Trajectory guide with angled or patterned lumens or height adjustment

• US 20040167543A1
• Filed: 02/20/2003
• Published: 08/26/2004
• Est. Priority Date: 02/20/2003
• Status: Active Grant

• Current Assignee: University of South Florida (State University System of Florida)
• Original Assignee: University of South Florida (State University System of Florida)
• Inventors: Freeman, Thomas B., Solar, Matthew S., Mazzocchi, Rudy A.
• Granted Patent: US 7,896,889 B2
• Time in Patent Office: Days
• US Class Current: 606/130
• CPC Class Codes: A61B 17/3462 with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals expandable cannulas A61B17/3417
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments
• CPC Class Codes: A61B 2017/3449 whereby the instrument channels merge into one single channel
• CPC Class Codes: A61B 2017/3466 for simultaneous sealing of multiple instruments
• CPC Class Codes: A61B 90/11 with guides for needles or instruments, e.g. arcuate slides or ball joints

Abstract

This document discusses trajectory guides that include an instrument guide with at least one lumen angled with respect to an orthogonal or other through-axis. In one example, patterned lumens on the instrument guide provide a mirror image pattern of trajectory axes intersecting a target plane. In another example, height adjustment of the instrument guide extends these or other targeting techniques to a three-dimensional volume. This document also describes a method of manufacturing such an instrument guide, which is also applicable to manufacturing an instrument guide providing parallel lumens.

Claims

1. An apparatus comprising:

a base, sized and shaped to be secured in or about an entry portal in a subject that includes a target within the subject beyond the entry portal, the entry portal defining an entry plane, and the target defining a target plane that is substantially parallel to the entry plane; and

an instrument guide, coupled to the base and configured to be oriented with respect to the base to define a first axis extending through the instrument guide and the entry portal toward the target, the instrument guide including a second lumen extending through the instrument guide to define a second axis nonparallel to the first axis.

2. The apparatus of claim 1, further comprising a first lumen extending through the instrument guide coaxially to the first axis.

3. The apparatus of claim 2, in which the instrument guide includes an outer surface, distal from the entry portal, the first and second lumens extending through the surface, the surface shaped such that a distance along the first lumen between the surface and the target plane is substantially equal to a distance along the second lumen between the surface and the target plane.

4. The apparatus of claim 1, in which the first and second axes define a first plane and the second axis is angled at a first angle, in the first plane, with respect to the first axis, and in which the first and second axes are configured to intersect in the subject at or beyond the entry portal.

5. The apparatus of claim 1, in which a first angle between the first and second axes is selected at a predetermined value to provide a predetermined offset distance between intersection points of the first and second axes with a range plane, located beyond the entry portal, that is substantially orthogonal to the first axis.

6. The apparatus of claim 5, in which the apparatus includes an adjustable coupling of the instrument guide and the base, the coupling configured to position the instrument guide at an adjustable height above the entry portal.

7. The apparatus of claim 6, in which the adjustable coupling is configured to position the instrument guide at a height above the entry portal that obtains intersection of at least a portion of the target by the range plane.

8. The apparatus of claim 5, in which the predetermined offset distance exceeds a radius of the entry portal.

9. The apparatus of claim 1, in which the apparatus includes an adjustable coupling of the instrument guide and the base, the coupling configured to position the instrument guide at an adjustable height above the entry portal.

10. The apparatus of claim 9, in which the adjustable coupling includes a threaded coupling.

11. The apparatus of claim 9, in which the adjustable coupling includes a sleeve on the instrument guide that is received in a collar on the base.

12. The apparatus of claim 1, in which the instrument guide includes a plurality of lumens through the instrument guide, the plurality of lumens configured to define corresponding axes passing through the entry portal, at least one of the axes being nonparallel to another of the axes.

13. The apparatus of claim 12, in which the axes corresponding to the plurality of lumens intersect a range plane beyond the entry portal, the range plane being substantially orthogonal to the first axis, and intersection points with the range plane of the axes corresponding to the lumens forming a scaled mirror image of intersection points between the axes and a plane through the instrument guide that is orthogonal to the first axis.

14. The apparatus of claim 13, in which the axes corresponding to the plurality of lumens are configured to substantially intersect about a single point in the subject adjacent to the entry portal.

15. The apparatus of claim 13, in which the apparatus includes a visualization portal configured to allow a user to view an instrument being inserted through at least one of the plurality of lumens into the subject.

16. The apparatus of claim 1, in which the instrument guide is rotatably coupled to the base to allow rotation of the instrument guide, with respect to the base, about the first axis when the instrument guide is oriented such that the first axis is orthogonal to the entry plane.

17. The apparatus of claim 16, in which at least one of the instrument guide and the base includes visual indicia providing information about a degree of rotation of the instrument guide with respect to the base.

