Detachable dilator blade
A tissue retraction system includes a dilator and a first retractor member and a retraction assembly. The dilator is configured to be inserted into a tissue body and also includes at least one engagement member. The first retractor member includes a body and at least one engagement member that is configured to attach to the at least one engagement member of the dilator so as to removably attach the retractor member to the dilator body. The retraction assembly includes a retractor body and at least a second retractor member that is movably supported by the retractor body. The retractor body is configured to be attached to the first retractor member. The tissue protection system may also include a neuromonitoring member configured to determine a characteristics of the tissue.
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This application is a broadening reissue of U.S. Pat. No. 9,265,490, which issued from U.S. patent application Ser. No. 13/447,931 filed on Apr. 16, 2012.
FIELD OF DISCLOSUREThe present disclosure generally relates to apparatus, systems, and methods for performing minimally invasive surgery, and more particularly, to dilator assemblies, retractors, systems, and methods for accessing a surgical site to conduct a surgical procedure.
BACKGROUNDIn some surgical procedures, surgeons employ open surgery or minimally invasive techniques to access a target site within the patient's body. Open surgery techniques typically require large incisions and high amounts of tissue displacement to gain access to the surgical target site. Due to the large incisions and high amounts of tissue displacement, patients who undergo open surgery usually require a relatively long recovery time. Minimally invasive techniques, in contrast, involve significantly smaller incisions and require less tissue displacement. As a consequence, patients who undergo minimally invasive procedure have significantly shorter recovery time than patients who undergo open surgery.
In view of the advantages of minimally invasive procedures over open surgery, surgical access systems have been developed to access a surgical target site using a minimally invasive approach. For example, surgical dilators, retractors, and systems typically displace or retract tissue to establish an operative corridor to a surgical target site. Surgeons have employed known surgical access retractors and systems in different kinds of surgeries. In spinal surgeries, for example, spinal access systems can be used to retract tissue in order to perform posterior lumbar interbody fusion (PLIF), anterior lumber interbody fusion (ALIF), or any other suitable spinal approach and surgery. A surgical target site can also be accessed via antero-lateral access, postero-lateral access, and direct-lateral access.
SUMMARYThe present disclosure relates to tissue retraction systems configured to dilate a tissue body. In one embodiment, the tissue retraction system generally includes a dilator and a first retractor member. The dilator is configured to be inserted into the tissue body toward a surgical site, and includes a dilator body that is elongate along a longitudinal direction and sized to dilate the tissue body. Furthermore, the dilator includes at least one engagement member. The first retractor member includes a body and at least one engagement member that is configured to attach to the at least one engagement member of the dilator so as to removably attach the retractor member to the dilator body. The first retractor member and the dilator cooperate so as to define a passageway when the first retractor member is attached to the dilator body. The tissue retraction system further includes a retractor assembly. The retraction assembly includes a retractor body and at least a second retractor member that is movably supported by the retractor body. The retractor body is configured to be attached to the first retractor member.
The present disclosure also relates to methods of accessing a surgical site. In an embodiment, the method includes the following steps: inserting a dilator assembly into a tissue body, the dilator assembly comprising a dilator and a retractor member removably attached to the dilator; advancing the dilator assembly toward the surgical site to dilate at least a portion of the tissue body; removing the dilator from the tissue body while leaving the retractor member in the tissue body; and attaching a retractor assembly to the retractor member disposed in the tissue body.
The foregoing summary, as well as the following detailed description of a preferred embodiment, are better understood when read in conjunction with the appended diagrammatic drawings. For the purpose of illustrating the invention, the drawings show an embodiment that is presently preferred. The invention is not limited, however, to the specific instrumentalities disclosed in the drawings. In the drawings:
With reference to
The tissue body 400 at least partially includes tissue, such as anatomical tissue and a tissue substitute, and can further include an implant or the like. Anatomical tissue can include, but is not limited to, soft tissue such as skin, tendons, ligaments, fascia, fibrous tissues, fat, muscle, nerves, blood vessels, and the like. For example, the tissue body 400 can include a psoas muscle 406, and the surgical site 402 can include a region of the spine 408, such as the lumbar region. Tissue substitutes can include soft tissue substitute, such as a graft.
