Surgical method and instrument therefor

Claim 2

A surgical method for manipulating selected tissue in a body cavity visual inspection, comprising: (a) employing a surgical instrument comprising a probe having (i) a flat upper surface, parallel sides, a convex lower surface, a generally closed distal end, and a lateral aperture in said upper surface and adjacent said closed distal end; wherein said distal end slopes away from said upper surface in a manner such that said distal end diverts displaceable tissue it contacts away from the region of the lateral aperture and said upper surface; (ii) an optical system disposed at least partially within the probe, said system having a distal portion position adjacent the lateral aperture, thereby defining a viewing space between the distal portion of the optical system, and the distal end and the lateral aperture, said space located with the field-of-view of the optical system; (iii) a working tool mounted within the viewing space capable of being extended from the viewing space; (iv) means for extending the working tool outwardly from the viewing space; (v) a grip handle connected to said probe; wherein said handle includes actuator means for extending said working tool outwardly from said probe; and (vi) adjustment means for adjusting the rotational orientation between said lateral aperture of said probe and said grip handle; wherein said adjustment means is adapted to temporarily fix said rotational orientation; (b) positioning the surgical instrument so that the lateral aperture is adjacent the selected tissue; (c) extending the working tool to a position appropriate to manipulate the selected tissue; and (d) manipulating the selected tissue, while avoiding inadvertent injury to surrounding tissue.

Claim 3

A method as recited in claim 1 wherein the instrument further comprises means for automatically retracting the working tool upon release of the actuating means.

Claim 4

A method as recited in claim 1, wherein the working tool comprises a cutting blade capable of dividing the selected tissue.

Claim 5

A method as recited in claim 1, wherein the optical system comprises a conventional examination telescope.

Claim 6

A surgical method for dividing the flexor retinaculum under visual inspection during carpal tunnel release, comprising: (a) forming a transverse incision which provides a passage to the proximal end of the carpal tunnel; (b) inserting a probe having a cutting blade and an optical system, which optical system comprises means for continuously observing the portion of the flexor retinaculum adjacent the cutting blade within its field-of-view, into the carpal tunnel through the passage; wherein said probe further comprises an upper surface, a generally closed distal end, and a lateral aperture in said upper surface and adjacent said closed distal end, and said cutting blade being adapted to extend outward from the probe to contact the flexor retinaculum; wherein the probe upper surface adjacent to the lateral aperture is configured generally as a flat or concave surface; and (c) dividing the flexor retinaculum, thereby releasing the carpal tunnel, under substantially continuous observation while minimizing the risk of injury to surrounding tissue.

Claim 7

A surgical method for dividing the flexor retinaculum under visual inspection during carpal tunnel release, comprising: (a) forming a transverse incision which provides a passage to the proximal end of the carpal tunnel; (b) inserting a probe having a cutting blade and an optical system, which optical system comprises means for continuously observing the portion of the flexor retinaculum adjacent the cutting blade within its field-of-view, into the carpal tunnel through the passage; wherein said probe further comprises an upper surface, a generally closed distal end, and a lateral aperture in said upper surface and adjacent said closed distal end, and said cutting blade being adapted to extend outward from the probe to contact the flexor retinaculum; wherein the probe upper surface adjacent to the lateral aperture is configured generally as a flat or concave surface; and (c) dividing the flexor retinaculum, thereby releasing the carpal tunnel, under substantially continuous observation while minimizing the risk of injury to surrounding tissue.

Claim 8

A method as recited in claim 5 wherein the flexor retinaculum is divided under substantially continuous observation.

Claim 9

A method as recited in claim 5 wherein the passage is provided for inserting the probe into the proximal end of the carpal tunnel.

Claim 10

A method as recited in claim 7 wherein the cutting blade of the surgical instrument contacts the flexor retinaculum at its distal end and divides the flexor retinaculum while the probe is withdrawn from the carpal tunnel.

