JP2009011495A - Component of endoscopic blood vessel harvesting system - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an endoscopic blood vessel harvesting system which enables simple and convenient operation in a limited space and is suitable for harvesting various target blood vessels with respect to a system, components, and to provide a method for endoscopically harvesting blood vessels. <P>SOLUTION: In an endoscopic blood vessel dissector 170 having a wiper blade or a finger 172 to make a field of view of a distal end dissection tip 174 with respect to tissues clear, the wiper blade 172 rotates about an axis 176 at a beginning position of a dissection tip 174 or an end position of a cannula 178. An activation rod 180 controlled by a thumb lever 182 is connected to the wiper blade 172, and a user moves to make the blade engage an outer surface of the dissection tip 174 or to detach the blade alternately. The tip 174 rotates about the axis of the cannula 178 when a knob 184 of a proximal end part of the device is rotated. The wiper blade 172 includes a scraper which is rigid and has the same elasticity as a wiper blade for vehicles. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

  The present invention relates to surgical devices and methods for incising and removing blood vessels from a patient's body, and more particularly to endoscopic blood vessel collection systems, components and methods.

  Endoscopic sampling of blood vessels is well known in the surgical field and is the goal of recent significant technological advances. Typically, harvested blood vessels are used to bypass arteries with reduced blood flow due to stenosis or other abnormalities, such as coronary artery aortic bypass graft surgery (CABG), ie as a shunt. Often, in CABG, the saphenous vein of the patient's foot is harvested in surgery for later use. Other vessels such as the radial artery can be harvested as well. Vascular harvesting involves pulling a blood vessel away from the surrounding tissue, opening a smaller lateral branch, cauterizing, joining or ligating the blood vessel proximally and distally, and incising both ends of the blood vessel before removing it from the body. Accompany.

  Known endoscope methods and apparatuses for collecting blood vessels are described in Patent Document 1, Patent Document 2, and Patent Document 3. Furthermore, Patent Document 4, Patent Document 5 and Patent Document 6 also describe various apparatuses and methods. In addition, VASOVIEW Uniport Plus and VASOVIEW 5, VASOVIEW 6 and VASOVIEW 7 commercial angiography systems are sold by Guidant Corporation of Santa Clara, California.

Another type of endoscopic blood vessel collection system is disclosed in US Pat. In these systems, various devices are used to first open a vein from the surrounding tissue and then harvest the vein. Each of the devices passes through a trocar guide tube inserted through the surface of the body, as disclosed in US Pat. Certain elements of these and other related patent disclosures are known in the VirtuoSaph endoscopic vein collection system sold by the Japanese company Terumo Cardiovascular Systems (see: "www.terumo-cvs.com/products") .
U.S. Patent No. 6,176,825 U.S. Pat.No. 6,406,425 U.S. Patent No. 6,471,638 U.S. Patent No. 5,895,353 U.S. Patent No. 6,162,173 U.S. Patent Application No. 10 / 602,490 US Patent Application No. 2003/0130674 US Patent Application No. 2005/0159764 U.S. Patent No. 6,863,674

  Despite the generally accepted endoscopic vessel collection systems and techniques, there is still a need for systems and components that reduce the user's task complexity and improve surgical outcomes.

  The present invention provides an endoscopic blood vessel collection system that allows simple and convenient surgery in a limited space and is suitable for collecting various target blood vessels. Although the present invention includes improvements to the various components of the blood vessel collection system, each of these component improvements can be used in combination with any other component improvements. Thus, it should be understood that any component, even if a particular combination is not explicitly described, can be used for any other component described herein unless the combination is structurally impossible. Can be used in combination with components.

  In accordance with a first aspect, the present invention provides a vascular incision instrument with an elongated cannula for use with an endoscope, including a lumen for receiving the endoscope therein and further containing a passage for venting gas. To do. The vascular incision device has an input connected to the vent gas supply port and in fluid communication with the passage. A port is in fluid communication with the passage and opens near the distal end of the elongate cannula from which vent gas is released. A fluid barrier covers the port and prevents inflow of fluid from the outside of the elongated cannula while allowing venting gas to escape from the passage inside the elongated cannula.

  The port is formed on the side of the elongated cannula. Desirably, the fluid barrier comprises a tubular member surrounding the distal end of the elongated cannula and covering the port. In one embodiment, the fluid barrier is a polymer material shield that is flexible enough to block the port from the outside while allowing venting gas to be released from the port. In another embodiment, the fluid barrier is a gas permeable / fluid impermeable member that allows venting gas release but prevents fluid entry into the passage.

  The angiotomy device is further disposed on the distal end of the elongate cannula and allows the operator of the device to view tissue inside the body through an endoscope objective lens located near the tip. With a transparent conical tip that allows an incision to be made. The vent gas port is located at the tip of a conical tip. The vasotomy instrument extends through the joint between the distal end of the elongate cannula and the transparent conical tip and the elongate cannula, allowing the user to tilt the tip relative to the axis of the elongate cannula And a control member. For example, the coupling is an accordion-like flexible boundary or sleeve or spherical bearing surface.

  According to a second aspect, the present invention provides a vascular incision instrument comprising an elongated cannula for use with an endoscope and including a lumen therein for receiving the endoscope. A hollow, externally conical transparent cutting tip is placed on the distal end of the elongated cannula, allowing the operator of the instrument to view tissue while viewing the internal body structure through the endoscope objective lens. Allows incision. The tip is generally shaped around the axis and distal in a shape that can reduce glare back to the objective lens of the endoscope compared to a conical inner wall that tapers symmetrically toward the tip. Includes a structure with an inner wall as an end. For example, the shape of the distal end of the inner wall of the incision tip is an internal surface that tapers at or toward the distal end along a line that forms an elongated internal corner. Either an internal surface that tapers downstream and becomes a flat surface set at an angle from the axis of the chip, or a reverse wedge. Desirably, the cutting tip has one tip diameter and the diameter of the elongated cannula adjacent to the cutting tip is between about 50% and 75% of the tip diameter.

  In a more robust system, a vasotomy instrument extends through the elongate cannula, a vascular retention tool adapted for longitudinal movement in the cannula, and elongates through the elongate cannula, It further includes a blood vessel cutting tool such as a tissue welder adapted for longitudinal movement. In this configuration, the cutting tip includes holes for the passage of the vascular retention tool and the vascular cutting tool. Preferably, both the vascular retention tool and the vascular cutting tool are anchored in the incision tip recess and have an external shape that conforms to the conical outer surface of the incision tip.

  According to a third aspect, the present invention provides a vascular incision instrument for use with an endoscope. The angiotomy instrument is defined by an elongated cannula that includes a lumen for receiving an endoscope therein. A transparent conical tip is placed over the distal end of the elongate cannula, allowing the instrument operator to incise the tissue while viewing the internal body structure through the objective lens of the endoscope To do. A wiper removes tissue from the outer surface of the transparent conical tip. The wiper is placed on an elongate cannula and pivots alternately to repeatedly contact and disengage the transparent conical tip, and the tip rotates by a mechanism that rotates the tip during contact to wipe tissue from the outer surface of the tip. Taken. Alternatively, the wiper is placed on an elongated cannula, contacts the conical tip and rotates around the axis of the device. In a further alternative, the wiper is an O-ring wiper fitted into a conical tip and is connected to a drive rod that moves the O-ring wiper lengthwise to wipe the conical tip. . In one variation, the wiper is placed on an elongate cannula to contact the conical tip and has an electrically conductive cutting electrode to remove tissue by ablation. Preferably, a handle located at the proximal end of the elongated cannula has a thumb lever connected to the activation rod for moving the wiper relative to the transparent conical tip to wipe tissue from the tip.

  According to a fourth aspect, the present invention provides a vascular incision instrument for use with an endoscope. The angiotomy device includes an elongate cannula including a lumen for receiving an endoscope therein and a vascular retention tool extending through the elongate cannula and adapted for longitudinal movement within the cannula. The distal end of the vascular retention tool includes a vascular hook and locking member that is used to capture the target vessel, and the hook is open on one side so that the locking member extends to completely surround and capture the target vessel Then close the open side of the hook. The vascular cutting tool has a distal working end that includes a structure that extends and is capable of moving longitudinally through an elongate cannula to cut a target vessel. The vascular retention tool includes a support rod that extends through an elongate cannula, the support rod configured to bend laterally at a location near the distal end of the tool, thereby causing lateral vascular manipulation. And improve the positioning of the vascular cutting tool relative to the target vessel.

  Desirably, the support rod is out of plane at a location near the distal end of the vascular retention tool so that the distal end of the vascular retention tool bends either in the direction of the vascular cutting tool or away from the vascular cutting tool. Bend. The support rod is flexible so that the bend can be drawn into the cannula and the vascular retention tool can extend distally from the elongated cannula to move its distal end laterally. The flexible support rod is surrounded by a rigid hypotube adapted for longitudinal movement with respect to the cannula, and the extension of the support rod and hypotube from the cannula and subsequent contraction of the hypotube from around the support rod is a vascular retention tool. Bend. Alternatively, the support rod is folded from a plane at a location near the distal end of the vascular retention tool using an active angling mechanism controlled from the proximal end of the elongated cannula.

