WO2007075903A2 - Écarteurs cardiaques endoscopiques comprenant des composants de pliage conçus pour une insertion par le biais d'orifices d'accès à effraction minimale et procédés associés - Google Patents

Écarteurs cardiaques endoscopiques comprenant des composants de pliage conçus pour une insertion par le biais d'orifices d'accès à effraction minimale et procédés associés Download PDF

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Publication number
WO2007075903A2
WO2007075903A2 PCT/US2006/048815 US2006048815W WO2007075903A2 WO 2007075903 A2 WO2007075903 A2 WO 2007075903A2 US 2006048815 W US2006048815 W US 2006048815W WO 2007075903 A2 WO2007075903 A2 WO 2007075903A2
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WO
WIPO (PCT)
Prior art keywords
blade
rod
retractor
blade body
robotic
Prior art date
Application number
PCT/US2006/048815
Other languages
English (en)
Other versions
WO2007075903A3 (fr
Inventor
Norihiko Ishikawa
L. Wiley Nifong
You Su Sun
Original Assignee
East Carolina University
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by East Carolina University filed Critical East Carolina University
Publication of WO2007075903A2 publication Critical patent/WO2007075903A2/fr
Publication of WO2007075903A3 publication Critical patent/WO2007075903A3/fr

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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
    • A61B17/02—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
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0281—Abdominal wall lifters
    • 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
    • A61B2017/0237—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for heart surgery

Definitions

  • the invention relates to tissue retractors for surgeries.
  • surgical tools are introduced into the body to carry out a desired cutting, forming or ablation procedure in the target location in the body.
  • one or more retractors can be used to provide a suitable access path or increased intra-body space for the tools to be able to reach the target location.
  • a minimally invasive, robotic-assisted surgical system has been used to carry out closed chest (rather than open heart) cardiac surgeries.
  • the closed chest surgeries can use both major and minor surgical access paths to allow for multiple instruments to be inserted into the body and used concurrently or serially during the procedure.
  • a cardio-surgical robotic-assisted system is the da Vinci® Surgical System by Intuitive Surgical Inc. of Sunnyvale, CA.
  • a surgeon's hands do not typically enter the patient.
  • the surgeon controls the instruments, including at least one miniature camera used to carry out the surgery, from a console, usually located in the operating room, to guide the instruments into position and operate the instruments to carry out their intended functions.
  • the camera provides real time (magnified) images of the operating site or access paths on a display that allows a surgeon to "see” the tools and operative site and remotely control the surgery.
  • Embodiments of the present invention are directed to retractors and methods that can facilitate surgeries.
  • Certain embodiments provide retractors that are suitable for minimally invasive endoscopic and/or robotic-assisted cardiac surgeries.
  • the retractors may be configured as an atrial lift retractor to facilitate intra-cardiac mitral valve repair procedures.
  • the retractors may be sized and configured to enter the body through a small incision into the trans-thoracic cavity and/or a surgical cannula access path/port.
  • the devices may be sized and configured to reside in situ proximate the mitral valve site at a left atria to splint open the left atrium (lift the roof) in response to robotic controlled direction of a surgeon for a mitral valve repair.
  • Some embodiments are directed to methods of retracting cardiac tissue during heart surgery, and may be particularly suitable for closed chest cardiac surgeries.
  • the methods include: (a) introducing an elongate rod into a small opening in a patient's chest into a trans-thoracic cavity; (b) placing a foldable blade body into the cavity using a cannula defining an access port; then (c) unfolding the blade body; then (d) attaching the rod to the blade body in the cavity; (e) inserting the blade body into a left atrium; and then (f) lifting a roof of the atrium using the blade body.
  • Other embodiments are directed to methods of retracting cardiac tissue during heart surgery.
  • the methods include: (a) inserting a rod attached to an articulatable blade into a cannula defining an access port to a thoracic cavity; (b) articulating the blade to extend substantially perpendicularly outward from the rod after the blade exits the cannula; then (c) lifting a roof of a left atrium using the articulated blade.
