Endoscopic retraction method

• US 6,558,318 B1
• Filed: 11/01/1999
• Issued: 05/06/2003
• Est. Priority Date: 02/22/1993
• Status: Expired due to Fees

• Current Assignee: Edwards Lifesciences LLC (Edwards Lifesciences Corporation)
• Original Assignee: Heartport, Inc. (Johnson & Johnson)
• Inventors: Deckman, Robert K., Daniel, S. Christopher, Garrison, Michi E.
• Primary Examiner(s): Leubecker, John P.
• Application Number:
  US09/430,929
• Time in Patent Office: 1,282 Days
• Field of Search: 600/201, 600/204, 600/210, 600/213, 600/226-230, 600/231-235, 600/215, 604/49, 604/142, 606/46, 623/2
• US Class Current: 600/213
• 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
• 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
• 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
• 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 thoracic cavity of a patient includes the step of providing a tissue positioning tool having a shaft, a tool support apparatus and a tissue supporting member releasably connectable to the shaft. The tool support apparatus includes a clamp assembly configured to secure the shaft to the tool support apparatus. The tool support apparatus is positioned on an outer surface of a patient'"'"'s chest and at least a portion of the shaft and the tissue supporting member are introduced into the patient'"'"'s thoracic cavity. The tissue supporting member is attached to the portion of the shaft that is disposed within the patient so as to contact a tissue structure. A force is applied to the shaft to displace the tissue structure and the shaft is locked to the tool support apparatus with the clamp assembly.

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 releasably connectable to the shaft, 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 at least a portion of the shaft and the tissue supporting member into the patient'"'"'s thoracic cavity;

attaching the tissue supporting member to the portion of the shaft disposed within the patient;

contacting a tissue structure in the thoracic cavity with the tissue supporting member;

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 introducing step is 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.

3. The method of claim 1, wherein the providing step is carried out with the tissue positioning tool including a tool support apparatus.

4. The method of claim 3, 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 to retain the tissue structure in the displaced position.

5. The method of claim 1, wherein the shaft has a distal end that is introduced into the patient through the at least one penetration in the patient and the tissue supporting member is attached to the distal end of the shaft.

6. The method of claim 1, wherein the introducing step is carried out by passing the tissue supporting member through a first opening in the patient'"'"'s chest and passing the at least a portion of the shaft through a second opening in the patient'"'"'s chest.

7. The method of claim 1, comprising the step of viewing the patient'"'"'s heart through a scope extending through a second penetration in the patient.

8. The method of claim 1, comprising the step of forming an opening in a chamber wall of the patient'"'"'s heart.

9. The method of claim 8, comprising the step of introducing an instrument through the at least one penetration and through the opening and performing a procedure on the patient'"'"'s heart with the instrument.

10. The method of claim 9, wherein the procedure is a valve replacement.

11. The method of claim 10, wherein the procedure is a mitral valve replacement.

12. 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 and at least a portion of the shaft into a patient through at least one penetration in the patient;

attaching the tissue supporting member to the portion of the shaft disposed 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.

13. The method of claim 12, wherein:

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.

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

15. 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 to retain the tissue structure in the displaced position.

16. The method of claim 12, wherein the tissue supporting member and the shaft are introduced into the patient'"'"'s thoracic cavity.

17. The method of claim 12, wherein the tissue supporting member is attached to the shaft within the patient'"'"'s thoracic cavity.

18. The method of claim 12, wherein the shaft has a distal end that is introduced into the patient through the at least one penetration in the patient and the tissue supporting member is attached to the distal end of the shaft.

19. The method of claim 12, wherein the introducing step is carried out by passing the tissue supporting member through a first opening in the patient'"'"'s chest and passing the at least a portion of the shaft through a second opening in the patient'"'"'s chest.

20. The method of claim 12, comprising the step of viewing the patient'"'"'s heart through a scope extending through a second penetration in the patient.

21. The method of claim 12, comprising the step of forming an opening in a chamber wall of the patient'"'"'s heart.

22. The method of claim 21, comprising the step of introducing an instrument through the at least one penetration and through the opening and performing a procedure on the patient'"'"'s heart with the instrument.

23. The method of claim 22, wherein the procedure is a valve replacement.

24. The method of claim 23, wherein the procedure is a mitral valve replacement.