US20160374539A1 - Atraumatic Arthroscopic Instrument Sheath - Google Patents
Atraumatic Arthroscopic Instrument Sheath Download PDFInfo
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- US20160374539A1 US20160374539A1 US15/195,825 US201615195825A US2016374539A1 US 20160374539 A1 US20160374539 A1 US 20160374539A1 US 201615195825 A US201615195825 A US 201615195825A US 2016374539 A1 US2016374539 A1 US 2016374539A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
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- A—HUMAN NECESSITIES
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- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00064—Constructional details of the endoscope body
- A61B1/00066—Proximal part of endoscope body, e.g. handles
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- A61B1/00131—Accessories for endoscopes
- A61B1/00135—Oversleeves mounted on the endoscope prior to insertion
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- A61B1/00147—Holding or positioning arrangements
- A61B1/00154—Holding or positioning arrangements using guiding arrangements for insertion
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- A—HUMAN NECESSITIES
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- A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
- A61B1/015—Control of fluid supply or evacuation
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- A61B1/313—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes
- A61B1/317—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes for bones or joints, e.g. osteoscopes, arthroscopes
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- A—HUMAN NECESSITIES
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- A—HUMAN NECESSITIES
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
- A61B17/1675—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the knee
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- A61B17/3421—Cannulas
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- A—HUMAN NECESSITIES
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- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/84—Drainage tubes; Aspiration tips
- A61M1/85—Drainage tubes; Aspiration tips with gas or fluid supply means, e.g. for supplying rinsing fluids or anticoagulants
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/06—Body-piercing guide needles or the like
- A61M25/0662—Guide tubes
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- A—HUMAN NECESSITIES
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- A61B1/00112—Connection or coupling means
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- A—HUMAN NECESSITIES
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- A61B1/00131—Accessories for endoscopes
- A61B1/0014—Fastening element for attaching accessories to the outside of an endoscope, e.g. clips, clamps or bands
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- A—HUMAN NECESSITIES
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/00336—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means with a protective sleeve, e.g. retractable or slidable
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
- A61B2017/3445—Cannulas used as instrument channel for multiple instruments
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B2017/3454—Details of tips
- A61B2017/3456—Details of tips blunt
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
- A61B2017/3482—Means for supporting the trocar against the body or retaining the trocar inside the body inside
- A61B2017/349—Trocar with thread on outside
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2217/00—General characteristics of surgical instruments
- A61B2217/002—Auxiliary appliance
- A61B2217/005—Auxiliary appliance with suction drainage system
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2217/00—General characteristics of surgical instruments
- A61B2217/002—Auxiliary appliance
- A61B2217/007—Auxiliary appliance with irrigation system
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Abstract
A removable, resilient atraumatic sheath for arthroscopic instruments. The sheath covers sharp edges on the arthroscopic instrument, particularly the distal tip of the rigid cannula, and thereby protects tissue and objects near a surgical site from accidental trauma. The sheath may be provided in the form of an inflow/outflow sheath that allows a surgeon to irrigate and drain a surgical field without the use of a separate irrigation instrument. The distal tip of the sheath may comprise a dissimilar material of a higher modulus of elasticity than the material comprising the remainder of the tube. The sheath is provided with a cylindrical grip on the proximal end to resiliently squeeze the proximal end of the arthroscopic instrument. A level is provided to move the grip radially outwardly to release the grip from the arthroscopic instrument.
Description
- This application is a continuation of U.S. patent application Ser. No. 14/475,378, filed Sep. 2, 2014, now U.S. Pat. No. 9,375,207, which is a continuation of U.S. patent application Ser. No. 13/225,908, filed Sep. 6, 2011, now U.S. Pat. No. 8,821,387, which is a continuation of Ser. No. 12/251,351, filed Oct. 14, 2008, now U.S. Pat. No. 8,012,083, which is a continuation of U.S. patent application Ser. No. 11/016,274, filed Dec. 17, 2004, now U.S. Pat. No. 7,435,214, which in turn is a continuation-in-part of U.S. patent application Ser. No. 10/769,629, filed Jan. 29, 2004, now U.S. Pat. No. 7,413,542.
