CN101217915A - Surgical access device, system, and methods of use - Google Patents

Abstract

A surgical access device can include a plurality of retractor members that together define a lumen having a first cross-sectional dimension. Each of the plurality of retractor members can be moved radially outward to at least a second cross-sectional dimension to create a surgical access passage. The surgical access device, systems and kits comprising the surgical access device, and methods of using the surgical access device can include a mechanism for inserting an elongate member from exterior the body to the surgical site, a mechanism for moving the retractor members radially outward, a mechanism for guiding the radially outward movement of the retractor members, a mechanism for securing each of the retractor members in a range of positions, and a mechanism for illuminating the surgical site. Variations of the devices, systems, kits, and methods are useful for creating and maintaining a surgical access passage for performing minimally invasive surgery.

Description

Surgical access device, system and using method

Cross reference to related application

The application requires the common unsettled U.S. Provisional Patent Application No.60/698 that submits on July 11st, 2005,430 priority, and this application is here incorporated into by integral body by reference.

Technical field

The present invention relates to a kind of surgical access device, comprise the system and the external member of surgical access device, and the method that is used to make and use surgical access device.Embodiments of the invention can be used for carrying out Minimally Invasive Surgery.

Background technology

Be positioned at the pathological changes of body depths and/or the traditional operation program of wound and can cause severe trauma between two parties organizing.The otch that the open surgery program often will be rectificated, muscle is peeled off on a large scale, the devasation of the tissue retraction of spinning out, denervation and tissue.Owing to during operative procedure, use general anesthesia and tissue damaged, the recovery room time of therefore most these requirements of operation a few hours and the postoperative recovery time of several weeks.In some cases, these intrusive mood operations cause permanent scar and pain.

Wicresoft substitutes, and for example arthroscopic techniques has reduced pain, postoperative recovery time and to the destruction of health tissues.In Minimally Invasive Surgery, because by inlet but not, therefore keep the integrity of tissue between two parties by remarkable otch inlet diseased region.These less invasive techniques also often only require local anesthesia.Avoid general anesthesia to reduce the risk of postoperative recovery time and complication.

Because the needs of depths and damage the important danger of tissue between two parties in the inlet body, so the Minimally Invasive Surgery technology is specially adapted to vertebra and neural operation is used.For example, the main muscle at back is peeled off or excised to the common open surgery requirement that is used for intervertebral disk hernia, vertebrae plate resection of carrying out the discectomy operation subsequently to expose vertebra.In the method, near the tissue that comprises spinal nerves and blood vessel dural sac, ligament and the muscle should bounce back so that the path from skin to the intervertebral disc is unimpeded rearward.These operations usually consume at least one by two hours under general anesthesia, to carry out and to require the postoperative recovery time of several weeks at least.Except long recovery time, be the major defect of open operation on vertebra to disorganization.As a result, a lot of patients are reluctant the pain that undergos surgery and caused by the vertebra state to eliminate.

In order to reduce postoperative recovery time and the pain relevant with other operation, developed micro-operative technique with vertebra.For example, in the microsurgery diskectomy, can cut out path from patient's back surfaces to the intervertebral disc intervertebral disc that enters the mouth by utilizing little otch.Operating microscope can be used in the observation operative region.The minor diameter microsurgical mrstruments can enter intervertebral disc by little otch between two medullary plates.Tissue damaged is lighter between two parties, because the path of otch and external-to-internal is less.Though it is lighter that these microsurgery programs are invaded, but they still relate to the same risk with the open surgery complications associated with arterial system, for example to the damage of nerve root and dural sac, form neural all cicatrixes, form hernia again in surgical site, and because excessive bone removes the unstability that causes.The shortcoming of this micro-operative technique relevant with these complication types is that they do not allow by operative doctor direct observation operative site.

The progress of percutaneous spinal operation makes shorten recovery time and postoperative pain alleviates, because they require minimum, if any, muscle excision and they can be carried out under local anesthesia.For example, a kind of outside method that is to use in this technology, the preferably percutaneous lumbar diskectomy that under fluorescent X-ray, carries out.Another kind of percutaneous spinal operation comprises the outstanding intervertebral disc decompression that utilizes back outside method.This method is two operation on mouth of going into, and it relates to percutaneously puts working column that is used for the outstanding intervertebral disc fragment of emptying and the observation sleeve pipe that is used to insert endoscope.This process allows to observe simultaneously in intervertebral disc operation and aspirate, wash and excise.Yet this traditional operation is restricted, because they do not provide to the direct observation of operative site and because they may require to enter the intravital a plurality of inlets of patient.In addition, this outside and back outside method be the restore intravertebral state not, and this state may require the center line method or remove skeleton or implant.

The endoscopic surgery technology allows by the less otch in the health and utilizes the bodily tissue destruction of limited extent to carry out operative procedure on patient body.Endoscopic surgery utilizes the tubular structure that is called the little otch in the telescopic insertion health usually.Sleeve pipe keeps otch to be opened and as the conduit that extends between the regional area that undergos surgery in health outside and body domestic demand.Since by sleeve pipe forms to enter intravital channel size less, so particular procedure program, for example behind excision and use the operation of controlled surgical unit to be difficult to use endoscopic technique to carry out.

A kind of percutaneous method that forms the operation access road is utilized a series of big expanded casings that become gradually.In this technology, the minor diameter sleeve pipe percutaneously is inserted into operative site.Thereby the sleeve pipe of larger diameter is then around be inserted into the expansion surrounding tissue than small casing a little.Constantly become big sleeve pipe, for example reach 12 sleeve pipes, the sleeve pipe that inserts before can being centered around is inserted into one according to the order that diameter increases at every turn, thereby constantly bounces back surrounding tissue.This method has the shortcoming of damaged tissue when a plurality of sterilization sleeve pipes are used in requirement and the bigger sleeve pipe of general inserts at every turn.

Relate to tubular sleeve in the another kind of method of authorizing disclosed formation operation access road in the U.S. Patent No. 6,800,084 of Davison etc. with first tubular portion and second tubular portion.Second tubular portion comprises the bow-shaped section of shell material that is rolled into tubular form and is attached to the far-end of first tubular portion.After sleeve pipe percutaneously was inserted into operative site, expander tool can be inserted into by sleeve pipe.The conical butt top of expander tool can be used to expand telescopic distal portions by bow-shaped section being launched into frusto-conical shape.

Have a plurality of shortcomings by disclosed apparatuses such as Davison and method.Though this method provides the working region that is expanded (at the boot proximal end place) in surgical site, thereby it does not provide bigger, constant diameter of section to allow by operative doctor direct observation whole surgery position along telescopic whole length.The expansion of sleeve pipe second tubular portion requires to use the independent instrument expanded that must be operated with abundant expansion second tubular portion in a plurality of positions.Also have following shortcoming by disclosed apparatuses such as Davison and method, promptly lack a kind of mechanism that is used for second tubular portion is effectively remained on the abundant expanding location of its frusto-conical shape.As a result, the intra-operative surrounding tissue begin to move turn back in the operative region and influence to the observation and the operative procedure itself of operative site.

The operating theater instruments that is used for Minimally Invasive Surgery often requires to provide light source to illuminate operative site.Traditional micro-surgical instruments and endoscopic instrument often comprise the light source that is integrated in or is attached to this apparatus or instrument, for example, and fibre optics cable.In percutaneous operation, thus by the operation access road settle light source for example fibre optics cable can hinder the direct observation of this passage influence substantially to operative site.

Therefore, need multiple apparatus and method, the direct observation that its permission is amplified operative procedure in the surgical work space of percutaneous inlet.Need this apparatus and method, it provides access path and/or illumination and does not hinder observation to this position in surgical site.Need this apparatus and method, it has reduced and has entered the intravital inlet number of patient.Need multiple apparatus and method, it provides this Minimally Invasive Surgery that is used for the percutaneous of various application and method.

Summary of the invention

The invention provides a kind of surgical access device, comprise the system and the external member of surgical access device, and the method that is used to make and use surgical access device.Embodiments of the invention are used to form and are kept for to carry out the operation access road of Minimally Invasive Surgery in human body or animal body.

In one embodiment, the invention provides a kind of surgical access device that comprises elongated member, this elongated member comprises near-end, far-end and a plurality of retractor parts.Each retractor parts has the inner surface in the chamber that forms elongated member together.This elongated member chamber has first sectional dimension.Each of these a plurality of retractor parts can radially outward move at least the second sectional dimension.In a kind of modification, the outside motion of retractor parts is configured to be formed on the operation access road that has the substantially constant sectional dimension the near-end of elongated member and the far-end from the health outside to the operation position.Formed operation access road can hold instrument and allow immediate access and/or observe operative site.

This surgical access device can comprise mechanism and/or the interface that is used for radially outward mobile retractor parts.This apparatus can comprise and is used for guiding the mechanism and/or the interface of motion radially outward of retractor parts and mechanism and/or the interface that is used for fixing in a series of positions each retractor parts.This apparatus also can comprise mechanism and/or the interface that is used for inserting to the operation position from the health outside elongated member.This apparatus also can comprise mechanism and/or the interface that is used to illuminate operative site.

The present invention comprises and comprises and being used to form and the embodiment of the system of this surgical access device of the access road that keeps performing the operation.The present invention comprises the embodiment of the external member that comprises this surgical access device.In certain embodiments, external member can comprise the various combinations of element.For example, external member can comprise elongated member, be used for radially outward mobile retractor parts mechanism, be used to guide the motion radially outward of retractor parts mechanism, be used for fixing in a series of positions each retractor parts mechanism, be used for from the health outside inserting the mechanism of elongated member and/or be used to illuminate the mechanism of operative site to the operation position.

Thereby the present invention includes the embodiment of the method that is used to form operation access road inlet operative site.This embodiment can utilize the surgical access device that comprises elongated member, this elongated member has a plurality of retractor parts, after in elongated member has been located in patient's body, these retractor parts can radially outward move at least the second from first sectional dimension, bigger sectional dimension.This method also can comprise and be used for from the health outside inserting to the operation position elongated member, the radially outer motion of guiding retractor parts, fixes each retractor parts in a series of positions and/or illuminate the step of operative site.

Surgical access device, system, external member and be used for making and use the feature of the method for surgical access device of the present invention to realize individually or combinedly at one or more embodiment of the present invention.As can realizing ground by those skilled in the art, surgical access device, system, external member and to be used to make and use a lot of different embodiment of the method for the surgical access device according to the present invention be possible.Other purposes of the present invention, advantage and feature provide in the illustrative examples of describing in detail and will be tangible to those skilled in the art by reading following explanation.

Description of drawings

Fig. 1 is the perspective view of a kind of modification of surgical access device in one embodiment of the invention, keeper ring, four retractor parts, four wheel locks is shown and inserts stylets in the surgical access device chamber.

Fig. 2 is in one embodiment of the invention, for example has been placed at apparatus to put in place not have the perspective view of the surgical access device that is shown in Fig. 1 of stylet after forming the operation access road.

Fig. 3 is the perspective view that is shown in the surgical access device of Fig. 2 in one embodiment of the invention, but is illustrated in the expanded body air bag apparatus for example that inserts surgical access device in the extended mode not.

Fig. 4 is the perspective view that is shown in the surgical access device of Fig. 3 in one embodiment of the invention, but wherein expanded body is expanded, and causes each retractor parts of surgical access device to be expanded radially outwardly.

Fig. 5 is in one embodiment of the invention, but has been expanded and after expanded body has been retracted and removed, is shown in the top plan view of the surgical access device of Fig. 1-4 at the retractor parts.

Fig. 6 is the perspective view that is shown in the keeper ring of Fig. 1 in one embodiment of the invention, and wherein retractor parts, retractor parts arm and wheel lock are removed.

Fig. 7 is the summary cross sectional view that is shown in the surgical access device of Fig. 4 in one embodiment of the invention, but the expanded body that is in the expanding location, the retractor parts that radially outward move is shown and retractor parts arm and retractor parts are fixed in wheel lock in the shift position.

Fig. 8 is the side view that is shown in the surgical access device of Fig. 1-4 in one embodiment of the invention, has the rotatable arm that rotatably is installed to the keeper ring and has pointed tip and have the flex socket of the light source that is attached to rotatable arm far-end.

Fig. 9 is the side view that is shown in the surgical access device of Fig. 8 in one embodiment of the invention, thereby thereby has the periphery that top that the rotatable arm flex socket that is rotated down passes skin and hypodermis layer flex socket via secondary puncture inlet is located in operative site.

