U.S. patent application number 10/437632 was filed with the patent office on 2003-10-16 for vessel harvesting retractor with dissection element.
This patent application is currently assigned to ETHICON, INC.. Invention is credited to Clem, Michael F., Hess, Christopher J., Jambor, Kristin L., Knight, Gary W., Nobis, Rudolph H., Schulze, Dale R..
Application Number | 20030195544 10/437632 |
Document ID | / |
Family ID | 25512450 |
Filed Date | 2003-10-16 |
United States Patent
Application |
20030195544 |
Kind Code |
A1 |
Hess, Christopher J. ; et
al. |
October 16, 2003 |
Vessel harvesting retractor with dissection element
Abstract
A surgical instrument for dissecting a vessel in a patient. The
surgical instrument includes a spoon retractor having a proximal
end and a distal end, said spoon retractor defining a working space
in the tissue of a patient, a dissecting element proximate to the
spoon retractor for dissecting tissue from a vessel, and a handle
for manipulating the spoon retractor near the vessel. Also provided
is a method for dissecting a vessel including the steps of
providing the surgical instrument for dissecting a vessel in a
patient described above. Making an incision in a patient. Inserting
the spoon retractor into the incision. Creating a working space in
the tissue of the patient near the vessel being dissected, and
manipulating the dissecting element to further dissect tissue
surrounding the vessel being dissected.
Inventors: |
Hess, Christopher J.;
(Lebanon, OH) ; Clem, Michael F.; (Maineville,
OH) ; Knight, Gary W.; (West Chester, OH) ;
Nobis, Rudolph H.; (Mason, OH) ; Schulze, Dale
R.; (Lebanon, OH) ; Jambor, Kristin L.;
(Cincinnati, OH) |
Correspondence
Address: |
SCULLY SCOTT MURPHY & PRESSER, PC
400 GARDEN CITY PLAZA
GARDEN CITY
NY
11530
|
Assignee: |
ETHICON, INC.
Somerville
NJ
|
Family ID: |
25512450 |
Appl. No.: |
10/437632 |
Filed: |
May 14, 2003 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10437632 |
May 14, 2003 |
|
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09967200 |
Sep 28, 2001 |
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6592604 |
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Current U.S.
Class: |
606/190 |
Current CPC
Class: |
A61B 2017/320044
20130101; A61B 17/0218 20130101; A61B 17/00008 20130101; A61B
17/320016 20130101; A61B 2017/00969 20130101 |
Class at
Publication: |
606/190 |
International
Class: |
A61B 017/00 |
Claims
What is claimed is:
1. A surgical instrument for dissecting a vessel in a patient, said
surgical instrument comprising: a spoon retractor having a proximal
end and a distal end, said spoon retractor defining a working space
in the tissue of a patient; a dissecting element proximate to said
spoon retractor for dissecting tissue from a vessel; and means for
manipulating said spoon retractor near the vessel.
2. The surgical instrument according to claim 1, wherein said means
for introducing and manipulating the spoon retractor near the
vessel comprises: a shaft having a distal end and a proximal end,
the distal end of the shaft connected to the proximal end of the
spoon retractor, the shaft having a lumen in communication with the
working space for insertion of an endoscope there through; and a
handle connected to a proximal end of the shaft for manipulation of
the spoon retractor connected thereto.
3. The surgical instrument according to claim 1, wherein the
dissecting element is rigidly fastened to the spoon retractor.
4. The surgical instrument according to claim 3, wherein the
dissecting element comprises a wireform, the wireform comprising a
left side rail and a right side rail rigidly connected to the spoon
retractor at a proximal end of the wireform, said left and right
side rails being connected to each other at a distal end of the
wireform and dissecting tissue from the left and right surfaces of
the vessel.
5. The surgical instrument according to claim 4, wherein the
wireform projects upward in the direction of the spoon retractor,
and forms a U-shape at the distal end of the wireform to facilitate
placement of the vessel between the left and right side rails.
6. The surgical instrument according to claim 1, comprising a
control for controlling the dissecting element, wherein said
dissecting element movably connects to said spoon retractor and
moves relative to said spoon retractor upon actuation of the
control, to facilitate dissection of tissue from the vessel.
