Patent Publication Number: US-2013237753-A1

Title: Surgical interface for use with endoscope

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     This application is a Continuation-In-Part of U.S. patent application Ser. No. 12/941,384, filed Nov. 8, 2010, which claims priority to U.S. Provisional Patent Application No. 61/258,922, filed Nov. 6, 2009, the disclosures of which are incorporated by reference in their entirety. 
    
    
     TECHNICAL FIELD 
     The present disclosure relates generally to surgical interfaces and adapters for introducing a surgical device into the body of a patient and, more particularly, to surgical interfaces for use with delivering a surgical device through an endoscope. 
     BACKGROUND 
     Endoscopic surgery allows for surgery to be performed while reducing damage to the surrounding tissue as compared to open surgical procedures. An endoscope typically includes at least one working channel allowing insertion and deployment of various medical devices to the surgical site. The endoscope also provides visualization of the surgical site during the procedure. 
     Once the desired position of the surgical site is reached, a surgical instrument may be inserted through the working channel and protrude from the distal end of the working channel at the visualized surgical site. For example, in one exemplary arrangement, a surgical cutting device is introduced to excise tissue samples from the surgical site. Such a surgical cutting instrument generally requires connection to a handpiece that provides rotary or reciprocative (or both) motion to the cutting portion of the instrument. When the cutting operation is enabled, tissue is generally drawn through the mouth of the cutting instrument, severed, and removed from the surgical site. 
     Unfortunately, during the procedure the handpiece must be constantly controlled by the surgeon to control the extension of the instrument beyond the working channel of the endoscope. As such, the distal end of the surgical cutting device may move independently from the endoscope. Indeed, to control the placement of the surgical cutting device, typically a surgeon must continually manipulate both the endoscope and the surgical cutting device, relying on the surgeon&#39;s hand-eye coordination, to insure proper placement of the surgical cutting instrument, and to prevent inadvertent movement away from a selected area of interest or moving too deep into area, thereby causing unintended damage to surrounding tissues or structures. This constant control of the instrument causes fatigue in the surgeon and makes it difficult to hold the endoscope still while precisely controlling the surgical cutting instrument during the procedure. 
     Further, during an endoscopic procedure, at times it is necessary to selectively adjust the depth of the medical device within the surgical site in order to precisely target a lesion for removal. To this end, the cutting element must be accurately positioned adjacent the lesion. While conventional endoscopes allow for insertion of a surgical cutting device through the working channel, they do not provide for independently maintaining the position of the surgical cutting device with the endoscope. 
     Accordingly, a surgical interface is needed that permit a surgical cutting device to be operatively connected to an endoscope, without requiring constant attention to fine hand-eye coordination. Further, a need exists for a surgical interface and adapter that facilitates adjustable and fixed positioning of the device within the patient, removal of the device from the working channel, and reinsertion of the device through the working channel to a desired position. 
    
    
     
       BRIEF DESCRIPTION OF THE D WINGS 
       Exemplary embodiments of the present disclosure will now by described by way of example in greater detail with reference to the attached figures, in which: 
         FIG. 1  is a side elevational view of an embodiment of an exemplary endoscope; 
         FIG. 2A  is a side elevational view of an embodiment of a trocar for use with the endoscope of  FIG. 1 ; 
         FIG. 2B  is a detail view of a distal tip of the trocar of  FIG. 2A ; 
         FIG. 3  is a perspective view of an exemplary surgical cutting device; 
         FIG. 4  is a side elevational view of an embodiment of a surgical system that includes an endoscope, a trocar and surgical cutting device; 
         FIG. 5  is perspective view of an exemplary surgical adapter for use with a surgical system; 
         FIG. 6  is an exploded view of the surgical adapter of  FIG. 5 ; 
         FIG. 7  is a partial side view of the surgical adapter of  FIG. 5 , as a surgical cutting device is being operatively connected thereto. 
         FIG. 8  is a partial side view of the surgical adapter of  FIG. 5  with the surgical cutting device operatively connected thereto to form a surgical sub-assembly. 
         FIG. 9  is a side view of the surgical sub-assembly of  FIG. 8 , as the sub-assembly is being operatively connected to a first type of endoscope. 
         FIG. 10  is a side view of the connected surgical sub-assembly of  FIG. 8  operatively connected to the endoscope shown in  FIG. 9 . 
         FIG. 11  is an enlarged view of encircled area  11  taken from  FIG. 10 . 
         FIG. 12  is a perspective view of an alternative embodiment of a surgical adapter for use with a surgical system; 
         FIG. 13  is an exploded view of the surgical adapter of  FIG. 12 ; 
         FIG. 14  is side view of the surgical adapter of  FIG. 12  as a surgical cutting device is being operatively connected thereto; 
         FIG. 15  is a side view of the surgical adapter of  FIG. 12  with the surgical cutting device operatively connected thereto to form a surgical sub-assembly; 
         FIG. 16  is a side view of the surgical sub-assembly of  FIG. 15  being operatively connected to the connected together endoscope and the trocar of  FIGS. 1 and 2 ; 
         FIG. 17  if a side view of the connected surgical sub-assembly of  FIG. 15  operatively connected to the connected together endoscope and trocar of  FIGS. 1 and 2 ; 
         FIG. 18  is an enlarged view of encircled area  18  taken from  FIG. 17 ; 
         FIG. 19  is a side view of another embodiment of a surgical system including a connector adapter for use with the surgical adapter of  FIG. 5 , an endoscope, and a surgical cutting device. 
         FIG. 20  is an enlarged view of encircled area  20  taken from  FIG. 19 . 
