Endarterectomy surgical instrument and procedure

• US 6,358,244 B1
• Filed: 04/20/1999
• Issued: 03/19/2002
• Est. Priority Date: 07/12/1996
• Status: Expired due to Term

• Current Assignee: Fredric Newman
• Original Assignee: ENDO Surgical Devices, Inc.
• Inventors: Knepshield, William R., Newman, Fredric A., Kaplitt, Martin J
• Primary Examiner(s): Dvorak, Linda C. M.
• Assistant Examiner(s): FARAH, AHMED M
• Application Number:
  US09/294,566
• Time in Patent Office: 1,064 Days
• Field of Search: 606/2, 606/7, 606/8, 606/13-15, 606/43, 606/46, 607/88, 607/89, 607/91
• US Class Current: 606/15
• CPC Class Codes: A61B 17/32037 for removing obstructions from inner organs or blood vessels, e.g. for atherectomy
• CPC Class Codes: A61B 17/32056 Surgical snare instruments for removing or smashing calculi A61B2017/2212; tonsillotomes A61B17/26
• 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 2017/22082 after introduction of a substance
• CPC Class Codes: A61B 2017/320741 for stripping the intima or the internal plaque from a blood vessel, e.g. for endarterectomy
• CPC Class Codes: A61B 2090/0817 Spatulas or spatula like extensions
• CPC Class Codes: A61B 2090/306 using optical fibres
• CPC Class Codes: A61B 2090/3614 using optical fibre

Abstract

An endarterectomy surgical instrument and procedure for removing plaque from a selected length of an artery and surgical instruments for cutting plaque build-ups. The endarterectomy surgical instrument has means for developing an image of the surgical site so that probing of the artery can be observed without requiring opening the artery along the selected length over which the plaque is removed.

Claims

1. A surgical instrument comprising:

(A) a spatula tip having at a first end thereof;

(a) an optics opening, and

(b) a plurality of fluid openings;

(B) first flexible tubular means extending through said spatula tip from said optics opening, said first flexible tubular means having;

(a) a remote end opposite said spatula tip,

(b) at least one fiber optic cable arranged to conduct light from a light source to said optics opening, and

(c) at least one other fiber optic cable to conduct an image of a surgical site to an image forming unit;

(C) second flexible tubular means extending through said spatula tip from said fluid openings in said spatula tip to a remote end; and

(D) connector means having an end connectable to;

(a) the light source;

(b) the image forming unit, and

(c) a fluid source

and an opposite end connectable to;

(a) said remote end of said first flexible tubular means, and

(b) said remote end of said second flexible tubular means.

2. A surgical instrument according to claim 1, wherein:

(a) said first flexible tubular means comprises a plurality of fiber optic cables disposed in a circular array arranged to conduct light from said light source to said optics opening, and

(b) said at least one other fiber optic cable is disposed at the center of said circular array.

3. A surgical instrument according to claim 1 wherein said spatula tip has a curved body and said optics opening, said at least one fiber optic cable and said at least one other fiber optic cable are within said curved body of said spatula tip.

4. A surgical instrument according to claim 1 wherein said spatula tip also has at said first end thereof a laser opening through which a laser beam is emitted.

5. A surgical instrument according to claim 1, wherein said first flexible means and said second flexible means are co-axially oriented.

6. A surgical instrument according to claim 1, wherein said first flexible tubular means comprises a plurality of fiber optic cables arranged to conduct light from said light source to said optics opening.

7. A surgical instrument according to claim 1 further including a flexible sheathing extending between said spatula tip and said connector means and through which said first flexible tubular means and said second flexible tubular means extend.

8. A surgical instrument according to claim 7 further including:

(a) a balloon bonded to said sheathing, and

(b) a fluid passage through which a fluid, under controlled pressure, is introduced into said balloon to inflate said balloon.

