Devices and methods for percutaneous surgery

A method for performing a surgical procedure at a location on the spine, comprising the steps of:

• creating a working channel through the skin and tissue of a patient;
• creating a working space in communication with the working channel and adjacent the location on the spine;
• extending a tool through the working channel beyond the end of the working channel and manipulating the tool in the working space;
• and
• placing optics through the working channel with the tool in the working channel, the optics extending beyond the end of the working channel adjacent the working space to directly visualize the working space and manipulation of the tool.

A method for performing a surgical procedure at a location on the spine, comprising the step of:

• creating a working channel through the skin and tissue of a patient;
• creating a working space in communication with the working channel and adjacent the location on the spine;
• removably inserting a first tool through the working channel;
• manipulating the first tool to perform a function at the location;
• removably inserting a second tool through the working channel simultaneous with the first tool;
• and
• manipulating the second tool to perform a function at the location.

A method for performing a surgical procedure at a location on the spine, comprising the steps of:

• creating a working channel through the skin and tissue of a patient;
• creating a working space in communication with the working channel and adjacent the location on the spine;
• removably inserting a first tool through the working channel wherein the first tool is a tissue retractor;
• manipulating the tissue retractor to retract tissue to maintain the working space;
• removably inserting a second tool through the working channel simultaneous with the first tool;
• and
• manipulating the second tool to perform a function at the location.

A method for performing a discectomy at a subject vertebral level on the spine, comprising the steps of:

• creating an incision in the skin substantially directly posterior to the subject vertebral level;
• creating a bore through the lamina at a posterior medial position on the spine;
• mounting a cannula through the incision at the bore in the lamina to create a working channel;
• inserting optics through the cannula to directly visualize the location on the spine beyond the end of the cannula;
• extending a retractor through the working channel to retract tissue to create a path to the spinal disc;
• extending the optics through the working channel and path to the spinal disc;
• and
• extending and manipulating discectomy instruments through the working channel to the disc to perform a discectomy under direct vision by the optics.

A method for performing a laminectomy, comprising the steps of:

• creating an incision in the skin substantially directly posterior to the subject vertebral level;
• inserting a cannula into the incision and through tissue to the lamina to define a working channel;
• extending optics through the working channel to directly visualize the lamina;
• and
• extending a bone cutting tool through the working channel simultaneous with the optics and manipulating the tool to perform a laminectomy under direct vision from the optics.

A method for implanting a vertebral fixation element, comprising the steps of:

• making an incision in the skin to provide access to the location on the vertebra at which the fixation element is to be implanted;
• inserting a cannula into the incision and through tissue to the location to define a working channel;
• inserting optics through the cannula to directly visualize the location;
• extending an insertion tool supporting the vertebral fixation element through the working channel to the location under direct vision;
• and
• manipulating the insertion tool to implant the fixation element at the location under direct vision from the optics.

A method for performing a surgical procedure at a location in a patient's body, comprising the steps of:

• creating a working channel through the skin and tissue of a patient;
• creating a working space in communication with the working channel and adjacent the location in the patient's body;
• inserting optics through the working channel to the working space;
• extending a first tool through the working channel to the working space wherein the first tool is a power tool;
• manipulating the first tool through the working channel to perform a surgical procedure on the location in the working space under direct vision from the optics and without directing irrigation fluid to the location;
• and
• providing aspiration at the working space to remove smoke generated by operation of the power tool.

A method for performing a surgical procedure at a location in a patient's body, comprising the steps of:

• creating a working channel through the skin and tissue of a patient by inserting a cannula into the patient, the cannula having an inner dimension defining the working channel;
• creating a working space in communication with the working channel and adjacent the location in the patient's body;
• inserting optics through the working channel to the working space;
• extending a first tool through the working channel to the working space;
• and
• manipulating the first tool through the working channel to perform a surgical procedure on the location in the working space under direct vision from the optics and without directing irrigation fluid to the location.

A method for performing a surgical procedure at a location on the spine, comprising the steps of:

• creating a working channel through the skin and tissue of a patient by inserting a cannula into the patient, the cannula having an inner dimension defining the working channel;
• creating a working space in communication with the working channel and adjacent the location on the spine;
• extending a tool through the working channel beyond the end of the working channel and manipulating the tool in the working space;
• and
• extending optics through the working channel beyond the end of the working channel adjacent the working space to directly visualize the working space and manipulation of the tool.

A method for performing a surgical procedure at a location on the spine, comprising the steps of:

• creating a working channel through the skin and tissue of a patient by inserting a cannula into the patient, the cannula having an inner dimension defining the working channel;
• creating a working space in communication with the working channel and adjacent the location on the spine;
• removably inserting a first tool through the working channel;
• manipulating the first tool to perform a function at the location;
• removably inserting a second tool through the working channel simultaneous with the first tool;
• and
• manipulating the second tool to perform a function at the location.

A method for performing a surgical procedure at a location in a patient's body, comprising the steps of:

• creating a working channel through the skin and tissue of a patient;
• creating a working space in communication with the working channel and adjacent the location in the patiant's body;
• extending a first tool through the working channel to the working space;
• and
• manipulating the first tool through the working channel to perform a surgical procedure on the location in the working space without directing irrigation fluid to the location.

A method for preparing a working channel adjacent the spine, comprising the steps of:

• inserting a guidewire through an incision in the skin and into the lamina of a vertebra;
• inserting a first dilator over the guidewire and through the incision into contact with the lamina;
• removing the guidewire;
• sequentially inserting dilators of increasing diameter over the first and subsequent dilators, each of the dilators having a tapered working end configured to atraumatically displace tissue;
• advancing a cannula over the last inserted dilator, the cannula having a distal end adjacent the lamina and an opposite proximal end;
• and
• then removing the dilators so that the cannula defines a working channel.

A method for implantation of at least one fusion device in a disc space between adjacent vertebrae, comprising the steps of:

• making an incision in the skin to provide access to the disc space where the fusion device is to be implanted,;
• inserting a cannula into the incision and through the tissue to the location to define a working channel to the disc space;
• inserting optics through the cannula to directly visualize the disc space;
• preparing the disc space through the working channel under direct vision from the optics for implantation of at least one fusion device;
• and
• advancing the fusion device through the working channel into the prepared disc space under direct vision from the optics.