Method and devices for minimally invasive arthroscopic procedures

Abstract

A surgical device is provided, the device having a tubular outer body member with a handle at its proximal end and a flexible distal end segment extending from its distal end. The surgical device also has an operable end extending from the distal end of the flexible distal end segment. The device is configured for selectively causing the flexible end segment to bend to adopt a desired curvature and for selectively rotating the operable end relative to the flexible distal end segment about an axis of the flexible distal end segment.

What is claimed is: 
     
         1 . A device for diagnostic or surgical procedures comprising:
 a tubular outer body member having a proximal end and a distal end;   a handle attached to the proximal end of the outer body member;   a flexible distal end segment extending from the distal end of the outer body member, the flexible distal end segment having an axial end segment passage formed therethrough;   a rotation control member comprising:
 an extension tube portion rotatably disposed within the outer body member and 
 a flexible drive shaft portion attached to and extending distally from a distal end of the extension tube portion for rotation therewith, at least a portion of the flexible drive shaft portion being rotatably and slidably disposed within the axial end segment passage so as to take on a profile of the flexible distal end segment; and 
   an operable end attached at a distal end of the flexible drive shaft portion for rotation therewith, the flexible drive shaft being selectively rotatable to establish a desired rotational orientation of the operable end.   
     
     
         2 . The device of  claim 1  wherein the flexible distal end segment comprises a plurality of vertebrae. 
     
     
         3 . The device of  claim 2  wherein the plurality of vertebrae are interconnected by an integral web. 
     
     
         4 . The device of  claim 3  wherein the vertebrae and web are integrally formed as a single member. 
     
     
         5 . The device of  claim 1  wherein the extension tube portion is operably connected to a rotation control mechanism housed in the handle, the rotation control mechanism being configured to allow selective rotation of the extension tube portion, the flexible drive shaft portion and the operable end while the flexible distal end segment remains fixed. 
     
     
         6 . The device of  claim 1  further comprising:
 first and second cables disposed so that a first portion of each cable is disposed within the outer body member and a second portion of each cable is disposed within the flexible distal end segment, each cable having a distal end attached to an attachment point of the flexible distal end segment on its outer surface adjacent its distal end, the attachment points of the first and second cables being diametrically opposed so that when tensile forces are applied to one or both of the cables, a difference in the tensile force applied to the two cables causes the flexible distal end segment to bend. 
 
     
     
         7 . The device of  claim 1  further comprising:
 bending means attached to the flexible distal end segment for selectively bending the flexible distal end segment to a desired bending profile. 
 
     
     
         8 . The device of  claim 7  further comprising:
 profile locking means for locking the flexible distal end segment in the desired bending profile. 
 
     
     
         9 . The device of  claim 1  further comprising:
 wherein the flexible distal end segment comprises 
 an exterior flexible member attached to the distal end of the outer body member, the exterior flexible member having an exterior member axial passage formed therethrough, and 
 an interior flexible member having proximal and distal ends and defining the axial end segment passage, at least a portion of the interior flexible member being disposed within the exterior flexible member so as to take on a profile of the exterior flexible member, 
 
     
     
         10 . The device of  claim 9  wherein the interior flexible member is configured so that when the flexible distal end segment is bent, the distal end of the interior flexible member engages a surface of the operable end and the proximal end of the interior flexible member engages a surface of the rotation control member. 
     
     
         11 . The device of  claim 10  wherein the interior flexible member is further configured to transmit a compression load from the operable end to the rotation control member when the operable end is operated. 
     
     
         12 . The device of  claim 10  further comprising:
 a biasing arrangement including a spring in engagement with the rotation control member and the tubular outer body member to bias the rotation control member in a proximal direction relative to the tubular outer body member. 
 
     
     
         13 . The device of  claim 9  wherein the interior flexible member is a flat coil spring. 
     
     
         14 . The device of  claim 13  wherein the biasing arrangement and the rotation control member are sized and configured so as to cause the operable end to maintain engagement with the distal end of the exterior flexible member through a predetermined range of flexible end segment bending profiles. 
     
     
         15 . The device of  claim 9  wherein the exterior flexible member comprises a plurality of vertebrae. 
     
     
         16 . The device of  claim 9  further comprising:
 first and second cables disposed so that a first portion of each cable is disposed within the outer body member and a second portion of each cable is disposed within the flexible distal end segment, each cable having a distal end attached to an attachment point of the exterior flexible member on its outer surface adjacent its distal end, the attachment points of the first and second cables being diametrically opposed so that when tensile forces are applied to one or both of the cables, a difference in the tensile force applied to the two cables causes the exterior flexible member to bend. 
 
     
     
         17 . A method of performing a surgical procedure within a confined body cavity of a patient using a surgical device having a tubular outer body member with a handle at its proximal end and a flexible distal end segment extending from its distal end and having an operable end extending from the distal end of the flexible distal end segment, the device being configured for selectively causing the flexible end segment to bend to adopt a desired curvature, and for selectively rotating the operable end relative to the flexible distal end segment about an axis of the flexible distal end segment, the method comprising:
 placing the flexible end segment into a straight configuration;   inserting the operable end and at least a portion of the flexible end segment into the body cavity;   linearly translating the operable end to a desired location within the body cavity;   adjusting the curvature of the flexible end segment to establish an engagement angle of the operable end relative to the outer body of the device;   rotating the operable end about an axis of the flexible end segment to establish a desired operable end rotational angle; and   operating the operable end to perform a surgical function with respect to a target tissue within the body cavity.   
     
     
         18 . A method according to  claim 17  wherein the surgical function is selected from the set consisting of viewing, imaging, grasping, resecting, ablating, and manipulating the target tissue. 
     
     
         19 . A method according to  claim 17  further comprising:
 rotating the surgical device about an axis of the outer body member. 
 
     
     
         20 . A method according to  claim 17  further comprising:
 returning the flexible end segment to the straight configuration; and 
 withdrawing the operable end at the at least a portion of the flexible end segment from the body cavity. 
 
     
     
         21 . A method according to  claim 17  wherein the body cavity is a hip capsule of the patient.