Cannulas for large diameter medical instruments, and related assemblies, systems, and methods

Abstract

An assembly for insertion of a medical instrument to a remote worksite includes a cannula tube comprising a cannula tube proximal end opening, a cannula tube distal end opening, and a cannula tube passage connecting the cannula tube proximal end opening and the cannula tube distal end opening. The cannula tube passage defines a first longitudinal axis. The assembly also includes a bushing removably engageable with the cannula tube and configured, in an engaged state with the cannula tube, to be held in a fixed position within a portion of the cannula tube passage. The bushing comprises a bushing proximal end opening, a bushing distal end opening, and a bushing passage connecting the bushing proximal end opening and the bushing distal end opening. The bushing passage defines a second longitudinal axis and is configured to receive a shaft of a medical instrument inserted through the cannula tube.

Description

PCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 CANNULAS FOR LARGE DIAMETER MEDICAL INSTRUMENTS, AND RELATED ASSEMBLIES, SYSTEMS, AND METHODSCROSS-REFERENCE TO RELATED APPLICATION

[0001] This application claims the benefit of U.S. Provisional Application 63 / 739,340, filed December 27, 2024, the entirety of which is incorporated by reference herein.TECHNICAL FIELD

[0002] Aspects of the present disclosure relate to cannulas for tools, such as medical instruments. In particular, aspects of the present disclosure relate to cannulas with configurations that can accommodate medical instruments having end effectors with relatively large lateral dimensions (e.g., diameters), such as circular staplers.INTRODUCTION

[0003] Cannulas may be used to guide, position, and / or support an instrument, such as a medical instrument, during a medical procedure, such as a minimally invasive medical procedure, including a surgical operation, diagnostic, and / or therapeutic procedure. For example, during some medical procedures, a cannula is inserted in a body wall, and a tool such as a medical instrument is inserted through the cannula to access a remote worksite at which the medical procedure is to be performed.

[0004] Medical systems that operate at least in part with computer-assisted control (sometimes referred to as “telesurgical systems” or “robotic surgical systems”), such as those employed for minimally invasive medical procedures, can include large and relatively complex equipment to precisely control medical instruments that are inserted into the body to access a remote worksite. The da Vinci® Surgical Systems commercialized by Intuitive Surgical, Inc. are examples of such telesurgical systemsPCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304

[0005] Circular stapler anastomosis is a medical procedure that can be carried out in a minimally invasive manner using a circular stapler. Some circular staplers, for example, have design features intended to support a surgeon in minimizing the risk of anastomotic leak, including minimizing tension, preserving blood supply, and apposing tissue accurately.

[0006] Such circular staplers are used for anastomosis of the colon to rectum, using an EEA (end-to-end anastomosis) stapler technique. In such procedures, since a relatively large diameter, circular stapler is inserted trans-anally instead of trans-abdom inally, thereby raising various design constraints, there are currently no established devices or procedures for carrying out such EEA stapler techniques (i.e. , using circular staplers) during minimally invasive medical procedures carried out using telesurgical systems.

[0007] There exists a need for cannulas, cannula assemblies, systems, and methods that facilitate insertion of relatively large diameter medical instruments, such as circular staplers, to remote worksites. A need also exists for cannulas, cannula assemblies, systems, and methods that enable use of such medical instruments with relatively large end effector lateral dimensions (e.g., diameters), such as circular staplers, which can be used with telesurgical systems.SUMMARY

[0008] Embodiments of the present disclosure may solve one or more of the above-mentioned problems and / or may demonstrate one or more of the above-mentioned desirable features. Other features and / or advantages may become apparent from the description that follows.PCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304

[0009] In accordance with at least one exemplary embodiment, an assembly for insertion of a medical instrument to a remote worksite comprises a cannula tube comprising a cannula tube proximal end opening, a cannula tube distal end opening, and a cannula tube passage connecting the cannula tube proximal end opening and the cannula tube distal end opening. The cannula tube passage defines a first longitudinal axis. The assembly also comprises a bushing removably engageable with the cannula tube and configured, in an engaged state with the cannula tube, to be held in a fixed position within a portion of the cannula tube passage. The bushing comprises a bushing proximal end opening, a bushing distal end opening, and a bushing passage connecting the bushing proximal end opening and the bushing distal end opening. The bushing passage defines a second longitudinal axis and is configured to receive a shaft of a medical instrument inserted through the cannula tube.

[0010] In accordance with at least another exemplary embodiment, a method for inserting a medical instrument to a remote worksite comprises positioning a cannula tube through an opening in a body wall. The cannula tube comprises a proximal end opening, a distal end opening, and a passage extending between the proximal end opening and the distal end opening. The method also comprises inserting the medical instrument into the passage through the proximal end opening; and sliding a bushing over a shaft of the medical instrument and at least partially through the proximal end opening of the cannula tube to position the bushing in engagement with an internal surface of the passage of the cannula tube.

[0011] In accordance with at least another exemplary embodiment, a method of supporting a medical instrument during a medical procedure comprises positioning thePCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 medical instrument through a passage of a cannula tube. The medical instrument has a working end having a first diameter and a shaft having a second diameter. The first diameter is larger than the second diameter. The method also comprises supporting the medical instrument in the passage of the cannula tube via a bushing engaged with an external surface of the shaft of the medical instrument and an internal surface of a portion of the passage of the cannula tube.

[0012] In accordance with at least another exemplary embodiment, a system for inserting a medical instrument through an orifice of a body of a patient comprises an obturator and a cannula tube defining a passage configured to receive the obturator. The cannula tube comprises a radially protruding flange configured to abut the body of the patient in an inserted position of the cannula tube through the orifice. The system also comprises a bushing removably engageable with the cannula tube and configured, in an engaged state with the cannula tube, to be held in a fixed position within a portion of the passage of the cannula tube.

[0013] Additional objects, features, and / or advantages will be set forth in part in the description which follows, and in part will be obvious from the description, or may be learned by practice of the present disclosure and / or claims. At least some of these objects and advantages may be realized and attained by the elements and combinations particularly pointed out in the appended claims.

