Devices and methods for percutaneous tissue retraction and surgery

Abstract

Methods and devices for performing percutaneous surgery in a patient are provided. A retractor includes a working channel formed by a first portion coupled to a second portion. The first and second portions are movable relative to one another from an unexpanded configuration to an expanded configuration to increase the size of the working channel along the length of the working channel while minimizing trauma to skin and tissue.

What is claimed is: 
     
       1. A kit for use in percutaneous surgery, comprising:
 a retractor having a working channel extending between a proximal end and a distal end of said retractor, said retractor having a first portion coupled to a second portion, said first and second portions movable relative to one another for engagement in an expanded configuration, wherein:
 said first portion and said second portion each include opposite edges extending between a proximal end and a distal end thereof; 
 said second portion includes an engagement surface extending along at least a portion of each of said opposite edges thereof; 
 in said unexpanded configuration said edges of said first portion extend around said second portion; 
 in said expanded configuration said opposite edges of said first portion engage adjacent ones of said engagement surfaces of said second portion; 
 
 an expansion instrument positionable in said working channel and engageable with said first portion and said second portion to move said first and second portions to said expanded configuration, wherein with said working channel in said expanded configuration said expansion instrument is positionable in said working channel to disengage said first and second portions for movement to an unexpanded configuration and 
 a series of tubular tissue dilators positionable one over the other to sequentially dilate bodily tissue, wherein said working channel of said retractor is sized for positioning about said tissue dilators when in an unexpanded configuration. 
 
     
     
       2. The kit of  claim 1 , wherein said first portion is pivotally coupled to said second portion at said proximal end of said retractor and said first and second portions are pivotal between said unexpanded configuration and said expanded configuration. 
     
     
       3. The kit of  claim 1 , wherein said expansion instrument is mountable on a proximal end of said retractor. 
     
     
       4. A kit for use in percutaneous surgery, comprising:
 a retractor having a working charnel extending between a proximal end and a distal end of said retractor, said retractor having a first portion coupled to a second portion in an unexpanded configuration, wherein said first and second portions are movable relative to one another for engagement in an expanded configuration to expand said working channel between said proximal and distal ends, wherein said working channel has a generally circular cross-section in said unexpanded configuration and in said expanded configuration said first and second portions define said working channel with a first width between opposite edges of said first and second portions and said first and second portions define a second width in a direction of expansion of the first and second portions that is transverse to said first width and greater than said first width, wherein said first width and said second width are measured on the same plane, where the plane is orthogonal to the longitudinal axis of said retractor; 
 a series of tubular tissue dilators positionable one over the other to sequentially dilate bodily tissue, wherein said working channel of said retractor is sized for positioning around said tissue dilators when said retractor is in said unexpanded configuration; and 
 an expansion instrument positionable in said working channel and engageable with said first portion and said second portion to move said first and second portions to said expanded configuration. 
 
     
     
       5. The kit of  claim 4 , wherein said first portion substantially envelopes said second portion in said unexpanded configuration. 
     
     
       6. The kit of  claim 4 , wherein said first portion is pivotally coupled to said second portion at proximal ends of said first and second portions and in said expanded configuration distal ends of said first and second portions are pivoted away from one another about said pivotally coupled proximal ends. 
     
     
       7. The kit of  claim 4 , wherein said first portion is pivotally coupled to said second portion along a pivot axis located proximally of proximal ends of said first portion and said second portion. 
     
     
       8. The kit of  claim 4 , wherein when in said expanded configuration:
 said working channel tapers in size from said distal end to said proximal end; and 
 said second portion includes opposite edges extending between distal and proximal ends of said second portion that overlap adjacent edges of said first portion adjacent a distal end of said first portion. 
 
     
     
       9. The kit of  claim 4 , wherein said retractor forms a tubular body in said unexpanded configuration and said series of tissue dilators includes a series of elongated tubes of increasing diameter. 
     
     
       10. The kit of  claim 4 , wherein in both said expanded and said unexpanded configurations said first portion and said second portion enclose said working channel between said proximal and distal ends of said working channel. 
     
     
       11. A kit for use in percutaneous surgery, comprising:
 a retractor having a working channel extending between a proximal end and a distal end of said retractor, said retractor having a first portion coupled to a second portion in an unexpanded configuration, wherein said first and second portions are movable relative to one another for engagement in an expanded configuration to expand said working channel between said proximal and distal ends, wherein:
 said first portion and said second portion each include opposite edges extending between a proximal end and a distal end thereof; 
 said second portion includes an engagement surface extending along at least a portion of each of said opposite edges thereof; 
 in said unexpanded configuration said edges of said first portion extend around said second portion; 
 in said expanded configuration said opposite edges of said first portion engage adjacent ones of said engagement surfaces of said second portion; and 
 
 a series of tubular tissue dilators positionable one over the other to sequentially dilate bodily tissue, wherein said working channel of said retractor is sized for positioning around said tissue dilators when said retractor is in said unexpanded configuration.