Surgical instruments for stabilizing a localized portion of a beating heart

• US 6,758,808 B2
• Filed: 01/24/2001
• Issued: 07/06/2004
• Est. Priority Date: 01/24/2001
• Status: Expired due to Term

• Current Assignee: Maquet Cardiovascular LLC (Getinge AB)
• Original Assignee: Cardiothoracic Systems, Inc. (Boston Scientific Corporation)
• Inventors: Reis, Eugene E., Ino, Harry, Wallin, Joshua K., Paul, David J., Cantu, Alfredo R., Green, Harry L., Taylor, Charles S.
• Primary Examiner(s): WEHNER, CARY ELLEN
• Application Number:
  US09/769,964
• Publication Number:
  US 20020099268A1
• Time in Patent Office: 1,259 Days
• Field of Search: 248/288.51, 403/56, 403/83, 403/84, 403/114, 600/206, 600/210, 600/229
• US Class Current: 600/229
• CPC Class Codes: A61B 17/0206 with antagonistic arms as supports for retractor elements
• CPC Class Codes: A61B 2017/0243 for immobilizing local areas of the heart, e.g. while it beats trocars attached to inner organs or inner body tissue A61B2017/3488
• CPC Class Codes: A61B 2017/306 holding by means of suction
• CPC Class Codes: A61G 13/12 Rests specially adapted therefor; Arrangements of patient-supporting surfaces rests for the surgeon A61B90/60; restraining devices A61F5/37

Abstract

Stabilization devices, systems and methods for stabilizing tissue to perform a surgical operation while the heart of the patient continues to beat. A stabilization system including a tissue contact member having a surface adapted to contact the tissue and temporarily maintain the tissue in a relatively immobilized state; and a maneuverable arm attached to the tissue contact member, which includes at least one articulating joint formed by a link having a male articulating surface composed of angled teeth and a female articulating surface having angled trenches adapted to receive the angled teeth.

Claims

1. A system for stabilizing tissue comprising:

a tissue contact member having a surface adapted to contact the tissue and temporarily maintain the tissue in a relatively immobilized state; and

a maneuverable arm attached to said tissue contact member, said maneuverable arm including an articulating joint formed by a link having a male articulating surface composed of angled teeth and a female articulating surface having angled trenches adapted to receive said angled teeth, wherein said articulating joint moves in one degree of freedom directed by said angled teeth sliding against said angled trenches.

2. The system of claim 1, wherein said maneuverable arm comprises a plurality of said articulating joints.

3. The system of claim 1, further comprising a rotational joint formed by a link having a male articulating surface and a link having a female articulating surface, said male and female articulating surfaces being positioned for relative rotation in a plane perpendicular to a longitudinal axis of said maneuverable arm.

4. The system of claim 3, wherein said maneuverable arm comprises at least two of said articulating joints, at least one of said articulating joints being positioned adjacent each side of said rotational joint.

5. The system of claim 4, wherein said rotational joint comprises a first rotational joint and said tissue contact member is attached to a distal end of said maneuverable arm, said maneuverable arm further comprising a second rotational joint distally positioned adjacent said at least one articulating joint positioned adjacent a distal side of said first rotational joint.

6. The system of claim 5, wherein said second rotational joint is formed by a component have a male articulating surface and a component having a female articulating surface, said male and female articulating surfaces being positioned for relative rotation in a plane perpendicular to a longitudinal axis of said maneuverable arm.

7. The system of claim 6, wherein one of said components is a link having an articulating surface at an end opposite to said rotational joint articulating surface which is composed of angled teeth or angled trenches for articulating with a link distally adjacent said component, and wherein the other of said components comprises a mount adapted to mount said system to a fixed object.

8. The system of claim 7, wherein said mount comprises a first mount portion integral with one of said male and female articulating surfaces of said second rotational joint, and a second mount portion attached to a proximal side of said first mount portion.

9. The system of claim 8, wherein said second mount portion is pivotally attached to said first mount portion, and is pivotable away from said first mount portion to position the mount over a fixed object, or release the mount from the fixed object.

