Visualization instrument holder for spinal procedures

Abstract

A visualization instrument holder device can be used during a medical procedure to easily and safely reposition and reorient a visualization instrument while maintaining a constant insertion depth. The device can include an instrument lock defining an opening, a distal tubular member coupled to the instrument lock, and a pivot coupled to the distal tubular member. The distal tubular member can include a channel extending therethrough, and the opening and the channel can be configured to receive the visualization instrument. The pivot can include a curved surface that allows the distal tubular member to pivot about and against the patient. The device can include a proximal tubular member movable relative to the distal tubular member, allowing adjustment of a total length of the device. The device can also include a fixing element for locking a position of the proximal tubular member relative to the distal tubular member.

Description

VISUALIZATION INSTRUMENT HOLDER FOR SPINAL PROCEDURESCROSS-REFERENCE TO RELATED APPLICATION

[0001] The present application claims the benefit of U.S. Provisional Patent Application No. 63 / 550,554, filed on February 6, 2024, the disclosure of which is incorporated herein by reference in its entirety.TECHNICAL FIELD

[0002] The present disclosure relates generally to medical systems and, more particularly, to systems, devices, and methods for holding visualization instruments or surgical instruments during spinal procedures.BACKGROUND

[0003] Individuals often suffer from damaged or displaced spinal discs and / or vertebral bodies due to trauma, disease, degenerative defects, or wear over an extended period of time. One result of this displacement or damage to a spinal disc or vertebral body may be chronic back pain. A common procedure for treating damage or disease of the spinal disc or vertebral body may involve partial or complete removal of an intervertebral disc. An intervertebral implant (commonly referred to as an interbody spacer or cage) can be inserted into the cavity created where the intervertebral disc was removed to help maintain height of the spine and / or restore stability to the spine. An interbody spacer may also provide a lordotic correction to the curvature of the spine. An example of an interbody spacer that has been commonly used is a fixed dimension cage, which typically is filled with bone and / or bone growth-inducing materials. Unfortunately, it may be difficult to implant the interbody spacer at the intended implantation site between vertebral bodies. Additionally, conventional surgical techniques can cause a significant amount of trauma at or near the implantation site (e.g., injury to nerve tissue), which can significantly increase recovery time and / or lead to patient discomfort.

[0004] Spinal nerve compression can be caused by narrowing of the spinal canal associated with arthritis (e.g., osteoarthritis) of the spine, degeneration of spinal discs, andthickening of ligaments. Arthritis of the spine often leads to the formation of bone spurs which can narrow the spinal canal and press on the spinal cord. In spinal disk degeneration, inner tissue of the disk can protrude through a weakened fibrous outer covering of the disk and can press on the spinal cord and / or spinal nerve roots. Ligaments located along the spine can thicken over time and press on the spinal cord and / or or nerve roots. Unfortunately, spinal nerve compression can cause lower back pain, hip pain, and / or leg pain and may also result in numbness, depending on the location of the compressed nerve tissue. Surgical decompression procedures can be performed to enlarge the spinal canal, remove soft tissue, and remove other tissue contributing to nerve compression. Unfortunately, nontargeted tissue, such as nerve tissue, can be injured during such procedures. Accordingly, there is a need for improved surgical systems, visualization techniques, related technologies for delivering a spinal implant, performing decompression procedures, and / or other surgical procedures.BRIEF DESCRIPTION OF THE DRAWINGS

[0005] Figures 1A and 1 B are perspective views of a spinal surgical system in accordance with an embodiment of the disclosure.

[0006] Figure 2A is a perspective view of a visualization instrument holder device in accordance with an embodiment of the disclosure.

[0007] Figure 2B is a perspective, partially exploded view of the device of Figure 2A.

[0008] Figures 3A and 3B are cross-sectional views of the device of Figure 2A in accordance with an embodiment of the disclosure.

[0009] Figure 4 is an enlarged perspective view of a proximal end of the device of Figure 2A.

[0010] Figure 5 is a perspective view of a fixing element of the device of Figure 2A in accordance with an embodiment of the disclosure.

[0011] Figure 6A is a perspective view of another visualization instrument holder device in accordance with an embodiment of the disclosure.

[0012] Figure 6B is a perspective, partially exploded view of the device of Figure 6A.

[0013] Figure 7 is a cross-sectional view of the device of Figure 6A in accordance with an embodiment of the disclosure.

[0014] Figure 8 is a flowchart illustrating a method for holding a visualization instrument adjacent to an implantation site in a patient in accordance with embodiments of the disclosure.DETAILED DESCRIPTION

[0015] The following disclosure describes various embodiments of visualization instrument holder devices and associated systems and methods of use. The devices can assist users by, for example, positioning visualization instruments, limiting motion of visualization instruments, holding visualization instruments at user-set depths (or ranges of depths), or combinations thereof. The devices can help position visualization instruments before, during, and / or after a surgical procedure, such as an implantation procedure, a decompression procedure, and / or other surgical procedure. The devices can include one or more locking mechanisms configured to hold the visualization instrument, locking the device in a user-set configuration, or the like. This allows the user to manipulate the visualization instrument within the patient while maintaining or keeping a distal end of the visualization instrument within an acceptable working zone or region to view, for example, anatomical features of interest, a working instrument, implantation site, etc.

[0016] The devices can hold visualization instruments to prevent, for example, hand or arm fatigue of a physician. Advantageously, the devices can hold the visualization instruments at user-selected depth while the user rolls, pivots, or otherwise moves the devices to reposition the visualization instrument within a working region or zone. In some embodiments, the visualization instrument holder devices are configured to extend or compress a preset amount to allow movement of the visualization instrument so as to adjust the depth of the visualization instrument in the patient. The device can be configured to limit a maximum depth of travel to prevent the instrument from contacting deeper non-targeted tissue. During a procedure, the user can adjust the depth of the visualization instrument any number of times to view different regions within the patient. This allows the user to perform certain types of surgical procedures under visualization. A kit can include multiple instrumentholder devices (e.g., visualization instrument holder devices, working instrument holders, etc.) with different ranges of travel.A. OVERVIEW

[0017] At least some embodiments are directed to visualization instrument holder devices and associated spinal surgery systems. The systems, devices, and methods disclosed herein can be used to reposition and / or reorient a visualization instrument during a procedure as needed in a safe and easy manner, while also adjusting and subsequently maintaining an insertion depth of the visualization instrument or other instruments.

[0018] In some embodiments, an instrument holder device can include a tubular device, a pivot, and an instrument lock. The tubular device can include a proximal end and a distal end. The tubular device can include a passageway between the distal and proximal ends. The passageway can be configured to receive a visualization instrument. The pivot can be coupled to the distal end of the tubular device opposite the proximal end. The pivot can be configured to rotate, pivot, and / or roll along the patient to adjust the relative position of the tubular device. For example, the pivot can have a curved surface that allows the tubular device to generally roll along the patient’s skin. In some embodiments, the curved surface can be a partially spherical surface that allows the pivot to roll about the axis to move a visualization instrument extending through the port within the patient’s body. In some procedures, the physician can manually sweep the instrument holder device back and forth by rolling the pivot along the patient’s skin to sweep the visualization instrument back and forth across the working zone in the patient. The instrument lock can be configured to hold the visualization instrument in the instrument holder device. The instrument lock can be a set screw collar configured to receive a set screw. When the instrument lock is unlocked, the visualization instrument can be advanced distally into the patient to a lower depth or pulled proximally to pull the visualization instrument out of the patient.

[0019] The instrument holder devices can be configured for use with different types of visualization instruments, working instruments, etc. For example, the visualization instrument can be replaced with a working instrument during a portion of the procedure. This allows the same instrument holder device to assist with visualization, surgical actions,etc. The tubular device can include a biasing device configured to allow a physician to adjust the depth of the instrument. The biasing device can bias the instrument toward a set position. In some embodiments, the tubular device can be biased to an extended position to hold the instrument at a first depth. The user can press downwardly to advance the instrument into the patient by overcoming the biasing force. The tubular device can be compressed until it reaches a fully compressed configuration. This stops the advancement of the instrument. When the tubular device is unlocked, the tubular device can be biased to extend to move the instrument away from working space in the patient. This can prevent inadvertent movement of the instrument into the patient, thereby preventing unintended injury to tissue. The configuration settings of the tubular device can be set before and / or during surgery to prevent the instrument from being advance too far into the patient. This allows the tubular device to protect non-targeted tissue, such as nerve tissue, including the spinal cord, from injury.

[0020] In some embodiments, a visualization instrument holder device is used in a spinal surgical system that also include a visualization instrument and / or other devices to assist the surgical procedure, including instrument holders, pillows, etc. Surgical techniques described herein can include a spinal implant delivery procedure, a decompression procedure, an oblique lumbar interbody fusion (OLIF) procedure, a lateral lumbar interbody fusion (LLIF) procedure, a posterior lumbar interbody fusion (PLIF) procedure, a transforaminal lumbar interbody fusion (TLIF) procedure, an anterior lumbar interbody fusion (ALIF) procedure, or combinations thereof.

