Arthroscopic retractor and method of using the same

• US 5,197,971 A
• Filed: 12/18/1990
• Issued: 03/30/1993
• Est. Priority Date: 03/02/1990
• Status: Expired due to Term

• Current Assignee: General Surgical Innovations Incorporated (Johnson Controls International plc)
• Original Assignee: Peter M. Bonutti
• Inventors: Bonutti, Peter M.
• Primary Examiner(s): Thaler, Michael H.
• Application Number:
  US07/631,740
• Time in Patent Office: 833 Days
• Field of Search: 606/198, 606/194, 606/192, 604/106-109, 604/104, 604/105, 604/96
• US Class Current: 606/192
• CPC Class Codes: A61B 17/02 for holding wounds open; Tractors specula A61B1/32 ; drainage appliances for wounds A61M27/00
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/320036 adapted for use within the carpal tunnel
• CPC Class Codes: A61B 17/320725 with radially expandable cutting or abrading elements A61B17/32075 takes precedence
• CPC Class Codes: A61B 17/3417 Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating syringe needles A61M5/32; dilators A61M29/00
• CPC Class Codes: A61B 2017/00535 pneumatically or hydraulically operated A61B2017/22051, A61B2090/401 take precedence
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/00986 Malecots, e.g. slotted tubes, of which the distal end is pulled to deflect side struts
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61B 2017/320048 Balloon dissectors
• CPC Class Codes: A61B 2017/3484 Anchoring means, e.g. spreading-out umbrella-like structure
• CPC Class Codes: A61B 2090/062 penetration depth
• CPC Class Codes: A61M 2025/006 having a special surface topography or special surface properties, e.g. roughened or knurled surface
• CPC Class Codes: A61M 25/1002 characterised by balloon shape A61M25/1006, A61M25/1009 take precedence

Abstract

A retractor for use in arthroscopic surgery. The retractor has a mechanical expanding portion for expanding against sub-surface tissues when the retractor is in use. The retractor also has a fluid-operated expanding portion, which may be independently controllable, for expanding against sub-surface tissues when the retractor is in use. The retractor is inserted through a small percutaneous opening, expanded in sub-surface tissues without significantly damaging the tissue, then collapsed after use for removal. The retractor can be manipulated to allow the surgeon to push or pull or lever on tissue. The retractor can be hollow like a cannula to permit the passage of one or more surgical devices through the retractor, with a side portal into the center of the retractor.

Claims

1. An expandable cannula for moving tissue such as bone, cartilage, tendon, and/or muscle to create an actual space within such tissue at a location, not within a normal body cavity such as inside an artery or vein, and not inside an existing body passage such as an alimentary passage, said cannula comprising:

a rigid longitudinally extending tubular body member having a rigid tubular wall with an outer cylindrical surface and an inner cylindrical surface,

said inner cylindrical surface defining a central instrument passage extending longitudinally through the entire length of said body member,

said tubular body member having proximal and distal ends defining the proximal and distal termini of the central instrument passage,

the central instrument passage having a diameter sufficiently large to receive therethrough surgical instruments of the type commonly used in endoscopic surgery, such instruments including but not limited to endoscopes, drills, reamers and other surgical instruments commonly used in arthroscopic surgery of joints such as a knee joint or a shoulder joint,

said tubular body member being strong and rigid enough to move tissue such as bone, cartilage, tendon, and/or muscle to create an actual space within such tissue both when (i) said expandable cannula is first inserted into such tissue and when (ii) said expandable cannula is already inserted into and is being moved around in the tissue such as bone, cartilage, tendon, and/or muscle by a surgeon using said expandable cannula during endoscopic surgery or arthroscopic surgery,

said expandable cannula including a sleeve member circumscribing said tubular body member, said sleeve member including a mechanical expanding portion intermediate said proximal and distal ends of said tubular body member and capable of expanding radially outwardly against tissue such as bone, cartilage, tendon, and/or muscle tissues and move such tissue away from the central instrument passage when said retractor is in use, to create an actual space therein; and

said sleeve member including a fluid-operated expanding portion intermediate said proximal and distal ends of said tubular body member and capable of expanding radially outwardly against tissue such as bone, cartilage, tendon, and/or muscle tissues and move such tissue away from the central instrument passage when said retractor is in use, to create an actual space therein;

said mechanical expanding portion being axially co-extensive with said fluid-operated expanding portion.

