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Claims  |
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What is claimed is:
1. A surgical device comprising:
a base unit;
an elongated guide stem having a passage therein, a ball attached to one
end of the guide stem, said ball having a passage therein, said ball
fitting within the base unit, said ball capable of rotating with respect
to the base unit;
a guide stem cable mount associated with said guide stem; and
a cable having an end attached to said guide stem cable mount such that
moving the cable moves the guide stem.
2. The surgical device of claim 1, wherein the base unit includes a recess
for receiving a cable.
3. The surgical device of claim 1, further comprising a locking member
which engages the ball and fixes the position of the ball and guide stem
upon tightening the locking member when the ball is properly positioned.
4. The surgical device of claim 1, further comprising a locking member
which engages the ball and fixes the position of the ball and guide stem
upon tightening the locking member when the ball is properly positioned,
said locking member having at least one slot therein through which the
cable passes.
5. The surgical device of claim 1, further comprising a positioning stem,
said positioning stem having an end which fits into the passage within the
guide stem, said positioning stem having a locator visible in a scanning
environment.
6. The surgical device of claim 1 wherein the guide stem cable mount is
attached to the guide stem.
7. The surgical device of claim 1 further comprising a surgical instrument
advancement assembly.
8. The surgical device of claim 7 further comprising a sleeve placed over
the guide stem between the base and the surgical instrument advancement
assembly, said sleeve placing the surgical instrument advancement assembly
in position to engage the guide stem.
9. The surgical device of claim 7 wherein the surgical instrument
advancement assembly further comprises:
a guide stem mounting block;
a surgical instrument lock;
a cable for moving the surgical instrument lock with respect to the guide
stem mounting block.
10. The surgical device of claim 9 wherein the surgical instrument
advancement assembly further comprises
a thumb ring attached at one end of the cable;
a finger ring attached near the end of the cable having the thumb ring
attached thereto, wherein the surgical instrument lock moves with respect
to the guide stem mounting block in response to the thumb ring moving with
respect to the finger ring.
11. The surgical device of claim 9 wherein the guide stem has a groove
therein near the opposite end distant from the ball end, said surgical
device further comprising a sleeve placed over the guide stem between the
guide stem cable mount and the surgical instrument advancement assembly,
said guide stem mounting block including a portion which engages the guide
stem, said sleeve placing the guide stem mounting block a selected
distance away from the locking member.
12. A surgical apparatus comprising:
a first base unit;
a first elongated guide stem having a passage therein, a ball attached to
one end of the guide stem, said ball having a passage therein, said ball
fitting within the first base unit, said ball capable of rotating with
respect to the first base unit;
a first guide stem cable mount associated with said first elongated guide
stem;
a second base unit;
a second elongated guide stem having a passage therein, a ball attached to
one end of the guide stem, said ball having a passage therein, said ball
fitting within the second base unit, said ball capable of rotating with
respect to the second base unit;
a second guide stem cable mount associated with said second elongated guide
stem; and
a cable connected at one end to the first guide stem cable mount and
connected at the other end to the second guide stem cable mount, wherein
the first elongated guide stem moves in response to moving the second
elongated guide stem.
13. The surgical apparatus of claim 12 wherein at least a portion of said
apparatus is used in an imaging environment, said cable made of a material
which is compatible in the imaging environment.
14. The surgical apparatus of claim 12 wherein said cable is a filament.
15. The surgical apparatus of claim 12 wherein said first base unit has a
recess for receiving said cable and said second base unit has a recess for
receiving said cable, said recesses acting as a cable guide.
16. The surgical apparatus of claim 12 further comprising a plurality of
cables, each of said cables connected at one end to the first guide stem
cable mount and connected at the other end to the second guide stem cable
mount, wherein said first base unit has a plurality of recesses for
receiving said plurality of cables and said second base unit has a
plurality of recesses for receiving said plurality of cables, said
recesses acting as a cable guides.
