Methods and apparatus for transesophageal microaccess surgery

• US 20100036197A1
• Filed: 07/31/2009
• Published: 02/11/2010
• Est. Priority Date: 08/01/2008
• Status: Active Grant

• Current Assignee: Microaccess Inc.
• Original Assignee: Microaccess Inc.
• Inventors: Mesallum, Sameh
• Granted Patent: US 8,771,170 B2
• Time in Patent Office: Days
• US Class Current: 600/104
• CPC Class Codes: A61B 17/00491 Surgical glue applicators surgical adhesives A61L24/00; two-component delivery syringes A61M5/19
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/3423 Access ports, e.g. toroid shape introducers for instruments or hands access sites for liquids A61M39/0247
• CPC Class Codes: A61B 17/3439 with means for changing the inner diameter of the cannula, e.g. expandable A61B17/3423, A61B17/3431 take precedence; catheters A61M25/0662
• CPC Class Codes: A61B 17/3498 Valves therefor, e.g. flapper valves, slide valves haemostasis valves A61M39/06; check valves A61M39/24
• CPC Class Codes: A61B 2017/00004 (bio)absorbable, (bio)resorbable or resorptive
• CPC Class Codes: A61B 2017/00278 Transorgan operations, e.g. transgastric
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/0225 flexible, e.g. fabrics, meshes, or membranes
• CPC Class Codes: A61B 2017/0641 having at least three legs as part of one single body
• CPC Class Codes: A61B 2017/0649 Coils or spirals
• CPC Class Codes: A61B 2017/22054 with two balloons
• CPC Class Codes: A61B 2017/22067 Blocking; Occlusion A61B2017/22054 takes precedence
• CPC Class Codes: A61B 2017/22069 Immobilising; Stabilising
• CPC Class Codes: A61B 2017/306 holding by means of suction
• CPC Class Codes: A61B 2017/3419 Sealing means between cannula and body

Abstract

The current invention describes methods of transesophageal access to the neck and thorax to perform surgical interventions on structures outside the esophagus in both the cervical and the thoracic cavity. It describes a liner device made of a complete or partial tubular structure, or a flat plate, the liner having means to facilitate creation of a side opening, which may include a valve. The liner with its side opening form a port structure inside the esophageal lumen. The port structure allows elongated surgical devices to pass through a perforation across the full thickness of the esophageal wall to outside location, in a controlled way. The elongated surgical devices can be diagnostic scopes, therapeutic scopes, manual elongated surgical devices, robotic arms or the like. After being deployed outside the esophagus, the surgical devices can access structures outside the esophagus, in the neck and thorax in 360 degrees of freedom around the esophageal circumference. These structures can be bony, cartilaginous, spinal, vascular, soft tissue, deep tissues, lymph nodal, cardiac, pulmonary, tracheal, nervous, muscular or diaphragmatic, skin and subcutaneous tissues of the neck, skin and subcutaneous tissues of the anterior chest wall, skin and subcutaneous tissues of the skin of the back, and skin and layers of the breast.

Claims

1. Means for isolating esophageal lumen tissue from contact with fluids, said means comprising a liner which is applied to said tissue to cover said tissue on at least one of the inside and the outside of said lumen.

2. Means as in claim 1 wherein said liner is a barrier and comprises a complete or partial opening to allow devices to go through the esophageal wall to a target outside the esophageal wall after the liner and the esophageal wall have been penetrated to create an opening.

3. Means as in claim 2 where said liner has a pre-formed location for creation of a hole to allow for passage through said liner.

4. Means as in claim 3 wherein a valve communicates with said hole, wherein said valve mechanism can be operated during a procedure affecting at least one of said esophageal tissue, and other tissue accessible through said hole.

5. Means as in claim 1 wherein said liner has a closed distal end.

6. Means as in claim 1 wherein said liner is affixed to said tissue by at least one attachment means.

7. Means as in claim 6 wherein the attachment means comprise at least one of vacuum, mechanical force, balloon inflation, welding, suturing, adhesives, and mechanical devices.

8. Means as in claim 1 wherein said liner has a form comprising an at least partially complete tubular structure.

9. Means as in claim 1 further comprising a side opening mechanism.

10. Means as in claim 1 attached to a deployment device, in which said deployment device is sufficiently long that it may be passed through a patient'"'"'s mouth and advanced to at least the distal esophagus, and still have its proximal end outside of the patient'"'"'s body.

11. Means as in claim 1 wherein said liner is a barrier and comprises a complete or partial opening to allow devices to go through the esophageal wall to a target outside the esophageal wall after the liner and the esophageal wall have been penetrated to create an opening.

12. Means as in claim 1 wherein the material of said liner is characterized in being one or more of degradable in vivo, antimicrobial in effect, and having more than one layer.

19. The method of claim 12 wherein the procedures to be performed are one or more of procedures on the lungs, bronchi, nerves, lymphatics, great vessels of the thorax, bony or cartilaginous structures, diaphragm, phrenic nerve, gastroesophageal junction and on the esophagus itself, including the delivery of an esophageal band for satiety or an intra-esophageal valve for reflux.

13. An improved method of performing transesophageal surgery, wherein the improvement comprises the provision of a liner affixed to the tissue of the esophagus.

14. The method of claim 13, wherein the liner is a barrier and comprises a complete or partial opening to allow devices to go through the esophageal wall to a target outside the esophageal wall after the liner and the esophageal wall have been penetrated to create an opening.

15. The method of claim 14 wherein the side opening can be closed by spontaneous closure upon withdrawal of an instrument.

16. The method of claim 13 wherein the liner is used in procedures including tumor excision or biopsy;

placement of drugs, tissues, and radioactive materials;

bronchial biopsy, airway bypass, manipulation of great vessels of the thorax, and pulmonary artery bypass.

17. The method of claim 13 wherein the procedures to be performed are one or more of disk surgery, vertebral column surgery, spinal cord surgery, nerve root surgery, spinal and paraspinal muscle surgery, vascular surgery, oncologic surgery, laser surgery, delivery of energy to tissue, delivery of tissue or genetic material, delivery of surgical devices in general, delivery of cardiac pacemaker or diaphragmatic pace maker, and performance of procedures affecting the esophagus itself including fundoplication, and stomach pacemaker implantation.

18. The method of claim 13 wherein the procedures to be performed are one or more cardiac procedures including mapping, cardiac ablation, valve surgery, closure of septal defects, laser surgery, delivery of energy to the heart and related structure for pacing or to enhance contractility, delivery of drugs or genetic material, and delivery of surgical devices to the heart and related structures.

20. A method for performing surgery in which a liner is placed in a tubular body lumen, including the esophagus, the intestine, the genitourinary (GU) tract, the cardiovascular system, the pulmonary system, the canaliculi of the inner ear, and the lymphatic system, and in which said liner serves as an opening for passage of instruments through the wall of the lumen.

21-41. -41. (canceled)