Detachable, length-adjustable snap-in portal saver separate from dermal fixation

Abstract

To provide a portal saver assembly with a dermal fixation device that is removably attached to a length-adjustable portal saver.SOLUTION: A portal saver assembly includes a tubular body having a rigid proximal end with threads and a proximal adjustment body having an outer ridge and an inner bore with threads. The threads on the rigid proximal end of the tubular body are configured to mate with the threads on the inner bore of the proximal adjustment body. The portal saver assembly also includes a dermal fixation device with a central bore and a locking mechanism around the central bore. The outer ridge of the proximal adjustment body is removably attached to within the central bore by the locking mechanism.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This specification is related to the "Revable, Adjustable-Length, Snap-in Portal Saver, Decupled" patent application filed on October 4, 2018. This application claims priority to U.S. Provisional Patent Application No. 62 / 740,992, entitled "Removable, Adjustable-Length Snap-in Portal Saver, Decoupled From Dermal Fixation," and to U.S. Provisional Patent Application No. 62 / 741,806, filed October 5, 2018, entitled "Removable, Adjustable-Length Snap-in Portal Saver, Decoupled From Dermal Fixation."

[0002] FIELD OF THE INVENTION The present invention is directed generally to portal saver devices, and more particularly to a portal saver assembly having a dermal fixation device removably attached to an adjustable length portal saver. [Background technology]

[0003] 2. Description of Related Art To maintain arthroscopic intra-articular hip joint access, traditionally, a series of access tools (e.g., switch sticks, slotted cannulas, disposable cannulas, etc.) are frequently used to insert and remove instruments from the patient. The time the surgeon spends using the access tools accounts for a significant portion of the procedure time; during this time, the surgeon is not performing any actual work related to the patient's pathology.

[0004] A common access tool in the arthroscopic surgical field is the "cannula." A cannula is used to maintain an open portal from outside the patient's body to the inside of the body, where the arthroscopic procedure will be performed. It is important that this cannula remain inside the body, maintain this pathway, and not become dislodged, dislodge laterally, or dislodge further inward. This is accomplished in many ways today, most often by placing aggressive threads on the exterior of the cannula to perforate (or drill) the dermis layer and underlying tissue. This requires a large incision to accommodate these threads, resulting in a correspondingly large scar.

[0005] Most current cannulas use mechanical threads that are external to the tubular body of the cannula itself. Some of these cannulas have a rigid tubular body or a rigid body with substantially no radial movement. While some current cannulas are more flexible, they still lack flexibility to accommodate a wide range of instruments. Traditional cannulas also have a fluid seal at the proximal end to prevent fluid leakage from the surgical site. Some cannulas have indicators along the tubular body to customize the size of the tubular body. These cannulas are often threaded with an obturator.

[0006] Alternatively, or in addition, some cannulas have barbs, which allow for straight insertion into the surgical site while benefiting from a slight oscillatory rotation during advancement into the body. Furthermore, cannulas use a folded, accordion-like member that can be stretched to reduce its diameter and compressed to increase its diameter. However, none of these conventional cannulas allow for insertion through a small incision and subsequent removal, as their rigid bodies cannot move significantly under the skin. Furthermore, the rigid bodies of these conventional cannulas are difficult to insert through a small incision and subsequently removed. None of them provide a small incision size or minimize trauma to the area surrounding the incision site. Additionally, none of the conventional cannulas provide a wide range of motion or freedom of movement.

[0007] Achieving dermal fixation and inserting a dermal fixation device during traditional cannulation can often involve large, forceful and twisting movements while attempting to navigate the dermal fixation structure into the patient. If a portal saver is attached to the dermal fixation while this is occurring, the distal end of the portal saver itself may move around in a way that poses a risk to structures deeper within the patient. Also, during surgery, it may be necessary to remove the portal saver, such as by trimming it to a shorter working length, or to replace it with a longer portal saver.

[0008] Therefore, a need exists for a portal saver assembly that includes a dermal fixation device that is removably attached to an adjustable length portal saver.

