Surgical support structure

Abstract

This document discusses, among other things, a system for translocating a multilayer patch. The system includes a support structure having a contact surface for bonding to the patch. The support structure has a shape configured to support the patch following separation of the patch from a surrounding tissue.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings, which are not necessarily drawn to scale, like numerals describe substantially similar components throughout the several views. Like numerals having different letter suffixes represent different instances of substantially similar components. The drawings illustrate generally, by way of example, but not by way of limitation, various embodiments discussed in the present document.

FIG. 1 illustrates a partial sagittal view of an eye.

FIG. 2 illustrates a cross-sectional block of the retina, choroid and sclera.

FIG. 3 illustrates a sectional view of a support structure.

FIGS. 4A-4E illustrate exemplary support structures.

FIG. 5 illustrates a support structure with an insertion guide.

FIGS. 6A and 6B illustrate helical support structures.

FIG. 7 illustrates a support structure with a particular surface finish.

FIGS. 8A, 8B and 8C illustrate sectional views of exemplary support structures.

FIG. 9 illustrates a perspective view of a support structure.

FIG. 10 illustrates a tool.

FIG. 11 illustrates a view of a support structure.

FIGS. 12A, 12B and 12C illustrate support structures in various configurations.

FIG. 12D illustrates a cut-away view of a support structure partially disposed in a cannula.

FIG. 13 illustrates a tool.

FIGS. 14A, 14B and 14C illustrate exemplary support structures and corresponding coagulated regions.

FIGS. 15A and 15B illustrate perspective views of exemplary support structures and a portion of tissue.

FIGS. 16 and 17 illustrate exemplary methods of the present subject matter.

FIG. 18 illustrates a perspective view of a graft supported by an exemplary support structure.

FIGS. 19A and 19B illustrate sectional views of a support structure.

FIGS. 20A, 20B, and 20C illustrate sectional views of a support structure.

FIGS. 21A and 21B illustrate portions of a manipulator for controlling a support structure.

FIGS. 22A and 22B illustrate views of tissue repair structures.

FIG. 23 illustrates a support structure having deployable features.

FIG. 24 illustrates a multi-element support structure.

FIGS. 25A and 25B each illustrate segmented insulation of a portion of a support structure.

FIG. 26 illustrates a partial sectional view of a feature affixed to a support structure.

Claims

1. A system for translocating a multilayer patch of choroid, Bruch's membrane, and retinal pigment epithelium (RPE), the system comprising: a support structure having a contact surface for bonding to the patch, the support structure having a shape configured to support the patch following separation of the patch from a surrounding tissue.

2. The system of claim 1 further including a tool configured to engage the support structure.

3. The system of claim 1 further including a cannula having at least one lumen, wherein the lumen is configured to pass the support structure.

4. The system of claim 1 wherein the support structure includes at least one ring shaped member.

5. The system of claim 1 wherein the support structure is configured to permanently bond to the patch.

6. The system of claim 1 wherein the support structure is configured for removal following translocation of the patch.

7. A system comprising: a support structure having a tissue contact surface configured to bond to a tissue and configured to maintain a fixed shape of the tissue after separation of the tissue from a membrane.

8. The system of claim 7 wherein the support structure has a circular configuration.

9. The system of claim 7 wherein the support structure includes a first member and a second member, each member of which is adapted to engage with the other.

10. The system of claim 9 wherein the first member includes a tongue and the second member includes a groove.

11. The system of claim 7 wherein the support structure includes at least one ring.

12. The system of claim 11 wherein the at least one ring is endless.

13. The system of claim 11 wherein the at least one ring contacts two opposing surfaces of the membrane.

14. The system of claim 7 wherein the support structure includes at least one of stainless steel, nitinol, a polymer, a shape memory material, a superelastic material, and a bioerodable material.

15. The system of claim 7 wherein the support structure includes at least one of a textured surface and a porous surface.

16. The system of claim 7 wherein the support structure includes a coated surface.

17. The system of claim 16 wherein the coated surface includes a drug eluting surface.

18. The system of claim 7 wherein a portion of the support structure has a cross section corresponding to at least one of a circle, a rectangle, and an oval.

19. The system of claim 7 wherein the support structure includes a first member and a second member, and further wherein the tissue contact surface includes a first surface on the first member and a second surface on the second member.

20. The system of claim 19 wherein the first member is coupled to the second member by a joint.

21. The system of claim 20 wherein the joint includes at least one of a portion of a helix, a hinge, and a flexible linkage.

22. The system of claim 7 wherein a first element of the support structure is configured for placement in at least one of a suprachoroidal space of an eye and on a retinal pigment epithelium (RPE) surface of the eye.

23. The system of claim 7 further including a manipulator configured to couple with the support structure.

24. The system of claim 23 wherein the manipulator includes one or more electrically conductive nodes and wherein the support structure includes one or more corresponding nodes.

25. The system of claim 23 wherein the manipulator includes a pair of forceps.

26. The system of claim 25 wherein the pair of forceps are adapted for delivering radio frequency (RF) energy.

27. The system of claim 25 wherein the pair of forceps is configured to provide bipolar energy.

28. The system of claim 25 wherein the pair of forceps includes clamping faces configured to exert a position dependent clamping force.

29. The system of claim 23 wherein the support structure includes at least one feature configured to engage a portion of the manipulator.

30. The system of claim 29 wherein the feature includes at least one of a tab, a cavity, a graduated section, a ball-shaped element, a t-slot element, a hole, a spring, and a deflectable portion.

