Patent Publication Number: US-2019167302-A9

Title: Low-profile surgical access devices with anchoring

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This Application is a Continuation Application of U.S. patent application Ser. No. 13/388,644, filed Sep. 24, 2012 which is a U.S. National Stage Application under 35 U.S.C. § 371 based on International Application No. PCT/US10/51955 filed Oct. 8, 2010 which is related and claims the benefit of priority to PCT Application No. PCT/US2009/60299, filed Oct. 10, 2009, which in turn claims the benefit of priority to U.S. Patent Application Ser. No. 61/104,475, filed Oct. 10, 2008. This Application also claims the benefit of priority to U.S. patent application Ser. No. 12/577,189, filed Oct. 11, 2009, now U.S. Pat. No. 9,289,233, which in turn claims the benefit of priority to U.S. Patent Application Ser. No. 61/104,475, filed 10 Oct. 2008. This Application also claims the benefit of priority of U.S. Patent Application Ser. No. 61/250,521, filed Oct. 11, 2009 and U.S. Patent Application Ser. No. 61/370,938, filed Aug. 5, 2010. This Application is also related to U.S. Pat. Nos. 7,182,752, 7,338,473, and 7,285,112, U.S. Patent Application Publication Number US 2007/0088275 and PCT application number PCT/US07/88017, published as Publication No. WO 2008/077080. Each of the foregoing Patents and Applications are incorporated herein by reference in its entirety. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates to surgical access devices for performing minimally-invasive surgical procedures. Particularly, the present invention is directed to surgical access devices that are particularly adapted to securely anchoring in an incision, such as one made through the abdominal wall of a patient. The present invention is also directed to such surgical access devices that include a non-mechanical pressure barrier for inhibiting loss of peritoneal pressure under abdominal insufflation. 
     Description of Related Art 
     A variety of access devices are known in the art for accessing a surgical site, such as the abdominal cavity. Typically, ensuring that such access devices stay securely mounted in the abdominal wall without causing excessive trauma is a primary goal. The present invention provides various solutions to these problems. 
     SUMMARY OF THE DISCLOSURE 
     The purpose and advantages of embodiments of the present invention will be set forth in and apparent from the description that follows. 
     To achieve these and other advantages and in accordance with the purpose of the invention, as embodied, the invention includes, in one aspect, a surgical access device including a housing having proximal and distal end portions, an access tube extending distally from the distal end of the housing, adapted and configured to extend at least partially though an incision formed in the abdominal wall of a patient, the access tube having a hyperbolic shape in cross section, with an expanded-diameter distal portion to inhibit removal from an incision, and a cover disposed over a proximal end portion of the housing adapted and configured to reduce sound from fluid flowing through the access device. 
     In accordance with further aspects, the cover can include a removable lid. The cover can include a sound-absorbing material. If desired, the cover can include an engagement portion adapted to engage with the housing, and a lid portion attached to the engagement portion by way of a hinge. The housing can include a distal housing portion having a discontinuous bottom end with extensions interrupted by openings. 
     In accordance with another embodiment, the disclosure provides a surgical access device having a housing having proximal end and a distal end, wherein the housing defines a side access port through a wall thereof between the proximal and distal ends. The device further includes an access tube extending distally from the distal end of the housing, adapted and configured to extend at least partially though an incision formed in the abdominal wall of a patient, the access tube having a an expanded-diameter distal portion to inhibit removal from an incision. 
     In accordance with further aspects, the device an further include a door to reduce sound from fluid flowing through the access device. The door is pivotable and/or flexible. A plenum chamber is preferably defined within the housing, the plenum chamber being in fluid communication with at least one nozzle, and being configured to direct pressurized fluid in an axial direction from the plenum chamber into a central bore of the access tube to provide a constant gaseous seal around a surgical instrument inserted therethrough, while inhibiting a loss of pressurized fluid from the body cavity therethrough, and wherein the plenum chamber is adapted and configured to receive pressurized fluid and conduct the pressurized fluid to the at least one nozzle. The plenum chamber preferably includes an inlet port for communicating with a source of pressurized fluid. 
     In accordance with a further aspect, the nozzle can be defined by a gap defined by an outer periphery of a nozzle insert disposed within the proximal housing and an inner periphery of a substantially annular insert disposed within the proximal housing. A pressure sensing chamber can be defined within the housing that is adapted and configured to be in fluid communication with the abdominal cavity of the patient to facilitate sensing of abdominal pressure. The pressure sensing chamber can have an outlet port for communicating with a pressure sensor of a connected system. The sensing chamber can be in fluid communication with a sensing channel defined in the access tube of the surgical access device. In some embodiments, the access tube can be a flexible wound retractor. If desired, the housing can define a plurality of side access ports through the wall. If desired, the housing can define a plurality of protrusions adjacent to the side access port, the protrusions being adapted and configured to hold and inhibit sliding of surgical instruments inserted through the port. 
     The disclosure further provides a wound protector having a proximal end portion, a central tubular structure, and a distal anchor portion, wherein the distal anchor portion is connected to the central tubular structure a web, wherein the central tubular structure supports the distal anchor portion by way of the web. In accordance with further aspects, the web can define a plurality of apertures therethrough to facilitate manipulation of the wound protector. The wound protector can include at least one of elastomeric material and a shape-memory alloy. 
     The disclosure still further provides a wound protector having a proximal end portion, a central tubular portion, a distal anchor portion and defines a longitudinal axis along its center between the proximal end portion and distal end portion, wherein the central tubular portion has an undulating configuration and defines a substantially sinusoidal aperture therethrough in a plane that is generally perpendicular to the longitudinal axis. 
     In accordance with further aspects, the aperture can be defined between opposing walls of the wound protector. In one embodiment, the aperture can be completely sealed by the opposing walls collapsing on each other. In another embodiment, the aperture can be adapted and configured to remain partially open. The wound protector is preferably adapted and configured to permit the passage one or more instruments through the aperture, and further wherein the walls move away from one another without stretching when instruments are passed through the aperture to permit the aperture to expand. 
     The disclosure further provides surgical access device including a nozzle assembly mounted for polyaxial spatial adjustability about a point of rotation, and a base portion adapted and configured to receive the nozzle assembly, the base portion including an access tube extending distally from the base portion, the tube being adapted and configured to extend at least partially though an incision formed in the abdominal wall of a patient, the access tube having a an expanded-diameter distal portion to inhibit removal from an incision. 
     The nozzle assembly can include a tube connection for mating with a high-pressure fluid source. The nozzle assembly can be held in place by a plurality of stanchions extending proximally from the base portion. The stanchions can define substantially spherical inner surface portions for mating with substantially spherical outer surface portions of the nozzle assembly. The nozzle assembly can include an annular upper portion and an annular lower portion separated by a plurality of standoffs to maintain a predetermined spacing between the upper and lower portions, wherein the upper and lower portions cooperate to define a pressure plenum there between. The upper portion and lower portion of the nozzle can be sealed within a ring shaped housing by a plurality of seal elements disposed in circumferential grooves on an outer peripheral edge of each of the upper and lower portion. 
     The disclosure further provides a surgical access device, including an outer cannula, an inner cannula disposed within the outer cannula including a wound protector, a tube center component disposed within a central bore of a ring jet assembly, wherein the tube center component and ring jet assembly cooperate to define a plurality of fluid nozzles disposed about a central axis of the device, and a fluid manifold attached to an exterior portion of the outer cannula. 
