Abstract:
An access device for surgical procedures is disclosed which includes a multiport end cap including a plurality of separate access ports for accommodating the introduction of individual surgical instruments into a body cavity or lumen of a patient, and a coupling for operatively connecting the multiport end cap to a tubular body.

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
       [0001]    The subject invention claims the benefit of and priority to U.S. Provisional Application Ser. No. 62/212,776 filed Sep. 1, 2015, the disclosure of which is herein incorporated by reference in its entirety. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    1. Field of the Invention 
         [0003]    The subject invention is directed to surgical access devices, and more particularly, to a multi-port access device for minimally invasive surgical procedures including single incision laparoscopic procedures. 
         [0004]    2. Description of Related Art 
         [0005]    Laparoscopic or “minimally invasive” surgical techniques are becoming commonplace in the performance of procedures such as cholecystectomies, appendectomies, hernia repair and nephrectomies. Benefits of such procedures include reduced trauma to the patient, reduced opportunity for infection, and decreased recovery time. Such procedures commonly involve filling or “insufflating” the abdominal (peritoneal) cavity with a pressurized fluid, such as carbon dioxide, to create what is referred to as a pneumoperitoneum. 
         [0006]    The insufflation can be carried out by a surgical access device equipped to deliver insufflation fluid, or by a separate insufflation device, such as an insufflation (veress) needle. SurgiQuest, Inc., Milford, Conn. has developed unique surgical access devices that permit ready access to an insufflated surgical cavity without the need for conventional mechanical seals, and it has developed related gas delivery systems for providing sufficient pressure and flow rates to such access devices, as described in whole or in part in U.S. Pat. No. 7,854,724 and U.S. Pat. No. 8,795,223, the disclosures of which are both herein incorporated by reference in their entireties. 
         [0007]    During typical laparoscopic procedures, a surgeon makes three to four small incisions, usually no larger than about twelve millimeters each, which are made with the surgical access devices themselves, typically using a separate inserter or obturator placed therein. Following insertion, the inserter is removed, and the trocar allows access for instruments to be inserted into the abdominal cavity. 
         [0008]    A variety of larger access devices are also known in the art for accessing a surgical site through a single relatively large incision to perform minimally invasive procedures, rather than through multiple small incisions. Examples of such devices are disclosed in U.S. Patent Application Publication No. 2013/0012782, the disclosure of which is herein incorporated by reference in its entirety. 
         [0009]    It would be beneficial to provide a single incision access device having multiple ports with a variety of different port sizes to give a surgeon more options for instrument introduction during a laparoscopic surgical procedure. It would also be beneficial to provide an access device having multiple ports with a variety of different port size that enables ready access to natural orifices for performing trans-anal minimally invasive surgical procedures or the like. 
       SUMMARY OF THE INVENTION 
       [0010]    The subject invention is directed to a new and useful access device for surgical procedures. The device includes an elongated tubular body portion defining a longitudinal axis which is configured for introduction through a natural orifice of a body lumen or through a single incision formed in the wall of the abdominal cavity of a patient. The device further includes a multiport end cap operatively associated with a proximal end portion of the tubular body portion and including a plurality of separate access ports for accommodating the introduction of individual surgical instruments into the body lumen or abdominal cavity of the patient. A coupling is provided for operatively connecting the multiport end cap to the proximal end portion of the tubular body portion. 
         [0011]    Preferably, the coupling is adapted and configured to permit relative axial rotation of the multiport end cap and tubular body portion. The coupling includes a ratchet mechanism for selectively positioning the multiport end cap relative to the tubular body portion. The coupling also includes spring loaded latches for selectively moving the ratchet mechanism. In one embodiment of the invention, the coupling also includes a connector for a pressurized gas line and a connector for a pressure sensing line having a lumen extending from the pressure sensing line through a bottom surface thereof. In another embodiment, the end cap includes a connector for a pressurized gas line and the tubular body portion includes a connector for a pressure sensing line. 
         [0012]    Preferably, a seal assembly is operatively associated with each of the access ports of the end cap, and each seal assembly includes a main orifice seal and a secondary duckbill seal, and at least one of the access ports has a larger access diameter than the other access ports. The seal assembly can be secured within each access port with an external retaining feature. The retaining feature can include a locking mechanism selected from the group consisting of hooks, ratchet teeth, pins and holes, pins and slots, I-beams and pull and twist ties. In one embodiment, the end cap can also include a trocar port. 
         [0013]    The multiport end cap can further include a weave layer to secure surgical instruments therethrough. In one embodiment, an assembly aid can assist is engaging multiport cap with the tubular body portion. In another embodiment, the tubular body portion can have an adjustable length. 
         [0014]    The subject invention is also directed to an access device for surgical procedures that includes a tubular adapter having opposed proximal and distal end portions, a multiport end cap including a plurality of separate access ports for accommodating the introduction of individual surgical instruments into the body lumen or abdominal cavity of the patient, a coupling for operatively connecting the multiport end cap to the proximal end portion of the tubular body portion, and a laparoscopic wound protector operatively associated with the distal end portion of the tubular adapter for introduction through a single incision formed in the wall of the abdominal cavity of a patient. In one embodiment of the device, a duckbill seal is operatively associated with the tubular adaptor. In another embodiment of the device, a generally S-shaped seal is operatively associated with the tubular adaptor. 
         [0015]    The subject invention is also directed to an access device for surgical procedures that includes a top ring having a plurality of circumferentially spaced apart openings extending therethrough. A latch assembly including diametrically opposed latches having a plurality of circumferentially spaced apart flexible tabs is configured to snap fit into corresponding openings of the top ring. A multiport end cap is operatively secured between the top ring and the latch assembly and includes a plurality of separate access ports for accommodating the introduction of individual surgical instruments into the body lumen or abdominal cavity of the patient. A retaining ring is operatively associated with the latch assembly and is configured to permit relative axial rotation of the multiport end cap. The retaining ring has a plurality of circumferentially spaced apart flexible tabs. A bottom ring has a plurality of circumferentially spaced apart openings extending therethrough for accepting corresponding flexible tabs of the retaining ring therein. An adapter is operatively secured between the retaining ring and the bottom ring. In one embodiment, the adapter is a duck bill seal. In another embodiment, the adapter is a seal having a generally S shape. 
