WO2015004667A1

WO2015004667A1 - Surgical device with combined differential gearing and deflection mechanism

Info

Publication number: WO2015004667A1
Application number: PCT/IL2014/050623
Authority: WO
Inventors: Tzony Siegal; Oded Loebl; Didier Toubia
Original assignee: Nlt Spine Ltd.
Priority date: 2013-07-11
Filing date: 2014-07-10
Publication date: 2015-01-15

Abstract

An apparatus includes differential gearing combined with an internal cable or strip or wire or similar to cause deflection of an elongated element, for example, a shaft, supporting a drill tip of the apparatus. The drill tip, for example, is rotated, oscillated, vibrated, or the like for performing tissue cutting. The deflection is at a predetermined curvature or other orientation, when the shaft with the drill tip exits a sleeve of the apparatus upon deployment to the work site.

Description

SURGICAL DEVICE WITH COMBINED DIFFERENTIAL GEARING

AND DEFLECTION MECHANISM

CROSS REFERENCES TO RELATED APPLICATIONS

This application is related to and claims priority from commonly owned U.S. Provisional Patent Application Serial No. 61/844,889, entitled: SURGICAL DEVICE WITH COMBINED

DIFFERENTIAL GEARING AND DEFLECTION MECHANISM, filed on July 1 1, 2013, the disclosure of which is incorporated by reference in its entirety herein.

TECHNICAL FIELD

The present invention is directed to instrumentation with differential gearing. BACKGROUND

Minimally invasive surgery, such as laparoscopic and endoscopic surgery, continues to be a common surgical option. These procedures typically require precise cutting, which is difficult over curved pathways, and in particular, over curved pathways of greater than 180°.

SUMMARY OF THE INVENTION

The present invention is directed to an apparatus, for example, a drill, for use in surgery, such as spinal and orthopedic surgery, but is also useful for other surgeries and in non-surgical operations as well, and methods for its use, both surgical and non-surgical. The drill tip, for example, is rotated, oscillated, vibrated, or the like for performing tissue cutting. The deflection is at a predetermined curvature or other orientation, when the shaft with the drill tip exits a sleeve of the apparatus upon deployment to the work site. The work site includes, for example, an animal body, such as a mammalian body.

Embodiments of the invention are directed to an apparatus. The apparatus comprises: a hollow sleeve; an elongated element, at least a portion of the elongated element extending within the sleeve, the elongated element being moveable so as to advance a length of the elongated element from the sleeve; a tensing element coextensive with the elongated element and linked to the l elongated element such that advancing of the tensing element through a length less than the length of the elongated element advanced from the sleeve, is in accordance with a predetermined ratio, and results in deflection of the extended length of the elongated element to a deflected orientation; and, a transmission cooperating with both the sleeve and the tensing element to maintain the predetermined ratio between movement of: 1) the elongated element relative to the sleeve, and, 2) movement of the tensing element relative to the sleeve.

Optionally, the elongated element includes a shaft.

Optionally, the shaft is fixed in association with a housing, the sleeve and the housing are housing are moveable with respect to each other, and the transmission is at least partially housed within the housing.

Optionally, the apparatus additionally comprises: a cutting tip; and, a motion translating member in communication with the cutting tip, the motion translating member configured for deflecting in a coordinated manner with the shaft.

Optionally, the motion translating member translates at least one of rotational, vibrational and oscillating motion to the cutting tip.

Optionally, the shaft includes segments at least at a distal end of the shaft, the segments for advancing from the sleeve, and at least one of the segments linked with the tensing element for restricting the advancement of the segments of the shaft from the sleeve in accordance with the predetermined ratio.

Optionally, the segments are configured such that their deflection upon advancement from the sleeve produces a tactile indication of the advancement.

Optionally, the at least one segment includes a distal most segment.

Optionally, the segments are joined consecutively in a hinged manner.

Optionally, the at least one end of adjacent ends of each of the consecutive segments is tapered to define the deflected orientation. Optionally, the tensing element includes a rotatable drum and a non-elastic cable extending from the drum through the shaft.

Optionally, the transmission includes at least one rounded gear for a cooperating meshing arrangement with a member communicating with both the sleeve and the housing, the transmission in communication with the drum of the tensing element.

Optionally, the drum and the at least one rounded gear are coaxially rotatably mounted to the housing, and are arranged for simultaneous rotation in the same direction, for advancing the shaft from the sleeve.

Optionally, the drum is at a fixed diameter ratio with respect to the transmission, the fixed diameter ratio corresponding to the predetermined ratio.

Optionally, the predetermined ratio is constant.

Optionally, the predetermined ratio is variable.

Optionally, at least a portion of the elongated member includes an implant.

Optionally, at least a portion of the elongate member includes a shaft portion, and the implant is separate from the shaft portion.

Optionally, at least a portion of the elongate member includes a shaft portion, and the implant is separable from the shaft portion.

Embodiments of the invention are directed to a cutting apparatus, for cutting, drilling and boring of tissue, as well as related operations. The apparatus comprises: a hollow sleeve; a shaft, at least a portion of the shaft extending within the sleeve, the shaft being moveable so as to advance a length of the shaft from the sleeve; a tensing element coextensive with the shaft and linked to the shaft such that advancing of the tensing element through a length less than the length of the shaft advanced from said sleeve, is in accordance with a predetermined ratio, and results in deflection of the extended length of the shaft to a deflected orientation; a transmission cooperating with both the sleeve and the tensing element to maintain the predefined ratio between movement of: 1) the shaft relative to the sleeve, and, 2) movement of the tensing element relative to the sleeve; a cutting tip; and, a motion translating member in communication with the cutting tip, the motion translating member configured for moving in a coordinated manner with the shaft.

