阅读说明：本技术 具有斜针***孔口和共面活塞的套管针 (Trocar with oblique needle insertion port and coplanar piston ) 是由 S·K·帕里哈 J·L·哈里斯 F·E·谢尔顿四世 于 2018-06-19 设计创作，主要内容包括：本发明公开了一种外科进入装置，所述外科进入装置包括插管和联接到所述插管的近侧端部的外壳组件。由插管管腔和外壳内部限定的工作通道沿所述外科进入装置的中心轴线在所述外科进入装置的近侧端部和远侧端部之间延伸。所述工作通道被构造成能够接纳外科器械，并且吹入孔口被构造成能够将吹入流体引导到所述工作通道中。第一针孔口和第二针孔口经所述外科进入装置的相应第一侧部分和第二侧部分通向所述工作通道。所述第一针孔口与所述吹入孔口沿直径相对。所述第一针孔口和所述第二针孔口中的每一者被构造成能够引导缝合线穿引器针以相对于所述中心轴线的倾斜角度横穿所述工作通道地穿过所述外科进入装置。(A surgical access device includes a cannula and a housing assembly coupled to a proximal end of the cannula. A working channel defined by a cannula lumen and a housing interior extends along a central axis of the surgical access device between proximal and distal ends of the surgical access device. The working channel is configured to receive a surgical instrument, and the insufflation aperture is configured to direct insufflation fluid into the working channel. First and second needle apertures open into the working channel through respective first and second side portions of the surgical access device. The first needle aperture is diametrically opposed to the insufflation aperture. Each of the first and second needle apertures is configured to guide a suture passer needle through the surgical access device at an oblique angle relative to the central axis across the working channel.)

1. A surgical access device, comprising:

(a) a cannula having a proximal end, a distal end, and a cannula lumen extending between the proximal and distal ends;

(b) a housing assembly coupled to the proximal end of the cannula, wherein the housing assembly defines a housing interior in communication with the cannula lumen;

(c) a working channel extending along a central axis of the surgical access device from a proximal end of the surgical access device to a distal end of the surgical access device, wherein the working channel is defined by the cannula lumen and the housing interior, wherein the working channel is configured to receive a surgical instrument therethrough;

(d) an insufflation orifice configured to direct insufflation fluid into the working channel;

(e) a first needle aperture opening into the working channel through a first side portion of the surgical access device, wherein the first needle aperture is diametrically opposed to the insufflation aperture; and

(f) a second needle aperture opening into the working channel through a second side portion of the surgical access device,

wherein each of the first and second needle apertures is configured to guide a suture passer needle through the surgical access device at an oblique angle relative to the central axis across the working channel.

2. The surgical access device of claim 1, wherein the second needle aperture is circumferentially offset from the insufflation aperture.

3. The surgical access device of claim 2, wherein the second needle aperture is circumferentially offset from the insufflation aperture by at least 17 degrees.

4. The surgical access device of claim 1, wherein the housing assembly comprises a proximal housing and a latch ring configured to releasably couple the proximal housing with the cannula, wherein the latch ring comprises a user engagement feature actuatable to release the proximal housing from the cannula, wherein the user engagement feature is circumferentially offset from the insufflation aperture throughout an allowable range of motion of the user engagement feature.

5. The surgical access device of claim 4, wherein the latch ring is movable to a position in which the user engagement feature is circumferentially offset from the insufflation aperture by at least 90 degrees.

6. The surgical access device of claim 4, wherein the user engagement feature comprises an outwardly projecting knob.

7. The surgical access device of claim 4, wherein the latch ring is rotatable about the central axis relative to the proximal housing.

8. The surgical access device of claim 1, wherein the cannula comprises a proximal hub configured to couple with the housing assembly, wherein the first and second needle apertures extend through the proximal hub.

9. The surgical access device of claim 1, wherein the first needle aperture comprises a first needle entry aperture and the second needle aperture comprises a second needle entry aperture, wherein the surgical access device further comprises a first needle exit aperture disposed distally of the first needle entry aperture and a second needle exit aperture disposed distally of the second needle entry aperture, wherein the first needle entry aperture and the first needle exit aperture together define a first suture pathway extending obliquely across the central axis of the surgical access device, wherein the second needle entry aperture and the second needle exit aperture together define a second suture pathway extending obliquely across the central axis of the surgical access device.

10. A surgical access device as recited in claim 9, wherein the cannula includes a proximal hub and a cylindrical portion extending distally from the proximal hub, wherein the first and second needle exit apertures open to the working channel through the cylindrical portion.

11. The surgical access device of claim 9, wherein the first and second needle entry apertures and the first and second needle exit apertures are arranged such that the first and second suture pathways extend through the central axis of the surgical access device.

12. The surgical access device of claim 9, further comprising a first needle guide structure configured to guide a suture passer needle through the first needle access aperture along the first suture path, and a second needle guide structure configured to guide a suture passer needle through the second needle access aperture along the second suture path.

13. The surgical access device of claim 12, wherein the first and second needle guide structures comprise first and second needle guide tubes.

14. The surgical access device of claim 9, wherein the first needle exit aperture is diametrically opposed to the first needle entry aperture, wherein the second needle exit aperture is diametrically opposed to the second needle entry aperture.

15. The surgical access device of claim 9, wherein the first needle entry aperture, the first needle exit aperture, and the insufflation aperture are located in a plane extending axially through the surgical access device along the central axis of the surgical access device.

16. A surgical access device, comprising:

(a) a cannula having a proximal hub, a distal tip, and a cannula lumen extending between the proximal hub and the distal tip;

(b) a housing assembly coupled to the proximal hub of the cannula, wherein the housing assembly defines a housing interior in communication with the cannula lumen;

(c) a working channel extending along a central axis of the surgical access device from a proximal end of the surgical access device to a distal end of the surgical access device, wherein the working channel is defined by the cannula lumen and the housing interior, wherein the working channel is configured to receive a surgical instrument therethrough;

(d) an insufflation orifice configured to direct insufflation fluid into the working channel; and

(e) a needle aperture opening through the proximal hub of the cannula to the working channel, wherein the needle aperture is diametrically opposed to the insufflation aperture, wherein the needle aperture is configured to guide a suture passer needle through the surgical access device at an oblique angle relative to the central axis across the working channel.

17. The surgical access device of claim 16, further comprising a second needle aperture opening through the proximal hub of the cannula to the working channel, wherein the second needle aperture is circumferentially offset from the insufflation aperture.

