SURGICAL INSTRUMENTS FOR CREATING A PNEUMOSTOMA AND TREATING CHRONIC OBSTRUCTIVE PULMONARY DISEASE

• US 20090209971A1
• Filed: 02/18/2009
• Published: 08/20/2009
• Est. Priority Date: 02/19/2008
• Status: Active Grant

• Current Assignee: Portaero, Inc
• Original Assignee: Portaero, Inc
• Inventors: Boseck, Gary L., Tanaka, Don, Cerier, Jeffrey C., Wiesman, Joshua P., Plough, David C., Wisdom, Richard S.
• Granted Patent: US 8,252,003 B2
• Time in Patent Office: Days
• US Class Current: 606/108
• CPC Class Codes: A61B 2017/00809 Lung operations
• CPC Class Codes: A61K 9/007 Pulmonary tract; Aromatherapy
• CPC Class Codes: A61M 1/04 Artificial pneumothorax apparatus
• CPC Class Codes: A61M 11/00 Sprayers or atomisers specially adapted for therapeutic purposes in general B05B; aerosol containers B65D83/14
• CPC Class Codes: A61M 11/005 using ultrasonics spraying or atomising liquids using ultrasonic vibrations in general B05B17/06
• CPC Class Codes: A61M 11/042 electrical
• CPC Class Codes: A61M 13/00 Insufflators for therapeutic or disinfectant purposes , i.e. devices for blowing a gas, powder or vapour into the body hand-held units in which gas flow is produced by muscular energy at the moment of use B05B11/062
• CPC Class Codes: A61M 15/0085 using ultrasonics spraying or atomising liquids using ultrasonic vibrations in general B05B17/06
• CPC Class Codes: A61M 15/009 using medicine packages with incorporated spraying means, e.g. aerosol cans pocket atomiser of the injector type A61M11/08
• CPC Class Codes: A61M 15/02 with activated or ionised fluids, e.g. electrohydrodynamic [EHD] or electrostatic devices; Ozone-inhalators with radioactive tagged particles
• CPC Class Codes: A61M 16/0816 Joints or connectors
• CPC Class Codes: A61M 16/0833 T- or Y-type connectors, e.g. Y-piece
• CPC Class Codes: A61M 16/202 electrically actuated
• CPC Class Codes: A61M 2039/0252 for access to the lungs
• CPC Class Codes: A61M 2039/0276 for introducing or removing fluids into or out of the body
• CPC Class Codes: A61M 2202/0208 Oxygen
• CPC Class Codes: A61M 2202/025 Helium
• CPC Class Codes: A61M 2202/064 Powder
• CPC Class Codes: A61M 2205/075 Bulb type
• CPC Class Codes: A61M 2205/7518 bacterial
• CPC Class Codes: A61M 2205/7536 : allowing gas passage, but preventing liquid passage, e.g. liquophobic, hydrophobic, water-repellent membranes
• CPC Class Codes: A61M 25/02 : Holding devices, e.g. on the body
• CPC Class Codes: A61M 25/04 : in the body, e.g. expansible A61M25/10, A61M16/0488 take precedence
• CPC Class Codes: A61M 25/10 : Balloon catheters A61M25/0125 takes precedence; embolectomy A61B17/22032; retractors A61B17/02; inflatable balloons for placing stents or stent-grafts A61F2/958 ; stomach balloons for treatment of obesity A61F5/0003; oesophagal tubes A61J15/00
• CPC Class Codes: A61M 27/00 : Drainage appliance for wounds or the like , i.e. wound drains, implanted drains negative pressure wound therapy devices A61M1/90; implements for holding wound open A61B17/02 ; middle ear drainage A61F11/202
• CPC Class Codes: A61M 39/02 : Access sites
• CPC Class Codes: A61M 39/0247 : Semi-permanent or permanent transcutaneous or percutaneous access sites to the inside of the body peritoneal dialysis catheters A61M1/285; tracheostomy devices A61M16/0465; measuring pressure within the body A61B5/03; colostomy devices A61F5/445; gastrotomy feeding tubes A61J15/0015; means for fixing a feeding tube outside of the body A61J15/0053

Abstract

Surgical instruments and techniques are provided for creating a pneumostoma through the chest wall into the lung of a patient. The pneumostomy instruments and techniques may be used to create a pneumostoma which allows gases to escape from the lung through the chest wall and thereby treat chronic obstructive pulmonary disease.

