U.S. patent application number 11/034473 was filed with the patent office on 2005-06-02 for illuminated and vacuum assisted retractor.
This patent application is currently assigned to Ethicon, Inc.. Invention is credited to Douglas, Peter, Gordon, Daniel.
Application Number | 20050119530 11/034473 |
Document ID | / |
Family ID | 32593245 |
Filed Date | 2005-06-02 |
United States Patent
Application |
20050119530 |
Kind Code |
A1 |
Douglas, Peter ; et
al. |
June 2, 2005 |
Illuminated and vacuum assisted retractor
Abstract
A retractor including: an extension member having distal and
proximal ends; a retractor member connected to the distal end of
the extension member, the retractor member having a retractor
surface. In a first implementation, at least a portion of the
retractor surface has a distal vacuum port for positively retaining
the tissue upon application of a vacuum to the vacuum port. In an
alternative implementation, the retractor has an illuminator for
transmitting light into an interior of the body proximate to the
tissue.
Inventors: |
Douglas, Peter; (New
Milford, NJ) ; Gordon, Daniel; (Newtown, PA) |
Correspondence
Address: |
SCULLY SCOTT MURPHY & PRESSER, PC
400 GARDEN CITY PLAZA
SUITE 300
GARDEN CITY
NY
11530
US
|
Assignee: |
Ethicon, Inc.
Somerville
NJ
|
Family ID: |
32593245 |
Appl. No.: |
11/034473 |
Filed: |
January 13, 2005 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
11034473 |
Jan 13, 2005 |
|
|
|
10323540 |
Dec 19, 2002 |
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Current U.S.
Class: |
600/212 |
Current CPC
Class: |
A61B 1/07 20130101; A61B
1/32 20130101; A61B 17/0218 20130101; A61B 2017/00243 20130101;
A61B 2017/00561 20130101; A61B 90/30 20160201 |
Class at
Publication: |
600/212 |
International
Class: |
A61B 001/32 |
Claims
1-23. (canceled)
24. A retractor comprising: an extension member having distal and
proximal ends; a retractor member connected to the distal end of
the extension member, the retractor member having an upper and
lower retractor surface; and a distal vacuum port formed into at
least a portion of the upper retractor surface for positively
retaining tissue to be retracted upon application of a vacuum to
the distal vacuum port.
25. The retractor of claim 24, wherein the extension member is a
tubular member having an internal lumen extending from the proximal
end to the distal end.
26. The retractor of claim 25, wherein the retractor member has an
internal conduit in fluid cooperation with both the internal lumen
and distal vacuum port, wherein vacuum applied to the proximal end
of the extension member is applied to the distal vacuum port
through the internal lumen and internal conduit.
27. The retractor of claim 26, further comprising a handle disposed
at the proximal end of the extension member, the handle having a
proximal vacuum port in fluid communication with the proximal end
of the internal lumen.
28. The retractor of claim 24, wherein the retractor member is a
curved blade having a convex surface and a concave surface, wherein
the distal vacuum port is at least partially formed in the convex
surface.
29. The retractor of claim 25, wherein the distal end of the
extension member has a male threaded portion and the retractor
member has a female threaded portion threadingly engaging the male
threaded portion of the extension member.
30. The retractor of claim 24, further comprising illumination
means for transmitting light into an interior of a body cavity
proximate to the tissue.
31. The retractor of claim 30, wherein the illumination means
comprises the retractor member having at least a portion fabricated
from a light transmitting material and light guide means for
directing light to the light transmitting material.
32. The retractor of claim 31, wherein the extension member is a
tubular member having an internal lumen extending from the proximal
end to the distal end, wherein a light fiber is disposed in the
internal lumen for directing the light to the light transmitting
material.
33. The retractor of claim 32, further comprising a light pipe
molded at least partially into the concave surface of the retractor
member for directing the light received from the light guide means
to the interior of the body cavity.
34. The retractor of claim 33, wherein the light pipe further
comprises lenses molded into the concave surface for directing the
light at an angle relative to the concave surface.
35. The retractor of claim 34, wherein the angle of the lenses
varies according to a surgical procedure performed with the
retractor.
36. The retractor of claim 31, wherein the retractor member is
comprised of transparent materials at least a portion of which is
the light transmitting material.
