Arthroscopic retractors and method of using the same

• US 5,716,325 A
• Filed: 08/01/1994
• Issued: 02/10/1998
• Est. Priority Date: 03/02/1990
• Status: Expired due to Term

• Current Assignee: General Surgical Innovations Incorporated (Johnson Controls International plc)
• Original Assignee: General Surgical Innovations Incorporated (Johnson Controls International plc)
• Inventors: Bonutti, Peter M.
• Primary Examiner(s): Thaler, Michael H.
• Application Number:
  US08/283,997
• Time in Patent Office: 1,289 Days
• Field of Search: 128/20, 606/198, 606/192, 604/96, 604/105-109, 604/101, 604/102, 600/104, 600/105, 600/106, 600/107, 600/108, 600/115, 600/116, 600/153, 600/204, 600/207
• US Class Current: 600/204
• 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 2017/00539 hydraulically
• 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. A retractor suitable for moving or retracting tissue in arthroscopic surgery and removable thereafter without significantly damaging the moved or retracted tissue, said retractor having a distal end and a proximal end, said retractor comprising:

a mechanical expanding portion for expanding against sub-surface tissues when said retractor is in use, said mechanical expanding portion comprising a plurality of substantially rigid arms;

a fluid-operated expanding portion adjacent to said mechanical expanding portion for expanding against sub-surface tissues when said retractor is in use; and

a third portion extending proximally from said mechanical expanding portion for manipulating said retractor when said retractor is in use, said third portion having a passage adapted to receive an instrument during surgery and a side opening in communication with said passage to permit said instrument to access sub-surface tissues which are radially adjacent to said third portion of said retractor, wherein said side opening extends farther from the distal end of the retractor than the mechanical expanding portion.

2. A method of displacing tissue layers comprising the steps of providing a retractor having a proximal end portion and a distal end portion which is expandable between a contracted condition and an expanded condition, inserting the retractor into body tissue with the distal end portion of the retractor leading and with the distal end portion of the retractor in the contracted condition, and expanding the distal end portion of the retractor from the retracted condition to the expanded condition with the distal end portion of the retractor in the body tissue, said step of expanding the distal end portion of the retractor including moving a plurality of arms disposed adjacent to a distal end of the retractor from a retracted condition to an extended condition in which distal and proximal portions of the arms extend outward to spaced apart connector portions of the arms, leaving space between connector portions of first and second arms of the plurality of arms open to body tissue, and blocking space between connector portions of the second arm and a third arm of the plurality of arms to body tissue by inflating an inflatable barrier.

3. A method as set forth in claim 2, wherein said step of expanding the distal end portion of the retractor further includes blocking space between connector portions of the first arm and a fourth arm of the plurality of arms to body tissue.

4. A method as set forth in claim 2, further comprising the steps of:

moving an end portion of an instrument through a passage in the retractor; and

engaging the body tissue with the end portion of the instrument at a location between the connector portions of the first and second arms while blocking space between connector portions of the second and third arms with the inflatable barrier.

5. A method as set forth in claim 2, wherein said step of expanding the distal end portion of the retractor includes moving a second plurality of arms which are spaced from the plurality of arms disposed adjacent to a distal end of the retractor from a retracted condition to an extended condition in which distal and proximal portions of the arms of the second plurality of arms extend outward to spaced apart connector portions of the arms of the second plurality of arms, leaving space between connector portions of first and second arms of the second plurality of arms open to body tissue, and blocking space between connector portions of the second arm of the second plurality of arms and a third arm of the second plurality of arms to body tissue by inflating a second inflatable barrier.

6. A method as set forth in claim 5, further including moving an end portion of an instrument along a longitudinal central axis of the retractor from the proximal end portion of the retractor to a location disposed between the plurality of arms disposed adjacent to the distal end of the retractor and the second plurality of arms, and moving the end portion of the instrument into engagement with body tissue at the location disposed between the plurality of arms disposed adjacent to the distal end of the retractor and the second plurality of arms.

7. A method comprising the steps of:

providing a retractor having a proximal end portion, a distal end portion, and an intermediate portion interconnecting said proximal and distal end portions, said distal end portion having an expansible member which is expandable between a contracted condition and an expanded condition, said intermediate portion having a passage adapted to receive an instrument during surgery and a side opening in communication with said passage to permit said instrument to access body tissue which is radially adjacent to said intermediate portion of said retractor, wherein said opening extends farther from the distal end of the retractor than the expansible member;

inserting the retractor into body tissue with the distal end portion of the retractor leading and with the distal end portion of the retractor in the contracted condition;

expanding the expansible member of the retractor from the contracted condition to the expanded condition with the distal end portion of the retractor in the body tissue, said step of expanding the expansible member of the retractor including moving a plurality of arms from a retracted condition to an extended condition in which distal and proximal portions of the arms extend outward to spaced apart connector portions of the arms, and blocking movement of body tissue into space between connector portions of adjacent arms by inflating an inflatable barrier to move at least a portion of the barrier into space between connector portions of adjacent arms; and

deploying said instrument to perform a procedure on body tissue disposed adjacent to said opening on said intermediate portion.