- The inventions described below relate to the field of arthroscopic surgical instruments.
- Arthroscopic surgery involves using optical instruments, such as an arthroscope, to visualize an operating field inside or near a joint of a patient. The same instrument or other instruments may be used to perform a surgical procedure in the operating field. Common instruments used in addition to the arthroscope include a trimming instrument for cutting tissue and an irrigation instrument for irrigating the surgical field. Each of the instruments requires its own incision to be introduced into the surgical field; thus, many surgeons prefer to use only a trimming instrument and an arthroscope during arthroscopic surgical procedures.
- Arthroscopes are fragile in relation to the forces applied during arthroscopic surgery, so a rigid cannula is placed over the arthroscope to reinforce it. The distal end of the rigid cannula is pointed, usually sharp, and so the rigid cannula can scratch or gouge soft tissue within the operating field. The rigid cannula can also become stuck between bones or cartilage during a procedure. A rigid cannula can also damage metal prosthetics used to replace joints, resulting in a shortening of the useful life of the prosthetic and forcing the patient to undergo additional, painful surgeries to correct the problem.
- An additional problem associated with arthroscopic surgery is maintaining a clear surgical field during surgery. Blood and debris can cloud the field, impairing a surgeon's ability to visualize tissue. One method of solving this problem is to use the irrigation instrument to clear the surgical field with saline; however, many surgeons strongly prefer to avoid the additional trauma caused by inserting a third instrument. These surgeons will perform arthroscopic surgeries despite problems with visualizing the surgical field. Thus, devices and methods are needed both to maintain a clear surgical field and reduce accidental injury to the patient while only using two instruments.
- The devices and methods shown below provide for a soft plastic, disposable atraumatic sheath that slides over the rigid cannula of an arthroscope. The distal end of the atraumatic sheath extends slightly past the distal end of the rigid cannula, thereby providing a soft, blunt cushion over the distal end of the rigid cannula. The atraumatic sheath thereby protects any surrounding tissue or objects from accidental injury or damage while the arthroscope is manipulated inside the operating field.
- The atraumatic sheath may also be provided as an inflow/outflow sheath that allows a surgeon to drain fluids from or introduce fluids into the surgical field, thereby keeping the surgical field clear. The inflow/outflow sheath is a multi-lumen tube into which the arthroscope is inserted. The proximal portion of the sheath is provided with fluid ports, a manifold and other means of controlling the flow of fluid inside the sheath. The distal portion of the inflow/outflow sheath is provided with a plurality of holes. Each hole communicates with one or more of the lumens inside the tube, thereby allowing fluid to flow between the surgical field and sources or sinks located outside the patient. The inflow/outflow sheath thereby allows the surgeon to maintain a clear surgical field and protect the patient from accidental injury while eliminating the need for a third irrigation instrument.
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FIG. 1 shows a method of performing arthroscopic surgery on a patient. -
FIG. 2 shows an atraumatic sheath for use with arthroscopic instruments. -
FIG. 2a shows an atraumatic sheath having two tabs. -
FIG. 3 shows an atraumatic sheath for use with arthroscopic instruments and an arthroscope disposed inside the atraumatic sheath. -
FIG. 4 shows an atraumatic sheath for use with arthroscopic instruments, an arthroscope disposed inside the atraumatic sheath and an irrigation tube disposed on the sheath. -
FIG. 5 shows a cross section of the atraumatic sheath shown inFIG. 2 and an arthroscopic instrument disposed inside the atraumatic sheath. -
FIG. 6 shows an inflow/outflow atraumatic sheath for use with arthroscopic instruments. -
FIG. 7 shows an inflow/outflow atraumatic sheath for use with arthroscopic instruments and an arthroscope disposed inside the atraumatic sheath. -
