U.S. patent application number 14/990542 was filed with the patent office on 2017-07-06 for medical device and method.
This patent application is currently assigned to TERUMO KABUSHIKI KAISHA. The applicant listed for this patent is TERUMO KABUSHIKI KAISHA. Invention is credited to Tatsunori Fujii, Makoto Jinno, Youichirou Kuwano, Satoru Suehara.
Application Number | 20170189055 14/990542 |
Document ID | / |
Family ID | 59236111 |
Filed Date | 2017-07-06 |
United States Patent
Application |
20170189055 |
Kind Code |
A1 |
Suehara; Satoru ; et
al. |
July 6, 2017 |
MEDICAL DEVICE AND METHOD
Abstract
A blood vessel dissecting device method involves inserting a
dissecting device into a living body, advancing the dissecting
device along a vein, and dissecting the vein and tissue bound to
the vein from other surrounding tissue.
Inventors: |
Suehara; Satoru;
(Ashigarakami-gun, JP) ; Jinno; Makoto; (Tokyo,
JP) ; Fujii; Tatsunori; (Ebina-city, JP) ;
Kuwano; Youichirou; (Atsughi-city, JP) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
TERUMO KABUSHIKI KAISHA |
Tokyo |
|
JP |
|
|
Assignee: |
TERUMO KABUSHIKI KAISHA
Tokyo
JP
|
Family ID: |
59236111 |
Appl. No.: |
14/990542 |
Filed: |
January 7, 2016 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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14986040 |
Dec 31, 2015 |
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14990542 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 2017/00907
20130101; A61B 17/00008 20130101; A61B 17/320016 20130101; A61B
90/361 20160201; A61B 2017/32006 20130101; A61B 2017/00778
20130101; A61B 17/32056 20130101; A61B 2017/00969 20130101; A61B
17/0218 20130101 |
International
Class: |
A61B 17/3205 20060101
A61B017/3205; A61B 17/00 20060101 A61B017/00 |
Claims
1. A method comprising: making an incision in a limb of a living
body to permit access to a side branch of a vein located inside the
living body from outside the living body; confirming a position of
the side branch of the vein; introducing two elongated bodies into
the living body by way of the incision; moving the two elongated
bodies in the living body to position the two elongated bodies
under the vein and on opposite sides of the side branch of the vein
so that an inner side of each of the two elongated bodies faces the
side branch of the vein; lifting the vein and tissue in contact
with the vein in a first direction away from fascia underlying the
tissue to create a space between the tissue and the fascia; moving
the inner side of each of the two elongated bodies into contact
with the side branch and holding the side branch of the vein using
the inner sides of the two elongated bodies; and pulling the side
branch of the vein in a second direction opposite the first
direction by moving the two elongated bodies, whose inner sides are
holding the side branch of the vein, in the second direction.
2. The method according to claim 1, further comprising dissecting
the side branch of the vein from other tissue adjacent the side
branch.
3. The method according to claim 1, wherein the lifting of the
tissue to create the space between the body tissue and the fascia
includes applying a force to the two elongated bodies that moves
the two elongated bodies in the first direction, positioning an
expandable body between each of the two elongated bodies and the
fascia, and expanding each expandable body.
4. The method according to claim 1, wherein the lifting of the
tissue to create the space between the body tissue and the fascia
includes moving each of the two elongated bodies along an inclined
tool.
5. The method according to claim 1, wherein the lifting of the
tissue to create the space between the body tissue and the fascia
includes inserting a plurality of the elongated bodies in stacked
relation on each lateral side of the side branch.
6. The method according to claim 1, wherein each of the two
elongated bodies includes first and second hinged parts, and
wherein the lifting of the tissue to create the space between the
body tissue and the fascia includes rotating the first part of each
elongated body relative to the second part so that the first and
second parts of each elongated body form an angle other than
180.degree. and 0.degree. relative to each other.
7. The method according to claim 1, further comprising retaining
the two elongated bodies in parallel relation to one another while
the two elongated bodies are holding the side branch and are moving
the side branch in the second direction.
8. The method according to claim 1, further comprising holding the
two elongated bodies in a fixed lateral position relative to one
another while the two elongated bodies are holding the side branch
and are moving the side branch in the second direction.
9. The method according to claim 1, further comprising pinching and
pulling a portion of skin on the limb while pulling the side branch
of the vein in the second direction to hold the space.
10. The method according to claim 1, further comprising squeezing a
portion of the limb on opposite sides of the limb while the two
elongated bodies are holding the side branch and are moving the
side branch in the second direction.
11. The method according to claim 1, wherein the lifting of the
tissue that is in contact with the vein in the first direction
includes rotating the two elongated bodies positioned on opposite
sides of the side branch in one rotational direction to create the
space, followed by moving the two elongated bodies toward the side
branch so that the inner side of each of the two elongated bodies
contacts the side branch, and then rotating the two elongated
bodies in contact with the side branch in an other rotational
direction opposite the one rotational direction to pull the side
branch of the vein in the second direction.
12. The method according to claim 1, wherein the introducing of the
two elongated bodies into the living body by way of the incision
includes introducing a distal end of each of the two elongated
bodies into the living body by way of the incision, the method
further comprising moving the two elongated bodies so that the
distal end of each of the two elongated bodies is exposed outside
the body while a portion of each of the two elongated bodies
located between the distal end and a proximal end is positioned in
the living body.
13. The method according to claim 1, wherein the holding of the
side branch of the vein by the inner sides of the two elongated
bodies is performed while inhibiting slippage between the inner
sides of the two elongated bodies and the side branch.
14. A method comprising: making an incision in a limb of a living
body to permit access, from outside the living body, to a side
branch of a vein located inside the living body; inserting a distal
end of each of two elongated bodies into the living body by way of
the incision; moving the two elongated bodies in the living body to
position the two elongated bodies on opposite sides of the side
branch of the vein; lifting tissue that is in contact with the vein
in a first direction away from fascia underlying the tissue to
create a space between the tissue and the fascia; holding the side
branch of the vein using the two elongated bodies; and pulling the
side branch of the vein in a second direction opposite the first
direction by moving the two elongated bodies, which are holding the
side branch, in the second direction.
15. The method according to claim 14, further comprising dissecting
the side branch from other tissue while the side branch is held by
the two elongated bodies.
16. The method according to claim 14, further comprising retaining
the two elongated bodies in parallel relation to one another while
the two elongated bodies are holding the side branch and are moving
the side branch in the second direction.
17. The method according to claim 14, further comprising holding
the two elongated bodies in a fixed lateral position relative to
one another while the two elongated bodies are holding the side
branch and are moving the side branch in the second direction.
18. The method according to claim 14, wherein the lifting of the
tissue includes rotating the two elongated bodies in one rotational
direction to create the space, followed by moving the two elongated
bodies toward the side branch so that the two elongated bodies
contact the side branch, and then rotating the two elongated bodies
in contact with the side branch in an other rotational direction
opposite the one rotational direction to pull the side branch of
the vein in the second direction.
19. The method according to claim 14, further comprising moving the
two elongated bodies so that the distal end of each of the two
elongated bodies is exposed outside the body while a portion of
each of the two elongated bodies located between the distal end and
a proximal end is positioned in the living body.
Description
TECHNICAL FIELD
[0001] The present disclosure relates to a blood vessel dissecting
device and a blood vessel dissecting method.
BACKGROUND DISCUSSION
[0002] It is known to use an artery graft represented by internal
thoracic artery, gastroepiploic artery and radial artery or a vein
graft represented by great saphenous vein as a bypass vessel in
performing vascular bypass grafting at the heart (coronary artery
bypass grafting: CABG). Besides, at present, it has been reported
that artery grafts (particularly, internal thoracic artery) offer
higher long-term patency rates than vein grafts. Thus, vein grafts
are commonly said to be poor in long-term patency rate. In recent
years, however, it has been reported that the long-term patency
rate concerning a vein graft is enhanced when the vein graft is
harvested in the state of being covered with the surrounding tissue
(for example, fat, connective tissue, tissue between a skin layer
and a muscle layer, tissue between a skin layer and an interosseous
membrane, branch vessels, etc.) and is used as a bypass vessel
while remaining covered with the tissue.
[0003] Generally speaking, there are two primary techniques for
harvesting blood vessels. One technique is referred to as open vein
harvesting. This technique involves making an elongated incision
along, for example, the patient's limb (leg), and then carrying out
the harvesting procedure for removing the blood vessel from the
patient's limb. This technique has been found to be somewhat
problematic in that it is rather invasive, requiring a rather
extensive incision in the patient's limb. Harvesting site
complications (e.g., infections) are also not uncommon.
[0004] Another technique is referred to as endoscopic vein
harvesting. This technique has some advantages over open vein
harvesting in that the endoscopic vein harvesting is less invasive
and has been found to have a lower incidences of infection.
Unfortunately, endoscopic vein harvesting exhibits a lower patency
rate because the harvested vein tends to be more damaged.
SUMMARY
[0005] The devices and methods disclosed here provide a technique
having an improved patency rate similar to the patency rate with
the open vein harvesting, but without the harvesting site
complications. The technique disclosed here is referred to as a
no-touch technique. This technique improves endothelial integrity
while reducing injury to the blood vessel (vein). It has also been
found that this technique delays arterial atherosclerotic
processes, conserves the vasa vasorum and it promotes the nitric
oxide synthase activity of endothelial cells
[0006] According to one aspect, a method comprises: making an
incision in a limb of a living body to permit access to a side
branch of a vein located inside the living body from outside the
living body; confirming a position of the side branch of the vein;
introducing two elongated bodies into the living body by way of the
incision; moving the two elongated bodies in the living body to
position the two elongated bodies under the vein and on opposite
sides of the side branch of the vein so that an inner side of each
of the two elongated bodies faces the side branch of the vein;
lifting the vein and tissue in contact with the vein in a first
direction away from fascia underlying the tissue to create a space
between the tissue and the fascia; moving the inner side of each of
the two elongated bodies into contact with the side branch and
holding the side branch of the vein using the inner sides of the
two elongated bodies; and pulling the side branch of the vein in a
second direction opposite the first direction by moving the two
elongated bodies, whose inner sides are holding the side branch of
the vein, in the second direction.
[0007] Another aspect involves a method comprising: making an
incision in a limb of a living body to permit access, from outside
the living body, to a side branch of a vein located inside the
living body; inserting a distal end of each of two elongated bodies
into the living body by way of the incision; moving the two
elongated bodies in the living body to position the two elongated
bodies on opposite sides of the side branch of the vein; lifting
tissue that is in contact with the vein in a first direction away
from fascia underlying the tissue to create a space between the
tissue and the fascia; holding the side branch of the vein using
the two elongated bodies; and pulling the side branch of the vein
in a second direction opposite the first direction by moving the
two elongated bodies, which are holding the side branch, in the
second direction.
BRIEF DESCRIPTION OF THE DRAWINGS
[0008] FIG. 1 is a plan view of a blood vessel dissecting device
according to a first embodiment of the present disclosure.
[0009] FIGS. 2A and 2B illustrate a dissecting device forming a
part of the blood vessel dissecting device shown in FIG. 1, wherein
FIG. 2A is a longitudinal cross-sectional view and FIG. 2B is a
transverse cross-sectional view taken along the section line 2B-2B
of FIG. 2A.
[0010] FIGS. 3A and 3B illustrate a cutting device forming a part
of the blood vessel dissecting device shown in FIG. 1, wherein FIG.
3A is a plan view and FIG. 3B is a cross-sectional view taken along
the section line 3B-3B of FIG. 3A.
[0011] FIGS. 4A and 4B show views explaining a blood vessel
dissecting method carried out using the blood vessel dissecting
device shown in FIG. 1.
[0012] FIGS. 5A and 5B show views explaining the blood vessel
dissecting method carried out using the blood vessel dissecting
device shown in FIG. 1.
[0013] FIG. 6 illustrates a dissecting device and a blood vessel
treating device forming a part of a blood vessel dissecting device
according to a second embodiment of the present disclosure.
[0014] FIGS. 7A to 7C are views explaining a blood vessel
dissecting method carried out using the blood vessel dissecting
device shown in FIG. 6.
[0015] FIG. 8 is a partial cross-sectional view showing a cutting
device forming a part of a blood vessel dissecting device according
to a third embodiment of the present disclosure.
[0016] FIGS. 9A and 9B are partial cross-sectional views showing a
cutting device forming a part of a blood vessel dissecting device
according to a fourth embodiment of the present disclosure.
[0017] FIGS. 10A to 10C are cross-sectional views showing a
dissecting device forming a part of a blood vessel dissecting
device according to a fifth embodiment of the present
disclosure.
[0018] FIG. 11 is a cross-sectional view for explaining an effect
of the dissecting device shown in FIGS. 10A to 10C.
[0019] FIGS. 12A to 12C illustrate a dissecting device forming a
part of a blood vessel dissecting device according to a sixth
embodiment of the present disclosure, wherein FIG. 12A is a top
plan view, FIG. 12B is a side view, and FIG. 12C is a top plan view
showing the dissecting device in the state of being used.
[0020] FIGS. 13A and 13B illustrate a dissecting device forming a
part of a blood vessel dissecting device according to a seventh
embodiment of the present disclosure, wherein FIG. 13A is a top
plan view and FIG. 13B is a top plan view showing the dissecting
device in the state of being used.
[0021] FIG. 14 is a perspective view of a blood vessel dissecting
device according to an eighth embodiment of the present
disclosure.
[0022] FIG. 15A illustrates a great saphenous vein, and FIG. 15B is
a plan view of a dissecting device forming a part of a blood vessel
dissecting device according to a ninth embodiment of the present
disclosure.
[0023] FIGS. 16A and 16B are plan views of a dissecting device
forming a part of a blood vessel dissecting device according to a
tenth embodiment of the present disclosure.
[0024] FIGS. 17A and 17B are plan views of a dissecting device
forming a part of a blood vessel dissecting device according to an
eleventh embodiment of the present disclosure.
[0025] FIGS. 18A and 18B are cross-sectional views of a blood
vessel dissecting device according to a twelfth embodiment of the
present disclosure.
[0026] FIG. 19 is a cross-sectional view showing a dissected blood
vessel.
[0027] FIG. 20A illustrates a leg of a living body and depicts the
great saphenous vein 1000 extending from the upper leg to the lower
leg, FIGS. 20B and 20C depict cross-sections of the upper leg and
the lower leg respectively, including the great saphenous vein, and
FIG. 21A and FIG. 21B are enlarged schematic illustrations of the
noted portions of FIGS. 20B and 20C respectively.
[0028] FIGS. 22A-22C illustrate an embodiment of an elongated
dissecting device.
[0029] FIGS. 23A-23C and 23B1 depict a manner of dissecting tissue
using the dissecting device shown in FIGS. 22A-22C.
[0030] FIGS. 24A and 24B illustrate a result of as dissecting
operation.
[0031] FIGS. 25A-25C depict aspects of a dissecting procedure.
[0032] FIGS. 26A-26C illustrate aspects of another dissecting
operation.
[0033] FIGS. 27A-27C show aspects of another dissecting
procedure.
[0034] FIGS. 28A-28C show a modified version of a dissecting
device.
[0035] FIGS. 29A and 29B illustrate a different dissecting device,
and FIGS. 29C-29E depict aspects of a dissecting procedure.
[0036] FIGS. 30A-30D show modified version of a dissecting
device.
[0037] FIGS. 31A-31B show aspects of another dissecting
procedure.
[0038] FIGS. 32A and 32B show aspects of another dissecting
procedure.
[0039] FIGS. 33 illustrates an aspect of another dissecting
procedure.
[0040] FIGS. 34-37 depict a dissecting device according to another
embodiment and a manner of using such dissecting device.
[0041] FIGS. 38-41 depict a dissecting device according to an
additional embodiment and a manner of using such dissecting
device.
[0042] FIGS. 42A-42C, 43A-43C, 44A-44C, 45A, 45B and 46 depict
another embodiment of a dissecting device.
[0043] FIGS. 47A-47F illustrate aspects of another dissecting
procedure.
[0044] FIG. 48 illustrate a dissecting device.
[0045] FIGS. 49A-49H show cross-sections of different versions of a
dissecting device.
[0046] FIGS. 50A-50D illustrate aspects of another embodiment of a
dissecting device and a dissecting procedure using the dissecting
device.
[0047] FIGS. 51A-51D illustrate aspects of an additional embodiment
of a dissecting device and a dissecting procedure using the
dissecting device.
[0048] FIG. 52 shows a modified aspect of a dissection
procedure.
[0049] FIG. 53A and 53B illustrate another modified aspect of a
dissection procedure.
[0050] FIG. 54 shows an additional modified aspect of a dissection
procedure.
[0051] FIG. 55A and 55B illustrate another modified aspect of a
dissection procedure.
[0052] FIGS. 56A-56C illustrate features of a dissecting device
useful in retaining the side branch in a held state.
[0053] FIGS. 57A-57C illustrate features of another dissecting
device useful in retaining the side branch in a held state.
[0054] FIGS. 58A-58F show features of another dissecting
device.
[0055] FIGS. 59A-59E illustrate features of a dissecting device
useful in the operational procedure shown in FIGS. 50A-50D.
[0056] FIGS. 60A-60F illustrate features of another dissecting
device useful in the operational procedure shown in FIGS.
50A-50D.
[0057] FIGS. 61A-61G illustrate features of a dissecting device
useful in the operational procedure shown in FIGS. 51A-51D.
[0058] FIGS. 62A-62C show aspects of operational procedures for
holding parts of the limb.
[0059] FIGS. 63A-63C show aspects of other operational procedures
for holding parts of the limb.
[0060] FIGS. 64A and 64B depict aspects of other operational
procedures for holding parts of the limb.
[0061] FIGS. 65A-65C show aspects of further operational procedures
for holding parts of the limb.
[0062] FIGS. 66A-66D illustrate features of another embodiment of a
dissecting device.
[0063] FIGS. 67A-67D illustrate features of an additional
embodiment of a dissecting device.
[0064] FIGS. 68A-68D illustrate features of a further embodiment of
a dissecting device.
DETAILED DESCRIPTION
[0065] Examples of a blood vessel dissecting device and a blood
vessel dissecting method disclosed here will be described in detail
below, referring to the attached drawings.
