WO2005092202A1

WO2005092202A1 - Medical instrument handle

Info

Publication number: WO2005092202A1
Application number: PCT/US2005/006622
Authority: WO
Inventors: Raymond A. Bojarski; Victor M. Ilizaliturri, Jr.; Jason Labeau
Original assignee: Smith & Nephew, Inc.
Priority date: 2004-03-05
Filing date: 2005-03-03
Publication date: 2005-10-06

Abstract

A surgical device includes a handle defining a bore having a first portion that releasably receives a first member, and a larger diameter second portion that releasably receives a second member over the first member. A torsional force applied to the handle is transmitted simultaneously to the first and second members to insert the first and second members into tissue. A fixation member frictionally couples at least one of the first and second members to the handle. A method includes coupling the first and second members to the handle with the first member received within a channel of the second member, and applying torsional force to the handle to simultaneously insert the first and second members into tissue. The first member is removed from the tissue using the handle while leaving the second member in tissue.

Description

MEDICAL INSTRUMENT HANDLE

TECHNICAL FIELD This disclosure relates to a medical instrument handle.

BACKGROUND When performing arthroscopic or endoscopic surgery, it can be desirable to enlarge a portal in a tissue before inserting a cannula through the portal, e.g., when performing arthroscopic surgery on a hip or shoulder joint. Generally, a guide wire is inserted into the joint under fluoroscopy creating a portal in the tissue. A switching stick is then passed over the guide wire and into the joint to enlarge the portal, and an enlarger is passed over the switching stick and into the joint to further enlarge the portal. Finally, a cannula is inserted into the enlarged portal over the enlarger and the enlarger and switching stick are removed from the tissue.