18. A surgical access device, comprising:

(a) a cannula having a proximal end, a distal end, and a cannula lumen extending between the proximal and distal ends;

(b) a housing assembly coupled to the proximal end of the cannula, wherein the housing assembly defines a housing interior in communication with the cannula lumen;

(c) a working channel extending along a central axis of the surgical access device from a proximal end of the surgical access device to a distal end of the surgical access device, wherein the working channel is defined by the cannula lumen and the housing interior, wherein the working channel is configured to receive a surgical instrument therethrough;

(d) an insufflation orifice configured to direct insufflation fluid into the working channel;

(e) a first needle access port opening through a side portion of the surgical access device to the working channel;

(f) a first needle exit aperture opening through a side portion of the surgical access device to the working channel, wherein the first needle exit aperture communicates with the first needle entry aperture to define a first needle channel configured to guide a suture passer needle through the surgical access device at an oblique angle relative to the central axis traversing the working channel;

(g) a second needle aperture opening through a side portion of the surgical access device to the working channel; and

(h) a second needle exit aperture opening through a side portion of the surgical access device to the working channel, wherein the second needle exit aperture is in communication with the second needle entry aperture to define a second needle channel configured to guide a suture passer needle through the surgical access device at an oblique angle relative to the central axis across the working channel,

wherein at least one of the first needle entry aperture or the second needle entry aperture and its respective needle exit aperture is located in an axial plane extending axially through the surgical access device along the central axis of the surgical access device, wherein the axial plane is offset from the insufflation aperture.

19. The surgical access device of claim 18, wherein the first needle entry aperture, the first needle exit aperture, and the insufflation aperture are located in a first axial plane extending axially through the surgical access device along the central axis of the surgical access device, wherein the second needle entry aperture and the second needle exit aperture are located in a second axial plane extending axially through the surgical access device along the central axis, wherein the second axial plane is offset from the first axial plane.

20. The surgical access device of claim 18, wherein each of the first and second needle access apertures is circumferentially offset from the insufflation aperture.

Background

A surgical procedure may require a clinician to access a cavity or other desired surgical site within a patient's body. To perform such a surgical procedure, an incision may be made through the patient's tissue into the cavity. Some conventional surgical procedures may apply a knife, such as a surgical knife, to tissue to form an incision, while some less invasive surgical procedures, such as laparoscopic and endoscopic surgical procedures, may access a cavity through a trocar assembly. Conventional trocar assemblies typically include a trocar obturator received within a trocar cannula. In use, a clinician guides the trocar obturator and cannula through tissue to access a cavity at a desired surgical site. Once accessed, the clinician withdraws the trocar obturator from the trocar cannula so that the trocar cannula can be used to introduce a surgical instrument into the cavity for treatment.

The following patents provide examples of trocar assemblies, components thereof, and other types of surgical access devices and wound closure devices: united states patent 7,981,092 entitled "vibrant Trocar" published 7/19/2011; U.S. patent 8,226,553 entitled "Access Device with Insert" published 24/7/2012; U.S. Pat. No. 8,251,900 entitled "Surgical Access Devices and Methods Providing Seal motion Predefined Paths" published at 28/8/2012; us patent 8,579,807 entitled "absorbing fluids in a scientific Access Device" published 11, 12.2013; U.S. patent 8,568,362 entitled "scientific Access Device with Sorbents" published on 29.10.2013; U.S. patent 8,636,686 entitled "scientific Access Device" published on 28.1.2014; U.S. patent 8,690,831 entitled "Gas Jet Fluid Removal in a Trocar" published 4, 8/2014; U.S. patent publication 2008/0200950 entitled "Surgical Hook" published on 21.8.2008; U.S. patent publication 2015/0038793 entitled "Devices, Systems, and Methods for Providing Surgical Access and cosmetic Access of Surgical Access Openings" published on 5.2.2015; U.S. patent publication 2015/0038994 entitled "Devices, Systems, and Methods for Providing Surgical Access and cosmetic closing of Surgical Access Openings" published on 5.2.2015; and U.S. patent publication 2015/0094741 entitled "Wound Closure Device including Mesh Barrier" published on 4/2/2015. The disclosure of each of the above-referenced U.S. patents and publications is incorporated herein by reference.

Surgical instruments used with such surgical access devices can have a distal end effector (e.g., endocutter, grasper, cutter, staplers, clip applier, access device, drug/gene therapy delivery device, and energy delivery device using ultrasonic vibration, RF, laser, etc.) for engaging tissue through the access device in a variety of ways to achieve a diagnostic or therapeutic effect. Laparoscopic and endoscopic surgical instruments may include a shaft between an end effector and a handle portion manipulated by a clinician. Such a shaft may enable insertion to a desired depth and rotation about the longitudinal axis of the shaft, thereby facilitating positioning of the end effector within a cavity of a patient. Positioning the end effector may be further facilitated by including one or more articulation joints or features that enable the end effector to be selectively articulated or otherwise deflected relative to the longitudinal axis of the shaft.

While various surgical instruments including surgical access devices and end effectors, as well as other associated components, have been manufactured and used, it is believed that no one prior to one or more of the inventors has made or used the invention described in the appended claims.

Drawings

The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention and, together with a general description of the invention given above, and the detailed description of the embodiments given below, serve to explain the principles of the invention.

FIG. 1 illustrates a perspective view of an exemplary trocar assembly;

FIG. 2 illustrates a partially exploded side elevational view of the trocar assembly of FIG. 1 having a trocar housing, a trocar cannula and an obturator;

FIG. 3A shows a side cross-sectional view of patient tissue with the trocar assembly of FIG. 1 passed through the tissue for manipulation by a clinician;

FIG. 3B illustrates a side cross-sectional view of the tissue and trocar assembly of FIG. 3A with the trocar assembly of FIG. 1 inserted through tissue and received within a cavity of a patient;

FIG. 3C illustrates a side cross-sectional view of the tissue and trocar assembly of FIG. 3A with the obturator withdrawn from the trocar cannula for access to the cavity via a working channel through the trocar cannula and trocar housing;

FIG. 3D illustrates a side cross-sectional view of the tissue and trocar assembly of FIG. 3C with the trocar housing and trocar cannula removed from the cavity and tissue of the patient;

FIG. 4A shows another side cross-sectional view of the tissue shown in FIGS. 3A-3D after removal of the trocar assembly of FIG. 1, wherein the tissue has an opening therethrough and a suture introduced into a portion of the tissue for suturing the closed opening;

FIG. 4B shows a side cross-sectional view of the tissue of FIG. 4A with a suture introduced through another portion of the tissue and pulled through the tissue;

FIG. 4C shows a side cross-sectional view of the tissue of FIG. 4A with the suture tightened and tied to at least partially close the opening;

FIG. 4D shows a side cross-sectional view of the tissue of FIG. 4A with additional sutures for further closing the opening;

FIG. 5 illustrates a perspective view of an exemplary trocar having a housing assembly, a cannula and a needle port;

FIG. 6 shows an exploded perspective view of the trocar of FIG. 5;

FIG. 7 illustrates a side cross-sectional view of the trocar of FIG. 5 showing an exemplary suture needle threader extending through the trocar along an exemplary first suture path oriented obliquely relative to a central axis of the trocar;

FIG. 8 shows a top elevational view of the trocar of FIG. 5 with a proximal housing of the housing assembly omitted;

FIG. 9 illustrates a top elevation view of another exemplary trocar;

FIG. 10 illustrates a perspective view of another exemplary trocar having a rotating collar; and is

FIG. 11 shows a disassembled perspective view of the rotating collar and distal housing of the trocar of FIG. 10.

