Abstract:
There&#39;s provided a flip-top cannula assembly including a cannula having a cannula seal for receiving a range of surgical instruments having a first predetermined diameter and a reducer cap movably mounted on the cannula. The reducer cap includes a reducer seal having an opening which is substantially smaller than that of a cannula seal associated with the cannula for receiving a range of surgical instruments having a diameter smaller than that of the first predetermined diameter. In the disclosed embodiments, the reducer seal is movable from a closed position wherein the reducer seal overlies the cannula seal to effectively reduce the seal opening of the cannula to a closed position wherein the reducer seal is spaced apart from the cannula seal.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
       [0001]    The present application claims the benefit of and priority to U.S. Provisional Application Ser. No. 61/028,532 filed on Feb. 14, 2008, the entire contents of which are incorporated herein by reference. 
     
    
     BACKGROUND 
       [0002]    1. Technical Field 
         [0003]    The present disclosure relates to flip-top style adapters for use with a cannula. More particularly, the present disclosure relates to cannulas having flip-top adapters for reducing the inlet opening of the cannula to accommodate smaller diameter instruments. 
         [0004]    2. Background of Related Art 
         [0005]    In various surgical procedures it is often desirable to access a body cavity with minimal trauma to a patient. These type of surgeries are often termed endoscopic or laparoscopic and involve forming one or more small incisions in the body of the patient and utilizing a cannula to provide access to the body cavity for various surgical instruments. The cannula is also used to provide a source of insufflation fluid to insufflate the body cavity thereby creating a working space within the body cavity. 
         [0006]    Cannulas typically include a cannula body defining an inner chamber and an elongate tubular member extending distally from the cannula body which is inserted through the incision to provide a pathway for the surgical instrument. A seal having an opening for receipt of the surgical instrument is provided at the proximal end of the cannula body to prevent escape of the insufflation gases. 
         [0007]    The opening of the cannula seal has a predetermined diameter which is configured to correspond to the diameters of a particular range of surgical instruments. Often however, it is necessary to utilize surgical instruments having a smaller diameter which is not sufficiently large to properly seal within the opening of the cannula seal. This may result in escape of insufflation fluids from the body cavity thereby making various surgeries more difficult. 
         [0008]    Thus, it is desirable to provide a cannula assembly which includes a reducer seal having a smaller diameter opening than the cannula seal to allow for the use of smaller diameter surgical instruments. It is further desirable to provide a cannula assembly which includes a reducer seal attached to the cannula assembly and selectively positionable adjacent the cannula seal to effectively reduce the diameter of the cannula seal. 
       SUMMARY 
       [0009]    There is disclosed a flip-top cannula including a cannula having a cannula body defining an inner chamber, an elongate tubular member extending distally from the cannula body and a cannula seal positioned on a proximal end of the cannula body. The cannula includes a seal having an opening of a first predetermined diameter for receipt of a first surgical instrument. The flip-top cannula additionally includes a reducer cap movably mounted on the cannula body and including a reducer seal defining a bore having a second predetermined diameter for receipt of a second surgical instrument, the second predetermined diameter being less than the first predetermined diameter. The reducer cap is movable from an open position spacing the reducer seal from the cannula seal to a closed position wherein the reducer seal overlies the cannula seal. 
         [0010]    The reducer cap is pivotally mounted to the cannula body. In one embodiment, the cannula body includes at least one pivot pin and the reducer cap is pivotally mounted on the at least one pin. In a specific embodiment, the cannula body includes a pair of pins and the reducer cap includes a back span defining a pair of legs extending distally from the back span, the legs being pivotally mounted to the pair of pins. The back span includes a center portion containing the reducer seal. 
         [0011]    There is also disclosed a flip-top cannula including a cannula having a cannula body defining an inner chamber, an elongate tubular member extending distally from the cannula body and a cannula seal positioned on a proximal end of the cannula body. The cannula seal has an opening of a first predetermined diameter for receipt of a first surgical instrument. The flip-top cannula further includes a reducer cap including a reducer seal defining a bore having a second predetermined diameter for receipt of a second surgical instrument, the second predetermined diameter being less than the first predetermined diameter. The reducer cap includes a first portion connected to the cannula body, a second portion movably mounted relative to the first portion and a flexible hinge connecting the first and second portions. The second portion is movable from an open position spacing the reducer seal from the cannula seal to a closed position wherein the reducer seal overlies the cannula seal. 
         [0012]    In one embodiment, the living hinge is integral with the first and second portions. In a specific embodiment, the living hinge is formed of an elastomeric material. In a yet more specific embodiment, the living hinge is molded to hold the second portion in an open position of approximately 135° relative to the first portion when the living hinge is in an unstressed condition. 
