Patent Publication Number: US-2021169522-A1

Title: Hip access portal saver

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     The present application relates and claims priority to U.S. Provisional Application No. 62/598,094, filed Dec. 13, 2017, and entitled “Baggula Hip Access Portal Saver,” U.S. Provisional Application No. 62/673,365, filed May 18, 2018, and entitled “Expanding Mechanism for Cannula Dermal Fixation,” U.S. Provisional Application No. 62/673,451, filed May 18, 2018, and entitled “Adhesive Disc for Cannula Dermal Fixation, U.S. Provisional Application No. 62/673,541, filed May 18, 2018, and entitled “Adhesive Disc for Cannula Dermal Fixation,” and U.S. Provisional Application No. 62/673,520, filed May 18, 2018, and entitled “Suction Cup for Cannula Dermal Fixation.” 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The present disclosure is directed generally to a portal saver device and, more particularly, to an obturator with a dilating assembly for accommodating instruments of various sizes and geometries. 
     2. Description of Related Art 
     In order to maintain arthroscopic intra-articular hip joint access, a series of access tools (switching stick, slotted cannula, disposable cannula, etc.) are conventionally used frequently for insertion and removal of the instruments performing work on the patient. The use of access tools account for a great percentage of the time spent in procedure by the surgeon. During the time spent using the access tools, the surgeon is not performing any actual work on the patient&#39;s pathology. 
     A common access tool in the field of arthroscopic surgery is a “cannula.” The cannula is used to maintain an open portal leading from outside the patient&#39;s body to inside the body to the location where the arthroscopic procedure is to be performed. It is important that this cannula stay inside the body, maintain this path, and not fall out, migrate outward, or migrate farther inward. This is accomplished by a number of means today, most frequently by placing aggressive threads on the outside of the cannula to auger (or drill) into the dermal layer and tissue below it. This can require a sizable incision be made to admit such screw threads, resulting in a corresponding-sized scar. 
     Current cannulas  1 , such as those shown in  FIGS. 1A-1C , mostly use mechanical threads  2  on the exterior  3  of the tube-like body  4  of the cannula  1  itself.  FIG. 1A  shows a standard cannula  1  with a stiff tube-like body  4 . The cannula  1  in  FIG. 1B  is less rigid than that shown in  FIG. 1A , but the tube-like body  4  has virtually no radial movement.  FIG. 1C  shows a cannula  1  which is more flexible than that shown in  FIG. 1B ; however, the cannula  1  in  FIG. 1C  is semi-flexible but cannot accommodate a wide range of instruments. Conventional cannulas  1  have a fluid seal  5  on the proximal end to prevent the leakage of fluid from the surgical site. Some cannulas have indicators  6 , as also shown in  FIG. 1C , along the tube-like body  4  for customizing the size of the tube-like body  4 . These cannulas are often screwed in with an obturator. 
     Current surgical procedures require instrumentation to be inserted and removed from the patient multiple times (through numerous portals). For example, in a hip surgical procedure, a surgeon must work through 2-3 portals and the portals in the hip are typically 4-6 inches long. Through these hip portals, the surgeon cannot simply remove an instrument/scope and move to another portal. It requires 2-3 different instruments (and approximately 9 steps or actions) to move the main instrument/scope between portals and this is done many times throughout an entire surgical (e.g., hip) procedure. The current cannulas on the market, such as those shown in  FIGS. 1A-1C , are too rigid and restrict movement and as a result, surgeons do not use these throughout the whole procedure. Cannulas are typically only used at the end of the procedure for placing anchors and passing suture. 
     Therefore, a need exists for a flexible portal saver device that allows for easy insertion and removal of instruments from a surgical site. 
     Some cannulas alternatively or additionally have barbs, and these cannulas can be inserted straight into the surgical site while benefiting from a bit of oscillating rotation during advancement into the body. Still, cannulas use a collapsing accordion-like member which can be stretched to decrease its diameter and compressed to increase its diameter. None of these conventional cannulas, however, provide the large displacement of rigid bodies sub-dermally that allow insertion and subsequent removal through a small incision. Further, none of these conventional cannulas provide for a small incision size or minimize trauma to the region surrounding the incision site. Even further, none of the conventional cannulas provide a wide a range of motion and freedom. 
     Description of the Related Art Section Disclaimer: To the extent that specific patents/publications/products are discussed above in this Description of the Related Art Section or elsewhere in this disclosure, these discussions should not be taken as an admission that the discussed patents/publications/products are prior art for patent law purposes. For example, some or all of the discussed patents/publications/products may not be sufficiently early in time, may not reflect subject matter developed early enough in time and/or may not be sufficiently enabling so as to amount to prior art for patent law purposes. To the extent that specific patents/publications/products are discussed above in this Description of the Related Art Section and/or throughout the application, the descriptions/disclosures of which are all hereby incorporated by reference into this document in their respective entirety(ies). 
     BRIEF SUMMARY OF THE INVENTION 
     Embodiments of the present invention recognize that there are potential problems and/or disadvantages with the conventional cannulas and access tools. For example, the exterior aggressive threads on conventional cannulas can cause additional trauma to an incision site (as described above). Therefore, a need exists for a portal saver device that allows for removal through a small incision and that minimizes trauma at the incision site. Various embodiments of the present invention may be advantageous in that they may solve or reduce one or more of the potential problems and/or disadvantages discussed herein. 
     The present disclosure is directed to an inventive configuration, structure, and resulting function of a portal saver assembly and a method for installing a flexible cannulated tube at a surgical site. According to one aspect, the portal saver assembly includes an obturator. The obturator can have an obturator body with a cannulated outer obturator tube extending therethrough. The outer obturator tube can have a distal tip with a dilating assembly movable between a collapsed, first configuration and an expanded, second configuration. A shaft expander can have a cannulated inner obturator tube, which is movable between a first position and a second position within the outer obturator tube. In the first position, the inner obturator tube is retracted from the distal tip of the outer obturator tube and the dilating assembly is in the first configuration. In the second position, the inner obturator tube is advanced within the distal tip of the outer obturator tube and the dilating assembly is in the second configuration. 
     According to an embodiment, the dilating assembly is a duck bill portion at the distal tip of the outer obturator tube. The duck bill portion has at least two arms composed of the outer obturator tube. 
