None.
The present invention relates to a lung access procedure, such as a lung biopsy, and, more particularly, to a system for use in sealing a portion of pleural layers together.
Pneumothorax is a problematic complication of the lung biopsy procedure where air or fluid is allowed to pass into the pleural space as a result of the puncture of the parietal pleura and visceral pleura. Pneumothorax and, more so, pneumothorax requiring chest tube placement, are significant concerns for clinicians performing, and patients undergoing, percutaneous lung biopsies. The incidence of pneumothorax in patients undergoing percutaneous lung biopsy has been reported to be anywhere from 9-54%, with an average of around 15%. On average, 6.6% of all percutaneous lung biopsies result in pneumothorax requiring a chest tube to be placed, which results in an average hospital stay of 2.7 days.
Factors that increase the risk of pneumothorax include increased patient age, obstructive lung disease, increased depth of a lesion, multiple pleural passes, increased time that an access needle lies across the pleura, and traversal of a fissure. Pneumothorax may occur during or immediately after the procedure, which is why typically a CT scan of the region is performed following removal of the needle. Other, less common, complications of percutaneous lung biopsy include hemoptysis (coughing up blood), hemothorax (a type of pleural effusion in which blood accumulates in the pleural cavity), infection, and air embolism.
What is needed in the art is a system for use in sealing a portion of pleural layers together.
The present invention provides a system for use in sealing a portion of pleural layers together.
The invention, in one form, is directed to a system for use in sealing a portion of pleural layers together. The system includes an electrical energy source, and an electrocautery probe electrically coupled to the electrical energy source. The electrocautery probe has a cannula shaft portion, a distal penetrating tip, and an intermediate portion interposed between the cannula shaft portion and distal penetrating tip. The electrocautery probe is configured to generate heat. A protein source is coupled to the intermediate portion of the electrocautery probe, wherein the protein source has a protein that is denatured by heat.
The invention, in another form, is directed to a system for use in sealing a portion of pleural layers together. The system may include a fluid source, an electrical energy source, a grounding pad, and a monopolar electrocautery probe. The fluid source is configured to deliver a sealing fluid, wherein the sealing fluid is heat-activated. The grounding pad is electrically coupled to the electrical energy source. The monopolar electrocautery probe is electrically coupled to the electrical energy source. The monopolar electrocautery probe and grounding pad cooperate to generate heat. The monopolar electrocautery probe has a cannula shaft portion, a distal penetrating tip, and an expandable portion interposed between the cannula shaft portion and distal penetrating tip. The cannula shaft portion has a cannula lumen coupled in fluid communication with the fluid source. The expandable portion is coupled in fluid communication with the fluid source via the cannula lumen. The expandable portion is configured to define a plurality of openings, and is configured such that the sealing fluid that is supplied by the fluid source exits the expandable portion through the plurality of openings to a location external to the monopolar electrocautery probe.
An advantage of the present invention is that the system allows the physician to create an airtight seal of the pleural layers prior to performing a lung procedure, such as a lung biopsy, thereby reducing the risk of pneumothorax during the procedure.
The above-mentioned and other features and advantages of this invention, and the manner of attaining them, will become more apparent and the invention will be better understood by reference to the following description of an embodiment of the invention taken in conjunction with the accompanying drawings, wherein:
Corresponding reference characters indicate corresponding parts throughout the several views. The exemplifications set out herein illustrate at least one embodiment of the invention, and such exemplifications are not to be construed as limiting the scope of the invention in any manner.
Referring now to the drawings, and more particularly to
In the present embodiment, electrical energy source 14 may be, for example, an electrosurgical radio frequency (RF) generator. In the present embodiment, electrical energy source 14 includes a first RF output 14-1 and a second RF output 14-2.
First RF output 14-1 of electrical energy source 14 is electrically coupled to monopolar electrocautery device 16 via a connector cable 24. Connector cable 24 may be, for example, a multi-conductor cable that includes electrical conductors that supply control signals from handpiece 20 to electrical energy source 14 to control a power output of electrical energy source 14, and includes conductors (e.g., a shielded cable, such as an electrical coaxial cable) to supply electrical RF power signals to monopolar electrocautery probe 22 of monopolar electrocautery device 16. Accordingly, monopolar electrocautery probe 22 is electrically coupled to first RF output 14-1 of electrical energy source 14 via connector cable 24.
Second RF output 14-2 of electrical energy source 14 is electrically coupled to grounding pad 18 via a ground path 26. Grounding pad 18 is configured for contact with the patient 12, as is known in the art. It is contemplated that the ground path 26 between electrical energy source 14 and grounding pad 18 may be in the form of a shielded cable, such as an electrical coaxial cable.
