U.S. patent number RE42,525 [Application Number 10/165,991] was granted by the patent office on 2011-07-05 for cannula and sizing insertion method.
This patent grant is currently assigned to DePuy Spine, Inc.. Invention is credited to Robert E. Simonson.
United States Patent |
RE42,525 |
Simonson |
July 5, 2011 |
**Please see images for:
( Certificate of Correction ) ** |
Cannula and sizing insertion method
Abstract
A relatively inexpensive cannula is sized by including indica on
a cannulated dilator that is used to measure the depth of a body
cavity, and in one embodiment with the use of a cuttable fixture
inserted into an initially enlarged dilator retractor made from a
cuttable material the excess of the dilator retractor is snipped by
a commercial cutter. A tool engaging the end of the cannulated
dilator provides leverage on the cannulated dilator for rotation as
it is forced into the body cavity, a pusher tool provides leverage
on the dilator retractor for inserting the dilator retractor into
the body cavity. A clamp that fits the top of the dilator retractor
serves to support the dilator retractor through an arm to a rigid
structure. In an alternate embodiment one of a series of sized
dilator retractors are selected commensurate with the measurement
attained by the scaled cannulated dilator.
Inventors: |
Simonson; Robert E. (Boca
Raton, FL) |
Assignee: |
DePuy Spine, Inc. (Raynham,
MA)
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Family
ID: |
23016824 |
Appl.
No.: |
10/165,991 |
Filed: |
June 10, 2002 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
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Reissue of: |
09266984 |
Mar 12, 1999 |
06159179 |
Dec 12, 2000 |
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Current U.S.
Class: |
604/117; 604/500;
604/164.01; 606/108 |
Current CPC
Class: |
A61B
17/0218 (20130101); A61B 17/3421 (20130101); A61B
2017/0046 (20130101); A61B 2017/00907 (20130101); A61B
2017/3492 (20130101); A61B 2090/062 (20160201); A61B
2017/00261 (20130101) |
Current International
Class: |
A61M
5/00 (20060101) |
Field of
Search: |
;604/117,158,164.01,164.1,164.04,164.06,164.09-164.11,264,272,500,506,510,104
;606/108,191,198,184,185,61 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
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WO 00/18306 |
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Apr 2000 |
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WO |
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WO 02/060330 |
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Aug 2002 |
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WO |
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Other References
US. Appl. No. 10/899,707, filed Jul. 26, 2004, Robert E. Simonson.
cited by other .
Wolfhard Caspar, Technique of Microsurgery, in Microsurgery of the
Lumbar Spine: Principles and Techniques in Spine Surgery 105-122
(Aspen Publications, 1990). cited by other .
Web page, http://brainlab.com, Apr. 2, 2002. cited by other .
Kambin, Parviz, "Arthroscopic Microdiscectomy: Minimal Intervention
in Spinal Surgery", National Library of Medicine, 1991, p. 67-100,
Urban & Schwarzenberg. cited by other .
Schaffer, Johnathan et al., "Percutaneous Posterolateral Lumbar
Discectomy and decompression with a 6.9 Millimeter Cannula", The
Journal of Bone and Joint Surgery, 1991, pp. 822-831. cited by
other .
Savitz,Martin, "Same-Day Microsurgical Arthroscopic Latera-Approach
Laser-Assisted (SMALL) Fluroscopic Discectomy", Journal of
Neurosurgery; Jun. 1994, pp. 1039-1045. cited by other .
Kambin, Parviz, "Percutaneous Posterolateral Discectomy", Clinical
Orthopaedics and Related Research, Section II, pp. 145-154. cited
by other .
Sofamor Danek Video Systems Brochure. cited by other .
Hilton, Donald et al., "Medtronic Sofamor Danek METRX
Microdiscectomy Surgical Technique Brochure",2001. cited by other
.
Wiltse, "New Uses and Refinements of the Paraspinal Approach to the
Lumbar Spine", Spine, vol. 13 No. 6 1988, p. 696-706. cited by
other .
Sofamor Danek, "MED MicroEndoscopic Discectomy System" (1997).
cited by other .
Schreiber, et al., "Doses Percutaneous Nucleotomy with Discoscopy
Replace Conventional Discectomy?", Clinical Orthopaedics and
Related Research, No. 238, Jan. 1989. cited by other .
Hsu, Ken et al., "Internal Fixation With Pedicle Screws," Lumbar
Spine Surgery, Techniques and Complications,The C. V. Mosby Company
pp. 322-338 (1987). cited by other .
Kambin, Parviz, "Posterolaterial Percutaneous Lumbar Interbody
Fusion," Arthroscopic Microdiscectomy: Minimal Intervention In
Spinal Surgery, pp. 117-121 (1991). cited by other .
Kambin, Parvis, "Arthroscopic Lumbar Intervertebral Fusion," The
Adult Spine: Principles and Practice, ch. 95, pps. 2037-2046
(1997). cited by other .
Kambin, Parvis, "Arthroscopic Techniques for Spinal Surgery,"
Operative Arthroscopy, ch. 89, pp. 1215-1225 (1996). cited by other
.