  The vascular hook of the vascular retention tool includes a blunt distal incision surface that is tapered for incision of tissue without bleeding. Further, the blood vessel hook of the blood vessel holding tool defines a space for accommodating the target blood vessel therein, and the lock member is formed as a wedge having a size that reduces the space inside the open blood vessel hook by about 50%, and the lock member extends. The locking member includes a tapered leading edge that helps to prevent the blood vessel from being clamped during the operation.

  According to a fifth aspect, the present invention provides a blood vessel collection instrument for use with an endoscope. The blood vessel collection instrument includes an elongated cannula that includes a lumen for receiving an endoscope therein. A blood vessel cutting tool extends through the elongate cannula and has a distal end working end that is adapted for longitudinal movement within the cannula and includes a structure for cutting the target vessel. A vascular retention tool extends through the elongate cannula and is adapted for longitudinal movement within the cannula, capturing a single support rod and target vessel extending through the elongate cannula to capture the side branch of the target vessel And a distal end portion including a vascular hook and a locking member used to handle the target vessel for handing to the vascular cutting tool. The hook is open on one side and the locking member extends to close and close the open side so as to completely surround and capture the target vessel. The locking member extends concentrically from a single support rod on one lateral side of the vascular hook, thus the single support rod reduces endoscopic visual field impairment compared to one or more support rods.

  The support rod is configured to bend laterally at a location near the distal end of the vascular retention tool, thereby allowing lateral vascular handling and improving the positioning of the vascular cutting tool on the target vessel. Desirably, the vascular hook of the vascular retention tool includes a blunt distal incision surface that is tapered for incision of tissue without bleeding.

  According to a sixth aspect, the present invention provides a blood vessel collection instrument for use with an endoscope. The blood vessel collection instrument includes an elongated cannula that includes a lumen for receiving an endoscope therein. A blood vessel cutting tool extends through the elongate cannula and has a distal end working end that is adapted for longitudinal movement within the cannula and includes a structure for cutting the target vessel. The vessel retention tool also extends through the cannula to allow longitudinal movement within the elongated cannula. The vascular retention tool includes a single support rod that extends through an elongate cannula and a vascular hook and lock member used to handle the target vessel to capture the target vessel and provide a side branch of the target vessel to the vessel cutting tool. And including a far end portion. The vascular hook is open on one side and the locking member extends to close and close the open side so as to completely surround and capture the target vessel. The distal end of the vascular retention tool, including the hook and lock member, is constructed with a thin wire shape to reduce obstruction of the endoscopic field. Preferably, the thin wire shape is formed from a metal or plastic wire having a thickness of between about 0.5 mm and 1.0 mm. Desirably, the support rod is configured to bend laterally at a location near the distal end of the tool, thus allowing lateral vessel handling and improving the positioning of the vessel cutting tool to the target vessel. .

  According to a seventh aspect, the present invention provides a blood vessel collection instrument for use with an endoscope. The blood vessel collection instrument includes an elongated cannula that includes a lumen for receiving an endoscope therein. A blood vessel cutting tool extends through the elongate cannula and has a distal end working end that is adapted for longitudinal movement within the cannula and includes a structure for cutting the target vessel. A vascular retention tool also extends through the elongate cannula and is adapted for longitudinal movement within the cannula to capture a single support rod and target vessel that extends through the elongate cannula and captures the side of the target vessel And a distal end portion including a vessel retainer that is used to handle the target vessel to hand the bifurcation to the vessel cutting tool. A buffering slip structure placed around the support rod of the vascular retention tool may cause a reaction force between the cannula and the support rod when the vascular retainer catches on any body structure and creates a reaction force against the support rod against the movement of the cannula. Allow relative movement. For example, the dampening slip structure is a friction collar that surrounds the support rod, or a piston / cylinder / spring configuration that couples the movement of the support rod and cannula.

  Preferably, the vessel holder of the vessel holding tool is open on one side and defines a space for receiving the target vessel therein. A locking member closes the open side of the retainer so as to completely surround and capture the target vessel. The locking member is formed in a wedge shape sized to reduce the internal space of the open vessel retainer by about 50% and is tapered to help prevent the target vessel from being clamped as the locking member extends. Including the leading edge. Also, the visibility of the vascular retention tool is improved by a single support rod extending from the elongated cannula. In this case, the locking member extends concentrically from a single support rod on one lateral side of the vascular retainer, so that the single support rod is in the endoscope compared to one or more support rods. Reduce visual field impairment. Desirably, the distal end of the vascular retention tool, including the retainer and the locking member, is constructed with a thin wire shape to reduce obstruction of the endoscopic field.

  According to an eighth aspect, the present invention provides a blood vessel collection instrument for use with an endoscope. The blood vessel collection instrument includes an elongated cannula that includes a lumen for receiving an endoscope therein. A vascular cutting tool extends through an elongate cannula and is adapted for longitudinal movement within the cannula and includes an open mouth that automatically adapts to a widely variable sized vessel to receive a target vessel A cutter having a distal end working end and associated with the mouth is included. A vascular retention tool extends through the elongated cannula and is adapted for longitudinal movement within the cannula and has a structure used to capture the target vessel and manipulate the target vessel relative to the vascular cutting tool . Preferably, the mouth of the vascular cutting tool accepts a blood vessel with a diameter in the range between 0.5 mm and 1.0 mm.

  In one variation, the mouth has two blood vessel contact portions that bend away from each other when the blood vessel is housed inside the mouth. The cutter includes a bipolar electrode that is placed in contact with a target vessel contained in the mouth. For example, bipolar electrodes include wire electrodes arranged in a cross pattern in the mouth. In another variation, the mouth has a stepped shape that includes several progressively smaller intermediate gaps having generally parallel sides, thereby forming a region of constant width surface contact with the blood vessel. The intermediate gap has a width that gradually decreases by 1.0 mm. The cutter may be a mechanical cutter that is positioned across the target vessel contained in the mouth. For efficiency, the fluid conduit terminates near the distal working end of the vascular cutting tool and is configured to carry a fluid jet to dislodge tissue that may adhere to the distal end.

  The vascular cutting tool is connected to the control rod and disposed in an arcuate slot formed in the elongated cannula, and the control rod moves the distal working end both laterally and laterally within the arcuate slot. be able to. The mouth of the vascular cutting tool may be open on one side of the distal working end. The vascular retention tool may include a support rod that extends through the elongate cannula and distal of the vascular retention tool so that the distal end bends either in the direction of the vascular cutting tool or away from the vascular cutting tool. The support rod bends from the plane at a position close to the end.

  According to a ninth aspect, the present invention provides a blood vessel collection instrument for use with an endoscope. The blood vessel collection instrument includes an elongated cannula that includes a lumen for receiving an endoscope therein. A pair of partially tubular vascular guards extend from the cannula to define a lumen sized to receive the target vessel and to define a gap sized to receive a side branch extending from the target vessel. A tubular knife blade that has a size that partially surrounds the tubular protective material and can move axially from the cannula advances and cuts the side branch received inside the gap, partially A tube-shaped protective material protects the target blood vessel from the cutting operation. The blood vessel cutting tool is a tubular knife blade. A fluid conduit terminates in the vicinity of the partially tubular protective material and carries a fluid jet to dislodge tissue that may adhere to the vascular protective material.

  According to a tenth aspect, the present invention provides a blood vessel collection instrument for use with an endoscope. The blood vessel collection instrument includes an elongated cannula that includes a lumen for receiving an endoscope therein. Electrodes for sealing a pair of fork-shaped blood vessels with teeth are spaced laterally so as to form a gap therebetween. The mandible that captures the blood vessel, or blood vessel capture mandible, moves in the gap between the electrodes to capture the target blood vessel located between the teeth. The cutting blade moves within the gap and cuts the target vessel. Desirably, the vascular capture mandible has a sawtooth shaped distal finger for securely capturing the target vessel within the tooth. Both the vessel capture mandible and the cutting blade have a control rod and are angled to engage the distal end of the elongate cannula and move both in the mutual direction by retracting the control rod proximally With a proximal surface. A fluid conduit that terminates near the fork-shaped vascular sealing electrode carries a fluid jet to dislodge tissue that may adhere to the sealing electrode.

  The nature and advantages of the present invention will be more clearly understood in the following description, particularly when considered in conjunction with the accompanying drawings. In the accompanying drawings, the same elements have the same reference numerals.

  This specification provides a number of improvements over prior art blood vessel collection systems. The various component parts of the blood vessel collection system disclosed herein are described on the assumption that each component can operate in combination with other components, unless stated to be mutually exclusive. Should be understood. For example, the various endoscopic vascular incision instruments described herein can be utilized in combination with any endoscopic vascular harvesting instrument. Furthermore, the single component improvements described herein can be incorporated into any endoscopic blood vessel collection device as long as the structure or function is still not mutually exclusive.

Prior Art Endoscopic Blood Vessel Collection System Three main components of one example of a prior art blood vessel collection system are shown in each of FIGS. 1A-1C. This particular system represents one type of prior art vascular collection system, and many of the improvements described herein will be described with direct reference to this system. However, as will be appreciated by those skilled in the art, any single improvement to the sub-components of the blood vessel collection system can in most cases be incorporated into other similar systems. More importantly, if any single improvement is independently claimed, its application should not be considered limited to the system shown in FIGS. 1A-1C. Specifically, the exemplary prior art system includes an endoscopic incision instrument 20 seen in FIG. 1A, an endoscopic vessel collection instrument 22 seen in FIG. 1B, and an access trocar 24 seen in FIG. 1C.

