`U3005569290A
`
`[19]
`United States Patent
`5,569,290
`[11] Patent Number:
`
`McAfee
`[45] Date of Patent:
`Oct. 29, 1996
`
`[54]
`
`[75]
`
`[73]
`
`[21]
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`[22]
`
`[51]
`[52]
`[58]
`
`[56]
`
`METHOD OF AND APPARATUS FOR
`LAPAROSCOPIC OR ENDOSCOPIC SPINAL
`SURGERY USING AN UNSEALED
`ANTERIORLY INSERTED TRANSPARENT
`TROCHAR
`
`Inventor: Paul C. McAfee, 621 E. Belfast Rd.,
`Sparks, Md. 21152
`
`Assignec: Paul C. McAfee, Towson, Md.
`
`Appl. No.: 380,393
`
`Filed:
`
`Jan. 30, 1995
`
`Int. Cl.6 ..................................................... A61B 17/34
`US. Cl.
`........................... 606/185; 606/179; 604/164
`Field of Search ..................................... 606/185, 179;
`604/164, 178, 174
`
`References Cited
`
`U.S. PATENT DOCUMENTS
`
`1,292,998
`2/1919 Bell.
`2,243,718
`5/1941 Moreira ..................................... 128/83
`3,039,468
`6/1962 Price ....................
`128/347
`
`3,750,667
`8/1973 Pshenichny etal.
`128/215
`
`3,789,852
`............
`2/1974 Kim et al.
`128/347
`4,493,707
`1/1985 lshihara
`604/164
`
`4,545,374 10/1985 Jacobson ..............
`128/303 R
`9/1986 Anspach, Jr. et al.
`....... 128/4
`4,608,965
`
`.........
`4,633,860
`1/1987 Korth et a1.
`128/305
`128/329 R
`4,774,948
`10/1988 Markham .....
`
`11/1988 Ward ....................................... 128/754
`4,785,826
`4,819,620
`4/1989 Okutsu ........................................ 128/4
`4,863,430
`9/1989 Klyce et a1.
`.
`604/164
`
`4,911,173
`3/1990 Terwilliger
`128/662.06
`
`6/1992 Allgood .......
`5,122,122
`604/174
`8/1992 Baber .......
`5,139,487
`604/165
`
`12/1993 Wilk ........... 128/20
`5,273,026
`1/1994 Sugarbaker ..
`5,279,575
`604/174
`
`
`3/1994 Pietrafitta ................. 604/1
`5,295,952
`.......................... 606/185
`5,385,572
`1/1995 Nobles et a1.
`
`OTHER PUBLICATIONS
`
`U.S.A. Today newspaper article, Oct. 18, 1993 by Mike
`Snider entitled “TV—aided Back Surgery Cuts Hospital
`Stay”.
`
`Primary Examiner—Michael Powell Buiz
`Assistant Examiner—~Mark S. Leonardo
`
`Attorney, Agent, or Firm—Armstrong, Westerman, Hattori,
`McLeland & Naughton
`
`[57]
`
`ABSTRACT
`
`A method of and apparatus for performing endoscopic or
`laparoscopic surgery on a patient’s spine is provided. The
`apparatus includes a trochar which is specifically design for
`spinal applications. The trochar includes of a first transpar—
`ent
`tubular member of a predetermined diameter and a
`second transparent
`tubular member of a slightly larger
`diameter than the first transparent tubular member. The first
`transparent tubular member fits slidingly within the second
`transparent tubular member in a telescoping manner. The
`first transparent tubular member has two ends: an end for
`remaining in side—to—side contact with said second tubular
`member and a free end which has an attached metal fitting
`with serrated teeth for anchoring in the patient’s vertebrae
`when the trochar is inserted through a incision made in the
`patient’s abdomen or chest. The trochar also includes a
`collar and set screw arrangement. The collar is made up of
`a short tubular portion having a flanged end. The flanged end
`is annularly shaped and protrudes approximately perpen-
`dicularly outwardly from the short tubular portion of the
`collar. The short tubular portion of the collar has a threaded
`aperture therethrough. The threaded aperture threadingly
`mates with a set screw which when turned far enough
`counterclockwise prevents the first tube from telescoping
`within the second tube. Additionally, the collar and set screw
`arrangement also functions to stabilize the trochar in an
`approximately upright position at an angle to the patient’s
`body.
