Minimally invasive access device and method

• US 7,226,451 B2
• Filed: 10/02/2003
• Issued: 06/05/2007
• Est. Priority Date: 08/26/2003
• Status: Active Grant

• Current Assignee: Zimmer Biomet Spine, Inc. (Zimvie Incorporated)
• Original Assignee: Endius Incorporated (Zimmer Biomet Holdings, Inc.)
• Inventors: Shluzas, Alan E., Lowery, Gary
• Primary Examiner(s): Robert; Eduardo C.
• Assistant Examiner(s): SWIGER III, JAMES L
• Application Number:
  US10/678,744
• Publication Number:
  US 20050075540A1
• Time in Patent Office: 1,342 Days
• Field of Search: 604/104, 604/106, 606/108, 606/86, 600/219, 600/220
• US Class Current: 606/86.00R
• CPC Class Codes: A61B 1/00149 using articulated arms
• CPC Class Codes: A61B 1/31 for the rectum, e.g. proctoscopes, sigmoidoscopes , colonoscopes
• CPC Class Codes: A61B 1/313 for introducing through surgical openings, e.g. laparoscopes
• CPC Class Codes: A61B 17/02 for holding wounds open; Tractors specula A61B1/32 ; drainage appliances for wounds A61M27/00
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/32002 with continuously rotating, oscillating or reciprocating cutting instruments
• CPC Class Codes: A61B 17/3403 Needle locating or guiding means guides for suture needles A61B17/0482; guiding or tracking by nuclear magnetic resonance G01R33/285
• CPC Class Codes: A61B 17/3423 Access ports, e.g. toroid shape introducers for instruments or hands access sites for liquids A61M39/0247
• CPC Class Codes: A61B 17/3439 with means for changing the inner diameter of the cannula, e.g. expandable A61B17/3423, A61B17/3431 take precedence; catheters A61M25/0662
• CPC Class Codes: A61B 17/3462 with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals expandable cannulas A61B17/3417
• CPC Class Codes: A61B 17/7001 Screws or hooks combined with longitudinal elements which do not contact vertebrae A61B17/7058 takes precedence
• CPC Class Codes: A61B 17/7007 Parts of the longitudinal elements, e.g. their ends, being specially adapted to fit around the screw or hook heads
• CPC Class Codes: A61B 17/701 Longitudinal elements with a non-circular, e.g. rectangular, cross-section A61B17/7005, A61B17/7007 take precedence
• CPC Class Codes: A61B 17/7032 Screws or hooks with U-shaped head or back through which longitudinal rods pass
• CPC Class Codes: A61B 17/7035 Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
• CPC Class Codes: A61B 17/7037 wherein pivoting is blocked when the rod is clamped
• CPC Class Codes: A61B 17/7038 to a different extent in different directions, e.g. within one plane only
• CPC Class Codes: A61B 17/7041 with single longitudinal rod offset laterally from single row of screws or hooks A61B17/7044 takes precedence
• CPC Class Codes: A61B 17/7044 also having plates, staples or washers bearing on the vertebrae
• CPC Class Codes: A61B 17/7079 : Tools requiring anchors to be already mounted on an implanted longitudinal or transverse element, e.g. where said element guides the anchor motion
• CPC Class Codes: A61B 17/7082 : for driving, i.e. rotating, screws or screw parts specially adapted for spinal fixation, e.g. for driving polyaxial or tulip-headed screws driving other bone screws A61B17/8875
• CPC Class Codes: A61B 17/7083 : Tools for guidance or insertion of tethers, rod-to-anchor connectors, rod-to-rod connectors, or longitudinal elements
• CPC Class Codes: A61B 17/7091 : for applying, tightening or removing longitudinal element-to-bone anchor locking elements, e.g. caps, set screws, nuts or wedges
• CPC Class Codes: A61B 17/8875 : Screwdrivers, spanners or wrenches
• CPC Class Codes: A61B 2017/00261 : Discectomy
• CPC Class Codes: A61B 2017/00557 : inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2090/062 : penetration depth
• CPC Class Codes: A61B 2090/08021 : of the patient or his organs
• CPC Class Codes: A61B 2090/306 : using optical fibres
• CPC Class Codes: A61B 2217/005 : with suction drainage system
• CPC Class Codes: A61B 2217/007 : with irrigation system
• CPC Class Codes: A61B 34/70 : Manipulators specially adapted for use in surgery
• CPC Class Codes: A61B 90/30 : Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
• 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: A61F 2/4611 : of spinal prostheses

Abstract

A device that provides access to a surgical location within a patient has an elongate body that has a proximal end, a distal end, and an inner surface. The inner surface defines a passage that extends through the elongate body. The elongate body is capable of having a configuration when inserted within the patient wherein the cross-sectional area of the passage at a first location is greater than the cross-sectional area of said passage at a second location. The first location is distal to the second location. The passage is capable of having a generally oval shaped cross section between the second location and the proximal end.

