Source: https://patents.google.com/patent/US9808280B2/en
Timestamp: 2019-05-21 00:06:52
Document Index: 693618047

Matched Legal Cases: ['Application No. 60', 'application No. 60', 'art.\n2', 'art.\n12', 'art.\n23', 'art.\n31', 'art.\n49', 'art.\n53', 'art.\n61', 'Application No. 06751099']

US9808280B2 - Diaphragm entry for posterior surgical access - Google Patents
US9808280B2
US9808280B2 US11/737,493 US73749307A US9808280B2 US 9808280 B2 US9808280 B2 US 9808280B2 US 73749307 A US73749307 A US 73749307A US 9808280 B2 US9808280 B2 US 9808280B2
US11/737,493
US20070249991A1 (en
2006-11-09 Priority to US11/558,419 priority patent/US8211011B2/en
2006-11-09 Priority to US11/558,417 priority patent/US8721597B2/en
2007-04-19 Application filed by AtriCure Inc filed Critical AtriCure Inc
2007-04-19 Priority to US11/737,493 priority patent/US9808280B2/en
2007-07-09 Assigned to NCONTACT SURGICAL, INC. reassignment NCONTACT SURGICAL, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: NEUBERT, REBECCA, ROGERS, EARL WAYNE, FLEISCHMAN, SIDNEY D., WHAYNE, JAMES G.
2007-10-25 Publication of US20070249991A1 publication Critical patent/US20070249991A1/en
2010-06-04 Assigned to FINISTERE-CHICAGO PARTNERS FUND I L.P., HIPPO VENTURES, L.L.C., TALL OAKS ABLATRICS PARTNERS, LP, FINISTERE-OCEANIA PARTNERS FUND I L.P., MASSEY BURCH VENTURE FUND II, L.P., INTERSOUTH PARTNERS VI, L.P., HARBERT VENTURE PARTNERS II, L.P. reassignment FINISTERE-CHICAGO PARTNERS FUND I L.P. SECURITY AGREEMENT Assignors: NCONTACT SURGICAL, INC.
2010-08-20 Assigned to TALL OAKS ABLATRICS PARTNERS, LP, MASSEY BURCH VENTURE FUND II, L.P., INTERSOUTH PARTNERS VI, L.P., HARBERT VENTURE PARTNERS II, L.P., HARBERT VENTURE PARTNERS (ANNEX FUND), LLC, FINISTERE-OCEANIA PARTNERS FUND I L.P., HIPPO VENTURES, L.L.C., FINISTERE-CHICAGO PARTNERS FUND I L.P. reassignment TALL OAKS ABLATRICS PARTNERS, LP SECURITY AGREEMENT Assignors: NCONTACT SURGICAL, INC.
2017-11-07 Publication of US9808280B2 publication Critical patent/US9808280B2/en
Methods and devices described herein facilitate improved treatment of body organs. More specifically, devices and methods described herein are for minimally invasive surgery permit improved diaphragmatic access to a body cavity to perform a surgical procedure, for example ablation and/or coagulation of cardiac tissue during minimally invasive surgical access to the heart. The diaphragmatic access described provides direct visualization of anatomic structures within the thoracic cavity such as the posterior left atrium, the posterior side of pulmonary veins, or any other such anatomic structure.
This application is a continuation-in-part of U.S. patent application Ser. No. 11/408,315, now U.S. Pat. No. 9,561,044, entitled, “Diaphragm Entry for Posterior Surgical Access, filed Apr. 21, 2006, which is a non-provisional of U.S. Provisional Application No. 60/726,342 filed Oct. 12, 2005, this application is also a continuation-in-part of U.S. patent application Ser. No. 11/558,417 now U.S. Pat. No. 8,721,597, entitled, “Diaphragm Entry for Posterior Surgical Access”, and U.S. patent application Ser. No. 11/558,419, now U.S. Pat. No. 8,211,011, entitled “Diaphragm Entry for Posterior Surgical Access,” both of which were filed on Nov. 9, 2006. Each of the above filings is hereby incorporated by reference in their entireties.