  Endoscopic instrument 20 includes an elongated tube or cannula 30 that extends between a distal conical tip 32 and a proximal handle 34. A bell-shaped port 36 at the proximal end of the handle 34 houses a prior art medical endoscope that can fit into the optical connector 40. Although not shown, the elongated shaft of the endoscope 38 extends through the entire length of the dissecting instrument 20 so that its viewing end terminates near the typically transparent conical tip 32. It should be understood that blood vessel collection systems are typically disposable and are typically packaged and sold separately from the endoscope to be reused. However, in all cases, these blood vessel collection systems are designed to house and function with prior art endoscopes.

  A capillary tube 42 supplies venting gas to the inlet portion inside the handle 34 that is open toward the elongated passage inside the cannula 30 (leading to the distal outlet port 44). In use, the user places the distal tip 32 and cannula 30 into the body via an access device such as the trocar 24 seen in FIG. 1C and the target vessel such as the saphenous vein of the leg. Insert at a position close to By pushing the conical tip 32 along the target vessel while looking through the endoscope, the user can roughly disconnect the connective tissue from around the vessel. Vent gas exiting the distal port 44 maintains the internal pressure of the incised cavity to facilitate further incision viewing. After the desired length of target vessel has been separated from the surrounding tissue, the dissecting instrument 20 is removed from the patient.

  Following the vessel incision, the blood vessel collection instrument 22 is inserted through the access trocar 24 into the open cavity around the target vessel. The blood collection device 22 also includes an elongated tube or cannula 50 that extends between the open distal end 52 and the proximal handle 54. Again, a conventional endoscope 38 is mounted into a proximal bell-shaped port 56 that includes an axial slot 58 for receiving an upright optical connector 40. As with the dissecting instrument 20, the elongated shaft of the endoscope passes completely through the cannula 50 and terminates at the viewing end or objective lens 60 near the open distal end 52.

  The blood vessel collection device 22 further includes a tool that simultaneously cuts a side branch from the target vessel while sealing to prevent bleeding. For example, the retention tool 62 can be used to handle the target vessel so that the cutting / sealing tool 64 can access the various side branches. Each of these tools is controlled by a control mechanism 66 provided on the handle 54. One of the control mechanisms 66 is a thumb lever that connects to a wiper blade on the distal end of the elongated cannula 50 to clean the objective lens 20 of the endoscope. A vented gas system that includes a capillary 68 may be provided to allow gas to escape from the open distal end 52 of the cannula 50 to facilitate blood vessel harvesting procedures. The electrical wire 70 can also be connected to the handle 54 to supply electrical energy to a coagulator built into the cutting / sealing tool 64. It should be understood that, as outlined above, these components of prior art vascular collection systems are well known in the art and are the subject of improvements of the present invention.

  The third major component of the blood vessel collection system is the access trocar 24 seen in FIG. 1C. In this embodiment, the trocar includes a main access tube 70 having an angled distal tip 72 and a proximal containment 74. Although not shown, an internal seal, such as a diaphragm seal, can be incorporated within the enclosure 74 to provide a gas plug interface to the dissecting instrument 20 or blood collection instrument 22 through the trocar 24. . A main access tube 70 extends through the incision in the body and a spring-biased clip 76 secures the trocar to the body.

Improved Incision Function FIG. 2A shows the distal end of an alternative vascular incision instrument 80 of the present invention that includes a knotted incision tip 82. The tip 82 is connected to an elongated cannula through an accordion-like flexible boundary or sleeve 86. A pair of puller wires 88 extend through cannula 84 and reach points on opposite sides of incision tip 82. By manipulating the puller wire 88, the user can tilt the generally conical tip 82 in any direction within the plane relative to the axis of the elongated cannula. By rotating the entire cannula 84, a tip movement in the range of 360 degrees is obtained. The flexible sleeve 86 acts like a compression spring to return the tip 82 to its previous position for axial alignment when the pulling force is released.

  FIG. 2B shows another alternative vascular incision instrument 90 having a knotted cutting tip 92. Similar to the lancing instrument 80, the tip 92 connects to the distal end of the cannula 94 in such a way that it can be tilted within a plane relative to the elongated cannula. In this embodiment, a spherical bearing surface 96 provides the interface between tip 92 and cannula 94. A pair of pull wires 98 connected to the chip 92 allows the user to tilt the chip as desired. A flexible spine member (not shown) may also be provided to provide a force to return the tip 92 to its previous position to axially align when the pulling force is released.

FIG. 3 shows possible flow paths of body fluid to an existing endoscopic angiotomy instrument 100 that includes one or more ports 102 near its distal end for the ventilation of gases such as CO ₂ . FIG. That is, a passage is formed within the cannula of vascular incision instrument 100 to carry gas from the proximal end to port 102. As fluid enters the cannula through the vent port 102, it will enter the transparent distal tip and ultimately prevent viewing of the endoscope.

  FIG. 4A shows the distal end of an alternative vasotomy instrument 110 of the present invention. This distal end includes a small fluid barrier 112 extending proximally from the distal tip 114 to prevent ingress of body fluid into the vent port 116 formed on the side of the lancing device. The fluid barrier 112 of this embodiment is constructed from a tubular protective material that can be formed from a relatively thin medical plastic. The fluid barrier 112 is preferably flexible, such as a reed valve, that allows gas to enter from the port 116 while preventing fluid or solids from entering.

  FIG. 4B shows an alternative angiotomy instrument 120 having an alternative fluid barrier 122 surrounding its distal end near the distal tip 124. The fluid barrier 122 of this embodiment is comprised of a tubular perforated membrane that covers the gas vent port 126 on the side of the cutting instrument cannula. This allows gas to exit but prevents entry of fluids or solids. The membrane 122 is a medically suitable gas permeable, fluid impermeable barrier such as ePTFE made by W.L. Gore.

  In a further embodiment, the port through which the vent gas is exhausted is located at the dissection tip secured to its distal end rather than the cannula body. For example, the incision tips 82, 92 of FIGS. 2A, B can also include a port through which gas can escape to the surrounding tissue cavity. Alternatively, the transparent conical tip 32 of FIG. 1A can include a port formed in the distal tip. In each of these alternative embodiments, the fluid barrier desirably fills or covers the port to allow gas ingress while preventing fluid or solid ingress. It is advantageous to have a port on the cutting tip. This is because the gas is expelled more distally and can be connected to a common cannula if a different tip is selected as required.

  FIG. 5A is a side block diagram of a prior art endoscopic angiotomy instrument 100 that passes through body tissue 104. Although ventilation helps to maintain an incised cavity or tunnel, friction can occur between the cannula and tissue because the cannula 106 is the same size as the incision tip 108.

  To facilitate passage of the cannula through tissue, the endoscopic vascular incision instrument 130 of the present invention seen in FIG. 5B includes a cannula 132 that is narrowed at least at a location adjacent to the dissection tip, preferably over its entire length. . The cannula 132 has a diameter that is smaller than the diameter of the cutting tip 134, preferably about 50-75% of the diameter of the cutting tip 134. A cannula narrowed close to the incision tip improves maneuverability and reduces shaft friction in the incised tunnel.

  6A-6C are longitudinal cross-sectional views of an alternative transparent tip for use with the endoscopic vascular incision instrument of the present invention. Prior art transparent cutting tips, such as those found in US Pat. No. 5,980,549, include the interior of a cavity with a front wall that tapers toward the tip. The external aspect maintains a more rounded and dull shape due to the atraumatic incision. A sharp internal tip helps to remove the distorted spot in the center of the field of view.

  In addition to distortion, some conical blunt dissection tips made of transparent material reflect light back from the optical fiber to the endoscope objective. To address this problem, the generally conical cutting tip 140 of FIG. 6A includes an internal surface 142 that tapers at the distal end of the line 144 to form an elongated internal corner or reverse wedge shape. . This configuration works to reduce glare that returns to the objective lens of the endoscope. In FIG. 6B, the cutting tip 146 includes an interior surface that tapers downstream toward its distal end and becomes a flat surface 148 disposed at an angle from the axis of the tip 146. In this case, since the objective lens is typically placed along or near the axis of the tip or incision cannula, the incident light is reflected away from the objective lens. Finally, FIG. 6C shows an incision tip 150 having an internal tapered portion that is inverted wedge-shaped at the distal end. This shape helps to divert light away from the fiber directly away from the back direction, thus reducing glare or reflection. All of these shapes have the effect of reducing incident glare that returns from the optical fiber to the objective lens of the endoscope, thus improving user visibility.

  A common technique for blood vessel collection is to provide independent angiotomy and blood vessel collection devices. These instruments are inserted into the body, typically one instrument at a time, typically via an access trocar. Such an instrument is shown in the system configuration of FIGS. 1A-1C. However, it is conceivable that the incision and collection functions can be combined into a single device to save time. For example, FIG. 7 is a block diagram of the distal end of the integrated endoscopic vascular incision / collection instrument 160 of the present invention having a blunt dissection tip 162 with a hole or depression for the collection tool. Specifically, the vascular retention tool 164 includes an outer surface that is tapered to conform to the incision tip 162 and is disposed within a depression in that surface. Similarly, a blood vessel cutting tool 166 having an external surface that mates with the cutting tip 162 has been retracted into a similar recess. Each of the vessel retention tool 164 and the vessel cutting tool 166 is disposed in the incision tip recess and has an external shape that matches the conical exterior of the incision tip. The distal end of the endoscope 168 extends into the transparent incision tip 162. With respect to the incision, the tools 164, 166 have been retracted to conform to the conical tip 162. Next, immediately after the tunnel portion around the main vessel is incised, the selected side branch or main vessel is moved by manipulating the vessel holding tool 164 and vessel cutting tool 166 (as by axial or rotational movement). Cut and sealed. Accordingly, the vascular incision / collection instrument 160 is advanced to the stage of performing incision and side branch management along the main blood vessel.

