US20090137865A1 - Tissue Stabilizer and Methods of Use - Google Patents
Tissue Stabilizer and Methods of Use Download PDFInfo
- Publication number
- US20090137865A1 US20090137865A1 US12/365,992 US36599209A US2009137865A1 US 20090137865 A1 US20090137865 A1 US 20090137865A1 US 36599209 A US36599209 A US 36599209A US 2009137865 A1 US2009137865 A1 US 2009137865A1
- Authority
- US
- United States
- Prior art keywords
- stabilizer
- foot
- tissue
- base member
- vacuum
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
Links
Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/30—Surgical pincettes without pivotal connections
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00831—Material properties
- A61B2017/00858—Material properties high friction, non-slip
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B2017/0237—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for heart surgery
- A61B2017/0243—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for heart surgery for immobilizing local areas of the heart, e.g. while it beats
Definitions
- the present invention relates generally to surgical instruments, and more particularly to methods and apparatus for stabilizing or immobilizing tissue during surgery.
- the tissue stabilizers described herein are particularly useful for stabilizing the beating heart during coronary artery bypass graft surgery.
- CABG coronary artery bypass graft
- a blocked or restricted section of coronary artery which normally supplies blood to some portion of the heart, is bypassed using a source vessel or a graft vessel to re-establish blood flow to the artery downstream of the blockage.
- This procedure requires the surgeon to create a fluid connection, or anastomosis, between the source or graft vessel and an arteriotomy or incision in the coronary artery. Forming an anastomosis between two vessels in this manner is a particularly delicate procedure requiring the precise placement of tiny sutures in the tissue surrounding the arteriotomy in the coronary artery and the source or graft vessel.
- the rigors of creating a surgical anastomosis between a coronary artery and a graft or source vessel demands that the target site for the anastomosis be substantially motionless.
- a number of devices have been developed which are directed to stabilizing a target site on the beating heart for the purpose of completing a cardiac surgical procedure, such as completing an anastomosis.
- Representative devices useful for stabilizing a beating heart are described, for example, in U.S. Pat. Nos. 5,894,843; 5,727,569; 5,836,311; and 5,865,730.
- the heart is typically accessed by way of a surgical incision such as a sternotomy or thoracotomy.
- a surgical incision such as a sternotomy or thoracotomy.
- one or more of the blocked or restricted coronary arteries are located a good distance away from the access incision requiring the stabilization device to traverse a longer and more tortuous path and engage the surface of the heart at somewhat difficult angular relationships or orientations.
- devices which operate to provide a mechanical compression force to stabilize the beating heart encounter difficulty maintaining mechanical traction against the surface of the heart.
- devices which utilize vacuum to engage the heart have a great deal of difficulty creating and maintaining an effective seal against the moving surface of the heart.
- the target coronary artery may be obscured by layers of fat or other tissue and is very difficult for the surgeon to see.
- the stabilization devices may distort the tissue surrounding the coronary artery or the coronary artery itself such that the arteriotomy is maintained in an unfavorable presentation for completion of the anastomosis.
- the coronary artery in the area of the arteriotomy may become excessively flattened, compressed or stretched in a manner that impedes the placement of sutures around the perimeter of the arteriotomy.
- the present invention will be primarily described for use in stabilizing the beating heart during a surgical procedure, but the invention is not limited thereto, and may be used in other surgical procedures.
- the present invention is a tissue stabilizer having one or more stabilizer feet that may be adjusted or oriented to provide optimal engagement against the tissue to be stabilized or to provide an optimal presentation of a portion of the stabilized tissue.
- the present invention may also include a tissue stabilizer having one or more flexible or compressible seals to ensure a reliable seal against the target tissue and may also include a stabilizer foot having at least one portion which is adjustable relative to the remainder of the stabilizer foot.
- One aspect of the present invention involves a device for stabilizing tissue within a patient's body comprising a base member, a first stabilizer foot extending outwardly from the base member and being rotatable relative to the base member about a first axis, and a second stabilizer foot extending outwardly from the base member and being rotatable relative to the base member about a second axis.
- the first and second stabilizer feet are independently rotatable relative to the base member.
- the first axis and the second axis are substantially parallel.
- the first and second stabilizer feet may each have hollow interiors defining first and second vacuum chambers each having at least one opening adapted to engage at least a portion of the tissue.
- the openings adapted to engage at least a portion of the tissue to be stabilized may have a raised seal around a perimeter thereof.
- the raised seal is made of a substantially rigid material.
- the raised seal is made of an elastomeric material or a compressible foam material.
- the base member may comprise an interior chamber therein, the interior chamber of the base member being in fluid communication with the first and second vacuum chambers.
- the base member may comprise a front base portion and a rear base portion, the front base portion being sealingly affixed to the rear base portion.
- the device may also include a post having a distal end connected to the base member and a proximal end terminating in a ball-shaped member.
- a shaft may be provided having a socket at a distal end, the socket being operably engaged with the ball.
- Another aspect of the present invention involves a device for stabilizing tissue within a patient's body having a base member and at least one stabilizer foot extending outwardly from the base member in a first direction, the stabilizer foot being rotatable relative to the base member about an axis of rotation which is oriented in substantially the same direction as the first direction.
- the axis of rotation is at an angle of no more than about 25° to the first direction, more preferably, the axis of rotation is substantially parallel to the first direction.
- the stabilizer foot has tissue engaging features adapted to engage an external surface of the tissue to be stabilized, the tissue engaging features being disposed at the bottom of the stabilizer foot.
- the tissue engaging features may comprise a vacuum chamber, preferably having a single opening for engaging the tissue to be stabilized, or may comprise a plurality of vacuum ports.
- the tissue engaging features may also comprise a textured surface, a perforated sheet, or a perforated sheet having projections extending outwardly therefrom.
- the axis of rotation of the stabilizer foot is offset from the tissue engaging features, more preferably offset from and parallel to the tissue engaging features.
- the stabilizer foot may have a hollow interior defining a vacuum chamber with a bottom opening adapted to engage at least a portion of the tissue.
- the stabilizer foot may also have a raised seal disposed around a perimeter of said opening, preferably around substantially the entire perimeter.
- the raised seal may be made from a rigid material, an elastomer, or a compressible foam.
- the vacuum chamber may have an inlet passage in fluid communication with a source of negative pressure.
- the inlet passage is in fluid communication with an interior chamber within the base member.
- the base member may include an external fluid connection to supply negative pressure to the interior chamber of the base member.
- a device for stabilizing a coronary artery on a patient's heart comprising a base member and a stabilizer foot for engaging a portion of the patient's heart.
- the base member has an interior chamber and at least a first bore, typically a cylindrical bore, having a first end in fluid communication with the interior chamber of the base member and a second end open to the exterior of the base member.
- the stabilizer foot has a substantially cylindrical fitting having a longitudinal axis, at least a portion of the fitting positioned within the bore and being rotatable within the bore about the longitudinal axis.
- the stabilizer foot may have a hollow interior defining a vacuum chamber, the vacuum chamber having at least one chamber opening adapted to engage at least a portion of the heart.
- the fitting may further have a fluid passage having a first end in fluid communication with the interior chamber of the base member and a second end in fluid communication with the vacuum chamber of the stabilizer foot.
- a raised seal may be disposed substantially completely around the perimeter of the chamber opening.
- the raised seal may be rigid, compressible or flexible, preferably compressible or flexible.
- the raised seal has a durometer with a valve in the range of between about 35 Shore-A to about 100 Shore-A.
- the stabilizer foot fitting may comprise a flange and further include an annular seal positioned adjacent the flange.
- the annular seal is positioned between the flange and the base member.
- the annular seal is preferably an O-ring.
- the fitting includes at least one flexure having a free end and a raised portion extending radially from the free end. The raised portion preferably engages the first end of the first cylindrical bore to restrict movement of the fitting relative to the base member.
- the tissue stabilizer may further include a second substantially cylindrical bore having a first end in fluid communication with the interior chamber of the base member and a second end open to the exterior of the base member.
- the tissue stabilizer may have a second stabilizer foot having a substantially cylindrical fitting having a longitudinal axis, at least a portion of the second stabilizer fitting positioned within the second bore and being rotatable within the second bore about the longitudinal axis of the fitting of the second stabilizer foot.
- a stabilizer foot for use in engaging a portion of tissue within a patient's body which includes a first foot portion having at least one vacuum port, a second foot portion having at least one vacuum port, and at least one malleable member connecting the first foot portion to the second foot portion, whereby the orientation of the first foot portion can be adjusted relative to the second foot portion.
- the first foot portion is a substantially rigid unitary member having at least two vacuum ports.
- the first foot portion may have a fluid passage in fluid communication with each of the vacuum ports associated with the first foot portion and the second foot portion may have a fluid passage in fluid communication with each of the vacuum ports associated with the second foot portion.
- the malleable member may be a cylindrical tube having a first end, a second end, and a lumen extending therebetween, the lumen fluidly connecting the fluid passage of the first foot portion with the fluid passage of the second foot portion, preferably, the tube is made of stainless steel.
- a flexible tube may be provided to connect the fluid passage of the first foot portion to the fluid passage of the second foot portion.
- the malleable member is then preferably offset from the flexible tube.
- the stabilizer foot includes two malleable members offset from opposing sides of the flexible tube.
- FIGS. 1A and 1B are top plan and top perspective views, respectively, of a tissue stabilizer constructed according to the principles of the present invention.
- FIG. 2 is a bottom perspective view of the tissue stabilizer of FIGS. 1A and 1B .
- FIG. 3 is a cross-sectional view taken along line 3 - 3 as shown in FIG. 1A .
- FIG. 4 is a cross-sectional view taken along line 4 - 4 as shown in FIG. 1A .
- FIG. 5 is a bottom perspective view of an alternate construction of a tissue stabilizer according to the principles of the present invention.
- FIG. 6 is an exploded perspective view of a tissue stabilizer.
- FIG. 7 is an exploded perspective view of an alternate construction of a tissue stabilizer.
- FIG. 8A is a magnified partial perspective view of a contacting surface of a preferred perforated screen for use in a tissue stabilizer.
- FIG. 8B is a partial cross-sectional view showing the perforated screen configuration of FIG. 8A engaged against a tissue structure.
- FIGS. 9A and 9B are partial cross-sectional views of a tissue stabilizer foot having a perimeter seal.
- FIG. 10 is a partial cross-sectional view of a tissue stabilizer foot having an alternate perimeter seal.
- FIG. 11 is a partial cross-section view of a tissue stabilizer foot having an alternate perimeter seal.
- FIG. 12 is a top plan view of a tissue stabilizer having an alternative perimeter seal.
- FIG. 13A is a top perspective view of the stabilizer foot of FIG. 12 .
- FIG. 13B is a cross-sectional view taken along line 13 B- 13 B as shown in FIG. 13A .
- FIG. 14 is a bottom perspective view of an alternate construction of a tissue stabilizer according to the principles of the present invention.
- FIG. 15 is a cross-sectional view of one of the stabilizer feet of FIG. 14 .
- FIG. 16 is a bottom plan view of an alternate construction of a stabilizer foot according to the principles of the present invention.
- FIG. 17 is a cross-sectional view taken along line 17 - 17 as shown in FIG. 16 .
- FIG. 18 is a bottom plan view of an alternate construction of a stabilizer foot.
- FIG. 19 is a cross-sectional view taken along line 19 - 19 as shown in FIG. 18 .
- FIG. 20 is a bottom plan view of an alternate construction of a stabilizer foot.
- FIG. 21 is a cross-sectional view taken along line 21 - 21 as shown in FIG. 20 .
- FIG. 22 is a partial cross-sectional view of an alternate construction of a tissue stabilizer according to the principles of the present invention.
- the present invention involves surgical instruments and methods for stabilizing tissue during a surgical operation.
- the devices described herein may be used in a wide variety of surgical applications that require a tissue structure to be stabilized or immobilized to provide a substantially stable and motionless surgical field on which a surgical procedure can be performed.
- the preferred embodiments described in detail below are directed to the stabilization of a portion of the heart to facilitate a surgical procedure on or within the heart, such as a coronary artery bypass graft (CABG) procedure.
- CABG coronary artery bypass graft
- the devices and methods of the present invention may have application in both conventional stopped-heart and beating heart procedures, they are preferably used to stabilize the beating heart during a CABG operation which has been specially developed to facilitate completion of an anastomosis, typically between a target coronary artery and a bypass graft or source artery, without requiring cardiac arrest and cardiopulmonary bypass.
- a typical beating heart CABG procedure involves accessing the beating heart by way of a sternotomy, mini-sternotomy, thoracotomy, mini-thoracotomy, or other suitable access incision, positioning a tissue stabilizer on, around or adjacent a coronary artery to stabilize the coronary artery, creating an arteriotomy in the coronary artery, and anastomosing the bypass graft or source artery to the arteriotomy.
- the tissue stabilizer has a heart engaging member at one end for engaging the surface of the beating heart and is connected at the other end to a stationary object such as a sternal retractor, rib retractor, or other such stationary structure.
- the devices of the present invention involve tissue stabilizers which provide superior engagement with the surface of the heart.
- the tissue stabilizer may have one or more stabilizer feet which provide for adjustment of the orientation of the features which contact or engage the surface of the heart.
- the orientation may be adjusted to ensure the engaging features will be properly aligned with the surface of the heart.
- the orientation may be adjusted to yield an optimum presentation of the target coronary artery and, in particular, the location at which the anastomosis will be performed.
- the stabilizer feet may include one or more compliant or flexible seals to ensure that there will be no vacuum leaks between the stabilizer foot and the surface of the heart.
- the stabilizer foot may have one or more portions which are adjustable relative to each other so that the stabilizer foot may be shaped according to the requirements of a particular surgical procedure or according to the specific anatomical features or characteristics of each individual patient.
- Tissue stabilizer 100 preferably has stabilizer feet 105 and 110 which typically engage the surface of the heart on opposite sides of a coronary artery. Tissue stabilizer 100 is typically positioned such that the coronary artery runs lengthwise in the space between stabilizer feet 105 and 110 .
- tissue stabilizer 100 preferably has a construction that does not occlude or otherwise contact the vessel as stabilizer feet 105 and 110 are placed on opposite sides of the coronary vessel portion to be stabilized.
- stabilizer feet 105 , 110 are spaced apart at a distance such that a coronary artery can be positioned therebetween.
- the base may include a recessed or raised portion to ensure that the vessel is not contacted by the stabilizer.
- manifold base 120 to which stabilizer feet 105 and 110 are attached, preferably has raised portion 126 under which the coronary vessel may pass without contact when stabilizer feet 105 and 110 are engaged to stabilize the heart in the vicinity of the coronary vessel.
- Stabilizer feet 105 and 110 are connected to manifold base 120 which will typically have mounting or connecting features for operably attaching a suitable shaft or other such structure.
- manifold base 120 has a ball 135 extending therefrom.
- a shaft (not shown), preferably having a suitably constructed socket, may be provided to engage ball 135 .
- the shaft may be used to position tissue stabilizer 100 at the desired location on the heart and may provide the necessary structure to hold the tissue stabilizer substantially motionless against the forces generated by the beating heart.
- the shaft or other appropriate connecting structure may be operably connected to the tissue stabilizer using any suitable connection which allows the desired maneuverability of the tissue stabilizer relative to the shaft. Suitable stabilizer shafts and their connections to a tissue stabilizer are described in co-pending U.S.
- Stabilization of the targeted tissue may be achieved by applying a localized compressive force to the heart through stabilizer feet 105 and 110 using an appropriate connecting structure attached to ball 135 .
- the tissue contacting features on the bottom of stabilizer feet 105 and 110 are designed to have high friction against the surface of the heart, for example, by using a textured surface or the like.
- negative pressure or vacuum may be applied to stabilizer feet 105 and 110 so that the beating heart may be engaged or captured by the suction created within a vacuum chamber or a plurality of suction ports.
- the heart portion may be rendered substantially motionless by fixing an attached shaft to a stationary object, such as a surgical retractor as described above.
- ball 135 is preferably connected to manifold base 120 by way of post 130 .
- Ball 135 and post 130 may have any suitable construction which provides the necessary attachment of the stabilizing shaft or other stabilizing structure and which can withstand the loads required to stabilize the beating heart with minimal deflection.
- the ball and post may be integrally molded features on the manifold base itself or may be separate components mechanically secured to manifold base 120 using, for example, a threaded or snap-fit connection or the like.
- manifold base 120 is constructed of a plastic material
- post 130 is rigidly attached to support member 155 which is made of a metal such as aluminum or stainless steel.
- support member 155 is secured within holding features such as cavities or pockets 156 and 158 formed in rear manifold portion 124 and front manifold portion 122 , respectively.
- Support member 155 may be secured within pockets 156 and 158 by a simple interference fit as manifold portions 122 and 124 are urged into their final assembled positions or may be held in place using mechanical fasteners, adhesive, or suitable bonding or welding technique.
- manifold base 120 When the tissue stabilizer is configured to use vacuum stabilization or vacuum-assisted stabilization, manifold base 120 preferably has a fitting or the like to which a vacuum supply may be connected. In a preferred embodiment, manifold base 120 has inlet tube 115 having an inlet opening 117 . Inlet tube 115 is preferably in fluid communication with a hollow space or chamber 134 formed within manifold base 120 . Manifold base 120 and internal chamber 134 provides for convenient distribution of a single vacuum source connected to inlet tube 115 to multiple stabilizer feet fluid connections, in this case to stabilizer feet 105 and 110 .
- Inlet tube 115 may have one or more barbs 119 to facilitate the secure and leak-free attachment of a length of flexible tubing (not shown) coming from a vacuum pump or other vacuum source (not shown) as is commonly known in the art.
- inlet tube 115 may be replaced with a generally cylindrical bore adapted to accept an O-ring sealed fitting forming a dynamically sealed rotating connection between the fitting and the manifold base similar in construction to the stabilizer foot connection described below with regard to FIG. 3 .
- manifold base 120 is preferably made in two or more portions and fixed together to form a sealed, hollow interior.
- manifold base 120 has front manifold portion 122 and rear manifold portion 124 which may be bonded together along bond line 125 as shown.
- the internal chamber 134 may reside primarily in either or both of front and rear manifold portions 122 and 124 .
- a portion of internal chamber 134 is formed in rear manifold portion 124 and one or more internal cavities 128 are included within front manifold portion 122 .
- the manifold portions are preferably injection molded and may be fixed together using standard mechanical fasteners, a snap fit construction, or any suitable adhesive, bonding, sealing, or welding technique compatible with the material of manifold base 120 .
- the manifold portions may have close fitting overlapping flanges.
- rear manifold portion 124 has an inner flange 152 and front manifold portion 122 has an overlapping outer flange 154 . This construction provides a particularly reliable sealed junction between front and rear manifold portions 122 and 124 , especially when used in conjunction with a suitable gap-filling adhesive.
- stabilizer feet 105 and 110 are secured to manifold base 120 .
