Device for cardiac surgery

A medical device assembly includes a hinge rod having a first portion and a second portion, and a pedestal is coupled to the second portion of the hinge rod, the pedestal having a top surface, and portions of the pedestal cooperate to define a trough that is configured to hold a first portion of a vessel on the top surface of the pedestal. A retainer is movably coupled to the pedestal, and the retainer has a planar member having a lower surface configured to oppose the top surface of the pedestal. A joint member is coupled to the hinge rod, and a clamp assembly is releasably coupled to the joint member such that when the clamp assembly is in a locked configuration, the hinge rod is not repositionable, and when the clamp assembly is in an unlocked configuration, the hinge rod is repositionable.

FIELD OF THE INVENTION

The claimed invention relates to minimally invasive cardiac surgical devices, and more specifically to a surgical device used in anastomosis during minimally invasive cardiac surgical procedures.

BACKGROUND

Minimally invasive surgical approaches are gaining increased interest in relation to coronary procedures. Coronary revascularization procedures such as the grafting of the internal thoracic artery (ITA) has shown superior long-term patency and improved patient outcome in coronary artery bypass graft (CABG) surgeries. While conventional approaches to ITA harvesting and grafting have included median sternotomy or multiple thoracoports, a minimally invasive approach is desirable. A minimally invasive procedure related to revascularization using either the left or right internal thoracic artery (ITA), or the left or right internal mammary artery (IMA) may utilize access to the ITAs via sub-xiphoid access, where increased surgical space is gained by accessing the internal thoracic arteries via incision at the subxiphocostal region.

Upon harvesting either the left internal thoracic artery (LITA) or the right internal thoracic artery (RITA) anastomoses to the left anterior descending (LAD) coronary artery and to the right coronary artery (RCA), respectively, can be performed without cardiopulmonary bypass (CPB). A significant advantage of this approach is that a perfectly harvested ITA graft can be perfectly anastomosed to the usual site on the LAD artery, or onto the RCA artery. A minimally invasive ITA harvesting procedure involving sub-xiphoid access also results in superior cosmetic results, is reasonably painless, and the arterial grafting can be accomplished on the beating heart. Recent approaches of minimally invasive ITA harvesting surgical techniques have been shown to result in increased effective length of ITA bypasses, reduced operation times, and improved patient recovery. These approaches, however, including all associated procedures, need to be minimally invasive if performed using a minimally invasive approach.

While less invasive surgical approaches for ITA harvesting and CABG have shown promise, the ability to conduct a CABG procedure without the use of CPB is highly desirable. Also, visualization, maintenance of insufflation, and distal suturing of a coronary anastomosis in totally endoscopic coronary artery bypass grafting on the beating heart is technically demanding. While minimally invasive surgical tools and procedures can create larger working spaces to accommodate additional surgical tools such as endoscopes, suturing tools, and the like, achieving an increased working space should ideally preserve chest wall integrity and avoid CPB. Likewise, a minimally invasive surgical approach should not compromise the reliability of a cardiac repair. Therefore, there is a need for improved minimally invasive surgical devices or procedures that contribute to facilitate improved efficacy and patency of minimally invasive coronary arty bypass grafting surgical procedures including anastomosis.

It will be appreciated that for purposes of clarity and where deemed appropriate, reference numerals have been repeated in the figures to indicate corresponding features, and that the various elements in the drawings have not necessarily been drawn to scale in order to better show the features.

DETAILED DESCRIPTION

FIG.1Ais a top-right front perspective view of a distal end of the minimally invasive surgical device used in cardiac surgery. A distal end10D of a device10used in minimally invasive cardiac surgery is illustrated. The device10has a sleeve18having a shaft tube20terminating in a hinge rod22which is coupled to a pedestal24. At a proximal end24P of the pedestal24a pedestal base84, an inner wall86, and an outer wall90, are defined by the pedestal24. The pedestal base84defines an articulation slot108which allows the hinge rod22to pass through and allows the pedestal24to be tilted from side to side for improved positioning during a minimally invasive surgical procedure. The inner wall86and the outer wall90further define a trough88, in a direction parallel to a longitudinal axis of the pedestal24extending from the proximal end24P to the distal end24D of the pedestal24. This trough88is configured to hold and guide a vessel in the pedestal24from the proximal end24P towards the distal end24D of the pedestal24. The pedestal24also defines several textured surface elements92that are configured to help hold a vessel steady when loaded into the distal end10D of the device10used in minimally invasive cardiac surgery. A stem26is fixedly attached to the pedestal24. The stem26is largely cylindrical in shape but has a tooth70on one side. Other teeth may be located on the stem, but only one is visible here. While the stem26shown here is cylindrical, stems having other shapes, such as rectangular, or other holding features may be utilized by one skilled in the art. A soft retainer28is placed onto the stem26and is movably coupled to translate up and down in a vertical direction, although other movable configurations may be used as well. The soft retainer28further defines a collar or grip72, a base74, a jaw76extending from the base74, and a planar member78at an end of the jaw76. The jaw76of the soft retainer28also defines an upper détente80and a lower détente82, which are configured to releasably hold suture or other filament for a temporary hold during a minimally invasive surgical procedure. The collar or grip72is configured to have a portion extending at least partially outside the base74of the soft retainer28The tooth70on the stem26is configured to releasably hold the soft retainer28in several designated vertical positions based on the vertical placement of the teeth. As configured here, the soft retainer28moves up and down relative to the pedestal24. The planar member78of the soft retainer28contacts the pedestal24at a position where the textured surface elements92are located. These textured surface elements92and several corresponding textured elements on the planar member78, not visible here, interface and combine to improve the grip onto a vessel held within the distal end10D of the device10.

