Multi-lumen cannula and methods of using same

Abstract

Disclosed herein are components, systems, and methods to provide access for multiple surgical instruments to a surgical site within a body through an incision in the body. A multi-lumen cannula includes a tubular body having proximal and distal ends, first and second lumens, and first and second ports. The first and second lumens each extend from the proximal end toward the distal end providing separate passageways for different surgical instruments through the tubular body. The first port intersects the first lumen, the second port intersects the second lumen, and the first and second lumens define a fluid flow path from the first port to the second port establishing fluid communication therebetween. The fluid flow path provides irrigation for the surgical site.

Description

MULTI-LUMEN CANNULA AND METHODS OF USING SAMECROSS-REFERENCE TO RELATED APPLICATION

[0001] This patent application claims priority of U.S. Patent Application No. 63 / 564,882, filed on March 13, 2024, the entire disclosure of which is hereby incorporated by reference herein for all purposes.BACKGROUND

[0002] Arthroscopic and endoscopic surgical procedures include the use of cannula(s) to access a surgical site (typically a joint or body cavity). Cannulas facilitate entry and removal of surgical instruments used during the surgical procedure. One advantage over traditional “open” surgery is that arthroscopic and endoscopic surgical procedures access the surgical site through smaller openings, using smaller surgical instruments. The cannula provides a rigid, fixed channel through an incision in the patient’s body to the surgical site.

[0003] Some procedures involve the use of multiple surgical instruments, for example a camera, to visualize the surgical site and a working device (e g., a probe, endoscope, electrode, cutter, etc.) to perform treatment on tissue at the surgical site. Endoscopes typically include long flexible tubes with a camera and a light source at one end, and in use, are inserted into the body through a small opening, often provided by the cannula. Inserting multiple instruments through a single cannula may result in the instruments becoming entangled during the procedure.

[0004] Additionally, some procedures involve irrigation of the surgical site during the procedure. Irrigation may facilitate removal of debris (e.g., tissue) that is treated (e.g., ablated, debrided, cauterized, cut, removed) during the surgical procedure. Removal of the debris clears the visual field and improves visibility provided by the camera.

[0005] Some surgical procedures generate heat at the surgical site (e.g., to ablate tissue) and irrigation helps remove the generated heat to prevent damage to surrounding tissue. The generated heat may also result in bubble formation, and the bubbles may decrease visibility. Irrigation removes the bubbles from the surgical site thereby increasing visibility and may also be used to distend the surgical site to increase a working area therein. Irrigation is typically provided through one or more channels (e.g., one entry and one exit) that are defined by a cannula separate from the one(s) used by the surgical instruments.

[0006] As the size and number of incisions increase, so does recovery time for the patient. Thus, even in view of conventional techniques and equipment, a need exists fordevices that advantageously provide the required access to a surgical site while employing fewer incisions.BRIEF SUMMARY

[0007] This disclosure relates to a multi-lumen cannula that may be placed in an opening of a body to maintain the opening and provide separate rigid passageways for surgical instruments, such as an endoscope and a working instrument, along the respective lumen to a surgical site (located within an interior portion of the body). Some embodiments described herein relate to a multi-lumen cannula that may be used during endoscopy to provide access for a plurality of surgical tools, simultaneously. The lumens of the cannula, beneficially, are fluidly connected to facilitate irrigation of the surgical site during a surgical procedure. Additional embodiments described herein include methods of use and assembly of the multi-lumen cannula.

[0008] This disclosure further relates to multi-lumen cannula including fluid entry / exit ports that are each connected to a respective one of the lumen, which, advantageously, are in fluid connection with one another to enable irrigation of the surgical site without the use of multiple cannulas each inserted through respective openings in the body.

[0009] Some surgical procedures utilize instruments of different sizes. For example, an endoscopic rhizotomy typically includes the use of a smaller endoscope to visualize the surgical site and a larger radiofrequency probe to treat (e.g., burn, destroy) tissue (e.g., a medial branch nerve) at the surgical site. Thus, in some cases, the multiple lumen of the multi-lumen cannula may be different sizes so as to improve configuration of the relative sizes of the surgical instruments to be used during a particular surgical procedure. In some embodiments, the different-sized lumens beneficially enable a tip with a reduced cross-section to enclose the multiple lumens.

[0010] According to some embodiments, a multi-lumen cannula includes an elongated body having a proximal end, a distal end, first and second lumens, and first and second ports. The first lumen and the second lumen each extend from the proximal end toward the distal end. The first port intersects the first lumen, the second port intersects the second lumen, and the first and second lumens define a fluid flow path from the first port to the second port establishing fluid communication therebetween. The first lumen and the second lumen extend along respective axes that are substantially parallel to one another.

[0011] According to some embodiments, a multi-lumen cannula includes an elongated body having a proximal end and a distal end. The multi-lumen cannula further includes first and second lumens each extending from the proximal end toward the distal endalong respective axes. Each of the respective axes extends through separate, respective openings in the proximal and distal ends. The elongated body is elongate along a length that is measured from the proximal end to the distal end along a direction parallel to the axes, and the first lumen is fluidly isolated from the second lumen within a first portion of the elongated body that extends from the proximal end toward the distal end along at least a majority of the length. Additionally, the first lumen is fluidly connected to the second lumen within a second portion of the elongated body that extends from the first portion to the distal end.

[0012] According to some embodiments, a method of use of a multi-lumen cannula includes inserting a distal end of an elongated body through an incision in a surface and into an internal volume enclosed by the surface, thereby forming a passage through the incision and into the internal volume. The method further includes inserting a first instrument into a first lumen of the multi-lumen cannula. The first lumen extends along the passage between a proximal end of the elongated body and the distal end of the elongated body.