[0021] Embodiments of the present disclosure will be described more fully hereinafter with reference to the accompanying drawings in which like numerals represent like elements throughout the several figures, and in which example embodiments are shown. Embodiments of the claims may, however, be embodied in many different forms and should not be construed as limited to the embodiments set forth herein. The examples set forth herein are non-limiting examples and are merely examples among other possible examples.B. SPINAL SURGICAL SYSTEMS

[0022] Figures 1A and 1 B are perspective views of a spinal surgical system 100 (“system 100”) positioned along a human patient’s spine 102 in accordance with an embodiment of the disclosure. Referring to Figures 1 A and 1 B together, the system 100 can include an instrument assembly 110, an instrument guide or cannula 112 (“instrument guide 112”), a visualization instrument 120, and a visualization instrument holder device 130 (“device 130”). The instrument guide 112 can hold tissue around an incision in the patient apart, and the instrument assembly 110 can be inserted into the patient along the instrument guide 112. The instrument assembly 110 can be used to deliver spinal implants to the spine 102, perform a spinal nerve decompression procedure, or perform other surgical procedures. The visualization instrument 120 can be used to view anatomical features of interest, a working instrument, implantation site, a working zone or region, etc. while the device 130 holds or supports the visualization instrument 120 to, for example, eliminate, reduce, or limit, hand or arm fatigue of a physician. For example, the spinal surgical system 100 can be surgeries with different lengths of operation (e.g., less than 30 minutes, more than 30 minutes, 1 hour or more, 1-3 hours, 1 -10 hours, etc.). For example, lumbar spinal surgeries can have a length of operation equal to or greater than 1 hour, 2 hours, 3 hours, 4 hours, 8 hours, 10 hours, etc. The device 130 can reduce or limit hand or arm fatigue of a physician during such procedures while helping to position instruments.

[0023] In some embodiments, the instrument assembly 110 can include a surgical tool, (e.g., retractor, muscle detacher, curette, dissector, Kerrison shaft, ball hook, etc.), an implant delivery device defining a delivery path along which an implant (e.g., an interbody spacer) can be delivered toward an implantation site on the spine 102, or the like. The instrument guide 112 can be a cannula (e.g., a tubular cannula, a U-shaped cannula, etc.), a slotted or split elongated delivery guide, and / or access instrument that can be inserted into a patient towards, for example, the implantation site for delivering the implant. In some embodiments, the instrument assembly 110 can be another type of device for performing surgical procedures on the spine 102. In some embodiments, the instrument assembly 110 can include one or more triangulation guides, marking guides, and other guides.

[0024] Referring now to Figure 1 A, the visualization instrument 120 can include an endoscope or other visualization tool 167, and / or a delivery guide for guiding such visualization tool. A distal end portion 122 of the visualization instrument 120 can be inserted into the patient and be positioned adjacent to the area of interest (e.g., the implantation site). The visualization tool 167 can provide intraoperative endoscopic viewing of workspaces, delivery paths, organs, tissue (e.g., nerve tissue) implantation sites, implants, interbody fusion devices (e.g., before, during, and / or after delivery), instrument(s) (including dispensers, dilators, decompression instruments, etc.), and other areas or features of interest. The visualization tool 167can be connected to a display device (e.g., a television screen, an electronic screen, a monitor, etc.) and can include a distal viewing tip 161. The distal viewing tip 161 can include, for example, one or more imaging devices, image sensors, light sources, and other components for capturing images of a working space. The visualization tool 167 can include, for example, fiber optics, irrigation features (e.g., irrigation lumens), and other features for providing visualization. The visualization instrument 120 can be positioned outside intervertebral spaces to view at least a portion of an intervertebral space, vertebral bodies, and / or a distal portion of the instrument assembly 110. Fluoroscopy, MR imaging, CT imaging, direct visualization, or other visualization techniques can be used in addition to or in lieu of the endoscopic viewing. The visualization instrument 120 can have a field of view suitable for viewing the spinal column and can be positioned using, for example, a transforaminal approach, a posterior approach, or a lateral approach. The position of the instrument assembly 110 and the visualization instrument 120 can be selected based on the procedure and optical characteristics (e.g., field of view, zoom capability, etc.) of the visualization instrument 120. In some procedures, multi-modality imaging of the target site can be performed using an external imaging device and the visualization instrument 120. The intraoperative imaging can be displayed via one or more digital screens (e.g., endoscopic imaging and fluoroscopy on different screens) in the surgical room.

[0025] As discussed further herein, the visualization instrument 120 and / or the device 130 can be moved throughout the procedure to provide intraoperative endoscopic viewing of one, multiple, or all of the surgical steps. For example, the visualization instrument 120can be used to view delivery of the spinal implant along the instrument assembly 110, tissue contributing to nerve compression caused by narrowing of the spinal canal associated with arthritis of the spine, degeneration of spinal discs, and thickening of ligaments. Arthritis of the spine often leads to the formation of bone spurs, which can narrow the spinal canal and press on the spinal cord. This tissue can be viewed using the visualization instrument 120. In spinal disc degeneration, the visualization instrument 120 can view the inner tissue of the disc protruding through a weakened fibrous outer covering of the disc and pressing on the spinal cord and / or spinal nerve roots. The protruding tissue can be viewed before and / or during removal. The visualization instrument 120 can be used to also view ligaments pressing on the spinal cord and / or nerve roots to assist in treatment.

[0026] The visualization instrument 120 can be a low-profile fiber-optic endoscope positioned directly through an incision (e.g., an elongate incision defining a port), an endoscopic port, or the like. The visualization instrument 120 can include one or more endoscopes having, without limitation, fiber optics (e.g., optical fibers), lenses, imaging devices, working lumens, light source controls, or the like for direct viewing or viewing via a display (e.g., an electronic screen, a monitor, etc.). In some embodiments, the visualization instrument 120 can include a lumen through which fluid flows to irrigate the surgical site. For example, saline, or another suitable liquid, can be pumped from a source 163, along a fluid line 165, and through visualization instrument 120 to remove tissue (e.g., loose tissue, bone dust, etc.) or other material impairing visualization. The visualization instrument 120 can also include one or more lumens (e.g., irrigation return lumens, vacuum lumens, etc.) through which the irrigation liquid can be withdrawn.

[0027] The visualization instrument 120 can illuminate the body cavity and enable high- resolution video visualization. A light source (e.g., a laser, light-emitting diode, etc.) located near or at the proximal end of the fiber optics can be used to transmit light to the distal end and provide illuminating light. This enables a surgeon to safely navigate into the patient’s body and to illuminate specific body anatomy to view vertebral spacing, vertebral structures, nerves, bony buildup (e.g., buildup that could be irritating and pressing against nerves contributing to nerve compression), etc. This also allows a surgeon to illuminate portions of the instrument assembly 110 and view a position of an implant along the length of theinstrument assembly 110. In some embodiments, visualization optics for vision and illumination are included within the distal tip of the visualization instrument 120. The configuration and functionality of the visualization instrument 120 can be selected based on the desired field of view, viewing resolution, pan / zoom functionality, or the like.

[0028] In some embodiments, the visualization instrument 120 can be rod-lens endoscopes with an outer diameter equal to or smaller than about 2 mm, 3 mm, 4 mm, 5 mm, 6 mm, 8 mm, or 10 mm, and a length equal to or shorter than about 15 cm, 20 cm, 30 cm, or 40 cm. The visualization instrument 120 can also have integrated irrigation features (e.g., valves, flow control buttons, fluid lines, fluid lumens, return lumens), connectors (e.g., electrical connectors, fluidic connectors, etc.), access ports (e.g., access ports connected to lumens, such as lumens through which instruments can pass), or the like. In embodiments with an angled lens, the distal viewing tip 161 can have an approximately 0-degree, 10- degree, 15-degree, 30-degree, or 45-degree lens angles, which are toward a light source. In other angled lens embodiments, the visualization instrument 120 can have an approximately 15-degree, 30-degree, or 45-degree lens angled away from a light source. The angle of the lens can be selected based on the area to be viewed. In some posterior or lateral spinal procedures, a 0-degree lens can provide a wide-angle view suitable for viewing nerve roots, the spinal cord, and intervertebral space. A 30- or 45-degree lens endoscope angled toward the light source can be used to provide an angled view toward, for example, the spine or midsagittal plane to view, for example, the spinous processes, spinal cord, or central regions of the intervertebral space. A 30- or 45-degree lens endoscope angled away from the light source can be used to provide an angled view toward the lateral features or the spine, such as nerve roots at the neural foramen, side regions of the intervertebral space, or the like.

[0029] In some embodiments, the instrument assembly 110 and the visualization instrument 120 can include instruments disclosed in U.S. App. Publication No. 2023 / 0104335, U.S. Patent No. 11 ,678,906, U.S. App. No. 17 / 902,685, and U.S. App. No. 16 / 687,520, the disclosures of which are incorporated herein by reference in their entireties. In some embodiments, the instrument assembly 110 and the visualization instrument 120can be used with, for example, tubes, sheaths, cannulas, access devices, and / or other devices or instruments.

