Methods and tools for accessing an anatomic space

• US 6,786,898 B2
• Filed: 01/15/2003
• Issued: 09/07/2004
• Est. Priority Date: 01/15/2003
• Status: Expired due to Term

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Guenst, Gary W.
• Primary Examiner(s): Flanagan, Beverly M.
• Application Number:
  US10/342,960
• Publication Number:
  US 20040138526A1
• Time in Patent Office: 601 Days
• Field of Search: 604/115, 604/117, 604/93.01, 604/164.4, 604/506, 604/500, 604/176, 604/902, 604/264, 604/96.01, 604/528, 604/908, 606/205, 606/167, 606/108, 600/509, 600/114, 600/115, 600/201, 600/37
• US Class Current: 606/1
• 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 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/306 holding by means of suction
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation

Abstract

A tubular access sleeve and suction tool for accessing an anatomic surface or anatomic space and particularly the pericardium to access pericardial space and the epicardial surface of the heart in a minimally invasive manner are disclosed. A suction tool trunk extending through a suction tool lumen of the sleeve is coupled to suction pads at the ends elongated support arms. The suction pads can be retracted into a sleeve working lumen during advancement of the access sleeve through a passage and deployed from the tubular access sleeve lumen and disposed against the an outer tissue layer. Suction can be applied through suction tool lumens to suction ports of the suction pads that fix to the outer tissue layer so as to tension the outer tissue layer and/or pull the outer tissue layer away from an inner tissue layer so that the anatomic space can be accessed by instruments introduced through the working lumen to penetrate the outer tissue layer.

Claims

1. A method of accessing an anatomic space within the body between an inner tissue layer and an outer tissue layer having an outer tissue layer outer surface comprising:

providing a tubular access sleeve having a sleeve body extending between a sleeve body proximal end and a sleeve body distal end and enclosing a working lumen extending between a working lumen proximal end opening and a working lumen distal end opening, and a suction tool lumen extending between a suction tool lumen proximal end opening and a suction tool lumen distal end opening proximal to the sleeve body distal end;

disposing a suction tool through the suction tool lumen with a suction tool proximal end disposed proximal to the sleeve body proximal end and with first and second suction pads housed within the working lumen distal to the suction tool lumen distal end;

advancing the access sleeve through the body to dispose the sleeve body distal end at the outer tissue layer;

advancing the suction tool distally to extend the first and second suction pads distally from the working lumen and against the outer tissue layer surface; and

applying suction through the suction pads to grasp the outer tissue layer surface, whereby the anatomic space may be accessed through the working lumen.

2. The method of claim 1, further comprising:

advancing a cutting instrument through the working lumen and through the outer tissue layer surface; and

cutting through the outer tissue layer while suction is applied through the suction pads to grasp the outer tissue layer surface.

3. The method of claim 2, wherein:

the first and second suction pads are mounted to respective first and second support arms branching from a suction tool trunk;

the disposing step further comprises disposing at least a portion of the first and second support arms within the suction tool lumen;

the step of advancing the suction tool distally further comprises advancing the first and second support arms from the suction tool lumen.

4. The method of claim 3, wherein at least one preformed bend is formed in the first and second support arms between the suction tool trunk and the first and second suction pads, respectively, the preformed bends extending the first and second support arms apart when the first and second support arms are advanced from the suction tool lumen.

5. The method of claim 1, further comprising:

advancing a cutting instrument through the working lumen and through the outer tissue layer surface; and

cutting through the outer tissue layer to form an incision while suction is applied through the suction pads to grasp the outer tissue layer surface; and

separating the first and second suction pads apart to tension the outer tissue layer and widen the incision, whereby access to the anatomic space through the incision upon removal of the cutting instrument from the working lumen is facilitated.

6. The method of claim 4, wherein:

the first and second suction pads are mounted to respective first and second support arms branching from a suction tool trunk;

the disposing step further comprises disposing at least a portion of the first and second support arms within the suction tool lumen;

the step of advancing the suction tool distally further comprises advancing the first and second support arms a first distance from the suction tool lumen sufficiently to extend the first and second suction pads from the distal section of the working lumen to contact the outer tissue layer outer surface; and

the separating step further comprises advancing the first and second support arms from the suction tool lumen a second distance exceeding the first distance.

7. The method of claim 1, wherein:

the first and second suction pads are mounted to respective first and second support arms branching from a suction tool trunk;

the disposing step further comprises disposing at least a portion of the first and second support arms within the suction tool lumen;

the step of advancing the suction tool distally further comprises advancing the first and second support arms from the suction tool lumen.

