Methods for transluminally performing surgery

• US 5,931,848 A
• Filed: 05/27/1997
• Issued: 08/03/1999
• Est. Priority Date: 12/02/1996
• Status: Expired due to Term

• Current Assignee: Advanced Cardiovascular Systems Incorporated (Abbott Laboratories)
• Original Assignee: Angiotrax, Inc.
• Inventors: Saadat, Vahid
• Primary Examiner(s): Dawson, Glenn K.
• Application Number:
  US08/863,791
• Time in Patent Office: 798 Days
• Field of Search: 128/898, 606/1, 606/108, 606/167, 606/170, 606/171, 606/184, 606/185, 606/190-200, 606/32, 606/37, 606/39, 606/40, 606/41, 606/45, 606/46, 606/48-52, 606/2, 606/7, 606/13-19, 604/19, 604/22, 604/35
• US Class Current: 606/167
• CPC Class Codes: A61B 17/3207 Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions A61B17/32037 takes precedence; endoscopic cutting instruments A61B17/320016
• CPC Class Codes: A61B 17/320758 with a rotating cutting instrument, e.g. motor driven A61B17/320725, A61B17/32075 and A61B17/320783 take precedence; for removing intra-ocular material A61F9/00763; endoscopic rotatable cutting instruments A61B17/32002
• CPC Class Codes: A61B 18/00 Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body eye surgery A61F9/007; ear surgery A61F11/00
• 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 2017/00022 Sensing or detecting at the treatment site
• CPC Class Codes: A61B 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/00039 Electric or electromagnetic phenomena other than conductivity, e.g. capacity, inductivity, Hall effect
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/00398 using powered actuators, e.g. stepper motors, solenoids
• CPC Class Codes: A61B 2017/00685 Archimedes screw
• CPC Class Codes: A61B 2017/00991 Telescopic means
• CPC Class Codes: A61B 2017/22077 with a part piercing the tissue A61B2017/22044 takes precedence
• CPC Class Codes: A61B 2017/306 holding by means of suction
• CPC Class Codes: A61B 2017/3488 Fixation to inner organ or inner body tissue
• CPC Class Codes: A61B 2018/00196 reciprocating lengthwise
• CPC Class Codes: A61B 2018/00208 actively driven, e.g. by a motor
• CPC Class Codes: A61B 2018/00267 having a basket shaped structure
• CPC Class Codes: A61B 2018/00279 deployable
• CPC Class Codes: A61B 2018/00291 using suction
• CPC Class Codes: A61B 2018/00392 : Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/00738 : Depth, e.g. depth of ablation
• CPC Class Codes: A61B 2018/00761 : Duration
• CPC Class Codes: A61B 2018/00839 : Bioelectrical parameters, e.g. ECG, EEG
• CPC Class Codes: A61B 2018/00916 : with means for switching or controlling the main function of the instrument or device
• CPC Class Codes: A61B 2018/124 : switching the output to different electrodes, e.g. sequentially
• CPC Class Codes: A61B 2018/1435 : Spiral
• CPC Class Codes: A61B 2018/1437 : whereby the windings of the spiral touch each other such as to create a continuous surface
• CPC Class Codes: A61B 2018/1861 : with an instrument inserted into a body lumen or cavity, e.g. a catheter
• CPC Class Codes: A61B 2090/034 : abutting on parts of the device itself
• CPC Class Codes: A61B 2090/0811 : for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
• CPC Class Codes: A61B 2090/3782 : transmitter or receiver in catheter or minimal invasive instrument
• CPC Class Codes: A61B 2217/005 : with suction drainage system
• CPC Class Codes: A61B 2218/002 : Irrigation
• CPC Class Codes: A61B 2218/007 : Aspiration
• CPC Class Codes: A61B 34/20 : Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 90/37 : Surgical systems with images on a monitor during operation
• CPC Class Codes: A61M 25/0084 : being one or more injection needles

Abstract

Apparatus and methods for performing surgery within a hollow-body organ are provided. A catheter is provided having a longitudinal axis and an end region carrying an end effector. The end region is movable to a series of positions along the longitudinal axis with a selectable orientation relative to the longitudinal axis. The catheter includes elements for stabilizing the end region of the apparatus within a hollow-body organ, and for counteracting reaction forces developed during actuation of the end effector. The end effector provides for tissue cutting and aspiration of severed tissue from a treatment site.

