Devices and methods for percutaneous tissue retraction and surgery

• US 7,261,688 B2
• Filed: 04/05/2002
• Issued: 08/28/2007
• Est. Priority Date: 04/05/2002
• Status: Expired

• Current Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Original Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Inventors: Foley, Kevin T., Lim, Roy, Smith, Maurice M., Roehm, Thomas E. III
• Primary Examiner(s): Rodriguez; Cris
• Assistant Examiner(s): STOKES, CANDICE CAPRI
• Application Number:
  US10/117,440
• Publication Number:
  US 20030191371A1
• Time in Patent Office: 1,971 Days
• Field of Search: 606/119, 606/80, 600/184, 600/185, 600/208, 600/214, 600/215, 600/211, 600/210, 600/206, 600/219, 600/222
• US Class Current: 600/210
• CPC Class Codes: A61B 1/32 Devices for opening or enlarging the visual field, e.g. of a tube of the body dilators A61M29/00
• CPC Class Codes: A61B 17/02 for holding wounds open; Tractors specula A61B1/32 ; drainage appliances for wounds A61M27/00
• CPC Class Codes: A61B 17/0206 with antagonistic arms as supports for retractor elements
• CPC Class Codes: A61B 17/0293 with ring member to support retractor elements
• 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 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/2837 with a locking ratchet

Abstract

Methods and devices for performing percutaneous surgery in a patient are provided. A retractor includes a working channel formed by a first portion coupled to a second portion. The first and second portions are movable relative to one another from an unexpanded configuration to an expanded configuration to increase the size of the working channel along the length of the working channel while minimizing trauma to skin and tissue.

Claims

1. A refractor for percutaneous surgery in a patient, comprising:

a first portion having a proximal end and a distal end;

a second portion having a proximal end coupled to said proximal end of said first portion, said second portion having a distal end and including opposite edges overlapping adjacent edges of said first portion at least adjacent said distal ends to form a working channel, said working channel having a length between said distal ends and said proximal ends of said first and second portions and a size between said first portion and said second portion along said length, wherein;

said first and second portions are positionable in an unexpanded configuration with said distal ends of said first and second portions in the patient and said proximal ends of said first and second portions outside the patient; and

said first and second portions are movable to an expanded configuration wherein said working channel tapers in size from said distal ends in the patient to said proximal ends outside the patient and said opposite edges of said second portion overlap adjacent edges at said distal end of said first portion in said expanded configuration.

2. The retractor of claim 1, further comprising an endoscopic viewing instrument extending through said working channel.

3. The retractor of claim 1, further comprising a microscopic viewing instrument over said working channel.

4. The retractor of claim 1, wherein one of said first and second portions includes a bracket extending from said proximal end thereof that is engageable to a flexible arm.

5. The retractor of claim 1, wherein said first portion and said second portion extend completely about said working channel from said proximal ends of said first and second portions to said distal ends of said first and second portions.

6. The retractor of claim 1, further comprising a ratchet and pawl mechanism at said proximal ends of said first and second portions to maintain said first and second portions in said expanded configuration.

7. The retractor of claim 1, further comprising:

a pair of coupling members engaging said first portion to said second portion;

a lever arm extending from respective ones of each of said pair of coupling members; and

said coupling members each have a first position wherein said first portion is pivotal relative to said second portion and are moveable to a second position wherein said coupling members fix said first portion relative to said second portion, said lever arms being moveable to move said coupling members from said second position to said first position.

8. The retractor of claim 1, wherein said first portion is pivotally coupled to said second portion about a pivot axis located proximally of said proximal ends of said first and second portions.

9. The retractor claim 1, wherein said second portion includes a partial cylindrical body and said first portion includes a partial cylindrical body positioned about said partial cylindrical body of said second portion.

10. The retractor of claim 1, wherein said working channel has a figure eight shape along said length in said expanded configuration.

11. The retractor of claim 10, wherein in said unexpanded configuration said working channel has a generally circular cross-section along said length and in said expanded configuration said working channel has a dimension in said second portion transverse to a primary expansion direction of said first and second portions that is less than a dimension of said working channel in said first portion transverse to said primary expansion direction.

12. The retractor of claim 1, wherein said second portion includes a semi-cylindrical body and said first portion includes a semi-cylindrical body positioned about said semi-cylindrical body of said second portion.

13. The retractor of claim 12, wherein said body of said first portion is flexible.

14. The retractor of claim 12, wherein said body of said first portion includes opposite edges extending therealong between said proximal end and said distal end of said first portion.