The figures are not intended to be limiting in any way and it is contemplated that various embodiments of the invention may be carried out in a variety of other ways, including those not necessarily shown in the figures. The accompanying drawings incorporated in and forming a part of the specification illustrate several aspects of the present invention and, together with the description, serve to explain the principles of the invention; it should be understood, however, that the invention is not limited to the precise arrangements shown.

Detailed Description

The following description of certain examples of the invention should not be used to limit the scope of the invention. Other examples, features, aspects, embodiments and advantages of the invention will become apparent to those skilled in the art from the following description, which is given by way of illustration, one of the best modes contemplated for carrying out the invention. As will be realized, the invention is capable of other different and obvious aspects, all without departing from the invention. Accordingly, the drawings and description are to be regarded as illustrative in nature and not as restrictive.

I. Exemplary surgical AccessDevice for measuring the position of a moving object

Fig. 1-2 illustrate an exemplary surgical access device in the form of a first exemplary trocar assembly (10) that includes a trocar cannula (12) and a trocar obturator (14). A trocar obturator (14) passes through a trocar housing (16) of the trocar cannula (12), removably received within the trocar cannula (12). With the trocar obturator (14) positioned within the trocar cannula (12), as shown in fig. 1, the clinician inserts the trocar assembly (12) through tissue (17) of the patient at the desired surgical site (see fig. 3A) to access a cavity (18) within the patient (see fig. 3A). By way of example only, the trocar assembly (10) may be inserted into the patient's abdominal cavity from between two of the patient's ribs or elsewhere. The tip (20) of the trocar obturator (14) protrudes distally from the trocar cannula (12) to pierce tissue (17) (see fig. 3A) in order to introduce the distal end portion of the trocar cannula (12) into the cavity (18) (see fig. 3B). The clinician withdraws the trocar obturator (14) proximally from the trocar cannula (12) such that a cavity (18) within the patient (see fig. 3C) communicates with the surgical environment via the trocar cannula (12). The clinician may then introduce a fluid, such as a gas, through the trocar cannula (12) for inflating the cavity (18) (see fig. 3A) and/or an end effector of the surgical instrument through the trocar cannula (12) for engaging tissue (17) to achieve a diagnostic or therapeutic effect.

It should be understood that terms such as "proximal" and "distal" are used herein with respect to a clinician grasping the trocar housing (16). Thus, the tip (20) is distal with respect to the more proximal trocar housing (16). It will also be appreciated that, for convenience and clarity, spatial terms such as "vertical" and "horizontal" are used herein in connection with the illustrations. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and absolute. Additionally, in some instances, component designations are interchangeable with and without the term "assembly" (e.g., trocar and trocar assemblies). The absence of a term is intended to mean a particular intention of the different components. Also, terms such as "instrument" and "device" may be used interchangeably.

A. Exemplary trocar Assembly with cannula and obturator

The trocar assembly (10) of fig. 1-2 includes a cannula (12) extending distally from a trocar housing (16). In this example, the trocar housing (16) has a generally cylindrical shape with a proximal removable cover (22) on top of a distal housing chamber (not shown). The cover (22) may be selectively attached to or detached from the housing chamber (not shown). The trocar housing (16) includes a housing sidewall (24) extending circumferentially about a central longitudinal axis (26) and extending through the trocar assembly (10) and thus along the trocar cannula (12). The trocar housing (16) also includes a central lumen (27) extending from a proximal housing end opening (28) to a distal housing end opening (not shown). As shown, the cover (22) selectively mates with the housing sidewall (24) via a distal mating member (not shown), and further includes a proximal mating member, such as a slot (not shown), configured to be removably connectable to a pair of tabs (32) extending distally from a portion of the obturator (14), respectively. However, it should be understood that alternative structures and devices may also be removably connected to the cover (22) during use.

The cannula (12) extends distally from the trocar housing (16) and is also generally defined by a cannula sidewall (33) extending circumferentially about the central longitudinal axis (26). The cannula sidewall (33) extends distally to the beveled end (34) such that the cannula sidewall (33) and the beveled end (34) are configured to be inserted through tissue (17) (see fig. 3A) to access the cavity (18) (see fig. 3A), as discussed in more detail below. To this end, the cannula (12) typically has a smaller diameter than the trocar housing (16) which is configured to remain outside of the tissue (17) (see fig. 3C). Further, the cannula (12) defines an internal lumen (35) having a proximal cannula end opening (not shown) and a distal cannula end opening (36), the internal lumen extending through the beveled end (34). In this example, a distal housing end opening (not shown) of the trocar housing (16) is fluidly connected to a proximal cannula end opening (not shown) such that the central lumen (27) of the trocar housing (16) and the inner lumen (35) of the cannula (12) define a working channel (38). Thus, a working channel (38) extends from the proximal housing end opening (28) to the distal cannula end opening (36) and is configured to receive one or more surgical instruments therethrough for accessing the cavity (18).

In addition, an insufflation orifice (40) is operatively connected to the trocar housing (16) to control the flow of insufflation fluid, such as carbon dioxide, through a portion of the cannula (12) and into the cavity (18). More specifically, the insufflation port (40) includes a piston valve (42) and a stopcock valve stem (44) that may work together to allow and/or prevent insufflation fluid from passing through the trocar housing (16) into the passageway (not shown) and into the trocar cannula (12). The trocar housing (16) and cannula (12) have proximal and distal seal assemblies (not shown) positioned within the central lumen (27) and inner lumen (35) of the working channel (38), respectively. In this example, the proximal seal assembly is an instrument seal (not shown) and the distal seal assembly (not shown) is a zero closure seal, such as a duckbill seal (not shown). An instrument seal (not shown) is retained within the cap (22) and is configured to fluidly seal a surgical instrument extending through the working channel (38). In contrast, when no instrument is disposed through the working channel (38), the duckbill seal (not shown) is configured to form a seal in the working channel, thereby preventing leakage of insufflation fluid during use. Of course, it should be understood that alternative seal assemblies may be positioned within the working channel (38) for preventing such leakage of insufflation fluid.

