Surgical operation system and method of securing working space for surgical operation in body

• US 5,976,146 A
• Filed: 06/11/1998
• Issued: 11/02/1999
• Est. Priority Date: 07/11/1997
• Status: Expired due to Term

• Current Assignee: Olympus Optical Corporation Limited (Olympus Corporation)
• Original Assignee: Olympus Optical Corporation Limited (Olympus Corporation)
• Inventors: Kogasaka, Takahiro, Ogawa, Akihisa, Nakada, Akio, Konou, Ryoichi
• Primary Examiner(s): Buiz, Michael
• Assistant Examiner(s): NGO, LIEN M
• Application Number:
  US09/095,848
• Time in Patent Office: 509 Days
• Field of Search: 606/86, 606/87, 606/53, 606/91, 606/151-153, 606/213, 606/79, 606/164, 623/11, 623/12, 623/22, 604/174, 604/175, 604/176, 600/114
• US Class Current: 606/86.00R
• 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 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take 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 17/3431 being collapsible, e.g. made of thin flexible material A61B17/3423 takes precedence
• CPC Class Codes: A61B 17/3439 with means for changing the inner diameter of the cannula, e.g. expandable A61B17/3423, A61B17/3431 take precedence; catheters A61M25/0662
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments catheters A61B2017/22072
• CPC Class Codes: A61B 2090/062 penetration depth
• CPC Class Codes: A61B 5/1077 Measuring of profiles
• CPC Class Codes: A61B 5/4504 Bones A61B5/4547 takes precedence
• CPC Class Codes: A61B 5/4528 Joints A61B5/4533, A61B5/4538 take precedence
• CPC Class Codes: A61B 90/37 Surgical systems with images on a monitor during operation
• CPC Class Codes: A61B 90/50 Supports for surgical instruments, e.g. articulated arms

Abstract

A surgical operation apparatus of this invention includes an operation sheath having a cavity securing portion that is inserted into vital tissue through the skin to secure a working cavity for a surgical operation in the body, and a sheet member that allows an operation tool to be inserted from outside the body into the cavity. The operation sheath is guided into the vital tissue by guide tools such as a dilator, a soft tube, and a mandrin.

Claims

1. A surgical operation system for percutaneously securing a working cavity for a surgical operation in a body, comprising:

a cavity securing tool including cavity securing means that is inserted into a living body through a skin to secure a working cavity in vital tissue and has a hole with an odd-shaped cross-section, and tool insertion channel means that allows a tool to be inserted into the cavity;

an insertion tool for forming an insertion path for introducing said cavity securing tool into the vital tissue through the skin; and

a cavity securing tool guide tool on which said cavity securing tool can be mounted, and which can be mounted on said insertion tool.

2. A system according to claim 1, wherein said insertion tool has a plurality of tubular members whose diameters increase stepwise, said tubular members being sequentially fitted on each other to be combined in the order of increasing diameter.

3. A system according to claim 2, wherein said cavity securing tool guide tool can be fitted on one of said tubular members of said insertion tool.

4. A system according to claim 3, wherein said cavity securing tool guide tool has an outer circumference smaller than that of one of said tubular members of said insertion tool which has the largest outer diameter.

5. A system according to claim 1, wherein said cavity securing tool guide tool has an elliptic or oval cross-section.

6. A system according to claim 1, wherein said cavity securing tool guide tool is a deformable, cylindrical member.

7. A system according to claim 6, wherein said cavity securing tool guide tool is transparent.

8. A system according to claim 6, wherein at least part of said cavity securing tool has a mesh structure.

9. A surgical operation system for percutaneously securing a working cavity for a surgical operation in a body, comprising:

a cavity securing tool including cavity securing means that is inserted into a living body through the skin to secure a cavity in vital tissue and has a hole, and tool insertion channel means that allows a tool to be inserted into the cavity; and

a cavity securing tool guide member including abrasion means formed on a distal end to abrade tissue from a bone, and guide means for guiding said cavity securing tool into the vital tissue.

