Endoscopic subxiphoid surgical procedures

• US 20040111101A1
• Filed: 01/17/2003
• Published: 06/10/2004
• Est. Priority Date: 08/10/1999
• Status: Active Grant

• Current Assignee: Maquet Cardiovascular LLC (Getinge AB)
• Original Assignee: Maquet Cardiovascular LLC (Getinge AB)
• Inventors: Chin, Albert K.
• Granted Patent: US 7,264,587 B2
• Time in Patent Office: Days
• US Class Current: 606/151
• 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; and

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

2. The surgical procedure according to claim 1 in which the incision is a subxiphoid incision.

3. The surgical procedure according to claim 1 in which the tacking instrument is manipulated to install 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.

4. The surgical procedure according to claim 1 in which the element includes a strand attached to each of the installed epicardial tacks in tension therebetween.

5. The surgical procedure according to claim 4 in which the strand is a suture.

6. The surgical procedure according to claim 4 in which the strand is a band or belt.

7. The surgical procedure according to claim 1 in which installing includes:

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; and

tensioning the trailing suture ends to tension the suture between the pair of loops disposed about the installed epicardial tacks.

8. The surgical procedure according to claim 7 in which tensioning includes 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.

9. The surgical procedure according to claim 3 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.

10. The surgical procedure according to claim 7 including:

attaching clips to the trailing suture ends to inhibit slip thereof through the knots.

11. The surgical procedure according to claim 10 including:

introducing a clip-applying instrument through the endoscopic cannula and attaching a clip to a trailing suture end adjacent the corresponding slip knot; and

trimming the trailing suture end remote from the clip attached thereof.