Endoscopic vascular clamping system and method

• US 5,569,274 A
• Filed: 06/24/1994
• Issued: 10/29/1996
• Est. Priority Date: 02/22/1993
• Status: Expired due to Term

• Current Assignee: Heartport, Inc. (Johnson & Johnson)
• Original Assignee: Heartport, Inc. (Johnson & Johnson)
• Inventors: Stevens, John H., Rapacki, Alan R.
• Primary Examiner(s): Buiz, Michael Powell
• Assistant Examiner(s): SCHMIDT, JEFFREY
• Application Number:
  US08/265,477
• Time in Patent Office: 858 Days
• Field of Search: 606/142, 606/143, 606/139, 606/151, 606/157, 606/158, 606/221, 227/901, 227/902, 128/843, 128/898
• US Class Current: 606/158
• 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 17/0057 Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect sutures A61B17/04; closing rectum or urethra near body surface A61F2/0009
• 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 17/0467 Instruments for cutting sutures surgical cutting instruments A61B17/32
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/06061 Holders for needles or sutures, e.g. racks, stands hand-held holding instruments A61B17/0483; holders for articles A61B50/20; racks for syringes or for hypodermic or infusion needles A61M5/008
• CPC Class Codes: A61B 17/064 Surgical staples, i.e. penetrating the tissue
• CPC Class Codes: A61B 17/068 Surgical staplers , e.g. containing multiple staples or clampsstaplers containing only one staple A61B17/10; magazines or containers for staples A61B17/105; for performing anastomosis A61B17/115; staplers in general B25C5/00
• CPC Class Codes: A61B 17/12013 for use in minimally invasive surgery, e.g. endoscopic surgery
• 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 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/2909 Handles
• CPC Class Codes: A61B 17/30 Surgical pincettes without pivotal connectionsfor holding suture needles or materials A61B17/0483; wound clamps A61B17/08 ; hand-held gripping tools without pivotal connections in general B25B9/02
• CPC Class Codes: A61B 17/3403 Needle locating or guiding means guides for suture needles A61B17/0482; guiding or tracking by nuclear magnetic resonance G01R33/285
• CPC Class Codes: A61B 18/1442 Probes having pivoting end effectors, e.g. forceps
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/00637 : for sealing trocar wounds through abdominal wall
• CPC Class Codes: A61B 2017/00663 : the implement being a suture
• CPC Class Codes: A61B 2017/0243 : for immobilizing local areas of the heart, e.g. while it beats
• CPC Class Codes: A61B 2017/047 : having at least one proximally pointing needle located at the distal end of the instrument, e.g. for suturing trocar puncture wounds starting from inside the body
• CPC Class Codes: A61B 2017/0472 : Multiple-needled, e.g. double-needled, instruments
• CPC Class Codes: A61B 2017/0474 : Knot pushers
• CPC Class Codes: A61B 2017/0475 : using sutures having a slip knot
• CPC Class Codes: A61B 2017/2943 : Toothed members, e.g. rack and pinion
• CPC Class Codes: A61B 2017/306 : holding by means of suction
• CPC Class Codes: A61B 2017/3405 : using mechanical guide means
• CPC Class Codes: A61B 2017/3427 : for intercostal space
• CPC Class Codes: A61B 2017/3492 : against the outside of the body
• CPC Class Codes: A61B 2018/00214 : Expandable means emitting energy, e.g. by elements carried thereon
• CPC Class Codes: A61B 2018/00232 : having an irregular shape
• CPC Class Codes: A61B 2018/00261 : arranged in a line
• CPC Class Codes: A61B 2018/00291 : using suction
• CPC Class Codes: A61B 2018/00363 : Epicardium
• CPC Class Codes: A61B 2018/00392 : Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/00577 : Ablation
• CPC Class Codes: A61B 2090/064 : for measuring force, pressure or mechanical tension
• CPC Class Codes: A61B 90/50 : Supports for surgical instruments, e.g. articulated arms
• CPC Class Codes: A61F 2/2427 : Devices for manipulating or deploying heart valves during implantation
• CPC Class Codes: A61M 2025/0003 : having an additional lumen transmitting fluid pressure to the outside for measurement
• CPC Class Codes: A61M 2025/028 : having a mainly rigid support structure
• CPC Class Codes: A61M 2039/0279 : for introducing medical instruments into the body, e.g. endoscope, surgical tools
• CPC Class Codes: A61M 2202/047 : cardioplegic
• CPC Class Codes: A61M 2205/3344 : Measuring or controlling pressure at the body treatment site
• CPC Class Codes: A61M 2205/3355 : Controlling downstream pump pressure
• CPC Class Codes: A61M 2205/366 : by liquid heat exchangers
• CPC Class Codes: A61M 2210/127 : Aorta
• CPC Class Codes: A61M 2230/005 : Parameter used as control input for the apparatus
• CPC Class Codes: A61M 25/1011 : Multiple balloon catheters
• 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
• CPC Class Codes: Y10S 227/901 : Surgical clip appliers
• CPC Class Codes: Y10S 227/902 : Surgical clips or staples

