AU2015201256A1 - Multiple portal guide - Google Patents

Abstract

he present disclosure relates to a guide assembly incuding. a guide having a body and a joint including at least one through hole wherein the joint is configured for Sliding along a lngTh of the body, and a first surgical device. The guide is coupled to the first > surgical device a a longitudinal axis ofthe through hole is co-radial with an end of the first surgical device. Other guide assemblies and methods of creating multiple portals during surgery are also disclosed,

Description

MWutiple Portal Guide [0001] The disclosure of the complete specification of Australian Patent Application No. 2008341062 as origially fied is incorporated herein by reference. BacA ground of the Invention 5 . Field afthe invention 100021 'This invention relates generally to medical devices for use in surgery and, more particular, a guide for use in creating multiple portals during surgery, 2. Related Art 100031 During arthroscopic surgery the joint areas of the body, such as the hip. 10 kneeIsoulden and other joint areas, are approached via the use of an endoscope. Some joints are harder to access than others. For example, the hip joint differs fiom other joints in that a much thicker layer of soft tissue, known as the hip capsule, surrounds it. This thick layer makes changing the trajectory of instruments placed into the joint difficnt and the importance of placing portals, or tissue passages, nore critical than otherjoints. 15 [00041 Presently, fluoroscopy is used to place the ponals that house the endoscope and other instruments used during sugery. Multiple xrays are taken while the surgeon tries various approaches to the joint using a thin needle that may be reinserted several times until the ideal portal placement is found. This process exposes the surgical team t iradiation, is time consuming, and can lead to trauma, particularly to the delicate articular cartilage and, in the case of 20 the hip joint, the acetabular labrum. 10005] There is a need for an apparatus and method that would allow fr the creation of' multiple portals 'while substantially reducing the possible harmful effects and the amount of time that is required of the present methods.

I Summary of the in venion [00061 It is in view of the above problems that the present disclosure was developed. 100071 In one aspect, the present disclosure relates to a guide assembly including a guide having a body and a joint including at least one through hole, wherein the joint is 5 configured for siidng along a length of the body, and a frst surgical device. The guide is coupled to the first surUical device and a longitudinal axis of thethrough hole is coadiai with an end of the first surgical device. 100081 In an embodiment, the guide assembly further includes a mechanism fIo loJking the joint in a position along the body, In ano Uther emod the guide assembly 10 further includes a second surgical device, such as a second cannula, disposed within the through hole, wherein the second surgical dcvc includes a longitudinal axis that is co radial with the end of the first surgical device. Ini yet another embodiment, the first surgical device is disposed within a first cannula such that the end of the first surcai device protrudes through an end of the first cannula. yet a further embodient, the longitudinal 15 axis of the through hole is coradial with a point that is offlet a distance, about 1 cm, from the end of the first surgical device. The first surgical device may include an endoscope, wherein the point is offset a distance about 1 cm, i a direction of view of the endoscope. hn an embodiment, the guide is coupled to the first cannula. I another embodiment the end of the first carmula includes a pointed tip offset a distance, about 1 curom the end of 20 the fst surgical device. Tn yet another embodiment, the frst surgical device includes an endoscope, wherein the pointed tip is offset a distance, about i cn in a direcion of view from the endoscope, 100091 In another eibodiment, the second surgical deyice includes a second cannula. In an embodiment, the second cannula includes a needle, wherein the needle 25 includes a first end and a second end and is slidaby disposed within the second cannula. In 3 another embodiment, the needle includes a first end, which may have a depth stop, and a second end that intersects an end of the first surgical device. hi an embodiment the second end of the needle does not advance past the end of the first surgical device. in a further embodiment, the body includes a first attachment portion located at a first end of the body 5 and a second attachment portion located near a second end of the body, where the first attachment portion and the second attachment portion are configured for coupling the body to the first surgical device, In yet a further eribodimenl, the second end of the body does not extend beyond a plane located between the second attachment portion and a iongitudinal axis of the first surgical device. In yet a. farthe enbodimen, an angle @, 1 which may be about 60', exists between the longtudinal axis of the first surgical device and the plane. {00101 In yet an even further embodimenthe first attachment portion includes a lever arm configured for coupling of thc first surgical device to the f t attachment portion. The lever arm is movable between a first position and a second position with respect to the 15 first attachment portion, wherein the first surgical device is coupled to the first attachment portion when the lever arm is in a second position. [00111 in yet a further embodiment, a longitudinal axis of the through hole is co radial with a point that is offset a distance, about I em, trot the end of the first surgical device. In an embodiment, the first surgical device includes an endoscope wherein the 20 point offset a distance, about 1 cmnn in a direction of view of the endoseope. 