FIG. 8 shows a cross section of the distal portion of the inflow/outflow atraumatic sheath ofFIG. 7 . -
FIG. 9 shows a cross section of the distal portion of an inflow/outflow atraumatic sheath. -
FIG. 10 shows a cross section of the distal portion of an inflow/outflow atraumatic sheath. -
FIG. 11 shows a cross section of the distal portion of an inflow/outflow atraumatic sheath. -
FIG. 12 shows a cross section of the distal portion of an inflow/outflow atraumatic sheath. -
FIG. 13 shows a cross section of the distal portion of an inflow/outflow atraumatic sheath. -
FIG. 14 shows a cross section of the distal portion of an inflow/outflow atraumatic sheath. -
FIG. 15 shows a cross section of the distal portion of an inflow/outflow atraumatic sheath. -
FIG. 16 shows a cross section of the distal portion of an inflow/outflow atraumatic sheath. -
FIG. 17 shows an inflow/outflow atraumatic sheath for use with arthroscopic instruments. -
FIG. 18 shows a cross section of the distal portion of the inflow/outflow sheath shown inFIG. 17 . -
FIG. 19 shows an inflow/outflow sheath having a distal portion that has an inner diameter that closely conforms to the outer diameter of the distal portion of an arthroscope. -
FIG. 20 shows an atraumatic sheath and an elastic grip disposed on the proximal portion of the sheath. -
FIG. 21 shows a cross section of an atraumatic sheath disposed over an arthroscope and an elastic grip disposed on the proximal portion of the sheath. -
FIG. 22 shows a cross section of an atraumatic sheath disposed over an arthroscope, an elastic grip and levers disposed inside the grip. -
FIG. 23 shows the distal end of the grip. -
FIG. 24 shows the distal end of the grip and levers extending distally from the openings in the grip. -
FIG. 25 shows the distal portion of an atraumatic sheath and an arthroscope extending distally of the distal end of the sheath. -
FIG. 26 shows the distal portion of an atraumatic sheath and an arthroscope extending distally of the distal end of the sheath. -
FIG. 1 shows a method of performing arthroscopic surgery on a patient by using anarthroscopic instrument 2 sheathed in anatraumatic introducer sheath 3. An arthroscopic instrument may be an arthroscope, endoscope, awl, pick, shaver, etc. InFIG. 1 , thearthroscopic instrument 2 shown is an arthroscope. (The various parts of the arthroscope are shown in phantom to indicate their positions inside the sheath.) Various anatomical landmarks in the patient's knee 4 are shown for reference, including thefemur 5, patella 6, posterior cruciate ligament 7, anterior cruciate ligament 8, meniscus 9,tibia 10 andfibula 11. During surgery, the surgeon introduces thearthroscope 2 into the knee via afirst incision 12 in order to visualize the surgical field. A trimminginstrument 13 is introduced through asecond incision 14 to remove or trim tissue that the surgeon determines should be removed or trimmed. Optionally, an irrigatinginstrument 15 may be introduced through athird incision 16 in order to irrigate the surgical field and thereby maintain a clear view. As provided below, the irrigating instrument may be replaced by a combined arthroscope and inflow/outflow atraumatic sheath, thus reducing the number on incisions required to perform the surgery. - The
arthroscope 2 is anoptical instrument 17 surrounded by arigid cannula 18 having a distal edge that typically is cut at an angle. To protect the patient from unintended injury or trauma during the procedure, the arthroscope has been inserted into a resilient, outer introducer sheath oratraumatic sheath 3 that extends over the rigid cannula. Thedistal tip 19 of the atraumatic sheath extends distally just past the distal end of the arthroscope and rigid cannula to further protect the patient. -
FIGS. 2 through 4 illustrate theatraumatic sheath 3. The atraumatic sheath is a tube of a resilient material, such as a soft plastic or rubber. The inner diameter of the atraumatic sheath is sized and dimensioned to closely fit over the outer diameter of an arthroscopic instrument. Thedistal tip 19 of the atraumatic sheath is provided with a shape that closely approximates the shape of the distal tip of the arthroscope and/or the rigid cannula. Aflange 30 disposed around the distal end of the sheath prevents the distal tip of the rigid cannula from gouging the patient. The flange is integral with the walls of the sheath and extends inwardly towards the axis of the sheath. The flange is sized and dimensioned to prevent the distal tip of the rigid cannula from accidentally slipping distally during a surgical procedure. Anopening 36 is provided in some atraumatic sheaths so that the surgeon may insert the endoscope or other instruments through the opening and into the surgical space. Thedistal lens 31 of an optical instrument is shown for reference inFIGS. 3 and 4 . - The
