CA2686281A1 - Trajectory guides for surgical instruments - Google Patents
Trajectory guides for surgical instruments Download PDFInfo
- Publication number
- CA2686281A1 CA2686281A1 CA002686281A CA2686281A CA2686281A1 CA 2686281 A1 CA2686281 A1 CA 2686281A1 CA 002686281 A CA002686281 A CA 002686281A CA 2686281 A CA2686281 A CA 2686281A CA 2686281 A1 CA2686281 A1 CA 2686281A1
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- CA
- Canada
- Prior art keywords
- stem
- movable member
- surgical
- positioning
- guide stem
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
- A61B90/11—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis with guides for needles or instruments, e.g. arcuate slides or ball joints
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00243—Type of minimally invasive operation cardiac
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
- A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
- A61B2017/00539—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated hydraulically
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00831—Material properties
- A61B2017/00902—Material properties transparent or translucent
- A61B2017/00911—Material properties transparent or translucent for fields applied by a magnetic resonance imaging system
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
- A61B2090/3954—Markers, e.g. radio-opaque or breast lesions markers magnetic, e.g. NMR or MRI
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
Abstract
Examples of a surgical device for use on a patient are disclosed. The surgical device includes a base unit for mounting to a body surface. A tubular body of the base unit has a seat positioned near a first end and an opening extending through the tubular body between a second end and the seat. The base unit includes a first bail and a second bail attached to the base unit, with at least one of the first bail and said second bail including markings. A movable member includes a passage therein. The movable member is configured to at least partially fit within and move with respect to the seat of the base unit. The opening through the tubular body and the passage of the movable member are configured to allow a surgical instrument to pass therethrough. The markings of the at least one of the first bail or second bail correspond to adjustment increments of the movable member and are configured to allow repositioning of the movable member to align the opening with a trajectory to a target within a patient. An attachment mechanism for attaching the base unit to the patient is positioned near the second end of the tubular body of the base unit. The seat and the attachment mechanism are separated by a distance.
Claims (173)
1. A surgical device comprising:
a base unit;
a ball having passage therein, said ball fitting within the base unit, said ball capable of rotating with respect to the base unit;
a positioning stem having a locator on each end of said positioning stem;
and a locking member and platform which engages the ball and fixes the position of the ball and positioning stem upon tightening the locking member when the ball is properly positioned.
a base unit;
a ball having passage therein, said ball fitting within the base unit, said ball capable of rotating with respect to the base unit;
a positioning stem having a locator on each end of said positioning stem;
and a locking member and platform which engages the ball and fixes the position of the ball and positioning stem upon tightening the locking member when the ball is properly positioned.
2. The surgical device of claim 1, wherein said locator on said positioning stem includes light emitting diodes.
3. The surgical device of claim 1, wherein said locator on said positioning stem includes a cavity which carries a liquid which is visible to a nuclear magnetic resonance imaging system.
4. The surgical device of claim 1, wherein said locator on said positioning stem includes at least one radiofrequency coils.
5. The surgical device of claim 1, wherein said platform further comprises a stage which is movable in the plane of the platform.
6. The surgical device of claim 1 further comprising a guide stem, said guide stem having an opening therein and attached to said surgical device such that the opening in the guide stem substantially aligns with the passage in the ball.
7. The surgical device of claim 6 holds the positioning stem fits within the opening of the guide stem.
8. The surgical device of claim 7 wherein the locator is readable by an imaging apparatus.
9. The surgical device of claim 7 further comprising an actuator attached to said guide stem, said actuator used to move the guide stem and ball having a passage therein.
10. The surgical device of claim 6 further comprising;
a suspension tube attached to said base unit; and a stage attached to said suspension tube, said stage moving the ball with the opening therein in a plane transverse to the opening in the guide stem and the passage in the ball.
a suspension tube attached to said base unit; and a stage attached to said suspension tube, said stage moving the ball with the opening therein in a plane transverse to the opening in the guide stem and the passage in the ball.
11. The surgical device of claim 6 further comprising an actuating system for positioning the guide stem and ball.
12. The surgical device of claim 6 further comprising an actuating system for moving an instrument through the opening in the guide stem and through the passage in the ball.
13. An apparatus comprising:
a base;
a movable member having a passage therein movably attached to said base;
a positioning stem further comprising:
a first locator; and a second locator, said first locator associated with a first portion of said positioning stem and said second locator associated with a second portion of said positioning stem, said positioning stem removably attached to said movable member and used to position the movable member and the passage therein;
a locking member for fixing the position of the movable member and the passage therein.
a base;
a movable member having a passage therein movably attached to said base;
a positioning stem further comprising:
a first locator; and a second locator, said first locator associated with a first portion of said positioning stem and said second locator associated with a second portion of said positioning stem, said positioning stem removably attached to said movable member and used to position the movable member and the passage therein;
a locking member for fixing the position of the movable member and the passage therein.
14. The apparatus of claim 13 wherein said first and second locators are readable by a body scanning mechanism.
15. The apparatus of claim 13 wherein said first and second locators are readable by a magnetic resonance imaging apparatus.
16. The apparatus of claim 15 wherein at least one of said first locator and said second locator includes a fluid readable by a magnetic resonance imaging apparatus.
17. The apparatus of claim 15 wherein at least one of said first locator and said second locator includes a radio frequency coil which is readable by a magnetic resonance imaging apparatus.
18. The apparatus of claim 17 wherein said source of radio frequency which is readable by a magnetic resonance imaging apparatus includes at least one or more radiofrequency coils.