[0014] It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the claims; rather the claims should be entitled to their full breadth of scope, including equivalents.PCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 BRIEF DESCRIPTION OF THE DRAWINGS

[0015] The present disclosure can be understood from the following detailed description, either alone or together with the accompanying drawings. The drawings are included to provide a further understanding of the present disclosure and are incorporated in and constitute a part of this specification. The drawings illustrate one or more embodiments of the present teachings and together with the description serve to explain certain principles and operation. In the drawings,

[0016] FIG. 1 is a schematic view of an embodiment of a medical instrument comprising an end effector;

[0017] FIG. 2 is a diagrammatic view of an embodiment of teleoperable, computer-assisted medical system including the medical instrument of FIG. 1 ;

[0018] FIG. 3 is perspective view of an embodiment of an assembly including a cannula with a medical instrument having an end effector with a large diameter inserted therein;

[0019] FIG. 4 is a side view of the assembly and medical instrument of FIG. 3;

[0020] FIG. 5 is a cross-sectional view of the cannula of the assembly of FIG. 3;

[0021] FIGS. 6A-6C are cross sectional views of the cannula of the assembly of FIG. 3, progressively illustrating insertion of the medical instrument of FIG. 3 into the cannula;

[0022] FIG. 7 is a cross-sectional view of the assembly and medical instrument of FIG.3;

[0023] FIG. 8 is a side view of the assembly of FIG. 3 with an obturator inserted therein;

[0024] FIGS. 9A-9D progressively illustrate the assembly of FIG. 3 during insertion of a medical instrument into an anus of a patient; andPCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304

[0025] FIG. 10 is a perspective view of another embodiment of cannula tube with a medical instrument inserted therein.DETAILED DESCRIPTION

[0026] The present disclosure contemplates various embodiments of cannulas, cannula assemblies, and insertion methods configured to facilitate insertion of medical instruments having end effectors with relatively large lateral dimensions (e.g., diameters), such as circular staplers used to perform EEA stapler techniques, to remote worksites. Exemplary embodiments of the present disclosure can, for example, enable use of such circular staplers with computer-assisted, teleoperated minimally invasive surgical systems (i.e. , as medical instruments connected to manipulator arms of telesurgical systems).

[0027] In various embodiments, a cannula assembly includes a cannula tube and a bushing removably engageable with the cannula tube. The cannula tube comprises a cannula tube proximal end opening and a cannula tube distal end opening, and a cannula tube passage defining a first longitudinal axis connecting the cannula tube proximal and distal end openings. In some embodiments, for example, the cannula tube comprises a mounting flange that is configured to releasably mount the cannula tube to a manipulator of a medical manipulator system (e.g., of a teleoperated minimally invasive surgical system as described further below). The mounting flange protrudes radially outward from an external surface of the cannula tube and is configured to hold the cannula tube in a position to permit insertion of the medical instrument into the cannula tube proximal end opening.PCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304

[0028] The bushing comprises a bushing proximal end opening and a bushing distal end opening, and a bushing passage defining a second longitudinal axis connecting the bushing proximal and distal end openings. In an engaged state with the cannula tube, the bushing is held in a fixed position within a portion of the cannula tube passage and is configured to receive a shaft of a medical instrument inserted through the cannula tube. In some embodiments, for example, in the engaged state with the cannula tube, the second longitudinal axis of the bushing is radially offset from the first longitudinal axis of the cannula tube, such that the cannula tube can accommodate insertion of a larger diameter working end of the medical instrument (i.e. , allowing a larger diameter of a EEA stapler head to pass through the cannula), while the bushing holds a smaller diameter instrument shaft at a required height (i.e., the correct height) relative to a carriage of the manipulator. In one contemplated embodiment, for example, the second longitudinal axis of the bushing passage is offset from a centerline axis of the bushing, as will be discussed further below.

[0029] In various embodiments, the cannula tube passage has a radial dimension that is larger than a radial dimension of the bushing passage, such that the cannula tube passage has a radial dimension that is configured to receive the working end of the medical instrument (e.g., a circular stapler having a first relatively large diameter), while the bushing passage has a radial dimension that is configured to receive a shaft of the medical instrument (e.g. the shaft having a second diameter that is smaller than the first diameter of the working end). In this manner, cannulas and cannula assemblies in accordance with the present disclosure may my used in conjunction with teleoperated minimally invasive surgical systems to accommodate medical instruments havingPCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 multiple diameters (e.g., a large diameter head and a small diameter shaft), while also positioning the medical instruments at the correct height relative to an insertion axis associated with a manipulator of the teleoperated minimally invasive surgical system.

[0030] In applications in which the cannula is inserted through an orifice of a body of a patient (e.g., inserted trans-anally for EEA stapler procedures within the rectum and colon), for ease of insertion of the cannula and medical instrument, the contemplated cannula assemblies can be used in conjunction with an obturator having a rounded tip, such that the cannula passage is also configured to receive the obturator. In this manner, to minimize the risk of unintended trauma to the patient during such procedures, the rounded obturator can be used to gradually dilate the sphincter during insertion of the cannula, thereby decreasing the force needed to push the head of the instrument (e.g., the circular, flat head of the EEA stapler) through the sphincter muscle during insertion of the medical instrument through the cannula.

[0031] In such embodiments (e.g., systems used for trans-anal applications), the cannula tube may comprise additional features to aid with the insertion and removal of the cannula from the body, and for using the cannula in conjunction with a teleoperated minimally invasive surgical system. In some embodiments, for example, the cannula can include a radially protruding flange configured to abut the body of the patient in an inserted position of the canula tube through the orifice. The flange can, for example, provide a datum surface against the patient’s body to establish a remote center (RC) for a teleoperated surgical system, at a safe distance relative to the patient’s sphincter.

[0032] In various embodiments, for example, the cannula tube may comprise a first cannula tube part and a second cannula tube part that is engageable with the firstPCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 cannula tube part. The first cannula tube part may include the cannula passage (i.e. , that is configured to receive the obturator) and the flange, while the second cannula tube part is configured to mate with a proximal end opening of the first cannula tube part and comprises the mounting flange (i.e., that is configured to removably mount the cannula tube to a manipulator of the surgical system) and is also configured to engage with the bushing. Thus, in some embodiments, the cannula tube may have a multi-part design that facilitates a changing of the control features displayed to a user of the surgical system. For example, it is contemplated that a magnetic code of a given cannula may be quickly adjusted (i.e., by adding or subtracting magnets via the addition or removal of a portion of the multi-part cannula) to change the control features of the cannula, which may not otherwise be standard control features accessible to the user.

[0033] In additional embodiments, the cannula tube may also include an anti-pinching feature at its distal end opening, which is configured to provide clearance between the patient’s tissue (e.g., colon wall tissue and / or butt tissue) and the medical instrument (e.g., the large diameter stapler head) upon removal of the instrument from patient. Such clearance may, for example, prevent the tissue from being pulled into the cannula and getting trapped between an inner wall of the cannula passage and the head of the instrument as the instrument is withdrawn back into the cannula passage for removal from the patient. In some exemplary embodiments, to provide clearance, a face of the cannula tube surrounding the cannula tube distal end opening is set in a plane at a non-orthogonal angle relative to the first longitudinal axis of the cannula tube passage.

