RU179099U1 - DEVICE FOR PERCUTANEOUS VIDEO-ENDOSCOPIC INTERVENTIONS ON THE SPINE - Google Patents

Abstract

The utility model relates to medical equipment used in traumatology, neurosurgery, vertebrology. The device consists of two coaxially located elongated elongated hollow metal tubes - internal and external. On the side of the proximal end of the inner tube, a millimeter scale is applied to its outer lateral surface to assess the degree of mutual movement of the tubes and the manipulation handle is placed, and its distal end is cut off at an angle of 25-30 ° with the aperture open to the side that coincides with the direction of the manipulation handle. On the side of the proximal end of the outer tube, a collet chuck is located on its lateral surface, providing mutual fixation of the position of the tubes relative to each other. The length of the inner tube exceeds the length of the outer tube by 30 mm. The outer diameter of the outer tube does not exceed 10 mm. The inner diameter of the inner tube is proportional to the outer diameter of the endoscope for its free movement inside the device. The utility model allows for the most secure and atraumatic surgical access in a shorter time by providing optimal visualization of the posterior structures of the spine in a continuous mode and expanding the functional capabilities of performing various manipulations on the neural structures of the spinal canal. 1 ave., 7 ill.

Description

The utility model relates to medical equipment used in traumatology, neurosurgery, vertebrology. This technical solution can be used in the implementation of various types of surgical interventions on the spine, carried out under video endoscopic control, including to ensure access to both the spinal column and intracanal located anatomical structures.

Currently, thanks to the rapid development of modern technologies and their active introduction into medical practice, surgical interventions on the spine have become much safer and less traumatic. One of these achievements was the development of a methodology for performing endoscopic interventions, during which all manipulations are performed through the working channel of an endoscope mounted inside a metal tube acting as a guide [Yeung AT, Tsou PM Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases // Spine. - 2002. - T. 27. - No. 7. - S. 722-731; Ruetten S., Komp M., Godolias G. An extreme lateral access for the surgery of lumbar disc herniations inside the spinal canal using the full-endoscopic uniportal transforaminal approach – technique and prospective results of 463 patients // Spine. - 2005. - T. 30. - No. 22. - S. 2570-2578; Schubert M., Hoogland T. Endoscopic transforaminal nucleotomy with foraminoplasty for lumbar disk herniation // Operative Orthopadie und Traumatologie. - 2005. - T. 17. - No. 6. - S. 641-661].

There are different types of tubular guides for the endoscope in the form of tubes, ports and trocars having different lengths and configurations of the distal end depending on the type of surgical access and the characteristics of the manipulation [RU patents for inventions 2093063, 2483687, US patent No. 5484437]. The most common among tubular guides is a port with a slanting (curly) cut of the distal end [Mayer H. M. Minimally invasive spine surgery // Minimally Invasive Spine Surgery. - Springer Berlin Heidelberg, 2006 .-- 492 p .; Ruetten S. et al. Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach // Journal of Neurosurgery: Spine. - 2007. - T. 6. - No. 6. - S. 521-530; Lewandrowski K. U., Lee S. H., Iprenburg M. Endoscopic Spinal Surgery. - JP Medical Ltd, 2013. - 162 p.]. The cut angle of the distal part of the port corresponds to the cut angle of the distal end of the endoscope (25º - 30º), forming at the same time the end of the tube elongated on only one side, the so-called “lip” of the port. This configuration of the distal end of the port allows you to get a wider field of view through the optical channel of the endoscope and provide the ability to perform additional surgical procedures, in addition to those that are performed through the working channel of the endoscope. Often, the “lip” of the port serves as the second (pushing) tool in the wound. So, for example, with posterior interlaminar endoscopic access to the spinal canal, the most popular surgical techniques are advancing the “lips” of the port through a small defect of the yellow ligament, expanding this defect by rotating it around its longitudinal axis and performing rotational maneuver by the port in the spinal canal, leading to displacement of the neural structures and taking them under the protection of the "lip" of the port from manipulation by surgical instruments (forceps, boron, coagulator, etc.).

