Single-phase surgical procedure for creating a pneumostoma to treat chronic obstructive pulmonary disease

• US 8,491,602 B2
• Filed: 02/18/2009
• Issued: 07/23/2013
• Est. Priority Date: 02/19/2008
• Status: Expired due to Fees

• Current Assignee: Portaero, Inc
• Original Assignee: Portaero, Inc
• Inventors: Tanaka, Don, Wiesman, Joshua P., Plough, David C.
• Primary Examiner(s): IWAMAYE, ANDREW MICHAEL
• Application Number:
  US12/388,441
• Publication Number:
  US 20090209970A1
• Time in Patent Office: 1,616 Days
• Field of Search: 128/898, 128/200.24, 128/200.26, 128/204.18, 12820714-20717, 604 23- 26, 604 44- 45, 604/93.01, 604/96.01, 604/99.03, 60410201-10203, 604/164.04, 604/174, 604/180, 604/264, 604/288.01, 604540-541, 606/108
• US Class Current: 606/108
• CPC Class Codes: A61B 2017/00809 Lung operations
• CPC Class Codes: A61K 9/007 Pulmonary tract; Aromatherapy
• CPC Class Codes: A61M 1/04 Artificial pneumothorax apparatus
• CPC Class Codes: A61M 11/00 Sprayers or atomisers specially adapted for therapeutic purposes in general B05B; aerosol containers B65D83/14
• CPC Class Codes: A61M 11/005 using ultrasonics spraying or atomising liquids using ultrasonic vibrations in general B05B17/06
• CPC Class Codes: A61M 11/042 electrical
• CPC Class Codes: A61M 13/00 Insufflators for therapeutic or disinfectant purposes , i.e. devices for blowing a gas, powder or vapour into the body hand-held units in which gas flow is produced by muscular energy at the moment of use B05B11/062
• CPC Class Codes: A61M 15/0085 using ultrasonics spraying or atomising liquids using ultrasonic vibrations in general B05B17/06
• CPC Class Codes: A61M 15/009 using medicine packages with incorporated spraying means, e.g. aerosol cans pocket atomiser of the injector type A61M11/08
• CPC Class Codes: A61M 15/02 with activated or ionised fluids, e.g. electrohydrodynamic [EHD] or electrostatic devices; Ozone-inhalators with radioactive tagged particles
• CPC Class Codes: A61M 16/0816 Joints or connectors
• CPC Class Codes: A61M 16/0833 T- or Y-type connectors, e.g. Y-piece
• CPC Class Codes: A61M 16/202 electrically actuated
• CPC Class Codes: A61M 2039/0252 for access to the lungs
• CPC Class Codes: A61M 2039/0276 for introducing or removing fluids into or out of the body
• CPC Class Codes: A61M 2202/0208 Oxygen
• CPC Class Codes: A61M 2202/025 Helium
• CPC Class Codes: A61M 2202/064 Powder
• CPC Class Codes: A61M 2205/075 Bulb type
• CPC Class Codes: A61M 2205/7518 bacterial
• CPC Class Codes: A61M 2205/7536 : allowing gas passage, but preventing liquid passage, e.g. liquophobic, hydrophobic, water-repellent membranes
• CPC Class Codes: A61M 25/02 : Holding devices, e.g. on the body
• CPC Class Codes: A61M 25/04 : in the body, e.g. expansible A61M25/10, A61M16/0488 take precedence
• CPC Class Codes: A61M 25/10 : Balloon catheters A61M25/0125 takes precedence; embolectomy A61B17/22032; retractors A61B17/02; inflatable balloons for placing stents or stent-grafts A61F2/958 ; stomach balloons for treatment of obesity A61F5/0003; oesophagal tubes A61J15/00
• CPC Class Codes: A61M 27/00 : Drainage appliance for wounds or the like , i.e. wound drains, implanted drains negative pressure wound therapy devices A61M1/90; implements for holding wound open A61B17/02 ; middle ear drainage A61F11/202
• CPC Class Codes: A61M 39/02 : Access sites
• CPC Class Codes: A61M 39/0247 : Semi-permanent or permanent transcutaneous or percutaneous access sites to the inside of the body peritoneal dialysis catheters A61M1/285; tracheostomy devices A61M16/0465; measuring pressure within the body A61B5/03; colostomy devices A61F5/445; gastrotomy feeding tubes A61J15/0015; means for fixing a feeding tube outside of the body A61J15/0053

Abstract

A single-phase surgical procedure is disclosed for creating a pneumostoma to treat chronic obstructive pulmonary disease. In a single-phase technique the pleurodesis is formed at the same time as the pneumostoma and does not require a separate step. The thoracic cavity is accessed to visualize the lung, the pneumostomy catheter is inserted into the lung and then the lung is secured to the channel through the chest wall creating a sealed anastomosis which matures into a pleurodesis after the procedure.

