Patent ID: 8246646
Filing Date: 2012-08-21
Classification: A61B

Abstract:
1. A surgical method comprising the steps of: percutaneously introducing into a patient an elongated first tube having proximal and distal ends, the first tube having a substantially cylindrical external surface substantially symmetrical about an axis of elongation of the tube, an internal passage for insertion of an instrument through the tube, and two retractor blades in opposed relationship to each other, said blades having outer, tissue-engaging, surfaces which face in opposite directions and are convex throughout substantially their entire lengths in cross-sectional planes to which said distal direction is perpendicular, and having inner surfaces which face toward each other and are concave throughout substantially their entire lengths in said cross-sectional planes, each said blade extending distally from the distal end of the tube and being pivoted for rotation about a pivot axis adjacent said distal end of the first tube, the pivot axis of each blade being disposed at a fixed location relative to the distal end of the first tube in a plane to which said axis of elongation is perpendicular; positioning a balloon, connected to a distal end of an elongated second tube extending through said internal passage, at a location distal with respect to the retractor blades; expanding the balloon by introducing a fluid into the interior of the balloon, thereby causing dissection of tissue at the location of the balloon; at least partially contracting the balloon; by moving the elongated first tube in the distal direction, causing the blades to move into a space created by the dissection of tissue by the balloon; spreading of the dissected tissue by moving at least one of the blades apart from the other by longitudinal movement of an adjuster rod connected to said one of the blades at a location spaced from the pivot axis of said one of the blades, said adjuster rod being accessible at a location adjacent the proximal end of said first tube and being restricted to movement in a longitudinal direction parallel to the axis of elongation of the first tube, said one of the blades being adjustable, by pivoting about its pivot axis from a position in which it is substantially within an axial projection of the substantially cylindrical external surface of the first tube but substantially entirely external to an axial projection of the second tube to a position in which parts of its outer, tissue-engaging, surface are external to said axial projection of the substantially cylindrical external surface of the first tube; withdrawing the elongated second tube from the internal passage of the elongated first tube; and while using the blades to maintain the dissected tissue in a spread condition, introducing another instrument through the internal passage of the first tube for surgery on anatomical structure exposed by the dissection and spreading steps.