[0034] Referring now to FIG. 1, a schematic side view of an embodiment of an instrument 100 (such as, for example, a medical instrument) is shown. The directionsPCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 “proximal” and “distal” are used herein to define the directions as shown in FIG. 1, with distal generally being in a direction further along a kinematic arm or closest to the worksite in the intended operational use of the instrument 100. While aspects of the present disclosure are discussed in the context of medial instruments having relatively large lateral dimensions (e.g., large diameters), such as, for example, circular staplers used for EEA procedures, embodiments of the present disclosure can be used with various instruments used in medical procedures. For example, such instruments include those used for diagnosis, therapy, and sensing, including, for example, imaging instruments such as endoscopes and other imaging instruments with larger lateral dimensions. Accordingly, medical instruments as used herein encompasses a variety of instruments used in surgical, diagnostic, and therapeutic applications. In addition, aspects of the disclosure can have non-surgical applications, such as in other remotely-actuatable instruments for inspection and other industrial uses, general robotic uses, manipulation of non-tissue work pieces, etc.

[0035] The instrument 100 includes a shaft 104 with a transmission mechanism 102 at a proximal end portion of the shaft 104 and an end effector 106 at a distal end portion 107 of the shaft 104. In an exemplary embodiment, the transmission mechanism 102 is configured to interface with a manipulating system, such as manipulating systems shown below in connection with FIG. 2. Alternatively, the transmission mechanism 102 can be configured to be operated manually such as for a manual, laparoscopic instrument, which can have a handle or other arrangement configured to be manipulated directly by a user.PCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304

[0036] The end effector 106 is coupled at the distal end portion 107 of the shaft 104. As would be understood by those of ordinary skill in the art, operation of the end effector 106 can be controlled by manipulation of the transmission mechanism 102, either manually or through drives of a manipulating system (e.g., the manipulating system shown in FIG. 2). The transmission mechanism 102 includes various mechanical and / or electromechanical devices that transmit motion, energy, and / or signals, e.g., from the manipulating system, or from inputs at the transmission mechanism 102 operable by a user, to the end effector 106. For example, one or more actuation elements (one actuation element 108 shown in FIG. 1) can extend from the transmission mechanism 102, through the shaft 104, and to the end effector 106 (e.g., a head of a stapler), to operably couple the transmission mechanism 102 (or a component therein) to the end effector 106. Force applied to the actuation element 108 by the transmission mechanism 102 can actuate (e.g., close, open, or otherwise control) the end effector 106.

[0037] While the end effector 106 illustrated in FIG. 1 comprises a head of a circular stapler, other end effectors with relatively large lateral dimensions (e.g., large diameters), including, but not limited to, jaw mechanisms, clip appliers, ligation tools, and other tools are considered within the scope of this disclosure.

[0038] In various embodiments, actuation elements can comprise flexible members, such as polymer or metal (e.g., tungsten) solid or braided actuation elements, such as cables. Selective tensioning of the actuation elements can cause transmission of force to the links of an articulatable mechanism to cause articulation in a given direction.PCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 Those of ordinary skill in the art are generally familiar with such components and they are thus not described in detail here.

[0039] In various embodiments, the transmission mechanism 102 is configured to operably couple to and receive drive inputs from a manipulator system of a teleoperable, computer-assisted medical system that operates at least in part with robotic technology (sometimes referred to as a “telesurgical system” or a “robotic surgical system”). One embodiment of such a computer-assisted medical system is illustrated in the schematic diagram of FIG. 2, depicting a manipulator system 1000 comprising a plurality of manipulator arms 1002 to which the transmission mechanism 102 of instrument 100 can operably couple, a user control system 2000 comprising various master inputs 52 and a user viewer 2006 which can include video images of the remote worksite taken through an endoscopic imaging device, and / or other graphical information, and a vision / control console 4000 which can also have a display 4006 presenting similar images as the user viewer 2006 or other information relating to a procedure.

[0040] The vision / control console 4000 also can in some embodiments comprise components that supply auxiliary functionality to instruments, such as via an auxiliary unit 80, which can be, for example, insufflation gas, vacuum for evacuation, electrosurgical energy, and similar flux supply units. Such units can be controlled through a controller integrated with the system and / or can be separately controlled at a stand-alone input unit 90, rather than through the user control system 2000. A nonlimiting embodiment of a teleoperable, computer-assisted medical system with which the instrument 100 and various instrument embodiments described herein can bePCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 utilized are the da Vinci® Surgical Systems commercialized by Intuitive Surgical, Inc., of Sunnyvale, California.

[0041] In various other embodiments contemplated within the scope of the present disclosure, the instrument 100 can be configured to be manually actuated, with the proximally located, transmission mechanism 102 having inputs that are configured to be manually actuated rather than coupled to a manipulator arm. Yet other embodiments contemplate the instrument can have both manually actuated inputs and inputs configured to be driven by drive outputs of a manipulator system.

[0042] Referring now to FIGS. 3 and 4, an embodiment of a cannula assembly 110 including a cannula tube 112 and a bushing 122 is shown, with a medical instrument having a large diameter, such as, for example, a circular EEA stapler 101 inserted therein. As discussed above, the cannula assembly 110 may be used in conjunction with a manipulator system of a teleoperated, computer-assisted surgical system, such as, for example, the manipulator system 1000 of FIG. 2, in order to use the circular EEA stapler 101 with the manipulator system 1000. In accordance with various embodiments, as will be discussed further below, the cannula assembly 110 is configured to attach to a manipulator arm 1002 of the manipulator system 1000 to establish a remote center (RC) for the stapler 101 (e.g., the cannula tube 112) and to hold the stapler 101 at the correct insertion axis Ai height (see FIG. 5) for the manipulator arm 1002 (e.g., via the bushing 122).

[0043] As further shown in FIGS. 5-7, the cannula tube 112 comprises a cannula tube proximal end opening 111 , a cannula tube distal end opening 113, and a cannula tube passage 114 defining a first longitudinal axis Li connecting the cannula tube proximalPCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 and distal end openings 111 and 113 (See FIG. 4). The cannula tube passage 114 is sized to permit advancement of the circular EEA stapler 101 through the cannula tube passage 114 for insertion of the stapler 101 into a remote worksite within a body of a patient. In various embodiments, the cannula tube passage 114 has a diameter (i.e. , an inner diameter of the cannula tube 112, such that the cannula tube passage 114 is sized to permit advancement of a stapler 101 through the cannula tube 112. In some embodiments, for example, the cannula tube 112 has a cannula tube passage 114 sized to permit advancement of an EEA stapler 101 having a maximum outer diameter of about 33 mm, while also having a minimized outer diameter to help prevent patient discomfort and / or injury during insertion of the cannula tube 112 (e.g., an outer diameter small enough to avoid damaging a sphincter muscle of the patient).

