KR20150126629A

KR20150126629A - Surgical access assembly and method of using same

Info

Publication number: KR20150126629A
Application number: KR1020157026382A
Authority: KR
Inventors: 조셉 엘. 마크; 브라이언 씨. 도허티
Original assignee: 니코 코포레이션
Priority date: 2013-03-05
Filing date: 2014-02-11
Publication date: 2015-11-12
Also published as: AU2014226508A1; BR112015021345A2; CA2901428A1; EP2964071A1; WO2014137551A1; JP2016508823A

Abstract

A surgical access assembly including an outer tube and an optionally removable occluder is described. The outer tube is defined by an open circular tip and an open proximal end and includes a hollow body portion therebetween. The occluder is defined by a distal end and a proximal end, and the distal end further comprises a tapered distal end member. The closure is configured to be received within the outer tube such that when the closure is in the configuration for introducing the closure, the tapered distal end member projects from the open distal end of the outer tube. The outer tube further includes a grip member, and the grip member includes at least one holding notch formed on the outer surface thereof.

Description

[0001] SURGICAL ACCESS ASSEMBLY AND METHOD OF USING SAME [0002]

FIELD OF THE INVENTION The present invention relates generally to surgical systems for use in fragile and critical tissues, approaches using the same, and surgical methods.

Diagnosis and treatment of diseases affecting the brain is one of the most difficult and complex problems facing the healthcare industry. The brain is a complex, fragile, soft multi-component tissue structure that controls body function through a complex neural network that is connected to the rest of the body through the spinal cord. The brain and spinal cord are accommodated in important skeletal structures, such as the skull and vertebrae, and are protected by the skull and vertebrae. A rigid skeletal protection Within the brain that determines the difficulty of approaching the brain through the skull and the ability of the human body to perform speech, visual, auditory, functional mobility, comprehension, emotional, respiratory, and other metabolic functions Given the fragile network and complex interactions that make up the accepted neural network, the diagnosis and treatment of brain disorders presents unique challenges that are not encountered elsewhere in the body.

For example, intracranial cerebral hematomas (ICH), abscesses, glioblastomas (GB), which appear in the intraparenchymal cortical space (ie, white matter) And metastases (mets), are particularly challenging and inaccessible to treatment. The ventricle of the brain accommodates vital communication structures (neural networks) called fiber tracts and fascicles located in the subcortical space. Therefore, in the past, access to abnormal ICH, GB, and / or tumor metastasis would not allow the disease to spread unless ICH, GB, and / or tumor metastasis were never considered to be "superficial & Only because they were considered to be harmful were these diseases considered to be inoperable. Similarly, tissue abnormalities such as tumor, cyst, and fibrous membrane growth within the brain's ventricular space are believed to be difficult, often inoperable, due to their location in the brain.

In order to aid diagnosis and subsequent treatment of brain disorders, it is required to clearly and accurately image brain tissue through the skull. Recently, stereotactic X-ray imaging, computerized axial tomography (CAT), computerized tomographic angiography (CTA), positron emission tomography (PET) Significant advances have been made in imaging technology including magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), and a career guidance system (instrument location tracking system). Such imaging devices and techniques , Allowing surgeons to observe disease in the brain in a non-invasive manner without opening the skull, and to include interest in structures such as blood vessels, membranes, tumor margins, If the unsteady portion is identified using one or more imaging techniques and / or techniques, the biopsy of the abnormal portion (biopsy ) Or removal may be necessary or desirable.

Once a policy is determined on the basis of one or more imaging techniques, surgical treatment may be required or required. To surgically operate the brain, access should be made through the cranium and soft brain tissue that accommodate vessels and nerves that may be adversely affected by some disability. Therefore, careful attention should be paid to brain surgery to avoid touching fragile blood vessels and nerves to prevent negative consequences resulting from surgical intervention.

Traditionally, the approach to the abnormal part, which appears in deeper spaces within the brain, has meant that surgery is needed to create a very invasive approach. In some cases, to access the target tissue, a substantial portion of the skull is removed, and the entire portion of the brain is pulled to approach. For example, a surgical brain retractor is used to pull or pull soft brain tissue, which can leave a pressure mark by the transverse edge of the retractor. In some cases, the use of a brain retractor may cause a problem known as "retraction injury ". Of course, this technique is not appropriate for all situations, and not all patients can withstand this invasive technique.

Although it is also known to approach certain parts of the brain with burr hole craniotomy, only limited surgical procedures can be performed through such smaller openings. Also, some techniques have been developed to enter through nasal passages, for example, to open access holes through the occipital bone to remove tumors located within the area of the pituitary gland.

Significant developments in brain surgery have been associated with stereotaxic X-ray images to guide the pathology guide system probe or other surgical instrument through the opening formed in the skull through the brain tissue to the target lesion or other body It is a stereotactic surgery involving a frame. Related developments are frame-less image induction where the image of the surgical instrument overlaps the pre-operative image to show the surgeon the location of the instrument and the additional movement trajectory of the probe or instrument.

