AU2012281139A1 - Surgical access apparatus and adapter - Google Patents

Abstract

A surgical access apparatus that includes a compressible access port having a proximal end, a distal end, an outer surface and defining at least one lumen therethrough. The lumen may be suitable for receiving and forming a substantially sealing engagement with a surgical object inserted therethrough. The apparatus may also include an adapter configured to be disposed on the outer surface of the compressible access port. The adapter may be expandable such that, in a first compressed condition, the adapter is suitable for insertion into an incision through body tissue, and, in a second expanded condition, the outer surface of the adapter expands so as to form a substantially sealing engagement with the incision. Also, a tissue engaging member, such as a wound protector, may be disposed between the adapter and the incision.

Description

WO 2013/009957 PCT/US2012/046411 SURGICAL ACCESS APPARATUS AND ADAPTER CROSS-REFERENCE TO RELATED APPLICATIONS [0001] This application claims priority to, and the benefit of, U.S. Provisional Patent Application Serial No. 61/507,175, filed on July 13, 2011, the entire contents of which are incorporated by reference herein. BACKGROUND 1. Technical Field [0002] The present disclosure relates to an access apparatus for use in minimally invasive surgical procedures, and more particularly to an access apparatus including a surgical access port with an adapter that expands, e.g., upon absorption of fluid, to accommodate a range of incision sizes. 2. Background of Related Art [0003] Minimally invasive surgery, e.g., laparoscopic, endoscopic, and thorascopic surgery, has many advantages over traditional open surgeries. In particular, minimally invasive surgery eliminates the need for a large incision, thereby reducing discomfort, recovery time, and many of the deleterious side effects associated with traditional open surgery. [0004] The minimally invasive surgeries are performed through small openings in a patient's skin. These openings may be incisions in the skin or may be naturally occurring body orifices (e.g., mouth, anus, or vagina). In addition, hand access surgery may also be performed. 1 WO 2013/009957 PCT/US2012/046411 In general, insufflation gas may be used to enlarge the area surrounding the target surgical site to create a larger, more accessible work area. [00051 As with any incision, the creation of a wound presents a risk of contamination of the wound, e.g., a bacterial infection. Various wound protectors are known in the art to inhibit contamination of the wound and protect the inner surfaces of a bodily opening to inhibit damage and/or minimize discomfort. [0006] The maintenance of a substantially fluid-tight seal is desirable so as to inhibit the escape of the insufflation gas and the deflation or collapse of the enlarged surgical site. It is further desirable for a single surgical access system to be able to provide a substantially fluid tight seal over openings of various sizes. A continuing need therefore exists for bodily opening protection devices that can form improved substantially fluid-tight seals. SUMMARY [00071 A surgical access apparatus that includes a compressible access port having a proximal end, a distal end, an outer surface and defining at least one lumen therethrough. The lumen may be suitable for receiving and forming a substantially sealing engagement with a surgical object inserted therethrough. The apparatus may also include an adapter configured to be disposed on the outer surface of the compressible access port. The adapter may be expandable such that, in a first compressed condition, the adapter is suitable for insertion into an incision through body tissue, and, in a second expanded condition, the outer surface of the adapter expands so as to form a substantially sealing engagement with the incision. Also, a 2 WO 2013/009957 PCT/US2012/046411 tissue engaging member, such as a wound protector, may be disposed between the adapter and the incision. [0008] In various embodiments, the adapter may be formed of a material that absorbs fluid, the adapter having a passage therethrough for receipt of the access port. A substantially fluid-tight seal may be formed between the access port and the adapter. The proximal end and the distal end of the access port may each be defined by a flange. A proximal end and a distal end of the adapter may engage these respective flanges. The adapter may exert a compressive force on the access port. In embodiments, the access port may be formed of foam. A transition of the access port from a first diameter to a second diameter may form a substantially fluid-tight seal with the layer of tissue. [0009] In various embodiments, the surgical access apparatus may also include a tissue engaging member disposed