7. The surgical instrument according to claim 6, wherein said
dissecting element comprising a movable arm having an extended
portion and a shank, the movable arm being rotatable about an axis
defined by the shank.
8. The surgical instrument according to claim 1, wherein the
dissecting element comprises a flexible arm slidably retained in
said spoon retractor, and movable between an extended position and
a retracted position.
9. The surgical instrument according to claim 8, wherein a distal
end of the flexible arm defines at least one curved portion, the
curved portion further defining an arm which extends to an outer
edge of the flexible arm and facilitating the dissection of tissue
from the vessel.
10. The surgical instrument according to claim 8, wherein the
flexible arm is prevented from entering the workspace by guide
rails.
11. The surgical instrument according to claim 1, wherein the
dissection element comprises a left curved edge and a right curved
edge extending from a bottom edge, the left and right curved edges
opposing each other, and surrounding a longitudinal axis of the
spoon retractor.
12. A method for dissecting a vessel comprising the steps of:
providing a surgical instrument for dissecting a vessel in a
patient, said surgical instrument comprising a spoon retractor
having a proximal end and a distal end, said spoon retractor
defining a working space in the tissue of the patient near the
vessel to be dissected, a dissecting element proximate to said
spoon retractor for dissecting tissue from a vessel; and a means
for manipulating said spoon retractor near the vessel; making an
incision in a patient; inserting said spoon retractor into the
incision; creating a working space in the tissue of the patient
near the vessel being dissected; and manipulating said dissecting
element to further dissect tissue surrounding the vessel being
dissected.
13. The method for dissecting a vessel as recited in claim 12,
further comprising the step of: providing a surgical instrument for
dissecting a vessel comprising a wireform rigidly attached to the
spoon retractor, the wireform comprising a left side rail and a
right side rail rigidly connected to the spoon retractor at a
proximal end of the wireform, said left and right sides being
connected to each other at a distal end of the wireform.
14. The method for dissecting a vessel as recited in claim 13,
wherein said manipulating step comprises sliding the wireform along
the vessel while the left and rights sides are laterally disposed
on the left and right sides of the vessel respectively.
15. The method for dissecting a vessel as recited in claim 12,
wherein the dissecting element is movably connected to the spoon
retractor, and wherein the manipulating comprises moving the
dissecting element relative to said spoon retractor upon actuation
of a control.
16. The method for dissecting a vessel as recited in claim 15,
wherein said dissecting element is a movable arm having an extended
portion and a shank, and wherein the manipulation comprises
rotating the movable arm about an axis defined by the shank.
17. The method for dissecting a vessel as recited in claim 16,
wherein said manipulating step comprises: sliding the spoon
retractor and attached the dissection element along the vessel; and
rotating the movable arm about the vessel to dissect the vessel
from the tissue surrounding the vessel.
18. The method for dissecting a vessel as recited in claim 12,
wherein the dissecting element comprises a flexible arm slidably
retained in said spoon retractor, and movable between an extended
position and a retracted position.
19. The method for dissecting a vessel as recited in claim 18,
wherein a distal end of the flexible arm defines at least one
curved portion, the curved portion further defining an arm which
extends to an outer edge of the flexible arm.
20. The method for dissecting a vessel as recited in claim 19,
wherein said manipulating step comprises: extending the flexible
arm from the retracted to the extended position; and sliding the
spoon retractor and attached dissection element along the vessel,
wherein the curved portion of the flexible arm is placed on at
least one side of the vessel to dissect the vessel from the
surrounding tissue.
21. The method for dissecting a vessel as recited in claim 12,
wherein the dissection element comprises at least one curved edge
extending from a bottom edge of the spoon retractor, and wherein
the manipulating step comprises, sliding the dissection element
along the vessel.
Description
FIELD OF THE INVENTION
[0001] This invention relates to surgical devices and methods for
dissecting around elongated tissue structures. In particular, this
invention relates to devices and methods for dissecting around a
blood vessel such as a saphenous vein during an endoscopic vessel
harvesting procedure.
