Method for performing a surgical procedure and a cannula for use in performing the surgical procedure

• US 7,674,273 B2
• Filed: 10/05/2004
• Issued: 03/09/2010
• Est. Priority Date: 08/20/1998
• Status: Active Grant

• Current Assignee: Zimmer Spine, Inc. (Zimmer Biomet Holdings, Inc.)
• Original Assignee: Zimmer Spine, Inc. (Zimmer Biomet Holdings, Inc.)
• Inventors: Taylor, Timothy E., Sher, Adam, Davison, Thomas W.
• Primary Examiner(s): Milano; Michael J
• Assistant Examiner(s): Nguyen; Victor X
• Application Number:
  US10/958,505
• Publication Number:
  US 20050043754A1
• Time in Patent Office: 1,981 Days
• Field of Search: 606/108, 606/191, 606/198, 606205-210, 606/127, 604/104, 604/105, 604/164.05, 604/264
• US Class Current: 606/198
• 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 17/0293 with ring member to support retractor elements
• CPC Class Codes: A61B 17/1735 for rasps or chisels
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/282 Jaws
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/320016 Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes A61B10/0233, A61B17/29, A61B17/3207 take precedence
• CPC Class Codes: A61B 17/32002 with continuously rotating, oscillating or reciprocating cutting instruments
• CPC Class Codes: A61B 17/3421 Cannulas
• 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 2017/00238 Type of minimally invasive operation A61B2017/00805 takes precedence
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/0046 with a releasable handle; with handle and operating part separable for prosthetic joint-implanting tools A61F2/4603

Abstract

A method of performing a surgical procedure on a body includes providing a cannula having a tubular structure with first and second tubular portions defining first and second passages for receiving surgical instruments. The second tubular portion is inserted inside the body and the first tubular portion is inserted so that the first tubular portion extends from an exterior of the body to inside the body. The second tubular portion expands to increase the cross-sectional area of the second passage in the second tubular portion while the second tubular portion is inside the body. The cross-sectional area of the first passage in the first tubular portion is maintained. The first tubular portion has a first thickness and the second tubular portion has a second thickness different than the first thickness.

Claims

1. A method for providing minimally invasive access to a spinal location of a patient, said method comprising:

inserting an access device through the skin of a patient, the access device having a first access portion having a first outer surface and a first inner surface at least partially defining a passage for receiving a plurality of surgical instruments, the access device having a second access portion attached to said first access portion, the second access portion having a second outer surface and a second inner surface at least partially defining the passage for receiving at least one surgical instrument;

positioning the access device in the patient such that a proximal portion thereof is outside the patient and a distal portion is near the spine;

inserting an expander device into the access device;

actuating the expander device to cause opposing portions of the distal portion of the access device to move in a direction generally transverse to a longitudinal axis of the passage, thereby moving the access device from a contracted condition to an expanded condition, causing the outer surface of the distal portion to retract the tissue surrounding the spine to provide a surgical field for the spinal surgical procedure;

pivoting the proximal portion of the access device from a first position to a second position adapted to enhance the visibility and access of the surgical field; and

inserting an instrument through the passage to perform a procedure on the spine.

2. The method of claim 1, wherein the first access portion comprises a portion of the proximal portion.

3. The method of claim 1, wherein the second access portion comprises a portion of the distal portion.

4. The method of claim 3, wherein the first access portion comprises a portion of the proximal portion.

5. The method of claim 4, wherein said access device further comprises a fastener and the pivoting is provided about said fastener.

6. The method of claim 5, wherein the first access portion comprises a first hole and the second access portion comprises a second hole, the fastener extending through the first hole and the second hole.

7. The method of claim 6, wherein the fastener comprises a rivet.

8. The method of claim 1, wherein the second access portion comprises an arcuate segment that is rolled such that first and second opposite ends overlap in an area where the first end extends over the second end.

