Method and apparatus for performing retro peritoneal dissection

• US 9,717,403 B2
• Filed: 10/21/2014
• Issued: 08/01/2017
• Est. Priority Date: 12/05/2008
• Status: Active Grant

• Current Assignee: Jeffrey B. Kleiner
• Original Assignee: Jeffrey B. Kleiner
• Inventors: Adair, Jeffrey, Wiggins, Kevin, Kleiner, Jeffrey
• Primary Examiner(s): NEAL, TIMOTHY JAY
• Application Number:
  US14/519,880
• Publication Number:
  US 20150094533A1
• Time in Patent Office: 1,015 Days
• CPC Class Codes: A61B 1/00103 designed for single use
• CPC Class Codes: A61B 1/00135 Oversleeves mounted on the endoscope prior to insertion
• CPC Class Codes: A61B 1/00154 using guiding arrangements for insertion
• CPC Class Codes: A61B 1/05 characterised by the image sensor, e.g. camera, being in the distal end portion
• CPC Class Codes: A61B 1/0607 for annular illumination
• CPC Class Codes: A61B 1/0684 using light emitting diodes [LED]
• CPC Class Codes: A61B 1/07 using light-conductive means, e.g. optical fibres
• 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 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 2017/00022 Sensing or detecting at the treatment site
• CPC Class Codes: A61B 2017/00991 Telescopic means
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61B 2017/0262 with a provision for protecting nerves
• CPC Class Codes: A61B 2090/306 using optical fibres
• CPC Class Codes: A61B 2090/309 using white LEDs
• CPC Class Codes: A61B 5/4893 Nerves
• CPC Class Codes: A61B 90/361 Image-producing devices, e.g. surgical cameras

Abstract

The foregoing application describes a system and method of performing a minimally invasive surgical operation. More specifically, the invention involves the use of disposable cannula and slender dilators of variable lengths, which incorporate a source of illumination to carry light to a surgical site and video capabilities for capturing and displaying images from a CMOS or CCD camera device. According to one embodiment, fiber optics run semi-circumferentially or along walls of the cannula/dilator and terminate at about a centimeter from the distal end of the cannula/dilator, thereby preventing illumination from “bottoming out” at the floor of the incision. According to one alternate embodiment, the light fibers may be fashioned in an annulus around one or more camera chips to provide illumination and video of the surgical site. In still another embodiment, the light fibers may be replaced by light emitting diodes in a more remote light source or alternatively at the distal-tip of the CMOS or CCD camera device.

Claims

1. A cannula system for accessing a surgical target site, comprising:

a plurality of sequentially sized dilator cannulas deliverable along a path to a targeted surgery site to create an operative corridor;

the plurality of sequentially sized dilator cannulas having a first end, a second end, and a longitudinal length therebetween, at least one of said sequentially sized dilator cannulas having a first end and a second end and a generally tubular body therebetween, said plurality of dilator cannulas having a non-circular cross-sectional shape having multiple radii of curvature the cross-sectional shape being symmetric about a first plane and asymmetric about a second plane, the first plane and second plane being disposed substantially perpendicular to one another, and wherein the cross-sectional shape comprises an inwardly deflecting portion such that a perimeter of the cross-section comprises at least two points of inflection;

a pilot member being configured to introduce said plurality of dilator cannulas toward the targeted surgery site to create an operative corridor to said surgical target site, said pilot member passing through a bore in said at least one of said sequentially sized dilator cannulas, said bore formed through the generally tubular body and extending from the first end to the second end;

wherein one of said sequentially sized cannulas is a working cannula that maintains the operative corridor, said working cannula having an inner surface defining a path for receiving surgical instruments, and wherein the dilator cannulas progressively expand the operative corridor so as to avoid impingement of areas with higher concentrations of nerve structures.

