CA2260019A1 - Endarterectomy surgical instruments and procedure - Google Patents
Endarterectomy surgical instruments and procedure Download PDFInfo
- Publication number
- CA2260019A1 CA2260019A1 CA002260019A CA2260019A CA2260019A1 CA 2260019 A1 CA2260019 A1 CA 2260019A1 CA 002260019 A CA002260019 A CA 002260019A CA 2260019 A CA2260019 A CA 2260019A CA 2260019 A1 CA2260019 A1 CA 2260019A1
- Authority
- CA
- Canada
- Prior art keywords
- flexible tubular
- tubular means
- surgical instrument
- spatula tip
- fiber optic
- 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
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
-
- 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
- A61B17/3205—Excision instruments
- A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
-
- 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
- A61B17/3203—Fluid jet cutting instruments
- A61B17/32037—Fluid jet cutting instruments for removing obstructions from inner organs or blood vessels, e.g. for atherectomy
-
- 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
- A61B17/3205—Excision instruments
- A61B17/32056—Surgical snare instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B2017/22082—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for after introduction of a substance
-
- 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
- A61B17/3205—Excision instruments
- A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
- A61B2017/320741—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions for stripping the intima or the internal plaque from a blood vessel, e.g. for endarterectomy
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0817—Spatulas or spatula like extensions
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
- A61B2090/306—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure using optical fibres
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/361—Image-producing devices, e.g. surgical cameras
- A61B2090/3614—Image-producing devices, e.g. surgical cameras using optical fibre
Abstract
An endarterectomy surgical instrument and procedure for removing plaque from a selected length of an artery and surgical instruments for cutting plaque buildups. The endarterectomy surgical instrument has means for developing an image of the surgical site so that probing of the artery can be observed without requiring opening the artery along the selected length over which the plaque is removed.
Description
2 PCT~US97/12174 ENDARTERECTOMY SURGICAL INSTRUMENTS
AND PROCEDURE
TECHNICAL FIEL~D
The present invention relates, in genera]L, to surgical instruments and procedures 5 and, in particular, to the çl~ning of arteries to remove plaque build-ups.
BACKGROUND OF THE INVENTION
It has been common praçti~e to open the fullL sel~cted length of an artery which is to be cleaned of plaque build-ups and te~ioucly se~ te the inner layers (i.e. the "core") from the outer layers to remove the plaque build-ups along the length of the artery after 10 which the full length of the openih~g is sutured closed using the outer layers for the closure. RP~ se such incisions, for example, can extend along the entire length of the leg from the groin to the foot, such a procedure is a massive surgical invasion. As the length of the incision increases, the difficulty of the surgica]L procedure increases.
Another procedure, involving relatively smaill in~ i~ion~ at the ends of the aItery 5 section to be clP~nP~, a]Lso has been performed in the past for the remova]L of plaque bui]Ld-ups. In this procedure, plaque bui]Ld-ups are removed or loosened by forceps which are introduced at the two incisions to "core out" the artery. To remove residue plaque, a pel" (e.g. a c~th~Pter-type unit) is passed through the entire blocked artery from the upper incision to tihe ]Lower incision and a certain, limited amount of residue plaque is 20 pushed out through tble lower incision. A swab is secured to the leading end of the catheter-type unit afte:r it has emerged through the lower incision. Upon retraction of the catheter-type unit, the swab carries residue plaque toward and out from the upper incision. The~lc;r, the two incisions are closed. Rec~llse this procedure is "blind" in that the artery section being cleaned is not open and exposed, it is inherently danger~us.
25 Also, the second incision is nPces~ either for an exit of plaque or to gain access to the catheter-type unit for ~rr"~;,.g the swab.
In another tec]mique for the remova]L of plaque build-ups, known as gas endarterectomy, a jet of carbon dioxide gas is injected into the waLL of an artery to create a "separation plane." A smaill open"lg is made in the artery and a specia]L gas spatula, ~ . .
CEI-019 .~ . ~. .. .
carefully rlf-C;~,I-~I not to injure the artery, is passed down the 5~p~ ;0n plane as carbon dioxide gas passes through the spatula further freeing up the entire length of the inner core. The inner core then is removed by tr~n~ecting the distal end and pulling the entire core out of the proximal opening in the artery after which the two openings are closed.
5 Reca-lse this procedure .31so is "blind" in that the artery section being cleaned is not open and exposed, it is inherently dangerous. Also, this procedure ~uih~.s at least two surgical incisions to expose both ends of the artery section to be cleaned and two openings in the artery itself. .-~n ..~ample for ~ "blind" endarteroctom~ spatula is shown in ~iS-A ~.5~5 ~9.
Gas endarterectomy also has been caIIied out by first surgically opening the body 0 part, but not the artery ~Yhich is to be c]~ne~, along the full sel~ed length of the artery and then ~,rOl~g the gas endarterectomy by viewing the probing of the artery through the aufficiently tIanspar nt ~rj ~all. Such a prcco~.,re a!so is a massive surO cal invasion. As the length of tne incision increases, the difficulty of the surgical procedure increases.
Because of the diff~iculties and hazards associated with the surgical proceduresdescribed above, bypass surgical procedures becarne popular. Instead of cleaning out a pla~ue build-up in an artery, the section of the altery having the plaque build-up is bypassed surgically. Such a bypass procedure also is a massive surgical invasion. As tne length of the bypass inc xases, the diR~culty of the surgical procedure ulcr~ses.
At the present tihne, there is a trend for reducing the degree of invasion in surgical p~ce~ s. Con~qu~nrly, more and more ,~ .ed interest is being ~ ssed in gas end~ e~"y which n~duces surgical invasion and the period of time the patient must remain in the hos~pital.
SUMMARY OF THE ~IVEN~ION
25 The present invention is described by the independent claims Advantageous embodiments are defined by the subclaims ~ t~ i L~
(~kT~l9 '; , ~,.- .
If it is R~Sf~ . y to cut the plaqu~ build up so that it c~n be removed, a fir~tsurgical instrument, constructed in accordance with the present inventiol~, in~
elongated flexible stem lmit, a handle at a first end of the elongated ~bfstem unit, and a cutting unit at a second end of the elongated ~lexible s~t, opposite from the first end. The cutting U~Iit has an inner cutting ed~curved outer blunt edge.
A second sur~ical ins~ument, co~ in accordance with the present invention for cutting plaque build-ups, in~n elongated tubular support unit and a cutting wire unit ~P~1in~ through t~3e ~gated tubular support unit and freely movable within the elongated tubu~/~t unit. The free ends of the cutting wire unit project from a fir-st 10 end o~ngated tubular support unit and a closed loop portion of the cutting wire unit ects from a &~ond en~ of thf~ ng~t~ Ul~r support ~ln;t~
B~IEF DESCRIP'IION OF THE DRAWINGS
Figure 1 is a top view, par~lly in cross-section, of an endarterectomy surgical instrument constructed in accordance with the present i~vention.
1~ Figure 2 is an end view of the spatula tip portion of the endarterectomy surgical instrument of Figure 1.
Figure 3 is a seclional view of the optics portion of the end~L~ ol-ly surgical instrument of Figure 1.
Figu~e 4 is a sec~ional view of a human artery partially filled with pl~que build-20 ups.
Figure 5 is an end view of a second embodiment of the spatula tip portion of theendalL~ y surgical instrument of Figure 1.
Figure 6 is a sec~onal view of a ponion of a third embodim ;:n~ an endarterectomy sur~ical instrument constructed in accordance with the present invention.
Figures 7A and ~7B are top and side views, respectively, of a first embodiment of a surgical ins~ument, coDstructed in accol.laDce with the present invention, for cutting plaque build-ups.
AMENDED SH~
W O 9BI02102 PCTrUS97/12174 Figure 7C shows an ~lt~n~tive form of the cutting unit portion of the surgical instrument of Figures 7A and 7B.
Figure 8 is top view of a second embodiment of a surgical instrument, constructed in accol~ ce with the present invention, for cutting plaque build-ups.
s Figure 9 is an ~pen, side view of a third embodiment of a surgical instrument, constructed in accordance with the present invention, for cutting plaque build-ups.
DETAILED DESCRIPIION OF THE INVENTION
Rere~ g to Figures l, 2 and 3, an end~le,ectomy surgical in~llulllel~l, constructed in accordance with the present invention, includes a spatula tip 10 having at a 0 first end thereof an optics (i.e. light and image) o~e~ g 12 and a plurality of fluid openings 14. As will be expl~in~d below, optics opening 12 permits a light from a light source to be con~ cte~1 to a surgical site and an image of the surgical site to be con-lucted to an image forming unit. In this way, the surgeon can observe the surgical procedure being conducted within the artery without the need to open the entire length of the artery which is being cleaned. As will also be explained below, fluid openings 14 permit the passage of a fluid, typically carbon dioxide, to the surgical site to increase the space (i.e.
the "separation plane") between the adventitia layer and the media layer of the artery. In this way, spatula tip 10 can be advanced along the length of the artery which is being cle~nP~ Spatula tip l0 preferably has a curved body which approximates the shape of aln artery and is sized for the particular artery being cle~n~qcl Preferably, spatula tip 10 also has at the first end thereof a plurality of liquid ope~ g~ 16a and 16b to permit the passage of a liquid to and from the surgical site to carry away plaque debris and clean optics opening 12. The liquid is con~lucted to the surgical site through liiquid opening 16a and is cond~cted away from the surgical site through liquid opening 16b. Typically, the liquid can be a saline solution.
An end~L~ omy surgical instrument, constructed in accordance with the present invention, also includ~,s first flexible tubular means 18 ex~Pnding through spatula tip 10 from optics opening 12 in the spatula tip for con(1llcting a light from a remote end of the first flexible tubular means through the optics opening to a surgiical site and an image of ~ ... . . . . .. .
CA 022600l9 l999-0l-l2 W O 98/02102 PCTrUS97/12174 the surgical site through the optics opening to the remote end of the first fl~PxihhP tubular means. Such first flexible tubular means 18 can include first fiber optic means through which light is con-lucted to the surgical site and second fiber optic means through which an image of the surgical site is con-iuct~P~I For the embodiment of the invention shown in Figure 3, the first fiber optic means include a plurality of fiber optic cables 20 disposed in a circular array and the second fiber optic means include a single fiber optic cable 22 disposed at the center of the circular array of the plurality of fiber optic cables 20 of the first fiber optic means. As shown in Figures 1 and 2, optics opening 12 and fiber optic cables 20 and 22 preferably are within the curved body of spatula tip 10 rather than o outside the inner and outer curved surfaces of the spatula tip to facilitate the design and ...i.~i..,i,.o. the size of the spatula tip.
An end~Le~;lol,ly surgical instrument, constructed in accordance with the present invention, further includes second flexible tubular means 24 ext~Pn~ling through 10 spatula tip from fluid ol)enings 14 in the spatula tip for conAucting a fluid from a remote end of the second flexible tubular means through the fluid openil~gs to the surgical site.