8. A method as set forth in claim 7, wherein said step of moving a plurality of arms from the retracted condition to the extended condition is performed under the influence of force applied to the proximal end portion of the retractor and conducted through a rigid portion of the retractor to the plurality of arms.

9. A method as set forth in claim 7, wherein said step of moving a plurality of arms from the retracted condition to the extended condition is performed independently of performance of said step of inflating an inflatable barrier.

10. A method as set forth in claim 7, wherein said step of inflating an inflatable barrier is ineffective to block space between connector portions of some of said arms of said plurality of arms.

11. A method comprising the steps of providing a retractor having a proximal end portion and a distal end portion which is expandable between a contracted condition and an expanded condition, inserting the retractor into body tissue with the distal end portion of the retractor leading and with the distal end portion of the retractor in the contracted condition, and expanding the distal end portion of the retractor from the retracted condition to the expanded condition with the distal end portion of the retractor in the body tissue, said step of expanding the distal end portion of the retractor including moving a plurality of arms from a retracted condition to an extended conditioning with distal and proximal portions of the arms extending outward to spaced apart connector portions of the arms, and blocking space between connector portions of some of the arms to body tissue by inflating an inflatable barrier while leaving space between connector portions of other arms of the plurality of arms open to body tissue.

12. A method as set forth in claim 11, wherein said step of moving a plurality of arms from a retracted condition to an extended condition includes moving the plurality of arms to an extended condition in which the connector portions of the arms are disposed in a circular array, said step of blocking space between connector portions of some of the arms to body tissue includes blocking space along a majority of a circumference of the circular array of connector portions.

13. A method as set forth in claim 11, wherein said step of moving a plurality of arms from a retracted condition to the extended condition includes moving the plurality of arms to an extended condition in which connector portions of first and second arms of the plurality of arms are spaced apart by a first arcuate distance as measured along the circumference of a circle having a center disposed on a longitudinal central axis of the retractor, said step of blocking space between connector portions of some of the arms to body tissue by inflating an inflatable barrier includes blocking space between connector portions which define a second arcuate distance as measured along the circumference of the circle having a center disposed on a longitudinal central axis of the retractor, the second arcuate distance being greater than the first arcuate distance.

14. A method as set forth in claim 11, wherein said step of inflating an inflatable barrier includes inflating an inflatable barrier having a first segment which is disposed between first and second arms of the plurality of arms and a second segment which is disposed between third and fourth arms of the plurality of arms.

15. A retractor for moving body tissue to facilitate arthroscopic surgery and removable thereafter without significantly damaging the moved tissue, said retractor comprising a body portion having a distal end portion, a proximal end portion, and an intermediate portion disposed between said proximal and distal end portions, and a tubular sleeve at least partially enclosing said body portion, said sleeve having a distal end portion disposed adjacent to said distal end portion of said body portion, said sleeve having a proximal end portion disposed adjacent to said proximal end portion of said body portion, said sleeve having an intermediate portion disposed between said distal and proximal end portions of said sleeve, said distal end portion of said sleeve including a plurality of arms, each of said arms including a distal portion and a proximal portion which are connected with the intermediate portion of said sleeve, said distal and proximal portions of said arms being interconnected by resiliently deflectable connector portions, said arms being movable from a retracted condition to an extended condition by deflection of at least said connector portions of said arms, said distal portions of said arms being spaced apart by distance which increases in a direction which extends away from said body portion toward said connector portions of said arms when said arms are in the extended condition, said proximal portions of said arms being spaced apart by distance which increases in a direction which extends away from said body portion toward said connector portions of said arms when said arms are in the extended condition, said connector portions of said arms being spaced apart when said arms are in the extended condition, and barrier means for blocking movement of tissue between the distal portions of a first one of said plurality of arms and a second one of said plurality of arms when said arms are in the extended condition, for blocking movement of tissue between the proximal portions of said first arm and said second arm when said arms are in the extended condition, and for blocking movement of tissue between the connector portions of said first arm and said second arm when said arms are in the extended condition, said barrier means having a first portion which is at least partially disposed between the distal portion of said first arm and the distal portion of said second arm, said first portion of said barrier means increasing in size in a direction which extends away from said body portion toward the connector portions of said first and second arms when said arms are in the extended condition, said barrier means having a second portion which is at least partially disposed between the proximal portions of said first and second arms when said arms are in the extended condition, said barrier mens having a third portion which is at least partially disposed between the connector portion of said first arm and the connector portion of said second arm, said third portion of said barrier means being formed as one piece with said first and second portions of said barrier means and blocking movement of tissue between the connector portions of said first and second arms when said arms are in the extended condition, said sleeve includes surface means for defining a side opening in said sleeve between said first arm and a third one of said plurality of arms, said third arm being disposed adjacent to a side of said first arm opposite from said second arm, said body portion including surface means for defining a passage which extends from said distal end portion of said body portion through said intermediate portion and said proximal portion of said body portion, said body portion having a side opening connecting said side opening in said sleeve in communication with said passage in said body portion.