[0030] Comparing Figures 1A and 1 B, Figure 1A illustrates the device 130 in an extended configuration and Figure 1 B illustrates the device 130 in a shortened, contracted, or compressed configuration. As described in further detail herein, the device 130 can be configured in the extended configuration, the compressed configuration, and various configurations in between to accommodate different patient anatomies, different operating procedures, different visualization instruments 120, etc. Referring to Figure 1A, a user can unlock the device 130 to set the depth of the visualization instrument 120. An instrument lock 210 in a locked state or position securely holds the visualization tool 167 stationary relative to the device 130 (e.g., prevents axial movement of the visualization tool 167). The instrument lock 210 can be moved to an unlocked state or position to move the visualization tool 167 into the patient, as indicated by arrow 121. Once the visualization tool 167 is moved to a desired position or depth, the instrument lock 210 can be moved back to the locked position. The insertion depth (e.g., depth of penetration) of the visualization tool 167 can also be changed while the instrument lock 210 is in the locked position by configuring the device between the extended configuration (Figure 1A) and the compressed configuration (Figure 1 B), thereby moving the visualization tool 167 held by the instrument lock 210.

[0031] The device 130 has a pivot 270 configured to move along a patient’s skin to allow positioning of the distal viewing tip 161 . For example, the pivot 270 can be rolled along the patient’s skin while the visualization instrument 120 is positioned within a port in the patient’s skin. This allows the distal viewing tip 161 to be swept back and forth as indicated by arrows 277, 279 of Figure 1A. In some embodiments, the device 130 can allow rotation of the translationally fixed visualization instrument 120, as indicated by arrows 123. The configuration of the device 130 can be selected to provide, for example, control over translation, locking, rotational movement, and other relative movement.C. VISUALIZATION INSTRUMENT HOLDER DEVICES

[0032] Figure 2A is a perspective view of the visualization instrument holder device 130 in accordance with an embodiment of the disclosure. The device 130 includes theinstrument lock 210, a proximal tubular member 230 coupled to the instrument lock 210, a distal tubular member 260 slidably coupled to the proximal tubular member 230, and a telescopic lock 239.

[0033] The telescopic lock 239 includes a slider or fixing element 250 movable between an unlocked position for allowing the proximal tubular member 230 to slide along the distal tubular member 260 and a locked position for holding the proximal tubular member 230 translationally fixed relative to the distal tubular member 260. The telescopic lock 239 can include a gripping element 240 coupled to the distal tubular member 260 and the fixing element 250 movably coupled to the gripping element 240. In some embodiments, the proximal tubular member 230 is fixedly coupled to or integrally formed with the instrument lock 210. In some embodiments, the gripping element 240 is fixedly coupled to or integrally formed with the distal tubular member 260. In some embodiments, the distal tubular member 260 is fixedly coupled to or integrally formed with the pivot 270.

[0034] In the illustrated embodiment, each of the instrument lock 210, the proximal tubular member 230, the gripping element 240, and the distal tubular member 260 has a cylindrical shape. The instrument lock 210 can include a through-hole defining an opening 202. The through-hole can include a tapered opening, as shown. Each of the proximal tubular member 230, the gripping element 240, and the distal tubular member 260 can include a passageway, channel, or lumen extending therethrough. A visualization instrument (e.g., the visualization instrument 120 shown in Figures 1A and 1 B) can be inserted into the opening 202, extend through the instrument lock 210, the proximal tubular member 230, the gripping element 240, and the distal tubular member 260, and extend out through exit 204 at a distal end of the distal tubular member 260.

[0035] In some embodiments, the instrument lock 210 comprises a set screw collar. The instrument lock 210 can have an aperture 212 through which a set screw 220 can extend and be removably coupled to the instrument lock 210. The aperture 212 can be oriented substantially perpendicular to the through-hole defining the opening 202. The pivot 270 can have a curved surface extending radially outward and upward (e.g., toward the rest of the device 130). In some embodiments, the curved surface can be a partially spherical surface that extends around and radially outward from the distal tubular member 260. This allowsthe pivot 270 to roll in different directions along the patient’s skin. The illustrated pivot 270 has a cutout section or instrument-receiving window 272 that allows an instrument to be positioned adjacent to the distal tubular member 260. For example, the instrument guide 112 of Figure 1 A can be positioned immediately adjacent the distal end of the distal tubular member 260. In some embodiments, the curved surface of the pivot 270 does extend fully around the second distal end of the distal tubular member 260. The pivot 270 can have one or more apertures 274 spaced along the curved surface.

[0036] As described in further detail herein, the proximal tubular member 230 can be slidably coupled to the gripping element 240 and / or the distal tubular member 260 such that(i) the instrument lock 210, the set screw 220, and the proximal tubular member 230, and(ii) the gripping element 240, the fixing element 250, the distal tubular member 260, and the pivot 270 can be moved vertically relative to each other. In some embodiments, the fixing element 250 can be operated to fix (e.g., at least temporarily) the relative positions of the two groups of components described above. Returning to Figures 1A and 1 B, Figure 1A illustrates the device 130 in an extended configuration in which the instrument lock 210 and the gripping element 240 are spaced apart, while Figure 1 B illustrates the device 130 in a shortened configuration in which the instrument lock 210 and the gripping element 240 are positioned adjacent to one another. Each of the instrument lock 210, the set screw 220, and the gripping element 240 can have a textured outer surface, as shown, that facilitates gripping by a user.

[0037] Figure 2B is a perspective, partially exploded view of the device 130. As shown, the device 130 can additionally include a first biasing member 280 and one or more second biasing members 252. In the illustrated embodiment, each of the first biasing member 280 and the one or more second biasing members 252 is a spring. As shown, the set screw 220 can include a threaded portion 222. In some embodiments, the aperture 212 of the instrument lock 210 is a tapped hole such that the threaded portion 222 of the set screw 220 can engage the aperture 212. The proximal tubular member 230 can include a notch or cutout 231 positioned to receive the set screw 220. The proximal tubular member 230 can also include a plurality of annular channels or grooves 232. The number of annular grooves 232 can be two, three, four, five, six, seven, eight, nine, ten, fifteen, twenty, more, or anynumber in between. In some embodiments, the annular grooves 232 do not extend fully around the proximal tubular member 230, as shown. The proximal tubular member 230 can further include a narrow portion 236 that extends from below the plurality of annular grooves 232.

[0038] Furthermore, one of ordinary skill in the art will appreciate that the components are not necessarily illustrated to scale. For example, the length of the proximal tubular member 230, the length of the distal tubular member 260, the radius and / or curvature of the pivot 270, and / or other features of the components of the device 130 can be varied to account for different patient anatomies, different operating procedures, different visualization instruments 120, etc.

[0039] To assemble the device 130, the fixing element 250 can be inserted into the gripping element 240 with the one or more second biasing members 252 positioned therebetween. The gripping element 240 can include one or more inner walls (not shown) against which the one or more second biasing members 252 can press against. The instrument lock 210, the proximal tubular member 230, the first biasing member 280, the gripping element 240, and the distal tubular member 260 can be aligned along a longitudinal axis L1 -L1. In the illustrated embodiment, the gripping element 240, the distal tubular member 260, and the pivot 270 form a single component (e.g., fixedly coupled to one another, integrally formed). The first biasing member 280 can be inserted into the lumens of the gripping element 240, the fixing element 250, and the distal tubular member 260. The narrow portion 236 and / or other portions of the proximal tubular member 230 can also be inserted at least partially into the lumens of the gripping element 240, the fixing element 250, and the distal tubular member 260. In some embodiments, the first biasing member 280 comprises a spring, and the spring can be positioned to coil around the narrow portion 236 when assembled. The instrument lock 210 can be coupled to the proximal tubular member 230 (e.g., via fasteners, adhesives, or other coupling mechanisms) such that the notch 231 aligns with the aperture 212.

[0040] Once the device 130 is assembled, as shown in Figure 2A, a visualization instrument can be inserted into the opening 202, through the device 130, and out through the exit 204. After positioning the visualization instrument at a desired depth relative to thedevice 130, the threaded portion 222 of the set screw 220 can be inserted through the aperture 212 of the instrument lock 210 along an axis S1-S1 to engage and clamp the visualization instrument at the desired depth relative to the device 130. In some embodiments, the instrument lock 210 and the set screw 220 can be replaced with other mechanisms for securing a visualization instrument to the device 130.

[0041] As described in further detail below with reference to Figures 3A-5, the first biasing member 280 can be positioned to bias the proximal tubular member 230 and / or the distal tubular member 260 toward the extended configuration (Figure 1A) or the shortened configuration (Figure 1 B). The one or more second biasing members 252 can be positioned to bias the fixing element 250 toward a locked position.

