Doppler directed suture ligation device and method

• US 6,638,286 B1
• Filed: 11/16/2000
• Issued: 10/28/2003
• Est. Priority Date: 11/16/2000
• Status: Expired due to Fees

• Current Assignee: Vascular Control Systems, Inc. (Johnson & Johnson)
• Original Assignee: Vascular Control Systems, Inc. (Johnson & Johnson)
• Inventors: Jones, Michael L., Altieri, Greig E., Burbank, Fred, Uyeno, Jill, Serra, R. J.
• Primary Examiner(s): Lindsey, Rodney M.
• Application Number:
  US09/713,020
• Time in Patent Office: 1,076 Days
• Field of Search: 606/139, 606/148, 606/157, 606/144, 606/437, 606/439, 606/462, 606/453, 606/455, 606/454, 606/456, 606/459
• US Class Current: 606/157
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• CPC Class Codes: A61B 17/12009 Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
• CPC Class Codes: A61B 17/32056 Surgical snare instruments for removing or smashing calculi A61B2017/2212; tonsillotomes A61B17/26
• CPC Class Codes: A61B 18/1477 Needle-like probes
• CPC Class Codes: A61B 18/1482 having a long rigid shaft for accessing the inner body transcutaneously in minimal invasive surgery, e.g. laparoscopy
• 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 2017/00867 shape memory effect for prostheses A61F2210/0014
• CPC Class Codes: A61B 2017/0472 Multiple-needled, e.g. double-needled, instruments
• CPC Class Codes: A61B 2017/06104 interconnected at their distal ends, e.g. two hollow needles forming a loop for passing a suture
• CPC Class Codes: A61B 2018/00601 Cutting
• CPC Class Codes: A61B 2018/0063 Sealing
• CPC Class Codes: A61B 2018/126 bipolar
• CPC Class Codes: A61B 2018/1425 Needle
• CPC Class Codes: A61B 2090/378 using ultrasound

Abstract

A ligation device includes a cannula having first and second extendable members and a Doppler wand. The Doppler wand permits an anatomical vessel, such as a blood vessel, to be located in close proximity to the distal end of the cannula. The extendable members are extendable on two opposite sides of the vessel. A length of ligation material, such as suture material, extends through the first extendable member, and is attached to a detachable element mounted to the distalmost end of the extendable member. The second extendable member includes a snare. The first extendable member includes curved portions which, when the member is extended distally, extend the detachable element into position for the snare so that the snare can grab the loop. Once ensnared, the detachable element is released from the first extendable member, which pulls the ligation material around the vessel. The ligation device does not require prior visualization or dissection of the area around the vessel.

Claims

1. A ligation device comprising:

a cannula having a proximal end, a distal end, and at least two lumens extending longitudinally from said proximal end to said distal end;

a first extendable member slidably received in said first cannula lumen, said first extendable member having a distal end and being movable in said first lumen from a retracted position in which said first extendable member distal end is proximal said cannula distal end, and an extended position in which said first extendable member distal end is distal of said cannula distal end, said first extendable member including a detachable element at said first extendable member distal end;

a second extendable member slidably received in said second cannula lumen, said second extendable member having a distal end and being movable in said second lumen from a retracted position in which said second extendable member distal end is proximal said cannula distal end, and an extended position in which said second extendable member distal end is distal of said cannula distal end, said second extendable member including a snare at said the distal end of the second extendable member distal end;

at least one of said the first extendable member and said second extendable member including a portion which extends laterally across said cannula when said at least one of said first extendable member and said second extendable member is in said extended position; and

a vessel detector located on the distal end of the cannula.

2. A ligation device according to claim 1, wherein said detachable element comprises a ball, and said snare comprises a lateral opening in a distal portion of second extendable member sized and positioned to receive and ensnare said ball in the lateral opening.

3. A ligation device according to claim 1, further comprising a length of ligation material extending from the second extendable member to the first extendable member and being secured to said detachable element.