[0013] The method further includes inserting a second instrument into a second lumen of the multi-lumen cannula. The second lumen extends along the passage between the proximal end of the elongated body and the distal end of the elongated body. The second instrument is inserted into the second lumen while the first instrument is positioned within the first lumen. A working end of the second instrument is moved through the distal end of the elongated body and into the internal volume, and a fluid is moved through the first lumen toward the distal end, while the first instrument is positioned within the first lumen. After moving the fluid through the first lumen, the method includes moving the fluid through the second lumen toward the proximal end, while the second instrument is positioned within the second lumen, and after moving the fluid through the second lumen, moving the fluid out of the second lumen.BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

[0014] In the drawings, identical reference numbers identify similar elements or acts. The sizes and relative positions of elements in the drawings are not necessarily drawn to scale. For example, the shapes of various elements and angles are not necessarily drawn to scale, and some of these elements may be arbitrarily enlarged and positioned to improve drawing legibility. Further, the particular shapes of the elements as drawn, are not necessarily intended to convey any information regarding the actual shape of the particular elements and may have been solely selected for ease of recognition in the drawings. The headings and Abstract of the Disclosure provided herein are for convenience only and do not interpret the scope or meaning of the embodiments.

[0015] Figure 1 is an isometric view of a multi-lumen cannula in use during a surgical procedure.

[0016] Figure 2 is an isometric view of the multi-lumen cannula illustrated in Figure1.

[0017] Figure 3 is a front elevation view of the multi-lumen cannula illustrated in Figure 2.

[0018] Figure 4 is a top plan view of the multi-lumen cannula illustrated in Figure 2.

[0019] Figure 5 is a bottom plan view of the multi-lumen cannula illustrated in Figure2.

[0020] Figure 6 is a cross-sectional view of the multi-lumen cannula illustrated in Figure 4, taken along line 6-6.

[0021] Figure 7 is a cross-sectional view of the multi-lumen cannula illustrated in Figure 6, taken along line 7-7.

[0022] Figure 8 is a cross-sectional view of the multi-lumen cannula illustrated in Figure 4, taken along line 6-6, in a first configuration.

[0023] Figure 9 is a cross-sectional view of the multi-lumen cannula illustrated in Figure 4, taken along line 6-6, in a second configuration.

[0024] Figure 10 is a cross-sectional view of the multi-lumen cannula illustrated in Figure 4, taken along line 6-6, in use with first and second instruments inserted in respective lumen of the multi-lumen cannula.

[0025] Figure 11 is an isometric view of a part of a surgical procedure that includes making an incision.

[0026] Figure 12 is an isometric view of a multi-lumen cannula in use during the surgical procedure illustrated in Figure 11 , the multi-lumen cannula being inserted through the incision.

[0027] Figure 13 is an isometric view of the multi-lumen cannula in use during the surgical procedure illustrated in Figure 12, the multi-lumen cannula forming rigid passageways through the incision.

[0028] Figure 14 is an isometric view of the multi-lumen cannula in use during the surgical procedure illustrated in Figure 12, the multi-lumen cannula forming rigid passageways for multiple surgical instruments.DETAILED DESCRIPTION

[0029] As noted above, during a surgical procedure, a multi-lumen cannula may be inserted through an opening (e.g., an incision) in a patient’s body to provide access to asurgical site within an interior portion of the body, and, in some cases, there may be times where irrigation of the surgical site is desired.

[0030] It has now been found that the disclosed multi-lumen cannula provides for multiple, synergistic advantages over conventional cannulas. For example, the disclosed cannula maintains the opening during the procedure and each of the lumens provides a stable passageway for respective instruments (e.g., endoscopes, drills, graspers, probes, etc.). In addition, entry / exit ports in fluid connection with respective lumen and the lumens in fluid connection with one another establishes a fluid flow path through the multi-lumen cannula for fluid to enter one of the lumen, flow toward the surgical site, gather and transport debris from the surgical site away from the surgical site via another of the lumen, before exiting the multi-lumen cannula. Irrigation of the surgical site (e.g., flow of the fluid) may be controlled by one or more valves positioned along the fluid flow path.

[0031] Some embodiments of the disclosure relate to a multi-lumen cannula that comprises multiple (e.g., first and second) lumens that extend through an elongated body from a proximal end of the body toward a distal end of the body. The multi-lumen cannula includes multiple (e.g., first and second) ports that are each in fluid connection with a respective one of the multiple lumens. The lumens are fluidly connected to one another to define a fluid flow path from the first port to the second port establishing a fluid connection therebetween.

[0032] The disclosed cannula (and its lumens) advantageously provide for multiple, separate passageways through a single incision prevents entanglement of the instruments while reducing the size and number of incisions used to provide access for the instruments to the surgical site. This reduction in the size and number of incisions results in faster procedures, as placement of each separate cannula according to known procedures involves multiple steps of incision, visualization, and placement of hardware (e.g., guide wires and the cannula). Additionally, the reduced size and number of incisions results in reduced recovery time, as larger, more numerous incisions take longer to heal. Further, decreasing the size and number of incisions formed in the body reduces the likelihood of negative outcomes, such as infection at the site(s) of the wound(s).

[0033] In some embodiments, the multi-lumen cannula comprises an elongated body having proximal and distal ends. The multi-lumen cannula may further comprise first and second lumens each extending from the proximal end toward the distal end along respective axes, which may be substantially parallel to one another. The elongated body is elongate along a length that is measured from the proximal end to the distal end along a direction parallel to the axes of the first and second lumens. The first lumen is fluidly isolated from the second lumen within a first portion of the elongated body that extends fromthe proximal end toward the distal end along (at least a majority of) the length. The first lumen is fluidly connected to the second lumen within a second portion of the elongated body that extends from the first portion to the distal end.

[0034] In some cases, the first portion of the elongated body extends along greater than 50 percent of the length, e.g., at least 60 percent, at least 70 percent, at least 80 percent, or at least 90 percent. In terms of upper limits, the first portion of the elongated body extends along less than 95 percent of the length, e.g., at less than 90 percent, less than 80 percent, less than 70 percent, or less than 60 percent. In terms of ranges, the first portion of the elongated body extends along from 40 percent to 95 percent of the length, e.g., from 50 percent to 90 percent, from 55 percent to 85 percent, from 60 percent to 90 percent, or from 65 percent to 85 percent.

