Endoscopic release surgery system

Abstract

The present invention relates to an endoscopic release surgical system comprising a retractor (1) comprising a blade (2) having an arched cross-section and a handle (3) extending upwardly from the proximal end of the blade. The handle (3) is adapted to removably receive an L-shaped endoscope holder (5). The vertical arm (52) of the L-shaped endoscope holder is adapted to receive an endoscope so that, during use, the endoscope is retained at the apex of the arched portion of the blade.

Description

Technical Field

[0001] The present invention generally relates to surgical systems for endoscopic debridement procedures. Background Art

[0002] Endoscopic release surgery is a procedure used to relieve discomfort associated with nerve compression syndromes or to treat various musculoskeletal conditions.

[0003] A nerve compression syndrome is a medical condition caused by direct pressure on a nerve. It typically causes symptoms such as pain, tingling, numbness, and muscle weakness. Common nerve compression syndromes include carpal tunnel syndrome, plantar fasciitis, cubital tunnel syndrome, and tarsal tunnel syndrome.

[0004] The carpal tunnel is a narrow passageway made up of bones and ligaments on the palm side of the wrist. The median nerve, which controls sensation and movement in the thumb and first three fingers, passes through this tunnel along with tendons to the fingers and thumb. Carpal tunnel syndrome (CTS) is a medical condition that causes pain, numbness, and tingling in the hand and arm when the median nerve becomes squeezed or compressed. Over time, if compression of the median nerve continues untreated, it can lead to nerve damage and worsening symptoms. To prevent permanent damage, some patients require surgery to relieve the pressure on the median nerve.

[0005] Typically, CTS is treated with open carpal tunnel release (OCTR) surgery, in which a vertical incision up to 5 centimeters is made at the base of the palm to allow the doctor to cut the transverse carpal ligament, thereby releasing pressure on the median nerve and relieving the symptoms of carpal tunnel syndrome. After the ligament is cut, the skin is closed with stitches.

[0006] During OCTR surgery, there is a risk of damage to the median nerve or other tissues. In addition, when the incision heals, there is a large amount of scar tissue, which is both unsightly and painful and may impair the full recovery of hand function.

[0007] Alternatively, CTS can also be treated with endoscopic carpal tunnel release (ECTR) surgery, which uses a thin tube with an endoscope to allow the doctor to see the structures of the carpal tunnel without having to open the entire area with a large incision. ECTR surgery can be performed using a single-port technique (also known as the Agee technique), in which a thin tube consisting of an endoscope and a cutting tool is guided through a small incision in the wrist, or a double-port technique (also known as the Chow technique), in which two small incisions are made in the wrist and palm. The endoscope is inserted through a small incision in the palm to visualize the carpal tunnel, and the transverse carpal ligament is cut through another small incision in the wrist to release pressure on the median nerve.

[0008] ECTR has been shown to result in a shorter recovery time and more complete restoration of hand strength compared to OCTR. However, ECTR is associated with a higher risk of transient median nerve dysfunction due to the surgical manipulation required to insert instruments into the narrow carpal tunnel.

[0009] In view of the above shortcomings, Ip et al. (2012) 1 and Ecker et al. (2014) 2 A supraretinacular ECTR (SRECTR) procedure has been proposed, in which an endoscope is inserted superficially into the flexor retinaculum (also known as the transverse carpal ligament). This technique improves visualization of the carpal tunnel structures and avoids disturbing the median nerve before the retinaculum dissection by not interfering with the carpal tunnel. In the article by IP et al., the instruments used included a sheath, two different sized dilators, and scissors. In the article by Ecker et al., an endoscope, different types of scissors, and a speculum were used.

[0010] 1. Wing-yuk Josephine Ip, Tamer Ahmed Sweed, Kwok Keung Boris Fung, George L. Tipoe, and Tze Shing Pun (2012). A new technique for single-port endoscopic carpal tunnel release. Journal of Surgical Techniques of the Hand and Upper Limb, Vol. 16, No. 1, March 2012, pp. 27-29.

[0011] 2. J. Ecker, N. Perera, and J. Ebert (2014). Endoscopic carpal tunnel release with support band: surgical technique with a prospective case series. Journal of Hand Surgery (European Volume) XXE(X) 1-6, February 25, 2014.

[0012] Patients reported a high incidence of postoperative strut pain and hypertrophic scarring. This may be due to the bulky instruments used in the SRECTR technique, as they were originally designed for cubital tunnel release.