around the perimeter of the incision through the layer of tissue. The adapter may form a substantially fluid-tight seal with the tissue engaging member and the tissue engaging member may form a substantially fluid-tight seal with the incision. The tissue engaging member may be a wound protector, and the wound protector may include a ring and/or a flange on its proximal and distal ends. [0010] The various aspects of this disclosure will be more readily understood from the following detailed description when read in conjunction with the appended drawings. BRIEF DESCRIPTION OF THE DRAWINGS [0011] FIG. 1 is a perspective view of an access port including an adapter; 3 WO 2013/009957 PCT/US2012/046411 [00121 FIG. 1A is an enlarged area of detail of a portion of the adapter showing a porous structure; [0013] FIG. 2 is a cross-sectional view of the access port and adapter as shown in FIG. 1, showing the engagement of the adapter and the access port, with multiple lumens disposed through the access port; [0014] FIG. 3 is a cross-sectional view of a surgical access apparatus, including the access port and adapter of FIG. 2, as well as a tissue engaging member ready for engagement with a layer of tissue; [00151 FIG. 4 is a cross-sectional view of the assembled surgical access apparatus, disposed in the layer of tissue with the adapter having a first diameter; [0016] FIG. 5 is a cross-sectional view of the surgical access apparatus as shown in FIG. 4, with the adapter having a second diameter; [00171 FIG. 6 is a cross-sectional view of the surgical access apparatus as shown in FIG. 5, with the access port removed. [0018] FIG. 7 is a cross-sectional view of an embodiment of a surgical access apparatus including an access port and an adapter, disposed in a layer of tissue having a tissue engaging member, with a proximal end of the adapter extending above the layer of tissue and rolled down toward a body surface; 4 WO 2013/009957 PCT/US2012/046411 [0019] FIG. 8 is a cross-sectional view of an embodiment of a surgical access apparatus including an access port and an adapter with a gap in its outer circumference, disposed in a layer with a tissue engaging member; and [0020] FIG. 9 is a top plan view of the surgical access apparatus of FIG. 8, disposed in a layer of tissue and showing the adapter securing the access port in place. DETAILED DESCRIPTION OF EMBODIMENTS [0021] The present disclosure will now describe in detail embodiments of a surgical access apparatus with reference to the drawings in which like reference numerals designate identical or substantially similar parts in each view. Throughout the description, the term "proximal" will refer to the portion of the apparatus closest to the operator, whereas the term "distal" will refer to the portion of the apparatus farthest from the operator. Although discussed in terms of an opening for a minimally invasive procedure, the presently disclosed surgical access apparatus may be used in any naturally occurring orifice (e.g. mouth, anus, or vagina). [0022] Referring initially to FIGS. 1 and 2, an access port 110 and an adapter 130 are shown. The access port 110 has a proximal end 112 and a distal end 114, and defines a longitudinal axis Al. The access port 110 may have a generally hourglass shape, or may have any number of shapes or profiles to suit the needs of a minimally invasive procedure. The proximal end 112 and the distal end 114 of the access port 110 are substantially perpendicular to the longitudinal axis Al. A flange 116 may define the proximal end 112 of the access port 110 and a flange 118 may define the distal end 114 of the surgical access port 110. The flanges 116, 118 may serve to anchor the surgical access apparatus 100 into a layer of tissue 500 (FIG. 3) or 5 WO 2013/009957 PCT/US2012/046411 to another object. Access port 110 may be formed of a compressible element suitable for contact with internal body surfaces, such as foam. [0023] Extending through the access port 110 along the longitudinal axis Al is at least one lumen 120, and in embodiments, multiple lumens 120. The lumens 120 are disposed substantially parallel to the longitudinal axis Al. Lumens 120 provide a path for objects such as surgical instruments to be inserted through the access port 110. Lumens 120 may also provide a path for insufflation fluids to be introduced to an internal body cavity 502 (FIG. 3) below access port 110. An access port of the type generally described above is disclosed in U.S. Patent Application Publication Nos. 2009/0093752 Al and 2010/0240960 Al, the entire disclosures of which are incorporated by reference herein. [0024] Circumferentially disposed on an outer surface of the access port 110 is adapter 130. Adapter 130 has a proximal end 132 and a distal end 134, and a passage therethrough for the receipt of access port 110. In various embodiments, the adapter 130 is formed of a compressible material such that its inner diameter is may accommodate a range of access ports 110. Alternatively, the adapter 130 may have a relatively rigid inner surface such that access ports 110, which may itself be compressible, may be accommodated therein. The outer diameter of adapter 130 may be varied so as to sealably engage a layer of tissue 500 of different sizes and configurations. A substantially fluid-tight seal is formed between the inner diameter of adapter 130 and the outer diameter of access port 110. The substantially fluid-tight seal between adapter 130 and access port 110 minimizes the escape of insufflation gases from an internal body cavity 502. 