CN111093553A

CN111093553A - Proximal end fixation of minimally invasive working channel

Info

Publication number: CN111093553A
Application number: CN201880057692.XA
Authority: CN
Inventors: P.希努尔; S.切吉尼; P.森; R.科查里安; J.里希特; D.托门
Original assignee: Medos International SARL
Current assignee: Medos International SARL
Priority date: 2017-09-05
Filing date: 2018-08-21
Publication date: 2020-05-01
Also published as: AU2018329468B2; JP2020533142A; AU2018329468A1; EP3678586A4; JP7230030B2; WO2019050665A1; EP3678586A1

Abstract

The present invention is directed to minimally invasive systems in which the proximal end portion of the working channel has zero or limited range of movement in the lateral direction. The first embodiment has a slidable collar attached to a pair of flanges, wherein movement of the collar is defined by the annular frame. The second embodiment has a substantially spherical element attached to the tube. The third embodiment has a plurality of caps. The fourth embodiment is suitable for larger working channels.

Description

Proximal end fixation of minimally invasive working channel

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This patent application is a continuation-in-part application of U.S. patent application 14/546,620 filed on month 11 and 18 of 2014, which is a continuation-in-part application of U.S. patent application 14/481,822 filed on 9 and 9 of 2014, each of which is incorporated herein by reference.

Background

The general trend in the treatment of spinal pathologies is towards minimally invasive approaches to reduce trauma to surrounding tissues during surgery. For treating lumbar lesions, a percutaneous approach can be selected within a working channel of 4-12 mm. The working channel serves as a safety barrier between the working instrument and sensitive tissue (e.g., nerves and blood vessels) during surgery. The treatment procedures, including discectomy, endplate preparation, implant insertion, and graft material insertion, should be performed through the working channel.

Disclosure of Invention

To ensure the safety of these procedures, the distal end portion of the working channel (from the surgeon's perspective) should be fixed/anchored to the desired point (see fig. 1A and 1B). Typically, these points are bone or intervertebral disc tissue. In addition to securing the distal end portion of the working channel, the proximal end portion of the working channel needs to be able to move laterally, move in cranial/caudal directions, or be substantially fixed, depending on the procedure being performed. For example, during a discectomy, the surgeon may want to change the angle of the working channel in order to better access more of the remaining disc tissue (see fig. 1B). At the same time, it may be desirable that the movement be limited to a given range and be fixed in the axial direction. Further, in some instances, it may be desirable for the proximal portion of the working channel to be completely fixed so as to form a two-point fixation channel between the proximal and distal portions.

Accordingly, the present invention is directed to minimally invasive systems in which the proximal end portion of the working channel has zero or limited range of movement in the lateral direction.

Thus, according to the present invention, there is provided a minimally invasive surgical access system, the system comprising:

a) a tube having an outer wall, a longitudinal bore, a proximal end portion, and a distal end portion;

b) a slide tab comprising a collar having a pair of opposing flanges extending therefrom, wherein the collar is slidable along the outer wall of the tube; and

c) an annular frame having a pair of substantially opposing slots, wherein the flanges of the collar extend through the slots of the annular frame, respectively, and wherein the tube extends through the annular frame.

a) a tube having an outer wall, a longitudinal bore, a proximal end portion, a distal end portion, and a substantially spherical element radially surrounding a segment of the outer wall;

b) a slide tab having a base and a pair of opposing flanges extending therefrom; the base having an aperture therethrough, the aperture defining an edge having a stationary portion and a slidable portion,

c) a ring frame having a pair of substantially opposing slots, wherein each flange of the sliding tab extends through a respective slot of the ring frame, wherein the tube extends through the ring frame, and wherein the stationary portion of the rim releasably contacts a first portion of the substantially spherical element and the slidable portion of the rim releasably contacts a second portion of the substantially spherical element.

a) an upper side cap forming a first portion of a substantially spherical surface,

b) an intermediate cap forming a second portion of the substantially spherical surface and having a central aperture,

c) a lower cap forming a third portion of the substantially spherical surface,

d) a tube comprising an outer wall having an attachment portion, a longitudinal bore, a proximal end portion, a distal end portion, wherein the upper and lower side caps are attached to and extend radially from the outer wall of the tube, wherein at least one of the upper and lower side caps is removably attached to the outer wall of the tube, wherein the tube is received within the central bore of the intermediate cap, and wherein the intermediate cap is received between the upper and lower side caps.

In some aspects, the present invention is directed to a surgical system for supporting an endoscope or other instrument.

Thus, according to the present invention, there is provided a surgical system, the system comprising:

a) an instrument having an outer wall, a proximal end portion, and a distal end portion;

b) a slide tab comprising a collar having a pair of opposing flanges extending therefrom, wherein the collar is slidable along the outer wall of the instrument; and

c) a ring frame having a pair of substantially opposing slots, wherein the flanges of the collar extend through the slots of the ring frame, respectively, and wherein the instrument extends through the ring frame.