19. The apparatus of claim 13 wherein said first and second locators are substantially aligned with the centerline of the passage in said movable member.
20. The apparatus of claim 13 wherein said first second locators are offset with respect to the centerline of passage in said movable member.
21. The apparatus of claim 13 wherein said first and second locators are offset with respect to the centerline of passage in said movable member.
22. The apparatus of claim 13 further comprising a guide stem, said guide stem having an opening therein and attached to said movable member such that the opening in the guide stem substantially aligns with the passage in the movable member.
23. The apparatus of claim 22 wherein said positioning stem is interchangeable with said guide stem.
24. The apparatus of claim 22 wherein said positioning stem fits within the opening in said guide stem.
25. The apparatus of claim 24 further comprising a first actuator system for positioning the guide stem.
26. The apparatus of claim 25 wherein said passage in said movable member and said opening in said guide stem form a trajectory, said first actuator system moving the positioning guide stem to a position where the trajectory is substantially aligned with a target area within the patient.
27. The apparatus of claim 25 wherein said passage in said movable member and said opening in said guide stem form a trajectory, said first actuator system moving the guide stem to a position where the trajectory is substantially aligned with a target area within the patient.
28. The apparatus of claim 25 further comprising a second actuator system for moving an instrument through the opening in the guide stem.
29. The apparatus of claim 13 wherein the base, the movable member, the positioning stem, and the locking member are made out of materials useable within a magnetic resonance imaging environment.
30. The apparatus of claim 13 wherein at least one of said first second locators includes a light emitting diode.
31. The apparatus of claim 13 further comprising a stage attached to the base, said stage defining a plane which intersects the centerline of the passage in the movable member.
32. The apparatus of claim 13 further comprising a cap and plug for sealing the opening in the base.
33. A method for determining a trajectory for an instrument through a guiding device for use with a scanning device, said scanning device including a central processing unit and a memory, said method comprising the steps of:
selecting a target within a patient;
attaching a positioning stem to a movable member carried by the guiding device, the movable member having a passage therein, said positioning stem having a first portion readable by the scanning device and a second portion readable by the scanning device;
determining the position of the first and second portions of the positioning stem;
determining if the passage in the movable member is substantially aligned with the target within the patient based on the position of the first and second portions of the positioning stem.
selecting a target within a patient;
attaching a positioning stem to a movable member carried by the guiding device, the movable member having a passage therein, said positioning stem having a first portion readable by the scanning device and a second portion readable by the scanning device;
determining the position of the first and second portions of the positioning stem;
determining if the passage in the movable member is substantially aligned with the target within the patient based on the position of the first and second portions of the positioning stem.
34. The method for determining a trajectory for an instrument of claim 33 further comprising the step of locking the movable member when the passage within the movable member is substantially aligned with the target within the patient.
35. The method for determining a trajectory for an instrument of claim 33 further comprising the steps of:
removing the positioning stem from the movable member; and attaching a guide stem to the movable member, said guide stem having an opening therein, said opening in the guide stem substantially aligned with the passage in the movable member when the guide stem is attached to the movable member.
removing the positioning stem from the movable member; and attaching a guide stem to the movable member, said guide stem having an opening therein, said opening in the guide stem substantially aligned with the passage in the movable member when the guide stem is attached to the movable member.
36. The method for determining a trajectory for an instrument of claim 33 further comprising the steps of:
removing the positioning stem from the movable member, said movable member including a guide stem attached to the movable member, said guide stem having an opening therein, said opening in the guide stem substantially aligned with the passage in the movable member, said step of removing the positioning stem including removing the positioning stem from the guide stem.
removing the positioning stem from the movable member, said movable member including a guide stem attached to the movable member, said guide stem having an opening therein, said opening in the guide stem substantially aligned with the passage in the movable member, said step of removing the positioning stem including removing the positioning stem from the guide stem.
37. The method for determining a trajectory for an instrument of claim 33 wherein the step of determining the position of the first and second portions of the positioning stem is performed at least in part by the central processing unit and the memory of the scanning device.
38. The method for determining a trajectory for an instrument of claim 33 wherein the step of determining if the passage in the movable member is substantially aligned with the target within the patient is performed at least in part by the central processing unit and the memory of the scanning device.
39. The method for determining a trajectory for an instrument of claim 33 further comprising the steps of:
providing a stage which defines a plane which intersects the centerline of the opening in the movable member; and moving the stage in the plane to define a trajectory which is substantially parallel to the initially determined trajectory.
providing a stage which defines a plane which intersects the centerline of the opening in the movable member; and moving the stage in the plane to define a trajectory which is substantially parallel to the initially determined trajectory.
40. The method for determining a trajectory for an instrument of claim 33 further comprising the steps of:
providing a stage which defines a plane which intersects the centerline of the opening in the movable member, said stage including the movable member;
and moving the stage in the plane to define a trajectory which is substantially parallel to the initially determined trajectory.
providing a stage which defines a plane which intersects the centerline of the opening in the movable member, said stage including the movable member;
and moving the stage in the plane to define a trajectory which is substantially parallel to the initially determined trajectory.
41. The method for determining a trajectory for an instrument of claim 33 further comprising the step of repositioning the first and second locators on the positioning stem using an actuator system.