17. The surgical apparatus of claim 16 further comprising:
a first locking member for fixing the position of the first elongated guide
stem with respect to the first base unit; and
a second locking member for fixing the position of the second elongated
guide stem with respect to the second base unit, said first locking member
and said second locking member having slots therein to accommodate the
plurality of cables.
18. The surgical apparatus of claim 12 further comprising:
a first locking member for fixing the position of the first elongated guide
stem with respect to the first base unit; and
a second locking member for fixing the position of the second elongated
guide stem with respect to the second base unit.
19. The surgical apparatus of claim 12 wherein
one of said first base unit and first elongated guide stem, or said second
base unit and second elongated guide stem is located in an imaging
environment, and
the other of said first base unit and first elongated guide stem, or said
second base unit and second elongated guide stem is located outside an
imaging environment.
20. The surgical apparatus of claim 19 further comprising:
a surgical instrument to be passed into the body of a patient associated
with the one of said first base unit and first elongated guide stem, or
said second base unit and second elongated guide stem is located in an
imaging environment; and
a surgical instrument advancement assembly.
21. The surgical apparatus of claim 20 wherein the surgical instrument
advancement assembly further comprises:
a guide stem mounting block for mounting on the elongated guide stem;
a surgical instrument lock;
a cable for moving the surgical instrument lock with respect to the guide
stem mounting block.
22. The surgical apparatus of claim 21 wherein the surgical instrument
advancement assembly further comprises
a thumb ring attached at one end of the cable; and
a finger ring attached near the end of the cable having the thumb ring
attached thereto, wherein the surgical instrument lock moves with respect
to the guide stem mounting block in response to the thumb ring moving with
respect to the finger ring.
23. The surgical apparatus of claim 22 further comprising the surgical
instrument advancement assembly further comprises a sleeve between the
thumb ring attached at one end of the cable and the finger ring attached
near the end of the cable, wherein the sleeve has markings thereon
corresponding to the movement instrument lock moves with respect to the
guide stem mounting block.
24. The surgical apparatus of claim 21 wherein said surgical instrument
lock further comprises:
an elastomeric sleeve positioned around the surgical instrument;
a first substantially inelastic end; and
a second substantially inelastic end, wherein drawing the first end toward
the second end causes the elastomeric sleeve to engage the surgical
instrument.
25. The surgical apparatus of claim 22 further comprising a surgical
instrument advancement lock for locking the position of the surgical
instrument with respect to the guide stem.
26. The surgical apparatus of claim 25 further comprising:
an L-shaped surgical instrument advancement lock; and
a locking pin for holding the advancement lock in place.
27. A method for introducing a surgical instrument into the body of a
patient, said patient positioned in a scanning environment, said method
comprising the steps of:
selecting a target within a patient;
attaching a first base and first movable elongated guide stem to the
patient;
connecting the first base and first movable elongated guide stem to a
second base and second movable elongated guide stem using cables;
placing a positioning stem within the guide stem, said positioning stem
having a first portion readable within the scanning device and a second
portion readable within the scanning environment; and
moving a second elongated guide stem with respect to the second base, said
second base and said second movable elongated guide stem positioned
outside the scanning environment, wherein moving the second elongated
guide stem with respect to the second base causes movement of the first
movable elongated guide stem with respect to the first base.
28. The method of claim 27 further comprising the steps of:
aligning a passage in the first elongated guide stem with the target within
the patient; and
locking the first elongated guide stem with respect to the first base.
29. The method of claim 28 further comprising the steps of:
replacing the positioning stem with a surgical instrument at the first
guide stem; and
introducing the surgical instrument into the patient.
30. The method of claim 29 further comprising the steps of:
locking the surgical instrument into a position with respect to the guide
stem. |
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Claims |
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Description |
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FIELD OF THE INVENTION
The present invention is related to surgical working platforms. More
specifically, the present invention relates to a working platform and
method for using the same which facilitates the alignment of surgical and
observational instruments into a patient.
