The disclosed embodiments relate generally to methods and systems for providing illumination during phlebectomy procedures. Phlebectomy is a standard treatment for varicosities arising from incompetent veins, particularly those below the saphenofemoral and saphenopopliteal junctions. This technique involves the avulsion and removal of the varicose veins through multiple stab incisions made directly over the veins, which are removed using surgical tools, such as hooks and mosquito forceps. Proper location of the veins to be removed is essential for proper situation of the incisions. In general, this is accomplished by preoperative vein location and marking, a procedure generally accomplished with the patient in a standing position so that the veins become engorged with blood due to the action of gravity and thus easily marked; however, the phlebectomy operation is generally conducted with the patient in a supine position. The position of the incompetent veins may shift during the transition from a standing to a supine position, and often further marking is conducted after the patient is placed in the surgical position in an attempt to track these shifts. Once the patient has been marked and incisions have been made along the length of the vein to be removed, the surgeon probes with the surgical implements, such as hooks, to locate the vein.
In one embodiment, a method comprises (a) illuminating a blood vessel in a relatively low-light surgical field by inserting a subcutaneous light source into tissue near the blood vessel and to a first location in the tissue underlying the blood vessel, and causing emission of light from the subcutaneous light source while the subcutaneous light source is at the first location, so that light from the subcutaneous light source passes through the tissue near the blood vessel, toward an observer; (b) drawing a portion of the tissue near the blood vessel through an incision in the skin; and (c) illuminating the drawn portion of tissue by activating an external light source in a hands-free manner, thereby facilitating determining whether the drawn tissue is the blood vessel.
In the method, the blood vessel can optionally be a vein, such as a varicose vein, or a superficial leg vein near the skin surface. The surgical field can optionally be an area at least about 20 cm wide and centered on the subcutaneous light source insertion site, extending at least about 20 cm from the skin surface at the subcutaneous light source insertion site toward an observer (e.g. a surgeon). The method can optionally further comprise, prior to drawing the portion of tissue near the vein, selecting the portion of the tissue based on observing the tissue illuminated by the subcutaneous light source. The external light source can optionally be worn on the surgeon's head and/or activated by a movement of the head (such as a nod of the head). The external light source can optionally be one which is activated without use of the hands or feet, and/or by the surgeon himself or herself without commanding another person to activate an external light source. The external light source can optionally provide broadband or white light in a floodlight fashion in the surgical field.
In another embodiment, a surgical illumination system comprises a subcutaneous illuminator having an elongate member configured for insertion into subcutaneous tissue. The elongate member has a light emitter near its distal end, and the light emitter is configured to emit light primarily in a generally radial direction, outward and away from a longitudinal axis of the elongate member. The system further comprises an external illuminator configured to illuminate a surgical field in a floodlight fashion. The external illuminator is configured for activation without use of the hands.
In the system, the external illuminator can optionally be configured to be worn on the surgeon's head and/or activated by a movement of the head (such as a nod of the head). The external illuminator can optionally include an inertial switch or accelerometer to facilitate such activation. The external illuminator can optionally be one which is activated without use of the hands or feet, and/or by the surgeon himself or herself without commanding another person to activate an external illuminator. The external illuminator can optionally provide broadband or white light in a floodlight fashion in the surgical field.
In the drawings:
Methods and systems for providing illumination during phlebectomy procedures are disclosed. The methods and systems can provide subcutaneous illumination for visualization of veins and surrounding tissue and external illumination of material removed through the incisions for identification thereof. More particularly, after the patient has been marked and at least one incision has been made during the phlebectomy procedure, the surgeon attempts to locate the vein through the incisions, which can be difficult when the vein has shifted from the marked positions upon movement of the patient to the supine position. To facilitate vein location, the surgeon can employ an illumination device, such as a subcutaneous illumination device, that provides internal illumination for visually distinguishing the vein from the surrounding tissue. The subcutaneous illumination device can emit light at wavelengths selected to render the appearance of the vein dark, such as black, against a highlighted background of surrounding tissue. The illumination source can be relatively small and concentrated, and the region illuminated by the subcutaneous illumination device can often be viewed best when the room is relatively dark, which can be achieved by turning off or dimming the room lights. After location of the vein inside the body, the surgeon pulls a hook or other surgical implement from the incision and visually inspects material removed therewith for identification of the vein. However, this visual inspection can be difficult when the room is relatively dark for optimized efficacy of the subcutaneous illumination device, and the surgeon can employ an external illumination device that provides external illumination to facilitate the visual inspection.
