US20030191371A1 — Devices and methods for percutaneous tissue retra…

Claim 1

Independent Claim 159 words

1 . A retractor for percutaneous surgery in a patient, comprising: a first portion having a proximal end and a distal end; a second portion having a proximal end coupled to said proximal end of said first portion, said second portion having a distal end and forming with said first portion a working channel, said working channel having a length between said distal ends and said proximal ends of said first and second portions and a size between said first portion and said second portion along said length, wherein: said first and second portions are positionable in an unexpanded configuration with said distal ends of said first and second portions in the patient and said proximal ends of said first and second portions outside the patient; and said first and second portions are movable to an expanded configuration wherein said working channel tapers in size from said proximal ends outside the patient to said distal ends in the patient.

Claim 2

Dependent Claim 159 words

1 . A retractor for percutaneous surgery in a patient, comprising: a first portion having a proximal end and a distal end; a second portion having a proximal end coupled to said proximal end of said first portion, said second portion having a distal end and forming with said first portion a working channel, said working channel having a length between said distal ends and said proximal ends of said first and second portions and a size between said first portion and said second portion along said length, wherein: said first and second portions are positionable in an unexpanded configuration with said distal ends of said first and second portions in the patient and said proximal ends of said first and second portions outside the patient; and said first and second portions are movable to an expanded configuration wherein said working channel tapers in size from said proximal ends outside the patient to said distal ends in the patient.

Claim 3

Dependent Claim 19 words

2 . The retractor of claim 1 , further comprising an endoscopic viewing instrument extending through said working channel.

Claim 4

Dependent Claim 18 words

3 . The retractor of claim 1 , further comprising a microscopic viewing instrument over said working channel.

Claim 5

Dependent Claim 33 words

4 . The retractor of claim 1 , wherein said second portion includes a semi-cylindrical body and said first portion includes a semi-cylindrical body positioned about said semi-cylindrical body of said second portion.

Claim 6

Dependent Claim 17 words

5 . The retractor of claim 4 , wherein said body of said first portion is flexible.

Claim 7

Dependent Claim 32 words

6 . The retractor of claim 4 , wherein said body of said first portion includes opposite edges extending therealong between said proximal end and said distal end of said first portion.

Claim 8

Dependent Claim 45 words

7 . The retractor of claim 6 , wherein said body of said first portion has a perimeter length between said opposite edges, said perimeter length being greater at said distal end of said first portion than at said proximal end of said first portion.

Claim 9

Dependent Claim 52 words

8 . The retractor of claim 6 , wherein said body of said second portion includes opposite edges extending therealong between said proximal end and said distal end, said body of said second portion further including an engagement surface extending along at least a portion of each of said opposite edges thereof.

Claim 10

Dependent Claim 32 words

9 . The retractor of claim 8 , wherein said opposite edges of said first portion engage adjacent ones of said engagement surfaces of said second portion when in said expanded configuration.

Claim 11

Dependent Claim 32 words

10 . The retractor of claim 1 , wherein said first portion includes a collar at said proximal end thereof and said second portion includes a collar at said proximal end thereof.

Claim 12

Dependent Claim 25 words

11 . The retractor of claim 10 , wherein said first portion and said second portion are pivotally coupled to one another at said collars.

Claim 13

Dependent Claim 64 words

12 . The retractor of claim 11 , wherein: said collar of said first portion includes first and second extensions extending therefrom on opposite sides of said first portion; and said collar of said second portion includes first and second recesses therein on opposite sides of said second portion, said first and second extensions positionable in respective ones of said first and second recesses.

Claim 14

Dependent Claim 71 words

13 . The retractor of claim 12 , wherein said collar of said second portion includes first and second extensions extending along said first and second recesses of said second collar, said first and second extensions of said first portion are each pivotally coupled to an adjacent one of said first and second extensions of said second portion in respective ones of said first and second recesses of said second portion.

Claim 15

Dependent Claim 58 words

14 . The retractor of claim 13 , wherein said collar of said first portion includes first and second recesses therein adjacent respective ones of said first and second extensions of said first portion, said first and second extensions of said second portion are positionable in respective ones of said first and second recesses of said first portion.

