Dissecting cannula and methods of use thereof

• US 8,267,951 B2
• Filed: 07/16/2008
• Issued: 09/18/2012
• Est. Priority Date: 06/12/2008
• Status: Active Grant

• Current Assignee: Atricure, Inc.
• Original Assignee: Ncontact Surgical, Inc.
• Inventors: Whayne, James G., Fleischman, Sidney D., Sicvol, Christopher W.
• Primary Examiner(s): Stigell, Theodore
• Assistant Examiner(s): LANDRY II, GERALD ERNEST
• Application Number:
  US12/174,549
• Publication Number:
  US 20090312783A1
• Time in Patent Office: 1,525 Days
• Field of Search: 600/101, 600/104, 600/115, 600/116, 600/204, 604/27, 604/28, 606/15, 606/40, 606/190, 606/192
• US Class Current: 606/190
• CPC Class Codes: A61B 17/320016 Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes A61B10/0233, A61B17/29, A61B17/3207 take precedence
• CPC Class Codes: A61B 17/3207 Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions A61B17/32037 takes precedence; endoscopic cutting instruments A61B17/320016
• CPC Class Codes: A61B 18/082 Probes or electrodes therefor
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/22038 with a guide wire
• CPC Class Codes: A61B 2017/22079 with suction of debris
• CPC Class Codes: A61B 2017/320004 abrasive
• CPC Class Codes: A61B 2017/320008 Scrapers
• CPC Class Codes: A61B 2017/320012 Brushes
• CPC Class Codes: A61B 2017/320044 Blunt dissectors
• CPC Class Codes: A61B 2017/320048 Balloon dissectors
• 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
• CPC Class Codes: A61B 2018/00363 Epicardium
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/00589 Coagulation
• CPC Class Codes: A61B 2090/3614 using optical fibre
• CPC Class Codes: A61B 2218/001 having means for irrigation and/or aspiration of substances to and/or from the surgical site A61B2018/00029 and A61B2018/1472 take precedence
• CPC Class Codes: A61B 90/02 : Devices for expanding tissue, e.g. skin tissue implements for holding wounds open, surgical tractors A61B17/02; implantable mammary prosthesis A61F2/12; dilators A61M29/00
• CPC Class Codes: A61B 90/361 : Image-producing devices, e.g. surgical cameras

Abstract

Methods and devices described herein facilitate improved access of locations within the body by providing a variety of dissection modes on a single access device.

Claims

1. A method of creating atrial lesion patterns on, a first and second atrial surfaces of a heart of a patient, the method comprising:

accessing a diaphragm through a first incision in an abdomen of the patient;

advancing at least a first and second access devices through separate openings in the diaphragm into a thoracic cavity of the patient and into a pericardial space adjacent to the first atrial surface;

positioning a coagulation device adjacent to the first atrial surface through one of the access devices;

creating a first coagulation region on the first atrial surface with the coagulation device; and

creating a second coagulation region on the second atrial surface with the coagulation device.

2. The method of claim 1, further comprising positioning a scope within the thoracic cavity to view the coagulation device.

3. The method of claim 2, where positioning the scope within the thoracic cavity comprises advancing the scope through one of the access devices.

4. The method of claim 1, where advancing at least the first and second access devices through the diaphragm into a thoracic cavity of the patient and into a pericardial space adjacent to the first atrial surface comprises maintaining lungs of the patient in an inflated state.

5. The method of claim 4, further comprising advancing at least the first and second access devices through the diaphragm and adjacent to the first atrial surface without creating an incision in a chest or through a rib cage.

6. The method of claim 1, further comprising dissecting a pericardial reflection with a dissecting surface of the first access device so that a second atrial surface is accessible from the first atrial surface.

7. The method of claim 6, where dissecting of the pericardial reflection comprises inserting a scope into the first access device.

8. The method of claim 6, where dissecting of the pericardial reflection comprises dissecting a first pericardial reflection, advancing the first access device adjacent to a pair of right pulmonary veins and further dissecting a second pericardial reflection adjacent to a transverse sinus of the heart.

9. The method of claim 1, where creating the first coagulation region on the first atrial surface with the coagulation device comprises creating a series of coagulation lines to isolate a right and a left pair of pulmonary veins.

10. The method of claim 1, further comprising withdrawing at least one access device and advancing the access device adjacent to the second atrial surface prior to creating the second coagulation region.

11. The method of claim 6, further comprising creating a third coagulation region across the first and second atrial surfaces and through at least one of the dissected pericardial reflections.

12. The method of claim 11, further comprising advancing the coagulation device from the first atrial surface to the second atrial surface through at least one of the dissected pericardial reflections to create the third coagulation region.

13. The method of claim 6, where dissecting of the pericardial reflection comprises rotating the first access device so that the dissecting surface of the access device gently dissects the pericardial reflection.