Certain terminology is used in the following description for convenience only and is not limiting. The words “right”, “left”, “lower” and “upper” designate directions in the drawings to which reference is made. The words “inner” or “distal” and “outer” or “proximal” refer to directions toward and away from, respectively, the geometric center of the implant and related parts thereof. The words, “anterior”, “posterior,” “superior,” “inferior,” “medial,” “lateral,” and related words and/or phrases designate preferred positions and orientations in the human body to which reference is made and are not meant to be limiting. The terminology includes the above-listed words, derivatives thereof and words of similar import.
As illustrated in
At least one or both of the dilator assembly 100 and the retractor assembly 300 can include one or more sensors that can, for instance, the sensors can be carried by the dilator 106 and retractor member 102, respectively. The sensors can be configured as probes, electrodes, or the like, that are configured to detect properties or characteristics of the tissue body 400. In use, the sensors can be used for electromyography (EMG), mechanomyogram (MMG), pressure sensing, and/or vibration sensing. The sensors thereby provide output to a user interface so as to provide guidance information to a user that can be used to guide the dilator 106 and the retractor member 102 without impinging upon nerve tissue.
During operation, the dilator assembly 100 can be inserted into the tissue body 400, such as the psoas muscle 406. The dilator assembly 100 can then be advanced toward the surgical site 402, such as the lumbar spine 408, until at least a portion of the dilator assembly 100 reaches a location adjacent to the surgical site 402. The retractor member 102 can be removed from the dilator 106, and the dilator 106 can be removed from the tissue body 400, leaving the retractor member 102 in the tissue body 400. The retractor body 301 can be attached to the retractor member 102, so as to retract the dilated tissue body 400 as discussed in more detail below. For instance, the retractor body 301 can be attached to the retractor member 102 before or after the dilator 106 has been removed from the tissue body 400. The dilator 106 is configured to be inserted into the tissue body 400 toward a surgical site 402.
With continuing reference to
The dilator 106 includes a dilator body 108 that is elongate along the longitudinal direction 110 and is sized to dilate the tissue body 400 as the dilator 106 is inserted into the tissue body 400. The dilator body 108 defines a proximal or first dilator end 112 and a distal or second dilator end 114. The first dilator end 112 and the second dilator end 114 of the dilator body 108 are spaced apart from each other along the longitudinal direction 110. The dilator body 108 further defines an inner dilator surface 126, an outer dilator surface 128 opposite to the inner dilator surface 126, a first dilator side 130 that is connected between the inner dilator surface 126 and outer dilator surface 128, and a second dilator side 132 disposed between the inner dilator surface 126 and the outer dilator surface 128. For instance, the first and second dilator sides 130 and 132 can define surfaces that extend between the inner and outer dilator surfaces 126 along a transverse direction 120 that extends substantially perpendicular to the longitudinal direction 110. The first and second dilator sides 130 and 132 can be spaced from each other so as to define a gap 133 that is defined between the first and second dilator sides 130 and 132, and is elongate along the longitudinal direction 110. Thus, the dilator body 108 can terminate at the first and second dilator sides 130 and 132. In accordance with one embodiment, the first and second dilator sides 130 and 132 can be spaced from each other along a lateral direction 121 that extends substantially perpendicular to the longitudinal direction 110 and the transverse direction 120; though it should be appreciated that the first and second dilator sides 130 and 132 can be spaced from each other along any suitable direction as desired.