Kambin, Parvis and Schaffer, Jonathan, "Arthroscopic Fusion of the
Lumbosacral Spine," Lumbosacral and Spinopelvic Fixation, ch. 44,
pp. 565-577 (1996). cited by other .
Leu, Hans-Jorg and Schreiber, Adam, "Percutaneous Lumbar
Restabilization," Arthroscopic Microdiscectomy: Minimal
Intervention in Spinal Surgery, pp. 123-125 (1990). cited by other
.
Leu, Hansjoerg Franz, et al., "Lumber Percutaneous Endoscopic
Interbody Fusion," Clinical Orthopaedics And Related Research, No.
337, pp. 58-63 (1997). cited by other .
Leu, Hans-Jorg and Schreiber, Adam, "La Nucleotomie Percutanee Avec
Discoscopie: Experiences Depuis 1979 Et Possibilities Actuelles,"
Revue Medicale De La Suisse Romande, vol. 109, pp. 477-482 (1989).
cited by other .
Schetrumpf, Jr., "Combined Retractor and Sucker with Built-in
Clearing Device for Spinal Surgery," Injury, 1973, pp. 352-3, vol.
4(4). cited by other .
Ozer, "A New Retractor for the Anterior Cervical Approach," Br J
Neurosurg, 1994, pp. 469-70, vol. 8(4). cited by other .
Styf, "The Effects of External Compression by Three Different
Retractors on Pressure in the Erector Spine Muscles During and
After Posterior Lumbar Spine Surgery in Humans," Spine, 1998, pp.
354-8, vol. 23(3), Lippincott-Raven Publishers. cited by other
.
Frank, "Endoscopic Dural Retractor for Spinal Stenosis Surgery,"
Minim Invasive Neurosurg, 2002, pp. 136-8, vol. 45(3). cited by
other .
Barone, "An Improved Retractor for the Anterior Approach in the
Surgical Management of Vertebral Fractures," Am J Orthop, 1998, pp.
703-04, vol. 27(10). cited by other .
Board of Patent Appeals and Interferences Decision in U.S. Appl.
No. 10/899,707 dated Dec. 2, 2010. cited by other .
Reply Brief in U.S. Appl. No. 10/899,707 dated Feb. 7, 2007. cited
by other .
Examiner's Answer in U.S. Appl. No. 10/899,707 dated Dec. 13, 2006
cited by other .
Appeal Brief in U.S. Appl . No. 10/899,707 dated May 31, 2006.
cited by other .
Advisory Action in U.S. Appl . No. 10/899,707 dated Mar. 29, 2006.
cited by other .
Amendment in U.S. Appl . No. 10/899,707 dated Mar. 13, 2006. cited
by other .
Office Action in U.S. Appl . No. 10/899,707 dated Feb. 7, 2006.
cited by other .
Amendment in U.S. Appl . No. 10/899,707 dated Nov. 16, 2005. cited
by other .
Office Action in U.S. Appl . No. 10/899,707 dated Aug. 16, 2005.
cited by other .
Amendment in U.S. Appl . No. 10/899,707 dated Jul. 5, 2005. cited
by other .
Office Action in U.S. Appl . No. 10/899,707 dated Mar. 31, 2005.
cited by other .
Amendment in U.S. Appl . No. 10/899,707 dated Feb. 5, 2005. cited
by other .
Office Action in U.S. Appl . No. 10/899,707 dated Dec. 8, 2004.
cited by other .
Schetrumpf, Jr., "Combined Retractor and Sucker with Built-in
Clearing Device for Spinal Surgery," Injury, 1973, pp. 352-3, vol.
4(4). cited by other .
Ozer, "A New Retractor For The Anterior Cervical Approach," Br J
Neurosurg, 1994, pp. 469-70, vol. 8(4). cited by other .
Styf, "The Effects of External Compression by Three Different
Retractors on Pressure in the Erector Spine Muscles During and
After Posterior Lumber Spine Surgery in Humans," Spine, 1998, pp.
354-8, vol. 23(3), Lippincott-Raven Publishers. cited by other
.
Frank, "Endoscopic Dural Retractor for Spinal Stenosis Surgery,"
Minim Invasive Neurosurg, 2002, pp. 136-8, vol. 45(3). cited by
other .
Barone, "An Improved Retractor for the Anterior Approach in the
Surgical Management of Vertebral Fractures," Am J Orthop, 1998, pp.
703-04, vol. 27(10). cited by other.
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Primary Examiner: Stigell; Theodore J
Attorney, Agent or Firm: Nutter McClennen & Fish LLP
Claims
I claim:
.[.1. A cannulated dilator having an outer surface, said cannulated
dilator for insertion into an access hole formed in a patient for
stretching the tissue adjacent to the access hole so as to enlarge
the same, said cannulated dilator having an elongated tubular body,
a beveled portion at the distal end thereof, the improvement
comprising indicia on the side outer surface of the cannulated
dilator for measuring the depth of the access hole, said cannulated
dilator having a proximal end and a tool engagement portion formed
thereon, in combination with a tool having an engagement portion
complementing the tool engagement portion of the cannulated dilator
adapted to fit thereon for rotation and applying leverage on said
cannulated dilator for insertion thereof into the access hole and a
cannula for fitting into said access hole for permitting the
performance of a medical procedure after the cannulated dilator has
been removed..].
