Controlled pressure endoscopic and percutaneous surgery

A system for controlling pressure during percutaneous kidney surgeries by converting an open percutaneous surgical procedure into a closed surgical procedure, the system comprising:

• a sheath comprising a proximal end and a distal end, the distal end of the sheath having an elongate percutaneous insertion section for insertion through the skin of the patient and extending to a surgical site, the sheath having a cross-sectional dimension configured to receive endoscopes of various diameters therethrough, the sheath and endoscope forming a space defining an open passage for irrigation outflow;
• a removable cap configured to engage the proximal end of the sheath, the cap comprising:
• a main body portion comprising:
• a circumferential pliable wall portion shaped to surround the proximal end of the sheath, the wall portion configured to engage sheaths of various dimensions, at least one sheath dimension comprising 30 French;
• a proximal end portion comprising an opening through which an endoscope can be introduced, the opening configured to form a seal around the endoscope, the opening being configured to receive endoscopes of various dimensions;
• an open distal end portion, and
• a closure mechanism mounted on the wall portion of the cap and configured to apply circumferential pressure to the cap to secure it to the proximal end of the sheath, the closure mechanism having an open position which does not apply cinching pressure to the cap, and a closed position which does apply cinching pressure to the cap, the closure system when in the open position providing replaceability of the cap on the sheath or other sheaths;
• the main body portion of the cap and the proximal end portion defining a closure of the passage at the proximal end of the sheath;
• an inflow port extending from the main body portion, the inflow port providing access from an irrigation source, the irrigation source including a pump to supply irrigation fluids to the lumen of the sheath;
• an outflow port extending from the main body portion, the outflow port providing an outlet for fluid flowing out of the sheath when the sheath cap is secured to the sheath, the outflow port being in fluid communication with a suction device;
• a pressure sensor connected to the sheath cap, the pressure sensor configured to generate a pressure measurement of the internal renal pelvic pressure at the surgical site within the patient;
• a user input control associated with the sheath to allow a user to input a desired internal pressure target;
• and
• a processing unit in communication with the pressure sensor, the user input control, the pump, and the suction device, the processing unit configured to direct fluid through at least one of the inflow port and the outflow port based on the pressure measurement to maintain the desired input pressure target, wherein the processing unit is configured to maintain a renal pelvic pressure at least in the range of about 15 mmHg and about 40 mmHg.