- Stabilizer feet 105 and 110 may be fixed in place in any convenient manner and immovable relative to manifold base 120 . More preferably, however, stabilizer feet 105 and 110 are moveable relative to manifold base 120 . Most preferably, stabilizer feet 105 and 110 are independently moveable with respect to each other as well. This allows the tissue engaging features of the tissue stabilizer to be optimally adjusted with respect to the size and shape of the tissue to be stabilized and, once engaged and in operation, may also allow the stabilizer feet to be moved to optimize the presentation of the stabilized tissue, and more particularly the target coronary artery.
- stabilizer feet 105 and 110 are connected to manifold base 120 in a manner which allows each foot to rotate relative to the manifold base 120 .
- the axis about which the stabilizer feet 105 and 110 rotate may be in any orientation that provides the desired stabilizer feet orientation relative to the heart for optimum engagement or tissue presentation.
- the axis of rotation is oriented generally in the same direction as the direction stabilizer feet 105 and 110 extend from manifold base 120 , although the axis of rotation and the direction the stabilizer feet extend may be offset from each other.
- the axis of rotation of the first stabilizer foot relative to the base member may be offset from the axis of rotation of the second stabilizer foot relative to the base member.
- the axis of rotation is preferably at an angle of no more than about 25° with respect to the included plane or surface approximated by the features adapted to engage the tissue surface to be stabilized. More preferably, the axis of rotation for each stabilizer foot 105 and 110 is generally parallel to the features adapted to engage the tissue surface to be stabilized.
- the axis of rotation is oriented as described above relative to a best-fit plane approximating the tissue engaging features or a central tangent plane.
- the axis of rotation for each stabilizer foot is also angled with respect to each other at an angle of no more than about 30°, and more typically the axis of rotation of stabilizer foot 105 is generally parallel to the axis of rotation of stabilizer foot 110 .
- a preferred stabilizer foot connection is illustrated with respect stabilizer foot 110 .
- Manifold base 120 and more specifically front manifold portion 122 , has a bore 149 extending through the exterior wall.
- Stabilizer foot 110 has an end portion or fitting 137 having an outside diameter 148 adapted to mate with bore 149 to allow fitting 137 , and thus stabilizer foot 110 , to rotate about central axis 133 of bore 149 .
- central axis 133 is offset from the features which engage the tissue to be stabilized, in this case perforated screen 141 .
- This offset facilitates improved vessel presentation as stabilizer feet 105 and 110 are rotated because, in addition to changing the overall orientation of the tissue engaging features, the eccentric relation of the tissue engagement features relative to the central axis moves the stabilizer feet together or apart as the stabilizer feet are rotated. This action allows the tissue and included coronary artery held between the stabilizer feet to be stretched or compressed as desired by rotating either or both of stabilizer feet 105 and 110 after they have become operably engaged with the tissue.
- the tissue stabilizer 100 is constructed to supply a negative pressure or vacuum to stabilizer feet 105 and 110 to assist in the engagement of the surface of the heart.
- Stabilizer feet 105 and 110 preferably have a hollow interior 132 to which a vacuum may be supplied through vacuum inlet 131 of fitting 137 , vacuum chamber 134 , and vacuum inlet tube 115 , which are interconnected in a manner which does not allow any significant vacuum leaks.
- the structures comprise a vacuum conducting chamber that communicates a negative pressure from a vacuum source to the surface of the beating heart.
- Vacuum inlet tube 131 may optionally have restriction or aperture (not shown) provided therein to restrict the amount of flow through vacuum inlet tube 131 when the sealed engagement against the tissue to be stabilized is broken. This allows vacuum chamber 134 of manifold base 120 to continue to provide sufficient vacuum to one stabilizer foot even when the engagement seal of the other stabilizer foot is compromised.
- the rotating connection between stabilizer feet 105 and 110 and manifold base 120 must be sealed to prevent any vacuum loss.
- This preferably accomplished using an appropriate dynamic annular or shaft seal that seals between the stabilizer foot and manifold base 120 but yet allows for rotation of the stabilizer foot within bore 149 without incurring any vacuum loss.
- a seal such as O-ring 145 is positioned within an annual seal cavity 146 at the entrance of bore 149 .
- the seal is captured and compressed within seal cavity 146 by cooperating annular seal flange 147 provided on stabilizer feet 105 and 110 as the stabilizer feet are urged into final position.
- Stabilizer feet 105 and 110 may be held in position by operation of an spring clip or e-clip 150 assembled to fitting 137 just beyond its exit of bore 149 .
- Hollow interior 132 is generally a closed chamber except for one or more openings for engaging the heart.
- the engagement opening or openings may be in the form of a perforated screen having a relatively large number of perforations or small holes which engage the surface of the heart, a single opening having a defined perimeter for sealing against the surface of the heart, or a plurality of individual suction pods each having a sealing perimeter.
- stabilizer feet 105 and 110 include thin perforated sheets or screens 140 and 141 , respectively which have a front surface 144 oriented to engage the surface of the heart.
- Perforated screens 140 and 141 are supported around their perimeter by a support step 138 which preferably has a raised perimeter edge or border 139 .
- Perforated screens 140 and 141 are characterized as having a plurality of perforations or holes 142 .
- perforated screens 140 and 141 are fabricated to have a contour or shape which corresponds to the expected size and shape of the cardiac tissue to be stabilized.
- perforated screen 140 and 141 may have a radius, R, which may be constant or variable.
- each perforation 142 As front surfaces 144 of perforated screens 140 and 141 are urged against the surface of the heart (or other tissue structure), the heart begins to contact front surface 144 around each perforation 142 and thus sealingly covering each perforation 142 . As each perforation 142 is covered in this manner, the relatively small portion of tissue residing over each perforation 142 is subjected to the vacuum existing within hollow interior 132 and is accordingly sucked against, and even slightly into, perforation 142 .
- the unperforated material between adjacent perforations is between about 0.015 inches (0.38 mm) and about 0.025 inches (0.635 mm) at its smallest point, most preferably about 0.02 inches (0.51 mm), and the diameter of the perforations are from about 0.06 inches (1.524 mm) to about 0.09 inches (2.286 mm).
- FIGS. 8A and 8B illustrate a perforated member 400 having a front contact surface 410 which has a number of perforations or holes 415 .
- the unperforated material of member 400 has a plurality of projections 420 extending outwardly from contact surface 410 .
- a plurality of projections are generally equally spaced around each perforation 415 .
- the projections may be formed, for example, by chemical machining or etching. Projections 420 operate to more aggressively bite or engage tissue structure 425 as it is urged into perforation 415 by operation of an applied vacuum.
- FIG. 5 illustrates tissue stabilizer 200 having a perimeter sealing member 215 disposed at the bottom of each stabilizer foot 205 and 210 . Perforated screens 140 and 141 are recessed from perimeter sealing member 215 .
- perimeter sealing member 215 makes contact with the surface of the heart around substantially its entire perimeter, the portion of the heart tissue within the perimeter is subjected to the negative pressure existing within the hollow interior of stabilizer feet 205 and 210 and is urged into engagement with stabilizer feet 205 and 210 .
- the negative or vacuum pressure may be sufficient to displace the portion heart tissue within the vacuum chamber created by perimeter sealing member 215 into forced contact with perforated screens 140 and 141 .
- perforated screens may optionally have projections as described above.
- FIG. 6 An exploded view of tissue stabilizer 200 is shown in FIG. 6 .
- Front manifold portion 122 has first and second bores 222 and 223 for receiving tubular members or fittings 208 associated with stabilizer feet 205 and 210 , respectively
- Fittings 208 are preferably integrally molded features of stabilizer feet 205 and 210 , but could alternatively be separate fittings secured to the stabilizer feet by way of, for example, a bonded, welded, or threaded connection.
- Fittings 208 have a flange 212 for retaining and compressing O-ring 202 within the seal cavity (not visible in this view) and groove 214 for receiving a external retaining ring, preferably of the spring type, e-type or the like.
- Fittings 208 preferably have a vacuum inlet opening 220 for communicating the negative pressure within manifold base 120 to the hollow interior region within stabilizer feet 205 and 210 .
- Stabilizer foot 205 may be assembled to front manifold portion 222 by installing O-ring 202 over fitting 208 and then installing fitting 208 through bore 222 . Fitting 208 and stabilizer foot 205 is secured in place by securing an external retaining ring 218 , into place within groove 214 . The same procedure is then used to install stabilizer foot 210 to manifold portion 222 . Post support member 155 is placed in the proper location between or within front and rear manifold portion 122 or 124 as the two manifold portions are brought together in the presence of an appropriate bonding agent or adhesive to make the assembly leak-free, air-tight, and permanent. Perforated screens 140 and 141 may be secured to stabilizer feet 205 and 210 at any convenient time before or after the assembly procedure just described.
- Tissue stabilizer 300 shown in exploded view in FIG. 7 , allows stabilizer feet 305 and 310 to be assembled to front manifold portion 122 using a simple snap-fit construction instead of an external retaining ring.
- the fitting portions of stabilizer feet 305 and 310 include a seal flange 310 , an uninterrupted base portion 304 and a number of flexures 302 having raised end features 303 .
- Flexures 302 allow raised features 303 to flex inwardly so that they fit through bore 222 and 223 and then flex outwardly as they exit bores 222 and 223 , thus becoming locked in place.
- Tissue stabilizer 300 may be assembled using the same basic procedure as described above with reference to tissue stabilizer 200 .
- the front and rear manifold portions 122 and 124 can be fully assembled and leak tested (if desired) before stabilizer feet 305 and 310 are installed.
- post support member 155 is positioned in place in or between front and rear manifold portions 122 and 124 as the two manifold portions are brought together in the presence of an appropriate bonding agent or adhesive to secure the manifold base assembly together.
- An O-ring 202 is then placed over uninterrupted portion 304 adjacent flange 310 and raised features 303 on flexures 302 are urged through bore 222 or 223 until it exits the bore and snaps open and into place, thus fixing stabilizer foot 305 or 310 to the assembled manifold base.
- Tissue stabilizer 300 shows a variation in which a stabilizer shaft 307 is pre-installed on ball 135 .
- Stabilizer shaft 307 has a socket housing 306 which is permanently operably attached to ball 135 .
- the ball 135 and post 130 is dropped into housing 306 from a distal direction prior to fixing shaft 307 thereto.
- Post support member 155 is then fixed to the proximal end of post 130 , rendering the assembly essentially inseparable. This eliminates any possibility of accidental separation of the stabilizer foot from the stabilizer shaft.
- stabilizer feet 305 and 310 may be rotated to obtain the desired orientation of each foot to provide maximum stabilization based on the clinical situation presented by an individual patient.
- Stabilizer feet 305 and 310 may be provided with additional features to facilitate adjustment of stabilizer feet 305 and 310 after engagement with the tissue to be stabilized.
- the features may be any holes, lever, protrusion, projection, or other suitable feature that allows the stabilizer feet to be easily manipulated during use. Since it is desirable for the device to have an unobstructingly low-profile, especially in the area of the stabilizer feet, the adjustment features are preferably one or more blind holes 308 adapted to receive a blunt instrument for manipulating the orientation of stabilizer feet 305 and 310 .
- a hex or nut-shaped feature could be added to each stabilizer foot distal of the seal flange for use with an appropriately sized wrench or the like to rotate the stabilizer feet.
- Perimeter sealing member 215 may have a variety of constructions. Sealing member 215 may simply be an integral extension of the stabilizer foot material. In that instance, sealing member 215 will typically be a relatively hard polymer or plastic material. Sealing member 215 may also be a relatively soft elastomer which is attached to or over-molded on stabilizer feet 205 and 210 . Sealing member 215 may also be constructed of a compressible foam material, preferably a closed cell foam.
- sealing member 215 When sealing member 215 is constructed of an elastomer or foam material, it will preferably have a durometer hardness in the range from about 35 Shore-A to about 100 Shore-A depending on the geometrical configuration of sealing member 215 .
- the perimeter seal has a variable thickness around its perimeter to provide a more reliable seal against the curvature of the surface of the heart, especially when the heart continues to beat during the procedure.
- FIGS. 9A and 9B show a portion of a stabilizer foot 430 having a perimeter seal 440 with a variable height or thickness around its perimeter. Similar to the previously discussed configurations, stabilizer foot 430 has a hollow interior 449 to which a negative pressure is communicated.
- Perforated screen 435 has a plurality of holes or perforations 437 and is mounted in position on step feature 447 within stabilizer foot 430 .
- Perimeter seal 440 is mounted at or near the bottom of stabilizer foot 430 , and is preferably retained within a groove or step 448 .
- the height that perimeter seal 440 extends from the bottom of stabilizer foot 430 typically varies at different locations around the perimeter of perimeter seal 440 .
- the tip height 441 and rear height 443 is generally greater than midpoint height 442 along either side of the stabilizer foot.
- height 446 of perimeter seal 440 along the inside of stabilizer foot 430 is generally less that the outside height 444 at a corresponding location along the stabilizer foot 430 .
- perimeter seal 440 is made from an elastomer, a closed-cell foam, or other flexible or compressible material to further optimize the ability of stabilizer foot to maintain its seal on the tissue to be stabilized. If the seal is broken or otherwise compromised, the stabilizer foot may disengage from the surface of the heart, adversely affecting stabilization. Seal 440 may be fixed to the stabilizer foot using an adhesive or bonding agent or may be made integral with the stabilizer foot using an injection over-molding process wherein seal 440 is molded over the stabilizer foot.
- Stabilizer foot 450 again has a hollow interior 449 and a perforated screen 435 having perforations or holes 437 .
- stabilizer foot 450 has a flexible seal 455 having first and second legs 458 and 459 disposed in an angular relationship which operates as a highly flexible joint allowing perimeter edge 456 to move relatively freely towards and away from the bottom of stabilizer foot 450 as required to effectuate a reliable seal against the surface of the tissue to be stabilized. For example, if the tissue under vacuum engagement with stabilizer foot 450 contracts and moves away from the tip of stabilizer foot 450 , flexible seal 455 can easily follow the movement to a new extended position 4551 without the seal being broken.
- Flexible seal 455 is preferably made from a medical grade elastomeric material such as silicone, urethane rubber, neoprene, nitrile rubber, hytrel, kraton, or other suitable material. Flexible seal 455 may be separately formed and later attached to stabilizer foot 450 or may be integrally over-molded onto stabilizer foot 450 . For secure attachment to stabilizer foot 450 , flexible seal 455 may optionally be provided with seal base portion 457 .
- stabilizer foot 460 has flexible seal 465 having continuously connected alternating flexible legs in the form of a bellows.
- Flexible seal 465 may include a base 467 to facilitate attachment to the bottom of stabilizer foot 460 and has a perimeter edge 466 to effectuate a reliable seal against the surface of the tissue to be stabilized.
- This type of seal generally compresses to a relatively solid, stable structure as the stabilizer foot is urged against the surface of the tissue, has a the ability to follow moving tissue over a relatively long travel if required, and yet occupies only a very small amount of space around the perimeter of the stabilizer foot.
- Tissue stabilizer 470 has a manifold base 473 comprised of front manifold portion 472 , rear manifold portion 474 having vacuum inlet tube 471 , and ball 476 to which a stabilizing shaft may be attached.
- Stabilizer feet 475 and 480 may be attached to stabilizer base 473 in any of the ways discussed above.
- stabilizer feet 475 and 480 have a fitting portion 485 which includes an uninterrupted cylindrical portion 486 , one or more flexures 487 each having raised features 488 that provide a positive snap-fit joint in cooperation within cylindrical bores formed in front manifold portion 472 as described in detail above.
- fitting 485 has a flange 479 for retaining and compressing a shaft seal or the like.
- Stabilizer feet 475 and 480 have attached thereto flexible seals 482 and 477 , respectively.
- Flexible seals 477 and 482 may extend completely around the perimeter of stabilizer feet 480 and 475 . More preferably, stabilizer feet 475 and 480 have at least one portion of its perimeter having a flexible seal and at least one portion without a flexible seal. According to this variation of the present invention, the stabilizer feet 475 and 480 are primarily sealed against the target tissue by operation of their own perimeter edge 481 .
- Flexible seals 482 and 477 are provided generally outside of perimeter edge 481 to provide a form of secondary or back-up seal in the event the seal at perimeter edge 481 becomes compromised as a result of misalignment or movement of the tissue.
- Flexible seals 477 and 482 are preferably sufficiently flexible to remain in contact with the movements of the beating heart so that when the seal breaks along 481 perimeter edge the vacuum loss is contained within flexible seal 482 or 477 . This containment typically allows the comprised area of perimeter edge 481 to become re-engaged against the tissue without significant vacuum loss.
- the vacuum seal formed at the perimeter edge of the stabilizer feet may be most likely to break at the tip region or along the outside edge of the stabilizer foot as the heart contracts away from the site of stabilization.
- flexible seals 477 and 482 need only be associated with these problem areas, leaving inside perimeter portion 478 and the space between stabilizer feet 475 and 480 open to avoid obstructing the surgical field of the anastomosis.
- Flexible seals 477 and 482 have a contoured outer periphery 483 which may be a relatively large distance away from the outer extents of the stabilizer feet 475 and 480 and may include extended tip portions 484 .
- Flexible seals 477 and 482 preferably have a top portion for attaching to the stabilizer feet about the perimeter edge 481 .
- Flexible seals 477 and 482 may be fixed in place using an adhesive or bonding agent or may be integrally over-molded as part of stabilizer feet 475 and 480 .
- Another way to prevent a complete loss of engagement and stabilization of the target tissue due to a compromised perimeter seal resulting from misalignment of the stabilizer feet or movement of the target tissue to be stabilized is to partition the vacuum chamber within the stabilizer feet into a plurality of chambers connected to the vacuum source through only a small aperture. In that way, a vacuum leak at a single location will is result in a reduced ability to maintain engagement of that partitioned section only and will not immediately compromise the engagement of the entire stabilizer foot.
- Tissue stabilizer 500 has a manifold base 501 , preferably having front and rear manifold portions 504 and 502 , to which first and second stabilizer feet 505 and 506 are attached.
- First and second stabilizer feet 505 and 506 have perimeter seal edges 507 and 508 which generally define the extents of the vacuum chambers for each stabilizer foot.
- One or more partitions 509 are provided to divide stabilizer feet 505 and 506 into two or more vacuum subchambers.
- stabilizer feet 505 and 506 have partitions 509 which divide the vacuum space into first, second, third, and fourth vacuum subchambers 517 , 518 , 549 , and 520 , respectively.
- Vacuum feed tube 510 is provided along the interior of stabilizer feet 505 and 506 to communicate the negative pressure from within the manifold base to each of subchambers 517 , 518 , 519 , and 520 .
- Vacuum feed tube 510 preferably has a side opening or aperture 512 within each of subchambers 517 , 518 , and 519 .
- Vacuum feed tube 510 may have an end opening or aperture 513 within subchamber 520 .
- the apertures 512 and 513 facilitate the separate communication of negative pressure to each vacuum subchamber and are preferably sized such that when one subchamber encounters a vacuum leak, the aperture is restricted enough so that the vacuum in the other subchambers can be maintained by the vacuum source.
- Stabilizer feet 505 and 506 are preferably rotatable with respect to manifold base 501 as discussed at length above.
- stabilizer feet 505 and 506 may have a fitting portion 515 which is preferably cylindrical to cooperate with a mating bore provided in manifold base 501 .
