Apparatus and methods for performing ablation
First Claim
Patent Images
1. An endoscopic procedure requiring access through only one side of a patient'"'"'s chest, said procedure comprising the steps of:
- advancing an instrument through an opening in the right chest of the patient;
dissecting the patient'"'"'s pericardium to provide access to a transverse pericardial sinus;
advancing a lead through the pericardium and the transverse pericardial sinus and into an oblique pericardial sinus of the patient;
dissecting the patient'"'"'s pericardium to provide access to the oblique pericardial sinus;
inserting an instrument into the oblique pericardial sinus; and
connecting the lead and the instrument together in the oblique pericardial sinus.
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Accused Products
Abstract
Apparatus and methods for performing endoscopic surgical procedures where only a minimal number of (or even one) openings are required to perform the procedures. Ablation procedures, including epicardial ablation procedures and apparatus for performing such procedures. Epicardial atrial ablation may be performed epicardially with access through only one side of a patient'"'"'s chest required to perform all procedures.
245 Citations
191 Claims
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1. An endoscopic procedure requiring access through only one side of a patient'"'"'s chest, said procedure comprising the steps of:
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advancing an instrument through an opening in the right chest of the patient;
dissecting the patient'"'"'s pericardium to provide access to a transverse pericardial sinus;
advancing a lead through the pericardium and the transverse pericardial sinus and into an oblique pericardial sinus of the patient;
dissecting the patient'"'"'s pericardium to provide access to the oblique pericardial sinus;
inserting an instrument into the oblique pericardial sinus; and
connecting the lead and the instrument together in the oblique pericardial sinus. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48)
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19. The procedure of claim 19, wherein said connecting comprises cinching said loop down around a distal end portion of said instrument.
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49. A minimally invasive method of encircling the pulmonary veins of a patient, wherein said method requires entry into the patient from only one side of the chest, said method comprising the steps of:
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advancing a lead through an opening in the chest of the patient, through a first opening in the pericardium, and into a transverse pericardial sinus of the patient, across the transverse pericardial sinus and into an oblique pericardial sinus of the patient as the lead tracks downward along a closed border of the pericardium on a side of the heart opposite to the opening in the pericardium;
inserting an instrument through a second opening in the pericardium and into the oblique pericardial sinus; and
connecting the lead and the instrument together in the oblique pericardial sinus. - View Dependent Claims (50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62)
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63. Surgical apparatus comprising:
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an elongated body having distal and proximal end portions and a lumen therethrough;
a lens in said lumen;
a transparent tip extending distally from said distal end portion; and
an elongated tube slidable over said elongated body and adapted to cannulate an opening through tissue formed by said tip. - View Dependent Claims (64, 65, 66, 67, 68)
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69. A surgical instrument for performing endoscopic functions, said instrument comprising:
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an elongated body having distal and proximal end portions and a lumen therethrough;
a lens in said lumen; and
a transparent tip extending distally from said distal end portion, said transparent tip having a distal end portion having a first cross-sectional area larger than a second cross-sectional area of said tip at a location proximal of said distal end portion of said tip, wherein images are viewable through said elongated body, lens and transparent tip. - View Dependent Claims (70, 71, 72)
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73. Surgical apparatus comprising:
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an endoscope having an elongated body and a lumen therethrough, a lens in said lumen, a distal end portion of said endoscope including a distal end portion of said elongated body and a tip extending distally from said elongated body, wherein images are viewable through said tip, lens and lumen; and
an elongated lead cinched over said distal end portion of said endoscope and extending proximally therefrom. - View Dependent Claims (74, 75, 76, 77, 78, 79, 80)
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81. Surgical apparatus comprising:
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a dissecting endoscope having an elongated body having distal and proximal end portions and a lumen therethrough;
a lens in said lumen; and
a transparent tip extending distally from said distal end portion; and
a tube having an inside diameter larger than an outside diameter of said elongated body, and slidable over said elongated body, said tube being adapted to be mounted on said elongated body prior to dissecting an opening through tissue by said dissecting endoscope, and to be slid distally with respect to said elongated body and through an opening established by said dissecting endoscope, thereby cannulating the opening, even after removal of said dissecting endoscope therefrom. - View Dependent Claims (82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94)
