# Patent

## Title
Cannula for receiving surgical instruments

## Abstract

A cannula (10) receives surgical instruments (120) for performing a surgical procedure on a body (130). The cannula (10) comprises a tube structure (12) defining a passage (16) through which the surgical instruments (120) are inserted into the body (130). The tube structure (12) has a proximal end (20) and a distal end (62). The tube structure (12) includes an expandable portion (40) for enabling an increase in the cross-sectional area of the passage (16) at the distal end (62). The expandable portion (40) of the tube structure (12), when expanded, has a conical configuration.

## Background
PRIORITY INFORMATION
This application is a continuation of U.S. application Ser. No. 09/772,605, filed Jan. 30, 2001 now U.S. Pat. No. 6,800,084, which is a continuation-in-part of U.S. application Ser. No. 09/137,335, filed Aug. 20, 1998, now U.S. Pat. No. 6,187,000.


TECHNICAL FIELD
The present invention is directed to a cannula for receiving surgical instruments for performing a surgical procedure on a body.
BACKGROUND OF THE INVENTION
Endoscopic surgical techniques allow a surgical procedure to be performed on a patient's body through a relatively small incision in the body and with a limited amount of body tissue disruption. Endoscopic surgery typically utilizes a tubular structure known as a cannula which is inserted into a small incision in the body. The cannula holds the incision open and serves as a conduit extending between the exterior of the body and the local area inside the body where the surgery is to be performed.
Due to the relatively small size of the passage into the body which is defined by the cannula, certain surgical procedures, such as posterior disectomies and procedures using steerable surgical instruments, have been difficult to perform using endoscopic techniques.
SUMMARY OF THE INVENTION
The present invention is a cannula for receiving surgical instruments for performing a surgical procedure on a body. The cannula comprises a tube structure defining a passage through which the surgical instruments are inserted into the body. The tube structure has a proximal end and a distal end. The tube structure includes an expandable portion for enabling an increase in the cross-sectional area of the passage at least at the distal end.
The expandable portion of the tube structure, when expanded, has a conical configuration. The expandable portion of the tube structure includes an arcuate slot and a guide pin disposed in the arcuate slot. The guide pin is movable from a terminal end of the slot to a second terminal end of the slot to enable the cross-sectional area of the passage at the distal end to increase.
The tube structure includes first and second tubular portions attached to one another. The second tubular portion comprises the expandable portion. The first tubular portion comprises a length of stainless steel tubing and the second tubular portion comprises an arcuate segment of stainless steel sheet stock rolled into a tubular shape.



BRIEF DESCRIPTION OF THE DRAWINGS
The foregoing and other features of the present invention will becomes apparent to one skilled in the art to which the present invention relates upon consideration of the following description of the invention with reference to the accompanying drawings, wherein:
FIG. 1 is an exploded perspective view of a surgical cannula constructed in accordance with the present invention, the cannula being shown in an expanded condition;
FIG. 2 is a perspective view of the cannula of FIG. 1 with parts removed for clarity, the cannula being shown in a contracted condition;
FIG. 3 is a schematic end view showing the cannula of FIG. 1 in the expanded position;
FIG. 4 is a roll out view of a part of the cannula of FIG. 1; and
FIG. 5 is a schematic sectional view of the cannula of FIG. 1 during a surgical procedure.



DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
The present invention is a cannula for receiving surgical instruments for performing a surgical procedure on a body. In one embodiment, the cannula comprises a tube structure defining a passage through which the surgical instruments are inserted into the body. The tube structure has a proximal end and a distal end. The tube structure includes an expandable portion for enabling an increase in the cross-sectional area of the passage at least at the distal end.
FIG. 1 illustrates a cannula 10 constructed according to the present invention. The cannula 10 is a tubular structure 12 centered on an axis 14. The tubular structure 12 defines a passage 16 through the cannula 10. Surgical instruments are inserted into the body during endoscopic surgery through the passage 16.
The tubular structure 12 comprises a first tubular portion 20 and a second tubular portion 40 attached to the first tubular portion. The first tubular portion 20 is preferably made of a length of stainless steel tubing, but could alternatively be made of another suitable material. The first tubular portion 20 has a proximal end 22 and a distal end 24. Parallel cylindrical inner and outer surfaces 26 and 28, respectively, extend between the ends 22, 24 of the first tubular portion 20. The inner surface 26 defines a first passage portion 30 of the passage 16 through the cannula 10. The first passage portion 30 has a diameter D1 which is preferably in the range from 10 mm to 20 mm.
The second tubular portion 40 of the tubular structure 12 is attached to the distal end 24 of the first tubular portion 20. The second tubular portion is preferably made from stainless steel, but could alternatively be made from another suitable material.
As best seen in the rollout view of FIG. 4, the second tubular portion 40 comprises an arcuate segment 42 of sheet stock. The arcuate segment 42 includes first and second arcuate edges 44 and 46, respectively, and first and second planar edges 48 and 50, respectively. The first and second planar edges 48 and 50 are rolled in an overlapping manner to form the tubular configuration of the second tubular portion 40.
When the second tubular portion 40 has been rolled into its tubular configuration, the first and second arcuate edges 44 and 46 define oppositely disposed first and second ends 60 and 62 (FIGS. 1 and 2), respectively, of the second tubular portion. The first and second ends 60 and 62 are connected by a central portion 64. The first end 60 of the second tubular portion 40 is attached to the distal end 24 of the first tubular portion 20 by a single fastener, such as a rivet 66. The rivet 66 extends through two aligned apertures 68 (FIG. 4) at the first end 60 of the second tubular portion 40. The first end 60 of the second tubular portion 40 is pivotable about the rivet 66.
The second tubular portion 40 includes parallel inner and outer surfaces 70 and 72 (FIGS. 1 and 2), respectively, extending between the first and second ends 60 and 62. The inner surface 70 defines a second passage portion 74 of the passage 16 through the cannula 10 which extends as a continuation of the first passage portion 30 in the first tubular portion 20.
An arcuate slot 80 is formed in the second tubular portion 40 and extends between the inner and outer surfaces 70 and 72 of the second tubular portion. The arcuate slot 80 extends along a curvilinear path in the central portion 64 of the second tubular portion 40 toward the second end 60 of the second tubular portion. The arcuate slot 80 has a first terminal end 82 located in the central portion 64 of the second tubular portion 40. A second terminal end 84 of the arcuate slot 80 is located adjacent the intersection of the second arcuate edge 46 and the first planar edge 48 of the arcuate segment 42.
A guide pin 90 is attached to the inner surface 70 of the second tubular portion 40 adjacent the intersection of the second arcuate edge 46 and the second planar edge 50. In the tubular configuration of the second tubular portion 40, the guide pin 90 is located in the arcuate slot 80 and is movable along the curvilinear path of the arcuate slot. A washer 92 is secured to an inner end of the guide pin 90 to retain the guide pin in the arcuate slot 80.
The second tubular portion 40 of the tubular structure 12 is expandable from a contracted condition shown in FIG. 2 to an expanded condition shown in FIG. 1. In the contracted condition, the guide pin 90 is located in the first terminal end 82 of the arcuate slot 80 in the second tubular portion 40 and the second passage portion 74 defined by the second tubular portion is cylindrical in shape. The second passage 74 has a generally constant diameter D2 (FIGS. 2 and 3) which is approximately equal to the diameter Dl of the first tubular portion 20. Thus, the cross-section area of the second passage portion 74 at the second end 62 of the second tubular portion 40, which is a function of the diameter D2, is approximately the same as the cross-sectional area at the first end 60 of the second tubular portion and is approximately the same as the cross-sectional area of the first passage portion 30 in the first tubular portion 20.