37. The retractor of claim 32, wherein the retractor member is a
curved blade, the curved blade having a convex surface and a
concave surface, wherein the distal vacuum port is formed at least
partially on the convex surface and the light transmitting material
is at least partially formed in the concave surface.
38. The retractor of claim 24, further comprising a flexible tube
connected to the retractor member and to an external vacuum source
to provide the vacuum to the distal vacuum port.
39. A retractor comprising: an extension member having a distal end
and a proximal end; a retractor member connected to the distal end
of the extension member and having a retractor surface configured
as a curved blade, the curved blade having an upper convex surface
and a lower concave surface; and illumination means for
transmitting light into an interior of a body cavity proximate to
tissue being retracted, wherein the illumination means transmits
light from the lower concave surface.
40. The retractor of claim 39, wherein at least a portion of the
retractor surface has a distal vacuum port for positively retaining
the tissue upon application of a vacuum to the vacuum port.
41. The retractor of claim 40, wherein the extension member is a
tubular member having an internal lumen extending from the proximal
end to the distal end.
42. The retractor of claim 41, wherein the retractor member has an
internal conduit in fluid cooperation with both the internal lumen
and the distal vacuum port, wherein vacuum applied to the proximal
end of the extension member is applied to the distal vacuum port
through the internal lumen and internal conduit.
43. The retractor of claim 40, wherein the distal vacuum port is at
least partially formed in the convex surface.
44. The retractor of claim 39, wherein the distal end of the
extension member has a male threaded portion and the retractor
member has a female threaded portion corresponding and threadingly
engaging the male threaded portion of the extension member.
45. The retractor of claim 39, wherein the illumination means
comprises the retractor member having at least a portion fabricated
from a light transmitting material and light guide means for
directing the light to the light transmitting material.
46. The retractor of claim 45, wherein the extension member is a
tubular member having an internal lumen extending from the proximal
end to the distal end, wherein a light fiber is disposed in the
internal lumen for directing the light to the light transmitting
material.
47. The retractor of claim 46 further comprising a handle disposed
at the proximal end of the extension member, the handle having a
light guide connector in optical communication with the light fiber
in the internal lumen.
48. A method for retracting tissue for accessing a surgical site
within a body of a patient, the method comprising: engaging an
upper surface of a retractor with tissue to be retracted; retaining
the tissue on the upper surface of the retractor; and providing a
vacuum at the upper surface to positively hold the tissue on the
retractor surface.
49. The method of claim 48, further comprising directing light from
a lower surface of the retractor to illuminate a body cavity
proximate to the retractor.
Description
BACKGROUND OF THE INVENTION
[0001] 1. Field of the Invention
[0002] The present invention relates generally to retractors for
retracting tissue, and more particularly, to an atrial retractor
for use in retracting the heart wall during minimally invasive
heart valve surgery.
[0003] 2. Prior Art
[0004] Various types of surgical procedures are currently performed
to investigate, diagnose, and treat diseases of the heart and the
great vessels of the thorax. Such procedures include repair and
replacement of mitral, aortic, and other heart valves, repair of
atrial and ventricular septal defects, pulmonary thrombectomy,
treatment of aneurysms, electrophysiological mapping and ablation
of the myocardium, and other procedures in which interventional
devices are introduced into the interior of the heart or a great
vessel.
[0005] Many of these procedures require a gross thoracotomy,
usually in the form of a median sternotomy, to gain access into the
patient's thoracic. cavity. A saw or other cutting instrument is
used to cut the stemum longitudinally, allowing two opposing halves
of the anterior or ventral portion of the rib cage to be spread
apart. A large opening into the thoracic cavity is thus created,
through which the surgical team may directly visualize and operate
upon the heart and other thoracic contents.
[0006] Surgical intervention within the heart generally requires
isolation of the heart and coronary blood vessels from the
remainder of the arterial system, and arrest of cardiac function.
Usually, the heart is isolated from the arterial system by
introducing an external aortic cross clamp through a sternotomy and
applying it to the aorta between the brachiocephalic artery and the
coronary ostia. Cardioplegic fluid is then injected into the
coronary arteries, either directly into the coronary ostia or
through a puncture in the aortic root, so as to arrest cardiac
function. In some cases, cardioplegic fluid is injected into the
coronary sinus for retrograde perfusion of the myocardium. The
patient is placed on cardiopulmonary bypass to maintain peripheral
circulation of oxygenated blood.
