Patent Publication Number: US-2021169521-A1

Title: Methods and apparatus for controlling surgical instruments using a surgical port assembly

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a Continuation Application of U.S. patent application Ser. No. 16/361,623, filed on Mar. 22, 2019, now U.S. Pat. No. 10,925,636, which is a Continuation Application of U.S. patent application Ser. No. 15/520,966, filed on Apr. 21, 2017, now U.S. Pat. No. 10,251,672, which is a U.S. National Stage Application filed under 35 U.S.C. § 371(a) of International Patent Application Serial No. PCT/US2015/055226, filed Oct. 13, 2015, which claims the benefit of and priority to U.S. Provisional Patent Application Ser. No. 62/067,698, filed Oct. 23, 2014, the entire disclosures of which are incorporated by reference herein. 
    
    
     BACKGROUND OF RELATED ART 
     Surgical techniques and instruments have been developed that allow a surgeon to perform an increasing range of surgical procedures with minimal incisions into the skin and body tissue of a patient. Minimally-invasive surgery has become widely accepted in many medical specialties, often replacing traditional open surgery. Unlike open surgery, which typically requires a relatively large incision, minimally-invasive procedures, such as endoscopy or laparoscopy, are performed through one or more relatively small incisions. 
     In laparoscopic and endoscopic surgical procedures, a small “keyhole” incision or puncture is typically made in a patient&#39;s body, e.g., in the abdomen, to provide an entry point for a surgical access device which is inserted into the incision and facilitates the insertion of specialized instruments used in performing surgical procedures within an internal surgical site. The number of incisions may depend on the type of surgery. It is not uncommon for some abdominal operations, e.g., gallbladder surgery, to be performed through a single incision. In most patients, the minimally-invasive approach leads to decreased post-operative pain, a shorter hospital stay, a faster recovery, decreased incidence of wound-related and pulmonary complications, cost savings by reducing post-operative care, and, in some cases, a better overall outcome. 
     Minimally-invasive surgical procedures are performed throughout the body and generally rely on obtaining access to an internal surgical site through a relatively small pathway, often less than one centimeter in diameter. One method of providing such a pathway is by inserting a trocar assembly through the skin of a patient. Commonly, to place the trocar assembly, the penetrating tip of the obturator of the trocar is pushed through the skin and underlying tissue until the distal end of the cannula is within the body cavity. Alternatively, some trocar devices have a blunt obturator tip for placing the cannula through a previously-made incision, for example. Once the trocar has been properly positioned, the obturator is removed and the cannula is then available as a pathway between the surgical site and the exterior of the patient&#39;s body through which the surgeon may introduce the various surgical instruments required to perform the desired procedures. Surgical instruments insertable through a cannula include forceps, clamps, scissors, probes, flexible or rigid scopes, staplers and cutting instruments. 
     In some procedures, a wall of a body cavity is raised by pressurization of the body cavity to provide sufficient working space at the surgical worksite and/or to allow a trocar to penetrate the body cavity without penetrating an organ within the cavity. The process of distending the abdomen wall from the organs enclosed in the abdominal cavity is referred to as insufflation. During a laparoscopic procedure (endoscopy in the abdominal cavity), insufflation may be achieved by introducing an insufflation gas, such as carbon dioxide, nitrogen, nitrous oxide, helium, argon, or the like, through a Veress needle or other conduit inserted through the abdominal wall, to enlarge the area surrounding the target surgical site to create a larger, more accessible work area. The surgeon is then able to perform the procedure within the body cavity by manipulating the instruments that have been extended through the surgical access device(s). The manipulation of such instruments within the internal body is limited by both spatial constraints and the need to maintain the body cavity in an insufflated state. 
     In minimally-invasive surgery, the surgeon does not have direct visualization of the surgical field, and thus minimally-invasive techniques require specialized skills compared to corresponding open surgical techniques. Although minimally-invasive techniques vary widely, surgeons generally rely on a lighted camera at the tip of an endoscope to view the surgical site, with a monitor displaying a magnified version of the site for the surgeon to use as a reference during the surgical procedure. The surgeon then performs the surgery while visualizing the procedure on the monitor. The camera is typically controlled by an assistant to the surgeon. In many instances, the assistant does not play any other role in the procedure other than to hold and direct the camera so that the surgeon can view the surgical site. The assistant may have difficulty understanding the surgeon&#39;s intent, requiring the surgeon either to move the camera himself or ask the assistant to redirect the camera. 
