Patent ID: 12185941

DETAILED DESCRIPTION OF THE INVENTIONS

FIG.1illustrates an exploded view of the system for driving a cannula into a surgical site. The system includes a rigid driver1, a cannula2, and a switching stick3. The driver, as shown inFIGS.3and4, comprises a handle9attached to the rigid tube4. The driver may have a hemispherical seal23. The driver may be cannulated (as shown) through its core to allow for insertion of the switching stick (FIG.5). The cannula is delivered into place with the rigid tube4that has an interlocking feature at the distal tip that engages with a mating locking feature in the distal tip of the cannula. In this way, the proximal portion of the cannula is “pulled” into a surgical portal or incision from its distal tip as the distal tip is pushed. The system allows for the use of a switching3, a rod typically about 4 mm in diameter that is used as a guide wire to place a cannula into a surgical portal. It should be appreciated that the switching stick is an optional feature, as is the driver cannulation which accommodates the switching stick.

FIG.2illustrates the system ofFIG.1when assembled, with the cannula disposed over the rigid tube4. The cannula shown has a side port5to allow fluid inflow and outflow from the joint, providing fluid management in order to maintain clarity in the joint during the arthroscopic surgical procedure. The cannula has a flexible distal flange6or flap to retain the cannula in the joint, preventing it from backing out of the surgical site. An expandable distal wiper seal7may be provided to hold fluid in the joint and prevent fluid leakage. External retention ridges8are disposed over the exterior of the cannula.

In use, the driver is inserted into the proximal end2P of the cannula2until the distally extending protrusion12at the distal tip11of the rigid driver engages the mating locking feature in the cannula. When the driver is engaged, the cannula is supported by the rigid tube. The switching stick3is inserted through the proximal end10of the driver1, through the driver, and out the distal end of the driver and through the cannula. The entire assembly comprising the switching stick, rigid driver and cannula are inserted into the surgical portal or incision. When the cannula is in the desired position in the surgical site, the switching stick3is withdrawn, and then the rigid driver1is withdrawn.

The driver and cannula can have a plurality of engaging features, as shown inFIGS.6,7and8. Each of the driver gripping features12correspondingly mate with detents13disposed on the inside wall of the cannula. Rather than one engagement point at the distal tip, the engagement features may be distributed along the length of the cannula. The plurality of engagement features allow the driver to push longer and lower durometer flexible cannulas into a surgical portal. The driver may have a uniform diameter. The gripping feature12of the driver engages with a proximally facing shoulder13of the cannula as shown inFIGS.7and8.

Generally, the cannula is a flexible portal cannula for use in conjunction with the cannula driver. The cannula driver comprises a shaft having a distal end and a proximal end and at least one distally extending projection extending from its distal end, or extending distally from the outer surface of the driver proximate its distal end. The flexible portal cannula comprises a flexible tube, characterized by a proximal end and a distal end and a lumen extending from the proximal end to the distal end of the flexible tube, and a distal tip on the distal end. The distal tip of the flexible tube is adapted for insertion through a surgical portal into an arthroscopic workspace proximate a joint in a patient. The flexible tube has a proximally facing groove disposed on an inner surface thereof, proximate its distal end, which is sized and dimensioned to receive a distally extending projection of the cannula driver. The proximally facing groove can be an annular groove entirely circumscribing the inner diameter of the portal cannula, or it may extend merely partially around the inner diameter. As illustrated, the groove is most conveniently formed by a ring extending proximally within the distal tip of the portal cannula. The ring can be suspended or fixed to an inwardly protruding flange which protrudes inwardly from the inner wall of the portal cannula, but can also be fixed directly to, or depend directly from, the inner wall of the portal cannula. The driver may be a solid shaft, but is preferably hollow, with a lumen suitable for passage of a switching stick. Also, the driver may be split longitudinally, into two or more elongate sections, to be used in conjunction with a portal cannula having two or more lumens separated by longitudinally extending webs, where the webs are sized to fit in the space separating the elongate sections, to provide a system for inserting a multi-lumen portal cannula.

FIG.9illustrates a cannula14with a distal flange15and a clip16. The flange15is resiliently foldable in a proximal direction while the cannula is passed through the surgical incision, and resiliently biased to return to the radially outwardly extending position after passing through the incision and into the arthroscopic workspace. The combination of the distal flange15and the clip16is operable to clamp the tissue disposed between the clip and the flange. The distal flange15is disposed at the distal end of the cannula and may have one or more slits17that allow the flange to fold back and thus reduce the force needed to push the cannula into the workspace. Perforations at the base of the flange where the flange connects to the outer surface of the cannula may be provided for ease of folding. Alternatively, the flange with split arrangement can be characterized as separate flaps attached to the outer surface of the cannula as shown. Ridges18on the shaft of the cannula allow for incremental adjustment of compression applied by the clip. The clip16is configured to frictionally engage the cannula and can easily be slipped onto the cannula after insertion to the desired compression. The clip16can be positioned, relative to the flange15, to compress intervening tissue.