- Fitting portion 515 may have a flange 514 for retaining a shaft seal and a groove for receiving an external retaining ring to secure fitting portion 515 within manifold base 501 .
- the bottom of stabilizer feet 505 and 506 may have a contoured shape having a variable or fixed radius, R.
- a flexible seal may optionally be included along one or all of sealing edges 507 , 508 , and 511 .
- a partitioned vacuum chamber as described above maximizes the area exposed to negative pressure for a particular size of stabilizer foot. That is, the ratio of the surface area exposed to negative pressure divided by the total surface area included with the boundary at the bottom of the stabilizer foot is maximized by the partitioned chamber configuration just described.
- rotatable stabilizer feet can be constructed to have a number of individual vacuum ports or pods.
- FIGS. 16 and 17 illustrate stabilizer foot 550 having a plurality of individual vacuum ports.
- stabilizer foot 550 has four suction ports 551 , 552 , 553 , and 554 each with a dedicated edge seal 561 .
- Negative pressure is communicated to each port through openings or apertures 560 provided in vacuum distribution passage 563 which is fluid communication with vacuum inlet 562 which in turn is placed in fluid communication with the negative pressure within a manifold base assembly having a construction as described above.
- Stabilizer foot 550 may be mounted for rotation within a cooperating bore of an appropriate manifold base by way of cylindrical fitting portion 556 which may include a seal flange 555 and groove 557 for receiving an external retaining ring to secure fitting portion 556 in place.
- FIGS. 18 and 19 show a variation of a stabilizer foot having a plurality of individual ports.
- Stabilizer foot 575 again has a fitting portion 599 having a seal flange 598 for retaining and compressing an appropriate shaft seal to provide the desired dynamic seal as stabilizer foot 575 is rotated about fitting portion 599 .
- To facilitate even greater adjustment of the shape and orientation of stabilizer foot 575 has a first foot portion 580 with at least one vacuum port and a second foot portion 585 with at least one vacuum port which are adjustable relative to one another, preferably by way of one or more malleable joints or links.
- first foot portion 580 has a plurality of separate vacuum ports 581 each with a perimeter seal 582 .
- first foot portion 580 has three vacuum ports 581 each supplied with negative pressure through apertures 578 in vacuum distribution channel or passage 593 .
- Second foot portion 585 has at least one vacuum port 583 having perimeter seal 584 and aperture 577 in fluid communication with vacuum passage 592 .
- First foot portion 580 and second foot portion 585 are preferably connected to each other by malleable tube 590 , which has a lumen or passage 591 therethrough.
- Malleable tube 590 is preferably made of stainless steel, more preferably annealed stainless steel or vacuum annealed stainless steel.
- the vacuum communicated from a manifold base or other vacuum source through vacuum inlet channel 595 is distributed to vacuum ports 581 and 583 through vacuum distribution channel 593 and associated apertures 578 , through malleable tube passage 591 , finally to vacuum passage 592 and associated aperture 577 .
- the orientation of second foot portion 585 and thus vacuum port 583 can be adjusted relative to first foot portion 580 by simple bending it to the desired orientation. This additional adjustment tends to eliminate problems associated with obtaining a reliable seal at the tip of the stabilizer foot as the beating heart contracts away from the stabilizer, yet maintains the reliability of having ports 603 molded to a unitary relatively rigid stabilizing structure.
- Malleable tube 590 may be secure to first foot portion 580 and second foot portion 585 in any convenient manner which provides a permanent and sealed connection.
- the exterior of malleable tube 590 may be pressed into mating counterbores 596 and 597 provided in the ends of Vacuum passages 593 and 592 as shown.
- a suitable adhesive or bonding agent may additionally be used to sealingly secure malleable tube 590 in place.
- malleable tube 590 and counterbores 596 and 597 may be threaded together or malleable tube 590 could be insert molded within first and second foot portions 580 and 585 .
- FIGS. 20 and 21 illustrate another embodiment of a stabilizer foot having foot portions which are adjustable relative to one another to improve the fit, and accordingly the operating vacuum seal, against the surface of the tissue structure to be stabilized.
- Stabilizer foot 600 has a first foot portion 601 and a second foot portion 602 .
- First foot portion 601 has one or more, preferably three, vacuum ports 603 and second foot portion 602 has one or more vacuum ports 608 .
- Each of vacuum ports 603 and 608 preferably have a flexible or compressible perimeter seal 604 and 609 , respectively, preferably made of a medical grade elastomer or foam.
- Negative pressure is supplied to vacuum ports 603 and 608 through openings or apertures 715 and 716 which in fluid communication with vacuum passages 711 and 712 .
- Negative pressure is supplied to vacuum passage 711 through inlet channel or passage 710 of fitting portion 718 .
- Fitting portion 718 connected to a vacuum chamber or source within a manifold base or like structure as described above.
- First foot portion 601 and second foot portion 602 are made adjustable relative to each other by providing one or more malleable links spanning between the two portions.
- first and second malleable members 606 and 607 are located off-center with respect vacuum ports 603 and 608 . The off-center position of malleable members 606 and 607 better protects against excessive torsional loads applied to tube 605 if second foot portion 602 were twisted relative to first foot portion 601 .
- Malleable members 606 and 607 may be glued or bonded within cavities or bores provided within first and second foot portions 601 and 602 or may be insert molded during fabrication of the foot portions.
- Tube 605 fluidly connects vacuum passages 711 and 712 .
- tube 605 may be malleable or may be a flexible tubing material.
- tube 605 is assembled within counterbores 713 and 714 .
- the tissue stabilizers of the present invention allow the stabilizer feet, and in particular the features which operate to engage the surface of the tissue to be stabilized, to be optimally adjusted to for a specific surgical procedure or to adjust for variations in size and orientation of a patient's anatomy.
- the stabilizer feet can be adjusted after engagement to the tissue to be stabilized to produce an improved presentation of the tissue subject to the surgical procedure.
- one or both of the stabilizer feet are adjusted to the desired orientation relative to the manifold base and each other.
- the orientation of the stabilizer feet are adjusted to account for the size and shape of the tissue to be stabilized, for example a target site on the surface of the heart. If either of the stabilizer feet have an adjustable portion, it may also be adjusted at this time.
- the tissue stabilizer is brought into engagement with the tissue to be stabilized and the vacuum is applied.
- the stabilizer shaft is then locked into place to immobilize the tissue stabilizer and the engaged tissue.
- one or both of the stabilizer feet may be rotated relative to the manifold base until the tissue between or adjacent the stabilizer feet obtains the best possible presentation for the procedure to be performed. If there appears to be any discernible vacuum leaks associated with the engagement of the stabilizer feet against the target tissue, the orientation of the stabilizer feet may be further adjusted or, if applicable, the feet portions may be adjusted, to eliminate or minimize vacuum leaks at the interface between the stabilizer feet and the target tissue.
- FIG. 22 illustrates tissue stabilizer 725 having a stabilizer foot rotatably connected with respect to a portion of common tubing having a flared end.
- Tube 740 may be a malleable tube, for example made of annealed stainless steel, which may be connected proximally to a manifold (not shown) shared with a second stabilizer foot or may be connected directly to a fixed mount (not shown) to effectuate stabilization.
- stabilizer foot 730 is connected to housing 735 which rotates about tube 740 .
- Tube 740 has a flared end 742 as is commonly known in the art.
- a shaft seal, such as O-ring 732 is place over tube 740 adjacent flared end 742 .
- Housing 735 has a first bore 737 and a second larger bore 738 .
- First bore 737 is larger than the outside diameter of tube 740 but preferably smaller than the diameter of flanged end 742 .
- Second bore 738 is preferably slightly larger than flanged end 742 .
- Tube 740 with O-ring 732 is assembled through second bore 738 until the O-ring is compressed at the distal entrance to first bore 737 .
- An O-ring cavity 736 may be provided if desired.
- Fitting portion 734 is inserted into second bore 738 and permanently fixed in place preferably using a fluid tight connection such as pipe threads, adhesive, bonding agent, welding, brazing, etc. With fitting portion 734 fixed to housing 735 , stabilizer foot 730 and housing 735 may be rotated relative to tube 740 without any appreciable vacuum leakage. Stabilizer foot 730 may be of any desirable configuration.
Abstract
Description
- The present invention relates generally to surgical instruments, and more particularly to methods and apparatus for stabilizing or immobilizing tissue during surgery. The tissue stabilizers described herein are particularly useful for stabilizing the beating heart during coronary artery bypass graft surgery.
- Certain surgical procedures require the surgeon to perform delicate operations on tissues within the body that are moving or otherwise unstable. The ability to stabilize or immobilize the surgical site provides greatly improved surgical accuracy and precision and reduces the time required to complete a particular procedure. A large and growing number of surgeons, for example, are routinely performing successful coronary artery bypass graft (CABG) surgery on the beating heart by temporarily stabilizing or immobilizing a localized area of the beating heart. Methods and apparatus for performing a CABG procedure on the beating heart are described in U.S. Pat. No. 5,894,843 and U.S. Pat. No. 5,727,569 to Benetti et al., the entirety of which is herein incorporated by reference.
- In a typical CABG procedure, a blocked or restricted section of coronary artery, which normally supplies blood to some portion of the heart, is bypassed using a source vessel or a graft vessel to re-establish blood flow to the artery downstream of the blockage. This procedure requires the surgeon to create a fluid connection, or anastomosis, between the source or graft vessel and an arteriotomy or incision in the coronary artery. Forming an anastomosis between two vessels in this manner is a particularly delicate procedure requiring the precise placement of tiny sutures in the tissue surrounding the arteriotomy in the coronary artery and the source or graft vessel.
- The rigors of creating a surgical anastomosis between a coronary artery and a graft or source vessel demands that the target site for the anastomosis be substantially motionless. To this end, a number of devices have been developed which are directed to stabilizing a target site on the beating heart for the purpose of completing a cardiac surgical procedure, such as completing an anastomosis. Representative devices useful for stabilizing a beating heart are described, for example, in U.S. Pat. Nos. 5,894,843; 5,727,569; 5,836,311; and 5,865,730.
- As beating heart procedures have evolved, new challenges have arisen in the design and engineering of the stabilization devices. The heart is typically accessed by way of a surgical incision such as a sternotomy or thoracotomy. Often one or more of the blocked or restricted coronary arteries are located a good distance away from the access incision requiring the stabilization device to traverse a longer and more tortuous path and engage the surface of the heart at somewhat difficult angular relationships or orientations. Under the most severe conditions, devices which operate to provide a mechanical compression force to stabilize the beating heart encounter difficulty maintaining mechanical traction against the surface of the heart. Similarly, devices which utilize vacuum to engage the heart have a great deal of difficulty creating and maintaining an effective seal against the moving surface of the heart.
- Even when the beating heart has been effectively stabilized, the target coronary artery may be obscured by layers of fat or other tissue and is very difficult for the surgeon to see. Moreover, the stabilization devices may distort the tissue surrounding the coronary artery or the coronary artery itself such that the arteriotomy is maintained in an unfavorable presentation for completion of the anastomosis. For example, the coronary artery in the area of the arteriotomy may become excessively flattened, compressed or stretched in a manner that impedes the placement of sutures around the perimeter of the arteriotomy.
- In view of the foregoing, it would be desirable to have methods and devices for stabilizing the beating heart that are capable of maintaining atraumatic engagement with the surface of the beating heart over a wider range of conditions and orientations. It would be further desirable to have stabilization methods and devices which provide for favorable presentation of the coronary artery.
- The present invention will be primarily described for use in stabilizing the beating heart during a surgical procedure, but the invention is not limited thereto, and may be used in other surgical procedures.
- The present invention is a tissue stabilizer having one or more stabilizer feet that may be adjusted or oriented to provide optimal engagement against the tissue to be stabilized or to provide an optimal presentation of a portion of the stabilized tissue. The present invention may also include a tissue stabilizer having one or more flexible or compressible seals to ensure a reliable seal against the target tissue and may also include a stabilizer foot having at least one portion which is adjustable relative to the remainder of the stabilizer foot.
- One aspect of the present invention involves a device for stabilizing tissue within a patient's body comprising a base member, a first stabilizer foot extending outwardly from the base member and being rotatable relative to the base member about a first axis, and a second stabilizer foot extending outwardly from the base member and being rotatable relative to the base member about a second axis. Preferably, the first and second stabilizer feet are independently rotatable relative to the base member. In a preferred embodiment, the first axis and the second axis are substantially parallel.
- The first and second stabilizer feet may each have hollow interiors defining first and second vacuum chambers each having at least one opening adapted to engage at least a portion of the tissue. The openings adapted to engage at least a portion of the tissue to be stabilized may have a raised seal around a perimeter thereof. In one variation the raised seal is made of a substantially rigid material. In other variations the raised seal is made of an elastomeric material or a compressible foam material.
- The base member may comprise an interior chamber therein, the interior chamber of the base member being in fluid communication with the first and second vacuum chambers. The base member may comprise a front base portion and a rear base portion, the front base portion being sealingly affixed to the rear base portion. The device may also include a post having a distal end connected to the base member and a proximal end terminating in a ball-shaped member. A shaft may be provided having a socket at a distal end, the socket being operably engaged with the ball.
- Another aspect of the present invention involves a device for stabilizing tissue within a patient's body having a base member and at least one stabilizer foot extending outwardly from the base member in a first direction, the stabilizer foot being rotatable relative to the base member about an axis of rotation which is oriented in substantially the same direction as the first direction. Preferably, the axis of rotation is at an angle of no more than about 25° to the first direction, more preferably, the axis of rotation is substantially parallel to the first direction.
- In a preferred variation, the stabilizer foot has tissue engaging features adapted to engage an external surface of the tissue to be stabilized, the tissue engaging features being disposed at the bottom of the stabilizer foot. The tissue engaging features may comprise a vacuum chamber, preferably having a single opening for engaging the tissue to be stabilized, or may comprise a plurality of vacuum ports. The tissue engaging features may also comprise a textured surface, a perforated sheet, or a perforated sheet having projections extending outwardly therefrom. Preferably, the axis of rotation of the stabilizer foot is offset from the tissue engaging features, more preferably offset from and parallel to the tissue engaging features.
- The stabilizer foot may have a hollow interior defining a vacuum chamber with a bottom opening adapted to engage at least a portion of the tissue. The stabilizer foot may also have a raised seal disposed around a perimeter of said opening, preferably around substantially the entire perimeter. The raised seal may be made from a rigid material, an elastomer, or a compressible foam. The vacuum chamber may have an inlet passage in fluid communication with a source of negative pressure. Preferably, the inlet passage is in fluid communication with an interior chamber within the base member. The base member may include an external fluid connection to supply negative pressure to the interior chamber of the base member.
- Another aspect of the present invention involves a device for stabilizing a coronary artery on a patient's heart comprising a base member and a stabilizer foot for engaging a portion of the patient's heart. The base member has an interior chamber and at least a first bore, typically a cylindrical bore, having a first end in fluid communication with the interior chamber of the base member and a second end open to the exterior of the base member. The stabilizer foot has a substantially cylindrical fitting having a longitudinal axis, at least a portion of the fitting positioned within the bore and being rotatable within the bore about the longitudinal axis.
- The stabilizer foot may have a hollow interior defining a vacuum chamber, the vacuum chamber having at least one chamber opening adapted to engage at least a portion of the heart. The fitting may further have a fluid passage having a first end in fluid communication with the interior chamber of the base member and a second end in fluid communication with the vacuum chamber of the stabilizer foot. A raised seal may be disposed substantially completely around the perimeter of the chamber opening. The raised seal may be rigid, compressible or flexible, preferably compressible or flexible. In a preferred embodiment, the raised seal has a durometer with a valve in the range of between about 35 Shore-A to about 100 Shore-A.
- The stabilizer foot fitting may comprise a flange and further include an annular seal positioned adjacent the flange. Preferably, the annular seal is positioned between the flange and the base member. The annular seal is preferably an O-ring. The fitting includes at least one flexure having a free end and a raised portion extending radially from the free end. The raised portion preferably engages the first end of the first cylindrical bore to restrict movement of the fitting relative to the base member.
- The tissue stabilizer may further include a second substantially cylindrical bore having a first end in fluid communication with the interior chamber of the base member and a second end open to the exterior of the base member. The tissue stabilizer may have a second stabilizer foot having a substantially cylindrical fitting having a longitudinal axis, at least a portion of the second stabilizer fitting positioned within the second bore and being rotatable within the second bore about the longitudinal axis of the fitting of the second stabilizer foot.
- Another aspect of the present invention involves a stabilizer foot for use in engaging a portion of tissue within a patient's body which includes a first foot portion having at least one vacuum port, a second foot portion having at least one vacuum port, and at least one malleable member connecting the first foot portion to the second foot portion, whereby the orientation of the first foot portion can be adjusted relative to the second foot portion. Preferably, the first foot portion is a substantially rigid unitary member having at least two vacuum ports.
- The first foot portion may have a fluid passage in fluid communication with each of the vacuum ports associated with the first foot portion and the second foot portion may have a fluid passage in fluid communication with each of the vacuum ports associated with the second foot portion. The malleable member may be a cylindrical tube having a first end, a second end, and a lumen extending therebetween, the lumen fluidly connecting the fluid passage of the first foot portion with the fluid passage of the second foot portion, preferably, the tube is made of stainless steel. In another variation, a flexible tube may be provided to connect the fluid passage of the first foot portion to the fluid passage of the second foot portion. The malleable member is then preferably offset from the flexible tube. Preferably, the stabilizer foot includes two malleable members offset from opposing sides of the flexible tube.
-
FIGS. 1A and 1B are top plan and top perspective views, respectively, of a tissue stabilizer constructed according to the principles of the present invention. -
FIG. 2 is a bottom perspective view of the tissue stabilizer ofFIGS. 1A and 1B . -
FIG. 3 is a cross-sectional view taken along line 3-3 as shown inFIG. 1A . -
FIG. 4 is a cross-sectional view taken along line 4-4 as shown inFIG. 1A . -
FIG. 5 is a bottom perspective view of an alternate construction of a tissue stabilizer according to the principles of the present invention. -
FIG. 6 is an exploded perspective view of a tissue stabilizer. -
FIG. 7 is an exploded perspective view of an alternate construction of a tissue stabilizer. -
FIG. 8A is a magnified partial perspective view of a contacting surface of a preferred perforated screen for use in a tissue stabilizer. -
FIG. 8B is a partial cross-sectional view showing the perforated screen configuration ofFIG. 8A engaged against a tissue structure. -
FIGS. 9A and 9B are partial cross-sectional views of a tissue stabilizer foot having a perimeter seal. -
FIG. 10 is a partial cross-sectional view of a tissue stabilizer foot having an alternate perimeter seal. -
FIG. 11 is a partial cross-section view of a tissue stabilizer foot having an alternate perimeter seal. -
FIG. 12 is a top plan view of a tissue stabilizer having an alternative perimeter seal. -
FIG. 13A is a top perspective view of the stabilizer foot ofFIG. 12 . -
FIG. 13B is a cross-sectional view taken alongline 13B-13B as shown inFIG. 13A . -
FIG. 14 is a bottom perspective view of an alternate construction of a tissue stabilizer according to the principles of the present invention. -
FIG. 15 is a cross-sectional view of one of the stabilizer feet ofFIG. 14 . -
FIG. 16 is a bottom plan view of an alternate construction of a stabilizer foot according to the principles of the present invention. -
FIG. 17 is a cross-sectional view taken along line 17-17 as shown inFIG. 16 . -
FIG. 18 is a bottom plan view of an alternate construction of a stabilizer foot. -
FIG. 19 is a cross-sectional view taken along line 19-19 as shown inFIG. 18 . -
FIG. 20 is a bottom plan view of an alternate construction of a stabilizer foot. -
FIG. 21 is a cross-sectional view taken along line 21-21 as shown inFIG. 20 . -
FIG. 22 is a partial cross-sectional view of an alternate construction of a tissue stabilizer according to the principles of the present invention. - The present invention involves surgical instruments and methods for stabilizing tissue during a surgical operation. The devices described herein may be used in a wide variety of surgical applications that require a tissue structure to be stabilized or immobilized to provide a substantially stable and motionless surgical field on which a surgical procedure can be performed. By way of example only, the preferred embodiments described in detail below are directed to the stabilization of a portion of the heart to facilitate a surgical procedure on or within the heart, such as a coronary artery bypass graft (CABG) procedure.