Another configuration envisioned to combine the function of a tissue dissector with blood vessel collection is to include a dissection tip that can be detached from a cannula containing a collection tool. For example, any of the conical tips shown in FIGS. 6A-6C can be separated from a cannula containing any of the collection tools shown below. With such a system, the user can alternate between ligation and cutting as desired. Moreover, such a removable conical tip can also include an opening to allow the CO ₂ vent. Following the incision, the cone is separated and ventilation continues through the open end of the cannula. Another alternative is to provide a tether that connects the removable conical tip to the cannula. This allows the tip to be removed but is held near the distal end of the cannula in preparation for reconnection.

  Occasionally, fat or other tissue will adhere to the outside of the conical cutting tip, hindering clear vision. FIG. 8 is a perspective view of the endoscopic vascular incision instrument 170 of the present invention with a wiper blade or finger 172 to clarify the field of view of the distal incision tip 174 to the tissue. In this embodiment, the wiper blade 172 pivots relative to the axis 176 at the starting position of the cutting tip 174, ie, the end position of the cannula 178. An activation rod 180 controlled by the thumb lever 182 is connected to the wiper blade 172. Thus, the user can engage the blade with the outer surface of the incision tip 174, pull it apart, or move it alternately. As the user rotates knob 184 at the proximal end of the device, tip 174 rotates about the axis of cannula 178. The wiper blade 172 is stiff and may include a resilient scraper similar to a car wiper blade. A description of the various structural details of this configuration is omitted, but within the skill of medical device design. Similarly, alternative configurations as shown in FIGS. 9 and 10 are envisioned.

  9 and 10 are perspective views of two alternative endoscopic vascular incision instruments of the present invention with a tip wiper function. The cutting instrument 190 of FIG. 9 includes a wiper blade or finger 192 to clarify the field of view of the conical cutting tip 194 to the tissue, similar to the cutting instrument 170 of FIG. However, instead of tip rotation, the blade 192 rotates around the axis of the device, for example through a connection with a rotating outer sleeve or shaft 196 of the elongated device. Again, details of the drive of the shaft 196 are omitted, but can be easily inferred from existing equipment. FIG. 10 shows a cutting instrument 200 that fits an O-shaped ring wiper 202 on a conical cutting tip. The actuating rod 204 changes the position of the O-ring wiper 202 lengthwise and cleans the incision tip. The O-type wiper 202 is formed as a loosely wound metal or plastic helix to facilitate expansion and contraction around the tip. Of course, there are many other wiper configurations that can be moved on the cutting tip, but this description is only an example.

  A further alternative to the tip wiper of FIGS. 8-10 adds an energized cutting electrode to the wiper blade to remove tissue by melting. That is, instead of an inactive stiff or resilient blade, a wire or bar electrode is incorporated to allow removal of stronger tissue via electrocautery. Although the specific structure is not shown, it will be understood that any of the wiper components shown in FIGS. 8-10 can serve as such an electric wiper.

Furthermore, any of the conical tips illustrated herein, including the simple conventional tip shown in FIG. 5A, is compatible with systems that use attached fluid to remove attached tissue. can do. For example, a ring-shaped opening or a series of independent circumferentially spaced openings is placed between the conical tip and the cannula, and the flow of saline discharged from the opening knocks the tissue off the tip. Other fluids such as CO ₂ injection can be used, but salt water is particularly suitable. Designed to expel fluid to flow distally along the surface of the cone using the Coanda effect, where the flow of fluid or gas tends to approach the convex profile when directed tangential to the surface Is intention.

Improved vessel retention function Once the target vessel is exposed, such as by an incision along the length, endoscopic vessel harvesting advances the elongate device along the vessel while viewing, cutting and sealing the side branches Includes steps. As mentioned above, there are many such systems currently available, including the system found in FIGS. 1A-1C. In such a system, the vessel retention tool manipulates the target vessel so that the side branch is located in front of the cutting / sealing tool. It is important that the side branch and the target blood vessel can be visually recognized well so that the user does not accidentally cut the target blood vessel instead of the side branch. It is also desirable to retract the target vessel so that the side branch can be cauterized as far away from the target vessel as possible to minimize the risk of damage to the vessel (spread of heat) by the ablation tool .

    FIGS. 11A and 11B are side block diagrams of a conventional endoscopic blood vessel collection instrument showing a blood vessel retention tool 210 and a modern cutting tool 212 extending axially from the distal end of the cannula 214. The holding tool 210 typically has a hook or other capture function that holds the main vessel 216. As the device advances, the system is operated so that the side branch 218 is encountered and the side branch aligns with the cutting tool 21 in position. This configuration has certain disadvantages. In particular, the linear stretching of the tools 210, 212 provides some awkwardness to maneuver for proper positioning of the side branches 218.

  FIGS. 12A and 12B are side block diagrams of the endoscopic blood vessel collection instrument 220 of the present invention, showing a blood vessel retention tool 222 and a cutting tool 224 extending from the distal end of the cannula 226. Vascular retention tool 222 is repositioned laterally so that positional alignment of side bifurcation 218 with cutting tool 224 can be more easily achieved. As seen in FIG. 12B, the effect of bending the retaining tool 222 radially outward allows the tool to advance along the main vessel 216 and straightens the side branch 218 for more effective cutting by the cutting tool 224. It is to make it. Comparing FIG. 11A and FIG. 12A, it can be seen that the distance between the holding tool and the cutting tool is increased, and more side branch lengths are exposed. Although not shown, the position of the holding tool 22 can be moved laterally as shown in FIG. 12 simply by placing the holding tool on a bent actuating rod or via an angled mechanism. In the case of a bent support rod, the rod is flexible so that it can be retracted into the cannula, and the lateral movement increases as the tool 222 extends. In general, the vascular retention tool 222 includes a support rod configured to extend through the elongate cannula and to lie sideways near its distal end.

  FIG. 13 is a side block diagram of an alternative endoscopic vessel collection device 230 of the present invention. The blood vessel retention tool 232 includes a tip that is bent in the direction of the blood vessel cutting tool 234. In this configuration, the retention tool 232 can position the main vessel 216 to align with the cutting tool 234. Eventually, after being separated from the connecting side branches, the main vessel 216 is cut at at least one end. A holding tool 232 makes this step feasible. It is also possible to combine the vessel harvesting devices 220 and 230 so that the vessel retention tool bends away from the cutting tool as seen in FIG. 12A and toward the cutting tool as seen in FIG. Can think. In other words, a knotted vascular retention tool with a support rod extending through the cannula can be provided. The holding tool is configured to branch laterally at a location near the distal end of the tool, allowing different angle formation depending on the situation.

  14A-B illustrate several transverse repositioning configurations of an alternative vascular retention tool 240 in an extension from the cannula 242 of the endoscopic blood vessel collection instrument of the present invention. In this embodiment, the retention tool 240 is placed at the end of a flexible wire shape 244 having a bend 246. When retracted, the wire shape 244 is straight within the transport channel 248. As the tool is extended, the bend 246 eventually exits the end of the path 248, resulting in the holding tool 240 moving sideways.

  Another form that allows angling of the distal end of the vascular retention tool is to provide a flexible support rod or wire shape and surround the tool with a rigid hypotube. Both structures extend longitudinally from the mouth of the cannula and the withdrawal of the hypotube from the periphery of the wire shape bends the vessel retention tool. In this embodiment, the operability of the vascular retention tube is further enhanced as it is angled to various axial positions than immediately after exiting the cannula.

  In yet another advantageous mechanism, the vascular hook of the vascular retention tool can include a blunt cutting surface that is tapered for tissue cutting without bleeding. The term “blunt” surface in this case means an incision surface that does not contain sharp points or corners but is tapered to some extent to facilitate the division or subdivision of the tissue plane. For example, the conical tip described herein is considered blunt and generally has no sharp points. However, conventional more linear tissue holders are too dull and not well suited for tissue dissection.

  It is important to minimize the obstacles in the field of view. That is, the greater the degree that the device interferes with the user's tissue viewing, the greater the risk of peeling and cauterization errors. 15A and 15B are side and perspective views of an alternative vessel retention tool 250 of the present invention. This tool 250 has a lower profile than the above-mentioned tool, and therefore its operating field is large. Returning to FIG. 1B, the prior art retention tool 62 includes two rods or support components extending from the cannula 50. These two rods become solid visual obstacles inserted between the endoscope objective lens and the actual blood vessel holding operation position. It is desirable to minimize such obstacles.