Claim 11

A surgical method for dividing the flexor retinaculum under visual inspection during carpal tunnel release, comprising: (a) positioning a probe comprising: (i) an upper surface, a generally closed distal end, and a lateral aperture in said upper surface and adjacent said closed distal end; wherein the distal end of the probe forms an acute angle with the upper surface of the probe and is configured to direct any displaceable tissue it contacts and divert said contacted tissue away from the region of the lateral aperture and the upper surface of the probe; (ii) an optical system disposed at least partially within the probe, said system having a distal portion terminating adjacent the lateral aperture, thereby defining a viewing space between the distal portion of the optical system, and the distal end and the lateral aperture, said viewing space located within the field-of-view of the optical system; (iii) a cutting blade mounted within the viewing space and capable of being extended from the space; and (iv) means for extending the cutting blade outwardly from the viewing space; (v) a grip handle connected to said probe; wherein said handle includes actuator means for extending said working tool; (vi) adjustment means for adjusting the relative orientation between said lateral aperture of said probe and said grip handle; wherein said adjustment means is adapted to temporarily fix said rotational orientation; and (vii) retraction means for automatically retracting said cutting blade upon release of said actuating means; such that the lateral aperture is adjacent the flexor retinaculum; (b) extending the cutting blade to a position appropriate to divide the flexor retinaculum; and (c) dividing the flexor retinaculum, while avoiding inadvertent injury to surrounding tissue.

Claim 12

A surgical method for dividing the flexor retinaculum under visual inspection during carpal tunnel release, comprising: (a) positioning a probe comprising: (i) an upper surface, a generally closed distal end, and a lateral aperture in said upper surface and adjacent said closed distal end; wherein the distal end of the probe forms an acute angle with the upper surface of the probe and is configured to direct any displaceable tissue it contacts and divert said contacted tissue away from the region of the lateral aperture and the upper surface of the probe; (ii) an optical system disposed at least partially within the probe, said system having a distal portion terminating adjacent the lateral aperture, thereby defining a viewing space between the distal portion of the optical system, and the distal end and the lateral aperture, said viewing space located within the field-of-view of the optical system; (iii) a cutting blade mounted within the viewing space and capable of being extended from the space; and (iv) means for extending the cutting blade outwardly from the viewing space; (v) a grip handle connected to said probe; wherein said handle includes actuator means for extending said working tool; (vi) adjustment means for adjusting the relative orientation between said lateral aperture of said probe and said grip handle; wherein said adjustment means is adapted to temporarily fix said rotational orientation; and (vii) retraction means for automatically retracting said cutting blade upon release of said actuating means; such that the lateral aperture is adjacent the flexor retinaculum; (b) extending the cutting blade to a position appropriate to divide the flexor retinaculum; and (c) dividing the flexor retinaculum, while avoiding inadvertent injury to surrounding tissue.

Claim 13

A method as recited in claim 9 wherein the probe is configured to be inserted into the carpal tunnel before the flexor retinaculum is divided; and wherein said cutting blade contacts the flexor retinaculum at its distal end and divides the flexor retinaculum while the probe is withdrawn from the carpal tunnel.

Claim 14

A method as recited in claim 9 wherein the upper surface adjacent to the lateral aperture is configured generally as a flat or concave surface.

Claim 15

A method as recited in claim 9, wherein the optical system comprises a conventional examination telescope.

Claim 16

A surgical instrument for manipulating selected tissue in a body cavity under visual inspection, comprising: (a) a probe having an upper surface, a generally closed distal end, and a lateral aperture in said upper surface and adjacent said closed distal end; wherein the upper surface adjacent to the lateral aperture is configured generally as a flat or concave surface; wherein said distal end slopes away from said upper surface in a manner such that said distal end diverts displaceable tissue it contacts away from the region of the lateral aperture and said upper surface; (b) an optical system disposed at least partially within the probe, said system having a distal portion terminating adjacent the lateral aperture, thereby defining a viewing space between the distal portion of the optical system, and the distal end and the lateral aperture, said viewing space located within the field-of-view of the optical system; (c) a working tool mounted within said probe and capable of being extended from the viewing space; and (d) means for extending the working tool outwardly from the viewing space; (e) a grip handle rotatably connected to said probe; and (f) adjustment means for adjusting the rotational orientation between said lateral aperture of said probe and said grip handle; wherein said adjustment means is adapted to temporarily fix said rotational orientation.