Figure 10 is the side view that is shown in the surgical access device of Fig. 1-4 in one embodiment of the invention, and the keeper ring has outward extending arm and comprises the guide groove that is used to hold and guide the straight connector with light source of percutaneous insertion.

Figure 11 is the top perspective that is shown in the surgical access device of Figure 10 in one embodiment of the invention, thereby the straight connector that the top that is directed straight connector by guide hole is positioned the periphery of operative site is shown.

Figure 12 is the top plan view that is shown in the keeper ring of Fig. 5 in one embodiment of the invention, comprises into four secondary retractor parts of one group, and each includes light source at its far-end.

Figure 13 is one the perspective view that is shown in the secondary retractor parts of Figure 12 in one embodiment of the invention, is illustrated in the light source of its far-end.

Figure 14 is in one embodiment of the invention as is shown in the keeper ring of Fig. 4 and the perspective view of the outside retractor parts that move, comprises the stabilizing ring that is positioned retractor parts far-end.

Figure 15 A is the perspective view that is shown in the stabilizing ring of Figure 14 in one embodiment of the invention, is illustrated in the light source of its far-end.

Figure 15 B is the top view that is shown in the stabilizing ring of Figure 15 A in one embodiment of the invention, is illustrated in the light source that the center of ring focuses on below.

Figure 16 is the perspective view that is shown in the keeper ring of Fig. 4-5 in one embodiment of the invention, have the retractor parts that are in the outside shift position and be illustrated in far-end or the keeper ring below the bottom side on light source.

Figure 17 is the bottom perspective view that is shown in the keeper ring of Figure 17 in one embodiment of the invention, is illustrated in four slits on the keeper ring bottom side, and each slit holds for example light emitting diode (LED) of light source.

Figure 18 is the flow chart that signal is used to form the step of operation access road in an embodiment of the inventive method.

Figure 19 A is the slidably top plan view of a kind of modification of the upper and lower keeper ring of rotation of surgical access device in another embodiment of the present invention.

Figure 19 B is the perspective view that is shown in the upper and lower keeper ring among the embodiment of Figure 19 A, and the keeper ring that is opened is shown.

Figure 20 A is the top plan view of another modification of keeper ring in one embodiment of the invention, and the retractor parts in the closed position are shown.The spike dowel that is attached to retractor parts arm is illustrated as being in the closed position of contiguous keeper ring slit inside.

Figure 20 B is the top plan view that is shown in the keeper ring of Figure 20 A, the retractor parts of the open position that mediates is shown and is attached to the spike dowel of retractor parts arm near the center of keeper ring slit.

Figure 20 C is the top plan view that is shown in the keeper ring of Figure 20 A and 20B, the retractor parts that are in abundant open position is shown and is close to the spike dowel of the outer type of keeper ring slit to retractor parts arm.

Figure 21 is the perspective view that has the surgical access device of threaded retractor parts arm and runner in another embodiment of the present invention.

The specific embodiment

The present invention includes surgical access device, comprise the system of surgical access device and external member, the method for manufacturing surgical access device and the embodiment that uses the method for surgical access device.Embodiments of the invention are used to carry out Minimally Invasive Surgery.

As, singulative " a () ", " an (one) " and " the (being somebody's turn to do) " comprise a plurality of quoting, unless other situation clearly pointed out in context with being used for this description and claims.Therefore, for example, term " retractor parts " is used to represent single retractor parts or one group of retractor parts.As, " near " is defined by close more datum mark for example initial point, tie-point or midline of body with being used for this description and claims.As, " far away " is defined by more away from datum mark for example initial point, tie-point or midline of body with being used for this description and claims.Therefore, word " near " and " far away " refer to close more respectively and insert the intravital instrument tip of patient (promptly away from utilizing more, far-end) medical apparatus and instruments is inserted the intravital operator of patient (for example, operative doctor, doctor, nurse, technician's etc.) direction.For example, the end of inserting the intravital medical apparatus and instruments of patient is the far-end of medical apparatus and instruments, and the end that is positioned at the medical apparatus and instruments of exterior is the near-end of medical apparatus and instruments.

In one embodiment, the invention provides a kind of for example telescopic surgical access device of elongated member that comprises, this elongated member comprises the mechanism that is used for the outside mobile elongated member of original position (that is after, in elongated member has been located in patient's body).The mechanism that is used for outwards moving can comprise a plurality of inflexible, interconnective retractor parts, and each has the inner surface that forms the elongated member chamber together.The retractor parts can radially outward move at least the second from first sectional dimension, bigger sectional dimension.Retractor parts this outwards moves the operation access road that has the substantially constant sectional dimension the near-end that can be formed on elongated member from the health outside to the operation position and the far-end.Formed operation access road can hold instrument and allow immediate access and/or observe operative site.

The mechanism that is used for outside mobile elongated member also can comprise can near the health outside be positioned the elongated member near-end and with the concentric keeper ring of elongated member.In one embodiment, the keeper ring is used to interconnect the retractor parts with one heart at interval by locating them around sleeve pipe.The keeper ring can comprise that also the retractor arm that is connected to the retractor parts can be inserted into guiding channel wherein.In this way, the retractor parts outwards moves and can be directed by the motion of retractor parts arm by guiding channel at least in part.

The keeper ring can additionally comprise and being used in their the primary importance neutralization that comprises first sectional dimension corresponding to second, more the second position at least of heavy in section size is the mechanism of each retractor parts fix in position.In one embodiment, each retractor arm can be fixed in the ad-hoc location in of keeper parts guiding channel.For example, in case arm has been located in required orientation, but then the adjustment devices of screw or other type can be used to prevent that the retractor arm from moving in guiding channel.In one embodiment, be used for the mechanism that retractor arm locking puts in place can be comprised and be juxtaposed to the retractor arm and can adjust threadably to engage a plurality of locks of taking turns of retractor arm by the keeper ring.

Surgical access device of the present invention also can comprise the element that is used for requiring into treatment sites place locating apparatus.For example, this apparatus can comprise the stylet that is used for the elongated member that retractor parts wherein are in first closed position is percutaneously inserted operative site.This stylet can comprise the thread eye that is used for location stylet on seal wire.

Surgical access device of the present invention also can comprise the mechanism that is used for radially outward mobile retractor parts.The mechanism that is used for radially outward mobile retractor parts can be used to retractor from first, the closed position is urged at least the second, open position.The mechanism that is used for mobile retractor parts can comprise less than elongated member first, close sectional dimension first, the sectional dimension of expansion not, and with elongated member second, open sectional dimension essentially identical at least the second, open sectional dimension.In one embodiment, the mechanism that is used for mobile retractor parts can comprise balloon catheter or other inflatable part.Alternately, can use other can expand apparatus.

Surgical access device of the present invention also can comprise mechanism and/or the interface that is used to illuminate operative site, for example light source.In one embodiment, the mechanism that is used to illuminate operative site can be located in the outside of elongated member.For example, the mechanism that is used to illuminate operative site can be configured for the far-end operation at individual jacket.This individual jacket can comprise and is used to enter the mouth the intravital mechanism of patient.In such an embodiment, this individual jacket can be inserted operative site to be used for the positioned light source at the periphery place of operative site by guiding percutaneously by the second puncture path.

In alternate embodiments, be used to illuminate the mechanism and/or the interface of operative site, perhaps light source can be positioned the inside of elongated member.For example, being used to illuminate the mechanism of operative site can be at the far-end of retractor parts or along the length setting of retractor parts.In another embodiment, the mechanism that is used to illuminate operative site can be located at or be attached to the inside (distally) of keeper ring thus the surface is directed to operative site.In another embodiment, surgical access device also can comprise when they are in the position that comprises second sectional dimension, can be located in the stabilizing mechanism in the retractor parts.In such an embodiment, the mechanism that is used for illuminating operative site can be located at stabilizing mechanism or its.At the embodiments of the invention that comprise the mechanism that is used for illuminating operative site, the operation access road is not used to illuminate the obstruction of the mechanism of operative site.

With reference now to accompanying drawing,, in the embodiment that is shown in Fig. 1-7,surgical access device 10 can comprise theelongated member 11 with near-end 12 and far-end 13.Elongatedmember 11 can have a plurality ofretractor parts 14, and each has theinner surface 15 that forms thechamber 16 ofelongated member 11 together in the closed position.Elongatedmember chamber 16 has first sectional dimension 17.Eachretractor parts 14 can radially outward move to from closed position with firstsectional dimension 17 have at least the second, the open position of heavy insection size 18more.Retractor parts 14 this outwards moves the operation access road that has the substantially constant sectional dimension the near-end 12 that can be formed onelongated member 11 from the health outside to the operation position and the far-end 13.Formed operation access road can hold instrument and allow immediate access and/or object observing operative site.

In one embodiment,elongated member 11 can comprise a plurality ofretractor parts 14, fourretractor parts 14 for example, as be shown in Fig. 1-7.The number range ofretractor parts 14 can from 2 to 20 or from 2 to 12 or from 2 to 6 or from 2 to 4.Support ridge 19 can be for example on the outside ofretractor parts 14 at least in part the length along eachretractor parts 14 extend.In the time of inretractor parts 14 outwards move and remain in corresponding to the position of heavy insection size 18 more,external support ridge 19 can provide support forelongated member 11 forretractor parts 14 provide other rigidity and help.

Retractor parts 14 are preferably enough hard with retraction surrounding tissue when radially outward mobile and keep this tissue to be in the advanced position during operativeprocedure.Retractor parts 14 can each all have far-end 13 blunt or sphering a little to alleviate the wound to tissue during inserting.Similarly, thus each far-end ofexternal support ridge 19 can be the blunt or intilted a little tissue of being convenient to pass.Be used for back and forth in the hollow region of operative site material for transfer one or more can the comprising ofretractor parts 14.

Eachretractor parts 14 can radially outward move to the open position with at least the secondsectional dimension 18 and can radially move inward and turn back to the closed position with first sectional dimension 17.In one embodiment, eachretractor parts 14 can be independent ofother retractor parts 14 and moves.Eachretractor parts 14, for example, each of fourretractor parts 14 that is shown in the embodiment of Fig. 1-7 can radially outward move to form the secondsectional dimension 18 at least.In one embodiment, eachretractor parts 14 can side by side move.

Thereby eachretractor parts 14 also can comprise from the angles of its near-end 12 with basic 90 degree and stretching out perpendicular to theretractor parts arm 20 of the longitudinal axis of elongated member 11.Retractor parts arm 20 can be integrated in or otherwise be attached to retractor parts 14.As being shown in Fig. 7-10,retractor parts arm 20 can be integrated in theexternal support ridge 19 ofretractor parts 14.

Keeper ring 21 can be configured at the near-end 12 of a plurality ofretractor parts 14 and with a plurality ofretractor parts 14 and settle with oneheart.Keeper ring 21 can be configured to and/or be suitable for resting on the patient skin on the targeted surgicalsite.Keeper ring 21 can comprise a plurality of retractorparts guiding channels 22,retractor parts arm 20 can be positioned in its each in.Retractor parts arm 20 can slide in guidingchannel 22.

Surgical access device 10 can comprise and being used in the primary importance that comprises firstsectional dimension 17 and theretractor parts arm 20 of the fixed connection of the second position at least that comprises secondsectional dimension 18 and the mechanism of retractor parts 14.For example, the mechanism that is used forretractor parts 14 fix in position can be by thewheel lock 23 in wheellock guiding piece 24 each keeperparts guiding channel 22 of screw-in of keeper ring 21.Wheel lock 23 can be oriented to contact adjustablyretractor parts arm 20 in this guiding channel 22.For example,wheel lock 23 can be rotated down to apply motion restriction power and be fixed in the desired location on retractor parts arm 20.Similarly, thus thewheel lock 23 motion restriction powerretractor parts arms 20 that can rotate up to be released on theretractor parts arm 20 can slide in guidingchannel 22.

As being shown in Fig. 1,surgical access device 10 can comprise the element that is used at theposition locating apparatus 10 that requires to handle.For example,apparatus 10 can comprise thestylet 30 that is used forelongated member 11 is percutaneously inserted operative site.Stylet 30 can comprise theend 32 of thehandle 31 that is used to handlestylet 30, point and run through thethread eye 33 ofstylet 30 length.Whenretractor parts 14 are in first, in the closed position time,stylet 30 can insert in thechamber 16 of elongated member 11.In this way, thethread eye 33 ofstylet 30 can be directed on the seal wire (not shown) to be used at surgical site location elongatedmember 11.

