CN101815475A - 扩张系统及其使用方法 - Google Patents

扩张系统及其使用方法 Download PDF

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CN101815475A
CN101815475A CN200880110134A CN200880110134A CN101815475A CN 101815475 A CN101815475 A CN 101815475A CN 200880110134 A CN200880110134 A CN 200880110134A CN 200880110134 A CN200880110134 A CN 200880110134A CN 101815475 A CN101815475 A CN 101815475A
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expansion device
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P·法通
B·兰达尔
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Synthes GmbH
Synthes USA LLC
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Abstract

本发明提供一种扩张系统及其使用方法。定向顺序和钝性刺激扩张系统(10)以及穿过病人腰肌肌肉(4)到达病人脊柱(2)的相关方法，包括其中形成有至少一条通道的顺序定向扩张器(30、40)或钝性刺激扩张器(100、100’)。优选地，使用刺激探针(20)测定腰肌肌肉内的神经元或神经(9)的位置，从而限定通向病人脊柱的通路的安全区。插入刺激探针穿过腰肌肌肉并朝向病人的脊柱。可插入定向顺序扩张器以扩张刺激探针的任一侧的组织，而不会严重地影响刺激探针的相对侧的可能邻近神经元的组织。该扩张器因具有孔(35、45)而定向，且通过这些孔能插入成位于彼此之上且在探针之上，所述孔从其纵向轴线(31、41)偏离。

Description

扩张系统及其使用方法
相关申请的交叉引用
本申请要求在2007年10月5号提交的名为“相邻或侧向扩张器及其使用方法”的美国临时申请No.60/977,882的权利，在此通过引用将该申请的全部内容合并于此。
背景技术
一般说来，顺序扩张系统能够使外科医生首先切开一个切口然后通过顺序地插入逐渐增大的扩张器而逐渐增大切口的大小。优选地，顺序扩张能够减少对组织的伤害以及相关的损伤，以加快病人的康复。而且，利用扩张来为手术部位准备好手术路径，并且可以和扩张器一起使用刺激器以沿着路径引导扩张器，从而避开病人身体的特定区域，比如神经元或神经。
发明内容
本发明的优选实施例通常涉及微创手术过程和设备，且更特别地涉及用于定向扩张切口的扩张系统及其相关方法，该切口用于开通通向病人脊柱的入口。更具体地，本发明涉及能够穿过病人的腰肌肌肉侧向地到达病人脊柱的腰部区域的扩张系统及其相关方法。根据本发明的一个方面，优选使用刺激探针测定腰肌肌肉的神经元或神经的位置，从而限定通道的安全区。插入刺激探针穿过腰肌肌肉并朝向或进入椎间隙。定向扩张器可用于扩张腰肌肌肉以仅在刺激探针的一侧基本分离组织。也就是说，可插入定向顺序扩张器以例如扩张刺激探针的前侧的腰肌肌肉，同时基本保存刺激探针的后侧的腰肌肌肉完整。具体而言，定向顺序扩张器可用于定向地扩张由刺激探针识别的病人体内的远离神经元或神经的组织，从而使得神经元或神经不被扩张处理或扩张后可能发生的其他手术治疗扰动或损伤。
可替换地，扩张系统及方法可包括具有至少一条形成于外表面的通道的钝性刺激扩张器。该通道接收刺激探针，该刺激探针用于测定腰肌肌肉的神经元或神经的位置从而限定通向病人脊柱的通道的安全区。插入该刺激扩张器穿过腰肌肌肉并朝向或进入椎间隙。然后将刺激探针插入形成于刺激扩张器的外表面的通道内，从而验证有无神经元或神经。
附图说明
结合附图，能够更好地理解前面的发明内容以及下文的本申请优选实施例的详细描述。为了解释本申请的扩张系统及其方法，附图中示出了优选实施例。但是，应该理解的是，本申请并不限于所示的精确布置和手段。在附图中：
图1示出了根据本发明的第一优选实施例的扩张系统的侧视图，这里该扩张系统通常作为定向顺序扩张系统；
图2示出了图1所示的定向顺序扩张系统的远端的放大透视图；
图2A示出了图2所示的定向顺序扩张系统的远端的分解图；
图3示出了沿着图1中的线3-3剖开的、图1所示的定向顺序扩张系统的剖面图；
图4示出了图1所示的定向顺序扩张系统的主视图，包括可与该定向顺序扩张系统一起使用的收缩器的示意图；
图5A示出了与图1示出的定向顺序扩张系统一起使用的第一定向扩张器的侧视图；
图5B示出了图5A所示的第一定向扩张器的主视图；
图6A示出了用于与图1所示的定向顺序扩张系统一起使用的第二定向扩张器的侧视图；
图6B示出了图6A所示的第二定向扩张器的主视图；
图7示出了根据本发明的第二优选实施例的扩张系统的侧视图，在此该扩张系统通常作为钝性刺激扩张系统。
图8示出了图7所示的钝性刺激扩张系统的俯视图；
图9示出了图7所示的钝性刺激扩张系统的近端的放大俯视透视图；
图10示出了图7所示的钝性刺激扩张系统的远端的放大仰视透视图；
图11示出了根据本发明的第三优选实施例的扩张系统的俯视图，其也由钝性刺激扩张系统构成；以及
图12示出了图11所示的钝性刺激扩张系统的近端的放大俯视透视图。
具体实施方式
下文描述所使用的某些术语仅为了方便且并不起限制作用。词语“左”、“右”、“上”和“下”在参考的附图中表示方向。词语“向内”和“向外”分别表示朝向和远离定向顺序和钝性刺激扩张系统以及其指定部分的几何中心的方向。词语“前”、“后”、“在上的”、“在下的”和相关词和/或短语表示所参考的人体的优选位置和方位，且并不旨在对其进行限定。术语包括上述词语、其派生词以及具有类似含义的词语。
现在将参考附图对本发明的某些示例性实施例进行描述。总体而言，这些实施例涉及到达病人脊柱的扩张系统，且优选地涉及侧向地到达病人脊柱的腰部区域的扩张系统。
如本领域普通技术人员通常所理解的，将关于到达脊柱以进行手术治疗来描述所述扩张系统，但是所述扩张系统不但用于矫形外科，还用于其他手术治疗，在所述其他手术治疗中，外科医生希望通过割开皮肤并穿过体壁来到达内腔，从而保持切口舒展开，使得能够插入手术器械。例如，所述扩张系统可用于在前或在后到达脊柱，到达脊柱的胸部或颈部区域，或到达身体的几乎任何其他部分。
参考图4，一般来说，在侧向地接近病人的脊柱2的过程中，优选地分离位于脊柱2的任意一侧的腰肌肌肉4，从而到达脊柱2，并且，特别地到达椎间隙6或到达位于病人脊柱内的一个或多个椎体8。理想的是，在此过程中避开位于腰肌肌肉4内的腰丛的神经元或神经9。通常认为腰肌肌肉4的前三分之一是用于肌肉分离的安全区。
优选地利用刺激探针20来测定腰肌肌肉4的神经元或神经9的位置。这样，优选地定位并识别腰肌肌肉4的最后面的无神经区。然后可插入刺激探针20，经由最后面的无神经组织区穿过腰肌肌肉4或穿过没有神经元或神经9的几乎任何其他区域并朝向脊柱2，或进入椎间隙6从而开始对腰肌肌肉4进行安全的组织分离。根据本发明的第一优选实施例的定向扩张器30、40可用于扩张肌肉分离。特别地，定向扩张器30、40可主要用于分离在刺激探针20的一侧(示为颅侧)的组织，优选地是刺激探针20的前侧(例如，刺激探针20最初识别并标记的安全区)。也就是说，通过利用定向顺序扩张器30、40，能移动刺激探针20一侧的组织同时基本限制刺激探针20的相对侧的组织的移动。比较地，同心扩张器径向地分离肌肉，并且因此扩张刺激探针两侧的组织。这又可能会触碰位于安全区之外的神经元或神经9。
参考图1-图6B，本发明的扩张系统的第一优选实施例由定向顺序扩张系统10构成。定向顺序扩张系统10优选地包括刺激探针20、第一定向扩张器30以及第二定向扩张器40。定向顺序扩张系统10可包括或多或少的扩张器，比如，例如一个、三个、四个等等。刺激探针20可为现在或此后因传输电脉冲而已知的任意探针。刺激探针20优选地包括探针末端20a和纵向探针轴线21。第一定向扩张器30优选地包括第一纵向轴线31、外表面32、近端33、远端34和从近端33延伸到远端34的第一孔35。第一定向扩张器30优选地还包括位于远端34处的第一纵向轴线31延伸穿过的第一末端30a。第一孔35具有从第一孔35的近端延伸到远端的第一孔轴线36。第一孔轴线36优选地偏离或定位成距离第一纵向轴线31第一偏离距离A。第一定向扩张器30还优选地包括形成于其外表面32的第一通道38。第一通道38优选地沿着第一孔35的整个长度与第一孔35连通。在使用时，第一孔35和第一通道38以组装的构造能去除地接收刺激探针20(例如，当刺激探针20能滑动地接收在第一定向扩张器30的第一孔35内时)，从而使得外科医生能刺激第一定向扩张器30。刺激探针20的探针轴线21优选地以组装的构造与第一定向扩张器30的第一孔轴线36同轴。
类似地，第二定向扩张器40优选地包括第二纵向轴线41、外表面42、近端43、远端44和从近端43延伸到远端44的第二孔45。第二孔45优选地具有从近端43延伸到远端44的第二孔轴线46。第二定向扩张器40还优选地包括位于远端44处的第二纵向轴线41延伸穿过的第二末端40a。第二孔45的第二孔轴线46偏离或定位成距离第二纵向轴线41第二偏离距离B。优选地涂敷第一和第二定向扩张器30、40的外表面32、42以防止在使用过程中漏电，这对本领域的普通技术人员而言是显而易见的。第二定向扩张器40还优选地包括形成于其外表面42且与第二孔45连通的第二通道48。在使用时，第二孔45和第二通道48以组装的构造将第一定向扩张器30接收在其中(例如，当第一定向扩张器30能滑动地接收在第二定向扩张器40的第二孔45内时)。当具有组装的构造时，第一定向扩张器30的第一纵向轴线31优选地与第二定向扩张器40的第二孔轴线46同轴。
因为第一和第二孔35、45的第一和第二孔轴线36、46分别从第一和第二定向扩张器30、40的第一和第二纵向轴线31、41偏离，所以将第一定向扩张器30插入至刺激探针20之上然后将第二定向扩张器40插入至第一定向扩张器30之上使得每个顺序扩张器“定向地”扩张开口，该开口优选在病人体内远离任何神经元、神经9或刺激探针20的相对侧的其他组织结构形成，这在下文中会更加详细地描述。
而且，第一和第二通道38、48的结合使得第一和第二定向扩张器30、40能够更加紧密地嵌套在一起，从而基本上消除当使用多个具有逐渐增加的内孔尺寸的同心扩张器时出现的“饼切”效应(“cookiecutter”effect)。
第一定向扩张器30优选地包括位于其外表面32上的多个第一深度指示器37(如在图5A和图5B最好地示出的那样)。多个第一深度指示器37大致垂直于第一纵向轴线31在第一定向扩张器30的外表面32上延伸。多个第一深度指示器37为外科医生指示在第一定向扩张器30的远端34处形成的第一末端30a和相应的深度指示器37之间的不同距离，使得在使用时外科医生能够确定第一定向控制器30已插入到病人体内的程度。类似地，如在图6A和图6B中最好地示出的那样，第二定向扩张器40优选地包括位于其外表面42上的多个第二深度指示器47。多个第二深度指示器47大致垂直于第二纵向轴线41在第二定向扩张器40的外表面42上延伸。多个第二深度指示器47为外科医生指示在第二定向扩张器40的远端44处形成的第二末端40a和相应的深度指示器47之间的不同距离，使得在使用时外科医生能够确定第二定向扩张器40已插入到病人体内的程度。在第一优选实施例中，多个第一和第二深度指示器37、47以10毫米(10mm)的增量与第一和第二末端30a、40a隔开80毫米(80mm)到150毫米(150mm)的距离。然而，多个多个第一和第二深度指示器37、47并不限于这些尺寸，可与第一和第二末端30a、40a隔开医生喜欢的且能够表示第一和第二定向扩张器30、40插入到病人体内的深度的几乎任何距离或间隔。
另外，第一和第二定向扩张器30、40优选地包括分别位于其近端32、42处的第一和第二把手39、49，从而能够更好地使医生在使用时抓握扩张器30、40。在手术期间，在插入、去除、扭转或以其他方式操作第一和第二定向扩张器30、40的过程中，医生可以利用第一和第二把手39、49。
如在图1中最好地示出的那样，第一定向扩张器30优选地具有第一长度L1，第二定向扩张器40具有第二长度L2。第一长度L1优选地大于所述第二长度L2从而方便操纵和插入。类似地，刺激探针20优选地具有探针长度L3，使得探针长度L3大于第一长度L1和第二长度L2。第一定向扩张器30的较大的第一长度L1允许第一定向扩张器30的近端33以组装的和操作的构造从病人体内进一步延伸出来，使得医生甚至在第二扩张器40插入到病人体内之后，也可以抓住第一把手39并去除或以其他方式操作第一定向扩张器30。在第一优选实施例中，第一长度为220毫米(220mm)，而第二长度为200毫米(200mm)，但并不仅限于此，且可以为允许以近端33、43从病人体内延伸出来的状态插入病人体内的几乎任何长度。另外，第一定向扩张器30优选地具有第一直径D1，而第二定向扩张器40具有第二直径D2，第二直径D2优选地大于第一直径D1。在第一优选实施例中，第一直径D1大约为7.7毫米(7.7mm)，而第二直径D2大约为17.5毫米(17.5mm)。然而，第一和第二直径D1、D2并不仅限于此，可以具有医生为了扩张距刺激探针20各种距离的组织而期望的几乎任何直径。进而，第一和第二定向扩张器30、40并不仅限于具有圆形截面，其可以具有允许以医生喜欢的方式进行定向扩张的几乎任何截面并且适合于不同的形状。例如，第一和第二定向扩张器30、40可具有椭圆形或长方形截面的形状，该椭圆形或长方形截面的形状比具有圆形截面的扩张器更能促进扩张和手术工作通道进一步远离探测到的神经9。
现在描述使用刺激探针20以及第一和第二定向扩张器30、40以到达病人的脊柱2的方法。虽然可以在病人身体的其他部分使用相似或相同的方法，但是特别需要该技术以经由侧向途径到达脊柱2的腰部区域。
使用刺激探针20和触发肌电图机(EMG)50，医生优选地在所关注的组织(例如，腰肌肌肉4)上测定出安全区，即，基本上没有任何神经元或神经9的区域。例如，在腰肌肌肉4上，通常认为腰肌肌肉4的前三分之一是安全区。
一旦确立了安全区，优选地通过术中透视确定组织布置。医生插入刺激探针20穿过腰肌肌肉4并朝向病人的脊柱2。如果手术正在椎间隙6上进行，则刺激探针20的远端可插入到希望的椎间隙6的环带内。优选地，刺激探针20将经由安全区的最后部插入。
