US 7,001,397 B2Grant
Cannula for receiving surgical instruments
Issue Date:2006-02-21
•57 Claims
•3 Drawing Sheets
Abstract
Methods and cannulae for providing access to a surgical location within a patient are described. A cannula (10) receives surgical instruments (120) for performing a surgical procedure on a body (130). The cannula (10) comprises a tube structure (12) defining a passage (16) through which the surgical instruments (120) are inserted into the body (130). The tube structure (12) has a proximal end (20) and a distal end (62). The tube structure (12) includes an expandable portion (40) for enabling an increase in the cross-sectional area of the passage (16) at the distal end (62). The expandable portion (40) of the tube structure (12), when expanded, has a conical configuration.
Metadata
Assignee
- Endius Incorporated
Inventors
- Thomas W. Davison
- Timothy E. Taylor
- Adam Sher
Application Information
Application Number:US 10/440,002
Filing Date:2003-05-16
Priority Date:1998-08-20
Art Unit:3731
Classifications
IPC:
A61B17/00
Patent Drawings (3 sheets)
Description
Priority Information
[0001] This application is a continuation of U.S. application Ser. No. 09/772,605, filed Jan. 30, 2001, now U.S. Pat. No. 6,800,084 which is a continuation-in-part of U.S. application Ser. No. 09/137,335, filed Aug. 20, 1998, now U.S. Pat. No. 6,187,000.
Technical Field
[0002] The present invention is directed to a cannula for receiving surgical instruments for performing a surgical procedure on a body.
Background of the Invention
[0003] Endoscopic surgical techniques allow a surgical procedure to be performed on a patient's body through a relatively small incision in the body and with a limited amount of body tissue disruption. Endoscopic surgery typically utilizes a tubular structure known as a cannula which is inserted into a small incision in the body. The cannula holds the incision open and serves as a conduit extending between the exterior of the body and the local area inside the body where the surgery is to be performed.
[0004] Due to the relatively small size of the passage into the body which is defined by the cannula, certain surgical procedures, such as posterior discectomies and procedures using steerable surgical instruments, have been difficult to perform using endoscopic techniques.
Summary of the Invention
[0005] The present invention is a cannula for receiving surgical instruments for performing a surgical procedure on a body. In one embodiement, the cannula comprises a tube structure defining a passage through which the surgical instruments are inserted into the body. The tube structure has a proximal end and a distal end. The tube structure includes an expandable portion for enabling an increase in the cross-sectional area of the passage at least at the distal end.
[0006] The expandable portion of the tube structure, when expanded, has a conical configuration. The expandable portion of the tube structure includes an arcuate slot and a guide pin disposed in the arcuate slot. The guide pin is movable from a terminal end of the slot to a second terminal end of the slot to enable the cross-sectional area of the passage at the distal end to increase.
[0007] The tube structure includes first and second tubular portions attached to one another. The second tubular portion comprises the expandable portion. The first tubular portion comprises a length of stainless steel tubing and the second tubular portion comprises an arcuate segment of stainless steel sheet stock rolled into a tubular shape.
Brief Description of the Drawings
[0008] The foregoing and other features of the present invention will becomes apparent to one skilled in the art to which the present invention relates upon consideration of the following description of the invention with reference to the accompanying drawings, wherein:
[0009] FIG. 1 is an exploded perspective view of a surgical cannula constructed in accordance with the present invention, the cannula being shown in an expanded condition;
[0010] FIG. 2 is a perspective view of the cannula of FIG. 1 with parts removed for clarity, the cannula being shown in a contracted condition;
[0011] FIG. 3 is a schematic end view showing the cannula of FIG. 1 in the expanded position;
[0012] FIG. 4 is a roll out view of a part of the cannula of FIG. 1 ; and
[0013] FIG. 5 is a schematic sectional view of the cannula of FIG. 1 during a surgical procedure.