Surgical access device 10 can use various technology percutaneously to be inserted targeted surgical site.In an illustrative examples, form in can the patient skin above targeted surgical site and stab or little otch.Little intubate (not shown) with pointed tip, for example trocar and cannula can be used in and passes tissue arrival operative site.The seal wire (not shown) can pass this intubate.Intubate can be removed, and keeps seal wire and puts in place.When stylet 30 inserted in thechamber 16 ofelongated members 11,stylet 30 andelongated member 11 can pass on seal wire by thecentral thread eye 33 in thestylet 30 then.This seal wire has diameter and the rigidity that is enough toelongated member 11 is directed to exactly operative site.When elongatedmember 11 was in the desired location, seal wire andstylet 30 can be removed from elongated member 11.Fig. 2 is illustrated in afterstylet 30 has been removed, for example, has been placed thesurgical access device 10 that puts in place with after forming the operation access road that arrives operative site atelongated member 11.

In another embodiment, the intubate that is used to form the initial percutaneous route that arrives operative site can be a Jamshidi pin (not shown).Stylet 30 andelongated member 11 can be worn to operative site on the Jamshidi pin.When elongatedmember 11 was in desired location, Jamshidi pin andstylet 30 can be removed from elongated member 11.Alternately, intubate and seal wire, Jamshidi pin or other insert mechanism and can be placed in thechamber 16 ofstylet 30 and/orelongated member 11 and withstylet 30 and/orelongated member 11 and insert operative site.

Preferably, located adjacent one another therebyretractor parts 14 are percutaneously inserted the edge of operativesite retractor parts 14 in position folding or that close.In this closed position,retractor parts 14 have theinner surface 15 in thechamber 16 that forms elongatedmember 11 together.This ofelongated member 11 closedchamber 16 and comprised first sectional dimension 17.When elongatedmember 11 had percutaneously been inserted and be positioned in the desired location of contiguous operative site,keeper ring 21 can be placed in the stop position on the patient skin of the operation access road that forms thus.

As be shown in Fig. 3, but the mechanism that is used for radially outwardmobile retractor parts 14 can be expandedbody 40, for example air bag.But expandedbody 40 can be inserted in thechamber 16 ofelongated member 11 and can activated to apply radially outward active force with mobile retractor parts 14.The mechanism that is used for radially outward mobile retractor parts can be coupled to the far-end ofelongated member 41, for example little sleeve pipe or conduit.But expandedbody 40 can not be inserted in thechamber 16 ofelongated member 11 in the extended mode.In case put in place, but then expandedbody 40 can be expanded so that theretractor parts 14 ofelongated member 11 are mobile radially outwardly from their original closed position.The 14 radially outer motions of retractor parts make surrounding tissue bounce back, thereby form the operation access road in theretractor parts 14 that outwards move.

The operation access road that is formed by this outside motion ofretractor parts 14 can be included in firstsectional dimension 17 inchamber 16 and equal sectional dimension in a series of sectional dimensions between the sectional dimension of internal diameter of keeper ring 21.For example, can to have scope be 3/4 inch to 11/4 inch diameter to operation access road sectional dimension.In certain embodiments, require ground definitely or as operative procedure as operation method, operation access road sectional dimension can have less than 3/4 inch or greater than 11/4 inch diameter.

But expandedbody 40, for example air bag can have the length near the length of theretractor parts 14 of elongated member 11.For example, in the one embodiment of the present of invention that are used for the operation on vertebra program, the length ofelongated member 11 can be in three to four inches scope.Therefore, but expandedbody 40 can have three to four inches length.In one embodiment, but the length of expandedbody 40 can be less than the length of retractor parts 14.For example, but expandedbody 40 can comprise 1/3rd length ofretractor parts 14 length roughly.Thereby can be inserted into its contiguous for example distally three/part ofretractor parts 14 in thechamber 16 ofelongated member 11 but have expandedbody 40 less than the length ofretractor parts 14 length.In this structure, but when expandedbody 40 expansions, thereby only 1/3rd of the distally ofretractor parts 14 distal part that can radially outward move the operation access road are tapers.

As be shown among the embodiment of Fig. 4, the mechanism that is used for radially outwardmobile retractor parts 14, for example but expandedbody 40 can be expanded inretractor parts 14 or outwards move, and causes one ormore retractor parts 14 outwards to move and therefore contiguous surrounding tissue retraction.When but expandedbody 40 andretractor parts 14 outwards moved at least the second requiredsectional dimension 18, thewheel lock 23 on the top ofkeeper ring 21 can be rotated down with contactretractor parts arm 20 and witharm 20 and 14 lockings of retractor parts and put in place.

Retractor parts 14 have radially outward been moved and expandedbody 40 has been retracted and thesurgical access device 10 afterelongated member 11 removes but Fig. 5 is illustrated in.In this position,retractor parts 14 can provide the operation access road that allows operative doctor direct observation operative site.As a result, operative doctor can directly be observed dissection and any wound and/or pathology, for example intervertebral disc of the operative site of contiguous operation access road.Carrying out operative procedure for example during laminectomy or the excision, operative doctor can directly be observed and monitor more exactly the motion of surgical unit and handle tissue in surgical site.

Fig. 6 illustrates the keeper ring 21 of Fig. 1, and wherein elongated member 11, retractor parts 14 and wheel lock 23 have been removed.Thereby each retractor parts arm 20 can slide along the axis of T shape retractor parts guiding channel 22 and allow retractor parts 14 radially outward and move inward.Fig. 7 is the side cross-sectional view that is shown in the surgical access device 10 of Fig. 4, but expanded body 40 that is in expanding location and the retractor parts 14 that radially outward move are shown.Wheel lock 23 can be inserted into be positioned at retractor parts guiding channel 22 directly over have a threaded ordinatedly lock guiding piece 24 of taking turns, perhaps in the screw hole.When retractor parts 14 were in desired location, wheel lock 23 can be rotated down with contact retractor parts arm 20 and with itself and retractor parts 14 fix in position, as is shown in Fig. 7.Similarly, when needs or outwards or when moving inward retractor parts 14 to the another location, thereby wheel lock 23 can rotate up contacting retractor parts arm 20 and can slide into the another location along guiding channel 22 with unlocking wheel lock 23 and retractor parts arm 20.Wheel lock 23 can be used to retractor parts 14 are fixed in the closed position to be used for that elongated member 11 percutaneously is inserted into operative site.

In one embodiment, one ormore retractor parts 14 can be hollow, and can be used in from operative site and remove material and/or material is inserted the operative site.

In some embodiment ofsurgical access device 10,retractor parts 14 can utilize and be used for the different mechanism of this purpose and/or interface and radially outward move.But except utilizing outwards moving of expandedbody 40 or air bag,retractor parts 14 can utilize hydraulic mechanism, utilize mechanically actuated or utilize other suitable mechanism radially outward to move.

For example, as be shown in the embodiment of Figure 19 A-19B,surgical access device 10 can comprise two keeper rings, top keeper ring 25 and bottom keeper ring 26.The basal surface of top keeper ring 25 rests on the top surface of bottom keeper ring 26.Upper and lower keeper ring 25,26 can be bonded with each other and relative to each other rotation slidably.Upper and lower keeper ring 25,26 respectively, can be bonded with each other in the various suitable mode of relative to each other rotating keeper ring 25,26.For example, upper and lower keeper ring 25,26, respectively, the interlocking groove that can be included in its interface rotates to allow keeper ring 25,26 to slide.The slip rotation relative to each other of upper and lower keeper ring can by towards or move top keeper ring handle 27 and/or bottom keeper ring handle 28 is realized away from another handle 27,28.

Bottom keeper ring 26 comprises the retractor parts guiding channel 22 (not being shown in Figure 19 A-19B) that is used for eachretractor parts arm 20, as is shown in Fig. 1-3 and 6.In the embodiment of Figure 19 A-19B, bottom keeper ring 26 comprise be arranged in each guidingchannel 22 top and with the parallel bottom keeper ring slit 34 of its longitudinal axis (view of taking apart at the keeper ring 25,26 of Figure 19 B illustrates best).Eachretractor parts arm 20 comprises thespike dowel 35 that upwards runs through the bottom keeper ring slit 34 that is positioned at theseretractor parts arm 20 tops fromretractor parts arm 20 with basic an angle of 90 degrees degree.Each retractor parts armspike dowel 35 can be at it by moving in the bottom keeper ring slit 34 of its extension.Promptly, whenretractor parts arm 20 by itsrespective guide passage 22 outwards and when moving inward, in the moving direction of retractor parts armspike dowel 35 and distance and the bottom keeper ring slit 34 ofretractor parts arm 20 above this guidingchannel 22 outwards or the direction that moves inward identical with distance.

Top keeper ring 25 comprises the top keeper ring slit 36 that is positioned at each keeper ring slit 34 top, bottom.The center of each top keeper ring slit 36 roughly is positioned at the top at the center of the bottom keeper ring slit 34 below it.Each the retractor parts armspike dowel 35 that runs through its corresponding bottom keeper ring slit 34 upwards runs through the top keeper ring slit 36 that is positioned at keeper ring slit 34 tops, bottom.Thereby each top keeper ring slit 36 with respect to bottom keeper ring slit 34 directional inclinations below it when upper and lower keeper ring handle 27,28, respectively, when relative to each other mobile, top keeper ring slit 36 is pressed to thespike dowel 35 that runs throughslit 34,36, makesspike dowel 35 according to the direction of motion of handle 27,28 outwards or move inward.Retractor parts arm 20 can outwards and/or move inward required amount with theretractor parts 14 that are attached thereto in thisway.Retractor parts 14 motion radially outward in this way makes surrounding tissue bounce back, to form the operation access road that allows immediate access and observation operative site in theretractor parts 14 that outwards move.

An embodiment withsurgical access device 10 of the upper and lower keeper ring 25,26 that can be slidably engaged respectively can comprise the suitable mechanism that is used for keeper ring 25,26 is fixed to desired location.For example, thus keeper ring 25,26 can comprise and can be threaded into the wheel lock (not being shown in Figure 19 A-19B) that is similar to wheel lock 23 (as being shown in Fig. 1-4) that contacts bottom keeper ring 26 adjustably by the wheel in the top keeper ring 25 lock guiding piece 24.Wheel lock 23 can be rotated down to apply motion restriction power between other upper and lower keeper ring 25,26 of branch, so that keeper ring 25,26 is fixed in the desired location.Correspondingly, thus keeper ring 25,26 can be fixed in the primary importance that comprises firstsectional dimension 17 and comprise secondsectional dimension 18 fixingretractor parts 14 in the second position at least.Similarly, thus thewheel lock 23 motion restriction power keeper rings 25,26 that can rotate up to be released between the keeper ring 25,26 can relative to each other move.Other suitable fixed mechanism can be used to keeper ring 25,26 is fixed in the desired location.

In the embodiment that is shown in Figure 19 A-19B, top keeper ring slit 35 tilts with respect to bottom keeper ring slit 34 with miter angle degree roughly.In other embodiments, thereby top keeper ring slit 36 can tilt when upper and lower keeper ring handle 27,28 with various degree, respectively, when relative to each other mobile, makesspike dowel 35 outwards and/or move inward.

In alternate embodiments, top keeper ring 25 can remove from bottom keeper ring 26.The embodiment that is shown in Figure 19 A-19B comprises the top keeper ring slit 36 that is used for each retractor parts arm 20.Top keeper ring 25 can be from the embodiment that bottom keeper ring 26 removes in the (not shown) therein, and top keeper ring 25 can comprise the number slit 36 still less than retractor parts arm 20.For example, once only moveretractor parts 14 if desired, then top keeper ring 25 can comprise only slit 36.In this way, in case pass through relative to each other mobile upper and lower keeper ring handle 27,28, respectively, and thefirst retractor parts 14 are moved to desired location (perhaps outside or inside), then top keeper ring 25 can be removed from bottom keeper ring 26.Second slit 34 and thespike dowel 35 of bottom keeper ring 26 top keeper ring slits 36 aligned with lower keeper rings thereby top keeper ring 25 can be rejoined.Then, handle 27,28 can relative to each other move so that thesecond retractor parts 14 are moved to desired location.These steps can repeat to moveother retractor parts 14 as required.Be independent of mobile eachother retractor parts 14 and allow to form operation access road with various structures.