`
`19 Claims, 3 Drawing Sheets
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`
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`NUVASIVE 1009
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`US. Patent
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`Oct. 29, 1996
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`Sheet 1 of 3
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`Oct. 29, 1996
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`1
`METHOD OF AND APPARATUS FOR
`LAPAROSCOPIC OR ENDOSCOPIC SPINAL
`SURGERY USING AN UNSEALED
`ANTERIORLY INSERTED TRANSPARENT
`TROCHAR
`
`FIELD OF THE INVENTION
`
`The present invention relates generally to instruments and
`procedures for performing spinal surgeries and, more par-
`ticularly,
`to a method of and apparatus for performing
`laparoscopic or endoscopic surgical procedures on a
`patient’s spine using a troehar specifically designed for
`spinal applications which includes a dually functioning
`flanged collar and set screw arrangement slidably mounted
`on the outer of two transparent telescoping inner and outer
`tubular members forming an unsealed, open-air passageway
`for insertion of surgical instruments therethrough after the
`troehar is inserted through an incision made in the patient’s
`abdomen or chest so that the free end of the inner tubular
`
`fitting with serrated teeth is
`member having a metal
`anchored into a vertebrae of the patient’s spine for end organ
`docking.
`
`BACKGROUND OF THE INVENTION
`
`instruments called troehars are well known
`Currently,
`within the medical sciences. Indeed, surgeons today often
`use trochars to perform a variety of medical and surgical
`procedures. A medical dictionary defines a troehar as a sharp
`pointed surgical instrument for use with a cannula in order
`to puncture a body cavity for fluid aspiration. However,
`troehars may also be used for paracentesis, i.e., as the means
`providing a passageway into a body cavity.
`troehar usually
`When used for paracentesis, a typical
`includes two tubular members. A first tubular member has a
`
`slightly larger diameter than a second tubular member. This
`allows the second tubular member which is of a slightly
`smaller diameter to be placed to fit within the first tubular
`member of a slightly larger diameter.
`The two tubular members when positioned one within the
`other may be moved relative to each other in a telescoping
`manner. When telescoped, each tubular member has one free
`end and one end remaining in side-to-side adjacent contact
`with the other tubular member.
`
`For use in a surgical procedure, the free end of the inner
`tubular member of the troehar is then usually inserted into a
`body cavity through an incision made in the patient’s body.
`The troehar is used as a passageway through which specially
`designed, long—necked surgical instruments can be inserted
`in order to perform a surgical procedure within the body
`cavity.
`Although troehars have previously been used to perform
`surgical procedures on a patient’s spine, spinal surgeries
`using troehars have not been the favored way of performing
`surgery on the spine. This is due to the following compli-
`cations of spine surgeries using troehars.
`A first complication stems from the fact that a typical
`spinal troehar to date has usually had two telescoping tubes
`made of metal. Metal seems to be the material of choice
`because it can withstand the high temperature necessary to
`sterilize the troehar. However, metal trochars are disadvan-
`tageous because they do not offer the surgeon any view of
`the area on which he or she is performing the surgery.
`To date, surgeons using metal troehars have had to depend
`on x-rays in order to view what is going on inside of the
`troehar. Continued exposure to X—rays can be harmful to the
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`the patient must be protected during
`patient. Therefore,
`surgery from the continual exposure to harmful x-rays by
`use of a heavy leaded gown. The leaded gown can add
`further difficulties to the surgery, particularly, if the patient’s
`position must be moved during the surgical procedure in
`order to access different bodily organs, bones or other
`internal parts.
`Additionally, the use of x—rays is a time—consuming and
`imprecise manner of performing surgery on a patient’s
`spine, especially since the spine is such a delicate and
`sensitive area of the body. Indeed, the spine protects the
`spinal chord which runs along the outside of the vertebrae
`nearer the skin on the patient’s back. The spinal chord
`houses various nerves which allow the patient to walk and
`perform other functions. Because the spinal chord runs
`along the patient’s back on the outside of the spine it is safest
`to perform spinal surgeries anteriorly rather than posteriorly
`in order not to interfere with the spinal chord in any way.