The outer dilator surface 128 and the inner dilator surface 126 can have a substantially curved shape or can define any suitable alternative shape. In accordance with the illustrated embodiment, the dilator body 108 can have a substantially partial cylindrical shape. Accordingly, the cross-section of the dilator body 108, taken along a direction that is substantially perpendicular to the longitudinal direction 110, can be substantially arc-shaped or substantially semicircular. It is envisioned, however, that the cross-section of the dilator body 108 can have other suitable shapes. In accordance with the illustrated embodiment, the first and second dilator sides 130 and 132 can be spaced from each other along an angular direction greater than 180 degrees as defined by the dilator body 108. Accordingly, as described in more detail below with reference to
The inner dilator surface 126 defines a channel 116 that can extend through the dilator body 108 from the first dilator end 112 to the second dilator end 114 along the longitudinal direction 110. The gap 133 can be in communication with the channel 116 along the transverse direction 120 or any alternative direction that is substantially perpendicular to the longitudinal direction 110. It should be appreciated that the retractor member 102 is attachable to the dilator body 108 so as to close at least a portion of the gap 133. As is described in more detail below, the retractor member 102 can be translatably attached to the dilator body 108 so as translate relative to the dilator body 108, and thus the gap 133, along the longitudinal direction 110. Thus, the gap 133 can be referred to as a variable sized gap. As used herein, the channel 116 can include, but is not limited, to a hole, a slot, a groove, an opening, a cavity, a void, or any open space that is configured and sized to receive another dilator that can define a channel that is smaller than the channel 116, such that the dilator 106 can dilate the tissue body 400 beyond the dilation from the other dilator. Thus, it should be appreciated that the dilator assembly 100 can include one or more dilators that have channels of different sizes that can be fitted over each other so as to sequentially dilate the tissue body 400.
In accordance with the illustrated embodiment, the inner and outer dilator surfaces 126 and 128 extend continuously between the first and second dilator sides 130 and 132. Accordingly, it can be said that the first and second dilator sides 130 and 132 are substantially fixed to each other, such that the channel 116 has a size that is fixed. For instance, the first and second dilator sides 130 and 132 are not configured to move with respect to each other so as to increase the size of the channel 116 when the dilator body 108 is inserted into the tissue body 400. In embodiments where the dilator body 108 is entirely rigid, the first and second dilator sides 130 and 132 are entirely fixed with respect to relative movement. In embodiments where the dilator body 108 is flexible, such that the dilator body 108 can be flexed in response to an applied force, the first and second dilator sides 130 and 132 can be referred to as substantially fixed with respect to each other, and not configured to move with respect to each other once the dilator body 108 is inserted into the tissue body 400. Furthermore, in accordance with the illustrated embodiment, the dilator 106 can include only a single monolithic dilator body 108.
Referring now also to
The inner and outer retractor surfaces 134 and 136 can extend between the first and second ends 138 and 140, respectively, along the longitudinal direction 111. The retractor member 102 can further define a first retractor side 148 that is connected between the inner retractor surface 134 and outer retractor surface 136, and a second retractor side 150 that is connected between the inner retractor surface 134 and the outer retractor surface 136. For instance, the first and second retractor sides 148 and 150 can define surfaces that extend between the inner and outer refractor surfaces 134 and 136 along a transverse direction 123 that extends substantially perpendicular to the longitudinal direction 111 and the lateral direction 113. In accordance with one embodiment, the first and second retractor sides 148 and 150 can be spaced from each other along a lateral direction 123 that extends substantially perpendicular to the longitudinal direction 110 and the transverse direction 113; though it should be appreciated that the first and second retractor sides 148 and 150 can be spaced from each other along any suitable direction as desired.
At least a portion up to all of the outer retractor surface 136 and the inner retractor surface 134 can have a substantially curved shape along a cross-section that is substantially perpendicular to the longitudinal direction 111, or can be alternatively shaped along the cross-section as desired. The first and second refractor sides 148 and 150 can be spaced a distance substantially equal to a distance that the first and second dilator sides 130 and 132 are spaced (for instance, along the lateral direction 123 and 121, respectively). Accordingly, at least one or both of the first and second retractor sides 148 and 150 are configured to attach to the complementary one or both of the first and second dilator sides 130 and 132, respectively, so as to attach the retractor member 102 to the dilator 106 as illustrated in
Referring now to
With continuing reference to
Thus, it should be appreciated that the dilator assembly 100 can include an attachment mechanism 152 that includes the at least one engagement member of the retractor member 102, such as the first and second retractor engagement members 154 and 158, respectively. The attachment mechanism 152 further includes the at least one engagement member of the dilator 106, such as the first and second dilator engagement members 156 and 160. The first retractor engagement member 154 is configured to attach to the first dilator engagement member 156 so as to translatably attach the retractor member 102 to the dilator 106. Similarly, the second retractor engagement member 158 is configured to translatably attach to the second dilator engagement member 160 so as to attach the retractor member 102 to the dilator 106. Thus, the retractor member 102 is configured to translate along the dilator 106, for instance along the longitudinal direction 110.
