# US 2017/0281154 A1 · Surgical access devices with integrated wound closure features > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 2017/0281154 A1 - Document ID: US20170281154A1 - Status: Published application - Kind: A1 - Application number: 15/088,723 - Filed: 2016-04-01 - Published: 2017-10-05 - Earliest claimed: 2016-04-01 - Assignees: Ethicon, Inc. - Applicants: Ethicon Endo-Surgery, LLC - Inventors: Christopher J. Hess; Frederick E. Shelton, IV; Jerome R. Morgan; Ryan A. Bledsoe; Douglas E. Withers; Craig T. Gates - Web page: https://patentgrep.com/patent/US20170281154A1 ## CPC - A61B 17/0469: {Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery} - A61B 17/0057: {Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect (sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009)} - A61B 17/0218: {for minimally invasive surgery (A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence)} - A61B 17/0482: {Needle or suture guides (guides for drills, pins or wire A61B17/17; guides for puncturing needles A61B17/3403)} - A61B 17/3417: {Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating (syringe needles A61M5/32; dilators A61M29/00)} - A61B 17/3421: {Cannulas} - A61B 17/3423: {Access ports, e.g. toroid shape introducers for instruments or hands (access sites for liquids A61M39/0247)} - A61B 17/3439: {with means for changing the inner diameter of the cannula, e.g. expandable (A61B17/3423, A61B17/3431 take precedence; catheters A61M25/0662)} - A61B 17/3462: {with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals (expandable cannulas A61B17/3417)} - A61M 39/04: having pierceable self-sealing members - A61B 2017/00637: {for sealing trocar wounds through abdominal wall} - A61B 2017/00663: {the implement being a suture} - A61B 2017/0225: {flexible, e.g. fabrics, meshes, or membranes} - A61B 2017/3441: {with distal sealing means} - A61B 2017/3445: {used as instrument channel for multiple instruments} - A61B 2017/3464: {with means acting on inner surface of valve or seal for expanding or protecting, e.g. inner pivoting fingers} - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) - A61M: DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY (introducing media into or onto the bodies of animals A61D7/00; means for inserting tampons A61F13/26; devices for administering food or medicines orally A61J; containers for collecting, storing or administering blood or medical fluids A61J1/05); DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY (surgery A61B; chemical aspects of surgical articles A61L); DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR {(Electrotherapy, e.g. producing anaesthesia by the use of alternating or intermittent currents A61N1/36021)} ## 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. ## Claims ### Claim 1 A surgical access device, comprising: a housing having a central lumen extending therethrough and a sidewall disposed around the central lumen, the sidewall having at least one opening extending therethrough, the at least one opening having an opening seal associated therewith; a cannula extending distally from the housing and in fluid communication with the central lumen to define a working channel that is sized and configured to receive a surgical instrument, the cannula having at least one sealed opening extending through a sidewall thereof; and a seal disposed within the working channel and configured to seal the working channel when no surgical instrument is disposed therethrough, wherein the at least one opening extending through the sidewall of the housing and the at least one sealed opening extending through the sidewall of the cannula are configured to form a suture path such that a suture can be passed from an outside environment, through the at least one opening of the housing, through the at least one sealed opening of the cannula, and to a surgical site. ### Claim 2 (depends on 1) The device of claim 1, wherein the at least one opening extending through the sidewall of the housing and the at least one sealed opening extending through the sidewall of the cannula are configured such that an angle formed between a central longitudinal axis extending through the cannula and an axis extending between the at least one opening extending through the sidewall of the housing and the at least one sealed opening extending through the sidewall of the cannula is adjustable. ### Claim 3 (depends on 2) The device of claim 2, wherein the at least one opening extending through the sidewall of the housing comprises a plurality of openings extending through the sidewall of the housing, each opening having a seal associated therewith, and wherein the angle is adjustable as a result of the axis extending between the at least one opening extending through the sidewall of the housing and the at least one sealed opening extending through the sidewall of the cannula having a first position at which the axis extends between a first opening of the plurality of openings extending through the sidewall of the housing and an opening of the at least one sealed opening extending through the sidewall of the cannula, and a second position at which the axis extends between a second opening of the plurality of openings extending through the sidewall of the housing and the opening of the at least one sealed opening extending through the sidewall of the cannula. ### Claim 4 (depends on 2) The device of claim 2, wherein the at least one sealed opening extending through the sidewall of the cannula comprises a plurality of sealed openings extending through the sidewall of the cannula, and wherein the angle is adjustable as a result of the axis extending between the at least one opening extending through the sidewall of the housing and the at least one sealed opening extending through the sidewall of the cannula having a first position at which the axis extends between an opening of the at least one opening extending through the sidewall of the housing and a first sealed opening of the plurality of sealed openings extending through the sidewall of the cannula, and a second position at which the axis extends between the opening of the at least one opening extending through the sidewall of the housing and a second sealed opening of the plurality of sealed openings extending through the sidewall of the cannula. ### Claim 5 (depends on 2) The device of claim 2, wherein the at least one opening extending through the sidewall of the