Optionally, the shaft is fixed in association with a housing, the sleeve and the housing are housing are moveable with respect to each other, the transmission is at least partially housed within the housing, and the motion translating member is at least partially housed within the housing.

Optionally, the motion translating member translates at least one of rotational, vibrational, or oscillating motion to the cutting tip.

Optionally, the at least one segment includes a distal most segment.

Optionally, the segments are joined consecutively in a hinged manner.

Optionally, the at least one end of adjacent ends of each of the consecutive segments is tapered to define the deflected orientation.

Optionally, the tensing element includes a rotatable drum and a non-elastic cable extending from the drum through the shaft.

Optionally, the drum is and the at least one rounded gear are coaxially rotatably mounted to the housing, and are arranged for simultaneous rotation in the same direction, for advancing the shaft from the sleeve. Optionally, the drum is at a fixed diameter ratio with respect to the transmission, the fixed diameter ratio corresponding to the predetermined ratio.

Another embodiment of the invention is directed to a method for cutting tissue. The method comprises first obtaining and apparatus comprising: a hollow sleeve; a shaft, at least a portion of the shaft extending within the sleeve, the shaft being moveable so as to advance a length of the shaft from the sleeve; a tensing element coextensive with the shaft and linked to the shaft such that advancing of the tensing element through a length less than the length of the shaft advanced from said sleeve, is in accordance with a predetermined ratio, and results in deflection of the extended length of the shaft to a deflected orientation; a transmission cooperating with both the sleeve and the tensing element to maintain the predefined ratio between movement of: 1) the shaft relative to the sleeve, and, 2) movement of the tensing element relative to the sleeve; a cutting tip; and, a motion translating member in communication with the cutting tip, the motion translating member configured for moving in a coordinated manner with the shaft. The shaft is advanced from the sleeve to cause the shaft to deflect at a predetermined orientation; and, motion is provided to the motion translating member for translating motion to the cutting tip for cutting tissue.

Optionally, the method additionally comprises: continuing to advance the shaft from the sleeve such that the cutting tip cuts tissue along the path defined by the orientation of the deflection of the advancing shaft.

Another embodiment of the invention is directed to a method for deploying an elongated member, for example, an implant, in an animal body, such as a mammalian body comprising, obtaining an apparatus comprising: a hollow sleeve; an elongated element, at least a portion of the elongated element extending within the sleeve, the elongated element being moveable so as to advance a length of the elongated element from the sleeve; a tensing element coextensive with the elongated element and linked to the elongated element such that advancing of the tensing element through a length less than the length of the elongated element advanced from the sleeve, is in accordance with a predetermined ratio, and results in deflection of the extended length of the elongated element to a deflected orientation; and, a transmission cooperating with both the sleeve and the tensing element to maintain the predetermined ratio between movement of: 1) the elongated element relative to the sleeve, and, 2) movement of the tensing element relative to the sleeve. Next, the elongated member is advanced from the sleeve to cause the elongated element to deflect at a predetermined orientation.

Optionally, the elongated element includes an implant.

Optionally, the elongated element additionally includes a shaft portion, the implant being separable from the shaft portion.

Optionally, the implant is separated from the shaft portion at the deployment site in the mammalian body.

Optionally, the implant is a two dimensional implant and advances in a two dimensional orientation.

Optionally, the two dimensional orientation includes planar.

Optionally, the implant is a three dimensional implant and advances in a three dimensional orientation.

Optionally, the three dimensional orientation includes helical.

Unless otherwise defined, all technical and/or scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which the invention pertains. Although methods and materials similar or equivalent to those described herein can be used in the practi ce or testing of embodiments of the invention, exemplary methods and/or materials are described below. In case of conflict, the patent specification, including definitions, will control. In addition, the materials, methods, and examples are illustrative only and are not intended to be necessarily limiting.

BRIEF DESCRIPTION OF THE DRAWINGS

Attention is now directed to the drawings where like numerals or characters represent like or corresponding components. In the drawings:

FIG. 1A side view of the apparatus in accordance with an embodiment of the invention; FIG. IB is a top view of the apparatus of FIG. 1 A; FIG. 1C is a bottom view of the apparatus of FIG. 1A;

FIG. 2 is sectional view of the apparatus of FIG. 1A, with a portion of the housing removed;

FIGs. 3 A and 3B are cross-sectional views of the apparatus of FIG. 1C taken along line 3-3 of FIG. 1C;

FIG. 4 is a detailed view of the distal portion of the apparatus of FIG. 3;

FIG. 5 is a perspective view of a portion of the apparatus in accordance with an embodiment of the invention;

FIG. 6 is a side view of some of the segments that form the outer shaft of the apparatus of FIG. 1A;

FIG. 7A is a perspective view of the outer shaft of the apparatus of FIG. 1A; FIG. 7B is a cross-sectional view of the outer shaft of FIG. 7A taken along line 7B-7B; FIG. 8 A side view of the apparatus of FIG. 1 A with the drill tip in an extended position; FIG. 8B is a bottom view of the apparatus of FIG. 8 A;

