MINIMAL INVASIVE ENDOSCOPIC
METHODS AND APPARATUS FOR
HARVESTING BLOOD VESSELS
CROSS REFERENCE TO RELATED 5
This application is a division of U.S. Ser. No. 10/139,367 filed on May 7, 2002 now U.S. Pat. No. 7,041,113.
BACKGROUND OF THE INVENTION
The present invention relates to coronary revascularization and in particular to methods and apparatus for harvesting sections of vascular vessels, such as saphenous veins. 15
For certain surgical procedures, such as coronary artery bypass grafting (CABG), a section of a vascular vessel such as a saphenous vein in a patient's leg is harvested and attached elsewhere to form a bypass between an arterial blood source and a coronary artery that is to be bypassed. 20
In an effort to reduce trauma to the patent, less-invasive vessel harvesting techniques have been developed which involve the use of an endoscope. In particular, a small incision is made in the patient's leg to enable the endoscope and surgical instruments to be inserted. For example, it is neces- 25 sary to sever and cauterize side branches of the vessel section being harvested, and then sever and cauterize the ends of that vessel section. That procedure traditionally involves the withdrawal of one instrument and the insertion of another, which intensifies the trauma to the vessel and the surrounding tissue. 30
It would be desirable to enable vessel harvesting procedures to be carried out in a minimally invasive manner that further reduces trauma to the patient by minimizing the number of insertions/removals of surgical instruments.
SUMMARY OF THE INVENTION
The present invention relates to a method of severing a blood vessel in a patient, comprising the steps of:
A. inserting a shaft through an incision in the patient, the 40 shaft carrying first and second clamps;
B. applying the first and second clamps to the vessel in closely adjacent relationship; and then
C. moving the first and second clamps in generally opposite directions to stress and sever the vessel at a location between the clamps.
Preferably, the clamps carry cauterizing pads for cauterizing the severed vessel.
Preferably, step C is performed by moving the clamps in 50 generally opposing directions along the axis of the vessel.
Another aspect of the present invention relates to an apparatus for severing a blood vessel. The apparatus includes a carrier shaft adapted to be inserted into a patient. First and second clamps are carried by the shaft. A displacement 55 mechanism is carried by the shaft and is arranged to close the first and second clamps against the vessel at respective locations disposed adjacent one another. The displacement mechanism is also arranged for moving the first and second clamps in generally opposite directions to sever the vessel. 60
Preferably, each clamp includes at least one cauterizing pad for cauterizing the vessel.
ferred embodiment thereof in connection with the accompanying drawings in which like numerals designate like elements and in which:
FIG. 1. is a top plan view of a front end of an endoscopic vessel-harvesting device according to the present invention, the device being oriented in a relationship to be inserted into a patient.
FIG. 2 is a front perspective view of FIG. 1.
FIG. 3 is a front perspective view of a main portion of a shaft of the device depicted in FIG. 1.
FIG. 4 is a front perspective view of an actuator sleeve forming part of the device depicted in FIG. 1.
FIG. 5 is a longitudinal sectional view taken through a front portion of the shaft depicted in FIG. 1.
FIG. 6 is a view similar to FIG. 2 depicting jaws of the device in an open state.
FIG. 7 is a side elevational view of FIG. 6.
FIG. 8 is similar to FIG. 6 with one of two clamps removed for clarity.
FIG. 9 is a sectional view, shown in perspective, of a clamp according to the present invention.
FIG. 10 is a front elevational view of the device, with the jaws being opened as shown in FIG. 6.
FIG. 11 is a side elevational view of the device, showing three different positions of an actuator sleeve.
FIG. 12a is a side elevational view of the device shown in FIG. 1, as the device approaches a blood vessel to be severed.
FIG. 12b is a top plan view of FIG. 12a.
FIG. 13a is a view similar to view FIG. 12a after the clamp has been opened and encompasses the vessel.
FIG. 13b is a top plan view of FIG. 13a.
FIG. 14a is a view similar to FIG. 13a after an actuator sleeve has been moved from a first position to a second position in order to close the clamp against the vessel.
FIG. 14b is a top plan view of FIG. 14a.
FIG. 15a. is a view similar to FIG. 14a after the actuator sleeve has been moved to a third position for moving the clamps away from one another.
FIG. 15b is a top plan view of FIG. 15a.
DETAILED DESCRIPTION OF A PREFERRED
EMBODIMENT OF THE INVENTION
An endoscopic vessel-harvesting device 10 according to the invention comprises a shaft 11 which includes a proximal section 12 and a distal section 16. The proximal section 12 includes four through-passages 18, 20, 22, 24 (see FIG. 3). The through-passage 18 accommodates the insertion of a conventional imaging system (not shown), comprising a lens arrangement connected to an optical fiber, to enable an operator to "see" objects of interest. The through-passages 20 and 22 accommodate left and right clamps in the form of jaw assemblies 26, 28, respectively (see FIG. 2). The throughpassage 24 accommodates a rod 29 which is connected to the distal section 16 and serves to keep the distal section attached to the distal section 12.
The distal section 16 includes three through-passages 18a, 20a, 22a (see FIGS. 2,5). The through-passage 18a is aligned with the through-passage 18, and the through-passages 20a, 22a, are aligned with the passages 20, 22, respectively. The through-passages 20a, 22a open rearwardly into a cavity 23 that receives a reduced-diameter front end 21 of the proximal section 12 (see FIG. 5). The through-passages 20a, 22a include respective cam surfaces 25 and springs 27 at forward ends thereof for a reason to be explained.
The distal section 16 also includes a rearwardly open blind hole 31 aligned with the through-hole 24 (FIG. 5). The blind