16. A retractor as set forth in claim 15, wherein the space between said first arm and said third arm is greater than the space between said first arm and said second arm.

17. A retractor as set forth in claim 15, wherein said barrier means is ineffective to block movement of tissue into the space between said first and third arms.

18. A retractor for moving body tissue to facilitate arthroscopic surgery and removal thereafter without significantly damaging the moved tissue, said retractor comprising a distal end portion, a proximal end portion and an intermediate portion interconnecting said distal and proximal end portions, means for defining a passage which extends from said distal end portion through said intermediate portion and said proximal end portion and which receives an instrument during arthroscopic surgery, said distal end portion including an array of arms which is expandable against body tissue from a retracted condition in which said array of arms is relatively small and can be inserted into a relatively small space in body tissue to an extended condition in which said array of arms is relatively large to expand the relatively small space in body tissue, each of said arms of said array of arms having surface means for applying force to move body tissue to expand the relatively small space upon expansion of said array of arms from the retracted condition to the extended condition, surface means for defining a longitudinally extending side opening in an outer side surface of said retractor, said side opening having a central axis which extends parallel to a longitudinal central axis of said passage, said side opening extending from said intermediate portion of said retractor to a location disposed within said array of arms when said array of arms is in the extended condition, said side opening being connected in communication with said passage to provide access for an instrument disposed within said passage to space within said array of arms when said array of arms is in the extended condition and to provide access to body tissue adjacent to said intermediate and distal end portions of slid retractor, and barrier means for blocking movement of body tissue through openings between at least some of said arms of said array of arms when said array of arms is in the extended condition, said barrier means being ineffective to block movement through a space between first and second arms of said array of arms when said array of arms is in the extended condition to provide access to body tissue for an instrument which is partially disposed within said passage and is partially disposed within the space within said array of arms when skid array of arms is in the extended condition.

19. A retractor as set forth in claim 18, further including a second array of arms disposed at an end of said intermediate portion adjacent to said proximal end portion of said retractor, said second array of arms being expandable against body tissue from a retracted condition in which said second array of arms is relatively small and can be inserted into a relatively small space in body tissue to an extended condition in which said second array of arms is relatively large to expand the relatively small space upon expansion of said second array of arms from the retracted condition to the extended condition, said side opening extending into said second array of arms when said second array of arms is in the extended condition to provide access for an instrument disposed within said passage to space within said second array of arms when said second array of arms is in the extended condition, said barrier means being effective to block movement of body tissue through openings between at least some of said arms of said second array of arms when said second array of arms is in the extended condition to provide access to body tissue for an instrument which is partially disposed within said passage and is partially disposed within the space within said second array of arms when said second array of arms is in the extended condition.

20. A retractor as set forth in claim 18, wherein said first and second arms of said array of arms are spaced apart by a distance which is greater than the spacing between other arms of said array of arms when said array of arms is in the extended condition.

21. A retractor for moving body tissue to facilitate arthroscopic surgery without significantly damaging the moved tissue, said retractor comprising:

a distal end portion;

a proximal end portion;

an intermediate portion interconnecting said distal and proximal end portions;

means for defining a first passage which extends from said distal end portion through said intermediate portion and said proximal end portion, wherein said proximal end portion of said first passage is adapted to receive an instrument during arthroscopic surgery;

said distal end portion including bladder means comprising a flexible bladder surface material which encloses a chamber which is inflatable to expand said bladder surface material against body tissue, said bladder surface material being adapted to apply force to move body tissue, said bladder surface material, when viewed in cross-section through said chamber, being shaped to provide a second passage through a portion of the bladder means, said passage being open to body tissue; and

surface means for defining a side opening in an outer surface of said retractor, said side opening extending from said intermediate portion of said retractor to a location adjacent to said bladder means, said side opening being circumferentially aligned with said second passage, said side opening being connected in communication with said first passage to provide access for an instrument disposed within said first passage to space which is at least partially formed by said bladder means when said bladder means is in an extended condition.

