SWITCHING STICK DILATION METHOD AND APPARATUS
A method of dilating an incision to provide access to a surgical site. Such method may include the steps of making an incision in the skin of a patient near a predetermined surgical site, inserting into the incision a dilator, inserting at least one shoe horn in juxtaposition or in direct apposition with the dilator, removing the dilator from the incision, inserting a blunt dissector adjacent the at least one shoe horn, removing the at least one shoe horn, inserting a retractor or a tube over the blunt dissector and into the incision such that the retractor or tube is at or adjacent the predetermined surgical site, removing the blunt dissector from the incision, and performing a surgical procedure at the predetermined surgical site through the retractor or tube.
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The present application is a divisional of U.S. patent application Ser. No. 11/363,404, filed on Feb. 27, 2006, which claims the benefit of the filing date of U.S. Provisional Patent Application No. 60/668,756, filed on Apr. 6, 2005, the disclosures of which are hereby incorporated herein by reference.
BACKGROUND OF THE INVENTIONThe present invention relates to the dilation of a small incision to facilitate introduction of instruments for the performance of surgery.
There is great interest in minimally invasive or less invasive surgery in most surgical procedures because there is believed to be less trauma to the patient and less healing time for the patient than through conventional open procedures. To accomplish the goals of minimally invasive or less invasive surgery, the surgical procedure is preferably conducted through a dilated small incision. Often, a retractor is used within a dilated small incision. The retractor maintains the small incision in a dilated state while a surgeon works through the retractor at the surgical site.
The preliminary procedure of dilating an incision is known and used for spinal surgeries, including static or dynamic stabilization, the insertion of fusion devices, a discectomy, a laminectomy, the insertion of motion preservation devices such as artificial discs, and like devices. Moreover, dilation of small incisions in other surgical procedures are very much applicable to spinal surgery.
The present invention provides an alternative to conventional procedures for dilating a small incision. Gradual dilation of a small incision is facilitated through the use of the present invention.
SUMMARY OF THE INVENTIONThe present invention may be reduced to practice through the introduction of a Cobb dilator into a small incision, preferably guided by a K wire. In a preferred embodiment, the Cobb dilator, or the first dilator, is cannulated to receive a K wire, or a pin, as a guide to the surgical site. In another aspect of the present invention, the Cobb dilator need not be cannulated. The surgeon may not need to be guided by a K wire to the surgical site, and thus cannulation would not be required. The introduction of the Cobb dilator is followed by the introduction of a first Kelly retractor, or shoe horn, and then preferably followed by the introduction of a second Kelly retractor, or shoe horn. The Cobb dilator may then be removed and the Kelly retractors manipulated to facilitate entry of a blunt dissector, preferably manifested as a solid tubular component, into the surgical incision between the Kelly retractors. The Kelly retractors may then be removed and a retractor or tubular port may be introduced over the blunt dissector. The blunt dissector can then be removed and the surgical area defined by the retractor blades, or the surgical area defined by a tube, can be accessed by the surgeon in performing a surgical procedure.
A variation of the above method may include the elimination of the Kelly retractors. Thus, a blunt dissector will follow the use of the Cobb dilator without using the Kelly retractors. A retractor or a tube is used in the same manner over the blunt dissector.
Yet another variation on the above methods would be to again eliminate the use of the Kelly retractor or shoe horn, and utilize not one, but two Cobb dilators. The first Cobb dilator could be used in connection with a K wire or pin and then removed from the incision. In the case of using a Cobb dilator with a K wire or pin, the K wire or pin would preferably be removed either together or after the removal of the first Cobb dilator. A second Cobb dilator or other dilator would be introduced into the incision and used to open the muscle towards the surgical site. The second dilator would be larger than the first dilator, and while the second Cobb dilator could be cannulated, it is not necessary if the K wire is removed with the first Cobb dilator. A retractor or a tube would be placed over the second dilator in the same manner as above.
In connection with yet another aspect of the present invention, whether or not the Cobb dilator is cannulated, the blunt dissector may be cannulated, wherein the cannulation in the blunt dissector is large enough to accept the Cobb dilator. Thus, in connection with this aspect of the present invention, the Cobb dilator will not need to be removed before the insertion of the blunt dissector. This preserves the surgical trajectory as identified by the Cobb dilator, and K wire, if used. Again, in connection with this latter concept, the present invention contemplates either using Kelly retractors to manipulate and gradually dilate the incision or to go forward without using the Kelly retractors. If Kelly retractors are utilized, the Kelly retractors may be removed prior to the introduction of the blunt dissector. However, the cannulated blunt dissector may be introduced over the Cobb dilator with the Kelly retractors, or at least one Kelly retractor, in place. This may facilitate protection of the tissue as the cannulated blunt dissector is introduced over the Cobb dilator.
