufflation gases into the surgical cavity.

[0121] Figures 36A-36E are similar to Figures 29A-29E, and similar features are similarly numbered. Reference numbers for the same or substantially similar features have the same last two digits as those described in Figures 29A-29E. In Figures 36A-36E, the distal end and a ledge 3620 on one side of the attachment can be angled to accommodate angled medical instruments and direct gases across the lens. A second lumen 3632 in the medical instrument attachment 3600 evacuates gases from the field of view, removing any smoke from the surgical cavity that may cause optical problems.

[0122] Figures 37A-37E are similar to Figures 30A-30E, and similar features are similarly numbered. Reference numbers for the same or substantially similar features have the same last two digits as those described in Figures 30A-30E. In Figures 37A-37E, a ledge 3720 on one side of the distal end and the attachment can be angled to accommodate angled medical instruments and direct gas across the lens. A second lumen 3732 with an inlet on the interior wall of the medical instrument attachment 3700 can allow gas to vent through the attachment after passing across the medical instrument. Gas can pass down the lumen and be directed across the distal end of the medical instrument by the ledge 3720, and as shown by the arrows in Figures 37A-37C, gas can vent through the attachment after passing across the medical instrument.

[0123] Example of medical device lens heating for use with medical device accessories FIG. 38 illustrates a heating device 3840 that can be used with any of the medical instrument accessories described herein. Heating the medical instrument and / or fluid, e.g., gas, can help prevent condensation by maintaining the temperature of the medical instrument lens above the humidity dew point of the gas surrounding the lens. This can be effective against condensation caused by surgical cavity conditions and electrosurgery. As shown in FIG. 38, the heating device 3840 can be a coiled heating device integrated into the wall of the medical instrument accessory. As shown in FIG. 38, a medical instrument 3810 can be received by a medical instrument accessory 3800. The accessory 3800 can have a body 3804 that can fit over or receive at least a portion of the medical instrument 3810. The body 3804 can have a lumen 3806 and an inner wall 3812. The inner wall 3812 may be spaced from the surface of the medical instrument 3810 and may fully or only partially limit the extent of the attachment 3800 when the device is in use by a guide element (not shown), such as those described with respect to FIGS. 12A-37E. The body 3804 may include a heating device 3840. During use, the heating device 3840 may directly or indirectly heat the medical instrument 3810. As shown in FIG. 38 , gas may enter the lumen 3806 of the body 3804 of the medical instrument attachment 3800 and be heated by the heating device 3840. The heated gas may pass through the distal end of the medical instrument 3810. In some cases, the heating device 3840 may heat along (or substantially along) the length of the shaft of the medical instrument 3810.

[0124] FIG. 39 illustrates a heating device 3940 that may be used with any of the medical instrument accessories described herein. The heating device 3940 may be a coiled heating device that is incorporated into the medical instrument accessory 3900 and used to heat a medical instrument 3910 placed within the accessory 3900. The medical instrument accessory 3900 may be used with the medical instrument 3910 and a cannula (not shown) as described herein. Additionally and / or alternatively, the heating device 3940 may be used to heat the medical instrument and gas passing through a gap between the accessory and the cannula. The accessory 3900 may have a body 3904 that may be fitted over at least a portion of the medical instrument 3910. The body 3904 may have a lumen 3906 and an inner wall 3912. The inner wall 3912 may contact a surface of the medical instrument 3910. The body 3904 may include or incorporate a heating device 3940. The heated gas may flow through a flow path defined by the outer wall of the fitting 3900 and the cannula lumen, then past the distal end of the medical instrument 3910 (as indicated by the arrow at the distal end). In some cases, the heating device 3940 may heat along (or substantially along) the length of the shaft of the medical instrument 3910. In some cases, as shown in FIG. 39 , the heating device 3940 may be powered by an electrical connection 3942.

[0125] 40A-40C illustrate a heating device 4040 that can be used with any of the medical instrument accessories described herein. The heating device 4040 can be incorporated into the medical instrument accessory 4000 and used to heat the medical instrument 4010. The heating device 4040 can be placed on or focus heating to a specific area of ​​the medical instrument 4010. For example, FIG. 40A illustrates a heating device 4040 that is focused on the distal end of the medical instrument, e.g., the scope lens, and can heat the distal end in a more directionally-oriented manner. The body of the medical instrument accessory 4000 can be of various lengths. In some cases, the length of the body can be less than, substantially equal to, or even longer than the length of the medical instrument shaft. FIG. 40B illustrates a heating device 4040 that is located on the majority of the medical instrument 4010. FIG. 40C shows a heating device 4040 in which the heating is focused closer to the proximal end of the medical instrument 4010 to conduct heat down the medical instrument shaft.

[0126] Figures 41A-41F illustrate various heating methods and materials that may be incorporated into any of the medical instrument accessory embodiments described herein. Figure 41A illustrates a coil heating device. Figure 41B illustrates a resistive material heating device. Figure 41C illustrates a flexible PCB heating device. Figure 41D illustrates a chemical reaction heating device. Figure 41E illustrates a layered heating device comprising an insulating material. The layered heating device may include a protective inner layer of wall 4144, a heating device 4140 in the middle layer, and an insulating protective material outer layer 4146. Figure 41F illustrates a heating device that uses latent heat of vaporization. A desiccant 4148 may be used in the walls of the medical instrument accessory. This may convert moisture in the gas to a liquid in an exothermic reaction, generating heat. A mesh 4149 may be used to expose the desiccant to the gas flow within the medical instrument accessory.

[0127] Figures 42A-42F show various options for providing power to the heating device. These options include powering via an external unit (Figure 42A); an associated cannula (Figure 42B); a battery (Figure 42C); a tubing set (Figure 42D); tubing (Figure 42E); and wireless power transfer (Figures 42F-42G). Wireless power transfer can work in conjunction with a heating coil. Figure 42G, a cross section taken along line 42G-42G in Figure 42F, shows a cross section of the cannula 4250, the medical instrument accessory heating device 4240, and the medical instrument 4210. The cannula 4250 can include a heated coil, and the accessory heating device 4240 can include a coil. The cannula coil can transfer power to the heating device 4240.

[0128] Figures 43A-43C show exemplary embodiments of how heat can be transferred to gas flowing by or through a medical instrument accessory 4300. Figure 43A shows a medical instrument accessory 4300 with a heating device that provides constant heating, as indicated by a dot pattern on the accessory wall. The heating device 4340 in Figure 43B provides gradient heating, as indicated by a gradient dot pattern on the accessory wall. The embodiment shown in Figure 43C has a heating device 4340 that provides localized heating, as indicated by a dot pattern on the distal end of the accessory wall. While the heating in Figure 43C is shown localized to the distal end of the medical instrument and accessory, heating can be localized to any portion of the medical instrument shaft or accessory wall.

[0129] Gas Supply Method 44-47 illustrate exemplary gas supply options that may be used with any of the cannulas, medical instrument accessories, or medical instruments described herein. FIG. 44A illustrates the use of insufflation gas delivered directly to the surgical cavity through an insufflation cannula 4460. As shown in FIG. 44A, a surgical humidifier, as well as other types of humidification systems, may be positioned between the insufflator and the cannula. The insufflation gas may be delivered directly to the surgical cavity through the cannula.

[0130] Figure 44B illustrates the delivery of insufflation gas (e.g., CO2 or other gas, or a mixture thereof) directly to the surgical cavity through a medical instrument accessory 4400. A surgical humidifier, or any other type of suitable humidification system, can be placed between the insufflator and the cannula, as shown in Figure 45. The insufflation gas is delivered to the surgical cavity through an inlet in the medical instrument accessory 4400. The gas can be delivered through the inlet into the lumen and out the distal end of the medical instrument accessory, which is placed within the surgical cavity.

[0131] FIG. 45 illustrates the use of a gas canister 4562, e.g., a CO2 canister, to supply a secondary gas source to the medical instrument accessory 4500. While CO2 is described in some instances, the gas canister may supply other gases, including, but not limited to, air, oxygen, nitrous oxide, argon, helium, and / or mixtures of these gases. Gas may be delivered to the medical instrument accessory 4500 when a control, e.g., a foot pedal 4561, is depressed, as shown in FIG. 45. In some instances, the control may be in operative communication with a gas flow mechanism, e.g., a valve. Depressing the foot pedal may cause a burst of gas to flow from the gas inlet, through the medical instrument accessory 4500, through the lumen, and out the distal end of the medical instrument accessory, where it may wash over the distal end of the medical instrument or the top side of the lens.

[0132] 46 illustrates the use of an additional CO gas supply unit, such as a syringe 4662, to deliver CO gas directly to the medical instrument accessory 4600. The CO gas may be in operative communication with a gas control mechanism, such as a foot pedal 4661. As shown in FIG. 46, CO may be delivered to the medical instrument accessory 4600 when the foot pedal 4661 is depressed.

[0133] Figure 47 illustrates delivery of insufflation gas to the surgical cavity using a bifurcation 4764 between the medical instrument accessory 4700 and the cannula 4760. As shown in Figure 47, insufflation gas can be delivered to the surgical cavity through both the cannula 4760 and the medical instrument accessory 4700 by means of a bifurcation connection 4764 at the distal end of the insufflation tube.