[0007] Of particular interest to the present invention are
intracardiac procedures for surgical treatment of heart valves,
especially the mitral and aortic valves. Various surgical
techniques may be used to repair a diseased or damaged valve,
including annuloplasty (contracting the valve annulus),
quadrangular resection (narrowing the valve leaflets),
commissurotomy (cutting the valve commissures to separate the valve
leaflets), shortening mitral or tricuspid valve chordae tendonae,
reattachment of severed mitral or tricuspid valve chordae tendonae
or papillary muscle tissue, and decalcification of valve and
annulus tissue. Alternatively, the valve may be replaced, by
excising the valve leaflets of the natural valve, and securing a
replacement valve in the valve position, usually by suturing the
replacement valve to the natural valve annulus. Various types of
replacement valves are in current use, including mechanical and
biological prostheses, homografts, and allografts.
[0008] The mitral valve, located between the left atrium and left
ventricle of the heart, is most easily reached through the wall of
the left atrium, which normally resides on the posterior side of
the heart, opposite the side of the heart that is exposed by a
median stemotomy. Therefore, to access the mitral valve via a
sternotomy, the heart is rotated to bring the left atrium into an
anterior position accessible through the stemotomy. An opening, or
atriotomy, is then made in the right side of the left atrium,
anterior to the right pulmonary veins. The atriotomy is retracted
by means of sutures or retraction devices, exposing the mitral
valve directly posterior to the atriotomy. One of the
aforementioned techniques may then be used to repair or replace the
valve.
[0009] An alternative technique for mitral valve access may be used
when a median sternotomy and/or rotational manipulation of the
heart are undesirable. In this technique, a large incision is made
in the right lateral side of the chest, usually in the region of
the fourth intercostal space. One or more ribs may be removed from
the patient, and other ribs near the incision are retracted outward
to create a large opening into the thoracic cavity. The left atrium
is then exposed on the posterior side of the heart, and an
atriotomy is formed in the wall of the left atrium, through which
the mitral valve may be accessed for repair or replacement.
[0010] Using such open-chest techniques, the large opening provided
by a median sternotomy which enables the surgeon to see the mitral
valve directly through the left atriotomy, and to position his or
her hands within the thoracic cavity in close proximity to the
exterior of the heart for manipulation of surgical instruments,
removal of excised tissue, and/or introduction of a replacement
valve through the atriotomy for attachment within the heart.
However, these invasive, open-chest procedures produce a high
degree of trauma, a significant risk of complications, an extended
hospital stay, and a painful recovery period for the patient.
Moreover, while heart valve surgery produces beneficial results for
many patients, numerous others who might benefit from such surgery
are unable or unwilling to undergo the trauma and risks of current
techniques.
[0011] In response to the various problems associated with
open-chest procedures, new methods of performing closed-chest
surgery on the heart using minimally invasive thoracoscopic
techniques have been recently developed. In these methods, the
patient's heart is arrested by occluding the patient's aorta
between the coronary arteries and the brachiocephalic artery with
an expandable balloon on the distal end of an endovascular catheter
introduced via a femoral artery. Cardioplegic fluid is then
delivered to the patient's myocardium through a lumen in the same
catheter or through a catheter positioned in the coronary sinus via
a peripheral vein. To repair or replace the mitral valve,
minimally-invasive cutting and suturing instruments are then
introduced thoracoscopically through a trocar sleeve in the right
lateral portion f the chest. A complete description of such methods
is found in U.S. Pat. No. 5,571,215 to Sterman, et al., issued on
Nov. 5, 1996, the contents of which is incorporated herein by
reference.
[0012] This new generation of thoracoscopic methods of performing
heart valve repair has, of course, created many new challenges. One
such challenge is that of retracting the left atrial wall to open
the atriotomy so that the mitral valve can be exposed for the
surgical procedure. The heart wall must be retracted anteriorly to
suitably expose the mitral valve and provide access through the
atriotomy for the cutting and suturing instruments introduced
through the right lateral portion of the chest. In addition, the
instruments that retract the heart wall must be introduced in a
minimally-invasive manner through small percutaneous incisions or
cannulae positioned in intercostal spaces in the patient's rib
cage.