         FIG. 21  is a perspective view of the connector adapter shown in the surgical system illustrated in  FIG. 19 . 
         FIG. 22  is a top plan perspective, as the connector adapter is being secured to the endoscope shown in  FIG. 19 . 
         FIG. 23  is a perspective view of a funnel attachment for use with an endoscope; 
         FIG. 24  is a partial perspective view of the funnel attachment of  FIG. 23  operatively attached to an endoscope; and 
         FIG. 25  is a side view of the funnel attachment of  FIG. 23  attached to the endoscope as a working channel of the surgical cutting device is being inserted therein. 
         FIG. 26  is a side view of another embodiment of a surgical system including a surgical interface, an endoscope, and a surgical cutting device. 
         FIG. 27  is a partial cross-sectional view of the surgical system of  FIG. 26 . 
         FIG. 28  is a partial perspective view of the surgical system of  FIG. 26 . 
         FIG. 29  is a side view of another embodiment of a surgical system including a surgical interface, an endoscope, and a surgical cutting device. 
         FIG. 30  is a partial cross-sectional view of the surgical system of  FIG. 29 . 
         FIG. 31  is a partial perspective view of the surgical system of  FIG. 29 . 
         FIG. 32  is a perspective exploded view of the surgical system of another embodiment of a surgical system. 
         FIG. 33  is a partial perspective view of the surgical system of  FIG. 32 . 
         FIG. 34  is a partial cross-sectional view of the surgical system of  FIG. 32 . 
     
    
    
     DETAILED DESCRIPTION 
     Referring now to the discussion that follows and also to the drawings, illustrative approaches to the disclosed systems and methods are shown in detail. Although the drawings represent some possible approaches, the drawings are not necessarily to scale and certain features may be exaggerated, removed, or partially sectioned to better illustrate and explain the present disclosure. Further, the descriptions set forth herein are not intended to be exhaustive or otherwise limit or restrict the claims to the precise forms and configurations shown in the drawings and disclosed in the following detailed description. 
     Described herein are surgical systems that include surgical adapters and interfaces for use with surgical devices that may be suited for neurosurgical applications, including, but not limited to, the removal of spine and brain tissue. The surgical systems of the present disclosure provide surgeons with an enhanced ability to control placement of a surgical device within a surgical site so as to effectively control the extent of tissue cutting, as well as the impact on surrounding tissue during tissue cutting procedures. 
     Endoscopes are used to visualize various areas of interest within a patient. Referring to  FIG. 1 , a first exemplary type of an endoscope  300  is depicted. Endoscope  300  comprises a housing  301 , an eye-piece  302 , a fiber optic light cable connector  304 , and a shaft  306 . Shaft  306  is defined by a proximal end  308  which is disposed in and connected to housing  301  and a distal end  310 . As may be seen, distal end  310  is spaced apart from proximal end  308 . Endoscope  300  is configured to allow a user to view a surgical area of interest proximate distal end  310  through eye-piece  302 , when distal end  310  is inserted into a surgical site. As is conventional in the art, shaft  306  also includes a conduit (not separately shown) for transmitting light provided via fiber optic connector  304  to the surgical area. Shaft  306  may also include a lens (not separately shown) for magnifying and viewing the surgical area. 
     Eye-piece  302  is connected to housing  301 . Eye-piece  302  may also be connected to a camera with a camera connector (not shown) so that the image generated by endoscope  300  can be viewed remotely on a display monitor. 
     To facilitate the use of endoscope  300  in surgical procedure, a trocar  307  may also be provided, as best seen in  FIGS. 2A and 2B . Trocar  307  is especially useful for closed surgical procedures. Trocar  307  comprises a trocar body  314  and a trocar shaft  312 . Trocar  307  is defined by a proximal end  316 , with a proximal opening formed in trocar body  314 , and a distal end  318  of shaft  312 . Shaft  312  defines one or more channels in its interior. As shown in  FIG. 2B , shaft  312  may have a plurality of channels,  324 ,  326 ,  328 , and  330  which terminate at a tip distal face  322 . In one embodiment, a working channel  324  is sized to accommodate an outer cannula  444  of a surgical cutting device  440  (to be described below in further detail). Channel  326  is sized to accommodate endoscope shaft  306 . Channel  328  may be configured as an irrigation channel used to direct irrigation fluid from an irrigation conduit  320  to the surgical site. Channel  330  may be configured as a relief channel used to relieve fluid pressure at the surgical site. During closed procedures, as irrigation fluid flows to a surgical site it can pressurize the site. 
     Referring to  FIG. 3 , an exemplary surgical cutting device  440  is shown, such as that disclosed in co-pending, and co-owned with the assignee of the present application, U.S. patent application Ser. No. 12/389,447, the contents of which are incorporated by reference in its entirety. Surgical cutting device  440  includes a handpiece  442  and a cutting element that includes an outer cannula  444  and an inner cannula (not shown). A distal end  447  of the cutting element is configured for insertion into a patient. 
     In one exemplary configuration, handpiece  442  is configured with a generally cylindrical shape. Handpiece  442  may be sized and shaped to be grasped with a single hand. Handpiece  442  also includes a lower housing  450  comprising a proximal section  446  and a distal section  448 . A front housing section  455  may be connected to a cam housing positioned in distal section  448 . An upper housing  452  is also provided. The cutting element is mounted to upper housing  452  and may be fluidly connected to a tissue collector  458 . In one exemplary arrangement, tissue collector  458  may be operatively connected directly to upper housing  452 . Alternatively, tissue collector  458  may be remotely connected to the cutting element by appropriate tubing. A vacuum line (not shown) may be connected to a proximal end of tissue collector  458  to direct tissue into the cutting element, as well as to deliver severed tissue to tissue collector  458 . A rotation dial  460  for selectively rotating the outer cannula  444  with respect to handpiece  442  is also mounted to upper housing  452 . 