More recently, it has focused on developing a surgical access system to provide access to areas that were previously difficult to access. However, although the access system proposed so far can provide a way of approaching certain brain tissue, such a system is configured to have a blunt-ended distal end, the blunt distal end of which has a cytoreduction, Thereafter, damage to blood vessels, cranial nerves, fibers and fibers can actually cause transient or even permanent deformations and trauma of the weak tissue structure, which itself may represent a temporary or permanent neurological deficit.

During surgery, it is often necessary to protect certain major vessels and / or structures adjacent to the area to be operated at the surgical site. It is known to use a surgical patty to cover such vessels or structures. However, there are certain problems with known surgical patties.

First, the known surgical patties consist of absorbent cotton gauzes, which can be chemically bonded together to give the gauze a relatively high wet strength. The resulting gauze structure has a surface containing various absorbent fibers. As the surgical patty is left in place at the surgical site, the existing fluid is permeable to the fibers, and the fibers may tend to adhere to the body tissue to which the gauze structure is touched. Therefore, when the surgical patty is placed on the tissue and moved along or removed from the surgical site, this movement can be used to wipe and tear the tissue and protect the soft nerves from which the patty is used to protect it from other equipment used during surgery Resulting in damage to vascular tissue.

Another problem experienced in known surgical patties is that it is difficult to maintain the location and location of the retrieval string during surgical operations to prevent the surgical patty from falling into the surgical site during surgical operations. Known systems use a lock surgical clamp or similar device called "snaps" to maintain the position of the surgical patty string within the surgical site. When the patty is displaced or removed within the surgical site, such a retaining device must be removed from the patty string again to relocate and reapply the patty.

Despite these advances, there remains a need for improved surgical techniques and devices for surgery in brain tissue. There is also a need for an improved surgical patty to address the particular difficulties of minimally invasive neurosurgery, including managing the retention and traction of such patty strings.

Exemplary embodiments of the present invention will now be described in more detail with reference to the accompanying drawings.
1 is a cross-sectional perspective view of an exemplary configuration of a surgical access assembly.
Figure 2 is a perspective view of the outer barrel of the surgical access assembly of Figure 1;
3 is an end view of the outer cylinder of Fig.
4 is a perspective view of an alternative configuration of the outer barrel of the surgical access assembly.
5 is an end view of the outer cylinder of Fig.
Figure 6 is a perspective view of an exemplary surgical device used for cytoreduction.
7 is a perspective view of a first side of an exemplary surgical patty.
Fig. 8 is a perspective view of the rear side of the surgical patty of Fig. 5; Fig.
Figure 9 is a partial cross-sectional view of a surgical access assembly in which the outer tube is in place in the brain and a surgical patty is inserted therein.

An exemplary approach to the disclosed assembly and method will now be described in detail with reference to the following description and also to the drawings. Although the figures illustrate some feasible approaches, the drawings are not necessarily to scale and some features may be exaggerated, removed, or partially separated to better illustrate and describe the present invention. It is also to be understood that the description provided herein is not intended to be exhaustive or to limit or limit the claims to the precise forms and configurations illustrated in the drawings and described in the following detailed description.

Described herein are surgical access assemblies, various components used in surgical access assemblies, and methods of using surgical access assemblies. The components disclosed herein provide the surgeon with an enhanced ability to minimize trauma to the patient, while providing an efficient, minimally invasive surgical technique, such as, for example, intracranial surgical techniques.

Referring to Figure 1, a cross-sectional perspective view of a surgical access assembly 100 is shown. In one exemplary configuration, the surgical access assembly 100 includes a hollow outer tube 102 and an optionally removable obturator 104. The occluder 104 is configured to allow the distal end 106 of the obturator 104 to protrude from the distal end 108 of the outer barrel 102 at a predetermined distance as will be described in greater detail below. And is configured to have a longer length than the length.

A locking member 110 may also be provided. As will be described in more detail below, the locking member 100 is configured to operably hold a separate, in-guided guide member 112 (shown in phantom) within the closure 104. The retaining member 114 may be secured within a portion of the closure 104 to prevent the locking member 110 from fully disengaging from the closure 104. [

Referring now to Figure 2, the outer tube 102 will be described in more detail. The outer tube 102 is defined as a distal end 108 and a proximal end 116 and includes a generally hollow body portion 118 and a grip portion 120. In one exemplary configuration, as shown in the figure, the grip portion 120 is comprised of a ring. However, it is understood that the gripper 120 need not be constituted as a ring. Hereinafter, the grip portion 120 will be referred to as a grip ring 120 for easy explanation. The phage ring 120 is securely fixed to the body portion 118 at the proximal end 116. [ In one exemplary configuration, the body portion 118 includes a transparent structure that permits observation of normal tissue, abnormal tissue as well as important structures disposed outside of the body portion 118 when the outer tube 102 is disposed within such tissue Conformable material. In one exemplary configuration, the outer tube 102 is comprised of polycarbonate, but other biocompatible materials, including resins, may be employed.

