US20130072758A1 - Vessel retractor - Google Patents
Vessel retractor Download PDFInfo
- Publication number
- US20130072758A1 US20130072758A1 US13/417,161 US201213417161A US2013072758A1 US 20130072758 A1 US20130072758 A1 US 20130072758A1 US 201213417161 A US201213417161 A US 201213417161A US 2013072758 A1 US2013072758 A1 US 2013072758A1
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- US
- United States
- Prior art keywords
- cannula
- retractor
- tip
- vessel
- cradle
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/313—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes
- A61B1/3137—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes for examination of the interior of blood vessels
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/32—Devices for opening or enlarging the visual field, e.g. of a tube of the body
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00008—Vein tendon strippers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00743—Type of operation; Specification of treatment sites
- A61B2017/00778—Operations on blood vessels
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B2017/320044—Blunt dissectors
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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
- A61B2017/3454—Details of tips
- A61B2017/3456—Details of tips blunt
Definitions
- This invention relates to a cannula used for vessel retraction, and more particularly to a cannula and method for retracting a vessel during dissection and transection.
- a properly configured tip can provide important functionality to a cannula.
- the functions of vessel dissection and transection are commonly performed by two separate instruments.
- the device described in the pending application Ser. No. 08/907,691, entitled “Tissue Separation Cannula with Dissection Probe and Method,” filed on Aug. 8, 1997 discloses a device for separating surrounding connective tissue from a vessel (dissection).
- the device described in the pending application Ser. No. 09/102,723, entitled Vessel Isolating Retractor Cannula and Method,” filed on Jun. 22, 1998 discloses a device for retracting the vessel, ligating side branches, and transecting the branches to allow removal of the vessel. It is desirable to use a single device for performing the above functions.
- a cannula tip also affects the visual field provided to a surgeon through an endoscope.
- an endoscope When an endoscope is situated in a lumen of the cannula, the surgeon looks through the endoscope and through the transparent tip to view the surgical site. It is desirable to have a tip which maximizes the visual field of the endoscope.
- the cannula tip may also be used to dilate a tunnel or anatomical space through tissue planes.
- a cannula is constructed with a bulbous element near the tip of the cannula for performing tissue dilation as the cannula is advanced.
- Cannula tips for dilating tunnels through tissue require force in order to advance the cannula and dilate the tissue. It is desirable to have a tip which can perform tissue dilation or dissection using a minimal amount of force and causing minimal trauma.
- a tissue retractor is positioned within a cannula with a dissection cradle end of the retractor positioned at the distal end of the cannula.
- the retractor includes a first portion that has an axis approximately parallel to a central axis of the cannula, and a second portion that has an axis which is at an angle with respect to the central axis of the cannula.
- the dissection cradle is located at the distal end of the second portion of the retractor.
- the retractor includes two legs having substantially parallel axes that selectively protrude from the distal end of the cannula.
- the protruding legs support the dissection cradle formed in the shape of a loop that is positioned in a plane skewed relative to the axes of the legs, with a bottom of the loop directed away from the cannula.
- the surgeon when the surgeon locates a vein and side branch of interest, the surgeon extends the retractor to cradle the vein in the dissection cradle. Once cradled, the retractor may be fully extended to urge the vein away from the axis of the cannula, causing the side branch to be isolated and exposed to a surgical tool. The surgical tool may then be extended from within the cannula to operate on the isolated and exposed side branch.
- the top of the loop of the dissection cradle is flat and thin, allowing atraumatic support of the vein, and minimizing contact between the retractor and the surgical tool.
- the retractor includes a single leg with the loop formed by the one leg of the retractor, and with a stopper coupled to the distal end of the retractor.
- the cannula comprises a sliding tube which encases the retractor, and in a first position is extended out to encase the second portion of the retractor, and in a second position is extended to encase only the first portion of the retractor.
- the second and first portions of the retractor are both approximately parallel to the axis of the cannula.
- the second portion of the retractor is skewed relative to the axis of the cannula.
- a removable, transparent tip is positioned at the distal end of the cannula to provide a single cannula for performing dissection and transection.
- the tip seals the distal end of the cannula in a fluid resistant manner.
- the tip is conical and ends in a sharp interior point and a slightly rounded exterior point which allows the surgeon to bluntly dissect tissue in the area of interest under endoscopic visualization.
- tissue dissection is complete, the surgeon can remove the tip from the cannula, and the surgeon is now able to use the cannula to transect side branches and vessel ends.
- the tip is configured to allow the apex of the tip to be aligned with the central axis of the endoscope.
- a distal end of the tip is tilted in an oblique fashion to allow the apex of the tip to align with or near to the central axis of the endoscope.
- the conical end of the tip has unequal taper angles relative to a plane of transition between the cylindrical and conical portions of the tip, thus skewing the position of the apex of the tip into alignment with or near to the central axis of the endoscope.
- wing-like protrusions are provided about the cannula near the tip to dilate tissue surrounding the vessel of interest.
- the wing-like protrusions are diametrically aligned in a planar configuration with tapered forward edges extending rearward from near the apex of the tip. The planar configuration of the wing-like dilating protrusions near the tip substantially reduces the resistive force encountered during advancement of the cannula through tissue.
- the wing-like protrusions are positioned on opposite sides of the tip to dissect tissue to form a cavity that may attain a round cross-section under insufflation, thus providing the same resultant tissue dilation as provided by a solid oval dilator, but with less force required to accomplish the tissue dilation.
- the leading edges of the wing-like protrusions are curved in a parabolic configuration away from the distal end of the cannula to provide the necessary dilation.
- FIG. 1 is a perspective view of a preferred embodiment of cannula 100 showing retractor 112 in an extended position.
- FIG. 2 a is a cut-away side view of retractor 112 and cannula 100 .
- FIG. 2 b is a top view of retractor 112 .
- FIG. 3 a is a perspective side view of cannula 100 with a sapphenous vein positioned within the cradle 116 .
- FIG. 3 b is a perspective side view of the distal end 122 of cannula 100 in an embodiment in which an endoscope 126 and a surgical tool 120 are present and partially extended.
- FIG. 3 c is a front view of the distal end 122 of cannula 100 in which the surgical tool 120 and the retractor 116 are partially extended, and an endoscope 126 is present.
- FIG. 4 a is a cut-away top view of cannula 100 .
- FIG. 4 b is a cut-away side view of cannula 100 .
- FIG. 5 a is a cut-away view of a sliding tube embodiment of cannula 100 in a first position.
- FIG. 5 b is a cut-away view of the sliding tube embodiment of FIG. 5 a in a second position.
- FIG. 6 a is a cut-away view of an embodiment of cannula 100 having an angling device 140 .
- FIG. 6 b is a cut-away side view of the apparatus illustrated in FIG. 6 a in which the retractor 112 is extended and the angling device 140 is actuated.
- FIG. 6 c is a cut-away side view of the angling device embodiment in which the angling device 140 is in a separate lumen from the retractor 112 .
- FIG. 7 a is a cut-away side view of a twistable retractor 112 in a straight position.
- FIG. 7 b is a side view of the retractor 112 of FIG. 7 a.
- FIG. 7 c is a cut-away side view of twistable retractor 112 in a crossed position.
- FIG. 7 d is a side view of the retractor 112 of FIG. 7 c.
- FIG. 8 a is a cut-away side view of the handle 104 .
- FIG. 8 b is a cut-away side view of an alternate embodiment of handle 104 .
- FIG. 9 a is a side view of cradle 116 .
- FIG. 9 b illustrates a first alternate embodiment of cradle 116 .
- FIG. 9 c illustrates multiple views of a second alternate embodiment of cradle 116 .
- FIG. 9 d illustrates multiple views of a third alternate embodiment of cradle 116 .
- FIG. 9 e illustrates multiple views of a fourth alternate embodiment of cradle 116 .
- FIG. 9 f illustrates multiple views of a fifth alternate embodiment of cradle 116 .
- FIG. 9 g illustrates multiple views of an embodiment of cradle 116 having a spur.
- FIG. 10 a illustrates a top view of an embodiment of the cradle 116 of FIG. 9 c without a “C” ring.
- FIG. 10 b illustrates a side view of the cradle 116 of FIG. 10 a.
- FIG. 10 c illustrates a top view of the cradle 116 of FIG. 9 c with the “C” ring attached.
- FIG. 10 d illustrates a side view of the cradle 116 of FIG. 10 c.
- FIG. 11 a illustrates a cut-away side view of a tip 1100 in a cannula housing an endoscope 126 .
- FIG. 11 b illustrates a side view of the tip 1100 isolated from cannula 100 .
- FIG. 12 a illustrates a side view of an offset tip 1200 in accordance with the present invention.
- FIG. 12 b illustrates a cut-away side view of the offset tip 1200 in a cannula 100 housing an endoscope 126 .
- FIG. 12 c illustrates a cut-away side view of an alternate embodiment of offset tip 1200 .
- FIG. 13 illustrates a cut-away side view of an alternate embodiment of the offset tip 1300 .
- FIG. 14 a illustrates a perspective side view of the offset tip 1200 and mounting rod 1404 .
- FIG. 14 b illustrates a perspective side view of cannula 100 for housing offset tip 1200 and mounting rod 1404 .
- FIG. 14 c illustrates a perspective side view of offset tip housing 1424 at the proximal end of the cannula 100 .
- FIG. 14 d illustrates a perspective side view of cannula 100 with offset tip 1200 and offset tip housing 1424 .
- FIG. 14 e illustrates a perspective side view of an alternate embodiment of offset tip mount 1424 .
