TREA

Method for performing a surgical procedure and a cannula for use in performing the surgical procedure

Follow

Information

  • Patent Grant
  • 6811558
  • Patent Number
    6,811,558
  • Date Filed
    Friday, May 9, 2003
    21 years ago
  • Date Issued
    Tuesday, November 2, 2004
    20 years ago
Information
Abstract
A method of performing a surgical procedure on a body includes providing a cannula having a tubular structure with first and second tubular portions defining first and second passages for receiving surgical instruments. The second tubular portion is inserted inside the body and the first tubular portion is inserted so that the first tubular portion extends from an exterior of the body to inside the body. The second tubular portion expands to increase the cross-sectional area of the second passage in the second tubular portion while the second tubular portion is inside the body. The cross-sectional area of the first passage in the first tubular portion is maintained. The first tubular portion has a first thickness and the second tubular portion has a second thickness different than the first thickness.
Description




TECHNICAL FIELD




The present invention is directed to a method for performing a surgical procedure on a body and a cannula for receiving surgical instruments during the surgical procedure.




BACKGROUND OF THE INVENTION




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.




Due to the relatively small size of the passage into the body which is defined by the cannula, certain surgical procedures, such as posterior disectomies and procedures using steerable surgical instruments, have been difficult to perform using endoscopic techniques.




SUMMARY OF THE INVENTION




The present invention is a method for performing a surgical procedure on a body and a cannula for receiving surgical instruments during the surgical procedure. In one embodiment, the method of performing the surgical procedure on the body includes providing the cannula having a tubular structure with first and second tubular portions defining first and second passages for receiving surgical instruments. The second passage is a continuation of the first passage.




The cannula is inserted through an incision in the body. The second tubular portion is inserted inside the body and the first tubular portion is inserted into the incision so that the first tubular portion extends from an exterior of the body to inside the body. The second tubular portion of the cannula expands to increase the cross-sectional area of the second passage in the second tubular portion while the second tubular portion is inside the body. The cross-sectional area of the first passage in the first tubular portion is maintained.




The first tubular portion of the cannula has a first thickness measured in a direction perpendicular to inner and outer surfaces of the first tubular portion. The second tubular portion has a thickness measured in a direction perpendicular to inner and outer surfaces of the second tubular portion. The first thickness is different than the second thickness.











BRIEF DESCRIPTION OF THE DRAWINGS




The foregoing and other features of the present invention will become 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:





FIG. 1

is an exploded perspective view of a surgical cannula constructed in accordance with a first embodiment of the present invention, the cannula being shown in an expanded condition;





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;





FIG. 3

is a schematic end view showing the cannula of

FIG. 1

in the expanded position;





FIG. 4

is a rollout view of a part of the cannula of

FIG. 1

;





FIG. 5

is a schematic sectional view of the cannula of

FIG. 1

during a surgical procedure;





FIG. 6

is a perspective view of a part of a surgical cannula constructed in accordance with a second embodiment of the present invention, the cannula being shown in an expanded condition;





FIG. 7

is a perspective view of the part of the cannula of

FIG. 6

, the cannula being shown in a contracted condition;





FIG. 8

is a perspective view of a part of a surgical cannula constructed in accordance with a third embodiment of the present invention, the cannula being shown in an expanded Condition; and





FIG. 9

is a sectional view of a portion of the cannula of

FIG. 8

showing a rivet connecting a first tubular portion to a second tubular portion.











DESCRIPTION OF THE INVENTION




The present invention is directed to a method for performing a surgical procedure on the body of a patient and a cannula for receiving surgical instruments during the surgical procedure. The present invention is applicable to a variety of surgical procedures in which endoscopic surgical techniques are used.





FIG. 1

illustrates a cannula


10


constructed according to a first embodiment of 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


.




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 such as a radiolucent 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 D


1


which is preferably in the range from 10 mm to 20 mm or approximately 0.4 inches to approximately 0.8 inches.




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 such as a radiolucent material.




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


.




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 suitable 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


.




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


.




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


.




A suitable guide member, such as 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


.




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 D


2


(

FIGS. 2 and 3

) which is approximately equal to the diameter D


1


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 D


2


, 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


.




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 D


3


(

FIG. 3

) which is larger than the diameter D


2


of the second passage portion at the first end


60


. Preferably, the diameter D


3


of the second passage portion


74


at the second end


62


of the second tubular portion is


40


is 40% to 80% greater than the diameter D


2


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 D


3


, is greater than the cross-sectional area of the second passage portion at the first end


60


of the second tubular portion.




