Devices and methods for percutaneous surgery
First Claim
1. A device for use in percutaneous spinal surgery, comprising:
- an elongated cannula having a first inner diameter and an outer diameter sized for percutaneous introduction into a patient, said cannula further including a distal working end and an opposite proximal end, said cannula defining a working channel between said ends having a second diameter equal to said first inner diameter sized for receiving a tool therethrough; and
an elongated viewing element mounted inside said cannula adjacent said working channel, said viewing element having a first end connectable to a viewing apparatus and an opposite second end disposed adjacent said distal working end of said cannula.
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Accused Products
Abstract
Devices and methods for performing percutaneous spinal surgery under direct visualization and through a single cannula are shown. A device (10) is provided which includes an elongated cannula (20) having a first inner diameter (DI) and an outer diameter (DO) sized for percutaneous introduction into a patient. The cannula (20) defines a working channel (25) between its ends (21, 22) which has a second diameter (D2) equal to the diameter (DI) of the cannula sized for receiving a tool therethrough. An elongated viewing element (50) is engageable to the cannula (20) adjacent the working channel (25), preferably by a fixture (30). The fixture (30) includes a housing (31) attachable to the proximal end (22) of the cannula (20) that defines a working channel opening (35) which is in communication with the working channel (25). The housing (31) also defines an optics bore (60) adjacent the working channel opening (35). In certain embodiments, the fixture (30) supports the viewing element (50) for translation and/or rotation within the optics bore (60) along the longitudinal axis of the bore, and for rotation of the housing (31) relative to the cannula (20) so that the longitudinal axis of the optics bore (60) will rotate about the longitudinal axis of the working channel (25). Methods are also provided for performing spinal surgeries percutaneously with direct visualization and without the requirement for a fluid-maintained workspace.
446 Citations
66 Claims
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1. A device for use in percutaneous spinal surgery, comprising:
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an elongated cannula having a first inner diameter and an outer diameter sized for percutaneous introduction into a patient, said cannula further including a distal working end and an opposite proximal end, said cannula defining a working channel between said ends having a second diameter equal to said first inner diameter sized for receiving a tool therethrough; and
an elongated viewing element mounted inside said cannula adjacent said working channel, said viewing element having a first end connectable to a viewing apparatus and an opposite second end disposed adjacent said distal working end of said cannula. - View Dependent Claims (2, 3, 4, 5, 6, 7)
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8. A device for use in percutaneous spinal surgery, comprising:
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an elongated cannula sized for percutaneous introduction into a patient having a distal working end and an opposite proximal end and defining a working channel between said ends, said working channel having an inner diameter sized to receive a tool therethrough;
an elongated viewing device having a first end connectable to a viewing apparatus and a second end including a lens positionable adjacent said working end of said cannula; and
a fixture connected to said proximal end of said cannula adjacent to said working channel and defining an optics bore having a longitudinal axis, said optics bore sized to removably receive said elongated viewing device therethrough, and said fixture supporting said viewing device for movement within said optics bore along the longitudinal axis of said bore to extend or retract said lens relative to said distal working end of said cannula. - View Dependent Claims (9, 10, 11, 12, 13)
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14. A device for use in percutaneous spinal surgery, comprising:
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an elongated cannula having a distal working end and an opposite proximal end and defining a working channel between said ends, said working channel having an inner diameter sized to receive a tool therethrough;
an elongated viewing device having a first end connectable to a viewing apparatus and a second end including a lens positionable adjacent said working end of said cannula; and
a fixture connected to said proximal end of said cannula adjacent to said working channel and defining an optics bore having a longitudinal axis, said optics bore sized to removably receive said elongated viewing device therethrough, and said fixture supporting said viewing device for rotation within said optics bore about the longitudinal axis of said bore. - View Dependent Claims (15, 16, 17, 18, 19, 20)
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21. A device for use in percutaneous spinal surgery comprising:
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an elongated cannula having a distal working end and an opposite proximal end and defining a working channel between said ends, said working channel having a first longitudinal axis and ana inner diameter sized to receive a tool therethrough; and
a fixture mounted to said proximal end of said cannula, said fixture including a housing defining a working channel opening in communication with said working channel of said cannula and an optics bore for receiving an elongated viewing device therethrough in communication with said working channel, said optics bore having a second longitudinal axis substantially parallel to said first longitudinal axis, said housing being rotatable relative to said cannula so that said second longitudinal axis of said optics bore rotates about said first longitudinal axis of said working channel. - View Dependent Claims (22, 23, 24, 25, 26, 27, 28, 29, 30, 31)
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32. A device for supporting an elongated viewing device within a cannula defining a working channel, comprising:
