Methods and apparatus for minimally invasive recovery of bone and/or other tissue
Methods and apparatus are provided for minimally invasive recovery of bone and other tissues. The methods include separating bone or other tissue from surrounding tissue in a minimally invasive fashion. The methods may be used for recovering an essentially intact bone from a donor with reduced detriment to the aesthetic appearance of the donor. The instruments include an elongated shaft and a tissue separator attached to one of the ends of the shaft. The separator may have a moderately sharp edge and/or a shape that is reciprocal to at least a portion of the shape of a bone. Kits are provided comprises an elongated shaft and two or more tissue separators which are attachable to the shaft. The separators may have substantially similar shapes but have different sizes, and/or may be different shapes.
1 . A method for minimally invasive recovery of tissue from a donor, the method comprising:
accessing an essentially intact tissue through a strategic incision;
removing the essentially intact tissue from the donor; and
leaving the surrounding tissue essentially intact inside the donor.
2 . The method of claim 1 , wherein the surrounding tissue comprises a vascular network, and the method comprises separating the surrounding tissue from the bone, while leaving essentially intact the vascular network of the surrounding tissue.
3 . The method of claim 1 , further comprising the step of passing a fluid through the vascular network of the surrounding tissue.
4 . The method of claim 1 , where the fluid is an embalming fluid.
5 . A method for recovering a substantial portion of a bone from a donor with reduced detriment to the aesthetic appearance of the donor, the bone having a proximal third, a distal third, and a central third, the method comprising:
(a) making an incision within the proximal or distal third of the bone;
(b) separating soft tissue surrounding the bone along at least a portion of the length of the bone by accessing the bone and the tissue through the incision; and
(c) removing a substantial portion of the bone through the incision.
6 . The method of claim 5 wherein the substantial portion of the bone is essentially intact bone.
7 . The method of claim 5 wherein the incision is made at the articulation of two connected bones.
8 . The method of claim 5 leaving essentially all of the surrounding tissue in the donor.
9 . The method of claim 5 wherein the donor is a cadaver.
10 . The method of claim 5 wherein the donor is a living patient.
11 . A method for removing an essentially intact tissue with reduced detriment to the donor's body, the method comprising:
accessing an essentially intact tissue through an opening having a length of not more than about 50 cm,
separating the essentially intact tissue from surrounding tissue,
removing the essentially intact tissue from the donor's body, and
leaving the surrounding tissue essentially intact inside the donor's body.
12 . The method of claim 11 , wherein the opening is an incision through the donor's skin.
13 . The method of claim 11 , wherein the surrounding tissue comprises a vascular network, and the method comprises separating the surrounding tissue from the bone, while leaving essentially intact the vascular network of the surrounding tissue.
14 . The method of claim 11 , further comprising the step of passing a fluid through the vascular network of the surrounding tissue.
15 . The method of claim 11 , where the fluid is an embalming fluid
16 . A method for separating a bone from surrounding tissue in a minimally invasive fashion, the bone having a length and two ends, the method comprising:
(a) making an incision which does not pass through the central third of the length of the bone; and
(b) accessing the bone through the incision; and
(c) separating the surrounding tissue from the bone along a majority of the perimeter and at least a portion of the length of the bone.
17 . The method of claim 16 wherein the incision does not extend into the central third of the length of the bone.
18 . The method of claim 16 wherein the incision passes through articulation of two connected bones.
19 . The method of claim 16 wherein the incision has a midpoint about at the center of the articulation.
20 . The method of claim 16 further comprising making a second incision at the other end of the bone and separating soft tissue along the circumference at least a second portion of the length of the bone through the second incision.
21 . The method of claim 16 wherein the bone is disposed in an extremity, and the method comprises making no more than three incisions in the extremity.
22 . The method of claim 16 wherein the incision is no more than about 20 cm long in the upper extremity.
23 . The method of claim 16 wherein the incision is no more than about 30 cm long in the lower extremity.
24 . The method of claim 16 wherein the length of the incision is no more than about 33% of the length of the bone.
25 . The method of claim 16 wherein the incision is located no more than about 20 cm from the end of the bone in the upper extremity.