Monopolar electrocautery probe 22 and grounding pad 18 form an RF circuit 28, wherein monopolar electrocautery probe 22 serves as a primary electrosurgical electrode and grounding pad 18 serves as a return electrode. Monopolar electrocautery probe 22 includes a cannula shaft portion 30, a distal penetrating tip 32, and an intermediate portion 34 interposed between the cannula shaft portion 30 and distal penetrating tip 32.
Monopolar electrocautery probe 22 and grounding pad 18 cooperate to generate heat when energized with RF energy. More particularly, electrical energy source 14 includes circuitry, as is known in the art, for generating an RF output signal having an RF frequency which may be, for example, in a range of 1.0 megahertz (MHz) to 10.0 MHz. The RF output signal generated by electrical energy source 14 is delivered to monopolar electrocautery probe 22 and grounding pad 18, so as to generate a heating effect at monopolar electrocautery probe 22. Optionally, cannula shaft portion 30 of monopolar electrocautery probe 22 may include a thermal and electrical insulating exterior layer, e.g., plastic or ceramic, to reduce a transfer of heat from the outer periphery of cannula shaft portion 30 to the surrounding tissue.
Referring to
In the present embodiment, button 46 may be in the form of a slider member that is slidable along a slot 40-1 formed in housing 40 of handpiece 20. Button 46 is connected to expander driver 42. Expander driver 42 may include a driver member 42-1, such as a push rod or cable, which is mechanically connected to each of, and interposed between, button 46 and distal penetrating tip 32 of monopolar electrocautery probe 22.
Alternatively, expander driver 42 may be an electromechanical device, such as a motor or solenoid, having a linearly movable component that is mechanically connected to driver member 42-1, wherein button 46 serves as a switch to electrically actuate the motor or solenoid of expander driver 42.
Button 48 is connected to fluid source 44 that carries a sealing fluid of a type that is heat-activated. Fluid source 44 is coupled in fluid communication with monopolar electrocautery probe 22, and in particular, cannula shaft portion 30 has a cannula lumen 30-1 that is coupled in fluid communication with fluid source 44. Stated differently, fluid source 44 is configured to deliver the sealing fluid through cannula lumen 30-1 of cannula shaft portion 30 to intermediate portion 34 of monopolar electrocautery probe 22, wherein the sealing fluid may be heat activated by application of heat supplied by monopolar electrocautery probe 22.
Referring also to
Also, in the present embodiment, sealing fluid 52 may be, for example, a solution that contains a protein that is denatured by heat. More particularly, sealing fluid 52 may be, for example, a protein-containing solution that includes a protein, e.g., 10 to 50% by weight, and optionally may include a crosslinking agent, e.g., 0.1-5.0% by weight. The protein in the solution may be, for example, albumin. In the optional embodiments that include the crosslinking agent, the crosslinking agent in the solution may be, for example, genipin.
As an alternative to providing fluid source 44 in the form of a syringe, it is contemplated that piston 44-3 of fluid source 44 may be replaced with an electric or pneumatic powered pump, wherein button 48 sends an electrical or pneumatic signal to operate the pump to supply sealing fluid 52 through cannula lumen 30-1 of cannula shaft portion 30 to intermediate portion 34 of monopolar electrocautery probe 22.
Referring also to
It is contemplated that in some embodiments, the use of memory material, e.g., nitinol, for the plurality of expansion members 62 of expandable portion 56, in combination with introducer cannula 36, may be used as a substitute to providing expander driver 42, button 46, and driver member 42-1 connected to distal penetrating tip 32. In such an alternative embodiment, introducer cannula 36 will be slid distally over expandable portion 56 to collapse expandable portion 56 to the collapsed state 58, and introducer cannula 36 will be slid proximally to expose expandable portion 56 such that expandable portion 56 expands in a self-expanding manner to the expanded state 60.
Expandable portion 56 includes a plurality of expansion members 62 at intermediate portion 34. In one embodiment, for example, the plurality of expansion members 62 may be formed by a plurality of longitudinal cuts or slots formed around a periphery of a tubular portion of monopolar electrocautery probe 22 to define intermediate portion 34. In such a case, intermediate portion 34 may be formed from the same material as that of cannula shaft portion 30 of monopolar electrocautery probe 22, such as for example, a biocompatible metal, such as stainless steel.
Alternatively, intermediate portion 34 may be a separate tubular component having a plurality of longitudinal cuts or slots formed around a periphery of a tubular portion of intermediate portion 34, and wherein intermediate portion 34 is inserted between, and attached to each of, cannula shaft portion 30 and distal penetrating tip 32. In such a case, intermediate portion 34 may be formed from a different material, e.g., a different biocompatible metal, from that of cannula shaft portion 30, such as for example, nitinol.