     In certain examples, tissue cutting device  440  may be combined with an imaging device to define a surgical system  303  that is capable of simultaneously imaging and cutting a target tissue, such as tissue associated with a patient&#39;s neurological system. Because assembly  303  effectively combines both imaging and cutting operations into a single, integral device, it is particularly advantageous in performing closed procedures where a surgical access path is created percutaneously. 
     Referring to  FIG. 4 , an exemplary surgical system  303  is depicted. Surgical system  303  comprises a surgical cutting device, such as surgical cutting device  440 , trocar  307 , and an endoscope, such as endoscope  300 . As shown in  FIG. 4 , endoscope  300  is inserted through trocar  307  via endoscope channel  326  (best seen in  FIG. 2B ) such that endoscope distal end  310  exits through, is flush with, or projects from trocar  307  at trocar shaft distal tip face  322 . Surgical cutting device  440  is connected to trocar  307  such that outer cannula  444  of the cutting element is inserted in the open proximal end  316 , through trocar body  314 , and through working channel  324  of trocar shaft  312 . Distal end  447  of the cutting element of surgical cutting device  440  projects through and away from shaft distal end  318  of trocar  307  at trocar shaft distal tip face  322 . 
     Although various configurations are possible, in surgical system  303  of  FIG. 4 , tissue cutting device  440  is positioned with a proximal portion of outer cannula  444  adjacent to endoscope housing  301 . Proximal end  319  of endoscope housing  301  is positioned distally of and adjacent to front housing  455  of surgical cutting device handpiece  442 . 
     To use surgical assembly  303 , a surgical access path is first created and/or the target tissue is accessed using an open procedure or a closed procedure. However, surgical assembly  303  is especially suited for closed procedures. In one exemplary example, the surgeon places one eye at eye-piece  302  and manipulates trocar shaft  312  to position distal trocar tip  318  proximate the target tissue. In another exemplary example, a camera is attached to eye-piece  302  and the surgeon views an image on a monitor that is connected to the camera. A vacuum level to be applied to device  440  is then set using panel controls on an attached surgical console. In one method, device  440  is configured to be gripped with a single hand so as to allow simultaneous manipulation of endoscope  300 , trocar  307 , and surgical cutting device  440 . A variety of different grips may be used. In one example, surgical cutting device  440  is held like a writing instrument, with distal housing section  448  placed between the thumb and forefinger of one hand and proximal housing section  446  placed between the base of the forefinger and the base of the thumb. In another example, the thumb is placed on one side of distal housing section  448  and the forefinger is placed on top of upper housing  452  with proximal housing section  446  between the base of the thumb and forefinger. In yet another example, the proximal housing section  446  is gripped with the thumb placed adjacent proximal-most housing portion  442 . 
     Depending on the selected hand and the surgeon&#39;s position with respect to that of the target tissue, dial  460  may be rotated to selectively rotate outer cannula  444  about its own longitudinal axis and to orient an outer cannula opening  449  immediately adjacent the target tissue. Surgical cutting device  440  is preferably configured such that when outer cannula  444  rotates, an inner cannula also rotates to maintain a fixed angular orientation between outer cannula  444  and the inner cannula. Once outer cannula opening  449  is in the desired position, a motor of surgical cutting device  440  is activated. In one example, the surgeon views the target tissue through eyepiece  302  to visualize the tissue&#39;s response (e.g., traction) to various levels of vacuum and selects a desired level. 
     Due to the application of vacuum, the target tissue proximate trocar distal end  318  is drawn into outer cannula opening  449 . If desired, an irrigation fluid such as saline may be fed to the target tissue area via irrigation conduit  320  (shown in  FIG. 2B ). 
     Endoscope  300  is configured to allow a surgeon to view the target tissue through eye-piece  302 . However, as discussed above, a camera may also be connected to a camera connector (not shown) attached to eyepiece  302  allowing the image generated by endoscope  300  to be viewed on a display monitor. In accordance with one example, the surgeon views the target tissue on the display monitor while manipulating surgical system  303  and cutting tissue. 
     In certain examples, surgical device  440  is configured such that its outer cannula  444  can be accommodated by working channels in known, industry standard sized trocars. For example, in certain embodiments, working channel  324  has an inner diameter of less than 8 mm, preferably less than 6 mm, more preferably less than 4 mm, and most preferably about 2 mm. However, it is understood that there may be other devices that include working channels  324  having an inner diameter even less than 2 mm. Outer cannula  444  is also configured with an outer diameter that allows outer cannula  444  to be slidably received in working channel  324 . In other examples, outer cannula  444  is at least as long as known working channels. In certain embodiments, outer cannula  444  is at least about 6 inches, preferably at least about 8 inches, more preferably at least about 10 inches, and even more preferably at least about 12 inches in length. 
     Surgical assembly  303  is useful in a number of procedures, but is especially beneficial in closed procedures. In one exemplary method, surgical assembly  303  is used to perform closed, percutaneous tissue cutting procedures in the third ventricle of the brain. Such procedures include removing tumors and membranes in the third ventricle. In addition, cerebrospinal fluid circulates through the third ventricle and into the spinal column. In certain patients, occlusions can form in the third ventricle, blocking the fluid circulation. Surgical assembly  303  may be used to remove such occlusions and restore circulation. Other closed procedures for which surgical assembly is particularly well suited include the removal of tumors from the hypothalamus. 