10. The system of claim 8, wherein said second mount portion is pivotable toward said first mount portion to fix said mount on the fixed object.

11. The system of claim 10, wherein said mount further comprises a locking mechanism adapted to lock said second mount portion to said first mount portion in a closed position upon pivoting said second mount portion toward said first mount portion, said closed position being configured to lock said mount on said fixed object.

12. The system of claim 11, wherein said fixed object is a sternal retractor.

13. The system of claim 12, wherein said first and second mount portions each further comprise a rail grip adapted to engage one side of a rail on said sternal retractor.

14. The system of claim 11, wherein said locking mechanism comprises a living hinge formed in one of said first and second mount portions and a pin extending transversely on the other of said first and second mount portions, said pin being adapted to snap fit into said living hinge.

15. The system of claim 8, further comprising a cable passing internally through each of said articulating joints, rotational joints and mount, said cable being further attached to a tensioning mechanism proximally of said mount.

16. The system of claim 15, wherein said tensioning mechanism comprises a screw mechanism and a knob, said screw mechanism having a first threaded component having a first set of threads and a second threaded component having a second set of threads adapted to mate with said first set of threads, said first threaded component being fixed to said cable and said knob being adapted to torque said second threaded component with respect to said first threaded component.

17. The system of claim 16, wherein said second threaded component comprises a torque limiter.

18. The system of claim 17, wherein said torque limiter further comprises a unidirectional slip clutch engaging said knob, wherein said knob positively engages said torque member for unthreading said second set of threads from said first set of threads, and positively engages said torque limiter for threading said second set of threads on said first set of threads until a predetermined amount of torque is required to further tension said cable.

19. The system of claim 18, wherein, upon reaching said predetermined amount of torque during threading, said torque limiter slips with respect to said knob.

20. The system of claim 18, wherein said slip clutch comprises at least one fin extending from an outer surface of said second threaded member at an angle to a line normal to a tangent line passing through the location from which said fin extends, each said fin adapted to engage a groove formed in an inner surface of said knob.

21. The system of claim 15, wherein said cable comprises a stop member fixed to a distal end of said cable, wherein, upon applying tension to said cable with said tensioning member, said stop member and said tensioning member apply a compressive force to said articulating joints and rotational joints, thereby locking every joint into an assumed orientation.

22. The system of claim 15, wherein said cable comprises a stop member fixed to a distal end of said cable and adapted to apply a compressive force to a distal end of said maneuverable arm when said cable is placed under tension.

23. The system of claim 22, further comprising a coupling mechanism linking said stop member to said tissue contact member, said coupling member adapted to lock said tissue contact member in an assumed position when said cable is placed under tension.

24. The system of claim 23, wherein said coupling mechanism includes a ball member fixed to said tissue contact member and a socket member rotatably joined with said stop member and adapted to receive said ball member to form a ball joint.

25. The system of claim 24, wherein said coupling mechanism further comprises a coupling link having arms adapted to lock with said socket member, and an upper abutment surface adapted to abut said stop member.

26. The system of claim 25, wherein said coupling link is a first coupling link and said coupling mechanism further comprises a second coupling link having driving surfaces adapted to contact a distal most link of a distal most articulating joint of said maneuverable arm, said second coupling link further including a lower abutment surface adapted to abut an upper portion of said ball member, wherein, upon tensioning of said cable, said stop member draws said first coupling link and said socket member in a proximal direction, whereby said socket member compresses said ball member against said lower abutment surface.

27. The system of claim 23, wherein said socket member includes a slot through a side wall thereof, said slot terminating in an enlarged opening dimensioned to permit said ball member to pass therethrough.

28. The system of claim 15, further comprising a flexible sleeve positioned over said articulating joints and said rotational joints.

29. The system of claim 28, wherein said flexible sleeve comprises an elastomer.

30. The system of claim 28, wherein said flexible sleeve comprises silicone or dip molded PVC.

31. The system of claim 28, wherein said flexible sleeve comprises a material having a four or six way stretch.

32. The system of claim 31, wherein said flexible sleeve comprises an elastomeric fabric of fibers containing polyurethane.