SUMMARY In an aspect, a surgical device includes a handle defining a bore having a first portion and a second portion of larger diameter than the first portion. The first portion is arranged to releasably receive a first member and the second portion is arranged to releasably receive a second member over the first member. The first and second portions are configured such that a torsional force applied to the handle can be transmitted simultaneously to the first and second members when received in the respective first and second portions to facilitate inserting the first and second members into tissue. Embodiments of this aspect may include one or more of the following features: The surgical device includes the first member, which is an elongated member, and the second member, which has a channel configured to receive the first member. The includes a shaft that defines the bore, and a cross-bar coupled to the shaft in a T-shaped configuration. The handle includes a fixation member configured to frictionally couple at least one of the first and second members to the handle. The fixation member includes one or more set screws or one or more O-rings. The handle includes an anti-rotation member that interacts with the first and second members such that a torsional force applied to the handle can be transmitted simultaneously to the first and second members. The anti-rotation member includes one or more pins passing transversely through the bore to impede rotation of the first and second members relative to the handle. The pin is configured to abut a flattened proximal portion of the first member and/or to abut a notch-cut out with a flat edge of the second member. The bore includes a third portion configured to allow a guide wire to pass freely therethrough. In another aspect, a surgical device includes a handle defining a bore having a first portion and a second portion of larger diameter than the first portion. The first portion is arranged to releasably receive a first member, the second portion being arranged to releasably receive a second member over the first member. A fixation member is configured to frictionally couple at least one of the first and second members to the handle when received in the bore to facilitate inserting the at least one of the first and second members into tissue. Embodiments of this aspect may include one or more of the following features. The surgical device includes the first member, which is an elongated member, and the second member, which has a channel configured to receive the first member. The fixation member includes one or more set screws and/or one or more O-rings. In another aspect, a method includes coupling a first member to a handle, coupling a second member to the handle such that the first member, while coupled to the handle, is received within a channel of the second member, and applying a torsional force to the handle to facilitate simultaneous insertion of the first and second members into tissue. Embodiments of this aspect may include one or more of the following features. The first member is an elongated member and the second member has a channel configured to receive the first member. An axial force is applied to the handle to facilitate the simultaneous insertion of the first and second members into tissue. The simultaneous insertion of the first and second members enlarges an opening into the tissue. A force is applied to the handle to remove the first member from the tissue while leaving the second member inserted into the tissue. A guide wire is inserted into the tissue and the first and second members are passed over the guide wire. A slotted cannula is passed over the second member, and the first and second members are removed from the tissue while leaving the slotted cannula in the tissue. The method includes impeding rotation of the first and second members relative to the handle and/or maintaining a friction fit between the handle and the first and second members. In another aspect, a method includes inserting, over a first member, a second member into tissue using a handle coupled to the second member, and removing the first member from the tissue using the handle while leaving the second member in the tissue. Embodiments of this aspect may include one or more of the following features. The first member is an elongated member and the second has a channel configured to receive the first member. Inserting the second member includes applying a torsional force to the handle and/or applying an axial force to the handle. Removing the first member includes applying a force to the handle. Prior to inserting the second member, the first member is inserted into the tissue using the handle coupled to the first member. A guide wire is inserted into the tissue and the first and second members are passed over the guide wire. A slotted cannula is passed over the second member. The method includes impeding rotation of the second member relative to the handle and/or maintaining a friction fit between the handle and the second member. According to another aspect, a handle includes a shaft defining a longitudinal bore. The bore has a first portion and a second portion of larger diameter than the first portion. The first portion is configured to releasably receive an elongated member, e.g., a switching stick, to facilitate pushing the elongated member into a tissue. The second portion is configured to releasably receive a cannulated member, e.g., an enlarger, to facilitate pushing the cannulated member over the elongated member. Embodiments of this aspect may include one or more of the following features: The handle includes a cross-bar coupled to the shaft in a T-shaped configuration. The shaft includes a first set screw for frictionally holding the elongated member and a second set screw for frictionally holding the cannulated member. The shaft includes a pin passing transversely through the second portion to impede rotation of the elongated member and the cannulated member relative to the shaft. The elongated member includes a flattened proximal portion that abuts the pin. The cannulated member includes a proximal end portion defining a notch cut-out having a flat edge that abuts the pin. The shaft includes a first shoulder configured to abut against an end of the elongated member and a second shoulder configured to abut against an end of the cannulated member. The bore includes a third portion configured to allow a guide wire to pass freely therethrough. The elongated member includes a tapered distal end configured to enlarge a portal in the tissue. The elongated member includes a throughbore configured to allow the elongated member to pass .over a guide wire. The cannulated member includes a tapered distal end configured to enlarge a portal in the tissue. The cannulated member includes a throughbore configured to allow the cannulated member to pass over the elongated member. According to another aspect, an elongated member, configured to enlarge an opening in a tissue, includes a flattened proximal portion adapted to be received in a bore of a shaft to impede rotation of the elongated member relative to the shaft. According to another aspect, an elongated cannulated member, configured to enlarge an opening in a tissue, has a notched cut-out with a flat edge adapted to be received in a bore of a shaft to impede rotation of the cannulated member relative to the shaft. According to another aspect, a method includes coupling an elongated member to a handle, pushing the handle to enlarge an opening in the tissue by inserting the elongated member into a tissue, removing the handle from the elongated member while leaving the elongated member in the tissue, coupling a cannulated member to the handle, and pushing the handle to further enlarge the opening in the tissue by passing the cannulated member over the elongated member and into the tissue. The method may include one or more of the following features: inserting a guide wire into the tissue and passing the elongated member over the guide wire; removing the handle from the cannulated member; passing a slotted cannula over the cannulated member; and removing the elongated member and cannulated member from the tissue while leaving the slotted cannula in the tissue. The method may also include impeding rotation of the elongated member and the cannulated member relative to the handle and maintaining a friction fit between the handle and the elongated member and between the handle and the cannulated member. Advantages may include one or more of the following. The handle provides a single instrument that allows a surgeon to insert both a switching stick and an enlarger to enlarge a portal in tissue. The handle, the switching stick, and the enlarger are configured to provide both linear and rotational stability between the handle and the switching stick and between the handle and the enlarger. The use of the handle provides control over the switching stick and the enlarger, limiting the chance of damaging the sunounding tissue or cartilage in the joint space. The handle enables the switching stick to be automatically grasped by the handle when placing the enlarger such that the switching stick can be removed leaving the enlarger in place. The details of one or more embodiments are set forth in the accompanying drawings and the description below. Other features, objects, and advantages will be apparent from the description and drawings, and from the claims.