proximal end 32 of the atraumatic sheath is provided with atab 33 to allow medical personnel to easily pull the atraumatic sheath over the rigid cannula, arthroscope and/or arthroscopic instrument. The proximal end of the atraumatic sheath may also be provided withfittings 38, such as a locking hub or snap latches, that attach tofittings 39 or openings disposed on the arthroscope or other instrument, thereby securing the atraumatic sheath as illustrated inFIG. 7 . - The
tab 33 is sized and dimensioned to divert liquids away from any device proximal the atraumatic sheath, such as cameras, optics, motors and other equipment that may be sensitive to liquids or moisture. Liquids that escapes the surgical site and that travel along the outer surface of the sheath will be deflected by the tab, which has a radial dimension greater than that of the lumen of the sheath. -
FIG. 2a shows anatraumatic sheath 3 having twotabs 33 disposed along the longitudinal length of the sheath. If the flow of liquids is expected to be heavy for a surgical procedure, then the additional tab ensure that liquids do not reach sensitive devices located proximally of the sheath. - Additional tabs may be provided along the longitudinal length of the sheath.
- The outer surface of the atraumatic sheath may be provided with a
smooth coating 40 as shown inFIG. 5 to allow the arthroscope and rigid cannula to more easily move within an operating site. For example, the sheath may be provided with a Teflon® (PTFE or expanded polytetrafluoroethylene) coating or covered with a water-activated lubricant. In contrast, the inner surface of the atraumatic sheath (the walls that define the lumen of the tube) may be provided with anon-slip coating 41 or other high coefficient of friction coating. For example, the inner surface of the atraumatic sheath may be coated with a co-extruded tacky thermoplastic elastomer (TPE). The non-slip coating prevents the sheath from easily slipping over the outer surface of the rigid cannula or arthroscope, thereby helping to prevent the atraumatic sheath from twisting or slipping around the arthroscope. -
FIGS. 3 and 4 show anatraumatic sheath 3 for use with arthroscopic instruments and an endoscope orarthroscope 2 disposed inside the atraumatic sheath. The atraumatic sheath shown inFIG. 3 is provided with aballoon 34 on the distal portion of the sheath. (The balloon may be integrally formed with the sheath.) The balloon allows a surgeon to open a space within tissue, thereby dissecting the surgical field. The arthroscope may then be extended distally out of theopening 36 and the surgical space visualized. In addition, the distal end of the sheath may be provided with a distally projecting spoon or other distally projecting object to prop open a space in front of the arthroscope. The balloon and the distally projecting spoon thus provide a means for dissecting or retracting tissue to form a small surgical space. -
FIG. 4 shows anatraumatic sheath 3 having a second, workingtube 35. The working tube allows irrigation, fiber optics, sutures, needles, probes or surgical tools through the lumen. The atraumatic sheath shown inFIG. 4 may be combined with the atraumatic sheath shown inFIG. 3 to provide an atraumatic sheath with both a balloon and a working tube. -
