US5954635A
Expired / Lapsed
US
⏱️ 0.0 years remaining
Devices and methods for percutaneous surgery
Assignee: SDGI Holdings Inc
•
Filing: 1997-08-29
•
Granted: 1999-09-21
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Expires: 2017-08-29
Abstract
Abstract Devices and methods for performing percutaneous spinal surgery under direct visualization and through a single cannula are shown. A device (10) is provided which includes an elongated cannula (20) having a first inner diameter (D I ) and an outer diameter (D O ) sized for percutaneous introduction into a patient. The cannula (20) defines a working channel (25) between its ends (21, 22) which has a second diameter (D 2 ) equal to the diameter (D I ) of the cannula sized for receiving a tool therethrough. An elongated viewing element (50) is engageable to the cannula (20) adjacent the working channel (25), preferably by a fixture (30). The fixture (30) includes a housing (31) attachable to the proximal end (22) of the cannula (20) that defines a working channel opening (35) which is in communication with the working channel (25). The housing (31) also defines an optics bore (60) adjacent the working channel opening (35). In certain embodiments, the fixture (30) supports the viewing element (50) for translation and/or rotation within the optics bore (60) along the longitudinal axis of the bore, and for rotation of the housing (31) relative to the cannula (20) so that the longitudinal axis of the optics bore (60) will rotate about the longitudinal axis of the working channel (25). Methods are also provided for performing spinal surgeries percutaneously with direct visualization and without the requirement for a fluid-maintained workspace.
Inventors
- 👤 Kevin Thomas Foley
- 👤 Maurice Mell Smith
- 👤 John B. Clayton
- 👤 Joseph Moctezuma
Bibliographic Details
Application Number
—
Jurisdiction
US
Data Source
google_patents
Last Synchronized
2026-10-23 02:00
CPC Classifications
A; A61; A61M; A61M29/00; A61M29/02; A61B; A61B17/00; A61B17/02; A61B17/34; A61B17/3417; A61B17/16; A61B17/1662; A61B17/1671; A61B17/3421; A61B17/00234; A61B2017/00238; A61B2017/00261; A61B2017/00292; A61B2017/00296; A61B2017/0046; A61B2017/00469; A61B17/025; A61B2017/0256; A61B2017/0262; A61B2017/3445; A61B2017/347; A61B90/00; A61B90/30; A61B2090/306; A61B90/36; A61B90/361; A61B2090/3614; A61B90/37; A61B2090/373; A61B90/50
Claims Analysis
Total Claims: 48
Claim 1
Independent Claim
112 words
The method for performing a surgical procedure at a location in a patient's body, comprising the steps of: creating a working channel through the skin and tissue of a patient; creating a working space in communication with the working channel and adjacent the location in the patient's body; inserting optics through the working channel to the working space; extending a first tool through the working channel to the working space with the optics in the working channel; and manipulating the first tool through the working channel to perform a surgical procedure on the location in the working space under direct vision from the optics and without directing irrigation fluid to the location.
Claim 2
Independent Claim
112 words
The method for performing a surgical procedure at a location in a patient's body, comprising the steps of: creating a working channel through the skin and tissue of a patient; creating a working space in communication with the working channel and adjacent the location in the patient's body; inserting optics through the working channel to the working space; extending a first tool through the working channel to the working space with the optics in the working channel; and manipulating the first tool through the working channel to perform a surgical procedure on the location in the working space under direct vision from the optics and without directing irrigation fluid to the location.
Claim 3
Dependent Claim
25 words
The method of claim 1 wherein the tool is a power drill and the surgical procedure is drilling through bone or tissue at the location.
Claim 4
Dependent Claim
39 words
The method of claim 1, further comprising the steps of: extending the optics through the working channel beyond the end of the working channel adjacent the working space for direct visualization of the working space and manipulating the tool.
Claim 5
Dependent Claim
36 words
The method of claim 1, further comprising the steps of: removably inserting a second tool through the working channel simultaneous with the first tool; and manipulating the second tool to perform a function at the location.
Claim 6
Dependent Claim
60 words
The method of claim 4 further comprising the steps of: inserting a guidewire into a patient through skin and tissue to the location; inserting a cannulated dilator over the guidewire and through the skin and tissue to the location; inserting a cannula over the dilator; removing the guidewire after inserting the dilator; and removing the dilator after inserting the cannula.