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95. Surgical apparatus comprising:
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an elongated lead having sufficient length to extend from an opening in a right chest of a patient and out of the patient'"'"'s body at a proximal end of said lead, around four pulmonary veins of the patient and back out of the opening in the right side of the patient at a distal end of said elongated lead, said elongated lead further comprising a first connector at a distal end thereof; and
an elongated instrument having sufficient length to extend through said opening, or a second opening in the right side of the patient to connect with said lead in an oblique pericardial sinus of the patient, said elongated instrument further comprising a second connector, wherein a connection between said elongated instrument and said elongated lead is made via said first and second connectors. - View Dependent Claims (96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132)
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133. A surgical device comprising:
an elongated tube having sufficient length to extend from an opening in a right chest of a patient and out of the patient'"'"'s body at a proximal end of said tube, around four pulmonary veins of the patient and back out of the opening in the right side of the patient at a distal end of said tube, said tube further comprising at least one slit between proximal and distal ends of said tube, said at least one slit being sufficiently long to form an opening to slidably receive an endoscope. - View Dependent Claims (134, 135, 136, 137, 138, 139, 140, 141)
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142. Surgical apparatus comprising:
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an elongated lead having sufficient length to extend from an opening in a right chest of a patient and out of the patient'"'"'s body at a proximal end of said lead, around four pulmonary veins of the patient and back out of the opening in the right side of the patient at a distal end of said elongated lead, said elongated lead comprising a first tube and a second tube, a proximal end of said first tube being connectable with a distal end of said second tube; and
an elongated instrument having sufficient length to extend through said opening and into a transverse pericardial sinus of the patient, wherein said first tube is configured to be freely slidable over said elongated instrument, and said first tube has a length less than a length of said elongated instrument, so that a distal end of said elongated instrument extends beyond a distal end of said first tube when said first tube is slid over said elongated instrument. - View Dependent Claims (143, 144, 145, 146, 147)
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148. Surgical apparatus comprising:
an expandable length tube having an expanded length configuration having sufficient length to extend from an opening in a right chest of a patient through a transverse pericardial sinus of the patient, around left pulmonary veins of the patient and into an oblique pericardial sinus of the patient, and a compressed length configuration having a length shorter than said expandable length configuration, said tube having an opening therethrough configured to pass an ablation probe therethrough. - View Dependent Claims (149, 150, 151, 152, 153, 154, 155, 156, 157, 158, 159, 160, 161, 162, 163, 164, 165, 166)
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167. A surgical device comprising:
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an elongated tubular instrument having a main tube with sufficient length to extend through an opening in the chest wall of a patient, through the pericardium of the patient and into the transverse pericardial sinus while a proximal portion of said instrument remains outside the body of the patient;
a transparent distal tip mounted to a distal end of said main tube; and
a second tube running parallel to said main tube and having an inside diameter sufficient to pass a snare catheter therethrough. - View Dependent Claims (168, 169, 170, 171, 172)
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173. A surgical device comprising:
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an elongated ablation probe having a proximal end portion and a distal end portion; and
an elongated, flexible tube having a proximal end portion and a distal end portion, said proximal end portion of said tube being releasably connectable to said distal end portion of said probe. - View Dependent Claims (174, 175, 176, 177, 178, 179, 180, 181)
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182. A surgical device comprising:
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an elongated tubular instrument having a main tube with sufficient length to extend through an opening in the chest wall of a patient, through the pericardium of the patient and into the transverse pericardial sinus while a proximal portion of said instrument remains outside the body of the patient;
a transparent distal tip mounted to a distal end of said main tube;
a lumen extending through said main tube and opening to a proximal end of said device, said lumen configured to receive an endoscope to permit viewing by said endoscope through said transparent distal tip; and
a second lumen extending through said main tube and opening at a proximal end portion of said device to receive a snare catheter therethrough. - View Dependent Claims (183, 184, 185, 186, 187, 188, 189, 190, 191)
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Specification