FIG. 2C illustrates another variation where the surgeon positions the access device 182 in the thoracic cavity. However, in this variation, the surgeon may also use a second scope 184 advanced in a conventional manner as discussed above (e.g., through trocars 106 as shown in FIG. 1A or 1C). The purpose of the second scope 184 is to view the anterior surface of the organs. This arrangement allows visualization of the anterior and posterior surfaces of the organ. Accordingly, as a surgeon performs a procedure on an anterior or posterior surface, as the surgeon breaks through to the opposite surface (i.e., the posterior or anterior surface) use of the two scopes 182 and 184 improves visualization. In one example, the DEPA scope may be used merely for posterior visualization during a video assisted thoracostomy procedure. Again, as noted herein, additional ports/trocars 106 can be placed to provide direct access to the thoracic cavity for manipulation of the treatment or other devices to ensure accurate creation of coagulation patterns across the various organs.
FIG. 3D, illustrates a variation of a treatment device 2 that has two opposing c-type electrodes. This device allows formation of a coagulation line around the pulmonary veins. FIGS. 3E and 3F illustrate treatment devices 2 using a single c-type electrode configuration to form coagulation lines on the atrial surface 188 around each side of the pulmonary veins 164. The use of the access device 182 and methods for posterior access allow for the creation of any number of coagulation patterns. The use of additional ports for thorascopic access is optional. For example, a surgeon can place the access device through the diagphragm entry method, and create any coagulation lesion patterns (or even a single or few coagulation lines) where desired using any conventional device. For instance, a surgeon could perform a coagulation procedure that isolates the pulmonary veins by advancing a clamp-type coagulation device through the access device such that electrodes of the clamp jaws are oriented on two sides of the left or right pulmonary veins, preferably along the antrum that connects the superior and inferior branches of the pulmonary veins to the left atrium. Once the jaws are actuated, the clamp-type coagulation device compresses the pulmonary veins (preferably along the antrum or at the orifice to the left atrium) between the jaws allowing the creation of a lesion that completely isolates the pulmonary veins from the rest of the atrium. The same action may be subsequently used to isolate the opposing (right or left) pulmonary veins. Accordingly, isolation of the pulmonary veins can be performed via diaphragm access to the thoracic cavity without creating any additional openings in the chest.
Examples of such probes are disclosed in: U.S. Patent Application Ser. No. to be determined and filed on the same day as this application, entitled “Vacuum Coagulation Probes”, U.S. patent application Ser. No. 11/408,302 entitled “Vacuum Coagulation Probes”; U.S. patent application Ser. No. 11/208,465 entitled “Vacuum Coagulation & Dissection Probes”; U.S. patent application Ser. No. 10/425,251 entitled “Vacuum Coagulation Probes”; U.S. Provisional application No. 60/726,342 entitled Diaphragm Entry for Posterior Access Surgical Procedures; and U.S. Pat. No. 6,893,442 the entirety of each of which is hereby incorporated by reference.
FIG. 26B illustrates another example where the guide wire 282 exits the access device 210 at the posterior region of the heart and then is manipulated behind the right pulmonary veins. Again, a surgeon can use the guide wire 282 to assist in placing a coagulation device to create one or more coagulation lesions on the epicardial surface. The guide wire 282 can be positioned back to the posterior surface or remain in the anterior region to create additional lesions.
1. A method of performing a minimally invasive procedure on a heart, the method comprising:
advancing an access device through the diaphragm into a thoracic cavity of the patient where the access device is inserted into the body to the thoracic cavity in a generally straight profile, and where a distal end of the access device is advanced through the diaphragm into the thoracic cavity adjacent to a posterior surface of the heart and exterior to a pericardium surrounding the heart such that the access device separates an organ from the heart to create a temporary cavity adjacent to a posterior surface of the heart, where the access device comprises at least at least one working channel; and
positioning a coagulation device into the thoracic cavity through the working channel and adjacent to the posterior surface of the heart; and
coagulating an area on the posterior surface of the heart.
2. The method of claim 1, where positioning the coagulation device comprises advancing a guidewire through the working channel to the area on the heart and passing the coagulation device over the guidewire.
3. The method of claim 1, where advancing the access device into the thoracic cavity comprises advancing the access device proximate to a posterior surface of the heart in the thoracic cavity.
4. The method of claim 3, where the positioning of the coagulation device and coagulating the area on the heart occur without creating any openings in the chest wall.
6. The method of claim 5, where positioning the coagulation device comprises advancing a guidewire through the working channel to the area on the heart and passing the coagulation device over the guidewire.