Although first flexible tubular means 18 and second flexible tubular means 24 are shown as being spaced apaIt, they can be arranged in a coaxial manner.
When a liquid is to be delivered to the surgical site, an en~le~clol,ly surgicalinstrument, constructed in accordance with present invention, further includes third flexible tubular means 26 e~tpn~iing through spatula tip 10 from liquid openings 16a and 16b in the spatula tip for cond~lcting liquid from a remote end of the third flexible tubular means to the surgical site through a first of the liquid openings and for con(lucting liquid through a second of the liquid openings from the surgical site to the remote end of the third flexible tubular means.
An end~t~ ull,y surgical instrument, constructed in accordance with present invention, also includes com~e-;lor means 28 adapted for connection to a light source, an image forming unit, and a fluid source and to which the remote end of first flexible tubular means 18 and the remote end of second flexible tubular means 24 are connP~te~.
When liquid is to delivered to and drawn from the surgical site, connector means 28 are adapted for col~eclion to a liquid source and a liquid discharge reservoir and the remote W O98/02102 PCTrUS97/12174 end of third flexible tubular means 26 are conn~ted to the connector means. In this way, light from the light source is con-lucted to first flexible tubular means 18, an image of the surgical site is conducted from first flexible tubular means 18 to the image forming unit, fluid from the fluid source is conducted to second flexible tubular means 24, and liquid is s to delivered from the liquid source to third flexible tubular means 26 and delivered from the third flexible tubular means to the liquid discharge reservoir.
Connector me~ms 28 can include conventional luer lock conn~lo,~ to which the fluid source and second flexible tubular means 24 are com~e~;L~d for the passage of fluid and to which the liquid source, liquid discharge reservoir and third flexible tubular means lO 26 are conn~cted for the passage of saline solution. In contrast, the first fiber optic means through which light is con~ cted to the surgical site and the second fiber optic means through which the image of the surgical site is cond~lcted to the image forming unit are continuous, ~ led fiber optic cables which pass through connector means 28 but are locked by the com~ector means against longit---lin~l and rotational sliding and sealed to prevent escape of carbon dioxide gas and saline solution.
Preferably, an endalLe,~;lu,l,y surgical instrument, constructed in accordance with the present invention, includes a flexible sh~thing 30 ext~n~ing between spatula tip 10 and connector means ,~8 and through which first flexible tubular means 18, second flexible tubular means 24 and third flexible tubular means 26 extend Flexible ~ ing 30 can be a tubular piece, as shown in Figure l, through which s~.dt~ly formed first tubular means 18, second tubular means 24 and third flexible tubular means 26 extend or the ~h~thing and the Itubular means can be formed as a single, flexible extruded piece with passages or channels through which the light, the image of the surgical site, the fluid and the saline solution are con~ cted The surgical instrument just descrihed can be used in an e~ld~lel~ctomy surgicalprocedure for removirlg a plaque build-up from a selected length of an artery inaccordance with the plresent invention. First, an incision is made and the artery is ~iissected at a first end of a sel~ted length of the artery from which a plaque build-up is to be removed. Next, the outer wall of the artery is peneLldl~d with a needle, typically 25 gauge, and carbon dioxide gas is introduced through the needle to start the sel ~d~ion of the adventitia layer and the media layer (i.e. the "sep~r~tiC)n plane"). The needle is removed and an incision is made into the artery wall.
Referring to Figure 4, the next step in the endalLe~ o,l.y surgical procedure, pelrolllled in accor~ ce with the present invention, is inserting a spatula 10 into the s artery at the incision belweell the adventitia layer 40 and the media layer 42 of the artery.
Next, the selected length of the artery is probed with the spatula while applying a fluid (e.g. carbon dioxide gas) under a controlled p~s~ through the spatula tip to increase the space between the adventitia layer 40 and the media layer 42 of the artery. The carbon dioxide gas also reduces the amount of blood at the surgical site. The carbon 10 dioxide gas is either absorbed or flows out through the incision in the artery wall. Saline solution, under a controlled pl~,ss~ll'e, can be delivered to the surgical site to flush away pieces of plaque which have broken away from the plaque build-up 44 and to clean the optics opening in the spatula tip. It is ihl"~ol~nt to control the p~S~ul~S of the carbon dioxide gas and saline solution to el..~ e the potential for creating damage to the artery when there is a total blockage of the artery by the plaque build-up.
As the artery is being probed, an image of the surgical site at the spatula is continuously developed, so that the surgeon l~clrolllling the procedure can view the image of the surgical site while ~lobing the artery. Side branches of the artery are isolated as the artery is probed. Probing of the artery is t.o.~nin~ted at a second end of the selected 20 length of the artery and the spatula is ~c~ 1~ and removed from the artery through the il~CiSiOll.
Next, the plaque build-up 44, along with the intima layer 46 and the media layer42 of the artery (i.e. the "core"), are removed from the artery. The core can be removed by pulling the plaque build-up out through the incision with forceps if the plaque has been 25 broken or we~kPned at the second end of the selected length of the artery. This can be delell"ined by viewing the image of the surgical site as the spatula is moved along the artery.
If np~ess~ry~ after the spatula has been retr~cted and removed from the artery asurgical instrument, such as the ones illustrated in Figures 7A, 7B, 7C and 8, can be 30 inserted into the artery through the incision and advanced to the second end of the select~d length of the artery at which the plaque build-up is cut. When the surgical cutting instrument is retracted and removed from the artery, the plaque build-up is pulled out through the incision by the surgical cutting insLl~,.,enl or with forceps.
After the plaque build-up has been removed, the té1lllindliOn transition at the 5 second end of the selected length of the altery is treated and the incision is closed. If the spatula is arranged with liquid o~e ~ings, liquid can be delivered to the surgical site and drawn away from the surgical site while the artery is being probed. It is illl~olL~rlL to remove phque debris from the artery before the incision is closed.
It is important to pr~ale the le...,i~ n t-~ncition or there can be further o stripping of plaque by blood flow. There is also the potential for clotting and debris at the terrnin~ti~ n if the ~n~ition is abrupt. The termination transition can be prepared by a laser instrument which can be included in an endarterectomy surgical instrument constructed in accoldance with the present invention. As shown in Figure S, spatula tip 10 can have a laser opening 32 through which a laser beam can be emitted to ~JlG~ 'e the 15 le.,.~in~ion transition.
As shown in Figure 6, an endarterectomy surgical instrument, constructed in accordance with the present invention, can be arranged with a balloon and used in a surgical procedure in the same way that a balloon c~th~.ter is used. The flexible ~he~thing 34 has a balloon 36 bonded to the outside surface of the che~thing. With balloon 36 20 dPfl~tffl, it lies flat against the outside surface of flexible ~ht-,~thing 34. When a fluid, under controlled ~1~ ssule, is introduced into balloon 36 through air passage 38, the balloon inflates as shown in Figure 6.
- Referring to Fiigures 7A and 7B, a first embodiment of a surgical ills~ lent for cutting plaque build-ups, constructed in accordance with the present invention, in~hldes 25 an elongated flexible stem unit S0, a handle S2 at a first end of the elongated flexible stem unit, and a cutting unit 54 at a second end of the elongated flexible stem unit, opposite from the first end. Cutting unit 54 has an inner cutting edge 56 and a curved outer blunt edge 58. A wall 60, e~t~,n-1ing between the inner cutting edge 56 and the curved outer blunt edge 58, has suf~lcient width to carry material which has been cut as handle 52 is , ~ ~, . .~ . . . .. .
CA 022600l9 l999-0l-l2 W O98/02102 PCTrUS97/12174 pulled or turned. Although cutting edge S6 is shown as being curved, it can take other forms, such as a straight edge.
Preferably, cutting unit 54 of the surgical instrument of Figures 7A and 7B lies in a plane which is disposed at an obtuse angle relative to elongated stem unit SO. With such 5 an all~g~,l,ent, after the surgical instrument is introduced through the incision, cutting unit 54 is moved easily along the surface of the core which will be removed from the artery to the point at which the cutting unit is to cut the plaque build-up. As side branches of plaque build-ups are encounleled, the surgical i"sll~",ent can be rotated to bypass such side branches. For a particular surgical instrument for cutting plaque build-lo ups, the flexibility of stem unit 50, the angle between cutting unit 54 and the stem unitand the shape, radius and length of cutting edge S6 are dependent upon the size and condition of the artery. The objective of the design of any such surgical instrument is to assure that as the surgical instrument is turned to cut through the plaque build-up, the surgical instrument does not cut through the artery wall. The desired effect is to have 15 cutting unit 54 encircle the plaque build-up as it cuts through the plaque build-up. When the cutting is completed, the cutting unit 54 can remain engaged with the core m~te.ri~l which has been cut to an extent suffficient to remove the core material through the incision as the surgical instrument is retracted and removed through the incision. Wall 60, e~tten(ling between inner cutting edge S6 and outer blunt edge S8, also is effective in 20 removing the cut core material through the incision.
The desired flexibility in stem unit 50 of the surgical instrument illustrated by Figures 7A and 7B is provided by a spring 62 between a first end of a first rigid member SOa and a first end of a second rigid member 50b. Handle 52 is ~ttach~d to a second end of first rigid member 50a of the elongated flexible stem unit and cutting unit 54 is 25 att~h~l to a second end of second rigid member SOb of the elongated flexible stem unit.
Spring 62 and the cant of cutting unit 54 provide a center of rotation of the cutting unit which prevents cutting the altery wall as handle S2 is turned to cut a plaque build-up.
Spring 62 is design~l to be sufficiently flexible to achieve this result, yet sufficiently rigid to cut a plaque build-up and permit carrying m~tçri~l which has been cut as handle S2 is 30 pulled or retracted from the incision.
' -- ' ' - t W O 98/02102 PCT~US97/12174 As shown in Pigure 7C, cutting unit 54 can be formed with a housing 64 which is ~tt~ h~d to a second end of second rigid member 50b of the elongated stem unit and has a curved outer blunt edge 58. A cutting blade 66 is positioned within hnu~ing 64. With this form of cutting unit, there is a wall which extends between inner cutting edge S6 of cutting blade 66 and outer blunt edge 58 of housing 64 and has s-lmcient width to carry material which has been cut as handle 52 is pulled.
It should be noted that a surgical in~ len~ for cutting plaque build-ups, such as the one illustrated in :Figures 7A, 7B and 7C, can be arranged with optics and irrigation as is the endarterectomy surgical instrument described above.
o Figures 8 and 9 show second and third embotlim~nt~ of a surgical illsLI~lllent for cutting plaque build-ups constructed in accordance with the present invention. Each of these surgical instruments incl~ldes an elongated tubular support unit and a cutting wire unit e~t~n~ling through the elongated tubular support unit and freely movable within the elongated tubular support unit. The free ends of the cutting wire unit project from one end of the elongated lubular support unit and a closed loop portion of cutting wire unit projects from a second end of the elongated tubular support unit.