BACKGROUND OF THE INVENTION
In the treatment of some diseases or defects associated with a patient, it
has been found necessary to access specific targets within a patient. In
the treatment of some diseases of or defects of human beings, it has been
found necessary to access specific portions of the brain. Currently there
are several methods for inserting surgical and observational instruments
into a patient's brain.
U.S. Pat. No. 3,055,370 issued to McKinney et al. shows one currently used
method for placing a surgical instrument to access a specific portion of
the brain. The surgical instrument of the '370 patent includes a ball
which has a bore. The direction of the bore can be changed. The instrument
has an elongated tube of a specific length. A stylet is inserted within
the tube to access the globus pallidus and perform a pallidotomy. An
opening or burr hole is made in the skull at a specific landmark on the
skull. Next, X-rays are taken in the fore-and-aft (AP) and lateral
positions, and the line of the bar is projected downwardly by a ruler both
in the fore-and-aft (AP) and lateral positions, so that the direction of
the needle can be determined before it is inserted. When the direction of
the longitudinal axis of the tubular member is determined to be
satisfactory, a holder is threaded further into a tap to force a surface
against a ball and lock a tubular member into place. Alignment of the
trajectory is not measurable along a specific line occurring at the
intersection of two planes. Alignment is dependent on placement of the
burr hole at a specific location to determine one plane. X-rays are used
to determine another plane-based use of common landmarks on the skull. The
end result is that an educated guess is being used to position the stylet
at the globus pallidus for the pallidotomy. One shortcoming with the
method of using X-ray imaging to direct a surgical or observational
instrument, is that many of the destinations within a patient are not
viewable via X-ray. Another shortcoming relates to the slight shifting of
intracranial contents, once a burr hole is placed and the dura and
arachnoid are penetrated. Once cerebrospinal fluid is released via the
burr hole, the intracranial contents (i.e. brain) may shift one or more
millimeters. In such a case, the calculated trajectory is no longer
accurate. Hence, there is an inherent inaccuracy with the described
scheme.
Several other methods are also used to place instruments, catheters, or
observational tools into patients. Currently, surgical procedures are
performed through craniotomy flaps or craniotomy burr holes. A burr hole
of about 14 mm is made in the skull. Needles or probes are typically
passed through the burr hole into the brain using framed stereotaxy,
frameless stereotaxy or freehand without stereotaxy.
The freehand method depends very heavily on the knowledge and judgment of
the surgeon. In the freehand method, the surgeon determines the insertion
point with a couple of measurements from a known landmark. The surgeon
then looks at the measured point, makes adjustments, determines the angle
of insertion and then inserts the surgical instrument or tool.
In framed stereotaxy, a ring frame is mounted to the patient's skull by
multiple (typically three or four) pins or screws. This ring frame is used
to determine a three dimensional data set. From this data set, Cartesian
coordinates are calculated for both the lesion, the location of the pins
or screws, and the fiducial marks on the frame. The ring frame fits into a
large frame. A large frame is then attached to the patient in the
operating suite. The large frame provides known positions and guides the
surgical or observational instruments. The large frame is used to position
the instrument to be introduced into the patient through a burr hole so
that it intersects the target. In frameless stereotaxy, the ring frame is
replaced with several markings on the patient's skull which can be used to
determine several known positions. The large frame is replaced by a
camera. The camera is usually infrared or some such device. Multiple
sensors readable by the camera are placed on the instrument. For example,
the surgical instrument or tool is provided with one or more light
emitting diodes ("LEDs") which are tracked by the camera. The position of
the surgical instrument can be calculated from the information from the
LEDs on the surgical instrument or observational tool.
U.S. Pat. No. 4,955,891 and U.S. Pat. No. 4,805,615, both issued to Carol,
each discuss the use of stereotaxy surgery with computerized tomographic
("CT") scanning. CT scanning is used to determine the exact position of a
lesion or specific portion of the brain. After the exact position of the
lesion or specific portion of the brain is determined, a phantom fixture
is set up. The phantom fixture replicates the position of the ring frame
on the patient. A phantom target is set up. The instrument can then be
positioned on the phantom such that it intersects the target. The
information from the phantom can then be used in actually positioning the
instrument in the operating suite.