     While surgical system  303  of  FIG. 4  represents an advancement in surgical devices and procedures, there is no mechanism that suitably secures surgical cutting device  440  to endoscope  300 . As such, distal end  447  of surgical cutting device  440  may move independently from shaft  312  of trocar  307 . Accordingly, the surgeon must be sure to manipulate both trocar  307  and surgical cutting device  40  to insure proper placement of distal end  447  of surgical cutting device  440  to prevent distal end  447  from inadvertently moving away from an area of interest or moving too deep into the area of interest causing unintended damage to surrounding tissues and structures. 
     Specifically referring to  FIGS. 5-12 , to operatively connect surgical cutting device  440  to an alternative endoscope  350  configuration, a first exemplary embodiment of a surgical adapter  500  is provided. Surgical adapter  500  comprises a connecting portion  502 , a housing portion  504  and an attachment mechanism  506 . In one exemplary embodiment, housing portion  504  may be constructed of a first portion  504   a  and a second portion  504   b  that fit together, such as in a snap-fit arrangement. Housing portion  504  may house an advancing mechanism  508 , a gear member  509  and a thrust washer or spring member  510 . A dial member  512  is partially received within housing portion  504  and rotatably mounted thereto. A shaft member  514  is partially received within a distal end  516  of housing portion  504 . 
     Gear member  409  is rotatably mounted within housing portion  504  and includes gear teeth  518  that mesh with gear teeth  520  mounted on dial member  512 . A channel  522  is formed through gear member  509 . A proximal end  524  of advancing mechanism  508  is fixedly received within channel  522 . Advancing mechanism  508  further includes threads  526  formed on an outer surface thereof, and a receiving channel  528 , both of which will be explained below in further detail. 
     A proximal end  530  of attachment mechanism  506  is secured to a distal end  532  of shaft member  514 . Shaft member  514  further comprises at least one slot member  534  into which a tab member  536  (seen, for example, mounted on first portion  504   a ) from housing portion  504  is slidably received. In another exemplary configuration, shaft member  514  may comprise more than slot member  534  that mate with a plurality of corresponding tab members  536 . In one exemplar configuration, tab members  536  are arranged in an opposing manner within housing portion  504 . It is understood that various locations for tab members  536  on housing portion  504  are contemplated. It is also understood that other configurations for keying shaft member  514  to housing  504  are also contemplated. 
     Threads  526  operatively engage with threads formed on an internal surface of shaft member  514 , to be explained in further detail below. Attachment mechanism  506  further includes a shaft member  538  and a cap member  540 . Shaft member  538  defines a passageway  539  therethrough. 
     Referring now to  FIGS. 7-11 , use of surgical adapter  500  will now be explained. First, distal end  447  (best seen in  FIG. 3 ) of surgical cutting device  440  is inserted into surgical adapter  500 . More specifically, distal end  447  of the cutting element of surgical cutting device  440  is inserted into a top portion  542  of connecting portion  502  and into receiving channel  528  of advancing mechanism and advanced through attachment mechanism  506 . Top portion  542  further includes a mounting groove that receives a distal end  462  of upper housing  452  for frictional engagement. A bottom portion  444  of connecting portion  502  also includes a mounting groove that receives distal end  451  of lower housing  450  for frictional engagement, as shown in  FIG. 8 . In one exemplary embodiment, assembly of surgical adapter  500  to surgical cutting device  440  is performed at the factory prior to packaging and delivery of the devices. Further, to provide increased stability to the surgical system, distal end  451  may be fixedly connected to the mounting groove. 
     Once secured, distal end  447  of the cutting element of surgical cutting device  440  is then received in a proximal end  446 ′ of an endoscope  300 ′. In one embodiment attachment mechanism  506  fixedly engages a portion  447  of endoscope  300 ′, thereby securing tissue cutting device  440  to endoscope  300 ′. More specifically, attachment mechanism  506  is disposed around proximal end  446 ′ such that proximal end  446 ′ is received within endoscope receiving portion  540 . Mounting groove member  538  is received within portion  447  of endoscope  300 ′. 
     However, in accordance with one aspect of the disclosure, the extent that distal end  447  may extend outwardly from a distal end of endoscope  300 ′ may be selectively controlled by the surgeon. More specifically, dial member  512  may be selectively rotated in a first direction to advance distal end  447  of the cutting element of surgical cutting device  440  with respect to the distal end of endoscope  300 ′. Dial member  512  may be selectively rotated in a second direction to move distal end  447  of surgical cutting device  440  toward proximal end  446 ′ of endoscope  300 ′. 
     Gear teeth  520  of dial member  512  mesh with gear teeth  518  of gear member  509  such that when dial member  512  is rotated, gear member  509  also rotates. Because proximal end  524  of advancing mechanism  508  is fixedly secured to gear member  509 , as gear member  509  rotates, advancing mechanism  508  also rotates. Receiving channel  528  is sized to receive outer cannula  444 . Thus rotation of advancing mechanism  508  causes shaft member  514  to move along tab member  536 , effectively moving distal end  447  of the cutting element. 
     Because surgical adapter  500  secures surgical cutting device  440  to endoscope  300 ′, the surgeon may better control the amount of extent of distal end  447  of outer cannula  444  to allow for safer, more secure, more stable and a more accurate placement of the cutting mechanism. 