[0044] In some embodiments, for example, the cannula tube 112 comprises a mounting flange 130 that is configured to releasably mount the cannula tube 112 to a manipulator arm of a manipulator system (e.g., a manipulator arm 1002 of the manipulator system 1000 of FIG. 2). The mounting flange 130 protrudes radially outward from an external surface 131 of the cannula tube 112 and is configured to hold the cannula tube 112 in a position to permit insertion of the stapler 101 into the cannula tube 112 proximal end opening 111. As shown in FIGS. 3-5, In various embodiments, the cannula tube 112 comprises a first cannula tube part 115 and a second cannula tube part 116, which is engageable with the first cannula tube part 115. For example, a distal end opening 113b of the second cannula tube part 116 may be configured to mate with a proximal end opening 111 a of the first cannula tube part 115, such as, for example, via receipt within the proximal end opening 111a, to form a complete cannula tube 112. In this manner,PCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 in an engaged state of the cannula tube parts 115 and 116 to form the complete cannula tube 112, a proximal end opening 111 b of the second cannula tube part 116 coincides with the proximal end opening 111 of the cannula tube 112 and a distal end opening 113a of the first cannula tube part 115 coincides with the distal end opening 113 of the cannula tube 112 (see FIG. 5).

[0045] In various embodiments, this multi-part cannula design may also facilitate changing of the control features displayed to a user of the manipulator system 1000 (e.g., via the user viewer 2006 and / or the display 4006 of the vision / control console 4000). For example, it is contemplated that a magnetic code of a given cannula assembly 110 may be quickly adjusted (i.e., by adding or subtracting magnets via the addition or removal of a part of the multi-part cannula tube 112) to change the control features of the cannula assembly 110, which may not otherwise be standard control features accessible to the user.

[0046] To help establish the remote center (RC) for an instrument 100 (e.g., the stapler 101 ) inserted within the cannula tube 112, in some embodiments, the first cannula tube part 115 includes a radially protruding flange 117 at its proximal end opening 111a, while the second cannula tube includes the mounting flange 130. For example, the radially protruding flange 117 is configured to abut a body wall of the patient in an inserted position of the cannula tube 112 through an orifice of a body of the patient, such that the flange 117 datums the cannula tube 112 against the patient’s body and sets the RC at a fixed distance D (see FIG. 4) away from the mounting flange 130. In other words, since in many procedures (e.g., trans-anal procedures) the RC plane is intracorporeal and is not visible to a user (e.g., surgeon) during a procedure, it isPCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 necessary for the cannula tube 112 to establish a datum surface against the patient’s anatomy. Thus, the flange 117 is configured to create a datum surface against the insertion orifice (e.g., the patients butt) to locate the cannula tube 112 and the corresponding RC within the patient’s body. In some additional embodiments, to help hold the cannula tube 112 in place within the patient’s body (e.g., prior to attaching the mounting flange 130 to a manipulator arm 1002), the first cannula tube part 115 can also include a lip 118 protruding outward at its distal end opening 113a (i.e. , the distal end opening 113 of the cannula tube 112). In still further embodiments, as will be discussed more below, to help reduce tissue pinch upon removal of the cannula tube 112 from the patient’s body, a face 119 of the cannula tube 112 surrounding the distal end opening 113 (i.e., the distal end opening 113a of the first cannula tube part 115) can be slanted such that the face 119 is in a plane at a non-orthogonal angle relative to the first longitudinal axis Li.

[0047] The bushing 122 is configured to be inserted within the cannula tube proximal end opening 111 (e.g., the proximal end opening 111 b of the second cannula tube part 116) such that the bushing 122 is removably engageable with the cannula tube 112 and, in an engaged state with the cannula tube 112, is held in a fixed position within a portion of the cannula tube passage 114. In accordance with various embodiments, for example, as will be described further below, an end effector 106 having a relatively large lateral dimension (e.g., a large diameter), such as, for example a flat head 103 of an EEA stapler 101 , can be inserted through the cannula tube passage 114 first, and the bushing 122 may then slide over a smaller diameter portion (i.e. , shaft 104) of the stapler 101 and into engagement with the cannula tube 112.PCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304

[0048] Like the cannula tube 112, the bushing 122 comprises a bushing proximal end opening 121, a bushing distal end opening 123, and a bushing passage 124 defining a second longitudinal axis L2 connecting the busing proximal and distal end openings 121 and 123 (See FIG. 4). In this manner, in the engaged state of the bushing 122 with the cannula tube 112, the bushing distal end opening 123 is positioned within the cannula tube passage 114, such that the bushing passage 124 is in fluid communication with the cannula tube passage 114 (see FIGS. 5 and 7). In some embodiments, as best shown in FIG. 7, the bushing 122 includes an insertable portion 125 that is sized to engage with an internal surface 132 of a portion of the cannula tube passage 114 via, for example, a friction fit. In additional embodiments, the bushing 122 also includes a flange portion 127 extending radially outward from the insertable portion 125, such that the flange portion 127 is configured to abut an end face 120 of the cannula tube 112 at the cannula tube proximal end opening 111 (i.e. , an end face of the second cannula tube part 116 at the proximal end opening 111b).

[0049] In other words, in various embodiments, the bushing passage 124 is configured to receive and slide upon the shaft 104 of the stapler 101 until the insertable portion 125 of the bushing 122 is received within the cannula tube passage 114 and the flange portion 127 of the bushing 122 abuts (or is adjacent to) the end face 120 of the proximal end opening 111 of the cannula tube 112. In this manner, the cannula tube passage 114 is configured to allow the head 103 of the stapler 101 (which as a larger diameter) to pass, while when in the engaged position of the bushing 122 with the cannula tube 112, the bushing passage 124 is configured to engage with and support the shaft 104 of the stapler 101 (which has a smaller diameter), thereby constraining the shaft 104 toPCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 maintain proper movement of the stapler 101 while mounted to the manipulator arm 1002. For example, although when engaged with the cannula tube 112 the bushing 122 is fixed within the cannula tube 112 (e.g., via a friction fit), the bushing 122 allows the instrument shaft 104 to freely move within the bushing passage 124, thereby allowing the stapler 101 to move freely into and out of the patient. In some embodiments, the head 103 of the circular stapler 101 may also be used to pull the bushing 122 out of the cannula tube 112 when the stapler 101 is removed from the cannula tube 112.

