Method for developing an anatomic space for laparoscopic procedures with laparoscopic visualization

• US 5,730,756 A
• Filed: 02/13/1995
• Issued: 03/24/1998
• Est. Priority Date: 06/02/1992
• Status: Expired due to Term

• Current Assignee: General Surgical Innovations Incorporated (Johnson Controls International plc)
• Original Assignee: General Surgical Innovations Incorporated (Johnson Controls International plc)
• Inventors: Echeverry, Jan M., Mollenauer, Kenneth H., Jervis, James E., Howell, Thomas A., Kayan, Helmut, Kieturakis, Maciej K.
• Primary Examiner(s): Dawson, Glenn K.
• Application Number:
  US08/388,233
• Time in Patent Office: 1,135 Days
• Field of Search: 604/96-104, 604/164, 604/264, 128/898, 600/201, 600/204, 600/207, 606/1, 606/127, 606/190, 606/192-198
• US Class Current: 606/190
• 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 17/320016 Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes A61B10/0233, A61B17/29, A61B17/3207 take precedence
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 17/3439 with means for changing the inner diameter of the cannula, e.g. expandable A61B17/3423, A61B17/3431 take precedence; catheters A61M25/0662
• CPC Class Codes: A61B 18/08 by means of electrically-heated probes
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/320044 Blunt dissectors blunt suture needles A61B2017/06085
• CPC Class Codes: A61B 2017/320048 Balloon dissectors
• CPC Class Codes: A61B 2090/0813 Accessories designed for easy sterilising, i.e. re-usable
• CPC Class Codes: A61B 90/361 Image-producing devices, e.g. surgical cameras
• CPC Class Codes: A61F 2/0063 Implantable repair or support meshes, e.g. hernia meshes
• CPC Class Codes: A61F 2002/0072 Delivery tools therefor
• CPC Class Codes: A61M 25/0668 splittable, tear apart
• CPC Class Codes: A61M 25/1002 characterised by balloon shape A61M25/1006, A61M25/1009 take precedence
• CPC Class Codes: A61M 29/02 Dilators made of swellable material balloon catheters for angioplasty A61M25/104

Abstract

Apparatus for creating an anatomic space in tissue in a body of a patient using a cannula with proximal and distal extremities and a bore extending therethrough to provide an open end. A balloon having an inflated space is provided. The balloon is capable of assuming collapsed and inflated conditions. A retainer is carried by the balloon for forming the balloon when in a collapsed condition into a generally cylindrical roll to aid in inserting the balloon into the tissue. An obturator shaft having a rounded distal end is sized so that it extends through the cannula and into the roll. A laparoscope can be introduced into the obturator shaft to permit viewing through the obturator shaft and the balloon. An inflation tube is provided for inflating the balloon after it is disposed in the tissue to cause the balloon to progressively expand to create separation forces in the tissue to create the anatomic space.

Claims

1. A method of dissecting a first layer of tissue from a second layer of tissue to cream a working space utilizing an expansible tunneling apparatus having a substantially rigid tunneling member and an inflatable balloon, the tunneling member having a bore extending therethrough and an open distal end, the method comprising the steps of:

inserting a scope into the bore in the tunneling member;

making an incision in the skin of the patient;

introducing the tunneling member, scope, and the deflated balloon into the incision;

while viewing with the scope through the open distal end of the tunneling member, advancing the tunneling member, scope and deflated balloon between the first and second tissue layers until a desired location is located;

withdrawing the tunneling member and scope slightly to gain clearance from the balloon prior to advancing the scope through the open distal end in the tunneling member;

inflating the balloon to dissect the first layer of tissue from the second layer of tissue to create the space and;

advancing the scope through the open distal end of the tunneling member during inflation of the balloon and observing tissue dissection as it occurs through a single layer of the balloon.

2. The method of claim 1 further comprising the steps of:

introducing a guide member into the incision with the tunneling member;

advancing the guide member and the tunneling member to a desired location while visualizing with the scope; and

after inflating the balloon to create the space, deflating the balloon and removing the tunneling member, scope and deflated balloon through the incision, leaving the guide member within the incision.