100121 In another aspect, the present disclosure relates to a guide assembly including a guide having a body vith at least one through hole and a first surgical device, wherein the guide is coupled zo the first surgical device and a longitudinal axis of the through hole is co-radial with an end of the first surgical device In an embodiment, the 25 body inchdcs multiple through holes and each through hole includes alongitudinal axis that is cc-radial with the end of the first surgical device, In another embodiment, the first surgical device is disposed within a fst cannula such that the end of the first surgical device protrudes through an end of the first cannula, In yet another embodiment the end of the first cannula includes a pointed tip offset a distance, about 1 cm, from the end of the 5 first surgical device. in a further embodiment, the ist surgical device includes an endoscope, wherein the pointed tip is offset a distance, about 1 cm, in a direction of view of the. endoscope, hi yet a further eibodiment, the first gici device includes an ainer arm, in an embodiment, the ainer ann rotates about a longiudinalaxis of the ainmer arm. in another embodiment, a second surgical device is disposed within the through hole, 10 wherein the second surgical device includes a longitudinal axis that is co-radial with a distal end of the abner. lI. yet another embodiment, the second surgical device includes a second cannula, wherein the second cannula includes a depth stop coupled to the second cannula. in a further tmbodimenh a needle is disposed within the second cannula and an end of the needle does not advance past the end of the first surgical device. 15 [00131 in yet another aspect, the present disclosure relates to a method of creating multiple portals during surgery. The method includes creating a first portal in tissue; inserting a fist surgical device through the first portal; coupling a guide to a rst end of the first surgical device, the guide inchiding a body having at least one through hole, wherein a longitudinal axis of the through hole is co-radial wih an end of the first surgical device; 20 and inserting a second surgical device through the hole and into the tissue to create a second portal, [0014] In an embodiment, the second surgical device is co-radial with the end of the first surgical device. In another embodiment, the body includes mutipie through holes, in yet another embodiment, each through hole includes longitudinal axis that is coradial 25 with the end of the first surgical device in a father embodiment the st surgic device is disposed within a first cannula such that the end of the first surgical device protrudes through an end of the first cannula. In yet a further embodiment, the end of the first carmula includes a pointed tip, wherein the pointed tip is offset a distance; about 1 cm, in a direction of view of the endoscope. In an emibodiment, the first surgical device includes an 5 endoscope, wherein the pointed tip is offset a distance in a direction of aiw uf the endoscope. In another embodiment; a. longitudinal axis of the through hole is co-radial with the pointed tip. In yet another enibodinent, the first surgical devie includes an cndoscojpc, wherein a lomgitudinal axis of the throu 'h hole is co-radid with a point that is offset a distance about I cm, from the end of the endoscope. 10 [00151 In yet another enibodinent, the second surgical device includes a second canulda in a further embodiment, the second cannula indldes a depth stop coupled to the second cannula. In yet a further embodimene the first surgical device includes an anner an, the airner arm having a distal end, In an embodiment, the ainer aan rotates about a longitudinal axis of the airner arn. in another embodinent the second surgical device 15 includes a longitudinal axis that is co-radia! with a distal end of the aimer am In yet another embodiment, a needle is disposed within the second cannula and an end of the needle does not advance past the end of the first surgical device, [0016] hi yet another aspect, the present disclosure relates to a method of creating multiple portals during surgery. The method includes creating a first portal in tissue; 20 inserting a first surgical device through the first portl; coupling a guido to a first end of the first surgical device, the guide including a body and a joint including at least one through hole wherein a longitudinal axis of the through hole is co-radial with an end of the first surgical device; and inserting a second surgical device through the hole and into the tissue to create a second portal.

