SURGICAL ACCESS INSTRUMENT
Embodiments of the invention include instruments and methods for providing surgical access to a surgical site. Some embodiments include a flexible arm that adjustably holds a retractor blade to enable access to the surgical site.
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The present invention relates generally to the field of instruments for providing access during surgical procedures, and more particularly relates to retractor instruments for enabling access to a surgical site and shielding tissue during a surgical procedure.
BACKGROUNDSurgical procedures have generally become less disruptive to peripheral tissues as surgical techniques have progressed. Traditional surgical procedures used to treat tissues through incisions have often been very disruptive to peripheral tissues. Such procedures may include incisions through the skin, muscles, vessels, nerves, and other tissues, and may include long and deep incisions. Traditional procedures may include retractors that are either larger than is necessary to effectively perform a procedure or that are cumbersome to operated and therefore require longer periods of retraction than is necessary to perform a procedure. Traditional procedures, consequently, may lead to more trauma to peripheral tissues, more pain, and more lengthy and expensive recoveries. Cumbersome equipment that results in longer operating times may also lead to greater hospital, surgical staff, and physician expenses.
Modern surgical instruments and techniques have enabled less invasive and more expedient access to surgical sites. By way of non-limiting example, less invasive surgical instruments and techniques have been used in spinal surgery to separate and progressively dilate and retract tissues rather than to sever and retract the tissues. Developments in less invasive surgical instruments and methods have been significant, but there remains a need for enhancement of instruments and methods. Enhanced instruments and methods may include features that enable one or more of improvements to the efficiency, speed, access capability, or size of an instrument used in one or more methods.
Although particular embodiments of the surgical instruments and methods are described herein in association with particular spinal surgical procedures and surgical approaches, certain instruments and methods may be equally effective in other surgical procedures in the spine or in other areas of the anatomy.
SUMMARYOne embodiment of the invention is a surgical access instrument. The surgical access instrument may include a flexarm retractor with a base, a first retractor appendage coupled to the base wherein the first retractor appendage has a length and lateral sides along its length, a flexible arm coupled to the base at a proximal end of the flexible arm such that a distal end of the flexible arm is movable relative to the base, and a second retractor appendage coupled to the flexible arm at the distal end of the flexible arm wherein the first retractor appendage has a length and lateral sides along its length. The surgical access instrument may also include a transverse retractor coupled to the base of the flexarm retractor. The transverse retractor may include an assembly with a frame, a threaded shaft rotatably coupled with the frame, a first carriage coupled with the threaded shaft that is configured to translate along the threaded shaft when the shaft is turned, and a second carriage coupled with the threaded shaft that is configured to translate along the threaded shaft when the shaft is turned. Embodiments of the transverse retractor may also include a first transverse retractor appendage coupled with the first carriage, wherein the first retractor appendage has a length and lateral sides along its length, and a second transverse retractor appendage coupled with the second carriage, wherein the second retractor appendage has a length and lateral sides along its length. In some embodiments, the first retractor appendage, the second retractor appendage, the first transverse retractor appendage, and the second transverse retractor appendage are configured to be aligned substantially along their respective lengths and an access portal to the surgical site is formed among a lateral side of the first retractor appendage, a lateral side of the second retractor appendage, a lateral side of the first transverse retractor appendage, and a lateral side of the second transverse retractor appendage.
An embodiment of the invention is a flexible retractor for holding back tissue near a surgical site. The flexible retractor may include a base, a first retractor appendage coupled to the base wherein the first retractor appendage has a length and lateral sides along its length, a flexible arm coupled to the base at a proximal end of the flexible arm such that a distal end of the flexible arm is movable relative to the base, and a second retractor appendage coupled to the flexible arm at the distal end of the flexible arm wherein the first retractor appendage has a length and lateral sides along its length. The first and second retractor appendages may be aligned substantially along their respective lengths and an access portal to the surgical site is formed between a lateral side of the first retractor appendage and a lateral side of the second retractor appendage.
