Method for subxiphoid endoscopic access

• US 7,398,781 B1
• Filed: 08/09/2000
• Issued: 07/15/2008
• Est. Priority Date: 08/10/1999
• Status: Expired due to Fees

• Current Assignee: Maquet Cardiovascular LLC (Getinge AB)
• Original Assignee: Maquet Cardiovascular LLC (Getinge AB)
• Inventors: Chin, Albert K.
• Primary Examiner(s): Matthews; William H.
• Application Number:
  US09/635,345
• Time in Patent Office: 2,897 Days
• Field of Search: 128/898, 600/121, 600/124
• US Class Current: 128/898
• CPC Class Codes: A61B 1/00154 using guiding arrangements for insertion
• CPC Class Codes: A61B 17/00008 Vein tendon strippers tube strippers A61M1/83
• CPC Class Codes: A61B 17/06109 Big needles, either gripped by hand or connectable to a handle
• 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 17/3468 for implanting or removing devices, e.g. prostheses, implants, seeds, wires devices for implanting seeds A61M37/0069
• 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 2017/3445 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: A61F 2/2481 : Devices outside the heart wall, e.g. bags, strips or bands
• CPC Class Codes: A61F 2002/2484 : Delivery devices therefor
• 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

Apparatus and method for performing surgical procedures within the mediastinum or within the pericardium include an endoscopic cannula that is introduced into the mediastinum and optionally into the pericardium via a subxiphoid incision. A cavity may be initially dilated for advancing the endoscopic cannula using a dilating tool having an inner cannula and an outer expansible sheath that is expansible to exert a laterally expansive force against the surrounding tissue. Surgical instruments such as a pericardial entry device are inserted into a lumen of the endoscopic cannula to grasp a flap of the pericardium, and a cutting tool is extended to cut the flap to create a small opening through which other surgical tools may be introduced. The endoscopic cannula can then be advanced inside the pericardium to access all regions of the heart by sweeping the endoscopic cannula around the heart. Other surgical instruments may be inserted through the opening to perform surgical procedures within the pericardium.

Claims

1. A method of performing a cardiac procedure with a rigid cannula and a laterally expandable sheath, comprising the steps of:

(a) incising skin overlying an entry point for the cardiac procedure;

(b) inserting the rigid cannula disposed within the expandable sheath into the incision;

(c) advancing the rigid cannula with the expandable sheath disposed thereon through tissue under endoscopic visualization to form a passage of dissected tissue between the incision and the pericardium; and

(d) laterally expanding the sheath within the passage responsive to withdrawing the rigid cannula through the expandable sheath in a direction toward a proximal end thereof for dilating tissue along the passage to form a working cavity in dilated tissue along the passage.

2. The method of claim 1 in which the rigid cannula has a selected diameter and includes a distal tip of greater than the selected diameter, and wherein dilating the working cavity further comprises:

laterally expanding the sheath responsive to the distal tip withdrawing with the rigid cannula through the sheath in a direction toward the proximal end thereof, leaving the expandable sheath positioned in the passage.

3. The method of claim 1 further comprising the step of:

(e) additionally dilating the working cavity to larger lateral dimensions of the distal tip on the rigid cannula responsive to insertion into the expandable sheath positioned within the passage of a surgical tool having lateral dimensions larger than the distal tip on the rigid cannula.

4. The method of claim 2 further comprising the steps of:

(e) inserting into a proximate end of the expandable sheath positioned within the passage an endoscopic cannula for performing a cardiac procedure in which the endoscopic cannula has a maximal lateral dimension greater than a maximal lateral dimension to which the sheath expanded in response to withdrawal therethrough of the distal tip of the rigid cannula;

(f) advancing the endoscopic cannula within the expandable sheath positioned within the working cavity toward a distal end thereof to laterally expand the expandable sheath and additionally dilate tissue in the working cavity; and

(g) performing a cardiac procedure using the endoscopic cannula.

5. The method of claim 3 in which the surgical tool includes an endoscopic cannula.

6. A method of performing a cardiac procedure with a rigid endoscopic cannula and a laterally expandable sheath, comprising the steps of:

incising skin overlying an entry point for the cardiac procedure;

inserting the expandable sheath into the incision;

advancing the endoscopic rigid cannula within the expandable sheath under endoscopic visualization to form a passage of dissected tissue between the incision and the pericardium in response to the endoscopic cannula passing through the expandable sheath in a direction toward a distal end thereof to form a working cavity in dilated tissue along the passage; and

performing a cardiac procedure through the endoscopic cannula.