33. The system of claim 4, further comprising a plurality of said articulating joints on each side of said rotational joint.

34. The system of claim 33, wherein each said articulating joint is rotatable in a plane perpendicular to said plane of rotation of said rotational joint.

35. The system of claim 1, wherein said maneuverable arm is rotationally attached, at a distal end thereof to said tissue contact member.

36. The system of claim 35, wherein said tissue contact member is rotatable in three degrees of freedom with respect to said distal end of said maneuverable arm.

37. The system of claim 36, further comprising a locking mechanism for locking said tissue contact member with respect to said maneuverable arm in virtually any position to which said tissue contact member may be maneuvered when in an unlocked state.

38. The system of claim 37, wherein said locking mechanism simultaneously locks said maneuverable arm in virtually any position to which said maneuverable arm may be maneuvered when in an unlocked state.

39. The system of claim 1, wherein said tissue contact member comprises a pair of feet extending substantially parallel to one another and adapted to straddle a target site on the tissue.

40. The system of claim 39, wherein said pair of feet extend from a common base portion, said common base portion being angled away from a plane in which said feet substantially extend.

41. The system of claim 39, further comprising a ball member linked to said common base portion with a post, said ball member being adapted to form a ball joint at said distal end of said maneuverable arm.

42. The system of claim 39, wherein each of said feet has a frictional surface adapted to contact the tissue.

43. The system of claim 39, wherein each said foot comprises a thin compliant seal extending around a perimeter of a bottom surface of the respective foot.

44. The system of claim 43, wherein each said compliant seal has a tapering thickness, wherein said thickness is greater adjacent said bottom surface of said foot and tapers thinner in a direction extending away from said bottom surface.

45. The system of claim 43, wherein each said foot has a proximal end and a distal end and each said seal has a tapering length, said length measuring a distance that said seal extends away from said bottom surface of the respective foot.

46. The system of claim 45, wherein said length of each said seal is greater near said proximal end of said foot than near said distal end of said foot.

47. The system of claim 43, wherein each said seal comprises compliant thermoplastic urethane.

48. The system of claim 39, wherein said tissue contact member further comprises a manifold base interconnected with said pair of feet, said manifold base being substantially hollow and having a pair of fittings extending therefrom, said feet being mounted on said fittings.

49. The system of claim 48, wherein each fitting has an opening therethrough which fluidly connects said respective foot with said manifold base.

50. The system of claim 49, wherein each said foot has a hollow interior defining a vacuum chamber, each said vacuum chamber having a first opening adapted to engage at least a portion of said tissue and a second opening fluidly coupled with said opening through said respective fitting.

51. The system of claim 50, wherein said vacuum chamber further comprises channels formed on an upper interior surface of each said foot.

52. The system of claim 51, wherein said channels are aligned substantially parallel to one another and extend in a direction said proximal end to said distal end of said foot.

53. The system of claim 52, further comprising a deep channel near said distal end of each said foot, said deep channel fluidly communicating with said opening through said fitting, respectively.

54. The system of claim 52, wherein each said foot comprises a thin compliant seal extending around a perimeter of a bottom surface of the respective foot and integrally molded in a pair of said channels nearest said perimeter.

55. The system of claim 54, wherein each said seal is provided with one or more grooves to further enhance the flexibility of said seal.

56. The system of claim 52, further comprising a porous filter covering at least a portion of said channel.

57. The system of claim 56, wherein each said foot comprises a thin compliant seal extending around a perimeter of a bottom surface of the respective foot and said porous filter is integrally molded with said thin compliant seal, respectively.

58. The system of claim 49, wherein each said fitting has an enlarged lip and said feet are adapted to snap fit over said enlarged lips, thereby substantially sealing said feet with said fittings without the need for an O-ring or other additional sealing member therebetween.

59. The system of claim 48, wherein each said foot is independently rotatable about said respective fitting.

60. The system of claim 48, wherein each said foot has an asymmetrical transverse cross-section, a portion of said cross-section further from the other of said feet being thicker than a portion nearer to the other of said feet, to provide more available space between said feet.