         [0013]    In one embodiment, the first portion circumferentially surrounds the cannula body such that the reducer cap is rotatable around at least a portion of the cannula body. 
         [0014]    In another embodiment, the second portion includes a concave portion surrounding the reducer seal such that the concave portion guides a surgical instrument towards the reducer seal. 
         [0015]    In a further embodiment, the cannula body includes a recess and the reducer cap includes an inwardly directed lip engageable with the recess to hold the reducer cap in the closed position. 
         [0016]    In a specific embodiment, the first portion includes a plurality of nubs to facilitate grasping the cannula. 
         [0017]    In another specific embodiment, the cannula body includes a suture flange defining a suture hole for receipt of suture material to secure the cannula relative to tissue. 
         [0018]    In yet a further specific, embodiment the cannula body includes at least one projection having a groove for receipt of suture material. 
         [0019]    There is also disclosed a flip-top cannula including a cannula having a cannula body defining an inner chamber, an elongate tubular member extending distally from the cannula body and a cannula seal positioned on a proximal end of the cannula body. The cannula seal has an opening of a first predetermined diameter for receipt of a first surgical instrument. The flip-top cannula additionally includes a reducer cap formed integrally with the cannula body and including a reducer seal defining a bore having a second predetermined diameter for receipt of a second surgical instrument, the second predetermined diameter being less than the first predetermined diameter. 
         [0020]    In a specific embodiment, the flip-top cannula further includes a flexible, living hinge integrally formed between the cannula and the reducer cap. 
         [0021]    In another specific embodiment, the cannula body includes a channel having at least one suture hole, the channel directing a surgical needle having suture material towards the at least one suture hole. In a more specific embodiment the reducer cap is asymmetric. 
     
    
     
       DESCRIPTION OF THE DRAWINGS 
         [0022]    Various embodiments of the presently disclosed cannulas are disclosed herein with reference to the drawings, wherein: 
           [0023]      FIG. 1  is a perspective view of one embodiment of a cannula incorporating a bail, flip-top reducer cap and illustrating the cannula inserted into tissue; 
           [0024]      FIG. 2  is a side view, partially shown in section, taken along line  2 - 2  of  FIG. 1 ; 
           [0025]      FIG. 3  is a perspective view of the embodiment of  FIG. 1  with the reducer cap separated from a cannula body; 
           [0026]      FIG. 4  is a perspective view similar to  FIG. 1  with the reducer cap pivoted out of alignment with a seal of the cannula; 
           [0027]      FIG. 5  is a perspective view of an alternative embodiment of a cannula incorporating an elastomeric, flip-top reducer cap; 
           [0028]      FIG. 6  is a side sectional view taken along line  6 - 6  of  FIG. 5 ; 
           [0029]      FIG. 7  is a side sectional view similar to  FIG. 6  with the reducer cap pivoted out of alignment with a seal of the cannula; 
           [0030]      FIG. 8  is a perspective view of the embodiment of  FIG. 5  with the reducer cap removed from a cannula body; 
           [0031]      FIG. 9  is a perspective view similar to  FIG. 5  with the reducer cap pivoted out of position relative to the seal; 
           [0032]      FIG. 10  is a perspective view of another alternative of a cannula incorporating a living-hinge, flip top reducer cap; 
           [0033]      FIG. 11  is a side sectional view taken along line  11 - 11  of  FIG. 10 ; 
           [0034]      FIG. 12  is a perspective view of the embodiment of  FIG. 10  with the reducer cap separated from a cannula body; 
           [0035]      FIG. 13  is a perspective view similar to  FIG. 10  with the reducer cap pivoted out of alignment relative to a seal of the cannula; 
           [0036]      FIG. 14  is a perspective view of still another embodiment of a cannula incorporating a restyled, flip-top reducer cap; 
           [0037]      FIG. 15  is a side sectional view taken along line  15 - 15  of  FIG. 14 ; 
           [0038]      FIG. 16  is a perspective view of the embodiment of  FIG. 14  with the reducer cap separated from a cannula body; 
           [0039]      FIG. 17  is a perspective view similar to  FIG. 14  with the reducer cap pivoted out of alignment with a seal of the cannula; 
           [0040]      FIG. 18  is a perspective view of yet a further embodiment of a cannula incorporating an integrated, flip-top reducer cap 
           [0041]      FIG. 19  is a side sectional view taken along line  19 - 19  of  FIG. 18 ; 
           [0042]      FIG. 20  is a perspective view of the embodiment of  FIG. 18  with the reducer cap in position on the body of the cannula; and 
           [0043]      FIG. 21  is a perspective view similar to  FIG. 18  with the reducer cap pivoted out of alignment with a seal of the cannula. 
