Device, system and method for implantation of filaments and particles in the body

• US 20030015203A1
• Filed: 06/13/2002
• Published: 01/23/2003
• Est. Priority Date: 12/01/1995
• Status: Abandoned Application

• Current Assignee: Claude Vidal, Joshua Makower, Russell J. Redmond, Thomas F. Banks
• Original Assignee: Claude Vidal, Joshua Makower, Russell J. Redmond, Thomas F. Banks
• Inventors: Banks, Thomas F., Vidal, Claude, Redmond, Russell J., Makower, Joshua
• Application Number:
  US10/172,788
• Publication Number:
  US 20030015203A1
• Time in Patent Office: Days
• US Class Current: 128/831
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/12022 Occluding by internal devices, e.g. balloons or releasable wires plugging an opening in the wall of an organ A61B17/0057; occluders for the cervical canal A61F6/146; vas deferens occluders A61F6/20
• CPC Class Codes: A61B 17/12099 characterised by the location of the occluder
• CPC Class Codes: A61B 17/12109 in a blood vessel
• CPC Class Codes: A61B 17/12113 within an aneurysm
• CPC Class Codes: A61B 17/12131 characterised by the type of occluding device
• CPC Class Codes: A61B 17/12145 having a pre-set deployed three-dimensional shape methods of manufacturing A61B2017/00526
• CPC Class Codes: A61B 17/12181 formed by fluidized, gelatinous or cellular remodelable materials, e.g. embolic liquids, foams or extracellular matrices
• CPC Class Codes: A61B 17/12186 liquid materials adapted to be injected
• CPC Class Codes: A61B 2017/00349 Needle-like instruments having hook or barb-like gripping means, e.g. for grasping suture or tissue A61B17/06066 takes precedence
• CPC Class Codes: A61B 2017/00526 Methods of manufacturing
• CPC Class Codes: A61B 90/39 Markers, e.g. radio-opaque or breast lesions markers

Abstract

A method of introducing continuous lengths of filament into the body in surgical procedures in which it is desirable to place a significant amount of material into the body through a small portal. The material so introduced may serve to bulk a tissue or cavity of the body or to occlude a vas, as well as to introduce diagnostic or therapeutic agents into a site in the body. A device for implementing the method has a mechanism for feeding the filament through a conduit in such a manner that sufficient force is applied to the filament that it is forced into the desired site. In one embodiment, a system of reciprocating cannulae and synchronized grippers is used to supply the requisite force to the filament.

Claims

1. A method for modifying a tissue property of a subject, the method comprising:

a. providing a quantity of filament;

b. opening a portal in the body of the subject;

c. inserting the filament through the portal into a region in the vicinity of the tissue; and

d. localizing the filament in the region so as to modify the tissue property.

2. A method according to claim 1, wherein the property includes at least one of the mass, bulk, orientation, rigidity, flexibility, springiness, and permeability of the tissue.

27. A method as in any one of the preceding claims further comprising the step of injecting a fluid into the body of the subject in conjunction with the filament.

33. A method as in any one of the preceding claims, wherein the filament is a length of suture.

34. A method as in any one of the preceding claims further comprising the step of severing the filament such as to provide a desired length of filament within the body of the subject.

35. A method according to claim 34, wherein the step of severing the filament includes determining the desired length of the filament during a clinical procedure.

38. A method according to claim 37, wherein the property includes at least one of the mass, bulk, orientation, rigidity, flexibility, springiness, and permeability of the tissue.

3. A method for bulking tissue of a subject, the method comprising:

a. providing a quantity of filament;

b. inserting the filament into a region in the vicinity of the tissue; and

c. localizing the filament in the region so as to achieve bulking of the tissue.

4. A bulking method according to claim 3, wherein the step of inserting includes the step of introducing the filament with the aid of an endoscope.

5. A bulking method according to claim 3, wherein the step of inserting includes the step of introducing the filament with the aid of a laparoscope.

6. A bulking method according to claim 3, further comprising the step of driving fluid through the portal into the tissue to dilate the region to be occupied by the filament.

7. A method for coapting walls of a vas to increase the resistance to flow of a bodily material within the vas, the method comprising:

a. providing a quantity of filament;

b. inserting the filament into the vicinity of the wall of the vas.