2. A cannulated dilator having an outer surface, said cannulated
dilator for insertion into an access hole formed in the body of a
patient for stretching the tissue adjacent the access hole and for
enlarging the same, said cannulated dilator having an elongated
tubular body, a beveled portion at the distal end thereof, the
improvement comprising indicia on the side outer surface of the
cannulated dilator for measuring the depth of the access hole, said
cannulated dilator having a pair of circumferentially spaced tabs
extending radially from the proximal end, in combination with a
tool having a rectangularly shaped planar body, a central bore
formed intermediate the ends thereof, an enlarged diameter recess
extending from one face into said planar body and being concentric
with said central bore but spaced from the opposite face thereof to
define a shoulder, said tabs complementing recesses formed in said
planar body adjacent to said enlarged diameter recess, whereby the
cannulated dilator fits into said tool and said cannulated dilator
engages said shoulder to permit the user to insert said cannulated
dilator into said access hole and rotate same as it progresses into
said access hole and a cannula for insertion into said access hole
to permit a surgical procedure after the cannulated dilator has
been removed.
.[.3. The combination of a cannulated dilator and a dilator
retractor wherein said cannulated dilator includes indicia for
measuring the depth of an access hole formed in a patient for
medical procedure and said dilator retractor being made from a
cuttable material and being dimensioned larger in length than is
anticipated of any depth of said access hole of the body of any
patient that is anticipated in the medical procedure, the dilator
retractor being cuttable commensurate with the depth of said access
hole as measured by said cannulated dilator for sizing said dilator
retractor to a length that is shorter than the original length of
the dilator retractor prior to being inserted into the access hole
so as to be utilized for performing the medical procedure whereby
said dilator retractor is sized for the anatomy of the
patient..].
.[.4. The combination of a cannulated dilator and a dilator
retractor as claimed in claim 3 wherein said dilator retractor is
made from a plastic material..].
.[.5. The combination of a cannulated dilator and a dilator
retractor as claimed in claim 4 wherein said dilator retractor is
made from a transparent material..].
.[.6. The combination of a cannulated dilator and dilator retractor
as claimed in claim 3 including an annular clamp, said clamp being
dimensioned to fit said dilator retractor and means including a
bracket extending from said annular clamp adapted to support the
dilator retractor to a rigid member..].
.[.7. The combination of a cannulated dilator and dilator retractor
as claimed in claim 6 wherein said clamp is split through a portion
thereof to define a gap between the ends adjacent the split, an
adjustment for enlarging or decreasing said gap and the inner
diameter portion surrounding the dilator retractor for securing
said annular clamp to the dilator retractor and including means
adapted to support the dilator retractor to a rigid member..].
.[.8. The combination of a cannulated dilator and dilator retractor
as claimed in claim 6 including an elongated fixture having a
circular cross section and made from a cuttable plastic material,
and means to cut said dilator retractor an amount commensurate with
the measurement attained by said cannulated retractor and the width
of said annular clamp..].
9. .[.The combination of a cannulated dilator and dilator retractor
as claimed in claim 8.]. .Iadd.The combination of a cannulated
dilator and a dilator retractor wherein said cannulated dilator
includes indicia for measuring the depth of an access hole formed
in a patient for medical procedure and said dilator retractor being
made from a cuttable material and being dimensioned larger in
length than is anticipated of any depth of said access hole of the
body of any patient that is anticipated in the medical procedure,
the dilator retractor being cuttable commensurate with the depth of
said access hole as measured by said cannulated dilator for sizing
said dilator retractor to a length that is shorter than the
original length of the dilator retractor prior to being inserted
into the access hole so as to be utilized for performing the
medical procedure whereby said dilator retractor is sized for the
anatomy of the patient, including an annular clamp, said clamp
being dimensioned to fit said dilator retractor and means including
a bracket extending from said annular clamp adapted to support the
dilator retractor to a rigid member, including an elongated fixture
having a circular cross section and made from a cuttable plastic
material, and means to cut said dilator retractor an amount
commensurate with the measurement attained by said cannulated
retractor and the width of said annular clamp,.Iaddend. wherein
said elongated fixture includes a series of axially spaced grooves
spaced a predetermined amount, said dilator retractor being
transparent and fitting over said elongated fixture for the spaced
grooves to be visible wherein the selection of said annular grooves
determines the length of the dilator retractor to be cut.
10. .[.The combination of a cannulated dilator and dilator
retractor as claimed in claim 3.]. .Iadd.The combination of a
cannulated dilator and a dilator retractor wherein said cannulated
dilator includes indicia for measuring the depth of an access hole
formed in a patient for medical procedure and said dilator
retractor being made from a cuttable material and being dimensioned
larger in length than is anticipated of any depth of said access
hole of the body of any patient that is anticipated in the medical
procedure, the dilator retractor being cuttable commensurate with
the depth of said access hole as measured by said cannulated
dilator for sizing said dilator retractor to a length that is
shorter than the original length of the dilator retractor prior to
being inserted into the access hole so as to be utilized for
performing the medical procedure whereby said dilator retractor is
sized for the anatomy of the patient,.Iaddend. including a pusher
tool having an elongated circular body, a central bore having a
dimension to complement the outer diameter of said cannulated
dilator, and a bottom surface overlying the end of said dilator
retractor so that when said pusher tool is pushed into the body
cavity the dilator retractor is forced into the body cavity and the
central bore slides over said cannulated dilator.