       
    
    
     DETAILED DESCRIPTION OF EMBODIMENTS 
       [0044]    Embodiments of the presently disclosed cannulas having flip-top type reducer caps will now be described in detail with reference to the drawings wherein like numerals designate identical or corresponding elements in each of the several views. As is common in the art, the term ‘proximal” refers to that part or component closer to the user or operator, i.e. surgeon or physician, while the term “distal” refers to that part or component further away from the user. 
         [0045]    Referring initially to  FIG. 1 , there is disclosed a bail type, flip-top cannula  10  generally including a cannula  12  and a bail type reducer cap  14  movably mounted on cannula  12 . Reducer cap  14  is provided to accommodate a first surgical instrument  16  having a predetermined diameter typically smaller than that of other surgical instruments used through cannula  12 . Reducer cap  14  incorporates a reducer seal  18  having reducer bore  20  configured to receive first surgical instrument  16  as described in more detail hereinbelow. 
         [0046]    Cannula  14  is of a type typically known in the art and generally includes an elongate tubular member  22  extending distally from a cannula body  24 . Elongate tubular member  22  is provided to extend through an incision I in a tissue T in order to provide access a body cavity BC for surgical instruments such as, for example, surgical instrument  16 . Cannula body  24  includes a valve  26  for receipt of a source of insufflation fluid  28 . Cannula body  24  also includes one or more suture holes  30 . As shown, suture holes  30  are provided to receive sutures  32  to secure cannula  12  to tissue T. 
         [0047]    Referring now to  FIG. 2 , as noted above, cannula  12  is generally constructed as a typical cannula and includes a first inner chamber  34  in fluid communication with elongate tubular member  22  and a second inner chamber  36 . A flange  38  supports a duck bill type valve  40  positioned between first and second inner chambers  34  and  36 . Duck bill valve  40  is provided to isolate first inner chamber  34  from second inner chamber  36  during insufflation of body cavity BC, as well as, seal around surgical instrument  16  when inserted therethrough. Cannula body  24  is also provided with a cannula seal  42  located on a proximal end  44  of cannula body  24 . Cannula seal  42  includes a seal opening  46  having a predetermined diameter d 1  to accommodate a surgical instrument having a different diameter than that of surgical instrument  16 . Diameter d 1  of seal opening  46  is larger than a diameter d 2  of reducer bore  20 , of reducer seal  18 , in order to accommodate surgical instruments having a diameter larger than that of surgical instrument  16  as described in more detail hereinbelow. Cannula seal  42  is supported within a flange  48  provided in proximal end  44  of cannula body  24 . 
         [0048]    Referring now to  FIGS. 2 and 3 , and as noted hereinabove, reducer cap  14  is movably mounted on cannula  12 . Specifically, reducer cap  14  is pivotally mounted on pivot pins  50  and  52  extending from a recessed area  54  on cannula body  24 . Recessed area  54  extends partially around cannula body  24  and is provided to receive reducer cap  14  such that reducer cap  14  is less obtrusive when moved to the open position away from cannula seal  42 . 
         [0049]    Referring specifically to  FIG. 3 , the details of reducer cap  14  will now be described. As noted hereinabove, reducer cap  14  is of a generally bail shape and generally includes a back span  56  having a circular central portion  58 . Circular central portion  58  is provided to support the reducer seal  18  centrally over cannula seal  42  when reducer cap  14  is in the closed position. A pair of arms  60  and  62  extend laterally away from central circular portion  58 . A pair of distally extending legs  64  and  66  extend distally from arms  60  and  62 , respectively, and are provided with pivot holes  68  and  70  at distal ends  72  and  74 , respectively. Circular central portion  58  is provided with a downwardly extending lips  72  which is configured to seal within a recess  74 , provided adjacent cannula seal  42 , when reducer cap  14  is in the closed position. While not specifically shown, legs  64  and  66  may be oriented offset of a longitudinal axis of cannula  12  to facilitate pivoting reducer cap  14 . 
         [0050]    Preferably, reducer cap  14  is formed of a substantially elastomeric material such that reducer cap  14  can be stretched up and away from proximal end  44  of cannula body  24  when reducer cap  14  is moved from the closed to the open position. Additionally, the elastomeric nature of reducer cap  14  allows reducer cap  14  to lie substantially within recessed area  54  in cannula body  24  thus allowing reducer cap  14  to be relatively unobtrusive when in the open position. 