- Although the devices and methods of the present invention may have application in both conventional stopped-heart and beating heart procedures, they are preferably used to stabilize the beating heart during a CABG operation which has been specially developed to facilitate completion of an anastomosis, typically between a target coronary artery and a bypass graft or source artery, without requiring cardiac arrest and cardiopulmonary bypass.
- A typical beating heart CABG procedure involves accessing the beating heart by way of a sternotomy, mini-sternotomy, thoracotomy, mini-thoracotomy, or other suitable access incision, positioning a tissue stabilizer on, around or adjacent a coronary artery to stabilize the coronary artery, creating an arteriotomy in the coronary artery, and anastomosing the bypass graft or source artery to the arteriotomy. Typically, the tissue stabilizer has a heart engaging member at one end for engaging the surface of the beating heart and is connected at the other end to a stationary object such as a sternal retractor, rib retractor, or other such stationary structure. Exemplar devices and methods for accessing the beating heart and mounting a stabilizer device are disclosed in co-pending U.S. patent application Ser. No. 09/305,810 titled “A SURGICAL RETRACTOR APPARATUS FOR OPERATING ON THE HEART THROUGH AN INCISION”, the entirety of which is herein incorporated by reference.
- The devices of the present invention involve tissue stabilizers which provide superior engagement with the surface of the heart. In preferred embodiments of the present invention, the tissue stabilizer may have one or more stabilizer feet which provide for adjustment of the orientation of the features which contact or engage the surface of the heart. In one instance, the orientation may be adjusted to ensure the engaging features will be properly aligned with the surface of the heart. In addition, once engaged with or connected to the heart, the orientation may be adjusted to yield an optimum presentation of the target coronary artery and, in particular, the location at which the anastomosis will be performed.
- When the tissue stabilizer is configured to facilitate the use of negative pressure to engage the surface of the heart, the stabilizer feet may include one or more compliant or flexible seals to ensure that there will be no vacuum leaks between the stabilizer foot and the surface of the heart. To ensure that the engaging features provided on a stabilizer foot will closely approximate the surface of the beating heart under operating conditions, the stabilizer foot may have one or more portions which are adjustable relative to each other so that the stabilizer foot may be shaped according to the requirements of a particular surgical procedure or according to the specific anatomical features or characteristics of each individual patient.
- Referring to the figures wherein like numerals indicate like elements, an exemplar tissue stabilizer is illustrated in
FIGS. 1A-4 .Tissue stabilizer 100 preferably hasstabilizer feet Tissue stabilizer 100 is typically positioned such that the coronary artery runs lengthwise in the space betweenstabilizer feet - For beating heart procedures where the target vessel is occluded,
tissue stabilizer 100 preferably has a construction that does not occlude or otherwise contact the vessel asstabilizer feet stabilizer feet stabilizer feet manifold base 120, to whichstabilizer feet portion 126 under which the coronary vessel may pass without contact whenstabilizer feet -
Stabilizer feet manifold base 120 which will typically have mounting or connecting features for operably attaching a suitable shaft or other such structure. Preferablymanifold base 120 has aball 135 extending therefrom. A shaft (not shown), preferably having a suitably constructed socket, may be provided to engageball 135. The shaft may be used to positiontissue stabilizer 100 at the desired location on the heart and may provide the necessary structure to hold the tissue stabilizer substantially motionless against the forces generated by the beating heart. Of course, the shaft or other appropriate connecting structure may be operably connected to the tissue stabilizer using any suitable connection which allows the desired maneuverability of the tissue stabilizer relative to the shaft. Suitable stabilizer shafts and their connections to a tissue stabilizer are described in co-pending U.S. patent application Ser. No. 08/931,158, titled “SURGICAL INSTRUMENTS AND PROCEDURES FOR STABILIZING THE BEATING HEART DURING CORONARY ARTERY BYPASS GRAFT SURGERY”, and in EPO Application 97102789.1, the entirety of each are herein incorporated by reference. - Stabilization of the targeted tissue may be achieved by applying a localized compressive force to the heart through
stabilizer feet ball 135. In that case, the tissue contacting features on the bottom ofstabilizer feet stabilizer feet stabilizer feet - Continuing to refer to
FIGS. 1A-4 ,ball 135 is preferably connected tomanifold base 120 by way ofpost 130.Ball 135 and post 130 may have any suitable construction which provides the necessary attachment of the stabilizing shaft or other stabilizing structure and which can withstand the loads required to stabilize the beating heart with minimal deflection. The ball and post may be integrally molded features on the manifold base itself or may be separate components mechanically secured tomanifold base 120 using, for example, a threaded or snap-fit connection or the like. - When
manifold base 120 is constructed of a plastic material, it may be desirable to fixpost 130 to a relatively rigid support member to help spread stabilization loads transmitted throughpost 130 over a larger area ofmanifold base 120. Preferably, post 130 is rigidly attached to supportmember 155 which is made of a metal such as aluminum or stainless steel. In a preferred embodiment,support member 155 is secured within holding features such as cavities or pockets 156 and 158 formed inrear manifold portion 124 andfront manifold portion 122, respectively.Support member 155 may be secured withinpockets manifold portions - When the tissue stabilizer is configured to use vacuum stabilization or vacuum-assisted stabilization,
manifold base 120 preferably has a fitting or the like to which a vacuum supply may be connected. In a preferred embodiment,manifold base 120 hasinlet tube 115 having aninlet opening 117.Inlet tube 115 is preferably in fluid communication with a hollow space orchamber 134 formed withinmanifold base 120.Manifold base 120 andinternal chamber 134 provides for convenient distribution of a single vacuum source connected toinlet tube 115 to multiple stabilizer feet fluid connections, in this case tostabilizer feet Inlet tube 115 may have one ormore barbs 119 to facilitate the secure and leak-free attachment of a length of flexible tubing (not shown) coming from a vacuum pump or other vacuum source (not shown) as is commonly known in the art. In an alternative embodiment,inlet tube 115 may be replaced with a generally cylindrical bore adapted to accept an O-ring sealed fitting forming a dynamically sealed rotating connection between the fitting and the manifold base similar in construction to the stabilizer foot connection described below with regard toFIG. 3 . - For ease of manufacturing,
manifold base 120 is preferably made in two or more portions and fixed together to form a sealed, hollow interior. In a preferred embodiment,manifold base 120 has frontmanifold portion 122 andrear manifold portion 124 which may be bonded together alongbond line 125 as shown. Theinternal chamber 134 may reside primarily in either or both of front and rearmanifold portions internal chamber 134 for a given outer-profile ofmanifold base 120, a portion ofinternal chamber 134 is formed inrear manifold portion 124 and one or moreinternal cavities 128 are included withinfront manifold portion 122. - The manifold portions are preferably injection molded and may be fixed together using standard mechanical fasteners, a snap fit construction, or any suitable adhesive, bonding, sealing, or welding technique compatible with the material of
manifold base 120. To facilitate reliable bonding between the manifold portions, the manifold portions may have close fitting overlapping flanges. In a preferred embodiment, best illustrated inFIG. 3 ,rear manifold portion 124 has aninner flange 152 andfront manifold portion 122 has an overlappingouter flange 154. This construction provides a particularly reliable sealed junction between front and rearmanifold portions - As mentioned above,
stabilizer feet manifold base 120.Stabilizer feet manifold base 120. More preferably, however,stabilizer feet manifold base 120. Most preferably,stabilizer feet - In a preferred embodiment,
stabilizer feet manifold base 120 in a manner which allows each foot to rotate relative to themanifold base 120. The axis about which thestabilizer feet direction stabilizer feet manifold base 120, although the axis of rotation and the direction the stabilizer feet extend may be offset from each other. Thus, the axis of rotation of the first stabilizer foot relative to the base member may be offset from the axis of rotation of the second stabilizer foot relative to the base member. - In a preferred embodiment, the axis of rotation is preferably at an angle of no more than about 25° with respect to the included plane or surface approximated by the features adapted to engage the tissue surface to be stabilized. More preferably, the axis of rotation for each
stabilizer foot stabilizer foot 105 is generally parallel to the axis of rotation ofstabilizer foot 110. - Referring to
FIG. 3 , a preferred stabilizer foot connection is illustrated withrespect stabilizer foot 110.Manifold base 120, and more specificallyfront manifold portion 122, has abore 149 extending through the exterior wall.Stabilizer foot 110 has an end portion or fitting 137 having anoutside diameter 148 adapted to mate withbore 149 to allow fitting 137, and thusstabilizer foot 110, to rotate aboutcentral axis 133 ofbore 149. In the configuration shown,central axis 133 is offset from the features which engage the tissue to be stabilized, in this case perforatedscreen 141. This offset facilitates improved vessel presentation asstabilizer feet stabilizer feet - In a preferred embodiment of the present invention, the
tissue stabilizer 100 is constructed to supply a negative pressure or vacuum tostabilizer feet Stabilizer feet hollow interior 132 to which a vacuum may be supplied throughvacuum inlet 131 of fitting 137,vacuum chamber 134, andvacuum inlet tube 115, which are interconnected in a manner which does not allow any significant vacuum leaks. Collectively, the structures comprise a vacuum conducting chamber that communicates a negative pressure from a vacuum source to the surface of the beating heart.Vacuum inlet tube 131 may optionally have restriction or aperture (not shown) provided therein to restrict the amount of flow throughvacuum inlet tube 131 when the sealed engagement against the tissue to be stabilized is broken. This allowsvacuum chamber 134 ofmanifold base 120 to continue to provide sufficient vacuum to one stabilizer foot even when the engagement seal of the other stabilizer foot is compromised. - To allow vacuum to be communicated to the engagement features of
stabilizer feet stabilizer feet manifold base 120 must be sealed to prevent any vacuum loss. This preferably accomplished using an appropriate dynamic annular or shaft seal that seals between the stabilizer foot andmanifold base 120 but yet allows for rotation of the stabilizer foot withinbore 149 without incurring any vacuum loss. Preferably, a seal such as O-ring 145 is positioned within anannual seal cavity 146 at the entrance ofbore 149. The seal is captured and compressed withinseal cavity 146 by cooperatingannular seal flange 147 provided onstabilizer feet Stabilizer feet e-clip 150 assembled to fitting 137 just beyond its exit ofbore 149. -
Hollow interior 132 is generally a closed chamber except for one or more openings for engaging the heart. As will be discussed in more detail below, the engagement opening or openings may be in the form of a perforated screen having a relatively large number of perforations or small holes which engage the surface of the heart, a single opening having a defined perimeter for sealing against the surface of the heart, or a plurality of individual suction pods each having a sealing perimeter. - Referring to
FIGS. 2 and 3 ,stabilizer feet front surface 144 oriented to engage the surface of the heart.Perforated screens support step 138 which preferably has a raised perimeter edge orborder 139.Perforated screens perforated screens perforated screen - As front surfaces 144 of
perforated screens front surface 144 around eachperforation 142 and thus sealingly covering eachperforation 142. As eachperforation 142 is covered in this manner, the relatively small portion of tissue residing over eachperforation 142 is subjected to the vacuum existing withinhollow interior 132 and is accordingly sucked against, and even slightly into,perforation 142. - Because the total vacuum or suction force applied to the tissue is a function of the total tissue area exposed to vacuum, it is desirable for
screens - A particularly advantageous configuration of
front surface 144 includes a plurality of projections or protrusions disposed at a number of locations between the holes or perforations.FIGS. 8A and 8B illustrate aperforated member 400 having afront contact surface 410 which has a number of perforations or holes 415. The unperforated material ofmember 400 has a plurality ofprojections 420 extending outwardly fromcontact surface 410. In a preferred embodiment, a plurality of projections are generally equally spaced around eachperforation 415. The projections may be formed, for example, by chemical machining or etching.Projections 420 operate to more aggressively bite or engagetissue structure 425 as it is urged intoperforation 415 by operation of an applied vacuum. - In the embodiments shown in
FIGS. 2 and 3 , the outermost extending surface ofborder 139 is generally even or flush withfront surface 144 ofperforated screens FIG. 5 illustratestissue stabilizer 200 having aperimeter sealing member 215 disposed at the bottom of eachstabilizer foot Perforated screens perimeter sealing member 215. - When
perimeter sealing member 215 makes contact with the surface of the heart around substantially its entire perimeter, the portion of the heart tissue within the perimeter is subjected to the negative pressure existing within the hollow interior ofstabilizer feet stabilizer feet perimeter sealing member 215 into forced contact withperforated screens - An exploded view of
tissue stabilizer 200 is shown inFIG. 6 .Front manifold portion 122 has first andsecond bores fittings 208 associated withstabilizer feet Fittings 208 are preferably integrally molded features ofstabilizer feet Fittings 208 have aflange 212 for retaining and compressing O-ring 202 within the seal cavity (not visible in this view) and groove 214 for receiving a external retaining ring, preferably of the spring type, e-type or the like.Fittings 208 preferably have a vacuum inlet opening 220 for communicating the negative pressure withinmanifold base 120 to the hollow interior region withinstabilizer feet - The multifunctional components of
tissue stabilizer 200 allow for simple and convenient assembly.Stabilizer foot 205 may be assembled tofront manifold portion 222 by installing O-ring 202 overfitting 208 and then installing fitting 208 throughbore 222. Fitting 208 andstabilizer foot 205 is secured in place by securing anexternal retaining ring 218, into place withingroove 214. The same procedure is then used to installstabilizer foot 210 tomanifold portion 222.Post support member 155 is placed in the proper location between or within front andrear manifold portion Perforated screens stabilizer feet -
Tissue stabilizer 300, shown in exploded view inFIG. 7 , allowsstabilizer feet front manifold portion 122 using a simple snap-fit construction instead of an external retaining ring. In this variation, the fitting portions ofstabilizer feet seal flange 310, anuninterrupted base portion 304 and a number offlexures 302 having raised end features 303.Flexures 302 allow raisedfeatures 303 to flex inwardly so that they fit throughbore -
Tissue stabilizer 300 may be assembled using the same basic procedure as described above with reference totissue stabilizer 200. In addition, however, because there is no retaining feature to be installed to the fitting portion after placement throughbores 222 and/or 223, the front and rearmanifold portions stabilizer feet support member 155 is positioned in place in or between front and rearmanifold portions ring 202 is then placed overuninterrupted portion 304adjacent flange 310 and raisedfeatures 303 onflexures 302 are urged throughbore stabilizer foot -
Tissue stabilizer 300 shows a variation in which astabilizer shaft 307 is pre-installed onball 135.Stabilizer shaft 307 has asocket housing 306 which is permanently operably attached toball 135. Theball 135 and post 130 is dropped intohousing 306 from a distal direction prior to fixingshaft 307 thereto.Post support member 155 is then fixed to the proximal end ofpost 130, rendering the assembly essentially inseparable. This eliminates any possibility of accidental separation of the stabilizer foot from the stabilizer shaft. - To gain the advantage of stabilizer feet having different constructions for different procedures or patients, the foregoing design allows the desired stabilizer feet to simply be snapped into place within
bores stabilizer feet -
Stabilizer feet stabilizer feet blind holes 308 adapted to receive a blunt instrument for manipulating the orientation ofstabilizer feet -
Perimeter sealing member 215 may have a variety of constructions. Sealingmember 215 may simply be an integral extension of the stabilizer foot material. In that instance, sealingmember 215 will typically be a relatively hard polymer or plastic material. Sealingmember 215 may also be a relatively soft elastomer which is attached to or over-molded onstabilizer feet member 215 may also be constructed of a compressible foam material, preferably a closed cell foam. The elastomer or foam materials will preferably compress, deflect or otherwise yield somewhat as the stabilizer feet become engaged with the irregular surface of the heart When sealingmember 215 is constructed of an elastomer or foam material, it will preferably have a durometer hardness in the range from about 35 Shore-A to about 100 Shore-A depending on the geometrical configuration of sealingmember 215. - In a preferred embodiment, the perimeter seal has a variable thickness around its perimeter to provide a more reliable seal against the curvature of the surface of the heart, especially when the heart continues to beat during the procedure.