[0013] U.S. Patent No. 5,431,153 discloses a surgical retractor for exposing the transverse carpal ligament through a small transverse incision along the wrist, thereby enabling the carpal ligament to be severed to decompress the carpal tunnel. The surgical retractor basically includes (1) a blade having an arcuate configuration in cross section, the blade gradually flattening toward the tip section and being substantially flat, spade-shaped in plan view, (2) a finger-like grip portion projecting upward from the proximal end of the blade, which is also relatively arcuate in cross section, and (3) a fiber optic conduit. The arcuate configuration provides a groove along the finger-like grip portion and the blade. The fiber optic conduit extends within the groove to illuminate a surgical cavity formed between the carpal ligament and the covering structure during carpal tunnel release surgery.

[0014] In use, the physician uses a gap beneath the fiber optic catheter in the blade portion to visualize the ligament and surrounding nerves through the incision along the top of the transverse carpal ligament to achieve a precise cut of the transverse carpal ligament.

[0015] The clearance below the fiber optic catheter in the blade is very small, and the fiber optic catheter is used only for illumination. Therefore, it does not provide the surgeon with a clear view of the surgical cavity. This has proven difficult for the surgeon to identify the ligaments and surrounding nerves necessary to perform the release procedure without complications.

[0016] Accordingly, the present invention aims to alleviate some or all of the problems of the prior art. Summary of the Invention

[0017] According to one aspect of the present invention, an endoscopic release surgical system is provided, comprising a retractor comprising a blade having an arched cross-section and a handle extending from the proximal end of the blade in a vertical direction away from the proximal end of the blade. The endoscopic release surgical system also comprises an L-shaped endoscope holder, the L-shaped endoscope holder having a horizontal arm and a vertical arm, the horizontal arm extending in a horizontal direction, the vertical arm extending in the vertical direction, the horizontal direction and the vertical direction being perpendicular to each other. The vertical arm of the L-shaped endoscope holder comprises a hole arranged at its distal end to receive and fix an endoscope. The handle comprises a through hole to removably receive and rigidly fix the horizontal arm of the L-shaped endoscope holder, so that the hole on the vertical arm of the L-shaped endoscope holder is aligned with the apex of the arched portion of the blade, thereby rigidly holding the endoscope at the apex of the arched portion of the blade when the endoscopic release surgical system is in use.

[0018] The handle is adapted to removably receive an L-shaped endoscope holder, wherein the vertical arm of the holder is adapted to receive an endoscope such that, in use, the endoscope is retained at the apex of the arched portion.

[0019] In one embodiment, the blade may include a distal tapered body having a taper of up to 2.5°. The distal tapered blade may also include a profile tapered body having a taper of up to 2.5°.

[0020] In another embodiment, the blade may be a non-distal tapered body. The non-distal tapered blade may also include a profile taper with a taper of up to 2.5°.

[0021] In yet another embodiment, the blade may have a semicircular, tilted or horseshoe-shaped arched cross-section.The length of the blade may be in the range of 4 cm to 6 cm.

[0022] According to an embodiment, the through hole may be arranged close to the proximal end of the blade.

[0023] The shape of the through hole may correspond to the cross section of the horizontal arm so that an L-shaped endoscope holder may be received in the through hole.

[0024] In another embodiment, the length of the horizontal arm may be greater than or correspond to the length of the vertical arm.

[0025] The present invention seeks to overcome the problems of the prior art by providing an endoscopic debridement system that is safe, easy to use and allows for a less invasive procedure.

[0026] When used to relieve carpal tunnel syndrome, the blade of the present invention, with its arched cross-section, is designed to define a surgical cavity between the flexor retinaculum and the overlying subcutaneous fat and skin for inserting an endoscope and ligament-cutting tools. This avoids the need to insert any instruments into the tight confines of the carpal tunnel to visualize the carpal tunnel ligament. Consequently, it significantly reduces the risk of iatrogenic injury to the median nerve and other adjacent structures.

[0027] The design of the surgical system of the present application advantageously provides the surgeon with an excellent field of view for advancing the retractor within the space between the flexor retinaculum and the covering structure. In addition, the arched portion allows access for endoscopes of varying diameters and ligament cutting instruments (e.g., Metzenbaum scissors, surgical blades, and laparoscopic scissors).