[0009] Description of Related Art Section Disclaimer: To the extent that specific patents / publications / products are discussed in this Description of Related Art section or elsewhere in this disclosure, these discussions should not be construed as an admission that the discussed patents / publications / products are prior art for purposes of patent law. For example, some or all of the discussed patents / publications / products may not be sufficiently early, may not reflect subject matter developed early enough, and / or may not be sufficiently authoritative to amount to prior art for purposes of patent law. To the extent that specific patents / publications / products are discussed above in this Description of Related Art section and / or throughout the application, the descriptions / disclosures thereof are incorporated herein by reference in their respective entireties. Summary of the Invention

[0010] Embodiments of the present invention are directed to a portal saver assembly including a dermal fixation device removably attached to a length-adjustable portal saver. According to one aspect, the invention is a portal saver device. The portal saver device includes a tubular body having a flat section between two rounded sections and a rigid, threaded proximal end. The device also includes a proximal adjustment body having a threaded internal bore. The threads on the rigid, proximal end of the tubular body are configured to mate with the threads on the proximal adjustment body internal bore. In a first configuration, the flat section is a first distance from the proximal adjustment body. In a second configuration, the flat section is a second distance from the proximal adjustment body, the second distance being less than the first distance.

[0011] According to another aspect, the present invention is a portal saver assembly. The portal saver assembly includes a tubular body having a rigid proximal end with threads and a proximal adjustment body having an outer ridge and an internal threaded bore. The threads on the rigid proximal end of the tubular body are configured to mate with the threads on the internal bore of the proximal adjustment body. The portal saver assembly also includes a dermal fixation device with a central bore and a locking mechanism around the central bore. The outer ridge of the proximal adjustment body is removably attached within the central bore by the locking mechanism.

[0012] These and other aspects of the invention will be apparent from and elucidated with reference to the embodiment(s) described hereinafter. [Brief explanation of the drawings]

[0013] One or more aspects of the present invention are particularly pointed out and distinctly claimed as examples of the claims at the end of this specification. The foregoing and other objects, features, and advantages of the present invention will become apparent from the following description taken in conjunction with the accompanying drawings.

[0014] [Figure 1] FIG. 1 is a perspective view of an exemplary portal saver assembly, according to one embodiment. [Figure 2]FIG. 2 is an exploded perspective schematic view of a portal saver assembly, according to one embodiment. [Figure 3] FIG. 3 is a schematic, partially exploded perspective view of a portal saver assembly, according to one embodiment. [Figure 4] FIG. 4 is a detailed side cross-sectional schematic view of a proximal dermal fixation device of a portal saver assembly, according to one embodiment. [Figure 5] FIG. 5 is a top perspective schematic view of a portal saver assembly in a first configuration, according to one embodiment. [Figure 6] FIG. 6 is a top perspective schematic view of a portal saver assembly in a second configuration, according to one embodiment. [Figure 7] FIG. 7 is a perspective schematic view of a portal saver assembly in a second configuration, according to one embodiment. [Figure 8] FIG. 8 is another perspective schematic view of the portal saver assembly in a second configuration, according to one embodiment. [Figure 9] FIG. 9 is a detailed top perspective schematic view of a proximal dermal fixation device of the portal saver assembly, according to one embodiment. [Figure 10] FIG. 10 is a side schematic view of a portal saver assembly in an extended position, according to one embodiment. [Figure 11] FIG. 11 is a side schematic view of a portal saver assembly in a retracted position, according to one embodiment. DETAILED DESCRIPTION OF THE INVENTION

[0015] Aspects of the present invention and its specific features, advantages, and details are more fully described below with reference to non-limiting examples illustrated in the accompanying drawings. Descriptions of well-known structures are omitted so as not to unnecessarily obscure the details of the invention. It should be understood, however, that the detailed description and specific non-limiting examples, while indicating aspects of the invention, are given by way of illustration only, and not by way of limitation. Various substitutions, modifications, additions, and / or arrangements within the spirit and / or scope of the underlying inventive concept will be apparent to those skilled in the art from this disclosure.

[0016] Referring now to the drawings, wherein like reference numerals refer to like parts throughout, FIG. 1 illustrates a perspective view of an exemplary portal saver assembly 200. Generally, the portal saver and obturator assembly 200 maintains a pathway from outside the body (e.g., the skin) to the surgical site (e.g., a joint), allowing the surgeon to move instruments from one portal to another in two steps or actions (versus nine steps or actions with conventional devices). The portal saver and obturator assembly 200 typically includes a proximal handpiece 202 configured to be removably attached to a portal saver assembly 204. The portal saver assembly 204 includes a distal tubular (or cannulated) body 206 extending from a proximal dermal fixation device 208. It is an object of an embodiment of the present invention to provide a mechanism for adjusting the length of the tubular body 206 while allowing the proximal dermal fixation device 208 shown in FIG. 1 to be separated from the tubular body 206.