- FIG. 14 f illustrates a cut-away side view of the offset tip mounting 1424 of FIG. 14 e.
- FIG. 15 a illustrates a side view of an alternate embodiment of offset tip 1200 .
- FIG. 15 b illustrates a side view of a cannula 100 modified for use with the offset tip 1200 of FIG. 15 a.
- FIG. 16 is a flow chart illustrating a method of dissecting and transecting vessels according to the present invention.
- FIG. 17 a illustrates a top view of an embodiment of an offset tip dilator 1700 according to the present invention.
- FIG. 17 b illustrates a side view of the embodiment of offset tip dilator 1716 of FIG. 17 a.
- FIG. 17 c illustrates a top view of an alternate embodiment of offset tip dilator 1700 .
- FIG. 18 is a flow chart illustrating a method of dilating tissue in accordance with the present invention.
- FIG. 1 illustrates a perspective view of a preferred embodiment of cannula 100 showing retractor 112 in an extended position.
- Cannula 100 includes an outer housing 102 of bioinert material such as polymed UD that may be approximately 12′′ to 18′′ in length.
- the proximal end of the cannula 100 is disposed in handle 104 that includes a button 106 which is coupled to retractor 112 for controlling the translational movement of retractor 112 , as described in more detail below.
- retractor 112 is formed of resilient wire which has a smooth bend intermediate to a first portion 110 and a second portion 114 of the retractor.
- the retractor 112 is described as having two portions for ease of description, although the retractor 112 may be formed as an integrated structure. However, retractor 112 may also be manufactured from two separate portions 110 , 114 that are coupled together.
- the first portion 110 of the retractor 112 is positioned within the cannula 100 with the axis 111 of the first portion 110 approximately parallel to the axis 101 of the cannula 100 .
- the second portion 114 is positioned to bend away from the central axis 101 of the cannula.
- the angle 117 of displacement between the axis 115 of the second portion and the central axis 101 of cannula 100 may be any angle from zero to 180 degrees.
- the second portion 114 includes a dissection cradle 116 at the distal end of the second portion 114 .
- the retractor 112 may be formed of bioinert material such as stainless steel, or a polymer such as nylon or polyetherimide, or other appropriately strong and resilient plastic.
- the retractor 112 includes a coating for lubrication, insulation, and low visual glare using, for example, parylene or nylon 11.
- FIG. 2 b illustrates the retractor 112 formed with two legs.
- the legs 141 , 142 of the retractor 112 at the distal end form the dissection cradle 116 in a loop or “U” shape, as shown in FIG. 2 a .
- the top portion 144 of the U-shaped bend is preferably flattened to provide additional surface area for atraumatically supporting a vein 118 or vessel of interest.
- the side arches 128 of the dissection cradle 116 are used for skeletonizing or dissecting the vein from the surrounding tissues, as well as acting as walls to keep the vessel captured within the arch.
- the several embodiments of dissection cradle 116 are described in more detail below.
- FIG. 3 a illustrates a perspective view of the cannula 100 in accordance with the present invention with the retractor fully extended, holding a sapphenous vein 118 , and also illustrates an external surgical tool 120 disposed adjacent the cannula 100 for performing a surgical operation, for example, severing a tributary or side branch of the vein 118 .
- the vein is positioned within the side arches 128 of the cradle 116 .
- the dissection cradle 116 may be used to cradle a vein, vessel, tissue or organ of interest, and surgical tool 120 may be any surgical tool suitable for performing a surgical procedure near the dissection cradle 116 .
- FIG. 3 b illustrates a perspective view of cannula 100 in an embodiment in which the surgical tool 120 is positioned within the cannula 100 , and an endoscope 126 is present.
- cradle 116 preferably overlays the endoscope 126 with sufficient clearance to facilitate relative movements thereof.
- the endoscope may also be located adjacent the surgical tool 120 .
- endoscope 126 is positioned with cannula 100 to allow a clear field of view upon extension of the retractor 112 .
- Surgical tool 120 is illustrated as cauterizing scissors, used to sever a tributary or side branch of a sapphenous vein 118 .
- surgical tool 120 is maximally displaced from the cradle 116 at the cannula end 122 . More specifically, as shown in FIG. 3 c , the “U”-shaped loop 129 of the cradle 116 is closest to the surgical tool 120 . This ensures that a vein 118 or other tissue of interest is retracted away from the surgical tool 120 to facilitate manipulating the surgical tool 120 relative to the side branch or other tissue.
- FIG. 4 a is a cut-away top view of cannula 100 .
- the retractor 112 is slidably positioned within minor lumens 113 along the length of the cannula 100 within close tolerances in order to position the retractor 112 stably within the cannula 100 .
- retractor legs 141 , 142 are approximately 0.045 inches in diameter and the lumens 113 encasing the legs 141 , 142 are approximately 0.080 inches in diameter, as friction between the legs of the retractor 112 and the lumens 113 holds the retractor stably within the cannula.
- This configuration restricts rotational movement of the retractor to provide more stable retraction as compared with conventional retractors.
- the legs 141 , 142 of the retractor 112 are formed of flexible, resilient material and are retained within the lumen 113 in substantially straight or flat orientation, but may return to a material bend or curve, as illustrated in FIG. 5 a , as the retractor 112 is extended from the distal end of the cannula 100 .
- the leg 141 of the retractor 112 passes through a sliding gas or fluid seal 130 at the proximal end of the lumen 113 .
- the leg 141 of the retractor 112 passes out of the cannula 100 and into handle 104 for attachment to a slider button 106 for facilitating translational movement of the retractor 112 from the proximal or handle end of the cannula 100 .
- other types of control devices such as knobs, grips, finger pads, and the like may be linked in conventional ways to the retractor 112 in order to manually control the translational movement of retractor 112 .
- the proximal end of leg 141 is bent relative to the axis of the cannula, and the button 106 is attached to the bent position of the leg 141 to facilitate moving the button 106 and the retractor 112 translationally under manual control.
- the button 106 preferably includes lateral grooves to prevent finger or thumb slippage during sliding manipulation of the retractor 112 .
- a user actuates the slider button 106 to extend retractor 112 out of the lumen 113 at the distal end of the cannula 100 .
- the resilient retractor 112 is formed in a smooth bend, as shown in FIG. 2 a , and gradually deflects away from the central axis 101 of the cannula 100 as the retractor is extended.
- the vessel Upon encountering the target vessel or tissue of interest, the vessel is restrained in the cradle 116 , and a lateral resilient force is exerted on the target vessel in a direction away from the cannula.
- the vessel is thus pushed away from the axis of the cannula 100 , isolating it from surrounding tissue or adjacent vessels such as tributaries or side branches.
- a surgical tool 120 such as cauterizing scissors may be safely employed to operate on the tributary without harming the sapphenous vein 118 .
- the retractor 112 is again resiliently straightened or flattened.
- a sliding tube 132 is added to provide operational versatility to cannula 100 .
- the sliding tube 132 In a first position, the sliding tube 132 is retracted and the retractor 112 protrudes from the distal end at an angle with respect to the central axis 101 of the cannula 100 .
- the sliding tube 132 In a second position, the sliding tube 132 is extended out, temporarily straightening the retractor 112 .
- a sliding tube 132 in a first position encases the retractor 112 up to the point at which the retractor 112 curves away from the central axis 101 of the cannula thus allowing the retractor 112 to displace and isolate a target vessel.
- the proximal end of the sliding tube 132 is linked to button 107 for translationally moving retractor 112 as well as actuating the sliding tube 132 .
- the sliding tube 132 is in a first position with the button 107 in an upright position.
- a spring 134 is coupled between a support structure 135 and the proximal end 137 of the sliding tube 132 . In the first position of sliding tube 132 , the spring 134 is extended fully and exerts little or no force on the sliding tube 132 .
- sliding tube 132 may be manually manipulated without linkage to a button 107 .
- button 107 is pushed down. As illustrated in FIG. 5 b , the button 107 has a cam surface 136 which pushes on the proximal end 137 of the sliding tube 132 as the button 107 is pressed.
- the sliding tube 132 is pushed forward, overcoming the resilient force of spring 134 , to encase the retractor 112 and decrease angle 117 between the distal end of the retractor 112 and the central axis 101 of the cannula 100 .
- the spring force urges the proximal end 137 of the sliding tube 132 back toward the first position against button 107 .
- the sliding tube 132 is formed of material having sufficient strength to force the retractor 112 to straighten out the angle 117
- the retractor 112 is formed of resilient material having a sufficient flexibility to straighten out the angle 117 in response to a tube 132 being slid over the retractor 112 , but having sufficient rigidity to cradle and dissect a target vessel. Resiliency of the retractor 112 ensures return to the downwardly-curved shape after being released from tube 132 .
- a manual actuator may be configured in other ways than button 107 to extend the sliding tube 132 in response, for example, to being pulled up instead of pushed down.
- FIGS. 6 a and 6 b Another embodiment employs a retractor 112 which has a naturally straight shape.
- an angling device 140 is disposed between the distal end of the retractor 112 and the proximal end of the cannula.
- the angling device 140 may be positioned within the same lumens 113 as the retractor 112 and preferably may comprise two wires coupled to points below the cradle 116 of the retractor 112 substantially in parallel positions on each of the legs 141 , 142 .
- the angling device 140 Upon extending the retractor 112 using button 106 , the angling device 140 is extended with the retractor 112 .
- the angling device 140 is coupled to a handle 145 at the proximal end of the cannula 100 to facilitate establishing an angle in the retractor 112 by pulling with a backward force on the angling device 140 .