RtÇe.,illg to Pigure 8, the elongated tubular support unit in(~l~ldes a first elongated tube 70 and a second ek ng~ted tube 72. The cutting wire unit includes first and second lengths of wire 74 and 76 which extend through first elongated tube 70 and second elongated tube 72, respectively. First and second free ends 74a and 74b of the first length of wire project from one end of the first elongated tube and a middle portion 74c of the first length of wire proje~;ls from the ol~po~ile end of the first elongated tube. First and second free ends 76a and 76b of the second length of wire project from one end of the second ek)ng~ted tube and a middle portion 76c of the second length of wire projects 2s from the opposi~e second end of the second elongated tube and is looped through middle portion 74c of the fir;t length of wire 74.
The surgical instrument of Figure 8 is used in the following manner. The surgical in~ llltl.l is introduced through the incision and is moved along the artery with middle portion 76c of wire 76 positioned outside the core m~teri~l which is to be cut to the point at which the plaque build-up is to be cut. By pulling on the free ends 74a and 74b of W O 98/02102 PCTrUS97/12174 wire 74 and the free ends 76a and 76b of wire 76, the slack in middle portion 76c of wire 76 is taken up and the core material is cut. The core m~t~ri~l can be removed either by retraction of the surgical instrument or with forceps if middle portion 76c of wire 76 moves through the core m~teri~l without pulling the core m~t~ri~l through the incision.
s Referring to Figure 9, the elongated tubular support unit includes an e10ng~t~1 tube 80 and a housing 82 attached to the elongated tube at a first end thereof. The cutting wire unit includes a length of wire 84 which extends through elongated tube 80 and housing 82 with first and second free ends 84a and 84b of the length of wire projecting from a second end of the elongated tube opposite from the first end of elongated tube.
o The middle portion 84c of the length of wire projects from the first end of elongated tube 80 and is looped from the elongated tube through housing 82 into the elongated tube.
The surgical instrument of Pigure 9 is used in much the same manner as the surgical instrument of Figure 8. The surgical instrument is introduced through the incision and is moved along the artery with middle portion 84c of wire 84 po~ition~d 1S outside the core m~tP.ri~l which is to be cut to the point at which the plaque build-up is to be cut. By pulling on the free ends 84a and 84b of wire 84, the slack in middle portion 84c of the wire is taken up and the core m~teri~l is cut. The core material can be removed either by retraction of the surgical instmment or with forceps. Housing 82 functions in much the same way as the wall in the surgical instrument of Figures 7A, 7B
and 7C in pulling the cut core m~teri~l as the surgical instrument is retracted and withdrawn through the inCision.
Whi}e in the folegoillg there have been described pl~rerr~d embo-lim~nt~ of the present invention, it should be understood by those skilled in the art that various mo~ifi~tions and changes can be made without departing from the true spirit and scope of the present invention.
AND PROCEDURE
TECHNICAL FIEL~D
The present invention relates, in genera]L, to surgical instruments and procedures 5 and, in particular, to the çl~ning of arteries to remove plaque build-ups.
BACKGROUND OF THE INVENTION
It has been common praçti~e to open the fullL sel~cted length of an artery which is to be cleaned of plaque build-ups and te~ioucly se~ te the inner layers (i.e. the "core") from the outer layers to remove the plaque build-ups along the length of the artery after 10 which the full length of the openih~g is sutured closed using the outer layers for the closure. RP~ se such incisions, for example, can extend along the entire length of the leg from the groin to the foot, such a procedure is a massive surgical invasion. As the length of the incision increases, the difficulty of the surgica]L procedure increases.
Another procedure, involving relatively smaill in~ i~ion~ at the ends of the aItery 5 section to be clP~nP~, a]Lso has been performed in the past for the remova]L of plaque bui]Ld-ups. In this procedure, plaque bui]Ld-ups are removed or loosened by forceps which are introduced at the two incisions to "core out" the artery. To remove residue plaque, a pel" (e.g. a c~th~Pter-type unit) is passed through the entire blocked artery from the upper incision to tihe ]Lower incision and a certain, limited amount of residue plaque is 20 pushed out through tble lower incision. A swab is secured to the leading end of the catheter-type unit afte:r it has emerged through the lower incision. Upon retraction of the catheter-type unit, the swab carries residue plaque toward and out from the upper incision. The~lc;r, the two incisions are closed. Rec~llse this procedure is "blind" in that the artery section being cleaned is not open and exposed, it is inherently danger~us.
25 Also, the second incision is nPces~ either for an exit of plaque or to gain access to the catheter-type unit for ~rr"~;,.g the swab.
In another tec]mique for the remova]L of plaque build-ups, known as gas endarterectomy, a jet of carbon dioxide gas is injected into the waLL of an artery to create a "separation plane." A smaill open"lg is made in the artery and a specia]L gas spatula, ~ . .
CEI-019 .~ . ~. .. .
carefully rlf-C;~,I-~I not to injure the artery, is passed down the 5~p~ ;0n plane as carbon dioxide gas passes through the spatula further freeing up the entire length of the inner core. The inner core then is removed by tr~n~ecting the distal end and pulling the entire core out of the proximal opening in the artery after which the two openings are closed.
5 Reca-lse this procedure .31so is "blind" in that the artery section being cleaned is not open and exposed, it is inherently dangerous. Also, this procedure ~uih~.s at least two surgical incisions to expose both ends of the artery section to be cleaned and two openings in the artery itself. .-~n ..~ample for ~ "blind" endarteroctom~ spatula is shown in ~iS-A ~.5~5 ~9.
Gas endarterectomy also has been caIIied out by first surgically opening the body 0 part, but not the artery ~Yhich is to be c]~ne~, along the full sel~ed length of the artery and then ~,rOl~g the gas endarterectomy by viewing the probing of the artery through the aufficiently tIanspar nt ~rj ~all. Such a prcco~.,re a!so is a massive surO cal invasion. As the length of tne incision increases, the difficulty of the surgical procedure increases.
Because of the diff~iculties and hazards associated with the surgical proceduresdescribed above, bypass surgical procedures becarne popular. Instead of cleaning out a pla~ue build-up in an artery, the section of the altery having the plaque build-up is bypassed surgically. Such a bypass procedure also is a massive surgical invasion. As tne length of the bypass inc xases, the diR~culty of the surgical procedure ulcr~ses.
At the present tihne, there is a trend for reducing the degree of invasion in surgical p~ce~ s. Con~qu~nrly, more and more ,~ .ed interest is being ~ ssed in gas end~ e~"y which n~duces surgical invasion and the period of time the patient must remain in the hos~pital.
SUMMARY OF THE ~IVEN~ION
25 The present invention is described by the independent claims Advantageous embodiments are defined by the subclaims ~ t~ i L~
(~kT~l9 '; , ~,.- .
If it is R~Sf~ . y to cut the plaqu~ build up so that it c~n be removed, a fir~tsurgical instrument, constructed in accordance with the present inventiol~, in~
elongated flexible stem lmit, a handle at a first end of the elongated ~bfstem unit, and a cutting unit at a second end of the elongated ~lexible s~t, opposite from the first end. The cutting U~Iit has an inner cutting ed~curved outer blunt edge.
A second sur~ical ins~ument, co~ in accordance with the present invention for cutting plaque build-ups, in~n elongated tubular support unit and a cutting wire unit ~P~1in~ through t~3e ~gated tubular support unit and freely movable within the elongated tubu~/~t unit. The free ends of the cutting wire unit project from a fir-st 10 end o~ngated tubular support unit and a closed loop portion of the cutting wire unit ects from a &~ond en~ of thf~ ng~t~ Ul~r support ~ln;t~
B~IEF DESCRIP'IION OF THE DRAWINGS
Figure 1 is a top view, par~lly in cross-section, of an endarterectomy surgical instrument constructed in accordance with the present i~vention.
1~ Figure 2 is an end view of the spatula tip portion of the endarterectomy surgical instrument of Figure 1.
Figure 3 is a seclional view of the optics portion of the end~L~ ol-ly surgical instrument of Figure 1.
Figu~e 4 is a sec~ional view of a human artery partially filled with pl~que build-20 ups.
Figure 5 is an end view of a second embodiment of the spatula tip portion of theendalL~ y surgical instrument of Figure 1.
Figure 6 is a sec~onal view of a ponion of a third embodim ;:n~ an endarterectomy sur~ical instrument constructed in accordance with the present invention.
Figures 7A and ~7B are top and side views, respectively, of a first embodiment of a surgical ins~ument, coDstructed in accol.laDce with the present invention, for cutting plaque build-ups.
AMENDED SH~
W O 9BI02102 PCTrUS97/12174 Figure 7C shows an ~lt~n~tive form of the cutting unit portion of the surgical instrument of Figures 7A and 7B.
Figure 8 is top view of a second embodiment of a surgical instrument, constructed in accol~ ce with the present invention, for cutting plaque build-ups.
s Figure 9 is an ~pen, side view of a third embodiment of a surgical instrument, constructed in accordance with the present invention, for cutting plaque build-ups.
DETAILED DESCRIPIION OF THE INVENTION
Rere~ g to Figures l, 2 and 3, an end~le,ectomy surgical in~llulllel~l, constructed in accordance with the present invention, includes a spatula tip 10 having at a 0 first end thereof an optics (i.e. light and image) o~e~ g 12 and a plurality of fluid openings 14. As will be expl~in~d below, optics opening 12 permits a light from a light source to be con~ cte~1 to a surgical site and an image of the surgical site to be con-lucted to an image forming unit. In this way, the surgeon can observe the surgical procedure being conducted within the artery without the need to open the entire length of the artery which is being cleaned. As will also be explained below, fluid openings 14 permit the passage of a fluid, typically carbon dioxide, to the surgical site to increase the space (i.e.
the "separation plane") between the adventitia layer and the media layer of the artery. In this way, spatula tip 10 can be advanced along the length of the artery which is being cle~nP~ Spatula tip l0 preferably has a curved body which approximates the shape of aln artery and is sized for the particular artery being cle~n~qcl Preferably, spatula tip 10 also has at the first end thereof a plurality of liquid ope~ g~ 16a and 16b to permit the passage of a liquid to and from the surgical site to carry away plaque debris and clean optics opening 12. The liquid is con~lucted to the surgical site through liiquid opening 16a and is cond~cted away from the surgical site through liquid opening 16b. Typically, the liquid can be a saline solution.
An end~L~ omy surgical instrument, constructed in accordance with the present invention, also includ~,s first flexible tubular means 18 ex~Pnding through spatula tip 10 from optics opening 12 in the spatula tip for con(1llcting a light from a remote end of the first flexible tubular means through the optics opening to a surgiical site and an image of ~ ... . . . . .. .