[0017] The tubular body 206 is preferably flexible and may be constructed from thermoplastic urethane (hereinafter "TPU"). TPU is a thermoplastic elastomer that includes a block copolymer. Specifically, TPU comprises linear alternating hard and soft segments, as will be understood by those skilled in the art. The hard segments are constructed from diisocyanates with short-chain diols (i.e., "chain extenders"), making them short, highly polar segments. The soft segments are constructed from diisocyanates with long-chain diols, making them short, highly polar segments. These are then split into long, low polarity segments.

[0018] The stiffness of TPU can be fine-tuned by increasing or decreasing the ratio of hard segments to soft segments. TPU has high mechanical properties, high heat resistance, high mineral oil resistance, high hydrolysis resistance, temperature flexibility, high resistance to microbial degradation, and high elasticity across the hardness range. Under standard atmospheric conditions, TPU has a hardness of 30 Shore A to 60 Shore D, as would be understood by those skilled in the art in conjunction with a review of this disclosure. An example of a TPU is Elastomaran®. Another example of a TPU is Greco's Isotane grade 5090A.

[0019] TPU offers many advantages for use as the composition for the tubular body 206. In one embodiment, the tubular body 206 is an extruded TPU composition that can be formed via extrusion and retain its shape after being manipulated. It is more flexible and thinner than conventional cannulas, allowing it to be moved into various twisted and tangled configurations. The flexibility and resilience of the tubular body 206 provide the surgeon with a better range of motion, as if it were operating percutaneously. The tubular body 206 is free to move anywhere, limited only in use by the proximal dermal anchoring device 208, which is anchored to the dermis. TPU is also resistant to cuts and other damage from sharp instruments, such as shaver blades and burrs. Furthermore, the heat-resistant, high-quality TPU, briefly described above, allows cutting instruments to be passed through the tubular body 206 without deformation or other damage.

[0020] In alternative embodiments, there are one or more seals along the length of the tubular body 206. The seals can be angled or perpendicular (i.e., approximately parallel to the length of the tubular body 206) to one another along the longitudinal axis of the tubular body 206. In other embodiments, the tubular body 206 includes indicators along its length for customizing the size of the obturator 204.

[0021] Referring now to FIG. 2 , an exploded perspective schematic view of the obturator 204 of the portal saver assembly 200 is shown, according to one embodiment. As shown, the tubular body 206 of the portal saver assembly 204 has two rounded sections 211 with a flat section 210 between them. The flat (or narrow) section 210 acts as a seal and may be constructed through a thermoforming process. The flat section 210 is heat-sealed to flatten the tubular body 206. The flat section 210 may be used as an alternative to a welded flat sheet of material with a seam. In some situations, a welded seam is preferred for the flat section 210 of the tubular body 206 because the compressive forces on the tubular body 206 with a welded seam tend to create high friction and trap instruments within the tubular body 206. This can lead to accidental withdrawal of instruments from the portal and can add a distinctive feature (i.e., sound) to the surgeon's sensory experience. The flat section 210 forms a seal between itself and an instrument passing through the tubular body 206. Thus, the tubular body 206 is tightly wrapped around the instrument. After the instrument is removed, the flat section 210 (i.e., the heat-pressed or sealed portion) returns to its flat shape. The flat section 210 also prevents fluids from the incision site from leaking out of the tubular body 206. The flat region 210 can be located anywhere along the tubular body 206. The flat region 210 can be located between the proximal and distal ends of the tubular body 206, near the proximal end of the tubular body 206, or directly near the distal end of the tubular body 206. For example, in situations where the flat region 210 is located near the proximal end of the tubular body 206, there can be an additional tubular body 206 located distal to the flat region 210 to increase the range of sizes the surgeon can trim for maximum length adjustability.

[0022] 2 , tubular body 206 extends distally from adjustment body 234, which is configured to removably connect to proximal dermal anchoring device 208. Tubular body 206 includes a rigid proximal end 236. Rigid proximal end 236 is a non-flexible lead-in portion of tubular body 206. Rigid proximal end 236 functions to provide a secure and stable connection between tubular body 206 and adjustment body 234. Rigid proximal end 236 includes threads 238 for attachment to adjustment body 234. Threaded, rigid distal end 236 also serves as a length adjustment mechanism for extending or retracting tubular body 206, as described in detail below.