Claim 7
Dependent Claim
63 words
The method for performing a surgical procedure of claim 1, wherein the step of creating a working channel includes: inserting a first dilator through the skin and tissue of the patient; sequentially inserting at least one more dilator over the first dilator; inserting a cannula over the last inserted dilator; and then removing the dilators so that the cannula defines the working channel.
Claim 8
Independent Claim
107 words
A method for performing a surgical procedure at a location on the spine, comprising the steps of: creating a working channel through the skin and tissue of a patient; creating a working space in communication with the working channel and adjacent the location on the spine; extending a tool through the working channel beyond the end of the working channel and manipulating the tool in the working space; and placing optics through the working channel with the tool in the working channel, the optics extending beyond the end of the working channel adjacent the working space to directly visualize the working space and manipulation of the tool.
Claim 9
Independent Claim
107 words
A method for performing a surgical procedure at a location on the spine, comprising the steps of: creating a working channel through the skin and tissue of a patient; creating a working space in communication with the working channel and adjacent the location on the spine; extending a tool through the working channel beyond the end of the working channel and manipulating the tool in the working space; and placing optics through the working channel with the tool in the working channel, the optics extending beyond the end of the working channel adjacent the working space to directly visualize the working space and manipulation of the tool.
Claim 10
Dependent Claim
63 words
The method for performing a surgical procedure of claim 7 wherein the step of creating a working channel includes: inserting a first dilator through the skin and tissue of the patient; sequentially inserting at least one more dilator over the first dilator; inserting a cannula over the last inserted dilator; and then removing the dilators so that the cannula defines the working channel.
Claim 11
Independent Claim
92 words
A method for performing a surgical procedure at a location on the spine, comprising the step of: creating a working channel through the skin and tissue of a patient; creating a working space in communication with the working channel and adjacent the location on the spine; removably inserting a first tool through the working channel; manipulating the first tool to perform a function at the location; removably inserting a second tool through the working channel simultaneous with the first tool; and manipulating the second tool to perform a function at the location.
Claim 12
Independent Claim
92 words
A method for performing a surgical procedure at a location on the spine, comprising the step of: creating a working channel through the skin and tissue of a patient; creating a working space in communication with the working channel and adjacent the location on the spine; removably inserting a first tool through the working channel; manipulating the first tool to perform a function at the location; removably inserting a second tool through the working channel simultaneous with the first tool; and manipulating the second tool to perform a function at the location.
Claim 13
Independent Claim
101 words
A method for performing a surgical procedure at a location on the spine, comprising the steps of: creating a working channel through the skin and tissue of a patient; creating a working space in communication with the working channel and adjacent the location on the spine; removably inserting a first tool through the working channel wherein the first tool is a tissue retractor; manipulating the tissue retractor to retract tissue to maintain the working space; removably inserting a second tool through the working channel simultaneous with the first tool; and manipulating the second tool to perform a function at the location.
Claim 14
Independent Claim
101 words
A method for performing a surgical procedure at a location on the spine, comprising the steps of: creating a working channel through the skin and tissue of a patient; creating a working space in communication with the working channel and adjacent the location on the spine; removably inserting a first tool through the working channel wherein the first tool is a tissue retractor; manipulating the tissue retractor to retract tissue to maintain the working space; removably inserting a second tool through the working channel simultaneous with the first tool; and manipulating the second tool to perform a function at the location.
Claim 15
Independent Claim
136 words
A method for performing a discectomy at a subject vertebral level on the spine, comprising the steps of: creating an incision in the skin substantially directly posterior to the subject vertebral level; creating a bore through the lamina at a posterior medial position on the spine; mounting a cannula through the incision at the bore in the lamina to create a working channel; inserting optics through the cannula to directly visualize the location on the spine beyond the end of the cannula; extending a retractor through the working channel to retract tissue to create a path to the spinal disc; extending the optics through the working channel and path to the spinal disc; and extending and manipulating discectomy instruments through the working channel to the disc to perform a discectomy under direct vision by the optics.
