Abstract
The invention involves a system and method for utilizing tools larger than the cannula bore of an endoscope in an endoscopic procedure. The system includes an endoscope having a cannula with an open or ported distal end. The ported distal end allows the shaft of an elongated tool having an oversized functional distal end to extend through the port with the oversized end in front of cannula bore. The tool and endoscope cannula are placed through a dilator tube that extends from outside the patient to the surgical site. A removeable and re-attachable handle is securable to the shaft of the oversized tool, which allows the surgeon to manipulate the tool through the cannula while visualizing the procedure utilizing the endoscope. This construction allows the surgeon to utilize tools that are too large to fit through the cannula of the endoscope including curettes, rasps, burrs, trials, Kerrison's, shavers and inserters.
Claims
1. An endoscopic surgical system comprising: an endoscope (46) having a first end (90) and a second end (94), the endoscope first end (90) including a working channel (44), the working channel (44) having an inner lumen (45) that has a substantially constant diameter and shape extending from the endoscope first end (90) to the endoscope second end (94); a tool tube (58), including a tool tube first end (64), a tool tube second end (66), the tool tube (58) having an inner bore (68) extending through the tool tube (58) from the tool tube first end (64) to the tool tube second end (66), the tool tube (58) having a sufficient length to extend from a position adjacent a surgical site to outside of an anatomy; a surgical tool (72) including a working end (76), a tool shaft (78) and a tool hand grip (80), wherein the tool shaft is sized to fit through the lumen (45) of the working channel (44) of the endoscope (46) having sufficient length to extend completely through the endoscope (46) for attachment to the tool hand grip (80), the working end (76) being sized to fit through the tool tube inner bore (68), but too large to fit through the lumen (45) of the working channel (44) of the endoscope (46), allowing rotation as well as linear translation of the tool working end (76) through the lumen (45) of the working channel (44).
2. The endoscopic surgical system of claim 1 wherein the endoscope (46) includes an endoscope manifold (92), the endoscope manifold (92) including at least one connection for video (96).
3. The endoscopic surgical system of claim 2 wherein the endoscope manifold (92) further includes a connection for pressurized fluid (100), wherein the pressurized fluid is directed to the first end (90) of the endoscope (46).
4. The endoscopic surgical system of claim 2 wherein the endoscope manifold (92) further includes a connection for vacuum (98).
5. The endoscopic surgical system of claim 2 wherein the endoscope (46) includes fiber optics (47) for viewing the area around the first end (90) of the endoscope (46).
6. The endoscopic surgical system of claim 2 wherein the endoscope (46) includes a camera chip (99) positioned near the first end (90) of the endoscope (46) within the lumen (45) of the working channel (44) with wiring extending through the lumen (45) of the working channel (44) to the video connection (96).
7. The endoscopic surgical system of claim 1 wherein the inner lumen (45) includes a seal (95), the seal (95) extending between an inner surface of the inner lumen (45) and an outer surface of the tool shaft (78).
8. The endoscopic surgical system of claim 7 wherein the seal (95) is an o-ring (97).
9. The endoscopic surgical system of claim 1 wherein the tool tube (58) includes a stabilizer arm (70) for securing the tool tube (58) rigidly in position.
10. The endoscopic surgical system of claim 1 wherein a distal end of the tool shaft (78) opposite the working end (76) includes an attachment portion (88) for removable attachment of the tool hand grip (80).
11. The endoscopic surgical system of claim 10 wherein the attachment portion (88) includes conjugate shapes (84) with respect to the tool hand grip (80) and the tool shaft (78) to prevent rotation therebetween and allow for the linear translation thereof.
12. An endoscopic surgical device comprising: an endoscope (46) having a first end (90) and a second end (94), the endoscope first end (90) including a working channel (44), the working channel (44) having an inner lumen (45) that has a substantially constant diameter and shape extending from the endoscope first end (90) to the endoscope second end (94), an endoscope manifold (92), the endoscope manifold (92) including at least one connection for video (96) and a connection for pressurized fluid (100), wherein the pressurized fluid (100) is directed to the first end (90) of the endoscope (46); a surgical tool (72) including a working end (76), a tool shaft (78) and a tool hand grip (80), wherein the tool shaft (78) is sized to fit through the lumen (45) of the working channel (44) of the endoscope (46) having sufficient length to extend completely through the endoscope (46) for attachment to the tool hand grip (80), the working end (76) being sized to fit through the tool tube inner bore (68), but too large to fit through the lumen (45) of the working channel (44) of the endoscope (46), allowing rotation as well as linear translation of the tool working end (76) through the lumen (45) of the working channel (44).
