WO2016053733A1

WO2016053733A1 - Surgical instrument and method of use thereof

Info

Publication number: WO2016053733A1
Application number: PCT/US2015/051862
Authority: WO
Inventors: Scott W. BELVIDERE
Original assignee: Smith & Nephew, Inc.
Priority date: 2014-10-03
Filing date: 2015-09-24
Publication date: 2016-04-07

Abstract

A surgical instrument for use during arthroscopic surgery comprising an elongated member, a handle, a tool disposed at the opposite end from the handle of the elongated member, and a reflecting member slidably received within an elongated track formed between the handle and the tool. Methods of using the surgical instrument are also disclosed.

Description

SURGICAL INSTRUMENT AND METHOD OF USE THEREOF

BACKGROUND

The invention described herein relates generally to medical instruments and, more particularly, to surgical instruments having a tool positioned at a working end thereof.

Arthroscopic surgery is a minimally-invasive surgical procedure during which an interior portion of the human body, such as a knee or shoulder joint, is examined or operated on using an arthroscope. An arthroscope is a type of endoscope or miniature camera that is passed through a cannula which is inserted into the joint through a small incision in the skin to enable a surgeon to view the joint and/or perform a surgical operation without fully opening the joint. Arthroscopy may also be used to diagnose and measure chondral defects in the cartilage of the shoulder, knee, ankle, hip, and elbow joints.

During arthroscopic surgery, a surgeon may also use an additional surgical instrument to push, pull or otherwise manipulate tissue in a patient's joint to evaluate tissue pathology. For example, the surgeon can make a diagnosis by observing how an additional instrument, such as a probe, pulls tissue apart or separates tissue from bone. The additional instrument may also be used as part of a surgical operation, such as shaving of bone tissue. The additional instrument is introduced into the patient through another incision in the skin and passed through a cannula that is adjacent to one used to introduce the arthroscope into the area of interest.

Sometimes it is difficult for the surgeon to see with the arthroscope underneath and around tissue, such as the undersurface of the patella or distal tibia, or the articular cartilage in the hip or shoulder. In the past, the surgeon might replace the arthroscope with another one having a different field of view (e.g., changing from an arthroscope with a 15° field of view to one with a 30° field of view), or the surgeon might even make an additional incision to insert the arthroscope into a different position to obtain an additional view. These approaches require additional time for the patient to be under anesthesia or in a tourniquet, sterilization time, and, in some cases, adds further trauma to and prolongs recovery time in the patient.

Accordingly, there is a need for a low-profile, adjustable tool that would increase the field of view of an arthroscope without requiring a surgeon to make multiple incisions in a patent when performing a diagnosis and/or a surgical operation during arthroscopic surgery. An additional advantage to such a tool would be that it could be used to measure a chondral defect in the cartilage of a joint while performing arthroscopic surgery. SUMMARY

The invention described herein is a surgical instrument used in arthroscopic surgery with a reflecting member, such as a mirror, which is movable along a track that runs between the handle of the instrument and a tool disposed at the end of the instrument. The reflecting member reflects the line of sight of an arthroscope during an arthroscopic surgery, improving the surgeon's view of a surgical site through the arthroscope. The surgical instrument of the current invention enables a surgeon to see aspects and regions previously difficult or impossible to see, as well as to aid in palpatory diagnosis of tissue pathology or in a surgical operation, without having to change portals within a joint of the human body, such as a hip, shoulder, or knee. For example, the invention described herein allows for full visualization of the undersurface of the patella during a knee operation, more visualization of the articular cartilage around the curve of the humeral head during a shoulder or hip operation, and/or complete visualization of the undersurface of the distal tibia during an ankle operation. The invention described herein could also be used to measure a chondral defect in the cartilage of a joint while performing arthroscopic surgery.

