Devices and methods for percutaneous surgery

• US 6,217,509 B1
• Filed: 01/20/1999
• Issued: 04/17/2001
• 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): Leubecker, John P.
• Application Number:
  US09/233,879
• Time in Patent Office: 818 Days
• Field of Search: 600/105, 600/114, 600/130, 600/135, 600/155, 600/156, 600/157, 600/158, 604/264
• US Class Current: 600/114
• 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
• CPC Class Codes: A61B 2017/00469 for insertion of instruments, e.g. guide wire, optical fibre
• CPC Class Codes: A61B 2017/00477 Coupling A61B2017/0046 takes precedence
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments
• CPC Class Codes: A61B 2017/347 Locking means, e.g. for locking instrument in cannula
• CPC Class Codes: A61B 2090/062 penetration depth
• 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 90/361 Image-producing devices, e.g. surgical cameras
• 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

Abstract

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, 170). The fixture (30, 170) includes a housing/body (31, 171) attachable to the proximal end (22) of the cannula (20). The housing (31) defines an optics bore (60, 180) to support a viewing element (50) for translation and rotation relative to the cannula (20) so that the longitudinal axis of the optics bore (60, 180) will translate parallel to and rotate about the longitudinal axis of the working channel (25). Methods are also provided for performing surgeries percutaneously with direct visualization and without the requirement for a fluid-maintained workspace.

Claims

1. A method for performing a spinal surgical procedure in a patient'"'"'s body, comprising:

inserting a cannula into a patient through skin and tissue to create a working channel to the spine;

creating a working space in communication with the working channel and adjacent the spine;

providing a viewing element having a lens at its distal end and a body with a ring sized to substantially encircle the cannula;

inserting the viewing element through the working channel to position the lens at the working space;

mounting the viewing element to the cannula by clamping the ring about the cannula;

providing an aspiration channel with an opening adjacent the working space; and

aspirating through the aspiration channel to draw air through the working channel and the working space.

2. The method according to claim 1, further including orienting the opening of the aspiration channel such that air is drawn past the lens of the viewing element during aspiration.

3. The method according to claim 2, wherein providing an aspiration channel further comprises alternately irrigating through the aspiration channel to clean the lens of the viewing element.

4. The method according to claim 1, further comprising providing the cannula with a distal end opening, a proximal end opening, and a working channel extending therebetween, wherein aspirating through the aspiration channel includes aspirating through the proximal end opening into the working channel of the cannula.

5. A method for performing a spinal surgical procedure in a patient'"'"'s body, comprising:

inserting a cannula into a patient through skin and tissue to create a working channel to the spine;

creating a working space in communication with the working channel and adjacent the spine;

providing a viewing element having a lens at its distal end and a body with a ring sized to substantially encircle the cannula;

inserting the viewing element through the working channel to position the lens at the working space;

mounting the viewing element to the cannula by clamping the ring about the cannula;

providing an aspiration/irrigation channel with an opening adjacent the working space; and

alternately aspirating and irrigating through the aspiration irrigation channel to keep the lens clear while it is adjacent the working space.

6. The method according to claim 5, further comprising providing the cannula with a distal end opening, a proximal end opening, and a working channel extending therebetween, wherein alternately aspirating and irrigating includes aspirating through the proximal end opening of the cannula.

7. A method for performing a spinal surgical procedure in a patient'"'"'s body, comprising:

providing a cannula having a proximal end opening, a distal end opening, and a working channel extending therebetween;

inserting the cannula into a patient through skin and tissue so the distal end of the cannula is adjacent the spine;

providing a body having a ring sized to substantially encircle the cannula, the body including an optics cannula having a lens at a distal end thereof and an aspiration port extending therethrough in communication with an aspiration channel having an opening adjacent the lens;

mounting the body by clamping the ring about the cannula with the optics cannula in the working channel and extending towards the distal end of the cannula to view the location; and

aspirating through the aspiration channel to draw air through the proximal end opening of the cannula and into the opening of the aspiration channel.

8. The method according to claim 7, further including orienting the opening of the aspiration channel such that air is drawn past the lens of the optics cannula during aspiration.

9. The method according to claim 7, wherein aspirating through the aspiration channel further comprises alternately irrigating through the aspiration channel.

10. The method according to claim 7, further comprising extending a power tool through the working channel.

11. The method according to claim 7, wherein the aspiration channel is formed by a tube extending beside the optics cannula.