3. The method of claim 2 further comprising the steps of:

loading a cannula and skin seal over the scope;

inserting the scope into the incision and following the guide member back to the created space;

removing the guide member from the incision; and

advancing the cannula tube into the incision over the scope and securing the skin seal.

4. The method of claim 1 further comprising the step of insufflating the created space with an insufflation gas.

5. The method of claim 1 wherein the tunneling apparatus further comprises a tubular member surrounding the balloon when the balloon is in a deflated state, the method further comprising the step of removing the tubular member prior to inflating the balloon.

6. A method of dissecting a first latter of tissue from a second layer of tissue to create a working space utilizing an expansible tunneling apparatus having a substantially rigid tunneling member and an inflatable balloon, the tunneling member having a bore extending therethrough and an open distal end, the method comprising the steps of:

inserting a scope into the bore in the tunneling member;

making an incision in the skin of the patient;

introducing the tunneling member, scope, and the deflated balloon into the incision;

introducing a guide member into the incision with the tunneling member;

advancing the guide member with the tunneling member to a desired location;

while viewing with the scope through the open distal end of the tunneling member, advancing the tunneling member, scope and deflated balloon between the first and second tissue layers until a desired location is located;

inflating the balloon to dissect the first layer of tissue from the second layer of tissue to create the space;

after inflating the balloon to create the space, deflating the balloon and removing the tunneling member and scope from the guide member, leaving the guide member and deflated balloon within the incision;

inserting the scope into the incision and following the guide member back to the created space with the scope; and

removing the guide member and deflated balloon from the incision.

7. The method of claim 6 further comprising the steps of:

loading a cannula and skin seal over the scope;

inserting the scope into the incision and following the guide member back to the created space; and

removing the guide member and the deflated balloon from the incision; and

advancing the cannula tube into the incision over the scope and securing the skin seal.

8. A method for creating a space between tissue layers underlying the skin in a body comprising the steps of:

inserting a scope into a bore in a tunneling member, the tunneling member having a distal end with an opening therein;

making an incision in the skin of the patient;

introducing the tunneling member with the scope inserted therein and a deflated balloon mounted on the tunneling member into the incision;

while observing with the scope through the opening provided in the distal end of the tunneling member, advancing the tunneling member, scope and the deflated balloon between the tissue layers until a desired location within the body is located;

withdrawing the tunneling member and scope slightly from the balloon and then pushing the scope through the opening in the distal end of the tunneling member;

inflating the balloon to dissect the tissue layers to create the space;

advancing the scope through the opening in the distal end of the tunneling member during inflation of the balloon so that visualization is through a single layer of the balloon;

deflating the balloon;

withdrawing the tunneling member, balloon, and scope from the space; and

insufflating the space.

9. The method of claim 8 further comprising the steps of:

loading a cannula and skin seal over the scope prior to reinsertion;

inserting the scope into the incision and following the guide member back to the dissected space with the scope;

removing the guide member from the incision; and

advancing the cannula into the incision over the scope and securing the skin seal.

10. A method for creating a space between tissue layers underlying the skin in a body comprising the steps of:

inserting a scope into a bore in a tunneling member, the tunneling member having a distal end with an opening therein;

making an incision in the skin of the patient;

introducing the tunneling member with the scope inserted therein and a deflated balloon mounted on the tunneling member into the incision;

while observing with the scope through the opening provided in the distal end of the tunneling member, advancing the tunneling member, scope and the deflated balloon between the tissue layers until a desired location within the body is located;

advancing an endoscope guide through the incision and between the tissue layers with the tunneling member;

inflating the balloon to dissect the tissue layers to create the space;

deflating the balloon;

withdrawing the tunneling member, balloon, and scope from the space;

insufflating the space;

after deflating the balloon, withdrawing the tunneling member, scope and deflated balloon through the incision, leaving the guide member extending through the incision into the created space; and

reinserting the scope into the incision and following the guide member as a path back to the created space.