U.S. patent application number 10/972094 was filed with the patent office on 2005-03-10 for poke-through tool.
This patent application is currently assigned to Cardica, Inc.. Invention is credited to Bender, Theodore M., Carranza, Jose R., Donohoe, Brendan M., Sherman, Benjamin.
Application Number | 20050055083 10/972094 |
Document ID | / |
Family ID | 33434371 |
Filed Date | 2005-03-10 |
United States Patent
Application |
20050055083 |
Kind Code |
A1 |
Carranza, Jose R. ; et
al. |
March 10, 2005 |
Poke-through tool
Abstract
A system for preparing a graft vessel for anastomosis includes a
poke-through tool held within a functional package. The
pull-through tool may be used to push a blood vessel onto the tines
of an anastomosis device in preparation for an anastomosis
procedure.
Inventors: |
Carranza, Jose R.; (South
San Francisco, CA) ; Donohoe, Brendan M.; (San
Francisco, CA) ; Bender, Theodore M.; (San Francisco,
CA) ; Sherman, Benjamin; (Milpitas, CA) |
Correspondence
Address: |
Brian A. Schar
Chief Patent Counsel
Cardica, Inc.
900 Saginaw Drive
Redwood City
CA
94063
US
|
Assignee: |
Cardica, Inc.
|
Family ID: |
33434371 |
Appl. No.: |
10/972094 |
Filed: |
October 22, 2004 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
10972094 |
Oct 22, 2004 |
|
|
|
10055179 |
Jan 23, 2002 |
|
|
|
6821286 |
|
|
|
|
Current U.S.
Class: |
623/1.23 |
Current CPC
Class: |
A61B 2050/0065 20160201;
A61B 50/30 20160201; A61B 17/29 20130101; A61B 2050/3008 20160201;
A61B 2017/1107 20130101; A61B 2017/00778 20130101; A61B 17/2833
20130101; A61B 50/33 20160201; A61B 17/068 20130101; A61B 17/0644
20130101; A61B 2017/0641 20130101 |
Class at
Publication: |
623/001.23 |
International
Class: |
A61F 002/06 |
Claims
What is claimed is:
1. A poke-through tool, comprising: a housing with an opening
therein; and at least one membrane connected to said housing, said
membrane accessible through said opening.
2. The poke-through tool of claim 1, further comprising at least
one slider extending from said housing.
3. The poke-through tool of claim 1, wherein at least one said
membrane is composed of polyester film.
4. The poke-through tool of claim 1, wherein at least one said
membrane is substantially circular.
5. The poke-through tool of claim 1, wherein at least one said
membrane is substantially 1 mil thick.
6. The poke-through tool of claim 1, wherein said housing comprises
a shoulder, and wherein at least one said membrane is connected to
said shoulder.
7. The poke-through tool of claim 1, wherein said housing is
substantially cylindrical, and said opening is located at an end of
said housing.
8. The poke-through tool of claim 1, further comprising at least
one slider extending from said housing.
9. A poke-through tool for use with a graft vessel and an
anastomosis device, comprising: a tensioning member; and at least
one membrane positioned against said tensioning member; wherein
said tensioning member is movable relative to the anastomosis
device to push the graft vessel onto the anastomosis device.
10. The poke-through tool of claim 9, further comprising a post
positioned substantially along the longitudinal centerline of said
tensioning member, wherein said post contacts at least one said
membrane.
11. The poke-through tool of claim 9, wherein said tensioning
member includes a drum, a base, and at least one spring member
connecting said drum to said base.
12. The poke-through tool of claim 11, further comprising a housing
connected to said base at a first location and connected to at
least one said membrane at a second location distal to said first
location.
13. The poke-through tool of claim 12, wherein at least one spring
member exerts a force in the distal direction on at least one said
membrane, whereby at least one said membrane is tensioned.
14. The poke-through tool of claim 9, wherein at least one said
membrane is composed of polyester film.
15. A system for handling a graft vessel, comprising: an
anastomosis device including a plurality of tines; and a
poke-through tool movable relative to said anastomosis device to
push the graft vessel onto said tines.
16. The system of claim 15, wherein said poke-through tool includes
at least one membrane penetrable by at least one said tine.
17. The system of claim 16, wherein said poke-through tool includes
a housing having an opening therein configured to receive said
anastomosis device; and wherein at least one said membrane is fixed
to said housing.
18. The system of claim 15, wherein said anastomosis device and
said poke-through tool are substantially coaxial.
19. The system of claim 15, further comprising a tray with a
channel defined therein; wherein said poke-through tool is movable
along said channel.
20. The system of claim 19, wherein said poke-through tool includes
at least one slider configured to engage said channel.
Description
[0001] This application is a continuation of U.S. patent
application Ser. No. 10/055,179, filed on Jan. 23, 2002, which is
incorporated by reference in its entirety.
FIELD OF THE INVENTION
[0002] The present invention relates generally to anastomosis, and
more particularly to a set of tools and a functional package for
preparing a graft vessel for anastomosis.
BACKGROUND
[0003] Anastomosis is a procedure where two separate tubular or
hollow organs are surgically grafted together to form a continuous
fluid channel between them. Vascular anastomosis involves creating
an anastomosis between blood vessels to create or restore blood
flow. When a patient suffers from coronary artery disease (CAD), an
occlusion or stenosis in a coronary artery restricts blood flow to
the heart muscle. In order to treat CAD, the area where the
occlusion occurs is bypassed to reroute blood flow by grafting a
vessel in the form of a harvested artery or vein, or a prosthesis.
Anastomosis is performed between a graft vessel and two target
vessels in order to bypass the blocked coronary artery, circumvent
the occlusion and restore adequate blood flow to the heart muscle.
This treatment is known as a coronary artery bypass graft procedure
(CABG).
[0004] In a CABG procedure, a graft vessel such as a saphenous
vein, mammary artery, radial artery or other blood vessel is
harvested from the patient or another source, then placed in a bowl
or other container and immersed in saline, blood or other
biocompatible liquid. Before that graft vessel is connected to the
target vessels, it may be prepared in some way, such as by
connecting it to an anastomosis device and/or a tool for applying
the anastomosis device. The graft vessel is typically connected to
the anastomosis device and/or tool manually by one or more people
in the operating room, using forceps, tweezers and/or other tools.
