Apparatus and methods for endoscopic surgical procedures
First Claim
1. A surgical instrument comprising:
- an elongated body having distal and proximal ends and a lumen therein;
a shaft slidably disposed within the lumen and having a proximal end extending beyond the proximal end of the body to facilitate movement of the shaft relative to the body;
an end effector disposed at the distal end of the shaft; and
a structure for supplying luminous flux to the end effector for illuminating tissue.
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0 Petitions
Accused Products
Abstract
Apparatus and method for performing surgical procedures within the mediastinum and within the pericardium include an endoscopic cannula having at least one lumen, a transparent tip, and an endoscope for introduction into the mediastinum and optionally into the pericardium via a single subxiphoid incision. A cavity may be initially dilated for advancing the endoscopic cannula using a dilating tool have an inner cannula and an outer expansible sheath that exerts a lateral-expansive, tissue-dilating force against the surrounding tissue cavity to allow the larger endoscopic cannula to be introduced into the mediastinum. Other surgical instruments, including a pericardial entry instrument are positioned through a lumen of the endoscopic cannula to cut a flap of the pericardium and create a small opening through which other surgical instruments such as an ablation probe or a restraining jacket may be introduced. All regions of the heart may be accessed by sweeping the endoscopic cannula around the heart through an aperture near the apex of the heart. Such access facilitates placement of epicardial tacks about the annulus of the mitral valve for supporting a tensioned suture or band to decrease the size of the mitral annulus to repair a regurgitant valve. Tensioning bands may also be tacked to the pericardium in order to inhibit distention of the heart.
608 Citations
56 Claims
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1. A surgical instrument comprising:
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an elongated body having distal and proximal ends and a lumen therein;
a shaft slidably disposed within the lumen and having a proximal end extending beyond the proximal end of the body to facilitate movement of the shaft relative to the body;
an end effector disposed at the distal end of the shaft; and
a structure for supplying luminous flux to the end effector for illuminating tissue. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8)
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9. A surgical instrument comprising:
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an elongated body having lateral flexibility and torsional rigidity and including a conduit; and
tissue-ablating apparatus disposed within the conduit for selectively ablating tissue in proximity thereto. - View Dependent Claims (10, 11, 12, 13, 14, 15, 16)
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17. A surgical procedure comprising the steps for:
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forming an incision;
advancing a cannula through the incision toward a target location on the patient'"'"'s pericardium;
introducing the illuminator through the cannula into contact with the pericardium at the target location;
attaching the illuminator to the pericardium; and
lighting the illuminator. - View Dependent Claims (18, 19, 20, 21, 22, 23, 24, 30, 31, 32, 35, 36)
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25. A surgical procedure comprising the steps for:
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forming an incision;
advancing an endoscopic cannula through the incision toward a target location on the patient'"'"'s pericardium;
introducing a pericardium-penetrating instrument through the endoscopic cannula into contact with the pericardium at the target location;
forming an aperture through the pericardium at the target site to expose cardiac tissue thereat;
advancing a tissue-ablating probe through the aperture and along a path within the intrapericardial space laterally adjacent a pulmonary vein; and
energizing the probe to ablate cardiac tissue. - View Dependent Claims (26, 27, 28, 29)
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33. A surgical procedure comprising the steps for:
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forming an intercostal thoracotomy;
inserting an endoscopic cannula through the thoracotomy and penetrating tissue along a path toward the pericardium;
forming an aperture through the pericardium at a location near the superior vena cava;
inserting a structure including an elongated body through the endoscopic cannula and aperture along a path traversing the transverse pericardial sinus;
forming a subxiphoid incision;
inserting an endoscopic cannula through the subxiphoid incision toward the pericardium;
forming another aperture in the pericardium at a location near the apex;
inserting a grasping instrument through the endoscopic cannula within the subxiphoid incision and through said another aperture to grasp a distal tip of the elongated body to extend the path thereof laterally along the left pulmonary veins;
grasping the distal end of the elongated body and extending the path thereof laterally of the right pulmonary veins substantially to the location of entry of the elongated body into the transverse pericardial sinus to substantially encircle the pulmonary vein ostia with the elongated body. - View Dependent Claims (34)
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37. Surgical apparatus comprising:
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an elongated cannula having first and second separate channels therein and including a suction port at a distal end of the elongated cannula in fluid communication with the first lumen;
a resilient suction cup disposed about the suction port; and
the second lumen having a distal end thereof displaced from the suction port for slidably extending a surgical instrument therethrough forward of the suction port. - View Dependent Claims (38, 39, 40, 41)
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42. A surgical procedure comprising the steps for:
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forming an incision;
advancing an endoscopic cannula through the incision toward a target location on a patient'"'"'s pericardium;
introducing a pericardium-penetrating instrument through the endoscopic cannula into contact with the pericardium at the target location;
forming an aperture through the pericardium at the target site to expose epicardial tissue;
introducing a tacking instrument through the endoscopic cannula through the aperture in the pericardium for installing a plural number of tacks at selected spaced locations in the epicardial tissue; and
installing an element in contact with at least a pair of the plural number of tacks to exert tension thereon. - View Dependent Claims (43, 44, 45, 46, 47, 48, 49, 50, 51, 52)
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53. A surgical procedure on the heart comprising the steps for:
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forming a subxiphoid incision;
advancing through the subxiphoid incision toward a target site on the pericardium an endoscopic cannula having a lumen therethrough;
introducing a pericardium entry instrument through the endoscopic cannula into contact with the pericardium at the target site;
forming an aperture through the pericardium at the target site;
inserting the endoscopic cannula through the aperture formed in the pericardium;
advancing one flexible surgical apparatus through the lumen in the endoscopic cannula into the transverse pericardial sinus toward the end of the sinus;
positioning a portion of the one flexible surgical apparatus along a path lateral to the left pulmonary veins and inferior to the inferior pulmonary veins;
forming an aperture through the posterior pericardium medial to the inferior vena cava and lateral and inferior to the right inferior pulmonary vein;
advancing an endoscopic cannula through the aperture in posterior pericardium to form an extrapericardial tract lateral to the right pulmonary veins and medial to vena cava and toward a region near the end of the transverse pericardial sinus; and
advancing another flexible surgical apparatus through the extra pericardial tract to substantially encircle all pulmonary veins with the one and another flexible surgical apparatuses. - View Dependent Claims (54, 55)
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56. A surgical procedure on the heart comprising the steps for:
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forming a subxiphoid incision;
advancing through the subxiphoid incision toward a target site on the pericardium an endoscopic cannula having a lumen therethrough;
introducing a pericardium entry instrument through the lumen in the endoscopic cannula into contact with the pericardium at the target site;
forming an aperture through the pericardium at the target site near the superior vena cava;
advancing one tissue-ablating probe through the aperture along a path laterally along the right pulmonary veins and inferior vena cava to a terminus for a distal end of the one probe in a pericardium reflection adjacent the superior vena cava;
advancing another tissue-ablating probe along a path across the oblique pericardial sinus and laterally adjacent the left pulmonary veins and across the transverse pericardial sinus to a terminus for a distal end of said another probe at said pericardial reflection hear the superior vena cava in substantial alignment with the distal end of the one probe on opposite sides of said pericardial reflection; and
ablating tissue along said one and said another paths.
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Specification