Figure 20 A-20C illustrates and is used atsurgical access device 10 radially outward and another embodiment of the mechanism of upcountry mobile retractor parts 14.In this modification ofsurgical access device 10,keeper ring 21 comprises the keeper ring slit 36 that is positioned at eachretractor parts arm 14top.Keeper ring 21 can be with respect to 22 rotations (as being shown in Fig. 1-4) of retractor parts guiding channel.For example,keeper ring 21 can comprise two interface component, comprises the upper component of keeper ring slit 36 and the lower member of guidingchannel 22 wherein is set.Upper and lower member (can be similar to upper and lower keeper ring 25,26, respectively, shown in Figure 19 A-19B) can be engaged with each other in the various suitable mode that is used for relative to each other rotating the upper and lower member.For example, the upper and lower member can be included in interlocking groove in its interface to allow the rotation of relative to each other sliding of upper and lower member.In such an embodiment, the slip rotation relative to each other of upper and lower keeper ring element can realize by the rotation upper component.

Eachretractor parts arm 20 comprises thespike dowel 35 that upwards runs through the keeper ring slit 36 that is positioned atretractor parts arm 20 tops with basic an angle of 90 degrees degree from retractor parts arm 20.Each retractor parts armspike dowel 35 can be at it by moving in the keeper ring slit 36 of its extension.Promptly, whenretractor parts arm 20 by its corresponding guidingchannel 22 outwards and when moving inward, moving direction outside or inside in the moving direction of retractor parts armspike dowel 35 and distance and the keeper ring slit 36 ofretractor parts arm 20 above this guidingchannel 22 is identical with distance.

Each keeper ring slit 36 is with respect to the directional inclination of the guidingchannel 22 below it.In the embodiment that is shown in Figure 20 A-20C, keeper ring slit 36 comprises bowed shape, and its each center roughly is positioned at the top at the center of the guidingchannel 22 below it.In this way, whenkeeper ring 21 rotation, keeper ring slit 36 is pressed to thespike dowel 35 that runs throughslit 36, makesspike dowel 35 according to direction of rotation outwards or move inward.Correspondingly,retractor parts arm 20 can outwards and/or move inward aequum with theretractor parts 14 that are attached thereto.The radially outer in this way motion ofretractor parts 14 makes surrounding tissue bounce back, thereby forms the operation access road that allows immediate access and observation operative site in theretractor parts 14 that outwards move.

This embodiment can comprise the suitable mechanism that is used forretractor parts 14 are fixed to desired location.For example,keeper ring 21 can comprise the wheel lock (not being shown in Figure 20 A-20C) that is similar to wheel lock 23 (as being shown in Fig. 1-4) that can be threaded into theretractor parts arm 20 belowcontact wheel lock 23 adjustably by the wheellock guiding piece 24 that runs throughkeeper ring 21, as described in reference to figure 1-4.

Keeper ring slit 36 is illustrated in the position sequence that is shown in Figure 20 A-20C with respect to the motion of spike dowel 35 and the relevant motion of retractor parts arm 20 and retractor parts 14.In Figure 20 A, retractor parts 14 are shown in the closed position, and spike dowel 35 is attached to the retractor parts arm 20 of the inside of contiguous keeper ring slit 36.From this closed position, keeper ring 21 can rotate with respect to guiding channel 22, thereby retractor parts 14 move to first open position (as being shown in Figure 20 B).In this first open position, be attached to the center of the spike dowel 35 of retractor parts arm 20 near keeper ring slit 36.Keeper ring 21 can be further rotated with respect to guiding channel 22, thereby retractor parts 14 move to second open position (as being shown in Figure 20 C), and this position is abundant open position in this case.When retractor parts 14 were in abundant open position, the spike dowel 35 that is attached to retractor parts arm 20 was positioned to the outside of contiguous keeper ring slit 36.Keeper ring 21 with respect to guiding channel 22 such rotatablely move be illustrated in Figure 20 A-20C in the relevant radial motion of retractor parts 14 be similar to rotatablely moving of the adjustment ring that can cover and expose camera gun.Retractor parts 14 can radially outward and be moved in fully closed position and the fully position of any number between the open position.

The number ofretractor parts 14,retractor parts arm 20 and keeper ring slit 36 can change.Embodiment among Figure 20 A-20C comprises sixretractor parts 14 and theretractor parts arm 20 that is connected, and six keeper ring slits 36 (eachretractor parts arm 20 uses aslit 36).(for simplicity, in Figure 20 A-20C, only mark in each ofretractor parts 14,retractor parts arm 20 and keeper ring slit 36 two.)

In one embodiment of the invention, surgical access device 10 can be included in retraction tissue and for example be attached to retractor parts 14 by what outwards moving of retractor parts 14 provided barrier between the operation access road that forms, as is shown in the material 39 of Figure 20 A-20C.In one embodiment, material 39 can be the solid tubular material that place the outside of the retractor parts 14 in the closed position, and for example, thin polymer elasticity material is latex for example, shown in Figure 20 A.For example, by utilizing radio frequency or package sealing with laser or utilizing other suitable mechanism that material 39 is sealed to retractor parts 14, material 39 can be coupled to the outside of retractor parts 14.In alternate embodiments, material 39 can be the sheet material that contiguous retractor parts 14 connect, for example polymer elasticity material sheet.Barrier material 39 can be bound up between two retractor parts 14 at least.Alternately, barrier material 39 can be bound up on each between the adjacent retractor parts 14.When retractor parts 14 outwards move, as be shown in Figure 20 B and 20C, when forming the operation access road, material 39 (perhaps tubulose or sheet form) outwards stretches to provide barrier between retraction tissue and operation access road.This barrier can help to provide and keep unimpeded passage so that immediate access and observation operative site.

In another embodiment,surgical access device 10 can comprise the mechanism that is used for radially outward and movesinward retractor parts 14 that is illustrated among Figure 21.In this embodiment, eachretractor parts 14 is connected to threaded retractor parts arm 29.Thereby threadedretractor parts arm 29 is connected toretractor parts 14 threadedretractor parts arms 29 can rotate (for example around rotatable pivoting articulation) at the junction point place with retractor parts 14.That is, whenretractor parts 14 did not rotate, threadedretractor parts arm 29 can rotate.Each threaded retractor parts arm 29 screws in and is similar to the having in the threaded ordinatedly retractor parts guiding channel (not shown) of the retractorparts guiding channel 22 that is shown in Fig. 1-3 and 6.Thereby each threadedretractor parts arm 29 also can pass theend 38 ofrunner 37 threadedretractor parts arms 29 of the outside ofcontiguous keeper ring 21 runs throughrunner 37.

Runner 37 can be attached to threadedretractor parts arm 29 securely or can be rotated around threaded retractor parts arm 29.Runner 37 is attached among the embodiment of threadedretractor parts arm 29 securely therein, is used for outwards can comprisingrunner 37 and threadedretractor parts arm 29 with the mechanism that moves inward retractor parts 14.Runner 37 can rotate to rotate threadedretractor parts arm 29 so that radially outward and/orupcountry transfer arm 29 is by threaded retractor parts guiding channel, and thefeasible retractor parts 14 that connect radially outward and/or upcountry move.

Whenretractor parts 14 are in desired location, for example, when helping to form secondsectional dimension 18,retractor parts 14 can be fixed in this position in the position of retraction tissue.Threadedretractor parts arm 29 and theretractor parts 14 that connect can utilize various suitable mechanisms to be fixed in the desired location.For example, thuskeeper ring 21 can comprise and be similar to the wheel lock (not being shown in Figure 21) that can screw in wheel lock 23 (as being shown in Fig. 1-4) that contact threadedretractor parts arm 29 adjustably by the wheel in thekeeper ring 21 lock guiding piece 24.Wheel lock 23 can be rotated down to apply motion restriction power to threadedretractor parts arm 29 and be fixed in the desired location with theretractor parts 14 with threadedretractor parts arm 29 and connection.Similarly, thuswheel lock 23 can rotate up with release action and can move to the another location to the threaded retractor parts of the motionrestriction power arm 29 of threadedretractor parts arm 29 and theretractor parts 14 of connection.

Runner 37 can be in the embodiment of threaded retractor parts arm 29 rotations therein, threadedretractor parts arm 29 can rotate withoutside transfer arm 29 and pass through threaded retractor parts guiding channel, makes theretractor parts 14 that connect outwardsmove.Runner 37 can be accommodated to the outer surface ofkeeper ring 21 then around threaded retractor parts arm 29 rotations until runner 37.In this way, thusrunner 37 can be used as the mechanism that is used for threadedretractor parts arm 29 andretractor parts 14 are fixed on desired location realizes immediate access and object observing operative site to keep the tissue retraction.

Eachretractor parts 14 all has among the embodiment of the threadedretractor parts arm 29 that rotatably is attached thereto therein, and eachretractor parts 14 can be independent ofother retractor parts 14 outwards and move inward.Therefore this embodiment provides operating flexibility to allow bouncing back that thereby tissue forms and maintenance has the operation access road of unsymmetrical section in non-homogeneous mode.In an illustrative application, the spinous process thatsurgical access device 10 can be close to vertebral body inserts in patient's body, may need to limit the motion of tissue towards spinous process herein.Thereby the operator can radially outward move in theretractor parts 14 of the embodiment that is shown in Figure 21 three along these three directions retraction tissues, yet theretractor parts 14 that keep contiguous spinous process are in its initial inwardly position.In this way, can be close to spinous process immediately forms the Minimally Invasive Surgery access road and need not towards spinous process tissue displacement.

The embodiment ofsurgical access device 10 of the present invention can comprise mechanism and/or the interface that is used to illuminate operative site.As be shown among the embodiment of Fig. 8-9, the mechanism that is used to illuminate operative site can compriserotatable arm 50 that rotatably is installed tokeeper ring 21 and theinsertion parts 51 that is attached to the bending of rotatable arm 50.Rotatable arm 50 can rotatably be installed to thepivot 52 in the rotatablearm support member 53 on the keeper ring 21.Crooked insertion parts 51 can be the flex socket that has pointed tip and be attached to the far-end of rotatable arm 50.Light source 60 can be coupled to or be integrated in the distal part top of crooked insertion parts 51.Light source 60 can be any suitable light source that is used to illuminate operative site, comprises, for example optical fiber source.In the traditional operation technology, the light source that is independent of the retraction apparatus by insertion makes it to illuminate operative site by the operation access road.In this method, light source may and/or be observed operative site at intra-operative influence inlet.

As be shown among the embodiment of Fig. 9, thereby can being rotated down crookedintubate parts 51,rotatable arm 50 will pass skin and hypodermis layer via the secondary puncture path that is independent of the operation access road.In this way, the insertion of the percutaneous ofinsertion parts 51 allows thelight source 60 of the distal part top end ofcrooked insertion parts 51 to be located in required orientation at the periphery place of operative site.Crooked insertion parts 51 is percutaneously inserted androtatable arm 50 arrives precalculated positions thereby the length of theintubate parts 51 of the length ofrotatable arm 50 and bending and curvature can scheduledly be worked as, for example become with the longitudinal axis ofelongated member 11 when roughly an angle of 90 degrees is spent, the top ofcrooked insertion parts 51 is accurately positioned in required orientation at operative site periphery place.Therebycrooked insertion parts 51 can have the different length ofelongated member 11 of theretractor parts 14 that are used to have different size and curvature when being inserted into, and operative site can be aimed in the top of crooked insertion parts 51.Light source 60 in thecrooked insertion parts 51 can provide then not to be influenced the operative doctor inlet and/or observes this position the illumination of operative site.

In another embodiment, as be shown in Figure 10-11, the mechanism that is used to illuminate operative site insurgical access device 10 of the present invention can comprise straight intubate, and perhaps parts 70.Straight intubateparts 70 can have sharp-pointed distal part top and be attached to or be integrated in thelight source 60 of this distal part topend.Keeper ring 21 can comprise and be used to hold and guide the straight cutting that percutaneously inserts to go into theguide groove 71 of parts 70.In one embodiment,keeper ring 21 can have the outward extendingarm 72 of side direction in the plane of keeper ring21.Guide groove 71 can be included in thekeeper ring arm 72, as is shown in Figure 10-11.Guide groove 71 can have and is used for straight cutting is gone into the predetermined angle thatparts 70 are directed to operative site.Straight cuttingduct member 70 can be conducted throughguide groove 71 and percutaneously pass skin and hypodermis layer via the secondary puncture path that is independent of the operation access road and insert, thereby straight cutting is gone into thelight source 60 of the top end ofparts 70 and can be located in required orientation at the periphery place of operative site.

