Methods and devices for improving percutaneous access in minimally invasive surgeries

• US 20050065517A1
• Filed: 06/15/2004
• Published: 03/24/2005
• Est. Priority Date: 09/24/2003
• Status: Active Grant

• Current Assignee: Stryker European Operations Holdings, LLC (Stryker Corporation)
• Original Assignee: Stryker Spine
• Inventors: Chin, Kingsley Richard
• Granted Patent: US 7,955,355 B2
• Time in Patent Office: Days
• US Class Current: 606/86.A
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 17/708 with tubular extensions coaxially mounted on the bone anchors
• CPC Class Codes: A61B 17/7083 Tools for guidance or insertion of tethers, rod-to-anchor connectors, rod-to-rod connectors, or longitudinal elements
• CPC Class Codes: A61B 17/7085 for insertion of a longitudinal element down one or more hollow screw or hook extensions, i.e. at least a part of the element within an extension has a component of movement parallel to the extension's axis
• CPC Class Codes: A61B 17/7088 wherein the rod is moved transverse to the axis of the bone anchor
• CPC Class Codes: A61B 17/7089 wherein insertion is along an arcuate path
• CPC Class Codes: A61B 2017/3443 with means for adjusting the length of a cannula
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments
• CPC Class Codes: A61B 90/39 Markers, e.g. radio-opaque or breast lesions markers

Abstract

A device for use as a portal in percutaneous minimally invasive surgery performed within a patient'"'"'s body cavity includes a first elongated hollow tube having a length adjusted with a self-contained mechanism. The first elongated tube includes an inner hollow tube and an outer hollow tube and the inner tube is adapted to slide within the outer tube thereby providing the self-contained length adjusting mechanism. This length-adjustment feature is advantageous for percutaneous access surgery in any body cavity. Two or more elongated tubes with adjustable lengths can be placed into two or more adjacent body cavities, respectively. Paths are opened within the tissue areas between the two or more body cavities, and are used to transfer devices and tools between the adjacent body cavities. This system of two or more elongated tubes with adjustable lengths is particularly advantageous in percutaneous minimally invasive spinal surgeries, and provides the benefits of minimizing long incisions, recovery time and post-operative complications.

Claims

1. A device for use as a portal in percutaneous minimally invasive spinal surgery performed within a patient'"'"'s body cavity comprising:

a first elongated hollow tube having a proximal end and a distal end and defining a first working channel between said proximal end and said distal end when placed within said body cavity and wherein said first tube comprises a mechanism for adjusting said first tube length within said body cavity, while maintaining a constant tube length outside said body cavity.

2. The device of claim 1 wherein said first tube comprises an outer hollow tube and an inner hollow tube placed concentric with said outer hollow tube and wherein said inner hollow tube is adapted to slide within the outer hollow tube thereby providing said mechanism for adjusting said first tube length within said body cavity.

3. The device of claim 2 wherein said inner hollow tube comprises an outer surface having at least one elongated groove extending along a length segment of said outer surface, wherein said outer hollow tube comprises an inner surface having at least one elongated appendage extending along a length segment of said inner surface, and wherein said appendage is adapted to slide within said groove thereby providing said mechanism for adjusting said first tube length.

4. The device of claim 2 wherein said inner hollow tube comprises an outer surface having at least one elongated appendage extending along a length segment of said outer surface, wherein said outer hollow tube comprises an inner surface having at least one elongated groove extending along a length segment of said inner surface, and wherein said appendage is adapted to slide within said groove thereby providing said mechanism for adjusting said first tube length.

5. The device of claim 1 wherein said first tube comprises an inner hollow tube having an outer cylindrical surface comprising a first set of helical threads and an outer hollow tube having an inner cylindrical surface comprising a second set of helical threads and wherein said outer hollow tube is adapted to rotate around said inner hollow tube while engaging said second set of helical threads with said first set of helical threads, thereby causing said inner hollow tube to move longitudinally relative to said outer hollow tube, thereby providing said mechanism for adjusting said first tube length.

6. The device of claim 2 wherein said inner hollow tube comprises a first slot opening extending the entire width of said inner hollow tube, said outer tube comprises a second slot opening extending the entire width of said outer hollow tube and wherein said first slot opening is aligned with said second slot opening when said inner hollow tube is assembled within said outer hollow tube, thereby forming a continuous opening extending the entire width of said first tube.