医生能够使第一定向扩张器30插入或滑动至刺激探针20之上，使得第一纵向轴线31定位于刺激探针20的一侧，优选地远离感测到的神经元或神经9，并穿过腰肌肌肉4且进入邻近病人脊柱2的位置。如果需要，然后医生插入第二定向扩张器40，以进一步扩张邻近第一定向扩张器30的外表面32并且更为远离感测到的神经元或神经9的组织。医生可以根据需要重复此过程。最后，如果需要，可将收缩器60插入至第二定向扩张器40之上，从而随后收缩组织并且允许去除第一和第二定向扩张器30、40以及刺激探针20。可替换地，可插入工作套管(未示出)至第二扩张器40之上，使得可穿过工作套管执行在脊柱2上实施的治疗。
另外，如果需要，可以在插入第二定向扩张器40之前，从第一孔35去除刺激探针20并且旋转扩张器/探针组合。此后，使用触发EMG刺激50，医生能验证神经根9位于第一定向扩张器30的期望侧，优选地与第一通道38相对。优选在插入第二定向扩张器40之前，再将刺激探针20插入第一孔35内。
与本领域技术人员通常已知的同心顺序扩张器相比，通过使用第一和第二定向扩张器30、40，使得定向顺序扩张系统10优选地确保入口远离腰肌肌肉4的神经元或神经9，从而避开可能例如位于刺激探针20的后侧的任何神经元或神经9。而且，在分离组织的时候，通过将组织分离的量最小化，定向顺序扩张系统10还减少了组织损伤的量。
可替换地，如在图7-图10中所示，可使用具有本申请的扩张系统的第二优选实施例的单步钝性刺激扩张器100。钝性刺激扩张器100包括外表面102、近端104、远端106和从近端104延伸到远端106的孔108。近端104包括用于附接刺激夹或线的区域110。远端106包括用于传递电刺激的暴露的优选是尖的末端112。优选地，涂敷刺激扩张器100的位于近端104和远端106之间的外表面102以防止漏电。刺激扩张器100还优选地包括形成于其外表面102的通道114，用于接收刺激探针120。刺激探针120可以是现在或此后因传输电脉冲而已知的任何探针。
刺激扩张器100使医生能够同时刺激并扩张腰肌肌肉4。在将刺激扩张器100的末端112放置入椎间隙中后，可沿着扩张器100的外表面102穿过通道114插入刺激探针120，从而刺激扩张的组织的周围。
可替换地，如在图11和图12中所示，由本申请的第三优选实施例构成的刺激扩张器100′可包括形成于其外表面102的多条通道114。例如，如所示出的那样，刺激扩张器100’可包括在扩张器100’的外表面102上径向间隔的四条通道114a-d。这样，一旦扩张器100’处于适当的位置，医生就能刺激前部、后部、头部、和下部以验证神经根的位置。本领域普通技术人员可以理解，刺激扩张器100’可以包括任意数量的通道114，例如两条、三条、五条或更多。
现在描述使用钝性刺激扩张系统的方法以到达脊柱2，尤其以提供经由侧向途径穿过脊柱2的腰部区域的腰肌肌肉4的入口。本领域普通技术人员可以理解，该方法也可利用另选的途径用于身体的其他部分。
在使用时，医生通过例如扭转动作将钝性刺激扩张器100、100’优选侧向地插入到腰肌肌肉4中。医生优选使用触发EMG50传输电脉冲进入钝性刺激扩张器100、100’，从而通过定位神经根9来定位病人腰肌肌肉4中的安全区。一旦确定任何神经根9的位置在钝性刺激扩张器100、100’的后面，医生就能侧向地插入钝性刺激扩张器100、100’穿过腰肌肌肉4并朝向病人的脊柱2，优选地进入椎间隙6的环带。医生将刺激探针20插入或滑入形成于钝性刺激扩张器100、100’的外表面102的通道114内。如果需要，医生在刺激探针120位于通道114内的状态下旋转钝性刺激扩张器100，同时使用EMG50验证神经根9的位置。可替换地，关于四条通道的钝性刺激扩张器100’，不需要旋转钝性刺激扩张器100。相反，刺激探针120可以独立地插入每条通道114a-d内以验证神经根9的位置。然后，如果需要，医生可将收缩器插入至刺激扩张器100、100’之上。
虽然前面的描述和附图代表本发明的优选实施例，但是可以理解的是，在不背离在所附的权利要求中所限定的本发明的精神和范围的情况下，可以对其进行各种增加、修改和替换。特别地，本领域技术人员明白，在不背离其精神或实质特点的情况下，本发明可表示为其他具体形式、结构、布置、比例，并且可以具有其他元件、材料和部件。本领域技术人员可以理解，本发明在使用时可以在结构、布置、比例、材料、和部件上有许多修改，并且可以其他方式用于发明实践中，这在不背离本发明的原则的情况下尤其适合特定的环境和操作要求。而且，本文所描述的特征可单独使用或者结合其他特征一起使用。因此，本文公开的实施例在所有方面都被认为是示例性的而不是限制性的，本发明的保护范围由所附的权利要求示出而且不限于前面的描述。

Claims (15)

1.一种用于远离病人身体的神经扩张的定向顺序扩张系统，所述定向顺序扩张系统包括：
具有探针轴线的刺激探针；
第一定向扩张器，其包括第一纵向轴线、从近端延伸到远端的第一孔、和与所述第一孔连通的第一通道，所述第一孔具有第一孔轴线，所述第一纵向轴线从所述第一孔轴线偏离；以及
第二定向扩张器，其包括第二纵向轴线、从所述第二定向扩张器的近端延伸到远端的第二孔、和与所述第二孔连通的第二通道，所述第二孔具有第二孔轴线，所述第二纵向轴线从所述第二孔轴线偏离；所述刺激探针能够能去除地接收在所述第一孔中，所述第一定向扩张器能够能去除地接收在所述第二孔中。
2.根据权利要求1所述的定向顺序扩张系统，其中所述探针轴线以组装的构造与所述第一孔轴线同轴。
3.根据权利要求1所述的定向顺序扩张系统，其中所述第一纵向轴线以组装的构造与所述第二孔轴线同轴。
4.根据权利要求1所述的定向顺序扩张系统，还包括：
第一末端，其位于所述第一定向扩张器的所述远端，所述第一纵向轴线通过所述第一末端；和
第二末端，其位于所述第二定向扩张器的所述远端，所述第二纵向轴线通过所述第二末端。
5.根据权利要求4所述的定向顺序扩张系统，还包括：
位于所述第一定向扩张器的第一外表面上的多个第一深度指示器，所述多个第一深度指示器通常垂直于所述第一纵向轴线分别在所述第一外表面上延伸，所述多个第一深度指示器分别限定所述第一末端和所述多个第一深度指示器之间的多个第一距离；以及
位于所述第二定向扩张器的第二外表面上的多个第二深度指示器，所述多个第二深度指示器通常垂直于所述第二纵向轴线分别在所述第二外表面上延伸，所述多个第二深度指示器分别限定所述第二末端和所述多个第二深度指示器之间的多个距离。
6.根据权利要求1所述的定向顺序扩张系统，其中所述第一扩张器和所述第二扩张器包括分别位于其近端处的第一和第二把手。
7.根据权利要求1所述的定向顺序扩张系统，其中所述第一定向扩张器具有第一长度，所述第二定向扩张器具有第二长度，所述第一长度大于所述第二长度。
8.根据权利要求7所述的定向顺序扩张系统，其中所述刺激探针具有探针长度，所述探针长度大于所述第一长度和所述第二长度。
9.根据权利要求1所述的定向顺序扩张系统，其中所述第一定向扩张器具有第一直径，所述第二定向扩张器具有第二直径，所述第二直径大于所述第一直径。
10.一种使用定向顺序扩张系统形成穿过腰肌肌肉到达病人脊柱的入口的方法，所述定向扩张系统具有刺激探针、第一定向扩张器和第二定向扩张器以避开神经，所述第一定向扩张器和所述第二定向扩张器分别具有第一孔和第二孔，所述第一孔和所述第二孔分别具有从第一纵向轴线和第二纵向轴线偏离的第一孔轴线和第二孔轴线，所述方法包括以下步骤：
(a)将所述刺激探针侧向地插入腰肌肌肉内；
(b)经由肌电图机将电脉冲传递到所述刺激探针中，从而定位位于腰肌肌肉内的安全区；
(c)将所述刺激探针穿过腰肌肌肉侧向地插入，从而使得探针末端邻近病人的脊柱；
(d)通过所述刺激探针与所述第一孔的滑动接合的引导，将所述第一定向扩张器插入穿过腰肌肌肉并朝向病人的脊柱，所述第一孔轴线定位成比所述第一纵向轴线更接近神经；以及
(e)通过所述第一定向扩张器与所述第二孔的滑动接合的引导，将所述第二定向扩张器插入穿过腰肌肌肉并朝向病人的脊柱，将所述第二孔轴线定位成比所述第二纵向轴线更接近神经。
11.根据权利要求10所述的方法，还包括步骤：
(f)将收缩器插入至所述第二定向扩张器之上。
12.根据权利要求10所述的方法，还包括步骤：
(f)在步骤(c)之前通过术中透视确定所述安全区的位置。
13.一种使用钝性刺激扩张系统形成穿过腰肌肌肉到达病人脊柱的入口的方法，所述钝性刺激扩张系统包括刺激探针、肌电图机以及具有第一刺激通道和第二刺激通道的刺激扩张器，以避开神经，所述方法包括以下步骤：
(a)将所述刺激扩张器侧向地插入腰肌肌肉内；
(b)经由肌电图机将电脉冲传递到所述刺激扩张器中，从而定位位于病人的腰肌肌肉内的安全区；
(c)将所述刺激扩张器侧向地插入穿过腰肌肌肉并朝向病人的脊柱；
(d)将所述刺激探针插入所述刺激通道内。
14.根据权利要求13所述的方法，还包括步骤(e)旋转所述刺激扩张器和所述刺激探针，同时使用所述肌电图机验证神经的位置。
15.根据权利要求13所述的方法，还包括步骤：
(e)从所述通道去除所述刺激探针；以及
(f)将所述刺激探针再插入所述第二刺激通道内。
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Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN106236187A (zh) * 2016-08-31 2016-12-21 蒋毅 椎间孔的工作管道及修复装置
CN109982625A (zh) * 2016-11-29 2019-07-05 奥林巴斯株式会社 内窥镜系统
CN110547795A (zh) * 2018-05-30 2019-12-10 张霞玲 一种脊柱外科手术用脊椎探针
CN112656510A (zh) * 2020-12-21 2021-04-16 山东大学齐鲁医院 一种基于肌电信号的脊柱手术机器人穿刺预警方法及系统

Families Citing this family (64)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9387313B2 (en) 2004-08-03 2016-07-12 Interventional Spine, Inc. Telescopic percutaneous tissue dilation systems and related methods
EP2120784B1 (en) * 2007-02-28 2017-02-15 Boston Scientific Scimed, Inc. Apparatus for organ suspension
KR20100080529A (ko) 2007-10-05 2010-07-08 신세스 게엠바하 팽창 시스템 및 이를 이용한 방법
US8088163B1 (en) 2008-02-06 2012-01-03 Kleiner Jeffrey B Tools and methods for spinal fusion
US8876851B1 (en) 2008-10-15 2014-11-04 Nuvasive, Inc. Systems and methods for performing spinal fusion surgery
US20100114147A1 (en) * 2008-10-30 2010-05-06 The University Of Toledo Directional soft tissue dilator and docking pin with integrated light source for optimization of retractor placement in minimally invasive spine surgery
US8366748B2 (en) 2008-12-05 2013-02-05 Kleiner Jeffrey Apparatus and method of spinal implant and fusion
US20110144687A1 (en) * 2009-12-10 2011-06-16 Kleiner Jeffrey Lateral Based Retractor System
US8992558B2 (en) 2008-12-18 2015-03-31 Osteomed, Llc Lateral access system for the lumbar spine
US9247943B1 (en) 2009-02-06 2016-02-02 Kleiner Intellectual Property, Llc Devices and methods for preparing an intervertebral workspace
US8998803B2 (en) * 2009-04-30 2015-04-07 Boston Scientific Scimed, Inc. Dissection and retraction device for vaginal sacral colpopexy
US9629729B2 (en) 2009-09-18 2017-04-25 Spinal Surgical Strategies, Llc Biological delivery system with adaptable fusion cage interface
US10245159B1 (en) 2009-09-18 2019-04-02 Spinal Surgical Strategies, Llc Bone graft delivery system and method for using same
US8906028B2 (en) 2009-09-18 2014-12-09 Spinal Surgical Strategies, Llc Bone graft delivery device and method of using the same
US10973656B2 (en) 2009-09-18 2021-04-13 Spinal Surgical Strategies, Inc. Bone graft delivery system and method for using same
US20170238984A1 (en) 2009-09-18 2017-08-24 Spinal Surgical Strategies, Llc Bone graft delivery device with positioning handle
DE112011102801B4 (de) 2010-08-23 2024-05-02 Nuvasive, Inc. Chirurgisches Zugangssystem und zugehörige Verfahren
