U.S. patent application number 15/333983 was filed with the patent office on 2017-09-14 for method and apparatus for accessing the interior of a hip joint, including the provision and use of a novel inflow access cannula.
The applicant listed for this patent is Pivot Medical, Inc.. Invention is credited to Jolene Cutts, Roger Pisarnwongs.
Application Number | 20170258491 15/333983 |
Document ID | / |
Family ID | 45439138 |
Filed Date | 2017-09-14 |
United States Patent
Application |
20170258491 |
Kind Code |
A1 |
Pisarnwongs; Roger ; et
al. |
September 14, 2017 |
METHOD AND APPARATUS FOR ACCESSING THE INTERIOR OF A HIP JOINT,
INCLUDING THE PROVISION AND USE OF A NOVEL INFLOW ACCESS
CANNULA
Abstract
An inflow access cannula system for allowing an instrument to
access a remote surgical site, wherein the instrument comprises a
distal portion having a smaller diameter and a proximal portion
having a larger diameter, the system comprising: an inflow access
cannula comprising a distal end, a proximal end and a central lumen
extending therebetween, wherein the central lumen has a diameter
larger than the distal portion of the instrument and smaller than
the proximal portion of the instrument; and an instrument adapter
for releasable connection to the inflow access cannula, the
instrument adapter comprising a lumen communicating with the
central lumen of the inflow access cannula, the lumen having a
diameter larger than the proximal portion of the instrument, the
instrument adapter further comprising a port and a fluid passageway
connecting the port with the lumen of the instrument adapter, and a
spacer for spacing the proximal portion of the instrument from the
distal end of the inflow access cannula, such that when an
instrument is disposed in the inflow access cannula system so that
the distal portion of the instrument extends within the central
lumen of the inflow access cannula and the proximal portion of the
instrument is disposed in the central lumen of the instrument
adapter and is in engagement with the spacer, fluid can flow into
the port of the instrument adapter, along the fluid passageway of
the instrument adapter, into the lumen of the instrument adapter
and through the lumen of the inflow access cannula.
Inventors: |
Pisarnwongs; Roger;
(Valencia, CA) ; Cutts; Jolene; (San Fransisco,
CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Pivot Medical, Inc. |
Sunnyvale |
CA |
US |
|
|
Family ID: |
45439138 |
Appl. No.: |
15/333983 |
Filed: |
October 25, 2016 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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13177446 |
Jul 6, 2011 |
9474544 |
|
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15333983 |
|
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61361783 |
Jul 6, 2010 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 17/3496 20130101;
A61B 2217/005 20130101; A61B 17/3421 20130101; A61B 2017/3456
20130101; A61B 2217/007 20130101; A61B 2017/3454 20130101; A61B
17/1746 20130101 |
International
Class: |
A61B 17/34 20060101
A61B017/34 |
Claims
1.-15. (canceled)
16. Apparatus for accessing a remote surgical site with an
instrument, the apparatus comprising: an access cannula comprising:
a rigid elongated tube comprising a distal end, a proximal end and
a lumen extending therebetween; and an atraumatic tip mounted to
the distal end of the elongated tube, wherein the atraumatic tip is
overmolded around the tube so that the atraumatic tip extends
radially outboard of the elongated tube and distally beyond the
distal end of the elongated tube, and further wherein the
atraumatic tip comprises barium sulfate in a range between 5 and
30% by weight.
17. (canceled)
18. A method for accessing a remote surgical site with an
instrument, the method comprising: providing an access cannula
comprising: a rigid elongated tube comprising a distal end, a
proximal end and a lumen extending therebetween; and an atraumatic
tip mounted to the distal end of the elongated tube, wherein the
atraumatic tip is overmolded around the tube so that the atraumatic
tip extends radially outboard of the elongated tube and distally
beyond the distal end of the elongated tube, and further wherein
the atraumatic tip comprises barium sulfate in a range between 5
and 30% by weight; advancing the access cannula through tissue to
the surgical site; and advancing the instrument into the lumen of
the access cannula.
19. A method for accessing a remote surgical site with an
instrument, the method comprising: providing an access cannula
comprising: a rigid elongated tube comprising a distal end, a
proximal end and a lumen extending therebetween; and an atraumatic
tip mounted to the distal end of the elongated tube, wherein the
atraumatic tip is overmolded around the tube so that the atraumatic
tip extends radially outboard of the elongated tube and distally
beyond the distal end of the elongated tube, and further wherein
the atraumatic tip comprises barium sulfate in a range between 5
and 30% by weight; providing an instrument adapter for releasable
connection to the access cannula, the instrument adapter being
adapted to mate with an instrument to be extended through the lumen
of the access cannula; advancing the access cannula through tissue
to the surgical site; mounting the instrument adapter to the
instrument; and advancing the instrument into the lumen of the
access cannula so that the instrument adapter mounts to the access
cannula.
20.-23. (canceled)
24. Apparatus according to claim 16 wherein the elongated tube is
formed out of at least one from the group consisting of a metal and
a plastic.
25. Apparatus according to claim 16 wherein the atraumatic tip
comprises a polymer.
26. Apparatus according to claim 16 wherein the atraumatic tip
comprises a thermoplastic.
27. Apparatus according to claim 16 further comprising an obturator
extending through the lumen of the elongated tube.