  • Some embodiments are directed to endoscopic cardiac retractors.
  • the retractors include: an intrathoracic cavity rod and a foldable blade being releasably attachable to the rod.
  • the rod is attached to the blade endoscopically after the rod and blade are disposed in the body.
  • the foldable blade is sized and configured to enter a left atrium and lift a roof of the left atrium.
  • the rod is configured for insertion through a small incision or stab entry in the chest into a thoracic cavity during closed chest heart surgery, and the foldable blade can be configured for insertion into the body using a surgical or camera access port of a robotic assisted surgical system.
  • FIG. 1 Other embodiments are directed to cardiac retractors that include: an elongate rod and a foldable blade body attached to the elongate rod.
  • the blade body is configured to slidably advance into an intrathoracic cavity via a cannula access port having a diameter of between about 8-15 mm.
  • the blade body is configured to articulate with respect to the rod such that the blade body has a use configuration whereby the blade body extends generally orthogonally outwardly from the rod into a left atria of the heart and a closed insertion or retraction configuration whereby the blade body is folded axially about the rod or the folded blade body axially extends beyond a distal end portion of the rod so that the folded blade body is substantially aligned with the rod.
  • the retractors include: a rod having opposing forward and rearward portions, the forward portion being attached to an axially articulating and transversely foldable blade.
  • the rod has a length sufficient to position the rearward portion of the rod outside a patient's body and the forward portion inside a patient proximate a lumen of cardiac tissue.
  • the articulating blade is sized and configured to extend outwardly away from the rod in an unfolded configuration to be inserted into a left atrium and lift a roof of the left atrium.
  • the rod and articulating blade are sized and configured for endoscopic introduction using a cannula access port with a diameter between about 10 mm to about 15 mm.
  • the retractor may be configured so that the unfolded blade body has a length of between about 40-60 mm and a width of between about 25 mm-40 mm.
  • the rod and blade may be configured for insertion and retraction using a single path defined by about a 10-15 mm diameter cannula: ⁇
  • the rod and blade can be configured for use in robotic-assisted closed chest surgery whereby the retractor has a compact use profile that allows for a plurality of robotic arms to move freely in an atrial cavity while the blade is in position in the left atrium.
  • the blade can have a blade body with a center blade member and two opposed pivotably attached outer blade members.
  • the retractor comprises a sleeve that surrounds at least a major portion of a length of the rod, the rod being pivotably attached to the center blade member.
  • the sleeve is configured to controllably axially float between a locked position and an unlocked position. In the locked position, the sleeve is pushed forward to enclose the rod pivot to hold the blade body in an axially outwardly extending lifting position. In the unlocked position, the sleeve axially translates away from the blade body to allow the blade body to pivot toward or away from the rod.
  • Figure 1 is a side perspective view of a foldable blade of a tissue retractor, illustrating the blade body in an exemplary folded configuration according to embodiments of the present invention.
  • Figure 2 is a end perspective view the device shown in Figure 1 illustrating the blade body in an unfolded configuration according to embodiments of the present invention.
  • Figure 3 is a side perspective view of the device shown in Figures 1 and 2 illustrating a releasably attachable rod attached to the blade according to embodiments of the present invention.
  • Figure 4 is a flow chart of actions or steps that can be used to carry out embodiments of the present invention.
  • Figures 5A-5C are schematic illustrations of a sequence of steps and/or actions that can be taken to retract tissue according to embodiments of the present invention.
  • Figure 6 is a schematic illustration of a robotic-assisted surgical system for cardiac surgery suitable for use with cardiac retractors according to embodiments of the present invention.
  • Figure 7 is another schematic illustration of a known prior art robotic-assisted surgical system with three arms and a central post.
  • Figure 8 is a side perspective partial view of a retractor according to other embodiments of the present invention.
  • Figure 9 is a side perspective view of the retractor shown in Figure 8 illustrating an exemplary unfolded "lifting" configuration according to embodiments of the present invention.
