METHOD AND APPARATUS FOR ACCESSING THE INTERIOR OF A HIP JOINT, INCLUDING THE PROVISION AND USE OF A NOVEL INFLOW ACCESS CANNULA

Abstract

An inflow access cannula system for allowing an instrument to access a remote surgical site, wherein the instrument comprises a distal portion having a smaller diameter and a proximal portion having a larger diameter, the system comprising: an inflow access cannula comprising a distal end, a proximal end and a central lumen extending therebetween, wherein the central lumen has a diameter larger than the distal portion of the instrument and smaller than the proximal portion of the instrument; and an instrument adapter for releasable connection to the inflow access cannula, the instrument adapter comprising a lumen communicating with the central lumen of the inflow access cannula, the lumen having a diameter larger than the proximal portion of the instrument, the instrument adapter further comprising a port and a fluid passageway connecting the port with the lumen of the instrument adapter, and a spacer for spacing the proximal portion of the instrument from the distal end of the inflow access cannula, such that when an instrument is disposed in the inflow access cannula system so that the distal portion of the instrument extends within the central lumen of the inflow access cannula and the proximal portion of the instrument is disposed in the central lumen of the instrument adapter and is in engagement with the spacer, fluid can flow into the port of the instrument adapter, along the fluid passageway of the instrument adapter, into the lumen of the instrument adapter and through the lumen of the inflow access cannula.

Claims

1.-15. (canceled)

16. Apparatus for accessing a remote surgical site with an instrument, the apparatus comprising: an access cannula comprising: a rigid elongated tube comprising a distal end, a proximal end and a lumen extending therebetween; and an atraumatic tip mounted to the distal end of the elongated tube, wherein the atraumatic tip is overmolded around the tube so that the atraumatic tip extends radially outboard of the elongated tube and distally beyond the distal end of the elongated tube, and further wherein the atraumatic tip comprises barium sulfate in a range between 5 and 30% by weight.

17. (canceled)

18. A method for accessing a remote surgical site with an instrument, the method comprising: providing an access cannula comprising: a rigid elongated tube comprising a distal end, a proximal end and a lumen extending therebetween; and an atraumatic tip mounted to the distal end of the elongated tube, wherein the atraumatic tip is overmolded around the tube so that the atraumatic tip extends radially outboard of the elongated tube and distally beyond the distal end of the elongated tube, and further wherein the atraumatic tip comprises barium sulfate in a range between 5 and 30% by weight; advancing the access cannula through tissue to the surgical site; and advancing the instrument into the lumen of the access cannula.

19. A method for accessing a remote surgical site with an instrument, the method comprising: providing an access cannula comprising: a rigid elongated tube comprising a distal end, a proximal end and a lumen extending therebetween; and an atraumatic tip mounted to the distal end of the elongated tube, wherein the atraumatic tip is overmolded around the tube so that the atraumatic tip extends radially outboard of the elongated tube and distally beyond the distal end of the elongated tube, and further wherein the atraumatic tip comprises barium sulfate in a range between 5 and 30% by weight; providing an instrument adapter for releasable connection to the access cannula, the instrument adapter being adapted to mate with an instrument to be extended through the lumen of the access cannula; advancing the access cannula through tissue to the surgical site; mounting the instrument adapter to the instrument; and advancing the instrument into the lumen of the access cannula so that the instrument adapter mounts to the access cannula.

20.-23. (canceled)

24. Apparatus according to claim 16 wherein the elongated tube is formed out of at least one from the group consisting of a metal and a plastic.

25. Apparatus according to claim 16 wherein the atraumatic tip comprises a polymer.

26. Apparatus according to claim 16 wherein the atraumatic tip comprises a thermoplastic.

27. Apparatus according to claim 16 further comprising an obturator extending through the lumen of the elongated tube.

28. Apparatus according to claim 16 further comprising an instrument adapter for mounting an instrument to the access cannula, the instrument adapter being adapted to mate with an instrument to be extended through the lumen of the access cannula.

29. Apparatus according to claim 28 wherein the instrument adapter is releasably mounted to the access cannula by a bayonet mount.

30. Apparatus according to claim 29 wherein the bayonet mount comprises an L-shaped groove formed in the access cannula and a radial pin mounted to the instrument adapter.

31. Apparatus according to claim 30 wherein the instrument adapter comprises a body and a rotating collar rotatably mounted to the body, and wherein the radial pin is mounted to the rotating collar.