[0050] To hold the stapler 101 at the correct insertion axis Ai height for the manipulator arm 1002, in some embodiments, as illustrated in FIG. 4, in the engaged state with the cannula tube 112, the second longitudinal axis l_2 of the bushing passage 124 is radially offset from the first longitudinal axis Li of the cannula tube passage 114. In this manner, the cannula tube 112 can accommodate insertion of a medical instrument 100 having an end effector 106 with relatively large lateral dimensions (e.g., a stapler 101 with a head 103 that has a large diameter compared to a shaft 104), thereby allowing for example an EEA stapler head to pass through the cannula tube 112, while the bushing 122 holds the shaft at a required height (i.e. , the correct insertion axis Ai height) relative to a carriage of the manipulator arm 1002. In one contemplated embodiment, for example, the second longitudinal axis of the bushing passage L2 is offset from a centerline axis (ACL) of the bushing, as illustrated in FIG. 3. In this manner, in various embodiments, the cannula tube passage 114 has a radial dimension that is larger than a radial dimension of the bushing passage 124, such that the cannula tube passage 114 has a radial dimension that is configured to receive the head 103 of the stapler 101 , while the bushing passage 124 has a radial dimension that is configured to receive thePCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 shaft 104 of the stapler 101. In this manner, cannulas and cannula assemblies in accordance with the present disclosure may be used in conjunction with the manipulator system 1000 to accommodate instruments 100 such as EEA staplers 101 , which have multiple diameters (e.g., a large diameter head and a small diameter shaft), while also positioning the instruments 100 at the correct height relative to an insertion axis Ai associated with a manipulator arm 1002 of the system 1000 (i.e., thereby maintaining motion from the manipulator arm 1002, while the stapler 100 is being driven). In other words, the bushing 122 is configured to align and hold the circular stapler 101 such that a centerline of the stapler 101 is at the correct distance from the manipulator arm 1002 (i.e., the centerline of the stapler 101 aligns with the insertion axis Ai).

[0051] As would be understood by those of ordinary skill in the art, the predefined arm mount height associated with a traditional manipulator system causes an interference between conventional cannulas and circular staplers 101 (e g., EEA staplers). Indeed, with the preexisting dimensions of, for example, the manipulator system 1000 and the relatively large lateral dimensions of the head 103 of the circular stapler 101, an underside portion of an arm mount for each manipulator arm 1002 would protrude into the insertion path of the circular stapler 101. Cannula designs of the present disclosure address such interference by providing an offset entrance path, which allows the head 103 of the stapler 101 to enter the cannula tube 112 at a height lower than the systems 1000 insertion axis Ai. As discussed further below, the cannula tube 112 is configured to allow the head 103 of the stapler 101 to pass under the mounting flange 130 and then pop back up to the correct axis alignment. In some embodiments, for example, the second cannula tube part 116 may include both a cutout portion 140 (i.e., adjacent thePCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 proximal end opening 111b) and a flared portion 142 (e.g., adjacent the distal end opening 113b) to allow the head 103 of the stapler 101 to first pass into the cannula tube passage 114 and then up into alignment with the insertion axis Ai. In this manner, the cannula tube 112 allows the circular stapler 101 to be inserted into the cannula tube passage 114 before the stapler 101 is connected to the manipulator arm 1002 of the manipulator system 1000.

[0052] Those of ordinary skill in the art will understand that that the cannula assembly 110, including the cannula tube 112 and the bushing 122, discussed and illustrated with reference to FIGS. 1-7, are exemplary only and that each of the cannula tube 112 and the bushing 122 may have various shapes, sizes, and / or configurations, and be configured to engage with each other via various mechanisms, without departing from the scope of the present disclosure and claims. For example, although the exemplary cannula tube 112 discussed above may be formed from two individual cannula parts 115 and 116, additional embodiments contemplate cannula assemblies utilizing a single, integrally formed cannula tube 112 (See, e.g., cannula tube 212 in the exemplary embodiment of FIG. 10). Indeed, those of ordinary skill in the art would understand that a particular application (e.g., type, shape, and dimensions of a particular instrument 100), with a defined set of design considerations, may dictate the shape, size, and / or configuration of any give cannula tube 112, the corresponding bushing 122, and the insertion procedure / path of the instrument 100 in conjunction with the cannula tube 112 and the bushing 122. As would be understood, for example, although it is described above that in various embodiments the circular stapler 101 is inserted into the cannula tube passage 114 before the stapler 101 is connected to the manipulator 1002 of thePCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 manipulator system 1000, and prior to engagement of the bushing 122 with the cannula tube 112, it is also contemplated that the circular stapler 101 may be inserted into the cannula tube passage 114 after the stapler 101 is connected to the manipulator 1002 and / or the bushing 122 is engaged with the cannula tube 122.

[0053] FIGS. 6A-6B illustrate an exemplary movement path of the head 103 of the circular stapler 101 as it is inserted into the cannula tube passage 114 (i.e., via the cannula tube proximal end opening 111 / 111 b) and passes through the cannula tube passage 114 and out the cannula tube distal end opening 113 / 113a. As shown in FIG.6A, to insert the stapler 101 into the cannula tube 112, the head 103 of the stapler 101 is first angled downward into the cannula tube passage 114 to pass under the mounting flange 130 (i.e., the head 103 approaches the proximal end opening of the cannula tube 111 / 111b at an angle G relative to the first longitudinal axis Li of the cannula tube 112). The stapler 101 is then straightened so that the head 103 can pass through the cannula tube passage 114 (i.e., a longitudinal axis Ls of the stapler 101 is aligned with the first longitudinal axis Li of the cannula tube 112), as shown in FIG. 6B. Finally, as shown in FIG. 6C, the stapler 101 is pulled back up to the correct insertion axis A to match the insertion axis height of the manipulator system 1000 (i.e., the longitudinal axis Lsof the stapler 101 is brought into alignment with the insertion axis Ai). In other words, the cannula tube 112 is configured such that a radial position of the stapler 101 can be adjusted relative to the cannula tube 112 so as to move the longitudinal axis Ls of the stapler 101 from an initial insertion position to an adjusted position relative to the first longitudinal axis Li of the cannula tube 112.PCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304

[0054] As discussed above, the bushing 122 may then be slid over the shaft 104 of the stapler 101 and at least partially through the proximal end opening 111 / 111b of the cannula tube 112 to engage the bushing 122 with an internal surface 132 of the cannula tube passage 114 and hold the stapler 101 at the correct insertion axis Ai (i.e. , to maintain an alignment between the longitudinal axis Lsof the stapler 101 and the insertion axis Ai). The cannula tube 112 is, therefore, configured to align the longitudinal axis Ls of the stapler 101 along a first radial position relative to the first longitudinal axis Li of the cannula tube 112 during insertion of the stapler 101 , while the bushing 122 is used to support the stapler 101 so as to align the longitudinal axis Lsof the stapler 101 relative to the cannula tube at a second radial position relative to the first longitudinal axis Li of the cannula tube 112 (i.e., the bushing 122 holds the stapler 101 in an adjusted radial position relative to a centerline of the cannula tube 112 such that the longitudinal axis Ls is offset from the longitudinal axis Li).