6 j00171 In an embodiment, the guide includes a mechanism for locking the joint in a position along the body, the method further including siding the joimt along the body to the position and locking the joint in the position before creating the second portal. 10018]J Fmrther features, aspects, aind advantages of the present disclosure, as wel as 5 the structure and operation of various embodiments of the present disclosure, arc described in detail below with reference to the accompanying drawings. .Brief Description f the Drawings 100191 The accomnpanying drawingswnh are incorporate in and form a part of the specification, illustrate the embodiments of the present disclosure and together with the 10 description, serve to explain the principles of the disclosure In the drawings: [00201 igs 1-4 show font views of a first guide assembly ofte present disclosure. [00211 Fig. 5 shows a front view of a second guide assembly of the present disclosure, 100221 Fig. 6 shows a front view of a third guide assembly of the present disclosure. 15 100231 Fig. 7 shows a front view of a oburtli guide assembly of the present disclosure. 100241 Fig. 8 shows an isometric view of the fourth guide assembly of the present disclosure. [00251 Fig. 9A shows a top view of the lever anm ot the fourth guide assembly, in a 20 first position. 100261 Fig. 9B shows a top view of the lever ann, of the fourh guide a in a second position, [0027] Fig. 10 shows a perspective view of the second attachment portion of the fourth guide assembly.

100281 Figs 1A"I ID show perspecive views of methods for attaching the guides of "he present disclosure to an endoscope cannula. 100291 ig, 12 shows a front view of the first guide of the present disclosure coupled to an ainer arm. Deailed Description of the Emhodiments [0030] Referring to the accompanying drawings in which like reference numbers indicate like elements; Fig. I snows a guide 10 that includes a body il having a first end 12. a second end 13, art arc along a length L of the body 11, and at least one through hole 14. Also shown in Fig. 1 is a first surgical instrument 20, such as an endoseopethat includes a 10 first end 21 and a second end 22. The second end 13 of the guide 10 iscoupled to the first end 21 of the endoscope 20, via a cannula 40, as further described below, and a longitudinal axis 15 of the throulgh hole 14 intersects, or is co-radialhith, the second end 22 of the endoscope 20. As also shown in Fig. 1, the body 11 may include multiple through holes 141 each of which includes a longitudinal axis 15 that intersects, or is conadial with, the second 15 end 22 of the endoscope 20, [00311 During arthroscopic surgery, especially hip arthroscopy, a first portal 31 is created in a relatively safe position, within a patient's body 32, where damage to internal structures is minimized, The portal 31 may be created via the use of fluoroscopy.as described above, or another method known to one of ordinary skill in the art The first 20 cannula 40 and endoscope 20 are then inserted through the portal 31. so that a clear vicw the inside of the patients body 32, especially the area 35 where surgery is to he perfonned (ie, the hip joint and the capsule surrounding the joint) Acan he seen, by the surgeon fhis view also shows the surgeon the anatory that must be avoided and where a safe area for placing other portals is. As wil be further discussed below, the endoscope 20 is disposed 25 within the first cannula 40 such that the second end 22 of the endoscope 20 protrudes 8 through a second end 42 of the cannula 40. Afterpositioing the second end 22 of the endoscope 20 at an area 36 where the surgeon wishes a second portal (Fig. 4 33) to he placed, such as the inner surface of the hip capsule, the gaide 10 is coupled to the first end 21 of the endoscope 20, via the cannula, and the second portal (Fig. 4, 33) is placed relative S to the second end 22 of the emdoscope 20 by inserting a second surgical device (Fig 4,34) such as a second cannula, through one of the through holes 14 and into the patient s body 32, Since the longitudinal axis 15 of the through hole 14 intersectsor is co-radial with, the second end 22 of the endoscope 20 the second cannula 34 would also be co-radial with the second end 22 of the endoscope 20. Furthernore. and as will be described below, this co 10 radia relationship between the second cannula 34 and the second end 22of the endoscope 20 alows a needle or other surgical instrument that may be placed within the second cannula 34 and used in the area 35 described above, to intersect the second end 22 of the endoscope 20. 