FIG. 9 is a cross sectional view of the apparatus of FIG. 1 A, along line 3-3 detailing its operation, with the drill tip in a retracted position;

FIGs. 10A and 1 OB are oppositely positioned views of the movement mechanism of the apparatus of FIG. 1 A and FIG. 9;

FIG. 11 is a detailed view of a portion of FIG. 1 OA;

FIG. 12A is a sectional view of the apparatus of FIG. 1 A with the housing removed, detailing its operation, with the drill tip in an extended position;

FIG. 12B is a cross sectional view of the apparatus of FIG. 1A, along line 3-3 detailing its operation, with the drill tip in the extended position;

FIGs. 13A and 13B are diagrams of an alternate embodiment outer shaft for the apparatus of FIG. 1A; FIG. 14A is a cross sectional view of an apparatus in accordance with another embodiment of the invention, with the implant in a retracted position;

FIG. 14B is a cross sectional view of the sleeve of the apparatus of FIG. 14 A;

FIG. 14C is a cut away view of the apparatus of FIG. 14 A, with the implant in an extended position, and,

FIG. 15 is a perspective view of an alternative implant. DETAILED DESCRIPTION

Before explaining at least one embodiment of the invention in detail, it is to be understood that the invention is not necessarily limited in its application to the details of construction and the arrangement of the components and/or methods set forth in the following description and/or illustrated in the drawings and/or the Examples. The invention is capable of other embodiments or of being practiced or carried out in various ways.

Initially, throughout this document, references are made to directions such as, for example, upper and lower, proximal, distal, clockwise, and the like. These directional references are exemplary only to illustrate the invention and embodiments thereof.

FIGs. 1 A-1C, 2, 3 A, 3B and 4, show an apparatus 20 in accordance with the present invention. The apparatus 20 is, for example, a drill, for use in surgery, such as spinal and orthopedic surgery, but is also useful for other surgeries and in non-surgical operations as well.

The apparatus 20 includes a body 22, formed of a housing 24 (which is typically two symmetric pieces, but may other multiple piece configurations), with a moveable extension member 26, extending from the housing 24. The apparatus 20 includes a proximal end 27P and a distal end 27D, these ends also defining the respective "proximal" and "distal" orientations as referenced herein.

The extension member 26 includes two meshed (toothed) members or tracks 28a, 28b, each track 28a, 28b extending along an arm or arm member 26a, 26b of the extension member 26. The tracks 28a, 28b movably engage correspondingly meshed gears 30a, 30b (FIGs. 2, 3A and 3B), which collectively form a transmission. The gears 30a, 30b are joined together by a central drum 32 (FIGs. 3A and 3B) of a tensing element (take-up mechanism) 33 (FIG. 3B). The extension member 26 terminates in a plate 34. A sleeve 36 is fixedly attached to and extends (e.g., distally) from the plate 34. The sleeve 36 has a hollow interior and terminates in a distal edge (edge 36x). The apparatus 20 is typically symmetric about a plane fonned by the line 3-3 of FIG. 1C (and corresponding axis AA (FIGs. 1C and 8B), extending between the proximal end 27P and the distal end 27D of the apparatus 20), which cuts the apparatus 20 into identical or nearly identical or symmetric halves at the drum 32.

The sleeve 36 envelopes an elongated element, for example, outer shaft 38, fonned by a plurality of segments 40 (the distal most or first segment indicated as 40' and the proximal most or last segment indicated as 40") and a rearward or proximally extending long portion 40x. The segments 40 are moveable within the sleeve 36, and vice versa (such that movement of the segments 40 and sleeve 36 are relative to each other). While multiple segments 40 are shown, there may be as few as two segments. For example, the segments 40 are joined consecutively in a hinged manner by pins 41. Alternately, the segments 40 may be joined by hinges or a combination of pins and integral hinges or joints, as well as flexible hinges, which attach to the adjacent segments 40.

In other alternatives, the segments may be formed on an integral (e.g., unitary) member, for example, of a bendable or deflectable material, with gaps between the segments, which allows for the bending, deflection, or other aspects of flexibility. Also, the segments can be arranged on a flat sheet adjoining two segments, which allows for bending, deflection, or other aspects of flexibility.

Coupled with the hinged joining of adjacent segments 40, the segments 40 are shaped to deflect or bend in a predetermined orientation, or bias, when outside of, or otherwise advanced from (so as to be outside of), the sleeve 36. For example, neighboring or adjacent segments 40 include at least one, and typically both adjacently facing ends 40b (FIG. 6) being tapered, to accommodate the bending. This biasing is, for example, typically secondary to the primary biasing caused by the tensing element 33, as detailed below. The last (proximal most) segment 40" of the consecutive segments 40 of the outer shaft 38 is hinged to the proximal portion 40x of the outer shaft 38, as shown in FIGs. 5, 6, 7A and 7B. The segments 40 may also be designed such that they interlock upon deflection. As shown in FIGs. 5 and 6, for example, each segment 40 has a shape with a hollow interior and hinged together along an upper end 40a. Each segment 40 tapers inwardly along both lateral ends 40b (except the distal most lateral end of the first segment 40' which is not tapered, so as to not allow the drill or cutting tip 46 (hereinafter "drill tip") to orient in an angled manner), to a lower end 40c. The tapers at the lateral ends 40b, are shown as symmetric, but may be angled differently (with respect to an axis extending through the outer shaft 38. For example, differently angled tapers at the lateral ends 40b allows deflection (bending) of the segments 40 to also be helical. This lower end 40c may be straight or curved, with the curvature being similar to the radius for curvature of the deployed outer shaft.