In one exemplary configuration, an imaging device that can visualize in real time tumors, blood vessels, fiber tracks, fascicles, and even healthy tissue can be integrated into the outer tube 102. Indeed, as will be described in more detail below, the imaging mechanism allows the physiological functional imaging to provide information about the characteristics of the cortical fibers to be visualized, thereby allowing the user to gain access to the desired location in the brain , Such fibers can be cut and positioned on both sides of the outer tube 102, instead of cutting, stretching and potentially damaging them. And, as will be described in more detail below, the imaging mechanism also allows the surgeon to position the outer tube 104 and then, in the course of an abnormality resection procedure therethrough, Information can be obtained. In addition to imaging with white matter tract, mapping of cerebral blood flow characteristics can be obtained.

In one exemplary embodiment, the imaging mechanism may be an ultrasonic probe integrated into the outer tube 102. For example, the outer tube 102 may have one or more channels within the wall defining the outer tube 102 configured to include one or more small diameter ultrasonic probes. In another configuration, a single ultrasonic probe configured to be received within the outer tube 102 may be provided. In another embodiment, a low field MRI probe may be selectively positioned within the outer tube 102 to provide improved imaging. In another embodiment, a low magnetic field MRI imaging coil may be molded or bonded into the outer casing 102. In another exemplary configuration, the probe may be optical coherent tomography (OCT) imaging or spectroscopy.

The distal end 108 of the outer barrel 102 is tapered to a tapered portion 108 extending toward the central axis AA of the outer barrel 102 with a distal edge 132 surrounding the opening 134 at the distal end 108 of the outer barrel 102 130). The tapered portion 130 extends from the diameter defining the body portion of the obturator 104 to the diameter defining the body portion 118 of the outer tube 102 without any tissue drag, And facilitates the transition between the outer cylinder 102 and the distal end portion 172. [ In one exemplary configuration, the distal end 108 has a radius or other configuration to create a smooth / atraumatic transition of the brain tissue when the surgical access assembly 100 is inserted into the brain Respectively.

For example, the distal edge 132 is configured to be non-sharpened and radiused. In one exemplary configuration, the distal edge 132 is configured as a rim curved with a 0.3 mm diameter. The tapered portion 130 and the curved distal end 132 cooperate with the obturator 104 to provide tissue and various structures in the brain including the white matter without cutting the tissue or such structure from the outer tube 102 without trauma . Indeed, unlike conventional devices that include a blunt distal tip or a tapered leading edge, the curved distal tip 132 may be engaged with the tapered portion 130 and the occluder 104 to create an indentation bruising) and prevent damage. More specifically, this configuration facilitates entry of the outer tube 102 into the soft tissue without severing the soft tissue. The insertion of the surgical access assembly 100 is described in further detail below.

The body portion 118 may further include a plurality of spaced indicators 136. 2, the indicator 136 extends generally around the periphery of the body portion 118, and each indicator further includes a secondary indicator 138 that visually indicates a predetermined position in the body portion 118 can do. Although FIG. 2 shows four indicators 136, it is understood that the body portion 118 can have various lengths and the indicator 136 can be provided in any number. The body portion 118 may also have a longitudinal indicator (not shown). An exemplary longitudinal indicator 140 is described in co-pending U. S. Patent Application Serial No. 13 / 280,015, the contents of which are incorporated in its entirety. Indicators 136 and 138 may be formed of a material such as, for example, fluro-deoxyglucose (FDG), Technicium 99, Gadolinium, titanium powder, barium sulfate, , A combination thereof, or other suitable imaging material, such as an ink, to the inside or outside of the body portion 118. Indicators 136 and 138 provide a reference point to the system 100 operator as the structure may be seen through the body portion 118. [ Indicators 136 and 138 may also be configured to be viewable with MRI, CT, PET, or any other suitable imaging technique to enable easy identification of the area of interest. In one alternate embodiment, the indicators 136 and 138 may be etched or printed on the body portion 118, i.e., the inner or outer surface of the body portion 118.

The details of the phage ring 120 are best shown in FIG. The phage ring 120 is generally configured as a flange member 142 defined by an outer rim 144 and an inner opening 146. The inner opening 146 may have a size corresponding generally to the diameter of the lumen 148 defined by the body portion 118. The outer surface 144 has a size that is larger in diameter than the lumen 148 of the body portion 26. The flange member 142 may further include one or more small openings 150 disposed therein. In one exemplary arrangement, a plurality of small openings 150 are provided that are generally equidistantly spaced about the inner opening 146. The small opening 150 is described in more detail below. The outer shell 144 may further include a textured surface 152 to facilitate gripping the outer tube 102. For example, in one exemplary configuration, the textured surface 152 includes a plurality of alternating ridges 154 and grooves 156. [ However, it is understood that a surface having a different texture may be employed.

Alignment features 160 may be provided on the proximal end surface 158 of the flange member 142. The alignment feature 160 may be used to indicate the position of the longitudinal indicator 140 when the barrel 102 is positioned within the brain.

