Methods of using endoscopic inflatable retraction devices

• US 5,527,264 A
• Filed: 02/08/1994
• Issued: 06/18/1996
• Est. Priority Date: 05/29/1991
• Status: Expired due to Term

• Current Assignee: Covidien AG (Medtronic Plc)
• Original Assignee: Origin Medsystems Inc. (Eli Lilly and Company)
• Inventors: Moll, Frederic H., Chin, Albert K., Hopper, Philip K., Gresl, Charles Jr.
• Primary Examiner(s): Thaler, Michael H.
• Application Number:
  US08/193,615
• Time in Patent Office: 861 Days
• Field of Search: 606/192, 606/198, 128/20, 128/898, 128/3, 604/101, 600/204, 600/207
• US Class Current: 600/204
• 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 17/0281 Abdominal wall lifters
• CPC Class Codes: A61B 17/22032 having inflatable gripping elements balloon catheters A61M25/10
• CPC Class Codes: A61B 17/3417 Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating syringe needles A61M5/32; dilators A61M29/00
• CPC Class Codes: A61B 17/3462 with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals expandable cannulas A61B17/3417
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/00535 pneumatically or hydraulically operated A61B2017/22051, A61B2090/401 take precedence
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/306 holding by means of suction
• CPC Class Codes: A61B 2017/320048 Balloon dissectors
• CPC Class Codes: A61B 2017/3486 Balloon
• CPC Class Codes: A61B 2090/306 using optical fibres
• CPC Class Codes: A61B 90/50 Supports for surgical instruments, e.g. articulated arms

Abstract

In a method for retracting an organ inside the body to provide access for treating a tissue, a retractor having a main envelope which defines a main chamber is positioned in a collapsed state adjacent to the organ to be retracted. The main chamber is subsequently inflated to retract the adjacent organ. A surgical instrument is passed through the main envelope into the main chamber to contact the tissue for treatment.

Claims

1. A method for retracting an organ inside the body to provide access for treating a tissue, the method comprising the steps of:

providing a retractor comprising a main envelope defining a main chamber,

providing a surgical instrument,

placing the main envelope in a collapsed state adjacent the organ,

inflating the main chamber to retract the organ, and

passing the surgical instrument through the main envelope into the main chamber to contact the tissue.

2. The method of claim 1, wherein, in the step of providing a retractor, a retractor is provided additionally comprising an additional envelope attached to and covering part of the main envelope, the additional envelope and the part of the main envelope defining an additional chamber.

3. The method of claim 2, wherein, after the step of inflating the main chamber, the method additionally comprises the steps of:

inflating the additional chamber, and

releasing the inflation of the main chamber.

4. The method of claim 1, wherein:

the method additionally comprises the step of providing an insertion tube,

in the step of providing a retractor, the retractor is provided with the main envelope maintained in its collapsed state by lacing, and

the step of placing the main envelope adjacent the organ includes the steps of;

pushing the main envelope through the insertion tube from outside the body; and

unlacing the lacing.

5. The method of claim 1, wherein:

the method additionally comprises the step of providing an insertion tube,

in the step of providing a retractor, the retractor is provided with the main envelope maintained in its collapsed state by a peelable sheath, and

the step of placing the main envelope adjacent the organ includes the steps of;

pushing the main envelope through the insertion tube from outside the body; and

peeling the peelable sheath away from the main envelope.

6. The method of claim 5, wherein:

in the step of providing a retractor, the peelable sheath includes a tear strip, and

the step of peeling the peelable sheath includes the step of removing the tear strip to release the peelable sheath from the main envelope.

7. The method of claim 1, wherein:

in the step of providing a retractor, a retractor is provided including a marker visible when the main envelope is in the collapsed state, and

the step of placing the main envelope adjacent the organ includes the step of orienting the main envelope relative to the organ by observing the marker.

8. The method of claim 1, wherein the step of passing a surgical instrument through the main envelope includes the step of piercing an aperture in the main envelope.

9. The method of claim 8, wherein:

in the step of providing a retractor, a retractor is provided additionally comprising an additional envelope attached to and covering part of the main envelope, the additional envelope and the part of the main envelope defining an additional chamber, and

in the step of piercing an aperture in the main envelope, the aperture is pierced in a part of the main envelope not covered by the additional envelope.

10. The method of claim 9, wherein, after the step of inflating the main chamber, the method additionally comprises the steps of:

inflating the additional chamber, and

releasing the inflation of the main chamber.

11. The method of claim 9, wherein:

in the step of providing a retractor, the retractor additionally comprises a gripping tab attached to the main envelope inside the main chamber, and

the method additionally comprises the steps of;

providing a gripping instrument, and

after the step of inflating the main chamber;

inflating the main chamber;

optimizing orientation of the main envelope relative to the tissue by repeating the sequence of;

observing the orientation of the main envelope relative to the tissue, and if the orientation is incorrect;

partially deflating the main chamber,

reorientating the main envelope by gripping the gripping tab with the gripping instrument and manipulating the gripping instrument, and

reinflating the main chamber, until the orientation of the retractor is correct;

inflating the additional chamber; and

releasing the inflation of the main chamber.

