Patent Publication Number: US-2021161558-A1

Title: Method and apparatus for providing access for a surgical procedure

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     This application is a continuation of U.S. application Ser. No. 16/531,534, filed on Aug. 5, 2019, which is a continuation of U.S. application Ser. No. 15/552,993, filed on Aug. 23, 2017, and issued as U.S. Pat. No. 10,368,909 on Aug. 6, 2019, which is a U.S. national phase application under 35 U.S.C. § 371 of International Application No. PCT/CA2016/000054, filed on Feb. 26, 2016, and published as WO 2016/134452 A1 on Sep. 1, 2016, which is based on and claims the benefit of priority from U.S. Provisional Application No. 62/121,357, filed Feb. 26, 2015. The entire disclosures of all of the above applications are incorporated herein by reference. 
    
    
     BACKGROUND 
     1. Field 
     This disclosure relates to apparatus used for surgical procedures and more particularly to providing access to a body cavity of a living animal for robotic and/or laparoscopic surgical instruments and equipment during the surgical procedure. 
     2. Description of Related Art 
     In robotic and laparoscopic surgery it is common to provide access to a body cavity of a patient through an access device. An incision is made by a surgeon in a wall of the body cavity and the access device is inserted into the incision to provide a sealed entry point for a surgical device such as a laparoscopic instrument. For robotic and laparoscopic surgery, the access device may be required to provide a seal to any instrument inserted into the body cavity through the access device. The seal maintains insufflation pressure in the body cavity during insertion and subsequent movement of the instrument. The access device further facilitates insufflation of the body cavity and the removal of smoke produced during electrocauterization of tissues within the body cavity, while maintaining the seal. 
     Commonly available access devices include surgical trocars such as those manufactured by Covidien PLC of Dublin, Ireland or by Stryker Corporation of Michigan, USA. Other types of access devices include wound protector/retractors such as the Alexis wound protector manufactured by Applied Medical Resources Corporation of Rancho Santa Margarita, Calif. and the SurgiSleeve™ wound protector manufactured by Covidien PLC. Wound retractors generally provide open access to the body cavity and are often used in conjunction with cap that covers the wound protector and provides a seal and a point of entry to the body cavity. Examples of available caps/sleeves that work with wound protectors are the GelPort laparoscopic system and the GelPOINT access platform, both manufactured by Applied Medical of California, USA. 
     SUMMARY 
     In accordance with one disclosed aspect there is provided an apparatus for providing surgical access to a body cavity of a living animal through an access port inserted in a wall of the body cavity. The apparatus includes a collapsible volume having an opening for sealingly receiving a surgical apparatus. The apparatus also includes an access coupler disposed at a distal end of the collapsible volume, the access coupler being operably configured to sealingly couple to an opening in the access port to place the collapsible volume in fluid communication with the body cavity. The collapsible volume is operably configured to collapse to permit the surgical apparatus to be inserted through the access coupler into the body cavity. 
     The access port may include an inlet for receiving a fluid flow for insufflating the body cavity and the collapsible volume may be subjected to an insufflation pressure in the body cavity. 
     The access coupler may be operably configured to initiate fluid communication between the body cavity and the collapsible volume when coupled to the opening in the access port. 
     The access port may include an access valve disposed to close the opening in the access port prior to the access coupler sealingly coupling to the opening. 
     The access valve may include a sealing element operably configured to be displaced by the access coupler when the access coupler is coupled to the opening in the access port. 
     The access port may include an outlet for expelling fluid from the body cavity. 
     The access coupler may include a barbed end operable to engage corresponding features within the opening in the access port for retaining the access coupler within the opening. 
     The collapsible volume may include a flexible sleeve. 
     The flexible sleeve may include a transparent portion operable to permit at least a portion of the surgical apparatus to be viewed while being inserted through the access coupler and the opening in the access port. 
     At least a portion of the collapsible volume may include a bellowed conduit. 
     The opening for sealingly receiving the surgical apparatus may include a collar for sealing to the surgical apparatus. 
     The collar may have a non-circular cross section for receiving and sealing to a surgical apparatus having a corresponding non-circular cross section. 
     The surgical apparatus received in the opening of the collapsible volume may include at least one of a camera for viewing an interior of the body cavity, an illumination source for illuminating the interior of the body cavity, a wash tube for delivering a wash fluid for cleaning a lens associated with one of the camera and the illumination source, and a bore for receiving a laparoscopic surgery instrument. 