Claim 16

Dependent Claim 70 words

15 . The retractor of claim 14 , wherein: said first and second extensions of said first portion each contact an engagement surface in each of said first and second recesses of said second portion in said expanded configuration; and said first and second extensions of said second portion each contact an engagement surface in each of said first and second recesses of said first portion in said expanded configuration.

Claim 17

Dependent Claim 24 words

16 . The retractor of claim 1 , wherein said working channel has a figure eight shape along said length in said expanded configuration.

Claim 18

Dependent Claim 71 words

17 . The retractor of claim 16 , wherein in said unexpanded configuration said working channel has a generally circular cross-section along said length and in said expanded configuration said working channel has a dimension in said second portion transverse to a primary expansion direction of said first and second portions that is less than a dimension of said working channel in said first portion transverse to said primary expansion direction.

Claim 19

Dependent Claim 32 words

18 . The retractor of claim 1 , wherein one of said first and second portions includes a bracket extending from said proximal end thereof that is engageable to a flexible arm.

Claim 20

Dependent Claim 42 words

19 . The retractor of claim 1 , wherein said first portion and said second portion extend completely about said working channel from said proximal ends of said first and second portions to said distal ends of said first and second portions.

Claim 21

Dependent Claim 36 words

20 . The retractor of claim 1 , further comprising a ratchet and pawl mechanism at said proximal ends of said first and second portions to maintain said first and second portions in said expanded configuration.

Claim 22

Dependent Claim 96 words

21 . The retractor of claim 1 , further comprising: a pair of coupling members engaging said first portion to said second portion; a lever arm extending from respective ones of each of said pair of coupling members; and said coupling members each have a first position wherein said first portion is pivotal relative to said second portion and are moveable to a second position wherein said coupling members fix said first portion relative to said second portion, said lever arms being moveable to move said coupling members from said second position to said first position.

Claim 23

Dependent Claim 35 words

22 . The retractor of claim 1 , wherein said first portion is pivotally coupled to said second portion about a pivot axis located proximally of said proximal ends of said first and second portions.

Claim 24

Dependent Claim 154 words

23 . A retractor for percutaneous surgery in a patient, comprising: a first portion having opposite edges extending between a proximal end and a distal end; a second portion coupled to said first portion and having opposite edges extending between a proximal end and a distal end, said second portion including an engagement surface extending along at least a portion of each of said opposite edges thereof, said first and second portions forming a working channel having a length extending between said distal ends and said proximal ends of said first and second portions; said first and second portions having an unexpanded configuration wherein said edges of said first portion extends around said second portion; and said first and second portions being pivotal relative to one another about said proximal ends to an expanded configuration wherein said opposite edges of said first portion engage adjacent ones of said engagement surfaces of said second portion.

Claim 25

Dependent Claim 154 words

23 . A retractor for percutaneous surgery in a patient, comprising: a first portion having opposite edges extending between a proximal end and a distal end; a second portion coupled to said first portion and having opposite edges extending between a proximal end and a distal end, said second portion including an engagement surface extending along at least a portion of each of said opposite edges thereof, said first and second portions forming a working channel having a length extending between said distal ends and said proximal ends of said first and second portions; said first and second portions having an unexpanded configuration wherein said edges of said first portion extends around said second portion; and said first and second portions being pivotal relative to one another about said proximal ends to an expanded configuration wherein said opposite edges of said first portion engage adjacent ones of said engagement surfaces of said second portion.

Claim 26

Dependent Claim 76 words

24 . The retractor of claim 23 , wherein: said first and second portions are positionable in the patient in said unexpanded configuration with said distal ends of said first and second portions in the patient and said proximal ends of said first and second portions outside the patient; and said expanded configuration increases a size of said working channel between said first portion and said second portion along said entire length of said working channel.

Claim 27

Dependent Claim 33 words

25 . The retractor of claim 23 , wherein said second portion includes a semi-cylindrical body and said first portion includes a semi-cylindrical body positioned about said semi-cylindrical body of said second portion.