EP2618743B1 (en) 2010-09-20 2018-03-07 Synthes GmbH Spinal access retractor
US8518087B2 (en) 2011-03-10 2013-08-27 Interventional Spine, Inc. Method and apparatus for minimally invasive insertion of intervertebral implants
US8394129B2 (en) * 2011-03-10 2013-03-12 Interventional Spine, Inc. Method and apparatus for minimally invasive insertion of intervertebral implants
US8834507B2 (en) 2011-05-17 2014-09-16 Warsaw Orthopedic, Inc. Dilation instruments and methods
US20140228874A1 (en) * 2011-09-09 2014-08-14 Spine Wave, Inc. Apparatus for dilating bodily tissue and for monitoring neural activity in the dilated bodily tissue
WO2013067179A2 (en) 2011-11-01 2013-05-10 Synthes Usa, Llc Dilation system
US9561059B1 (en) 2011-11-23 2017-02-07 Nuvasive, Inc. Minimally invasive facet release
US9888859B1 (en) 2013-03-14 2018-02-13 Nuvasive, Inc. Directional dilator for intraoperative monitoring
US20150051576A1 (en) * 2012-03-30 2015-02-19 Koninklijke Philips N.V. Nested cannula tips
US9265490B2 (en) * 2012-04-16 2016-02-23 DePuy Synthes Products, Inc. Detachable dilator blade
US20140067069A1 (en) 2012-08-30 2014-03-06 Interventional Spine, Inc. Artificial disc
US9370348B2 (en) * 2012-10-23 2016-06-21 Amendia, Inc. Dilator delivered nerve shield
US9456846B2 (en) * 2012-12-19 2016-10-04 Life Spine, Inc. Directional sequential dilation system with neuro monitoring
US10532197B2 (en) 2012-12-19 2020-01-14 Life Spine, Inc. Directional sequential dilation system with neuro monitoring
US9277928B2 (en) 2013-03-11 2016-03-08 Interventional Spine, Inc. Method and apparatus for minimally invasive insertion of intervertebral implants
US9993353B2 (en) 2013-03-14 2018-06-12 DePuy Synthes Products, Inc. Method and apparatus for minimally invasive insertion of intervertebral implants
KR102390107B1 (ko) 2013-05-30 2022-04-25 그라함 에이치. 크리시 국부 신경 자극
US11229789B2 (en) 2013-05-30 2022-01-25 Neurostim Oab, Inc. Neuro activator with controller
US10716536B2 (en) 2013-07-17 2020-07-21 Tissue Differentiation Intelligence, Llc Identifying anatomical structures
US9757151B2 (en) * 2013-11-14 2017-09-12 Globus Medical, Inc. Endoscopic fusion system and method with neuromonitoring
US9339263B2 (en) * 2014-01-03 2016-05-17 DePuy Synthes Products, Inc. Dilation system and method
US9662002B2 (en) * 2014-07-10 2017-05-30 Amendia, Inc. Endoscopic portal protective shield assembly
US10258228B2 (en) * 2014-08-08 2019-04-16 K2M, Inc. Retraction devices, systems, and methods for minimally invasive spinal surgery
US11077301B2 (en) 2015-02-21 2021-08-03 NeurostimOAB, Inc. Topical nerve stimulator and sensor for bladder control
USD797290S1 (en) 2015-10-19 2017-09-12 Spinal Surgical Strategies, Llc Bone graft delivery tool
US9675363B2 (en) 2015-11-13 2017-06-13 Advance Research System, Llc Surgical tools having application for spinal surgical procedures and method of use
US9924932B2 (en) * 2015-12-01 2018-03-27 Seth K. WILLIAMS Technique and system for lateral lumbar spine fusion
WO2017127502A1 (en) * 2016-01-19 2017-07-27 K2M, Inc. Tissue dilation system and methods of use
US10299838B2 (en) 2016-02-05 2019-05-28 Medos International Sarl Method and instruments for interbody fusion and posterior fixation through a single incision
US11701086B1 (en) 2016-06-21 2023-07-18 Tissue Differentiation Intelligence, Llc Methods and systems for improved nerve detection
US11166709B2 (en) 2016-08-23 2021-11-09 Stryker European Operations Holdings Llc Instrumentation and methods for the implantation of spinal implants
EP3357459A1 (en) 2017-02-03 2018-08-08 Spinal Surgical Strategies, LLC Bone graft delivery device with positioning handle
EP3443912B1 (en) 2017-08-17 2022-08-24 Stryker European Operations Holdings LLC Expanders for rod retraction
EP3706856A4 (en) 2017-11-07 2021-08-18 Neurostim Oab, Inc. NON-INVASIVE NERVOUS ACTIVATOR WITH ADAPTIVE CIRCUIT
EP3545857B1 (en) 2018-03-30 2024-01-03 Stryker European Operations Holdings LLC Lateral access retractor and core insertion
US11413029B2 (en) 2018-10-24 2022-08-16 Stryker European Operations Holdings Llc Anterior to psoas instrumentation
US10624623B1 (en) 2019-02-12 2020-04-21 Edward Rustamzadeh Lateral retractor system for minimizing muscle damage in spinal surgery
US10925593B2 (en) 2019-02-12 2021-02-23 Edward Rustamzadeh Lateral retractor system for minimizing muscle damage in spinal surgery
US11246582B2 (en) 2019-02-12 2022-02-15 Edward Rustamzadeh Dual-motion rotation and retraction system for minimizing muscle damage in spinal surgery
US10363023B1 (en) * 2019-02-12 2019-07-30 Edward Rustamzadeh Lateral retractor system for minimizing muscle damage in spinal surgery
US10631842B1 (en) * 2019-02-12 2020-04-28 Edward Rustamzadeh Lateral retraction system for minimizing muscle damage in spinal surgery
US20220031298A2 (en) 2019-02-12 2022-02-03 Edward Rustamzadeh Lateral retractor system for minimizing muscle damage in spinal surgery
CN114126704A (zh) 2019-06-26 2022-03-01 神经科学技术有限责任公司 具有自适应电路的非侵入性神经激活器
US11564674B2 (en) 2019-11-27 2023-01-31 K2M, Inc. Lateral access system and method of use
JP2023506713A (ja) 2019-12-16 2023-02-20 ニューロスティム テクノロジーズ エルエルシー 昇圧電荷送達を用いた非侵襲性神経アクティベータ
US11246637B2 (en) 2020-05-11 2022-02-15 Alphatec Spine, Inc. Stimulating targeting needle
USD1002842S1 (en) 2021-06-29 2023-10-24 Edward Rustamzadeh Combination surgical spinal dilator and retractor system

Family Cites Families (374)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2878701A (en) 1957-08-14 1959-03-24 Weersma Arnold Allen wrench set
US3698391A (en) 1970-12-16 1972-10-17 David T Mahony Meatal dilator
DE3025785C2 (de) 1980-07-08 1984-08-16 Storz, Karl, 7200 Tuttlingen Dilatator, Verfahren zu seiner Verwendung und Vorrichtung zur Durchführung des Verfahrens
US4350151A (en) 1981-03-12 1982-09-21 Lone Star Medical Products, Inc. Expanding dilator
US4573448A (en) 1983-10-05 1986-03-04 Pilling Co. Method for decompressing herniated intervertebral discs
US4678459A (en) 1984-07-23 1987-07-07 E-Z-Em, Inc. Irrigating, cutting and aspirating system for percutaneous surgery
GB8424436D0 (en) 1984-09-27 1984-10-31 Pratt Int Ltd Burnerd Surgical appliance
US4646738A (en) 1985-12-05 1987-03-03 Concept, Inc. Rotary surgical tool
US4863430A (en) 1987-08-26 1989-09-05 Surgical Dynamics, Inc. Introduction set with flexible trocar with curved cannula
