Process for transecting remote constrained surgical locations such as the transverse carpal ligament

Claim 2

A process for surgery on the transverse carpal ligament of a hand comprising the steps of: providing a probe having a blunt non-dissecting tip, said probe defining a first interior conduit; providing means for defining a cavity behind said tip, said cavity having an opening, said blunt non-dissecting tip being adapted for insertion into the hand with said cavity opening disposed to the palmar side of the hand; providing said first interior conduit of said probe with an optical viewing device, said optical viewing device protruding into said cavity for viewing of said cavity at the end of said probe; providing a second conduit for conducting energy sufficient for the non-contact transection of the transverse carpal ligament, said second conduit protruding from said opening of said cavity at the end of said probe and terminating in the field of view of said viewing device for the discharge of said energy; making an incision for inserting said probe into the hand; inserting said probe into the hand within the carpal tunnel with said cavity behind said blunt non-dissecting tip being upwardly exposed underneath the transverse carpal ligament; visualizing the transverse carpal ligament through said optical viewing device at said opening of said cavity; supplying to said second conduit energy for transecting the transverse carpal ligament during said visualization step with the interface of the transecting being visible through the optical viewing device.

Claim 3

The process of claim 1 further including moving said second conduit with respect to said probe during said supplying of energy to said second conduit.

Claim 4

The process of claim 2 wherein said moving of said second conduit includes moving said second conduit in and out of said probe.

Claim 5

The process of claim 2 wherein said moving of said second conduit includes steering said second conduit with respect to said probe.

Claim 6

The process of claim 4 wherein said steering of said second conduit includes steering said second conduit side to side and up and down with respect to said probe.

Claim 7

The process of claim 1 wherein said optical viewing device is movable relative to said probe.

Claim 8

The process of claim 1 wherein said supplying of energy to said second conduit includes supply lasing energy to said second conduit.

Claim 9

The process of claim 1 further including: providing said probe with a suction conduit and, providing suction to said suction conduit.

Claim 10

The process of claim 1 wherein providing said means for defining a cavity includes: providing said probe with a collapsible and expansible shield; collapsing said shield with respect to said probe during said insertion of said probe into the hand; and, expanding said shield during said supplying of energy to said second conduit.

Claim 11

The process of claim 9 wherein said shield is disposed between the contents of said carpal tunnel and said transverse carpal ligament when said probe is inserted into the hand.

Claim 12

The process of claim 9 wherein said providing of a collapsible shield further comprises: providing a flexible mesh structure disposed about the exterior of said probe as said shield; collapsing said flexible mesh structure about said probe during said insertion of said probe into the hand such that said collapsible mesh structure at least partially encloses said cavity and thereby defines a first cavity size; and, expanding said flexible mesh structure to create an expanded second size of said cavity during said supplying of energy to said second conduit.

Claim 13

The process of claim 9 wherein said providing of a shield further comprises: providing a balloon disposed about the exterior of said probe as said shield; collapsing said balloon against said probe during said insertion of said probe into the hand; and, expanding said balloon during said supplying of energy to said second conduit.

Claim 14

The process of claim 1 wherein said insertion of said probe into the hand includes inserting said probe proximate to the wrist adjacent the hand.

Claim 15

The process of claim 1 wherein said probe rotates.

Claim 16

The process of claim 1 further including providing a grasping device in said probe.

Claim 17

A process for surgery on the transverse carpal ligament of a hand comprising the steps of: providing a probe having a blunt non-dissecting tip, said probe defining at least one interior conduit; providing said probe with a cavity behind said tip for defining an operating interval behind said blunt non-dissecting tip, said cavity having an opening adapted to be disposed to the palmar side of the hand; providing said at least one interior conduit of said probe with an optical viewing device, said optical viewing device protruding into said cavity; providing a fiber for conducting laser energy sufficient for the non-penetrating transection of the transverse carpal ligament, said fiber being disposed within and protruding from the opening of said cavity at the end of said probe behind said blunt non-dissecting tip and terminating in the field of view of said viewing device for the discharge of said laser energy; making an incision for inserting said probe into the hand; inserting said probe into the hand within the carpal tunnel underneath the transverse carpal ligament with said blunt non-dissecting tip inserted into said incision followed by the remainder of said probe; visualizing the transverse carpal ligament through said optical viewing device at said opening of said cavity; supplying laser energy to said fiber for non-penetrating transecting of the transverse carpal ligament during said visualization with the interface of the transecting being visible through the optical viewing device step.