[0028] After inserting the blade of the present invention into the space between the flexor retinaculum and the covering structure, the endoscope is then inserted through the blade's arched portion into the defined surgical cavity. The endoscope retainer is shaped and configured to stabilize the insertion of the endoscope through the arched portion and maintain the position of the endoscope at the apex of the arched portion throughout the procedure. This advantageously provides a stable endoscopic field of view throughout the SRECTR procedure and substantially prevents the endoscope from impinging on adjacent structures.

[0029] Furthermore, when the surgical retractor of the present application is used, the incision is made transversely along the radiocarpal wrist flexion crease, which advantageously provides rapid healing and excellent scar tissue formation after SRECTR surgery. BRIEF DESCRIPTION OF THE DRAWINGS

[0030] The invention is illustrated, without however being limited, by the following description of embodiments with reference to the accompanying drawings, in which:

[0031] Figures 1a to 1d A perspective view of the blade of the distal cone together with the handle according to a preferred embodiment of the present invention is shown.

[0032] Figure 2 yes Figures 1a to 1d Front view of.

[0033] Figure 3 yes Figures 1a to 1d side view.

[0034] Figures 4a to 4d A perspective view of a blade without a distal tapered body and a handle according to another embodiment of the present invention is shown.

[0035] Figure 5 yes Figures 4a to 4d Front view of.

[0036] Figure 6 yes Figures 4a to 4d side view.

[0037] Figure 7 A perspective view of an endoscope holder according to an embodiment of the present invention is shown.

[0038] Figure 8 Shown is a side view of the retractor prior to attachment of the endoscope holder.

[0039] Figure 9 Shown Figure 8 Exploded perspective view of a retractor.

[0040] Figure 10 Shown after attaching the endoscope holder Figure 9 Stereoscopic view of the retractor.

[0041] Figure 11 Shown Figure 10 Front view of.

[0042] Figure 12 is a schematic diagram of a patient's hand with Kaplan baseline and hamate hook landmarks.

[0043] Figure 13 yes Figure 1a Schematic diagram of the retractor blade being inserted into the supraclavicular space through a transverse incision made in the radiocarpal flexion crease.

[0044] Figure 14 is a schematic diagram of the endoscope holder attached to the handle of the retractor.

[0045] Figure 15 This is a schematic diagram showing an endoscope being inserted into the arch portion through the hole of the endoscope holder.

[0046] Figure 16 The cutting tool then passes through Figure 15 Schematic diagram of the endoscope being inserted into the space above the retinaculum through the gap below. DETAILED DESCRIPTION

[0047] The invention provides an endoscopic release surgery system, which is suitable for release surgeries of ligaments, tendons and bones in different parts of the body.

[0048] The endoscopic release surgical system mainly includes a retractor 1, which includes a blade 2 with an arched cross-section and a handle 3 extending upward from the proximal end of the blade 2, and the handle is suitable for removably receiving an L-shaped endoscope holder 5, wherein the vertical arm 52 of the endoscope holder is suitable for receiving an endoscope so that the endoscope is retained at the apex of the arched portion of the blade during use.

[0049] The blade 2 may be of any suitable configuration and size, depending on the type of release procedure, the part of the body on which the retractor is to be used, the size of the patient, and (for carpal tunnel release procedures) the size of the space on the retinaculum available.

[0050] Taking the above into account, the blade 2 can have any suitable arcuate cross-sectional configuration, such as a semicircular, tilted, or horseshoe-shaped arcuate cross-section. The cross-section of the blade is arcuate, so that a dome portion 21 is defined on its ventral surface. The dome portion includes a crown portion 23 and longitudinal edges 22 arranged substantially parallel to each other. An endoscope and a ligament cutting tool can be inserted into the dome portion.

[0051] Figures 1a to 1d An embodiment of a retractor 1 according to the present invention is shown, in which the blade 2 is a distal taper. In this embodiment, the arch 21 tapers from the proximal end of the blade 2 toward the distal end. The taper of the blade 2 can be up to 2.5°, preferably 1.9°. This results in the arch being wider at its proximal end than at its distal end. The width at the proximal end can range from 1.10 cm to 1.20 cm, preferably 1.20 cm, and the width at the distal end can range from 0.7 cm to 1.2 cm, preferably 0.9 cm.

[0052] Figures 4a to 4d Another embodiment of the retractor 1 according to the present invention is shown, in which the blade 2 is a non-distal tapered body. In this embodiment, the size of the arch 21 is uniform, that is, the width at the proximal and distal ends of the blade is the same, ranging from 0.7 cm to 1.20 cm.