In some embodiments, the instrument may be an endoscopic or surgical visualization instrument.

a) an instrument having an outer wall, a proximal end portion, a distal end portion, and a substantially spherical element radially surrounding a segment of the outer wall;

c) a ring frame having a pair of substantially opposing slots, wherein each flange of the sliding tab extends through a respective slot of the ring frame, wherein the instrument extends through the ring frame, and wherein the stationary portion of the rim releasably contacts a first portion of the substantially spherical element and the slidable portion of the rim releasably contacts a second portion of the substantially spherical element.

c) a lower cap forming a third portion of the substantially spherical surface,

d) an instrument comprising an outer wall having an attachment portion, a proximal end portion, a distal end portion, wherein the superior cap and the inferior cap are attached to the outer wall of the instrument and extend radially therefrom, wherein at least one of the superior cap and the inferior cap is removably attached to the outer wall of the instrument, wherein the instrument is received within the central aperture of the intermediate cap, and wherein the intermediate cap is received between the superior cap and the inferior cap.

Drawings

Fig. 1A and 1B disclose the desired range of motion of the system of the present invention.

Fig. 2 discloses a first embodiment of the invention with a slidable collar.

Fig. 3 discloses a second embodiment of the invention with a substantially spherical element attached to the tube.

Fig. 4A-B disclose a third embodiment of the invention having a plurality of caps.

Fig. 5A-C disclose different steps of mounting and fixing the embodiment of fig. 4.

Fig. 6A discloses an exploded view of the device of a fourth embodiment of the invention.

Fig. 6B discloses an assembly drawing of the device of the fourth embodiment of the invention.

Fig. 6C, 6K, 6L, 6M, 6N and 6O disclose various desired orientations of the fourth device embodiment relative to the functional spine unit.

Fig. 6D-6E disclose possible cranial-caudal tilt angles of a fourth embodiment.

Figures 6F-6G disclose possible inside-outside tilt angles for the fourth embodiment.

Fig. 6H-6J disclose respective side, perspective and top views of a fourth embodiment apparatus.

Fig. 6K-6O disclose various views of the device relative to the spine.

Figures 6P-6Q disclose views of a fourth embodiment device in which the inner and outer rods extend parallel to the spine.

Fig. 7 discloses an apparatus for supporting a surgical instrument, such as an endoscope, relative to a patient.

Detailed Description

For the purposes of the present invention, a "distal end portion of a tube" is the portion of the tube closest to the patient and farthest from the surgeon when the tube is inserted into the patient, and a "proximal end portion of a tube" is the portion of the tube farthest from the patient and closest to the surgeon when the tube is inserted into the patient. Additionally, the "working channel" and "tube" are considered interchangeable. In some embodiments, a surgical or surgical visualization instrument can be inserted through the tube, mounted to the interior or exterior of the tube, and/or movably or fixedly coupled to the tube. Although tubes are described in many of the examples herein, the tubes may be replaced by surgical instruments such as endoscopic or surgical visualization instruments.

In the following description, several concepts are described that encompass the following subject matter: a) limiting lateral movement of the proximal end portion of the tube, b) eliminating lateral movement of the proximal end portion of the tube, and c) eliminating axial movement of the proximal end portion of the tube.

Referring now to fig. 2, there is provided a minimally invasive surgical access system comprising:

a) a tube 1, the tube 1 having an outer wall 3, a longitudinal bore 5, a proximal end portion 7 and a distal end portion 9;

b) a slide tab 11, the slide tab 11 comprising a collar 13, the collar 13 having a pair of opposing flanges 15 extending therefrom, wherein the collar is slidable along the outer wall of the tube; and

c) an annular frame 17, the annular frame 17 having a pair of substantially opposed slots 19, wherein the flanges of the collar extend through the slots of the annular frame, respectively, and wherein the tube extends through the annular frame.

The embodiment shown in fig. 2 includes a ring frame that can be secured to a stationary unit, such as an operating table, to anchor the system. As previously described, the distal end portion of the tube may be secured to bony structures within the lumbar spine (such as vertebral bodies) or soft tissue (such as disc cartilage). When the tube is so anchored distally, the proximal end portion of the tube may move in a substantially conical volume, with the distal end of the tube being its apex. The ring frame of the embodiment of fig. 2 secured in the space limits the range of motion of the proximal end portion of the tube. The sliding tab portion of the system is comprised of a collar and a pair of opposing flanges extending therefrom. Preferably, the shape of the flange forms part of a spherical surface simulating limited movement of the tube. The outer annular frame has a pair of opposing mating slots that slidably receive their respective flanges. Preferably, each slot is shaped in an arc matching the arc cross-section of the flange it receives. The working channel is mounted and fixed to the sliding tabs with set screws 21 received in threaded holes in the collar. The set screw may extend through the collar and contact an outer wall of the tube in the proximal end portion of the tube so as to lock the collar to the tube, thereby preventing movement of the tube channel in the axial direction. The limit of lateral movement of the proximal end portion is defined by the outer annular frame. The outer ring frame can be fixed to an operating table 24 with extension arms 23.