Claim 18

A process for surgery on the transverse carpal ligament of a hand comprising the steps of: providing a probe having a blunt non-dissecting tip, said probe defining at least one interior conduit; providing said probe with a cavity behind said tip for defining an operating interval behind said blunt non-dissecting tip, said cavity having an opening adapted to be disposed to the palmar side of the hand; providing said at least one interior conduit of said probe with an optical viewing device, said optical viewing device protruding into said cavity; providing a fiber for conducting laser energy sufficient for the non-penetrating transection of the transverse carpal ligament, said fiber being disposed within and protruding from the opening of said cavity at the end of said probe behind said blunt non-dissecting tip and terminating in the field of view of said viewing device for the discharge of said laser energy; making an incision for inserting said probe into the hand; inserting said probe into the hand within the carpal tunnel underneath the transverse carpal ligament with said blunt non-dissecting tip inserted into said incision followed by the remainder of said probe; visualizing the transverse carpal ligament through said optical viewing device at said opening of said cavity; supplying laser energy to said fiber for non-penetrating transecting of the transverse carpal ligament during said visualization with the interface of the transecting being visible through the optical viewing device step.

Claim 19

The process of claim 16 further including moving said fiber with respect to said probe during said supplying of laser energy to said fiber.

Claim 20

The process of claim 16 wherein said providing of said probe includes providing a semi rigid probe.

Claim 21

The process of claim 16 wherein said providing of said probe includes providing a rigid probe.

Claim 22

The process of claim 16 and further including steering said fiber side to side and up and down with respect to said probe.

Claim 23

The process of claim 16 further including: providing said probe with a suction conduit; and, providing suction to said suction conduit.

Claim 24

The process of claim 16 further including: providing an expansible and collapsible shield to said probe; collapsing said shield with respect to said probe during said insertion of said probe in the hand; and, expanding said shield during said supplying of laser energy to said fiber.

Claim 25

The process of claim 22 wherein said shield is disposed between the contents of said carpal tunnel and said transverse carpal ligament when said probe is inserted into the hand.

Claim 26

The process of claim 22 wherein said providing of said shield further comprises: providing a flexible mesh structure disposed about the exterior of said probe as said shield; collapsing said flexible mesh structure about said probe during said insertion of said probe in the hand such that said collapsible mesh structure at least partially encloses said cavity and thereby defines a first cavity size; and, expanding said flexible mesh structure to create an expanded second size of said cavity during said supplying of laser energy to said fiber.

Claim 27

The process of claim 22 wherein said providing of a shield further comprises: providing a balloon disposed around the exterior of said probe as said shield; collapsing said balloon to said probe during said insertion of said probe in the hand; and, expanding said balloon during said supplying of laser energy to said fiber.

Claim 28

The process of claim 22 wherein said insertion of said probe includes inserting said probe proximate to the wrist adjacent the hand.