In accordance with the illustrated embodiment, the first and second retractor engagement members 154 and 158 are configured to be received in the complementary first and second dilator engagement members 156 and 160 so as to translatably attach the refractor member 102 to the dilator 106. Thus, the first and second retractor engagement members 154 and 158 can be referred to as tongues, and the first and second dilator engagement members 156 and 160 can be referred to as grooves, such that the attachment mechanism 152 defines a tongue-and-groove interface that attaches the retractor member 102 to the dilator 106. It should be appreciated, of course, that the first and second retractor engagement members 154 and 158 can be alternatively configured as desired. For instance, the first and second retractor engagement members 154 and 158 can be configured as grooves that are recessed into the body 122, for instance into the sides 148 and 150. Furthermore, it should be appreciated that the first and second dilator engagement members 156 and 160 can be alternatively configured as desired. For instance, the first and second dilator 156 and 160 can be configured as protrusions that extend out from the dilator body 108, for instance from the first and second sides 130 and 132, respectively. The engagement members of the dilator 106 and the retractor member 102 attach such that the retractor member 102 is movable with respect to the dilator 106. In an embodiment, the engagement members of the dilator 106 and the retractor member 102 attach such that the retractor member 102 can translate relative to the dilator 106.
Referring to
Furthermore, when the refractor member 102 is attached to the dilator 106, the dilator assembly 100 defines a passageway 142 that is partially defined by the inner retractor surface 134 of the body 122, and is further partially defined by the inner dilator surface 126 of the dilator body 108. It should be appreciated that inner retractor surface 134 can at least partially cover the channel 116 of the dilator 106 so as to define the passageway 142. For instance, the inner retractor surface 134 can enclose the channel 116, such that the passageway 142 is enclosed along all directions that are substantially perpendicular to the longitudinal direction 110. Alternatively, the inner retractor surface 134 can partially enclose the channel 116, such that a portion of the passageway can be open along a direction substantially perpendicular to the longitudinal direction 110. It can thus be said that the body 122, for instance at the inner retractor surface 134, at least partially encloses the channel 116 when the retractor member 102 is attached to the dilator 106.
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In operation, the central arm 306 and the retractor member 102 are moved relative to each other so that the lock 166 is advanced toward the retention member 332 until the top angled surface 169 abuts the angled surface 342. The lock 166 is then advanced toward the fastening indentation 330. As the lock 166 is advanced toward the fastening indentation 330, the angled surface 342 slides along the top angled surface 169 to facilitate insertion of the lock 166 into the fastening indentation 330. While the angled surface 342 slides along the top angled surface 169, the lock 166 urges the retention member 332 in a direction opposite to the direction indicated by arrow 340 to allow the lock 166 to be inserted into the fastening indentation 330. Upon further advancement of the lock 166 toward the fastening indentation 330, the lock 166 is no longer positioned over the retention member 332. Consequently, the biasing member 336 biases the retention member 332 in the transverse direction as indicated by arrow 340. As the retention member 332 is biased in the transverse direction, the top surface 344 of the retention member 332 contacts the bottom surface 165 of the lock 166, causing the lock 166 to be secured within the fastening indentation 330. As a consequence, the retractor member 102 is attached to the central arm 306 of the retractor assembly 300. The retractor member 102 can be releasably attached to the central arm 306 of the retractor assembly 300. In an alternative embodiment as shown in
With reference to
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Before inserting at least one of the obturator 500 or the second dilator 502, a sensor 501 can be used to detect the position of nerves in the tissue body 400. For example, the sensor 501, which can be a neuromonitoring probe, can be inserted laterally and advanced toward the surgical site 402 until its tip 505 is inserted into the surgical site 402. As illustrated in
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In one embodiment, the method of accessing the surgical site can include the following steps inserting a dilator assembly into a tissue body, the dilator assembly comprising a dilator and a refractor member removably attached to the dilator; advancing the dilator assembly toward the surgical site to dilate at least a portion of the tissue body; detaching the dilator from the retractor member; removing the dilator from the tissue body while leaving the refractor member in the tissue body; and attaching a retractor assembly to the retractor member disposed in the tissue body.