12. The method of claim 8, wherein, in the step of passing the surgical instrument through the main envelope,

the surgical instrument is passed through the aperture to contact the tissue.

13. The method of claim 12, wherein:

in the step of providing a retractor, a retractor including a main inflation tube attached to the main envelope is provided, and

in the step of passing a surgical instrument into the main chamber, the surgical instrument is passed from outside the body through the main inflation tube into the main chamber.

14. The method of claim 12, wherein:

the step of piercing an aperture in the main envelope includes the step of piercing an additional aperture in the main envelope, and

in the step of passing a surgical instrument into the main chamber, the surgical instrument is passed from outside the body through the additional aperture into the main chamber.

15. The method of claim 12, additionally comprising the steps of:

using the surgical instrument to pull the tissue through the aperture into the main chamber; and

treating the tissue inside the main chamber.

16. The method of claim 15, wherein:

in the step of providing a retractor, a retractor is provided including a main inflation tube attached to the main envelope, and

in the step of passing the surgical instrument into the main chamber, the surgical instrument is passed from outside the body through the main inflation tube into the main chamber.

17. The method of claim 15, wherein:

the step of piercing an aperture in the main envelope includes the step of piercing an additional aperture in the main envelope, and

in the step of passing a surgical instrument into the main chamber, the surgical instrument is passed from outside the body through the additional aperture into the main chamber.

18. The method of claim 15, wherein:

in the step of providing a retractor, a retractor is provided additionally comprising an additional envelope attached to and covering part of the main envelope, the additional envelope and the part of the main envelope defining an additional chamber, and

after the step of inflating the main chamber, the method additionally comprises the steps of;

inflating the additional chamber; and

releasing the inflation of the main chamber.

19. The method of claim 12, wherein:

in the step of providing a retractor, a retractor is provided additionally comprising an additional envelope attached to and covering part of the main envelope, the additional envelope and the part of the main envelope defining an additional chamber, and

after the step of inflating the main chamber, the method additionally comprises the steps of;

inflating the additional chamber; and

releasing the inflation of the main chamber.

20. The method of claim 8, wherein:

in the step of providing a retractor, a retractor is provided additionally comprising an additional envelope attached to and covering part of the main envelope, the additional envelope and the part of the main envelope defining an additional chamber, and

after the step of inflating the main chamber, the method additionally comprises the steps of;

inflating the additional chamber; and

releasing the inflation of the main chamber.

21. The method of claim 8, wherein the method is a method for retracting the bowel to provide anterior access for treating an organ lying outside the peritoneum, the organ lying outside the peritoneum being chosen from a group including the spinal column, the aorta and the kidneys, and wherein:

in the step of placing the main envelope adjacent the organ, the main envelope is placed adjacent the bowel,

in the step of inflating the main chamber, the bowel is retracted, and

in the step of piercing an aperture in the main envelope, the aperture is pierced in the main envelope adjacent the peritoneum overlying the organ lying outside the peritoneum.

22. The method of claim 8, wherein the method is for retracting the liver to provide access for treating gastro-esophagal reflux, and wherein:

in the step of placing the main envelope adjacent the organ, the main envelope is placed between the liver and the gastro-esophagal junction,

in the step of inflating the main chamber, the liver is retracted away from the gastro-esophagal junction, and

in the step of piercing an aperture in the main envelope, the aperture is pierced in the main envelope adjacent the gastro-esophagal junction.

23. The method of claim 8, wherein the method is for retracting the liver to provide access for sectioning the vagus nerve, and wherein:

in the step of placing the main envelope adjacent the organ, the main envelope is placed between the liver and the gastro-esophagal junction,

in the step of inflating the main chamber, the liver is retracted away from the gastro-esophagal junction, and

in the step of piercing an aperture in the main envelope, the aperture is pierced in the main envelope adjacent the vagus nerve.

24. The method of claim 1, wherein the method is a method for retracting the bowel to provide anterior access for treating an organ lying outside the peritoneum, the organ lying outside the peritoneum being chosen from a group including the spinal column, the aorta and the kidneys, and wherein:

in the step of placing the main envelope adjacent the organ, the main envelope is placed adjacent the bowel,

in the step of inflating the main chamber, the bowel is retracted, and

in the step of passing the surgical instrument through the main envelope, the surgical instrument is passed through the main envelope to contact the to the peritoneum overlying the organ lying outside the peritoneum.

25. The method of claim 1, wherein the method is for retracting the liver to provide access for treating gastro-esophagal reflux, and wherein:

in the step of placing the main envelope adjacent to the organ, the main envelope is placed between the liver and the gastro-esophagal junction,

in the step of inflating the main chamber, the liver is retracted away from the gastro-esophagal junction, and

in the step of passing the surgical instrument through the main envelope, the surgical instrument is passed through the main envelope to contact the gastro-esophagal junction.

26. The method of claim 1, wherein the method is for retracting the liver to provide access for sectioning the vagus nerve, and wherein:

in the step of placing the main envelope adjacent to the organ, the main envelope is placed between the liver and the gastro-esophagal junction,

in the step of inflating the main chamber, the liver is retracted away from the gastro-esophagal junction, and

in the step of passing the surgical instrument through the main envelope, the surgical instrument is passed through the main envelope to contact the vagus nerve.