     Referring to  FIGS. 12-18 , an alternative embodiment of a surgical adapter  600  is shown. Surgical adapter  600  is similar to surgical adapter  500  in that it comprises a connecting portion  602 , a housing portion  604  and an attachment mechanism  606 . In one exemplary embodiment, housing portion  604  is constructed of a first portion  604   a  and a second portion  604   b  that matingly fit together, such as in a snap-fit arrangement. Housing portion  604  may house an advancing mechanism  608 , a gear member  609  and a wave washer or spring member  610 . A dial member  612  is partially received within housing portion  604  and rotatably mounted thereto. A shaft member  614  is partially received within a distal end  616  of housing portion  604 , similar to that which was described above in connection with surgical adapter  500 . 
     Gear member  609  is rotatably mounted within housing portion  604  and includes gear teeth  618  that mesh with gear teeth  620  mounted on dial member  612 . A channel  622  is formed through gear member  609 . A proximal end  624  of advancing mechanism  608  is fixedly received within channel  622 . Advancing mechanism  608  further includes threads  626  formed on an outer surface thereof, and a receiving channel  628 , both of which will be explained below in further detail. 
     Attachment mechanism  606  is secured to a distal end of shaft member  614 . Shaft member  614  further comprises at least one slot member  634  into which a tab member  636  from housing portion  604  is slidably received. Threads  626  operatively engage with threads formed on an internal surface of shaft member  614 , to be explained in further detail below. Attachment mechanism  606  includes a mounting groove member  638  having a cannula receiving portion  639  and an endoscope receiving portion  640 . A retaining member  641  is selectively engageable with attachment mechanism  606 , to be explained below in further detail. A locking washer  643  may also be included. 
     Referring now to  FIGS. 14-18 , use of surgical adapter  600  will now be explained. First, distal end  447  (best seen in  FIG. 3 ) of surgical cutting device  440  is inserted into surgical adapter  600 . More specifically, distal end  447  of the cutting element of surgical cutting device  440  is inserted into a top portion  642  of connecting portion  602  and into receiving channel  628  and advanced through cannula receiving portion  639  of attachment mechanism  606 . Top portion  642  includes a mounting groove that receives distal end  462  of upper housing  452  for frictional engagement. A bottom portion  644  of connecting portion  602  also includes a mounting groove that receives a distal end  451  of lower housing  450  for frictional engagement, as shown in  FIG. 15 . In one exemplary embodiment, assembly of surgical adapter  600  to surgical cutting device  440  is performed at the factory prior to packaging and delivery of the devices. 
     Once secured, distal end  447  of outer cannula  44  (and inner cannula positioned therein) is then received in proximal end  316  of trocar  307 . In one embodiment attachment mechanism  606  fixedly engages a portion of endoscope  300 , thereby securing surgical cutting device  440  to endoscope  300 . More specifically, endoscope receiving portion  640  is sized to engage an outer surface of endoscope  300 , leaving cannula receiving portion  639  open, but in general alignment with working channel  324 . Once properly positioned, fastening mechanism  641  is actuated to frictionally attach attachment mechanism  606  to endoscope  300 . Endoscope  300  is also attached to trocar  307 , as described above. Thus, tissue cutting device  40  is also fixed with respect to trocar  307 . 
     However, in accordance with one aspect of the disclosure, the extent that distal end  447  may extend outwardly from distal end face  322  of trocar  307  may be selectively controlled by the surgeon. More specifically, dial member  612  may be selectively rotated in a first direction to advance distal end  447  of outer cannula  444  of tissue cutting device  440  with respect to distal end face  322  of trocar  307 . Dial member  612  may be selectively rotated in a second direction to move distal end  447  of outer cannula  444  toward trocar  307 . 
     Gear teeth  620  of dial member  612  mesh with gear teeth  618  such that when dial member  612  is rotated gear mechanism  609  rotates. Because proximal end  624  of advancing mechanism  608  is fixedly secured to gear mechanism  609 , as gear mechanism  609  rotates, advancing mechanism  608  also rotates. Receiving channel  628  is sized to receive outer cannula  444 . Thus rotation of advancing mechanism  608  causes shaft member  614  to move along tab member  636 , effectively moving distal end  447  of outer cannula  444 . 
     Because surgical adapter  600  secures surgical cutting device  440  to endoscope  300 , the surgeon may better control the amount of extent of distal end  447  of outer cannula  444  to allow for safer, more secure, more stable and more accurate placement of the cutting mechanism. 
     Referring to  FIGS. 19-22 , a surgical system  800  is depicted. Surgical system  800  comprises an endoscope  300 ″, a surgical adapter  500  and a connector adapter  700 . In one exemplary arrangement, endoscope  300 ″ is a LOTTA® style endoscope distributed by the Karl Storz Endoscopy-America, Inc., El Segundo, Calif., and further includes a proximal end  446 ″. 
     Connector adapter  700  comprises a shaft member  702 , a proximal mounting member  704 , a support member  706  and selectively engageable connecting members  708 . A seal member  709  (best seen in  FIG. 22 ) is secured to support member  706 . Each connecting member  708  is operatively secured to support member  706  by a living hinge  710 . 
     Connector adapter  700  provides a user with the ability to utilize a variety of instrumentation with endoscope  300 ″, without requiring any permanent modifications to endoscope  300 ″ or to the instrumentation by a user in the field, or by the manufacturer of endoscope  300 ″. Moreover, connector adapter  700  is configured to provide a selectively attachable sealed interface between a working channel of endoscope  300 ″ and a surgical instrument such as, for example, the NICO MYRIAD® manufactured and distributed by Nico Corporation of Indianapolis, Ind. 