26 . The method of claim 16 wherein the incision is located no more than about 30 cm from the end of the bone in the lower extremity.
27 . The method of claim 16 wherein the incision is approximately at the hip and is about 2 cm above the tissue at or near the anterior portion of an iliac crest.
28 . The method of claim 16 wherein the bone is a femur, and the incisions are approximately at a hip and a knee.
29 . The method of claim 16 wherein the bone is a tibia, and the incisions are approximately at a knee and an ankle.
30 . The method of claim 16 wherein the bone is a fibula, and the incisions are approximately at a knee and an ankle.
31 . The method of claim 16 wherein the incision is approximately at the hip and is less than about 40 cm long.
32 . The method of claim 16 wherein the incision is approximately at the knee and is less than about 35 cm long.
33 . The method of claim 16 wherein the incision is approximately at the ankle and is less than about 30 cm long.
34 . The method of claim 16 wherein the incision is approximately at the hip and is about 25 cm long.
35 . The method of claim 16 wherein the incision is approximately at the knee and is about 20 cm long.
36 . The method of claim 16 wherein the incision is approximately at the ankle and is about 15 cm long.
37 . The method of claim 16 wherein the bone is a humerus, and the incisions are approximately at a shoulder and an elbow.
38 . The method of claim 16 wherein the bone is a radius, and the incisions are approximately at an elbow and a wrist.
39 . The method of claim 16 wherein the bone is an ulna, and the incisions are approximately at an elbow and a wrist.
40 . The method of claim 16 wherein the bone is a scapula, and the incision is approximately at a shoulder.
41 . The method of claim 16 wherein the bone is a rib, and the incisions are approximately at any point about the rib and from about 2 to about 4 cm long.
42 . The method of claim 16 wherein the bone is a phalanx, and the incisions are approximately at a proximal end of a proximal phalanx or a distal end of an associated metacarpal or metatarsal.
43 . The method of claim 16 wherein the incision is approximately at the shoulder and is less than about 30 cm long.
44 . The method of claim 16 wherein the incision is approximately at the elbow and is about 25 cm long.
45 . The method of claim 16 wherein the incision is approximately at the shoulder and is about 15 cm long.
46 . The method of claim 16 wherein the incision is approximately at the elbow and is about 10 cm long.
47 . The method of claim 16 wherein the incision is approximately at the wrist and is about 10 cm long.
48 . The method of claim 16 wherein the incision is approximately at the wrist and is about 4 cm long.
49 . The method of claim 16 separating the soft tissue from bone without dividing the bone tissue.
50 . The method of claim 16 further comprising the step of dividing the bone into pieces to facilitate removal.
51 . The method of claim 16 separating the tissue with a rounded instrument.
52 . The method of claim 16 separating the tissue with scissors.
53 . A method for removing a long bone or a substantial portion of a long bone from a limb of a deceased donor, with reduced detriment to the appearance of the donor's body, the method comprising:
accessing the long bone through a strategic incision which spans less than the length of the long bone;
separating the long bone from the surrounding tissue; and
removing the long bone or substantial portion of the long bone from the limb.
54 . The method of claim 53 , wherein the surrounding tissue is left essentially intact inside the limb.
55 . The method of claim 53 , wherein the long bone is removed essentially intact from the limb.
56 . The method of claim 53 , further comprising replacing the long bone with a prosthesis which restores the appearance of the donor's body.
57 . The method of claim 53 , further comprising closing the strategic incisions to restore the appearance of the donor's body.
58 . The method of claim 53 wherein the strategic incision has a length that is less than ⅔ of the length of the long bone.
59 . The method of claim 53 wherein the strategic incision has a length that is less than ½ of the length of the long bone.
60 . The method of claim 53 wherein the strategic incision has a length that is less than ⅓ of the length of the long bone.
61 . The method of claim 53 wherein the strategic incision has a length that is less than ¼ of the length of the long bone.
62 . The method of claim 53 wherein the strategic incision has a length that is less than ⅕ of the length of the long bone.
63 . The method of claim 53 wherein the strategic incision has a length that is less than 1/10 of the length of the long bone.