[0134] Mounting Options 48-52 illustrate exemplary attachment options for securing components of a surgical assembly that incorporates the medical instrument accessories described herein and may be used with any of the cannulas, medical instrument accessories, or medical instruments described herein.

[0135] FIG. 48 illustrates an embodiment of an alignment feature 4870 that can be removably secured to a medical instrument accessory 4800. It should be appreciated that in other embodiments, the feature 4870 is integrally formed with or permanently attached to the accessory 4800. Fluid, such as insufflation gas, can be delivered directly to the medical instrument accessory 4800 through the fluid inlet 4816. The alignment feature 4870 can assist in properly orienting the medical instrument accessory 4800 relative to the medical instrument 4810, e.g., a scope. The alignment feature 4870 defines a recess 4872 dimensioned to partially surround a connection port 4866, such as an optical cable connector, protruding from the medical instrument 4810. The recess 4872 in the alignment feature 4870 can be used to prevent relative rotational and axial movement of the medical instrument 4810 relative to the medical instrument accessory 4800. For example, this may aid in locating the distal end and lens of the instrument 4810 relative to the distal end of the accessory 4800, increasing the precision of directing fluid flow across the end and lens of the instrument 4810 by the accessory 4800. Additionally, the alignment feature 4870 may position the fluid inlet 4816 adjacent to the connection port 4866, making it more convenient to connect the light source and fluid source to the instrument 4810 and accessory 4800, respectively. In other embodiments, the recess of the alignment feature 4870 may be defined by an alternatively shaped structure, such as a V-shape defined by two elongated members extending in different directions from a common point.

[0136] 49A-49B show an embodiment of an accessory securement assembly including a threaded ring 4970 configured to engage the proximal end of an accessory. In some cases, gas can be delivered to the cannula and redirected by the scope accessory. The accessory can include a threaded portion 4968 at the proximal end of the shaft that corresponds to threaded features (not shown) located on the inner surface of the threaded ring 4970. FIG. 49A shows the ring 4970 removed from the threaded features 4968 of the accessory 4910. FIG. 49B shows the ring 4970 engaged with the accessory when the threaded surfaces of the ring 4970 threadably engage with the corresponding threaded portion of the accessory. In some cases, the medical instrument accessory can have a tapered proximal end. The ring 4970 can tighten the tapered end of the medical instrument accessory around the medical instrument 4910. In some cases, a friction-fit connection of the tapered end of the connector portion can be used instead of or in addition to a threaded engagement.

[0137] 50A-50B illustrate an embodiment of a mounting assembly for mounting an accessory to a trocar assembly or cannula. The medical instrument accessory 5000 is mounted inside the cannula 5060 and may be secured in place by clipping within the cannula housing or by any other suitable means. The medical instrument 5010 may move freely relative to the assembly of the accessory 5000 and cannula 5060. Insufflation gas is supplied to the cannula through the gas inlet 5016 and may be redirected through the medical instrument accessory 5000 by any of the means described herein. The proximal end of the accessory 5000 may have a seal 5072 to prevent gas escape. The medical instrument accessory 5000 may include one or more protrusions that engage with corresponding apertures in the cannula body. The medical instrument accessory 5000 may be secured to the cannula by a clip press mechanism 5074 that clips within the proximal end of the cannula. Figure 50B shows a cross-sectional view taken along line 50B-50B in Figure 50A. As shown in Figure 50A, gas flow can enter gas inlet 5016 and pass down through medical instrument 5010 between ribs or any other features that direct gas flow within a cannula or medical instrument accessory, as described herein.

[0138] 51A-51B show a medical instrument accessory 5100 with a threaded ring 5170 that aligns and mounts the medical instrument accessory 5100 onto the medical instrument 5110. The medical instrument accessory 5100 may include a threaded ring 5170 that tightens over the tapered end of the medical instrument accessory 5100. The medical instrument accessory 5100 may have a shaft with external thread features 5168 that correspond to the threads in the threaded ring 5170. The ring may be tightened and closed onto the medical instrument 5110 when the ring 5170 is tightened onto the shaft of the accessory 5100. This allows the accessory 5100 to be directly attached to the medical instrument 5110. For example, the accessory 5100 may be attached to a medical instrument, such as a cutting tool. In some cases, a friction-fit engagement of the tapered end of a connector portion may be used instead of or in addition to a threaded engagement. Figure 51A shows the ring 5170 in an open configuration and removed from the thread features 5168 of the medical instrument 5110. Figure 51B shows the ring 5170 in a closed configuration where the ring 5170 is tightened onto the shaft of the medical instrument accessory 5100.

[0139] Figures 52A-52D show exemplary mounting assemblies for securing any of the medical instrument accessories described above, particularly those incorporating a heating device. Figure 52A shows the use of mounting parts that are clips on the two sections of the heating device. Figure 52B shows the use of mounting parts that use push-to-release clamps on the heating device. Figure 52C shows the use of mounting parts that use adhesive on the two sections of the heating device. Figure 52D shows the use of mounting parts that use a friction fit on the mounting part of the heating device.

[0140] 52E-52F show a locking mechanism 7620 positioned adjacent to an opening defined in the proximal end of the medical instrument accessory 7600. The locking mechanism 7620 includes a cam 7622 that is rotatable about an axis to move between a first (open) position (shown in FIG. 52E) and a second (locked) position (shown in FIG. 52F). The locking mechanism 7620 can be operated, for example, by a user manipulating a lever 7626 extending from the cam 7622. As shown in FIG. 52E, the cam 7622 is shown in the open position so that the cam 7622 does not block the opening and therefore does not interact with a medical instrument positioned within the accessory 7600. FIG. 52F shows the cam 7622 in a locked position extending into the opening. Positioning the cam 7622 in the locked position allows the cam 7622 to interfere with the medical instrument, securing the instrument within the accessory 7600. The attachment 7600 may also include a sealing element 7624 similar to the sealing element 7520 described below with respect to FIG.

[0141] Example of a medical device fitting for directing gas flow In some cases, the medical instrument accessory may include a mounting structure / framework configured to attach to the medical instrument. FIGS. 53A-53B show a cannula 5360 with a gas flow path between the cannula lumen 5306 and the medical instrument 5310. The cannula 5360 may include a gas inlet 5316. The medical instrument mounting part 5300 may have a body 5304 and structure for positioning the medical instrument 5310 within the cannula lumen 5306. As shown in FIG. 53A, the medical instrument mounting part 5300 may be a mounting part positionable on the medical instrument 5310. The medical instrument mounting part that attaches to the medical instrument 5310 may incorporate a guide element, as described herein. In some cases, as shown in FIG. 53A, the mounting part 5300 may include one or more ribs 5320. In other embodiments, the medical instrument fitting 5300 can include any of the features described herein to direct gas flow through the cannula. The ribs 5320 position the medical instrument shaft within the cannula lumen 5360 such that a gas flow path is defined between the lumen 5360 wall and the shaft of the medical instrument 5310. The gas flow path can direct gas around the distal end of the medical instrument 5310. The ribs 5320 can be located on or adjacent to the exterior surface of the medical instrument 5310. Gas can enter the cannula 5360 through the inlet 5316 and travel through the gas flow path created between the cannula inner sidewall 5312 and the assembly of the medical instrument 5310 and the medical instrument fitting 5300. FIG. 53B shows a cross-sectional view taken along line 53B-53B of FIG. 53A. As shown in FIG. 53B, gas can be channeled between the medical instrument 5310 and the lumen 5306 of the cannula 5360.

[0142] FIGS. 54A and 54B show a medical instrument 5410 including a medical instrument attachment 5400. FIGS. 54A-54B show a medical instrument attachment 5400 similar to the medical instrument attachment 5400 described with reference to FIGS. 53A-53B. However, the assembly is shown without the cannula surrounding it. The medical instrument attachment 5400 can have a body 5404 and ribs 5420 that position the medical instrument shaft within a cannula lumen or other medical instrument accessory. The ribs 5420 can be located on or adjacent to the exterior surface of the medical instrument 5410. In some cases, the body 5404 can be fixed to the medical instrument 5410. The ribs 5420 on the medical instrument 5410 can be any length along the shaft of the medical instrument 5410. FIG. 54B shows a cross-sectional view taken along line 54B-54B of FIG. 54A. As shown in FIG. 54B, ribs 5420 hold medical instrument 5410 concentrically within the cannula and gas can flow concentrically around the medical instrument.

[0143] 55A-55B show a medical instrument 5510 with a pair of medical instrument fittings 5500 attached thereto. Optionally, more than one medical instrument fitting 5500 may be attached to the medical instrument 5510. The medical instrument fitting 5500 may have ribs 5520 that position the medical instrument shaft within the cannula lumen or other medical instrument fitting. The ribs 5520 may be located on or adjacent to the exterior surface of the medical instrument 5510. FIG. 55B shows a cross-sectional view taken along line 55B-55B in FIG. 55A. As shown in FIG. 55B, the ribs 5520 may be attached to the medical instrument 5510 and may hold the medical instrument 5510 concentrically within the cannula, and gas may flow concentrically around the medical instrument. In some cases, the medical device fitting may be attached to the medical device 5510 by a friction fit or adhesive.