Thus, in a preferred embodiment of the first embodiment of the invention, the system further comprises an arm extending from the fixation unit, wherein the arm is attached to the ring frame. Preferably, the collar includes a threaded bore and the system further includes a set screw received in the threaded bore of the collar. Preferably, the set screw may extend through the collar and contact an outer wall of the tube in the proximal end portion of the tube to lock the collar to the tube. Preferably, each flange comprises a portion of the spherical surface 25 and each slot forms an arc, wherein the flange mates with the slot. Preferably, the distal end portion of the tube has an abutment feature (such as a plurality of distally extending teeth 27) adapted to abut to bone or cartilage. In some embodiments, the collar does not contact the annular frame. In some embodiments, the ring frame has a cutout 29, the cutout 29 adapted to allow a screwdriver to access the collar in order to tighten or loosen the set screw. Preferably, the notch is radially aligned with the set screw. Preferably, the proximal end portion of the tube is movable in a substantially frustoconical volume when the distal end portion of the tube is fixed. The tube may be, may be replaced by, and/or may include, for example, a surgical instrument inserted therethrough. The surgical instrument may be an endoscope or other visualization instrument. The system does not necessarily have to provide surgical access, but may be used to support an endoscope or other surgical instrument alone, or in combination with other functions to accomplish such an operation.

Referring now to fig. 3, there is provided a minimally invasive surgical access system comprising:

a) a tube 31, the tube 31 having an outer wall 33, a longitudinal bore 35, a proximal end portion 37, a distal end portion 39, and a substantially spherical element 41 radially surrounding a segment of the outer wall;

b) a slide tab 43, the slide tab 43 having a base 45 and a pair of opposing flanges 47 extending therefrom; the base has an aperture 48 therethrough, the aperture 48 defining an edge 49 having a stationary portion 51 and a slidable portion 53,

c) an annular frame 55, the annular frame 55 having a pair of substantially opposing slots 57, wherein each flange of the sliding tab extends through a respective slot of the annular frame, wherein the tube extends through the annular frame, and wherein the stationary portion of the rim releasably contacts a first portion of the substantially spherical element and the slidable portion of the rim releasably contacts a second portion of the substantially spherical element.

The second embodiment of fig. 3 comprises an outer ring frame which is fixable to a fixed unit, such as an operating table. As previously described, the distal end portion of the tube may be secured to bony structures or soft tissue of the spine such that the proximal end portion of the tube is movable in a substantially frustoconical volume with the distal tip being an apex. In this particular embodiment, the sliding tab has a flat flange that is easier to manufacture. Also, the outer annular frame has a pair of simple linear slots to slidably receive the flanges. The slide tab has an axial bore therein defining a rim including a stationary hemispherical portion and a movable hemispherical portion. When the working channel enters the sliding tab, the set screw 61 can be rotated to move the dynamic hemisphere, thereby holding or releasing the spherical protrusion of the working channel, thereby fixing or releasing the angle of the sliding tab relative to the tube. This allows movement over a desired range. The entire structure allows lateral movement of the distal end within a given range (defined by the slot on the outer frame) and prevents axial movement of the distal end.

Preferably, in this second embodiment, the system further comprises an arm 63 extending from the fixation unit 64, wherein the arm is attached to the ring frame. Preferably, the base includes a first cutout 65 and also includes a sliding door 66 slidably received in the cutout. Preferably, the sliding door comprises a second portion of the edge. Preferably, the sliding door further comprises a substantially hemispherical portion extending from the slidable portion of the rim, wherein the substantially hemispherical portion releasably contacts the second portion of the substantially spherical element to lock the sliding tab to the tube. Preferably, the sliding door is slidably actuated by a set screw. Preferably, each flange of the sliding tab is flat and each respective slot is substantially rectangular such that the flange mates with the slot. Preferably, the distal end portion of the tube has an abutment feature (such as distally extending teeth 67) adapted to abut to bone or cartilage. In some embodiments, the substantially spherical element does not contact the annular frame. Preferably, the ring frame has a second cutout 69 (designed to allow the entry of a screwdriver) radially aligned with the set screw. Preferably, the proximal end portion of the tube is movable in a substantially frustoconical volume when the distal end portion of the tube is fixed. In some embodiments, the flat flange of the sliding tab is not orthogonal to the tube. The tube may be, may be replaced by, and/or may include, for example, a surgical instrument inserted therethrough. The surgical instrument may be an endoscope or other visualization instrument. The system does not necessarily have to provide surgical access, but may be used to support an endoscope or other surgical instrument alone, or in combination with other functions to accomplish such an operation.