- the angling device 140 is actuated and a bend is created in the retractor 112 as the backward force exerted on the distal end of the retractor is exerted against the relatively fixed position of the retractor legs 141 , 142 disposed within the lumens 113 .
- the angling device 140 may also be located in a separate lumen 202 from the retractor 112 with part of the angling device 140 positioned outside of the cannula 100 when the retractor 112 is in the retracted position.
- FIG. 7 a illustrates another embodiment of cannula 100 in which the retractor 112 is pre-formed with one leg 141 of the retractor 112 bent at an angle at its proximal end skewed to the axis of the distal end of the other leg 142 .
- the bent portion of the leg 141 may be linked to a sliding knob 147 for convenient manual manipulation of this embodiment of the invention.
- the knob 147 Upon sliding the knob 147 , the leg 142 coupled to knob 147 is twisted rotationally.
- the two legs 141 , 142 of retractor 112 are coupled together via cradle 116 .
- the axis of the second portion of the retractor 112 in the first position is at a first angle 117 to the axis of the cannula 100 , as shown in FIG. 7 b .
- leg 141 is rotated and crosses under leg 142 , as shown in FIG. 7 c .
- This causes cradle 116 to flip 180 degrees and bends the retractor 112 at a second angle 119 , as shown in FIG. 7 d .
- the vessel is transported to the other side of the cannula 100 . This allows the user to isolate the vessel by simply actuating knob 147 .
- FIG. 8 a illustrates a cut-away side view of button 106 on the handle 104 of cannula 100 , with an endoscope 126 positioned within cannula 100 .
- button 106 is coupled to one leg 141 of the proximal end of retractor 112 . Sliding the button 106 in groove 146 translationally moves the retractor 112 . Groove 146 is preferably minimally wider than the shaft of button 106 to minimize excessive horizontal movement of button 106 while still allowing smooth translational movement of button 106 .
- the button 106 may include locking or ratcheting teeth 152 to give tactile feedback of its location, and to positively retain the button and the associated leg 141 in an extended or retracted position.
- button 106 is released and is retained place by the engaged teeth 148 , 152 .
- FIG. 9 a illustrates a top view of cradle 116 in an embodiment in which the cradle 116 is formed by two legs 141 , 142 of retractor 112 .
- the distal end of the legs form “U”-shaped side guides.
- the top 144 of the distal portion of the “U” is preferably flattened. This provides atraumatic support for the target vessel retained within cradle 116 . Additionally, by minimizing the thickness of distal portion 144 , contact with other devices in close proximity with retractor 112 is minimized.
- the cradle 116 may have other effective shapes, for example, as illustrated in FIG. 9 b in which a “C” ring element is attached to legs of the cradle 116 .
- the “C” ring may have a small hole 200 in one side with an axis approximately parallel to the axis of the retractor 112 . This hole 200 is used to hold suture or other ligating materials, and may also be used as a knot pusher.
- FIGS. 10 a and 10 b in an alternate embodiment of the embodiment of FIG.
- the retractor 112 is formed and flattened and a “C”-shaped ring is coupled to the retractor 112 by, for example, gluing or molding the “C” ring to the distal end of the retractor 112 , as shown in FIGS. 10 c and 10 d.
- the side guides of the cradle may include a loop 129 in a “V” shape, an arced “U” shape, or a semi-circular shape.
- the retractor 112 has only one leg 141 , and the cradle 116 is formed by the leg 141 .
- a stopper 160 is coupled to the end of the leg 141 to serve as a guide to retain the target vessel, and add a blunt surface to the end of the wire, for example, for pushing and probing tissue.
- 9 g illustrates a retractor 112 having a spur 204 formed in one or both legs 141 , 142 for allowing the retractor 112 to be used for dissection.
- Sinusoidal, half-sinusoidal, and other geometric configurations may be used equally effectively as the shape of loop 129 in accordance with the present invention.
- FIG. 11 a illustrates a tip 1100 for use with a multi-lumen cannula 100 housing an endoscope 126 .
- the tapered tip 1100 may be removed from, and reattached to the distal end of a cannula 100 , as desired. Upon attachment, the tip 1100 seals the distal end of a cannula 100 in a fluid-tight manner.
- the tip 1100 is configured to provide dissection of the tissue surrounding the vessel of interest, and has a distal radius of approximately 0.045′′ to reduce the hazard of penetrating the vessel of interest.
- the inner surface of the tip 1100 tapers to a sharp interior point and a slightly rounded exterior point and the tip 1100 has a uniform wall thickness.
- the tip 1100 preferably has taper angles of approximately 15° which provides a maximal, undistorted, visual field through an endoscope 126 .
- the tip 1100 tapers outward to a maximal diameter of about 123 ⁇ 4 mm at its shoulder to cover the cannula 100 body which also has a diameter of about 123 ⁇ 4 mm. All of these features allow the tip 1100 to effectively dissect tissue.
- the tip 1100 of FIG. 11 a has a central axis 1150 aligned with the central axis 1108 of the cannula 100 .
- the visual field provided by the endoscope 126 although satisfactory for surgical procedures, is not complete because the endoscope 126 is in a lumen that is offset from the central axis 1108 of the cannula 100 .
- the endoscope 126 is offset because of the space required inside the cannula 100 for housing retractors and other instruments in adjacent lumens.
- FIG. 11 b illustrates this tip 1100 detached from the cannula 100
- FIG. 12 a illustrates an offset tip 1200 for a cannula 100 in accordance with the present invention.
- the offset tip 1200 is a transparent, tapered tip as described above for use in endoscopic dissection of a vessel.
- the axis 1250 of the tip 1200 is skewed relative to the central axis 1108 of the cannula 100 .
- the axis 1250 of the tip 1200 is skewed approximately 8°, an angle that is chosen to align the apex 1232 of the tip 1200 with a central axis 1112 of the endoscope 126 , as shown in more detail in FIG. 12 b.
- FIG. 12 b illustrates the offset tip 1200 housed in cannula 100 in more detail.
- the cannula 100 houses a 5 mm endoscope 126 having a central axis 1112 eccentric to the central axis 1108 of the cannula 100 .
- the tapered tip 1200 is tilted or inclined by approximately 8° toward the lumen housing the endoscope 126 . This allows the apex 1232 of the tip 1200 to approximately intersect with the central axis 1112 of the endoscope 126 .
- FIG. 12 b illustrates the offset tip 1200 housed in cannula 100 in more detail.
- the cannula 100 houses a 5 mm endoscope 126 having a central axis 1112 eccentric to the central axis 1108 of the cannula 100 .
- the tapered tip 1200 is tilted or inclined by approximately 8° toward the lumen housing the endoscope 126 . This allows the apex 1232 of the tip 1200 to approximately
- the tip 1200 is inclined toward the central axis 1112 of the endoscope 126 without altering the taper angles 1236 and 1240 of the side walls. This is accomplished by forming a transition 1228 between the proximal or cylindrical portion 1204 of the tip 1200 and the distal or conical portion of the cannula body 1208 of the tip 1200 substantially along a plane 1230 that is skewed from normal to the central axis 1108 of the cannula 100 .
- the distal portion 1208 of the tip 1200 retains its conical shape and equal taper angles 1228 , 1236 between the side walls and the transition plane.
- the slight extension of the cannula body at the transition plane provides sufficient incline to allow the apex 1232 of the tip 1200 to intersect the central axis 1112 of the endoscope 126 .
- the tip 1200 may be formed of separate conical and cylindrical parts that are attached together, or the tip 1200 may be formed as an integrated structure in the shape thus described.
- the tip 1200 is inclined at a lesser angle, for example, 5 degrees, toward the axis 1112 of the endoscope 126 , positioning the axis 1250 of the distal end 1232 of the tip 1200 intermediate between the central axis 1108 of the cannula 100 and the axis 1112 of the endoscope 126 . Positioning the axis 1250 of the tip 1200 to this intermediate point allows the retention of steep conical angles in the tip 1200 which allow for easier advancement of the cannula 100 while using a minimal amount of force. The intermediate positioning also provides a more complete visual field as seen through endoscope 126 .
- FIG. 13 An alternate embodiment of an offset tip 1200 is shown in FIG. 13 in which the taper angles 1320 , 1324 of the side walls are selected to form the apex 1328 of the tip 1200 aligned with the central axis 1112 of the endoscope 126 .
- the lower region 1316 of the cylindrical part 1304 extends beyond the upper region 1312 of the cylindrical part at a plane of transition between cylindrical and tapered regions of the tip.
- the taper angles 1320 , 1324 are not equal and the thirty degree angled conical configuration of the tapered part 1308 is not maintained.
- the lower taper angle 1324 is increased to an obtuse angle and the upper taper angle 1320 is a reduced acute angle relative to the plane of transition between the cylindrical and tapered portions of the tip.
- the apex 1328 of the tip 1200 aligns with the central axis 1112 of the endoscope 126 .
- a tip 1200 is provided which allows a maximal visual field to be viewed by the surgeon via the endoscope 126 that is eccentric the central axis 1108 of the cannula 100 , but that is aligned with or near to the apex 1232 of the tip 1200 .
- FIG. 14 a illustrates a perspective side view of the offset tip 1200 and mounting rod 1404 .
- the tip 1200 is attached to the cannula 100 via the long rod 1404 which extends through an eccentric lumen of the cannula 100 , as shown in FIG. 14 b , and the apex of the tip 1200 is tilted away from the rod 1404 and towards the endoscopic lumen (not shown).