Detailed Description of the Preferred Embodiment
[0014] The present invention is directed to a cannula for receiving surgical instruments for performing a surgical procedure on the body of a patient. The present invention is applicable to a variety of surgical procedures in which endoscopic surgical techniques are used.
[0015] FIG. 1 illustrates a cannula 10 constructed according to the present invention. The cannula 10 is a tubular structure 12 centered on an axis 14. The tubular structure 12 defines a passage 16 through the cannula 10. Surgical instruments are inserted into the body during endoscopic surgery through the passage 16.
[0016] The tubular structure 12 comprises a first tubular portion 20 and a second tubular portion 40 attached to the first tubular portion. The first tubular portion 20 is preferably made of a length of stainless steel tubing, but could alternatively be made of another suitable material. The first tubular portion 20 has a proximal end 22 and a distal end 24. Parallel cylindrical inner and outer surfaces 26 and 28, respectively, extend between the ends 22, 24 of the first tubular portion 20. The inner surface 26 defines a first passage portion 30 of the passage 16 through the cannula 10. The first passage portion 30 has a diameter D1 which is preferably in the range from 10 mm to 20 mm.
[0017] The second tubular portion 40 of the tubular structure 12 is attached to the distal end 24 of the first tubular portion 20. The second tubular portion is preferably made from stainless steel, but could alternatively be made from another suitable material.
[0018] As best seen in the rollout view of FIG. 4 , the second tubular portion 40 comprises an arcuate segment 42 of sheet stock. The arcuate segment 42 includes first and second arcuate edges 44 and 46, respectively, and first and second planar edges 48 and 50, respectively. The first and second planar edges 48 and 50 are rolled in an overlapping manner to form the tubular configuration of the second tubular portion 40.
[0019] When the second tubular portion 40 has been rolled into its tubular configuration, the first and second arcuate edges 44 and 46 define oppositely disposed first and second ends 60 and 62 (FIGS. 1 and 2 ), respectively, of the second tubular portion. The first and second ends 60 and 62 are connected by a central portion 64. The first end 60 of the second tubular portion 40 is attached to the distal end 24 of the first tubular portion 20 by a single fastener, such as a rivet 66. The rivet 66 extends through two aligned apertures 68 (FIG. 4 ) at the first end 60 of the second tubular portion 40. The first end 60 of the second tubular portion 40 is pivotable about the rivet 66.
[0020] The second tubular portion 40 includes parallel inner and outer surfaces 70 and 72 (FIGS. 1 and 2 ), respectively, extending between the first and second ends 60 and 62. The inner surface 70 defines a second passage portion 74 of the passage 16 through the cannula 10 which extends as a continuation of the first passage portion 30 in the first tubular portion 20.
[0021] An arcuate slot 80 is formed in the second tubular portion 40 and extends between the inner and outer surfaces 70 and 72 of the second tubular portion. The arcuate slot 80 extends along a curvilinear path in the central portion 64 of the second tubular portion 40 toward the second end 60 of the second tubular portion. The arcuate slot 80 has a first terminal end 82 located in the central portion 64 of the second tubular portion 40. A second terminal end 84 of the arcuate slot 80 is located adjacent the intersection of the second arcuate edge 46 and the first planar edge 48 of the arcuate segment 42.
[0022] A guide pin 90 is attached to the inner surface 70 of the second tubular portion 40 adjacent the intersection of the second arcuate edge 46 and the second planar edge 50. In the tubular configuration of the second tubular portion 40, the guide pin 90 is located in the arcuate slot 80 and is movable along the curvilinear path of the arcuate slot. A washer 92 is secured to an inner end of the guide pin 90 to retain the guide pin in the arcuate slot 80.