In one exemplary configuration, the end surface 158 may include at least one retaining notch 161. [ The retaining notch 161 extends from the outer periphery 144 to the periphery of the inner opening 146. As will be described in more detail below, the retention notch 161 retains a string or cord from the surgical patty, another absorbent surgical sponge, or other object that is temporarily positioned within the outer tube 102 .

An alternative configuration of the outer casing 202 is shown in Figs. The outer cylinder 200 is similar to the outer cylinder 102. The outer tube 202 is defined as a distal end 208 and a proximal end 216 and includes a generally hollow body portion 218 and a grip portion 220. The grip portion 220 is firmly fixed to the body portion 218 at the proximal end 216 thereof. In one exemplary configuration, the body portion 218 is comprised of a transparent biocompatible material that permits observation of the tissue as well as the critical structure disposed on the outside of the body portion 218 when the outer tube 202 is disposed within the tissue . In one exemplary configuration, the outer tube 202 is comprised of polycarbonate, but other biocompatible materials including resins may be employed. Like the outer cylinder 102, as described above, the outer cylinder 202 may also include an image capturing mechanism.

The distal end 208 of the outer tube 202 also has a tapered portion 230 extending toward the central axis of the outer tube 202 with a distal edge 232 surrounding the opening of the distal end 208 of the outer tube 202 Respectively. The distal end 208 may be configured to have a radius or other configuration to produce a smooth / non-traumatic transition of the brain tissue when the surgical access assembly 200 is inserted into the brain.

Although not shown, the body portion 218 may further include a plurality of spaced-apart indicators, as shown for the body portion 118.

The details of the gripper 220 are best shown in FIG. The grip portion 220 is generally configured as a flange member 242 defined by an outer 244 and an inner 246 opening. The inner opening 246 may have a size corresponding generally to the diameter of the lumen defined by the body portion 218. The enclosure 244 has a size that is larger in diameter than the lumen 248 of the body portion 218.

The flange member 242 may further include one or more small openings 250 disposed therein. Unlike the flange member 142 of the outer tube 102, in an exemplary configuration, the opening 250 is configured such that the opening 250 is positioned outward from the lumen of the outer tube 202, as described in more detail below, 0.0 > 244 < / RTI >

In one exemplary configuration, the portion 260 surrounding the small opening 250 may be axially offset from the proximal end surface 258 of the flange member 220. More specifically, the portion 260 of the flange member 220 can be configured to have a smaller thickness than the rest of the flange member 220. The portion 260 may extend slightly radially outward from the enclosure 244. One of the portions 260 'may extend further radially outward than the rest of the portions 260 to serve as alignment features. The alignment feature 260 'may be used to indicate the position of a longitudinal indicator disposed in the outer barrel 202 when the barrel 202 is positioned within the brain.

The alignment features may also be used for alignment, attachment, or combination with other devices, such as, but not limited to, an imaging device. Likewise, aperture 250 may be used in a similar manner. The feature 260 may also be aligned and used to indicate the position of the surgical region of interest within the tissue, or may be used with the depth indicator 136 shown in FIG. 2 for the same purpose. The outer tube 102/202 is particularly useful for surgical imaging and application platforms performed during surgery because the outer tube is made of materials that are safe and image compatible with CT, MRI and PET.

In one exemplary configuration, the end face 258 may also include one or more retaining notches 261. Each retaining notch 261 is configured to extend from the enclosure 244 to the periphery of the inner opening 246. 4), the retaining notch 261 does not extend past the thickness of the flange member 220, including the enclosure 244. In one exemplary embodiment, As will be described in more detail below, the retention notch 261 is configured to retain a string or cord from a surgical patty, another absorbent surgical sponge, or other object that is temporarily positioned within the outer tube 102.

Closure 104 can be seen in Fig. The occluder 104 is defined by a distal end 106, a proximal end 166, a body portion 168, and a handle portion 170. Distal end 106 is configured with a generally conical distal tip 172 that tapers to distal member 174 to provide a non-traumatic extension of tissue. In one exemplary configuration, the tip 172 is tapered toward the closed tip member 174 to prevent coring of tissue when the closure 104 is inserted into the brain. Additional details of exemplary occluders may be found in co-pending U.S. Patent Application No. 13 / 280,015.

Distal tip 174 is configured to be curved so that tip member 174 is round, dull, or not sharp. More specifically, tip member 174 is configured to have no flattened portion that may stretch or tear soft tissue such as blood vessels, fibers and fibers found in the brain upon insertion. And, because the tip member 174 is closed, damage to such soft tissue and fibers is also prevented. In one exemplary embodiment, the tip member 174 is configured to have a radius of 0.5 mm. As will be described in more detail below, the configuration of the tip member 174 is designed to smoothly displace the tissue into which the tip member is inserted; That is, when the surgical access assembly 100 is inserted into a tissue, it allows introduction into the intra-fascilar manner and para-fascilar manner, as opposed to cutting the tissue. Gt; tissue < / RTI >