Claim 17

A surgical instrument for manipulating selected tissue in a body cavity under visual inspection, comprising: (a) a probe having an upper surface, a generally closed distal end, and a lateral aperture in said upper surface and adjacent said closed distal end; wherein the upper surface adjacent to the lateral aperture is configured generally as a flat or concave surface; wherein said distal end slopes away from said upper surface in a manner such that said distal end diverts displaceable tissue it contacts away from the region of the lateral aperture and said upper surface; (b) an optical system disposed at least partially within the probe, said system having a distal portion terminating adjacent the lateral aperture, thereby defining a viewing space between the distal portion of the optical system, and the distal end and the lateral aperture, said viewing space located within the field-of-view of the optical system; (c) a working tool mounted within said probe and capable of being extended from the viewing space; and (d) means for extending the working tool outwardly from the viewing space; (e) a grip handle rotatably connected to said probe; and (f) adjustment means for adjusting the rotational orientation between said lateral aperture of said probe and said grip handle; wherein said adjustment means is adapted to temporarily fix said rotational orientation.

Claim 18

An instrument as recited in claim 13 wherein the grip handle comprises actuator means for extending the working tool through the lateral aperture of the probe.

Claim 19

An instrument as recited in claim 14 wherein the instrument further comprises means for automatically retracting the working tool upon release of the actuating means.

Claim 20

An instrument as recited in claim 13, wherein the working tool comprises a cutting blade capable of dividing the selected tissue.

Claim 21

An instrument as recited in claim 13, wherein said optical system comprises a conventional examination telescope.

Claim 22

An instrument as recited in claim 13, wherein the means for extending the working tool through the viewing space of the probe comprises a longitudinally displaceable actuation shaft contained within the probe, said actuation shaft being connected to said working tool in actuating relationship therewith providing means for transforming longitudinal displacement of the actuation shaft into outward extension of the working tool.

Claim 23

An instrument as recited in claim 18 wherein said actuation shaft is adapted to respond to actuating movement by an operator of the instrument.

Claim 24

An instrument as recited in claim 18 wherein each additional increment of longitudinal displacement of the actuation shaft produces a correspondingly greater increment in the extension of the working tool.

Claim 25

An instrument as recited in claim 18 wherein the working tool is cooperatively engaged with an axially fixed, rotatable pivot in the distal end of the probe so that longitudinal displacement of the actuation shaft produces an angular displacement of the working tool as the actuation shaft approaches the pivot, thereby outwardly extending the working tool.

Claim 26

An instrument in accordance with claim 13, wherein said probe includes a flat upper surface, parallel sides, and a convex lower surface.

Claim 27

A surgical instrument for dividing the flexor retinaculum under visual inspection during carpal tunnel release, while minimizing the risk of injury to surrounding tissue; comprising: (a) a probe having an upper surface, a generally closed distal end, and a lateral aperture in said upper surface and adjacent said closed distal end; wherein said distal end slopes away from said upper surface in a manner such that said distal end diverts displaceable tissue it contacts away from the region of the lateral aperture and said upper surface; wherein said upper surface of said probe adjacent to said lateral aperture is configured generally as a flat or concave surface; (b) an optical system disposed at least partially within the probe, said system having a distal portion terminating adjacent the lateral aperture, thereby defining a viewing space between the distal portion of the optical system, and the distal end and the lateral aperture, said viewing space located within the field-of-view of the optical system; (c) a cutting blade mounted within the viewing space and capable of being extended from the viewing space; (d) means for extending the working tool outwardly from the viewing space; (e) a grip handle rotatably connected to said probe; wherein said handle includes actuator means for extending said cutting blade; (f) adjustment means for adjusting the rotational orientation between said lateral aperture of said probe and said grip handle; wherein said adjustment means is adapted to temporarily fix said rotational orientation; and (g) retraction means for automatically retracting said cutting blade upon release of said actuator means.