42. A surgical device comprising:
a base unit;
a ball having passage therein, said ball fitting within the base unit, said ball capable of rotating with respect to the base unit; and a positioning stem having a first locator and a second locator on said positioning stem, said first locator and said second locator made of a material unreadable by a nuclear magnetic resonance imaging system, and surrounded by a liquid visible to a nuclear magnetic resonance imaging system; and a locking member which engages the ball and fixes the position of the ball with respect to the base unit when the ball is in a selected position.
a base unit;
a ball having passage therein, said ball fitting within the base unit, said ball capable of rotating with respect to the base unit; and a positioning stem having a first locator and a second locator on said positioning stem, said first locator and said second locator made of a material unreadable by a nuclear magnetic resonance imaging system, and surrounded by a liquid visible to a nuclear magnetic resonance imaging system; and a locking member which engages the ball and fixes the position of the ball with respect to the base unit when the ball is in a selected position.
43. The surgical device of claim 42, wherein said positioning stem includes a cavity for carrying the liquid visible to a nuclear magnetic resonance imaging system, said locator shaped such that the locator and liquid form a nuclear magnetic resonance image having a first notch and a second notch for use in aligning the positioning stem.
44. The surgical device of claim 43, wherein said first locator and said second locator are located near the ends of the positioning stem.
45. The surgical device of claim 43, wherein one of said first locator and said second locator are located at one end of the positioning stem.
46. The surgical device of claim 42 further comprising a guide stem, said guide stem having an opening therein and attached to said surgical device such that the opening in the guide stem substantially aligns with the passage in the ball.
47. The surgical device of claim 46 wherein the positioning stem has a threaded portion which engages threads associated with the opening of the guide stem.
48. The surgical device of claim 42 further comprising an actuator attached to said ball, said actuator used to move the ball to a selected position where the passage in the ball aligns with a selected target.
49. A surgical apparatus comprising:
a base;
a movable member having a passage therein movably attached to said base;
a first locator; and a second locator, said first locator associated with a first portion of said movable member and said second locator associated with a second portion of said movable member, said first locator and said second locator used to position the movable member and the passage therein to a selected position; and an actuator attached to said movable member to position the movable member.
a base;
a movable member having a passage therein movably attached to said base;
a first locator; and a second locator, said first locator associated with a first portion of said movable member and said second locator associated with a second portion of said movable member, said first locator and said second locator used to position the movable member and the passage therein to a selected position; and an actuator attached to said movable member to position the movable member.
50. The apparatus of claim 49 wherein said actuator is made of a material compatible with a magnetic resonance imaging apparatus.
51. The apparatus of claim 49 wherein said actuator is further comprised of:
a first subactuator for moving the movable member about a first axis; and a second subactuator for moving the movable member about a second axis.
a first subactuator for moving the movable member about a first axis; and a second subactuator for moving the movable member about a second axis.
52. The apparatus of claim 51 wherein said first subactuator and said second subactuator are hydraulic.
53. The apparatus of claim 51 wherein said first subactuator and said second subactuator include wires.
54. The apparatus of claim 51 wherein said first subactuator and said second subactuator are strings.
55. The apparatus of claim 51 wherein said actuator further comprises a second assembly, said second assembly comprising:
a second base;
a second movable member having a passage therein movably attached to said second base; and a second actuator attached to said second movable member to position the movable member, wherein moving the second movable member produces a corresponding movement in the movable member.
a second base;
a second movable member having a passage therein movably attached to said second base; and a second actuator attached to said second movable member to position the movable member, wherein moving the second movable member produces a corresponding movement in the movable member.
56. The apparatus of claim 55 wherein the second assembly is located a distance away from the base, movable member, first locator, and second locator.
57. The apparatus of claim 56 further comprising hydraulic lines connecting the first assembly and the second assembly, said first and second assembly separated by an intermediate hydraulic ram.
58. A method for introducing a surgical instrument into a target within the body comprising the steps of :
selecting a target within a patient;
holding a movable member near the body and near the target within the patient;
aligning a passage within the movable member with the target within the body using magnetic resonance imaging;
passing a twist drill through the passage;
drilling an opening within the body;
removing the twist drill after the opening within the body is made; and passing the surgical instrument through the passage and through the opening within the body.
selecting a target within a patient;
holding a movable member near the body and near the target within the patient;
aligning a passage within the movable member with the target within the body using magnetic resonance imaging;
passing a twist drill through the passage;
drilling an opening within the body;
removing the twist drill after the opening within the body is made; and passing the surgical instrument through the passage and through the opening within the body.
59. The method for introducing a surgical instrument of claim 58 wherein the step of aligning a passage within the movable member with the target within the body using magnetic resonance imaging further comprises the steps of:
locating a first locator, said first locator nearest the target;
locating a second locator, said first locator associated with a first portion of said movable member and said second locator associated with a second portion of said movable member;
determining the desired trajectory of the opening in the movable member based on the position of the target and the position of first locator; and moving the movable member until the trajectory of the opening aligns with the desired trajectory to the target within the patient.
locating a first locator, said first locator nearest the target;
locating a second locator, said first locator associated with a first portion of said movable member and said second locator associated with a second portion of said movable member;
determining the desired trajectory of the opening in the movable member based on the position of the target and the position of first locator; and moving the movable member until the trajectory of the opening aligns with the desired trajectory to the target within the patient.
60. The method for introducing a surgical instrument of claim 59 wherein the step of moving the movable member is done under software control.
61. The method for introducing a surgical instrument of claim 59 wherein the step of moving the movable member until the trajectory of the opening corresponds to the desired trajectory is done using actuators.
62. The method for introducing a surgical instrument of claim 59 wherein the step of moving the movable member until the trajectory of the opening corresponds to the desired trajectory is done using actuators attached to said movable member.