[0023] As shown in FIG. 2 , the adjustment body 234 includes a threaded internal bore 240. The threaded internal bore 240 extends entirely through the adjustment body 234 from its proximal end 242 to its distal end 244. The adjustment body 234 also includes an outer surface 246 having an adjustment wheel 248 extending radially therefrom. The adjustment wheel 248 extends entirely around the circumference of the adjustment body 234. The adjustment wheel 248 may have a protrusion 250 (or similar protrusion / ridge) extending radially therefrom to improve the user's grip and can be used during the length adjustment procedure. The adjustment body 234 further includes a ridge 252 extending around its entire circumference, as shown in FIG. 2 . The ridge 252 extends radially from the adjustment body 234. In the illustrated embodiment, the ridge 252 is distal to the adjustment wheel 248.

[0024] 3, a partially exploded perspective schematic view of the portal saver assembly 204 and obturator assembly 200 of the portal saver is shown, according to one embodiment. As shown in FIG. 3, an adjustment body 234 is connected to a tubular body 206. The rigid proximal end 236 and threads 238 (FIG. 2) of the tubular body 206 are threaded into an internal bore 240 threaded from the distal end 244 of the adjustment body 234 to form an adjustable-length portal saver device 254. As described above, the portal saver device 254 may be removably connected to the dermal fixation device 208.

[0025] Referring briefly to FIG. 2 , the proximal end 242 of the adjustment body 234 may be removably attached to the dermal fixation device 208. The dermal fixation device 208 includes a body 212 (e.g., a rectangular body) having a central bore 214 therethrough. As shown in the exemplary embodiment of FIG. 4 , the central bore 214 extends through a rotating portion 216 and a non-rotating portion 218. The rotating portion 216 and the non-rotating portion 218 are configured to function in conjunction to fine-tune the attachment of the dermal fixation device 208 to the tubular (or cannulated) rod 220 of the hand piece 202, as shown in FIG. 1 . To insert and position the dermal fixation device 208 (separate from the portal saver device 254), the hand piece 202 may be temporarily connected to the dermal fixation device 208.

[0026] Rotating portion 216 is a movable female connector, such as a threaded channel 222, extending from central opening 214. Non-rotating portion 218 is an unthreaded (or relatively smooth) channel 224 connected within threaded channel 222. Unthreaded channel 222 is also connected to tubular body 206 near flat section 210, as shown. When dermal fixation device 208 is attached to handpiece 202, rotating portion 216 and non-rotating portion 218 receive tubular rod 220, and rotating portion 216 rotates such that threaded channel 222 tightens around tubular body 220. In use, an instrument may be inserted proximally within tubular rod 220 and passed through tubular body 206.

[0027] 5, a top perspective view of the obturator 204 in a first configuration is shown, according to one embodiment. The dermal anchoring device 208 includes one or more petals 228 extending distally from within the body 212 of the dermal anchoring device 208 (also shown in FIG. 4). The petals 228 are movable from the first configuration to the second configuration using an actuator 230 on the body 212. As shown in FIGS. 4 and 5, the petals 228 are attached to the tubular body 206. In the illustrated embodiment, the petals 228 extend in a direction parallel to the length of the tubular body 206 in the first configuration. When the petals 228 are in the first configuration, the actuator 230 is in a first position, as shown. In one embodiment, the first position is an unlocked position, in which the petals 228 are substantially flush with the tubular body 206 for insertion into the patient.

[0028] 6-8, petals 228 are in a second configuration. To move petals 228 to the second configuration, actuator 230 is activated. In the illustrated embodiment, actuator 230 is rotated or otherwise moved to the second position. (The first and second positions of actuator 230 may be indicated by indicator 232 of 212, as shown in FIG. 6.) When petals 228 are in the second configuration, they are expanded and extend at an angle relative to tubular body 206, as shown. In the second configuration, petals 228 function to retain portal saver assembly 204 within the patient.

[0029] 9 is a top perspective schematic view of a proximal dermal anchor 208 of a portal saver assembly 204, according to one embodiment. The proximal dermal anchor 208 of FIGS. 2 and 11 includes a central bore 214 therethrough. The central bore 214 is configured to receive a ridge 252 of the adjustment body 234 (FIG. 2). In one embodiment, the ridge 252 of the adjustment body 234 is configured to snap-fit ​​within the central bore 214.

[0030] The dermal fixation device 208 of Figures 2 and 11 also includes a locking mechanism 256. In the illustrated embodiment, the locking mechanism 256 is a spring clip. In the illustrated embodiment, the spring clip 256 is a double-wishbone-shaped retaining spring clip. In other words, it includes an arcuate first arm 258 having three connected, substantially straight segments 260 and an arcuate second arm 262 having three connected, substantially straight segments 260. The first arm 258 and the second arm 262 are oriented or otherwise positioned within the body 212 of the dermal fixation device 208 such that they join or intersect, forming a substantially hexagonal shape. The spring clip 256 is configured to snap onto the ridges 252 of the adjustment body 234.