FIGS. 9A and 9B show a portion of astabilizer foot 430 having aperimeter seal 440 with a variable height or thickness around its perimeter. Similar to the previously discussed configurations,stabilizer foot 430 has ahollow interior 449 to which a negative pressure is communicated.Perforated screen 435 has a plurality of holes orperforations 437 and is mounted in position onstep feature 447 withinstabilizer foot 430.Perimeter seal 440 is mounted at or near the bottom ofstabilizer foot 430, and is preferably retained within a groove orstep 448. - The height that
perimeter seal 440 extends from the bottom ofstabilizer foot 430, typically varies at different locations around the perimeter ofperimeter seal 440. For example, thetip height 441 andrear height 443 is generally greater thanmidpoint height 442 along either side of the stabilizer foot. In addition,height 446 ofperimeter seal 440 along the inside ofstabilizer foot 430, that is the side closest to the target artery, is generally less that theoutside height 444 at a corresponding location along thestabilizer foot 430. - The variable height results in a contoured shape of
perimeter seal 440 which tends to remain sealed against the heart when the heart expands and contracts as it beats to pump blood. In a preferredembodiment perimeter seal 440 is made from an elastomer, a closed-cell foam, or other flexible or compressible material to further optimize the ability of stabilizer foot to maintain its seal on the tissue to be stabilized. If the seal is broken or otherwise compromised, the stabilizer foot may disengage from the surface of the heart, adversely affecting stabilization.Seal 440 may be fixed to the stabilizer foot using an adhesive or bonding agent or may be made integral with the stabilizer foot using an injection over-molding process whereinseal 440 is molded over the stabilizer foot. - Another seal variation is illustrated with reference to
stabilizer foot 450, a portion of which is shown inFIG. 10 .Stabilizer foot 450 again has ahollow interior 449 and aperforated screen 435 having perforations or holes 437. In this variation,stabilizer foot 450 has aflexible seal 455 having first andsecond legs perimeter edge 456 to move relatively freely towards and away from the bottom ofstabilizer foot 450 as required to effectuate a reliable seal against the surface of the tissue to be stabilized. For example, if the tissue under vacuum engagement withstabilizer foot 450 contracts and moves away from the tip ofstabilizer foot 450,flexible seal 455 can easily follow the movement to a new extended position 4551 without the seal being broken. -
Flexible seal 455 is preferably made from a medical grade elastomeric material such as silicone, urethane rubber, neoprene, nitrile rubber, hytrel, kraton, or other suitable material.Flexible seal 455 may be separately formed and later attached tostabilizer foot 450 or may be integrally over-molded ontostabilizer foot 450. For secure attachment tostabilizer foot 450,flexible seal 455 may optionally be provided withseal base portion 457. - If greater extension of the flexible seal's perimeter sealing edge away from the stabilizer foot is required, a seal having a greater number of flexible legs in a bellows or accordion type arrangement is employed. Referring to
FIG. 11 ,stabilizer foot 460 hasflexible seal 465 having continuously connected alternating flexible legs in the form of a bellows.Flexible seal 465 may include a base 467 to facilitate attachment to the bottom ofstabilizer foot 460 and has aperimeter edge 466 to effectuate a reliable seal against the surface of the tissue to be stabilized. This type of seal generally compresses to a relatively solid, stable structure as the stabilizer foot is urged against the surface of the tissue, has a the ability to follow moving tissue over a relatively long travel if required, and yet occupies only a very small amount of space around the perimeter of the stabilizer foot. - Another flexible seal arrangement is illustrated in
FIGS. 12-13B with reference totissue stabilizer 470.Tissue stabilizer 470 has amanifold base 473 comprised of frontmanifold portion 472,rear manifold portion 474 havingvacuum inlet tube 471, andball 476 to which a stabilizing shaft may be attached.Stabilizer feet stabilizer base 473 in any of the ways discussed above. Most preferably,stabilizer feet fitting portion 485 which includes an uninterruptedcylindrical portion 486, one ormore flexures 487 each having raisedfeatures 488 that provide a positive snap-fit joint in cooperation within cylindrical bores formed infront manifold portion 472 as described in detail above. Preferably, fitting 485 has aflange 479 for retaining and compressing a shaft seal or the like. -
Stabilizer feet flexible seals Flexible seals stabilizer feet stabilizer feet stabilizer feet own perimeter edge 481.Flexible seals perimeter edge 481 to provide a form of secondary or back-up seal in the event the seal atperimeter edge 481 becomes compromised as a result of misalignment or movement of the tissue.Flexible seals flexible seal perimeter edge 481 to become re-engaged against the tissue without significant vacuum loss. - After engagement and stabilization of the beating heart, the vacuum seal formed at the perimeter edge of the stabilizer feet may be most likely to break at the tip region or along the outside edge of the stabilizer foot as the heart contracts away from the site of stabilization. In such circumstances,
flexible seals perimeter portion 478 and the space betweenstabilizer feet Flexible seals outer periphery 483 which may be a relatively large distance away from the outer extents of thestabilizer feet tip portions 484.Flexible seals perimeter edge 481.Flexible seals stabilizer feet - Another way to prevent a complete loss of engagement and stabilization of the target tissue due to a compromised perimeter seal resulting from misalignment of the stabilizer feet or movement of the target tissue to be stabilized, is to partition the vacuum chamber within the stabilizer feet into a plurality of chambers connected to the vacuum source through only a small aperture. In that way, a vacuum leak at a single location will is result in a reduced ability to maintain engagement of that partitioned section only and will not immediately compromise the engagement of the entire stabilizer foot. Of course, it may be desirable to combine any one of the flexible seals described above with partitioning to further increase the reliability of the stabilizer foot seal against the tissue structure to be stabilized.
- A tissue stabilizer embodiment having stabilizer feet with a partitioned vacuum chamber is illustrated in
FIGS. 14 and 15 .Tissue stabilizer 500 has amanifold base 501, preferably having front and rearmanifold portions second stabilizer feet second stabilizer feet more partitions 509, each having a sealingedge 511, are provided to dividestabilizer feet stabilizer feet partitions 509 which divide the vacuum space into first, second, third, andfourth vacuum subchambers -
Vacuum feed tube 510 is provided along the interior ofstabilizer feet subchambers Vacuum feed tube 510 preferably has a side opening oraperture 512 within each ofsubchambers Vacuum feed tube 510 may have an end opening oraperture 513 withinsubchamber 520. Theapertures -
Stabilizer feet manifold base 501 as discussed at length above. For example,stabilizer feet fitting portion 515 which is preferably cylindrical to cooperate with a mating bore provided inmanifold base 501. Fittingportion 515 may have aflange 514 for retaining a shaft seal and a groove for receiving an external retaining ring to securefitting portion 515 withinmanifold base 501. The bottom ofstabilizer feet edges - A partitioned vacuum chamber as described above maximizes the area exposed to negative pressure for a particular size of stabilizer foot. That is, the ratio of the surface area exposed to negative pressure divided by the total surface area included with the boundary at the bottom of the stabilizer foot is maximized by the partitioned chamber configuration just described. In another embodiment, although less efficient in that regard, rotatable stabilizer feet can be constructed to have a number of individual vacuum ports or pods.
-
FIGS. 16 and 17 illustratestabilizer foot 550 having a plurality of individual vacuum ports. By way of example only,stabilizer foot 550 has foursuction ports dedicated edge seal 561. Negative pressure is communicated to each port through openings orapertures 560 provided invacuum distribution passage 563 which is fluid communication withvacuum inlet 562 which in turn is placed in fluid communication with the negative pressure within a manifold base assembly having a construction as described above.Stabilizer foot 550 may be mounted for rotation within a cooperating bore of an appropriate manifold base by way of cylindricalfitting portion 556 which may include aseal flange 555 and groove 557 for receiving an external retaining ring to securefitting portion 556 in place. -
FIGS. 18 and 19 show a variation of a stabilizer foot having a plurality of individual ports.Stabilizer foot 575 again has afitting portion 599 having aseal flange 598 for retaining and compressing an appropriate shaft seal to provide the desired dynamic seal asstabilizer foot 575 is rotated aboutfitting portion 599. To facilitate even greater adjustment of the shape and orientation ofstabilizer foot 575 has afirst foot portion 580 with at least one vacuum port and asecond foot portion 585 with at least one vacuum port which are adjustable relative to one another, preferably by way of one or more malleable joints or links. - In a preferred embodiment,
first foot portion 580 has a plurality ofseparate vacuum ports 581 each with aperimeter seal 582. Preferably,first foot portion 580 has threevacuum ports 581 each supplied with negative pressure throughapertures 578 in vacuum distribution channel orpassage 593.Second foot portion 585 has at least onevacuum port 583 havingperimeter seal 584 andaperture 577 in fluid communication withvacuum passage 592.First foot portion 580 andsecond foot portion 585 are preferably connected to each other bymalleable tube 590, which has a lumen orpassage 591 therethrough.Malleable tube 590 is preferably made of stainless steel, more preferably annealed stainless steel or vacuum annealed stainless steel. - With this configuration, the vacuum communicated from a manifold base or other vacuum source through
vacuum inlet channel 595 is distributed to vacuumports vacuum distribution channel 593 and associatedapertures 578, throughmalleable tube passage 591, finally tovacuum passage 592 and associatedaperture 577. The orientation ofsecond foot portion 585 and thusvacuum port 583 can be adjusted relative tofirst foot portion 580 by simple bending it to the desired orientation. This additional adjustment tends to eliminate problems associated with obtaining a reliable seal at the tip of the stabilizer foot as the beating heart contracts away from the stabilizer, yet maintains the reliability of havingports 603 molded to a unitary relatively rigid stabilizing structure. -
Malleable tube 590 may be secure tofirst foot portion 580 andsecond foot portion 585 in any convenient manner which provides a permanent and sealed connection. Preferably, the exterior ofmalleable tube 590 may be pressed intomating counterbores Vacuum passages malleable tube 590 in place. Alternatively,malleable tube 590 andcounterbores malleable tube 590 could be insert molded within first andsecond foot portions -
FIGS. 20 and 21 illustrate another embodiment of a stabilizer foot having foot portions which are adjustable relative to one another to improve the fit, and accordingly the operating vacuum seal, against the surface of the tissue structure to be stabilized.Stabilizer foot 600 has afirst foot portion 601 and asecond foot portion 602.First foot portion 601 has one or more, preferably three,vacuum ports 603 andsecond foot portion 602 has one ormore vacuum ports 608. Each ofvacuum ports compressible perimeter seal ports apertures vacuum passages vacuum passage 711 through inlet channel orpassage 710 offitting portion 718. Fittingportion 718 connected to a vacuum chamber or source within a manifold base or like structure as described above. -
First foot portion 601 andsecond foot portion 602 are made adjustable relative to each other by providing one or more malleable links spanning between the two portions. In one variation, first and secondmalleable members respect vacuum ports malleable members tube 605 ifsecond foot portion 602 were twisted relative tofirst foot portion 601. -
Malleable members second foot portions Tube 605 fluidly connectsvacuum passages tube 605 may be malleable or may be a flexible tubing material. Preferably,tube 605 is assembled withincounterbores - In operation, the tissue stabilizers of the present invention allow the stabilizer feet, and in particular the features which operate to engage the surface of the tissue to be stabilized, to be optimally adjusted to for a specific surgical procedure or to adjust for variations in size and orientation of a patient's anatomy. In addition, the stabilizer feet can be adjusted after engagement to the tissue to be stabilized to produce an improved presentation of the tissue subject to the surgical procedure.
- In a preferred method of operation for a tissue stabilizer having first and second rotatable stabilizer feet connected to a manifold base having a stabilizer shaft attached thereto, one or both of the stabilizer feet are adjusted to the desired orientation relative to the manifold base and each other. Preferably, the orientation of the stabilizer feet are adjusted to account for the size and shape of the tissue to be stabilized, for example a target site on the surface of the heart. If either of the stabilizer feet have an adjustable portion, it may also be adjusted at this time. Next, the tissue stabilizer is brought into engagement with the tissue to be stabilized and the vacuum is applied. The stabilizer shaft is then locked into place to immobilize the tissue stabilizer and the engaged tissue. With the surgical site now relatively motionless, one or both of the stabilizer feet may be rotated relative to the manifold base until the tissue between or adjacent the stabilizer feet obtains the best possible presentation for the procedure to be performed. If there appears to be any discernible vacuum leaks associated with the engagement of the stabilizer feet against the target tissue, the orientation of the stabilizer feet may be further adjusted or, if applicable, the feet portions may be adjusted, to eliminate or minimize vacuum leaks at the interface between the stabilizer feet and the target tissue.
- Although the illustrative stabilizer feet described above have been primarily directed to embodiments configured for connection to a common manifold base, the stabilizer feet of the present invention will operate with equal benefit when connected to any number of alternative structures. For example,
FIG. 22 illustratestissue stabilizer 725 having a stabilizer foot rotatably connected with respect to a portion of common tubing having a flared end.Tube 740 may be a malleable tube, for example made of annealed stainless steel, which may be connected proximally to a manifold (not shown) shared with a second stabilizer foot or may be connected directly to a fixed mount (not shown) to effectuate stabilization. - In a preferred embodiment,
stabilizer foot 730 is connected tohousing 735 which rotates abouttube 740.Tube 740 has a flaredend 742 as is commonly known in the art. A shaft seal, such as O-ring 732, is place overtube 740 adjacent flaredend 742.Housing 735 has afirst bore 737 and a secondlarger bore 738. First bore 737 is larger than the outside diameter oftube 740 but preferably smaller than the diameter offlanged end 742.Second bore 738 is preferably slightly larger thanflanged end 742.Tube 740 with O-ring 732 is assembled throughsecond bore 738 until the O-ring is compressed at the distal entrance tofirst bore 737. An O-ring cavity 736 may be provided if desired. Fittingportion 734 is inserted intosecond bore 738 and permanently fixed in place preferably using a fluid tight connection such as pipe threads, adhesive, bonding agent, welding, brazing, etc. Withfitting portion 734 fixed tohousing 735,stabilizer foot 730 andhousing 735 may be rotated relative totube 740 without any appreciable vacuum leakage.Stabilizer foot 730 may be of any desirable configuration. - While certain embodiments are illustrated in the drawings and have just been described herein, it will be apparent to those skilled in the art that many modifications can be made to the embodiments without departing from the inventive concepts described. For purposes of illustration only, the principles of the present invention has been described with reference to stabilizing the heart during a coronary artery bypass procedure but may readily be applied to other types surgical procedures on various types of tissue structures not specifically described. Many other uses are well-known in the art, and the concepts described herein are equally applicable to those other uses. Further, the different components and their equivalents of the various exemplar embodiments described above can be combined to achieve any desirable construction.
Claims (38)
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US12/365,992 US20090137865A1 (en) | 1999-08-03 | 2009-02-05 | Tissue Stabilizer and Methods of Use |
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US09/366,190 US6511416B1 (en) | 1999-08-03 | 1999-08-03 | Tissue stabilizer and methods of use |
US10/272,036 US7503891B2 (en) | 1999-08-03 | 2002-10-15 | Tissue stabilizer and methods of use |