U.S. Pat. No. 4,998,938 issued to Ghajar et al. shows another surgical
device for facilitating the insertion of an instrument into a patient's
cranial cavity through a burr hole. The device includes a guide having an
end configured to pass into the burr hole. There is a separate locking
member. A body member includes alignment markings to help with insertion
of a catheter or stylet. Unlike the '370 patent, there is no movable
member for adjusting the path of the guide.
The methods currently in use all have a number of shortcomings. Most of the
techniques currently used to place a surgical instrument or observational
tool within a patient employ a limited amount of accuracy. In particular,
current framed, frameless, and freehand methods compute or predict
trajectories on the basis of imaging data or anatomic landmarks that do
not account for the slight, but real shifting of the brain upon opening
the cranium and meninges to the level of the subarachnoid space. This
inherent inaccuracy inherently limits the success of these various
methodologies. In other words, these systems do not use any means of
updating the data files to include data obtained following the placement
of a surgical burr hole and opening of the meninges. In addition, all the
methods require large amounts of judgment on the part of the surgeon
placing the surgical instrument or tool, and in particular, offer no
direct feedback on the success or failure of the trajectory to reach the
target. Very few of the techniques use an imaging or scanning apparatus to
aid in the placement of the surgical instrument or observational tool. The
only one that does requires a phantom frame and target to be set up to
simulate the real geometry. In short, none of the apparatuses appear to
use an imaging or scanning apparatus as extensively as they could be used
to minimize the time and effort needed to accurately place a surgical
instrument into a patient, and to offer immediate data on the success or
failure of the trajectory to reach the target.
Still another disadvantage is that the apparatuses used today are not
remotely controlled or actuated. In some operating environments, the
patient is not accessible to the surgeon. Therefore, it is advantageous to
have remote control of the tool. One such environment is within an MR
magnet associated with an MR operating suite. When the patient is in an
open magnet, the surgeon may have direct access to the patient. When in a
closed magnet, the surgeon probably will not have such direct access to
the patient.
SUMMARY OF THE INVENTION
A surgical method and apparatus for accurately aligning the trajectory of,
guiding of, and introducing or withdrawal of an instrument is disclosed.
The apparatus includes a base which has a movable member movably attached
to the base. The movable member has a passage therein which forms a
portion of the trajectory path. The movable member also includes a guide
stem which has an opening therein. The guide stem is attached to said
movable member such that the opening in the guide stem substantially
aligns with the passage in the movable member. The movable member can
include either an integral guide stem for holding the positioning stem or
a removably attached guide stem. In the case of the former, a positioning
stem is inserted into the opening of the guide stem for purposes of
trajectory alignment. In the case of the latter, the removably attached
guide stem can be removed and replaced with a positioning stem.
A positioning stem further includes a first locator and a second locator.
The first and second locators are associated with two different portions
of the positioning stem so that they are essentially two points on a line.
The first and second locators are also locatable by a scanning or imaging
system. The positioning stem is either inserted into the guide stem that
is integral to the movable member, or is removably attached to said
movable member and used to position the movable member. Moving the
positioning stem while either within the guide stem or removably attached
to the movable member also moves the passage therein to different
trajectories. Once the passage within the movable member more or less is
aligned with a target within the body, a locking member locks the movable
member into a fixed position.
In one embodiment the first locator and the second locator are readable by
a magnetic resonance imaging apparatus. The locator can include a fluid
readable by a magnetic resonance imaging apparatus or a source of radio
frequency, such as a coil, which is readable by a magnetic resonance
imaging apparatus. In the latter embodiment, the first and second locators
may be small radio frequency (RF) coils that detect an electromagnetic
signal in a magnetic resonance imaging environment. The electromagnetic
signal detected can be used to locate the first and second locators. The
line formed by the first locator and the second locator may be
substantially aligned with the centerline of the passage in the movable
member or may be offset from the centerline of passage in the movable
member. In other embodiments, the first and second locators may be light
emitting diodes which are readable by an infrared camera.