DESCRIPTION OF DRAWINGS FIG. 1 shows a handle coupled to an enlarger that is being passed over a switching stick and into tissue surrounding a hip joint. FIG. 2 is a perspective view of the handle of Fig 1. FIG. 3 is a side view of a shaft of the handle of Fig. 2. FIG. 4 is a side view of the shaft of the handle of Fig. 3 along line 4-4. FIG. 5 is an end view of the shaft of the handle of Fig. 3 along line 5-5. FIG. 6 is a side view of a cross-bar of the handle of Fig. 2. FIG. 7 is a side view of the switching stick of Fig. 1. FIG. 8 is a perspective view of a proximal portion of the switching stick of Fig. 7. FIG. 9 is a side view of the of the enlarger of Fig. 1. FIG. 10 is a perspective view of a proximal portion of the enlarger of Fig. 9. FIG. 11 is a cut-away perspective view of the handle coupled to the switching stick and the enlarger. FIG. 12 is a perspective view of the switching stick and the enlarger abutting against a cross pin, with the other elements of the handle not shown. FIG. 13 shows a guide wire inserted into the tissue surrounding the hip joint. FIG. 14 is a perspective view of the switching stick coupled to the handle. FIG. 15 shows the handle the switching stick being passed over the guide wire and into the tissue. FIG. 16 shows the switching stick inserted in the tissue with the handle removed. FIG. 17 is a perspective view of the enlarger coupled to the handle. FIG. 18 shows a slotted cannula being inserted into the tissue over the expander after removal of the handle from the expander. FIG. 19 is a perspective view of the slotted cannula inserted into the tissue with the handle, switching stick, and enlarger removed. FIG. 20 shows the switching stick and the enlarger being inserted simultaneously into the tissue. FIG. 21 is a perspective view of another embodiment of a handle that can be coupled to the enlarger and the switching stick. FIG. 22 is an exploded cross-sectional view of the handle of FIG. 21. FIG. 23 is a cross-sectional view of the handle of FIG. 21 coupled to the switching stick and the enlarger. DETAILED DESCRIPTION Referring to Fig. 1, a handle 10 includes a shaft 12 that releasably receives an elongated member, e.g., a switching stick 14, and a cannulated member, e.g., an enlarger 16. Handle 10 includes a cross-bar 18 coupled to shaft 12 in a T-shape configuration for grasping handle 10. Handle 10 facilitates introduction of switching stick 14 and enlarger 16 into a portal 76 in tissue 72 to enlarge portal 76 by providing a single tool for manipulating both switching stick 14 and enlarger 16 and a grip for applying axial and torsional forces to switching stick 14 and enlarger 16. Referring to Figs. 2-4, shaft 12 defines a longitudinal bore 20 having a distal portion 22, an intermediate portion 24, and a proximal portion 26, each having a progressively smaller diameter. At the junction of proximal and intermediate portions 26, 24 is formed a proximal shoulder 28. At the junction of distal and intermediate portions 22, 24 is formed a distal shoulder 30. Proximal portion 26 has a smaller diameter than switching stick 14 and is sized so that a guide wire can freely pass therethrough. Intermediate portion 24 has a smaller diameter than enlarger 16 and is sized to releasably receive switching stick 14 with an end of switching stick 14 abutting against proximal shoulder 28. Distal portion 22 is sized to releasably receive enlarger 16 with an end of enlarger 16 abutting against distal shoulder 30. For example, in some implementations, proximal portion 26 has a diameter DI of approximately 0.02 to 0.1 inches (.05 to 0.25 cm) intermediate portion has a diameter D2 of approximately 0.05 to 0.9 inches (0.13 to 2.29 cm), and distal portion has a diameter D3 of approximately 0.07 to 1 inch (0.18 to 2.54 cm). In other implementations, proximal portion 26 has a diameter Di of approximately 0.09 to 0.1 inches (0.23 to 0.25 cm), intermediate portion has a diameter D₂ of approximately 0.185 to 0.195 inches (0.47 to 0.49 cm), and distal portion has a diameter D₃ of approximately 0.24 to 0.25 inches (0.61 to 0.64 cm). Shaft 12 includes a cylindrical distal section 21, a cylindrical intermediate section 