BACKGROUND OF THE INVENTION
[0002] Endoscopic vein harvesting (EVH), particularly of the
greater saphenous vein in the leg, is a surgical procedure for
obtaining a graft vessel for a coronary artery bypass graft (CABG)
procedure. A physician's assistant (PA) typically performs the EVH
on one or both legs of the patient while a cardiac surgeon operates
on the patient's chest in preparation for the grafts. Performing
the EVH in a timely manner is important so that the PA can present
the prepped vessel to the surgeon by the time the surgeon is ready
to attach the graft vessel to the heart. The EVH procedure learning
curve and additional time required to harvest a blood vessel using
minimally invasive techniques continue to be issues for the rapid
adoption of the procedure. The present invention improves the ease
of use and decreases the time required to harvest a vessel.
Specifically, this invention reduces the number of instrument
exchanges through the surgical incision in the patient.
[0003] Several investigators have proposed devices and methods for
performing EVH, as disclosed in the patents cited. For example,
U.S. Pat. No. 5,928,138 ("Method and Devices for Endoscopic Vessel
Harvesting", assigned to Ethicon Endo-Surgery, Inc., and issued on
Jul. 27, 1999) discloses an optical dissector having a concave
working head. A commercial version of this optical dissector is
called the ClearGlide subcutaneous retractor and is available from
Ethicon, Inc., Somerville, N.J. The ClearGlide is currently one of
the main products available today for performing EVH, and provides
good access and visibility to the surgical site along the greater
saphenous vein.
[0004] The PA normally uses the ClearGlide with other endoscopic,
surgical dissection instruments in order to isolate the vessel from
surrounding tissues. The PA introduces these instruments through a
channel provided in the handle and shaft of the ClearGlide in order
to operate on tissues within a working space created by a concave
working head.
[0005] Known methods and devices for performing vessel dissection
are discussed in detail in U.S. Pat. Nos. 5,667,480 issued Sep. 16,
1997 and 5,722,934 issued Mar. 3, 1998, both issued to Knight, et
al, both of which are incorporated herein by their reference.
[0006] Of the known devices and methods for dissection of tissues
there remains one constant problem. The problem is that to perform
the dissection, extra tools must be inserted along the guide rails
of the device through the original incision. Often times this means
that to perform a single dissection of a vessel multiple tools must
be inserted in succession into the body. Additionally, the
harvesting device remains in the body throughout the procedure.
[0007] This requirement of inserting the tools in succession and
exchanging one tool for another to perform each step of the
operation requires extra time, this in turn can be a drain on the
individual surgeons resources. Further, because of this increased
amount of time, which the surgeon requires to perform the
operation, the stress on the patient is increased. Minimization of
patient stress is naturally a concern during any surgical
procedure. Therefore, the elimination of some or all of the time
extending tool exchanges would greatly benefit not only the patient
but the surgeon as well.
[0008] What is needed, therefore, is a surgical instrument having a
concave working head for creating a working space near the vessel
to be harvested, and that has at least one dissection element
connected to the concave working head. An operator may use the
dissection element for dissecting around all sides of the vessel so
that it is less necessary to use other dissection instruments. The
operator may also use the dissecting element for supporting a
tissue structure such as a side branch while it is operated on by
another surgical instrument, such as a surgical scissors, ligation
instrument, or the like.
SUMMARY OF THE INVENTION
[0009] The present invention is directed to solving the
shortcomings of known vessel retractors, by providing a superior
vessel retractor, promoting efficient dissection of vessels, and
limiting the stress on patients. The objects of the present
invention are the minimization of the tool exchanges, increased
efficiency of operation, minimization of patient stress, and
increased ease of the overall harvest operation. Further, the
present invention pertains to a vessel retractor having a
dissecting element. The surgical instrument comprises a spoon
retractor having a proximal end and a distal end, said spoon
retractor defining a working space in the tissue of a patient, a
dissecting element proximate to said spoon retractor for dissecting
tissue from a vessel, and means for manipulating said spoon
retractor near the vessel. The means for introducing and
manipulating the spoon retractor near the vessel comprises, a shaft
having a distal end and a proximal end, the distal end of the shaft
connected to the proximal end of the spoon retractor, the shaft
having a lumen in communication with the working space for
insertion of an endoscope there through and a handle connected to a
proximal end of the shaft for manipulation of the spoon retractor
connected thereto.