7. The device of claim 1 wherein said first tube further comprises a second hollow tube extending from a side opening of said first tube located outside said body cavity and forming a second working channel and wherein said second working channel is in communication with said first working channel.

8. The device of claim 7 wherein said first and second tubes are sized for delivering objects to a pathology location within said body cavity and wherein said objects are selected from a group consisting of carrier devices, surgical instruments, medical devices, fixation devices, vertebral disc replacement devices, interbody devices, fixation tools, connecting devices, connecting tools, tissue, grafting material, and illumination devices.

9. The device of claim 8 wherein said surgical instruments are selected from a group consisting of scissors, scalpels, saws, drills, tissue dilators, biting and grabbing instruments, curettes, knot tying, and cautery.

10. The device of claim 8 wherein said fixation devices are selected from a group consisting of screws, hooks, loops, pins, nuts, washers, wires, sutures, and staples.

11. The device of claim 8 wherein said fixation tools are selected from a group consisting of screw drivers, pushers, holders, wrenches, staplers, and knot tiers.

12. The device of claim 8 wherein said connecting devices are selected from a group consisting of plates, rods, wires, vertebral disc replacements, interbody fusion devices, and articulating versions thereof.

13. The device of claim 8 wherein said illumination devices are selected from a group consisting of light sources, fiber optic cables, infrared detectors, magnification devices, and microscopes.

14. The device of claim 1 wherein said first tube comprises a mechanism for engaging and disengaging a fixation device.

15. The device of claim 14 wherein said first tube comprises a slot at said distal end and wherein said slot is sized for engaging and disengaging an appendage of said fixation device thereby engaging said fixation device and securing said fixation device to said first tube through a clockwise rotation around a longitudinal axis of said first working channel, and disengaging said fixation device and removing said fixation device from said first tube by performing a counter-clock-wise rotation around said longitudinal axis, respectively.

16. The device of claim 1 wherein said first elongated hollow tube comprises a length measuring scale on an outer surface of said first tube.

17. The device of claim 6 wherein said continuous opening is sized for delivering objects from said first working channel of said first elongated tube to a first working channel of a second elongated hollow tube located adjacent to said first elongated hollow tube.

18. The device of claim 17 wherein said objects are selected from a group consisting of surgical equipment, medical devices, intervertebral disc replacement devices, interbody fusion devices, fixation devices, fixation tools, carrier devices, connecting devices, connecting tools, tissue, grafting material, and illumination devices.

19. The device of claim 18 wherein said carrier devices comprise a material selected from a group consisting of flexible, malleable, rigid and materials expandable at body temperature.

20. The device of claim 2 wherein any of said hollow tubes comprises a taper along its length.

21. The device of claim 2 wherein said inner hollow tube is adapted to slide within a space formed between an inner cylindrical wall and an inner planar wall of said outer hollow tube.

22. The device of claim 2 wherein said inner hollow tube is adapted to slide within a space formed between an inner cylindrical wall of said outer tube and an outer cylindrical wall of a second hollow tube placed concentric with said inner and outer hollow tubes.

46. The device of claim 1 wherein said first tube comprises a material selected from a group consisting of flexible, malleable, semi rigid, and rigid materials.

47. The device of claim 3 wherein said groove ends prior to reaching a top end of said outer surface of said inner hollow tube.

48. The device of claim 3 wherein said inner hollow tube comprises a lip at a top edge of said inner hollow tube and said outer hollow tube comprises a ledge at a bottom edge of said outer hollow tube and wherein said lip provides a stop against said ledge.

23. A system for use in percutaneous minimally invasive spinal surgery comprising:

two or more elongated hollow tubes placed within two or more adjacent body cavities of a patient, respectively, and wherein each of said two or more hollow tubes comprises a proximal end and a distal end defining a first working channel between said proximal end and said distal end and wherein at least one of said two or more hollow tubes comprises a mechanism for adjusting the length of said at least one hollow tube within the respective body cavity, while maintaining a constant length outside the respective body cavity.

24. The system of claim 23 wherein said two or more hollow tubes define two or more first working channels, respectively and wherein said two or more hollow tubes comprise two or more side openings, respectively, located within said two or more adjacent body cavities, respectively, and extending the entire width of said two or more tubes, respectively, and wherein said two or more side openings are aligned with each other and are sized for allowing delivering of objects between said two or more hollow tubes.

