Method and apparatus for direct access endoscopic surgery

An apparatus for creating an adjustable operating window for less invasive, direct access endoscopic surgery, said apparatus comprising:

• a rigid frame capable of supporting applied loads required to perform retraction of an incision site, said rigid frame including a handle at one end;
• a lower blade mount rotatably connected to said rigid frame opposite said handle;
• a translation frame slidably connected to said rigid frame through a rigid frame slot on each side of said rigid frame, wherein said slidable connection is constructed and arranged to allow said handle to translate said translation frame with respect to said rigid frame and wherein said handle is constructed and arranged to prevent sliding of said translation frame along said slidable connection in at least one direction;
• an upper blade mount rotatably connected to said translation frame, wherein a distance between said lower blade mount and said upper blade mount is adjusted by sliding said translation frame along said slidable connection;
• a lower blade releasably attached to said lower blade mount;
• an upper blade releasably attached to said upper blade mount;
• a first adjusting assembly functionally connected between said lower blade mount and said rigid frame for independently adjusting the angle of said lower blade mount without lateral displacement of said lower blade mount;
• and
• a second adjusting assembly functionally connected between said upper blade mount and said rigid frame for independently adjusting the angle of said upper blade mount without lateral displacement of said upper blade mount, and wherein said first and second adjusting assemblies are constructed and arranged to prevent rotation along said rotatable connections in at least one direction,
• wherein the size of said operating window is determined by the distance between said upper and lower blade mounts as set by said handle, and by the angles of said upper and lower blades as set by said first and second adjusting assemblies.

A method of less invasive, direct access endoscopic surgery performed within a surgical site through an operating window created with an apparatus comprised of a rigid frame capable of supporting applied loads during retraction of a surgical incision site, said rigid frame including a handle at one end, said handle having a handle slot therein, a lower blade mount rotatably connected to said rigid frame opposite said handle, rigid frame slots on either side of said rigid frame, and a translation frame slidably connected to said rigid frame through said handle slot and said rigid frame slots, said translation frame including an upper blade mount rotatably connected thereto, said slidable connection constructed and arranged to allow said handle to translate said translation frame, with respect to said rigid frame, to adjust a distance between said lower blade mount and said upper blade mount, said handle constructed and arranged to prevent sliding of said translation frame along said slidable connection in at least one direction, said apparatus further including a retractor blade mounted to one of said lower and upper blade mounts wherein the other of said lower and upper blade mounts is left empty, a first adjusting assembly functionally connected between said lower blade mount and said rigid frame for independently adjusting the angle of said lower blade mount without lateral displacement of said lower blade mount, and a second adjusting assembly connected between said upper blade mount and said rigid frame for independently adjusting the angle of said upper blade mount without lateral displacement of said upper blade mount, said first and second adjusting assemblies constructed and arranged to prevent rotation along said rotatable connections in at least one direction, wherein the size of said operating window is determined by the distance between said lower blade mount and said upper blade mount as set by the handle and by the angles of said lower and upper blade mounts as set by said first and second adjusting assemblies, said method of less invasive, direct access endoscopic surgery comprising the steps of:

• creating a small incision in the skin corresponding to a surgical site;
• retracting said incision with a hand retractor comprised of a retractor handle having a retractor blade removably attached thereto, by inserting said hand retractor blade into said incision;
• removing said retractor handle from said hand retractor blade;
• placing said apparatus over said incision;
• inserting said apparatus retractor blade into said incision;
• attaching said hand retractor blade to said empty blade mount on said apparatus;
• adjusting said apparatus handle and said first and second adjusting assemblies to create the desired sized operating window;
• and
• performing surgery within said surgical site through said operating window.