2. The cannula system of claim 1, wherein the cannulas are coupled to one another by way of a compression fit.

3. The cannula system of claim 1, wherein the working cannula has an oblong, elliptical cross-section with a width of about 20 mm about a major axis and a width of about 16 mm about a minor axis, said working cannula being from 3 cm to 10 cm in length.

4. The cannula system of claim 1, wherein the working cannula has a shape selected from the group consisting of crescent-shaped, half-sphere shape, half-oval shape, and half round cross-sectional shape.

5. The cannula system as set forth in claim 1, wherein the cannulas are secured to each other by an interlocking fit that permits the cannula system to expand in a telescoping fashion.

6. The cannula system as set forth in claim 1, further comprising a camera insert comprising one or more CMOS or CCD camera devices.

7. The cannula system as set forth in claim 6, wherein said one or more CMOS or CCD devices have at least one wireless transmitter for transmitting images captured by the one or more CMOS or CCD devices to a display.

8. The cannula system of claim 1, wherein said sequentially sized cannulas have a shape that is asymmetrical to allow visualization of a facet joint.

9. The cannula system as set forth in claim 1, wherein the cannulas are disposable and interlocked in a predetermined configuration that permits the cannula system to expand in a telescoping fashion.

10. The cannula system as set forth in claim 1, further comprising a camera insert comprising one or more CMOS or CCD camera devices;

at least one slot disposed on an interior surface of the bore of the cannula configured to receive the camera insert within the at least one slot of the cannula; and

at least one second channel configured to insert one or more illumination devices.

11. The cannula system as set forth in claim 10, wherein said one or more CMOS or CCD devices have at least one wireless transmitter for transmitting images captured by the one or more CMOS or CCD devices to a display.

12. The cannula system according to claim 1, wherein one or more illumination devices are operably associated with said working cannula, said illumination devices comprised of fiber optic strands or bundles.

13. The cannula system according to claim 1 wherein one or more illumination devices are arranged circumferentially along at least one of said cannulas.

14. The cannula system according to claim 1, wherein the shape of the cannulas have an egg-shaped cross section.

15. The cannula system according to claim 1, further comprising a probe comprised of one or more electrodes powered at a low level to sense the position of nerves.

16. The cannula system according to claim 1, wherein at least one of the cannulas is an expandable tip cannula which functions both as an access portion for spinal surgery and as a system for nerve surveillance, such that the presence and relative position of para-spinal nerves of a patient can be detected as the expandable tip cannula is inserted through the patient'"'"'s facia and musculature.

17. The cannula system according to claim 1, wherein said cannulas are asymmetrical about their lengths.

18. The cannula system according to claim 1, wherein the surgical target site is the facet joint of a patient and said cannulas allow visualization of the facet joint of the spine.

19. The cannula system according to claim 1, wherein said cannulas are disposable.

20. The cannula system according to claim 1, wherein said cannulas include channels for inserting one or more fiber optic bundles for providing illumination.

21. The cannula system according to claim 1, wherein at least one of the plurality of sequentially sized dilator cannulas has an angle at the second end.

22. The cannula system according to claim 1, wherein said second end of said cannulas has a curved distal end.

23. The cannula system according to claim 1, wherein said cannulas have sloped surfaces at their second end for accommodating access in viewing of an implant site.

24. The cannula system according to claim 1, wherein said cannulas have bottom openings and top openings, said bottom openings being angled oblique to the top openings.

25. The cannula system according to claim 1, further comprising a screw for securing the cannula system to the surgical target site.

26. The cannula system according to claim 1, wherein at least one of the cannulas include at least one channel for inserting a screw.

27. The cannula system according to claim 1, wherein the cannulas are interlocking cannulas.

28. The cannula system according to claim 1, wherein said cannulas are configured to be interlocked in a predetermined configuration that permits said cannulas to expand in a telescoping fashion.

29. The cannula system according to claim 1, wherein at least one of the cannulas has a wall thickness that is uniform and does not vary in thickness around the perimeter of the cannulas.