The duckbill seal is also configured to be manipulated to provide a working channel (38) with an opening that is larger than the corresponding opening provided by the instrument seal. This larger opening provided by the duckbill seal can facilitate extraction of body tissue through the trocar housing (16) during surgery. Specifically, the cap (22) and proximal instrument seal may be removed to expose the duckbill seal and thereby enable the surgeon to extract proximally through the duckbill seal opening body tissue that is too bulky to extract proximally through the instrument seal opening.

As briefly discussed above, the obturator (14) is used with a cannula (12) for inserting a trocar assembly (10) into a patient. The obturator (14) of the present example includes a handle head (46) having a cylindrical shaft (48) extending distally therefrom to a tip (20) that is generally configured to pierce tissue (17) (see fig. 3A), as described in more detail below. The handle head (46) is configured to be grasped by a clinician during use and optionally includes a movable tab (32) extending distally to removably connect with the trocar housing (16) for selective securement. The shaft (48) is received through the working channel (38) such that the tip (20) extends distally from the beveled end (34). Of course, the obturator (14) may be selectively removed from the cannula (12) and trocar housing (16) to release the working channel (38) for use. While the trocar assembly (10) of the present example has an obturator (14), it should be understood that in some examples, the cannula (12) may be inserted without the obturator (14), or may alternatively be configured to assist insertion without the use of the obturator (14).

B. Exemplary methods of accessing a body lumen of a patient

Fig. 3A-3D illustrate the use of the trocar assembly (10) described above to pass through tissue (17) into cavity (18). More specifically, the tissue (17) of the present example has a relatively outward superficial layer and a relatively inward deep layer. The top layer generally includes an outer skin layer (52) and an inner fat layer (54); and the deep layer includes a fibrous and flexible fascia layer (56) having a relatively higher tensile strength than the skin layer. With the obturator (14) received within the cannula (12) and connected to the trocar housing (16), the clinician manipulates the trocar assembly (10) to urge the tip (20) of the obturator (14) against the skin (52) and inwardly toward the cavity (18) while rotating the trocar assembly (10) back and forth, as shown in fig. 3A. Arrows (49) and (50) indicate the inward movement and the rotational movement, respectively. Continued inward pushing of the trocar assembly (10) further guides the distal tip (20) and beveled end (34) of the cannula (12) through the adipose layer (54) and fascia layer (56) and into the cavity (18), as shown in fig. 3B. The clinician then disconnects the obturator (14) from the trocar housing (16) and withdraws the obturator (14) from the cannula (12) to establish access from the exterior of the tissue (17) into the cavity (18) via the working channel (38), as shown in fig. 3C, for achieving a diagnostic or therapeutic effect with another surgical instrument (not shown). Once the diagnostic or therapeutic effect is achieved, the clinician withdraws the cannula (12) and trocar housing (16) outwardly for removal from the tissue (17), as shown in fig. 3D.

As shown in fig. 4A, removal of the cannula (12) from the tissue (17) typically results in a tissue opening (58), which may also be referred to as a tissue aperture or tissue wound, that the clinician closes to promote healing of the tissue (17). While some tissue openings may be sufficiently closed by tissue (17) gathering together, other openings, such as tissue opening (58), are closed with suture (60). In one example shown in fig. 4A-4D, the suture (60) is removably coupled with the needle (62) for guiding the suture (62) through the tissue (17) as the clinician manipulates the needle (62). More specifically, as shown in fig. 4B, the clinician guides the needle (62) down through the fascia (56) on one side of the tissue opening (58) and then up through the fascia (56) on the other side of the tissue opening (58) as the needle (62) is fully passed through the tissue (17). Notably, the clinician passes the needle (62) distally through the fascia (56) a desired distance from the tissue opening (58) so as to be relatively closer to the tissue opening (58); while also passing through a sufficient distance to provide sufficient fascia (56) to anchor the suture (60) therein. In addition, the clinician angles the tip of the needle (62) at an oblique angle away from the central axis of the opening (58) at an appropriate angle to achieve adequate "bite" when anchoring the suture (60) within the fascia (56). As shown in fig. 4C, sutures (60) from respective sides of the tissue opening (58) are brought together and pulled to similarly pull the tissues (17) together and at least partially close the tissue opening (58). The clinician then ties the suture (60) to secure the tissue (17) together and substantially closes the tissue opening (58) with the resulting suture (64), as shown in FIG. 4D. Additional sutures (64) may be placed along the tissue (17) to further close the tissue opening (58) and promote healing of the tissue (17).

While the above-described suturing technique shown in fig. 4A-4D is one exemplary process of closing a tissue opening (58) with suture (60) after use of the trocar assembly (10) (see fig. 1), other exemplary processes and devices may alternatively be used to close such tissue openings. By way of example, U.S. patent application 15/088,723 entitled "Surgical access devices with Integrated Wound Closure needles," filed 4/1/2016, describes an alternative trocar assembly and suturing technique, the entire contents of which are incorporated herein by reference. To this end, the clinician may use alternative trocar assemblies and suturing techniques in any combination as desired.

Exemplary surgical access devices with wound closure features

A. Exemplary trocar having needle port and insufflation port in a first arrangement

Fig. 5-8 illustrate another exemplary surgical access device in the form of a trocar (100). For example, although not shown, one of ordinary skill in the art will recognize that the trocar (100) may be used in conjunction with any suitable trocar obturator, such as the obturator (14) described above. The trocar (100) generally includes a housing assembly (102) and a cannula (104) coupled to the housing assembly (102) and extending distally therefrom along a central longitudinal axis of the trocar (100). The housing assembly (102) includes a proximal housing (106), a housing cover plate (108), a latch ring (110), and a distal housing (112). The proximal housing (106) has a proximal housing head (114) and a proximal housing base (116). The proximal housing (106) is coupled to and selectively releasable from the remainder of the trocar (100) via a housing cover plate (108) and a latch ring (110). As described in greater detail below, the trocar (100) also includes a plurality of needle entry apertures (150) and needle exit apertures (152) that define a corresponding plurality of suture pathways extending obliquely through the trocar (100) transverse to the trocar central axis. In this example, at least one of the needle access aperture (150) and the corresponding needle guide structure (154) is positioned in a coplanar relationship diametrically opposite the insufflation aperture (134) of the trocar (100).

As shown in fig. 6, the cannula (104) includes a proximal hub (118), a distal tip (120), and a cylindrical body (122) extending along a central axis of the trocar (100) between the proximal hub and the distal tip. The proximal hub (118) flares radially outward in a proximal direction from the cylindrical body (122) and defines a proximal opening to the cannula lumen (124), while the distal tip (120) defines a distal opening to the cannula lumen (124). The distal tip (120) itself is beveled and includes a chamfered edge (126) configured to facilitate insertion of the distal tip (120) through tissue into a body cavity of a patient during a surgical procedure. The outer surface of the cylindrical body (122) may be provided with a plurality of tissue engaging ribs (128) or similar features adapted to frictionally engage the inner wall of a tissue opening through which the cannula (104) is received into the body cavity.