28. Apparatus according to claim 16 further comprising an
instrument adapter for mounting an instrument to the access
cannula, the instrument adapter being adapted to mate with an
instrument to be extended through the lumen of the access
cannula.
29. Apparatus according to claim 28 wherein the instrument adapter
is releasably mounted to the access cannula by a bayonet mount.
30. Apparatus according to claim 29 wherein the bayonet mount
comprises an L-shaped groove formed in the access cannula and a
radial pin mounted to the instrument adapter.
31. Apparatus according to claim 30 wherein the instrument adapter
comprises a body and a rotating collar rotatably mounted to the
body, and wherein the radial pin is mounted to the rotating
collar.
32. Apparatus according to claim 31 wherein the rotating collar is
spring-biased relative to the body.
33. Apparatus according to claim 28 wherein the instrument
comprises an endoscope.
34. A system for accessing a remote surgical site with an
instrument, the system comprising: an access cannula comprising: a
rigid elongated tube comprising a distal end, a proximal end and a
lumen extending therebetween; and an atraumatic tip mounted to the
distal end of the elongated tube, wherein the atraumatic tip is
overmolded around the tube so that the atraumatic tip extends
radially outboard of the elongated tube and distally beyond the
distal end of the elongated tube, and further wherein the
atraumatic tip comprises barium sulfate in a range between 5 and
30% by weight; and an instrument adapter for releasable connection
to the access cannula, the instrument adapter being adapted to mate
with an instrument to be extended through the lumen of the access
cannula.
35. A system according to claim 34 wherein the instrument comprises
an endoscope.
36. A system according to claim 34 wherein the instrument comprises
an obturator.
Description
REFERENCE TO PENDING PRIOR PATENT APPLICATION
[0001] This patent application claims benefit of pending prior U.S.
Provisional Patent Application Ser. No. 61/361,783, filed Jul. 6,
2010 by Jolene Cutts et al. for METHOD AND APPARATUS FOR ACCESSING
THE INTERIOR OF A HIP JOINT, INCLUDING THE PROVISION AND USE OF A
NOVEL INFLOW ACCESS CANNULA (Attorney's Docket No. FIAN-61 PROV),
which patent application is hereby incorporated herein by
reference.
FIELD OF THE INVENTION
[0002] This invention relates to surgical methods and apparatus in
general, and more particularly to methods and apparatus for
treating the hip joint.
BACKGROUND OF THE INVENTION
The Hip Joint In General
[0003] The hip joint is a ball-and-socket joint which movably
connects the leg to the torso. The hip joint is capable of a wide
range of different motions, e.g., flexion and extension, abduction
and adduction, medial and lateral rotation, etc. See FIGS. 1A, 1B,
1C and 1D.
[0004] With the possible exception of the shoulder joint, the hip
joint is perhaps the most mobile joint in the body. Significantly,
and unlike the shoulder joint, the hip joint carries substantial
weight loads during most of the day, in both static (e.g., standing
and sitting) and dynamic (e.g., walking and running)
conditions.
[0005] The hip joint is susceptible to a number of different
pathologies. These pathologies can have both congenital and
injury-related origins. In some cases, the pathology can be
substantial at the outset. In other cases, the pathology may be
minor at the outset but, if left untreated, may worsen over time.
More particularly, in many cases, an existing pathology may be
exacerbated by the dynamic nature of the hip joint and the
substantial weight loads imposed on the hip joint.
[0006] The pathology may, either initially or thereafter,
significantly interfere with patient comfort and lifestyle. In some
cases, the pathology can be so severe as to require partial or
total hip replacement. A number of procedures have been developed
for treating hip pathologies short of partial or total hip
replacement, but these procedures are generally limited in scope
due to the significant difficulties associated with treating the
hip joint.
[0007] A better understanding of various hip joint pathologies, and
also the current limitations associated with their treatment, can
be gained from a more thorough understanding of the anatomy of the
hip joint.
Anatomy Of The Hip Joint
[0008] The hip joint is formed at the junction of the leg and the
hip. More particularly, and looking now at FIG. 2, the head of the
femur is received in the acetabular cup of the hip, with a
plurality of ligaments and other soft tissue serving to hold the
bones in articulating condition.
[0009] More particularly, and looking now at FIG. 3, the femur is
generally characterized by an elongated body terminating, at its
top end, in an angled neck which supports a hemispherical head
(also sometimes referred to as "the ball"). As seen in FIGS. 3 and
4, a large projection known as the greater trochanter protrudes
laterally and posteriorly from the elongated body adjacent to the
neck of the femur. A second, somewhat smaller projection known as
the lesser trochanter protrudes medially and posteriorly from the
elongated body adjacent to the neck. An intertrochanteric crest
(FIGS. 3 and 4) extends along the periphery of the femur, between
the greater trochanter and the lesser trochanter.
[0010] Looking next at FIG. 5, the hip socket is made up of three
constituent bones: the ilium, the ischium and the pubis. These
three bones cooperate with one another (they typically ossify into
a single "hip bone" structure by the age of 25 or so) in order to
collectively form the acetabular cup. The acetabular cup receives
the head of the femur.
[0011] Both the head of the femur and the acetabular cup are
covered with a layer of articular cartilage which protects the
underlying bone and facilitates motion. See FIG. 6.
[0012] Various ligaments and soft tissue serve to hold the ball of
the femur in place within the acetabular cup. More particularly,
and looking now at FIGS. 7 and 8, the ligamentum teres extends
between the ball of the femur and the base of the acetabular cup.