US5529580A (en) 1987-10-30 1996-06-25 Olympus Optical Co., Ltd. Surgical resecting tool
US4862891A (en) 1988-03-14 1989-09-05 Canyon Medical Products Device for sequential percutaneous dilation
US4888146A (en) 1988-05-19 1989-12-19 Dandeneau James V Method and apparatus of forming extruded article
US5129906A (en) 1989-09-08 1992-07-14 Linvatec Corporation Bioabsorbable tack for joining bodily tissue and in vivo method and apparatus for deploying same
US5080662A (en) 1989-11-27 1992-01-14 Paul Kamaljit S Spinal stereotaxic device and method
US5120318A (en) 1990-06-25 1992-06-09 Harinathareddy Nallapareddy Arthroscopy portal maker
US5269785A (en) 1990-06-28 1993-12-14 Bonutti Peter M Apparatus and method for tissue removal
US5158543A (en) 1990-10-30 1992-10-27 Lazarus Harrison M Laparoscopic surgical system and method
US5071410A (en) 1991-03-14 1991-12-10 Pazell John A Arthroscopic surgery system
US5241972A (en) 1991-05-03 1993-09-07 Meditron Devices, Inc. Method for debulking tissue to remove pressure on a nerve
US5370134A (en) 1991-05-29 1994-12-06 Orgin Medsystems, Inc. Method and apparatus for body structure manipulation and dissection
US5545228A (en) 1991-08-15 1996-08-13 Smith & Nephew Richards Inc. Offset bone bolt
US5242443A (en) 1991-08-15 1993-09-07 Smith & Nephew Dyonics, Inc. Percutaneous fixation of vertebrae
US5480440A (en) 1991-08-15 1996-01-02 Smith & Nephew Richards, Inc. Open surgical technique for vertebral fixation with subcutaneous fixators positioned between the skin and the lumbar fascia of a patient
US5584887A (en) 1991-08-15 1996-12-17 Smith & Nephew Richards, Inc. Percutaneous screw adapter
US5285795A (en) 1991-09-12 1994-02-15 Surgical Dynamics, Inc. Percutaneous discectomy system having a bendable discectomy probe and a steerable cannula
US5269797A (en) 1991-09-12 1993-12-14 Meditron Devices, Inc. Cervical discectomy instruments
IT1249714B (it) 1991-10-11 1995-03-09 Mauro Caponi Strumento chirurgico a doppia cannula.
US5195541A (en) 1991-10-18 1993-03-23 Obenchain Theodore G Method of performing laparoscopic lumbar discectomy
US5395317A (en) 1991-10-30 1995-03-07 Smith & Nephew Dyonics, Inc. Unilateral biportal percutaneous surgical procedure
US5762629A (en) * 1991-10-30 1998-06-09 Smith & Nephew, Inc. Oval cannula assembly and method of use
US5171279A (en) 1992-03-17 1992-12-15 Danek Medical Method for subcutaneous suprafascial pedicular internal fixation
US5580344A (en) 1992-10-22 1996-12-03 Hasson; Harrith M. Incision converter & method of using the same
US5735792A (en) 1992-11-25 1998-04-07 Clarus Medical Systems, Inc. Surgical instrument including viewing optics and an atraumatic probe
US5540706A (en) 1993-01-25 1996-07-30 Aust; Gilbert M. Surgical instrument
US5439464A (en) 1993-03-09 1995-08-08 Shapiro Partners Limited Method and instruments for performing arthroscopic spinal surgery
US5387220A (en) 1993-06-15 1995-02-07 Pisharodi; Maohaven Stereotactic frame and localization method
US5513827A (en) 1993-07-26 1996-05-07 Karlin Technology, Inc. Gooseneck surgical instrument holder
DE9415039U1 (de) 1994-09-16 1994-11-03 Kernforschungsz Karlsruhe Vorrichtung zur Führung chirurgischer Instrumente
US5575176A (en) * 1994-12-30 1996-11-19 Rohrs; Henry W. Three-dimensional positioning device
US5562695A (en) 1995-01-10 1996-10-08 Obenchain; Theodore G. Nerve deflecting conduit needle and method
US5569290A (en) 1995-01-30 1996-10-29 Paul C. McAfee Method of and apparatus for laparoscopic or endoscopic spinal surgery using an unsealed anteriorly inserted transparent trochar
AU694915B2 (en) 1995-03-22 1998-08-06 Evi Corporation Intra-artery obstruction clearing apparatus and methods
DE19520277C1 (de) 1995-06-02 1996-11-21 Winter & Ibe Olympus Endoskopisches Instrument
US5820623A (en) 1995-06-20 1998-10-13 Ng; Wan Sing Articulated arm for medical procedures
US5591187A (en) 1995-07-14 1997-01-07 Dekel; Moshe Laparoscopic tissue retrieval device and method
US5733242A (en) 1996-02-07 1998-03-31 Rayburn; Robert L. Intubation system having an axially moveable memory cylinder
CA2198036C (en) 1996-02-20 2000-12-05 Charles S. Taylor Access platform for internal mammary dissection
EP0891156B1 (en) 1996-03-22 2004-07-14 SDGI Holdings, Inc. Device for percutaneous surgery
US5792044A (en) 1996-03-22 1998-08-11 Danek Medical, Inc. Devices and methods for percutaneous surgery
US6679833B2 (en) * 1996-03-22 2004-01-20 Sdgi Holdings, Inc. Devices and methods for percutaneous surgery
JP3819962B2 (ja) 1996-04-01 2006-09-13 ペンタックス株式会社 椎体間固定インプラントのガイド装置
DE69726491T2 (de) 1996-05-09 2004-10-28 Olympus Optical Co., Ltd. Knochenchirurgisches Werkzeug zum Halten eines Hohlraums, chirurgisches Werkzeug zum Halten eines Hohlraums, System für die endoskopische Chirurgie mit Verwendung eines Werkzeugs zum Halten eines Hohlraums
US5741261A (en) 1996-06-25 1998-04-21 Sdgi Holdings, Inc. Minimally invasive spinal surgical methods and instruments
US7104986B2 (en) 1996-07-16 2006-09-12 Arthrocare Corporation Intervertebral disc replacement method
US5976080A (en) 1996-09-20 1999-11-02 United States Surgical Surgical apparatus and method
US6322498B1 (en) 1996-10-04 2001-11-27 University Of Florida Imaging scope
TW375522B (en) 1996-10-24 1999-12-01 Danek Medical Inc Devices for percutaneous surgery under direct visualization and through an elongated cannula
US6033105A (en) 1996-11-15 2000-03-07 Barker; Donald Integrated bone cement mixing and dispensing system
US5894369A (en) 1996-11-15 1999-04-13 Fuji Photo Optical Co., Ltd. Lens device with anti-fogging
EP1006886B1 (en) 1997-02-13 2003-07-09 Boston Scientific Limited Dilator for minimally invasive pelvic surgery
WO1998049944A1 (en) 1997-05-02 1998-11-12 Pilling Weck Incorporated Adjustable supporting bracket having plural ball and socket joints
US5976146A (en) 1997-07-11 1999-11-02 Olympus Optical Co., Ltd. Surgical operation system and method of securing working space for surgical operation in body
US5964761A (en) 1997-07-15 1999-10-12 Kambin; Parviz Method and instruments for percutaneous arthroscopic disc removal, bone biopsy and fixation of vertebrae
US6175758B1 (en) 1997-07-15 2001-01-16 Parviz Kambin Method for percutaneous arthroscopic disc removal, bone biopsy and fixation of the vertebrae
NL1006944C2 (nl) 1997-09-04 1999-03-11 Mark Hans Emanuel Chirurgische endoscopische snij-inrichting.