[0013] Introducing an instrument through an intercostal space in
the anterior side of the chest presents additional problems. One
such problem is that the patient's rib cage is typically structured
so that the ribs in the anterior portion of the chest are closer
together than in the lateral portions of the chest. In addition,
the tissue layer in the anterior chest wall contains nerves that
could be damaged by a large percutaneous incision. Therefore, a
retraction device introduced from the anterior side should be as
small as possible, preferably on the order of 3-8 mm, to fit within
the smaller anterior intercostal spaces and to avoid unnecessary
trauma to the patient. Another problem is that the part of the
retraction device that engages the heart wall must be wide enough
to engage a sufficient portion of the heart wall to open the
atriotomy enough to expose the mitral valve. It must also be long
enough to extend a sufficient distance into the heart to extend
beneath the interatrial septum and prevent it from sagging or
otherwise inhibiting access to the mitral valve. Introducing an
instrument that is large enough to sufficiently expose the mitral
valve through the smaller intercostal spaces in the anterior
portion of the chest is problematic.
[0014] U.S. Pat. No. 5,613,937 to. Garrison, et al., issued on Mar.
25, 1997, the contents of which are incorporated herein by
reference, teaches such an instrument. The retractor of U.S. Pat.
No. 5,613,937 includes a threaded shaft and a retractor blade
having a mating threaded portion. The retractor blade has a width
and length sufficient to provide the necessary retraction of the
heart wall and has a thickness that allows it to pass through a
lateral thoracotomy. Therefore, the retractor blade and threaded
shaft are disassembled and the retractor blade is positioned in the
chest cavity. Once inside the chest cavity, the thin threaded shaft
is also passed through the intercostal space and is mated to the
retractor blade. The retractor is then used to retract the left
atrial wall to open the atriotomy so that the mitral valve can be
exposed for the surgical procedure. Generally, in these types of
retractors, surface texturing or raised projections are provided to
keep the heart wall from slipping off of the retractor blade. Since
the retractors of the prior art use mechanical force applied to the
retractor to hold the atrium open, it may cause the heart wall to
compress over time, which causes trauma and the need to adjust the
retractor to compensate for the compression. Also due to the
inherent force needed to lift the heart wall, the chest wall (which
supports the retractor) may be pulled down toward the heart instead
of the heart wall being lifted. Furthermore, when such retractors
are used to provide access to the mitral valve, illumination
devices must also be used to illuminate the interior of the heart
so that the surgeon can see the valve and perform the necessary
procedures. Typically, the illumination device is an endoscope
having a light fiber attached to a light source or a light source
adapted to the surgeon's head, such as on his glasses or forehead.
Therefore, illumination of the interior of the heart requires
additional instrumentation and because it is external to the heart
interior, it often produces shadows and dark regions, which make it
difficult for the surgeon to visualize valves in the heart's
interior.
SUMMARY OF THE INVENTION
[0015] Therefore it is an object of the present invention to
provide a retractor that overcomes the disadvantages associated
with retractors of the prior art.
[0016] Accordingly, a first implementation of a retractor is
provided. The first implementation retractor comprises: an
extension member having distal and proximal ends; a retractor
member connected to the distal end of the extension member, the
retractor member having a retractor surface, at least a portion of
the retractor surface having a distal vacuum port for positively
retaining tissue upon application of a vacuum to the vacuum
port.
[0017] Preferably, the extension member is a tubular member having
an internal lumen extending from the proximal end to the distal
end. The retractor member preferably has an internal conduit in
fluid cooperation with both the internal lumen and distal vacuum
port, wherein vacuum applied to the proximal end of the extension
member is applied to the distal vacuum port through the internal
lumen and internal conduit. The retractor preferably further
comprising a handle disposed at the proximal end of the extension
member, the handle having a proximal vacuum port in fluid
communication with the proximal end of the internal lumen.
Preferably, the distal end of the extension member has a male
threaded portion and the retractor member has a female threaded
portion threadingly engaging the male threaded portion of the
extension member.
[0018] Preferably, the retractor member is a curved blade, the
curved blade having a convex surface and a concave surface, wherein
the distal vacuum port is at least partially formed in the convex
surface. The convex surface preferably further has at least one lip
for preventing the tissue from slipping from the retractor
surface.
[0019] The retractor preferably further comprises illumination
means for transmitting light into an interior of the body proximate
to the tissue. Preferably, the illumination means comprises the
retractor member having at least a portion fabricated from a light
transmitting material and light guide means for directing the light
to the light transmitting material. The extension member is
preferably a tubular member having an internal lumen extending from
the proximal end to the distal end, wherein a light fiber is
disposed in the internal lumen for directing the light to the light
transmitting material. The retractor member is preferably a curved
blade, the curved blade having a convex surface and a concave
surface, wherein the distal vacuum port is formed at least
partially on the convex surface and the light transmitting material
is at least partially formed in the concave surface.