FIG. 5 shows a cross section of theatraumatic sheath 3 shown inFIG. 2 and anarthroscopic instrument 2 disposed inside the sheath. The atraumatic sheath is provided with atab 33 on the proximal end of the sheath in order to increase the ease of pulling the sheath over the arthroscope. The distal end of the sheath is provided with anopening 36 to allow light to pass between the arthroscope and the operating space and, optionally, to allow additional instruments to pass through or alongside the arthroscope and into the surgical field. Thewalls 37 of the sheath at thedistal end 19 of the sheath are thicker than the rest of the sheath walls to form aflange 30 at the distal end of the sheath. (The flange may be a separate ring of material attached to the inside of the sheath.) The flange covers the sharp distal tip of the arthroscopic instrument and prevents the instrument from slipping distally throughopening 36. The rest of the walls of the atraumatic sheath are thin in order to minimize the overall thickness of the combined sheath and arthroscopic instrument. - In use, the atraumatic sheath is provided and pulled over an arthroscopic instrument. (The instrument may also be thought of as being inserted into the sheath.) The sheathed arthroscopic instrument is then inserted into the surgical site and the surgeon performs a medical procedure therein. If a balloon is provided, the balloon is used to dissect tissue so that the arthroscope may be extended distally out of the
opening 36 and the surgical space visualized. -
FIGS. 6 and 7 show an inflow/outflowatraumatic sheath 50 and anarthroscope 2 disposed inside the sheath. Like the sheath shown inFIG. 2 , the inflow/outflowatraumatic sheath 50 is formed of a resilient material that protects the patient from accidental injury should the arthroscope poke at or scrape along tissue. The sheath material may also be radiopaque. A preferred durometer hardness of the sheath material is in the range of about 40 Shore D to about 90 Shore D. In this hardness range the sheath is sufficiently resilient that the sheath protects the patient from accidental injury but is sufficiently hard to prevent the lumens within sheath from collapsing. - The inflow/
outflow sheath 50 is a multi-lumen tube into which an arthroscope is inserted. Each lumen extends from thedistal portion 51 of the sheath to theproximal portion 52 of the sheath. The proximal portion of the sheath is provided with one or more fluid ports, such asfirst port 53 orsecond port 54; one ormore stopcocks 55 or fluid switches; one or more valves, such as a check valve; a manifold 56; or other means of controlling the flow of fluid inside the sheath. Thedistal portion 51 of the inflow/outflow sheath is provided with a plurality ofholes 57. Each hole communicates with one or more of the lumens inside the tube, thereby allowing fluid to flow between the surgical field and the lumens inside the sheath. - Prior to surgery, medical personnel or the device manufacturer inserts the arthroscope into the inflow/outflow atraumatic sheath and secures the sheath to the arthroscope via a set-screw, snap-on attachment, other releasable attachments or
other means 58 for securing the sheath to the arthroscope. During use, a surgeon may cause a fluid, preferably saline, to flow from afluid source 59, through the arthroscope and into the surgical field, as shown byinflow arrows 60. (The arthroscope is provided with one or more lumens, ports or working tubes that allow fluid to flow through the arthroscope and into the surgical field.) In turn, blood, other fluids and debris are drained from the surgical field through theholes 57, as shown byoutflow arrows 61, and flow through one or more lumens in the sheath. The inflow of clear saline and the outflow of cloudy fluid and debris allow the surgeon to maintain a clear surgical field using a single instrument. In turn, this capability eliminates the need to use an irrigating instrument. - Thus, the surgeon may have a clear field of view while using only a two-incision arthroscopic procedure.
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FIG. 7 also shows that fluids are drained through the inflow/outflow atraumatic sheath by using avacuum source 70 or gravity drain operatively attached to a fluid port, such asport 53, connected to thesheath manifold 56. Fluids are provided through thearthroscope 2 from a fluid source 59 (by using a pump or gravity feed) operatively attached to a fluid port, such asthird port 72 orfourth port 73 connected to the arthroscope. Depending on the capabilities of the arthroscope and the surgeon's needs, the vacuum source and fluid source may be connected to different combinations of ports provided with the inflow/outflow sheath or the arthroscope. For example, the vacuum source may be attached toport 73 and the fluid source may be attached toport 72 on the inflow/outflow sheath. In this case, the surgeon may both introduce fluids into and drain fluids from the surgical site using only the inflow/outflow sheath. Thus, even if the arthroscope is incapable of introducing fluids to or draining fluids from the surgical site, the inflow/outflow sheath allows the surgeon to eliminate the need for the irrigation instrument. In any case, a pressure sensor, and flow rate control system and feedback control system may be provided to automatically monitor and control the rate of fluid flow into and out of the surgical site. -