     More specifically, shaft member  702  is fixedly mounted to support member  706 . A working channel  712  extends through support member  706  and shaft member  702 . Mounting member  704  may be secured to a proximal end of shaft member  702 . In one exemplary configuration, mounting member  704  is configured as a flange member. However, it is understood that other mounting elements may also be provided including, but not limited to, threaded engagements. 
     As discussed above, connector adapter  700  further includes connecting members  708 . In one exemplary arrangement, connecting members  708  are arranged in an opposing manner, as shown in  FIG. 21 . In one exemplary arrangement, connecting adapter  700  includes at least two connecting members  708   a,  and  708   b.  First connecting member  708   a  is configured with at least one selectively depressible locking tab  714 . Second connecting member  708   b  is configured with a corresponding number of receiving grooves  716 . Locking tabs  714  are configured to be selectively received and retained within corresponding receiving grooves  716  when connector adapter  700  is mounted to a surgical system, as will be explained in further detail below. 
     In operation, surgical adapter  500  is attached to a surgical cutting instrument such as that discussed above in connection with  FIG. 3 . Mounting member  704  of connector adapter  700  is then connected to cap member  540  of surgical adapter  500  such that shaft member  538  (best seen in  FIG. 6  above) is received within working channel  712 . Mounting member  704  is configured to engage with a corresponding mounting feature formed in cap member  540 . For example, an internal surface of cap member  540  may be configured with frictional members that secure mounting portion  704  therein. Alternatively, as discussed above, both cap member  540  and mounting portion  704  may be provided with corresponding threads such that a threaded attachment may be achieved. 
     Once mounting portion  704  is secured to surgical adapter  500 , connector adapter  700  is brought into engagement with a proximal end  446 ″of endoscope  300 ″ such that seal member  709  engages proximal end  446 ″. Seal member  709  is also configured with an opening therethrough (not shown) that is axially aligned with working channel  712  of shaft member  702 . Seal member  709 , which is constructed of a suitable sealing material to achieve a fluid-tight seal, is also configured so as to have a circumference that is at least as large as a circumference of an entrance piece to proximal end  446 ″ of endoscope  300 ″. 
     When seal member  709  is initially brought into engagement with proximal end  446 ″ of endoscope  300 ″, first and second connecting member  708   a  and  708   b  oriented toward support member  706  such that connecting members  708   a,    708   b  are separated form one another, as shown in  FIGS. 21 and 22 . In other words, first and second connecting members  708   a  and  708   b  pivoted about living hinges  710 . 
     In one exemplary configuration, first and second connecting members  708   a,    708   b  are each configured with a mount surface  718  that mates with seal member  709  when first and second connecting members  708   a,    708   b  are in a connected position (as shown in  FIGS. 19-20 ). Connecting members  708   a,    708   b  each may also be provided with an angled contacting face  720  that extends from living hinge  710  to an outer surface  722  of each connecting member  708   a,    708   b.  Angled contacting face  720  is configured with cooperate with a corresponding angled contacting face  724  disposed on either side of support member  706 . 
     Once seal member  709  engaged with proximal end  446 ″ of endoscope  300 ″, connecting members  708   a,    708   b  are then pivoted toward one another so as to surround and mate to proximal end  446 ″ of endoscope  300 ″. Locking tabs  714  are then engaged with receiving grooves  716  so as to lock connecting members  708   a,    708   b  quickly and easily together, thereby securing connector adapter  700  onto endoscope  300 ″. Once the medical procedure is completed, connector adapter  700  may be selectively detached from endoscope  300 ″ by simply depressing a portion of locking tabs  714  that is disposed externally from an outer surface  726  of connector adapter  700  (best seen in  FIG. 20 ) to release locking tabs  714  form retaining grooves  716 . 
     Referring to  FIGS. 23 and 24 , a funnel attachment  900  designed to direct distal end  447  of a cutting element from a surgical cutting instrument, such as cutting instrument  440 , into a working channel  328  of trocar  307  is shown. During a surgical procedure, when a distal end of trocar  307  is positioned within a patient, the surgeon is viewing the surgical field, either through eyepiece  302  or on a display monitor. Thus, while the surgeon is viewing the surgical area, the surgeon may also be trying to insert distal end  447  into working channel  328  blindly. This approach often results in multiple frustrating attempts at trying to locate the opening of working channel  328  for receiving the outer cannula or other surgical component, and cause the loss of efficiency and valuable operating time. 
     To address this concern, funnel attachment  900  is provided. Funnel attachment  900  comprises a directing portion  902  and leg members  904 . Leg members  904  are configured to fit over a housing  301  of an endoscope  300  and abut up against a proximal end of trocar  307 . Feet members  906  extending from leg members  904  engage a bottom surface of housing  301  to secure funnel attachment  900  thereto. 
     Funnel attachment  900  is further defined by a proximal side  908  and a distal side  910 . Directing portion  902  is defined by a funnel-like surface  912  that tapers toward a directing groove  914 . When funnel attachment  900  is secured to endoscope  300 , directing portion  902  is positioned such that directing groove  914  generally aligns with working channel  328  of trocar  307 . Thus, as the surgeon is viewing the surgical area, the funnel-like surface  912  will serve to direct distal end  447  of an outer cannula  44  of a surgical cutting instrument  440  into directing groove  914 , resulting in outer cannula  444  being correctly placed within working channel  328 . 
     While funnel attachment  900  is not shown in use with surgical adapters  500 ,  600  or connector adapter  700 , it is understood that funnel attachment  900  may be used with all of these components. 
     Referring now to  FIGS. 26-34 , a surgical interface  1000  is now described for operably connecting a medical instrument  1040  to an endoscope  300  via an interface housing  1005 . The interface housing  1005  may be operably connected to a luer  1015 , which may be operably connected to an attachment mechanism  1006  of the adapter  500 . 
