The invention relates generally to medical devices, and more particularly to methods and apparatus for restricting the movement of a cannula during a surgical procedure.
Minimally invasive or percutaneous surgical procedures often involve the use of catheters and/or cannulas for providing access to internal tissue (e.g., bone, soft tissue, etc.). In such procedures, an opening is formed in the skin, either by making an incision or using a device such as a trocar. Once the opening is formed in the skin, the catheter or cannula can be advanced to a desired location. In connection with certain procedures, the cannula can be advanced into soft tissue and/or a bony structure.
In some surgical procedures, temporary or permanent implants are delivered through a cannula and positioned in a desired location. In some procedures, medical devices, or portions thereof, are removed through the cannula after a procedure is performed. In certain instances, when the force required to remove the medical device through the cannula is greater than the frictional force maintaining the position of the cannula, the cannula can be advanced further into the body, causing tissue damage or inhibiting the removal of the medical device from the body through the cannula. For example, in connection with a spinal procedure, a pod is delivered into a vertebra, filled with a bone cement and then extracted. When the pod is extracted through the cannula, the cannula may have enough frictional force from contact with the bone to prevent movement of the cannula. If the force retaining the pod in the vertebral body is greater than the cannula-bone interface frictional force, however, the extraction of the pod will force the cannula further into the body (i.e., in a distal direction) instead of pulling the pod out of the body (i.e., in a proximal direction).
Thus, a need exists for methods and apparatus for restricting movement of a cannula during a surgical procedure.
In some embodiments, an apparatus includes a first portion and a second portion. The first portion includes a guide member and a coupling portion that collectively define a lumen configured to receive a cannula therethrough. The guide member is configured to move relative to the coupling portion between a first position and a second position when the cannula is disposed within the lumen. The first portion has a first configuration when the guide member is in the first position relative to the coupling portion. The first portion has a second configuration when the guide member is in the second position relative to the coupling portion. The second portion is coupled to a distal end of the first portion. The second portion defining a lumen configured to receive at least a portion of the cannula. The lumen of the second portion is in fluid communication with the lumen of the first portion. The second portion includes a contact surface that is configured to contact a bodily tissue of a patient when at least a portion of the cannula is disposed through the lumen of the second portion and within the body of the patient. The second portion and the first portion are collectively configured to maintain a position of the cannula relative to the bodily tissue when at least a portion of the cannula is disposed through the lumen of the first portion, the lumen of the second portion and within the body of the patient.
Medical devices are described herein. In some embodiments, a medical device includes a retainer having a brace and a body portion. The brace and body portion collectively define an opening configured to receive a cannula therethrough. The brace is configured to be disposed adjacent bodily tissue and the body portion is configured to be disposed between a hub of a cannula and the brace. The body portion is adjustable between multiple configurations such that it is configured to maintain the cannula in position relative to bodily tissue. As described in greater detail herein, in some embodiments, the brace is positioned against a patient's skin. In some embodiments, the brace is positioned against a bony structure. Accordingly, instead of relying completely on the friction between the cannula and the bone to prevent anterior (i.e., distal) advancement of the cannula, the load applied during removal of a medical device through the cannula is distributed onto other tissues. By increasing the area to which the withdrawal forces are applied, the cannula retainer reduces the probability of cannula advancement and associated negative clinical outcomes (e.g., tissue damage, incorrect device placement, etc.).
In some embodiments, the retainer is a modification of the cannula shaft, a modification to the cannula hub or a separate device that is attached to the cannula. The retainer can be permanently attached to the cannula, configured to slidably engage the cannula before placement into the patient, or configured to fit onto the cannula shaft in such a way as to allow installation after the cannula has been positioned in the patient.
In some embodiments, the cannula tip can be modified to include flutes, knurls, threads, etc to increase or supplement frictional forces between the cannula shaft and the bone. Such a modification can be instead of or in addition to use of the retainer as described herein. In other embodiments, the cannula can include a retractable retention mechanism configured to engage the bone to limit movement of the cannula shaft with respect to the bone.
In some embodiments, a method includes forming an opening in a bodily tissue, inserting a cannula into the opening, coupling a retainer to the cannula, and adjusting the retainer to maintain the position of the cannula relative to the bodily tissue. In some embodiments, the cannula is coupled to the retainer before the cannula is inserted in the bodily tissue.
As used in this specification, the words “proximal” and “distal” refer to direction closer to and away from, respectively, an operator (e.g., surgeon, physician, nurse, technician, etc.) who would insert the medical device into the patient, with the tip-end (i.e., distal end) of the device inserted inside a patient's body first. Thus, for example, the end of a medical device first inserted or closest to the inside of the patient's body would be the distal end, while the end of the medical device to last enter the patient's body or furthest from the body would be the proximal end of the medical device.
The retainer 100 includes a brace 110 and a body portion 120. In some embodiments, the brace 110 is configured to be positioned against the skin of a patient. In other embodiments, the brace 110 is configured to be positioned against internal bodily tissue (e.g., a bone) into which the cannula is inserted. In embodiments in which the brace 110 is to be positioned against the bone, the diameter of the brace need only be slightly greater than the diameter of the opening in the bone through which the cannula is inserted.
