Intraoperative tissue treatment methods

• US 6,602,204 B2
• Filed: 04/27/2001
• Issued: 08/05/2003
• Est. Priority Date: 02/10/1998
• Status: Expired due to Term

• Current Assignee: Artemis Medical, Inc. (Johnson & Johnson)
• Original Assignee: Artemis Medical, Inc. (Johnson & Johnson)
• Inventors: Fulton, Richard E., Dubrul, William R., Curtis, Robert M.
• Primary Examiner(s): Hindenburg, Max F.
• Assistant Examiner(s): SZMAL, BRIAN SCOTT
• Application Number:
  US09/844,661
• Publication Number:
  US 20020019597A1
• Time in Patent Office: 830 Days
• Field of Search: 600/567, 600/431, 600/432, 600/436, 604/13, 604/19, 606/1, 606/41, 606/117, 606/113-115, 128/899
• US Class Current: 600/567
• CPC Class Codes: A61B 10/02 Instruments for taking cell samples or for biopsy A61B10/0038 and A61B10/0045 take precedence; needle locating or guiding means A61B17/3403; samplers for enzymology or microbiology C12M1/26; sampling or preparing biological specimens G01N33/48
• CPC Class Codes: A61B 10/0266 means for severing sample
• CPC Class Codes: A61B 17/221 Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions surgical snare instruments A61B17/32056
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 18/14 Probes or electrodes therefor
• CPC Class Codes: A61B 2090/3904 specially adapted for marking specified tissue
• CPC Class Codes: A61B 2090/3908 Soft tissue, e.g. breast tissue
• CPC Class Codes: A61B 2090/3962 palpable
• CPC Class Codes: A61B 6/502 for diagnosis of breast, i.e. mammography
• CPC Class Codes: A61B 90/39 Markers, e.g. radio-opaque or breast lesions markers

Abstract

Intraoperative tissue treatment methods are used following the removal of target tissue, e.g. diseased tissue, from a target site, e.g. within a patient'"'"'s breast, leaving access to the target site. In one method an expandable element is introduced into and expanded within a void at the target site. If all of the target tissue was not removed, then a layer of tissue at least partially surrounding the expanded element is removed from the patient, preferably in a substantially intact form. In a second method the suction inlet of a suction device is in fluid communication with the void. If all of the target tissue has not been removed, at least a portion of the collapsed tissue is removed from the patient and analyzed. With a third method, a flexible implant is passed through the sheath and into the void to at least substantially fill the void.

Claims

1. An intraoperative tissue treatment method, for use following the removal of target tissue from a target site leaving access to the target site, comprising:

introducing an expandable element into a void at a target site;

expanding the expandable element to at least substantially fill the void;

determining whether adequate target tissue at the target site was removed; and

if the results of the determining step is no, then;

separating additional tissue, at least partially surrounding the expanded element, from surrounding tissue;

the separating step comprising rotating a cutter around the expanded element; and

removing the additional tissue and the expanded element from the patient.

2. The method according to claim 1 wherein the introducing step is carried out before the determining step.

3. The method according to claim 1 wherein the determining step is carried out with the target tissue being diseased tissue.

4. The method according to claim 1 wherein the introducing step is carried out using at least one of a balloon, an expandable mesh and a malecot-type element as the expandable element.

5. The method according to claim 1 wherein the introducing step is carried out with the target site being within a patient'"'"'s breast.

6. The method according to claim 1 wherein the introducing step is carried out through a hollow sheath.

7. The method according to claim 1 wherein the expanding step is carried out so that the expanded element at least substantially fills the void.

8. The method according to claim 1 wherein said separating step is carried out so said additional tissue completely surrounds said expanded element.

9. The method according to claim 1 wherein the removing step creates an expanded void at the body site, and further comprising introducing a second expandable element into the expanded void and expanding the second expandable element within the expanded void.

10. The method according to claim 9 wherein the introducing steps are carried out using two separate expandable elements.

11. An intraoperative tissue treatment method, for use following the removal of target tissue from a target site leaving access to the target site, comprising:

introducing an expandable element into a void at a target site;

expanding the expandable element to at least substantially fill the void;

determining whether adequate target tissue at the target site was removed; and

if the results of the determining step is no, then;

separating additional tissue, at least partially surrounding the expanded element, from surrounding tissue using a blade which passes about the expanded element; and

removing the additional tissue and the expanded element from the patient.

12. An intraoperative tissue treatment method, for use following the removal of target tissue from a target site leaving access to the target site, comprising:

introducing an expandable element into a void at a target site;

expanding the expandable element to at least substantially fill the void;

determining whether adequate target tissue at the target site was removed; and

if the results of the determining step is no, then;

separating additional tissue, at least partially surrounding the expanded element, from surrounding tissue, said additional tissue comprising an inner, at least partially void-defining surface and an outer surface; and

removing the additional tissue and the expanded element from the patient.

13. An intraoperative tissue treatment method, for use following the removal of target tissue from a target site leaving access to the target site, comprising:

introducing an expandable element into a void at a target site;

expanding the expandable element to at least substantially fill the void;

determining whether adequate target tissue at the target site was removed; and

if the results of the determining step is no, then;

separating additional tissue, at least partially surrounding the expanded element, from surrounding tissue;

the separating step comprising extending an expandable and contractible cutting loop at least partially over the expanded element; and

removing the additional tissue and the expanded element from the patient.