23, and a cylindrical proximal section 25. Intermediate section 23 has a larger diameter than distal section 21 and proximal section 25 to facilitate supporting a fixation member, as described below. Proximal section 25 and distal section 21 have smaller diameters than intermediate section 23 to reduce the weight of shaft 12. For example, in some implementations distal section 21 has a diameter of approximately 0.425 to 0.45 inches (1.08 to 1.14 cm), intermediate section 23 has a diameter of approximately 0.6 to 0.65 inches (1.5 to 1.6 cm), and proximal section 25 has a diameter of approximately 0.475 to 0.525 inches (1.2 to 1.3 cm). In other implementations, distal section 21, intermediate section 23, and proximal section 25 each have a diameter of approximately 0.25 to 1.5 inches (0.6 to 3.8 cm). Intermediate section 23 of shaft 12 defines a first hole 32 extending from an outer surface 27 of intermediate section 23 into intermediate portion 24 of bore 20 for receiving a first fixation member, e.g., a first set screw (not shown). Similarly, intermediate section 23 of shaft 12 defines a second hole 34 extending from outer surface 27 of intermediate section 23 into distal portion 22 of bore 20 for receiving a second fixation member, e.g., a second set screw 33 (Fig. 5). Shaft 12 also includes a cross hole 36 extending across a bottom portion 31 of distal portion 22 of bore 20 at a position between first hole 32 and second hole 34 for receiving an anti- rotation member, e.g., cross pin 37 (Fig. 5). As shown in Fig. 5, cross bore hole 36 is sized and positioned so that cross pin 37 is approximately tangent to intermediate portion 24 of bore 20. Cross pin 37 limits rotation of switching stick 14 and enlarger 16, as described below. Referring to Figs. 2 and 6, cross-bar 18 of handle 10 defines a cylindrical opening 38 for receiving a proximal end portion 39 of shaft 12 (shown in Fig. 3). Cross-bar 18 is attached to handle 10, for example, by press-fitting, welding, soldering, or using an adhesive material. Cylindrical opening 38 is in communication with a smaller opening 40 that has approximately the same diameter as proximal portion 26 of bore 20. When assembled smaller opening 40 is in communication with proximal portion 26 of bore 20 such that a guide wire can be threaded through bore 20 and smaller opening 40. Cross bar 18 additionally defines lateral cutouts 42 and 44 that reduce the weight of cross bar 18. Referring to Figs. 7 and 8, switching stick 14 has the shape of an elongated cylindrical rod with an outer diameter slightly less than the diameter of intermediate portion 24 of bore 20. For example, in some implementations switching stick 14 has a length of approximately 3 to 15 inches (7 to 38 cm) and a diameter of approximately 0.05 to 0.9 inches (0.13 to 2.3 cm). In other implementations switching stick 14 has a length of approximately 11 to 13 inches (28 to 33 cm) and a diameter of approximately 0.167 to 0.169 inches (0.42 to 0.43 cm). Switching stick 14 includes a tapered distal end portion 46 to facilitate inserting switching stick 14 into a portal in tissue to enlarge the portal. For example, tapered end portion 46 has a length of approximately 0.15 to 0.2 inches (0.38 to 0.5 cm) and is tapered at an angle. In certain implementations the angle of the taper is approximately 5 to 45 degrees. In other implementations, the angle of the taper is approximately 15 to 20 degrees. Switching stick 14 also defines a longitudinal throughbore 48 for receiving a guide wire, as described below. In certain implementations, throughbore 48 has a diameter of approximately 0.02 to 0.1 inches (0.05 to 0.25 cm). In other implementations, throughbore 48 has a diameter of approximately 0.054 to 0.058 inches (0.14 to 0.15 cm). Switching stick 14 has a proximal portion 50 that includes a flattened portion 52 for purposes discussed below. Flattened portion 52 has a length up to the length of switching stick 14. For example, in certain implementations, flattened portion 52 has a length Li of approximately 2.25 to 2.75 inches (5.7 to 7 cm). A height Hi between flattened portion 52 and the outer diameter of switching stick 14 (as measured along