         [0051]    Referring for the moment back to  FIG. 1 , in use, cannula  12  is positioned against tissue T and is manipulated such that elongate tubular member  22  is inserted through incision I to position an open distal end  76  of elongate tubular member  22  within body cavity BC. As shown, reducer cap  14  is in the closed position with reducer seal  18  positioned over cannula seal  42  (see  FIG. 2 ). In this position, the smaller diameter reducer bore  20  in reducer seal  18  is in a position to receive first surgical instrument  16 . Since the diameter of first surgical instrument  16  is substantially similar to smaller diameter d 2  of reducer bore  20  surgical instrument  16  seals within reducer seal  18 . As noted hereinabove, body cavity BC can be insufflated by opening valve  26  and allowing insufflation gases to pass through source of insufflation fluids  28 , into first inner chamber  34  and through elongate tubular member  22  into body cavity BC. In the absence of surgical instrument  16 , duck bill valve  40  seals against the escape of insufflation gases out of cannula body  24 . A series of surgical procedures can now be performed within body cavity by first surgical instrument  16 . 
         [0052]    Referring now to  FIG. 4 , should a larger diameter surgical instrument, such as, for example, second surgical instrument  78 , be needed to continue performing surgical operations within body cavity BC, reducer cap  14  can be pivoted from the open position to the closed position wherein reducer cap  14  lies substantially adjacent reduced area  54  of cannula body  24 . In this condition, cannula seal  42  having the larger diameter seal opening  46  is available to receive larger diameter second surgical instrument  78  therethrough. As with first surgical instrument  16  hereinabove, second surgical instrument  78  passes through duck bill valve  40  and elongate tubular member  22  to perform further surgical operations within body cavity BC. 
         [0053]    Referring now to  FIG. 5 , there is disclosed an elastomeric, flip-top cannula  80  which generally includes a cannula  82  and an elastomeric reducer cap  84  movably mounted to cannula  82 . Reducer cap  84  includes a reducer seal  86  having a reducer bore  88  which is configured to seal about a surgical instrument having a predetermined diameter such as, for example, first surgical instrument  16 . 
         [0054]    Cannula  82  generally includes a cannula body  90  having an elongate tubular member  92  extending distally from cannula body  90 . Elongate tubular member  92  is configured to pass through an incision I in tissue T and into body cavity BC to provide access for first surgical instrument  16  into body cavity BC to perform surgical procedures therein. Similar to cannula  12  describe hereinabove, cannula body  90  is provided with a valve  94  which is connected to a source of insufflation fluid  96 . Cannula body  90  additionally includes one or more suture holes  98  which are configured to receive sutures  100  and secure cannula  82  to tissue T. 
         [0055]    Elastomeric reducer cap  84  is formed of a flexible, elastomeric material and generally includes a first, substantially circumferential portion  102  and a second, substantially circumferential portion  104 . Second circumferential portion  104  supports reducer seal  86 . A concave portion  106  is formed within second circumferential portion  104  and substantially surrounds reducer seal  86  so as to facilitate guiding first surgical instrument  16  toward reducer bore  88  in reducer seal  86 . First and second substantially circumferential portions  102  and  104  are connected by a flexible or living hinge  108  which allows second circumferential portion  104  to be movable relative to cannula body  90 . Second circumferential portion  104  is movable between a closed position placing reducer seal  86  in a position to receive first surgical instrument  16  to an open position such that second circumferential portion  104  is moved or pivoted out of a position to receive first surgical instrument  16 . Living hinge  108  is molded such that in an open, unstressed position second circumferential portion  104  is held at an angle of approximately 135° relative to first circumferential portion  102 . A plurality of nubs  110  are provided on first circumferential portion  102  to facilitate grasping cannula  82 . Additionally, nubs  110  may allow reducer cap  84  to be rotated about cannula body  90  such that second circumferential portion  104  may be positioned out of the way of valve  94  when in the open position. 
         [0056]    In this embodiment, suture holes  98  are formed through suture flanges  112  extending from a distal end  114  of cannula body  90 . Suture flanges  112  may be affixed to distal end  114  or may be formed integrally therewith. 
         [0057]    Referring now to  FIGS. 6 and 7 , similar to cannula body  24  described hereinabove, cannula body  90  includes a first inner chamber  116  and a second inner chamber  118  separated by a duck bill valve  120 . A cannula seal  122  is supported within cannula body  90  by a flange  124  and defines a seal opening  123  having a predetermined diameter d 1  ( FIG. 6 ) for receipt of a surgical instrument having a larger diameter that surgical instrument  16 . 