The hinging of each segment 40 to the next consecutive segment 40, and shape of the segments 40, coupled with the outer shaft 38 of the segments 40, pulled by a cable 80, of the tensing element 33 or take up member, (FIGs. 3B, 4, 6 and 11), taken up by the central drum 32, to which the cable is linked. This linking, for example, the cable 80 being linked to the central drum 32 and the distal most segment 40' of the outer shaft 38, serves as the primary biasing for the outer shaft 38 including its segments 40 (e.g., extending from the first or distal most segment 40' to the last or proximal most segment 40"). The take up or winding of the cable 80 by the central drum 32, causes the segments 40 to deflect in a predetermined curvature, as shown in FIGs. 7A and 7B, for example, when the segments 40 leave (go outside of or advance from) the sleeve 38 consecutively. The segments 40 may also be shaped so as to assume other

predetermined orientations when advanced from the sleeve 38.

An inner shaft 42, which is flexible, of a fixed length, and rotatable by a motor (not shown) or manually, and extends through the sleeve 36 and the body 22, terminating in a connector 44 for a motor (which attaches at a stem 44a of the connector). The inner shaft 42 extends through a cavity 45 in the body 22 to the connector 44, which seats in a cavity 72 of the body 22, which confines axial movement of the connector 44 but allows for rotational movement (clockwise, counterclockwise or combinations thereof, and also oscillating) of the connector 44. The outer shaft 38 terminates at or proximate to a drill tip 46. The drill tip 46 attaches to the inner shaft 42, and is rotated for drilling upon rotation of the inner shaft 42.

The drill tip 46 as shown, includes a burr 47. Alternatively, the drill tip 46 may be any mechanism for cutting, fding, grating, polishing, and the like. The outer shaft 38, formed of segments 40, and enveloping the inner shaft 42, is moveable, or moveable into positions, between a fully retracted position, where the drill tip 46 is close to or in abutment with the sleeve 36, as shown in FIGs. 1 A-1C, and various extended positions, where the segments 40 are outside of the sleeve 36 (beyond the edge 36x), and for example, deflected or bent into a predetermined orientation, as shown in FIGs. 7A and 7B. The advancement of the outer shaft 38 and segments 40 thereof, is, for example, axial, along the axis AA, as shown in FIG. 8B.

The plate 34 is fixed to the extension member 26, forming a single piece 50. This single piece 50 is moveable with respect to the housing 24, such that when the piece 50 is moved toward the housing 24, and vice versa, the drill tip 46, segments 40 and inner shaft 42 move out of the sleeve 36, typically advancing by successive segments 40. This advancement by segments 40 results in the segments 40 deflecting or bending in accordance with their predetermined orientation, as shown in FIGs. 8 A and 8B.

Turning back to FIGs. 2, 3A, 3B and 4, the inner shaft 42 extends between the drill tip 46 (at the distal end 27D of the apparatus 20) and the connector member 44 (at the proximal end 27P of the apparatus 20). The connector member 44 connects to a motor (not shown), which imparts rotation to the inner shaft 42, that in turn rotates the drill tip 46, for example, clockwise, counterclockwise or combinations thereof, in accordance with the rotational arrow 66. The drill tip 46 may also be oscillated or vibrated. The connector member 44, with a distally positioned spring 68 seats in a cavity 72 of the body 24, in which the connector member 44 and spring 68 are confined, but rotatable, as detailed above.

The body 22 also includes a cavity 73 configured for maintaining the gears 30a, 30b. This cavity 73 is continuous with the channel 45, which is continuous with the cavity 72. Each gear 30a, 30b includes an end 74a, 74b (FIG. 10B) which rotationally mounts to the body 22. As shown in FIG. 4, a cable 80 extends within the segments 40, which form the outer shaft 38, and is anchored in and/or linked to the distal most or first segment 40'. The cable 80 is taken up and held in tension by the central drum 32. The cable 80, for example, is non-elastic, but possesses inherent flexibility, and as such, is suitable for absorbing or compensating for intolerances (variations in tolerances) in the design and motion of the segments 40 of the outer shaft 38. Other than accommodating minor tolerances, cable 80 is preferably sufficiently non-elastic that it does not significantly stretch during normal operation of the device.

The drum 32 is fixed to the gears 30a, 30b. The drum 32 and gears 30a, 30b, are for example, circular in cross section and arranged coaxially, as well as being mounted rotationally in the housing 24. The drum 32 is of a diameter to pull the cable 80, the length of one segment 40 (corresponding to the length of the segment's upper end 40a, represented by the distance "K", as shown in FIG. 6), for every segment 40 length K, as segments 40 exit the sleeve 38

consecutively. For example, due to the size of the gears 30a, 30b, a typical gear differential includes a diameter ratio of GeanDrum, for example, is 3:2, with 3 of the ratio equal to the distance K. Segments 40 can be advanced consecutively, for one a proximal lower end 40c of a segment 40 passes the edge of the sleeve 36x, it moves into the predetermined curvature, and the cable 80, pulling the first (distal most) segment 40', keeps the segments 40 in tension, as it is wound on the rotating drum 32. The advancing segments 40 deflect with a curvature, which is illustrated in FIGs. 1 OA and 10B. Based on the gearing geometry above, the uptake of the cable 80 by the drum 32 (uptake is represented by U) is minus G (G being the gap between the segments, shown in FIG. 6), or expressed as U = - G.

