US20150157193A1 - Surgical tissue protection sheath - Google Patents
Surgical tissue protection sheath Download PDFInfo
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- US20150157193A1 US20150157193A1 US14/626,184 US201514626184A US2015157193A1 US 20150157193 A1 US20150157193 A1 US 20150157193A1 US 201514626184 A US201514626184 A US 201514626184A US 2015157193 A1 US2015157193 A1 US 2015157193A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00147—Holding or positioning arrangements
- A61B1/00154—Holding or positioning arrangements using guiding arrangements for insertion
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/32—Devices for opening or enlarging the visual field, e.g. of a tube of the body
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/24—Surgical instruments, devices or methods, e.g. tourniquets for use in the oral cavity, larynx, bronchial passages or nose; Tongue scrapers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
- A61B17/3423—Access ports, e.g. toroid shape introducers for instruments or hands
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
- A61B17/3431—Cannulas being collapsible, e.g. made of thin flexible material
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00278—Transorgan operations, e.g. transgastric
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00831—Material properties
- A61B2017/0084—Material properties low friction
- A61B2017/00849—Material properties low friction with respect to tissue, e.g. hollow organs
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- A61B2017/00876—Material properties magnetic
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- A61B2017/2926—Details of heads or jaws
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- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
- A61B2017/345—Cannulas for introduction into a natural body opening
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- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0801—Prevention of accidental cutting or pricking
- A61B2090/08021—Prevention of accidental cutting or pricking of the patient or his organs
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
- A61B2090/306—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure using optical fibres
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B2217/002—Auxiliary appliance
- A61B2217/005—Auxiliary appliance with suction drainage system
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- A61B2217/00—General characteristics of surgical instruments
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- A61B2217/007—Auxiliary appliance with irrigation system
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/84—Drainage tubes; Aspiration tips
- A61M1/85—Drainage tubes; Aspiration tips with gas or fluid supply means, e.g. for supplying rinsing fluids or anticoagulants
Definitions
- Endoscopic surgery within the head is a common procedure in neurological surgery and otolaryngology. It avoids large cranial incisions and can reduce the need brain retraction and prolonged wound healing. Endoscopic surgery within the head also provides improved illumination and visualization of the target tissues because the camera of the endoscope is brought directly to the surgical site.
- tissue in the surgical pathway there may be local trauma to the tissues in the surgical pathway, resulting from pressure or abrasion caused by the surgical instruments.
- these tissues are the nasal mucosa, turbinates, nasal septum, and sphenoid/frontal/maxillary sinus.
- orbital and periorbital tissue are subject to local trauma.
- Surgical pathway trauma can add to the trauma of the procedure and prolong the patient's recovery time. Liquids in the surgical pathway, such as mucous, blood, and soiled irrigation fluid, tend to obscure the view of the endoscope. This leads to the constant need for irrigation and suction of the obstructing liquids.
- the endoscope may also have to be removed, cleaned and replaced multiple times during a single procedure. This disadvantage tends to increase the complexity and time requirements of the operation.
- the surrounding tissues are put at risk of additional trauma. Improved devices and methods are therefore needed.
- FIG. 1 is a side view of a tissue protection sheath.
- FIG. 2 is a bottom view of the sheath shown in FIG. 1 .
- FIG. 3 is a section view of the sheath shown in FIG. 1 .
- FIG. 4 is left end view of the sheath of FIG. 1 .
- FIG. 5 is a right end view of the sheath of FIG. 1 .
- FIG. 6 is an enlarged detail view of detail A shown in FIG. 3 .
- FIG. 7 is front, top and right side perspective view of the sheath shown in FIG. 1 .
- FIG. 8 is rear, bottom and right side perspective view of the sheath shown in FIG. 1 .
- FIG. 9 is a side view of a second embodiment of a tissue protection sheath.
- FIG. 10 is a bottom view of the sheath of FIG. 9 .
- FIG. 11 is a centerline section view of the sheath of FIG. 9 .
- FIG. 12 is left end view of the sheath of FIG. 9 .
- FIG. 13 is a right end view of the sheath of FIG. 9 .
- FIG. 14 is front, top and right side perspective view of the sheath shown in FIG. 9 .
- FIG. 15 is rear, bottom and right side perspective view of the sheath shown in FIG. 9 .