     According to an embodiment, the obturator also includes an actuator such as a post on the inner obturator tube which forces the at least two arms radially outward from the collapsed, first configuration to the expanded, second configuration. 
     According to an embodiment, the outer obturator tube extends past a distal end of the obturator body. 
     According to an embodiment, the obturator includes a cannulated tube which extends around the outer obturator tube distal the obturator body. 
     According to an embodiment, the obturator includes a pair of stirrups extending proximally from the cannulated tube. 
     According to an embodiment, the pair of stirrups is removably attached to the obturator body via one or more connectors. 
     According to an embodiment, the obturator includes a stirrup release actuator on the obturator body configured to release the pair of stirrups from the one or more connectors. 
     According to an embodiment, the cannulated tube is composed of a flat sheet material with a pair of seams extending along a length of the cannulated tube. 
     According to an embodiment, the cannulated tube has a flattened section between two rounded sections. 
     According to an embodiment, the obturator includes a rigid body connected around the cannulated tube, which is moveable along a length of the cannulated tube. 
     According to an embodiment, the rigid body comprises a proximal telescoping assembly and distal exterior barbs. 
     According to an embodiment, the proximal telescoping assembly comprises one or more blades. 
     According to an another aspect, a method for installing a cannulated tube includes (but is not limited to) the steps of: (i) providing an obturator comprising an obturator body having a cannulated outer obturator tube extending therethrough and past a distal end of the obturator body, a shaft expander comprising a cannulated inner obturator tube which is movable within the outer obturator tube, a cannulated tube around the outer obturator tube distal the obturator body, and a rigid body; (ii) advancing the cannulated tube within a surgical incision; (iii) sliding the rigid body along the cannulated tube; (iv) fixing the rigid body under a dermal layer; (v) adjusting a length of the cannulated tube; and (vi) removing the obturator from the cannulated tube. 
     According to an embodiment, the rigid body comprises a proximal telescoping assembly with a blade and distal exterior barbs. The exterior barbs are configured to grip the dermal layer. 
     According to an embodiment, the step of adjusting the length of the cannulated tube includes the step of moving the telescoping assembly along the cannulated tube and cutting the cannulating tube with the blade. 
     According to an embodiment, a pair of stirrups extend proximally from the cannulated tube. 
     According to an embodiment, the method includes the step of removably attaching the pair of stirrups to the obturator body via one or more connectors. 
     According to an embodiment, the obturator includes a stirrup release actuator on the obturator body. 
     According to an embodiment, the step of removing the obturator from the cannulated tube includes the step of actuating the stirrup release actuator on the obturator body. 
     According to one aspect, the portal saver assembly includes a portal saver device. The portal saver device includes a tubular flexible body extending distally from a dermal threaded body, wherein the tubular flexible body is movable radially with respect to the dermal threaded body, and a first seal and a second seal connected to the dermal threaded body. 
     According to an embodiment, the tubular flexible body is composed of thermoplastic urethane (TPU). 
     According to an embodiment, the portal saver device includes external threads on the dermal threaded body. 
     According to an embodiment, the first seal comprises a circular opening. 
     According to an embodiment, the second seal comprises an opening formed from three slits converging at a central location. 
     According to an embodiment, the tubular flexible body comprises a seal along its length. 
     According to an embodiment, the tubular flexible body is a single continuous piece of material. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The present invention will be more fully understood and appreciated by reading the following Detailed Description in conjunction with the accompanying drawings. The accompanying drawings illustrate only typical embodiments of the disclosed subject matter and are therefore not to be considered limiting of its scope, for the disclosed subject matter may admit to other equally effective embodiments. 
       Reference is now made briefly to the accompanying drawings, in which: 
         FIG. 1A  is a perspective view schematic representation of a cannula of the prior art; 
         FIG. 1B  is a perspective view schematic representation of another cannula of the prior art; 
         FIG. 1C  is a perspective view schematic representation of yet another cannula of the prior art; 
         FIG. 2A  is a perspective view schematic representation of a portal saver device, according to an embodiment; 
         FIG. 2B  is another perspective view schematic representation of a portal saver device, according to an embodiment; 
         FIG. 2C  is a perspective view schematic representation of the portal saver device of  FIG. 2B  with the flexible body in a knotted configuration; 
         FIG. 2D  is a perspective view schematic representation of the portal saver device of  FIG. 2B  with the flexible body in a twisted configuration; 
         FIG. 2E  is a side view schematic representation of a dermal threaded body and a seal, according to an embodiment; 
         FIG. 2F  is a top view schematic representation of a dermal threaded body and a seal, according to an embodiment; 
         FIG. 2G  is a front view schematic representation of a seal, according to an embodiment; 
         FIG. 2H  is a front view schematic representation of a double seal, according to an embodiment; 
         FIG. 2I  is a front view schematic representation of a double seal, according to an embodiment; 
         FIG. 2J  is a perspective view schematic representation of a double seal, according to an embodiment; 
         FIG. 3A  is a perspective view schematic representation of a portal saver assembly, according to an embodiment; 
         FIG. 3B  is another perspective view schematic representation of a portal saver assembly, according to an embodiment; 
         FIG. 4  is a perspective view schematic representation of a portal saver device, according to an alternative embodiment; 
         FIG. 5  is a perspective section view schematic representation of the portal saver assembly, according to an embodiment; 
         FIG. 6  is a side section view schematic representation of the distal tip of the portal saver assembly in a first configuration, according to an embodiment; 
         FIG. 7  is a perspective side section view schematic representation of the portal saver assembly in the first configuration, according to an embodiment; 
         FIG. 8  is a side view schematic representation of the portal saver assembly in the first configuration, according to an embodiment; 
         FIG. 9  is a side section view schematic representation of the portal saver assembly in the first configuration, according to an embodiment; 
         FIG. 10  is a perspective section view schematic representation of the portal saver assembly in a second configuration, according to an embodiment; 
         FIG. 11  is a side section view schematic representation of the portal saver assembly in a second configuration, according to an embodiment; 
         FIG. 12  is an exploded perspective view schematic representation of a portal saver assembly, according to an alternative embodiment; 
         FIG. 13  is a perspective view schematic representation of a distal body, according to an alternative embodiment; 
         FIG. 14  is a side section view schematic representation of a distal body in a first configuration, according to an alternative embodiment; 
         FIG. 15  is a side section view schematic representation of a distal body in a second configuration, according to an alternative embodiment; 
         FIG. 16  is a perspective diagrammatic view of a dermal fixation device, according to an embodiment; 
         FIG. 17  is a perspective diagrammatic view of a dermal fixation device, according to an alternative embodiment; 
         FIG. 18  is a side perspective view schematic representation of a portal saver assembly, according to an alternative embodiment; 
         FIG. 19  is a side perspective view schematic representation of an obturator of the portal saver assembly of  FIG. 18 ; 
         FIG. 20  is a detailed side section view schematic representation of a seal assembly of the obturator of  FIG. 19 ; 
         FIG. 21  is a top perspective view schematic representation of the obturator of  FIG. 19  in a first configuration; and 
         FIG. 22  is a top perspective view schematic representation of the obturator of  FIG. 19  in a second configuration. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     Aspects of the present invention and certain features, advantages, and details thereof, are explained more fully below with reference to the non-limiting examples illustrated in the accompanying drawings. Descriptions of well-known structures are omitted so as not to unnecessarily obscure the invention in detail. It should be understood, however, that the detailed description and the specific non-limiting examples, while indicating aspects of the invention, are given by way of illustration only, and are not by way of limitation. Various substitutions, modifications, additions, and/or arrangements, within the spirit and/or scope of the underlying inventive concepts will be apparent to those skilled in the art from this disclosure. 