[0020] Also provided is a second implementation retractor. The
second implementation comprises: an extension member having a
distal and proximal end; a retractor member connected to the distal
end of the extension member, the retractor member having a
retractor surface and is configured as a curved blade, the curved
blade having a convex surface and a concave surface; and
illumination means for transmitting light into an interior of the
body proximate to tissue being retracted, wherein the illumination
means transmits light from the concave surface.
[0021] Preferably, at least a portion of the retractor surface has
a distal vacuum port for positively retaining the tissue upon
application of a vacuum to the vacuum port. The extension member is
preferably a tubular member having an internal lumen extending from
the proximal end to the distal end. Preferably, the retractor
member has an internal conduit in fluid cooperation with both the
internal lumen and distal vacuum port, wherein vacuum applied to
the proximal end of the extension member is applied to the distal
vacuum port through the internal lumen and internal conduit.
[0022] Preferably, the distal vacuum port is at least partially
formed in the convex surface. Preferably, the convex surface
further has at least one lip for preventing the tissue from
slipping from the retractor surface. Preferably, the distal end of
the extension member has a male threaded portion and the retractor
member has a female threaded portion corresponding and threadingly
engaging the male threaded portion of the extension member.
[0023] The illumination means preferably comprises the retractor
member having at least a portion fabricated from a light
transmitting material and light guide means for directing the light
to the light transmitting material. Preferably, the extension
member is a tubular member having an internal lumen extending from
the proximal end to the distal end, wherein a light fiber is
disposed in the internal lumen for directing the light to the light
transmitting material. The retractor preferably further comprises a
handle disposed at the proximal end of the extension member, the
handle having a light guide connector in optical communication with
the light fiber in the internal lumen. Preferably, the retractor
member is a curved blade, the curved blade having a convex surface
and a concave surface, wherein the distal vacuum port is formed at
least partially on the convex surface and the light transmitting
material is at least partially formed in the concave surface.
[0024] Still provided is a first implementation of a method for
retracting tissue for accessing a surgical site within a body of a
patient, the method comprising: engaging a surface of a retractor
with the tissue to be retracted; and providing a vacuum at the
surface to positively hold the tissue on the retractor surface. The
method preferably further comprises directing light from the
retractor to illuminate a body cavity proximate to the
retractor.
BRIEF DESCRIPTION OF THE DRAWINGS
[0025] These and other features, aspects, and advantages of the
apparatus and methods of the present invention will become better
understood with regard to the following description, appended
claims, and accompanying drawings where:
[0026] FIG. 1 illustrates an isometric view of a preferred
implementation of a retractor of the present invention.
[0027] FIG. 2 illustrates a partial isometric view of the retractor
member and extension member of FIG. 1.
[0028] FIG. 3 illustrates a sectional view of the retractor member
and extension member of FIG. 2 as taken along line 3-3 in FIG. 2,
the retractor member being shown in cooperation with heart tissue
and the extension member being shown disposed in an intercostal
space between adjacent ribs.
[0029] FIG. 4 illustrates a partial sectional view of the handle
and extension member of the retractor of FIG. 1 as taken along line
4-4 in FIG. 1.
[0030] FIG. 5 illustrates a sectional view of an alternative
implementation of the retractor member and extension member of FIG.
2 as if it were taken along line 3-3 in FIG. 2.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
[0031] Although this invention is applicable to numerous and
various types of retractors for use with retraction of different
tissue, it has been found particularly useful in the environment of
an atrial retractor for use in the retraction of the heart wall
during minimally invasive heart valve surgery. Therefore, without
limiting the applicability of the invention to an atrial retractor
for use in the retraction of the heart wall during minimally
invasive heart valve surgery, the invention will be described in
such enviromnent.