The first and second locators may be located within an essentially solid
plastic positioning stem, or in another embodiment, the first and second
locators may be located within an MR-visible chamber within the
positioning stem. In the latter embodiment, the chamber may be filled with
an MR-visible fluid (paramagnetic, for example), which can be used to
afford a first approximation of alignment. The first and second locators
may be either MR-visible (different than the MR-visible chamber) or may be
MR-invisible, in which case they would exhibit a negative image against
the background of the MR-visible fluid within the larger chamber of the
positioning stem. Advantageously, the fluid in the chamber produces an
image which can be easily located and can be used to roughly align the
positioning stem. The MR-visible or MR-invisible fluid of the first and
second locators can then be used for fine or precise alignment.
In the embodiment where the guide stem and positioning stems are removably
attached to the movable member, the movable member can include a threaded
opening which receives either the guide stem or the positioning stem. In
this embodiment where the guide stem is interchangeable with the
positioning stem, one end of both the guide stem and positioning stem is
threaded. A portion of the passage in the movable member has internal
threads for receiving the threaded end of either the guide stem or the
positioning stem. In the embodiment where the guide stem is formed as part
of the movable member, the positioning stem fits within the opening in the
guide stem. The movable member is a ball capable of swiveling with respect
to the base.
In another embodiment, the movable member may also include a stage which
allows for planar movement in a direction intersecting the trajectory. A
surgical instrument, such as a needle, probe (cryotherapy probe, laser
probe, RF ablation probe, microwave interstitial therapy probe, or
focussed ultrasound therapy probe), catheter, endoscope, or electrode, can
then be inserted through the movable member and the opening in said guide
stem to guide the instrument toward the target position within the
patient. In this embodiment, it is possible to reposition the surgical
instrument without altering the trajectory itself, by first withdrawing it
from the targeted tissue and then adjusting the stage in a direction
intersecting the trajectory.
It is advantageous to have the trajectory guide operable from a remote
location. Among the advantages is that the patient will not have to be
moved in and out of an environment in order to make adjustments to the
trajectory guide. Adjustments or use of the trajectory guide does not have
to be interrupted when used in an environment where a surgeon or
technician does not have access to the trajectory guide on the patient.
This shortens the time spent for the surgical procedure which is
appreciated by both the surgeon or technician as well as the patient. It
should also be noted that the trajectory guide is also adaptable to other
environments such as for use in a CT scan environment. In CT scanning,
x-radiation is used in order to form the images. Overexposure to x-rays is
harmful to patients who are undergoing procedures. Overexposure to x-rays
is a concern to surgeons or technicians who perform these procedures.
Therefore, it is advantageous to have the capability to maneuver the
trajectory guide from a remote location so that the procedure can be done
in a shorter amount of time and so that the physicians and technicians
that may be using the trajectory guide can keep exposure to various
imaging environments to a minimum.
In a first preferred embodiment of a remotely controlled trajectory guide,
there is the actual trajectory guide and a remote trajectory guide. The
remote trajectory guide is a duplicate of the actual trajectory guide. The
remote trajectory guide has the same look and feel as the actual
trajectory guide so that the surgeon or technician used to using the
actual guide can move the remote guide as if it was the actual guide
attached to the patient. The objective is to make the movement of the
remote feel as though it was the actual guide. In this way, once the
physician surgeon or the technician learns to use the actual guide they do
not have to learn how to use the remote device. In the first embodiment,
the tilt or trajectory defined by the trajectory guide and the advancement
and of the surgical instrument is provided for by using a mechanical
device using a cable or filament.