     Referring now to the figures, wherein like reference numerals refer to like parts throughout,  FIGS. 2A-2J  are various views schematic representations of a portal saver device  16 , according to an embodiment. The portal saver device  14  in  FIGS. 2A-2B  comprises a tube-like (or cannulated) flexible body  11  extending distally from a dermal threaded body  13  (with a fluid seal  17 ). In the embodiment depicted in  FIG. 2A , the portal saver device  14  comprises indicators  15  along the flexible body  11  for customizing the size of the flexible body  11 . The portal saver device  14  maintains the path from outside the body (e.g., the skin) to the surgical site (e.g., the joint), which allows the surgeon to move an instrument from one portal to another in two steps or actions (as opposed to 9 steps or actions with conventional devices). In the embodiment depicted in  FIG. 2B , the flexible body  11  is formed via extrusion. However, in alternative embodiments, there are one or more seals along a length of the flexible body  11 . The seals can be angled or perpendicular to each other along the longitudinal axis of the flexible body  11  (which is approximately parallel to the length to the flexible body  11 ). 
     The flexible body  11  of  FIGS. 2A-2B  can be composed of thermoplastic urethane (hereinafter “TPU”)). TPU is a thermoplastic elastomer comprising block copolymers. Specifically, TPU comprises linear alternating hard segments and soft segments—as should be understood by those of ordinary skill in the art. The hard segments are composed of diisocyanates with short-chain diols (i.e., “chain extenders”), making them short, high polarity segments. The soft segments are composed of diisocyanates with long-chain diols, making them long, low polarity segments. The rigidity of TPU can be fine-tuned by increasing or decreasing the ratio of hard segments to soft segments. TPU has high mechanical properties, high heat resistance, high resistance to mineral oils, high hydrolysis resistance, high low-temperature flexibility, high resistance to microbiological degradation, and high elasticity across the entire hardness range. TPU has a hardness of 30 Shore A to 60 Shore D under standard atmospheric conditions—as should be understood by those of ordinary skill in the art in conjunction with a review of this disclosure. An example of TPU is Elastollan®. Another example of TPU is Isothane grade 5090A, made by Greco. 
     TPU provides a number of advantages for use as the composition for the flexible body  11 . In  FIGS. 2C and 2D , the flexible body  11  is an extruded TPU composition that can retain its shape after being manipulated. It is more flexible and thinner than conventional cannulas.  FIG. 2C  shows the flexible body  11  in a knotted configuration and  FIG. 2D  shows the flexible body  11  in a twisted configuration. Both the knotted and twisted configurations illustrate the flexibility of a flexible body  11  composed of TPU. The flexibility and resiliency of the flexible body  11  gives a better range of motion for the surgeon, as if there were operating percutaneously. The flexible body  11  is free to move anywhere and only limited on by the proximal dermal threaded body  13 , which is fixed to the dermis. TPU is also resistant to cuts or other damage from sharp instruments, such as a shaver blade or bur. Further, the heat resistant qualities TPU mentioned briefly above allow for the passage of ablation instruments without deformation or other damage to the flexible body  11 . 
     Turning now to  FIGS. 2E-2G , there are shown various views schematic representations of the dermal threaded body  13  and seal  17 , according to an embodiment. In the depicted embodiment, the dermal threaded body  13  comprises external threads  19 , as shown in  FIGS. 2E-2F .  FIG. 2G  shows the seal  17  at the proximal end of the dermal threaded body  13 . The seal  17  comprises an opening  21 , which is as small as possible but also sized to accommodate all surgical devices for a surgical field or type of procedure (e.g., hip surgical devices). Although the seal  17  will prevent fluid leakage from the surgical site, it also prevents bubbles from migrating to the surgical site and blocking the view of a video scope. Exemplary embodiments of the seal  17  are shown in  FIGS. 2H-2J . In the depicted embodiment, the seal  17  is a double seal. The double seal  17  includes a first seal  23 A with a circular opening  21 A and a second seal  23 B “Mercedes” opening  21 B (meaning an opening formed from three slits meeting at a central location), as shown in  FIGS. 2I-2J . 
     Referring now to  FIGS. 3A-3B , there are shown perspective views schematic representations of a portal saver assembly  10 , according to an embodiment. The portal saver assembly  10  comprises an obturator  12  removably connected to an alternative embodiment of the portal saver device  14 . The portal saver device  14  includes a rigid, flexible body  16  extending to a pair of stirrups  18 A,  18 B, as shown in  FIG. 4 . In the embodiment depicted in  FIG. 4 , the flexible body  16  can be composed of flat sheet material and is welded, creating two seams  20 A,  20 B extending along a length of the flexible body  16 . By nature, the flat sheet material composing the flexible body  16  is prone to collapsing back to a flat shape, which is beneficial for sealing and fluid management. In an alternative embodiment, the flat sheet material composing the flexible body  16  is imperfectly welded such that there is a frangible seal to peel apart the flexible body  16 . In yet another embodiment, the flexible body  16  is extruded from the same flexible material (e.g., thermoplastic urethane (“TPU”)) with no welded seams so that the flexible body  16  maintains a relaxed state (as shown in  FIGS. 2A-2D ). 