         [0016]    Preferably, an elongated tubular body portion can extend distally from the adapter configured for introduction through a natural orifice of a body lumen or through a single incision formed in the wall of the abdominal cavity of a patient. 
         [0017]    Preferably, the retaining ring includes a first connector for a pressurized gas line and a connector for a second pressure sensing line. The retaining ring can further include an O-ring seal positioned within an annular groove thereof. The retaining ring can also include a ratchet mechanism for selectively positioning the multiport end cap relative to the adapter. In one embodiment, a plurality of suture tie down flanges extends outwardly from the bottom ring. 
         [0018]    These and other features of the subject invention and the manner in which it is manufactured and employed will become more readily apparent to those having ordinary skill in the art from the following enabling description of the preferred embodiments of the subject invention taken in conjunction with the several drawings described below. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0019]    So that those skilled in the art to which the subject invention appertains will readily understand how to make and use the access devices of the subject invention without undue experimentation, preferred embodiments thereof will be described in detail herein below with reference to certain figures, wherein: 
           [0020]      FIG. 1  is a perspective view of a multi-port access device for use in trans-anal surgical procedures in accordance with the subject invention, showing a fully assembled access device connected to an air seal line and a sense tube with a surgical device extending therethrough; 
           [0021]      FIG. 2  is an exploded view of the multi-port access device, showing a multi-port sub assembly and a wound protector sub assembly; 
           [0022]      FIG. 3  is an exploded view of the multi-port access device, showing an O-ring and a retaining ring; 
           [0023]      FIG. 4  is an exploded view of the multi-port sub assembly showing access ports and a latch assembly 
           [0024]      FIG. 5  is a cross-sectional view taken along line  5 - 5  of  FIG. 1 , showing ratchet teeth of the latch assembly engaged with the retaining ring; 
           [0025]      FIG. 6  is an exploded view of a single access port of the multi-port sub assembly, showing a seal assembly therein; 
           [0026]      FIG. 7  is an exploded view of the seal assembly, showing a main seal and a duck bill seal; 
           [0027]      FIG. 8  is a cross-sectional view taken along line  8 - 8  of  FIG. 6 , showing alignment of the main seal and duck bill seal; 
           [0028]      FIG. 9  is an exploded view of the latch assembly of the multi-port sub assembly, showing a coupler body and symmetrical latches; 
           [0029]      FIG. 10  is a perspective view of a portion of the coupler body, showing spring pockets and through slots; 
           [0030]      FIG. 11  is a perspective view of a latch of the latch assemblies, showing ratchet teeth; 
           [0031]      FIG. 12  is a perspective view of an assembled wound protector sub assembly, showing a spring within the latch assembly in a compressed position; 
           [0032]      FIG. 13  is a cross-sectional view taken along line  13 - 13  of  FIG. 12 , showing engagement of the ratchet teeth of the latch assembly and the retaining ring when the spring is in an uncompressed position; 
           [0033]      FIG. 14  is a perspective view of the wound protector sub assembly, showing rotation of the locking ring; 
           [0034]      FIG. 15  is a cross-sectional view taken along line  12 - 12  of  FIG. 11 , showing pressure on a button of the latch assembly releases ratchet teeth from retaining ring. 
           [0035]      FIG. 16  is an exploded view of an alternate embodiment of a latch assembly, showing flexible tabs; 
           [0036]      FIG. 17  is an exploded view a portion of the latch assembly of  FIG. 16 , showing flexible tabs aligned with a flat face of coupler body; 
           [0037]      FIG. 18  shows an embodiment of the multi-port access device of the subject invention for connecting the multi-port sub assembly to a wound protector sub assembly for use in laparoscopic surgical procedures; 
           [0038]      FIG. 19  is an exploded view of the multi-port access device of  FIG. 18 , showing a seal; 
           [0039]      FIG. 20  is a perspective view of an alternate embodiment of an elastic access portion of the multi-port sub assembly, showing access ports of varying sizes; 
           [0040]      FIG. 21  is a perspective view of an alternate embodiment of a wound protector sub assembly showing a lumen molded therein; 
           [0041]      FIG. 22  is a perspective view of the wound protector of  FIG. 21 , showing the lumen extending through the wound protector body; 
           [0042]      FIG. 23  is a perspective view of an alternate embodiment of a port for the multi-port sub assembly; 
           [0043]      FIG. 24  is an exploded view of the port of  FIG. 23 , showing main seal and duck bill seal between a top and bottom; 
           [0044]      FIG. 25  is a cross-sectional view taken along line  25 - 25  of  FIG. 23 , showing an assembled port of the embodiment of  FIG. 23 ; 
           [0045]      FIG. 26  is a perspective view of an alternate embodiment of a port for the multi-port access device; 
           [0046]      FIG. 27  is an exploded view of the port of  FIG. 26 , showing flexible tabs and slots; 
           [0047]      FIG. 28  is a cross-sectional view taken along line  28 - 28  of  FIG. 26 , showing an assembled port of the embodiment of  FIG. 26 ; 
           [0048]      FIG. 29  is an exploded view of an alternate embodiment for a retaining feature of the access port, showing a spring hose clamp; 
           [0049]      FIG. 30  is an exploded view of an alternate embodiment for a retaining feature of the access port, showing a living hinge and ratchet teeth closure; 
           [0050]      FIG. 31  is an exploded view of an alternate embodiment for a retaining feature of the access port, showing a belt closure with a pin and hole; 
           [0051]      FIG. 32  is a perspective view of an alternate embodiment of a belt closure for the access port, showing a pin and key; 
           [0052]      FIG. 33  is a perspective view of an alternate embodiment of a belt closure for the access port, showing a graduated ratchet; 
           [0053]      FIG. 34  is a perspective view of an alternate embodiment of a belt closure for the access port, showing a hook and lock; 
           [0054]      FIG. 35  is a perspective view of an alternate embodiment of a belt closure for the access port, showing a hook and lock; 
           [0055]      FIG. 36  is a perspective view of an alternate embodiment of a belt closure for the access port, showing I-beams; 
           [0056]      FIG. 37  a perspective view of is an alternate embodiment of a belt closure for the access port, showing a hook and lock; 