10032j Having multiple through holes 14 in the guide 10 alows for flexibility in 15 the placement of the second portal 33 so that damage to intemal structures can be minimized. However, a guide 10 having only one through hole 14 may be used. [00334 Figure 2 shows the endoscope 20 disposed within the first cannula 40 as described above, such that the second end 22 of the endoscope 20 protrudes through a second end 42 of the cannula 40, The guide 10 is coupled to a first end 41 of the irst 20 Wana 40. The caun -la 40 has a pointed tip 43, 1octed at the second end 42. which is offset a distance d from the endoscope 20 or in a direction of view 37 of the endoscope 20. As shown in Figure 2 and in subsequent figures. as descbrihcd below, the distance d is measured from the optical center 23 of the endoscope 20, The direction ofview 37 of the endoscope 20 is located at an angle about 70', relative to a longitudinal axis 26 of the 25 endoscope 20 Sometae, the anatomy of the body prevents the second end 22 of the 9 endoscope 20 from being positioned in the area 36, such as the inner surface of the hip capsule as described above, where the surgeon wishes the second portal (Fig. 4, 33) to be placed. When this happens, the cannula 40 with the pointed tip 43 can be usd to identify this area 36 and a longitudinal axis 15 of the guide through hole 14 could be made to 5 intersect, or be co-radial with, the pointed tip 43, Ranller than using a eanulan with a pointed tip, the endoscope 20 could be fitted with a pointed tip similar to the pointed tip 43 of the csawma 40. The endoscope 20 and pointed tip could be introduced into the patient's body via a slotied cannula, [00341 Fig.3is similar to Fig 2 in that a longitudinal axis 15 of the through hole 10 14 intersects with an area 36 that is ofstet a distane d f n e endoscope 20 or in a direction of view 37 of the endoscope 20, However, rather than using the pointed tip 43 of the cannula 40 to identity tbis area 36 the average distance d between the endoscope 20 and the point of intersection with area 36 is detennired and an offse equal to that average distance d, is built into the guide 10 so that a longitudinal axis 15 of the through hole 14 15 intersects with this area 36. For example,; during hip arthroscopya surgeon may want to introduce a needle into the hip capsule 35, but the hip anatomy may prevent the second end 22 of the endoscope 20 froa bing, brought up against the inner suriae 36 of the hip capsule. Since the endoscope 20 rray be a distance from the capsuie inner surface 36, an error where the needle penetrates the capsule wold result To overcome this problem, the 20 pointed tip 43 or the builtin offset d, as described above, could be used. For the puposes of this disclosure, the distance d is about I em. However the distance d wil vary based on the location of the endoscope 20 relative to area 36. [00351 Fig 4 shows the second cannula 34 disposed within the through hole 14 and second portal 33. The cannula 34 includes a depth stop 38 that substantially reduces the 25 possibility of a first end 39a of a needle 39 or other surgical instrument, disposed within 10 the cannula 34, from advancing past the second end 22 of the endoscope 20 by haing a second eAnd 39b of the needle 39 abut a second end 38b of the depth stop 38, The depth stop 38 may be part of the second cannula 34 or separate from the second cannula 34- This allows the second cannula 34 to be positioned to any depth within the through hole14yet 5 still have a fixed depth stop relative to the guide 10. [00361 Fig, 5 shows a guide 60 that includes a body 61 haing a first end 62 a second end 63, and an arc along a length L of the body 61 The guide 60 also includes a joint 64 configured for sliding along the length L of the body 61, The joint 64 includes at least one through hole 65. Similar to the guide 10 disclosed in Figs. 1-4, guide 60 is also 10 coupled to a first surgical device 20, such as an endoscope. The endoscope 20 may be disposed within a first cannuha 40, similar to the first carnula disclosed in Fig' 2 and described above, such that the second end 22 of the endoscope 20 protrudes through a second end 42 of the cannula 40. 