Tethered clamp retractor

• US 5,415,666 A
• Filed: 03/04/1993
• Issued: 05/16/1995
• Est. Priority Date: 03/23/1992
• Status: Expired due to Term

• Current Assignee: Dacomed Corp. (Imagyn Medical Technologies, Inc.)
• Original Assignee: Advanced Surgical, Inc. (Imagyn Medical Technologies, Inc.)
• Inventors: Gourlay, Stuart J., Lubock, Paul, Noda, Wayne A., Buelna, Terry
• Primary Examiner(s): Pellegrino, Stephen C.
• Assistant Examiner(s): SCHMIDT, JEFFREY
• Application Number:
  US08/027,505
• Time in Patent Office: 803 Days
• Field of Search: 606/148, 606/139, 606/142-144, 606/151, 606/157, 606/158, 606/221, 604/167
• US Class Current: 606/142
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• 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 17/122 Clamps or clips , e.g. for the umbilical cord for the vas deferens A61F6/206
• CPC Class Codes: A61B 17/1227 Spring clips
• CPC Class Codes: A61B 17/1285 for minimally invasive surgery
• CPC Class Codes: A61B 2017/00265 Hand assisted surgery, i.e. minimally invasive surgery with at least part of an assisting hand inside the body
• CPC Class Codes: A61B 2017/00287 Bags for minimally invasive surgery
• CPC Class Codes: A61B 2017/00349 Needle-like instruments having hook or barb-like gripping means, e.g. for grasping suture or tissue A61B17/06066 takes precedence
• CPC Class Codes: A61B 2017/2808 Clamp, e.g. towel clamp

Abstract

The invention provides a tissue manipulation system including a tethered clamp, a clamp applicator for positioning the clamp through a trocar sleeve and applying the clamp to a tissue location in the abdominal cavity, and a rigid positioning shaft for engaging the clamp and/or tether to manipulate the clamp. In a further embodiment, the tissue manipulation system includes an introducer through which the tether can be withdrawn from the abdominal cavity and a retainer attached to the proximal end of the introducer for clamping the tether in position. The tissue manipulation system further includes an obturator for inserting the introducer into the abdomen, and a tether snare for retrieving the tether and withdrawing it through the introducer.

Claims

1. A method of manipulating tissue comprising the steps of:

introducing a clamp having one end of a flexible tether attached thereto through a percutaneous cannula to a tissue location in a body cavity so that the other end of the tether remains in the cannula;

securing the clamp to the tissue at the tissue location;

percutaneously introducing a rigid positioning shaft at a location on the patient distanced from the cannula;

engaging the flexible tether with a distal end of the rigid positioning shaft;

retracting the rigid positioning shaft until the free end of the tether is removed from the cannula to manipulate the tissue in a first direction;

further retracting the positioning shaft until the positioning shaft and the free end of the tether are removed from the patient'"'"'s body cavity; and

introducing a positioning member along the tether and pushing on the positioning member to further manipulate the tissue in a second direction.

2. The method of claim 1 further comprising the step of securing the tether after the retracting step.

3. The method of claim 2 wherein the rigid positioning shaft is percutaneously introduced through a percutaneous introducer and wherein the step of retracting comprises pulling the free end of the tether through the percutaneous introducer.

4. The method of claim 3 wherein the step of securing the tether comprises actuating a retainer disposed at a proximal end of the introducer.

5. The method of claim 3 wherein the percutaneous introducer is positioned using an obturator removably mounted in the introducer.

6. The method of claim 3 wherein the tether is pulled through the percutaneous introducer by inserting a hook at the distal end of the positioning shaft through the introducer, engaging the tether with the hook, and retracting the positioning shaft with the tether in the hook through the introducer.

7. The method of claim 6 wherein the introducer is positioned by applying energy to tissue through an electrode at the distal end of the introducer.

8. The method of claim 7 wherein the energy is radiofrequency energy.

9. The method of claim 7 wherein the energy is ultrasonic energy.

10. The method of claim 7 wherein the energy is thermal energy.

11. The method of claim 3 wherein the distal end of the positioning shaft is introduced through an axial passage of the introducer.

12. The method of claim 11 wherein the tissue is pulled in a first direction by pulling the tether and positioned in a second direction by pushing on the positioning shaft.

13. The method of claim 11 wherein the step of introducing the clamp further comprises introducing the clamp to a tissue location having gallbladder tissue, and wherein said clamp is secured to said gallbladder tissue.

14. The method of claim 13 wherein the introducer is positioned in an abdominal region below the ribs.

15. The method of claim 11 further comprising gaseously sealing the axial passage of the introducer while the positioning shaft is positioned therethrough.

16. The method of claim 1 further comprising securing the free end of the tether to a second tissue location in the body cavity.

17. The method of claim 16 wherein the step of engaging further comprises using a hook at the distal end of the positioning shaft to engage the tether.

18. The method of claim 1 wherein the rigid positioning shaft is introduced by penetrating tissue with the distal end of the rigid positioning shaft.

