Surgical access device having a variable tissue approach angle

Abstract

Surgical access devices having wound closure features incorporated as part of the device are provided. The devices allow suture to be inserted directly into the device and operated to close an opening through which the device is disposed as or shortly after the device is removed from the surgical site. Further, the wound closure features allow for various orientations of wound closure to be achieved by adjusting an angle at which the suture enters tissue surrounding the opening to be closed. Some of the wound closure features provided for include openings formed in both the housing and cannula of the surgical access device, multiple openings formed in one or both the housing and cannula, locations of the openings being adjustable or otherwise movable, and various flexible seals. Other features, as well as methods of closing an opening through which the surgical access device was disposed, are also provided.

1 .- 33 . (canceled) 
     
     
         34 . A surgical device comprising:
 (a) a proximal structure extending along a longitudinal axis, wherein the proximal structure includes:
 (i) a first entry port disposed on a first side of the longitudinal axis, and 
 (ii) a second entry port disposed on the first side of the longitudinal axis; and 
   (b) a cannula extending distally from the proximal structure and having a distal end configured to pass through tissue and into a body cavity of a patient, wherein the cannula includes:
 (i) a working channel sized and configured to receive a surgical instrument axially therethrough, 
 (ii) a first exit port disposed on a second side of the longitudinal axis, and 
 (iii) a second exit port disposed on the second side of the longitudinal axis, 
   wherein the first entry port is configured to cooperate with the first exit port to define a first suture path passing from the first side to the second side and having a first angle relative to the longitudinal axis,   wherein the second entry port is configured to cooperate with the second exit port to define a second suture path passing from the first side to the second side and having a second angle relative to the longitudinal axis, wherein each of the first and second suture paths is configured to receive suture therethrough.   
     
     
         35 . The surgical device of  claim 34 , wherein the first and second entry ports are both defined by a common guide structure, wherein the common guide structure extends away from the longitudinal axis and extends from an external surface of the proximal structure. 
     
     
         36 . The surgical device of  claim 34 , wherein the proximal structure includes a third entry port disposed on the first side of the longitudinal axis. 
     
     
         37 . The surgical device of  claim 36 , wherein the cannula includes a third exit port disposed on the second side of the longitudinal axis, wherein the third entry port is configured to cooperate with the third exit port to define a third suture path passing from the first side to the second side and having a third angle relative to the longitudinal axis. 
     
     
         38 . The surgical device of  claim 36 , wherein the second entry port is proximal of the third entry port. 
     
     
         39 . The surgical device of  claim 36 , wherein the common guide structure further defines the third entry port on the first side of the longitudinal axis. 
     
     
         40 . The surgical device of  claim 34 , wherein the first entry port is proximal of the second entry port. 
     
     
         41 . The surgical device of  claim 34 , wherein the first entry port is configured to cooperate with the second exit port to define a third suture path extending from the first side to the second side and having a third angle relative to the longitudinal axis. 
     
     
         42 . The surgical device of  claim 41 , wherein the proximal structure further includes a third entry port disposed on the first side of the longitudinal axis, wherein the cannula further includes a third exit port disposed on the second side of the longitudinal axis, wherein the third entry port is configured to cooperate with any of the first exit port, the second exit port, or the third exit port to define a fourth suture path extending from the first side to the second side and having a fourth angle relative to the longitudinal axis. 
     
     
         43 . A surgical device comprising:
 (a) a proximal structure extending along a longitudinal axis, wherein the proximal structure includes an adjustable entry port disposed on a first side of the longitudinal axis, wherein the adjustable entry port is configured to receive a suture device; and   (b) a cannula extending distally from the proximal structure and having a distal end configured to pass through tissue and into a body cavity of a patient, wherein the cannula includes:
 (i) a working channel sized and configured to receive a surgical instrument axially therethrough, and 
 (ii) an exit port including an elongate shape, 
   wherein the adjustable entry port is configured to cooperate with the exit port to define a suture path that extends across the working channel at a suture path angle relative to the longitudinal axis,   wherein the adjustable entry port is configured to move relative to the proximal structure between a plurality of entry port positions each defining a respective suture path angle.   
     
     
         44 . The surgical device of  claim 43 , further including a rotary dial configured to rotate relative to the proximal structure and about the longitudinal axis between a plurality of rotary dial positions each corresponding to a respective entry port position and a respective suture path angle. 
     
     
         45 . The surgical device of  claim 44 , wherein the rotary dial includes a receiving opening configured to allow the suture device to pass through the rotary dial from the adjustable entry port to the exit port. 
     
     
         46 . The surgical device of  claim 45 , wherein the rotary dial includes a cam surface configured to engage the suture device when the rotary dial is rotated about the longitudinal axis to adjust an angular orientation of the suture device relative to the longitudinal axis. 
     
     
         47 . The surgical device of  claim 46 , wherein the rotary dial is rotatable to adjust the suture path angle from about 15 degrees to about 60 degrees. 
     
     
         48 . The surgical device of  claim 43 , wherein a portion of the proximal structure is configured to rotate relative to the cannula around the longitudinal axis to adjust the suture path angle. 
     
     
         49 . The surgical device of  claim 43 , wherein the proximal structure includes a slot, wherein the adjustable entry port is configured to be moved along a length of the slot, wherein the slot extends parallel with the longitudinal axis. 
     
     
         50 . The surgical device of  claim 43 , wherein the elongate shape of the exit port has a length that extends in a direction transverse to the longitudinal axis. 
     
     
         51 . The surgical device of  claim 43 , wherein the elongate shape of the exit port has a length that extends in a direction parallel to the longitudinal axis. 
     
     
         52 . A surgical device comprising:
 (a) a proximal structure extending along a longitudinal axis, wherein the proximal structure includes an entry port disposed on a first side of the longitudinal axis, wherein the entry port is configured to receive a suture device; and   (b) a cannula extending distally from the proximal structure and having a distal end configured to pass through tissue and into a body cavity of a patient, wherein the cannula includes:
 (i) a working channel sized and configured to receive a surgical instrument axially therethrough, 
 (ii) an elongate exit port configured to receive the suture device, wherein the elongate exit port is disposed on a second side of the longitudinal axis, and 
 (iii) a seal configured to cover the elongate exit port and prevent fluids from entering the working channel, 
   wherein the entry port is configured to cooperate with the elongate exit port to define a suture path that extends across the working channel,   wherein the elongate exit port is configured to allow a suture device to pass along the suture path at multiple discrete suture path angles relative to the longitudinal axis.   
     
     
         53 . The surgical device of  claim 52 , wherein the cannula includes a recessed portion having a first diameter and a remaining cannula portion having a second diameter that is larger than the first diameter, wherein the seal includes a sleeve configured to be fitted around the recessed portion, wherein the sleeve includes an outside diameter that is equal to the second diameter such that the sleeve is configured to sit flush with an outer surface of the remaining cannula portion.