  In one of the low profile holders as described above, the vascular retention tool 250 has a single main rod or support piece 252 extending distally from the distal end of the cannula 254 and a vascular hook 256. Transport. The hook 256 has a shape that partially surrounds the main blood vessel and manipulates the blood vessel to pass a side branch to an associated blood vessel cutting tool (not shown). FIG. 15B shows a locking member 258 that is, for example, a concentric or nested extension of the main rod 252. The hook 256 is substantially C-shaped so that it can partially surround the blood vessel, and the extension of the locking member 258 closes the remaining open side so that the blood vessel is completely enclosed and trapped therein. In this way, the blood vessel is held firmly by the holding tool 250 without being forced against it, and the field of view from the objective lens is maximized because one of the support rods has been removed.

  FIGS. 16A and B show a further vascular holder tool 260 of the present invention formed of a thin wire. This configuration is also reduced in contour and reduced obstruction to the endoscopic field of view, thus improving the field of view and accuracy of the operation. Tool 260 extends from cannula 262 and includes a hook portion 264 formed of a single wire and a position movement locking member 266 formed of another wire or pin. Again, the locking member 266 extended from the holding tool 260 completely surrounds the blood vessel for manipulation and cutting. There are two support rods extending from the cannula, but they are so thin that they minimize the field obstruction for the objective lens. Preferably, the holding tool 260 is formed from a metal or plastic wire having a thickness between about 0.5 mm and 1.0 mm.

  FIG. 17A is a partial cross-sectional view of a vascular retention tool 270 of the present invention that incorporates a mechanism for preventing vascular detachment. This type of vessel retention tool is used to hook a main vessel, move in its length, and cut a side branch while occasionally stopping. Damage can occur if the tool moves too far or moves rapidly when reaching the side branch. Tool 270 includes a hook portion 272 disposed at the end of repositioning rod 274 extending from cannula 276. Within the cannula 276, the rod 274 passes through a friction collar (collar) 278 that acts as a buffer slip structure between the hook portion 272 and the cannula 276. That is, if the hook portion 272 experiences resistance as it moves along the length of the main vessel, it will not pull or push the vessel further as the cannula 276 moves further, but instead between the cannula and the hook portion. Relative motion is attenuated.

  Similarly, FIG. 17B shows a vascular retention tool 280 that includes a hook portion 282 disposed on a repositioning rod 284 extending from the cannula 286. The slip structure 288, in this case a piston / cylinder / spring configuration, reduces the relative movement of the tool / cannula in case the hook portion is caught in any body structure and repositions the rod against the cannula movement. A reaction force is generated at 284. Of course, FIGS. 17A and 17B are merely examples, and other clutch mechanisms that perform similar functions may be substituted.

  Finally, FIG. 18 shows yet another vascular retention tool 290 of the present invention having a locking member 292 that is expanded to better position the blood vessel 294. That is, the blood vessel 294 is first held within the hook portion 296 and then the locking member 292 is extended axially to capture the blood vessel. The locking member described above was a thin rod or pin that left a relatively large space inside the mouth of the hook portion 296 and was particularly capable of moving relatively small blood vessels. In this embodiment, the locking member 292 has a large wedge shape so as to constrain the space holding the blood vessel 294, thus increasing the stability of the blood vessel prior to the side branch cutting operation. As far as relative size is concerned, the locking member 292 when extended desirably reduces the space in the mouth of the hook member 296 by about 50%. The tapered leading edge helps prevent the vessel from being clamped as the locking member 292 extends.

There are a number of instruments suitable for coagulating, sealing, joining or cutting improved tissue for vascular cutting function, for example, cutting a target vessel from an enclosing side branch and securing a separate end for hemostasis. Such devices typically include a pair of tweezers, jaws or forceps that grasp and hold tissue therebetween. The device can be a heating element that contacts the tissue, an ultrasonic heater that utilizes frictional heat on the tissue, or a monopolar or bipolar electrode heating system that conducts current through the tissue so that the tissue is heated by its own electrical resistance. Operates using. The device heats the tissue to a temperature such that the tissue is “cut” or “sealed”. Specifically, when heated above 100 ° C., tissue located between tweezers, jaws or forceps is destroyed and “cut”. However, when the tissue is heated to a temperature between 50 ° C. and 90 ° C., the tissue is simply “sealed” or “welded” to the adjacent tissue. Monopolar and bipolar probes, forceps or scissors use high frequency current through the tissue to be coagulated. Current through the tissue heats the tissue, resulting in protein coagulation. In these monopolar instruments, the current leaves the electrode, passes through the tissue, and then returns to the generator through a “ground plate” connected to a distant part of the patient's body. In bipolar electrosurgical instruments, the current passes between the two electrodes and the tissue passes between the two electrodes, as in the case of the “Kleppinger bipolar forceps” used for occlusal positioning of the fallopian tube. Positioned. A new development in this area is the “Tripolar” instrument sold by Cabot and Circon-ACMI. This incorporates a mechanical cutting element in addition to the monopolar coagulation electrode. A similar combined sealing and mechanical cutting device is known as tissue “Bisector” (a term that combines bipolar cautery and divider). One of the organizations “Bisector” is sold as part of the VVASOVIE ™ 6 blood vessel collection system by the Guidant Corporation of Santa Clara, California. In an ultrasonic tissue heater, a high frequency (ultrasonic) vibrating element or rod contacts the tissue. Rapid vibration generates heat and causes tissue proteins to coagulate. Conductive tissue welding instruments typically include a jaw, one or both of which is heated by resistance and sandwiches the tissue therebetween. In this type of instrument, no current passes through the tissue as in the case of a monopolar or bipolar cautery.

  It should be understood that any such prior art device for cutting or sealing a blood vessel or any such device described below may be used with any of the various components of the blood vessel collection system described herein. But they can be combined. It should be further understood that various configurations of monopolar, bipolar or other types of electrodes can be provided on the vessel cutting / sealing tool described below. It will be appreciated by those skilled in the art that the particular shape and size of the electrodes and their relative placement with other electrodes define power requirements and operational constraints. Furthermore, some embodiments described herein may work better utilizing one or other types of electrodes or heating elements, but cover all such optimal arrangements. Is not described in

  One important feature of all cutting tools is the ability to handle different sized vessels without extra effort on the part of the user. This is particularly important for bipolar ablation tools that must achieve good tissue contact with both electrodes for optimal performance. With fixed electrodes (such as the “bi-sector” described above), small blood vessels are more difficult to cauterize. That is, the user is asked to position the blood vessel between the bi-sector electrodes and then rotate the bi-sector to confirm good contact with both electrodes. Simply reducing the distance between the electrodes for good contact prevents its use for larger blood vessels. Movable electrodes or jaws are a solution, but require additional effort to avoid over-tightening of the blood vessels that can cause damage.

  FIGS. 19A and 19B are block diagrams of an alternative vessel cutting tool 300 of the present invention having two wire electrodes 302 that intersect and overlap a large gap G defined by a vessel containing mouth. In contrast to some of the previously described devices, the gap G is large enough to accommodate both lateral branches and main blood vessels, and preferably between about 4.0 mm and 6.0 mm. Is approximately 6.0 mm. The wire electrodes 302 that overlap in a cross pattern across the gap G are elastic because they automatically adapt to vessel sizes that vary widely. “Fit” means contacting both sides of the blood vessel. This is particularly important to ensure good contact with very small blood vessels. Vascular cutting tool 300 desirably fits blood vessels having a diameter ranging between 0.5 mm and 6.0 mm. In one variation of the embodiment of FIGS. 19A and 19B, the vascular cutting tool is defined by two vascular face-to-face contacts (the contacts need not be electrodes) that bend away when the vessel is received. Have a mouth. Any cutting tool can be combined with a variable sized mouth that can secure blood vessels of various sizes.

  Desirably, the wire electrode is made of stainless steel to bend easily so that the blood vessel can move further into the gap and ensure good contact with the blood vessel, between about 0.5 mm and 1.0 mm. With wire thickness. Also, as seen in FIG. 19B, the two wire electrodes 302 are set at different diameter distances from the central axis of the tool so that they do not touch each other, thereby providing the separation required for bipolar coagulation. It is done. One distinct advantage of the vessel cutting tool 300 over conventional designs is the ability to automatically adapt to variable size vessels. That is, for example, the movable jaw can accommodate various vessel diameters, but this is not possible without careful handling by the user. Thus, the tool 300 can reduce the overall time for blood vessel harvesting surgery and include the cutting of multiple blood vessels.

  FIG. 20 is a side view of an alternative blood vessel cutting tool 310 of the present invention having a stepped vessel storage port 312. The stepped shape of the mouth 312 ensures good contact with, for example, tissue ablation electrodes (not shown) on opposite sides of the mouth, while adapting to a wider range of blood vessel sizes. In contrast to the fixed V-shaped gap, the stepped shape of the mouth 312 provides several gradually decreasing intermediate gaps with generally parallel sides that provide a constant width surface contact area with the blood vessel. In addition, a smaller step to the next intermediate gap contacts the blood vessel. This “bracketing” of the blood vessel helps to ensure a good seal without the risk of undue pressure. The blood vessel cutting tool 300 desirably fits blood vessels having a diameter in the range between 0.5 mm and 6.0 mm. In one embodiment, the mouth 312 of the vascular cutting tool 300 defines an intermediate gap with a decreasing width of 1.0 mm. For example, the intermediate gap is 6-5-4 mm or 5-4-3 mm.