[0055] As discussed above, those of ordinary skill in the art will understand that the cannula assembly 110, including the cannula tube 112 and the bushing 122, discussed and illustrated with reference to FIGS. 1-7, are exemplary only and that cannula assemblies 110 in accordance with the present disclosure can have various types and configurations of components, including and in addition to the cannula tube 112 and the bushing 122, to aid in the insertion of medical instruments into preexisting orifices within a patient’s body, such as for example, the insertion of circular EEA staplers into a patient’s anus. Indeed, those of ordinary skill in the art would understand that a particular application (e.g., type of medical procedure), with a defined set of designPCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 considerations, may dictate the type and configuration of components used in the cannula assembly.

[0056] As illustrated in FIG. 8, for example, in applications in which the cannula is inserted through an orifice of a body of a patient (e.g., inserted trans-anally for EEA stapler procedures within the rectum and colon), for ease of insertion of the cannula tube 112 and circular EEA stapler 101 into the rectum, the contemplated cannula assemblies 110 can be used in conjunction with an obturator 150 having a rounded tip 152, such that the cannula tube passage 114 is also configured to receive the obturator 150 (e.g. , a portion of the cannula tube passage 114 defined by the first cannula tube part 115 is configured to receive the obturator 150 as will be discussed further below). In this manner, to minimize the risk of unintended trauma to the patient during such procedures, the rounded obturator 150 can be used to gradually dilate the sphincter during insertion of the cannula tube 112, thereby decreasing the force needed to push the end effector 106 (e.g., the circular, flat head 103 of the EEA stapler 101) through the sphincter muscle during insertion of the instrument 100 through the cannula tube 112.

[0057] An exemplary method for inserting an instrument 100, such as the circular stapler 101, to a remote worksite (i.e., via an orifice of a patient such as the rectum) using a contemplated cannula assembly, such as the cannula assembly 110, is discussed below with reference to FIGS. 9A-9D. As shown in FIG. 9A, prior to insertion of any portion of the cannula tube 112, the obturator 150 is inserted into the first cannula tube part 115 of the cannula tube 112. This assembly is then manually inserted into the patient such that the cannula tube 112 is positioned through an opening in a body wall (e.g., the assembly is inserted into the patient’s anus). The obturator 150 is thenPCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 removed, while the first cannula tube part 115 remains in the patient’s body, as shown in FIG. 9B (in which the patient’s body is not shown for ease of illustration). The second cannula tube part 116 is then connected to the first cannula tube part 115 (i.e., to form the complete cannula tube 112) and the flange 130 on the second cannula tube part 116 is attached to a manipulator arm 1200 of the system 1000. As shown by the arrows in FIG. 9C, in various embodiments, the distal end opening 113b of the second cannula tube part 116 is inserted within the proximal end opening 111a of the first cannula tube part 115 and the second cannula tube part 116 is rotated into a locking engagement with the first cannula tube part 115 (e.g. via flanges 137 adjacent the distal end opening 113b of the second cannula tube part 116). As illustrated and discussed above with reference to FIGS. 6A-6C, the circular stapler 101 is then inserted into the cannula tube passage 114 formed by the complete cannula tube 112. As shown in FIG. 9D (in which the stapler 101 is not shown for ease of illustration) the bushing 122 is then slid over the shaft 104 of the stapler 101 to support the shaft 104, as discussed above, while the circular stapler 101 is being used. The bushing 122, for example, is slid at least partially through the proximal end opening 111 of the cannula tube 112 to position the bushing 122 in engagement with the internal surface 132 of the cannula tube passage 114.

[0058] In such embodiments (e.g., used for trans-anal applications), the cannula tube 112 may also include additional features to aid with the insertion and removal of the cannula tube 112 from the body. As discussed above, to provide a datum surface, in some embodiments, for example, the cannula tube 112 can include a radially protruding flange 117 configured to abut the body of the patient in an inserted position of the cannula tube 112 through the orifice. The flange 117 provides a datum surface againstPCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 the patient’s body that establishes the remote center (RC) (i.e., for the manipulator system 1000) at a safe distance relative to the patient’s sphincter.

[0059] In additional embodiments, the cannula tube 112 is configured to reduce tissue pinching while inserting, removing, and / or driving the circular stapler 101. As would be understood by those of ordinary skill in the art, the thin tissue of the colon can often get pulled into a cannula and pinched between the inner surface of the cannula tube 112 and the head 103 of the circular stapler 101 during insertion and removal of the stapler 101. The contemplated cannula tubes 112 function to help eliminate such tissue pinching via several features, including, for example: (1) an oversized distal end face 119 surrounding the cannula tube distal end opening 113 (i.e., relative to a diameter of the head 103 of the stapler 101) to help keep tissue pulled away from the head 103 (which is generally tapered), (2) a slanted face 119 such that the face 119 is in a plane at a non-orthogonal angle relative to the first longitudinal axis Li of the cannula tube 112 to help prevent tissue from getting sucked inside of the cannula tube passage 114 during removal of the stapler 101 (e.g., the tapered face 119 provides space for tissue to slide away from the head 103, and (3) a lip 118 protruding outward at the cannula tube distal end opening 113 that can hold the loose tissue away from the head 103. Those of ordinary skill in the art would understand that the above-described features are exemplary only and that various other features, and additional components, may be used to help reduce tissue pinch when using the cannula tubes 112 and cannula assemblies 110 in accordance with the present disclosure.

[0060] The cannula assembly 110, including cannula tube 112, bushings 122, and obturator 150, discussed and illustrated with reference to the embodiments of FIGS.PCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 3-9, are exemplary only and, as discussed above, cannula assemblies in accordance with the present disclosure can have various types and configurations of cannulas tubes, bushings, and obturators, which have various structures and utilize various types and configurations of features, without departing from the scope of the present disclosure and claims. Based on a particular application, further modifications and alternative embodiments will be apparent to those of ordinary skill in the art in view of the disclosure herein. Different configurations and arrangements of cannulas and components may, for example, be substituted for those illustrated and described herein, parts and processes may be reversed, and certain features of the present teachings may be utilized independently, all as would be apparent to one skilled in the art after having the benefit of the description herein.