First Embodiment
[0066] FIGS. 1-5B illustrate a blood vessel dissecting device and
blood vessel dissecting method carried out using the blood vessel
dissecting device according to a first embodiment representing one
example of the disclosure here. In the following description, for
convenience of explanation, the right side in FIG. 1 will be
referred to as "distal" side or end, and the left side in the
figure as "proximal" side or end.
Blood Vessel Dissecting Device
[0067] A blood vessel dissecting device 100 shown in FIG. 1 is a
device used to harvest a blood vessel for use as a bypass vessel in
carrying out blood vessel bypass grafting (particularly, coronary
artery bypass grafting: CABG). By use of the blood vessel
dissecting device 100, a blood vessel can be harvested in the state
of being covered with the surrounding tissue (fat, connective
tissue, etc.), preferably to the extent that the blood vessel is
not exposed to the surface of the surrounding tissue and the blood
vessel does not have the lateral surface that is exposed to the
external atmosphere. More preferably, to the extent that an outer
surface of the blood vessel is not exposed to the surface of the
surrounding tissue and the outer surface of the blood vessel does
not have the lateral surface that is exposed to the external
atmosphere. Note that the blood vessel to be harvested using the
blood vessel dissecting device 100 is not particularly limited
insofar as it is a blood vessel that can be used as a bypass
vessel. Examples of the applicable blood vessel include internal
thoracic artery, gastroepiploic artery, radial artery, and great
saphenous vein.
[0068] It is preferable, however, that the blood vessel to be
harvested is the great saphenous vein. As aforementioned, the use
of the blood vessel dissecting device 100 facilitates harvesting of
a blood vessel in the state in which the blood vessel is covered
with the surrounding tissue. When the great saphenous vein is
harvested by using the blood vessel dissecting device 100 and is
used as a bypass vessel, therefore, it is considered that an
enhanced long-term patency rate is obtained after the bypass
grafting operation. In view of this, in the following, an example
of harvesting a great saphenous vein by use of the blood vessel
dissecting device 100 will be described on a representative
basis.
[0069] As shown in FIG. 1, the blood vessel dissecting device 100
includes a dissecting device 200 and a cutting device 300. Both the
dissecting device 200 and the cutting device 300 are devices which
are inserted into a living body along the great saphenous vein. The
dissecting device 200 and the cutting device 300 will now be
described in detail below.
Dissecting Device
[0070] The dissecting device 200 has an elongated bar-like shape
(bar-shaped) extending substantially straight, and is provided at
its distal end with a dissecting section 220 for dissecting tissue.
In addition, as shown in FIG. 2B, the dissecting device 200 has a
flat shape (flattened shape as seen in vertical cross-section to a
central axial direction of the dissecting device) in section. The
cross-sectional shape of the dissecting device 200 is not
specifically restricted; for example, the cross-sectional shape may
be a crushed-circle-like shape (flattened circular shape), such as
an oblong and an ellipse, a rectangle rounded at corners, or the
like.
[0071] The width (the length in the major axis direction of the
cross-sectional shape) W1 of the dissecting device 200 is greater
than the outside diameter of the blood vessel to be harvested (in
this embodiment, the great saphenous vein). To be more specific,
the width W1 is preferably about 4 mm to 2 cm greater than the
outside diameter of the blood vessel to be harvested. This helps
ensure that the possibility of contact between the cutting device
300 and the great saphenous vein can be effectively lowered at the
time of inserting the cutting device 300 into the living body along
the dissecting device 200, as will be explained in the "blood
vessel harvesting method" described later.
[0072] In addition, the dissecting device 200 is provided, at both
ends of the major axis of the cross-sectional shape thereof, with
rails 231 and 232 in the form of linear stretches of recess (or
trenches/grooves) which extend in the axial direction of the
dissecting device 200. Each of the rails 231 and 232 is used for
connection of the dissecting device 200 with the cutting device
300, and functions as a guide section for guiding the cutting
device 300. Note that the rails 231 and 232 are not limited to the
linear stretches of recess (or trenches/grooves) but may be, for
example, linear stretches of projection (or ridges or ribs),
insofar as they each enable connection of the dissecting device 200
with the cutting device 300.
[0073] As shown in FIG. 2A, the dissecting device 200 is provided
with an insertion hole 210 which opens at the proximal end and
extends to a distal portion (the dissecting section 220). In this
illustrated embodiment, the insertion hole 210 is a blind hole,
meaning the insertion hole 210 is closed at its distal end. Into
the insertion hole 210 is inserted an imaging device 400. The
imaging device 400 is not specifically restricted. For example, the
imaging device 400 in this embodiment, as depicted in FIG. 2A,
includes an elongated main body section 410, and an illuminating
section (not shown) for emitting illumination light and an imaging
section 430 for imaging the front side of the dissecting device
200. The illuminating section and the imaging section 430 are
disposed at a distal portion of the main body section 410. The
imaging section 430 includes, for example, an objective lens system
disposed at the distal portion of the main body section 410 and an
imaging element (e.g., solid state image sensor such as CMOS image
sensor or CCD sensor) disposed opposite to the objective lens
system.
[0074] The dissecting section 220 is tapered in a narrowing manner
toward the distal end of the dissecting device 200. More
specifically, the distal end portion of the dissecting section 220
possesses a tapered roughly conical shape so that the length in the
minor axis direction and the length in the major axis direction of
the cross-sectional shape of the dissecting section 220 are both
gradually decreased in a direction toward the distal end. Such a
dissecting section 220 is blunt in the thickness direction, and has
such a degree of sharpness (bluntness) as to be able to dissect
tissues having different properties (for example, fat and skin, fat
and fascia, fat and blood vessel, fat and bone, etc.) from each
other without cutting branch vessels branched from the great
saphenous vein. This helps ensure that a dissecting function can be
sufficiently exhibited and the branch vessels are restrained from
being damaged or cut by the dissecting section 220. Accordingly,
bleeding can be suppressed, and the intended technique can be
performed safely and smoothly. Note that the shape of the
dissecting section 220 is not particularly limited insofar as it
enables dissection of tissues in the thickness direction (minor
axis direction) of the tissues. For example, the dissecting section
220 may be in the shape of a duck-bill such that the length in the
minor axis direction of the cross-sectional shape of the dissecting
section 220 is gradually decreased (tapered) toward the distal end
and the cross-sectional shape at the distal end is a line segment
along the major axis direction.
[0075] The dissecting section 220 is substantially colorless and
transparent and is light-transmitting. This helps ensure that when
the imaging device 400 is inserted into the insertion hole 210, the
front side of the dissecting device 200 can be observed through the
dissecting section 220 by the imaging device 400. In other words,
the dissecting section 220 has the function as an observation
section for observation of the inside of the living body (the great
saphenous vein and its surroundings), in addition to the
aforementioned function as the dissecting section. Note that the
dissecting section 220 is not limited to the colorless transparent
property but may be colored in red, blue, green or the like,
insofar as it is light-transmitting.
Cutting Device
[0076] The cutting device 300, at the time of moving along a great
saphenous vein 1000, cuts the fat (inclusive of connective tissue)
surrounding the great saphenous vein 1000 and, in addition, cuts
and stanches the branch vessels branched from the great saphenous
vein 1000.
[0077] The cutting device 300 is elongated plate-like in shape
(plate-shaped). As shown in FIGS. 1 and 3A, the cutting device 300
has a groove portion 320 opening in a distal portion of the cutting
device. The groove portion 320 includes: a tapered blood vessel
guide groove section (first groove section) 321 having a width
gradually decreasing toward the proximal side; and a straight blood
vessel treating groove section (second groove section) 322 which is
located on the proximal side of the blood vessel guide groove
section 321 and is substantially constant in width. The blood
vessel guide groove section 321 is a groove section for guiding a
branch vessel into the blood vessel treating groove section 322 at
the time of pushing the cutting device 300 forward in a living
body, and is tapered in shape for the guiding to be smoothly
achieved. On the other hand, the blood vessel treating groove
section 322 is a groove section for cutting and stanching the
branch vessel guided to the blood vessel treating groove section
322 by the blood vessel guide groove section 321. Further, the
blood vessel treating groove section 322 is provided with a
treating section 330 for cutting and stanching a branch vessel.
[0078] As shown in FIG. 3A, the treating section 330 has a bipolar
structure including a pair of electrodes 331 and 332 configured to
generate an electric field inside the blood vessel treating groove
section 322. The electrode 331 is disposed at a proximal end
portion of the blood vessel treating groove section 322, while the
electrode 332 is disposed on both sides with respect to the width
direction of the blood vessel treating groove section 322. With a
high-frequency AC voltage impressed between the electrodes 331 and
332, it is possible to heat and cut a branch vessel 1100 guided
into the blood vessel treating groove section 322 and to stanch the
blood vessel through thermal coagulation. A distal portion (a
portion exposed to the blood vessel treating groove section 322)
331a of the electrode 331 is preferably so sharp as to be able to
cut the branch vessel 1100. This helps ensure that if thermal
coagulation (stanching) of the branch vessel 1100 can at least be
achieved by the electric field generated between the electrodes 331
and 332, the branch vessel 1100 can be physically cut by the distal
portion 331a of the electrode 331. Accordingly, the assuredness of
the treatment by the treating section 330 is enhanced.
[0079] The width W2 of the blood vessel treating groove section 322
is not particularly limited but it is preferably narrower than the
outside diameter of the branch vessel 1100. This helps ensure that
the branch vessel 1100 can be pressed flat inside the blood vessel
treating groove section 322 as shown in FIG. 3A, and, consequently,
the treatment (cutting and stanching) at the treating section 330
can be performed more reliably.
[0080] The cutting device 300 is provided with a cutting edge
section (cutting section) 350 for cutting the fat surrounding the
great saphenous vein 1000. The cutting edge section 350 is disposed
at a distal portion of the cutting device 300; in this embodiment,
it is disposed along the blood vessel guide groove section 321. As
will be explained also in the "blood vessel harvesting method"
described later, the cutting edge section 350 has the function of
cutting the fat surrounding the great saphenous vein 1000 at the
time of pushing the cutting device 300 forward in the living body.
Such a cutting edge section 350 preferably has such a sharpness as
to be able to cut the fat without cutting the branch vessel 1100.
This helps ensure that cutting of the branch vessel 1100 by the
cutting edge section 350 is inhibited, so that bleeding is
restrained, and the intended technique can be performed safely and
smoothly.
[0081] As shown in FIG. 3B, the cutting device 300 has a pair of
protection sections 341 and 342 provided on both sides with respect
to the cutting device's width direction (the direction orthogonal
to its moving direction). The protection sections 341 and 342 each
extend along the axial direction of the cutting device 300, and
their peripheral surfaces (side surfaces and distal surfaces) are
rounded. As will be explained also in the "blood vessel harvesting
method" described later, the protection section 341 moves along and
between fat and skin while dissecting them from each other, at the
time of pushing the cutting device 300 toward the distal side in a
living body. Since the fat and the skin having different
properties, they are rather easy to dissect from each other, even
though a distal end portion of the protection section 341 is
rounded, and the dissecting function of dissecting the fat and the
skin from each other can be exhibited sufficiently. In addition,
the rounding helps ensure that a branch vessel can be restrained
from being damaged or cut by the protection section 341, and,
further, damage to (cauterization of) the skin due to sliding
against (friction with) the protection section 341 can be
restrained. Similarly, the protection section 342 moves along and
between the fat and the fascia while dissecting them from each
other at the time of pushing the cutting device 300 toward the
distal side in the living body. Since the fat and the fascia having
different properties, they are easy to dissect from each other,
even though a distal end portion of the protection section 342 is
rounded, and the dissecting function of dissecting the fat and the
fascia from each other can be exhibited sufficiently. Besides, the
rounding helps ensure that the branch vessel can be restrained from
being damaged or cut by the protection section 342, and, further,
damage to (cauterization of) the fascia due to sliding against
(friction with) the protection section 342 can be restrained.
[0082] As shown in FIGS. 3A and 3B, the cutting device 300 has
connection sections 381, 382, 383 and 384 configured to connect
with the rails 231 and 232 of the dissecting device 200. The
connection sections 381 and 382 are provided at the protection
section 341, and disposed on mutually opposite surface sides.
Similarly, the connection sections 383 and 384 are provided at the
protection section 342, and disposed on mutually opposite surface
sides. These connection sections 381 to 384 are composed of
stretches (lengths) of projection (or ridges or ribs) which extend
in the axial direction of the cutting device 300 and correspond to
the stretches of recess (trenches) of the rails 231 and 232. Since
such connection sections 381 to 384 are provided, unintended
detachment of the dissecting device 200 and the cutting device 300
from each other is prevented, so that the intended technique can be
carried out more smoothly and accurately. Thus, in this example of
the blood vessel dissecting device, both the cutting device 300 and
the dissecting device 200 include connection structure configured
to connect the cutting device 300 and the dissecting device 200 to
each other.
Blood Vessel Harvesting Method
[0083] A method of harvesting a blood vessel by use of the blood
vessel dissecting device 100 includes: a first step (blood vessel
dissecting method) of dissecting the great saphenous vein 1000 in
the state of being covered with surrounding fat 1200 by use of the
blood vessel dissecting device 100; a second step of ligating the
great saphenous vein 1000 and then cutting the great saphenous vein
1000; and a third step of extracting the great saphenous vein 1000
in the state of being covered with the surrounding fat 1200 from
the living body. [0084] First Step
[0085] First, the position of the great saphenous vein 1000 to be
harvested is confirmed, and skin is incised on the basis of the
position of the great saphenous vein. Next, the dissecting device
200 with the imaging device 400 inserted in the dissecting device
200 is prepared, and, while observing the inside of the living body
by the imaging device 400, the dissecting device 200 is inserted
from the incision 1300 into the living body along the great
saphenous vein 1000 while keeping the dissecting device 200 spaced
from the great saphenous vein 1000. Then, as shown in FIG. 4A, the
dissecting device 200 is disposed on the upper side (the skin 1400
side) of the great saphenous vein 1000. In this case, the
dissecting device 200 is so disposed that the thickness direction
of the dissecting device 200 agrees substantially with the aligning
direction in which the dissecting device 200 and the great
saphenous vein 1000 are aligned. In this operation, the dissecting
device 200 is inserted between the fat 1200 and the skin 1400
(between the tissues having different properties), and the skin
1400 and the fat 1200 are dissected from each other in the
thickness direction of the dissecting device 200 (in the aligning
direction in which the dissecting device 200 and the great
saphenous vein 1000 are aligned). Such an area is an area where
dissection can be achieved particularly easily, so that this
operation can be carried out more smoothly and accurately. The
dissecting device 200 thus dissects tissue in a direction along the
longitudinal extent of the vein.
[0086] Subsequently, the cutting device 300 is prepared, and the
connection section 381 is connected to the rail 231 of the
dissecting device 200. Then, the state of the dissecting device 200
is aligned on the upper side of the great saphenous vein 1000, the
cutting device 300 is inserted into and moved in the living body
while guiding the cutting device 300 with the dissecting device 200
as shown in FIG. 4B. In this case, the cutting device 300 is moved
forward while dissecting the skin 1400 from the fat 1200 by the
protection section 341, and while dissecting the fascia 1500 from
the fat 1200 by the protection section 342. Furthermore, the
cutting device 300 cuts the fat 1200 present on the one lateral
side of the great saphenous vein 1000 by the cutting edge section
350 in the left-right direction (in the aligning direction in which
the cutting device 300 and the great saphenous vein 1000 are
aligned), and, concurrently, cuts and stanches the branch vessel
1100 by the treating section 330.
[0087] Here, since the width W1 of the dissecting device 200 is
greater than the outside diameter of the great saphenous vein 1000
as aforementioned, the cutting device 300 can be pushed forward
along the great saphenous vein 1000 while keeping the cutting
device 300 laterally spaced from the great saphenous vein 1000, as
shown in FIG. 4B, so that the great saphenous vein 1000 can be
prevented from being damaged during this operation. In addition,
since the protection sections 341 and 342 are rounded, the
possibility of damaging the skin 1400 or the fascia 1500 by contact
with the cutting device 300 is lowered.
[0088] Next, the cutting device 300 is drawn out, and the
connection section 382 of the cutting device 300 thus drawn out is
connected to the rail 232 of the dissecting device 200. Then, the
cutting device 300 is inserted again into the living body while
guiding the cutting device 300 with the dissecting device 200, to
dispose the cutting device 300 on the other lateral side of the
great saphenous vein 1000, as shown in FIG. 5A.
[0089] Subsequently, the dissecting device 200 is drawn out, and
the rail 232 of the dissecting device 200 thus drawn out is
connected to the connection section 384 of the cutting device 300.
Then, the dissecting device 200 is inserted again into the living
body while guiding the dissecting device 200 with the cutting
device 300, to dispose the dissecting device 200 on the lower side
(the fascia 1500 side (bone side)) of the great saphenous vein
1000, as shown in FIG. 5B. In this operation, the dissecting device
200 is inserted between the fat 1200 and the fascia 1500 (inserted
into the boundary between the tissues having different properties),
and the fat 1200 and the fascia 1500 are dissected from each other
in the thickness direction of the dissecting device 200. Such an
area is an area where dissection can be particularly easily
achieved, so that this operation can be carried out more smoothly
and accurately.
[0090] By the above-mentioned operations, the fat 1200 surrounding
the great saphenous vein 1000 is dissected over the entire
perimeter of the vein, and the great saphenous vein 1000 is
dissected in the state of being covered with the surrounding fat
1200. The thickness of the fat 1200 dissected together with the
great saphenous vein 1000 and located in the surroundings of the
great saphenous vein 1000 is not particularly limited. It is
preferable, however, that the thickness is about 0.1 mm to 10 mm,
more preferably about 1 mm to 8 mm, and further preferably about 3
mm to 5 mm [0091] Second Step
[0092] Next, both ends of that part of the great saphenous vein
1000 which is to be harvested are ligated and then cut. [0093]
Third Step
[0094] Subsequently, the great saphenous vein 1000 is extracted in
the state of being covered with the surrounding fat 1200, to the
outside of the living body via the incision 1300.