Substantial skill is required to connect the slippery graft vessel
to the anastomosis device and/or tool without damaging the graft
vessel or otherwise rendering it unusable.
SUMMARY
[0005] A system for preparing a graft vessel for anastomosis
includes one or more tools held within a functional package.
[0006] In one aspect of the invention, a functional package
includes a tray having multiple recesses. The package can be
sealed, and sterilized along with its contents. The recesses are
used to hold one or more tools for preparing a graft vessel for
anastomosis. The tray includes one or more recesses or other
features molded into it that allow for storing a graft vessel in a
biocompatible fluid such as blood or saline solution, for moving
one or more tools relative to one another, or for performing other
functions that would otherwise be handled by additional tools,
trays, bowls or other items. Thus, the package reduces waste and
operating room clutter.
[0007] In another aspect of the invention, an assembly for
receiving a vein graft is held in a recess in the package. The
assembly includes a crown, an anastomotic device that is connected
to one end of the crown, and an expander tube within the crown. The
crown may be connected to a cartridge or other structure. The
package holds the crown snugly, which in turn holds the expander
tube. The package holds the assembly while a graft vessel is loaded
onto it.
[0008] In another aspect of the invention, a pull-through tool
includes a handle connected to a tension member. The handle is held
in a recess in the package, and the tension member is prepositioned
within and slidable through the crown. At least one grasping
element is connected to the tension member. When the tension member
is in a first position, at least one grasping element is configured
to receive an end of a graft vessel. When the tension member is
moved to a second position, at least one grasping element is
configured to compress or puncture the end of the graft vessel,
thereby holding the graft vessel. The tension member is pulled into
one end of the expander and crown, carrying the graft vessel with
it. After a preselected length of the graft vessel has been pulled
out of the other end of the crown, the graft vessel is cut to
release it from the grasping element or elements. The pull-through
tool thus allows for simple loading of a graft vessel through the
crown and expander tubes and onto the anastomotic device.
[0009] In another aspect of the invention, a detachable eversion
shield is held in the package, covering at least part of the
anastomotic device. The anastomotic device includes barbs or sharp
tips, which are covered by the eversion shield to provide a
substantially continuous smooth surface onto which an end of the
graft vessel can be everted. The eversion shield is then removed
from the crown.
[0010] In another aspect of the invention, a poke-through tool is
held in a recess in the package. The poke-through tool includes a
membrane through which tines or sharp tips of the anastomotic
device can penetrate, such that contact between the membrane and
the end of the graft vessel pushes the graft vessel down onto the
tines to fully engage them, thereby preparing the graft vessel for
deployment. A channel in the package may be configured to receive a
portion of the poke-through tool and guide the travel of the
poke-through tool relative to the crown. The channel substantially
prevents rotation of the poke-through tool during its translation
relative to the anastomotic device, and is positioned such that
motion of the poke-through tool along the entire length of the
channel ensures that the poke-through tool has pushed the graft
vessel onto the tines of the anastomosis device. Thus, the channel
provides for better control of the poke-through tool. The
poke-through tool also may be used to release the eversion shield
from the anastomosis device.
[0011] In another aspect of the invention, the prepared graft
vessel is immersed in a biocompatible fluid, such as saline
solution or blood, within a recess in the tray. This may be the
same recess in which the crown, expander tube and anastomosis
device were originally held, or another recess in the tray. The
graft vessel is then available for use in an anastomosis tool or
other device as needed. By using the package to immerse and hold
the prepared graft vessel, the preparation process is simplified,
and the number of fluid containers used is reduced.
[0012] In another aspect of the invention, an anastomosis tool is
held in a recess in the package. After the graft vessel has been
prepared, the assembly is removed from the package and the crown,
expander tube and graft vessel are inserted into an appropriate
passage within the anastomosis tool. A removable guide may be held
in the integrated anastomosis tool to facilitate insertion of the
crown, expander tube and graft vessel, and is removed after the
anastomosis tool has received at least a portion of the crown,
expander tube and graft vessel.
BRIEF DESCRIPTION OF THE DRAWINGS
[0013] FIG. 1 is an expanded view of the components of a functional
package.
[0014] FIG. 2 is a perspective view of a tray that is a component
of the functional package of FIG. 1.
[0015] FIG. 3 is a perspective view of the tray of FIG. 2 in which
a pull-through tool is held in a recess in the tray.
[0016] FIG. 4 is a perspective view of an outer shell that is a
component of the functional package of FIG. 1.
[0017] FIG. 5 is a perspective view of the pull-through tool.
[0018] FIG. 6 is a top view of the pull-through tool.
[0019] FIG. 7 is a perspective view of the tray of FIG. 2 in which
a number of components are held.
[0020] FIG. 8 is a side view of an assembly including a crown and
an anastomosis device.
[0021] FIG. 9 is a top view of a stop clip that is detachably
connectable to the tray.
[0022] FIG. 10 is a side cross-section view of the stop clip of
FIG. 9.
[0023] FIG. 11 is a perspective view of an eversion shield.
[0024] FIG. 12 is a different perspective view of the eversion
shield of FIG. 11.
[0025] FIG. 13 is a perspective view of an alternate eversion
shield.
[0026] FIG. 14 is a perspective view of the eversion shield of FIG.
13 covering an anastomosis device.
[0027] FIG. 15 is a perspective view of the eversion shield of FIG.
13 illustrating the eversion of a graft vessel over the eversion
shield.
[0028] FIG. 16 is a cutaway exploded view of the poke-through
tool.
[0029] FIG. 17 is a side view of the poke-through tool.
[0030] FIG. 18 is a perspective view of the graft vessel relative
to the anastomosis device after the poke-through tool has pushed
the graft vessel through the tines of the anastomosis device.
[0031] FIG. 19 is a perspective view of the eversion shield of FIG.
13 after the poke-through tool has split it for removal.
[0032] FIG. 20 is a perspective view of an anastomosis tool and a
guide used therewith.
[0033] FIG. 21 is a perspective view of the guide of FIG. 20.
[0034] The use of the same reference symbols in different figures
indicates similar or identical items.