     The compressible volume may be further operably configured to permit lateral movement of the surgical apparatus with respect to the access coupler to facilitate alignment of the surgical instrument for insertion through the access port. 
     The collapsible volume may be sized to accommodate at least one line extending through the collapsible volume and the access port into the body cavity. 
     The at least one line may include one of an electrical signal line, an optical signal line, a power line, and a wash tube for cleaning a lens associated with a camera disposed on a distal end of the surgical apparatus. 
     In accordance with another disclosed aspect there is provided a method for providing surgical access to a body cavity of a living animal through an access port inserted in a wall of the body cavity. The method involves sealingly receiving a surgical apparatus through an opening in a collapsible volume, and sealingly coupling an access coupler disposed at a distal end of the collapsible volume to an opening in the access port to place the collapsible volume in fluid communication with the body cavity. The method also involves causing the collapsible volume to collapse to permit the surgical apparatus to be inserted through the access coupler into the body cavity. 
     Other aspects and features of the present disclosure will become apparent to those ordinarily skilled in the art upon review of the following description of specific embodiments of the disclosure in conjunction with the accompanying figures. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       In drawings which illustrate embodiments of the invention, 
         FIG. 1  is a depiction of a human patient undergoing a surgical procedure; 
         FIG. 2  is a perspective view of an access port and an apparatus according to a first embodiment of the invention for providing access for a surgical procedure within a body cavity of the patient shown in  FIG. 1 ; 
         FIG. 3  is a front perspective view of the access port shown in  FIG. 2 ; 
         FIG. 4  is a perspective view of one embodiment of a surgical apparatus used during the surgical procedure; 
         FIG. 5  is a perspective view of the apparatus shown in  FIG. 2  receiving the surgical apparatus shown in  FIG. 4 ; 
         FIG. 6  is a perspective view of the apparatus shown in  FIG. 5  in a collapsed state; 
         FIG. 7  is a perspective view of the apparatus shown in  FIG. 6  receiving a surgical instrument; 
         FIG. 8  is a perspective view of an apparatus according to another embodiment of the invention for providing access for a surgical procedure within a body cavity of the patient shown in  FIG. 1 ; 
         FIG. 9  is a perspective view of the apparatus shown in  FIG. 8  in a collapsed 
         FIG. 10  is a perspective view of an alternative access port embodiment; 
         FIGS. 11-13  are a series of views depicting insertion of a valve conduit into a gel seal for configuring the access port shown in  FIG. 10 ; 
         FIG. 14  is a perspective view of the surgical apparatus of  FIG. 4  being received in the access port shown in  FIG. 10 ; and 
         FIG. 15  is a perspective view of the surgical apparatus of  FIG. 4  coupled to the access port shown in  FIG. 10 . 
     
    
    
     DETAILED DESCRIPTION 
     Referring to  FIG. 1 , a human patient  100  is shown on a surgical table  102 . The patient  100  has had an access device  104  inserted in the abdominal wall  105  to permit access to the patient&#39;s abdominal body cavity for a surgical procedure. In this embodiment the access device  104  (shown in hidden detail in  FIG. 1 ) is a wound protector/retractor having a resilient internal ring  106  and a flexible or rigid external ring  108  joined by a sleeve  110 . To insert the wound retractor, a surgeon makes an incision in abdominal wall  105  and deforms the internal ring  106  to facilitate insertion through the incision. The internal ring  106  then retracts inside the body cavity and the internal and external ring  108  on either side of the incision hold the access device  104  in place within the abdominal wall  105 . 
     In the embodiment shown, an access port  112  is configured to sealingly engage the external ring  108  of the access device  104  providing a sealed point of entry into the body cavity. The access port  112  includes an inlet  114  for receiving a fluid flow from an insufflation line  116 . Insufflation of the abdominal body cavity with a gas such as carbon dioxide distends the abdomen providing for entry and sufficient operating space for manipulation of surgical instruments during the surgical procedure. In this embodiment access port  112  also includes an outlet  118  in communication with an evacuation line  119  for expelling fluid from the body cavity. The expelled fluid may include smoke and other vapors produced by electrocauterization of tissue, for example. The inlet and outlet ports  114  and  118  may be implemented using standard fluid connections such as Luer taper connections. 