The plurality of expansion members 62 longitudinally extend between cannula shaft portion 30 and distal penetrating tip 32. Also, the plurality of expansion members 62 form an annular periphery of intermediate portion 34 between cannula shaft portion 30 and distal penetrating tip 32.
Expandable portion 56 at intermediate portion 34 is coupled in fluid communication with fluid source 44 via cannula lumen 30-1. Referring to
Referring again also to
Referring to
While in the present embodiment coating 74 is applied over intermediate portion 34 having expandable portion 56 that includes a plurality of expansion members 62, it is contemplated that, alternatively, the coating 74 may be applied to an intermediate portion that does not include expandable portion 56.
Referring to
Monopolar electrocautery probe 22 is shown positioned in access opening 84, with expandable portion 56 of intermediate portion 34 located distal to (and adjacent), i.e., below, the visceral pleura 92 and in the expanded state 60 (see also
At step S100, monopolar electrocautery probe 22 is inserted along access opening 84, with expandable portion 56 of intermediate portion 34 in the collapsed state 58 (see also
At step S102, expandable portion 56 of monopolar electrocautery probe 22 is expanded to the expanded state 60 (see also
At step S104, monopolar electrocautery probe 22 is moved by the user, i.e., pulled, in a proximal direction so that expandable portion 56 of monopolar electrocautery probe 22 (in the expanded state 60; see also
At step 5106, electrical energy source 14 is actuated, e.g., by depressing button 50 (see
At step S108, fluid source 44 is actuated, e.g., by depressing button 48 (see
It is contemplated that steps S106 and S108 may be performed sequentially in the order introduced above, or alternatively, may be performed simultaneously. As a further alternative, it is contemplated the order of performing steps S106 and S108 may be reversed.
At step S110, in embodiments that include introducer cannula 36 at step S100, introducer cannula 36 may then be advanced distally along access opening 84 and through the sealed portion of the pleural layers 88, 92.
At step S112, expandable portion 56 of monopolar electrocautery probe 22 is collapsed to the collapsed state 58 (see also
At alternative step S114, in embodiments that do not include introducer cannula 36 at step S100, following the withdrawal of monopolar electrocautery probe 22 from access opening 84, then introducer cannula 36 may be inserted into access opening 84 and through the sealed portion of the pleural layers 88, 92 to maintain an access path to lung 82.
Following the positioning of introducer cannula 36 through the sealed portion of the pleural layers 88, 92, a lung procedure, e.g., a lung biopsy, may be performed through introducer cannula 36.
While the primary embodiment above utilizes monopolar electrocautery probe 22, grounding pad 18, and electrical energy source 14 in the form of a radio frequency (RF) generator, it is contemplated that the system may be alternatively be configured to utilize a bipolar electrocautery probe having the structural characteristics as in monopolar electrocautery probe 22 to facilitate localized delivery of the heat-activated protein material. Also, it is contemplated that an electrocautery probe may take other forms, such as an electrocautery probe having an electrical heating element (DC or AC), having the structural characteristics as in monopolar electrocautery probe 22 to facilitate localized delivery of the heat-activated protein material.
The following items also relate to the invention:
In one form, the invention relates to a system for (use in) sealing a portion of pleural layers together. The system may include an electrical energy source, an electrocautery probe, and a protein source. The electrocautery probe is electrically coupled to the electrical energy source. The electrocautery probe may have a cannula shaft portion, a distal penetrating tip, and an intermediate portion interposed between the cannula shaft portion and distal penetrating tip, wherein the electrocautery probe is configured to generate heat. The protein source is coupled to the intermediate portion of the electrocautery probe. The protein source has a protein that is configured to be denatured or denaturable by heat. In particular, the protein source comprises a substance characterized by comprising such protein.
In some embodiments, the protein source may be a fluid source configured to deliver a supply of a sealing fluid that includes the protein, and the cannula shaft portion has a cannula lumen coupled in fluid communication with the fluid source. The intermediate portion may be an expandable portion that is coupled in fluid communication with the fluid source via the cannula lumen, wherein the expandable portion is configured to define a plurality of openings configured such that the sealing fluid that is supplied by the fluid source exits the expandable portion through the plurality of openings to a location external to the electrocautery probe.
In embodiments that include the expandable portion, the expandable portion may be configured to have an (to be in an) extended position that defines a collapsed state and a retracted position that defines an expanded state. The expandable portion may include a plurality of expansion members, wherein a respective opening of the plurality of openings is located between each pair of adjacent expansion members of the plurality of expansion members.
In the embodiment according to the immediately preceding paragraph, each expansion member of the plurality of expansion members may include a proximal end, a distal end, and an articulation joint, wherein the proximal end is connected to the cannula shaft portion, the distal end is connected to the distal penetrating tip, and the articulation joint is located between the proximal end and the distal end.