         [0058]    As best seen in  FIGS. 7 and 8 , second circumferential portion  104  of reducer cap  84  generally includes a top surface  126  and a circumferential downwardly extending side surface  128 . In order to secure second circumferential portion  104  against cannula body  90 , side surface  128  is provided with an inner lip  130  which is configured to engage a recess  132  formed in proximal end  134  of cannula body  90 . A tab  136  may be provided on side surface  128  to facilitate disengaging inner lip  130  from recess  132 . 
         [0059]    A concave portion  138  adjacent cannula seal  122  in cannula body  90  is provided to seal against concave portion  106  of second circumferential portion  104  of reducer cap  84  when reducer cap  84  is in the closed position. 
         [0060]    Referring for a moment to  FIG. 7 , first circumferential portion  102  of reducer cap  84  may be secured to cannula fighting  90  by gluing, welding, etc. Alternatively, referring to  FIG. 8 , first circumferential portion  102  may engage a recess  139  in cannula body  90 . In this configuration, reducer cap  84  may be rotatable within recess  139  so as to rotate reducer cap  84  relative to cannula body  90 . This allows the surgeon to orient second circumferential portion  104  away from valve  94  when second circumferential portion  104  of reducer cap  84  is in the open position spaced away from cannula seal  122 . 
         [0061]    Referring back to  FIG. 5 , in use, cannula  82  is manipulated such that elongate tubular member  92  is positioned through incision I in tissue T so as to locate elongate tubular member  92  within body cavity BC. Thereafter, a valve  94  may be opened to receive source of insufflation fluid  96  in order to insufflated body cavity BC. When using first surgical instrument  16 , second circumferential portion  104  of reducer cap  84  is in the closed position placing reducer seal  86  in a position to receive surgical instrument  16 . Thereafter, surgical instrument  16  is inserted through reducer bore  88  and reduces seal  86  to position surgical instrument  16  within body cavity BC. Surgical procedures may now be performed within body cavity BC with surgical instrument  16 . 
         [0062]    Referring now to  FIG. 9 , when the surgical procedures requires the use of a second surgical instrument  78  having a diameter greater than that of first surgical instrument  16 , second circumferential portion  104  of reducer cap  84  may be moved to the open position to expose cannula seal  122 . Specifically, tab  136  on second circumferential portion  104  is manipulated to disengage inner lip  130  from recess  132  formed in cannula body  90 . Second surgical instrument  78  is advanced towards cannula body  90  such that second surgical instrument  78  is guided towards cannula seal  122  by concave portion  138  formed in cannula body  90 . Second surgical instrument  78  is advanced through seal opening  123 , and thus through elongate tubular member  92 , to position second surgical instrument  78  within body cavity BC. Further surgical procedures may now be performed within body cavity BC by surgical instrument  78 . 
         [0063]    Thus, elastomeric flip top cannula  80 , including concave portion  106  in second circumferential portion  104  and concave portion  138  formed in cannula body  90 , provides the advantage of improving guidance of a surgical instrument towards reducer seal  86  and cannula seal  122 , respectively. 
         [0064]    Referring now to  FIG. 10 , there is disclosed a living hinge, flip-top cannula  140  for use in receiving various diameter surgical instruments to perform surgical procedures within a body cavity BC. Living hinge, flip-top cannula  140  generally includes a cannula  142  and a living hinge reducer cap  144  movably mounted to cannula  142 . Reducer cap  144  includes a reducer seal  146  having a reducer bore  148  for receipt of a relatively small diameter surgical instrument, such as, for example, first surgical instrument  16 . 
         [0065]    Similar to the cannulas described hereinabove, cannula  142  generally includes a cannula body  150  and an elongate tubular member  152  extending distally from cannula body  150 . A valve  154  is provided on cannula body  150  and is engageable with a source of insufflation fluid  156  so as to supply insuffulation fluid  156  to body cavity BC. Cannula body  150  is also provided with one or more projections  158  extending radically outward from cannula body  150 . Projections  158  include suture grooves  160  extending at least partially around projections  158 . Suture grooves  160  allow a single wrap of sutures, such as, for example sutures  162 , to be utilized to secure cannula  142  to tissue T. A plurality of ribs  164  are provided circumferentially about cannula body  150  to facilitate manipulation of cannula  142 . 
         [0066]    Reducer cap  144  includes a first circumferential portion  166  and a second circumferential portion  168 . First and second circumferential portions  166  and  168 , respectively, are interconnected by a living hinge  170 . As noted hereinabove, reducer cap  144  is formed of a flexible, elastomeric material. Living hinge  170  is molded to hold first circumferential portion  166  at an angle of approximately 150° relative to second circumferential portion  168  when first circumferential portion  166  is in the unstressed or disconnected conditioned from cannula body  150 . Second circumferential portion  168  includes reducer seal  146  and a concave portion  172  which is configured to guide a surgical instrument, such as, for example, surgical instrument  16  toward reducer bore  148  in reducer seal  146 . 