[0031] The spring clip 256 includes an exposed portion 264 and an unexposed portion 266. As shown in FIG. 11 , the unexposed portion 266 is within the body 212 of the dermal fixation device 208. The unexposed portion 266 includes the first arm 258 and the second arm 262 of the spring clip 256. The exposed portion 264 is a tab 268 attached to both the first arm 258 and the second arm 262. The tab 268 extends from the body 212 of the dermal fixation device 208, as shown in FIGS. 2 and 11 . Pressing the tab 268 toward the body 212 of the dermal fixation device 208 opens the spring clip 256. In other words, by pressing the tab 268 inward, the first arm 258 and the second arm 262 move away from each other in opposite directions, opening the spring clip 256.

[0032] When the spring clip 256 is opened (by pressing the tab 268), the ridges 252 of the adjustment body 234 can be inserted therein. The tab 268 is then released, gripping or otherwise snapping onto the ridges 252 of the adjustment body 234, locking the tubular body 206 within the dermal fixation device 208, as shown in FIG. 7 . To release the ridges 252 of the adjustment body 212, the tab 268 is pressed again, thereby opening the spring clip 256 and releasing the adjustment body 234 (with the attached tubular body 206), as shown in FIG. 3 . In this manner, the adjustment body 234 can be coupled to and separated from the dermal fixation device 208, which allows removal of the portal saver device 254, as shown in FIG. 3 . In other words, the dermal fixation device 208 can be attached to the portal saver device 254 (its The dermal fixation device 208 and the portal saver device 254 can be inserted and positioned before the dermal fixation device 208 and the portal saver device 254 are added.

[0033] 10 , a schematic side view of the obturator 204 in the extended position is shown, according to one embodiment. In the extended position, the flattened section 210 of the tubular body 206 is a first distance from the dermal fixation device 208. To achieve the extended position, the adjustment wheel 248 rotates in a first direction, exposing the stiff proximal end 236 and thereby retracting the tubular body 206 distally. This increases the working length of the overall portal saver assembly 200. The adjustment wheel 248 can be rotated at any time during the procedure to lengthen the portal saver assembly 200.

[0034] 11 , a side schematic view of the portal saver assembly 204 in a retracted position is shown, according to one embodiment. In the retracted position, the flattened section of the tubular body 206 is a second distance from the dermal fixation device 208. In one embodiment, the second distance is shorter or less than the first distance. To achieve the retracted position, the adjustment wheel 248 is rotated in a second direction opposite the first direction, thereby directing the stiff proximal end 236 into the dermal fixation device 208. Rotating the adjustment wheel 248 in the second direction extends or retracts the tubular body 206 proximally, thereby reducing the overall working length of the portal saver assembly 204. The adjustment wheel 248 can be rotated at any time during the procedure to shorten the portal saver assembly 204.

[0035] In use, the dermal fixation device 208 is advanced (e.g., via the handpiece 202 of FIG. 1 ) into the incision site without risking surrounding structures (e.g., the femoral head) due to its small diameter. (The dermal fixation device 208 can be configured for dermal openings used in most procedures, including dermal opening diameters of 12 mm, smaller than those used with most cannulas.) The dermal fixation device 208 is further advanced until the petals 228 enter the dermal layer. The actuator 230 further moves from the first position to the second position, deploys the petals 228, and moves them from the first configuration to the second configuration.

[0036] With the dermal fixation device 208 in place and secured to the dermal layer, the portal saver device 254 can be coupled to the dermal fixation device 208. The user presses the tab 268 inward, moving the first arm 258 and the second arm 262 away from each other in opposite directions and opening the spring clip 256. While pressing the tab 268 toward the body 212 of the dermal fixation device 208, the user inserts the ridge 252 of the adjustment body 234, which is configured to snap into the central hole 214. The tab 268 is then released, and the spring clip 256 locks (at the ridge 252) around and onto the adjustment body 234, coupling the portal saver device 254 and the dermal fixation device 208. As described above, with the portal saver device 254 coupled to the dermal fixation device 208, the length of the portal saver device 254 can be adjusted using the adjustment body 234 during the procedure. Upon completion of use of the portal saver device 254, the user may press the tabs 268 inward toward the body 212 of the dermal fixation device 208 to release the ridges 252 from the spring clips 256. With the ridges 252 released, the user may remove the portal saver device 254 from the dermal fixation device 208 and from the original incision for easy removal without causing further trauma or scarring to the patient's skin or dermis.