It is also noted that the retractor 108 shown in step 5 of
The retractor shown in
In
The Kelly retractors 102 and 104 (or shoe horns) are shown in
The blunt dissector 106 shown in
With respect to the method in accordance with the present invention, reference is made to steps 1-5 of
A small incision is made in the patient's skin near the surgical site. Preferably, a K wire 120 or a pin is inserted to the surgical site, or adjacent the surgical site. This step is conventional and is not depicted in
In step 4, it can be seen that the blunt dissector 106 is inserted between the Kelly retractors 102 and 104 (or shoe horns). Once the blunt dissector 106 has been sufficiently inserted into the skin incision, such that it is at or near the surgical site, the Kelly retractors 102 and 104 can be removed. The small incision has now been gradually dilated to the size of the blunt dissector 106. The retractor 108, as shown in step 5 of
Surgical procedures such as those described in the above referenced patent applications can now be performed by the surgeon.
There are many variations to the method in accordance with the present invention, some of which are described above.
While the foregoing description and figures illustrate preferred embodiments of the shoe horn dilation method and apparatus in accordance with the present invention, it should be appreciated that certain modifications can be made, and are encouraged to be made in the structure, materials, and techniques of the disclosed embodiments without departing from the spirit and scope of the present invention which is intended to be captured by the overall reading of the present application, and in particular, that set forth in the Summary of the Invention, as well as the claims in general, as set forth below.
Claims
1. A kit for dilation of an incision to provide access to a surgical site, the kit comprising:
- first and second shoe horns each extending along a length and having at least a portion with an arcuately shaped cross-section in a plane perpendicular to an axis of the length, the arcuately shaped cross-section defining a concave inner surface,
- wherein in an operative configuration in which the concave inner surfaces of the first and second shoe horns face each other, the first and second shoe horns define a passage through which access to a surgical site can be provided.
2. The kit of claim 1, wherein the concave inner surface of at least one of the first and second shoe horns is partially oval shaped.
3. The kit of claim 1, wherein an insertion end of at least one of the first and second shoe horns is rounded.
4. The kit of claim 1, further comprising a dilator.
5. The kit of claim 4, wherein the dilator is cannulated to define a bore along a length thereof.
6. The kit of claim 5, further comprising a K wire configured to be disposed within the bore.
7. The kit of claim 4, wherein the dilator has a first diameter, and further comprising a second dilator having a second diameter larger than the first diameter.
8. The kit of claim 4, wherein at least a portion of the dilator extends along an axis and has an oval shaped cross-section in a plane perpendicular to the axis thereof.
9. The kit of claim 8, wherein the oval shaped cross-section of the dilator substantially conforms to the concave inner surfaces of the first and second shoe horns when the first and second shoe horns are in the operative configuration.
10. The kit of claim 4, further comprising a blunt dissector cannulated to define a bore along a length thereof.
11. The kit of claim 10, wherein the bore of the blunt dissector is configured to accept the dilator therein.
12. The kit of claim 10, wherein the bore of the blunt dissector is sized and configured to substantially match an outer contour of the dilator.
13. The kit of claim 1, further comprising a blunt dissector.
14. The kit of claim 13, wherein at least a portion of the blunt dissector extends along an axis and has an oval shaped cross-section in a plane perpendicular to the axis.
15. The kit of claim 1, further comprising a retractor.
16. The kit of claim 15, wherein the retractor is expandable.
17. The kit of claim 1, further comprising a surgical implant for introduction to the surgical site.
18. A kit for dilation of an incision to provide access to a surgical site, the kit comprising:
- a first shoe horn extending along a length and having at least a portion with an arcuately shaped cross-section in a plane perpendicular to an axis of the length, the arcuately shaped cross-section defining a concave inner surface;
- a dilator;
- a blunt dissector; and
- a retractor.
19. The kit of claim 18, further comprising:
- a second shoe horn extending along a length and having at least a portion with an arcuately shaped cross-section in a plane perpendicular to an axis of the length of the second shoe horn, the arcuately shaped cross-section defining a concave inner surface,
- wherein in an operative configuration in which the concave inner surfaces of the first and second shoe horns face each other, the first and second shoe horns define a passage through which access to a surgical site can be provided and into which at least the blunt dissector can be inserted.
20. The kit of claim 18, further comprising a K wire.
Type: Application
Filed: Mar 21, 2013
Publication Date: Aug 29, 2013
Applicant: STRYKER SPINE (Cestas)
Inventor: Christopher McDonnell (Sandy Hook, CT)
Application Number: 13/848,361
International Classification: A61B 17/02 (20060101);