Keeper ring arm 72 can comprise one ormore guide grooves 71, goes into the periphery thatparts 70 can be directed into operative site at the far-end of theretractor parts 14 with length-specific thereby eachguide groove 71 has the certain angle straight cutting.Eachguide groove 71 can have different angles straight cutting is gone into the accurate orientation thatparts 70 are directed to surgical site, and its inlet is realized by theelongated member 11 and theretractor parts 14 of different length.In one embodiment,keeper ring 21 can comprise one or more keeper ring arms 72.Eachkeeper ring arm 72 can comprise the differently guidegroove 71 of inclination.Alternately, each a plurality ofguide groove 71 with different angles can be included in each keeper ring arm 72.Keeper ring 21 and/orkeeper ring arm 72 can comprise theelongated member 11 of each length that is used for using thiskeeper ring 21 and theguide groove 71 that differently tilts of retractor parts 14.In one embodiment,keeper ring 21 can be with acting on for example assembly ground of cutting tool or photographing unit of other surgical unit adnexa.

Straight cutting is gone intoparts 70 can compriseinsertion guiding piece 73, and for example labelling is gone intoparts 70 have been advancedpast guide groove 71 towards operative site distance with the signal straight cutting.In one embodiment, inserting guidingpiece 73 can be to be used for stopping to advance straight cutting to go into the mechanism ofparts 70 byguide groove 71, for example lasso (not shown) at the selected element place of the length of going intoparts 70 along straight cutting.Thereby insert guidingpiece 73 can be positioned at straight cutting go on theparts 70 when top that straight cutting is gone intoparts 70 when the operative site periphery accurately is positioned at place, required orientation,insertion guiding piece 73 can be aimed at the top surface or thearm 72 of keeper ring 21.Insert guiding piece 73 for example straight cutting go into labelling on theparts 70 and lasso and can help operative doctor to be identified for inserting straight cutting to go intoparts 70 and be used for straight cutting being gone into the distal part top ofparts 70 and the suitable distance thatlight source 60 is positioned at place, required orientation in surgical site towards operative site.

In another embodiment, the mechanism that is used to illuminate operative site insurgical access device 10 of the present invention can be included in thelight source 60 at one or more far-ends 13 places of a plurality of retractor parts 14.Light source can be, for example light emitting diode (LED), optical fiber source or be used to illuminate any suitable light source of operative site.In another embodiment, as be shown in Figure 12,keeper ring 21 can comprise one or moresecondary retractor parts 80, and each is positioned between the contiguous retractor parts 14.In such an embodiment, the mechanism that is used to illuminate operative site can comprise thelight source 60 of one or more far-end of secondary retractor parts 80.Embodiment at thelight source 60 of the far-end ofsecondary retractor parts 80 is shown among Figure 13.Light source 60 inmain retractor parts 14 orsecondary retractor parts 80 for example optical fiber source can be by the battery in theretractor parts 14,80 or viaconnection 81 power supplies that arrive external power source.Can provide from the position periphery at thelight source 60 at main far-endsretractor parts 14 orsecondary retractor parts 80 13 places does not influence inlet and/or observes this position the illumination of operative site.

In one embodiment, whenmain retractor parts 14 were radially outward mobile,secondary retractor parts 80 also can radially outward move.Alternately, aftermain retractor parts 14 were radially outward moved,secondary retractor parts 80 can pass guide groove or the carriage (not shown) in thekeeper ring 21 between retractor parts guiding channel 22.In case be in the position of the contiguousmain retractor parts 14 that outwards move, as be shown in Figure 12, outwards localizedsecondary retractor parts 80 can provide other retraction surface and provide enhanced stability to the operation access road thus by the tissue in remaining in advanced position.

In another embodiment, as be shown in Figure 14,surgical access device 10 of the present invention also can comprise and be used for being stablized the stabilizing mechanism ofretractor parts 14 after radially outward moving.Stabilizing mechanism can comprise can be inretractor parts 14 and along the localized stabilizingring 90 of its length.But incase retractor parts 14 for example radially outward moved by expansion as the expandedbody 40 that is shown among Fig. 4, but and expandedbody 40 shrink and be removed, stabilizingring 90 can passkeeper ring 21 in retractor parts 14.Preferably, stabilizingring 90 can be positioned adjacent to the far-end 13 of retractor parts 14.Stabilizingring 90 can provide rigid support to theinner surface 15 ofretractor parts 14 so that keep tissue to be in the advancedposition.Stabilizing ring 90 can have various sizes with to being in various outside shift positions for example corresponding to second, more theretractor parts 14 in the position of heavy insection size 18 provide the rigidity retraction to support.

As be shown in Figure 15 A and 15B, in such an embodiment, the mechanism that is used for illuminating operative site can comprise thelight source 60 of stabilizing ring 90.Light source 60 can connect 81 by power supply and be connected to external power source.Alternately, power supply for example battery can be housed inside in the stabilizing ring 90.Light source 60 can provide light along distal direction to illuminate the major part of operative site from the far-end of stabilizing ring 90.Alternately, as be shown in Figure 15 B, concentrate light, perhaps " aura ring " effect in operative site formation therebylight source 60 can provide from the inside light of the inner surface of stabilizing ring 90.In one embodiment, the light source in stabilizingring 90 60 can provide the light distad of broad pattern and towards the concentrated light at operative site center.The mechanism that is used for illuminating operative site therein comprises among the embodiment oflight source 60 of stabilizingring 90, can realize illuminating operative site and not influencing inlet and/or observe this position from the position periphery.

In another embodiment, be used to illuminate the mechanism of operative site and/or thelight source 60 that interface can comprise the inward flange of close keeper ring 21.This embodiment is illustrated among Figure 16-17, and whereinretractor parts 14 are shown in the position of outwardsmoving.Keeper ring 21 can comprise one or more recesses 91 (four shown in Figure 17) on the bottom side of keeper ring 21.Each recess 91 can and can holdlight source 60 between contiguous retractor parts 14.In one embodiment,light source 60 can connect near the inward flange ofkeeper ring 21 and not be housed inside in the recess 91.Eachlight source 60 can be directed to for example illumination in different quadrants in the zones of different that is provided at operative site.Light can be towards the centre convergence of operative site.The mechanism that is used for illuminating operative site therein comprises among the embodiment oflight source 60 ofkeeper ring 21, can realize illuminating operative site and not influencing inlet and/or observe this position from the position periphery.

Light source 60 can be any suitable light source, for example light emitting diode (LED).Led light source, optical fiber source and/or can be used for other light source in the embodiment of the invention can be included in theconnection 81 of power supply and electronic component (not shown) with power supply, start and regulate light source.Alternately, power supply for example battery can be housed inside in the ad hoc structure ofsurgical access device 10.

Some embodiments of the present invention provide the advantage that is better than traditional operation inlet apparatus and technology.For example, use the embodiment of apparatus of the present invention, system, external member and/or method to form and the access road that keeps performing the operation so that immediate access and/or the observation to operative site to be provided.In such an embodiment, having scope is that about 3/4 inch operation access road to about 11/4 inch diameter is possible.Compare with the inlet inlet that is provided by traditional Minimally Invasive Surgery method, this operation access road size is the improvement aspect the direct sight line amount of operative site.Be better than this bigger operation access road, can under to the direct observation of operative site, use a plurality of surgical units simultaneously.This instrument comprises for example controlled instrument, resectoscope, dissector, shears, tweezers, retractor, dilator, endoscopic surgery instrument and camera.

Some embodiments of the present invention can allow operative doctor use than traditional method still less instrument and form and keep direct observation operation access road with the shorter time.Traditional method may require to use a plurality of dilators and/or retractor.For example, tissue expander may require to insert the constantly big a plurality of dilators of change of diameter have the retractor of carrying out the operative procedure required size in the zone in vivo and instrument with insertion before in that the operation access road is enough big.In addition, it may be huge, heavy that tradition is organized retractor, and is difficult to remain on given position.In one embodiment of the invention,retractor parts 14 can outwards move at the one-step process of tissue expander gradually and be fixed on place, various orientation along the continuous sectional dimension of the access road that is used to perform the operation.As be shown among the embodiment of Fig. 1-4, the scope of area of section can be included in firstsectional dimension 17 of closingchamber 16 ofelongated member 11 to any sectional dimension or area between the sectional dimension of the internal diameter that equalskeeper ring 21.

For example, if the operation access road of 1/2nd inch diameters is enough, then the retractor parts 14 that operative doctor can radially outward mobile elongated member 11 are to form 1/2nd inches cross-sectional passage.The operation access road of an inch diameter if desired, then operative doctor can continue the retractor parts 14 of radially outward mobile elongated member 11 to form one inch cross-sectional passage.In this way, the operation access road that can use same instruments to form to have the different cross section size need not process more consuming time, labour-intensive and that equipment is intensive thus.Therefore, can be along the continuous size that is not subjected to for example fixed dimension restriction of expanded casing from a plurality of a series of sectional dimensions that the operation access road is provided with the different size of cumulative mode.Therefore, compare with other installing that is used to enter the mouth with the branch that is used to bounce back that is used for traditional instruments and technology, in an embodiment of the present invention, separately surgical access device 10 can along from the health outside to the passage at operation position be used to enter the mouth operative site and retraction tissue.For the Minimally Invasive Surgery program, utilize still less instrument in shorter time, realizes the ability of the immediate access of this use of operation access road and raising and/or observation operative site can cause still less operation risk and lower cost.

By move theretractor parts 14 ofelongated member 11 with various amounts, the size of operation access road can be customized according to each patient's operative site.During tissue retraction, when particular organization when for example muscle begins excessively to be stretched, operative doctor can be felt.Therefore, the operation access road of the customization that is provided by the embodiment of the invention allows operative doctor that muscle and other tissue are caused lighter wound.As a result, the risk of the potential complication of operative procedure for example infects with blood loss and can be lowered.Correspondingly, postoperative discomfort, healing time and hospital stays can be reduced.

In some embodiments of the invention, the motion of retractor parts 14 can change.In one embodiment, each retractor parts 14 can radially outward move from its original closed position that forms the chamber 16 of elongated member 11.In another embodiment, each retractor parts 14 can side by side radially outward move.In yet another embodiment, one or more retractor parts 14 can radially outward move more or less than other retractor parts 14.For example, in the illustrative examples of surgical access device 10 with four retractor parts 14, as be shown in Fig. 1-7, two relative retractor parts 14 and can radially outward move to primary importance, for example arrive between these first pair of retractor parts 14 1/2nd inches size place.Two relative retractor parts 14 can radially outward move to the second position in addition, for example, arrive one inch size place between these second pair of retractor parts 14.Like this, can provide operation access road with avette or elliptic cross-section structure.In one embodiment, the operation access road that is formed by surgical access device 10 according to the present invention can comprise the far-end 13 substantially invariable sectional dimensions from the near-end 12 of the elongated member 11 of health outside to the elongated member 11 at operation position.In such an embodiment, can form operation access road with various noncircular cross section structures.In this way, operative doctor can form the operation access road according to the size and dimension customization of operative site.Operation access road based on the size and dimension of each needs of patients allows operative doctor at the less tissue of intra-operative damage, therefore reduces postoperative complication and for example infects risk with blood loss, and alleviate and do not accommodate healing time.

In one embodiment of the invention, the retraction degree that is provided bysurgical access device 10 can be different for different organized layers.For example,retractor parts 14 can be from the closed position radially outward move to arrive and are used for first of skin and open sectional dimension, arrival is used at least the second of fatty tissue and opens sectional dimension, and arrive the access road that is used for performing the operation remaining tissue at least the three open sectional dimension.This transmutability of tissue retraction can easy to usely be different from available those the operation inlet method of traditional instruments and method.

Some embodiments of the present invention can comprise to be avoided via operation access road immediate access and/or observe the mechanism that is used to illuminate operative site that operative site causes obstruction.Therefore, the embodiment ofsurgical access device 10 of the present invention, system, external member and method be can utilize and independent observation element for example optical instrument such as endoscope need not.Compare with the traditional method of Minimally Invasive Surgery inlet, avoid using independent observation element can provide the direct more accurately observation of operative site and other advantage that reduces cost.