With reference to
In one embodiment, the method of accessing the surgical site 400 includes the following steps: inserting a dilator assembly into a tissue body, the dilator assembly comprising a dilator and a refractor member removably attached to the dilator; advancing the dilator assembly toward the surgical site to dilate at least a portion of the tissue body; removing the dilator from the tissue body while leaving the retractor member in the tissue body; and attaching a retractor assembly to the retractor member disposed in the tissue body. The step of attaching the retractor assembly to the retractor member can be performed after the step of removing the dilator from the tissue body. The step of attaching the retractor assembly to the retractor member can be performed before the step of removing the dilator from the tissue body. The dilator can be referred to as the first dilator, and the method can further include the step of advancing a second dilator toward the surgical site to dilate at least a portion of the tissue body. The step of advancing the dilator assembly toward the surgical site can include moving the dilator assembly over the second dilator so that the dilator assembly at least partially surrounds the second dilator. The method can further include advancing an obturator toward the surgical site, wherein the step of advancing the second dilator toward the surgical site includes moving the second dilator over the obturator such that at least a portion of the second dilator surrounds at least a portion of the obturator.
With reference to
The neuromonitoring device 602 can include a first portion 612 and a second portion 614 both of which can be removed from the third dilator 610. The first portion 612 can also be referred to as the proximal portion, and the second portion 614 can be referred to as the distal portion. The first portion 612 can be partly or entirely made of a reusable or disposable material. For instance, the first portion 612 can partly or entirely made of aluminum, polyetheretherketone (PEEK), stainless steel or any other suitable material. The first portion 612 and the second portion 614 can be connected to each other to define the neuromonitoring device 602. The second portion 614 can be configured as a neuromonitoring member 615 that is configured to detect properties or characteristics of the tissue body 400. For instance, the neuromonitoring member 615 can be used for electromyography (EMG), mechanomyogram (MMG), pressure sensing, vibration sensing, or a combination thereof. The neuromonitoring device 602 can thereby provide output to a user interface so as to provide guidance information to a user that can be used to guide the dilator assembly 600 without impinging upon nerve tissue. The neuromonitoring device 602 can be removed from the third dilator 606.
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Then, the first dilator 606 can be advanced into the tissue body 400 and toward the surgical site 402 in order to dilate the tissue body 400 from an initial position to a first dilated position. Then, the second dilator 608 can be advanced over the first dilator 606 and toward the surgical site 402 to further dilate the tissue body 400. For instance, the second dilator 608 can be positioned over the first dilator 606 such that the first dilator 606 is disposed in the dilator opening 732. Then, the second dilator 608 can be advanced into the tissue body 400 and toward the surgical site 402 in order to dilate the tissue body 400 from the first dilated position to the second dilated position. During insertion of the second dilator 608 into the tissue body 400, the electrode 738 of the second dilator 608 can monitor properties or characteristics of the tissue body 400 as discussed above. For example, the electrode 738 can monitor the direction, pathology, and proximity of nerves. The electrode 732 can continue to detect the properties or characteristics of the tissue body 400 even after the second dilator 608 has been placed in the desired position.
Next, the third dilator 610 that is pre-connected to the neuromonitoring device 602 can be advanced into the tissue body 400 and toward the surgical site 402. Specifically, the pre-connected third dilator 610 and neuromonitoring device 602 can be positioned over the second dilator 608 such that the second dilator 608 is disposed in the dilator opening 628. Then, the pre-connected third dilator 610 and neuromonitoring device 602 can be advanced over the second dilator 608 so that neuromonitoring device 602 faces the posterior side of the patient. The third dilator 610 can be advanced over the second dilator 608 so that the During insertion of the-connected third dilator 610 and neuromonitoring device 602 into the tissue body 400, the electrode 617 can monitor properties or characteristics of the tissue body 400 as discussed above. The electrode 617 can continue to detect the properties or characteristics of the tissue body 400 even after the neuromonitoring device 602 has been placed in the desired position.