     As also shown in  FIG. 4 , the stirrups  18 A,  18 B of the portal saver device  14  extend proximally from the flexible body  16  such that the stirrups  18 A,  18 B are spaced and approximately parallel. In the depicted embodiment, the stirrups  18 A,  18 B each have an aperture  22 A,  22 B extending therethrough and the apertures  22 A,  22 B are aligned. In an alternative embodiment, the portal saver device  14  does not have stirrups, meaning that the flexible body  16  is connected to the obturator  12  directly. In yet another embodiment, the flexible body  16  does not extend to stirrups  18 A,  18 B, but instead has an exterior threaded portion adjacent a tubular end cap. 
     Referring back to  FIGS. 3A-3B , as briefly mentioned above, the portal saver device  14  is connected to the obturator  12 . Specifically, in the depicted embodiment, the obturator  12  comprises an obturator body  24  and the stirrups  18 A,  18 B extend into or onto the obturator body  24 , while the flexible body  16  extends from a distal end  26  of the obturator body  24 . The obturator body  24  in  FIGS. 3A-3B  is ergonomically shaped with spaced ridges  28  to aid in providing a secure grip for the surgeon (or any other user). Near or at the distal end  26  of the obturator body  24 , a holding pin  30  (or any other conventional connector) extends through the obturator body  24  and through an aperture  20 A of a stirrup  18 A within the obturator body  24 . A second holding pin  30  may also extend through the obturator body  24  and through the other aperture  20 B on the other stirrup  18 B within the obturator body  24 . The holding pins  30  secure the stirrups  18 A,  18 B in place within the obturator body  24 . The portal saver assembly  10  additionally comprises a stirrup release actuator  38 . In the depicted embodiment, the stirrup release actuator  38  is a push button. Depressing or otherwise activating the stirrup release actuator  38  releases the portal saver device  14  from obturator body  24 . 
     Still referring to  FIGS. 3A-3B , the portal saver assembly  10  includes a distal rigid body  33 . As shown, the rigid body  33  is secured around the portal saver device  14 . In the depicted embodiment, the rigid body  33  is connected at a proximal end  36  of the flexible body  16 . The rigid body  33  comprises a telescoping assembly  32 , which is movable along the flexible body  16 . The telescoping assembly  32  comprises one or more blades  34  ( FIG. 8 ) for axial slitting of the flexible body  16  to reduce the effective length of the portal saver assembly  10 . As also shown in  FIGS. 3A-3B , the rigid body  33  also comprises exterior barbs  40  for fixation to the patient. In the depicted embodiment, the barbs  40  are adjacent and distal to the telescoping assembly  32 . 
     The portal saver assembly  10  in  FIGS. 3A-3B  also includes an obturator shaft expander  42  which is movable within the obturator  12  and the flexible body  16 . Turning now to  FIG. 5 , there is shown a perspective sectional view schematic representation of the portal saver assembly  10 , according to an embodiment. In the depicted embodiment, the shaft expander  42  is movable within a cannulated outer obturator tube  44  within the obturator body  24 . As shown in  FIG. 5 , the outer obturator tube  44  extends through to obturator body  24 , creating a channel within the obturator body  24  to receive the shaft expander  42 . 
     The shaft expander  42  comprises a proximal handpiece  46  connected to cannulated inner obturator tube  48 . The inner obturator tube  48  is sized and configured to slide within the channel of the cannulated outer obturator tube  44 . In addition, the inner obturator tube  48  extends through the handpiece  46  such that an instrument can be inserted through the handpiece  46 , the inner obturator tube  48 , and out of the outer obturator tube  44  ( FIG. 7 ). When the portal saver device  14  is connected to the obturator  12 , as shown in  FIG. 5 , the inner obturator tube  48  is extendable through the outer obturator tube  44  and the flexible body  16  of the portal saver device  14 . 
     Turning now to  FIG. 6 , there is shown a close-up perspective view schematic representation of the distal tip  50  of the portal saver assembly  10 , according to an embodiment. As shown in the depicted embodiment, the distal tip  50  comprises a duck bill portion  52  of the outer obturator tube  44 . The duck bill portion  52  includes a pair of arms or prongs  56  (which can include additional arm or prong portions, or can in some embodiments can include one arm) formed by a recess (e.g., triangular or prism-shaped) in the outer obturator tube  44  that narrows toward the distal tip  50  of the outer obturator tube  44  (or portal saver assembly  10 ). The duck bill portion  52  opens when an actuator (e.g., small post)  54  on the inner obturator tube  48  is advanced toward the distal tip  50  of the outer obturator tube  44 . As the small post  54  has not been advanced toward the distal tip  50  in  FIG. 6 , the arms  56  of the duck bill portion  52  are collapsed (i.e., in a first configuration). 
     Turning now to  FIGS. 7-9 , there is shown perspective and side section views schematic representations of the portal saver assembly  10  in the first configuration, according to an embodiment. Referring now to  FIG. 7 , there is shown a perspective side section view schematic representation of the portal saver assembly  10  in the first configuration, according to an embodiment. Specifically,  FIG. 7  shows the obturator  12  with the portal saver device  14  removed (or unattached). In the depicted embodiment, the shaft expander  42  is in a first position relative to the obturator body  12 . When the shaft expander  42  is in the first position, the inner obturator tube  48  is at least partially proximally retracted within the outer obturator tube  44 . As a result, the duck bill portion  52  is collapsed in the first configuration, as shown in  FIG. 7 . 