The handle portion 170 is located at the proximal end 166 of the closure 104. [ The grip portion 170 includes a stop member 176 and a grip member 178. The stop member 176 is located on the circle of the grip member 178 and is configured to have a larger width than the diameter of the body portion 168 and the diameter of the outer cylinder 102. Gripping member 178 is configured to have a width (W ₂₎ than the width (W ₁₎ of the stop member 176, provides a configuration of the step-shaped. The stop member 176 may further define an engagement surface 177 that is axially spaced from the distal surface of the grip member 178. [

In one exemplary configuration, the handle portion 170 is configured to have a generally planar surface 180. The plane 180 may be configured to have a receiving aperture 184 configured to receive the locking member 110. In one exemplary configuration, the receiving opening 184 is threaded. In the receiving opening, a channel 186 at least partially extending over the entire grip portion 170 is disposed in communication with the receiving opening. After the locking member 110 is at least partially engaged in the receiving opening 184, a retaining member (not shown) may be positioned within the channel 186.

An access opening 188 is formed through the proximal end 166. The access opening 188 extends through the handle portion 170. In one exemplary configuration, the access opening 188 may have an inwardly extending chamfer portion that tapers toward the access opening 188. The chamfer portion provides a self-directing feature for inserting a career guide member (shown in phantom) into the access opening 188. The access opening 188 communicates with the first channel portion that extends through the handle portion 170 and into the body portion 168.

The body portion 168 extends between the distal end 106 and the proximal end 166. The body portion 168 may include one or more elongate void areas 190 (void areas). The cavity area 190 serves to reduce the weight of the obturator 104 to facilitate manipulation of the obturator 104 during a surgical procedure. Cavity region 190 also allows for sterilization of closure 104 by moisture retention within body portion 168 of closure 104. The cavity area 190 also provides venting to prevent vacuum from being generated when the closure 104 during operation is withdrawn from the outer tube 102. The cavity region 190 is separated by a web portion 192 extending axially through a portion of the length of the body portion 168.

The body portion 168 may further include one or more transverse webs 196. The transverse webs 196 are oriented to traverse the web portion 192 to connect the web portions 192 together. In one exemplary configuration, the body portion 168 includes at least one transverse web 196 that operatively defines the outer diameter of the body portion 168. The outer diameter can be sized to fit within the lumen of the outer tube 102 such that the closure 104 and the outer tube 102 can selectively slide relative to each other. However, the outer diameter is also sized to minimize or even eliminate any clearance between the inner surface of the outer tube 102 and the outer surface of the obturator 104. The transverse web 196 serves to provide structural integrity and improved stiffness of the obturator 104.

The use of the surgical access assembly 100 is now described in the context of surgical operations. In operation, once a plan for the surgical locus is established, the surgeon creates a craniotomy and a dural approach incision. Then, the closure 104 is inserted into the outer cylinder 102 until the grip ring 120 abuts against the first stop member 176, for example, as shown in Fig. The career guide member 112 is then operatively connected to the closure 104. Various types of career guide members may be used, as described in co-pending U.S. Patent Application No. 13 / 280,015, and the present invention is not limited to the configurations disclosed herein.

Once the surgical access assembly 100 is assembled and operatively connected to the career guidance system, the surgical access assembly 100 is guided to the area of interest. In one exemplary configuration, the distal tip 178 of the occluder 104 faces the outermost margin of the region of interest, as described in co-pending U. S. Patent Application No. 13 / 280,015.

Due to the tapered configuration of the closure 104 and the closed and curved distal tip 174 and the curved distal tip 132 of the outer tube 102 the surgical access assembly 100 is inserted into the brain and into the region of interest As the pathway is guided, the tissue is pushed gently to either side of the surgical access assembly 100, causing the tissue to expand traumatically, minimizing tissue trauma. And because the surgical access assembly 100 is operatively connected to the career guide member 112, as the surgical access assembly 100 is inserted into the brain tissue, the career guide member 112 is interlocked with the imaging technique To provide real time information about the fiber tract in the locus T so that the surgeon can minimize damage or damage to the fiber during insertion of the surgical access assembly 100. [

Once the surgical access assembly 100 is positioned in the area of interest, the career guide member 112 is removed or removed from the surgical access assembly 100.

The outer barrel 102 is then operatively positioned relative to the area of interest 500. More specifically, as described in co-pending U. S. Patent Application Serial No. 13 / 280,015, the outer tube 102 is moved relative to the obturator 104 such that the distal end 108 of the outer tube 102 is positioned at the distal end of the obturator 104 And is moved toward the distal end 106. This action is performed by holding the grip ring 120 with one hand, for example, by holding the grip member 178 with the other hand and keeping the stopper 104 in a stopped state. The grip ring 120 may be gently rotated and / or rotated about the central axis of the closure 104 to move the outer cylinder 102 relative to the closure 104 in the circle. The first stop member 176 helps to grasp and manipulate the outer tube 102 and a gap 423 (see FIG. 1) is created between the distal end surface of the grip ring 120 and the distal end surface of the grip member. The outer cylinder 102 is positioned within the region of interest 500 by moving the outer cylinder 102 a distance generally corresponding to the length of the distal end portion 172 of the closure 104. [

Once the outer tube 102 is properly positioned, the closure 104 is then removed from the outer tube 102. More specifically, the outer tube 102 remains relatively stationary in the region of interest 500 and the obturator 104 is moved in the proximal direction until it is completely removed from the outer tube 102. This action causes the outer barrel 102 to form a passageway to the region of interest 500.