Once the dilator assembly 600 has been positioned in the desired location in the tissue body 400, the first portion 612 of the neuromonitoring device 602 can be decouple from the third dilator 610 and removed from the tissue body 400, while leaving the second portion 614 in the tissue body 400. The second portion 614 can be anchored to the surgical site, such as the intervertebral disc annulus, using a shim that slidably coupled to the second portion 614. The insertion of the shim to a portion of the tissue body 400, such as the disc annulus, facilitates securement and stabilization of the second portion 614 before insertion of the retractor members 102 into the tissue body 400. The secure and stabilization of the second portion 614 in the tissue body 400 also prevents, or at least minimizes, tissue encroachment from the posterior side of the second portion 614 because the second portion 614 is prepositioned and secured before the retractor members 102 are introduced into the tissue body 400. If necessary or desired, the first dilator 606, the second dilator 608, and the wire 604 can be removed from the tissue body 400. Alternatively, the first dilator 606 and the second dilator 608 can be removed from the tissue body 400 while leaving the wire 604 in the tissue body 400. Also, the first dilator 606, the second dilator 608, the third dilator 610, and the wire 604 can be removed from the tissue body 400 while leaving only the second portion 614 in the tissue body 400. Also, the first dilator 606, the second dilator 608, and the third dilator 610 can be removed from the tissue body 400 while leaving the wire 604. Regardless of which components are removed from the tissue body 400 at this juncture of the process, the second portion 614 can remain in the tissue body 400. Before connecting the retractor assembly 300 to the second portion 614, the electrical connection member 656 can be bent to avoid interference with the retractor assembly 300.
Then, the retractor assembly 300 is advanced toward the tissue body 400 so that the retractor members 102 are advance d toward the surgical site 402. For instance, the retractor members 102 can be advanced toward the surgical site 402 such that the retractor members 102 are disposed around the wire 604, the third dilator 610, or both. While the retractor members 102 are advanced into the tissue body 400 and toward the surgical site 402, the partial retractor member 303 can be connected to the second section 614 as discussed above. Then, if necessary, the first dilator 606, the second dilator 608, the third dilator 610, the wire 604, or a combination thereof, can be removed from the tissue body 400, while leaving the second portion 614 neuromonitoring device 602 in the tissue body 400. As discussed above, the electrode 617 of the second portion 614 can detect properties or characteristics of the tissue body 400. For instance, the electrode 617 can monitor the direction, pathology, and proximity of nerves.
The use of the dilator assembly 600 and associated methods as describe above allow continuous neuromonitoring of the tissue body 400 during advancement of the retractor members 102 into the tissue body 400, because the second portion 614, which contains an electrode 617, remains in the tissue body 400 during insertion of the retractor members 102 into the tissue body. It is envisioned that the retractor members 102 can be constructed as the partial retractor 303, and therefore can be attached to other second portions 614 that have neuromonitoring capabilities as described above.
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It should be noted that the illustrations and discussions of the embodiments shown in the figures are for exemplary purposes only, and should not be construed limiting the disclosure. One skilled in the art will appreciate that the present disclosure contemplates various embodiments. It should be further appreciated that the features and structures described and illustrated in accordance one embodiment can apply to all embodiments as described herein, unless otherwise indicated. Additionally, it should be understood that the concepts described above with the above-described embodiments may be employed alone or in combination with any of the other embodiments described above.
Claims
1. A tissue retraction system configured to dilate a tissue body, the tissue retraction system comprising:
- a dilator configured to be inserted into the tissue body toward a surgical site, the dilator including a dilator body that is elongate along a respective longitudinal direction and sized to dilate the tissue body, the dilator body defining a proximal end and a distal end that is spaced from the proximal end along the respective longitudinal direction, and the dilator body terminates at first and second dilator sides that extend between the proximal and distal ends, the dilator further including at least one engagement member that is recessed along at least one of the dilator sides;
- a first retractor member that includes a body that is elongate along the respective longitudinal direction and at least one engagement member that is configured to attach to the at least one engagement member of the dilator so as to removably attach the first retractor member to the dilator body along the respective longitudinal direction, the first retractor member and the dilator cooperate so as to define a passageway when the first retractor member is attached to the dilator body, wherein one of the at least one engagement members of the dilator and the first retractor member defines a protrusion that is elongate along the respective longitudinal direction and the other of the at least one engagement members of the dilator and the first retractor member defines a groove that is elongate along the respective longitudinal direction and receives the protrusion so as to removably attach the first retractor member to the dilator; and
- a retractor assembly including a retractor body and at least a second retractor member that is movably supported by the retractor body, the retractor body configured to be attached to the first retractor member, wherein the retractor body is configured so as to cause the second retractor member to splay away from the first retractor member when the first retractor member is attached to the retractor body.