- the elongated rod 1404 may be attached to the tip 1200 , or may be constructed as an integral part of the tip 1200 .
- the elongated rod 1404 preferably is secured in housing 1424 , shown in FIG.
- the housing 1424 includes a slot 1420 configured to slip over the light cable outlet 1428 on the endoscope 126 as assembled within the cannula 100 .
- the housing 1424 preferably contains a rotating nut 1416 which accepts the threaded proximal end 1408 of the rod 1404 .
- the housing 1424 prevents the cannula 100 from rotating about the endoscope 126 by holding the endoscope 126 fixed with respect to the handle 1412 . This allows the operator to maintain the correct orientation of the endoscope 126 on the vessel. If the endoscope 126 is allowed to rotate freely, the image may turn sideways or upside down without the operator realizing it, and injury may occur to the vessel if the cannula 100 is advanced in the wrong direction.
- the elongated rod 1404 slips into the housing 1424 via a groove 1450 near its proximal end, and passes through the main hole 1454 in the housing 1424 .
- the groove 1450 allows for the housing 1424 to cover the proximal end of the mounting rod 1404 without completely clearing the most proximal tip of the mounting rod 1404 . This allows more room for attaching the housing 1424 which lies between the elongated rod 1404 and additional optical components.
- the rod 1404 may contain an elastic section, or the rod 1404 may be somewhat elastic along its entire length to facilitate stretching the rod 1404 and pulling it into position in the slot 1454 on the housing 1424 , while locking the tip 1200 in place. The elastic force also facilitates sealing the tip 1200 against the distal face of the cannula body.
- FIGS. 15 a and 15 b illustrates an alternate embodiment of offset tip 1200 and cannula 100 .
- offset tip 1200 is formed with an elongated case 1500 which slides over the cannula body 100 and locks to the proximal end of cannula 100 .
- proximal end of cannula 100 is threaded and allows a threaded proximal section of elongated case 1500 to mate securely to the cannula 100 .
- the surgeon first incises 1600 the skin overlying a vessel of interest to expose the vessel as an initial step of the procedure illustrated in the flow chart of FIG. 16 .
- a scissor tool is inserted 1602 into the incision to create a path to the vessel by dissecting the overlying tissue.
- the tip 1200 of the cannula 100 is inserted 1604 into the incision to bluntly dissect tissue to form an initial tunnel along the vessel from the incision.
- the incision is then sealed 1608 using a blunt tip trocar and a tunnel is insufflated 1612 .
- the cannula is advanced 1616 along the vessel to dissect tissue adjacent the vessel under endoscopic visualization through the transparent tip.
- the offset tip 1200 with the apex thereof in alignment with the endoscope 126 provides a full visual field for the surgeon as the cannula 100 is advanced.
- the conical end of the tip 1200 dissects the tissue as the cannula 100 is advanced along the vessel.
- the surgeon dissects both on the anterior and posterior sides of the vessel to create a full 360 degree tunnel around the vessel.
- the cannula 100 is removed 1620 from the incision seal and the tip 1200 is removed 1624 from the cannula 100 .
- the tip 1200 is removed by unscrewing the threaded portion 1408 of the rod 1404 from the rotating nut 1416 .
- the tip housing 1424 itself is also removed in this embodiment.
- Insufflation is maintained and the cannula 100 without tip 1200 is inserted 1628 into the seal into the tunnel adjacent the vessel.
- Transecting devices are then inserted 1630 into the cannula 100 .
- the cannula 100 can now be used for transecting 1632 side branches and the ends of the vessel of interest using endoscopic instruments that are selectively installed and removed within instrument lumens in the cannula body 100 . After these procedures are completed, the vessel may be removed 1636 .
- FIG. 17 a illustrates another embodiment of an offset tip dilator 1700 .
- the tip 1700 also includes wing-like protrusions for enlarging or dilating a peri-vascular cavity in the course of separating a vessel from adjacent connective tissue.
- tissue dissection with an offset tip 1200 to form a tunnel or working cavity adjacent a target vessel by dissecting along the anterior and posterior sides of the vessel the cannula 100 is removed from the distal end of the body, the offset tip 1200 is detached, and a second tip 1700 is attached to the distal end of the cannula body 100 .
- the second tip 1700 includes a transparent tapered tip with planar wing-like protrusions or extensions disposed proximal to the distal end 1720 of the tip 1700 .
- the wing-like protrusions 1702 , 1704 each include a swept back leading edge. As shown in FIG. 17 b , the tip 1200 is tilted away from the mounting rod 1404 to align with the central axis of an endoscopic lumen (not shown).
- the wing-like protrusions 1702 , 1704 may also include curved distal and proximal edges, for example, in a parabolic configuration as shown in FIG. 17 c , providing a smoother withdrawal of the cannula 100 from the insufflated tunnel.
- the tip 1700 attaches to the cannula body 100 in the same manner as previously described with reference to the offset tip 1200 , with an elongated rod 1404 extending through a lumen of the cannula 100 and locking at the proximal end of the handle 1412 .
- the cannula 100 may thus be advanced through tissue under full-field endoscopic visualization through the tapered tip 1720 with the wing-like protrusions 1702 , 1704 extending substantially diametrically to facilitate tunnel dilation.
- the wing-like protrusions 1702 , 1704 of the tip 1700 are arranged in substantially planar geometry in contrast to the solid bulbous, oval element described above.
- the planar configuration of the wing-like protrusions 1702 , 1704 substantially reduce the frontal profile of the dilator required to penetrate tissue, and thus reduces the resistive force encountered during advancement of the cannula 100 through tissue.
- the tissue-dilating force is exerted on tissue surrounding the cavity in a bilateral, substantially planar orientation by the outer edges of the wing-like protrusions 1702 , 1704 that dissect tissue forming the cavity walls
- the dilated cavity may retain a round cross-section for example, within an insufflated cavity, in the same manner as if tissue dilation was performed using a solid oval dilator that applies dilating force circumferentially.
- FIG. 18 illustrates a method of dilating tissue in accordance with one method embodiment of the present invention.
- the skin is incised 1800 overlying the vessel of interest, and the scissor tool is inserted into the incision to create a path to the vessel by dissecting the overlying tissue.
- the incision is then bluntly dissected 1804 using the offset tip 1200 to expose the vessel surface.
- the incision is sealed 1808 and a tunnel is insufflated 1812 .
- the cannula 100 is advanced 1816 along the vessel under endoscopic visualization through the transparent tip 1200 .
- the cannula 100 is removed 1820 and the incision seal is removed or slid backwards to the proximal end of the cannula 100 .
- the offset tip 1200 is then replaced 1824 with the dilating tip 1700 .
- the seal is reinserted and the incision is sealed 1826 .
- the cannula 100 is advanced 1828 and the cavity is further dilated responsive to the advancement of the planar wing-like protrusions 1702 , 1704 through tissue forming the tunnel walls.
- the cannula 100 is removed 1832 a second time, and the incision seal is again removed or slid backwards to the proximal end of the cannula 100 .
- the dilating tip is removed 1836 and the incision is sealed 1837 .
- Transection devices are loaded 1838 through instrument lumens within the cannula body 100 into the cannula 100 and the cannula 100 is then inserted 1839 back into the incision. Without any tip covering the distal end of the cannula 100 , the vessel side branches and ends are transected 1840 using endoscopic instruments, and the vessel is then removed 1844 from the dilated tunnel.
Abstract
A retractor and a surgical tool are positioned within a cannula, and a dissection cradle of the retractor is positioned at the distal end of the cannula. The retractor includes a first portion with an axis approximately parallel to the axis of the cannula and a second portion with an axis that can be skewed relative to the axis of the cannula. The dissection cradle is located at the distal end of the second portion of the retractor, and may include two substantially parallel, spaced legs with the retractor shaped in a loop between and in a plane skewed relative to the axes of the legs, and with the loop directed away from the surgical tool. Thus, in operation, a surgeon locates a vessel and side branch of interest and extends the retractor to cradle the vessel in the dissection cradle. Once cradled, the retractor may be deflected to urge the vessel away from the axis of the cannula to isolate the side branch for exposure to the surgical tool. Removable, transparent tips are selectively positioned at the distal end of the cannula for performing dissection and transection via a single cannula. Additionally, the tips are configured to align the apices of the tips with the central axis of the endoscope to maximize the visual field through the tips via the endoscope. Wing-like protrusions on an alternate tip for the cannula facilitate tissue dissection in forming a tunnel in tissue along a target vessel. Swept back forward edges on the wing-like protrusions promote easy tissue dissection using reduced force to advance the cannula and alternate tip through tissue surrounding the target vessel.
Description
- The present application is a continuation of application Ser. No. 10/807,368, filed on Mar. 22, 2004, which is a continuation of application Ser. No. 10/218,475, filed on Aug. 12, 2002, now issued as U.S. Pat. No. 6,752,756, which is a continuation of application Ser. No. 09/490,552, filed Jan. 25, 2000, and now issued as U.S. Pat. No. 6,432,044, which is a continuation of Ser. No. 09/227,393, filed Jan. 8, 1999, now abandoned, which is a continuation-in-part application of application Ser. No. 09/102,723 filed on Jun. 22, 1998, now issued as U.S. Pat. No. 5,895,353 and the subject matter hereof is related to the subject matter of application Ser. No. 08/593,533 entitled “Tissue Separation Cannula” filed on Jan. 24, 1996 by Albert K. Chin, now abandoned, which is a continuation-in-part application of application Ser. No. 08/502,494, entitled “Tissue Separation Cannula And Method,” filed on Jul. 13, 1995, now abandoned, which prior applications are assigned to the same assignee as the present application and are incorporated herein in their entireties by this reference thereto.
