Classifications

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  • A61B17/00—Surgical instruments, devices or methods
  • 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
• • A—HUMAN NECESSITIES
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  • A61B1/313—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 for introducing through surgical openings, e.g. laparoscopes
• • A—HUMAN NECESSITIES
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  • A61B1/00064—Constructional details of the endoscope body
  • A61B1/00071—Insertion part of the endoscope body
  • A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
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  • A61B1/04—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 combined with photographic or television appliances
  • A61B1/042—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 combined with photographic or television appliances characterised by a proximal camera, e.g. a CCD camera
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  • A61B1/06—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 with illuminating arrangements
  • A61B1/0661—Endoscope light sources
  • A61B1/0684—Endoscope light sources using light emitting diodes [LED]
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• • A—HUMAN NECESSITIES
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• • A—HUMAN NECESSITIES
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  • A61B90/10—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 for stereotaxic surgery, e.g. frame-based stereotaxis
  • A61B90/11—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 for stereotaxic surgery, e.g. frame-based stereotaxis with guides for needles or instruments, e.g. arcuate slides or ball joints
• • A—HUMAN NECESSITIES
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  • A61B2017/00022—Sensing or detecting at the treatment site
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  • A61B2017/00831—Material properties
  • A61B2017/00902—Material properties transparent or translucent
• • A—HUMAN NECESSITIES
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  • A61B2017/00907—Material properties transparent or translucent for light
• • A—HUMAN NECESSITIES
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  • 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
  • A61B2017/3425—Access ports, e.g. toroid shape introducers for instruments or hands for internal organs, e.g. heart ports
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  • A61B17/3421—Cannulas
  • A61B17/3439—Cannulas with means for changing the inner diameter of the cannula, e.g. expandable
  • A61B2017/3441—Cannulas with means for changing the inner diameter of the cannula, e.g. expandable with distal sealing means
• • A—HUMAN NECESSITIES
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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
  • A61B2017/3454—Details of tips
• • A—HUMAN NECESSITIES
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  • A61B2034/2046—Tracking techniques
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  • A61B90/10—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 for stereotaxic surgery, e.g. frame-based stereotaxis
  • A61B2090/103—Cranial plugs for access to brain
• • A—HUMAN NECESSITIES
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  • A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
  • A61B2090/309—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure using white LEDs
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  • A61B5/40—Detecting, measuring or recording for evaluating the nervous system
  • A61B5/4058—Detecting, measuring or recording for evaluating the nervous system for evaluating the central nervous system
  • A61B5/4064—Evaluating the brain
• • A—HUMAN NECESSITIES
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  • A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
  • A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
  • A61B5/6867—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive specially adapted to be attached or implanted in a specific body part
  • A61B5/6868—Brain
• • A—HUMAN NECESSITIES
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  • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
  • A61B90/361—Image-producing devices, e.g. surgical cameras

Definitions

• obturator tip that obturates the cannula at its distal end.
• a surgeon can advance the cannula into the brain while viewing tissue distal to the obturator tip, through the obturator tip.
• the obturator tip may reverse the image of the tissue distal to the obturator tip, presenting at its proximal surface an image of tissue distal to the tip (at its distal surface) which is reversed, depending on its construction .
• the devices and methods described below provide for improved visualization of the brain during minimally invasive surgery.
• the device comprises a cannula system with a camera mounted on the proximal end of the cannula with a view into the cannula lumen and the tissue within and below the lumen, and a obturator comprising a narrow shaft and a larger distal tip, which is transmissive to visible light (transparent or translucent), so that the tissue distal to the tip is at least partially visible, through the tip, from the proximal end of the cannula.
• the obturator tip preferably has a pointed, acutely conical distal tip, and includes an optically opaque component, such as a rod, disposed along the central axis of the obturator tip, which serves to prevent image reversal.
• the small cross-section obturator shaft is much smaller than the inner diameter of the cannula, affording a sizable annular or circular space between the shaft and the cannula wall to provide good visibility (from the camera) of the proximal surface of the obturator tip.
• Lights if necessary, may be provided in the cannula to illuminate the distal end of the obturator tip and cannula or tissue near the distal end of the cannula (lighting may instead be provided from a source outside the assembly, or from lights mounted on the proximal end of the cannula or any combination of the foregoing).
• obturator tip Light reflected by tissue near the distal surface of the obturator tip passes through the obturator and out of the proximal surface of the obturator tip, so that a surgeon inserting or manipulating the assembly can easily see that the obturator tip is near brain tissue (which is white to gray) or blood (which is red to black) .
• Figure 1 illustrates the head of a patient with an area requiring surgical intervention.
• Figures 2 through 5 illustrate the cannula and obturator, in which the obturator is provided with an opaque component within a transparent tip.