As shown in fig. 7, the cannula lumen (124) is in fluid communication with the interior (130) of the housing assembly (102) to collectively define a working channel (132) extending through the trocar along a central axis of the trocar (100). A distal opening to the working channel (132) is defined by the distal tip (120) of the cannula (104), and a proximal opening to the working channel (132) is defined by the proximal housing head (114). When the proximal housing (106) is separated from the remainder of the trocar (100), a proximal opening to the working channel (132) is defined by the housing cover plate (108). For example, the working channel (132) is configured to receive one or more surgical instruments therethrough, such as various endoscopic surgical instruments, for accessing a patient's body cavity and viewing and/or treating accessible tissue therein.

As shown in fig. 6 and 7, the insufflation orifice (134) (or "piston") is operably connected to the proximal hub (118) of the cannula (104) at a fitting (136). The insufflation orifice (134) includes an internal valve (137) and a valve stem (138), and may be integrally formed with the fitting (136) or alternatively coupled to the fitting (136) during assembly of the trocar (100). An insufflation conduit (not shown) is coupled to an inlet of the insufflation orifice (134) and directs insufflation fluid, such as carbon monoxide, from a fluid source into the insufflation orifice (134) which directs the fluid distally through the working channel (132) into the patient's body cavity. The valve stem (138) is configured to rotate the internal valve (137) between an open position and a closed position to control a flow of insufflation fluid through the insufflation aperture (134).

Similar to the trocar assembly (10), the trocar (100) may include a proximal (or "outer") seal assembly and/or a distal (or "inner") seal assembly each disposed within the working channel (132). In this example, the trocar (100) includes a distal seal assembly in the form of an instrument seal (140) disposed within the tapered portion of the proximal hub (118). The distal instrument seal (140) includes a central opening (142) configured to receive a surgical instrument therethrough and configured to sealingly engage an outer surface of the surgical instrument to prevent bodily fluids and/or tissues from being advanced proximally into the housing assembly interior (130). In an exemplary configuration, the instrument seal (140) can be configured to absorb or otherwise remove bodily fluids from an outer surface of the surgical instrument as the surgical instrument is retracted proximally through the instrument seal (140).

One of ordinary skill in the art will recognize that the trocar (100) may include various suitable configurations of proximal and/or distal seal assemblies, such as those disclosed in U.S. patent application 15/088,723, incorporated by reference above. For example, although not shown, the trocar (100) may include a proximal seal assembly in the form of an instrument seal disposed within the proximal housing (106), and/or a distal seal assembly in the form of a zero closure seal, such as a duckbill seal, disposed within the proximal hub (118) of the cannula (104). As described above with reference to the trocar assembly (10), such zero closure seals are generally configured to form a fluid-tight seal in the working channel (132) to maintain insufflation even in the absence of surgical instruments in the working channel (132). Further, the distal zero closure seal can be manipulated to provide an opening to a distal portion of the working channel (132) (e.g., the cannula lumen (124)) that is large enough to enable proximal withdrawal of tissue therethrough, particularly when the proximal housing (106) is separated from the trocar (100) to provide access to the distal zero closure seal.

As shown in fig. 6, the trocar (100) also includes a plurality of needle apertures formed in a selected side portion of the cannula (104). As described in more detail below, each needle aperture is configured to guide a suture passer needle (or simply "suture passer") across a working channel (132) of the trocar (100) at an oblique angle relative to a central axis of the trocar (100), thereby establishing an oblique suture path extending through the trocar (100) and adjacent tissue. As used herein, the term "tilted" means neither parallel nor perpendicular to a reference axis, such as the central axis of the trocar (100).

In this example, the trocar (100) includes a pair of needle entry apertures (150) and a corresponding pair of needle exit apertures (152) disposed distally of the needle entry apertures (150). Each needle access aperture (150) is defined by a respective needle guide structure, shown in the form of a needle guide tube (154) integrally formed with the proximal hub (118) and projecting obliquely outwardly therefrom at a respective side portion of the cannula (104). A needle access aperture (150) extends through the proximal hub (118) and opens into the cannula lumen (124), as best shown in fig. 7. As best shown in fig. 5-7, each needle exit aperture (152) extends through the cylindrical body (122) of the cannula (104) and opens into the cannula lumen (124) at a location that is substantially diametrically opposite a respective one of the needle entry aperture (150) and its corresponding needle guide tube (154). In the present example, each needle exit aperture (152) is generally elongated along a central axis of the trocar (100), but in alternative examples, the needle exit apertures (152) may be formed to have various other shapes.

As used herein with reference to various first and second structures or reference points, the term "diametrically opposed" encompasses, but is not limited to, configurations in which the reference structures or reference points are located at the same longitudinal position along the central axis of the trocar (100). For example, in the present example, each needle entry aperture (150) is spaced proximally from its respective needle exit aperture (152), but the apertures (150,152) are still understood to be diametrically opposed to each other along the same axially extending plane containing the central axis of the trocar (100). Of course, in an alternative form of the trocar (100), the needle entry aperture (150) may lie in a first plane containing the trocar central axis and the corresponding needle exit aperture (152) lies in a second plane containing the trocar central axis and offset from the first plane such that the needle entry and exit apertures (150,152) are not diametrically opposed to one another.

As best shown in fig. 7, each needle entry aperture (150) and its respective needle guide tube (154) are configured to cooperate with the opposing needle exit aperture (152) to guide a suture passer needle (156) along a respective suture path extending obliquely relative to a central axis of the trocar (100). Specifically, a needle entry aperture (150) and its corresponding needle guide tube (154) on a first side portion of the cannula (104) cooperate with a needle exit aperture (152) on a second side portion of the cannula (104) to define a first angled suture path. In addition, a needle entry aperture (152) and its corresponding needle guide tube (154) on the second side portion of the cannula (104) cooperate with a needle exit aperture (152) on the first side portion of the cannula (104) to define a second angled suture path.

Each needle exit aperture (152) is distally spaced from its respective needle entry aperture (150) by a distance suitable to achieve a desired suture path angle (or "tissue bite angle") measured between the resulting suture path and the central axis of the trocar (100). In this example, each needle exit aperture (152) is distally spaced from its respective needle entry aperture (150) by the same axial distance such that the resulting suture path exhibits the same suture path angle. However, in other examples, the needle exit apertures (152) may be spaced distally different axial distances from their respective needle entry apertures (150) to achieve different suture path angles.

