Patent Publication Number: US-2019175010-A1

Title: Multi-function cannulated surgical device and systems thereof

Description:
BACKGROUND 
     The field of disclosure relates generally to the field of surgical tools, for example, endoscopic surgical tools and, more particularly, to a multi-function cannulated surgical device suitable for endoscopic applications, among others. 
     In traditional surgical procedures involving endoscopy, at least two incisions are typically required. A first incision allows for the insertion of a scope while a second incision accommodates a surgical tool. The traditional methodology requires significant manual dexterity as the operating physician must generally operate both the scope and surgical tool simultaneously. 
     In addition, in many endoscopic applications, the nature of the procedure and the treatment area results in very awkward positioning of the scope and surgical tool. For example, in the case of endoscopic plantar fasciotomy, the standard procedure requires insertion of the endoscope from one side of the patient&#39;s foot, while a cutting blade or other surgical tool is inserted from the opposite side of the foot. This orientation requires a difficult mental correction by the surgeon with respect to the direction of required movement of the surgical tool as the endoscopic is providing a view that is opposite to the orientation of the surgical tool. 
     Therefore, it would be advantageous to provide a multi-function surgical device that allows for the introduction of multiple types of scopes and surgical tools from the same orientation without interfering with the physician&#39;s view of the treatment area and requiring a single incision. 
     SUMMARY 
     A surgical instrument includes a first cannula having a first pair of sidewalls and a first end wall extending along the first pair of sidewalls. The first pair of sidewalls and the first end wall at least partially define a first cavity. The surgical instrument also includes a second cannula comprising a second pair of sidewalls and a second end wall extending along the second pair of sidewalls. The second pair of sidewalls and the second end wall at least partially define a second cavity. The first pair of sidewalls are configured to slidably couple to the second pair of sidewalls such that as the first cannula moves axially along the second cannula, the first end wall moves away from the second end wall. 
     A surgical instrument includes a first cannula having a first interior space and a second cannula having a second interior space. The first interior space and the second interior space form a combined interior space having a first size when the first and second cannulas are in a first relative position and a second, enlarged size when the first and second cannulas are in a second relative position. 
     A surgical procedure includes making a single incision at a desired location and inserting a first cannula into the incision, wherein the first cannula includes a first end wall that at least partially defines a first cavity. The procedure also includes coupling a second cannula to the first cannula, wherein the second cannula includes a second end wall that at least partially defines a second cavity. The first cavity and the second cavity define a combined interior space. The procedure also includes sliding the second cannula along the first cannula from a first relative position to a second relative position such that as the first cannula moves axially along the second cannula, the first end wall moves away from the second end wall. The combined interior space has a first size in the first relative position and second, enlarged size in the second relative position. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a perspective view of components of a surgical system; 
         FIG. 2A  is a perspective view of a cannulated surgical device of the surgical system shown in  FIG. 1  in a first position illustrating a first cannula and a second cannula. 
         FIG. 2B  is a cross-sectional view taken along line  2 - 2  in  FIG. 2A . 
         FIG. 3  is a bottom view of the cannulated surgical device shown in  FIG. 2  in an intermediate position. 
         FIG. 4A  is a perspective view of the cannulated surgical device shown in  FIG. 2  in a second position. 
         FIG. 4B  is a cross-sectional view taken along line B-B in  FIG. 4A . 
         FIG. 4C  is a cross-sectional view taken along line C-C in  FIG. 4A . 
         FIG. 5  is a top view of the first cannula. 
         FIG. 6  is a perspective view of the first cannula. 
         FIG. 7  is a perspective view of the second cannula. 
         FIG. 8  is a top view of the second cannula. 
         FIG. 9  is a perspective view of the cannulated surgical device assembled with a cutting insert and a scope. 
         FIG. 10  is an exploded top view of the cannulated surgical device and the cutting insert with the scope. 
         FIG. 11  is an enlarged view of a portion of the cannulated surgical device assembled with the cutting insert and the scope as shown in  FIG. 9 . 