           [0057]      FIG. 38  is an exploded view of an alternate embodiment a multi-port sub assembly, showing a weave layer; 
           [0058]      FIG. 39  is an exploded perspective view showing the weave layer of  FIG. 38  in an alternating pattern; 
           [0059]      FIG. 40  is a perspective view showing a surgical instrument inserted through the weave layer of  FIG. 38 ; 
           [0060]      FIG. 41  is a perspective view of an alternate embodiment of a multi-port sub assembly, showing a parallel stitch design; 
           [0061]      FIG. 42  is an exploded perspective view of an alternate embodiment of a multi-port sub assembly, showing a stitch design with multiple layers; 
           [0062]      FIG. 43  is a perspective view of an alternate embodiment of a multi-port sub assembly, showing a vacuum port; 
           [0063]      FIG. 44  is a perspective view of an alternate embodiment of a multi-port sub assembly, showing ports of varying lengths; 
           [0064]      FIG. 45  is a cross-sectional view taken along line  45 - 45  of  FIG. 44 , showing a groove to engage a wound protector sub assembly; 
           [0065]      FIG. 46  is a perspective view of an alternate embodiment of a multi-port sub assembly, showing a trocar port; 
           [0066]      FIG. 47  is a cross-sectional view taken along line  47 - 47  of  FIG. 46 , showing a plurality of grooves to engage a wound protector sub assembly; 
           [0067]      FIG. 48  is an exploded perspective view of an alternate embodiment of a latch assembly for the multi-port access device, showing spring loaded horizontal latches; 
           [0068]      FIG. 49  is a detailed view of latches of  FIG. 48 , showing a flex arm and tab; 
           [0069]      FIG. 50  is a detailed view of the latches of  FIG. 48 , show pressure on the flex arm releases tab; 
           [0070]      FIG. 51  is an exploded view of an alternate embodiment of a latch assembly for the multi-port access device, showing spring loaded vertical latches; 
           [0071]      FIG. 52  is a perspective view of the latches of  FIG. 51 , showing a flex arm and hook; 
           [0072]      FIG. 53  is a perspective view of the latches of  FIG. 51 , show pressure on the flex arm releases hook; 
           [0073]      FIG. 54  is an exploded view of an alternate embodiment of a latch assembly for a multi-port access device, showing a spring loaded ratchet ring; 
           [0074]      FIG. 55  is a perspective view of the ratchet ring of  FIG. 55  in an uncompressed position; 
           [0075]      FIG. 56  is a perspective view of the ratchet ring of  FIG. 55  in a compressed position; 
           [0076]      FIG. 57  is an exploded perspective view of an alternate embodiment of a latch assembly for a multi-port access device, showing a spring loaded hose clamp; 
           [0077]      FIG. 58  is a perspective view of the hose clamp of  FIG. 58 , showing alignment of an inner ring and an outer ring; 
           [0078]      FIG. 59  is a perspective view of the hose clamp of  FIG. 58 , showing compression of the outer ring; 
           [0079]      FIG. 60  is a perspective view of an alternate embodiment of a latch assembly for a multi-port access device, showing a top ring having release pads; 
           [0080]      FIG. 61  is an exploded view of the embodiment of  FIG. 60 , showing a ratchet feature of the top ring; 
           [0081]      FIG. 62  is a cross sectional view taken along line  62 - 62  of  FIG. 60 , showing the ratchet feature aligned with slots of wound protector; 
           [0082]      FIG. 63  is a perspective view of an alternate embodiment of a latch assembly for a multi-port access device, showing a spring loaded shroud; 
           [0083]      FIG. 64  is an exploded view of the multi-port access device of  FIG. 63 , showing alignment of the spring loaded shroud, retaining ring and wound protector body; 
           [0084]      FIG. 65  is an exploded view of the shroud of  FIG. 63 , showing flex arms of the spring loaded shroud; 
           [0085]      FIG. 66  is a perspective view of the shroud of  FIG. 64 , showing compression of the flex features; 
           [0086]      FIG. 67  is a perspective view of an alternate embodiment of a latch assembly for a multi-port access device, showing an outer release ring and a bottom ring; 
           [0087]      FIG. 68  is an exploded perspective view of the multi-port access device of  FIG. 67 , showing flexible arms of an inner ring; 
           [0088]      FIG. 69  is a perspective view of the multi-port access device of  FIG. 67 , showing locking tabs inserted into a slot of bottom ring; 
           [0089]      FIG. 70  is perspective view of an alternate embodiment of a latch assembly for a multi-port access device, showing a dynamic screw ring; 
           [0090]      FIG. 71  is an exploded perspective view of the multi-port access device of  FIG. 71 , showing locking features on screw ring; 
           [0091]      FIG. 72  is an exploded perspective view of the multi-port access device of  FIG. 70 , showing flexible tabs of the screw ring; 
           [0092]      FIG. 73  is an exploded perspective view of an alternate embodiment for assembling a multi-port sub assembly, showing an assembly aid; 
           [0093]      FIG. 74  is an exploded perspective view of an alternate embodiment of a multi-port access device, showing a telescoping wound protector; 
           [0094]      FIG. 75  is an exploded perspective view of the multi-port access device of  FIG. 74 , showing the wound protector fully extended; 
           [0095]      FIG. 76  is an exploded perspective view of an alternate embodiment of a multi-port access device, showing a threaded wound protector; 
           [0096]      FIG. 77  is a perspective view of the multi-port access device of  FIG. 76 , showing the assembled device; 
           [0097]      FIG. 78  is a perspective view of an alternate embodiment of a multi-port access device, having snap fit features for assembly; 
           [0098]      FIG. 79  is an exploded perspective view of the multi-port access device of  FIG. 78 , showing alignment between a top ring of a multi-port sub assembly and bottom ring of a wound protector assembly; 
           [0099]      FIG. 80  is a detailed view of alignment of the multi-port sub assembly and wound protector assembly with air seal port; 
           [0100]      FIG. 81  is a perspective view of an alternate embodiment of a multi-port access device, having a seal therein; 
           [0101]      FIG. 82  is an exploded perspective view of the multi-port access device of  FIG. 81 , showing alignment between a top ring of a multi-port sub assembly and bottom ring of a wound protector assembly; 
           [0102]      FIG. 83  is a detailed view of alignment of the multi-port sub assembly and wound protector assembly with air seal port; 
           [0103]      FIG. 84  is a perspective view of a duck bill seal for use in the multi-port access device of  FIG. 81 ; and 
           [0104]      FIG. 85  is a perspective view of a generally S shaped seal for use in the multi-port access device of  FIG. 81 . 
