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.

An articulating working channel system for use with a plurality of flexible tools which are adapted to be interleaved in a single surgical procedure, comprising: a working channel subassembly including a hollow flexible shaft; and a surgical tool subassembly including the flexible tool, wherein the flexible tool includes a flexible tube which is adapted to be inserted into the flexible shaft and wherein the flexible shaft is adapted to be articulated and the flexible tube is adapted to be passively articulated therewith.

An instrument manipulator may comprise a frame comprising an outer shell and an inner frame, the inner frame being movably coupled to the outer shell. The instrument manipulator may also include a plurality of actuator outputs protruding in a distal direction from the frame and an instrument support feature coupled to the outer shell. The instrument manipulator may further comprise a latching mechanism, the latching mechanism being configured to move the inner frame, the outer shell, or both relative to one another, so as to operably engage the plurality of actuator outputs with a plurality of actuator inputs of an instrument supported by the instrument support feature.

Systems and methods for minimally invasive tele-surgery are described. For example, the disclosure describes methods for independently controlling motions of the robotic manipulator, cannula, and surgical instrument in various surgical contexts.

An invention for transfixing a plurality of cannulas 14 through a tissue 25 for providing a plurality of entry-ports 33 to a surgical site 26, comprising: a base 10; and a plurality of cannulas 14 connected to said base 10; wherein each said cannula 14 includes an access-port 3, is provided. Also, the invention for transfixing a plurality of cannulas 14 through a tissue 25 for providing a plurality of entry-ports 33 to a surgical site 26, comprising: a sleeve 9 including a base 10; said sleeve 9 including a plurality of cannulas 14 connected to said base 10; a mandrel 1 including a handle 7; and said mandrel 1 including a plurality of piercing tips 2 connected to said handle 7; wherein said mandrel 1 detachably engage said sleeve 9 forming a single punch assembly; wherein said cannula 14 includes an access-port 3 to a surgical site 26, is provided.

A surgical instrument may comprise an elongated shaft extending between a proximal end and a distal end and defining a longitudinal axis. The surgical instrument may also comprise a plurality of cables extending along the longitudinal axis and a first bending section positioned between the proximal end and the distal end of the elongated shaft. The first bending section may comprise links having pairs of articulation holes extending longitudinally through the links to permit the plurality of pull wires to pass therethrough. Each pair of articulation holes may comprise first and second articulation holes that are spaced apart from the longitudinal axis (i) at different radii and (ii) at a same rotation angle.

A surgical system comprises a manipulator arm, configured to secure to a base, and an actuator assembly. The actuator assembly includes an instrument mounting bracket and a plurality of actuator disks supported on a first end of the instrument mounting bracket. The surgical system also includes a surgical instrument including a plurality of interface disks supported on a face of the surgical instrument. The plurality of interface disks is configured to mate with the plurality of actuator disks. The instrument also includes an attachment mechanism configured to removably attach the surgical instrument to the actuator assembly and an instrument body tube extending from the face of the surgical instrument. The instrument body tube is capable of passing by or passing through the instrument mounting bracket when the surgical instrument is attached to the instrument mounting bracket.

A dilation introducer for orthopedic surgery is provided for minimally invasive access for insertion of an intervertebral implant. The dilation introducer may be used to provide an access position through Kambin’s triangle from a posterolateral approach. A first dilator tube with a first longitudinal axis is provided. A second dilator tube may be introduced over the first, advanced along a second longitudinal axis parallel to but offset from the first. A third dilator tube may be introduced over the second, advanced along a third longitudinal axis parallel to but offset from both the first and the second. An access cannula may be introduced over the third dilator tube. With the first, second, and third dilator tubes removed, surgical instruments may pass through the access cannula to operate on an intervertebral disc and/or insert an intervertebral implant.

A method for closing an opening in biological tissue of intra-abdominal structures, which includes the steps of (i) providing a tissue closure system that includes a suture guide sub-system for engaging tissue disposed proximate the tissue opening and a suture passer sub-system that slideably engages the suture guide sub-system, (ii) inserting the suture guide sub-system into and through a tissue opening, (iii) inserting the suture passer sub-system with a section of suture engaged thereto into and through a first tissue region, (iv) rotating the suture guide sub-system, (v) inserting the suture passer sub-system with another section of suture engaged thereto into and through a second tissue region, (vi) withdrawing suture guide sub-system, (vii) releasing both sections of the suture captured by the suture guide sub-system, and (viii) drawing both sections of the suture together, wherein the first and second tissue regions are drawn together and the tissue opening is closed.

An access device for accessing an intervertebral disc having an outer shield comprising an access shield with a larger diameter (˜16-30 mm) that reaches from the skin down to the facet line, with an inner shield having a second smaller diameter (˜5-12 mm) extending past the access shield and reaches down to the disc level. This combines the benefits of the direct visual microsurgical/mini open approaches and the percutaneous, “ultra-MIS” techniques.