     In an alternative embodiment the access port  112  may be implemented using a surgical trocar (not shown). Surgical trocars generally include a cannula that is either inserted directly through the incision or inserted through a capped access device such as a wound retractor. The cannula has a bore that permits insertion of instruments into the body cavity and may also include an insufflation inlet and an evacuation outlet. Whether received directly in the incision or through an access device  104 , the trocar provides a sealed point of entry to the body cavity, as in the case of the access port  112  shown in  FIG. 1 . 
     In other embodiments surgery may be performed in body cavities other than an abdominal body cavity of the patient  100  or the surgery may be performed on an animal. 
     Referring to  FIG. 2 , an apparatus for providing surgical access to a body cavity of the patient  100  according to a first embodiment of the invention is shown generally at  120 . The apparatus  120  includes a collapsible volume  122  and an opening  124  in communication with the collapsible volume. In this embodiment the opening  124  is provided by a collar  126  for receiving and sealing to a surgical apparatus such as a portion of a robotic surgical system (not shown in  FIG. 2 ). The apparatus  120  further includes an access coupler  128  disposed at a distal end  130  of the collapsible volume  122 . In this embodiment the collapsible volume  122  is provided by a bellowed conduit extending between the collar  126  and the access coupler  128 . The bellowed conduit encloses the collapsible volume  122  and includes a plurality of convoluted sections  132  formed end to end that have sufficient compliance to permit the conduit to be flexibly extended or compressed. 
     In the embodiment shown, the access port  112  includes an opening  134  and the access coupler  128  is configured to sealingly couple to the opening. In this embodiment the access coupler  128  includes a barbed end  136  that engages corresponding features in the opening  134  for retaining and/or sealing the access coupler to the access port  112 . In other embodiments, the access coupler  128  may be configured for coupling to other access ports having different openings, sealing, and retaining configurations. For example the access coupler  128  may include a bayonet-type twist lock connection. 
     In the embodiment shown the access port  112  includes an access valve  138  disposed in the opening  134 . The access valve  138  provides a penetrable seal for sealing the opening  134  and thus the body cavity, prior to the access coupler  128  being received in the opening  134 . The access port  112  and access valve  138  are shown in front perspective view in  FIG. 3 . Referring to  FIG. 3 , in one embodiment the access valve  138  is implemented using a duck-bill seal having displaceable cross-slits  140  that initially seal the opening  134  and are displaced by the access coupler  128  when received in the opening. In other embodiments the access valve  138  may be implemented using other types of sealing elements, such as a displaceable gel seal. 
     The access valve  138  facilitates installation of the access port  112  in the incision in the abdominal wall  105  while closing off incision to maintain sterile conditions within the body cavity of the patient  100 . The access coupler  128  of the apparatus  120  may thus be coupled to the access port  112  after the access port  112  is installed. The opening  134  of the access port  112  remains closed by the access valve  138  until the access coupler  128  is coupled to the opening. The distal end  130  of the access coupler  128  displaces the access valve  138  placing the collapsible volume  122  in fluid communication with the body cavity through the access port  112 . The body cavity may thus be insufflated before the apparatus  120  is coupled to the access port  112 . 
     In other embodiments the access coupler  128  may be coupled to the access port  112  prior to the access port being inserted in the incision in the abdominal wall  105  and the access valve  138  may be omitted from the access port  112 . In this case the apparatus  120  may include a seal that initially closes off the collapsible volume  122  to prevent escape of the insufflation gas through the opening  124  when connected to the access port  112 . In one embodiment, the seal may be disposed in the opening  124  of the apparatus  120  and may include a valve such as the access valve  138  shown in  FIG. 3 . In another alternative embodiment, the collapsible volume  122  of the apparatus  120  may be sealed by a surgical apparatus that is received in the opening  124  prior to coupling the access coupler  128  to the access port  112 . The access port  112 , apparatus  120 , and the surgical apparatus may thus be sealingly coupled together before insertion of the access port into the abdominal wall  105  of the patient  100 . 
     Referring to  FIG. 4  an example of a surgical apparatus is shown at  150 . In the embodiment shown the surgical apparatus  150  is a portion of a robotic surgical system that is sized for insertion through the opening  134  in the access port  112 . The surgical apparatus  150  includes an actuator interface  152 , a bulkhead  154 , and an elongate shaft  156  extending from the bulkhead. In this embodiment the surgical apparatus  150  has two bores  158  and  159  that run internally through the shaft  156  and are operable to receive a surgical instrument (not shown in  FIG. 4 ). Each bores  158  and  159  may also include a closure such as a displaceable valve (not shown) for preventing escape of insufflation gas through the bores when not in use. 
