Method of epidural surgery

• US 6,464,682 B1
• Filed: 01/03/2000
• Issued: 10/15/2002
• Est. Priority Date: 07/06/1992
• Status: Expired due to Fees

• Current Assignee: Catheter Imaging Systems Incorporated
• Original Assignee: Catheter Imaging Systems Incorporated
• Inventors: Snoke, Phillip Jack
• Primary Examiner(s): Casler, Brian L.
• Assistant Examiner(s): RODRIGUEZ, CRIS LOIREN
• Application Number:
  US09/476,847
• Time in Patent Office: 1,016 Days
• Field of Search: 604/28, 604/48, 604/500, 604/506, 604/508, 604/510, 604/95-1-, 128/898, 600/433
• US Class Current: 604/510
• CPC Class Codes: A61B 1/01 Guiding arrangements therefore
• CPC Class Codes: A61B 1/12 with cooling or rinsing arrangements
• CPC Class Codes: A61B 1/3132 for laparoscopy
• CPC Class Codes: A61B 1/3135 for examination of the epidural or the spinal space
• CPC Class Codes: A61B 17/3401 Puncturing needles for the peridural or subarachnoid space or the plexus, e.g. for anaesthesia local anaesthesia A61M19/00
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 6/506 for diagnosis of nerves
• CPC Class Codes: A61B 90/361 Image-producing devices, e.g. surgical cameras
• CPC Class Codes: A61M 25/0009 Making of catheters or other medical or surgical tubes
• CPC Class Codes: A61M 25/0133 Tip steering devices
• CPC Class Codes: A61M 25/0136 Handles therefor

Abstract

A method of epidural surgery is provided that improves visibility in the epidural space of a patient for more effectively conducting therapeutic surgery therein. The method includes the steps of distending a portion of the epidural space of a patient by filling the portion of the epidural space with a fluid supplied from a catheter and positioning a portion of an optical scope in the distended portion of the epidural space by inserting the optical scope through the same catheter that supplies the distending fluid to thereby provide a visual image of the epidural space.

Claims

1. A method of enhancing viewing within the epidural space of a patient during an epidural procedure, the method comprising:

inserting a distal end portion of a steerable catheter through an opening in a patient and into the epidural space, the steerable catheter having a plurality of lumen formed in an elongate tube portion having a tube diameter, said plurality of lumen including at least a first working lumen and a second working lumen, each of said first and second working lumen having distinct, non-coincident longitudinal axes, each of said first and second working lumen being separated from each other by a portion of the elongate tube, with each of said first and second working lumen being substantially symmetrically positioned along both sides of said tube diameter, a handle connected to the elongate tube portion, at least one access port connected to the handle and in fluid communication with the elongate tube portion to provide access to the plurality of lumen, and a steering controller connected to the handle and associated with the elongate tube to steeringly control movement of at least the distal end of the elongate tube portion;

passing a fluid through said first working lumen of the steerable catheter;

distending a portion of the epidural space of the patient by filling the portion of the epidural space with the fluid supplied from the steerable catheter to thereby create a fluid cavity within the epidural space;

inserting a fiber optic scope through the second working lumen of the same steerable catheter when the distal end portion of the same steerable catheter is positioned in the epidural space;

viewing the fluid cavity by use of the inserted fiber optic scope; and

steering the steerable catheter to a structure within the epidural space for further viewing.

2. A method as defined in claim 1, wherein the step of inserting a fiber optic scope includes the step of connecting the fiber optic scope to an imaging apparatus which displays the visual image received from the fiber optic scope.

3. A method as defined in claim 1, wherein the step of distending a portion of the epidural space includes the step of supplying fluid to the steerable catheter and to the epidural space from the steerable catheter to the extent to maintain the portion of the epidural space in an open position for adequately visualizing the epidural space.

4. A method as defined in claim 1, wherein the step of inserting a fiber optic scope includes the step of advancing the fiber optic scope through the second working lumen of the steerable catheter and into the epidural space.