[0010] The dissecting element may be rigidly fastened to the spoon
retractor. In such a configuration the dissecting element comprises
a wireform, the wireform comprises a left side rail and a right
side rail rigidly connected to the spoon retractor at a proximal
end of the wireform, said left and right side rails being connected
to each other at a distal end of the wireform and dissecting tissue
from the left and right surfaces of the vessel. Additionally the
wireform may project upward in the direction of the spoon
retractor, and form a U-shape at the distal end of the wireform to
facilitate placement of the vessel between the left and right side
rails.
[0011] The surgical instrument may comprise a control for
controlling the dissecting element, when the dissecting element
movably connects to the spoon retractor and moves relative to said
spoon retractor upon actuation of the control, to facilitate
dissection of tissue from the vessel. In such a configuration the
dissecting element comprises a movable arm having an extended
portion and a shank, the movable arm being rotatable about an axis
defined by the shank.
[0012] In another configuration the dissection element may comprise
a flexible arm slidably retained in said spoon retractor, and
movable between an extended position and a retracted position. In
such a configuration the distal end of the flexible arm defines at
least one curved portion, the curved portion further defining an
arm which extends to an outer edge of the flexible arm and
facilitating the dissection of tissue from the vessel. The flexible
arm is prevented from entering the workspace by guide rails.
[0013] Also provided is a method for dissecting a vessel comprising
the steps of: providing a surgical instrument for dissecting a
vessel in a patient; said surgical instrument comprising a spoon
retractor having a proximal end and a distal end; said spoon
retractor defining a working space in the tissue of the patient
near the vessel to be dissected; a dissecting element proximate to
said spoon retractor for dissecting tissue from a vessel; and a
means for manipulating said spoon retractor near the vessel, making
an incision in a patient; inserting said spoon retractor into the
incision; creating a working space in the tissue of the patient
near the vessel being dissected; and manipulating said dissecting
element to further dissect tissue surrounding the vessel being
dissected.
[0014] The method further comprises the step of providing a
surgical instrument for dissecting a vessel comprising a wireform
rigidly attached to the spoon retractor, the wireform comprising a
left side rail and a right side rail rigidly connected to the spoon
retractor at a proximal end of the wireform, said left and right
sides being connected to each other at a distal end of the
wireform.
[0015] Preferably the manipulating step comprises sliding the
wireform along the vessel while the left and rights sides are
laterally disposed on the left and right sides of the vessel
respectively.
[0016] In a configuration where the dissecting element is movably
connected to the spoon retractor, the manipulating step may
comprise moving the dissecting element relative to said spoon
retractor upon actuation of a control.
[0017] In a configuration where said dissecting element is a
movable arm having an extended portion and a shank, the
manipulation may comprise rotating the movable arm about an axis
defined by the shank, wherein said manipulating step further
comprises sliding the spoon retractor and attached the dissection
element along the vessel, and rotating the movable arm about the
vessel to dissect the vessel from the surrounding tissue.
[0018] The method for dissecting may also comprise using a
dissecting element comprising a flexible arm slidably retained in
said spoon retractor, and movable between an extended position and
a retracted position. Wherein the distal end of the flexible arm
defines at least one curved portion, the curved portion further
defining an arm which extends to an outer edge of the flexible
arm.
[0019] In such a configuration the manipulating step preferably
comprises, extending the flexible arm from the retracted to the
extended position, and sliding the spoon retractor and attached
dissection element along the vessel, wherein the curved portion of
the flexible arm is placed on at least one side of the vessel to
dissect the vessel from the surrounding tissue.
BRIEF SUMMARY OF THE DRAWINGS
[0020] FIG. 1 is a perspective view of a preferred implementation
of a surgical instrument of the present invention, used for
dissecting and harvesting a vein;
[0021] FIG. 2 is a front view of a spoon retractor of the surgical
instrument of FIG. 1, the spoon retractor having a flexible arm as
a dissecting element in an extended position;
[0022] FIG. 3 is a side sectional view of the spoon retractor shown
in FIG. 2 taken along line 3-3;
[0023] FIG. 4 is a sectional view of the spoon retractor shown in
FIG. 3 taken along line 4-4;
[0024] FIG. 5 is a side view of the spoon retractor shown in FIG. 3
in a retracted position;
[0025] FIG. 6 is a bottom view of the spoon retractor shown in FIG.