[0032] The invention provides methods and devices for performing
surgical interventions within the heart or a great vessel such as
the aorta, superior vena cava, inferior vena cava, pulmonary
artery, pulmonary vein, among other vessels. While the specific
embodiments of the invention described herein will refer to mitral
valve repair and replacement, it should be understood that the
invention will be useful in performing a great variety of surgical
procedures, including repair and replacement of aortic, tricuspid,
or pulmonary valves, repair of atrial and ventricular septal
defects, pulmonary thrombectomy, removal of atrial myxoma, patent
foramen ovate closure, treatment of aneurysms, electrophysiological
mapping and ablation of the myocardium, myocardial drilling,
annloplasty, artial fibulation, correction of congenital defects,
and other procedures in which interventional devices are introduced
into the interior of the heart, coronary arteries, or great
vessels. Advantageously, the invention facilitates the performance
of such procedures through percutaneous penetrations within
intercostal spaces of the rib cage, obviating the need for a median
stemotomy or other form of gross thoracotomy.
[0033] The terms "percutaneous intercostal penetration" and
"intercostal penetration" as used herein refer to a penetration, in
the form or a small cut, incision, hole, cannula, trocar sleeve, or
the like, through the chest wall between two adjacent ribs, wherein
the patient's rib cage and sternum remain substantially intact,
without cutting, removing, or significantly displacing the ribs or
sternum. These terms are intended to distinguish a gross
thoracotomy such as a median sternotomy, wherein the sternum and/or
one or more ribs are cut or removed from the rib cage, or one or
more ribs are retracted significantly, to create a large opening
into the thoracic cavity. A "percutaneous intercostal penetration"
may abut or overlap the adjacent ribs between which it is formed,
but the maximum width of the penetration which is available for
introduction of instruments, prostheses and the like into the
thoracic cavity will be the width of the intercostal space, bounded
by two adjacent ribs in their natural, substantially un-deflected
positions. It should be understood that one or more ribs may be
retracted or deflected a small amount without departing from the
scope of the invention; however, the invention specifically seeks
to avoid the pain, trauma, and complications which result from the
large deflection or cutting of the ribs in conventional, open-chest
techniques.
[0034] Referring now to FIG. 1, there is shown a preferred
implementation of a retractor of the present invention, generally
referred to by reference numeral 100. In general, the retractor 100
includes an extension member 102 having distal 104 and proximal 106
ends. A retractor member 108 is connected to the distal end 104 of
the extension member 102. The retractor member 108 has a retractor
surface 110 in contact with a tissue to be retracted. At least a
portion of the retractor surface 110 has a distal vacuum port 112
for positively retaining the tissue upon application of a vacuum to
the distal vacuum port 112.
[0035] Referring now also to FIGS. 2, 3, and 4 the preferred
implementation of the retractor 100 will be described in more
detail. Preferably, the extension member 102 is a tubular member
having an internal lumen 114 extending from the proximal end 106 to
the distal end 104. Preferably, the extension member 102 is
fabricated from surgical grade stainless steel. The distal end 104
of the extension member 102 has a means for coupling and uncoupling
it with the retractor member 108. Preferably, such means is
provided by a male threaded portion 116 at the distal end 104 of
the extension member 102. In which case, the retractor member 108
has a corresponding female threaded portion 118 threadingly
engaging the male threaded portion 116 of the extension member 102.
Those skilled in the art will appreciate that other means for
coupling and uncoupling the extension and retractor members 102,
108 are possible without departing from the scope or spirit of the
prior art, such as a "bayonet" type means in which one or more
projections (not shown) on the distal end 104 of the extension
member 102, engage a spiral slot (not shown) in the retractor
member 108. The bayonet type means can also have a spring or other
biasing means (not shown) for biasing the projections into a locked
position in the slot. Other means include a "quick-connect" type of
coupling as is known in the art. Furthermore, it is preferred that
the extension member 102 be used with many different size retractor
members for different surgical applications. Each of the different
size retractor members 108 are interchangeably coupled and
uncoupled from the extension member 102.
[0036] Preferably, a handle 120 is disposed at the proximal end 106
of the extension member 102. As well as providing a convenient
place for a surgeon to grasp and manipulate the retractor 100, the
handle 120 also has a proximal vacuum port 122 in fluid
communication with the proximal end 106 of the internal lumen 114.
The handle 120 has a main bore 124, a distal portion of which
preferably has a counter bore 126 which is press fit and/or adhered
with an adhesive to the proximal end 106 of the extension member
102. Those skilled in the art will appreciate that other means of
fastening the handle to the extension member are possible without
departing from the scope or spirit of the present invention, such
as a threaded connection similar to that described with regard to
the distal end 104 of the extension member 102. The proximal vacuum
port 122 is preferably a barbed fitting 122 as is known in the art.