`Another complication with conventional spinal surgical
`procedures using troehars is that to date these surgeries have
`always been performed in such a manner so as to require
`insufflation. Insufflation is defined as the act of blowing a
`powder, vapor, gas, or air into a body cavity.
`The body cavity through which a troehar must be passed
`contains carbon dioxide or CO2 gas. To date, surgeons have
`always felt that the troehar used needs to be sealed against
`ambient air entering the CO2 filled body cavity. Thus, in
`order to keep the ambient air in the operating room from
`entering the body cavity,
`troehars have been scaled and
`carbon dioxide gas has been blown into the passageway
`created by the troehar in order that ambient air not enter the
`body cavity. However, trying to pass a surgical instrument
`through a sealed troehar is difiicult and time consuming and
`there is always some amount of leakage.
`As noted above there are numerous drawbacks associated
`
`with conventional troehars now being used in spinal surgical
`procedures. Because the present invention is the first troehar
`specifically designed for spinal surgeries it tends to avoid
`many of the pitfalls which occur with conventional troehars.
`More particularly, the troehar of the present invention was
`designed for end organ docking which means it goes from
`the patient’s skin and inserts directly into an anchored
`position in the patient’s spine without harming the spine.
`To date,
`few,
`if any,
`troehars have been made of a
`transparent material as is the apparatus of the present
`invention, mainly because no plexiglass-like material could
`be found that could be pushed, pulled and twisted through
`the extrusion process and would not break. The present
`invention uses an acrylic tubing that can withstand the
`extrusion process and the high temperatures necessary to
`sterilize the troehar for surgery.
`It would be desirable to have a troehar which allowed the
`surgeon a more direct View of the area of the patient’s spine
`on which he or she was performing the medical procedure in
`order to perform the spinal surgery with more precision and
`accuracy. The apparatus of the present invention allows for
`better viewing of the area in which the surgeon is performing
`the surgery by means of a miniaturized video camera placed
`adjacent to the outer periphery of the troehar’s transparent
`tubular members. The video camera lights the surgical area
`to be viewed during the course of the surgery and provides
`video images via a fiberoptic cable to allow the surgeon to
`view from a monitor the area on which he is operating.
`Another disadvantage of conventional spinal surgical
`troehars used today is that the troehars are typically designed
`in such a manner that the cylindrical passageway which is
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`created by the trochar for insertion of the surgical instru-
`ments must be kept closed and sealed so that the ambient air
`in the operating room cannot come into contact with the air
`in the passageway of the trochar in order not to contaminate
`the conditions in the body cavity into which trochar has been
`introduced.
`
`With the apparatus of the present invention, the trochar is
`specifically designed to be open at the instrument insertion
`end. It is desired to allow the ambient air to flow into and out
`of the cylindrical passageway created by the trochar between
`the sterilized conditions in the operating room and the
`internal cavity of the patient
`into which the trochar is
`inserted. It has been found that there is no need to seal the
`cylindrical passageway of the trochar from the ambient air
`conditions and thus, there is no need for insufflation. This
`simplifies the surgical procedure and allows the surgeon to
`concentrate on the details of the surgery rather than worrying
`about maintaining the sealed condition of the trochar pas-
`sageway. However, the trochar of the present invention may
`be used either with or without the insufflation of gas to
`perform surgical procedures on the thoracic or the lumbar
`spine.
`An advantage of the method and apparatus of the present
`invention is that in connecting with the external environment
`rather than creating an articifially sealed environment, the
`trochar creates lesser damage and disturbance to the sur—
`rounding tissue. This allows patients a faster recuperative
`period. In fact, tests have shown that patients may be getting
`out of bed and moving around in a matter of days after
`surgery with the trochar of the present invention rather than
`weeks as is required with the conventional surgical appara-
`tus and procedures.
`It is an object of the present invention to provide a trochar
`which is specifically designed for spinal surgery performed
`through an incision made in the patient’s abdomen.
`Another object of the present invention is to provide a
`surgical instrument designed as an end organ trochar so that
`the trochar goes from an incision made through the patient’s
`skin to be inserted into the patient’s spine and anchored by
`means of sharp prongs or serrated teeth into a spinal bone or
`vertebrae.
`
`Another object of the present invention is to provide the
`first trochar which is transparent so that the removal of
`spinal bones or ligaments can be visualized directly with the
`aid of a video camera placed adjacent to the outside wall of
`the transparent trochar.
