Devices and methods for percutaneous surgery

• US 6,679,833 B2
• Filed: 03/23/2001
• Issued: 01/20/2004
• Est. Priority Date: 03/22/1996
• Status: Expired due to Term

• Current Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Original Assignee: SDGI Holdings Incorporated (Medtronic Plc)
• Inventors: Null, William Barry, Foley, Kevin T., Smith, Maurice M., Roehm, Thomas E. III
• Primary Examiner(s): Leubecker, John P.
• Application Number:
  US09/815,693
• Publication Number:
  US 20020022764A1
• Time in Patent Office: 1,033 Days
• Field of Search: 600/101, 600/102, 600/114, 600/125, 600/136, 604/164, 604/167, 604/264, 604/283
• 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 2017/3445 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 2090/306 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 90/37 Surgical systems with images on a monitor during operation
• 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

Methods and devices for performing surgery in a patient are provided. A cannula provides a working channel for access to a location in the patient. A clamp assembly is removably engaged to the cannula. The clamp assembly allows use of an endoscopic viewing system or can be removed to allow use of a microscopic viewing system in order to view the surgical site in the patient through the working channel. The clamp assembly includes a viewing element mounting portion having a length along which an endoscopic viewing element can be selectively positioned.

Claims

1. A device for use in spinal surgery, comprising:

a cannula sized for introduction into a patient, said cannula defining a working channel extending between a distal end and an opposite proximal end, said cannula further defining a first length between said distal end and said proximal end;

a clamp assembly configured to apply a clamping force to said inner surface and said outer surface of said cannula to releasably engage said clamp assembly thereto, said clamp assembly including a viewing element mounting portion extending proximally from said cannula and having a second length; and

a viewing element engageable at various positions along said second length of said viewing element mounting portion.

2. The device of claim 1, wherein said viewing element mounting portion includes a body along said second length, said body having a plurality of grooves formed in a first side thereof.

3. The device of claim 2, wherein said clamp assembly includes a bracket assembly movably mounted to said viewing element mounting portion, said viewing element being attached to said bracket assembly.

4. The device of claim 3, wherein said bracket assembly has a connector and a roller rotatably mounted to said connector, said body being positioned between said connector and said roller with said roller engaged with at least one of said plurality of grooves in said body.

5. The device of claim 4, wherein said bracket assembly further includes a support member extending from said connector, said viewing element being attached to said support member.

6. The device of claim 5, wherein said support member includes a ledge along a bottom portion thereof upon which said viewing element sits.

7. The device of claim 6, wherein said support member has a hole therethrough for receiving a fastener and said ledge includes a pin extending upwardly therefrom, said fastener and said pin engageable to said viewing element to secure said viewing element to said bracket assembly.

8. The device of claim 4, wherein said roller includes a number of teeth formed thereabout having a V-shape, each of said plurality of grooves having a V-shape and sized to receive said teeth.

9. The device of claim 1, wherein said clamp assembly contacts an inner surface and an outer surface of said cannula when engaged thereto.

10. The device of claim 1, wherein said cannula has a circular cross-section.

11. The device of claim 1, wherein said viewing element includes an endoscope positionable in said working channel of said cannula when said viewing element is engaged to said viewing element mounting portion.

12. The device of claim 1, wherein said clamp assembly comprises:

a foot extending from said viewing element mounting portion, said foot having a channel positionable over the proximal end of said cannula; and

a lever arm pivotably attached to said foot, said lever arm having a handle and a clamping member, said clamping member having a clamping surface frictionally engageable to an outer surface of said cannula.

13. The device of claim 12, wherein said cannula has a ring member at said proximal end defining a lip around said outer surface of said cannula, said channel of said foot being positionable on said ring and said clamping member having an upper surface positionable against said lip when said clamp assembly is engaged to said cannula.

14. The device of claim 13, wherein upper surface of said clamping member has a ramped portion facilitating passage of said clamping member below said lip.

15. The device of claim 1, wherein said cannula includes a bracket extending from a proximal end thereof engageable to a flexible arm.

16. A device for supporting a viewing element during surgery in a patient, comprising:

a cannula having a length extending between a proximal end and a distal end, said cannula further having an outer surface and an inner surface defining a working channel extending between said proximal end and said distal end; and

a clamp assembly configured to apply a clamping force to said inner surface and said outer surface of said cannula to releasably engage said clamp assembly thereto, said clamp assembly including a viewing element mounting portion extending proximally from said cannula.

17. The device of claim 16, wherein said clamp assembly comprises:

a foot extending from said viewing element mounting portion, said foot having a channel positionable over the proximal end of said cannula; and

a lever arm pivotably attached to said foot, said lever arm having a clamping member with a clamping surface frictionally engageable to an outer surface of said cannula.

