CA2289449A1 - Trajectory guides for surgical instruments - Google Patents

Trajectory guides for surgical instruments Download PDF

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Publication number
CA2289449A1
CA2289449A1 CA002289449A CA2289449A CA2289449A1 CA 2289449 A1 CA2289449 A1 CA 2289449A1 CA 002289449 A CA002289449 A CA 002289449A CA 2289449 A CA2289449 A CA 2289449A CA 2289449 A1 CA2289449 A1 CA 2289449A1
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CA
Canada
Prior art keywords
stem
movable member
positioning
surgical
opening
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.)
Granted
Application number
CA002289449A
Other languages
French (fr)
Other versions
CA2289449C (en
Inventor
Charles L. Truwit
Haiying Liu
Debra F. Bauer
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
University of Minnesota
Original Assignee
Regents Of The University Of Minnesota
Charles L. Truwit
Haiying Liu
Debra F. Bauer
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Priority claimed from US09/058,092 external-priority patent/US6267769B1/en
Application filed by Regents Of The University Of Minnesota, Charles L. Truwit, Haiying Liu, Debra F. Bauer filed Critical Regents Of The University Of Minnesota
Priority to CA2686281A priority Critical patent/CA2686281C/en
Publication of CA2289449A1 publication Critical patent/CA2289449A1/en
Application granted granted Critical
Publication of CA2289449C publication Critical patent/CA2289449C/en
Anticipated expiration legal-status Critical
Expired - Lifetime legal-status Critical Current

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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
    • 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

A surgical method and apparatus for accurately aligning the trajectory of, guiding of, and introducing or withdrawal of an instrument is disclosed. The apparatus includes a base which has a movable member movably attached to the base. The movable member has a passage therein which forms a portion of the trajectory path. A positioning stem further includes a first locator and a second locator. The first and second locators are associated with two different portions of the positioning stem so that they are essentially two points on a line. The first and second locators are also locatable by a scanning or imaging system. The positioning stem is removably attached to said movable member and used to position the movable member. Moving the movable member also moves the passage therein to different trajectories. Once the passage within the movable member more or less is aligned with a target within the body, a locking member locks the movable member into a fixed position. The movable member can be moved to different trajectories using a first hydraulic system. A second hydraulic system can be used to introduce or withdraw an instrument to or from the patient. A mechanical advancement tool can be substituted for the second hydraulic system. The surgical instrument may also be provided with a remote portion for controlling the instrument from a remote location. The instrument can also be computer controlled.

Claims (135)

1. A surgical device comprising:
a base unit;
a ball having passage therein, said ball fitting within an opening associated with the base unit, said ball capable of rotating with respect to the opening associated with the base unit;
a positioning stem futher including a first locator and a second locator for locating said positioning seem and a second locator for locating said positioning stem; and a locking member positioned near the opening associated with base, said locking member engaging the ball and fixing the position of the ball and positioning stem upon tightening the locking member.
2. The surgical device of claim 1, wherein said first and second locators for locating said positioning stem includes at least two light emitting diodes.
3. The surgical device of claim 1, wherein said positioning stem includes a cavity which carries a liquid visible to a nuclear magnetic resonance imaging system or to a computer tomography system, said first and second locators for locating said positioning stem located near the ends of the cavity.
4. The surgical device of claim 1, wherein one of said first and second locators for locating said positioning stem is a radio frequency coil.
5. The surgical device of claim 1, wherein the opening associated with the base unit is within the base unit.
6. Tne surgical device of claim 1 further comprising a guide stem, said guide stem interchangeable with the positioning 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 is the ball.
7. 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 tree guide stem substantially aligns with the passage in the ball wherein the positioning stem fits within the opening of the guide stem.
8. The surgical device of claim 7 wherein the first and second locators for locating the positioning stem are 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 into alignment with another point.
10. The surgical device of claim 6 further comprising;
a suspension element attached to the base; and a stage attached to said suspension element, said stage including the opening therein, said stage movable in a plane substantially 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 with respect to the opening.
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. A surgical apparatus comprising:
a base for mounting to a body surface, said base having an opening therein;
a movable member having a passage therein movably attached to said opening in the base, said movable member swiveling within the opening in the 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 first locator and said second locator for locating the 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 threadably attached to the base and positioned near the opening in the base for facing 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 clans 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 or clam 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 stern, 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 a 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 he movably member.
32. The apparatus cf 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 guiding device including a base mounted to a body surface, said base having an opening therein and said guiding device including a movable member having a passage therein pivotable within the opening in the base, 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 and the target by performing a first scan;
determining if the passage of the movable member is substantially aligned with the target within tha patient based on the position of the first and second portions of the positioning stem with respect to the target;
determining a line between the target and at least one of the first portion readable by the scanning device of the positioning stem or the second portion readable by tha scanning device of the positioning stem; and moving the positioning stem until a second scan reseals that the other of the first portion readable by the scanning device of the positioning stem or the second portion readable by the scanning device of the positioning stem is substantially aligned with the line between the target and at least one of the first portion readable by the scanning device of the positioning stem or the second portion readable by the scanning device 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 interchangable with the positioning stem, 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 step 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.
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 dense 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.
43. The surgical device or 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 fur 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 and 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 wide 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.
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.
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.
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 patent;
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 throw 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.
60. The method tar 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;
moving the movable member until the trajectory of the opening aligns with the target within the patient; and introducing a surgical instrument through the opening in the moveable member.
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 movably 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 cap 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 56 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 tha 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 tile 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 farther 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.