DETAILED DESCRIPTION
[0035] Referring to FIG. 1, a functional package 2 for preparing a
graft vessel for anastomosis is shown. The system includes a tray
4, a tray top 6, an outer shell 8, a cover 10 and an exterior box
12. Referring also to FIGS. 2-3, the tray 4 is shown in greater
detail. The tray 4 is constructed from vacuum-formed plastic or
other biocompatible material. The tray 4 need not be vacuum-formed,
and may be constructed in a different way if desired. A lip 24
extends outward at least partly around the perimeter of the tray 4.
The lip 24 is substantially horizontal. Alternately, the lip 24 may
be oriented differently in whole or in part. For example, the lip
24 may be angled relative to the horizontal. Alternately, two or
more separate lips 24 are provided along portions of the perimeter
of the tray 4. The lip 24 extends outward from a ledge 26 that
extends at least partly around the perimeter of the tray 4. The
ledge 26 extends substantially vertically. Alternately, the ledge
26 may be oriented differently in whole or in part. For example,
the ledge 26 may be angled relative to the vertical. Alternately,
two or more separate ledges 26 are provided along portions of the
perimeter of the tray 4. The ledges 26 extend downward to a surface
27 that is substantially horizontal. The surface 27 may be oriented
differently, if desired. A number of recesses are formed into the
tray 4, recessed relative to the surface 27. These recesses may be
molded into the tray 4, or formed in another way. These recesses
may include a working recess 28, a poke-through tool recess 30, an
anastomosis tool recess 32, and a stabilizing recess 34. The
functions of the recesses 28, 30, 32, 34 are described in greater
detail below.
[0036] Referring back to FIG. 1, the tray top 6 rests on the tray
4, and may be sealed to it. One or more features 40 are formed into
the tray top 6 to provide clearance for tools held in the tray 4.
The features 40 may be molded into the tray top 6 or otherwise
formed into the tray top 6. The tray top 6 assists in restraining
the tools held in the tray and protecting them from contamination.
One or more lips 36 extend outward from the perimeter of the tray
top 6. The lip 36 of the tray top 6 is constructed to correspond
with the lip 24 of the tray. Thus, if the lip 24 of the tray 4 is
substantially horizontal, then the lip 36 of the tray top 6 is
substantially horizontal. When the tray top 6 is placed on the tray
4, the lip 36 of the tray top 6 contacts the lip 24 of the tray
4.
[0037] Referring also to FIG. 4, the outer shell 8 is substantially
rectangular, and a protrusion 36 is provided at or near each corner
of the outer shell 8. Alternately, the outer shell 8 is shaped
differently. Alternately, the protrusions 36 may be located in less
than all corners of the outer shell 8, or in different positions in
the outer shell 8. The protrusions 36 extend into an open space
within the outer shell 8. Each protrusion 36 includes a depression
37 shaped to correspond to the shape of the lip 24 at each
corresponding corner of the tray 4. The lip 24 of the tray 4 rests
on one or more of the depressions 37. By holding the tray 4 at each
of its corners, the tray 4 is supported and stabilized relative to
the outer shell 8. The depressions 37 substantially prevent lateral
motion of the lip 24 of the tray 4 relative to the outer shell 8.
Alternately, the tray 4 may be held more securely at one or more of
the depressions 37, such as by the use of clips, friction fitting,
adhesive, or other structures, mechanisms or methods. Alternately,
other or additional features may be provided in the inner surface
of the outer shell 8 to hold the tray 4. The lip 36 of the tray top
6 is placed on the lip 24 of the tray 4, and is held in place by
the depressions 37 in the same manner as the lip 24 of the tray 4.
The depressions 37 are sized to receive and hold both lips 24,
36.
[0038] One or more ridges 38 may be defined in the outer shell 8 in
addition to the protrusions 36. If so, the lip 24 of the tray 4 may
rest on the ridge or ridges 38 as well. Optionally, dimples (not
shown) may be provided in a wall 41 of the outer shell 8 above the
ridge or ridges 38. The lower surface of each dimple is positioned
above a corresponding ridge 38 a distance substantially equal to
the thickness of the lip 24 of the tray 4, in order to retain the
tray 4 more securely within the outer shell 8. Thus, the tray 4 is
snapped into place in the outer shell 8 over the dimples.
Alternately, each dimple is positioned above a corresponding ridge
38 a distance substantially equal to the combined thickness of the
lip 24 of the tray 4 and the lip 36 of the tray top 6, in order to
retain both the tray 4 and the tray top 6 more securely.
[0039] The cover 10 is bonded to the outer shell 8, such that the
cover 10 seals the interior of the outer shell 8. The outer shell 8
may include a lip 43 extending outward from its perimeter, such
that the cover 10 is sealed to the surface of the lip 43. The cover
10 may be fabricated out of TYVEK.RTM. brand protective material, a
breathable, paper-thin material fabricated from olefin fibers. A
different material capable of sealing the outer shell 8 may be used
instead. The cover 10 is sealed to the outer shell 8 in such a way
as to allow sterility to be maintained within the outer shell 8.
Thus, the combination of the outer shell 8 and the cover 10 protect
the tray 4 and tray top 6, allow them and the tools held within
them to be sterilized and to remain sterile during storage, and
provide a sterile interior even when the outer shell 8 is placed on
a non-sterile surface.
[0040] The outer shell 8 and cover 10 may be placed in the exterior
box 12. The exterior box 12 protects the outer shell 8 and cover 10
from outside elements during storage and during transportation to
the surgery location. The exterior box 12 may be constructed from
any material. The entire functional package 2 and its contents are
sterilizable through the exterior box 12.
[0041] To begin preparation of a graft vessel for anastomosis, the
exterior box 12 is opened, and the outer shell 8 and the cover 10
are slid out of it. The outer shell 8 is placed upon a table or
other surface in an operating room. The cover 10 is then removed
from the outer shell 8. The tray 4 and tray top 6 then may be moved
into the sterile field and the exterior box 12 and the cover 10 may
be discarded. The tray top 6 is then removed and set aside or
discarded, and the tray 4 is moved to a surgical table or other
area near the patient. The tray 4 and the tools within are then
exposed and available for use.
