Methods and apparatuses for fluoro-less or near fluoro-less percutaneous surgery access
A needle access assembly and method for obtaining percutaneous needle access with little or no fluoroscopy. The method can include selecting a target for percutaneous access, directing a laser guide at a desired needle-insertion angle and in line with the selected target, aligning the needle access assembly with the laser, and inserting the needle into the target.
1. A method of obtaining percutaneous needle access into a patient, the method comprising:
selecting a site for percutaneous access;
directing a light source beam at a desired needle-insertion angle and in line with the site;
aligning a needle access device with the light source beam, the needle access device comprising:
a needle;
an opaque proximal cap portion comprising an axial opening through the cap portion, the axial opening having a first diameter;
a non-opaque main body portion positioned between the cap portion and the needle, the main body portion having an interior space forming a hollow inner illumination chamber having a second interior diameter greater than the first diameter of the axial opening, wherein the illumination chamber comprises a distal wall portion and a translucent wall portion through which the light source beam can be visualized and wherein the first diameter is less than the second interior diameter by at least 50%; and
a proximal-facing, interior surface within the hollow illumination chamber of the main body portion and proximal to the distal wall portion of the illumination chamber, the interior surface comprising a convex reflective surface configured to reflect and scatter light from the light source beam throughout the entire illumination chamber when the light source beam is axially aligned with the needle and the opening in the cap portion; and
inserting the needle access device into the selected site, wherein inserting the needle access device comprises:
aligning the opening of the cap portion with the light source beam such that the light source beam is reflected and scattered within the illumination chamber so as to be visible through the translucent walk portion of the illumination chamber of the main body portion.
2. The method of claim 1 , wherein the light source beam is from a laser.
3. The method of claim 1 , further comprising decoupling the main body portion from the needle.
4. The method of claim 1 , further comprising:
positioning a flexible endoscope in the selected site;
detecting a position of a tip of the flexible endoscope; and
marking on a skin of the patient a location corresponding to the position of the tip of the flexible endoscope.
5. The method of claim 4 , wherein marking comprises positioning a clamp, a tool, or a radiopaque device on the skin of the patient at the location corresponding to the position of the tip of the flexible endoscope.
6. The method of claim 4 , wherein the endoscope comprises an ureteroscope and the selected site comprises a calyx.
7. The method of claim 4 , further comprising delivering an percutaneous surgery instrument through the endoscope.
8. The method of claim 7 , wherein the percutaneous surgery instrument comprises an expandable member.
9. The method of claim 7 , further comprising:
passing a guidewire through the needle to the site;
capturing the guidewire with a basket passed retrograde through the endoscope; and
pulling the basket to bring the guidewire down to establish through and through access.
10. The method of claim 4 , further comprising inserting a wire through the needle.
11. The method of claim 10 , further comprising:
advancing a basket catheter through the flexible endoscope, the basket catheter comprising a basket configured to move between an expanded configuration and a constrained configuration;
inserting the wire through an opening formed by the basket in the expanded configuration;
moving the basket from the expanded configuration to the constrained configuration; and
pulling the wire with the basket catheter.
12. The method of claim 1 , further comprising applying fluoroscopy for less than one minute.
13. The method of claim 1 , further comprising applying fluoroscopy for less than ten seconds.
14. The method of claim 1 , further comprising inserting the needle through a cannula.
15. The method of claim 14 , further comprising withdrawing the needle from the cannula after inserting the needle into the selected site.
16. The method of claim 1 wherein the first diameter is less than the second interior diameter by at least 50%.