         FIG. 12  is a top view of the cannulated surgical device assembled with a delivery mechanism and a scope. 
         FIG. 13  is an exploded perspective view of the cannulated surgical device and the delivery mechanism with the scope. 
         FIG. 14  is a bottom view of the delivery mechanism shown in  FIGS. 12 and 13 . 
         FIG. 15  is an enlarged view of a portion of the cannulated surgical device assembled with the delivery mechanism and the scope as shown in  FIG. 9 . 
         FIG. 16  is a top view of the second cannula assembled with an obturator. 
         FIG. 17  is a side view of the obturator shown in  FIG. 16 . 
     
    
    
     DETAILED DESCRIPTION 
       FIG. 1  is a perspective view of components of a surgical system  100 . System  100  includes a cannulated surgical device  102  including a first cannula  104  and a second cannula  106 . In the exemplary embodiment, second cannula  106  is inserted into an incision and first cannula  104  slides along second cannula  106  to widen the incision and to form a cavity between cannulas  104  and  106  that is configured to receive other components of system  100  as described herein. System  100  also includes a cutting mechanism  108  and a probe  110  that are simultaneously inserted into the cavity defined by the cannulas  104  and  106  to enable the physician to view what needs to be cut from within the cutting mechanism  108 , as described herein. System  100  also includes a delivery mechanism  112  for delivering a biologic or medicine into the patient&#39;s body. A source of the fluid, for example a syringe  114 , is coupled to delivery mechanism  112  via a tube  116 . Delivery mechanism  112  is inserted into the cavity defined by cannulas  104  and  106  to facilitate delivering the fluid within the incision. Additionally, system  100  includes an obturator  118  that couples to and slides along second cannula  106  before obturator  118  and second cannula  106  are inserted into the incision. Obturator  118  provides a gripping mechanism to assist the physician with inserting second cannula into the incision. 
       FIG. 2  is a perspective view of a cannulated surgical device  102  of surgical system  100  shown in  FIG. 1  in a first position  120 .  FIG. 3  is a top perspective view of cannulated surgical device  102  in an intermediate position  122 .  FIG. 4  is a bottom view of cannulated surgical device  102  in a second position  124 .  FIG. 5  is a top view of first cannula  104 .  FIG. 6  is a perspective view of first cannula  104 .  FIG. 7  is a perspective view of second cannula  106 .  FIG. 8  is a top view of second cannula  106 . 
     In the exemplary embodiment, as best shown in  FIGS. 5 and 6 , first cannula  104  includes a first, distal end  126  and a second, proximal end  128 . First end  126  includes a stop  130  configured to contact a tip of second cannula  106 , as described in further detail below, and second end  128  includes a handle  132  to facilitate use of first cannula  104 . First cannula  104  also includes a pair of sidewalls  134  that extend from first end  126  to second end  128 . In the exemplary embodiment, sidewalls  134  are parallel to each other and are substantially planar along their lengths. Alternatively, sidewalls  134  may be non-parallel and may be any shape that facilitates operation of cannulated surgical device  102  as described herein. Additionally, sidewalls  134  include a tapered height along their lengths. More specifically, sidewalls  134  include a first height H 1  proximate first end  126  and a second height H 2  proximate second end  128 . In the exemplary embodiment, first height H 1  is less than second height H 2  such that the height of sidewalls  134  increases from first end  126  to second end  128 . Alternatively, the opposite may be true where first and second heights H 1  and H 2  are switched and the height of sidewalls  134  decreases from first end  126  to second end  128 . 
     Each sidewall  134  also includes a groove  136  defined therein that extends the length of sidewall  134  from first end  126  to second end  128 . In the exemplary embodiment, grooves  136  are configured to receive corresponding guides on second cannula  106  to enable first cannula  104  to slidably engage with and move along second cannula  106 , as described herein. The height of grooves  136  is constant between ends  126  and  128  such that, at first end  126 , the first height H 1  of sidewalls  134  is substantially similar to the height of grooves  136 . Whereas, at second end  128 , the second height H 2  of sidewalls  134  is larger than the height of grooves  136 . 