The pedestal24also defines a suturing template30towards a distal end24D of the pedestal24. The suturing template30portion of the pedestal also defines a top surface94having a hole96passing therethrough. At the most distal end24D of the pedestal24, the suturing template30defines three indicating guides98, a recess106, a lower guide fin104and two upper guide fins,100,102located on either side of the lower guide fin104. The upper guide fins100,102and the lower guide fin104are further towards the distal end24D of the pedestal than the three guides98. The upper guide fin100and upper guide fin102are shaped such that they alternate with the lower guide fin104and could entrain or temporarily hold or restrain a filament or suture across the suturing template30in a direction substantially perpendicular to an axis extending from the proximal end24P to the distal end24D of the pedestal24. Adjacent to each upper guide fin100,102are two suture channels110which communicate from the top surface94of the suturing template30to the underside of the suturing template30portion of the pedestal24. These suture channels110and the upper guide fins100,102and lower fin104are configured such that a suture could be directed from the underside of the pedestal24, up through one of the suture channels110, distally relative to upper guide fin102, proximally relative to lower guide fin104, distally relative to upper guide fin100, and back through the opposite suture channels110adjacent to upper guide fin100. It should be noted that other arrangements or suture routing could be employed in other embodiments. More details relating to these aforementioned features and suture pathways will be discussed later.FIG.1Bis a top-left-front perspective view of the distal end of the minimally invasive device used in cardiac surgery ofFIG.1A.

FIG.2is a top right front perspective view of the entire minimally invasive surgical device used in cardiac surgery ofFIGS.1A and1B.FIG.2illustrates the entire device10in perspective view. At a proximal end10P of the device10, there is a suture locking apparatus14coupled to a lever arm12. The lever arm12defines a grip34and has a lever32to which the suture locking apparatus14is directly coupled. The suture locking device14has a central conduit through which suture may pass and can be held fixedly within when engaged. The lever32has a grip36also, and the lever32is biased away from the lever arm12with a spring. There is a sleeve18coupled to the arm12which has an internal shaft tube20fixedly attached within. The sleeve18and shaft tube20terminate in a hinge rod22which is coupled to the distal end10D of the device10at the pedestal24. As previously described in regard toFIGS.1A and1B, the stem26, soft retainer28, and suturing template30of the distal end10D of the device10are also shown here. The sleeve18also has a movable ball clamp66defining an equator68about its external surface. A clamp16is coupled to the ball clamp66. The clamp16includes an upper clamp jaw40, a clamp adapter42, and a lower clamp jaw44. The clamp adapter42is fixedly attached to the upper clamp jaw40by a screw56and the lower clamp jaw44is pivotably attached to the clamp adapter42by a pin194passed through the clamp adapter42. The clamp16also has a thumb screw46having a thumb screw grip48and a thumb screw shaft52wherein the thumb screw shaft passes through both the upper clamp jaw40and the lower clamp jaw44through a gap50defined in the lower clamp jaw44in order to maintain a set tension between the upper clamp jaw40and the lower clamp jaw44. It should be presumed that threading is present within the gap, but it is not visible in this view. The upper clamp jaw40and the lower clamp jaw44, when clamped together as illustrated inFIG.2, hold the ball clamp66in place. When the upper clamp jaw40and lower clamp jaw44are loosened, the ball clamp may still be held between the upper clamp jaw40and the lower clamp jaw44, but the lowered compression of the ball clamp66along its equator68allow the two halves or segments of the ball clamp66delineated by the equator68to separate slightly. This renders the ball clamp66movable in a vertical direction along the sleeve18of the device10. This also renders the ball clamp66and therefore the sleeve18pivotable in multiple orientations relative to the clamp16by allowing the ball clamp66to move freely within the jaws of the clamp16when the thumb screw46is loosened. While this structure is shown inFIG.2, other methods and structures capable of clamping in a manner that allows for movement and adjustment of the distal end of a device such as the embodiments illustrated herein along several degrees of freedom such as the structure described here. A pull tab15is attached at a proximal end10P of the entire device10. The tab15is configured to securely hold a suture and pull the suture remotely from the proximal end10P of the device10when necessary.

Further articulation of the device10, in particular the distal end10D of the device10, can be achieved by squeezing or compressing the lever32towards the arm12. When the lever32is squeezed towards the arm12, and the arm12pivots around a pivot point38, it defeats or limits a downward vertical compression on a smaller ball at the proximal end of the hinge rod22, not shown in this view. When the lever32is squeezed towards the arm12, the hinge rod22is pivotable and rotatable relative to the attachment point of the hinge rod22to the shaft tube20. The downward vertical compression is the at rest configuration in the device10by biasing the lever32towards the arm12when not squeezed. The articulating rod, or articulating hinge rod provides a pivotable link useful in delivering and placing the distal end10D of the device10to a specific targeted area for a surgical procedure.

FIGS.3A,3B,3C,3D,3E, and3Fare front, left side, right side, rear, top, and bottom elevational views, respectively, of the pedestal ofFIG.1A. While the features of the pedestal24have already been described in regard toFIGS.1A and1B, additional features are visible in the elevational views.FIG.3Eillustrates a top view of the trough88, the textured surface elements92and the template30including the location of the anchor suture channels110, which defines the space on the pedestal24where a resected IMA may be held in place during a minimally invasive cardiac surgery. Also visible inFIG.3Eare several internal recesses112along the articulation slot108which can temporarily and releasably hold the pedestal24in place along several indexed positions with respect to the hinge rod. This permits the pedestal24to tilt side to side and be held in fixed positions along the pathway defined by the articulation slot108. Also visible is the hole114through which the stem26can be inserted and fixedly attached to the pedestal24.FIG.3Fillustrates the bottom of the pedestal24showing the location of the hinge rod channel116which passes from the proximal end24P of the pedestal24towards the distal end24D of the pedestal24. The hinge rod channel116is discontinuous at the bottom surface but continues throughout the pedestal24. Also illustrated are two suture channels118that communicate with the hinge rod channel116and through the pedestal24to the suture channels110on the top surface, as well as a side suture channel120branching off from one of the suture channels110.