10. A system according to claim 9, further comprising an insertion tool for forming an insertion path for introducing said cavity securing tool into the vital tissue through the skin.

11. A system according to claim 9, wherein said cavity securing tool guide member also serves as said insertion tool.

12. A system according to claim 10, wherein said insertion tool comprises a plurality of tubular members whose diameters increase stepwise.

13. A system according to claim 10, wherein said cavity securing tool guide member can be fitted on one of said tubular members of said insertion tool.

14. A system according to claim 10, wherein said cavity securing tool guide member has an outer circumference smaller than that of one of said tubular members of said insertion tool which has the largest outer diameter.

15. A system according to claim 10, wherein a length of a blade edge line of said abrasion means is smaller than half the circumference of one of said tubular members of said insertion tool which has the largest outer diameter.

16. A system according to claim 9, wherein said cavity securing tool guide member has an elliptic or oval cross-section.

17. A system according to claim 16, wherein said abrasion means has a blade edge line extending along a major axis direction of the cross-section of said cavity securing guide member.

18. A system according to claim 9, wherein said tool insertion guide member is made of a deformable member.

19. A system according to claim 9, wherein said tool insertion guide member is made of a transparent member.

20. A system according to claim 9, wherein said tool insertion guide member is made of a member having a mesh structure.

45. A system according to claim 14, wherein a length of a blade edge line of said abrasion means is smaller than the largest diameter of the edrity securing tool guide member.

46. A system according to claim 15, wherein a length of a blade edge line of said abrasion means is smaller than the largest diameter of the diameters of said tubular member of said insertion tool.

47. A system according to claim 11, wherein said insertion tool comprises a plurality of tubular members whose diameters increase stepwise.

48. A system according to claim 11, wherein said cavity securing tool guide member can be fitted on one of said tubular members of said insertion tool.

21. An insertion tool to be inserted into a living body through the skin, comprising a plurality of tubular members, each having a different inner diameter and a different outer diameter, and anchor means formed on a distal end of at least one of the tubular members and designed to engage with a bone.

22. A tool according to claim 21, further comprising a surgical cavity securing tool that can be fitted on one of said tubular members of said insertion tool.

23. A surgical operation cavity securing tool percutaneously inserted and used in a body, comprising:

cavity securing means that is inserted into a living body through a skin to secure a cavity in vital tissue;

deformable tool insertion guide means that communicates with the cavity secured by said cavity securing means to cause the cavity to communicate with the outside of the body;

a rigid portion coupled to said cavity securing means and extending outside the body; and

a gripping portion coupled to said rigid portion,

wherein a cross-sectional shape of a hole of said cavity securing means has major and minor axes, and said rigid portion is coupled to said cavity securing means at a position parallel to the major axis.

24. A surgical operation cavity securing tool that is used near a spina after being placed therenear through a skin of a back, comprising:

cavity securing means that is inserted into a living body through an incision to secure a cavity in vital tissue;

deformable tool insertion guide means that communicates with the cavity secured by said cavity securing means to cause the cavity to communicate with the outside of the body;

a rigid portion that is coupled to said cavity securing means, placed laterally with respect to a set treatment cavity, and extends outside the body; and

a gripping portion coupled to said rigid portion.

25. A surgical operation cavity securing tool percutaneously inserted and used in a body, comprising cavity securing means that is inserted into a living body through an skin to secure a cavity in vital tissue, said cavity securing means having engaging means for a bone,

wherein said engaging means for a bone comprises an opening portion to be engaged with a vertebral arch portion, the opening portion having a substantially symmetrical shape with respect to a plane passing through a center axis.

26. A tool according to claim 25, wherein the opening portion includes at least two opening portions, the two opening portions being located at opposing positions.