An example of the invention described herein may include a surgical instrument comprising an elongated member having a proximal end, a distal end, and a longitudinal axis extending between the proximal and distal ends; a handle extending from the proximal end of the elongated member; a tool disposed at the distal end of the elongated member; an elongated track formed integrally with the elongated member between the handle and the tool; and a reflecting member slidably received within the track, the reflecting member including a first end closer to the proximal end of the elongated member, a second end closer to the distal end of the elongated member, and a surface extending between the first and second ends.

In other examples, the surgical instrument may also include at least one locking means for releasably locking the reflecting member to the track which may be a set screw. The track may include first and second side panels perpendicular to a surface of the elongated member, and a top panel parallel to the surface of the elongated member extending between the first and second side panels. An outer surface of at least one of the top, first and side panels of the track may include at least one groove. The reflecting member may include first and second lateral walls perpendicular to the surface of the elongated member, an inner surface of the first and second lateral walls having at least one projection received within the at least one groove. The at least one projection may also include at least one bore for receiving a locking means.

In further examples of the invention described herein, a length of a side of the reflecting member may be longer than a length of both the first end and second ends, and a long dimension of the reflecting member may be parallel to the longitudinal axis of the elongated member. A short dimension of the reflecting member may be transverse to the longitudinal axis of the elongated member. A length of the first end of the reflecting member may be longer than a length of the second end of the reflecting member, or a length of the second end of the reflecting member may be longer than a length of the first end of the reflecting member. A height of the first end of the reflecting member with respect to a surface of the elongated member may be greater than a height of the second end, or a height of the second end of the reflecting member with respect to a top surface of the elongated member may be greater than a height of the first end. The surface of the reflecting member may comprise polished metal and may be planar, convex or concave with respect to a surface of the elongated member. A circumferential surface of the elongated member may also comprises a plurality of measurement markings spaced apart at a uniform distance.

Examples of the methods of the invention described herein may include adjusting a reflective member slidably received within a track of a surgical instrument described herein; securing the reflective member to the track; providing the surgical instrument in an area adjacent to the arthroscope during arthroscopic surgery; and reflecting a line of sight of the arthroscope with the reflective member.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other objects, features and advantages will be apparent from the following more particular description of the examples, as illustrated in the accompanying drawings. FIGs. la-d are schematic views of various examples of the reflecting member of the current invention;

FIGs. 2a-e are schematic perspective views of further examples of the reflecting member;

FIG. 3a is a schematic view of an example the surgical instrument of the current invention;

FIGs. 3b-e and FIG. 4 are schematic views of further examples of the surgical instrument;

FIG. 5 is a perspective view of an arthroscopic procedure of a knee joint using an arthroscope and an example of current invention;

FIGs. 6a-c are schematic views of further examples of the reflecting member;

FIGs. 7a-c are schematic views of further examples of the reflecting member, including an articulating arm; and

FIG. 8 is a detailed schematic view of the articulating arm of FIGS. 7a-c.

DETAILED DESCRIPTION

In the description that follows, like components have been given the same reference numerals, regardless of whether they are shown in different examples. To illustrate an example(s) of the present invention in a clear and concise manner, the drawings may not necessarily be to scale and certain features may be shown in somewhat schematic form.

Features that are described and/or illustrated with respect to one example may be used in the same way or in a similar way in one or more other examples and/or in combination with or instead of the features of the other examples.

As used in the specification and in the claims, the singular form of "a", "an", and "the" include plural referents unless the context clearly dictates otherwise.

As used in the specification and in the claims, for the purposes of describing and defining the invention, the terms "about" and "substantially" are used represent the inherent degree of uncertainty that may be attributed to any quantitative comparison, value, measurement, or other representation. The terms "about" and "substantially" are also used herein to represent the degree by which a quantitative representation may vary from a stated reference without resulting in a change in the basic function of the subject matter at issue.