In the expanded condition, the guide pin 90 is located in the second terminal end 84 of the arcuate slot 80 in the second tubular portion 40 and the second tubular portion has a conical configuration. At the second end 62 of the second tubular portion 40, the second passage portion 74 has a diameter D3 (FIG. 3) which is larger then the diameter D2 of the second passage portion at the first end 60. Preferably, the diameter D3 of the second passage portion 74 at the second end 62 of the second tubular portion 40 is 40% to 80% greater than the diameter D2 of the second passage portion at the first end 60. Thus, in the expanded condition, the cross-sectional area of the second passage portion 74 at the second end 62 of the second tubular portion 40, which is a function of the diameter D3, is 40% to 80% greater than the cross-sectional area of the second passage portion at the first end 60 of the second tubular portion.
The cannula 10 inculdes an outer layer 100 (FIG.1) for maintaining the second tubular portion 40 of the cannula in the contracted condition.It is contemplated that other suitable means for maintaining the second tubular portion 40 in the contracted condition could be employed. In accordance with a preferred embodiment of the present invention, the outer layer 100 comprises a section of plastic tubing 102 which is heat shrunk over both the first and second tubular portion 20 and 40 to hold the second tubular portion in the contracted condition.
In addition, a loop of nylon string 104 for tearing the heat shrink tubing 102 is wrapped around the heat shrink tubing so that it extends both underneath and on top of the tubing. An outer end 106 of the string 104 extends beyond the tubing 102.
The cannula 10 further includes an actuatable device 110 for expanding the second tubular portion 40 from the contracted condition to the expanded condition. In accordance with a preferred embodiment of the present invention, the actuatable device 110 comprises a manually operated expansion tool 112. The expansion tool 112 resembles a common pair of scissors and has a pair of legs 114 pivotally connected to one another. The expansion tool 112 includes a frustoconical end section 116 fromed by a pair of frustoconical halves 118. Each of the frustoconical halves 118 extends from a respective one of the legs 114 of the expansion tool 112. It is contemplated that other suitable means for expanding the second tubular portion 40 toward the expanded condition could be employed, such as an inflatable balloon (not shown).
During an endoscopic surgical procedure, the cannula 10 is inserted into the body of a patient in the contracted condition. The outer end 106 of the string 104 is then manually pulled on by the surgeon. Pulling on the string 104 tears the heat shrink tubing 102 which is then removed from the cannula 10 by the surgeon. With the heat shrink tubing 102 removed, the second tubular portion 40 of the cannula 10 is thereby released for expansion toward the expanded condition.
Next, the expansion tool 112 is inserted into the passage 16 in the cannula 10 until the frustoconical end section 114 is located at the second end 62 of the second tubular portion 40. The legs 118 of the expansion tool 112 are manually separated, causing the frustoconical halves 118 to separate also. As the halves 118 separate, a radially outwardly directed force is exerted on the inner surface 70 of the second tubular portion 40 by the halves 118, causing the second tubular portion to expand toward condition. Under the force of the expanding expansion tool 112, the guide pin 90 slides from the first terminal end 82 of the arcuate slot 80 the second terminal end 84 of the arcuate slot to permit the expansion of the second tubular portion 40. The expansion tool 112 can be rotated about the axis 14 to ensure that the second tubular portion 40 of the cannula 10 is completely expanded to the completely expanded condition. The expansion tool 112 is then collapsed and removed so that one or more surgical instruments (indicated schematically at 120 in FIG. 5) and a viewing element can be received through the cannula 10 and inserted into a patient's body 130. The expandable second tubular portion 40 of the cannula 10 provides a significantly larger working area for the surgeon inside the body 130 within the confines of the cannula.
The expandable second tubular portion 40 of the cannula 10 provides a significantly larger working area for the surgeon inside the body 130 within the confines of the cannula. As a result, the simultaneous use of a number of endoscopic surgical instruments, including but not limited to steerable instruments, shavers, dissectors, scissors, forceps, retractors, dilators, and video cameras, is made possible by the expandable cannula 10.
It is contemplated that the cannula 10 described herein could be the centerpiece of a endoscopic surgical kit which would include an assortment of surgical instruments designed and/or selected for use with the cannula.
From the above description of the invention, those skilled in the art will perceive improvements, changes and modifications. Such improvements, changes and modifications within the skill of the art are intended to be covered by the appended claims.