One embodiment of the system comprises a subcutaneous illumination apparatus 10, an example of which is illustrated in
In the illustrated embodiment, the blade 22 or shaft 20 incorporates the electroluminescent device 16, which is configured to both generate and emit light in a generally radial direction, outward and away from a longitudinal axis of the illuminator portion 14. Any suitable type of electroluminescent lighting apparatus that can be accommodated within the blade 22 or shaft 20 can be employed as the electroluminescent device 16. Examples of electroluminescent devices include LED elements and other solid state light emitters. Individual light emitting elements 24 can be assembled into a linear array to form the device 16, as seen in the enlarged plan view of the electroluminescent device 16 in
The subcutaneous illumination apparatus 10 shown in
As mentioned above, the illumination system comprises the external illumination apparatus 30 in addition to the subcutaneous illumination apparatus 10. While the subcutaneous illumination apparatus 10 provides internal illumination (i.e., illumination internal of the body of the patient) for identifying veins, the external illumination apparatus 30 provides external illumination (i.e., illumination external to the body of the patient) for inspection of the material removed from the patient's body. The external illumination apparatus 30 provides the external illumination without the use of the hands of the surgeon so that the hands remain free for manipulating the subcutaneous illumination apparatus 10, hooks, and/or other surgical instruments. The illustrated embodiment of the external illumination apparatus 30 achieves hands-free operation via mounting the apparatus 30 on the surgeon's head and actuation of the apparatus 30 in response to movement of the surgeon's head.
Referring now to
The headband 34 supports an illumination assembly 50 at the front portion 36 and a power source 52 for the illumination assembly 50 at the rear portion 38. The illumination assembly 50 comprises an illumination source 54 provided within an illumination source housing 56 and a lens 58 positioned at the front end of the housing 56. The lens 58 protects the illumination source 54 within the housing 56 and can optionally function as a filter for light emitted by the illumination source 54. An adjustable mount 60 couples the housing 56 to the headband 34 and includes a pivotable joint 62 at which the housing 56 connects to the mount 60 and about which the housing 56 can pivot for moving the housing 56 and, thereby, the illumination source 54, in up and down directions. In some embodiments, the mount 60 can be configured for additional adjustment of the housing 56 and/or the illumination source 54 in other directions, such as lateral or side-to-side movement. In certain embodiments, the mount 60 can be configured for adjustment of the housing 56 and/or the illumination source 54 in any direction, such as via a universal or U-joint. The adjustment of the housing 54 and/or the illumination source 54 in the illustrated embodiment is accomplished manually, and other embodiments employ other adjustment methods, such as verbal/speech recognition adjustment to further render the external illumination apparatus 30 hands-free.
The illumination source 54 can be any suitable device that provides desired external illumination during a phlebectomy procedure. In one embodiment, the desired external illumination is a broad field of white light that sufficiently illuminates a relatively dark room to allow the surgeon to perform the visual inspection of the material removed from the patient. Such light can be provided by any suitable illumination source, including, but not limited to, electroluminescent illumination sources, such as LEDs, and conventional light bulbs, such as fluorescent and incandescent light bulbs. In other embodiments, the desired external illumination can be a broad field of colored (i.e., not white) light that facilitates the visual inspection of the material or a narrow, focused field of white or colored light. In one embodiment, the wavelength(s) of light provided by the illumination source 54 can be selected to aid the surgeon in distinguishing the vein from surrounding tissues, such as fat tissue.
The power source 52 that provides power to the illumination source 54 in the illustrated embodiment comprises a portable power source in the form of a battery. The battery can be any suitable battery, including replaceable and/or rechargeable batteries. In one embodiment, the battery can be rechargeable and removed from the head mount 32 for coupling to a charger. In another embodiment, the entire external illumination apparatus 30 can be coupled to a charger, such as via a docking station or a cord that connects the battery to a power outlet. The power source 52 can also include a cord or other physical connection that couples the illumination source 54 to an external source of power, either to replace the portable power source or to be used as a back-up in the event that the portable power source becomes depleted during use of the external illumination apparatus 30.
A set of wires 70, 72 electrically connects the power source 52 to the illumination source 54, and a switch 80 controls the supply of electricity from the power source 52 to the illumination source 54. As best viewed in
In the illustrated embodiment, the switch 80 is an inertial switch in the form of an acceleration switch responsive to the movement of the surgeon's (or other wearer's) head. The switch 80 is partially located within a switch housing 82 mounted to the harness 44. Referring now to
Actuation of the switch 80 results from movement of the ball 90 within the chamber 88. When the switch 80 undergoes sufficient movement for the ball 90 to accelerate forward and overcome the bias of the compression spring 92, the moving ball 90 compresses the compression spring 92 and eventually contacts the plunger 96. The moving ball 90 applies a linear force to the plunger 96, which responds by moving linearly through the bore 94 to an extended position whereby the first electrical contact 98 on the plunger 96 contacts the second electrical contact 104 on the arm 102, as illustrated in
The electrical circuit can be any suitable electrical circuit that functions to turn the illumination source 54 on and off upon actuation of the switch 80, and
Referring now to
As just described, movement of the head of the surgeon wearing the external illumination apparatus 30 actuates the switch 80 to turn the illumination source 54 on and off. The switch 80 defaults to the unactuated condition shown in
An exemplary method of operation of the above described embodiment of the system for providing illumination during phlebectomy procedures follows. The method comprises providing internal illumination with the subcutaneous illumination apparatus 10 and providing external illumination with the external illumination apparatus 30.