       
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
       [0105]    Referring now to the drawings wherein like reference numerals identify similar structural features and/or elements of the subject matter disclosed herein, there is illustrated in  FIG. 1  a multi-port access device for single incisions minimally invasive surgical procedures in accordance with a preferred embodiment of the subject invention and designated generally by reference numeral  100 . It will be understood by those skilled in the art that embodiments of the multi-port access device shown and described herein can be used for any procedure through a single opening or incision including, but not limited to, rectal (TAMIS) procedures and laparoscopic procedures. 
         [0106]    With reference to  FIG. 1 , a fully assembled multi-port access device  100  is shown positioned within a single opening of a patient. The access device  100  allows for a plurality of surgical instruments  104  to be inserted through one incision or natural body lumen providing more options for a surgeon. Also, using natural orifices when possible improves the patient&#39;s recovery time, pain and discomfort. The access device  100  is configured and designed to cooperate with an air seal line  106  and a sensing line  108  during a surgical procedure. 
         [0107]    As best shown in  FIG. 2 , the access device  100  includes a multi-port assembly  200  coupled to a wound protector assembly  300 . The wound protector assembly  300  is generally an elongated tubular body portion  304  defining a longitudinal axis. The multi-port assembly  200  is operatively associated with a proximal end portion  304   a  of the tubular body portion  300 . A coupling connects the multi-port assembly  200  and wound protector assembly  300  and is configured to allow 360 degree rotation of the multi-port assembly  200  without moving the air seal  106  or pressure sensing lines  108 . 
         [0108]    The multi-port assembly  200  is comprised of an elastic access portion  210  and a latch assembly  240  (shown best in  FIG. 4 ). The elastic access portion  210  is generally dome shaped and includes a plurality of access ports  212  for insertion of surgical instruments therethrough  104 . The latch assembly  240  couples the multi-port assembly  200  to a ratchet ring  312  (shown in  FIG. 3 ) of the wound protector assembly  300 . 
         [0109]    Referring to  FIGS. 6-8 , each access port  212  of the elastic access portion  210  includes a seal assembly  220  and a retaining feature  214  for maintaining the seal assembly  220  in position. As shown in  FIG. 7 , the seal assembly  220  includes a top  222  which encloses a main seal  224  and a duck bill seal  226  between the top  222  and a bottom ring  228 . The top  222  and the bottom ring  228  are press fit together when tabs  228   a  of the bottom ring  228  are inserted into openings  222   a  of the top  222 . Each seal assembly  220  is inserted into a tip  216  of the respective access port  212 . The retaining feature  214  is positioned on an external surface of the tip  216  to compress the tip  216  onto the seal assembly  220  and prevent movement. 
         [0110]    With reference to  FIGS. 9-15 , the latch assembly  240  of the multi-port assembly  200  is shown. The latch assembly  340  includes a circular coupler body  242  and two symmetrical latches  246 ,  248  with buttons  243 ,  245 , respectively. The latches  246 ,  248  are generally semi-circular with parallel extensions  246   a ,  246   b ,  248   a ,  248   b  configured to slideably engage with slots  247  of coupler body  242 . Each extension  246   a ,  246   b ,  248   a ,  248   b  includes a hole  246   c    246   d ,  248   c ,  248   d  which engages a post  243   a ,  245   a  on the button  243 ,  245  of the opposing latch. For example, as best seen in  FIG. 12 , hole  246   a  of extension  246  engages post  245   a  of button  245 . 
         [0111]    In addition, at least one extension  246   a ,  248   a  of each latch  246 ,  248  includes a notch  246   e ,  248   e  (shown in  FIG. 11 ) to engage corresponding post of button  243 ,  245  such that button  243 ,  245  securely fits to latch  246 ,  248 . Further, coupler body  242  includes ribs  249  (shown in  FIG. 10 ) to help maintain positioning of button  243 ,  245 . 
         [0112]    Each latch  246 ,  248  further includes ratchet teeth  252  (shown in  FIG. 11 ) to mate with the ratchet ring  312  of the wound protector assembly. Two springs  262 ,  266  (shown best in  FIG. 9 ) are disposed within spring pockets  264 ,  268  between the body  242  and a respective button  243 ,  245  for releasing the latch assembly  246 ,  248  from the ratchet ring  312 . More specifically, compression of the springs  262 ,  266  manipulates extensions  246   a ,  246   b ,  248   a ,  248   b  and flexes ratchet teeth  252  to lock or release from the ratchet ring  312 . 
         [0113]    The ratchet ring  312  includes a plurality of circumferentially arranged ratchet teeth  322  to mate with ratchet teeth  252  of the latch assemblies  240 . An O-ring  332  is positioned within an annular groove  334  of the ratchet ring to seal and secure the multi-port assembly  200  to the wound assembly  300 . Ports  342 ,  346  for the air seal line  106  and sensing line  108  extend from the ratchet ring  312  and secure into openings  348 ,  349  of the wound protector assembly  300 . 
         [0114]    As best shown in  FIG. 3 , the wound protector assembly  300  includes an elastic wound protector body  304  extending downwardly from the ratchet ring  312 . The wound protector  304  includes at least one tie down feature  352  at the proximal end  304   a  for securing the access device  100  during a surgical procedure. A flange  306  extends from a distal end  304   b  of the wound protector  304  to secure the wound protector  304  within the opening of the patient. 
         [0115]    To assemble multi-port sub-assembly  200  to the wound protector sub-assembly  300  a user squeezes the buttons  243 ,  245  of the latch assembly  240 . The multi-port sub assembly  200  is pressed down and over the O-ring  332  and ratchet ring  312  until the ratchet teeth  252  on the latches  246 ,  248  are aligned with corresponding ratchet teeth  322  of the ratchet ring  312 . Referring to  FIG. 13 , releasing the buttons  243 ,  245  allows the ratchet teeth  252  to lock into the ratchet ring  312 . 