6 WO 2013/009957 PCT/US2012/046411 [00251 Adapter 130 may be formed of a material that is selectively compressible by a user, e.g., such that after being compressed, it may expand towards its original shape. In various embodiments, the adapter 130 may be expandible upon absorption of fluids, e.g., it may retain such fluids absorbed during its use, although such compressibility/expandability may, additionally or alternatively, be due to the resilient nature of the material of the adapter 130, e.g., compressible foam. It should be recognized hereinafter that, where specific examples are discussed whereby expansion occurs by the absorption of fluids, the present invention also contemplates that such examples may instead employ adapters that expand without absorption, e.g., where the adapter is not configured to absorb fluid but instead expands due to its resilient material. In various embodiments, adapter 130 may be formed of a sponge-like material, woven fabrics, knitted fabrics, or open or closed cell foam. [0026] Turning momentarily to FIG. 1A, the adapter 130 may be formed of a material that is porous. Pores 136 may provide spaces in which fluids may be disposed. Pores 136 may be interconnected across the adapter 130, or may be segregated. Depending on the constituent material of the adapter 130, the pores 136 may expand upon retaining fluid. [00271 Referring back to FIG. 1, adapter 130 and access port 110 may be formed as one single unit, or may be separable, with the access port 110 inserted into adapter 130 before or during use. The outer surface of access port 110 and the inner surface of adapter 130 may frictionally engage upon insertion, or may be provided with a lubricous surface treatment so as to ease insertion. [0028] Turning now to FIG. 3, a cross sectional view of a surgical access apparatus 100 is shown in partial assembly above layer of tissue 500. The access port 110 is shown disposed 7 WO 2013/009957 PCT/US2012/046411 proximally of the adapter 130, which is readied for insertion into the layer of tissue 500. Surgical access apparatus 100 may also include a tissue engaging member 150, e.g., a wound protector/surgical retractor. [0029] Tissue engaging member 150 has a proximal end 152 and a distal end 154 connected by a flexible, e.g., elastic, sleeve, and is disposed around the perimeter of the incision through the layer of tissue 500. Tissue engaging member 150 covers a portion of a body surface 504, extends through the incision of tissue layer 500, into internal body cavity 502, and onto an internal tissue wall 506. Distal end 154 of tissue engaging member 150 may be defined by a flange, or as shown, a ring, that contacts internal tissue wall 506. The, e.g., ring at the distal end 154 of tissue engaging member may be formed, e.g., by rolling the edge of tissue engaging member 150, or may contain a rigid or resilient ring-like element over which tissue engaging member 150 may be attached, e.g., welded, glued, rolled, etc. Proximal end 152 of tissue engaging member 150 may also be defined by a flange or a ring and may also contact body surface 504. Proximal end 152 of tissue engaging member 150 may contain a rigid or resilient arcuate element 156, e.g., a ring, over which the sleeve portion of the tissue engaging member 150 may be rolled. The arcuate/crescent or kidney bean cross-sectional shape of the arcuate element 156 may inhibit the tissue engaging member 150 from unrolling at the proximal end 152. Other shapes, both cross-sectional and when viewed from above, of the flanges and/or rings are also contemplated. One or both of the rings may be a rigid or resilient rolling member. In embodiments, an operator may shorten the length of tissue engaging member 150 between the proximal end 152 and distal end 154. Such shortening, e.g., by rolling the proximal end 154, of tissue engaging member 150 may also exert force on a layer of tissue 500 such that it may retract the incision through the layer of tissue 500. 