Still another embodiment of the invention is a transverse retractor. Embodiments of the transverse retractor include an assembly with a frame, a threaded shaft rotatably coupled with the frame, a first carriage coupled with the threaded shaft that is configured to translate along the threaded shaft when the shaft is turned, and a second carriage coupled with the threaded shaft that is configured to translate along the threaded shaft when the shaft is turned. Embodiments of the transverse retractor include a first transverse retractor appendage coupled with the first carriage, wherein the first retractor appendage has a length and lateral sides along its length, and a second transverse retractor appendage coupled with the second carriage, wherein the second retractor appendage has a length and lateral sides along its length. In some embodiments, a first portion of the threaded shaft that is coupled with the first carriage has right-hand threads and a second portion of the threaded shaft that is coupled with the second carriage has left-hand threads such that rotation of the shaft in a first rotational direction causes the first and second transverse retractor appendages to move together simultaneously and rotation of the shaft in a second rotational direction opposite from the first rotational direction causes the first and second transverse retractor appendages to move apart simultaneously.
Another embodiment of the invention is a method of creating an access portal to a surgical site. The method may include introducing a first retractor into the surgical site such that the retractor is in a position to separate tissues along a first axis, and introducing a flexarm retractor into the surgical site such that the flexarm retractor is in a position to separate tissues along a second axis that is substantially transverse to the first axis. The flexarm retractor of some embodiments may include a base, a first retractor appendage coupled to the base, a flexible arm coupled to the base at a proximal end of the flexible arm, and a second retractor appendage coupled to the flexible arm at a distal end of the flexible arm. Method embodiments may also include coupling the flexarm retractor with the first retractor, separating the first retractor appendage from the second retractor appendage to create an access portal to the surgical site, and actuating a control on the flexarm retractor to stiffen the flexible arm to fix the second retractor appendage in a desired location.
Yet another embodiment of the invention is a method of creating an access portal to a surgical site. The method includes introducing a retractor with two appendages into the surgical site such that the retractor is in a position to separate tissues along an axis. The retractor may include mechanisms for switching from a first state where one rotational control moves both appendages simultaneously together or apart along the axis to a second state where the one rotational control moves only one of the appendages along the axis.
An embodiment of a surgical access instrument 1 is illustrated in
The flexarm retractor 10 illustrated includes a base 11. As most clearly illustrated in
The coupling between the C-shaped body 12 and the transverse retractor 30 may also be a fixed or pinned coupling in some embodiments. By way of example and without limitation, the coupling may be achieved by welding, may include an adhesive, may include a fastener such as a screw, pin, bolt, rivet, or the like, or may be accomplished through any other effective mechanism.
The rack 13 of the embodiment illustrated in
The pinion assembly 24 also includes a spindle 27 in some embodiments. The spindle 27 includes one or more cogs (not shown) around a perimeter of the spindle 27 that engage with the teeth 14 of the rack 13. By turning the spindle 27, the cogs may be advanced along the teeth 14 to move the rack 13 relative to the pinion assembly 24. The spindle 27 may further include a wing nut, internal hex, external hex, or other opening or component useful in applying torque to the spindle 27 to turn the spindle 27 and move the rack 13 relative to the pinion assembly 24.
As illustrated in
As illustrated in
All of the cannulated joints 18 have been removed from the tensile element 19 in the
As shown in
As is shown in combinations of
In
The threaded shaft 40 shown at least in part in each of
The threaded shaft 40 may be a unitary piece in some embodiments. In other embodiments, such as the one shown in more detail in
A first receiver 71 for a rotational tool in the first portion 41 of the threaded shaft 40 is shown in
A second receiver for a rotational tool may be embodied in either or both internal receiver 72 and external receiver 73, as illustrated in
The threaded shaft 40 shown in
A detent 39 is shown in
In operation, when the detent 39 is in the first indention 81, the first key 87 is engaged with a like shaped opening in the first threaded portion 41, and the second key 88 is engaged with a like shaped opening in the second threaded portion 42. Consequently, turning of any of the first receiver 71, the internal receiver 72, or the external receiver 73 will result in turning of both the first threaded portion 41 and the second threaded portion 42, and the first carriage 31 and the second carriage 32 will move simultaneously.