[0035] The disclosed cannula provides for passage for instruments and for irrigation fluid reduces the reliance on additional incisions dedicated only to irrigation. The dual purpose (instrument and fluid) lumens result in a cannula with a smaller cross-sectional profile. Additionally, the lumens being separated / isolated toward the proximal end, but fluidly connected toward the distal end results in an effective fluid flow through the elongated body of the cannula that effectively irrigates the surgical site, beneficially removes heat, and removes debris and bubbles thereby improving visualization.

[0036] Some embodiments of the disclosure relate to a multi-lumen cannula with an elongated body that terminates at a distal end with cross-sectional shape having a maximum cross-sectional dimension that is less than 10 mm. In terms of upper limits, the maximum cross-sectional dimension at the distal end may be less than 10 mm, e.g., less than 8 mm, less than 7.5 mm, less than 6 mm, or less than 5 mm. In terms of lower limits, the maximum cross-sectional dimension at the distal end is greater than 4 mm, e.g., greater than 5 mm, greater than 6 mm, or greater than 7 mm. In terms of ranges, the maximum cross-sectional dimension at the distal end is between 4 mm and 10 mm, e.g., between 4.5 mm and 9 mm, between 5 mm and 8.5 mm, between 5.5 mm and 8 mm, or between 6 mm and 7.5 mm.

[0037] The distal end has a non-circular (e.g., oval) shape that is tapered along a length perpendicular to the cross-sectional shape. The tapered, distal end enables insertion of the multi-lumen cannula through a smaller incision (e.g., a single stab wound formed by a scalpel). Thus, the embodiments of the multi-lumen cannula advantageously simplify the incision process for surgical procedures.

[0038] Referring now to the drawings, and specifically to Figure 1 , some surgical procedures (e.g., endoscopies such as endoscopic rhizotomies) involve the insertion of surgical instruments (e.g., an endoscope 110 and a radiofrequency probe 112) through an opening (e.g., an incision 114) of a body 116 to view and / or interact with an interior portion ofthe body 116 (e.g., at a surgical site 118). The opening may be maintained with a working tube (e.g., a multi-lumen cannula 120), that defines a passageway through the opening, into the interior portion of the body 116, and to the surgical site 118. A cannula holder (not shown) may be used to secure a position of the multi-lumen cannula 120 (e.g., relative to a fixed reference point such as the incision 114 in the body 116 or an operating table upon which the body 116 is supported during the procedure).

[0039] Referring to Figures 2 to 10, the multi-lumen cannula 120 may include a tubular body 122 that is elongated (e.g., along an axis 124 that is parallel to a first direction D1). The multi-lumen cannula 120 may include a proximal end 126 and a distal end 128 opposite one another with respect to the first direction D1 such that the tubular body 122 extends between the proximal end 126 and the distal end 128 (e.g., from the proximal end 126 and the distal end 128). In some of the procedures in which the multi-lumen cannula 120 is to be used it may be beneficial for the tubular body 122 to be visible in an x-ray image. Accordingly, the tubular body 122 may be radiopaque. In some procedures in which the multi-lumen cannula 120 is used it may be beneficial for the tubular body 122 to be invisible in an x-ray image. Accordingly, the tubular body 122 may be radiolucent.

[0040] The multi-lumen cannula 120 may include a plurality of lumens (e.g., a first lumen 130 and a second lumen 132) each extending between the proximal end 126 and the distal end 128 (e.g., along respective axes substantially parallel to the first direction D1). For example, the first lumen 130 may extend along the axis 124 such that the axis 124 is a central axis within the first lumen 130. Similarly, the second lumen 132 may extend along an axis 117 that is substantially parallel (e.g., plus or minus about 5°) to the axis 124 and centrally located within the second lumen 132. Additionally, the multi-lumen cannula 120 may include ports (e.g., a first port 134 and a second port 136) that each intersect with a respective one of the plurality of lumens. For example, the first port 134 may intersect with the first lumen 130 and the second port 136 may intersect with the second lumen 132.

[0041] The multi-lumen cannula 120 may define a fluid flow path 148 that establishes fluid communication between the first port 134 and the second port 136 (e.g., via the first lumen 130 and the second lumen 132 as described in further detail below). According to one embodiment, the fluid flow path 148 may exit the first port 134 and enter the first lumen 130, then travel along the first lumen 130 (e.g., toward the distal end 128 along the first direction D1). The fluid flow path 148 may exit the first lumen 130 and enter the second lumen 132, and then travel along the second lumen 132 (e.g., toward the proximal end 126 along the first direction D1), before exiting the second lumen 132 and entering the second port 136.

[0042] The multi-lumen cannula 120 may define a first channel 144 extending through the first port 134 and intersecting with the first lumen 130 (e.g., between the proximal end 126 and the distal end 128). As shown, a portion of the fluid flow path 148 may travel along the first channel 144 as the fluid flow path 148 pass through the first port 134. The multi-lumen cannula 120 may define a second channel 146 extending through the second port 136 and intersecting the second lumen 132 (e.g., between the proximal end 126 and the distal end 128). As shown, a portion of the fluid flow path 148 may travel along the second channel 146 as the fluid flow path 148 passes through the second port 136. The first channel 144 and the second channel 146 may be coplanar intersecting their respective lumen along the length L, e.g., at a similar position or at the same position along the length.