[0042] Figures 3A and 3B are cross-sectional views of the device 130. Specifically, Figure 3A illustrates the fixing element 250 is a locked position and Figure 3B illustrates the fixing element 250 in an unlocked position. Referring to both Figures 3A and 3B, the device 130 includes a combined channel 306 (also referred to as “the endoscope-receiving passageway 306” or “the instrument-receiving passageway 306” herein) that extends between the opening 202 and the exit 204. The proximal tubular member 230 can include a first shoulder or lip portion 334 (also referred to as “the thinned-walled region 334” herein) defined by the narrow portion 236, and the distal tubular member 260 (or the pivot 270, which may be integrally formed with the distal tubular member 260) can include a second lip portion 376 at the second distal end of the distal tubular member 260. The first biasing member 280 can be positioned between the first lip portion 334 and the second lip portion 376. As shown, the first biasing member 280 can also be positioned around (e.g., coiled around) the narrow portion 236 of the proximal tubular member 230 and within the channel or lumen of the distal tubular member 260. The first biasing member 280 can be configured to bias the proximal tubular member 230 relative to the distal tubular member 260. For example, the first biasing member 280 can comprise a compressed spring that biases the device 130 toward the extended configuration (Figure 1A). In another example, the first biasing member 280 can comprise a spring under tension that biases the device 130 toward the shortened configuration (Figure 1 B).

[0043] Figure 4 is an enlarged perspective view of the device 130 with the gripping element 240 removed to avoid obscuring certain features of the disclosure. Figure 5 is a perspective view of the fixing element 250. Referring first to Figure 5, the fixing element 250 includes an aperture 551 that can form part of the combined channel 306 (Figures 3A and 3B), a protrusion or ridge 554 positioned in the aperture 551 and extending inward, a pressing portion 552, and one or more surfaces 556. As shown in Figure 4, the one or more second biasing members 252 can be positioned against the one or more surfaces 556 of the fixing element 250. And as discussed above, the gripping element 240 (not shown in Figure 4) can include one or more inner walls against which the one or more second biasing members 252 can press against. Therefore, the one or more second biasing members 252 can be configured to bias the fixing element 250 towards the locked position, as described in further detail below.

[0044] Returning to Figure 3A, when in the locked position, the ridge 554 of the slider or fixing element 250 (on the right side) engages the plurality of annular grooves 232 of the proximal tubular member 230. In particular, the ridge 554 is positioned in one of the annular grooves 232 such that the proximal tubular member 230 cannot slide vertically relative to the distal tubular member 260. Also, when in the locked position, the pressing portion 552 of the fixing element 250 (on the left side) protrudes out of the gripping element 240 (as also shown in Figure 2A). The pressing portion 552 can serve as a button that an operator can press against (e.g., with a finger) to move the fixing element 250 in the direction indicated by the arrow in Figure 3A.

[0045] Referring next to Figure 3B, when in the unlocked position, the fixing element 250 is moved deeper in the gripping element 240 (e.g., rightward) such that the ridge 554 is no longer positioned in any of the grooves 232. Therefore, the proximal tubular member 230 is free to slide vertically relative to the distal tubular member 260. While keeping the fixing element 250 in the unlocked position (e.g., by continuing the press against the pressing portion 552), an operator can slide the proximal tubular member 230 and / or the distal tubular member 260 relative to one another to a desired configuration (e.g., while holding the instrument lock 210 with one hand and holding the gripping element 240 with the other hand).

[0046] The multiple annular grooves 232 define the various relative positions that the proximal tubular member 230 and the distal tubular member 260 can be configured at. For example, Figures 1 A, 3A, and 3B illustrate the device 130 in the extended configuration in which the ridge 554 is positioned in the bottom-most groove. In another example, Figure 1 B illustrates the device 130 in the shortened configuration in which the ridge 554 is positioned in the top-most groove. Once the device 130 has been moved to the desired configuration, the operator can release the pressing portion 552 and the one or more second biasing members 252 can return the fixing element 250 to the locked position.

[0047] Returning to Figures 1 A and 1 B, during operation of the device 130, an operator can position the device 130 such that the pivot 270 abuts against the patient (e.g., the skin of the patient). The curved surface of the pivot 270 allows the operator to pivot the device 130 against the patient (e.g., pivot about the second distal end of the distal tubular member 260). This can allow the operator to easily and safely reposition and / or reorient the visualization instrument 120 during a procedure while maintaining the same insertion depth of the visualization instrument 120 (e.g., set by the set screw 220). For example, if the visualization instrument 120 is unable to properly view the implantation site, the operator can move the visualization instrument 120 by rolling the pivot 270 on the patient’s skin. In another example, if the visualization instrument 120 is about to or likely to hit a sensitive part of the body, such as the spine 102, the operator can move the visualization instrument 120 by rolling the pivot 270 on the patient’s skin.

[0048] In some embodiments, the apertures 274 of the pivot 270 can serve as windows through which the operator can view the patient’s skin and determine the position of the pivot 270 relative to the patient. The apertures 274 can also allow a portion of the patient’s skin to partially squeeze through while the device 130 presses against the patient during the procedure, providing greater or improved positional stability for the device 130. In some embodiments, the cutout section 272 of the pivot 270 can serve as a visual indicator to the operator that the device 130 should remain oriented such that the pivot 270 contacts the patient and the visualization instrument correctly extends towards the implantation site or other area of interest.

[0049] Also, as discussed above with reference to Figures 3A-5, the operator can adjust the relative positions of the proximal tubular member 230 and the distal tubular member 260 to accommodate different patient anatomies, different operating procedures, different visualization instruments 120, etc. For example, comparing Figures 1A and 1 B, the pivot 270 is positioned closer to the patient’s spine 102 when the device 130 is in the extended configuration (Figure 1A) than when the device 130 is in the shortened configuration (Figure 1 B). This can be to accommodate different patients having different distances between the skin on the back and the spine 102. In some embodiments, the operator can configure the device 130 to the extended configuration, the shortened configuration, or any configuration therebetween (e.g., defined by the plurality of annular grooves 232) prior to inserting the visualization instrument 120 through the device 130.

[0050] As an example, Figures 1A and 1 B show that the distance between the top portion of the visualization instrument 120 and the instrument lock 210 is the same while the length of the distal end portion 122 of the visualization instrument 120 that is inserted into the patient is different. Once the operator determines the appropriate insertion depth of the distal end portion 122 of the visualization instrument 120, the operator can configure the device 130 to the appropriate configuration such that the operator can insert the visualization instrument 120 through the device 130 until the top portion of the visualization instrument 120 is at a predetermined, fixed distance from the instrument lock 210. The set screw 220 can then be used to maintain the position of the visualization instrument 120 relative to the device 130 such that the operator can perform the procedure while maintaining a constant and appropriate insertion depth of the distal end portion 122 of the visualization instrument 120.

[0051] Figure 6A is a perspective view of another visualization instrument holder device 600 (“device 600”) in accordance with an embodiment of the disclosure. The device 600 can include components generally similar to the components of the device 130 illustrated in and described above with reference to Figures 2A-5, and similarly labeled components can be generally similar or identical in structure and function. In the illustrated embodiment, the device 600 includes an instrument lock 610 (e.g., the instrument lock 210, a set screw collar), a set screw 620 (e.g., the set screw 220) removably coupleable to the instrument lock 610,a distal tubular member 660 (e.g., the distal tubular member 260) having a first distal end coupled to the instrument lock 610, and a pivot 670 (e.g., the pivot 270) coupled to a second distal end of the distal tubular member 660 opposite the first distal end. In some embodiments, the distal tubular member 660 is fixedly coupled to or integrally formed with the instrument lock 610. In some embodiments, the pivot 670 is fixedly coupled to or integrally formed with the distal tubular member 660.

[0052] In the illustrated embodiment, each of the instrument lock 610 and the distal tubular member 660 has a cylindrical shape. The instrument lock 610 can include a through- hole defining an opening 602. The through-hole can be tapered, as shown. The distal tubular member 660 can include a channel or lumen extending therethrough. A visualization instrument (e.g., the visualization instrument 120 shown in Figures 1A and 1 B) can be inserted into the opening 602, extend through the instrument lock 610 and the distal tubular member 660, and extend out through exit 604 at the second distal end of the distal tubular member 660. Each of the instrument lock 210 and the set screw 220 can have a textured outer surface, as shown, that facilitates gripping by a surgeon or other operator.

[0053] The instrument lock 610 can also have an aperture 612 (e.g., the aperture 212) through which the set screw 620 can extend and be removably coupled to the instrument lock 610. The aperture 612 can be oriented substantially perpendicular to the through-hole defining the opening 602. The pivot 670 can have a curved surface extending radially outward and upward (e.g., toward the rest of the device 600). In some embodiments, the curved surface corresponds to a spherical segment. The pivot 670 can have one or more apertures 674 spaced along the curved surface. Further, in the illustrated embodiment, the curved surface of the pivot 670 does not extend fully around the second distal end of the distal tubular member 660, but instead has a shape of a sector and defines a cutout zone 672.