The central shaft 80 may be translated along the common axis relative to the first portion 41 and the second portion 42 of the threaded shaft 40 by applying a force F to the central shaft 80, as noted in
In the transverse retractor 30 shown in
The first transverse retractor appendage 51 illustrated has a radius or curve about its longitudinal axis. The curve of the illustrated embodiment is a relatively small radius, but may be significantly enlarged in some designs of the invention. For example, the radius may be enlarged to produce a slightly curved appendage as illustrated in
The second transverse retractor appendage 52 illustrated has a radius or curve about its longitudinal axis. The curve of the illustrated embodiment is a relatively small radius, but may be significantly enlarged in some designs of the invention. For example, the radius may be enlarged to produce a slightly curved appendage as illustrated in
As is shown in combinations of
Another embodiment of a surgical access instrument 101 is illustrated in
A rack 113 of the illustrated embodiment provides a connection between the base 111 and the first retractor appendage 121 through a bar 123. The bar 123 extends away for the base 111 and terminates at the first retractor appendage 121. The bar 123 shown is fixed to the base 111. In other embodiments, the bar 123 may be slideably coupled to the base 111 so that the first retractor appendage 121 may be moved closer to or more distant from the surgical site relative to the base 111 by sliding the bar 123 relative to the base 111.
The first retractor appendage 121 includes a length extending along its longitudinal axis and lateral sides 129 along its length. The first retractor appendage 121 illustrated has a radius or curve about its longitudinal axis. The curve of the illustrated embodiment has a relatively large radius, but may be significantly reduced in some designs of the invention. For example, the radius may be small to produce essentially a section of a tube. In other embodiments, the retractor appendage may be substantially flat or planar to form a substantially flat blade.
A flexible arm 115 is coupled to the base 111 at a proximal end 116 of the flexible arm 115. A distal end 117 of the flexible arm 115 is movable relative to the base 111. In the embodiment shown, multiple cannulated joints 118 interconnect with one another along a curvilinear path to form a continuous cannulated member. In some embodiments, the multiple cannulated joints 118 may interconnect with one another along a linear path. A tensile element (not shown) may be disposed through the cannula of the multiple cannulated joints 118. The flexarm retractor 110 includes a control 127 in some embodiments attached to the tensile element to tighten and release the tensile element. The flexible arm 115 of the illustrated embodiment may have a free state and a locked state relative to the base 111. The free state may exist when the tensile element is loosened and some or all of the cannulated joints 118 are rotatable relative to one another. Another example of a free state is where tension is applied to the tensile element to create some resistance between the cannulated joints 118, but adequate lateral pressure to the flexible arm 115 will result in movement of the flexible arm 115 relative to the base 111. A locked state may exist where significant tension is applied to the tensile element to prevent rotation or movement of the cannulated joints 118 relative to one another. In some embodiments, the second retractor appendage 122 may separately or in conjunction with the flexible arm 115 include a free state and a locked state as a result of tension applied to the tensile element or by other effective mechanisms.
In some embodiments, the control 127 also releases and locks the bar 123 relative to the base 111. Therefore, by common activation of the control 127, the first retractor appendage 121, the flexible arm 115, and the second retractor appendage 122 may all be switched between a free state and a locked state relative to the base 111. In other embodiments, the bar 123 is independently movable relative to the base 111 and the tensile element is separately able to be tensioned.
The second retractor appendage 122 includes a length extending along its longitudinal axis and lateral sides 109 along its length. The second retractor appendage 122 illustrated has a radius or curve about its longitudinal axis. The curve of the illustrated embodiment has a relatively large radius, but may be significantly reduced in some designs of the invention. For example, the radius may be small to produce essentially a section of a tube. In other embodiments, the retractor appendage may be substantially flat or planar to form a substantially flat blade.
As is shown in
The transverse retractor 130 may be coupled to an operating table or other piece of surgical support structure through eyelets 195. An assembly 135 includes a frame 136, a threaded shaft 140 rotatably coupled with the frame 136, a first carriage 131 coupled with the threaded shaft 140 that is configured to translate along the threaded shaft 140 when the threaded shaft is turned, and a second carriage 132 coupled with the threaded shaft 140 that is configured to translate along the threaded shaft 140 when the shaft is turned. The frame 136 illustrated includes a housing 133, a center strut 134, a first end cap 137, and a second end cap 138. The housing 133 of the illustrated embodiment is coupled to the center strut 134. The first end cap 137 is coupled to the housing 133, and the second end cap 138 is coupled to the housing 133. Couplings between the components of the frame 136 may be by any effective means, such as but not limited to, welding, application of adhesives, clamping, snap fit components, or with any type of fastener.