US5967970A (en) 1997-09-26 1999-10-19 Cowan; Michael A. System and method for balloon-assisted retraction tube
AUPP294698A0 (en) 1998-04-15 1998-05-07 Gray, Bruce Removable ball joint
US5910155A (en) 1998-06-05 1999-06-08 United States Surgical Corporation Vascular wound closure system
US6110182A (en) 1998-06-22 2000-08-29 Ohio Medical Instruments Company, Inc. Target socket
US6245052B1 (en) 1998-07-08 2001-06-12 Innerdyne, Inc. Methods, systems, and kits for implanting articles
US6063021A (en) 1998-07-31 2000-05-16 Pilling Weck Incorporated Stabilizer for surgery
US6053907A (en) 1998-08-13 2000-04-25 Endius Incorporated Surgical instruments with flexible drive shaft
US6296644B1 (en) 1998-08-26 2001-10-02 Jean Saurat Spinal instrumentation system with articulated modules
US6286179B1 (en) 1998-10-19 2001-09-11 Donny M. Byrne Apparatus and method for removing debris from the lens-cleaning nozzle of an endoscope
WO2000038574A1 (en) * 1998-12-23 2000-07-06 Nuvasive, Inc. Nerve surveillance cannulae systems
US5964698A (en) 1999-01-20 1999-10-12 Lone Star Medical Products, Inc. Sliding hook assembly for use with a surgical retractor stay apparatus and methods for use
US6159179A (en) 1999-03-12 2000-12-12 Simonson; Robert E. Cannula and sizing and insertion method
US6055456A (en) 1999-04-29 2000-04-25 Medtronic, Inc. Single and multi-polar implantable lead for sacral nerve electrical stimulation
US6626830B1 (en) 1999-05-04 2003-09-30 Cardiothoracic Systems, Inc. Methods and devices for improved tissue stabilization
EP1194074A4 (en) 1999-05-19 2002-09-11 Innerdyne Medical Inc SYSTEM AND METHOD TO ENABLE VASCULAR ACCESS
US7637905B2 (en) 2003-01-15 2009-12-29 Usgi Medical, Inc. Endoluminal tool deployment system
US6283966B1 (en) 1999-07-07 2001-09-04 Sulzer Spine-Tech Inc. Spinal surgery tools and positioning method
US6200322B1 (en) 1999-08-13 2001-03-13 Sdgi Holdings, Inc. Minimal exposure posterior spinal interbody instrumentation and technique
DE29916026U1 (de) 1999-09-11 1999-11-18 Aesculap Ag & Co Kg Haltevorrichtung für ein chirurgisches Instrument
JP4326134B2 (ja) 1999-10-20 2009-09-02 ウォーソー・オーソペディック・インコーポレーテッド 外科的手順を実行する方法及び装置
US6447446B1 (en) 1999-11-02 2002-09-10 Medtronic Xomed, Inc. Method and apparatus for cleaning an endoscope lens
US6354992B1 (en) 1999-11-08 2002-03-12 Daniel T. Kato Automated laparoscopic lens cleaner
US6637435B2 (en) 1999-12-07 2003-10-28 Cook Incorporated Percutaneous dilational device
US6648915B2 (en) 1999-12-23 2003-11-18 John A. Sazy Intervertebral cage and method of use
US6336914B1 (en) 2000-01-13 2002-01-08 Gillespie, Iii Richard D. Releasable interlock assembly having axial and rotational engagement
US6684886B1 (en) 2000-01-21 2004-02-03 Prospine, Inc. Intervertebral disc repair methods and apparatus
US6808505B2 (en) 2000-02-01 2004-10-26 Kadan Jeffrey S Diagnostic needle arthroscopy and lavage system
NL1014255C2 (nl) 2000-02-01 2001-08-02 Univ Medisch Centrum Utrecht Steunarm voor operatiedoeleinden.
US6575979B1 (en) 2000-02-16 2003-06-10 Axiamed, Inc. Method and apparatus for providing posterior or anterior trans-sacral access to spinal vertebrae
US20030191474A1 (en) 2000-02-16 2003-10-09 Cragg Andrew H. Apparatus for performing a discectomy through a trans-sacral axial bore within the vertebrae of the spine
AU2001238377A1 (en) 2000-02-18 2001-08-27 University Of Massachussets Devices and methods for warming and cleaning lenses of optical surgical instruments
US6383191B1 (en) 2000-03-15 2002-05-07 Sdgi Holdings, Inc. Laparoscopic instrument sleeve
US6589262B1 (en) 2000-03-31 2003-07-08 Medamicus, Inc. Locking catheter introducing system
DE10019321C2 (de) 2000-04-19 2002-03-14 Storz Karl Gmbh & Co Kg Flexible Spannvorrichtung ,insbesondere für medizinische Zwecke
DE10024728A1 (de) 2000-05-19 2001-11-22 Ami Gmbh Optikreinigungsvorrichtung für ein Endoskopiegerät
WO2002002016A1 (en) 2000-06-30 2002-01-10 Abbott Laboratories Surgical support clamp
US6579281B2 (en) 2000-10-11 2003-06-17 Popcab, Llc Instrument stabilizer for through-a-port surgery
CN2453957Y (zh) * 2000-10-11 2001-10-17 聂伟 一种椎骨扩张器
US6558407B1 (en) 2000-10-24 2003-05-06 Tyco Healthcare Group Lp Breast stabilizer with instrument guide
US6676597B2 (en) 2001-01-13 2004-01-13 Medtronic, Inc. Method and device for organ positioning
US6673023B2 (en) 2001-03-23 2004-01-06 Stryker Puerto Rico Limited Micro-invasive breast biopsy device
US7144393B2 (en) 2001-05-15 2006-12-05 Dipoto Gene P Structure for receiving surgical instruments
US6974412B2 (en) 2001-05-24 2005-12-13 Minnesota Scientific, Inc. Cam-wedge locking mechanism
IL143682A0 (en) 2001-06-11 2002-04-21 Shalman Michael Endoscope with cleaning optics
US7137949B2 (en) 2001-07-13 2006-11-21 United States Surgical Corporation Surgical instrument
WO2003026482A2 (en) 2001-09-25 2003-04-03 Nuvasive, Inc. System and methods for performing surgical procedures and assessments
US6887198B2 (en) 2001-10-05 2005-05-03 Burns P. Phillips Gooseneck surgical retractor positioner and method of its use
US20030083553A1 (en) 2001-10-26 2003-05-01 Minnesota Scientific, Inc. Apparatus for retaining otherwise hand-held retractors
US20030083555A1 (en) 2001-10-29 2003-05-01 Scott Hunt Segmented arm support system and method for stabilizing tissue
US7008431B2 (en) * 2001-10-30 2006-03-07 Depuy Spine, Inc. Configured and sized cannula
JP2003169809A (ja) 2001-12-05 2003-06-17 Pentax Corp 開創器のブレードおよび開創器
US7182731B2 (en) 2002-01-23 2007-02-27 Genesee Biomedical, Inc. Support arm for cardiac surgery
US6896675B2 (en) 2002-03-05 2005-05-24 Baylis Medical Company Inc. Intradiscal lesioning device
US6758809B2 (en) 2002-06-06 2004-07-06 Medtronic, Inc. Surgical tool for engagement of body tissue
US7582058B1 (en) 2002-06-26 2009-09-01 Nuvasive, Inc. Surgical access system and related methods
DK1393768T3 (da) 2002-08-24 2006-09-18 Smiths Group Plc Medico-kirurgiske instrumenter
US7074226B2 (en) * 2002-09-19 2006-07-11 Sdgi Holdings, Inc. Oval dilator and retractor set and method
US8137284B2 (en) 2002-10-08 2012-03-20 Nuvasive, Inc. Surgical access system and related methods
US6849064B2 (en) 2002-10-25 2005-02-01 James S. Hamada Minimal access lumbar diskectomy instrumentation and method
WO2004039235A2 (en) 2002-10-25 2004-05-13 Endius Incorporated Apparatus and methods for shielding body structures during surgery
EP1558157B1 (en) 2002-10-30 2012-11-21 Zimmer Spine, Inc. Spinal stabilization system insertion
US20040147928A1 (en) 2002-10-30 2004-07-29 Landry Michael E. Spinal stabilization system using flexible members
JP2006507841A (ja) 2002-11-14 2006-03-09 ダーマコン， インコーポレイテッド 機能的ｓｉＲＮＡおよび超機能的ｓｉＲＮＡ
US7636596B2 (en) 2002-12-20 2009-12-22 Medtronic, Inc. Organ access device and method
US7004971B2 (en) 2002-12-31 2006-02-28 Depuy Acromed, Inc. Annular nucleus pulposus replacement
US7691057B2 (en) 2003-01-16 2010-04-06 Nuvasive, Inc. Surgical access system and related methods
US7819801B2 (en) 2003-02-27 2010-10-26 Nuvasive, Inc. Surgical access system and related methods
US7641659B2 (en) 2003-03-13 2010-01-05 Zimmer Spine, Inc. Spinal access instrument
US20040199052A1 (en) 2003-04-01 2004-10-07 Scimed Life Systems, Inc. Endoscopic imaging system
US7141015B2 (en) 2003-05-09 2006-11-28 Bernard Joseph Ruane Expandable and pivotally adjustable surgical retractor
US7794456B2 (en) 2003-05-13 2010-09-14 Arthrocare Corporation Systems and methods for electrosurgical intervertebral disc replacement
EP1624790A4 (en) 2003-05-19 2008-05-21 Usgi Medical Inc ENDOLUMINAL TOOL FILLING SYSTEM
WO2004110247A2 (en) 2003-05-22 2004-12-23 Stephen Ritland Intermuscular guide for retractor insertion and method of use
US7097612B2 (en) 2003-07-29 2006-08-29 Endoscopic Technologies, Inc. Tissue positioner
US7771384B2 (en) 2003-08-20 2010-08-10 Biagio Ravo Trocar with integral irrigation and suction tube
US7811303B2 (en) 2003-08-26 2010-10-12 Medicine Lodge Inc Bodily tissue dilation systems and methods
WO2005030318A1 (en) * 2003-09-25 2005-04-07 Nuvasive, Inc. Surgical access system and related methods
US7905840B2 (en) 2003-10-17 2011-03-15 Nuvasive, Inc. Surgical access system and related methods
US8313430B1 (en) 2006-01-11 2012-11-20 Nuvasive, Inc. Surgical access system and related methods
ES2260557T3 (es) 2003-10-17 2006-11-01 Henke-Sass, Wolf Gmbh Endoscopio.