From the perspective of the tensing element 33 and gears 30a, 30b, the advancing of the tensing element 33, including the cable 80 being pulled proximally, by being wound on the drum 32, through a length less than the length of the outer shaft 38 advanced from the sleeve 36, is in accordance with a predetermined ratio of lengths. The predetermined ratio may be either constant or variable. The gears 30a, 30b cooperate with both the sleeve 36 and the tensing element 33 to maintain the predetermined ratio (of lengths) between movement of the outer shaft 38 including the segments 40 thereof, relative to the sleeve 36, and the movement of the tensing element 33, e.g., the length of the cable 80 being pulled proximally, relative to the sleeve 36.

While two tracks 28a, 28b for supporting two gears 30a, 30b with a drum 32 engaged

therebetween are shown, and are preferable, so that the load is more symmetric and equalized, embodiments with a single track, single gear, and single drum are also suitable. Additionally, embodiments with the aforementioned two tracks need not be symmetric, and can vary in some components. 14 050623

Alternatively, the drum 32 may include teeth on the outer surface, which engage con-espondingly configured teeth on a cable member. The cable member would replace some (for example, the proximal portion) or all of cable 80.

Alternatively, embodiments may use a drum which is elliptical or otherwise rounded, instead of circular (drum 32) as shown. This elliptical drum would enable the outer shaft 38 to deflect ellipticaily upon deployment.

In alternative embodiments, the outer shaft 138 (similar to shaft 38 detailed above) may have segments 140 (similar to segments 40 detailed above, and joined to each other, for example, in the same manner as the segments 40 detailed above) that are not symmetrically shaped, have different tapers at the lateral sides 140b, do not have a constant radius on the inner (lower) surface 140c, and have gaps that are not constant in size, as shown in FIG. 13 A. When advanced/deployed out of the sleeve 36, the cable 80 (FIGs. 3B and 4) is pulled at a non-uniform rate (by being coiled or wound on the non-cylindrical drum) such that the segments 140 interface to form a non circular structure, shown in FIG. 13B.

FIGs. 9, 10A, 10B, 11, 12A and 12B detail the drill 20 in an exemplary operation. Initially, the apparatus 20 is such that all of the segments 40 are within the sleeve 36, in a fully retracted position, as shown, for example, in FIG. 9. For example, the apparatus 20 accesses the surgical site by conventional body accessing techniques. In this retracted position, the plate 34 with the tracks 28a, 28b is at a distance "d" from the housing 24.

The shafts, outer 38 and inner 42, are advanced, by movement of the plate 34 and housing 24 toward, for example, relative to, each other, decreasing the distance "d." Typically, the housing 24 is pushed forward or distally toward the plate 34, for example, axially along axis AA, in the direction of the arrow 90 (FIG. 9), to advance the drill tip 46 and the outer shaft 38, which supports the drill tip 46 and houses the inner shaft 42 (rotatably attached to the drill tip 46). Advancement of the outer shaft 38 (e.g., including from the sleeve 36), is typically by consecutive segments 40, due to the shape of the segments 40, coupled with the tension from the cable 80, and the diameter ratio of the gears 30a, 30b to the drum 32. This advancement of the outer shaft 38 in consecutive segments 40 (from the sleeve 36), results in the segments 40 deflecting at a predetermined orientation, such that the inner shaft 42 deflects in a corresponding manner and the drill tip 46 (connected or otherwise linked to the inner shaft 42) moves (and is able to drill or cut tissue) along a pathway, for example, a curved or rounded pathway greater than 180°, as defined by the predetermined orientation of the deflection.

When advancement of the segments 40 out of or from the sleeve 38 is desired, the housing 24 is moved (e.g., axially) toward the plate 34 (and/or vice versa), moving the tracks 28a, 28b rearward or proximally, toward the housing 24 (as per the arrow 92 of FIG. 11). This movement causes the gears 30a, 30b, and drum 32 to rotate (for example, clockwise, in the direction of the arrow 94 of FIG. 11). The rotation is by the same arc length, but a different travel length. Due to the geometry of each segment 40, when a segment 40 has been pushed out of the sleeve 36, when the lower end 40c reaches the edge of the sleeve 36, it will immediately cause the segment 40 to bend at the hinge 41, in accordance with the lateral surfaces 40b, where a "click" can be heard, and the segment 40 deflects at the predetermined orientation or curvature. This deflection of each of the segments 40 can be felt (tactilely) by the surgeon, via the "click," as each segment 40 is advanced forward or distally, outside of the sleeve 36. As the inner shaft 42 is flexible, it will bend with the deflection of the consecutively extending segments 40, in accordance with the predetermined curvature. The cable 80 continues to provide a pulling force on the outer shaft 38, to cause deflection of the segments 40 (in the predefined curvature), as the cable 80 is taken up by the drum 32, also rotating clockwise here (in the direction of the arrow 94).