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73. The surgical instrument of claim 10 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.
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 clan 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.
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 31 wherein over said first surgical instrument a 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 resonance imaging.
83. A surgical device for use on a patient comprising:
a base unit for mounting to a body surface, said base having a tubular body, said base unit further comprising:
a first end; and a secured 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 tubular body having a cup shaped opening therein;
a ball having passage therein, said ball fitting within the cup shaped opening in the second end of the base unit, said ball capable of rotating with aspect to the cup shaped opening in the second end of the base unit; 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, said ball and tubular body of the base unit adapted to allow a surgical instrument to pass therethrough.
84. The surgical device of claim 83, wherein the opening in the second end has a sufficient diameter to allow surgical instruments 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 ef 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.
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 designed to be pass through 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 adapted for attachment to the body of a patient, said other of the first open end or the second open end of the tubular base having an opening therein;
a movable member having a passage therein movably attached to said opening in the tubular base, paid movable member swiveling within the opening in the 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 first locator and said second locator for locating the 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 threadably attached to the base and positioned near the opening in the base for fixing the position of the movable member and the passage therein.
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.
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 and attached to a patient, said seat and said attachment mechanism separated by a distance, said surgical device also including a movable member with an opening therethrough, said movable member having a portion which moves within said seat and a positioning stem for moving the movable member, said opening in the movable member and in the second end adapted to allow a surgical instrument to pass therethrough, 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 larger; 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 to the second position.
123. The method of claim 116 further comprising the step of indicating coordinates for moving the positioning stem to the second position.
124. The method of claim 116 wherein the step or indicating coordinates for moving the positioning stem to 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 he 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.
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.
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.
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.
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 or 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 stems 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.
135. A surgical deuce 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;
a trajectory wide attached to the other 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 and can be repositioned 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 to allow the base unit to rotate and to be repositioned 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 as 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.
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.
153. The surgical device of claim 152 where 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.
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 wide stem mounting block a selected distance away from the locking member.
55. 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 cable of rotating with respect to the first bass unit;
a fast 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 step cable mount associated with said second elongated guide stem; and a cable connected at one and 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.
155. 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 a 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 ocher 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 wherein 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.
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.
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 black.
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 cubic 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.
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.
169. The surgical apparatus of claim 158 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 he 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 scaring 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 object; and locking the first elongated grade stem with respect to the first base.
172. The method of claim 171 further comprising the steps of:
replacing the positioning stem with an instrument at the first guide stem;
and introducing the instrument into the object.

173. The method of claim 172 further comprising the steps of:
locking the instrument into a position with respect to the guide stem.

