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1. EP0837712 - DEVICES AND METHODS FOR PORT-ACCESS MULTIVESSEL CORONARY ARTERY BYPASS SURGERY

Office European Patent Office
Application Number 96916899
Application Date 31.05.1996
Publication Number 0837712
Publication Date 29.04.1998
Publication Kind A4
IPC
A61B 1/00
AHUMAN NECESSITIES
61MEDICAL OR VETERINARY SCIENCE; HYGIENE
BDIAGNOSIS; SURGERY; IDENTIFICATION
1Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
A61B 17/00
AHUMAN NECESSITIES
61MEDICAL OR VETERINARY SCIENCE; HYGIENE
BDIAGNOSIS; SURGERY; IDENTIFICATION
17Surgical instruments, devices or methods, e.g. tourniquets
A61B 17/02
AHUMAN NECESSITIES
61MEDICAL OR VETERINARY SCIENCE; HYGIENE
BDIAGNOSIS; SURGERY; IDENTIFICATION
17Surgical instruments, devices or methods, e.g. tourniquets
02for holding wounds open; Tractors
A61B 17/04
AHUMAN NECESSITIES
61MEDICAL OR VETERINARY SCIENCE; HYGIENE
BDIAGNOSIS; SURGERY; IDENTIFICATION
17Surgical instruments, devices or methods, e.g. tourniquets
03for closing wounds, or holding wounds closed, e.g. surgical staples; Accessories for use therewith
04for suturing wounds; Holders or packages for needles or suture materials
A61B 17/06
AHUMAN NECESSITIES
61MEDICAL OR VETERINARY SCIENCE; HYGIENE
BDIAGNOSIS; SURGERY; IDENTIFICATION
17Surgical instruments, devices or methods, e.g. tourniquets
03for closing wounds, or holding wounds closed, e.g. surgical staples; Accessories for use therewith
04for suturing wounds; Holders or packages for needles or suture materials
06Needles; Holders or packages for needles or suture materials
A61B 17/064
AHUMAN NECESSITIES
61MEDICAL OR VETERINARY SCIENCE; HYGIENE
BDIAGNOSIS; SURGERY; IDENTIFICATION
17Surgical instruments, devices or methods, e.g. tourniquets
03for closing wounds, or holding wounds closed, e.g. surgical staples; Accessories for use therewith
064Surgical staples
CPC
A61F 7/10
AHUMAN NECESSITIES
61MEDICAL OR VETERINARY SCIENCE; HYGIENE
FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
7Heating or cooling appliances for medical or therapeutic treatment of the human body
10Cooling bags, e.g. ice-bags
A61B 17/00234
AHUMAN NECESSITIES
61MEDICAL OR VETERINARY SCIENCE; HYGIENE
BDIAGNOSIS; SURGERY; IDENTIFICATION
17Surgical instruments, devices or methods, e.g. tourniquets
00234for minimally invasive surgery
A61B 17/0057
AHUMAN NECESSITIES
61MEDICAL OR VETERINARY SCIENCE; HYGIENE
BDIAGNOSIS; SURGERY; IDENTIFICATION
17Surgical instruments, devices or methods, e.g. tourniquets
0057Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect
A61B 17/0218
AHUMAN NECESSITIES
61MEDICAL OR VETERINARY SCIENCE; HYGIENE
BDIAGNOSIS; SURGERY; IDENTIFICATION
17Surgical instruments, devices or methods, e.g. tourniquets
02for holding wounds open; Tractors
0218for minimally invasive surgery
A61B 17/0467
AHUMAN NECESSITIES
61MEDICAL OR VETERINARY SCIENCE; HYGIENE
BDIAGNOSIS; SURGERY; IDENTIFICATION
17Surgical instruments, devices or methods, e.g. tourniquets
04for suturing wounds; Holders or packages for needles or suture materials
0467Instruments for cutting sutures
A61B 17/0469
AHUMAN NECESSITIES
61MEDICAL OR VETERINARY SCIENCE; HYGIENE
BDIAGNOSIS; SURGERY; IDENTIFICATION
17Surgical instruments, devices or methods, e.g. tourniquets
04for suturing wounds; Holders or packages for needles or suture materials
0469Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
Applicants HEARTPORT INC
Inventors BOYD STEPHEN W
RAPACKI ALAN R
VASKA MATTHIAS
DONLON BRIAN S
PETERS WILLIAMS S
STEVENS JOHN H
Designated States
Priority Data 08486941 07.06.1995 US
9608244 31.05.1996 US
Title
(DE) VORRICHTUNGEN UND METHODEN ZUM MULTIVASCULAREN PORTZUGANG BEI DER CORONAREN ARTERIENBYPASSCHIRURGIE
(EN) DEVICES AND METHODS FOR PORT-ACCESS MULTIVESSEL CORONARY ARTERY BYPASS SURGERY
(FR) DISPOSITIFS ET PROCEDES DE PONTAGE AORTOCORONARIEN MULTIVASCULAIRE A ACCES PAR ORIFICES
Abstract
(EN)
Surgical methods and instruments are disclosed for performing port-access or closed-chest coronary artery bypass (CABG) surgery in multivessel coronary artery disease. In contrast to standard open-chest CABG surgery, which requires a median sternotomy or other gross thoracotomy to expose the patient's heart, post-access CABG surgery is performed through small incisions or access ports made through the intercostal spaces between the patient's ribs, resulting in greatly reduced pain and morbidity to the patient. In situ arterial bypass grafts, such as the internal mammary arteries and/or the right gastroepiploic artery, are prepared for grafting by thoracoscopic or laparoscopic takedown techniques. Free grafts, such as a saphenous vein graft or a free arterial graft, can be used to augment the in situ arterial grafts. The graft vessels are anastomosed to the coronary arteries under direct visualization through a cardioscopic microscope inserted through an intercostal access port. Retraction instruments are provided to manipulate the heart within the closed chest of the patient to expose each of the coronary arteries for visualization and anastomosis. Disclosed are a tunneler and an articulated tunneling grasper for rerouting the graft vessels, and a finger-like retractor, a suction cup retractor, a snare retractor and a loop retractor for manipulating the heart. Also disclosed is a port-access topical cooling device for improving myocardial protection during the port-access CABG procedure. An alternate surgical approach using an anterior mediastinotomy is also described.

