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US 5,029,573 AGranted
System for endoscopic surgery
OwnerJames C. Chowinventor
Life of this patent
Estimating the term…
Abstract
An endoscopic method and system are provided which include a guide member, or sheath, open at both ends and having a continuous opening in the sheath along its entire length. A trocar proportioned to fit within the sheath includes a prominence which fits within the opening of the sheath to provide a smooth surface on the exterior of the sheath for insertion into, for example, a hand for the endoscopic release of the carpal ligament. The trocar is removed and a videoarthroscope is inserted in one end of the sheath while a cutting instrument or other instrument is inserted in the opposite end to permit direct observation of the procedure.
Claims35
A system for use in endoscopic surgical procedures on tissues comprising:
- a guide member having generally uniform cross-sectional dimensions along an operative portion of its length, opposing proximal and distal open ends and an opening along its length;
- and
- an insertion member configured to slidably fit within said guide member and define at said distal end and along said opening of said guide member a smooth surface for atraumatic insertion of at least said operative portion of said guide member through tissue.
A system for use in endoscopic surgical procedures on tissue comprising:
- a guide member having opposing proximal and distal open ends and an opening along its length, said guide member including an elongate tube defining a bore therethrough, said opening extending along the length of said tube, a collar disposed at said proximal end of said guide member to provide a stop for preventing entry of said proximal end into the tissue and means mounted on said collar for marking the position of said opening when said tube is inserted in the tissue;
- and
- an insertion member configured to slidably fit within said bore of said elongate tube and define at said distal end and along said opening of said guide member a smooth surface for atraumatic insertion through tissue.
A system for use in endoscopic surgical procedures on tissue comprising:
- a guide member having opposing proximal and distal open ends and an opening along its length;
- an insertion member configured to slidably fit within said guide member and define at said distal end and along said opening of said guide member a smooth surface for atraumatic insertion through tissue;
- and
- an endoscopic and at least one cutting instrument, said endoscope being receivable in one said end of said guide member such that said endoscope permits visualization of tissue through said opening of said guide member and said cutting instrument being simultaneously receivable in the opposing said end of said guide member when said insertion member is removed from said guide member following insertion of said guide member through tissue, said cutting instrument having a portion thereof configured to extend through said opening of said guide member to contact tissue.
1 more element
A system for the release of the carpal ligament of a hand comprising:
- a guide member having opposing proximal and distal open ends and an opening along its length;
- an insertion member configured to slidably fit within said guide member and define at said distal end and along said opening of said guide member a smooth surface for atraumatic insertion through tissue;
- and
- means for hyperextending a patient's wrist and hand.
1 more element
An instrument for use in endoscopic surgical procedures on tissue comprising:
- an elongate guide member having opposing open ends for simultaneously receiving an endoscope in one said end and a surgical instrument in the opposing said end, said guide member having an opening along its length through which tissue can be viewed by means of the endoscope and made accessible to the surgical instrument.
An instrument for use in endoscopic surgical procedures comprising:
- an insertion member for use with a guide member which has open proximal and distal ends and an opening along its length, said insertion member having an elongate shaft having a proximal end, a tapered distal end and a prominence along the length thereof;
- and
- a handle at said proximal end of said shaft;
- said shaft being longer than said guide member such that said proximal end of said shaft is generally coterminous with said open proximal end of said guide member and said tapered distal end of said shaft extends beyond said open distal end of said guide member and said prominence is configured to fit within the entire length of said opening of said guide member when said insertion member is inserted within said proximal end of said guide member.
1 more element
A method of endoscopic surgery comprising the steps of:
- making a first incision at a predetermined site on a patient to establish an entry portal;
- inserting an insertion member into a longitudinal bore of a guide member, said guide member having opposing proximal and distal open ends and an opening along its length and said insertion member being configured to be slidably received within said guide member such that portions of said insertion member mate with said open distal end and said opening of said guide member to define in combination a smooth exterior surface;
- inserting said insertion member and said guide member in combination into said entry portal and advancing such combination toward a predetermined operative site;
- making a second incision at a desired site on the patient to establish an exit portal;
- advancing said insertion member and said guide member in combination to a point at which the distal end of said guide member exits said exit portal but before the proximal end of said guide member enters said entrance portal;
- withdrawing said insertion member;
- inserting an endoscope in one said end of said guide member;
- inserting a first surgical instrument in the opposing said end of said guide member under direct visualization by means of said endoscope;
- operatively extending an operative portion of said first surgical instrument through said opening in said guide member to contact tissue at said operative site under direct visualization by means of said endoscope;
- performing a first desired maneuver on said tissue with said operative portion of said first surgical instrument under direct visualization of such first desired maneuver by means of said endoscope;
- withdrawing said surgical instrument;
- withdrawing said endoscope;
- withdrawing said guide member;
- and
- suturing said first and second incisions.
12 more elements
An endoscopic procedure for carpal ligament release comprising the steps of:
- making a first transverse incision to the radial side and proximal to the pisiform bone of a patient's hand;
- cutting skin, subcutaneous tissue and fascia at the site of said first incision to establish an entry portal;
- retracting flexor tendons to the radial side;
- inserting an insertion member into a longitudinal bore of a guide member, said guide member having opposing proximal and distal open ends and an opening along its length and said insertion member being configured to be slidably received within said guide member such that portions of said insertion member mate with said open distal end and said opening of said guide member to define in combination a smooth exterior surface;
- inserting said insertion member and said guide member in combination into said entry portal in a space between the flexor tendons and the ulnar neurovascular bundle and advancing such combination distally to the base of the hook of hamate whereupon said combination is moved along the contour of the hook of hamate to a position beneath the transverse carpal ligament and advancing said combination distally;
- hyperextending the patient's hand and wrist to tighten the carpal ligament;
- advancing said insertion member and guide member combination distally to the tissue beneath the palm of the patient's hand;
- making a second incision to define an exit portal;
- advancing said insertion member and said guide member in combination through said exit portal to a point at which said distal end of said guide member is exterior to said exit portal and said proximal end of said guide member is exterior to said entry portal;
- withdrawing said insertion member;
- inserting an endoscope into one end of said guide member to thereafter permit direct visualization in the vicinity of said guide member, said opening and the tissue visible through said opening;
- inserting a probe knife into the opposing said end of said guide member, said probe knife having a blunt portion and a blade section;
- extending said blunt portion of said probe knife through said opening of said guide member to probe tissue in the vicinity of the carpal ligament to expose the carpal ligament to view;
- withdrawing said blunt portion into said guide member and extending said blade section of said probe knife through said opening;
- making an initial stab with said blade section of said probe knife at the base of the carpal ligament;
- withdrawing said probe knife from said guide member;
- inserting a first cutting instrument into the opposing said end of said guide member, said first cutting instrument having an operative portion;
- extending said operative portion of said first cutting instrument through said opening of said guide member;
- cutting the carpal ligament with said operative portion;
- withdrawing said first cutting instrument from said guide member;
- withdrawing said endoscope from said guide member;
- withdrawing said guide member through said entry portal;
- and
- suturing said first and second incisions.
21 more elements
Dependencies are inferred from the claim text.