  • Figure 10 is a flow chart of actions or steps that can be used to carry out embodiments of the present invention.
  • Figures 1 IA-I IF are schematic illustrations of a sequence of steps and/or actions that can be used to carry out embodiments of the present invention.
  • Figure 12 is a schematic illustration of a robotic-assisted surgical system and semi-automated retractor according to embodiments of the present invention.
  • phrases such as “between X and Y” and “between about X and Y” should be interpreted to include X and Y.
  • phrases such as “between about X and Y” mean “between about X and about Y.”
  • phrases such as “from about X to Y” mean “from about X to about Y.” Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs.
  • first, second, etc. may be used herein to describe various elements, components, regions, layers and/or sections, these elements, components, regions, layers and/or sections should not be limited by these terms. These terms are only used to distinguish one element, component, region, layer or section from another region, layer or section. Thus, a first element, component, region, layer or section discussed below could be termed a second element, component, region, layer or section without departing from the teachings of the present invention.
  • the sequence of operations (or steps) is not limited to the order presented in the claims or figures unless specifically indicated otherwise.
  • the term "axially” and derivatives thereof mean in a generally lengthwise direction.
  • small incision means an incision that is less than about 2 inches wide and/or long, typically between about 1-5 mm, and more typically between about 2-3 mm.
  • the small incision for insertion of a rod can be disposed below or to the side of the sternum, and can be located above an intercostal space in the sternum while the chest is closed (no separation of the sternum is needed, although rib spreaders may optionally be used).
  • endoscopically refers to a minimally invasive surgery that uses an endoscope and/or a robotic-assisted system.
  • the endoscope and/or robotic system can include a camera and video (for providing real-time vision of the internal site) and can include a lighted medical instrument comprising a long tube that can be inserted into the body, usually through a small incision and/or cannula defining an intraoperative access.
  • atraumatic means that the device can be introduced into the body without major trauma, i.e., typically using a small incision, an access cannula (port) or a "surgically implemented stab" entry.
  • the surgical instruments described herein may be particularly suitable for robotic-assisted cardiac surgeries in which the heart of the patient is arrested for a brief period while the patient is placed on a heart-lung machine so that a surgeon can operate.
  • surgeries of the left atrium are carried out to repair, remove and/or replace faulty valve tissue (or the mitral valve itself).
  • Robotic-assisted closed- chest cardiac surgeries are typically carried out using a small thoracotomy and several thoracoports to provide operative visibility and access to the target cardiac site.
  • the surgical instruments may also be used for other surgeries, typically minimally invasive surgeries, of other target regions in the body, within or outside the mediastinum.
  • the invention(s) will be discussed primarily below in relationship to robotic-assisted closed chest cardiac surgeries.
  • the instruments and methods are not limited thereto as they can be useful for other surgeries such as non-robotic, endoscopic or general surgeries andVor for retracting non-cardiac tissue or other target organs or tissue.
  • sutures for annular closure, intraleaflet closure and/or annuloplasty can be placed robotically using, for example, 2-0 braided sutures and 4-0 monofilament sutures, all of which may be shortened to a desired length beforehand.
  • a side surgeon can cut and retrieve the sutures using conventional scissors and forceps after ligation of the sutures.
  • the number of sutures can vary with a patient, but for a quadrantectomy, more than 10 sutures are typically used with the ordinary sliding technique, and in an annuloplasty, between about 10-14 sutures can be used.
  • a lifting retractor can lift the heart.
  • Embodiments of the present invention can increase visualization of the operative field or site, and may be particularly useful in minimally invasive mitral valve surgeries (or mitral valve surgeries combined with Maze procedures for atrial fibrillation) to open the left atrium just posterior to the intra-atrial groove and anterior to the right pulmonary veins to expose the mitral valve without unduly interfering with robotic instruments or arms.
  • Figures 1-3 illustrate a first exemplary embodiment of a tissue retractor 15 with a rod 10 and a foldable blade 20.