Claim 28

A surgical instrument for dividing the flexor retinaculum under visual inspection during carpal tunnel release, while minimizing the risk of injury to surrounding tissue; comprising: (a) a probe having an upper surface, a generally closed distal end, and a lateral aperture in said upper surface and adjacent said closed distal end; wherein said distal end slopes away from said upper surface in a manner such that said distal end diverts displaceable tissue it contacts away from the region of the lateral aperture and said upper surface; wherein said upper surface of said probe adjacent to said lateral aperture is configured generally as a flat or concave surface; (b) an optical system disposed at least partially within the probe, said system having a distal portion terminating adjacent the lateral aperture, thereby defining a viewing space between the distal portion of the optical system, and the distal end and the lateral aperture, said viewing space located within the field-of-view of the optical system; (c) a cutting blade mounted within the viewing space and capable of being extended from the viewing space; (d) means for extending the working tool outwardly from the viewing space; (e) a grip handle rotatably connected to said probe; wherein said handle includes actuator means for extending said cutting blade; (f) adjustment means for adjusting the rotational orientation between said lateral aperture of said probe and said grip handle; wherein said adjustment means is adapted to temporarily fix said rotational orientation; and (g) retraction means for automatically retracting said cutting blade upon release of said actuator means.

Claim 29

An instrument as recited in claim 23, wherein said optical system comprises a conventional examination telescope.

Claim 30

An instrument as recited in claim 23, wherein the means for extending the cutting blade through the viewing space of the probe comprises a longitudinally displaceable actuation shaft contained within the probe, said actuation shaft being connected to said cutting blade in actuating relationship therewith providing means for transforming longitudinal displacement of the actuation shaft into outward extension of the cutting blade; wherein said actuation shaft is adapted to respond to movement of said actuator means.

Claim 31

An instrument as recited in claim 25 wherein each additional increment of longitudinal displacement of the actuation shaft produces a correspondingly greater increment in the extension of the cutting blade.

Claim 32

An instrument as recited in claim 26 wherein the cutting blade is cooperatively engaged with pivot means in the distal end of the probe so that longitudinal displacement of the actuation shaft produces an angular displacement of the cutting blade as the actuation shaft approaches the pivot means, thereby outwardly extending the cutting blade.

Claim 33

An instrument in accordance with claim 25, wherein said probe is detachably connected to said grip handle; wherein said upper surface adjacent to said lateral aperture is flat; and wherein said actuation shaft is adapted to respond to actuating movement of a trigger carried by said grip handle.

Claim 34

An instrument in accordance with claim 23, wherein said probe includes a flat upper surface, parallel sides, and a convex lower surface.

Claim 35

A surgical instrument for manipulating selected tissue in a body cavity under visual inspection, comprising: (a) a probe having an upper surface, a generally closed distal end, and a lateral aperture in said upper surface and adjacent said closed distal end; wherein the upper surface adjacent to the lateral aperture is configured generally as a flat or concave surface; wherein said distal end slopes away from said upper surface in a manner such that said distal end diverts displaceable tissue it contacts away from the region of the lateral aperture and said upper surface; (b) an optical system disposed at least partially within the probe, said system having a distal portion terminating adjacent the lateral aperture, thereby defining a viewing space between the distal portion of the optical system and the distal end of said probe, said viewing space located within the field-of-view of the optical system; (c) a working tool mounted within the probe and capable of being extended from the viewing space; (d) means for extending the working tool outwardly from the viewing space; (e) a grip handle rotatably connected to said probe; and (f) adjustment means for adjusting the rotational orientation between said lateral aperture of said probe and said grip handle; wherein said adjustment means is adapted to temporarily fix said rotational orientation.

Claim 36

A surgical instrument for manipulating selected tissue in a body cavity under visual inspection, comprising: (a) a probe having an upper surface, a generally closed distal end, and a lateral aperture in said upper surface and adjacent said closed distal end; wherein the upper surface adjacent to the lateral aperture is configured generally as a flat or concave surface; wherein said distal end slopes away from said upper surface in a manner such that said distal end diverts displaceable tissue it contacts away from the region of the lateral aperture and said upper surface; (b) an optical system disposed at least partially within the probe, said system having a distal portion terminating adjacent the lateral aperture, thereby defining a viewing space between the distal portion of the optical system and the distal end of said probe, said viewing space located within the field-of-view of the optical system; (c) a working tool mounted within the probe and capable of being extended from the viewing space; (d) means for extending the working tool outwardly from the viewing space; (e) a grip handle rotatably connected to said probe; and (f) adjustment means for adjusting the rotational orientation between said lateral aperture of said probe and said grip handle; wherein said adjustment means is adapted to temporarily fix said rotational orientation.