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.




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


.




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).




During an endoscopic surgical procedure, the cannula


10


is inserted in the contracted condition through an incision into the body of a patient. The second tubular portion


40


is inserted inside the body. The first tubular portion


20


is inserted into the incision so that the first tubular portion extends from an exterior of the body to inside the body.




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.




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


114


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

) 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. 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


.




A cannula


150


constructed according to a second embodiment of the present invention is illustrated in

FIGS. 6-7

. The cannula


150


includes a tubular structure


152


centered on an axis


154


. The tubular structure


152


defines a passage


156


through the cannula


150


. Surgical instruments are inserted into the body during endoscopic surgery through the passage


156


.




The tubular structure


152


(

FIG. 6

) comprises a first tubular portion


160


and a second tubular portion


180


attached to the first tubular portion. The first tubular portion


160


is preferably made of a length of stainless steel tubing, but could alternatively be made of another suitable material, such as a radiolucent material. The first tubular portion


160


has a proximal end


162


and a distal end


164


. Parallel cylindrical inner and outer surfaces


166


and


168


extend between the ends


162


,


164


of the first tubular portion


160


. The first tubular portion


160


has a thickness measured perpendicular to the surfaces


166


and


168


in the range of 0.02 inches to 0.04 inches or approximately 0.5 mm to approximately 1.0 mm.




The inner surface


166


defines a first passage portion


170


of the passage


156


through the cannula


150


. The first passage portion


170


has a diameter d


1


which is preferably in the range from 10 mm to 20 mm or approximately 0.4 inches to approximately 0.8 inches. The inner surface


166


has a non-reflective coating


174


. The non-reflective coating


174


reduces glare on any video image produced by a video camera inserted through the passage


156


. It is contemplated that the inner surface


166


may not have the coating


174


.




The second tubular portion


180


(

FIG. 6

) of the tubular structure


152


is attached to the distal end


164


of the first tubular portion


160


. The second tubular portion


180


is preferably made from stainless steel, but could alternatively be made from another suitable material, such as a radiolucent material.




The second tubular portion


180


includes an arcuate segment


182


of sheet stock. The arcuate segment


182


includes first and second arcuate edges


184


and


186


. The arcuate segment


182


also includes a first planar edge


188


and a second planar edge extending between the arcuate edges


184


and


186


, which is not shown in FIG.


6


. The first and second planar edges are rolled in an overlapping manner to form the tubular configuration of the second tubular portion


180


.




When the second tubular portion


180


has been rolled into its tubular configuration, the first and second arcuate edges


184


and


186


define oppositely disposed first and second ends


200


and


202


of the second tubular portion. The first and second ends


200


and


202


are connected by a central portion


204


. The first end


200


of the second tubular portion


180


is attached to the distal end


164


of the first tubular portion


160


by a suitable fastener, such as a screw


206


and nut


208


threaded on the screw. It is contemplated that the second tubular portion


180


could be connected to the first tubular portion


160


by a rivet. The screw


206


extends through two aligned apertures


240


at the first end


200


of the second tubular portion


180


. The first end


200


of the second tubular portion


180


is pivotable about the screw


206


.




The second tubular portion


180


includes parallel inner and outer surfaces


212


and


214


extending between the first and second ends


200


and


202


. The inner surface


212


defines a second passage portion


216


of the passage


156


through the cannula


150


which extends as a continuation of the first passage portion


170


in the first tubular portion


160


. The second tubular portion


180


has a thickness measured perpendicular to the surfaces


212


and


214


in the range of 0.003 inches to 0.005 inches or approximately 0.075 mm to approximately 0.125 mm. The inner surface


212


has a non-reflective coating


218


. The non-reflective coating


218


reduces glare on any video image produced by a camera inserted through the passage


156


. It is contemplated that the inner surface


212


may not have the coating


218


.




An arcuate slot


220


(

FIG. 6

) is formed in the second tubular portion


180


and extends between the inner and outer surfaces


212


and


214


of the second tubular portion. The arcuate slot


220


extends along a curvilinear path in the central portion


204


of the second tubular portion


180


toward the end


184


of the second tubular portion. The arcuate slot


220


has a first terminal end (not shown) located in the central portion


204


of the second tubular portion


180


. A second terminal end


224


of the arcuate slot


220


is located adjacent the intersection of the second arcuate edge


186


and the planar edge


188


of the arcuate segment


182


.