The outer tube 102 may then be secured in place to prevent cranial pressure from pressing the outer tube 102 from the brain tissue. In one exemplary configuration, a securing member may be utilized with the small opening 150 (or the opening 250 of the grip member 220) of the grip ring 120 to temporarily secure the outer tube 102 have. However, the fixation member may be stationary to allow a limited degree of movement and may result in a floating system that allows selective repositioning. Suitable fastening members include, but are not limited to, bridle sutures, flexible bands with retention hooks, or even retractor arms.

Once the outer tube 102 is properly positioned, debulking of the region of interest 500 may be performed. Conventionally, a drug, such as mannitol, is administered to a patient prior to intracranial surgery to reduce intracranial pressure (ICP) of the brain prior to surgery. Indeed, ICPs are often experienced by patients due to the natural response to craniotomy and / or the presence of abnormal parts within the brain. The inventors have found that it may be advantageous to omit or minimize the use of drugs to reduce ICP. More specifically, after the occlusion device 104 is removed from the outer barrel 102, the target tissue is removed from the outer barrel 102 due to the cranial pressure, since the brain tends to occupy the available space within the skull. It may tend to flow into the open distal end 108 of itself and appear to itself. The region of interest 500 may actually move into the outer barrel 102 itself, thereby helping delivery and minimizing the required manipulation of the barrel 102 during the process.

It is contemplated that a wide range of surgical devices may be inserted into the outer tube 102 to remove tissue anomalies. In one exemplary configuration, the outer tube 102 may have an inner diameter of up to about 20 mm, so that a grasper, a dissector, a scissors, a cautery, and a suction device Can be inserted through the outer cylinder 102. [0051] As shown in Fig.

One exemplary surgical device that may be utilized is NICO MYRIAD ^® , manufactured and distributed by Nico Corporation of Indianapolis, Indiana. Referring to FIG. 4, there is shown an exemplary surgical cutting apparatus 640 as disclosed in co-pending U. S. Patent Application Serial No. 12 / 389,447, the contents of which are incorporated herein by reference in their entirety. The surgical cutting device 640 includes a handpiece 642 and a cutting element including an outer cannula 644 and an inner cannula (not shown). In one exemplary configuration, the handpiece 642 is configured to have a generally cylindrical shape. The handpiece 642 may have a size and shape that can be gripped by one hand. The handpiece 642 also includes a lower housing 650 that includes a proximal portion 646 and a distal portion 648. A front housing portion 655 may be connected to the cam housing located at the distal portion 648. [ An upper housing 652 is also provided. The cutting element is mounted to the upper housing 652 and may be fluidly connected to a tissue collector 658. In one exemplary configuration, the tissue collector 658 may be operatively connected directly to the upper housing 652. Alternatively, the tissue collector 658 may be remotely connected to the cutting element by suitable tubing. A vacuum line (not shown) may be connected to the proximal end of the tissue collector 658 to direct the tissue into the cutting element and deliver the severed tissue to the tissue collector 658. A rotary dial 660, which selectively rotates the outer cannula 644 relative to the handpiece 642, is also mounted to the upper housing 652 to provide a controlled cutting action.

The use of surgical device 640 is advantageous in that space is limited for performing tissue loss surgery, and particularly when other instruments are inserted simultaneously into outer tube 102, the use of conventional surgical scissors is difficult . In addition, fibrosis of the tumor may make it difficult to use conventional suction-reduction devices. Conventional graspers work by tearing the tissue of interest. However, if the blood vessels or fibers are too close to the tearing tissue and such blood vessels or fibers are also torn, such tearing can be a problem.

As the region of interest 500 is cytoreductively debulked, it may be necessary to reposition or move the outer tube 102. When the positional change is required, in one exemplary configuration, the operating member may be provided. An example of an operating member is described in co-pending U. S. Patent Application No. 13 / 280,015.

The outer tube 102 is configured such that a plurality of instruments can be simultaneously inserted therein, thereby increasing the speed and safety of the surgical procedure. In one exemplary configuration, the endoscope can be partially inserted into and retained at one side of the outer tube 102, so that while the surgical instrument, such as the surgical instrument 640, is also inserted into the outer tube 102, 500) to the monitor. It is also contemplated that endoscope and surgical (e.g., as described in co-pending US patent application Ser. No. 13 / 280,015), which is inserted through an access opening in which the illumination ring is aligned with opening 146 of the grip ring 120 Can be used with instruments. Because the illumination ring provides light to the outer barrel 102, a relatively small diameter endoscope can be used, which can increase the space in the outer barrel 102 where other surgical instruments are available. In another exemplary arrangement, the surgeon can simultaneously insert both the surgical instrument and the cautery instrument into the outer tube 102, allowing the surgeon to cauterize during surgery.