The present invention includes and can be used for forming and be kept for performing the operation or the embodiment of the system of the operation access road of people or other treatment of animal.The embodiment of this system can compriseelongated member 11, this elongated member comprise in situ (that is after, in elongated member has been located in patient's body) from firstsectional dimension 17 radially outward move at least the second, a plurality ofretractor parts 14 of heavy insection size 18 more.This system also can comprise mechanism and/or the interface that is used for radially outward mobile retractor parts 14.This system also can comprise and is used for guiding the mechanism and/or the interface of motion radially outward ofretractor parts 14 and mechanism and/or the interface that is used for fixing in a series of positions each retractor parts 14.This system also can comprise mechanism and/or the interface that is used for from the health outsideelongated member 11 being inserted operative site.This system also can comprise mechanism and/or the interface that is used to illuminate operative site.

In the illustrative examples of this system, each of a plurality ofretractor parts 14 ofelongated member 11 has as being shown in theinner surface 15 that Fig. 2 forms thechamber 16 ofelongated member 11 together.Closechamber 16 and have first sectional dimension 17.Eachretractor parts 14 can radially outward move at least the second from firstsectional dimension 17 of closingchamber 16, more heavy insection size 18 to be to be used to form the operation access road.In one embodiment, secondsectional dimension 18 can be from the health outside to operation position substantially constant the near-end 12 ofelongated member 11 and far-end 13.In the operation access road that is formed by this system, this passage can hold instrument and allow immediate access and/or observe operative site.

Be used to guide the mechanism of motion radially outward ofretractor parts 14 can comprise thekeeper ring 21 that has a plurality of retractorparts guiding channels 22 and be configured at near-end 12 places of a plurality ofretractor parts 14 and settle with one heart with it.Eachretractor parts 14 can have with the near-end 12 outward extendingretractor parts arms 20 of basic an angle of 90 degrees degree fromretractor parts 14, thereby eachretractor parts arm 20 can slide in a guiding channel 22.The mechanism that is used for fixing eachretractor parts 14 can comprise by thewheel lock 23 in the lock of the wheel in thekeeper ring 21 guidingpiece 24 each keeperparts guiding channel 22 of screw-in.Wheel lock 23 can form adjustable the contact to be used at this guidingchannel 22keeper parts 14 fix in position with keeper parts arm 20.Eachretractor parts 14 can be fixed in a series of positions, comprises primary importance with firstsectional dimension 17, has the second position of secondsectional dimension 18 and a plurality of select locations between it.

In an embodiment of system, be used for to comprise tool slightly pointedterminal 32 and thestylet 30 that runs through thethread eye 33 ofstylet 30 from the health outside to the mechanism of operation position insertion elongatedmember 11.Stylet 30 can be inserted in thechamber 16 to be used on seal wire elongatedmember 11 being directed to operative site.

In an embodiment of this system, the mechanism that is used for radially outward mobile retractor parts can be inserted intochamber 16 and activated to apply the active force radially outward of mobile retractor parts 14.In one embodiment, but the mechanism that is used for radially outwardmobile retractor parts 14 comprises expanded body 40.In alternate embodiments, the mechanism that is used for radially outward mobile retractor parts can be mechanical mechanism or hydraulic mechanism.

The operation access road that forms bymobile retractor parts 14 radially outward in this system can comprise the sectional dimension in a series of sectional dimensions.This a series of sectional dimension can comprisechamber 16 firstsectional dimension 17, equal the sectional dimension and any sectional dimension between these two sizes of the internal diameter of keeper ring 21.For example, operation access road sectional dimension can have scope be about 3/4 inch to about 1 1/4 inches diameter.In one embodiment, operation access road sectional dimension can have less than 3/4 inch or greater than 11/4 inch diameter.In one embodiment, one ormore retractor parts 14 can radially outward move more or less than other retractor parts 14.In this way, can form the operation access road of sectional dimension with noncircular cross section structure.

In an embodiment of system, as be shown in Fig. 8-9, the mechanism that is used to illuminate operative site can compriserotatable arm 50 that rotatably is installed tokeeper ring 21 and thecrooked insertion parts 51 that is attached to rotatable arm 50.Light source 60 can be coupled to or be integrated in the distal part top of crooked insertion parts 51.Thereby thelight source 60 thatcrooked insertion parts 51 can percutaneously be inserted the distal part top end ofcrooked insertion parts 51 can be located in place, required orientation at the operative site periphery.

In an embodiment of system, as be shown in Figure 10-11,keeper ring 21 can comprise thekeeper ring arm 72 that laterally extends and have theinclined guide groove 71arm 72 from keeper ring 21.The mechanism that is used to illuminate operative site can comprise having and is attached to or is integrated in straight cutting and go into the straight cutting of the verticallight source 60 of distal part ofparts 70 and go into parts 70.Thereby straight cutting is gone intoparts 70 and can be passedguide groove 71light sources 60 and can be located in place, required orientation at the operative site periphery by guiding percutaneously.Straight cutting is gone intoparts 70 and can be comprised labelling 73 or be used to illustrateinsertion parts 70 by other mechanism of the distance of inserting towards operative site with respect to guide groove 71.Distal part top andlight source 60 that thisinsertion guiding piece 73 can help operative doctor at the operative site periphery straight cutting to be gone intoparts 70 are positioned at place, required orientation.

In another embodiment of system, as be shown in Figure 12-13, the mechanism that is used to illuminate operative site can comprise and being positioned at or near thelight source 60 of the far-end 13 of one or more retractor parts 14.In another embodiment, as be shown in Figure 16-17, the mechanism that is used to illuminate operative site can comprise thelight source 60 near the inward flange ofkeeper ring 21.

This system also can comprise and is used for the mechanism that stablizedretractor parts 14 when radially outward mobile when retractor parts 14.This stabilizing mechanism can for example be the stabilizingring 90 as being shown in Figure 14,15A and 15B.In such an embodiment, the mechanism that is used for illuminating operative site can comprise thelight source 60 of stabilizingring 90.

The present invention comprise comprise be used to form and be kept for to perform the operation or the operation access road of people or other treatment of animal, as the embodiment of the external member of thesurgical access device 10 here described.The embodiment of this external member can compriseelongated member 11, and this elongated member comprises radially outward move at least the second from firstsectional dimension 17 after can be inelongated member 11 has been located in patient's body, more a plurality ofretractor parts 14 of heavy in section size 18.This external member also can comprise the mechanism that is used for radially outward mobile retractor parts 14.This external member also can comprise the mechanism that is used for guiding the mechanism that radially outward moves ofretractor parts 14 and is used for fixing in a series of positions each retractor parts 14.This external member also can comprise and being used for from the health outside to the mechanism of operation position insertion elongated member 11.This external member also can comprise the mechanism that is used to illuminate operative site.

In certain embodiments, external member can comprise the various combinations of these and/or other element.For example, in one embodiment, external member can compriseelongated member 11, be used for radially outwardmobile retractor parts 14 mechanism, be used to guide the mechanism that radially outward moves ofretractor parts 14 and be used in a series of positions the fixedly mechanism of retractor parts 14.In this embodiment, this external member can comprise or can not comprise and is used for from the health outside mechanism that insertselongated member 14 to the operation position.For example, if preferably the member of this external member is reusable, thendisposable stylet 30 can be set individually except being used for thestylet 30 from the health outside to operation position insertion elongated member 11.In another embodiment, this external member can comprise a plurality of or alternative mechanism that is used to illuminate operative site.

In the illustrative examples of this external member, each of a plurality ofretractor parts 14 ofelongated member 11 has as being shown in Fig. 2, forms theinner surface 15 in thechamber 16 ofelongated member 11 together.Closechamber 16 and have first sectional dimension 17.Eachretractor parts 14 can radially outward move at least the second from firstsectional dimension 17 of closingchamber 16, more heavy insection size 18 to be to be used to form the operation access road.In one embodiment, secondsectional dimension 18 can be from the health outside to operation position substantially constant the near-end 12 ofelongated member 11 and far-end 13.In the operation access road that is formed by the surgical access device in thisexternal member 10, this passage can hold instrument and allow immediate access and/or observe operative site.

In an embodiment of external member, be used to guide the mechanism of motion radially outward ofretractor parts 14 can comprise having a plurality of retractorparts guiding channels 22 and be configured at near-end 12 places of a plurality ofretractor parts 14 and the keeper ring of settling with one heart with a plurality ofretractor parts 14 21.Eachretractor parts 14 can have with the near-end 12 outward extendingretractor parts arms 20 of basic an angle of 90 degrees degree fromretractor parts 14, thereby eachretractor parts arm 20 can slide in a guiding channel 22.The mechanism that is used for fixing eachretractor parts 14 can comprise by thewheel lock 23 in the lock of the wheel in thekeeper ring 21 guidingpiece 24 each keeperparts guiding channel 22 of screw-in.Wheel lock 23 can form adjustable the contact to be used at this guidingchannel 22keeper parts 14 fix in position with keeper parts arm 20.Eachretractor parts 14 can be fixed in a series of positions, comprises primary importance with firstsectional dimension 17, has the second position of secondsectional dimension 18 and a plurality of select locations between it.

In an embodiment of external member, be used for to comprise tool slightly pointedterminal 32 and thestylet 30 that runs through thethread eye 33 ofstylet 30 from the health outside to the mechanism of operation position insertion elongatedmember 11.Stylet 30 can be inserted in thechamber 16 to be used on seal wire elongatedmember 11 being directed to operative site.

In an embodiment of external member, the mechanism that is used for radially outwardmobile retractor parts 14 can be inserted intochamber 16 and activated to apply the active force radially outward of mobile retractor parts 14.In one embodiment, but the mechanism that is used for radially outwardmobile retractor parts 14 comprises expanded body 40.In alternate embodiments, the mechanism that is used for radially outwardmobile retractor parts 14 can be mechanical mechanism or hydraulic mechanism.

In this external member, can comprise sectional dimension in a series of sectional dimensions by the operation access road that utilizes the radially outward mobile retractor parts ofsurgical access device 10 14 to form.This a series of sectional dimension can comprisechamber 16 firstsectional dimension 17, equal the sectional dimension and any sectional dimension between these two sizes of the internal diameter of keeper ring 21.In one embodiment, one ormore retractor parts 14 can radially outward move more or less than other retractor parts 14.In this way, can form the operation access road of sectional dimension with noncircular cross section structure.

In an embodiment of external member, as be shown in Fig. 8-9, the mechanism that is used to illuminate operative site can compriserotatable arm 50 that rotatably is installed tokeeper ring 21 and thecrooked insertion parts 51 that is attached to rotatable arm 50.Light source 60 can be coupled to or be integrated in the distal part top of crooked insertion parts 51.Thereby thelight source 60 thatcrooked insertion parts 51 can percutaneously be inserted the distal part top end ofcrooked insertion parts 51 can be located in place, required orientation at the operative site periphery.

In an embodiment of external member, as be shown in Figure 10-11,keeper ring 21 can comprise thekeeper ring arm 72 that laterally extends and have theinclined guide groove 71arm 72 from keeper ring 21.The mechanism that is used to illuminate operative site can comprise having and is attached to or is integrated in straight cutting and go into the straight cutting of the verticallight source 60 of distal part ofparts 70 and go into parts 70.Thereby straight cutting is gone intoparts 70 and can be passedguide groove 71light sources 60 and can be located in place, required orientation at the operative site periphery by guiding percutaneously.Straight cutting is gone intoparts 70 and can be comprised labelling 73 or be used to illustrateinsertion parts 70 by other mechanism of the distance of inserting towards operative site with respect to guide groove 71.Distal part top andlight source 60 that thisinsertion guiding piece 73 can help operative doctor at the operative site periphery straight cutting to be gone intoparts 70 are positioned at place, required orientation.

In another embodiment of external member, as be shown in Figure 12-13, the mechanism that is used to illuminate operative site can comprise and being positioned at or near thelight source 60 of the far-end 13 of one or more retractor parts 14.In another embodiment, as be shown in Figure 16-17, the mechanism that is used to illuminate operative site can comprise thelight source 60 near the inward flange ofkeeper ring 21.

This external member also can comprise and is used for the mechanism that stablizedretractor parts 14 when radially outward mobile when retractor parts 14.This stabilizing mechanism can for example be the stabilizingring 90 as being shown in Figure 14,15A and 15B.In such an embodiment, the mechanism that is used for illuminating operative site can comprise thelight source 60 of stabilizingring 90.