`Another object of the present invention is to provide a
`trochar for spinal surgery that can be used with or without
`insufilation, i.e., the act or process of blowing a gaseous
`vapor into a body cavity or an airway, on the thoracic or
`lumbar spine.
`Another object of the present invention is to provide a
`trochar for spinal surgery which is open to ambient air
`without having to be sealed against the entry of air into the
`passageway into which the surgical instruments are placed.
`Another object of the present invention is to reduce blood
`loss during the operation and pain drugs needed during and
`after the surgical procedure by means of smaller incisions
`and less tearing and damage to internal tissue.
`Another object of the present invention is to reduce the
`amount of time the patient must remain in the intensive care
`unit in the hospital and in the hospital in general.
`Another object of the present invention is to provide a
`surgical instrument which causes the patient to have better
`post-operative results as previously used equipment.
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`Another object of the present invention is to get patients
`back to normal sooner, often within four (4) to six (6) weeks
`as compared to three (3) months with the prior art procedure.
`
`SUMMARY OF THE INVENTION
`
`The present invention provides a method of and apparatus
`for performing endoscopic or laparoscopic surgery on a
`patient’s spine through an anterior approach. The apparatus
`includes a trocar having two telescoping, clear or transparent
`tubes with a first tube being of a slightly smaller or lesser
`diameter than a second tube in order for the first tube to fit
`
`within the second tube in a slidingly telescoping manner.
`The apparatus also includes a collar with a set screw
`arrangement.
`The collar is slidingly mounted on and around the outer
`tube of larger diameter in order to be able to prevent
`telescoping of the smaller diameter tube within the larger
`diameter tube by means of tightening the set screw which
`threadingly mates with an aperture through the side wall of
`the collar. When the set screw is turned in a clockwise
`manner, it begins to make the outer larger diameter tube
`press against the inner smaller diameter tube of the trochar.
`When the tubes are pressed against each other tightly
`enough, the inner smaller diameter tube will be prevented
`from telescoping within the outer larger diameter tube
`The collar also functions as a stabilizer in that when the
`trochar is fully inserted into the incision made in the
`patient’s abdomen so that the metal fitting on the end of the
`inner smaller diameter tube is anchored on a spinal bone, the
`surgeon will position the collar directly adjacent and resting
`against the patient’s abdomen or chest in order to keep the
`trochar in as stable of an approximately upright position
`relative to the patient’s body as possible.
`The apparatus also includes an anchoring member in the
`form of a toothed cylindrical metal fitting which is used to
`anchor the inner, smaller diameter tubular member directly
`to one of the patient’s spinal bone.
`The method of the performing a variety of endoscopic or
`laparoscopic surgical procedures on a patient’s spine using
`the trochar of the present invention includes the method
`steps of: making a small incision in the patient’s abdomen or
`chest; inserting a trochar which includes a first transparent
`tube of a predetermined diameter and a second transparent
`tube of a slightly greater diameter that slidingly accepts the
`first
`tube in a telescoping manner through the incision;
`anchoring a pronged or toothed metal member threadingly
`placed on one end of the first transparent tube in to one of
`the patient’s spine bones; positioning a set screw and collar
`arrangement slidingly mounted on the second transparent
`tube against the patient’s body so that a flanged end of said
`collar arrangement rests against the patient’s body in order
`to stabilize the trochar in an approximately upright position
`somewhat perpendicular to the patient’s body; and tighten-
`ing a set screw threadingly mounted through the collar
`arrangement slidingly mounted on the second transparent
`tube to prevent further telescoping of the first and second
`transparent tubes during surgery.
`The method further includes the step of passing a minia-
`turized video camera with lens and fiberoptic cable through
`the incision in order for the camera lens to be positioned
`adjacent the outer periphery of the first and second trans—
`parent telescoping tubes. The method further includes the
`method step of turning on the miniaturized video camera in
`order to View an area of the patient’s spine to be operated on.
