Method for manipulating a tissue structure within a thoracic cavity

• US 5,980,455 A
• Filed: 07/15/1997
• Issued: 11/09/1999
• Est. Priority Date: 02/22/1993
• Status: Expired due to Term

• Current Assignee: Edwards Lifesciences LLC (Edwards Lifesciences Corporation)
• Original Assignee: Heartport, Inc. (Johnson & Johnson)
• Inventors: Garrison, Michi E., Deckman, Robert K., Daniel, S. Christopher
• Primary Examiner(s): Leubecker, John P.
• Application Number:
  US08/893,066
• Time in Patent Office: 847 Days
• Field of Search: 600/201, 600/204, 600/210, 600/213, 600/226, 600/227, 600/228, 600/229, 600/230, 600/231, 600/232, 600/233, 600/234, 600/235, 600/215, 600/114, 604/49, 604/142, 606/46, 623/2
• US Class Current: 600/235
• 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 17/0218 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 17/2909 Handles
• 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 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 2017/00349 Needle-like instruments having hook or barb-like gripping means, e.g. for grasping suture or tissue A61B17/06066 takes precedence
• CPC Class Codes: A61B 2017/0243 for immobilizing local areas of the heart, e.g. while it beats trocars attached to inner organs or inner body tissue A61B2017/3488
• 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 J-shaped suture needles A61B2017/0608
• 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 2017/2946 Locking means
• 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 2017/3425 : for internal organs, e.g. heart ports
• 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 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 2025/028 : having a mainly rigid support structure
• CPC Class Codes: A61M 2039/027 : having a particular valve, seal or septum septum A61M2039/0036
• CPC Class Codes: A61M 2039/0279 : for introducing medical instruments into the body, e.g. endoscope, surgical tools
• 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 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

Abstract

A method for manipulating a tissue structure within a body cavity provides for retracting and supporting the heart wall to provide access into the heart during a cardiac surgical procedure. In one embodiment of the present invention, a surgical tool support apparatus comprises a base having an atraumatic tissue-engaging surface and an aperture for receiving an elongate tool. The apparatus also has a clamp assembly aligned with the aperture and spaced-apart from a surface of the base opposite to the tissue-engaging surface. The apparatus is particularly useful in maintaining a retracting force on a surgical tool used to manipulate tissue within a body cavity such as the thoracic cavity.

Claims

1. A method for manipulating a tissue structure within a thoracic cavity of a patient, comprising the steps of:

providing a tissue positioning tool having a shaft, a tool support apparatus, and a tissue supporting member, the tool support apparatus having a clamp assembly configured to secure the shaft to the tool support apparatus, the tool support apparatus also having a base, the clamp assembly being pivotable relative to the base;

positioning the tool support apparatus on an outer surface of a patient'"'"'s chest;

introducing the tissue supporting member into the patient'"'"'s thoracic cavity;

contacting a tissue structure in the thoracic cavity with the tissue supporting member, the tissue supporting member being coupled to the shaft;

applying a force to the shaft so that the tissue supporting member moves the tissue structure to a displaced position; and

locking the shaft to the tool support apparatus with the clamp assembly after the applying step so that the tissue structure maintains the displaced position.

2. The method of claim 1, wherein the providing step is carried out with the clamp assembly having an actuator, the actuator being movable to a locked position which secures the shaft relative to the tool support apparatus, the actuator also fixing an angular orientation of the clamp assembly relative to the base when moved to the locked position thereby preventing pivoting of the clamp assembly relative to the base.

3. The method of claim 1, wherein the locking, applying, contacting, introducing and positioning steps are carried out with only the shaft penetrating the patient'"'"'s chest and the tool support apparatus engaging only the outer surface of the patient'"'"'s chest.

4. The method of claim 1, wherein the providing step is carried out with the tool support apparatus having a base, the base having a bottom surface having a surface area of at least 3 square inches.

5. The method of claim 1, wherein:

the providing step is carried out with the tool support apparatus having an elastomeric cushion; and

the positioning step is carried out with the elastomeric cushion engaging the outer surface of the patient'"'"'s chest.

6. A method for manipulating a tissue structure within a thoracic cavity of a patient, comprising the steps of:

providing a tissue positioning tool having a shaft, a tool support apparatus, and a tissue supporting member, the tool support apparatus having a clamp assembly configured to secure the shaft to the tool support apparatus;

positioning the tool support apparatus on an outer surface of a patient'"'"'s chest;

introducing the tissue supporting member into the patient'"'"'s thoracic cavity;

contacting a tissue structure in the thoracic cavity with the tissue supporting member, the tissue supporting member being coupled to the shaft;

applying a force to the shaft so that the tissue supporting member moves the tissue structure to a displaced position; and

locking the shaft to the tool support apparatus with the clamp assembly after the applying step so that the tissue structure maintains the displaced position;

the introducing step being carried out with the tissue supporting member passing through a first opening in the patient'"'"'s chest; and

the applying step being carried out with the shaft passing through a second opening in the patient'"'"'s chest.

7. The method of claim 6, wherein the providing step is carried out with the tool support apparatus having a base, the clamp assembly being pivotable relative to the base.

8. The method of claim 6, further comprising the step of:

attaching the tissue supporting member to the shaft within the patient'"'"'s chest.

9. A method for manipulating a tissue structure within a thoracic cavity of a patient, comprising the steps of:

providing a tissue positioning tool having a shaft, a tool support apparatus, and a tissue supporting member, the tool support apparatus having a clamp assembly configured to secure the shaft to the tool support apparatus, the tool support apparatus also having a base, the base having a bottom surface having a surface area of at least 3 square inches and a maximum outer dimension of no more than 3.5 inches;

positioning the tool support apparatus on an outer surface of a patient'"'"'s chest;

introducing the tissue supporting member into the patient'"'"'s thoracic cavity;

contacting a tissue structure in the thoracic cavity with the tissue supporting member, the tissue supporting member being coupled to the shaft;

applying a force to the shaft so that the tissue supporting member moves the tissue structure to a displaced position; and

locking the shaft to the tool support apparatus with the clamp assembly after the applying step so that the tissue structure maintains the displaced position.

10. The method of claim 9, wherein the providing step is carried out with the bottom surface having a circular shape with a radial slot.

11. A method of retracting a tissue structure, comprising the steps of:

providing a tissue positioning tool having a shaft and a tissue supporting member;

introducing the tissue supporting member into the patient through a first penetration in the patient;

introducing the shaft through a second penetration in the patient;

attaching the tissue supporting member to the shaft within the patient;

contacting a tissue structure in the patient with the tissue supporting member; and

applying a force to the shaft so that the tissue supporting member moves the tissue structure to a displaced position.

12. The method of claim 11, wherein the providing step is carried out with the tissue positioning tool including a tool support apparatus.

13. The method of claim 12, further comprising the steps of:

positioning the tool support apparatus on an outer surface of a patient'"'"'s chest; and

locking the shaft to the tool support apparatus after the applying step so that the tissue structure maintains the displaced position.