63. A computer-implemented method for introducing a surgical instrument into a target within the body using a movable member having a first locator and a second locator, said method comprising the steps of:
locating a first locator;
locating a second locator, said first locator associated with a first portion of said movable member and said second locator associated with a second portion of said movable member;
determining a trajectory of the opening in the movable member based on the position of the first locator and the position of second locator; and moving the movable member until the trajectory of the opening aligns with the target within the patient.
locating a first locator;
locating a second locator, said first locator associated with a first portion of said movable member and said second locator associated with a second portion of said movable member;
determining a trajectory of the opening in the movable member based on the position of the first locator and the position of second locator; and moving the movable member until the trajectory of the opening aligns with the target within the patient.
64. A storage medium having a computer program stored thereon for causing a suitably programmed system to interactively apply align a surgical instrument with a target within a human body by performing the following steps when such a program is executed on the system:
locating a first locator, said first locator nearest the target;
locating a second locator, said first locator associated with a first portion of said movable member and said second locator associated with a second portion of said movable member;
determining the desired trajectory of the opening in the movable member based on the position of the target and the position of first locator; and moving the movable member until the trajectory of the opening aligns with the desired trajectory to the target within the patient.
locating a first locator, said first locator nearest the target;
locating a second locator, said first locator associated with a first portion of said movable member and said second locator associated with a second portion of said movable member;
determining the desired trajectory of the opening in the movable member based on the position of the target and the position of first locator; and moving the movable member until the trajectory of the opening aligns with the desired trajectory to the target within the patient.
65. A surgical instrument comprising:
a first arm having a handle on one end and a cup proximate the other end;
a second arm having a handle on one end and a cup proximate the other end, said first arm pivotally attached to the second arm; and a movable member having an opening therein, said movable member held between the cup of the first arm and the cup of the second arm.
a first arm having a handle on one end and a cup proximate the other end;
a second arm having a handle on one end and a cup proximate the other end, said first arm pivotally attached to the second arm; and a movable member having an opening therein, said movable member held between the cup of the first arm and the cup of the second arm.
66. The surgical instrument of claim 65 further comprising a biasing element attached to one of the first arm or the second arm, the biasing member producing a force which biases the cup of the first arm toward the cup of the second arm.
67. The surgical instrument of claim 66 wherein the biasing element produces a force sufficient to hold the movable member between the cup of the first arm and the cup of the second arm.
68. The surgical instrument of claim 67 wherein the handle of the first arm and the handle of the second arm are forced toward one another to allow for adjustable movement of the movable member.
69. The surgical instrument of claim 68 further comprising a stop attached to one of the first arm or the second arm to prevent disengagement of the movable member with the cup of the of the first arm and the cup of the second arm.
70. The surgical instrument of claim 65 further comprising a platform for holding the first or the second arm.
71. The surgical instrument of claim 70 wherein the platform includes a frame attached to an operating table at a height which allows a patient to pass beneath the frame.
72. The surgical instrument of claim 70 wherein the platform includes a snake attached to an operating table.
73. The surgical instrument of claim 70 wherein the platform includes a plate attached to a patient in the area near a target associated with the patient.
74. A method for performing surgery comprising:
placing a surgical instrument in a first position with respect to a patient;
and remotely controlling the surgical instrument from a second position.
placing a surgical instrument in a first position with respect to a patient;
and remotely controlling the surgical instrument from a second position.
75. The method of claim 74 further comprising the step of monitoring the surgical instrument in the first position from the second position.
76. The method of claim 75 wherein the first position is within a nuclear magnetic resonance imaging environment and the second position is outside the nuclear magnetic resonance imaging environment.
77. The method of claim 76 wherein the surgical instrument is monitored with a nuclear magnetic resonance imaging system.
78. A surgical instrument comprising:
a first portion associated with the patient; and a second portion for remotely controlling the first portion.
a first portion associated with the patient; and a second portion for remotely controlling the first portion.
79. The surgical instrument of claim 78 wherein the first portion further comprises a mechanism for observing the first portion from a remote location.
80. The method of claim 74 wherein said placing and/or remotely controlling of the surgical instrument is performed on a first surgical instrument which is viewed by magnetic resonant imaging.
81. The method of claim 80 wherein said viewing by way of magnetic resonant imaging determines the position of said first surgical instrument within a patient, and a determination of accuracy with respect to the position of said first surgical instrument is made from data from said magnetic resonant imaging, and where said determination is indicative of insufficient or inappropriate alignment of said first surgical instrument, said first surgical instrument is realigned.
82. The method of claim 81 wherein after said first surgical instrument is realigned, said first surgical instrument or a second surgical instrument interacting with or independently of said first surgical instrument is advanced by remote control to a target point determined by data generated from magnetic resonant imaging.
83. A surgical device for use on a patient comprising:
a base unit having a tubular body, said base unit further comprising:
a first end; and a second end, said tubular body having a seat therein, said seat positioned near said first end, said tubular body having an opening in said second end; and an attachment mechanism positioned near the second end of the tubular body of the base unit, said attachment mechanism for attaching the base unit to a patient, said seat and said attachment mechanism separated by a distance.
a base unit having a tubular body, said base unit further comprising:
a first end; and a second end, said tubular body having a seat therein, said seat positioned near said first end, said tubular body having an opening in said second end; and an attachment mechanism positioned near the second end of the tubular body of the base unit, said attachment mechanism for attaching the base unit to a patient, said seat and said attachment mechanism separated by a distance.
84. The surgical device of claim 83, wherein the opening in the second end has a sufficient diameter to allow tools to pass through the opening.