  Although a non-movable cutting / sealing tool is appropriate for a particular application, it is often desirable to apply a certain amount of pressure to the blood vessel, for example using a movable jaw. 21A and 21B illustrate a blood vessel cutting tool 320 of the present invention having two jaws 322 that are flexibly deflected from each other and can be partially closed. The jaw 322 can carry bipolar or monopolar electrodes. A puller wire or control rod 324 connects to the closure ring and allows axial movement of the ring 326 to close the jaw 322 as seen in FIG. Next, through the viewing of the cutting / sealing operation, the user is allowed to change the degree of closure of the jaw 322 and thus the amount of pressure applied. The jaw 322 cannot be completely closed and has a minimum gap between about 0.5 mm and 1.0 mm, as seen in FIG. 21B. This minimum gap is adjusted so that the tool 320 adapts to the smallest possible blood vessels, but there is no contact between the jaws 322, thereby reducing excessive tightening of many more blood vessels.

  FIG. 22 is a side view of a blood vessel cutting tool 330 having a stationary jaw 332 and a rotating blade 334 incorporated into the jaw. The rotary blade 334 is an automatic forceless knife blade that is connected to electrical power and functions as a cutting electrode or operates in conjunction with an independent sealed electrode (not shown) provided on the jaw 332. This configuration eliminates the need to provide an electrode that performs the dual function of cutting and sealing, giving the designer the freedom to optimize the sealing electrode.

  FIGS. 23A and B are two side views of a blood vessel cutting tool 340 having a movable blade 342. The movable blade 342 desirably operates in conjunction with an electrode (not shown) that seals the severed blood vessel. A control rod 344 is connected to move the blade 342 in the direction of the anvil 346 provided in the hook portion 348 of the tool 340. The blade 342 and the associated anvil 346 are slightly tilted as shown to cut the blood vessel with the pinching action. Such a mechanical cutter is desirable in contrast to electrocautery, which is time consuming and causes thermal damage to the tissue and is generally inefficient.

FIG. 24 is a block diagram of a blood vessel cutting tool 350 having a system for removing tissue using gas injection. Occasionally, repeated application of heat or electricity to the tissue causes adhesion or seizure of the tissue to the electrodes. One means of solving this problem is to provide a capillary tube 352 that extends adjacent to the cutting / sealing tool 354. The capillary tube 352 ends near the cutting edge or electrode of the tool 354, and a jet of gas such as CO2 is emitted from the open end or from a special nozzle, and the tissue is swept away from the tool. While other fluids such as brine can be used, CO ₂ is particularly suitable because it is already used for ventilation of the body cavity.

  25A and B are a front view and an overhead view of an alternative blood vessel cutting tool 360 that can be moved transversely and longitudinally. Electrode transport member 362 moves circumferentially within arcuate slot 364 and is driven by control rod 366. This arrangement greatly improves the maneuverability of the tool and thus enhances user options.

  In FIG. 26, the cutting / sealing tool 370 shown from the front side within the vented tunnel 372 has a pair of partially tubular vascular protection features 374 extending around the main vessel 376. Includes a cannula. The gap between the protective features 374 fits into the side branch 378 from the main vessel 376. A tubular cutting element 380 that is axially displaced from the cannula surrounds the sealing mechanism 374. The user positions the protection mechanism around a blood vessel 376 having a side branch 378 as shown and then advances the cutting element 380. A protective mechanism 374 protects the blood vessel 376 and ensures proper cut length of the bifurcated portion 378 to be incised. The cutting element 380 is a tube-shaped knife blade or an electrode designed for cutting.

  27A and B are side and overhead views of a blood vessel cutting / sealing tool 400 incorporating several moving parts. Tool 400 includes a pair of fork electrodes 402 spaced laterally to form a gap and moving a cutting blade 404 within the gap. The vessel trapping mandible 406 also moves within the gap between the electrodes. In use, it can be seen that the blood vessel 408 is placed in the teeth of the forked electrode 402 prior to capture by the lower jaw 406. Mandible 406 has a saw-shaped distal finger to securely capture the target vessel within the tooth. The upward movement of the lower jaw captures the blood vessel 408, at which point electrical energy is supplied by the electrode 402 and the coagulation process begins. Subsequently, the blade 404 is moved downward to cut the blood vessel 408. Although the mechanism to move both the blade 404 and the lower jaw 406 is not shown, both engage the delivery cannula and move the elements upward relative to each other in response to using the control rod to refract the proximal portion. With an angled or arcuate proximal surface that can be utilized.

  28A and B are two block diagrams of a vascular cutting / sealing tool 420 incorporating a side open cutting / sealing instrument 422. FIG. In the enlarged view of FIG. 28B, the cutting instrument 422 is composed of an upper electrode 424 and a lower electrode 426 that are separated with a slot 428 in between. The upper and lower electrodes 424, 426 may be bipolar, and the slot 428 may accommodate a knife blade or other such cutting element. FIG. 29 illustrates the use of a tool 420 to cut the side branch 430 from the main vessel 432 in an endoscopic image.

  Finally, FIG. 30 is an overhead view of an alternative cutting tool 440 having a first ring electrode 442 extending from the cannula structure 444 and a second coil electrode 446 disposed concentrically around the first electrode. It is.

  Although the present invention has been described with reference to preferred embodiments, it is to be understood that the terminology used is a descriptive term and not a limitation. Therefore, changes may be made within the scope of the appended claims without departing from the proper scope of the invention.

1 is a perspective view of a prior art endoscopic vascular incisor. FIG. 1 is a perspective view of a prior art endoscopic blood vessel collector. FIG. 1 is a perspective view of a prior art access trocar. FIG. FIG. 6 is a side view of the distal end of an alternative vascular incision device of the present invention including a knotted cutting tip. FIG. 6 is a side view of the distal end of an alternative vascular incision device of the present invention including a knotted cutting tip. 1B is a side block diagram illustrating possible flow paths of body fluid to the prior art endoscopic vascular incisor of FIG. 1A. FIG. FIG. 6 is a side view of the distal end of an alternative vascular incision device of the present invention including a structure that prevents inflow of body fluid into the incision device cannula. FIG. 6 is a side view of the distal end of an alternative vascular incision device of the present invention including a structure that prevents inflow of body fluid into the incision device cannula. 1 is a side block diagram of a prior art endoscopic vascular incision device passing through body tissue. FIG. 1 is a side block diagram of an endoscopic vascular incision device of the present invention having a cannula narrowed for a path that more easily passes through body tissue. FIG. FIG. 6 is a longitudinal cross-sectional view of an alternative transparent conical tip for use with the endoscopic vascular incision device of the present invention. FIG. 6 is a longitudinal cross-sectional view of an alternative transparent conical tip for use with the endoscopic vascular incision device of the present invention. FIG. 6 is a longitudinal cross-sectional view of an alternative transparent conical tip for use with the endoscopic vascular incision device of the present invention. FIG. 6 is a cross-sectional block diagram of the distal end of an alternative endoscopic angiotomy instrument of the present invention incorporating a tool for blood vessel collection. 1 is a perspective view of an endoscopic vascular incision device of the present invention having a wiper blade that cleans a distal incision tip. FIG. FIG. 6 is a perspective view of the distal tip of an alternative endoscopic angiotomy device of the present invention with tip wiper function. FIG. 6 is a perspective view of the distal tip of an alternative endoscopic angiotomy device of the present invention with tip wiper function. 1 is a side block diagram of a prior art endoscopic vessel harvesting instrument showing a vessel retention and cutting tool extending from the distal end of a cannula. FIG. 1 is a side block diagram of a prior art endoscopic vessel harvesting instrument showing a vessel retention and cutting tool extending from the distal end of a cannula. FIG. FIG. 3 is a side block diagram of an endoscopic blood vessel collection instrument of the present invention showing a blood vessel retention and cutting tool extending from the distal end of the cannula, wherein the blood vessel retention tool moves laterally for better vessel storage. FIG. 3 is a side block diagram of an endoscopic blood vessel collection instrument of the present invention showing a blood vessel retention and cutting tool extending from the distal end of the cannula, wherein the blood vessel retention tool moves laterally for better vessel storage. FIG. 6 is a side block diagram of an alternative endoscopic blood vessel collection instrument of the present invention, wherein the blood vessel retention tool includes a tip bent in the direction of the blood vessel cutting tool. FIG. 6 is a block diagram illustrating several transverse repositioning configurations of an alternative vascular retention tool from the endoscopic blood vessel collection instrument of the present invention. FIG. 6 is a block diagram illustrating several transverse repositioning configurations of an alternative vascular retention tool from the endoscopic blood vessel collection instrument of the present invention. FIG. 6 is a block diagram illustrating several transverse repositioning configurations of an alternative vascular retention tool from the endoscopic blood vessel collection instrument of the present invention. FIG. 6 is a side and perspective view of an alternative vascular retention tool of the present invention having one connecting rod. FIG. 6 is a side and perspective view of an alternative vascular retention tool of the present invention having one connecting rod. 2 is a side view and perspective view of a low profile blood vessel retention tool of the present invention formed of a thin wire. FIG. 2 is a side view and perspective view of a low profile blood vessel retention tool of the present invention formed of a thin wire. FIG. FIG. 6 is a partial cross-sectional view of an alternative vascular retention tool of the present invention that incorporates a mechanism for preventing vascular detachment. FIG. 6 is a partial cross-sectional view of an alternative vascular retention tool of the present invention that incorporates a mechanism for preventing vascular detachment. FIG. 6 is a side view of the proximal end of an alternative vascular retention tool of the present invention having an enlarged locking member for better positioning of a blood vessel. FIG. 6 is a block diagram of an alternative blood vessel cutting tool of the present invention having a wire electrode extending into a gap that houses a blood vessel. FIG. 6 is a block diagram of an alternative blood vessel cutting tool of the present invention having a wire electrode extending into a gap that houses a blood vessel. FIG. 6 is a block diagram of an alternative blood vessel cutting tool of the present invention having a stepped vessel storage gap. 1 is a side view of a blood vessel cutting tool of the present invention having a movable jaw. FIG. 1 is a side view of a blood vessel cutting tool of the present invention having a movable jaw. FIG. 1 is a side view of a blood vessel cutting tool of the present invention incorporating a rotating blade. FIG. 1 is a side view of a blood vessel cutting tool of the present invention having a movable blade. FIG. 1 is a side view of a blood vessel cutting tool of the present invention having a movable blade. FIG. 1 is a block diagram of a blood vessel cutting tool of the present invention having a system for removing tissue using gas injection. FIG. FIG. 6 is a front cross-sectional view and an overhead view of an alternative blood vessel cutting tool of the present invention that can move in the longitudinal direction as well as in the transverse direction. FIG. 6 is a front cross-sectional view and an overhead view of an alternative blood vessel cutting tool of the present invention that can move in the longitudinal direction as well as in the transverse direction. FIG. 6 is a front block diagram of an alternative vascular cutting tool of the present invention having a tubular cutting element surrounding a tubular main vascular protection mechanism. FIG. 6 is a side and overhead view of a further alternative vessel cutting / sealing tool that incorporates a movable mandible that captures a vessel and a mechanical blade that cuts the vessel. FIG. 6 is a side and overhead view of a further alternative vessel cutting / sealing tool that incorporates a movable mandible that captures a vessel and a mechanical blade that cuts the vessel. FIG. 6 is a block diagram of a side open vessel cutting / sealing tool. FIG. 6 is a block diagram of a side open vessel cutting / sealing tool. FIG. 29 is a longitudinal view of a endoscope showing the use of the tool of FIG. 28. FIG. 6 is an overhead view of an alternative vessel cutting with a ring and concentric coil bipolar electrodes.