     In the embodiment shown the surgical apparatus  150  also includes a camera  162  located at a distal end  160  of the shaft  156 . The camera  162  is mounted on linkages  164  and  166 , which are initially disposed to cause the camera to be axially aligned with the shaft  156 . The actuator interface  152  includes actuators (not shown) for actuating the linkages  164  and  166  to deploy the camera  162  after insertion through the opening  134  in the access port  112 . The camera  162  would also generally include an illumination source (not shown) for illuminating the body cavity. In the embodiment shown the surgical apparatus  150  includes a wash tube  167 . During a surgical procedure, the wash tube  167  would be connected to a wash fluid supply operable to deliver wash fluid for cleaning lenses associated with the camera  162  and/or illumination source. In this embodiment, the wash tube  167  extends external to the shaft  156  between the bulkhead  154  and the camera  162 . In other embodiments the wash tube  167  may be accommodated within a bore of the shaft  156 . The wash fluid supply would generally include a reservoir of wash fluid and a pump (not shown) for delivering the wash fluid through the wash tube  167 . 
     While the embodiments herein are described with reference to the specific example of the surgical apparatus  150  shown in  FIG. 4 , other robotic and/or laparoscopic surgical instruments may be used in conjunction with the apparatus  120 . 
     Referring to  FIG. 5 , the surgical apparatus  150  is shown being received in the opening  124  of the apparatus  120 . The shaft  156  of the surgical apparatus  150  has been received through the opening  124  such that at least a portion  168  extends into the collapsible volume  122 . In  FIG. 5 , the access coupler  128  has already been coupled to the opening  134  of the access port  112 . Alternatively, when the access port includes an access valve as described above, the surgical apparatus  150  may be inserted into the opening  124  of the apparatus  120  prior to coupling the access coupler  128  to the access port  112 . 
     In the embodiment shown, the bulkhead  154  has a generally cylindrical cross section having a diameter selected to correspond to a diameter of the collar  126 . The collar  126  provides a sufficient seal at the bulkhead  154  for maintaining insufflation pressure within the body cavity when the apparatus  120  is connected to the access port  112 . In general, sealing of the body cavity at the access port  112  and bulkhead  154  should be sufficient to prevent any significant leakage of insufflation gas. Maintaining low leakage conserves insufflation gas by minimizing a required inflow of gas for purposes of maintaining the insufflation pressure and also reduces drying out of the body cavity. In one embodiment the collar  126  may be fabricated from a compliant material such as a thermoplastic that is able to stretch over the bulkhead  154  to provide an adequate seal and to maintain engagement with the surgical apparatus  150  during the surgical procedure. In other embodiments, the collar  126  may be configured to engage the bulkhead  154  using an interlocking coupler such as a bayonet or snap-on connector and an o-ring may be provided between the collar and the bulkhead for maintaining an adequate seal. 
     When the access coupler  128  is coupled to the opening  134  of the access port  112 , fluid communication is provided between the collapsible volume  122  and the body cavity, thus extending the insufflated volume of the body cavity to include the collapsible volume. The collapsible volume  122  is thus subjected to the insufflation pressure in the body cavity when coupled to the access port  112 . The collapsible volume  122  may be sized such that the portion  168  of the surgical apparatus  150  that extends into the collapsible volume does not initially protrude through the distal end  130  of the access coupler  128 , such that the body cavity may be fully insufflated before the surgical apparatus is received within the body cavity. When the access port  112  includes an access valve  138 , the collapsible volume  122  would be sized such that the access coupler  128  causes the access valve to open prior to any portion of the surgical apparatus  150  being received through the opening. The camera  162  at the distal end  160  therefore need not push through the access valve  138 , which may risk occlusion of camera lenses. Additionally no sharp objects such as laparoscopic instruments are required to push through the access valve  138 , which may compromise the seal provided by the access valve. 
     In other embodiments, the access coupler  128  and access port  112  may be configured for coupling using alternative sealing and retaining configurations, such as a bayonet-type twist lock. Additionally the retaining configuration may be further configured to provide a secure interlocking feature (not shown) preventing the access coupler from de-coupled until the interlock is released. 