A guide member or screw


230


is attached to the inner surface


212


of the second tubular portion


180


adjacent the intersection of the second arcuate edge


186


and the planar edge (not shown). It is contemplated that a guide pin could be used instead of the screw


230


. In the tubular configuration of the second tubular portion


180


, the guide member


230


is located in the arcuate slot


220


and is movable along the curvilinear path of the arcuate slot.




The second tubular portion


180


of the tubular structure


152


is expandable from a contracted condition, shown in

FIG. 7

, to an expanded condition, shown in FIG.


6


. In the contracted condition (FIG.


7


), the guide member


230


is located in the first terminal end (not shown) of the arcuate slot


220


in the second tubular portion


180


and the second passage portion


216


defined by the second tubular portion is cylindrical in shape. The second passage


216


has a generally constant diameter d


2


which is approximately equal to the diameter d


1


of the first tubular portion


160


. Thus, the cross-sectional area of the second passage portion


216


at the second end


202


of the second tubular portion


180


, which is a function of the diameter d


2


, is approximately the same as the cross-sectional area at the first end


200


of the second tubular portion and is approximately the same as the cross-sectional area of the first passage portion


170


in the first tubular portion


160


.




In the expanded condition (FIG.


6


), the guide member


230


is located in the second terminal end


224


of the arcuate slot


220


in the second tubular portion


180


and the second tubular portion has a conical configuration. At the second end


202


of the second tubular portion


180


, the second passage portion


216


has a diameter d


3


which is larger than the diameter d


2


of the second passage portion at the first end


200


. Preferably, the diameter d


3


of the second passage portion


216


at the second end


202


of the second tubular portion


180


is 40% to 80% greater than the diameter d


2


of the second passage portion at the first end


200


. Thus, in the expanded condition, the cross-sectional area of the second passage portion


216


at the second end


202


of the second tubular portion


180


, which is function of the diameter d


3


, is greater than the cross-sectional area of the second passage portion at the first end


200


of the second tubular portion.




The cannula


150


includes an outer member (not shown) for maintaining the second tubular portion


180


of the cannula in the contracted condition. It is contemplated that other suitable means for maintaining the second tubular portion


180


in the contracted condition could be employed. In accordance with the present invention, the outer member may be similar to the layer


100


shown in FIG.


1


and include a section of plastic tubing which is heat shrunk over both the first and second tubular portions


160


and


180


to hold the second tubular portion in the contracted condition. In addition, a loop of nylon string (not shown) for tearing the heat shrink tubing is wrapped around the heat shrink tubing so that it extends both underneath and on top of the tubing. An outer end of the string extends beyond the tubing.




During an endoscopic surgical procedure, the cannula


150


is inserted in the contracted condition through an incision into the body of a patient. The second tubular portion


180


is inserted inside the body. The first tubular portion


160


is inserted into the incision so that the first tubular portion extends from an exterior of the body to inside the body.




The outer end of the string is then manually pulled on by the surgeon. Pulling on the string tears the heat shrink tubing which is then removed from the cannula


150


by the surgeon. With the heat shrink tubing removed, the second tubular portion


180


of the cannula


150


is thereby released for expansion toward the expanded condition.




Next, the expansion tool


112


, shown in

FIG. 1

, is inserted into the passage


156


in the cannula


150


until the frustoconical end section


114


is located at the second end


202


of the second tubular portion


180


. The legs


114


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


212


of the second tubular portion


180


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 member


230


slides from the first terminal end of the arcuate slot


220


to the second terminal end of the arcuate slot to permit the expansion of the second tubular portion


180


. The expansion tool


112


can be rotated about the axis


154


to ensure that the second tubular portion


180


of the cannula


150


is completely expanded to the expanded condition. The expansion tool


112


is then collapsed and removed so that one or more surgical instruments can be received through the cannula


150


and inserted into a patient's body.




The thickness of the second tubular portion


180


allows the second tubular portion to deform as the second tubular portion expands. As the second tubular portion


180


expands and engages tissue in the body, the tissue resists expansion of the second tubular portion. The second tubular portion


180


must deform slightly to prevent the second tubular portion from being damaged while expanding.