11. The combination of a cannulated dilator and dilator retractor
as claimed in claim 10 wherein said pusher tool is integral with
said elongated .[.fixture.]. .Iadd.circular body.Iaddend..
12. The combination of a cannulated dilator and dilator retractor,
said cannulated dilator being .[.in the.]. .Iadd.last in a
.Iaddend.series of .[.the last.]. cannulated .[.dilator.].
.Iadd.dilators .Iaddend.for enlarging the access hole in the body
of a patient, at least one of said cannulated dilators having an
elongated body, indicia on said elongated body indicative of a
measurement of depth for measuring the depth of the access hole,
said dilator retractor including a series of dilator retractors
each having different lengths, whereby the dilator retractor for
use in the access hole is selected from said series of dilator
retractors that is commensurate with the measurement of said
.[.cannula(d.]. .Iadd.cannulated .Iaddend.dilator as obtained from
said indicia when inserted into said access hole for defining a
working space for performing a medical procedure when the
cannulated dilator has been removed.
13. The method of sizing the length of a cannula to fit the depth
of an access hole formed in the body of a patient including the
steps of: i. providing a cannula that is oversized in length; ii.
providing a cannulated dilator that is .[.in the.]. last .[.of.].
.Iadd.in .Iaddend.a series of cannulated dilators used for
enlarging the access hole with indicia of a scale for measuring a
length; iii. measuring the depth of the access hole by inserting
the cannulated dilator obtained in the step of providing a
cannulated dilator into the aceess hole to ascertain the depth; iv.
cutting the cannula to the size obtained in the step of measuring
before being inserted into the access hole; and v. inserting the
cannula obtained in the step of cutting into the access hole over
the cannulated dilator and removing the cannulated dilator to
define a working space to perform a medical procedure.
14. The method as claimed in claim 13 including the step of
providing a template made from a cuttable material that is
dimensioned to fit into the cannula; i. inserting the template into
the cannula; ii. cutting the cannula and template at the length
commensurate with the access hole.
15. The method as claimed in claim 14 including the provision of
including markings on said template graduated to a scale
commensurate with the scale of the indicia on the cannulated
dilator; and the cannula being transparent so that the scale on the
fixture is visible.
16. The method as claimed in claim 14 including a clamp to fit the
end of the cannula; cutting in the step of cutting the cannula to a
length that includes the width of the clamp.
17. The method as claimed in claim 14 including the step of
providing a tool for engaging the proximal end of the cannulated
dilator and inserting the cannulated dilator by pushing and turning
the tool.
18. The method as claimed in claim 14 including the step of
providing a tool for engaging said cannula for pushing said cannula
into the access hole.
19. The method of sizing the length of a cannula to fit the depth
of an access hole formed in the body of a patient including the
steps of: i. providing a series of different length cannulas; ii.
providing a cannulated dilator with indicia of a scale for
measuring a length; iii. measuring the depth of the access hole by
inserting the cannulated dilator into the access hole to ascertain
the depth; iv. selecting from said different length cannulas
obtained in the step of providing a series of different length
cannulas the length correlating to the length obtained in the step
of measuring before inserting said selected cannula; and v.
inserting said the cannula obtained in the step of selecting from
said different length cannulas into said access hole for defining a
working chamber for performing the medical procedure.
20. The combination of a cannulated dilator and dilator retractor
as claimed in claim 12 including an annular clamp, said clamp being
dimensioned to fit any of said dilator retractor from said series
of said dilator retractors and a bracket extending from said
annular clamp adapted to support the dilator retractor to a rigid
member.
21. The combination of a cannulated dilator and dilator retractor
as claimed in claim 12 wherein each of said cannulated dilator has
a proximal end and a tool engagement portion formed thereon, a tool
having an engagement portion complementing the tool engagement
portion of the cannulated dilator adapted to fit thereon for
rotation and applying leverage on said cannulated dilator for
insertion thereof into the body cavity.
.[.22. The combination of a cannulated dilator and dilator
retractor, said cannulated dilator having an elongated body, said
cannulated dilator for obtaining the measurement of depth of an
access hole formed in a body, said dilator retractor including a
series of dilator retractors having different lengths, whereby the
dilator retractor for use in the access hole is selected from said
series of dilator retractors that is commensurate with the
measurement obtained from said cannulated dilator when extended
into said access hole..].
23. The combination of a cannulated dilator and dilator retractor
as claimed in claim 12 wherein said dilator retractor is made
.[.form.]. .Iadd.from .Iaddend.a plastic material.
24. The combination of a cannulated dilator and dilator retractor
as claimed in claim 23 wherein said dilator .[.retractr.].