Claim 16
Independent Claim
136 words
A method for performing a discectomy at a subject vertebral level on the spine, comprising the steps of: creating an incision in the skin substantially directly posterior to the subject vertebral level; creating a bore through the lamina at a posterior medial position on the spine; mounting a cannula through the incision at the bore in the lamina to create a working channel; inserting optics through the cannula to directly visualize the location on the spine beyond the end of the cannula; extending a retractor through the working channel to retract tissue to create a path to the spinal disc; extending the optics through the working channel and path to the spinal disc; and extending and manipulating discectomy instruments through the working channel to the disc to perform a discectomy under direct vision by the optics.
Claim 17
Dependent Claim
72 words
The method of claim 11 wherein the step of creating a bore includes conducting a laminectomy comprising the steps of: inserting a cannula into the incision and through tissue to the lamina to define a working channel; extending optics through the working channel to directly visualize the lamina; and extending a bone cutting tool through the working channel and manipulating the tool to perform a laminectomy under direct vision from the optics.
Claim 18
Independent Claim
80 words
A method for performing a laminectomy, comprising the steps of: creating an incision in the skin substantially directly posterior to the subject vertebral level; inserting a cannula into the incision and through tissue to the lamina to define a working channel; extending optics through the working channel to directly visualize the lamina; and extending a bone cutting tool through the working channel simultaneous with the optics and manipulating the tool to perform a laminectomy under direct vision from the optics.
Claim 19
Independent Claim
80 words
A method for performing a laminectomy, comprising the steps of: creating an incision in the skin substantially directly posterior to the subject vertebral level; inserting a cannula into the incision and through tissue to the lamina to define a working channel; extending optics through the working channel to directly visualize the lamina; and extending a bone cutting tool through the working channel simultaneous with the optics and manipulating the tool to perform a laminectomy under direct vision from the optics.
Claim 20
Dependent Claim
54 words
The method for performing a laminectomy of claim 13, wherein the step of inserting a cannula includes: inserting a first dilator into the incision and through tissue to the lamina; sequentially inserting at least one more dilator over the first dilator; inserting the cannula over the last inserted dilator; and then removing the dilators.
Claim 21
Independent Claim
101 words
A method for implanting a vertebral fixation element, comprising the steps of: making an incision in the skin to provide access to the location on the vertebra at which the fixation element is to be implanted; inserting a cannula into the incision and through tissue to the location to define a working channel; inserting optics through the cannula to directly visualize the location; extending an insertion tool supporting the vertebral fixation element through the working channel to the location under direct vision; and manipulating the insertion tool to implant the fixation element at the location under direct vision from the optics.
Claim 22
Independent Claim
101 words
A method for implanting a vertebral fixation element, comprising the steps of: making an incision in the skin to provide access to the location on the vertebra at which the fixation element is to be implanted; inserting a cannula into the incision and through tissue to the location to define a working channel; inserting optics through the cannula to directly visualize the location; extending an insertion tool supporting the vertebral fixation element through the working channel to the location under direct vision; and manipulating the insertion tool to implant the fixation element at the location under direct vision from the optics.
Claim 23
Dependent Claim
14 words
The method of claim 15, wherein the vertebral fixation element is a bone screw.
Claim 24
Independent Claim
129 words
A method for performing a surgical procedure at a location in a patient's body, comprising the steps of: creating a working channel through the skin and tissue of a patient; creating a working space in communication with the working channel and adjacent the location in the patient's body; inserting optics through the working channel to the working space; extending a first tool through the working channel to the working space wherein the first tool is a power tool; manipulating the first tool through the working channel to perform a surgical procedure on the location in the working space under direct vision from the optics and without directing irrigation fluid to the location; and providing aspiration at the working space to remove smoke generated by operation of the power tool.
Claim 25
Independent Claim
129 words
A method for performing a surgical procedure at a location in a patient's body, comprising the steps of: creating a working channel through the skin and tissue of a patient; creating a working space in communication with the working channel and adjacent the location in the patient's body; inserting optics through the working channel to the working space; extending a first tool through the working channel to the working space wherein the first tool is a power tool; manipulating the first tool through the working channel to perform a surgical procedure on the location in the working space under direct vision from the optics and without directing irrigation fluid to the location; and providing aspiration at the working space to remove smoke generated by operation of the power tool.