While the needle guide structure of the present example is shown in the form of a needle guide tube (154) integrally formed with the cannula (104), one of ordinary skill in the art will recognize that various other configurations and structures suitable for guiding a suture passer needle (156) along an oblique suture path of a trocar (100) may be implemented. For example, the Trocar (100) may be provided with a Needle guide tube integrally formed with or otherwise defined by the distal housing (112), such as disclosed in U.S. application entitled "Trocar with underlying Needle Insertion Port and percussive seal latch," filed on even date herewith, the disclosure of which is incorporated herein by reference [ attorney reference number END8139USNP ]. In other examples, such outwardly projecting needle guide structures may be omitted from the trocar (100).

As shown in fig. 6 and 7, each needle port (150,152) of the trocar (100) is provided with a pierceable seal configured to assist in maintaining insufflation as the suture passer needle (156) is guided through the trocar (100) along a suture path and/or as the suture passer needle (156) is withdrawn from the trocar (100). In the present example, each needle access aperture (150) is provided with an access seal, shown in the form of a sealing cap (158) received within the access end of the respective needle guide tube (154). Further, each needle exit aperture (152) is provided with an exit seal, shown in the form of an elongate protrusion (162) projecting radially inwardly from the inner surface of the cannula sleeve (160). As shown in fig. 5 and 6, the cannula sleeve (160) is received over the narrowed region of the cylindrical body (122) of the cannula (104) and has an outer diameter similar to the outer diameter of the distal portion of the cylindrical body (122) distal to the tissue engaging rib (128). In an exemplary configuration, the sealing cap (158) and cannula sleeve (160) (including the protrusion (162)) may be formed of an elastomeric material. Additionally, the cannula sleeve (160) and/or the sealing cap (158) may be formed by, for example, an overmolding process.

As shown in fig. 5-7, the distal housing (112) is in the form of a generally annular shell shaped to receive and enclose the proximal hub (118) of the cannula (104). The distal housing (112) includes a pair of diametrically opposed side wings (164) that can be grasped by a surgeon when introducing the trocar (100) through patient tissue. The distal housing (112) further includes a cutout (166) sized and shaped to receive the insufflation orifice (134) therethrough and a pair of axially extending slots (168) sized and shaped to receive the needle guide tube (154) therethrough. In the present example, the distal housing (112) is oriented relative to the cannula (104) and the needle guide tube (154) such that the slot (168) is disposed into a respective sidewall portion extending between the wings (164). In alternative configurations, the distal housing (112) may be oriented such that the slot (168) is disposed in the side wings (164) or various other portions of the distal housing (112).

A proximal housing (106) defined by a proximal housing head (114) in combination with a proximal housing base (116) is configured to be coupled and selectively decoupled from a remaining distal portion of the trocar (100) via manipulation of the latch ring (110) relative to the housing cover plate (108). As shown in fig. 6 and 7, the proximal housing head (114) includes a central opening (170) that defines a proximal end of the working channel (132) of the trocar (100) when the proximal housing (106) is coupled with the cannula (104). The proximal housing head (114) also includes a pair of slots (172) configured to receive a corresponding pair of tabs extending distally from the proximal head of the obturator, such as tabs (32) of the obturator (14) shown in fig. 2, to releasably connect the obturator to the trocar (100). The proximal housing head (114) is supported by or connected to a proximal housing base (116), such as by a snap-fit connection. Although not shown, a proximal seal assembly (such as an instrument seal) may be disposed between the proximal housing head (114) and the proximal housing base (116). Such a proximal seal assembly may cooperate with the distal seal assembly (140) described above to ensure sealing engagement between the trocar (100) and a surgical instrument inserted through the trocar (100).

The proximal housing base (116) includes a plurality of distally extending mating features configured to facilitate attachment and release of the proximal housing (106) to the housing cover plate (108) and the latch ring (110). Specifically, as shown in fig. 6, the underside of the proximal housing base (116) includes a pair of distally extending latch tabs (174) and a pair of distally extending latch posts (176). The housing cover plate (108) includes a pair of tab slots (178) configured to receive the latch tabs (174) therethrough and a pair of post holes (180) configured to receive the latch posts (176) therethrough. The housing cover plate (108) also includes a plurality of distally extending coupling posts (182) configured to be receivable by a corresponding plurality of coupling holes (184) formed on the distal housing (112) to couple the housing cover plate (108) with the distal housing (112), such as by a press-fit or snap-fit engagement.

The latch ring (110) is disposed distally of the housing cover plate (108) and is received radially inward of a sidewall of the housing cover plate (108) at an upper proximal end of the latch ring (110) and radially inward of the distal housing (112) at a lower distal end of the latch ring (110). As shown in fig. 6, the latch ring (110) includes a user engagement feature in the form of an outwardly projecting knob (186). The latch ring (110) also includes a plurality of inwardly projecting latch features in the form of a pair of latch arms (188) and a pair of cam ramps (190) circumferentially spaced between the latch arms (188).

The latch ring (110) is rotatable about a central axis of the trocar (100) between a latched position in which a latching feature of the latch ring (110) captures a distally extending feature of the proximal housing base (116) and an unlatched position in which the latching feature of the latch ring (110) releases the distally extending feature of the proximal housing base (116), allowing proximal separation of the proximal housing (106). More specifically, in the latched position, the latch arm (188) engages the latch post (176) and the cam ramp (190) engages the latch tab (174). In the unlatched position, the latch arms (188) disengage the latch posts (176) and the cam ramps (190) disengage the latch tabs (174), thereby releasing the proximal housing (106) from the remaining distal portion of the trocar (100). The latch ring (110) is rotatable between a latched position and an unlatched position by a knob (186) that projects radially through a circumferential slot (not shown) formed in a side wall of the housing cover plate (108).

The components of the housing assembly (102), including the proximal housing (106), the housing cover plate (108), and the latch ring (110), may be further constructed and operated in accordance with one or more teachings of U.S. application attorney docket number END8139USNP, incorporated by reference above. For example, in various examples, the trocar (100) may be configured such that the latch ring knob (186) remains circumferentially spaced (or "offset") from each needle guide tube (154) throughout the range of allowable rotation of the latch ring (110) relative to the housing cover plate (108), thereby ensuring unimpeded access to the needle guide tubes (154) during a suturing procedure performed with the trocar (100).

As best shown in fig. 8, in the present example, the first needle guide tube (154) and its needle entry orifice (150) are arranged diametrically opposite the insufflation orifice (134). Thus, the first needle guide tube (154), its needle entry orifice (150), corresponding needle exit orifice (152), and insufflation orifice (134) are disposed in a first plane (P1) extending axially along and through (i.e., containing) the central axis of the trocar (100). The second needle guide tube (154) and its needle entry and exit orifices (150,152) are arranged in a second axially extending plane (P2) containing the central axis of the trocar (100). Thus, the first and second suture paths defined by the needle apertures (150,152) and the needle guide tube (154) intersect at the central axis. The knob (186) of the latch ring (110) is disposed in a third axially extending plane (P3) containing the central axis. It should be appreciated that the third plane (P3) may correspond to a midpoint of a circumferential path along which the knob (186) travels as the latch ring (110) is rotated relative to the remainder of the trocar (100).