'Thre carnula 40 has a pointed ip 43 similar to the pointed tip shown in Fig. 2 and described above. A second surgical device 34, similar to the 15 second surgical device shown in 1ig. 4, is disposed within the through hole 65. A longitudinal axis 66 of the through ole 65, and there ofe of the second surgiel device 34 intersects, or is co-radial with, the pointed tip 43. However, the longitudina axis 66 could be made to intersect, or be co-radial with, the second end 22 of the endoscope 20 orwith an area 36 that is offset a distance d front the endoscop 20, as shown in Figs. 1 and '3 20 100371 The joint 64 nay be slid along the length L of the body 61 to decide where to pace the second portal 33 so that damage to internal structures can be miniied Since the longitudinal axis 66 of the though hole 65 and the second surgical device 34 is o radial with the pointed tip 43, a needle or other surgical instrument disposed within the second surgical device 34, will intersect the pointed tip 43, regardless of where the second 25 podal 33 is placed. The joint 64 and the body 61 may include openings 67 to make the it guide 60 lightweight and ensure that the joint 64 and body 61 cool quickly afer autoclaving. 100381 Similar to the guide 60 shown in ig 5 Fig. shows a guide 70 that includes a body 71 having a mrst end 72, and a second end 73. The guide 70 also includes S a joint 74 conhgured for' sliding along the body 71. The joint 74 includes at least one through hole 75, Similar to the guide 10 disclosed in Figs 1-4, guide 70 is also coupled to a first surgical device 20, such as an endoscope via a cannula 40. A second surgical device 34, similar to the second surgical devie shown in Fig, 4, is disposed within the through bole75 A longitudinal axis 76 of the through hole 75. and therefore of the second surgical 10 device 34, intersects, or is co-radial with, an area 36 that is offset a distance d from the endoscope 20. However, the longitudinal axis 76 could be made to intersect, or be co radial with, a pointed tip 43 of the canula 40 or the second endZ2 of the endoscope 20, as shown in Figs, 2, 5, 1 and 4, [00391 As also shown inig an described above, the joint 74 may be slid 15 the body 71 to vary the stance d based upon the distance between the second end 22 of the cndoscope 20 and the capsule inner surface 36 Since the second surgical device 34 is co-radial with the area 36, a needle or other surgical instrument disposed within the second surgical device 34, will e cthe area 36, regardless of where the second portal 33 is placed, The guide 70 also includes a mechanism 7 such as a locking nut, for engaging 20 the joint 74 and holding it in a position along the bodyL Oneh surgeon determined the position of the second portal 33, thelocking nut 77 will be tightened to, engage the join. 74 and hold it in a position along the body 71, The second surgicaldevice 34 will then be inserted into the. through hole 75 and though the patients body 32 to ke the second portal 33, 12 [00401 Similar to the gudes 60,70 shown in Figs. 5 and 6, the guide 80 shown in Fig, 7 includes a body 81 having a first end 81a a second end 81 b, and an arc along a length L of the body 81. The guide 80 also includes a ioint 84 configured for sliding along a length L of the body 81. The joint 84 includes at least one through hole 85 Sinilar to 5 the guide 10,6070 disclosed in Figs, 16, guide 80 is also coupled to a first sugiadevice 20, such as an endoscope via the first end 21 of the endoscope 20 and the first end 41 of the canmua 40. A second surgical device 34, sinilar to the second surgical device shown in Figs, 4-6 is disposed within the through hole 85. A longitudinal axis 86 of the through hole 85, and therefore of the second surgical device 34, intersects5 or is co'-adial with, the it) second end 22 of the endoscope 2M. However, the longitudinal axis 86 could be made to intersect.or be co-adia. with, a pointed tip 43 of the cannula 40 or an area 36 that is ofset a distance d from the endoscope 20, a.s shown in Figs, 4, 5, and 3. 