Claim 26
Independent Claim
122 words
A method for performing a surgical procedure at a location in a patient's body, comprising the steps of: creating a working channel through the skin and tissue of a patient by inserting a cannula into the patient, the cannula having an inner dimension defining the working channel; creating a working space in communication with the working channel and adjacent the location in the patient's body; inserting optics through the working channel to the working space; extending a first tool through the working channel to the working space; and manipulating the first tool through the working channel to perform a surgical procedure on the location in the working space under direct vision from the optics and without directing irrigation fluid to the location.
Claim 27
Independent Claim
122 words
A method for performing a surgical procedure at a location in a patient's body, comprising the steps of: creating a working channel through the skin and tissue of a patient by inserting a cannula into the patient, the cannula having an inner dimension defining the working channel; creating a working space in communication with the working channel and adjacent the location in the patient's body; inserting optics through the working channel to the working space; extending a first tool through the working channel to the working space; and manipulating the first tool through the working channel to perform a surgical procedure on the location in the working space under direct vision from the optics and without directing irrigation fluid to the location.
Claim 28
Independent Claim
114 words
A method for performing a surgical procedure at a location on the spine, comprising the steps of: creating a working channel through the skin and tissue of a patient by inserting a cannula into the patient, the cannula having an inner dimension defining the working channel; creating a working space in communication with the working channel and adjacent the location on the spine; extending a tool through the working channel beyond the end of the working channel and manipulating the tool in the working space; and extending optics through the working channel beyond the end of the working channel adjacent the working space to directly visualize the working space and manipulation of the tool.
Claim 29
Independent Claim
114 words
A method for performing a surgical procedure at a location on the spine, comprising the steps of: creating a working channel through the skin and tissue of a patient by inserting a cannula into the patient, the cannula having an inner dimension defining the working channel; creating a working space in communication with the working channel and adjacent the location on the spine; extending a tool through the working channel beyond the end of the working channel and manipulating the tool in the working space; and extending optics through the working channel beyond the end of the working channel adjacent the working space to directly visualize the working space and manipulation of the tool.
Claim 30
Independent Claim
109 words
A method for performing a surgical procedure at a location on the spine, comprising the steps of: creating a working channel through the skin and tissue of a patient by inserting a cannula into the patient, the cannula having an inner dimension defining the working channel; creating a working space in communication with the working channel and adjacent the location on the spine; removably inserting a first tool through the working channel; manipulating the first tool to perform a function at the location; removably inserting a second tool through the working channel simultaneous with the first tool; and manipulating the second tool to perform a function at the location.
Claim 31
Independent Claim
109 words
A method for performing a surgical procedure at a location on the spine, comprising the steps of: creating a working channel through the skin and tissue of a patient by inserting a cannula into the patient, the cannula having an inner dimension defining the working channel; creating a working space in communication with the working channel and adjacent the location on the spine; removably inserting a first tool through the working channel; manipulating the first tool to perform a function at the location; removably inserting a second tool through the working channel simultaneous with the first tool; and manipulating the second tool to perform a function at the location.
Claim 32
Independent Claim
88 words
A method for performing a surgical procedure at a location in a patient's body, comprising the steps of: creating a working channel through the skin and tissue of a patient; creating a working space in communication with the working channel and adjacent the location in the patiant's body; extending a first tool through the working channel to the working space; and manipulating the first tool through the working channel to perform a surgical procedure on the location in the working space without directing irrigation fluid to the location.
Claim 33
Independent Claim
88 words
A method for performing a surgical procedure at a location in a patient's body, comprising the steps of: creating a working channel through the skin and tissue of a patient; creating a working space in communication with the working channel and adjacent the location in the patiant's body; extending a first tool through the working channel to the working space; and manipulating the first tool through the working channel to perform a surgical procedure on the location in the working space without directing irrigation fluid to the location.
Claim 34
Dependent Claim
25 words
The method of claim 21, wherein the tool is a power drill and the surgical procedure is drilling through bone or tissue at the location.
Claim 35
Dependent Claim
36 words
The method of claim 21, further comprising the steps of: removably inserting a second tool through the working channel simultaneous with the first tool; and manipulating the second tool to perform a function at the location.