In this example, the second plane (P2) is offset from the first plane (P1) such that the first and second needle cannulae (154) are positioned in a non-diametrically opposed relationship and the resulting first and second suture paths lie in different planes. More specifically, in some examples, the second plane (P2) may be offset from the first plane (P1) by approximately 17 degrees. Further, in the present example, the third plane (P3) extends perpendicular to the first plane (P1) such that the knob (186) is circumferentially offset approximately 90 degrees from each of the first needle guide tube (154) and the insufflation aperture (134). Thus, in this example, the needle guide tube (154), the insufflation aperture (134), and the latch ring knob (186) are circumferentially offset from one another. In addition, the knob (186) remains circumferentially offset from each needle guide tube (154) and insufflation aperture (134) throughout the allowable range of rotation of the latch ring (110) about the central axis of the trocar (100). This configuration ensures unobstructed access to the needle guide tube (154) during use of the trocar (100).

It should be appreciated that in other examples, the axially extending planes (P1, P2, P3) may be arranged in various other configurations. In this regard, a second plane (P2) containing the second needle guide tube (154) and its needle entry orifice (150) may be offset from the first plane (P1) by more or less than 17 degrees. Further, the third plane (P3) containing the latch ring knob (186) may not be perpendicular to the first plane (P1). For example, the third plane (P3) may be oriented such that the knob (186) is circumferentially offset from the insufflation aperture (134) or the first needle guide tube (154) by more or less than 90 degrees. Further, while the trocar (100) of the present example is shown and described as providing two suture pathways oriented in a particular arrangement, each suture pathway defined by a respective needle entry aperture (150) and needle exit aperture (152), other versions of the trocar (100) may be suitably configured to provide alternative numbers and arrangements of suture pathways. For example, the trocar (100) may be configured to provide three or more suture pathways.

B. Exemplary trocar with needle port and insufflation port in a second arrangement

Fig. 9 illustrates another exemplary surgical access device in the form of a trocar (200), wherein like reference numerals refer to like features described above in connection with the trocar (100). The trocar (200) is substantially similar to the trocar (100) except as follows. Specifically, the trocar (200) includes a pair of needle guide tubes (202) and corresponding needle access ports (204) arranged in diametrically opposed relation along a first axially extending plane (P1) containing a central axis of the trocar (200). A second axially extending plane (P2) extends through the central trocar axis and the latch ring knob (186), and a third axially extending plane (P3) extends through the central trocar axis and the insufflation aperture (134). In various examples, the second plane (P2) may extend through a path endpoint or a path midpoint of the knob (186).

In this example, the second plane (P2) extends perpendicular to the third plane (P3) such that the latch ring knob (186) is circumferentially offset 90 degrees from the insufflation aperture (134). Additionally, the first plane (P1) is angularly offset from the second plane (P2) and the third plane (P3) such that the needle guide tube (202) and the needle entry orifice (204) are circumferentially offset from the knob (186) and the insufflation orifice (134). In this example, the first plane (P1) is angularly offset from the second plane (P2) by about 17 degrees. An alternative version of the trocar (200) may exhibit an angular offset of the first plane (P1) relative to the second plane (P2) of greater than or less than 17 degrees.

C. With arrangement on a rotating collarExemplary trocar of a needle port

During a suturing procedure in which a trocar having a needle that defines one or more suture pathways enters and exits a port, such as one or both of the trocars (100,200) described above, to close a tissue opening, it may be desirable to adjust the rotational position of the one or more suture pathways about the central axis of the trocar in situ without rotating the trocar relative to the patient as a whole. Such adjustment may be desirable, for example, to better accommodate certain anatomy of the patient and to achieve a better "bite" of the tissue fascia being sutured. The example trocar features described below enable such adjustment.

Fig. 10 illustrates an exemplary trocar (210) configured to selectively rotationally adjust its suture path about a central axis of the trocar (210). The trocar (210) is similar to the trocar (100)) in that the trocar (210) includes a housing assembly (212) and a cannula (214) coupled to the housing assembly (212) and extending distally therefrom along a trocar central axis. The housing assembly (212) includes a proximal housing (216) having a proximal housing head (218) and a proximal housing base (220), a housing cover plate (222), a latch ring (not shown) similar to the latch ring (110), and a distal housing (224). The components of the trocar (210) are substantially similar in structure and function to the corresponding components of the trocar (100) described above, except as described below.

Unlike the housing assembly (102) of the trocar (100), the housing assembly (212) of the trocar (210) includes a rotating collar (226) disposed between a housing cover plate (222) and a distal housing (224). The rotating collar (226) supports a pair of needle guide tubes (228), each guide tube (228) defining a needle access port (232) in communication with a working channel (230) of the trocar (210). The rotating collar (226) is configured to selectively rotationally adjust one or both of the needle guide tubes (228) and their respective suture pathways about the trocar central axis relative to a rotationally fixed component of the trocar (210) including a pair of needle exit apertures (234) formed in the cannula (214). For example, in the present example, the needle guide tube (228) is fixed relative to the rotating collar (226), and the rotating collar (226) is configured to rotate about the trocar central axis. Thus, the first and second needle guide tubes (228) rotate together about the trocar central axis. In other examples, the rotating collar (226) may be fixed relative to the cannula (214), while the first and second needle guide tubes (228) or other needle guide structures are configured to be rotatable independently or in relation to each other about the trocar central axis, such as along one or more circumferentially extending tracks (not shown) formed in the rotating collar (226).

The rotating collar (226) is configured to be rotatable relative to the cannula (214) between a first end position and a second end position, as indicated by reference numerals (a, B) in fig. 10. The first and second end positions (a, B) are circumferentially offset from each other by any suitable angle, for example about 30-45 degrees. Further, the rotating collar (226) is mounted to the trocar (210) such that the first needle guide tube (228) is circumferentially offset from the insufflation aperture (236) by a selected angle, for example, approximately 17 degrees, when the rotating collar (226) is in its first end position (a). Thus, in an exemplary configuration in which the rotating collar (226) rotates through a 45 degree range between a first end position in which the guide tube (228) is offset 17 degrees from the insufflation aperture and a second end position (a, B) in which the needle guide tube (228) is offset 57 degrees from the insufflation aperture (236), the first needle guide tube (228) is movable from the first end position to the second end position. In various examples, the trocar (210) may include one or more detent mechanisms or other rotation limiting mechanisms (not shown) configured to releasably retain the rotating collar (226) in one or more predetermined rotational positions relative to the cannula (214).