Claims

1. A device for retracting tissue to provide access to a spinal location within a patient, said device comprising:

an elongate body having a proximal end and a distal end and defining a length between the proximal and distal ends such that the distal end can be positioned inside the patient adjacent the spinal location, said elongate body comprising a generally oval shaped proximal portion and an expandable distal portion; and

a passage extending through the elongate body between the proximal and distal ends;

wherein said elongate body is expandable between a first configuration sized for insertion into the patient and a second configuration wherein the cross-sectional area of said passage at the distal end is greater than the cross-sectional area of said passage at the proximal end, wherein the passage is substantially enclosed by the elongate body between the proximal and distal ends in both the first configuration and the second configuration.

2. The device of claim 1, wherein said distal portion is generally oval shaped in the first configuration.

3. The device of claim 1, wherein said proximal portion and said distal portion comprise discrete members.

4. The. device of claim 1, wherein said distal portion comprises a first member and a second member.

5. The device of claim 1, wherein said distal portion comprises a first overlapping portion and a second overlapping portion, the first and second overlapping portions defining an overlap area, wherein the extent of overlap area is reduced when said distal portion is in the second configuration.

6. The device of claim 1, wherein said proximal portion is pivotable relative to said distal portion.

7. The device of claim 1, wherein said distal portion comprises a first dimension of about 24 mm and a second dimension of about 35 mm when said elongate body is in said first configuration.

8. The device of claim 1, wherein said distal portion comprises a first dimension of about 45 mm and a second dimension of about 70 mm when said elongate body is in said second configuration.

9. The device of claim 8, wherein said distal portion comprises a first dimension of about 24 mm and a second dimension of about 35 mm when said elongate body is in said first configuration.

10. The device of claim 1, wherein said proximal portion has a cross section having a first dimension of about 24 mm and a second dimension of about 35 mm.

11. The device of claim 1, wherein said passage is defined by a metallic inner surface extending substantially entirely around a perimeter of said passage between the proximal and distal ends in both the first configuration and the second configuration.

12. The device of claim 1, wherein said elongate body comprises multiple discrete pieces defining said passage.

13. The device of claim 1, wherein said elongate body comprising a generally oval shaped proximal portion in the first configuration.

14. The device of claim 1, wherein said elongate body comprising a generally oval shaped proximal portion in the second configuration.

15. The device of claim 1, wherein said elongate body comprising the same generally oval shaped proximal portion in both the first and the second configurations.

16. A device for providing access to a surgical location within a patient, said device comprising:

an elongate body having a proximal end, a distal end, and an inner surface, said inner surface defining a passage extending through the elongate body and through which surgical instruments can be inserted to the surgical location, said elongate body capable of having a configuration when located within the patient wherein the cross-sectional area of said passage at a first location is greater than the cross-sectional area of said passage at a second location, wherein the first location is distal to the second location, said passage being substantially enclosed at least when the elongate body is in an insertion configuration, said proximal end capable of having a generally oblong shaped cross section.

17. The device of claim 16, wherein said proximal end is capable of having a generally elliptical cross section.

18. The device of claim 16, wherein said proximal end is capable of having a non-circular cross section.

19. The device of claim 16, wherein the cross section is symmetrical about a first axis and a second axis, wherein the first axis is generally normal to the second axis.

20. The device of claim 16, wherein the configuration of the elongate body between the first location and the second location is generally conical when the elongate body is located within the patient.

21. The device of claim 16, wherein the first location is at a distal end of the elongate body, and the second location is at a proximal end of the elongate body.

22. The device of claim 16, wherein the elongate body is configured to be inserted through the skin of the patient and is sized to provide access to a spinal location.

23. The device of claim 16, wherein the elongate body is movable from a first configuration to a second configuration when located within the patient, the second configuration providing the cross-sectional area of said passage at a first location greater than the cross-sectional area of said passage at a second location, wherein the first location is distal to the second location.

24. The device of claim 23, wherein the elongate body is expandable from the first configuration to the second configuration.

25. The device of claim 23, wherein the elongate body has an oblong shaped cross section at its proximal end at least when the elongate body is in the second configuration.