85. The surgical device of claim 83, wherein said attachment mechanism further comprises a flange.
86. The surgical device of claim 83, wherein said attachment mechanism further comprises a flange, said flange having a plurality of openings therein, each opening receiving a fastener.
87. The surgical device of claim 86, wherein the fastener is a bone screw.
88. The surgical device of claim 83 further comprising a movable member which includes a portion which fits within said seat.
89. The surgical device of claim 88 further comprising a positioning stem for moving the movable member.
90. The surgical device of claim 88 wherein the positioning stem includes a mechanism for locating the positioning stem in a CT scanning environment.
91. The surgical device of claim 88 wherein the positioning stem includes a dopant for locating the positioning stem using CT scanning equipment.
92. The surgical device of claim 88 wherein the positioning stem includes a mechanism for locating the positioning stem in a frameless stereotaxy environment.
93. The surgical device of claim 88 wherein the positioning stem includes at least two light emitting diodes for locating the positioning stem in a frameless stereotaxy environment.
94. The surgical device of claim 93 wherein the frameless stereotaxy environment includes at least two detectors for light from light emitting diodes.
95. The surgical device of claim 88 wherein the positioning stem includes a mechanism for locating the positioning stem in a magnetic resonance imaging environment.
96. The surgical device of claim 95 wherein the positioning stem includes a dopant for locating the positioning stem in a magnetic resonance imaging environment.
97. The surgical device of claim 88 wherein the base further includes:
a first bail attached to said base; and a second bail attached to said base, said first and second bail used for repositioning the positioning stem.
a first bail attached to said base; and a second bail attached to said base, said first and second bail used for repositioning the positioning stem.
98. The surgical device of claim 97 wherein at least one of the first bail or the second bail is rotatably attached to the base unit of the surgical device.
99. The surgical device of claim 97 wherein the first bail includes markings thereon and the second bail includes markings thereon.
100. The surgical device of claim 88 further comprising a remote mechanism for controlling the positioning member from a position away from the positioning member.
101. The surgical device of claim 100 further comprising a locking mechanism for holding an instrument in position, said locking mechanism actuatable from a position remote from the positioning member.
102. The surgical device of claim 100 wherein the locking mechanism for holding an instrument in position includes a locking collar for clamping the surgical instrument.
103. The surgical device of claim 100 wherein the remote mechanism for controlling the positioning member includes a duplicate surgical device remotely located from the positioning member.
104. The surgical device of claim 103 wherein the remote mechanism for controlling the positioning member includes a plunger remotely located from the positioning member.
105. The surgical device of claim 100 further comprising a computer, said computer determining the initial position of the positioning stem and determining a position where the positioning stem is aligned with a trajectory to a target within a patient.
106. The surgical device of claim 88 wherein the moveable member includes a positioning member, said moveable member and the positioning member having openings therein for guiding surgical instruments.
107. The surgical device of claim 88 wherein the moveable member has an opening therein for guiding surgical instruments, a portion of the opening having threads therein, said threaded portion for receiving a positioning member.
108. The surgical device of claim 107 wherein the threaded portion of the moveable member receives a guide stem having an opening therein, the openings in the moveable member and the guide stem for guiding a surgical instrument.
109. A surgical adapter device for use with surgical instruments that formerly fit within a burr hole in a patient, said surgical adapter device comprising:
a tubular base unit having a first open end and a second open end; and a flange positioned near one of the first open end or the second open end of the tubular base, said flange for attaching the tubular base to a patient, said other of the first open end or the second open end of the tubular base having approximately the same diameter as a burr hole, said other end of the first open end or the second open end of the tubular base for receiving a surgical instrument.
a tubular base unit having a first open end and a second open end; and a flange positioned near one of the first open end or the second open end of the tubular base, said flange for attaching the tubular base to a patient, said other of the first open end or the second open end of the tubular base having approximately the same diameter as a burr hole, said other end of the first open end or the second open end of the tubular base for receiving a surgical instrument.
110. The surgical device of claim 109, wherein the second opening includes a inside threaded portion.
111. The surgical device of claim 109, wherein said attachment mechanism further comprises a plurality of openings within the flange, each opening receiving a fastener.
112. The surgical device of claim 111, wherein the fastener is a bone screw.
113. The surgical device of claim 109 further comprising a band, said band attached to said flange, wherein said band is attached to the patient.
114. The surgical device of claim 113, wherein said band has an opening therein for receiving a fastener.
115. The surgical device of claim 109 further comprising:
a first head band; and a second head band, wherein said first and second head band are attached to the patient.
a first head band; and a second head band, wherein said first and second head band are attached to the patient.
116. A method for determining a trajectory for an instrument through a surgical device having a tubular body with a first end and a second end, said tubular body having a seat therein, said seat positioned near said first end, said tubular body having an opening in said second end, said second end attached to a patient, said seat and said attachment mechanism separated by a distance, said surgical device also including a movable member having a portion which moves within said seat and a positioning stem for moving the movable member, said method comprising the steps of:
selecting a target within a patient;
determining an initial position of said positioning stem;
determining a second position for said positioning stem, an opening within the movable member aligning with a trajectory to the target, said trajectory defined by a line between the portion of the opening in the movable member closest to the target and the target; and moving the positioning stem to the second position.
selecting a target within a patient;
determining an initial position of said positioning stem;
determining a second position for said positioning stem, an opening within the movable member aligning with a trajectory to the target, said trajectory defined by a line between the portion of the opening in the movable member closest to the target and the target; and moving the positioning stem to the second position.
117. The method of claim 116 wherein the step of determining the initial position includes locating the positioning stem using x-radiation.