The expandable second tubular portion


180


of the cannula


150


provides a significantly larger working area for the surgeon inside the body 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


150


.




A cannula


250


constructed according to a third embodiment of the present invention is illustrated in

FIGS. 8-9

. In the embodiment of the invention illustrated in

FIGS. 6-7

the tubular portions


160


and


180


are connected by a screw


206


and nut


208


and the guide member is a screw


230


. In the embodiment of the invention illustrated in

FIGS. 8-9

the tubular portions are connected by a rivet and the guide member is a rivet. The cannula


250


is generally similar to the cannula


150


shown in

FIGS. 6-7

. Accordingly, only the rivets will be described in detail.




The cannula


250


(

FIG. 8

) includes a tubular structure


252


centered on an axis


254


. The tubular structure


252


defines a passage


256


through the cannula


250


. The tubular structure


252


includes a first tubular portion


260


and a second tubular portion


280


attached to the first tubular portion. The first tubular portion


260


has a proximal end


262


and a distal end


264


. Parallel cylindrical inner and outer surfaces


266


and


268


extend between the ends


262


,


264


of the first tubular portion


260


. The inner surface


266


defines a first passage portion


270


of the passage


256


through the cannula


250


. The inner surface


266


could have a non-reflective coating (not shown).




The second tubular portion


280


(

FIG. 8

) of the tubular structure


252


is attached to the distal end


264


of the first tubular portion


260


. The second tubular portion


280


includes an arcuate segment


282


of sheet stock. The arcuate segment


282


includes first and second arcuate edges


284


and


286


. The arcuate segment


282


also includes a first planar edge


288


and a second planar edge extending between the arcuate edges


284


and


286


, which is not shown in FIG.


8


. The first and second planar edges are rolled in an overlapping manner to form the tubular configuration of the second tubular portion


280


.




When the second tubular portion


280


has been rolled into its tubular configuration, the first and second arcuate edges


284


and


286


define oppositely disposed first and second ends


300


and


302


of the second tubular portion. The first and second ends


300


and


302


are connected by a central portion


304


. The first end


300


of the second tubular portion


280


is attached to the distal end


264


of the first tubular portion


260


by a rivet


306


. The rivet


306


extends through two aligned apertures


340


at the first end


300


of the second tubular portion


280


. The first end


300


of the second tubular portion


280


is pivotable about the rivet


306


.




The rivet


306


(

FIGS. 8 and 9

) has a first portion


308


and a second portion


310


. The first portion


308


has a shaft


312


extending from a head


314


. The shaft


312


extends through the apertures


340


in the tubular portion


280


and the head


314


engages the inner surface


266


of the first tubular portion


260


. A cylindrical opening


316


extends through the shaft


312


and the head


314


.




The second portion


310


of the rivet


306


has a shaft


318


extending from a head


320


. The shaft


318


extends into the opening


316


in the first portion


308


of the rivet


306


and the head


320


engages the second tubular portion


280


. The shaft


318


of the second portion


310


extends into the opening


316


in the first portion


308


to connect the first and second portions of the rivet


306


and pivotally connect the second tubular portion


280


to the first tubular portion


260


.




The second tubular portion


280


(

FIG. 8

) includes parallel inner and outer surfaces


322


and


324


extending between the first and second ends


300


and


302


. The inner surface


322


defines a second passage portion


326


of the passage


256


through the cannula


250


which extends as a continuation of the first passage portion


270


in the first tubular portion


260


. The inner surface


322


could have a non-reflective coating (not shown).




An arcuate slot


330


is formed in the second tubular portion


280


and extends between the inner and outer surfaces


322


and


324


of the-second tubular portion. The arcuate slot


330


extends along a curvilinear path in the central portion


304


of the second tubular portion


280


toward the end


284


of the second tubular portion. The arcuate slot


330


has a first terminal end (not shown) located in the central portion


304


of the second tubular portion


280


. A second terminal end


334


of the arcuate slot


330


is located adjacent the intersection of the second arcuate edge


286


and the planar edge


288


of the arcuate segment


282


.




A rivet


336


is attached to the inner surface


322


of the second tubular portion


280


adjacent the intersection of the second arcuate edge


286


and the planar edge (not shown). It is contemplated that a guide pin could be used instead of the rivet


336


. In the tubular configuration of the second tubular portion


280


, the rivet


336


is located in the arcuate slot


330


and is movable along the curvilinear path of the arcuate slot. The rivet


336


extends through a washer


338


to retain the rivet in the arcuate slot


330


.