       FIGS. 8 and 9  show a side view schematic representation and side section view schematic representation, respectively, of the portal saver assembly  10  in the first configuration, according to an embodiment. In both  FIGS. 8 and 9 , the portal saver device  14  is connected to the obturator  12 . As shown, when the shaft expander  42  is retracted to the first position, the duck bill portion  52  is collapsed in the first configuration. Although the outer obturator tube  44  is collapsed, the flexible body  16  of the portal saver device  14  is not, as shown in  FIG. 8 . 
     Referring now to  FIGS. 10 and 11 , there is shown a perspective section view schematic representation and side section view schematic representation, respectively, of the portal saver assembly  10  in a second configuration, according to an embodiment.  FIG. 10  shows the obturator  12  with the portal saver device  14  removed (or unattached). When the shaft expander  42  is moved distally or fully advanced toward the obturator body  24  to a second position, the inner obturator tube  48  extends distally into the duck bill portion  52  of the outer obturator tube  44 . Specifically, the small post  54  on the inner obturator tube  48  is advanced toward the distal tip  50  of the outer obturator tube  44 , forcing the arms  56  of the duck bill portion  52  to open to an expanded, second configuration, as shown in  FIGS. 10-11 . Thus, the small post  54  functions to increase an inner diameter of the outer obturator tube  44 . 
       FIG. 11  shows the duck bill portion  52  in the expanded, second configuration when the portal saver device  14  is attached to the obturator  12 . When the duck bill portion  52  is opened to the second configuration, frictional force is applied to the flexible body  16  near the distal tip  50 . The friction of the duck bill portion  52  overcomes the friction of the tissue of the patient as the flexible body  16  is inserted down into the joint (i.e., surgical site), which in turn prevents the flexible body  16  from slipping or rolling up. The expanded or increased inner diameter of the outer obturator tube  44  in the second configuration also allows for flexibility of instruments passing through the portal saver assembly  10 . Accordingly, instruments with a relatively larger diameter or instruments with a bend can be passed through the portal saver assembly  10 . 
     Although a duck bill portion  52  is shown, any other dilation assembly can be used that applies radially outward force to the outer obturator tube  44 . In an alternative embodiment, the dilating assembly is a bead instead of the small post  54 . The inner obturator tube  48  extends past the duck bill portion  52  with a bead, forcing the outer obturator tube  44  to expand (via the arms  56 ). Other actuator or dilating assemblies are contemplated for alternative embodiments. For example, a small pocket on an exterior of distal tip  50  of the outer obturator tube  44  can be used. In another example, a solid rod can be used to displace the distal tip  50  of the outer obturator tube  44 . 
     In order to use the portal saver assembly  10 , the surgeon (or other user) can slide the portal saver assembly  10 , in the first configuration into the hip joint. The portal saver assembly  10  is advanced medially into the patient until the distal tip  50  gains intra-ocular joint access. Then, the rigid body  33  is advanced distally down the flexible body  16  until it is fully engaged with the patient dermis. (The portal saver assembly  10  can be configured for the dermal openings used in most procedures, including a 16 mm dermal opening diameter). At this time, the proximal telescoping assembly  32  simultaneously cleaves (via the blade  34 ) the flexible body  16  while locking its position until the distal barbs  40  are sub-flush with the patient&#39;s dermis. The flexible body  16  is trimmed flush with the blade  34  of the proximal telescoping assembly  32 . 
     In an alternative embodiment, the length of the flexible body  16  can be shortened by cutting it to a desired length. In such an embodiment, the flexible body  16  may have measurements or indicators (via printing or etching, for example) along the length of the flexible body  16 . In yet another embodiment, the flexible body  16  may have perforations or other like grooves along its length for tearing to the desired length. 
     With the flexible body  16  trimmed to the desired length and the barbs  40  securing the rigid body  33  within the patient, the stirrup release actuator  38  on the obturator  12  is actuated and disengages the rigid body  33  and the cleaved flexible body  16 . The obturator  12  is then removed. The obturator  12  can be reloaded with additional rigid bodies  33  and cannulated tubes  16  for the placement of additional intra-articular access portals on the patient. Now, with the rigid body  33  and flexible body  16  in place, all surgical instruments can gain intra-articular access through the flexible body  16  in lieu of dedicated access instruments. The rigid body  33  and flexible body  16  can be removed at the end of the procedure. 
     Referring now to  FIG. 12 , there is shown an exploded perspective view schematic representation of a portal saver assembly  100 , according to an alternative embodiment. In the depicted embodiment, the portal saver assembly  100  comprises a proximal obturator  102  with an outer obturator tube  104  extending therefrom. In an embodiment, the outer obturator tube  104  is composed of flat sheet material and is welded, creating two seams (not shown) extending along a length of the outer obturator tube  104 . By nature, the flat sheet material composing the outer obturator tube  104  is prone to collapsing back to a flat shape, which is beneficial for sealing and fluid management. 
     As shown in  FIG. 12 , the outer obturator tube  104  terminates in a distal tip  106 . The obturator  102  and the outer obturator tube  104  are cannulated such that they are configured to receive instruments therethrough. The outer obturator tube  104  additionally comprises a covering  108  which is connected to an exterior  110  of the outer obturator tube  104 . As shown in  FIG. 12 , the covering  108  is rectangular (or square) with a central aperture  112  which is sized and configured to fit around and connect (or fix) to the outer obturator tube  104 . In the depicted embodiment, the outer obturator tube  104  and the covering  108  are formed via molding such that the outer obturator tube  104  and covering  108  are made from the same piece of material. 
     Still referring to  FIG. 12 , the portal saver assembly  100  shown also includes an adjustable seal  114  and a dermal threaded body  116  for fixing the portal saver assembly  100  to the patient. The adjustable seal  114  is flexible and comprises a rectangular (or square) distal end  118  and an inner obturator tube  120  extending proximally therefrom. The inner obturator tube  120  is flexible such that it can be expanded to accommodate the outer obturator tube  104  and the instruments therein. The rectangular distal end  118  comprises an aperture  122  to receive the distal tip  106  of the outer obturator tube  104 . The dermal threaded body  116  comprises a rectangular (or square) distal end  124  and a cannulated tube  126  extending proximally therefrom. The cannulated tube  126  has plurality of threads  128  on its exterior surface  130  which lock the dermal threaded body  116  (and the portal saver assembly  100 ) within the patient. 