The segments 40 are advanced consecutively, as detailed above, until the plate 34 either abuts the housing 24, at surface 24a, which serves as a stop or travel limit for the plate 34, and hence, the segments 40 of the outer shaft 38, or is in close proximity thereto, with a distance represented by d\ This distance d' is less than distance d with distance d' representative of the outer shaft 38 in its fully extended position, as shown in FIGs. 8 A and 8B. In this extended position, as well as any other extended positions between d and d', the drill tip 46 may be operated, by activating the motor (not shown), to perform the desired procedure.

Should it be necessary, the advancement of the drill tip 46 and segments 40 of the outer shaft 38 may be extended out of the sleeve 6 by moving the plate 34 toward the housing 24, in a direction opposite that of arrow 90 (FIG. 9). This movement would decrease the distance d toward distance d', and would require simultaneously or contemporaneously manually advancing the apparatus 20 toward the requisite site. The advancement of the drill tip 46 and segments 40 of the outer shaft 38 may be extended out of the sleeve 36 by moving the plate 34 toward the housing 24, and the housing toward the plate simultaneously, so as to decrease the distance d toward distance d'. Manually advancing the apparatus 20 toward the requisite site may be required, depending on the position of the drill tip 46 in the body with respect to the surgical site.

Alternative embodiments of the apparatus 20 are such that the apparatus 20, as shown and described above, can easily be adapted (for example, by removing the drill tip 46 and where necessary, the inner shaft 42) for applications such as deployment of instrumentation and surgical implants, such as segmented and flexible implants, two-dimensional (2D) curvature implants and three-dimensional (3D) curvature implants.

For example, an alternate apparatus 1420 for delivering the aforementioned implants is shown in FIGs. 14A-14C, to which attention is directed. In the apparatus 1420, components which are the same or similar to those of the apparatus 20 are numbered in the "1400s" and are in accordance with the descriptions provided above for the apparatus 20, except where indicated.

In the apparatus 1420, the outer shaft 38 of the apparatus 20 is replaced by an elongated element 1421, with an implant 1421a, deployable in the body, separate and/or separable (e.g., detachable or removable) from the shaft portion or shaft 1421b of the elongated element 1421. The implant 1421a and shaft portion 1421b may be temporarily attached by adhesives and/or mechanical fasteners or may be attached to be separated by being cut off or broken away. The implant 1421a is not fixed or otherwise mounted to or with respect to the housing 1424, while the shaft portion 1421b is mounted to the housing 1421, like that of the shaft 38 in the housing 24.

The implant 1421a and typically part of the shaft portion 1421b are initially in the sleeve 1436. The implant 1421a (at its proximal end 1421a-p) is proximate to, and, for example, in abutment, with the shaft portion 1421b, at the distal end 1421b-d of the shaft portion 1421b, as shown in FIGs. 14A and 14B. The implant 1421a is deflectable in a predetermined orientation, based partially on the configuration of the implant 1421a. For example, the implant 1421a as shown includes segments 142 lax with gaps 142 lay, between the segments 142 lax, which allows the implant 1421a to bend or deflect when pulled proximally by the cable 1480 of the tensing element 1433 when the implant 1421a is advanced from the sleeve 1436, as detailed further below. While multiple segments 1421ax are shown, there may be as few as two segments. The segments 142 lax may also be designed such that they interlock upon deflection.

The implant 1421a, shaft portion 1421b, and sleeve 1436 are movable relative to each other. Coupled with the abutment of the implant 1421a with the shaft portion 1421 , advancement of the implant 1421a from, such as outside of or beyond the sleeve 1436, occurs when one or both of the housing 1424 and the plate 1434 are moved toward each other, as shown in FIG. 14C.

The implant 1421a, for example, is a tube or tube-like structure with a hollow interior, and closed or partially closed at least at the proximal end 1421 a-p, to create an abutment with the shaft portion 1421b at the distal end 1421b-d thereof. For example, the distal end 1421a-d of the implant 1421a may also be closed. Alternately, the shaft portion 1421b may have its distal end 1421p~d dimensioned such that portions thereof can come into abutment with the proximal end 1421 a-p of the implant 1421 a.

A cable 1480 links to the implant 1421a in the hollow interior. The cable 1480 extends proximally through the interior of the implant 1421a, and extends proximally through the interior of the shaft portion 1421b (which is also hollow or includes a bore extending therethrough to accommodate the cable 1480), terminating at the drum 1432. The cable 1480 is tensioned by being wound (taken up) on the drum 1432 of the tensing element 1433, for example, by the clockwise rotation of the drum 1432. For example, the cable 1480 attaches to the implant 1421a at the distal end 1421a-d of the implant 1421a (shown by point 1480x), and this may be at or proximate to the distal most edge of implant 1421a (in the axial direction). The ratios of the gears 1430a, 1430b to the drum 1432, may be in accordance with that detailed above for the apparatus 20.

The implant 1421a is a two dimensional (2D) implant, as its deployment, for example, in the body, is substantially planar. The implant 1421a, while shown detachable from the shaft portion 1421b, is also detachable at any point outside of the sleeve 1436. Additionally, as shown, for example, at least a portion, e.g., the distal end 1421a-d, of the implant 1421a, prior to deploying the implant 1421a in the apparatus 1420 should be outside or beyond the sleeve 1436, such that the implant 1421 a is not fully contained in the sleeve 1436 upon insertion into the body. Alternatively the implant 1421a may be solid, with an internal bore extending through the implant 1421a axially (from the distal end 1421a-d to the proximal end 1421a-p). The cable 480 would then be anchored at the distal end 1421a~d of the implant 1421a and extend proximally through the internal bore, the interior of the shaft portion 1421b, and on to the drum 1432.

