Patent Application
20080188794
The present invention relates to methods and devices for performing surgical procedures, and in particular to methods and devices for manipulating tissue and creating a space in a body cavity.
In certain minimally invasive surgical procedures, e.g., endoscopic and laparoscopic surgeries, a surgeon performs diagnostic and therapeutic procedures at the surgical site through a natural body aperture or through one or more small incisions, using instruments specially designed for this purpose. Problems encountered by a surgeon in such minimally invasive surgical procedures include reduced visibility and field of vision. Other problems that emerge during such surgeries include limited availability of space for the use of additional tools, since existing access devices, such as endoscopes, take up nearly all of the afforded space.
Further, some minimally invasive surgical procedures employ insufflation techniques to create a working and viewing space in the target lumen or organ. However, insufflation can lead to several problems. For example, the pressure required to insufflate the abdominal cavity can cause the stomach to collapse. Difficulties with insufflating only the target body cavity can also arise.
Accordingly, there is a need for methods and devices for manipulating tissue and creating space in a body cavity, which avoid the need for insufflation techniques, and provided enhanced visibility and field of vision.
The present invention generally provides methods and devices for manipulating tissue and creating space in a body cavity, particularly during minimally invasive surgical procedures. In one embodiment, a device for manipulating tissue can include a first elongate member with a cable coupled thereto, a second elongate member slidably disposed on the cable and movable between a first position in which the first elongate member and second elongate member are configured to be inserted through a hollow tube, and a second position in which the first elongate member and second elongate member mate to one another and are configured to engage tissue. The device can further include an imaging apparatus disposed on at least one of the first elongate member, the second elongate member, and the cable. In one aspect, the imaging apparatus is at least one of a CCD chip and a CMOS chip.
The cable of the device of the present invention can be manipulated to move the tissue. The cable can also include a proximal end having a piercing tip. In one aspect, the piercing tip can be in the form of a needle.
The first and second elongate members can be mated to another in a variety of ways. In one embodiment, a first surface of the first elongate member has a first mating structure formed therein and a mating surface of the second elongate member has a second mating structure formed thereon, the second mating structure being complementary with the first mating structure. The first and second mating structures can be configured to engage each other when the first and second elongate members are operatively mated. In another aspect, the first elongate member and the second elongate member mate in a substantially perpendicular orientation.
In another embodiment, at least one of the first elongate member, the second elongate member, and the cable can further include at least one illumination element coupled thereto. In one aspect, the illumination element can be in the form of a light-emitting diode.
In yet another embodiment, the device can also include an actuation mechanism to enable operation of the imaging apparatus, and an actuation mechanism effective to enable operation of the illumination element. In one aspect, the cable communicates a signal from the imaging apparatus. In another aspect, a wire, which communicates a signal from the imaging apparatus, is adjacent the cable.
In one embodiment, an exemplary method for creating a space in a body cavity can include delivering a tissue-tenting apparatus coupled to a cable in a delivery configuration to a surgical site through a natural body orifice, manipulating the cable to configure the tissue-tenting apparatus in a deployed configuration such that at least a portion of the tenting apparatus is capable of lifting tissue at the surgical site, and activating an imaging apparatus formed on one of the tenting apparatus and the cable to enable visualization of the surgical site.
In one aspect, the surgical site is the stomach. In another aspect, the tenting apparatus, in the deployed configuration, is in the form of a first and second elongate members mated to one another in a substantially perpendicular orientation.
In another embodiment, manipulating the cable is effected by breaching the stomach wall and the peritoneal wall with a proximal portion of the cable such that it exits the body cavity, and exerting a pulling force on the cable. Following manipulation of the cable, the exemplary method can further include activating an illumination source associated with one of the tenting apparatus and the cable.
The invention will be more fully understood from the following detailed description taken in conjunction with the accompanying drawings, in which:
Certain exemplary embodiments will now be described to provide an overall understanding of the principles of the structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments and that the scope of the present invention is defined solely by the claims. The features illustrated or described in connection with one exemplary embodiment may be combined with the features of other embodiments. Such modifications and variations are intended to be included within the scope of the present invention.
The present invention generally provides methods and devices for manipulating tissue, and in particular for tenting a wall of a body cavity to create a space within the body cavity. The term “body cavity” is used herein in its broad sense and includes any hollow lumen within the body, such as organs, as well as cavities within the body, such as the peritoneal cavity.
The methods and devices described herein can include introducing and deploying a space-creating frame within a body cavity, manipulating a lifting wire to tent a tissue wall of the body cavity, and activating an illumination source and imaging apparatus to provide visibility within the body cavity. Effecting the manipulation of tissue and creation of a space within a body cavity with a deployable apparatus is advantageous in that it avoids the complications associated with insufflation of body cavities. In addition, the use of a deployable apparatus that includes illumination and imaging components provides enhanced illumination and visibility in the space created by the deployable apparatus.
While the devices and methods disclosed herein can be used in conventional, open surgical procedures, they are particularly useful in minimally invasive surgical procedures, such as laparoscopic and endoscopic procedures. The principles described herein can be applicable to the particular types of tools described herein, and to a variety of other surgical tools having similar functions. In addition, the tools can be used alone in a surgical procedure, or they can be used in conjunction with other devices, such as endoscopes, that facilitate minimally invasive surgical procedures.