[0054] Figure 6B is a perspective, partially exploded view of the device 600. As shown, the distal tubular member 660 can include a notch or cutout (e.g., the notch 231 ) at the first distal end. To assemble the device 600, the instrument lock 610 and the distal tubular member 660 can be aligned along a longitudinal axis L2-L2. In the illustrated embodiment, the distal tubular member 660 and the pivot 670 form a single component (e.g., fixedlycoupled to one another, integrally formed). The instrument lock 610 can be coupled to the first distal end of the distal tubular member 660 (e.g., via fasteners, adhesives, magnets, one or more pins, snap connections, or other coupling mechanisms) such that the notch aligns with the aperture 612.

[0055] Once the device 600 is assembled, as shown in Figure 6A, a visualization instrument can be inserted into the opening 602, through the device 600, and out through the exit 604. After positioning the visualization instrument at a desired depth relative to the device 130, a threaded portion 222 (e.g., the threaded portion 222) of the set screw 620 can be inserted through the aperture 612 of the instrument lock 610 along an axis S2-S2 to engage and clamp the visualization instrument at the desired depth relative to the device 600.

[0056] Figure 7 is a cross-sectional view of the device 600. As shown, the through- hole of the instrument lock 610 and the channel or lumen of the distal tubular member 660 can form part of a combined channel 606 that extends between the opening 602 and the exit 604. A threaded portion 622 of the set screw 620 can extend at least partially into the combined channel 606 to engage and clamp the visualization instrument in the combined channel 606, as discussed above. In some embodiments, the portion 622 includes one or more magnets, friction elements (e.g., rubber elements, elastomer elements, etc.) configured to inhibit, limit, or substantially prevent movement of the retained instrument. For example, the end of the portion 622 can include a friction element that is pressed against the side of the instrument.

[0057] In operation, the pivot 670 can be used to pivot the device 600 against and about a patient to reposition and / or reorient the visualization instrument extending therethrough, similar to how the pivot 270 is used as described above. For example, the operator can hold the instrument lock 610 and / or the distal tubular member 660 with one hand. Compared to the device 130 illustrated in Figures 1A-5, the device 600 illustrated in Figures 6A-7 cannot be vertically adjusted, but includes fewer components, providing a more compact visualization instrument holder device with a smaller size and a lower cost.

[0058] Figure 8 is a flowchart illustrating a method 800 for holding a visualization instrument adjacent to an implantation site in a patient in accordance with embodiments of the disclosure. While the method 800 is described below with respect to the devices 130, 600, one of ordinary skill in the art will appreciate that the method 800 can be practiced with other visualization instrument holder devices.

[0059] The method 800 can include inserting a visualization instrument (e.g., the visualization instrument 120) into a visualization instrument holder device (e.g., the device 130, 600) such that a distal end of the visualization instrument is positioned adjacent to an implantation site of a patient (process portion 802). The device can include an instrument lock (e.g., the instrument lock 210, 610) defining an opening (e.g., the opening 202, 602), a distal tubular member (e.g., the distal tubular member 260, 660) having a first distal end coupled to the instrument lock, wherein the distal tubular member includes a channel or passageway extending therethrough, and a pivot (e.g., the pivot 270, 670) coupled to a second distal end of the distal tubular member opposite the first distal end. In some embodiments, inserting the visualization instrument into the device comprises inserting the visualization instrument through the opening and the channel of the distal tubular member.

[0060] The method 800 can also include fixing, via the instrument lock, a position of the visualization instrument relative to the device (process portion 804). The method 800 can further include pivoting, via the pivot, the distal tubular member about the second distal end and against the patient, thereby adjusting a position of the distal end of the visualization instrument relative to the implantation site (process portion 806).

[0061] In some embodiments, the device further includes a proximal tubular member (e.g., the proximal tubular member 230) coupled between the instrument lock and the distal tubular member , and the proximal tubular member can include a plurality of annular grooves (e.g., the plurality of annular grooves 232). The device can further include a fixing element (e.g., the fixing element 250) including a ridge (e.g., the ridge 554) configured to fit in between one of the annular grooves. In some embodiments, the method 800 can further include moving the fixing element from a locked position in which the ridge is positioned in a first one of the annular grooves to an unlocked position in which the ridge is not positioned in one of the annular grooves. The method 800 can further include moving the proximaltubular member at least partially in or out of the channel of the distal tubular member. The method 800 can further include moving the fixing element from the unlocked position to the locked position such that the ridge is positioned in a second one of the annular grooves.

[0062] In some embodiments, the device further includes a biasing member (e.g., the first biasing member 280), such as a spring, positioned between the proximal tubular member and the distal tubular member. Moving the proximal tubular member at least partially in or out of the channel of the distal tubular member can comprise allowing the biasing member to move the proximal tubular member relative to the distal tubular member. In some embodiments, the instrument lock includes an aperture (e.g., the aperture 212, 612) extending substantially perpendicular to the opening, and the device can further include a set screw (e.g., the set screw 220, 620). In some embodiments, the method 800 further includes positioning the set screw through the aperture of the instrument lock, and clamping the visualization instrument in the opening of the instrument lock.D. EXAMPLES