         [0067]    Referring now to  FIG. 11 , cannula body  150  includes a first inner chamber  174  and a second inner chamber  176 . First and second inner chambers  174  and  176  respectively, are separated by a duckbill valve  178  which is supported within a flange  180  in cannula body  150 . Cannula body  150  additionally includes a cannula seal  182  supported within a flange  184  on cannula body  150 . Cannula seal  182  defines a seal opening  186  having a predetermined diameter d 1  for receipt of surgical instruments having a diameter larger than that of surgical instrument  16 . As shown, reducer bore  148  of reducer seal  146  as a predetermined diameter d 2  which is less than that of diameter d 1  of seal opening  186  of cannula seal  182 . 
         [0068]    Second circumferential portion  168  is provided with a tab  188  to facilitate moving second circumferential portion  168  from the closed or stressed condition wherein reducer seal  146  overlies cannula seal  182  to an open or unstressed position wherein reducer seal  146  is spaced away from cannula body  150  to allow surgical instruments to be inserted through cannula seal  182 . As noted hereinabove, in the unstressed condition, second circumferential portion  168  is held at an angle of approximately 135° relative to first circumferential portion  166  and cannula body  150 . 
         [0069]    Referring now to  FIGS. 11 and 12 , first circumferential portion  166  is provided with an inner lip  190  which is configured to engage a recess  192  formed in cannula body  150 . Cut outs  194  provided in first circumferential portion  166  enable first circumferential portion  166  to be movable relative to cannula body  150 . Specifically, first circumferential portion  166 , and thus living hinge reducer cap  144 , are rotatably mounted on cannula body  150 . 
         [0070]    Referring specifically to  FIG. 12 , second circumferential portion  168  is provided with a downward projection  196  surrounding reducer seal  146 . Downward projection  196  seals against cannula seal  182  when second circumferential portion  168  is in the closed position. Cannula body  150  includes a concave portion  198  surrounding cannula seal  182 . Concave portion  198  assists in guiding a surgical instrument towards cannula seal  182  when second circumferential portion  168  of reducer cap  144  is in the open or unstressed condition. 
         [0071]    Referring back to  FIG. 10 , in use, living hinge flip-top cannula  140  is manipulated so as to insert elongate tubular member  152  through incision I in tissue T to position elongate tubular member  152  within body cavity BC. Sutures  162  are threaded around grooves  160  in projections  158  and used to secure elastomeric flip top cannula  80  to tissue T. Thereafter a valve  154  is opened to supply source of inflation fluid  156  into body cavity BC. Where a surgical instrument, such as surgical instrument  16  having a relatively small diameter is desired to be used, second circumferential portion  168  of reducer cap  144  is in the closed the position relative to first circumferential portion  166 . Surgical instrument  16  is inserted through reducer opening  148  in reducer seal  146  and the desired surgical procedure is performed within body cavity BC. 
         [0072]    Referring now to  FIG. 13 , where a larger diameter surgical instrument, such as, for example surgical instrument  78 , is desired to be used, second circumferential portion  168  is moved to the open or unstressed condition relative to first circumferential portion  166  of reducer cap  144 . As noted hereinabove this is facilitated by the provision of tab  188  on second circumferential portion  168 . It should be noted that reducer cap  144  may be rotated relative to cannula body  150  so as to position second circumferential portion  168  away from valve  154  to facilitate operation a valve  154 . Second surgical instrument  78  is inserted through cannula opening  186  in cannula seal  182  and is used to perform additional surgical procedures within body cavity BC. 
         [0073]    Thus, it can be seen that living hinge flip-top cannula  140  provides the advantages of having a reducer cap  144  that is rotatable relative to cannula body  150  to facilitate operation of valve  154 , as well, as facilitating application of sutures  162  about projections  158  and through tissue T. 
         [0074]    Referring now to  FIGS. 14-17 , and initially with regard to  FIG. 14 , there is disclosed a restyled, flip-top cannula  200  for use with various diameter surgical instruments. Restyled, flip-top cannula  200  generally includes a cannula  202  and a restyled reducer cap  204 . Reducer cap  204  includes a reducer seal  206  having a reducer bore  208 . Cannula  202  includes a cannula body  210  having an elongate tubular member  212  extending distally there from. A valve  214  is provided on cannula body  210  and is connected to a source of insufflation fluid  216 . A suture flange  218  is provided about cannula body  210  and is provided with one or more suture holes  220 . Sutures  224  are provided to pass through suture holes  220  and secure restyled flip-top cannula  200  to tissue T. A plurality of depressions  226  are provided about cannula body  210  to facilitate manipulation of restyled flip-top cannula  200  through tissue T. 