13. The endoscopic surgical device of claim 12 wherein the inner lumen (45) includes a seal, the seal (95) extending between an inner surface of the inner lumen (45) and an outer surface of the tool shaft (78).
14. The endoscopic surgical device of claim 13 wherein the seal (95) is an o-ring (97).
15. The endoscopic surgical device of claim 12 including a tool tube (58), the tool tube (58) including a tool tube first end (64), and a tool tube second end (66), the tool tube (58) having an inner bore (68) extending through the tool tube (58) from the tool tube first end (64) to the tool tube second end (66), the tool tube (58) having a sufficient length to extend from a position adjacent a surgical site to outside of an anatomy.
Description
BRIEF DESCRIPTION OF THE FIGURES
[0017] FIG. 1 is a top front left perspective view of a human spine, illustrating the connection of the bones and vertebrae;
[0018] FIG. 2 is a partial front perspective view of FIG. 1, illustrating the L1 through L5 portion of the spine of FIG. 1;
[0019] FIG. 3 is a left side view of the L3-L4 portion of the spine shown in FIG. 1;
[0020] FIG. 4 is a section view taken along lines 4-4 of FIG. 3, illustrating a disc and a vertebra;
[0021] FIG. 5 is a perspective view of the vertebrae illustrated in FIG. 4, further showing the disc and the vertebrae;
[0022] FIG. 6 is a partial section view taken along lines 6-6 of FIG. 5;
[0023] FIG. 7 is a side view of one embodiment of the endoscope and surgical tool suitable for use with the present system;
[0024] FIG. 8 is a partial view of the embodiment shown in FIG. 7, illustrated with the handle removed for manipulating the surgical tool;
[0025] FIG. 9 is an exploded view of the embodiment shown in FIG. 7;
[0026] FIG. 10 is a partial side view of the endoscopic system, illustrating the tool tube and the surgical tool;
[0027] FIG. 11 is a partial side view, illustrating insertion of a Jamshidi needle to the surgical site;
[0028] FIG. 12 is a partial side view, illustrating insertion of dilation tubes over the Jamshidi needle to open a channel to the surgical site;
[0029] FIG. 13 is a partial side view, illustrating insertion of further dilation tubes to expand the channel to the surgical site;
[0030] FIG. 14 is a partial side view, illustrating the tool tube in position, as well as the surgical tool through the endoscope; and
[0031] FIG. 15 is an illustrative view showing use of the present endoscopic system and method.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0032] While the present invention is susceptible of embodiment in various forms, there is shown in the drawings and will hereinafter be described a presently preferred embodiment with the understanding that the present disclosure is to be considered an exemplification of the invention and is not intended to limit the invention to the specific embodiments illustrated. It should be appreciated that like drawing numbers on different drawing views identify identical, or functionally similar, structural elements of the invention.
[0033] Referring generally to FIGS. 1-6, a human spinal column 10 is illustrated. As shown in FIG. 1, thirty-three individual bones 12 interlock with each other to form the spinal column 10. The vertebrae 14 are numbered and divided into regions. The cervical vertebrae 16, levels C1-C7, form the neck and support the head. The thoracic vertebrae 18, levels T1-T12, join with the ribs to form the rib cage (not shown). The five lumbar vertebrae 20, levels L1-L5, carry most of the weight of the upper body. Five vertebrae of the sacrum 22, level S, and four of the coccyx 24, level C, are fused to comprise the back wall of the pelvis 26.