[0043] According to one embodiment, a portion 150 of the fluid flow path 148 that travels along the first channel 144 may be substantially perpendicular (e.g., plus or minus about 5°) to a portion 152 of the fluid flow path 148 that travels along the first lumen 130 (e.g., toward the distal end 128). According to some embodiments, the portion 150 and the portion 152 may be oblique (intersecting at a non-perpendicular angle). The portion 152 of the fluid flow path 148 that travels along the first lumen 130 may be substantially parallel (e.g., plus or minus about 5°) to a portion 154 of the fluid flow path 148 that travels along the second lumen 132 (toward the proximal end 126). The portion 154 of the fluid flow path 148 that travels along the second lumen 132 may be substantially perpendicular (e.g., plus or minus about 5°) to a portion 156 of the fluid flow path 148 that travels along the second channel 146 through the second port 136. According to some embodiments, the portion 154 and the portion 156 may be oblique (intersecting at a non-perpendicular angle).

[0044] As shown, the multi-lumen cannula 120 may include a barrier 160 positioned between the first channel 144 and the second channel 146 such that a direct path from the first channel 144 to the second channel 146 is blocked by the barrier 160. According to some embodiments, the direct path from the first channel 144 to the second channel 146 is blocked by the barrier 160 such that a water tight barrier is formed or such that fluid flow from the first channel to the second channel that does not follow the fluid flow path 148 is significantly impeded (e.g., not water tight allowing for some leakage). The barrier 160 blocking the direct path from the first channel 144 to the second channel 146 forces fluid within the multi-lumen cannula 120 to follow the fluid flow path 148 (e.g., travelling “down” the first lumen 130 along one vector of the first direction D1 toward the distal end 128 and then back “up” the second lumen 132 along the opposite vector of the first direction D1 toward the proximal end 126).

[0045] The tubular body 122 may be elongate along a length L of the multi-lumen cannula 120 measured from the proximal end 126 to the distal end 128 (e.g., along the axis124). As shown, the first lumen 130 may be fluidly isolated from the second lumen 132 within a first portion 138 of the tubular body 122, and in fluid communication with the second lumen 132 within a second portion 140 of the tubular body 122.

[0046] According to one embodiment, the first portion 138 extends from the proximal end 126 toward the distal end 128 along at least 50 percent of the length L. For example, the first portion 138 of the tubular body 122 may extend along between 60 percent of the length and 80 percent of the length. In terms of lower limits, the first portion 138 of the tubular body 122 extends along greater than 50 percent of the length L, e.g., at least 60 percent, at least 70 percent, at least 80 percent, or at least 90 percent. In terms of upper limits, the first portion 138 of the tubular body 122 may extend along less than 95 percent of the length L, e.g., less than 90 percent, less than 80 percent, less than 70 percent, or less than 60 percent. In terms of ranges, the first portion 138 of the tubular body 122 may extend along from 40 percent to 95 percent of the length L, e.g., from 50 percent to 90 percent, from 55 percent to 85 percent, from 60 percent to 80 percent, or from 65 percent to 75 percent. If the fluid flow path 148 is too far from the distal end 128, effectiveness of the fluid to irrigate the surgical site 118 and remove debris may be negatively impacted.

[0047] The second portion 140 may extend from the first portion 138 toward (e.g., to) the distal end 128. The first portion 138 and the second portion 140 may cooperatively extend along an entirety of the length L of the multi-lumen cannula 120, as shown. Alternatively, the tubular body 122 may include additional portions on either end of or between the first portion 138 and the second portion 140 that contribute to the length L. In some cases, the first portion 138 is longer (e.g., between 2 and 25 times longer) than the second portion 140. In terms of lower limits, the first portion 138 may be at least 2 times longer, e.g., at least 4 times longer, at least 8 times longer, or at least 12 times longer than the second portion 140. In terms of upper limits, the first portion 138 may be up to 25 times longer, e.g., up to 20 times longer, up to 15 times longer, up to 10 times longer, or up to 4 times longer than the second portion 140. In terms of ranges, the first portion 138 may be between 2 and 25 times longer than the second portion 140, e.g., between 2.5 and 20 times longer, between 2.75 and 15 times longer, between 3 and 10 times longer, or between 4 and 6 times longer.

[0048] The multi-lumen cannula 120 may define a cross-sectional shape that lies within a plane P that is normal to, or close to normal to (e.g., within plus or minus 10°) the direction of elongation of the tubular body 122 (e.g., the first direction D1). The cross- sectional shape may be defined by an outer wall 142 of the tubular body 122. As shown, the cross-sectional shape may be non-circular (e.g., oval).

[0049] According to an embodiment of the disclosure, the outer wall 142 may enclose both the first lumen 130 and the second lumen 132. For example, the outer wall 142 may define portions of both the first lumen 130 and the second lumen 132. The first lumen 130 may have a first maximum cross-sectional dimension J1 as measured perpendicular to the length L (e.g., within the plane P), and the second lumen 132 may have a second maximum cross-sectional dimension J2 measured perpendicular to the length L (e.g., within the plane P).

[0050] As shown, the first maximum cross-sectional dimension J1 may be different than (e.g., less than) the second maximum cross-sectional dimension J2. According to one embodiment, the first lumen 130 may be sized to receive a first surgical instrument (e.g., the endoscope 110) with an outer diameter less than about 5 mm, (e.g., less than about 4 mm, or less than about 3 mm). In terms of lower limits, the first maximum cross-sectional dimension J1 may be at least 1 mm, e.g., at least 2 mm, at least 3 mm, or at least 4 mm. In terms of upper limits, first maximum cross-sectional dimension J1 may be less than 5 mm, e.g., less than 4 mm, less than 3 mm, or less than 2 mm. In terms of ranges, the first maximum cross-sectional dimension J1 may be between 1 mm and 5 mm, e.g., between 1 .25 mm and 4 mm, between 1 .5 mm and 3 mm, between 1 .75 mm and 2.5 mm, or between 2 mm and 2.25 mm.