a line perpendicular to flattened portion 52 and through the center of a cross section of switching stick 14) is, for example, in certain implementations approximately 0.04 to 0.75 inches (0.1 to 1.9 cm) and in other implementations approximately 0.159 to 0.161 inches (0.40 to 0.41 cm). Referring to Figs. 9 and 10, enlarger 16 has the shape of an elongated cylindrical rod and can be shorter than switching stick 14. Enlarger 16 has an outer diameter slightly less than the diameter of distal portion 22 of bore 20. For example, in certain implementations, enlarger 16 has a length of approximately 3 to 15 inches (7 to 38 cm) and a diameter of approximately 0.07 to 1 inch (0.18 to 2.54 cm). In other implementations, enlarger 16 has a length of approximately 10 to 12 inches (25 to 30 cm) and a diameter of approximately 0.217 to 0.218 inches (0.55 to 0.56 cm). Enlarger 16 includes a tapered distal end portion 54 to facilitate further enlarging a portal in a tissue. For example, tapered end portion 54 has a length of approximately 0.05 to 0.1 inches (0.13 to 0.25 cm) and is tapered at an angle. In certain implementations the angle is approximately 5 to 45 degrees. In other implementations, the angle is approximately 20 to 30 degrees. Enlarger 16 also defines a longitudinal throughbore 56 having a diameter slightly 5 greater than the outer diameter of switching stick 14, for example, for receiving switching stick 14, as described below. In certain implementations, throughbore 56 has a diameter of about 0.05 to 0.9 inches (0.13 to 0.23 cm). In other implementations, throughbore 56 has a diameter of approximately 0.178 to 0.18 inches (0.45 to 0.46 cm). Enlarger 16 has a proximal portion 58 that includes a notch cut-out 60 defining flat edges 62 and 64, for purposes discussed below. o Notch cut-out 60 has a length L₂ that can be up to almost the entire length of the enlarger 16. For example, in certain implementations, notch cut-out 60 has a length L₂ of approximately 0.29 to 0.31 inches (0.74 to 0.79 cm). A height H₂ between flat edges 62, 64 and the outer diameter of enlarger 16 (as measured along a line perpendicular to flat edges 62 and 64 and through the center of a cross section of enlarger 16) is, in some implementations, approximately 0.055 to5 0.76 inches (0.14 to 1.9 cm), and, in other implementations, approximately 0.182 to 0.184 inches (0.46 to 0.47 cm). Flat edges 62 and 62 each have a width, in some implementations, of approximately 0.007 to 0.1 inches (0.02 to 0.25 cm), and, in other implementations, of approximately 0.02 inches (0.05 cm). Referring to Figs. 11 and 12, enlarger 16 is received in distal portion 22 of bore 20 in0 shaft 12 of handle 10 such that a proximal end 66 of enlarger 16 abuts against distal shoulder 30. Enlarger 16 is axially held in shaft 12 by a friction fit between enlarger 16 and second set screw 35. Second set screw 35 can be adjusted to provide a friction fit between enlarger 16 and shaft 12 so that a predetermined amount of force is required to remove enlarger 16 from shaft 12. Torsion of enlarger 16 relative to shaft 12 is impeded by flat edges 62 and 64 of enlarger 165 abutting against cross-pin 37. Switching stick 14 is received in longitudinal bore 56 of enlarger 16. Proximal portion 50 of switching stick 14 is received in intermediate portion 24 of bore 20 in shaft 12 of handle 10. Longitudinal throughbore 48 (shown in Fig. 12) of switching stick 14 is aligned with proximal portion 26 of bore 20 to permit a guide wire to pass through longitudinal throughbore0 48 of switching stick 14 and through proximal portion 26 of bore 20. Switching stick 14 axially is held in place by a friction fit between switching stick 14 and first set screw 33. First set screw 33 can be adjusted to provide a friction fit between switching stick 14 and shaft 12 so that a predetermined amount of force is required to remove switching stick 14 from shaft 12. Torsion of switching stick 14 relative to shaft 14 is impeded by flattened portion 52 of switching stick 14 abutting against cross pin 37. Referring to Fig. 13, in use, the operator inserts a guide wire 70 into tissue 72 surrounding a hip joint 74 creating portal 