JP7745320B2 - Tissue adhesive sheet insertion device for percutaneous total endoscopy of the spine (scored type) - Google Patents

Description

The present invention relates to an instrument for assisting in the insertion of tissue adhesive sheets during percutaneous, fully endoscopic spinal surgery.

In order to minimize invasiveness in spinal surgery, one method uses a spinal percutaneous total endoscope, which is a small-diameter endoscope that combines all the necessary functions. As shown in Figures 1 and 2, the spinal percutaneous total endoscope 900 is a long, slender cylinder with an outer diameter of approximately 6 to 7 mm. The main body 901, which is the part inserted into the body, is housed within a tube 902, light source 903, irrigation channel 904, and working lumen 905. An outer tube 906 is inserted into the body through a skin incision S, and the main body 901 is inserted into it. While water is flowing through the irrigation channel 904 to wash the area around the target, an image from a camera connected to the tube 902 is magnified and displayed on a monitor, and instruments such as forceps 200 inserted into the working lumen 905 are used to manipulate the vertebral arch 4, intervertebral disc 5, etc. The instruments that can be inserted into the working lumen 905 are basically long, cylindrical instruments with an outer diameter of approximately 2.5mm to 4mm and a length of approximately 200mm to 400mm, and are equipped with handles or other attachments.

In spinal canal expansion surgery for spinal stenosis, as shown in Figure 3, the dural canal 2 (a cavity surrounded by the dura mater 1, through which spinal fluid, the spinal cord, and nerve roots pass) is expanded by removing the surrounding tissues, such as the herniated disc 3, vertebral arch 4, intervertebral disc 5, and ligamentum flavum, which are compressing the dural canal. During this procedure, the dura mater 1 is a thin membrane and may be damaged. If damaged, cerebrospinal fluid may leak from the hole, causing symptoms of low spinal cord pressure, or a nerve may become trapped in the hole, causing neurological symptoms; therefore, it is necessary to close the hole to prevent cerebrospinal fluid from leaking out. Traditionally, suturing is used for closure, but there is also a method of covering it with a tissue-adhesive sheet.
Tissue adhesive sheets 10 such as Tachoseal (manufactured by CSL Behring) are sheet-like biological tissue adhesives and closures, as shown in Figure 4, which combine a sponge-like collagen sheet support 11 with an adhesive surface 12 to which the active ingredients human fibrinogen and human-derived thrombin fraction are fixed. This has the advantage of being able to adhere even in liquids. Since the surgical field is immersed in irrigation fluid in percutaneous total endoscopic surgery, it is particularly useful to be able to use the sheet without draining the irrigation fluid.

Patent No. 5192254

When using a tissue adhesive sheet in percutaneous total endoscopic spinal surgery, it is cut to an appropriate size and inserted into the working cavity of the percutaneous total endoscope, then pushed to the tip of the endoscope with a stick. However, this procedure causes the tissue adhesive sheet to stick to the tip of the stick. However, since only one instrument can be inserted, it is not possible to insert another instrument to remove it. As a result, the tissue adhesive sheet is somehow removed by rubbing the tip of the stick against the corners of the surrounding bones, but there are often no conveniently shaped corners nearby, which is not easy, and it also requires shifting the field of view.

In percutaneous total endoscopic spinal surgery, as with other surgical procedures, dural damage occurs with some frequency, so it is necessary to make tissue adhesive sheets easier to use as a treatment for this.

The tissue adhesive sheet insertion device for spinal percutaneous total endoscopy of the present invention will be referred to as the device below. As shown in Figures 5 to 11, the device 100 has a long, slender cylindrical main body 110 with an outer diameter that allows it to be inserted into the working cavity of a percutaneous total endoscope, and two or four scoring lines 112 extend from the tip 111 of the main body toward the proximal side. The scoring lines widen halfway through to form slits 113, which continue toward the proximal side but do not continue all the way to the proximal end 114 of the main body.
A push rod 120 is located within the lumen of the main body, and a bulge 121 is located at the proximal end of the push rod 120. A spring 130 is located between the proximal end 114 of the main body and the bulge 121. The push rod 120 can slide within the lumen of the main body.
The inner diameter of the ring 140 is slightly larger than the outer diameter of the main body, and it is placed over the outer surface of the main body.
The thickness of the opening member 150 is smaller than the gap of the slit 113, and its width is larger than the gap of the slit.