8 WO 2013/009957 PCT/US2012/046411 [00301 Tissue engaging member 150 engages the outer surface of adapter 130, as will be discussed further in detail below, and protects tissue layer 500 from contamination and/or from damage caused by frictional engagement, shifting during operation, or other harmful forces caused during minimally invasive procedures. Tissue engaging member 150 is separate from access port 110 and adapter 130, and may be inserted into a layer of tissue prior to, or in conjunction with, the introduction of access port 110 and adapter 130. Tissue engaging member 150 is formed of a material suitable for contact with internal body surfaces, such as plastic or polymer. Further, the surface of tissue engaging member 150 that is in contact with adapter 130 may be designed to provide an enhanced frictional engagement to secure adapter 130 and access port 110 in place, or may be lubricous so as to ease insertion of the adapter 130 and access port 110 into a layer of tissue 500. In alternative embodiments, the tissue engaging member 150 may be attached to an outer surface of the adapter 130 or the access port 110 by adhesion or fusion, or may be integrally formed with an outer surface of the adapter 130 or access port 110. In further embodiments, tissue engaging member 150 may be absent, with the surface geometry of the access port 110 or adapter 130 configured to perform similar functions to tissue engaging member 150 described above. [0031] Referring to FIG. 4, a cross-sectional view of the surgical access apparatus 100 is shown fully assembled and disposed in a layer of tissue 500. Prior to use and upon initial introduction to a layer of tissue 500, adapter 130 has a first diameter "D1" as shown. The diameter D1 may be such that a gap is disposed between the outer surface of the adapter 130 and the layer of tissue 500. Alternatively, the adapter 130 having diameter D1 may be in loose contact with, but not form a substantially fluid-tight seal with the layer of tissue 500. When initially disposed in the layer of tissue 500, adapter 130 will be able to expand, e.g., by exposure 9 WO 2013/009957 PCT/US2012/046411 to fluids 138. Fluids 138 may be absorbed by the adapter 130 from body fluids in the surrounding layer of tissue 500, from fluids such as insufflation fluids introduced incidental to minimally invasive procedures, or may be introduced directly to the adapter 130 by an operator using a tube, needle, sprayer, or other suitable delivery device. [0032] Turning to FIG. 5, the adapter 130 is shown disposed in the layer of tissue 500 and having a second diameter "D2". Adapter 130 transitions from diameter D1 to diameter D2 upon introduction of fluids 138 (FIG. 4) to the adapter 130. Adapter 130 expands radially, as shown, and transitions from diameter D1 to diameter D2. The expansion of adapter 130 may exert a compressive force on access port 110, enhancing the engagement and substantially fluid tight seal between the access port 110 and the adapter 130. The engagement of flanges 116, 118 with the proximal and distal ends 132, 134 of the adapter 130 may inhibit adapter 130 from expanding axially, though it is contemplated that the flanges 116, 118 and the adapter 130 may be disposed such that the adapter 130 is free to expand axially. [00331 Transition of the adapter 130 from diameter D1 to D2 has the effect of reducing the gap between the adapter 130 and the layer of tissue 500. Diameter D2 may be of sufficient size such that the engagement of the adapter 130 and the layer of tissue 500 forms a substantially fluid-tight seal. The adapter 130 having the expanded diameter D2 may also serve to anchor the adapter 130 and access port 110 to the layer of tissue 500. [0034] In use, the operator of the surgical access apparatus 100 will insert the tissue engaging member 150 into the layer of tissue 500, and roll the arcuate element 156 such that the tissue engaging member 150 has a desired axial length. The arcuate element 156 may be further rolled to exert a tensile force and cause retraction of the incision through the layer of tissue 500. 10 WO 2013/009957 PCT/US2012/046411 An operator will then insert access port 110 into adapter 130, and dispose the surgical access apparatus 100 in a layer of tissue 500. Alternatively, access port 110 may be pre-assembled with adapter 130, or may be a single component including a fluid-absorbing surface, as discussed above. Flanges 116, 118 of the access port may anchor the surgical access apparatus 100 in the layer of tissue 500. Upon contact with one or more fluids, the adapter 130 or other fluid absorbing surface will transition from diameter D1 to diameter D2, closing any gap between the adapter 130 and the layer of tissue 500. Surgical instruments may then be inserted into surgical access port 110 and procedures, e.g., minimally invasive procedures, may be performed. While disposed in a layer of tissue 500, access port 110 may be removed from adapter 130 and replaced with another access