8. A method for occluding a vas of a subject, the method comprising:

a. providing a quantity of filament;

b. inserting the filament into the vas; and

c. localizing the filament in a region so as to achieve the occlusion of the vas.

9. An occluding method according to claim 8, wherein the step of providing filament further comprises the step of training the filament to take a preset shape.

10. An occluding method according to claim 8, wherein the step of providing filament further comprises the step of providing filament that has been coated with an clotting compound.

11. A method for preventing pregnancy in a subject, the method comprising:

a. providing a quantity of filament;

b. inserting the filament into a region in the vicinity of the fallopian tube of the subject; and

c. localizing the filament in the region so as to achieve the occlusion of the fallopian tube.

14. An ulcer clotting method according to claim 13, wherein the step of providing filament further comprises the step of preloading the filament with at least one therapeutic agent.

15. An ulcer clotting method according to claim 13, wherein the step of providing filament includes the step of providing electrically conducting filament and the method further comprises the step of applying radio-frequency energy for heating the filament.

19. A method for treating a bleeding esophageal varix according to claim 18, wherein the step of providing filament further comprises the step of providing filament preloaded with at least one therapeutic agent.

20. A method for treating a bleeding esophageal varix according to claim 18, wherein the step of providing filament includes the step of providing electrically conducting filament and the method further comprises the step of applying radio-frequency energy for heating the filament.

12. A method for sterilizing a subject, the method comprising:

a. providing a quantity of filament;

b. inserting the filament into a region in the vicinity of the ductus deferens of the subject; and

c. localizing the filament in the region so as to achieve the occlusion of the ductus deferens.

13. A method for clotting of an ulcer fed by a blood vessel, the method comprising:

a. providing a quantity of filament;

b. inserting the filament into a region in the vicinity of the blood vessel; and

c. localizing the filament in the region so as to stop the supply of blood to the ulcer.

16. A method of inserting a filament into the body, the method comprising:

a. providing a filament having an end with shape memory;

b. opening a portal in the body of the subject;

c. inserting the filament through the portal; and

d. causing the filament end to assume the shape in its memory.

17. A method for treating an aortic aneurism having an aneurysmal pocket, the method comprising:

a. delivering a stent graft percutaneously;

b. providing a quantity of filament;

c. inserting the filament into the aneurism; and

d. localizing the filament in a region of the aneurysm so as to clot off the aneurysmal pocket.

18. A method for treating a bleeding esophageal varix in a subject, the method comprising:

a. providing a quantity of filament;

b. inserting the filament into a region in the vicinity of the bleeding varix; and

c. localizing the filament in the region so as to occlude the bleeding varix.

21. A method for providing chemotherapy in a subject having malignant tissue, the method comprising:

a. providing a quantity of filament preloaded with at least one therapeutic agent;

b. inserting the filament into a region in the vicinity of the malignant tissue; and

c. localizing the filament in the region.

22. A method for releasing a drug into a subject, the method comprising:

a. providing a quantity of filament;

b. preloading the filament with at least one therapeutic agent; and

c. inserting the filament into the body of the subject.

23. A method for catalyzing biochemical reactions in the body of a subject, the method comprising:

a. providing a quantity of filament having requisite catalytic properties; and

b. inserting the filament into the body of the subject.

24. A method for monitoring of biochemical processes in situ, the method comprising:

a. providing a quantity of filament;

b. preloading the filament with at least one diagnostic agent;

c. inserting the filament into the body of the subject; and

d. monitoring the response of the agent.

25. A method for providing birth control in a subject, the method comprising:

a. providing a quantity of filament;

b. preloading the filament with at least one contraceptive agent; and

c. inserting the filament into the body of the subject.

26. A method for supporting cell growth in a subject, the method comprising:

a. providing a quantity of filament;

b. inserting the filament into the subject; and

c. localizing the filament in a reticulate manner so as to form a matrix; and

d. allowing the entrance of cells into the matrix.

28. A method for sewing tissue, the method comprising:

a. providing a quantity of filament;

b. feeding an end of the filament into a hollow shaft having a tip;

c. inserting the hollow shaft into the tissue;

d. advancing the filament along the shaft into the tissue; and

e. binding the filament so as to suture the tissue.