[0053] In any of the above embodiments, the distal tapered blade or the non-distal tapered blade may also include a profile taper. The longitudinal edge 22 of the blade tapers from the proximal end toward the distal end of the blade 2 ( Figure 3 and Figure 6), wherein the taper reaches 2.5°, preferably 1.9°. Alternatively, the crown 23 of the blade can be tapered from the proximal end to the distal end of the blade 2, wherein the taper reaches 1.5°, preferably 1.3°. This results in the height of the blade being greater at its proximal end than at its distal end. The height of the blade 2 at the proximal end can be in the range of 5mm to 11mm, preferably 10.28mm, and the height at the distal end can be in the range of 3mm to 11mm, preferably 8.2mm.

[0054] The blade 2 can be configured to have different lengths ranging from 4 cm to 6 cm. As will be appreciated by those skilled in the art, the length depends on the type of release surgery. For example, for SRECTR surgery, the length of the blade 2 is preferably 4.5 cm.

[0055] A handle 3 extends upwardly from the proximal end of the blade 2. The handle may be angled to slope 12.4° to 12.6° from vertical towards the distal end of the blade 2.

[0056] The handle 3 may be of any suitable structure that can be grasped by a physician so that the retractor 1 can be easily manipulated as needed during surgery.

[0057] In addition, the handle 3 is adapted to removably receive an L-shaped endoscope holder 5. Any form of adaptation may be used as long as it allows the endoscope holder 5 to be removably attached to the handle 3 and then securely fixed there to prevent the endoscope holder 5 from vibrating during the operation. This can be achieved by fastening, stowing, clamping, hooking or mounting. For this purpose, the handle 3 may include a slot 4, which is arranged near the proximal end ( Figure 3 and Figure 6 ). The slot 4 can be constructed in any suitable structure. Figure 8 In the embodiment of the present invention, the slot is a through hole. Mainly, the through hole can be any shape corresponding to the cross section of the horizontal arm 51 of the endoscope holder 5.

[0058] An L-shaped endoscope holder 5 is provided separately from the retractor 1, and the holder serves as a support to stabilize and hold the endoscope in place during surgery.

[0059] As its name suggests, the L-shaped endoscope holder 5 includes a horizontal arm 51 and a vertical arm 52. The size of the endoscope holder 5 can be varied. The lengths of the horizontal arm 51 and the vertical arm 52 can be the same or different. In addition, the horizontal arm 51 and the vertical arm 52 can have rectangular, square, or circular cross-sections.

[0060] exist Figure 8 and Figure 10In the embodiment of FIG. 4 , the horizontal arm 51 of the L-shaped endoscope holder 5 is inserted into the slot 4 and can be rigidly fixed therein to prevent the endoscope holder 5 from oscillating during surgery.

[0061] The vertical arm 52 of the endoscope holder 5 is configured with a structure suitable for receiving and holding an endoscope at the apex of the arched portion 21 of the blade 2. For example, the structure may be a clamp or forceps or any structure that allows the endoscope to be inserted into the arched portion 21 and holds the endoscope at the apex of the arched portion 21 of the blade 2 once the endoscope reaches a certain depth within the arched portion 21. Figure 7 In the embodiment of the present invention, the hole 53 is provided at the distal end of the vertical arm 52. In use, when the endoscope holder 5 has been attached to the handle 3, the hole is positioned so that it is aligned with the apex of the arched portion 21 of the blade ( Figure 11 ). This enables the endoscope to pass through the hole 53 into the arched portion of the blade, such as Figure 8 Indicated by dotted arrows.

[0062] The hole 53 can have different diameters depending on the type or size of the endoscope being used. However, the hole 53 is designed to be sized to allow the endoscope to pass through while at the same time retaining the endoscope at the apex of the arcuate portion of the blade during surgery.

[0063] The L-shaped endoscope holder 5 can be made of any suitable material that is safe for use during surgery and allows for sterilization (if reused). Preferably, the L-shaped endoscope holder 5 is made of surgical stainless steel. However, the L-shaped endoscope holder 5 can be disposable. Therefore, any suitable medical-grade plastic material can be used.

[0064] As mentioned at the beginning of this section, the endoscopic release surgery system of the present invention can be used for release surgery of ligaments, tendons and bones in different parts of the body, such as carpal tunnel release surgery, plantar fascia release surgery, and gastrocnemius muscle release surgery.