9. A surgical instrument according to claim 7 wherein:

(a) said spatula tip also has at said first end thereof a plurality of liquid openings, and said instrument further includes;

(E) third flexible tubular means extending through said spatula tip from said liquid openings in said spatula tip for conducting liquid from a remote end of said third flexible tubular means connected to said connector means to the surgical site through a first of said liquid openings and for conducting liquid through a second of said liquid openings from the surgical site to said remote end of said third flexible tubular means.

10. A surgical instrument according to claim 9 wherein said third flexible tubular means extend through said flexible sheathing.

11. A surgical instrument comprising:

(A) an elongated body having a spatula tip disposed at a first end thereof for use at a surgical site, said spatula tip including;

(1) an optics opening, and

(2) at least one first fluid opening adapted to be used in combination with a fluid apparatus to deliver fluid to the surgical site; and

(B) a fiber optics assembly coupled to said optic opening, said fiber optics assembly including;

(1) at least one fiber optic cable to conduct light from a light source to the surgical site through said optics opening; and

(2) at least one other fiber optic cable to conduct an image of the surgical site to an image forming unit through said optics opening.

12. A surgical instrument according to claim 11, wherein said fiber optics assembly includes a plurality of fiber optic cables to conduct light from said light source to the surgical site through said optics opening.

13. A surgical instrument according to claim 11, wherein said fluid opening is adapted to receive a gas and the fluid apparatus is an apparatus for delivering the gas to said opening.

14. A surgical instrument according to claim 13, wherein the gas is CO₂.

15. A surgical instrument according to claim 11, wherein said spatula tip includes at least one second fluid opening adapted to be used in combination with a liquid apparatus to receive a liquid and deliver the liquid to the surgical site.

16. A surgical instrument according to claim 15, wherein said spatula tip includes at least one third fluid opening adapted to be used in combination with a liquid apparatus to receive a liquid and carry the liquid from the surgical site.

17. A surgical instrument according to claim 16, wherein the fluid is saline.

18. A surgical instrument comprising:

(A) an elongated body having a spatula tip disposed at a first end thereof for use at a surgical site, said spatula tip including;

(1) an optics opening, and

(2) at least one first fluid opening adapted to be used in combination with a fluid apparatus to deliver fluid to the surgical site; and

(B) a fiber optics assembly coupled to said optics opening to conduct an image of the surgical site to an image forming unit through said optics opening.

19. A surgical instrument according to claim 18, wherein said fiber optics assembly includes a plurality of fiber optic cables to conduct light from a light source to the surgical site through said optics opening.

20. A surgical instrument comprising:

(A) an elongated body having a spatula tip disposed at a first end thereof for use at a surgical site, said spatula tip including means for delivering fluid to the surgical site; and

(B) means for conducting an image of the surgical site to an image forming unit.

21. A method for removing a plaque build-up from a selected length of artery using a surgical instrument having a spatula tip, said method comprising the steps of:

making an incision in said selected length of artery;

inserting said spatula tip into said incision such that said spatula tip is placed in a space between an adventitia layer and a media layer of said selected length of artery;

probing said selected length of artery with said spatula tip at a surgical site to separate said plaque build-up from said selected length of artery while using said spatula tip to apply a fluid to said space;

continuously developing an image of said surgical site, said image capable of being viewed on a monitor;

terminating said probing at a second end of said selected length of artery; and

removing said separated plaque build-up through said incision.

22. A method for removing plaque build-up from a selected length of artery according to claim 21, wherein said fluid is carbon dioxide gas.

23. A method for removing plaque build-up from a selected length of artery according to claim 21, further comprising the step of preparing a termination transition in said selected length of artery using a laser beam provided in said spatula tip.

24. A method for removing plaque build-up from a selected length of artery according to claim 21, further comprising the step using said spatula tip to deliver a saline solution to said surgical site.

25. A method for removing plaque build-up from a selected length of artery according to claim 24, further comprising the step of drawing plaque debris away from said surgical site through an opening in said spatula tip.