Methods and apparatus for performing transluminal and other procedures

• US 20070135803A1
• Filed: 09/14/2006
• Published: 06/14/2007
• Est. Priority Date: 09/14/2005
• Status: Abandoned Application

• Current Assignee: Intuitive Surgical Operations, Inc. (Intuitive Surgical Holdings, LLC)
• Original Assignee: Intuitive Surgical Operations, Inc. (Intuitive Surgical Holdings, LLC)
• Inventors: Belson, Amir
• Application Number:
  US11/522,305
• Publication Number:
  US 20070135803A1
• Time in Patent Office: Days
• US Class Current: 606/1
• CPC Class Codes: A61B 1/00087 Tools A61B17/00234 takes precedence
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• CPC Class Codes: A61B 1/0055 Constructional details of insertion parts, e.g. vertebral elements
• CPC Class Codes: A61B 1/0057 Constructional details of force transmission elements, e.g. control wires
• CPC Class Codes: A61B 1/008 Articulations
• CPC Class Codes: A61B 1/01 Guiding arrangements therefore
• CPC Class Codes: A61B 1/015 Control of fluid supply or evacuation
• CPC Class Codes: A61B 1/0615 for radial illumination
• CPC Class Codes: A61B 1/31 for the rectum, e.g. proctoscopes, sigmoidoscopes , colonoscopes
• CPC Class Codes: A61B 1/3132 for laparoscopy
• CPC Class Codes: A61B 17/0057 Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/064 Surgical staples, i.e. penetrating the tissue
• CPC Class Codes: A61B 17/1114 of the digestive tract, e.g. bowels or oesophagus
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• CPC Class Codes: A61B 17/1155 Circular staplers comprising a plurality of staples
• CPC Class Codes: A61B 17/1285 for minimally invasive surgery
• CPC Class Codes: A61B 17/3462 with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals expandable cannulas A61B17/3417
• CPC Class Codes: A61B 17/3476 : Powered trocars, e.g. electrosurgical cutting, lasers, powered knives
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• CPC Class Codes: A61B 2017/3419 : Sealing means between cannula and body
• CPC Class Codes: A61B 2017/3445 : used as instrument channel for multiple instruments catheters A61B2017/22072
• CPC Class Codes: A61B 2017/3447 : Linked multiple cannulas
• CPC Class Codes: A61B 2017/347 : Locking means, e.g. for locking instrument in cannula
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• CPC Class Codes: A61B 2017/3488 : Fixation to inner organ or inner body tissue
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• CPC Class Codes: A61B 2034/2055 : Optical tracking systems
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• CPC Class Codes: A61B 2090/508 : with releasable brake mechanisms
• CPC Class Codes: A61B 34/20 : Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 34/70 : Manipulators specially adapted for use in surgery
• CPC Class Codes: A61B 34/71 : Manipulators operated by drive cable mechanisms
• CPC Class Codes: A61B 5/0071 : by measuring fluorescence emission
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• CPC Class Codes: A61B 5/0084 : for introduction into the body, e.g. by catheters A61B5/1459 takes precedence
• CPC Class Codes: A61B 5/064 : using markers A61B5/062 takes precedence
• CPC Class Codes: A61B 5/418 : lymph vessels, ducts or nodes
• CPC Class Codes: A61B 90/36 : Image-producing devices or illumination devices not otherwise provided for
• CPC Class Codes: A61B 90/361 : Image-producing devices, e.g. surgical cameras
• CPC Class Codes: A61B 90/50 : Supports for surgical instruments, e.g. articulated arms
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Abstract

The invention is directed to an apparatus for use in a transluminal procedure. The apparatus, comprising, for example, a housing having a guide lumen and a seal proximal to a distal end of the housing that extends across and completely seals the guide lumen; a fixation element in the housing and adapted to secure the distal end of the housing to tissue; and a channel extending through the side wall of the housing having an outlet in communication with the lumen distal of the seal. Methods are also provided. For example, a method includes, performing a transluminal procedure by: securing a datum and position indicator to a wall of a target lumen; forming an opening in the wall; advancing an instrument through the opening; and tracking the advancement of the instrument using the datum and position indicator.

Claims

1. A method for performing a transluminal procedure, comprising:

securing a datum and position indicator to a wall of a target lumen;

forming an opening in the wall;

advancing an instrument through the opening; and

tracking the advancement of the instrument using the datum and position indicator.

2. The method of claim 1 wherein the forming step comprises forming the opening with an instrument coupled to the datum and position indicator.

3. The method of claim 1 wherein the advancing step comprises advancing the instrument through a guide lumen in the datum and position indicator.

4. The method of claim 3 further comprising piercing a sheath extending across the guide lumen while advancing the instrument through the lumen in the datum and position indicator.