In a second preferred embodiment of a remotely controlled trajectory guide,
a first hydraulic cylinder and a second hydraulic cylinder control
actuators which may be used to position the positioning member. Once so
positioned and after the movable member locked is locked, thereby also
locking in the trajectory, the first and second hydraulic cylinder control
actuators may be removed. A third hydraulic cylinder and actuator may then
be used to control the insertion or withdrawal of an instrument. The
hydraulic cylinders are especially useful for positioning the movable
member and inserting or withdrawing the instrument when the patient is
positioned remotely from the surgeon. Although many scanning devices allow
access to a patient, there are many styles of scanning devices that do not
allow access to the patient during a scanning operation. For example, in
an MRI type scanning device, the magnet producing the magnetic field can
be of several shapes. Some of the magnets are shaped such that a patient
must be positioned out of reach of the surgeon in order to be within the
homogeneous imaging volume of the magnetic field during a scanning
operation.
In operation, a target within a patient is initially selected. A surgical
opening into the body is made and the base is inserted into and surgically
secured to the opening. The movable member and outer locking ring are also
removably attached to the base. The positioning stem is then used to move
the movable member and the passage therein to form a trajectory toward the
target. The first locator portion and the second locator portion are read
by the scanning device to determine the trajectory represented by the line
of the positioning stem. The positioning stem is moved until the line
represented by the positioning stem intersects the selected target. The
positioning stem can be moved manually or by using the first hydraulic
cylinder and actuator, and the second hydraulic cylinder and actuator. The
line of the positioning stem may also be offset from the target in an
alternate embodiment. Of course, the determination of the position of the
first and second portions of the positioning stem is performed at least in
part by the central processing unit and the memory of the scanning device.
Once alignment is indicated, the movable member is locked into position
which locks the trajectory represented by the positioning stem. The
positioning stem is then removed either from the guide stem that is
integral to the movable member, or, when the guide stem is not integral
with the movable member, from the movable member itself. In the latter
case, a guide stem is then attached to the movable member. The opening in
the guide stem and the substantially aligned passage in the movable member
form a trajectory in line with the selected target. The instrument is
passed therethrough.
The third hydraulic cylinder and associated actuator can be used to control
insertion or withdrawal of the instrument, if remote operation is
desirable. Insertion or withdrawal can also be done manually. In
situations where the target may be quite small, if the surgical
instrument, upon successfully reaching the quite small target, reveals
that the target selected, due to anatomic variance, is indeed not the true
target, repositioning of the surgical instrument can be made by means of a
slight offset. In such a situation, a stage can be moved so that a
parallel trajectory can be followed. In such a situation, it may be
advantageous and safer to employ a stage in order to minimize surgical
trauma to the tissues.
The opening within the movable member and guide stem (whether integral to
the movable member or removably attached) are designed to accommodate
surgical instruments and observational tools. As there is a wide variety
of different surgical instruments and observational tools, it is
anticipated that multiple movable members and guide stems with openings of
different diameter for such a wide array of surgical instruments and
observational tools will be employed. In addition, in the case of a guide
stem that is integral to the movable member, additional positioning stems
of similar diameters to fit appropriately into the guide stems will be
employed.
Advantageously, the scanning device used for diagnostic purposes can be
employed to place an instrument within the body of a patient. There is no
need for framed stereotaxy or unframed stereotaxy, two procedures which
require large amounts of time to perform. Procedures that formerly
required many hours can now be performed in substantially less amounts of
time with the trajectory guide. Time is saved over framed or unframed
stereotaxy since there is no need to spend time placing a frame onto the
patient or calculating the location of several selected points before the
actual introduction of a surgical instrument. The procedure is not only
quicker, but provides for real time feedback as the surgical instrument
progresses into the body. The computer associated with the scanning device
also calculates the trajectory to determine if the line defined by the
first locator and the second locator is collinear with the trajectory.