- FIG. 16 is a side view of a third embodiment of a tissue protection sheath.
- FIG. 17 is a bottom view of the sheath shown in FIG. 9 .
- FIG. 18 is a section view of the sheath of FIG. 16 taken along a centerline.
- FIG. 19 is left end view of the sheath of FIG. 15 .
- FIG. 20 is a right end view of the sheath of FIG. 15 .
- FIG. 21 is front, top and right side perspective view of the sheath shown in FIG. 15 .
- FIG. 22 rear, bottom and right side perspective view of the sheath shown in FIG. 15 .
- FIG. 23 is rear, top and right side perspective view of another sheath design.
- FIG. 24 rear, top and right side perspective view of a sheath similar to the sheath of FIG. 1 and further including side pockets.
- FIG. 25 is a side view of a sheath delivery tool.
- FIG. 26 is a rear, top and right side perspective view of the sheath of FIG. 1 with surgical instruments schematically illustrated in use.
- FIG. 27 is a front, top and right side perspective view of the sheath and surgical instruments as shown in FIG. 26 .
- FIGS. 1-8 show a first design for a sheath 50 having a body section 52 , and angle section 54 and a flare or conical section 56 .
- the sheath 50 may be molded of rubber or plastic as a one piece unit with the body section 52 , the angle section 54 and the flare section integrally joined together.
- the sheath 50 may have a thin flexible wall 58 having a thickness TT which allows the sheath to conform to the surgical space, or the inner wall of the patient's nostrils.
- the flare section 56 may be provided as a conical ring forming an angle DD of 120-160 or 130-150 degrees with the top wall of the angle section.
- the sheath 50 may have a single through passageway 60 extending from a distal opening 62 to a proximal opening 65 .
- the openings 62 and 65 , and the cross section of the body 52 may be generally in the shape of an oval or an ellipse.
- the distal opening 62 may lie in a plane forming an angle forming an angle BB with the bottom of the sheath, with BB ranging from 95 to 125 or 100 to 115 degrees.
- the angled section 54 may be described as joined to the body section 52 at a vertical line 51 .
- the upper and lower walls of the sheath extend distally away from the vertical line 51 towards the distal opening 62 at acute angles to the line 51 , which may the same or different angles.
- the included angle CC between the top surface of the angled section 54 and the lower wall of the body section may range from 25 to 40 or 30 to 35 degrees.
- the angle PP in FIG. 1 relating to the diverging angle of the top and bottom surfaces of the body section is typically 10-20 or 12-16 degrees.
- Dimension KK may be 8-16 or 10-14 mm, with dimensions MM and SS both generally about 65-85 or 70-80 mm.
- the sheath 50 may be provided as a cut-to-length unit.
- the sheath may be provided in a sterile package, and have a length up to about 100 mm, with the surgeon cutting off a section of the front or distal end 62 , to obtain a desired length.
- Scale markings inches or millimeters may optionally be printed or molded on an outside surface of the sheath for this purpose.
- one or more ridges 64 may be provided on an outer surface of the body section 52 .
- the ridges 64 may project up by 0.5 to 3 mm above the nominal outer surface of the sheath 50 .
- a cluster of 2-5 ridges 64 may be provided near the distal opening 52 , as shown in FIGS. 1 and 2 .
- These ridges 64 may be parallel to each other, and optionally also parallel to the plane of the distal opening 52 .
- Additional ridges 64 oriented at an angle of e.g., 10-20 or 13-17 degrees, may be provided more centrally on the body section 52 of the sheath 50 .
- the ridges may optionally be provided as rings extending continuously around the outside surface of the body section.
- one or more spring or elastic elements 66 may be attached to or embedded in the sheath 50 , to help expand the sheath from a folded or collapsed position into and expanded deployed position, after the sheath is positioned in the surgical pathway.
- the elastic element 66 may be a Nitinol wire.
- the dimensions and angles shown in the drawings of all embodiments may typically be varied by 10, 20 or 30% depending on various design parameters.