18. The apparatus of claim 1, in which the base and the instrument guide are integrally formed of a customized fixed size and shape that is tailored to orient the first axis toward the target within the subject.

19. The apparatus of claim 1, in which the base and the instrument guide are adjustably coupled together to adjustably orient the first axis toward the target within the subject.

20. The apparatus of claim 19, further including a ball-and-socket adjustable coupling between the base and the instrument guide.

21. The apparatus of claim 19, in which the base and the instrument guide are adjustably coupled using at least one of:

a rotational coupling that allows rotation of the instrument guide about an axis that is substantially orthogonal to the entry portal; and

a saddle coupling that allows adjustment of an angle between the first axis and the axis that is substantially orthogonal to the entry portal.

22. The apparatus of claim 1, in which the base includes a viewing portal through which the entry portal is visible.

23. A method comprising:

securing a position of an instrument guide with respect to an entry portal in a subject to obtain a first axis that passes substantially through a center of the entry portal toward a target in the subject; and

providing a second trajectory through the instrument guide along a second axis directed through the entry portal, to obtain a nonzero first angle between the first and second axes.

24. The method of claim 23, further comprising providing a first trajectory through the instrument guide along the first axis.

25. The method of claim 23, wherein the providing the second trajectory includes locating the second axis such that the first and second axes intersect at a point, within the subject, that is located at or beyond the entry portal.

26. The method of claim 23, in which the providing the second trajectory includes selecting the first angle to provide a predetermined offset distance between intersection points of the first and second axes with a range plane, beyond the entry portal, that is substantially orthogonal to the first axis.

27. The method of claim 26, in which the predetermined offset distance exceeds a radius of the entry portal.

28. The method of claim 26, further comprising adjusting a height between the instrument guide and the entry portal to adjust a distance between the entry portal and the range plane corresponding to the predetermined offset distance.

29. The method of claim 23, further comprising providing a plurality of different trajectories through the instrument guide along corresponding axes intersecting a range plane beyond the entry portal, the range plane being substantially orthogonal to the first axis, the intersection points with the range plane of the axes of the trajectories forming a scaled mirror image of intersection points between the axes of the trajectories and a plane through the instrument guide that is orthogonal to the first axis.

30. The method of claim 29, comprising providing the trajectories along corresponding axes that substantially intersect about a single point in the subject adjacent to the entry portal.

31. The method of claim 29, comprising providing access for viewing an entry point of instrument being inserted along one of the trajectories into the subject.

32. The method of claim 23, further comprising rotating the instrument guide, with respect to the entry portal, about the first axis, to obtain a desired orientation of the instrument guide with respect to the entry portal.

33. The method of claim 31, further comprising viewing visual indicia associated with at least one of the instrument guide and a base in determining a degree of rotation of the instrument.

34. The method of claim 23, in which the securing the position includes providing a base carrying the instrument guide.

35. The method of claim 34, further including tailoring at least one of a size and a shape of at least one of the base and the instrument guide to orient the first axis toward the target within the subject upon securing the base about the entry portal.

36. The method of claim 35, in which the tailoring includes adjusting a height of the instrument guide with respect to the entry portal.

37. The method of claim 34, further including adjusting a coupling between the base and the instrument guide to adjustably orient the first axis toward the target within the subject.

38. A method comprising:

securing a position of an instrument guide with respect to an entry portal in a subject to obtain a first trajectory along a first axis that passes through a first access point on an outer surface of the instrument guide and passes substantially through a center of the entry portal toward a target in the subject, the first axis defining a range plane that is orthogonal to the first axis at a first range point on the first axis that is within the subject beyond the entry portal, the first axis also defining a first distance between the first access point and the first range point; and

providing a second trajectory through the instrument guide along a second axis that passes through a second access point on the outer surface of the instrument guide and through the entry portal, to obtain a nonzero first angle between the first and second axes, and to obtain a second distance between the second access point and a second range point at an intersection between the second access and the range plane, wherein the second distance is equal to the first distance.

39. A method comprising:

disposing at least one tube in a desired orientation within at least a portion of a bushing;

introducing a flowable hardening agent about the tube within at least a portion of the bushing; and

allowing the agent to harden.

40. The method of claim 39, in which the disposing at least one tube comprises:

disposing at least one pin in the desired orientation within at least a portion of the bushing; and

placing at least one tube over the respective at least one pin.

41. The method of claim 40, further including removing the at least one pin after allowing the agent to harden.

42. The method of claim 39, in which the allowing the agent to harden includes allowing the agent to harden into a plug that includes the at least one tube, wherein the plug is configured to be used as an instrument guide for providing a trajectory for an instrument in a medical procedure.