     Multi-function robotic surgical systems are available with laparoscopic camera control. In general, robotic surgical systems are large and bulky, requiring a large amount of space around the patient, and have complex, time-consuming setups. Extensive training time is typically required for surgeons to learn to operate the remotely-controlled, camera-toting devices, and additional specialized training is also typically required for the entire operating room team. The extremely high initial cost of purchasing a robotic surgical system as well as the relatively high recurring costs of the instruments and maintenance can make it prohibitive for many hospitals and health-care centers to invest in such systems. 
     SUMMARY 
     The present disclosure relates to surgical port assemblies including a plurality of inflatable members for applying a force to a portion of a shaft of a surgical instrument which is inserted through an interior space of the surgical port assembly, and to surgical systems including a surgical port assembly, an endoscopic camera, and a control mechanism for controlling inflation and deflation of the plurality of inflatable members of the surgical port assembly. 
     According to an aspect of the present disclosure, surgical port assembly for use with surgical instruments, is provided. The surgical port assembly includes a body and a control interface. The body includes an exterior surface and an interior surface. The interior surface defines an interior space, which is configured to allow a surgical instrument to pass therethrough. The control interface includes a plurality of inflatable members coupled to the body and inflatable to selectively apply a force to a portion of a shaft of the surgical instrument when the shaft is disposed within the interior space. Each of the plurality of inflatable members is independently selectively inflatable to move a distal portion of the surgical instrument to a desired position. 
     In disclosed embodiments, at least one of the plurality of inflatable members is configured to apply a force to the endoscopic instrument in a direction perpendicular to a longitudinal axis of the body. 
     Additionally, the disclosure includes embodiments where the plurality of inflatable members includes nine inflatable members. It is further disclosed that the nine inflatable members include a first set of three axially-aligned inflatable members, a second set of three axially-aligned inflatable members, and a third set of three axially-aligned inflatable members. It is further disclosed that the nine inflatable members include a first set of three radially-aligned inflatable members, a second set of three radially-aligned inflatable members, and a third set of three radially-aligned inflatable members. 
     In disclosed embodiments, at least one of the plurality of inflatable members includes a friction-enhancing material. It is further disclosed that a majority of each inflatable member is made from a first material, and that the friction-enhancing material is different from the first material. 
     The present disclosure also relates to a surgical system including a surgical port assembly, an endoscopic camera, and a control mechanism. The surgical port assembly includes a body and a control interface. The body includes an exterior surface and an interior surface, which defines an interior space configured to allow a surgical instrument to pass therethrough. The control interface includes a plurality of inflatable members coupled to the body and inflatable to selectively apply a force to a portion of a shaft of the surgical instrument when the shaft is disposed within the interior space. Each of the plurality of inflatable members is independently selectively inflatable to move a distal portion of the surgical instrument to a desired position. A portion of the endoscopic camera is positionable within a body cavity and configured to view the distal portion of the endoscopic instrument. The control mechanism is disposed in operative engagement with the surgical port assembly and the endoscopic camera, and is configured to control inflation and deflation of the plurality of inflatable members. 
     It is further disclosed that the control mechanism is configured to control inflation and deflation of each the plurality of inflatable members in response to information received from the endoscopic camera. 
     Embodiments of the system of the present disclosure also include an inflation medium disposed in fluid communication with each of the plurality of inflatable members individually. It is further disclosed that the inflation medium is disposed in operative communication with the control mechanism. 
     In disclosed embodiments of the system, at least one of the plurality of inflatable members includes a friction-enhancing material. It is further disclosed that a majority of each inflatable member is made from a first material, and wherein the friction-enhancing material is different from the first material. 