The disadvantage of this configuration of the distal part of the port is the difficulty of surgical access to the spinal canal due to the constant penetration of soft tissues (muscle, fat) and blood through a diagonally oriented aperture into the lumen of the port tube, which complicates the video endoscopic visualization of bone structures and the yellow ligament in conditions of sharply limited space. This leads to an increase in the duration of the approach phase to the spinal canal.

It is also known "Device for endoscopic posterior interbody fusion" [RU patent for invention No. 2299037], containing a tube with a working channel, a blunt obturator and a handle-holder. The tube is made with a beveled distal end and contains two channel ports on diametrically opposite sides. The channels are oriented at an acute angle to the axis of the tube and are made to change the location of the endoscope and suction, equipped with collet clamps at the ends and end in the lumen of the working channel. The tube has a smooth outer surface, side sampling and the thickness of the remaining part equal to 3/4 of the diameter.

However, the device has several of the following disadvantages, which do not allow it to be used for percutaneous video endoscopic interventions on the spine. The large diameter of the tube (18 mm.) Does not meet the criteria for percutaneous video endoscopy (the maximum outer diameter of the port should be no more than 10 mm.), Which makes surgical interventions using this device more traumatic. The device is designed to perform operations in the air under conditions of endoscopic assistance, with constant direct visual control of the surgical field directly through the lumen of the tube, while in the method of percutaneous endoscopy, the lumen of the working port is completely occupied by the endoscope, which transfers the image to the monitor screen, and all manipulations are performed through a special the internal channel of the endoscope, the diameter of which allows only one surgical instrument.

The closest analogue to the claimed utility model is a port with a distal end cut off at an angle of 90º. This technique allows close contact with the yellow ligament and vertebrae, ensuring their clear visualization by means of an endoscope, and sufficient isolation from spaces and soft tissues outside the port tube [Mayer H. M. Minimally invasive spine surgery // Minimally Invasive Spine Surgery. - Springer Berlin Heidelberg, 2006 .-- 492 p .; Ruetten S. et al. Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach // Journal of Neurosurgery: Spine. - 2007. - T. 6. - No. 6. - S. 521-530; Lewandrowski K. U., Lee S. H., Iprenburg M. Endoscopic Spinal Surgery. - JP Medical Ltd, 2013. - 162 p.].

However, a port with a direct cut in the area of the distal end makes it difficult to access the spinal canal and makes it impossible to perform a rotational maneuver on neural structures, and therefore it will be necessary to replace the port with a direct cut with an identical sized port with an oblique cut. However, replacing the ports is only possible “blindly” after the implementation of the flavotomy stage, i.e. without visual inspection through an endoscope. To do this, after removing the endoscope, a rigid conductor is inserted into the port with a direct cut, the port is removed, another port with an oblique cut is introduced along the conductor, then the conductor is removed and the endoscope is inserted. With the implementation of such a surgical technique, the risk of damage to neural structures increases due to the lack of visual control over them, especially in cases of a defect in the yellow ligament. At the same time, the likelihood of the conductor moving to the side increases, which can lead to incorrect installation of the port with an oblique cut. A subsequent search for video endoscopic landmarks of the yellow ligament defect and spinal canal structures will significantly increase the duration of surgery.

The objective of the claimed utility model is the development of a device for percutaneous video endoscopic interventions on the spine, which allows for the most secure and atraumatic surgical access in a shorter time by providing optimal visualization of the posterior structures of the spine in a continuous mode, eliminating the need for removal and re-introduction of the endoscope, and expanding functionality performing various manipulations on the neural structures of the spinal canal.

The essence of the claimed utility model lies in the fact that in the device for percutaneous video endoscopic interventions on the spine, which is a long elongated hollow external metal tube with a distal end cut at a right angle, the latter is placed inside with the possibility of reciprocating and rotational movements relative to its longitudinal axis of the inner hollow metal tube, from the side of the proximal end of which on its outer side surface is applied a millimeter an even scale for assessing the degree of mutual movement of the tubes and the manipulation handle is placed, and its distal end is cut off at an angle of 25º - 30º with the aperture open to the side coinciding with the direction of the manipulation handle, while a collet chuck is located on the side of the proximal end of the outer tube providing mutual fixation of the position of the tubes relative to each other, the length of the inner tube exceeds the length of the outer tube by 30 mm, the outer diameter of the outer tube does not exceed 10 mm, and the inner minutes diameter commensurate with the inner tube to the outer diameter of the endoscope to its free movement within the device.