As seen in FIGS. 8 and 9, a labrum is disposed about the perimeter
of the acetabular cup. The labrum serves to increase the depth of
the acetabular cup and effectively establishes a suction seal
between the ball of the femur and the rim of the acetabular cup,
thereby helping to hold the head of the femur in the acetabular
cup. In addition to the foregoing, and looking now at FIG. 10, a
fibrous capsule extends between the neck of the femur and the rim
of the acetabular cup, effectively sealing off the ball-and-socket
members of the hip joint from the remainder of the body. The
foregoing structures (i.e., the ligamentum teres, the labrum and
the fibrous capsule) are encompassed and reinforced by a set of
three main ligaments (i.e., the iliofemoral ligament, the
ischiofemoral ligament and the pubofemoral ligament) which extend
between the femur and the perimeter of the hip socket. See, for
example, FIGS. 11 and 12, which show the iliofemoral ligament, with
FIG. 11 being an anterior view and FIG. 12 being a posterior
view.
Pathologies Of The Hip Joint
[0013] As noted above, the hip joint is susceptible to a number of
different pathologies. These pathologies can have both congenital
and injury-related origins.
[0014] By way of example but not limitation, one important type of
congenital pathology of the hip joint involves impingement between
the neck of the femur and the rim of the acetabular cup. In some
cases, and looking now at FIG. 13, this impingement can occur due
to irregularities in the geometry of the femur. This type of
impingement is sometimes referred to as cam-type femoroacetabular
impingement (i.e., cam-type FAI). In other cases, and looking now
at FIG. 14, the impingement can occur due to irregularities in the
geometry of the acetabular cup. This latter type of impingement is
sometimes referred to as pincer-type femoroacetabular impingement
(i.e., pincer-type FAI). Impingement can result in a reduced range
of motion, substantial pain and, in some cases, significant
deterioration of the hip joint.
[0015] By way of further example but not limitation, another
important type of congenital pathology of the hip joint involves
defects in the articular surface of the ball and/or the articular
surface of the acetabular cup. Defects of this type sometimes start
out fairly small but often increase in size over time, generally
due to the dynamic nature of the hip joint and also due to the
weight-bearing nature of the hip joint. Articular defects can
result in substantial pain, induce and/or exacerbate arthritic
conditions and, in some cases, cause significant deterioration of
the hip joint.
[0016] By way of further example but not limitation, one important
type of injury-related pathology of the hip joint involves trauma
to the labrum. More particularly, in many cases, an accident or
sports-related injury can result in the labrum being torn away from
the rim of the acetabular cup, typically with a tear running
through the body of the labrum. See FIG. 15. These types of
injuries can be very painful for the patient and, if left
untreated, can lead to substantial deterioration of the hip
joint.
The General Trend Toward Treating Joint Pathologies Using
Minimally-Invasive, And Earlier, Interventions
[0017] The current trend in orthopedic surgery is to treat joint
pathologies using minimally-invasive techniques. Such
minimally-invasive, "keyhole" surgeries generally offer numerous
advantages over traditional, "open" surgeries, including reduced
trauma to tissue, less pain for the patient, faster recuperation
times, etc.
[0018] By way of example but not limitation, it is common to
re-attach ligaments in the shoulder joint using minimally-invasive,
"keyhole" techniques which do not require laying open the capsule
of the shoulder joint. By way of further example but not
limitation, it is common to repair torn meniscal cartilage in the
knee joint, and/or to replace ruptured ACL ligaments in the knee
joint, using minimally-invasive techniques.
[0019] While such minimally-invasive approaches can require
additional training on the part of the surgeon, such procedures
generally offer substantial advantages for the patient and have now
become the standard of care for many shoulder joint and knee joint
pathologies.
[0020] In addition to the foregoing, in view of the inherent
advantages and widespread availability of minimally-invasive
approaches for treating pathologies of the shoulder joint and knee
joint, the current trend is to provide such treatment much earlier
in the lifecycle of the pathology, so as to address patient pain as
soon as possible and so as to minimize any exacerbation of the
pathology itself. This is in marked contrast to traditional
surgical practices, which have generally dictated postponing
surgical procedures as long as possible so as to spare the patient
from the substantial trauma generally associated with invasive
surgery.
Treatment For Pathologies Of The Hip Joint
[0021] Unfortunately, minimally-invasive treatments for pathologies
of the hip joint have lagged far behind minimally-invasive
treatments for pathologies of the shoulder joint and the knee
joint. This is generally due to (i) the constrained geometry of the
hip joint itself, and (ii) the nature and location of the
pathologies which must typically be addressed in the hip joint.
[0022] More particularly, the hip joint is generally considered to
be a "tight" joint, in the sense that there is relatively little
room to maneuver within the confines of the joint itself. This is
in marked contrast to the shoulder joint and the knee joint, which
are generally considered to be relatively "spacious" joints (at
least when compared to the hip joint). As a result, it is
relatively difficult for surgeons to perform minimally-invasive
procedures on the hip joint.
[0023] Furthermore, the pathways for entering the interior of the
hip joint (i.e., the natural pathways which exist between adjacent
bones and/or delicate neurovascular structures) are generally much
more constraining for the hip joint than for the shoulder joint or
the knee joint. This limited access further complicates effectively
performing minimally-invasive procedures on the hip joint.