CA 022600l9 l999-0l-l2 W O 98/02102 PCTrUS97/12174 the surgical site through the optics opening to the remote end of the first fl~PxihhP tubular means. Such first flexible tubular means 18 can include first fiber optic means through which light is con-lucted to the surgical site and second fiber optic means through which an image of the surgical site is con-iuct~P~I For the embodiment of the invention shown in Figure 3, the first fiber optic means include a plurality of fiber optic cables 20 disposed in a circular array and the second fiber optic means include a single fiber optic cable 22 disposed at the center of the circular array of the plurality of fiber optic cables 20 of the first fiber optic means. As shown in Figures 1 and 2, optics opening 12 and fiber optic cables 20 and 22 preferably are within the curved body of spatula tip 10 rather than o outside the inner and outer curved surfaces of the spatula tip to facilitate the design and ...i.~i..,i,.o. the size of the spatula tip.
An end~Le~;lol,ly surgical instrument, constructed in accordance with the present invention, further includes second flexible tubular means 24 ext~Pn~ling through 10 spatula tip from fluid ol)enings 14 in the spatula tip for conAucting a fluid from a remote end of the second flexible tubular means through the fluid openil~gs to the surgical site.
Although first flexible tubular means 18 and second flexible tubular means 24 are shown as being spaced apaIt, they can be arranged in a coaxial manner.
When a liquid is to be delivered to the surgical site, an en~le~clol,ly surgicalinstrument, constructed in accordance with present invention, further includes third flexible tubular means 26 e~tpn~iing through spatula tip 10 from liquid openings 16a and 16b in the spatula tip for cond~lcting liquid from a remote end of the third flexible tubular means to the surgical site through a first of the liquid openings and for con(lucting liquid through a second of the liquid openings from the surgical site to the remote end of the third flexible tubular means.
An end~t~ ull,y surgical instrument, constructed in accordance with present invention, also includes com~e-;lor means 28 adapted for connection to a light source, an image forming unit, and a fluid source and to which the remote end of first flexible tubular means 18 and the remote end of second flexible tubular means 24 are connP~te~.
When liquid is to delivered to and drawn from the surgical site, connector means 28 are adapted for col~eclion to a liquid source and a liquid discharge reservoir and the remote W O98/02102 PCTrUS97/12174 end of third flexible tubular means 26 are conn~ted to the connector means. In this way, light from the light source is con-lucted to first flexible tubular means 18, an image of the surgical site is conducted from first flexible tubular means 18 to the image forming unit, fluid from the fluid source is conducted to second flexible tubular means 24, and liquid is s to delivered from the liquid source to third flexible tubular means 26 and delivered from the third flexible tubular means to the liquid discharge reservoir.
Connector me~ms 28 can include conventional luer lock conn~lo,~ to which the fluid source and second flexible tubular means 24 are com~e~;L~d for the passage of fluid and to which the liquid source, liquid discharge reservoir and third flexible tubular means lO 26 are conn~cted for the passage of saline solution. In contrast, the first fiber optic means through which light is con~ cted to the surgical site and the second fiber optic means through which the image of the surgical site is cond~lcted to the image forming unit are continuous, ~ led fiber optic cables which pass through connector means 28 but are locked by the com~ector means against longit---lin~l and rotational sliding and sealed to prevent escape of carbon dioxide gas and saline solution.
Preferably, an endalLe,~;lu,l,y surgical instrument, constructed in accordance with the present invention, includes a flexible sh~thing 30 ext~n~ing between spatula tip 10 and connector means ,~8 and through which first flexible tubular means 18, second flexible tubular means 24 and third flexible tubular means 26 extend Flexible ~ ing 30 can be a tubular piece, as shown in Figure l, through which s~.dt~ly formed first tubular means 18, second tubular means 24 and third flexible tubular means 26 extend or the ~h~thing and the Itubular means can be formed as a single, flexible extruded piece with passages or channels through which the light, the image of the surgical site, the fluid and the saline solution are con~ cted The surgical instrument just descrihed can be used in an e~ld~lel~ctomy surgicalprocedure for removirlg a plaque build-up from a selected length of an artery inaccordance with the plresent invention. First, an incision is made and the artery is ~iissected at a first end of a sel~ted length of the artery from which a plaque build-up is to be removed. Next, the outer wall of the artery is peneLldl~d with a needle, typically 25 gauge, and carbon dioxide gas is introduced through the needle to start the sel ~d~ion of the adventitia layer and the media layer (i.e. the "sep~r~tiC)n plane"). The needle is removed and an incision is made into the artery wall.
Referring to Figure 4, the next step in the endalLe~ o,l.y surgical procedure, pelrolllled in accor~ ce with the present invention, is inserting a spatula 10 into the s artery at the incision belweell the adventitia layer 40 and the media layer 42 of the artery.
Next, the selected length of the artery is probed with the spatula while applying a fluid (e.g. carbon dioxide gas) under a controlled p~s~ through the spatula tip to increase the space between the adventitia layer 40 and the media layer 42 of the artery. The carbon dioxide gas also reduces the amount of blood at the surgical site. The carbon 10 dioxide gas is either absorbed or flows out through the incision in the artery wall. Saline solution, under a controlled pl~,ss~ll'e, can be delivered to the surgical site to flush away pieces of plaque which have broken away from the plaque build-up 44 and to clean the optics opening in the spatula tip. It is ihl"~ol~nt to control the p~S~ul~S of the carbon dioxide gas and saline solution to el..~ e the potential for creating damage to the artery when there is a total blockage of the artery by the plaque build-up.
As the artery is being probed, an image of the surgical site at the spatula is continuously developed, so that the surgeon l~clrolllling the procedure can view the image of the surgical site while ~lobing the artery. Side branches of the artery are isolated as the artery is probed. Probing of the artery is t.o.~nin~ted at a second end of the selected 20 length of the artery and the spatula is ~c~ 1~ and removed from the artery through the il~CiSiOll.
Next, the plaque build-up 44, along with the intima layer 46 and the media layer42 of the artery (i.e. the "core"), are removed from the artery. The core can be removed by pulling the plaque build-up out through the incision with forceps if the plaque has been 25 broken or we~kPned at the second end of the selected length of the artery. This can be delell"ined by viewing the image of the surgical site as the spatula is moved along the artery.
If np~ess~ry~ after the spatula has been retr~cted and removed from the artery asurgical instrument, such as the ones illustrated in Figures 7A, 7B, 7C and 8, can be 30 inserted into the artery through the incision and advanced to the second end of the select~d length of the artery at which the plaque build-up is cut. When the surgical cutting instrument is retracted and removed from the artery, the plaque build-up is pulled out through the incision by the surgical cutting insLl~,.,enl or with forceps.
After the plaque build-up has been removed, the té1lllindliOn transition at the 5 second end of the selected length of the altery is treated and the incision is closed. If the spatula is arranged with liquid o~e ~ings, liquid can be delivered to the surgical site and drawn away from the surgical site while the artery is being probed. It is illl~olL~rlL to remove phque debris from the artery before the incision is closed.
It is important to pr~ale the le...,i~ n t-~ncition or there can be further o stripping of plaque by blood flow. There is also the potential for clotting and debris at the terrnin~ti~ n if the ~n~ition is abrupt. The termination transition can be prepared by a laser instrument which can be included in an endarterectomy surgical instrument constructed in accoldance with the present invention. As shown in Figure S, spatula tip 10 can have a laser opening 32 through which a laser beam can be emitted to ~JlG~ 'e the 15 le.,.~in~ion transition.
As shown in Figure 6, an endarterectomy surgical instrument, constructed in accordance with the present invention, can be arranged with a balloon and used in a surgical procedure in the same way that a balloon c~th~.ter is used. The flexible ~he~thing 34 has a balloon 36 bonded to the outside surface of the che~thing. With balloon 36 20 dPfl~tffl, it lies flat against the outside surface of flexible ~ht-,~thing 34. When a fluid, under controlled ~1~ ssule, is introduced into balloon 36 through air passage 38, the balloon inflates as shown in Figure 6.
- Referring to Fiigures 7A and 7B, a first embodiment of a surgical ills~ lent for cutting plaque build-ups, constructed in accordance with the present invention, in~hldes 25 an elongated flexible stem unit S0, a handle S2 at a first end of the elongated flexible stem unit, and a cutting unit 54 at a second end of the elongated flexible stem unit, opposite from the first end. Cutting unit 54 has an inner cutting edge 56 and a curved outer blunt edge 58. A wall 60, e~t~,n-1ing between the inner cutting edge 56 and the curved outer blunt edge 58, has suf~lcient width to carry material which has been cut as handle 52 is , ~ ~, . .~ . . . .. .
CA 022600l9 l999-0l-l2 W O98/02102 PCTrUS97/12174 pulled or turned. Although cutting edge S6 is shown as being curved, it can take other forms, such as a straight edge.
Preferably, cutting unit 54 of the surgical instrument of Figures 7A and 7B lies in a plane which is disposed at an obtuse angle relative to elongated stem unit SO. With such 5 an all~g~,l,ent, after the surgical instrument is introduced through the incision, cutting unit 54 is moved easily along the surface of the core which will be removed from the artery to the point at which the cutting unit is to cut the plaque build-up. As side branches of plaque build-ups are encounleled, the surgical i"sll~",ent can be rotated to bypass such side branches. For a particular surgical instrument for cutting plaque build-lo ups, the flexibility of stem unit 50, the angle between cutting unit 54 and the stem unitand the shape, radius and length of cutting edge S6 are dependent upon the size and condition of the artery. The objective of the design of any such surgical instrument is to assure that as the surgical instrument is turned to cut through the plaque build-up, the surgical instrument does not cut through the artery wall. The desired effect is to have 15 cutting unit 54 encircle the plaque build-up as it cuts through the plaque build-up. When the cutting is completed, the cutting unit 54 can remain engaged with the core m~te.ri~l which has been cut to an extent suffficient to remove the core material through the incision as the surgical instrument is retracted and removed through the incision. Wall 60, e~tten(ling between inner cutting edge S6 and outer blunt edge S8, also is effective in 20 removing the cut core material through the incision.
The desired flexibility in stem unit 50 of the surgical instrument illustrated by Figures 7A and 7B is provided by a spring 62 between a first end of a first rigid member SOa and a first end of a second rigid member 50b. Handle 52 is ~ttach~d to a second end of first rigid member 50a of the elongated flexible stem unit and cutting unit 54 is 25 att~h~l to a second end of second rigid member SOb of the elongated flexible stem unit.
Spring 62 and the cant of cutting unit 54 provide a center of rotation of the cutting unit which prevents cutting the altery wall as handle S2 is turned to cut a plaque build-up.
Spring 62 is design~l to be sufficiently flexible to achieve this result, yet sufficiently rigid to cut a plaque build-up and permit carrying m~tçri~l which has been cut as handle S2 is 30 pulled or retracted from the incision.
' -- ' ' - t W O 98/02102 PCT~US97/12174 As shown in Pigure 7C, cutting unit 54 can be formed with a housing 64 which is ~tt~ h~d to a second end of second rigid member 50b of the elongated stem unit and has a curved outer blunt edge 58. A cutting blade 66 is positioned within hnu~ing 64. With this form of cutting unit, there is a wall which extends between inner cutting edge S6 of cutting blade 66 and outer blunt edge 58 of housing 64 and has s-lmcient width to carry material which has been cut as handle 52 is pulled.