[0061] With reference to FIG. 10, for example, another exemplary embodiment of a cannula tube 212 is shown. The cannula tube 212 utilizes a c-clip 222 in lieu of a bushing 122 to accommodate an instrument 200, such as a stapler 201, which has multiple diameters (e.g., a large diameter head 203 and a small diameter shaft 204), while also positioning the instrument 200 at the correct height relative to an insertion axis associated with a manipulator arm 1002 of the system 1000. In such embodiments, the head 203 of the stapler 101 can be brought underneath the c-clip 222 and inserted directly into the cannula tube 212, then the shaft 204 can be rotated up into the c-clip 222 to be constrained at the appropriate height. In this manner, similar to the bushing 122, the c-clip 222 is configured to align and hold the circular stapler 201 such that a centerline of the stapler 201 is at the correct distance from the manipulator armPCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 1002 (i.e. , the centerline of the stapler 201 aligns with the insertion axis of the manipulator arm 1002).

[0062] In some embodiments, as further shown in FIG. 10, the cannula tube 212 also includes a flared nose 218 at a distal end 213 of the cannula tube 212, which is configured to pull loose tissue up and away from a cannula tube passage 214 extending through the cannula tube 212, to prevent tissue pinch at the distal end 213 of the cannula tube 212.

[0063] As discussed above, the embodiments described herein can be well suited for use in medical applications. In particular, some embodiments are suitable for use in, for example, surgical, teleoperated surgical, diagnostic, therapeutic, and / or biopsy procedures. Such procedures could be performed, for example, on human patients, animal patients, human cadavers, animal cadavers, and portions or human or animal anatomy. Some embodiments can also be suitable for use in, for example, for non-surgical diagnosis, cosmetic procedures, imaging of human or animal anatomy, gathering data from human or animal anatomy, training medical or non-medical personnel, and procedures on tissue removed from human or animal anatomies (without return to the human or animal anatomy). Even if suitable for use in such medical procedures, the embodiments can also be used for benchtop procedures on non-living material and forms that are not part of a human or animal anatomy.Moreover, some embodiments are also suitable for use in non-medical applications, such as industrial robotic uses. In non-limiting embodiments, the techniques, methods, and devices described herein can be used in, or can be part of, a computer-assisted surgical system employing robotic technology such as the da Vinci® Surgical SystemsPCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 commercialized by Intuitive Surgical, Inc., of Sunnyvale, California. Those skilled in the art will understand, however, that aspects disclosed herein can be embodied and implemented in various ways and systems, including manually operated instruments and computer-assisted, teleoperated systems, in both medical and non-medical applications. Reference to the daVinci® Surgical Systems are illustrative and not to be considered as limiting the scope of the disclosure herein.

[0064] As used herein and in the claims, terms such as computer-assisted or teleoperable in referencing manipulator systems, or the like should be understood to refer broadly to any system comprising one or more controllable kinematic structures (“manipulators”) that are movable and controllable at least in part through the aid of an electronic controller (with or without human inputs). Such systems can occasionally be referred to in the art and in common usage as robotically assisted systems or robotic systems. Such systems include systems that are controlled by a user (for example through teleoperation), by a computer automatically (so-called autonomous control), or by some combination of these. In examples in which a user controls at least some of the operations of the manipulator, an electronic controller (e.g., a computer) can facilitate or assist in the operation. The term “computer” as used in “computer-assisted manipulator systems” refers broadly to any electronic control device for controlling, or assisting a user in controlling, operations of the manipulator, and is not intended to be limited to things formally defined as or colloquially referred to as “computers.” For example, the electronic control device in a computer-assisted manipulator system could range from a traditional “computer” (e.g., a general-purpose processor plus memory storing instructions for the processor to execute) to a low-level dedicated hardware devicePCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 (analog or digital) such as a discrete logic circuit or application specific integrated circuit (ASIC), or anything in between. Further, manipulator systems can be implemented in a variety of contexts to perform a variety of procedures, both medical and non-medical. Thus, although some examples described in greater detail herein can be focused on a medical context, the devices and principles described herein are also applicable to other contexts, such as industrial manipulator systems.

[0065] This description and the accompanying drawings that illustrate embodiments should not be taken as limiting. Various mechanical, compositional, structural, and operational changes may be made without departing from the scope of this description and the invention as claimed, including equivalents. In some instances, well-known structures and techniques have not been shown or described in detail so as not to obscure the disclosure. Like numbers in two or more figures represent the same or similar elements. Furthermore, elements and their associated features that are described in detail with reference to one embodiment may, whenever practical, be included in other embodiments in which they are not specifically shown or described. For example, if an element is described in detail with reference to one embodiment and is not described with reference to a second embodiment, the element may nevertheless be claimed as included in the second embodiment.

[0066] For the purposes of this specification and appended claims, unless otherwise indicated, all numbers expressing quantities, percentages, or proportions, and other numerical values used in the specification and claims, are to be understood as being modified in all instances by the term “about,” to the extent they are not already so modified. Accordingly, unless indicated to the contrary, the numerical parameters setPCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 forth in the following specification and attached claims are approximations that may vary depending upon the desired properties sought to be obtained. At the very least, and not as an attempt to limit the application of the doctrine of equivalents to the scope of the claims, each numerical parameter should at least be construed in light of the number of reported significant digits and by applying ordinary rounding techniques.

[0067] It is noted that, as used in this specification and the appended claims, the singular forms “a,” “an,” and “the,” and any singular use of any word, include plural referents unless expressly and unequivocally limited to one referent. As used herein, the term “include” and its grammatical variants are intended to be non-limiting, such that recitation of items in a list is not to the exclusion of other like items that can be substituted or added to the listed items.

[0068] Further, this description’s terminology is not intended to limit the invention. For example, spatially relative terms — such as “beneath”, “below”, “lower”, “above”, “upper”, “proximal”, “distal”, and the like — may be used to describe one element’s or feature’s relationship to another element or feature as illustrated in the figures. These spatially relative terms are intended to encompass different positions (i.e. , locations) and orientations (i.e., rotational placements) of a device in use or operation in addition to the position and orientation shown in the figures. For example, if a device in the figures is turned over, elements described as “below” or “beneath” other elements or features would then be “above” or “over” the other elements or features. Thus, the exemplary term “below” can encompass both positions and orientations of above and below. A device may be otherwise oriented (rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein interpreted accordingly.PCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304

[0069] Further modifications and alternative embodiments will be apparent to those of ordinary skill in the art in view of the disclosure herein. For example, the devices and methods may include additional components or steps that were omitted from the figures and description for clarity of operation. Accordingly, this description is to be construed as illustrative only and is for the purpose of teaching those skilled in the art the general manner of carrying out the present teachings. It is to be understood that the various embodiments shown and described herein are to be taken as exemplary. Elements and materials, and arrangements of those elements and materials, may be substituted for those illustrated and described herein, parts and processes may be reversed, and certain features of the present teachings may be utilized independently, all as would be apparent to one skilled in the art after having the benefit of the description herein.Changes may be made in the elements described herein without departing from the spirit and scope of the present teachings and following claims.