.Iadd.retractor .Iaddend.is made .[.form.]. .Iadd.from .Iaddend.a
transparent material.
.Iadd.25. The method of sizing the length of a cannula to fit the
depth of an access hole formed in the body of a patient including
the steps of: i. providing a series of different length cannulas;
ii. providing a measurement instrument for measuring a length; iii.
measuring the depth of the access hole by the instrument obtained
in the previous step ii; iv. selecting from said different length
cannulas obtained in the step of providing a series of different
length cannulas the length correlating to the length obtained in
the step of measuring before inserting said selected cannula; and
v. inserting said the cannula obtained in the step of selecting
from said different length cannulas into said access hole for
defining a working chamber for performing the medical
procedure..Iaddend.
.Iadd.26. A method of surgically creating a working channel in a
patient through which to conduct a surgical procedure, comprising:
sequentially inserting a series of dilators into a patient to form
an access hole, at least one of the dilators having indicia formed
thereon for measuring a depth of the access hole; inserting a
cannula over the dilators, the cannula having a length that is
commensurate with the measured depth of the access hole; and
removing the dilators from the cannula to provide a working channel
through the cannula..Iaddend.
.Iadd.27. The method of claim 26, wherein the access hole extends
to vertebral disc space..Iaddend.
.Iadd.28. The method of claim 26, wherein the dilators are
cannulated and they are inserted over a guidewire..Iaddend.
.Iadd.29. The method of claim 26, wherein, prior to the step of
inserting a cannula over the dilators, the cannula is cut to have a
length that is commensurate with the measured depth of the access
hole..Iaddend.
.Iadd.30. The method of claim 26, wherein the cannula is selected
from a series of cannulas having different lengths..Iaddend.
.Iadd.31. A method of surgically creating a working channel in a
patient through which to conduct a surgical procedure, comprising:
forming an access hole in a patient using a series of dilators;
measuring a depth of the access hole using one of the dilators:
inserting a cannula over the dilators, the cannula having a length
that is commensurate with the measured depth of the access hole;
and removing the dilators from the cannula to provide a working
channel through the cannula..Iaddend.
.Iadd.32. The method of claim 31, wherein the step of forming an
access hole in a patient using a series of dilators comprises
inserting a guide wire into the patient and sequentially inserted a
series of cannulated dilators over the guidewire to create an
access hole..Iaddend.
.Iadd.33. The method of claim 31, wherein, prior to the step of
inserting a cannula over the dilators, the cannula is cut to have a
length that is commensurate with the measured depth of the access
hole..Iaddend.
.Iadd.34. The method of claim 31, wherein the cannula is selected
from a series of cannulas having different lengths..Iaddend.
.Iadd.35. A method of surgically creating a working channel in a
patient through which to conduct a surgical procedure, comprising:
inserting a first dilator into a patient; inserting one or more
cannulated dilators over the first dilator to form an access hole
in the patient; measuring a depth of the access hole using one of
the dilators; inserting a cannula over the dilators, the cannula
having a length that is commensurate with the measured depth of the
access hole; and removing the dilators from the cannula to provide
a working channel through the cannula..Iaddend.
Description
TECHNICAL FIELD
This invention relates to a cannula and cannulated dilator and more
particularly to a cannula intended to be utilized in surgery on a
patient which cannula is sized by the measurement obtained from the
cannulated dilator for obtaining a desired length of the cannula
inserted into the body cavity of the patient for ease of the
surgical procedure being preformed by the surgeon and the apparatus
for insertion of the cannulated dilator and the dilator retractor
into the body cavity.
BACKGROUND OF THE INVENTION
As is known in the medical field, the cannula is utilized for
creating a passage extending from the exterior into a cavity in the
patient to a particular location where the surgical procedure is to
be performed. For example, in current day practices lumbar
discectomy whose objective is to decompress the affected nerve
root, endoscopic and micro endoscopic techniques are often used.
These techniques are becoming popular inasmuch as the patient
benefits from the small incision, limited tissue disruption, better
visualization and illumination all of which shortens the hospital
stay and hastens recovery. One of the techniques for performing the
lumbar discectomy is the use of tubular retractor (a specific
cannula) which allows for laminotomy, deical facetectomy,
foraminotomy, nerve root retraction and disectomy. A typical
procedure is to advance a guidewire through a small incision which
is advanced to the inferior edge of the superior lamina. A small
incision is then made that extends either cranially or caudally. A
.[.calnulated.]. .Iadd.cannulated .Iaddend.dilator is then inserted
over the guidewire. Larger diameter cannulated dilators are
sequentially inserted over each other to increase the opening into
the body cavity. Typically the guide wire is removed after the
first cannulated dilators installed and eventually the cannulated
dilators are all removed after the, tubular retractor has been
inserted over the largest of the cannulated dilators. Once these
procedures are accomplished, the tubular retractor is locked into
position by a retractor clamp that is clamped to a retractor
clamping arm which is fixed to a rigid member such as the operating
table. This provides an unencumbered zone where the surgeon can
perform the medical procedure that was intended to be
performed.