30. A method for modifying a tissue property of a subject, the method comprising:

a. providing a quantity of filament;

b. feeding an end of the filament into a hollow shaft having a tip;

c. inserting the hollow shaft into a region that includes at least a portion of the tissue;

d. advancing the filament along the shaft into the tissue; and

e. localizing the filament in the region so as to modify the tissue property.

29. A method for sewing tissue according to claim 30, wherein the hollow shaft of steps (b), (c), and (d) has a longitudinal axis and the tip is deformed so as to lie off the axis to facilitate curving the path of the filament into the tissue.

32. A method for delivering anesthesia into a tissue comprising the steps of.

a. providing a quantity of filament;

b. preloading the filament with at least one liquid anesthetic agent;

c. feeding an end of the filament into a hollow shaft having a tip;

d. inserting the hollow shaft into a region that includes at least a portion of the tissue;

e. advancing the filament along the shaft into the tissue.

31. A method according to claim 32, wherein at least a portion of the shaft includes a passageway, and the step (b) includes the step of advancing the filament through the passageway.

36. A method for delivering a stent into a vas of a body, the method comprising:

a. preloading the stent into a shaft;

b. inserting the shaft into the vas;

c. advancing a filament along the shaft into the body so as to propel the stent in advance of the filament; and

d. retracting the filament.

37. A method for modifying a tissue property of a subject, the method comprising:

a. providing a quantity of suture material in particulate form;

b. suspending the suture material in a liquid carrier to create a suture suspension;

c. opening a portal in the body of the subject; and

d. inserting the suture suspension through the portal into a region that includes at least a portion of the tissue.

39. A method for removing filament from a site in the body comprising:

a. inserting a hollow shaft into the site;

b. hooking the filament with a hooked tool;

c. withdrawing the filament via the hollow shaft.

40. A device for inserting a filament having a diameter into a site in the body of a subject, the vice comprising:

a. a conduit having an axis, an interior wall, a distal end for inserting into the site, and a proximal end; and

b. a feeding mechanism for supplying the filament incrementally along the axis of the conduit so as to emerge from the distal end into the site in a manner such that support is provided across all lengths of the filament longer than three times the diameter of the filament.

55. A device as in any one of claims 40, 41, or 52-54 inclusive, wherein the conduit includes one of a rigid, semi-rigid, and flexible tubular structure.

56. A device as in any one of claims 40, 41, or 52-54 inclusive, further comprising:

a. an inlet for receiving fluid;

b. a channel for directing the flow of fluid toward the site; and

c. a fluid control for regulating the injection of fluid into the channel.

57. A device according to claim 56, wherein the channel is identical to the conduit inserted into the site.

58. A device as in any one of claims 40, 41, or 52-54 inclusive, further comprising a storage arrangement for storing filament before it is supplied by the feeding mechanism.

59. A device according to claim 58, wherein the storage arrangement is a spool.

60. A device as in any one of claims 40, 41, or 52-54 inclusive, further comprising a rewind mechanism for retracting filament from the site.

61. A device as in any one of claims as in any one of claims 40, 41, or 52-54 inclusive, further comprising a counter for tracking the length of filament which has been fed into the body site.

62. A device as in any one of claims 40, 41, or 52-54 inclusive, further comprising a filament cutter.

63. A device according to claim 62, wherein the filament cutter comprises:

a. a torquable head, disposed adjacent to the distal end of the conduit, having a rotation axis coincident with the axis of the conduit and an off-axis window for passing the filament into the site in the body;

b. a shearing surface disposed on at least one of the distal end of the conduit and the torquable head such that rotation of the torquable head severs the filament; and

c. a means for rotating the torquable head about the rotation axis of the torquable head.

64. A device according to claim 63, wherein the means for rotating the torquable head is a torque wire disposed along the axis of the conduit.

67. A device according to claim 40, 41, or 52-54 inclusive, further comprising a motor for repetitively cycling the feeding mechanism.

41. A device for inserting a filament having a diameter into a site in the body of a subject, the vice comprising:

a. a conduit having an axis, an interior wall, a distal end for inserting into the site, and a proximal end;

b. an inner cannula having an inner diameter corresponding generally to the diameter of the filament;

c. a mounting arrangement permitting axial movement of the inner cannula; and

d. an actuator mechanism for urging the inner cannula in axial reciprocation consisting of forward motion and retrograde motion with respect to the mounting arrangement.

42. A device according to claim 41, wherein the inner diameter of the inner cannula is approximately equal to the diameter of the filament.