US7338495B2 (en) 2003-10-22 2008-03-04 Medtronic Xomed, Inc. Angled tissue cutting instruments having flexible inner tubular members of tube and sleeve construction
US7946981B1 (en) 2003-10-23 2011-05-24 Anthony Cubb Two-piece video laryngoscope
US7226413B2 (en) 2003-11-17 2007-06-05 Aeolin Llc Nerve root retractor and sucker
US7144368B2 (en) 2003-11-26 2006-12-05 Synthes Spine Company, Lp Guided retractor and methods of use
US20050137461A1 (en) 2003-12-18 2005-06-23 Depuy Spine, Inc. Telescoping blade assembly and instruments for adjusting an adjustable blade
US7108698B2 (en) 2004-01-13 2006-09-19 Zimmer Spine, Inc. Combined distractor and retractor instrument and methods
DE602005011575D1 (de) 2004-02-19 2009-01-22 Applied Med Resources Embolektomie-fangschleuse
US8784421B2 (en) 2004-03-03 2014-07-22 Boston Scientific Scimed, Inc. Apparatus and methods for removing vertebral bone and disc tissue
US7435219B2 (en) 2004-03-25 2008-10-14 Depuy Spine, Inc. Surgical retractor positioning device
US20060004398A1 (en) * 2004-07-02 2006-01-05 Binder Lawrence J Jr Sequential dilator system
US7434325B2 (en) 2004-07-26 2008-10-14 Warsaw Orthopedic, Inc. Systems and methods for determining optimal retractor length in minimally invasive procedures
US9387313B2 (en) 2004-08-03 2016-07-12 Interventional Spine, Inc. Telescopic percutaneous tissue dilation systems and related methods
US8460310B2 (en) 2004-08-04 2013-06-11 Leslie Stern Surgical base unit and retractor support mechanism
WO2006017886A1 (en) 2004-08-15 2006-02-23 Kevin Seex Distraction and retraction assemblies
US7479106B2 (en) 2004-09-30 2009-01-20 Boston Scientific Scimed, Inc. Automated control of irrigation and aspiration in a single-use endoscope
WO2006042241A2 (en) 2004-10-08 2006-04-20 Nuvasive, Inc. Surgical access system and related methods
US8585584B2 (en) 2004-10-11 2013-11-19 Nitesh Ratnakar Dual view endoscope
US6983930B1 (en) 2004-10-28 2006-01-10 Christopher Louis La Mendola Clamping device with flexible arm
US7594888B2 (en) 2004-10-29 2009-09-29 Depuy Spine, Inc. Expandable ports and methods for minimally invasive surgery
US20060195017A1 (en) * 2004-11-22 2006-08-31 Shluzas Alan E Expandable device for providing access to the spine
US8568305B2 (en) 2004-12-29 2013-10-29 Us Spine, Inc. Minimally-invasive portal system for performing lumbar decompression, instrumented fusion/stabilization, and the like
US8182422B2 (en) 2005-12-13 2012-05-22 Avantis Medical Systems, Inc. Endoscope having detachable imaging device and method of using
EP1834571A4 (en) 2005-01-07 2012-12-05 Olympus Medical Systems Corp INSERTION UNIT FOR ENDOSCOPE
WO2006073121A1 (ja) 2005-01-07 2006-07-13 Olympus Medical Systems Corp. 内視鏡用挿入部
US7785253B1 (en) 2005-01-31 2010-08-31 Nuvasive, Inc. Surgical access system and related methods
US8078266B2 (en) 2005-10-25 2011-12-13 Voyage Medical, Inc. Flow reduction hood systems
US9675235B2 (en) 2005-03-21 2017-06-13 Jonas V. Lieponis Multi-purpose surgical instrument with removable component
US20060217754A1 (en) * 2005-03-23 2006-09-28 Boehm Frank H Jr Expandable intervertebral disc dilating cannula
US8092464B2 (en) 2005-04-30 2012-01-10 Warsaw Orthopedic, Inc. Syringe devices and methods useful for delivering osteogenic material
EP1906810B1 (en) 2005-06-22 2016-04-27 Vycor Medical, Inc. Surgical access instruments for use with spinal or orthopedic surgery
US8740783B2 (en) 2005-07-20 2014-06-03 Nuvasive, Inc. System and methods for performing neurophysiologic assessments with pressure monitoring
WO2007016368A2 (en) 2005-07-28 2007-02-08 Blackstone Medical, Inc. Nerve protection system
DE602006019736D1 (de) 2005-07-29 2011-03-03 Vertos Medical Inc Perkutane gewebeexzisionsvorrichtungen
WO2007021772A2 (en) * 2005-08-09 2007-02-22 Trans1, Inc. Exchange system for axial spinal procedures
US20070055259A1 (en) 2005-08-17 2007-03-08 Norton Britt K Apparatus and methods for removal of intervertebral disc tissues
US7537565B2 (en) 2005-09-27 2009-05-26 Daniel Bass Surgical retractor with rotating blades
ES2348811T3 (es) 2005-10-05 2010-12-14 Orlando Da Rold Arbol hueco flexible.
US20070129634A1 (en) 2005-10-17 2007-06-07 Hickey Katherine M Biomedical positioning and stabilization system
US7927361B2 (en) 2005-11-29 2011-04-19 Medtronic Xomed, Inc. Method and apparatus for removing material from an intervertebral disc space, such as in performing a nucleotomy
US7758501B2 (en) 2006-01-04 2010-07-20 Depuy Spine, Inc. Surgical reactors and methods of minimally invasive surgery
US7985179B2 (en) 2006-01-23 2011-07-26 Pioneer Surgical Technology Retraction apparatus and method of use
US20070203396A1 (en) 2006-02-28 2007-08-30 Mccutcheon John G Endoscopic Tool
US20070225556A1 (en) 2006-03-23 2007-09-27 Ethicon Endo-Surgery, Inc. Disposable endoscope devices
US7794393B2 (en) 2006-04-13 2010-09-14 Larsen Dane M Resectoscopic device and method
US7955255B2 (en) 2006-04-20 2011-06-07 Boston Scientific Scimed, Inc. Imaging assembly with transparent distal cap
US7935053B2 (en) 2006-06-06 2011-05-03 Globus Medical, Inc Surgical Retractor System
US8992425B2 (en) 2006-06-06 2015-03-31 Globus Medical, Inc. Surgical retractor system
US20090018566A1 (en) 2006-06-30 2009-01-15 Artheromed, Inc. Atherectomy devices, systems, and methods
US20080033251A1 (en) 2006-06-30 2008-02-07 Ali Araghi Surgical retractor and method of use
US20080003325A1 (en) 2006-06-30 2008-01-03 Seaver Richard T Baffle for mold cooling systems
US7959564B2 (en) 2006-07-08 2011-06-14 Stephen Ritland Pedicle seeker and retractor, and methods of use
US7892174B2 (en) 2006-07-19 2011-02-22 Zimmer Spine, Inc. Surgical access system and method of using the same
JP5030507B2 (ja) 2006-08-30 2012-09-19 オリンパスメディカルシステムズ株式会社 内視鏡の先端フードとフード付き内視鏡
US20080081951A1 (en) 2006-09-29 2008-04-03 Depuy Spine, Inc. Inflatable retractor
WO2008041226A2 (en) 2006-10-03 2008-04-10 Virtual Ports Ltd A clip device, system and method for assisting surgical procedures
US20100286477A1 (en) 2009-05-08 2010-11-11 Ouyang Xiaolong Internal tissue visualization system comprising a rf-shielded visualization sensor module
US7922658B2 (en) 2006-11-09 2011-04-12 Ebi, Llc Surgical retractor device and related methods
ES2279733B1 (es) 2006-11-27 2008-08-16 Rudolf Morgenstern Lopez Dispositivo para eliminacion de tejido en operaciones endoscopicas.