Claim 28

Dependent Claim 17 words

26 . The retractor of claim 25 , wherein said body of said first portion is flexible.

Claim 29

Dependent Claim 45 words

27 . The retractor of claim 25 , wherein said body of said first portion has a perimeter length between said opposite edges, said perimeter length being greater at said distal end of said first portion than at said proximal end of said first portion.

Claim 30

Dependent Claim 31 words

28 . The retractor of claim 25 , wherein said body of said first portion has a thickness that is less than a thickness of said body of said second portion.

Claim 31

Dependent Claim 32 words

29 . The retractor of claim 23 , wherein said first portion includes a collar at said proximal end thereof and said second portion includes a collar at said proximal end thereof.

Claim 32

Dependent Claim 104 words

30 . The retractor of claim 29 , wherein: said collar of said first portion includes first and second extensions extending therefrom on opposite sides of said first portion; and said collar of said second portion includes first and second recesses therein on opposite sides of said second portion, said collar of said second portion including first and second extensions along each of said first and second recesses, said first and second extensions of said first portion are positioned in respective ones of said first and second recesses of said second portion and pivotally engaged to first and second extensions of said second portion.

Claim 33

Dependent Claim 52 words

31 . The retractor of claim 30 , wherein said collar of said first portion includes first and second recesses along said first and second extensions thereof, said first and second extensions of said second portion are each positioned in respective ones of said first and second recesses of said first portion.

Claim 34

Dependent Claim 70 words

32 . The retractor of claim 31 , wherein: said first and second extensions of said first portion each contact an engagement surface in each of said first and second recesses of said second portion in said expanded configuration; and said first and second extensions of said second portion each contact an engagement surface in each of said first and second recesses of said first portion in said expanded configuration.

Claim 35

Dependent Claim 69 words

33 . The retractor of claim 23 , wherein in said unexpanded configuration said working channel has a generally circular cross-section along said length and in said expanded configuration said working channel has a dimension in said second portion transverse to a pivot direction of said first and second portions that is less than a dimension of said working channel in said first portion transverse to said pivot direction.

Claim 36

Dependent Claim 35 words

34 . The retractor of claim 23 , wherein said first portion is pivotally coupled to said second portion about a pivot axis located proximally of said proximal ends of said first and second portions.

Claim 37

Dependent Claim 131 words

35 . A retractor for percutaneous surgery in a patient, comprising: a first portion extending between a proximal end and a distal end, said first portion including a collar extending about said proximal end; and a second portion extending between a proximal end and a distal end, said second portion including a collar extending about said proximal end, said first and second portions forming a working channel having a length extending between said distal ends and said proximal ends of said first and second portions and a size between said first and second portions, wherein said collar of said first portion is pivotally coupled to said collar of said second portion and said first and second portions are pivotal relative to one another between an unexpanded configuration and an expanded configuration.

Claim 38

Dependent Claim 131 words

35 . A retractor for percutaneous surgery in a patient, comprising: a first portion extending between a proximal end and a distal end, said first portion including a collar extending about said proximal end; and a second portion extending between a proximal end and a distal end, said second portion including a collar extending about said proximal end, said first and second portions forming a working channel having a length extending between said distal ends and said proximal ends of said first and second portions and a size between said first and second portions, wherein said collar of said first portion is pivotally coupled to said collar of said second portion and said first and second portions are pivotal relative to one another between an unexpanded configuration and an expanded configuration.

Claim 39

Dependent Claim 85 words

36 . The retractor of claim 35 , wherein: said first and second portions are positionable in said unexpanded configuration with said distal ends of said first and second portions in the patient and said proximal ends of said first and second portions outside the patient; and said expanded configuration increases said size of said working channel between said first portion and said second portion from said proximal ends of said first and second portions to said distal ends of said first and second portions.

Claim 40

Dependent Claim 27 words

37 . The retractor of claim 35 , further comprising a viewing element selected from the group comprising: an endoscopic viewing instrument and a microscopic viewing instrument.

Claim 41

Dependent Claim 33 words

38 . The retractor of claim 35 , wherein said second portion includes a semi-cylindrical body and said first portion includes a semi-cylindrical body positioned about said semi-cylindrical body of said second portion.