As is well known in this field of technology, the cannulated
dilators and tubular retractors are made from surgical metal
material and are sized for the largest depth that is anticipated in
the surgical procedure. Hence, whether the depth is 10 millimeters
(mm), 20 mm, 30 mm, etc. Measured from the exterior of the cavity
to the most interior position in the cavity (inferior edge of the
superior lamina) the tubular retractor that may be available for
use ii the surgical procedure could be 100 mm or larger. The
additional or excess length of the dilator retractor is not only
cumbersome to use, it is unnecessary and undesirable.
This invention obviates this problem by providing the necessary
elements that allow the dilator retractor (cannula) to be cut to
size once the incision and diameter of the cavity has been
established. Hence, in the surgical procedure described above the
last cannulated dilator in the procedure in accordance with this
invention includes indicia of a graduated vertical scale on the
tubular wall, preferably in millimeters that is viewed by the user.
A cannula or dilator retractor, which basically is a cylindrical
tube made from a plastic or synthetic material in one preferred
embodiment or surgical metal in another embodiment which is easy to
cut and which is transparent in one embodiment and opaque in
another is provided in the largest length contemplated in this
particular procedure or alternatively is pre-sized in a series of
sized cannulas. A template that has a diameter that is slightly
smaller than the diameter of the dilator retractor made from a soft
plastic material such as Teflon material that may include graduated
annular grooves that are graduated vertically in scale that is
commensurate with the indicia scale on the cannulated dilator. Or
alternatively, the dilator retractor may also include on the wall
indicia corresponding to the indicia on the cannulated dilator.
Hence, the surgeon or user merely has to count the annular grooves
or the indicia on the wall of the dilator retractor to match the
depth of the cavity and with a cutter, cut through the delator
retractor which will provide a cannula that is acceptable to the
surgeon without the unnecessary length that has heretofore
presented a problem.
An annular retractor clamp is provided to fit over the top of the
dilator retractor which obviously is sized to accommodate the width
of the retractor clamp which, in turn, is utilized to mate with a
rigid holder that is clamped to a rigid member such as the
operating table or other convenient member to secure the cannula in
place.
This invention also contemplates a tool for insertion of the
cannulated dilator and a tool for the insertion of the dilator
retractor into the body cavity. The tool for insertion of the
cannulated dilator is a rectangular shaped planar member that
removably fits the cannulated dilator and serves to provide
leverage for the surgeon to turn the dilator retractor while it is
being inserted into the body cavity to reach its ultimate
destination. A tool for insertion of the dilator retractor is
generally a pusher which may be made integral with the template
includes an inner bore that is slightly larger than the outer
diameter of the cannulated dilator and includes a flat bottom
surface that overlies the top end wall surface of the dilator
retractor so that the pusher provides leverage for the surgeon to
slide the dilator retractor over the scaled cannulated dilator
until it reaches the final destination in the body cavity.
As an alternate to the use of the cutter and template, it is
contemplated within the scope of this invention, that a series of
different length dilator retractors will be made available so that
the surgeon after making the measurement of the depth of body
cavity with the cannulated dilator will select the dilator
retractor that most closely matches the size desired.
SUMMARY OF THE INVENTION
An object of this invention is to provide a dilator retractor that
is sized to fit the patient for use in a surgical procedure.
A feature of this invention is to provide indicia of a vertical
scale on the cannulated dilator to ascertain the depth of the
cavity in the body in which a medical procedure is to be performed.
In one embodiment a template made from a relatively soft plastic
material fits into the dilator retractor having a scale
commensurate with the scale on the cannulated dilator for
supporting the dilator retractor as it is cut to the desired
length. In another embodiment the dilator retractor includes
indicia on the outer surface that correlates to the indicia on the
cannulated dilator. In one embodiment the dilator retractor is
transparent, in another embodiment it is opaque, and it can be made
from either plastic or metallic material when in the opaque
embodiments.
Another feature of this invention is the provision of a tool that
is adapted to fit the cannulated dilator to allow the surgeon to
turn the cannulated dilator as the surgeon pushes the cannulated
dilator into the body cavity against the resistance of the body
tissue. In one embodiment the tool includes concentric bores that
define a shoulder that engages the end of the cannulated dilator
and recesses that engage tabs axially extending from the proximate
end of the cannulated dilator.
An alternative to the cutting procedure is the provision of
predetermined different length dilator retractors that permit the
surgeon to select the desire length commensurate with the depth of
the body cavity.
Another feature of this invention is an annular retractor clamp
that is slidable over the outer surface of the dilator retractor
that is locked into place and adaptable to fit onto a flexible arm
that is rigidly connected to a static structure such as the
operating table.