[0024] In addition to the foregoing, the nature and location of the
pathologies of the hip joint also complicate performing
minimally-invasive procedures on the hip joint. By way of example
but not limitation, consider a typical detachment of the labrum in
the hip joint. In this situation, instruments must generally be
introduced into the joint space using an angle of approach which is
offset from the angle at which the instrument addresses the tissue.
This makes drilling into bone, for example, significantly more
complicated than where the angle of approach is effectively aligned
with the angle at which the instrument addresses the tissue, such
as is frequently the case in the shoulder joint. Furthermore, the
working space within the hip joint is typically extremely limited,
further complicating repairs where the angle of approach is not
aligned with the angle at which the instrument addresses the
tissue.
[0025] As a result of the foregoing, minimally-invasive hip joint
procedures are still relatively difficult to perform and relatively
uncommon in practice. Consequently, patients are typically forced
to manage their hip pain for as long as possible, until a
resurfacing procedure or a partial or total hip replacement
procedure can no longer be avoided. These procedures are generally
then performed as a highly-invasive, open procedure, with all of
the disadvantages associated with highly-invasive, open
procedures.
[0026] As a result, there is, in general, a pressing need for
improved methods and apparatus for treating pathologies of the hip
joint.
Arthroscopic Access To The Interior Of The Hip Joint
[0027] Successful hip arthroscopy generally requires safe and
effective access to the interior of the hip joint. More
particularly, successful hip arthroscopy generally requires the
creation of a plurality of access portals which extend from the
surface of the skin, down through the intervening tissue, and then
into the interior of the hip joint. Depending on the specific
surgical site which is to be accessed within the interior of the
hip joint, different anatomical pathways may be utilized for the
access portals. By way of example but not limitation, one
anatomical pathway may be used where a torn labrum is to be
repaired, and another anatomical pathway may be used where the
lesser trochanter must be addressed. And, in most cases, multiple
access portals are generally required, with one access portal being
used for visualization (i.e., to introduce an arthroscope into the
interior of the hip joint), while other access portals are used to
pass surgical instruments to and from the surgical site, etc.
[0028] Establishing these access portals typically involves forming
an opening from the top surface of the skin down to the interior of
the joint, and lining that opening with a tubular liner (sometimes
referred to as an "access cannula"). This access cannula holds the
incision open and provides a surgical pathway (or "corridor") from
the top surface of the skin down to the interior of the hip joint,
thereby enabling keyhole surgery to be performed on the hip
joint.
Prior Art Access Cannulas
[0029] Access cannulas of the sort discussed above are well known
in the art. However, such prior art access cannulas are typically
designed to serve a wide range of different purposes and, as a
result, often perform certain specific tasks in a fairly mediocre
manner, e.g., initial access creation and endoscope support.
Furthermore, such prior art access cannulas typically have distal
ends which can cause substantial trauma to tissue when they come
into contact with tissue, e.g., during cannula insertion. In
addition, such prior art access cannulas are typically relatively
inefficient in their use of space, and hence cover a substantial
portion of an instrument's length, thereby reducing access of the
instrument to deep surgical sites within the joint space.
The Need For A New And Improved Access Cannula
[0030] On account of the foregoing, it will be appreciated that
there is a need for a new and improved access cannula which can
overcome the deficiencies of prior art access cannulas.
[0031] Among other things, there is a need for a new and improved
access cannula which can perform certain specific tasks unusually
well (e.g., initial access creation and endoscope support), has a
distal end which is relatively atraumatic when it comes into
contact with tissue, and which is highly efficient in its use of
space so as to cover a reduced portion of an instrument's length,
thereby increasing access of the instrument to deep surgical sites
within the joint space.
SUMMARY OF THE INVENTION
[0032] These and other objects of the present invention are
addressed by the provision and use of a new and improved inflow
access cannula for accessing the interior of a hip joint or other
interior body space.
[0033] Among other things, this new and improved inflow access
cannula can perform certain specific tasks unusually well (e.g.,
initial access creation and endoscope support), has a distal end
which is relatively atraumatic when it comes into contact with
tissue, and which is highly efficient in its use of space so as to
cover a reduced portion of an instrument's length, thereby
increasing access of the instrument to deep surgical sites within
the joint space.
[0034] In one form of the present invention, there is provided an
inflow access cannula system for allowing an instrument to access a
remote surgical site, wherein the instrument comprises a distal
portion having a smaller diameter and a proximal portion having a
larger diameter, the system comprising:
[0035] an inflow access cannula comprising a distal end, a proximal
end and a central lumen extending therebetween, wherein the central
lumen has a diameter larger than the distal portion of the
instrument and smaller than the proximal portion of the instrument;
and
[0036] an instrument adapter for releasable connection to the
inflow access cannula, the instrument adapter comprising a lumen
communicating with the central lumen of the inflow access cannula,
the lumen having a diameter larger than the proximal portion of the
instrument, the instrument adapter further comprising a port and a
fluid passageway connecting the port with the lumen of the
instrument adapter, and a spacer for spacing the proximal portion
of the instrument from the distal end of the inflow access cannula,
such that when an instrument is disposed in the inflow access
cannula system so that the distal portion of the instrument extends
within the central lumen of the inflow access cannula and the
proximal portion of the instrument is disposed in the central lumen
of the instrument adapter and is in engagement with the spacer,
fluid can flow into the port of the instrument adapter, along the
fluid passageway of the instrument adapter, into the lumen of the
instrument adapter and through the lumen of the inflow access
cannula.