5. The method of claim 3 further comprising unrolling a sheath contained in the datum and position indicator while advancing the instrument through the guide lumen.

6. The method of claim 1 further comprising rigidizing a guide tube coupled to the datum and position indicator before tracking the advancement of the instrument.

7. The method of claim 1 further comprising sterilizing the wall of the target lumen after securing the datum and position indicator for the wall of the target lumen.

8. The method of claim 1 wherein the tracking step comprises providing instrument tracking information to a system used to monitor the progress of the instrument.

9. The method of claim 1 further comprising controlling articulation of the instrument using information from the tracking step.

10. Apparatus for performing a transluminal procedure comprising:

a cutting tool; and

a datum and position indicator comprising a luminal wall attachment mechanism and an instrument tracking mechanism adapted to monitor passage of an instrument through a luminal wall opening formed by the cutting tool.

11. The apparatus of claim 10 wherein the cutting tool is coupled to the datum and position indicator.

12. The apparatus of claim 10 further comprising a guide lumen, the instrument tracking mechanism being adapted to detect passage of an instrument through the guide lumen and through the luminal wall opening formed by the cutting tool.

13. The apparatus of claim 12 wherein the guide lumen comprises a rigidizable guide tube.

14. The apparatus of claim 10 further comprising a luminal wall sterilizing mechanism.

15. The apparatus of claim 10 further comprising a instrument tracking monitor in communication with the tracking mechanism to receive instrument tracking information.

16. Apparatus for performing a transluminal procedure comprising:

a cutting tool;

a transluminal instrument; and

a datum and position indicator comprising a guide lumen, a luminal wall attachment mechanism and an instrument tracking mechanism adapted to detect passage of the instrument through a luminal wall opening formed by the cutting tool.

17. The apparatus of claim 16 wherein the guide lumen comprises a sheath and the transluminal instrument comprises a sheath piercing mechanism adapted to pierce the sheath.

18. The apparatus of claim 16 wherein the guide lumen comprises a rolled sheath adapted to unroll as the instrument advances through the guide lumen.

19. The apparatus of claim 16 further comprising an instrument control in communication with the instrument tracking mechanism to control articulation of the instrument.

20. A method for providing a sterile field during a transluminal procedure, comprising:

securing an elongated body to a wall of a lumen;

advancing a sterilization device through the elongated body to a position adjacent the lumen wall; and

sterilizing a target portion of the lumen wall with the sterilization device.

21. The method of claim 20 wherein the sterilizing step comprises spraying a sterile sealant onto the lumen wall.

22. The method of claim 20 wherein the sterilizing step comprises securing a patch against and completely covering the target portion of the lumen wall.

23. The method of claim 20 further comprising creating an opening through the lumen wall after the sterilizing step.

24. Apparatus for performing a transluminal procedure comprising:

an elongated body comprising a luminal wall attachment mechanism at a distal portion of the elongated body; and

a luminal wall sterilization device extending from a proximal portion of the elongated body to the distal portion of the elongated body.

25. The apparatus of claim 24 wherein the sterilization device comprises a sprayer and a sterile sealant source.

26. The apparatus of claim 24 wherein the sterilization device comprises a patch, the patch comprising a luminal wall attachment mechanism.

27. The apparatus of claim 24 further comprising a cutting tool extending from a proximal portion of the elongated body to the distal portion of the elongated body.

28. An apparatus for use in a transluminal procedure, comprising:

a housing having a guide lumen and a seal proximal to a distal end of the housing that extends across and completely seals the guide lumen;

a fixation element in the housing and adapted to secure the distal end of the housing to tissue; and

a channel extending through the side wall of the housing having an outlet in communication with the lumen distal of the seal.

29. The apparatus of claim 28 wherein the fixation element comprises a plurality of tines.

30. The apparatus of claim 28 wherein the fixation element comprises a shaft and a plurality of wires extending from the shaft.

31. The apparatus of claim 28 wherein the fixation element is adapted to engage with tissue by rotating less than one half of one revolution.

32. The apparatus of claim 28 further comprising at least one cutting blade distal to the seal.

33. The apparatus of claim 32 wherein the at least one cutting blade distal to the seal is disposed entirely within the sidewall of the housing.

34. The apparatus of claim 28 wherein the housing is a guide tube.

35. The apparatus of claim 34 wherein the guide tube is a semi-rigidizable guide tube.

36. A method for performing a transluminal procedure comprising:

securing a distal end of a housing to tissue, the housing comprising a guide lumen and a seal proximal to a distal end of the housing that extends across and completely seals the guide lumen; and

sterilizing a region within the guide lumen distal to the seal.

37. The method of claim 36 further comprising forming an opening in tissue distal to the seal after the sterilizing step.

38. The method of claim 37 further comprising advancing an instrument through the seal after the sterilizing step.