[0070] It is to be understood that the particular examples and embodiments set forth herein are non-limiting, and modifications to structure, dimensions, materials, and methodologies may be made without departing from the scope of the present teachings.

[0071] Other embodiments in accordance with the present disclosure will be apparent to those skilled in the art from consideration of the specification and practice of the invention disclosed herein. It is intended that the specification and examples be considered as exemplary only, with the following claims being entitled to their fullest breadth, including equivalents, under the applicable law.

Claims

1. PCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 WHAT IS CLAIMED IS:

1. An assembly for insertion of a medical instrument to a remote worksite, the assembly comprising:a cannula tube comprising:a cannula tube proximal end opening,a cannula tube distal end opening, anda cannula tube passage connecting the cannula tube proximal end opening and the cannula tube distal end opening, the cannula tube passage defining a first longitudinal axis; anda bushing removably engageable with the cannula tube and configured, in an engaged state with the cannula tube, to be held in a fixed position within a portion of the cannula tube passage, the bushing comprising:a bushing proximal end opening,a bushing distal end opening, anda bushing passage connecting the bushing proximal end opening and the bushing distal end opening, the bushing passage defining a second longitudinal axis and configured to receive a shaft of a medical instrument inserted through the cannula tube.

2. The assembly of any of claim 1 , wherein, the cannula tube passage has a radial dimension larger than a radial dimension of the bushing passage.PCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 3. The assembly of any of claims 1 and 2, wherein, in the engaged state of the bushing with the cannula tube, the second longitudinal axis of the bushing passage is radially offset from the first longitudinal axis of the cannula tube passage.

4. The assembly of any of claims 1 and 2, wherein the second longitudinal axis of the bushing passage is offset from a centerline axis of the bushing.

5. The assembly of any of claims 1 and 2, wherein the bushing comprises an insertable portion sized to engage with an internal surface of a portion of the cannula tube passage and a flange portion extending radially outward from the insertable portion.

6. The assembly of claim 5, wherein the flange portion is configured to abut an end face of the cannula tube at the cannula tube proximal end opening.

7. The assembly of any of claims 1 and 2, wherein a face of the cannula tube surrounding the cannula tube distal end opening is in a plane at a non-orthogonal angle relative to the first longitudinal axis.

8. The assembly of any of claims 1 and 2, wherein the cannula tube further comprises a lip protruding radially outward at the cannula tube distal end opening.

9. The assembly of any of claims 1 and 2, wherein the cannula tube further comprises a mounting flange configured to releasably mount the cannula tube to a manipulator of a medical manipulator system.PCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 10. The assembly of claim 9, wherein the mounting flange protrudes radially outward from an external surface of the cannula tube and is configured to hold the cannula tube in a position to permit insertion of a medical instrument into the cannula tube proximal end opening.

11. A method for inserting a medical instrument to a remote worksite, the method comprising:positioning a cannula tube through an opening in a body wall, the cannula tube comprising a proximal end opening, a distal end opening, and a passage extending between the proximal end opening and the distal end opening;inserting the medical instrument into the passage through the proximal end opening; andsliding a bushing over a shaft of the medical instrument and at least partially through the proximal end opening of the cannula tube to position the bushing in engagement with an internal surface of the passage of the cannula tube.

12. The method of claim 11 , wherein inserting the medical instrument through the proximal end opening comprises approaching the proximal end opening of the cannula tube with the medical instrument at an angle relative to a longitudinal axis of the cannula tube.

13. The method of claim 12, further comprising, after inserting the medical instrument, before sliding the bushing over the shaft of the medical instrument, adjusting a radial position of the medical instrument relative to the cannula tube so as to move aPCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 longitudinal axis of the medical instrument from an initial insertion position to an adjusted position relative to the longitudinal axis of the cannula tube.

14. The method of claim 13, wherein the bushing holds the medical instrument in the adjusted radial position relative to the cannula tube.

15. The method of any of claims 13 and 14, wherein the bushing holds the medical instrument in the adjusted radial position such that the longitudinal axis of the medical instrument is offset from the longitudinal axis of the cannula tube.

16. A method of supporting a medical instrument during a medical procedure, the method comprising:positioning the medical instrument through a passage of a cannula tube, wherein the medical instrument has a working end having a first diameter and a shaft having a second diameter, the first diameter being larger than the second diameter; and supporting the medical instrument in the passage of the cannula tube via a bushing engaged with an external surface of the shaft of the medical instrument and an internal surface of a portion of the passage of the cannula tube.

17. The method of claim 16, wherein the bushing defines a bushing passage and the shaft of the medical instrument extends through the bushing passage.

18. The method of claim 17, wherein a longitudinal axis of the bushing passage is offset from a centerline axis of the bushing.PCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.00304 19. A system for inserting a medical instrument through an orifice of a body of a patient, the system comprising:an obturator;a cannula tube defining a passage configured to receive the obturator, the cannula tube comprising a radially protruding flange configured to abut the body of the patient in an inserted position of the cannula tube through the orifice; anda bushing removably engageable with the cannula tube and configured, in an engaged state with the cannula tube, to be held in a fixed position within a portion of the passage of the cannula tube.

20. The system of claim 19, wherein the passage of the cannula tube is sized to permit advancement of a circular stapler through the passage.

21. The system of claim 20, wherein the bushing is configured to engage with and support a shaft of the circular stapler in the engaged state of the bushing with the cannula tube.

22. The system of claim 21 , wherein a longitudinal axis of the circular stapler aligns along a first radial position relative to a longitudinal axis of the cannula tube during insertion of the circular stapler, and wherein the bushing is used to support the circular stapler so as to align the longitudinal axis of the circular stapler relative to the cannula tube at a second radial position relative to the longitudinal axis of the cannula tube.

23. The system of any of claims 19-22, wherein the obturator has a rounded tip.PCT APPLICATION ATTORNEY DOCKET NO. P06949-WO ALTERNATE REFERENCE NO. 1084.0245.0030424. The system of any of claims 19-22, wherein the cannula tube comprises a first cannula tube part and a second cannula tube part engageable with the first cannula tube part, wherein the bushing is removably engageable with the second cannula tube part.

25. The system of claim 24, wherein the first cannula tube part comprises the passage configured to receive the obturator and the radially protruding flange and wherein the bushing is engageable with the second cannula tube part.

26. The system of claim 25, wherein the second cannula tube part is configured to mate with a proximal end opening of the first cannula tube part, and wherein the second cannula tube part comprises a mounting flange configured to removably mount the cannula tube to a manipulator system of a surgical system.

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