The barbed fitting is also preferably press fit and/or adhered with
an adhesive into a side bore 128 which is in fluid communication
with the main bore 124. The barbed fitting has an internal conduit
122a and one or more external barbs 130 over which flexible tubing
is sealingly disposed. The flexible tubing (not shown) is attached
to a vacuum source (not shown) such as a vacuum pump (not shown)
for generating a vacuum at the proximal vacuum port 122. Other
types of vacuum fittings are also possible, such as luer fittings
known in the medical arts. Furthermore, a syringe (not shown) may
be connected directly to the flexible tubing for applying a vacuum
at the proximal vacuum port 122.
[0037] The retractor member 108 preferably has an internal conduit
132 in fluid cooperation with both the internal lumen 114 of the
extension member 102 and the distal vacuum port 112. The internal
conduit 132 preferably comprises two segments, a first segment
132a, which is a continuation of the female thread 118, and a
second segment 132b that connects the first segment 132a to the
distal vacuum port 112. The distal vacuum port 112 is preferably
shaped to cover a major portion of the retractor surface 110, such
as a rectangle. Those skilled in the art will appreciate that other
shapes or several shapes and ports are possible without departing
from the scope or spirit of the present invention. From the
foregoing description, those skilled in the art will also
appreciate that vacuum applied to the proximal end of the extension
member is applied to the distal vacuum port 112 through the
internal lumen 114 and internal conduit 132. Where the handle 120
is provided, the vacuum applied at the proximal vacuum port 122 is
applied to the distal vacuum port 112 through the conduit 122a,
side bore 128, main bore 124, internal lumen 114 and internal
conduit 132. Those skilled in the art will appreciate that the
vacuum path to the distal vacuum port 112 may vary from that
described above with regard to the preferred implementation of the
retractor 100. For example, a vacuum port may be provided directly
on a surface of the retractor member 108 and a flexible tube
connected thereto and to a vacuum source can be external to the
extension member 102. As discussed below, the retractor member 108
is preferably fabricated from a transparent material, at least a
portion of which is fabricated from a light transmitting material,
to facilitate illuminating an interior of the body proximate the
retractor member 108. However, as shown in FIG. 5, the retractor
100 may be configured without such an illumination means, and as
such, may be fabricated from any appropriate medically approved
material, such as a thermoplastic, or stainless steel.
[0038] The retractor surface 110 of the retractor member 108 is
configured to retract tissue, preferably, heart tissue. Preferably,
the retractor member 108 is shaped as a curved rigid blade wherein
the retractor surface 110 is a convex surface 134 and the retractor
member 108 further has a concave surface 136. The distal vacuum
port 112 is preferably at least partially formed in the convex
surface 134 corresponding to the retractor surface 110. The convex
surface 134 further has at least one lip 138 for preventing the
tissue from slipping from the retractor surface 110. Although,
suction generated at the distal vacuum port 112 may act to
positively retain the tissue on the retractor surface 110, the lip
138 provides additional retention of the tissue and may serve to
retain the tissue while the retractor 100 is being positioned and
before the vacuum is applied or fully established.
[0039] As discussed briefly above, the retractor 100 preferably
further comprises illumination means for transmitting light into an
interior of the body proximate to the tissue. The illumination
means preferably comprises the retractor member 108 having at least
a portion fabricated from a light transmitting material and light
guide means for directing the light to the light transmitting
material. In the preferred implementation of the retractor 100
discussed above where the extension member 102 is a tubular member
having an internal lumen 114, a light fiber 140 is disposed in the
internal lumen 114 for directing the light to the light
transmitting material. Where suction is also provided at the
retractor surface 110, the vacuum is applied through an annular
space between the exterior surface of the light fiber 140 and an
interior surface of the internal lumen 114. Furthermore, the handle
120 includes a light guide coupling 142 for coupling a light guide
cable (not shown) from a light source (not shown) to the light
fiber 140. Light guide couplings 142 for coupling light sources to
internal light fibers 142 or optics are well known in the medical
arts, particularly in the endoscope arts.
[0040] Preferably, the retractor member 108 is fabricated from a
transparent material and has a light pipe 144 molded therein. The
light pipe 144 is fabricated from a light transmitting material,
such as polycarbonate. The light fiber 140 directs light onto a
surface of the light pipe 144, which directs the light as desired.