member. When a minimally invasive procedure is completed, surgical instruments may be removed from access port 110, tissue engaging member 150 may be unrolled, and the surgical access apparatus 100 may be removed from the layer of tissue 500. After use, the access port 110 or adapter 130 may be compressed manually by an operator or with a tool or instrument to release absorbed fluid. In embodiments, a source of vacuum or other external device may be used to draw absorbed fluid from the adapter 130. This may have the effect of reducing the diameter of the access port 110 or adapter 130 to aid in removal from the layer of tissue 500. [00351 Referring to FIG. 6, the surgical access apparatus 100 is shown disposed in the layer of tissue 500 with the access port 110 (FIG. 5) removed. The adapter 130 may be inserted into the layer of tissue 500 prior to the introduction of an access port 110, or may be left disposed in a layer of tissue 500 after the removal of an access port 110. As the adapter 130 is shown having the expanded diameter D2, the adapter 130 is sufficiently engaged with the tissue engaging member 150 and the layer of tissue 500 such that the adapter 130 is anchored in place 11 WO 2013/009957 PCT/US2012/046411 in the layer of tissue 500. The size of the openings through the adapter 130 may enable a specimen to be removed and/or passed through the layer of tissue 500 (e.g., the permanent removal of diseased internal anatomy and/or the temporary removal of portions of the colon to be manipulated outside of the body before being returned to inside the body) without the need to remove the adapter 130, thereby providing a protective layer for the layer of tissue 500 against, e.g., contamination via cancer cell seeding or the like. Surgical instruments may also be introduced directly through the adapter 130. It should be recognized that, where relatively large specimens are desired to be removed from the surgical site, the adapter 130 mat be removed leaving the tissue engaging member 150 in place for protection of the tissue and to keep the incision sufficiently retracted. [0036] Turning to FIG. 7, a surgical access apparatus 200 is shown. Surgical access apparatus 200 includes an access port 110 and tissue engaging member 150, as discussed above with respect to previous embodiments. [00371 Surgical access apparatus 200 includes an adapter 230 that has a proximal end 232, a distal end 234, and a passage therethrough for the receipt of access port 110. Adapter 230 sealably engages access port 110 so as to minimize the escape of insufflation gases from the internal body cavity 502 below surgical access apparatus 100. Adapter 230 may be formed of material that absorbs fluids upon contact, and thus may expand upon introduction to one or more fluids in a manner described above with respect to the previous embodiment. [0038] At a proximal end 232 of adapter 230, the edges of adapter 230 are curled away from the access port 110, and are rolled toward body surface 504. Thus, proximal end 232 of adapter 230 is defined by the rolled edge of adapter 230. The rolled proximal end 232 of adapter 12 WO 2013/009957 PCT/US2012/046411 120 may serve to act as a flange to anchor surgical access apparatus 200 to the layer of tissue 500. The extent to which the edge at the proximal end 232 of adapter 230 is rolled necessarily shortens the length of adapter 230 that is disposed around the body of access port 110. In this way, the operator of the surgical access apparatus 200 may change the axial length of the adapter 230. [0039] In use, the operator of the surgical access apparatus 200 will insert the tissue engaging member 150 into a layer of tissue 500. The proximal edge 152 of tissue engaging member 152 may then be rolled to adjust the length of tissue engaging member 150 or to retract layer of tissue 500. The operator will then insert the access port 110 into adapter 230. Proximal end 232 of adapter 230 will extend proximally above the access port 110. The operator of the surgical access apparatus 200 will curl the proximal end 232 of the adapter 230 away from the access port 110 and roll it toward a body surface 504 to a desired degree. Alternatively, the distal end 234 of the adapter 230 may be rolled after insertion into the tissue engaging member 150 and the layer of tissue 500. Insertion of the access port 110 and the adapter 230 into the tissue engaging member 150 proceeds as described above with respect to surgical access apparatus 100. Alternatively, tissue engaging member 150 may be inserted into a layer of tissue 500 in conjunction with access port 110 and adapter 230. Minimally invasive procedures can then be performed in a manner described above. [0040] Referring to FIG. 8, a surgical access apparatus 300 is shown disposed in a layer of tissue 500. Surgical access apparatus 300 includes an access port 110 and a tissue engaging member 150 having a configuration substantially similar to access port 110 and tissue engaging member 150 discussed above with respect to previous embodiments. 