8. The method of claim 1, where coagulating the area on the heart comprises creating at least one coagulation pattern on a posterior epicardial surface.
9. The method of claim 8, where creating the coagulation pattern on the posterior epicardial surface occurs without dissecting any posterior pericardial reflections.
10. The method of claim 9, where coagulating at least one coagulation pattern on the posterior epicardial surface comprises coagulating a posterior surface of the heart adjacent to a pulmonary vein without dissecting the pulmonary vein from cardiac tissue.
11. The method of claim 9, where coagulating at least one coagulation pattern on the posterior epicardial surface comprises creating the coagulation pattern on a side of a pulmonary vein without dissecting the pulmonary vein from a posterior surface of the heart.
12. The method of claim 9, where coagulating at least one coagulation pattern on the posterior epicardial surface comprises creating the coagulation pattern on each side of a pulmonary vein.
13. The method of claim 8, where coagulating at least one coagulation pattern on the posterior epicardial surface comprises creating the coagulation pattern between a superior vena cava and a pulmonary vein.
14. The method of claim 8, where coagulating at least one coagulation pattern on the posterior epicardial surface comprises creating the coagulation pattern across the right pulmonary veins.
15. The method of claim 8, where coagulating at least one coagulation pattern on the posterior epicardial surface comprises creating the coagulation pattern across the left pulmonary veins.
16. The method of claim 8, where coagulating at least one coagulation pattern on the posterior epicardial surface comprises creating a lesion across an atrial surface between pulmonary veins.
17. The method of claim 8, where creating the coagulation pattern on the posterior epicardial surface comprises creating the coagulation pattern on a pericardial reflection.
18. The method of claim 8, further comprising passing the coagulation device to an anterior epicardial surface and creating at least one coagulation pattern on the anterior epicardial surface.
19. The method of claim 18, where creating the coagulation pattern on the anterior epicardial surface occurs without dissecting any anterior pericardial reflections.
20. The method of claim 18, where creating the coagulation pattern on the anterior epicardial surface comprises creating the coagulation pattern on a pericardial reflection.
21. The method of claim 1, further comprising coupling a visualization system to the working channel.
22. The method of claim 1, further comprising inserting a scope-type device into the working channel to provide visual access to the posterior surface of the heart.
23. The method of claim 22, where the scope-type device comprises a 0 degree, 30 degree, or 60 degree scope.
24. The method of claim 1, further comprising inserting at least one surgical instrument through the working channel into the temporary cavity.
25. The method of claim 24, where the at least one surgical instrument comprises a plurality of surgical instruments.
26. The method of claim 1, where the working channel comprises an oval-cross section.
27. The method of claim 1, where the access device further includes at least one expandable member at an exterior of the device, and further comprising forming a temporary cavity by expanding the expandable member to separate adjacent tissue structures.
28. The method of claim 27, where the expandable member comprises at least one enlargeable strand.
29. The method of claim 27, where the expandable member comprises at least one balloon member.
30. The method of claim 27, further comprising performing a surgical procedure on or near the heart.
31. The method of claim 27, where the expandable member on the access device conforms to the adjacent tissue structures while separating to stabilize the tissue structures.
32. The method of claim 1, where the posterior surface of the heart comprises a valve, and where the access device is placed adjacent to a posterior valve annulus.
33. A method of performing epicardial coagulation on a heart in a patient, the method comprising:
advancing an access device through the diaphragm into a thoracic cavity of the patient where a distal end of the access device is advanced through the diaphragm adjacent to a posterior surface of the heart exterior to a pericardium surrounding the heart such that the access device separates an organ from the heart to forming a temporary cavity in the thoracic cavity, where the access device comprises at least at least one working channel; and
coupling a visualization system to the working channel; and
34. The method of claim 33, where the positioning of the coagulation device and coagulating the area on the heart occurs without creating any openings in the chest wall.
35. The method of claim 33, where positioning the coagulation device comprises advancing a guidewire through the working channel to the area on the heart and passing the coagulation device over the guidewire.
36. The method of claim 33, where advancing the access device into the thoracic cavity comprises advancing the access device proximate to a posterior surface of the heart in the thoracic cavity.
37. The method of claim 36, where the positioning of the coagulation device and coagulating the area on the heart occurs without creating any openings in the chest wall.