118. The method of claim 116 wherein the step of determining the initial position includes locating the positioning stem using light detectors.
119. The method of claim 116 wherein the step of determining the initial position includes locating the positioning stem using magnetic resonance imaging.
120. The method of claim 116 wherein the step of determining the second position is done by a computer.
121. The method of claim 116 wherein the step of moving the positioning stem to the second position includes moving the positioning stem using a remote mechanism.
122. The method of claim 116 further comprising the step of indicating when the positioning stem is in the second position.
123. The method of claim 116 further comprising the step of indicating coordinates for moving the positioning stem is in the second position.
124. The method of claim 116 wherein the step of indicating coordinates for moving the positioning stem is in the second position includes the steps of:
indicating a position on a first bail; and indicating a position on a second bail;
moving the second bail to the position on the first bail; and moving the positioning stem to the position on the second bail.
indicating a position on a first bail; and indicating a position on a second bail;
moving the second bail to the position on the first bail; and moving the positioning stem to the position on the second bail.
125. The method of claim 123 further comprising the steps of:
removing the positioning stem; and placing a surgical instrument into an opening in the movable member.
removing the positioning stem; and placing a surgical instrument into an opening in the movable member.
126. The method of claim 123 further comprising the steps of:
removing the positioning stem;
placing a surgical instrument into an opening in the movable member;
and inserting the surgical instrument a desired distance into the movable member.
removing the positioning stem;
placing a surgical instrument into an opening in the movable member;
and inserting the surgical instrument a desired distance into the movable member.
127. The method of claim 123 further comprising the steps of:
removing the positioning stem;
placing a surgical instrument into an opening in the movable member;
inserting the surgical instrument a desired distance into the movable member; and locking the surgical instrument into place after it has reached the target.
removing the positioning stem;
placing a surgical instrument into an opening in the movable member;
inserting the surgical instrument a desired distance into the movable member; and locking the surgical instrument into place after it has reached the target.
128. The method of claim 123 further comprising the steps of:
removing the positioning stem;
placing a surgical instrument into an opening in the movable member;
and inserting the surgical instrument a desired distance into the movable member.
removing the positioning stem;
placing a surgical instrument into an opening in the movable member;
and inserting the surgical instrument a desired distance into the movable member.
129. The method of claim 116, wherein the step of determining the position of the positioning stem is performed at least in part by a central processing unit and the memory of a scanning device.
130. The method of claim 129, wherein the scanning device obtains images through computerized tomography.
131. The method of claim 129, wherein the scanning device obtains images through magnetic resonance imaging.
132. The method of claim 129, wherein the scanning device obtains images using frameless stereotaxy.
133. The method of claim 129 wherein the step of determining the position of the positioning stem further comprises the step of placing the positioning stem in a selected plane.
134. The method of claim 130 wherein the step of determining the position of the positioning stem further comprises the step of transforming a spiral scan to determine the position of the positioning stem.
135. The method of claim 129 wherein the step of determining the position of the positioning stem further comprises the step of reconstructing the scan to the plane in which the positioning stem is located.
136. A surgical device for use with surgical instruments comprising:
a base unit further comprising:
a first open end;
a second open end; and a flat portion positioned near one of the first open end or the second open end of the base unit; and a flexible body patch attached to the flat portion of the base unit, said flexible body patch for attaching the base unit to a patient, said other of the first open end or the second open end of the base unit for receiving a surgical instrument.
a base unit further comprising:
a first open end;
a second open end; and a flat portion positioned near one of the first open end or the second open end of the base unit; and a flexible body patch attached to the flat portion of the base unit, said flexible body patch for attaching the base unit to a patient, said other of the first open end or the second open end of the base unit for receiving a surgical instrument.
137. The surgical device of claim 136, wherein the base unit rotates with respect to the flexible body patch.
138. The surgical device of claim 136 further comprising a ring engaged with the base unit on the inner diameter and engaged with the flexible body patch on the outer diameter, said ring enabling rotation of the base unit with respect to the flexible body patch.
139. The surgical device of claim 136, wherein the base unit further comprises a tubular portion between the first end and the second end.
140. The surgical device of claim 136, wherein the base unit further comprises a tubular portion between the first end and the second end, said tubular portion being angled with respect to the flat portion.
141. The surgical device of claim 136 wherein one of the first open end and the second open end is cup-shaped, said cup-shaped open end receiving a moveable member.
142. The surgical device of claim 141 wherein the moveable member further comprises:
an end that fits within the cup-shaped end; and an end carrying RF microcoils.
an end that fits within the cup-shaped end; and an end carrying RF microcoils.
143. A surgical device comprising:
a base unit;
an elongated guide stem having a passage therein, a ball attached to one end of the guide stem, said ball having a passage therein, said ball fitting within the base unit, said ball capable of rotating with respect to the base unit;
and a guide stem cable mount associated with said guide stem.
a base unit;
an elongated guide stem having a passage therein, a ball attached to one end of the guide stem, said ball having a passage therein, said ball fitting within the base unit, said ball capable of rotating with respect to the base unit;
and a guide stem cable mount associated with said guide stem.
144. The surgical device of claim 143 further comprising a cable having an end attached to said guide stem cable mount such that moving the cable moves the guide stem.
145. The surgical device of claim 144, wherein the base unit includes a recess for receiving a cable.
146. The surgical device of claim 144, further comprising a locking member which engages the ball and fixes the position of the ball and guide stem upon tightening the locking member when the ball is properly positioned.
147. The surgical device of claim 144, further comprising a locking member which engages the ball and fixes the position of the ball and guide stem upon tightening the locking member when the ball is properly positioned, said locking member having at least one slot therein through which the cable passes.