     In the exemplary embodiment, first cannula  104  also includes a first end wall, or top wall  138  that extends between sidewalls  134  the length of first cannula  104  from first end  126  to second end  128 . Together, top wall  138  and sidewalls  134  form a U-shape that defines a first cavity  140  within an interior of the U-shaped first cannula  104 . Alternatively, walls  138  and  134  define any shape that defines first cavity  140  within first cannula  104 . Because first cavity  140  is partially defined by tapered sidewalls  134 , first cavity  140  is also tapered along its length. More specifically, first cavity  140  includes a first cross-sectional area defined by sidewalls  134  at first height H 1  proximate first end  126 . Similarly, first cavity  140  includes a second cross-sectional area defined by sidewalls  134  at second height H 2  proximate second end  128 . In the exemplary embodiment, the first cross-sectional area of first cavity at first end  126  is smaller than the second cross-sectional area of first cavity  140  at second end  128  because the height of sidewalls  134  is smaller at first end  126  than at second end  128 . Alternatively, in embodiments where the height of sidewalls  134  is larger at first end  126  than at second end  128 , the cross-sectional areas of first cavity  140  are correspondingly switched such that the first area is larger at first end  126  than at second end  128 . 
     Top wall  138  also includes an elongated first opening  142  that extends a majority of the length of top wall  138  between first end  126  and second end  128 . As described herein, first opening  142  enables tools or fluids in first cavity  140  to extend radially from the interior of first cannula  104 , through first opening  142  in top wall  138 , and into an exterior of first cannula  104  to contact the patient&#39;s body. Furthermore, a second opening  144  is defined in first cannula  104  proximate second end  128  at handle  132 . Second opening  144  enables the physician to axially insert a tool into first cavity  140  from second end  128  of first cannula  104 . 
     As best shown in  FIGS. 7 and 8 , in the exemplary embodiment, second cannula  106  includes a first, distal end  146  and a second, proximal end  148 . First end  146  includes a tapered tip  150  configured to facilitate insertion of second cannula  106  into an incision, as described in further detail below. Alternatively, first end  146  includes a variety of different tips that may be selected based upon the procedure in which cannulated surgical device  102  is being used. For example, second cannula  106  may include a split, beveled, or a spatula tip. 
     Second end  148  also includes a handle  152  to facilitate use of second cannula  106 . Second cannula  106  also includes a pair of sidewalls  154  that extend from first end  146  to second end  148 . In the exemplary embodiment, sidewalls  154  are parallel to each other and are substantially planar along their lengths. Alternatively, sidewalls  154  may be non-parallel and may be any shape that facilitates operation of cannulated surgical device  102  as described herein. Additionally, sidewalls  154  include a tapered height along their lengths. More specifically, sidewalls  154  include a third height H 3  proximate first end  146  and a fourth height H 4  proximate second end  148 . In the exemplary embodiment, third height H 3  is greater than fourth height H 4  such that the height of sidewalls  154  decreases from first end  146  to second end  148 . Alternatively, the opposite may be true where third and fourth heights H 3  and H 4  are switched and the height of sidewalls  154  increases from first end  146  to second end  148 . More specifically, when the height of sidewalls  134  of first cannula  104  increases from first end  126  to second end  128 , then the height of sidewalls  154  of second cannula  106  decreases from first end  146  to second end  148 , and vis versa. 
     Each sidewall  154  also includes a guide rail  156  extending therefrom in a direction away from the opposite sidewall  154 . Guides  156  extend the length of sidewalls  134  from first end  126  to second end  128 . In the exemplary embodiment, guides  156  are configured to engage corresponding grooves  136  on first cannula  104  to enable first cannula  104  to slidably engage with and move along second cannula  106 , as described herein. The height of guides  156  is constant between ends  126  and  128  to correspond with grooves  136 . 