Claims

1. An instrument adapted to create a stoma into a lung of a patient the patient having a chest wall, a parietal membrane, a visceral membrane and a pleural cavity between the parietal membrane and visceral membrane, the stoma passing through the chest wall, the parietal membrane and the visceral membrane into parenchymal tissue of the lung and being sealed from the pleural cavity, wherein the instrument comprises:

a flexible tube having a proximal end, a distal end and a lumen;

a flange received on the flexible tube and adapted to engage the chest wall of the patient, wherein the flange may be positioned at a variable distance from the distal end of the flexible tube and selectively secured to the flexible tube;

an expandable device connected to the distal end of the flexible tube wherein the expandable device has a first configuration in which it has approximately the same diameter as the flexible tube and a second configuration in which it is significantly larger in diameter than the flexible tube and wherein expansion of the expandable device from the first configuration to the second configuration is adapted to displace parenchymal tissue of the lung and securing the expandable device within the lung;

a coupling attached to the proximal end of the tube;

a substantially non-flexible mandrel having a proximal end and a distal end,

wherein, when the mandrel is received in the lumen of the flexible tube and the proximal end of the mandrel is engaged by the coupling, the distal end of the mandrel engages the expandable device and maintains the expandable device in the first configuration; and

wherein, when the mandrel is disengaged by the coupling and withdrawn from the distal end of the flexible tube, the expandable device expands from the first configuration to the second configuration thereby displacing parenchymal tissue of the lung and securing the expandable device within the lung.

2. The instrument of claim 1, wherein:

the mandrel has a sharp tip which protrudes from the distal end of the flexible tube, the sharp tip being adapted to dissect tissue thereby facilitating percutaneous insertion of the instrument through the chest wall, the parietal membrane and the visceral membrane into parenchymal tissue of the lung.

3. The instrument of claim 1, wherein the expandable device comprises a plurality of arms which project from the expandable device in the second configuration.

4. The instrument of claim 1, wherein the expandable device comprises a plurality of arms which project from the axis of the flexible tube in the second configuration, the plurality of arms being covered with a thin flexible balloon.

5. The instrument of claim 1, wherein at least one of the flexible tube and expandable device comprises a chemical agent adapted to promote pleurodesis between the visceral membrane and the parietal membrane adjacent the stoma.

6. The instrument of claim 1, wherein the flexible tube is adapted to be folded against the chest of the patient while maintaining the expandable device in the second configuration.

7. The instrument of claim 1, wherein:

the mandrel has a sharp tip adapted to initially protrude from the expandable device;

the sharp tip being adapted to dissect tissue thereby facilitating percutaneous insertion of the instrument through the chest wall, the parietal membrane and the visceral membrane into parenchymal tissue of the lung; and

the sharp tip being adapted to be retractable such that after the expandable device has entered the parenchymal tissue of the lung, the sharp tip may be retracted within the expandable device.

8. The instrument of claim 1, further comprising a filament attached to the expandable device, wherein the filament passes through the lumen of the flexible tube to a lock at the proximal end of the flexible tube and wherein the filament may be operated to secure the expandable device in the second configuration.

9. The instrument of claim 1, further comprising a support block adapted to support the flexible tube such that the proximal end of the flexible tube is oriented approximately parallel to the chest wall and the flexible tube is oriented approximately perpendicular to the chest wall between the support and the distal end of the flexible tube.

10. The instrument of claim 1, wherein:

the mandrel has a sharp tip adapted to initially protrude from the expandable device;

the sharp tip being adapted to dissect tissue thereby facilitating percutaneous insertion of the instrument through the chest wall, the parietal membrane and the visceral membrane into parenchymal tissue of the lung; and

the sharp tip being adapted to automatically retract such that after the expandable device has entered the parenchymal tissue of the lung, the sharp tip automatically retracts within the expandable device.

11. A pneumostomy instrument comprising:

a flexible tube having a proximal end, a distal end and a lumen;

a pneumoplasty device connected to the distal end of the flexible tube wherein the pneumoplasty device has first configuration in which it has approximately the same diameter as the flexible tube and a second configuration in which it is significantly larger in diameter than the flexible tube;

a coupling attached to the proximal end of the tube;

a substantially non-flexible mandrel the mandrel having a proximal end and a distal end,

wherein, when the mandrel is received in the lumen of the flexible tube and the proximal end of the mandrel is engaged by the coupling, the distal end of the mandrel engages the pneumoplasty device and maintains the pneumoplasty device in the first configuration; and

wherein, when the mandrel is disengaged by the coupling and withdrawn from the distal end of the flexible tube, the pneumoplasty device expands from the first configuration to the second configuration.

12. An instrument for forming a stoma into a lung of a person the person having a chest wall, a parietal membrane, a visceral membrane and a pleural cavity between the parietal membrane and visceral membrane, the stoma passing through the chest wall, the parietal membrane and the visceral membrane into the lung and being sealed from the pleural cavity, wherein the instrument comprises:

a shaft having a proximal end and a distal end wherein the shaft is adapted to be inserted through the chest wall, visceral membrane and parietal membrane into parenchymal tissue of the lung;

an expanding device attached to the distal end of the shaft wherein the expanding device is adapted to be expanded within the parenchymal tissue of the lung to displace parenchymal tissue of the lung and thereby anchor the distal end of the shaft within the lung;

means for causing the expanding device to expand after placement of the expanding device within parenchymal tissue of the lung;

a sliding flange received on the shaft and adapted to engage the skin of the chest wall such that, with the distal end of the shaft anchored within the lung, the distal end of the shaft and lung may be drawn towards the chest wall and then secured in place by drawing the shaft through the flange and then securing the flange to the shaft.