 The technical result of the claimed utility model.

The design features of the claimed product allow for quick surgical access and provide a clear visualization of the posterior structures of the spine due to the snug fit of the distal end of the outer tube with a straight cut and isolation of the inner space of the tubes from the space outside the device. Such a technique as the implementation of a device from two coaxially located hollow tubes with the possibility of reciprocating and rotational movements of the inner tube with a curly cut provides atraumatic stages of bone resection, flavotomy and rotational maneuvers on the neural structures of the spinal canal under constant video endoscopic control. Also, these features of the device eliminate the need to replace the port with a direct cut to a port with a slant cut to perform various stages of surgical intervention.

The inventive utility model is illustrated using FIG. 1-7, which depict: FIG. 1 is a longitudinal section of a device for percutaneous video endoscopic interventions on the spine; in FIG. 2 is a general view of the device with an endoscope inserted into the lumen of the inner tube; FIG. 3 - the relative position of the distal ends of the tubes (a - at the stage of access to the spine, b - during manipulations on the neural structures of the spinal canal); in FIG. 4 - video endoscopic image of the internal space of the device at the stage of access to the posterior structures of the spine to the stage of dissection of bone structures and the yellow ligament; in FIG. 5 is a video endoscopic image of the position of the distal end of the device on the posterior structures of the vertebral canal at the stage of resection of the lower edge of the LV arch of the vertebra (the curved arrow indicates the stepwise shape of the bottom of the surgical wound due to the lower edge of the LV arch of the vertebra rising above the yellow ligament; the semi-shaft indicates the area of the resection of the lower edge arc of the LV vertebra using boron); in FIG. 6 is a video endoscopic image of the position of the distal end of the external tube of the device on the yellow ligament of the interosseous space of the LV-SI vertebrae on the left; in FIG. 7 is a video endoscopic image of the position of the distal end of the external tube on the intervertebral disc of the LV-SI vertebrae. The black arrows in FIG. 4, 5, 7, the edge of the curved end of the inner tube is indicated at the boundary with the inner surface of the outer tube. In FIG. 1-3 positions 1-11 are indicated:

1 - proximal end of the inner tube;

2 - millimeter scale on the outer side surface of the inner tube;

3 - manipulation handle of the inner tube;

4 - the distal end of the inner tube;

5 - proximal end of the outer tube;

6 - four-jaw replaceable collet collet chuck;

7 - metal nut collet cartridge;

8 - the site of the outer tube;

9 - thread for tightening the nut of the collet chuck;

10 - the distal end of the outer tube;

11 - endoscope.

A device for percutaneous video endoscopic interventions on the spine is two coaxially located elongated elongated hollow metal tubes - an external and an internal one. The latter is placed inside the outer tube with the possibility of reciprocating and rotational movements relative to its longitudinal axis due to the execution of the outer diameter of the inner tube commensurate with the inner diameter of the outer tube. From the side of the proximal end of the inner tube 1, a millimeter scale 2 is applied to its outer side surface to assess the degree of mutual movement of the tubes and the manipulation handle 3 is placed. The distal end 4 of the inner tube is cut at an angle of 25-30 ° with the aperture open to the side that coincides with the direction of the manipulation handle 3. On the side of the proximal end 5 of the outer tube, a collet chuck is located on its lateral surface, providing mutual fixation of the position of the tubes relative to each other and consisting from a four-jaw replaceable collet 6 made of a polymeric material and a metal nut 7 with a thread on the inner surface. On the side of the proximal end 5 of the outer tube there is an extension in the form of a pad 8, designed to support the collet 6. On the side surface of the outer tube in the area of the pad 8 there is a thread 9 for tightening the nut 7 of the collet chuck. The distal end 10 of the outer tube is cut at a right angle. The length of the inner tube exceeds the length of the outer tube by 30mm. The inner diameter of the inner tube is proportional to the outer diameter of the endoscope 11 with the possibility of its free movement along the longitudinal axis of the device.