9. The method of claim 8, wherein the overlap area is reduced by actuating the expander device.

10. The method of claim 9, wherein said access device further comprises a fastener and the pivoting is provided about said fastener.

11. The method of claim 10, wherein the first access portion comprises a first hole and the second access portion comprises a second hole, the fastener extending through the first hole and the second hole.

12. The method of claim 10, wherein the fastener comprises a rivet.

13. The method of claim 1, further comprising forming an incision in the skin of the patient and inserting the access device through the incision.

14. The method of claim 1, further comprising:

advancing a first surgical instrument through the passage to the spinal location; and

inserting a second surgical instrument into the passage while the first surgical instrument is in the passage.

15. The method of claim 1, wherein the passage has a width in the second access portion that is greater than about 14 mm.

16. The method of claim 1, wherein the passage has a width in the second access portion that is between about 14 mm and about 36 mm.

17. The method of claim 1, wherein actuating the expander device in the access device causes the second access portion to be shaped like a portion of a cone.

18. The method of claim 1, wherein the first access portion comprises a tubular portion.

19. The method of claim 18, wherein the second access portion is coupled with the tubular portion and extends distally therefrom.

20. The method of claim 1, wherein the cross-sectional area of a portion of the passage in the distal portion is approximately constant before and after actuating the expander tool.

21. The method of claim 1, wherein the access device further comprises a first edge and a second edge, the first edge and second edge cooperating to limit movement of the distal portion of the access device.

22. The method of claim 21, wherein the access device comprises an arcuate slot and a guide member disposed in said arcuate slot, the first edge defining an edge of the slot and the second edge defining a portion of the guide member.

23. A method for providing minimally invasive access to a spinal location of a patient, said method comprising:

inserting an access device through the skin of a patient, the access device having a first access portion having a first outer surface and a first inner surface at least partially defining a passage for receiving a plurality of surgical instruments, the access device having a second access portion attached to said first access portion, the second access portion formed of an arcuate segment of sheet stock having first and second opposite ends, the sheet rolled into a tubular shape with overlapping first and second ends, the sheet having a second outer surface and a second inner surface at least partially defining the passage for receiving at least one surgical instrument;

inserting the access device through an incision in the patient such that a proximal portion thereof is outside the patient and a distal portion is near the spine;

inserting an expander device into the access device

actuating the expander device to cause opposing portions of the distal portion of the access device to moved in a direction generally transverse to a longitudinal axis of the passage, thereby moving the access device from a contracted condition to an expanded condition causing the outer surface of the distal portion to retract the tissue surrounding the spine to provide a surgical field for the spinal surgical procedure;

pivoting the proximal portion of the access device from a first position to a second position adapted to enhance the visibility and access of the surgical field; and

inserting an instrument through the passage to perform a procedure on the spine.

24. A method for providing minimally invasive access to a spinal location of a patient, said method comprising:

inserting an access device through the skin of a patient, the access device having a first access portion having a first outer surface and a first inner surface at least partially defining a passage for receiving a plurality of surgical instruments, the access device having a second access portion attached to said first access portion, the second access portion having a second outer surface and a second inner surface at least partially defining the passage for receiving at least one surgical instrument, the second access portion having an arcuate slot and a guide member disposed in the arcuate slot;

positioning the access device in the patient such tat a proximal portion thereof is outside the patient and a distal portion is near the spine;

inserting an expander device into the access device

actuating the expander device to cause the guide member of the access device to move from a first terminal end of the slot toward a second terminal end of the slot to move opposing portions of the distal portion of the access device in a direction generally transverse to a longitudinal axis of the passage, thereby moving the access device from a contracted condition to an expanded condition, thereby increasing a cross sectional area of the passage and causing the outer surface of the distal portion to retract the tissue surrounding the spine to provide a surgical field for the spinal surgical procedure;

pivoting the proximal portion of the access device from a first position to a second position adapted to enhance the visibility and access of the surgical field; and

inserting an instrument through the passage to perform a procedure on the spine.