• Figure 1 illustrates a patient 1 with a blood mass 2 in the brain 3 that necessitates surgical intervention.
• a cannula 4 has been inserted into the brain, with the distal end of the cannula proximate the blood mass.
• a camera 5 is mounted on the proximal rim of the cannula, with a portion of the camera overhanging the rim of the cannula and disposed over the lumen of the cannula, and is operable to obtain video or still images of the blood mass or other tissue at the distal end of the cannula.
• the cannula comprises a cannula tube 6, with a distal end 6d adapted for insertion into the body of the patient, and the proximal end 6p which remains outside the body during use.
• the camera 5 is mounted on the proximal end 6p of the cannula tube via a mounting structure 7 secured to the proximal end of the cannula.
• the camera which may include or be fitted with a prism, a reflector or other mirror structure or optical element, overhangs the lumen 8 of the cannula tube. If the camera is small compared to the cannula lumen, the camera may be used without the prism or reflector, and may be oriented with its viewing axis aligned along the long axis of the cannula.
• Figures 1 and 2 also illustrate the obturator 9.
• the obturator comprises the obturator tip 10, shaft 11 and a handle 12.
• the obturator tip is preferably a solid structure with a conically convex distal surface lOd, a conically convex proximal surface lOp, and an axially short circumferential surface 10c.
• the tip in the region of the circumferential surface, has an outer diameter (a transverse diameter, along a plane perpendicular to the long axis of the cannula, and corresponding to the transverse cross-sectional diameter of the cannula) that closely matches the inner diameter of the cannula, but allows easy longitudinal translation of the tip through the lumen of the cannula.
• the tip configured as shown in Figure 1, will act as a lens, such that light rays (represented the arrows) are refracted through the tip, and bent such that any "image" passing through the tip, when formed as illustrated, may be reversed.
• the tip may have a rectilinear longitudinal cross-section, with a central cylindrical portion and distal and proximal conical portions, as illustrated, or a more rounded cross-section.
• the distal taper preferably ends in an acutely pointed tip which is preferred for use in the brain. As illustrated, the preferred conical tip has an apex angle of about 35° to 45°.
• the sharpened distal tip extending distally of the cannula tube facilitates advancement of the assembly through brain tissue.
• the distal surface and proximal surface need not be symmetric about the longitudinal axis, or symmetric about a transverse axis.
• the distal surface may be pointed, with a rectilinear cross-section, while the proximal surface is pointed, rounded, or flat.
• the distal surface of the obturator tip may be blunt, such as spherical or spheroid, and the entire obturator tip may be formed as a sphere, a spheroid, a prolate spheroid (a football, rugby ball), and oblate spheroid, or an ovoid ( egg-shaped ) .
• the obturator tip is optically transmissive, not optically opaque, and may be optically transparent or
• the transmittance of the tip need only be adequate, in the visible spectrum, to pass the color of tissue in contact with the distal surface, given the
• the obturator tip has a
• transverse cross-section closely matching a transverse cross- section of the cannula, and is slidable within the cannula tube, and positionable within the cannula tube such that the proximal end of the obturator shaft extends proximally out of the cannula proximal end while the tapered distal tip extends out of the cannula distal end.
• the obturator shaft has a transverse cross-section smaller than the lumen of the cannula and smaller that the transverse cross-section of the obturator tip, so that the proximal surface of the obturator tip is visible from the proximal end of the cannula, through the lumen, when the obturator tip is disposed within the cannula such that the tapered distal tip extends out of the cannula distal end.
• the tip may be made of glass, silica, acrylic, polycarbonate, silicone, nylon, polyamides or copolymers or any other material suitable for use in a medical device.
• the obturator tip surface may be polished or frosted.
• obturator tip may optionally comprise radiopaque substances (elements or compounds such as platinum particles, for
• the obturator tip may optionally comprise sensors such as pH sensors, impedance sensors, force sensors, glucose sensors, etc., to assist in detecting a blood mass or CSF and distinguishing them from surrounding brain tissue.
• the proximal surface of the tip which tapers to a small diameter in the proximal direction, also provides for clearance of the tip when the obturator must be removed to make room for other devices, despite the position of the camera assembly at the distal end of the cannula tube.
• the obturator tip is modified by the inclusion of an opaque component or
• components such as a rod 13 or any opaque substance which serves to prevent image reversal, disposed along the central axis of the obturator tip.
• the opaque component extends through the central cylindrical portion defined by the
• the opaque component is disposed along the central long axis 10L of the obturator tip, and is preferably coaxial with the obturator shaft, leaving the periphery of the obturator tip clear for maximum passage of light, and is preferably a single discrete component or single compact mass of substance.
