Methods, systems and devices for carpal tunnel release

• US 8,613,745 B2
• Filed: 05/20/2011
• Issued: 12/24/2013
• Est. Priority Date: 10/15/2004
• Status: Active Grant

• Current Assignee: Spinal Elements, Inc.
• Original Assignee: Baxano Surgical, Inc.
• Inventors: Bleich, Jeffery L.
• Primary Examiner(s): BOLES, SAMEH RAAFAT
• Application Number:
  US13/112,918
• Publication Number:
  US 20110224710A1
• Time in Patent Office: 949 Days
• Field of Search: 606/79, 606/85, 606/103, 606/110, 606/119, 606/131, 606/163, 606171-176, 606/167
• US Class Current: 606/79
• CPC Class Codes: A61B 17/149 Chain, wire or band saws
• CPC Class Codes: A61B 17/1671 for the spine
• 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 17/32053 Punch like cutting instruments, e.g. using a cylindrical or oval knife A61B17/326 takes precedence; trepans A61B17/1695; for use on the cornea A61F9/007
• CPC Class Codes: A61B 17/320758 with a rotating cutting instrument, e.g. motor driven A61B17/320725, A61B17/32075 and A61B17/320783 take precedence; for removing intra-ocular material A61F9/00763; endoscopic rotatable cutting instruments A61B17/32002
• CPC Class Codes: A61B 17/3401 Puncturing needles for the peridural or subarachnoid space or the plexus, e.g. for anaesthesia local anaesthesia A61M19/00
• 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 17/3421 Cannulas
• CPC Class Codes: A61B 17/3496 Protecting sleeves or inner probes; Retractable tips for protecting body piercing guide needles A61M25/0612
• CPC Class Codes: A61B 18/02 by cooling, e.g. cryogenic techniques devices for cooling specific reflex points of the body within cell-life limits A61H39/06
• CPC Class Codes: A61B 18/04 by heating by applying electromagnetic radiation A61B18/18; hyperthermia using electric or magnetic fields, radiation or ultrasound A61N
• CPC Class Codes: A61B 18/1442 Probes having pivoting end effectors, e.g. forceps
• CPC Class Codes: A61B 18/1477 Needle-like probes
• CPC Class Codes: A61B 18/1487 Trocar-like, i.e. devices producing an enlarged transcutaneous opening
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/00287 Bags for minimally invasive surgery
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/00867 shape memory effect for prostheses A61F2210/0014
• CPC Class Codes: A61B 2017/320004 : abrasive
• CPC Class Codes: A61B 2017/320044 : Blunt dissectors blunt suture needles A61B2017/06085
• CPC Class Codes: A61B 2017/32006 : with a cutting strip, band or chain, e.g. like a chainsaw
• CPC Class Codes: A61B 2017/3445 : used as instrument channel for multiple instruments catheters A61B2017/22072
• CPC Class Codes: A61B 2017/3447 : Linked multiple cannulas
• CPC Class Codes: A61B 2018/00577 : Ablation
• CPC Class Codes: A61B 2018/00589 : Coagulation
• CPC Class Codes: A61B 2018/1407 : Loop
• CPC Class Codes: A61B 2018/1425 : Needle
• CPC Class Codes: A61B 2090/061 : for measuring dimensions, e.g. length
• CPC Class Codes: A61B 2090/08021 : of the patient or his organs
• CPC Class Codes: A61B 90/04 : Protection of tissue around surgical sites against effects of non-mechanical surgery, e.g. laser surgery protection of eyes against laser radiation A61F9/022
• CPC Class Codes: A61N 1/0551 : Spinal or peripheral nerve electrodes
• CPC Class Codes: A61N 1/36017 : with leads or electrodes penetrating the skin

Abstract

Described herein are methods, systems, and devices for performing a minimally invasive carpal tunnel release procedure to cut a target transverse carpal ligament. In some embodiments, the method may include the steps of advancing a probe percutaneously though a patient'"'"'s skin from a first location, advancing a tissue modification device from the first location and between the target ligament and non-target tissue so that a proximal handle on the tissue modification device extends from the patient at the first location, attaching a distal handle in communication with the distal end of the tissue modification device. In some embodiments, a system may include a probe configured to be advanced percutaneously though a patient'"'"'s skin from a first location, a tissue modification device comprising a proximal handle and a flexible distal region having uni-directional blades, and a distal handle configured to connect to the distal end of the tissue modification device.

Claims

1. A method of performing a minimally invasive carpal tunnel release procedure to cut a target transverse carpal ligament, the method comprising:

advancing a probe percutaneously through a patient'"'"'s skin from a first location;

advancing a tissue modification device from the first location and between the target ligament and non-target tissue so that a proximal handle on the tissue modification device extends from the patient at the first location, wherein the tissue modification device includes a flexible distal region having uni-directional blades, wherein the tissue modification device comprises an atraumatic cover forming an aperture through which the blades may engage the target ligament;

attaching a distal handle in communication with the distal end of the tissue modification device, wherein the distal handle extends from the patient at a second location; and

reciprocating the tissue modification device using the proximal handle and distal handles to incise the transverse carpal ligament with the uni-directional blades.

2. The method of claim 1, wherein reciprocating further comprises tensioning the tissue modification device to urge the blades towards the target ligament.

3. The method of claim 1, further comprising verifying correct device placement with a nerve stimulator.

4. The method of claim 3, further comprising attaching a nerve stimulator to a tissue modification device assembly.

5. A method of performing a minimally invasive carpal tunnel release procedure to cut a target transverse carpal ligament, the method comprising:

advancing a tissue modification device through a small incision at a first location on a subject'"'"'s skin and between the target ligament and non-target tissue so that a proximal handle on the tissue modification device extends from the patient at the first location, wherein the tissue modification device includes a flexible distal region having uni-directional blades, wherein the tissue modification device comprises an atraumatic cover forming an aperture through which the blades may engage the target ligament;

attaching a distal handle in communication with the distal end of the tissue modification device, wherein the distal handle extends from the patient at a second location; and

reciprocating the tissue modification device using the proximal handle and distal handles to incise the transverse carpal ligament with the uni-directional blades.

6. The method of claim 5, wherein reciprocating further comprises tensioning the tissue modification device to urge the blades towards the target ligament.

7. The method of claim 5, further comprising verifying correct device placement with a nerve stimulator.

8. The method of claim 7, further comprising attaching a nerve stimulator to a tissue modification device assembly.

9. A method for modifying a transverse carpal ligament in a patient, the method comprising:

advancing a distal portion of an elongate tissue modification device into the patient'"'"'s body and along a path between target and non-target tissues, such that a distal end of the distal portion exits the patient'"'"'s body, wherein the tissue modification device comprises an atraumatic cover forming an aperture through which one or more tissue modifying members may engage the target ligament;

applying a first force to a distal portion of the tissue modification device outside the patient;

applying a second force to a proximal portion of the tissue modification device, the first and second forces urging one or more tissue modifying members of the tissue modification device against the target tissue; and

reciprocating at least a portion of the tissue modification device back and forth to cause the one or more tissue modifying members to modify the target tissue.

10. The method of claim 9, wherein the target tissue is the transverse carpal ligament.

11. The method of claim 10, wherein reciprocating at least a portion of the tissue modification device back and forth causes the one or more tissue modifying members incise the transverse carpal ligament.

12. The method of claim 9, further comprising coupling a first handle with the distal portion of the tissue modification device outside the patient and applying the first force to the distal handle.