     In  FIG. 5 , the collapsible volume  122  is shown in a partially extended state, in which the plurality of convoluted sections  132  are only slightly compressed or slightly extended. In this state the collar  126  of the apparatus  120  and the bulkhead  154  of the surgical apparatus  150  may be advanced toward the access coupler  128  while compressing the plurality of convoluted sections  132 , causing the distal end  160  of the surgical apparatus  150  to move toward the access port  112  to facilitate insertion of the surgical apparatus into the body cavity. The compression of the plurality of convoluted sections  132  requires only minimal force and the collapsible volume  122  is sized to permit free movement of the shaft  156  of the surgical apparatus  150  toward the body cavity while permitting some lateral movement within lateral confines of the collapsible volume. The lateral movement facilitates alignment of the surgical apparatus  150  for insertion through the access coupler  128  and through the opening  134  in the access port  112 . 
     In the embodiment shown in  FIG. 5  the collapsible volume  122  is at least partially transparent and permits the surgical apparatus  150  to be viewed while being inserted through the access coupler  128  and the opening  134  in the access port  112  and into the body cavity (not shown). Transparency of the collapsible volume  122  thus acts as an aid to the surgeon for aligning the distal end  160  of the surgical apparatus  150  during insertion through the access coupler  128  and opening  134  into the body cavity. 
     Referring to  FIG. 6 , the access port  112  is shown installed in the abdominal wall  105  of the patient  100  and the body cavity  169  (represented to the left of the abdominal wall  105  in  FIG. 5 ). The plurality of convoluted sections  132  have been compressed causing the surgical apparatus  150  to be advanced through the access port  112  in a direction aligned with an axis  172  of the shaft  156 . The distal end  160  of the surgical apparatus  150  has thus entered the body cavity  169  and a portion  170  of the shaft  156  also extends into the body cavity. Axial translation of the surgical apparatus  150  in either direction along the axis  172  may be provided manually by an attendant or the surgeon or may be provided by a drive actuator (not shown) attached to the actuator interface  152  or bulkhead  154 . 
     The opening  134  of the access port  112  and the access coupler  128  may be sized to permit free axial movement of the shaft  156  within the access port  112 . The movements can occur within the bounds provided by the collapsible volume  122 , the access coupler  128 , and the opening  134 . The access valve  138  is displaced by the access coupler  128  when initially connected and does not provide any further constraint to movement of the shaft  156 . The apparatus  120  thus extends the insufflation volume into the collapsible volume  122  and also removes the need for a sliding seal at the access port  112  that would be commonly required for robotic or laparoscopic surgery. 
     The collapsible volume  122  and access coupler  128  may additionally be sized to accommodate additional lines or tubes for operating the surgical apparatus  150 . For example, while the wash tube for the camera  162  may be accommodated in a bore within the shaft  156 , the available space within the bore may be limited due to constraints on the diameter of the shaft and space within the bore required for other purposes. The diameter of the collapsible volume  122  of the apparatus  120  may thus be selected to facilitate running the wash tube  167  external to the shaft  156 . Since the collapsible volume  122  is sealed from the environment, no additional sliding seal would be required for the wash line  167 , which would extend through the collapsible volume  122  and the opening  134  within the insufflated volume. Other lines may also be run through the collapsible volume  122 . For example, signal or power lines associated with camera operation may also be run external to the shaft  156  within the collapsible volume  122 . 
     When the surgical apparatus  150  has accessed the body cavity  169  as shown in  FIG. 6 , the linkages  164  and  166  may be actuated to cause the camera  162  to be deployed by moving laterally away from the axis  172 . Further actuation of the linkages  164  and  166  may be employed to articulate the camera  162  as necessary for viewing and/or illuminating the surgical site within the body cavity. The surgical apparatus  150  may also be further moved axially along the longitudinal axis  172  in either direction to initially dispose the surgical apparatus  150  proximate the surgical site in the body cavity  169  and to place the camera  162  in a suitable location for viewing and illuminating the surgical site. The plurality of convoluted sections  132  of the collapsible volume  122  facilitate such axial movements by compressing or retracting as necessary depending on the size of the body cavity  169  and the location of the surgical site within the body cavity. In general the length of the collapsible volume  122  may be selected to provide sufficient axial translation range of the surgical apparatus  150  for both larger and smaller body cavities  169 . 