[0144] 56 shows a medical instrument 5610 with a medical instrument fitting 5600 attached to the medical instrument 5610. The medical instrument fitting 5600 may be a spiral fitting 5620 secured to the medical instrument 5610 to direct flow in a vortex pattern around the medical instrument 5610. In some embodiments, gas flow may be directed between the medical instrument and the cannula lumen.

[0145] FIGS. 57A-57B show a medical instrument 5710 including a medical instrument attachment 5700. The medical instrument attachment 5700 can have a body 5704 and ribs 5720 that position the medical instrument shaft within a cannula lumen or other medical instrument attachment. The ribs 5720 can be located on or adjacent to the exterior surface of the medical instrument 5710. In some cases, the body 5704 can be fixed to the medical instrument 5710. As shown in FIG. 57A, the ribs 5720 can be unevenly spaced around the medical instrument 5710 to deflect contaminants or water droplets from the lens or to promote evaporation of condensation / cloudiness that forms on the lens. The ribs can be at any point along the attachment or length. FIG. 57B shows a cross-sectional view taken along line 57B-57B of FIG. 57A. 57B shows uneven spacing of ribs 5720 on medical instrument 5710. The ribs may hold the medical instrument concentrically within the cannula and allow gas to flow concentrically around it.

[0146] FIGS. 58A-58B show a medical instrument 5810 with a medical instrument attachment 5800. The medical instrument attachment 5800 can have a body 5804 and ribs 5820 that position the medical instrument shaft within a cannula lumen or other medical instrument attachment. The ribs 5820 can be located on or adjacent to the exterior surface of the medical instrument 5810. In some cases, the body 5804 can be fixed to the medical instrument 5780. As shown in FIG. 58A, the width of the ribs 5820 can be uneven around the medical instrument 5810, directing a jet of gas over the top side of the lens for a cleaning effect. The ribs can be at any point along the attachment or its entire length. FIG. 58B shows a cross-sectional view taken along line 58B-58B of FIG. 58A. FIG. 58B illustrates the uneven width of the ribs 5820 on the medical instrument 5810. The ribs may hold the medical instrument concentrically within the cannula and gas may flow concentrically around it.

[0147] FIGS. 59A-59B show a medical instrument 5910 including a medical instrument accessory 5900. The medical instrument accessory 5900 can have a body 5904 and a non-circular cross-section. As shown in FIG. 59A, the medical instrument accessory 5900 can be secured to the medical instrument 5910. Depending on the position of the medical instrument 5910, gas can either flow concentrically around the medical instrument 5910 or be jetted over its upper side. FIG. 59B shows a cross-sectional view taken along line 59B-59B in FIG. 59A. FIG. 59B shows the non-circular shape of the medical instrument accessory 5900. While the shape of the non-circular cross-section is shown as elliptical, the non-circular cross-section of the body of the medical instrument accessory can be any non-circular shape.

[0148] In some cases, a medical instrument may have features integrated into the medical instrument, i.e., built into the medical instrument. FIGS. 60A-60B show a cannula 6060 with a gas flow path between the cannula lumen 6006 and the medical instrument 6010. The cannula 6060 may include a gas inlet 6016. The medical instrument 6010 may have a shaft 6012 and protrusions 6020 for positioning the medical instrument 6010 within the cannula lumen 6006. In some cases, the surface of the shaft may have one or more protrusions extending radially outward. The one or more protrusions may contact the inner wall of the cannula during use. As shown in FIG. 60A, the protrusions 6020 may be built into the medical instrument 6010. The cannula inner wall and the protrusions may define the gas flow path. In some cases, as shown in FIG. 60A, the protrusions on the medical instrument 6010 may be one or more ribs 6020. In other embodiments, the protrusions can be any of the features described herein for directing gas flow through the cannula. The ribs 6020 can extend at least a portion of the length of the shaft 6012. The ribs 6020 on the medical instrument shaft 6012 can extend the length (or substantially the length) of the shaft. A gas flow path can be defined between the cannula 6060 and the shaft 6012 of the medical instrument 6010. Gas can enter the cannula 6060 through the inlet 6016 and travel within the gas flow path created between the cannula 6060 and the medical instrument 6010. The medical instrument 6010 can direct the gas flow over or adjacent to the distal end of the shaft 6012. FIG. 60B shows a cross-sectional view taken along line 60B-60B of FIG. 60A. As shown in FIG. 60B, gas can be channeled between the medical instrument 6010 and the lumen 6006 of the cannula 6060.

[0149] FIGS. 61A-61C illustrate embodiments of medical instruments with lumens for directing gas flow through the medical instrument. FIG. 61A illustrates a medical instrument 6110 with a gas inlet 6116 and a shaft 6112. FIG. 61B illustrates a longitudinal cross-section of the medical instrument 6110 with a shaft 6112 and an internal lumen 6132. As shown in FIG. 61B, the shaft 6112 can have a lumen 6132 that directs gas flow through the shaft 6112 and out the distal end of the shaft 6112. The directional lumen 6132 can direct gas flow across the distal end or lens of the medical instrument. FIG. 61C illustrates a cross-section taken along line 61C-61C of FIG. 61B. As shown in FIG. 61C, the lumen 6132 can be offset from the center of the shaft 6112.

[0150] FIGS. 62A-62C illustrate embodiments of medical instruments with lumens for directing gas flow through the medical instrument. FIG. 62A illustrates a medical instrument 6210 with a gas inlet 6216 and a shaft 6212. FIG. 61B illustrates a longitudinal cross-section of the medical instrument 6210 with a shaft 6212 and an internal lumen 6232. As shown in FIG. 62B, the shaft 6212 can have a lumen 6232 that directs gas flow through the shaft 6212 and out the distal end of the shaft 6212. The lumen 6232 can direct gas flow for concentric flow or for flow across the distal end or lens of the medical instrument. FIG. 62C illustrates a cross-section taken along line 62C-62C of FIG. 62B. As shown in FIG. 62C, the lumen 6232 can be a concentric lumen for flow directed around the distal end of the medical instrument.

[0151] Figures 63A-63B show protrusions evenly spaced around the circumference of the medical instrument shaft to direct flow concentrically around the medical instrument. As shown in Figure 63A, the protrusions may be ribs 6320. The medical instrument ribs 6320 may be of any length along the medical instrument shaft 6312. The ribs 6320 may be evenly (or substantially evenly) spaced around the circumference of the shaft 6312. Figure 63B shows a cross-sectional view taken along line 63B-63B in Figure 63A. As shown in Figure 63B, the ribs 6320 may hold the medical instrument 6310 concentrically within the cannula (not shown), and gas may flow concentrically therearound.

[0152] 64A-64B show two sets of protrusions evenly spaced around the circumference of the medical instrument shaft to direct flow concentrically around the medical instrument. The first set of protrusions 6472 is horizontally offset from the second set of protrusions 6474. As shown in FIG. 64A, the first set of protrusions 6472 can be positioned at the proximal end of the shaft 6412, and the second set of protrusions 6474 can be positioned at the distal end of the shaft 6412. The sets of protrusions can be located anywhere along the shaft of the medical instrument. In some cases, as shown in FIG. 64A, the protrusions can be ribs 6420. The ribs 6420 on the medical instrument can be any length and positioned anywhere along the medical instrument shaft 6412. The ribs 6420 can be evenly (or substantially evenly) spaced around the circumference of the shaft 6412. Figure 64B shows a cross-sectional view taken along line 64B-64B of Figure 64A. As shown in Figure 64B, ribs 6420 can concentrically retain medical instrument 6410 within the cannula (not shown), and gas can flow concentrically around it.

[0153] Figure 65 shows a spiral arrangement of protrusions around the circumference of the shaft of a medical instrument to direct flow concentrically around the medical instrument. As shown in Figure 65, the protrusions may be spiral fins 6520. The spiral fins 6520 may direct flow in a vortex pattern around the medical instrument 6510. The gas flow may be directed between the medical instrument and a cannula (not shown).

[0154] FIGS. 66A-66B show protrusions that are non-uniformly spaced around the circumference of the medical instrument shaft to direct flow concentrically around the medical instrument. The protrusions may be unevenly spaced or unevenly distributed around the medical instrument shaft. In some cases, as shown in FIGS. 66A-66B, the protrusions may be ribs 6620 that are unevenly spaced around the medical instrument 6610. The ribs 6620 on the medical instrument 6610 may be any length and positioned at any point along the medical instrument shaft 6612. The ribs 6620 may be unevenly spaced around the medical instrument 6610 to deflect contaminants or water droplets away from the lens or to promote evaporation of condensation / cloudiness that forms on the lens. The ribs 6620 may be at any point along the shaft 6612 of the medical instrument 6610 or along the entire length of the medical instrument 6610. Figure 66B shows a cross-sectional view taken along line 66B-66B in Figure 66A. As shown in Figure 66B, the ribs 6620 can hold the medical instrument 6610 concentrically within the cannula (not shown), and gas can flow concentrically around it.