[0037] In another form of the present invention, there is provided
an inflow access cannula comprising:
[0038] an elongated body comprising a distal end, a proximal end
and a lumen extending therebetween, the distal end of the elongated
body comprising an atraumatic tip.
[0039] In another form of the present invention, there is provided
a method for accessing a remote surgical site with an instrument,
wherein the instrument comprises a distal portion having a smaller
diameter and a proximal portion having a larger diameter, the
method comprising:
[0040] providing an inflow access cannula system comprising: [0041]
an inflow access cannula comprising a distal end, a proximal end
and a central lumen extending therebetween, wherein the central
lumen has a diameter larger than the distal portion of the
instrument and smaller than the proximal portion of the instrument;
and [0042] an instrument adapter for releasable connection to the
inflow access cannula, the instrument adapter comprising a lumen
communicating with the central lumen of the inflow access cannula,
the lumen having a diameter larger than the proximal portion of the
instrument, the instrument adapter further comprising a port and a
fluid passageway connecting the port with the lumen of the
instrument adapter, and a spacer for spacing the proximal portion
of the instrument from the distal end of the inflow access cannula,
such that when an instrument is disposed in the inflow access
cannula system so that the distal portion of the instrument extends
within the central lumen of the inflow access cannula and the
proximal portion of the instrument is disposed in the central lumen
of the instrument adapter and is in engagement with the spacer,
fluid can flow into the port of the instrument adapter, along the
fluid passageway of the instrument adapter, into the lumen of the
instrument adapter and through the lumen of the inflow access
cannula;
[0043] advancing the inflow access cannula system through tissue to
the surgical site; and
[0044] advancing the instrument into the inflow access cannula
system.
[0045] In another form of the present invention, there is provided
a method for accessing a remote surgical site with an instrument,
wherein the instrument comprises a distal portion having a smaller
diameter and a proximal portion having a larger diameter, the
method comprising:
[0046] providing an inflow access cannula system comprising: [0047]
an inflow access cannula comprising a distal end, a proximal end
and a central lumen extending therebetween, wherein the central
lumen has a diameter larger than the distal portion of the
instrument and smaller than the proximal portion of the instrument;
and [0048] an instrument adapter for releasable connection to the
inflow access cannula, the instrument adapter comprising a lumen
communicating with the central lumen of the inflow access cannula,
the lumen having a diameter larger than the proximal portion of the
instrument, the instrument adapter further comprising a port and a
fluid passageway connecting the port with the lumen of the
instrument adapter, and a spacer for spacing the proximal portion
of the instrument from the distal end of the inflow access cannula,
such that when an instrument is disposed in the inflow access
cannula system so that the distal portion of the instrument extends
within the central lumen of the inflow access cannula and the
proximal portion of the instrument is disposed in the central lumen
of the instrument adapter and is in engagement with the spacer,
fluid can flow into the port of the instrument adapter, along the
fluid passageway of the instrument adapter, into the lumen of the
instrument adapter and through the lumen of the inflow access
cannula;
[0049] advancing the inflow access cannula through tissue to the
surgical site;
[0050] mounting the instrument adapter to the instrument; and
[0051] advancing the instrument into the inflow access cannula so
that the instrument adapter mounts to the inflow access
cannula.
[0052] In another form of the present invention, there is provided
an access cannula system for allowing an instrument to access a
remote surgical site, the system comprising:
[0053] an access cannula;
[0054] an instrument adapter for releasable connection to the
access cannula, the instrument adapter being adapted to mate with
an instrument to be extended through the lumen of the access
cannula; and
[0055] wherein the instrument adapter is relesably mounted to the
access cannula by a bayonet mount.
BRIEF DESCRIPTION OF THE DRAWINGS
[0056] These and other objects and features of the present
invention will be more fully disclosed or rendered obvious by the
following detailed description of the preferred embodiments of the
invention, which is to be considered together with the accompanying
drawings wherein like numbers refer to like parts, and further
wherein:
[0057] FIGS. 1A-1D are schematic views showing various aspects of
hip motion;
[0058] FIG. 2 is a schematic view showing the bone structure in the
region of the hip joints;
[0059] FIG. 3 is a schematic view of the femur;
[0060] FIG. 4 is a schematic view of the top end of the femur;
[0061] FIG. 5 is a schematic view of the pelvis;
[0062] FIGS. 6-12 are schematic views showing the bone and soft
tissue structure of the hip joint;
[0063] FIG. 13 is a schematic view showing cam-type
femoroacetabular impingement (FAI);
[0064] FIG. 14 is a schematic view showing pincer-type
femoroacetabular impingement (FAI);
[0065] FIG. 15 is a schematic view showing a labral tear;
[0066] FIGS. 16-26 are schematic views showing one preferred form
of inflow access cannula system formed in accordance with the
present invention; and
[0067] FIGS. 27-42 are schematic views showing another preferred
form of inflow access cannula system formed in accordance with the
present invention.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0068] The present invention provides a new and improved inflow
access cannula system for accessing the interior of a hip joint or
other interior body space.
[0069] Among other things, this new and improved inflow access
cannula can perform certain specific tasks unusually well (e.g.,
initial access creation and endoscope support), has a distal end
which is relatively atraumatic when it comes into contact with
tissue, and which is highly efficient in its use of space so as to
cover a reduced portion of an instrument's length, thereby
increasing access of the instrument to deep surgical sites within
the joint space.
