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Publication Number
US-10376209-B2
Publication Date
2019-08-13
Expiration Date
Abstract
A method of locating a nerve within an intracorporeal space includes advancing a distal end portion of a stimulator toward an anatomical target within the intracorporeal space, and periodically applying a first electrical stimulus from a first electrode disposed on a central axis of the stimulator. If a muscular response to the first electrical stimulus is detected, a locating electrical stimulus is then applied from a plurality of locations offset from the central axis of the stimulator, and a magnitude of the response of the muscle is monitored. A distance between the nerve and each of the plurality of locations is determined from the magnitude of the muscular response, and from a magnitude of the locating electrical stimulus provided at each of the plurality of locations. The location of the nerve is then triangulated from the determined distance at each of the plurality of locations.
Core Innovation
The invention relates to a method of locating a nerve within an intracorporeal space by exploring the intracorporeal space with a stimulator shaped as an elongated cylinder with a distal end portion tapering to a tip and a central axis intersecting the tip. A first electrode is disposed in a first location at the tip on the central axis, and at least one second electrode is spaced apart from the first electrode and radially offset from the central axis in a second location.
A first electrical stimulus is periodically applied from the first electrode while the stimulator explores the intracorporeal space. A mechanical response of a muscle innervated by a nerve within the intracorporeal space to the first electrical stimulus is detected with a non-invasive mechanical sensor providing a mechanomyography output signal corresponding to the mechanical response of the muscle. After detecting the mechanical response, a locating electrical stimulus is applied from the at least one second electrode at a plurality of locations, and the magnitude of the mechanical response of the muscle to the locating electrical stimulus is monitored at the second location.
A distance between the nerve and the second location is determined from the magnitude of the mechanical response to the locating electrical stimulus and from a magnitude of the locating electrical stimulus without using an electromyography signal corresponding to an electrical potential of the muscle and skin of the subject. A location of the nerve is determined by triangulating the location from the determined distance at each of the plurality of locations, thereby precisely guiding the stimulator within the intracorporeal space without contacting the nerve.
The document further supports determining distances and a location by using determining a minimum magnitude of the electrical stimulus needed to induce the mechanical response at each of the plurality of locations, and then triangulating the nerve location from the determined minimum magnitude without using an electromyography signal. The approach is described with optional concepts of maintaining a virtual three-dimensional model of the nerve in a virtual workspace using the triangulated nerve location and a monitored position of the stimulator.
Claims Coverage
Two independent claims are identified. Across the independent claims, the coverage includes a shaped elongated-cylinder stimulator with a central-axis first electrode and radially offset second electrodes, non-invasive mechanomyography-based detection, electromyography excluded for distance/location determination, and triangulation to guide the stimulator without contacting the nerve.
Elongated-cylinder stimulator with central-axis and radially offset electrodes for exploring and locating
The stimulator is shaped as an elongated cylinder having a distal end portion tapering to a tip and a central axis intersecting the tip; a first electrode is disposed at the tip on the central axis and at least one second electrode is spaced apart from the first electrode and radially offset from the central axis in a second location.
Non-invasive mechanomyography-based detection of nerve-innervated muscle mechanical response
A mechanical response of a muscle innervated by a nerve to the first electrical stimulus is detected with a non-invasive mechanical sensor configured to provide a mechanomyography output signal corresponding to the mechanical response of the muscle.
Locating electrical stimulus at plurality of radially offset locations and mechanomyography magnitude monitoring
After detecting the mechanical response, a locating electrical stimulus is applied from the at least one second electrode at a plurality of locations, and the magnitude of the mechanical response of the muscle to the locating electrical stimulus is monitored at the plurality of locations.
Distance and triangulation without using electromyography signal
A distance is determined from mechanical-response magnitude and a magnitude of the locating electrical stimulus without using an electromyography signal corresponding to an electrical potential of the muscle and skin of the subject, and a location of the nerve is determined by triangulating the location from the determined distance at each plurality of locations to precisely guide the stimulator within the intracorporeal space without contacting the nerve.
Minimum magnitude locating-stimulus determination for triangulation
A minimum magnitude of the electrical stimulus needed to induce the mechanical response is determined at each of the plurality of locations, and a location of the nerve is determined by triangulating from the determined minimum magnitude of the locating electrical stimulus at each of the plurality of locations without using an electromyography signal.
The independent claims center on locating a nerve using a cylindrically-shaped stimulator with a central-axis first electrode and radially offset locating electrodes, detecting a muscle mechanical response using non-invasive mechanomyography, and deriving nerve distance or location from mechanomyography and locating-stimulus magnitudes while excluding electromyography, followed by triangulation to guide the stimulator without contacting the nerve.
Stated Advantages
Precisely guide the stimulator within the intracorporeal space without contacting the nerve.
Determine a distance and nerve location without using an electromyography signal corresponding to an electrical potential of the muscle and skin of the subject.
Documented Applications
Locating a nerve within an intracorporeal space of a subject to guide the stimulator without contacting the nerve.
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