The body portion 120 can be reconfigured or adjusted to facilitate maintaining the position of the cannula. In some embodiments, a length of the body portion 120 can be changed to prevent advancement of the cannula further into the body. For example, in a first configuration, the body portion has a length L. The body portion 120 is maintained in the first configuration until the cannula is positioned appropriately within the bodily tissue. Once the cannula is inserted to a desired depth/position, the body portion 120 is moved to a second configuration having a length L′, which is at least substantially equal to the distance between the hub H of the cannula C and brace 110.
As discussed in greater detail herein, in some embodiments, the body portion has multiple portions movable relative to one another such that the length of the body portion can change. For example, the body portion 120 can include a first portion and a second portion that are telescopically arranged, threadedly engaged, etc. such that the length L of the body portion can move to length L′.
In some embodiments, prior to insertion of the cannula, the brace 110 is positioned adjacent the body portion 120. After the cannula is inserted into the body and is appropriately positioned, the brace 120 is moved into position (i.e., against the skin or bone).
The body portion 220 is adjustable by moving threaded adjustment portion 222 relative to barrel 224. As the barrel moves along the length of the threaded adjustment portion 222, the overall length of body portion 220 changes. In some embodiments, instead of using the threaded adjustment portion 222 and barrel 224, the body portion can include telescoping portions that are locked in place using friction fit, screws, pins, etc.
Although the retainer 100 shown and described above includes a brace 110 configured to be positioned against the skin of a patient, in other embodiments, a retainer can include a brace that can be at least partially disposed within the body and/or that can be positioned against the internal bodily tissue (e.g., a bone) into which the cannula is inserted. For example,
The internal bodily tissue can be any suitable bodily tissue within which a portion of the cannula C is disposed. For example, as shown in
The retainer 600 includes a brace 610 and a body 620. The brace 610 includes a contact surface 612 and a threaded portion 614. The body 620 includes a threaded portion that corresponds to the threaded portion 614 of the brace 610. In use, the brace 610 and the body 620 are each disposed about the shaft of the cannula C such that the proximal end portion of the body 620 is in contact with the hub H of the cannula, and the brace 610 is threadably coupled to the distal end portion of the body 620. As described above, the brace 610 can be rotated relative to the body 620 and/or the cannula C to adjust the length L between the contact surface 612 of the brace 610 and the hub H of the cannula C. Similarly stated, the brace 610 can be rotated relative to the body 620 and/or the cannula C to adjust the length L of the retainer 600.
In use, the retainer 600 is disposed about the cannula C, and the cannula C is inserted into the body such that a distal end portion of the cannula is within the vertebra and the contact surface 612 is disposed against the outer portion 32 of the vertebra 30. The distance within which the distal end portion of the cannula C is disposed within the vertebra 30 can be adjusted by adjusting the length L of the retainer 600, as described above. In some embodiments, the retainer 600 can be disposed into the body until the contact surface 612 is in position against the bodily tissue, and then the cannula C can be inserted into the body through the retainer 600 until the hub H contacts the proximal portion of the body 620 of the retainer 600.
Although shown in
The size of the distal end portion of the brace 610 (i.e., the portion adjacent the contact surface 612) need only be slightly greater than the size of the opening through the outer portion of the vertebra 30. In this manner, the brace 610 is configured to be disposed into the body via the same incision and/or path through which the cannula C is disposed.
Although the retainer 600 is shown and described as circumscribing the cannula C, in other embodiments, a retainer need only surround a portion of the cannula C. In such embodiments, the retainer can be disposed about the cannula after the cannula has been inserted into the body. For example,
The body 720 includes a threaded portion that corresponds to the threaded portion 714 of the brace 710. The body 720 defines an opening 717 such that the body 720 only partially circumscribes the cannula C. In use, the brace 710 and the body 720 are each disposed about the shaft of the cannula C such that the proximal end portion of the body 720 is in contact with the hub H of the cannula, and the brace 710 is threadably coupled to the distal end portion of the body 720. As described above, the brace 710 can be rotated relative to the body 720 and/or the cannula C to adjust the length L between the contact surface 712 of the brace 710 and the hub H of the cannula C. Similarly stated, the brace 710 can be rotated relative to the body 720 and/or the cannula C to adjust the length L of the retainer 700. Moreover, the openings 715 and 717 allow the retainer 700 to be disposed about the cannula C after the cannula C is disposed into the body.
While various embodiments of the invention have been described above, it should be understood that they have been presented by way of example only, and not limitation. Where methods described above indicate certain events occurring in certain order, the ordering of certain events may be modified. Additionally, certain of the events may be performed concurrently in a parallel process when possible, as well as performed sequentially as described above.
This application claims priority to and the benefit of U.S. Patent Provisional Application No. 61/515,139, filed Aug. 4, 2011, entitled “Apparatus and Method for Restricting Movement of a Cannula during a Surgical Procedure,” which is incorporated herein by reference in its entirety.
Number | Date | Country | |
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61515139 | Aug 2011 | US |