Referring now to FIG. la, a reflecting member 10 of an example of the current invention is shown in its coronal view. The reflecting member 10 may have a rectangular shape with smooth corners and at least one mirror surface 12. The at least one mirror surface 12 of the reflecting member 10 can be made of or coated with polished metal or other suitable materials to create a reflection of structures opposing it. Many variations of the reflecting member 10 are possible and are described in greater detail below.

FIG. lb shows an axial view of an example of the reflecting member 10. In this example, the reflecting member 10 includes first and second lateral walls 14, 16 with the mirror surface 12 extending therebetween. The internal surfaces of first and second lateral walls 14, 16 may comprise one or more projections 18.

FIG. lc is a sagittal view of an example of the reflecting member 10 showing openings 20 which allow for a securing means 22, such as set screws or other suitable securing means, to be passed through the openings 20. The securing means 22 may optionally comprise a quick-release button (not shown).

FIG. Id shows an axial view of an example the mirror-track assembly 26. A cross- section of the mirror- track assembly 26 at the level of the securing means 22 (shown in this example as set screws) shows the at least one projections 18 interdigitating with one or more grooves 28 on the outer surfaces of the track 24. Bores 19 run transversely through the first and second lateral walls 14, 16 of the reflecting member 10. When the reflecting member 10 is moved to a desired position along the track 24, it can then be secured in place with securing means 22 received within the bores 19.

FIGs. 2a-e are perspective views of further examples of the reflecting member 10. FIG. 2a shows an example of the reflecting member 10 with a proximal end 30 and a distal end 32, as well as openings 20 and securing means 22. In FIG. 2a, the proximal end 30 and the distal end 32 are of substantially equal lengths. FIG. 2b shows an angled reflecting member 10 with the distal end 32 longer than the proximal end 30. FIG. 2c shows an angled reflecting member 10 with the proximal end 30 longer than the distal end 32. The examples shown in FIGS. 2b and 2c may be used to better look around corners at increased angles. In FIGs. 2d and 2e, the mirror surface 12 is shown as concave or convex, respectively, to provide magnification or a wider field of view.

FIG. 3a shows an example of the mirror-track assembly 26 in combination with a surgical instrument 40. The surgical instrument 40 is shown as including a proximal end 34 and a distal end 36 with a longitudinal shaft 44 extending therebetween. At the proximal end 34 is a handle 46. The distal end 36 of the surgical instrument 40 includes a tool 42, which transitions to a widened area 38 where the shaft 44 of the surgical instrument 40 begins. The tool 42 may have an axis transverse to the longitudinal axis of the shaft 44 but is not limited thereto. In FIG. 3a, the tool 42 is shown for illustrative purposes as a probe; however, the tool 42 could be configured to provide any one or more of a plurality of surgical functions, such as ablating, burring, biting, sawing, shaving, suctioning and/or the like.

In FIG. 3a, an example of a reflecting member 10 is shown as mounted onto the track 24, with the length of the reflecting member 10 being parallel to a longitudinal axis of the shaft 44 and the width of the reflecting member 10 being transverse to the longitudinal axis of the shaft 44. The width of the reflecting member 10 at its widest point is variable but is preferably at least about 3mm wide, and more preferably about 5mm to about 7.5mm, which corresponds to the widths of standard surgical cannulas used during arthroscopic surgery. The length of the reflecting member 10 is also variable and is determined based on the desired function of the surgical instrument 40 or tool 42. Various types of reflecting members 10 could be mounted onto the track 24, including the examples shown in FIGS. 2a-e.