[0063] The present technology is illustrated, for example, according to various aspects described below as numbered examples (1 , 2, 3, etc.) for convenience. These are provided as examples and do not limit the present technology. It is noted that any of the dependent examples may be combined in any combination, and placed into a respective independent example. The other examples can be presented in a similar manner.1 . A visualization instrument holder device comprising: a tubular device having a proximal end and a distal end, wherein the tubular device includes a passageway extending therethrough, wherein the passageway is configured to receive a visualization instrument; a pivot coupled to the distal end of the tubular device, wherein the pivot has a curved surface configured to allow the tubular device to roll about a port in a patient’s skin while the visualization instrument extends through the tubular device into the port; andan instrument lock configured to hold the visualization instrument in the passageway of the tubular device.2. The visualization instrument holder device of example 1 wherein the tubular device is movable from an extended configuration to a compressed configuration to advance the visualization instrument held by the instrument lock into the patient.3. The visualization instrument holder device of example 1 or example 2 wherein the tubular device includes a set of telescoping tubular members movable relative to one another to move the instrument lock relative to the curved surface.4. The visualization instrument holder device of any one of examples 1-3 wherein the tubular device includes a telescoping lock configured to lock at least one telescoping component of the tubular device.5. The visualization instrument holder device of any one of examples 1 -4, further comprising a telescopic lock configured to prevent or allow telescoping of the tubular device while the instrument lock holds the visualization instrument.6. The visualization instrument holder device of any one of examples 1-5 wherein the tubular device includes at least one biasing element that biases the tubular device in a compressed configuration toward an extended configuration.7. The visualization instrument holder device of example 6 wherein the tubular device includes an inner tubular member and an outer tubular member, and wherein at least a portion of the at least one biasing element is positioned between a thinned-walled region of the inner tubular member and the outer tubular member.8. The visualization instrument holder device of example 6 or example 7 wherein the at least one biasing element includes a spring held between a distal shoulder of the pivot and a proximal shoulder of the tubular device.9. The visualization instrument holder device of any one of examples 1 -8, further comprising a first member of the tubular device, a telescoping lock configured to hold the first member, a second member of the tubular device connecting the telescoping lock to the pivot, and at least one biasing member held between a first shoulder of the first member and a second shoulder of the second member.10. The visualization instrument holder device of any one of examples 1-9 wherein the tubular device has a plurality of extended locked configurations and includes a lock movable from a locked configuration for holding the tubular device at one of the extended locked configurations and an unlocked configuration allowing the tubular device to move between the extended locked configurations.11 . The visualization instrument holder device of example 10 wherein the tubular device has annular features defining respective ones of the extended configurations.12. The visualization instrument holder device of example 10 or example 11 wherein the tubular device is configured to extend and contract while the instrument lock holds the visualization instrument so as to adjust a depth of penetration of the visualization instrument.13. The visualization instrument holder device of any one of examples 1-12 wherein the tubular device includes: a distal tubular member coupled to the pivot; a proximal tubular member telescopically disposed within the distal tubular member and slidable along the distal tubular member to adjust a length of the tubular device; anda telescopic lock including a slider movable between an unlocked position for allowing the proximal tubular member to slide along the distal tubular member and a locked position for holding the proximal tubular member translationally fixed relative to the distal tubular member.14. The visualization instrument holder device of example 13 wherein the telescopic lock in the locked position allows rotational movement between the distal and proximal tubular members.15. The visualization instrument holder device of example 13 or example 14, further comprising a biasing member positioned between the distal tubular member and the slider, wherein the biasing member is configured to bias the slider toward the locked position.16. The visualization instrument holder device of any one of examples 1-15 wherein the instrument lock includes a set screw collar coupled to the proximal end of the tubular device.17. The visualization instrument holder device of any one of examples 1-16 wherein the tubular device further comprises: a proximal tubular member coupled to the instrument lock, wherein the proximal tubular member includes a plurality of annular grooves; a distal tubular member coupled between the proximal tubular member and the pivot; and a fixing element configurable between an unlocked position and a locked position, wherein the fixing element includes a ridge configured to fit in one of the annular grooves when the fixing element is in the locked position, wherein, in the unlocked position, the fixing element allows the proximal tubular member to move at least partially in and out of a channel of the distal tubular member, andwherein, in the locked position, the fixing element fixes a position of the proximal tubular member relative to the distal tubular member.18. The visualization instrument holder device of example 17, further comprising a biasing member positioned around the proximal tubular member, within the channel, and between the proximal tubular member and the distal tubular member, wherein the biasing member is configured to bias the proximal tubular member relative to the distal tubular member.19. The visualization instrument holder device of example 18, further comprising a biasing member positioned between the fixing element and the distal tubular member, wherein the biasing member is configured to bias the fixing element toward the locked position.20. The visualization instrument holder device of any one of examples 1-19 wherein the instrument lock includes an aperture extending substantially perpendicular to the passageway, and wherein the visualization instrument holder device further comprises a set screw configured to extend through the aperture and clamp the visualization instrument in the passageway.21. The visualization instrument holder device of any one of examples 1-20 wherein the curved surface includes a plurality of apertures configured to, while the pivot presses against the patient’s skin, receive a portion of the patient’s skin and thereby provide improved positional stability for the visualization instrument holder device.22. The visualization instrument holder device of any one of examples 1-21 wherein the curved surface corresponds to a spherical segment.23. The visualization instrument holder device of any one of examples 1-22 wherein the curved surface comprises a cutout section.24. The visualization instrument holder device of any one of examples 1-23 wherein the tubular device includes a plurality of spaced apart positioning features each configured to define a respective position of a telescopic lock.25. The visualization instrument holder device of example 24, further comprising a telescopic lock including a gripping element configured to be receive a respective one of the positioning features.26. The visualization instrument holder device of example 24 or example 25 wherein the positioning features are annular channels or grooves.27. An endoscope holder device comprising: a tubular device having a proximal end and a distal end, wherein the tubular device includes an endoscope-receiving passageway extending therethrough, wherein the endoscope-receiving passageway is configured to receive an endoscope; a pivot coupled to the distal end of the tubular device and having a curved surface configured to allow the tubular device to roll about a port in a patient’s skin while the endoscope extends along the endoscope-receiving passageway into the port; and an endoscope lock configured to fixedly hold the endoscope positioned in the endoscope-receiving passageway of the tubular device.28. The endoscope holder device of example 27 wherein the endoscope lock is configured to prevent axial movement of the endoscope relative to the tubular device.29. The endoscope holder device of example 27 or example 28 wherein the tubular device is movable from an extended configuration to a compressed configuration to advance the endoscope held by the endoscope lock into the patient.30. The endoscope holder device of any one of examples 27-29 wherein the tubular device includes a set of telescoping tubular members movable relative to one another to move the endoscope lock relative to the curved surface.31 . The endoscope holder device of any one of examples 27-30 wherein the tubular device includes a telescoping lock configured to lock at least one telescoping component of the tubular device.32. The endoscope holder device of any one of examples 27-31 , further comprising a telescopic lock configured to prevent or allow telescoping of the tubular device while the endoscope lock holds the endoscope.33. The endoscope holder device of any one of examples 27-32 wherein the tubular device includes at least one biasing element that biases the tubular device in a compressed configuration toward an extended configuration.34. The endoscope holder device of example 33 wherein the tubular device includes an inner tubular member and an outer tubular member, wherein at least a portion of the at least one biasing element is positioned between a thinned-walled region of the inner tubular member and the outer tubular member.35. The endoscope holder device of example 33 or example 34 wherein the at least one biasing element includes a spring held between a distal shoulder of the pivot and a proximal shoulder of the tubular device.36. The endoscope holder device of any one of examples 27-35, further comprising a first member of the tubular device, a telescoping lock configured to hold the first member, a second member of the tubular device connecting the telescoping lock to the pivot, and at least one biasing member held between a first shoulder of the first member and a second shoulder of the second member.37. The endoscope holder device of any one of examples 27-36 wherein the tubular device has a plurality of extended configurations and includes a lock movable from a locked configuration for holding the tubular device at one of the extended configurations and an unlocked configuration allowing the tubular device to move between the extended configurations.38. The endoscope holder device of example 37 wherein the tubular device has annular features defining respective ones of the extended configurations.39. The endoscope holder device of example 37 or example 38 wherein the tubular device is configured to extend and contract while the endoscope lock holds the endoscope so as to adjust a depth of penetration of the endoscope.40. The endoscope holder device of any one of examples 27-39 wherein the tubular device includes: a distal tubular member coupled to the pivot; a proximal tubular member telescopically disposed within the distal tubular member and slidable along the distal tubular member to adjust a length of the tubular device; and a telescopic lock including a slider movable between an unlocked position for allowing the proximal tubular member to slide along the distal tubular member and a locked position for holding the proximal tubular member translationally fixed relative to the distal tubular member.41 . An endoscope holder device comprising: a telescoping tubular assembly including: an endoscope-receiving passageway, an endoscope lock configured to fixedly hold an endoscope positioned in the endoscope-receiving passageway, anda telescoping lock having a locked state for locking the telescoping tubular assembly to hold the endoscope and an unlocked state for allowing extension and compression of the telescoping tubular assembly to move the endoscope toward or away from a working space in a patient; and a pivot coupled to the telescoping tubular assembly and configured to allow the telescoping tubular assembly to roll about a port in the patient’s skin while the endoscope extends along the endoscope-receiving passageway into the port.42. The endoscope holder device of example 41 wherein the telescoping lock in the locked state is configured to hold the endoscope translationally fixed relative to a working space while the pivot allows the endoscope to pivot relative to the patient’s body.43. The endoscope holder device of example 41 or example 42 wherein the telescoping tubular assembly is configured to extend to move the endoscope lock and the telescoping lock away from each other and to contract to move the endoscope lock and the telescoping lock toward each other.44. The endoscope holder device of any one of examples 41-43 wherein the telescoping lock is configured to lock the telescoping tubular assembly at a plurality of different lengths.45. The endoscope holder device of any one of examples 41-44 wherein the telescoping tubular assembly includes a biasing member configured to cause the telescoping tubular assembly to move the endoscope away from a working space in the patient when the telescoping lock is in the unlocked state.46. A surgical kit comprising: a plurality of multi-portal surgical instruments; and an instrument holder device including:a tubular device having a proximal end, a distal end, and a passageway extending therethrough, wherein the passageway is configured to receive one or more of the multi-portal surgical instruments, a pivot coupled to the distal end of the tubular device, wherein the pivot has a curved surface configured to allow the tubular device to roll about a port in a patient’s skin while the received one or more of the multi-portal surgical instruments extends through the tubular device into the port, and an instrument lock configured to hold the one of the multi-portal surgical instruments in the passageway of the tubular device.47. The surgical kit of example 46, wherein the instrument holder device is the holder device of one of examples 1-45.48. A method for holding a visualization instrument adjacent to an implantation site in a patient, the method comprising: inserting a visualization instrument into a visualization instrument holder device such that a distal end of the visualization instrument is positioned adjacent to an implantation site of a patient, wherein the visualization instrument holder device comprises: an instrument lock defining an opening; a distal tubular member having a first distal end coupled to the instrument lock, wherein the distal tubular member includes a channel extending therethrough; and a pivot coupled to a second distal end of the distal tubular member opposite the first distal end, wherein inserting the visualization instrument into the visualization instrument holder device comprises inserting the visualization instrument through the opening and the channel; fixing, via the instrument lock, a position of the visualization instrument relative to the visualization instrument holder device; andpivoting, via the pivot, the distal tubular member about the second distal end and against the patient, thereby adjusting a position of the distal end of the visualization instrument relative to the implantation site.49. The method of example 48 wherein the device further comprises: a proximal tubular member coupled between the instrument lock and the distal tubular member, wherein the proximal tubular member includes a plurality of annular grooves; and a fixing element including a ridge configured to fit in one of the annular grooves, wherein the method further comprises: moving the fixing element from a locked position in which the ridge is positioned in a first one of the annular grooves to an unlocked position in which the ridge is not positioned in any of the annular grooves; moving the proximal tubular member at least partially in or out of the channel of the distal tubular member; and moving the fixing element from the unlocked position to the locked position such that the ridge is positioned in a second one of the annular grooves.50. The method of example 49 wherein the device further comprises a biasing member positioned between the proximal tubular member and the distal tubular member, wherein moving the proximal tubular member at least partially in or out of the channel of the distal tubular member comprises allowing the biasing member to move the proximal tubular member relative to the distal tubular member.51. The method of example 49 or example 50 wherein the device further comprises a biasing member positioned between the distal tubular member and the fixing element, and wherein moving the fixing element from the unlocked position to the locked position comprises allowing the biasing member to move the fixing element to the locked position.52. The method of any one of examples 48-51 wherein the instrument lock includes an aperture extending substantially perpendicular to the opening, wherein the device further comprises a set screw, and wherein the method further comprises: positioning the set screw through the aperture of the instrument lock; and clamping the visualization instrument in the opening of the instrument lock.53. The method of any one of examples 48-52 wherein the pivot includes a curved surface including a plurality of apertures, and wherein the method further comprises determining a position of the pivot relative to the patient by viewing the patient’s skin through the plurality of apertures.E. CONCLUSION