     In use, the distal end  124  of the dermal threaded body  116  is configured to lock (via a snap connection other similar connection) into the distal end  118  of the adjustable seal  114  and the covering  108  around the outer obturator tube  104 , securing the adjustable seal  114  between the dermal threaded body  116  and the covering  108 . The portal saver assembly  100  is advanced into the incision site and the dermal threaded body  116  is rotated into the dermal layer. (The portal saver assembly  100  can be configured for the dermal openings used in most procedures, including a 15 mm dermal opening diameter). The threads  128  on the exterior surface  130  of the dermal threaded body  116  create a holding force in the dermal layer. The connection (e.g., snap connection) between the distal end  124  of the dermal threaded body  116  and the covering  108  around the outer obturator tube  104  can be broken (e.g., unsnapped) to remove the obturator  102  from the incision site. The holding force created by the threads  128  of the dermal threaded body  116  prevents cannulas, instruments, and other tools from falling out of the portal. When the surgical procedure is complete, the adjustable seal  114  can be disconnected (e.g., unsnapped) and the dermal threaded body  116  can be unscrewed or otherwise removed and then passed back through the original incision for easy removal without causing additional trauma or scarring to the skin or dermis of the patient. 
     Referring now to  FIGS. 13-15 , there are shown various views schematic representations of the distal (unthreaded) body  116 , according to an alternative embodiment.  FIG. 13  shows a perspective view schematic representation of the distal body  116 . The distal body  116  comprises a cup-like top portion  131 . In the depicted embodiment, the top portion  131  has a rectangular (or square) cross-section. The top portion  131  comprises a threaded interior bore  134  on a first end  136  and at least two petals  138  extending from the second end  140  of the top portion  131 . The petals  138  are arms or prongs which are movable in relation to each other from a first configuration to a second configuration. Although two petals  138  are shown in  FIG. 13 , additional petals  138  can be utilized. 
       FIG. 14  shows the petals  138  in the first configuration. In the first configuration, the petals  138  are approximately parallel to each other such that they extend in the same direction. As shown, each petal  138  has raised portions  142  (e.g., ridges or other protrusions) on an interior surface  144  of the petal  138 . If force is applied to the raised portions  140  in the distal direction, the petals  138  move from the first configuration to the second configuration. In an embodiment, the raised portions  140  are pushed downward (in the distal direction) by a disc  146  with male threads  148  configured to mate with the female threads  150  of the interior bore  134  in the top portion  131 . As the disc  146  advances downward (in the distal direction) through the interior bore  134 , it presses or otherwise applies pressure to the raise portions  142  causing the petals  138  to expand (or pivot about a pivot point) to the second configuration shown in  FIG. 15 . In other words, the disc  146  pushes the petals  138  from a relatively parallel position in the first configuration to an angled position in the second configuration. 
     In use, the distal body  116  is in the first configuration with the petals  138  approximately parallel, making the distal body  116  small in size. The small size allows the distal body  116  to enter the human body through a smaller incision as compared to those for other cannulas with coarse aggressive exterior threads. The distal body  116  is inserted to a depth within the incision where the top portion  131  is in contact with the skin of the patient. Thereafter, the disc  146  is threaded or advanced into the interior bore  134  of the top portion  131 . As a result, the disc  146  pushes the petals  138  radially outward to the expanded, second configuration. The expansion of the petals  138  under the dermal layer of the patient creates a holding force in the dermal layer. The holding force prevents the cannula from falling out of the portal. When the surgical procedure is complete, the disc  146  can be unscrewed or otherwise removed, causing the petals  138  to retract and move toward each other to the first configuration. The distal body  116  can then be removed or passed back through the original incision for easy cannula removal without causing additional trauma or scarring to the skin or dermis of the patient. 
     In an alternative embodiment, each petal  138  has a “living hinge” as a means to connect the petal  138  to the top portion  131  instead of a mechanical pivoting point (as in  FIGS. 13-15 ). Further,  FIGS. 13-15  show petals  138  having a half-cylinder section; however, any conceivable shape, length, and cross-section can be used. In the depicted embodiment, each petal  138  has a small barb  152  on an exterior surface  154 . However, in other embodiments, any number of barbs  152  or other features can be used to increase the hold of the petal  138  on the tissue. 
     Referring now to  FIGS. 16-17 , there are shown dermal fixation devices  60 , according to alternative embodiments. The dermal fixation devices  60  in  FIGS. 16-17  can be used as an alternative to exterior mechanical threads on the dermal threaded body  116  ( FIG. 12 ) or any other mechanism threads for fixation of an access tool into the skin or dermis of the patient described herein.  FIGS. 16-17  provide dermal fixation devices  60  that do not require any such external mechanical threads. The dermal fixation device  60  in  FIG. 16  is an adhesive disc. The disc  60  comprises a central aperture  62  such that a cannula  64  can be placed therethrough, as shown in  FIG. 16 . In an embodiment, the disc  60  is flexible to conform to the shape of the patient&#39;s skin. In other embodiments, the disc  60  is semi-rigid or rigid. While the disc  60  in the depicted embodiment is circular, the disc  60  may be non-circular. Further, multiple discs  60  or a network of discs  60  may be utilized with a plurality of instruments and cannulas  64  to form a surgical system. 
     As shown in  FIG. 16 , the disc  60  comprises a plurality of weep holes  66  (i.e., apertures) adjacent the central aperture  62 . In the depicted embodiment, the plurality of weep holes  66  surround the central aperture  62 . Ideally, the plurality of weep holes  66  are above the surgical incision to allow fluid leaking from the incision to exit out from under the disc  60  through a controlled pathway that does not disrupt the adhesive/skin interface. In other words, the weep holes  66  allow for the release of fluid that may otherwise lift the adhesive disc  60  away from the skin. Although weep holes  66  are shown in  FIG. 16 , the disc  60  may be utilized without weep holes  66 . 
     In an embodiment, prior to use of the disc  60  at the surgical incision, the cannula  64  can be attached to the disc  60 . In one example, the disc  60  may comprise a layer of hook and loop fasteners (or any similar fasteners) configured to attach to complimentary hook and loop fasteners on the cannula  64 . Using the hook and loop fasteners, the cannula  64  can be temporarily (i.e., removably) attached to the disc  60 . Any other surgical resource may also comprise complimentary hook and loop fasteners for this purpose. With the cannula  64  attached to the disc  60 , the disc  60  is likely to remain in-place throughout the duration of the surgical procedure. In addition, the user can selectively install or un-install the cannula  64  (or other surgical resource) at-will without disrupting the adhesive/skin interface during the surgical procedure. 