61. The system of claim 48, further comprising a third fitting extending from said manifold base, said third fitting an opening therethrough which is adapted to connect said manifold base with a vacuum source.

62. The system of claim 61, further comprising a rotatable fitting adapted to snap fit over said third fitting, said rotatable fitting further comprising an inlet tube configured for connecting with a vacuum line, whereby the vacuum line is rotatably mounted to said manifold base.

63. The system of claim 39, wherein said pair of feet extend from a common base portion, and a ball member is linked to said common base portion with a post, said ball member being adapted to form a ball joint at said distal end of said maneuverable arm.

64. The system of claim 63, wherein each of said pair of feet comprises an extremely low profile structural member and a thin compliant seal extending from a bottom perimeter of said structural member.

65. The system of claim 64, wherein each said thin compliant seal comprises a vacuum inlet adapted to connect with a vacuum line.

66. The system of claim 64, wherein said extremely low profile structural member is formed from a sheet of stainless steel.

67. A maneuverable arm adapted to position a surgical tool mounted at a distal end thereof in a variety of orientations, said maneuverable arm comprising:

at least one articulating joint formed by a link having a male articulating surface composed of angled teeth and a female articulating surface having angled trenches adapted to receive said angled teeth, wherein said articulating joint moves in one degree of freedom directed by said angled teeth sliding against said angled trenches.

68. The maneuverable arm of claim 67, wherein said trenches have an aspect ratio of at least about 1:

2.

69. The maneuverable arm of claim 68, wherein said aspect ration of said trenches is about 1:

1.

70. The maneuverable arm of claim 67, wherein said teeth have an aspect ratio of at least about 1:

2.

71. The maneuverable arm of claim 70, wherein said aspect ration of said teeth is about 1:

1.

72. The maneuverable arm of claim 67, wherein said at least one articulating joint comprises a plurality of said articulating joints.

73. The maneuverable arm of claim 72, further comprising a cable extending internally through each of said articulating joints, said cable having a stop member at a distal end thereof, said maneuverable arm further comprising an anchor fixed to a proximal end of said cable, wherein each of said articulating joints are sequentially held together in approximation by said cable, stop member and anchor.

74. The maneuverable arm of claim 73, further comprising a mount adjacent a proximal most of said articulating joints, said cable passing through said mount and said mount being approximated with said articulating joints by said anchor.

75. The maneuverable arm of claim 74, further comprising a rotational joint formed by a link having a male articulating surface and a link having a female articulating surface, said male and female articulating surfaces being positioned for relative rotation in a plane perpendicular to a longitudinal axis of said maneuverable arm.

76. The maneuverable arm of claim 75, wherein said rotational joint is positioned between a pair of said articulating joints.

77. The maneuverable arm of claim 76, wherein said link of said rotational joint having a male articulating surface has an articulating surface at an opposite end thereof which comprises trenches or teeth for articulating with said adjacent articulating joint, and wherein said link of said rotational joint having a female articulating surface has an articulating surface at an opposite end thereof which comprises trenches or teeth for articulating with said adjacent articulating joint.

78. The maneuverable arm of claim 75, wherein said rotational joint is positioned between a proximal most one of said articulating links and said mount, and wherein said male or female articulating surface of said rotational joint is integral with said mount.

79. The maneuverable arm of claim 78, wherein said male articulating surface of said rotational joint is integral with said mount.

80. The maneuverable arm of claim 83, wherein said rotational joint is positioned as an end joint of said maneuverable arm.

81. The maneuverable arm of claim 74, wherein said mount comprises a first mount portion adjacent said proximal most of said articulating joints, and a second mount portion attached to a proximal side of said first mount portion.

82. The maneuverable arm of claim 81, wherein said second mount portion is pivotally attached to said first mount portion, and is pivotable away from said first mount portion to position the mount over a fixed object, or release the mount from the fixed object.

83. The maneuverable arm of claim 81, wherein said second mount portion is pivotable toward said first mount positioned to fix said mount on the fixed object.

84. The maneuverable arm of claim 83, wherein said mount further comprises a locking mechanism adapted to lock said second mount portion to said first mount portion in a closed position upon pivoting said second mount portion toward said first mount portion, said closed position being configured to lock said mount on said fixed object.