43. A device according to claim 41, wherein the mounting arrangement includes an outer cannula disposed coaxially with and external to the inner cannula.

44. A device according to claim 41, wherein the feeding mechanism further comprises a gripper for grasping the filament synchronously with forward motion of the inner cannula.

45. A device according to claim 41, wherein the feeding mechanism further comprises a second gripper acting out of phase with the first gripper for retaining the filament during retrograde motion of the inner cannula.

46. A device according to claim 41, wherein the feeding mechanism further comprises a brake for retaining the filament during retrograde motion of the inner cannula.

47. A device according to claim 41, wherein the inner cannula comprises distinct distal and proximal segments.

48. A device according to claim 41, further comprising a containment spring for retracting the distal segment of the inner cannula toward the proximal segment of the inner cannula during retrograde motion of the distal segment of the inner cannula.

49. A device according to claim 41, wherein the mounting arrangement includes a tip for penetrating body tissue.

50. A device according to claim 41, wherein the mounting arrangement further comprises a window, disposed proximally to the tip of the mounting arrangement and having a distal edge, for feeding the filament into the site.

51. A device according to claim 41, wherein the device further comprises a rotation arrangement for holding the mounting arrangement in a chosen azimuthal angle with respect to the axis of the conduit.

65. A device according to claim 41, further comprising a filament cutter, the filament cutter comprising:

a. a stop disposed within the mounting arrangement proximally to the distal end of the mounting arrangement; and

b. a sharpened edge disposed on at least one of the inner cannula and the stop such that motion of the inner cannula against the stop causes cutting of the filament.

66. A device according to claim 50 further comprising a filament cutter having a mechanism for driving the inner cannula past the distal edge of the window of the mounting arrangement in such a manner as to cause shearing of the filament.

52. A device for inserting a filament having a diameter into a site in the body of a subject, the device comprising:

a. a conduit having an axis, an interior wall, a distal end for inserting into the site, and a proximal end;

b. a plurality of conveyor belts engaged against the filament; and

c. at least one pulley for moving the conveyor belts.

53. A device for inserting a filament having a diameter into a site in the body of a subject, the device comprising:

a. a conduit having an axis, an interior wall, a distal end for inserting into the site, and a proximal end;

b. a toothed wheel for advancing the filament; and

c. an idler wheel for retaining the filament in contact with the toothed wheel.

54. A device for inserting a filament having a diameter into a site in the body of a subject, the device comprising:

a. a conduit having an axis, an interior wall, a distal end for inserting into the site, and a proximal end;

b. a first and second strut for holding the filament against the wall of the conduit;

c. a reciprocating shaft disposed along the wall of the conduit having a head articulated downward from a bend in the shaft and a channel disposed proximally with respect to the head;

d. a partial pivot disposed across the conduit in a sense perpendicular to the axis of the conduit and distally with respect to the head of the shaft for forcing the shaft head into engagement with the filament; and

e. a mechanism for driving the shaft in an advancing direction such that the filament is advanced into the tissue until the channel of the reciprocating shaft aligns with the partial pivot, permitting it to spring back into its original shape and to disengage the filament.

68. A device for inserting a filament having a diameter into a site in the body of a subject, the device comprising:

a. a conduit having an axis, an interior wall, a distal end for inserting into the site, and a proximal end; and

b. a feeding mechanism for supplying the filament along the axis of the conduit so as to emerge from the distal end; and

c. a filament cutter for shearing the filament.

69. A device for inserting a filament having a diameter into a site in the body of a subject, the device comprising:

a. a conduit having an axis, an interior wall, a distal end for inserting into the site, and a proximal end; and

b. a feeding mechanism for supplying the filament continuously along the axis of the conduit so as to emerge from the distal end; and

c. a filament cutter for shearing the filament.

70. A device for inserting a filament having a diameter into a site in the body of a subject, the device comprising:

a. a conduit having an axis, an interior wall, a distal end for inserting into the site, and a proximal end; and

b. a feeding mechanism for supplying the filament incrementally along the axis of the conduit so as to emerge from the distal end; and

c. a filament cutter for shearing the filament.

71. A device for removing a filament from a site in the body of a subject, the device comprising:

a. a conduit having a distal end for inserting into the site; and

b. a hook for snagging and withdrawing the filament through the conduit.