13 WO 2013/009957 PCT/US2012/046411 [00411 Surgical access apparatus 300 includes an adapter 330 having a proximal end 332 and a distal end 334, and having a passage therethrough for the receipt of access port 110. Adapter 330 may be formed of material that expands, e.g., absorbs fluids upon contact, and thus may expand, e.g., upon introduction to one or more fluids, in a manner described above with respect to the previous embodiments. Adapter 330 has a gap 336 (FIG. 9) in its circumference. Adapter 330, upon expansion due to stresses from access port 110 or another object inserted therethrough, biases gap 336 toward a closed position. The tendency of adapter 330 to bias gap 336 closed may be enhanced by the fluid absorbing and subsequent expanding properties of its constituent material. Thus, when access port 110 is inserted into adapter 330, adapter 330 biases the gap 336 toward a closed position such that adapter 330 is securely engaged around access port 110. The pressed engagement of the access port 110 and adapter 330 in a layer of tissue 500 forms a substantially fluid-tight seal and minimizes the escape of insufflation gases from an internal body cavity 502 below surgical access apparatus 300. [0042] In use, an operator of a surgical access apparatus 300 inserts the tissue engaging member 150 into a layer of tissue 500. The proximal edge 152 of tissue engaging member 150 may then be rolled to adjust the length of tissue engaging member 150 or to retract a layer of tissue 500. The operator will then insert access port 110 into adapter 330. Alternatively, adapter 330 may be wrapped around the outer circumference of access port 110 by widening the gap 336 during placement. With the access port 110 disposed within adapter 330, and adapter 330 expanded in response, adapter 330 tends to bias the gap 336 toward a closed position, thus securing access port 110 in place. Insertion of the surgical access port 110 and adapter 530 into the tissue engaging member 150 and performing minimally invasive procedures proceeds in a manner described above with respect to the previous embodiments. Alternatively, tissue 14 WO 2013/009957 PCT/US2012/046411 engaging member 150 may be inserted into a layer of tissue 500 in conjunction with surgical access port 110 and adapter 330. [0043] Turning to FIG. 9, a top plan view of surgical access apparatus 300 is shown disposed in a layer of tissue 500. The relative positioning of the access port 110, adapter 330, and tissue engaging member 150 is shown. Further, with the access port 110 inserted into adapter 330, the secure engagement of the access port 110 and the adapter 330 is shown as the adapter 330 biases the gap 336 toward a closed position. [0044] In this way, an access port of standard size may be utilized through an opening in tissue or naturally occurring orifice that has a larger diameter than the surgical access port. It is contemplated that the surgical access port may be inserted into any of the above-described adapters before, during or after the adapter has already been positioned within an opening in tissue. Still further, with the adapter, the user may selectively increase the size of the opening during the course of the minimally invasive procedure (e.g., a surgeon may create an initial relatively small opening in tissue - such that the surgical access port is maintained in the opening without the adapter being used - and may later, if the surgeon decides that doing so is warranted, make a larger opening - such that the surgical access port is maintained in the opening with the adapter being present. This flexibility may enable a surgeon to minimize the size of the opening in tissue made during the surgical procedure, as the surgeon may wait to make a larger incision until after he or she has determined, using the initially smaller opening, to enlarge the opening based on his or her observations. It also enables the surgeon to utilize the same surgical access port regardless of the size of the opening and regardless of whether the surgeon elects to make an initially small opening in tissue or to make an initially larger opening, thereby eliminating the 15 WO 2013/009957 PCT/US2012/046411 need for different sized surgical access ports. It should be noted that these above-described benefits are applicable to all of the embodiments set forth herein. [0045] It will be understood that various modifications may be made to the embodiments disclosed herein. Therefore, the above description should not be construed as limiting, but merely as exemplifications of embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the present disclosure. 16