It should be noted that a surgical in~ len~ for cutting plaque build-ups, such as the one illustrated in :Figures 7A, 7B and 7C, can be arranged with optics and irrigation as is the endarterectomy surgical instrument described above.
o Figures 8 and 9 show second and third embotlim~nt~ of a surgical illsLI~lllent for cutting plaque build-ups constructed in accordance with the present invention. Each of these surgical instruments incl~ldes an elongated tubular support unit and a cutting wire unit e~t~n~ling through the elongated tubular support unit and freely movable within the elongated tubular support unit. The free ends of the cutting wire unit project from one end of the elongated lubular support unit and a closed loop portion of cutting wire unit projects from a second end of the elongated tubular support unit.
RtÇe.,illg to Pigure 8, the elongated tubular support unit in(~l~ldes a first elongated tube 70 and a second ek ng~ted tube 72. The cutting wire unit includes first and second lengths of wire 74 and 76 which extend through first elongated tube 70 and second elongated tube 72, respectively. First and second free ends 74a and 74b of the first length of wire project from one end of the first elongated tube and a middle portion 74c of the first length of wire proje~;ls from the ol~po~ile end of the first elongated tube. First and second free ends 76a and 76b of the second length of wire project from one end of the second ek)ng~ted tube and a middle portion 76c of the second length of wire projects 2s from the opposi~e second end of the second elongated tube and is looped through middle portion 74c of the fir;t length of wire 74.
The surgical instrument of Figure 8 is used in the following manner. The surgical in~ llltl.l is introduced through the incision and is moved along the artery with middle portion 76c of wire 76 positioned outside the core m~teri~l which is to be cut to the point at which the plaque build-up is to be cut. By pulling on the free ends 74a and 74b of W O 98/02102 PCTrUS97/12174 wire 74 and the free ends 76a and 76b of wire 76, the slack in middle portion 76c of wire 76 is taken up and the core material is cut. The core m~t~ri~l can be removed either by retraction of the surgical instrument or with forceps if middle portion 76c of wire 76 moves through the core m~teri~l without pulling the core m~t~ri~l through the incision.
s Referring to Figure 9, the elongated tubular support unit includes an e10ng~t~1 tube 80 and a housing 82 attached to the elongated tube at a first end thereof. The cutting wire unit includes a length of wire 84 which extends through elongated tube 80 and housing 82 with first and second free ends 84a and 84b of the length of wire projecting from a second end of the elongated tube opposite from the first end of elongated tube.
o The middle portion 84c of the length of wire projects from the first end of elongated tube 80 and is looped from the elongated tube through housing 82 into the elongated tube.
The surgical instrument of Pigure 9 is used in much the same manner as the surgical instrument of Figure 8. The surgical instrument is introduced through the incision and is moved along the artery with middle portion 84c of wire 84 po~ition~d 1S outside the core m~tP.ri~l which is to be cut to the point at which the plaque build-up is to be cut. By pulling on the free ends 84a and 84b of wire 84, the slack in middle portion 84c of the wire is taken up and the core m~teri~l is cut. The core material can be removed either by retraction of the surgical instmment or with forceps. Housing 82 functions in much the same way as the wall in the surgical instrument of Figures 7A, 7B
and 7C in pulling the cut core m~teri~l as the surgical instrument is retracted and withdrawn through the inCision.
Whi}e in the folegoillg there have been described pl~rerr~d embo-lim~nt~ of the present invention, it should be understood by those skilled in the art that various mo~ifi~tions and changes can be made without departing from the true spirit and scope of the present invention.
Claims (9)
1. An endarterectmy surgical instrument comprising:
a spatula tip (10) having at a first end thereof:
(a) an optics opening (12), and (b) a plurality of fluid openings (14);
first flexible tubular means (18) extending through said spatula tip (10) from said optics opening (12) in said spatula tip (10) for conducting:
(a) a light from a light source at a remote end of said first flexible tubular means (18) through said optics (12) opening to a surgical site, and (b) an image from an imaging source at the surgical site through said optics (12) opening to said remote end of said first flexible tubular means (18);
second flexible tubular means (24) extending through said spatula tip (10) from said fluid openings (14) in said spatula tip (10) for conducting a fluid from a remote end of said second flexible tubular means (24) through said fluid openings (14) to the surgical site; and connector means (28) adapted for connection to:
(a) a light source, (b) an image forming unit, and (c) a fluid source and to which:
(a) said remote end of said first flexible tubular means (18), and (b) said remote end of said second flexible tubular means (24) are connected for conducting:
(a) the light from the light source to said first flexible tubular means (18), (b) the image of the surgical site from said first flexible tubular means (18) to the image forming unit, and (c) fluid from the fluid source to said second flexible tubular means (24).
a spatula tip (10) having at a first end thereof:
(a) an optics opening (12), and (b) a plurality of fluid openings (14);
first flexible tubular means (18) extending through said spatula tip (10) from said optics opening (12) in said spatula tip (10) for conducting:
(a) a light from a light source at a remote end of said first flexible tubular means (18) through said optics (12) opening to a surgical site, and (b) an image from an imaging source at the surgical site through said optics (12) opening to said remote end of said first flexible tubular means (18);
second flexible tubular means (24) extending through said spatula tip (10) from said fluid openings (14) in said spatula tip (10) for conducting a fluid from a remote end of said second flexible tubular means (24) through said fluid openings (14) to the surgical site; and connector means (28) adapted for connection to:
(a) a light source, (b) an image forming unit, and (c) a fluid source and to which:
(a) said remote end of said first flexible tubular means (18), and (b) said remote end of said second flexible tubular means (24) are connected for conducting:
(a) the light from the light source to said first flexible tubular means (18), (b) the image of the surgical site from said first flexible tubular means (18) to the image forming unit, and (c) fluid from the fluid source to said second flexible tubular means (24).
2. An endarterectomy surgical instrument according to claim 1 further including a flexible sheathing (30) extending between said spatula tip (10) and said connector means (28) and through which said first flexible tubular means (18) and said second flexible tubular means (24) extend.
3. An endarterectomy surgical instrument according to claim 2 wherein said first flexible tubular means (18) include:
(a) first fiber optic means through which the light is conducted, and (b) second fiber optic means through which the image of the surgical site is conducted.
(a) first fiber optic means through which the light is conducted, and (b) second fiber optic means through which the image of the surgical site is conducted.
4. An endarterectomy surgical instrument according to claim 3 wherein:
(a) said first fiber optic means include a plurality of fiber optic cables (20) disposed in a circular array, and (b) said second fiber optic means include a single fiber optic cable (22) disposed at the center of said circular array of said plurality of fiber optic cables (20) of said first fiber optic means.
(a) said first fiber optic means include a plurality of fiber optic cables (20) disposed in a circular array, and (b) said second fiber optic means include a single fiber optic cable (22) disposed at the center of said circular array of said plurality of fiber optic cables (20) of said first fiber optic means.
5. An endarterectomy surgical instrument according to claim 4 wherein said spatula tip (10) has a curved body and said optics opening (12), said plurality of fiber optic cables (20) and said single fiber optic cable (22) are within said curved body of said spatula tip (10).
6. An endarterectomy surgical instrument according to claim 2 wherein:
(a) said spatula tip (10) also has at said first end thereof a plurality of liquid openings (14), (b) said connector means (28) also are adapted for connection to a liquid source and a liquid discharge reservoir, and (c) said endarterectomy surgical instrument further includes third flexible tubular means (26) extending through said spatula tip (10) from said liquid openings (14) in said spatula tip (10) for conducting liquid from a remote end of said third flexible tubular means (26) connected to said connector means to the surgical site through a first of said liquid openings (16a) and for conducting liquid through a second of said liquid openings (16b) from the surgical site to said remote end of said third flexible tubular means (26).
(a) said spatula tip (10) also has at said first end thereof a plurality of liquid openings (14), (b) said connector means (28) also are adapted for connection to a liquid source and a liquid discharge reservoir, and (c) said endarterectomy surgical instrument further includes third flexible tubular means (26) extending through said spatula tip (10) from said liquid openings (14) in said spatula tip (10) for conducting liquid from a remote end of said third flexible tubular means (26) connected to said connector means to the surgical site through a first of said liquid openings (16a) and for conducting liquid through a second of said liquid openings (16b) from the surgical site to said remote end of said third flexible tubular means (26).
7. An endarterectomy surgical instrument according to claim 6 wherein said third flexible tubular means (26) extend through said flexible sheathing (30).
8. An endarterectomy surgical instrument according to claim 2 wherein said spatula tip (10) also has at said first end thereof a laser opening (32) through which a laser beam is emitted.
9. An endarterectomy surgical instrument according to claim 2 further including:
(a) a balloon (36) bonded to said sheathing (30), and (b) a fluid passage (38) through which a fluid, under controlled pressure, is introduced into said balloon (36) to inflate said balloon (36).
(a) a balloon (36) bonded to said sheathing (30), and (b) a fluid passage (38) through which a fluid, under controlled pressure, is introduced into said balloon (36) to inflate said balloon (36).