Abstract

The invention provides a system and method for performing less-invasive surgical procedures within a body cavity. In a preferred embodiment, the invention provides a system and method for temporarily occluding a blood vessel in an arterial graft in a thoracoscopic coronary artery bypass grafting procedure. The system comprises a clamp (2) and an introducer (1) for introducing the clamp through a percutaneous penetration into the body cavity and applying the clamp to a tissue structure such as a blood vessel. The clamp has a pair of movable jaws (65, 67) coupled to one another, each jaw having a distal portion for engaging the tissue structure and a proximal portion having a camming surface (66, 68). The introducer has a longitudinal shaft (3) with a clamp engaging member (25) slidably coupled to the distal end of the shaft for releasably holding the clamp. A handle (11) is coupled to the proximal end of the shaft. The handle can be manipulated to axially slide the shaft with respect to the clamp engaging member so that the shaft engages the camming surfaces of the clamp to open and close the distal portions of the jaws without releasing the clamp from the introducer.

Claims

1. A surgical clamp configured for introduction through a small percutaneous incision in the body for occluding a vessel in a body cavity, the surgical clamp comprising:

first and second jaws having distal sand proximal ends, the proximal ends being coupled together such that the distal ends are movable between an open position where the first and second jaws are disposed apart and a closed position where the first and second jaws are disposed closer together, the first and second jaws including atraumatic surfaces on the first and second jaws configured to atraumatically occlude the vessel without damaging the vessel;

means at the proximal ends of the first and second jaws for releasably holding the clamp, the holding means including a spherical member;

first and second camming surfaces on the first and second jaws distal to the holding means configured so that sliding engagement of the camming surfaces in an axial direction opens and closes the first and second jaws; and

means for biasing the first and second jaws into the closed position.

2. The surgical clamp of claim 1 wherein the atraumatic surfaces comprise a soft, elastomeric material.

3. The surgical clamp of claim 1 wherein the holding means includes a transverse bore.

4. The surgical clamp of claim 3 wherein the transverse bore is a cylindrical bore encircled by a coil of wire.

5. The surgical clamp of claim 1 wherein the first and second jaws and the camming surfaces are formed from a single, continuous length of wire, the wire having a spring force that biases the first and second jaws into the closed position.

6. The surgical clamp of claim 5 wherein at least one of the camming surfaces is oriented at an angle with respect to an axial direction so that sliding engagement of the camming surfaces in the axial direction forces the proximal portion of the first and second jaws towards each other and opens the distal portions of the first and second jaws.

7. The surgical clamp of claim 1 wherein the first and second jaws have a distal portion for engaging the vessel and a proximal portion on which the camming surfaces are disposed, the proximal and distal portions being on opposing sides of the clamp so that deflection of the proximal portions toward each other moves the distal portions away from each other.

8. The surgical clip of claim 7 wherein the distal portion of the first and second jaws has an axial length between 15 and 25 mm.