         [0116]    As shown best in  FIGS. 14 and 15 , to rotate the multi-port assembly  200 , the user again squeezes the buttons  243 ,  245  to release the ratchet teeth  252  from ratchet ring  312  (shown in  FIG. 13 ) and then rotates (shown in  FIG. 12 ) the multi-port assembly  200  until the desired position of access ports  212  is reached. Once the desired position is reached, releasing the buttons  243 ,  245  will again lock ratchet teeth  252  with ratchet teeth  332  and secure the multi-port assembly  200  in position for use. 
         [0117]    With reference to  FIGS. 16 and 17 , an alternate embodiment of a latch assembly  640  is shown. Latch assembly  640  can be used in a similar manner as latch assembly  240  with multi-port assembly  200  and wound protector assembly  300 . Latch assembly  640  includes latches  646 ,  648  and buttons  643 ,  645 , however springs are replaced with flexible tabs  672 ,  674 . More specifically, flexible tabs  672 ,  674  having a generally “V” shape extend from buttons  643 ,  645 . Flexible tabs  672 ,  674  mate with a flat face  682  on coupler body  642  when buttons  643 ,  645  are pressed. Flexible tabs  672 ,  674  operate in a similar manner as springs  262 ,  266  in that pressure on buttons  643 ,  645 , compresses flexible tabs  672 ,  674  to release or lock ratchet teeth  652  to ratchet ring  312 . 
         [0118]      FIGS. 18 and 19  illustrate an alternate embodiment of a multi-port access device  800  preferably for use during laparoscopic procedures. The multi-port assembly  900  is similar to multi-port assembly  200  having an elastic access portion  910  with a plurality of access ports  912  and a latch assembly  940 . In addition, retaining ring  912  is similar to retaining ring  312  having an O-ring seal  934 , ratchet teeth  922  and ports for air seal  942  and pressure sensing  946 . 
         [0119]    In this embodiment, wound protector  1004  includes a bottom lip  1024  around a distal end  1004   b . At least one top lip  1026  surrounds a proximal end  1004   a  to secure an adaptor  1049  (best seen in  FIG. 19 ) to wound protector  1004 . Adaptor  1049  is generally ring-shaped that fits over top lip  1026  and includes openings for  1048 ,  1049  for ports  942  and  946 , respectively. Adaptor  1049  also includes suture tie downs  1052  similar to suture tie downs  352 . A duck bill seal  1032  mates with the adaptor  1049  and the wound protector  1004 . 
         [0120]    To assemble, the wound protector  1004  is first inserted into an opening of a patient. The adaptor  1049  is pressed down and over lip  1026  of the wound protector  1004 . Retaining ring  912  is positioned on top of adaptor  1049  with ports  942 ,  946  in openings  1048 ,  1049 , respectively. Duck bill seal  1032  is next fit into retaining ring  912  and adaptor  1049  and multi-port assembly  900  is attached to retaining ring  912  in the same manner as multi-port assembly  200  and retaining ring  312 . 
         [0121]      FIG. 20  illustrates an alternate embodiment of an elastic access portion  2010  for use in the multi-port assembly  200 . Access ports  2012  and seal assemblies  2020  with retaining rings  2014  are shown in various dimensions. For example, 12 mm, 10 mm, 8 mm, and 5 mm access ports  2012  can be used. Potential use of even smaller ports (3 mm) is also envisioned. In this embodiment, an air seal port  2042  is also part of the elastic access portion  2010 . 
         [0122]      FIGS. 21 and 22  show an alternate embodiment of a wound protector  2100  for use with retaining ring  312 . A lumen  2156  is molded into the wound protector body  2104  which connects from the sensing port  346  to the flange  2106  of the wound protector  2104 . This embodiment can potentially enhance smoke evacuation by increasing the distance between the sensing line  346  and air seal line  342 . 
         [0123]      FIGS. 23-28  show alternate embodiments for seal assemblies  2320  and  2620  within access ports  2312  and  2612 , respectively. Similar to access port  220 , access port  2320  and  2620  include main seals  2324  and  2624  and duck bill seals  2326  and  2626  between tops  2322  and  2622  and bottom rings  2328  and  2628 , respectively. With reference to  FIGS. 23-25 , bottom ring includes a proud ring feature  2328   a  (shown in  FIG. 24 ) which engages an internal groove  2322   a  of top  2322  (shown in  FIG. 25 ). In this embodiment, the top  2322  and bottom ring  2328  are press fit together and hold the main seal  2324  and duckbill  2326  seal together. With reference to  FIGS. 26-28 , top  2622  includes flexible tabs  2622   a  which engage slots  2628   a  on the bottom ring  2628 . Once the flexible tabs  2622   a  are press fit into the slots  2628   a , the flex tabs  2622   a  will lock in place and hold the main seal  2624  and duckbill  2626  seal together. 
         [0124]      FIG. 29  shows an alternate embodiment for a retaining feature for maintaining seal assembly  220  within access ports  212  of the elastic access portion  210  utilizing a spring hose clamp  2932 . The clamp  2932  is held in position and operated with an inner ring  2934  and outer ring  2936 . The inner ring  2934  holds one end  2932   a  of the clamp  2932  and another end  2932   b  of the clamp  2932  is held by the outer ring  2936 . Rotating the outer ring  2936  and inner ring  2934  in opposing directions will open and close the clamp  2932  and allow for adjustability. 
         [0125]      FIG. 30  shows another embodiment of a retaining feature  3032  wherein a living hinge  3034  is included in a  3032 . The retaining feature  3032  has ratchet teeth  3042  that mate with opposing ratchet teeth  3046  of the ring  3032  and that once wrapped around an access port  220  will ratchet closed. 
         [0126]      FIG. 31  shows yet another embodiment for the retaining feature including a strap or belt  3132  that could be used to hold access port  220  within the opening  212 . In this embodiment, outward extending pins  3132   a  mate with holes  3132   b  of opposing ends of strap to secure  3132  the strap together. 
         [0127]      FIGS. 32-37  show varying embodiments of locking mechanisms for straps  3232 ,  3332 ,  3432 ,  3532 ,  3632 ,  3732 . Strap  3232  includes a pin configured to be inserted and slid through slot to lock strap into position. Strap  3332  includes a pull and twist design which allows for tightening the strap as needed to hold seal assembly in position.  FIG. 34  illustrates strap  3432  having one generally arrow shaped end that can be inserted into an opening at an opposing end by press fitting the ends together.  FIGS. 35 and 37  illustrate straps  3532  and  3732  each having hook features with varying orientations. Strap  3632 , shown in  FIG. 36 , includes I-beams on opposing ends that snap fit together. 