Claims

1. A pneumostomy procedure used to create a pneumostoma through a chest wall, parietal membrane and visceral membrane into a lung of a patient, wherein the pneumostomy procedure comprises:

(a) creating an opening through the chest wall and parietal membrane;

(b) engaging the visceral membrane of the lung;

(c) securing the visceral membrane to the parietal membrane adjacent the opening;

(d) making another opening through the visceral membrane;

(e) inserting a distal end of a pneumostomy catheter through the another opening into parenchymal tissue of the lung;

(f) expanding an expandable device at the distal end of the pneumostomy catheter to displace parenchymal tissue of the lung and secure the distal end of the pneumostomy catheter within the lung;

(g) securing the pneumostomy catheter to the chest wall of the patient;

(h) leaving the distal end of the pneumostomy catheter embedded in the parenchymal tissue to create the pneumostoma;

(i) collapsing the expandable device at the distal end of the pneumostomy catheter;

(j) removing the pneumostomy catheter from the patient after formation of the pneumostoma, wherein the pneumostoma includes an artificial channel connecting a cavity in the parenchymal tissue created by the pneumostomy catheter to the air external to the patient'"'"'s body;

(k) inserting a pneumostoma management device into the pneumostoma to protect the pneumostoma and maintain patency of the pneumostoma, wherein the pneumostoma management device has a different structure than the pneumostomy catheter; and

(l) wherein an airtight pleurodesis seal between the visceral and parietal membranes is not formed prior to performing (a), (b), (c), (d), (e), (f), and (g), thereby allowing the lung to deflate during the procedure resulting in a temporary pneumothorax.

2. The pneumostomy procedure of claim 1, wherein step (c) comprises implanting one or more fasteners to secure the visceral membrane to the parietal membrane adjacent the opening.

3. The pneumostomy procedure of claim 1, wherein step (c) comprises securing the visceral membrane to the parietal membrane adjacent the opening by implanting one or more fasteners wherein the fasteners comprise one or more fasteners from the group consisting of:

staples, clips, tacks and sutures.

4. The pneumostomy procedure of claim 1, wherein step (c) comprises suturing the visceral membrane to the parietal membrane adjacent the opening.

5. The pneumostomy procedure of claim 1, wherein the expandable device at the distal end of the pneumostomy catheter is a balloon which is connected by a tube to a coupling at the proximal end of the pneumostomy catheter and wherein step (f) comprises:

operating a syringe connected at the proximal end of the pneumostomy catheter to introduce a fluid through the tube into the balloon; and

thereby expanding the balloon at the distal end of the pneumostomy catheter to displace parenchymal tissue of the lung and secure the pneumostomy catheter within the lung.

6. The pneumostomy procedure of claim 1, wherein step (g) comprises:

(g1) applying tension to the pneumostomy catheter after step (f) to draw the lung towards the opening; and

(g2) securing the pneumostomy catheter to the chest wall of the patient thereby stabilizing the opening during healing of the pneumostoma.

7. The pneumostomy procedure of claim 1 wherein step (c) include using an automatic suture device to secure the visceral membrane to the parietal membrane.

8. A surgical technique used to create a pneumostoma through a chest wall, parietal membrane and visceral membrane into a lung of a patient, wherein the following steps are performed in a single surgical procedure:

(a) accessing a pleural cavity through an opening in the chest wall;

(b) engaging the visceral membrane of the lung;

(c) inserting a distal end of a pneumostomy catheter into the lung through the visceral membrane;

(d) expanding an expandable device at the distal end of the pneumostomy catheter to displace parenchymal tissue of the lung and secure the pneumostomy catheter within the lung;

(e) securing the visceral membrane to the parietal membrane adjacent the opening in the chest wall;

(f) securing a proximal end of the pneumostomy catheter to the chest wall of the patient;

(g) leaving the distal end of the pneumostomy catheter embedded in the parenchymal tissue to create the pneumostoma;

(h) collapsing the expandable device at the distal end of the pneumostomy catheter;

(i) removing the pneumostomy catheter from the patient after formation of the pneumostoma, wherein the pneumostoma includes an artificial channel connecting a cavity in the parenchymal tissue created by the pneumostomy catheter to the air external to the patient'"'"'s body;

(j) inserting a pneumostoma management device into the pneumostoma to protect the pneumostoma and maintain patency of the pneumostoma, wherein the pneumostoma management device has a different structure than the pneumostomy catheter; and

(k) wherein an airtight pleurodesis seal between the visceral and parietal membranes is not formed prior to performance (a), (b), (c), (d), (e), and (f), thereby allowing the lung to deflate during the procedure resulting in a temporary pneumothorax.