[0095] By the first to third steps as above-mentioned, the great
saphenous vein 1000 can be harvested while the great saphenous vein
is in the state of being covered with the surrounding fat 1200. In
such a method, while using the dissecting device 200 for treating a
part which is rather easy to dissect so as to reduce such damages
as bleeding and while using the cutting device 300 for treating the
fat which is difficult to dissect, the great saphenous vein 1000
can be harvested smoothly and with low invasion. In addition, since
the first step can be carried out without cutting the great
saphenous vein 1000, blood can be kept flowing through the great
saphenous vein 1000 for a time as long as possible. Accordingly,
the great saphenous vein 1000 is placed in an ischemic state for a
shortened period of time, so that the great saphenous vein 1000 can
be harvested with less damage.
[0096] Here, a great saphenous vein 1000 covered with fat 1200
constitutes a bypass vessel having a superior long-term patency
rate, as compared with a great saphenous vein 1000 not covered with
fat 1200. The reason is considered as follows. While the great
saphenous vein 1000 is used as an artery bypass vessel, arteries
are generally higher than veins in the blood pressure (the internal
pressure exerted thereon by blood). When a great saphenous vein in
an exposed state of being not covered with tissue is used as a
bypass vessel, therefore, the great saphenous vein cannot endure
the blood pressure and is therefore expanded by the blood pressure,
resulting in lowered blood flow. In addition, thickening of blood
vessel wall occurs in the process of remodeling (structural
alteration) or in the process of recovery from damage to tissue.
Such thickening of blood vessel wall is considered to influence the
development of arterial sclerosis. From such a cause, the use of a
great saphenous vein in the exposed state of being not covered with
tissue as a bypass vessel would, in the long run, lead to vascular
occlusion.
[0097] On the other hand, where the great saphenous vein 1000 is
covered with fat 1200, expansion of the great saphenous vein 1000
is restrained by the fat 1200, and bending and the like of the
great saphenous vein 1000 are also restrained. Therefore, the
lowering in blood flow as above-mentioned can be inhibited. In
addition, the covering with the fat 1200 reduces damages to the
great saphenous vein 1000, specifically, damages to
endotheliocytes, smooth muscles, nutrient vessels (capillary
plexus), etc. Therefore, the aforementioned thickening of blood
vessel walls can be restrained. For these reasons, the use of the
great saphenous vein 1000 covered with the fat 1200 as a bypass
vessel enables an excellent long-term patency rate. Especially, in
this embodiment, nutrient vessels are left at the blood vessel
walls of the great saphenous vein 1000 and in the fat 1200. For
this reason, nutrients are supplied to the great saphenous vein
1000 serving as the bypass vessel, even after the bypass grafting.
This is considered to be the reason why the aforementioned effect
is enhanced.
[0098] While this embodiment has been described, the configuration
of the blood vessel dissecting device 100 is not limited to the
configuration in this embodiment. For example, the rails 231 and
232 may be omitted from the dissecting device 200, and the
connection sections 381 to 384 may be omitted from the cutting
device 300. In this case, for example, it may be sufficient to
insert the cutting device 300 into a living body along the
dissecting device 200 which is inserted into the living body
earlier. Alternatively, it may be sufficient to insert the
dissecting device 200 into a living body along the cutting device
300 which is inserted into the living body earlier.
[0099] The cutting device 300 is not specifically restricted
insofar as it can cut the fat 1200. For instance, a configuration
may be adopted in which the fat 1200 is cut by something like a
pair of scissors.
[0100] The blood vessel dissecting method is not limited to the
procedure adopted in this embodiment. For instance, the order of
insertion of the dissecting device 200 and the cutting device 300
is not specifically restricted, and any of left, right, upper and
lower portions of the great saphenous vein 1000 may be dissected
first. For instance, a procedure may be adopted in which, first,
upper and lower sides of the great saphenous vein 1000 are
dissected by use of the dissecting device 200, and, then, left and
right sides of the great saphenous vein 1000 are dissected by use
of the cutting device 300. On the other hand, left and right sides
of the great saphenous vein 1000 may first be dissected by use of
the cutting device 300, and, then, upper and lower sides of the
great saphenous vein 1000 may be dissected by use of the dissecting
device 200.
[0101] While one dissecting device 200 and one cutting device 300
are used in this embodiment, two dissecting devices 200 and two
cutting devices 300 may be used. In this case, for example, a
procedure may be adopted wherein, first, a first dissecting device
200 is disposed on the upper side of the great saphenous vein 1000,
next a first cutting device 300 is disposed on one of left and
right sides of the great saphenous vein 1000, then a second cutting
device 300 is disposed on the other of the left and right sides of
the great saphenous vein 1000, and a second dissecting device 200
is disposed on the lower side of the great saphenous vein 1000.
Such a procedure eliminates the need to draw out the dissecting
device 200 and the cutting device 300 in the course of the
procedure, so that the aforementioned procedure can be carried out
smoothly.
[0102] While the dissecting device 200 is inserted between the fat
1200 and the skin 1400 and between the fat 1200 and the fascia 1500
in this embodiment, the insertion position of the dissecting device
200 is not particularly limited. For instance, the dissecting
device 200 may be inserted between tissues having different
properties, such as between the fat 1200 and a blood vessel (other
than the great saphenous vein 1000), between the fat 1200 and a
bone, between the fascia 1500 and a bone, or the like. Further, the
insertion between tissues having different properties (insertion
into the boundary between tissues having different properties,
insertion into tissue between tissues having different properties,
or the like) is not restrictive; for example, the dissecting device
200 may be inserted into the fat 1200, thereby dissecting the fat
1200.
[0103] While fat is cut by the cutting device 300 in this
embodiment, the tissue to be cut by the cutting device 300 is not
limited to fat. For instance, tissue between a skin-fat boundary
and a fat-muscle boundary, tissue between a skin-fat boundary and a
fat-interosseous membrane boundary, connective tissue, tissue
between a skin layer and a muscle layer, tissue between a skin
layer and an interosseous membrane, branch vessels, and the like
may also be cut by the cutting device 300.
[0104] While the dissecting device 200 is disposed spaced from the
great saphenous vein 1000 so as not to contact the great saphenous
vein 1000 in this embodiment, the dissecting device 200 may be
disposed in contact with the great saphenous vein 1000. In other
words, the dissecting device 200 may be inserted between the great
saphenous vein 1000 and the fat 1200.
Second Embodiment
[0105] FIGS. 6-7C illustrate a second embodiment of a blood vessel
dissecting device and a blood vessel dissecting method representing
another example of the disclosure here.
[0106] Referring to these figures, the second embodiment will be
described below. The following description will primarily describe
differences associated with this embodiment relative to the
aforementioned embodiment, and a detailed description of features
which are the similar to features in the first embodiment will not
be repeated.
[0107] This embodiment is the same as the first embodiment
described above, except mainly that the blood vessel dissecting
device in this embodiment further includes a blood vessel treating
device used together with the dissecting device.
Blood Vessel Dissecting Device
[0108] A blood vessel dissecting device 100 in this embodiment
includes a dissecting device 200, a cutting device 300, and a blood
vessel treating device 500. Since the cutting device 300 is
configured in the same manner as in the cutting device 300 in the
first embodiment, the following detailed description will primarily
focus on the dissecting device 200 and the blood vessel treating
device 500.
Dissecting Device
[0109] The dissecting device 200 possesses the same configuration
as described above in the first embodiment. In addition, the
dissecting device 200 in this embodiment has a passing hole 240 in
which the blood vessel treating device 500 is inserted and passed,
as shown in FIG. 6. The passing hole 240 opens at the proximal end
and a dissecting section 220 of the dissecting device 200. The
passing hole 220 is thus a through hole open at both ends. The
blood vessel treating device 500 can be inserted into the
dissecting device 200 via the proximal-side opening, and can
protrude from (distally beyond) the distal end of the dissecting
device 200 via the distal-side opening.
Blood Vessel Treating Device
[0110] As shown in FIG. 6, the blood vessel treating device 500
includes a plate-shaped main body section 510, and a bar-shaped
operating section 520 connected to the proximal end of the main
body section 510. The main body section 510 has a groove portion
530 opening at a distal portion of the main body section 510. The
groove portion 530 includes a tapered blood vessel guide groove
section 531 having a width gradually decreasing toward the distal
side, and a straight blood vessel treating groove section 532 which
is located on the proximal side of the blood vessel guide groove
section 531 and is substantially constant in width. The blood
vessel guide groove section 531 is a groove section for guiding a
branch vessel 1100 into the blood vessel treating groove section
532. On the other hand, the blood vessel treating groove section
532 is a groove section for cutting and stanching the branch vessel
1100 guided by the blood vessel guide groove section 531. The blood
vessel treating groove section 532 is provided with a treating
section 540 adapted to cut and stanch a branch vessel. The treating
section 540 has a bipolar structure including a pair of electrodes
541 and 542 configured to generate an electric field inside the
blood vessel treating groove section 532. The configuration of the
treating section 540 is the same as that of the treating section
330 described above in the first section, and, therefore, a
detailed description of the treating section 330 is not repeated
here.
Blood Vessel Dissecting Method
[0111] In a first step, the dissecting device 200 is inserted into
a living body. When a branch vessel 1100 appears on the forward
side of the dissecting device 200, as depicted in FIG. 7A, the
blood vessel treating device 500 is protruded from (extended
distally beyond) the distal-side opening of the passing hole 240,
as shown in FIG. 7B, and the branch vessel 1100 is cut and stanched
by the treating section 540. Then, the blood vessel treating device
500 is retracted into the passing hole 240, as shown in FIG. 7C,
and the dissecting device 200 is moved forward again. When such a
procedure is followed, cutting of the branch vessel 1100 by the
dissecting device 200 can be effectively prevented.
[0112] The blood vessel treating device 500 is not specifically
restricted so long as it can treat the branch vessel 1100. For
instance, the blood vessel treating device 500 may be one with a
monopolar structure, such as an electrosurgical knife, or a pair of
scissors may be used. In the case where a pair of scissors is used,
a ligation device may be used jointly.
[0113] By the second embodiment described above, also, the same or
equivalent effects to those of the aforementioned first embodiment
can be produced.
Third Embodiment
[0114] FIG. 8 illustrates a cutting device forming a part of a
blood vessel dissecting device according to a third embodiment of
the present disclosure.
[0115] Referring to this figure, the third embodiment will be
described below. The description below will primarily focus on
differences between this third embodiment and the embodiments
described above.. A detailed description of features and aspects of
this third embodiment that are the same as those described above
will not be repeated. This embodiment is the same as the first
embodiment described above, except mainly that an imaging device
can be inserted or provided in a cutting device.
Cutting Device
[0116] As shown in FIG. 8, a cutting device 300 in this embodiment
has insertion holes 371 and 372 which are formed inside protection
sections 341 and 342 and are open at proximal ends. Into the
insertion holes 371 and 372 can be inserted imaging devices 400. In
addition, at least distal portions of the protection sections 341
and 342 are substantially colorless and transparent and are
light-transmitting. With the imaging devices 400 inserted in the
insertion holes 371 and 372, therefore, the forward side of the
cutting device 300 (particularly, a boundary area between fat 1200
and skin 1400, and a boundary area between fat 1200 and fascia
1500) can be observed by the imaging devices 400 through the
protection sections 341 and 342. Consequently, the cutting device
300 can be inserted into a living body smoothly and accurately.
[0117] While the distal portions of the protection sections 341 and
342 are substantially colorless and transparent in this embodiment,
these portions are not limited to being colorless and transparent
insofar as they are light-transmitting; thus, the distal portions
may be colored in red, blue, green or the like. While the
protection sections 341 and 342 of the cutting device 300 in this
embodiment are formed therein with the insertion holes such that
two imaging devices 400 can be simultaneously inserted therein, the
number of the insertion holes is not limited to two. For example,
only one insertion hole may be provided. The layout of the
insertion holes is also not particularly limited. In addition, a
configuration may be adopted wherein the insertion holes are
omitted and, for example, an imaging device 400 can be fixed on the
outside of the cutting device 300.
[0118] By the third embodiment described above, also, the same or
equivalent effects to those of the aforementioned first embodiment
can be produced.
Fourth Embodiment
[0119] FIGS. 9A and 9B illustrate a cutting device forming a part
of a blood vessel dissecting device according to a fourth
embodiment of the present disclosure.
[0120] Referring to these figures, the fourth embodiment will be
described below. The following description will primarily focus on
differences between this fourth embodiment and embodiments
described above. A detailed description of features and aspects of
this fourth embodiment that are the same as those described above
will not be repeated.
[0121] This embodiment is the same as the first embodiment
described above, except mainly for differences in the configuration
of cutting device.
Cutting Device
[0122] As shown in FIGS. 9A and 9B, a cutting device 300 in this
embodiment has an insertion guide section 390 for facilitating the
insertion of the cutting device 300 into a living body.
[0123] The insertion guide section 390 has accommodation holes 391a
and 391b which are formed along and inside protection sections 341
and 342 and have distal ends opening in the protection sections 341
and 342. Furthermore, the insertion guide section 390 includes a
first guide mechanism 392a disposed in the accommodation hole 391a,
and a second guide mechanism 392b disposed in the accommodation
hole 391b. The first guide mechanism 392a includes a proximal
portion 393a disposed slidably in the accommodation hole 391a, a
distal portion 394a located on the distal side of the proximal
portion 393a and connected to and turnable relative to the proximal
portion 393a, a spring member (biasing section) 395a for biasing
the distal portion 394a toward the center axis side with reference
to the proximal portion 393a, and a cord (operating section) 396a
connected to the proximal portion 393a. Similarly, the second guide
mechanism 392b includes a proximal portion 393b disposed slidably
in the accommodation hole 391b, a distal portion 394b located on
the distal side of the proximal portion 393b and connected to and
turnable relative to the proximal portion 393b, a spring member
395b for biasing the distal portion 394b toward the center axis
side with reference to the proximal portion 393b, and a cord 396b
connected to the proximal portion 393b.
[0124] In the insertion guide section 390 as above, when the distal
portions 394a and 394b protrude from (extend distally outside of)
the accommodation holes 391a and 391b, the distal portions 394a and
394b are tilted toward the center axis side by the biasing forces
of the spring members 395a and 395b so that their distal ends come
in contact with each other. As a result, the groove section 320 is
closed, and a distal portion of the cutting device 300 is deformed
into a tapered shape. Accordingly, it becomes easier for the
cutting device 300 to be inserted into a living body via an
incision 1300. In addition, the distal portions 394a and 394b have
cutting edge sections 394a' and 394b' directed toward the forward
side when the distal portions 394a and 394b are tilted to the
center axis side. This helps ensure easier insertion of the cutting
device 300 into the living body through the incision 1300. On the
other hand, when the cords 396a and 396b are pulled proximally, the
distal portions 394a and 394b are retracted into the accommodation
holes 391a and 391b so that the groove section 320 and a treating
section 330 appear, as depicted in FIG. 9B.
[0125] When the cutting device 300 having the insertion guide
section 390 as above is inserted, in the state shown in FIG. 9A,
into a living body, the inserting operation can be carried out more
smoothly. Thereafter, the cutting device 300 is moved forward
within the living body in the state shown in FIG. 9B, whereby
cutting of fat 1200 and a treatment (cutting and stanching) of a
branch vessel 1100 can be performed in the same manner as in the
aforementioned first embodiment.
[0126] By the fourth embodiment described above, also, the same or
equivalent effects to those of the aforementioned first embodiment
can be produced.
Fifth Embodiment
[0127] FIGS. 10A to 11 illustrate a dissecting device forming a
part of a blood vessel dissecting device according to a fifth
embodiment of the present disclosure.
[0128] Referring to these figures, the fifth embodiment will be
described below. In the following, the description will focus
primarily on differences between this fifth embodiment and the
embodiments described above. A detailed description of features and
aspects of this fifth embodiment that are the same as those
described above will not be repeated.
[0129] This embodiment is the same as the first embodiment
described above, except mainly for differences in the configuration
of the dissecting device.
Dissecting Device
[0130] As shown in FIGS. 10A to 10C, a dissecting device 200 in
this embodiment has an anchoring mechanism 290 for reducing a
slippage (displacement) of the dissecting device 200 in a living
body. The anchoring mechanism 290 includes: a projection (anchoring
section) 291 disposed and configured to project from and retract
into the dissecting device 200; a spring member (biasing section)
292 for biasing the projection 291 toward the inside of the
dissecting device 200; and an operating section 293 for operating
(depressing) the projection 291. The projections 291 are arranged
on both sides with respect to the width direction of the dissecting
device 200, and are arranged plural in number in spaced-apart
relation in along the axial direction of the dissecting device 200.
Each of the projections 291 is biased toward the inside by the
spring member 292, and, in the retracted state depicted in FIG.
10B, the projection 291 is retracted in the dissecting device 200.
The operating section 293 is disposed inside the dissecting device
200 so as to be slidably moved in the axial direction. The
operating section 293 has a contact surface 293a which is inclined
against the axial direction and makes contact with the projection
291. When the operating section 293 is slid toward the distal side,
the projection 291 is depressed downward by the contact surface
293a, as shown in FIG. 10C, resulting in that the projection 291
protrudes from the surface (lower surface) of the dissecting device
200 to the exterior. When the operating section 293 is slid toward
the proximal side starting from this condition, the biasing force
of the spring member 292 causes the projection 291 to be again
retracted into the dissecting device 200.
[0131] The dissecting device 200 having the anchoring mechanism 290
as above helps ensure that when the dissecting device 200 with the
projections 291 in the retracted state is inserted into a living
body and thereafter the projections 291 protrude to the side of a
great saphenous vein 1000, the projections 291 bite into fat 1200,
as shown in FIG. 11. As a result, slippage of the dissecting device
200 in relation to the great saphenous vein 1000 can be reduced, so
that the dissecting device 200 can be maintained in an appropriate
position during the intended technique. Accordingly, it is
possible, for example, to guide the cutting deice 300 more
accurately.