10041] As also shown in Fg. 7 and described above, he joint 84 may be siid along the length L of the body 81 to decide where to place a second portal so that. damage to 15 internal structures can be inimized. Since the second surgical device 34 is co-radial with the second end 22 of the endoscope 20, a needle 90 or other surgical instrument disposed within the second surgical device 34, will intersect the second end 22, regarles of where the scond portal is placed. The body 80 includes a slot 81 c that runs the entire length 1. of the body 80 and that houses the joint 84, In addition, similar to he guide 70 of Fig6the 20 guide 80 includes a mechanism 87, such as a looking nut, for engaging theOint 84 and holding it in a position along the body 8L During surgery, use of the locking nut 87 in creating a second portal occurs in the same manner as described above. ter the second surgical device 34, or second cannula, has been inserted intothe parent's body, the needle 90. or other instmrment, may be inserted through the canmaa 34 for use in performing a 25 surgical procedure. The needle 90 which intersects, or is co-adial wit the second end 22 13 of the endoscope 20, may include a depth stop 90, at a first end 90a of the needle 90, that abuts a first cnd 34a of the cannula 34 to substantially reduce the possibility of 0he second end 90b of the needle 94) from advancing past the second end 22 of the endoscope 20. 100421 As shown in Figs 7 and 8, the guide 80 includes a first attachment portion 5 88 and a second attachment portion 89., both of which are configured for coupling the body 81 to the first surgical device 20 via the first surgical device 20 and the cannuia 40, The first attachment portion 88, which includes an anti-rotation lock, is located at the first end 81 a of the body 81 and extends substantially perpendicular to the axis 26 of the endoscope 20. As shown in Figs. 9A and 9B, the anti-rotation lock 88 includes a lever arm 88c 10 located between a top surface 88a and bottom surface 88b of the antrotationlock 88. The lever arn 88 eis coupled to the surfaces 88ab via a pivot pin or screw 88d and a spring 88e. When the endoscope 20 is not coupled to the ant-rotation lock 88, the lever arm 88c is in a first position, as shown. in Fig, 9A, such that the spring 88e is in a relaxed. state. However, when the endoscope 20 is coupled to the antirotation lock 88, the lever arm 88c 15 is in a second position, as shown in Fig. 9B, such that the lever arm 88C is gushed against the light post 24 of the endoscope 20, and substantially reduces the possibibty of rotation of the light post 24 in a direction that would uncouple the cannula 40 rom the endoscope 20. 10043] As shown in Figs, 7 and 8, the second attachment portion 89 is located near the second end 81b of the body 81 and extends substantially perpendicular to the 20 longitudinal axis 26 of the endoscope 20 The portion 89 includes two prongs 89aibboth of which extend lon tudialy from the portion 89, and an opening 89e located between the prongs 89a,b that extends longitudinal into the portion 89 As shown in Fig. 10, the cannula 40 includes a coupling portion 45 configued for coupling of the second attachment portion 89 to the cannula 40. The coupling portion 45 includes two holes 45a 25 and a projection 45b that extends longitudinafly fom the coupling portion 45 The second 14 attachment portion 89 is coupled to the coupling portion 45 such that the prongs 89ab ae disposed within the holes 45a and the projection 45b is disposed within the opening 89. 