Where, the retractor member 108 is a curved blade as discussed
above, having a convex surface 134 and a concave surface 136, the
light transmitting material, e.g., the light pipe 144, is at least
partially formed in the concave surface 136 to direct the light
from the concave surface 136. Preferably, small lenses 145, such as
Microlens.RTM. manufactured by Lumitex Inc., are molded into the
concave surface 136 in the vicinity of the light pipe 144 to direct
the light A from the concave surface 136 at a predetermined angle a
with respect to the concave surface 136. In this way, light is
diffusely delivered into an operative area through the retractor
member 108. The predetermined angle .alpha. can be chosen depending
on the application for the retractor 100. When used in mitral valve
repair or replacement, the preferred angle .alpha. is approximately
30 degrees. When using the small lenses 145 molded in the concave
surface 136, it is preferred that an additional layer 146 is
disposed on the concave surface 136. The additional layer 146 can
be molded onto the retractor member 108 as a secondary operation to
the fabrication of the retractor member 108. However, it is
preferred that the additional layer be a thin transparent adhesive
label that is adhered to the concave surface 136.
[0041] In addition to performing mitral valve repair and
replacement, the techniques of the invention also facilitate
surgical intervention into other regions of the heart and great
vessels and may also be used in other vessels and organs in
general. The devices and methods described above may be used to
form an opening directly into the left ventricle, right atrium, or
right ventricle, or into a great vessel such as the aorta, superior
vena cava, inferior vena cava, pulmonary artery, or pulmonary vein,
for surgical intervention in such cavities. For example, a
penetration may be made in the wall of the aorta, and the aortic
valve may be repaired or replaced with prosthesis, using techniques
and devices like those described above for mitral valve
replacement. Moreover, the devices and methods of the invention
also facilitate intercardiac procedures such as repair of atrial or
ventricular septal defects, electrophysiological mapping and
ablation of the myocardium, myocardial drilling, and other
procedures. Furthermore, devices may be introduced through an
opening into the heart or great vessel and advanced therefrom into
vessels such as the coronary arteries to perform procedures such as
angioplasty, atherectomy, coronary artery bypass grafting, or
treatment of aneurysms. The retractor 100 is preferably used in
combination with a thoracotomy or stemotomy retractor or used as a
stand-alone retractor system that uses the patient's chest wall as
its opposing force. Preferably, the retractor 100 is fastened to
the thoracotomy or stemotomy retractor by using a ball socket clamp
as is known in the art. The ball socket clamp preferably grasps the
retractor 100 by the extension member 102.
EXAMPLE
[0042] An example procedure using the preferred implementation
retractor 100 of the present invention for minimally invasive
mitral valve surgery will now be described with reference to FIGS.
3 and 4. The extension member 102 with light fiber 140 is inserted
first using a stab incision through an intercostals space 148 on
the patients chest between adjacent ribs 150, 152. The retractor
member 108 is then inserted into the operative space through a
lateral thoracotomy and is threaded onto the distal end 104 of the
extension member 102. Once the extension member 102 is attached to
the retractor member 108, a light source (not shown) and vacuum
line (not shown) are attached to the light guide coupling 142 and
proximal vacuum port 122, respectively. The connection of the light
fiber to the retractor member 108 is inherently made when the
extension member 102 is connected to the retractor member 108. The
retractor member 108 is then positioned in the right atrium of the
heart 154 through an atriotomy 156. Once the retractor 100 is in
place, the suction is turned on to hold the position of the
retractor member 108 relative to the heart 154. The extension
member 102 is then attached to a thoracotomy retractor (not shown)
or can be used on its own by using the patients chest for the
opposing force once the atrium wall is lifted. The latter would be
done by using a clamp around the extension member 102 or an
assisting device such as an "Atrial Assistant" manufactured by
Heartport Inc. Once the retractor 100 is anchored, the light source
(not shown) is turned on to illuminate the interior 158 of the
heart 154 including the atrium and the mitral valves. The physician
then repairs of replaces the atrium and/or mitral valves as
discussed above and as is known in the art.
[0043] While there has been shown and described what is considered
to be preferred embodiments of the invention, it will, of course,
be understood that various modifications and changes in form or
detail could readily be made without departing from the spirit of
the invention. It is therefore intended that the invention be not
limited to the exact forms described and illustrated, but should be
constructed to cover all modifications that may fall within the
scope of the appended claims.
* * * * *