5 in the retracted position;
[0026] FIG. 7 is a front view of a first variation of the spoon
retractor of the present invention with curved edges as a
dissecting element;
[0027] FIG. 8 is a side view of the spoon retractor shown in FIG.
7;
[0028] FIG. 9 is a front view of a second variation of the spoon
retractor of the present invention with fixed rails as a dissecting
element;
[0029] FIG. 10 is a side view of the spoon retractor shown in FIG.
9;
[0030] FIG. 11 is a front view of a third variation of the spoon
retractor of the present invention with a movable arm as a
dissecting element in a retracted position;
[0031] FIG. 12 is a side view of the spoon retractor shown in FIG.
11;
[0032] FIG. 13 is a front view of the spoon retractor shown in FIG.
11 in an extended position; and
[0033] FIG. 14 is a side view of the spoon retractor shown in FIG.
13 in an extended position.
DETAILED DESCRIPTION OF THE INVENTION
[0034] A surgical instrument for endoscopic dissection of vessels
for CABG surgery as known in the art generally comprises a concave
working head, a shaft, and a handle. The instrument is typically
fitted with an endoscope inserted through a handle and the shaft so
that an operator may view into a working space created by concave
working head.
[0035] In operation the surgeon introduces the concave working head
and a portion of shaft through a surgical incision and manipulates
surgical instrument alongside the saphenous vein in order to free
the vein from surrounding tissues and to isolate side branches of
the vein that must be ligated prior to removal of the vein from the
patient's leg.
[0036] The concave working head may be made from a clear plastic so
that the operator may visualize tissue structures adjacent to it as
well as inside the working space. U.S. Pat. No. 5,928,138 also
discloses how surgical instrument may be used with other surgical
instruments for dissecting and harvesting a vein. The present
invention reduces the time required to perform the EVH procedure
(and subsequent trauma to tissue) due to fewer exchanges of these
additional instruments into incision.
[0037] Referring now to FIG. 1, a surgical instrument is
illustrated therein generally referred to by reference number 2.
The present invention includes at least one dissecting element
(shown in FIGS. 2-14), which is either movably connected or fixed
to a concave working head, also referred to as a spoon retractor
10. The spoon retractor 10 is useful for dissection of tissue such
as is required for separating the saphenous vein from surrounding
tissues during an EVH. Surgical instrument 2 may be used with an
endoscope 18 in order to view inside the working space. In the
descriptions that follow, several variations of the spoon retractor
10 and dissecting elements are described. For the embodiments
shown, the spoon retractor 10 is preferably attached to an
elongated shaft 1 and a handle 3, similar to the surgical
instrument of the prior art.
[0038] FIG. 2 is a front view and FIG. 3 is a side sectional view
of a spoon retractor 10 of the present invention. Spoon retractor
10 is an improvement of concave working head of the prior art. In
this implementation, spoon retractor 10 is symmetrically shaped
with a proximal end 17 attached to the distal end of a shaft 1.
Spoon retractor 10 tapers to a distal end 19 so that an operator 4
may easily use spoon retractor 10 to separate tissue layers and
isolate a vein 6 from surrounding tissues. Spoon retractor 10 is
preferably made of a medical grade, injection moldable plastic such
as polycarbonate and is optionally clear for endoscopic viewing of
tissue both inside the working space and adjacent to spoon
retractor 10. In the implementation of FIGS. 2 and 3, spoon
retractor 10 includes a retractable, flexible arm 12. An upper
layer 14 and a lower layer 16 of spoon retractor 10 define a
channel that extends partially between distal end 19 and proximal
end 17, and slidably retains flexible arm 12. An operator 4 may
position flexible arm 12 at an extended position such as shown in
FIGS. 2 and 3, at a retracted position, as shown in FIGS. 4 and 5,
or at any position between the extended and retracted positions. A
control (not shown) for moving flexible arm 12 is preferably
located on a portion of the surgical instrument 2 that remains
external to the patient during the procedure, such as on the
proximal end 50 of shaft 1 or on handle 3, as may be easily
envisioned by those skilled in the art.
