Method for creating a mediastinal working space

• US 5,823,946 A
• Filed: 06/05/1997
• Issued: 10/20/1998
• Est. Priority Date: 07/22/1994
• Status: Expired due to Term

• Current Assignee: Maquet Cardiovascular LLC (Getinge AB)
• Original Assignee: Origin Medsystems Inc. (Eli Lilly and Company)
• Inventors: Chin, Albert K.
• Primary Examiner(s): Thaler, Michael H.
• Application Number:
  US08/869,830
• Time in Patent Office: 502 Days
• Field of Search: 600/235, 600/204, 600/215, 600/210, 606/198
• 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 2017/00243 cardiac
• 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 2017/320048 Balloon dissectors
• CPC Class Codes: A61B 2090/306 using optical fibres
• CPC Class Codes: A61B 90/50 Supports for surgical instruments, e.g. articulated arms

Abstract

A mechanical lifting retractor is provided which increases working space in the chest for cardiac surgery by temporarily expanding the space between the rib cage and the pericardium. The lifting device has a pair of parallel right-angled retractors. Distal portions of the retractors are insertable in side-by-side parallel relation between a pair of adjacent ribs in the rib cage and into the mediastinal space between the ribs and sternum and the pericardium beneath them. The distal portions are pivotable into a lifting position in which they are separated by a rotational angle of approximately 180°. Following insertion of the distal portions into the mediastinal space, the distal portions are rotated into the lifting position and oriented in the sagittal plane such that each distal portion extends beneath one of the ribs. A lifting force is applied to the lifting retractor, causing the distal portions to engage the ribs and to lift the rib cage and thereby enlarging the mediastinal space. The lifting force is maintained for the duration of the surgical procedure.

Claims

1. A method of elevating a rib cage having ribs and a sternum to create a working space beneath the sternum and rib cage without performing a sternotomy, said method comprising the steps of:

(a) providing a retractor device having a distal portion and a proximal portion;

(b) forming an endoscopic incision in tissue adjacent to the rib cage;

(c) passing the distal portion of the retractor device through the incision;

(d) engaging the rib cage with the retractor device;

(e) applying a lifting force to the proximal portion of the retractor device to lift the rib cage and the sternum, thus creating a mediastinal working space within the rib cage;

(f) introducing surgical instruments between a pair of the ribs which adjoin the sternum at one side of the sternum and into the mediastinal working space; and

(g) performing a surgical procedure with the surgical instruments within the mediastinal working space while maintaining the lifting force for the duration of the surgery.

2. The method of claim 1 wherein:

step (b) includes the steps of

(i) forming a first, subxiphoid, incision, and

(ii) forming a second incision in a diaphragm positioned adjacent to the rib cage;

step (c) includes the steps of

(i) passing the distal portion of the retractor device through the first incision, and

(ii) passing the distal portion of the retractor device through the second incision; and

step (d) includes the step of positioning the distal portion of the retractor device against the rib cage.

3. The method of claim 1 wherein:

step (b) includes the step of forming a suprasternal incision;

step (c) includes the step of passing the distal portion of the retractor device through the suprasternal incision; and

step (d) includes the step of positioning the distal portion of the retractor device against the rib cage.

4. The method of claim 1 wherein step (f) includes the steps of:

(g) forming auxiliary incisions in the tissue;

(h) passing surgical instruments through the auxiliary incisions and into the working space; and

(i) performing the surgery using the surgical instruments.

5. The method of claim 1 wherein step (f) includes the step of passing the surgical instruments through the incision formed in step (b) and into the working space.

6. A method of elevating a rib cage having ribs and a sternum to create a working space beneath the sternum and rib cage without performing a sternotomy, said method comprising the steps of:

(a) providing a retractor device having a first distal portion and a first proximal portion;

(b) forming an endoscopic suprasternal incision in tissue adjacent to the rib cage;

(c) passing the first distal portion of the retractor device through the suprasternal incision;

(d) positioning the first distal portion of the retractor device against the rib cage and engaging the rib cage with the retractor device;

(e) applying a lifting force to the first proximal portion of the retractor device to lift the rib cage and the sternum, thus creating a mediastinal working space within the rib cage;

(f) performing a surgical procedure with the surgical instruments within the mediastinal working space while maintaining the lifting force for the duration of the surgery.

7. The method of claim 6 wherein:

step (a) provides the retractor to have a first distal portion that is elongate, that has a length that substantially exceeds the thickness of a patient'"'"'s rib, and that extends laterally of the first proximal portion.

8. A method of elevating a rib cage having ribs and a sternum to create a working space beneath the sternum and rib cage without performing a sternotomy, said method comprising the steps of:

(a) providing a retractor device having a first distal portion and a first proximal portion;

(b) forming a first, endoscopic subxiphoid, incision and a second incision in a diaphragm positioned adjacent to the rib cage;

(c) passing the first distal portion of the retractor device through the first and second incisions;

(d) positioning the first distal portion of the retractor device against the rib cage and engaging the rib cage with the retractor device;

(e) applying a lifting force to the first proximal portion of the retractor device to lift the rib cage and the sternum, thus creating a mediastinal working space within the rib cage;

(f) performing a surgical procedure with the surgical instruments within the mediastinal working space while maintaining the lifting force for the duration of the surgery.

9. The method of claim 8 wherein:

step (a) provides the retractor to have a first distal portion that is elongate, that has a length that substantially exceeds the thickness of a patient'"'"'s rib, and that extends laterally of the first proximal portion.

10. A method of elevating a rib cage having ribs and a sternum to create a working space beneath the sternum and rib cage without performing a sternotomy, said method comprising the steps of:

(a) providing a retractor device having a proximal portion and an elongate distal portion extending laterally of the proximal portion;

(b) forming a small incision in tissue adjacent to the rib cage;

(c) passing the elongate distal portion through the incision, between a pair of the ribs which adjoin the sternum at one side of the sternum, and into a space beneath the rib cage, leaving the proximal portion extending between the ribs and out of the space beneath the rib cage;

(d) positioning the distal portion beneath at least one of the ribs;

(e) applying a lifting force to the proximal portion to engage the rib cage with the retractor and to lift the rib cage and the sternum, thus creating a mediastinal working space within the rib cage; and

(f) performing a surgical procedure within the mediastinal working space while maintaining the lifting force for the duration of the surgery.

11. The method of claim 10 wherein:

step (a) provides the elongate distal portion to have a length that substantially exceeds the thickness of a patient'"'"'s rib.