     It is further disclosed that the plurality of inflatable members includes nine inflatable members. It is further disclosed that the nine inflatable members include a first set of three axially-aligned inflatable members, a second set of three axially-aligned inflatable members, and a third set of three axially-aligned inflatable members. Additionally, it is disclosed that the nine inflatable members include a first set of three radially-aligned inflatable members, a second set of three radially-aligned inflatable members, and a third set of three radially-aligned inflatable members. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Embodiments of the present disclosure are described herein with reference to the accompanying drawings, wherein: 
         FIG. 1  is a schematic diagram of a system including a port assembly positioned partially within a patient, a surgical instrument positioned within the port assembly, and an endoscopic camera positioned within the patient, where the port assembly is in communication with the endoscopic camera, in accordance with embodiments of the present disclosure; 
         FIG. 2  is a cut-away view of the port assembly of  FIG. 1  in accordance with embodiments of the present disclosure; 
         FIG. 3  is a top view of the port assembly of  FIGS. 1 and 2  in accordance with embodiments of the present disclosure; 
         FIG. 4  is a cross-sectional view of the port assembly of the present disclosure, taken along line  4 - 4  of  FIG. 3 , shown with a surgical instrument extending longitudinally through an interior space therein; 
         FIG. 5  is a cross-sectional view of the port assembly of  FIGS. 1-4  shown with a surgical instrument extending through the interior space of the port assembly at an angle; 
         FIG. 6  is a schematic illustration of a surgical system in accordance with the present disclosure; 
         FIG. 7  is a perspective view of a surgical assembly in accordance with an embodiment of the present disclosure illustrated being attached to robot arms of a robotic surgical system; and 
         FIG. 8  is an enlarged view of the surgical assembly of  FIG. 7 , shown extended through a guide ring. 
     
    
    
     DETAILED DESCRIPTION 
     Embodiments of the presently disclosed port assemblies, surgical devices, and systems are described in detail with reference to the drawings, in which like reference numerals designate identical or corresponding elements in each of the several views. As used herein the term “distal” refers to that portion of the adapter assembly or surgical device, or component thereof, farther from the user, while the term “proximal” refers to that portion of the adapter assembly or surgical device, or component thereof, closer to the user. 
     A minimally-invasive procedure may be defined as any procedure that is less invasive than open surgery used for the same purpose. As it is used in this description, “endoscopic surgery” is a general term describing a form of minimally-invasive surgery in which access to a body cavity is achieved through several small percutaneous incisions. While endoscopic surgery is a general term, “laparoscopic” and “thoracoscopic” describe endoscopic surgery within the abdomen and thoracic cavity, respectively. 
     As it is used in this description, “transmission line” generally refers to any transmission medium that can be used for the propagation of signals from one point to another. 
     Various embodiments of the present disclosure provide a port assembly adapted to hold and/or control the movement and/or positioning of a surgical instrument inserted therethrough in conjunction with an endoscopic camera. Embodiments of the presently-disclosed port assembly may be suitable for use in laparoscopic procedures as well as other minimally-invasive surgical procedures, for example. 
     Various embodiments of the present disclosure provide a port assembly wherein control of the movement and/or positioning of a surgical instrument inserted therethrough may be performed manually or automatically depending on the preference of the surgeon. In some embodiments, the surgical instrument or an endoscopic camera may be provided with a user interface including one or more user-actuable controls and a wireless transmitter to provide a communicative link between the user interface and the port assembly, e.g., to allow the surgeon to change the position and/or orientation of the surgical instrument inserted through the port assembly. 
     During minimally-invasive surgical procedures, the working end of an instrument is frequently located near the anatomical structure of interest and/or the surgical site within the working envelop. In some embodiments, wherein automatic control is employed for controlling the movement and/or positioning of an endoscopic camera or instrument, a sensor and/or transmitter may be disposed in association with the working end of an instrument, e.g., located on the tip of the instrument, and the endoscopic camera may be automatically controlled to “track” the movement of the instrument tip (e.g., align the field of view of the camera with the working end of the instrument) based on one or more signals outputted by the sensor and/or transmitter. In some embodiments, the sensor and/or transmitter may include an attachment mechanism, e.g., an adhesive backing, to allow the surgeon to selectively position the sensor and/or transmitter on a particular instrument and/or at a particular location on a select instrument, e.g., depending on surgeon preference, the type of surgery, etc. 
     Some examples of instruments used in minimally-invasive procedures include staplers, graspers, cutters, forceps, dissectors, sealers, dividers, and other tools suitable for use in the area of the anatomical structure of interest. The instrument may be a standalone tool suitable for use within a body cavity or external to the patient&#39;s body cavity. 