Explanation of symbols

38 Endoscope 80 Vascular incision instrument 84, 94 Cannula 42 Ventilation gas supply port 116, 126 Port 112, 122 Fluid barrier

Claims (62)

An angiotomy device used with an endoscope,
An elongate cannula including a lumen for receiving an endoscope therein and further containing a passage for venting gas;
An input connected to the vent gas supply port and in fluid communication with the passage;
A port in fluid communication with the passage, opening near the distal end of the elongate cannula and releasing vent gas;
A fluid barrier covering the port, allowing venting gas to escape from a passage inside the elongate cannula and preventing inflow of fluid from the outside of the elongate cannula;
An angiotomy device comprising:   The vascular incision device of claim 1, wherein the port is formed on a side of an elongated cannula.   The vascular incision device of claim 2, wherein the fluid barrier comprises a tubular member surrounding a distal end of an elongated cannula and covering the port.   The vascular incision device according to claim 1, wherein the fluid barrier is a polymer material shield having flexibility so as to block the port from the outside while allowing a vent gas to be discharged from the port.   The angiotomy device of claim 1, wherein the fluid barrier is a gas permeable / fluid impermeable member that allows venting gas to escape but prevents fluid inflow into the passageway. Located on the distal end of an elongated cannula, allows the operator of the instrument to incise tissue while viewing the internal body structure through an endoscope objective lens located near the tip The device further comprises a transparent conical tip to
The vascular incision device of claim 1, wherein the port is located at the tip of a conical tip. Located on the distal end of an elongated cannula, allows the operator of the instrument to incise tissue while viewing the internal body structure through an endoscope objective lens located near the tip With a transparent conical tip to make,
A joint between the distal end of the elongate cannula and the transparent conical tip, and a control member that extends through the elongate cannula and allows the user to tilt the tip relative to the axis of the elongate cannula ,
The vascular incision device according to claim 1, further comprising:   The vascular incision device of claim 7, wherein the coupling is selected from the group comprising an accordion-like flexible boundary or sleeve and a spherical bearing surface. An angiotomy device used with an endoscope,
An elongated cannula including a lumen for receiving an endoscope therein;
A hollow, outwardly cone that is positioned over the distal end of an elongated cannula and allows the operator of the instrument to incise tissue while viewing the internal body structure through an endoscope objective lens A transparent incision tip in the shape,
With
The distal end is shaped so that the tip is arranged around the axis and can reduce glare back to the objective lens of the endoscope rather than a conical inner wall that tapers symmetrically toward the tip. An angiotomy device comprising a structure having an inner wall that terminates in a tube.   The vascular incision device according to claim 9, wherein the shape of the distal end of the inner wall of the cutting tip is an internal tapered surface that terminates at the distal end along a line that forms an elongated internal corner. .   The shape of the distal end of the inner wall of the cutting tip is an inner surface that tapers down towards the distal end and terminates at a flat surface set at an angle from the axis of the tip; The vascular incision device according to claim 9.   The blood vessel incision device according to claim 9, wherein the shape of the distal end portion of the inner wall of the incision tip is a reverse wedge.   The vascular incision device according to claim 9, wherein the cutting tip has a tip diameter and the diameter of the elongated cannula adjacent to the cutting tip is between about 50% and 75% of the tip diameter. The angiotomy device comprises:
A vascular retention tool that extends through the elongated cannula and is adapted for longitudinal movement within the cannula;
A blood vessel cutting tool that extends through an elongated cannula and is adapted for longitudinal movement within the cannula;
Further including
The vascular incision device of claim 9, wherein the incision tip includes holes for passages of the vascular retention tool and the vascular cutting tool.   15. The vascular incision device of claim 14, wherein each of the vascular retention tool and the vascular cutting tool is anchored in the incision tip recess and has an external shape that conforms to the conical outer surface of the incision tip.   The vascular incision device according to claim 14, wherein the vascular cutting tool is a tissue welder. An angiotomy device used with an endoscope,
An elongated cannula including a lumen for receiving an endoscope therein;
A transparent conical tip placed on the distal end of an elongated cannula that allows the operator of the instrument to incise tissue while viewing the internal body structure via the objective lens of the endoscope When,
A wiper to remove tissue from the outer surface of the transparent conical tip;
An angiotomy device comprising:   A wiper is placed on the elongate cannula and pivots to alternately contact and disengage the transparent conical tip, and the tip rotates by a mechanism that rotates the tip during contact to wipe tissue from the outer surface of the tip. 18. A vascular incision device according to claim 17, which is taken.   18. A vasotomy instrument according to claim 17, wherein the wiper is disposed on the elongated cannula, contacts the conical tip and rotates about the axis of the device.   18. The wiper of claim 17, wherein the wiper is an O-ring wiper fitted into a conical tip and connected to a drive rod that moves the O-shaped ring wiper lengthwise to wipe the conical tip. Angiotomy instrument.   18. An angiotomy device according to claim 17, wherein the wiper is disposed on an elongate cannula in contact with the conical tip and has an electrically conductive cutting electrode for removing tissue by ablation.   A handle disposed at the proximal end of the elongate cannula and a thumb lever on the handle connected to the actuating rod for moving the wiper relative to the transparent conical tip to wipe tissue from the tip. Item 18. A vascular incision device according to Item 17. A blood vessel collection device used with an endoscope,
An elongated cannula including a lumen for receiving an endoscope therein;
A vascular retention tool that extends through an elongate cannula and is adapted for longitudinal movement within the cannula, wherein the distal end of the vascular retention tool is used to capture a target vessel and A blood vessel retention tool including a locking member, wherein the hook is open on one side and the locking member extends to close the open side of the hook so as to completely surround and capture the target vessel;
A blood vessel cutting tool extending through the elongated cannula and adapted for longitudinal movement within the cannula and having a distal working end including a structure for cutting the target vessel;
With
The vascular retention tool includes a support rod that extends through an elongated cannula, the support rod being folded laterally at a location near the distal end of the tool, thereby allowing lateral vascular manipulation and the target vessel A blood vessel harvesting instrument that improves the positioning of the blood vessel cutting tool relative to.   24. The blood vessel harvesting device of claim 23, wherein the support rod bends out of the plane at a location near the distal end of the blood vessel retention tool such that the distal end of the blood vessel retention tool is bent in the direction of the blood vessel cutting tool.   24. The support rod is flexible so that the bend can be drawn into the cannula and the vascular retention tool can extend distally from the elongated cannula to move its distal end laterally. The blood vessel collection device described in 1.   The support rod is flexible and is surrounded by a rigid hypotube adapted for longitudinal movement with respect to the cannula, and both the support rod and the hypotube can be stretched from the cannula and then the contraction of the hypotube from around the support rod The blood vessel collection device of claim 24, wherein the retention tool is folded.   24. The blood vessel harvesting device of claim 23, wherein the support rod is bent from a plane at a location near the distal end of the vascular retention tool using an active angling mechanism controlled from the proximal end of the elongated cannula.   24. The blood vessel harvesting device of claim 23, wherein the vascular hook of the vascular retention tool comprises a blunt distal incision surface that is tapered for incision of tissue without bleeding.   When the blood vessel hook of the blood vessel holding tool defines a space for accommodating the target blood vessel inside, the lock member is formed as a wedge having a size that reduces the space inside the open blood vessel hook by about 50%, and the lock member is extended. 24. The blood vessel harvesting device of claim 23, wherein the locking member includes a tapered leading edge that helps to prevent the vessel from being clamped. A blood vessel collection device used with an endoscope,
An elongated cannula including a lumen for receiving an endoscope therein;
A blood vessel cutting tool that extends through an elongate cannula and is adapted for longitudinal movement within the cannula and has a distal end working end that includes a structure for cutting a target vessel;
Stretched through the elongate cannula, adapted for longitudinal movement within the cannula, captures a single support rod and target vessel that extends through the elongate cannula and hands the side branch of the target vessel to the vessel cutting tool A vessel holding tool having a distal end portion including a vessel hook and locking member used to handle the target vessel
With
The hook is open on one side and the locking member extends to close and open the open side so that it completely surrounds and captures the target vessel, and the locking member is removed from a single support rod on one lateral side of the vessel hook. A blood vessel harvesting device that extends concentrically and thus reduces a field of view of an endoscope as compared to one or more support rods.   The support rod is configured to bend laterally at a location near the distal end of the vascular retention tool, thereby allowing lateral vascular handling and improving the positioning of the vascular cutting tool on the target vessel; The blood vessel collection device according to claim 30.   31. The blood vessel harvesting device of claim 30, wherein the vascular hook of the vascular retention tool includes a blunt distal incision surface that is tapered for incision of tissue without bleeding. A blood vessel collection device used with an endoscope,