Claims

1. A method of performing surgery on an interior wall of a hollow-body organ or vessel comprising steps of:

providing a catheter having a distal region, a guide disposed for translation along the catheter, the guide including an end effector disposed in an end region movable from a transit position aligned with a longitudinal axis of the catheter to a working position at an angle relative to the longitudinal axis, means for stabilizing the distal region within a hollow-body organ;

inserting the catheter within a cavity of a hollow-body organ;

moving the end region to the working position;

deploying the means for stabilizing the distal region within the cavity;

actuating the end effector to perform surgery by removing tissue from the interior wall of the hollow-body organ or vessel; and

aspirating tissue removed from the interior wall of the hollow-body organ or vessel.

2. The method as defined in claim 1 wherein the step of actuating the end effector comprises:

advancing the end effector to bore a channel of predetermined depth in the interior wall of the hollow-body organ or vessel.

3. The method as defined in claim 2 further comprising a step of providing a radio-frequency current that coagulates the portion of the interior wall defining the channel.

4. The method as defined in claim 1 further comprising a step of determining a location of the end effector relative to the interior wall of the hollow-body organ or vessel.

5. The method as defined in claim 1 further comprising, after the step of actuating the end effector, a step of translating the guide relative to the catheter to reposition the end effector.

6. The method as defined in claim 5 further comprising steps of serially repeating the steps of translating the guide and actuating the end effector.

7. The method as defined in claim 1 further comprising, after the step of actuating the end effector at a first location, steps of:

partially retracting the means for stabilizing;

rotating the catheter to reposition the end effector at a second position laterally displaced from the first location;

redeploying the means for stabilizing; and

actuating the end effect at the second position.

8. The method as defined in claim 7 further comprising, after the step of actuating the end effector at second position, a step of translating the guide relative to the catheter to reposition the end effector.

9. The method as defined in claim 8 further comprising steps of serially repeating the steps of translating the guide and actuating the end effector.

10. A method of performing transmyocardial revascularization comprising steps of:

providing a catheter having a distal region, a guide disposed for translation along the catheter, the guide including an end effector disposed in an end region movable from a transit position aligned with a longitudinal axis of the catheter to a working position at an angle relative to the longitudinal axis, means for stabilizing the distal region within a left ventricle;

inserting the catheter within a left ventricular cavity;

moving the end region to the working position;

deploying the means for stabilizing the distal region within the left ventricular cavity;

actuating the end effector to bore a channel extending from the endocardium into the myocardium in the wall of the left ventricle; and

aspirating tissue removed from the wall of the left ventricle.

11. The method as defined in claim 10 wherein the step of actuating the end effector comprises:

advancing the end effector to form a channel of predetermined depth.

12. The method as defined in claim 11 further comprising a step of providing a radio-frequency current that coagulates the portion of the wall of the left ventricle defining the channel.

13. The method as defined in claim 10 further comprising a step of determining a location of the end effector relative to the wall of the left ventricle.

14. The method as defined in claim 10 further comprising, after the step of actuating the end effector, a step of translating the guide relative to the catheter to reposition the end effector.

15. The method as defined in claim 14 further comprising steps of serially repeating the steps of translating the guide and actuating the end effector.

16. The method as defined in claim 10 further comprising, after the step of actuating the end effector at a first location, steps of:

partially retracting the means for stabilizing;

rotating the catheter to reposition the end effector at a second position laterally displaced from the first location;

redeploying the means for stabilizing; and

actuating the end effect at the second position.

17. The method as defined in claim 16 further comprising, after the step of actuating the end effector at second position, a step of translating the guide relative to the catheter to reposition the end effector.

18. The method as defined in claim 17 further comprising steps of serially repeating the steps of translating the guide and actuating the end effector.