Claim 29

A process for surgery on the transverse carpal ligament of the hand comprising the steps of: providing a probe having a blunt non-dissecting tip, said probe defining a first interior conduit; providing said probe, with a cavity behind said tip for providing upon insertion to said carpal tunnel an operating cavity, said cavity forming the distal end of said first interior conduit and including an opening adapted to face the palmar side of the hand; providing said first interior conduit of said probe with an optical viewing device, said optical viewing device protruding into said cavity; providing a second conduit for conducting energy sufficient for the non-penetrating transection of the transverse carpal ligament, said second conduit protruding from the opening at the end of said probe and terminating in the field of view of said viewing device for the discharge of said energy; making an incision for inserting said probe into the hand; inserting said probe into the hand within the carpal tunnel underneath the transverse carpal ligament with said blunt non-dissecting tip inserted first followed by the remainder of said probe; providing a shield to said probe; collapsing said shield with respect to said probe during said insertion of said probe into the hand; visualizing the transverse carpal ligament through said optical viewing device at said cavity behind said blunt non-dissecting tip of said probe from the carpal tunnel to and toward the palmar side of the hand; supplying said second conduit with energy for the non-penetrating transecting of the transverse carpal ligament during said visualization with the interface of the transecting being visible through the optical viewing device step; and expanding said shield during said supplying of said energy to said second conduit.

Claim 30

A process for surgery on the transverse carpal ligament of the hand comprising the steps of: providing a probe having a blunt non-dissecting tip, said probe defining a first interior conduit; providing said probe, with a cavity behind said tip for providing upon insertion to said carpal tunnel an operating cavity, said cavity forming the distal end of said first interior conduit and including an opening adapted to face the palmar side of the hand; providing said first interior conduit of said probe with an optical viewing device, said optical viewing device protruding into said cavity; providing a second conduit for conducting energy sufficient for the non-penetrating transection of the transverse carpal ligament, said second conduit protruding from the opening at the end of said probe and terminating in the field of view of said viewing device for the discharge of said energy; making an incision for inserting said probe into the hand; inserting said probe into the hand within the carpal tunnel underneath the transverse carpal ligament with said blunt non-dissecting tip inserted first followed by the remainder of said probe; providing a shield to said probe; collapsing said shield with respect to said probe during said insertion of said probe into the hand; visualizing the transverse carpal ligament through said optical viewing device at said cavity behind said blunt non-dissecting tip of said probe from the carpal tunnel to and toward the palmar side of the hand; supplying said second conduit with energy for the non-penetrating transecting of the transverse carpal ligament during said visualization with the interface of the transecting being visible through the optical viewing device step; and expanding said shield during said supplying of said energy to said second conduit.

Claim 31

The process of claim 27 wherein said shield is disposed between the contents of said carpal tunnel and said transverse carpal ligament when the probe is inserted into the hand.

Claim 32

The process of claim 27 wherein said providing of said shield further comprises: providing a flexible mesh structure disposed about the exterior of said probe as said shield; collapsing said flexible mesh structure about said probe during said insertion of said probe into the hand such that said collapsible mesh structure at least partially encloses said cavity and thereby defines a first cavity size; and, expanding said flexible mesh structure to create an expanded second size of said cavity about said probe during said supplying of energy to said second conduit.

Claim 33

The process of claim 27 wherein said providing of said shield further comprises: providing a balloon disposed about the exterior of said probe as said shield; collapsing said balloon to said probe during said insertion of said probe into the hand; and, expanding said balloon during said supplying of energy to said second conduit.

Claim 34

A process for surgery on an operating site adjacent to constrained surfaces having narrow substantially non-compressible entrance confines with structure to be differentiated within a constrained cavity within the human anatomy comprising the steps of: providing a probe defining a first interior conduit having an opening, said probe being adapted for insertion into a constrained area adjacent said surfaces along said narrow, substantially non-compressible entrance confines with said opening disposed to an operating site within said constrained area adjacent said surface; providing a blunt non-dissecting tip to said probe; providing a cavity behind said tip wherein said cavity is aligned with said opening for providing at said tip an interval for exposing said operating site; providing said first interior conduit of said probe with an optical viewing device, said optical viewing device protruding into said cavity for viewing of said operating site at the end of said probe; providing a second conduit for conducting energy sufficient for the non-penetrating transection, incision or treatment of the anatomy of said operating site adjacent said constrained area, said second conduit protruding from the opening of said interior conduit and terminating in the field of view of said viewing device for the discharge of said energy; making an incision overlying said narrow, substantially non-compressible entrance confines for inserting said probe into the constrained area adjacent said surfaces; inserting said probe into the constrained area along said narrow, substantially non-compressible entrance confines with said blunt non-dissecting tip leading said probe during said inserting; visualizing the operating site through said optical viewing device; supplying said second conduit with energy for transecting, incising or treating the operating site during said visualization step with the interface of cutting visible to the optic viewing device.