- the angle section 54 may allow the proximal end of the sheath 50 to be more easily stretched and/or deflected. This allows for more versatile movement of surgical instruments extending through the sheath during surgery. As shown in FIGS. 1 and 3 , the angle section 54 forms an irregular quadrilateral shape in cross section. In FIG. 3 , the angle section 54 may be defined by line F4 along with segments or lines F1, F2 and F3, with F4 and F2 forming a first acute angle and with F1 and F3 forming a second acute angle. Each of the sides or segments F4, F1, F2 and F3 forming the angle section 54 may also have different lengths. F3 may be substantially perpendicular to F2. The angle section 54 may alternatively be described via a centerline AN perpendicular to and bisecting segment or line F4 and intersecting a centerline AF of the conical section 54 at an angle AB of 5-30 or 10-20 degrees.
- the wall thickness of the sheath 50 may be thinner at the proximal end adjacent to the flare 56 , to allow the proximal end to more easily stretch.
- the sheath 50 shown in FIGS. 1-8 may be 6 to 10 cm long with the proximal 10 to 30% of the length having a reduced wall thickness in comparison to the rest of the sheath.
- the wall thickness of this section may be 20 to 80 or 30 to 70% of the regular wall thickness of the rest of the sheath.
- the wall thickness may optionally be largely uniform with all sections of the sheath having a similar thickness TT.
- FIGS. 9-15 show a second design 70 similar to the sheath 50 but without the angle section 54 .
- the sheath 70 may have distal and proximal openings oriented in non-parallel planes.
- the sheath 70 may have a flare end 74 that is flatter than the flare end 56 on the sheath 50 , with the flare end 74 at an angle EE to the centerline of 50 to 70 or 55 to 65 degrees, and with angle FF typically ranging from 8 to 15 degrees.
- the outer diameter GG of the flare end 74 may be 22-30 or 24-28 mm, with the outer diameter of the front end generally about 16-22 mm.
- the sheath 70 may also have a longer and narrower through passageway, as shown in FIG. 12 . Comparing FIG. 13 to FIG. 3 shows that the body section of the sheath 70 may be symmetrical about the centerline 71 while the body section of the sheath 50 is not similarly symmetrical.
- the body section of the sheath 70 and/or the distal opening 62 may have upper and lower creases 73 and 75 having a radius of 2 mm or less, with curved sidewalls 77 leading from the creases to a substantially flat center sidewall 79 .
- the proximal opening 65 may be an oval.
- FIGS. 16-22 show a third design 80 that is similar to the sheath 70 but having a distal opening 62 in a plane forming an acute angle with a longitudinal centerline of the body section, similar to FIG. 1 , as opposed to the perpendicular distal opening orientation in FIG. 9 .
- the proximal opening 62 may have non-parallel sidewalls upwardly converging sidewalls W1 and W2 joined by a smaller radius of curvature at the top and and a larger radius of curvature at the bottom, in the form of a teardrop or an uneven oval.
- the body section may be at least 2, 4, 6, 8 or 10 times longer than the conical section, or the combined length of the conical section and the angle section, if used.
- FIG. 23 shows a similar design further including pleats or folds 92 at the proximal end.
- the flare end may also be split into an upper section 94 and a lower section 96 , with no flare section overlying the pleats 92 .
- the pleats 92 may be molded into the proximal end of the sheath 90 , with the pleats reducing and blending into the body section of the sheath towards the distal end of the sheath 90 .
- the wall thickness at the pleats may be reduced to e.g., 0.2-0.7 mm, to allow the pleats to stretch with nominal force.
- FIG. 24 shows a sheath which may be similar or the same as the sheaths 50 , 70 or 80 , and further including pockets 110 on opposite sides configured to accept the jaws of a bayonet forceps.
- the pockets may help the forceps to grasp and hold the sheath, and also allow the sheath to be pushed forward using the forceps, but without excessively clamping or squeezing the sheath.
- FIG. 25 shows a sheath deployment tool 130 that may be used to deploy a sheath.
- the tool 130 has a plunger 134 slidable into a handle 132 .
- a hook 136 or other grasping feature on the plunger 134 engages a hook slot 138 on the sheath, with the hook slot 138 shown in FIG. 1 .
- Funnel guides 140 may be provided on the handle 132 to collapse down and guide the sheath into the handle. The tool 130 may then be used to place the sheath into a surgical pathway.
- FIGS. 26 and 27 show two surgical tools in use with the sheath. As the sheath tapers outwardly from the proximal opening 65 to the distal opening 62 , clashing of the instruments may be reduced as the sheath provides more room for the instruments to move at a distance from the leverage point of the nostril.