[0034] FIGS. 2-6 are illustrative of the removal of the nucleus of the disc between the L3 40 and L4 42 vertebrae, a common area of the spine for degeneration and pain in the spine where a surgeon may need to perform a discectomy. However, it should be noted that the teachings of the present system and method may be utilized along any portion of the spine for any procedure where a surgeon may need to utilize a tool that will not fit through the working channel 44 (FIG. 14) of an endoscope 46 (FIG. 7). FIG. 2 illustrates an anterior perspective view of the lumbar section 20 of the spinal column 10. Disc D.sub.L3-L4 28 is shown in an enlarged side view in FIG. 3. This figure also shows various anatomical structures of the spine, including facets F3A 30 and F4A 32, facet joint FJ 34, spinous processes SP3 36 and SP4 38, transverse processes TP3A 48 and TP4A 50, and intervertebral foramen IF 52. FIG. 4 is a top view of the section of the spinal column 10 shown in FIG. 3, with the L3 40 vertebra removed to expose annulus A 54 and nucleus N 56 of disc D.sub.L3-L4 28. FIG. 5 is an anterior perspective view of the section of the spinal column 10 shown in FIG. 4. FIG. 6 is a partial cross-sectional view of the section of the spinal column 10 shown in FIG. 5, but with vertebra L3 40 in place atop disc D.sub.L3-L4 28.
[0035] Referring to FIGS. 7-10, an endoscope assembly 60 constructed and arranged to carry out the present system and method is illustrated. The endoscope assembly 60 includes a tool tube 58, an endoscope 46, and an oversized tool assembly 62. The tool tube 58 includes a tool tube first end 64, a tool tube second end 66, and a stabilizer arm 70. An inner bore 68 extends through the tool tube 58 from the tool tube first end 64 to the tool tube second end 66. The tool tube inner bore 68 may be supplied having any sized bore that is suitable for the tools required to perform the operation. In this manner, the tool tube 58 may have a much larger diameter than is required for the passage of the endoscope working channel 44. When the present system and method is utilized with an implant inserter tool (not shown), the tool tube inner bore may be 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, or even 2.0 times or more with respect to the size of the working channel 44 of the endoscope 46. The tool tube 58 has a sufficient length so that the tool tube second end 66 extends outside of the surgical patient, while the tool tube first end 64 is positioned adjacent to the surgical site to provide a pathway for the surgical tool 72 and the endoscope 46. The stabilizer arm 70 can be utilized to secure the tool tube 58 in a substantially fixed position during a surgical procedure. In one such example, the stabilizer arm 70 may be secured to the surgical table with a segmented mount assembly 74, (FIG. 15). It should be noted that the tool tube 58 can be utilized without the stabilizer arm 70 without departing from the scope of the invention. The surgical tool 72 includes a working end 76 that is sized to fit through the tool tube inner bore 68, but too large to fit through the lumen 45 of the working channel 44 of the endoscope 46 (FIG. 14). Tool working ends 76 may include, but should not be limited to, curettes, rasps, burrs, Kerrison's, inserters, brushes, trials, and shavers. A tool shaft 78 sized to fit through the lumen 45 of the working channel 44 of the endoscope 46 has sufficient length to extend completely through the endoscope 46 for attachment to a tool hand grip 80. The tool hand grip 80 may be secured to the distal end 82 of the tool shaft 78 in various manners suited to the best use of the tool working end 76 configuration. The securement configurations may include, but should not be limited to, bayonet mounts, threads, conjugate shapes 84 and the like. The securement configuration in a most preferred embodiment allows rotation as well as translation of the tool working end 76 through the lumen 45 of the working channel 44. The tool hand grip 80 includes a grip portion 86 sized for grasping with a human hand. The grip portion 86 may include rubber, serrations, or other grip enhancing surfaces that provide for securely grasping the hand grip portion with surgical gloves that may be wet. An attachment portion 88 is provided for securement to the distal end of the tool shaft 82 and is preferably constructed of metal to provide a rigid connection between the tool hand grip 80 and the distal end of the tool shaft 82. The endoscope 46 has a first end 90, the endoscope manifold 92, and the endoscope second end 94. The endoscope first end 90 includes the working channel 44; the working channel 44 having an inner lumen 45 of the working channel 44 that has a substantially constant diameter and shape extending from the endoscope first end 90 to the endoscope second end 94 through which endoscopic surgery is typically performed. The endoscope manifold 92 typically includes connections for video 96, pressurized fluid 100 which may be water or air, and a vacuum connection 98. Video may be provided by fiber optics 47 which extend through the lumen 45 of the working channel 44, or by a camera chip 49 that may be positioned near the first end 90 of the endoscope 46 within the lumen 45 of the working channel 44 with wiring extending through the lumen 45 of the working channel 44 to the video connection 96. The video connection 96 is preferably connected to a monitor 102 via wiring 104 (FIG. 15). The second end 94 of the endoscope 46 includes a port 106 sized to allow passage of the tool shaft 78. In a preferred embodiment, an o-ring 97, seal 95 or the like (not shown) is positioned in the port 106 to cooperate with an outer surface of the tool shaft 78 to reduce or eliminate leakage of fluids and/or vacuum through the lumen 45 of the working channel 44.