The threaded shaft 140 shown couples with and rotates in the frame 136. In the illustrated embodiment, the frame 136 supports the threaded shaft 140 with rotatable couplings in the first end cap 137, the second end cap 138, and at the center strut 134. One or all of the rotatable couplings may include a bushing, a bearing, or a close tolerance fitting or some operable type. The rotatable couplings may include components made from materials other than the materials of the first end cap 137, the second end cap 138, and at the center strut 134, or may be formed as a part of these components.
The threaded shaft 140 may be a unitary piece in some embodiments. In other embodiments, the threaded shaft 140 is composed of multiple components and interacts to provide additional functionality to the transverse retractor 130 and surgical access instrument 101 as, for example, detailed with regard to the transverse retractor 30 above. A first portion of the threaded shaft 140 may have right-hand threads that interact with a first carriage 131, and a second portion of the threaded shaft 140 may have left-hand threads that interact with a second carriage 132. With such an arrangement, rotation of the threaded shaft 140 in a first rotational direction will result in the first carriage 131 and the second carriage 132 moving together, or toward one another, simultaneously. Rotation of the threaded shaft 140 in a second rotational direction opposite from the first rotational direction will result in the first carriage 131 and the second carriage 132 moving apart simultaneously.
In embodiments of the transverse retractor 130, various transverse retractor appendages may be coupled to one or both of the first carriage 131 and the second carriage 132. Transverse retractor appendages 51, 52 detailed above are non-limiting examples of devices that may be used in conjunction with the first carriage 131 and the second carriage 132.
Embodiments of the invention include a portal means for accessing a surgical site. The portal or access means may include a first retractor means for retracting tissue in a first direction. Additionally, the portal means may include a flexarm retractor means for retracting tissue in a second direction substantially transverse to the first direction. The flexarm retractor may further be capable of assuming a flexible state and a rigid state along its length in response to the actuation of a single control.
All or a portion of the surgical access instruments of embodiments of the disclosed invention may be made of any biocompatible material. For example and without limitation, materials of the surgical access instruments may include non-reinforced polymers, carbon-reinforced polymer composites, PEEK and PEEK composites, low density polyethylene, shape-memory alloys, titanium, titanium alloys, cobalt chrome alloys, stainless steel, ceramics and combinations thereof. Material of the surgical access instruments may be radiopaque or may be radiolucent. If radiolucent, the instruments may include markers placed in certain components of the instruments to provide for guidance of the instruments under radiographic imaging.
Another embodiment of the invention is a method of creating an access portal to a surgical site. The method includes introducing a first retractor into the surgical site such that the retractor is in a position to separate tissues along a first axis. The first retractor may include mechanisms for independently moving two retractor appendages or blades along the first axis. The method also includes introducing a flexarm retractor into the surgical site such that the flexarm retractor is in a position to separate tissues along a second axis that is substantially transverse to the first axis. The flexarm retractor of some embodiments includes a base, a first retractor appendage coupled to the base, a flexible arm coupled to the base at a proximal end of the flexible arm, and a second retractor appendage coupled to the flexible arm at a distal end of the flexible arm. The method further includes coupling the flexarm retractor with the first retractor, separating the first retractor appendage from the second retractor appendage to create an access portal to the surgical site, and actuating a control on the flexarm retractor to stiffen the flexible arm to fix the second retractor appendage in a desired location. In some embodiments, actuating the control on the flexarm retractor to stiffen the flexible arm also locks the first retractor appendage relative to the base. Embodiments of the method may further include operating the first retractor to separate tissues along the first axis.