     In the exemplary embodiment, second cannula  106  also includes a second end wall, or bottom wall  158  that extends between sidewalls  154  the length of second cannula  106  from first end  146  to second end  148 . Together, bottom wall  158  and sidewalls  154  form a U-shape that defines a second cavity  160  within an interior of the U-shaped second cannula  106 . Alternatively, walls  158  and  154  define any shape that defines second cavity  160  within second cannula  106 . Because second cavity  160  is partially defined by tapered sidewalls  154 , second cavity  160  is also tapered along its length. More specifically, second cavity  160  includes a third cross-sectional area defined by sidewalls  154  at third height H 3  proximate first end  146 . Similarly, second cavity  160  includes a fourth cross-sectional area defined by sidewalls  154  at fourth height H 4  proximate second end  148 . In the exemplary embodiment, the third cross-sectional area of second cavity  160  at first end  146  is greater than the fourth cross-sectional area of second cavity  160  at second end  148  because the height of sidewalls  154  is greater than at first end  146  than at second end  148 . Alternatively, in embodiments where the height of sidewalls  154  is smaller at first end  146  than at second end  148 , the cross-sectional areas of second cavity  160  are correspondingly switched such that the third area is smaller at first end  146  than at second end  148 . 
     Bottom wall  158  is substantially solid and continuous along its length and between sidewalls  154 . Additionally, bottom wall  158  also at least partially defines an opening  162  in second cannula  106  proximate second end  148  at handle  152 . Opening  162  enables the physician to axially insert a tool into second cavity  160  from second end  148  of second cannula  106 . 
     As described above,  FIG. 2A  is a perspective view of a cannulated surgical device  102  of surgical system  100  shown in  FIG. 1  in a first position  120 .  FIG. 2B  is a cross-sectional view taken along line  2 - 2  in  FIG. 2A .  FIG. 3  is a bottom view of cannulated surgical device  102  in an intermediate position  122 .  FIG. 4A  is a perspective view of cannulated surgical device  102  in a second position  124 .  FIG. 4B  is a cross-sectional view taken along line B-B in  FIG. 4A .  FIG. 4C  is a cross-sectional view taken along line C-C in  FIG. 4A . 
     In operation, such as during a surgical procedure, a single incision is made at a desired location on the patient. Second cannula  106  is then inserted into the incision. First cannula  104  is slidably coupled to second cannula  106  via guides  156  of second cannula  106  engaging grooves  136  of first cannula  104 . When cannulas  104  and  106  are coupled together, sidewalls  134  and  152  are parallel to each other and top wall  138  is parallel to bottom wall  158  such that cannulas  104  and  106  form cannulated surgical device  102  having an interior cavity  164 . More specifically, first cavity  140  of first cannula  104  and second cavity  160  of second cannula  106  combine, and may partially overlap to form interior cavity  164  of device  102 . In the first position  120 , cavity  164  includes a first cross sectional area that is relatively small because the portions of cannulas  104  and  106  that overlap to form cavity  164  (first end  126  and second end  148 ) are the portions where sidewalls  134  and  154  are shortest. 
     The physician then slides first cannula  104  along second cannula  106  from first position  120 , through the intermediate position  122 , and until first cannula reaches the second position  124 . As shown in  FIGS. 4B and 4C , interior cavity  164  has a substantially similar cross-sectional area proximate both first ends  126  and  146  and second ends  128  and  148  when cannulas  102  and  104  are in the second position  124 . The cross-sectional area of interior cavity  164  in second position  124  at any location along cavity  164  is larger than the cross-sectional area of interior cavity  164  in the first position  120 . As such, as first cannula  104  moves axially along second cannula  106 , first cannula top wall  138  moves radially away from second cannula bottom wall  158 , and cavity  164  defined between first cannula  104  and second cannula  106  enlarges as first cannula  104  moves axially along second cannula  106 . 
     In the second position  124 , sidewalls  134  of first cannula  104  lies substantially against the exterior surfaces of sidewalls  154  of second cannula  106 . This position minimizes the total exterior thickness of the device  102 , thereby easing insertion and extraction of the device  102  through an incision. In the expanded position  124 , the total, combined, interior cavity  164  of the device  104  is maximized to allow for the introduction of multiple instruments into interior cavity  164 . This allows both a scope and another surgical instrument to be used by the physician at the same time. 