To use this device, as shown in Figure 12, first insert the spreader 150 into the slit and twist it to spread the scoring line 112, expanding the tip of the main body 110. Then, a tissue adhesive sheet cut to an appropriate size is placed over the tip 111 of the main body, with the adhesive surface 12 facing downwards (Figure 12a). The spreader is then removed, compressing the tissue adhesive sheet. Moving the ring 140 toward the tip securely closes the scoring line (Figure 12b). The main body is inserted into the working cavity of the spinal percutaneous total endoscope and advanced. At this time, the ring at the tip is moved toward the proximal end. Once the tip of the main body reaches the target dura, the push rod 120 is pressed, pushing out the tissue adhesive sheet from the cavity at the tip of the main body (Figure 12c), stretching slightly and adhering to the dura.

The adhesive surface of the tissue adhesive sheet moves while remaining inside the lumen at the tip of the main body, so it only adheres to the lumen of the main body. Therefore, when pushed out with the push rod, it can be reliably peeled off from the device and pushed out into the dura mater.

Only instruments with an outer diameter smaller than the lumen of a spinal percutaneous total endoscope can be inserted, and if a tissue adhesive sheet is to be placed inside the lumen of that instrument, only a very small one can fit. However, by using a score line, it can be widened, allowing a tissue adhesive sheet larger than the lumen of the instrument to be inserted.

Schematic diagram of the lumbar cross section and instruments used during percutaneous total endoscopic spinal surgery. Oblique view of the spinal percutaneous total endoscope and the tip of the outer tube. Cross section of the spine. Schematic diagram of tissue adhesive sheet. Overall side view of embodiment 1 of the present invention. A perspective view of the tip side of embodiment 1 of the present invention. Cross-sectional view of the tip side of embodiment 1 of the present invention. 1 is a perspective view of the hand side of the first embodiment of the present invention. Cross-sectional view of the proximal side of the first embodiment of the present invention. Front view of the tip of embodiments 1 and 2 of the present invention. 1 is a perspective view of a dilator according to a first embodiment of the present invention. Schematic diagram of embodiment 1 of the present invention in use.

Embodiment 1 of the present invention will be explained using Figures 5 to 11. The main components of this instrument 100 are a main body 110 and a push rod 120. The main body 110 is a long, thin cylinder with an outer diameter of 3 to 4 mm and a length of approximately 350 mm, which can be inserted into the working cavity of a spinal percutaneous total endoscope. Two scoring lines 112 extend from the tip 111 of the main body toward the proximal side, and the scoring lines 112 widen partway to form slits 113, which do not continue all the way to the proximal end 114 of the main body.
There is a push rod 120 inside the main body cavity, and at the proximal end of the push rod 120 there is an enlarged portion 121 with a larger outer diameter . There is a spring 130 between the proximal end 141 of the main body and the enlarged portion 121. The push rod 120 can slide inside the main body cavity.
The inner diameter of the ring 140 is slightly larger than the outer diameter of the main body 110 , that is, within 1 mm , and is placed over the outer surface of the main body.

As shown in Figure 10, there may be two dividing lines 112 and two slits facing each other (a, embodiment 1), or two more lines offset by 90 degrees from the first, for a total of four (b, embodiment 2).

The thickness of the expander 150 is smaller than the gap of the slit 113, but its width is larger than the gap of the slit 113 (Figure 11a). The expander can be inserted into the slit and twisted to expand the secant line.
Another possible configuration of the expander 160 is one in which the thickness at the tip is smaller than the gap in the slit 113, and larger at the proximal end (Figure 11b). By inserting and pushing this expander 160 into the slit 113, the dividing line can be expanded.

Claims (3)

An instrument for assisting in the insertion of a tissue adhesive sheet in spinal percutaneous total endoscopic surgery, the instrument having a long, thin cylindrical body with an outer diameter that can be inserted into the working cavity of a spinal percutaneous total endoscope,
Two or four score lines extend from the tip of the main body toward the handle, and the gaps between the score lines widen halfway through to form slits, but the slits do not extend to the handle end of the main body.
There is a push rod inside the cavity of the main body, and the push rod can be slid inside the cavity of the main body to push out what is inserted at the tip of the main body.
The inner diameter of the ring is slightly larger than the outer diameter of the main body, and the ring is placed over the outer surface of the main body.
A percutaneous, total endoscopic spinal instrument characterized by the ability to open the cleavage line by inserting a dilator into the slit. The spinal percutaneous total endoscopic instrument according to claim 1, characterized in that the spreader has a thickness smaller than the gap of the slit and a width larger than the gap of the slit, and the secant line can be spread by inserting the spreader into the slit and twisting it. The spinal percutaneous total endoscopic instrument according to claim 1, characterized in that the thickness of the spreader is smaller than the gap of the slit at the tip and larger than the gap of the slit at the proximal end, and the dividing line can be spread by inserting the spreader into the slit and pushing it in.