100441 As shown in Fig. 7, the second end 8b of the body 81 does not extend 5 beyond a plane 90, located between the second attachment portion 89 and a longitudinal axis 26 of the first surgical device 20, and that orns an angie fl about 60', with the longitudinal axis 26, 100451 Figs. 1 A-11D show methods for coupling the second end13 of the guide 10 to the first end 41 of the cannula 40. As shown in Fig. Athe second end B includes 10 a first arm Ba, a second arm 13b and a slot 13R located between the finst and second arms 13ab. The first end 41 of the cannula 40 includes a coupling portion 46, similar to the coupling portion 45 shown in Fig. 10 albeit with channels 46a instead holess 45a The second end 13 of the guide 10 is coupled to the fist end 41 of the cannula 40 such that the first and second arms 13a,b are housed within the channels 46a and the projection 46b is 15 housed within the slot 13e Both arms 13a,b include an edge 13a' 13b, wherein each edge 13W, 13W is configured for attaching to the backside 46c of the coupling portion 46 when the guide 10 is coupled to the coupling poison 46, therefore creating a snap-lit connection bet ween the arms 13ab and the coup mig portion 46. [00461 As shown in 1113, the second end 13 of the guide 10 includes a frst arm 13a 20 and a second aim 13, The first end 41 of the cannula 40 includes an adaptor 47 that has been slid over the cannula 40. The first and second arms 13ak ofthe guide 10 are coupled 'to the adaptor 47 such that an interference it or a dip-on connection, is created betweenn the arms 13ab and tu adaptor 47, [0047] As shown in 1I C. the second end 13 of the guide 10 includes a base portion 25 13d that partially surrounds the first end 41 of the carnula 40 and includes a hook Be that is pIaced on the irrigation extender 50, whieb is oupled to the cannula 40, Showtn if Fig, I ID is a guide 10 that includes a second end 13 having an arm 13 including an openmg 13f and a siot 13f' finned in the arm E3, The fist end 41 of the cannula 40 includes a coupling portion 49, similar io the conpling portions 45, 46 shown in Figs. 1 0 and I A, 5 albert without holes or channels, The second end 13 of the guide 10 is coupled to the first end 41 of the cannula 40 such that the first end 41 of the cannula 40 is disposed within the opening 13P" and the projection (not shown) is housed within the slot 3ft Thec guide 10 may be placed onto the first end 41 by placing the opening 13V over the first end 41 and sliding the arm 13f around the coupung portion 49, so as to create a snap-it connection -0 between the arm 13f and the first end 41. Other methods of coupling the guide to the cannula ma'y also be used, 10048] As shown i.n Fig. 12, a guide 100, similar to the guide 10 in Figs, 1-4, is coupled to a first surgical device 200, such as an lier annr that includes, a dista end 200b in the shape of a hook. ''he distal end 200b of the aier arm 200 is positioned in the 15 posterior region 300h of the yip joint 300, A, second surgical device 400, such as a cannula, is disposed within the through hole 104 of the guide 100. A longitudinal axis 401 of the cannula 400 is co-radial with the tip 200c om.he dista end 200h of the anner arn 200. This co-adial relationship alows access to the posterior region 30b of the hip oint 300, via the temoral neck 300a, by a surgical tool such as a drill (not shown), disposed 20 within the carnula 400. The ainer ann 200 may be introduced into the body 32 in the same manner as the endoscope 20 is introduced as descnbed above, or another manner known to one of ordinary skil in the art. Likewise, the guide 100 maybe coupled to dhe aner arn 200 in the same manner as guide 80 is coupled to the cannula 40 in Fig , in the same manner as guide 10 is coupled to the canmula 40 in Figs i AI 4or another manner .2 5 known to one of ordinary skill in the art. The aimer ann 200 may rtiate aound a 16 longitudinal axis 201 of the aimer arm 200 via a rotational coupling (not shown) located at the proximal end 200a of the amer arn 200, 100491 For the purposes of this discIosure, a manual or automatic milling machine is used to create the through holes of the guides described above Other apparatuses and 5 methods of creating the through holes may also be used. The grades are manufactIred from a metal material, such as stainless steel or titanunb, ut may be manufactured from another material known to one of ordinary skill in the art. In addition, the first and second carnulas and the aimer ann described above are manufactured from a biocompatible metal material, such as stainless steel, but nay be manufactured from another biocompatible material 10 known to one of ordinary skill in the art. Furthermore, for the purposes of this disclosure, the guides include a body having an are along the length of the body, but an arc is not necessary and the body may be straight or incorporate any other shapes known to one of ordinary skill in the art. Although the present disclosure relates to the use of the above described guides for the placement of portals during hip arftroscopy, the basic prnciples 15 and methods may also be applied to other joint areas ofthe body. 100501 in view of the foregoin, it will be seen that the several advantages of the disclosum are achieved and attained. 