[0023] The second tubular portion 40 of the tubular structure 12 is expandable from a contracted condition shown in FIG. 2 to an expanded condition shown in FIG. 1 . In the contracted condition, the guide pin 90 is located in the first terminal end 82 of the arcuate slot 80 in the second tubular portion 40 and the second passage portion 74 defined by the second tubular portion is cylindrical in shape. The second passage 74 has a generally constant diameter D2 (FIGS. 2 and 3 ) which is approximately equal to the diameter D1 of the first tubular portion 20. Thus, the cross-sectional area of the second passage portion 74 at the second end 62 of the second tubular portion 40, which is a function of the diameter D2, is approximately the same as the cross-sectional area at the first end 60 of the second tubular portion and is approximately the same as the cross-sectional area of the first passage portion 30 in the first tubular portion 20.
[0024] In the expanded condition, the guide pin 90 is located in the second terminal end 84 of the arcuate slot 80 in the second tubular portion 40 and the second tubular portion has a conical configuration. At the second end 62 of the second tubular portion 40, the second passage portion 74 has a diameter D3 (FIG. 3 ) which is larger than the diameter D2 of the second passage portion at the first end 60. Preferably, the diameter D3 of the second passage portion 74 at the second end 62 of the second tubular portion 40 is 40% to 80% greater than the diameter D2 of the second passage portion at the first end 60. Thus, in the expanded condition, the cross-sectional area of the second passage portion 74 at the second end 62 of the second tubular portion 40, which is a function of the diameter D3, is 40% to 80% greater than the cross-sectional area of the second passage portion at the first end 60 of the second tubular portion.
[0025] The cannula 10 includes an outer layer 100 (FIG. 1 ) for maintaining the second tubular portion 40 of the cannula in the contracted condition. It is contemplated that other suitable means for maintaining the second tubular portion 40 in the contracted condition could be employed. In accordance with a preferred embodiment of the present invention, the outer layer 100 comprises a section of plastic tubing 102 which is heat shrunk over both the first and second tubular portions 20 and 40 to hold the second tubular portion in the contracted condition.
[0026] In addition, a loop of nylon string 104 for tearing the heat shrink tubing 102 is wrapped around the heat shrink tubing so that it extends both underneath and on top of the tubing. An outer end 106 of the string 104 extends beyond the tubing 102.
[0027] The cannula 10 further includes an actuatable device 110 for expanding the second tubular portion 40 from the contracted condition to the expanded condition. In accordance with a preferred embodiment of the present invention, the actuatable device 110 comprises a manually operated expansion tool 112. The expansion tool 112 resembles a common pair of scissors and has a pair of legs 114 pivotally connected to one another. The expansion tool 112 includes a frustoconical end section 116 formed by a pair of frustoconical halves 118. Each of the frustoconical halves 118 extends from a respective one of the legs 114 of the expansion tool 112. It is contemplated that other suitable means for expanding the second tubular portion 40 toward the expanded condition could be employed, such as an inflatable balloon (not shown).
[0028] During an endoscopic surgical procedure, the cannula 10 is inserted in the contracted condition into the body of a patient. The outer end 106 of the string 104 is then manually pulled on by the surgeon. Pulling on the string 104 tears the heat shrink tubing 102 which is then removed from the cannula 10 by the surgeon. With the heat shrink tubing 102 removed, the second tubular portion 40 of the cannula 10 is thereby released for expansion toward the expanded condition.
[0029] Next, the expansion tool 112 is inserted into the passage 16 in the cannula 10 until the frustoconical end section 114 is located at the second end 62 of the second tubular portion 40. The legs 118 of the expansion tool 112 are manually separated, causing the frustoconical halves 118 to separate also. As the halves 118 separate, a radially outwardly directed force is exerted on the inner surface 70 of the second tubular portion 40 by the halves 118, causing the second tubular portion to expand toward the expanded condition. Under the force of the expanding expansion tool 112, the guide pin 90 slides from the first terminal end 82 of the arcuate slot 80 to the second terminal end 84 of the arcuate slot to permit the expansion of the second tubular portion 40. The expansion tool 112 can be rotated about the axis 14 to ensure that the second tubular portion 40 of the cannula 10 is completely expanded to the expanded condition. The expansion tool 112 is then collapsed and removed so that one or more surgical instruments (indicated schematically at 120 in FIG. 5 ) and a viewing element can be received through the cannula 10 and inserted into a patient's body 130. The expandable second tubular portion 40 of the cannula 10 provides a significantly larger working area for the surgeon inside the body 130 within the confines of the cannula.