FIG. 15 shows an elongated member 1521 , for example, as a three dimensional (3D) implant 1521a, as deployed from the apparatus 1420 of FIGs. 14A-14C, as detailed above. . The implant 1521a is shown deploying helically or along different planes, as the implant advances from the sleeve 1436 of the apparatus 1420 (FIGs. 14A 4C) (cable 1480 not shown). Except where indicated, the implant 3521a is similar in all aspects to the implant 1421a detailed above, with all components of the implant 1521a, shaft portion or shaft 1521b, corresponding to the elongated member 1421, implant 1421a and shaft portion 1421b, having the same numbers but in the "1500s", and are in accordance with the corresponding descriptions above. The segments 152 lax have gaps 152 lay between them, for example, with the axes 152 lay' of the gaps 152 lay at an oblique angle (a) relative to a direction of elongation (advancement) of the implant 1523 a, to allow for the helical bending or deflection as shown. While multiple segments 1521 ax are shown, there may be as few as two segments. The segments 152 lax may also be designed such that they interlock upon deflection.

The implant 1521a, while shown detachable from the shaft portion 1521b, is also detachable at any point outside of the sleeve 1436. Additionally, as shown, for example, at least a portion, e.g., the distal end 1521a-d, of the implant 1521a, prior to deploying the implant 1521a in the apparatus 1420, should be outside or beyond the sleeve 1436, such that the implant 1521a is not fully contained in the sleeve 1436 upon insertion into the body.

The implants 1421a, 1521a may be, for example, any of the implants disclosed in commonly owned US Patent No. 7,503,920 and 7,918,874, both of which are incorporated by reference in their entireties herein.

As used herein, the singular form "a", "an" and "the" include plural references unless the context clearly dictates otherwise. It is appreciated that certain features of the invention, which are, for clarity, described in the context of separate embodiments, may also be provided in combination in a single embodiment. Conversely, various features of the invention, which are, for brevity, described in the context of a single embodiment, may also be provided separately or in any suitable subcombination or as suitable in any other described embodiment of the invention. Certain features described in the context of various embodiments are not to be considered essential features of those embodiments, unless the embodiment is inoperative without those elements.

Although the invention has been described in conjunction with specific embodiments thereof, it is evident that many alternatives, modifications and variations will be apparent to those skilled in the art. Accordingly, it is intended to embrace all such alternatives, modifications and variations that fall within the spirit and scope of the appended claims.

Claims

What is claimed is:

1. An apparatus comprising: a hollow sleeve; an elongated element, at least a portion of the elongated element extending within the sleeve, the elongated element being moveable so as to advance a length of the elongated element from the sleeve; a tensing element coextensive with the elongated element and linked to the elongated element such that advancing of the tensing element through a length less than the length of the elongated element advanced from the sleeve, is in accordance with a predetermined ratio, and results in deflection of the extended length of the elongated element to a deflected orientation; and, a transmission cooperating with both the sleeve and the tensing element to maintain the predetermined ratio between movement of: 1) the elongated element relative to the sleeve, and, 2) movement of the tensing element relative to the sleeve.

2. The apparatus of claim 1, wherein the elongated element includes a shaft.

3. The apparatus of claim 2, wherein the shaft is fixed in association with a housing, the sleeve and the housing are housing are moveable with respect to each other, and the transmission is at least partially housed within the housing.

4. The apparatus of claim 2, additionally comprising: a cutting tip; and, a motion translating member in communication with the cutting tip, the motion translating member configured for deflecting in a coordinated manner with the shaft.

5. The apparatus of claim 4, wherein the motion translating member translates at least one of rotational, vibrational and oscillating motion to the cutting tip.

6. The apparatus of claim 2, wherein the shaft includes segments at least at a distal end of the shaft, the segments for advancing from the sleeve, and at least one of the segments linked with the tensing element for restricting the advancement of the segments of the shaft from the sleeve in accordance with the predetermined ratio.

7. The apparatus of claim 6, wherein the segments are configured such that their deflection upon advancement from the sleeve produces a tactile indication of the advancement.

8. The apparatus of claim 6, wherein the at least one segment includes a distal most segment.

9. The apparatus of claim 8, wherein the segments are joined consecutively in a hinged manner.

10. The apparatus of claim 9, wherein the at least one end of adjacent ends of each of the consecutive segments is tapered to define the deflected orientation.

11. The apparatus of claim 8, wherein the tensing element includes a rotatable drum and a non- elastic cable extending from the drum through the shaft.

12. The apparatus of claim 11, wherein the transmission includes at least one rounded gear for a cooperating meshing arrangement with a member communicating with both the sleeve and the housing, the transmission in communication with the drum of the tensing element.

13. The apparatus of claim 12, wherein the drum and the at least one rounded gear are coaxially rotatably mounted to the housing, and are arranged for simultaneous rotation in the same direction, for advancing the shaft from the sleeve.

14. The apparatus of claim 13, wherein the drum is at a fixed diameter ratio with respect to the transmission, the fixed diameter ratio corresponding to the predetermined ratio.

