Single port instrument access device
Disclosed are medical devices for surgical procedures, especially procedures that involve the manipulation of surgical instrument end effectors close to the skin surface at an incision site. In accordance with some embodiments, an instrument access device is configured to couple to a wound retractor at a distal end of the device and to receive a multiple instrument entry guide in a port at the proximal end of the instrument access device, with an envelope between the distal and proximal ends defining a sealed cavity for maintaining insufflation pressure. Various embodiments provide means for rotating an assistant port in the envelope about a port that receives the instrument entry guide without twisting the envelope. Also disclosed are various envelope shapes. Also disclosed is an instrument entry guide that aligns surgical instrument shafts.
1 . A medical device comprising:
an envelope comprising a proximal opening; and
a proximal coupling component in the proximal opening of the envelope;
the proximal coupling component comprising:
an outer element coupled to the envelope,
an orbital element comprising a first opening and a second opening,
an entry guide receptacle received in the first opening, and
a gear train coupling the entry guide receptacle to the outer element;
the gear train comprising:
a first gear fixedly positioned in the proximal opening of the envelope,
a second gear fixedly coupled to a periphery of the entry guide receptacle, and
one or more intermediate gears engaged with the first and the second gears,
the first gear being rotatable relative to the second gear without rotating around a central axis of the first gear, and
the one or more intermediate gears being rotatable and translatable relative to the first gear and the second gear.
2 . The medical device of claim 1 , wherein:
the orbital element comprises a center; and
the first and second openings are positioned eccentrically on the orbital element.
3 . The medical device of claim 1 , wherein:
movement of the first gear, the second gear, and the one or more intermediate gears rotate the orbital element and the second opening around the first opening and the entry guide receptacle.
4 . The medical device of claim 1 , wherein the one or more intermediate gears comprise:
an idler gear; and
an intermediate gear;
the idler gear being engaged with the second gear and the intermediate gear; and
the intermediate gear being engaged with the idler gear and the first gear.
5 . The medical device of claim 4 , wherein:
the intermediate gear comprises a step gear comprising a third gear and a fourth gear coupled to the third gear;
the third gear is engaged with the first gear; and
the fourth gear engaged with the idler gear.
6 . The medical device of claim 5 , wherein:
a gear ratio of the third gear to the fourth gear is equal to a gear ratio of the first gear to the second gear.
7 . The medical device of claim 5 , wherein:
the first gear and the second gear are ring gears; and
the idler gear and the intermediate gear are spur gears.
8 . The medical device of claim 1 , wherein:
the one or more intermediate gears comprise a step gear comprising a third gear and a fourth gear coupled to the third gear;
the third gear being engaged with the first gear; and
the fourth gear being engaged with the second gear.
9 . The medical device of claim 8 , wherein:
a gear ratio of the third gear to the fourth gear is equal to a gear ratio of the first gear to the second gear.
10 . The medical device of claim 8 , wherein:
the first gear and the second gear are ring gears; and
the third gear and the fourth gear are spur gears.
11 . The medical device of claim 1 , wherein:
the envelope pressurized with insufflation gas comprises a spherical shape.
12 . The medical device of claim 1 , wherein:
the envelope pressurized with insufflation gas comprises an oblate spherical shape.
13 . The medical device of claim 1 , wherein:
the envelope pressurized with insufflation gas comprises a lenticular shape.
14 . The medical device of claim 1 , wherein:
the envelope pressurized with insufflation gas comprises a barrel shape.
15 . The medical device of claim 1 , wherein:
the envelope pressurized with insufflation gas comprises a bellows shape.
16 . The medical device of claim 1 , wherein:
the envelope pressurized with insufflation gas comprises an ovoid shape.
17 . The medical device of claim 1 , further comprising:
a distal coupling component coupled to a distal opening of the envelope.
18 . The medical device of claim 17 , wherein:
the distal coupling component is configured to be coupled to a wound retractor assembly.
19 . The medical device of claim 1 , further comprising:
a multiple instrument entry guide received in the entry guide receptacle.
20 . The medical device of claim 19 , further comprising:
an entry guide seal received in the entry guide receptacle;
wherein the multiple instrument entry guide is received in and sealed by the entry guide seal.
21 . The medical device of claim 1 , wherein:
movement of the gear train rotates the orbital element and the second opening around the first opening and the entry guide receptacle.