- This invention relates to a cannula used for vessel retraction, and more particularly to a cannula and method for retracting a vessel during dissection and transection.
- One important component of a surgical cannula is the tip, disposed on the distal end of the cannula. A properly configured tip can provide important functionality to a cannula. For example, the functions of vessel dissection and transection are commonly performed by two separate instruments. The device described in the pending application Ser. No. 08/907,691, entitled “Tissue Separation Cannula with Dissection Probe and Method,” filed on Aug. 8, 1997, discloses a device for separating surrounding connective tissue from a vessel (dissection). The device described in the pending application Ser. No. 09/102,723, entitled Vessel Isolating Retractor Cannula and Method,” filed on Jun. 22, 1998, discloses a device for retracting the vessel, ligating side branches, and transecting the branches to allow removal of the vessel. It is desirable to use a single device for performing the above functions.
- The construction of a cannula tip also affects the visual field provided to a surgeon through an endoscope. When an endoscope is situated in a lumen of the cannula, the surgeon looks through the endoscope and through the transparent tip to view the surgical site. It is desirable to have a tip which maximizes the visual field of the endoscope.
- The cannula tip may also be used to dilate a tunnel or anatomical space through tissue planes. In pending application Ser. No. 09/133,136, entitled “TISSUE DISSECTOR APPARATUS AND METHOD,” filed Aug. 12, 1998, assigned to the same assignee as the present application, and which is hereby incorporated by reference, a cannula is constructed with a bulbous element near the tip of the cannula for performing tissue dilation as the cannula is advanced. Cannula tips for dilating tunnels through tissue require force in order to advance the cannula and dilate the tissue. It is desirable to have a tip which can perform tissue dilation or dissection using a minimal amount of force and causing minimal trauma.
- In accordance with the present invention, a tissue retractor is positioned within a cannula with a dissection cradle end of the retractor positioned at the distal end of the cannula. The retractor includes a first portion that has an axis approximately parallel to a central axis of the cannula, and a second portion that has an axis which is at an angle with respect to the central axis of the cannula. The dissection cradle is located at the distal end of the second portion of the retractor. In another embodiment, the retractor includes two legs having substantially parallel axes that selectively protrude from the distal end of the cannula. The protruding legs support the dissection cradle formed in the shape of a loop that is positioned in a plane skewed relative to the axes of the legs, with a bottom of the loop directed away from the cannula. Thus, in operation, when the surgeon locates a vein and side branch of interest, the surgeon extends the retractor to cradle the vein in the dissection cradle. Once cradled, the retractor may be fully extended to urge the vein away from the axis of the cannula, causing the side branch to be isolated and exposed to a surgical tool. The surgical tool may then be extended from within the cannula to operate on the isolated and exposed side branch.
- In another embodiment, the top of the loop of the dissection cradle is flat and thin, allowing atraumatic support of the vein, and minimizing contact between the retractor and the surgical tool. In yet a further embodiment, the retractor includes a single leg with the loop formed by the one leg of the retractor, and with a stopper coupled to the distal end of the retractor. In still another embodiment, the cannula comprises a sliding tube which encases the retractor, and in a first position is extended out to encase the second portion of the retractor, and in a second position is extended to encase only the first portion of the retractor. In response to the sliding tube being in the first position, the second and first portions of the retractor are both approximately parallel to the axis of the cannula. In response to the sliding tube being in the second position, the second portion of the retractor is skewed relative to the axis of the cannula.
- In accordance with an alternate embodiment of the present invention, a removable, transparent tip is positioned at the distal end of the cannula to provide a single cannula for performing dissection and transection. When attached, the tip seals the distal end of the cannula in a fluid resistant manner. The tip is conical and ends in a sharp interior point and a slightly rounded exterior point which allows the surgeon to bluntly dissect tissue in the area of interest under endoscopic visualization. When tissue dissection is complete, the surgeon can remove the tip from the cannula, and the surgeon is now able to use the cannula to transect side branches and vessel ends. In order to maximize the visual field provided by the endoscope, the tip is configured to allow the apex of the tip to be aligned with the central axis of the endoscope. In one embodiment, a distal end of the tip is tilted in an oblique fashion to allow the apex of the tip to align with or near to the central axis of the endoscope. In an alternate embodiment, the conical end of the tip has unequal taper angles relative to a plane of transition between the cylindrical and conical portions of the tip, thus skewing the position of the apex of the tip into alignment with or near to the central axis of the endoscope.
- In another embodiment, wing-like protrusions are provided about the cannula near the tip to dilate tissue surrounding the vessel of interest. In one embodiment, the wing-like protrusions are diametrically aligned in a planar configuration with tapered forward edges extending rearward from near the apex of the tip. The planar configuration of the wing-like dilating protrusions near the tip substantially reduces the resistive force encountered during advancement of the cannula through tissue. The wing-like protrusions are positioned on opposite sides of the tip to dissect tissue to form a cavity that may attain a round cross-section under insufflation, thus providing the same resultant tissue dilation as provided by a solid oval dilator, but with less force required to accomplish the tissue dilation. In an alternate embodiment, the leading edges of the wing-like protrusions are curved in a parabolic configuration away from the distal end of the cannula to provide the necessary dilation.
-
FIG. 1 is a perspective view of a preferred embodiment ofcannula 100 showingretractor 112 in an extended position. -
FIG. 2 a is a cut-away side view ofretractor 112 andcannula 100. -
FIG. 2 b is a top view ofretractor 112. -
FIG. 3 a is a perspective side view ofcannula 100 with a sapphenous vein positioned within thecradle 116. -
FIG. 3 b is a perspective side view of thedistal end 122 ofcannula 100 in an embodiment in which anendoscope 126 and asurgical tool 120 are present and partially extended. -
FIG. 3 c is a front view of thedistal end 122 ofcannula 100 in which thesurgical tool 120 and theretractor 116 are partially extended, and anendoscope 126 is present. -
FIG. 4 a is a cut-away top view ofcannula 100. -
FIG. 4 b is a cut-away side view ofcannula 100. -
FIG. 5 a is a cut-away view of a sliding tube embodiment ofcannula 100 in a first position. -
FIG. 5 b is a cut-away view of the sliding tube embodiment ofFIG. 5 a in a second position. -
FIG. 6 a is a cut-away view of an embodiment ofcannula 100 having anangling device 140. -
FIG. 6 b is a cut-away side view of the apparatus illustrated inFIG. 6 a in which theretractor 112 is extended and theangling device 140 is actuated. -
FIG. 6 c is a cut-away side view of the angling device embodiment in which theangling device 140 is in a separate lumen from theretractor 112. -
FIG. 7 a is a cut-away side view of atwistable retractor 112 in a straight position. -
FIG. 7 b is a side view of theretractor 112 ofFIG. 7 a. -
FIG. 7 c is a cut-away side view oftwistable retractor 112 in a crossed position. -
FIG. 7 d is a side view of theretractor 112 ofFIG. 7 c. -
FIG. 8 a is a cut-away side view of thehandle 104. -
FIG. 8 b is a cut-away side view of an alternate embodiment ofhandle 104. -
FIG. 9 a is a side view ofcradle 116. -
FIG. 9 b illustrates a first alternate embodiment ofcradle 116. -
FIG. 9 c illustrates multiple views of a second alternate embodiment ofcradle 116. -
FIG. 9 d illustrates multiple views of a third alternate embodiment ofcradle 116. -
FIG. 9 e illustrates multiple views of a fourth alternate embodiment ofcradle 116. -
FIG. 9 f illustrates multiple views of a fifth alternate embodiment ofcradle 116. -
FIG. 9 g illustrates multiple views of an embodiment ofcradle 116 having a spur. -
FIG. 10 a illustrates a top view of an embodiment of thecradle 116 ofFIG. 9 c without a “C” ring. -
FIG. 10 b illustrates a side view of thecradle 116 ofFIG. 10 a. -
FIG. 10 c illustrates a top view of thecradle 116 ofFIG. 9 c with the “C” ring attached. -
FIG. 10 d illustrates a side view of thecradle 116 ofFIG. 10 c. -
FIG. 11 a illustrates a cut-away side view of atip 1100 in a cannula housing anendoscope 126. -
FIG. 11 b illustrates a side view of thetip 1100 isolated fromcannula 100. -
FIG. 12 a illustrates a side view of an offsettip 1200 in accordance with the present invention. -
FIG. 12 b illustrates a cut-away side view of the offsettip 1200 in acannula 100 housing anendoscope 126. -
FIG. 12 c illustrates a cut-away side view of an alternate embodiment of offsettip 1200. -
FIG. 13 illustrates a cut-away side view of an alternate embodiment of the offset tip 1300. -
FIG. 14 a illustrates a perspective side view of the offsettip 1200 and mountingrod 1404. -
FIG. 14 b illustrates a perspective side view ofcannula 100 for housing offsettip 1200 and mountingrod 1404. -
FIG. 14 c illustrates a perspective side view of offsettip housing 1424 at the proximal end of thecannula 100. -
FIG. 14 d illustrates a perspective side view ofcannula 100 with offsettip 1200 and offsettip housing 1424. -
FIG. 14 e illustrates a perspective side view of an alternate embodiment of offsettip mount 1424. -
FIG. 14 f illustrates a cut-away side view of the offset tip mounting 1424 ofFIG. 14 e. -