148. The surgical device of claim 144, further comprising a positioning stem, said positioning stem having an end which fits into the passage within the guide stem, said positioning stem having a locator visible in a scanning environment.
149. The surgical device of claim 143 wherein the guide stem cable mount is attached to the guide stem.
150. The surgical device of claim 144 further comprising a surgical instrument advancement assembly.
151. The surgical device of claim 143 further comprising a sleeve placed over the guide stem between the base and the surgical instrument advancement assembly, said sleeve placing the surgical instrument advancement assembly in position to engage the guide stem.
152. The surgical device of claim 150 wherein the surgical instrument advancement assembly further comprises:
a guide stem mounting block;
a surgical instrument lock;
a cable for moving the surgical instrument lock with respect to the guide stem mounting block.
a guide stem mounting block;
a surgical instrument lock;
a cable for moving the surgical instrument lock with respect to the guide stem mounting block.
153. The surgical device of claim 152 wherein the surgical instrument advancement assembly further comprises a thumb ring attached at one end of the cable;
a finger ring attached near the end of the cable having the thumb ring attached thereto, wherein the surgical instrument lock moves with respect to the guide stem mounting block in response to the thumb ring moving with respect to the finger ring.
a finger ring attached near the end of the cable having the thumb ring attached thereto, wherein the surgical instrument lock moves with respect to the guide stem mounting block in response to the thumb ring moving with respect to the finger ring.
154. The surgical device of claim 152 wherein the guide stem has a groove therein near the opposite end distant from the ball end, said surgical device further comprising a sleeve placed over the guide stem between the guide stem cable mount and the surgical instrument advancement assembly, said guide stem mounting block including a portion which engages the guide stem, said sleeve placing the guide stem mounting block a selected distance away from the locking member.
155. A surgical apparatus comprising:
a first base unit;
a first elongated guide stem having a passage therein, a ball attached to one end of the guide stem, said ball having a passage therein, said ball fitting within the first base unit, said ball capable of rotating with respect to the first base unit;
a first guide stem cable mount associated with said first elongated guide stem;
a second base unit;
a second elongated guide stem having a passage therein, a ball attached to one end of the guide stem, said ball having a passage therein, said ball fitting within the second base unit, said ball capable of rotating with respect to the second base unit;
a second guide stem cable mount associated with said second elongated guide stem; and a cable connected at one end to the first guide stem cable mount and connected at the other end to the second guide stem cable mount, wherein the first elongated guide stem moves in response to moving the second elongated guide stem.
a first base unit;
a first elongated guide stem having a passage therein, a ball attached to one end of the guide stem, said ball having a passage therein, said ball fitting within the first base unit, said ball capable of rotating with respect to the first base unit;
a first guide stem cable mount associated with said first elongated guide stem;
a second base unit;
a second elongated guide stem having a passage therein, a ball attached to one end of the guide stem, said ball having a passage therein, said ball fitting within the second base unit, said ball capable of rotating with respect to the second base unit;
a second guide stem cable mount associated with said second elongated guide stem; and a cable connected at one end to the first guide stem cable mount and connected at the other end to the second guide stem cable mount, wherein the first elongated guide stem moves in response to moving the second elongated guide stem.
156. The surgical apparatus of claim 155 wherein at least a portion of said apparatus is used in an imaging environment, said cable made of a material which is compatible in the imaging environment.
157. The surgical apparatus of claim 155 wherein said cable is a filament.
158. The surgical apparatus of claim 155 wherein said first base unit has a recess for receiving said cable and said second base unit has a recess for receiving said cable, said recesses acting as a cable guide.
159. The surgical apparatus of claim 155 further comprising a plurality of cables, each of said cables connected at one end to the first guide stem cable mount and connected at the other end to the second guide stem cable mount, wherein said first base unit has a plurality of recesses for receiving said plurality of cables and said second base unit has a plurality of recesses for receiving said plurality of cables, said recesses acting as a cable guides.
160. The surgical apparatus of claim 159 further comprising:
a first locking member for fixing the position of the first elongated guide stem with respect to the first base unit; and a second locking member for fixing the position of the second elongated guide stem with respect to the second base unit, said first locking member and said second locking member having slots therein to accommodate the plurality of cables.
a first locking member for fixing the position of the first elongated guide stem with respect to the first base unit; and a second locking member for fixing the position of the second elongated guide stem with respect to the second base unit, said first locking member and said second locking member having slots therein to accommodate the plurality of cables.
161. The surgical apparatus of claim 155 further comprising:
a first locking member for fixing the position of the first elongated guide stem with respect to the first base unit; and a second locking member for fixing the position of the second elongated guide stem with respect to the second base unit.
a first locking member for fixing the position of the first elongated guide stem with respect to the first base unit; and a second locking member for fixing the position of the second elongated guide stem with respect to the second base unit.
162. The surgical apparatus of claim 155 wherein one of said first base unit and first elongated guide stem, or said second base unit and second elongated guide stem is located in an imaging environment, and the other of said first base unit and first elongated guide stem, or said second base unit and second elongated guide stem is located outside an imaging environment.
163. The surgical apparatus of claim 162 further comprising:
a surgical instrument to be passed into the body of a patient associated with the one of said first base unit and first elongated guide stem, or said second base unit and second elongated guide stem is located in an imaging environment;
and a surgical instrument advancement assembly.
a surgical instrument to be passed into the body of a patient associated with the one of said first base unit and first elongated guide stem, or said second base unit and second elongated guide stem is located in an imaging environment;
and a surgical instrument advancement assembly.