[0065] The use of the endoscopic release surgical system of the present application will now be described using carpal tunnel release surgery as an example. This in no way limits the scope of the claims, but rather serves as an exemplary illustration of the use of the endoscopic release surgical system. The same technology is equally applicable when used in other release surgeries, such as plantar fascia release and gastrocnemius muscle release.

[0066] During carpal tunnel release surgery, an approximately 2-cm transverse incision is made above the radiocarpal wrist flexion crease, between the palmaris longus tendon and the ulnar border of the ring finger.

[0067] Using Meizenbaum scissors, a supraretinacular space is created between the flexor retinaculum and the overlying subcutaneous fat and skin by blunt dissection along the axis between the middle and ring fingers, terminating at Kaplan's cardinal line, as shown in Figure 2. Figure 12 The width of the space on the support belt is about 2cm-3cm to allow the retractor 1 to be inserted easily.

[0068] refer to Figure 13 and Figure 14 , the retractor 1 is inserted into the space on the retinaculum via the transverse incision, and the L-shaped endoscope holder 5 is then attached to the handle 3 .

[0069] Next, the endoscope is inserted into the arch of the blade via the hole 53 of the endoscope holder 5. Due to the secure attachment of the endoscope holder 5 to the handle 3 and due to the alignment of the holes 53, the endoscope is rigidly held at the apex of the arch. This allows visualization of the entire transverse carpal ligament. The Meizenbaum scissors are inserted under the L-shaped endoscope holder 5 ( Figure 15 ) to peel off the proximal portion of the transverse carpal ligament, thereby visualizing the median nerve underneath. The transverse carpal ligament is then divided along the longitudinal axis of the radial border of the ring finger using Meissenbaum scissors under endoscopic observation. This is performed in a series of small, continuous incisions. Before making the cuts, the tissue beneath the transverse carpal ligament is peeled off to ensure that no structures, especially the median nerve, adhere to it. These steps are repeated until the entire transverse carpal ligament is released. Retractor 1 can then be removed through the incisions.

[0070] All directional statements made herein, such as front / forward, back / rear, top, bottom, side, inward, outward, are relative to the orientation of the device in use.

[0071] It will be apparent to those skilled in the art that the present invention can be readily implemented in other specific forms without departing from the scope or essential characteristics of the invention. Therefore, the present embodiments should be considered as merely illustrative and not restrictive, the scope of the invention being indicated by the claims rather than the foregoing description, and all changes falling therein are therefore intended to be included therein.

Claims

1. An endoscopic release surgical system comprising: A retractor (1) comprising: a blade (2) having an arched cross-section; and a handle (3) extending from a proximal end of the blade (2) in a vertical direction away from the proximal end of the blade (2). It is characterized by: The endoscopic release surgical system further comprises a separate L-shaped endoscope holder (5), wherein the L-shaped endoscope holder (5) has a horizontal arm (51) and a vertical arm (52), wherein the horizontal arm (51) extends in a horizontal direction and the vertical arm (52) extends in the vertical direction, wherein the horizontal direction and the vertical direction are perpendicular to each other; The vertical arm (52) of the L-shaped endoscope holder includes a hole (53) arranged at its distal end to receive and fix an endoscope. The handle (3) of the retractor includes a through hole (4) for removably receiving and rigidly fixing the horizontal arm (51) of the L-shaped endoscope holder so that the hole on the vertical arm (52) of the L-shaped endoscope holder (5) is aligned with the apex of the arched portion of the blade (2), thereby rigidly holding the endoscope at the apex of the arched portion of the blade (2) when the endoscopic release surgical system is in use.

2. The endoscopic debonding surgical system according to claim 1, wherein the length of the blade (2) is in the range of 4 cm to 6 cm.

3. The endoscopic release surgical system according to claim 1, wherein the through hole (4) of the handle (3) is arranged close to the proximal end of the blade (2).

4. An endoscopic release surgical system according to any one of claims 1 and 3, wherein the shape of the through hole (4) corresponds to the cross-section of the horizontal arm (51), so that the L-shaped endoscope holder (5) can be received in the through hole (4).

5. The endoscopic release surgical system according to any one of claims 1 and 4, wherein the length of the horizontal arm (51) is greater than the length of the vertical arm (52).

6. The endoscopic release surgical system according to any one of claims 1 and 4, wherein the length of the horizontal arm (51) corresponds to the length of the vertical arm (52).

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