FIG. 15 a illustrates a side view of an alternate embodiment of offsettip 1200. -
FIG. 15 b illustrates a side view of acannula 100 modified for use with the offsettip 1200 ofFIG. 15 a. -
FIG. 16 is a flow chart illustrating a method of dissecting and transecting vessels according to the present invention. -
FIG. 17 a illustrates a top view of an embodiment of an offsettip dilator 1700 according to the present invention. -
FIG. 17 b illustrates a side view of the embodiment of offset tip dilator 1716 ofFIG. 17 a. -
FIG. 17 c illustrates a top view of an alternate embodiment of offsettip dilator 1700. -
FIG. 18 is a flow chart illustrating a method of dilating tissue in accordance with the present invention. -
FIG. 1 illustrates a perspective view of a preferred embodiment ofcannula 100 showingretractor 112 in an extended position.Cannula 100 includes an outer housing 102 of bioinert material such as polymed UD that may be approximately 12″ to 18″ in length. The proximal end of thecannula 100 is disposed inhandle 104 that includes abutton 106 which is coupled toretractor 112 for controlling the translational movement ofretractor 112, as described in more detail below. - The distal end of the cannula houses a
retractor 112, and optionally anendoscope 126 and asurgical tool 120, described below.FIG. 2 a illustrates theretractor 112 in more detail. In one embodiment,retractor 112 is formed of resilient wire which has a smooth bend intermediate to afirst portion 110 and asecond portion 114 of the retractor. Theretractor 112 is described as having two portions for ease of description, although theretractor 112 may be formed as an integrated structure. However,retractor 112 may also be manufactured from twoseparate portions first portion 110 of theretractor 112 is positioned within thecannula 100 with theaxis 111 of thefirst portion 110 approximately parallel to theaxis 101 of thecannula 100. Thesecond portion 114 is positioned to bend away from thecentral axis 101 of the cannula. Theangle 117 of displacement between theaxis 115 of the second portion and thecentral axis 101 ofcannula 100 may be any angle from zero to 180 degrees. Thesecond portion 114 includes adissection cradle 116 at the distal end of thesecond portion 114. Theretractor 112 may be formed of bioinert material such as stainless steel, or a polymer such as nylon or polyetherimide, or other appropriately strong and resilient plastic. In one embodiment, theretractor 112 includes a coating for lubrication, insulation, and low visual glare using, for example, parylene or nylon 11. -
FIG. 2 b illustrates theretractor 112 formed with two legs. Thelegs retractor 112 at the distal end form thedissection cradle 116 in a loop or “U” shape, as shown inFIG. 2 a. Thetop portion 144 of the U-shaped bend is preferably flattened to provide additional surface area for atraumatically supporting avein 118 or vessel of interest. Theside arches 128 of thedissection cradle 116 are used for skeletonizing or dissecting the vein from the surrounding tissues, as well as acting as walls to keep the vessel captured within the arch. The several embodiments ofdissection cradle 116 are described in more detail below. -
FIG. 3 a illustrates a perspective view of thecannula 100 in accordance with the present invention with the retractor fully extended, holding asapphenous vein 118, and also illustrates an externalsurgical tool 120 disposed adjacent thecannula 100 for performing a surgical operation, for example, severing a tributary or side branch of thevein 118. The vein is positioned within theside arches 128 of thecradle 116. Thedissection cradle 116 may be used to cradle a vein, vessel, tissue or organ of interest, andsurgical tool 120 may be any surgical tool suitable for performing a surgical procedure near thedissection cradle 116. -
FIG. 3 b illustrates a perspective view ofcannula 100 in an embodiment in which thesurgical tool 120 is positioned within thecannula 100, and anendoscope 126 is present. In this embodiment,cradle 116 preferably overlays theendoscope 126 with sufficient clearance to facilitate relative movements thereof. However, the endoscope may also be located adjacent thesurgical tool 120. In one embodiment,endoscope 126 is positioned withcannula 100 to allow a clear field of view upon extension of theretractor 112.Surgical tool 120 is illustrated as cauterizing scissors, used to sever a tributary or side branch of asapphenous vein 118. In this embodiment,surgical tool 120 is maximally displaced from thecradle 116 at thecannula end 122. More specifically, as shown inFIG. 3 c, the “U”-shapedloop 129 of thecradle 116 is closest to thesurgical tool 120. This ensures that avein 118 or other tissue of interest is retracted away from thesurgical tool 120 to facilitate manipulating thesurgical tool 120 relative to the side branch or other tissue. -
FIG. 4 a is a cut-away top view ofcannula 100. Theretractor 112 is slidably positioned withinminor lumens 113 along the length of thecannula 100 within close tolerances in order to position theretractor 112 stably within thecannula 100. For example, in oneembodiment retractor legs lumens 113 encasing thelegs retractor 112 and thelumens 113 holds the retractor stably within the cannula. This configuration restricts rotational movement of the retractor to provide more stable retraction as compared with conventional retractors. Thelegs retractor 112 are formed of flexible, resilient material and are retained within thelumen 113 in substantially straight or flat orientation, but may return to a material bend or curve, as illustrated inFIG. 5 a, as theretractor 112 is extended from the distal end of thecannula 100. - The
leg 141 of theretractor 112 passes through a sliding gas orfluid seal 130 at the proximal end of thelumen 113. Theleg 141 of theretractor 112 passes out of thecannula 100 and intohandle 104 for attachment to aslider button 106 for facilitating translational movement of theretractor 112 from the proximal or handle end of thecannula 100. However, other types of control devices such as knobs, grips, finger pads, and the like may be linked in conventional ways to theretractor 112 in order to manually control the translational movement ofretractor 112. In one configuration, the proximal end ofleg 141 is bent relative to the axis of the cannula, and thebutton 106 is attached to the bent position of theleg 141 to facilitate moving thebutton 106 and theretractor 112 translationally under manual control. Thebutton 106 preferably includes lateral grooves to prevent finger or thumb slippage during sliding manipulation of theretractor 112. - Thus, in the operation of a preferred embodiment, a user actuates the
slider button 106 to extendretractor 112 out of thelumen 113 at the distal end of thecannula 100. In one embodiment, theresilient retractor 112 is formed in a smooth bend, as shown inFIG. 2 a, and gradually deflects away from thecentral axis 101 of thecannula 100 as the retractor is extended. Upon encountering the target vessel or tissue of interest, the vessel is restrained in thecradle 116, and a lateral resilient force is exerted on the target vessel in a direction away from the cannula. The vessel is thus pushed away from the axis of thecannula 100, isolating it from surrounding tissue or adjacent vessels such as tributaries or side branches. As a tributary is thus isolated, asurgical tool 120 such as cauterizing scissors may be safely employed to operate on the tributary without harming thesapphenous vein 118. When retracted into thecannula 100, theretractor 112 is again resiliently straightened or flattened. - In an alternate embodiment as illustrated in
FIGS. 5 a and 5 b, a slidingtube 132 is added to provide operational versatility tocannula 100. In a first position, the slidingtube 132 is retracted and theretractor 112 protrudes from the distal end at an angle with respect to thecentral axis 101 of thecannula 100. In a second position, the slidingtube 132 is extended out, temporarily straightening theretractor 112. As illustrated inFIG. 5 a, a slidingtube 132, in a first position encases theretractor 112 up to the point at which theretractor 112 curves away from thecentral axis 101 of the cannula thus allowing theretractor 112 to displace and isolate a target vessel. The proximal end of the slidingtube 132 is linked tobutton 107 for translationally movingretractor 112 as well as actuating the slidingtube 132. In one embodiment, as illustrated inFIG. 5 a, the slidingtube 132 is in a first position with thebutton 107 in an upright position. Aspring 134 is coupled between asupport structure 135 and theproximal end 137 of the slidingtube 132. In the first position of slidingtube 132, thespring 134 is extended fully and exerts little or no force on the slidingtube 132. Of course, slidingtube 132 may be manually manipulated without linkage to abutton 107. - To extend the sliding
tube 100,button 107 is pushed down. As illustrated inFIG. 5 b, thebutton 107 has acam surface 136 which pushes on theproximal end 137 of the slidingtube 132 as thebutton 107 is pressed. The slidingtube 132 is pushed forward, overcoming the resilient force ofspring 134, to encase theretractor 112 anddecrease angle 117 between the distal end of theretractor 112 and thecentral axis 101 of thecannula 100. Upon releasing thebutton 107, the spring force urges theproximal end 137 of the slidingtube 132 back toward the first position againstbutton 107. The slidingtube 132 is formed of material having sufficient strength to force theretractor 112 to straighten out theangle 117, and theretractor 112 is formed of resilient material having a sufficient flexibility to straighten out theangle 117 in response to atube 132 being slid over theretractor 112, but having sufficient rigidity to cradle and dissect a target vessel. Resiliency of theretractor 112 ensures return to the downwardly-curved shape after being released fromtube 132. Thus, in accordance with this embodiment, a user may employ the curved retractor for certain applications and employ the straightened form for other applications. A manual actuator may be configured in other ways thanbutton 107 to extend the slidingtube 132 in response, for example, to being pulled up instead of pushed down. - Another embodiment employs a