[0051] As shown, the first maximum cross-sectional dimension J1 may be different than (e.g., less than) the second maximum cross-sectional dimension J2. According to one embodiment, the first lumen 130 may be sized to receive a first surgical instrument (e.g., the endoscope 110) with an outer diameter less than about 5 mm, (e.g., less than about 4 mm, or less than about 3 mm). In terms of lower limits, the first maximum cross-sectional dimension J1 may be at least 1 mm, e.g., at least 2 mm, at least 3 mm, or at least 4 mm. In terms of upper limits, first maximum cross-sectional dimension J1 may be less than 5 mm, e.g., less than 4 mm, less than 3 mm, or less than 2 mm. In terms of ranges, the first maximum cross-sectional dimension J1 may be between 1 mm and 5 mm, e.g., between 1 .25 mm and 4 mm, between 1 .5 mm and 3 mm, between 1 .75 mm and 2.5 mm, or between 2 mm and 2.25 mm.

[0052] The first maximum cross-sectional dimension J1 may be between 50 percent and 85 percent of the first maximum cross-sectional dimension J2. In terms of lower limits, the first maximum cross-sectional dimension J1 may be at least 50 percent of the second maximum cross-sectional dimension J2, e.g., at least 60 percent, at least 70 percent, at least 75 percent, or at least 80 percent. In terms of upper limits, the first maximum cross-sectional dimension J1 may be less than 85 percent of the second maximum cross-sectional dimension J2, e.g., less than 80 percent, less than 75 percent, less than 70 percent, or lessthan 60 percent. In terms of ranges, the first maximum cross-sectional dimension J1 is between 50 percent and 85 percent of the second maximum cross-sectional dimension J2, e.g., between 60 percent and 80 percent, between 70 percent and 78 percent, or between 72 percent and 76 percent.

[0053] The distal end 128 may have a cross-sectional shape that defines a maximum cross-sectional dimension J3 measured in a direction substantially perpendicular to the length L (e.g., in a plane substantially parallel to the plane P). The maximum cross- sectional dimension J3 of the distal end 128 may be less than 8 mm. In terms of upper limits, the maximum cross-sectional dimension J3 may be less than 10 mm, e.g., less than 9 mm, less than 8 mm, less than 7 mm, or less than 6 mm. In terms of lower limits, the maximum cross-sectional dimension J3 may be greater than 4 mm, e.g., greater than 5 mm, greater than 6 mm, or greater than 7 mm. In terms of ranges, the maximum cross-sectional dimension at the distal end 128 is between 4 mm and 10 mm, e.g., between 4.5 mm and 9 mm, between 5 mm and 8.5 mm, between 6 mm and 8 mm, or between 7 mm and 7.5 mm.

[0054] The cross-sectional shape of the distal end 128 may defines a minor cross- sectional dimension measured perpendicular to the maximum cross-sectional dimension J3 (e.g., in the plane substantially parallel to the plane P). The minor cross-sectional dimension of the distal end 128 may be less than 5 mm. In terms of upper limits, the minor cross- sectional dimension may be less than 8 mm, e.g., less than 7 mm, less than 6 mm, less than 5 mm, or less than 4 mm. In terms of lower limits, the minor cross-sectional dimension may be greater than 3 mm, e.g., greater than 4 mm, greater than 5 mm, or greater than 6 mm. In terms of ranges, the minor cross-sectional dimension at the distal end 128 may be between 3 mm and 6 mm, e.g., between 3.5 mm and 5 mm, or between 4 mm and 4.5 mm.

[0055] The distal end 128 may have a non-circular (e.g., oval) shape that forms a closed perimeter around both the first lumen 130 and the second lumen 132. The distal end 128 may be tapered along the length L (as shown in Figure 3), such that a size (e.g., an area) of the cross-sectional shape of the tubular body 122 increases along a portion of the tubular body 122 as the tubular body 122 extends away from the distal end 128 toward the proximal end 126.

[0056] The multi-lumen cannula 120 may include one or more valves (e.g., a first valve 162 and a second valve 164) that transition between an open configuration and a closed configuration. Each of the one or more valves may be positioned along the fluid flow path 148, as shown in the illustrated embodiment. When in the open configuration, fluid following the fluid flow path 148 passes through the valve and when in the closed configuration the fluid is blocked from passing through the valve.

[0057] Each of the valves may be supported by a respective one of the ports and positioned such that when in the closed configuration the fluid flow path 148 is blocked within the channel of the port. For example, the first valve 162 may be supported by the first port 134 and positioned within the first channel 144 upstream of an intersection 166 of the first channel 144 and the first lumen 130 with respect to the fluid flow path 148. Similarly, the second valve 164 may be supported by the second port 136 and positioned within the second channel 146 downstream of an intersection 168 of the second channel 146 and the second lumen 132 with respect to the fluid flow path 148.

[0058] The one or more valves may be transitioned between the open and closed configurations independently. For example, the first valve 162 may be in the closed configuration and the second valve 164 may be in the open configuration (as shown in Figure 8), or vice versa (as shown in Figure 9). The one or more valves may include respective handles accessible to a user of the multi-lumen cannula 120. As shown, the first valve 162 may include a first handle 163 that is pivotable to transition the first valve 162 from the open configuration to the closed configuration, and vice versa. Similar, the second valve 164 may include a second handle 165 that is pivotable to transition the second valve 164 from the open configuration to the closed configuration, and vice versa.

[0059] Fluid flow through the multi-lumen cannula 120 (e.g., along the fluid flow path 148) may be driven by a pump and / or pressure source positioned upstream of the multi-lumen cannula 120. Additionally or alternatively, fluid flow through the multi-lumen cannula 120 (e.g., along the fluid flow path 148) may be driven by a vacuum and / or suction source positioned downstream of the multi-lumen cannula 120.