FIGS.4A,4B,4C,4D,4E, and4Fare front, left side, right side, rear, top, and bottom elevational views, respectively, of the retainer ofFIG.1A. While the features of the soft retainer28have already been described in regard toFIGS.1A and1B, additional features are visible in the elevational views. The respective locations of the collar or grip72, base74, planar member78, upper détente80, and lower détente82are illustrated. Also shown are a central hole122for passing the stem26therethrough, several texture elements124on the bottom of the planar member78, and a tab126in the central portion of the central hole122. The tab126is configured to interface with one or more teeth on the stem26for the purpose of releasably holding the vertical position of the soft retainer28in place along the stem26when the entire device10is in use.

FIGS.5A-5Dare a series of exploded views illustrating assembly steps of the minimally invasive device used in cardiac surgery ofFIG.2.FIG.5Aillustrates the assembly of the device used in cardiac surgery ofFIG.2. Beginning with the pedestal24, the stem26is inserted through the central hole122of the soft retainer28and into the hole114of the pedestal24. The distal end22D of the hinge rod22is inserted into the hinge rod channel116of the pedestal24, which is not visible here, allowing for the proximal end22P of the hinge rod22to pass into the articulation slot108of the pedestal24. This is possible due to a first bend160and a second bend162along the length of the hinge rod22. It should be noted that the hinge rod22is hollow and will allow filaments or suture to pass through the internal diameter of the hinge rod22. A ball156having a center158is fixedly attached to the proximal end22P of the hinge rod22. A hole154is held against the ball156and a plunger164is inserted into a hole154of the inner tube152. The plunger164has a protrusion168. A first tube half146and a second tube half148are placed around the inner tube152. It should be noted that both the first tube half146and second tube half148have recessed features166,167to accommodate the ball156and the plunger164in the first tube half146and second tube half148without completely fixing their positions to or against the first tube half146or the second tube half148.FIG.5Billustrates the sleeve18being slid over the first tube half146and second tube half148such that the protrusion168of the plunger164still projects from within the center of the sleeve18. Over the outside of the sleeve18, the sleeve18is inserted into the center210of the movable ball clamp66.

After the assembly steps illustrated inFIG.5B, the end of the sleeve18with protrusion168projecting from the first tube half146and second tube half148has a channel140in lever32placed over the first tube half146and second tube half148, as illustrated inFIG.5C. The lever32also has a hole138on the side of the lever32. A housing130is fixedly attached to a proximal end32P of the lever32. The lever arm12, having a pivot point38, is placed over the distal end32D of lever32. A pin206is placed in pivot point38and through hole138to hold the lever arm12permanently and pivotably onto the lever32. A spring214is also fixedly attached within the lever32to maintain a bias of the arm12against the plunger164. A suture tube142is placed into the housing130, between the features of the tube gripping elements134and the suture gripping elements136, with the proximal end144being held in a tube stop145. A suture212is inserted into the proximal end142P of the suture tube142, down through the center of the lever32, through the sleeve18, hinge rod22, and through to the distal end24D of the pedestal24. Finally, the first half15A and the second half15B of the pull tab15are closed over the two ends212E of the suture212. The pull tab15holds the suture firmly at the distal end of the device and can pull the suture212back through its described pathway through the entire device10.

FIG.5Dshows some of the final assembly steps of the device10ofFIG.2. The upper clamp jaw40has an adapter channel182at its distal end40D and also defines a hole176, a recessed portion180with a hole178. The lever lock58is inserted into a hole174on the upper clamp jaw40. The lever lock58has a cam insert184that engages a hole208on the locking cam60. The locking cam60also has a flat64. A screw62is then inserted through the hole208and into a corresponding hole on the cam insert184. The lower adapter clamp42is then mated with the upper clamp jaw40. The upper clamp jaw40is mated with lower adapter clamp42. The lower adapter clamp42further defines a hole188, a top hole190, and a bottom hole192. The lower clamp jaw44further defines an end hole196, a top hole198, and a side hole200. The lower clamp jaw44is inserted into the lower adapter clamp42with the end hole196aligned with the top hole190and the bottom hole192on the lower adapter clamp42. A pin194is inserted into the bottom hole192through the hole196on the lower clamp jaw44, and through the top hole190to fixedly and pivotably attach the lower clamp jaw44to the lower adapter clamp42. The lower clamp jaw44also defines a curved jaw202at its distal end44D. The barrel54, having a center186is inserted into the top hole198on the lower clamp jaw44. The adapter channel182and a corresponding channel on the lower adapter clamp42form a channel for inserting a surgical equipment holder and holding and positioning the clamp16portion of the overall entire device10onto a surgical equipment holder. The thumb screw46further defines a thumb screw grip48and a shaft172. The shaft172has a recess170. Once the thumb screw46is inserted into the hole178on the upper clamp jaw40, a retaining ring204snaps into the recess170on the shaft172, and then the shaft172is passed through the center186on the barrel54and finally through the side hole200on the lower clamp jaw44. Tightening the thumb screw grip48into threads within the lower clamp jaw44, which are not visible in this view, tightens the lower clamp jaw44relative to the upper clamp jaw40and closes the curved jaw201and the curved jaw202around the ball clamp66, and also the ball clamp66around the sleeve18of the entire device10.