The surgical instrument can also be used in other applications without a
first and second locator. For example, the movable member with a passage
can be held by a clamp to guide catheters and other surgical instruments
into the human body. The clamp includes a pair of cups for holding the
movable member. The clamp is spring loaded so that it engages the movable
member when the clamp is not held open. Several of the clamps can be held
above a patient by individual snake devices or by a support bar that holds
a plurality of clamps. A plate that holds several movable members can also
be held above the patient or even attached to a patient to provide a
platform from which to pass one or more surgical instruments through
corresponding movable members. Such arrangements can be used for any type
of surgery where it is advantageous to use rigid or flexible type surgical
instruments, particularly as might be used in minimally-invasive surgical
procedures. The trajectory defined by the trajectory guide and the
advancement of the surgical instrument can be controlled from outside the
scanning environment.
BRIEF DESCRIPTION OF THE DRAWINGS
For a better understanding of the present invention, reference may be made
to the accompanying drawings in which:
FIG. 1 is a block diagram of a patient scanning system.
FIG. 2 is a side view of a patient on which the trajectory guide is being
used.
FIG. 3 is an exploded isometric view of the trajectory guide with a
removably attached guide member installed.
FIG. 4 is an exploded isometric view of the trajectory guide with a
removably attached positioning member installed.
FIG. 5a is a top view of the movable member or ball of the trajectory
guide.
FIG. 5b is a side view of the movable member or ball of the trajectory
guide.
FIG. 6a is a side view of the base of the trajectory guide.
FIG. 6b is a top view of the base of the trajectory guide.
FIG. 7a is a top view of the locking member of the trajectory guide.
FIG. 7b is a cutaway side view of the locking member of the trajectory
guide, along line 7b-7b of FIG. 7a.
FIG. 8 is an exploded view showing a stage for attachment to the base of
the trajectory guide.
FIG. 9 is a cutaway side view of another preferred embodiment of the
movable member of the trajectory guide and a positioning stem.
FIG. 10 is a side view of a hydraulic actuator used to move the guide stem
of the trajectory guide.
FIG. 11 is a top view of a guide stem of a trajectory guide having two
hydraulic actuators attached to the guide stem.
FIG. 12 is an isometric view of a first clamp for holding a hydraulic
cylinder.
FIG. 13 is an isometric view of a first clamp for holding a hydraulic
cylinder.
FIG. 14 is an exploded isometric view of the first clamp and the second
clamp for holding a hydraulic cylinder onto a surgical instrument and a
trajectory guide.
FIG. 15 is an attachment including a RF coil for the base.
FIG. 16 is a cap for the attachment shown in FIG. 15.
FIG. 17 is an side view of an alternate embodiment of a guide stem for the
trajectory guide.
FIG. 18 is view of an image as seen on a display of a nuclear magnetic
imaging system.
FIG. 19 is a remotely controlled actuator mechanism used to control
movement of the movable member associated with the patient.
FIG. 20 shows the set of intermediary hydraulic rams used to interconnect
the movable member associated with the patient and the movable member
associated with remote control.
FIG. 21 is a flow chart of the software program used to control movement of
the movable member.
FIG. 22 is a flow chart of the process for performing a surgical procedure
through a small opening within the body.
FIG. 23 is a top view of a surgical instrument for holding a movable
member.
FIG. 24 is a top view of a snake clamp for holding a movable member.
FIG. 25 is a top view of a platform or bar which holds a plurality of
surgical instruments.
FIG. 26 is a top view of a plate which includes a plurality of movable
members attached to a pair of ribs.
FIG. 27 is a top view of a surgical instrument designed to grip or be held
within a burr hole a patient's skull.
FIG. 28 shows a top view of a doublet instrument which is a combination of
the instrument of FIG. 23 and a combination of the instrument shown in
FIG. 27.
FIG. 29 shows a side view of a doublet instrument which is a combination of
the instrument of FIG. 23 and a combination of the instrument shown in
FIG. 27.
FIG. 30 shows a perspective view of a preferred embodiment of a mechanical
remotely actuated trajectory guide mechanism.