[0030] The expandable second tubular portion 40 of the cannula 10 provides a significantly larger working area for the surgeon inside the body 130 within the confines of the cannula. As a result, the simultaneous use of a number of endoscopic surgical instruments, including but not limited to steerable instruments, shavers, dissectors, scissors, forceps, retractors, dilators, and video cameras, is made possible by the expandable cannula 10.
[0031] It is contemplated that the cannula 10 described herein could be the centerpiece of a endoscopic surgical kit which would include an assortment of surgical instruments designed and/or selected for use with the cannula.
[0032] From the above description of the invention, those skilled in the art will perceive improvements, changes and modifications. Such improvements, changes and modifications within the skill of the art are intended to be covered by the appended claims.
Claims
What is claimed is:
1. A method for providing access to a vertebral location within a patient, the method comprising:
providing an elongate body and an outer member, said elongate body having a proximal end, a distal end, an outer surface and an inner surface, said inner surface defining a passage extending through the elongate body and through which surgical instruments can be inserted to the vertebral location, said outer member at least partially surrounding and contacting said outer surface;
inserting said distal end of said elongate body into the patient such that the distal end resides proximate the vertebral location; and
configuring said elongate body so that 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, wherein configuring said elongate body causes said outer surface to engage body tissue.
2. The method of claim 1, wherein configuring said elongate body comprises expanding said elongate body.
3. The method of claim 1, wherein configuring said elongate body comprises configuring said elongate body as a cone.
4. The method of claim 1, wherein the first location is at a distal end of the elongate body, and the second location is at a proximal end of the elongate body.
5. The method of claim 1, further comprising providing a tubular portion attached to said elongate body, the tubular portion extending proximally therefrom.
6. The method of claim 5, wherein providing said elongate body comprises providing a second tubular portion.
7. The method of claim 6, wherein configuring said elongate body comprises expanding said second tubular body.
8. The method of claim 1, wherein inserting said elongate body into the patient further comprises inserting the elongate body through an incision in the skin to the vertebral location.
9. The method of claim 1, wherein configuring the elongate body further comprises moving the elongate body from a first configuration to a second configuration, wherein when the elongate body is in the second configuration 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.
10. The method of claim 1, wherein providing the elongate body further comprises providing an elongate body having a width greater than about 14 mm.
11. The method of claim 1, wherein providing the elongate body further comprises providing an elongate body having a width between about 14 mm and about 36 mm.
12. The method of claim 1, wherein said elongate body comprises rigid material extending around substantially the entire perimeter of the cross-sectional area between the first and second locations.
13. The method of claim 1, wherein inserting further comprises inserting the elongate body into the patient such that the proximal end remains outside the patient.
14. The method of claim 1, wherein the elongate body comprises a first elongate member at least partially defining said inner surface and a second elongate member pivotably coupled with the first elongate member, wherein at least the second elongate member is configured to at least partially reside adjacent the skin of the patient.
15. The method of claim 14, wherein the first elongate member comprises a distally expandable conical structure and the second elongate member comprises a non-expanding proximal portion.