         [0128]    With reference to  FIGS. 38-42  alternate designs to the multi-port sub assembly  200  are shown by incorporating stitching underneath the access ports  212 . When assembled the stitching is enclosed within the latch assembly  240 . The stitching includes elastic stitches  3828  in an alternating pattern, a continuous stitch, or multiple layers with alternating gaps. 
         [0129]    More specifically, as shown in  FIG. 39  each individual elastic string  3828  overlaps in an alternating pattern such that there are no openings or leaks. As best seen in  FIG. 40 , this embodiment includes a circular bottom plate  3822 , a top ring plate  3824  and a plurality of posts  3826  along the circumference of the bottom plate  3822  for looping each stitch  3828  around. This design can include one more than one layer of weaving to compensate for “cat-eyeing”. 
         [0130]      FIG. 41  shows a continuous elastic stitch  4128  design that would be wound in one direction around posts  4126  between a bottom plate  4122  and a top ring  4124 .  FIG. 42  shows a plurality of circular elastic layers  4226   a - d  where elongated gaps  4228  on each layer  4226   a - d  are angled with each adjacent layer  4226   a - d . In this embodiment, each layer  4226   a - d  is manufactured the same, but assembled in different orientations (0, 45, 90, 135 degrees). Regardless of the embodiment, a user inserts surgical instruments through the weave, stitch, or layers to maintain stability of the surgical instruments during a surgical procedure. 
         [0131]    Referring now to  FIGS. 43-47  alternate embodiments of a multi-port assembly are shown. Various combinations in the numbers of access ports, the heights, and different combinations of access ports and trocar ports are contemplated. For example, multi-port sub assembly  4300  (shown in  FIG. 43 ) includes access ports  4312  with equal heights and a pressure/vacuum port  4318 . Multi-port assembly  4400  (shown in  FIG. 44 ) includes access ports  4412  of varying heights and a trocar port  4418  and multi-port assembly  4600  (shown in  FIG. 46 ) includes access ports  4612  and a trocar port  4618 . 
         [0132]      FIGS. 45 and 47  also show alternate embodiments of attaching the multi-port assemblies  4300 ,  4400  and  4600  to a wound protector, for example, wound protector  1004  (shown in  FIG. 19 ). Assemblies  4300 ,  4400  and  4600  include internal elastic features, for example grooves  4426 ,  4628  and  4626 , which mate with at least one exterior ring, for example ring  1026 , on the wound protector. The elastic feature seals the multi-port assembly to the wound protector. 
         [0133]      FIGS. 48-50  show an alternate embodiment of a latch assembly  5140  for mating the multi-port assembly  4800  with the wound protector assembly  300 . Multi-port assembly  2800  includes latch assembly  5040  having a coupler body  5042  with diametrically opposed horizontally aligned spring loaded latches  5043 ,  5045 . Each latch  5043 ,  5045  has a ratchet tooth  5052  at one end, a flexible arm  5056  on the opposing end and a middle portion  5054  therebetween to pivot around. The coupler body  5042  has two slots  5064  (only one shown in  FIG. 49-51  for clarity) for inserting the ratchet tooth  5052  therein and a groove  5068  for the flexible arm  5056  to mate with. 
         [0134]    To operate, a user squeezes flexible arm  5056  and pivots the latches  5043 ,  5045  outwardly such that ratchet teeth  5052  engage ratchet teeth  322  of retaining ring  312 . This design also allows the user to reposition the multi-port sub-assembly  4800  rotationally without losing the seal in a similar manner as multi-port sub assembly  200 , described in  FIGS. 1-15 . 
         [0135]      FIGS. 51-53  illustrate yet another alternate embodiment of a latch assembly  5140  for mating multi-port assembly  5100  with the wound protector assembly  300 . Latch assembly  5140  includes a coupler body  5142  with diametrically opposed vertically aligned spring loaded latches  5143 ,  5145 . Each latch  5143 ,  5145  has a ratchet tooth  5152  at one end, a flexible arm  5156  on the opposing end and a middle portion  5154  therebetween to pivot around. The coupler body  5142  has an annular groove  5168  for flexible arm  5156  to mate with. This embodiment works similar to latch assembly  5040 . To operate, a user squeezes flexible arm  5156  and pivots the latches  5143 ,  5145  outwardly such that ratchet teeth  5152  engage ratchet teeth  322  of retaining ring  312 . 
         [0136]      FIGS. 54-56  show an alternate embodiment of a latch assembly  5440  for mating the multi-port assembly  200  with the wound protector assembly  300 . A spring loaded horizontal latch ring  5450  is configured to engage wound protector  300 . More specifically, the latch ring  5450  includes a ratchet feature  5452  that can engage ratchet teeth  322  of wound protector  300 . In an alternate embodiment, the ratchet feature may also simply mate with the elastic wound protector directly. 
         [0137]    A button  5445  on the latch ring  5450  contains spring  5462  which manipulates the ratchet feature  5452 . By pressing the button  5445 , the ratchet feature  5452  is moved outwards (shown in  FIG. 56 ) to an open position, and a user can either engage or disengage from the wound protector  300 . Releasing the spring (shown in  FIG. 55 ) returns the ratchet feature to a closed position and maintains the connection between ratchet feature  5452  and ratchet teeth  322 . This embodiment also allows the user to reposition the top multi-port assembly  200  rotationally without losing the seal. 
         [0138]      FIGS. 57-59  show yet another alternate embodiment for a latch assembly  5740 . In this embodiment, a spring loaded hose clamp  5742  engages wound protector assembly  5900 . In this embodiment, wound protector assembly  5900  includes an elastic body  5904  and a proximal ring  5904   a  that maintains the seal between multi-port assembly  5700  and the wound protector body  5904 . 