An elongated cannula including a lumen for receiving an endoscope therein;
A blood vessel cutting tool that extends through an elongate cannula and is adapted for longitudinal movement within the cannula and has a distal end working end that includes a structure for cutting a target vessel;
Stretched through an elongate cannula, adapted for longitudinal movement within the cannula, captures a single support rod and target vessel that extends through the elongate cannula and provides a side branch of the target vessel to the vessel cutting tool A blood vessel retention tool having a blood vessel hook and a distal end portion including a locking member used to handle the target vessel to
With
The hook is open on one side, the locking member extends and closes the open side to completely surround and capture the target vessel, and the distal end of the vessel holding tool including the hook and the locking member is the endoscope A blood vessel collection device constructed with a thin wire shape to reduce visual field obstruction.   34. The blood vessel collection device of claim 33, wherein the thin wire shape is formed from a metal or plastic wire having a thickness of between about 0.5 mm and 1.0 mm.   The support rod is configured to bend laterally at a location near the distal end of the tool, thereby allowing lateral vessel handling and improving positioning of the vessel cutting tool to the target vessel. 34. The blood vessel collection device according to 33. A blood vessel collection device used with an endoscope,
An elongated cannula including a lumen for receiving an endoscope therein;
A blood vessel cutting tool that extends through an elongate cannula and is adapted for longitudinal movement within the cannula and has a distal end working end that includes a structure for cutting a target vessel;
Stretched through the elongate cannula, adapted for longitudinal movement within the cannula, captures a single support rod and target vessel that extends through the elongate cannula and hands the side branch of the target vessel to the vessel cutting tool A vascular retention tool having a distal end portion including a vascular retainer used to handle the target vessel
If the vessel retainer catches on any body structure and creates a reaction force against the cannula movement on the support rod, around the support rod of the vessel holding tool to allow relative movement between the cannula and the support rod With a buffer slip structure,
A blood vessel collection device comprising:   38. The blood vessel collection device of claim 36, wherein the buffer slip structure is a friction collar surrounding the support rod.   37. The blood vessel harvesting device of claim 36, wherein the buffer slip structure is a piston / cylinder / spring configuration that couples the motion of the support rod and cannula.   The vascular retainer of the vascular retention tool is open on one side to define a space to receive the target vessel inside, and the vascular retainer is opened so that it completely surrounds and captures the target vessel A locking member that closes the closed side, the locking member being formed in a wedge shape that reduces the internal space of the open vessel retainer by about 50%, and tightening the target vessel as the locking member extends 38. The blood vessel harvesting device of claim 36, including a tapered leading edge locking member that helps to prevent this.   A single support rod extending through the elongate cannula improves the visibility of the vascular retention tool, and the locking member extends concentrically from a single support rod on one lateral side of the vascular retainer so that 1 37. The blood vessel collection device of claim 36, wherein a single support rod reduces endoscopic visual field impairment compared to more than one support rod.   37. The blood vessel harvesting device of claim 36, wherein the distal end of the vascular retention tool including the retainer and the locking member is constructed with a thin wire shape to reduce endoscopic field obstruction. A blood vessel collection device used with an endoscope,
An elongated cannula including a lumen for receiving an endoscope therein;
A blood vessel cutting tool that extends through an elongate cannula and is adapted for longitudinal movement within the cannula, an open mouth that automatically adapts to a wide range of variable sized vessels to receive the target vessel A blood vessel cutting tool comprising a cutter having a distal end working end including and associated with the mouth;
A vascular retention tool that extends through an elongate cannula, is adapted for longitudinal movement within the cannula, and has a structure used to capture the target vessel and manipulate the target vessel relative to the vessel cutting tool;
A blood vessel collection device comprising:   43. The blood vessel harvesting device of claim 42, wherein the mouth of the blood vessel cutting tool receives a blood vessel having a diameter in a range between 0.5 mm and 1.0 mm.   44. The blood vessel sampling device according to claim 43, comprising two blood vessel face-to-face contact portions that bend away from each other when the blood vessel is housed in the mouth.   43. The blood vessel harvesting device of claim 42, wherein the cutter includes a bipolar electrode positioned to contact a target blood vessel housed in the mouth.   46. The blood vessel collection device of claim 45, wherein the bipolar electrode is a wire electrode disposed in a cross pattern in the mouth.   43. The blood vessel collection device of claim 42, wherein the mouth has a stepped shape including a number of gradually decreasing intermediate gaps having generally parallel sides, thereby forming a region of constant width surface contact with the blood vessel.   The blood vessel collection device according to claim 47, wherein the intermediate gap has a width that gradually decreases by 1.0 mm.   43. The blood vessel harvesting device of claim 42, wherein the cutter comprises a mechanical cutter positioned across the target blood vessel contained in the mouth.   43. The fluid conduit further comprising a fluid conduit adapted to carry a fluid jet for terminating tissue proximate to the distal working end of the vascular cutting tool and to dislodge tissue that may adhere to the distal end. The blood vessel collection device described.   A vascular cutting tool is connected to the control rod and disposed in an arcuate slot formed in the elongated cannula, the control rod moving the distal working end in the lateral direction within the arcuate slot as well as in the lengthwise direction. 43. The blood vessel collection device of claim 42, wherein the blood vessel collection device is capable of.   43. The blood collection device of claim 42, wherein the mouth of the blood vessel cutting tool is open on one side of the distal working end.   The vascular retention tool includes a support rod extending through the elongate cannula, and the support rod bends from a plane at a location near the distal end of the vascular retention tool such that the distal end bends toward the vascular cutting tool. Item 43. The blood vessel collection device according to Item 42.   The vascular retention tool includes a support rod that extends through the elongate cannula, and the support rod bends from a plane near the distal end of the vascular retention tool so that the distal end bends away from the direction of the vascular cutting tool 43. A blood vessel collection device according to claim 42.   The vascular retention tool includes a support rod that extends through the elongate cannula and uses an active angling mechanism that is controlled from the proximal end of the elongate cannula to support the support rod at a location near the distal end of the vascular retention tool 43. The blood vessel collection device of claim 42, wherein the bends from a plane. A blood vessel collection device used with an endoscope,
An elongated cannula including a lumen for receiving an endoscope therein;
A pair of partially tubular guards extending from the cannula, defining a lumen sized to receive the target vessel, and defining a gap sized to receive a side branch extending from the target vessel;
A tubular cutting element that has a size that partially surrounds the tubular protective material and is movable axially from the cannula;
With
A blood vessel harvesting device wherein the tubular cutting element is advanced to cut the side branch received within the gap, and the partially tubular protective material protects the target vessel from the cutting action.   57. A blood vessel harvesting device according to claim 56, wherein the blood vessel cutting tool is a tubular knife blade.   57. The fluid conduit of claim 56, further comprising a fluid conduit that terminates near the partially tubular guard and is adapted to carry a fluid jet to dislodge tissue that may adhere to the vascular guard. Blood collection device. A blood vessel collection device used with an endoscope,
An elongated cannula including a lumen for receiving an endoscope therein;
A pair of fork-shaped vascular sealing electrodes having teeth and spaced laterally to form a gap therebetween;
A blood vessel capture mandible arranged to move in a gap between the electrodes to capture a target blood vessel located between the teeth;
A cutting blade attached to move within the gap to cut the target vessel;
A blood vessel collection device comprising:   60. The blood vessel harvesting device of claim 59, wherein the blood vessel capture mandible has a saw-shaped distal finger for securely capturing the target blood vessel in the tooth.   Both the vessel capture mandible and the cutting blade have a control rod and are angled to engage the distal end of the elongate cannula and move both in the mutual direction by retracting the control rod proximally 60. The blood vessel collection device of claim 59, having a proximal surface.   60. The blood vessel harvesting device of claim 59, further comprising a fluid conduit adapted to carry a fluid jet to terminate tissue proximate to the fork-shaped vascular sealing electrode and to adhere to the sealing electrode.

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