Claim 42

Dependent Claim 17 words

39 . The retractor of claim 38 , wherein said body of said first portion is flexible.

Claim 43

Dependent Claim 75 words

40 . The retractor of claim 38 , wherein: said body of said first portion has a perimeter length between opposite edges thereof that is greater at said distal end of said first portion than at said proximal end of said second portion; and said body of said second portion has a perimeter length between opposite edges thereof that is generally the same at said distal end and said proximal end of said second portion.

Claim 44

Dependent Claim 38 words

41 . The retractor of claim 23 , wherein said collar of first portion is pivotally coupled to said collar second portion about a pivot axis located proximally of said proximal ends of said first and second portions.

Claim 45

Dependent Claim 104 words

42 . The retractor of claim 41 , wherein: said collar of said first portion includes first and second extensions extending therefrom on opposite sides of said first portion; and said collar of said second portion includes first and second recesses therein on opposite sides of said second portion, said collar of said second portion including first and second extensions along each of said first and second recesses, said first and second extensions of said first portion are positioned in respective ones of said first and second recesses of said second portion and pivotally engaged to first and second extensions of said second portion.

Claim 46

Dependent Claim 52 words

43 . The retractor of claim 42 , wherein said collar of said first portion includes first and second recesses along said first and second extensions thereof, said first and second extensions of said second portion are each positioned in respective ones of said first and second recesses of said first portion.

Claim 47

Dependent Claim 70 words

44 . The retractor of claim 43 , wherein: said first and second extensions of said first portion each contact an engagement surface in each of said first and second recesses of said second portion in said expanded configuration; and said first and second extensions of said second portion each contact an engagement surface in each of said first and second recesses of said first portion in said expanded configuration.

Claim 48

Dependent Claim 65 words

45 . The retractor of claim 35 , wherein in said unexpanded configuration said working channel includes a generally circular cross-section along said length and in said expanded configuration said working channel has a dimension in said second portion transverse to a pivot direction of said first and second portions that is less than a dimension in said first portion transverse to said pivot direction.

Claim 49

Dependent Claim 25 words

46 . The retractor of claim 35 , wherein said first portion includes opposite edges extending therealong between said proximal end and said distal end.

Claim 50

Dependent Claim 42 words

47 . The retractor of claim 46 , wherein said first portion has a perimeter length between said opposite edges, said perimeter length being greater at said distal end of said first portion than at said proximal end of said second portion.

Claim 51

Dependent Claim 46 words

48 . The retractor of claim 46 , wherein said second portion includes opposite edges extending therealong between said proximal end and said distal end, said second portion further including an engagement surface extending along at least a portion of each of said opposite edges thereof.

Claim 52

Dependent Claim 38 words

49 . The retractor of claim 48 , wherein said opposite edges of said first portion engage adjacent ones of said engagement surfaces of said second portion when said first and second portions are in said expanded configuration.

Claim 53

Dependent Claim 94 words

50 . A kit for use in percutaneous surgery, comprising: a retractor having a working channel extending between a proximal end and a distal end of said retractor, said retractor having a first portion coupled to a second portion, said first and second portions movable relative to one another to an expanded configuration; and an expansion instrument positionable in said working channel and engageable with said first portion and said second portion to move said first and second portions to said expanded configuration, said expansion instrument mountable on said proximal end of said retractor.

Claim 54

Dependent Claim 94 words

50 . A kit for use in percutaneous surgery, comprising: a retractor having a working channel extending between a proximal end and a distal end of said retractor, said retractor having a first portion coupled to a second portion, said first and second portions movable relative to one another to an expanded configuration; and an expansion instrument positionable in said working channel and engageable with said first portion and said second portion to move said first and second portions to said expanded configuration, said expansion instrument mountable on said proximal end of said retractor.

Claim 55

Dependent Claim 42 words

51 . The kit of claim 50 , wherein said first portion is pivotally coupled to said second portion at said proximal end of said retractor and said first and second portions are pivotal from an unexpanded configuration to said expanded configuration.

