Apparatus and method for dissecting tissue layers

• US 6,540,764 B1
• Filed: 01/06/1999
• Issued: 04/01/2003
• Est. Priority Date: 06/02/1992
• Status: Expired due to Fees

• Current Assignee: General Surgical Innovations Incorporated (Johnson Controls International plc)
• Original Assignee: General Surgical Innovations Incorporated (Johnson Controls International plc)
• Inventors: Echeverry, Jan M., Robinson, Janine C., Mollenauer, Kenneth H., Jervis, James E., Howell, Thomas A., Kayan, Helmut, Kieturakis, Maciej J.
• Primary Examiner(s): Dawson, Glenn K.
• Application Number:
  US09/229,409
• Time in Patent Office: 1,546 Days
• Field of Search: 606/190-200, 606/151, 606/213, 128/898, 600/201, 600/204, 600/207, 604/1, 604/11-18
• US Class Current: 606/190
• 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 17/02 for holding wounds open; Tractors specula A61B1/32 ; drainage appliances for wounds A61M27/00
• 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 2017/00902 transparent or translucent
• CPC Class Codes: A61B 2017/0225 flexible, e.g. fabrics, meshes, or membranes
• 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 2017/320056 Tunnelers
• CPC Class Codes: A61B 2090/0813 Accessories designed for easy sterilising, i.e. re-usable
• CPC Class Codes: A61B 90/02 Devices for expanding tissue, e.g. skin tissue implements for holding wounds open, surgical tractors A61B17/02; implantable mammary prosthesis A61F2/12; dilators A61M29/00
• 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: A61F 2250/0003 having an inflatable pocket filled with fluid, e.g. liquid or gas
• CPC Class Codes: A61M 2025/1004 Balloons with folds, e.g. folded or multifolded
• 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 25/1027 : Making of balloon catheters
• CPC Class Codes: A61M 29/02 : Dilators made of swellable material balloon catheters for angioplasty A61M25/104

Abstract

An expansible tunneling apparatus and assosiated methods for creating an anatomic working space for a surgical procedure such as a hernia repair. Various embodiments of one and two piece apparatus that permit laparoscopic observation both during tunneling and during subsequent balloon dissection are disclosed. In a disclosed one piece embodiment, a tubular member has a bore extending therethrough and an open distal end. A lip is formed in the distal end of the tubular member to capture the distal tip of a laparoscope that is inserted into the tubular member to permit observation of the procedure both during tunneling to a desired location and during subsequent balloon inflation. An elongated neck of the balloon is secured to the tunneling member. The elongated neck permits the tubular member to be withdrawn slightly from the balloon after inflation to facilitate observation. After the balloon has been advanced to the desired location in the body it is inflated through a balloon inflation lumen to cause the balloon to dissect tissue and create an operating space. The operating space may then be insulated with gas to form a working space for repairing a hernia.

Claims

1. A method of providing access through the abdominal wall to repair a hernia, the abdominal wall including the peritoneum and the properitoneal fascia, the method comprising the steps of:

a) introducing an inflatable chamber in a collapsed state between the peritoneum and the properitoneal fascia;

b) inflating the inflatable chamber into an expanded state to maintain the peritoneum in a separated state from the properitoneal fascia, and to create a working space therebetween;

c) introducing insufflation gas into the working space; and

d) repairing the hernia.

2. The method of claim 1, wherein the step of introducing the inflatable chamber in a collapsed state between the peritoneum and the properitoneal fascia includes the steps of:

(1) providing an elongate tube with the inflatable chamber attached hereto,

(2) making an incision through the abdominal wall, excluding the peritoneum, and

(3) introducing the inflatable chamber and part of the elongate tube into the incision.

3. The method of claim 2, wherein the step of introducing insufflation gas into the working space includes the steps of:

(1) deflating the inflatable chamber,

(2) withdrawing the inflatable chamber from the working space by separating the inflatable chamber from the elongate tube,

(3) advancing an introducer sleeve distally along the elongate tube, and

(4) introducing insufflation gas through the introducer sleeve into the working space.

4. The method of claim 1, wherein the step of introducing the inflatable chamber in a collapsed state between the peritoneum and the properitoneal fascia includes the steps of:

(1) providing an elongate tube with the inflatable chamber attacehed hereto, the elongate tube having a proximal and a distal end,

(2) providing a blunt tip at the distal end of the elongate tube,

(3) making an incision through the abdominal wall, excluding the peritoneum, and

(4) introducing the distal end of the elongate tube and the inflatable chamber into the incision.

5. The method of claim 4, wherein the step of introducing insufflation gas into the working space includes the steps of:

(1) deflating the inflatable chamber,

(2) withdrawing the inflatable chamber from the working space by separating the inflatable chamber from the elongate tube,

(3) advancing an introducer sleeve distally along the elongate tube, and

(4) introducing insufflation gas through the introducer sleeve into the working space.

6. The method of claim 1, wherein the step of introducing the inflatable chamber in a collapsed state between the peritoneum and the properitoneal fascia includes the steps of:

(1) providing an elongate tube with the inflatable chamber attached hereto, the elongate tube having a proximal and a distal end,

(2) providing a detachable tip at the distal end of the elongate tube,

(3) making an incision through the abdominal wall, excluding the peritoneum, and

(4) introducing the distal end of the elongate tube and the inflatable chamber into the incision.

7. The method of claim 6, wherein the step of introducing insufflation gas into the working space includes the steps of:

(1) deflating the inflatable chamber,

(2) withdrawing the inflatable chamber from the working space by separating the inflatable chamber from the elongate tube,

(3) advancing an introducer sleeve distally along the elongate tube, and

(4) introducing insufflation gas through the introducer sleeve into the working space.