8. A system for accessing an anatomic space within the body between an inner tissue layer and an outer tissue layer having an outer tissue layer outer surface comprising:

a tubular access sleeve having a sleeve body extending between a sleeve body proximal end and a sleeve body distal end and enclosing a working lumen extending between a working lumen proximal end opening and a working lumen distal end opening and a suction tool lumen extending between a suction tool lumen proximal end opening and a suction tool lumen distal end opening proximal to the sleeve body distal end; and

a suction tool comprising a suction tool trunk extending through the suction tool lumen between a trunk proximal end and a trunk distal end, the trunk proximal end disposed proximal to the sleeve body proximal end, first and second support arms extending distally from the trunk distal end to respective first and second support arm distal ends, and first and second suction pads, respectively, coupled to the respective first and second support arm distal ends, the suction tool further comprising suction lumens extending from the first and second suction pads through the first and second support arms and through the suction tool trunk to the trunk proximal end,

wherein the first and second suction pads are housed within the working lumen distal to the suction tool lumen distal end by proximal retraction of the suction tool trunk and at least proximal portions of the first and second support arms into the suction tool lumen and are deployable distally from the working lumen upon distal advancement of suction tool trunk within the suction tool lumen and at least distal portions of the first and second support arms from the working lumen.

9. The system of claim 8, further comprising a suction fitting at the trunk proximal end communicating with the suction tool lumen that can be coupled to an available surgical operating room vacuum source.

10. The system of claim 9, wherein each of the first and second support arms comprise a distal forearm extending from a suction pad to a flexible elbow and a proximal upper arm extending from the flexible elbow to a flexible shoulder joint at the distal end of the suction tool trunk.

11. The system of claim 10, wherein each of the first and second support arms is formed of a flexible tube that has preformed bends at the flexible elbow and flexible shoulder joint that, when unrestrained, dispose the suction pads apart from one another a distance so that the suction pads can cooperatively grasp the outer tissue layer at separated apart locations so that the outer tissue layer between the suction pads can be operatively accessed through the working lumen.

12. The system of claim 11, wherein the bends in each preformed tube can be straightened as the first and second support arms are drawn into the suction tool lumen.

13. The system of claim 9, wherein each of the first and second support arms comprise a distal forearm extending from a flexible wrist at the suction pad to a flexible elbow and a proximal upper arm extending from the flexible elbow to a flexible shoulder joint at the distal end of the suction tool trunk.

14. The system of claim 13, wherein each of the first and second support arms is formed of a flexible tube that has preformed bends at the flexible wrist, flexible elbow and flexible shoulder joint that, when unrestrained, dispose the suction pads apart from one another a distance so that the suction pads can cooperatively grasp the outer tissue layer at separated apart locations so that the outer tissue layer between the suction pads can be operatively accessed through the working lumen.

15. The system of claim 14, wherein the bends in each preformed tube can be straightened as the first and second support arms are drawn into the suction tool lumen.

16. The system of claim 8, wherein each of the first and second support arms comprise a distal forearm extending from a suction pad to a flexible elbow and a proximal upper arm extending from the flexible elbow to a flexible shoulder joint at the distal end of the suction tool trunk.

17. The system of claim 16, wherein each of the first and second support arms is formed of a flexible tube that has preformed bends at the flexible elbow and flexible shoulder joint that, when unrestrained, dispose the suction pads apart from one another a distance so that the suction pads can cooperatively grasp the outer tissue layer at separated apart locations so that the outer tissue layer between the suction pads can be operatively accessed through the working lumen.

18. The system of claim 17, wherein the bends in each preformed tube can be straightened as the first and second support arms are drawn into the suction tool lumen.

19. The system of claim 8, wherein each of the first and second support arms comprise a distal forearm extending from a flexible wrist at the suction pad to a flexible elbow and a proximal upper arm extending from the flexible elbow to a flexible shoulder joint at the distal end of the suction tool trunk.

20. The system of claim 19, wherein each of the first and second support arms is formed of a flexible tube that has preformed bends at the flexible wrist, flexible elbow and flexible shoulder joint that, when unrestrained, dispose the suction pads apart from one another a distance so that the suction pads can cooperatively grasp the outer tissue layer at separated apart locations so that the outer tissue layer between the suction pads can be operatively accessed through the working lumen.