[0060] According to one embodiment, the multi-lumen cannula 120 may include a flexible opening for each of the plurality of lumens. As shown, the multi-lumen cannula 120 may include a first flexible opening 170 that provides passage into the first lumen 130, and a second flexible opening 172 that provides passage into the second lumen 132. The first flexible opening 170 may be formed by a plurality of resilient flaps 174 that form a seal against an instrument (e.g., the endoscope 110) when the instrument is inserted through the first flexible opening 170 and into the first lumen 130. Similarly, the second flexible opening 172 may be formed by a plurality of resilient flaps 176 that form a seal against an instrument (e.g., the radiofrequency probe 112) when the instrument is inserted through the second flexible opening 172 and into the second lumen 132. The seal formed by the resilient flaps 174, 176 may be sufficient to prevent most up to all of the fluid following the fluid flow path 148 from escaping the multi-lumen cannula 120 through the respective first flexible opening 170 or second flexible opening 172.

[0061] Referring to Figures 1 to 14, a method of use of the multi-lumen cannula 120 may include inserting the distal end 128 of the tubular body 122 through the incision 114 in a surface (e.g., of the body 116) and into an internal volume (e.g., the surgical site 118), thereby forming a passage through the incision 114 and into the internal volume (e.g., to the surgical site 118). The incision 114 may be formed, according to one embodiment, using a scalpel 108 to make a stab incision having a maximum dimension J4 that is greater than a maximum dimension J3 of the distal end 128 of the tubular body 122.

[0062] The method may further include advancing the multi-lumen cannula 120 through the incision 114 until the distal end 128 is proximate the surgical site 118. When the distal end 128 is proximate the surgical site 118, a first instrument (e.g., the endoscope 110) may be inserted into the first lumen 130 (e.g., via the first flexible opening 170) and advanced along the first lumen 130 toward the distal end 128 (e.g., along the first direction D1).

[0063] According to one embodiment, the endoscope 110 may be advanced along the first lumen 130 toward the distal end 128 until a portion of the endoscope 110 is positioned within the second portion 140 of the tubular body 122 (as shown in Figure 10). The method may include inserting a second instrument (e.g., the radiofrequency probe 112) into the second lumen 132 (e.g., via the second flexible opening 172) and advancing the second instrument along the second lumen 132 toward the distal end 128 (e.g., along the first direction D1). As shown in Figure 10, the radiofrequency probe 112 may be advanced along the second lumen 132 toward the distal end 128 until a portion (e.g., a working end 180) of the second instrument is positioned within the second portion 140 of the tubular body 122.

[0064] The method may include moving the working end 180 of the second instrument through the distal end 128 of the tubular body 122, thereby exiting the tubular body 122 (as shown in Figure 14). A flow of a fluid 182 may be established through the first lumen 130 toward the distal end 128 (e.g., along the fluid flow path 148), while the first instrument is positioned within the first lumen 130 (e.g., through a gap 184 between the first instrument and the tubular body 122). According to one embodiment, the method includes transitioning the first valve 162 from the closed configuration to the open configuration to establish the flow of the fluid 182. The method may further include transitioning the second valve 164 from the closed configuration to the open configuration to establish the flow of the fluid 182.

[0065] After moving the fluid 182 through the first lumen 130, the method may include moving the fluid 182 through the second lumen 132 toward the proximal end 126. As shown, the fluid 182 may move through the second lumen 132 while the secondinstrument is positioned within the second lumen 132 (e.g., through a gap 186 between the second instrument and the tubular body 122). The method may further include treating tissue (e.g., at the surgical site 118 with the working end 180 of the second instrument while providing vision / visualizing the working end 180 via the first instrument).

[0066] Treating the tissue may include formation of debris (e.g., small particles of the treated tissue), and the method may include removing the debris from the surgical site 118 via the fluid 182 as it flows through the second lumen 132. According to one embodiment, treating the tissue may include generating heat at the surgical site 118, and the method may include removing heat from the surgical site 118 via the fluid 182 as it flows through the second lumen 132. Treating the tissue may include ablating the tissue, thereby forming the debris and / or generating the heat. After the fluid 182 has moved through the second lumen, the method may include moving the fluid 182 out of the second lumen 132 and into the second port 136 (e.g., via the second channel 146) and evacuating the fluid 182 (and any carried debris and / or heat) from the multi-lumen cannula 120.

[0067] The method may further include blocking movement of the fluid 182 (e.g., along the fluid flow path 148) at a location upstream from the first lumen 130. According to one embodiment, blocking movement of the fluid 182 (e.g., along the fluid flow path 148) at a location downstream from the second lumen 132 may include closing the second valve 164.

[0068] The above description of illustrated embodiments, including what is described in the Abstract, is not intended to be exhaustive or to limit the embodiments to the precise forms disclosed. Although specific embodiments of and examples are described herein for illustrative purposes, various equivalent modifications can be made without departing from the spirit and scope of the disclosure, as will be recognized by those skilled in the relevant art. The various embodiments described above can be combined to provide further embodiments.

[0069] The methods described herein can be performed with variations. For example, many of the methods may include additional acts, omit some acts, and / or perform acts in a different order than as illustrated or described.

[0070] As used herein, “greater than” and “less than” limits may also include the number associated therewith. Stated another way, “greater than” and “less than” may be interpreted as “greater than or equal to” and “less than or equal to.” It is contemplated that this language may be subsequently modified in the claims to include “or equal to.” For example, “greater than 4.0” may be interpreted as, and subsequently modified in the claims as “greater than or equal to 4.0.

[0071] In some embodiments, any or some of the components or steps disclosed herein may be considered optional. In some cases, the disclosed compositions mayexpressly exclude any or some of the aforementioned elements or steps in this description, e.g., via claim language. For example, claim language may be modified to recite that the disclosed cannulas and / or methods, etc., do not utilize or comprise ports and / or valves, e.g., the disclosed cannulas and / or methods do not comprise a port and / or valve. As another example, the claim language may be modified to recite that the disclosed cannulas and / or methods do not comprise central axes and / or specific shapes and sizes. Such negative limitations are contemplated, and this text serves as support for negative limitations for components, steps, and / or features.

[0072] These and other changes can be made to the embodiments in light of the above-detailed description. In general, in the following claims, the terms used should not be construed to limit the claims to the specific embodiments disclosed in the specification and the claims but should be construed to include all possible embodiments along with the full scope of equivalents to which such claims are entitled. Accordingly, the claims are not limited by the disclosure.