Some embodiments of the present invention can comprise the method that is used to make apparatus of the present invention, system and external member.For example, surgical access device 10 of the present invention can be made by rustless steel or other surgical grade material or plastics.Member according to surgical access device 10 of the present invention, system and external member can be made by the enough intensity with execution expectation function in various operative procedure and the material of ruggedness.For example, retractor parts 14 can preferably be made with the material that separates various types of tissue plane by having sufficient intensity.All or part of can being designed to of this surgical access device 10, system and external member reuses after sterilization or can go out of use after once using.For example, in one embodiment, elongated member 11, the mechanism (for example the keeper ring 21) that is used for guiding the motion radially outward of retractor parts 14, the mechanism that is used in a series of positions the fixing mechanism of retractor parts 14 (for example the wheel lock 23) and is used to illuminate operative site can be formed into and reuse.In such an embodiment, be used for the mechanism (but for example expanded body 40) of radially outward mobile retractor parts 14 and being used for inserts elongated member 11 to the operation position from the health outside mechanism (for example stylet 30) and can be formed into disposable member.

Some embodiments of the present invention can comprise being used to form and be used to perform the operation or the method for the operation access road of the inlet operative site of people or other treatment of animal.Figure 18 illustrates the embodiment of this method 100.In such an embodiment, can provide the surgical access device of describing as here 10 (104).After in elongated member 11 has been located in patient's body, a plurality of retractor parts 14 of the elongated member 11 in this surgical access device 10 can radially outward move at least the second from first sectional dimension 17, heavy in section size 18 more.The motion of retractor parts 14 can be guided radially outwardly.This method also can be included in and fix each retractor parts 14 (112) in a series of positions.This method also can comprise the step that is used for from the health outside inserting elongated member 11 to the operation position (101-103,105-106).This method also can comprise and illuminates operative site (113).In the operation access road that is formed by this method, second sectional dimension 18 can be from the health outside to operation position substantially constant the near-end 12 of elongated member 11 and far-end 13.In the operation access road that is formed by this method, passage can hold instrument and allow immediate access and/or observe operative site.

An illustrative examples that is used to form the method for operation access road can comprise provides the elongated member 11 (104) that comprises near-end 12, far-end 13 and a plurality of retractor parts 14.Eachretractor parts 14 can have theinner surface 15 that forms thechamber 16 of theelongated member 11 with firstsectional dimension 17together.Elongated member 11 can percutaneously be inserted (105) operative site by stabbing of forming or little otch in the patient skin above target site.In case elongatedmember 11 is in the desired location of contiguous operative site, but then expandedbody 40 can insert in thechamber 16 of (107)elongated member 11 and expansion (108,109) so that each of a plurality ofretractor parts 14 is radially outward moved at least the second sectional dimension 18.But expandedbody 40 can be shunk then and remove (111) from the operation access road.

In such an embodiment, elongatedmember 11 is percutaneously inserted operative site and can comprise that also at first percutaneously inserting (102) inserts the instrument (not shown) to be provided to the insertion passage of operative site.This insertion instrument can be the small casing with pointed tip, for example, and trocar cannula.This insertion instrument can comprise thread eye and pass the seal wire (101) of thread eye.Be inserted into (102) operative site to form the insertion passage in case insert instrument, it can be removed, and stays seal wire simultaneously and is in the insertion passage (103).In one embodiment, comprise that theend 32 of point and thestylet 30 that runs through thethread eye 33 ofstylet 30 can insert in thechamber 16 of (104) elongated member 11.By pass (105)stylet thread eye 33 on seal wire,stylet 30 andelongated member 11 can be inserted into operative site by inserting passage then.Afterelongated member 11 put in place,stylet 30 and seal wire can be removed (106) by thechamber 16 from elongated member 11.Alternately, insert instrument and can directly be placed thechamber 16 ofelongated member 11, and need notstylet 30, insertion instrument andelongated member 11 are inserted operative site together.

In another embodiment, being used to form the initial percutaneous route at operation position or the insertion instrument of insertion passage can be Jamshidi pin (not shown).Elongated member 11 can directly be worn to operative site on the Jamshidi pin.When elongatedmember 11 was in desired location, the Jamshidi pin can be removed fromelongated member 11.

In an embodiment of this method, eachretractor parts 14 can be fixed (112) in a series of positions, comprises position with firstsectional dimension 17, has the position of secondsectional dimension 18 and any sectional dimension between this.For example,keeper ring 21 can be located with one heart at the near-end 12 of a plurality ofretractor parts 14 and with a plurality of retractor parts 14.Keeper ring 21 can be in the stop position that is placed in by the operation access road that insertselongated member 11 formation on the patient skin.Eachretractor parts 14 can have with the near-end 12 outward extendingretractor parts arms 20 of basic an angle of 90 degrees degree from retractor parts 14.Keeper ring 21 can comprise a plurality of retractorparts guiding channels 22, thereby and eachretractor parts arm 20 can be positioned and can in a guidingchannel 22, slide.

In this layout, whenretractor parts 14 were radially outward mobile, eachretractor parts arm 20 can outwards slide by retractor parts guiding channel 22.Retractor parts arm 20 can utilize adjustably bykeeper ring 21 insert each guidingchannel 22 be positioned whereinretractor parts arm 20 and form fixedly contact threaded and take turns and lock 23 and be fixed.But expandedbody 40 can be expanded (109) in firstsectional dimension 17 inchamber 16 with equal a sectional dimension in a series of sectional dimensions between the sectional dimension of internal diameter of keeper ring 21.But utilize expandedbody 40, the 14 radially outer motions of retractor parts make and form the operation access road thus by surrounding tissue retraction (108) in theretractor parts 14 that outwards move.But when expandedbody 40 be expanded andretractor parts 14 be in corresponding to the position of required sectional dimension in the time, can adjustwheel lock 23 downwards so thatretractor parts arm 20 andretractor parts 14 are fixed in this position by the threadedlock guiding piece 24 of taking turns that matches.Then, but expandedbody 40 can shrink and be removed (111) from elongated member 11.In this way, can form and the access road that keeps performing the operation to be used for immediate access and/or to observe operative site.

The operation access road that forms in this method can comprise substantially invariable sectional dimension between the far-end 13 of theelongated member 11 of the near-end 12 of theelongated member 11 of health outside and surgical site.This operation access road can comprise that having scope is about 3/4 inch sectional dimension to about 11/4 inch diameter.In certain embodiments, operation access road sectional dimension can have less than 3/4 inch or greater than 11/4 inch diameter, and this can be determined or according to the requirement of operative procedure by operation method.In the embodiment of method,retractor parts 14 can radially outward move the operation access road (110) that has the noncircular cross section structure to provide more or less than anotherretractor parts 14.

The embodiment of method that is used to form the operation access road also can comprise and utilizes the light source (for example, LED light or fiber optic line) 60 that is positioned the operative site periphery to illuminate (113) operative site.In one embodiment, the mechanism that is used to illuminate operative site can be located inelongated member 11 outsides.For example, the mechanism that is used to illuminate operative site can be configured for and separate the far-end operation ofsleeve pipe 51,70.Separatingsleeve pipe 51,70 can be passed the second puncture path by guiding percutaneously and arrive operative site to be used at operative site periphery positioned light source 60.In alternate embodiments, the mechanism that is used to illuminate operative site can be located in the inside of elongated member 11.For example, the mechanism that is used to illuminate operative site can be located at inside (distally) face ofretractor parts 14,keeper ring 21, and/or on the stabilizing mechanism in can being located in theretractor parts 14 that outwards move.Among this this embodiment, the operation access road is not used to illuminate the obstruction of the mechanism of operative site.

An embodiment who is used to form the method for operation access road also can comprise a plurality of surgical units insertion operation access roades (114).An embodiment of method also can be included in the immediate access of operative site and/or observe and carry out operative procedure (115) down.

Embodying apparatus of the present invention, system, external member and method can be applicable in the interior operative procedure type of a lot of suitable body regions and people and animal body, as long as the purpose of access road to be used for the treatment of or to diagnose that need be used for immediate access and/or observe operative site.In conjunction with the apparatus that is used for the treatment of vertebra, system, external member and method illustrative examples has been described.For example, operative site can be vertebra or joint.In other embodiments, the present invention can be used for other interior body region or types of organization.

Though invention has been described by the reference specific embodiment, should be realized that these embodiment only are used to illustrate the principle of the invention.One of ordinary skill in the art will appreciate that surgical access device, system, external member and be used to make and use the method for the surgical access device that is used to carry out Minimally Invasive Surgery can be otherwise and embodiment structure and realizing.In addition, though said method and step illustrate the particular event specifically to occur in sequence, benefit from that the order that one of skill in the art will recognize that particular step of the present disclosure can be changed and this change is consistent with modification of the present invention.Additionally, some step can synchronously be carried out in parallel procedure as far as possible, and is sequentially carried out as mentioned above.Correspondingly, should not think that the description has here limited the present invention, because other embodiment also falls into scope of the present invention.

Claims (74)

1. apparatus comprises:

Elongated member, described elongated member comprise near-end, far-end and a plurality of retractor parts, and each retractor parts has inner surface, and described inner surface limits the chamber of described elongated member together, and described chamber has first sectional dimension,

Each of described a plurality of retractor parts can radially outward move to second sectional dimension so that form the operation access road that can hold instrument.

2. apparatus according to claim 1, wherein said operation access road also comprises the substantially invariable sectional dimension between described near-end and the described far-end.

3. apparatus according to claim 1, wherein said operation access road also is included in the immediate access of operative site.

4. apparatus according to claim 1 also comprises:

Retractor parts arm stretches out from the described near-end of each retractor parts; And

The keeper ring, comprise a plurality of retractor parts guiding channels and be configured for being placed on the described proximal end of described a plurality of retractor parts and concentric with described a plurality of retractor parts, each retractor parts arm in of described guiding channel slidably.

5. apparatus according to claim 4 also comprises being used for each of described a plurality of retractor parts is fixed on the mechanism that the primary importance neutralization that comprises described first sectional dimension is fixed on the second position that comprises described second sectional dimension.

6. apparatus according to claim 5, each the described mechanism that wherein is used for fixing described a plurality of retractor parts comprises the wheel lock, and the described lock of taking turns passes wheel lock guiding piece in the described keeper ring and enters each keeper parts guiding channel and enter with adjusting of described keeper parts arm in the described guiding channel and contact.

7. apparatus according to claim 1 also comprises stylet, and described stylet comprises the end of point and run through the thread eye of described stylet that described stylet can insert and be used in the described chamber on seal wire described elongated member being directed to operative site.

8. apparatus according to claim 1 also comprises the mechanism that can insert in the described chamber and can activated the mobile described retractor parts to apply radially outer power.

9. apparatus according to claim 8, but the described mechanism that wherein is used for moving described retractor parts comprises expanded body.

10. apparatus according to claim 9, described a plurality of retractor parts have a length, but wherein said expanded body comprises the length near the described length of described retractor parts.

11. apparatus according to claim 9, described a plurality of retractor parts have a length, but wherein said expanded body comprises the length less than the described length of described retractor parts.

12. apparatus according to claim 8, the described mechanism that is used for mobile described retractor parts also comprises hydraulic mechanism.

13. apparatus according to claim 8, the described mechanism that is used for mobile described retractor parts also comprises mechanical mechanism.

14. apparatus according to claim 4, described operation access road also comprise described first sectional dimension in described chamber and equal a sectional dimension in a series of sectional dimensions between the sectional dimension of interior diameter of described keeper ring.

15. apparatus according to claim 1, described operation access road has the sectional dimension of the diameter in the scope that comprises 0.75 inch to 1.25 inches.

16. apparatus according to claim 1, described operation access road also comprise the noncircular cross section structure.

17. apparatus according to claim 1, described retractor parts one or more also comprise and are used for hollow region that material is sent to operative site and transmits material from operative site.

18. apparatus according to claim 1 also comprises the light source that is used to illuminate operative site.

19. apparatus according to claim 18 also comprises the keeper ring, this keeper ring is configured for being placed on the described proximal end of described a plurality of retractor parts and concentric with described a plurality of retractor parts,

Rotatable arm is rotatably installed on the described keeper ring, and

Can be connected to the insertion parts of the bending of described rotatable arm, it has described light source in the distal part end of described insertion parts, and described light source percutaneous can be inserted into the periphery of described operative site.

20. apparatus according to claim 18 also comprises the keeper ring, this keeper ring is configured for being placed on the described proximal end of described a plurality of retractor parts and concentric with described a plurality of retractor parts,

Keeper ring arm laterally extends and comprises angled guide groove from described keeper ring, and

Straight cutting is gone into parts, and it has described light source and can be directed the percutaneous insertion by described guide groove in the distal part end of described insertion parts makes described light source can be positioned the periphery of described operative site.