- the sheaths described above are useful in transnasal and transorbital surgery of the head.
- the sheaths may also be used in other surgical procedures for protection of tissue around a surgical pathway.
- the sheaths above are discussed in terms of having different sections only for purposes of description.
- the sheaths may be manufactured from rubber or plastic as an integral one-piece unit, without specific or visible separation lines or features between the sections described.
Abstract
A surgical sheath for use in endoscopic trans-nasal or intra-ocular surgery has an angle section joined to a conical section, with the conical section having a central axis not parallel to a central axis of the angle section. A body section is joined to the angle section, with the body section having a length at least twice the length of the angle section. The conical section, the angle section and the body section may be a flexible or compliant material. The sheath reduces collateral trauma to the tissues in the surgical pathway.
Description
- This application is a Continuation of U.S. patent application Ser. No. 13/798,990, filed Mar. 13, 2013, and now pending, which claims priority to U.S. Provisional Patent Application No. 61/730,588 filed Nov. 28, 2012. U.S. patent application Ser. No. 13/798,990 is also a Continuation-in-Part of U.S. patent application Ser. No. 12/943,779, filed on Nov. 10, 2010, now abandoned, which claims priority to U.S. Provisional Patent Application Nos. 61/261,310, filed Nov. 14, 2009; 61/293,932, filed Jan. 11, 2010; and 61/346,476, filed May 20, 2010. This application is also a Continuation-in-Part of U.S. Patent Application No. 13/760,971 filed Feb. 6, 2013 and now pending, which claims priority to U.S. Provisional Patent Application No. 61/596,996 filed Feb. 9, 2012. Each of the applications listed above is incorporated herein by reference
- Endoscopic surgery within the head is a common procedure in neurological surgery and otolaryngology. It avoids large cranial incisions and can reduce the need brain retraction and prolonged wound healing. Endoscopic surgery within the head also provides improved illumination and visualization of the target tissues because the camera of the endoscope is brought directly to the surgical site.
- During this type of surgery, there may be local trauma to the tissues in the surgical pathway, resulting from pressure or abrasion caused by the surgical instruments. Generally these tissues are the nasal mucosa, turbinates, nasal septum, and sphenoid/frontal/maxillary sinus. When transorbital approaches are used, orbital and periorbital tissue are subject to local trauma. Surgical pathway trauma can add to the trauma of the procedure and prolong the patient's recovery time. Liquids in the surgical pathway, such as mucous, blood, and soiled irrigation fluid, tend to obscure the view of the endoscope. This leads to the constant need for irrigation and suction of the obstructing liquids. In some cases the endoscope may also have to be removed, cleaned and replaced multiple times during a single procedure. This disadvantage tends to increase the complexity and time requirements of the operation. In addition, with each movement of a surgical tool into or out of the surgical pathway, the surrounding tissues are put at risk of additional trauma. Improved devices and methods are therefore needed.
- In the drawings, the same reference number indicates the same element in each of the views.