4. A ligation device according to claim 1, further comprising a length of ligation material extending through said first extendable member and secured to said detachable element.

5. A ligation device according to claim 1, further comprising a Doppler wand in said cannula.

6. A ligation device according to claim 5, wherein said Doppler wand is removably mounted in said device.

7. A ligation device according to claim 5, wherein said Doppler wand is mounted in said device so as not to be removable.

8. A ligation device according to claim 5, wherein said Doppler wand, said first extendable member, and said second extendable member are coplanar.

9. A ligation device according to claim 5, wherein said Doppler wand has a distal end proximal of said cannula distal end.

10. A ligation device according to claim 5, wherein said Doppler wand has a distal end distal of said cannula distal end.

11. A ligation device according to claim 7, wherein said cannula comprises a second lumen, said Doppler wand being positioned in said cannula second lumen.

12. A ligation device according to claim 1, wherein said detachable element comprises a loop, and wherein said snare comprises a slot sized to receive portions of said loop therein.

13. A ligation device according to claim 1, wherein said first extendable member curved portions are formed of a superelastic material.

14. A ligation device according to claim 13, wherein said superelastic material comprises nitinol.

15. A ligation device according to claim 1, further comprising a handle attached to said cannula proximal end.

16. A ligation device according to claim 15, wherein said handle comprises:

a housing;

a first actuation member slidably mounted in said housing, said first actuation member attached to said first extendable member; and

a second actuation member slidably mounted in said housing, said second actuation member attached to said second extendable member.

17. A ligation device according to claim 16, wherein each of said first and second actuation members include first portions extending outside said housing which allow a practitioner to manipulate the first and second actuation members.

18. A ligation device according to claim 16, wherein said housing comprises two longitudinally extending slots, and each of said first and second actuation members include tabs extending through said slots to limit the range of motion of said first and second actuation members.

19. A ligation device according to claim 1, further comprising a loop, wherein the first extendable member comprises a slot at the distal end of said first extendable member, and said loop is releasably mounted in said slot.

20. A ligation device according to claim 1, further comprising:

a first block, a proximal portion of said first extendable member fixedly mounted to said first block; and

a second block, a proximal portion of said second extendable member fixedly mounted to said second block.

21. A ligation device according to claim 20, wherein said first and second blocks are connected together.

22. A ligation device according to claim 20, wherein said first and second blocks are both cylindrically shaped.

23. A ligation device according to claim 20, wherein each of said first and second blocks includes an interior chamber and a slot communicating said interior chamber with the exterior of said block.

24. A ligation device according to claim 23, wherein said first and second extendable members include proximal portions extending through said slots of said first and second blocks, respectively.

25. A ligation device according to claim 1, wherein both of said first and second extendable members include curved portions.

26. A ligation device according to claim 1, wherein said detachable element comprises an arrowhead-shaped member, and said snare comprises a lateral opening in a distal portion of said second extendable member sized and positioned to receive and ensnare said arrowhead-shaped member in the lateral opening.

27. A ligation device according to claim 26, wherein said first extendable member and said second extendable member both include exterior surfaces having electrical insulation thereon.

28. A ligation device according to claim 1, wherein said first extendable member and said second extendable member both include closed distal ends and laterally inwardly directed openings.

29. A ligation device according to claim 28, wherein said closed distal ends of said first and second extendable members are conically shaped.

30. A method of preparing an anatomical vessel for ligation, comprising:

providing a cannula including a first extended member, a second extended member, an ultrasonic vessel detector, and a distal end;

positioning the cannula adjacent to an anatomical vessel;

transmitting ultrasound signals toward the vessel with the ultrasonic vessel detector;

receiving ultrasound signals reflected by the vessel with the ultrasonic vessel detector;

positioning the first extended member on a first side of the vessel;

positioning the second extended member on a second side of the vessel opposite the first side; and

extending a length of ligation material between the first and second extended members on a side of the vessel opposite the cannula distal end.