FIG.6is a top-right-front perspective view of a distal end of another embodiment of a minimally invasive surgical device used in cardiac surgery. A distal end220D of a device220used in minimally invasive cardiac surgery is terminated in a hinge rod222which is coupled to a pedestal224. A proximal end224P of the pedestal224defines a pedestal base242, an inner wall244, and an outer wall248. The pedestal base242also defines an articulation slot258which allows the hinge rod222to pass through and allows the pedestal224to be tilted from side to side for improved positioning during a minimally invasive surgical procedure. The inner wall244and the outer wall248further define a trough246, in a direction parallel to a longitudinal axis of the pedestal224extending from the proximal end224P to the distal end224D of the pedestal224. This trough246is configured to hold and guide a vessel in the pedestal224from the proximal end224P towards the distal end224D of the pedestal224. The pedestal224also defines several textured surface elements250that are configured to help hold a vessel steady when loaded into the distal end220D of the device220used in minimally invasive cardiac surgery. A stem226is fixedly attached to the pedestal224. The stem226is largely cylindrical in shape but has a tooth232on one side. Additional teeth may be located on the stem, but only one is visible here. While the stem226shown here is cylindrical, stems having other shapes, such as rectangular, or other holding features may be utilized by one skilled in the art. A soft retainer228is placed onto the stem226and is movably coupled to translate up and down in a vertical direction, although other movable configurations may be used as well. The soft retainer228further defines a grip234, a base236, a jaw238extending from the base236, and a planar member240at an end of the jaw238. The grip234is extended beyond the base236of the soft retainer228to allow for a space or location to enable grasping with forceps or other surgical tools to aid vertical positioning of the soft retainer228. The jaw238of the soft retainer228also defines an upper détente268and a lower détente266, which are configured to releasably hold suture or other filament for a temporary hold during a minimally invasive surgical procedure. The tooth232on the stem226is configured to releasably hold the soft retainer228in several designated vertical positions based on the vertical placement of the teeth232. As configured here, the soft retainer228moves up and down relative to the pedestal224. The planar member240of the soft retainer228contacts the pedestal224at a position where the textured surface elements250are located. These textured surface elements250and several corresponding textured elements on the planar member240, not visible here, interface and combine to improve the grip onto a vessel held within the distal end220D of the device220.

The pedestal224also defines a suturing template230towards a distal end224D of the pedestal224. The suturing template230portion of the pedestal also defines a top surface252having a hole254passing therethrough. At the most distal end224D of the pedestal224, the suturing template230defines several recesses256and a horizontal slot262. The horizontal slot262may entrain or temporarily hold or restrain a filament of suture near the template230in a direction substantially perpendicular to an axis extending from the proximal end224P to the distal end224D of the pedestal224. This suture, not shown here, would also span the recesses256. The recesses256are configured to allow for the passage of a needle or suturing device to pass over or around a suture held in the horizontal slot262. Adjacent to the distal end224D of the pedestal224are two suture channels260which communicate from the top surface252of the suturing template230to the underside of the suturing template230portion of the pedestal224. These suture channels260, the horizontal slot262, and the recesses256are configured such that a suture could be directed from the underside of the pedestal224, up through one of the suture channels260, horizontally through the horizontal slot262and the recesses256, and back through the opposite suture channel260. It should be noted that other arrangements or suture routing could be employed in other embodiments. More details relating to these aforementioned features and suture pathways will be discussed later.

FIG.7is a top-right-front perspective of a distal end of another embodiment of a minimally invasive surgical device used in cardiac surgery. A distal end280D of a device280used in minimally invasive cardiac surgery is illustrated. The device280terminates in a hinge rod282which is coupled to a pedestal284. At a proximal end284P of the pedestal284a pedestal base302, an inner wall304, and an outer wall308, are defined by the pedestal284. The pedestal base302also defines an articulation slot318which allows the hinge rod282to pass through and allows the pedestal284to be tilted from side to side for improved positioning during a minimally invasive surgical procedure. The inner wall304and the outer wall308further define a trough306, in a direction parallel to a longitudinal axis of the pedestal284extending from the proximal end284P to the distal end284D of the pedestal284. This trough306is configured to hold and guide a vessel in the pedestal284from the proximal end284P towards the distal end284D of the pedestal284. The pedestal284also defines several textured surface elements310that are configured to help hold a vessel steady when loaded into the distal end280D of the device280used in minimally invasive cardiac surgery. A stem286is fixedly attached to the pedestal284. The stem286is largely cylindrical in shape but has a tooth292on one side. Other teeth may be located on the stem, but only one is visible here. While the stem286shown here is cylindrical, stems having other shapes, such as rectangular, or other holding features may be utilized by one skilled in the art. A soft retainer288is placed onto the stem286and is movably coupled to translate up and down in a vertical direction, although other movable configurations may be used as well. The soft retainer288further defines a grip294, a base296, a jaw298extending from the base296, and a planar member300at an end of the jaw298. The soft retainer is configured similarly to other previously described embodiments. The jaw298of the soft retainer288also defines an upper détente324and a lower détente322, which are configured to releasably hold suture or other filament for a temporary hold during a minimally invasive surgical procedure. The tooth292on the stem286is configured to releasably hold the soft retainer288in several designated vertical positions based on the vertical placement of the teeth. As configured here, the soft retainer288moves up and down relative to the pedestal284. The planar member300of the soft retainer288contacts the pedestal284at a position where the textured surface elements310are located. These textured surface elements310and several corresponding textured elements on the planar member300, not visible here, interface and combine to improve the grip onto a vessel held within the distal end280D of the device280.