164. The surgical apparatus of claim 163 wherein the surgical instrument advancement assembly further comprises:
a guide stem mounting block for mounting on the elongated guide stem;
a surgical instrument lock;
a cable for moving the surgical instrument lock with respect to the guide stem mounting block.
a guide stem mounting block for mounting on the elongated guide stem;
a surgical instrument lock;
a cable for moving the surgical instrument lock with respect to the guide stem mounting block.
165. The surgical apparatus of claim 164 wherein the surgical instrument advancement assembly further comprises a thumb ring attached at one end of the cable; and a finger ring attached near the end of the cable having the thumb ring attached thereto, wherein the surgical instrument lock moves with respect to the guide stem mounting block in response to the thumb ring moving with respect to the finger ring.
166. The surgical apparatus of claim 164 wherein said surgical instrument lock further comprises:
an elastomeric sleeve positioned around the surgical instrument;
a first substantially inelastic end; and a second substantially inelastic end, wherein drawing the first end toward the second end causes the elastomeric sleeve to engage the surgical instrument.
an elastomeric sleeve positioned around the surgical instrument;
a first substantially inelastic end; and a second substantially inelastic end, wherein drawing the first end toward the second end causes the elastomeric sleeve to engage the surgical instrument.
167. The surgical apparatus of claim 164 further comprising a surgical instrument advancement lock for locking the position of the surgical instrument with respect to the guide stem.
168. The surgical apparatus of claim 167 further comprising:
an L-shaped surgical instrument advancement lock; and a locking pin for holding the advancement lock in place.
an L-shaped surgical instrument advancement lock; and a locking pin for holding the advancement lock in place.
169. The surgical apparatus of claim 168 wherein said L-shaped surgical instrument advancement lock includes a portion positioned in the opening of the locking member for locking the guide stem with respect to the base.
170. A method for introducing a surgical instrument into the body of a patient, said patient positioned in a scanning environment, said method comprising the steps of:
selecting a target within a patient;
attaching a first base and first movable elongated guide stem to the patient;
connecting the first base and first movable elongated guide stem to a second base and second movable elongated guide stem using cables;
placing a positioning stem within the guide stem, said positioning stem having a first portion readable within the scanning device and a second portion readable within the scanning environment; and moving a second elongated guide stem with respect to the second base, said second base and said second movable elongated guide stem positioned outside the scanning environment, wherein moving the second elongated guide stem with respect to the second base causes movement of the first movable elongated guide stem with respect to the first base.
selecting a target within a patient;
attaching a first base and first movable elongated guide stem to the patient;
connecting the first base and first movable elongated guide stem to a second base and second movable elongated guide stem using cables;
placing a positioning stem within the guide stem, said positioning stem having a first portion readable within the scanning device and a second portion readable within the scanning environment; and moving a second elongated guide stem with respect to the second base, said second base and said second movable elongated guide stem positioned outside the scanning environment, wherein moving the second elongated guide stem with respect to the second base causes movement of the first movable elongated guide stem with respect to the first base.
171. The method of claim 170 further comprising the steps of:
aligning a passage in the first elongated guide stem with the target within the patient; and locking the first elongated guide stem with respect to the first base.
aligning a passage in the first elongated guide stem with the target within the patient; and locking the first elongated guide stem with respect to the first base.
172. The method of claim 171 further comprising the steps of:
replacing the positioning stem with a surgical instrument at the first guide stem; and introducing the surgical instrument into the patient.
replacing the positioning stem with a surgical instrument at the first guide stem; and introducing the surgical instrument into the patient.
173. The method of claim 172 further comprising the steps of:
locking the surgical instrument into a position with respect to the guide stem.
locking the surgical instrument into a position with respect to the guide stem.
Applications Claiming Priority (9)
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| US85666497A | 1997-05-15 | 1997-05-15 | |
| US91964997A | 1997-08-28 | 1997-08-28 | |
| US09/058,092 US6267769B1 (en) | 1997-05-15 | 1998-04-09 | Trajectory guide method and apparatus for use in magnetic resonance and computerized tomographic scanners |
| US08/856,664 | 1998-05-14 | ||
| US09/078,913 US5993463A (en) | 1997-05-15 | 1998-05-14 | Remote actuation of trajectory guide |
| US08/919,649 | 1998-05-14 | ||
| US09/078,913 | 1998-05-14 | ||
| US09/058,092 | 1998-05-14 | ||
| CA2289449A CA2289449C (en) | 1997-05-15 | 1998-05-15 | Trajectory guides for surgical instruments |
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|---|---|---|---|
| CA2289449A Division CA2289449C (en) | 1997-05-15 | 1998-05-15 | Trajectory guides for surgical instruments |
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| CA2686281A1 true CA2686281A1 (en) | 1998-11-19 |
| CA2686281C CA2686281C (en) | 2012-07-24 |
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| Application Number | Title | Priority Date | Filing Date |
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| CA2686281A Expired - Lifetime CA2686281C (en) | 1997-05-15 | 1998-05-15 | Trajectory guides for surgical instruments |
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| US (1) | US6267769B1 (en) |
| CA (1) | CA2686281C (en) |
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| US11298043B2 (en) | 2016-08-30 | 2022-04-12 | The Regents Of The University Of California | Methods for biomedical targeting and delivery and devices and systems for practicing the same |
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Also Published As
| Publication number | Publication date |
|---|---|
| CA2686281C (en) | 2012-07-24 |
| US6267769B1 (en) | 2001-07-31 |
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