  • the rod 10 is releasably attachable to the blade 20.
  • the rod 10 can have a distal end portion with female threads 11 that engage with male threads 21t in a receiving member 21 of the blade 20.
  • Other releasable attachment means can be used including, but not limited to, a bayonet fit, friction fit, and the like.
  • the rod 10 can have a unitary body with sufficient rigidity to provide the desired tissue retraction. In other embodiments, the rod 10 can be formed via a series of attached segments.
  • the retractor rod 10 may. comprise metal, ceramic, composite and/or elastomeric material, or combinations of same.
  • the retractor 10 may be single use and disposable or reuseable (after sterilization).
  • the rod 10 can have a cross-sectional width or thickness sized for atraumatic introduction via a single small incision, stab entry or other opening in the body.
  • the rod access path can be defined via a "blind stick”. Remote viewing via a video or camera of the use location can be used to position the rod in situ.
  • the cross-sectional width can be between about 1- 5 mm, typically between about 2-4 mm, and more typically about 3 mm. It is noted that the rod 10 can have various geometric cross-sectional shapes. The rod 10 can have the same cross- sectional width and/or shape over its entire length or may have varying widths and/or shapes over its length. The rod 10 can have a length that is between about 10-80 cm, typically about 30-60 cm. The rod 10 can be formed with a biocompatible material and/or coated with a biocompatible material, hard-coat or gel to promote slidability, decrease friction and/or facilitate insertion.
  • the rod 10 can be inserted through a surgically introduced "stab" or incision entry that can be about a 3 mm skin incision.
  • the rod 10 can have a length sufficient to enter the intrathoracic cavity and position the blade 20 inside the left atrium, typically so that the rod is outside the cardiac lumen and the blade 20 engages a roof of the left atrium to lift the roof upwardly and expose the mitral valve.
  • the blade 20 includes a center blade member 23 and first and second outer blade members 24, 26, each respective outer blade member having a pivot joint or hinge 25 along an innermost edge to be able to pivot relative to the center blade member 23.
  • the outer blade members 24, 26 can close above the center member 23 to form a generally triangular folded configuration suitable for compact insertion into the body.
  • the outer members 24, 26 can be configured to remain open and apart when folded as shown or may have a length and angle sufficient to contact each other (not shown).
  • other foldable blade configurations may be used, such as, for example, a shape memory alloy or an elastomeric blade body configured to preferentially fold axially at one, two or more transversely spaced apart locations (not shown).
  • the blade members 23, 24, 26 may all have substantially the same width and length, or may have different lengths and widths. In some embodiments, the blade members 23, 24, 26 are sized so that when folded any maximum width dimension is between about 8-14 mm (to be able to fit into a cannula having a diameter of between about 10-15 mm, typically between about 12 -15 mm).
  • the blade 20 can be configured so that when unfolded the blade 20 has a width of between about 25-40 mm.
  • the center member 23 will have a width W ( Figure 3) that is between about 8-13 mm.
  • the outer members 24, 26 can have a width that is between about 8-13 mm as well; however, lesser or greater widths (typically lesser) may be used.
  • the center member 23 can be widest and the outer members 24, 26 can have lesser widths. Alternatively, the center member 23 can be more narrow than one or more of the outer members 24, 26. In particular embodiments, the center member 23 has a width of about 10 mm, and the outer members 24, 26 are also about 10 mm.
  • the length L of the blade 20 ( Figure 3) can be any suitable length, but is typically between about 40-60 mm.
  • Figure 4 illustrates exemplary operational steps that may be used to retract tissue in heart surgery.
  • An elongate rod is introduced into a small opening in the patient's chest into an intra- and/or trans-thoracic cavity (block 105).
  • the foldable blade body is placed in the cavity using different access path, such as a cannula defining an access port (block 110). Once in the body, the blade body can be unfolded (block 112).
  • the rod can be attached to the body in situ (block 114).
  • the blade can be inserted into a left atrium (or other desired lumen) to lift a roof of the atrium (block 115).