174. A surgical apparatus comprising:
a base directly mounted to a body surface, said base having an opening therein;
a movable member having a passage therein, said movable member movably attached to said opening in the base, said movable member swiveling within the opening in the base;

a 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 movably member:
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 first locator and said second locator for locating the positioning stem, said positioning stem fitting within the passage in the guide stem and removable from the passage in the guide stem, said guide stem used to position the movable member and the passage therein; and a locking member threadably attached to the base and positioned near the opening in the base for fixing the position of the movable member and the passage herein.
175. The apparatus of claim 174 wherein said first and second locators are readable by a body scanning mechanism.
176. The apparatus of claim 174 wherein said first and second locators are readable by a magnetic resonance imaging apparatus.
177. The apparatus of claim 176 wherein at least one of said first locator and said second locator includes a fluid readable by a magnetic resonance imaging apparatus.
178. The apparatus of claim 175 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.
179. The apparatus of claim 178 wherein said source of radio frequency which is readable by a magnetic resonance imaging apparatus includes at least one or more radiofrequency coils.

180. The apparatus of claim 174 wherein said first and second locators are substantially aligned with the centerline of the passage in said movable member.

181. The apparatus of claim 174 wherein said first and second locators are offset with respect to the centerline of passage in said movable member.

182. The apparatus of claim 174 wherein said first and second locators are offset with respect to the centerline of passage in said movable member.

183. The apparatus of claim 174 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.

184. The apparatus of claim 183 wherein said positioning stem is interchangeable with said guide stem.

185. The apparatus of claim 183 wherein said positioning stem fits within the opening in said guide stem.

186. The apparatus of claim 184 wherein at least one of said fist locator and said second locator includes a light emitting diode which is readable in a frameless stereotaxy environment.

187. The surgical device of claim 174 further comprising a mechanism for controlling the movable member from a remote position.

188. The surgical device of claim 187 further comprising a locking mechanism adapted to cold an instrument in a position, said locking mechanism actuatable from a remote position.

189. Tho surgical device of claim 188 wherein the locking mechanism for holding an instrument in position includes a locking collar for clamping the surgical instrument.

194. the surgical device of claim 187 further comprising an instrument insertion mechanism adapted to move an instrument through the moveable member, said instrument insertion mechanism actuatable from a remote position.

191. The surgical device of claim 174 wherein the base further comprises:
a tubular portion having a first open end and a second open end;
a flange positioned near one of the first open end or the second open end of the tubular base, said flange adapted for attachment to the body of a patient, said other of the first open end or the second open end of the tubular base having an opening therein;
a movable member having a passage therein movably attached to said opening in the tubular base, said movable member swiveling within the opening in the 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 threadably attached to the base and positioned near she opening in the base for fixing the position of the movable member and the passage therein.

192. The surgical device of claim 174 wherein the base further comprises:
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 adapted to attach the base unit to a patient. said other end of the first open end or the second open end of the base unit adapted to receive a surgical instrument.

193. The surgical device of claim 187 wherein the mechanism for controlling the movable member from a remote position includes at least one hydraulic mechanism.

194. The surgical device of claim 187 wherein the mechanism for controlling the movable member from a remote position includes at least one wire mechanism.

195. The surgical device of claim 187 wherein the mechanism for controlling the movable member from a remote position includes at least one string mechanism.

196. The surgical device of claim 187 wherein the mechanism for controlling the movable member from a remote position includes a computer interfacing with the movable member, said computer for determining an initial portion and for determining the amount of motion for alignment of the passage in the moveable member with a target.

197. The surgical device of claim 187 wherein the mechanism for controlling the movable member from a remote position includes a computer interfacing with the movable member, said computer for determining an initial instrument portion and for determining the distance to a target.
CA2289449A 1997-05-15 1998-05-15 Trajectory guides for surgical instruments Expired - Lifetime CA2289449C (en)

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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
PCT/US1998/010008 WO1998051229A1 (en) 1997-05-15 1998-05-15 Trajectory guides for surgical instruments

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JP (1) JP4053607B2 (en)
AU (1) AU7686998A (en)
CA (1) CA2289449C (en)
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WO (1) WO1998051229A1 (en)

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US6206890B1 (en) 2001-03-27
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US6267770B1 (en) 2001-07-31
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US20020019641A1 (en) 2002-02-14
US5993463A (en) 1999-11-30

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