15. The refractor of claim 14, wherein said body of said first portion has a perimeter length between said opposite edges, said perimeter length being greater at said distal end of said first portion than at said proximal end of said first portion.

16. The retractor of claim 14, wherein said body of said second portion includes opposite edges extending therealong between said proximal end and said distal end, said body of said second portion further including an engagement surface extending along at least a portion of each of said opposite edges thereof.

17. The retractor of claim 16, wherein said opposite edges of said first portion engage adjacent ones of said engagement surfaces of said second portion when in said expanded configuration.

18. The retractor of claim 1, wherein said first portion includes a collar at said proximal end thereof and said second portion includes a collar at said proximal end thereof.

19. The retractor of claim 18, wherein said first portion and said second portion are pivotally coupled to one another at said collars.

20. The retractor of claim 19, wherein:

said collar of said first portion includes first and second extensions extending therefrom on opposite sides of said first portion; and

said collar of said second portion includes first and second recesses therein on opposite sides of said second portion, said first and second extensions positionable in respective ones of said first and second recesses.

21. The retractor of claim 20, wherein said collar of said second portion includes first and second extensions extending along said first and second recesses of said second collar, said first and second extensions of said first portion are each pivotally coupled to an adjacent one of said first and second extensions of said second portion in respective ones of said first and second recesses of said second portion.

22. The retractor of claim 21, wherein said collar of said first portion includes first and second recesses therein adjacent respective ones of said first and second extensions of said first portion, said first and second extensions of said second portion are positionable in respective ones of said first and second recesses of said first portion.

23. The retractor of claim 22, wherein:

said first and second extensions of said first portion each contact an engagement surface in each of said first and second recesses of said second portion in said expanded configuration; and

said first and second extensions of said second portion each contact an engagement surface in each of said first and second recesses of said first portion in said expanded configuration.

24. A retractor for percutaneous surgery in a patient, comprising:

a first portion having opposite edges extending between a proximal end and a distal end;

a second portion coupled to said first portion and having opposite edges extending between a proximal end and a distal end, said second portion including an engagement surface extending along at least a portion of each of said opposite edges thereof, said first and second portions forming a working channel having a length extending between said distal ends and said proximal ends of said first and second portions;

said first and second portions having an unexpanded configuration wherein said edges of said first portion extends around said second portion; and

said first and second portions being pivotal relative to one another about said proximal ends to an expanded configuration wherein said opposite edges of said first portion engage adjacent ones of said engagement surfaces of said second portion.

25. The retractor of claim 24, wherein:

said first and second portions are positionable in the patient in said unexpanded configuration with said distal ends of said first and second portions in the patient and said proximal ends of said first and second portions outside the patient; and

said expanded configuration increases a size of said working channel between said first portion and said second portion along said entire length of said working channel.

26. The retractor of claim 24, wherein in said unexpanded configuration said working channel has a generally circular cross-section along said length and in said expanded configuration said working channel has a dimension in said second portion transverse to a pivot direction of said first and second portions that is less than a dimension of said working channel in said first portion transverse to said pivot direction.

27. The retractor of claim 24, wherein said first portion is pivotally coupled to said second portion about a pivot axis located proximally of said proximal ends of said first and second portions.

28. The refractor of claim 24, wherein said second portion includes a semi-cylindrical body and said first portion includes a semi-cylindrical body positioned about said semi-cylindrical body of said second portion.

29. The retractor of claim 28, wherein said body of said first portion is flexible.

30. The retractor of claim 28, wherein said body of said first portion has a perimeter length between said opposite edges, said perimeter length being greater at said distal end of said first portion than at said proximal end of said first portion.

31. The retractor of claim 28, wherein said body of said first portion has a thickness that is less than a thickness of said body of said second portion.

32. The retractor of claim 24, wherein said first portion includes a collar at said proximal end thereof and said second portion includes a collar at said proximal end thereof.

33. The retractor of claim 32, wherein:

said collar of said first portion includes first and second extensions extending therefrom on opposite sides of said first portion; and

said collar of said second portion includes first and second recesses therein on opposite sides of said second portion, said collar of said second portion including first and second extensions along each of said first and second recesses, said first and second extensions of said first portion are positioned in respective ones of said first and second recesses of said second portion and pivotally engaged to first and second extensions of said second portion.

34. The retractor of claim 33, wherein said collar of said first portion includes first and second recesses along said first and second extensions thereof, said first and second extensions of said second portion are each positioned in respective ones of said first and second recesses of said first portion.