64 . A method for recovering an essentially intact bone or substantial portion of a bone from a donor with reduced detriment to the appearance of the donor, the method comprising:
a) separating the bone from essentially all surrounding soft tissue;
b) removing the bone or a substantial portion of the bone from the donor's body; and
c) leaving the soft tissue essentially intact in the donor's body
65 . A method for recovering an essentially intact bone or substantial portion of a bone from a donor with reduced detriment to the appearance of the donor, the method comprising:
(a) accessing the long bone through a strategic incision having a length which is less than the length of the long bone;
(b) removing the bone or a substantial portion of bone from the donor's body; and
(c) leaving the soft tissue essentially intact in the donor's body.
66 . The method of claim 65 wherein the strategic incision has a length that is less than ⅔ of the length of the long bone.
67 . The method of claim 65 wherein the strategic incision has a length that is less than ½ of the length of the long bone.
68 . The method of claim 65 wherein the strategic incision has a length that is less than ⅓ of the length of the long bone.
69 . The method of claim 65 wherein the strategic incision has a length that is less than ¼ of the length of the long bone.
70 . The method of claim 65 wherein the strategic incision has a length that is less than ⅕ of the length of the long bone.
71 . A method for separating a bone from surrounding tissue with reduced detriment to the surrounding tissue, the method comprising:
(a) making an incision which provides access to the bone while leaving the surrounding tissue essentially intact;
(b) positioning a moderately sharp edge at a surface of the bone through the incision;
(c) moving the moderately sharp edge between the bone and the surrounding tissue for at least part of the length of the bone.
72 . A method for removing a tendon from a limb of a deceased donor, the limb having a length, the method comprising:
accessing the tendon through a strategic incision having a length less than twice the length of the tendon;
separating the tendon from surrounding tissue; and
removing the tendon from the limb.
73 . The method of claim 72 , wherein the surrounding tissue is left essentially intact inside the limb.
74 . The method of claim 72 , wherein the tendon removed from the limb is essentially intact.
75 . The method of claim 72 , wherein the tendon is attached to one or more portions of bone, and the attached bone portions are removed from the limb with the tendon.
76 . The method of claim 72 , further comprising closing the strategic incisions to restore the appearance of the donor's body.
77 . An instrument for separating a bone from soft tissue surrounding the bone in a minimally invasive fashion, the instrument comprising:
(a) an elongated shaft having a length and two ends; and
(b) a tissue separator attached to one of the ends of the shaft, the tissue separator having a moderately sharp edge, the edge being essentially perpendicular to the length of the elongated shaft.
78 . The instrument of claim 77 , wherein the shaft comprises a plurality of connected segments.
79 . The instrument of claim 77 , wherein each of the segments are removably connected.
80 . The instrument of claim 77 , wherein the shaft comprises a plurality of telescoping segments.
81 . The instrument of claim 77 , further comprising a handle attached to the shaft at the end of the shaft opposite to the separator.
82 . The instrument of claim 77 wherein the moderately sharp edge is a lead edge, and the separator further comprises a sharp edge on the back side.
83 . The instrument of claim 77 wherein the shaft assembly is at least about 15 cm long.
84 . The instrument of claim 77 wherein the shaft assembly comprises a handle at the end opposite to the separator.
85 . The instrument of claim 77 wherein the edge is offset from the shaft by at least about 0.5 cm.
86 . The instrument of claim 77 wherein the edge has a shape that is reciprocal to at least a portion of the shape of a bone.
87 . The instrument of claim 77 wherein the edge has a shape that is reciprocal to at least a portion of the exterior of a femur.
88 . The instrument of claim 77 wherein the edge has a shape that is reciprocal to at least a portion of the exterior of a tibia.
89 . The instrument of claim 77 wherein the edge has a shape that is reciprocal to at least a portion of the exterior of a fibula.
90 . The instrument of claim 77 wherein the edge has a shape that is reciprocal to at least a portion of the exterior of a humerus.
91 . The instrument of claim 77 wherein the edge has a shape that is reciprocal to at least a portion of the exterior of a radius.
92 . The instrument of claim 77 wherein the edge has a shape that is reciprocal to at least a portion of the exterior of an ulna.
93 . The instrument of claim 77 wherein the edge has a shape that is reciprocal to at least a portion of the exterior of an iliac crest.