The foregoing and other features of the present invention will
become more apparent from the following description and
accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a perspective view in elevation showing the details of
the cannulated dilator of this invention;
FIG. 2 is a perspective view in elevation and section of the
cannulated dilator inserted into the cavity of a body and extending
to the inferior edge of the superior lamina and a turning tool
adapted to retractor clamp onto the tabs extending from the
proximate end of the cannulated dilator;
FIG. 2A is a partial view in cross section taken along the lines
2A--2A of FIG. 2;
FIG. 3 is an exploded view in perspective illustrating the dilator
retractor being fitted onto the graduated template and pusher prior
to being cut to the desired length;
FIG. 4 is a view in perspective illustrating the dilator retractor
fitted onto the template;
FIG. 5 is a view in perspective illustrating the dilator retractor
being cut by a commercially available cutting tool;
FIG. 6 is a view in perspective illustrating the pusher for pushing
the dilator retractor into the body cavity;
FIG. 7 is a view in perspective illustrating the pusher and dilator
retractor of FIG. 6 when pushed to the destination;
FIG. 8 is a view in perspective of the dilator retractor and the
retractor clamp and the cannulated dilator of this invention;
FIG. 9 is a view in perspective of a series of pre-sized dilator
retractors made from an inexpensive material that as an alternative
embodiment to the cut in situ dilator retractor; and
FIG. 10 is a perspective exploded view similar to FIG. 3 showing
another embodiment with the grooves in the template removed and the
dilator retractor having indicia on the outer surface.
DETAILED DESCRIPTION OF THE INVENTION
While in the preferred embodiment this invention is being described
in connection with a particular surgical procedure, namely, a
lumbar disectomy, it is to be understood that this invention has
utility in other types of procedures and as one skilled in this art
can appreciate, the invention has particular utility where it is
desirable to provide a length of the cannula that is commensurate
with the depth of the body cavity. As used in this patent
application the term "cannulated dilator" means a surgical
instrument that is utilized to widen the body cavity and the term
"dilator retractor" is a cannula intended to fit into the body
cavity. As used throughout this disclosure the term "body cavity"
unless indicated otherwise refers to an access hole formed in the
body of the patient in order to reach the target where the medical
procedure is being performed and the term cannula or dilator
retractor serves to define a working cavity or chamber that the
surgeon uses to perform a medical procedure. While in the preferred
embodiment, it is preferred that the dilator retractor is made from
a plastic material and is transparent as will be appreciated and as
will be described herein below this invention contemplates a
dilator retractor made from metallic material and in certain
embodiments the material is opaque.
To best understand this invention reference is being made to FIGS.
1 through 8 which shows the cannulated dilator generally
illustrated by reference numeral 10 (FIGS. 1, 2, 6, 8), the
template and pusher tool instrument combination generally
illustrated by reference numeral 12 (FIGS. 3-6), the dilator
retractor generally illustrated by reference numeral 14 (FIGS. 3,
6, 7, 8) and the retractor clamp generally illustrated by reference
numeral 16 (FIG. 8). As best seen in FIG. 1 the cannulated dilator
10 comprises a hollow tubular body 18 typically made from surgical
metal such as surgical stainless steel, having a beveled end 20 at
the distal end of the tubular body 18 and a pair of
circumferentially spaced tabs 22 extending from the proximate end
surface 24 of the tubular body 18. The beveled at the distal end 20
serves to help the insertion of the cannulated retractor 10
entering the body of the patient and the tabs 22 serve to fit into
a tool that the surgeon utilizes to insert the cannulated dilator
10 as it progresses into the body until it reaches the inferior
edge of the superior lamina as will be described in more detail
hereinbelow. It is contemplated within the scope of this invention
that other techniques for attaching the tool to the cannulated
dilator 10 could be utilized, as for example a poly-sided recesses
or reversal of the tabs by affixing them to the tool rather than
the cannulated dilator and affixing complementary recesses in the
cannulated dilator and other such techniques could be employed.
What is contemplated by the tool is that it provides leverage to
the user so that it allows the cannulated dilator to be turned
while it is being pushed into the body cavity against the
resistance of the body's tissues.
In accordance with this invention, indica 26 is placed on the
exterior of the body 18 and is a graduated scale in millimeters
(although any other unit of measurement can be utilized) that
serves to indicate the depth of the body cavity and is used to
determine the length of the dilator retractor 14 as will be
described in more detail herein below. The dilator retractor 14 in
one embodiment is made from a plastic material that is transparent
and is sufficiently strong that exhibits hoop integrity that is
capable of withstanding the forces of the tissue tending to exert a
lateral force. This provides a relatively inexpensive member that
is capable of being cut while the patient is in the operating room.
In one embodiment the dilator retractor is fitted onto the
fixture--and the fixture includes spaced grooves that are
correlated to the measurement of the depth of the body cavity that
is determined by the indicia of the cannulated dilator 10.
As mentioned above, once the depth of the body cavity as measured
by the indicia on the cannulated dilator 10, the dilator retractor
14 is fitted on the scaled end of the template portion 30 which
includes a series of annular grooves that are axially spaced a
predetermined distance, say at 10 mm, so that the dilator retractor
14 being transparent in this instance, once fitted onto the
template can be sized. Hence, the user merely counts the number of
grooves that is commensurate with the measurement taken from the
indicia of the cannulated dilator and the desired length is then
cut to the desired length. Obviously, it is important that the
dilator retractor 14 is initially oversized so that the length will
be longer than any of the depths of the body cavity contemplated.