21. The system of claim 20, wherein the bends in each preformed tube can be straightened as the first and second support arms are drawn into the suction tool lumen.

22. A system for accessing an anatomic space within the body between an inner tissue layer and an outer tissue layer having an outer tissue layer outer surface comprising:

a tubular access sleeve having a sleeve body extending between a sleeve body proximal end and a sleeve body distal end and enclosing a working lumen extending between a working lumen proximal end opening and a working lumen distal end opening and a suction tool lumen extending between a suction tool lumen proximal end opening and a suction tool lumen distal end opening proximal to the sleeve body distal end; and

a suction tool comprising a suction tool trunk extending through the suction tool lumen between a trunk proximal end and a trunk distal end, the trunk proximal end disposed proximal to the sleeve body proximal end, first and second support arms extending distally from the trunk distal end to respective first and second support arm distal ends, and first and second suction pads, respectively, coupled to the respective first and second support arm distal ends, the suction tool further comprising suction lumens extending from the first and second suction pads through the first and second support arms and through the suction tool trunk to the trunk proximal end, wherein the first and second support arms further comprise;

means for proximally retracting the first and second suction pads into the working lumen to enable advancement and withdrawal of the tubular access sleeve through a body passage; and

means for deploying the first and second suction pads distally from the working lumen.

23. The system of claim 22, further comprising a suction fitting at the trunk proximal end communicating with the suction tool lumen that can be coupled to an available surgical operating room vacuum source.

24. The system of claim 23, wherein each of the first and second support arms comprise a distal forearm extending from a suction pad to a flexible elbow and a proximal upper arm extending from the flexible elbow to a flexible shoulder joint at the distal end of the suction tool trunk.

25. The system of claim 24, wherein each of the first and second support arms is formed of a flexible tube that has preformed bends at the flexible elbow and flexible shoulder joint that, when unrestrained, dispose the suction pads apart from one another a distance so that the suction pads can cooperatively grasp the outer tissue layer at separated apart locations so that the outer tissue layer between the suction pads can be operatively accessed through the working lumen.

26. The system of claim 25, wherein the bends in each preformed tube can be straightened as the first and second support arms are drawn into the suction tool lumen.

27. The system of claim 22, wherein each of the first and second support arms comprise a distal forearm extending from a flexible wrist at the suction pad to a flexible elbow and a proximal upper arm extending from the flexible elbow to a flexible shoulder joint at the distal end of the suction tool trunk.

28. The system of claim 27, wherein each of the first and second support arms is formed of a flexible tube that has preformed bends at the flexible wrist, flexible elbow and flexible shoulder joint that, when unrestrained, dispose the suction pads apart from one another a distance so that the suction pads can cooperatively grasp the outer tissue layer at separated apart locations so that the outer tissue layer between the suction pads can be operatively accessed through the working lumen.

29. The system of claim 28, wherein the bends in each preformed tube can be straightened as the first and second support arms are drawn into the suction tool lumen.

30. The system of claim 22, wherein each of the first and second support arms comprise a distal forearm extending from a suction pad to a flexible elbow and a proximal upper arm extending from the flexible elbow to a flexible shoulder joint at the distal end of the suction tool trunk.

31. The system of claim 30, wherein each of the first and second support arms is formed of a flexible tube that has preformed bends at the flexible elbow and flexible shoulder joint that, when unrestrained, dispose the suction pads apart from one another a distance so that the suction pads can cooperatively grasp the outer tissue layer at separated apart locations so that the outer tissue layer between the suction pads can be operatively accessed through the working lumen.

32. The system of claim 31, wherein the bends in each preformed tube can be straightened as the first and second support arms are drawn into the suction tool lumen.

33. The system of claim 22, wherein each of the first and second support arms comprise a distal forearm extending from a flexible wrist at the suction pad to a flexible elbow and a proximal upper arm extending from the flexible elbow to a flexible shoulder joint at the distal end of the suction tool trunk.

34. The system of claim 33, wherein each of the first and second support arms is formed of a flexible tube that has preformed bends at the flexible wrist, flexible elbow and flexible shoulder joint that, when unrestrained, dispose the suction pads apart from one another a distance so that the suction pads can cooperatively grasp the outer tissue layer at separated apart locations so that the outer tissue layer between the suction pads can be operatively accessed through the working lumen.

35. The system of claim 34, wherein the bends in each preformed tube can be straightened as the first and second support arms are drawn into the suction tool lumen.