a fixture mountable to said proximal end of the cannula, said fixture including a housing defining a working channel opening arranged to communicate with the working channel when said fixture is mounted to the cannula, said working channel opening sized to receive tools therethrough, and said housing further defining an optics bore for receiving an elongated viewing device therethrough and arranged so that the viewing device received within said optics bore will extend into the working channel of the cannula when said fixture is mounted to the cannula. - View Dependent Claims (33, 34, 35, 36, 37, 38, 39)
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40. A tissue retractor for use in percutaneous surgery through a cannula having an inner cylindrical surface, said retractor comprising:
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a working tip configured to atraumatically displace tissue as the retractor is manipulated through the tissue; and
a body having a proximal first end and a distal second end, said second end being integral with said working tip, said body having a convex surface configured to conform to the inner cylindrical surface of the cannula when said tissue retractor is disposed within the cannula, said body sized to be rotatable received within the cannula and having a length from a said first end to a said second end sufficient so that said first end and said working tip can be outside the cannula when said body is within the cannula. - View Dependent Claims (41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53)
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54. A tissue dilator, comprising:
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a sleeve having a tapered working end and an opposite end, said working end configured to displace tissue; and
a gripping portion on an outer surface of said sleeve adjacent said opposite end, said gripping portion defining a plurality of circumferential grooves configured for manually gripping the dilator to manipulate the dilator within tissue.
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55. A method for performing a surgical procedure at a location in a patient'"'"'s body, comprising:
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inserting a cannula into a patient through skin and tissue to create a working channel;
creating a working space in communication with the working channel and adjacent the location in the patient'"'"'s body;
inserting optics through the working channel to the working space;
extending a first tool through the working channel to the working space; and
manipulating the first tool through the working channel to perform a surgical procedure on the location in the working space under direct vision from the optics and without directing irrigation fluid to the location. - View Dependent Claims (56, 57, 58, 59)
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60. A method for performing a surgical procedure at a location on the spine, comprising:
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inserting a cannula into a patient through skin and tissue to create a working channel;
creating a working space in communication with the working channel and adjacent the location on the spine;
extending a tool through the working channel beyond the end of the working channel and manipulating the tool in the working space; and
extending optics through the working channel beyond the end of the working channel adjacent the working space to directly visualize the working space and manipulation of the tool.
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61. A method for performing a surgical procedure at a location on the spine, comprising:
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inserting a cannula into a patient through skin and tissue to create a working channel;
creating a working space in communication with the working channel and adjacent the location on the spine;
removably inserting a first tool through the working channel;
manipulating the first tool to perform a function at the location;
removably inserting a second tool through the working channel simultaneous with the first tool; and
manipulating the second tool to perform a function at the location. - View Dependent Claims (62)
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63. A method for performing a discectomy at a subject vertebral level on the spine, comprising:
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creating an incision in the skin substantially directly posterior to the subject vertebral level;
creating a bore through the lamina at a posterior medial position on the spine;
mounting a cannula through the incision at the bore in the lamina to create a working channel;
inserting optics through the cannula to directly visualize the location on the spine underneath the working channel;
extending a retractor through the working channel to retract tissue to create a path to the spinal disc;
extending the optics through the working channel an d path to the spinal disc; and
extending and manipulating discectomy instruments through the working channel to the disc to perform a discectomy under direct vision by the optics. - View Dependent Claims (64)
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65. A method for performing a laminectomy, comprising:
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creating an incision in the skin substantially directly posterior to the subject vertebral level;
inserting a cannula into the incision and through tissue to the lamina to define a working channel;
extending optics through the working channel to directly visualize the lamina; and
extending a bone cutting tool through the working channel and manipulating the tool to perform a laminectomy under direct vision from the optics.
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66. A method for implanting a vertebral fixation element, comprising:
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making an incision in the skin to provide access to the location on the vertebra at which the fixation element is to be implanted;
inserting a cannula into the incision and through tissue to the location to define a working channel;
inserting optics through the cannula to directly visualize the location;
extending an insertion tool supporting the vertebral fixation element through the working channel to the location under direct vision; and
manipulating the insertion tool to implant the fixation element at the location under direct vision from the optics.
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Specification