retractor 112 which has a naturally straight shape. As illustrated inFIGS. 6 a and 6 b, anangling device 140 is disposed between the distal end of theretractor 112 and the proximal end of the cannula. Theangling device 140 may be positioned within thesame lumens 113 as theretractor 112 and preferably may comprise two wires coupled to points below thecradle 116 of theretractor 112 substantially in parallel positions on each of thelegs - Upon extending the
retractor 112 usingbutton 106, theangling device 140 is extended with theretractor 112. Theangling device 140 is coupled to ahandle 145 at the proximal end of thecannula 100 to facilitate establishing an angle in theretractor 112 by pulling with a backward force on theangling device 140. As illustrated inFIG. 6 b, after theretractor 112 is extended, theangling device 140 is actuated and a bend is created in theretractor 112 as the backward force exerted on the distal end of the retractor is exerted against the relatively fixed position of theretractor legs lumens 113. As shown inFIG. 6 c, theangling device 140 may also be located in aseparate lumen 202 from theretractor 112 with part of theangling device 140 positioned outside of thecannula 100 when theretractor 112 is in the retracted position. -
FIG. 7 a illustrates another embodiment ofcannula 100 in which theretractor 112 is pre-formed with oneleg 141 of theretractor 112 bent at an angle at its proximal end skewed to the axis of the distal end of theother leg 142. The bent portion of theleg 141 may be linked to a sliding knob 147 for convenient manual manipulation of this embodiment of the invention. Upon sliding the knob 147, theleg 142 coupled to knob 147 is twisted rotationally. The twolegs retractor 112 are coupled together viacradle 116. The axis of the second portion of theretractor 112 in the first position is at afirst angle 117 to the axis of thecannula 100, as shown inFIG. 7 b. As knob 147 is moved,leg 141 is rotated and crosses underleg 142, as shown inFIG. 7 c. This causescradle 116 to flip 180 degrees and bends theretractor 112 at asecond angle 119, as shown inFIG. 7 d. Thus, if a vessel is disposed on one side ofcradle 116 orcannula 100 while theretractor 112 is in the first position, then upon rotating the knob 147, the vessel is transported to the other side of thecannula 100. This allows the user to isolate the vessel by simply actuating knob 147. -
FIG. 8 a illustrates a cut-away side view ofbutton 106 on thehandle 104 ofcannula 100, with anendoscope 126 positioned withincannula 100. As mentioned above,button 106 is coupled to oneleg 141 of the proximal end ofretractor 112. Sliding thebutton 106 ingroove 146 translationally moves theretractor 112.Groove 146 is preferably minimally wider than the shaft ofbutton 106 to minimize excessive horizontal movement ofbutton 106 while still allowing smooth translational movement ofbutton 106. As illustrated inFIG. 8 b, thebutton 106 may include locking or ratchetingteeth 152 to give tactile feedback of its location, and to positively retain the button and the associatedleg 141 in an extended or retracted position.Several mating teeth 148 are located underneathgroove 146, and aspring member 150 is attached tobutton 106 to exert pressure against the base ofgroove 146, to engagemating teeth button 106, the interlocking sets of teeth are disengaged andbutton 106 can move freely. Upon achieving the desired extension or retraction of theleg 141,button 106 is released and is retained place by the engagedteeth -
FIG. 9 a illustrates a top view ofcradle 116 in an embodiment in which thecradle 116 is formed by twolegs retractor 112. The distal end of the legs form “U”-shaped side guides. The top 144 of the distal portion of the “U” is preferably flattened. This provides atraumatic support for the target vessel retained withincradle 116. Additionally, by minimizing the thickness ofdistal portion 144, contact with other devices in close proximity withretractor 112 is minimized. - The
cradle 116 may have other effective shapes, for example, as illustrated inFIG. 9 b in which a “C” ring element is attached to legs of thecradle 116. The “C” ring may have asmall hole 200 in one side with an axis approximately parallel to the axis of theretractor 112. Thishole 200 is used to hold suture or other ligating materials, and may also be used as a knot pusher. As shown inFIGS. 10 a and 10 b, in an alternate embodiment of the embodiment ofFIG. 9 b, theretractor 112 is formed and flattened and a “C”-shaped ring is coupled to theretractor 112 by, for example, gluing or molding the “C” ring to the distal end of theretractor 112, as shown inFIGS. 10 c and 10 d. - Referring back to
FIGS. 9 c, 9 d, and 9 e, the side guides of the cradle may include aloop 129 in a “V” shape, an arced “U” shape, or a semi-circular shape. In one embodiment, as illustrated inFIG. 9 f, theretractor 112 has only oneleg 141, and thecradle 116 is formed by theleg 141. Astopper 160 is coupled to the end of theleg 141 to serve as a guide to retain the target vessel, and add a blunt surface to the end of the wire, for example, for pushing and probing tissue.FIG. 9 g illustrates aretractor 112 having aspur 204 formed in one or bothlegs retractor 112 to be used for dissection. Sinusoidal, half-sinusoidal, and other geometric configurations may be used equally effectively as the shape ofloop 129 in accordance with the present invention. -
FIG. 11 a illustrates atip 1100 for use with amulti-lumen cannula 100 housing anendoscope 126. The taperedtip 1100 may be removed from, and reattached to the distal end of acannula 100, as desired. Upon attachment, thetip 1100 seals the distal end of acannula 100 in a fluid-tight manner. Thetip 1100 is configured to provide dissection of the tissue surrounding the vessel of interest, and has a distal radius of approximately 0.045″ to reduce the hazard of penetrating the vessel of interest. The inner surface of thetip 1100 tapers to a sharp interior point and a slightly rounded exterior point and thetip 1100 has a uniform wall thickness. Thetip 1100 preferably has taper angles of approximately 15° which provides a maximal, undistorted, visual field through anendoscope 126. Thetip 1100 tapers outward to a maximal diameter of about 12¾ mm at its shoulder to cover thecannula 100 body which also has a diameter of about 12¾ mm. All of these features allow thetip 1100 to effectively dissect tissue. Thetip 1100 ofFIG. 11 a has a central axis 1150 aligned with thecentral axis 1108 of thecannula 100. The visual field provided by theendoscope 126, although satisfactory for surgical procedures, is not complete because theendoscope 126 is in a lumen that is offset from thecentral axis 1108 of thecannula 100. Theendoscope 126 is offset because of the space required inside thecannula 100 for housing retractors and other instruments in adjacent lumens.FIG. 11 b illustrates thistip 1100 detached from thecannula 100. -
FIG. 12 a illustrates an offsettip 1200 for acannula 100 in accordance with the present invention. The offsettip 1200 is a transparent, tapered tip as described above for use in endoscopic dissection of a vessel. However, in this embodiment theaxis 1250 of thetip 1200 is skewed relative to thecentral axis 1108 of thecannula 100. Theaxis 1250 of thetip 1200 is skewed approximately 8°, an angle that is chosen to align theapex 1232 of thetip 1200 with acentral axis 1112 of theendoscope 126, as shown in more detail inFIG. 12 b. -
FIG. 12 b illustrates the offsettip 1200 housed incannula 100 in more detail. Thecannula 100 houses a 5mm endoscope 126 having acentral axis 1112 eccentric to thecentral axis 1108 of thecannula 100. In order to bring the distal end orapex 1232 of the axis of the taperedtip 1200 into the center of the visual field along thecentral axis 1112 of theendoscope 126, the taperedtip 1200 is tilted or inclined by approximately 8° toward the lumen housing theendoscope 126. This allows theapex 1232 of thetip 1200 to approximately intersect with thecentral axis 1112 of theendoscope 126. As illustrated inFIG. 12 b, thetip 1200 is inclined toward thecentral axis 1112 of theendoscope 126 without altering the taper angles 1236 and 1240 of the side walls. This is accomplished by forming atransition 1228 between the proximal orcylindrical portion 1204 of thetip 1200 and the distal or conical portion of thecannula body 1208 of thetip 1200 substantially along aplane 1230 that is skewed from normal to thecentral axis 1108 of thecannula 100. Thedistal portion 1208 of thetip 1200 retains its conical shape and equal taper angles 1228, 1236 between the side walls and the transition plane. The slight extension of the cannula body at the transition plane provides sufficient incline to allow theapex 1232 of thetip 1200 to intersect thecentral axis 1112 of theendoscope 126. Thetip 1200 may be formed of separate conical and cylindrical parts that are attached together, or thetip 1200 may be formed as an integrated structure in the shape thus described. - Alternatively, as shown in
FIG. 12 c, thetip 1200 is inclined at a lesser angle, for example, 5 degrees, toward theaxis 1112 of theendoscope 126, positioning theaxis 1250 of thedistal end 1232 of thetip 1200 intermediate between thecentral axis 1108 of thecannula 100 and theaxis 1112 of theendoscope 126. Positioning theaxis 1250 of thetip 1200 to this intermediate point allows the retention of steep conical angles in thetip 1200 which allow for easier advancement of thecannula 100 while using a minimal amount of force. The intermediate positioning also provides a more complete visual field as seen throughendoscope 126. - An alternate embodiment of an offset
tip 1200 is shown inFIG. 13 in which the taper angles 1320, 1324 of the side walls are selected to form theapex 1328 of thetip 1200 aligned with thecentral axis 1112 of theendoscope 126. As illustrated, thelower region 1316 of thecylindrical part 1304 extends beyond theupper region 1312 of the cylindrical part at a plane of transition between cylindrical and tapered regions of the tip. However, in this embodiment, the taper angles 1320, 1324 are not equal and the thirty degree angled conical configuration of thetapered part 1308 is not maintained. Rather, the lower taper angle 1324 is increased to an obtuse angle and theupper taper angle 1320 is a reduced acute angle relative to the plane of transition between the cylindrical and tapered portions of the tip. In this configuration of theconical portion 1308, theapex 1328 of thetip 1200 aligns with thecentral axis 1112 of theendoscope 126. Thus, in accordance with either embodiment, atip 1200 is provided which allows a maximal visual field to be viewed by the surgeon via theendoscope 126 that is eccentric thecentral axis 1108 of thecannula 100, but that is aligned with or near to theapex 1232 of thetip 1200. -