2. An expandable cannula as set forth in claim 1 including means for expanding said mechanical expanding portion independently of fluid-operated expansion of said fluid-operated expanding portion, and means for expanding said fluid-operated expanding portion independently of mechanical expansion of said mechanical expanding portion, whereby said mechanical expanding portion is expandable independently of said fluid-operated expanding portion.

3. An expandable cannula as set forth in claim 1 wherein said mechanical expanding portion and said fluid-operated expanding portion are disposed at the distal end of said tubular body member for expansion at the distal end of said tubular body member.

4. An expandable cannula as set forth in claim 1 wherein said sleeve member includes a plurality of longitudinally extending strips which buckle radially outwardly upon axial compression of said strips, said strips forming said mechanical expanding portion of said expandable cannula, said expandable cannula including an axially movable member for compressing said strips of said sleeve member axially to buckle said strips radially outwardly to move tissue such as bone, cartilage, tendon, and/or muscle radially outwardly away from the central instrument passage.

5. An expandable cannula as set forth in claim 1 wherein said fluid-operated expanding portion comprises a bladder disposed radially outwardly of and circumscribing said mechanical expanding portion, said bladder being inflatable radially outwardly to move tissue such as bone, cartilage, tendon, and/or muscle radially outwardly away from the central instrument passage.

6. An expandable cannula as set forth in claim 1 including a handle portion extending proximally from said mechanical expanding portion for grasping by a surgeon manipulating said expandable cannula when said expandable cannula is in use, said expandable cannula being substantially rigid enough over its entire length such that movement of said handle portion of said cannula results in corresponding movement of said tubular body member of said cannula.

7. A method comprising the steps of:

providing an expandable cannula comprising;

a rigid longitudinally extending tubular body member having a rigid tubular wall with an outer cylindrical surface and an inner cylindrical surface, the inner cylindrical surface defining a central instrument passage extending longitudinally through the entire length of the body member, the tubular body member having proximal and distal ends defining the proximal and distal termini of the central instrument passage,

the central instrument passage having a diameter sufficiently large to receive therethrough surgical instruments of the type commonly used in endoscopic surgery, such instruments including but not limited to endoscopes, drills, reamers and other surgical instruments commonly used in arthroscopic surgery of joints such as a knee joint or a shoulder joint,

the tubular body member being strong and rigid enough to move tissue such as bone, cartilage, tendon, and/or muscle to create and actual space within such tissue both when (i) the expandable cannula is first inserted into such tissue and when (ii) the expandable cannula is already inserted into and is being moved around in the tissue such as bone, cartilage, tendon, and/or muscle by a surgeon using the expandable cannula during endoscopic surgery or arthroscopic surgery,

the expandable cannula including a sleeve member circumscribing the tubular body member, the sleeve member including a mechanical expanding portion intermediate the proximal and distal ends of the tubular body member and capable of expanding radially outwardly against bone, cartilage, tendon, and/or muscle tissue tissues and move such tissue away from the central instrument passage when the retractor is in use, to create an actual space therein; and

the sleeve member including a fluid-operated expanding portion intermediate the proximal and distal ends of the tubular body member and capable of expanding radially outwardly against tissue such as bone, cartilage, tendon, and/or muscle tissues and move such tissue away from the central instrument passage when the retractor is in use, to create and actual space therein, the mechanical expanding portion being axially co-extensive with the fluid-operated expanding portion;

inserting the expandable cannula into tissue such as bone, cartilage, tendon, and/or muscle; and

expanding the cannula to create an actual space within such tissue at a location not within a normal body cavity such as inside an artery or vein, and not inside an existing body passage such as a urinary passage or an alimentary passage.

8. A method as set forth in claim 7 wherein said expanding step includes expanding the mechanical expanding portion independently of the fluid-operated expanding portion.

9. A method as set forth in claim 7 wherein said expanding step includes expanding the cannula at the distal end of the tubular body member.

10. A method as set forth in claim 7 wherein the expandable cannula includes a handle portion extending proximally from the mechanical expanding portion for grasping by a surgeon manipulating the expandable cannula when the expandable cannula is in use such that movement of the handle portion of the cannula results in corresponding movement of the tubular body member of the cannula.