27. A surgical operation cavity securing tool to be inserted into vital tissue through a skin so as to secure a working cavity for a surgical operation in a body, comprising:

a cavity securing portion for securing a working cavity for a surgical operation in vital tissue; and

a deformable tool insertion guide portion that communicates with a cavity secured by said cavity securing portion to cause the cavity to communicate with the outside of the body,

wherein a surgical operation is performed upon insertion of an endoscope and an operation tool into the cavity secured by said cavity securing portion through said tool insertion guide portion, and said tool insertion guide portion comprises at least one deformable plate structure.

28. A surgical operation cavity securing tool to be inserted into a body from a back portion of the body so as to perform a surgical treatment on a spine, comprising:

a cavity securing portion for securing a working cavity in the body, and a tool insertion guide portion connected to said cavity securing portion and extending to the outside of the body,

wherein said tool insertion guide portion has a guide surface communicating with the cavity formed by said cavity securing portion, and is constituted by a soft, tubular member to be positioned in tissue, and a semi-hard member formed continuously with said soft, tubular member and located outside the body.

29. A surgical operation system for securing a working space for a surgical operation in a body, and performing a surgical operation by using an endoscope, comprising:

an endoscope serving as an observation means;

a cavity securing tool including a cavity securing means that is inserted into vital tissue through a skin portion to secure a working space in the body, and a wall member having a hole for causing the cavity to communicate with the outside of the body, said wall member having at least a transparent portion;

at least one port that is inserted into the vital tissue through another skin portion and guided to the cavity;

port insertion means for forming an insertion path for said port; and

means for coupling said port to said cavity securing tool in the cavity.

30. A surgical operation system for securing a working space for a surgical operation in a body, and performing a surgical operation by using an endoscope, comprising:

an endoscope serving as observation means;

a cavity securing tool including cavity securing means that is inserted into vital tissue through a skin portion to secure a working space in the body, and a wall member having a hole for causing the cavity to communicate with the outside of the body;

at least one port that is inserted into the vital tissue through another skin portion and guided to the cavity; and

port insertion means for forming an insertion path for said port,

wherein said cavity securing tool and said port insertion means are made of titanium and can be observed by magnetic resonance imaging means (MRI).

31. An endoscope surgical operation system for securing a working space for a surgical operation in a body, said system using an endoscope, comprising:

a cavity securing tool for securing a cavity in a region of surgical object; and

cavity securing tool guide means having insertion position detection means that is arranged on a distal end to detect a position where said cavity securing tool is to be inserted, said guide means being used to insert said cavity securing tool into vital tissue.

32. A system according to claim 31, wherein said insertion position detection means detects a shape of the region of surgical object.

33. A system according to claim 32, wherein said shape detection means comprises:

a reference member that is formed on a distal end of said means and brought into contact with a portion near the region of surgical object; and

an indicator member having a cross-sectional area smaller than that of said reference member,

said reference member and said indicator member are arranged parallel to each other to be movable in a major axis direction, and the shape of the region of surgical object is detected from change amounts of said indicator member and said reference member.

34. A system according to claim 32, wherein said shape detection means comprises:

a reference member that is formed on a distal end of said means and brought into contact with a portion near the region of surgical object; and

an indicator member having a cross-sectional area smaller than that of said reference member,

said reference member and said indicator member are arranged parallel to each other to be movable in a major axis direction, a total length of said indicator member is larger than that of said reference member, and

change amounts of said indicator member and said reference member and a difference between a length of a proximal end of said indicator member and a length of a proximal end of said reference member change depending on an insertion position, thereby detecting the shape of the region of surgical object.

35. A system according to claim 33, wherein said indicator member also serves as an insertion tool for forming an insertion path for said cavity securing tool.

36. A system according to claim 31, wherein said insertion position detecting means comprises transfer means for transferring a shape of a portion around the region of surgical object as a shape of a portion located outside the body.

37. A system according to claim 36, wherein said transfer means comprises:

detection means for detecting a shape of a portion around a region of surgical object;

reflection means for reflecting the detected shape in a shape of a portion located outside the body; and

transfer means for transferring the shape detected by said detection means to said reflection means.

38. A system according to claim 37, wherein said detection means, said reflection means, and said transfer means are continuously and systematically arranged, and are constituted by a bundle of rod-like members having the same total length.