[0037] All definitions defined and used herein should be understood to control for dictionary definitions, definitions in documents incorporated by reference, and / or ordinary meanings of the defined terms.

[0038] While various embodiments have been described and illustrated herein, those skilled in the art will readily envision various other means and / or structures for performing the functions and / or obtaining the results and / or one or more advantages described herein, and each of such variations and / or modifications is deemed to be within the scope of the embodiments described herein. More generally, those skilled in the art will readily appreciate that all parameters, dimensions, materials, and configurations described herein are exemplary, and that the actual parameters, dimensions, materials, and / or configurations will depend on the specific application or applications for which the teachings are used. Those skilled in the art will recognize, or be able to ascertain using no more than routine experimentation, many equivalents to the specific embodiments described herein. Accordingly, the foregoing embodiments are presented by way of example only, and it will be understood that, within the scope of the appended claims and their equivalents, the embodiments may be practiced otherwise than as specifically described and claimed. Embodiments of the present disclosure are directed to each individual feature, system, article, material, kit, and / or method described herein. Furthermore, any combination of two or more such features, systems, articles, materials, kits, and / or methods is within the scope of the present disclosure, provided that such features, systems, articles, materials, kits, and / or methods are not mutually inconsistent.

[0039] The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. As used herein, the singular forms "a," "an," and "the" are intended to include the plural forms as well, unless the context clearly dictates otherwise. It will be further understood that the terms "comprise" (and any form of comprise such as "comprises" and "comprising"), "have" (and any form of have such as "has" and "having"), "include" (and any form of include such as "includes" and "including"), and "contain" (and any form of contain such as "contains" and "containing") are open-ended linking verbs. Consequently, a method or device "comprises," "has," "includes," or "contains" one or more steps or elements. Similarly, a method step or device element that "comprises," "has," "includes," or "contains" one or more features possesses those one or more features, but is not limited to possessing only those features or features. Furthermore, a device or structure that is configured in a particular way is configured in at least that way, but may also be configured in ways not listed.

[0040] The corresponding structure, material, acts, and equivalents of all means or steps plus functional elements in the following claims are intended to include any structure, material, or acts for performing a function, if any, in combination with elements of other claims that are specifically claimed. The description of the present invention has been presented for purposes of illustration and description, but is not intended to be exhaustive or to be limited to the invention in the form disclosed. Many modifications and variations will be apparent to those skilled in the art without departing from the scope and spirit of the invention. The embodiments were chosen and described to best explain the principles and practical application of one or more aspects of the invention and to enable others skilled in the art to understand one or more aspects of the invention in various embodiments with various modifications suitable for the particular uses contemplated.

Claims

1. 1. A portal saver device, comprising: a tubular body having along a longitudinal axis two round tubular sections, a flat section between the two round tubular sections, and a non-flexible, rigid proximal end having a thread; a proximal adjustment body for adjusting the length of the portal saver device, the proximal adjustment body having an internal bore with a screw thread; the flat section of the tubular body is narrower than the round tubular section and forms a seal with an instrument passing through the tubular body; the threads on the rigid proximal end of the tubular body are configured to mate with the threads on the internal bore of the proximal adjustment body; In a first configuration, the tubular body is positioned relative to the proximal adjustment body such that the flattened section is a first distance in the longitudinal direction from the proximal adjustment body; In a second configuration, the tubular body is positioned relative to the proximal adjustment body such that the flattened section is a second longitudinal distance from the proximal adjustment body that is different from the first distance; the proximal adjustment body has an outer ridge; The portal saver device, wherein the outer ridge of the proximal adjustment body is removably attached within the central bore of the dermal fixation device by a locking mechanism disposed about the central bore of the dermal fixation device.

2. The portal saver device of claim 1 , further comprising an adjustment wheel extending radially from the proximal adjustment body to achieve the first and second configurations.

3. The portal saver device of claim 2 , wherein the adjustment wheel is rotatable in a first direction and an opposite second direction.

4. The portal saver device of claim 3 , wherein rotating the adjustment wheel in the first direction moves the flat section away from the proximal adjustment body.

5. The portal saver device of claim 3 , wherein rotating the adjustment wheel in the second direction moves the flat section toward the proximal adjustment body.

6. The portal saver device of claim 1 , wherein the second distance is less than the first distance.

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