As further illustrated in FIG. 3a, the track 24 can be formed integrally with the shaft 44 of the surgical instrument 40. The one or more grooves 28 of the track 24 can run proximally up to the handle 46 of the surgical instrument 40 to allow for adjustability of the reflecting member 10. The track 24 is shown in FIG. 3a as continuous, however it may also be segmented up the shaft 44 of the surgical instrument 40 or it may only run a partial length along the shaft 44. The securing means 22 may be loosened and the reflecting member 10 may be adjusted proximally or distally to the surgeon's preference. The placement of the reflecting member 10 from the tool 42, as well as the degree of reflectivity of the reflecting member 10, is variable and determined based on the desired function of the surgical instrument 40 or tool 42. FIG. 3a also shows an example of graduations 48 marked on the shaft 44 of the surgical instrument 40. The graduations 48 may be laser markings and circumferentially placed in uniform increments (such as 5mm increments) to allow for measuring surrounding structures when used during surgery. When the surgical instrument 40 is placed in a joint to assist in visualization, the reflecting member 10 may identify a structure that would otherwise be difficult to visualize. After the area in question is found, the surgical instrument 40 may be rotated 180 degrees on its longitudinal axis to assess the size of the defect or structure.

In FIG. 3a, the reflecting member 10 is shown with the height of the proximal end 30 of the reflecting member 10 with respect to the shaft 44 greater than a height of the distal end 32. However, as shown in FIG. 3b, the reflecting member can be flat or planar with respect to the shaft 44 of the surgical instrument 40 - that is, the proximal end 30 and the distal end 32 can lie in substantially the same plane. Furthermore, as shown in FIG. 3c, the height of the distal end 32 of the reflecting member 10 with respect to the shaft 44 can be greater than a height of the proximal end 30. This height adjustability further enables changes in the field of view of the mirror surface 12. Additionally, the surface 12 of the reflecting member 10 can be concave (FIG. 3d) or convex (FIG. 3e) with respect to the shaft 44.

FIG. 4 shows an example of the surgical instrument 40 with the same angled reflecting member 10 of FIG. 3a mounted on the opposite side of the track 24. This feature would allow for normal function of the surgical instrument 40. In an example where only one side of the reflecting member 10 comprises a mirror surface 12, the surgical instrument 40 would simply be rotated 180 degrees to allow access to the mirror surface 12. The surgical instrument 40 may be rotated again to continue use of the tool 42.

In an example of a method as shown in FIG. 5, when a surgeon performs an arthroscopic procedure, whether an examination or an operation, the surgeon selects the surgical instrument 40 that includes the teachings of the present invention, such as the probing device as shown in FIG. 3A. Depending upon the area to be viewed, the surgeon slides the reflecting member 10 along the track 24 and secures it in the desired position with securing means 22. After making incisions adjacent to an area of interest of the body, such as a knee joint 60, the surgeon independently inserts a portion of the arthroscope 62 and the probe end 70 of the surgical instrument 40 into the incisions and through surgical cannulas (not shown) so that the portion of the arthroscope 62 and the probe end 70 of the surgical instrument 40 substantially converge on the knee joint 60. If the surgeon is having difficulty viewing the area of interest directly via the arthroscope 62, the surgeon rotates the surgical instrument 40 so that the reflecting member 10 reflects an image of the area of interest to the arthroscope 62.

FIGS. 6a-c show additional examples of the reflecting member 10. In FIGs. 6a-c, the reflecting member 10 is shown as a 1 cm 2 circle, a 3 cm 2 circle, and an oval, respectively. These examples of the reflecting member 10 can be used to measure a chondral defect in a joint while doing arthroscopy, with area measured as 7Ur . Some chondral defects do not meet a circular shape but often an oval shape instead. The reflecting member 10 could be constructed to represent the surface area it possesses and also improve visualization while sizing of the chondral defect. The sizer is also the reflecting member 10.

FIGS. 7a-c show examples of the reflecting member 10 as a polished metal dome 50 mounted onto a handle 52 that may be introduced into a joint and into a chondral defect. The size of the dome 50 may vary depending on the size of the chondral defect. The dome 50 may need to be angled in order to fully seat into the chondral defect. An articulating arm 54 that is spring-loaded in its center (see FIG. 8) may allow for bending the articulating arm 54 and locking back into place. The disc wheel 56 as shown in FIG. 8 with a spring 58 loaded in the center may be pushed apart and moved, then allowed to retract back together in its new position at the desired angle.