18. The device of claim 17, wherein said foot includes:

an inner lip along one side of said channel positionable adjacent said inner surface of said cannula; and

an outer lip along the opposite side of said channel positionable adjacent said outer surface of said cannula,

wherein one of said inner lip and said outer lip have a radius of curvature that substantially differs from the radius of curvature of the adjacent surface of said cannula.

19. The device of claim 17, wherein said cannula has a ring member at said proximal end defining a lip around said outer surface, said ring being positionable in said channel and said clamping member having an upper surface positionable against said lip when said clamp assembly is engaged to said cannula.

20. The device of claim 19, wherein said upper surface of said clamping member has a ramped portion facilitating passage of said clamping member under said lip.

21. A kit for use in percutaneous surgery, comprising:

an elongated cannula sized for introduction into a patient, said cannula defining a working channel and having a longitudinal axis extending between a distal end and a proximal end, said cannula further defining a length between said distal end and said proximal end;

a clamp assembly engageable to said proximal end of said cannula, wherein said clamp assembly is configured to apply a clamping force to an inner surface and an outer surface of said cannula to engage said clamp assembly thereto, said clamp assembly including a viewing element mounting portion extending proximally from said cannula;

a viewing element supported by said clamp assembly, said viewing element having an optics cannula positionable in said working channel; and

a microscope positionable over said proximal end of said cannula.

22. The device of claim 21, wherein said clamp assembly is engageable at a plurality of locations about the proximal end of said cannula to reposition said optics cannula in said working channel.

23. The device of claim 21, wherein said clamp assembly includes a viewing element mounting portion extending proximally from said cannula when said clamp assembly is engaged to said cannula, said viewing element being engageable at various positions along the length of said viewing element mounting portion to reposition a distal end of said optics cannula with respect to said distal end of said cannula.

24. A kit for use in percutaneous surgery, comprising:

an elongated cannula sized for introduction into a patient, said cannula defining a working channel and having a longitudinal axis extending between a distal end and a proximal end, said cannula further defining a length between said distal end and said proximal end;

a clamp assembly engageable to said cannula, wherein said clamp assembly is engageable at a plurality of locations about the proximal end of said cannula to reposition said optics cannula in said working channel;

a viewing element supported by said clamp assembly, said viewing element having an optics cannula positionable in said working channel; and

a microscope positionable over said proximal end of said cannula.

25. The device of claim 24, wherein said clamp assembly is engaged to said proximal end of said cannula.

26. The device of claim 24, wherein said clamp assembly is configured to apply a clamping force to an inner surface and an outer surface of said cannula to engage said clamp assembly thereto, said clamp assembly including a viewing element mounting portion extending proximally from said cannula.

27. The device of claim 24, said clamp assembly includes a viewing element mounting portion extending proximally from said cannula when said clamp assembly is engaged to said cannula, said viewing element being engageable at various positions along the length of said viewing element mounting portion to reposition a distal end of said optics cannula with respect to said distal end of said cannula.

28. A kit for use in percutaneous surgery, comprising:

an elongated cannula sized for introduction into a patient, said cannula defining a working channel and having a longitudinal axis extending between a distal end and a proximal end, said cannula further defining a length between said distal end and said proximal end;

a clamp assembly engageable to said cannula, wherein said clamp assembly includes a viewing element mounting portion extending proximally from said cannula when said clamp assembly is engaged to said cannula, said viewing element being engageable at various positions along the length of said viewing element mounting portion to reposition a distal end of said optics cannula with respect to said distal end of said cannula;

a viewing element supported by said clamp assembly, said viewing element having an optics cannula positionable in said working channel; and

a microscope positionable over said proximal end of said cannula.

29. The device of claim 28, wherein said clamp assembly is engaged to said proximal end of said cannula.

30. The device of claim 28, wherein said clamp assembly is configured to apply a clamping force to an inner surface and an outer surface of said cannula to engage said clamp assembly thereto, said clamp assembly including a viewing element mounting portion extending proximally from said cannula.

31. The device of claim 28, wherein said clamp assembly is engageable at a plurality of locations about the proximal end of said cannula to reposition said optics cannula in said working channel.

32. A method for performing a surgical procedure at a location in a patient, comprising:

inserting into the patient a cannula having a distal end and a proximal end and a working channel therebetween;

alternately employing during the same surgical procedure an endoscopic viewing system engageable to the proximal end of the cannula and a microscopic viewing system to view the location in the patient through the working channel of the cannula; and

securing a clamp assembly having an endoscopic viewing element mounted thereto to the proximal end of the cannula when employing the endoscopic viewing system.

33. The method of claim 32, further comprising:

sizing the cannula so that the proximal end of the cannula is positioned at the skin level of the patient when the distal end is positioned adjacent the location in the patient.

34. The method of claim 32, further comprising:

removing the clamp assembly before employing the microscopic viewing system.