9. The surgical clamp of claim 1 wherein the biasing means provides sufficient force to occlude a lumen of the vessel in which a fluid has a pressure of at least about 80 mm of mercury.

10. The surgical clamp of claim 9 wherein the biasing means comprises a torsion spring.

11. The surgical clamp of claim 1 wherein the first and second jaws are sized to occlude a lumen of a mammary artery.

12. The surgical clip of claim 1 wherein the distal ends of the first and second jaws are a distance apart when the first and second jaws are in the open position, the distance being between 10 and 20 mm.

48. The surgical clamp of claim 1 wherein the biasing means comprises a coiled wire torsion spring and wherein the holding means comprises a transverse bore through the coiled wire torsion spring.

13. A surgical clamp comprising:

a left wire member and a right wire member, said left wire member and said right wire member each comprising;

a first segment having a first camming surface on an outer surface thereof and a second segment having a second camming surface on an outer surface thereof, said first segment being deflectably connected to said second segment, a first crossover segment extending from a distal end of said first segment and a second crossover segment extending from a distal end of said second segment, said first crossover segment and said second crossover segment crossing over one another in slidable relation, a first jaw segment extending from said first crossover segment and a second jaw segment extending from said second crossover segment,

said first jaw segment of said left wire member and said first jaw segment of said right wire member combining to form a first jaw of said surgical clamp, and

said second jaw segment of said left wire member and said second jaw segment of said right wire member combining to form a second jaw of said surgical clamp,

whereby when a mutually inward force is applied to said first camming surface and said second camming surface, said first jaw and said second jaw are spread apart, and when said mutually inward force is released, said first jaw and said second jaw move toward one another.

14. The surgical clamp of claim 13 wherein said left wire member and said right wire member are formed of a single, continuous strand of wire.

15. The surgical clamp of claim 13 further comprising a means for joining said left wire member and said right wire member.

16. The surgical clamp of claim 15 wherein said means for joining said left wire member and said right wire member comprises a first jaw surface connecting said first jaw segment of said left wire member to said first jaw segment of said right wire member and a second jaw surface connecting said second jaw segment of said left wire member to said second jaw segment of said right wire member.

17. The surgical clamp of claim 15 wherein said means for joining said left wire member and said right wire member comprises a first tubular member surrounding said first jaw segment of said left wire member and said first jaw segment of said right wire member and a second tubular member surrounding said second jaw segment of said left wire member and said second jaw segment of said right wire member.

18. The surgical clamp of claim 13 wherein, for each of said left wire member and said right wire member, said first segment is deflectably connected to said second segment at a common apex connecting a proximal end of said first segment to a proximal end of said second segment.

19. The surgical clamp of claim 18 further comprising a means for joining said apex of said left wire member to said apex of said right wire member.

20. The surgical clamp of claim 13 wherein, for each of said left wire member and said right wire member, said first segment is deflectably connected to said second segment by a torsional spring connecting a proximal end of said first segment to a proximal end of said second segment.

21. The surgical clamp of claim 20 wherein, for each of said left wire member and said right wire member, said torsional spring comprises a loop of wire of at least 360°

.

22. The surgical clamp of claim 13 wherein said left wire member and said right wire member are mirror images of one another.

23. The surgical clamp of claim 13 wherein said second crossover segment of said left wire member and said second crossover segment of said right wire member are substantially parallel to one another and are spaced apart to form a gap therebetween, and wherein at least one of said first crossover segment of said left wire member or said first crossover segment of said right wire member pass through said gap, thereby maintaining an alignment between said first jaw and said second jaw of said clamp.

24. The surgical clamp of claim 13 wherein said second crossover segment of said left wire member and said second crossover segment of said right wire member are substantially parallel to one another and are spaced apart to form a gap therebetween, and wherein said first crossover segment of said left wire member and said first crossover segment of said right wire member pass through said gap, thereby maintaining an alignment between said first jaw and said second jaw of said clamp.