  • the retractor may alternatively be used to retract other cardiac or target tissue.
  • the method is carried out during a closed chest robotic- assisted surgery (block 106) and/or can be used to carry out a mitral valve repair (block 108).
  • Figures 5A-5C illustrate a series of actions or steps that can be used to retract tissue.
  • Figure 5A illustrates the rod 10 being inserted into the intra-thoracic cavity 13 using a robotically controlled or manual endoscopic forceps 130 and the blade 20 being introduced via a cannula access path 129 (which may be the camera port for a robotoic assisted system).
  • the rod 10 is attached to the blade 20 in situ.
  • the forceps 130 can be used to unfold the blade 20.
  • the blade 20 can have a generally concave shape when unfolded and/or the outer blade members 24, 26 can angle downwardly outwardly away from the center member 23. That retractor 11 can lift tissue to better expose a surgical access path or target surgical site.
  • the compact configuration of the retractor 11 allows for multiple interventional robotic controlled and/or endoscopic tools to be used concurrently with the retractor 11.
  • the blade 20 when unfolded can be inserted into a left atrium 200a to lift tissue and expose a mitral valve region of the heart and/or open a view of or provide an access path into the heart. After placing the blade 20, the same port can be used to for a robotic camera or tool.
  • the tissue retractor 11 may releasably attach to an external mounting (stabilizer) fixture 30 that can hold the rod 10 and blade 20 in a desired intra-body orientation and position.
  • the external mounting fixture 30 shown can be a flexible snake arm that may have adjustable rigidity and may attach to a table, bed, or floor fixture or other suitable mounting structure.
  • the fixture 30 may also attach to a rib spreader or chest-mounted fixture (not shown).
  • other types of mounting fixtures can be used, whether chest mounted or mounted remotely from the patient.
  • An example of a commercially available snake arm is the XPOSE cardiac stabilizer from Guidant Corporation, located in Santa Clara, CA. See also, U.S. Patent Nos. 6,758,809, 6,740,028, and 6,581 ,889, the contents of which are hereby incorporated by reference as if recited in full herein.
  • the rod 10 may be sized and configured to be inserted percutaneously through an incision in the chest into the thoracic cavity.
  • the rod 10 may be tapered from a smaller front edge portion to a larger medial portion to allow for easier penetration of an incision ⁇ i.e., the front edge portion enters the incision first).
  • Figures 6 and 7 illustrate a robotic-assisted system 300 positioned to carry out a closed-chest surgical procedure.
  • the robotic-assisted system 300 can include a post 30Op with a plurality of arms, typically one being a camera arm 302 and two being interventional/manipulation arms 301, 303, each being able to enter the body via an access port.
  • a post 30Op with a plurality of arms, typically one being a camera arm 302 and two being interventional/manipulation arms 301, 303, each being able to enter the body via an access port.
  • the rod 10 is inserted into the chest wall.
  • a surgical access opening 75 proximate the xiphoid process or tip of the sternum cavity can be used to position the camera or other robotic instruments.
  • Supplemental incisions for side entry via percutaneous penetration can provide additional, typically minor, surgery access paths 176, 177 to the heart or great vessel (or other target regions) to allow surgery via visualization of the target site.
  • One or more paths 175-177 can be used by one or more surgeons for inserting tools used to carry out minimally invasive surgeries, such as endoscopic procedures. These paths 175- 177 can be particularly suitable for robotic-assisted systems as noted above.
  • Tools can be inserted serially through each path, and in some embodiments, cooperating tools can be inserted concurrently, one or more through a different access path to meet at a common location in situ.
  • One or more of the entry paths can be defined by an intra-body port with a cannula (also generally known as a trocar).
  • one or more intra-body ports can be provided by a small cannula, typically one that is between about 5-30 mm wide, and more typically about 10-20 mm wide.
  • An example of a commercially available port suitable for providing one or more access path is the THORACOPORTTM cannula, available from U.S. Surgical, Inc., a division of Tyco Healthcare, having a place of business in Norwalk, CT.