Claim 35

A process for surgery on an operating site adjacent to constrained surfaces having narrow substantially non-compressible entrance confines with structure to be differentiated within a constrained cavity within the human anatomy comprising the steps of: providing a probe defining a first interior conduit having an opening, said probe being adapted for insertion into a constrained area adjacent said surfaces along said narrow, substantially non-compressible entrance confines with said opening disposed to an operating site within said constrained area adjacent said surface; providing a blunt non-dissecting tip to said probe; providing a cavity behind said tip wherein said cavity is aligned with said opening for providing at said tip an interval for exposing said operating site; providing said first interior conduit of said probe with an optical viewing device, said optical viewing device protruding into said cavity for viewing of said operating site at the end of said probe; providing a second conduit for conducting energy sufficient for the non-penetrating transection, incision or treatment of the anatomy of said operating site adjacent said constrained area, said second conduit protruding from the opening of said interior conduit and terminating in the field of view of said viewing device for the discharge of said energy; making an incision overlying said narrow, substantially non-compressible entrance confines for inserting said probe into the constrained area adjacent said surfaces; inserting said probe into the constrained area along said narrow, substantially non-compressible entrance confines with said blunt non-dissecting tip leading said probe during said inserting; visualizing the operating site through said optical viewing device; supplying said second conduit with energy for transecting, incising or treating the operating site during said visualization step with the interface of cutting visible to the optic viewing device.

Claim 36

The process of claim 31 wherein said constrained area is selected from a group of cavities consisting of: portals in the hand, elbow, wrist, foot, ankle, temporomandibular joint, and the scar tissue interface between the female breast and an inserted breast implant.

Claim 37

The process of claim 31 further including moving said second conduit with respect to said probe during said supplying of energy to said second conduit.

Claim 38

The process of claim 33 wherein said moving of said second conduit includes moving said second conduit in and out of said probe.

Claim 39

The process of claim 33 wherein said moving of said second conduit includes steering said second conduit with respect to said probe.

Claim 40

The process of claim 35 wherein said steering of said second conduit includes steering said conduit side to side and up and down with respect to said probe.

Claim 41

The process of claim 31 wherein said supplying of energy to said second conduit includes supply lasing energy to said second conduit.

Claim 42

The process of claim 31 further including: providing said probe with a suction conduit; and, providing suction to said suction conduit.

Claim 43

The process of claim 31 further including the steps of: providing a collapsible and expansible shield to said probe; collapsing said shield with respect to said probe during said insertion of said probe into the constrained area; and, expanding said shield during said supplying of energy to said second conduit.

Claim 44

The process of claim 31 further including the steps of providing a grasping device at the distal end of said probe; and grasping a portion of the anatomy during said supplying of energy to said second conduit.

Claim 45

The process of claim 39 wherein said constrained area is the carpal tunnel and said shield is disposed between the contents of said carpal tunnel and said transverse carpal ligament when said probe is inserted into said constrained area.

Claim 46

The process of claim 41 wherein said providing of said shield further comprises: providing a flexible mesh structure disposed about the exterior of said probe as said shield; collapsing said flexible mesh structure about said probe during said insertion of said probe into said constrained area such that said shield at least partially encloses said cavity and thereby defines a first cavity size; and, expanding said flexible mesh structure to create an expanded second size of said cavity during said supplying of energy to said second conduit.

Claim 47

The process of claim 41 wherein said providing of said collapsible shield further comprises: providing a balloon disposed about the exterior of said probe as said shield; collapsing said balloon to said probe during said insertion of said probe into said constrained area; and, expanding said balloon during said supplying of energy to said second conduit.

Claim 48

The process of claim 31 wherein said insertion of said probe further includes inserting said probe proximate to a wrist of a patient.