-
FIG. 1 is a side view of a tissue protection sheath. -
FIG. 2 is a bottom view of the sheath shown inFIG. 1 . -
FIG. 3 is a section view of the sheath shown inFIG. 1 . -
FIG. 4 is left end view of the sheath ofFIG. 1 . -
FIG. 5 is a right end view of the sheath ofFIG. 1 . -
FIG. 6 is an enlarged detail view of detail A shown inFIG. 3 . -
FIG. 7 is front, top and right side perspective view of the sheath shown inFIG. 1 . -
FIG. 8 is rear, bottom and right side perspective view of the sheath shown inFIG. 1 . -
FIG. 9 is a side view of a second embodiment of a tissue protection sheath. -
FIG. 10 is a bottom view of the sheath ofFIG. 9 . -
FIG. 11 is a centerline section view of the sheath ofFIG. 9 . -
FIG. 12 is left end view of the sheath ofFIG. 9 . -
FIG. 13 is a right end view of the sheath ofFIG. 9 . -
FIG. 14 is front, top and right side perspective view of the sheath shown inFIG. 9 . -
FIG. 15 is rear, bottom and right side perspective view of the sheath shown inFIG. 9 . -
FIG. 16 is a side view of a third embodiment of a tissue protection sheath. -
FIG. 17 is a bottom view of the sheath shown inFIG. 9 . -
FIG. 18 is a section view of the sheath ofFIG. 16 taken along a centerline. -
FIG. 19 is left end view of the sheath ofFIG. 15 . -
FIG. 20 is a right end view of the sheath ofFIG. 15 . -
FIG. 21 is front, top and right side perspective view of the sheath shown inFIG. 15 . -
FIG. 22 rear, bottom and right side perspective view of the sheath shown inFIG. 15 . -
FIG. 23 is rear, top and right side perspective view of another sheath design. -
FIG. 24 rear, top and right side perspective view of a sheath similar to the sheath ofFIG. 1 and further including side pockets. -
FIG. 25 is a side view of a sheath delivery tool. -
FIG. 26 is a rear, top and right side perspective view of the sheath ofFIG. 1 with surgical instruments schematically illustrated in use. -
FIG. 27 is a front, top and right side perspective view of the sheath and surgical instruments as shown inFIG. 26 . -
FIGS. 1-8 show a first design for asheath 50 having abody section 52, andangle section 54 and a flare orconical section 56. Thesheath 50 may be molded of rubber or plastic as a one piece unit with thebody section 52, theangle section 54 and the flare section integrally joined together. As shown inFIG. 6 , thesheath 50 may have a thinflexible wall 58 having a thickness TT which allows the sheath to conform to the surgical space, or the inner wall of the patient's nostrils. Theflare section 56 may be provided as a conical ring forming an angle DD of 120-160 or 130-150 degrees with the top wall of the angle section. Thesheath 50 may have a single throughpassageway 60 extending from a distal opening 62 to aproximal opening 65. As shown inFIGS. 4 , 5 and 8, theopenings body 52, may be generally in the shape of an oval or an ellipse. - Referring to
FIGS. 1 and 3 , thedistal opening 62 may lie in a plane forming an angle forming an angle BB with the bottom of the sheath, with BB ranging from 95 to 125 or 100 to 115 degrees. As best shown inFIG. 3 , theangled section 54 may be described as joined to thebody section 52 at a vertical line 51. The upper and lower walls of the sheath extend distally away from the vertical line 51 towards thedistal opening 62 at acute angles to the line 51, which may the same or different angles. As shown inFIG. 1 , the included angle CC between the top surface of theangled section 54 and the lower wall of the body section may range from 25 to 40 or 30 to 35 degrees. The angle PP inFIG. 1 relating to the diverging angle of the top and bottom surfaces of the body section is typically 10-20 or 12-16 degrees. Dimension KK may be 8-16 or 10-14 mm, with dimensions MM and SS both generally about 65-85 or 70-80 mm. - For some procedures the
sheath 50 may be provided as a cut-to-length unit. For example, the sheath may be provided in a sterile package, and have a length up to about 100 mm, with the surgeon cutting off a section of the front ordistal end 62, to obtain a desired length. Scale markings (inches or millimeters) may optionally be printed or molded on an outside surface of the sheath for this purpose. - Turning to
FIGS. 1-2 and 7-8, one ormore ridges 64 may be provided on an outer surface of thebody section 52. Theridges 64 may project up by 0.5 to 3 mm above the nominal outer surface of thesheath 50. A cluster of 2-5ridges 64 may be provided near thedistal opening 52, as shown inFIGS. 1 and 2 . Theseridges 64 may be parallel to each other, and optionally also parallel to the plane of thedistal opening 52.Additional ridges 64, oriented at an angle of e.g., 10-20 or 13-17 degrees, may be provided more centrally on thebody section 52 of thesheath 50. The ridges may optionally be provided as rings extending continuously around the outside surface of the body section. - Optionally, one or more spring or elastic elements 66, such as a spring wire 66, may be attached to or embedded in the
sheath 50, to help expand the sheath from a folded or collapsed position into and expanded deployed position, after the sheath is positioned in the surgical pathway. The elastic element 66 may be a Nitinol wire. The dimensions and angles shown in the drawings of all embodiments may typically be varied by 10, 20 or 30% depending on various design parameters. - The