     In some embodiments, the controls may include an attachment mechanism, e.g., an adhesive backing, to allow the physician to selectively position the controls on a particular instrument and/or at a preferred location on a select instrument. In some embodiments, the capability may be provided to interface with an existing operating-room management system, e.g., using speech recognition technology, to control one or more settings of operating-room equipment. In some embodiments, the port assembly may be a standalone tool that interfaces with any suitable endoscopic camera. 
     The present disclosure includes a surgical system  5 , which includes a surgical instrument  10 , a port assembly  100 , an endoscopic camera  200 , and/or a control mechanism  300 . 
       FIG. 1  illustrates surgical instrument  10  inserted through an embodiment of port assembly  100  according to the present disclosure. A distal portion of surgical instrument  10  is shown within tissue “T” (e.g., adjacent a surgical site). A distal portion of an endoscopic camera  200  is also shown positioned within the tissue “T.” Endoscopic camera  200  is positioned such that endoscopic camera  200  can view a distal portion of surgical instrument  10  within the tissue “T.” 
     In  FIG. 1 , an embodiment of surgical instrument  10  is shown for use with various surgical procedures and generally includes a housing assembly  20 , a handle assembly  30 , and an end-effector assembly  22 . Surgical instrument  10  includes a shaft  12  that has a distal end  16  configured to mechanically engage the end-effector assembly  22  and a proximal end  14  configured to mechanically engage the housing assembly  20 . End-effector assembly  22  generally includes a pair of opposing jaw assemblies  23  and  24  pivotably mounted with respect to one another. In various embodiments, actuation of a movable handle  40  toward a fixed handle  50  pulls a drive sleeve (not shown) proximally to impart movement to the jaw assemblies  23  and  24  from an open position, wherein the jaw assemblies  23  and  24  are disposed in spaced relation relative to one another, to a clamping or approximated position, wherein the jaw assemblies  23  and  24  cooperate to grasp tissue therebetween. Although  FIG. 1  depicts a particular type of surgical instrument  10  (e.g., an electrosurgical forceps) for use in connection with endoscopic surgical procedures, port assembly  100 , endoscopic camera  200 , and control mechanism  300  may be used with a variety of instruments, e.g., depending on the type of surgery. 
     In some embodiments, as shown in  FIG. 1 , the port assembly  100  is coupled to a holding member  150 . Holding member  150  may be adapted to be attachable to a table to provide support for the port assembly  100 , e.g., to provide additional stability and/or reduce the weight of the tool on the patient&#39;s body. 
     When a powered surgical instrument is being used, it is envisioned that a transmission line operably connects the surgical instrument  10  to an electrosurgical power generating source  28 . Surgical instrument  10  may alternatively be configured as a wireless device or battery-powered. Surgical instrument  10  may include a switch  65  configured to permit the user to selectively activate the surgical instrument  10 . When the switch  65  is depressed, electrosurgical energy is transferred through one or more electrical leads (not shown) to the jaw assemblies  23  and  24 , for instance. 
     In some embodiments, as shown in  FIG. 1 , the surgical instrument  10  includes a user interface  140 , which may be adapted to provide a wireless (or wired) communication interface with the control mechanism  300  of the surgical system  5 . Additionally, or alternatively, the surgical instrument  10  may include a sensor and/or transmitter  141 , e.g., disposed in association with the end effector assembly  22 , or component thereof, e.g., jaw assembly  23 . Further, the user interface  140  may be associated with the endoscopic camera  200 , for example. 
     User interface  140  may be disposed on another part of the surgical instrument  10  (e.g., the fixed handle  50 , etc.) or another location on the housing assembly  20 . User interface  140  may include one or more controls (e.g., two controls  142  and  143  shown in  FIG. 1 ), which may include a switch (e.g., push button switch, toggle switch, slide switch) and/or a continuous actuator (e.g., rotary or linear potentiometer, rotary or linear encoder). In some embodiments, the user interface  140  includes a first control (e.g., control  142 ) adapted to transmit signals indicative of user intent to effect movement of the end effector assembly  22  within the body cavity. User interface  140  may additionally, or alternatively, include a second control (e.g., control  143 ) adapted to transmit signals indicative of user intent to adjust the tilt angle of the shaft  12 . 