The rivet


336


is generally similar to the rivet


306


and, therefore, will not be described in detail. The rivet


336


has a first portion


342


and a second portion


344


. The first portion


342


has a shaft


346


extending from a head


348


. The shaft


346


extends through the slot


330


and the head


348


engages the washer


338


. A cylindrical opening


350


extends through the shaft


346


and the head


348


.




The second portion


344


of the rivet


336


has a shaft


352


extending from a head


354


. The shaft


352


extends into the opening


350


in the first portion


342


of the rivet


336


and the head


354


engages the outer surface


324


of the second tubular portion


280


. The shaft


352


extends into the opening


350


to connect the first portion


342


of the rivet


336


to the second portion


344


.




The second tubular portion


280


of the tubular structure


252


is expandable from a contracted condition to an expanded condition, shown in FIG.


8


. In the contracted condition the rivet


336


is located in the first terminal end (not shown) of the arcuate slot


330


in the second tubular portion


280


and the second passage portion


326


defined by the second tubular portion is cylindrical in shape. The second passage portion


326


has a generally constant diameter which is approximately equal to the diameter of the first tubular portion


260


. Thus, the cross-sectional area of the second passage portion


326


at the second end


302


of the second tubular portion


280


is approximately the same as the cross-sectional area at the first end


300


of the second tubular portion and is approximately the same as the cross-sectional area of the first passage portion


270


in the first tubular portion


260


.




In the expanded condition (FIG.


8


), the rivet


336


is located in the second terminal end


334


of the arcuate slot


330


in the second tubular portion


280


and the second tubular portion has a conical configuration. At the second end


302


of the second tubular portion


280


, the second passage portion


326


has a diameter which is larger than the diameter of the second passage portion at the first end


300


. Thus, in the expanded condition, the cross-sectional area of the second passage portion


326


at the second end


302


of the second tubular portion


280


is greater than the cross-sectional area of the second passage portion at the first end


300


of the second tubular portion.




During an endoscopic surgical procedure, the cannula


250


is inserted in the contracted condition through an incision into the body of a patient. The second tubular portion


280


is inserted inside the body. The first tubular portion


260


is inserted into the incision so that the first tubular portion extends from an exterior of the body to inside the body.




Heat shrink tubing is removed from the cannula


250


by the surgeon. With the heat shrink tubing removed, the second tubular portion


280


of the cannula


250


is thereby released for expansion toward the expanded condition. Next, the expansion tool


112


, shown in

FIG. 1

, is inserted into the passage


256


in the cannula


250


until the frustoconical end section


114


is located at the second end


302


of the second tubular portion


280


. The legs


114


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


312


of the second tubular portion


280


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 rivet


336


slides from the first terminal end of the arcuate slot


330


to the second terminal end


334


of the arcuate slot to permit the expansion of the second tubular portion


280


. The expansion tool


112


is then collapsed and removed so that one or more surgical instruments can be received through the cannula


250


and inserted into a patient's body.




The expandable second tubular portion


280


of the cannula


250


provides a significantly larger working area for the surgeon inside the body 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


250


.




It is contemplated that the cannula


10


,


150


, and/or the cannula


250


described herein could be the centerpiece of an endoscopic surgical kit which would include an assortment of surgical instruments designed and/or selected for use with the cannula.




