Methods of using inflatable retraction devices in laparoscopic surgery

• US 5,575,759 A
• Filed: 06/01/1995
• Issued: 11/19/1996
• Est. Priority Date: 05/29/1991
• Status: Expired due to Term

• Current Assignee: Covidien AG (Medtronic Plc)
• Original Assignee: Origin Medsystems Inc. (Boston Scientific Corporation)
• Inventors: Forster, David C., Smith, Jeffrey A., Wallace, Daniel T., Moll, Frederic H., Chin, Albert K.
• Primary Examiner(s): Thaler, Michael H.
• Application Number:
  US08/457,396
• Time in Patent Office: 537 Days
• Field of Search: 600/207, 600/204, 606/192, 128/898
• US Class Current: 600/207
• 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
• CPC Class Codes: Y10T 156/1003 by separating laminae between spaced secured areas [e.g., honeycomb expanding]

Abstract

Apparatus for retracting an organ to gain access to treat a tissue. The apparatus has a main envelope, a second envelope, a first inflation device and a second inflation device. The main envelope encloses a main chamber, and includes a window and a removable window. The second envelope covers substantially all the main envelope, except the window and the removable window. The second envelope and the main envelope enclose a second chamber outside the main chamber. The first inflation device passes a fluid into the main chamber to expand the main chamber and the second chamber from a compacted state to retract the organ. The second inflation device passes a fluid into the second chamber to further expand the second chamber to maintain the organ in its retracted state after fluid has been released from the main chamber.

Claims

1. A method for properitoneal hernia repair, the method comprising the steps of:

providing an inflatable retraction device in a compacted state, the inflatable retraction device including;

a main envelope enclosing a main chamber, the main envelope including a window and a removable window,

a second envelope covering substantially all the main envelope, except the window and the removable window, the second envelope and the main envelope enclosing a second chamber outside the main chamber,

an attachment point centered in the removable window, and

an insertion shaft passing through the main chamber, and having a distal end temporarily attached to the attachment point, the attachment point providing a distal tip for the inflatable retraction device;

making an incision through the abdominal wall at the umbilicus as far as the properitoneal layer;

inserting the distal tip of the inflatable retraction device into the incision;

using the inflatable retraction device to dissect the peritoneum from the properitoneal layer while advancing the inflatable retraction device inferiorly between the peritoneum and the properitoneal layer towards the hernia;

passing a fluid into the main chamber to expand the main chamber and the second chamber from the compacted state to dissect further the peritoneum from the properitoneal layer;

passing a fluid into the second chamber to further expand the second chamber;

releasing fluid from the main chamber; and

detaching the removable window from the main envelope.

2. The method of claim 1 additionally comprising the step of repairing the hernia using an instrument passed through the main chamber.

3. The method of claim 1, additionally comprising the step of detaching the insertion shaft from the removable window before the step of detaching the removable window.

4. The method of claim 1, wherein:

the step of passing a fluid into the main chamber expands the main chamber to create a working space; and

after the step of detaching the removable window, the method additionally comprises the step of passing insufflation gas through the main chamber to insufflate the working space.

5. The method of claim 1, additionally comprising the step of driving a trocax through the window into the main chamber.

6. The method of claim 5, wherein the step of driving a trocar through the window includes the steps of:

pressing a probe on the abdominal wall above the window to cause a protrusion in the properitoneal layer;

observing the provision in the properitoneal layer through the window from inside the main chamber;

moving the probe until the provision is centered in the window; and

substituting the trocar for the probe.

7. The method of claim 1, wherein the step of using the inflatable retraction device to dissect the pefitoneum from the properitoneal layer is continued until the removable window is centered on the hernia, using the endoscope.

8. The method of claim 1, wherein:

the step of providing a compacted inflatable retraction device provides an insertion shaft having an endoscope mounted therein, the endoscope providing observation through the distal tip of the inflatable retraction device; and

the step of using the inflatable retraction device to dissect the peritoneum from the properitoneal layer is continued until the hernia is seen using the endoscope.

9. The method of claim 1, wherein the step of using the inflatable retraction device to dissect the peritoneum from the properitoneal layer includes the steps of:

locating the hernia by feel through the abdominal wall; and

advancing the inflatable retraction device until the distal tip of the inflatable retraction device and the hernia are felt together through the abdominal wall.

10. A method for retracting an organ to gain access to treat a tissue, the method comprising the steps of:

providing an inflatable retraction device in a compacted state, the inflatable retraction device including;

a main envelope enclosing a main chamber, the main envelope including a window and a removable window, and

a second envelope covering substantially all the main envelope, except the window and the removable window, the second envelope and the main envelope enclosing a second chamber outside the main chamber;

placing the inflatable retraction device in the compacted state adjacent the organ;

passing a fluid into the main chamber to expand the main chamber and the second chamber from the compacted state to retract the organ;

passing a fluid into the second chamber to further expand the second chamber;

releasing fluid from the main chamber; and

detaching the removable window from the main envelope.

11. The method of claim 10, additionally comprising the step of treating the tissue using an instrument passed through the main chamber.

12. The method of claim 10, additionally comprising the step of driving a trocar through the window into the main chamber.

13. The method of claim 12, wherein:

the inflatable retraction device is located inside a body wall; and

the step of driving a trocar through the window includes the steps of;

pressing a probe onto the body wall above the window to cause a provision in the body wall;

observing the provision in the body wall through the window from inside the main chamber;

moving the probe until the provision is centered in the window; and

substituting the trocar for the probe.

14. The method of claim 10, wherein, in the step of placing the inflatable retraction device adjacent the organ, the inflatable retraction device is placed adjacent the organ using an insertion shaft.

15. The method of claim 14, additionally comprising the step of detaching the insertion shaft from the removable window before the step of detaching the removable window.

16. The method of claim 10, wherein:

the step of providing a compacted inflatable retraction device provides an insertion shaft having an endoscope mounted therein, the endoscope providing observation through the distal tip of the inflatable retraction device; and

in the step of placing the inflatable retraction device adjacent the organ, the insertion shaft is manipulated until the organ is seen using the endoscope.