35. The retractor of claim 34, wherein:

said first and second extensions of said first portion each contact an engagement surface in each of said first and second recesses of said second portion in said expanded configuration; and

said first and second extensions of said second portion each contact an engagement surface in each of said first and second recesses of said first portion in said expanded configuration.

36. A retractor for percutaneous surgery in a patient, comprising:

a first portion extending between a proximal end and a distal end, said first portion including a collar extending about said proximal end; and

a second portion extending between a proximal end and a distal end, said second portion including a collar extending about said proximal end, said first and second portions forming a working channel having a length extending between said distal ends and said proximal ends of said first and second portions and a size between said first and second portions, wherein said collar of said first portion is pivotally coupled to said collar of said second portion and said first and second portions are pivotal relative to one another between an unexpanded configuration and an expanded configuration and in at least said unexpanded configuration said first portion overlaps said second portion between said proximal and distal ends to enclose said working channel along said first and second portions.

37. The retractor of claim 36, wherein:

said first and second portions are positionable in said unexpanded configuration with said distal ends of said first and second portions in the patient and said proximal ends of said first and second portions outside the patient; and

said expanded configuration increases said size of said working channel between said first portion and said second portion from said proximal ends of said first and second portions to said distal ends of said first and second portions.

38. The retractor of claim 36, further comprising a viewing element selected from the group comprising:

an endoscopic viewing instrument and a microscopic viewing instrument.

39. The refractor of claim 36, wherein said first portion includes opposite edges extending therealong between said proximal end and said distal end.

40. The retractor of claim 36, wherein said second portion includes a partial cylindrical body and said first portion includes a partial cylindrical body positioned about said partial cylindrical body of said second portion.

41. The retractor of claim 36, wherein said second portion includes a semi-cylindrical body and said first portion includes a semi-cylindrical body positioned about said semi-cylindrical body of said second portion.

42. The retractor of claim 41, wherein said body of said first portion is flexible.

43. The retractor of claim 41, wherein:

said body of said first portion has a perimeter length between opposite edges thereof that is greater at said distal end of said first portion than at said proximal end of said second portion; and

said body of said second portion has a perimeter length between opposite edges thereof that is generally the same at said distal end and said proximal end of said second portion.

44. The retractor of claim 36, wherein said collar of first portion is pivotally coupled to said collar of said second portion about a pivot axis located proximally of said proximal ends of said first and second portions.

45. The retractor of claim 44, wherein:

said collar of said first portion includes first and second extensions extending therefrom on opposite sides of said first portion; and

said collar of said second portion includes first and second recesses therein on opposite sides of said second portion, said collar of said second portion including first and second extensions along each of said first and second recesses, said first and second extensions of said first portion are positioned in respective ones of said first and second recesses of said second portion and pivotally engaged to first and second extensions of said second portion.

46. The refractor of claim 45, wherein said collar of said first portion includes first and second recesses along said first and second extensions thereof, said first and second extensions of said second portion are each positioned in respective ones of said first and second recesses of said first portion.

47. The retractor of claim 46, wherein:

said first and second extensions of said first portion each contact an engagement surface in each of said first and second recesses of said second portion in said expanded configuration; and

said first and second extensions of said second portion each contact an engagement surface in each of said first and second recesses of said first portion in said expanded configuration.

48. A refractor for percutaneous surgery in a patient, comprising:

a first portion extending between a proximal end and a distal end, said first portion including a collar extending about said proximal end; and

a second portion extending between a proximal end and a distal end, said second portion including a collar extending about said proximal end, said first and second portions forming a working channel having a length extending between said distal ends and said proximal ends of said first and second portions and a size between said first and second portions, wherein said collar of said first portion is pivotally coupled to said collar of said second portion and said first and second portions are pivotal relative to one another between an unexpanded configuration and an expanded configuration, wherein in said unexpanded configuration said working channel includes a generally circular cross-section along said length and in said expanded configuration said working channel has a dimension in said second portion transverse to a pivot direction of said first and second portions that is less than a dimension in said first portion transverse to said pivot direction.

49. A retractor for percutaneous surgery in a patient, comprising:

a first portion extending between a proximal end and a distal end, said first portion including a collar extending about said proximal end; and

a second portion extending between a proximal end and a distal end, said second portion including a collar extending about said proximal end, said first and second portions forming a working channel having a length extending between said distal ends and said proximal ends of said first and second portions and a size between said first and second portions, wherein said collar of said first portion is pivotally coupled to said collar of said second portion and said first and second portions are pivotal relative to one another between an unexpanded configuration and an expanded configuration, wherein said first portion includes opposite edges extending therealong between said proximal end and said distal end and said first portion has a perimeter length between said opposite edges, said perimeter length being greater at said distal end of said first portion than at said proximal end of said second portion.