21. apparatus according to claim 20, described straight cutting are gone into parts and also comprised labelling, this labelling is used to the distance of indicating described insertion parts to insert towards described operative site.

22. apparatus according to claim 18 also comprises at least one the light source of far-end of described a plurality of retractor parts.

23. apparatus according to claim 18, also comprise stabilizing ring, can be positioned on the described far-end of the inboard and close described retractor parts of described retractor parts when described retractor parts are in the position that comprises described second sectional dimension, wherein said stabilizing ring comprises described light source.

24. apparatus according to claim 18, also comprise the keeper ring, this keeper ring is configured for being placed on the described proximal end of described a plurality of retractor parts and concentric with described a plurality of retractor parts, and wherein said light source comprises the light source near the inward flange of described keeper ring.

25. apparatus according to claim 1 also comprises the barrier material between at least two of described retractor parts.

26. apparatus according to claim 1, each that also comprises adjacent retractor parts between barrier material.

27. apparatus according to claim 1, wherein said operation access road is positioned at the human or animal.

28. apparatus according to claim 1, wherein said operation access road comprises the inlet that arrives vertebra.

29. apparatus according to claim 1, wherein said operation access road comprises the inlet that arrives the joint.

30. an apparatus comprises:

Elongated member, described elongated member comprise near-end, far-end and a plurality of retractor parts, and each retractor parts has inner surface, and described inner surface limits the chamber of described elongated member together, and described chamber has first sectional dimension;

Retractor parts arm stretches out from the described near-end of each retractor parts;

Bottom keeper ring, comprise a plurality of retractor parts guiding channels and be configured for being placed on the described proximal end of described a plurality of retractor parts and concentric with described a plurality of retractor parts, each retractor parts arm in of described guiding channel slidably; And

Top keeper ring can engage described bottom keeper ring and can be with respect to the rotation of sliding of described bottom keeper ring; And

When described upper and lower keeper ring relative to each other rotated, each of described a plurality of retractor parts can radially outward move to second sectional dimension to form the operation access road that can hold instrument.

31. apparatus according to claim 30, wherein

Described bottom keeper ring comprises and is positioned at each guiding channel top and parallel with it bottom keeper ring slit;

Described top keeper ring comprises top keeper ring slit, the center of the described bottom of the centrally aligned keeper ring slit of this top keeper ring slit, and this top keeper ring slit is with respect to the longitudinal axis inclination of described bottom keeper ring slit; And

Each retractor parts arm comprises spike dowel, and this spike dowel passes described bottom and top keeper ring slit extends upward,

Make that described top keeper ring slit is pressed on the described spike dowel, causes that described retractor parts move radially when described upper and lower keeper ring relative to each other rotates.

32. apparatus according to claim 30 also comprises the mechanism that is used for described upper and lower keeper ring is fixed on relative to each other desired location.

33. apparatus according to claim 30 also comprises being used for each of described a plurality of retractor parts is fixed on the mechanism that the primary importance neutralization that comprises described first sectional dimension is fixed on the second position that comprises described second sectional dimension.

34. apparatus according to claim 30 also comprises the light source that is used to illuminate operative site.

35. apparatus according to claim 30, wherein said operation access road also comprises the substantially invariable sectional dimension between described near-end and the described far-end.

36. apparatus according to claim 30, wherein said operation access road also is included in the immediate access of operative site.

37. an apparatus comprises:

Elongated member, described elongated member comprise near-end, far-end and a plurality of retractor parts, and each retractor parts has inner surface, and described inner surface limits the chamber of described elongated member together, and described chamber has first sectional dimension;

Threaded retractor parts arm is rotatably connected to the near-end of each retractor parts and stretches out from it;

The keeper ring, comprise a plurality of threaded ordinatedly retractor parts guiding channels and be configured for being placed on the described proximal end of described a plurality of retractor parts and concentric with described a plurality of retractor parts, each threaded retractor parts arm is rotatable in of described guiding channel; And

When described threaded retractor parts arm rotated, each of described a plurality of retractor parts can radially outward move to second sectional dimension to form the operation access road that can hold instrument.

38. according to the described apparatus of claim 37, wherein each threaded retractor parts arm inserts regularly by the runner of the outside of contiguous described keeper ring, and the rotation of wherein said runner causes that the retractor parts of connection move radially.

39., also comprise being used for each of described a plurality of retractor parts is fixed on the mechanism that the primary importance neutralization that comprises described first sectional dimension is fixed on the second position that comprises described second sectional dimension according to the described apparatus of claim 37.

40., also comprise the light source that is used to illuminate operative site according to the described apparatus of claim 37.

41. according to the described apparatus of claim 37, wherein said operation access road also comprises the substantially invariable sectional dimension between described near-end and the described far-end.

42. according to the described apparatus of claim 37, wherein said operation access road also is included in the immediate access of operative site.

43. an external member comprises:

Elongated member, this elongated member comprises near-end, far-end and a plurality of retractor parts, each retractor parts has inner surface, this inner surface limits the chamber of described elongated member together, described chamber has first sectional dimension, and each of described a plurality of retractor parts can radially outward move to second sectional dimension to form the operation access road; And

The keeper ring, it comprises a plurality of retractor parts guiding channels and is configured for being placed on the described proximal end of described a plurality of retractor parts and concentric with described a plurality of retractor parts, each retractor parts in of described guiding channel slidably.

44. according to the described external member of claim 43, wherein said operation access road also comprises the substantially invariable sectional dimension between described near-end and the described far-end.

45. according to the described external member of claim 43, also comprise stylet, described stylet comprises the end of point and runs through the thread eye of described stylet that described stylet can insert and be used in the described chamber on seal wire described elongated member being directed to operative site.

46. according to the described external member of claim 43, also comprise the mechanism that is used for radially outward moving described retractor parts, thereby described mechanism can insert in the described chamber and can activated to apply the mobile described retractor parts of radially outer power.

47., also comprise the light source that is used to illuminate described operative site according to the described external member of claim 43.

48. a system comprises:

A plurality of interconnective retractor parts, each retractor parts has inner surface, this inner surface limits the chamber together, and described chamber has first sectional dimension, and each of described a plurality of retractor parts can radially outward move to second sectional dimension to form access road; And

Be configured to control the mechanism of the motion of described a plurality of interconnective retractor parts.

49. according to the described system of claim 48, wherein said access road also comprises the substantially invariable sectional dimension between near-end and far-end and described near-end and the described far-end.

50. according to the described system of claim 48, thereby the described mechanism that wherein is used for controlling the motion of described retractor parts can insert described chamber and can activated to apply power and radially outward moves described retractor parts.

51. according to the described system of claim 50, but the described mechanism that wherein is used to control the motion of described retractor parts comprises expanded body.

52. according to the described system of claim 51, but wherein said expanded body comprises air bag.

53., also comprise according to the described system of claim 48

Retractor parts arm stretches out from the near-end of each retractor parts; And

The keeper ring, comprise a plurality of retractor parts guiding channels and be configured for being placed on the described proximal end of described a plurality of retractor parts and concentric with described a plurality of retractor parts, each retractor parts arm in of described guiding channel slidably.

54., also comprise being used for each of described a plurality of retractor parts is fixed on the mechanism that the primary importance neutralization that comprises described first sectional dimension is fixed on the second position that comprises described second sectional dimension according to the described system of claim 48.

55. according to the described system of claim 48, also comprise stylet, described stylet comprises the end of point and runs through the thread eye of described stylet that described stylet can insert in the described chamber on seal wire described elongated member is directed to operative site.

56. according to the described system of claim 53, described access road also comprises described first sectional dimension in described chamber and equals a sectional dimension in a series of sectional dimensions between the sectional dimension of interior diameter of described keeper ring.

57., also comprise the light source that is used to illuminate operative site according to the described system of claim 48.

58., also comprise the barrier material between at least two of described retractor parts according to the described system of claim 48.

59. according to the described system of claim 48, each that also comprises adjacent retractor parts between barrier material.

60. a method that forms the operation access road comprises:

The elongated member that will comprise near-end, far-end and a plurality of retractor parts percutaneously is inserted into operative site, and each retractor parts has inner surface, and this inner surface limits the chamber of described elongated member together, and described chamber has first sectional dimension;

But expanded body is inserted in the described chamber of described elongated member;

But expand described expanded body so that described a plurality of retractor parts are radially outward moved to second sectional dimension; And

But but shrink described expanded body and remove described expanded body from described operation access road.

61., wherein percutaneously insert described elongated member and also comprise according to the described method of claim 60:

The insertion instrument that has thread eye and pass the seal wire of described thread eye is provided;

Percutaneously insert described insertion instrument to provide the insertion passage to described operative site;

When described seal wire being retained in the described insertion passage, remove described insertion instrument from described insertion passage;

Stylet is inserted in the described chamber of described elongated member, described stylet comprises the end of point and runs through the stylet thread eye of described stylet;

On described seal wire, pass described stylet thread eye so that described stylet and described elongated member are inserted the insertion passage that arrives described operative site; And

The described chamber of described stylet from described elongated member removed.

62., also comprise being fixed on described retractor parts in the position that comprises described first sectional dimension or being fixed in the position that comprises described second sectional dimension according to the described method of claim 60.

63. according to the described method of claim 62, retractor parts arm stretches out from the described near-end of each retractor parts, described method also comprises

Place the keeper ring that comprises a plurality of retractor parts guiding channels with one heart in the described proximal end of described a plurality of retractor parts and with described a plurality of retractor parts, each retractor parts arm is positioned among of described guiding channel and can slides therein

Wherein fixing described retractor parts also comprises: utilization is passed described keeper ring adjustably and is inserted in each guiding channel to form the threaded lock of taking turns that fixedly contacts with the described retractor parts arm that is positioned wherein, each of fixing described retractor parts arm.

64., also comprise according to the described method of claim 60

Place the keeper ring with one heart in the described proximal end of described a plurality of retractor parts and with described a plurality of retractor parts,

Also comprise and but described expanded body expanded to described first sectional dimension in described chamber and equal a sectional dimension in a series of sectional dimensions between the sectional dimension of interior diameter of described keeper ring but wherein expand described expanded body.

65. according to the described method of claim 60, wherein said operation access road comprises the described near-end and the substantially invariable sectional dimension between the described far-end of described surgical site of health outside.

66. according to the described method of claim 60, wherein said operation access road comprises the sectional dimension of the diameter in the scope with 0.75 inch to 1.25 inches.

67., wherein radially outward move described a plurality of retractor parts and comprise that also another of more or less radially outward moving described retractor parts than described retractor parts is to provide the described operation access road with noncircular cross section structure according to the described method of claim 60.

68., also comprise and utilize the light source of the periphery that is positioned described operative site to illuminate described operative site according to the described method of claim 60.

69., also comprise a plurality of surgical units inserted in the described operation access road according to the described method of claim 60.

70., also be included in the direct visual operative procedure of carrying out down of described operative site according to the described method of claim 60.

71. according to the described method of claim 60, wherein said operative site comprises vertebra.

72. according to the described method of claim 60, wherein said operative site comprises the joint.

73. a method that forms the operation access road comprises:

The elongated member that will comprise near-end, far-end and a plurality of retractor parts percutaneously is inserted into operative site, each retractor parts has inner surface, this inner surface limits the chamber of described elongated member together, retractor parts arm stretches out from the described near-end of each retractor parts, and described chamber has first sectional dimension;

Place the bottom keeper ring that comprises a plurality of retractor parts guiding channels with one heart in the described proximal end of described a plurality of retractor parts and with described a plurality of retractor parts, and the top keeper ring that can engage described bottom keeper ring and slidably rotate with respect to described bottom keeper ring, each retractor parts arm in of described guiding channel slidably; And

Described upper and lower keeper ring is rotated relative to each other each of described a plurality of retractor parts is radially outward moved to second sectional dimension to form the operation access road that can hold instrument.

74. according to the described apparatus of claim 73, wherein

Described bottom keeper ring comprises and is positioned at each guiding channel top and parallel with it bottom keeper ring slit;

Described top keeper ring comprises top keeper ring slit, the centrally aligned of the center of this top keeper ring slit and described bottom keeper ring slit, and this top keeper ring slit is with respect to the longitudinal axis inclination of described bottom keeper ring slit; And

Each retractor parts arm comprises spike dowel, and this spike dowel passes described bottom and top keeper ring slit extends upward,

Make that described top keeper ring slit is pressed on the described spike dowel, causes that described retractor parts move radially when described upper and lower keeper ring relative to each other rotates.

Images