76 in tissue 72. Referring to Fig. 14, the operator then attaches switching stick 14 to shaft 12 such that proximal end 51 of switching stick 14 abuts against proximal shoulder 28 of shaft 12. Refening to Fig. 15, the operator positions switching stick 14 over guide wire 70 and applies an axial force to handle 10 in the direction of arrow 80 and a torsional force to handle 10 in the direction of arrow 81 to pass switching stick 14 over guide wire 70 and into tissue 72 to enlarge portal 76. Referring to Fig. 16, the operator then removes handle 10 from switching stick 14 by pulling handle 10 with one hand while holding switching stick 14 in place with the other hand, leaving switching stick 14 and guide wire 70 in tissue 72. The force needed to remove switching stick 14 from handle 10 is greater than the force needed to remove switching stick 14 from tissue 72. The operator then removes guide wire 70 from tissue 72 by pulling the guide wire with one hand or with an instrument while holding switching stick 14 in tissue 72 with the other hand. Referring to Fig. 17, the operator attaches enlarger 16 to shaft 12. Referring again to Fig. 1, the operator positions enlarger 16 over switching stick 14 and applies an axial force to handle 10 in the direction of arrow 82 and a torsional force to handle 10 in the direction of arrow 83 to pass enlarger 16 over switching stick 14 and into tissue 72 to further enlarge portal 76. As enlarger 16 is passed into tissue 72, switching stick 14 is received in intermediate portion 24 of bore 20 and coupled to handle 12, as discussed above with respect to Fig. 11. Referring to Fig. 18, the operator then removes handle 10 from enlarger 16 by pulling handle 10 with one hand while holding enlarger 16 in place with the other hand, thus leaving enlarger 16 in tissue 72 and removing switching stick 14. The force needed to remove handle 10 from enlarger 16 is greater than the force needed to remove enlarger 16 from tissue. Then, the operator passes a slotted cannula 90 over enlarger 16 and into portal 76 in tissue 72. Referring to Fig. 19, once slotted cannula 90 has been inserted into portal 76, enlarger 16 is removed from tissue 72 by manually grasping the enlarger 16 or by coupling enlarger 16 to handle 10 and pulling handle 10 to remove enlarger 16 from tissue 72. The operator can then perform arthroscopic surgery by passing surgical instruments through slotted cannula 90 and into tissue 72 through portal 76. Alternatively, as shown in Fig. 20, after the operator has inserted the guide wire 70 into the tissue 72 creating the portal 76 in the tissue 72 (Fig. 13), the operator attaches switching stick 14 and enlarger 16 to handle 10 such that enlarger 16 is received over switching stick 14. The operator then passes switching stick 14 over guide wire 70, and applies an axial force to handle 10 in the direction of arrow 92 and a torsional force to handle 10 in the direction of anow 93 to simultaneously insert switching stick 14 and enlarger 16 into tissue 72. Thus, distal end portion 46 of switching stick is inserted into tissue 72 followed immediately by distal end 54 of enlarger 16 to enlarge portal 76. After switching stick 14 and enlarger 16 are inserted into tissue 72, the operator removes switching stick 14 from tissue 72 by pulling handle 10 with one hand while holding enlarger 16 in place with the other hand, thus leaving enlarger 16 in tissue 72 and removing switching stick 14, as shown in Fig. 18. Other embodiments are within the scope of the following claims. For example, referring to Fig. 21, a handle 210 includes a two-piece shaft 212 for releasably receiving switching stick 14 and enlarger 16, and a cross-bar 218 coupled to shaft 212. Handle 210 includes anti-rotation members, e.g., cross-pins 214 and 216, that limit rotation of enlarger 14 and switching stick 16, respectively, and fixation members, e.g., O-rings 215 and 217, that hold switching stick 14 and enlarger 16, respectively, in shaft 212 by friction fit. For ease of manufacturability, shaft 212 is formed into a proximal member 220 and a distal member 240 that are connected, for example, by press-fitting, welding, soldering, or using