     In accordance with a further aspect, the wound protector can include a proximal end portion, a central tubular portion, a distal anchor portion and can define a longitudinal axis along its center between the proximal end portion and distal end portion, wherein the central tubular portion has an undulating configuration and defines a substantially sinusoidal aperture therethrough in a plane that is generally perpendicular to the longitudinal axis. 
     It is to be understood that both the foregoing general description and the following detailed description are exemplary and are intended to provide a non-limiting explanation of the invention. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings, which are incorporated in and constitute part of this specification, are included to illustrate and provide a further understanding of the method and system of the invention. Together with the description, the drawings serve to explain the principles of the invention, wherein: 
         FIG. 1  is a cross sectional view of one embodiment of an example surgical access device in accordance with the invention, having a substantially hyperbolic flexible body tube; 
         FIG. 2  illustrates a second exemplary embodiment of a surgical access device in accordance with the invention, which is adapted for use with flexible wound retractors and the like; 
         FIG. 3  illustrates an exemplary embodiment of a wound retractor for use with the surgical access device of  FIG. 2 ; 
         FIG. 4  is a cross-sectional view of the surgical access device of  FIG. 2 , showing the wound retractor seated within a groove of the device; 
         FIG. 5(A)  is a cross-sectional view of the surgical access device of  FIG. 2 , showing a fluid plenum defined within a housing; 
         FIG. 5(B)  is a cross-sectional view of the surgical access device of  FIG. 2 , showing a recirculation chamber within the housing; 
         FIG. 6  is a cross-sectional view of the surgical access device of  FIG. 2 , showing a cap applied to the housing; 
         FIG. 7  illustrates a third exemplary embodiment of a surgical access device in accordance with the invention, having opposed distal spring anchors for engaging an abdominal wall of a patient; 
         FIG. 8  is a side view of the surgical access device of  FIG. 7 , showing a compatible opturator; 
         FIG. 9  is a bottom view of the surgical access device of  FIG. 8 , showing the spring anchors and stops; 
         FIG. 10  is a perspective view of the surgical access device of  FIG. 8 , showing stubs of the obturator; 
         FIG. 11  is an exploded view of the surgical access device of  FIG. 8 , showing notches of the spring anchors; 
         FIG. 12  illustrates a fourth exemplary embodiment of a surgical access device in accordance with the invention, having expandable spring anchors at a distal end thereof, and a contractible body tube; 
         FIG. 13  is a perspective view of the surgical access device of  FIG. 12 , showing the spring anchors is the expanded position and the body tube contracted; 
         FIG. 14  illustrates a fifth exemplary embodiment of a surgical access device in accordance with the invention, having opposed deployable anchor elements; 
         FIG. 15  is a perspective view of the anchor elements of the surgical access device of  FIG. 14 ; 
         FIG. 16  is a perspective view of the surgical access device of  FIG. 15  with an obturator removed and the anchor elements in a curved orientation; 
         FIG. 17  illustrates a sixth exemplary embodiment of surgical access devices in accordance with the invention, having circumferentially arranged deployable anchor elements; 
         FIG. 18  is a perspective view of an obturator for use with the surgical access device of  FIG. 17 , showing articulating hooks; 
         FIG. 19  is a perspective view of the surgical access device of  FIG. 17  with the obturator inserted therein engaged with the anchoring elements; 
         FIG. 20  is a perspective view of the surgical access device of  FIG. 17  with the obturator removed and the anchoring elements returning to a curved orientation; 
         FIG. 21  is a top view of the surgical access device of  FIG. 17 , showing a lumen shaped substantially as an ellipse; 
         FIG. 22  is perspective view of an anchoring element of the surgical access device of  FIG. 17 , showing pins to secure the anchoring elements to the body; 
         FIG. 23  is a side view of an anchoring element of the surgical access device of  FIG. 17 , showing the anchoring element is a curved orientation; 
         FIG. 24  is a side view of an anchoring element of the surgical access device of  FIG. 17 , showing a protrusion for securing the anchoring element to the body; 
         FIG. 25  is a side view of the anchoring element of the surgical access device of  FIG. 17 , showing the protrusion for securing the anchoring element to the body; 
         FIG. 26  is perspective view of the anchoring element of the surgical access device of  FIG. 17 , showing the protrusion for securing the anchoring element to the body; 
         FIG. 27  illustrates a seventh exemplary embodiment of a surgical access device in accordance with the invention having at least one slot formed in a distal body portion thereof to enhance a range of motion of a surgical instrument inserted therethrough; 
         FIG. 28  is a perspective view of the surgical access device of  FIG. 27 , showing a surgical instrument through the slot; 
         FIG. 29  is a top view of the surgical access device of  FIG. 27 , showing an angle of insertion through the body; 
         FIG. 30  illustrates an eighth exemplary embodiment of a surgical access device according to the invention, having distal coiled anchor elements; 
         FIG. 31  is a perspective view of the surgical access device of  FIG. 30 , showing a movable actuator; 
         FIG. 32  is a perspective view of an anchor element associated with the surgical access device of  FIG. 30 ; 
         FIG. 33  is a perspective view of the anchor element of the surgical access device of  FIG. 30  housed within the body; 
         FIG. 34  illustrates a ninth exemplary embodiment of a surgical access device according to the invention, having radially deployable anchor elements; 
         FIG. 35  is a perspective view of the surgical access device of  FIG. 34 , showing at least one shaft for deploying the anchor elements; 
         FIG. 36  illustrates a surgical access device in accordance with a further embodiment of the invention, which can be provided with a proximal engagement portion; 
         FIG. 37  is a perspective view of the surgical access device of  FIG. 36 , showing the engagement portion coupled to a proximal portion of the body; 
         FIG. 38  is a side view of the surgical access device of  FIG. 36 , showing a hinge of the engagement portion; 
         FIG. 39  is a side view of the surgical access device of  FIG. 36 , showing the engagement portion as a ring; 
         FIG. 40  is a side view of the surgical access device of  FIG. 36 , showing the engagement portion in an open position; 
         FIG. 41  is a bottom view of the surgical access device of  FIG. 36 , showing a proximal portion of a wound protector positioned within a lower housing portion; 
         FIG. 42  illustrates a further embodiment of a surgical access device in accordance with the invention having a housing with a cover, in-turn with an optional removable lid, as well as a side-access port; 
         FIG. 43  is a top view of the surgical access device of  FIG. 42 , showing the removable lid; 
         FIG. 44  is a side view of the surgical access device of  FIG. 42 , showing the cover; 
         FIG. 45  is a side view of the surgical access device of  FIG. 42 ; 
         FIG. 46  is a front view of the surgical access device of  FIG. 42 , showing a side access port and flexible door; 
         FIG. 47  is a side view of the surgical access device of  FIG. 42 ; 
         FIG. 48  is a perspective view of the surgical access device of  FIG. 42 , showing a plurality of protrusions; 
         FIG. 49  is a bottom view of the surgical access device of  FIG. 42 ; 
