Instruments and methods for minimally invasive tissue retraction and surgery
DC CAFCFirst Claim
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1. A tissue retractor for percutaneous surgery in a patient, comprising:
- a first portion having a proximal end and a distal end; and
a second portion having a proximal end and a distal end, said second portion forming with said first portion a working channel in communication with an exterior of said first and second portions at said proximal ends and said distal ends with said working channel being enclosed by said first portion and said second portion between said distal and proximal ends, wherein said working channel is enlargeable by laterally moving each of said first and second portions away from one another and pivoting each of said distal ends of said first and second portions away from one another such that only a portion of said working channel is enclosed by said first and second portions.
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Abstract
Methods and devices retract tissue for minimally invasive surgery in a patient. A retractor includes a working channel formed by a first portion and a second portion. The first and second portions are movable relative to one another from a first configuration for insertion that minimizes trauma to skin and tissue to an enlarged configuration after insertion to further retract skin and tissue in a minimally invasive manner. Instruments are engageable to the first and second portions and operable to move the first and second portions relative to one another.
479 Citations
76 Claims
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1. A tissue retractor for percutaneous surgery in a patient, comprising:
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a first portion having a proximal end and a distal end; and
a second portion having a proximal end and a distal end, said second portion forming with said first portion a working channel in communication with an exterior of said first and second portions at said proximal ends and said distal ends with said working channel being enclosed by said first portion and said second portion between said distal and proximal ends, wherein said working channel is enlargeable by laterally moving each of said first and second portions away from one another and pivoting each of said distal ends of said first and second portions away from one another such that only a portion of said working channel is enclosed by said first and second portions. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23)
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24. A tissue retractor for percutaneous surgery in a patient, comprising:
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a first portion and a second portion adjacent said first portion, said first and second portions each having a length between a distal end and a proximal end thereof such that said proximal ends are positionable outside the patient and said distal ends are positionable in the patient;
a working channel between said first and second portions sized to receive at least one surgical instrument for performance of a surgical procedure; and
said working channel having an insertion configuration wherein said working channel has a cross-section circumscribed by said first and second portions and an enlarged configuration wherein each of said first and said portions are laterally separable and pivotable relative to one another to provide said working channel with a cross-section circumscribeable by each of said first and second portions and tissue of the patient between said first and second portions when said working channel is enlarged in the patient. - View Dependent Claims (25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36)
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37. A tissue retractor for percutaneous surgery in a patient, comprising:
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a first portion extending between a proximal end and a distal end;
a second portion extending between a proximal end and a distal end, said first and second portions forming a working channel between said distal ends and said proximal ends of said first and second portions, said working channel having an insertion configuration wherein said working channel is substantially circumscribed by said first and second portions, said working channel further having an enlarged configuration wherein said first portion is separated from said second portion; and
means for simultaneously laterally separating and pivoting each of said first and second portions relative to the other of said first and second portions. - View Dependent Claims (38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48)
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49. A kit for use in percutaneous surgery, comprising:
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a retractor having a first portion and a second portion forming a working channel, said working channel having an insertion configuration wherein said working channel is substantially circumscribed by said first and second portions, said first and second portions separable from one another to open said working channel to an exterior of said retractor thereby enlarging said working channel;
at least one guide member extending between and coupling said first portion and said second portion to one another; and
a separation instrument engageable with said first and second portions and operable to separate and pivot each of said first and second portions relative to said guide member and to the other of said first and second portions. - View Dependent Claims (50, 51, 52, 53, 54, 55)
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56. A kit for use in percutaneous surgery, comprising:
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a retractor having a working channel extending between a proximal end and a distal end of said retractor, said retractor having a first portion and a second portion substantially circumscribing said working channel in an insertion configuration, said first and second portions separable from one another to enlarge said working channel; and
a separation instrument engageable to said first and second portions, said separation instrument having a lateral separator operable to laterally separate each of said first portion and said second portion from the other of said first portion and said second portion and a rotational separator operable to pivot each of said first portion and second portion relative to the other of said first portion and said second portion. - View Dependent Claims (57, 58, 59, 60, 61, 62)
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63. A method for performing a surgical procedure at a location in a patient, comprising:
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making an incision in skin and tissue of the patient to access the location;
forming a substantially enclosed working channel through the incision to the location by inserting a distal end of a retractor into the patient with a proximal end of the retractor located outside of the patient; and
enlarging the working channel by laterally separating and pivoting each one of first and second portions of the retractor relative to the other of the first and second portions of the retractor to expose the working channel to tissue along the retractor. - View Dependent Claims (64, 65, 66, 67, 68, 69)
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70. A surgical method for accessing a location in a patient, comprising:
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sequentially dilating tissue of the patient to the location;
placing a retractor through the sequentially dilated tissue to provide a substantially enclosed working channel to the location, the retractor having a length between a distal end and a proximal end thereof;
performing a first surgical procedure through the substantially enclosed working channel;
enlarging the working channel to expose the working channel to tissue along the length of the retractor by separating and pivoting each of a first portion and a second portion of the retractor relative to one another; and
performing a second surgical procedure through the enlarged working channel. - View Dependent Claims (71, 72, 73, 74, 75, 76)
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Specification