Devices and methods for percutaneous surgery

• US 6,206,822 B1
• Filed: 07/02/1999
• Issued: 03/27/2001
• Est. Priority Date: 03/22/1996
• Status: Expired due to Term

• Current Assignee: SDGI Holdings Incorporated (Medtronic Plc)
• Original Assignee: SDGI Holdings Incorporated (Medtronic Plc)
• Inventors: Clayton, John B., Smith, Maurice Mell, Moctezuma, Joseph, Foley, Kevin Thomas
• Primary Examiner(s): Dvorak, Linda C. M.
• Assistant Examiner(s): RAM, JOCELYN D
• Application Number:
  US09/347,200
• Time in Patent Office: 634 Days
• Field of Search: 604/164.01, 604/164.1, 604/164.11, 600/102, 600/114, 600/171
• US Class Current: 600/114
• CPC Class Codes: A61B 17/02 for holding wounds open; Tractors specula A61B1/32 ; drainage appliances for wounds A61M27/00
• CPC Class Codes: A61B 17/1671 for the spine
• 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 17/3421 Cannulas
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/00296 mounted on an endoscope
• CPC Class Codes: A61B 2017/0046 with a releasable handle; with handle and operating part separable for prosthetic joint-implanting tools A61F2/4603
• CPC Class Codes: A61B 2017/00469 for insertion of instruments, e.g. guide wire, optical fibre
• CPC Class Codes: A61B 2017/0262 with a provision for protecting nerves
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments catheters A61B2017/22072
• CPC Class Codes: A61B 2017/347 Locking means, e.g. for locking instrument in cannula
• CPC Class Codes: A61B 2090/306 using optical fibres
• CPC Class Codes: A61B 2090/3614 using optical fibre
• CPC Class Codes: A61B 2090/373 using light, e.g. by using optical scanners
• CPC Class Codes: A61B 90/50 Supports for surgical instruments, e.g. articulated arms
• CPC Class Codes: A61M 29/00 Dilators with or without means for introducing media, e.g. remedies instruments for performing visual medical inspections of cavities or tubes of the body A61B1/00
• CPC Class Codes: A61M 29/02 Dilators made of swellable material balloon catheters for angioplasty A61M25/104

Abstract

Devices and methods for performing percutaneous spinal surgery under direct visualization and through a single cannula are shown. A device (10) is provided which includes an elongated cannula (20) having a first inner diameter (D_I) and an outer diameter (D_O) sized for percutaneous introduction into a patient. The cannula (20) defines a working channel (25) between its ends (21, 22) which has a second diameter (D₂) equal to the diameter (D_I) of the cannula sized for receiving a tool therethrough. An elongated viewing element (50) is engageable to the cannula (20) adjacent the working channel (25), preferably by a fixture (30). The fixture (30) includes a housing (31) attachable to the proximal end (22) of the cannula (20) that defines a working channel opening (35) which is in communication with the working channel (25). The housing (31) also defines an optics bore (60) adjacent the working channel opening (35). In certain embodiments, the fixture (30) supports the viewing element (50) for translation and/or rotation within the optics bore (60) along the longitudinal axis of the bore, and for rotation of the housing (31) relative to the cannula (20) so that the longitudinal axis of the optics bore (60) will rotate about the longitudinal axis of the working channel (25). Methods are also provided for performing spinal surgeries percutaneously with direct visualization and without the requirement for a fluid-maintained workspace.

Claims

1. A kit for performing a surgical procedure at a location in a patient'"'"'s body, comprising:

a series of tissue dilators having successively larger diameters for sequential insertion through the skin and tissue of the patient;

a cannula sized for insertion over the largest of said dilators to define a working channel through the skin and tissue of the patient after removal of said dilators, said cannula having a proximal end and an opposite distal end, a first longitudinal axis between said ends and a length along said longitudinal axis sized so that said distal end is adjacent the location in the patient'"'"'s body and said proximal end is outside the patient'"'"'s body;

a viewing element extendable into said cannula, said viewing element having a viewing end positionable adjacent the distal end of said cannula; and

a fixture for movably supporting said viewing element on said cannula for positioning said viewing element at selected positions about said longitudinal axis of said cannula.

2. The kit of claim 1, wherein said working channel defines an inner dimension sized to simultaneously receive a plurality of tools therethrough.

3. The kit of claim 1, wherein said fixture includes:

a housing attached to the proximal end of the cannula, said housing defining a working channel opening therethrough in communication with said working channel, said working channel opening sized to substantially correspond to said inner dimension of said working channel to receive a tool therethrough;

said housing further defining an optics bore adjacent said working channel opening.

4. The kit of claim 3, wherein said viewing element includes an image transmission channel extending between said proximal end and said viewing end.

5. The kit of claim 4, wherein said viewing element includes a fiber-optic cable having illumination fibers and image transmission fibers.

6. The kit of claim 4, wherein said viewing element includes a lens, said lens defines an optical axis, said optical axis being offset at an angle relative to a longitudinal axis of said optics bore.

7. The kit of claim 1, wherein said fixture includes a housing defining a working channel opening in communication with said working channel of said cannula and an optics bore for receiving said viewing element therethrough in communication with said working channel, said optics bore having a second longitudinal axis substantially parallel to said first longitudinal axis, said housing being rotatable relative to said cannula so that said second longitudinal axis of said optics bore rotates about said first longitudinal axis of said working channel.