Claim 36
Dependent Claim
30 words
The method of claim 21, wherein said step of creating a working channel includes inserting a cannula into the patient, the cannula having an inner dimension defining the working channel.
Claim 37
Dependent Claim
64 words
The method for performing a surgical procedure of claim 21, wherein the step of creating a working channel includes: inserting a first dilator into the incision and through tissue to the lamina; sequentially inserting at least one more dilator over the first dilator; inserting a cannula over the last inserted dilator; and then removing the dilators so that the cannula defines a working channel.
Claim 38
Independent Claim
110 words
A method for preparing a working channel adjacent the spine, comprising the steps of: inserting a guidewire through an incision in the skin and into the lamina of a vertebra; inserting a first dilator over the guidewire and through the incision into contact with the lamina; removing the guidewire; sequentially inserting dilators of increasing diameter over the first and subsequent dilators, each of the dilators having a tapered working end configured to atraumatically displace tissue; advancing a cannula over the last inserted dilator, the cannula having a distal end adjacent the lamina and an opposite proximal end; and then removing the dilators so that the cannula defines a working channel.
Claim 39
Independent Claim
110 words
A method for preparing a working channel adjacent the spine, comprising the steps of: inserting a guidewire through an incision in the skin and into the lamina of a vertebra; inserting a first dilator over the guidewire and through the incision into contact with the lamina; removing the guidewire; sequentially inserting dilators of increasing diameter over the first and subsequent dilators, each of the dilators having a tapered working end configured to atraumatically displace tissue; advancing a cannula over the last inserted dilator, the cannula having a distal end adjacent the lamina and an opposite proximal end; and then removing the dilators so that the cannula defines a working channel.
Claim 40
Dependent Claim
22 words
The method of claim 26, further comprising the step of affixing to the cannula a mounting bracket having a flexible arm support.
Claim 41
Dependent Claim
12 words
The method of claim 27, wherein the flexible arm support is contoured.
Claim 42
Dependent Claim
29 words
The method of claim 26, further comprising the step of advancing a fixture over the proximal end of the cannula for supporting a viewing element adjacent the working channel.
Claim 43
Independent Claim
117 words
A method for implantation of at least one fusion device in a disc space between adjacent vertebrae, comprising the steps of: making an incision in the skin to provide access to the disc space where the fusion device is to be implanted,; inserting a cannula into the incision and through the tissue to the location to define a working channel to the disc space; inserting optics through the cannula to directly visualize the disc space; preparing the disc space through the working channel under direct vision from the optics for implantation of at least one fusion device; and advancing the fusion device through the working channel into the prepared disc space under direct vision from the optics.
Claim 44
Independent Claim
117 words
A method for implantation of at least one fusion device in a disc space between adjacent vertebrae, comprising the steps of: making an incision in the skin to provide access to the disc space where the fusion device is to be implanted,; inserting a cannula into the incision and through the tissue to the location to define a working channel to the disc space; inserting optics through the cannula to directly visualize the disc space; preparing the disc space through the working channel under direct vision from the optics for implantation of at least one fusion device; and advancing the fusion device through the working channel into the prepared disc space under direct vision from the optics.
Claim 45
Dependent Claim
13 words
The method of claim 30, wherein the fusion device is a bone dowel.
Claim 46
Dependent Claim
13 words
The method of claim 30, wherein the fusion device is a push-in implant.
Claim 47
Dependent Claim
13 words
The method of claim 30, wherein the fusion device is a threaded implant.
Claim 48
Dependent Claim
12 words
The method of claim 30, wherein the fusion device is graft material.
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USPTO Annuity & Maintenance Windows
| Annuity Stage | Window Opens | Payment Deadline | Surcharge Period Until | Estimated Fee | Status |
|---|---|---|---|---|---|
| 3.5 Years (Year 4) | 2002-09-20 | 2003-03-22 | 2003-09-21 | $2000.00 | Window Closed / Lapsed |
| 7.5 Years (Year 8) | 2006-09-20 | 2007-03-22 | 2007-09-21 | $3760.00 | Window Closed / Lapsed |
| 11.5 Years (Year 12) | 2010-09-20 | 2011-03-22 | 2011-09-21 | $7700.00 | Window Closed / Lapsed |