[0155] FIGS. 67A-67B show protrusions of unequal widths around the shaft of the medical instrument to direct flow concentrically around the medical instrument. In some cases, as shown in FIGS. 67A-67B, the protrusions can be ribs 6720 of unequal widths around the medical instrument 6710. The ribs 6720 on the medical instrument 6610 can be any length and positioned at any point along the medical instrument shaft 6712. The ribs 6720 can be of different widths around the medical instrument 6710 to deflect contaminants or water droplets away from the lens or to promote evaporation of condensation / fog that forms on the lens. The ribs 6720 can be at any point along the shaft 6712 of the medical instrument 6710 or along the entire length of the medical instrument 6710. FIG. 67B shows a cross-sectional view taken along line 67B-67B of FIG. 67A. As shown in FIG. 67B, the ribs 6720 may have unequal widths and may hold the medical instrument 6710 concentrically within the cannula (not shown) and allow gas to flow concentrically around it.

[0156] FIGS. 68A-68B show a medical instrument 6810 with a shaft 6812 of a non-circular cross-section. The medical instrument 6800 can be used with a circular cannula lumen, which allows gas to flow through the cannula regardless of the position of the medical instrument. Depending on the position of the medical instrument 6800, gas can flow around the scope or be jetted over its upper side. FIG. 68B shows a cross-sectional view taken along line 68B-68B in FIG. 68B. As shown in FIG. 68B, the shaft 6812 can have a non-circular shape. In some cases, the non-circular shape can be elliptical, as shown in FIG. 68B. In other cases, the shaft 6812 can be any non-circular shape.

[0157] FIGS. 69A-69C show a medical instrument 6910 that includes a deflection structure in the form of a ledge 6920. The ledge 6920 extends inward from the edge of the distal end of the shaft 6912 of the medical instrument 6910. In some cases, the ledge 6920 may be at least partially annular. In this embodiment, the ledge 6920 is configured as a continuous ring. However, it should be appreciated that the ledge 6920 may include multiple structures to form discontinuous rings. The ring-shaped ledge 6920 may be positioned around the lens of the medical instrument to direct gas across the lens in all directions in the plane of the ledge. FIGS. 69A-69B show a ring ledge 6920 around the distal end of the medical instrument 6910 to direct gas across the distal end of the medical instrument. FIG. 69C shows a cross-sectional view taken along line 69C-69C of FIG. 69B. As shown in FIG. 69C, the outer shell 6980 of the medical device 6910 can form a lumen for gas flow around the central medical device 6910.

[0158] FIGS. 70A-70C show a medical instrument 7010 including a deflecting structure in the form of a ledge 7020 on one side of the medical instrument 7010 to direct gas across the lens. The ledge 7020 extends inward from the edge of the distal end of the shaft 7012 of the medical instrument 7010. The medical instrument 7010 may also have a flange 7024 extending distally from the medical instrument. The flange 7024 may be adjacent to the lens 7082 of the medical instrument 7010. FIG. 70B shows a longitudinal cross-section of the medical instrument 7010. As shown in FIGS. 70A-70B, the ledge may direct gas flow across the lens of the scope. FIG. 70C shows a cross-section taken along line 70C-70C of FIG. 70B. In some cases, a lumen within the scope may deliver gas across the lens 7082. In some cases, the lumen may be a single lumen or a full concentric lumen. In some cases, a flange may direct gas flow from the concentric lumen across the distal end of the shaft.

[0159] FIGS. 71A-71C show a medical instrument 7110 having an outer body 7180 defining a circular ledge 7120 around an angled distal end. The outer body can be spaced from the inner body to define a cavity between the bodies. Gas can be introduced between the bodies such that the ledge 7120 directs the gas across the angled end in all directions in the plane of the ledge. The ledge 7120 can extend inward from the edge of the distal end of the medical instrument 7110. As shown in FIGS. 71A-71B, the ledge can direct gas flow across a lens at the distal end of the medical instrument. FIG. 71C shows a cross-sectional view taken along line 71C-71C of FIG. 71B. As shown in FIG. 71C, the outer body 7180 of the medical instrument 7110 can form a lumen for gas to flow around the inner body. In some cases, a lumen within the medical instrument 7110 can deliver gas across the lens. In some cases, the lumen can be a single lumen or a full concentric lumen. In some cases, a ledge 7120 can direct gas flow from the concentric lumen across the distal end of the shaft.

[0160] FIGS. 72A-72C show an angled medical instrument 7210 including a deflecting structure in the form of a ledge 7220 on one side of the angled medical instrument 7210 to direct gas across the lens. The ledge 7220 extends inward from the edge of the distal end of the medical instrument 7210. The medical instrument 7210 may also have a flange 7224 extending distally from the medical instrument. The flange 7224 may be adjacent to the lens 7282 of the medical instrument 7210. FIG. 72B shows a longitudinal cross-section of the medical instrument 7210. As shown in FIGS. 72A-72B, the ledge may direct gas flow across the lens of the scope. FIG. 72C shows a cross-section taken along line 72C-72C in FIG. 72B. In some cases, a lumen within the scope may deliver gas across the lens 7282. In some cases, the lumen may be a single lumen or a full concentric lumen. In some cases, a flange may direct gas flow from the concentric lumen across the distal end of the shaft.

[0161] In some cases, the medical instrument, or the shaft of the medical instrument itself, may include a heating device. Heated medical instruments may be incorporated into any of the medical instrument embodiments described herein. FIGS. 73A-73E show embodiments of power options for a heating device for a medical instrument. FIG. 73A shows a medical instrument powered directly by a cable. FIG. 73B shows a medical instrument powered directly by a battery. FIG. 73C shows a medical instrument powered externally. FIG. 73D shows a medical instrument powered directly by wireless power transmission. In some cases, wireless power transmission may be used in conjunction with a coil. FIG. 73E shows a cross-sectional view taken along line 73E-73E of FIG. 73D. As shown in FIG. 73E, there may be a coil within the cannula 7360 and a coil within the medical instrument 7310. The cannula coil may transmit power to the scope coil.

[0162] In some cases, the cannulas and accessories described herein may be based on operating a regulated gas supply. In some cases, a continuously positive and / or substantially constantly flowing gas supply, as well as intermittent and / or variable flow, may be regulated and operated. In some cases, optimizing the humidity source and operating a regulated gas supply may assist in the use of the systems and devices described herein. In some cases, a continuous exhaust may allow for continuous gas flow, as well as regulation or operation of intermittent and / or variable flow. In some cases, the exhausted gas may be filtered.

[0163] Redirecting flow can increase resistance in the system, so reducing gas restriction will help offset this and increase compatibility with gas supplies. Reduced restriction in gas connections, tubing sets with less friction, tubing sets with consistent diameters, and tubing sets with multiple connections can be used.

[0164] 74A-74I illustrate an embodiment of a medical instrument accessory 7400 including at least one deflection structure arranged to direct fluid flow transversely to a longitudinal axis defined by the accessory 7400. In the illustrated embodiment, the or each deflection structure is arranged to direct fluid flow toward the distal end of the accessory 7400 and, consequently, toward the distal end of a medical instrument received within the accessory 7400. In the embodiment of FIGS. 74A-74C, the deflection structure is in the form of a ledge 7420 extending partially across an opening defined in the distal end of the accessory 7400. It should be appreciated that in other embodiments, the deflection structure may be defined by a shelf, shoulder, boss, or other structure defining one or more surfaces arranged to direct fluid flow. The medical instrument accessory 7400 has one or more sidewalls 7406 defining a first diameter portion 7424 and a second diameter portion 7422. 74C , the first portion 7424 defines a first inner diameter that is dimensioned to be substantially the same as the outer diameter of the medical instrument to provide a snug, and in some embodiments, a friction fit, with the instrument. In the illustrated embodiment, the first portion 7424 extends away from the distal end of the accessory 7400 and partially along the shaft of the accessory 7400. In other embodiments, the first portion 7424 extends along most of the shaft of the accessory 7400. Because the first portion 7424 is dimensioned to provide a snug fit with the instrument, little or no gas can flow past the instrument at this portion 7424 of the accessory 7400.