15. The apparatus of claim 1, wherein the predetermined ratio is constant.

16. The apparatus of claim 1 , wherein the predetermined ratio is variable.

17. The apparatus of claim 1, wherein at least a portion of the elongated member includes an implant.

18. The apparatus of claim 17, wherein at least a portion of the elongate member includes a shaft portion, and the implant is separate from the shaft portion.

19. The apparatus of claim 17, wherein at least a portion of the elongate member includes a shaft portion, and the implant is separable from the shaft portion.

20. An apparatus comprising: a hollow sleeve; a shaft, at least a portion of the shaft extending within the sleeve, the shaft being moveable so as to advance a length of the shaft from the sleeve; a tensing element coextensive with the shaft and linked to the shaft such that advancing of the tensing element through a length less than the length of the shaft advanced from said sleeve, is in accordance with a predetermined ratio, and results in deflection of the extended length of the shaft to a deflected orientation; a transmission cooperating with both the sleeve and the tensing element to maintain the predefined ratio between movement of: 1) the shaft relative to the sleeve, and, 2) movement of the tensing element relative to the sleeve; a cutting tip; and, a motion translating member in communication with the cutting tip, the motion translating member configured for moving in a coordinated manner with the shaft.

21. The apparatus of claim 20, wherein the shaft is fixed in association with a housing, the sleeve and the housing are housing are moveable with respect to each other, the transmission is at least partially housed within the housing, and the motion translating member is at least partially housed within the housing.

22. The apparatus of claim 21, wherein the motion translating member translates at least one of rotational, vibrational, or oscillating motion to the cutting tip.

23. The apparatus of claim 20, wherein the shaft includes segments at least at a distal end of the shaft, the segments for advancing from the sleeve, and at least one of the segments linked with the tensing element for restricting the advancement of the segments of the shaft from the sleeve in accordance with the predetermined ratio.

24. The apparatus of claim 23, wherein the segments are configured such that their deflection upon advancement from the sleeve produces a tactile indication of the advancement.

25. The apparatus of claim 23, wherein the at least one segment includes a distal most segment.

26. The apparatus of claim 25, wherein the segments are joined consecutively in a hinged manner.

27. The apparatus of claim 26, wherein the at least one end of adjacent ends of each of the consecutive segments is tapered to define the deflected orientation.

28. The apparatus of claim 25, wherein the tensing element includes a rotatable drum and a non- elastic cable extending from the drum through the shaft.

29. The apparatus of claim 28, wherein the transmission includes at least one rounded gear for a cooperating meshing arrangement with a member communicating with both the sleeve and the housing, the transmission in communication with the drum of the tensing element.

30. The apparatus of claim 29, wherein the drum is and the at least one rounded gear are coaxially rotatably mounted to the housing, and are arranged for simultaneous rotation in the same direction, for advancing the shaft from the sleeve.

3 . The apparatus of claim 30, wherein the drum is at a fixed diameter ratio with respect to the transmission, the fixed diameter ratio corresponding to the predetermined ratio.

32. A method for cutting tissue comprising: obtaining an apparatus comprising: a hollow sleeve; a shaft, at least a portion of the shaft extending within the sleeve, the shaft being moveable so as to advance a length of the shaft from the sleeve; a tensing element coextensive with the shaft and linked to the shaft such that advancing of the tensing element through a length less than the length of the shaft advanced from said sleeve, is in accordance with a predetermined ratio, and results in deflection of the extended length of the shaft to a deflected orientation; a transmission cooperating with both the sleeve and the tensing element to maintain the predefined ratio between movement of: 1) the shaft relative to the sleeve, and, 2) movement of the tensing element relative to the sleeve; a cutting tip; and, a motion translating member in communication with the cutting tip, the motion translating member configured for moving in a coordinated manner with the shaft; advancing the shaft from the sleeve to cause the shaft to deflect at a predetermined orientation; and, providing motion to the motion translating member for translating motion to the cutting tip for cutting tissue.

33. The method of claim 32, additionally comprising, continuing to advance the shaft from the sleeve such that the cutting tip cuts tissue along the path defined by the orientation of the deflection of the advancing shaft.

34. A method for deploying an elongated member in a mammalian body comprising: obtaining an apparatus comprising: a hollow sleeve; an elongated element, at least a portion of the elongated element extending within the sleeve, the elongated element being moveable so as to advance a length of the elongated element from the sleeve; a tensing element coextensive with the elongated element and linked to the elongated element such that advancing of the tensing element through a length less than the length of the elongated element advanced from the sleeve, is in accordance with a predetermined ratio, and results in deflection of the extended length of the elongated element to a deflected orientation; and, a transmission cooperating with both the sleeve and the tensing element to maintain the predetermined ratio between movement of: 1) the elongated element relative to the sleeve, and, 2) movement of the tensing element relative to the sleeve; and, advancing the elongated member from the sleeve to cause the elongated element to deflect at a predetermined orientation.

35. The method of claim 34, wherein the elongated element includes an implant.

36. The method of claim 35, wherein the elongated element additionally includes a shaft portion, the implant being separable from the shaft portion.

37. The method of claim 36, wherein the implant is separated from the shaft portion at the deployment site in the mammalian body.

38. The method of claim 35, wherein the implant is a two dimensional implant and advances in a two dimensional orientation.

39. The method of claim 38, wherein the two dimensional orientation includes planar.

40. The metliod of claim 35, wherein the implant is a three dimensional implant and advances in a three dimensional orientation.

41. The method of claim 40, wherein the three dimensional orientation includes helical.