  • FIGs 8 and 9 illustrate another embodiment of a cardiac tissue retractor 111 with a foldable blade 120 and rod 110.
  • the rod 110 is attached to the blade 120 and the entire retractor 111 can be inserted into the body via a single - cannula access port (129, Figure HA).
  • the blade 120 can articulate with respect to the rod 110 as shown in Figure 8.
  • the blade 120 is attached to the rod 110 via pivot joint 113.
  • the blade 120 can fold axially rearward about the rod 110 as also shown in Figure 8.
  • the outer blade members 124, 126 can fold about the rod 110 as shown in Figure HA during insertion into the body via the cannula 129.
  • the blade 120 can articulate with respect to the rod 110 to provide a compact insertion and extraction configuration that can allow the use of a small cannula 129, typically a cannula 129 with a diameter of between about 10- 15 mm.
  • the blade 120 is foldable similar to the blade 20 discussed above and can include the same features, sizes and configurations discussed for blade 20 above. In a typically "use" configuration, the blade 120 extends substantially orthogonal to the rod HO as shown in Figure 9.
  • the retractor 111 can include a sleeve 114 that can slide over the rod 110.
  • the sleeve 114 is disposed upstream of the pivot 113 which allows the blade 120 to articulate with respect to the rod 110.
  • the blade 120 can fold toward the rod 110 which can be the typical insertion configuration.
  • the blade 120 may also articulate axially away (and aligned with) the rod 110 (i.e., disposed at about 180 degrees rather than the "0" degree orientation/fold shown in Figure 8).
  • the sleeve 114 can translate axially forward to encase the pivot 113 and lock the blade 120 in the lift orientation.
  • the sleeve 114 can, but is not required to, have a relatively short and substantially fixed axial translation distance, typically between about 5 mm to about 15 mm.
  • the sleeve 114 is pushed forward to reside against an upper primary surface of the center blade member 123 as shown.
  • other locking configurations may also be used.
  • the retractor 111 can also include a lock mechanism 140.
  • the lock mechanism 140 can include a spring 141 and an activation member 140m.
  • the activation member 140m can be configured for endoscopic activation, via either manual or robotic-assisted deployment.
  • the sleeve 114 can include an annular cap 114c that cooperates with the activation member 140m and spring 141 to push the sleeve 114 forward and compress the spring 141 in response to activation (depression) of member 140m.
  • the activation member 141m can be depressed again (or rotated or otherwise deployed), releasing the spring 141, which releases the sleeve 114 from the pivot 113.
  • the spring 141 and sleeve 114 can provide a sufficiently strong locking force to hold the retractor in the lifting configuration.
  • the spring 141 can be attached to the sleeve 114 to bias the sleeve 114 to return to an unlocked configuration.
  • the retractor 111 can include tensioning wires 127 that extend axially about an outer edge portion of each of the outer blade members 124, 126.
  • the tensioning wires 127 can be controllably tightened to force the outer perimeter of the blades 124, 126 upward and inward to thereby fold the outer blades 124, 126 ( Figure HC).
  • FIG. 10 illustrates operations that can be used to retract tissue using the retractor 111.
  • a rod attached to an articulatable blade can be inserted into a cannula defining an access path to a thoracic cavity (block 200).
  • the blade can be articulated to extend substantially perpendicularly outward from the rod after the blade exits the cannula (block 204).
  • the roof of the left atrium or other lumen can be lifted using the articulated blade (block 208).
  • the retractor can be used during a closed chest robotic-assisted surgery (block 206) and may be used to carry out a mitral valve repair (block 207).
  • Figures 1 IA-I IF illustrate exemplary actions that can be carried out to retract tissue using port access (cannula).
  • Figure HA illustrates the blade 120 pivoted rearward and folded about the rod 110.
  • the folded blade configuration may be generally triangular with the rod 110 enclosed by the outer blade members 124, 126 and center blade member 123. After exiting the cannula 129, the blade 120 pivots forward and outward to extend substantially orthogonal to the rod 110.