32. Apparatus according to claim 31 wherein the rotating collar is spring-biased relative to the body.

33. Apparatus according to claim 28 wherein the instrument comprises an endoscope.

34. A system for accessing a remote surgical site with an instrument, the system comprising: an access cannula comprising: a rigid elongated tube comprising a distal end, a proximal end and a lumen extending therebetween; and an atraumatic tip mounted to the distal end of the elongated tube, wherein the atraumatic tip is overmolded around the tube so that the atraumatic tip extends radially outboard of the elongated tube and distally beyond the distal end of the elongated tube, and further wherein the atraumatic tip comprises barium sulfate in a range between 5 and 30% by weight; and an instrument adapter for releasable connection to the access cannula, the instrument adapter being adapted to mate with an instrument to be extended through the lumen of the access cannula.

35. A system according to claim 34 wherein the instrument comprises an endoscope.

36. A system according to claim 34 wherein the instrument comprises an obturator.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0056] These and other objects and features of the present invention will be more fully disclosed or rendered obvious by the following detailed description of the preferred embodiments of the invention, which is to be considered together with the accompanying drawings wherein like numbers refer to like parts, and further wherein:

[0057] FIGS. 1A-1D are schematic views showing various aspects of hip motion;

[0058] FIG. 2 is a schematic view showing the bone structure in the region of the hip joints;

[0059] FIG. 3 is a schematic view of the femur;

[0060] FIG. 4 is a schematic view of the top end of the femur;

[0061] FIG. 5 is a schematic view of the pelvis;

[0062] FIGS. 6-12 are schematic views showing the bone and soft tissue structure of the hip joint;

[0063] FIG. 13 is a schematic view showing cam-type femoroacetabular impingement (FAI);

[0064] FIG. 14 is a schematic view showing pincer-type femoroacetabular impingement (FAI);

[0065] FIG. 15 is a schematic view showing a labral tear;

[0066] FIGS. 16-26 are schematic views showing one preferred form of inflow access cannula system formed in accordance with the present invention; and

[0067] FIGS. 27-42 are schematic views showing another preferred form of inflow access cannula system formed in accordance with the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0068] The present invention provides a new and improved inflow access cannula system for accessing the interior of a hip joint or other interior body space.

[0069] Among other things, this new and improved inflow access cannula can perform certain specific tasks unusually well (e.g., initial access creation and endoscope support), has a distal end which is relatively atraumatic when it comes into contact with tissue, and which is highly efficient in its use of space so as to cover a reduced portion of an instrument's length, thereby increasing access of the instrument to deep surgical sites within the joint space.

[0070] Looking now at FIGS. 16-26, there is shown an inflow access cannula system 5 which generally comprises an inflow access cannula 10 and an endoscope adapter 15.

[0071] In accordance with the present invention, an obturator (not shown) is intended to be positioned within inflow access cannula 10, and the inflow access cannula is intended to be inserted into the tissue of a patient so that the distal end of the inflow access cannula is disposed within the hip joint and the proximal end of the inflow access cannula is disposed at the surface of the skin. When inflow access cannula 10 has been properly positioned in the tissue of the patient, the obturator is removed, endoscope adapter 15 is positioned on the proximal end of inflow access cannula 10, and an endoscope 20 is advanced through the central lumen of the endoscope adapter and the central lumen of the inflow access cannula, whereby to provide visualization of, and fluid flow to and/or from, a remote surgical site. Alternatively, endoscope adapter 15 may be mounted on endoscope 20 remote from inflow access cannula 10 and then the two elements (i.e., the endoscope and the endoscope adapter) advanced together as a unit so as to seat on inflow access cannula 10.

[0072] More particularly, inflow access cannula 10 generally comprises an elongated tube 25 having a distal end 30, a proximal end 35 and a central lumen 40 (FIG. 21) extending therebetween. The shaft of elongated tube 25 is long enough so that it can extend between the outer surface of the patient's skin and the interior of the joint. Furthermore, the shaft of elongated tube 25 is preferably formed out of metal (e.g., stainless steel) so as to provide strength and rigidity during insertion of the inflow access cannula into the tissue of the patient and its subsequent use as a liner for the access corridor extending down to the remote surgical site. Alternatively, the shaft of elongated tube 25 may be a metal tube coaxial with a plastic tube, the metal tube being disposed either inside of, or outside of, the plastic tube. The outer surface of elongated tube 25 is preferably smooth so as to minimize trauma to tissue as inflow access cannula 10 is inserted in the tissue.

[0073] Distal end 30 of inflow access cannula 10 preferably comprises a soft, atraumatic distal tip 45 so as to also minimize tissue trauma during cannula insertion and use.