`The method further includes the method step of transmitting
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`video images of the area of the patient’s spine being oper-
`ated on to assist a surgeon in performing a particular surgical
`procedure on the patient’s spine. The method further
`includes the method step of inserting a surgical instrument
`into a passageway created by the first and second transparent
`telescoping tubes in order to use the instrument to perform
`a particular part of said surgical procedure on the patient’s
`spine and then removing the surgical instrument from the
`passageway. The method further includes the method step of
`removing the trochar from the incision made in the patient’s
`body. The method further includes the method step of
`suturing the incision made in the patient’s abdomen or chest
`in order to complete the surgical procedure.
`
`BRIEF DESCRIPTION OF THE DRAWING
`FIGURES
`
`FIG. 1 is a perspective view of the apparatus of the present
`invention.
`
`FIGS. 2 is a plan view of the first tubular member or the
`end organ docking member of the trochar of the present
`invention.
`
`FIG. 3 is a plan view of the second tubular member or the
`guide shield of the trochar of the present invention.
`FIG. 4 is a plan view of the collar and set screw arrange-
`ment of the trochar of the present invention.
`FIG. 5 is a plan view of the bottom drive bushing of the
`trochar of the present invention.
`FIG. 6 is a perspective view of a physician performing
`laparoscopic or endoscopic surgery on a patient’s spine
`using the trochar of the present invention with an anterior
`approach.
`
`DETAILED DESCRIPTION OF THE
`INVENTION
`
`The drawing figures depict the method of and apparatus
`for performing endoscopic or laparoscopic surgery on a
`patient’s spine using an anterior approach. Referring to FIG.
`1, the apparatus 10 of the present invention is shown in
`perspective view. The apparatus 10 is a trochar which
`includes two transparent tubular members 12, 14 as are
`shown in more detail in FIGS. 2 and 3.
`
`Referring to FIG. 2, the first or inner tubular member 12
`is also called an end organ docking tubular member because
`it goes all the way from an incision made in the skin to and
`inserts into the spine. The first or inner tubular member 12
`is of a slightly smaller diameter than the second tubular
`member 14.
`
`In the preferred embodiment of the present invention, the
`outer diameter of the first or inner tubular member 12 is
`
`approximately 0.75 of an inch and the inner diameter is
`approximately 0.59 of an inch. The walls of the first or inner
`tubular member are preferably approximately 0.125 of an
`inch thick.
`The first tubular member 12 has two ends 16 and 18. The
`first end 16 is smoothly rounded in order to be inserted into
`the second tubular member 14 for telescopingly sliding. The
`second end 18 of the first
`tubular member 12 is also
`smoothly rounded to accept a metallic fitting called a bottom
`drive bushing 20. The bottom drive bushing 20 has a serrated
`end 22 and a threaded end 24. The threaded end 24 is
`screwed into the second end 18 of the first tubular member
`12 in order to threadingly mate with the inner periphery 26
`of the first or inner tubular member 12.
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`Referring to FIG. 5, the serrated end 22 has teeth which
`are preferably approximately 0.25 of an inch long with the
`entire metal fitting being preferably approximately 0.50 of
`an inch long. The serrated end 22 is preferred because it
`helps drive the trochar into the incision made in the patient’s
`abdomen in order to come to rest and anchor into one of the
`spinal vertebrae.
`Referring to FIG. 3, the second or outer tubular member
`14 is shown. The second or outer tubular member 14 is also
`called the guide shield. This is because the first or inner
`tubular member 12 is inserted into the second or outer
`tubular member 14 in order to be guided by the second or
`outer tubular member 14 in its telescoping motion.
`The second or outer tubular member also has two ends 26
`and 28. Both ends 26, 28 are smoothly rounded with the first
`end acting as the beginning of the cylindrical passageway 30
`into which the surgeon inserts the surgical instruments to
`perform the surgical procedure on the patient’s spine.
`In the preferred embodiment of the present invention, the
`outer diameter of the second or outer tubular member 14 is
`approximately 1
`inch and the inner diameter is approxi-
`mately 0.76 of an inch. The walls of the second or outer
`tubular member 14 are preferably approximately 0.125 of an
`inch thick.
`
`In the preferred embodiment of the invention, the tubular
`members 12, 14 are each approximately twelve (12) inches
`long. However, the length of the tubular members 12, 14 is
`not limiting and the tubular members can be made of any
`length that is suitable to the purpose for which the trochar 10
`is to be used.