Because the outer barrel 102 can be positioned directly in the area of interest in a manner that prevents unnecessary damage to the critical structure and because the surgical device 640 can be positioned directly in the field of view of the area of interest, Utilizing the access system 100 provides the ability to ablate most of the area of interest, such as the tumor. As will be appreciated by those skilled in the art, the more tumors are ablated and removed, the less the therapies required for treatment. In other words, the more abstinence of the diseased tissue, the less the sick tissue to destroy.

During surgical operations, the surgeon often deploys a surgical patty or pledget in or near the area of interest. Surgical patties are used for brains in spinal surgery for various functions. One of these functions is to protect the brain and nerve tissue from devices deployed adjacent to these brain and nerve tissues. Another function is to allow removal of fluids that may interfere with or interfere with surgical procedures and treatments performed in the area of interest.

However, current surgical patties have some problems. Certain known surgical patties consist of absorbent cotton gauzes, which are chemically bonded together to give the felt a relatively high wet strength. Therefore, the resulting gauze structure has a surface containing various absorbent fibers. If the surgical patty is left in place, the fluid present will be transmitted through the fibers, so that the fibers are no longer absorbent and tend to adhere to the neurovascular tissues to which the gauze structures are in contact. Another problem encountered with surgical patties is that the gauze side should not abrade the tissue when the surgical patty is pulled across the tissue.

An exemplary configuration of a surgical patio assembly 700 that may be deployed within the outer casing 102 is shown in Figs. 7-9. The surgical patio assembly 700 generally includes a patty body 702. Also, a retention code 704 may be provided. In one exemplary configuration, the patty body 702 is configured such that the patty body 702 is relatively thin and the profile is relatively thin. In one exemplary configuration, the patty body 702 has a rectangular portion 706 and a converging portion 708, although the patty body 702 can have a variety of shapes. The converging portion 708 may terminate at the rounded tip 710 to permit selective placement of the patty body 702 within the tight or constricted space.

The patty body 702 is defined by first and second faces 712, 714. The first side 712 may be composed of a non-abrasive material that is not attached to the tissue by having low surface energy. For example, the first side 712 may be comprised of an elastomeric material such as silicone, polyester, polyurethane, polyethylene, high friction rubber, and the like. In one exemplary configuration, the first side 712 is configured to be punctured with a plurality of small openings 716, as will be described in greater detail below.

The second surface 714 may be constructed of a gauze material to provide cushioning as a buffer to protect the tissue from contact with the instrument device and subsequent contusion, contusion or permanent damage. In addition, the gauze material can absorb the fluid into the gauze material without absorbing fluid in the surgical area into the fibers of the gauze. . In one exemplary configuration, rayon gauze may be used.

As described above, in one exemplary configuration, a retention code 704 may be provided. Retention cords 704 may be constructed of non-tacky materials such as polyester so that retention cords 704 may not adhere to the tissue. The end 718 of the retaining cord 704 may be bonded to the second face 714 or between the two faces 712, 714.

In another exemplary configuration, the radiation-opaque strip 720 may be disposed on the second side 714. The radiopaque strip 720 may be used with an imaging system suitable for detecting the position of the patty 700 when deployed within a patient's body.

Referring now to Fig. 9, the use of patty 700 is now described. After the outer tube 102/202 is positioned within the brain, the patty 700 can be positioned within the outer tube 102/202. Although shown as having a width generally corresponding to the diameter of the outer tube 102/202, it is understood that the patty 700 can have any size. The patty 700 can then be positioned within the outer tube 102/202 through a surgical tweezer or other surgical instrument to facilitate removal of the surgical patty 700 while the retention cord 704 May be oriented so as to extend from the outer cylinder 102 away from the region of interest.

The retention cord 704 may be used to hold the surgical patty 700 in the area of interest and to position the retention cord 704 away from the primary surgical path to prevent the retention cord 704 from physically and visually interfering with the surgical path. Can be engaged with a separate holding member (not shown). In one exemplary configuration, as described above, the gripping members 120/220 have at least one retaining notch 161/261. Each retaining notch 161/261 is configured to receive retaining cord 704 to selectively retain retaining cord 704 during surgical operation. This arrangement allows the surgical staff to more easily and visually identify the surgical patties used in the prescribed surgery. This arrangement also helps prevent retention cord 704 from falling to the surgical site.

During a surgical operation, at certain times, it may be necessary to inhale the surgical area to remove fluid. However, in order to prevent unintentional direct inhalation of such a structure which may lead to tearing or other damage, careful attention must be paid to applying suction adjacent to the critical structure. The surgical patty 700 helps to solve this problem due to the perforations 716 formed on the first side 712. More specifically, the first side 712 is a perforated, non-abrasive material and is positioned adjacent to or adjacent to the neurovascular structure. Therefore, perforations are also placed against this structure. A suction may then be applied to the second side 714 of the surgical patty 700 to cause fluid to be sucked through the surgical patty 700 so that the first side 712 Thereby allowing passage of the fluid through the patty 700 without absorption at the second side 714. Because the first side 712 is a non-absorbable material and is non-abrasive, the tissue may not adhere to the surgical patty 700.