[0074] In one preferred form of the invention, at least the atraumatic distal tip 45 of inflow access cannula 10 comprises a polymer or other material which contains barium sulfate, preferably in the range of 5-30% (and preferably about 15%) by weight, so as to render the inflow access cannula visible under X-ray or fluoroscopy. This range (by weight) of barium sulfate is generally preferred since concentrations below 5% tend to be too low for good visualization in hip applications, whereas concentrations above 30% can lead to degradation of material properties. Alternatively, other opacifiers, at appropriate weight concentrations, may also be used to render the inflow access cannula visible under X-ray or fluoroscopy. Atraumatic distal tip 45 can be a thermoplastic which is over-molded onto the distal end of elongated tube 25 (see FIGS. 16 and 17).

[0075] A mount 50 is secured to proximal end 35 of elongated tube 25. Mount 50 includes a keyway 55 for receiving a corresponding key (not shown) of an obturator (also not shown), whereby to releasably rotatably lock the obturator to inflow access cannula 10, e.g., so as to permit rotational driving deployment of the inflow access cannula into the tissue via the obturator. Mount 50 also includes a stem 60 (FIG. 21) which protrudes upward from the floor 65 of mount 50. Stem 60 includes a lumen 70 (FIG. 26) which communicates with central lumen 40 (FIG. 21) of elongated tube 25. Stem 60 also includes an L-shaped keyway 75 (FIG. 17) which receives corresponding keys 80 provided on endoscope adapter 15, whereby to releasably axially lock endoscope adapter 15 to inflow access cannula 10, as will hereinafter be discussed in further detail.

[0076] Endoscope adapter 15 comprises a body 85 which is adapted to mate with mount 50 of inflow access cannula 10. More particularly, body 85 of endoscope adapter 15 is designed to seat over stem 60 of cannula mount 50 so that (i) an endoscope 20 can extend down lumen 70 (FIG. 26) of endoscope adapter 15 and down central lumen 40 (FIG. 21) of elongated tube 25, and (ii) fluid introduced through ports 90 of endoscope adapter 15 can flow down to the surgical site through lumen 70 of endoscope adapter 15 and central lumen 40 of elongated tube 25 or, conversely, fluid at the surgical site can flow up through central lumen 40 of elongated tube 25 and lumen 70 of endoscope adapter 15, and then out one of the ports 90. Endoscope adapter 15 also includes keys 80 for mounting in keyways 75 of endoscope adapter 15 when endoscope adapter 15 is connected to, and seats into, inflow access cannula 10. This engagement keeps endoscope adapter 15 connected to inflow access cannula 10 during surgical use.

[0077] More particularly, endoscope adapter 15 comprises an annular chamber 95 (FIG. 23) which communicates with a plurality of radial passageways 100, which in turn communicate with an annular opening 105 formed about the perimeter of stem 60. Thus, fluid is able to pass into ports 90, along annular chamber 95, through radial passageways 100, up annular opening 105, down lumen 70 of stem 60 and then down lumen 40 of elongated tube 25. Correspondingly, fluid is able to leave the surgical site by passing up lumen 40 of elongated tube 25, through lumen 70 of stem 60, down annular opening 105, through radial passageways 100, along annular chamber 95 and then out ports 90. In this respect it will be appreciated that an O-ring 106 ensures a fluid seal between body 85 of endoscope adapter 15 and mount 50 of inflow access cannula 10, and an O-ring 107 ensures a fluid seal between body 85 of endoscope adapter 15 and endoscope 20—thus, when endoscope 20 is seated in assembled endoscope adapter 15/inflow access cannula 10, a closed flow path is established between ports 90 and lumen 40 of elongated tube 25. Significantly, O-ring 107 also acts as a spacer to maintain a gap G (FIG. 23) between the proximal end of the endoscope's body B and the mouth of lumen 70 of stem 60, so that fluid can pass from annular opening 105, through gap G and into lumen 70 of stem 60 (or from lumen 70 of stem 60, through gap G and into annular opening 105). Thus it will be seen that with the foregoing construction, ports 90 are disposed distal to the proximal end of stem 60. By virtue of the ports 90 being “below” (i.e., distal) to the top of stem 60, the overall height of the assembled endoscope adapter 15/inflow access cannula 10 is minimized. This provides for a significantly more compact design (in terms of length) which covers a reduced portion of an instrument's length, thereby increasing access of the instrument (e.g., endoscope 20) to deep surgical sites within the joint space. In other words, the compact design of the assembled endoscope adapter 15/inflow access cannula 10 provides a more effective working length to the shaft of endoscope 20 (i.e., the length the endoscope shaft that extends distal to the distal surface of mount 50). Thus, while the flow path between ports 90 and the mouth of lumen 70 of stem 60 may be non-linear with the present invention, a more compact endoscope adapter/inflow access cannula design is obtained and the effective working length of an instrument (e.g., the endoscope) is increased. This is a significant advantage in the art.