Claims

CLAIMS1 . A multi-lumen cannula comprising: an elongated body having a proximal end and a distal end; a first lumen extending from the proximal end toward the distal end; a second lumen extending from the proximal end toward the distal end; a first port intersecting the first lumen; and a second port intersecting the second lumen, the first and second lumens defining a fluid flow path from the first port to the second port establishing fluid communication therebetween.

2. The multi-lumen cannula of claim 1 wherein the first lumen extends along a first axis, and the second lumen extends along a second axis substantially parallel to the first axis.

3. The multi-lumen cannula of any one of claims 1 and 2 wherein the elongated body is elongate along a length measured from the proximal end to the distal end, and the fluid flow path extends through the first lumen along at least 50 percent of the length.

4. The multi-lumen cannula of claim 3 wherein the fluid flow path extends through the first lumen along between 60 percent of the length and 80 percent of the length.

5. The multi-lumen cannula of any one of claims 3 and 4 wherein fluid flow from the first lumen to the second lumen is blocked within a first portion of the elongated body such that the fluid flow path exits the first lumen and enters the second lumen within a second portion of the elongated body, and the first portion is between 2 to 25 times longer than the second portion.

6. The multi-lumen cannula of any one of claims 3 to 5 wherein the distal end has a maximum cross-sectional dimension measured in a direction perpendicular to the length, and the maximum cross-sectional dimension of the distal end is less than 8 mm.

7. The multi-lumen cannula of any one of claims 3 to 6 wherein the distal end has a non-circular shape.

8. The multi-lumen cannula of any one of claims 3 to 7 wherein the distal end has a tapered oval shape.

9. The multi-lumen cannula of any one of claims 3 to 8 wherein the distal end is tapered along the length.

10. The multi-lumen cannula of any one of claims 1 to 9 wherein the first lumen has a first maximum cross-sectional dimension, the second lumen has a second maximum cross-sectional dimension, and the first maximum cross-sectional dimension is greater than the second maximum cross-sectional dimension.11 . The multi-lumen cannula of claim 10 wherein the first maximum cross- sectional dimension and the second maximum cross-sectional dimension are both measured within a plane, and the first lumen is normal to the plane.

12. The multi-lumen cannula of any one of claims 10 and 11 wherein the first maximum cross-sectional dimension is between 50 percent and 80 percent of the second maximum cross-sectional dimension.

13. The multi-lumen cannula of any one of claims 10 to 12 wherein the first maximum cross-sectional dimension is a diameter between 2 mm and 2.5 mm, and the second maximum cross-sectional dimension is a diameter between 2.5 mm and 3 mm.

14. The multi-lumen cannula of any one of claims 1 to 13 wherein the fluid flow path exits the first port and enters the first lumen, then travels along the first lumen toward the distal end, then exits the first lumen and enters the second lumen, then travels along the second lumen toward the proximal end, and then exits the second lumen and enters the second port15. The multi-lumen cannula of claim 14, further comprising: a first channel extending through the first port and intersecting the first lumen between the proximal end and the distal end, wherein a portion of the fluid flow path that passes through the first port travels along the first channel; and a second channel extending through the second port and intersecting the second lumen between the proximal end and the distal end, wherein a portion of the fluid flow path that passes through the second port travels along the second channel,wherein the first channel and the second channel are coplanar.

16. The multi-lumen cannula of claim 15 wherein: the portion of the fluid flow path that travels along the first channel is substantially perpendicular to a portion of the fluid flow path that travels along the first lumen; the portion of the fluid flow path that travels along the first lumen is substantially parallel to a portion of the fluid flow path that travels along the second lumen; and the portion of the fluid flow path that travels along the second lumen is substantially perpendicular to the portion of the fluid flow path that travels along the second port.

17. The multi-lumen cannula of any one of claims 15 and 16, further comprising: a physical barrier positioned between the first channel and the second channel such that a direct path from the first channel to the second channel is blocked by the physical barrier.

18. The multi-lumen cannula of any one of claims 15 to 17, further comprising: a valve that transitions between an open configuration and a closed configuration, wherein the valve is positioned along the flow path such that: when in the open configuration the fluid flow path passes through the valve, and when in the closed configuration the fluid flow path is blocked by the valve.

19. The multi-lumen cannula of claim 18 wherein the valve is supported by the first port and is positioned such that when in the closed configuration the fluid flow path is blocked prior to an intersection of the first channel and the first lumen.

20. The multi-lumen cannula of claim 19 wherein the valve is a first valve, the multi-lumen cannula further comprising: a second valve that transitions between an open configuration and a closed configuration, wherein the second valve is positioned along the flow path such that: when in the open configuration the fluid flow path flow passes through the second valve, and when in the closed configuration the fluid flow path is blocked by the second valve.21 . The multi-lumen cannula of claim 20 wherein the second valve is positioned such that when in the closed configuration the fluid flow path is blocked by the second valve downstream from an intersection of the second lumen and the second channel.

22. The multi-lumen cannula of any one of claims 1 to 21 wherein the elongated body is radiolucent.

23. The multi-lumen cannula of any one of claims 1 to 21 wherein the elongated body is radiopaque.

24. A multi-lumen cannula comprising: an elongated body having a proximal end and a distal end; a first lumen extending from the proximal end toward the distal end along a first axis, the first axis extending through a first opening in the proximal end and through an opening in the distal end; a second lumen extending from the proximal end toward the distal end along a second axis, the second axis extending through a second opening in the proximal end that is separate from the first opening and through the opening in the distal end; wherein the elongated body is elongate along a length that is measured from the proximal end to the distal end along a direction parallel to the first axis, fluid flow from the first lumen to the second lumen is blocked within a first portion of the elongated body that extends from the proximal end toward the distal end along at least 50 percent of the length, and fluid flow from the first lumen to the second lumen is unblocked within a second portion of the elongated body that extends from the first portion to the distal end.