31. A method of preparing an anatomical vessel for ligation, comprising the steps of:

positioning a cannula adjacent to said vessel, said cannula including a first extendable member, a second extendable member, a Doppler wand, and a distal end;

transmitting ultrasound signals toward said vessel with said Doppler wand;

receiving ultrasound signals reflected by said vessel with said Doppler wand;

extending said first extendable member on a first side of said vessel;

extending said second extendable member on a second side of said vessel opposite said first side; and

extending a length of ligation material between said first and second extendable members on a side of said vessel opposite said cannula distal end.

32. A method according to claim 31, wherein said first extendable member includes a detachable element to which said ligation material is attached, and further comprising grabbing said detachable element with portions of said second extendable member.

33. A method according to claim 32, further comprising the steps of:

retracting said second extendable member in a proximal direction; and

releasing said detachable element from said first extendable member.

34. A device useful for guiding a length of ligation material around an anatomical feature comprising:

a cannula including a hollow interior, a distal end, and a fenestration in the cannula proximal of the distal end;

a hollow arm positioned in the cannula at the fenestration, the hollow arm including a rotatable pivot by which the arm is mounted to the cannula, the arm being rotatable from a retracted orientation with the arm positioned inside the cannula and a deployed orientation with a portion of the arm rotated about the pivot and through the fenestration;

a pair of flexible and flat wire guides connected to the cannula and extending distally into the arm;

at least one wire connected to the arm and extending proximally;

wherein when the at least one wire is pulled proximally, the arm is rotated about the pivot into the deployed orientation.

35. A device in accordance with claim 34, wherein said at least one wire comprises:

a first pullwire connected to the arm on a first side of the arm and extending proximally;

a second pullwire connected to the arm on a second side of the arm opposite the first side of the arm and extending proximally; and

wherein when the second pullwire is pulled proximally, the arm is rotated about the pivot into the retracted orientation.

36. A device in accordance with claim 35, further comprising a yoke mounted in the cannula, the second pullwire passing around the yoke, the yoke acting as a bearing surface for the pullwire.

37. A device in accordance with claim 36, wherein the yoke comprises:

a pair of arms secured to the cannula; and

a curved middle portion extending between the yoke arms.

38. A device in accordance with claim 36, wherein the yoke is positioned distally of the arm pivot.

39. A device in accordance with claim 34, wherein the cannula further comprises a wire port proximal of the fenestration and on the same side of the cannula as the fenestration, the at least one wire extending through the wire port.

40. A device in accordance with claim 39, wherein the cannula further comprises a trough in the exterior of the cannula and extending between the wire port and the fenestration.

41. A device in accordance with claim 34, further comprising a guide tube mounted in the cannula, the wire guides including proximal ends secured to the guide tube, the at least one wire extending between the guide tube and the cannula.

42. A device in accordance with claim 34, wherein the wire guides have distal ends which are not secured to the arm.

43. A device in accordance with claim 34, wherein the arm further comprises a cutout portion, the wire guides extending through the cutout portion when the arm is in the deployed orientation.

44. A ligation device comprising:

a cannula having a proximal end, a distal end, and first and second cannula lumens extending longitudinally from the proximal end to the distal end;

a first extendable member slidably received in the first cannula lumen having a distal end and a detachable element at the first extendable member distal end;

a second extendable member which is slidably received in the second cannula lumen, which has a distal end, which is movable in the lumen from a retracted position in which said second extendable member distal end is proximal said cannula distal end, and an extended position in which said second extendable member distal end is distal of said cannula distal end, said second extendable member including a snare at said distal end of the second extendable member distal end; and

at least one of said the first extendable member and said second extendable member including a portion which extends laterally across said cannula when said at least one of said first extendable member and said second extendable member is in said extended position.