[0078] Furthermore, keys 80 are preferably mounted on a rotating collar 110. Rotating collar 110 is rotatably mounted to body 85 of endoscope adapter 15, where it is fixed in the axial direction but can spin about the longitudinal axis of endoscope adapter 15. Rotating collar 110 is spring-biased to force key 80 into the L-shaped keyway 75. As such, when endoscope adaptor 15 is connected to inflow access cannula 10, key 80 will be spring-biased into bottom corner 115 of L-shaped keyway 75. To release, or disengage, endoscope adaptor 15 from inflow access cannula 10, rotating collar 110 is rotated, which shifts key 80 out of bottom corner 115 to the vertical groove portion 120 of L-shaped keyway 75; this enables endoscope adaptor 15 to be moved axially away from inflow access cannula 10. In FIG. 26, rotating collar 110 and straight key 80 (without additional components of endoscope adaptor 15) are illustrated to show engagement of key 80 into the L-shaped keyway 75 of mount 50 of inflow access cannula 10. This design minimizes the length required to connect the endoscope adapter 15 and inflow access cannula 10, hence providing for a more effective working length of the shaft of scope 20.

[0079] Inflow access cannula system 5 may be used in various ways to provide access to the interior of a hip joint. Among other things, due to the smooth shaft of elongated tube 25 and the atraumatic distal tip 45 of the elongated tube, atraumatic cannula deployment can be achieved. Furthermore, the use of endoscope adapter 15 allows custom docking (secure seating and fluid flow) to be achieved when an endoscope is mounted in the inflow access cannula. And, significantly, the more compact design (in terms of length) of the assembled endoscope adapter/inflow access cannula covers a reduced portion of an instrument's length, thereby increasing access of the instrument (e.g., endoscope 20) to deep surgical sites within the joint space.

[0080] Looking next at FIGS. 27-42, there is shown another inflow access cannula system 125 which generally comprises an inflow access cannula 130, an obturator 135 and an endoscope adapter 140. Obturator 135 is intended to be positioned within an inflow access cannula 130 during insertion of the inflow access cannula into the tissue of the patient, as will hereinafter be discussed in further detail. As will also hereinafter be discussed in further detail, when the inflow access cannula 130 has been properly positioned in the tissue of the patient, obturator 135 is removed, endoscope adapter 140 is positioned on the proximal end of inflow access cannula 130, and an endoscope 145 is advanced through the central lumen of the endoscope adapter and the inflow access cannula, whereby to provide visualization of, and fluid flow to and/or from, a remote surgical site. Alternatively, endoscope adapter 140 may be mounted on endoscope 145 remote from inflow access cannula 130 and then the two elements advanced together as a unit so as to seat on inflow access cannula 130.

[0081] More particularly, inflow access cannula 130 generally comprises an elongated tube 150 having a distal end 155, a proximal end 160 and a central lumen 165 (FIG. 41) extending therebetween. The shaft of elongated tube 150 is long enough so that it can extend between the outer surface of the patient's skin and the inside of the joint. Furthermore, the shaft of elongated tube 150 is preferably formed out of metal so as to provide strength and rigidity during insertion of the cannula into the tissue of the patient and its subsequent use as a liner for the access corridor extending down to the remote surgical site. Alternatively, the shaft of elongated tube 150 may be a metal tube coaxial with a plastic tube, the metal tube being disposed either inside or outside of the plastic tube. The outer surface of elongated tube 150 is preferably smooth so as to minimize trauma to tissue as inflow access cannula 130 is inserted in the tissue.

[0082] Distal end 155 of inflow access cannula 130 preferably comprises a soft, atraumatic distal tip 170 (FIG. 27) so as to also minimize tissue trauma during cannula insertion and use.