US12/365,992 US20090137865A1 (en) | 1999-08-03 | 2009-02-05 | Tissue Stabilizer and Methods of Use |
Related Parent Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US10/272,036 Continuation US7503891B2 (en) | 1999-08-03 | 2002-10-15 | Tissue stabilizer and methods of use |
Publications (1)
Publication Number | Publication Date |
---|---|
US20090137865A1 true US20090137865A1 (en) | 2009-05-28 |
Family
ID=23442011
Family Applications (3)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US09/366,190 Expired - Fee Related US6511416B1 (en) | 1999-08-03 | 1999-08-03 | Tissue stabilizer and methods of use |
US10/272,036 Expired - Fee Related US7503891B2 (en) | 1999-08-03 | 2002-10-15 | Tissue stabilizer and methods of use |
US12/365,992 Abandoned US20090137865A1 (en) | 1999-08-03 | 2009-02-05 | Tissue Stabilizer and Methods of Use |
Family Applications Before (2)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US09/366,190 Expired - Fee Related US6511416B1 (en) | 1999-08-03 | 1999-08-03 | Tissue stabilizer and methods of use |
US10/272,036 Expired - Fee Related US7503891B2 (en) | 1999-08-03 | 2002-10-15 | Tissue stabilizer and methods of use |
Country Status (1)
Country | Link |
---|---|
US (3) | US6511416B1 (en) |
Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US8460172B2 (en) | 2010-07-29 | 2013-06-11 | Medtronic, Inc. | Tissue stabilizing device and methods including a self-expandable head-link assembly |
Families Citing this family (67)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5665062A (en) * | 1995-01-23 | 1997-09-09 | Houser; Russell A. | Atherectomy catheter and RF cutting method |
US7445594B1 (en) * | 1995-09-20 | 2008-11-04 | Medtronic, Inc. | Method and apparatus for temporarily immobilizing a local area of tissue |
US20070244476A1 (en) * | 1998-03-17 | 2007-10-18 | Kochamba Gary S | Tissue stabilization and ablation device |
US20070244534A1 (en) * | 1998-03-17 | 2007-10-18 | Kochamba Gary S | Tissue stabilization and ablation methods |
US6258023B1 (en) | 1999-07-08 | 2001-07-10 | Chase Medical, Inc. | Device and method for isolating a surface of a beating heart during surgery |
US6511416B1 (en) * | 1999-08-03 | 2003-01-28 | Cardiothoracic Systems, Inc. | Tissue stabilizer and methods of use |
DE60136441D1 (en) * | 2000-02-11 | 2008-12-18 | Endoscopic Technologies Inc | TISSUE STABILIZATION DEVICE |
US6676597B2 (en) | 2001-01-13 | 2004-01-13 | Medtronic, Inc. | Method and device for organ positioning |
US7338441B2 (en) * | 2001-09-06 | 2008-03-04 | Houser Russell A | Superelastic/shape memory tissue stabilizers and surgical instruments |
US7591818B2 (en) | 2001-12-04 | 2009-09-22 | Endoscopic Technologies, Inc. | Cardiac ablation devices and methods |
US7749157B2 (en) * | 2001-12-04 | 2010-07-06 | Estech, Inc. (Endoscopic Technologies, Inc.) | Methods and devices for minimally invasive cardiac surgery for atrial fibrillation |
US6849075B2 (en) * | 2001-12-04 | 2005-02-01 | Estech, Inc. | Cardiac ablation devices and methods |
US7399300B2 (en) * | 2001-12-04 | 2008-07-15 | Endoscopic Technologies, Inc. | Cardiac ablation devices and methods |
US20090281541A1 (en) * | 2008-05-09 | 2009-11-12 | Estech, Inc. | Conduction block systems and methods |
US7226448B2 (en) * | 2001-12-04 | 2007-06-05 | Estech, Inc. (Endoscopic Technologies, Inc.) | Cardiac treatment devices and methods |
US20040002625A1 (en) * | 2002-06-27 | 2004-01-01 | Timothy Dietz | Apparatus and methods for cardiac surgery |
US8182494B1 (en) | 2002-07-31 | 2012-05-22 | Cardica, Inc. | Minimally-invasive surgical system |
US7494460B2 (en) | 2002-08-21 | 2009-02-24 | Medtronic, Inc. | Methods and apparatus providing suction-assisted tissue engagement through a minimally invasive incision |
US7931590B2 (en) * | 2002-10-29 | 2011-04-26 | Maquet Cardiovascular Llc | Tissue stabilizer and methods of using the same |
US7682305B2 (en) * | 2002-12-06 | 2010-03-23 | Endoscopic Technologies, Inc. | Methods and devices for cardiac surgery |
US20040176764A1 (en) * | 2003-03-03 | 2004-09-09 | Centerpulse Spine-Tech, Inc. | Apparatus and method for spinal distraction using a flip-up portal |
US7270670B1 (en) | 2003-04-21 | 2007-09-18 | Cardica, Inc. | Minimally-invasive surgical system utilizing a stabilizer |
US7479104B2 (en) * | 2003-07-08 | 2009-01-20 | Maquet Cardiovascular, Llc | Organ manipulator apparatus |
US8052676B2 (en) | 2003-12-02 | 2011-11-08 | Boston Scientific Scimed, Inc. | Surgical methods and apparatus for stimulating tissue |
US7497823B2 (en) * | 2004-06-30 | 2009-03-03 | Ethicon, Inc. | Flexible shaft stabilizing devices with improved actuation |
US20060041194A1 (en) * | 2004-08-23 | 2006-02-23 | Mark Sorochkin | Surgical gripper with foldable head |
US20060079736A1 (en) | 2004-10-13 | 2006-04-13 | Sing-Fatt Chin | Method and device for percutaneous left ventricular reconstruction |
US7780592B2 (en) * | 2004-10-29 | 2010-08-24 | Medtronic, Inc. | Distal portion of an endoscopic delivery system |
US20070088203A1 (en) * | 2005-05-25 | 2007-04-19 | Liming Lau | Surgical assemblies and methods for visualizing and performing surgical procedures in reduced-access surgical sites |
US8083664B2 (en) | 2005-05-25 | 2011-12-27 | Maquet Cardiovascular Llc | Surgical stabilizers and methods for use in reduced-access surgical sites |
US8016822B2 (en) * | 2005-05-28 | 2011-09-13 | Boston Scientific Scimed, Inc. | Fluid injecting devices and methods and apparatus for maintaining contact between fluid injecting devices and tissue |
US7766816B2 (en) | 2005-06-09 | 2010-08-03 | Chf Technologies, Inc. | Method and apparatus for closing off a portion of a heart ventricle |
WO2007022519A2 (en) | 2005-08-19 | 2007-02-22 | Chf Technologies, Inc. | Steerable heart implants for congestive heart failure |
US8506474B2 (en) | 2005-08-19 | 2013-08-13 | Bioventrix, Inc. | Method and device for treating dysfunctional cardiac tissue |
AU2007248456A1 (en) * | 2006-05-05 | 2007-11-15 | The Cleveland Clinic Foundation | Apparatus and method for stabilizing body tissue |
US8123668B2 (en) | 2006-09-28 | 2012-02-28 | Bioventrix (A Chf Technologies' Company) | Signal transmitting and lesion excluding heart implants for pacing defibrillating and/or sensing of heart beat |
US9211115B2 (en) | 2006-09-28 | 2015-12-15 | Bioventrix, Inc. | Location, time, and/or pressure determining devices, systems, and methods for deployment of lesion-excluding heart implants for treatment of cardiac heart failure and other disease states |
US8216221B2 (en) * | 2007-05-21 | 2012-07-10 | Estech, Inc. | Cardiac ablation systems and methods |
US8491455B2 (en) | 2007-10-03 | 2013-07-23 | Bioventrix, Inc. | Treating dysfunctional cardiac tissue |
US10136909B2 (en) * | 2007-12-20 | 2018-11-27 | Atricure, Inc. | Magnetic introducer systems and methods |
US8998892B2 (en) | 2007-12-21 | 2015-04-07 | Atricure, Inc. | Ablation device with cooled electrodes and methods of use |
US8353907B2 (en) * | 2007-12-21 | 2013-01-15 | Atricure, Inc. | Ablation device with internally cooled electrodes |
US8469957B2 (en) * | 2008-10-07 | 2013-06-25 | Covidien Lp | Apparatus, system, and method for performing an electrosurgical procedure |
US8430875B2 (en) * | 2009-05-19 | 2013-04-30 | Estech, Inc. (Endoscopic Technologies, Inc.) | Magnetic navigation systems and methods |
US8206295B2 (en) * | 2009-06-15 | 2012-06-26 | Ashutosh Kaul | Suction-based tissue manipulator |
US20100331838A1 (en) * | 2009-06-25 | 2010-12-30 | Estech, Inc. (Endoscopic Technologies, Inc.) | Transmurality clamp systems and methods |
US9572624B2 (en) * | 2009-08-05 | 2017-02-21 | Atricure, Inc. | Bipolar belt systems and methods |
US10123821B2 (en) | 2009-09-10 | 2018-11-13 | Atricure, Inc. | Scope and magnetic introducer systems and methods |
WO2011073892A1 (en) * | 2009-12-17 | 2011-06-23 | Koninklijke Philips Electronics N.V. | Swallowable capsule for monitoring a condition |
US20110152741A1 (en) * | 2009-12-21 | 2011-06-23 | Michael Banchieri | Cannula system |
WO2011159733A1 (en) | 2010-06-14 | 2011-12-22 | Maquet Cardiovascular Llc | Surgical instruments, systems and methods of use |
EP3175797B1 (en) | 2011-09-30 | 2020-02-12 | Bioventrix, Inc. | Trans-catheter ventricular reconstruction structures and systems for treatment of congestive heart failure and other conditions |
WO2013162741A1 (en) * | 2012-04-23 | 2013-10-31 | Thoratec Corporation | Engagement device and method for deployment of anastomotic clips |
DE102012219752A1 (en) * | 2012-10-29 | 2014-04-30 | Aesculap Ag | Stabilizer for beating heart surgery |
US9603590B2 (en) * | 2013-03-15 | 2017-03-28 | Robert E. Michler | Single-arm stabilizer having suction capability |
AU2014268717A1 (en) | 2013-05-24 | 2015-12-03 | Bioventrix, Inc. | Cardiac tissue penetrating devices, methods, and systems for treatment of congestive heart failure and other conditions |
CA2922126A1 (en) | 2013-08-30 | 2015-03-05 | Bioventrix, Inc. | Cardiac tissue anchoring devices, methods, and systems for treatment of congestive heart failure and other conditions |
CA2922132A1 (en) | 2013-08-30 | 2015-03-05 | Bioventrix, Inc. | Heart anchor positioning devices, methods, and systems for treatment of congestive heart failure and other conditions |
CN103654884B (en) * | 2013-12-11 | 2019-07-09 | 刘永安 | Minimally invasive auricle traction device, that is, auricle tractor |
US11723718B2 (en) | 2015-06-02 | 2023-08-15 | Heartlander Surgical, Inc. | Therapy delivery system that operates on the surface of an anatomical entity |
US10149672B2 (en) | 2015-06-30 | 2018-12-11 | Emory University | Devices and methods for stabilizing tissue |
US10206779B2 (en) | 2015-09-10 | 2019-02-19 | Bioventrix, Inc. | Systems and methods for deploying a cardiac anchor |
US11478353B2 (en) | 2016-01-29 | 2022-10-25 | Bioventrix, Inc. | Percutaneous arterial access to position trans-myocardial implant devices and methods |
KR102023574B1 (en) * | 2018-04-13 | 2019-09-24 | 한국과학기술연구원 | Peripheral Nerve Fixing Apparatus |
USD951440S1 (en) * | 2019-06-17 | 2022-05-10 | Terumo Cardiovascular Systems Corporation | Suction stabilizer for minimally invasive off-pump bypass surgery |
US11690649B2 (en) * | 2019-12-13 | 2023-07-04 | Tautona Group IP Holding Company, LLC | Retractor apparatus and methods for use |
GR20200100249A (en) * | 2020-05-13 | 2021-12-09 | Χρηστος Πανοτοπουλος | MULTIFUNCTIONAL SURGICAL INSTRUMENT |
Citations (85)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US810675A (en) * | 1905-04-24 | 1906-01-23 | Gustav F Richter | Dilator. |
US1706500A (en) * | 1927-08-01 | 1929-03-26 | Henry J Smith | Surgical retractor |
US2590527A (en) * | 1947-04-03 | 1952-03-25 | Joseph Niedermann | Suction massage device |
US3720433A (en) * | 1970-09-29 | 1973-03-13 | Us Navy | Manipulator apparatus for gripping submerged objects |
US3783873A (en) * | 1971-09-16 | 1974-01-08 | H Jacobs | Weighted surgical clamp having foldable prop |
US3858926A (en) * | 1973-07-23 | 1975-01-07 | Ludger Ottenhues | Vacuum lifting device |
US4366819A (en) * | 1980-11-17 | 1983-01-04 | Kaster Robert L | Anastomotic fitting |
US4368736A (en) * | 1980-11-17 | 1983-01-18 | Kaster Robert L | Anastomotic fitting |
US4428368A (en) * | 1980-09-29 | 1984-01-31 | Masakatsu Torii | Massage device |
US4434791A (en) * | 1982-03-15 | 1984-03-06 | Humboldt Products Corp. | Surgical retractor array system |
US4492229A (en) * | 1982-09-03 | 1985-01-08 | Grunwald Ronald P | Suture guide holder |
US4637377A (en) * | 1985-09-20 | 1987-01-20 | Loop Floyd D | Pillow or support member for surgical use |
US4646747A (en) * | 1983-10-28 | 1987-03-03 | Astra-Tech Aktiebolag | Electrode for electrocardiographic examinations |
US4718418A (en) * | 1983-11-17 | 1988-01-12 | Lri L.P. | Apparatus for ophthalmological surgery |
US4726356A (en) * | 1985-11-12 | 1988-02-23 | Kapp Surgical Instrument, Inc. | Cardiovascular and thoracic retractor |
US4736749A (en) * | 1985-04-26 | 1988-04-12 | Astra-Tech Aktiebolag | Holder for medical use fixed by vacuum |
US4803984A (en) * | 1987-07-06 | 1989-02-14 | Montefiore Hospital Association Of Western Pennsylvania | Method for performing small vessel anastomosis |
US4808163A (en) * | 1987-07-29 | 1989-02-28 | Laub Glenn W | Percutaneous venous cannula for cardiopulmonary bypass |
US4904012A (en) * | 1986-11-26 | 1990-02-27 | Sumitomo Electric Industries, Ltd. | Suction device |
US4989587A (en) * | 1989-04-26 | 1991-02-05 | Farley Daniel K | Sternal retractor |
US4991578A (en) * | 1989-04-04 | 1991-02-12 | Siemens-Pacesetter, Inc. | Method and system for implanting self-anchoring epicardial defibrillation electrodes |
US4993862A (en) * | 1989-08-16 | 1991-02-19 | Pilling Company | Clamp assembly for surgical retractor support |
US5009660A (en) * | 1989-09-15 | 1991-04-23 | Visx, Incorporated | Gas purging, eye fixation hand piece |
US5011469A (en) * | 1988-08-29 | 1991-04-30 | Shiley, Inc. | Peripheral cardiopulmonary bypass and coronary reperfusion system |
US5080088A (en) * | 1987-11-09 | 1992-01-14 | Minnesota Scientific, Inc. | Flexible retractor |
US5098369A (en) * | 1987-02-27 | 1992-03-24 | Vascor, Inc. | Biocompatible ventricular assist and arrhythmia control device including cardiac compression pad and compression assembly |
US5192070A (en) * | 1990-09-06 | 1993-03-09 | Smc Kabushiki Kaisha | Suction pad |
US5196003A (en) * | 1990-11-06 | 1993-03-23 | Ethicon, Inc. | Endoscopic surgical instrument for taking hold of tissue |
US5287861A (en) * | 1992-10-30 | 1994-02-22 | Wilk Peter J | Coronary artery by-pass method and associated catheter |
US5290082A (en) * | 1992-07-06 | 1994-03-01 | Palmer Harold D | Battery operated hand held vacuum handling device |
US5293863A (en) * | 1992-05-08 | 1994-03-15 | Loma Linda University Medical Center | Bladed endoscopic retractor |
US5300087A (en) * | 1991-03-22 | 1994-04-05 | Knoepfler Dennis J | Multiple purpose forceps |
US5382756A (en) * | 1993-01-22 | 1995-01-17 | Dagan; Gideon B. | Encapsulation closure for cables |
US5383840A (en) * | 1992-07-28 | 1995-01-24 | Vascor, Inc. | Biocompatible ventricular assist and arrhythmia control device including cardiac compression band-stay-pad assembly |
US5480425A (en) * | 1994-06-09 | 1996-01-02 | Carbomedics, Inc. | Integrated heart valve rotator and holder |
US5484391A (en) * | 1992-07-30 | 1996-01-16 | Univ Temple | Direct manual cardiac compression method |
US5498256A (en) * | 1993-05-28 | 1996-03-12 | Snowden-Pencer, Inc. | Surgical instrument handle |
US5503617A (en) * | 1994-07-19 | 1996-04-02 | Jako; Geza J. | Retractor and method for direct access endoscopic surgery |
US5509890A (en) * | 1993-12-16 | 1996-04-23 | Kazama; Shigeru | Heart retractor |
US5512037A (en) * | 1994-05-12 | 1996-04-30 | United States Surgical Corporation | Percutaneous surgical retractor |
US5607446A (en) * | 1995-01-31 | 1997-03-04 | Beehler; Cecil C. | Pupil dilator |
US5607421A (en) * | 1991-05-01 | 1997-03-04 | The Trustees Of Columbia University In The City Of New York | Myocardial revascularization through the endocardial surface using a laser |
US5613937A (en) * | 1993-02-22 | 1997-03-25 | Heartport, Inc. | Method of retracting heart tissue in closed-chest heart surgery using endo-scopic retraction |
US5713951A (en) * | 1993-02-22 | 1998-02-03 | Heartport, Inc. | Thoracoscopic valve prosthesis delivery device |
US5727569A (en) * | 1996-02-20 | 1998-03-17 | Cardiothoracic Systems, Inc. | Surgical devices for imposing a negative pressure to fix the position of cardiac tissue during surgery |
US5730757A (en) * | 1996-02-20 | 1998-03-24 | Cardiothoracic Systems, Inc. | Access platform for internal mammary dissection |
US5735290A (en) * | 1993-02-22 | 1998-04-07 | Heartport, Inc. | Methods and systems for performing thoracoscopic coronary bypass and other procedures |
US5865730A (en) * | 1997-10-07 | 1999-02-02 | Ethicon Endo-Surgery, Inc. | Tissue stabilization device for use during surgery having remotely actuated feet |
US5868770A (en) * | 1993-12-23 | 1999-02-09 | Oticon A/S | Method and instrument for establishing the receiving site of a coronary artery bypass graft |
US5876332A (en) * | 1997-07-24 | 1999-03-02 | Genzyme Corporation | Surgical support member |
US5875782A (en) * | 1996-11-14 | 1999-03-02 | Cardiothoracic Systems, Inc. | Methods and devices for minimally invasive coronary artery revascularization on a beating heart without cardiopulmonary bypass |
US5879291A (en) * | 1997-10-08 | 1999-03-09 | Ethicon Endo-Surgery, Inc. | Device used with a surgical retractor to elevate body parts |
US5882299A (en) * | 1997-01-31 | 1999-03-16 | Minnesota Scientific, Inc. | Device and procedure for minimally invasive coronary anastomosis |
US5885271A (en) * | 1997-03-14 | 1999-03-23 | Millennium Cardiac Strategies, Inc. | Device for regional immobilization of a compliant body |
US5888247A (en) * | 1995-04-10 | 1999-03-30 | Cardiothoracic Systems, Inc | Method for coronary artery bypass |
US5891017A (en) * | 1997-01-31 | 1999-04-06 | Baxter Research Medical, Inc. | Surgical stabilizer and method for isolating and immobilizing cardiac tissue |
US5894843A (en) * | 1996-02-20 | 1999-04-20 | Cardiothoracic Systems, Inc. | Surgical method for stabilizing the beating heart during coronary artery bypass graft surgery |
US6010531A (en) * | 1993-02-22 | 2000-01-04 | Heartport, Inc. | Less-invasive devices and methods for cardiac valve surgery |
US6013027A (en) * | 1997-10-07 | 2000-01-11 | Ethicon Endo-Surgery, Inc. | Method for using a tissue stabilization device during surgery |
US6015378A (en) * | 1995-09-20 | 2000-01-18 | Medtronic, Inc. | Method and apparatus for temporarily immobilizing a local area tissue |
US6015427A (en) * | 1997-07-07 | 2000-01-18 | Eclipse Surgical Technologies, Inc. | Heart stabilizer with controllable stay suture and cutting element |