     Referring to  FIG. 7 , deployment of the camera  162  provides clearance for a surgical instrument  180  to be introduced into one of the bores  158  and  159  of the surgical apparatus  150  and advanced through the shaft  156  to access the body cavity  169 . In the embodiment shown, the surgical instrument  180  has a tool  182  disposed at its distal end, which protrudes from the end of the shaft  156  and is disposed to perform surgical operations within the body cavity  169 . The tool  182  may be any of a variety of tools such as are generally used in laparoscopic surgery such as surgical scissors, forceps, or an electrocauterization tool. In the embodiment shown an additional surgical instrument (not shown) may be inserted through a remaining one of the bores  158  and  159 . While the surgical apparatus  150  described herein is configured to receive the surgical instrument  180  through the bores  158  and  159 , in other embodiments the surgical instrument may be an integral part of the surgical apparatus  150  and the apparatus  120  may be configured to directly receive the surgical instrument. 
     Once inserted, the surgical instrument  180 , tool  182 , and the camera  162  may be remotely controlled by a surgeon. In the embodiment shown in  FIG. 7 , a portion  184  of the surgical instrument  180  is configured as an articulated tool positioner as described in detail in commonly owned patent applications PCT/CA2013/001076 entitled “ARTICULATED TOOL POSITIONER AND SYSTEM EMPLOYING SAME” and PCT/CA2015/000098 entitled “ACTUATOR AND DRIVE FOR MANIPULATING A TOOL” filed on Feb. 18, 2015. The articulated tool positioner permits dexterous movement of the portion  184  and thus the tool  182  in response to actuation forces received at an instrument interface  186 . In addition to the dexterous movement provided by the portion  184  of the surgical instrument  180 , further axial movements of the surgical apparatus  150  and the surgical instrument  180  within the bore  158  or  159  are provided by an instrument drive (not shown), which may be coupled to the instrument interface  186 . The instrument drive is operable to cause movement of the surgical instrument  180  in a direction aligned with the longitudinal axis  172  of the shaft  156  for advancing or retracting the surgical instrument  180  within the bore  158  or  159 . Additionally, should the surgical instrument  180  need to be repositioned within the body cavity  169 , the surgical apparatus  150  may be axially moved to a new location, either extending or compressing the plurality of convoluted sections  132  of the collapsible volume  122 . The combination of independent axial movements of the surgical apparatus  150  and the surgical instrument  180  may be employed during the surgical procedure to reposition the camera  162  and/or tool  182  as necessary for performing surgical operations within the body cavity  169 . 
     In the embodiment shown in  FIGS. 4-7  the bulkhead  154  of the surgical apparatus  150  and the collar  126  both have generally circular cross sections. In other embodiments, the collar  126  may be configured to accept a surgical apparatus  150  having a non-circular cross section or to accept other lines for operating the surgical apparatus. In the embodiment shown in  FIG. 2 , the opening  134  of the access port  112  is shown as being centered within the access port. However, in other embodiments the opening  134  may be located off center and additional ports for auxiliary instruments and/or lines may also be provided in the access port  112 . In one embodiment the apparatus  120  may be fabricated using a relatively inexpensive plastic and/or elastic materials. The apparatus  120  may be packed in sterile packaging for a single use and discarded once the surgery is completed. In other embodiments the apparatus  120  may be fabricated from more durable material and may be used for a pre-determined number of uses and sterilized after each use. 
     Referring to  FIG. 8 , an apparatus for providing access for a surgical procedure within a body cavity of a living animal according to another embodiment of the invention is shown generally at  200 . The apparatus  200  includes a collar  202  having an opening  204  for receiving the surgical apparatus  150 . The apparatus  200  also includes an access coupler  206 . In this embodiment a flexible sleeve  208  extends between the collar  202  and the access coupler  206  and provides the collapsible volume  210 . In one embodiment the flexible sleeve  208  may be fabricated using a transparent polythene material. The shaft  156  of the surgical apparatus  150  is received in the opening  204  of the bulkhead  154  and seals to the collar  202  as generally described above. 
     Referring to  FIG. 9 , when the access coupler  206  is coupled to the access port  112 , the collar  202  and bulkhead  154  may be advanced toward the access coupler  206  and the access port  112  such that a portion  212  of the surgical apparatus  150  extends through the access coupler and into the body cavity  169 . The flexible sleeve  208  is able to fold and/or crumple to facilitate movement while inserting the surgical apparatus  150  through the access coupler  206  into the body cavity  169 . Similarly when retracting the surgical apparatus  150  the flexible sleeve  208  unfolds and/or stretches while maintaining the sealed body cavity  169 . When coupled to the access port  112 , the collapsible volume  210  is subjected to the insufflation pressure from the body cavity, which has the tendency keep the flexible sleeve  208  inflated, thus facilitating free passage for the surgical apparatus  150  within the volume. The apparatus  200  may be packed in sterile packaging for a single use and discarded after the surgery. 