[0165] The second portion 7422 of the attachment 7400 defines a second inner diameter that is dimensioned larger than the first diameter. In the illustrated embodiment, the attachment 7400 is shaped to define the second diameter concentrically with the first diameter. It should be appreciated that in other embodiments, the second diameter may be disposed about an axis that is axially offset from the axis of the first diameter—forming a non-concentric diameter. The second portion 7422 may align with the position of the ledge 7420 relative to the inner sidewall 7406. In some embodiments, the ledge may include various shapes other than a tab-like protrusion, such as an arc or ramped region. The second diameter portion 7422 may create a flow path, as indicated by the unidirectional arrow. The flow path directs flow longitudinally through the attachment 7400, past the instrument, and up to the ledge 7420, where the fluid is directed transversely to the longitudinal axis of the attachment 7400 and at least partially flows in a direction non-parallel to the axis. In the illustrated embodiment, the fluid is directed substantially perpendicular to the axis. For example, the fluid may be directed to flow parallel to and across the distal end of the instrument, thereby causing the fluid flow to be parallel to a lens disposed within the attachment 7400. It should be appreciated that in other embodiments, the fluid may be directed at other angles relative to the axis, for example, directing the fluid toward or away from the distal end of the instrument. In some cases, the inner sidewall 7406 defines a second, larger diameter on the side of the attachment 7400 where the ledge 7420 is located. This allows gas to flow underneath the attachment 7400 and be diverted by the ledge 7420 as it exits into the surgical cavity. Figure 74C shows a cross section taken along line 74C-74C of Figure 74B. Figure 74C shows the first and second inner diameters. The attachment 7400 may include an abutment surface 7426 positioned to abut the distal end of the instrument when received within the attachment 7400. In the illustrated embodiment, the abutment surface 7426 is defined by the first portion 7424 such that it is axially spaced from the ledge 7420.This allows for positioning the medical instrument within the attachment 7400 a specific distance from the ledge 7420, which may assist in directing fluid across the end of the medical instrument via the ledge 7420. FIGS. 74A-74C show an embodiment of the attachment 7400 configured to accept a flat scope and lens. However, it should be understood that the attachment 7400 may have a distal end disposed transversely to the axis of the attachment 7400, as described with reference to the previous embodiment, to accommodate a scope with an angled lens. It should be appreciated that the first portion 7424 and the second portion 7422 may be formed into an end cap that can be permanently or removably secured to a shaft defining a constant inner diameter. In such an embodiment, the shaft may define an inner diameter substantially equal to the inner diameter of the second portion 7422.

[0166] 74D-74I show end views of alternative embodiments of medical instrument accessories 7400 having differently configured distal end structures that allow for directing fluid flow in one or more specific directions relative to the longitudinal axis of the accessory 7400, for example, by directing air to form multiple directional streams. Each of the illustrated embodiments includes a deflection structure extending from the second portion 7422 partially across the distal opening. Each deflection structure is positioned to direct fluid relative to the longitudinal axis of the accessory 7400, such as transversely and / or perpendicularly or radially relative to the axis. Each deflection structure is positioned to receive fluid flowing through the accessory 7400 along its longitudinal axis and deflect the fluid to flow transversely relative to the axis. Each structure may include a curved or ramped portion positioned to enhance fluid flow transitioning from axial to transverse. In the illustrated embodiment, each deflector structure defines a curved or compound curved edge 7423 that extends at least partially across the opening. In other embodiments, the deflector structure defines an at least partially straight edge that extends at least partway across the opening similar to the embodiment of Figures 74A-74C. In further embodiments, the deflector structure defines this edge to have multiple straight and / or curved regions, for example, extending along a facet portion.

[0167] In FIG. 74D , a deflection structure, in this embodiment in the form of a shelf structure 7430, extends from the distal end and defines a pair of deflection surfaces 7432. The surfaces 7432 are positioned to receive fluid flowing through the second portion 7424 of the attachment 7400, along the longitudinal axis of the attachment 7400, and past an instrument disposed within the attachment 7400, and direct the received fluid transverse to the axis. In the illustrated embodiment, the shelf structure 7430 is configured to be placed adjacent to a flat-ended medical instrument to direct the fluid substantially perpendicular to the axis. The surfaces 7432 are positioned to direct the fluid flow into two streams toward the axis, as indicated by the single-headed arrows. This allows the two streams of fluid to be directed toward an intersection region or point. For example, in the illustrated embodiment, the deflecting surfaces 7432 are positioned to direct the fluid streams radially to overlap at or near the axis of the accessory 7400. As a result, the fluid streams may intersect at or near the center of the distal end of the housed instrument, such as the center of the lens of a scope. The directed streams may interact, thereby facilitating cleaning of debris or fluid from the end of the instrument.

[0168] In FIG. 74E , a deflection structure, in this embodiment in the form of a shelf structure 7434, can extend from the distal end and define a plurality of deflection surfaces 7436. The surfaces 7436 are positioned to receive fluid flowing through the second portion 7424 of the accessory 7400 along the longitudinal axis of the accessory 7400 and direct the received fluid to flow in multiple parallel streams transverse to and across the axis, as indicated by the single-headed arrows. In some embodiments, the surfaces 7436 are positioned to direct the parallel streams perpendicularly across the axis, e.g., to allow flow parallel to and across the distal end of a flat scope. In other embodiments, one or more of the surfaces 7436 can be positioned to direct the parallel streams at an angle across the axis, e.g., to allow parallel flow across the distal end of an angled scope. The parallel streams may form "blades" of fluid, which may create a shearing effect to clean debris or fluid from the end of an instrument housed within the attachment 7400. In the illustrated embodiment, each of the deflecting surfaces 7436 are planar and are disposed flush with one another, allowing for the formation of fluid blades that substantially traverse the distal end of the attachment 7400 and medical instrument. In other embodiments, the surfaces 7436 may be offset from one another in spaced apart planes, allowing the fluid streams to flow at spaced apart levels.

[0169] In Figure 74F, a deflection structure, in this embodiment in the form of a shelf structure 7438, extends from the distal end and defines a deflection surface 7440. Surface 7440 is positioned to receive fluid flowing through second portion 7424 of attachment 7400 and direct the received fluid in multiple streams toward the axis. As indicated by the unidirectional arrows, surface 7440 is positioned to direct the streams to intersect at or near the axis, providing a combination of the approaches of the embodiments of Figures 74D and 74E.

[0170] In FIG. 74G, a deflection structure, in this embodiment in the form of a shelf structure 7442, extends from the distal end and defines a plurality of deflection surfaces 7444. The surfaces 7444 are positioned to receive fluid flowing through the second portion 7424 of the accessory 7400 and direct the received fluid into a plurality of diverging streams transverse to the axis, as indicated by the single-headed arrows. The diverging streams may form fluid “blades” that may help create a shearing effect to clear debris or fluid from the end of an instrument housed within the accessory 7400. In the illustrated embodiment, the surfaces 7444 are positioned to direct the diverging streams at an angle across the axis, for example, to allow parallel flow across the distal end of an angled scope. This is more clearly shown in FIGS. 74H and 741, which show the deflection structure formed within an end cap 7446 shaped to receive an angled scope. In other embodiments, the surfaces 7444 are positioned to direct the diverging streams parallel to the longitudinal axis of the accessory 7400. Referring to FIGS. 74H and 74I, the deflecting structure is defined in an end cap 7446 that can be secured to the shaft of the accessory 7400. As best shown in FIG. 74I, the end cap 7446 is shaped to accept an angled-end scope, and the deflecting surfaces 7444 are positioned to direct the flow at a complementary angle relative to the longitudinal axis of the accessory 7400 to the extent that the fluid flows across the end of the scope. It should be appreciated that the embodiments of FIGS. 74D-74F can also be formed as end caps, each end cap being securable to the shaft of the accessory 7400. This allows for the provision of a kit including a shaft and multiple, interchangeable, differently configured end caps to tailor the fluid flow to the end of the accessory 7400 to accommodate different medical instruments. It should be appreciated that the embodiments of Figures 74D-74G may be alternatively configured to define more or fewer deflection surfaces, and that the multiple deflection surfaces shown in these figures are exemplary.

[0171] Figure 75 shows a medical instrument accessory 7500 that includes a sealing element 7520 at the proximal end of the shaft of the accessory 7500 to prevent gas from exiting or leaking at the proximal end. As shown in Figure 75, the medical instrument 7510 can seal the proximal end of the lumen of the accessory 7500 with a friction fit against the sealing element 7520. The accessory 7500 can have a gas inlet 7516 that allows gas to be delivered directly to the lumen of the accessory 7500.

[0172] 76A and 76B illustrate an alternative embodiment of the alignment feature 4870 described above, where the feature 4870 includes a body 4871 that can be secured adjacent the proximal end of the accessory 4800. The body includes a pair of elongated, spaced apart members 4873 that define a recess 4872. The members 4873 are configured to extend parallel to the longitudinal axis of the accessory 4800 such that the recess 4872 is an elongated, open slot. FIG. 76A illustrates a pair of elastically deformable tabs 4874 that enable the alignment feature 4870 to be secured to the accessory 4800, such as to form a removable “snap-fit” connection. FIG. 76B illustrates the feature 4870 mounted adjacent the proximal end of the accessory 4800. In some embodiments, the feature 4870 can be mounted to the accessory 4800 such that the recess 4872 is aligned with the fluid inlet 4816. In the illustrated embodiment, the proximal end of the attachment 4800 is configured as an end cap 4802 that can be removably secured to the shaft. In other embodiments, two or more of the alignment feature 4800, the proximal end, and the shaft are integrally formed.