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
  • 1. A system for providing access in a spinal surgical procedure the system comprising:an access device comprising: a first access portion having a first outer surface for engaging the body of a patient and a first inner surface at least partially defining a passage for receiving a plurality of surgical instruments used to perform the procedure; and a second access portion attached to said first access portion and having a second outer surface for engaging the body of a patient and having a second inner surface at least partially defining a passage for receiving the surgical instruments; the access device having a proximal portion adapted to be positioned outside of the patient and a distal portion adapted to be positioned near the spine, the outer surface of the distal portion of the access device being expandable to retract the tissue surrounding the spine to provide a surgical field for the spinal surgical procedure; the proximal portion of the access device having a non-pivoted position and a pivoted position adapted to enhance the visibility and access of the surgical field; and an expander configured to be inserted into the passage and to engage at least one of the first inner surface and the second inner surface to cause opposing portions of the distal portion to be moved to increase access to the surgical location.
  • 2. A system as set forth in claim 1 wherein said second access portion is expandable to enable enlargement of a cross-sectional area of said passage in said second access portion to a size which is greater than a cross-sectional area of said passage in said first access portion.
  • 3. A system as set forth in claim 2 wherein said passage, when said second access portion is expanded, has a conical configuration.
  • 4. A system as set forth in claim 2 wherein said second access portion has an arcuate slot and a guide member disposed in said arcuate slot, said guide member being movable from a first terminal end of said slot toward a second terminal end of said slot to enable the cross-sectional area of said passage to increase.
  • 5. A system as set forth in claim 1 wherein said second access portion comprises an arcuate segment of sheet stock rolled into a tubular shape.
  • 6. A system for providing access to a surgical location and for receiving surgical instruments for performing a surgical procedure at the surgical location, said system comprising:a device having an inside surface, an outside surface, a proximal end and a distal end, said inside surface of said device defining a passage for receiving surgical instruments extending from said proximal end to said distal end, said device having a contracted condition and an expanded condition, said passage having a first cross-sectional area at said distal end when said device is in said contracted condition, said passage having a second cross-sectional area at said distal end greater than said first cross-sectional area when said device is in said expanded condition, said second cross-sectional area being greater than a cross-sectional area of said passage at said proximal end when said device is in said expanded condition; and an expander configured to be inserted into the passage to engage said inner surface to cause opposing portions of said device to be moved to increase access to the surgical location.
  • 7. A system as set forth in claim 6 wherein said cross-sectional area of said passage at said proximal end when said device is in said expanded condition is approximately equal to a cross-sectional area of said passage at said proximal end when said device is in said contracted condition.
  • 8. A system as set forth in claim 6 wherein said device has a cylindrical configuration when said device is in said contracted condition.
  • 9. A system as set forth in claim 6 wherein said device has a conical configuration when said device is in said expanded condition.
  • 10. A system as set forth in claim 6 wherein said device includes a first edge movable relative to a second edge of said device that said first edge overlaps, said first edge moving relative to said second edge as said device moves between said contracted and said expanded conditions.
  • 11. A system as set forth in claim 10 further including a guide for guiding movement of said first edge relative to said second edge.
  • 12. A system as set forth in claim 11 wherein said guide includes a guide member connected with one of said first and second edges extending into a slot in said device adjacent to the other one of said first and second edges.
  • 13. A system as set forth in claim 10 wherein said first edge is pivotable relative to said second edge.
  • 14. A system as set forth in claim 13 wherein a proximal end of said first edge is pivotally connected to a proximal end of said second edge.
  • 15. A system as set forth in claim 10 wherein said device includes an arcuate segment of sheet stock rolled into a tubular shape.
  • 16. A system as set forth in claim 6 further including a releasable member for maintaining said device in said contracted condition.
  • 17. A system as set forth in claim 6 further including a proximal portion connected with said proximal end of said device, said proximal portion defining a second passage for receiving surgical instruments, said second passage being a continuation of said passage defined by said device.
  • 18. A system as set forth in claim 17 wherein said device is pivotable relative to said proximal portion.
  • 19. A system as set forth in claim 6 wherein said passage has a diameter in the range of 10 mm to 20 mm at said proximal end.
  • 20. A system as set forth in claim 6 wherein said second cross-sectional area of said passage at said distal end is in the range of 40% to 80% greater than said cross-sectional area of said passage at said proximal end when said device is in said expanded condition.
  • 21. A system as set forth in claim 6 further including an endoscope in said passage for viewing a surgical site in a patient's body.
  • 22. A system as set forth in claim 21 further including a surgical instrument in said passage.
  • 23. A system as set forth in claim 6 further including a surgical instrument in said passage.
  • 24. A system for providing access to a surgical location, the system comprising:an access device having a distal portion, a proximal portion, an outer surface, and an inner surface defining a passage extending along an axis through the access device through which a plurality of instruments can be inserted to the surgical location to perform a surgical procedure, the access device having a contracted condition and an expanded condition, the passage having a first cross-sectional area at a first location proximate the distal portion when the access device is in the contracted condition, the passage having a second cross-sectional area at the first location greater than the first cross-sectional area when the access device is in the expanded condition, the second cross-sectional area being greater than a cross-sectional area of the passage at a second location that is proximal of the first location when the device is in the expanded condition; and an expander device configured to be engagable with the access device to cause the access device to be articulated from the contracted condition to the expanded condition and to be disengagable therefrom during the surgical procedure, the expander further configured to pivot the distal portion of the access device with respect to the proximal portion to increase access to the surgical location.
  • 25. The system of claim 24, wherein the access device further comprises a proximal portion extending distally from the proximal portion and a distal portion extending proximally from the distal portion, the proximal and distal portions being pivotably coupled.
  • 26. The system of claim 24, wherein the access device further comprises a pivot joint that couples the proximal portion with the distal portion at a single location.
  • 27. The system of claim 24, wherein the expander device is configured to be inserted into the passage and to engage the inside surface of the access device to articulate the access device from the contracted condition to the expanded condition.
  • 28. The system of claim 24, wherein said access device has a cylindrical configuration when said access device is articulated to said contracted condition.
  • 29. The system of claim 28 wherein said access device has a conical configuration when said access device is articulated to said expanded condition.
  • 30. The system of claim 24, further comprising an endoscope in said passage for viewing the surgical location.
  • 31. The system of claim 24, further including at least one surgical instrument configured to be inserted into the passage.
Parent Case Info