an adhesive material.. Referring also to Figs. 22 and 23, proximal member 220 of shaft 212 defines a longitudinal bore 222 having a proximal portion 224 for receiving the guide wire, and a distal portion 226 for receiving the switching stick. Proximal member 220 defines a cross hole 235 for receiving cross pin 214. Similar to cross hole 36 shown in Fig. 5, cross hole 235 is sized and positioned so that cross pin 214 is approximately tangent to proximal portion 224 of bore 222. Cross pin 214 limits rotation of switching stick 14. Distal member 240 of shaft 212 defines a longitudinal bore 242 having a proximal portion 244 for receiving a distal section 236 of member 220, and a distal portion 248 for receiving enlarger 16. Formed in distal portion 248 is a distal annular groove 252 that is sized to receive O-ring 217 for forming a friction fit with enlarger 16, and a proximal annular groove 254 that is sized to receive O-ring 215 for forming a friction fit with switching stick 14. Distal member 240 defines a cross hole 237 for receiving cross pin 216, which is sized and positioned to limit rotation of switching stick 14 and enlarger 16. Alternatively, instead of two cross-pins 214 and 216, only a single cross-pin can be used, for example, as described above with respect to handle 10. When working and viewing portals have been established, for example, in the hip joint, the operator can switch the portals using handle 10 or 210, ^"by inserting the switching stick through the cannula in the working portal and removing the cannula from the working portal while leaving the switching stick in the tissue. Next, the operator inserts the working cannula into the joint over the arthroscopic cannula in the viewing portal and removes the arthroscopic cannula, while leaving the working cannula in place. Finally, the operator inserts the arthroscopic cannula over the switching stick, and uses the handle to remove the switching stick while leaving the arthroscopic cannula in place. A number of embodiments have been described. Nevertheless, it will be understood that various modifications may be made without departing from the spirit and scope . For example, the handle and shaft can have other shapes such as a tube having a hexagonal or rectangular cross section. The sections of the shaft can have different outside diameters or the shaft can have a constant outside diameter. The shaft can be made of multiple members attached together or can be integral. Instead of set screws or O-rings, other fixa-tion mechanisms can be used to frictionally hold the switching stick and enlarger in place, s.nch as spring loaded ball plungers, j- locks, snap fits, or leaf springs. The set screws can be adjusted to change the force of the friction fit before or during use of the handle. Any number or combination of these fixation mechanisms can be used, such as a single O-ring that forms a friction fit against the outside surfaces of both the switching stick and the enlarger. Other mechanisms can be used to limit rotation of the switching stick and enlarger relative to the shaft, such as by making the switching stick, enlarger, and bore in the shaft have mating non-circular cross-sections. Any number or combination of these mechanisms can be used. The handle can have additional sections in the bore of progressively larger diameters to receive a number of progressively larger diameter enlargers, to further enlarge the portal in the tissue. The guide wire can rremain in place in the tissue during the entire procedure. Similarly, the switching stick can rerrxain in the tissue while the slotted cannula is passed over the expander. The slotted cannula can be inserted into the portal while the handle remains coupled to the enlarger and/or to the switching stick. In addition to enlarging a portal in the tissue, the switching stick and/or the enlarger can be used to form or enlarge a second portal in a tissue by continuing to push the switching stick and/or enlarger through the joint and out of the joint through a second portal. The handle, switching stick and enlarger can be made from any biocompatible material, including stainless steel, titanium, plastic, or ceramic.