The first elongate member 20 can be fixably mated to the distal end 32 of the cable 30 with the second elongate member 40 slidably disposed thereon. The second elongate member 40 can be configured such that is movable between a first position and a second position.
The first elongate member 20 and the cable 30 can be coupled to one another in a variety of ways, and one or both of the first and second elongate members 20, 40 can have mating features, as described below, to facilitate mating. In one embodiment, the cable 30 is coupled to an intermediate portion of the body 22 of the first elongate member 20. One skilled in the art will appreciate that the first elongate member 20 and the cable 30 can be coupled to one another along any portion or length thereof, such that the cable 30 and the first elongate member 20 are configured to cooperate to move tissue. Further, as shown in
The first and second elongate members can have virtually any configuration that enables them to manipulate tissue and tent a wall of a body cavity. For example, the device 10 can be constructed as a deployable mechanical wall lift, or formed from a set of elongate members that can be assembled, in situ, into the form of a cross-bar. In another example, the device 10 can be formed from a large spiral screw, which may be introduced percutaneously, and positioned to accommodate atraumatic lifting of a tissue or lumen wall. Alternatively, the device 10 can be formed from a large extra-corporal vacuum cup that facilitates atraumatic lifting of tissue or a lumen wall from outside the body.
The first and second elongate members 20, 40, can further include various shapes and dimensions. As shown in
As described above, the cable 30 of the device 10 can have a distal end 32 and a proximal end (not shown). The proximal end of the cable 30 can include a piercing tip, which in one embodiment, can be in the form of a needle. It will be understood by one skilled in the art that the piercing tip can have any shape or configuration that enables the proximal end of the cable 30 to breach tissue or a body cavity wall.
The cable 30 can be formed in varying lengths and thickness, but it should be suitable to enable the cable 30 to be passed transmurally such that the distal end 32 remains within a body cavity, while the proximal end extends to a location external to the body cavity. The thickness of the cable 30 can have any circumference suitable for enabling the elongate members 20, 40 to be slidably movable along the cable. Further, the cable 30 can have a strength sufficient to support the elongate members, as well as to absorb the stress associated with lifting and tenting tissue or a wall of a body cavity.
As illustrated in
The present invention further provides for an imaging apparatus 50 disposed on at least one of the first elongate member 20, the second elongate member 40, and the cable 30. In one exemplary embodiment, as illustrated in
The device 10 can also include an actuation mechanism to enable operation of at least one of the illumination element 60. An actuation mechanism to enable operation of the imaging apparatus 50 can further be included. In an exemplary embodiment, the cable 30 can serve as the actuation mechanism providing a signal wire and a power wire for operation of the illumination element 60 and the imaging apparatus 50. Alternatively, a wire communicating a signal from the imaging apparatus 50 and/or the illumination element 60 can be separately provided and positioned adjacent the cable 30.
In general, the various components of the device 10 can be formed from virtually any material suitable for use within a patient's body. By way of non-limiting example, suitable materials include metals such as aluminum, stainless steel or titanium, shape-memory materials, polymers, or various other biocompatible materials. The components of the device 10 can also be rigid or flexible. In one exemplary embodiment, the elongate members 20, 40 and the cable 30 are sufficiently flexible to allow the elongate members 20, 40 and the cable 30 to be inserted endoscopically through a natural orifice and through a tortuous body lumen. In another embodiment, the elongate members 20, 40 can be sufficiently rigid to enable manipulation of tissue when coming into contact therewith. The cable 30 can also have sufficient rigidity to effectively transmit a pulling force or tension from the proximal end of the cable 30 to the distal end 32 thereof.
As shown in
Exemplary methods for creating a space in a body cavity and tenting a wall of a body cavity are further described with reference to
Following the delivery of the tissue-tenting apparatus 100 to the stomach 70, a proximal portion 134 of the cable 130, which can include a piercing tip 135, can be passed through the stomach region to pierce the stomach wall and the peritoneal wall, such that the proximal portion 134 of the cable 130 exits the stomach 70 and the body of the patient.
Upon transmural passage of the cable 130, tension, such as a pulling force, can be exerted on the proximal portion 134 thereby manipulating the cable 130 to configure the tissue-tenting apparatus 100 in a deployed configuration such that at least a portion of the tissue-tenting apparatus 100 is capable of lifting tissue at the surgical site. As illustrated in
Once the stomach wall 72 is tented as illustrated in
The method described above can provide many advantages. For example, the creation of a space in a body cavity using a mechanical wall lift avoids the need for insufflation techniques when performing minimally invasive surgical procedures. In addition, the provision of illumination elements and an imaging apparatus on a wall lift provide enhanced illumination and visibility to an internal surgical site. While the above method has been described in terms of the manipulation and creation of space in the stomach, one skilled in the art will appreciate that the methods and devices described herein are equally applicable to the manipulation of other tissue or body cavities in a variety of minimally invasive surgical procedures.
One skilled in the art will appreciate further features and advantages of the invention based on the above-described embodiments. Accordingly, the invention is not to be limited by what has been particularly shown and described, except as indicated by the appended claims. All publications and references cited herein are expressly incorporated herein by reference in their entirety.