US6017304A (en) * | 1994-08-31 | 2000-01-25 | Vierra; Mark A. | Device and method for isolating a surgical site |
US6019722A (en) * | 1997-09-17 | 2000-02-01 | Guidant Corporation | Device to permit offpump beating heart coronary bypass surgery |
US6030340A (en) * | 1997-12-19 | 2000-02-29 | United States Surgical | Surgical retractor |
US6029671A (en) * | 1991-07-16 | 2000-02-29 | Heartport, Inc. | System and methods for performing endovascular procedures |
US6033362A (en) * | 1997-04-25 | 2000-03-07 | Beth Israel Deaconess Medical Center | Surgical retractor and method of use |
US6036641A (en) * | 1996-02-20 | 2000-03-14 | Cardiothoracic System, Inc. | Surgical instruments for stabilizing the beating heart during coronary artery bypass graft surgery |
USD421803S (en) * | 1998-03-07 | 2000-03-21 | Koros Tibor B | Retractor for coronary artery bypass surgery |
US6042539A (en) * | 1999-03-26 | 2000-03-28 | Ethicon Endo-Surgery, Inc. | Vacuum-actuated tissue-lifting device and method |
US6183486B1 (en) * | 1995-02-24 | 2001-02-06 | Heartport, Inc. | Device and method for minimizing heart displacements during a beating heart surgical procedure |
US6190311B1 (en) * | 1997-05-02 | 2001-02-20 | Cardiothoracic Systems, Inc. | Retractor and instrument platform for a less invasive cardiovascular surgical procedure |
US6193652B1 (en) * | 1997-10-07 | 2001-02-27 | Ethicon Endo-Surgery, Inc. | Tissue stabilization device for use during surgery having spherical curved feet |
US6193732B1 (en) * | 1999-01-08 | 2001-02-27 | Cardiothoracic System | Surgical clips and apparatus and method for clip placement |
US6196982B1 (en) * | 1995-10-30 | 2001-03-06 | Terry A. Ball | Vacuum massager |
US6200263B1 (en) * | 1998-01-23 | 2001-03-13 | United States Surgical Corporation | Surgical instrument holder |
US6210323B1 (en) * | 1998-05-05 | 2001-04-03 | The University Of British Columbia | Surgical arm and tissue stabilizer |
US6213940B1 (en) * | 1996-04-26 | 2001-04-10 | United States Surgical Corporation | Surgical retractor including coil spring suture mount |
US6348036B1 (en) * | 1999-01-24 | 2002-02-19 | Genzyme Corporation | Surgical retractor and tissue stabilization device |
US6506149B2 (en) * | 1999-09-07 | 2003-01-14 | Origin Medsystems, Inc. | Organ manipulator having suction member supported with freedom to move relative to its support |
US6511416B1 (en) * | 1999-08-03 | 2003-01-28 | Cardiothoracic Systems, Inc. | Tissue stabilizer and methods of use |
US6676597B2 (en) * | 2001-01-13 | 2004-01-13 | Medtronic, Inc. | Method and device for organ positioning |
US7018328B2 (en) * | 2000-02-11 | 2006-03-28 | Endoscopic Technologies, Inc. | Tissue stabilizer |
US7179224B2 (en) * | 2003-12-30 | 2007-02-20 | Cardiothoracic Systems, Inc. | Organ manipulator and positioner and methods of using the same |
US7338434B1 (en) * | 2002-08-21 | 2008-03-04 | Medtronic, Inc. | Method and system for organ positioning and stabilization |
US7497823B2 (en) * | 2004-06-30 | 2009-03-03 | Ethicon, Inc. | Flexible shaft stabilizing devices with improved actuation |
Family Cites Families (151)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US452131A (en) | 1891-05-12 | Depurator | ||
US634036A (en) * | 1898-10-29 | 1899-10-03 | Harry L Ayer | Car-wheel. |
FR473451A (en) | 1914-06-15 | 1915-01-13 | Pierre Antoine Gentile | Advanced Parallel Spreader |
GB168216A (en) | 1920-07-07 | 1921-09-01 | William J Cameron | Improvements in and relating to gagging-appliances and tongue depressors |
US2296793A (en) | 1942-02-02 | 1942-09-22 | Harry M Kirschbaum | Surgical retractor |
US2693795A (en) | 1950-09-09 | 1954-11-09 | Herman R Grieshaber | Surgical retractor |
US2863444A (en) | 1956-08-21 | 1958-12-09 | Winsten Joseph | Liver retractor for cholecystectomies |
US3392722A (en) | 1965-07-29 | 1968-07-16 | Roger L. Jorgensen | Post-operative surgical valve |
US3466079A (en) * | 1965-09-08 | 1969-09-09 | Western Electric Co | Pressurized fluid pickup device |
GB1251833A (en) | 1968-02-26 | 1971-11-03 | ||
US3683926A (en) | 1970-07-09 | 1972-08-15 | Dainippon Pharmaceutical Co | Tube for connecting blood vessels |
US3916909A (en) * | 1973-08-01 | 1975-11-04 | Bio Medicus Inc | Suction surgical instrument of the forceps type |
US4048987A (en) | 1973-08-06 | 1977-09-20 | James Kevin Hurson | Surgical acid |
US3882855A (en) | 1973-11-12 | 1975-05-13 | Heyer Schulte Corp | Retractor for soft tissue for example brain tissue |
US3912317A (en) * | 1974-07-10 | 1975-10-14 | Shiroyama Kogyo Kk | Vacuum suction type manipulator |
GB1526933A (en) * | 1974-09-13 | 1978-10-04 | Johnson Matthey Co Ltd | Vacuum head for handling transfers |
US4047532A (en) | 1975-04-21 | 1977-09-13 | Phillips Jack L | Vacuum forcep and method of using same |
US3983863A (en) | 1975-06-02 | 1976-10-05 | American Hospital Supply Corporation | Heart support for coronary artery surgery |
DE2527706A1 (en) * | 1975-06-21 | 1976-12-30 | Hanfried Dr Med Weigand | DEVICE FOR THE INTRODUCTION OF CONTRAST AGENTS INTO AN ARTIFICIAL INTESTINAL OUTLET |
US4049002A (en) | 1975-07-18 | 1977-09-20 | Bio-Medicus, Inc. | Fluid conveying surgical instrument |
US4049000A (en) | 1975-08-01 | 1977-09-20 | Williams Robert W | Suction retraction instrument |
GB1530332A (en) * | 1976-03-13 | 1978-10-25 | Vinten Ltd | Balanced portable pedestals |
US4052980A (en) | 1976-06-10 | 1977-10-11 | Guenter A. Grams | Triaxial fiberoptic soft tissue retractor |
US4226228A (en) | 1978-11-02 | 1980-10-07 | Shin Hee J | Multiple joint retractor with light |
US4217890A (en) | 1978-11-03 | 1980-08-19 | Owens Milton L | Surgical sling for positioning a harvested kidney during surgical reattachment |
US4230119A (en) | 1978-12-01 | 1980-10-28 | Medical Engineering Corp. | Micro-hemostat |
US4306561A (en) | 1979-11-05 | 1981-12-22 | Ocean Trading Co., Ltd. | Holding apparatus for repairing severed nerves and method of using the same |
SU1088712A1 (en) * | 1979-11-14 | 1984-04-30 | Всесоюзный научно-исследовательский и испытательный институт медицинской техники | Apparatus for circular suture of blood vessels |
US4421107A (en) | 1980-10-15 | 1983-12-20 | Estes Roger Q | Surgical retractor elements and assembly |
US4688570A (en) | 1981-03-09 | 1987-08-25 | The Regents Of The University Of California | Ophthalmologic surgical instrument |
US4457300A (en) | 1982-06-07 | 1984-07-03 | Ohio Medical Instrument Co., Inc. | Surgical retractor |
US4461284A (en) | 1982-09-30 | 1984-07-24 | Fackler Martin L | Surgical retaining device |
US4747395A (en) | 1983-08-24 | 1988-05-31 | Brief L Paul | Surgical retractor for bone surgery |
US4627421A (en) | 1984-08-03 | 1986-12-09 | Symbas Panagiotis N | Sternal retractor |
WO1986001099A1 (en) | 1984-08-10 | 1986-02-27 | World Products Pty. Limited | Device for manipulative treatments |
US4949707A (en) | 1984-11-08 | 1990-08-21 | Minnesota Scientific, Inc. | Retractor apparatus |
US4617916A (en) | 1984-11-08 | 1986-10-21 | Minnesota Scientific, Inc. | Retractor apparatus |
USD293470S (en) | 1985-03-14 | 1987-12-29 | Adler David T | Combined adjustable positioner and holder for surgical instruments |
US4955896A (en) | 1985-09-27 | 1990-09-11 | Freeman Jerre M | Universal medical forcep tool |
USRE34150E (en) | 1985-11-12 | 1992-12-29 | Kapp Surgical Instrument, Inc. | Cardiovascular and thoracic retractor |
DE3609133A1 (en) | 1986-03-19 | 1987-09-24 | Glatt Gmbh | DEVICE FOR PELLETIZING OD. DGL. TREATMENT OF PARTICLES AND FOLLOWABLE PROCEDURE |
SE454942B (en) | 1986-05-22 | 1988-06-13 | Astra Tech Ab | HEART HELP DEVICE FOR INOPERATION IN BROSTHALAN |
FR2599238B1 (en) | 1986-05-28 | 1988-08-19 | Delacroix Chevalier Sa | STERNAL RETRACTOR. |
US4754746A (en) | 1986-09-25 | 1988-07-05 | Cox Kenneth L | Self-retaining metatarsal spreader |
US4702230A (en) | 1986-12-08 | 1987-10-27 | Pilling Co. | Adapter for surgical retractor |
US5036868A (en) | 1990-01-29 | 1991-08-06 | Unilink Inc. | Anastomosis preparation technique |
US4925443A (en) | 1987-02-27 | 1990-05-15 | Heilman Marlin S | Biocompatible ventricular assist and arrhythmia control device |
US4863133A (en) | 1987-05-26 | 1989-09-05 | Leonard Medical | Arm device for adjustable positioning of a medical instrument or the like |
US4827926A (en) | 1987-06-30 | 1989-05-09 | Carol Mark P | Flexible support arm for medical instruments |
US4852552A (en) | 1987-09-03 | 1989-08-01 | Pilling Co. | Sternal retractor |
US4884559A (en) | 1987-12-04 | 1989-12-05 | Collins Jason H | Surgical speculum |
US4854318A (en) | 1987-12-18 | 1989-08-08 | Scanlan International | Blood vessel holder and method of using in anastomosis |
US4865019A (en) | 1988-02-25 | 1989-09-12 | Phillips Steven J | Retractor apparatus for use in harvesting mammary arteries during heart by-pass surgery |
US5052373A (en) | 1988-07-29 | 1991-10-01 | Michelson Gary K | Spinal retractor |
SE8802904D0 (en) | 1988-08-16 | 1988-08-16 | Mogens Bugge | DR MOGENS BUGGE'S MAMMARIA HAKE |
US4971037A (en) | 1988-09-19 | 1990-11-20 | Pilling Co. | Surgical retractor support |
US4962758A (en) | 1988-11-23 | 1990-10-16 | Jeffrey Lasner | Vibratory device for releasing air bubbles trapped in the heart muscle |
US5152777A (en) | 1989-01-25 | 1992-10-06 | Uresil Corporation | Device and method for providing protection from emboli and preventing occulsion of blood vessels |
US4963857A (en) | 1989-06-26 | 1990-10-16 | Sackett Robert L | Translatable dual magnets |
GB2233561B (en) | 1989-07-07 | 1993-03-24 | Engineering In Medicine Limite | Clamp assemblies |
US5632746A (en) | 1989-08-16 | 1997-05-27 | Medtronic, Inc. | Device or apparatus for manipulating matter |
US5167223A (en) | 1989-09-08 | 1992-12-01 | Tibor Koros | Heart valve retractor and sternum spreader surgical instrument |
US5019086A (en) | 1989-09-12 | 1991-05-28 | Neward Theodore C | Manipulable vacuum extractor for childbirth and method of using the same |
US4973300A (en) | 1989-09-22 | 1990-11-27 | Pioneering Technologies, Inc. | Cardiac sling for circumflex coronary artery surgery |
US5203380A (en) | 1989-10-13 | 1993-04-20 | Kabushiki Kaisha Machida Seisakusho | Bending device |
US4949927A (en) | 1989-10-17 | 1990-08-21 | John Madocks | Articulable column |
US5139517A (en) | 1989-11-08 | 1992-08-18 | Corral David F | Orthotopic intraventricular heart pump |
US5053041A (en) | 1990-03-12 | 1991-10-01 | Ansari Shapoor S | Vessel holder |
DE9004513U1 (en) | 1990-04-20 | 1990-06-28 | Herzberg, Wolfgang, Dr.Med., 2000 Wedel, De | |
US5037428A (en) | 1990-06-21 | 1991-08-06 | Applied Medical Technology, Inc. | Vessel approximation and alignment device |
US5131905A (en) | 1990-07-16 | 1992-07-21 | Grooters Ronald K | External cardiac assist device |
US5125395A (en) | 1990-09-12 | 1992-06-30 | Adair Edwin Lloyd | Deflectable sheath for optical catheter |
US5119804A (en) | 1990-11-19 | 1992-06-09 | Anstadt George L | Heart massage apparatus |
US5159921A (en) | 1990-11-27 | 1992-11-03 | Hoover Rocklin L | Surgical retractor |
US5133724A (en) | 1991-04-04 | 1992-07-28 | Pilling Co. | Abdominal aortic clamp |
MX9202604A (en) | 1991-05-29 | 1994-05-31 | Origin Medsystems Inc | APPARATUS FOR MECHANICAL PROPERTY RETRACTION AND METHODS OF USE. |
US5520610A (en) | 1991-05-31 | 1996-05-28 | Giglio; Steven R. | Self retaining retractor |
US5231974A (en) | 1991-05-31 | 1993-08-03 | Giglio Steven R | Self retaining retractor |
US5452733A (en) | 1993-02-22 | 1995-09-26 | Stanford Surgical Technologies, Inc. | Methods for performing thoracoscopic coronary artery bypass |
US5571215A (en) | 1993-02-22 | 1996-11-05 | Heartport, Inc. | Devices and methods for intracardiac procedures |
US5766151A (en) | 1991-07-16 | 1998-06-16 | Heartport, Inc. | Endovascular system for arresting the heart |
US5150706A (en) | 1991-08-15 | 1992-09-29 | Cox James L | Cooling net for cardiac or transplant surgery |
US5171254A (en) | 1991-11-19 | 1992-12-15 | Sher Neal A | Eye fixation device |
GB9201214D0 (en) | 1992-01-21 | 1992-03-11 | Mcmahon Michael J | Surgical retractors |
US5348259A (en) | 1992-02-10 | 1994-09-20 | Massachusetts Institute Of Technology | Flexible, articulable column |
GB2267827B (en) | 1992-06-15 | 1995-11-08 | Himansu Kumar Dasmahapatra | A device for internal mammary artery dissection |
US5336252A (en) | 1992-06-22 | 1994-08-09 | Cohen Donald M | System and method for implanting cardiac electrical leads |
US5437266A (en) | 1992-07-02 | 1995-08-01 | Mcpherson; William | Coil screw surgical retractor |
US5318013A (en) | 1992-11-06 | 1994-06-07 | Wilk Peter J | Surgical clamping assembly and associated method |
US5256132A (en) | 1992-08-17 | 1993-10-26 | Snyders Robert V | Cardiac assist envelope for endoscopic application |
US6478029B1 (en) * | 1993-02-22 | 2002-11-12 | Hearport, Inc. | Devices and methods for port-access multivessel coronary artery bypass surgery |
US5797960A (en) | 1993-02-22 | 1998-08-25 | Stevens; John H. | Method and apparatus for thoracoscopic intracardiac procedures |
US5799661A (en) | 1993-02-22 | 1998-09-01 | Heartport, Inc. | Devices and methods for port-access multivessel coronary artery bypass surgery |
US6494211B1 (en) * | 1993-02-22 | 2002-12-17 | Hearport, Inc. | Device and methods for port-access multivessel coronary artery bypass surgery |
US5425705A (en) | 1993-02-22 | 1995-06-20 | Stanford Surgical Technologies, Inc. | Thoracoscopic devices and methods for arresting the heart |
US5569274A (en) | 1993-02-22 | 1996-10-29 | Heartport, Inc. | Endoscopic vascular clamping system and method |
NZ250994A (en) | 1993-05-27 | 1995-09-26 | Ndm Acquisition Corp | Wound dressing comprising a hydrogel layer bound to a porous backing layer which is bound to a thin film layer by adhesive |
US5513827A (en) | 1993-07-26 | 1996-05-07 | Karlin Technology, Inc. | Gooseneck surgical instrument holder |
US5437651A (en) | 1993-09-01 | 1995-08-01 | Research Medical, Inc. | Medical suction apparatus |
US5772583A (en) | 1994-01-21 | 1998-06-30 | Wright; John T. M. | Sternal retractor with attachments for mitral & tricuspid valve repair |
US5514076A (en) | 1994-01-27 | 1996-05-07 | Flexmedics Corporation | Surgical retractor |
CA2141522A1 (en) | 1994-02-16 | 1995-08-17 | Thomas D. Weldon | Electrophysiology positioning catheter |
US5453078A (en) | 1994-03-04 | 1995-09-26 | Merocel Corporation | Endoscopic wedge and organ positioner |
US5417709A (en) | 1994-04-12 | 1995-05-23 | Symbiosis Corporation | Endoscopic instrument with end effectors forming suction and/or irrigation lumens |
US5522819A (en) | 1994-05-12 | 1996-06-04 | Target Therapeutics, Inc. | Dual coil medical retrieval device |
US5547458A (en) | 1994-07-11 | 1996-08-20 | Ethicon, Inc. | T-shaped abdominal wall lift with telescoping member |
US5795291A (en) | 1994-11-10 | 1998-08-18 | Koros; Tibor | Cervical retractor system |
US5529571A (en) | 1995-01-17 | 1996-06-25 | Daniel; Elie C. | Surgical retractor/compressor |
US5667480A (en) | 1995-10-20 | 1997-09-16 | Ethicon Endo-Surgery, Inc. | Method and devices for endoscopic vessel harvesting |
US5755660A (en) | 1995-10-31 | 1998-05-26 | Tyagi; Narendra S. | Combination surgical retractor, light source, spreader, and suction apparatus |
US5813410A (en) | 1996-02-01 | 1998-09-29 | Levin; John M. | Internal body pump and systems employing same |
US5782746A (en) | 1996-02-15 | 1998-07-21 | Wright; John T. M. | Local cardiac immobilization surgical device |
CA2198036C (en) | 1996-02-20 | 2000-12-05 | Charles S. Taylor | Access platform for internal mammary dissection |
US5651378A (en) | 1996-02-20 | 1997-07-29 | Cardiothoracic Systems, Inc. | Method of using vagal nerve stimulation in surgery |
US5913876A (en) | 1996-02-20 | 1999-06-22 | Cardiothoracic Systems, Inc. | Method and apparatus for using vagus nerve stimulation in surgery |
US5976171A (en) | 1996-02-20 | 1999-11-02 | Cardiothoracic Systems, Inc. | Access platform for internal mammary dissection |
CA2197608C (en) | 1996-02-20 | 2000-02-01 | Charles S. Taylor | Surgical devices for imposing a negative pressure to stabilize cardiac tissue during surgery |
US5947896A (en) | 1996-04-26 | 1999-09-07 | United States Surgical Corporation | Heart stabilizer apparatus and method for use |
US6152874A (en) | 1996-04-26 | 2000-11-28 | Genzyme Corporation | Adjustable multi-purpose coronary stabilizing retractor |
US5846187A (en) | 1996-09-13 | 1998-12-08 | Genzyme Corporation | Redo sternotomy retractor |
US5976080A (en) | 1996-09-20 | 1999-11-02 | United States Surgical | Surgical apparatus and method |
JP3036686B2 (en) | 1997-02-27 | 2000-04-24 | 政夫 高橋 | Hemostatic holding device for vascular anastomosis used for coronary artery bypass surgery |
US5967972A (en) | 1997-03-28 | 1999-10-19 | Kapp Surgical Instrument, Inc. | Minimally invasive surgical retractor and method of operation |
US6458079B1 (en) * | 1997-04-25 | 2002-10-01 | Beth Israel Deaconess Medical Center | Surgical retractor and method of use |
US5846193A (en) | 1997-05-01 | 1998-12-08 | Wright; John T. M. | Midcab retractor |
US5984867A (en) | 1997-05-02 | 1999-11-16 | Heartport, Inc. | Surgical retractor and method of retracting |
WO1998049944A1 (en) | 1997-05-02 | 1998-11-12 | Pilling Weck Incorporated | Adjustable supporting bracket having plural ball and socket joints |
US5957835A (en) | 1997-05-16 | 1999-09-28 | Guidant Corporation | Apparatus and method for cardiac stabilization and arterial occlusion |
US6102854A (en) | 1997-08-27 | 2000-08-15 | Coroneo Inc. | Sternum retractor for performing bypass surgery on a beating heart |
US5944658A (en) | 1997-09-23 | 1999-08-31 | Koros; Tibor B. | Lumbar spinal fusion retractor and distractor system |
US5984864A (en) | 1997-10-07 | 1999-11-16 | Ethicon Endo-Surgery, Inc. | Tissue stabilization device for use during surgery |
US6007486A (en) | 1997-10-07 | 1999-12-28 | Ethicon Endo-Surgery, Inc. | Tissue stabilization device for use during surgery having a segmented shaft |