         [0075]    Reducer cap  204  includes a first circumferential portion  228  and a second circumferential portion  230 . First and second circumferential portion stood  28 ,  230 , respectively, are interconnected by a hinge  232 . Hinge  232  may be integral with first and second circumferential portions  228 ,  230 , respectively, or may be provided as a separate member. Reducer cap  204  is formed from elastomeric material and hinge  232  is molded such that in an unstressed condition second circumferential portion  230  is maintained at an angle of approximately 135° relative to first circumferential portion  228 . Second circumferential portion  230  is provided with a concave portion  234  adjacent reducer seal  206  to facilitate guiding instruments towards reducer bore  208  in reducer seal  206 . A protrusion  236  is provided on second circumferential portion  230  to facilitate moving second circumferential portion  230  from a closed position adjacent first circumferential portion  228  to an open or unstressed position spaced apart from first circumferential portion  228 . 
         [0076]    Referring now to  FIG. 15 , cannula body  210  includes a first inner chamber  238  and a second inner chamber  240 . First and second inner chambers  238  and  240  are separated by a duckbill valve  242  supported within a flange  244  formed within cannula body  210 . Cannula body  210  further includes a cannula seal  246  supported within a flange  248  formed in cannula body  210 . Cannula seal  246  defines a seal opening  250  having a predetermined diameter d 1  for receipt of surgical instruments having a diameter greater than that of surgical instrument  16 . 
         [0077]    Referring to  FIGS. 15 and 16 , first circumferential portion  228  is provided with an inner lip  252  which is configured to engage a recess  254  formed in cannula body  210 . Cut outs  256  formed in first circumferential portion  228  allow first circumferential portion  228  to engage cannula body  210  in a manner which allows reducer  204  to be rotated relative to cannula body  210 . Similar to those embodiments described hereinabove, second circumferential portion  230  is provided with a downward projection  258  surrounding reducer seal  206  which allows second circumferential portion  232  seal against cannula body  210  and thus against cannula seal  246  when second circumferential portion  230  is in a close position relative to first circumferential portion  228 . As shown, cannula body  210  additionally includes a concave portion  260  which is provided to guide surgical instruments towards seal opening  250  in cannula seal  246 . 
         [0078]    Referring now to  FIG. 14 , in use, restyled flip-top cannula  200  is manipulated to insert elongate tubular member  212  through incision I in tissue T so as to position elongate tubular member  212  within body cavity BC. As noted hereinabove, sutures  224  are passed through suture holes  220  in suture flange  218  to secure restyled flip top cannula  200  to tissue T. thereafter, valve  214  may be opened to allow insufflation fluid to flow through a source of insufflation fluid  216  through elongate tubular member  212  and into body cavity BC. Once body cavity BC has been insufflated, surgical instrument  16  may be inserted through reducer bore  208  in reducer seal  206  and into body cavity BC to perform surgical operations therein. 
         [0079]    Referring to  FIG. 17 , when a larger diameter surgical instrument, such as, for example surgical instrument  78  is needed to perform surgical procedures within body cavity BC, protrusion  236  on second circumferential portion  230  may be manipulated to move or pivot second circumferential portion  230  away from first circumferential portion  228  of reducer cap  204 . Thereafter, surgical instrument  78  may be inserted through the larger diameter seal opening  250  formed in cannula seal  246  and passed into body cavity BC so as to perform additional surgical procedures. As noted hereinabove, reducer cap  204  is rotatable relative to cannula body  210  so as to orient second circumferential portion  230  away from valve  214 . 
         [0080]    Thus, it can be seen that restyled flip-top cannula  200  provides the advantages of having a rotatable reducer cap  204 , relatively large concave portions  234  and  260  for guiding various diameter surgical instruments towards the disclosed seals as well as providing integrated suture ears for securing restyled flip top cannula  200  to tissue. 
         [0081]    Referring now to  FIGS. 18 through 21 , and initially with regard to  FIG. 18 , there is disclosed an integrated flip-top cannula  262  for use with various diameter surgical instruments. Integrated flip-top cannula  262  generally includes a cannula  264  having an integrated reducer cap  266 . Reducer cap  266  includes a reducer seal  268  having a reducer bore  270  for receipt of surgical instruments therethrough. 