[0173] 76C and 76D show a further alternative embodiment of the alignment feature 4870, including a shroud 4876 shaped and dimensioned to receive a section of the instrument 4810 for a snug fit. In this illustrated embodiment, the shroud defines a square or rectangular cavity that allows it to mate with and interlock with a square or rectangular section of the instrument 4810. As shown in FIG. 76D, the shroud 4876 defines a recess 4872 on its side that is positioned to align with the connection port 4866 for connecting to an optical cable during use. This form of alignment feature 4870 is useful when the instrument 4810 defines a square or rectangular section, as mating this section with the shroud 4876 can tightly prevent relative rotation between the instrument 4810 and the accessory 4800. It should be appreciated that the shroud 4876 may be alternatively shaped to complement sections of other instruments, e.g., defining opposing sides, where the other instruments may be, for example, hexagonal or oval / elliptical sections, or circular sections, having protrusions that abut the sides of recesses 4872, such as light ports 4866. While the illustrated embodiment shows the shroud 4876 integrally formed with the proximal end cap 4802 of the accessory 4800, it should also be appreciated that in other embodiments, the shroud 4876 may be removably connectable to the end cap 4802 and / or the accessory 4800. This also allows the shroud 4876 to be replaced with the embodiment of the alignment feature 4870 shown in FIG.

[0174] 77A-77F illustrate an embodiment of a locking mechanism 7620 including a cam 7622 and a proximal end cap 7601 of the accessory 7600. The end cap 7601 can be secured to a shaft 7603 of the accessory 7600. It should be appreciated that in other embodiments, the shaft 7603 and end cap 7601 are one piece. FIGS. 77A and 77B illustrate the arrangement of the cam 7622 in an open position and a locked position relative to an instrument, such as a scope 7710, disposed within the accessory 7600. In these figures, the cam 7622 is disposed about its axis of rotation such that a lever 7626 can be manipulated, typically downward, to rotate the lever 7626 toward the accessory 7600 and place the cam 7622 in the locked position. As shown in FIG. 77B, the cam 7622 is dimensioned such that when disposed in the locked position, the cam 7622 interferes with the instrument, creating a frictional engagement. The end cap 7601 defines an aperture dimensioned to receive the shaft of an instrument and may also include one or more seals positioned to extend at least partially around the aperture to enable fluid to be prevented from exiting the proximal end of the accessory 7600.

[0175] 77C and 77D illustrate the assembly of the cam 7622 to the end cap 7601. As shown in these figures, the proximal end of the end cap 7601 defines a first slot 7602 that intersects with a second slot 7604 that is disposed to extend transversely relative to the first slot 7602. In the illustrated embodiment, the first slot 7602 extends parallel to the longitudinal axis of the accessory 7600, and the second slot 7604 extends perpendicular to this axis. It should be appreciated that in other embodiments, the slots 7602, 7604 are disposed alternately with one another. The cam 7622 includes a shaft 7628 extending from opposite sides and a protrusion 7630 disposed on each end of the shaft 7628. The first slot 7602 is dimensioned to receive the shaft 7628 and the protrusion 7630, and the second slot 7604 is dimensioned to receive only the shaft 7628, such that the protrusion is disposed outside the slot 7604. Securing the cam 7622 to the end cap 7601 involves passing the shaft 7628 and the protrusion 7630 through the first slot 7602 to the base of the slot 7602, and then moving the cam 7622 outward, away from the longitudinal axis of the accessory 7600, so that the shaft 7628 slides within the second slot 7604, with the protrusion 7630 disposed outside the slot 7604, until the shaft 7628 rides on a detent feature 7606 positioned to hold the shaft 7628 at the end of the slot 7604. The shape of the protrusion 7630 and its arrangement outside the slot 7604 engage the cam 7622 with the accessory 7600. 77E and 77F show an abutment surface 7608 defined adjacent the end of the second slot 7604 and positioned to interfere with the protrusion 7630 to limit rotation of the cam 7622. As best shown in FIG. 77E, this can prevent further rotation of the cam 7622 and define an open position. FIG. 77F shows the cam 7622 positioned in a locked position.

[0176] Terminology Examples of medical gas delivery systems and related components and methods have been described with reference to the drawings. The drawings illustrate various systems and modules and the connections between them. The various modules and systems may be combined in various configurations, and the connections between the various modules and systems may represent physical or logical links. The representations in the drawings are presented for clarity of principles, and details regarding portions of modules or systems are provided for ease of explanation rather than to detail separate physical embodiments. The examples and drawings are intended to illustrate, but not to limit, the scope of the inventions described herein. For example, the principles herein may be applied to the delivery or evacuation of fluids from any desired site relative to a patient's anatomy.

[0177] The examples described herein show concentric attachments that are used in conjunction with and support a medical instrument concentrically. In some cases, the attachment may be used to concentrically hold other medical instruments, such as surgical tools. Additionally, as referred to herein, the terms "concentric," "concentrically," and / or "substantially concentric," or any variation of these terms, may also refer to a small axial offset between the attachment and the medical instrument.

[0178] The examples described herein refer to reducing fogging or condensation on medical instruments. However, other obstacles or complications to visualization may be prevented or reduced. When reference is made herein to reducing fogging or condensation by the methods, procedures, and devices described herein, it may be understood that these methods, procedures, and devices may also reduce or prevent fogging, condensation, unwanted debris, and / or other obstructions to the field of vision.

[0179] Although several embodiments and examples are disclosed herein, the inventive subject matter extends beyond the specifically disclosed embodiments to other alternative embodiments and / or uses, as well as modifications and equivalents thereof. Therefore, the scope of the claims or the embodiments appended thereto is not limited to any of the specific embodiments described herein. For example, in any method or process disclosed herein, the acts or operations of the method or process may be performed in any suitable order and are not necessarily limited to any particular disclosed order. Various operations may also be described as multiple separate operations, as may be helpful in understanding some embodiments; however, the order of description should not be construed to imply that these operations are order dependent. Furthermore, structures described herein may be provided as integrated or separate components. For purposes of comparing various embodiments, several aspects and advantages of these embodiments will be described. Not necessarily all such aspects or advantages are achieved by any particular embodiment. Thus, for example, various embodiments may be implemented to achieve or optimize one advantage or group of advantages as taught herein, but need not also achieve other aspects or advantages as taught or suggested herein.

[0180] As used herein, conditional language, such as, among others, "can," "could," "might," "may," "eg," and the like, is intended to generally convey that some embodiments include certain features, elements, and / or conditions, but not others, unless specifically stated otherwise or understood otherwise in the context of use. Therefore, such conditional language does not generally imply that features, elements, and / or conditions are required in one or more embodiments. As used herein, the terms "comprises," "comprising," "includes," "including," "has," "having," or any other variation thereof, are intended to cover a non-exclusive inclusion. For example, a process, method, article, or apparatus that includes a list of elements is not necessarily limited to those elements and may include other elements not expressly listed or inherent in such process, method, article, or apparatus. Also, the term "or" is used in its inclusive sense (rather than its exclusive sense), so that, for example, when used to connect a list of elements, the term "or" means one, some, or all of the elements of the list. Connective language such as the phrase "at least one of X, Y, and Z" is understood in context as otherwise used to generally convey that an item, term, etc. can be either X, Y, or Z, unless specifically stated otherwise. Thus, such connective language is not intended to generally imply that some embodiments require that there be at least one X, at least one Y, and at least one Z, respectively. As used herein, the word "about" or "approximately" can mean a value within ±10%, ±5%, or ±1% of the stated value.

[0181] It should be emphasized that many variations and modifications may be made to the embodiments described herein, and elements thereof are understood to be particularly acceptable examples. All such modifications and variations are intended to be included herein within the scope of this disclosure and protected by the following claims. Moreover, the above disclosure is not intended to imply that any particular component, feature, or process step is required or essential.

Claims

1. 1. An accessory for a medical instrument for localizing fluid infusion or evacuation near a distal end of the medical instrument, comprising: a body fittable over at least a portion of a medical instrument shaft, the body having an inner lumen, a proximal end, and a distal end, the distal end including an opening, the distal end configured to be disposed at or adjacent to the distal end of the medical instrument during use; and A medical instrument accessory, wherein the outer wall of the medical instrument shaft and the inner lumen define a fluid flow path, and fluid flows into and / or out of the fluid flow path at or adjacent the distal end of the medical instrument shaft.

2. The medical instrument accessory of claim 1 , wherein the body is elongated.

3. 3. The medical instrument accessory of claim 1, wherein the body is generally cylindrical.

4. The medical instrument accessory of any one of claims 1 to 3, wherein the fluid flow path is defined at least in part by an inner wall of the body and the outer wall of the medical instrument shaft.

5. The medical instrument accessory of any one of claims 1 to 4, wherein the body is configured to attach to the distal end of a cannula.

6. The medical instrument accessory of any one of claims 1 to 5, wherein the body is at least partially flexible and / or includes an extendable element configured to attach to a distal end of the cannula.

7. The medical instrument accessory of any preceding claim, wherein the body is movable between a retracted position and an extended position.

8. The medical instrument accessory of any one of claims 1 to 7, wherein the body is configured to attach to a proximal end of the medical instrument by an attachment part.

9. The medical instrument accessory of any one of claims 1 to 8, wherein the fitting is a sealing fitting.

10. The medical instrument accessory of any preceding claim, wherein the fitting is configured to create a fluid-tight seal.