49. A system according to claim 34, wherein said indicator member also serves as an insertion tool for forming an insertion path for said cavity securing tool.

39. An endoscopic operation system comprising:

a cavity securing tool having a surface on a distal end which is brought into contact with a portion near a region of surgical object, the surface serving as a reference surface;

a cavity securing tool guide member having an indicator portion on a distal end which has a cross-sectional area smaller than that of the reference surface; and

insertion position detection means for detecting an insertion position of said cavity securing tool by combining said cavity securing tool and said cavity securing tool guide member,

wherein said cavity securing tool and said cavity securing tool guide member are arranged parallel to each other to be movable in a major axis direction, and a shape is detected from change amounts of said cavity securing tool and said cavity securing tool guide member.

40. An endoscopic operation system comprising a cavity securing tool for securing a working cavity in tissue, said tool having engaging means to be engaged with a region of surgical object, cavity securing tool guide means serving as a guide for inserting said cavity securing tool into a body, and means for detecting an insertion position of said cavity securing tool by combining said cavity securing means and said cavity securing tool guide means,

wherein said insertion position detection means is formed such that when said cavity securing tool is engaged with the region of surgical object, a sum of a protrusion amount of a bone portion into a cavity securing portion and a total length of said cavity securing tool guide means is almost equal to a total length of said cavity securing means, and detects the insertion position of said cavity securing means on the basis of coincidence between a proximal end of said cavity securing means and a proximal end of said cavity securing tool guide means.

41. An endoscopic operation system according to claim 40, wherein said cavity securing tool comprises:

a ring-like cavity securing portion that has engaging means to be engaged with a region of surgical object and forms a working cavity in tissue; and

a pusher for pushing said ring-like cavity securing portion, and

said insertion position detection means is formed such that when said cavity securing tool is engaged with the region of surgical object, a sum of a protrusion amount of a bone portion into a cavity securing portion and a total length of said cavity securing tool guide means is almost equal to a sum of a height of said cavity securing portion and a total length of said pusher, and detects the insertion position of said cavity securing means on the basis of coincidence between a proximal end of said pusher and a proximal end of said cavity securing tool guide means.

42. A treatment method using a system including a discectomy cavity securing tool that is inserted into tissue to form a working cavity, said tool having means for observing the cavity, tool insertion guide means through which a treatment tool is inserted, and engaging means having a distal end to be engaged with a posterior spine vertebral arch of a spine, and extracorporeal detection means for detecting a position of a region of surgical object, comprising the steps of:

(a) forming an insertion path in vital tissue at a predetermined position and angle;

(b) inserting said detecting means into the path and detecting the region of surgical object;

(c) inserting said discectomy cavity securing tool by using said detection means as a guide;

(d) engaging said discectomy cavity securing tool with the posterior spine vertebral arch;

(e) observing the cavity with said observation means; and

(f) inserting a treatment tool into said tool insertion guide means, and performing a treatment on a bone under observation.

43. A method according to claim 42, further comprising:

the step of abrading tissue before said cavity securing tool is inserted into the body.

44. A treatment method using a system including a discectomy cavity securing tool that is inserted into tissue to form a working cavity, said tool having means for observing the cavity, tool insertion guide means through which a tool is inserted, engaging means to be engaged with a posterior spine vertebral arch of a spine, and abrasion means for abrading vital tissue from a bone, comprising the steps of:

(a) forming an insertion path in vital tissue at a predetermined position and angle;

(b) inserting said discectomy cavity securing tool guide member into the path, and abrading tissue around a region of surgical object with a distal end of said guide member;

(c) inserting said discectomy cavity securing tool, along said discectomy cavity securing tool guide member, into a place where abrasion is performed;

(d) engaging said discectomy cavity securing tool with the posterior spine vertebral arch;

(e) observing the cavity with said observation means; and

(f) inserting a treatment tool into said tool insertion guide means, and performing a treatment on a bone under observation.