100511 The embodinents were chosen and described in order to best explain the principles of the disclosure and its practical application to thereby enable oters skilled in the 20 art to best utilize the disclosed in various embodiments and with various modifications as are suited to the particular use contemplated 100521 As various modifications could be made in the constructions and methods herein described and illustrated without departing fom thc scope of the disclosure, it is intended that all matter contained in the foregoing descriplon or shown in the accompanying 25 drawings shall be interpreted as illustrative rather an limiing Thus, the breadth and scope 17 of the present disclosure should not be limited by any of the above-deserbed eXempUPr embodiments, but should be defined only in accordance with the following claims appended hereto and their equivalent,

Claims (5)

1. A method of creating multiple portals during surgery coniprising. creating a frst portal in tissue; inerting a first surgical device though the first portal; directly attaching a 5 first attachment portion of the guide to a first cannula housing the first surgical device, the guide comprising a body and a joint including at least one through hole wherein a longitudinal axis of the through hole is coradial with an end of the first surgical device; and inserting a second surgical device through the hole and into the tissue to create a second portal. 1 0 21 The inethod of' claim I wherein the guide includes a imechanisrn for locking the joint in a position along the body, the method father comprising siding the joint along the body to the position and locking the joint in the position before creating the second portal. 15 3 The method of claim I wherein the second surgical device is co-radial with the end of the first surgical device.

4. ihe method of claim I wherein the body includes mliplethrough. holes. 20 T The method of claim 4 wherein each through hole includes a longitudinal axis that is co-radial with the end of the first surgical device.

6. The method of claim 1 wherein the first surgical device is disposed within the first cannula such that the end of the first surgical device protrudes through an end of the first 25 cannula.

7., T'he method of claim 6 wherein the end of the first cannula includes a pointed tip. the pointed tip offset a distance from the end of the hrst surgical device. 30 8. The method of clain 7 wherein the first surgical device includes an endoscope. the pointed tip offset a distance in a direction of view of the endoscope

9. The method of cialm 7 wherein the longitudinal axis of the through hole is co ai al i.th the pointed tip. 5 10 The method of claim i wherein the first surgical device includes an endoscorpe, the longitudinal axis of tbe through hole co-radial with a point that is offset a distance fiom the end of the endoscope. I . The method of claim 7 wherein the distance is about I cm. 1(} 12, The method of clam 1.0 ierein the distance is about I cm,. 11 [he method of claim I wherein the second surgical device comprises a second cannula. 1.5 14, The method of claim 1.3 herein the second cannula includes a depth stop compIe! to the second cannla. 1. The method of claim I wherein the first surgical device includes an airier arnt the 20 aibner arm having a distal end. 16 The method of clain 15 wherein the aimer arm states about a longitudinal axis of the aner ann. 25 17. The method of claim 15 wherein the second surgical device includes a longitudinal axis that is co-radial with a distal end of the aimer arm. 18, The method of claim 13 wherein a needle is disposed within the second cannula and an end of the needle does not advance past the end of the first surgical device. 30