FIG.8is a top-left-front perspective of a distal end of another embodiment of a minimally invasive surgical device used in cardiac surgery. A distal end340D of a device340used in minimally invasive cardiac surgery is illustrated. The device340terminates in a shaft384having a holding portion382holding an articulating380which is connected to a smaller shaft segment378terminating in a mount374. The mount374is connected to a stem346, which is connected to a pedestal base362of a pedestal344. At a proximal end344P of the pedestal344the pedestal base362, an inner wall364, and an outer wall368, are defined by the pedestal344. Movement of the stem346by way of connection to the articulation ball380allows the pedestal344to be tilted from side to side for improved positioning during a minimally invasive surgical procedure. The inner wall364and the outer wall368further define a trough366, in a direction parallel to a longitudinal axis of the pedestal344extending from the proximal end344P to the distal end344D of the pedestal344. This trough366is configured to hold and guide a vessel in the pedestal344from the proximal end344P towards the distal end344D of the pedestal344. The stem346is fixedly attached to the pedestal344. The stem346is largely cylindrical in shape but has several352on one side. Other teeth may be located on the stem, but only three are visible here. While the stem346shown here is cylindrical, stems having other shapes, such as rectangular, or other holding features may be utilized by one skilled in the art. A soft retainer348, which is similar to other embodiments described herein, is placed onto the stem346and is movably coupled to translate up and down in a vertical direction, although other movable configurations may be used as well. The soft retainer348further defines a grip354, a base356, a jaw358extending from the base356, and a planar member360at an end of the jaw358. The jaw358of the soft retainer348also defines an upper détente386and a lower détente388, which are configured to releasably hold suture or other filament for a temporary hold during a minimally invasive surgical procedure. The teeth352on the stem346are configured to releasably hold the soft retainer348in several designated vertical positions based on the vertical placement of the teeth. As configured here, the soft retainer348moves up and down relative to the pedestal344. The planar member360of the soft retainer348contacts the pedestal344at a position where a vessel might be held. The soft retainer and the trough366interface and combine to improve the grip onto a vessel held within the distal end340D of the device340.

The pedestal344also defines a suturing template350towards a distal end344D of the pedestal344. The suturing template350portion of the pedestal also defines a top surface372. Around the distal end344D of the pedestal344, the suturing template350defines several recesses376and a horizontal slot370placed around the distal end344D of the pedestal344. The recess376and horizontal slot370are configured such that could entrain or temporarily hold or restrain a filament or suture across the suturing template350in a direction substantially perpendicular to an axis extending from the proximal end344P to the distal end344D of the pedestal344. More details relating to these aforementioned features and suture pathways will be discussed later.

FIG.9is a top-left-front perspective of a distal end of another embodiment of a minimally invasive surgical device used in cardiac surgery. A distal end400D of a device400used in minimally invasive cardiac surgery is illustrated. The device400terminates in a hinge rod402which is coupled to a pedestal404. At a proximal end404P of the pedestal404a pedestal base420, an inner wall422, and an outer wall426, are defined by the pedestal404. The pedestal base420defines an articulation slot442which allows the hinge rod402to pass through in such a manner that it allows the pedestal404to be tilted from side to side for improved positioning during a minimally invasive surgical procedure. The inner wall422and the outer wall426further define a trough424, in a direction parallel to a longitudinal axis of the pedestal404extending from the proximal end404P to the distal end404D of the pedestal404. This trough424is configured to hold and guide a vessel in the pedestal404from the proximal end404P towards the distal end404D of the pedestal404. The pedestal404also defines several textured surface elements428that are configured to help hold a vessel steady when loaded into the distal end400D of the device400used in minimally invasive cardiac surgery. A stem406is fixedly attached to the pedestal404. The stem406is largely cylindrical in shape but has a tooth on one side, which is not visible here. Other teeth may be located on the stem in alternate embodiments. While the stem406shown here is cylindrical, stems having other shapes, such as rectangular, or other holding features may be utilized by one skilled in the art. A soft retainer408is placed onto the stem406and is movably coupled to translate up and down in a vertical direction, although other movable configurations may be used as well. The soft retainer408further defines a grip412as described in regard to other embodiments, a base414, a jaw416extending from the base414, and a planar member418at an end of the jaw416. The jaw416of the soft retainer408also defines an upper détente448, which is configured to releasably hold suture or other filament for a temporary hold during a minimally invasive surgical procedure. As configured here, the soft retainer408moves up and down relative to the pedestal404. The planar member418of the soft retainer408contacts the pedestal404at a position where the textured surface elements428are located. These textured surface elements428and several corresponding textured elements on the planar member418, not visible here, interface and combine to improve the grip onto a vessel held within the distal end400D of the device400.

The pedestal404also defines a suturing template410towards a distal end404D of the pedestal404. The suturing template410portion of the pedestal also defines a top surface430having a hole432passing therethrough. At the most distal end404D of the pedestal404, the suturing template410defines a recess440, a horizontal slot446, and three fins434,436,438. The fins434,436,438are adjacent to the distal end404D of the pedestal404. The fins434,436,438are shaped such that they could entrain or temporarily hold or restrain a filament or suture across the suturing template410in a direction substantially perpendicular to an axis extending from the proximal end404P to the distal end404D of the pedestal404. Adjacent to the fins434,436,438are two suture channels444which communicate from the distal end404D of the pedestal404to the underside of the suturing template410portion of the pedestal404. These suture channels444and the fins434,436,438are configured such that a suture could be directed from the underside of the pedestal404, up through one of the suture channels444, and around the various features of the suturing template410. It should be noted that other arrangements or suture routing could be employed in other embodiments. More details relating to these aforementioned features and suture pathways will be discussed later.

FIG.10is a top-left-front perspective of the distal end of the embodiment of a minimally invasive surgical device ofFIG.9.FIG.10shows the distal end400D of the device400with a vessel452held between the planar member418on the soft retainer408and the surface430of the pedestal404. The vessel452is held in the trough424and terminates in a prepared “cobra head”454end of the vessel452. The cobra head454is so named due to its resemblance to the head of a cobra. The arrangement of the vessel452illustrated inFIG.10is demonstrative of the manner in which the device400would hold or stabilize a vessel452during an anastomosis procedure as part of a minimally invasive CABG operation. Several suturing site indicators are noted on the cobra head454of the vessel452, indicating ideal locations of suture placement during the grafting of the vessel452. Also illustrated inFIG.10is the placement of a guide suture458. The guide suture458can help the surgeon by guiding and holding stitches during the anastomosis procedure, keeping the stitching operations tangle free and organized.