Still another embodiment of the invention is a method of creating an access portal to a surgical site. The method includes introducing a retractor with two appendages into the surgical site such that the retractor is in a position to separate tissues along an axis. The retractor may include mechanisms for switching from a first state where one rotational control moves both appendages simultaneously together or apart along the axis to a second state where the one rotational control moves only one of the appendages along the axis. In some embodiments, the mechanism for switching between the first and second states requires application of a force to a portion of the retractor along the axis. In some embodiments, application of another force in a direction substantially opposite to the direction of the first force results in a return to the first state where one rotational control moves both appendages simultaneously together or apart along the axis.
Various method embodiments of the invention are described herein with reference to particular devices. However, in some circumstances, each disclosed method embodiment may be applicable to each of the devices, or to some other device operable as disclosed with regard to the various method embodiments.
Terms such as proximal, distal, near, lower, upper, lateral, and the like have been used herein to note relative positions. However, such terms are not limited to specific coordinate orientations, but are used to describe relative positions referencing particular embodiments. Such terms are not generally limiting to the scope of the claims made herein.
While embodiments of the invention have been illustrated and described in detail in the disclosure, the disclosure is to be considered as illustrative and not restrictive in character. All changes and modifications that come within the spirit of the invention are to be considered within the scope of the disclosure.
Claims
1. A surgical access instrument comprising:
- a flexarm retractor comprising: a base, a first retractor appendage coupled to the base wherein the first retractor appendage has a length and lateral sides along its length, a flexible arm coupled to the base at a proximal end of the flexible arm such that a distal end of the flexible arm is movable relative to the base, and a second retractor appendage coupled to the flexible arm at the distal end of the flexible arm wherein the first retractor appendage has a length and lateral sides along its length; and a transverse retractor coupled to the base of the flexarm retractor comprising: an assembly comprising: a frame, a threaded shaft rotatably coupled with the frame, a first carriage coupled with the threaded shaft that is configured to translate along the threaded shaft when the shaft is turned, and a second carriage coupled with the threaded shaft that is configured to translate along the threaded shaft when the shaft is turned,
- a first transverse retractor appendage coupled with the first carriage, wherein the first retractor appendage has a length and lateral sides along its length, and
- a second transverse retractor appendage coupled with the second carriage, wherein the second retractor appendage has a length and lateral sides along its length;
- wherein the first retractor appendage, the second retractor appendage, the first transverse retractor appendage, and the second transverse retractor appendage are configured to be aligned substantially along their respective lengths and an access portal to the surgical site is formed among a lateral side of the first retractor appendage, a lateral side of the second retractor appendage, a lateral side of the first transverse retractor appendage, and a lateral side of the second transverse retractor appendage.
2. The instrument of claim 1 wherein one or more of the first retractor appendage, the second retractor appendage, the first transverse retractor appendage, and the second transverse retractor appendage is a substantially flat blade.
3. The instrument of claim 1 wherein one or more of the first retractor appendage, the second retractor appendage, the first transverse retractor appendage, and the second transverse retractor appendage is a member curved about a longitudinal axis of the respective retractor appendage.
4. The instrument of claim 1 wherein the first retractor appendage includes a free state and a locked state relative to the base.
5. The instrument of claim 1 wherein the flexible arm comprises: multiple cannulated joints that interconnect with one another along a linear or curvilinear path to form a continuous cannulated member, and a tensile element disposed through the cannula of the multiple cannulated joints.
6. The instrument of claim 1 wherein the flexible arm and the second retractor appendage each include a free state and a locked state relative to the base.
7. The instrument of claim 1, further comprising a control to switch the flexible arm and the second retractor appendage both between a free state and a locked state relative to the base with a common actuation of the control.
8. The instrument of claim 1, further comprising a control to switch the first retractor appendage, the flexible arm, and the second retractor appendage all between a free state and a locked state relative to the base with a common actuation of the control.
9. The instrument of claim 1 wherein a first portion of the threaded shaft that is coupled with the first carriage has right-hand threads and a second portion of the threaded shaft that is coupled with the second carriage has left-hand threads such that rotation of the threaded shaft in a first rotational direction causes the first and second transverse retractor appendages to move together simultaneously and rotation of the threaded shaft in a second rotational direction opposite from the first rotational direction causes the first and second transverse retractor appendages to move apart simultaneously.
10. The transverse retractor of claim 9 wherein the threaded shaft comprises a central shaft on a common axis with and disposed through the first portion of the threaded shaft and the second portion of the threaded shaft, and wherein the first portion of the threaded shaft and the second portion of the threaded shaft are separate pieces.