31. The system of claim 29 wherein the feature allows exertion of a torque on the support structure.

32. The system of claim 29 wherein the feature is configured to couple with a radio frequency (RF) energy source.

33. The system of claim 7 further including a cannula configured to pass the support structure.

34. The system of claim 33 wherein the cannula includes a curved lumen.

35. The system of claim 33 wherein the cannula has at least two lumens.

36. The system of claim 33 wherein the cannula includes at least two pushrods in contact with the reinforcement structure.

37. The system of claim 7 wherein the support structure includes a mesh.

38. The system of claim 37 wherein the support structure includes a first portion and a second portion and wherein the mesh is disposed on the first portion.

39. The system of claim 7 wherein the support structure is configured for placement on a single side of the membrane.

40. The system of claim 7 wherein the support structure includes a first portion configured for placement on a first surface of the membrane and a second portion configured for placement on a second surface of the membrane.

41. The system of claim 40 wherein a tissue contacting surface of the first portion includes at least two conductors separated by an insulator.

42. The system of claim 41 wherein the at least two conductors includes concentric metal conductors.

43. A method comprising: affixing a first support structure on a target of a membrane; andseparating the target from the membrane by manipulating the first support structure.

44. The method of claim 43 further comprising positioning the target at a destination site of the membrane.

45. The method of claim 44 further comprising affixing the target at the destination site.

46. The method of claim 43 further comprising placing a second support structure on a second surface of the membrane.

47. The method of claim 46 wherein placing the second support structure includes orienting the first support structure and the second support structure in a predetermined alignment.

48. The method of claim 43 wherein separating includes at least one of coagulating, ablating, and forming an incision.

49. The method of claim 43 wherein affixing the first support structure includes transitioning a superelastic material from a first configuration to a second configuration during introduction into the eye.

50. The method of claim 43 wherein affixing the first support structure includes transitioning a shape memory material from a first configuration to a second configuration.

51. The method of claim 43 wherein affixing includes manipulating a linear element within a guide.

52. The method of claim 43 wherein affixing includes bonding the first support structure to the membrane.

53. The method of claim 52 wherein bonding includes applying energy.

54. The method of claim 53 wherein applying energy includes applying at least one of radio frequency energy, thermal energy, optical energy, and electrical energy.

55. A system comprising: a guide having a central lumen;an internal member disposed in the central lumen; anda pair of split rings coupled to the internal member wherein each split ring is held in parallel alignment.

56. The system of claim 55 wherein the pair of split rings includes nitinol.

57. The system of claim 55 wherein the internal member includes a first linear wire and a second linear wire and further wherein each of the first linear wire and the second linear wire is coupled to one each of the pair of split rings.

58. A method comprising: bonding tissue to a support structure, the tissue supported by a membrane;separating the bonded tissue from the membrane; andmanipulating the support structure to reposition the bonded tissue.

59. The method of claim 58 wherein bonding includes forming a chemical bond.

60. The method of claim 59 wherein forming a chemical bond includes using an adhesive.

61. The method of claim 58 further including selectively disbonding the support structure.

62. The method of claim 61 wherein selectively disbonding includes at least one of bioeroding and laser ablating.

63. The method of claims 58 wherein manipulating includes engaging a feature of the support structure.

64. The method of claim 58 wherein manipulating includes exerting a torque on the support structure.

65. The method of claim 58 wherein bonding includes applying radio frequency (RF) energy.

66. The method of claim 58 wherein bonding includes coupling with a surgical tool.

67. The method of claim 58 wherein bonding includes applying RF energy at each of a plurality of features of the support structure.

68. The method of claim 58 wherein separating includes at least one of coagulating and forming an incision.

69. A system comprising: a cannula configured to pass through a tissue wall, the cannula having at least one lumen; anda support structure disposed for passage through the lumen, wherein the support structure is configured to change shape upon ejection from the lumen and is configured to bond to a membrane.

70. The system of claim 69 wherein the support structure is configured to bond to two surfaces of the membrane.

71. The system of claim 69 wherein the at least one lumen is curved.

72. The system of claim 69 wherein the support structure includes a ring.

73. The system of claim 72 wherein the ring is separable from a pushrod, and wherein a portion of the pushrod is configured for passage through the lumen.

74. The system of claim 72 further comprising a pushrod configured for passage through the lumen and wherein the ring is in contact with the pushrod.

75. The system of claim 72 wherein a portion of the ring has a cross section corresponding to at least one of a circle, a rectangle, and an oval.

76. The system of claim 69 wherein the support structure includes at least one of a shape memory material and a superelastic material.

77. The system of claim 69 wherein the support structure includes a split ring.

78. The system of claim 69 wherein the support structure includes two ring members in parallel alignment.

79. The system of claim 69 wherein the support structure includes an electrical conductor.

80. The system of claim 79 wherein an electric current in the support structure causes the support structure to bond to the membrane.

81. The system of claim 69 wherein a first portion of the support structure is configured to bond to a first surface of the membrane and a second portion of the support structure is configured to bond to an opposing surface of the membrane.

82. A system for translocating a multilayer patch of choroid, Bruch's membrane, and retinal pigment epithelium (RPE) the system comprising: support means having a contact surface for bonding to the patch, the support means having a shape configured to support the patch following separation of the patch from a surrounding tissue.

83. The system of claim 82 further including an engaging means to couple with the support means.

84. The system of claim 82 further including a passing means having a lumen, wherein the lumen is configured to pass the support means.

85. The system of claim 82 wherein the support means includes at least one ring shaped member.

86. The system of claim 82 wherein the support means is configured to permanently bond to the patch.

87. The system of claim 82 wherein the support means is configured for removal following translocation of the patch.