         FIG. 50  is an exploded view of the surgical access device of  FIG. 50 , showing a connection arrangement between the cover and lid; 
         FIG. 51  illustrates still a further surgical access device in accordance with the invention having a plurality of side-access ports; 
         FIG. 52  illustrates a wound protector compatible with the surgical access devices, of the invention having an anchor portion, central tubular structure and curved sealing members; 
         FIG. 53  is a perspective view of the wound protector of  FIG. 52 , showing a plurality of apertures within a web to facilitate manipulation; 
         FIG. 54  is a top view of the wound protector of  FIG. 53 , showing a substantially sinusoidal aperture; 
         FIG. 55  is a bottom view of the wound protector of  FIG. 53 ; 
         FIG. 56  is a side view of the wound protector of  FIG. 53 , showing a proximal end portion and a distal end portion; 
         FIG. 57  is a perspective view of the wound protector of  FIG. 53 ; 
         FIG. 58  illustrates a further embodiment of a surgical access device in accordance with the invention, including a plurality of flexible atraumatic anchor portions, which extend outwardly from the body; 
         FIG. 59  is a side view of the surgical access device of  FIG. 58 , showing a connection for a tube set; 
         FIG. 60  is a perspective of an atraumatic anchor portion, showing a configuration for insertion through an incision; 
         FIG. 61  is a top view of the surgical access device of  FIG. 58 ; 
         FIG. 62  is an exploded view of the surgical access device of  FIG. 58 ; 
         FIG. 63  illustrates still a further embodiment of a surgical access device in accordance with the invention, including a nozzle assembly mounted for spatial adjustability with respect to a base portion thereof; 
         FIG. 64  is a perspective view of the surgical access device of  FIG. 63 , showing the nozzle assembly and opposing stanchions; 
         FIG. 65  is a side view of the surgical access device of  FIG. 63 , showing the nozzle assembly and opposing stanchions; 
         FIG. 66  is a side view of the surgical access device of  FIG. 63 , showing the nozzle assembly and tube connection; 
         FIG. 67  is an exploded view of the surgical access device of  FIG. 63 , showing pins and corresponding slots of the nozzle assembly; 
         FIG. 68  is a top view of the surgical access device of  FIG. 63 ; 
         FIG. 69  is a bottom view of the surgical access device of  FIG. 63 ; 
         FIG. 70  illustrates a nozzle assembly in accordance with the invention, including an upper portion and a lower portion; 
         FIG. 71  is a perspective view of the nozzle assembly of  FIG. 70 , showing standoffs; 
         FIG. 72  is a perspective view of the nozzle assembly of  FIG. 70 , showing the upper and lower portions; 
         FIG. 73  is a detailed view of a portion of the nozzle assembly of  FIG. 72 , showing a plurality of recesses and jets; 
       
         FIG. 74 
       
         FIG. 75  is a cross-sectional view of the nozzle assembly of  FIG. 70 , showing a stepped interface between upper and lower portions; 
         FIG. 76  is an exploded view of the nozzle assembly of  FIG. 70 ; 
         FIG. 76(A)  is a side view of the nozzle assembly of  FIG. 70 ; 
         FIG. 77(A)  illustrates yet a further embodiment of a surgical access device in accordance with the disclosure, which is adapted for use with flexible wound retractors and the like; 
         FIG. 77(B)  is a side view of the surgical access device of  FIG. 77(A) , showing a high pressure plenum; 
         FIG. 77(C)  is a side view of a wound retractor with a proximal ring held in place by surgical access device of  FIG. 77(A) ; 
         FIG. 77(D)  is a side view of the surgical access device of  FIG. 77(A) , showing a manifold; 
         FIG. 77(E)  is a top view of the surgical access device of  FIG. 77(A) , showing an outer cannula; 
         FIG. 77(F)  is a side view of the surgical access device of  FIG. 77(A) ; 
         FIG. 77(G)  is a bottom view of the surgical access device of  FIG. 77(A) ; 
         FIG. 78(A)  is a perspective view of a wound retractor for use with a surgical access device of the present disclosure; 
         FIG. 78(B)  is a side view of the wound retractor of  FIG. 78(A) ; 
         FIG. 78(C)  is a top view of the wound retractor of  FIG. 78(A) ; 
         FIG. 78(D)  is a side view of the wound retractor of  FIG. 78(A) ; 
         FIG. 78(E)  is a bottom view of the wound retractor of  FIG. 78(A) ; 
         FIG. 79(A)  is a perspective view of a ring jet associated with the surgical access device of the present disclosure; 
         FIG. 79(B)  is a perspective view of a ring jet associated with the surgical access device of the present disclosure; 
         FIG. 79(C)  is a side view of a ring jet associated with the surgical access device of the present disclosure; 
         FIG. 79(D)  is a top view of a ring jet associated with the surgical access device of the present disclosure; 
         FIG. 80(A)  is a perspective view of an outer cannula associated with a surgical access device of the present disclosure; 
         FIG. 80(B)  is a side view of the outer cannula of  FIG. 80(A) ; 
         FIG. 80(C)  is a side view of the outer cannula of  FIG. 80(A) ; 
         FIG. 80(D)  is a side view of the outer cannula of  FIG. 80(A) ; 
         FIG. 80(E)  is a top view of the outer cannula of  FIG. 80(A) ; 
         FIG. 80(F)  is a bottom view of the outer cannula of  FIG. 80(A) ; 
         FIG. 80(G)  is a side view of the outer cannula of  FIG. 80(A) ; 
         FIG. 81(A)  is a perspective view of a cap associated with the surgical access device of the present disclosure; 
         FIG. 81(B)  is a cross-sectional view of the cap of  FIG. 81(A) , showing a circumferential groove; 
         FIG. 82(A)  is a perspective view of a tube center component associated with the surgical access device of the present disclosure; 
         FIG. 82(B)  is a perspective view of the tube center component of  FIG. 82(A) , showing a circumferential groove; 
         FIG. 82(C)  is a side view of the tube center component of  FIG. 82(A) , showing a plurality of detents; 
         FIG. 82(D)  is a top view of the tube center component of  FIG. 82(A) ; 
         FIG. 83(A)  is a perspective view of a fluid manifold associated with the surgical access device of the present disclosure; 
         FIG. 83(B)  is a perspective view of a fluid manifold of  FIG. 82(A) , showing a plurality of ports; 
         FIG. 83(C)  is a top view of a fluid manifold of  FIG. 82(A) ; 
         FIG. 83(D)  is a side view of a fluid manifold of  FIG. 82(A) ; 
         FIG. 83(E)  is a bottom view of a fluid manifold of  FIG. 82(A) ; 
         FIG. 83(F)  is a side view of a fluid manifold of  FIG. 82(A) ; 
         FIG. 83(G)  is a cross-sectional view of a fluid manifold of  FIG. 82(A) ; 
         FIG. 83(H)  is a side view of a fluid manifold of  FIG. 82(A) ; 
         FIG. 84(A)  illustrates still another embodiment of a surgical access device in accordance with the invention, which is adapted for use with flexible wound retractors and the like; 
         FIG. 84(B)  is a cross-sectional view of the surgical access device of  FIG. 84(A) ; 
         FIG. 84(C)  is a side view of the surgical access device of  FIG. 84(A) ; 
         FIG. 84(D)  side view of the surgical access device of  FIG. 84(A) ; 
         FIG. 84(E)  is a top view of the surgical access device of  FIG. 84(A) ; 
         FIG. 84(F)  is a side view of the surgical access device of  FIG. 84(A) ; 
         FIG. 84(G)  is a bottom view of the surgical access device of  FIG. 84(A) ; 
         FIG. 85(A)  is a perspective of a wound retractor associated with the surgical access device of  FIG. 84(A) ; 
         FIG. 85(B)  is a side view of the wound retractor of  FIG. 85(A) , showing an expanded condition; 
         FIG. 85(C)  is a side view of the wound retractor of  FIG. 85(A) , showing a retracted condition; 
         FIG. 85(D)  is a top view of the wound retractor of  FIG. 85(A) ; and 
         FIG. 85(E)  is a bottom view of the wound retractor of  FIG. 85(A) . 