11. The medical instrument accessory of any one of claims 1 to 10, wherein the proximal end of the body is in fluid communication with a fluid source and / or a vent.

12. 12. The medical instrument accessory of claim 1, wherein the body has a first portion where the inner lumen has a first diameter substantially the same as a diameter of the medical instrument outer wall, and a second portion where the inner lumen has a second diameter larger than the diameter of the medical instrument outer wall, and the body has at least one aperture in fluid communication with the fluid flow path.

13. The medical instrument accessory of claim 12, wherein the diameter of the lumen transitions from the first diameter to the second diameter.

14. The medical instrument accessory of claim 13 , wherein the at least one aperture is located at the transition between the first diameter and the second diameter.

15. 15. The medical instrument accessory of any one of claims 1 to 14, wherein the medical instrument is a laparoscope, and fluid is released from or introduced into the fluid flow path adjacent a lens of the laparoscope.

16. 16. The medical instrument accessory of any one of claims 1 to 15, wherein the medical instrument is a laparoscope, and fluid is emitted from or introduced into the fluid flow path parallel to a lens of the laparoscope.

17. 17. The medical instrument accessory of claim 1, wherein the body includes a ring portion disposed at the distal end, the ring portion having at least one aperture in a surface of the ring.

18. 18. The medical instrument accessory of claim 17, wherein the ring portion has an inner diameter that is smaller than a diameter of the medical instrument.

19. The medical instrument accessory of any one of claims 1 to 18, wherein the medical instrument is an electrocautery tool.

20. 20. The medical instrument accessory of any one of claims 1 to 19, wherein the length of the body extends substantially the length of the medical instrument, to the extent that the distal end is adjacent the distal end of the medical instrument.

21. 1. An accessory for a medical instrument for confining fluid flow around a distal end of the medical instrument, the accessory comprising: a body configured to fit over at least a portion of a shaft of the medical instrument, the body comprising: A lumen with an inner wall, Proximal end, an open distal end; and At least one structure configured to position the medical instrument shaft in the lumen during use such that a fluid flow path is defined between the inner lumen wall and the medical instrument shaft, wherein fluid may be directed around the end of the medical instrument into or out of the open distal end. Including the main body Including accessories.

22. 22. The medical instrument accessory of claim 21, wherein the at least one structure is on the interior wall of the accessory.

23. 23. The medical instrument accessory of claim 21 or 22, wherein the body is configured to fit over at least a portion of the medical instrument shaft.

24. The medical instrument accessory of any one of claims 21 to 23, wherein the proximal end of the body is in fluid communication with a fluid source or a vent.

25. The medical instrument accessory of any one of claims 21 to 24, wherein the at least one structure comprises a plurality of structures.

26. The medical instrument accessory of any one of claims 21 to 25, wherein the at least one structure holds the medical instrument shaft substantially concentrically within the lumen.

27. The medical instrument accessory of any one of claims 21 to 26, wherein the at least one structure includes one or more ribs extending inwardly from the inner wall.

28. 28. The medical instrument accessory of claim 27, wherein the one or more ribs extend substantially the entire length of the interior wall.

29. 29. The medical instrument accessory of claim 27 or 28, wherein the one or more ribs are located around the open distal end.

30. The medical instrument accessory of any one of claims 27 to 29, wherein the one or more ribs are located adjacent the proximal end.

31. The medical instrument accessory of any one of claims 27 to 30, wherein the one or more ribs are located adjacent the proximal and distal open ends.

32. The medical instrument accessory of any one of claims 21 to 31, wherein the at least one structure comprises one or more protrusions extending inwardly from the inner wall of the lumen.

33. 33. The medical instrument accessory of claim 32, wherein the one or more protrusions are located at one or more of the proximal end, distal end, or intermediate along the length of the lumen.

34. 34. The medical instrument accessory of any one of claims 27 to 33, wherein the one or more ribs or one or more protrusions are substantially uniformly spaced around the diameter of the lumen.

35. 34. The medical instrument accessory of any one of claims 27 to 33, wherein the one or more ribs or one or more protrusions are non-uniformly spaced to define fluid flow paths of different sizes.

36. The medical instrument accessory of any one of claims 21 to 35, wherein the at least one structure includes one or more fins extending inwardly from the inner lumen wall.

37. 37. The medical instrument accessory of claim 36, wherein the one or more fins are arranged in a substantially spiral formation.

38. The medical instrument accessory of any one of claims 21 to 37, wherein the at least one structure includes one or more flexible members extending from the open distal end.

39. 39. The medical instrument accessory of any one of claims 21 to 38, wherein the at least one structure includes a movable tip mounted on the distal open end, the movable tip having a flexible portion and a solid edge with one or more protrusions extending radially inward.

40. 40. The medical instrument accessory of claim 39, wherein the solid edge is laterally movable and substantially parallel to the open distal end.

41. 41. The medical instrument accessory of claim 39 or 40, wherein the solid edge is configured to engage an end of the medical instrument.

42. The medical instrument accessory of any one of claims 21 to 41, wherein the lumen has a cross-sectional shape that is different from the shape of the medical instrument shaft.

43. The medical instrument accessory of any one of claims 21 to 42, wherein the cross-sectional shape of the lumen is substantially elliptical.

44. The medical instrument accessory of any one of claims 21 to 43, wherein the at least one structure comprises one or more channels disposed in the inner wall of the lumen.

45. 45. The medical instrument accessory of claim 44, wherein the one or more channels extend substantially the entire length of the lumen.

46. 1. An accessory for a medical instrument for directing fluid flow around and / or across a distal end of the medical instrument, comprising: a body configured to fit over at least a portion of a shaft of the medical instrument, the body comprising: a lumen with an inner wall; proximal end; Open Distal End a body including: a stop portion at or adjacent said open distal end; Including accessories.

47. 47. The medical instrument accessory of claim 46, wherein the stop portion is configured to position the end of the medical instrument shaft a predetermined distance from the open distal end of the body during use.

48. 48. The medical instrument accessory of claim 46 or 47, further comprising one or more protrusions disposed on or adjacent the interior wall of the lumen.

49. 49. The medical instrument accessory of claim 48, comprising a plurality of said protrusions arranged substantially concentrically around said inner wall of said lumen.

50. 50. The medical instrument accessory of any one of claims 46-49, wherein the body defines a longitudinal axis between the ends and further includes a deflection structure extending partially across the open distal end to receive fluid flowing through the lumen and deflect the fluid to flow transverse to the longitudinal axis.

51. 51. The medical instrument accessory of claim 50, wherein the deflection structure extends radially inward from an edge of the open distal end.

52. 52. The medical instrument accessory of claim 50 or 51, wherein the deflection structure includes a plurality of deflection surfaces arranged to direct fluid into a respective plurality of streams transverse to the longitudinal axis.

53. 53. A medical instrument accessory according to any one of claims 50 to 52, wherein the deflection structure is configured as a ledge.

54. 54. The medical instrument accessory of claim 53, wherein the ledge is configured in a ring extending substantially perpendicularly from the edge of the open distal end.

55. 55. A medical instrument accessory according to claim 53 or 54, wherein the ledge comprises a surface area that is a segment of a circle.

56. The medical instrument accessory of any one of claims 46 to 55, wherein the stop portion is disposed within the lumen and axially spaced from the ledge.

57. 57. The medical instrument accessory of any one of claims 46 to 56, further comprising a protruding portion extending longitudinally from the open distal end.

58. 58. The medical instrument accessory of claim 57, wherein the protruding portion extends from an edge of the open distal end to partially surround the opening.

59. 59. An accessory for a medical instrument according to claim 57 or 58, wherein the protruding portion is configured as a flange.

60. 60. The medical instrument accessory of any one of claims 57 to 59, wherein the flange defines a free end, and the ledge extends radially inward from the free end of the flange.

61. 61. The medical instrument accessory of any one of claims 46-60, wherein the body includes a second lumen configured to channel insufflation gases out of the accessory to allow the insufflation gases to be directed into a surgical cavity.

62. 62. The medical instrument accessory of any one of claims 46 to 61, wherein the body includes an evacuation lumen configured to allow fluid to be evacuated from a location adjacent the accessory, thereby enabling fluid to be evacuated from the surgical cavity.

63. 63. The medical instrument accessory of claim 62, wherein the exhaust lumen has an inlet disposed within the body.

64. 64. The medical instrument accessory of any one of claims 46 to 63, wherein the open distal end is angled relative to the longitudinal axis of the body.

65. 1. A medical instrument accessory for heating a medical instrument, comprising: a body configured to fit over at least a portion of the medical instrument, the body including a heating device; Including, The heating device heats the medical instrument directly or indirectly during use.

66. 61. The medical instrument accessory of claim 60, wherein the body defines a lumen with an inner wall, the inner wall configured to contact a surface of the medical instrument.

67. 61. The medical instrument accessory of claim 60, wherein the body defines a lumen with an inner wall, the inner wall configured to be spaced from a surface of the medical instrument during use.