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US08/680,594 US5954713A (en) | 1996-07-12 | 1996-07-12 | Endarterectomy surgical instruments and procedure |
US08/680,594 | 1996-07-12 |
Publications (1)
Publication Number | Publication Date |
---|---|
CA2260019A1 true CA2260019A1 (en) | 1998-01-22 |
Family
ID=24731720
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CA002260019A Abandoned CA2260019A1 (en) | 1996-07-12 | 1997-07-11 | Endarterectomy surgical instruments and procedure |
Country Status (11)
Country | Link |
---|---|
US (3) | US5954713A (en) |
EP (1) | EP0917445B1 (en) |
JP (2) | JP2000515402A (en) |
KR (1) | KR20000023753A (en) |
CN (1) | CN1228687A (en) |
AT (1) | ATE260605T1 (en) |
AU (1) | AU741165B2 (en) |
CA (1) | CA2260019A1 (en) |
DE (1) | DE69727938T2 (en) |
IL (1) | IL128015A0 (en) |
WO (1) | WO1998002102A2 (en) |
Families Citing this family (47)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5954713A (en) * | 1996-07-12 | 1999-09-21 | Newman; Fredric A. | Endarterectomy surgical instruments and procedure |
EP0979635A2 (en) | 1998-08-12 | 2000-02-16 | Origin Medsystems, Inc. | Tissue dissector apparatus |
DE29814889U1 (en) * | 1998-08-19 | 1999-12-30 | Burgard Gunther | Resection instrument |
ATE317244T1 (en) * | 1999-11-16 | 2006-02-15 | Deka Products Lp | SURGICAL INSTRUMENT FOR INTERNAL ARTERY SKIN REMOVAL |
US20020198551A1 (en) * | 1999-11-16 | 2002-12-26 | Grant Kevin Lee | Endoscopic tissue separator surgical device |
US6558313B1 (en) | 2000-11-17 | 2003-05-06 | Embro Corporation | Vein harvesting system and method |
WO2003041603A1 (en) * | 2001-11-14 | 2003-05-22 | Latis, Inc. | Improved catheters for clot removal |
US7018336B2 (en) * | 2001-12-27 | 2006-03-28 | Medtronic Minimed, Inc. | Implantable sensor flush sleeve |
US7734332B2 (en) * | 2002-10-18 | 2010-06-08 | Ariomedica Ltd. | Atherectomy system with imaging guidewire |
US8142457B2 (en) * | 2003-03-26 | 2012-03-27 | Boston Scientific Scimed, Inc. | Percutaneous transluminal endarterectomy |
US20050267520A1 (en) | 2004-05-12 | 2005-12-01 | Modesitt D B | Access and closure device and method |
US7678133B2 (en) * | 2004-07-10 | 2010-03-16 | Arstasis, Inc. | Biological tissue closure device and method |
CN101217916B (en) | 2005-05-12 | 2013-04-10 | 阿尔斯塔西斯公司 | Access and closure device and method |
US7938819B2 (en) | 2005-09-12 | 2011-05-10 | Bridgepoint Medical, Inc. | Endovascular devices and methods |
US8083727B2 (en) | 2005-09-12 | 2011-12-27 | Bridgepoint Medical, Inc. | Endovascular devices and methods for exploiting intramural space |
US7918870B2 (en) | 2005-09-12 | 2011-04-05 | Bridgepoint Medical, Inc. | Endovascular devices and methods |
EP1924315B1 (en) | 2005-09-12 | 2019-12-04 | Bridgepoint Medical, Inc. | Endovascular devices |
US11020141B2 (en) | 2005-09-12 | 2021-06-01 | Bridgepoint Medical, Inc. | Endovascular devices and methods |
US9770230B2 (en) | 2006-06-01 | 2017-09-26 | Maquet Cardiovascular Llc | Endoscopic vessel harvesting system components |
US10888354B2 (en) | 2006-11-21 | 2021-01-12 | Bridgepoint Medical, Inc. | Endovascular devices and methods for exploiting intramural space |
US9060802B2 (en) | 2006-11-21 | 2015-06-23 | Bridgepoint Medical, Inc. | Endovascular devices and methods for exploiting intramural space |
US11298511B2 (en) | 2006-11-21 | 2022-04-12 | Bridgepoint Medical, Inc. | Endovascular devices and methods for exploiting intramural space |
US20090105744A1 (en) * | 2007-10-17 | 2009-04-23 | Modesitt D Bruce | Methods for forming tracts in tissue |
EP3659664A1 (en) | 2007-10-22 | 2020-06-03 | Bridgepoint Medical, Inc. | Devices for crossing chronic total occlusions |
US8337425B2 (en) | 2008-02-05 | 2012-12-25 | Bridgepoint Medical, Inc. | Endovascular device with a tissue piercing distal probe and associated methods |
EP2259830B1 (en) | 2008-02-05 | 2017-08-16 | Bridgepoint Medical, Inc. | Crossing occlusions in blood vessels |
EP2291128B1 (en) | 2008-04-28 | 2016-08-31 | Bridgepoint Medical, Inc. | Apparatus for crossing occlusions in blood vessels |
JP2011528606A (en) * | 2008-07-21 | 2011-11-24 | アルスタシス,インコーポレイテッド | Apparatus and method for forming a tract in tissue |
JP2011528605A (en) * | 2008-07-21 | 2011-11-24 | アルスタシス,インコーポレイテッド | Device, method, and kit for forming a tube in tissue |
WO2010132835A1 (en) * | 2009-05-15 | 2010-11-18 | Arstasis, Inc. | Devices, methods and kits for forming tracts in tissue |
NL2003063C2 (en) * | 2009-06-22 | 2010-12-23 | Ureca B V | SURGICAL CUTTING INSTRUMENT. |
AU2010298315A1 (en) * | 2009-09-22 | 2012-04-19 | Arstasis, Inc. | Devices, methods, and kits for forming tracts in tissue |
JP5865252B2 (en) | 2009-11-02 | 2016-02-17 | パルス セラピューティクス インコーポレイテッド | Magnetostatic stator system and wireless control method of magnetic rotor |
WO2012013246A1 (en) * | 2010-07-30 | 2012-02-02 | Ethicon Endo-Surgery, Inc. | A system and method for submucosal tunneling of the gi tract for the diversion of bodily fluids |
WO2012097292A1 (en) | 2011-01-14 | 2012-07-19 | Lemaitre Vascular, Inc. | Systems and methods for remote endarterectomy |
US10149697B2 (en) | 2011-10-04 | 2018-12-11 | Angioworks Medical, B.V. | Devices and methods for percutaneous tissue removal |
US20130317481A1 (en) | 2012-05-25 | 2013-11-28 | Arstasis, Inc. | Vascular access configuration |
US20130317438A1 (en) | 2012-05-25 | 2013-11-28 | Arstasis, Inc. | Vascular access configuration |
USD938095S1 (en) | 2013-04-01 | 2021-12-07 | Pathy Medical, Llc | Lighting device |
EP2981394B1 (en) | 2013-04-01 | 2021-06-02 | Vinod V. Pathy | Lighting device |
US10363065B2 (en) * | 2013-10-15 | 2019-07-30 | Boston Scientific Scimed, Inc. | Medical devices and methods for manipulating bodily tissues |
DE102014208168A1 (en) * | 2014-04-30 | 2015-11-19 | Epflex Feinwerktechnik Gmbh | Fangkelinstrument with distal Fangkelchstruktur |
EP3302312B1 (en) | 2015-05-27 | 2019-08-28 | Angioworks Medical B.V. | Devices for minimally invasive tissue removal |
US11839398B2 (en) | 2016-09-09 | 2023-12-12 | Endovascular Instruments, Inc. | Adjustable ring stripper for more efficiently and effectively removing plaque from arteries |
WO2019070782A1 (en) * | 2017-10-03 | 2019-04-11 | Research Development Foundation | Systems and methods for coronary occlusion treatment |
CN108338812A (en) * | 2018-04-17 | 2018-07-31 | 四川大学华西医院 | A kind of cold light source guiding stitching unstrument |
US11918315B2 (en) | 2018-05-03 | 2024-03-05 | Pulse Therapeutics, Inc. | Determination of structure and traversal of occlusions using magnetic particles |
Family Cites Families (158)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US1246338A (en) | 1916-08-21 | 1917-11-13 | Isaac J Smit | Illuminated transparent retractor. |
US2944552A (en) * | 1958-12-29 | 1960-07-12 | Richard B Wilk | Surgical instrument |
US3368280A (en) * | 1966-03-23 | 1968-02-13 | C & B Inc | Dental tool |
US3525339A (en) * | 1968-05-20 | 1970-08-25 | Becton Dickinson Co | Flexible gas endarterectomy spatula |
US3903892A (en) * | 1973-05-17 | 1975-09-09 | Olympus Optical Co | Forceps means for removing cellular tissue from the body cavities |
US3886943A (en) * | 1973-08-10 | 1975-06-03 | Aphrodite P Skiff | Surgical instrument |
DE2612315C3 (en) * | 1976-03-23 | 1978-10-12 | Kievskij Gosudarstvennyj Institut Usoverschenstvovanija Vratschei | Device for exfoliating thrombi and arteriosclerotic sequesters |
US4372316A (en) | 1979-08-02 | 1983-02-08 | Blake Joseph W Iii | Surgical device |
US4617933A (en) | 1980-02-19 | 1986-10-21 | Hasson Harrith M | Laparoscope cannula with improved suture receiving means |
US4418688A (en) | 1981-07-06 | 1983-12-06 | Laserscope, Inc. | Microcatheter having directable laser and expandable walls |
US4759348A (en) | 1981-09-28 | 1988-07-26 | Cawood Charles David | Endoscope assembly and surgical instrument for use therewith |
US5041108A (en) * | 1981-12-11 | 1991-08-20 | Pillco Limited Partnership | Method for laser treatment of body lumens |
US4445509A (en) | 1982-02-04 | 1984-05-01 | Auth David C | Method and apparatus for removal of enclosed abnormal deposits |
US4448188A (en) | 1982-02-18 | 1984-05-15 | Laserscope, Inc. | Method for providing an oxygen bearing liquid to a blood vessel for the performance of a medical procedure |
JPS59172621A (en) | 1983-03-22 | 1984-09-29 | Sumitomo Electric Ind Ltd | Fiberscope |
US4619247A (en) * | 1983-03-31 | 1986-10-28 | Sumitomo Electric Industries, Ltd. | Catheter |
US4557255A (en) | 1983-08-22 | 1985-12-10 | Goodman Tobias M | Ureteroscope |
US4601710B1 (en) | 1983-08-24 | 1998-05-05 | United States Surgical Corp | Trocar assembly |
US4747405A (en) * | 1984-03-01 | 1988-05-31 | Vaser, Inc. | Angioplasty catheter |
US4627436A (en) * | 1984-03-01 | 1986-12-09 | Innoventions Biomedical Inc. | Angioplasty catheter and method for use thereof |
US4685458A (en) | 1984-03-01 | 1987-08-11 | Vaser, Inc. | Angioplasty catheter and method for use thereof |
US4842579B1 (en) | 1984-05-14 | 1995-10-31 | Surgical Systems & Instr Inc | Atherectomy device |
EP0177124A3 (en) | 1984-07-18 | 1987-01-21 | Sumitomo Electric Industries Limited | Catheter |
US4862886A (en) | 1985-05-08 | 1989-09-05 | Summit Technology Inc. | Laser angioplasty |
EP0214712B1 (en) * | 1985-07-31 | 1992-09-02 | C.R. Bard, Inc. | Infrared laser catheter apparatus |
US4654030A (en) | 1986-02-24 | 1987-03-31 | Endotherapeutics | Trocar |
US4739760A (en) | 1986-06-06 | 1988-04-26 | Thomas J. Fogarty | Vein valve cutter apparatus |
US4782819A (en) | 1987-02-25 | 1988-11-08 | Adair Edwin Lloyd | Optical catheter |