14. An intraoperative tissue treatment method, for use following the removal of target tissue from a target site leaving access to the target site, comprising:

introducing an expandable element into a void at a target site;

expanding the expandable element to at least substantially fill the void;

determining whether adequate target tissue at the target site was removed; and

if the results of the determining step is no, then;

separating additional tissue, at least partially surrounding the expanded element, from surrounding tissue;

the separating step comprising extending a tubular mesh cutter, having a radially expandable and contractible distal cutting end, over the expanded element; and

removing the additional tissue and the expanded element from the patient.

15. An intraoperative tissue treatment method, for use following the removal of target tissue from a target site leaving access to the target site, comprising:

introducing an expandable element into a void at a target site;

expanding the expandable element to at least substantially fill the void;

determining whether adequate target tissue at the target site was removed; and

if the results of the determining step is no, then;

substantially simultaneously removing additional tissue, at least partially surrounding the expanded element, and the expanded element from the patient.

16. An intraoperative tissue treatment method, for use following the removal of diseased tissue from a target site within a patient'"'"'s breast leaving access to the target site, comprising:

introducing an expandable element into a void at a target site;

expanding the expandable element to at least substantially fill the void;

determining whether all diseased tissue at the target site was removed; and

if the results of the determining step is no, then;

separating a layer of tissue at least substantially surrounding the expanded element so said layer of tissue comprises an inner, a void-defining surface and an outer surface;

removing the separated layer of tissue, together with the expanded element, from the patient while maintaining said separated layer of tissue in a substantially intact form; and

inspecting the outer surface for evidence of said diseased tissue.

17. The method according to claim 16 wherein the separating and removing steps are carried out so that said layer of tissue is in at most three sections.

18. An intraoperative tissue treatment method, for use following the removal of target tissue from a target site leaving a void at the target site, comprising:

locating a suction inlet of a suction device in fluid communication with a void at the target site;

withdrawing fluid through the suction inlet thereby at least partially collapsing the tissue defining the void;

determining whether all target tissue at the target site was removed;

if the results of the determining step is no, then;

removing at least a portion of the collapsed tissue from the patient.

19. The method according to claim 18 wherein the locating step is carried out before the determining step.

20. The method according to claim 18 wherein the fluid withdrawing step is carried out to withdraw at least liquid and gas through the suction inlet.

21. The method according to claim 18 further comprising positioning a blocking element at a position distal of the target site.

22. The method according to claim 21 wherein the blocking element is removed during the removing step.

23. The method according to claim 18 wherein the removing step comprises removing the suction device from the patient generally simultaneously with the collapsed tissue portion.

24. The method according to claim 18 wherein the removing step comprises passing a tissue separator through tissue surrounding the target site thereby separating said portion of said collapsed tissue surrounding the target site from surrounding tissue.

25. The method according to claim 24 wherein the removing step comprises passing a radially expandable, tubular mesh material between the collapsed tissue portion and the surrounding tissue.

26. The method according to claim 18 wherein the removing step comprises:

separating said collapsed tissue portion from surrounding tissue, the separating step being carried out so said collapsed tissue portion comprises an outer surface;

maintaining said separated collapsed tissue portion in a substantially intact form; and

further comprising;

inspecting the outer surface for evidence of said target tissue.

27. An intraoperative tissue treatment method, for use following the removal of target tissue from a target site leaving a void at the target site, comprising:

positioning a blocking element at a position distal of the target site, the positioning step being carried out with a radially expandable mesh device as the blocking element;

locating a suction inlet of a suction device in fluid communication with a void at the target site;

withdrawing fluid through the suction inlet thereby at least partially collapsing the tissue defining the void;

determining whether all target tissue at the target site was removed;

if the results of the determining step is no, then;

removing at least a portion of the collapsed tissue from the patient.

28. An intraoperative tissue treatment method, for use following the removal of diseased tissue from a target site within a patient'"'"'s breast leaving a void at the target site, comprising:

locating a suction inlet of a suction device within a void at the target site;

positioning a blocking element at a position distal of the target site;

withdrawing fluid through the suction inlet thereby at least partially collapsing the tissue defining the void;

determining whether all diseased tissue at the target site was removed with the excised tissue; and

if the results of the determining step is no, then;

passing a tissue separator through tissue surrounding the target site thereby separating at least a portion of the collapsed tissue, comprising an outer surface, at least partially surrounding the target site from surrounding tissue;

passing a radially expandable, tubular mesh material between the collapsed tissue portion and the surrounding tissue;

removing the collapsed tissue portion, the blocking element, the tissue cutter and the tubular mesh material from the patient while maintaining said collapsed tissue portion in a substantially intact form; and

inspecting the outer surface for evidence of said diseased tissue.

29. The method according to claim 28 wherein the removing step is carried out to generally simultaneously remove the collapsed tissue portion, the blocking element, the tissue cutter and the tubular mesh material from the patient.

30. An intraoperative tissue treatment method, for use following the removal of tissue from a target site leaving a void at the target site and a sheath at least part way along a passageway from a region external of the patient to a void at a target site, comprising:

maintaining the sheath at least part way along the passageway from the region external of the patient to the void at the target site;

passing a generally flexible bag-type implant though the sheath and into the void;

at least partially filling the void with the implant; and

removing the sheath from the patient.

31. The method according to claim 30 wherein the maintaining step is carried out with the sheath extending into the void.

32. The method according to claim 30 wherein the passing step is carried out using a bioabsorbable implant.

33. The method according to claim 30 wherein said filling step is carried out without the addition of material into the implant once it is within the void.

34. The method according to claim 30 wherein said filling step is carried out so to at least substantially fill the void.

35. The method according to claim 30 wherein the passing step is carried out using a non-bioabsorbable implant.