     The interface housing  1005  may include an inner attachment portion  1010  disposed therein, as shown in  FIG. 27 . The inner attachment portion  1010  has an inner body  1020  and an inner extension  1025  extending at the proximal end of the inner attachment portion  1010  such that the inner body  1020  has a larger diameter than that of the inner extension  1025 . The inner body  1020  of the inner attachment portion  1010  defines an opening at a proximal end of the inner attachment portion  1010 . 
     The distal end of the interface housing  1005  may also define an interface retainer  1030  at the opening for receiving a proximal portion of the endoscope  300 . The interface retainer  1030  may include an interface lip  1035  that is sloped outwardly at the opening at the distal end of the interface housing  1005 . Further, the inner extension  1025  extends into the proximal portion of the endoscope  300 . The proximal portion of the endoscope  300  is flared and the interface retainer  1030  defined by the distal end of the interface housing  1005  is configured to receive the flared portion  1032 . A seal  1045  is disposed around the inner extension, abutting the proximal portion of the endoscope  300 . 
     The luer  1015  has a proximal male extension  1050  at a proximal end of the luer  1015  and a distal male extension  1055  at a distal end of the luer  1015 . The opening at a proximal end of the inner body  1020  is configured to receive the distal male extension  1055 . A luer body portion  1060  extends perpendicular and in-between the male extensions  1050 ,  1055 . The proximal end of the interface housing  1005  abuts the distal male extension  1055  and aligns adjacent the luer body portion  1060 . The attachment mechanism  1006  is configured to receive the distal male extension  1055 . 
     Thus, the interface housing  1005  is configured to operably connect to the luer and endoscope such that a portion of the endoscope is receivable within the interface housing  1005  so as to be operably connected to a distal end of the medical instrument  1040  via the interface housing  1005 . 
     In operation, the interface housing  1005  is attached to an endoscope  300  such as that discussed above in connection with  FIG. 21 . The interface housing  1005  may include first and second connecting members  1065   a,    1065   b  connected at a hinge  1070 . Once the proximal portion of the endoscope  300  is placed in the interface retainer  1030  of the inner attachment portion  1010 , and once the distal end of the luer  1015  is placed within the opening defined by the inner attachment portion  1010  at the proximal end, the connecting members  1065   a,    1065   b  may be pivoted toward one another so as to surround and mate to the proximal portion of the endoscope. Additionally or alternatively, the distal end of the luer  1015  may be inserted into the opening after the connecting members  1065   a,    1065   b  have closed around the endoscope  300 . The seal  1045  may be an O-ring such that the proximal end of the endoscope  300  is securely received within the interface housing  1005  and a sealed connection between the interface housing  1005  and the endoscope  300  is created. Thus, via the luer  1015  and interface housing  1005 , the attachment mechanism  1006  of an adapter  500  is operably connected to the medical device  1040 . 
     As discussed above, the inner attachment portion  1010  is defined by a proximal end member  1075  and a distal cap member  1080 , wherein the distal cap member  1080  may be selectively engaged with the proximal male extension  1050  of the luer  1015 . The proximal male extension  1050  may include threads (not shown) that operatively engage with threads  1090  formed on an internal surface of the cap member  1080 . The cap member  1080  further includes a shaft member  1095  extending therethrough. The shaft member  1095  defines a passageway  1100  through which the portion of the medical device  1040  may extend. 
     In an additional example, shown in  FIGS. 29-31 , the proximal end of the interface housing  1005  has an outer support ring  1105  engaging the inner attachment portion  1010  (see  FIG. 30 .) The inner attachment portion  1010  is disposed within the housing portion  1005  and defines a channel  1110  within the interface housing  1005  between the housing walls and the inner attachment portion  1010 . The inner attachment portion  1010  includes a protrusion  1115  at the proximal end thereof and the outer support ring  1105  defines a cavity  1120  for receiving the protrusion  1115 . A proximal end of the outer support ring  1105  aligns with the proximal end of the inner attachment portion  1010 . The proximal ends of the inner attachment portion  1010  and outer support ring  1105  are flush with each other and adjacent the luer body portion  1060 . The shaft  1095  of the attachment mechanism  1006  extends beyond the attachment mechanism  1006  at the distal end thereof. The proximal male extension  1050  defines a luer recess  1030  for receiving the extended shaft  1095  whereby a portion of the proximal male extension  1050  extends into the attachment mechanism  1006 . 
     The proximal portion of the endoscope  300  defines an endoscope recess  1135  configured to receive the inner extension of the inner housing portion  1010 . The proximal portion of the endoscope  300  also includes an endoscope lip  1040  configured to engage the interface retainer  1030 . The interface retainer  1030  includes an interface lip  1035  at the opening of the interface housing  1005 . In operation, the endoscope  300  may be pushed into the opening and the endoscope lip  1040  may engage the interface lip  1035 , thus locking the proximal end of the endoscope  300  with the interface housing  1005 . The seal  1045  may be an  0 -ring and be disposed between and adjacent to the proximal end of the endoscope and the inner body portion. Thus, a sealed connection is created between the endoscope  300  and the interface housing  1005 . 