[0132] The projections 291 are configured to protrude or project in
the thickness direction of the dissecting device 200 from a surface
201 on one side with respect to the thickness direction, but the
place and the direction of protrusion of each of the projections
291 are not restricted in this way. In addition, while the
projection 291 is used as the anchoring section in this embodiment,
the anchoring section is not limited to this; for example, a
plate-shaped member may be used in place of the projection. While
the projection 291 is protruded and retracted by use of the
operating section 293 and the spring member 292 in this embodiment,
the configuration for protrusion and retraction of the projection
291 is not restricted to this; for example, a drive source such as
a motor may be used to electrically effect protrusion and
retraction of the projection 291.
[0133] By the fifth embodiment described above, also, the same or
equivalent effects to those of the first embodiment described above
can be produced.
Sixth Embodiment
[0134] FIGS. 12A to 12C illustrate a dissecting device possessed by
a blood vessel dissecting device according to a sixth embodiment of
the present disclosure.
[0135] Referring to these figures, the sixth embodiment will be
described below. In the following, the detailed description will
primarily focus on differences between this embodiment and the
embodiments described above. A detailed description of features and
aspects of this sixth embodiment that are the same as those
described above will not be repeated.
[0136] This embodiment is the same as the first embodiment
described above, except mainly for differences in the configuration
of dissecting device.
Dissecting Device
[0137] As shown in FIGS. 12A and 12B, a dissecting device 200 in
this embodiment includes: an insertion section 200A inserted into a
living body; and an operating section (grip section) 200B located
on the proximal side of the insertion section 200A and used for
operating the insertion section 200A. The operating section 200B is
shifted (deviated) in relation to the center axis J of the
insertion section 200A, both in the thickness direction and in the
width direction. In other words, the operating section 200B is
offset from the center axis J of the insertion section 200A, both
in the thickness direction and in the width direction.
[0138] The dissecting device 200 configured as above helps ensure
easier disposition of the dissecting device 200 on the lower side
(bone side) of a great saphenous vein 1000. To be more specific,
since the operating section 200B is offset from the center axis J
of the insertion section 200A, at the time of inserting the
dissecting device 200 to the lower side of the great saphenous vein
1000, the operating section 200B does not overlap with (does not
make contact with) the great saphenous vein 1000, as shown in FIG.
12C. Therefore, the dissecting device 200 can be more easily
disposed along the great saphenous vein 1000.
[0139] By the sixth embodiment described above, also, the same or
equivalent effects to those of the first embodiment described above
can be produced.
Seventh Embodiment
[0140] FIGS. 13A and 13B illustrate a dissecting device possessed
by a blood vessel dissecting device according to a seventh
embodiment of the present disclosure.
[0141] Referring to these figures, the seventh embodiment will be
described below. The following detailed description will focus
primarily on differences between this seventh embodiment and the
embodiments described above. A detailed description of features and
aspects of this seventh embodiment that are the same as those
described above will not be repeated.
[0142] This embodiment is the same as the first embodiment
described above, except mainly for differences in the configuration
of dissecting device.
Dissecting Device
[0143] As shown in FIG. 13A, a dissecting device 200 in this
embodiment includes: a dissecting section 220; and an operating
section 200B located on the proximal side of the dissecting section
220 and used to operate the dissecting section 220. The operating
section 200B is disposed so that the operating section 200B is
shifted (deviated) in the width direction in relation to the center
axis J of the dissecting section 220. The dissecting device 200
configured in this way helps ensure that at the time of disposing
the dissecting device 200 on the lower side (bone side) of a great
saphenous vein 1000, the great saphenous vein 1000 and the
operating section 200B do not overlap with each other, as shown in
FIG. 13B. Therefore, it is easier to dispose the dissecting device
200 as desired.
[0144] By the seventh embodiment described above, also, the same or
equivalent effects to those of the first embodiment described above
can be produced.
Eighth Embodiment
[0145] FIG. 14 is a perspective view of a blood vessel dissecting
device according to an eighth embodiment of the present
disclosure.
[0146] Referring to this figure, the eighth embodiment will be
described below. The following detailed description will focus
primarily on differences between this embodiment and the
embodiments described above. A detailed description of features and
aspects of this eighth embodiment that are the same as those
described above will not be repeated.
[0147] This embodiment is the same as the aforementioned first
embodiment, except mainly for differences in the configuration of
cutting device.
Cutting Device
[0148] As shown in FIG. 14, a cutting device 300 in this embodiment
has a roughly C-shaped cross-section. A protection section 341 is
disposed at one end portion with respect to the circumferential
direction, and a protection section 342 is disposed at the other
end portion with respect to the circumferential direction. The
protection section 341 is provided with a connection section 385,
in the form of a stretch of projection (or a rib or ridge), for
connection with a rail 231 of a dissecting device 200. The
protection section 342 is provided with a connection section 386,
in the form of a stretch or length of projection (or a rib or
ridge), for connection with the rail 232 of the dissecting device
200. In addition, groove sections 320 and treating sections 330 are
disposed in pluralities along the circumferential direction. In the
illustrated embodiment, the treating section 330 is positioned
circumferentially between the groove sections 320.
[0149] An example of a manner of use of the cutting device 300
configured in this fashion is as follows. First, the dissecting
device 200 is inserted into a living body (on the upper side or
lower side of a great saphenous vein 1000). Next, the cutting
device 300 is connected to the dissecting device 200, and the
cutting device 300 is inserted into the living body while the
cutting device 300 is guided by the dissecting device 200. As a
result, the great saphenous vein 1000 is dissected over the entire
range in the circumferential direction of the vein. This embodiment
helps ensure that, for example as compared with the first
embodiment, the first step can be carried out in a reduced number
of procedures (steps).
[0150] By the eighth embodiment described above, also, the same or
equivalent effects to those of the first embodiment described above
can be produced.
Ninth Embodiment
[0151] FIG. 15A illustrates a great saphenous vein, and FIG. 15B is
a plan view of a dissecting device forming a part of a blood vessel
dissecting device according to a ninth embodiment of the present
disclosure.
[0152] Referring to these figures, the ninth embodiment will be
described below. The following detailed description will focus
primarily on differences between this ninth embodiment and the
embodiments described above. A detailed description of features and
aspects of this ninth embodiment that are the same as those
described above will not be repeated.
[0153] This embodiment is the same as the first embodiment
described above, except mainly for differences in the configuration
of dissecting device.
[0154] As depicted in FIG. 15B, a great saphenous vein 1000 may not
extend straight but may extend tortuously (in a somewhat meandering
manner). In view of this, a dissecting device 200 in this
embodiment is designed to be sufficiently large in width so that
upon insertion into a living body, the dissecting device 200
overlaps the whole area of that portion of the great saphenous vein
1000 which is to be dissected. This helps ensure that, at the time
of inserting a cutting device 300 along the dissecting device 200
after insertion of the dissecting device 200 into the living body,
contact between the cutting device 300 and the great saphenous vein
1000 can be prevented from occurring. Therefore, damage to the
great saphenous vein 1000 can be avoided or prevented. In addition,
the dissection of the great saphenous vein 1000 in a state where
the vein part to be dissected is entirely covered with fat 1200 can
be achieved more reliably.
[0155] By the ninth embodiment described above, also, the same or
equivalent effects to those of the first embodiment described above
can be produced.
Tenth Embodiment
[0156] FIGS. 16A and 16B are plan views of a dissecting device
forming a part of a blood vessel dissecting device according to a
tenth embodiment of the present disclosure.
[0157] Referring to these figures, the tenth embodiment will be
described below. The following detailed description will focus
primarily on differences between this embodiment and the
embodiments described above. A detailed description of features and
aspects of this tenth embodiment that are the same as those
described above will not be repeated.
[0158] This embodiment is the same as the first embodiment
described above, except mainly for differences in the configuration
of dissecting device.
[0159] A dissecting device 200 in this embodiment is deformable at
least in the width direction of the dissecting device 220, and is
configured to retain its deformed state. First, as shown in FIG.
16A, the dissecting device 200 set in a substantially straight form
is inserted into a living body along a great saphenous vein 1000 to
form an insertion hole, and then the dissecting device 200 is drawn
out of the living body. The dissecting device 200 may overlap the
whole area of that portion of the great saphenous vein 1000 which
is to be dissected before the dissecting device 200 set in the
substantially straight form is inserted into the living body along
the great saphenous vein 1000 to faun the insertion hole, and then
the dissecting device 200 is drawn out of the living body. The
dissecting device 200 is deformed in conformity with the shape of
the great saphenous vein 1000, and thereafter the deformed
dissecting device 220 is inserted again into the insertion hole. By
this procedure, the dissecting device 200 can be disposed in
conformity with the tortuous state of the great saphenous vein
1000, as shown in FIG. 16B. At the time of inserting the cutting
device 300 into the living body along the dissecting device 200,
therefore, contact between the cutting device 300 and the great
saphenous vein 1000 can be prevented from occurring, so that damage
to the great saphenous vein 1000 can be avoided or prevented. In
addition, the great saphenous vein 1000 can be dissected in a state
of being entirely covered substantially evenly with fat 1200.
Cutting-away of the fat 1200 in a surplus amount can also be
restrained.
[0160] The tortuous state of the great saphenous vein 1000 can be
grasped on the basis of images obtained, for example, by a
diagnosis carried out using MRI (magnetic resonance imaging), CT
(computed tomography) scan, ultrasound, infrared rays (near
infrared rays), X-rays, an endoscope, or the like.
[0161] With the dissecting device 200 secured to the living body (a
leg part of the patient), the insertion of the cutting device 300
can be carried out more smoothly. The method for securing the
dissecting device 200 to the living body is not particularly
limited. For example, there can be adopted a method wherein a
fixture capable of being fixed by winding around a leg part is
mounted onto the leg part, and the dissecting device 200 is secured
to the fixture.
[0162] By the tenth embodiment described above, also, the same or
equivalent effects to those of the first embodiment described above
can be produced.
Eleventh Embodiment
[0163] FIGS. 17A and 17B are plan views of a dissecting device
possessed by a blood vessel dissecting device according to an
eleventh embodiment of the present disclosure.
[0164] Referring to these figures, the eleventh embodiment will be
described below. The following detailed description will focus
primarily on differences between this eleventh embodiment and the
embodiments described above. A detailed description of features and
aspects of this embodiment that are the same as those described
above will not be repeated.
[0165] This embodiment is the same as the first embodiment
described above, except mainly that the blood vessel dissecting
device in this embodiment further includes a guide device.
[0166] A blood vessel dissecting device 100 in this embodiment
includes a guide device 600 shown in FIG. 17A, in addition to a
dissecting device 200 and a cutting device 300. The guide device
600 is designed in conformity to a preliminarily grasped shape of a
great saphenous vein 1000. The guide device 600 is provided with
rails 601 and 602 for guiding the cutting device 300; on the other
hand, rails 231 and 232 are omitted from the dissecting device
200.
[0167] In using the blood vessel dissecting device 100 configured
in this way, first, the dissecting device 200 is inserted into the
living body along the great saphenous vein 1000 to form an
insertion hole, and is drawn out of the living body. Next, the
guide device 600 is inserted again into the insertion hole. As a
result, the guide device 600 can be disposed in conformity with the
tortuous state of the great saphenous vein 1000 as shown in FIG.
17B.
[0168] Therefore, at the time of inserting the cutting device 300
into the living body along the guide device 600, contact between
the cutting device 300 and the great saphenous vein 1000 can be
prevented from occurring, so that damage to the great saphenous
vein 1000 can be avoided or prevented. The great saphenous vein
1000 can be dissected in a state of being entirely covered
substantially evenly with fat 1200. In addition, cutting-away of
the fat 1200 in a surplus amount can be restrained.
[0169] By the eleventh embodiment described above, also, the same
or equivalent effects to those of the first embodiment described
above can be produced.
Twelfth Embodiment
[0170] FIGS. 18A and 18B are cross-sectional views showing a blood
vessel dissecting device according to a twelfth embodiment of the
present disclosure.
[0171] Referring to these figures, the twelfth embodiment will be
described below. The following detailed description will focus
primarily on differences between this twelfth embodiment and the
embodiments described above..
[0172] This embodiment is the same as the eleventh embodiment
described above, except mainly for differences in the configuration
of the dissecting device.
[0173] As shown in FIG. 18A, a dissecting device 200 in this
embodiment is provided with an insertion hole (insertion groove or
insertion recess) 280 in which a guide device 600 can be inserted.
The insertion hole 280 opens to a surface on one side of the
dissecting device 200 (a surface oriented to the side of a great
saphenous vein 1000 when the dissecting device 200 is inserted in a
living body). In using the blood vessel dissecting device 100
configured in this way, first, the dissecting device 200 is
inserted into the living body along the great saphenous vein 1000,
as shown in FIG. 18A. Next, as shown in FIG. 18B, the guide device
600 is inserted into the insertion hole 280. By this, the guide
device 600 can be rather smoothly disposed in conformity to the
tortuous state of the great saphenous vein 1000. Subsequently, the
cutting device 300 is inserted into the living body along the guide
device 600. This procedure helps ensure that at the time of
inserting the cutting device 300, contact between the cutting
device 300 and the great saphenous vein 1000 can be prevented from
occurring, so that damage to the great saphenous vein 1000 can be
avoided or prevented. In addition, the great saphenous vein 1000
can be dissected in a state of being entirely covered substantially
evenly with fat 1200. Cutting-away of the fat 1200 in a surplus
amount can also be restrained.
[0174] By the twelfth embodiment described above, also, the same or
equivalent effects to those of the first embodiment described above
can be produced.
[0175] While the blood vessel dissecting device and the blood
vessel dissecting method according to the described aspects of the
present disclosure have been described above on the basis of the
embodiments illustrated in the drawings, the disclosure is not
limited to the embodiments. The configuration of each component can
be replaced by any configuration that has a function similar or
substantially equivalent to the original. And other structure may
be added to the configuration according to the present disclosure.
In addition, the embodiments and application examples may be
combined in a desired manner
[0176] The great saphenous vein is dissected in the state of being
covered with fat over the entire perimeter of the vein in the
aforementioned embodiments, but the great saphenous vein may not
necessarily be covered with fat over its entire perimeter. Thus,
the great saphenous vein may be dissected in a state where the
periphery of the vein is partly covered with fat, or in a state of
being not covered with fat. For instance, the great saphenous vein
1000 may be dissected in a state of being covered with flat-shaped
fat 1200, as shown in FIG. 19, wherein the fat 1200 present on the
upper and lower sides is relatively thin (or the fat 1200 is absent
on the upper and lower sides) and wherein the fat 1200 present on
the left and right sides is relatively thick. In such a state, the
conditions (for example, the presence or absence of damages, shape,
twisting, etc.) of the great saphenous vein 1000 can be easily
checked and confirmed from above and from below. Consequently, it
is possible to use the great saphenous vein 1000 as a bypass vessel
or the like after grasping the conditions of the great saphenous
vein 1000.
Other Embodiments
[0177] Set forth next is a description of various other embodiments
of dissecting devices and techniques according to the disclosure
here. For purposes of facilitating an understanding of general
aspects of the anatomy involved here, FIG. 20A shows a leg of a
living body (patient) and depicts the great saphenous vein 1000
extending from the upper leg to the lower leg, FIGS. 20B and 20C
depict cross-sections of the upper leg and the lower leg
respectively, including the great saphenous vein, and FIGS. 21A and
schematically depict the noted portions of the upper and lower leg
respectively.
[0178] As shown in FIGS. 21A and 21B, the great saphenous vein 1000
(hereinafter referred to as the saphenous fascia) extends between
the upper and lower leg of a living body (patient), and tissue or a
membrane 1600 is bound to this vein 100. This bound tissue or
membrane is referred to as saphenous fascia 1600. A physical
properties or characteristics of the saphenous fascia 1600 are
different from a physical properties or characteristics of the
muscular fascia 1500 and the fat tissue 1200 (fat), meaning it is
relatively easy to dissect the saphenous fascia 1600 from the fat
1200 and the muscular fascia 1500. The embodiments of the
techniques and devices described below and illustrated in the
drawing figures represent examples of the techniques and devices
disclosed here, and can be used to dissect tissue from other
tissue, such as dissecting the saphenous fascia 1600 from the fat
1200. The description below describes a variety of operations and
techniques for dissecting a vein/tissue from other adjacent tissue.
The description refers specifically to dissecting the saphenous
vein 100/saphenous fascia 1600 from adjacent tissue, namely fat and
the muscular fascia. But it is to be understood that the dissection
(and cutting) operations and methods described below are not
limited to dissecting (cutting) only such vein/tissue.
[0179] One embodiment of the blood vessel dissecting device
includes the combination of a dissecting device and a cutting
device. The dissecting device 700 is illustrated in FIGS. 22A and
22B, and can be used in combination with the cutting device 300
illustrated in FIGS. 3A and 3B. The dissecting device 700 shown in
FIGS. 22A and 22B is an elongated bar-shaped member comprised of a
main body section 702 and a dissecting section 704 for dissecting
tissue. As illustrated in FIG. 22A, the dissecting section 704 is
at the distal end of the dissecting device 700 and is slightly
curved or upturned relative to the main body section 702. The main
body section 702 lies in a common plane, whereas the slightly
curved dissecting section 704 is located out of that common plane
(i.e., the dissecting section 704 curves out of the plane in which
the main body section 702 lies). The cross-sectional shape of the
dissecting device 700 can be similar to that described above with
respect to the dissecting device 200 shown in FIG. 2B, meaning the
dissecting device possesses a flat shape (vertically flattened
shape as seen in transverse cross-section) in cross-section, though
the dissecting device is not limited to the specific flattened
shape shown as other shapes (e.g., a crushed-circle-like shape
(flattened circular shape), such as an oblong and an ellipse, a
rectangle rounded at corners, etc.). The dissecting device 700
possesses a width that is preferably greater than the outside
diameter of the blood vessel or vein to be harvested (e.g., the
saphenous vein). In this regard, the dissecting device 700 can
possess a dimensional relationship relative to the blood vessel
similar to that described above with respect to the dissecting
device 200.
[0180] As illustrated in FIGS. 22C, the opposite sides or edges of
the dissecting device include rails 731, 732 in the form of
recesses, grooves or the like. These rails 731, 732 are similar to
the rails 231, 232 associated with the above-described embodiment
of the dissecting device 200, and are configured as connection
mechanisms for connecting cutting devices to the dissecting device
700.