angle section 54 may allow the proximal end of thesheath 50 to be more easily stretched and/or deflected. This allows for more versatile movement of surgical instruments extending through the sheath during surgery. As shown inFIGS. 1 and 3 , theangle section 54 forms an irregular quadrilateral shape in cross section. InFIG. 3 , theangle section 54 may be defined by line F4 along with segments or lines F1, F2 and F3, with F4 and F2 forming a first acute angle and with F1 and F3 forming a second acute angle. Each of the sides or segments F4, F1, F2 and F3 forming theangle section 54 may also have different lengths. F3 may be substantially perpendicular to F2. Theangle section 54 may alternatively be described via a centerline AN perpendicular to and bisecting segment or line F4 and intersecting a centerline AF of theconical section 54 at an angle AB of 5-30 or 10-20 degrees. - The wall thickness of the
sheath 50 may be thinner at the proximal end adjacent to theflare 56, to allow the proximal end to more easily stretch. For example, thesheath 50 shown inFIGS. 1-8 may be 6 to 10 cm long with the proximal 10 to 30% of the length having a reduced wall thickness in comparison to the rest of the sheath. The wall thickness of this section may be 20 to 80 or 30 to 70% of the regular wall thickness of the rest of the sheath. The wall thickness may optionally be largely uniform with all sections of the sheath having a similar thickness TT. -
FIGS. 9-15 show asecond design 70 similar to thesheath 50 but without theangle section 54. As with thesheath 50, thesheath 70 may have distal and proximal openings oriented in non-parallel planes. Thesheath 70 may have aflare end 74 that is flatter than theflare end 56 on thesheath 50, with theflare end 74 at an angle EE to the centerline of 50 to 70 or 55 to 65 degrees, and with angle FF typically ranging from 8 to 15 degrees. The outer diameter GG of theflare end 74 may be 22-30 or 24-28 mm, with the outer diameter of the front end generally about 16-22 mm. Thesheath 70 may also have a longer and narrower through passageway, as shown inFIG. 12 . ComparingFIG. 13 toFIG. 3 shows that the body section of thesheath 70 may be symmetrical about thecenterline 71 while the body section of thesheath 50 is not similarly symmetrical. - As shown in
FIGS. 9 and 13 , the body section of thesheath 70 and/or thedistal opening 62 may have upper andlower creases curved sidewalls 77 leading from the creases to a substantiallyflat center sidewall 79. As shown inFIGS. 12 and 15 , theproximal opening 65 may be an oval. -
FIGS. 16-22 show athird design 80 that is similar to thesheath 70 but having adistal opening 62 in a plane forming an acute angle with a longitudinal centerline of the body section, similar toFIG. 1 , as opposed to the perpendicular distal opening orientation inFIG. 9 . As shown inFIG. 19 theproximal opening 62 may have non-parallel sidewalls upwardly converging sidewalls W1 and W2 joined by a smaller radius of curvature at the top and and a larger radius of curvature at the bottom, in the form of a teardrop or an uneven oval. In each of the sheaths described, the body section may be at least 2, 4, 6, 8 or 10 times longer than the conical section, or the combined length of the conical section and the angle section, if used. -
FIG. 23 shows a similar design further including pleats or folds 92 at the proximal end. The flare end may also be split into anupper section 94 and alower section 96, with no flare section overlying thepleats 92. This allows the proximal end of thesheath 90 to more easily stretch open to better accommodate manipulation of surgical tools. Thepleats 92 may be molded into the proximal end of thesheath 90, with the pleats reducing and blending into the body section of the sheath towards the distal end of thesheath 90. The wall thickness at the pleats may be reduced to e.g., 0.2-0.7 mm, to allow the pleats to stretch with nominal force. -
FIG. 24 shows a sheath which may be similar or the same as thesheaths pockets 110 on opposite sides configured to accept the jaws of a bayonet forceps. The pockets may help the forceps to grasp and hold the sheath, and also allow the sheath to be pushed forward using the forceps, but without excessively clamping or squeezing the sheath. -
FIG. 25 shows asheath deployment tool 130 that may be used to deploy a sheath. Thetool 130 has aplunger 134 slidable into ahandle 132. Ahook 136 or other grasping feature on theplunger 134 engages ahook slot 138 on the sheath, with thehook slot 138 shown inFIG. 1 . Funnel guides 140 may be provided on thehandle 132 to collapse down and guide the sheath into the handle. Thetool 130 may then be used to place the sheath into a surgical pathway. -
FIGS. 26 and 27 show two surgical tools in use with the sheath. As the sheath tapers outwardly from theproximal opening 65 to thedistal opening 62, clashing of the instruments may be reduced as the sheath provides more room for the instruments to move at a distance from the leverage point of the nostril. - The sheaths described above are useful in transnasal and transorbital surgery of the head. The sheaths may also be used in other surgical procedures for protection of tissue around a surgical pathway. The sheaths above are discussed in terms of having different sections only for purposes of description. The sheaths may be manufactured from rubber or plastic as an integral one-piece unit, without specific or visible separation lines or features between the sections described.
