Insertion and tunneling tool for a subcutaneous wire patch electrode

• US 5,300,106 A
• Filed: 06/07/1991
• Issued: 04/05/1994
• Est. Priority Date: 06/07/1991
• Status: Expired due to Term

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Heil, John, Kadera, James D., Hoch, J. Michael, Wickham, Robert W., Dahl, Roger W.
• Primary Examiner(s): Kamm, William E.
• Assistant Examiner(s): Getzow, Scott M.
• Application Number:
  US07/710,716
• Time in Patent Office: 1,033 Days
• Field of Search: 128/785, 128/786, 604/164, 604/160, 604/165
• US Class Current: 607/119
• CPC Class Codes: A61M 25/0668 splittable, tear apart
• CPC Class Codes: A61N 1/05 for implantation or insertion into the body, e.g. heart electrode A61N1/06 takes precedence

Abstract

A tool for subcutaneously implanting a subcutaneous electrode comprising several wire patch electrode segments by way of a single surgical incision. The tunneling tool comprises a stylet and a peel-away sheath. The tunneling tool is inserted into an incision, in a direction which corresponds to the desired placement of an electrode segment. Once the tunneling tool reaches a desired position, the stylet is withdrawn, thereby revealing the interior of the peel-away sheath and a resulting subcutaneous tunnel. The corresponding electrode segment is then inserted into this subcutaneous tunnel, and subsequently implanted in the patient. The implantation procedure is then repeated as many times as is necessary, using the same incision, until all the electrode segments for the particular electrode configuration have been implanted. In addition, the tunneling tool can be adapted to conform to varying electrode segment sizes, which thereby allows the tool to conform to the varying needs of each individual patient. As an even further feature, the tunneling tool can be constructed in a curved configuration to facilitate electrode implantation in the lateral thoracic region of the body.

Claims

1. A tunneling tool for subcutaneously implanting electrode segments, said tunneling tool comprising:

at least one peel-away sheath for providing a subcutaneous tunnel into which an electrode segment is inserted for purposes of implantation in a patient, said peel-away sheath being removable after electrode segment implantation;

a stylet for inserting said at least one peel-away sheath subcutaneously into a patient, said stylet fitting snugly within said at least one peel-away sheath, and comprising a slightly pointed distal tip for tunneling through tissue, and a rigid body for providing structural support while the tunneling tool is inserted through said tissue; and

means for maintaining a predetermined rotational orientation of said peel-away sheath with respect to the stylet and the patient.

2. The tunneling tool of claim 1, wherein said at least one peel-away sheath is provided with at least one pull tab for facilitating withdrawal from the patient by peeling off said at least one peel-away sheath after implantation of the electrode segments, and wherein the means for maintaining a predetermined rotational orientation is adapted for maintaining said at least one pull tab in a predetermined rotational orientation with respect to the stylet and the patient.

3. The tunneling tool of claim 1 further comprising an adjusting means for selectively maintaining a predetermined longitudinal orientation between the stylet and said at least one peel-away sheath.

4. The tunneling tool of claim 3, wherein the adjusting means comprises an adjustable orientation spring which is wrapped around the rigid body of the stylet, said spring being under sufficient tension to apply a frictional force against the stylet and thereby prevent spring motion relative to the stylet, said spring becoming positionally adjustable by being twisted tangentially so as to increase the spring'"'"'s cross sectional radius, and thereby reduce the frictional force that otherwise prevents spring motion relative to the stylet.

5. The tunneling tool of claim 3, wherein the adjusting means also selectively maintains a predetermined rotational orientation between the stylet and said at least one peel-away sheath.

6. The tunneling tool of claim 5, wherein the adjusting means comprises an adjustable orientation spring which is wrapped around the rigid body of the stylet, said spring being under sufficient tension to apply a frictional force against the stylet and thereby prevent spring motion and rotation relative to the stylet, said spring becoming positionally and rotationally adjustable by being twisted tangentially so as to increase the spring'"'"'s cross sectional radius, and thereby reduce the frictional force that otherwise prevents spring motion and rotation relative to the stylet.

7. The tunneling tool of claim 6, wherein said at least one peel-away sheath is provided with at least one pull tab for facilitating withdrawal from the patient by peeling off said at least one peel-away sheath after implantation of the electrode segments, and wherein the orientation spring is equipped with a catch hook for maintaining a predetermined orientation of said at least one pull tab with respect to the stylet and the patient.

8. The tunneling tool of claim 1, wherein said at least one peel-away sheath is provided with at least one pull tab for facilitating withdrawal from the patient by peeling off said at least one peel-away sheath after implantation of the electrode segments.

9. The tunneling tool of claim 1, wherein the stylet and said at least one peel-away sheath are constructed with a sufficiently large diameter to permit implantation of a main lead body.

10. The tunneling tool of claim 1, wherein said at least one peel-away sheath is provided with a coextensively longitudinal perforation and pull tabs for splitting said at least one peel-away sheath, for facilitating a peel-away withdrawal of said at least one peel-away sheath from the patient.