     In other embodiments, the collapsible volume  122  or  210  may be provided by an inflexible sleeve. For example, the sleeve may include a plurality of telescoping segments having sliding seals between the segments. 
     The above embodiments provide convenient deployment and insertion of a surgical apparatus for a surgical procedure. The need for a sliding seal is eliminated in favor of more simple static seals or valves provided between the collar ( 126 ,  204 ) and the device  150  and also at the opening  134  of the access port  112 . In this case there is no need to overcome sliding friction associated with seals used in many robotic surgery access ports and the action of coupling the access coupler ( 128 ,  206 ) to the access port  112  may thus result in reduced forces applied to the access port  112  and the abdominal wall  105 . Furthermore, subsequent movements of the surgical apparatus  150  back and forth within the body cavity would also only exert minimal force on the access port  112  since free access is provided through the opening  134 . Furthermore, for a surgical apparatus having a non circular shaft cross section there is no further constraint at the access port due to complex sealing requirements since the access valve  138  is displaced to open by connecting the access coupler ( 128 ,  206 ) and the access coupler may be sized to accommodate the instrument cross section. Additional lines such as a wash tube for delivering wash fluid for lens cleaning may also be run through the collapsible volume ( 122 ,  210 ) and access coupler ( 128 ,  206 ) without additional complexity in coupling through the access port  112 . Again, the access coupler ( 128 ,  206 ) and access port  112  need only be sized to accommodate the additional lines. 
     Referring to  FIG. 10 , an alternative embodiment of an access port is shown at  300 . In this embodiment the access port  300  is provided by a valve conduit  302  inserted through a gel seal  304 . The gel seal  304  may be the GelPOINT access platform manufactured by Applied Medical of California, USA, which includes a displaceable gel portion  306  surrounded by a substantially rigid rim  308 . The rim  308  may be configured to attach to the access device  104  shown in  FIG. 1 . The valve conduit  302  includes an access valve  310  implemented using a duck-bill seal having displaceable cross-slits  312 . 
     In one embodiment the valve conduit  302  and gel seal  304  may be supplied in separate sterile packaging (not shown) and the valve conduit may be inserted through the gel seal  304  prior to use. Referring to  FIG. 11 , a sterile obturator  314  having a sharp tip  316  may be provided together with the valve conduit  302  for piercing the gel portion  306  of the gel seal  304 . Referring to  FIG. 12 , the obturator  314  is inserted through the valve conduit  302  and the sharp tip  316  is pressed through the gel portion  306  of the gel seal  304 . The inserted valve conduit  302  is shown in  FIG. 13 , and following insertion of the access conduit, the sterile obturator  314  may be removed and discarded. The access port  300  may then be coupled to the access device  104  generally as shown in in  FIG. 1 . In this embodiment the gel seal  304  is sized to provide a free area of the gel portion  306  surrounding the valve conduit  302  to permit additional access through the abdominal wall  105  of the patient  100  for additional instruments or the surgeon&#39;s fingers etc. 
     In  FIG. 14  the access port  300  is shown being attached to the access device  104  that retracts to provide an opening  320  in the abdominal wall  105  of the patient. In one embodiment the surgical apparatus  150  (shown in  FIG. 4 ) is inserted through the valve conduit  302  of the access port  300 . The displaceable cross-slits  312  of the access valve  310  permit the distal end  160  of the surgical apparatus  150  to access the patient&#39;s body cavity through the access port  300 . In this embodiment the collapsible volume  122  is initially maintained in a collapsed state with the access coupler  128  partway along the shaft  156 . Referring to  FIG. 15  the access coupler  128  is then  30  sealingly coupled to the valve conduit  302  and the distal end  160  of the surgical apparatus  150  is able to enter the body cavity through the access valve  310  (shown in  FIG. 10 ). When the access valve  310  is breeched by the distal end  160  of the surgical apparatus  150 , the collapsible volume  122  is placed in fluid communication with the body cavity. 
     While specific embodiments of the invention have been described and illustrated, such embodiments should be considered illustrative of the invention only and not as limiting the invention as construed in accordance with the accompanying claims.