US5846194A (en) | 1998-01-23 | 1998-12-08 | Ethicon Endo-Surgery, Inc. | Surgical retraction apparatus |
US6015382A (en) * | 1997-10-16 | 2000-01-18 | General Surgical Innovations, Inc. | Inflatable manipulator for organ positioning during surgery and method of use |
US6231585B1 (en) * | 1997-11-20 | 2001-05-15 | Medivas, Llc | Device for stabilizing a treatment site and method of use |
EP1049409A4 (en) | 1998-01-23 | 2009-09-09 | United States Surgical Corp | Surgical instrument |
US6251065B1 (en) * | 1998-03-17 | 2001-06-26 | Gary S. Kochamba | Methods and apparatus for stabilizing tissue |
US6113534A (en) * | 1998-03-19 | 2000-09-05 | Koros; Tibor B. | Adjustable heart surface stabilizer |
US5908382A (en) | 1998-07-08 | 1999-06-01 | Koros; Tibor B. | Minimally invasive retractor for internal mammary artery harvesting |
US6063021A (en) | 1998-07-31 | 2000-05-16 | Pilling Weck Incorporated | Stabilizer for surgery |
BR9913759A (en) * | 1998-09-15 | 2001-06-12 | Medtronic Inc | System to temporarily immobilize an area of tissue, and system to stabilize tissue |
US5984865A (en) | 1998-09-15 | 1999-11-16 | Thompson Surgical Instruments, Inc. | Surgical retractor having locking interchangeable blades |
US6007523A (en) | 1998-09-28 | 1999-12-28 | Embol-X, Inc. | Suction support and method of use |
US6468265B1 (en) * | 1998-11-20 | 2002-10-22 | Intuitive Surgical, Inc. | Performing cardiac surgery without cardioplegia |
US6398726B1 (en) * | 1998-11-20 | 2002-06-04 | Intuitive Surgical, Inc. | Stabilizer for robotic beating-heart surgery |
US6099468A (en) | 1999-01-15 | 2000-08-08 | Kapp Surgical Instrument, Inc. | Retractor for partial sternotomy |
US6475142B1 (en) * | 1999-11-12 | 2002-11-05 | Genzyme Corporation | Curved stabilization arm for use with surgical retractor and tissue stabilization device and methods related thereto |
US6626830B1 (en) * | 1999-05-04 | 2003-09-30 | Cardiothoracic Systems, Inc. | Methods and devices for improved tissue stabilization |
US6231506B1 (en) | 1999-05-04 | 2001-05-15 | Cardiothoracic Systems, Inc. | Method and apparatus for creating a working opening through an incision |
US6258023B1 (en) * | 1999-07-08 | 2001-07-10 | Chase Medical, Inc. | Device and method for isolating a surface of a beating heart during surgery |
US6375611B1 (en) * | 2000-01-07 | 2002-04-23 | Origin Medsystems, Inc. | Organ stabilizer |
-
1999
- 1999-08-03 US US09/366,190 patent/US6511416B1/en not_active Expired - Fee Related
-
2002
- 2002-10-15 US US10/272,036 patent/US7503891B2/en not_active Expired - Fee Related
-
2009
- 2009-02-05 US US12/365,992 patent/US20090137865A1/en not_active Abandoned
Patent Citations (99)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US810675A (en) * | 1905-04-24 | 1906-01-23 | Gustav F Richter | Dilator. |
US1706500A (en) * | 1927-08-01 | 1929-03-26 | Henry J Smith | Surgical retractor |
US2590527A (en) * | 1947-04-03 | 1952-03-25 | Joseph Niedermann | Suction massage device |
US3720433A (en) * | 1970-09-29 | 1973-03-13 | Us Navy | Manipulator apparatus for gripping submerged objects |
US3783873A (en) * | 1971-09-16 | 1974-01-08 | H Jacobs | Weighted surgical clamp having foldable prop |
US3858926A (en) * | 1973-07-23 | 1975-01-07 | Ludger Ottenhues | Vacuum lifting device |
US4428368A (en) * | 1980-09-29 | 1984-01-31 | Masakatsu Torii | Massage device |
US4366819A (en) * | 1980-11-17 | 1983-01-04 | Kaster Robert L | Anastomotic fitting |
US4368736A (en) * | 1980-11-17 | 1983-01-18 | Kaster Robert L | Anastomotic fitting |
US4434791A (en) * | 1982-03-15 | 1984-03-06 | Humboldt Products Corp. | Surgical retractor array system |
US4492229A (en) * | 1982-09-03 | 1985-01-08 | Grunwald Ronald P | Suture guide holder |
US4646747A (en) * | 1983-10-28 | 1987-03-03 | Astra-Tech Aktiebolag | Electrode for electrocardiographic examinations |
US4718418A (en) * | 1983-11-17 | 1988-01-12 | Lri L.P. | Apparatus for ophthalmological surgery |
US4736749A (en) * | 1985-04-26 | 1988-04-12 | Astra-Tech Aktiebolag | Holder for medical use fixed by vacuum |
US4637377A (en) * | 1985-09-20 | 1987-01-20 | Loop Floyd D | Pillow or support member for surgical use |
US4726356A (en) * | 1985-11-12 | 1988-02-23 | Kapp Surgical Instrument, Inc. | Cardiovascular and thoracic retractor |
US4904012A (en) * | 1986-11-26 | 1990-02-27 | Sumitomo Electric Industries, Ltd. | Suction device |
US5098369A (en) * | 1987-02-27 | 1992-03-24 | Vascor, Inc. | Biocompatible ventricular assist and arrhythmia control device including cardiac compression pad and compression assembly |
US4803984A (en) * | 1987-07-06 | 1989-02-14 | Montefiore Hospital Association Of Western Pennsylvania | Method for performing small vessel anastomosis |
US4808163A (en) * | 1987-07-29 | 1989-02-28 | Laub Glenn W | Percutaneous venous cannula for cardiopulmonary bypass |
US5080088A (en) * | 1987-11-09 | 1992-01-14 | Minnesota Scientific, Inc. | Flexible retractor |
US5011469A (en) * | 1988-08-29 | 1991-04-30 | Shiley, Inc. | Peripheral cardiopulmonary bypass and coronary reperfusion system |
US4991578A (en) * | 1989-04-04 | 1991-02-12 | Siemens-Pacesetter, Inc. | Method and system for implanting self-anchoring epicardial defibrillation electrodes |
US4989587A (en) * | 1989-04-26 | 1991-02-05 | Farley Daniel K | Sternal retractor |
US4993862A (en) * | 1989-08-16 | 1991-02-19 | Pilling Company | Clamp assembly for surgical retractor support |
US5009660A (en) * | 1989-09-15 | 1991-04-23 | Visx, Incorporated | Gas purging, eye fixation hand piece |
US5192070A (en) * | 1990-09-06 | 1993-03-09 | Smc Kabushiki Kaisha | Suction pad |
US5196003A (en) * | 1990-11-06 | 1993-03-23 | Ethicon, Inc. | Endoscopic surgical instrument for taking hold of tissue |
US5300087A (en) * | 1991-03-22 | 1994-04-05 | Knoepfler Dennis J | Multiple purpose forceps |
US5607421A (en) * | 1991-05-01 | 1997-03-04 | The Trustees Of Columbia University In The City Of New York | Myocardial revascularization through the endocardial surface using a laser |
US6029671A (en) * | 1991-07-16 | 2000-02-29 | Heartport, Inc. | System and methods for performing endovascular procedures |
US5293863A (en) * | 1992-05-08 | 1994-03-15 | Loma Linda University Medical Center | Bladed endoscopic retractor |
US5290082A (en) * | 1992-07-06 | 1994-03-01 | Palmer Harold D | Battery operated hand held vacuum handling device |
US5383840A (en) * | 1992-07-28 | 1995-01-24 | Vascor, Inc. | Biocompatible ventricular assist and arrhythmia control device including cardiac compression band-stay-pad assembly |
US5484391A (en) * | 1992-07-30 | 1996-01-16 | Univ Temple | Direct manual cardiac compression method |
US5287861A (en) * | 1992-10-30 | 1994-02-22 | Wilk Peter J | Coronary artery by-pass method and associated catheter |
US6027476A (en) * | 1992-12-03 | 2000-02-22 | Heartport, Inc. | Methods and systems for performing thoracoscopic coronary bypass and other procedures |
US5382756A (en) * | 1993-01-22 | 1995-01-17 | Dagan; Gideon B. | Encapsulation closure for cables |
US6010531A (en) * | 1993-02-22 | 2000-01-04 | Heartport, Inc. | Less-invasive devices and methods for cardiac valve surgery |
US5728151A (en) * | 1993-02-22 | 1998-03-17 | Heartport, Inc. | Intercostal access devices for less-invasive cardiovascular surgery |
US5613937A (en) * | 1993-02-22 | 1997-03-25 | Heartport, Inc. | Method of retracting heart tissue in closed-chest heart surgery using endo-scopic retraction |
US5713951A (en) * | 1993-02-22 | 1998-02-03 | Heartport, Inc. | Thoracoscopic valve prosthesis delivery device |
US5735290A (en) * | 1993-02-22 | 1998-04-07 | Heartport, Inc. | Methods and systems for performing thoracoscopic coronary bypass and other procedures |
US5498256A (en) * | 1993-05-28 | 1996-03-12 | Snowden-Pencer, Inc. | Surgical instrument handle |
US5509890A (en) * | 1993-12-16 | 1996-04-23 | Kazama; Shigeru | Heart retractor |
US5868770A (en) * | 1993-12-23 | 1999-02-09 | Oticon A/S | Method and instrument for establishing the receiving site of a coronary artery bypass graft |
US5512037A (en) * | 1994-05-12 | 1996-04-30 | United States Surgical Corporation | Percutaneous surgical retractor |
US5480425A (en) * | 1994-06-09 | 1996-01-02 | Carbomedics, Inc. | Integrated heart valve rotator and holder |
US5503617A (en) * | 1994-07-19 | 1996-04-02 | Jako; Geza J. | Retractor and method for direct access endoscopic surgery |
US6017304A (en) * | 1994-08-31 | 2000-01-25 | Vierra; Mark A. | Device and method for isolating a surgical site |
US5607446A (en) * | 1995-01-31 | 1997-03-04 | Beehler; Cecil C. | Pupil dilator |
US6183486B1 (en) * | 1995-02-24 | 2001-02-06 | Heartport, Inc. | Device and method for minimizing heart displacements during a beating heart surgical procedure |
US6167889B1 (en) * | 1995-04-10 | 2001-01-02 | Cardiothoracic Systems, Inc. | Method for coronary artery bypass |
US5888247A (en) * | 1995-04-10 | 1999-03-30 | Cardiothoracic Systems, Inc | Method for coronary artery bypass |
US6015378A (en) * | 1995-09-20 | 2000-01-18 | Medtronic, Inc. | Method and apparatus for temporarily immobilizing a local area tissue |
US6334843B1 (en) * | 1995-09-20 | 2002-01-01 | Medtronic, Inc. | Method and apparatus for temporarily immobilizing a local area of tissue |
US6336898B1 (en) * | 1995-09-20 | 2002-01-08 | Medtronic, Inc. | Method and apparatus for temporarily immobilizing a local area of tissue |
US6350229B1 (en) * | 1995-09-20 | 2002-02-26 | Medtronic, Inc. | Method and apparatus for temporarily immobilizing a local area of tissue |
US6196982B1 (en) * | 1995-10-30 | 2001-03-06 | Terry A. Ball | Vacuum massager |
US6050266A (en) * | 1996-02-20 | 2000-04-18 | Cardiothracic Systems, Inc. | Procedures for stabilizing the beating heart during coronary artery bypass graft surgery |
US5727569A (en) * | 1996-02-20 | 1998-03-17 | Cardiothoracic Systems, Inc. | Surgical devices for imposing a negative pressure to fix the position of cardiac tissue during surgery |
US6701930B2 (en) * | 1996-02-20 | 2004-03-09 | Cardiothoracic Systems, Inc. | Surgical instruments and procedures for stabilizing the beating heart during coronary artery bypass graft surgery |
US5894843A (en) * | 1996-02-20 | 1999-04-20 | Cardiothoracic Systems, Inc. | Surgical method for stabilizing the beating heart during coronary artery bypass graft surgery |
US6346077B1 (en) * | 1996-02-20 | 2002-02-12 | Cardiothoracic Systems, Inc. | Surgical instrument for stabilizing the beating heart during coronary artery bypass graft surgery |
US6213941B1 (en) * | 1996-02-20 | 2001-04-10 | Cardiothoracic Systems, Inc. | Surgical instruments for stabilizing the beating heart during coronary bypass graft surgery |
US5730757A (en) * | 1996-02-20 | 1998-03-24 | Cardiothoracic Systems, Inc. | Access platform for internal mammary dissection |
US6036641A (en) * | 1996-02-20 | 2000-03-14 | Cardiothoracic System, Inc. | Surgical instruments for stabilizing the beating heart during coronary artery bypass graft surgery |
US6032672A (en) * | 1996-02-20 | 2000-03-07 | Cardiothoracic Systems, Inc. | Surgical devices for imposing a negative pressure to stabilize cardiac tissue during surgery |
US6537212B2 (en) * | 1996-04-26 | 2003-03-25 | United States Surgical Corporation | Surgical retractor |
US6213940B1 (en) * | 1996-04-26 | 2001-04-10 | United States Surgical Corporation | Surgical retractor including coil spring suture mount |
US5875782A (en) * | 1996-11-14 | 1999-03-02 | Cardiothoracic Systems, Inc. | Methods and devices for minimally invasive coronary artery revascularization on a beating heart without cardiopulmonary bypass |
US5891017A (en) * | 1997-01-31 | 1999-04-06 | Baxter Research Medical, Inc. | Surgical stabilizer and method for isolating and immobilizing cardiac tissue |
US5882299A (en) * | 1997-01-31 | 1999-03-16 | Minnesota Scientific, Inc. | Device and procedure for minimally invasive coronary anastomosis |
US5885271A (en) * | 1997-03-14 | 1999-03-23 | Millennium Cardiac Strategies, Inc. | Device for regional immobilization of a compliant body |
US6033362A (en) * | 1997-04-25 | 2000-03-07 | Beth Israel Deaconess Medical Center | Surgical retractor and method of use |
US6190311B1 (en) * | 1997-05-02 | 2001-02-20 | Cardiothoracic Systems, Inc. | Retractor and instrument platform for a less invasive cardiovascular surgical procedure |
US6015427A (en) * | 1997-07-07 | 2000-01-18 | Eclipse Surgical Technologies, Inc. | Heart stabilizer with controllable stay suture and cutting element |
US5876332A (en) * | 1997-07-24 | 1999-03-02 | Genzyme Corporation | Surgical support member |
US6019722A (en) * | 1997-09-17 | 2000-02-01 | Guidant Corporation | Device to permit offpump beating heart coronary bypass surgery |
US5865730A (en) * | 1997-10-07 | 1999-02-02 | Ethicon Endo-Surgery, Inc. | Tissue stabilization device for use during surgery having remotely actuated feet |
US6193652B1 (en) * | 1997-10-07 | 2001-02-27 | Ethicon Endo-Surgery, Inc. | Tissue stabilization device for use during surgery having spherical curved feet |
US6013027A (en) * | 1997-10-07 | 2000-01-11 | Ethicon Endo-Surgery, Inc. | Method for using a tissue stabilization device during surgery |
US5879291A (en) * | 1997-10-08 | 1999-03-09 | Ethicon Endo-Surgery, Inc. | Device used with a surgical retractor to elevate body parts |
US6030340A (en) * | 1997-12-19 | 2000-02-29 | United States Surgical | Surgical retractor |
US6200263B1 (en) * | 1998-01-23 | 2001-03-13 | United States Surgical Corporation | Surgical instrument holder |
USD421803S (en) * | 1998-03-07 | 2000-03-21 | Koros Tibor B | Retractor for coronary artery bypass surgery |
US6210323B1 (en) * | 1998-05-05 | 2001-04-03 | The University Of British Columbia | Surgical arm and tissue stabilizer |
US6193732B1 (en) * | 1999-01-08 | 2001-02-27 | Cardiothoracic System | Surgical clips and apparatus and method for clip placement |
US6348036B1 (en) * | 1999-01-24 | 2002-02-19 | Genzyme Corporation | Surgical retractor and tissue stabilization device |
US6042539A (en) * | 1999-03-26 | 2000-03-28 | Ethicon Endo-Surgery, Inc. | Vacuum-actuated tissue-lifting device and method |
US6511416B1 (en) * | 1999-08-03 | 2003-01-28 | Cardiothoracic Systems, Inc. | Tissue stabilizer and methods of use |
US7503891B2 (en) * | 1999-08-03 | 2009-03-17 | Maquet Cardiovascular, Llc | Tissue stabilizer and methods of use |
US6506149B2 (en) * | 1999-09-07 | 2003-01-14 | Origin Medsystems, Inc. | Organ manipulator having suction member supported with freedom to move relative to its support |
US7018328B2 (en) * | 2000-02-11 | 2006-03-28 | Endoscopic Technologies, Inc. | Tissue stabilizer |
US6676597B2 (en) * | 2001-01-13 | 2004-01-13 | Medtronic, Inc. | Method and device for organ positioning |
US7326173B2 (en) * | 2001-01-13 | 2008-02-05 | Medtronic, Inc. | Device for organ positioning |
US7338434B1 (en) * | 2002-08-21 | 2008-03-04 | Medtronic, Inc. | Method and system for organ positioning and stabilization |
US7179224B2 (en) * | 2003-12-30 | 2007-02-20 | Cardiothoracic Systems, Inc. | Organ manipulator and positioner and methods of using the same |
US7497823B2 (en) * | 2004-06-30 | 2009-03-03 | Ethicon, Inc. | Flexible shaft stabilizing devices with improved actuation |
Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US8460172B2 (en) | 2010-07-29 | 2013-06-11 | Medtronic, Inc. | Tissue stabilizing device and methods including a self-expandable head-link assembly |
US9066714B2 (en) | 2010-07-29 | 2015-06-30 | Medtronic, Inc. | Tissue stabilizing device and methods including a self-expandable head-link assembly |
Also Published As
Publication number | Publication date |
---|---|
US20030088150A1 (en) | 2003-05-08 |
US7503891B2 (en) | 2009-03-17 |
US6511416B1 (en) | 2003-01-28 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US6511416B1 (en) | Tissue stabilizer and methods of use | |
US10383612B2 (en) | Organ manipulator apparatus | |
US6406424B1 (en) | Tissue stabilizer having an articulating lift element | |
US7399272B2 (en) | Methods and apparatus providing suction-assisted tissue engagement | |
USRE38814E1 (en) | Local cardiac immobilization surgical device | |
US6231585B1 (en) | Device for stabilizing a treatment site and method of use | |
US6159201A (en) | Device for regional immobilization of a compliant body | |
US6478028B1 (en) | Surgical apparatus and method for performing transabdominal cardiac surgery | |
US20120022333A1 (en) | Apparatus and system for simultaneous use of multiple instruments | |
EP1800606B1 (en) | Treatment instrument for coronary artery bypass operation | |
KR20080080607A (en) | Implant connector | |
CA3078477C (en) | Devices for performing minimally invasive surgery having rotating multiport access | |
CA3078494C (en) | Devices for performing minimally invasive surgery having bellows support housing | |
US20040143153A1 (en) | Devices and methods for manipulation of organ tissue | |
EP3925556B1 (en) | Seal assembly for surgical access assemblies | |
US20050096500A1 (en) | Apparatus and methods for cardiac surgery |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
AS | Assignment |
Owner name: CARDIOTHORACIC SYSTEMS, INC., CALIFORNIA Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:GREEN, HARRY LEONARD, II;WALLIN, JOSHUA K.;REEL/FRAME:022221/0604 Effective date: 19990611 |
|
AS | Assignment |
Owner name: CARDIOTHORACIC SYSTEMS, LLC, CALIFORNIA Free format text: CHANGE OF NAME;ASSIGNOR:CARDIOTHORACIC SYSTEMS, INC.;REEL/FRAME:022770/0001 Effective date: 20080103 |
|
AS | Assignment |
Owner name: MAQUET CARDIOVASCULAR LLC, CALIFORNIA Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:CARDIOTHORACIC SYSTEMS, LLC;REEL/FRAME:022814/0772 Effective date: 20081202 |
|
STCB | Information on status: application discontinuation |
Free format text: ABANDONED -- FAILURE TO RESPOND TO AN OFFICE ACTION |