This application is a divisional of U.S. Ser. No. 09/772,605 filed on Jan. 30, 2001 which is a continuation-in-part of U.S. patent application Ser. No. 09/137,335, filed Aug. 20, 1998, now U.S. Pat. No. 6,187,000, issued Feb. 13, 2001.

US Referenced Citations (85)
Number Name Date Kind
3044461 Murdock Jul 1962 A
3789852 Kim et al. Feb 1974 A
4449532 Storz May 1984 A
4451256 Weikl et al. May 1984 A
4545374 Jacobson Oct 1985 A
4601713 Fuqua Jul 1986 A
4716901 Jackson et al. Jan 1988 A
4819620 Okutsu Apr 1989 A
4863133 Bonnell Sep 1989 A
4899729 Gill et al. Feb 1990 A
4921478 Solano et al. May 1990 A
4984564 Yuen Jan 1991 A
5025778 Silverstein et al. Jun 1991 A
5131382 Meyer Jul 1992 A
5139499 Small et al. Aug 1992 A
5163949 Bonutti Nov 1992 A
5171279 Mathews Dec 1992 A
5190561 Graber Mar 1993 A
5195541 Obenchain Mar 1993 A
5197971 Bonutti Mar 1993 A
5224680 Greenstein et al. Jul 1993 A
5232443 Leach Aug 1993 A
5287845 Faul et al. Feb 1994 A
5295994 Bonutti Mar 1994 A
5312417 Wilk May 1994 A
5354302 Ko Oct 1994 A
5370647 Graber et al. Dec 1994 A
5395317 Kambin Mar 1995 A
5439464 Shapiro Aug 1995 A
5454365 Bonutti Oct 1995 A
5472426 Bonati et al. Dec 1995 A
5484437 Michelson Jan 1996 A
5489307 Kuslich et al. Feb 1996 A
5520607 Frassica et al. May 1996 A
5571072 Kronner Nov 1996 A
5575754 Konomura Nov 1996 A
5601590 Bonutti et al. Feb 1997 A
5601690 Gauld et al. Feb 1997 A
5667520 Bonutti Sep 1997 A
5707359 Bufalini Jan 1998 A
5792044 Foley et al. Aug 1998 A
5795289 Wyttenbach Aug 1998 A
5827319 Carlson et al. Oct 1998 A
5865802 Yoon et al. Feb 1999 A
5902231 Foley et al. May 1999 A
5954635 Foley et al. Sep 1999 A
5961499 Bonutti et al. Oct 1999 A
5997508 Lunn et al. Dec 1999 A
6120437 Yoon et al. Sep 2000 A
6162236 Osada Dec 2000 A
6171299 Bonutti Jan 2001 B1
6187000 Davison et al. Feb 2001 B1
6306170 Ray Oct 2001 B2
6312443 Stone Nov 2001 B1
6338730 Bonutti et al. Jan 2002 B1
6358266 Bonutti Mar 2002 B1
6361488 Davison et al. Mar 2002 B1
6371968 Kogasaka et al. Apr 2002 B1
6383195 Richard May 2002 B1
6494893 Dubrul et al. Dec 2002 B2
6497654 Leonard et al. Dec 2002 B1
6524320 DiPoto Feb 2003 B2
6530880 Pagliuca Mar 2003 B2
6530926 Davison Mar 2003 B1
6564078 Marino et al. May 2003 B1
6652553 Davison et al. Nov 2003 B2
20010011170 Davison et al. Aug 2001 A1
20010049498 Davison et al. Dec 2001 A1
20020002360 Orth et al. Jan 2002 A1
20030009130 Stecker et al. Jan 2003 A1
20030014068 Bonutti et al. Jan 2003 A1
20030040656 Pagliuca et al. Feb 2003 A1
20030073998 Pagliuca et al. Apr 2003 A1
20030139648 Foley et al. Jul 2003 A1
20030153927 DiPoto et al. Aug 2003 A1