In embodiments that include the expandable portion, the cannula shaft portion may have a first diameter and the expandable portion may have a second diameter, wherein in the collapsed state the first diameter and the second diameter are substantially equal.
In embodiments that include the expandable portion, in the expanded state, the cannula shaft portion may have a first diameter and the expandable portion may be configured to have a largest circumference that has a second diameter, wherein the second diameter is greater than the first diameter.
In embodiments that include a sealing fluid, the fluid source may be a syringe, and/or the sealing fluid may include albumin.
Optionally, in any of the embodiments, the protein source may include a coating that contains a collagen, and/or the coating may be located, e.g., formed, over at least one of the intermediate portion and the distal penetrating tip.
In one embodiment, for example, the intermediate portion may be an expandable portion that includes a plurality of expansion members, and/or the plurality of expansion members have a coating as the protein source. The coating may be a heat-activated material that includes the protein, and/or the plurality of expansion members may be configured to have a collapsed state and an expanded state.
In the embodiment according to the immediately preceding paragraph, the coating may include a collagen.
In another form, the invention relates to a system for (use in) sealing a portion of pleural layers together, that has a fluid source configured to deliver a sealing fluid, wherein the sealing fluid is heat-activatable. The system according to this embodiment may include an electrical energy source, a grounding pad electrically coupled to the electrical energy source, and a monopolar electrocautery probe that is electrically coupled to the electrical energy source, wherein the monopolar electrocautery probe and grounding pad cooperate to generate heat. The monopolar electrocautery probe may have a cannula shaft portion, a distal penetrating tip, and an expandable portion interposed between the cannula shaft portion and distal penetrating tip. The cannula shaft portion has a cannula lumen coupled in fluid communication with the fluid source. The expandable portion is coupled in fluid communication with the fluid source via the cannula lumen. The expandable portion is configured to define a plurality of openings, and configured such that the sealing fluid that is supplied by the fluid source exits the expandable portion through the plurality of openings to a location external to the monopolar electrocautery probe.
In the embodiment according to the immediately preceding paragraph, the expandable portion may be configured to have an (to be in an) extended position that defines a collapsed state and a retracted position that defines an expanded state. The expandable portion may include a plurality of expansion members, wherein a respective opening of the plurality of openings is located between each pair of adjacent expansion members of the plurality of expansion members.
In some embodiments that include the expandable portion that has the plurality of expansion members, each expansion member of the plurality of expansion members may have a proximal end connected to the cannula shaft portion and a distal end connected to the distal penetrating tip.
In some embodiments that include the expandable portion that has the plurality of expansion members, each expansion member of the plurality of expansion members may further comprise an articulation joint located between the proximal end and the distal end, wherein the expanded state facilitates a flow of the sealing fluid between the plurality of fluid expansion members to a location external to the expandable portion.
In any of the embodiments that include the expandable portion, the cannula shaft portion may have a first diameter and the expandable member may have a second diameter, wherein in the collapsed state the first diameter and the second diameter are substantially equal.
In any of the embodiments that include the expandable portion, in the expanded state, the cannula shaft portion may have a first diameter and the expandable member may have a largest circumference that has a second diameter, wherein the second diameter is greater than the first diameter.
In any of the embodiments that include the expandable portion, the expandable portion may be made from a biocompatible metal.
In any of the embodiments that include a fluid source, the fluid source may be a syringe.
Optionally, in the embodiment according to the immediately preceding paragraph, the system may further include a Luer fitting connected to a proximal end of the cannula shaft portion, wherein the Luer fitting is in fluid communication with the cannula lumen, and wherein the syringe is connected to the Luer fitting.
In any of the embodiments that include a sealing fluid, the sealing fluid may include a protein.
Optionally, in any of the embodiments that have an expandable portion, the system may include a coating that may be located, e.g., formed, over at least one of the expandable portion and the distal penetrating tip, and/or wherein the coating is a heat-activated material that includes a secondary protein.
As used herein, the term “substantially”, and other words of degree, are relative modifiers intended to indicate permissible variation from the characteristic so modified. Such terms are not intended to be limited to the absolute value of the characteristic which it modifies, but rather possessing more of the physical or functional characteristic than the opposite.
While this invention has been described with respect to at least one embodiment, the present invention can be further modified within the spirit and scope of this disclosure. This application is therefore intended to cover any variations, uses, or adaptations of the invention using its general principles. Further, this application is intended to cover such departures from the present disclosure as come within known or customary practice in the art to which this invention pertains and which fall within the limits of the appended claims.
Filing Document | Filing Date | Country | Kind |
---|---|---|---|
PCT/US2019/059308 | 11/1/2019 | WO |