FIG. 8 shows a cross section of the distal portion of the inflow/outflow sheath 3 shown inFIG. 6 . The inflow/outflow sheath 50 has acentral lumen 80, bounded byinner wall 81, through which the arthroscope is inserted. The sheath has four outer lumens, including a firstouter lumen 82, a secondouter lumen 83, a thirdouter lumen 84 and a fourthouter lumen 85 bounded by theinner wall 81, theouter wall 86 and four relativelystiff ribs 87 that extend between the inner and outer walls and that run along the length of the sheath. The outer lumens are annular. The distal end of the sheath in the area of theouter lumens Holes 57 or apertures disposed in the outer wall allow fluids to flow into or out of the outer lumens. For example,lumens lumens -
FIGS. 9 through 16 show cross sections of the distal portion of various inflow/outflow atraumatic sheaths.FIG. 9 shows an inflow/outflow sheath having a second set of inner lumens, including a firstinner lumen 100, a secondinner lumen 101, a thirdinner lumen 102 and a fourthinner lumen 103. With this design, the surgeon can increase the rate of fluid exchange by using all of the inner lumens to introduce fluids into the surgical site and by using all of theouter lumens -
FIG. 10 shows an inflow/outflow sheath 50 without an inner wall. Instead, the outer surface of thearthroscope 2 serves as the inner wall of the sheath once the arthroscope has been inserted into the sheath. The four, relativelystiff ribs 87 form a seal with the outer surface of the arthroscope, thereby creating the fourouter lumens elastic flanges 104 to enhance the seal made between the ribs and the arthroscope. This configuration reduces the overall size of the combined inflow/outflow sheath and arthroscope. (If theouter wall 86 is made of an elastomeric material, then the tube can stretch radially to accommodate a variety of sizes of arthroscopes.) -
FIG. 11 shows an inflow/outflowatraumatic sheath 50 similar to that shown inFIG. 10 . The relativelyhard ribs 87 are pleated, but still form a seal with the outer wall of thearthroscope 2, thereby forming theouter lumens FIG. 11 accommodates a variety of sizes of arthroscopes since the pleated ribs will bend to a degree necessary to accommodate larger sizes of arthroscopes, as shown inFIG. 12 . -
FIG. 13 shows an inflow/outflowatraumatic sheath 50 similar to that shown inFIG. 11 . Theribs 87 of this sheath are elastic tubes that form a seal with the outer wall of thearthroscope 2, thereby forming theouter lumens FIG. 13 accommodates a variety of sizes of arthroscopes since the tubes will compress to a degree necessary to accommodate larger sizes of arthroscopes, as shown inFIG. 14 . -
FIG. 15 shows a “C”-shaped or slit inflow/outflow sheath 50. Like the sheath ofFIG. 8 , fourouter lumens ribs 87, theinner wall 81 and theouter wall 86. When thearthroscope 2 is inserted into the sheath, asmall gap 105 may form between the respective tips of the firstarcuate segment 106 and the secondarcuate segment 107. (As the arthroscope is inserted into the surgical space,tissue 108 will seal the gap and prevent fluids from leaking from the surgical space to outside the body.) The sheath ofFIG. 15 accommodates a variety of sizes of arthroscopes since the arcuate segments will move radially outwardly as a larger arthroscope is inserted into the sheath, as shown inFIG. 16 . - Optionally, a protrusion or a
guide rail 109 may extend from either the arthroscope or the sheath. The guide rail helps the user align the sheath on the arthroscope while inserting the arthroscope into the sheath. The guide rail also prevents unwanted rotation or twisting of the sheath over the arthroscope during a surgical procedure. -