       FIG. 9  is a perspective view of the cannulated surgical device  102  assembled with cutting mechanism  108  and scope  110 .  FIG. 10  is an exploded top view of the cannulated surgical device  102  and the cutting mechanism  108  with scope  110 .  FIG. 11  is an enlarged view of a portion of the cannulated surgical device  102  assembled with the cutting mechanism  108  with the scope  110 . In the exemplary embodiment, cutting mechanism  108  including a first end  168 , a second end  170 , a handle  172  at first end  168 , a hollow shaft  174  extending between ends  168  and  170 , and a blade  176  coupled to shaft  174  proximate first end  168 . 
     The cutting mechanism  108  may also be provided with one or more surgical tools that are selected for a particular procedure and are known within the field of endoscopic surgery. In the case of the illustrated embodiment, a cutting mechanism  108  suitable for endoscopic plantar fasciotomy (“EPF”), or similar cutting applications, is shown. This form of the cutting mechanism  108  is provided with a cutting blade  176  at the second end  170 . This particular version has a hooked blade specific to EPF and designed to cut bands of the plantar fascia. This particular version may also have applicability in carpal tunnel release and gastric resection procedures, among others. 
     Although described herein as a cutting mechanism with a hooked blade, it should be noted that this is a non-limiting example of the possible variations of the mechanism  108 . Variations of the mechanism  108  can be provided with different probes, curettes, grabbers, biters, biopsy tools, cauterization tips, punches, needles, and drills, and all of these variations are considered to be within the scope of the present invention. The possible attachments to the mechanism  108  include devices that serve as electrocautery probes for removal of unwanted or harmful tissue, coagulation of bleeding tissue, and sealing blood vessels to help reduce or stop bleeding. The electrocautery probe function can be incorporated into the tips of the previous listed instruments, e.g., hook, grabber, needle, drill, etc. 
     In the exemplary embodiment, probe  110  includes a shaft  178  that is inserted into shaft  174  of mechanism  108  until probe shaft  178  contacts a shaft stopper  180  of mechanism  108 . Probe  110  may include a camera and/or a light source to enable the physician to view what needs to be cut from within the cutting mechanism  108 . More specifically, mechanism shaft  174  includes a viewport  182  defined therein that enables a camera of probe  110  to “see” blade  176 . 
     In operation, probe  110  is inserted into cutting mechanism  108  and cutting mechanism  108  with probe  110  are simultaneously inserted into cannulated surgical device  102 . More specifically, cutting mechanism  108  with probe  110  are simultaneously inserted through openings  144  and  162  in second ends  128  and  148  of cannulas  104  and  106  and into interior cavity  164  of device  102 . Opening  142  in top wall  138  of first cannula  104  allows for communication between the exterior and interior of cannulated surgical device  102 . More specifically, opening  142  allows for surgical instruments, such as blade  176 , inserted into cavity  164  of cannulated surgical device  102  to interact with the environment exterior to cannulated surgical device  102  and within the treatment area. The location, shape, and size of the opening  142  will be variable depending upon the nature of the procedure for which cannulated surgical device  102  will be used. As a non-limiting example, the opening  142  referenced above takes the form of an open slot in top wall  138  of first cannula  104 . As such, the physician is able to insert the cutting mechanism in the same orientation as the cannulated surgical device  102  without interfering with the physician&#39;s view of the treatment area and requiring a single incision. 
       FIG. 12  is a top view of the cannulated surgical device  102  assembled with delivery mechanism  112  and scope  110 .  FIG. 13  is an exploded perspective view of the cannulated surgical device  102  and the delivery mechanism  112  with the scope  110 .  FIG. 14  is a bottom view of the delivery mechanism  112  shown in  FIGS. 12 and 13 .  FIG. 15  is an enlarged view of a portion of the cannulated surgical device  102  assembled with the delivery mechanism  112  and the scope  110  as shown in  FIG. 9 . 