     
    
    
     DETAILED DESCRIPTION 
     Reference will now be made in detail to the presently preferred embodiments of the invention, examples of which are illustrated in the accompanying drawings. The related methods of the invention will be described in conjunction with the detailed description of the devices. 
     In accordance with the invention, and as illustrated in  FIG. 1 , a surgical access device  100  is provided, which is advantageously has a relatively low profile, allowing surgical instruments  190  inserted therethrough to be less restricted in movement than with more conventional surgical access devices. The access device  100  includes a housing  120 , and a compliant access tube  110  extending distally from the distal end of the housing  120 . The access tube  110  is adapted and configured to extend at least partially though an incision formed in the abdominal wall of a patient. In the illustrated embodiment, the access tube  110  has hyperbolic shape in cross section. An expanded-diameter distal portion of the access tube  110  inhibits removal of the access device  100  from the incision formed in the patient. In accordance with the invention, the length of the access tube  110  can be sufficiently long so as to extend fully though the abdominal wall of the patient and into the peritoneal space. 
     In accordance with the invention, the access device  100  can further include insufflation capability, can be adapted and configured to form a fluidic seal or barometric barrier around an instrument inserted therethrough and/or can be adapted to facilitate recirculation of insufflation gasses. Details of such capabilities are set forth in U.S. Pat. No. 7,182,752, U.S. Pat. No. 7,285,112, U.S. Pat. No. 7,338,473, U.S. Patent Publication No. US 2007/0088275 and PCT Publication No. WO 2008/077080, which documents are incorporated herein by reference in their entirety. 
     As illustrated in  FIG. 1 , for example, the surgical access device  100  can include an a pressurized fluid plenum  123  defined within the housing  120 . In the illustrated embodiment, the plenum  123  is defined between the housing  120 , a lower insert  130  and an upper insert  140 . The plenum  123  is in fluid communication with at least one nozzle  128 , and is configured to direct pressurized fluid in a substantially axial direction from the plenum  123  into a central lumen  118  of the access tube  110  to provide a constant gaseous seal around a surgical instrument inserted therethrough, and/or across the lumen  118  when an instrument is not inserted therethrough, for example. 
     Similarly, as illustrated, a recirculation chamber  121  can be defined in the access device  100 , between the housing  120  and the lower insert  130 . One or more sealing elements, such as resilient O-rings or the like, can be provided in seats  132 ,  142 , which are formed respectively in each of the first and second inserts  130 ,  140 . One or more openings  114  can be provided between the lumen  118  and the recirculation chamber  121  to allow gasses to pass into the recirculation chamber  121 . 
     One or more additional chambers or other fluid conduits can further be provided, to facilitate fluid communication between a pressure-sensing device and/or a surgical insufflator, and the operative site. A fluid conduit can be formed within the wall of or on the inner or outer surfaces of the access tube  110 . Alternatively, a separate tube can be passed though the lumen  118  for such purpose, if so desired. In still alternate embodiments, and as illustrated in the embodiment of  FIGS. 2-6  for example, a pressure sensing and/or insufflation aperture  424  can simply be in fluid communication with the upper portion of the lumen  418 . 
     As illustrated, a connection  125  is provided on the housing  120 , and has at least one channel formed therein, in fluid communication with one of the aforementioned chambers and/or conduits. It is in fluid communication with such chambers and/or conduits by passages formed therein and in the housing  120 . The connection  125  facilitates connection of multiple conduits, which may be embodied in a single set, to the access device  100  quickly and simply. The conduits, in-turn are connected to the appropriate equipment, including insufflation devices, recirculation devices and the like. 
     If desired, the housing  120  and the access tube  110  can be detachable from one another. The access tube  110  can be provided in assorted lengths and shapes, and with assorted features, as desired or required. Accordingly, a surgeon can decide before or during a procedure what length or diameter access tube  110  to use, and can attach it to the body  120  of the access device. Alternatively, a range of access devices of varying diameters, lengths and having varying features can be provided fully assembled to be available to the surgeon. 
     As set forth above, the illustrated cross-section of the access tube  110 , which is taken in a plane parallel to the longitudinal axis  180  of the access device  100  is hyperbolic, and in three-dimensions is shaped as a hyperboloid of revolution. In cross-section, in a plane perpendicular to the central axis  180 , for example, the cross-section can be circular, oval, elliptical or otherwise oblong in shape. 
     As illustrated in  FIGS. 2-6 , a surgical access device  200  in accordance with the invention can be adapted and configured for use with any desired tubular surgical access device, such as a flexible wound retractor  310  ( FIG. 3 ), for example. Example wound retractors are set forth in U.S. Pat. Nos. 5,524,644, 3,347,226, 3,347,227, 5,159,921, 5,524,644, 6,450,983, 6,254,534, 6,846,287, 5,672,168, 5,906,577, 6,142,936, 5,514,133, 7,238,154, 6,945,932, 6,908,430, 6,972,026, 5,741,298, or 6,945,932, which disclosures are incorporated herein by reference in their entirety. 
     In such embodiments, the wound retractor can be inserted through an incision formed in the patient, and secured by any suitable means. The body  120  can then be secured, such as by interference fit, friction fit, clamps, straps or otherwise secured to the proximal end of the wound retractor, for the purpose of providing insufflation, recirculation and/or filtration and/or fluidic sealing capability to prevent loss of abdominal pressure when insufflated, without introducing a mechanical seal. 
     As illustrated, and as best seen in the cross-sectional views of  FIGS. 4-6 , a flexible wound retractor  300 , which includes a sheath body  312 , distal ring  313  and proximal ring  311  is seated in a distally positioned groove  429  in an expanded-diameter portion of the housing  220  of the surgical access device  200 . The distal and proximal rings  311 ,  313  are typically made of a compliant material, such as a rubber, foam rubber or the like, and thus have an inherent shape and size. When the wound retractor  300  is inserted through an incision and secured to the patient, as by rolling or other technique, the housing  200  can be applied thereto, with the proximal ring  311  compressing initially during insertion, and then expanding to fit within the groove  429 . The internal hoop stresses maintain the ring  311  and thus the retractor  300  within the groove  429 , and inhibit unintentional removal therefrom. 
     Alternate connections between the wound retractor  310  and the housing  200  are conceived, including but not limited to use of clamp devices and the like, with the housing being seated at least partially within a lumen of the wound retractor, for example. 
     As with the surgical access device  100  of  FIG. 1 , the surgical access device  200  of  FIG. 2-6  includes a housing  220 , with a connector  225  extending therefrom. The internal components thereof, which will be explained in more detail below in connection with  FIG. 4-6  are held within the housing by a retainer, which is embodied as a snap ring or “circlip”  260 , which is used to maintain a relatively low profile, but other configurations are possible. 