     Further details of a control mechanism, various sensors, and control interfaces are disclosed in U.S. Pat. No. 8,641,610, which issued on Feb. 4, 2014, the entire contents being incorporated by reference herein. 
     In disclosed embodiments, a multi-functional sensor  210  is disposed in association with a distal portion of endoscopic camera  200 . In some embodiments, multi-functional sensor  210  provides illumination and houses a camera chip. It is to be understood that other sensor embodiments may be utilized. Sensor  210  is operably coupled to a power source (e.g., power supply  312  shown in  FIG. 1 ) via a transmission line  310  coupled to the endoscopic camera  200 . Wireless transmission of data from sensor  210  is also contemplated by the present disclosure. 
     With particular reference to  FIGS. 2-5 , port assembly  100  generally includes a body  110  and a control interface  160 . Body  110  includes an exterior surface  112 , an interior surface  114 , and an interior space  116  defined by the interior surface  114 . In  FIGS. 1, 2, 4 and 5 , the exterior surface  112  of the body  110  is shown disposed in sealable contact with tissue “T” at an entry site into the patient&#39;s body cavity. Body  110  of port assembly  100  is adapted to allow access into the body cavity, e.g., to allow access of at least one surgical instrument  10  through interior space  116 , and may include at least one sealing element or mechanism (not explicitly shown in the interest of clarity) to seal the opening into the body cavity in the presence and/or absence of a surgical instrument  10 , e.g., to help prevent the escape of insufflation gas. Body  110  may be formed of any suitable material such as a metal, plastic, alloy, composite material or any combination of such materials, for example. 
     Control interface  160  includes a plurality of inflatable members  180  (e.g., inflatable members  180   a - 180   i  shown in  FIG. 2 ) coupled to, or otherwise disposed in association with, the body  110  of port assembly  100 . 
     Each inflatable member  180  is inflatable and deflatable to apply a force (e.g., perpendicular to a longitudinal axis “A” defined by body  110 ) to a portion of the elongated shaft  12  of the surgical instrument  10  (i.e., when the elongated shaft  12 , or portion thereof, is disposed within the interior space  116  as shown in  FIGS. 1 and 3-5 ) to move the elongated shaft  12  and/or end effector assembly  22  of the surgical instrument  10  to a desired position within the body cavity, for example. As shown in  FIG. 1 , a portion of the elongated shaft  12  may be disposed within the interior space  116  of the body  110  of the port assembly  100 , while the end effector assembly  22  is disposed within the body cavity. 
     Control interface  160  is adapted to controllably move and/or position the elongated shaft  12  of the surgical instrument  10  to effect movement of the end effector assembly  22  within the body cavity. In disclosed embodiments, the control interface  160  is adapted to receive signals from control mechanism  300  (which is schematically illustrated in  FIG. 1 ). Based on the signals received from the control mechanism  300 , the control interface  160  may adjust the spatial aspects of the surgical instrument  10  (e.g., by causing inflation/deflation of at least one inflatable member  180 ) and/or perform other control functions, alarming functions, or other functions in association therewith. Some examples of spatial aspects associated with the surgical instrument  10  that may be adjusted include tilt angle of the elongated shaft  12  relative to longitudinal axis “A,” and rotation of the elongated shaft  12  about a longitudinal axis “B” defined by the elongated shaft  12 . 
     Inflatable members  180  are disposed in mechanical cooperation with the interior surface  114  of the body  110  of the port assembly  100 . In disclosed embodiments, each inflatable member  180  is independently controllable with respect to the other inflatable members  180 . Here, each inflatable member  180  is in fluid communication with an inflation medium  190  via a conduit  182 . (For clarity,  FIG. 1  illustrates three conduits  182 , but any number of conduits  182  may be included, such as the same number of inflatable members  180 ). Inflation medium  190  includes any suitable gas (e.g., oxygen, etc.) or fluid (e.g., water or saline) that can be transferred to and from inflatable members  180  of the port assembly  100 . 
     The amount, shape, size, arrangement, and orientation of inflatable members  180  are not limited by the examples shown in the accompanying figures. Rather, any amount, shape, size, arrangement, and orientation of inflatable members  180  are contemplated by the present disclosure. 