8. The kit of claim 7, wherein said optics bore is defined by a C-shaped clip.

9. The kit of claim 8, wherein said C-shaped clip is formed of a resilient material and said optics bore defined by said clip has an inner dimension that is slightly less than an outer dimension of said viewing element so that said viewing element resiliently deflects said C-shaped clip when said viewing device is disposed within said optics bore.

10. The kit of claim 7, wherein said housing further defines a number of grooves in said receiving bore.

11. The kit of claim 10, further comprising sealing members disposed in each of said number of grooves, said sealing members disposed between said housing and said outer dimension of said cannula.

12. The kit of claim 7 wherein said fixture includes engagement means, disposed between said housing and said cannula when said fixture is mounted to said proximal end of said cannula for providing a gripping engagement between said housing and said cannula.

13. The kit of claim 1, wherein said cannula is cylindrical.

14. The kit of claim 1, wherein at least one of said tissue dilators includes a sleeve having a tapered working end and an opposite end, said working end configured to displace tissue.

15. The kit of claim 14, wherein said at least one tissue dilator further comprises a gripping portion on an outer surface of said sleeve adjacent said opposite end, said gripping portion defining a plurality of circumferential grooves configured for manually gripping the dilator to manipulate the dilator within tissue.

16. A kit for performing a surgical procedure at a location in a patient'"'"'s body, comprising:

a series of tissue dilators having successively larger diameters for sequential insertion through the skin and tissue of the patient;

a cannula sized for insertion over the largest of said dilators to define a working channel through the skin and tissue of the patient after removal of said dilators, said cannula having a proximal end and an opposite distal end, a first longitudinal axis between said ends and a length along said longitudinal axis sized so that said distal end is adjacent the location in the patient'"'"'s body and said proximal end is outside the patient'"'"'s body;

a viewing element sized for introduction into said cannula; and

a support connected to said viewing element and mounted at one end of said cannula to permit positioning of said viewing element relative to said cannula at selected arcuate locations about said longitudinal axis of said cannula.

17. The kit of claim 16, wherein said support includes a fixture movably mounted to said cannula at said proximal end, said fixture defining an optics bore sized to receive at least a portion of said viewing element therethrough.

18. The kit of claim 17, wherein:

said viewing element is elongated having a lens at a distal end and an opposite proximal end; and

said elongated viewing element being slidably disposed within said optics bore to extend or retract said lens relative to said distal end of said cannula.

19. The kit of claim 17, wherein said fixture is configured to engage said cannula at said proximal end to support said viewing element for rotation about said longitudinal axis of said cannula.

20. A kit for performing a surgical procedure at a location in a patient'"'"'s body, comprising:

a series of tissue dilators having successively larger diameters for sequential insertion through the skin and tissue of the patient;

an elongated cannula having an inner dimension for insertion over the largest of said dilators to define a working channel through the skin and tissue of the patient after removal of said dilators and an outer dimension sized for percutaneous introduction into a patient, said cannula further including a distal working end and an opposite proximal end, said working channel sized for receiving at least one tool therethrough;

a viewing element having a first end connectable to a viewing apparatus and a lens disposed at an opposite second end; and

means for movably supporting said viewing element within said working channel to permit movement of said lens at said working end without movement of the at least one tool when the at least one tool extends through said working channel.

21. The kit of claim 20, wherein said means for movably supporting includes a fixture mounted adjacent said proximal end of said cannula and defining a working channel opening communicating with said working channel and sized to receive the at least one tool therethrough.

22. The kit of claim 21, wherein said fixture is rotatably mounted to said cannula to permit arcuate movement of said viewing element.

23. A kit for performing a surgical procedure at a location in a patient'"'"'s body, comprising:

a series of tissue dilators having successively larger diameters for sequential insertion through the skin and tissue of the patient;

an elongated cannula sized for insertion over the largest of said dilators to define a working channel through the skin and tissue of the patient after removal of said dilators, said cannula having a length and defining a first area within said cannula transverse to said length and an outer dimension sized for percutaneous introduction into a patient, said cannula further including a distal working end and an opposite proximal end, said working channel extending between said ends having a second area sized for receiving a surgical tool therethrough;

a viewing element including a lens at a distal end thereof; and

a fixture supporting said viewing element adjacent said working channel with said lens disposed adjacent said working end of said cannula, whereby said second area is substantially equal to said first area.

24. The kit of claim 23, wherein said second area is sized to simultaneously receive a plurality of surgical tools therethrough.

25. The kit of claim 24, wherein said viewing element has a proximal end adjacent said proximal end of said cannula and includes an image transmission channel extending from said lens at least to said proximal end thereof.

26. The kit of claim 25, wherein said viewing element includes a fiber-optic cable having illumination fibers and image transmission fibers disposed within said image transmission channel.

27. The kit of claim 23, wherein said fixture includes means for removably mounting said fixture to said cannula adjacent said proximal end of said cannula.

28. The kit of claim 27, wherein said fixture includes means for supporting said viewing element within said working channel.

29. The kit of claim 23, wherein at least one of said tissue dilators includes a sleeve having a tapered working end and an opposite end, said working end configured to displace tissue.

30. The kit of claim 29, wherein said at least one tissue dilator further comprises a gripping portion on an outer surface of said sleeve adjacent said opposite end, said gripping portion defining a plurality of circumferential grooves configured for manually gripping the dilator to manipulate the dilator within tissue.