- Thus, a novel surgical sheath has been shown and described. Various changes and substitutions may of course be made without departing from the spirit and scope of the invention. The invention, therefore, should not be limited except by the following claims and their equivalents.
Claims (12)
1. A surgical sheath comprising:
a conical section having a larger conical section first end tapering to a smaller conical section second end, with the larger conical section first end forming a proximal opening of the surgical sheath;
an angle section having a quadrilateral cross-sectional shape, and the smaller conical section second end joined to a first side of the angle section;
a body section having a larger body section first end tapering to a smaller body section second end, with a second side of the angle section joined to the body section second end; and
with the body section having a first length and the conical section having a second length, and with the first length greater than the second length, and with the conical section, the angle section and the body section comprising a flexible material to allow the sheath to conform to inner walls of a patient's nostril.
2. The sheath of claim 1 further comprising one or more pleats on the body section to allow the body section to stretch outwardly more easily than the conical section.
3. The sheath of claim 1 with the body section having a wall thickness less than a wall thickness of the conical section.
4. The sheath of claim 1 further comprising two or more ridges on an outside surface of the body section.
5. The sheath of claim 1 with conical section having an opening in a plane at an acute angle of 50-70 degrees to a central axis of the body section.
6. The sheath of claim 1 with the body section having a central axis and a distal opening in a plane oriented substantially perpendicular to the central axis.
7. The sheath of claim 1 with the angle section having four sides and with none of the sides parallel to each other.
8. The sheath of claim 1 with the first and second sides of the angle section opposite from each other, and with the angle section having third and fourth sides opposite from each other, and with the third side perpendicular to the first side.
9. The sheath of claim 1 with the body section having a central axis perpendicular to the second side of the angle section.
10. The sheath of claim 12 wherein the body section has a central axis that bisects the second side of the angle section.
11. A surgical sheath comprising:
a conical section having a free first end tapering to a smaller second end, with the free first end forming a proximal opening of the surgical sheath;
an angle section having at least first, second and third sides, with first side at an acute angle to the second side, and the smaller second end of the conical section adjoining the first side of the angle section;
a body section having a free first end tapering to a smaller second end, with the second side of the angle section joined to the smaller second end of the body section; and
with the body section having a first length and the conical section having a second length, and with the first length greater than the second length, and with the conical section, the angle section and the body section comprising a flexible material to allow the sheath to conform to inner walls of a patient's nostril.
12. The sheath of claim 11 with the third side of the angle section forming a first acute angle with the first side of the angle section and forming a second acute angle with the second side of the angle section.