26. The device of claim 25, wherein the elongate body has an oblong shaped cross section along substantially the entire length between the proximal end and the second location.

27. The device of claim 26, wherein said elongate body between the proximal end and the second location has a cross section having a first dimension of about 24 mm and a second dimension of about 35 mm.

28. The device of claim 25, wherein the elongate body has an oblong shaped cross section at its proximal end when the elongate body is in the first configuration.

29. The device of claim 16, wherein said passage is substantially enclosed by said inner surface.

30. The device of claim 16, wherein said passage is sized to receive multiple surgical instruments simultaneously.

31. A device for providing access to a surgical location within a patient, said device comprising:

an elongate body having a proximal end, a distal end, and an inner surface, said inner surface defining a passage extending through the elongate body and through which surgical instruments can be inserted to the surgical location, said elongate body comprising a first arcuate side portion and a second arcuate side portion, said elongate body being expandable from a first configuration to a second configuration when located within the patient such that in the second configuration the cross-sectional area of said passage at a first location is greater than the cross-sectional area of said passage at a second location, wherein the first location is distal to the second location, said first arcuate side portion and said second arcuate side portion being discrete members configured to substantially enclose said passage at least in the first configuration.

32. The device of claim 31, wherein the cross sectional area of the passage is symmetrical about a first axis and a second axis, wherein the first axis is generally normal to the second axis.

33. The device of claim 31, wherein the configuration of the elongate body between the first location and the second location is generally conical when the elongate body is expanded within the patient.

34. The device of claim 31, wherein the first location is at a distal end of the elongate body, and the second location is at a proximal end of the elongate body.

35. The device of claim 31, wherein the elongate body is configured to be inserted through the skin of the patient and is sized to provide access to a spinal location.

36. The device of claim 31, wherein the elongate body has a generally oval shaped cross section at its proximal end at least when the elongate body is in the second configuration.

37. The device of claim 36, wherein the elongate body has a generally oval shaped cross section along substantially the entire length between the proximal end and the second location.

38. The device of claim 37, wherein said elongate body between the proximal end and the second location has a cross section having a first dimension of about 24 mm and a second dimension of about 35 mm.

39. The device of claim 31, wherein said passage is sized to receive multiple surgical instruments simultaneously.

40. The device of claim 31, wherein said passage is substantially closed from said proximal end to said distal end at least in the first configuration.

41. The device of claim 31, wherein said passage is capable of having a generally oval shaped cross section between the first location and the proximal end at least in the first configuration.

42. The device of claim 31, wherein said first arcuate side portion and said second arcuate side portion are discrete members configured to substantially enclose said passage in the second configuration.

43. A device for providing access to a surgical location within a patient, said device comprising:

an elongate body having a proximal end, a distal end, and an inner surface, said inner surface defining a passage extending through the elongate body, said passage sized to receive multiple surgical instruments that can be inserted simultaneously to the surgical location, said elongate body being actuatable from a closed configuration to an expanded configuration wherein the cross-sectional area of said passage in said expanded configuration at a first location is greater than the cross-sectional area of said passage at a second location, wherein the first location is distal to the second location, said proximal end of said elongate body defining an oblong shaped cross section at least in the expanded configuration, said passage being substantially enclosed in at least said closed configuration by a first generally arcuate side portion and a second generally arcuate side portion, said first and second generally arcuate side portions being discrete members capable of moving away from each other as said elongate body is actuated from said closed configuration to said expanded configuration.

44. The device of claim 43, wherein the cross section is symmetrical about a first axis and a second axis, wherein the first axis is generally normal to the second axis.

45. The device of claim 43, wherein said elongate body between the proximal end and the second location has a cross section having a first dimension of about 24 mm and a second dimension of aboLlt 35 mm.

46. The device of claim 43, wherein the configuration of the elongate body between the first location and the second location is generally conical when the elongate body is located within the patient.

47. The device of claim 43, wherein the first location is at a distal end of the elongate body, and the second location is at a proximal end of the elongate body.

48. The device of claim 43, wherein the elongate body is configured to be inserted through the skin of the patient and is sized to provide access to a spinal location.

49. The device of claim 43, wherein the elongate body defines an oblong-shaped cross-section in the closed configuration.

50. The device of claim 43, wherein the passage is substantially enclosed by the first and second generally arcuate sides portions in the expanded configuration.

51. The device of claim 43, wherein the first and second generally arcuate side portions have at least one slot with a locking mechanism.