22. A retractor as set forth in claim 21, further including an array of arms which is expandable against body tissue, wherein said array of arms is operably disposed within the chamber of said flexible bladder surface material;

wherein said side opening extends from said intermediate portion of said retractor to a location adjacent to said array of arms, said side opening being circumferentially aligned with said second passage, said side opening being connected in communication with said first passage to provide access for an instrument disposed within said first passage to space which is at least partially formed by said array of arms when said array of arms is in an extended condition.

23. A retractor for moving body tissue to facilitate arthroscopic surgery without significantly damaging the moved tissue, said retractor comprising:

a distal end portion;

a proximal end portion;

an intermediate portion interconnecting said distal and proximal end portions;

means for defining a passage which extends from said distal end portion through said intermediate portion and said proximal end portion, wherein said proximal end portion of said passage is adapted to receive an instrument during arthroscopic surgery;

said distal end portion including bladder means which is inflatable to expand said bladder means against body tissue, said bladder means having surface means for applying force to move body tissue;

said distal end portion further including a mechanical expanding portion for expanding against sub-surface tissue when said retractor is in use, said mechanical expanding portion comprising a plurality of substantially rigid arms; and

surface means for defining a side opening in an outer surface of said retractor, an edge of said side opening extending longitudinally from a point which is proximal to the proximal end of said bladder means to a point which is distal to the proximal end of said bladder means and thereby overlapping with a portion of said bladder means, said side opening being connected in communication with said passage to provide access for an instrument disposed within said passage to space which is at least partially formed by said bladder means when said bladder means is in an extended condition, wherein said side opening extends farther from the distal end of the retractor than the mechanical expanding portion.

24. A retractor for moving body tissue, said retractor comprising:

a distal end portion;

a proximal end portion;

an intermediate portion interconnecting said distal and proximal end portions;

said retractor having a passage which extends from distal end portion through said intermediate portion and said proximal end portion, wherein said proximal end portion of said passage is adapted to receive an instrument;

said distal end portion including bladder means comprising a first flexible bladder surface material which encloses a first chamber and a second flexible bladder surface material which encloses a second chamber, said bladder means is inflatable to expand said first and said second bladder surface material against body tissue, said first and said second bladder surface material being adapted to apply force to move body tissue; and

said retractor having an outer surface with a side opening which extends longitudinally from said first bladder surface material of said first chamber to said second bladder surface material of said second chamber, said side opening being connected in communication with said passage to provide access for an instrument disposed within said passage to space which is at least partially formed by said bladder means when said bladder means is in an extended condition.

25. The retractor of claim 24, wherein said first chamber and said second chamber are in fluid communication.

26. The retractor of claim 24, wherein said first chamber and said second chamber are separately inflatable.

27. A method for moving body tissue during a surgical procedure without damaging the tissue, said method comprising the steps of:

providing a retractor having a distal end portion, a proximal end portion, an intermediate portion interconnecting the distal and proximal end portions, and a passage which extends from the distal end portion through the intermediate portion and the proximal end portion, wherein the proximal end portion of the passage is adapted to receive an instrument during surgery, the distal end portion including a flexible bladder surface material which encloses a chamber which is inflatable to expand the bladder surface material against body tissue, the distal portion further including a mechanical expanding portion for expanding against sub-surface tissue when said retractor is in use, said mechanical expanding portion comprising a plurality of substantially rigid arms, the retractor having a side opening in an outer surface of the retractor, the side opening extending from the intermediate portion of the retractor to a location adjacent to the bladder surface material, wherein an edge of the side opening extends farther from the distal end portion of the retractor than the proximal edge of the inflatable chamber, wherein said side opening extends farther from the/distal end of the retractor than the mechanical expanding portion, the side opening being connected in communication with the passage to enable a surgical instrument disposed within the passage to access body tissue which is radially adjacent to the retractor;

inserting the retractor into body tissue with the distal end portion of the retractor leading and with the distal end portion of the retractor in a contracted condition;

inflating the inflatable chamber of the retractor from the contracted condition to an expanded condition with the distal end portion of the retractor in the body tissue;

expanding said plurality of substantially rigid arms from a retracted condition to an extended condition; and

said instrument through said side opening to perform a procedure on body tissue disposed adjacent to the side opening on the retractor.