Referring now to fig. 4A-4B, a minimally invasive surgical access system is provided, the system comprising:

a) an upper side cap 71, the upper side cap 71 forming a first portion 73 of a substantially spherical surface,

b) an intermediate cap 75, the intermediate cap 75 forming a second portion 77 of a substantially spherical surface and having a central aperture 79,

c) a lower cap 81, the lower cap 81 forming a third portion 83 of a substantially spherical surface,

d) a tube 85, the tube 85 including an outer wall 87 having an attachment portion 89, a longitudinal bore 91, a proximal end portion 93, a distal end portion 95, wherein upper and lower side caps are attached to and extend radially from the outer wall of the tube, wherein at least one of the upper and lower side caps is removably attached to the outer wall of the tube, wherein the tube is received within the central bore of the middle cap, and wherein the middle cap is received between the upper and lower side caps.

The concept includes three spherical caps stacked on top of each other. The middle cap is the proximal point where the rigid arm is fixed. The lower cap extends from and is preferably integral with the working channel. The lower cap helps prevent the working channel from pulling proximally through the aperture of the middle cap. The intermediate cap has a hole of a predetermined size which allows limited lateral movement of the working channel, thereby defining the boundary of the allowed movement. The middle cap is secured to the operating table via an attachment, as described above. The intermediate cap may have a securing element to facilitate securing. The upper cap has a threaded bore 97 and helps prevent the channel from advancing distally when threadably engaged to the threaded 89 portion of the working channel. In this concept, if the upper cap is advanced distally, it will create friction between the caps and prevent movement of the caps relative to each other. In other words, the concept allows for movement of the working channel and, at the same time, complete fixation of the distal and proximal ends of the working channel at the desired direction.

Preferably, in the embodiment of fig. 4, the upper side cap is located proximal to the lower side cap. Preferably, the intermediate cap has a fixing element 101 for fixing to a fixing unit. Preferably, the system further comprises an arm 103 extending from the fixation unit 105, wherein the arm is attached to the fixation element. Preferably, the proximal portion of the tube is movable in a substantially frustoconical volume when the distal end portion of the tube is fixed. Preferably, the distal end portion of the tube has an abutment feature 107 adapted to abut to bone. Preferably, the upper, middle and lower side caps are located in the proximal-most quarter PQ of the tube.

In some embodiments, the upper cap has a threaded bore 97, the outer wall of the working channel has a threaded portion 89, and wherein the upper cap is threadedly received on the threaded portion of the outer wall of the tube.

In fig. 4, the upper side cap is shown as removable due to its threadable engagement on the outer wall of the tube. However, removability is not limited to threaded features. For example, in some embodiments, the tube and cap can provide a Morse taper lock. In other embodiments, the cap is made of an elastic material that fits snugly against the outer wall of the tube.

In some embodiments, one of the superior and inferior caps is removably attached to the outer wall of the tube, and the other is integrally attached to the outer wall of the tube.

In some embodiments, one of the upper or lower side caps has a threaded bore, the outer wall has a threaded portion, and the cap having the threaded bore is threadedly received on the threaded portion of the outer wall of the tube.

In some embodiments, both the upper and lower side caps are removably attached to the outer wall of the tube, preferably threadedly attached.

A functional prototype of the method is shown in fig. 5A-C, which have different steps of mounting and fixing. In fig. 5A, a tube having an upper threaded portion and a lower cap permanently attached thereto is provided. In fig. 5B, the middle cap is lowered onto the lower cap. In fig. 5C, an upper side cap having a threaded bore is placed over the middle cap and threadedly engaged onto the threaded portion of the pipe, thereby capturing the middle cap between the upper and lower side caps. Finally, the intermediate cap is attached to the fixing unit.

In some embodiments, the features of the upper and lower side caps are reversed. Thus, according to the invention, one of the upper and lower side caps is removably attached to the outer wall of the tube, and the other of the caps is integrally attached to the outer wall of the tube. Alternatively, both the upper and lower side caps are removably attached to the outer wall of the tube.

The tube may be, may be replaced by, and/or may include, for example, a surgical instrument inserted therethrough. The surgical instrument may be an endoscope or other visualization instrument. The system does not necessarily have to provide surgical access, but may be used to support an endoscope or other surgical instrument alone, or in combination with other functions to accomplish such an operation.

It is believed that the above embodiments, in combination with a working channel diameter of only a few millimeters, are generally suitable for use in typical percutaneous spinal procedures. However, in certain spinal procedures, the use of the above-described embodiments may require very large and cumbersome configurations. These particular procedures (including direct reduced pressure procedures performed through a small incision posterior or medial bypass) typically require:

a) a tube having a working channel diameter greater than usual (e.g., a diameter of about 10mm to about 30 mm), or

b) The larger cranial tail and the internal and external inclination angles enable a larger angular motion range to be realized.