[0181] The dissecting device 200 also includes an insertion hole
710 which is open at both ends. The insertion hole 710 is thus a
through hole. The insertion hole 710 is configured to receive an
imaging device such as the imaging device 400 described above to
permit visual imaging inside the living body during use of the
dissecting device.
[0182] The dissecting section 704 at the distal end of the
dissecting device 200 is tapered in a narrowing manner toward the
distal end of the dissecting device 700 as seen in FIG. 22B. The
dissecting section 704 preferably possesses an appropriate degree
of sharpness or bluntness so that the dissecting section 704 is
able to dissect tissues having different properties (e.g., fat and
skin, fat and fascia, fat and blood vessel, fat and bone, etc.)
from each other without cutting branch vessels or side branches
from the saphenous vein.
[0183] The dissecting device 700 is a flat dissecting device except
for the slightly curved or upturned dissecting section 704 at the
distal end of the dissecting device 700. The upturned distal end of
the dissecting device 700 can reduce damage to the saphenous vein
because the upturned distal end of the dissecting device does not
strike or dig into the saphenous vein.
[0184] FIGS. 23A-23C illustrates an example of a dissecting
technique or method utilizing the dissecting device 700 shown in
FIGS. 22A and 22B, together with the cutting device 300 shown above
in FIGS. 3A and 3B. First, an incision is made in the leg of the
patient (living body) to provide an access site to the
vein/saphenous fascia on the vein. Next, the distal end of the
dissecting device 700 is inserted into the living body by way of
the incision or access site in the leg of the patient. The
dissecting device 700 is moved in the living body so that, as
illustrated in FIG. 23A, the dissecting device 700 is positioned
between the saphenous vein 1000 and the skin 1400. More
specifically, the dissecting device 700 is inserted so that the
under-surface of the dissecting device 700 (i.e., the surface of
the dissecting device 700 facing the saphenous vein 1000) is in
contact with the thin layer (the connective tissue) or saphenous
fascia 1600 bound to the saphenous vein 1000. The vein 1000 may be
visible through the connective tissue from outside of the living
body before inserting the distal end of the flat elongated
dissecting device. The dissecting device 700 is generally located
at the interface between the saphenous fascia 1600 and the fat
1200. The dissecting device 700 is moved within the living body
while maintaining this contact between the under-surface of the
dissecting device 700 and the fascia layer (the saphenous fascia
1600). In this way, the fascia layer or saphenous fascia is
dissected or separated from the adjacent tissue (e.g., fat) in the
thickness direction of the dissecting device 700. That is, the
fascia layer is separated from the other tissue in the vertical or
up-and-down direction in FIGS. 23A-23C.
[0185] The dissecting technique or method continues, as illustrated
in FIG. 23B, by inserting a second dissecting device 700' between
the muscular fascia 1500 and the great saphenous vein 1000. This
second dissecting device 700' is similar to the first dissecting
device 700, except that the second dissecting device 700' includes
a cutting device 701' positioned in the central part of the
dissecting device 700' and movable along the length of the
dissecting device 700'. FIG. 23B1 illustrates an example of the
second dissecting device 700', but with the cutting device 701'
omitted. The second dissecting device 700' includes two
side-by-side elongated sections 7001, 7002 spaced apart from one
another with inwardly facing grooved sides 7003, 7004 that face one
another and are configured to receive the cutting device 701'. The
second dissecting device 700' is inserted into the living body, for
example by way of the same incision used to insert the first
dissecting device 700, and is moved along the saphenous vein 1000
along a movement path that crosses a side branch 1100 of the great
saphenous vein 1000 as illustrated in FIG. 23B. The side branch
1100 of the vein can be a perforator or a collateral vein. The
second dissecting device 700' may be inserted into the living body
before the first dissecting device 700 is inserted into the living
body.
[0186] A cutting device 701' is then inserted into a connecting
portion of the second connecting device 700'. The connecting
portion can be similar to the rail 731, 732 shown in FIG. 22C,
except that the connecting portion is provided on inwardly facing
sides or edges of spaced apart portion of the second dissecting
device 700'. The cutting device 701' is then moved in the forward
direction, relative to the second dissecting device 700', towards
the distal end of the second dissecting device 700'. During this
movement of the cutting device 701', the cutting device 701' cuts
the side branch of the vein (e.g., a perforator or a collateral
vein).
[0187] The dissecting method continues by inserting a pair of
further cutting devices into the living body. This is shown in FIG.
23C where a pair of second cutting devices 300, similar to the
cutting devices 300 shown in FIGS. 3A and 3B above, are inserted on
opposite sides of the saphenous vein 1000. The second connecting
devices 300 are connected to connecting portions on the outer side
edges of the first dissecting device 700 and the second dissecting
device 700'. Thus, the second dissecting device 700' includes rails
on both the inner and the outer side of the second connecting
device. The second cutting devices 300 are moved along (relative
to) the two dissecting devices 700, 700' towards the distal ends of
the dissecting devices 700, 700'. During this movement, the second
cutting devices 300 cut or sever the side branches 1101 of the
saphenous vein 1000. After the cutting by the second cutting
devices 300 is complete, the saphenous vein, together with the
surrounding tissue bound to the vein (saphenous fascia 1600) are
removed from the living body (limb) of the patient, together with
the dissecting devices and cutting devices.
[0188] The first and second cutting devices described above and
used with the two dissecting devices 700, 700' can be bi-polar type
electric devices as described previously. Also, the two dissecting
devices 700, 700' can be inserted sequentially one after the other
as described above, or generally at the same time.
[0189] FIG. 24A illustrates a portion of the living body (limb) in
transverse cross-section after removing the cutting devices and the
first dissecting device, and FIG. 24B illustrates a portion of the
limb in longitudinal cross-section after such removal. FIG. 24B
also illustrates, somewhat schematically, loop-shaped members that
are used for stanching.
[0190] FIGS. 25A-25C, 26A-26C and 27A-27C illustrate different
harvested vein shapes. FIG. 25A illustrates a U-shaped dissecting
device 700'' (cutting device) used together with the dissecting
device 700. FIG. 25C illustrates the cross-section of the vein and
bound tissue that is ultimately removed from the living body, and
FIG. 25B illustrates the living body in transverse cross-section
after removal of the vein and bound/surrounding tissue.
[0191] FIG. 26A illustrates an example in which the dissecting
device 300 is positioned between the tissue (saphenous fascia)
bound to the saphenous vein 1000 and the muscular fascia 1500, a
pair of the cutting devices 300 are positioned on opposite sides of
the great saphenous vein 1000, and another cutting device 300'
similar to the first pair of cutting devices 300 is positioned
between the skin 1400 and the vein 1000. FIG. 26C illustrates the
saphenous vein 1000 and the surrounding or bound tissue that is
removed after the procedure shown in FIG. 26A, and FIG. 26B
illustrates the portion of the living body after the removal of the
saphenous vein and surrounding tissue.
[0192] FIG. 27A is similar to FIG. 26A except that the particular
configuration of the surrounding tissue that is dissected (cut
away) and removed from the living body is slightly different.
[0193] FIGS. 25A-25C, FIGS. 26A-26C and FIGS. 27A-27C illustrate
that using differently shaped dissecting devices (or cutting
devices) together with the positioning and relative location of
such devices will alter the shape of the surrounding tissue that is
removed with the vein. FIGS. 27A-27C show an embodiment in which
the cutting devices and dissecting devices are slightly spaced
apart relative to the arrangement of the cutting devices and
dissecting devices in FIGS. 26A-26C.
[0194] The cutting device illustrated in FIG. 25A can be the same
as the cutting device 300 shown in FIG. 14 which possesses the
generally U-shaped configuration in transverse cross-section. In
the aspect of the method illustrated in FIG. 25A, the cutting
device 300 and the dissecting device 700 together form a space that
encloses, covers or surrounds the saphenous vein 1000. It is also
possible to use other differently shaped or configured dissecting
devices and/or cutting devices to vary the configuration of the
tissue (i.e., tissue bound to the saphenous vein) that is removed
together with the saphenous vein 1000. The methods or operational
procedures described above involve steps or operations performed to
harvest a vein (e.g., the saphenous vein 1100) from the living body
of a patient. It is to be understood that the methods and
operational procedures described above are not necessarily limited
to dissecting the saphenous vein/saphenous fascia from the adjacent
fat tissue or muscular fascia, as the disclosure has general
application to dissecting tissue bound to a vein from other
adjacent tissue in the living body. The methods or operational
procedures involve providing access to the vein and tissue in the
living body by making an incision in a patient's leg, thereby
exposing the thin layer (e.g., tissue layer or saphenous fascia)
that is bound to the vein. The operations or steps carried out
above are then performed to dissect or separate the thin layer
(e.g., fascia layer or tissue layer) from the other tissue (e.g.,
fat) as described above.
[0195] The methods or procedures described above can be furthered
by solidifying the fat 1200 or the saphenous fascia 1600,
preferably before inserting any of the dissecting devices and/or
cutting devices into the living body. This can be accomplished by
utilizing cooling techniques that cool the patient's limb (leg)
from which the vein is being harvested. Cooling the leg can be
carried out to subject the patient's limb (leg) to a temperature
below room temperature that reduces the body temperature to below a
typical body temperature of 98.6.degree. F. The leg can be cooled
to reduce the temperature of the patient's limb to between
14.degree. F. and 68.degree. F., more preferably between 32.degree.
F. and 50.degree. F.
[0196] Another possibility to enhance the dissecting operation is
to melt the fat tissue, once again before inserting any of the
dissecting devices and/or cutting devices into the living body.
This melting of the fat can be accomplished by heating the
patient's limb (leg) in some way. The heating would be accomplished
by subjecting the leg to a temperature above room temperature that
raises the temperature of the patient's limb (leg) to a temperature
above the typical body temperature of 98.6.degree. F. The leg can
be heated to increase the temperature of the patient's limb to
between 122.degree. F. and 176.degree. F., more preferably between
131.degree. F. and 167.degree. F.
[0197] FIGS. 28A-28C illustrates additional modifications to the
dissecting devices described above. FIG. 28A illustrates a
modification that is intended to facilitate advancement of the
dissecting device through the interface between the two tissues
being dissected, the saphenous fascia and fat tissue in this
example. The dissecting device 720 includes a proximally located
relatively hard section or part 722 and a distally located
relatively soft section or part 724. The relatively hard part 722
allows a force applied to the dissecting device 720 to be
transmitted in a way that advances the dissecting device 720 in the
living body in the forward direction indicated by the arrow, while
the relatively soft part 724 is able to flex or bend while moving
in the living body to help navigate along the saphenous fascia-fat
tissue interface. The saphenous fascia 1600 possesses different
characteristics relative to the fat tissue and is thus relatively
easily separated from the fat tissue 1200. The relatively soft part
724 of the dissecting device 720 is thus able to be advanced along
and generally conform (follow) the saphenous fascia-fat tissue
interface in a way that facilitates separation or dissection
without puncturing or otherwise damaging the two types of
tissues.
[0198] FIG. 28B illustrates a modified form of the dissecting
device 730 that includes a plate-shaped main body portion 736 and a
distal end that is rounded, representing a portion of a circle. The
edge shape of the distal end of the dissecting device 730 is thus
blunted or softened in a way that is not so likely to break or
otherwise damage the saphenous fascia and/or fat tissue. The
rounded distal end of the dissecting section 730 can have an edge
that is wider than a mesh size (void size) of the fat septum (fat
particles), and can have an edge that is softer than the saphenous
fascia and fat septum. The edge being wider than the mesh size of
the fat septum and being softer than the saphenous fascia and fat
septum help facilitate relatively easy movement along the saphenous
fascia without entering between the fat septums. As the dissecting
device enters between the fat septums, the dissecting member may
not be able to move to a destination to lose landmarks. The phrase
"wider edge" as used above refers to a diameter of the rounded
distal end 732. The dissecting device 730 also includes a tapering
portion 734 that tapers from the plate-shaped main body portion 736
to the rounded distal end 732.
[0199] FIG. 28C illustrates a further embodiment of the dissecting
device in which the dissecting device 744 includes a freely
rotatable roller 742 mounted at the distal end of the main body
portion 744. This roller portion 742 helps reduce the sheer stress
on the tissue at the saphenous fascia-fat tissue interface because
the roller is able to rotate during the forward movement (indicated
by the arrow in FIG. 28C) as the dissecting device 740 is pushed.
An alternative to the roller would be to apply a sheer
stress-reducing coating such as polytetrafluoroethylene (PTFE) on
the distal end portion of the dissecting device. Such a coating
could be applied, for example, to the rounded distal end of the
dissecting device shown in FIG. 28B.
[0200] Another aspect of the disclosure here involves utilizing a
dissecting device configured to inhibit or prevent movement or
deviation of the vein (and the dissecting device) during the
dissecting operation or procedure. FIGS. 29A-29E illustrates one
embodiment of such a dissecting device. The dissecting device 750
shown in FIGS. 29A-29E includes an elongated member that, as seen
in the top view of FIG. 29A, narrows from the proximal end (i.e.,
the right hand side in FIG. 29A) toward the distal end (i.e., the
left-end in FIG. 29A). In the illustrated embodiment, the taper is
continuous and gradual from the distal-most end of the dissecting
device to the proximal-most end of the dissecting device.
[0201] FIG. 29B illustrates the dissecting device 750 in side view,
and shows that the dissecting device vary from a straight portion
at the distal end of the dissecting device to an enclosing or
covering portion 754 that is not plate-shaped. As seen in the
cross-sections of FIGS. 29C-29E, the straight portion at the distal
end is flat or plate-shaped, and the covering portion 754 is
radially curved. The radially curved covering portion generally
encloses or surrounds the saphenous vein 1000. The drawing figures
illustrate that the dissecting device 750 transitions from the
straight portion to the cross-section of the covering portion shown
in FIG. 29E. That is, the cross-sectional shape of the dissecting
device 750 gradually transitions, beginning at the straight
portion/covering portion interface, from the flat plate-shaped to
the curved shape. In addition, the covering portion 754 exhibits a
gradually increasing circumferential extent towards the proximal
end of the dissecting device 750. Thus, as seen in FIG. 29D, the
dissecting device is an approximate half-circle extending over a
circumferential extent of about 180.degree. to the cross-section
shown in FIG. 29E in which the circumferential extent of the
covering portion is greater, preferably about 300.degree.. Thus,
the circumferential extent at the cross-section shown in FIG. 29E
is more than 1.5 times the circumferential extent at the
cross-section shown in FIG. 29D. Also, the distance between the
edges of the dissecting device as seen in the cross-section of FIG.
29E (a vertical cross-section to a central axis of the dissecting
device) is preferably between about 3.0 cm and 7.0 cm, more
preferably between about 4.0 cm and 6.0 cm.
[0202] The dissecting device 750 illustrated in FIGS. 29A-29E can
be used in the following manner. An operational procedure begins by
making an incision in the limb (e.g., leg) of the living body of
the patient to create an access site to the vein (e.g. saphenous
vein 1000). The distal end of the dissecting device 750 is then
inserted into the living body by way of the incision, and the
dissecting device 750 is moved along the vein 1000. When the
dissecting device 750 is positioned relative to the vein 1000 in
the manner such as illustrated in FIGS. 29A and 29B, the straight
flat portion 752 of the dissecting device 750 is located between
the vein 1000 and the skin as shown in FIG. 29C. At this time, the
covering portion 754 of the dissecting device 750 is positioned
relative to the vein 1000 in the manner shown in FIGS. 29D and 29E.
As illustrated in FIG. 29D, the circumferential free ends of the
dissecting device 750, as seen in transverse cross-section, contact
the side branches or side vessels of the vein to hold the vein in
position. Farther towards the proximal-most end of the dissecting
device 750, the dissecting device has a much greater
circumferential extent and thus tends to squeeze the side vessels
of the vein 1000 towards one another in a way that constrains or
holds the vein. The vein is thus held in a way that inhibits
movement of the vein during subsequent cutting operations.
[0203] In this particular embodiment just described, the covering
portion 754 is fixed in shape or configuration. It is possible to
implement a modified construction in which the shape or
configuration of the covering portion 754 changes or can be
varied/adjusted.
[0204] For example, FIGS. 30A and 30B illustrate a dissecting
device 760 that includes a flat straight portion 762 at the distal
end similar to the flat straight portion 752 in the embodiment
described above, together with an adjustable or changeable covering
portion 764. In this illustrated embodiment, the shape-adjustable
covering portion 764 is comprised of a pair of legs 765, 765
connected to one another at a hinge pin 766. The hinge pin allows
the legs 765, 765 to be moved relative to one another. With this
embodiment, the dissecting device 760 can be inserted into the
living body by way of the incision, and after insertion so that the
covering portion 764 overlies the vein 1000, the two legs 765, 765
are rotated to a position such as illustrated in FIG. 30B so that
the legs 765, 765 hold the vein 1000 by way of the side branches
1100. Changing the legs 765, 765 to the position shown in FIG. 30B
can help harvest a significant amount of fat with the dissecting
device. Thereafter, the dissecting device 760 is moved.
[0205] FIG. 30C illustrates another version of the dissecting
device 760' in which the covering portion 764' is shape-adjustable.
Here, the covering portion 764' is comprised of an elongated member
765' that is configured to be bent into a curved shape. The
dissecting device 765 shown in FIG. 30C includes the same flat
straight distal end portion 762 shown in FIG. 30A. This embodiment
of the dissecting device 760' is used in the manner similar to the
dissecting device 760 described above in which the dissecting
device 760' is inserted into the living body and moved to a
position along the vein 1000, and is then changed to the curved
shape shown in FIG. 30C. When in the configuration shown in FIG.
30C, the covering portion 764' applies a force to the side branches
1100 of the vein or surrounding the tissue of the vein tending to
hold the vein 1000 in place. In this embodiment, like the
embodiment shown in FIG. 30B, the thin layer bound to the vein 1000
(i.e., the saphenous fascia 1600 bound to the vein 1000) is
contacted by the covering portion 764'.