  • the sleeve 114 can translate forward to lock the blade 120 in the lifting configuration.
  • the forward portion of the blade 120 can be inserted into the desired lumen (such as, for example, the left atrium).
  • the sleeve 114 is slidably translated above the pivot joint 113 and the rod 110 is pulled upwardly.
  • the rearward portion of the blade 120 proximate the pivot 113 is pushed down, which acts to straighten the blade 120 axially.
  • the wires 127 can be tensioned tighter and directed inward to fold the outer blade members 124, 126 toward each other.
  • the folded blade can be slidably extracted from the cannula 129.
  • the retractor 111 may be configured so that the blade 120 can self-fold and unfold without the use of a triangular sleeve, or any overlying sleeve, directly in the cannula 129.
  • Figure 12 is a schematic of a robotic assisted system 300 that includes a display IOOD and an actuator 60 that can remotely actuate the locking mechanism 140 and can remotely introduce the retractor 111 to the body via cannula 129.
  • the blade 120 can be unfolded (opened automatically after entry into the thoracic cavity or other region). Once the surgeon pushes the activation member 140m after use, the locking mechanism of the blade 120 is released and the device 111 can be extracted via the port 129.
  • the retractor 111 can be attached to a fixation structure such as a snake manipulator 30 ( Figure 6).
  • the retractor 111 can have a length sufficient to allow external mounting or fixation to a desired structure. An exemplary length is between about 500-1000 mm.
  • the cannula 129 can provide an operative access path that even with the rod 110 in position can be left substantially open or free to allow robotic controlled devices to access a mitral valve repair site upstream of the blade 120 while the retractor 111 is in position.
  • the cannula 129 can be dedicated to the retractor 111 while the retractor 111 is used.
  • the devices described herein can be particularly suitable for facilitating totally endoscopic mitral valve repair.

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Abstract

L'invention concerne des écarteurs cardiaques comprenant une tige et une lame pliable pouvant être introduites par le biais d'orifices d'accès à effraction minimale, tels que ceux ménagés par une canule de cavité intra-thoracique. La tige et la lame peuvent être d'une seule pièce ou peuvent être fixées amovible in situ. Les dispositifs peuvent être dimensionnés et conçus de manière à être placés in situ à proximité du site de la valvule mitrale, au niveau de l'oreillette gauche, de manière à éclisser la valvule mitrale afin qu'elle soit ouverte (lever le toit de la valvule mitrale), en réponse à une instruction robotisée d'un chirurgien, en vue de la réparation de la valvule mitrale, au cours d'une intervention cardiaque à effraction minimale à coeur fermé.
PCT/US2006/048815 2005-12-27 2006-12-21 Écarteurs cardiaques endoscopiques comprenant des composants de pliage conçus pour une insertion par le biais d'orifices d'accès à effraction minimale et procédés associés WO2007075903A2 (fr)

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US75410705P 2005-12-27 2005-12-27
US60/754,107 2005-12-27

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WO2007075903A2 true WO2007075903A2 (fr) 2007-07-05
WO2007075903A3 WO2007075903A3 (fr) 2008-08-07

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WO2011072104A1 (fr) 2009-12-09 2011-06-16 Poo Ramon E Écarteur pour soulèvement d'oreillette