FIG.11is a top right front perspective view of another embodiment of a minimally invasive surgical device used in cardiac surgery.FIG.11is a top right front perspective view of another embodiment of an entire minimally invasive surgical device used in cardiac surgery.FIG.11illustrates the entire device460in perspective view, the device460having an alternate clamping system. At a proximal end460P of the device460, there is a suture locking apparatus464coupled to a lever arm462. The lever arm462defines a grip474and has a lever468to which the suture locking apparatus464is directly coupled. The lever468has a grip36also, and the lever468is biased away from the lever arm462with a spring. There is a sleeve476coupled to the arm462which has an internal shaft tube, not visible here, fixedly attached within. The sleeve476and shaft tube terminate in a hinge rod478which is coupled to the distal end460D of the device460at the pedestal484. As previously described in regard toFIGS.1A and1B, the stem480, soft retainer482, and suturing template486of the distal end460D of the device460are also shown here. The sleeve476also has a movable spherical anchor490, some details of which will be described later. This spherical anchor clamping system includes a spherical clamp488coupled to the spherical anchor490. The clamp488includes a clamp base496attached to a base492, and a lever494pivotably coupled to the clamp base496. The clamp base496has an upper partial spherical clamp jaw504having a recess508and the lever494has a lower partial spherical clamp jaw506which also has a recess, not visible in this view. The clamp base496also includes an adapter end, not visible here, for attachment to a surgical equipment holder as previously described herein. The adapter end of the clamp base496can be locked onto a surgical equipment holder by engaging a lever lock498, which is pivotably attached to the end of the clamp base496. The base492also has an interference latch500which defines a latch guide502which can be rotated to serve as an interference once the spherical anchor clamp488is released to prevent the spherical anchor clamp488from being unintentionally squeezed and allowing the movable spherical anchor490to move along the sleeve476of the device460. The spherical anchor clamp488can be squeezed by moving the lever494closer to the clamp base496. The lever494is normally biased away from the clamp base496by a spring, which brings the upper partial spherical clamp jaw504and the lower partial spherical clamp jaw506closer together by pivoting around a pin510, thereby compressing the movable spherical anchor490and preventing it from moving along the sleeve476. This biasing spring is not illustrated here but will be described in more detail later. Another feature of the spherical anchor clamp488is the two partial spherical clamp jaws504,506. This feature of the partial spherical clamp jaws504,506is to allow for the sleeve476of the device460to pass through the spherical anchor clamp488and the spherical anchor490, but still be clamped from a substantially perpendicular or transverse direction with respect to a longitudinal axis of the sleeve. The sleeve476can still be pivoted or swiveled to some extent within the spherical anchor clamp488, but the motion of the sleeve476is limited by the boundaries formed by the recesses508of the partial spherical clamp jaws504,506. There is also, not entirely shown in this view, a split in the movable spherical anchor490. When the upper partial spherical clamp jaw40and lower partial spherical clamp jaw44are positioned away from one another, the spherical anchor490may still be held between the upper partial spherical clamp jaw40and the lower partial spherical clamp jaw44, but the lowered force on the movable spherical anchor490along its equator allow the two halves of the spherical anchor490delineated by the equator to separate slightly. This renders the movable spherical anchor490movable in a vertical direction along the sleeve476of the device460. This also renders the spherical anchor490and also the sleeve476pivotable in multiple orientations relative to the spherical anchor clamp488by allowing the spherical anchor490to move freely within the partial spherical clamp jaws504,506of the spherical anchor clamp488when the spherical anchor clamp488is loosened. Some embodiments of the spherical anchor490may also have partial or complete circumferential protrusions around the external surface of the spherical anchor. These protrusions can provide a motion limiting feature when engaged with the recesses of one or both of the partial spherical clamp jaws of the spherical anchor clamp488. While this structure is shown inFIG.11, other methods and structures capable of clamping in a manner that allows for movement and adjustment of the distal end of a device such as the embodiments illustrated herein along several degrees of freedom such as the structure described here. A pull tab466is also attached at a proximal end460P of the device460. The tab466is configured to securely hold a suture and pull the suture remotely from the proximal end460P of the device460when necessary.

Further articulation of the device460, in particular the distal end460D of the device460, can be achieved by squeezing or compressing the lever468towards the arm462. When the lever468is squeezed towards the arm462, and the arm462pivots around a pivot point470, it defeats or limits a downward vertical compression on a smaller ball at the proximal end of the hinge rod478, not shown in this view but previously described. When the lever468is squeezed towards the arm462, the hinge rod478is pivotable and rotatable relative to the attachment point of the hinge rod478to the shaft tube which is not shown in this view. The downward vertical compression is the at rest configuration in the device460by biasing the lever468away from the arm462when it is not squeezed.