     In the embodiment illustrated in  FIG. 2 , port assembly  100  includes nine inflatable members  180   a - 180   i  associated therewith. The inflatable members  180   a - 180   i  of the illustrated embodiment include a first, proximal row of three inflatable members  180   a - 180   c  radially disposed about interior surface  114  of the body  110 , a second, middle row of three inflatable members  180   d - 180   f  radially disposed about interior surface  114  of the body  110 , and a third, distal row of three inflatable members  180   g - 180   i  radially disposed about interior surface  114  of the body  110 . As noted above, the amount, shape, size, arrangement, and orientation of inflatable members  180  are not limited by the accompanying figures. For example, more or fewer inflatable members are contemplated by the present disclosure. 
     Each inflatable member  180   a - 180   i  includes a respective conduit  182   a - 182   i  ( FIG. 2 ) fluidly linking the inflatable member  180   a - 180   i  to the inflation medium  190 . It is envisioned that inflation medium  190  is stored in individual storage containers (e.g., one storage container for each conduit  182   a - 182   i ), or that the inflation medium  190  is stored in a single storage container, and that each conduit  182   a - 182   i  includes a valve for controlling the amount of inflation medium  190  that can travel between the conduit  182   a - 182   i  and the respective inflatable member  180   a - 180   i.    
     In use, endoscopic camera  200  is configured to view at least a portion of the end effector assembly  22  of the surgical instrument  10  within the body cavity. The sensor  210  is configured to store and/or relay information regarding the precise orientation and positioning of the end effector assembly  22  (e.g., the degree tilt of the shaft  12  with respect to the longitudinal axis “A,” and the amount of rotation of the end effector assembly  22  about the longitudinal axis “B”) within the body cavity with respect to the endoscopic camera  200 . The sensor  210  is also configured to compare the current orientation and positioning information of the end effector assembly  22  with stored (e.g., initial, optimal, user-defined, etc.) orientation and positioning information. 
     The sensor  210  is further configured to communicate the orientation and positioning information of the end effector assembly  22  with control mechanism  300  including a controller. Moreover, the sensor  210  is configured to communicate the difference between the current orientation and positioning of the end effector assembly  22  with the stored (e.g., initial) orientation and positioning information. The control mechanism  300  is configured to distribute the inflatable medium  190  to the appropriate inflatable member(s)  180  in order to move the shaft  12  of the surgical device  10  to re-orient the end effector assembly  22 , such that the end effector assembly  22  moves to its stored (e.g., initial) orientation and position. For example, and with particular reference to  FIG. 5 , to tilt the end effector  22  with respect to the longitudinal axis “A” in the general direction of arrow “C,” inflatable members  180   a  and  180   i  could be inflated and/or inflatable members  180   c  and  180   g  could be deflated. (Inflatable members  180   b ,  180   e  and  180   h  are not shown in  FIG. 5  due to the particular cross-sectional view illustrated.) 
     Additionally, it is envisioned that rotation of the elongated shaft  12  about the longitudinal axis “B” could be accomplished by sequential inflation and/or deflation of adjacent inflatable members  180  (e.g., inflatable members  180  that are axially-aligned and radially-adjacent). For instance, rotation of the elongated shaft  12  may be accomplished by first inflating inflatable member  180   a  a certain amount (e.g., by a particular volume and/or a particular duration) while deflating inflatable member  180   b , then inflating inflatable member  180   c  while deflating inflatable member  180   a , then inflating inflatable member  180   b  while deflating inflatable member  180   c . Additionally, it is envisioned that radially-aligned and axially-offset inflatable members (e.g.,  180   a ,  180   d  and  180   g ;  180   b ,  180   e  and  180   h ; and  180   c ,  180   f  and  180   i ) can be inflated and/or deflated concurrently to facilitate rotation of the elongated shaft  12  about longitudinal axis “B.” 