[0206] FIG. 30D illustrates another shape-adjustable version of the
dissecting device 76 in which the covering portion 764'' is
comprised of three legs 765'', 765''. The adjacent legs can be
connected to one another by hinge pins similar to the hinge pins
shown in FIG. 30B. In this embodiment shown in FIG. 30D, the hinge
pins would be located at the corners of the covering portion 764''
in the configuration shown in FIG. 30D. The dissecting device 760''
shown in FIG. 30D also includes, at the distal end portion, a flat
straight portion similar to the flat straight portion 762 shown in
FIG. 30A. The use of the embodiment of the dissecting device
illustrated in FIG. 30D is similar to that described above with
respect to the embodiment depicted in FIGS. 29A-29E.
[0207] FIGS. 31A-31B illustrates one manner of using the dissecting
device 750 illustrated in FIGS. 29A-29E, together with cutting
devices. First, the flat straight distal end portion of the
dissecting device 750 is inserted into the living body by way of
the incision, and the dissecting device is moved in the forward
direction along the vein 1000 until the dissecting device is
positioned at the desired place for dissecting the tissue and
harvesting the vein 1000. At this position, illustrated in FIG.
31A, the free ends of the curved covering portion 754 contact and
press against the vein 1000 (the side branches 1100) thus holding
the vein 1000 in place to inhibit movement. Next, as illustrated in
FIG. 31B, a flat dissecting device like the flat dissecting 700'
shown in FIG. 23B is inserted to a position illustrated in FIG. 31B
in which the flat dissecting device is positioned between the vein
1000 and the muscular fascia 1500. The flat dissecting device is
then moved to a position near the side branch 1100.
[0208] Next, a cutting device (first cutting device) like the
cutting device 701' shown in FIG. 23B is inserted into the flat
elongated dissecting device 700' so that the cutting device engages
the connecting portion of the flat dissecting device 701'. The
first cutting device is advanced along the flat dissecting device
701' toward the distal end of the flat dissecting device to thereby
cut the side branch of the vein.
[0209] Next, the cutting device (first cutting device) is removed
from the dissecting device 750, and two second cutting devices,
which can be similar to the cutting devices 300 shown in FIG. 3A
and 3B, are inserted into the loving body on opposite sides of the
vein 1000 (saphenous fascia 1600). Each of the second cutting
devices 300 is inserted into a respective connecting portion at the
side of the flat dissecting device 700' in a manner similar to that
described above. That is, the dissecting device 700' can include
rails or grooves on the outwardly facing outer surfaces of the
dissecting device 750 similar to the rails or grooves 231, 232
shown in FIGS. 2A and 2B. The second cutting devices 300 are then
moved in the forward direction toward the end of the flat
dissecting device 700' to thereby cut the side branches of the vein
1000. This insertion and movement of the second cutting device to
cut the side branches 1100 can be carried out at the same time.
Alternatively, one of the second cutting devices 300 can be
inserted into the connecting portion on one side of the flat
dissecting device 700' and then advanced in the forward direction
to cut one of the side branches, and then the other second cutting
device 300 can be inserted into the connecting portion at the other
side of the flat dissecting device 700' and moved forward to cut
the other side branch. Thereafter, the flat dissecting device 700'
and the two second cutting devices 300 are removed followed by
removable of the dissected/harvested vein 1000 with the severed
side branches 1100.
[0210] With respect to the dissecting device 750 illustrated in
FIGS. 29A-29E, it is possible during use of this dissecting device
to apply pressure from outside the living body and to apply such
pressure to the proximal portion of the dissecting device 750, such
as at the location identified by the arrow 757 in FIG. 29A. This
application of an external force from outside the living body can
help hold the vein and inhibit or prevent the vein from moving.
FIGS. 32A and 32B illustrate the effect of such a pressing
operation. FIG. 32A shows the portion of a limb of a living body
before insertion of the dissecting device 750, while FIG. 32B
illustrates the same portion of the limb of the living body after
the dissecting device is inserted and after a force is applied as
indicated by the arrow 757 in FIG. 32B. The applied force causes
the vein (the side branches 1100) to be bent or folded as shown in
FIG. 32B, thus holding the vein in place and inhibiting the vein
from moving.
[0211] FIG. 33 illustrates another way of applying a holding force
to hold the vein 1000 in place and inhibit movement of the vein.
This method involves utilizing two flat dissecting devices which
can be similar to the flat dissecting devices 700 illustrated in
FIGS. 22A and 22B. As an alternative, it is also possible to use
the flat dissecting devices 200 illustrated in FIGS. 2A and 2B.
This method involves inserting the two flat dissecting devices 700
into the limb (leg) of the living body (patient) by way of the
incision, and moving the flat dissecting devices 700 along the vein
1000 on opposite sides of the vein 1000. Pressing the two flat
dissecting devices 700 towards one another as schematically
illustrated in FIG. 33 by way of the arrows results in the vein
1000 being held in place to inhibit movement of the vein. This
applied force can also fold the side branches 1100 somewhat while
the dissecting devices 700 also contact the tissue bound to the
vein (saphenous fascia). Once the vein is held by the two
dissecting devices 700, it is possible to introduce a dissecting
device like the dissecting device 700' described above and
illustrated in FIG. 31B, followed by insertion and movement of the
cutting device 701' to cut the side branch. Thereafter, the two
dissecting devices 700 can be removed, and cutting devices like the
cutting device 300 shown in FIG. 31C can be inserted along opposite
sides of the vein.
[0212] With respect to the various aspects of the disclosure
described above and illustrated in FIGS. 29A-29E, FIGS. 30A-30D,
31A, 31B, 32A, 32B and 33, it is possible to solidify the fat or
saphenous fascia before inserting the dissecting device or to melt
the fat before inserting the dissecting device as described above.
It is also possible to implement with these various embodiments the
additional aspects described above and illustrated in FIG.
28A-28C.
[0213] Set forth next is a description of alternative embodiments
of a dissecting device for dissecting tissue. In these embodiments,
the dissecting device includes a wire configured to dissect one
tissue (e.g., saphenous fascia) from other tissue (fat). Referring
to FIG. 34, the dissecting device 800 includes a pair of rods or
elongated members 802 mounted in respective rod holders (holders)
806. The rods 802 can be hollow tubes. In the illustrated
embodiment, the two rods 802 are parallel to one another. The
holders 806 are both mounted on a rod holder guide 808. Each of the
holders 806is preferably individually movable relative to the rod
holder guide 808 through suitable operation of a dial (lever) 804.
By operating the dial 804 of each holder 806, the holders 806 are
movable relative to the guide 808, making it possible to adjust the
position of the holder 806, and thus the rod or elongated member
802, along the guide 808 to thereby adjust the spacing or distance
between the two rods or elongated members 802. Operating the dial
804 again (e.g., tightening the dial) fixes the position of the
holder 806, and thus the rod or elongated member 802, along the
guide 808 to thereby fix the position of the two rods or elongated
members 802.
[0214] A wire 810 spans or extends between the two rods 802 near
the distal ends of the rods 802 as illustrated in FIG. 34. The wire
preferably passes through respective holes or slits near the distal
end of each of the rods 802 and extend into the hollow interior of
each of the rods 802. There is a suitable length of the wire 810
inside each of the rods 802 to accommodate movement of the rods 802
away from one another.
[0215] In the illustrated embodiment, the distal ends of the rods
802 are preferably tapered to a pointed or sharp end as illustrated
in FIG. 34. This allows the rods to be introduced into the living
body by way of an incision while permitting relatively easy
insertion and movement in the living body.
[0216] The movable mounting of the holders 806 on the guide 808 is
schematically illustrated in FIG. 34. Any suitable arrangement can
be utilized for adjusting the position of the holders 806 along the
guide 808. For example, each of the holders 806 can include a
tubular mount encircling the guide 808. The dial (lever) 804 can
pass through a hole in such tubular mount and press against the
outer peripheral surface of the guide 808. Loosening the dial 804
allows the holder 806 to be moved along the guide 808. Once again
tightening the dial 804 causes the dial to frictionally engage the
outer peripheral surface of the guide 808 and thereby fix the
position of the holder 806 relative to the guide 808.
[0217] FIGS. 35-37 illustrate operational aspects of a method or
procedure utilizing the dissecting device 800 shown in FIG. 34.
Initially, as illustrated in FIG. 35, after an incision is made in
the limb (e.g., leg) of the living body (patient), the distal ends
of the rods 802 are positioned adjacent the saphenous vein 1000 or
saphenous fascia 1600. The purpose for this is to adjust the
spacing between the rods 802 so that they are positioned at the
desired place relative to the desired dissection that is to be
performed. For example, to dissect the saphenous vein 1000 and the
saphenous fascia 1600 bound to the saphenous vein from the adjacent
fat 1200, the dissecting device 800 would be positioned generally
as illustrated in FIG. 35 so that the rods 802 are located at the
interface between the saphenous fascia 1600 and the fat 1200. The
dial 804 on one or both of the holders 806 is then loosened to
adjust the position of the rod(s) 802 along the guide 808 so that
the distal ends of the rods 802 are spaced apart by a distance
which positions the distal ands of the rods 802 at the interface
between the saphenous fascia 1600 and the fat 1200.
[0218] FIG. 36 illustrates the adjustment of the spacing between
the rods 802 so that they are positioned at the desired relative
position for dissecting. FIG. 36 illustrates the loosening
(represented by the arrows 803) of the dial 804 and the subsequent
movement (represented by the arrows 805) of the holders 806 along
the guide 808 to move the rods 802 away from one another to the
desired spacing. Next, as illustrated in FIG. 37, the rods 802 are
inserted into the limb (leg) of the living body by way of the
previously made incision in the limb, and are moved along the vein
1000. As the rods 802 and the wire 810 are moved along the vein in
the forward or distal direction, the wire performs dissection
(e.g., dissection of the saphenous fascia from the surrounding
tissue or fat). The dissecting device 800 can be inserted into the
limb of the living body along any of the sides of the vein
1000/fascia 1600. For example, the rods 802 and the wire 810 can be
inserted between the saphenous fascia 1600 and the fat 1200,
between the saphenous fascia 1600 and the skin 1400, or on opposite
lateral sides of the vein 1000. The dissecting device 800 can be
moved forward and backward in the distal and proximal directions in
the living body to ensure that the tissue bound to the vein is
appropriately dissected from the surrounding tissue.
[0219] The embodiment of the dissecting device 800 described above
can include rods 802 that are fixed relative to the respective
holders 806. But it is also possible to implement a configuration
in which the rods 802 are axially adjustable along their
longitudinal extent relative to the holders 806. For example, the
rods 802 can be slidably positioned in the respective holder 806,
and adjustable by way of a set screw that threadably engages a
through hole in the holder 806. The set screw would be adjustable
between one position in which the set screw bears against the outer
surface of the rod 802 to fix the position of the rod 802 relative
to the holder 806, and another position in which the set screw is
spaced from (i.e., not in engagement with) the outer periphery of
the rod 802 to permit the rod 802 to move relative to the holder
806.
[0220] Another alternative would be to utilize rods 802 comprised
of two telescoping tubes, one positioned inside the other. With
this possibility, a set screw could threadably engage a through
hole in the outer tube to engage the outer periphery of the inner
tube. Moving the set screw out of contacting engagement with the
outer periphery of the inner tube would allow the inner tube to be
axially moved or adjusted to change the length/position of the rod
802.
[0221] FIGS. 38-41 illustrate a variation on the dissecting 800
illustrated in FIGS. 34-37. The embodiment of the dissecting device
800' shown in FIGS. 38-41 is similar to the earlier embodiment
shown in FIGS. 34-37, except for the following points. First, the
embodiment shown in FIGS. 38-41 includes a third rod 802 mounted in
a rod holder 806 that is adjustably mounted on the guide 808 in a
manner similar to that described above with respect to the other
holders 806. The third rod is centrally positioned relative to the
other two rods (outer rods). In addition, each of the rods or
elongated members 802 is comprised of an outer tube provided with a
slit or slot 803 and an inner tube slidably received inside the
outer tube. According to one possibility, one length of wire 810
extends between the distal ends of both the central rod 802 and the
right-most rod 802 in FIG. 38, while another length of wire 810
extends between the distal ends of both the central rod 802 and the
left-most rod 802 in FIG. 38. One end of each wire length is fixed
relative to one of the rods, while the opposite end of the wire
length is positioned in the interior of the other rod in a manner
that allows the wires to move relative to the other rod to
accommodate movement between the rods when the spacing between the
rods is varied. Alternatively, a length of wire can be fixed to the
distal end of the central rod 802 while freely passing through a
hole in the inner tube in the other two rods 802. The wire 810 can
be fixed to the distal end portion of the inner tube of each of the
outer rods while being so that as the inner tube is moved towards
the distal end of the outer tube, the wire is advanced in the
forward or distal direction. The outer rods 802 have a spiral
spring (set screw) 807 that connects with the wire so that the wire
is always taught during the cutting operation.
[0222] Each of the rods 802 also includes an adjustment mechanism,
such as a set screw 807, to allow the inner tube to be adjusted
relative to the outer tube, and to then fix the position of the
inner tube relative to the outer tube. This adjustment mechanism
could be a set screw that threadably engages a through-hole in the
outer tube and bears against the outer surface of the inner
tube.
[0223] One manner of use of the dissecting device 800' illustrated
in FIGS. 38-41, is described below. First, as illustrated in FIG.
38, the central rod 802 is used as a mechanism for positioning the
dissecting device 800' at the appropriate location. This is
accomplished by positioning the central rod 802 distally beyond the
other two rods 802 as illustrated in FIG. 38. This can be achieved
by providing an adjustment mechanism between the rod 802 and the
holder 806. A set screw or the like can be used in this regard to
allow the rod 802 to move relative to the holder 806. This same
adjustment mechanism can be provided for all of the holders 806
relative to the respective rods 802.
[0224] Next, as illustrated in FIG. 39, the dial (lever) 804
associated with each of the rods 802 is loosened to adjust the
position of the respective holder 806 along the guide 808. The
adjustment is carried out to position the rods 802 at the desired
position for dissecting the desired tissue. The two outer rods 802
are preferably spaced apart from one another by a distance greater
than the width of the saphenous vein 1000 and saphenous fascia
1600. Next, as illustrated in FIG. 40, the two outermost rods 802
are moved relative to their respective holders 806 and are inserted
into tissue in the limb of the living body. This forward of distal
movement of the outermost rods 802 is indicated by the arrows 809
in FIG. 40.
[0225] Next, as illustrated in FIG. 41, the wire 810 is advanced in
the forward or distal direction. This movement is accomplished by
loosening each of the adjustment devices 807 to allow the inner
tube to be moved relative to the outer tube of each respective rod
802.
[0226] Loosening the adjustment mechanism 807 associated with each
rod 802 allows the inner tube to be moved or advanced in the
forward direction which also moves the wire 810 in the forward
direction so that dissection of the tissue occurs. The dissection
will take place depending upon the location of the outermost rods
802. Thus, positioning the rods 802 at the saphenous fascia and fat
interface will result in dissection of the fat 1200 from the
saphenous fascia 1600. The inner tube of each respective rod 802
can be moved in the forward direction relative to the outer tube to
carry out the desired extent of movement of the wire and the
desired extent of dissection. After the dissection is complete, the
dissecting device 800' is removed from the limb of the living body.
It is also possible to use the dissecting device once again in the
manner described above but along a different side or region of the
saphenous vein 1000/saphenous fascia 1600.
[0227] FIGS. 42A-42C illustrate additional embodiments of the
dissecting device that are variations on the dissecting device
shown in FIGS. 38-41 and that represent other examples of the
dissecting device disclosed here. FIG. 42A illustrates the wire 810
being used to dissect one tissue from another, for example the
saphenous fascia from the fat. This straight configuration of the
wire 810 is a configuration the wire would possess using the
arrangement of the dissecting device shown in FIGS. 34-37. FIG. 42B
illustrates a different wire configuration, namely a V-shaped wire
configuration. This configuration of the wire 810' can be produced
by positioning the rods 802 at, for example, rod positions so as to
be in a state in which the wire 810' is straight in FIG. 42B. This
wire configuration could be produced using the embodiment of the
dissecting device shown in FIGS. 37-41.
[0228] FIG. 42C illustrates another variation in which the wire
810'' possesses an arcuate, curved or partial circular-shaped wire
configuration. This could be accomplished by utilizing more than
three rods, and by arranging the rods so that they are generally
positioned along a circular arc like that represented by the wire
810'' in FIG. 42C. This configuration of the wire 810'' could be
produced with the embodiment of the dissecting device shown in
FIGS. 37-41.
[0229] FIGS. 43A-43C, 44A-44C, 45A, 45B and 46 illustrate another
embodiment of a dissecting device representing another example of
the dissecting device disclosed here. As shown in FIG. 46, this
embodiment of the dissecting device 820 includes a rod holder guide
822, a pair of rod holders 824, and three rods 826, 826, 828. FIGS.
43A-43C illustrate the rod holder guide 822 in more detail. The rod
holder guide 822 is an elongated rectangular-shaped member 821 on
which the rod holders 824 are mounted. The rod holder guide 822 is
provided with a plurality of threaded screw through holes 823, each
adapted to receive, for example, a threaded set-screw to permit and
prevent sliding movement of the rod holders 824 on the guide 822.
The guide 82 also includes a C-shaped holder portion 833 positioned
at the center portion of the guide 822. The holder portion 833 is
configured to receive the rod 828 illustrated in FIG. 45B. As seen
in FIG. 43C, opposite sides of the elongated member 821 each
include a V-shaped groove 821'.
[0230] Both of the rod holders 824 is comprised of a block-shaped
member 836 provided with a centrally located C-shaped holder
portion 835. The holder portion 835 of one of the rod holders 824
receives one of the rods 826 shown in FIGS. 45A while the holder
portion 835 of the other rod holder 824 receives the other rod 826
illustrated in FIG. 45A. The lower surface of the holder portion
824 is recessed, and the inner walls of the recess include inwardly
directed V-shaped projections 836' that are received in the
V-shaped recesses 821' in the guide 822.
[0231] FIG. 45B illustrates the rod 828 which is configured to be
positioned in the holder portion 833 of the guide 822 (the
center-positioned holder). This rod 828 includes an outer tube 831
and an inner tube 833. The outer tube includes a slit or slot 831',
and the inner tube 833 is slidably movable relative to the outer
tube 831.