## Claims

1. A method for providing treatment at or near the spine of patient, the method comprising:
providing an elongate body having a proximal end, a distal end, an outer surface and an inner surface, said inner surface defining a passage extending through the elongate body and through which surgical instruments can be inserted to a surgical location proximate the spine;
inserting said distal end of said elongate body into the patient such that the distal end resides proximate the surgical location, the proximal end remaining outside the patient;
configuring said elongate body so that the cross-sectional area of said passage at a first location is greater than the cross-sectional area of said passage at a second location, wherein the first location is distal to the second location; and
inserting a first surgical instrument into the passage to a surgical location at or near the spine.

2. The method of claim 1, wherein the step of inserting a first surgical instrument further comprises inserting an endoscopic surgical instrument.

3. The method of claim 1, further comprising performing a treatment with said first surgical instrument.

4. The method of claim 3, further comprising inserting a second surgical instrument, and performing a second treatment with said second surgical instrument.

5. The method of claim 4, wherein the second surgical instrument is inserted before the first surgical instrument is completely removed.

6. A method for providing treatment at or near the spine of patient, the method comprising:
providing an elongate body having a distal end, a proximal end, an outer surface and an inner surface, said inner surface defining a passage extending through the elongate body and through which surgical instruments can be inserted to a surgical location proximate the spine;
inserting the distal end of said elongate body through an incision in the skin of the patient to the surgical location, the proximal end remaining outside the patient;
expanding said elongate body so that the cross-sectional area of said passage at a first location is greater than the cross-sectional area of said passage at a second location, wherein the first location is distal to the second location; and
inserting a first surgical instrument into the passage to a surgical location at or near the spine.

7. The method of claim 6, wherein the step of inserting a first surgical instrument further comprises inserting an endoscopic surgical instrument.

8. The method of claim 6, further comprising performing a treatment with said first surgical instrument.

9. The method of claim 8, further comprising inserting a second surgical instrument, and performing a second treatment with said second surgical instrument.

10. The method of claim 9, wherein the second surgical instrument is inserted before the first surgical instrument is completely removed.

11. A method of providing treatment at or near the spine of patient, the method comprising:
providing an elongate body having a distal end, a proximal end, an outer surface and an inner surface defining a passage extending through the elongate body, the inner surface defining a major axis being the largest distance across said passage;
inserting the distal end of said elongate body through an incision in the skin of the patient to a surgical location at or near the spine of the patient, the proximal end remaining outside the patient;
configuring said elongate body so that the major axis at the first location is greater than the major axis at the second location, wherein the first location is distal to the second location; and
inserting a first surgical instrument into the passage to a surgical location at or near the spine.

12. The method of claim 11, wherein the step of inserting a first surgical instrument further comprises inserting an endoscopic surgical instrument.

13. The method of claim 11, further comprising performing a treatment with said first surgical instrument.

14. The method of claim 13, further comprising inserting a second surgical instrument, and performing a second treatment with said second surgical instrument.

15. The method of claim 14, wherein the second surgical instrument is inserted before the first surgical instrument is completely removed.

16. A method of advancing surgical instruments to a location adjacent a spine of a patient, the method comprising:
inserting an access device into said patient, the access device having an elongate body with a proximal end and a distal end and defining a length between the proximal and distal ends;
advancing the access device until the distal end is positioned inside the patient adjacent the spinal location and the proximal end is positioned outside the patient;
actuating at least a distal portion of the elongate body of the access device from a first configuration to a second configuration, the first configuration adapted for insertion wherein the elongate body defines a substantially enclosed conduit, the second configuration adapted to retract tissue to enlarge access to the spinal location; and
delivering more than one surgical instrument simultaneously through an entire. length of a passage extending through the elongate body between the proximal and distal ends,
wherein the cross-sectional area of the passage at a first location proximate the distal end in the second configuration is greater than the cross-sectional area of the passage at the first location in the first configuration.

17. The method of claim 16, wherein the enclosed conduit defines a circular transverse cross-section in the first configuration.

18. The method of claim 16, wherein when the elongate body is in the second configuration, the cross-sectional area of said passage at a first location is greater than the cross-sectional area of said passage at a second location, wherein the first location is distal to the second location.

19. The method of claim 16, wherein the elongate body comprises a proximal portion and a distal portion coupled with the proximal portion.

20. The method of claim 19, wherein the proximal portion and the distal portion are pivotably coupled.

21. The method of claim 16, wherein the elongate body comprises rigid material extending around substantially the entire perimeter of the cross-sectional proximate the distal end in the first configuration.

22. The method of claim 16, wherein the elongate body comprises rigid material extending around substantially the entire perimeter of the cross-sectional proximate the distal end in the second configuration.

23. The method of claim 22, wherein the elongate body comprises rigid material extending around substantially the entire perimeter of the cross-sectional proximate the distal end in the first configuration.

24. The method of claim 16, wherein the elongate body is substantially tubular in the first configuration.

25. The method of claim 16, wherein the width of the passage at the first location is greater than about 14 mm.

26. The method of claim 16, wherein the width of the passage at the first location is between about 14 mm and about 36 mm.

27. The method of claim 16, wherein the second configuration of the elongate body is substantially conical.