housing comprises an elongate opening having an elongate length that extends substantially parallel to the central longitudinal axis, the elongate opening comprising an adjustable entry point movable along the elongate length to adjust the angle formed between the central longitudinal axis extending through the cannula and the axis extending between the elongate opening and the at least one sealed opening extending through the sidewall of the cannula. ### Claim 6 (depends on 2) The device of claim 2, wherein the housing comprises: a first rotary disc having a first opening of the at least one opening extending through the sidewall of the housing disposed thereon, the first rotary disc being configured to rotate about the central longitudinal axis extending through the cannula; and a second rotary disc disposed distal of the first rotary disc and having a second opening of the at least one openings extending through the sidewall of the housing disposed thereon, the second rotary disc being configured to rotate about the central longitudinal axis extending through the cannula, and wherein the first and second openings are movable to adjust the angle formed between the central longitudinal axis extending through the cannula and the axis extending between the at least one opening extending through the sidewall of the housing and the at least one sealed opening extending through the sidewall of the cannula. ### Claim 7 (depends on 6) The device of claim 6, wherein the first and second openings are configured to be moved to an alignment position in which the first and second openings are aligned to form an elongate opening having an elongate length that extends substantially parallel to the central longitudinal axis, the elongate opening being configured to allow for multiple entry points of a surgical instrument to thereby provide the adjustable angle formed between the central longitudinal axis extending through the cannula and the axis extending between the at least one opening extending through the sidewall of the housing and the at least one sealed opening extending through the sidewall of the cannula. ### Claim 8 (depends on 2) The device of claim 2, further comprising a rotary dial configured to move the at least one opening extending through the sidewall of the housing to adjust the angle formed between the central longitudinal axis extending through the cannula and the axis extending between the at least one opening extending through the sidewall of the housing and the at least one sealed opening extending through the sidewall of the cannula. ### Claim 9 (depends on 2) The device of claim 2, wherein the angle is adjustable approximately between values of about 15 degrees to about 60 degrees. ### Claim 10 (depends on 1) The device of claim 1, wherein the at least one sealed opening extending through the sidewall of the cannula comprises a seal having a patterned guide surface facing towards the working channel and configured to direct a surgical instrument through one or more pre-defined resealable openings of the seal. ### Claim 11 (depends on 10) The device of claim 10, wherein the patterned guide surface provides a slidable, floating instrument entrance that allows an angle formed between a central longitudinal axis extending through the cannula and an axis extending between the at least one opening extending through the sidewall of the housing and the at least one sealed opening extending through the sidewall of the cannula to be adjustable. ### Claim 12 (depends on 1) The device of claim 1, wherein a proximal portion of the cannula has a portion of the sidewall that is thinner than surrounding portions of the sidewall of the cannula, the thinner portion having the at least one sealed opening extending therethrough, and wherein the device further comprises a sealing sleeve sized to be disposed over the thinner portion such that an outer diameter of the combination of the thinner portion of the sidewall and the sealing sleeve is substantially similar to an outer diameter of the surrounding portions of the sidewall of the cannula, the sealing sleeve providing the sealable nature of the at least one sealed opening. ### Claim 13 A surgical access device, comprising: a housing; a cannula extending distally from the housing, the housing and the cannula defining a working channel extending therethrough that is sized and configured to receive a surgical instrument; a seal disposed within the working channel and configured to seal the working channel when no instrument is disposed therethrough; at least one entry port disposed in or proximate to the housing, the at least one entry port having a seal associated therewith; and at least one sealed exit port extending through a sidewall of the cannula, wherein the at least one entry port and the at least one sealed exit port are configured such that an angle formed between a central longitudinal axis extending through the cannula and an axis extending between the at least one entry port and the at least one sealed exit port is adjustable. ### Claim 14 (depends on 13) The device of claim 13, wherein the angle is adjustable approximately between values of about 15 degrees to about 60 degrees. ### Claim 15 (depends on 13) The device of claim 13, wherein the at least one entry port comprises a plurality of entry ports disposed in or proximate to the housing, each entry port having a seal associated therewith, and wherein the angle is adjustable as a result of the axis extending between the at least one entry port and the at least one sealed exit port having a first position at which the axis extends between a first entry port of the plurality of entry ports and a sealed exit port of the at least one sealed exit port, and a second position at which the axis extends between a second entry port of the plurality of entry ports and the sealed exit port of the at least one sealed exit port. ### Claim 16 (depends on 13) The device of claim 13, wherein the at least one sealed exit port comprises a plurality of sealed exit ports extending through the sidewall of the cannula, and wherein the angle is adjustable as a result of the axis extending between the at least one entry port and the at least one sealed exit port having a first position at which the axis extends between an entry port of the at least one entry port disposed in or proximate to the housing and a first sealed exit port of the plurality of sealed exit ports, and