[0064] The foregoing detailed description has set forth various embodiments of the devices and / or processes via the use of block diagrams, flowcharts, and / or examples. Insofar as such block diagrams, flowcharts, and / or examples contain one or more functions and / or operations, it will be understood by those within the art that each function and / or operation within such block diagrams, flowcharts, or examples can be implemented, individually and / or collectively, by a wide range of hardware, software, firmware, or virtually any combination thereof. In one embodiment, several portions of the subject matter described herein may be implemented via Application Specific Integrated Circuits (ASICs), Field Programmable Gate Arrays (FPGAs), digital signal processors (DSPs), or other integrated formats. However, those skilled in the art will recognize that some aspects of the embodiments disclosed herein, in whole or in part, can be equivalently implemented in integrated circuits, as one or more computer programs running on one or more computers (e.g., as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (e.g., as one or more programs running on one or more microprocessors), as firmware, or as virtually any combination thereof, and that designing the circuitry and / or writing the code for the software and / or firmware would be well within the skill of one skilled in the art in light of this disclosure. In addition, those skilled in the art will appreciate that the mechanisms of the subject matter described herein arecapable of being distributed as a program product in a variety of forms, and that an illustrative embodiment of the subject matter described herein applies regardless of the particular type of signal-bearing medium used to actually carry out the distribution. Examples of a signalbearing medium include, but are not limited to, the following: a recordable type of medium such as a floppy disk, a hard disk drive, a CD, a DVD, a digital tape, a computer memory, etc.; and a transmission type medium such as a digital and / or an analog communication medium (e.g., a fiber-optic cable, a waveguide, a wired communications link, a wireless communication link, etc.).

[0065] The above detailed descriptions of embodiments of the technology are not intended to be exhaustive or to limit the technology to the precise form disclosed above. Although specific embodiments of, and examples for, the technology are described above for illustrative purposes, various equivalent modifications are possible within the scope of the technology, as those skilled in the relevant art will recognize. For example, while steps are presented in a given order, alternative embodiments may perform steps in a different order. Features from various systems, methods, and instruments can be combined with features disclosed in U.S. App. No. 15 / 793,950; U.S. App. No. 17 / 902,685; U.S. App. No. 18 / 335,737; U.S. App. No. 18 / 464,949; U.S. App. No. 18 / 470,140; U.S. App. No. 18 / 764,784; U.S. App. No. 18 / 988,467; U.S. Pat. No. 8,632,594; U.S. Pat. No. 9,308,099; U.S. Pat. No. 10,105,238; U.S. Pat. No. 10,201 ,431 ; U.S. Pat. No. 10,898,340; U.S. Pat. No. 11 ,464,648; U.S. Pat. No. 11 ,678,906; U.S. Pat. No. 11 ,950,770; PCT App. No. PCT / US20 / 49982; and PCT App. No. PCT / US22 / 21193, which are hereby incorporated by reference and made a part of this application. For example, instrument assemblies (e.g., instrument assembly 110 of FIGS. 1A-1 B) can include one or more working or surgical instruments (e.g., curettes, rongeurs, retractors, nerve root retractors, etc.), decompression instruments, or other instruments disclosed in the incorporated by reference applications and patents. Moreover, visualization instrument holder devices discloses herein can be used as, or configured to be, working instrument holders configured to hold, for example, curettes, rongeurs, retractors, nerve root retractors, etc. A surgical kit can include devices, components, features, and systems disclosed herein and features of surgical kits aredescribed in the incorporated by reference applications and patents. Variations of the implants are contemplated.

[0066] Systems, components, and instruments disclosed herein can be disposable or reusable. For example, the ports, instruments, or cannulas can be disposable to prevent cross-contamination. As used herein, the term “disposable” when applied to a system or component (or combination of components), such as an instrument, a tool, or a distal tip or a head, is a broad term and generally means, without limitation, that the system or component in question is used a finite number of times and is then discarded. Some disposable components are used only once and are then discarded. In other embodiments, the components and instruments are non-disposable and can be used any number of times. In some kits, all of the components can be disposable to prevent cross-contamination. In some other kits, components (e.g., all or some of the components) can be reusable.

[0067] Where the context permits, singular or plural terms may also include the plural or singular term, respectively. Moreover, unless the word “or” is expressly limited to mean only a single item exclusive from the other items in reference to a list of two or more items, then the use of “or” in such a list is to be interpreted as including (a) any single item in the list, (b) all of the items in the list, or (c) any combination of the items in the list. Additionally, the term “comprising” is used throughout to mean including at least the recited feature(s) such that any greater number of the same feature and / or additional types of other features are not precluded. It will also be appreciated that specific embodiments have been described herein for purposes of illustration, but that various modifications may be made without deviating from the technology. Further, while advantages associated with certain embodiments of the technology have been described in the context of those embodiments, other embodiments may also exhibit such advantages, and not all embodiments need necessarily exhibit such advantages to fall within the scope of the present technology. Accordingly, the disclosure and associated technology can encompass other embodiments not expressly shown or described herein.

Claims

CLAIMSWhat is claimed is:1 . A visualization instrument holder device comprising: a tubular device having a proximal end and a distal end, wherein the tubular device includes a passageway extending therethrough, wherein the passageway is configured to receive a visualization instrument; a pivot coupled to the distal end of the tubular device, wherein the pivot has a curved surface configured to allow the tubular device to roll about a port in a patient’s skin while the visualization instrument extends through the tubular device into the port; and an instrument lock configured to hold the visualization instrument in the passageway of the tubular device.

2. The visualization instrument holder device of claim 1 wherein the tubular device is movable from an extended configuration to a compressed configuration to advance the visualization instrument held by the instrument lock into the patient.

3. The visualization instrument holder device of claim 1 wherein the tubular device includes a set of telescoping tubular members movable relative to one another to move the instrument lock relative to the curved surface.

4. The visualization instrument holder device of claim 1 wherein the tubular device includes a telescoping lock configured to lock at least one telescoping component of the tubular device.

5. The visualization instrument holder device of claim 1 , further comprising a telescopic lock configured to prevent or allow telescoping of the tubular device while the instrument lock holds the visualization instrument.

6. The visualization instrument holder device of claim 1 wherein the tubular device includes at least one biasing element that biases the tubular device in a compressed configuration toward an extended configuration.

7. The visualization instrument holder device of claim 6 wherein the tubular device includes an inner tubular member and an outer tubular member, and wherein at least a portion of the at least one biasing element is positioned between a thinned-walled region of the inner tubular member and the outer tubular member.

8. The visualization instrument holder device of claim 6 wherein the at least one biasing element includes a spring held between a distal shoulder of the pivot and a proximal shoulder of the tubular device.

9. The visualization instrument holder device of claim 1 , further comprising a first member of the tubular device, a telescoping lock configured to hold the first member, a second member of the tubular device connecting the telescoping lock to the pivot, and at least one biasing member held between a first shoulder of the first member and a second shoulder of the second member.

10. The visualization instrument holder device of claim 1 wherein the tubular device has a plurality of extended locked configurations and includes a lock movable from a locked configuration for holding the tubular device at one of the extended locked configurations and an unlocked configuration allowing the tubular device to move between the extended locked configurations.

11. The visualization instrument holder device of claim 10 wherein the tubular device has annular features defining respective ones of the extended configurations.

12. The visualization instrument holder device of claim 10 wherein the tubular device is configured to extend and contract while the instrument lock holds the visualization instrument so as to adjust a depth of penetration of the visualization instrument.

13. The visualization instrument holder device of claim 1 wherein the tubular device includes: a distal tubular member coupled to the pivot; a proximal tubular member telescopically disposed within the distal tubular member and slidable along the distal tubular member to adjust a length of the tubular device; and a telescopic lock including a slider movable between an unlocked position for allowing the proximal tubular member to slide along the distal tubular member and a locked position for holding the proximal tubular member translationally fixed relative to the distal tubular member.

14. The visualization instrument holder device of claim 13 wherein the telescopic lock in the locked position allows rotational movement between the distal and proximal tubular members.

15. The visualization instrument holder device of claim 13, further comprising a biasing member positioned between the distal tubular member and the slider, wherein the biasing member is configured to bias the slider toward the locked position.

16. The visualization instrument holder device of claim 1 wherein the instrument lock includes a set screw collar coupled to the proximal end of the tubular device.

17. The visualization instrument holder device of claim 1 wherein the tubular device further comprises: a proximal tubular member coupled to the instrument lock, wherein the proximal tubular member includes a plurality of annular grooves;a distal tubular member coupled between the proximal tubular member and the pivot; and a fixing element configurable between an unlocked position and a locked position, wherein the fixing element includes a ridge configured to fit in one of the annular grooves when the fixing element is in the locked position, wherein, in the unlocked position, the fixing element allows the proximal tubular member to move at least partially in and out of a channel of the distal tubular member, and wherein, in the locked position, the fixing element fixes a position of the proximal tubular member relative to the distal tubular member.