US20130041229A2 (en) * 2010-09-29 2013-02-14 Alfred E. Mann Institute For Biomedical Engineering At The University Of Southern California Minimally obstructive retractor
US20130123852A1 (en) * 2011-11-14 2013-05-16 Custom Spine, Inc. Cervical Spine Retractor
WO2014067840A1 (fr) * 2012-10-29 2014-05-08 Aesculap Ag Rétracteur atrial
US20140364698A1 (en) * 2011-09-29 2014-12-11 Alfred E. Mann Institute For Biomedical Engineering At The University Of Southern Californ Minimally obstructive retractor for vaginal repairs
US9005221B2 (en) 2010-02-24 2015-04-14 Miami Instruments Llc Knot setter
ES2557517A1 (es) * 2015-07-20 2016-01-26 Anas SARRAJ ASIL Retractor de cirugía cardiaca perfeccionado
CN105266870A (zh) * 2015-09-17 2016-01-27 刘敏敏 带缝合孔的张合手术刀
CN109927077A (zh) * 2019-03-18 2019-06-25 江苏卫生健康职业学院 造瘘袋剪切器
US20230149006A1 (en) * 2021-11-17 2023-05-18 Usb Medical Limited Tricuspid Retractor Blade Assembly

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Cited By (24)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2011072104A1 (fr) 2009-12-09 2011-06-16 Poo Ramon E Écarteur pour soulèvement d'oreillette
EP2509489A1 (fr) * 2009-12-09 2012-10-17 Miami Instruments, LLC Écarteur pour soulèvement d'oreillette
US8388525B2 (en) 2009-12-09 2013-03-05 Miami Instruments Llc Atrial lift retractor
EP2509489A4 (fr) * 2009-12-09 2015-04-01 Miami Instr Llc Écarteur pour soulèvement d'oreillette
US9005221B2 (en) 2010-02-24 2015-04-14 Miami Instruments Llc Knot setter
US20130041229A2 (en) * 2010-09-29 2013-02-14 Alfred E. Mann Institute For Biomedical Engineering At The University Of Southern California Minimally obstructive retractor
US9050048B2 (en) * 2010-09-29 2015-06-09 Alfred E. Mann Institute For Biomedical Engineering At The University Of Southern California Minimally obstructive retractor
EP2621328B1 (fr) * 2010-09-29 2018-01-10 Proa Medical, Inc. Écarteur à obstruction minimale
US9861349B2 (en) 2011-09-29 2018-01-09 Proa Medical, Inc. Speculum for obstetrical and gynecological exams and related procedures
US20140364698A1 (en) * 2011-09-29 2014-12-11 Alfred E. Mann Institute For Biomedical Engineering At The University Of Southern Californ Minimally obstructive retractor for vaginal repairs
US9907544B2 (en) 2011-09-29 2018-03-06 Proa Medical, Inc. Minimally obstructive retractor for vaginal repairs
US20130123852A1 (en) * 2011-11-14 2013-05-16 Custom Spine, Inc. Cervical Spine Retractor
US8668715B2 (en) * 2011-11-14 2014-03-11 Custom Spine, Inc. Cervical spine retractor
US10238372B2 (en) 2012-10-29 2019-03-26 Aesculap Ag Atrium retractor
JP2015533312A (ja) * 2012-10-29 2015-11-24 アエスキュラップ アーゲー 心房開創器
WO2014067840A1 (fr) * 2012-10-29 2014-05-08 Aesculap Ag Rétracteur atrial
WO2017013283A1 (fr) * 2015-07-20 2017-01-26 Sarraj Asil Anas Écarteur de chirurgie cardiaque perfectionné
ES2557517A1 (es) * 2015-07-20 2016-01-26 Anas SARRAJ ASIL Retractor de cirugía cardiaca perfeccionado
US10517581B2 (en) 2015-07-20 2019-12-31 Anas SARRAJ ASIL Cardiac surgery retractor
CN105266870A (zh) * 2015-09-17 2016-01-27 刘敏敏 带缝合孔的张合手术刀
CN109927077A (zh) * 2019-03-18 2019-06-25 江苏卫生健康职业学院 造瘘袋剪切器
CN109927077B (zh) * 2019-03-18 2024-03-15 江苏卫生健康职业学院 造瘘袋剪切器
US20230149006A1 (en) * 2021-11-17 2023-05-18 Usb Medical Limited Tricuspid Retractor Blade Assembly
WO2023091501A1 (fr) * 2021-11-17 2023-05-25 Usb Medical Limited Ensemble lame de rétracteur tricuspide

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