FIG. 14 a illustrates a perspective side view of the offsettip 1200 and mountingrod 1404. Thetip 1200 is attached to thecannula 100 via thelong rod 1404 which extends through an eccentric lumen of thecannula 100, as shown inFIG. 14 b, and the apex of thetip 1200 is tilted away from therod 1404 and towards the endoscopic lumen (not shown). Theelongated rod 1404 may be attached to thetip 1200, or may be constructed as an integral part of thetip 1200. Theelongated rod 1404 preferably is secured inhousing 1424, shown inFIG. 14 c, viathreads 1408 on the proximal end ofrod 1404 and mating threads within nut orknob 1416. Therod 1404 andhousing 1424 abut against the proximal end of thecannula handle 1412, as illustrated in the perspective side view of the assembled device shown inFIG. 14 d. Referring back toFIGS. 14 a-c, thehousing 1424 includes aslot 1420 configured to slip over thelight cable outlet 1428 on theendoscope 126 as assembled within thecannula 100. Thehousing 1424 preferably contains arotating nut 1416 which accepts the threadedproximal end 1408 of therod 1404. When tightened onto therod 1404, as shown inFIG. 14 d, thehousing 1424 prevents thecannula 100 from rotating about theendoscope 126 by holding theendoscope 126 fixed with respect to thehandle 1412. This allows the operator to maintain the correct orientation of theendoscope 126 on the vessel. If theendoscope 126 is allowed to rotate freely, the image may turn sideways or upside down without the operator realizing it, and injury may occur to the vessel if thecannula 100 is advanced in the wrong direction. - In one embodiment, as shown in
FIGS. 14 e and 14 f, theelongated rod 1404 slips into thehousing 1424 via agroove 1450 near its proximal end, and passes through themain hole 1454 in thehousing 1424. Thegroove 1450 allows for thehousing 1424 to cover the proximal end of the mountingrod 1404 without completely clearing the most proximal tip of the mountingrod 1404. This allows more room for attaching thehousing 1424 which lies between theelongated rod 1404 and additional optical components. Therod 1404 may contain an elastic section, or therod 1404 may be somewhat elastic along its entire length to facilitate stretching therod 1404 and pulling it into position in theslot 1454 on thehousing 1424, while locking thetip 1200 in place. The elastic force also facilitates sealing thetip 1200 against the distal face of the cannula body. -
FIGS. 15 a and 15 b illustrates an alternate embodiment of offsettip 1200 andcannula 100. In this embodiment, offsettip 1200 is formed with anelongated case 1500 which slides over thecannula body 100 and locks to the proximal end ofcannula 100. In this embodiment, proximal end ofcannula 100 is threaded and allows a threaded proximal section ofelongated case 1500 to mate securely to thecannula 100. - In a surgical procedure using the tissue-dissecting cannula of the present invention, the surgeon first incises 1600 the skin overlying a vessel of interest to expose the vessel as an initial step of the procedure illustrated in the flow chart of
FIG. 16 . A scissor tool is inserted 1602 into the incision to create a path to the vessel by dissecting the overlying tissue. Next, thetip 1200 of thecannula 100 is inserted 1604 into the incision to bluntly dissect tissue to form an initial tunnel along the vessel from the incision. The incision is then sealed 1608 using a blunt tip trocar and a tunnel is insufflated 1612. The cannula is advanced 1616 along the vessel to dissect tissue adjacent the vessel under endoscopic visualization through the transparent tip. The offsettip 1200 with the apex thereof in alignment with theendoscope 126 provides a full visual field for the surgeon as thecannula 100 is advanced. The conical end of thetip 1200 dissects the tissue as thecannula 100 is advanced along the vessel. The surgeon dissects both on the anterior and posterior sides of the vessel to create a full 360 degree tunnel around the vessel. Once a selected surgical site is reached, thecannula 100 is removed 1620 from the incision seal and thetip 1200 is removed 1624 from thecannula 100. In one embodiment, as described above, thetip 1200 is removed by unscrewing the threadedportion 1408 of therod 1404 from therotating nut 1416. Thetip housing 1424 itself is also removed in this embodiment. Insufflation is maintained and thecannula 100 withouttip 1200 is inserted 1628 into the seal into the tunnel adjacent the vessel. Transecting devices are then inserted 1630 into thecannula 100. Withouttip 1200 disposed over the distal end, thecannula 100 can now be used for transecting 1632 side branches and the ends of the vessel of interest using endoscopic instruments that are selectively installed and removed within instrument lumens in thecannula body 100. After these procedures are completed, the vessel may be removed 1636. -
FIG. 17 a illustrates another embodiment of an offsettip dilator 1700. In this embodiment of the present invention, thetip 1700 also includes wing-like protrusions for enlarging or dilating a peri-vascular cavity in the course of separating a vessel from adjacent connective tissue. For example, after tissue dissection with an offsettip 1200 to form a tunnel or working cavity adjacent a target vessel by dissecting along the anterior and posterior sides of the vessel, thecannula 100 is removed from the distal end of the body, the offsettip 1200 is detached, and asecond tip 1700 is attached to the distal end of thecannula body 100. In one embodiment, thesecond tip 1700 includes a transparent tapered tip with planar wing-like protrusions or extensions disposed proximal to thedistal end 1720 of thetip 1700. The wing-like protrusions FIG. 17 b, thetip 1200 is tilted away from the mountingrod 1404 to align with the central axis of an endoscopic lumen (not shown). The wing-like protrusions FIG. 17 c, providing a smoother withdrawal of thecannula 100 from the insufflated tunnel. Thetip 1700 attaches to thecannula body 100 in the same manner as previously described with reference to the offsettip 1200, with anelongated rod 1404 extending through a lumen of thecannula 100 and locking at the proximal end of thehandle 1412. Thecannula 100 may thus be advanced through tissue under full-field endoscopic visualization through the taperedtip 1720 with the wing-like protrusions - The wing-
like protrusions tip 1700 are arranged in substantially planar geometry in contrast to the solid bulbous, oval element described above. The planar configuration of the wing-like protrusions cannula 100 through tissue. Although the tissue-dilating force is exerted on tissue surrounding the cavity in a bilateral, substantially planar orientation by the outer edges of the wing-like protrusions -
FIG. 18 illustrates a method of dilating tissue in accordance with one method embodiment of the present invention. The skin is incised 1800 overlying the vessel of interest, and the scissor tool is inserted into the incision to create a path to the vessel by dissecting the overlying tissue. The incision is then bluntly dissected 1804 using the offsettip 1200 to expose the vessel surface. The incision is sealed 1808 and a tunnel is insufflated 1812. Thecannula 100 is advanced 1816 along the vessel under endoscopic visualization through thetransparent tip 1200. After sufficient length of tunnel is formed adjacent the vessel, thecannula 100 is removed 1820 and the incision seal is removed or slid backwards to the proximal end of thecannula 100. The offsettip 1200 is then replaced 1824 with thedilating tip 1700. The seal is reinserted and the incision is sealed 1826. Thecannula 100 is advanced 1828 and the cavity is further dilated responsive to the advancement of the planar wing-like protrusions cannula 100 is removed 1832 a second time, and the incision seal is again removed or slid backwards to the proximal end of thecannula 100. The dilating tip is removed 1836 and the incision is sealed 1837. Transection devices are loaded 1838 through instrument lumens within thecannula body 100 into thecannula 100 and thecannula 100 is then inserted 1839 back into the incision. Without any tip covering the distal end of thecannula 100, the vessel side branches and ends are transected 1840 using endoscopic instruments, and the vessel is then removed 1844 from the dilated tunnel.
Claims (2)
1. A surgical apparatus comprising:
an elongated cannula having a lumen extending therein between proximal and distal ends;
a retractor disposed to slide within the lumen to extend a distal end thereof beyond the distal end of the cannula;
an angling device attached near the distal end of the retractor and extending within the cannula toward the proximal end thereof for selectively deflecting the distal end of the retractor during extension thereof away from a central axis of the cannula in response to manual manipulation of the angling device from near the proximal end of the cannula.
2-12. (canceled)
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US13/417,161 US20130072758A1 (en) | 1998-06-22 | 2012-03-09 | Vessel retractor |
US14/139,782 US20140343367A1 (en) | 1998-06-22 | 2013-12-23 | Vessel retractor |
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US09/102,723 US5895353A (en) | 1998-06-22 | 1998-06-22 | Vessel isolating retractor cannula and method |
US22739399A | 1999-01-08 | 1999-01-08 | |
US09/490,552 US6432044B1 (en) | 1999-01-08 | 2000-01-25 | Combined vessel dissection and transection device and method |
US10/218,475 US6752756B2 (en) | 1998-06-22 | 2002-08-12 | Combined vessel dissection and transection device and method |
US10/807,368 US7326178B1 (en) | 1998-06-22 | 2004-03-22 | Vessel retraction device and method |
US11/969,318 US8241210B2 (en) | 1998-06-22 | 2008-01-04 | Vessel retractor |
US13/417,161 US20130072758A1 (en) | 1998-06-22 | 2012-03-09 | Vessel retractor |
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Also Published As
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US20140343367A1 (en) | 2014-11-20 |
US7326178B1 (en) | 2008-02-05 |
US8241210B2 (en) | 2012-08-14 |
US20080103365A1 (en) | 2008-05-01 |
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