Claims

CLAIMS WHAT IS CLAIMED IS:

1. A surgical device comprising:

5 a handle defining a bore having a first portion and a second po ϋon of larger diameter than the first portion, the first portion being arranged to releasably receive a first member, the second portion being ananged to releasably receive a second member over the first member, wherein the first and second portions are configured such that a. torsional force applied to the handle can be transmitted simultaneously to the first and second members when received in o the respective first and second portions to facilitate inserting the first and second members into tissue. 2. The surgical device of claim 1 further comprising the fixst member. 3. The surgical device of claim 1 or 2 further comprising tJhe second member. 4. The surgical device of claim 4 wherein the second menxber defines a channel 5 configured to receive the first member. 5. The surgical device of claims 1-4 further comprising a fixation member configured to frictionally couple at least one of the first and second members to the handle. 6. The surgical device of claims 1-5 further comprising an anti-rotation member positioned within the bore to impede rotation of the first and second members relative to the0 handle. 7. The surgical device of claim 6 wherein the anti-rotation member comprises a pin passing transversely through the bore to impede rotation of the first and second members relative to the handle. 8. The surgical device of claim 7 wherein the pin is confignred to abut a flattened5 proximal portion of the first member. 9. The surgical device of claim 7 wherein the pin is configured to abut a notch-cut out with a flat edge of the second member. 10. The surgical device of claims 1-9 wherein the bore includes a third portion configured to allow a guide wire to pass freely therethrough.0 11. A surgical device comprising: a handle defining a bore having a first portion and a second portion of larger diameter than the first portion, the first portion being arranged to releasably receive a first member, the second portion being ananged to releasably receive a second member over the first member, and a fixation member configured to frictionally couple at least one of the first and second members to the handle when received in the bore to facilitate inserting the at least one of the first and second members into tissue. 12. The surgical device of claim 11 wherein the fucation member comprises a set screw. 13. The surgical device of claim 11 or 12 wherein the fixation member comprises an O-ring. 14. A method comprising: coupling a first member to a handle; coupling a second member to the handle such that the first member, while coupled to the handle, is received within a channel of the second member; and applying a torsional force to the handle to facilitate simultaneous insertion of the first and second members into tissue. 15. The method of claim 14 further comprising applying a force to the handle to remove the first member from the tissue while leaving the second member inserted in the tissue. 16. The method of claim 14 or 15 further comprising impeding rotation of the first and second members relative to the handle. 17. The method of claims 14-16 further comprising maintaining a friction fit between the handle and the first and second members. 18. A method comprising: inserting, over a first member, a second member into ti ssue using a handle coupled to the second member; and removing the first member from the tissue using the h ndle while leaving the second member in the tissue. 19. The method of claim 18 further comprising, prior to inserting the second member, inserting the first member into the tissue using the handle coupled to the first member.

20. The method of claim 18 or 19 further comprising passing a slotted cannula over the second member.