Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B17/34—Trocars; Puncturing needles
  • A61B17/3403—Needle locating or guiding means
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B17/34—Trocars; Puncturing needles
  • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B17/34—Trocars; Puncturing needles
  • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
  • A61B17/3421—Cannulas

Definitions

• Figures 6a and 6b comprise a flow chart illustrating a surgical procedure in accordance with the present invention
• Figure 15 is a partial plan view of a releasable guide in accordance with the embodiment illustrated in Figure 10;
• Figure 29 is a perspective view of the clamp of Figure 28 disposed in another operational configuration according to one embodiment of the present invention.
• Figure 30 is a perspective view of the clamp of Figure 28 disposed in another operational configuration according to one embodiment of the present invention.
• the superior channel 11 may be about 2-2.5 mm in diameter with an internal bore of sufficient size to accommodate a cardiac lead 21 of diameter up to approximately 2 mm in diameter.
• the suction pod 17 includes a flexible, resilient suction cup 19, as shown in Figure 4, that may be mounted in alignment with the closed channel 9 which serves as the vacuum channel, or may be mounted in skewed orientation thereto for convenient positioning of the surface electrodes 8, 12 about the epicardium.
• Each of the surface electrodes 8, 12 is connected to a conductor 22, 24 that extends along the vacuum channel 9 to a proximal location at which a diagnostic instrument of conventional design such as a cardiac pace/sense analyzer (PSA), for example, may be connected.
• PSA cardiac pace/sense analyzer
• the suction pod 17 is temporarily affixed to the epicardium in response to suction applied to the porous face 19 of the suction pod 17 under control of a suction valve 15, with the surface electrodes 8, 12 carried on the distal face of the suction cup disposed in contact with epicardium at a test site.
• the cardiac lead 21 may then be advanced and rotated from the proximal end to anchor the distal end 25 into the myocardium at an accurately positioned surgical site, all within the visual field of the endoscope 29 through the transparent tip 31.
• the insertion cannula 10 may be configured to facilitate deforming the epicardial surface in order to achieve pe ⁇ endicular entry of the distal end 25 of a cardiac lead 21 into the myocardium, as illustrated in Figure 3.
• the suction pod 17 of the insertion cannula 10 temporarily attaches to the epicardial surface upon application of vacuum under control of the valve 15. Downward pressure can be exerted on the epicardial surface via the substantially rigid insertion cannula 10.
• the pliable myocardium thus deforms to create a surface ledge 100 distal to the suction pod 17 oriented perpendicular to the axis of the superior instrument channel 11 of the insertion cannula 10, as illustrated in Figure 3.
• the distal end electrode 25 enters the myocardium generally pe ⁇ endicularly to the epicardial surface as thus deformed for desirable lead placement.
• the guide channel formed by segments 85, 87 is retained in substantially parallel axial alignment with the suction tube 81 as the suction pod 91 and the distal end of the guide channel are relatively slidably positioned near and against the epicardium of a patient's heart.
• the assembly of guide tube 83 and suction tube 81 and guide channel 85, 87 may all be disposed within the instrument channel of an endoscopic cannula 101 having a distal end disposed to facilitate endoscopic viewing of the suction pod 91 and the distal end of the guide channel 85, 87.
• the upper and lower segment 85, 87 of the guide channel may include stepped flanges 103, 105 at the proximal ends thereof, as illustrated in Figures 15, 18 and 19, to facilitate positive orientation of the upper and lower segments 85, 87 in the closed configuration until the upper segment 87 is slid proximally, or slid proximally and rotated, relative to the lower segment 85 in order to re-configure the guide channel in the alternate configuration of an elongated open slot along the entire length thereof.
• the upper 87 segment can be rotated in the lower segment 85 from the closed configuration in order to align the respective elongated slots sufficiently to release a cardiac lead 89 from within the guide channel.

Landscapes

• Health & Medical Sciences (AREA)
• Surgery (AREA)
• Life Sciences & Earth Sciences (AREA)
• Medical Informatics (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Engineering & Computer Science (AREA)
• Biomedical Technology (AREA)
• Heart & Thoracic Surgery (AREA)
• Pathology (AREA)
• Molecular Biology (AREA)
• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
• Public Health (AREA)
• Veterinary Medicine (AREA)
• Surgical Instruments (AREA)
• Electrotherapy Devices (AREA)

Applications Claiming Priority (2)

Publications (2)

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• 2004
  • 2004-10-19 EP EP04795673A patent/EP1689486A4/de not_active Withdrawn
  • 2004-10-19 JP JP2006538086A patent/JP2007509702A/ja active Pending

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