19. The method of claim 18 wherein the rigid positioning shaft has a sharpened distal point to penetrate tissue.

20. The method of claim 18 wherein the rigid positioning shaft has an RF electrode on its distal end to penetrate tissue.

21. The method of claim 18 wherein the rigid positioning shaft has an ultrasonic transducer on its distal end to penetrate tissue.

22. The method of claim 18 wherein the rigid positioning shaft has a thermal electrode on its distal end to penetrate tissue.

23. The method of claim 1 further comprising passing a free end of the tether through an eye at a distal end of a positioning member and sliding the positioning member along the tether toward the clamp.

24. The method of claim 1 further comprising distending the body cavity by insufflation.

25. The method of claim 24 further comprising visualizing the tissue location using a laparoscope.

26. The method of claim 24 further comprising gaseously sealing the percutaneous cannula during the step of introducing the clamp.

27. An apparatus in kit form for tissue manipulation comprising:

a clamp having a pair of movable jaws and means for closing and opening the jaws;

an applicator for applying the clamp through a percutaneous cannula to a first tissue site comprising an elongated body with a distal end, a proximal end and an axial passageway therebetween, a pair of movable arms disposed at the distal end configured to engage the means for closing and opening the jaws of the clamp, means at the proximal end of the body for actuating the arms, a linkage disposed in the axial passageway, the linkage connecting the arms to the means for actuating, and means for biasing the arms in an open configuration;

a flexible tether having a first end attached to the clamp and a free end opposite the first end for manipulating the clamp in a first direction; and

a rigid positioning shaft having a distal end for engaging the clamp, and a proximal end for pushing on the shaft to manipulate the clamp in a second direction.

28. The apparatus as in claim 27 further comprising means for retrieving the free end of the tether.

29. The apparatus as in claim 28 wherein the means for retrieving the tether comprises an elongated snare having a hooked end for grasping the tether.

30. The apparatus as in claim 27 further comprising means separated from the clamp for securing the tether in tension so as to maintain the tissue in a desired position.

31. The apparatus as in claim 30 wherein the means for securing the tether comprises an introducer having a distal end, a proximal end and an axial passage therebetween, and a retainer disposed at the proximal end of the introducer, whereby the tether may be passed through the axial passageway and detachably secured in the retainer.

32. The apparatus as in claim 31 wherein the introducer further comprises means for gaseously sealing the axial passage.

33. The apparatus as in claim 31 wherein the retainer comprises a stopcock having a housing with a bore therethrough and a valve for closing off the bore, whereby the tether may be positioned in the bore and engaged by the valve.

34. The apparatus as in claim 30 wherein the means for securing the tether comprises means attached to the tether for detachably securing the tether to a second tissue site.

35. The apparatus as in claim 37 wherein the clamp further comprises means for biasing the jaws in a closed configuration.

36. The apparatus as in claim 27, wherein the means for actuating the arms comprises a tubular handle and a plunger slidably mounted in the handle and coupled to the linkage.

37. The apparatus as in claim 27 wherein the positioning shaft further comprises means for guiding the positioning shaft along the tether toward the clamp.

38. The apparatus as in claim 37 wherein the means for guiding comprises a loop attached to the distal end of the positioning shaft, the loop having an eye through which the free end of the tether is passed.

39. The apparatus as in claim 38 wherein the loop engages a knot in the tether near the first end.

40. An apparatus in kit form for tissue manipulation comprising:

a clamp having a pair of movable jaws and means for opening and closing the jaws;

a flexible tether having a first end attached to the clamp and a free end opposite the first end for manipulating the clamp in a first direction;

an introducer having a proximal end, a distal end and an axial passage therebetween, wherein the distal end may be percutaneously positioned with the free end of the tether drawn through the axial passage; and

a rigid positioning shaft having a rigid positioning means on a distal end for guiding the positioning shaft along the tether toward the clamp, the distal end being insertable through the axial passage while the free end of the tether is drawn through the axial passage for engaging the clamp and a proximal end for pushing on the positioning shaft to manipulate the clamp in a second direction.

41. The apparatus as in claim 40 further comprising means for holding a portion of the tether in tension.

42. The apparatus as in claim 40 wherein the means for holding comprises a stopcock disposed at the proximal end of the introducer.

43. The apparatus as in claim 40 further comprising means for retrieving the free end of the tether and drawing the free end through the axial passage of the introducer.

44. The apparatus as in claim 43 wherein the means for retrieving and drawing comprises an elongated snare having a hooked end configured to pass through the axial passage of the introducer.

45. The apparatus as in claim 40 further comprising means for percutaneously inserting the introducer.

46. The apparatus as in claim 45 wherein the means for inserting the introducer comprises an obturator removably disposed in the axial passage of the introducer.

47. The apparatus as in claim 40 further comprising means for applying the clamp to the tissue through a percutaneous cannula.