[0232] FIG. 45A illustrates the rods 826 which are positioned in
the holder portions 835 of the respective rod holder 824. Each of
these rods 826 includes an inner tube 825 slidably positioned in an
outer tube 827. The outer tube 827 of each of the rods 826 includes
a slit or slot 827', and the inner tube 825 of each of the rods 826
is provided with a through-hole 825'. A wire 810 extends between
the two rods 826, passing through respective through-holes 825'.
One end of the wire 810 is preferably fixed to the inner tube of
one of the rods 826, and preferably is loosely received in the
interior of the inner tube of the other rod 826 so that the spacing
or distance between the two rods 826 can be adjusted.
[0233] To use the dissecting device 820, the rod holders 824 are
mounted on the guide 822 so that the rod holders 824 are positioned
on opposite sides of the holder portion 833. The rod holders 824
are mounted on the guide 822 so that the V-shaped projections on
the recesses at the underside of the holder portions 824 engage or
are received in the V-shaped recesses along the opposite edges or
sides of the elongated member 821 forming the guide 822. To
facilitate the sliding movement of the holders 824 on the guide
822, the under surface of the holders 824 can be provided with
roller bearings that engage the sides of the guide 822 during
sliding movements. Next, the rod 828 is mounted on the holder
portion 833 of the guide 821, one of the rods 826 is positioned in
the holder portion 835 of one of the rod holders 824, and the other
rod 826 is positioned in the holder portion of the other rod holder
824.
[0234] The dissecting device 820 illustrated in FIG. 46 is used or
operated in a manner similar to that described above with respect
to the dissecting device 800 illustrated in FIGS. 38-41. First, the
centrally located rod 828 is positioned forwardly of the rods 826
on either side. This can be accomplished by moving the rod 828 (the
outer tube 831) relative to the holder portion 833. It is possible
to provide a suitable mechanism to fix the rod 828 in position
relative to the holder portion 833 after the rod 828 has been
positioned at the desired location relative to the holder portion
833. This mechanism can be, for example, a set screw as described
above.
[0235] The rod or elongated member 828 is then inserted onto the
saphenous vein 1000 or the saphenous fascia 1600 as described
above. Next, the distance between the two outer rods or elongated
members 826 is adjusted to position the rods 826 at the desired
position to achieve the desired dissection with the wire 810. The
distance between the rods 826 can be adjusted by moving one or both
of the rod holders 824 relative to the guide 822. When the desired
spacing is achieved, the rod holders 824 are fixed in place. This
fixation of the rod holders 824 can be achieved by tightening set
screws positioned in the through-holes 823 so that they press
against the holders 824 in a way that fixes the holders 824 in
place. The two rods or elongated members 826 can then be moved in
the forward direction relative to the holder portions 835 of the
respective holder 824 to position the rods 826 in the tissue
adjacent the saphenous vein 1000 or saphenous fascia 1600. Finally,
the inner tube 825 of each of the rods 826 is moved in the forward
direction relative to the outer tubes 827 to move the wire 810 in
the living body to thereby perform the desired dissection. The wire
can thus cut tissue (fat, adipose tissue and muscle tissue in legs)
and stop bleeding.
[0236] In the embodiments described above and illustrated in FIGS.
34-46, it is possible during use to apply a pressing force to the
rods or elongated members 826, 828 (the outer tubes) at the
proximal portion and from outside the body to press the rods
against the veins and hold the vein in place as described
previously in connection with other embodiments.
[0237] The embodiments of the dissecting device described above
that utilize a wire for dissection can be modified in a variety of
ways. For example, the wire can be configured so that it is loosely
received in the inner tubes of the rods or elongated members so
that the wire can be moved back and forth during dissection. Such
modification may be helpful in the case of dissecting relatively
hard tissue. It is also possible to configure the wire so that it
spins around its central axis during dissection to help facilitate
the dissection operation. Also, the wire can possess a somewhat
wavy shape to help dissect relatively hard tissue. The wire can be
a straight wire, a twisted or braided wire providing greater
frictional engagement with the tissue, or a barbed wire. Each
length of wire can also be comprised of more than a single wire
length. For example, the wire length 810 in FIGS. 34-37 can be
comprised of several wire lengths, and the wire lengths can be
wound around one another. It is also possible to utilize wire that
is an electrode of RF (mono and multi) for progress anteriorly with
the rod.
[0238] The various embodiments of the dissecting device described
above that utilize a wire can also include modifications or
enhancements pertaining to the rods or elongated members. For
example, the rods can be configured to permit insertion of an
endoscope into the rods to facilitate viewing during the
operational procedure. The tip of the rod is preferably transparent
in this regard to permit viewing through operation of the
endoscope. During use, the tip of the rod can exfoliate fat from
the saphenous fascia or the surrounding tissue from the saphenous
vein in the leg while certainly or reliably following the saphenous
vein.
[0239] Another aspect of the disclosure here involves facilitating
dissection of the vein by implementing various operations involving
pulling the side branches of the vein. FIGS. 47A-47F illustrates
one possibility. Pulling the side branches represents a procedure
performed in addition to the dissecting procedures described
above.
[0240] FIG. 47A illustrates that the procedure begins by making an
incision at opposite ends of the limb (leg) of the living body
(patient) to provide an entry incision and an exit incision. It is
thus possible to expose the vein (saphenous vein) while securing an
opening for a flat elongated dissecting device like the flat
elongated dissecting device 700 shown in FIGS. 22A and 22B. FIG.
47B illustrates that after the incisions are made, the distal end
of the flat elongated dissecting device 700 is inserted into the
living body by way of the entry incision. And the flat elongated
dissecting device 700 may be inserted on the muscular fascia or
into the fat between the muscular fascia and the saphenous vein. As
illustrated in FIG. 47C, the flat elongated dissecting device is
moved inside the living body, along the vein 1000, so that the
distal end of the flat elongated device 700 is exposed to the
exterior of the body by way of the exit incision. Thus, both the
distal and proximal ends of the flat elongated device 700 are
exposed outside the body, while the intermediate portion of the
flat elongated dissecting device between the distal and proximal
ends is located inside the living body. The distal end of a second
flat elongated dissecting device is also inserted into the entry
incision and moved along the living body and along the vein 1000
until the distal end of the second flat elongated dissecting device
is once again exposed outside the living body. The two flat
elongated devices are positioned on opposite sides of the vein
1000. The two flat elongated devices are positioned on opposite
sides of the vein 1000, but the two flat elongated devices may also
be positioned out of alignment between the muscular fascia and the
saphenous vein.
[0241] Next, as illustrated in FIG. 47D, the distal and proximal
ends of both flat elongated dissecting devices exposed outside the
living body are pulled upwardly in the direction of the arrows away
from the muscular fascia 1500. A space 1575 is thus created under
the flat elongated dissecting devices 700 (i.e., between the
muscular fascia 1500 and the surface of the flat elongated
dissecting device 700 facing the muscular fascia 1500). Next, as
illustrated in FIG. 47E, the flat elongated dissecting devices 700
are moved towards one another to apply a pressing force to the side
branch 1100 of the vein 1000, thereby holding the vein 1000. The
flat elongated dissecting devices 700 may be moved towards one
another to apply the pressing force to a bifurcation area of the
vein of a vein side of the side branch 1100. According to this
disclosed example, the flat elongated dissecting devices 700 are
moved towards one another into contact with the side branch 1100 of
the vein 1000. Finally, the method concludes as shown in FIG. 47F
by pulling the side branch 1100 downwardly towards the muscular
fascia 1500 and then the vein 1000 and the surrounding tissue are
pulled towards the muscular fascia 1500 to thus separate the
saphenous fascia 1600 from the adjacent tissue (fat tissue 1200) as
indicated by the space 1475 between the saphenous fascia 1600 and
the fat 1200 in FIG. 47F. This thus presents an alternative way of
effecting dissection of one tissue such as the tissue bound to a
vein (e.g., saphenous fascia bound to the saphenous vein) from
other adjacent or adjoining tissue (e.g., fat). Before or after the
flat elongated dissecting devices 700 are inserted near to the side
branch, an imaging device may be inserted between the saphenous
fascia and the fat. The flat elongated dissecting devices 700 can
be reliably positioned close to the side branch. Before or after
the flat elongated dissecting devices 700 are inserted near to the
side branch, the flat elongated dissecting devices 200 may be
inserted between the saphenous fascia and the skin. The flat
elongated dissecting devices 200 can create or make a space 1475
between the tissue bound to the vein 1000 and the adjacent tissue
(fat tissue) or between the vein 1000 and the surrounding
tissue.
[0242] To help enhance the effectiveness of the dissecting
operation, the flat elongated dissecting device 700 can be
configured to enhance the ability of the flat elongated dissecting
device 700 to grip the side branch of the vein. FIG. 48 illustrates
the flat elongated dissecting devices 700, and FIGS. 49A-49H
illustrate different possible cross-sectional shapes for the flat
elongated dissecting devices to facilitate this gripping effort. In
FIG. 49A, the flat elongated dissecting devices 700a possess a
crescent-shaped cross-section so that the inwardly facing side
edges of the devices 700a exhibit a sharp edge for grabbing and
holding the side branch.
[0243] FIG. 49B illustrates flat elongated dissecting devices 700b
that have inner edges or inner sides facing one another. These
inner side edges are pointed (i.e., include a projection) to
enhance the gripping ability of the flat elongated dissecting
devices. FIG. 49C shows that the flat elongated dissecting devices
can possess an oval-shaped cross-section so that the inwardly
facing sides or edges narrow in a manner enhancing the gripping
ability.
[0244] As shown in FIG. 49D, the inwardly facing sides or edges of
the flat elongated dissecting devices 700d can be serrated or
saw-tooth shaped in a way that enhances the ability of the devices
700 to grip the side branch of the vein. FIGS. 49E and 49F
illustrate flat elongated dissecting devices in which the inwardly
facing edges or sides interfit with one another in an interleaving
or overlapping manner FIG. 49G illustrates a further cross-section
for the flat elongated dissecting devices 700g in which the
inwardly facing edge or side of one dissecting device includes a
projection that fits into a recess or groove in the inwardly facing
side or edge of the other dissecting device. Finally, FIG. 49H
illustrates a further alternative in which anti-slip material 700h'
is applied to the inwardly facing side or edges of both of the
devices. Examples of the anti-slip material include rubber,
spongy-plastics, textured-metal, felt, fabric.
[0245] The configuration shown in FIG. 49D is an anti-slip design
that effects secure holding, while the alternatives in FIGS.
49E-49G represent interfitting edge types that help maintain or
keep the holding position in addition to the anti-slip
function.
[0246] FIGS. 50A-50D illustrate a another embodiment of the
dissection procedure representing a further example of the method
or operational procedure disclosed here. In this embodiment, the
two flat elongated dissecting devices 700 are inserted into the
limb of the living body (patient) by way of the entry incision or
access site in the manner described above, and are positioned on
opposite sides of the vein (saphenous vein 1000) so as to be
positioned on opposite sides of the side branch 1100. Then, as
shown in FIG. 50B, the flat elongated dissecting devices 700 are
rotated upwardly so that the inwardly facing sides or edges of the
dissecting devices 700 are raised and moved away from the muscular
fascia 1500 to create the space 1575 between the lower surface of
the elongated dissecting device 700 and the muscular fascia 1500.
The two flat elongated dissecting devices 700 are then moved toward
one another as illustrated in FIG. 50C so that the inner sides or
edges of the dissecting devices 700 come into contact with the side
branch 1100 of the vein 1000. Finally, as illustrated in FIG. 50D,
the inner sides or edges of the dissecting devices 700 are shifted
or rotated downwardly while the outer sides or edges of the
dissecting devices 700 are shifted or rotated upwardly, thus
pulling the side branch 1100 of the vein, together with the vein
itself, downwardly. As a result, tissue bound to the vein 1000
(saphenous fascia 1600) is dissected or separated from the adjacent
tissue (e.g., fat 1200). This dissection operation results in a
space 1475 between the tissue bound to the vein 1000 and the
adjacent tissue (fat tissue).
[0247] FIGS. 59A-59E illustrate additional details about the
dissecting device for carrying out the operational procedure shown
in FIG. 50A-50D. In this embodiment, the opposite end of each of
the flat elongated dissecting devices 700 is provided with a pin
792. The pins can be fixed relative to the dissecting devices 700
or can be removable/detachable. FIG. 59B shows that the pins are
not coaxial with the central axis of the respective dissecting
device 700. The pins at each end of the dissecting devices 700 are
mounted in a common mounting block 796 that is comprised of a
holder 793 and a stopper 794. As illustrated in FIGS. 59C-59E, the
holder 793 includes a tapering through hole 793' that tapers in
size from a larger dimension closer to the dissecting devices 700
to a smaller dimension closer to the stopper 794. This allows the
pins 792 on the ends of the dissecting devices 700 to move toward
one another as the pins are inserted further into the holders 796
is shown in FIGS. 59D and 59E,. Thus, when the pins 792 are
positioned relative to the holder 796 in the manner illustrated in
FIG. 5D, the dissecting devices 700 are positioned farther away
from one another compared to the pins 792 being positioned relative
to the holder 796 as shown in FIG. 59E. After the pins 792 are
inserted into the holder 796, the stopper 794 is placed around the
ends of the pins as shown in FIG. 50A to thus fix the position of
the pins 792. The stopper 794 can be made of a rubber material, and
the opening in the stopper 794 can be dimensioned so that the
stopper 794 tends to grip the pins and thus fix the position of the
pins and the dissecting devices 700.
[0248] In use, the distal ends of the dissecting devices 700 are
inserted into the limb of the living body by way of a previously
made entry incision, and are moved in the living body along the
vein (side branch of the vein) until the distal ends of the
dissecting devices 700 exit outside the living body at the exit
incision. To engage and hold the side branch of the vein, the pins
792 at each end of the dissecting devices 700 are positioned in one
of the holder's 793 to move the dissecting devices 700 towards one
another and into contact with the side branch to hold the side
branch. Thereafter, one of the stoppers 794 is mounted on the pins
792 at each end of the dissecting devices 700 to fix the position
of the pins 792 and thus the dissecting devices 700 so that the
holding force applied to the side branch of the vein is
maintained
[0249] FIG. 60A-60F illustrate additional details about another
dissecting device for carrying out the operational procedure shown
in FIG. 50A-50D. Referring to FIG. 60A, the dissecting devices 700
are mounted in respective holes in a holder 780. The dissecting
devices 700 are illustrated as being positioned in a single holder
provided with two separated through holes 780, but it is to be
understood that it is possible to mount each dissecting device 700
in respective holder 780 each provided with a through hole so that
the end of one dissecting device is held by one holder and the
other end of the dissecting device is held by another holder.
[0250] The two holes 782 in the holder 780 possess the same shape,
but are mirror images of each other as can be seen from a
comparison of the two holes illustrated in FIGS. 60B-60F. The hole
is particularly configured to allow the dissecting devices 700 to
be positioned in the different positions shown in FIGS. 50A-50D
associated with holding the side branch.
[0251] The two holes 782 are configured so that the dissecting
devices 700 are initially positionable in the manner shown in FIG.
60B. This position of the dissecting devices is similar to the
positioning of the dissecting 700 in FIGS. 50A in which the
dissecting devices 700 are located on a side of the muscular fascia
and both side of the side branch.
[0252] The holes 782 in the holder 780 are also configured so that
the dissecting devices 700 can move from the position shown in FIG.
60B to the position shown in FIG. 60C. The position shown in FIG.
60C is similar to the position of the dissecting devices shown in
FIG. 50B in which the dissecting devices 700 are rotated to lift
the tissue bound to the vein (the saphenous fascia 1600) and space
such tissue from the adjacent tissue (muscular fascia 1500).
[0253] The holes 782 are further configured to allow the dissecting
devices 700 to shift from the position shown in FIG. 60C to the
position shown in FIG. 60D in which the dissecting devices are
moved toward one another to pinch, hold or grip the side branch.
This positioning of the dissecting devices 700 is similar to the
positioning of the dissecting devices shown in FIG. 50C.
[0254] The holes 782 are also configured to allow the dissecting
devices 700 to move from the position shown in FIG. 60 to the
position shown in FIG. 60E and then ultimately to the position
shown in FIG. 60F. Changing the position of the dissecting devices
700 from the position shown in FIG. 60D to the position shown in
FIG. 60E and ultimately to the position depicted in FIG. 60F
results in the side branch being pull downwardly, similar to the
operation depicted in FIG. 50D, to carry out the dissection
previously discussed.
[0255] In use, the distal ends of the dissecting devices 700 are
introduced into the limb of the living body by way of a previously
made entry incision, and are advanced in the living body while
moving along the vein (side branch of the vein) until the distal
ends of the dissecting devices 700 exit outside the living body at
the exit incision. Thus, both ends of both dissecting devices are
positioned outside the living body. The distal ends of the
dissecting devices 700 are positioned in the through holes 782 of
one of the holders (or a pair of holders), and the proximal ends of
the dissecting devices 700 are positioned in the through holes 782
of another holder (or another pair of holders). Thereafter, the
dissecting devices 700 are moved in the manner shown in FIGS.
60B-60F and described above to perform the dissection.
[0256] FIGS. 51A-51D illustrate another dissecting procedure or
method. This version of the dissecting operation involves the use
of a pair of flat elongated dissecting devices 7001 which are
positioned in a living body on a side of the muscular fascia and
both sides of the side branch in the manner described previously.
These dissecting devices 7001 are each comprised of two segments or
sections 7001', 7001'' connected together at a hinge. After the
dissecting devices 7001 are inserted into the living body, the two
elongated dissecting devices 7001 are lifted upwardly to create the
space 1575 between the lower surface of the dissecting devices 7001
and the muscular fascia 1500 as illustrated in FIG. 51B. The next
step in the operation involves, as illustrated in FIG. 51C, moving
the two dissecting devices 7001 towards one another so that the
inner sides or inner edges of the dissecting devices 7001 contact
the opposite outer sides of the side branch 1100 to apply a holding
force to the side branch. Finally, as illustrated in FIG. 51D, the
outer segment 7001' of each dissecting device 7001 is rotated
upwardly to pull the vein and the side branch downwardly, thus
carrying out the dissection depicted in FIG. 51D.