Thus, to address these circumstances, in a fourth embodiment, and referring now to fig. 6A-6O, there is provided an apparatus comprising:

a) an arm 1, the arm 1 having a distal end portion 5 and a proximal end portion 3 connected to a fixation object,

b) an inner and outer rod 7, the inner and outer rod 7 being connected to the distal end portions of the arms and having a first rail 9;

c) a cranial-caudal rod 11, the cranial-caudal rod 11 having:

i) a first guide rail 13, the first guide rail 13 being slidably engaged with the first guide rails of the inner and outer bars in a first direction; and

ii) a second rail 15, the second rail 15 extending substantially perpendicular to the first rail of the cranium-caudal rod;

d) a working channel configuration 17, the working channel configuration 17 comprising:

i) a tube 19, the tube 19 having an outer surface 20 and a proximal end portion 22; and

ii) a slider 21 attached to the outer surface of the tube and having a first rail 23 slidably engaged with a second rail of the cranial tail rod.

The function of this fourth embodiment is substantially similar to the previously described embodiments. For example, the working channel tube thereof has a limited range of motion in the axial direction. Secondly, the fourth embodiment also allows angular movement of the proximal end of the working channel configuration, so as to keep the tip of the tube always in the same position. See, e.g., fig. 6D-6G.

This fourth embodiment is particularly useful in direct decompression surgery when a) the diameter of the tube of the working channel needs to be about 10mm to about 30mm, or b) a larger cranial-caudal and medial-lateral inclination angle is required in order to require a larger range of angular motion.

In fig. 6A-6B of the present invention, the working channel tube may be attached and detached from the slide during surgery. Various coupling or button mechanisms may be selected for such attachment.

In fig. 6A-6O, the slider is slidably connected to the cranial rod by a mating guide rail. Preferably, the mating rails of the slider and the cranium caudal rod have mating arcuate shapes. See fig. 6D-6E. Preferably, the curvature of these arcuate tracks is selected such that the common radius defined by their curves corresponds to the distance between the bend location in the final assembly and the end of the working channel tube. In other words, the distal tip of the working channel tube defines the center point of the circle formed by the mating guide rails. In this way, it is ensured that when the position of the slider along the guide rail of the cranial caudal rod is changed in space, the position of the tube distal end center point in space is not changed, only the direction of the working channel tube center axis is changed. Typically, the curved slider rail can slide smoothly along the mating curved rail of its cranio-caudal rod (thereby continuously changing the cranio-caudal angle of the working channel configuration). However, in some embodiments, the position of the rails relative to each other may be fixed. Various mechanisms can be selected to fix the relative positions of these rails. For example, opposing teeth may be provided along each of the mating tracks, as shown in fig. 6A. These teeth can act as anchors when fixation is desired. This fixation defines the cranial-caudal angle of the working channel tube.

In fig. 6A-6O, the first and second rails of the cranium caudal rod are each arcuate. Preferably, the arcs of the rails are equal so that the cranial rod defines a spherical surface. The center of the sphere is defined by the end positions of the working channel configuration in the final assembly. The rails of the inner and outer rods cooperate with the first rail of the cranium-caudal rod and therefore also preferably have an arc shape with the same radius. The two pole members are slidably connected to each other through these arc-shaped guide rails. A bolt-slot connection or similar configuration may be used to slidably connect the two rods to ensure that the cranium-caudal rod not only maintains its perpendicular orientation with respect to the inner and outer rods, but is also able to slide along the slot. The position of the cranium rod relative to the inner and outer rods defines the inner and outer angles of the working channel configuration. This position may be fixed if desired. Various mechanisms are contemplated to achieve the positional fixation. For example, teeth may be provided along each rail that act as anchors.

In fig. 6C, the inner and outer rods are attached to a rigid arm whose position can be fixed relative to the operating room table during surgery.

Although the cranium-caudal rod is shown in fig. 6A as having four rails to form a rectangle with an interior window, in some embodiments, the cranium-caudal rod may include 3 rails (defining a "U" shape) or 2 rails (defining an "L" shape). While the "4-rail" configuration described may provide the highest stability of these embodiments against bending of the working channel configuration about the axis along the rod, and at the same time may provide the finest dimensions of the rail, it is also contemplated that a stable, extremely rigid sliding/connecting mechanism may be required that is supported by only one rail or does not require a closure rod.

In some embodiments (as shown in fig. 6B), the craniocerebral rod has a release button 25 for releasable attachment to the inner and outer rods. Typically, depressing the button releases the toothed elements on the cranium caudal rod from engagement with the teeth of the rails of the inner and outer rods.