     As best seen in the cross-sectional views of  FIGS. 4-6 , the surgical access device  200  is provided with a relatively low profile, allowing surgical instruments inserted therethrough to be less restricted in movement than with more conventional surgical access devices, as with the access device  100  of  FIG. 1 . The access device  200  includes a housing  220 , adaptable with a flexible wound retractor  310  extending distally from the distal end of the housing  220 . 
     In accordance with the invention, the access device  200  can include insufflation capability, can be adapted and configured to form a fluidic seal or barometric barrier around an instrument inserted therethrough and/or can be adapted to facilitate recirculation of insufflation gasses. 
     As illustrated the surgical access device  200  includes a pressurized fluid plenum  423  defined within the housing  220 . In the illustrated embodiment, the plenum  423  is defined between the housing  220 , a lower insert  430  and an upper insert  440 . The plenum  423  is in fluid communication with at least one nozzle  428 , and is configured to direct pressurized fluid in a substantially axial direction from the plenum  423  into a central lumen  418  of the wound retractor to provide a constant gaseous seal around a surgical instrument inserted therethrough, and/or across the lumen  418  when an instrument is not inserted therethrough, for example. 
     Similarly, as illustrated, a recirculation chamber  421  can be defined in the access device  200 , between the housing  220  and the lower insert  430 . One or more sealing elements, such as resilient O-rings or the like, can be provided in annular seats which are formed respectively in each of the first and second inserts  430 ,  440 . An aperture  422  is provided in the housing  220  between the lumen  118  and the connector  225  to allow gasses to pass into a recirculation portion of a connected system. 
     One or more additional chambers or other fluid passageways or conduits  424  can further be provided, to facilitate fluid communication between a pressure-sensing device and/or a surgical insufflator, and the operative site. The fluid conduit can be formed within the wall of or on the inner or outer surfaces of a wound retractor connected thereto. Alternatively, a separate tube can be passed though the lumen  418  for such purpose, if so desired. In still alternate embodiments, and as illustrated in the embodiment of  FIGS. 2-6  for example, a pressure sensing and/or insufflation aperture  424  can simply be in fluid communication with the upper portion of the lumen  418 . 
     As illustrated, a connection  225  is provided on the housing  220 , and has at least one channel formed therein, in fluid communication with one of the aforementioned chambers and/or conduits. It is in fluid communication with such chambers and/or conduits by passages formed therein and in the housing  220 . The connection  225  facilitates connection of multiple conduits, which may be embodied in a single set, to the access device  200 . The conduits, in-turn are connected to the appropriate equipment, including insufflation devices, recirculation devices and the like. 
     In cross-section, in a plane perpendicular to the central axis of the lumen  418 , for example, the cross-section or the lumen portion of the housing  220  can be circular, oval, elliptical or otherwise oblong in shape. 
     As illustrated in the cross-sectional view of  FIG. 6 , a proximal cap  650  can be applied to the housing  220 , and can incorporate sound attenuation features, such as sound absorbing materials or sound attenuation surface features to absorb, cancel or reduce sound created by fluid flowing through the lumen  418  of the access device. An internal skirt  660  is optionally provided, and is seated within the housing  220  and the lumen  418 . Apertures can be formed in the housing portion of the skirt  660  to allow fluid to enter the recirculation plenum  421 . Moreover, a tube or other passageway can be integrated into the skirt  660 , in fluid communication with pressure sensing and/or insufflation components of attached systems, connected through the respective passageway of the connector  425 . 
       FIGS. 7-11  illustrate a further surgical access device  700  in accordance with the invention, which includes a housing  720  with connector  725 , with internal components that are substantially similar, and may include the same optional features to that of the foregoing embodiments, and which for simplicity will not be discussed in detail with respect to this embodiment. However, the surgical access device  700  includes a different anchoring mechanism than that of the foregoing embodiments. The surgical access device  700  includes spring anchors  715 , which are provided in tracks formed in or alternatively on a surface of the housing  720 , terminating in stops  716 . The spring anchors are formed so as to secure the access device  700  to the abdominal wall of a patient, while preventing trauma thereto, and accordingly include a reverse bend at the distal end thereof. The spring anchors can be maintained within the housing  720 , and not deployed, or can be deployed from a stowed position when the access device  700  is inserted. The spring anchors  715  can be formed of any suitable material including but not limited to stainless steel or shape-memory alloys. 
     In accordance with a preferred aspect, the access device  700  is provided with a compatible obturator  790 , having opposed planar slots  795  with stubs  792  extending into the slots, offset from a bottom surface of the slots  795 . As best seen in the exploded partial view of  FIG. 11 , notches  1116  are defines in the spring anchors  715 . As the obturator  790  is advanced longitudinally, the stubs  792  pass through the notches  1116  and in combination with the slots  795  engage the spring anchors  715  and straighten them from their inherently curved configuration. The obturator  790  can be used to hold the spring anchors  715  in a straightened configuration during insertion of the access device  700 , as well as during removal thereof from the patient. 
       FIGS. 12-13  illustrate a further surgical access device  1200  in accordance with the invention, which includes a housing  1220  with connector  1225 , with internal components that are substantially similar, and may include the same optional features to those of the foregoing embodiments, and which for simplicity will not be discussed in detail with respect to this embodiment. 
     The surgical access device  1200  includes still a different anchoring mechanism than that of the foregoing embodiments. The surgical access device  1200  includes spring anchors  1215 , which are maintained during insertion of the access device  1200  by a distal end cap  1210 , which can function as or be integrated with a surgical obturator  1290 . When the access device  1200  is fully inserted into an incision formed in the abdominal wall of a patient, the cap  1210  is removed by urging the cap distally. The cap  1210  can be reapplied to the access device  1200  to allow for removal of the access device  1200 . 
     The spring anchors  1215  can be formed of any suitable material, including shape memory alloys. 
     As illustrated, the body of the access device includes an adjustable bellows portion  1230  to aid in securing the access device  1200  to the abdominal wall. Following initial insertion of the access device  1200 , the distal end portion  1229  of the body can be pulled proximally to effectively pinch the abdominal wall, securing the access device  1200  thereto. Such a connection can be accomplished by way of a spring-loaded component which is maintained in an extended configuration during insertion of an obturator  1290 , or alternatively a cable arrangement attached to the distal end portion  1229  and pulled proximally. 
       FIGS. 14-16  illustrate a further surgical access device  1400  in accordance with the invention, which includes a housing  1420  with connector  1425 , with internal components that are substantially similar, and may include the same optional features to those of the foregoing embodiments, and which for simplicity will not be discussed in detail with respect to this embodiment. 
     The surgical access device  1400  includes distal anchor elements  1415 , which can be formed of any suitable material, including but not limited to stainless steel or a shape memory alloy, for example. The anchor elements  1415  are maintained in a straight orientation ( FIG. 14 ), when engaged with a distal end portion  1410  of a surgical obturator  1490 . As best seen in  FIG. 15 , the track  1417  is integrated with the anchor elements  1415  and is adapted to engage one or more protrusions on the obturator  1490  to maintain the anchor elements  1415  in the desired position. A frame  1416  of the anchor elements  1415  defines the overall shape, and terminates as pivots  1419 . The frame  1416  can be provided with a coating  1418 , which can be made of a cushioning material to minimize trauma to the patient and/or to enhance anchoring of the access device  1400 . The cushioning material can be silicone rubber for example, but can be another suitable material, and can extend into a web  1481  define within the frame  1416 , effectively increasing the surface area of the anchor element  1415 . 
       FIG. 16  shows the access device  1400  with the obturator  1490  removed therefrom. 