A device for percutaneous video endoscopic interventions on the spine is used as follows. The inner tube of smaller diameter is set relative to the outer tube, providing a comparison of their distal ends relative to each other, eliminating the possibility of the distal end of the inner tube beyond the edge of the outer tube. In this case, the mutual arrangement of the tubes corresponds to the position "0" on the millimeter scale, deposited on the outer side surface of the inner tube. The achieved position of the tubes relative to each other is fixed with a collet chuck. To do this, tighten the collet nut, pushing into the cartridge. Due to its shape, the collet chuck is elastically deformed, squeezing the inner tube from the outside. After the device, through a mini-section of the skin of the back, the metal conductor is inserted through the soft tissue to the posterior structures of the spine. The conductor is removed and an endoscope is inserted through the inner channel of the inner tube. The distal end of the outer tube, cut at right angles, allows the device to be firmly in contact with the surface of the yellow ligament and provide verification of its video endoscopic landmarks, while isolating the internal space of the structure from surrounding soft tissues and blood under conditions of continuous irrigation with physiological sodium chloride solution delivered through the endoscope channel . After dissecting the yellow ligament (flavotomy) and performing (if necessary) a partial laminotomy, the collet nut is temporarily untwisted and the inner tube is advanced through the rotational-translational movements into the spinal canal to the required depth, then it is fixed again in the reached position by tightening the collet nut. In this case, the position of the distal end of the outer tube remains unchanged. The depth of insertion of the inner tube into the spinal canal is controlled simultaneously by the image on the monitor screen of the endoscopic column and the millimeter scale plotted on the outer side of the inner tube, which is especially important in the case of a two-dimensional image on the monitor. Subsequent manipulations of the distal part of the inner tube to perform rotational and other maneuvers (with the aim of displacing the neural structures and approaching the intervertebral disc) are performed using the manipulation handle or by turning around the longitudinal axis of the entire device at the same time. The distal end of the inner tube is controlled by the position of the manipulation handle directed toward the aperture and visually by transmitting the video image to the monitor. If necessary and there is sufficient space in the spinal canal after performing a rotational maneuver on the neural structures and taking the inner tube with the lip “protected” by the “lip”, the collet nut nut can be unscrewed again and the outer tube advanced into the spinal canal until it is in close contact with the intervertebral disc . This maneuver allows you to isolate the epidural space from the internal space of the device, which eliminates the penetration of epidural fat and blood into its lumen, thereby improving visualization of the intervertebral disc, as well as reducing the risk of complications associated with increased pressure in the epidural space due to the injection of physiological sodium chloride solution into the process of surgery. After performing all stages of the surgical procedure, the device is removed in the reverse order: the endoscope is removed, the inner tube is moved relative to the external until their distal ends coincide, their position relative to each other is fixed and the device is removed.

Example.

The inventive device is manufactured and tested on biological models. The studies have proved the validity of using the combination of the claimed design features of the device, allowing atraumatic to carry out various maneuvers associated with the movement of the distal ends of the tubes relative to each other (see Fig. 4-7), significantly reducing the time period spent on the implementation of surgical access to the spinal canal, and making surgical procedures on neurovascular structures safer and more functional.

Claims (1)

A device for percutaneous video endoscopic interventions on the spine, which is an elongated elongated hollow outer metal tube with a distal end cut at a right angle, characterized in that the inside of the latter is placed with the possibility of reciprocating and rotational movements relative to its longitudinal axis, an inner hollow metal tube, from the side of the proximal end of which a millimeter scale is applied to its outer lateral surface to assess the degree of mutually the movement of the tubes and placed the manipulation handle, and its distal end is cut off at an angle of 25-30º with the aperture open to the side coinciding with the direction of the manipulation handle, while a collet chuck is located on the side of the proximal end of the outer tube, providing mutual fixation of the position tubes relative to each other, the length of the inner tube exceeds the length of the outer tube by 30 mm, the outer diameter of the outer tube does not exceed 10 mm, and the inner diameter of the inner tube is commensurate with the outer diameter of the endoscope for its free movement inside the device.

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