METHOD AND SYSTEM FOR TRANSHIATAL ESOPHAGECTOMY

• US 20140163318A1
• Filed: 12/11/2013
• Published: 06/12/2014
• Est. Priority Date: 12/12/2012
• Status: Active Grant

• Current Assignee: Boston Scientific Scimed (Boston Scientific Corporation)
• Original Assignee: Boston Scientific Scimed (Boston Scientific Corporation)
• Inventors: SWANSTROM, Lee L.
• Granted Patent: US 9,375,235 B2
• Time in Patent Office: Days
• US Class Current: 600/104
• CPC Class Codes: A61B 1/00154 using guiding arrangements for insertion
• CPC Class Codes: A61B 1/018 for receiving instruments
• CPC Class Codes: A61B 17/28 Surgical forceps for holding suture needles or materials A61B17/0483; for removing or smashing calculi A61B17/221; surgical scissors A61B17/3201 ; obstetrical forceps A61B17/44; for inserting intraocular lenses A61F2/1662; hand-held gripping tools in general B25B7/00 ]
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/3205 Excision instruments
• CPC Class Codes: A61B 17/34 Trocars; Puncturing needles pointed biopsy instruments A61B10/0233; devices for piercing the ear-lobes A44C7/001; seals or hemostasis valves A61M39/06
• CPC Class Codes: A61B 17/3431 being collapsible, e.g. made of thin flexible material A61B17/3423 takes precedence
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/2906 Multiple forceps
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments catheters A61B2017/22072
• CPC Class Codes: A61B 2090/571 for clamping a support arm to a bed or other supports
• CPC Class Codes: A61B 90/50 Supports for surgical instruments, e.g. articulated arms

Abstract

Embodiments include a method of performing a medical procedure in a patient. The method includes creating an incision in an abdominal wall of the patient, inserting a flexible guide tube into the incision, and advancing a flexible instrument through the guide tube. The method also includes positioning a distal tip of the guide tube adjacent to a gastroesophageal junction and passing the instrument through an esophageal hiatus.

Claims

1. A method of performing a medical procedure in a patient, the method comprising:

creating an incision in an abdominal wall of the patient;

inserting a flexible guide tube into the incision;

advancing a flexible instrument through the guide tube;

positioning a distal tip of the guide tube adjacent to a gastroesophageal junction; and

passing the instrument through an esophageal hiatus.

2. The method of claim 1, further including passing the distal tip of the guide tube through the esophageal hiatus and dissecting at least part of an esophagus from the gastroesophageal junction to a cervical region of the esophagus.

3. The method of claim 1, further including mobilizing the gastroesophageal junction.

4. The method of claim 1, further including retracting a liver of the patient to visualize the gastroesophageal junction.

5. The method of claim 1, further including dividing circumferentially a phrenoesophageal ligament.

6. The method of claim 1, wherein dissecting includes starting a dissection laterally and includes anterior to posterior dissection.

7. The method of claim 1, further including dilating the esophageal hiatus.

8. The method of claim 1, further including articulating at least one of the guide tube and the instrument.

9. The method of claim 1, further including dissecting surrounding tissue to access at least part of an esophagus.

10. The method of claim 1, wherein the instrument includes at least one of a dissector, a grasper, a retractor, a cutting device, and an electrocautery device.

11. The method of claim 1, further including positioning a platform relative to the patient, wherein the platform is fixedly positioned relative to the patient, fixedly coupled to the guide tube, and configured to permit selective movement of the guide tube relative to the patient.

12. The method of claim 11, wherein the platform includes a mounting system configured to permit free and locked movement between the guide tube and the patient, and a sliding assembly configured to permit incremental movement between the guide tube and the patient.

13. A method of performing a medical procedure in a patient, the method comprising:

creating an incision in the patient;

passing a distal tip of a flexible guide tube through the incision;

locating a flexible optical device and a flexible instrument within the guide tube;

retracting at least part of an organ to create a pathway from the incision to an esophageal hiatus;

advancing the distal tip of the guide tube along the pathway to the esophageal hiatus;

positioning the optical device to visualize a phrenoesophageal ligament;

dividing the phrenoesophageal ligament using the instrument; and

passing at least one of the guide tube, the optical device, and the instrument through the esophageal hiatus.

14. The method of claim 13, wherein the incision is a single incision.

15. The method of claim 13, further including dissecting at least part of an esophagus from tissue surrounding the esophagus.

16. The method of claim 13, further including dilating the esophageal hiatus.

17. A method of performing a medical procedure in a patient, the method comprising:

creating an incision in an umbilicus of the patient;

passing a distal end of a flexible guide tube and a distal end of a flexible instrument through the incision;

creating a pathway from the incision to an esophageal hiatus using at least one of the guide tube and the instrument;

positioning an optical device to visualize the esophageal hiatus;

dilating the esophageal hiatus using the instrument; and

passing the instrument through the esophageal hiatus and into a mediastinum.

18. The method of claim 17, further including passing the guide tube through the esophageal hiatus and into the mediastinum.

19. The method of claim 17, further including dissecting an esophagus from a gastroesophageal junction to a cervical esophagus.

20. The method of claim 17, further including removing a lymph node from the mediastinum.