[0070] Looking now at FIGS. 16-26, there is shown an inflow access
cannula system 5 which generally comprises an inflow access cannula
10 and an endoscope adapter 15.
[0071] In accordance with the present invention, an obturator (not
shown) is intended to be positioned within inflow access cannula
10, and the inflow access cannula is intended to be inserted into
the tissue of a patient so that the distal end of the inflow access
cannula is disposed within the hip joint and the proximal end of
the inflow access cannula is disposed at the surface of the skin.
When inflow access cannula 10 has been properly positioned in the
tissue of the patient, the obturator is removed, endoscope adapter
15 is positioned on the proximal end of inflow access cannula 10,
and an endoscope 20 is advanced through the central lumen of the
endoscope adapter and the central lumen of the inflow access
cannula, whereby to provide visualization of, and fluid flow to
and/or from, a remote surgical site. Alternatively, endoscope
adapter 15 may be mounted on endoscope 20 remote from inflow access
cannula 10 and then the two elements (i.e., the endoscope and the
endoscope adapter) advanced together as a unit so as to seat on
inflow access cannula 10.
[0072] More particularly, inflow access cannula 10 generally
comprises an elongated tube 25 having a distal end 30, a proximal
end 35 and a central lumen 40 (FIG. 21) extending therebetween. The
shaft of elongated tube 25 is long enough so that it can extend
between the outer surface of the patient's skin and the interior of
the joint. Furthermore, the shaft of elongated tube 25 is
preferably formed out of metal (e.g., stainless steel) so as to
provide strength and rigidity during insertion of the inflow access
cannula into the tissue of the patient and its subsequent use as a
liner for the access corridor extending down to the remote surgical
site. Alternatively, the shaft of elongated tube 25 may be a metal
tube coaxial with a plastic tube, the metal tube being disposed
either inside of, or outside of, the plastic tube. The outer
surface of elongated tube 25 is preferably smooth so as to minimize
trauma to tissue as inflow access cannula 10 is inserted in the
tissue.
[0073] Distal end 30 of inflow access cannula 10 preferably
comprises a soft, atraumatic distal tip 45 so as to also minimize
tissue trauma during cannula insertion and use.
[0074] In one preferred form of the invention, at least the
atraumatic distal tip 45 of inflow access cannula 10 comprises a
polymer or other material which contains barium sulfate, preferably
in the range of 5-30% (and preferably about 15%) by weight, so as
to render the inflow access cannula visible under X-ray or
fluoroscopy. This range (by weight) of barium sulfate is generally
preferred since concentrations below 5% tend to be too low for good
visualization in hip applications, whereas concentrations above 30%
can lead to degradation of material properties. Alternatively,
other opacifiers, at appropriate weight concentrations, may also be
used to render the inflow access cannula visible under X-ray or
fluoroscopy. Atraumatic distal tip 45 can be a thermoplastic which
is over-molded onto the distal end of elongated tube 25 (see FIGS.
16 and 17).
[0075] A mount 50 is secured to proximal end 35 of elongated tube
25. Mount 50 includes a keyway 55 for receiving a corresponding key
(not shown) of an obturator (also not shown), whereby to releasably
rotatably lock the obturator to inflow access cannula 10, e.g., so
as to permit rotational driving deployment of the inflow access
cannula into the tissue via the obturator. Mount 50 also includes a
stem 60 (FIG. 21) which protrudes upward from the floor 65 of mount
50. Stem 60 includes a lumen 70 (FIG. 26) which communicates with
central lumen 40 (FIG. 21) of elongated tube 25. Stem 60 also
includes an L-shaped keyway 75 (FIG. 17) which receives
corresponding keys 80 provided on endoscope adapter 15, whereby to
releasably axially lock endoscope adapter 15 to inflow access
cannula 10, as will hereinafter be discussed in further detail.
[0076] Endoscope adapter 15 comprises a body 85 which is adapted to
mate with mount 50 of inflow access cannula 10. More particularly,
body 85 of endoscope adapter 15 is designed to seat over stem 60 of
cannula mount 50 so that (i) an endoscope 20 can extend down lumen
70 (FIG. 26) of endoscope adapter 15 and down central lumen 40
(FIG. 21) of elongated tube 25, and (ii) fluid introduced through
ports 90 of endoscope adapter 15 can flow down to the surgical site
through lumen 70 of endoscope adapter 15 and central lumen 40 of
elongated tube 25 or, conversely, fluid at the surgical site can
flow up through central lumen 40 of elongated tube 25 and lumen 70
of endoscope adapter 15, and then out one of the ports 90.
Endoscope adapter 15 also includes keys 80 for mounting in keyways
75 of endoscope adapter 15 when endoscope adapter 15 is connected
to, and seats into, inflow access cannula 10. This engagement keeps
endoscope adapter 15 connected to inflow access cannula 10 during
surgical use.
