Patent Application
20080208227
Not applicable.
Not applicable.
The present invention relates to the harvesting of blood vessels and, more particularly, to a method and apparatus for dissection and removal of sections of blood vessels.
The harvested vessels are used in many surgical procedures, including use as a coronary artery bypass graft, or in other cardiovascular procedures. As one example, in vascular and cardiovascular procedures, a blood vessel or vessel section, such as an artery or vein, is “harvested” (i.e., removed) from its natural location in a patient's body and is used elsewhere in the body. In coronary artery bypass grafting surgery, for example, the harvested blood vessel is used to form a bypass between an arterial blood source and the coronary artery that is to be bypassed. Among the preferred sources for the vessels to be used as the bypass graft are the saphenous vein in the leg and the radial artery in the arm.
Endoscopic surgical procedures for harvesting a section of a blood vessel (e.g., the saphenous vein) subcutaneously have been developed in order to avoid disadvantages and potential complications of harvesting of the blood vessel. In the past, the harvesting was done through a continuous incision (e.g., along the leg) that exposed the full length of the desired vein section. The continuous incision had been necessary in order to provide adequate exposure for visualizing the vein and for introducing the surgical instruments to sever, cauterize and ligate the tissue and side branches of the vessel.
A more recent development has been a minimally-invasive technique that employs a small incision for locating the desired vessel and for introducing one or more endoscopic devices into the small incision.
Commercially available products for performing the endoscopic blood vessel harvesting procedure include a number of separate devices that are each connected to remote or outside devices. Current devices use an insufflation device having plastic tubing to supply air or CO2 device to insufflate the subcutaneous area, an endoscope having a camera and light cables in order to visualize both the dissection and harvesting procedures, and a harvester and/or dissector device having electrical or other lines to supply the dissecting and/or cauterizing of the vessel. In certain instances, the combination of wires, plastic tubing and fittings can be bulky and cumbersome for the person performing the vessel harvesting.
It would be desirable to have a dissector/harvester device that is more compact and does not require many external wires, cables or tubes.
In one aspect, there is provided a self-contained device for dissecting and/or harvesting a vessel and severing any branches extending therefrom The self-contained dissecting/harvesting device has a sheath for insertion in a body through a cut skin portion.
In one particular aspect, positioned within the sheath are a self-contained light source, a self-contained imaging system, and a severing device.
In certain embodiments, the severing device comprises a tip in an axial position over a distal end of the sheath, the tip being configured to be axially movable between an open position and a closed position configured to dissect the vessel and branch upon movement to the closed position.
In certain embodiments, the self-contained light source and the self-contained imaging system are removable from the device. Also, when present, the self-contained insufflation device can be removable from the device.
In certain embodiments, both the distal end of the sheath and a proximal end of the tip have at least one generally mating surface whereby, when the tip is adjacent to the sheath, the generally mating surfaces are configured to secure the vessel being harvested while a vessel branch is being severed. The tip and the sheath can include electrodes configured for being electrically energized to sever and cauterize a vessel branch.
In certain embodiments, the self-contained dissector/harvester device further includes a self-contained insufflation device to supply a gas subcutaneously to an area adjacent to the vessel.
In another aspect, there is provided a method of severing branches from a vessel during harvesting from a body by a self-contained dissector/harvester device which includes: inserting a distal end of the self-contained dissector/harvester device into the body alongside the vessel to form a cavity substantially surrounding the vessel; activating the self-contained light source to at least illuminate a portion of the branch; activating the self-contained imaging system to view at least a portion of the illuminated branch; and, moving the severing device to a position substantially adjacent to the branch and activating the severing device, whereby the vessel and branch are severed from the vessel. In certain embodiments, the method further includes supplying a gas subcutaneously to an area adjacent to the vessel to be dissected and harvested.
Various objects and advantages of this invention will become apparent to those skilled in the art from the following detailed description of the preferred embodiment, when read in light of the accompanying drawings.
A tip 20 is axially positioned over the distal end 18 of the sheath 12. At least a portion of the dissector tip 20 is transparent in order to allow visualization of the vessel V and the surrounding tissue, as further explained below. As best seen in
Referring again to
The self-contained dissector/harvester device 10 also includes a self-contained imaging system 40 that is axially positioned within inner space 24 of the tip 20. It is to be understood, that in other embodiments, the self-contained imaging system 40 can be axially positioned within the inner space 14 of the sheath 12 is a spaced apart relationship to the tip 20.
In the embodiment shown in
The camera 41 that is pivotably mounted on a support 42 and can be oriented in a first, or proximal-viewing, direction toward the light source 30 or in a second, or distal-viewing, direction toward the tip 20. In one non-limiting embodiment shown in the FIGURES herein, the self-contained imaging system 40 can include, for example, a spring mechanism 44 axially mounted on the support 42. The spring mechanism 44 can include a tangentially extending end 46 that is operatively connected to a longitudinally extending member 47 which, in turn, is connected to a handle 48 for pivotably moving the camera 41 between the first and second directions.
It should be understood, that in other embodiments, other suitable mechanisms can be used for directing the movement of the camera 41 and/or for receiving the images from the imaging system 40. For example, in the embodiment shown in
In certain embodiments, the self-contained imaging system 40 and the self-contained light source 30 are in an opposed axial relationship where the self-contained imaging system 40 is configured to be directed in a direction towards the self-contained light source 30. In other embodiments, the self-contained imaging system 40 and the self-contained light source 30 are in a parallel relationship and re generally configured to be directed in the same direction.