       FIGS. 17-26  illustrate a further embodiment of a surgical access device  1700  in accordance with the invention, and detailed views of anchoring elements  1715  thereof. The surgical access device is similar to the embodiment of  FIGS. 14-16 , and includes a housing  1720  with internal components as set forth above, a connection element  1725  and anchor elements  1715 . 
     As shown in  FIGS. 18 and 19 , an obturator for use with the access device  1700  includes a distal end portion  1810 , which engages the anchor elements  1715  by way of articulating hooks  1811 . Upon insertion, the articulating hooks  1811 . The anchor elements  1715  are maintained in a straight position during insertion and are released when the access device  1700  is fully inserted through the abdominal wall of the patient. 
     As with the access device  1400  of  FIGS. 14-16 , the access device  1700  includes a plurality of circumferentially arranged anchors  1715 , which are formed of a material such but not limited to stainless steel or shape-memory alloys. Alternatively, with this or other embodiments described herein, resilient polymeric materials can be used. Optional features including coverings, a web element or the like can be applied to advantageous effect. 
       FIG. 21  is a top view of the surgical access device  1700 , which illustrates an overall cross-sectional shape and lumen shaped substantially as an ellipse. As set forth above, alternate shapes are possible, including but not limited to circular, cat-eye shape or oblong of another configuration. 
     As best seen in  FIGS. 22-26 , the anchors  1715  include a main body  2275 , spring elements  2273 , pins  2271  extending from the body  2275 , one or more struts  2277 . The body  2275  can be formed of any suitable material, including but not limited to polymeric materials. The tendency of the anchors  1715  to curve is imparted in the illustrated embodiment by way of the spring elements  2273 , which as with foregoing embodiments can be formed of any suitable material including but not limited to polymeric materials and metals, including shape memory alloys. 
     The pins  2271  are provided to secure the anchors  1715  to the body  1720  of the surgical access device  1700 . Further protrusions  2279  can be provided on the anchors  1715  to additionally secure the anchors  1715  to the body  1720 . 
       FIGS. 27-29  illustrate an access device  2700  which includes a slot  2712  formed in a distal end portion  2710  of the body  2720  thereof. This feature can be applied to any other embodiment set forth herein, which includes an elongated body. The slot allows for extended range of motion of a surgical instrument  2799  inserted through the access device  2700 . As with the above-described embodiments, the housing  2720  includes a connection  2725 . As best seen in  FIGS. 28-29 , the cross-sectional shape is substantially elliptical, but alternatively can have another shape, as mentioned above. 
       FIGS. 30-33  illustrate a further embodiment of a surgical access device  3000  in accordance with the invention, having a housing  3020  with connection  3025 . The surgical access device  3000  includes circularly coiled anchor elements  3015  circumferentially arranged in a distal end portion thereof. An axially movable actuator  3076  is provided, in connection with the anchor elements  3015 , which when contracted are housed within the body  3020  of the access device  3000 . When the actuator  3076  is urged distally, the anchor elements  3015  extend from the distal end of the housing  3020 , and coil in radial planes, perpendicular to a longitudinal axis of the access device  3000 . When deployed, the anchor elements  3015  abut the abdominal wall, thereby helping anchor the access device  3000 . As with foregoing embodiments, the anchor elements  3015  can be formed of a spring material, which can be, for example, a resilient polymeric material, or a metal such as stainless steel or a shape memory alloy. 
       FIGS. 34 and 35  illustrate a surgical access device  3400  having yet a further alternative anchoring mechanism, with radially deployable anchor elements  3415 , actuated by one or more shafts  3417  provided in a housing  3420  thereof. When the access device is inserted through an incision, the anchor elements  3415  are deployed to anchor the access device  3400  to the abdominal wall of the patient. 
       FIGS. 36-41  illustrate a surgical access device  3600  similar to the embodiment illustrated in  FIGS. 2-5B . The surgical access device  3600  includes an upper housing portion  3620  and a distal, or lower, housing portion  3627 . The lower housing portion  3627  includes a discontinuous bottom end, with extensions  3628 , being interrupted by openings  3629 . Such an arrangement facilitates connection with and removal from a detachable body tube, such as the flexible proximal ring  311  of a flexible wound retractor. A nozzle assembly  3630  is provided in the housing  3620 . 
     A lid assembly  3640  is optionally provided, and as embodied includes an engagement portion  3641 , a lid portion  3643  and a hinge  3645  arranged therebetween. The engagement portion  3641 , as embodied, is a ring that surrounds the housing  3620 . However, it is to be understood that this element need not be limited to such a configuration. The engagement portion  3641  can be connected to the housing  3620  by friction fit, adhesive, bonding such as solvent, friction welding or ultrasonic welding, for example. 
       FIGS. 42-50  illustrate a further embodiment of a surgical access device  4200  in accordance with the invention. The surgical access device  4200  includes a housing  4220 , and a cover  4229  with an optional removable lid  4228 . The cover  4229  is preferably fit over the body  4220  and serves to reduce sound from fluid flowing through the access device  4200  to an observer, for example, in the operating room during use of device  4200 . As such, the cover  4229  is, in accordance with one aspect, formed of a sound-absorbing material, at least in part. Further, the cover  4229  can be removed quickly during a surgical procedure if increased access to a surgical site is required. 
     The housing  4220  includes, defined therein, a side access port  4226 , which can be provided with a pivotable or flexible door  4227  to reduce noise coming through the side access port  4226  when not in use. When desired, surgical instruments or accessories, such as sutures can be inserted through the port  4226 , or specimens can be removed therethrough. The configuration of a nozzles, provided in the surgical access device  4200  permits openings to the side of the housing  4220 , as with the side access port  4226 . In such arrangements, a pressure barrier is formed below the port  4226 , and as such, the port  4226  experiences lower pressure than those experienced in the abdomen under insufflation. Accordingly, insufflation gasses remain in the abdominal cavity, or are recirculated through the surgical access device  4200 . 
     Additionally, a plurality of protrusions  4281  can be provided adjacent to the side access port  4226 . The protrusions serve to hold and inhibit sliding of surgical instruments inserted through the port  4226 , and also serve as fulcrums for applying leverage to surgical instruments inserted through the port  4226 . 
     As can be seen in the view of  FIG. 48 , a plurality of standoffs  4281  can be provided to maintain a positioning of a nozzle insert in the housing  4220 . In the exploded view of  FIG. 50 , an exemplary connection arrangement between the cover  4229  and lid  4228  is illustrated, whereby studs  4298  extend from the lid  4228 , and engage corresponding apertures  4299  in the cover  4229 . A circlip  260  can be provided for securing a nozzle insert within the housing  4220 . 
       FIG. 51  illustrates a further surgical access device  5100 , which, similar to the embodiment of  FIGS. 42-50 , is provided with side access ports  5191 a-e in the housing  5120  thereof. The surgical access device  5100  is not illustrated with a nozzle insert for simplicity of illustration, but one would be provided, as with other embodiments set forth herein. The side access ports  5191 a-e permit insertion of multiple instruments through a surgical incision, while maintaining positioning thereof in respective ports. As set forth above, a pressure barrier is formed below the ports  5191 a-e, and therefore no mechanical seals are required. In accordance with the invention, one or more ports  5191  a-c can be used with an endoscope, and such an arrangement can also facilitate use with robotic surgical systems, by defining secure positions in which instruments can be placed, relative to a patient&#39;s anatomy. 