85. The maneuverable arm of claim 84, wherein said fixed object is a sternal retractor.

86. The maneuverable arm of claim 85, wherein said first and second mount portions each further comprise a rail grip adapted to engage one side of a rail on said sternal retractor.

87. The maneuverable arm of claim 84, wherein said locking mechanism comprises a living hinge formed in one of said first and second mount portions and a pin extending transversely on the other of said first and second mount portions, said pin being adapted to snap fit into said living hinge.

88. The maneuverable arm of claim 74, further comprising a tensioning mechanism connected proximally of said mount, wherein said tensioning mechanism comprises a screw mechanism and a knob, said screw mechanism having a first threaded component having a first set of threads and a second threaded component having a second set of threads adapted to mate with said first set of threads, said first threaded component being fixed to said cable and said knob being adapted to torque said second threaded component with respect to said first threaded component.

89. The maneuverable arm of claim 88, wherein said second threaded component comprises a torque limiter.

90. The maneuverable arm of claim 89, wherein said torque limiter further comprises a unidirectional slip clutch engaging said knob, wherein said knob positively engages said torque member for unthreading said second set of threads from said first set of threads, and positively engages said torque limiter for threading said second set of threads on said first set of threads until a predetermined amount of torque is required to further tension said cable.

91. The maneuverable arm of claim 90, wherein, upon reaching said predetermined amount of torque during threading, said torque limiter slips with respect to said knob.

92. The maneuverable arm of claim 90, wherein said slip clutch comprises at least one fin extending from an outer surface of said second threaded member at an angle to a line normal to a tangent line passing through the location from which said fin extends, each said fin adapted to engage a groove formed in an inner surface of said knob.

93. The maneuverable arm of claim 88, wherein, upon applying tension to said cable with said tensioning member, said stop member and said tensioning member apply a compressive force to said maneuverable arm, thereby locking every joint into an assumed orientation.

94. The maneuverable arm of claim 73, further comprising a rotational joint formed by a link having a male articulating surface and a link having a female articulating surface, said male and female articulating surfaces being positioned for relative rotation in a plane perpendicular to a longitudinal is of said maneuverable arm.

95. The maneuverable arm of claim 94, wherein said rotational joint is positioned between a pair of said articulating joints.

96. The maneuverable arm of claim 95, wherein said link of said rotational joint having a male articulating surface has an articulating surface at an opposite end thereof which comprises trenches or teeth for articulating with said adjacent articulating joint, and wherein said link of said rotational joint having a female articulating surface has an articulating surface at an opposite end thereof which comprises trenches or teeth for articulating with said adjacent articulating joint.

97. The maneuverable arm of claim 94, wherein said rotational joint is positioned as an end of said maneuverable arm.

98. A tensioning mechanism for applying tension to a cable passing through a maneuverable surgical instrument having at least one articulating joint through which the cable passes, said tensioning mechanism comprising a screw mechanism and a knob, said screw mechanism having a first threaded component having a first set of threads and a second threaded component having a second set of threads adapted to mate with said first set of threads, said first threaded component being fixed to said cable and said second threaded component comprising a torque limiter, said knob being adapted to torque said second threaded component with respect to said first threaded component.

99. The mechanism of claim 98, wherein said torque limiter further comprises a unidirectional slip clutch engaging said knob, wherein said knob positively engages said torque member for unthreading said second set of threads from said first set of threads, and positively engages said torque limiter for threading said second set of threads on said first set of threads until a predetermined amount of torque is required to further tension said cable.

100. The mechanism of claim 99, wherein, upon reaching said predetermined amount of torque during threading, said torque limiter slips with respect to said knob.

101. The mechanism of claim 99, wherein said slip clutch comprises at least one fin extending from an outer surface of said second threaded member at an angle to a line normal to a tangent line passing through the location from which said fin extends, each said fin adapted to engage a groove formed in an inner surface of said knob.

102. The mechanism of claim 98, wherein, upon torquing said second threaded component with respect to said first threaded component, said cable is drawn under tension.