11. A tunneling tool for subcutaneously implanting electrode segments, said tunneling tool comprising:

at least one peel-away sheath for providing a subcutaneous tunnel into which an electrode segment is inserted for purposes of implantation in a patient, said peel-away sheath being removable after electrode segment implantation;

a stylet for inserting said at least one peel-away sheath subcutaneously into a patient, said stylet fitting snugly within said at least one peel-away sheath, and comprising a slightly pointed distal tip for tunneling through tissue, and a rigid body for providing structural support while the tunneling tool is inserted through said tissue; and

wherein the rigid body of the stylet is constructed in a curved configuration for facilitating electrode segment implantation in the lateral thoracic region of a patient.

12. A tunneling tool for subcutaneously implanting electrode segments, said tunneling tool comprising:

at least one peel-away sheath for providing a subcutaneous tunnel into which an electrode segment is inserted for purposes of implantation in a patient, said peel-away sheath being removable after electrode segment implantation;

a stylet for inserting said at least one peel-away sheath subcutaneously into a patient, said stylet fitting snugly within said at least one peel-away sheath, and comprising a slightly pointed distal tip for tunneling through tissue, and a rigid body for providing structural support while the tunneling tool is inserted through said tissue; and

wherein said at least one peel-away sheath is constructed of radiopaque material so that the positioning of said at least one peel-away sheath can be verified by fluoroscopic techniques and repositioned if necessary, prior to electrode segment implantation.

13. A method of implanting a subcutaneous electrode segment, said method comprising the steps of:

making an incision at a location of implantation;

inserting a tunneling tool into the incision, said tunneling tool having a stylet contained in a peel-away sheath, said tunneling tool being inserted with an orientation corresponding to the desired placement of an electrode segment subcutaneously in a patient;

withdrawing said stylet from said sheath upon achieving a desired placement of said tool subcutaneously in the patient, said withdrawal revealing a subcutaneous tunnel defined by said peel-away sheath;

inserting an electrode segment into said peel-away sheath;

withdrawing the peel-away sheath from the patient leaving the electrode segment in its proper position; and

verifying the position of said peel-away sheath using fluoroscopic techniques prior to said step of inserting an electrode segment.

14. The method of claim 13, and further comprising the step of repositioning of said peel-away sheath upon detecting an inappropriate position during said step of verifying.

15. A method of implanting an electrode comprising at least one subcutaneous electrode segment, said method comprising the steps of:

making an incision at a location of implantation;

inserting a tunneling tool into the incision, said tunneling tool having a stylet contained in a peel-away sheath, said tunneling tool being inserted with an orientation corresponding to the desired placement of an electrode segment subcutaneously in a patient;

withdrawing said stylet from said sheath upon achieving a desired placement of said tool subcutaneously in the patient, said withdrawal revealing a subcutaneous tunnel defined by said peel-away sheath;

inserting subsequent peel-away sheaths using the same stylet to reveal subsequent subcutaneous tunnels, each peel-away sheath corresponding to a particular electrode segment which is to be implanted;

inserting an electrode segment into each of said peel-away sheaths;

withdrawing each peel-away sheath from the patient leaving the electrode segments in their proper positions; and

adjusting the stylet to accept a particular peel-away sheath length and to maintain a predetermined longitudinal relationship between said stylet and said peel-away sheath.

16. The method of claim 15, and further comprising the step of attaching each electrode segment to the surrounding tissue of an implantation site, prior to said step of withdrawing each peel-away sheath from the patient.

17. The method of claim 16, wherein the step of attaching each electrode segment, includes making at least one more incision and subsequently suturing said electrode segment to the surrounding tissue through said at least one more incision.

18. The method of claim 15, and further comprising the step of attaching each electrode segment by way of tines to the surrounding tissue of an implantation site, prior to said step of withdrawing each peel-away sheath from the patient.

19. A method of implanting an electrode comprising at least one subcutaneous electrode segment, said method comprising the steps of:

making an incision at a location of implantation;

inserting a tunneling tool into the incision, said tunneling tool having a stylet contained in a peel-away sheath, said tunneling tool being inserted with an orientation corresponding to the desired placement of an electrode segment subcutaneously in a patient;

withdrawing said stylet from said sheath upon achieving a desired placement of said tool subcutaneously in the patient, said withdrawal revealing a subcutaneous tunnel defined by said peel-away sheath;

inserting subsequent peel-away sheaths using the same stylet to reveal subsequent subcutaneous tunnels, each peel-away sheath corresponding to a particular electrode segment which is to be implanted;

inserting an electrode segment into each of said peel-away sheaths;

withdrawing each peel-away sheath from the patient leaving the electrode segments in their proper positions; and

verifying the position of said peel-away sheath using fluoroscopic techniques prior to said step of inserting an electrode segment.

20. The method of claim 19, and further comprising the step of repositioning said peel-away sheath upon detecting an inappropriate position during said step of verifying.

