Systems, devices, and methods for accessing body tissue

Abstract

Systems, devices and methods to access and/or treat targeted body tissue (e.g., tendon tissue, ligament tissue, muscle tissue, bony tissue, and the like) under the guidance of ultrasound imaging equipment are described. Such systems can permit the intra-operative identification of the targeted tissue and the ability to deliver the appropriate instrumentation to that tissue.

1 . A system for treating body tissue under guidance of ultrasound instrumentation, the system comprising:
 a cannula to percutaneously access targeted tissue, the cannula comprising a distal tip portion that comprises echogenic material so as to be viewable by ultrasound imaging equipment;   an elongate working instrument that is insertable into a proximal opening of the cannula and through a distal opening of the cannula, the elongate working instrument comprising a working shaft that comprises a working tip to act upon the targeted tissue, the working tip comprising echogenic material so as to be viewable by ultrasound imaging equipment; and   a handheld driver unit having a powered actuator to drive the working tip of the elongate working instrument to act upon the targeted tissue, wherein the handheld driver unit is releasably securable to the cannula such that at least a portion of the elongate working instrument resides in the cannula.   
     
     
         2 . A system according to  claim 1 , wherein the cannula comprises an adjustable length such that the distance between the distal tip portion of the cannula and the handheld driver unit is adjustable. 
     
     
         3 . A system according to  claim 1 , wherein the cannula comprises an adjustable cross-sectional area. 
     
     
         4 . A system according to  claim 1 , wherein the cannula comprises a lateral width of about 12 gauge or less. 
     
     
         5 . A system according to  claim 1 , further comprising a trocar located within the cannula, wherein the trocar comprises a pointed tip protruding from the distal tip portion of the cannula. 
     
     
         6 . A system according to  claim 1 , wherein the working tip of the working instrument is selected from the group consisting of a drill tip, a chisel tip, a burr device, and a micro-augur device. 
     
     
         7 . A system according to  claim 1 , wherein the working shaft comprises an adjustable length, wherein the distance between the working tip and the proximal opening of the cannula is adjustable. 
     
     
         8 . A system according to  claim 1 , wherein the working shaft is smaller than an inner diameter of the cannula such that an outer lumen is defined between the working shaft and the inner diameter of the cannula. 
     
     
         9 . A system according to  claim 1 , wherein the working shaft comprises a hollow working shaft such that fluid can pass between a proximal port and a distal opening of the working shaft. 
     
     
         10 . A system according to  claim 1 , wherein the working shaft is smaller than an inner diameter of the cannula such that an outer lumen is defined between the working shaft and the inner diameter of the cannula, and the working shaft comprises a hollow working shaft such that fluid can pass between a proximal port and a distal opening of the working shaft. 
     
     
         11 . A system according to either of  claims 9  and  10 , wherein the working tip comprises a micro-auger. 
     
     
         12 . A method of ultrasound-guided percutaneous tenotomy, comprising:
 disposing an ultrasound transducer device over a portion of skin proximate to targeted tendon tissue;   monitoring under the guidance of ultrasound imaging equipment the insertion of an echogenic distal tip portion of a cannula toward the targeted tendon tissue;   releasably securing a handheld driver unit to a proximal portion of the cannula extending outside the skin such that an elongate working instrument coupled to the handheld driver unit resides at least partially in the cannula; and   viewing the ultrasound imaging equipment as a working tip at a distal end of a working shaft of the elongate working instrument acts upon the targeted tendon tissue.   
     
     
         13 . A method according to  claim 12 , wherein the cannula comprises an adjustable length, and wherein the method comprises adjusting the distance between the distal tip portion of the cannula and the handheld driver unit. 
     
     
         14 . A method according to  claim 12 , wherein the working shaft comprises an adjustable length, and wherein the method comprises adjusting the distance between the working tip and the proximal opening of the cannula. 
     
     
         15 . A method according to  claim 12 , wherein the working shaft is smaller than an inner diameter of the cannula such that an outer lumen is defined between the working shaft and the inner diameter of the cannula, and wherein the method comprises moving fluid through the outer lumen. 
     
     
         16 . A method according to  claim 12 , wherein the working shaft comprises a hollow working shaft such that fluid can pass between a proximal port and a distal opening of the working shaft, and wherein the method comprises moving fluid through the hollow working shaft. 
     
     
         17 . A method according to  claim 12 , wherein the working shaft is smaller than an inner diameter of the cannula such that an outer lumen is defined between the working shaft and the inner diameter of the cannula, and the working shaft comprises a hollow working shaft such that fluid can pass between a proximal port and a distal opening of the working shaft, wherein the method comprises moving fluid through the outer lumen and the hollow working shaft.