         [0082]    Cannula  264  includes a cannula body  272  having an elongate tubular member  274  extending distally there from. Cannula  264  additionally includes a valve  276  connected to a source of insufflation fluid  278  for insufflating body cavity BC. Suture ears  280  are formed about cannula body toward  72  and are provided to facilitate guiding a surgical needle (not shown) towards suture holes  282  to facilitate securing integrated flip top cannula  262  to tissue T with sutures  284  and a manner similar to that described with respect to prior embodiments hereinabove. Ribs  286  are provided about cannula body  272  to facilitate manipulating integrated flip top cannula  262  through tissue T. 
         [0083]    Referring to  FIG. 19 , cannula body  272  generally includes a first inner chamber  288  and a second inner chamber  290 . First and second inner chambers  288  and  290 , respectively, are separated by a duckbill valve  292 . Duckbill valve  292  is supported within cannula body  272  by a flange  294 . Cannula seal  296  defines a seal opening  300  having a predetermined diameter d 1  for receipt of surgical instruments having a diameter larger than that of surgical instrument  16 . 
         [0084]    Reducer cap  266  is generally asymmetric and includes an upper dished portion  302  surrounding reducer seal  268 . Reducer cap  266  further includes a generally elongated depending side portion  304  which terminates in an inwardly directed flexible catch  306 . Flexible catch  306  is configured to engage and undercut side  308  formed in cannula body  272  to secure a reducer cap  266  a closed position adjacent cannula body  272 . As shown, a downwardly projecting circular portion  310  extends distally from dished portion  302  two seal against cannula seal  296  when reducer cap  266  is in the closed position. As shown, reducer bore  270  of reducer seal  268  as a predetermined diameter d 2  which is configured to receive surgical instruments such as, for example, surgical instrument  16 . Diameter d 2  of reducer seal  268  is smaller than diameter d 1  of cannula seal  296 . 
         [0085]    Referring now to  FIGS. 19 and 20 , integrated flip-top cannula  262  differs from the previously disclosed embodiments in that reducer cap  266  is formed integrally with cannula body  272 . Specifically, a portion of cannula body  272  is formed with a living hinge  312  which is integral with reducer cap  266 . Reducer cap  266  is movable from a closed position wherein flexible catch  306  is engaged with undercut  308  formed in cannula body  272  to an open position wherein reducer cap  266  is spaced apart approximately of 135° from cannula seal  296 . While not specifically shown, living hinge  312  may incorporate a detents mechanism to hold reducer cap  266  in the open position. Alternatively, living hinge  312  may be molded such that in an unstressed position it holds reducer cap  266  in the open position similar to those embodiments describe hereinabove. 
         [0086]    Referring to  FIG. 18 , in use, integrated flip-top cannula  262  is manipulated to insert elongated tubular member  274  through incision I in tissue T such that elongated tubular member  274  is positioned within body cavity BC. Similar to those procedures describe hereinabove, valve  276  is manipulated to cause insuffulation fluid to flow through source of insufflation fluid  278  and into body cavity BC. Thereafter, a surgical needle (not shown) is manipulated along suture ears  280  and through suture holes  282  to secure integrated flip top cannula  262  to tissue T with sutures  284 . Surgical instrument  16  may now be inserted through reducer bore  270  in reducer seal  268  and pass into body cavity BC so as to perform various surgical procedures. 
         [0087]    As best shown in  FIG. 21 , when the use of a larger diameter surgical instrument, such as, for example, surgical instrument  78  is desired flexible catch  306  may be drawn away from undercut  308  in cannula body  272  to allow reducer cap  266  to be pivoted about hinge  312  and moved to the open position exposing cannula seal  296 . It should be noted that cannula body  272  may incorporate a slightly concave portion  314  to facilitate guiding surgical instrument  78  toward seal opening  300  in cannula seal  296 . Once positioned through integrated flip top cannula  262 , surgical instrument  78  may be utilized to perform various additional surgical procedures. 
         [0088]    Thus, it can be appreciated, that in this embodiment, by providing reducer cap  266  integrally with cannula body  272  the amount of components included in integrated flip top cannula  262  is reduced. 
         [0089]    It will be understood that various modifications may be made to the embodiments disclosed herein. For example, the disclosed embodiments may incorporate various types of detent mechanisms to maintain the disclosed reducer caps in the open position relative to the cannula body. Further, the disclosed reducer caps may be formed entirely or partially of a flexible, elastomeric material. Additionally, the disclosed cannula bodies may incorporate various sealing structure other than duckbill valves or no internal sealing structure at all. Still further, other methods of securing the cannula body to a tissue may be provided, such as, for example, adhesives, stapling, etc. Therefore, the above description should not be construed as limiting, but merely as exemplifications of particular embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.