Claim 56

Dependent Claim 48 words

52 . The kit of claim 51 , further comprising a first coupling member on one side of said retractor and a second coupling member on an opposite side of said retractor, said first and second coupling members pivotally coupling said first and second portions to one another.

Claim 57

Dependent Claim 51 words

53 . The kit of claim 52 , wherein said expansion instrument includes a pair of arms pivotally extending therefrom, said arms each including a mounting member engageable with a corresponding one of said first and second coupling members to mount said expansion instrument on said proximal end of said retractor.

Claim 58

Dependent Claim 55 words

54 . The kit of claim 50 , wherein said expansion instrument includes a pair of proximal handles pivotally coupled to one another and a pair of distal feet extending from a respective one of said pair of handles, each of said distal feet engageable with a respective one of said first and second portions.

Claim 59

Dependent Claim 25 words

55 . The kit of claim 54 , wherein at least one of said distal feet is adjustable to select a desired amount of expansion.

Claim 60

Dependent Claim 116 words

56 . A kit for use in percutaneous surgery, comprising: a retractor having a working channel extending between a proximal end and a distal end of said retractor, said retractor having a first portion coupled to a second portion, said first and second portions movable relative to one another for engagement in an expanded configuration; and an expansion instrument positionable in said working channel and engageable with said first portion and said second portion to move said first and second portions to said expanded configuration, wherein with said working channel in said expanded configuration said expansion instrument is positionable in said working channel to disengage said first and second portions for movement to an unexpanded configuration.

Claim 61

Dependent Claim 116 words

56 . A kit for use in percutaneous surgery, comprising: a retractor having a working channel extending between a proximal end and a distal end of said retractor, said retractor having a first portion coupled to a second portion, said first and second portions movable relative to one another for engagement in an expanded configuration; and an expansion instrument positionable in said working channel and engageable with said first portion and said second portion to move said first and second portions to said expanded configuration, wherein with said working channel in said expanded configuration said expansion instrument is positionable in said working channel to disengage said first and second portions for movement to an unexpanded configuration.

Claim 62

Dependent Claim 42 words

57 . The kit of claim 56 , wherein said first portion is pivotally coupled to said second portion at said proximal end of said retractor and said first and second portions are pivotal between said unexpanded configuration and said expanded configuration.

Claim 63

Dependent Claim 21 words

58 . The kit of claim 56 , wherein said expansion instrument is mountable on a proximal end of said retractor.

Claim 64

Dependent Claim 98 words

59 . A method for performing a surgical procedure at a location in a patient, comprising: making an incision in the skin and tissue of the patient to access the location; forming a working channel through the incision to the location by inserting a distal end of a retractor into the patient with a proximal end of the retractor located outside of the patient; and pivoting a first portion of the retractor relative to a second portion of the retractor about a pivot axis adjacent the proximal end of the retractor expand the working channel through the incision.

Claim 65

Dependent Claim 98 words

59 . A method for performing a surgical procedure at a location in a patient, comprising: making an incision in the skin and tissue of the patient to access the location; forming a working channel through the incision to the location by inserting a distal end of a retractor into the patient with a proximal end of the retractor located outside of the patient; and pivoting a first portion of the retractor relative to a second portion of the retractor about a pivot axis adjacent the proximal end of the retractor expand the working channel through the incision.

Claim 66

Dependent Claim 31 words

60 . The method of claim 59 , further comprising: mounting an expansion instrument on the proximal end of the retractor before pivoting the first portion relative to the second portion.

Claim 67

Dependent Claim 21 words

61 . The method of claim 59 , further comprising: positioning a viewing element to view the location through the retractor.

Claim 68

Dependent Claim 30 words

62 . The method of claim 59 , wherein forming the working channel includes sequentially dilating skin and tissue through the incision before inserting the distal end of the retractor.

Claim 69

Dependent Claim 22 words

63 . The method of claim 59 , wherein the pivot axis is located proximally of the proximal end of the retractor.

Claim 70

Dependent Claim 51 words

64 . A surgical method for accessing a location in a patient, comprising: sequentially dilating tissue of the patient to the location; placing an unexpanded retractor through the sequentially dilated tissue; expanding the retractor predominantly in a first direction through the tissue; and performing a surgical procedure through the expanded retractor.

