Surgical access system and related methods

Abstract

A surgical access system including a tissue distraction assembly and a tissue refraction assembly, both of which may be equipped with one or more electrodes for use in detecting the existence of (and optionally the distance and/or direction to) neural structures before, during, and after the establishment of an operative corridor to a surgical target site.

1 . A method comprising:
 advancing a plurality of blades in a trans-psoas fashion to a surgical target site within a patient while the plurality of blades is in a closed position;   while advancing the plurality of blades:
 causing electrical stimulation signals to be provided to the patient via a stimulation electrode; and 
 determining a proximity of nerve tissue to the plurality of blades based on a response to the electrical stimulation; and 
   selectively open the plurality of blades to create a customized operative corridor to the surgical target site.   
     
     
         2 . The method of  claim 1 , further comprising:
 determining a nerve direction relative to the plurality of blades.   
     
     
         3 . The method of  claim 1 , further comprising:
 coupling the stimulation electrode to at least one of the plurality of blades;   electrically coupling the stimulation electrode to a patient module; and   communicatively coupling the patient module to a control unit having a touch screen display.   
     
     
         4 . The method of  claim 1 , further comprising:
 electrically coupling the stimulation electrode to a patient module;   communicatively coupling the patient module to a control unit having a touch screen display;   coupling a sensor harness to the patient; and   electrically coupling the sensor harness to the patient module.   
     
     
         5 . The method of  claim 1 , further comprising:
 actuating a knob, thereby causing one or more teeth to engage within ratchet-like grooves of an assembly that includes the plurality of blades.   
     
     
         6 . A method comprising:
 while a plurality of blades of a retractor assembly is being advanced simultaneously to a surgical target site while in a closed position:
 sending electrical stimulation signals to patient tissue via one or more stimulation electrodes provided at the retractor assembly such that, depending upon a proximity of the plurality of blades to nerve tissue, the electrical stimulation signals cause the nerve tissue to depolarize, thereby causing one or more muscle groups to generate electromyography responses; 
 sensing the electromyography responses via an electromyography harness; and 
 providing an indication of a level of the electromyography responses at a user interface of a touch screen. 
   
     
     
         7 . The method of  claim 6 , further comprising:
 providing an indication of nerve directed at the touch screen based on the electromyography responses.   
     
     
         8 . The method of  claim 6 , further comprising:
 receiving one or more user commands over the touch screen,   wherein the sending of the electrical stimulation signals is based on the one or more user commands.   
     
     
         9 . The method of  claim 6 , further comprising:
 receiving the sensed electromyography responses at a patient module coupled to the electromyography harness;   digitizing the sensed electromyography responses at the patient module; and   communicating the digitized responses to a control unit,   wherein the providing of the indication is performed by the control unit.   
     
     
         10 . The method of  claim 9 , further comprising:
 processing the digitized responses at the control unit to extract characteristic information for the one or more muscle groups; and   providing a result of the processing at the user interface.   
     
     
         11 . The method of  claim 6 , further comprising:
 providing, at the user interface, at least two of the following:
 a graphical representation of a patient; 
 myotome levels being monitored; 
 a name of an instrument being used; 
 a size of the instrument being used; 
 a graphical representation of the instrument being used; 
 a stimulation current being applied; 
 an instruction to a user; and 
 an indication of a direction from the instrument to a nerve.