Claims (13)

1. A surgical access apparatus, comprising: a compressible access port having a proximal end, a distal end, an outer surface and defining at least one lumen therethrough, the lumen suitable for receiving and forming a substantially sealing engagement with a surgical object inserted therethrough; an adapter configured to be disposed on the outer surface of the compressible access port, the adapter being expandable between a compressed and an expended condition such that, when the adapter is in the compressed condition, the adapter and the compressible access port are collectively suitable for insertion into an incision through body tissue, and, when the adapter is in the expanded condition, the outer surface of the adapter expands so as to form a substantially sealing engagement with the incision.

2. The surgical access apparatus of claim 1, wherein the adapter is formed of a material that absorbs fluid, the adapter having a passage therethrough for receipt of the access port.

3. The surgical access apparatus of claim 2, wherein a substantially fluid-tight seal is formed between the access port and the adapter.

4. The surgical access apparatus of claim 1, wherein the proximal end and the distal end of the access port are each defined by a flange.

5. The surgical access apparatus of claim 4, wherein a proximal end and a distal end of the adapter engages the respective flanges. 17 WO 2013/009957 PCT/US2012/046411

6. The surgical access apparatus of claim 2, wherein the adapter exerts a compressive force on the access port.

7. The surgical access apparatus of claim 1, wherein the access port is formed of foam.

8. The surgical access apparatus of claim 7, wherein the transition of the access port from the first diameter to the second diameter forms a substantially fluid-tight seal with the layer of tissue.

9. The surgical access apparatus of claim 1, further comprising a tissue engaging member disposed around the perimeter of the incision through the layer of tissue.

10. The surgical access apparatus of claim 9, wherein the adapter forms a substantially fluid tight seal with the tissue engaging member and the tissue engaging member forms a substantially fluid-tight seal with the incision.

11. The surgical access apparatus of claim 1, wherein the tissue engaging member comprises a wound protector.

12. The surgical access apparatus of claim 11, wherein the wound protector includes at least one of a ring and a flange on its proximal and distal ends. 18 WO 2013/009957 PCT/US2012/046411

13. The surgical access apparatus of claim 11, wherein the wound protector includes a ring on its proximal end, the ring configured to be rolled so as to shorten a sleeve of the wound protector and thereby retract the incision. 19