[0042] The tray 4 is placed on a substantially flat surface such as
a tabletop. The recesses 28, 30, 32 are shaped and positioned such
that they rest on that substantially flat surface. When saline
solution, blood or other biocompatible fluid is introduced into
those recesses 28, 30, 32, the weight of that fluid holds the tray
4 against that surface. One or more stabilizing recesses 34
additionally may be provided in the tray 4. The stabilizing
recesses 34 receive saline solution or other biocompatible fluid as
well, such that the weight of that fluid holds the stabilizing
recess 34 down and provides additional stability to the tray 4.
Alternately, one or more of the recesses 28, 30, 32 do not contact
the surface on which the tray 4 is placed. Alternately, none of the
recesses 28, 30, 32 contact the surface on which the tray 4 is
placed, and the tray 4 is stabilized solely by the use of
stabilizing recesses 34. A graft vessel storage recess 42
optionally may be provided in the tray 4. Biocompatible fluid such
as blood or saline is placed in the graft vessel storage recess 42,
and the graft vessel for use in the anastomosis procedure is placed
in that fluid in the graft vessel storage recess 42 until the
appropriate time for preparing it. Alternately, where at least one
stabilizing recess 34 is provided, a stabilizing recess 34 is used
for storing the graft vessel before its preparation.
[0043] Referring to FIGS. 3, 5 and 6, a pull-through tool 44 rests
within the working recess 28 before it is used. The pull-through
tool 44 may be interference-fit to the working recess 28 to
substantially prevent its movement relative to the tray 4.
Alternately, the pull-through tool 44 is loosely fit within the
working recess 28. Alternately, the tray top 6 is shaped to
restrain the pull-through tool 44 within the working recess 28.
[0044] The pull-through tool 44 includes a handle 48 connected to a
tube 50, through which at least one tension member 52 extends. The
handle 48 includes two flexible members 54. The members 54 are
connected to one another, directly or indirectly, at the proximal
end and the distal end of the handle 48. The members 54 may be
connected to one another at different or at additional locations.
The flexibility of each member 54 of the handle 48 may be provided
by one or more living hinges 56 that connect segments 57 of each
member 54. Each segment 57 may be a thin, substantially rectangular
structure. Alternately, the segments 57 may be shaped differently.
The handle 48 is injection-molded plastic, such that the living
hinges 56 are sufficiently strong and flexible to allow the members
54 to flex. The handle 48 may be constructed in a different manner
or from a different material, if desired. Alternately, the handle
48 may be constructed from a compliant material, or made flexible
in another manner. One or more segments 57 may include a grip 55
configured to be held by an operator. Each grip 55 is a structure
curved to fit a human finger or thumb. Alternately, the grips 55
may be shaped differently.
[0045] The distal end of the handle 48 includes a collar 58
connected to and coaxial with the tube 50. Alternately, the collar
58 is located at a position on the handle other than its distal
end. The members 54 may be connected to each other at their distal
ends through connection with the collar 58. The tube 50 is also
hollow, having a lumen therethrough. A lumen extends through the
tube 50 and the collar 58. Alternately, the collar 58 is not used,
and a hole or other passage is defined through the distal end of
the handle 48 at or near the distal intersection of the members 54.
The tube 50 is fixed to the collar 58. Alternately, the tube 50 is
moveable relative to the handle 48. The tube 50 is constructed from
a substantially flexible biocompatible material, such as
polyethylene. Alternately, the tube 50 is not substantially
flexible.
[0046] The handle 48 also includes a first arm 70 and a second arm
72, each connected to a different member 54. The arms 70, 72 are
positioned relative to one another such that compression of the
handle 48 moves them closer together. The first arm 70 is connected
to one member 54 of the handle 48. The first arm 70 includes a
ratchet pawl 74 at one end and a release element 76 on its surface.
The ratchet pawl 74 and/or the release element 76 may be provided
on other portions of the first arm 70, if desired. The ratchet pawl
74 is a wedge configured to mate with a corresponding element on
the second arm 72, as described below. The ratchet pawl 74 may take
another shape, if desired. The release element 76 is a protrusion
or other structure connected to or formed into the first arm 70 in
a direction substantially perpendicular to the first arm 70. The
release element 76 may have a different angle relative to the first
arm 70, if desired. The first arm 70 is configured to flex in a
direction substantially perpendicular to the first arm 70, or in a
different direction. The second arm 72 is connected to the other
member 54. The second arm 72 includes one or more recesses 78 into
which the ratchet pawl 74 of the first arm 70 can be received. The
recesses 78 are provided on the underside of the second arm 72.
Alternately, the recesses 78 are provided on a different surface of
the second arm 72. A channel 79 extends substantially through the
center of the second arm 72, providing a space through which the
release element 76 can pass when the handle 48 is compressed.
Alternately, the channel 79 is offset within the second arm 72. The
recesses 78 are located on both sides of the channel 79, such that
the ratchet pawl 74 can engage recesses 78 on both sides of the
channel 79. Alternately, the channel 79 is not provided, where the
release element 76 has a different configuration or is not used, or
where the arms 70, 72 are configured differently.
[0047] Two tension members 52 are utilized. Alternately, a single
tension member 52 is provided, having a split distal end including
two or more grasping elements 60. Alternately, three or more
tension members 52 may be used. Each tension member 52 is a wire
constructed from stainless steel or other biocompatible material.
Alternately, each tension member 52 may be constructed from a
different material, or take a form other than a wire, such as a
loop. The tension members 52 extend through the lumen of the tube
50. The proximal end of each tension member 52 is connected to the
proximal end of the handle 48. The proximal end of the handle 48
may include a stud 66 to which the proximal end of each tension
member 52 is fixed. More than one stud 66 may be provided, such
that each tension member 52 is connected to a separate stud 66. The
distal end of each tension member 52 extends out of the distal end
of the tube 50. The distal ends of the tension members 52 are
angled relative to the axis of the tube 50. A grasping element 60
is located at the distal end of each tension member 52.
Alternately, the grasping element 60 is connected to a different
location on the tension member 52. The distal end of each tension
member 52 is bent to form the grasping element 60. A separate
grasping element 60 may instead be connected to the distal end of
each tension member 52. The grasping element 60 of each tension
member 52 is oriented inward, toward the axis of the tube 50.
Alternately, the grasping element 60 may be oriented at least
partly in a different direction. One or more positioners 80 may be
included on or connected to the tension members 52, each contacting
and slidable relative to the inner surface of the tube 50, to
facilitate motion of the tension members 52 through the tube
50.