In some embodiments (as shown in fig. 6B), the slider has a release button 27 for releasable attachment to a cranial tail rod. Typically, the button engages the teeth of the second rail of the cranium caudal rod.

In some embodiments (as shown in fig. 6A), the inner and outer rods have a first window 29 or slot therein for slidably receiving a cranial tail rod. Typically, the slot is adjacent to the rails of the inner and outer rods, and the first rail of the cranium caudal rod has a bolt-like shape to provide a slidable bolt-slot connection with the inner and outer rods.

In some embodiments (as shown in fig. 6A), the cranium caudal rod has a third rail 31, the third rail 31 extending from the first rail of the cranium caudal rod in a direction substantially parallel to the second rail of the cranium caudal rod. This embodiment may provide a cranial caudal rod having a U-shape. In this embodiment, stops may be provided at both ends of the U-shape so that the slider is retained within the pocket of the U-shape.

In some embodiments, the slider further comprises iii) a second rail (not shown) substantially parallel to the first rail of the slider, wherein the second rail of the slider is slidably engaged with the third rail of the cranial tail rod.

In some embodiments (as shown in fig. 6B), the tube is disposed between the second rail and the third rail of the cranial caudal rod. This allows the force acting on the tube to be uniformly supported by the pair of rails of the cranial tail rod.

In some embodiments (as shown in fig. 6A), a fourth rail (connecting rod) 35 connects the second rail and the third rail of the cranium caudal rod to form a second window 37, and the tube extends through the second window. This ensures that the slider will remain slidably attached to the cranial rod.

In some embodiments (as shown in fig. 6B), the first rails of the inner and outer rods and the first rail of the cranium caudal rod have mating teeth 39 thereon, and the second rail of the cranium caudal rod and the first rail of the working channel configuration have mating teeth 41 thereon. This allows the relative position of the components to be fixed with the aid of a member integral with the components sliding along the guide rail with the teeth and engageable with the teeth, thereby ensuring the position of the working channel tube relative to the patient.

In some embodiments, the medical device is located within a tube. In some embodiments thereof, the medical device is an instrument, while in other embodiments, the medical device is an implant. Typically, the medical device is delivered from the proximal end portion of the tube to the distal end portion of the working tube.

In some embodiments, the first rails of the medial and lateral rods and the first rail of the cranial caudal rod have matching arcuate shapes. This allows the tube to tilt in a first plane relative to the patient while maintaining the position of the distal end of the tube.

In some embodiments, the second rail of the cranial caudal rod and the first rail of the slider have matching arcuate shapes. This allows the tube to tilt in a second plane relative to the patient while maintaining the position of the distal end of the tube.

In some embodiments, the slider may be attached to and detachable from the outer surface of the tube at the proximal end portion of the tube. This allows fine control of the position of the proximal end portion of the tube. This also allows the tube to be introduced at the correct position in the patient's body in the first surgical step. The remainder of the components are pre-assembled and can be attached to the tube at this attachment location of the slider, with the arm in a flexible configuration. After attaching the tube to the rest of the assembly, the arm can be made to a rigid configuration, thereby leaving only the option of changing the position of the tube relative to the patient to an angular change through a rail connection.

In some embodiments, the first rail of the cranium caudal rod is slidably engaged with the first rails of the inner and outer rods via a bolt-and-slot connection. This arrangement helps maintain the orientation of the craniocaudal rod relative to the internal and external rods. Fig. 6K-6L disclose views of a fourth embodiment device in which the inner and outer rods extend parallel to the spine.

For example, fig. 7 shows an exemplary embodiment in which the tube is replaced by an endoscope 59. The endoscope may be flexible or rigid. The endoscope may include any one or more of a lens, a light source, a camera, an eyepiece, and a working channel. The endoscope may be a cystoscope, nephroscope, bronchoscope, arthroscope, colonoscope, and/or laparoscope. Endoscopes may be used to visualize surgical sites within a patient's body, such as the spine, abdomen, pelvis, joints, GI system, colon, bladder, kidney, larynx, ears, skull, and the like.

The components of the invention are preferably made of a biocompatible metal such as stainless steel, titanium alloy or cobalt chromium alloy. However, it is contemplated that the components may be made of polymeric materials in order to provide an inexpensive single use system.

Claims

1. A minimally invasive surgical access system comprising:

c) a ring frame having a pair of substantially opposing slots,

wherein the flanges of the collars respectively extend through the slots of the ring frame, and

wherein the tube extends through the annular frame.

2. The system of claim 1, further comprising:

d) an arm extending from a stationary unit, wherein the arm is attached to the ring frame.

3. The system of claim 1, wherein the collar comprises a threaded hole, and further comprising:

d) a set screw received in the threaded bore of the collar.