US7803159B2 (en) 2006-11-29 2010-09-28 Mi4Spine, Llc Disc space preparation device for spinal surgery
US20080188714A1 (en) 2007-02-07 2008-08-07 Boston Scientific Scimed, Inc. Electromechanical in-situ cleaning of optical elements
US8425602B2 (en) 2007-02-09 2013-04-23 Alphatec Spine, Inc. Curvilinear spinal access method and device
US8535220B2 (en) 2007-02-16 2013-09-17 Robert MONDSCHEIN Laparoscope cleaning system
US7811230B2 (en) 2007-03-02 2010-10-12 United Orthopedic Corporation Expansion mechanism for minimally invasive lumbar operation
US8202216B2 (en) 2007-03-08 2012-06-19 Warsaw Orthopedic, Inc. Tissue retractor
US20100256446A1 (en) 2007-05-11 2010-10-07 Board Of Regents, The University Of Texas System Medical scope carrier and scope as system and method
US9380966B2 (en) 2007-06-22 2016-07-05 Vioptix, Inc. Tissue retractor oximeter
US8372131B2 (en) 2007-07-16 2013-02-12 Power Ten , LLC Surgical site access system and deployment device for same
AU2008293549A1 (en) 2007-08-27 2009-03-05 Spine View, Inc. Balloon cannula system for accessing and visualizing spine and related methods
WO2009033207A1 (en) 2007-09-12 2009-03-19 Columna Pty Ltd Equipment for, and a method of, removing tissue from a site in a patient's body
US20090287061A1 (en) 2007-10-01 2009-11-19 Gft Technologies Surgical access device for minimally invasive surgery
KR20100080529A (ko) 2007-10-05 2010-07-08 신세스 게엠바하 팽창 시스템 및 이를 이용한 방법
US8343079B2 (en) 2007-10-18 2013-01-01 Innovative Surgical Solutions, Llc Neural monitoring sensor
US20090105543A1 (en) 2007-10-19 2009-04-23 Miller Eric C Endoscope Lens Cleaner
US8096944B2 (en) 2007-10-26 2012-01-17 Harrel Stephen K Air shield for videoscope imagers
US8043381B2 (en) 2007-10-29 2011-10-25 Zimmer Spine, Inc. Minimally invasive interbody device and method
US8236006B2 (en) 2008-01-17 2012-08-07 Life Spine, Inc. One step entry pedicular preparation device and disc access system
JP2009189637A (ja) 2008-02-15 2009-08-27 Fujinon Corp 内視鏡の流体供給装置
US20090240111A1 (en) 2008-03-18 2009-09-24 Joshua Kessler Light Source and Lens Cleaner for Laparoscopic Surgery
WO2009126953A2 (en) 2008-04-11 2009-10-15 Physcient, Inc. Methods and devices to decrease tissue trauma during surgery
KR101464983B1 (ko) 2008-05-01 2014-11-25 스파인셀 프러프라이어테리 리미티드 조직 보형물의 형성 및 삽입기구 및 그의 시스템 및 방법
US20100004651A1 (en) 2008-06-13 2010-01-07 The University Of Toledo Transpedicular access to the intervertebral disc space for discectomy, end plate preparation, and interbody fusion
JP5166133B2 (ja) 2008-06-23 2013-03-21 富士フイルム株式会社 内視鏡
US8932207B2 (en) 2008-07-10 2015-01-13 Covidien Lp Integrated multi-functional endoscopic tool
US20100022824A1 (en) 2008-07-22 2010-01-28 Cybulski James S Tissue modification devices and methods of using the same
JP5124376B2 (ja) 2008-07-22 2013-01-23 富士フイルム株式会社 内視鏡の光学系装置およびこれを備えた内視鏡
DE102008034722A1 (de) 2008-07-25 2010-02-04 Karl Storz Gmbh & Co. Kg Wundspreizer mit verstellbaren Valven
CN102164550A (zh) 2008-07-25 2011-08-24 脊柱诊察公司 用于基于缆索的清除器的系统和方法
CN107260231A (zh) 2008-10-20 2017-10-20 脊柱诊察公司 用于进入和察看脊柱的牵开器套管系统
US20100114147A1 (en) 2008-10-30 2010-05-06 The University Of Toledo Directional soft tissue dilator and docking pin with integrated light source for optimization of retractor placement in minimally invasive spine surgery
CN102300512B (zh) 2008-12-01 2016-01-20 马佐尔机器人有限公司 机器人引导的倾斜脊柱稳定化
US9655639B2 (en) 2008-12-16 2017-05-23 Nico Corporation Tissue removal device for use with imaging devices in neurosurgical and spinal surgery applications
US8470043B2 (en) 2008-12-23 2013-06-25 Benvenue Medical, Inc. Tissue removal tools and methods of use
US8468637B2 (en) 2009-02-06 2013-06-25 Endoclear Llc Mechanically-actuated endotracheal tube cleaning device
US8062218B2 (en) 2009-02-27 2011-11-22 Warsaw Orthopedic, Inc. Surgical access instrument
US9848904B2 (en) 2009-03-06 2017-12-26 Procept Biorobotics Corporation Tissue resection and treatment with shedding pulses
DE102009015391A1 (de) 2009-03-20 2010-09-23 Aesculap Ag Chirurgischer Haltearm und chirurgische Haltevorrichtung
US8801739B2 (en) 2009-04-17 2014-08-12 Spine View, Inc. Devices and methods for arched roof cutters
US20100280325A1 (en) 2009-04-30 2010-11-04 Tamer Ibrahim Retractors and surgical systems including the same
US20100284580A1 (en) 2009-05-07 2010-11-11 Ouyang Xiaolong Tissue visualization systems and methods for using the same
KR101767274B1 (ko) 2009-05-20 2017-08-10 신세스 게엠바하 환자-장착 견인 장치
US9101268B2 (en) 2009-06-18 2015-08-11 Endochoice Innovation Center Ltd. Multi-camera endoscope
US8926502B2 (en) 2011-03-07 2015-01-06 Endochoice, Inc. Multi camera endoscope having a side service channel
US8721536B2 (en) 2009-07-28 2014-05-13 Trinity Orthopedics, Llc Arcuate surgical guidance system and methods
US8876712B2 (en) 2009-07-29 2014-11-04 Edwards Lifesciences Corporation Intracardiac sheath stabilizer
US8152720B2 (en) 2009-08-05 2012-04-10 Thomas Stuart Loftus Retracto component system and method of using same
WO2011022787A1 (en) 2009-08-31 2011-03-03 Kevin Seex Retractor blade including a flexible member for anchorage engagement
GB2474309B (en) 2009-10-12 2011-09-07 Endoguard Ltd Flow guide for an endoscope
GB2481727B (en) 2009-10-12 2012-05-09 Endoguard Ltd Flow guide for an endoscope
US9801732B2 (en) 2009-10-30 2017-10-31 Spinefrontier, Inc System and method for an intervertebral implant assembly
US9050146B2 (en) 2009-11-10 2015-06-09 Nuvasive, Inc. Method and apparatus for performing spinal surgery
US8795162B2 (en) 2009-11-10 2014-08-05 Invuity, Inc. Illuminated suction apparatus
WO2011060192A1 (en) 2009-11-13 2011-05-19 Interlace Medical, Inc. Access system with removable outflow channel
WO2011069036A1 (en) 2009-12-03 2011-06-09 Thompson Surgical Instruments, Inc. Posterior lumbar retractor system
US8435174B2 (en) 2009-12-11 2013-05-07 Ethicon Endo-Surgery, Inc. Methods and devices for accessing a body cavity
US8460186B2 (en) 2009-12-11 2013-06-11 Ethicon Endo-Surgery, Inc. Methods and devices for providing access through tissue to a surgical site
EP2512577B1 (en) 2009-12-16 2018-03-07 Boston Scientific Scimed, Inc. Arrangements for effecting an endoluminal anatomical structure
US9078562B2 (en) 2010-01-11 2015-07-14 Minimally Invasive Devices, Inc. Systems and methods for optimizing and maintaining visualization of a surgical field during the use of surgical scopes
US8636655B1 (en) 2010-01-19 2014-01-28 Ronald Childs Tissue retraction system and related methods
US8353826B2 (en) 2010-03-11 2013-01-15 Globus Medical, Inc. Tissue retractor and method of use
US8460180B1 (en) 2010-04-16 2013-06-11 Hector Zarate Endoscopic lens cleaner
JP2011245004A (ja) 2010-05-26 2011-12-08 Olympus Corp 内視鏡装置
EP3187119B1 (en) 2010-06-14 2020-07-15 Maquet Cardiovascular LLC Surgical organ stabilizer instruments
US8617062B2 (en) 2010-07-08 2013-12-31 Warsaw Orthopedic, Inc. Over dilation
US9486296B2 (en) 2010-07-08 2016-11-08 Warsaw Orthopedic, Inc. Surgical assembly with flexible arm
JP5968886B2 (ja) 2010-08-04 2016-08-10 ミニマリー インべーシブ デバイシーズ， インコーポレイテッド 手術用顕微鏡を使用する間に術野の可視化を最適化および維持するためのシステムおよび方法
DE112011102801B4 (de) 2010-08-23 2024-05-02 Nuvasive, Inc. Chirurgisches Zugangssystem und zugehörige Verfahren
US8845734B2 (en) 2010-09-03 2014-09-30 Globus Medical, Inc. Expandable fusion device and method of installation thereof
JP5685406B2 (ja) 2010-09-06 2015-03-18 富士フイルム株式会社 画像撮像装置およびその作動方法
EP2618743B1 (en) 2010-09-20 2018-03-07 Synthes GmbH Spinal access retractor
US10080486B2 (en) 2010-09-20 2018-09-25 Endochoice Innovation Center Ltd. Multi-camera endoscope having fluid channels
US8870756B2 (en) 2010-10-08 2014-10-28 ERBE-USA, Inc. Hybrid apparatus for fluid supply for endoscopic irrigation and lens cleaning
US9795771B2 (en) 2010-10-19 2017-10-24 Warsaw Orthopedic, Inc. Expandable spinal access instruments and methods of use
US9763567B2 (en) 2010-10-20 2017-09-19 Covidien Lp Endoscope wiper blade cleaner
US8690764B2 (en) 2010-10-20 2014-04-08 Covidien Lp Endoscope cleaner
US9320535B2 (en) 2010-11-15 2016-04-26 Spine View, Inc. Tissue removal system with retention mechanism
WO2012075487A2 (en) 2010-12-03 2012-06-07 Minimally Invasive Devices, Llc Devices, systems, and methods for performing endoscopic surgical procedures
EP3420886B8 (en) 2010-12-09 2020-07-15 EndoChoice, Inc. Flexible electronic circuit board multi-camera endoscope
WO2012088167A2 (en) 2010-12-20 2012-06-28 Spine View, Inc. Articulating tissue removal systems and methods
KR102022106B1 (ko) 2011-02-16 2019-09-17 더 제너럴 하스피탈 코포레이션 내시경용 광 결합기
US8702600B2 (en) 2011-03-08 2014-04-22 Pioneer Surgical Technology, Inc. Apparatus and method for enlarging an incision
US10357239B2 (en) 2011-03-08 2019-07-23 Pioneer Surgical Technology, Inc. Apparatus and method for enlarging an incision
US8394129B2 (en) 2011-03-10 2013-03-12 Interventional Spine, Inc. Method and apparatus for minimally invasive insertion of intervertebral implants
US8518087B2 (en) 2011-03-10 2013-08-27 Interventional Spine, Inc. Method and apparatus for minimally invasive insertion of intervertebral implants
JP5318142B2 (ja) 2011-03-31 2013-10-16 富士フイルム株式会社 電子内視鏡
CN102727309B (zh) 2011-04-11 2014-11-26 上海优益基医疗器械有限公司 结合内窥镜影像的外科手术导航系统
US8974381B1 (en) 2011-04-26 2015-03-10 Nuvasive, Inc. Cervical retractor
US9307972B2 (en) 2011-05-10 2016-04-12 Nuvasive, Inc. Method and apparatus for performing spinal fusion surgery