FIG.12is an exploded view of a spherical anchor clamp system used in the minimally invasive surgical device ofFIG.11. The clamp base496defines a hole520into which a lever lock498is inserted. The lever lock498further defines a lever lock shaft514terminating in a lever lock insert516. The lever lock insert516is configured to interface and connect to a hole524on a locking cam518. The locking cam518also defines a cam flat519that is configured to engage and releasably lock into an instrument attachment end on a surgical equipment holder. The locking cam518and the lever lock498are movably attached to the clamp base496with the use of a screw522, although alternative means of attachment known to one skilled in the art may also be used. Next, the clamp base496is placed onto the base492and aligned using two pins538,548which are inserted into two holes536,532, respectively, which are defined by the base492to align the base492to the clamp base496. The base492is fixedly attached to the clamp base496with the use of a screw550, although alternate means of attachment known to one skilled in the art may also be used. A latch500having a latch guide502an outer hole544, and a spring guide hole545is placed over the base492and into a latch recess540defined by the base492. The latch recess540effectively limits the travel of the latch500between a substantially horizontal position and a substantially vertical position. The movement and configuration of the latch500will be described later. A spring549is placed within an inner instrument adapter channel495of the base492and into a hole545of the latch500and is biased against the bottom of the clamp base496when assembled. The latch500is held in place by the insertion of a latch pin542first into hole530on the base492, into corresponding hole544on the latch500, and finally a hole, not visible here, on the opposite side of the base492. Next, a release latch528having a latch tab562is inserted into a spring546. This release latch528and spring546are placed into a recess, not shown here, in the bottom side of the clamp base496. There is a corresponding slot554on lever494in which the release latch528can translate within when the spherical clamp488is assembled. The lever494, in addition to the slot554, also defines a channel501, a tab503, a hole557in the side of lever494, and two holes558adjacent to the partial spherical clamp jaws506. The lower partial spherical clamp jaws506further define a recess560, which similar to the recess508on the upper partial spherical clamp jaws504, are configured to allow some movement of a shaft connected to a spherical anchor, but also limit the pivotable travel and movement of a shaft connected to a spherical anchor by nature of the size and shape of the recesses560,508in the assembled spherical clamp488. The final assembly steps shown inFIG.12involve the insertion of a spring552, the placement of lever494onto the assembly, aligning holes558on the lever494with corresponding holes526on the clamp base496. The pins510are inserted into holes558on the lever494and holes526on the clamp base496to pivotably attach the upper partial spherical clamp jaws504to the lower partial spherical clamp jaws506. A latch pin556is then inserted into hole557in a position to interfere with and contact the latch tab562portion of the release latch528which is held captive in the structure of the spherical clamp488.

FIG.13is an exploded view of an embodiment of a spherical anchor system used in minimally invasive surgical devices. This embodiment of a spherical anchor564is constructed of a spherical anchor segment566having a circumferential protrusion586and a shaft recess portion584and a second spherical anchor segment568having a circumferential protrusion588and a shaft recess portion578. The two spherical anchor segments566,568are combined to form a singular spherical anchor564with a central compliant member580defining a shaft channel582held therebetween. The central compliant member580surrounds a shaft inserted through the spherical anchor564and provides a resilient, compliant, and compressive force directly onto the shaft to firmly and releasably hold the spherical anchor564and therefore the shaft of an instrument or device inserted therein. The combined shaft recess portions584,578of the two spherical anchor segments566,568are configured to allow a shaft or sleeve of an instrument to pass through a completed spherical anchor564when mated with a corresponding feature on another spherical anchor segment568. While the shaft recess portion584illustrated inFIG.13has a shape and size that corresponds to a shaft or sleeve of the instruments shown and described herein, other embodiments of the spherical anchor564may have other shapes to accommodate other instrumentation or surgical devices. The spherical anchor segment568also defines a central recess576configured to hold a portion of the compliant member580, a latch570having a tab572, and a latch recess574. Other embodiments may have a compliant member or recess that are not exactly centered within the spherical anchor and may be otherwise oriented. The latch recess574is configured to receive a corresponding latch and tab on the first spherical anchor segment566but not visible here. Similarly, the latch570and tab572on the second spherical anchor segment568are configured to be inserted into a corresponding latch recess, not shown here, on the internal surface of the first spherical anchor segment566. The two spherical anchor segments566,568are combined by inserting the compliant member580into the central recess576of the second spherical anchor segment568, then placing the first spherical anchor segment566onto the second spherical anchor segment568while engaging the latch570and tab572into the corresponding recess on the first spherical anchor segment566, and engaging the corresponding latch and tab on the first spherical anchor segment566into the latch recess574on the second spherical anchor segment568. Once fixedly attached, there may be some intentional latitude in the tightness of the fit of the two spherical anchor segments566,568for the purpose of allowing some compression on the two segments566,568of the spherical anchor564by a spherical clamp such as the one described in regard toFIG.11. While these spherical anchor segments566,568are identical, interlocking, and configured to engage and connect concurrent with their identical structure, other embodiments may not have identical parts but still perform similarly configured functions as the ones described herein. When combined, the spherical anchor564structure also defines a circumferential protrusion586,588that acts as a pivoting limiter when a conventional clamp is used, as opposed to the previously described spherical anchor clamp. While the partial spherical clamp jaws of the spherical anchor clamp limit the pivotable motion of the shaft or sleeve by virtue of the shaft or sleeve contacting the configured shape of the recess, a conventional clamp has no such features. The circumferential protrusion on the spherical clamp illustrated inFIG.13acts as the limiting feature by contacting the surfaces of a conventional clamp jaw while clamped onto a shaft or sleeve. This function limits the pivotability to a certain range which is appropriate for the procedural requirements of certain instrumentation and devices used in minimally invasive cardiac surgical procedures.

FIGS.14A-14Eare a series of cross-sectional side views illustrating the operation of the spherical anchor system ofFIG.11.FIG.14Aillustrates the spherical anchor system with the spherical anchor clamp488in an open position and the spherical anchor490having a sleeve476and the inner hinge rod478passing therethrough. The spherical anchor clamp488is also illustrated in cross-section, with the respective locations of the upper partial spherical clamp jaw504, lower partial spherical clamp jaw506, release latch528, latch pin556, clamp base496, base492, lever494, compressed spring552, and other features indicated. The positions of a distal end528D of the release latch528, the latch tab562, and the spring546are also indicated. The spherical anchor490is engaged with and clamped into the spherical anchor clamp488by moving the spherical anchor490in direction590. By moving the spherical anchor490in direction590, the spherical anchor490contacts the distal end528D of the release latch528and pushes the release latch528in direction590while compressing spring546. When release latch528is moved in direction590, the latch tab562is disengaged from the latch pin556.