FIG. 31 is a perspective view of one of the first or second trajectory
guides used as part of the mechanical remotely actuated trajectory guide
mechanism shown in FIG. 30.
FIG. 32 is a top view of the base of the trajectory guide used as part of
the mechanical remotely actuated trajectory guide mechanism.
FIG. 33 is a side view of the guide stem of the trajectory guide used as
part of the mechanical remotely actuated trajectory guide mechanism.
FIG. 34 is a top view of the locking member of the trajectory guide used as
part of the mechanical remotely actuated trajectory guide mechanism.
FIG. 35 is a top view of the guide stem cable mount of the trajectory guide
used as part of the mechanical remotely actuated trajectory guide
mechanism.
FIG. 36 is an exploded perspective view of the mechanical remotely actuated
trajectory guide mechanism with the spacing sleeve for spacing the
surgical instrument advance mechanism up the guide stem.
FIG. 37 is an exploded perspective view of the surgical instrument advance
mechanism for use with the mechanical remotely actuated trajectory guide
mechanism.
FIG. 38 is a side view of a patient on which an externalizer and trajectory
guide are being used.
FIG. 39 is an exploded isometric view of the trajectory guide with an
externalizer and a removably attached guide member installed.
FIG. 40 is an exploded isometric view of the trajectory guide with an
externalizer and a removably attached positioning member installed.
FIG. 41a is a side view of the base of the trajectory guide.
FIG. 41b is a top view of the base of the trajectory guide.
FIG. 42 is an isometric view of another preferred embodiment of the
trajectory guide.
FIG. 43 is a block diagram of a computerized tomographic type patient
scanning system.
FIG. 44 is an isometric view of another preferred embodiment of the
trajectory guide having arched positioning bails.
FIG. 45 is an isometric view of yet another preferred embodiment of the
trajectory guide having arched positioning bails.
FIG. 46 is a flow chart indicating the steps in using the trajectory guide
in a CT scanning environment.
FIG. 47 is a side view of the positioning stem of the trajectory guide
which includes light-emitting diodes.
FIG. 48 is a top view of a burr hole extension apparatus.
FIG. 49 is a side view of the burr hole extension apparatus shown in FIG.
10.
FIG. 50 is a top view of another embodiment of the burr hole extension
apparatus.
FIG. 51 is an end view of a patient positioned within a magnet having a
body type trajectory guide attached thereto.
FIG. 52 is a side view of a patient positioned within a magnet having a
body type trajectory guide attached thereto.
FIG. 53 is a side view of a body type trajectory guide.
FIG. 54 is a cutaway side view of the body type trajectory guide.
FIG. 55 is a top view of the body type trajectory guide.
DESCRIPTION OF THE EMBODIMENT
In the following detailed description of the embodiment, reference is made
to the accompanying drawings which form a part hereof, and in which is
shown by way of illustration specific preferred embodiments in which the
invention may be practiced. These embodiments are described in sufficient
detail to enable those skilled in the art to practice the invention, and
it is to be understood that other embodiments may be utilized and that
structural, logical and electrical changes may be made without departing
from the spirit and scope of the present invention. The following detailed
description is, therefore, not to be taken in a limiting sense, and the
scope of the present invention is defined only by the appended claims.
This application incorporates the following U.S. applications by reference:
U.S. patent application Ser. No. 08/919,649 entitled "Surgical Instrument
Trajectory Guide Method and Apparatus", filed on Aug. 28, 1997;
U.S. patent application Ser. No. 08/856,664 entitled "Surgical Instrument
Trajectory Guide Method and Apparatus", filed on May 15, 1997; and
U.S. patent application Ser. No. 09/058,092 entitled "Trajectory Guide
Method and Apparatus for use in Magnetic Resonance and Computerized
Tomographic Scanners", filed on Apr. 9, 1998.
FIG. 1 is a block diagram of a patient scanning system 100. The specific
scanning system shown is for a magnetic resonance | | |