21. A tunneling tool for implanting a subcutaneous electrode in a patient, said electrode comprising at least one electrode segment, said tunneling tool comprising:

an elongated stylet having proximal and distal ends, a handle at the proximal end, a slightly pointed tip at the distal end for inserting through an incision to create a subcutaneous tunnel through tissue;

an elongated sheath having proximal and distal open ends, and receiving said stylet in a coextensive manner so that the slightly pointed tip at the distal end of the stylet extends out of the distal end of the sheath, and the proximal end of the sheath not extending beyond proximal end of the stylet, said sheath providing a subcutaneous tunnel when the stylet is removed from the sheath while the sheath is inside the patient; and

wherein the stylet is provided with an adjusting means for maintaining a predetermined rotational and longitudinal positional relationship between the stylet and the sheath.

22. The tunneling tool of claim 21, wherein the adjusting means comprises an adjustable orientation spring which is wrapped around the stylet, said spring being under sufficient tension to apply a frictional force against the stylet and thereby prevent spring motion and rotation relative to the stylet, said spring becoming positionally adjustable and rotatable by being twisted tangentially so as to increase the spring'"'"'s cross sectional radius, and thereby reduce the frictional force that otherwise prevents spring motion and rotation relative to the stylet.

23. The tunneling tool of claim 22, wherein said sheath is provided with pull tabs for facilitating withdrawal from the patient by peeling off the sheath after implantation of the electrode segments, and wherein the orientation spring is equipped with a catch hook for maintaining a predetermined orientation between the pull tabs and the body of a patient.

24. The tunneling tool of claim 21, wherein said sheath is provided with pull tabs for facilitating withdrawal from the patient by peeling off the sheath after implantation of the electrode segments.

25. The tunneling tool of claim 21, wherein the stylet and sheath are constructed with a sufficiently large diameter to permit implantation of a main lead body.

26. A tunneling tool for implanting a subcutaneous electrode in a patient, said electrode comprising at least one electrode segment, said tunneling tool comprising:

an elongated stylet having proximal and distal ends, a handle at the proximal end, a slightly pointed tip at the distal end for inserting through an incision to create a subcutaneous tunnel through tissue;

an elongated sheath having proximal and distal open ends, and receiving said stylet in a coextensive manner so that the slightly pointed tip at the distal end of the stylet extends out of the distal end of the sheath, and the proximal end of the sheath not extending beyond proximal end of the stylet, said sheath providing a subcutaneous tunnel when the style tis removed from the sheath while the sheath is inside the patient; and

wherein the stylet is constructed in a curved configuration for facilitating electrode segment implantation in the lateral thoracic region of the patient.

27. A tunneling tool for implanting a subcutaneous electrode in a patient, said electrode comprising at least one electrode segment, said tunneling tool comprising:

an elongated stylet having proximal and distal ends, a handle at the proximal end, a slightly pointed tip at the distal end for inserting through an incision to create a subcutaneous tunnel through tissue;

an elongated sheath having proximal and distal open ends, and receiving said stylet in a coextensive manner so that the slightly pointed tip at the distal end of the stylet extends out of the distal end of the sheath, and the proximal end of the sheath not extending beyond proximal end of the stylet, said sheath providing a subcutaneous tunnel when the stylet is removed from the sheath while the sheath is inside the patient; and

wherein said sheath is constructed of radiopaque material so that fluoroscopic techniques can be used to verify peel-away sheath positioning prior to electrode segment implantation.

28. A method of implanting a subcutaneous electrode segment, said method comprising the steps of:

making an incision at a location of implantation;

inserting a tunneling tool into the incision, said tunneling tool having a stylet contained in a radiopaque peel-away sheath, said tunneling tool being inserted with an orientation corresponding to the desired placement of an electrode segment subcutaneously in a patient;

withdrawing said stylet from said radiopaque peel-away sheath upon achieving a desired placement of said tool subcutaneously in the patient, said withdrawal revealing a subcutaneous tunnel defined by said radiopaque peel-away sheath;

verifying the position of said radiopaque peel-away sheath using fluoroscopic techniques;

repositioning said radiopaque peel-away sheath upon detecting an inappropriate position during said step of verifying;

inserting an electrode segment into said radiopaque peel-away sheath; and

withdrawing the radiopaque peel-away sheath from the patient leaving the electrode segment in its proper position.

29. The method of claim 28, and further comprising the step of attaching the electrode segment by way of tines to the surrounding tissue of an implantation site, prior to said step of withdrawing the radiopaque peel-away sheath from the patient.

30. The method of claim 28, and further comprising the step of attaching the electrode segment to the surrounding tissue of an implantation site, prior to said step of withdrawing the radiopaque peel-away sheath from the patient.

31. The method of claim 30, wherein the step of attaching the electrode segment to surrounding tissue, includes making at least one more incision and subsequently suturing said electrode segment to the surrounding tissue through said at least one more incision.