5. A method as defined in claim 1, wherein the step of passing a fluid through the first working lumen includes continuously supplying fluid through the first working lumen to the epidural space.

6. A method as defined in claim 5, wherein the step of steering includes advancing the distal end portion of the tube portion to a suspected problem area, and wherein the method further comprises treating the suspected problem area through at least one of the plurality of lumen of the steerable catheter.

7. A method as defined in claim 1, wherein said elongate tube portion is substantially circular in shape, said first working lumen having a first cross-sectional diameter, said second working lumen having a second cross-sectional diameter, the first and second cross-sectional diameters being substantially coincident with the tube diameter of said substantially circular elongate tube portion.

8. A method as defined in claim 7, wherein the first and second cross-sectional diameters are substantially unequal in size.

9. A method as defined in claim 1, wherein distending the portion of the epidural space comprises delivering the fluid supplied from the steerable catheter into the epidural space in a direction substantially parallel with a line of sight extending from the fiber optic scope to a portion of the fluid cavity viewed by the fiber optic scope, the line of sight being defined as an imaginary line from the fiber optic scope to the portion of the fluid cavity viewed by the fiber optic scope.

10. A method as defined in claim 1, wherein distending the portion of the epidural space comprises directing the delivery of fluid supplied from the steerable catheter into the epidural space so as to create sufficient fluid pressure against the preselected portion of tissue to thereby create a fluid cavity.

11. A method as defined in claim 1, wherein distending the portion of the epidural space comprises connecting a syringe containing the fluid to said first working lumen, injecting fluid from the syringe into said first working lumen, and conveying the fluid through said first working lumen into the portion of the epidural space.

12. A method as defined in claim 1, wherein distending the portion of the epidural space comprises positioning a fluid container in fluid communication with said first working lumen, delivering fluid from the container into the first working lumen and conveying the fluid through the first working lumen into the portion of the epidural space.

13. A method as defined in claim 12, wherein distending the portion of the epidural space further comprises regulating fluid pressure within the fluid cavity by interposing a stop-cock in fluid communication with and between the container and said first working lumen to thereby control the amount of fluid supplied to the fluid cavity and the rate at which the fluid is supplied.

14. A method as defined in claim 1, wherein distending the portion of the epidural space comprises directing the delivery of fluid supplied from the steerable catheter into the epidural space to a preselected portion of tissue within the epidural space so as to create sufficient fluid pressure against the portion of tissue to thereby create and maintain a fluid cavity.

15. A method as defined in claim 1, wherein continuously supplying a fluid through the first working lumen of said steerable catheter, and into the epidural space, comprises providing a stop-cock having at least three access ports defining first, second, and third access ports respectively, connecting the steerable catheter to the first access port, connecting a syringe containing fluid to the second access port, and connecting a fluid container to the third access port.

16. A method as defined in claim 15, wherein continuously supplying a fluid through the steerable catheter and into the epidural space comprises opening the first and second access ports to permit injection of the fluid from the syringe into the steerable catheter and through the steerable catheter into the epidural space to thereby distend the portion of the epidural space, closing the second access port and opening the third access port to permit fluid to flow from the container into the steerable catheter and through the steerable catheter in to the epidural space to thereby maintain the portion of the epidural space in a distended state.

17. A method as defined in claim 15, wherein the injection of the fluid from the syringe into the steerable catheter and through the steerable catheter into the epidural space comprises injecting fluid from a syringe capable of delivering at least twenty cubic centimeters (20 cc) of fluid into the steerable catheter and through the steerable catheter into the epidural space.

18. A method as in claim 15, wherein the flow of fluid from the container into the steerable catheter and through the steerable catheter into the epidural space comprises permitting fluid to flow into the steerable catheter from a pliable intravenous (I.V.) bag.

19. A method as defined in claim 18, wherein continuously supplying fluid through the steerable catheter and into the epidural space comprises controlling the amount of fluid supplied into the epidural space and the rate at which fluid is supplied into the epidural space from the I.V. bag using the third access port of the stop-cock.