45. A ligation device for vessel occlusion, comprising:

a. a cannula having a proximal end, a distal end, at least one lumen extending longitudinally from the proximal end to the distal end;

b. a vessel detector at the distal end of the cannula;

c. a first extended member having a distal end and a detachable element at the distal end of the first extended member;

d. a second extended member having a distal end and a snare at the distal end of the second extended member; and

e. at least one of the first extended member and the second extended member having a portion which extends at least in part across the distal end of the cannula.

46. The ligation device of claim 45 wherein the vessel detector is an ultrasonic vessel detector.

47. The ligation device of claim 46, wherein the ultrasonic vessel detector is removably mounted in the device.

48. The ligation device of claim 46, wherein the ultrasonic vessel detector is mounted in the device so as not to be removable.

49. The ligation device of claim 46, wherein the ultrasonic vessel detector comprises a Doppler ultrasound detector.

50. The ligation device of claim 45, wherein a length of ligation material extends through at least one of the first extended member and the second extended member and is secured to the detachable element.

51. The ligation device of claim 45, wherein the detachable element is a loop.

52. The litigation device of claim 51 wherein the snare includes a slot sized to receive portions of the loop therein.

53. The ligation device of claim 45, wherein the portion which extends at least in part across the distal end of the cannula is formed of a superelastic material.

54. The ligation device of claim 53, wherein the superelastic material comprises nitinol.

55. The ligation device of claim 45, wherein the cannula has a handle attached to the proximal end of the cannula.

56. The ligation device of claim 55, wherein the handle comprises:

a housing;

a first actuation member which is slidably mounted in the housing and which is attached to the first extended member; and

a second actuation member which is slidably mounted in the housing, which is attached to the second extended member.

57. The ligation device of claim 56, wherein each of the first and second actuation members include projections which extend out of the housing to facilitate manipulation of the actuation members.

58. The ligation device of claim 45, further comprising:

a first block, a proximal portion of the first extended member fixedly mounted to the first block; and

a second block, a proximal portion of the second extended member fixedly mounted to the second block.

59. A ligation device for vessel occlusion according to claim 58, wherein the first and second blocks are connected together.

60. A ligation device for vessel occlusion according to claim 58, wherein the first and second blocks are both cylindrically shaped.

61. A ligation device for vessel occlusion according to claim 58, wherein each of the first and second blocks includes an interior chamber and a slot communicating the interior chamber with the exterior of the block.

62. A ligation device for vessel occlusion according to claim 45, wherein the snare comprises a lateral opening in a distal portion of the second extended member sized and positioned to receive and ensnare the detachable element in the lateral opening.

63. A ligation device for vessel occlusion according to claim 62, wherein the detachable element comprises an arrowhead.

64. A ligation device for vessel occlusion according to claim 62, wherein the detachable element comprises a ball.

65. A ligation device for vessel occlusion according to claim 45, wherein the first extended member and the second extended member both include closed distal ends and laterally inwardly directed openings.

66. A ligation device for vessel occlusion according to claim 65, wherein the closed distal ends of the first and second extended members are conically shaped.

67. A ligation device comprising:

a cannula having a proximal end, a distal end, and at least two lumens extending longitudinally from said proximal end to said distal end;

a first extendable means slidably received in said first cannula lumen, said first extendable means having a distal end and being movable in said first lumen from a retracted position in which said first extendable means distal end is proximal said cannula distal end, and an extended position in which said first extendable means distal end is distal of said cannula distal end, said first extendable means including a detachable element at said first extendable means distal end;

a second extendable means slidably received in said second cannula lumen, said second extendable means having a distal end and being movable in said second lumen from a retracted position in which said second extendable member distal end is proximal said cannula distal end, and an extended position in which said second extendable means distal end is distal of said cannula distal end, said second extendable means including a snare at said the distal end of the second extendable means distal end;

at least one of said the first extendable means and said second extendable means including a portion which extends laterally across said cannula when said at least one of said first extendable means and said second extendable means is in said extended position; and

a vessel detecting means located on the distal end of the cannula.