These and other features and characteristics, as well as the methods of operation and functions of the related elements of structure and the combination of parts and economies of manufacture, will become more apparent upon consideration of the following description and the appended claims with reference to the accompanying drawings, all of which form a part of this specification, wherein like reference numerals designate corresponding parts in the various figures. It is to be expressly understood, however, that the drawings are for the purpose of illustration and description only and are not intended as a definition of the limits of claims.

Claims

CLAIMS What is claimed is:

1. A surgical instrument comprising:

an elongated member having a proximal end, a distal end, and a longitudinal axis extending between the proximal and distal ends;

a handle extending from the proximal end of the elongated member;

a tool disposed at the distal end of the elongated member;

an elongated track formed integrally with the elongated member between the handle and the tool; and

a reflecting member slidably received within the track, the reflecting member comprising a first end closer to the proximal end of the elongated member, a second end closer to the distal end of the elongated member, and a surface extending between the first and second ends.

2. The surgical instrument of claim 1, further comprising at least one locking means for releasably locking the reflecting member to the track.

3. The surgical instrument of claim 2, wherein the locking means is a set screw.

4. The surgical instrument of claim 1, wherein the track comprises first and second side panels perpendicular to a surface of the elongated member, and a top panel parallel to the surface of the elongated member extending between the first and second side panels.

5. The surgical instrument of claim 4, wherein an outer surface of at least one of the top, first and side panels of the track comprise at least one groove.

6. The surgical instrument of claim 5, wherein the reflecting member comprises first and second lateral walls perpendicular to the surface of the elongated member, an inner surface of the first and second lateral walls comprising at least one projection received within the at least one groove.

7. The surgical instrument of claim 6, wherein the at least one projection comprises at least one bore for receiving a locking means.

8. The surgical instrument of claim 1, wherein a length of a side of the reflecting member is longer than a length of both the first end and second ends.

9. The surgical instrument of claim 1, wherein a long dimension of the reflecting member is parallel to the longitudinal axis of the elongated member.

10. The surgical instrument of claim 1, wherein a short dimension of the reflecting member is transverse to the longitudinal axis of the elongated member.

11. The surgical instrument of claim 1, wherein a length of the first end of the reflecting member is longer than a length of the second end of the reflecting member.

12. The surgical instrument of claim 1, wherein a length of the second end of the reflecting member is longer than a length of the first end of the reflecting member.

13. The surgical instrument of claim 1, wherein a height of the first end of the reflecting member with respect to a surface of the elongated member is greater than a height of the second end with respect to the surface of the elongated member.

14. The surgical instrument of claim 1, wherein a height of the second end of the reflecting member with respect to a top surface of the elongated member is greater than a height of the first end with respect to the top surface of the elongated member.

15. The surgical instrument of claim 1, wherein the surface of the reflecting member comprises polished metal.

16. The surgical instrument of claim 1, wherein the surface of the reflecting member is planar with respect to a surface of the elongated member.

17. The surgical instrument of claim 1, wherein the surface of the reflecting member is convex with respect to a surface of the elongated member.

18. The surgical instrument of claim 1, wherein the surface of the reflecting member is concave with respect to a surface of the elongated member.

19. The surgical instrument of claim 1, wherein a circumferential surface of the elongated member comprises a plurality of measurement markings spaced apart at a uniform distance.

20. A method of increasing the line of sight of an arthroscope during arthroscopic surgery without removing or repositioning the arthroscope, the method comprising the steps of:

adjusting a reflective member slidably received within a track of a surgical instrument according to any preceding claim;

securing the reflective member to the track;

providing the surgical instrument in an area adjacent to the arthroscope during arthroscopic surgery; and

reflecting a line of sight of the arthroscope with the reflective member.