4. The system of claim 3, wherein the set screw is configured to extend through the collar and contact the outer wall of the tube in the proximal end portion of the tube to lock the collar to the tube.

5. The system of claim 1, wherein each flange comprises a portion of a spherical surface and each slot forms an arc, wherein the flange mates with the slot.

6. The system of claim 1, wherein the distal end portion of the tube has a docking feature adapted to dock to bone or cartilage.

7. The system of claim 1, wherein the collar does not contact the annular frame.

8. The system of claim 3, wherein the ring frame has a cutout.

9. The system of claim 8, wherein the cutout is radially aligned with the set screw.

10. The system of claim 1, wherein the proximal portion of the tube is movable in a substantially frustoconical volume when the distal end portion of the tube is fixed.

11. A minimally invasive surgical access system comprising:

c) a ring frame having a pair of substantially opposing slots,

wherein each flange of the sliding tab extends through a respective slot of the ring frame,

wherein the tube extends through the annular frame, and

wherein the stationary portion of the rim releasably contacts a first portion of the substantially spherical element and the slidable portion of the rim releasably contacts a second portion of the substantially spherical element.

12. The system of claim 11, further comprising:

13. The system of claim 11, wherein the base includes a first cutout, and the system further comprises:

d) a sliding door slidably received in the cutout.

14. The system of claim 13, wherein the sliding door includes the slidable portion of the edge.

15. The system of claim 14, wherein the slidable portion of the rim comprises a substantially hemispherical portion, wherein the substantially hemispherical portion releasably mates with the second portion of the substantially spherical element.

16. The system of claim 13, wherein the sliding door is slidably actuated by a screw.

17. The system of claim 13, wherein the ring frame has a second cutout.

18. The system of claim 11, wherein the distal end portion of the tube has a docking feature adapted to dock to bone or cartilage.

19. The system of claim 11, wherein each flange is flat and each slot is substantially rectangular, wherein the flange mates with the slot.

20. The system of claim 19, wherein the second cutout is radially aligned with the set screw.

21. The system of claim 11, wherein the stationary portion of the rim comprises a substantially hemispherical portion that releasably mates with the first portion of the substantially spherical element.

22. The system of claim 11, wherein the flange of the sliding tab is not orthogonal to the tube.

23. A minimally invasive surgical access system comprising:

c) a lower cap forming a third portion of the substantially spherical surface,

d) a tube comprising an outer wall having an attachment portion, a longitudinal bore, a proximal end portion, a distal end portion,

wherein the upper and lower side caps are attached to the outer wall of the tube and extend radially therefrom,

wherein at least one of the superior cap and the inferior cap is removably attached to the outer wall of the tube,

wherein the tube is received in the central bore of the intermediate cap, and

wherein the intermediate cap is received between the upper side cap and the lower side cap.

24. The system of claim 23, wherein the superior cap is located proximal to the inferior cap.

25. The system of claim 23, wherein the intermediate cap has a securing element for securing to a securing unit.

26. The system of claim 25, further comprising:

e) an arm extending from the fixation unit, wherein the arm is attached to the fixation element.

27. The system of claim 23, wherein the proximal portion of the tube is movable in a substantially frustoconical volume when the distal end portion of the tube is fixed.

28. The system of claim 23, wherein the distal end portion of the tube has an abutment feature adapted to abut to bone.

29. The system of claim 23, wherein the upper cap, the middle cap, and the lower cap are located in a proximal-most quarter of the tube.

30. The system of claim 23, wherein one of the upper or lower side caps has a threaded bore, the outer wall has a threaded portion, and the cap having the threaded bore is threadedly received on the threaded portion of the outer wall of the tube.

31. The system of claim 23, wherein one of the superior and inferior caps is removably attached to the outer wall of the tube and the other of the caps is integrally attached to the outer wall of the tube.

32. The system of claim 23, wherein both the upper side cap and the lower side cap are removably attached to the outer wall of the tube.

33. The system of claim 23, wherein the upper and lower side caps are both threadably attached to the outer wall of the tube.

34. An apparatus, comprising:

a) an arm having a distal end portion and a proximal end portion connected to a fixation object,

b) an inner and outer rod connected to the distal end portion of the arm and having a first rail;

c) a cranial caudal rod having:

i) a first rail slidably engaged with the first rails of the inner and outer rods in a first direction; and

ii) a second rail extending substantially perpendicular to the first rail of the cranium-caudal rod;

d) a working channel configuration, the working channel configuration comprising:

i) a tube having an outer surface and a proximal end portion; and

ii) a slider attached to the outer surface of the tube and having a first rail slidably engaged with the second rail of the cranial tail rod.

35. The apparatus according to claim 34, wherein said craniocaudal stem has a release button for releasable attachment to said inner and outer stems.

36. The apparatus according to claim 34, wherein the slider has a release mechanism for releasable attachment to the cranial tail rod.