EP0311295A3 (en) * | 1987-10-07 | 1990-02-28 | University College London | Improvements in surgical apparatus |
US5053002A (en) | 1988-01-11 | 1991-10-01 | Olympus Corporation | Irrigation system for angioscope |
US4886061A (en) | 1988-02-09 | 1989-12-12 | Medinnovations, Inc. | Expandable pullback atherectomy catheter system |
US5423745A (en) | 1988-04-28 | 1995-06-13 | Research Medical, Inc. | Irregular surface balloon catheters for body passageways and methods of use |
US5116317A (en) | 1988-06-16 | 1992-05-26 | Optimed Technologies, Inc. | Angioplasty catheter with integral fiber optic assembly |
US6120437A (en) | 1988-07-22 | 2000-09-19 | Inbae Yoon | Methods for creating spaces at obstructed sites endoscopically and methods therefor |
US5556376A (en) | 1988-07-22 | 1996-09-17 | Yoon; Inbae | Multifunctional devices having loop configured portions and collection systems for endoscopic surgical procedures and methods thereof |
US6066130A (en) * | 1988-10-24 | 2000-05-23 | The General Hospital Corporation | Delivering laser energy |
US4878485A (en) | 1989-02-03 | 1989-11-07 | Adair Edwin Lloyd | Rigid video endoscope with heat sterilizable sheath |
US5022399A (en) | 1989-05-10 | 1991-06-11 | Biegeleisen Ken P | Venoscope |
US4962755A (en) | 1989-07-21 | 1990-10-16 | Heart Tech Of Minnesota, Inc. | Method for performing endarterectomy |
ES2079483T3 (en) | 1989-08-18 | 1996-01-16 | Evi Corp | CATHETER ATEROTOME. |
US5282484A (en) | 1989-08-18 | 1994-02-01 | Endovascular Instruments, Inc. | Method for performing a partial atherectomy |
US5156610A (en) | 1989-08-18 | 1992-10-20 | Evi Corporation | Catheter atherotome |
JPH0741451Y2 (en) * | 1989-11-14 | 1995-09-27 | オリンパス光学工業株式会社 | Venous valve opener |
US5893863A (en) | 1989-12-05 | 1999-04-13 | Yoon; Inbae | Surgical instrument with jaws and movable internal hook member for use thereof |
US5916210A (en) * | 1990-01-26 | 1999-06-29 | Intraluminal Therapeutics, Inc. | Catheter for laser treatment of atherosclerotic plaque and other tissue abnormalities |
US5514153A (en) | 1990-03-02 | 1996-05-07 | General Surgical Innovations, Inc. | Method of dissecting tissue layers |
US5084054A (en) | 1990-03-05 | 1992-01-28 | C.R. Bard, Inc. | Surgical gripping instrument |
US5624392A (en) | 1990-05-11 | 1997-04-29 | Saab; Mark A. | Heat transfer catheters and methods of making and using same |
US5092841A (en) | 1990-05-17 | 1992-03-03 | Wayne State University | Method for treating an arterial wall injured during angioplasty |
US5100424A (en) | 1990-05-21 | 1992-03-31 | Cardiovascular Imaging Systems, Inc. | Intravascular catheter having combined imaging abrasion head |
US5320634A (en) | 1990-07-03 | 1994-06-14 | Interventional Technologies, Inc. | Balloon catheter with seated cutting edges |
JP3256540B2 (en) | 1990-10-09 | 2002-02-12 | メッドトロニック・インコーポレイテッド | Device or device for manipulating the target object |
US5254115A (en) * | 1990-10-11 | 1993-10-19 | The General Hospital Corporation | Coagulating scalpels |
US5190541A (en) | 1990-10-17 | 1993-03-02 | Boston Scientific Corporation | Surgical instrument and method |
US5304171A (en) * | 1990-10-18 | 1994-04-19 | Gregory Kenton W | Catheter devices and methods for delivering |
US5275594A (en) * | 1990-11-09 | 1994-01-04 | C. R. Bard, Inc. | Angioplasty system having means for identification of atherosclerotic plaque |
US5474539A (en) | 1991-02-07 | 1995-12-12 | Origin Medsystems, Inc. | Trocar with retracting tip |
IT1249059B (en) * | 1991-05-22 | 1995-02-11 | Rosa Antonio | ULTRASONIC DISSECTOR-DISCONNECTOR OF ATEROSCLEROTIC PLATES |
EP0629379A1 (en) * | 1993-06-01 | 1994-12-21 | Antonio La Rosa | Ultrasonic apparatus for detaching sclerotic plaque |
US5250070A (en) | 1991-05-28 | 1993-10-05 | Parodi Juan C | Less traumatic angioplasty balloon for arterial dilatation |
US5704372A (en) | 1991-05-29 | 1998-01-06 | Origin Medsystems, Inc. | Endoscopic inflatable retraction devices for separating layers of tissue, and methods of using |
US5527264A (en) | 1991-05-29 | 1996-06-18 | Origin Medsystem, Inc. | Methods of using endoscopic inflatable retraction devices |
AU2185192A (en) | 1991-05-29 | 1993-01-08 | Origin Medsystems, Inc. | Retraction apparatus and methods for endoscopic surgery |
US5468248A (en) * | 1991-05-29 | 1995-11-21 | Origin Medsystems, Inc. | Endoscopic inflatable retraction devices for separating layers of tissue |
US5865728A (en) | 1991-05-29 | 1999-02-02 | Origin Medsystems, Inc. | Method of using an endoscopic inflatable lifting apparatus to create an anatomic working space |
US5836871A (en) | 1991-05-29 | 1998-11-17 | Origin Medsystems, Inc. | Method for lifting a body wall using an inflatable lifting apparatus |
US5632761A (en) | 1991-05-29 | 1997-05-27 | Origin Medsystems, Inc. | Inflatable devices for separating layers of tissue, and methods of using |
US5431173A (en) | 1991-05-29 | 1995-07-11 | Origin Medsystems, Inc. | Method and apparatus for body structure manipulation and dissection |
US5728119A (en) | 1991-05-29 | 1998-03-17 | Origin Medsystems, Inc. | Method and inflatable chamber apparatus for separating layers of tissue |
US5562603A (en) | 1991-05-29 | 1996-10-08 | Origin Medsystems, Inc. | Endoscopic inflatable retraction device with fluid-tight elastomeric window |
US5361752A (en) * | 1991-05-29 | 1994-11-08 | Origin Medsystems, Inc. | Retraction apparatus and methods for endoscopic surgery |
US5370134A (en) | 1991-05-29 | 1994-12-06 | Orgin Medsystems, Inc. | Method and apparatus for body structure manipulation and dissection |
MX9202604A (en) | 1991-05-29 | 1994-05-31 | Origin Medsystems Inc | APPARATUS FOR MECHANICAL PROPERTY RETRACTION AND METHODS OF USE. |
US5803901A (en) | 1991-05-29 | 1998-09-08 | Origin Medsystems, Inc. | Inflatable devices for separating layers of tissue and methods of using |
US5735290A (en) | 1993-02-22 | 1998-04-07 | Heartport, Inc. | Methods and systems for performing thoracoscopic coronary bypass and other procedures |
US5879499A (en) | 1996-06-17 | 1999-03-09 | Heartport, Inc. | Method of manufacture of a multi-lumen catheter |
US5490819A (en) | 1991-08-05 | 1996-02-13 | United States Surgical Corporation | Articulating endoscopic surgical apparatus |
DE69229736D1 (en) * | 1991-08-30 | 1999-09-09 | Origin Medsystems | TROKAR WITH SEVERAL ADAPTERS AND A REMOVABLE OBTURATOR |
US5285795A (en) * | 1991-09-12 | 1994-02-15 | Surgical Dynamics, Inc. | Percutaneous discectomy system having a bendable discectomy probe and a steerable cannula |
US5374273A (en) | 1992-10-05 | 1994-12-20 | Nakao; Naomi L. | Method for retrieval of retained common bile duct stones |
US5433725A (en) | 1991-12-13 | 1995-07-18 | Unisurge, Inc. | Hand-held surgical device and tools for use therewith, assembly and method |
US5437660A (en) * | 1991-12-30 | 1995-08-01 | Trimedyne, Inc. | Tissue ablation and a lateral-lasing fiber optic device therefor |
DE9290166U1 (en) | 1992-01-13 | 1994-10-13 | Schneider Usa Inc | Surgical cutting tool |
ES2116355T3 (en) | 1992-01-13 | 1998-07-16 | Schneider Usa Inc | CUTTING DEVICE FOR ATERECTOMY CATHETER. |
US5324299A (en) * | 1992-02-03 | 1994-06-28 | Ultracision, Inc. | Ultrasonic scalpel blade and methods of application |
US5267994A (en) * | 1992-02-10 | 1993-12-07 | Conmed Corporation | Electrosurgical probe |
US5246437A (en) * | 1992-04-10 | 1993-09-21 | Abela George S | Cell treatment apparatus and method |
US5395331A (en) | 1992-04-27 | 1995-03-07 | Minnesota Mining And Manufacturing Company | Retrograde coronary sinus catheter having a ribbed balloon |
US5607443A (en) | 1992-06-02 | 1997-03-04 | General Surgical Innovations, Inc. | Expansible tunneling apparatus for creating an anatomic working space with laparoscopic observation |
US5540711A (en) | 1992-06-02 | 1996-07-30 | General Surgical Innovations, Inc. | Apparatus and method for developing an anatomic space for laparoscopic procedures with laparoscopic visualization |
US5305121A (en) | 1992-06-08 | 1994-04-19 | Origin Medsystems, Inc. | Stereoscopic endoscope system |
US5373840A (en) | 1992-10-02 | 1994-12-20 | Knighton; David R. | Endoscope and method for vein removal |
US5487730A (en) | 1992-12-30 | 1996-01-30 | Medtronic, Inc. | Balloon catheter with balloon surface retention means |
US5354265A (en) | 1992-12-30 | 1994-10-11 | Mackool Richard J | Fluid infusion sleeve |
US5342358A (en) * | 1993-01-12 | 1994-08-30 | S.L.T. Japan Co., Ltd. | Apparatus for operation by laser energy |
US5409483A (en) | 1993-01-22 | 1995-04-25 | Jeffrey H. Reese | Direct visualization surgical probe |
US5407433A (en) * | 1993-02-10 | 1995-04-18 | Origin Medsystems, Inc. | Gas-tight seal accommodating surgical instruments with a wide range of diameters |
US5411483A (en) * | 1993-02-10 | 1995-05-02 | Origin Medsystems, Inc. | Gas-tight seal accommodating surgical instruments with a wide range of diameters |
US5350375A (en) * | 1993-03-15 | 1994-09-27 | Yale University | Methods for laser induced fluorescence intensity feedback control during laser angioplasty |
US5366476A (en) | 1993-04-02 | 1994-11-22 | Laparomed Corporation | Handle for laparoscopic instrument |
US5344419A (en) * | 1993-04-23 | 1994-09-06 | Wayne State University | Apparatus and method for making a diffusing tip in a balloon catheter system |
CA2118886C (en) | 1993-05-07 | 1998-12-08 | Dennis Vigil | Method and apparatus for dilatation of a stenotic vessel |
US5439468A (en) | 1993-05-07 | 1995-08-08 | Ethicon Endo-Surgery | Surgical clip applier |
US5630822A (en) | 1993-07-02 | 1997-05-20 | General Surgical Innovations, Inc | Laparoscopic tissue removal device |