     It is envisioned that a user is able to set various parameters using the control mechanism  300 . For example, it is envisioned that a user is able to set an initial orientation and position of end effector assembly  22  (e.g., after end effector assembly  22  is desirably positioned within the body cavity) via touch screen or pressing a button on the surgical device  10  and/or the control mechanism  300 , for example. It is further envisioned that a user can select whether the control mechanism  300  changes the orientation and position of the end effector assembly  22  continuously (i.e., continuously ensuring the current orientation and position of the end effector assembly  22  matches the initial orientation and position), intermittently (i.e., changing the orientation and position of the end effector assembly  22  after a given amount of time, if necessary, such that the current orientation and position of the end effector assembly  22  matches the initial orientation and position), based on amount of movement of the end effector assembly  22  from its initial position (i.e., changing the orientation and position of the end effector assembly  22  after the end effector assembly  22  has moved a predetermined amount from its initial position), and/or at user-defined times (e.g., after removal and re-insertion of the surgical instrument  10  or a different surgical instrument), for example. 
     It is further envisioned that control mechanism  300 , or another portion of the surgical system  5 , is configured to give feedback to a user corresponding to a particular amount of change in position and/or orientation of the end effector assembly  22  of the surgical instrument  10 . For example, it is envisioned that surgical system  5  gives visual (e.g., illuminating a light), audible (e.g., producing a beeping sound), and/or tactile (e.g., causing a handle of the surgical instrument  10  to vibrate) feedback in response to the change of position and/or orientation of the end effector assembly  22  which exceeds a predetermined value. Upon receiving this feedback, the user may manually instruct (e.g., by pushing a button) the control mechanism  300  to reposition the surgical instrument  10  back to its initial position and orientation, for example. 
     The present disclosure also comprises the inclusion of a friction-enhancing surface or coating on an instrument-engaging surface  181  (see  FIG. 3 ) of at least one (e.g., all) inflatable member  180 . It is envisioned that the friction-enhancing surface  181  is made from a material that is different from another portion of the inflatable member  180 . For example, a majority of each inflatable member  180  may be made from, and the friction-enhancing surface or coating may include. 
     In use, it may be desirable to insert and/or position the surgical instrument  10  when inflatable members  180  are at least partially deflated, and then to inflate necessary inflatable members  180  to help secure the location, position and orientation (e.g., initial position) of the surgical instrument  10 . 
     System  5  of the present disclosure may include a storage device. The storage device may include a set of executable instructions for performing a method of controlling surgical instruments using a port assembly  100  as described herein. In some embodiments, the system  5  also includes a processing unit and/or a database. Further details of exemplary processing units and databases are described in U.S. Pat. No. 8,641,610, which has been incorporated by reference hereinabove. 
     The present disclosure also includes methods of controlling surgical instruments using system  5 , or portions thereof, as described above. It is to be understood that the features of the method provided herein may be performed in combination and in a different order than presented herein without departing from the scope of the disclosure. 
     The various embodiments disclosed herein may also be configured to work with robotic surgical systems and what is commonly referred to as “Telesurgery.” Such systems employ various robotic elements to assist the surgeon in the operating theater and allow remote operation (or partial remote operation) of surgical instrumentation. Various robotic arms, gears, cams, pulleys, electric and mechanical motors, etc. may be employed for this purpose and may be designed with a robotic surgical system to assist the surgeon during the course of an operation or treatment. Such robotic systems may include, remotely steerable systems, automatically flexible surgical systems, remotely flexible surgical systems, remotely articulating surgical systems, wireless surgical systems, modular or selectively configurable remotely operated surgical systems, etc. 
     The robotic surgical systems may be employed with one or more consoles that are next to the operating theater or located in a remote location. In this instance, one team of surgeons or nurses may prepare the patient for surgery and configure the robotic surgical system with one or more of the instruments disclosed herein while another surgeon (or group of surgeons) remotely control the instruments via the robotic surgical system. As can be appreciated, a highly skilled surgeon may perform multiple operations in multiple locations without leaving his/her remote console which can be both economically advantageous and a benefit to the patient or a series of patients. 
     The robotic arms of the surgical system are typically coupled to a pair of master handles by a controller. The handles can be moved by the surgeon to produce a corresponding movement of the working ends of any type of surgical instrument (e.g., end effectors, graspers, knifes, scissors, etc.) which may complement the use of one or more of the embodiments described herein. The movement of the master handles may be scaled so that the working ends have a corresponding movement that is different, smaller or larger, than the movement performed by the operating hands of the surgeon. The scale factor or gearing ratio may be adjustable so that the operator can control the resolution of the working ends of the surgical instrument(s). 
