Endoscopic subxiphoid surgical procedures

• US 7,264,587 B2
• Filed: 01/17/2003
• Issued: 09/04/2007
• Est. Priority Date: 08/10/1999
• Status: Expired due to Fees

• Current Assignee: Maquet Cardiovascular LLC (Getinge AB)
• Original Assignee: Origin Medsystems Inc. (Boston Scientific Corporation)
• Inventors: Chin, Albert K
• Primary Examiner(s): Marmor, II; Charles A.
• Assistant Examiner(s): HOPKINS, CHRISTINE D
• Application Number:
  US10/346,663
• Publication Number:
  US 20040111101A1
• Time in Patent Office: 1,691 Days
• Field of Search: 600/37, 600 16- 18, 600/508
• US Class Current: 600/37
• CPC Class Codes: A61B 17/00008 Vein tendon strippers tube strippers A61M1/83
• CPC Class Codes: A61B 17/3403 Needle locating or guiding means guides for suture needles A61B17/0482; guiding or tracking by nuclear magnetic resonance G01R33/285
• 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 17/3421 Cannulas
• CPC Class Codes: A61B 17/3478 Endoscopic needles, e.g. for infusion biopsy needles A61B10/0233; catheters with injection needles A61M25/0067
• 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 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/061 hollow or tubular suture extending inside a hollow needle A61B2017/06052; hollow sutures A61B2017/06185
• CPC Class Codes: A61B 2017/22077 with a part piercing the tissue A61B2017/22044 takes precedence
• CPC Class Codes: A61B 2017/306 holding by means of suction
• CPC Class Codes: A61B 2017/320044 Blunt dissectors blunt suture needles A61B2017/06085
• CPC Class Codes: A61B 2017/320069 for ablating tissue
• CPC Class Codes: A61B 2017/32007 with suction or vacuum means
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments catheters A61B2017/22072
• CPC Class Codes: A61B 2017/3488 Fixation to inner organ or inner body tissue
• CPC Class Codes: A61B 2018/00291 using suction
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/00982 combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
• CPC Class Codes: A61B 2090/036 abutting on tissue or skin
• CPC Class Codes: A61B 2090/062 : penetration depth
• CPC Class Codes: A61B 90/11 : with guides for needles or instruments, e.g. arcuate slides or ball joints
• CPC Class Codes: A61B 90/39 : Markers, e.g. radio-opaque or breast lesions markers
• CPC Class Codes: A61N 1/0587 : Epicardial electrode systems; Endocardial electrodes piercing the pericardium
• CPC Class Codes: A61N 2001/0578 : having means for removal or extraction

Abstract

Endoscopic subxiphoid surgical procedures and instruments facilitate translumination of tissue through the pericardium, and promote encircling an intrapericardial region with one or more tissue-ablating probes for ablating cardiac tissue substantially encircling the left and right pulmonary veins as a treatment for chronic atrial fibrillation. Such endoscopic subxiphoid surgical procedures and instruments also facilitate placement of epicardial tacks about the annulus of the mitral valve for supporting a tensioned suture or band that decreases the size of the mitral annulus to repair a regurgitant valve. Suction-oriented instruments facilitate temporary attachment to an organ to establish precise positioning on the organ during a surgical procedure.

Claims

1. A surgical procedure comprising:

forming an incision;

advancing an endoscopic cannula through the incision toward a target location on a patient'"'"'s pericardium;

introducing a pericardium-penetrating instrument through the endoscopic cannula into contact with the pericardium at the target location;

forming an aperture through the pericardium at the target site to expose epicardial tissue;

introducing a tacking instrument through the endoscopic cannula through the aperture in the pericardium for installing a plural number of tacks at selected locations in the epicardial tissue including one epicardial tack at a region of the mitral annulus below the circumflex coronary artery, and another epicardial tack at a region of the mitral annulus below the coronary sinus; and

installing an element in contact with at least a pair of the plural number of tacks to exert tension therebetween.

3. The surgical procedure according to claim 1 including:

installing an additional number of epicardial tacks intermediate said one and another tacks; and

installing elements in tension between at least pairs of the number of installed epicardial tacks.

2. A surgical procedure comprising:

forming an incision;

advancing an endoscopic cannula through the incision toward a target location on a patient'"'"'s pericardium;

introducing a pericardium-penetrating instrument through the endoscopic cannula into contact with the pericardium at the target location;

forming an aperture through the pericardium at the target site to expose epicardial tissue;

introducing a tacking instrument through the endoscopic cannula through the aperture in the pericardium for installing a plural number of tacks at selected locations in the epicardial tissue;

installing an element in contact with at least a pair of the plural number of tacks to exert tension therebetween including;

assembling a suture with a pair of loops formed with slip knots having trailing suture ends at spaced locations along the length of the suture;

positioning one of the pair of loops of the suture about one of the plural number of installed epicardial tacks;

positioning another of the pair of loops of the suture about another of the plural number of installed epicardial tacks;

advancing an elongated hollow tube along a trailing suture end from a slip knot for engagement thereof with a distal end of the tube; and

pulling on the trailing suture end relative to the tube to selectively decrease a suture loop about an installed epicardial tack for tensioning the trailing suture ends to tension the suture between the pair of loops disposed about the installed epicardial tacks.