Once the surgical operation is complete, the surgical patty 700 can be removed from the area of interest and, in particular, can be extracted from the outer tube 102. More specifically, retentive cord 704 can be disengaged from retention notch 161/261, and retaining cord 704 can be pulled away from outer tube 102/202. The surgical patty 700 will not unintentionally damage such tissue because the first side 712, which is a surface located in neural vascular tissue or adjacent to neurovascular tissue, is non-adherent and non-abradable. And since the first side 712 is relatively smooth, it will also be non-abrasive to tissue. Therefore, removal of surgical patties will not cause trauma to these tissues and will not even wear tissue during use or removal.

It will be appreciated that the surgical access systems and methods described herein have broad applicability. The foregoing embodiments have been chosen and described in order to illustrate some practical applications as well as the principles of the methods and apparatuses. The foregoing description is in accordance with the particular application contemplated and, therefore, would enable those skilled in the art to utilize the various embodiments and methods of the various embodiments. In accordance with the provisions of patent laws, the principles and manner of operation of the present invention are described and illustrated in the illustrative embodiments.

The scope of the method and apparatus of the present invention is intended to be defined by the claims that follow. It is to be understood, however, that the invention can be practiced otherwise than as specifically described and shown, without departing from the spirit or scope thereof. It should be understood by those skilled in the art that various alternatives to the embodiments described herein may be employed in practicing the claims, without departing from the spirit and scope of the following claims. The scope of the present invention should not be determined with reference to the above description, but instead should be determined with reference to the appended claims and the full scope of equivalents to which such claims are entitled. It is anticipated and contemplated that future developments will occur in the techniques described herein and that the disclosed systems and methods will be included in such later examples. In addition, all terms used in the claims are intended to be accorded the broadest and most appropriate interpretation and ordinary meaning understood by those skilled in the art, unless the context clearly indicates otherwise. In particular, the use of a singular article, such as "a," "the," "said," and the like, should be understood to include one or more of the indicated elements, unless the specific limitation is contradicted by the claims. The following claims define the scope of the invention and are intended to fall within the scope of the appended claims and their equivalents. In sum, it should be understood that the present invention can be modified and modified, and is limited only by the claims that follow.

Claims

An outer tube defined by an open circular tip and an open proximal end and including a hollow body portion therebetween;
Wherein the distal end is defined by a distal end and a proximal end, the distal end further comprising a tapered distal end member,
Wherein the closure is configured to be received within the outer tube such that the tapered distal end member protrudes from the open distal end of the outer tube when the closure is in the configuration for introduction,
Wherein the outer tube further comprises a gripping member, wherein the gripping member comprises at least one retaining notch formed on an outer surface thereof.

The method according to claim 1,
Wherein the gripping member comprises a plurality of retaining notches.

3. The method of claim 2,
Wherein the plurality of notches are equidistantly spaced from each other.

4. The method according to any one of claims 1 to 3,
Wherein the gripping member is located about the open proximal end.

5. The method according to any one of claims 1 to 4,
Wherein the outer tube further comprises at least one reference member interlocking with the imaging device to indicate the position of the outer tube during insertion into the body.

6. The method according to any one of claims 1 to 5,
And a surgeon patty configured to be deployed through the outer tube.

The method according to claim 6,
Wherein the surgical patty comprises a body member and the first side of the body member comprises a non-abrasive material that is not attached to tissue.

8. The method of claim 7,
Wherein the first surface comprises a perforation through which the fluid can pass.

9. The method according to any one of claims 7 to 8,
Wherein the first side is comprised of one of silicone, polyester, polyurethane, polyethylene and rubber.

10. The method according to any one of claims 7 to 9,
Wherein the body member comprises a second side comprising a fluid absorbent material.

11. The method of claim 10,
The material is a rayon gauze, a surgical access system.

12. The method according to any one of claims 7 to 11,
A radiopaque strip is included in the body member.

13. The method according to any one of claims 6 to 12,
And a retaining cord attached to the body member of the surgical patty.

14. The method according to any one of claims 1 to 13,
Wherein the gripping portion further comprises a retaining opening disposed therein and wherein the retaining opening is configured to interlock with a fastening element to selectively secure the outer tube to the patient.

15. The method of claim 14,
Said retaining apertures being spaced equidistant from one another.

16. The method according to any one of claims 14 and 15,
Wherein the retaining opening is located adjacent the peripheral edge of the gripping portion to be spaced from the open proximal end of the outer barrel.

17. The method according to any one of claims 14 to 16,
Wherein the retaining opening is axially offset from an upper surface of the gripping portion.

18. The method according to any one of claims 1 to 17,
Wherein the distal end of the outer barrel includes a tapered portion extending toward a central axis of the outer barrel.

19. The method according to any one of claims 1 to 18,
Wherein the distal end of the barrel terminates at a distal edge that surrounds the open distal end, and wherein the distal edge is curved.