[0048] Referring also to FIGS. 7-8, an assembly 94 includes a
cartridge 62, a crown 96, and an anastomosis device 98. An expander
tube (not shown) is also included in the assembly 94, and is
located partly within and coaxial with the crown 96, and partly
within and coaxial with the anastomosis device 98. The crown 96 is
a tube having two ends. One end of the crown 96 is slidably
connected to the cartridge 62. The cartridge 62 is a component of
an anastomosis tool 64 that is held in the anastomosis tool recess
32 of the tray 4. The cartridge 62 and the crown 96 may be a single
piece that is molded or otherwise formed together. The crown 96 may
extend through the entire cartridge 62, through part of the
cartridge 62, or none of the cartridge 62. The cartridge 62
includes a lumen defined therethrough to receive the crown 96, the
expander tube, and the tube 50 of the pull-through tool 44. The
anastomosis device 98 is connected to the other end of the crown
96. This connection may be made by any structure, mechanism or
method. The assembly 94 is held in a portion of the working recess
28. Alternately, a separate recess may be provided for the assembly
94. The assembly 94 may be friction-fit to the working recess 28 to
substantially prevent its movement relative to the tray 4.
Alternately, the assembly 94 is loosely fit within the working
recess 28. Alternately, the tray top 6 is shaped to restrain the
assembly 94 within the working recess 28. The assembly 94 is held
in the tray 4 such that the tube 50 of the pull-through tool 44
extends into the expander tube within the crown 96 and out of the
end of the cartridge 62 opposite to the crown 96. The working
recess 28 is shaped to align the pull-through tool 44 and the
assembly 94 such that the tube 50 can extend into the expander tube
within the crown 96 while both are held in the tray 4.
[0049] Referring to FIGS. 7-10, a stop clip 82 is detachably
connected to the tray 4. The stop clip 82 is pressure-fit into a
depression 84 in the tray 4. However, the stop clip 82 may be
connected to the tray 4 in another way. As one example, the stop
clip 82 may be fixed to the tray 4, as with adhesive, or by molding
the stop clip 82 and the tray 4 as a unit. The stop clip 82
includes a flange 86 that is fit against the surface of the tray 4
when the stop clip 82 is connected to the tray 4. The flange 86 may
be omitted, if desired. The stop clip 82 includes a guide 88 that
is wide enough to receive the tube 50 of the pull-through tool 44.
The tube 50 may extend within the guide 88 while the pull-through
tool 44 is held in the tray 4. Alternately, the guide 88 is above
the tube 50 while the pull-through tool 44 is held in the tray 4.
The guide 88 is sloped upward in the direction toward the handle 48
of the pull-through tool 44, and may widen in that direction as
well. The stop clip 82 may also include two depressions 90, one on
each side of the guide 88, where the guide 88 extends upward
relative to the bottom surface of each depression 90.
[0050] The pull-through tool 44 is moveable between a neutral
configuration, in which the grasping elements 60 are separated from
one another to receive a graft vessel, and an engaged
configuration, in which the grasping elements 60 have moved
together to engage the graft vessel. Initially, the pull-through
tool 44 is in the neutral configuration as shown in FIG. 5. To
operate the pull-through tool 44, a graft vessel 92 is removed from
the graft vessel storage recess 42 of the tray 4 or otherwise
obtained. The graft vessel 92 may be a vein graft such as a
saphenous vein or a radial artery, as commonly used during a CABG
procedure. However, the graft vessel 92 may be a tubular vessel
other than one from the vasculature, and may be used in a surgery
other than a CABG procedure. Advantageously, the end of the graft
vessel 92 to be engaged by the pull-through tool 44 is cut at an
angle on two opposite sides, in order to taper the graft vessel and
facilitate its passage through the crown 96. The end of the graft
vessel 92 may instead be cut substantially to its axis, or may not
be cut at all. That end of the graft vessel 92 is held between the
vein-grabbing elements 60 of the tension members 52 with forceps,
by hand, or with a different tool. The operator of the pull-through
tool 44 then begins to squeeze the handle 48. As the handle 48 is
squeezed, the arms 70, 72 approach one another. Additionally, as
the handle 48 is squeezed, the members 54 of the handle move closer
to one another, and the length of the handle 48 increases. The
proximal end of each tension member 52 is fixed to the proximal end
of the handle 48, and the tension members 52 are slidable relative
to the tube 50. As a result, the proximal end of the handle 48
pulls the tension members 52 proximally relative to the collar 58.
Because the tube 50 is fixed to the collar 58, the tension members
52 thus move proximally relative to the tube 50 as well. The distal
ends of the tension members 52 are angled relative to the axis of
the tube 50. Thus, as the tension members 52 move proximally, they
move into the tube 50, and contact between the angled distal ends
of the tension members 52 and the tube 50 causes the tension
members 52 to move closer to one another. Consequently, the
grasping elements 60 move closer to one another.
[0051] Referring as well to FIG. 5A, as the handle 48 continues to
be squeezed, the distance between the grasping elements 60
continues to decrease, and they engage the graft vessel 92 by
penetrating it. Alternately, the grasping elements 60 may be
configured to capture the graft vessel 92 without piercing or
penetrating it. The arms 70, 72 are configured such that the
ratchet pawl 74 of the first arm 70 encounters at least one recess
78 of the second arm 72 after the grasping elements 60 have moved
to a position in which they are holding the graft vessel 92. The
recesses 78 may be downwardly-extending spaces between teeth, or
may be shaped differently. The first arm 70 is moveable in a
direction perpendicular to its direction of motion toward the
second arm 72, such that the ratchet pawl 74 can be deflected
downward as the ratchet pawl 74 moves toward a recess 78, then
deflect upward into a recess 78. The first arm 70 is configured to
bias the ratchet pawl 74 into the recess 78 to secure the ratchet
pawl 74 and recess 78 together when the grasping elements 60 have
engaged the graft vessel. Recesses 78 may be provided at different
distances from the first arm 70, such that the handle 48 can lock
into a selected one of a number of different positions.
