An instrument access device (1) comprises an instrument seal, a wound retractor for retracting a wound opening (2), and an opening element for at least partially opening the seal to facilitate insertion of an instrument (6) through the seal. The instrument seal comprises a gelatinous elastomeric seal (3) with a pinhole opening (4) extending therethrough, and a housing (5) around the seal (3). The opening element may be employed to at least partially open the pinhole opening (4) to facilitate insertion of the instrument (6) through the pinhole opening (4). The opening element comprises a sheet (11) of flexible material. The sheet (11) is movable distally relative to the seal (3) between a rest configuration and an opening configuration. In the rest configuration the sheet (11) is substantially planar. In the opening configuration, the pointed, the leading end (16) of the sheet (11) enters the pinhole opening (4) and moves distally through the pinhole opening (4) to at least partially open the pinhole opening (4).