[0039] In the retracted position, the flexible arm 12 lies above
the level of the endoscope 18, and portions which are located
outside of the spoon retractor 10 may lie on the shaft 1. Flexible
arm 12 may be made of a medical grade, injection moldable plastic
such as high-density polyethylene. A distal end of flexible arm 12
comprises two opposing curved portions 11 for a traumatically
sliding along the sides of an elongate tissue structure such as a
vein 6 in order to free the vein 6 from surrounding tissues. Curved
portions 11 define an arm 13 that extends distally to an outer edge
15 to assist in separating the vein 6 from the connecting
tissues.
[0040] FIG. 6 shows a bottom view of spoon retractor 10 and
corresponds with FIGS. 4 and 5 for when flexible arm 12 is in the
retracted position. Lower layer 16 (see FIG. 3) comprises two guide
rails 22 to support flexible arm 12. Guide rails 22 connect to an
inside surface of spoon retractor 10. The guide rails 22 also serve
to insure that the flexible arm 12 does not restrict the field of
view of the endoscope 18.
[0041] FIGS. 7 and 8 are a front view and a side view of a first
variation of a spoon retractor 10, respectively, with a left curved
edge 30 and an opposing right curved edge 31 extending from a
bottom edge 29 on each side of spoon retractor 10. In this
implementation, a left middle section (not shown) and a right
middle section 34 blends with the curvation on each side of spoon
retractor 10. As can be seen in FIG. 7, left curved edge 30, right
curved edge 31 and spoon retractor 10 approximately surround the
longitudinal axis of spoon retractor 10, thus allowing an operator
to place spoon retractor 10 near a vessel with left curved edge 30
and right curved edge 31 on opposing sides of the vessel. The
operator 4 may then slide spoon retractor 10 back and forth along
the vessel to free the vessel from surrounding tissue.
[0042] FIGS. 9 and 10 show a second variation of the spoon
retractor 10 of the present invention. FIG. 9 is a front view and
FIG. 10 is a side view, showing a wireform dissecting element 37
comprising a left side rail 38 and a right side rail 39 fixed to
spoon retractor 10. Wireform dissecting element 37 preferably has a
curved distal end 36 joining left side rail 38 and right side rail
39. Wireform dissecting element 37 further comprises a pair of
proximal ends 44, which are fixedly connected to spoon retractor
10. Cavity 48 of spoon retractor 10 retains and supports curved
distal end 36. Wireform dissecting element 37 is made from a
medical grade material such as stainless steel wire having a
diameter approximately in the range of one to two millimeters. The
operator 4 may position left side rail 38 and right side rail 39
and on either side of a vessel and move spoon retractor 10 slowly
forward and back to separate vein 6 from the connecting tissue
layers.
[0043] FIGS. 11-14 show a third variation of the spoon retractor 10
of the present invention. FIGS. 11 and 12 show front and side
views, respectively, of spoon retractor 10, and include a movable
arm 50 shown in a first position. An extended portion 46 at a
proximal end 42 of the spoon retractor 10 rotatably retains a shank
54 of movable arm 50. An operator 4 moves movable arm 50 between
the retracted first position and a second position (FIGS. 11 and
13, respectively) by actuating a rotation control (not shown)
preferably located on the proximal end of shaft 1 or on handle 3
(see FIG. 1). Actuation of a distal element of a surgical element
by a control rod is well known in the art.
[0044] Movable arm 50 includes a tip 52 for dissecting tissues.
Shank 54 preferably lies directly below endoscope 18. Movable arm
50 is preferably made from a stainless steel wire having a diameter
approximately in the range of one to two millimeters. Movable arm
50 may rotate in either direction about the axis defined by the
shank and may also rotate a full 360 degrees.
[0045] The operation of the surgical instrument 2 of the present
invention will now be discussed with reference to the figures. The
surgical instrument 2 of the present invention has a particular
ability in dissecting vessels from tissue in a patient however,
such a use is given by way of example only and does not limit the
scope or spirit of the present invention.
[0046] Once a device comprising at least one of the dissection
elements discussed above is provided, the surgeon determines the
location of the vessel to be dissected, and makes an incision in
the patient. The spoon retractor is inserted into the incision and
blunt dissection of the tissue surrounding the vessel 6 is
performed. For extraction purposes, it is preferable to dissect as
much tissue from the vessel as possible. The initial insertion of
the spoon retractor 10 creates a working space 7 in the tissue of
the patient near the vessel 6 being dissected. This working space
provides a location where the operator may utilize the various
dissection elements, discussed above to dissection the vessel from
the surrounding tissue. Finally the dissection elements need to be
manipulated by the user to further dissect tissue surrounding the
vessel 6 being dissected.