[0052] The graft vessel 92 is thus firmly held by the grasping
elements 60 of the pull-through tool 44. The user then begins to
pull the handle 48 of the pull-through tool 44 in a direction away
from the assembly 94. In this way, the pull-through tool 44 begins
to pull the graft vessel 92 through the lumen of the cartridge 62
and the crown 96. In order to pull the pull-through tool 44 in this
direction, the handle 48 is lifted out of the working recess 28.
The guide 88 of the stop clip 82 is shaped to allow the handle 48
to be moved away from the axis of the crown 96, and to control the
motion of the tube 50 through the crown 96 to be substantially
coaxial with the axis of the crown 96. The tube 50 is flexible,
such that it bends based on its contact with the guide 88. The
handle 48 continues to be moved away from the cartridge 62 until a
portion of the graft vessel 92 is pulled out of the crown 96
adjacent to the anastomosis device 98 far enough to allow it to be
cut with a scissors, scalpel or other tool. This cut is made
between the anastomosis device 98 and the grasping members 60,
thereby freeing the graft vessel 92 from the pull-through tool 44.
The pull-through tool 44 and the portion of the graft vessel 92
retained by the grasping members 60 may then be discarded.
[0053] The release element 76 on the first arm 70 of the handle 48
can be used at any time during the operation of the pull-through
tool 44 to release the graft vessel 92. By pressing on the release
element 76, the first arm 70 is moved out of engagement with the
recesses 78 of the second arm 72. The direction in which the
release element 76 is pressed is substantially opposite to the
direction in which the first arm 70 is biased. The handle 48 is
then free to move back to its original, neutral configuration.
Consequently, the tension members 52 move distally relative to the
handle 48, and the grasping elements 60 once again move apart from
one another, freeing the graft vessel 92. As an example of the use
of the release element 76, an operator may utilize the release
element 76 to free the graft vessel 92 if he or she is not
satisfied with the security with which the grasping elements 60
have engaged the graft vessel 92.
[0054] The anastomosis device 98 is positioned at one end of the
crown 96. Referring to FIGS. 7 and 11-12, the anastomosis device 98
may include one or more tines 99 extending outward from it, at
least partially in the direction of the axis of the crown 96. One
or more tines 99 may extend in a different direction, if desired.
An eversion shield 100 is placed over the anastomosis device 98,
covering at least one of the tines 99, to facilitate eversion of
the graft vessel 92. The eversion shield 100 is optional. If the
eversion shield 100 is not used, the graft vessel 92 is everted
over the anastomosis device 98 directly. The eversion shield 100
includes a substantially tubular body 102. The body 102 instead may
be shaped differently. A barrier 104 is located at one end of the
body 102. The barrier 104 is substantially tubular as well. The
barrier 104 substantially encircles the tines 99 on the anastomosis
device 98 and may contact them in whole or in part. The barrier 104
also extends further in the axial direction than the tines 99.
Thus, the barrier 104 substantially covers the tines 99. The
surface of the barrier 104 is substantially smooth, and the end of
the barrier 104 is smoothed and/or finished to ensure that contact
between the barrier 104 and the graft vessel 92 does not damage the
graft vessel. The barrier 104 is open, allowing passage of the
graft vessel 92 through it. The tines 99 are positioned in front of
the anastomosis device 98. Thus, the barrier 104 may have a
different diameter than the body 102 or taper to a narrower
dimension than the body 102 in order to contact and cover the tines
99. Alternately, the barrier 104 may have substantially the same
diameter as the body 102, depending on the configuration of the
anastomosis device 98.
[0055] One or more slots 106 are positioned between the barrier 104
and the body 102. The slots 106 extend in a direction substantially
parallel to the axis of the body 102, and are cut through the
eversion shield 100. Alternately, the slots 106 do not extend
entirely through the eversion shield 100. Alternately, the slots
106 extend in a different direction. The end of the body 102
opposite the barrier 104 may be connected to a secondary body 108
that is wider than the body 102. The secondary body 108 instead may
be formed into the body 102. A tab 110 is connected to the
secondary body 108 at or near the end of the secondary body 108
opposite from the body 102. Alternately, the tab 110 may be
connected to another portion of the secondary body 108 or to the
body 102, as long as its position does not interfere with the
eversion of the graft vessel 92. The tab 110 is sized to be
graspable by a user. The tab 110 may include ribs 112 or other
features to enhance the user's grip upon the tab 110.
[0056] As another example of an eversion shield 100, referring to
FIGS. 13-15, at one end of the eversion shield 100 the barrier 104
is positioned to cover at least one of the tines 99, as described
above. The eversion shield 100 includes a body 102 connected to the
barrier 104. The body 102 is substantially tubular, but may be
shaped differently if desired. One or more slots 106 are cut
through the body 102 in a direction substantially parallel to the
axis of the body 102. The slots 106 may be cut in a different
direction, if desired. At the end of the body 102 opposite from the
barrier 104 is a stop 116. The slots 106 extend substantially as
far as the stop 116. Alternately, the slots 106 do not extend as
far as the stop 116. The stop 116 is a ring having a diameter
larger than the diameter of the body 102. The stop 116 instead may
be shaped differently.
[0057] Referring particularly to FIG. 15, a person utilizes one or
more forceps 118 or other tools to evert the end of the graft
vessel 92 over the barrier 104. Two or more people may work
together to perform the eversion, if desired. The graft vessel 92
is everted across the single substantially smooth end of the
barrier 104 and onto the outer surface of the barrier 104. Eversion
over the smooth end and surface of the barrier 104 is simpler than
eversion over one or more tines 99. Further, the amount of eversion
can be adjusted after the end of the graft vessel has been everted
over the barrier 104, because the graft vessel 92 can slide over
the smooth end of the barrier 104 without being damaged.
[0058] After the graft vessel 92 has been everted over the barrier
104, the eversion shield 100 is removed and the tines 99 are poked
through the graft vessel 92. Referring to FIG. 7, a poke-through
tool 120 is held in the poke-through tool recess 30. Referring also
to FIGS. 16-17, the poke-through tool 120 includes three primary
components: a shell 122, a membrane 126, and a tensioning member
160. The shell 122 has an opening 124 at one end that is large
enough to be slid over the anastomosis device 98. The shell 122
includes a shoulder 125, where the diameter of the shell 122
increases from a first diameter to a second, larger diameter. The
first diameter of the shell 122 is near the opening 124, and the
second diameter is further from the opening 124. The shell 122 may
be shaped differently, such that the shoulder 125 is present at the
location at which the area enclosed by a perpendicular
cross-section of the shell 122 increases. A membrane 126 is
connected to the shell 122 at the shoulder 125. The membrane 126 is
made of polyester film, and is substantially 1 mil (0.001) inches
thick. However, the membrane 126 may be made of any other
appropriate material or combination of materials, and/or have a
different thickness.