       FIG. 52-57  illustrate a wound protector  5200 , compatible with the foregoing surgical access devices. The wound protector  5200  includes a proximal end portion  5216 , a central tubular structure  5210 , and a distal anchor portion  5214 . The anchor portion  5214  is supported by the central tubular structure  5210  by a web  5212 . Apertures  5213  can be defined in the web  5212  to facilitate manipulation of the wound protector  5200  and material reduction. The wound protector  5200  is preferably molded of an elastomeric material, but can optionally be provided with an internal structure of a shape-memory alloy, if desired. 
     The proximal end portion  5216  includes an upper surface  5218  with standoffs  5219 , which, as illustrated are configured to directly interface with nozzle components for forming pressure barriers, such as those described herein. As such, the surface  5218  can partially define a chamber or plenum, such as a return plenum for recirculation capability. 
     The central tubular portion  5210  includes an undulating configuration, best seen in the top view of  FIG. 54 , wherein a substantially sinusoidal aperture  5281  is defined between opposite walls  5280 ,  5282 . The aperture  5281  can be completely sealed by the walls  5280 ,  5282 , or alternatively can be configured so as to remain partially open. In any case, the illustrated configuration permits passage of one or more instruments through the lumen  5299  and aperture  5281 , while the walls  5280 ,  5282  move away or “unfold” from the lumen, but without stretching. In this manner, excessive forces are not applied to instruments inserted therethrough. The forces experienced passing through the aperture  5281  are substantially less than for an instrument passing through a typical “duckbill” type seal member. 
     Further, the configuration of the sinusoidal aperture  5281  and opposed walls  5280 ,  5282  reduces, the overall cross-sectional area of available area of the lumen  5299 , as compared with a fully open (e.g. circular) lumen. 
     The wound protector  5200  can be inserted through in incision by inverting the web  5212  and distal anchor portion  5214 , and inserting the distal end of the wound protector  5200  through the incision. Once inserted sufficiently far, the distal anchor portion  5214  then deploys and maintains the position of the wound protector  5200  in the incision. 
       FIG. 58-62  illustrate a further embodiment of a surgical access device  5800  in accordance with the invention. The surgical access device  5800  preferably includes a plurality of flexible atraumatic anchor portions  5810 , which extend outwardly from the body  5820 . Any nozzle configuration can be provided in connection with this embodiment, but as illustrated, the nozzle configuration is that  7000  of  FIGS. 70-76 (A) (described hereinbelow). It should be understood that the surgical access device  5800  as well as other surgical access devices described herein need not only be provided in connection with a pressure-barrier nozzle (e.g. nozzle  7000 ), but can be advantageously provided instead, or in addition, with more traditional physical sealing members, such as septum seals, duckbill-type seals, and so on. 
     Additionally a side access port  5828  is provided, which can be advantageously used to permit passage of and hold an endoscope, for example. In such a manner, the endoscope can be inserted and can remain in position, while other surgical instruments are inserted through the lumen  5819 . The housing  5820 , as illustrated, is substantially elliptical. Alternatively, the housing  5820  can be round or another shape, for example, as with any embodiment set for the herein. 
     The connection  5827  for a tube set is provided on the housing  5820  and offset therefrom with an extension  5825 , which removes any connection from the area of a patient&#39;s skin, and thus minimizes any trauma to the patient&#39;s skin in the area of the incision, during a surgical procedure. 
     The anchor portions  5810  are preferably atraumatic in configuration, and therefore have a relatively wide and rounded configuration. The anchor portions  5810  can be formed of a polymeric material uniquely, or can be formed of a plurality of materials, such as a polymer molded over a metal structure, such as one formed of a spring steel or a shape-memory alloy, for example. 
       FIG. 60  illustrates the surgical access device  5800  in configuration for insertion through an incision. The anchor portions  5810  are preferably extended from a resting (relaxed) position into a substantially longitudinally-aligned position. In such a configuration, the anchor portions  5810  can be inserted through an incision, maintained in position by hand, or by an insertion device, and then released within the abdominal cavity, when the anchor portions  5810  return to their resting state, and hold the surgical access device  5800  in position in the incision. 
       FIGS. 63-69  illustrate still a further embodiment of a surgical access device  6300  in accordance with the invention. The surgical access device  6300  includes a nozzle assembly  6330  mounted for spatial adjustability with respect to a base portion  6328  of the surgical access device  6300 , and thus an incision to which the surgical access device  6300  is mounted. A tube connection  6327  is provided on the nozzle assembly  6330 , which is held by opposed stanchions  6323 , having spherical inner surfaces for mating with a spherical outer surface of the nozzle assembly  6330 . Accordingly, the nozzle assembly  6330  is permitted to rotate in a substantially spherical path, with respect to the stanchions  6323 , the plate portion  6326  to which the stanchions  6323  are secured, a lower portion  6328  of the surgical access device  6300  and therefore, to the incision. 
     The plate portion  6326 , and therefore, the stanchions  6323  and nozzle assembly  6323  are also linearly adjustable, as illustrated, by way of pins  6322 , engaging nuts  6325 , and corresponding slots  6324  formed in the plate portion  6326 . 
       FIGS. 70-76 (A) illustrate various views of a nozzle assembly  7000  in accordance with the invention. The nozzle assembly  7000  includes an upper portion  7790  and a lower portion  7780 . Standoffs  7792  and corresponding recesses  7783  are provided to maintain relative spacing, and a pressure plenum there between. The upper portion  7790  and lower portion  7780  are sealed to the housing, into which they are inserted, by seal elements, such as o-rings, held in circumferential grooves  7789 ,  7799  on the outside of the lower portion  7780  and upper portion  7790 , respectively. As best seen in the cross-sectional view of  FIG. 75 , the upper portion  7790  and lower portion  7780  can be sealed at their inner-most edge, causing pressurized fluid to be diverted through discrete jets  7781  distributed about the lower portion  7780 . A stepped interface  7079  can be provided between the upper portion  7790  and the lower portion  7780 . Moreover, the upper portion  7790  and the lower portion  7780  can be mutually adhered at the protrusions  7792  and or at the stepped interface  7079 , for example, to create a sub-assembly and enhance structural stability of the nozzle assembly  7000 . 
     As illustrated in  FIGS. 77(A)-77(G) , a cut away view of a surgical access device  8100  is presented. Device  8100  is made by assembling a number of nested components discussed in further detail below. As depicted in  FIG. 81(A) , device  8100  includes, in a nested configuration, an outer cannula or body  8120 , an inner cannula/wound retractor  8310 , a ring jet assembly  8130 , a tube center component  8140  and a fluid manifold  8150  attached to an exterior portion of the outer cannula  8120 . A cap  8160  may also be provided as illustrated in  FIGS. 81(A)-81(B)  and as discussed in detail below. Each of the aforementioned components will now be illustrated in further detail. 