16. A method for providing access to a spinal location within a patient, the method comprising:
providing an elongate body having a distal end, a proximal end, an outer surface, an inner surface, a first planar edge, a second planar edge, and a gap extending from the outer surface to the inner surface between the first and second planar edges, said inner surface defining a passage extending through the elongate body and through which surgical instruments can be inserted to the spinal location, and said first and second planar edges extending to the proximal end and the distal end of said elongate body;
inserting the distal end of said elongate body through an incision in the skin of the patient to the spinal location; and
expanding said elongate body so that a first distance extending transversely to a longitudinal axis of said elongate body at the distal end of the elongate body is greater than a second distance extending transversely to a longitudinal axis of said elongate body at the proximal end of the elongate body.
17. The method of claim 16, comprising expanding said elongate body so that 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.
18. The method of claim 16, wherein the inner surface defines a major axis being the largest distance across said passage, and comprising expanding said elongate body such that the major axis at a first location is greater than the major axis at a second location, wherein the first location is distal to the second location.
19. The method of claim 18, wherein said elongate body has an inner surface defining a minor axis being the smallest distance across said passage, wherein said minor axis and said major axis at a location are about equal.
20. The method of claim 16, wherein inserting further comprises inserting the elongate body such that the proximal end remaining outside the patient.
21. The method of claim 16, wherein expanding said elongate body further comprises moving the first planar edge relative to the second planar edge to increase an exposed area of said gap between said first and second planar edges.
22. The method of claim 16, wherein said elongate body comprises a length of stainless steel sheet stock and said gap is an arcuate slot in said steel sheet stock.
23. The method of claim 22, wherein said gap is configured to define the path of travel of a guide pin attached to the inner surface of the elongate body.
24. The method of claim 23, further comprising providing an outer member at least partially surrounding said elongate body and contacting said outer surface.
25. The method of claim 24, further comprising expanding said elongate body so that the cross-sectional area of the 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.
26. The method of claim 16, further comprising inserting said elongate body through an incision formed posterior of the spine and laterally of the spinous process.
27. The method of claim 16, further comprising inserting a dilator into the patient.
28. The method of claim 16, further comprising inserting a viewing instrument into the elongate body and directing the viewing instrument toward the distal end of the elongate body.
29. The method of claim 28, wherein the viewing instrument is a camera.
30. The method of claim 28, further comprising inserting a dissector simultaneously with the viewing instrument.
31. The method of claim 16, further comprising performing a discectomy through the elongate body.
32. The method of claim 16, wherein the elongate body comprises a first elongate member at least partially defining said inner surface and a second elongate member pivotably coupled with the first elongate member, wherein at least the second elongate member is configured to at least partially reside adjacent the skin of the patient.
33. The method of claim 32, wherein the first elongate member comprises a distally expandable conical structure and the second elongate member comprises a non-expanding proximal portion.
34. A method for providing access to a spinal location within a patient, the method comprising:
providing an elongate body and an outer member, said elongate body having a proximal end, a distal end, an outer surface and an inner surface, said inner surface defining a passage extending through the elongate body and through which surgical instruments can be inserted to the spinal location, said outer member at least partially surrounding and contacting said outer surface, the elongate body being actuatable between a contracted configuration and an expanded configuration;
inserting said distal end of said elongate body into the patient such that the distal end resides proximate the spinal location, said elongate body remaining in its contracted configuration until the distal end resides proximate the spinal location; and
actuating said elongate body from its collapsed configuration to its expanded configuration after said distal end is proximate the spinal location.
35. The method of claim 34, said outer member at least partially limiting expansion of said elongate body until said distal end resides proximate the spinal location.
36. The method of claim 34, wherein the outer member comprises a plastic outer tubular layer.
37. The method of claim 34, wherein the outer member restrains at least the proximal end of the elongate body.
38. The method of claim 34, further comprising disengaging the outer member to allow the elongate body to take on the expanded configuration.
39. The method of claim 38, further comprising providing a release device coupled with the outer member that is accessible at the proximal end of the elongate body.