[0083] In one preferred form of the invention, at least the atraumatic distal tip 170 of inflow access cannula 130 comprises a polymer or other material which contains barium sulfate, preferably in the range of 5-30% (and preferably about 15%) by weight, so as to render the inflow access cannula visible under X-ray or fluoroscopy. This range (by weight) of barium sulfate is generally preferred since concentrations below 5% tend to be too low for good visualization in hip applications, whereas concentrations above 30% can lead to degradation of material properties. Alternatively, other opacifiers, at appropriate weight concentrations, may also be used to render the inflow access cannula visible under X-ray or fluoroscopy.

[0084] A mount 175 (FIG. 27) is secured to the proximal end of elongated tube 150. Mount 175 includes a keyway 180 (FIG. 27) for receiving a key 185 (FIG. 30) of obturator 135, whereby to releasably rotatably lock obturator 135 to inflow access cannula 130. Mount 175 also includes one or more keys 190 (FIG. 37) for receipt in corresponding keyways 195 (FIG. 38) in endoscope adapter 140, whereby to releasably rotatably lock endoscope adapter 140 to inflow access cannula 130. Mount 175 also includes a stem 200 (FIG. 37) which protrudes upward from the floor 205 of mount 175. Stem 200 includes a lumen 210 (FIG. 37) which communicates with central lumen 165 (FIG. 41) of elongated tube 150.

[0085] Obturator 135 generally comprises a shaft 215 (FIG. 30) terminating in a blunt distal end 220 and a proximal handle 225. Handle 225 includes a key 185 for receipt in the aforementioned keyway 180 (FIG. 27) of mount 175, whereby to releasably rotatably lock obturator 135 to inflow access cannula 130. As seen in FIG. 32, the distal end 220 of obturator shaft 215 protrudes from atraumatic tip 170 of cannula tube 150 when obturator key 185 is seated in cannula keyway 180, so that the blunt distal end 220 of obturator 135 leads the assembly and prevents tissue coring by inflow access cannula 130 when the inflow access cannula is advanced through tissue.

[0086] Endoscope adapter 140 comprises a body 230 (FIG. 41) which mates with mount 175 of inflow access cannula 130. More particularly, body 230 of endoscope adapter 140 is designed to seat over stem 200 of cannula mount 175 so that (i) an endoscope 145 can extend down lumen 210 (FIG. 37) of endoscope adapter 140 and down central lumen 165 of elongated tube 150, and (ii) fluid introduced through ports 235 (FIG. 42) of endoscope adapter 140 can flow down to the surgical site through central lumen 165 of elongated tube 150 or, conversely, fluid at the surgical site can flow up through central lumen 165 of elongated tube 150 and then out one of the ports 235. As noted above, cannula mount 175 also includes keys 190 (FIG. 37) for mating with keyways 195 (FIG. 38) of endoscope adapter 140, so that proper alignment of inflow access cannula 130 and endoscope adapter 140 can be ensured. Cannula mount 175 also includes a keyway 240 (FIG. 27) for mating with flexure key 245 (FIG. 29) of endoscope adapter 140. Flexure key 245 comprises a locking tab 250 which engages notch 255 (FIG. 27) when endoscope adapter 140 is connected to, and seats into, inflow access cannula 130. This engagement keeps endoscope adapter 140 connected to inflow access cannula 130 during surgical use. Flexure key 245 can be compressed and moved radially inwardly (i.e., toward the center axis of endoscope adapter 140) to disengage locking tab 250 from notch 255 and thus allow endoscope adapter 140 to be disconnected from inflow access cannula 130.

[0087] Inflow access cannula system 125 may be used in various ways to provide access to the interior of a hip joint. Among other things, due to the smooth shaft of elongated tube 150 and the atraumatic distal tip 170 of the elongated tube, atraumatic cannula deployment can be achieved. Furthermore, the use of endoscope adapter 140 allows custom docking (secure seating and fluid flow) to be achieved when an endoscope is mounted in the inflow access cannula. And, significantly, the more compact design (in terms of length) of the assembled endoscope adapter/inflow access cannula covers a reduced portion of an instrument's length, thereby increasing access of the instrument (e.g., endoscope 20) to deep surgical sites within the joint space.

Use Of The Inflow Access Cannula For Other Applications

[0088] It should be appreciated that the novel inflow access cannula of the present invention may be used for accessing joints other than the hip joint (e.g., the inflow access cannula may be used to access the interior of a shoulder joint), and/or for accessing other interior body spaces (e.g., the abdominal cavity).

Modifications Of The Preferred Embodiments

[0089] It should be understood that many additional changes in the details, materials, steps and arrangements of parts, which have been herein described and illustrated in order to explain the nature of the present invention, may be made by those skilled in the art while still remaining within the principles and scope of the invention.