US8834507B2 (en) 2011-05-17 2014-09-16 Warsaw Orthopedic, Inc. Dilation instruments and methods
US9603510B2 (en) 2011-05-17 2017-03-28 Mario Ammirati Method and apparatus for delivering an endoscope via microsurgical instruments while performing microscopic surgery
US20120298820A1 (en) 2011-05-25 2012-11-29 Spiros Manolidis Surgical tool holder
US8556809B2 (en) 2011-06-10 2013-10-15 Raghavendra Rao Vijayanagar Surgical tissue retractor
US20140128682A1 (en) 2011-07-10 2014-05-08 Nlt Spine Ltd. Retractor tool
EP2734169B1 (en) 2011-07-22 2016-12-28 Frederick Sklar Surgical head holder and surgical accessories for use with same
US20130103067A1 (en) 2011-07-28 2013-04-25 Myra I. L. Fabro Discectomy devices and related methods
US9232935B2 (en) 2011-08-01 2016-01-12 Misder, Llc Handle for actuating a device
JP5788261B2 (ja) 2011-08-03 2015-09-30 オリンパス株式会社 内視鏡
WO2013028571A1 (en) 2011-08-19 2013-02-28 Lanx, Inc. Surgical retractor system and methods of use
EP3170457A3 (en) 2011-08-31 2017-11-01 Lanx, Inc. Lateral retractor system and methods of use
US9113853B1 (en) 2011-08-31 2015-08-25 Nuvasive, Inc. Systems and methods for performing spine surgery
JP5806407B2 (ja) 2011-09-01 2015-11-10 コヴィディエン リミテッド パートナーシップ 螺旋駆動軸を有するカテーテルおよび製造方法
US9247997B2 (en) 2011-09-30 2016-02-02 Ethicon Endo-Surgery, Inc. Patient-referenced surgical support frame
US9237933B2 (en) 2011-10-21 2016-01-19 Specialty Surgical Instrumentation Inc. Universal arm system
US20130103103A1 (en) 2011-10-24 2013-04-25 Warsaw Orthopedic, Inc Surgical system methods for spinal access
US9028522B1 (en) 2011-11-15 2015-05-12 Seaspine, Inc. Tissue dilator and retractor system and method of use
US8795167B2 (en) 2011-11-15 2014-08-05 Baxano Surgical, Inc. Spinal therapy lateral approach access instruments
US20130150674A1 (en) 2011-12-07 2013-06-13 Covidien Lp Thoracic scope port sponge cleaner
US20130150670A1 (en) 2011-12-07 2013-06-13 Covidien Lp Thoracic scope port cleaner
US9668643B2 (en) 2011-12-29 2017-06-06 Cook Medical Technologies Llc Space-optimized visualization catheter with oblong shape
US8936605B2 (en) 2011-12-30 2015-01-20 Blackstone Medical, Inc. Direct vertebral rotation tool and method of using same
US8585726B2 (en) 2012-01-31 2013-11-19 Globus Medical, Inc. Surgical disc removal tool
US20140074170A1 (en) 2012-02-10 2014-03-13 Herbert H. Mertens Delivery Device With Interior Dilation Element Channel
US8986199B2 (en) 2012-02-17 2015-03-24 Ethicon Endo-Surgery, Inc. Apparatus and methods for cleaning the lens of an endoscope
US9271711B2 (en) 2012-03-30 2016-03-01 DePuy Synthes Products, Inc. Methods and devices for tissue retraction
US9265490B2 (en) 2012-04-16 2016-02-23 DePuy Synthes Products, Inc. Detachable dilator blade
US9498297B2 (en) 2012-04-18 2016-11-22 United Arab Emirates University Manipulator for surgical tools
US20130289399A1 (en) 2012-04-27 2013-10-31 Vertiflex, Inc. Decompression systems and methods of using the same
US20150342621A1 (en) 2014-05-29 2015-12-03 Avery M. Jackson, III Illuminated endoscopic pedicle probe with dynamic real time monitoring for proximity to nerves
EP2854716A1 (en) 2012-05-28 2015-04-08 NLT Spine Ltd. Surgical impaling member
TWI481382B (zh) 2012-08-31 2015-04-21 Univ Nat Cheng Kung 經皮穿刺輔助裝置及經皮導引組件
ES2544994T3 (es) 2012-09-06 2015-09-07 Medacta International S.A. Dispositivo quirúrgico para fusión espinal mínimamente invasiva y sistema quirúrgico que comprende el mismo
JP2015535702A (ja) 2012-09-19 2015-12-17 ナンヤン テクノロジカル ユニヴァーシティＮａｎｙａｎｇ Ｔｅｃｈｎｏｌｏｇｉｃａｌ Ｕｎｉｖｅｒｓｉｔｙ フレキシブルマスター‐スレーブロボット内視鏡システム
US9480855B2 (en) 2012-09-26 2016-11-01 DePuy Synthes Products, Inc. NIR/red light for lateral neuroprotection
JP5583873B1 (ja) 2012-09-28 2014-09-03 オリンパスメディカルシステムズ株式会社 洗浄機構を有する内視鏡装置
US20140142584A1 (en) 2012-11-16 2014-05-22 Spinal Generations, Llc Multichannel cannula and methods for using same
US9198674B2 (en) 2012-12-14 2015-12-01 Warsaw Orthopedic, Inc. Surgical instrument and method
US9456846B2 (en) 2012-12-19 2016-10-04 Life Spine, Inc. Directional sequential dilation system with neuro monitoring
CN105073023A (zh) 2012-12-20 2015-11-18 脊柱诊察公司 椎间盘切除装置和方法
US20140215736A1 (en) 2013-02-05 2014-08-07 Next Wave Surgical LLC Minimally invasive apparatus and method for cleaning endoscope lenses
US9277928B2 (en) 2013-03-11 2016-03-08 Interventional Spine, Inc. Method and apparatus for minimally invasive insertion of intervertebral implants
US9408596B2 (en) 2013-03-11 2016-08-09 Spinal Elements, Inc. Method of using a surgical tissue retractor
US20140257489A1 (en) 2013-03-11 2014-09-11 Interventional Spine, Inc. Method and apparatus for minimally invasive insertion of intervertebral implants
US9993353B2 (en) 2013-03-14 2018-06-12 DePuy Synthes Products, Inc. Method and apparatus for minimally invasive insertion of intervertebral implants
WO2014140909A2 (en) 2013-03-15 2014-09-18 Pro Med Instruments Gmbh Flexible arm and method of using
US9603610B2 (en) 2013-03-15 2017-03-28 DePuy Synthes Products, Inc. Tools and methods for tissue removal
US9700378B2 (en) 2013-04-26 2017-07-11 Medtronic Xomed, Inc. Endoscope lens cleaning device
US20170065287A1 (en) 2013-04-28 2017-03-09 Octavio Cesar Silva Infrared Endoscopic Probe
US20160113484A1 (en) 2013-05-16 2016-04-28 Advanced Healthcare Co., Ltd. Trocar, port, and surgery assistance system
US20140357945A1 (en) 2013-05-30 2014-12-04 Edward Duckworth Laparoscopic Trocar with Ventriculoperitoneal Shunt Entry Port
US10709434B2 (en) 2013-07-09 2020-07-14 Globus Medical, Inc. Surgical access systems and methods
US20160174814A1 (en) 2013-08-31 2016-06-23 Morena Medical Applications Ltd. Endoscope with shared working channel
EP3053996A4 (en) 2013-09-30 2017-05-31 Nagase Medicals Co., Ltd. Endoscope lens cleaner
DE202013105202U1 (de) 2013-11-18 2013-11-26 Fehling Instruments Gmbh & Co. Kg Spreizer, insbesondere für die Schädelchirurgie
US20160095505A1 (en) 2013-11-22 2016-04-07 Massachusetts Institute Of Technology Instruments for minimally invasive surgical procedures
US9370295B2 (en) 2014-01-13 2016-06-21 Trice Medical, Inc. Fully integrated, disposable tissue visualization device
DE102014205312A1 (de) 2014-03-21 2015-09-24 Olympus Winter & Ibe Gmbh Endoskopobjektiv, Verfahren zum Reinigen eines Endoskopobjektivs und zum Reparieren eines Endoskops
US9414828B2 (en) 2014-05-01 2016-08-16 Blackstone Medical, Inc. Integrated retractor-distractor system for use with modular bone screws
EP3685734B1 (en) 2014-05-22 2022-03-09 Invuity, Inc. Medical device featuring cladded waveguide
US9980737B2 (en) 2014-08-04 2018-05-29 Medos International Sarl Flexible transport auger
GB2543468B (en) 2014-08-13 2021-11-03 Nuvasive Inc Minimally disruptive retractor and associated methods for spinal surgery
US10111712B2 (en) 2014-09-09 2018-10-30 Medos International Sarl Proximal-end securement of a minimally invasive working channel
US9924979B2 (en) 2014-09-09 2018-03-27 Medos International Sarl Proximal-end securement of a minimally invasive working channel
US10426454B2 (en) 2014-10-21 2019-10-01 Globus Medical, Inc. Orthopedic tools for implantation
US10080488B2 (en) 2014-12-12 2018-09-25 Medix3d LLC Cleaning device for cleaning a scope, laparoscope or microscope used in surgery or other medical procedures and a method of using the device during surgical or other medical procedures
JP6750152B2 (ja) 2015-01-09 2020-09-02 東レ・メディカル株式会社 内視鏡レンズ用清拭デバイス及びこの清拭デバイスを備えた内視鏡
DE102015100932A1 (de) 2015-01-22 2016-07-28 Aesculap Ag Stent-Retraktor/Distraktor
WO2016125013A2 (en) 2015-02-05 2016-08-11 Pro Med Instruments Gmbh System and method for invasive and non-invasive head fixation
KR101556881B1 (ko) 2015-02-10 2015-10-01 강윤식 내시경
WO2016131077A1 (en) 2015-02-16 2016-08-25 Eftekhar Behzad Surgical rectractor blade with distal end formation for engaging anchor pin
US10786264B2 (en) 2015-03-31 2020-09-29 Medos International Sarl Percutaneous disc clearing device
WO2016168673A1 (en) 2015-04-15 2016-10-20 Trustees Of Boston University Retractable endoscopic suction tube
EP3302678A4 (en) 2015-05-27 2019-02-20 University of Maryland, Baltimore DEVICE AND METHOD FOR PLACING A DEVICE ON ANY WALL OF A BODY LUMEN
US10548467B2 (en) 2015-06-02 2020-02-04 GI Scientific, LLC Conductive optical element
WO2017006684A1 (ja) 2015-07-07 2017-01-12 株式会社カネカ 内視鏡用レンズ清掃具
KR20180041140A (ko) 2015-07-21 2018-04-23 지아이 사이언티픽, 엘엘씨 각도 조정성 배출 포털을 갖는 내시경 부속품
US10709324B2 (en) 2015-07-31 2020-07-14 Purdue Research Foundation Systems and methods for performing a surgical procedure
EP3334322A1 (en) 2015-08-11 2018-06-20 Trice Medical, Inc. Fully integrated, disposable tissue visualization device
US10987129B2 (en) 2015-09-04 2021-04-27 Medos International Sarl Multi-shield spinal access system
US20190246878A1 (en) 2015-11-13 2019-08-15 Daryl BODNER Endoscope
US10299838B2 (en) 2016-02-05 2019-05-28 Medos International Sarl Method and instruments for interbody fusion and posterior fixation through a single incision

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN106236187A (zh) * 2016-08-31 2016-12-21 蒋毅 椎间孔的工作管道及修复装置
CN109982625A (zh) * 2016-11-29 2019-07-05 奥林巴斯株式会社 内窥镜系统
CN110547795A (zh) * 2018-05-30 2019-12-10 张霞玲 一种脊柱外科手术用脊椎探针
CN112656510A (zh) * 2020-12-21 2021-04-16 山东大学齐鲁医院 一种基于肌电信号的脊柱手术机器人穿刺预警方法及系统

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