Access systems and methods for minimally invasive surgery

• US 20050273133A1
• Filed: 08/26/2004
• Published: 12/08/2005
• 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: DiPoto, Gene P., Shluzas, Alan E., Stoeckmann, Walter, Kirk, Karl Dallas III
• Granted Patent: US 7,179,225 B2
• Time in Patent Office: Days
• US Class Current: 606/198
• CPC Class Codes: A61B 1/00149 using articulated arms
• CPC Class Codes: A61B 1/00154 using guiding arrangements for insertion
• 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 1/3135 for examination of the epidural or the spinal space
• CPC Class Codes: A61B 17/00 Surgical instruments, devices or methods, e.g. tourniquets A61B18/00 takes precedence; contraceptive devices, pessaries, or applicators therefor A61F6/00; eye surgery A61F9/007; ear surgery A61F11/00
• CPC Class Codes: A61B 17/02 for holding wounds open; Tractors specula A61B1/32 ; drainage appliances for wounds A61M27/00
• CPC Class Codes: A61B 17/0218 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 17/7037 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 17/7058 : Plates mounted on top of bone anchor heads or shoulders
• 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 17/7085 : for insertion of a longitudinal element down one or more hollow screw or hook extensions, i.e. at least a part of the element within an extension has a component of movement parallel to the extension's axis
• 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 90/11 : with guides for needles or instruments, e.g. arcuate slides or ball joints
• 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

Abstract

A retractor has an elongate body and an expandable shroud. The elongate body has an outer surface and an inner surface partially defining a passage. The elongate body also has a first longitudinal edge and a second longitudinal edge. The elongate body is capable of having an enlarged configuration when inserted within the patient. In the enlarged configuration the first longitudinal edge is spaced apart from the second longitudinal edge. The expandable shroud is configured to extend from the first longitudinal edge to the second longitudinal edge when the first and second edges are spaced apart. The shroud partially defines the passage. The cross-sectional area of said passage at a first location is greater than the cross-sectional area of the passage at a second location, wherein the first location is distal to the second location.

Claims

1. A retractor comprising:

an elongate body having an outer surface, an inner surface partially defining a passage, a first longitudinal edge, and a second longitudinal edge, said elongate body capable of having an enlarged configuration when inserted within the patient wherein the first longitudinal edge is spaced apart from the second longitudinal edge; and

an expandable shroud configured to extend from the first longitudinal edge to the second longitudinal edge when the first and second edges are spaced apart, the shroud partially defining the passage;

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.

2. The retractor of claim 1, wherein the elongate body comprises a distal portion of the retractor and further comprising a proximal portion comprising a first proximal side portion having a first proximal longitudinal edge and a second proximal side portion having a second proximal longitudinal edge, the first and second proximal side portions being movable relative to each other such that the first and second proximal longitudinal edges can be positioned in close proximity to each other or spaced apart.

3. The retractor of claim 2, wherein the shroud is configured to extend from the first proximal longitudinal edge to the second proximal longitudinal edge when the first and second proximal longitudinal edges are spaced apart.

4. The retractor of claim 2, wherein first and second proximal side portions are configured to be spaced apart by a selected amount from the proximal end to the distal end of the proximal portion.

5. The retractor of claim 2, wherein the proximal portion comprises an inside surface at least partially defining the passage, at least a portion of the proximal portion capable of having a circular transverse cross-section.

6. The retractor of claim 2, wherein the proximal portion comprises an inside surface at least partially defining the passage, at least a portion of the proximal portion capable of having a oval transverse cross-section.

7. The retractor of claim 1, wherein the enlarged configuration is a second configuration and the elongate body is capable of having a first configuration for insertion into the patient, the first configuration having a generally circular cross-section and the second configuration having an oblong configuration.

8. The retractor of claim 1, further comprising a first linkage coupled with the elongate body adjacent the first longitudinal edge and the second longitudinal edge, the linkage having a collapsed position and an extended configuration, the extended configuration corresponding to the enlarged configuration of the elongate body.

9. The retractor of claim 8, further comprising a second linkage coupled with the elongate body.

10. The retractor of claim 9, wherein the second linkage is coupled with a third and fourth longitudinal edge of the elongate body, the third longitudinal edge being located on an opposite side of the elongate body from the first longitudinal edge and the fourth longitudinal edge on an opposite side of the elongate body from the second longitudinal edge.

11. The retractor of claim 1, wherein the elongate body has a contracted configuration in which the first and second edges are close together, the expandable shroud configured to contract in the contracted configuration.

12. The retractor of claim 1, wherein the expandable shroud extends substantially entirely around at least a portion of the elongate body.

13. The retractor of claim 1, wherein the expandable shroud comprises a polymeric material.

14. The retractor of claim 1, wherein the expandable shroud comprises an elastomeric material.

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

an elongate body having a longitudinal axis, an outer surface, an inner surface, a proximal end, and a distal portion, said inner surface defining a passage extending through the elongate body along the longitudinal axis through which surgical instruments can be inserted to the surgical location, said elongate body capable of having a configuration when inserted 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 elongate body capable of having a first dimension between said proximal end and said distal portion and a second dimension between said proximal end and said distal portion different from the first dimension.

31. The access device of claim 30, wherein the first dimension is greater than the second dimension.