40. The method of claim 39, wherein the release device is accessible at the proximal end of the elongate body.
41. The method of claim 39, wherein the release device is positioned between the outer member and the elongate body.
42. The method of claim 34, wherein the elongate body includes an area of overlap between the inner surface of the elongate body and the outer surface of the elongate body, and wherein expanding the elongate body comprises reducing the amount of overlap between the inner surface of the elongate body and the outer surface of the elongate body.
43. The method of claim 34, wherein inserting further comprises inserting the elongate body such that the proximal end remains outside the patient.
44. The method of claim 34, said elongate body further comprising a first planar edge, a second planar edge, and a gap extending from the outer surface to the inner surface between the first and second planar edges, said first and second planar edges extending to the proximal end and the distal end of said elongate body.
45. The method of claim 34, wherein the elongate body comprises a first elongate member at least partially defining said inner surface and a second elongate member pivotably coupled with the first elongate member, wherein at least the second elongate member is configured to at least partially reside adjacent the skin of the patient.
46. The method of claim 45, wherein the first elongate member comprises a distally expandable conical structure and the second elongate member comprises a non-expanding proximal portion.
47. A method for providing access to a surgical location within a patient, the method comprising:
providing an elongate body having a proximal end, a distal end, an outer surface, an inner surface, a first planar edge, a second planar edge, and a gap extending from the outer surface to the inner surface between the first and second planar edges, said inner surface at least partially defining a passage extending through the elongate body and through which surgical instruments can be inserted to the surgical location, said first and second planar edges extending to the distal end of said elongate body, the elongate body being actuatable between a contracted configuration and an expanded configuration;
inserting said distal end of said elongate body into the patient such that the distal end resides proximate the surgical location;
engaging an expansion tool with the elongate body;
rotating the expansion tool while the elongate body is being expanded from its contracted configuration to its expanded configuration; and
disengaging the expansion tool from the elongate body.
48. The method of claim 47, wherein the elongate body includes an area of overlap between the inner and outer surfaces, and actuating the expansion tool to expand the elongate body reduces the area of overlap between the inner and outer surfaces.
49. The method of claim 47, wherein the distal end of the elongate body is inserted proximate to a spinal location with the patient.
50. The method of claim 47, wherein expanding the elongate body causes the outer surface to engage tissue.
51. The method of claim 47, wherein inserting said distal end of said elongate body further comprises inserting the elongate body such that the proximal end remaining outside the patient.
52. The method of claim 47, wherein the elongate body comprises a first elongate member at least partially defining said inner surface and a second elongate member pivotably coupled with the first elongate member, wherein at least the second elongate member is configured to at least partially reside adjacent the skin of the patient.
53. The method of claim 52, wherein the first elongate member comprises a distally expandable conical structure and the second elongate member comprises a non-expanding proximal portion.
54. A method for providing access to a spinal location within a patient, the method comprising:
providing an elongate body and an outer member, said elongate body having a proximal end, a distal end, an outer surface and an inner surface, said inner surface defining a passage extending through the elongate body and through which surgical instruments can be inserted to the spinal location, the elongate body being actuatable between a contracted configuration and an expanded configuration, said outer member at least partially surrounding and contacting said outer surface;
inserting said distal end of said elongate body into the patient such that the distal end resides proximate the spinal location; and
applying a force adjacent a proximal end of an expansion device to rotate a distal portion of the expansion device about a pivot, whereby said elongate body is expanded from its contracted configuration to its expanded configuration.
55. The method of claim 54, wherein the expansion device comprises a first leg extending between the proximal end and the distal portion and a second leg extending between the proximal end and the distal portion, the first and second legs being coupled at the pivot for rotation thereabout.
56. The method of claim 54, wherein when the force is applied adjacent to the proximal end, the distal portion rotates into contact with the inner surface to apply a force to the inner surface.
57. The method of claim 54, wherein the elongate body further comprises a first planar edge, a second planar edge, and a gap extending from the outer surface to the inner surface between the first and second planar edges, said first and second planar edges extending to the proximal end and the distal end of said elongate body.
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