During use, the imaging system 40 is pivotably movable to the first, proximal-viewing direction so that an image of the inner space 14 of the sheath 12 is visible when the branch B is being severed from the vessel V. The imaging system 40 is pivotably movable to the second, distal-viewing direction so that an image through the tip 20 is visible when the vessel V is being harvested and separated from the surrounding tissue. In one non-limiting embodiment, the camera 41 is pivotably movable in an accurate manner along a longitudinal axis defined by the sheath 12. In certain embodiments, the camera 41 is pivotably movable in an arc from about 0° to about 180°.
In certain embodiments, the self-contained dissector/harvester device 10 further includes a self-contained insufflation device 50. The insufflation device 50 is axially positioned within the inner space 14 of the sheath 12. The insufflation device 50 includes a cartridge 52 containing a supply of a suitable gas and a supply line 54 having a discharge end 58. In certain embodiments, the discharge end 58 of the supply line 54 is located near the distal end 18 of the sheath 12. The insufflation device 50 can be operatively connected to a release mechanism 56, as shown in
Also, in certain embodiments, the self-contained dissector/harvester device 10 further includes a self-contained severing device 60. In one embodiment, the self-contained severing device 60 can comprise a bipolar electrocautery tool or an ultrasonic cauterizing tool. In certain embodiments, the self-contained severing device 60 comprises a cauterizing tool where a first cauterizing member 62 is operatively mounted on the distal end 18 of the sheath 12 and a second cauterizing member 64 is operatively mounted on the proximal end 26 of the tip 20.
The self-contained severing device 60 is activated by axially displacing the tip 20 in a direction away from the sheath 12. The self-contained severing device 60 is maneuvered adjacent to the branch B such that the branch B is positioned between the distal end 18 of the sheath 12 and the proximal end 26 of the tip 20. The tip 20 is then retracted to a position adjacent to the sheath 12.
The self-contained severing device 60 is activated by axially moving the tip 20 in an axial direction toward the sheath 12. The electrodes 62 and 64 are axially moved toward each other and are used to initially grasp the branch B being dissected. The electrodes 62 and 64 are activated, severing the branch B from the vessel V.
In certain embodiments, the self-contained severing device 60 also includes an axially displacing member 66 that is operatively connected to the tip 20 to move the tip 20 in the axial direction toward and away from the sheath 12. The displacing member 66 can be connected to a displacing button 68 that advances and returns along the longitudinal direction. The advancing and returning force is transmitted to the displacing member 66 and the tip 20 is longitudinally moved.
Also, in certain embodiments, the proximal end 16 of the sheath 12 is operatively connected to a handle 70. The handle 70 can include a removable closure device 72 so that one or more of the self-contained light source 30, self-contained imaging system 40 and self-contained insufflation device 50 can be removed from the inner space 14 of the sheath 12.
To begin the dissection procedure, the dissector tip 20 is inserted through an initial incision in the patient. In operation, the dissector tip 20 is pressed into the tissues surrounding the vessel, thereby forming a tunnel or cavity around the vessel. In certain embodiments, it is desired that the dissector tip 20 be pressed into the surrounding tissue generally along the direction of the vessel in order to separate the vessel from adjacent tissue without damage to the surrounding tissue.
Upon inserting the self-contained dissector/harvester device 10 under the patient's skin, it is possible to obtain an image illuminated by the illuminating light 34 from the self-contained light source 30. The camera 41 in the imaging system 40 can be pivotably moved to the distal-viewing direction such that the vessel is viewed through the transparent tip 20.
In certain embodiments, the self-contained insufflation device 50 is activated for inflating the area adjacent the vessel as the cavity is being formed.
The dissector tip 20 is used to perform an initial, or blunt, dissection of the vessel from the surrounding tissue. Also, the self-contained severing device 60 is engaged to sever any branches B extending from the vessel.
In certain other embodiments, as shown in
In certain other embodiments, as shown in
The insufflation device 250 includes a cartridge 252 containing a supply of a suitable gas and a supply line 254 having a discharge end 258. The discharge end 258 of the supply line 254 is axially positioned within an inner space 214 of the sheath 212 near a distal end 218 of the sheath 212.
The supply line 254 also has a proximal end 256 that extends through an opening 251 in the sheath 212. The supply line 254 has a proximal end 259 that extends through the opening 251 and is operatively connected to the cartridge 152. The insufflation device 150 can also include a release mechanism 256 to allow the gas to be discharged from the supply line 254.
In the embodiment shown in
The sidewall 260 also defines a proximal detent 272 that includes an inner proximal flange 274 that is at least partially within the inner space 214 of the sheath 212, and an outer distal flange 276 that at least partially extends in a radially outward direction from a plane formed by the sidewall 260. The inner and outer distal flanges 274 and 276, respectively, define a proximal recess 278 that is configured to receive at least a second end 255 of the cartridge 252. The recess 278 also has a suitable configuration that allows the proximal end 255 of the cartridge 252 to be readily mounted on the sheath 212. In one non-limiting embodiment, as shown in
In another particular embodiment, the dissector/harvester device can include a sheath having a severing device therein, a free-standing light source having tether that is externally tethered to a power supply, and a free-standing imaging system having a tether that is externally tethered to an image receiving system. In certain embodiments, the dissector/harvester device further includes a insufflation device to supply a gas subcutaneously to an area adjacent to the vessel. In a particular embodiment, the insufflation device can include a tether that is externally connected to a supply of gas. In another particular embodiment, at least a supply of the gas of the insufflation device can be externally mounted on the sheath.
While the invention has been described with reference to various and preferred embodiments, it should be understood by those skilled in the art that various changes may be made and equivalents may be substituted for elements thereof without departing from the essential scope of the invention. In addition, many modifications may be made to adapt a particular situation or material to the teachings of the invention without departing from the essential scope thereof. Therefore, it is intended that the invention not be limited to the particular embodiment disclosed herein contemplated for carrying out this invention, but that the invention will include all embodiments falling within the scope of the claims.