     In another embodiment, the adhesive on the disc  60  is covered with a protective covering (e.g., a peel-away liner) to protect the adhesive film until it is needed. Further, once the cannula  64  is inserted into the surgical incision, the area around the incision can be cleaned to improve adhesion of the disc  60  to the patient&#39;s skin before the protective covering is removed. 
     In an embodiment, as shown in  FIG. 16 , a funnel-shaped lead-in  68  can be used on a distal end  70  of the cannula  64  for the easy insertion of surgical instruments. The flexibility of the disc  60  allows for great flexibility and freedom of motion for surgical instruments. As there are no screw threads or barbs in the disc  60  shown in  FIG. 16 , the disc  60  has a small enough diameter to easily pass through a small incision, minimizing scarring and trauma to the region surrounding the incision. To remove the disc  60 , it is pulled away from the incision site, starting at an outer edge of the disc  60  and slowly lifting it to peel it away. Once the disc  60  is separated from the incision site, the cannula  64  (preferably with no barbs or threads) can be easily and smoothly removed with minimal trauma. 
     Turning now to  FIG. 17 , the dermal fixation device  60  is a suction cup. In the depicted embodiment, the suction cup  60  is annular-shaped with a central aperture  62  to receive and attach to a cannula  64 . The cannula  64  is connected to the suction cup  60  such that the cannula  64  can articulate and pivot (via an articulating attachment  67 ) with respect to the suction cup  60 . In the depicted embodiment, the suction cup  60  is flexible in order to conform to the contours of the patient&#39;s skin for a secure seal. In other embodiments, the suction cup  60  is semi-rigid or rigid. While the suction cup  60  in the depicted embodiment is annular, the suction cup  60  may be non-round or non-annular. Further, multiple suction cups  60  or a network of suction cups  60  may be utilized with a plurality of instruments and cannulas  64  to form a surgical system. 
     The suction cup  60  may also comprise a plurality of weep holes  66  (i.e., apertures) adjacent or surrounding the central aperture  62 . The weep holes  66  are above the surgical incision to allow fluid leaking from the incision to exit out from under the suction cup  60  so that the fluid does not disrupt the suction cup/skin interface. Although weep holes  66  are shown in  FIG. 17 , the suction cup  60  may be utilized without weep holes  66 . 
     In an embodiment, prior to use of the suction cup  60  at the surgical incision, the cannula  64  can be attached to the suction cup  60 . In one example, the suction cup  60  may comprise a layer of hook and loop fasteners (or any similar fasteners) configured to attach to complimentary hook and loop fasteners on the cannula  64 . Using the hook and loop fasteners, the cannula  64  can be temporarily (i.e., removably) attached to the suction cup  60 . Any other surgical resource may also comprise complimentary hook and loop fasteners for this purpose. With the cannula  64  attached to the suction cup  60 , the suction cup  60  is likely to remain in-place throughout the duration of the surgical procedure. In addition, the user can selectively install or un-install the cannula  64  (or other surgical resource) at-will without disrupting the suction cup/skin interface during the surgical procedure. 
     In use, the cannula  64  is inserted into the patient and the area surrounding the incision is cleaned to improve the suction cup/skin interface. Next, the suction cup  60  is brought into contact with the patient&#39;s skin at the incision site. A vacuum  72  from a regulated vacuum supply is applied to the annular suction cup  60  via a portal  74  on the suction cup  60 . In the depicted embodiment, the portal  74  is on a proximal side  76  of the suction cup  60 ; however, the portal  74  may be placed at any accessible location on the suction cup  60 . The suction of the vacuum  72  causes the suction cup  60  to adhere to the skin, causing the cannula  64  to be become fixated to the patient&#39;s skin. 
     As with the dermal fixation device  60  described above and shown in  FIG. 16 , a funnel-shaped lead-in  68  can be used on a distal end  70  of the cannula  64  for the easy insertion of surgical instruments. The flexibility of the articulating mounting point allows for great flexibility and freedom of motion for surgical instruments. As there are no screw threads or barbs in the suction cup  60  shown in  FIG. 17 , the suction cup  60  has a small enough diameter to easily pass through a small incision, minimizing scarring and trauma to the region surrounding the incision. To remove the suction cup  60 , the vacuum supply is turned off and the suction cup  60  is lifted away from the incision site. Once the suction cup  60  is separated from the incision site, the cannula  64  (preferably with no barbs or threads) can be easily and smoothly removed with minimal trauma. 
     Turning now to  FIGS. 18-22 , there are shown various views of a portal saver assembly  200 , according to another alternative embodiment. As shown in  FIG. 18 , the portal saver assembly  200  includes a proximal handpiece  202  configured to removably attach to a distal obturator  204 . The obturator  204  can be removably connected to a distal tube-like (cannulated) flexible body  206  extending from a proximal seal assembly  208 . The flexible body  206  can be composed of TPU and can have the same features and be used in the same fashion as the flexible body  11  described above with reference to  FIGS. 2A-2D . The flexible body  206  has a flattened (or narrow) section  210  which acts as a seal and be constructed through heat forming processes. The flattened section  210  is heat sealed to make the obturator tube flat. As shown in  FIG. 19 , the flexible body  206  has two round sections  211  with the flattened section  210  therebetween. The flattened section  210  can be used as an alternative to a welded flat sheet material with seams (as described with the portal saver assembly  10  in  FIGS. 1-11 ). In some situations, the flattened section  210  for the flexible body  206  is preferable to welded seams because the compression force on the flexible body  206  with welded seams creates high frictions, which tends to grab onto instruments within the flexible body  206 . This can lead to accidental withdraw of instruments from a portal and can add a dimension (i.e., “noise) to the sense of feel for the surgeon. The flattened section  210  forms a seal between itself and an instrument extending through the flexible body  206 . Thus, the flexible body  206  is tighter around the instrument. After the instrument is removed, the flattened section  210  (i.e., the heat pressed or sealed portion) returns to the flat shape. The flattened section  210  also prevents fluid from leaking out of the flexible body  206  from the incision site. 