[0059] The tensioning member 160 includes a drum 174 connected by
spring members 176 to a base 178. The drum 174 is sized and shaped
to contact the membrane 126, tension it, and hold it in place. The
shoulder 125 includes a substantially circumferential groove 162
defined therein. Alternately, the groove 162 may extend in a
different direction, or multiple, smaller grooves or notches may be
used. A ridge 164 is defined at the end of the drum 174 that
contacts the membrane 126. The ridge 164 is shaped and sized to
correspond to the groove 162, such that axial force applied to the
tensioning member 160 causes the ridge 164 to press a portion of
the membrane 126 into the groove 162, holding it in place and
tensioning it. Thus, the membrane 126 is substantially flat where
the tines 99 contact it. A post 166 is located substantially at the
axial centerline of the tensioning member 160, at the end of the
drum 174 that contacts the membrane 126. A trough 168 at least
partially surrounds the post 166.
[0060] One or more flexures 170 are provided on the base 178 of the
tensioning member 160, configured to engage mating structures 172
defined in the shell 122. Such engagement connects the tensioning
member 160 to the shell 122, and axially compresses the spring
members 176. This axial compression acts against the membrane 126
and the shoulder 125 to hold the membrane 126 in place and tension
it. Other structures, mechanisms or methods than flexures 170 may
be used to connect the tensioning member 160 to the shell 122.
Further, other structures, mechanisms or methods may be used to
exert a substantially axial force on the membrane 126 to hold it in
position and to tension it.
[0061] The poke-through tool 120 also includes one or more sliders
128 extending from the shell 122. Referring also to FIG. 3, the
sliders 128 are sized to fit into and slide within a channel 130
located in the working recess 28. The channel 130 is a
substantially rectangular depression having a substantially
rectangular cross-section in the working recess 28. Alternately,
the channel 130 may have a different shape or cross-section. The
channel 130 has a centerline that is substantially parallel to the
axis of the crown 96. The sliders 128 are sized to place the shell
122 substantially coaxial with the crown 96. Thus, motion of the
poke-through tool 120 along the channel 130 causes the shell 122 to
move substantially coaxially relative to the crown 96. The sliders
128 are curved structures extending from the shell 122, shaped to
substantially prevent lateral movement or angular movement of the
poke-through tool 120 relative to the axis of the crown 96.
Alternately, one slider 128 is used, having a substantially
rectangular shape substantially as wide as the channel 130.
Alternately, the slider or sliders 128 have a different shape. Any
shape or number of sliders 128 may be used that substantially
prevent lateral movement or angular movement of the poke-through
tool 120 relative to the axis of the crown 96.
[0062] In operation, the poke-through tool 120 is removed from the
poke-through tool recess 30. The sliders 128 of the poke-through
tool 120 are placed in the channel 130 in the working recess 28,
with the opening 124 of the shell 122 facing the anastomosis device
98. The poke-through tool 120 is then slid toward the anastomosis
device 98 along the channel 130. The shape of the channel 130 and
its contact with the sliders 128 substantially prevents rotation of
the poke-through tool 120 during its translation relative to the
anastomotic device 98. As the poke-through tool 120 moves toward
the anastomosis device 98, the anastomosis device 98 enters the
opening 124 in the shell 122. The graft vessel 92 has been everted
over the anastomosis device 98, as described above. The membrane
126 contacts the everted graft vessel 92 at a point in the
translation of the poke-through tool 120. The motion of the
membrane 126 forces the graft vessel 92 onto the tines 99, causing
the tines to poke through the graft vessel 92. The tips of the
tines 99 then contact the membrane 126, penetrating it and entering
the trough 168. This penetration may make a sound, providing
auditory confirmation that the tines 99 have pierced the membrane
126. The post 166 supports the membrane 126 against the forces that
result from contact between the tines 99 and the membrane 126. The
poke-through tool 120 continues to translate in the same direction,
such that the membrane 126 pushes the graft vessel 92 down onto the
tines 99 of the anastomosis device 98. The channel 130 is sized and
positioned such that motion of the poke-through tool 120 along the
entire length of the channel ensures that the poke-through tool 120
has pushed the graft vessel onto the tines 99 a preselected amount.
That is, the length of the channel 130 controls the amount of
translation of the poke-through tool 120. The poke-through tool 120
is then moved in the opposite direction along the channel 130, away
from the anastomosis device 98. The end result is shown in FIG. 18,
where the graft vessel 92 has been pushed down onto the tines
99.
[0063] Referring also to FIGS. 11-12, if the eversion shield 100 is
used, the poke-through tool 120 also cooperates with the eversion
shield 100 to release the eversion shield 100 from the crown 96
and/or anastomosis device 98. As the poke-through tool 120 moves
relative to the crown 96, a portion of the poke-through tool 120
contacts the shoulder 107 between the body 102 and the secondary
body 108 of the eversion shield 100. Because the barrier 104 has a
smaller diameter than the shoulder 107, the eversion shield 100
resists motion in the direction of the motion of the poke-through
tool 120. Additionally, the poke-through tool 120 may stress the
shoulder 107 via direct contact. Further attempted motion of the
poke-through tool 120 relative to the eversion shield 100 in the
same direction thus results in a force on the eversion shield 100.
This force results in stress within the eversion shield 100. This
stress acts to extend the slots 106 in the direction toward the
poke-through tool 120 and split one end of each slot 106 open
relative to the end of the eversion shield 100 nearest the
poke-through tool 120. The shape of the slots 106 and the thickness
and composition of the body 102 are selected to result in such
splitting upon this stress. After the slots 106 have split open,
the width of the barrier 104 is no longer a constraint on the
motion of the eversion shield 100, which is free to move relative
to the crown 96, away from the anastomotic device 98. Referring to
FIG. 12, the eversion shield 100 includes a split 109 on one
surface to allow it to be removed from the crown 96 entirely. The
split 109 extends along the body 102 and secondary body 108 of the
eversion shield 100, such that the body 102 and secondary body 108
can flex as the eversion shield 100 is pulled from the crown 96 in
a direction substantially perpendicular to the axis of the crown
96.