[0047] The dissection of the vessel 6 is accomplished by moving the
spoon retractor 10 along the vessel and separating the tissue from
the vessel. To assist in the dissection there are various forms of
dissection elements which can be provided, as discussed above. Each
of the various dissection elements can be incorporated into the
method described here with some variation of the manipulation
step.
[0048] One of the dissection elements which may be provided is
shown in FIGS. 7 and 8. The dissection element comprises the spoon
retractor 10 having curved edges 30, 31 extending from the bottom
edge on each side of the spoon retractor. The dissection element is
used by orienting the vessel 6 between the two curved edges 31.
Once the vessel is so oriented the spoon retractor 10 is moved
along the vessel 6. This movement causes the curved edges 30, 31 to
dissect the vessel from the tissue located on either side.
[0049] Another dissection element provided comprises a rigidly
attached wireform 37 having left and right side rails 38, 39, and
these rails are connected at the distal end of the wireform 37.
Such a dissection element 37 is used by orienting the left side
rail 38, on a first side of the vessel 6, and the right side rail
39 on a second side of the vessel 6. The vessel is captured by the
wireform by operation of the U-Shape connection point of the
dissection element. After the vessel 6 is captured, the spoon
retractor 10 and wireform 37 are slid along the length of the
vessel. The left side rail dissecting on the first side of the
vessel and the right side rail dissecting the right side of the
vessel. The U-shaped connection assists in the dissection of tissue
on the top surface of the vessel.
[0050] Yet another dissection provided is one having a movable arm
50 having an extended portion and a shank 44 as shown in FIGS.
11-14. The dissecting element is movably connected to the spoon
retractor 10, and the manipulation comprises rotating the movable
arm 50 about an axis defined by the shank 44. Sliding the spoon
retractor 10 and attached movable arm 50 along the vessel, and
simultaneously rotating the movable arm 50 about the vessel tissue,
dissects on all sides of the vessel from the surrounding
tissue.
[0051] Additionally, when the movable arm 50 is in the position
shown in FIG. 14, the dissection element can slidingly engage the
tissue along the axis defined by the shank to dissect it from the
vessel. The movable arm 50 can be forced along one side of the
vessel 6 while the spoon retractor 10 is moved along another
surface of the vessel 6. Upon projecting the spoon retractor a
certain distance, the movable arm can be rotated to dissect tissue
from the vessel by the circumferential movement of the movable arm
around the vessel 6.
[0052] Still another dissection element provided is one having a
flexible arm 12 slidably retained in said spoon retractor, and
movable between an extended position and a retracted position, as
shown in FIGS. 2-8. The distal end of the flexible arm 12 defines
at least one curved portion 11. The curved portion 11 further
defining an arm 13 which extends to an outer edge of the flexible
arm 12. This dissection element is manipulated by extending the
flexible arm from the retracted to the extended position, and
sliding the spoon retractor 10 and attached flexible arm 12 along
the vessel 6, at the same time the curved portion 11 of the
flexible arm 12 is placed on at least one side of the vessel 6to
dissect the vessel 6 from the surrounding tissue. Typically, the
flexible arm 12 has two curved portions 11 and will be used to
dissect the tissue from one side of the vessel 6 and then a second
side of the vessel 6. During the dissection the curved portion 11
slides along the surface of the vessel 6. The arm 13 facilitates
the dissection on the underside of the vessel 6.
[0053] Those skilled in the art will appreciate that the methods of
the present invention do not require the insertion multiple
dissection tools to perform procedure. Nor do they require multiple
tool exchanges. Accordingly, the procedure as a whole is far
easier, and efficient that those previously known. As a result the
stress on the patient is reduced.
[0054] Although only a few exemplary embodiments of this invention
have been described in detail above, those skilled in the art will
readily appreciate that many modifications are possible without
materially departing from the novel teachings and advantages of
this invention. Accordingly, all such modification are intended to
be included within the scope of this invention as defined in the
following claims.
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