     In the exemplary embodiment, delivery mechanism  112  includes a first end  188 , a second end  186 , a handle  189  at second end  186 , and a hollow shaft  190  extending between ends  188  and  186 . Shaft  190  includes a probe stop  191  and a nozzle  192  positioned at first end  188 . A viewport  194  is defined in shaft  190  to enable the camera in probe  110  to “see” the area. Tube  116  is inserted into an opening  196  proximate second end  186  and extends the length of shaft  190 , beneath and parallel to probe shaft  178 , and is coupled to nozzle  192 . 
     In operation, probe  110  is inserted into delivery mechanism  112  and delivery mechanism  112  with probe  110  are simultaneously inserted into cannulated surgical device  102 . More specifically, delivery mechanism  112  with probe  110  are simultaneously inserted through openings  144  and  162  in second ends  128  and  148  of cannulas  104  and  106  and into interior cavity  164  of device  102 . Opening  142  in top wall  138  of first cannula  104  allows for communication between the exterior and interior of cannulated surgical device  102 . More specifically, opening  142  allows for the fluid within syringe  114  to flow through tube  116  and be discharged through nozzle  192  into cavity  164  of cannulated surgical device  102  and through opening  142  to interact with the environment exterior to cannulated surgical device  102  and within the treatment area. As such, the physician is able to insert the delivery mechanism in the same orientation as the cannulated surgical device  102  without interfering with the physician&#39;s view of the treatment area and requiring a single incision. 
       FIG. 16  is a top view of the second cannula  106  assembled with an obturator  118 , and  FIG. 17  is a side view of the obturator  118 . In the exemplary embodiment, obturator  118  includes a handle portion  198  and a shaft portion  200 . Shaft portion  200  is tapered similar to sidewalls  134  of first cannula  104  such that obturator  118  is slidably couplable with second cannula  106 . More specifically, once the incision is made, the obturator  118  is then coupled to second cannula  106  and together the obturator  118  and second cannula  106  are inserted into the incision. Handle portion  198  facilitates gripping obturator  118  to assist with inserting second cannula  106  into the incision. 
     As a non-limiting example of use of the illustrated system  100 , the steps involved in using the device in an EPF procedure are provided. The physician first makes a 1 cm incision on the medial aspect of the patient&#39;s foot, at or just proximal to the high point of the arch of the foot. Blunt dissection lateral to the middle band of the plantar fascia using the cannulated member  202  then occurs. Next, the obturator  118  is coupled to second cannula  106  and inserted into the incision. Then obturator  118  is removed and first cannula  104  is slidably coupled to second cannula  106  within the incision to form cavity  164  within device  102 . Next, mechanism  108  is fitted with probe  110 , for example an endoscope, e.g. a 2.7 mm/70°/4″ scope. The mechanism  108  with the inserted scope  110  is introduced into the cannulated device  102  to allow for viewing of the plantar fascia and simultaneous cutting. When the mechanism  108  with the inserted scope  110  is in the proper position, mechanism  108  is raised to extend blade  176  through opening  142  in first cannula  104  to cut the fascia as required. When cutting is complete, mechanism  108  is dropped back down into cavity  164  and retracted from the cannulated device  102  with probe. The cannulated device  102  is then removed through the incision. 
     In general, embodiments of the present invention are particularly well-suited for a variety of applications, including, for example, endoscopic procedures such as fascial release—plantar, carpal, ulnar, etc.—muscle release—gastric/soleous, etc. Although specific features of various embodiments of the invention may be shown in some drawings and not in others, this is for convenience only. In accordance with the principles of the invention, any feature of a drawing may be referenced and/or claimed in combination with any feature of any other drawing. 
     This written description uses examples to disclose various embodiments, which include the best mode, to enable any person skilled in the art to practice those embodiments, including making and using any devices or systems and performing any incorporated methods. The patentable scope is defined by the claims, and may include other examples that occur to those skilled in the art. Such other examples are intended to be within the scope of the claims if they have structural elements that do not differ from the literal language of the claims, or if they include equivalent structural elements with insubstantial differences from the literal languages of the claims.