Hence, in this manner the cannula is made to fit each individual
patient. The technique for making the measurement and cutting to
size is described as follows. If the depth of the body cavity
measurement taken from the cannulated dilator was 30 mm the user
would count 3 annular grooves which are spaced 10 mm apart to
determine the length of the dilator retractor desired and would add
an addition amount to compensate for the attachment dimension of
the annular retractor clamp .[.18.]. .Iadd.16.Iaddend.. Hence, if
the width of the clamp .[.18.]. .Iadd.16 .Iaddend.is 10 mm and the
depth of cavity is 30 mm, the user would select 40 mm as the
juncture where the dilator retractor is cut to size.
Once the length of the depth of the body cavity as calculated by
the cannulated dilator 10 is determined and while the dilator
retractor 14 is mounted on the fixture portion 30, and after the
user determines the number of annular grooves on the fixture
portion that will match the depth of the body cavity as measured by
the indicia on the cannulated dilator and the amount necessary to
hold the retractor clamp .[.18.]. .Iadd.16.Iaddend., the user with
the use of the commercially available cutters 34 snips off the end
of the retractor dilator 14. The fixture will also be cut and this
system for cutting assures that the dilator retractor 14 will have
a clean, smooth cut. A suitable cutter 34 is one that is available
in many hardware stores such as Home Depot and is under the name
"Orbit". This cutter was tested and has proven to work
satisfactory. However, any type of cutter is contemplated for use
with this invention, such as commercially available knives and pipe
cutters, being other examples.
Once the dilator retractor 14 has been cut to size the dilator
retractor 14 is then fitted over the cannula dilator 10 and is
forced into the body cavity with a suitable pusher tool of the type
shown in FIG. 4. Pusher tool portion 36 which in this instance is
integral with the member 12 is formed on one end and includes the
enlarged diameter portion 38 having a central axial bore that
complements the outer diameter of the cannulated dilator 10. The
bottom annular face 40 is formed with a flat surface that bears
against the end 42 of the dilator retractor 14. This serves to
provide leverage for the surgeon to push the dilator retractor 14
into the body cavity.
Also in accordance with this invention the end clamp 16 comprises
an annular body 46 being split at 47 and including a threaded
lateral bore that accommodates the tightening screw 50. The central
opening is dimensioned to fit over the end of the dilator retractor
14 and slide thereon. Once in position the screw is tightened to
secure the clamp to the dilator retractor 14. A bracket 56 having a
bifurcated slot 58 serves to engage a flexible arm that is clamped
to a rigid member. This serves to support the dilator retractor 14
while the surgeon is performing the surgical procedure.
FIG. 9 exemplifies another embodiment of this invention where the
dilator retractors 14 come in a series of different sizes so that
the surgeon after determining the size of the depth of the body
cavity as ascertained by the graduated scale on the cannulated
dilator 10, the surgeon merely selects the size to match the body
cavity depth taking into consideration the extra length needed to
accommodate the clamp 16.
The cannulated retractor tool 39 is a relatively rectangular flat
member 41 having a central bore 43 that is made from two spaced
diameters. The most inner diameter on the bottom face of the tool
39 is slightly larger than the outer diameter of the cannula
dilator 10 and the outer diameter on the top face of the tool 39 is
equivalent to the inner diameter of the cannulated dilator 10 to
provide a shoulder for bearing on the annular top surface 45 of the
cannulated dilator 10. A pair of concentrically spaced recesses 49
are formed in the top surface extending through the upper portion
of tool 40 to accommodate and complement the tabs 22. Thus tool 39
serves to provide a leverage tool that helps the surgeon for
forcing the cannulated dilator 10 into the body cavity and against
the resistance created by the body tissue adjacent thereto.
FIG. 10 exemplifies another embodiment of this invention where the
fixture 12a which is identical to fixture 12 does not include the
spaced annular grooves and the cannula 14a which is identical to
the cannula 14 includes indicia on the outer wall that corresponds
to the indicia on the cannulated dilator 10. As is apparent from
the foregoing the user merely has to size the cannula 14a by making
a measurement of the body cavity with the cannulated dilator 10 and
select the measurement corresponding thereto from the indicia on
the cannula 14a, and after the cannula is inserted onto the fixture
12a, the user cuts the cannula 14a and fixture 12a so that the
cannula 14a is sized to fit the body cavity. Obviously, the cannula
14a in this instance need not be transparent and can be opaque.
What has been described by this invention is a cannula that is
sized to fit the individual patient. A cannulated dilator includes
indicia of a scale for measuring the depth of the individual
patient. With that measurement, the cannula in one embodiment may
be made from a plastic, transparent material fits onto a fixture
that is cuttable and contains a visible predetermined scale to cut
the cannula to the particular length. In another embodiment the
cannula includes indicia of a scale corresponding to the scale on
the cannulated dilator and is similarly cut. The invention teaches
a tool is provided to insert the cannulated dilator into the cavity
and another tool to insert the cannula into the body cavity. In
another embodiment a series of pre-sized cannulas are provided so
that the user can select from this series the size that corresponds
to the measurement obtained with the cannulated dilator.
Although this invention has been shown and described with respect
to detailed embodiments thereof, it will be appreciated and
understood by those skilled in the art that various changes in form
and detail thereof may be made without departing from the spirit
and scope of the claimed invention.
* * * * *
References