11. The transverse retractor of claim 10 wherein the central shaft may be translated along the common axis relative to the first portion of the threaded shaft and the second portion of the threaded shaft.
12. (canceled)
13. A flexible retractor for holding back tissue near a surgical site comprising:
- a base;
- a first retractor appendage coupled to the base wherein the first retractor appendage has a length and lateral sides along its length;
- a flexible arm coupled to the base at a proximal end of the flexible arm such that a distal end of the flexible arm is movable relative to the base; and
- a second retractor appendage coupled to the flexible arm at the distal end of the flexible arm wherein the first retractor appendage has a length and lateral sides along its length;
- wherein the first and second retractor appendages are aligned substantially along their respective lengths and an access portal to the surgical site is formed between a lateral side of the first retractor appendage and a lateral side of the second retractor appendage.
14. The instrument of claim 13, further comprising a bar coupled between the base and the first retractor appendage.
15. The instrument of claim 14 wherein the bar is slideably coupled to the base such that the first retractor appendage may be moved closer to or more distant from the surgical site relative to the base by sliding the bar relative to the base.
16. The instrument of claim 13 wherein the first retractor appendage includes a free state and a locked state relative to the base.
17. The instrument of claim 13 wherein the flexible arm and the second retractor appendage each include a free state and a locked state relative to the base.
18. The instrument of claim 13, further comprising a control to switch the flexible arm and the second retractor appendage both between a free state and a locked state relative to the base with a common actuation of the control.
19. The instrument of claim 13, further comprising a control to switch the first retractor appendage, the flexible arm, and the second retractor appendage all between a free state and a locked state relative to the base with a common actuation of the control.
20. A transverse retractor comprising:
- an assembly comprising: a frame, a threaded shaft rotatably coupled with the frame, a first carnage coupled with the threaded shaft that is configured to translate along the threaded shaft when the shaft is turned, and a second carnage coupled with the threaded shaft that is configured to translate along the threaded shaft when the shaft is turned; a first transverse retractor appendage coupled with the first carriage, wherein the first retractor appendage has a length and lateral sides along its length; and a second transverse retractor appendage coupled with the second carriage, wherein the second retractor appendage has a length and lateral sides along its length;
- wherein a first portion of the threaded shaft that is coupled with the first carriage has right-hand threads and a second portion of the threaded shaft that is coupled with the second carriage has left-hand threads such that rotation of the threaded shaft in a first rotational direction causes the first and second transverse retractor appendages to move together simultaneously and rotation of the threaded shaft in a second rotational direction opposite from the first rotational direction causes the first and second transverse retractor appendages to move apart simultaneously.
21. The transverse retractor of claim 20 wherein the frame includes a housing disposed around at least a majority of a perimeter of the threaded shaft, and wherein the frame supports the threaded shaft with rotatable couplings at each longitudinal end of the housing.
22. The transverse retractor of claim 20 wherein the first portion of the threaded shaft includes a first receiver for a rotation tool.
23. The transverse retractor of claim 20 wherein the second portion of the threaded shaft includes a second receiver for a rotation tool.
24. The transverse retractor of claim 20 wherein the threaded shaft comprises a central shaft on a common axis with and disposed through the first portion of the threaded shaft and the second portion of the threaded shaft, and wherein the first portion of the threaded shaft and the second portion of the threaded shaft are separate pieces.
25. The transverse retractor of claim 24 wherein the central shaft includes a central shaft receiver for a rotation tool.
26. The transverse retractor of claim 24 wherein the central shaft may be translated along the common axis relative to the first portion of the threaded shaft and the second portion of the threaded shaft.
27. (canceled)
Type: Application
Filed: Oct 21, 2011
Publication Date: Feb 9, 2012
Applicants: Warsaw Orthopedic, Inc. (Warsaw, IN), MEDTRONIC (Memphis, TN)
Inventors: Kelli N. SEBASTIAN (Arlington, TN), Dimitri K. PROTOPSALTIS (Memphis, TN)
Application Number: 13/278,610
International Classification: A61B 1/32 (20060101);