Trajectory guide

Abstract

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. 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 removably attached to said movable member and used to position the movable member. Moving 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. The movable member can be moved to different trajectories using a first hydraulic system. A second hydraulic system can be used to introduce or withdraw an instrument to or from the patient. A mechanical advancement tool can be substituted for the second hydraulic system. The surgical instrument may also be provided with a remote portion for controlling the instrument from a remote location. The instrument can also be computer controlled.

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; and    a guide stem cable mount associated with said guide stem.    
     
     
         2 . The surgical device of  claim 1  further comprising a cable having an end attached to said guide stem cable mount such that moving the cable moves the guide stem.  
     
     
         3 . The surgical device of  claim 2 , wherein the base unit includes a recess for receiving a cable.  
     
     
         4 . The surgical device of  claim 2 , 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.  
     
     
         5 . The surgical device of  claim 2 , 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.  
     
     
         6 . The surgical device of  claim 2 , 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.  
     
     
         7 . The surgical device of  claim 1  wherein the guide stem cable mount is attached to the guide stem.  
     
     
         8 . The surgical device of  claim 2  further comprising a surgical instrument advancement assembly.  
     
     
         9 . The surgical device of  claim 1  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.  
     
     
         10 . The surgical device of  claim 8  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.  
 
     
     
         11 . The surgical device of  claim 10  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.  
 
     
     
         12 . The surgical device of  claim 10  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.  
     
     
         13 . 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.    
     
     
         14 . The surgical apparatus of  claim 13  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.  
     
     
         15 . The surgical apparatus of  claim 13  wherein said cable is a filament.  
     
     
         16 . The surgical apparatus of  claim 13  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.  
     
     
         17 . The surgical apparatus of  claim 13  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.  
     
     
         18 . The surgical apparatus of  claim 17  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.  
 
     
     
         19 . The surgical apparatus of  claim 13  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.  
 
     
     
         20 . The surgical apparatus of  claim 13  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.  
 
     
     
         21 . The surgical apparatus of  claim 20  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.  
 
     
     
         22 . The surgical apparatus of  claim 21  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.  
 
     
     
         23 . The surgical apparatus of  claim 22  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.  
 
     
     
         24 . The surgical apparatus of  claim 22  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 . The surgical apparatus of  claim 23  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.  
     
     
         28 . 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.    
     
     
         29 . The method of  claim 28  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.  
 
     
     
         30 . The method of  claim 29  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.  
 
     
     
         31 . The method of claim  30  further comprising the steps of: 
 locking the surgical instrument into a position with respect to the guide stem.