`
`The tubes are preferably made of a clear or transparent
`polycarbonate (PCB) plastic similar to plexi-glass except
`having glass reinforced Lexan resins in order to bring the
`performance of the polycarbonate to levels approaching
`metals. However, any material with suitable properties of
`transparency and toughness may be used.
`Referring to FIG. 4, a collar 32 and thumb set screw 34
`arrangement or the purse string and suture sleeve is shown.
`The collar 32 is made of metal, preferably steel, and has a
`tubular portion 36 with an outwardly transverse extending
`flange 38. The tubular portion 36 of the collar 32 has an
`inner diameter of approximately 1 inch or slightly larger in
`order to fit slidingly on and around the second or outer
`tubular member 14.
`
`At one end of the tubular portion 36 of the collar 32 is a
`flange 38 which is an annular shaped member protruding
`approximately perpendicularly outwardly from the tubular
`portion 36 of the collar 32. The tubular portion 36 of the
`collar 32 has a threaded aperture 40 therethrough in order to
`threadingly mate or accept a threaded thumb set screw 34.
`The set screw 34 turns in a counterclockwise manner in
`
`order to be threaded into the aperture 40 in the tubular
`portion 36 of the collar 32. When the set screw 34 is turned
`far enough clockwise, the end 42 of the set screw 34, which
`is preferably nylon tipped, begins to protrude past the inner
`peripheral surface 44 of the tubular portion 36 of the collar
`32 and pushes against the outer peripheral wall 46 of the
`second transparent tubular member 14. In so doing,
`the
`second transparent tubular member 14 is constricted and
`tightens about the first transparent tubular member 12.
`When the set screw 34 is turned far enough counterclock-
`wise, the first or inner telescoping transparent tubular mem-
`ber 12 is prevented from telescoping within the second
`transparent tubular member 14. This is necessary because it
`is not desirable to have the trochar telescoping during the
`surgical procedure the surgeon is performing on the patient’s
`spine.
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`The collar 32 itself serves a second function other than
`preventing the telescoping of the first and second transparent
`tubular members 12, 14. The collar 32 also acts as a
`stabilizer. Once the trochar 10 is positioned within the
`incision made in the patient’s abdomen, the flanged end 38
`of the collar 32 is positioned so as to rest against the patient’ 5
`body. In this manner, the collar 32 acts to stabilize the
`trochar 10 in an upright position, approximately perpendicu—
`lar to the patient’s body. It is important during surgery that
`the trochar 10 be stable in order for the surgeon to insert
`surgical instruments through the cylindrical passageway 30
`within the trochar 10 to be able to perform various medical
`procedures on the patient’s spine.
`A prototype of the trochar 10 of the present invention has
`been built and tested. The two transparent telescoping tubu-
`lar members 12, 14 of the trochar 10 were made of a
`plexiglass-like material such as polycarbonate (PCB) plas-
`tic. The polycarbonate was manufactured with a glass rein—
`forced Lexan resin in order to bring the performance to
`levels approaching metals. This material was chosen
`because of its transparency, toughness and durability.
`In operation, the trochar of the present invention is used
`as follows. First, a patient is gotten ready for surgery or
`prepped and given anesthesia. Referring to FIG. 6,
`the
`surgeon then makes an incision in the patient’s abdominal or
`chest cavity. The trochar 10 is inserted through the patient’s
`abdomen or chest and is anchored in one of the spinal bones
`via the pronged or serrated metal fitting 20 on the second end
`of the first transparent tubular member 12.
`The first and second transparent tubular members 12, 14
`are telescoped to an appropriate length for surgery and the
`collar 32 and set screw 34 arrangement that is slidingly
`mounted on said second transparent tubular member 14 is
`positioned against said patient’s body so that a flat flanged
`end 38 of the collar 32 rests against the patient’s body in
`order to stabilize the trochar 10 in an upright position
`approximately perpendicular to the patient’s body. Then, the
`set screw 34 that is threadingly mounted on the collar 32
`slidingly mounted on said second transparent tubular mem—
`ber 14 is turned counterclockwise to be tightened in order to
`prevent further telescoping of said first and second trans-
`parent tubular members 12, 14 during surgery.