(FR)
Procédés et instruments chirurgicaux pour la réalisation d'un pontage aortocoronarien à accès par orifices ou à thorax fermé dans le traitement de la coronaropathie multivasculaire. A la différence du pontage aortocoronarien normal à thorax ouvert qui exige une sternotomie médiane ou une autre thoracotomie macroscopique pour mettre à nu le coeur du malade, le pontage aortocoronarien à accès par orifices s'effectue au travers de petites incisions pratiquées dans les espaces intercostaux du malade, ce qui permet une forte réduction des douleurs et de la morbidité chez le malade. Des techniques de prise thoracoscopique ou laparoscopique permettent de préparer à la greffe les greffons de pontage artériel tels que les artères mammaires internes et/ou l'artère gastroépiploïque droite. Les greffes libres, par exemple une greffe de veine saphène ou une greffe artérielle libre, peuvent s'ajouter aux greffes artérielles $i(in situ). On anastomose les vaisseaux greffés avec les artères coronaires sous visualisation directe au moyen d'un microscope cardioscopique introduit par un orifice d'accès intercostal. On utilise des instruments écarteurs pour manipuler le coeur à l'intérieur du thorax fermé du malade afin de mettre à nu chacune des artères coronaires en vue de la visualisation et de l'anastomose. On décrit un instrument de formation de tunnels et un instrument articulé de préhension pour la formation de tunnels, ces instruments étant destinés à modifier le parcours des vaisseaux greffés, ainsi qu'un écarteur en forme de doigt, un écarteur à ventouse, un écarteur à anse et un écarteur à boucle pour la manipulation du coeur. On décrit également un dispositif de refroidissement topique à accès par orifices destiné à améliorer la protection myocardique au cours de la procédure de pontage aortocoronarien à accès par orifices. En outre, on décrit une autre approche chirurgicale mettant en oeuvre une médiastinotomie antérieure.

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