Vessel harvesting method and instrument including access port

• US 5,916,233 A
• Filed: 03/05/1998
• Issued: 06/29/1999
• Est. Priority Date: 03/05/1998
• Status: Expired due to Term

• Current Assignee: Maquet Cardiovascular LLC (Getinge AB)
• Original Assignee: Origin Medsystems Inc. (Boston Scientific Corporation)
• Inventors: Chin, Albert K.
• Primary Examiner(s): Buiz, Michael
• Assistant Examiner(s): Shai, Daphna
• Application Number:
  US09/035,704
• Time in Patent Office: 481 Days
• Field of Search: 606/190, 606/192, 606/194, 606/200, 898/128
• US Class Current: 606/190
• CPC Class Codes: A61B 17/00008 Vein tendon strippers tube strippers A61M1/83
• 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 2017/00969 used for transplantation
• 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

Abstract

A blunt dissection cannula and method selectively isolate a vessel of interest within the body of a patient by dissecting connective tissue in and about the adventitial tissue plane. The procedure includes selectively advancing the cannula and transparent tapered tip along the vessel of interior to form an insufflated cavity along the course of the vessel while visualizing the vessel and side branches within the field of view of an endoscope through the transparent tip. An electrocautery electrode selectively extends through an access port at the distal end of the cannula, eccentrically relative to the transparent tip, to facilitate visualizing rotational and translational positioning of the electrode to contact and electrocauterize side branches within the field of view through the transparent tip. A hook-shaped end of the electrode in contact with a cauterized side branch exerts severing tension on the cauterized side branch to isolate the vessel of interest within the insufflated cavity for subsequent transection and removal from the body of the patient.

Claims

1. Surgical apparatus comprising:

an elongated cannula having a proximate end and a distal end, and including plural lumina extending within the cannula between the ends thereof;

an endoscope disposed within one of the plural lumina and extending from an eyepiece near the proximal end to a viewport near the distal end;

a dissection tip attached to the distal end of the cannula substantially about the outer perimeter thereof and including a transparent tapered tip attached thereto in alignment with the viewport of the endoscope in said one of the plural lumina to permit visualization through the transparent tip within a field of view forward thereof, the dissection tip including an access port aligned with another of said plural lumina to permit protrusion therethrough of a surgical instrument into said field of view forward of the transparent tapered tip in a position of alignment with the viewport of the endoscope, and wherein the transparent tapered tip includes substantially conical outer walls which converge from a rim that mates with the distal end of the cannula towards a rounded end, and includes inner substantially conical walls that converge from the rim to a sharp point that is substantially axially aligned with the rounded end on the outer walls to reduce visual distortion within said field of view.

2. Surgical apparatus as in claim 1 in which the rim is disposed in fluid-tight sealing engagement with said one of the plural lumina in alignment with the viewport of the endoscope.

3. Surgical apparatus as in claim 2 in which said dissection tip includes locking apparatus for releasably securing the dissection tip to the distal end of the cannula.

4. Surgical apparatus as in claim 1 in which said one of the plural lumina is eccentric an elongation axis of the cannula, and said transparent tapered tip aligned with a viewport of the endoscope is eccentric said axis, and said access port is also eccentric said axis.

5. Surgical apparatus as in claim 1 in which the access port is disposed within substantially the differential area between the outer perimeter of the cannula at the distal end thereof, and the outer conical wall of the transparent tapered tip.

6. Surgical apparatus as in claim 5 in which the electrode includes a hook-like remote end that is disposed to selectively protrude and retract through the access port for positioning of said remote end within the field of view through the transparent tapered tip.

7. Surgical apparatus as in claim 1 including an elongated electrode slidably and rotatably disposed within another of the plural lumina aligned with the access port for selective extension and rotation of the electrode in protrusion through the access port.

8. Surgical apparatus as in claim 7 in which said electrode is electrically insulated substantially between ends thereof, and is electrically coupled to a supply of high voltage electrical signal.

9. Surgical apparatus according to claim 1 in which the access port is disposed within a projection of the conical walls of the tapered tip toward the outer perimeter of the distal end of the cannula.

10. Surgical apparatus as in claim 1 in which the conical wall of the transparent tapered tip between rim and rounded end is approximately 0.50 inches and the rounded end includes a radius of approximately 0.040 inches.

11. A method of harvesting a vessel of interest from within the body of a patient, using an elongated cannula containing an endoscope and including a transparent, tapered, tissue-dissecting tip at the distal end of the cannula, the cannula including an elongated instrument disposed within the cannula, the cannula including an elongated instrument disposed within the cannula the method comprising:

forming an incision in the body of the patient to expose the vessel of interest;

sealing the incision in gas-tight relationship about the cannula to support insufflation with gas under pressure about the vessel of interest;

selectively advancing the tip along the course of the vessel of interest in contact with anterior and posterior surfaces thereof to dissect connective tissue therefrom within a field of view of the endoscope through the transparent tip to form an insufflated cavity about the vessel of interest; and

selectively extending an end of the elongated instrument from the distal end of the cannula into the field of view of the endoscope through the transparent tip through an access port to selectively position the end of the elongated instrument in contact with a tributary of the vessel of interest as visualized through the endoscope.

12. The method according to claim 11 including an electrocautery electrode as the elongated instrument within the cannula, the method comprising:

selectively extending the electrode from the distal end of the cannula in eccentric orientation relative to the endoscope to position a remote end of the electrode in contact with a tributary vessel within the field of view of the endoscope.

13. The method performed according to claim 12 with a hook-shaped remote end of the electrode, the method comprising:

selectively electrocauterizing the tributary vessel at a location thereon away from the vessel of interest; and

retracting the electrode toward the distal end of the cannula with the hook-shaped remote end within the field of view of the endoscope and engaged with the tributary vessel to exert severing tension thereon substantially at the cauterized location.

14. The method according to claim 12 comprising:

transecting the isolated vessel of interest at spaced locations therealong within the insufflated cavity; and

removing the transected vessel of interest from the body of the patient.

15. The method according to claim 13 comprising:

forming another incision spaced from the initial incision along the course of the vessel of interest; and

the transecting of the isolated vessel of interest is performed within said initial and another incision for removal from the body of the patient through one of said incisions.

16. The method according to claim 13 comprising:

forming a suture loop about the isolated vessel of interest including a slip knot near the initial incision;

transferring the suture loop along the vessel of interest to a location therealong remote from the initial incision;

tightening the suture loop and slip knot about the vessel of interest at the remote location prior to transecting and removing the vessel of interest from the body of the patient.

17. The method according to claim 11 in which a plurality of tributary vessels are severed from the vessel of interest by multiply electrocauterizing and severing under tension each such tributary vessel to isolate the vessel of interest within the insufflated cavity.