94 . The instrument of claim 77 wherein the edge has a shape that is reciprocal to at least a portion of the exterior of a pelvis.
95 . The instrument of claim 77 wherein the edge has a semi-circular shape.
96 . The instrument of claim 77 wherein the semi-circular edge defines a radius, and the radius is from about 1 cm to about 15 cm.
97 . The instrument of claim 77 wherein the edge has a circular shape.
98 . The instrument of claim 77 wherein the circular edge defines a radius, and the radius is from about 0.5 cm to about 20 cm.
99 . The instrument of claim 77 wherein the edge has a J-shape.
100 . The instrument of claim 77 wherein the J-shaped edge defines an angle, and the angle is from about 60 degrees to about 160 degrees.
101 . The instrument of claim 77 wherein the edge has a U-shape.
102 . The instrument of claim 77 wherein the U-shaped edge comprises two essentially parallel arms separated by a distance, and the distance is from about 0.5 cm to about 3.5 cm.
103 . The instrument of claim 77 wherein the edge has a C-shape.
104 . The instrument of claim 77 wherein the C-shaped edge comprises two arms with endpoints separated by a distance, and the distance is from about 0.1 cm to about 8.5 cm.
105 . The instrument of claim 77 wherein the edge has a O-shape.
106 . The instrument of claim 77 wherein the O-shaped edge comprises an essentially circular edge, and the diameter is from about 0.5 cm to about 20 cm.
107 . The instrument of claim 77 wherein the separator is removably attached to the shaft.
108 . The instrument of claim 77 wherein the separator is attached to the shaft by a screw-tapped surface.
109 . The instrument of claim 77 wherein the separator is attached to the shaft by a pin that intersects the shaft and the separator.
110 . The instrument of claim 77 wherein the separator is attached to the shaft by a screw that intersects the shaft and the separator.
111 . The instrument of claim 77 wherein the separator is attached to the shaft by a cotter pin.
112 . The instrument of claim 77 wherein the separator is attached to the shaft by a spring-loaded ball.
113 . The instrument of claim 77 wherein the separator is attached to the shaft by a key that allows slip and twist, and is locked in place with a threaded collar.
114 . An instrument for separating two soft tissues from one another in a minimally invasive fashion, the instrument comprising:
an elongated shaft having a length and two ends; and
a rigid tissue separator attached to one of the ends of the shaft, the tissue separator having a moderately sharp edge, the edge being essentially perpendicular to the length of the elongated shaft.
115 . The instrument of claim 114 wherein the edge has a U-shape.
116 . The instrument of claim 114 wherein the separator comprises an opening such that the separator is not a closed loop.
117 . An instrument for separating an Achilles tendon from a donor in a minimally invasive fashion, the instrument comprising:
an elongated shaft having a length and two ends;
a tissue separator attached at one end of the shaft, wherein the separator comprises a scoop.
118 . The method of claim 117 wherein the scoop is oriented along the length of the shaft.
119 . The method of claim 117 wherein the scoop has inside and outside surfaces, and each surface has a single trailing edge.
120 . The method of claim 117 wherein the scoop has an inner radius of from about 1 cm to about 5 cm and an outer radius of from about 0.5 cm to about 10 cm.
121 . The method of claim 117 wherein the scoop has a height of from about 0.1 cm to about 15 cm and a width of from about 0.5 cm to about 10 cm.
122 . A kit for procuring an essentially intact bone from a donor with reduced detriment to the donor, the kit comprising:
an elongated shaft having a length and two ends;
two or more tissue separators, wherein each of the tissue separators is selected from the group consisting of:
separators comprising a separator edge having a semi-circular shape;
separators comprising a separator edge having a circular shape;
separators comprising a separator edge having a J-shape;
separators comprising a separator edge having a C-shape;
separators comprising a separator edge having a U-shape; and
separators comprising a separator edge having a scoop shape;
wherein each of the separators is attachable to one of the ends of the shaft.
123 . A kit for procuring a bone from a donor with reduced detriment to the donor, the kit comprising:
an elongated shaft having a length and two ends;
two or more tissue separators, wherein each of the two or more tissue separators as a substantially similar shape but a different size than another of the separators.