48. The apparatus as in claim 47 wherein the means for applying comprises:

an elongated body having a distal end, a proximal end and an axial passageway therebetween;

a pair of movable arms disposed at the distal end of the body configured to engage the means for opening and closing the jaws of the clamp;

means at the proximal end of the body for actuating the arms; and

a linkage disposed in an axial passageway and connecting the arms to the means for actuating.

49. The apparatus as in claim 48, wherein the means for actuating the arms comprises a tubular handle and a plunger slidably mounted in the handle and coupled to the linkage.

50. The apparatus as in claim 40 wherein the introducer includes means for gaseously sealing the axial passage.

51. The apparatus as in claim 40 wherein the means for guiding comprises a loop attached to the distal end of the positioning shaft, the loop having an eye through which the free end of the tether is passed.

52. The apparatus as in claim 51 wherein the first end of the tether is connected to the clamp by a knot.

53. The apparatus as in claim 52 wherein the loop at the distal end of the positioning shaft is rigid to assist in engaging the knot.

54. The apparatus as in claim 40 wherein the means for opening and closing the jaws of the clamp comprises a pair of levers attached to the jaws and connected by a hinge disposed between the levers and the jaws.

55. An apparatus in kit form for tissue manipulation comprising:

a clamp having a pair of movable jaws and means for opening and closing the jaws;

a flexible tether having a first end directly attached to the clamp and a free end opposite the first end for manipulating the clamp in a first direction;

means for percutaneously applying the clamp to the tissue;

an introducer separate from the clamp applying means having a proximal end, a distal end and an axial passage therebetween, whereby the tether may be passed through the axial passage;

a rigid positioning shaft having a rigid distal end insertable through the axial passage while the tether extends through the passage for engaging the clamp and a proximal end for pushing on the positioning shaft to manipulate the clamp in a second direction; and

means on the proximal end of the introducer for retaining the tether which passes through the axial passage.

56. The apparatus as in claim 55 wherein the means for applying comprises:

an elongated body having a distal end, a proximal end and an axial passageway therebetween;

a pair of movable arms disposed at the distal end of the body configured to engage the means for opening and closing the jaws of the clamp;

means at the proximal end of the body for actuating the arms; and

a linkage disposed in the axial passageway and connecting the arms to the means for actuating.

57. The apparatus as in claim 56, wherein the means for actuating the arms comprises a tubular handle and a plunger slidably mounted in the handle and coupled to the linkage.

58. The apparatus as in claim 56 wherein the means for applying a clamp further comprises means for biasing the arms in an open configuration.

59. The apparatus as in claim 55 further comprising means for retrieving the free end of the tether and drawing the free end through the axial passage of the introducer.

60. The apparatus as in claim 59 wherein the means for retrieving the free end comprises an elongated snare with a hooked end configured to pass through the axial passage of the introducer.

61. The apparatus as in claim 60 wherein the snare comprises means at a distal end thereof for penetrating tissue to facilitate percutaneous introduction of the snare.

62. The apparatus as in claim 61 wherein the means for penetrating comprises a sharpened point.

63. The apparatus as in claim 61 wherein the means for penetrating comprises means for applying energy to tissue.

64. The apparatus as in claim 63 wherein the means for applying energy comprises an RF electrode.

65. The apparatus as in claim 63 wherein the means for applying energy comprises an ultrasonic transducer.

66. The apparatus as in claim 63 wherein the means for applying energy comprises a thermal electrode.

67. The apparatus as in claim 55 further comprising means for percutaneously inserting the introducer into a patient.

68. The apparatus as in claim 67 wherein the means for inserting the introducer comprises an obturator having a distal point for piercing tissue.

69. The apparatus as in claim 67 wherein the means for inserting the introducer comprises means disposed at the distal end of the introducer for applying energy to tissue so as to penetrate therethrough.

70. The apparatus as in claim 69 wherein the means for applying energy comprises a radiofrequency electrode.

71. The apparatus as in claim 69 wherein the means for applying energy comprises an ultrasonic transducer.

72. The apparatus as in claim 69 wherein the means for applying energy comprises a thermal electrode.

73. The apparatus as in claim 55 wherein the clamp further comprises means for biasing the jaws in a closed configuration.

74. The apparatus as in claim 55 wherein the introducer includes means for gaseously sealing the axial passage.

75. The apparatus as in claim 55 wherein the positioning shaft further comprises means for guiding the positioning shaft along the tether toward the clamp.

76. The apparatus as in claim 75 wherein the means for guiding comprises a loop attached to the distal end of the positioning shaft, the loop having an eye through which the free end of the tether is passed.

77. The apparatus as in claim 76 wherein the first end of the tether is connected to the clamp by a knot.

78. The apparatus as in claim 77 wherein the loop at the distal end of the positioning shaft is rigid to assist in engaging the knot.

79. The apparatus as in claim 55 wherein the means for opening and closing the jaws of the clamp comprises a pair of levers attached to the jaws and connected by a hinge disposed between the levers and the jaws.