     In an additional example, shown in  FIGS. 32-34 , the surgical interface  1000  includes an interface housing  1205 . The interface housing  1205  may be a hallow cylinder with each of its proximal and distal ends defining an opening. The opening at the distal end may include a tapered wall  1210 . The interface  1000  includes an inner attachment portion  1010  such that the inner body  1020  has a larger diameter than that of the inner extension  1025 . The inner body  1020  includes an inner base  1215  on the proximal end of the inner body  1020 . The inner base  1215  defines an opening at a proximal end of the inner attachment portion  1010  for receiving the distal male extension  1055  of the male luer  1015 . The inner base  1215  may also include a plurality of inner base nobs  1220  extending outwardly from the inner base  1215 . The inner base nobs  1220  may provide leverage for rotating the inner attachment portion  1010  as it is inserted into the interface housing  1025 . The inner body  1020  includes inner body threads  1230  formed on an outer surface thereof. The inner body threads  1230  extend around the inner body  1020  from the inner base and to the inner extension  1025 . The inner extension  1025  may present at least one wing  1235  extending radially outwardly from the inner extension. 
     A flexible surround  1245  may be configured to surround the inner attachment portion  1010 . The flexible surround  1245  defines a hollow center and includes a cylindrical base portion  1250  configured to surround at least a portion of the inner body  1020 . The base portion  1250  includes base portion threads  1255  for engaging the inner body threads  1230 . The surround  1245  may also include a plurality of surround extensions  1260  extending from a distal end of the base portion  1250 . The surround extensions  1260  may be spaced from one another and increase in thickness and/or width as each extends from the base portion  1250 . Thus, the thickness of the surround extensions  1260  at their distal ends is greater than the thickness of their proximal end at the base portion  1250 . 
     Distal ends  1265  of the surround extensions  1260  may form a triangular shape with a base of the triangular shape facing an outer surface of the flexible surround  1245 . The outer surface of each surround extension  1260  may include a pair of guides  1270  defining a recess  1275  therebetween. The surround extensions  1260  extend inwardly at the distal ends  1265  towards the hollow center of the surround  1245  forming a void between the extensions. The void is configured to receive the proximal portion of the endoscope  300 . 
     Similar to the examples described above with respect to  FIGS. 27-31 , a seal  1045  may be disposed between and adjacent to the proximal end of the endoscope  300  and the inner extension  1025 . An inner lip  1285  may extend outwardly at the distal end of the inner extension  1025  to act as a retainer for the seal  1045 . 
     In operation, the proximal portion of the endoscope  300  is a flared portion  1032  and is received by the surround extensions  1260  at the distal end of the flexible surround  1245 . The surround extensions  1260  may be radially movable so as to allow the flared portion  1032  to be inserted into the void. Each distal end  1265  of the extensions  1260  may form a lip  1280  for receiving the flared portion  1032  of the endoscope  300 . 
     Once the flared portion  1032  is received by the surround extensions  1260 , the flexible surround  1245  is received by the interface housing  1205 . The flexible surround may be pushed into the distal end of the interface housing  1205 . The base portion  1250  will thus be inserted first. As the surround extensions are inserted into the interface housing  1205 , the guides  1270  on the outer surface of the surround extensions  1260  will abut the inside surface of the interface housing  1205 . The guides may be made of a less frictional surface than that of the surround  1245 . As the surround  1245  is inserted into the housing  1205 , the extensions  1260  may be pressed radially inwardly thus tightening the hold that the distal ends  1265  have on the flared portion  1032 . Once the entire surround  1245  is enclosed by the housing  1205 , the distal ends  1265  may extend flush with the distal end of the housing  1205  such that the distal ends are received at the tapered wall  1210 . Moreover, the proximal end of the endoscope is securely locked within the surgical interface  1000 . 
     The inner attachment portion  1010  may then be inserted at the proximal end of the interface housing  1205 . The inner attachment portion  1010  may be rotated and pushed into the housing  1205  so that the inner body threads  1230  may engage the base portion threads  1255  of the flexible surround  1245 . Once the inner attachment portion  1010  has been inserted into the flexible surround, the proximal end of the interface housing  1205  may abut the inner base  1215 . The at least one wing  1235  on the inner extension  1025  may extend outwardly so as to operably engage the inner surface of at least one of the surround extensions  1260 . Thus, a sealed connection is created between the endoscope  300  and the interface housing  1205  allowing the surgical interface  1000  to operably connect a medical instrument  1040  to an endoscope  300 . 
     It will be appreciated that the devices and methods described herein have broad applications. The foregoing embodiments were chosen and described in order to illustrate principles of the methods and apparatuses as well as some practical applications. The preceding description enables others skilled in the art to utilize methods and apparatuses in various embodiments and with various modifications as are suited to the particular use contemplated. In accordance with the provisions of the patent statutes, the principles and modes of operation of this invention have been explained and illustrated in exemplary embodiments. 
     It is intended that the scope of the present methods and apparatuses be defined by the following claims. However, it must be understood that this invention may be practiced otherwise than is specifically explained and illustrated without departing from its spirit or scope. It should be understood by those skilled in the art that various alternatives to the embodiments described herein may be employed in practicing the claims without departing from the spirit and scope as defined in the following claims. The scope of the invention should be determined, not with reference to the above description, but should instead be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled. It is anticipated and intended that future developments will occur in the arts discussed herein, and that the disclosed systems and methods will be incorporated into such future examples. Furthermore, all terms used in the claims are intended to be given their broadest reasonable constructions and their ordinary meanings as understood by those skilled in the art unless an explicit indication to the contrary is made herein. In particular, use of the singular articles such as “a,” “the,” “said,” etc. should be read to recite one or more of the indicated elements unless a claim recites an explicit limitation to the contrary. It is intended that the following claims define the scope of the invention and that the method and apparatus within the scope of these claims and their equivalents be covered thereby. In sum, it should be understood that the invention is capable of modification and variation and is limited only by the following claims.