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US15/340,718 US9949621B2 (en) | 2009-11-14 | 2016-11-01 | Surgical tissue protection sheath |
US15/680,947 US20170347865A1 (en) | 2013-03-13 | 2017-08-18 | Surgical tissue protection sheath |
US15/933,036 US10470647B2 (en) | 2009-11-14 | 2018-03-22 | Surgical tissue protection sheath |
US16/211,776 US10986984B2 (en) | 2013-03-13 | 2018-12-06 | Surgical tissue protection sheath |
US16/427,151 US11039735B2 (en) | 2013-03-13 | 2019-05-30 | Surgical tissue protection sheath |
US17/152,559 US11737659B2 (en) | 2013-03-13 | 2021-01-19 | Surgical tissue protection sheath |
US29/826,106 USD999375S1 (en) | 2013-03-13 | 2022-02-09 | Surgical sheath |
US29/826,069 USD999374S1 (en) | 2013-03-13 | 2022-02-09 | Surgical sheath |
US18/349,714 US20230346206A1 (en) | 2013-03-13 | 2023-07-10 | Surgical tissue protection sheath |
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US12/943,779 US20110118551A1 (en) | 2009-11-14 | 2010-11-10 | Collateral soft tissue protection surgical device |
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US201261730588P | 2012-11-28 | 2012-11-28 | |
US13/760,971 US9011326B2 (en) | 2009-11-14 | 2013-02-06 | Soft tissue shield for trans-orbital surgery |
US13/798,990 US8986201B2 (en) | 2009-11-14 | 2013-03-13 | Surgical tissue protection sheath |
US14/626,184 US20150157193A1 (en) | 2009-11-14 | 2015-02-19 | Surgical tissue protection sheath |
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WO2010107894A1 (en) * | 2009-03-17 | 2010-09-23 | Nasolex | Sleep apnea therapy with naso-phyrangeal bypass |
US8323184B2 (en) | 2009-03-31 | 2012-12-04 | Covidien Lp | Surgical access port and associated introducer mechanism |
US8257251B2 (en) * | 2009-04-08 | 2012-09-04 | Ethicon Endo-Surgery, Inc. | Methods and devices for providing access into a body cavity |
US8839790B2 (en) * | 2009-07-29 | 2014-09-23 | Adva Beck Arnon | Nasal inserts |
US20110118551A1 (en) | 2009-11-14 | 2011-05-19 | SPI Surgical, Inc. | Collateral soft tissue protection surgical device |
US8986201B2 (en) * | 2009-11-14 | 2015-03-24 | Spiway Llc | Surgical tissue protection sheath |
US9451981B2 (en) * | 2009-11-14 | 2016-09-27 | Spiway Llc | Surgical tissue protection sheath |
US20120203069A1 (en) * | 2009-11-14 | 2012-08-09 | Blake Hannaford | Surgical shield for soft tissue protection |
US8579810B2 (en) * | 2010-02-12 | 2013-11-12 | Covidien Lp | Expandable thoracic access port |
DE102010054786A1 (en) * | 2010-12-16 | 2012-06-21 | Günter Böhm | Apparatus for supporting nasal respiration, has base material whose outer mold is formed according to inner contour of front region of nasal cavity |
DE202010017673U1 (en) * | 2010-12-16 | 2012-10-22 | Günter Böhm | A device for assisting nasal breathing |
US9205237B2 (en) * | 2011-07-13 | 2015-12-08 | Khoury Medical Devices, Llc | Single lumen distal perfusion sheath |
US9004071B2 (en) | 2011-10-18 | 2015-04-14 | Ian Joseph Alexander | Nasal guide and method of use thereof |
DE202012100028U1 (en) * | 2012-01-04 | 2012-04-25 | Hubert Hipp | nasal tube |
FR2985660A1 (en) * | 2012-01-13 | 2013-07-19 | Georges Antoine Creps | NASAL AMBULATORY DEVICE |
WO2014052595A2 (en) * | 2012-09-26 | 2014-04-03 | University Of Virginia | Devices and methods for protecting an internal channel of a subject |
-
2013
- 2013-03-13 US US13/798,990 patent/US8986201B2/en active Active
-
2015
- 2015-02-19 US US14/626,184 patent/US20150157193A1/en not_active Abandoned
-
2016
- 2016-11-01 US US15/340,718 patent/US9949621B2/en active Active
-
2018
- 2018-03-22 US US15/933,036 patent/US10470647B2/en active Active
Also Published As
Publication number | Publication date |
---|---|
US20130190571A1 (en) | 2013-07-25 |
US8986201B2 (en) | 2015-03-24 |
US9949621B2 (en) | 2018-04-24 |
US10470647B2 (en) | 2019-11-12 |
US20170042409A1 (en) | 2017-02-16 |
US20180206709A1 (en) | 2018-07-26 |
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Legal Events
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AS | Assignment |
Owner name: SILICON VALLEY BANK, CALIFORNIA Free format text: SECURITY INTEREST;ASSIGNOR:SPIWAY, LLC;REEL/FRAME:037805/0277 Effective date: 20160219 |
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STCB | Information on status: application discontinuation |
Free format text: ABANDONED -- FAILURE TO RESPOND TO AN OFFICE ACTION |