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

• US 20100204707A1
• Filed: 02/11/2010
• Published: 08/12/2010
• Est. Priority Date: 02/11/2009
• Status: Active Grant

• Current Assignee: Portaero, Inc
• Original Assignee: Portaero, Inc
• Inventors: Boseck, Gary L., Wisdom, Richard S., Tanaka, Don, Cerier, Jeffrey C., Wiesman, Joshua P., Plough, David C.
• Granted Patent: US 8,518,053 B2
• Time in Patent Office: Days
• US Class Current: 606/108
• CPC Class Codes: A61B 2017/00809 Lung operations
• CPC Class Codes: A61B 2017/3427 for intercostal space
• CPC Class Codes: A61B 2017/3486 Balloon
• CPC Class Codes: A61B 2017/3488 Fixation to inner organ or inner body tissue
• CPC Class Codes: A61M 1/04 Artificial pneumothorax apparatus
• CPC Class Codes: A61M 2025/0233 specifically adapted for attaching to a body wall by means which are on both sides of the wall, e.g. for attaching to an abdominal wall
• CPC Class Codes: A61M 2025/0246 fixed on the skin having a cover for covering the holding means
• CPC Class Codes: A61M 2025/028 having a mainly rigid support structure
• 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 25/01 Introducing, guiding, advancing, emplacing or holding catheters A61M25/10 takes precedence
• 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 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:

an elongate tube having a proximal end, a distal end and a lumen;

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

a grip attached to the proximal end of the tube;

a lever mounted on the grip;

one or more filaments connecting the lever and the expandable device such that operation of the lever pulls the filaments towards the proximal end of the tube thereby causing expansion of the expanding device from the first configuration to the second configuration.

2. The instrument of claim 1, wherein the expanding device comprises an expanding basket.

3. The instrument of claim 1, wherein:

the expanding device comprises a distal tube connected by a plurality of individual struts to a proximal tube;

the filaments are connected to the distal tube;

wherein operation of the lever pulls the filaments pulls the filaments towards the proximal end of the tube thereby pulling the distal tube towards the proximal tube and causing the plurality of struts to bend outwards, thereby causing expansion of the expanding device from the first configuration to the second configuration.

4. The instrument of claim 1, wherein the expanding device comprises one or more radiopaque markers which allow verification of the position and expansion of the expanding device within a lung of a patient.

5. The instrument of claim 1, wherein the grip includes a catch adapted to secure the lever and thereby secure the expanding device in the second configuration.

6. The instrument of claim 5, wherein the grip includes a device which prevents operation of the lever by the patient.

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

8. The instrument of claim 1, wherein the expanding device comprises one or more radiopaque markers positioned on the arms to allow visualization of the arms within a lung of a patient.

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

10. The instrument of claim 1, in combination with a support block adapted to support the elongate tube such that a proximal portion of the elongate tube is oriented approximately parallel to a chest wall and a distal portion of the elongate tube is oriented approximately perpendicular to the chest wall.

11. The instrument of claim 1, wherein the elongate tube comprises a metal reinforcing element which increases column strength of the elongate tube without preventing bending of the elongate tube.

12. The instrument of claim 1, wherein the elongate tube comprises a coil spring which reduces kinking of the elongate tube upon bending of the elongate tube.

13. 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 which is approximately the same in diameter as the flexible tube and a second configuration in which it is significantly larger in diameter than 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;

a grip attached to the proximal end of the flexible tube;

a lever mounted on the grip;

one or more filaments connecting the lever and the pneumoplasty device such that operation of the lever pulls the filaments towards the proximal end of the flexible tube thereby causing expansion of the pneumoplasty device from the first configuration to the second configuration.

14. The instrument of claim 13, wherein:

the pneumoplasty device comprises a distal tube connected by a plurality of individual struts to a proximal tube;

the filaments are connected to the distal tube;

wherein operation of the lever pulls the filaments towards the proximal end of the flexible tube thereby pulling the distal tube towards the proximal tube and causing the plurality of struts to bend outwards, thereby causing expansion of the expanding device from the first configuration to the second configuration.

16. The instrument of claim 13, wherein the grip includes a catch adapted to secure the lever and thereby secure the pneumoplasty device in the second configuration.

17. The instrument of claim 16, wherein the grip includes a device which prevents operation of the lever by the patient.

18. A method 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 method comprises:

receiving an instrument having an expandable device at a distal end of a flexible tube and a manual actuator at a proximal end of the flexible tube and a mandrel position within the flexible tube;

making an incision in a chest wall of a patient;

placing the expandable device through the incision in the chest wall of the patient, through the parietal membrane and visceral membrane and into the lung of the patient;

removing the mandrel from a lumen of the flexible tube;

operating the manual actuator to cause the expanding device to transition from a first configuration in which it is similar in diameter as the flexible tube and a second configuration in which it is significantly larger in diameter than the flexible tube and thereby engage the lung of the patient;

applying traction to the proximal end of the tube to place the parietal membrane in contact with the visceral membrane surrounding the flexible tube;

and causing pleurodesis of the parietal membrane visceral membrane surrounding the flexible tube.

19. The method of claim 18, further comprising:

inserting a mandrel into the lumen of the flexible tube to cause the expanding device to transition form the second configuration to the first configuration; and

removing the expanding device through the incision in the chest wall of the patient.

20. The method of claim 18, wherein the expanding device is operated so as to create a cavity in a parenchymal tissue of the lung of the patient by displacing parenchymal tissue of the lung of the patient.