a second position at which the axis extends between the entry port of the at least one entry port and a second sealed exit port of the plurality of sealed exit ports. ### Claim 17 (depends on 13) The device of claim 13, wherein the at least one entry port comprises an elongate opening having an elongate length that extends substantially parallel to the central longitudinal axis, the elongate opening comprising an adjustable entry point movable along the elongate length to adjust the angle formed between the central longitudinal axis extending through the cannula and the axis extending between the elongate opening and the at least one sealed exit port. ### Claim 18 (depends on 13) The device of claim 13, wherein the housing comprises: a first rotary disc having a first entry port of the at least one entry port disposed in or proximate to the housing disposed thereon, the first rotary disc being configured to rotate about the central longitudinal axis extending through the cannula; and a second rotary disc disposed distal of the first rotary disc and having a second entry port disposed in or proximate to the housing disposed thereon, the second rotary disc being configured to rotate about the central longitudinal axis extending through the cannula, and wherein the first and second entry ports are movable to adjust the angle formed between the central longitudinal axis extending through the cannula and the axis extending between the at least one entry port and the at least one sealed exit port. ### Claim 19 (depends on 18) The device of claim 18, wherein the first and second openings are configured to be moved to an alignment position in which the first and second openings are aligned to form an elongate opening having an elongate length that extends substantially parallel to the central longitudinal axis, the elongate opening being configured to allow for multiple entry points of a surgical instrument to thereby provide the adjustable angle formed between the central longitudinal axis extending through the cannula and the axis extending between the at least one entry port and the at least one sealed exit port. ### Claim 20 (depends on 13) The device of claim 13, further comprising a rotary dial configured to move the at least one entry port to adjust the angle formed between the central longitudinal axis extending through the cannula and the axis extending between the at least one entry port and the at least one sealed exit port. ### Claim 21 (depends on 13) The device of claim 13, wherein the at least one sealed exit port comprises a seal having a patterned guide surface facing towards the working channel and configured to direct a surgical instrument through one or more pre-defined resealable openings of the seal. ### Claim 22 (depends on 21) The device of claim 21, wherein the patterned guide surface provides a slidable, floating instrument entrance that allows the angle to be adjustable. ### Claim 23 (depends on 13) The device of claim 13, wherein a proximal portion of the cannula has a portion of the sidewall that is thinner than surrounding portions of the sidewall of the cannula, the thinner portion having the at least one sealed exit port extending therethrough, and wherein the device further comprises a sealing sleeve sized to be disposed over the thinner portion such that an outer diameter of the combination of the thinner portion of the sidewall and the sealing sleeve is substantially similar to an outer diameter of the surrounding portions of the sidewall of the cannula, the sealing sleeve providing the sealable nature of the at least one sealed exit port. ### Claim 24 A surgical method, comprising: passing a first filament tail through a first opening extending through a sidewall of a housing of a surgical access device passing the first filament tail through a first opening extending through a sidewall of a cannula that extends distally from the housing; passing the first filament tail through tissue adjacent to an opening in tissue; passing a second filament tail through a second opening extending through the sidewall of the housing of the surgical access device; passing the second filament tail through a second opening extending through the sidewall of the cannula; passing the second filament tail through tissue adjacent to the opening in the tissue; applying tension to at least one of the first and second filament tails to decrease a size of the opening in the tissue. ### Claim 25 (depends on 24) The method of claim 24, wherein at least one of the steps of passing the first filament tail through a first opening extending through a sidewall of the housing and passing a second filament tail through a second opening extending through the sidewall of the housing further comprises: selecting one opening of a plurality of openings extending through the sidewall of the housing that are proximate to each other to be the respective first or second opening based on the desired angle at which the respective first or second filament tail is to passed through the tissue. ### Claim 26 (depends on 24) The method of claim 24, wherein at least one of the steps of passing the first filament tail through a first opening extending through a sidewall of the cannula and passing a second filament tail through a second opening extending through the sidewall of the cannula further comprises: selecting one opening of a plurality of openings extending through the sidewall of the cannula to be the respective first or second opening based on the desired angle at which the respective first or second filament tail is to passed through the tissue. ### Claim 27 (depends on 24) The method of claim 24, wherein at least one of the first and second openings extending through the sidewall of the housing comprises an elongate opening having an elongate length that extends substantially parallel to a central longitudinal axis extending through the cannula and an adjustable entry point movable along the elongate length, the method further comprising: moving the adjustable entry point longitudinally to adjust an angle at which the respective first or second filament tail is directed to enter the tissue. ### Claim 28 (depends on 24) The method of claim 24, further comprising: moving at least one of the first and second openings extending through the sidewall of the housing to adjust an angle at which the respective first or second filament tail is directed to enter the tissue.