18. The visualization instrument holder device of claim 17, further comprising a biasing member positioned around the proximal tubular member, within the channel, and between the proximal tubular member and the distal tubular member, wherein the biasing member is configured to bias the proximal tubular member relative to the distal tubular member.

19. The visualization instrument holder device of claim 18, further comprising a biasing member positioned between the fixing element and the distal tubular member, wherein the biasing member is configured to bias the fixing element toward the locked position.

20. The visualization instrument holder device of claim 1 wherein the instrument lock includes an aperture extending substantially perpendicular to the passageway, and wherein the visualization instrument holder device further comprises a set screw configured to extend through the aperture and clamp the visualization instrument in the passageway.

21. The visualization instrument holder device of claim 1 wherein the curved surface includes a plurality of apertures configured to, while the pivot presses against thepatient’s skin, receive a portion of the patient’s skin and thereby provide improved positional stability for the visualization instrument holder device.

22. The visualization instrument holder device of claim 1 wherein the curved surface corresponds to a spherical segment.

23. The visualization instrument holder device of claim 1 wherein the curved surface comprises a cutout section.

24. The visualization instrument holder device of claim 1 wherein the tubular device includes a plurality of spaced apart positioning features each configured to define a respective position of a telescopic lock.

25. The visualization instrument holder device of claim 24, further comprising a telescopic lock including a gripping element configured to be receive a respective one of the positioning features.

26. The visualization instrument holder device of claim 24 wherein the positioning features are annular channels or grooves.

27. An endoscope holder device comprising: a tubular device having a proximal end and a distal end, wherein the tubular device includes an endoscope-receiving passageway extending therethrough, wherein the endoscope-receiving passageway is configured to receive an endoscope; a pivot coupled to the distal end of the tubular device and having a curved surface configured to allow the tubular device to roll about a port in a patient’s skin while the endoscope extends along the endoscope-receiving passageway into the port; andan endoscope lock configured to fixedly hold the endoscope positioned in the endoscope-receiving passageway of the tubular device.

28. The endoscope holder device of claim 27 wherein the endoscope lock is configured to prevent axial movement of the endoscope relative to the tubular device.

29. The endoscope holder device of claim 27 wherein the tubular device is movable from an extended configuration to a compressed configuration to advance the endoscope held by the endoscope lock into the patient.

30. The endoscope holder device of claim 27 wherein the tubular device includes a set of telescoping tubular members movable relative to one another to move the endoscope lock relative to the curved surface.31 . The endoscope holder device of claim 27 wherein the tubular device includes a telescoping lock configured to lock at least one telescoping component of the tubular device.

32. The endoscope holder device of claim 27, further comprising a telescopic lock configured to prevent or allow telescoping of the tubular device while the endoscope lock holds the endoscope.

33. The endoscope holder device of claim 27 wherein the tubular device includes at least one biasing element that biases the tubular device in a compressed configuration toward an extended configuration.

34. The endoscope holder device of claim 33 wherein the tubular device includes an inner tubular member and an outer tubular member, wherein at least a portion of the at least one biasing element is positioned between a thinned-walled region of the inner tubular member and the outer tubular member.

35. The endoscope holder device of claim 33 wherein the at least one biasing element includes a spring held between a distal shoulder of the pivot and a proximal shoulder of the tubular device.

36. The endoscope holder device of claim 27, further comprising a first member of the tubular device, a telescoping lock configured to hold the first member, a second member of the tubular device connecting the telescoping lock to the pivot, and at least one biasing member held between a first shoulder of the first member and a second shoulder of the second member.

37. The endoscope holder device of claim 27 wherein the tubular device has a plurality of extended configurations and includes a lock movable from a locked configuration for holding the tubular device at one of the extended configurations and an unlocked configuration allowing the tubular device to move between the extended configurations.

38. The endoscope holder device of claim 37 wherein the tubular device has annular features defining respective ones of the extended configurations.

39. The endoscope holder device of claim 37 wherein the tubular device is configured to extend and contract while the endoscope lock holds the endoscope so as to adjust a depth of penetration of the endoscope.

40. The endoscope holder device of claim 27 wherein the tubular device includes: a distal tubular member coupled to the pivot; a proximal tubular member telescopically disposed within the distal tubular member and slidable along the distal tubular member to adjust a length of the tubular device; and a telescopic lock including a slider movable between an unlocked position for allowing the proximal tubular member to slide along the distal tubular member and alocked position for holding the proximal tubular member translationally fixed relative to the distal tubular member.41 . An endoscope holder device comprising: a telescoping tubular assembly including: an endoscope-receiving passageway, an endoscope lock configured to fixedly hold an endoscope positioned in the endoscope-receiving passageway, and a telescoping lock having a locked state for locking the telescoping tubular assembly to hold the endoscope and an unlocked state for allowing extension and compression of the telescoping tubular assembly to move the endoscope toward or away from a working space in a patient; and a pivot coupled to the telescoping tubular assembly and configured to allow the telescoping tubular assembly to roll about a port in the patient’s skin while the endoscope extends along the endoscope-receiving passageway into the port.

42. The endoscope holder device of claim 41 wherein the telescoping lock in the locked state is configured to hold the endoscope translationally fixed relative to a working space while the pivot allows the endoscope to pivot relative to the patient’s body.

43. The endoscope holder device of claim 41 wherein the telescoping tubular assembly is configured to extend to move the endoscope lock and the telescoping lock away from each other and to contract to move the endoscope lock and the telescoping lock toward each other.

44. The endoscope holder device of claim 41 wherein the telescoping lock is configured to lock the telescoping tubular assembly at a plurality of different lengths.

45. The endoscope holder device of claim 41 wherein the telescoping tubular assembly includes a biasing member configured to cause the telescoping tubular assembly to move the endoscope away from a working space in the patient when the telescoping lock is in the unlocked state.

46. A surgical kit comprising: a plurality of multi-portal surgical instruments; and an instrument holder device including: a tubular device having a proximal end, a distal end, and a passageway extending therethrough, wherein the passageway is configured to receive one or more of the multi-portal surgical instruments, a pivot coupled to the distal end of the tubular device, wherein the pivot has a curved surface configured to allow the tubular device to roll about a port in a patient’s skin while the received one or more of the multi-portal surgical instruments extends through the tubular device into the port, and an instrument lock configured to hold the one of the multi-portal surgical instruments in the passageway of the tubular device.

47. The surgical kit of claim 46, wherein the instrument holder device is the holder device of one of claims 1-45.

48. A method for holding a visualization instrument adjacent to an implantation site in a patient, the method comprising: inserting a visualization instrument into a visualization instrument holder device such that a distal end of the visualization instrument is positioned adjacent to an implantation site of a patient, wherein the visualization instrument holder device comprises: an instrument lock defining an opening;a distal tubular member having a first distal end coupled to the instrument lock, wherein the distal tubular member includes a channel extending therethrough; and a pivot coupled to a second distal end of the distal tubular member opposite the first distal end, wherein inserting the visualization instrument into the visualization instrument holder device comprises inserting the visualization instrument through the opening and the channel; fixing, via the instrument lock, a position of the visualization instrument relative to the visualization instrument holder device; and pivoting, via the pivot, the distal tubular member about the second distal end and against the patient, thereby adjusting a position of the distal end of the visualization instrument relative to the implantation site.

49. The method of claim 48 wherein the device further comprises: a proximal tubular member coupled between the instrument lock and the distal tubular member, wherein the proximal tubular member includes a plurality of annular grooves; and a fixing element including a ridge configured to fit in one of the annular grooves, wherein the method further comprises: moving the fixing element from a locked position in which the ridge is positioned in a first one of the annular grooves to an unlocked position in which the ridge is not positioned in any of the annular grooves; moving the proximal tubular member at least partially in or out of the channel of the distal tubular member; and moving the fixing element from the unlocked position to the locked position such that the ridge is positioned in a second one of the annular grooves.

50. The method of claim 49 wherein the device further comprises a biasing member positioned between the proximal tubular member and the distal tubular member, wherein moving the proximal tubular member at least partially in or out of the channel of thedistal tubular member comprises allowing the biasing member to move the proximal tubular member relative to the distal tubular member.

51. The method of claim 49 wherein the device further comprises a biasing member positioned between the distal tubular member and the fixing element, and wherein moving the fixing element from the unlocked position to the locked position comprises allowing the biasing member to move the fixing element to the locked position.

52. The method of claim 48 wherein the instrument lock includes an aperture extending substantially perpendicular to the opening, wherein the device further comprises a set screw, and wherein the method further comprises: positioning the set screw through the aperture of the instrument lock; and clamping the visualization instrument in the opening of the instrument lock.

53. The method of claim 48 wherein the pivot includes a curved surface including a plurality of apertures, and wherein the method further comprises determining a position of the pivot relative to the patient by viewing the patient’s skin through the plurality of apertures.

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