25. The system of claim 24 wherein said objects are selected from a group consisting of surgical equipment, medical devices, intervertebral disc replacement devices, interbody fusion devices, fixation devices, fixation tools, carrier devices, connecting devices, connecting tools, tissue, grafting material, and illumination devices.

26. The system of claim 23 further comprising visualization of said two or more hollow tubes.

27. A method for performing percutaneous minimally invasive spinal surgery on a patient comprising:

making a first incision on a first location of said patient'"'"'s skin;

advancing a first guide wire through said first incision, through tissue underlying said first location and into a first underlying bone;

forming said first body cavity around said first guide wire; and

inserting a first elongated hollow tube within a first body cavity of said patient, wherein said first tube has a proximal end and a distal end and defining a first working channel between said proximal end and said distal end and wherein said first tube comprises a mechanism for adjusting said first tube length within said first body cavity, while maintaining a constant length outside said first body cavity.

28. The method of claim 27 wherein said first body cavity is formed by advancing a tissue dilator over said first guide wire.

29. The method of claim 30 further comprising:

engaging a fixation device to said distal end of said first tube before inserting said first tube into said first body cavity;

attaching said fixation device to a first bone within said first body cavity after inserting said first tube into said first body cavity; and

disengaging said fixation device from said distal end of said first tube.

30. The method of claim 27 wherein said first tube comprises an inner hollow tube and an outer hollow tube and wherein said inner hollow tube is adapted to slide within the outer hollow tube thereby providing said mechanism for adjusting said first tube length.

31. The method of claim 27 further comprising inserting a cutting tool into said first tube and incising tissue around said first body cavity.

32. The method of claim 31 wherein said first tube comprises a first opening extending the entire width of said first tube and being located in a portion of said first tube within said first body cavity and wherein said cutting tool is used to incise said tissue around said first body cavity through said first opening.

33. The method of claim 27 further comprising:

making a second incision on a second location adjacent to said first location of said patient'"'"'s skin;

advancing a second guide wire through said second incision, through tissue underlying said second location and into a second underlying bone;

forming a second body cavity around said second guide wire;

inserting a second elongated hollow tube within said second body cavity, wherein said second tube has a proximal end and a distal end and defining a second working channel between said proximal end and said distal end and wherein said second tube comprises a mechanism for adjusting said second tube length within said second body cavity.

34. The method of claim 33 further comprising:

incising tissue between said first body cavity and said second body cavity, thereby forming a path extending from said first body cavity to said second body cavity;

inserting a connecting device into said first tube; and

transferring said connecting device from said first tube to said second tube through said path.

35. The method of claim 34 further comprising:

attaching a first end of said connecting device to a first bone within said first body cavity via a first fixation device; and

attaching a second end of said connecting device to a second bone within said second body cavity via a second fixation device.

36. The method of claim 35 wherein said first bone within said first body cavity comprises a first vertebra, and said second bone within said second body cavity comprises a second vertebra.

37. The method of claim 35 wherein said first and second fixation devices are selected from a group consisting of screws, hooks, loops, pins, nuts, washers, wires, sutures, and staples.

38. The method of claim 35 wherein said connecting device is selected from a group consisting of plates, rods, wires and articulating versions thereof.

39. The method of claim 34 wherein said tissue between said first and said second body cavities comprises a lumbodorsal fascia and said path is located either above or below said lumbodorsal fascia.

40. The method of claim 33 wherein said first and second tubes are sized for delivering objects to first and second locations within said first and second body cavities, respectively, and said objects are selected from a group consisting of carrier devices, surgical instruments, fixation devices, fixation tools, connecting devices, connecting tools, tissue, grafting material, and illumination devices.

41. The method of claim 33 further comprising visualizing said first and second working channels.

42. The method of claim 35 further comprising inserting additional elongated tubes within additional body cavities of said patient, respectively, and wherein said additional body cavities are adjacent to said first and second body cavities.

43. The method of claim 34 further comprising removing said first and second tubes from said first and second body cavities and closing said first and said second incisions.

44. The method of claim 33 wherein said connecting device is transferred within a carrier device and wherein said carrier device comprises a material selected from a group consisting of flexible, malleable, rigid and materials expandable at body temperature.

45. The method of claim 44 wherein said carrier device comprises a boat-shaped body with a closed front end.