Medical devices for
surgical procedures are disclosed, particularly procedures involving manipulation of a
surgical instrument end
effector proximate a
skin surface at an
incision site. According to some embodiments, an instrument access device is configured to couple to a
wound retractor at a distal end of the device and receive a multi-instrument entry guide in a port at a proximal end of the instrument access device, with an envelope between a distal end and a proximal end defining a sealed cavity for maintaining a
gas pressure. Various embodiments provide means for rotating an auxiliary port in the envelope around a port receiving an instrument entry guide without twisting the envelope. Various envelope shapes are also disclosed. An instrument entry guide that aligns a
surgical instrument shaft is also disclosed.