         [0139]    The hose clamp  5742  is embedded inboard of an inner ring  5736  (shown in  FIG. 58 ), which in turn, is positioned inboard of an outer ring  5738 . The outer ring  5738  mates the latch assembly  5740  to the multi-port sub assembly  5800 . Each of the inner ring  5736  and outer ring  5738  include a finger tab  5736   a ,  5738   a , respectively, to manipulate the clamp  5742 . A user squeezes the tabs  5736   a ,  5738   a  towards one another (as shown in  FIG. 59 ) which compresses the clamp  5742  to loosen the engagement from the wound protector body  5904 . This design also allows the user to reposition the multi-port assembly  200  rotationally. 
         [0140]      FIGS. 60-62  illustrate an alternate embodiment of multi-port sub assembly  6000  and wound protector sub assembly  6100  having a push on design with ratchet feature  6122 . The elastic access portion  6010  is coupled to a top ring  6012  which has diametrically opposed release pads  6014  and inwardly protruding ratchet teeth  6022  along a bottom circumference thereof. The wound protector  6100  has a bottom ring  6132  at a proximal end  6104   a  of the wound protector body  6104  with ratchet features  6134 . 
         [0141]    To assemble and disassemble, a user squeezes the release pads  6014  inwards to flex the top ring  6012  and pushes the top ring  6012  over the bottom ring  6132  until ratchet teeth  6022  align with the ratchet features  6134 . Releasing the pads  6014  will return the top ring  6012  to a home position and ratchet teeth  6022  of the top ring  6012  will lock with the ratchet features  6134  of the bottom ring  6132 . To adjust rotation, the user squeezes the release pads  6014  and rotates the multi-port assembly  6000  until the desired position is reached. 
         [0142]    With reference to  FIGS. 63-66  another alternate embodiment of a multi-port assembly  6300  and wound protector sub assembly  6400  is shown. In this embodiment, retaining ring  6412  is part of the multi-port assembly, in contrast to the previous embodiments wherein the retaining ring was part of the wound protector assembly (for example as shown in  FIGS. 1-15 ). With this design, a top ring  6432  is coupled to the elastic access portion  6410  and includes a ratchet button  6433 . The ratchet button  6433  has two flexible hooks  6433   a  on opposing ends which engage a ratchet feature  6422  of the retaining ring  6412 . The top ring  6432  further includes downwardly extending flexible tabs  6434  that snap over the ratchet feature  6422  and keep the top ring  6432  and elastic access portion  6410  from disengaging linearly. By pressing the ratchet button  6433  the hooks  6433   a  flex outwardly and allow rotational movement of the elastic access portion  6410 . 
         [0143]    The retaining ring  6412  includes press fit slots  6424  to accept a spring loaded shroud  6452  and a plurality of 90 degree cams slots  6426  for mating with wound protector  6400 . The shroud  6452  has flexible arms  6454  which attach to the ratchet ring  6412  and bias the shroud  6452  away from the ratchet ring  6412 . The wound protector  6400  has a bottom ring  6414  at a proximal end  6404   a  of the wound protector body  6404  without circumferentially arranged perpendicularly extending posts  6414   a  that mate with the cam slots  6426  of the ratchet ring  6412 . 
         [0144]    The shroud  6452  includes a plurality of cross-arms  6456  to engage the posts  6414   a  of the bottom ring  6414  as the posts  6414   a  are inserted into the cam slots  6426 . As a user pushes and twists the multi-port sub assembly  6300  onto the wound protector  6400  the posts  6414   a  of wound protector  6400  migrate through the cam slots  6426  and the shroud  6456  extends over the proximal portion  6404   a  of the wound protector body  6404  thereby locking the multi-port sub assembly  6300  to the wound protector  6400 . To remove, the user will lift the shroud  6456  away from the wound protector  6400 , reverse twist and pull off. 
         [0145]      FIGS. 67-69  show yet another alternate embodiment of a multi-port assembly  6700  and wound protector assembly  6800  having a push and twist design with three rotational positions. The multi-port assembly  6700  includes an inner ring  6714 , and an outer ring  6716  attached thereto. The inner ring  6714  has a plurality of flexible arms  6722  (shown in  FIG. 69 ) with a ratchet tooth  6724  on one end. Each ratchet tooth  6724  includes a perpendicularly extending post  6724   a  that engages a corresponding hole  6718  of outer ring  6716 . The inner ring  6714  also has a plurality of 90 degree locking tabs  6732  (shown in  FIG. 68 ) to lock the multi-port assembly  6700  to the wound protector sub assembly  6800 . 
         [0146]    The wound protector sub-assembly  6800  has a proximal flange  6812  extending from a proximal portion  6804   a  of the wound protector body  6404  that includes a plurality of elongated slots  6814  to accept the inner ring locking tabs  6732 , and openings  6818  to accept the ratchet tooth  6724  of the inner ring  6714  therein. The openings  6818  are positioned as a set of three between the elongated slots  6814 . 
         [0147]    To assemble, a user positions the locking tabs  6732  of the inner ring  6714  over the elongated slots  6814  of the proximal flange  6812  and pushes downwardly and twists. The 90 degree shape of the locking tab  6732  will fit into a keyed portion  6814   a  of elongated slot  6814 . The twisting motion locks the multi-port sub assembly  6700  to the wound protector  6800  (shown in  FIG. 69 ). The elongated slot  6814  allows the user to continue to twist the multi-port sub assembly  6700  to three rotational positions corresponding to the openings  6818  along the proximal flange  6812 . To remove, the user will lift the outer ring  6716  which will release the ratchet teeth  6724  out of the openings  6818  and reverse twist to migrate the locking tabs  6732  back to the keyed portion  6814   a  of the elongated slots  6814 . The multi-port assembly  6700  can then be pulled away and off of the wound protector sub assembly  6800 . 
         [0148]      FIGS. 70-72  illustrate another alternate embodiment of a multi-port assembly  7000  and a wound protector sub assembly  7100 . The multi-port assembly includes a static ring  7014  engaged with a dynamic ring  7016 . The static ring  7014  has mating pockets  7022  to accept ratchet teeth  7032  of the dynamic ring  7016  therein (shown in  FIG. 72 ). The dynamic ring  7016  also has flexible tabs  7034  to bias the ratchet teeth  7032  into the static ring  7014 . In addition, the dynamic ring  7016  includes an internal thread  7036  and flexible locking features  7038  (shown in  FIG. 71 ) to couple the multi-port assembly  7000  to the wound protector assembly  7100  and prevent linear movement therebetween. 