[0077] More particularly, endoscope adapter 15 comprises an annular
chamber 95 (FIG. 23) which communicates with a plurality of radial
passageways 100, which in turn communicate with an annular opening
105 formed about the perimeter of stem 60. Thus, fluid is able to
pass into ports 90, along annular chamber 95, through radial
passageways 100, up annular opening 105, down lumen 70 of stem 60
and then down lumen 40 of elongated tube 25. Correspondingly, fluid
is able to leave the surgical site by passing up lumen 40 of
elongated tube 25, through lumen 70 of stem 60, down annular
opening 105, through radial passageways 100, along annular chamber
95 and then out ports 90. In this respect it will be appreciated
that an O-ring 106 ensures a fluid seal between body 85 of
endoscope adapter 15 and mount 50 of inflow access cannula 10, and
an O-ring 107 ensures a fluid seal between body 85 of endoscope
adapter 15 and endoscope 20--thus, when endoscope 20 is seated in
assembled endoscope adapter 15/inflow access cannula 10, a closed
flow path is established between ports 90 and lumen 40 of elongated
tube 25. Significantly, O-ring 107 also acts as a spacer to
maintain a gap G (FIG. 23) between the proximal end of the
endoscope's body B and the mouth of lumen 70 of stem 60, so that
fluid can pass from annular opening 105, through gap G and into
lumen 70 of stem 60 (or from lumen 70 of stem 60, through gap G and
into annular opening 105). Thus it will be seen that with the
foregoing construction, ports 90 are disposed distal to the
proximal end of stem 60. By virtue of the ports 90 being "below"
(i.e., distal) to the top of stem 60, the overall height of the
assembled endoscope adapter 15/inflow access cannula 10 is
minimized. This provides for a significantly more compact design
(in terms of length) which covers a reduced portion of an
instrument's length, thereby increasing access of the instrument
(e.g., endoscope 20) to deep surgical sites within the joint space.
In other words, the compact design of the assembled endoscope
adapter 15/inflow access cannula 10 provides a more effective
working length to the shaft of endoscope 20 (i.e., the length the
endoscope shaft that extends distal to the distal surface of mount
50). Thus, while the flow path between ports 90 and the mouth of
lumen 70 of stem 60 may be non-linear with the present invention, a
more compact endoscope adapter/inflow access cannula design is
obtained and the effective working length of an instrument (e.g.,
the endoscope) is increased. This is a significant advantage in the
art.
[0078] Furthermore, keys 80 are preferably mounted on a rotating
collar 110. Rotating collar 110 is rotatably mounted to body 85 of
endoscope adapter 15, where it is fixed in the axial direction but
can spin about the longitudinal axis of endoscope adapter 15.
Rotating collar 110 is spring-biased to force key 80 into the
L-shaped keyway 75. As such, when endoscope adaptor 15 is connected
to inflow access cannula 10, key 80 will be spring-biased into
bottom corner 115 of L-shaped keyway 75. To release, or disengage,
endoscope adaptor 15 from inflow access cannula 10, rotating collar
110 is rotated, which shifts key 80 out of bottom corner 115 to the
vertical groove portion 120 of L-shaped keyway 75; this enables
endoscope adaptor 15 to be moved axially away from inflow access
cannula 10. In FIG. 26, rotating collar 110 and straight key 80
(without additional components of endoscope adaptor 15) are
illustrated to show engagement of key 80 into the L-shaped keyway
75 of mount 50 of inflow access cannula 10. This design minimizes
the length required to connect the endoscope adapter 15 and inflow
access cannula 10, hence providing for a more effective working
length of the shaft of scope 20.
[0079] Inflow access cannula system 5 may be used in various ways
to provide access to the interior of a hip joint. Among other
things, due to the smooth shaft of elongated tube 25 and the
atraumatic distal tip 45 of the elongated tube, atraumatic cannula
deployment can be achieved. Furthermore, the use of endoscope
adapter 15 allows custom docking (secure seating and fluid flow) to
be achieved when an endoscope is mounted in the inflow access
cannula. And, significantly, the more compact design (in terms of
length) of the assembled endoscope adapter/inflow access cannula
covers a reduced portion of an instrument's length, thereby
increasing access of the instrument (e.g., endoscope 20) to deep
surgical sites within the joint space.
[0080] Looking next at FIGS. 27-42, there is shown another inflow
access cannula system 125 which generally comprises an inflow
access cannula 130, an obturator 135 and an endoscope adapter 140.
Obturator 135 is intended to be positioned within an inflow access
cannula 130 during insertion of the inflow access cannula into the
tissue of the patient, as will hereinafter be discussed in further
detail. As will also hereinafter be discussed in further detail,
when the inflow access cannula 130 has been properly positioned in
the tissue of the patient, obturator 135 is removed, endoscope
adapter 140 is positioned on the proximal end of inflow access
cannula 130, and an endoscope 145 is advanced through the central
lumen of the endoscope adapter and the inflow access cannula,
whereby to provide visualization of, and fluid flow to and/or from,
a remote surgical site. Alternatively, endoscope adapter 140 may be
mounted on endoscope 145 remote from inflow access cannula 130 and
then the two elements advanced together as a unit so as to seat on
inflow access cannula 130.
[0081] More particularly, inflow access cannula 130 generally
comprises an elongated tube 150 having a distal end 155, a proximal
end 160 and a central lumen 165 (FIG. 41) extending therebetween.
The shaft of elongated tube 150 is long enough so that it can
extend between the outer surface of the patient's skin and the
inside of the joint. Furthermore, the shaft of elongated tube 150
is preferably formed out of metal so as to provide strength and
rigidity during insertion of the cannula into the tissue of the
patient and its subsequent use as a liner for the access corridor
extending down to the remote surgical site. Alternatively, the
shaft of elongated tube 150 may be a metal tube coaxial with a
plastic tube, the metal tube being disposed either inside or
outside of the plastic tube. The outer surface of elongated tube
150 is preferably smooth so as to minimize trauma to tissue as
inflow access cannula 130 is inserted in the tissue.