[0257] FIGS. 61A-61G illustrate additional details about the
dissecting device for carrying out the operational procedure shown
in FIG. 51A-51D. In this embodiment, the dissecting devices 7001
are comprised of two sections 7001', 7001'' hinged to one another
and mounted in respective holders 770. An adjustment mechanism is
operatively connected to the respective dissecting device 7001. In
the illustrated embodiment representing one example of the
disclosure here, the adjustment mechanism is a rotatable adjustment
mechanism (dial) 772 operatively connected to the respective
dissecting device 7001. Rotating the adjustment mechanism (dial)
772 rotates one of the sections 7001' of the dissecting device
relative to the other section 7001'' of the dissecting device as
illustrated in FIG. 61F. It is thus possible to change the
dissecting device from the configuration shown in FIG. 61D to the
position shown in FIG. 61E.
[0258] A further aspect of this embodiment is shown in FIG. 61G in
which each of the dissecting devices 7001 can be configured to be
removably mounted to and detachably disconnected from the holder
770 and adjustment mechanism 772.
[0259] FIG. 52-55 illustrates further modifications to the already
described dissecting operations involving holding and pulling the
vein side branch. FIG. 52 shows that it is possible to position an
expandable body 700 between each of the dissecting devices 700 and
the muscular fascia 1500. Thus, after the dissecting devices 700
are inserted into the living body on opposite sides of the side
branch 1100, the expandable member 850 is inserted, in the
non-expanded or uninflated condition, between the muscular fascia
1500 and the dissecting devices 700. Thereafter, the expandable
members 850 are expanded outwardly through inflation of the
expandable members 850 to lift the dissecting devices 700 as shown
in FIG. 52. Of course, the expandable members 850 can be inserted
into the living body on opposite sides of the side branch before
inserting the dissecting devices 700 or at the same time as
insertion of the dissecting devices 700. The dissecting device 700
and the expandable member 850 may be integrally formed.
[0260] FIGS. 53A and 53B illustrate another embodiment that
utilizes a slide and lift device. This slide and lift device 860 is
positioned exterior of the body, but is used to lift the dissecting
devices 700 as shown in FIG. 53A. That is, after the flat elongated
dissecting devices 700 are inserted into the living body and moved
along the vein 1000 to position the dissecting devices 700 on
opposite sides of the side branch 1100 with the distal and proximal
ends of the dissecting devices 700 exposed outside the living body
by way of the entry and exit incisions, one of the slide and lift
devices 860 is positioned under the proximal end portion of the
dissecting device 700, and another of the slide and lift devices
860 is positioned under the distal end portion of the dissecting
device 700. The dissecting devices 700 are then moved towards one
another and towards the side branch 1100. During this movement, the
dissecting devices 700 slide along the slide and lift devices 860
and are lifted by virtue of the configuration of the slide and lift
devices 860.
[0261] FIG. 54 illustrates an alternative embodiment in which a
stack of (plural number of) dissecting devices 700 is positioned on
opposite sides of the side branch 1100. The stacks of dissecting
devices 700 can be inserted together as a unit on opposite sides of
the side branch, or can be inserted one on top of another in
sequence.
[0262] FIGS. 55A and 55B illustrate another embodiment of the
dissecting devices that once again includes two segments connected
together by an intermediately located hinge. These dissecting
devices are similar to the dissecting devices associated with the
dissecting operation shown in FIGS. 51A-51D. But in the embodiment
illustrated in FIGS. 55A and 55B, after the dissecting devices 7001
are inserted into the living body on opposite sides of the side
branch 1100, the inner-most of the two segments of each dissecting
device 7001 is rotated upwardly to lift the tissue that is bound to
the vein 1000 (e.g., saphenous fascia 1600).
[0263] In each of the embodiments shown in FIGS. 52-55, the
dissecting devices are moved into contact with the side branch of
the vein as discussed previously, and the vein 1000 (side branch
1100) is pulled downwardly to carry out the dissection as described
previously. The embodiments shown in FIGS. 52-55 disclose examples
of ways to make a space to pull the side branch.
[0264] The dissecting operations illustrated in FIGS. 47-55 involve
moving the dissecting devices towards one another to apply a force
to the side branch that holds the side branch (e.g., moving the
dissecting devices so that the inner sides or inner edges of the
dissecting devices contact the side branch of the vein), and then
pulling the side branch to carry out the dissection. It is
desirable as a part of this operation to retain the engaged
condition between the dissecting devices and the side branch. That
is, it is preferable if the dissecting devices are able to maintain
a strong hold on the side branch. FIGS. 56A-56C and FIGS. 57A-57C
illustrate examples for achieving this result.
[0265] FIGS. 56A -56C illustrate a retention device 860 for
retaining the dissecting devices 700 in a generally coplanar
relation with each other and in close engagement with one another.
The retention device includes a pair of clamps, with one clamp 872
located near one end of the pair of dissecting devices 700 and the
other clamp 872 positioned near the opposite end of the pair of
dissecting devices 700. FIG. 56B illustrates that each of the
clamps 872 includes a pair of plates 874, the distance between
which is controlled by suitable connectors like screws of the like
that are adjustable to permit the distance between the two plates
874 to be varied. In this way, the two dissecting devices 700 can
be positioned between the two plates 874 as shown in FIG. 56A, and
then the connectors 876 can be tightened to maintain the two
dissecting devices 700 in generally coplanar relation to one
another.
[0266] The retention device 872 also includes a pair of loop
members (endless members) made of an elastic material so that the
loop members 878 are rubber band like in nature. One of the loop
members 878 is positioned at one end portion of the pair of
dissecting devices 700 and the other loop member 878 is positioned
at the opposite end portion of the pair of dissecting devices 700.
The elastic loop members 878 urge the inner sides or edges of the
dissecting devices 700 towards one another and maintain the inner
sides or edges of the dissecting devices 700 in contact with the
side branch.
[0267] FIG. 57A -57C illustrates another embodiment of the
retention device 890 that includes a pair of engaging members 892
that engage the dissecting devices 700. The engaging members 892
are generally C-shaped members that are freely slidably received on
one or more shafts 894. In the illustrated embodiment the engaging
members 892 are slidably mounted on a pair of shafts 894. A spring
896 bears against a block at the end of each shaft 894 and applies
a biasing force to the engaging members 892 that urges the engaging
members 892 towards one another.
[0268] In use, the dissecting devices 700 are positioned in the
C-shaped engaging members 892 as shown in FIG. 57C. The C-shaped
nature of the engaging members 892 retains the dissecting devices
700 in a generally coplanar relationship. The springs 896 bias the
engaging members 892 toward one another to thus urge the two
dissecting devices towards one another. In this way, the inner
edges or sides of the dissecting devices 700 are retained in
contacting engagement with the side branch of the vein.
[0269] FIGS. 58A-58F illustrates an alternative configuration for
the dissecting devices 7002. In this embodiment, the end portions
of the dissecting devices 7002 possess the generally flattened
shape, somewhat oval in shape, whereas the intermediate portions or
middle portion of the dissecting devices 7002 possess a different
shape. The intermediate or middle portion of the dissecting devices
possesses the cross-sectional shape shown in FIG. 58C. This
cross-sectional shape is enlarged at three axially spaced locations
so that the dissecting devices possess enlarged and rounded ends,
and an enlarged middle portion. Between the enlarged ends and the
enlarged middle is a necked down or narrowed region. In the
illustrated embodiment, the transition from the larger size portion
of the dissecting devices 7002 to the smaller size portions of the
dissecting devices 7002 is a gradual taper.
[0270] FIG. 58E illustrates the dissecting devices 7002 positioned
relative to one another to engage the side branch of the vein,
while FIG. 58F illustrates the dissecting devices during the
dissecting operation. The pivot point of each of the dissecting
devices 7002 is the center of curvature of the surfaces that
contact the side branch of the vein. The shape of the dissecting
device in FIG. 58C (700, 7002) fits the hole 782 of the holder 780
of FIG. 60B. Therefore, when a user uses the dissecting device 700,
7002 and the holder 780, movement of the dissecting device 700,
7002 is restricted and supplemented by the shape of the hole 782 of
the holder 780 to be the same movement of FIGS. 50A-50D. The
dissecting device of FIG. 58B and FIG. 58D is flat. Therefore, the
dissecting device is easily inserted into the living body. The
operational sequence in FIGS. 58E and 58F is similar to that shown
in FIGS. 50A-50D. A contact portion of the dissecting device 7002
has a curve that is bigger than a curve of a contact portion of the
dissecting device 700. When the dissecting device 7002 pinches the
side branch of the vein together with the other dissecting device,
the bigger curve of the dissecting devices 7002 that pinch the side
branch are harder to shift than the smaller curve of the dissecting
device 700.
[0271] The various features and aspects illustrated in FIGS.
47A-47F involve ways of tearing out dissection by holding the vein
(side branch of the vein) and pulling the vein (side branch of the
vein) in a direction away from the tissue to be separated. In each
of these aspects, the method generally involves making an incision
in a limb to expose the vein and provide an access opening for
inserting the dissecting device. It is possible to confirm the
location of the tissue bound to the vein (saphenous fascia) and the
adjacent tissue from which the tissue bound to the vein is to be
separated from (muscular fascia). This can be accomplished
visually. An incision is also made for allowing exiting of the
distal end of the dissecting devices during the placement of the
dissecting devices. This exit incision can be made at the same time
as the entry incision or after moving the dissecting device along
the vein. The distal ends of the dissecting devices are then
inserted into the living body and moved along the vein. The
presence and location of the side branch can be confirmed, either
under visualization or through use of an imaging device. The
dissecting devices are advanced or moved along the vein until the
distal ends of the dissecting devices pass through the exit
incision and are located exterior of the body. The two dissecting
bodies (elongated flat body) are then lifted or rotated to produce
a space between the saphenous fascia bound to the vein and the
muscular fascia. The two dissecting devices are next moved toward
one another to contact a hold the side branch. With the side branch
held by the dissecting devices, the dissecting devices are then
moved or pulled in a direction to carry out the dissection. The
vein or the tissue bound to the vein is thus separated from other
tissue (fat) by pulling the side branch of the vein and twisting
the side branch of the vein. Twisting the side branch of the veins
slides the tissue relative to other tissue in a circumferential
direction and an area of a fitting part of the tissue and other
tissue decrease. Therefore, twisting the side branch of the vein
and pulling the side branch of the vein at the same time can effect
more easy separation.
[0272] As a way of enhancing the dissection that occurs by holding
and pulling the side branch of the vein away from the tissue to be
separated (fat), it is possible to implement another holding aspect
involving holding a portion of the limb (leg) to maintain the space
created during the pulling-up of the side branch. FIGS. 62A-62C
illustrate one example of a procedure that reliably creates a
space. The embodiment shown in FIG. 62A illustrates the side branch
being pulled away from the fat 1200 to dissect the saphenous fascia
1600 from the fat 1200, thus creating the space 1475 between the
fat 1200 and the saphenous fascia 1600. To maintain this space, it
is possible to, manually pinch the skin of the patient from outside
the body, in the region of the dissection, and pull upwardly as
indicated by the upwardly directed arrows in FIGS. 62A and 62B. An
alternative is illustrated in 62C. Here, hooks 771 are used to
engage (hook) portions of the limb on the skin side of the vein, in
the region of the dissection, and to then apply an upwardly
directed pulling force using the hooks. This once again maintains
the space 1475.
[0273] FIGS. 63A-63C illustrate another embodiment in which
pressure is applied from opposite sides of the limb in the region
of the dissection to help maintain the space 1475. One embodiment
illustrated in FIG. 63B involves applying manual pressure on
opposite sides of the rim as indicated by the direction of the
arrows in FIGS. 63A and 63B to hold the space 1475.
[0274] Another possibility shown in FIG. 63C involves using a pair
of plates 773 (flat plates) to apply pressure on opposite sides of
the limb as indicated by the arrows to thereby help maintain the
space 1475 resulting from the dissection.
[0275] Another alternative shown in FIGS. 64A and 64B involves
inserting a pair of elongated rods 775 at a position adjacent the
vein 1000 and the side branch 1100 as shown in FIG. 61B. A pair of
dissecting devices 700 and the pair of elongated rods 775 are
inserted between the saphenous fascia and the muscular fascia. The
pair of dissecting devices 700 makes a space and the pair of
elongated rods 775 holds the side branch 1100 and pulls the side
branch.
[0276] FIGS. 65A-65C illustrate another variation. Here, the rods
775 are inserted either between the saphenous fascia and the fat
1200, or between the fat 1200 and the skin 1400. In both cases
shown in FIG. 65B and 65C, the elongated rod 775, when positioned
in the manner illustrated, are pulled upwardly in the direction
indicated by the arrows to apply a pulling force that helps
maintain or hold the space 1475 created by the dissection.
[0277] FIGS. 66A-66D depict another embodiment of a dissecting
device. FIG. 66A illustrates that the dissecting device 900
includes a first dissecting device 902 and a second dissecting
device 904. The first dissecting device 902 is a flat elongated
member that includes a rail 903. The second dissecting device 904
is specifically configured to be mounted in the rail and then slid
or moved along the rail. The second dissecting device 904 can thus
move along, and relative to, the first dissecting device 902. As
illustrated in the top view of FIG. 66C, the second dissecting
device 904 includes three dissecting portions 905, each of which is
in the form of a pointed projection. The second dissecting device
904 also includes curved portions 906 between the dissecting
portions 905 (projections).
[0278] A dissecting operation involving use of the dissecting
apparatus 900 shown in FIGS. 66A-66D is as follows. In FIG. 66B,
the lower side represents the calf side and the top side represents
in the body and the thin side. First, an incision is made in the
limb (leg) of the living body (patient). The distal end of the
first dissecting device 902 is then inserted into the living body
by way of the entry incision so that the first dissecting device is
located under the vein (saphenous vein 1000) such as shown in FIG.
66B. The first dissecting device is thus located between the fascia
and the vein, or between fascia and fat. After the second
dissecting device is inserted into the living body, the first
dissecting device is slidably mounted on the first dissecting
device, or was previously mounted on the first dissecting device
and then introduced into the living body by way of the entry
incision. This second dissecting device 904, slidably mounted on
the first dissecting device 902, is then pushed from outside the
living body so that the second dissecting device 904 is moved along
the vein. As a result, the vein is dissected from other tissue
(e.g., fat) in the thickness direction of the dissecting device. In
FIG. 66B, the lower side represents the calf side and the top side
represents in the body and the thin side.
[0279] FIGS. 66B and 66D show that the second dissecting device 904
can be configured as a generally upside-down U-shaped dissecting
device. Thus, when the second dissecting device 904 is mounted on
the rail 903 of the first dissecting device 902 and is advanced
along the vein 1000 by the pushing force applied to the second
dissecting device from outside the body, the first and second
dissecting devices together surround or enclose the vein 1000 so
that moving the second dissecting device 904 along the first
dissecting device 902 results in the vein and/or tissue bound to
the vein being dissected from the surrounding tissue such as fat.
It is thus not necessary to insert and remove the dissecting device
multiple times, or insert multiple detecting devices.
[0280] FIGS. 67A-67D illustrate another embodiment of the
dissecting apparatus. This embodiment of a dissecting apparatus 910
includes a flat elongated first dissecting device 912 and a second
dissecting device 914. As is apparent from FIGS. 67B-67D, the first
dissecting device 912 includes two spaced apart legs 913 connected
at their front or distal ends. Each leg 913 of the first dissecting
device 912 includes a groove 917, and the first dissecting device
914 includes a plurality of rollers 919 positioned in each of the
grooves of the legs 913 to facilitate movement of the second
dissecting device 914 along the first dissecting device 912. The
first dissecting device 912 is otherwise similar to the first
dissecting device described above in that it possesses an
upside-down U-shaped configuration as illustrated in FIGS. 67B and
67D. In addition, the first dissecting device 914 includes a
plurality of projecting dissecting portions 916, with a curve
between adjacent dissecting portions.
[0281] The operation of this embodiment is similar to that
described above with respect to the dissecting apparatus 900. But
in this embodiment shown in FIGS. 67A-67D, the curves of the second
dissecting device catch the side branch of the vein 1000 and cut
the side branch. The second dissecting device 914 includes an
energy device 915 on its forwardly facing surface, and this energy
device allows the side branch to be cut and to stop bleeding. The
energy device can be located on the curved portions 918 of the
first dissecting device. The energy device can be RF, laser and
others.
[0282] The embodiment shown in FIGS. 68A-68D is very similar to the
embodiment shown in FIGS. 66A-66D, except that the second
dissecting device possesses an upstanding pusher 920. This
upstanding pusher 920 makes it easier to push the second dissecting
device from outside the body and move the second dissecting device
relative to the first dissecting device in the living body along
the vein. Preferably, the skin is convex by the pusher to rather
easily push.
[0283] It is possible with the embodiments shown in FIGS. 66-68 to
configure the curved upper portion 906, 918 of the second
dissecting device from an elastic material. The second dissecting
device can also be made of mesh material. In the illustrated
embodiment, the second dissecting device includes three dissecting
portions (projections), but it is to be understood that a different
number of dissecting portions can be utilized. Each of these three
dissecting portions is preferably an acute angle (i.e., the
projection). Each of the curves of the second dissecting device
also acts as a cutting device. The cutting device may be the energy
device and a blade. The energy device associated with the
embodiment shown in FIGS. 67A-67D can be mono-polar/bi-polar.
[0284] The harvesting of a bypass vessel for use in vascular bypass
grafting has been described above in the aforementioned
embodiments, but the use of the harvested blood vessel is not
limited to the bypass vessel.
[0285] The detailed description above describes embodiments of a
blood vessel dissecting device and blood vessel dissecting method
representing examples of the invention disclosed here. The
invention is not limited, however, to the precise embodiments and
variations described. Various changes, modifications and
equivalents can be effected by one skilled in the art without
departing from the spirit and scope of the invention as defined in
the accompanying claims. It is expressly intended that all such
changes, modifications and equivalents which fall within the scope
of the claims are embraced by the claims.
* * * * *