Claim 71

Dependent Claim 51 words

64 . A surgical method for accessing a location in a patient, comprising: sequentially dilating tissue of the patient to the location; placing an unexpanded retractor through the sequentially dilated tissue; expanding the retractor predominantly in a first direction through the tissue; and performing a surgical procedure through the expanded retractor.

Claim 72

Dependent Claim 19 words

64 . The method of claim 63 , wherein the location is adjacent the spinal column of the patient.

Claim 73

Dependent Claim 23 words

65 . The method of claim 63 , wherein the retractor defines a working channel therethrough that is substantially enclosed by the retractor.

Claim 74

Dependent Claim 40 words

66 . The method of claim 63 , wherein the retractor is expanded by pivoting a first portion of the retractor relative to a second portion of the retractor about a pivot axis adjacent the proximal end of the retractor.

Claim 75

Dependent Claim 43 words

67 . A surgical method for accessing a location in a patient, comprising: placing an unexpanded retractor through tissue to the location; expanding the retractor to an expanded configuration; unexpanding the retractor before removing the retractor; and removing the retractor from the patient.

Claim 76

Dependent Claim 43 words

67 . A surgical method for accessing a location in a patient, comprising: placing an unexpanded retractor through tissue to the location; expanding the retractor to an expanded configuration; unexpanding the retractor before removing the retractor; and removing the retractor from the patient.

Claim 77

Dependent Claim 17 words

68 . The method of claim 67 , further comprising locking the retractor in the expanded configuration.

Claim 78

Dependent Claim 17 words

69 . The method of claim 68 , further comprising unlocking the retractor before unexpanding the retractor.

Claim 79

Dependent Claim 40 words

70 . The method of claim 67 , wherein the retractor is expanded by pivoting a first portion of the retractor relative to a second portion of the retractor about a pivot axis adjacent a proximal end of the retractor.

Claim 80

Dependent Claim 22 words

71 . The method of claim 70 , wherein the pivot axis is located proximally of the proximal end of the retractor.

Claim 81

Dependent Claim 119 words

72 . A tissue retractor for surgery in a patient, comprising: a first portion and a second portion coupled to said first portion, said first and second portions each having a length between a distal end and a proximal end thereof such that said proximal ends are positionable outside the patient and said distal ends are positionable in the patient; a working channel extending therealong between said distal ends and said proximal ends of said first and second portions; and said first and second portions have an unexpanded configuration wherein said working channel has a generally circular cross-section and an expanded configuration wherein said working channel has a non-circular cross-section tapering from said distal end to said proximal end..

Claim 82

Dependent Claim 119 words

72 . A tissue retractor for surgery in a patient, comprising: a first portion and a second portion coupled to said first portion, said first and second portions each having a length between a distal end and a proximal end thereof such that said proximal ends are positionable outside the patient and said distal ends are positionable in the patient; a working channel extending therealong between said distal ends and said proximal ends of said first and second portions; and said first and second portions have an unexpanded configuration wherein said working channel has a generally circular cross-section and an expanded configuration wherein said working channel has a non-circular cross-section tapering from said distal end to said proximal end..

Claim 83

Dependent Claim 20 words

73 . The retractor of claim 72 , wherein said first and second portions are locked in said expanded configuration.

Claim 84

Dependent Claim 21 words

74 . The retractor of claim 72 , wherein said first portion substantially envelopes said second portion in said unexpanded configuration.

Claim 85

Dependent Claim 16 words

75 . The retractor of claim 74 , wherein said first portion has a flexible body.

Claim 86

Dependent Claim 24 words

76 . The retractor of claim 72 , wherein said first portion is pivotally coupled to said second portion at said proximal ends thereof.

Claim 87

Dependent Claim 37 words

77 . The retractor of claim 72 , wherein said first portion is pivotally coupled to said second portion along a pivot axis located proximally of said proximal ends of said first portion and said second portion.

Devices and methods for percutaneous tissue retraction and surgery

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