25. A method for occluding a mammary artery in a chest cavity defined by a plurality of ribs within a patient comprising:

introducing a surgical clamp releasably connected to an elongated shaft through a first percutaneous intercostal penetration between two ribs in the patient'"'"'s chest;

viewing an internal portion of the patient'"'"'s chest through a scope extending through a second percutaneous intercostal penetration between two ribs in the patient'"'"'s chest;

applying the clamp to the mammary artery to occlude a lumen of the mammary artery; and

releasing the clamp from the shaft.

26. The method of claim 25 wherein the elongated shaft is introduced through a cannula positioned in the percutaneous intercostal penetration.

27. The method of claim 25 wherein the percutaneous intercostal penetration is created in a left lateral portion of the patient'"'"'s chest.

28. The method of claim 25 wherein the percutaneous intercostal penetration is in an intercostal space selected from the group consisting of the second intercostal space, the third intercostal space, the fourth intercostal space, the fifth intercostal space, the sixth intercostal space and the seventh intercostal space.

29. The method of claim 25 wherein the clamp is applied to a position along the mammary artery downstream from a subclavian artery a distance of about 1 to 5 cm.

30. The method of claim 29 further including the step of severing the mammary artery downstream of the position in which the clamp is applied to create a free end of the mammary artery.

31. The method of claim 30 further including the step of connecting the free end of the mammary artery to a coronary artery downstream from an occlusion in the coronary artery.

32. The method of claim 31 further including the step of removing the clamp from the mammary artery after the mammary artery has been connected to the coronary artery.

33. The method of claim 25 wherein the lumen of the mammary artery has a fluid pressure of at least 80 mm of mercury.

34. The method of claim 25 wherein the step of introducing the surgical clamp is performed without cutting, removing, or significantly displacing or retracting the ribs of the patient.

35. The method of claim 34 wherein the step of viewing an internal portion of the patient'"'"'s chest through a scope is performed without cutting, removing, or significantly displacing or retracting the ribs of the patient.

36. A method for occluding a vessel in a chest cavity defined by a plurality of ribs within a patient comprising:

introducing a surgical clamp releasably held within an axial channel in an introducer through a percutaneous intercostal penetration between two ribs in the chest of the patient;

positioning first and second jaws of the clamp around the vessel;

sliding the clamp axially relative to the channel to extend the clamp distally therefrom thereby closing the jaws onto the vessel; and

releasing the clamp front the introducer.

37. The method of claim 36 wherein the releasing step is performed after the sliding step so that the clamp is retained by the introducer after the jaws are closed onto the vessel.

38. The method of claim 36 wherein the introducer is introduced through a cannula positioned in a percutaneous penetration.

39. The method of claim 36 wherein the sliding step includes sliding a shaft of the introducer in a proximal direction with respect to the clamp to extend the clamp distally from an axial lumen in the shaft, the axial lumen having sidewalls for engaging camming surfaces on the clamp to open and close the jaws.

40. The method of claim 39 further comprising, before the positioning step, sliding the shaft in a distal direction with respect to the clamp, the sidewalls of the shaft engaging the camming surfaces on the clamp to open the jaws.

41. The method of claim 39 wherein the releasing step includes further moving the shaft in the proximal direction to open a clamp engaging means at a distal end of the shaft.

42. The method of claim 41 wherein the clamp engaging means comprises a pair of jaws defining an aperture for grasping a handle member on the clamp.

43. The method of claim 41 wherein the clamp engaging means comprises a pair of opposing arms for grasping a bore in the clamp.

44. The method of claim 39 wherein the releasing step includes disengaging a hook from a bore in the clamp.

45. The method of claim 36 further including the step of retracting the vessel by tensioning a flexible tether attached to the clamp.

46. The method of claim 36 further including, before the releasing step, the step of repositioning the vessel by manipulating the introducer after the jaws have closed onto the vessel.

47. The method of claim 36 wherein the step of introducing the surgical clamp is performed without cutting, removing, or significantly displacing or retracting the ribs of the patient.