68. 63. A medical instrument accessory according to any one of claims 60 to 62, wherein the length of the body is less than the total length of the shaft of the medical instrument.

69. 64. The medical instrument accessory of any one of claims 60 to 63, wherein the heating device comprises one or more selected from the group consisting of: a heating coil, a resistive material, a flexible PCB, chemical heating, an insulating material, and vaporization.

70. 65. A medical instrument accessory according to any one of claims 60 to 64, wherein the heating device is powered by one or more of an external unit, an associated cannula, a battery, a tubing set, a tubing, and wireless power transmission.

71. 66. A medical instrument accessory according to any one of claims 60 to 65, wherein the heating device provides heating along substantially the entire length of the shaft of the medical instrument.

72. 67. A medical instrument accessory according to any one of claims 60 to 66, wherein the heating device is configured to provide graduated heating along the shaft of the medical instrument.

73. 68. The medical instrument accessory of any one of claims 60 to 67, wherein the heating device is configured to provide heating localized to a portion of the shaft of the medical instrument.

74. 1. An accessory for a medical instrument for confining fluid flow around a distal end of the medical instrument, the accessory comprising: a body configured to fit over at least a portion of the shaft of the medical instrument; The body has at least one structure configured, during use, to position the medical instrument shaft within a cannula lumen to define a fluid flow path between a wall of the cannula lumen and the medical instrument shaft.

75. 70. The medical instrument accessory of claim 69, wherein the fluid flow path directs fluid around or across a distal end of the medical instrument.

76. 71. The medical instrument accessory of claim 69 or 70, wherein the at least one structure comprises a plurality of structures.

77. 72. A medical instrument accessory according to any one of claims 69 to 71, wherein the at least one structure is configured to overlie or reside adjacent to an outer surface of the medical instrument in use.

78. 1. A medical instrument for use in a laparoscopic surgical procedure, comprising: a shaft configured to direct fluid flow over or adjacent to a distal end of the shaft; Including medical equipment.

79. 74. The medical device of claim 73, wherein the shaft has a lumen for directing fluid flow through the shaft and out the distal end of the shaft.

80. 75. The medical device of claim 74, wherein the lumen is concentric with the shaft.

81. 76. The medical instrument of any one of claims 73 to 75, wherein the medical instrument includes a ledge extending inward from the end of the shaft and a flange that directs fluid flow from the concentric lumen across the distal end of the shaft.

82. 77. The medical instrument of claim 76, wherein the ledge is ring-shaped.

83. The medical device of any one of claims 74 to 77, wherein the lumen is offset from the center of the shaft.

84. 77. The medical instrument of claim 76, wherein the ledge extends inwardly from the edge of the distal end of the shaft and the flange is located adjacent a lumen opening.

85. 80. The medical device of any one of claims 73 to 79, wherein the surface of the shaft has one or more protrusions extending radially outward, the one or more protrusions configured to contact an inner wall of a cannula in use.

86. 81. The medical device of claim 80, wherein the cannula inner wall and the one or more protrusions define a fluid flow path.

87. 82. The medical device of claim 80 or 81, wherein the one or more protrusions are ribs that extend at least partially along the length of the shaft.

88. 83. The medical instrument of claim 82, wherein the ribs extend substantially the entire length of the shaft.

89. The medical device of any one of claims 80 to 83, wherein the one or more protrusions are substantially uniformly distributed around the circumference of the shaft.

90. The medical device of any one of claims 80 to 83, wherein the one or more protrusions are non-uniformly distributed around the circumference of the shaft.

91. 84. The medical device of any one of claims 80 to 83, wherein the one or more protrusions are of different sizes and are circumferentially disposed around the shaft, the one or more protrusions of different sizes being configured to create various gas path sizes.

92. The medical device of any one of claims 80 to 86, wherein the one or more protrusions include spiral fins.

93. The medical device of any one of claims 73 to 87, wherein the cross-sectional shape of the shaft is different from the cross-sectional shape of the cannula.

94. The medical instrument of any one of claims 73 to 88, wherein the shaft of the medical instrument includes a heating device.

95. 1. A medical instrument accessory for localizing the injection or evacuation of a fluid from a distal end of a medical instrument having a shaft, said medical instrument accessory comprising: a body configured to be attached to the medical instrument, the body defining an inner lumen dimensioned to receive at least a portion of the shaft, a proximal end, a distal end defining an opening, and a longitudinal axis between the ends; Including, the distal end is configured to be disposed at or adjacent the distal end of the medical instrument during use; and The medical instrument accessory, wherein the inner lumen is shaped to define a fluid flow path, and wherein, in use, fluid flows into and / or out of the fluid flow path through the opening.

96. 96. The medical instrument accessory of claim 95, comprising at least one deflection structure positioned to receive fluid flowing through the inner lumen and direct the received fluid to flow transversely to the longitudinal axis.

97. 97. The medical instrument accessory of claim 96, wherein the at least one deflection structure is configured such that, in use, the or each deflection structure directs the received fluid to flow substantially across the distal end of the medical instrument.

98. 98. The medical instrument accessory of claim 97, wherein the at least one deflection structure is configured to direct the received fluid to flow substantially parallel to the distal end of the medical instrument during use.

99. 99. A medical instrument accessory according to any one of claims 96 to 98, wherein the at least one deflection structure is arranged to direct the received fluid to flow substantially perpendicular to the longitudinal axis.

100. 100. A medical instrument accessory according to any one of claims 96 to 99, wherein the at least one deflecting structure is arranged to direct the received fluid into a plurality of separate streams.

101. 101. The medical instrument accessory of claim 100, wherein the at least one deflecting structure is positioned to direct at least two of the streams to intersect with one another.

102. 102. The medical instrument accessory of claim 101, wherein the at least one deflection structure is positioned such that the at least two of the streams are each directed radially toward the longitudinal axis.

103. 101. The medical instrument accessory of claim 100, wherein the at least one deflecting structure is positioned to orient at least two of the streams parallel to one another.

104. 101. The medical instrument accessory of claim 100, wherein the at least one deflecting structure is positioned to direct at least two of the streams to diverge away from each other.

105. 105. The medical instrument accessory of any one of claims 100 to 104, wherein the at least one deflection structure is arranged to direct the plurality of streams across two or more planes axially spaced from one another.

106. A medical instrument accessory according to any one of claims 96 to 105, wherein the or each deflection structure is arranged to extend from half of the inner lumen.

107. A medical instrument accessory according to any one of claims 96 to 105, wherein the or each deflection structure is arranged to cover equal to or less than half of the opening defined by the distal end.

108. 108. The medical instrument accessory of any one of claims 96 to 107, wherein the inner lumen defines two portions, a first portion defining a first diameter and a second portion defining a second diameter greater than the first diameter, and the or each deflecting structure extending partially across the opening from the second portion.

109. 109. The medical instrument accessory of claim 108, wherein the first diameter is substantially equal to an outer diameter of the medical instrument and is dimensioned such that the first portion fits snugly with the medical instrument during use.

110. 110. The medical instrument accessory of any one of claims 96 to 109, wherein the body includes a shaft and an end cap removably securable to the shaft, and the at least one deflection structure is defined by the end cap.

111. 111. A medical instrument accessory according to any one of claims 95 to 110, including alignment features defining a recess shaped to at least partially receive a portion of the medical instrument, the recess positioned to prevent relative rotation between the medical instrument and the accessory.

112. 112. The medical instrument accessory of claim 111, wherein the alignment feature is located at or adjacent the proximal end of the body.

113. 113. The medical instrument accessory of claim 111 or 112, wherein the recess is configured to be an open slot configured to extend along the longitudinal axis.

114. 114. The medical instrument accessory of claim 113, wherein the recess is defined by a pair of spaced apart elongated members.

115. 113. A medical instrument accessory according to claim 111 or 112, wherein the recess is defined by a shroud shaped to complement and at least partially surround a portion of the medical instrument.

116. 116. A medical instrument accessory according to any one of claims 111 to 115, wherein the body includes a shaft and an end cap removably securable to the shaft, and the alignment feature extends from the end cap.

117. 117. The medical instrument accessory of claim 116, wherein the alignment feature is removably securable to the end cap.

118. A medical instrument accessory according to any one of claims 95 to 117, including a locking mechanism operable to retain the medical instrument within the accessory.

119. 119. The medical instrument accessory of claim 118, wherein the locking mechanism includes a cam rotatable about an axis between an open position and a locked position, wherein in the locked position the cam is positioned to interfere with the medical instrument during use.

120. 120. The medical instrument accessory of claim 118 or 119, wherein the locking mechanism is located at or adjacent the proximal end of the body.

121. 121. A medical instrument accessory according to any one of claims 118 to 120, wherein the body defines a first slot and a second slot extending perpendicular to and intersecting the first slot, and the cam includes a shaft, and each slot is dimensioned to receive the shaft.

122. 122. The medical instrument accessory of claim 121, wherein the cam includes a protrusion on each end of the shaft, and the first slot is dimensioned to receive the shaft and the protrusion, and the second slot is dimensioned to receive only the shaft, with the protrusion positioned outside the second slot to engage the cam with the body.

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