9. The surgical technique of claim 8, wherein step (e) further comprises implanting one or more fasteners to secure the visceral membrane to the parietal membrane adjacent the opening.

10. The surgical technique of claim 8, wherein step (e) further comprises implanting one or more fasteners around the opening to secure the visceral membrane to the parietal membrane wherein the fasteners comprise one or more fasteners from the group consisting of:

staples, clips, tacks and sutures.

11. The surgical technique of claim 8, wherein the expandable device at the distal end of the pneumostomy catheter is a balloon which is connected by a tube to a coupling at the proximal end of the pneumostomy catheter and wherein step (d) comprises:

operating a syringe connected at the proximal end of the pneumostomy catheter;

the syringe to introduce a fluid through the tube into the balloon; and

thereby expanding the balloon at the distal end of the pneumostomy catheter to displace parenchymal tissue of the lung and secure the pneumostomy catheter within the lung.

12. The surgical technique of claim 8, wherein step (e) comprises:

(e1) applying tension to the pneumostomy catheter after step (d) to draw the lung towards the opening; and

(e2) securing the pneumostomy catheter to the chest wall of the patient thereby stabilizing the opening during healing of the pneumostoma.

13. The surgical technique of claim 8, wherein step (e) includes treating a localized region of said at least one of the parietal and visceral membranes of the lung of the patient with an adhesive to induce acute adhesion between the parietal membrane and the visceral membrane and wherein the adhesive induces the acute adhesion with a few minutes of application.

14. The pneumostomy procedure of claim 8 wherein step (e) include using an automatic suture device to secure the visceral membrane to the parietal membrane.

15. A surgical technique used to create a pneumostoma through a chest wall, parietal membrane and visceral membrane into a lung of a patient comprising the steps of:

(a) accessing a pleural cavity through an opening in the chest wall;

(b) engaging the visceral membrane of the lung;

(c) inserting a distal end of a pneumostomy catheter into the lung through the visceral membrane such that the distal end is positioned within and in contact with parenchymal tissue of the lung;

(d) expanding an expandable device at the distal end of the pneumostomy catheter within the parenchymal tissue of the lung to displace parenchymal tissue of the lung and create a cavity within the parenchymal tissue of the lung and secure the pneumostomy catheter within the lung;

(e) securing the visceral membrane to the parietal membrane adjacent the opening in the chest wall;

(f) securing a proximal end of the pneumostomy catheter to the chest wall of the patient;

(g) leaving the distal end of the pneumostomy catheter embedded in the parenchymal tissue to create the pneumostoma;

(h) collapsing the expandable device at the distal end of the pneumostomy catheter;

(i) removing the pneumostomy catheter from the patient after formation of the pneumostoma, wherein the pneumostoma includes an artificial channel connecting the cavity in the parenchymal tissue created by the pneumostomy catheter to the air external to the patient'"'"'s body;

(j) inserting a pneumostoma management device into the pneumostoma to protect the pneumostoma and maintain patency of the pneumostoma, wherein the pneumostoma management device has a different structure than the pneumostomy catheter; and

(k) wherein an airtight pleurodesis seal between the visceral and parietal membranes is not formed prior to performing (a), (b), (c), (d), (e), and (f), thereby allowing the lung to deflate during the procedure resulting in a temporary pneumothorax.

16. The surgical technique of claim 15 wherein steps (a) through (f) are performed in a single surgical procedure.

17. The surgical technique of claim 15, wherein step (e) further comprises implanting one or more fasteners around the opening to secure the visceral membrane to the parietal membrane wherein the fasteners comprise one or more fasteners from the group consisting of:

staples, clips, tacks and sutures.

18. The surgical technique of claim 15, wherein step (e) comprises:

(e1) applying tension to the pneumostomy catheter after step (d) to draw the lung towards the opening; and

(e2) securing the pneumostomy catheter to the chest wall of the patient thereby stabilizing the opening during healing of the pneumostoma.

19. The surgical technique of claim 15, wherein step (e) includes treating a localized region of said at least one of the parietal and visceral membranes of the lung of the patient with an adhesive to induce acute adhesion between the parietal membrane and the visceral membrane and wherein the adhesive induces the acute adhesion with a few minutes of application.

20. The surgical technique of claim 15 wherein step (e) includes using an automatic suture device to secure the visceral membrane to the parietal membrane.