50. A retractor for percutaneous surgery in a patient, comprising:

a first portion extending between a proximal end and a distal end, said first portion including a collar extending about said proximal end; and

a second portion extending between a proximal end and a distal end, said second portion including a collar extending about said proximal end, said first and second portions forming a working channel having a length extending between said distal ends and said proximal ends of said first and second portions and a size between said first and second portions, wherein said collar of said first portion is pivotally coupled to said collar of said second portion and said first and second portions are pivotal relative to one another between an unexpanded configuration and an expanded configuration, wherein said first portion includes opposite edges extending therealong between said proximal end and said distal end and said second portion includes opposite edges extending therealong between said proximal end and said distal end, said second portion further including an engagement surface extending along at least a portion of each of said opposite edges thereof.

51. The retractor of claim 50, wherein said opposite edges of said first portion engage adjacent ones of said engagement surfaces of said second portion when said first and second portions are in said expanded configuration.

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

making an incision in the skin and tissue of the patient to access the location;

forming a working channel through the incision to the location by sequentially dilating tissue and inserting a distal end of a retractor into the patient with a proximal end of the retractor located outside of the patient; and

pivoting a first portion of the retractor relative to a second portion of the retractor about a pivot axis adjacent the proximal end of the retractor to expand the working channel through the incision.

53. The method of claim 52, further comprising:

mounting an expansion instrument on the proximal end of the retractor before pivoting the first portion relative to the second portion.

54. The method of claim 52, further comprising:

positioning a viewing element to view the location through the retractor.

55. The method of claim 52, wherein forming the working channel includes sequentially dilating skin and tissue through the incision before inserting the distal end of the refractor.

56. The method of claim 52, wherein the pivot axis is located proximally of the proximal end of the retractor.

57. The method of claim 56, wherein the retractor defines a working channel therethrough that is substantially enclosed by the retractor.

58. The method of claim 56, wherein the retractor is expanded by pivoting a first portion of the retractor relative to a second portion of the retractor about a pivot axis adjacent the proximal end of the retractor.

59. The method of claim 56, wherein the location is adjacent the spinal column of the patient.

60. A surgical method for accessing a location in a patient, comprising:

sequentially dilating tissue of the patient to the location;

placing an unexpanded retractor through the sequentially dilated tissue;

expanding the retractor predominantly in a first direction through the tissue; and

performing a surgical procedure through the expanded retractor.

61. A surgical method for accessing a location in a patient, comprising:

placing an unexpanded retractor through sequentially dilated tissue to the location;

expanding the retractor to an expanded configuration;

unexpanding the retractor before removing the retractor; and

removing the retractor from the patient.

62. The method of claim 61, further comprising locking the retractor in the expanded configuration.

63. The method of claim 62, further comprising unlocking the retractor before unexpanding the retractor.

64. The method of claim 61, wherein the retractor is expanded by pivoting a first portion of the retractor relative to a second portion of the retractor about a pivot axis adjacent a proximal end of the retractor.

65. The method of claim 64, wherein the pivot axis is located proximally of the proximal end of the retractor.

66. A tissue retractor for surgery in a patient, comprising:

a first portion and a second portion coupled to 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 extending therealong between said distal ends and said proximal ends of said first and second portions; and

said first and second portions have an unexpanded configuration wherein said working channel has a generally circular cross-section and an expanded configuration wherein said working channel has a non-circular cross-section tapering from said distal end to said proximal end, wherein said first portion substantially envelopes said second portion in said unexpanded configuration.

67. The refractor of claim 66, wherein said first and second portions are locked in said expanded configuration.

68. The retractor of claim 66, wherein said first portion has a flexible body.

69. The refractor of claim 66, wherein said first portion is pivotally coupled to said second portion at said proximal ends thereof.

70. The retractor of claim 66, wherein said first portion is pivotally coupled to said second portion along a pivot axis located proximally of said proximal ends of said first portion and said second portion.

71. A tissue retractor for surgery in a patient, comprising:

a first portion and a second portion coupled to 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 extending therealong between said distal ends and said proximal ends of said first and second portions; and

said first and second portions have an unexpanded configuration wherein said working channel has a generally circular cross-section and an expanded configuration wherein said working channel has a non-circular cross-section tapering from said distal end to said proximal end, wherein said second portion includes a partial cylindrical body and said first portion includes a partial cylindrical body positioned about said partial cylindrical body of said second portion.