The cannula clip16features an extension13for sorting sutures. The extension13sorts and engages sutures coming out of a shoulder during a rotator cuff repair or any repair procedure involving sutures. The clip16has an extension13for sorting and arranging sutures for the convenience of the surgeon, consisting of a plurality of slots19around the perimeter of the extension13of the clip16. The extension13has pairs of slots19to sort pairs of sutures used in common double loaded suture anchors, to keep the sutures neatly out of the way of other tools, and conveniently held for retrieval. In this way the surgeon can avoid tying the wrong pairs of sutures together, which can require significant extra surgical time and cost, as well as additional risk and trauma to the patient to correct. These slots19may be identified with markings, letters or numbers that associate the location and orientation of the slots to anatomical locations in the joint. An example of such identifying marks is the “clock” nomenclature for identifying anatomic locations on the shoulder glenoid, for example 12:00, 3:00, 6:00, and 9:00. The slots can be tapered to grip different diameters of sutures. The slots can be “L shaped” (as shown inFIG.10) to cleat the suture and keep the sutures from slipping out of the slot19.

FIGS.10through17illustrates a cannula with a plurality of flaps or tabs20which fold back when the cannula is inserted into the incision. Four separate tabs are shown, but any plurality of tabs may be provided. The tabs20are disposed at the distal end of the cannula, proximate the distal tip11, and extend radially outwardly from the outer surface of the cannula. Each tab has a root21and a tip22, with the root21at a first end nearest to the cannula outer surface and the tip22at the second end of the tab furthest from the cannula outer surface. The root is the part of the flap immediately adjacent to the cannula. As shown inFIG.16, the root has a width dimension B, that is smaller than the tab face width, dimension A, so that the force of insertion into a portal will cause each tab to fold back.

Each flap includes a root portion proximate the outer surface of the cannula, a radially outward portion radially outward of the root, and a proximal face and a distal face, wherein the root portion spans a first circumferential arc (dimension B) and the radially outward portion spans a second circumferential arc (dimension A) larger than the first circumferential arc. The root portion of each flap has a first thickness D, and in the radially outward portion each flap has a second thickness C greater than the first thickness D, as shown inFIG.17. The tabs are arranged circumferentially around the distal end of the cannula proximate the distal tip. The tabs are made of a flexible material.

Distally positioned flaps or tabs20extend radially outwardly from the outer surface of the cannula and are resiliently foldable in a proximal direction while passing through the surgical portal, to lie against the outer surface of the cannula, and resiliently biased to return to a radially outwardly extending position when unconstrained when the distal tip of the cannula is within the arthroscopic workspace.

FIG.18illustrates a cannula with slots19disposed on the flaps20for sorting and anchoring sutures within the surgical site. A plurality of slots19are disposed around the perimeter of the flaps. A slot may also be formed at the root portion of the flaps for suture anchoring and sorting. The slots are configured to accept a segment of suture.

FIG.19illustrates a cannula with slots19disposed circumferentially around the cannula distal tip11for sorting and anchoring sutures within the surgical site. The slots are configured to accept a segment of suture.

FIG.20illustrates a suture sorting accessory for use in an arthroscopic surgical procedure utilizing sutures. A flexible tab20is disposed on the distal end of a handled rigid tube. The flexible tab20has slots19disposed on the perimeter of the tab. The device may be inserted through a cannula or portal into a surgical site. The slots are configured to accept a segment of suture.

FIGS.21and22illustrates a cannula where the tabs are disposed on a ring24that mounts onto the body of a cannula. The cannula25has a retaining groove26for matable attachment to a ring24. The tabs27are disposed circumferentially around the ring. The matable attachment of the ring24and cannula25may be via retaining groove26, screw, snap-fit or other means.

FIG.23illustrates a cannula with two tabs or flaps28disposed on the distal end of the cannula29in opposition to each other. Each flap has a proximal face, which is the face closest to the cannula proximal end, and a distal face. Each flap has a flexible web30provided on the proximal face of the flap connecting the proximal face of the tab to the outer surface of the cannula. The flaps fold inward toward the outer surface of the cannula when the cannula is being inserted into the incision and resiliently return to the original unconstructed or extended position when the flaps are placed within the arthroscopic workspace. The webs maintain the flaps in the extended position.

While the preferred embodiments of the devices and methods have been described in reference to the environment in which they were developed, they are merely illustrative of the principles of the inventions. The elements of the various embodiments may be incorporated into each of the other species to obtain the benefits of those elements in combination with such other species, and the various beneficial features may be employed in embodiments alone or in combination with each other. Other embodiments and configurations may be devised without departing from the spirit of the inventions and the scope of the appended claims.