2. The tissue retraction system as recited in claim 1, wherein the engagement members of the dilator and the first retractor member attach such that the first retractor member is movable with respect to the dilator along the respective longitudinal direction.
3. The tissue retraction system as recited in claim 1, wherein the passageway is enclosed along all directions that are substantially perpendicular to the longitudinal direction.
4. The tissue retraction system as recited in claim 1, wherein the body of the first retractor member defines a proximal end and a distal end that is spaced from the proximal end along the longitudinal direction, the body of the first retractor member terminates at first and second retractor sides that extend between the proximal and distal ends of the body of the first retractor member, and the at least one engagement member of the first retractor member extends out of least one of the retractor sides.
5. The tissue retraction system as recited in claim 1, wherein the dilator defines first and second protrusions, and the first retractor member defines first and second grooves that are configured to receive the first and second protrusions.
6. The tissue retraction system as recited in claim 1, wherein the first retractor member includes an engagement assembly that is configured to secure the body of the first retractor member to the retractor assembly.
7. The tissue retraction system as recited in claim 6, wherein the retractor assembly defines an engagement opening that is configured to receive the engagement assembly to secure the first retractor member to the retractor assembly.
8. The tissue retraction system as recited in claim 7, wherein the retractor assembly includes a retention member that is configured to retain the engagement assembly in the engagement opening so as to secure the first retractor member to the retractor assembly.
9. The tissue retraction system as recited in claim 8, wherein the retractor assembly includes a biasing member that is configured to bias the retention member in a direction away from the retractor body.
10. The tissue refraction system as recited in claim 1, further comprising a fastener that is configured to connect the first retractor member to the retractor assembly.
11. The tissue retraction system as recited in claim 10, wherein the first retractor member defines a hole, and the retractor assembly defines an engagement opening that is configured to be aligned with the hole such that the engagement opening and the hole are configured to collectively receive the fastener to secure the first retractor member to the retractor assembly.
12. The tissue retraction system as recited in claim 1, further comprising
- a neuromonitoring member configured to detect at least one property of the tissue body, the neuromonitoring member configured to be coupled to the dilator.
13. The tissue retraction system as recited in claim 12, wherein the dilator body defines an outer dilator surface, and the neuromonitoring member is configured to be coupled along the outer dilator surface.
14. The tissue retraction system as recited in claim 12, wherein the neuromonitoring member includes at least one electrode that is configured to detect at least one property of the tissue body.
15. The tissue retraction system as recited in claim 14, wherein the neuromonitoring member includes at least one electrical connection member that is configured to transmit electrical energy to the electrode from an electrical power source.
16. A tissue retraction system configured to dilate a tissue body, the tissue retraction system comprising:
- a dilator configured to be inserted into the tissue body toward a surgical site, the dilator including a dilator body that is elongate along a respective longitudinal direction and sized to dilate the tissue body, the dilator further including at least one engagement member;
- a first retractor member that includes a body that is elongate along the respective longitudinal direction, at least one engagement member that is configured to attach to the at least one engagement member of the dilator so as to removably attach the first retractor member to the dilator body, wherein the first retractor member and the dilator cooperate so as to define a passageway when the first retractor member is attached to the dilator body, the first retractor member including an engagement assembly; and
- a retractor assembly including a retractor body, an engagement opening that is configured to receive the engagement assembly, a retention member that is configured to retain the engagement assembly in the engagement opening so as to secure the first retractor member to the retractor assembly, and a biasing member that is configured to bias the retention member in a direction away from the retractor body, the retractor assembly further including at least a second retractor member that is movably supported by the retractor body such that the second retractor member is moveable away the first retractor member when the first retractor member is secured to retractor assembly.