FIGS. 17 and 18 show an inflow/outflowatraumatic sheath 50 and anarthroscope 2 inserted into the sheath. In contrast to the inflow/outflow sheaths shown inFIGS. 6 through 16 , theouter wall 86 of thedistal portion 51 of the sheath is made from a continuous tube (the distal portion of the sheath is not provided with holes). Nevertheless, like the sheath ofFIG. 8 the sheath ofFIG. 17 has an inner lumen to accommodate the arthroscope and four outer lumens to accommodate fluid inflow and outflow, including a firstouter lumen 82, a secondouter lumen 83, a thirdouter lumen 84, and a fourthouter lumen 85. The outer lumens are bounded by theinner wall 81,outer wall 86 and supportingribs 87. The instrument shown inFIG. 17 provides fluid inflow and outflow out of thedistal end 110 of the sheath. -
FIG. 19 shows an inflow/outflowatraumatic sheath 50 having a closely-conformingdistal portion 111 that has an inner diameter that closely conforms to the outer diameter of the distal portion of anarthroscope 2. The fluid-conductingportion 112 of the sheath is set proximally from the closely conformingdistal portion 111 of the sheath. The outer diameter of thefluid conducting portion 112 and the outer diameter of the closely conformingdistal portion 111 may be formed integrally with each other such that both portions are part of the same sheath.Holes 57 disposed in the fluid-conductingportion 112 just proximally of thedistal portion 111 of the sheath communicate with one or more lumens inside the sheath, thereby allowing a surgeon to either introduce or drain fluids from a surgical site. The sheath shown inFIG. 19 has adistal portion 111 with a relatively small radius, since the sheath closely conforms to the arthroscope at the distal portion of the arthroscope. This provides the surgeon with the capability of inserting the arthroscope into narrow surgical sites. In addition, the fluid-conduction portion still allows a surgeon to irrigate the surgical field with the combined sheath/arthroscope instrument. -
FIGS. 20 and 21 show anatraumatic sheath 3 disposed over anarthroscope 2 and anelastic grip 120 disposed on theproximal portion 121 of the sheath. Thegrip 120 is preferably a hollow, ergonomic cylinder of elastic material (such as a thermoplastic elastomer) that is sized and dimensioned to allow a surgeon to manipulate the arthroscope and sheath easily, even if the surgeon's hands become wet. The grip extends proximally of theproximal end 32 of the sheath so that theproximal portion 122 of the grip will extend over anarthroscope 2 disposed within thesheath 3. (Theproximal portion 121 of the sheath inFIG. 20 is shown in phantom to indicate its position inside the grip.) The grip is designed such that the grip is biased to assume a shape having an inner diameter less than the outer diameter of the arthroscopic instrument and preferably less than the inner diameter of the sheath's inner lumen. Thus, the grip will exert an inwardly directed radial force, as indicated byarrows 123 inFIG. 21 , against an instrument disposed within the sheath. - In use, the
proximal portion 122 of thegrip 120 will squeeze down on and grasp anarthroscope 2 disposed within thesheath 3. If the proximal portion of the grip is peeled back and released, the grip is biased to spring back to its original shape. Thus, the arthroscope will remain secure within the sheath as the arthroscope or sheath is manipulated during surgery. -
FIG. 22 shows a cross section of anatraumatic sheath 3 disposed over anarthroscope 2, anelastic grip 120 andlevers FIG. 22 is provided with afirst channel 126 and asecond channel 127 into which a correspondingfirst lever 124 andsecond lever 125 have been inserted. The levers are provided with barbs, tangs or other means for securing the levers within their respective channels. The distal portions of the levers are provided with an arcuate shape such that the levers bend away from the sheath. - In use, a user presses on the distal portions of the levers. As the distal portions of the levers move radially inwardly, the proximal portions of the levers will exert a force directed radially outwardly against a corresponding segment of the proximal portion of the grip, thereby bending the proximal portion of the grip radially outwardly. This action widens the proximal opening of the grip. With the proximal opening of the grip widened, the user may easily insert or remove the arthroscope from the sheath.