A method of less invasive, direct access endoscopic surgery performed with a retractor endoscope and a tool, said retractor endoscope having adjustable blades that can be positioned to create an operating window, said tool including a distal working portion comprising two working members, a proximal handle, angled at a predetermined angle with respect to said distal working portion, said proximal handle having two finger rings, and a region between said distal working portion and said proximal handle, said region including a single pivot joint, said single pivot joint constructed and arranged so that actuation of said proximal handle by moving said finger rings apart or together in substantially a horizontal plane results in said working members moving apart or together in a working plane tilted at said predetermined angle from said horizontal plane, said predetermined angle of said proximal handle enabling visualization through said operating window during use of said tool, said method comprising the steps of:

• creating a short incision in the skin corresponding to a surgical site;
• retracting the incision with said retractor endoscope to form an operating window and expose said surgical site;
• pivoting said adjustable blades about an axis substantially parallel to or coplanar with said operating window, while the adjustable blades remain connected to the retractor endoscope, to increase access to the surgical site, without increasing the size of the operating window;
• illuminating said operating window with high intensity fiberoptic lighting;
• causing said working portion of said tool to enter said surgical site through said operating window while said proximal handle remains removed from said surgical site;
• and
• performing surgery within said surgical site wherein said surgery includes manipulating said working portion of said tool through actuation of said angled handle while observing said surgical site through said operating window.

An apparatus for less invasive, direct access endoscopic surgery within a surgical site, said surgery performed through an operating window, said apparatus comprising:

• a rigid frame capable of supporting applied loads created during retraction of an incision, corresponding to said surgical site, said rigid frame including a handle at one end, said handle having a handle slot therein;
• a lower blade mount rotatably connected to said rigid frame opposite said handle, wherein said lower blade mount rotates without lateral displacement thereof;
• a rigid frame slot on either side of said rigid frame;
• a translation frame slidably connected to said rigid frame through said handle slot and said rigid frame slots;
• an upper blade mount rotatably connected to said translation frame, wherein said upper blade mount rotates without lateral displacement thereof, wherein said slidable connection is constructed and arranged to allow said handle to translate said translation frame, with respect to said rigid frame, to adjust the distance between said lower blade mount and said upper blade mount and wherein said handle is constructed and arranged to prevent sliding of said translation frame along said slidable connection in at least one direction;
• a lower blade releasably mounted to said lower blade mount;
• an upper blade releasably mounted to said upper blade mount;
• at least one of said lower blade and said upper blade having at least one pivot mount for a high intensity fiberoptic;
• a first adjusting assembly functionally connected between said lower blade mount and said rigid frame for independently adjusting the angle of rotation of said lower blade mount;
• a second adjusting assembly functionally connected between said upper blade mount and said rigid frame for independently adjusting the angle of rotation of said upper blade mount, wherein said first and second adjusting assemblies are constructed and arranged to prevent rotation of said lower and upper blade mounts in at least one direction and wherein the size of said operating window is defined by the distance between said lower blade mount and said upper blade mount, as set by said handle, and by the angle of rotation of said lower blade mount and of said upper blade mount, as set by said first and second adjusting assemblies.

An apparatus for forming an operating window to perform less invasive, direct access endoscopic surgery comprising:

• a rigid frame capable of supporting an applied load required to perform retraction of an incision site;
• a translation frame slidably connected to said rigid frame wherein said rigid frame and said translation frame define said operating window;
• an upper blade connected to said rigid frame and a lower blade connected to said translation frame;
• adjustment means operatively engaged to said translation frame and rigid frame, said adjustment means being adapted to vary the load and size of said operating window;
• at least one of said upper and lower blade being pivotable about an axis substantially parallel to or coplanar with said operating window while remaining connected to said rigid frame or said translation frame, respectively;
• and
• wherein pivoting said upper or lower blade about said axis, while connected to said rigid frame or said translation frame, respectively, increases access to a surgical site without increasing the size of the operating window.

An apparatus for forming an operating window to perform less invasive, direct access endoscopic surgery comprising:

• a rigid frame capable of supporting an applied load required to perform retraction of an incision site;
• a translation frame slidably connected to said rigid frame wherein said rigid frame and said translation frame define said operating window;
• an upper blade mount connected to said rigid frame and a lower blade mount connected to said translation frame, said upper and lower blade mount being adapted to receive an upper and lower blade therein, respectively;
• adjustment means operatively engaged to said translation frame and rigid frame, said adjustment means being adapted to vary the load and size of said operating window;
• at least one or more of said upper and lower blade mounts being pivotable about an axis substantially parallel to or coplanar with said operating window while remaining connected to said rigid frame or said translation frame, respectively;
• and
• wherein pivoting said upper or lower blade mount about said axis, while connected to said rigid frame or said translation frame, respectively, increases access to a surgical site without increasing the size of the operating window.