Commonly, phlebectomy procedures involve the use of tumescent anesthesia, using, for example, large-volume, low-concentration lidocaine. Subcutaneous application of the tumescing solution elevates the veins closer to the skin surface and increases the field of illumination. Where the standard anesthesia protocol is inadequate to provide the desired conditions for illumination, additional saline solution can be injected.
The surgeon's preparation for the phlebectomy procedure includes placing the external illumination apparatus 30 upon the head by positioning the headband 34 around the head with the front portion 36 on the forehead and the rear portion 38 on the rear of the head such that the illumination assembly 50 and power source 52 are located on the forehead and the rear of the head, respectively, as shown in
During the following portion of the method involving the use of the subcutaneous illumination apparatus 10, the illumination source 54 of the external illumination apparatus 30 is in the off condition. At the least, the illumination source 54 is in the off condition when the subcutaneous illumination apparatus 10 illuminates the interior of the body for vein identification. Further, lights in the procedure room, such as an operating room, are preferably off or dimmed for optimized performance of the subcutaneous illumination apparatus 10.
Holding the handle 12 of the apparatus 10, the surgeon inserts the illuminator portion 14 through a skin incision made in the vicinity of a vein to be avulsed. The surgeon can engage the electroluminescent device 16 using the switch 18 either before inserting the illuminator portion 14 or after insertion. The handle 12 is manipulated to place the apparatus 10 beneath a vein to be avulsed, with the electroluminescent device 16 facing upward (or radially outward, or otherwise toward the surgeon or observer). The light emitted by the electroluminescent device 16 passes upward through the vein (including the deoxygenated blood in the vein) and the surrounding tissue, thereby enabling the surgeon to better visualize the vein. For example, where the electroluminescent device 16 emits red, yellow or amber light, or light having a wavelength of 630-670 nm, or approximately 610 nm or less, the vein appears black in contrast to the surrounding tissue, which appears red or yellow. When viewed through the skin, the vein appears as a dark shadow, thereby facilitating location and the placement of further incisions, if required.
For the initial location of the vein, in one embodiment, the surgeon orients the longitudinal axis of the electroluminescent device 16 transverse to the presumed longitudinal axis of the vein. This configuration offers an improved chance that the vein falls within the field of illumination of the electroluminescent device 14. Once the vein has been located, the surgeon can employ the blade 22 to locally avulse the vein prior to its removal through the skin incisions. Alternatively, a separate surgical implement such as a phlebectomy hook or forceps can be inserted into the incision(s) and employed to hook or grip, and avulse the vein along its length while it is being visualized through the skin.
When the surgeon removes the vein through the incision, some other material, such as fat and other surrounding tissues, is frequently removed along with or instead of the vein, and the surgeon performs a visual inspection of the removed material for identification of the vein and separation of the vein from the surrounding tissue. Because the procedure room is relatively dark, the surgeon can employ the external illumination apparatus 30 to provide illumination for the visual inspection. In particular, the surgeon, wearing the external illumination apparatus 30 on the head, quickly nods the head to actuate the switch 80, as described above in detail, to convert the illumination source 54 from the off condition to the on condition. The light provided from the illumination source 54 enables the surgeon to better visualize the removed material for more accurate identification of the removed vein. If surrounding tissue has indeed been removed with the vein, the surgeon can separate the vein from the surrounding tissue. Upon completion of the visual inspection or whenever desired, the surgeon performs another quick head nod to actuate the switch 80 and, thereby, convert the illumination source 54 from the on condition to the off condition. The surgeon can turn the illumination source 54 on and off as needed throughout the phlebectomy procedure.
The above method can be adapted for use with other types of apparatuses that provide internal illumination. Examples of other operation methods for other types of internal illumination apparatuses are given in the aforementioned and incorporated '371 publication and corresponding application. Further, the above method can be adapted for use with other types of switches that are activated in hands-free (or hands-free and feet-free) manners other than nodding the head.
While the external illumination apparatus 30 has been described as part of the illumination system for phlebectomy procedures, the apparatus 30 can be employed alone or in other systems for other types of procedures. Further, the external illumination apparatus 30 can be employed with other types of internal illumination devices for phlebectomy or other types of procedures.
While certain invention(s) have been specifically described herein in connection with certain specific embodiments thereof, it is to be understood that this description is an illustration of useful embodiments of the invention(s) and not a limitation of the scope of the invention(s).
This application claims the benefit of priority under 35 U.S.C. §119(e) of U.S. Provisional Application No. 61/174,631 filed on May 1, 2009 and entitled “METHODS AND SYSTEMS FOR ILLUMINATION DURING PHLEBECTOMY PROCEDURES,” which is hereby incorporated herein by reference in its entirety and is to be considered a part of this specification.
Number | Date | Country | |
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61174631 | May 2009 | US |