Fulcrums 128 disposed on the distal portions of the levers prevent the levers from moving radially inwardly by more than a pre-determined amount. The fulcrums also allow a user to apply more outward force to corresponding segments in the proximal portion of the grip, thereby making the insertion of instruments easier. -
FIGS. 23 and 24 show the distal end of thegrip 120 andlevers sheath 3 is shown extending distally from the grip inFIG. 23 for reference.Channels -
FIG. 25 shows the distal portion of anatraumatic sheath 3 and anarthroscope 2 extending distally of thedistal end 140 of thesheath 3.Holes 57 are provided in the distal portion of the sheath. The holes communicate with one or more lumens in the sheath. The lumen or lumens communicate with a vacuum source, fluid source, therapeutic agent source or a combination of sources. Thus, the holes provide for the inflow and outflow of fluids during a procedure. - The
distal tip 141 of the sheath is made of an elastic material having a higher modulus of elasticity than the modulus of elasticity found in the material of the proximal portion of the sheath. In another embodiment, the sheath and thedistal tip 141 may be manufactured from a single flexible sterilizable polymer. The distal tip of the sheath also has an inner diameter that is slightly smaller than the outer diameter of most arthroscopes. In another embodiment, the sheath and thedistal tip 141 may be manufactured from a single flexible sterilizable polymer. - In use, a user inserts the arthroscope into the sheath. The distal tip expands as the distal end of the arthroscope slides past the distal tip of the sheath. Because the inner diameter of the tip is less than the outer diameter of the arthroscope, the tip will form a fluid-proof seal with the arthroscope.
-
FIG. 26 shows the distal portion of anatraumatic sheath 3 and anarthroscope 2 extending distally of thedistal end 140 of the sheath.Holes 57 are provided in the sheath to allow the inflow and outflow of fluids during a surgical procedure. Thedistal tip 141 of the sheath is made of an elastic material having a hardness that is less than the hardness of the proximal portion of the sheath. Aslit 142 is provided in the tip and may extend into the distal portion of the sheath. In use, the slit and tip expand as a user slides an arthroscope through the tip. Thus, the slit allows the sheath to accommodate larger arthroscopes or other medical instruments. - Since the atraumatic sheath may be designed or sized and dimensioned to conform to differently shaped instruments, the sheath is also useful with other medical instruments and other surgical procedures in which it is desirable to protect surrounding tissue from accidental trauma. For example, the atraumatic sheath may be disposed over a trimming instrument for use during arthroscopic surgery or over an energy-delivering medical instrument, such as a laser or RF energy instrument. Other procedures in which the atraumatic sheath is useful include laparoscopic surgery and other kinds of endoscopic surgery. For thin arthroscopes or other fragile medical instruments, the walls of sheath may be provided with braided carbon fibers or a mesh of steel, plastic or other composite that resists bending. As the sheath and instrument bend, force is transferred to the mesh within the sheath, thereby protecting the fragile instrument inside the sheath. In addition, the various sheath configurations shown herein may be combined to form additional types of instrument sheaths. Thus, 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. Other embodiments and configurations may be devised without departing from the spirit of the inventions and the scope of the appended claims.
Claims (1)
1. A surgical device comprising:
arthroscopic means for performing an arthroscopic surgical procedure, said arthroscopic means having an outer diameter and a proximal end;
a tubular means for removably enclosing the arthroscopic means, the tubular means having a proximal portion, a proximal end, an outer surface and an inner diameter sized and dimensioned to closely conform to the outer diameter of the arthroscopic means;
a means for gripping the tubular means disposed coaxially over the outer surface of the tubular means on the proximal portion of the tubular means, said means for gripping having a proximal portion that extends proximally beyond the proximal end of the tubular means;
wherein the proximal portion of the means for gripping frictionally engages the proximal end of the arthroscopic means; and
a first lever means operably attached to the means for gripping to move a first segment of the proximal portion of the means for gripping in a radially outwardly direction.
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US15/195,825 US20160374539A1 (en) | 2004-01-29 | 2016-06-28 | Atraumatic Arthroscopic Instrument Sheath |
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US14/475,378 US9375207B2 (en) | 2004-01-29 | 2014-09-02 | Atraumatic arthroscopic instrument sheath |
US15/195,825 US20160374539A1 (en) | 2004-01-29 | 2016-06-28 | Atraumatic Arthroscopic Instrument Sheath |
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US20050192532A1 (en) | 2005-09-01 |
US20120116164A1 (en) | 2012-05-10 |
US20090043165A1 (en) | 2009-02-12 |
US8821387B2 (en) | 2014-09-02 |
US8012083B2 (en) | 2011-09-06 |
US7435214B2 (en) | 2008-10-14 |
US9375207B2 (en) | 2016-06-28 |
US20150087906A1 (en) | 2015-03-26 |
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