     Referring now to  FIG. 20 , there is shown a detailed section view schematic representation of the seal assembly  208 , according to an embodiment. The seal assembly  208  comprises a body  212  (e.g., rectangular body) with a central aperture  214  extending through a rotating portion  216  and a non-rotating portion  218 . The rotating portion  216  and the non-rotating portion  218  are configured to work in conjunction to fine tune the attachment of the obturator  204  to a tubular body  220  extending through the handpiece  202 . The rotating portion  216  is a movable female connector, such as a threaded channel  222  extending from the central aperture  214  as shown. The non-rotating portion  218  is a non-threaded (or relatively smooth) channel  224  connected within the threaded channel  222 . The non-threaded channel  222  is also connected to the flexible body  206  near the flattened section  210 , as shown in  FIG. 18 . When the seal assembly  208  is attached to the handpiece  202 , the rotating portion  216  and the non-rotating portion  218  receive the tubular body  220  extending through the handpiece  202  ( FIG. 18 ) and the rotating portion  216  is rotated such that the threaded channel  222  tightens around the tubular body  220 . In use, instruments can be inserted into a proximal end  226  of the tubular body  220  and pass through the flexible body  206  of the seal assembly  208 . 
     As shown in  FIGS. 21-22 , one or more petals  228  extend distally from within the body  212  of the seal assembly  208 . The petals  228  are movable from a first configuration to a second configuration using an actuator  230  on the body  212 . Referring briefly to  FIG. 21 , the petals  228  are in the first configuration, closed against the flexible body  206 . In the depicted embodiment, the petals  228  extend in a direction parallel to a length of the flexible body  206  in the first configuration. When the petals  228  are in the first configuration, the actuator  230  is in a first position, as shown. In an embodiment, the first position is the unlocked position wherein the petals  228  are approximately flush with the flexible body  206  for insertion into the patient. 
     Turning now to  FIG. 22 , the petals  228  are in the second configuration. To move the petals  228  into the second configuration, the actuator  230  is activated. In the depicted embodiment, the actuator  230  is rotated or otherwise moved to a second position. (The first and second positions of the actuator  230  can be denoted by indicators  232  on the  212 , as shown). When the petals  228  are in the second configuration, they are expanded and extending at an angle relative to the flexible body  206 , as shown. In the second configuration, the petals  228  function to retain the portal saver assembly  200  within the patient. 
     In use, the obturator  204  is attached to the proximal handpiece  202  using the rotating portion  216  and non-rotating portion  218 , as described above. The length of the flexible body  206  can be trimmed (within an 11 mm range, for example) prior to insertion into the incision site. The portal saver assembly  200  is partially advanced into the incision site without posing any risk to surrounding structures (e.g., femoral head) due to its small diameter. (The portal saver assembly  200  can be configured for the dermal openings used in most procedures, including a 12 mm dermal opening diameter, which is smaller than that used for most cannulas). The portal saver assembly  200  (flexible body  206 ) is advanced farther until the petals  228  are in the dermal layer. The actuator  230  is then moved from the first position to the second position, deploying the petals  228  and moving them from the first configuration to the second configuration. At any time, the length of the flexible body  206  can be trimmed to fine-tune and adjust the length. The proximal handpiece  202  can be removed from the obturator by unscrewing the rotating portion  216 . When the surgical procedure is complete, the petals  228  can be moved back to the first configuration (via the actuator  230 ) and the obturator  202  and flexible body  206  can be passed back through the original incision for easy removal without causing additional trauma or scarring to the skin or dermis of the patient. 
     All definitions, as defined and used herein, should be understood to control over dictionary definitions, definitions in documents incorporated by reference, and/or ordinary meanings of the defined terms. 
     While various embodiments have been described and illustrated herein, those of ordinary skill in the art will readily envision a variety of other means and/or structures for performing the function and/or obtaining the results and/or one or more of the advantages described herein, and each of such variations and/or modifications is deemed to be within the scope of the embodiments described herein. More generally, those skilled in the art will readily appreciate that all parameters, dimensions, materials, and configurations described herein are meant to be exemplary and that the actual parameters, dimensions, materials, and/or configurations will depend upon the specific application or applications for which the teachings is/are used. Those skilled in the art will recognize, or be able to ascertain using no more than routine experimentation, many equivalents to the specific embodiments described herein. It is, therefore, to be understood that the foregoing embodiments are presented by way of example only and that, within the scope of the appended claims and equivalents thereto, embodiments may be practiced otherwise than as specifically described and claimed. Embodiments of the present disclosure are directed to each individual feature, system, article, material, kit, and/or method described herein. In addition, any combination of two or more such features, systems, articles, materials, kits, and/or methods, if such features, systems, articles, materials, kits, and/or methods are not mutually inconsistent, is included within the scope of the present disclosure. 
     The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. As used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprise” (and any form of comprise, such as “comprises” and “comprising”), “have” (and any form of have, such as, “has” and “having”), “include” (and any form of include, such as “includes” and “including”), and “contain” (any form of contain, such as “contains” and “containing”) are open-ended linking verbs. As a result, a method or device that “comprises”, “has”, “includes” or “contains” one or more steps or elements. Likewise, a step of method or an element of a device that “comprises”, “has”, “includes” or “contains” one or more features possesses those one or more features, but is not limited to possessing only those one or more features. Furthermore, a device or structure that is configured in a certain way is configured in at least that way, but may also be configured in ways that are not listed. 
     The corresponding structures, materials, acts and equivalents of all means or step plus function elements in the claims below, if any, are intended to include any structure, material or act for performing the function in combination with other claimed elements as specifically claimed. The description of the present invention has been presented for purposes of illustration and description, but is not intended to be exhaustive or limited to the invention in the form disclosed. Many modifications and variations will be apparent to those of ordinary skill in the art without departing from the scope and spirit of the invention. The embodiment was chosen and described in order to best explain the principles of one or more aspects of the invention and the practical application, and to enable others of ordinary skill in the art to understand one or more aspects of the present invention for various embodiments with various modifications as are suited to the particular use contemplated.