25. The multi-lumen cannula of claim 24 wherein the distal end has a maximum cross-sectional dimension measured in a direction perpendicular to the length, and the maximum cross-sectional dimension of the distal end is less than 8 mm.

26. The multi-lumen cannula of any one of claims 24 and 25 wherein the distal end has a non-circular shape.

27. The multi-lumen cannula of any one of claims 24 to 26 wherein the distal end has a tapered oval shape.

28. The multi-lumen cannula of any one of claims 24 to 27 wherein the distal end is tapered along the length.

29. The multi-lumen cannula of any one of claims 24 to 28 wherein the first lumen has a first maximum cross-sectional dimension, the second lumen has a second maximumcross-sectional dimension, and the first maximum cross-sectional dimension is greater than the second maximum cross-sectional dimension.

30. The multi-lumen cannula of claim 29 wherein the first maximum cross- sectional dimension and the second maximum cross-sectional dimension are both measured within a plane, and the first axis is normal to the plane.31 . The multi-lumen cannula of any one of claims 29 and 30 wherein the first maximum cross-sectional dimension is between 50 percent and 80 percent of the second maximum cross-sectional dimension.

32. The multi-lumen cannula of any one of claims 29 to 31 wherein the first maximum cross-sectional dimension is a diameter between 2 mm and 2. 5 mm, and the second maximum cross-sectional dimension is a diameter between 2.5 mm and 3 mm.

33. The multi-lumen cannula of any one of claims 24 to 32, further comprising: a first channel extending through a first port and intersecting the first lumen; and a second channel extending through the second port and intersecting the second lumen; wherein the first channel is fluidly connected to the second channel via a fluid flow path that exits the first channel and enters the first lumen, then travels along the first lumen toward the distal end, then exits the first lumen and enters the second lumen, then travels along the second lumen toward the proximal end, and then exits the second lumen and enters the second channel.

34. The multi-lumen cannula of claim 33 wherein the first channel and the second channel are coplanar.

35. The multi-lumen cannula of any one of claims 33 and 34 wherein: a portion of the fluid flow path travels along the first channel in a direction substantially perpendicular to a direction of travel of the portion of the fluid flow path that travels along the first lumen; the portion of the fluid flow path that travels along the first lumen is substantially parallel to a portion of the fluid flow path that travels along the second lumen; and the portion of the fluid flow path that travels along the second lumen is substantially perpendicular to a portion of the fluid flow path that travels along the second channel.

36. The multi-lumen cannula of any one of claims 33 to 35, further comprising: a physical barrier positioned between the first channel and the second channel such that a direct path from the first channel to the second channel is blocked by the physical barrier.

37. The multi-lumen cannula of any one of claims 33 to 36, further comprising: a valve that transitions between an open configuration and a closed configuration, wherein the valve is positioned along the flow path such that: when in the open configuration the fluid flow path flow passes through the valve, and when in the closed configuration the fluid flow path is blocked by the valve.

38. The multi-lumen cannula of claim 37 wherein the valve is supported by the first port and is positioned such that when in the closed configuration the fluid flow path is blocked prior to an intersection of the first channel and the first lumen.

39. The multi-lumen cannula of claim 38 wherein the valve is a first valve, the multi-lumen cannula further comprising: a second valve that transitions between an open configuration and a closed configuration, wherein the second valve is positioned along the flow path such that: when in the open configuration the fluid flow path flow passes through the second valve, and when in the closed configuration the fluid flow path is blocked by the second valve.

40. The multi-lumen cannula of claim 39 wherein the second valve is positioned such that when in the closed configuration the fluid flow path is blocked by the second valve downstream from an intersection of the second lumen and the second channel.41 . The multi-lumen cannula of any one of claims 24 to 40 wherein the elongated body is radiolucent.

42. The multi-lumen cannula of any one of claims 24 to 40 wherein the elongated body is radiopaque.

43. A method of use of a multi-lumen cannula, the method comprising: inserting a distal end of an elongated body through an incision in a surface and into an internal volume enclosed by the surface, thereby forming a passage through the incision and into the internal volume;inserting a first instrument into a first lumen of the multi-lumen cannula, the first lumen extending along the passage between a proximal end of the elongated body and the distal end of the elongated body; inserting a second instrument into a second lumen of the multi-lumen cannula, the second lumen extending along the passage between the proximal end of the elongated body and the distal end of the elongated body, while the first instrument is positioned within the first lumen; moving a working end of the second instrument through the distal end of the elongated body and into the internal volume; moving a fluid through the first lumen toward the distal end, while the first instrument is positioned within the first lumen; after moving the fluid through the first lumen, moving the fluid through the second lumen toward the proximal end, while the second instrument is positioned within the second lumen; after moving the fluid through the second lumen, moving the fluid out of the second lumen.

44. The method of claim 43, further comprising: ablating tissue with the working end of the second instrument; and providing vision of the working end of the second instrument ablating tissue with the first instrument.

45. The method of claim 44, further comprising: evacuating the ablated tissue via movement of the fluid through the second lumen.

46. The method of any one of claims 43 to 45, further comprising: blocking movement of the fluid at a location upstream from the first lumen.

47. The method of claim 46, further comprising: closing a valve supported by a first port having a first channel intersecting the first lumen between the proximal end and the distal end, thereby blocking movement of the fluid upstream of the first lumen.

48. The method of any one of claims 43 to 47, further comprising: blocking movement of the fluid at a location downstream from the second lumen.

49. The method of claim 48, further comprising: closing a valve supported by a second port having a second channel intersecting the second lumen between the proximal end and the distal end, thereby blocking movement of the fluid downstream of the second lumen.

50. The method of any one of claims 43 to 49, further comprising: forming the incision in the surface using a scalpel to make a stab incision having a maximum dimension that is greater than a maximum dimension of the distal end of the elongated body.