As shown in fig. 10, a needle exit aperture (234) is formed in the proximal cylindrical portion of the cannula (214). Each exit orifice (234) extends circumferentially about the trocar central axis with a circumferential dimension sufficient to enable the corresponding needle guide tube (228) to align with the needle exit orifice (234) throughout the range of rotation of the rotating collar (226) between its first and second end positions (a, B). In addition, each needle exit aperture (234) is formed with an axial dimension sufficient to accommodate suture paths therethrough having a variety of different suture path angles. In an alternative example, the trocar (210) may include a plurality of needle exit orifices arranged circumferentially about the trocar central axis at locations corresponding to predetermined rotational positions of the rotating collar (226). Each needle exit orifice (234) includes a pierceable seal (238) configured to help maintain insufflation during surgery, similar to the seal (162) of the trocar (100). Each needle guide tube (228) may also include a pierceable seal (not shown), such as a sealing cap (not shown) similar to the sealing cap (158) of the trocar (100).

Fig. 11 shows additional details of exemplary features of the rotating collar (226) and distal housing (224). The rotating collar (226) includes a generally annular body (240) and an outer sidewall (242) that supports the needle guide tube (228). Each needle guide tube (228) is supported by a shoulder element (244) projecting radially outwards from the annular body (240), and the needle guide tubes (228) are arranged at diametrically opposite positions on the annular body (240). In other examples, the needle guide tube (228) may be arranged in various other configurations, such as those described above in connection with the trocars (100, 200). Additionally, the needle guide tube (228) and/or shoulder element (244) may be omitted and replaced by various other forms of needle guide structures, such as structures integrated within the annular body (240) of the rotating collar (226). The rotating collar (226) also includes a pair of downwardly depending L-shaped legs (246) configured to couple the rotating collar (226) with the distal housing (224) and guide rotation of the rotating collar (226) relative to the distal housing (224), as described below. In this example, the legs (246) are diametrically opposed to each other and are equally spaced circumferentially between the needle guide tubes (228).

The distal housing (224) of the present example includes a generally annular body (248) having an upper wall (250). A pair of circumferentially extending slots (252) are disposed in the upper wall (250) and are configured to receive the downwardly depending legs (246) of the rotating collar (226). A pair of circumferentially extending sealing openings (254) are also disposed in the upper wall (250) and are configured to receive a suture passer needle (not shown) therethrough. The slots (252) and the seal openings (254) are arranged in a circumferentially alternating manner such that each slot (252) is configured to be alignable with a respective leg (246) and each seal opening (254) is configured to be alignable with a distal end of a respective needle guide tube (228). Each slot (252) has a radially enlarged opening (256) configured to receive a radially projecting distal foot (258) of a respective leg (246) when the rotating collar (226) is assembled with the distal housing (224). Each slot (252) also includes an elongate channel (260) extending circumferentially from the enlarged opening (256) and configured to retain and guide the leg (246) along a circumferential path as the rotating collar (226) is rotated relative to the distal housing (224). The circumferential length of the slot (252) defines the allowable range of rotation of the rotation collar (226) relative to the distal housing (224), and may be appropriately sized to provide any desired range of rotation.

Each circumferentially extending seal opening (254) is formed with a circumferential length sufficient to enable a distal end of a respective needle guide tube (228) to be aligned with the seal opening (254) throughout an allowable range of rotation of the rotating collar (226) relative to the distal housing (224). Each seal opening (254) is provided with a pierceable seal (262) configured to be pierceable by a suture passer needle distally guided through a respective needle guide tube (228). In various examples, each pierceable seal (262) can include a circumferentially-extending slit (not shown) configured to facilitate distal insertion of a suture passer needle through the pierceable seal (262) and rotation of the rotating collar (226) relative to the distal housing (224) while the suture passer needle extends through the pierceable seal (262). Each seal opening (254) is configured to guide a suture passer needle into the working channel (230) and toward a respective needle exit aperture (234) on the cannula (214). In addition, each seal opening (254) is formed with a radial dimension sufficient to accommodate suture pathways therethrough having a variety of different suture pathway angles.

Each of the above-described exemplary trocars (100,200,210) is configured to be implemented as a suture guide mechanism for guiding a suture guide needle and a suture carried by the suture guide needle distally through and into tissue at a predetermined suture path angle for closing an opening formed in a patient with the suture through the trocar cannula. Any of the trocars (100,200,210) may be implemented in conjunction with the general steps of an exemplary suturing procedure, such as disclosed in U.S. application attorney docket number END8139USNP, incorporated by reference above. Additionally, the teachings presented herein with respect to a trocar (100,200,210) may be further combined with the various teachings of any one or more of the following applications: U.S. application entitled "Needle Guide Instrument with track Suture Capture Feature" [ attorney reference number END8137USNP ], the disclosure of which is incorporated herein by reference; U.S. application entitled "future grading Instrument," filed on even date herewith [ attorney docket number END8138USNP ], the disclosure of which is incorporated herein by reference; U.S. application entitled "Structure Page Instrument with Performance Site Identification Feature," filed on even date herewith [ attorney docket number END8141USNP ], the disclosure of which is incorporated herein by reference; U.S. application entitled "trailer armrest with reverse Needle Ports," filed on even date herewith [ attorney reference number END8142USNP ], the disclosure of which is incorporated herein by reference; U.S. application entitled "Surgical Port with wooden clouurechannels" filed on even date herewith [ attorney docket number END8143USNP ], the disclosure of which is incorporated herein by reference; U.S. application entitled "trailer architecture with Detachable rotation Tissue Fastener" filed on even date herewith [ attorney reference number END8144USNP ], the disclosure of which is incorporated herein by reference; U.S. application entitled "Method of completing a Trocar Patch increment," filed on even date herewith [ attorney docket number END8153USNP ], the disclosure of which is incorporated herein by reference; and/or other patents and patent application publications incorporated by reference herein.

Exemplary combinations

The following examples relate to various non-exhaustive ways in which the teachings herein may be combined or applied. It should be understood that the following examples are not intended to limit the scope of coverage of any claims that may be presented at any time in this patent application or in subsequent filing of this patent application. Disclaimer is not intended. The following examples are provided for illustrative purposes only. It is contemplated that the various teachings herein may be arranged and applied in a variety of other ways. It is also contemplated that some variations may omit certain features mentioned in the following embodiments. Thus, none of the aspects or features mentioned below should be considered critical unless explicitly indicated otherwise, e.g., by the inventors or their successor of interest at a later date. If any claim made in this patent application or in a subsequent filing document related to this patent application includes additional features beyond those mentioned below, then these additional features should not be assumed to be added for any reason related to patentability.