• the proximal conical section of the obturator tip includes a bore 14 which accommodates the distal end of the obturator shaft. This bore can terminate distally within the proximal conical section, or within the central
• the opaque component 13 is disposed within a bore as well, and this additional bore 14d may be of smaller diameter than the bore that accommodates the shaft 11, or it may be the same diameter (and may be formed as a continuation of the shaft bore 14 or may be formed from the distal surface such that it is blind to the shaft bore).
• the opaque component may be provided as a component 13 separate from the obturator shaft 11, as shown in Figure 3, with a transverse dimension (a radial diameter, for example, if the radial cross section is circular) which is smaller than the transverse dimension of the obturator shaft 11.
• the obturator shaft distal end 16d may terminate also in the distal conical section, and the distal tip of the obturator shaft may serve as the optically opaque component 13, such that the opaque component is not a
• the obturator tip comprises a proximal portion lOp and a central cylindrical portion 10c
• the tapered distal tip lOd is a distal conical portion
• the obturator further comprises a bore 14, 14d extending from a proximal-most extent of the proximal portion, distally into the central cylindrical portion, and in which the distal end lOd of the shaft is disposed within the bore, where the bore has a length such that, when proximal end of the
• the obturator shaft extends proximally out of the cannula proximal end the tapered distal tip extends out of the cannula distal end, the bore 14, 14d terminates distally at a point distal to the distal end of the cannula tube.
• the opaque component may comprise the distal end lid of the shaft.
• the opaque component/distal end of the obturator shaft may have a transverse dimension which is smaller than the
• the neuro-navigation stylet distal tip 16d may extend distally beyond the shaft bore 14 (the larger bore which accommodated the shaft 11), and extend into the distal conical section (in the smaller bore 14d extending beyond the shaft bore, of smaller diameter that the shaft bore), for example into a smaller diameter bore the extends distally from the shaft bore, to serve as the opaque component.
• the neuro-navigation stylet has a distal end a proximal end, and is sized and dimensioned for insertion in a lumen of the obturator shaft, such that when proximal end of the obturator shaft extends proximally out of the cannula proximal end the tapered distal tip extends out of the cannula distal end, and the neuro-navigation stylet is disposed within the lumen of the obturator shaft, the distal end of the neuro-navigation stylet terminates distally at a point distal to the distal end of the cannula tube.
• the distal end of the neuro-navigation stylet may serve as the opaque component comprises.
• the shaft 11 may be a solid rod or a tube, with a small diameter, or transverse cross-section, compared to the cannula lumen and the obturator tip, so that the tip proximal surface can be viewed from the cannula proximal end.
• the lumen of the shaft may accommodate a neuro-navigation stylet or probe 15 with markers detectable by the neuro-navigation system, useful for guidance of the assembly into the brain.
• the rod 16 of the neuro-navigation stylet may be inserted into the lumen of tubular shaft, as shown, so that the assembled cannula, obturator and stylet may be tracked by a neuro-navigation system, through tracking of the markers 17 on a frame 18 to aid in accurate placement of the distal tip of the assembly.
• the shaft 11 may also
• the distal tip of the stylet can terminate at any point within the obturator shaft, and may terminate proximal to the obturator tip, or within the obturator tip at a point proximal to the distal edge of the cannula or distal to the distal edge of the cannula.
• the method may entail providing a cannula system comprising the cannula tube, the obturator and the neuro-navigation stylet and assembling the cannula tube, obturator and neuro-navigation stylet such that the obturator is disposed within the cannula tube with the obturator tip extending distally from the cannula distal end and the distal end of end the neuro-navigation stylet extends distally from the obturator shaft and into the distal tip of the obturator tip to provide the opaque component within the distal tip, and advancing the assembled cannula system into the body while observing body tissue distal to the cannula tube, through the obturator tip
• obturator where the obturator tip further includes an opaque component disposed in the distal tip, and assembling the cannula tube and obturator such that the obturator is disposed within the cannula tube with the obturator tip extending distally from the cannula distal end such that the opaque component within the distal tip is disposed distally of the distal end of the cannula tube, and advancing the assembled cannula system into the body while observing body tissue distal to the cannula tube, through the obturator tip, from the proximal end of the cannula tube.
• lights may be incorporated into the obturator tip to cast light on tissue distal to the tip and make it easier to see the tissue through the obturator tip from the proximal end of the cannula tube.
• a light such as an LED 19, may be disposed within the distal conical portion, and may be embedded in the
• An LED may instead be disposed within the proximal portion ( Figure 3) or the cylindrical portion ( Figure 4), and may be embedded in the material of the obturator or fixed at the bottom of the bore 14 which accommodates the obturator shaft 11.
• the light source may be employed in embodiments which omit the opaque component. Wiring necessary to power the light can be

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• 2020
  • 2020-02-18 WO PCT/US2020/018643 patent/WO2020172165A1/en not_active Ceased
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