[0064] Similarly, the poke-through tool 120 also cooperates with
the eversion shield 100 as shown in FIGS. 13-15. The poke-through
tool 120 encounters the stop 116 as the poke-through tool 120 is
moved toward the anastomosis device 98. Because the barrier 104 has
a smaller diameter than the anastomotic device 98 and the crown 96,
the eversion shield 100 resists motion in the direction of the
motion of the poke-through tool 120. Further attempted motion of
the poke-through tool 120 relative to the eversion shield 100 in
the same direction thus results in a force on the eversion shield
100. This force results in stress within the eversion shield 100.
Referring also to FIG. 19, this stress acts to extend the slots 106
in the direction toward the poke-through tool 120 and split one end
of each slot 106 open relative to the end of the eversion shield
100 nearest the poke-through tool 120. The shape of the slots 106
and the thickness and composition of the eversion shield 100 are
selected to result in such splitting upon this stress. Further, the
shape of the slots 106 is chosen such that fracturing and tear
propagation begins at the end 115 of each slot 106. After the slots
106 have split open, the width of the barrier 104 is no longer a
constraint on the motion of the eversion shield 100. The freed
eversion shield 100 is then pushed behind the everted portion of
the graft vessel 92, away from the anastomotic device 98, such that
individual elements 117 formed by the fracturing of the eversion
shield 100 splay outward at an angle to the axis of the eversion
shield 100. The eversion shield 100 can thus be safely slid forward
over the everted portion of the graft vessel 92, and removed from
the crown 96. Alternately, the eversion shield 100 may be
constructed to be removable from the anastomotic device 98 and/or
the crown 94 without contacting the poke-through tool 120.
Alternately, a tool other than the poke-through tool 120 may be
used to remove the eversion shield 100 from the anastomotic device
98 and/or the crown 94.
[0065] The graft vessel 92 is then ready for an anastomotic
procedure. The pull-through recess 28 is filled with saline or
other biocompatible fluid to a depth such that the prepared graft
vessel 92 held on the assembly 94 is substantially immersed in that
fluid until needed. Thus, the graft vessel 92 can be prepared
before or while a surgeon or other medical professional prepares
the patient and/or performs other tasks preparatory to the
anastomotic surgery. In this way, the tray 4 not only holds a
number of tools 44, 100, 120 used for preparing the graft vessel
92, but also provides a sterile retaining area in which the graft
vessel 92 can be immersed after being prepared. The working recess
28 is deep enough to hold biocompatible fluid up to a level
covering the crown 96 and the prepared graft vessel 92. When the
crown 96 is covered with fluid, the expander tube within is located
below the fluid level as well. Thus, the assembly 94 is held within
the working recess 48 while one or more tools, such as the
pull-through tool 44 and the poke-through tool 120, are moved
relative to and/or interface with the assembly 94 in order to
prepare the graft vessel 92. The assembly 94 and the attached graft
vessel 92 are held within the working recess 48 until the surgeon
is ready to perform anastomosis.
[0066] When the surgeon is ready to perform anastomosis, the
assembly 94 is removed from the biocompatible fluid within the
working recess 28 and connected to the anastomosis tool 64.
Referring to FIG. 20, the anastomosis tool 64 includes a passage
132 therethrough with a diameter large enough to receive the crown
96, expander tube, anastomosis device 98 and graft vessel 92. The
anastomosis tool 64 includes at least one edge 136 for mating with
the cartridge 62, and may include one or more flanges 138. A clip
134 is connected to and detachable from the anastomosis tool 64.
The clip 134 includes an indented feature 139 configured to fit
onto the edge 136. This fit may be a pressure fit. Alternately, the
clip 134 is connected to the edge 136 and/or at least one flange
138, or to another portion of the anastomosis tool 64, in a
different way. Alternately, the indented feature 139 may be
configured to fit onto a different structure on the anastomosis
tool 64.
[0067] The clip 134 includes tabs 140, 142 configured to fit onto
one of the flanges 138. Two tabs 140 fit over the flange 138, and
one tab 142 fits under the flange 138. Structures other than or in
addition to the tabs 140, 142 may be used to connect the clip 134
to at least one flange 138 and/or to another structure. A stop 141
extends upward from the proximal tab 140. The clip 134 includes a
paddle 148 extending away from the anastomosis tool 64. The paddle
148 includes a grip feature 144 that an operator can grasp or
otherwise engage. The paddle 148 may be an indentation, hole, or
other feature. The paddle 148 may also include a passage 146
through which a strap or other retainer (not shown) may be
inserted, in order to reduce the parts count. Alternately, the
passage 146 is not used, and the strap or other retainer passes
through the grip feature 144.
[0068] The clip 134 includes a platform 150 that extends between
the indented feature 139 and the tabs 140, 142. The platform 150
includes an indentation 152. The indentation 152 has an arcuate
cross-section that is aligned with the passage 132 in the
anastomotic tool 64. The indentation 152 is shaped to guide the
crown 96 into the passage 132. Thus, the indentation 152 is shaped
to have a radius of curvature similar to the crown 96. Alternately,
the indentation 152 may have a different shape or radius of
curvature. By sliding the crown 96 along the indentation 152, the
crown 96 is guided into the passage 132. When the cartridge 62
contacts the stop 141 or comes close to contacting the stop 141,
the clip 134 is removed from the anastomosis tool 64, and the
assembly 94 is moved to its final position relative to the
anastomosis tool 64. The tool 64 is then ready for use.
[0069] While the invention has been described in detail, it will be
apparent to one skilled in the art that various changes and
modifications can be made and equivalents employed, without
departing from the present invention. For example, the tools and
functional package described above may be used for surgical
procedures other than CABG procedures, such as peripheral vascular
surgery, neurovascular surgery, or transplant surgery. It is to be
understood that the invention is not limited to the details of
construction and/or the arrangements of components set forth in the
above description or illustrated in the drawings. Therefore, the
invention is not to be restricted or limited except in accordance
with the following claims and their legal equivalents.
* * * * *