     The master handles may include various sensors to provide feedback to the surgeon relating to various tissue parameters or conditions, e.g., tissue resistance due to manipulation, cutting or otherwise treating, pressure by the instrument onto the tissue, tissue temperature, tissue impedance, etc. As can be appreciated, such sensors provide the surgeon with enhanced tactile feedback simulating actual operating conditions. The master handles may also include a variety of different actuators for delicate tissue manipulation or treatment further enhancing the surgeon&#39;s ability to mimic actual operating conditions. 
     With reference to  FIGS. 6-8 , a surgical system, such as, for example, a robotic surgical system is shown generally as surgical system  1000  and is usable with surgical system  5 , or portions thereof, of the present disclosure. Surgical system  1000  generally includes a plurality of robotic arms  1002 ,  1003 , a control device  1004 , and an operating console  1005  coupled with control device  1004 . Operating console  1005  includes a display device  1006 , which is set up in particular to display three-dimensional images; and manual input devices  1007 ,  1008 , by means of which a person (not shown), for example a surgeon, is able to telemanipulate robotic arms  1002 ,  1003  in a first operating mode, as known in principle to a person skilled in the art. 
     Each of the robotic arms  1002 ,  1003  is composed of a plurality of members, which are connected through joints. System  1000  also includes an instrument drive unit  1200  connected to distal ends of each of robotic arms  1002 ,  1003 . Surgical instrument  10  supporting end-effector assembly  22  may be attached to instrument drive unit  1200 , in accordance with any one of several embodiments disclosed herein, as will be described in greater detail below. 
     Robotic arms  1002 ,  1003  may be driven by electric drives (not shown) that are connected to control device  1004 . Control device  1004  (e.g., a computer) is set up to activate the drives, in particular by means of a computer program, in such a way that robotic arms  1002 ,  1003 , their instrument drive units  1200  and thus the surgical instrument  10  (including end-effector assembly  22 ) execute a desired movement according to a movement defined by means of manual input devices  1007 ,  1008 . Control device  1004  may also be set up in such a way that it regulates the movement of robotic arms  1002 ,  1003  and/or of the drives. 
     Surgical system  1000  is configured for use on a patient  1013  lying on a patient table  1012  to be treated in a minimally invasive manner by means of end-effector assembly  22 . Surgical system  1000  may also include more than two robotic arms  1002 ,  1003 , the additional robotic arms likewise being connected to control device  1004  and being telemanipulatable by means of operating console  1005 . A surgical instrument  10  (including end-effector assembly  22 ; see  FIGS. 7 and 8 ) may also be attached to the additional robotic arm. 
     Reference may be made to U.S. Patent Publication No. 2012/0116416, filed on Nov. 3, 2011, now U.S. Pat. No. 8,828,023, entitled “Medical Workstation,” the entire content of which is incorporated herein by reference, for a detailed discussion of the construction and operation of surgical system  1000 . 
     Turning to  FIGS. 7 and 8 , surgical system  1000  includes a surgical assembly  1300 , which includes robotic arm  1002 , an instrument drive unit  1200  connected to robotic arm  1002 , and surgical instrument  10  coupled with or to instrument drive unit  1200 . Instrument drive unit  1200  is configured for driving an actuation of end-effector assembly  22  of surgical instrument  10  and to operatively support surgical instrument  10  therein. Instrument drive unit  1200  transfers power and actuation forces from motors “M” to surgical instrument  10  to ultimately drive movement of cables that are attached to end-effector assembly  22 , for example. 
     In use, a trocar shaft  1232  is moved between a pre-operative position, as shown in  FIG. 7 , and an operative position, as shown in  FIG. 8 . In the pre-operative position, a guide ring  1240  and end-effector assembly  22  are coplanar. In the operative position, guide ring  1240  is located proximal to end-effector assembly  22 . 
     Although embodiments have been described in detail with reference to the accompanying drawings for the purpose of illustration and description, it is to be understood that the inventive processes and apparatus are not to be construed as limited thereby. It will be apparent to those of ordinary skill in the art that various modifications to the foregoing embodiments may be made without departing from the scope of the disclosure.