     Various views of outer cannula  8120  are depicted in  FIGS. 80(A)-80(G) . As illustrated, outer cannula  8120  has a proximal end  8122  helping to define a proximal region  8122 A, a distal end  8124  helping to define a distal region  8124 A, and defines a longitudinal bore  8126  therethrough. The external surface of outer cannula  8120  defines thereon a mounting fixture  8125  to receive a fluid manifold  8150 , described below. As illustrated, fluid manifold  8150  defines therethrough three fluid passages that initiate at ports  8152  on the top of manifold  8150  and that terminate at slots  8123  defined through the side of outer cannula  8120 . Each of the aforementioned fluid passages cooperate with the other portions of device  8100  to define fluid passages, or plena. Each plenum, annotated by reference numerals  8520 ,  8530  and  8540 , serves a different purpose in operation of device  8100  as described below. Manifold  8150  is preferably permanently joined to outer cannula  8120  to ensure that the fluid plena remain fluidly separated from each other by way of a gas tight seal. 
     As illustrated in  FIGS. 77 and 84  surgical access device  8100 ,  8200  can be adapted and configured for use with any desired tubular surgical access device, such as a flexible inner cannula/wound retractor  8310 ,  8410  ( FIGS. 78(A)-78(E), 85(A)-85(E) ), for example. Examples of wound retractors are set forth in U.S. Pat. Nos. 5,524,644, 3,347,226, 3,347,227, 5,159,921, 5,524,644, 6,450,983, 6,254,534, 6,846,287, 5,672,168, 5,906,577, 6,142,936, 5,514,133, 7,238,154, 6,945,932, 6,908,430, 6,972,026, 5,741,298, or 6,945,932, which disclosures are incorporated herein by reference in their entirety. 
     In such embodiments, the wound retractor  8310  can be inserted through an incision formed in the patient, and secured by any suitable means. In the disclosed embodiment, the outer cannula  8120  is assembled with retractor  8310  in advance of any medical procedure. As illustrated, and as best seen in the cross-sectional views of  FIGS. 77(A)-77(G) , a flexible wound retractor  8310 , which includes a sheath body  8312 , distal ring  8313  and proximal ring  8311 . Proximal ring  8311  is held in place by the assembly of nested components  8120 ,  8130 ,  8140 . The distal and proximal rings  8311 ,  8313  are typically made of a compliant material, such as a rubber, foam rubber or the like, and thus have an inherent shape and size. 
     For purposes of further illustration, and not limitation, tube center component  8140  and ring jet assembly  8130  nest to form one or more fluid jets. Specifically, as illustrated in  FIGS. 82(A)-82(D) , tube center component  8140  defines one or more detents  8143  on its outer surface. When the outer surface of center component  8140  nests within the inner surface of ring jet assembly  8130 , the detents  8143  cooperates with the inner surface of ring assembly  8130  to form a conduit that is in fluid communication with high pressure plenum  8520  ( FIG. 77(B) ). High pressure plenum  8520  is pressurized with a working gas so as to drive a high speed gas flow through each of the jets disposed about the periphery of the distal circumferential interface  8524  of the center component  8140  and the ring jet  8130 . A fluid tight seal about plenum  8520  is ensured by seals  8554 ,  8556  disposed in circumferential grooves  8141 ,  8131  formed in each of center tube portion  8140  and ring jet  8130 , respectively. 
     Proximal ring  8311  of inner cannula/wound retractor  8310  is captured between and seals against inner ridge  8129  of outer cannula  8120  and distal circumferential face  8136  of ring jet  8130 . When assembled, these components cooperate to define sensing plenum  8540  in cooperation with dedicated passageway  8542  in manifold  8150  and exhaust or recirculation plenum  8530  for evacuating gas and other fluids from device  8100  and/or the abdomen of the patient into a filtration and recirculation assembly (not shown). Openings  8135  in ring jet  8130  facilitate passage of recirculating fluids. 
     Preferably, the gas jets exit and wrap around the outer distal surface of the center tube component before breaking free of the surface, thus obtaining some angularity with respect to a longitudinal axis of the trocar, such that the main direction of the jet flow is generally off-axis, indicated for example by arrow “A” in  FIG. 77(B) . The momentum of the gas exiting the circumferentially disposed peripheral jets forms a pressure gradient inside the bore  8106  of the device  8100 , such that the pressure at the distal end  8102  of the device can be about  15  mm of Hg higher than the atmospheric pressure outside the trocar in the operating room. Proper axial spacing between center tube assembly  8140  and ring jet  8130  is ensured by the height of proximal spacers  8132  disposed on the proximal face of the ring jet  8130 . 
     In operation, sensing plenum  8540  includes one or more pressure sensors (not shown) in a fluid flow control unit (not shown) to maintain the pressure of a patient&#39;s abdomen at a preselected pressure (e.g., 15 mm Hg). Suitable gas flow control units are described, for example, in Provisional Patent Application Ser. No. 61/246,921, and provisional Patent Application Ser. No. 61/384,412, filed Sep. 20, 2010, each of which is incorporated by reference herein in its entirety. For example, if the pressure detected in the abdomen is too high, the flow control unit decreases the delivery of gas to plenum  8520 , resulting in less gas being delivered through the high speed jets and into the bore  8106  of the device  8100 . By way of further example, if the gas pressure is too low in the abdomen, the flow control unit increases the delivery of gas to plenum  8520 , resulting in more gas being delivered through the high speed jets and into the bore  106  of the device  8100 . 
     If desired, the outer cannula  8120  and the inner cannula/wound retractor  8310  can be detachable from one another. The inner cannula/wound retractor  8310  can be provided in assorted lengths (see, e.g., the embodiment of  FIGS. 84-85 ) and shapes, and with assorted features, as desired or required. For example, the inner cannula/wound retractor  8310  of  FIG. 2  defines an “S”-shaped narrowed region  8315  ( FIG. 2(E) ) while that of  FIG. 85  defines a straight elongate narrowed region  8415  ( FIG. 85(E) ). Accordingly, a surgeon can decide before or during a procedure what length or diameter inner cannula/wound retractor  8310  to use, and can attach it to the outer cannula  8120  of the access device  8100 . Alternatively, a range of access devices of varying diameters, lengths and having varying features can be provided fully assembled to be available to the surgeon. 
     In accordance with the invention, the access device  8100  can include insufflation capability, can be adapted and configured to form a fluidic seal or barometric barrier around an instrument inserted therethrough and/or can be adapted to facilitate recirculation of insufflation gasses. 
     As illustrated in  FIGS. 81(A)-81(B) , a proximal cap  8160  can be applied to the device  8100 , and if desired can incorporate sound attenuation features, such as sound absorbing materials or sound attenuation surface features to absorb, cancel or reduce sound created by fluid flowing through the bore  8106  of the access device  8100 . As illustrated most clearly in  FIG. 81(B)  with respect to cross-sectional plane “X”, cap  8160  can be provided with an internal circumferential groove  8162  that is adapted and configured to engage flange  8122 B (illustrated in  FIG. 77(F) ) at proximal end  8122  of outer cannula  8120 . 
       FIGS. 84-85  illustrate a further surgical access device  8200  in accordance with the disclosure, which includes an outer cannula  8220 , a ring jet  8230 , a center tube adapter  8240  and manifold  8250 . Embodiment  8200  is substantially the same as embodiment  8100 , but has a truncated inner cannula/wound retractor  8410 . 
     As mentioned above, compatible features described in connection with one embodiment of the invention can advantageously be incorporated with other embodiments of the invention. The devices and related methods of the present invention, as described above and shown in the drawings, provide surgical access devices with advantageous properties including anchoring capabilities without causing excessive trauma to the patient. It will be apparent to those skilled in the art that various modifications and variations can be made in the devices, systems and related methods of the present invention without departing from the spirit or scope of the invention.