17. The tissue retraction system as recited in claim 16, wherein the engagement members of the dilator and the first retractor member attach such that the first retractor member is movable with respect to the dilator along the respective longitudinal direction.
18. The tissue retraction system as recited in claim 16, wherein the passageway is enclosed along all directions that are substantially perpendicular to the longitudinal direction.
19. The tissue retraction system as recited in claim 16, wherein one of the at least one engagement members of the dilator and the first retractor member defines a protrusion that is elongate along the respective longitudinal direction, and the other of the at least one engagement members of the dilator and the first retractor member defines a groove that is elongate along the respective the longitudinal direction and receives the protrusion so as to removably attach the first retractor member to the dilator.
20. The tissue retraction system as recited in claim 16, wherein the dilator body defines a proximal end and a distal end that is spaced from the proximal end along the longitudinal direction, the dilator body terminates at first and second dilator sides that extend between the proximal and distal ends, and the at least one engagement member of the dilator is recessed in at least one of the dilator sides.
21. A tissue retraction system, comprising:
- a dilator having a dilator body that defines a proximal end, a distal end that is spaced from the proximal end along a respective longitudinal direction, an inner surface, and an outer surface, the dilator including an electrode, the dilator body terminating at first and second dilator sides that extend between the proximal and distal ends, the dilator including at least one engagement member that is recessed along at least one of the dilator sides;
- a retractor member having a body that defines a proximal end, a distal end, at least one engagement member that is configured to attach to the at least one engagement member of the dilator so as to removably attach the retractor member to the dilator body along the respective longitudinal direction, and a retractor member opening that extends through the body from the proximal end to the distal end, the retractor member opening being configured to receive the dilator therethrough, wherein one of the at least one engagement members of the dilator and the retractor member defines a protrusion that is elongate along the respective longitudinal direction and the other of the at least one engagement member of the dilator and the retractor member defines a groove that is elongate along the respective longitudinal direction and receives the protrusion so as to removably attach the retractor member to the dilator; and
- a mechanomyogram (MMG) neuromonitoring system, the electrode of the dilator being electrically coupled to an electrically conductive member extending longitudinally along the dilator, the electrically conductive member being connected to the MMG neuromonitoring system.
22. The system of claim 21, wherein the retractor member defines a circumferentially-enclosed working channel that extends from the proximal end to the distal end of the body.
23. The system of claim 21, wherein the electrode is configured to detect properties or characteristics of tissue in which the first dilator is disposed.
24. The system of claim 21, wherein the electrode is configured to provide output to a user interface so as to provide guidance information to a user that can be used to guide the first dilator without impinging upon nerve tissue.
25. The system of claim 21, wherein the electrode is configured to monitor the direction, pathology, and proximity of nerves.
26. The system of claim 21, wherein the electrode is configured to continue to detect the properties or characteristics of tissue after the dilator is placed in a desired position.
27. The system of claim 21, wherein the dilator is longer than the retractor member.
28. The system of claim 21, wherein the retractor member is tubular.
29. The system of claim 21, wherein the dilator includes a curved outer surface that mates with a curved inner surface of the retractor member.
30. The system of claim 21, wherein an inner diameter of the retractor member is greater than an outer diameter of the dilator.
31. The system of claim 21, wherein the dilator is longitudinally movable relative to the retractor member.
32. The system of claim 21, wherein the dilator and the retractor member are movable relative to one another to dilate tissue.
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Type: Grant
Filed: Feb 22, 2018
Date of Patent: Apr 27, 2021
Assignee: DePuy Synthes Products, Inc. (Raynham, MA)
Inventors: Brian Scott Bowman (San Diego, CA), Corbett Stone (San Diego, CA), Benjamin Arnold (San Diego, CA), Kabir Gambhir (San Diego, CA), Robert J. Bishop (West Chester, PA)
Primary Examiner: Cary E Wehner
Application Number: 15/901,920
International Classification: A61B 1/32 (20060101); A61B 17/02 (20060101); A61B 5/0488 (20060101); A61B 17/00 (20060101); A61M 29/00 (20060101);