37. The apparatus according to claim 34, wherein said inner and outer rods have a first window therein for slidably receiving said cranial-caudal rod.

38. The apparatus according to claim 34, wherein the cranium-caudal rod has a third rail extending from the first rail of the cranium-caudal rod in a direction substantially parallel to the second rail of the cranium-caudal rod.

39. The apparatus according to claim 38, wherein the slider further comprises iii) a second rail substantially parallel to the first rail of the slider, wherein the second rail of the slider is slidably engaged with the third rail of the cranial tail rod.

40. The apparatus of claim 39, wherein the tube is disposed between the second rail and the third rail of the cranial caudal rod.

41. The apparatus of claim 40, wherein a fourth rail connects the second rail and the third rail of the cranium caudal rod to form a second window, and the tube extends through the second window.

42. The apparatus of claim 34 wherein the first rails of the inner and outer rods and the first rail of the cranium-caudal rod have mating teeth thereon.

43. The apparatus according to claim 34, wherein the second rail of the cranial tail rod and the first rail of the slider have mating teeth thereon.

44. The apparatus of claim 34, further comprising: e) a medical device positioned within the tube.

45. The apparatus of claim 44, wherein the medical device is an instrument.

46. The apparatus of claim 44, wherein the medical device is an implant.

47. The apparatus of claim 34, wherein the first rails of the inner and outer rods and the first rail of the cranium-caudal rod have matching arcuate shapes.

48. The apparatus of claim 34, wherein the second rail of the cranial tail rod and the first rail of the slider have matching arcuate shapes.

49. The apparatus of claim 34, wherein the slider is attached to the outer surface of the tube at the proximal end portion of the tube.

50. The apparatus of claim 34, wherein the outer surface of the tube has threads thereon at the proximal end portion of the tube, the slider includes a window having mating threads thereon, and the slider is threadably engaged with the proximal end portion of the tube.

51. The apparatus of claim 34, wherein the first rail of the cranium-caudal rod is slidably engaged with the first rails of the inner and outer rods via a bolt-slot connection.

52. The device of claim 34, wherein the tube has a distal end center point, and the distal end center point remains at the same position in space as the position of the slider along the second rail of the cranial tail rod changes.

53. An apparatus, comprising:

c) a cranial caudal rod having:

d) a surgical instrument configuration, the surgical instrument configuration comprising:

i) an endoscope having an outer surface and a proximal end portion; and

ii) a slider attached to the outer surface of the endoscope and having a first rail slidably engaged with the second rail of the cranial tail rod.

54. The apparatus according to claim 53, wherein said craniocaudal stem has a release button for releasable attachment to said inner and outer stems.

55. The apparatus according to claim 53, wherein the slider has a release mechanism for releasable attachment to the cranial tail rod.

56. The apparatus according to claim 53, wherein said inner and outer rods have a first window therein for slidably receiving said cranial-caudal rod.

57. The apparatus of claim 53, wherein the cranium caudal rod has a third rail extending from the first rail of the cranium caudal rod in a direction substantially parallel to the second rail of the cranium caudal rod.

58. The apparatus according to claim 57 wherein the slider further comprises iii) a second rail substantially parallel to the first rail of the slider, wherein the second rail of the slider is slidably engaged with the third rail of the cranial tail rod.

59. The apparatus according to claim 58, wherein the endoscope is disposed between the second rail and the third rail of the cranial caudal rod.

60. The apparatus according to claim 59, wherein a fourth rail connects the second rail and the third rail of the cranial caudal rod to form a second window, and the endoscope extends through the second window.

61. The apparatus according to claim 53, wherein said first rails of said inner and outer rods and said first rail of said cranium-caudal rod have mating teeth thereon.

62. The apparatus of claim 53, wherein the second rail of the cranial tail rod and the first rail of the slider have mating teeth thereon.

63. The apparatus of claim 53, wherein the first rails of the inner and outer rods and the first rail of the cranium-caudal rod have matching arcuate shapes.

64. The apparatus of claim 53, wherein the second rail of the cranial tail rod and the first rail of the slider have matching arcuate shapes.

65. The apparatus of claim 53, wherein the slider is attached to the outer surface of the endoscope at the proximal end portion of the endoscope.

66. The apparatus of claim 53, wherein the outer surface of the endoscope has threads thereon at the proximal end portion of the endoscope, the slider comprises a window having mating threads thereon, and the slider is threadably engaged with the proximal end portion of the endoscope.

67. The apparatus of claim 53, wherein the first rail of the cranium-caudal rod is slidably engaged with the first rails of the inner and outer rods via a bolt-slot connection.

68. The apparatus according to claim 53 wherein the endoscope has a distal end center point and the distal end center point remains at the same position in space as the position of the sled changes along the second rail of the cranial tail rod.