Once the spherical anchor490is in the desired position and pushed into the upper partial spherical clamp jaw504and lower partial spherical clamp jaw506of the spherical anchor clamp488, and the latch tab562is released from the latch pin556as illustrated inFIG.4B, the spherical anchor490is fully seated in and clamped into the inner space defined by upper partial spherical clamp jaw504and the lower partial spherical clamp jaw506.FIG.14Cillustrates the release, in direction592of the lever494away from the clamp base496as spring552decompresses. Also shown inFIG.14Cis the movement of the interference latch500, which was also held by a spring in a compressed state, moving in direction594. The position of the interference latch500, now braced between the base492and the lever494prevents the spherical anchor clamp488from being disengaged unintentionally. The steps described and shown in regard toFIGS.14B and14Cmay happen in sequence, nearly simultaneously, or simultaneously. The position of the upper partial spherical clamp jaw504and the lower partial spherical clamp jaw506illustrated inFIG.14Csurround the spherical anchor490such that it cannot be removed from the spherical anchor clamp488unless the spherical anchor clamp488is opened. One contributing factor to the clamping mechanism is that the partial spherical clamp jaw of the clamp base has a single arc center point and the partial spherical clamp jaw of the lever has a single arc center point as well. These respective single arcs are defined by the internal shape of walls of the upper and lower partial spherical clamp jaws504,506. These two partial spherical clamp jaws share substantially the same arc and the arcs share the same center point. In addition, the single arc center point of the combined clamp jaws504,506is also coincident with the center point of the spherical anchor490. The inner space and shape defined by the upper partial spherical clamp jaw504and the lower partial spherical clamp jaw506is also similar to the outer surface and shape of the spherical anchor490where in contact with the upper partial spherical clamp jaw504and the lower partial spherical clamp jaw506. The rotation and pivoting of the spherical anchor490immobilized by being consistently clamped in the spherical anchor clamp488and the compliant squeezing of the spherical anchor490by the spherical anchor clamp488also immobilizes the movement of the sleeve476while held within the spherical anchor490.FIG.14Dillustrates the release of the spherical anchor clamp488by moving interference latch500in direction598followed by squeezing the lever494towards the clamp base496. This pivots the upper partial spherical clamp jaw504and the lower partial spherical clamp jaw506away from the spherical anchor490, allowing it to be removed from the inner space defined by the upper partial spherical clamp jaw504and the lower partial spherical clamp jaw506. Finally,FIG.14Eillustrates the spherical anchor490being removed from the spherical anchor clamp488by moving it in direction600.

FIG.15is a top right front perspective view of a portion of a surgical instrument housing having a spherical anchor in combination with the spherical clamping system ofFIG.11.FIG.15shows a surgical instrument having a housing602with a spherical anchor604incorporated into the distal end602D of the housing602of the surgical instrument. While this embodiment shows the spherical anchor604incorporated into a housing602as a singular piece, other embodiments may have a spherical anchor attached by welding, screws, fasteners, or other means known to those skilled in the art.FIG.15illustrates the spherical anchor604of the instrument housing602engaged in the upper partial spherical clamp jaw504and the lower partial spherical clamp jaw506of the spherical anchor clamp488.

The instruments and devices described herein may be used in various cardiac surgical procedures where suturing using a template or guide may facilitate the minimally invasive surgical procedure. One example of such a procedure is an anastomosis as part of minimally invasive IMA Harvesting and CABG procedure. Once the heart of a patient is accessed, the aorta is prepared, and a proximal anastomosis is completed, the surgical device including a suturing template may be introduced. Once the heart is positioned and visible through the window, the suturing template is placed through the 4th or 5th ICS incision.

Upon stabilization of the IMA graft with the use of the soft retainer and placement of the distal end (cobra head) on the U-channel zone of the AnastoPod™ or suturing template, the position of the AnastoPod™ is adjusted to allow minimum distance between the IMA cobra head and the targeted coronary artery site for creating the anasotomosis. Once the coronary arteriotomy is made, the suturing template is placed parallel to the arteriotomy site. To stabilize the IMA cobra head place the first stich at the toe (inside out) and then pass both ends of the suture through the suture deck or suturing template. When the desired tension is applied, the suture locking apparatus is engaged to maintain tension on the IMA graft.

The anastomosis is started at the toe (9 o'clock position) and worked towards the heel (3 o'clock position) by taking inside-out bites on the coronary artery and outside—in bites on the IMA graft. Once the back wall is completed, the suture lock apparatus mechanism is released, and the IMA graft is removed from the suturing template by lifting the soft retainer. The front wall is sutured in routine fashion and the anastomoses are completed using mechanical fasteners.

Various advantages of a minimally invasive surgical device used in cardiac surgery have been discussed above. Embodiments discussed herein have been described by way of example in this specification. It will be apparent to those skilled in the art that the foregoing detailed disclosure is intended to be presented by way of example only, and is not limiting. As just one example, although the end effectors in the discussed examples were often focused on the use of a scope, such systems could be used to position other types of surgical equipment. Various alterations, improvements, and modifications will occur and are intended to those skilled in the art, though not expressly stated herein. These alterations, improvements, and modifications are intended to be suggested hereby, and are within the spirit and the scope of the claimed invention. The drawings included herein are not necessarily drawn to scale. Additionally, the recited order of processing elements or sequences, or the use of numbers, letters, or other designations therefore, is not intended to limit the claims to any order, except as may be specified in the claims. Accordingly, the invention is limited only by the following claims and equivalents thereto.