[0082] Distal end 155 of inflow access cannula 130 preferably
comprises a soft, atraumatic distal tip 170 (FIG. 27) so as to also
minimize tissue trauma during cannula insertion and use.
[0083] In one preferred form of the invention, at least the
atraumatic distal tip 170 of inflow access cannula 130 comprises a
polymer or other material which contains barium sulfate, preferably
in the range of 5-30% (and preferably about 15%) by weight, so as
to render the inflow access cannula visible under X-ray or
fluoroscopy. This range (by weight) of barium sulfate is generally
preferred since concentrations below 5% tend to be too low for good
visualization in hip applications, whereas concentrations above 30%
can lead to degradation of material properties. Alternatively,
other opacifiers, at appropriate weight concentrations, may also be
used to render the inflow access cannula visible under X-ray or
fluoroscopy.
[0084] A mount 175 (FIG. 27) is secured to the proximal end of
elongated tube 150. Mount 175 includes a keyway 180 (FIG. 27) for
receiving a key 185 (FIG. 30) of obturator 135, whereby to
releasably rotatably lock obturator 135 to inflow access cannula
130. Mount 175 also includes one or more keys 190 (FIG. 37) for
receipt in corresponding keyways 195 (FIG. 38) in endoscope adapter
140, whereby to releasably rotatably lock endoscope adapter 140 to
inflow access cannula 130. Mount 175 also includes a stem 200 (FIG.
37) which protrudes upward from the floor 205 of mount 175. Stem
200 includes a lumen 210 (FIG. 37) which communicates with central
lumen 165 (FIG. 41) of elongated tube 150.
[0085] Obturator 135 generally comprises a shaft 215 (FIG. 30)
terminating in a blunt distal end 220 and a proximal handle 225.
Handle 225 includes a key 185 for receipt in the aforementioned
keyway 180 (FIG. 27) of mount 175, whereby to releasably rotatably
lock obturator 135 to inflow access cannula 130. As seen in FIG.
32, the distal end 220 of obturator shaft 215 protrudes from
atraumatic tip 170 of cannula tube 150 when obturator key 185 is
seated in cannula keyway 180, so that the blunt distal end 220 of
obturator 135 leads the assembly and prevents tissue coring by
inflow access cannula 130 when the inflow access cannula is
advanced through tissue.
[0086] Endoscope adapter 140 comprises a body 230 (FIG. 41) which
mates with mount 175 of inflow access cannula 130. More
particularly, body 230 of endoscope adapter 140 is designed to seat
over stem 200 of cannula mount 175 so that (i) an endoscope 145 can
extend down lumen 210 (FIG. 37) of endoscope adapter 140 and down
central lumen 165 of elongated tube 150, and (ii) fluid introduced
through ports 235 (FIG. 42) of endoscope adapter 140 can flow down
to the surgical site through central lumen 165 of elongated tube
150 or, conversely, fluid at the surgical site can flow up through
central lumen 165 of elongated tube 150 and then out one of the
ports 235. As noted above, cannula mount 175 also includes keys 190
(FIG. 37) for mating with keyways 195 (FIG. 38) of endoscope
adapter 140, so that proper alignment of inflow access cannula 130
and endoscope adapter 140 can be ensured. Cannula mount 175 also
includes a keyway 240 (FIG. 27) for mating with flexure key 245
(FIG. 29) of endoscope adapter 140. Flexure key 245 comprises a
locking tab 250 which engages notch 255 (FIG. 27) when endoscope
adapter 140 is connected to, and seats into, inflow access cannula
130. This engagement keeps endoscope adapter 140 connected to
inflow access cannula 130 during surgical use. Flexure key 245 can
be compressed and moved radially inwardly (i.e., toward the center
axis of endoscope adapter 140) to disengage locking tab 250 from
notch 255 and thus allow endoscope adapter 140 to be disconnected
from inflow access cannula 130.
[0087] Inflow access cannula system 125 may be used in various ways
to provide access to the interior of a hip joint. Among other
things, due to the smooth shaft of elongated tube 150 and the
atraumatic distal tip 170 of the elongated tube, atraumatic cannula
deployment can be achieved. Furthermore, the use of endoscope
adapter 140 allows custom docking (secure seating and fluid flow)
to be achieved when an endoscope is mounted in the inflow access
cannula. And, significantly, the more compact design (in terms of
length) of the assembled endoscope adapter/inflow access cannula
covers a reduced portion of an instrument's length, thereby
increasing access of the instrument (e.g., endoscope 20) to deep
surgical sites within the joint space.
Use Of The Inflow Access Cannula For Other Applications
[0088] It should be appreciated that the novel inflow access
cannula of the present invention may be used for accessing joints
other than the hip joint (e.g., the inflow access cannula may be
used to access the interior of a shoulder joint), and/or for
accessing other interior body spaces (e.g., the abdominal
cavity).
Modifications Of The Preferred Embodiments
[0089] It should be understood that many additional changes in the
details, materials, steps and arrangements of parts, which have
been herein described and illustrated in order to explain the
nature of the present invention, may be made by those skilled in
the art while still remaining within the principles and scope of
the invention.
* * * * *