         [0149]    The wound protector sub assembly  7100  includes posts  7102  and slots  7106  circumferentially spaced around a proximal ring  7112  at a proximal end  7104   a  of wound protector body  7104 . A user screws the multi-port assembly  7000  over the posts  7102  on the proximal ring  7112  until the flexible locking tabs  7038  snap into mating slots  7106  on the proximal ring  7112 . The top multi-port assembly  7000  is now locked onto the wound protector  7100 . 
         [0150]    To rotate the multi-port assembly  7000 , the user pushes the static ring  7014  onto the dynamic ring  7016 , which will flex the tabs  7034  of the dynamic ring and move the static ring slot/pockets  7022  off the dynamic ring ratchet teeth  7032  and allow rotation. To remove, the user flexes the locking feature  7038  on the dynamic ring  7016  to disengage the slot  7106  of the wound protector  7100  and twists the multi-port sub assembly to unscrew. 
         [0151]      FIG. 73  illustrates an alternate design for assembling a multi-port assembly  7302  to the wound protector  7350 . This embodiment includes an assembly aid  7300  that engages the elastic access portion  7310  of the multi-port assembly  7302 . The assembly aid  7300  has four flexible arms  7312  which are attached together with a coupler  7332  that acts as a pivot for each of the flexible arms  7312 . Each of the flexible arms  7312  has a first end  7312   a  that engages a corresponding slot  7321  of the elastic access portion  7310 . By squeezing a second end  7312   b  of the each arm  7312 , the arms  7312  pivot outward allowing the elastic access portion  7310  to assemble over the wound protector  7350 . In an alternate embodiment, a rotational disc  7342  with openings for the flexible arms  7312  can be used to squeeze and pivot the flex arms  7312 . 
         [0152]      FIGS. 74-75  illustrate an alternate embodiment for a wound protector sub assembly  7400  having an adjustable length. More specifically, the wound protector assembly  7400  includes a plurality of telescoping sections  7404   a - c  biased closed with springs  7406   b - c . The springs  7408   b - c  are held in position by a flange  7406   b - c  of each telescoping section. The flange of the outermost telescoping section  7406   a  anchors into the patient and extends through the incision to allow the multi-port sub assembly  200  to attach with retaining ring  312 . Rotation of each telescoping section  7404   a - c  allows for adjusting the length of the wound protector assembly  7400 . 
         [0153]      FIG. 76  illustrates an alternate embodiment for extending the length of a wound protector assembly  7600 . In this embodiment an external thread  7612  positioned on a proximal portion  7604   a  of wound protector body  7604  is configured to engage an internal thread  7614  of a proximal ring  7622 . The proximal ring  7622  can be lifted or lowered simply by twisting thereby adjusting the height of the multi-port sub assembly  200  as needed. 
         [0154]      FIG. 77  shows another embodiment of a multi-port sub assembly and wound protector sub assembly which is particularly adapted for specimen removal. In this regard, the device includes an “S” shaped duckbill seal  7720 . A similar type of seal structure is disclosed for example in U.S. Patent Application Publication No. 2013/0012782, the disclosure of which is herein incorporated by reference in its entirety. 
         [0155]    Referring to  FIGS. 78-80  another alternate embodiment of multi-port assembly  7900  and wound protector assembly  8000  is shown having snap fit features. As best seen in  FIG. 80 , multi-port sub assembly  7900  includes a top ring  7926  with a plurality of circumferentially spaced apart openings therethrough. Latch assembly  7940 , similar to latch assembly  240 , includes a plurality of circumferentially space upwardly extending flexible tabs  7940   a  designed and configured to snap fit into corresponding openings of the top ring. A flange  7914  on the elastic access portion  7910  of the multi-port end cap  7910  is squeezed between top ring  7926  and latch assembly  7940  securing the multi-port end cap therebetween. 
         [0156]    Retaining ring  8012 , similar to retaining ring  312 , includes ratchet features  322  that engage with ratchet teeth  252  of the latch assembly  7940 . A smoke evacuation port  8048  can be inserted into retaining ring  8012  with pressure sensing port  8046 . As shown in  FIG. 81 , the air seal port  8042  includes an annular groove  8062  for mating with flex tabs  8064  of the retaining ring  8012 . O-ring seals  8043 ,  8047  are positioned between the air seal port  8042  and pressure sensing port  8046 , respectively, and the retaining ring  8012  to maintain the seal during a surgical procedure (shown best in  FIG. 81 ). 
         [0157]    Wound protector assembly  8000  includes a bottom ring  8018  having circumferentially spaced openings therethrough that allow flexible tabs  8012   a  of retaining ring  8012  to be snap fitted therein. An adapter  8034  is secured and held into position between the retaining ring  8012  and bottom ring  8018 . Both the adapter  8034  and bottom ring  8318  are dimensioned and configured to allow air seal port  8042  and pressure sensing port  8046  to easily engage with the retaining ring  8012 . As shown in  FIG. 79 , the adapter  8034  is a proximal portion of the wound protector body  8004 , similar to wound protector  304 , configured for insertion into a patient. 
         [0158]      FIGS. 81-83  illustrate an alternate embodiment of wound protector assembly  8300 . Wound protector assembly  8300  is coupled to multi-port sub assembly  7900 . In this embodiment, adapter is in the form of a seal  8332  positioned between retaining ring  8012  and bottom ring  8318 . Both the seal  8332  and bottom ring  8318  are dimensioned and configured to allow air seal port  8042  and pressure sensing port  8046  to easily engage with the retaining ring  8012 . 
         [0159]    Seal  8332  mates with a proximal portion  8304   a  of wound protector body  8304 , similar to wound protector  1004 . Bottom ring slides around seal  8332  and aligns with an annular flange or groove to further maintain seal in position. Referring to  FIGS. 84 and 85  two seal configurations are shown capable of use with wound protector assembly  8300 . Seal  8332  illustrates a duck bill design and seal  8334  illustrates a generally S shape. 
         [0160]    While the subject invention have been shown and described with reference to a preferred embodiment, those skilled in the art will readily appreciate that various changes and/or modifications may be made thereto without departing from the spirit and scope of the subject invention as defined by the appended claims.