Access system with removable outflow channel

Abstract

A surgical access device can comprise a working channel providing a first lumen having an axial opening for insertion of a surgical instrument having an outflow channel, the first lumen having a fluid inlet for allowing fluid flow through the working channel and into the body, wherein fluid flows out of the body through the outflow channel of the surgical instrument; and a optical channel providing a second lumen for a visualization element and a light source, wherein the working channel comprises a larger cross-sectional area than the cross-sectional area of the optical channel. The surgical access device can further comprise a seal apparatus coupled to the working channel and configured to receive the surgical instrument, the seal apparatus comprising a first seal portion and a second seal portion, the first seal portion configured to close the fluid path into the seal apparatus, and the second seal portion configured to form a seal with the surgical instrument.

1 . A method of accessing an internal site in a uterus of a patient, the method comprising:
 positioning a hysteroscope within the uterus, the hysteroscope comprising a proximal end, a distal end, and an elongate body extending therebetween, the elongate body having a working channel extending axially through the hysteroscope;   connecting the working channel to an inflow fluid source for introducing inflow fluid into the patient through the working channel;   inserting axially a removable outflow channel through the working channel, the removable outflow channel having a lumen extending between a distal end and a proximal end of the removable outflow channel;   connecting the removable outflow channel to a vacuum source for removing inflow fluid from the patient through the removable outflow channel;   distending the uterus by introducing the inflow fluid into the working channel and into the uterus; and   removing the removable outflow channel from the working channel by proximally retracting the removable outflow channel to a first position to close a seal device coupled to the proximal end of the hysteroscope, wherein the seal device prevents the inflow fluid from escaping from the proximal end of the hysteroscope.   
     
     
         2 . The method of  claim 1 , wherein inserting axially the removable outflow channel through the working channel further comprises opening the seal device coupled to the proximal end of the hysteroscope and generating a seal between the removable outflow channel and the hysteroscope. 
     
     
         3 . The method of  claim 1 , wherein the seal device comprises a first sealing element and a second sealing element, the first sealing element positioned distal relative to the second sealing element. 
     
     
         4 . The method of  claim 3 , wherein retracting the removable outflow channel to the first position closes the first sealing element to prevent the inflow fluid from escaping from the proximal end of the hystroscope while the second sealing element maintains a seal around the removable outflow channel to prevent back splash as the first sealing element closes. 
     
     
         5 . The method of  claim 1 , further comprising advancing axially a surgical tool through the removable outflow channel and into the patient. 
     
     
         6 . The method of  claim 5 , further comprising:
 retracting axially the surgical tool from the removable outflow channel;   retracting axially the removable outflow channel from the working channel; and   advancing axially a morcellator through the working channel and into the patient, the morcellator having an outflow channel.   
     
     
         7 . The method of  claim 5 , further comprising:
 retracting axially the surgical tool from the removable outflow channel; and   advancing axially a morcellator through the removable outflow channel and into the patient.   
     
     
         8 . The method of  claim 1 , further comprising:
 advancing axially a surgical instrument through the working channel and into the patient, the surgical instrument having an outflow channel.   
     
     
         9 . The method of  claim 8 , wherein the surgical instrument is a morcellator. 
     
     
         10 . The method of  claim 1 , wherein connecting the working channel to an inflow fluid source creates an inflow fluid path. 
     
     
         11 . The method of  claim 10 , further comprising removing the surgical instrument from the working channel by proximally retracting the surgical instrument to a first position to close a first seal of the seal device, wherein the first seal closes the inflow fluid path. 
     
     
         12 . The method of  claim 11 , wherein the removing the surgical instrument further comprises proximally retracting the surgical instrument to a second position to close a second seal of the seal device. 
     
     
         13 . The method of  claim 11 , wherein at least one of the first or second seals comprises a dome-shaped portion having at least one slit opening. 
     
     
         14 . The method of  claim 13 , wherein the dome-shaped portion comprises a concave side, the concave side positioned to face the distal end of the hysteroscope. 
     
     
         15 . The method of  claim 13 , wherein the at least one slit opening in the dome-shaped portion is formed by cutting from the concave side. 
     
     
         16 . A method of accessing an internal site in a uterus of a patient, the method comprising:
 positioning a hysteroscope within the uterus, the hysteroscope comprising a proximal end, a distal end, and an elongate body extending therebetween, the elongate body having a working channel extending axially through the hysteroscope;   connecting the working channel to an inflow fluid source for introducing inflow fluid into the patient through the working channel;   inserting axially a morcellator through the working channel, the morcellator having a lumen extending between a distal end and a proximal end of the morcellator;   connecting the morcellator to a vacuum source for removing inflow fluid from the patient through the morcellator;   distending the uterus by introducing the inflow fluid into the working channel and into the uterus; and   removing the morcellator from the working channel by proximally retracting the morcellator to a first position to close a seal device coupled to the proximal end of the hysteroscope, wherein the seal device prevents the inflow fluid from escaping from the proximal end of the hysteroscope.   
     
     
         17 . The method of  claim 16 , wherein inserting axially the morcellator through the working channel further comprises opening the seal device coupled to the proximal end of the hysteroscope and generating a seal between the morcellator and the hysteroscope. 
     
     
         18 . The method of  claim 16 , wherein the seal device comprises a first sealing element and a second sealing element, the first sealing element positioned distal relative to the second sealing element. 
     
     
         19 . The method of  claim 18 , wherein retracting the morcellator to the first position closes the first sealing element to prevent the inflow fluid from escaping from the proximal end of the hystroscope while the second sealing element maintains a seal around the morcellator to prevent back splash as the first sealing element closes. 
     
     
         20 . The method of  claim 18 , wherein at least one of the first or second seal elements comprises a dome-shaped portion having a slit opening.