[0036] Referring generally to the figures, and more specifically to FIGS. 11-14, performance of a discectomy using the present system and method is illustrated. FIG. 11 illustrates a jamshidi needle 108 having a shaft portion 110 and point portion 112 piercing annulus 54 and nucleus 56 of disc 28 (D.sub.L3-L4). Once the surgeon has pierced the annulus 54 and entered the disc 28 (D.sub.L3-L4) with jamshidi needle 108, the entry channel is enlarged with a plurality of increasingly larger dilators 113, as best shown in FIG. 12. This figure shows the second dilator 114 and third dilator 116 being introduced down shaft portion 110, and eventually into annulus 54 and the center of nucleus 56 of disc 28 (D.sub.L3-L4). FIG. 13 further illustrates the discectomy (diskectomy) procedure, namely, introduction of progressively larger dilators 113, into the nucleus 56 of disc 28 (D.sub.L3-L4). This is done to increase the size of the opening in the annulus 54 and into the disc 28 for the eventual introduction of the tool tube 58 (shown in FIG. 14) proximate to the nucleus 56. Once the dilators 113 have made the opening large enough, the tool tube 58 is introduced over the dilators 113. FIG. 14 illustrates introduction of the tool tube 58 with its working channel 44 through annulus 54 of disc 28 (D.sub.L3-L4) proximate to nucleus 56 just prior to introduction of surgical instruments into the disc. When the tool tube 58 is in place proximate to nucleus 56, all dilators 113 are removed. The tool tube 58 may now be secured in position, if desired, with the stabilizer arm 70. A surgical tool 72 is now placed within the tool tube 58 with the working end 76 of the tool in close proximity to the disc 28. The tool shaft 78 is extending out of the tool tube 58 without the tool hand grip 80. The endoscope 46 is then threaded over the tool shaft 78 with the tool shaft extending through the lumen 45 of the working channel 44, and the outer diameter of the working channel 44 is simultaneously threaded into the lumen of the tool tube 58. Once the endoscope 46 is in position to view the surgery, the hand grip 80 is secured to the tool shaft 78. The video connection 96, pressurized fluid connection 100 and vacuum connection 98 may be attached prior to or after the placement of the endoscope 46 into the tool tube 58. In this manner, the surgeon can manipulate the working ends 76 of the surgical tools through the endoscope 46 while still maintaining a view of the surgical site with the endoscope 46. Should the surgeon need a different surgical tool 72, the hand grip 80 is removed from the surgical tool 72 and the endoscope 46 is removed from the tool tube 58. The tool 72 is replaced and the hand grip 80 may be attached prior to insertion of the endoscope 46 into the tool tube 58.
[0037] It is to be understood that while a certain form of the invention is illustrated, it is not to be limited to the specific form or arrangement herein described and shown. It will be apparent to those skilled in the art that various changes may be made without departing from the scope of the invention and the invention is not to be considered limited to what is shown and described in the specification and any drawings/figures included herein.
[0038] One skilled in the art will readily appreciate that the present invention is well adapted to carry out the objectives and obtain the ends and advantages mentioned, as well as those inherent therein. The embodiments, methods, procedures, and techniques described herein are presently representative of the preferred embodiments, are intended to be exemplary, and are not intended as limitations on the scope. Changes therein and other uses will occur to those skilled in the art which are encompassed within the spirit of the invention and are defined by the scope of the appended claims. Although the invention has been described in connection with specific preferred embodiments, it should be understood that the invention as claimed should not be unduly limited to such specific embodiments. Indeed, various modifications of the described modes for carrying out the invention which are obvious to those skilled in the art are intended to be within the scope of the following claims.