US5397335A (en) * | 1993-07-13 | 1995-03-14 | Origin Medsystems, Inc. | Trocar assembly with improved adapter seals |
US5501654A (en) | 1993-07-15 | 1996-03-26 | Ethicon, Inc. | Endoscopic instrument having articulating element |
US5370653A (en) | 1993-07-22 | 1994-12-06 | Micro Therapeutics, Inc. | Thrombectomy method and apparatus |
EP0746362B1 (en) | 1993-08-23 | 2002-01-16 | Boston Scientific Corporation | Improved balloon catheter |
US5364365A (en) | 1993-08-30 | 1994-11-15 | Surgin Surgical Instrumentation, Inc. | Safety device for laparoscopic instruments |
NL9301842A (en) | 1993-10-25 | 1995-05-16 | Mekka Medical Supplies B V | Instrument for releasing and cutting an intima from a blood vessel and a method therefor. |
US5411016A (en) | 1994-02-22 | 1995-05-02 | Scimed Life Systems, Inc. | Intravascular balloon catheter for use in combination with an angioscope |
DE4405656C2 (en) | 1994-02-22 | 1998-12-10 | Ferton Holding | Body stone removal device |
US5562658A (en) * | 1994-03-25 | 1996-10-08 | Snj Company, Inc. | Laser-powered surgical device for making incisions of selected depth |
US5569183A (en) | 1994-06-01 | 1996-10-29 | Archimedes Surgical, Inc. | Method for performing surgery around a viewing space in the interior of the body |
US5690668A (en) | 1994-06-29 | 1997-11-25 | General Surgical Innovations, Inc. | Extraluminal balloon dissection |
US5672171A (en) | 1994-06-30 | 1997-09-30 | American Medical Systems, Inc. | Apparatus and method for interstitial laser treatment |
AU2960195A (en) | 1994-07-01 | 1996-01-25 | Origin Medsystems, Inc. | Everting cannula apparatus and method |
US5458572A (en) | 1994-07-01 | 1995-10-17 | Boston Scientific Corp. | Catheter with balloon folding into predetermined configurations and method of manufacture |
US5571172A (en) | 1994-08-15 | 1996-11-05 | Origin Medsystems, Inc. | Method and apparatus for endoscopic grafting |
US5817144A (en) * | 1994-10-25 | 1998-10-06 | Latis, Inc. | Method for contemporaneous application OF laser energy and localized pharmacologic therapy |
US5569291A (en) | 1995-02-01 | 1996-10-29 | Ethicon Endo-Surgery, Inc. | Surgical penetration and dissection instrument |
US5569292A (en) | 1995-02-01 | 1996-10-29 | Ethicon Endo-Surgery, Inc. | Surgical penetration instrument with transparent blades and tip cover |
US5613973A (en) | 1995-03-10 | 1997-03-25 | Wilson Greatbatch Ltd. | Laraposcopic surgical grasper having an attachable strap |
US5738628A (en) | 1995-03-24 | 1998-04-14 | Ethicon Endo-Surgery, Inc. | Surgical dissector and method for its use |
US5556380A (en) | 1995-04-05 | 1996-09-17 | Duke University | Method for removing fibrin sheaths from catheters |
US5591183A (en) | 1995-04-12 | 1997-01-07 | Origin Medsystems, Inc. | Dissection apparatus |
US5980549A (en) | 1995-07-13 | 1999-11-09 | Origin Medsystems, Inc. | Tissue separation cannula with dissection probe and method |
DE19515280C2 (en) | 1995-04-26 | 1997-06-12 | Siegfried Riek | Device for removing tissue or the like from the abdominal cavity |
US5593418A (en) | 1995-05-19 | 1997-01-14 | General Surgical Innovations, Inc. | Methods and devices for harvesting blood vessels with balloons |
US5601581A (en) | 1995-05-19 | 1997-02-11 | General Surgical Innovations, Inc. | Methods and devices for blood vessel harvesting |
US5702417A (en) | 1995-05-22 | 1997-12-30 | General Surgical Innovations, Inc. | Balloon loaded dissecting instruments |
US6004340A (en) | 1995-05-22 | 1999-12-21 | General Surgical Innovations, Inc. | Balloon dissecting instruments |
US6179854B1 (en) | 1995-05-22 | 2001-01-30 | General Surgical Innovations, Inc. | Apparatus and method for dissecting and retracting elongate structures |
US5667476A (en) | 1995-06-05 | 1997-09-16 | Vision-Sciences, Inc. | Endoscope articulation system to reduce effort during articulation of an endoscope |
US5658275A (en) * | 1995-06-07 | 1997-08-19 | Trimedyne, Inc. | Surgical laser instrument |
US5944686A (en) | 1995-06-07 | 1999-08-31 | Hydrocision, Inc. | Instrument for creating a fluid jet |
US5643301A (en) | 1995-06-07 | 1997-07-01 | General Surgical Innovations, Inc. | Cannula assembly with squeeze operated valve |
US5634935A (en) | 1995-06-16 | 1997-06-03 | Taheri; Syde A. | Balloon dissection instrument and method of dissection |
US5713863A (en) | 1996-01-11 | 1998-02-03 | Interventional Technologies Inc. | Catheter with fluid medication injectors |
US5968065A (en) | 1995-07-13 | 1999-10-19 | Origin Medsystems, Inc. | Tissue separation cannula |
US5695514A (en) | 1995-07-13 | 1997-12-09 | Guidant Corporation | Method and apparatus for harvesting blood vessels |
US5766203A (en) | 1995-07-20 | 1998-06-16 | Intelliwire, Inc. | Sheath with expandable distal extremity and balloon catheters and stents for use therewith and method |
US5681336A (en) | 1995-09-07 | 1997-10-28 | Boston Scientific Corporation | Therapeutic device for treating vien graft lesions |
US5779716A (en) | 1995-10-06 | 1998-07-14 | Metamorphic Surgical Devices, Inc. | Device for removing solid objects from body canals, cavities and organs |
US5667480A (en) | 1995-10-20 | 1997-09-16 | Ethicon Endo-Surgery, Inc. | Method and devices for endoscopic vessel harvesting |
US5782753A (en) | 1995-10-20 | 1998-07-21 | United States Surgical Corporation | Surgical retractor |
US5792158A (en) | 1995-11-15 | 1998-08-11 | Lary; Banning Gray | University dilator with expandable incisor |
US5769871A (en) | 1995-11-17 | 1998-06-23 | Louisville Laboratories, Inc. | Embolectomy catheter |
US5772576A (en) | 1995-12-11 | 1998-06-30 | Embro Vascular L.L.C. | Apparatus and method for vein removal |
US5817013A (en) | 1996-03-19 | 1998-10-06 | Enable Medical Corporation | Method and apparatus for the minimally invasive harvesting of a saphenous vein and the like |
US6055989A (en) | 1996-03-21 | 2000-05-02 | Robert D. Rehnke | Method for surgical dissection, sizing and expansion |
US5792044A (en) | 1996-03-22 | 1998-08-11 | Danek Medical, Inc. | Devices and methods for percutaneous surgery |
US5980503A (en) | 1996-04-08 | 1999-11-09 | Guidant Corporation | Endoscopic cardioplegia infusion cannula and method of use |
EP0893970B1 (en) | 1996-04-19 | 2006-06-21 | Applied Medical Resources Corporation | Grasping clip applier |
US6149660A (en) | 1996-04-22 | 2000-11-21 | Vnus Medical Technologies, Inc. | Method and apparatus for delivery of an appliance in a vessel |
US5788710A (en) | 1996-04-30 | 1998-08-04 | Boston Scientific Corporation | Calculus removal |
US5906621A (en) | 1996-05-14 | 1999-05-25 | United States Endoscopy Group, Inc. | Endoscopic surgical device |
US5954713A (en) * | 1996-07-12 | 1999-09-21 | Newman; Fredric A. | Endarterectomy surgical instruments and procedure |
-
1996
- 1996-07-12 US US08/680,594 patent/US5954713A/en not_active Expired - Lifetime
-
1997
- 1997-07-11 AU AU36610/97A patent/AU741165B2/en not_active Ceased
- 1997-07-11 CA CA002260019A patent/CA2260019A1/en not_active Abandoned
- 1997-07-11 AT AT97933420T patent/ATE260605T1/en not_active IP Right Cessation
- 1997-07-11 DE DE69727938T patent/DE69727938T2/en not_active Expired - Fee Related
- 1997-07-11 IL IL12801597A patent/IL128015A0/en unknown
- 1997-07-11 JP JP10506215A patent/JP2000515402A/en active Pending
- 1997-07-11 CN CN97197604A patent/CN1228687A/en active Pending
- 1997-07-11 WO PCT/US1997/012174 patent/WO1998002102A2/en not_active Application Discontinuation
- 1997-07-11 EP EP97933420A patent/EP0917445B1/en not_active Expired - Lifetime
-
1999
- 1999-01-12 KR KR1019990700217A patent/KR20000023753A/en not_active Application Discontinuation
- 1999-04-20 US US09/294,566 patent/US6358244B1/en not_active Expired - Lifetime
-
2002
- 2002-02-04 US US10/067,630 patent/US20020120257A1/en not_active Abandoned
-
2007
- 2007-01-25 JP JP2007015568A patent/JP2007160125A/en active Pending
Also Published As
Publication number | Publication date |
---|---|
US5954713A (en) | 1999-09-21 |
KR20000023753A (en) | 2000-04-25 |
DE69727938T2 (en) | 2005-07-07 |
US20020120257A1 (en) | 2002-08-29 |
EP0917445A2 (en) | 1999-05-26 |
AU741165B2 (en) | 2001-11-22 |
CN1228687A (en) | 1999-09-15 |
DE69727938D1 (en) | 2004-04-08 |
IL128015A0 (en) | 1999-11-30 |
WO1998002102A2 (en) | 1998-01-22 |
ATE260605T1 (en) | 2004-03-15 |
JP2000515402A (en) | 2000-11-21 |
EP0917445B1 (en) | 2004-03-03 |
US6358244B1 (en) | 2002-03-19 |
WO1998002102A3 (en) | 1998-03-26 |
JP2007160125A (en) | 2007-06-28 |
AU3661097A (en) | 1998-02-09 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
CA2260019A1 (en) | Endarterectomy surgical instruments and procedure | |
JP4138251B2 (en) | Direct visual subcutaneous tissue retractor | |
US5634935A (en) | Balloon dissection instrument and method of dissection | |
EP0343094B1 (en) | Angioscope catheter apparatus with a deflector | |
US5092872A (en) | Valvulotome catheter | |
CA2361305C (en) | Kit for endovascular venous surgery | |
US5556405A (en) | Universal dilator with reciprocal incisor | |
US5601580A (en) | Venous valve cutter | |
US5913870A (en) | Surgical dissector | |
US7981133B2 (en) | Tissue dissection method | |
US5352232A (en) | Method for using detachable tip valvulotome | |
US7938842B1 (en) | Tissue dissector apparatus | |
US5702417A (en) | Balloon loaded dissecting instruments | |
US6264670B1 (en) | Tissue dissection method | |
EP0912139A4 (en) | ||
CA2390922C (en) | Endarterectomy surgical instrument | |
JPWO2006051593A1 (en) | Biological tissue collection device |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
EEER | Examination request | ||
FZDE | Discontinued | ||
FZDE | Discontinued |
Effective date: 20050330 |