38. The method of claim 36, further comprising inserting at least one port into a right chest area of the patient to provide access to the thoracic cavity and a second access point for the coagulation device.
39. The method of claim 38, where positioning the coagulation device comprises advancing a guidewire through the working channel to the area on the heart and passing the coagulation device over the guidewire.
40. The method of claim 39, further comprising advancing the guidewire from a posterior region of the thoracic cavity to an anterior region by manipulating the guidewire through the port.
41. The method of claim 33, where coagulating the area on the heart comprises creating at least one coagulation pattern on a posterior epicardial surface.
42. The method of claim 41, where creating the coagulation pattern on the posterior epicardial surface occurs without dissecting any posterior pericardial reflections.
43. The method of claim 42, where coagulating at least one coagulation pattern on the posterior epicardial surface comprises coagulating a posterior surface of the heart adjacent to a pulmonary vein without dissecting the pulmonary vein from cardiac tissue.
44. The method of claim 41, where coagulating at least one coagulation pattern on the posterior epicardial surface comprises creating the coagulation pattern between a superior vena cava and a pulmonary vein.
45. The method of claim 41, where coagulating at least one coagulation pattern on the posterior epicardial surface comprises creating the coagulation pattern across the right pulmonary veins.
46. The method of claim 41, where coagulating at least one coagulation pattern on the posterior epicardial surface comprises creating the coagulation pattern across the left pulmonary veins.
47. The method of claim 41, where coagulating at least one coagulation pattern on the posterior epicardial surface comprises creating the lesion across an atrial surface between pulmonary veins.
48. The method of claim 47, where coagulating at least one coagulation pattern on the posterior epicardial surface comprises creating the coagulation pattern on a side of a pulmonary vein without dissecting the pulmonary vein from a posterior surface of the heart.
49. The method of claim 47, where coagulating at least one coagulation pattern on the posterior epicardial surface comprises creating the coagulation pattern on each side of one of the pulmonary veins.
50. The method of claim 41, where creating the coagulation pattern on the posterior epicardial surface comprises creating the coagulation pattern on a pericardial reflection.
51. The method of claim 33, where the access device is inserted into the body to the thoracic cavity in a generally straight profile.
52. The method of claim 33, further comprising inserting a scope-type device into the working channel to provide visual access to the posterior surface of the heart.
53. The method of claim 52, where the scope-type device comprises a 0 degree, 30 degree, or 60 degree scope.
54. The method of claim 33, further comprising inserting at least one surgical instrument through the working channel into the temporary cavity.
55. The method of claim 54, where the at least one surgical instrument comprises a plurality of surgical instruments.
56. The method of claim 33, where the working channel comprises an oval-cross section.
57. The method of claim 33, where the access device further includes at least one expandable member at an exterior of the device, and further comprising forming a temporary cavity by expanding the expandable member to separate adjacent tissue structures.
58. The method of claim 57, where the expandable member comprises at least one enlargeable strand.
59. The method of claim 57, where the expandable member comprises at least one balloon member.
60. The method of claim 57, further comprising performing a surgical procedure on or near the heart.
61. The method of claim 57, where the expandable member on the access device conforms to the adjacent tissue structures while separating to stabilize the tissue structures.
62. The method of claim 61, where the heart comprises a valve on a posterior surface of a heart, and where the access device is placed adjacent to a posterior valve annulus.
US11/737,493 2005-10-12 2007-04-19 Diaphragm entry for posterior surgical access Active 2030-07-01 US9808280B2 (en)
US15/726,251 Continuation US20180028225A1 (en) 2005-10-12 2017-10-05 Diaphragm entry for posterior surgical access
US20070249991A1 US20070249991A1 (en) 2007-10-25
US9808280B2 true US9808280B2 (en) 2017-11-07
US11/737,493 Active 2030-07-01 US9808280B2 (en) 2005-10-12 2007-04-19 Diaphragm entry for posterior surgical access
US15/726,251 Pending US20180028225A1 (en) 2005-10-12 2017-10-05 Diaphragm entry for posterior surgical access
2007-04-19 US US11/737,493 patent/US9808280B2/en active Active
2017-10-05 US US15/726,251 patent/US20180028225A1/en active Pending
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US20070249991A1 (en) 2007-10-25
US20180028225A1 (en) 2018-02-01