`A thoracoscope or miniaturized television or video cam—
`era 48 with lens 50 and fiberoptic cable 52 is passed through
`the incision made in the patient’s abdomen in order to be
`placed adjacent the outer peripheral side wall of the first and
`second telescoping transparent tubular members 12, 14. The
`thoracoscope or miniaturized television or video camera 48
`is turned on in order to light the area of said patient’s spine
`being operated on. A video image of the area of the patient’s
`spine being operated on is transmitted to a screen to assist
`the surgeon in performing a particular surgical procedure on
`the patient’s spine.
`The surgeon is then ready to insert various surgical
`instruments into the passageway 30 created by the first and
`second transparent telescoping tubular members 12, 14, in
`order to perform the appropriate surgical procedures on the
`patient’s spine. Once the surgeon has completed the surgery,
`the trochar be and miniaturized video camera 48 are
`removed from the incision made in the patient’s abdomen
`and the incision in the patient’s abdomen is sutured in order
`to complete said surgical procedure and allow the patient to
`recover and heal.
`
`The present invention has been shown in the drawing
`figures and described in detail in its preferred embodiment
`for the purposes of illustration, however, variations and
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`departures can be made therefrom by one of ordinary skill in
`the art without departing from the spirit and scope of the
`invention as claimed below.
`I claim:
`
`1. An apparatus for use in endoscopic or laparoscopic
`surgery on a patient’s spine comprising:
`means for forming a passageway to said patient’s spine
`through an incision made in said patient’s abdominal or
`chest for the insertion of specially designed long—
`necked surgical instruments therethrough to perform a
`surgerical procedure on said patient’s spine wherein
`said means forming said passageway includes an inner
`tubular member of a first diameter and an outer tubular
`member of a second diameter which is slightly larger
`than said first diameter in order for said inner tubular
`member to fit telescopingly within said outer tubular
`member;
`
`means for dually functioning to prevent telescoping of
`said inner tubular member within said outer tubular
`member and to stabilize said means for forming a
`passageway in a position for use during surgery against
`movement relative to said patient’s spine; and
`means positioned on an end of said inner tubular member
`for anchoring said means for forming a passageway to
`a vertebrae in said patient’s spine, wherein said means
`for anchoring is a tubular metal fitting and wherein said
`tubular metal fitting has a plurality of serrated teeth on
`one end and on an opposite end a threaded outer
`periphery which mates with an inner periphery of said
`inner tubular member.
`2. The apparatus as in claim 1 wherein said serrated teeth
`are approximately 0.25 inches long and have an approxi—
`mately 60° angle.
`3. The apparatus as in claim 2 wherein said means for
`dually functioning to prevent telescoping and to stabilize is
`a collar and set screw arrangement.
`4. The apparatus as in claim 3 wherein said collar has a
`means for slidingly mounting on said outer tubular member.
`5. The apparatus as in claim 4 wherein said means for
`mounting on said outer tubular member is a short metal tube
`portion having a flanged end such that said flanged end
`protrudes approximately perpendicularly outwardly from
`said short metal tube portion.
`6. The apparatus as in claim 5 wherein said short metal
`tube portion has a threaded aperture therethrough which
`mates with a set screw in order to prevent telescoping of said
`inner transparent tube within said outer transparent tube.
`7. The apparatus as in claim 6 wherein said set screw has
`a nylon tip in order to tighten said set screw without harming
`either of said tubular members.
`8. The apparatus as in claim 7 wherein said short metal
`tube portion with said flanged end is made of steel.
`9. The apparatus as in claim 8 wherein said inner and
`outer tubular members are made of a transparent material.
`10. The apparatus as in claim 9 wherein said transparent
`material is a plastic which is resilient enough to be capable
`being extruded and can withstand the high temperatures
`necessary for sterilization.
`11. The apparatus as in claim 10 wherein said plastic is
`polycarbonate with glass reinforced Lexan resins in order
`for said polycarbonate to perform at levels approaching
`metals.
`
`12. The apparatus as in claim 11 further comprising a
`miniaturized video camera including a lens and having an
`attached fiberoptic cable wherein said video camera is
`passed through said incision made in said patient’s abdomen
`or chest and positioned adjacent an outer periphery of said
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`first telescoping transparent tubular member in order to light
`an area of said patient’s spine to be operated on and to
`transmit video images of said area.
`13. A method of performing endoscopic or laparoscopic
`surgery on a patent’s spine comprising the method steps of:
`making an incision in said p