20030191371 Smith et al. Oct 2003 A1
20030195405 Marino et al. Oct 2003 A1
20030195493 Davison et al. Oct 2003 A1
20030195549 Davison et al. Oct 2003 A1
20030195550 Davison et al. Oct 2003 A1
20030195551 Davison et al. Oct 2003 A1
20030199871 Foley et al. Oct 2003 A1
20030199885 Davison et al. Oct 2003 A1
20040093002 Davison et al. May 2004 A1
20040097907 DiPoto May 2004 A1
Foreign Referenced Citations (17)
Number Date Country
0 528 562 Feb 1993 EP
0807415 Nov 1997 EP
0 807 415 Aug 1998 EP
0 980 677 Feb 2000 EP
1 305 077 May 2003 EP
2000-83960 Mar 2000 JP
2001-149376 Jun 2001 JP
WO 9221292 Feb 1993 WO
WO 9314801 Aug 1993 WO
WO 9403114 Feb 1994 WO
WO 9510218 Apr 1995 WO
WO 9532663 Dec 1995 WO
WO 0154560 Aug 2001 WO
WO 0154560 Aug 2001 WO
WO 0209801 Feb 2002 WO
WO 02078767 Oct 2002 WO
WO 03007783 Jan 2003 WO
Non-Patent Literature Citations (14)
Entry
U.S. patent application Ser. No. 10/686154, Davison, filed Oct. 15, 2003.
U.S. patent and Trademark Office, Office Action, application No. 10/439,979, Apr. 7, 2004.
Ditsworth, David A., M.D., Surg Neurol, 49; 588-598, 1998 “Endoscopic Transforaminal Lumbar Discectomy and Reconfiguration: A Postero-lateral Approach into the Spinal Canal”.
Endius Marketing Bulletin, 2002, Atavi Atraumatic Spine Fusion System, “How Do I Decompress Using Atavi System?”.
Endius Marketing Bulletin, 2002, Atavi Atraumatic Spine Fusion System, “Minimally Invasive Update on Danek”.
Foley, Kevin T., M.D., et al. Neurosurg Focus, 10:1-8, 2001 “Percutaneous Pedicle Screw Fixation of the Lumbar Spine”.
Guiot, Bernard H., M.D. et al., SPINE, 27, 4:432-438, 2002 “A Minimally Invasive Technique for Decompression of the Lumbar Spine”.
Kambin, Parviz, Publisher Unknown, Chapter 77:1055-1066, Date Unknown “Arthroscopic Lumber Interbody Fusion”.
Kambin, Parviz, Publisher Unknown, Chapter 9:117-121, Date Unknown “Posterlateral Percutaneous Lumbar Interbody Fusion”.
Medtronic Sofamor Danek, METRx MicroEndoscopic Discectomy, 1999 “An Evolution in Minimally Invasive Spine Surgery”.
Medtronic Sofamor Danek, METRx MicroDiscectomy System, 2000 “The Next Step in Minimally Invasive Discectomy Utilizing the Operating Microscope”.
Medtronic Sofmor Danek, METRx Microdiscectomy Surgical Technique, 2001 as described by Donald L. Hilton, Jr., M.D., F.A.C.S. and Sylvain Palmer, M.D., F.A.C.S.
Medtronic Sofamor Danek, Orthopedics Today, 1-20, 20002 “Minimal Access Spinal Technologies”.
Stauber, Martin H. M.D. et al., SPINE, 19, 1:57-61, 1994 “Pedicle Screw Placement with Intraosseous Endoscopy”.
Continuation in Parts (1)
Number Date Country
Parent 09/137335 Aug 1998 US
Child 09/772605 US