Búsqueda Imágenes Maps Play YouTube Noticias Gmail Drive Más »
Iniciar sesión
Usuarios de lectores de pantalla: deben hacer clic en este enlace para utilizar el modo de accesibilidad. Este modo tiene las mismas funciones esenciales pero funciona mejor con el lector.

Patentes

  1. Búsqueda avanzada de patentes
Número de publicaciónUS20070270654 A1
Tipo de publicaciónSolicitud
Número de solicitudUS 11/437,838
Fecha de publicación22 Nov 2007
Fecha de presentación19 May 2006
Fecha de prioridad19 May 2006
También publicado comoCA2654372A1, CA2654372C, EP2026692A2, EP2026692A4, US8246539, US20070270882, US20100152542, WO2007136814A2, WO2007136814A3, WO2007136814A9
Número de publicación11437838, 437838, US 2007/0270654 A1, US 2007/270654 A1, US 20070270654 A1, US 20070270654A1, US 2007270654 A1, US 2007270654A1, US-A1-20070270654, US-A1-2007270654, US2007/0270654A1, US2007/270654A1, US20070270654 A1, US20070270654A1, US2007270654 A1, US2007270654A1
InventoresPaul Andrew Pignato, Aaron J. Hjelle, Robert G. Walsh, Richard C. Mattison
Cesionario originalAcorn Cardiovascular, Inc.
Exportar citaBiBTeX, EndNote, RefMan
Enlaces externos: USPTO, Cesión de USPTO, Espacenet
Pericardium management tool for intra-pericardial surgical procedures
US 20070270654 A1
Resumen
Tools for managing the pericardium during intra-pericardial procedures such as the delivery of cardiac support devices. One embodiment of the tool includes a tubular body of low friction material having a diameter, a fixed lip on an exterior end and an extendable lip on an interior end. The extendable lip moves with respect to the body between a retracted state and an expanded state. The tool is inserted through an incision in the pericardium and deployed by moving the lip to the expanded state. When deployed a barrier portion of the body engages the edges of the incision and the extendable lip lines the inside of the pericardium around the incision.
Imágenes(16)
Previous page
Next page
Reclamaciones(36)
1. A tool for managing a patient's pericardium during an intra-pericardial procedure, including:
a tubular body having a diameter and first and second ends;
a lip on one or both of the first and second ends of the body, the lip extendable with respect to the body between a retracted state and an expanded state to form a lip extending from and having a diameter greater than the diameter of the body.
2. The tool of claim 1 and further including an actuating member attached to the lip for extending the lip between the retracted and expanded states.
3. The tool of claim 2 wherein the actuating member is a hand-actuated member.
4. The tool of claim 2 wherein the actuating member includes an elongated wire member attached to the lip and forming a hoop that is movable between a first diameter state and a second, enlarged diameter state, for moving the lip between the retracted and expanded states.
5. The tool of claim 4 wherein the actuating member causes the elongated wire to move in a generally lengthwise direction to move the hoop between the first and second diameter states.
6. The tool of claim 5 wherein the body and lip include flexible material, and wherein the elongated wire is attached to the flexible material at the lip.
7. The tool of claim 1 wherein the body and lip include flexible material.
8. The tool of claim 7 wherein the flexible material includes a plurality of strips of material.
9. The tool of claim 8 wherein portions of the strips of material overlap at a barrier portion when the lip is in the expanded state.
10. The tool of claim 8 wherein portions of the strips of material that form the body are positioned adjacent to one another at a barrier portion when the lip is in the expanded state.
11. The tool of claim 10 wherein portions of the strips of material that form the lip fan out from the portions forming the body.
12. The tool of claim 11 and further including a hoop on the ends of the strips of material for fanning the portions of the strips of material.
13. The tool of claim 12 wherein the lip formed by the hoop and fanned portions of the strips is an external end of the tool.
14. The tool of claim 13 and including a second lip on an internal end of the tool.
15. The tool of claim 7 wherein the body and lip include a single flexible piece of material.
16. The tool of claim 1 wherein the body and lip are formed of flexible material.
17. The tool of claim 16 wherein the body and lip are formed of elastic material.
18. The tool of claim 1 wherein the body has a relatively low friction interior surface.
19. The tool of claim 1 wherein the body and lip are formed of relatively low friction material.
20. The tool of claim 18 wherein the body and lip are formed of fluorinated polymer.
21. The tool of claim 1 wherein the body includes a plurality of strips of material having adjacent side edges.
22. The tool of claim 21 wherein the strips of material include engagement structure for engaging adjacent strips of material.
23. The tool of clam 22 wherein the engagement structure includes adhesive.
24. The tool of claim 21 wherein the strips of material have non-linear side edges.
25. The tool of claim 24 wherein the strips of material have concave side edges.
26. The tool of claim 21 wherein the strips of material have at least portions that are flexible
27. The tool of claim 1 wherein the body includes a polymer member having a lubricious coating.
28. A retractor for managing a patient's pericardium through an incision in the pericardium to provide access to a pericardial space, including:
a pair of blades, each having an wall portion for engaging an edge of the pericardium and a lip extending from the wall for engaging the pericardium within the pericardial space; and
an actuating mechanism connected to the blades, for moving the blades between a closed position for insertion into the pericardial space through the incision and an open position into engagement with the pericardium to create an opening into the pericardial space.
29. The retractor of claim 28 wherein the wall portions of the blade have a convex surface for engaging the edge of the pericardium.
30. The retractor of claim 28 wherein the lips have a convex edge.
31. The retractor of claim 28 wherein:
the wall portions of the blade have a convex surface for engaging the edge of the pericardium; and
the lips have a convex edge.
32. The retractor of claim 28 wherein the actuating mechanism includes a pair of handles pivotally connected to one another.
33. The retractor of claim 28 wherein the actuating mechanism includes:
a handle, wherein one of the blades is fixedly mounted to the handle; and
an actuating member movably mounted to the handle, wherein another of the blades is mounted to the actuating mechanism.
34. A kit for forming a tool to manage a patient's pericardium during intra-pericardial procedures, including a plurality of flexible, lubricious elements that can be inserted into an incision in the pericardium, spaced around an edge of the opening and extended under the pericardium to line the pericardium around the incision.
35. The kit of claim 34 wherein the elements are strips of flexible material.
36. The kit of claim 34 wherein the elements include structures for attaching adjacent elements to one another.
Descripción
    FIELD OF THE INVENTION
  • [0001]
    The invention is a device for manipulating the pericardium during surgical or other procedures requiring access to the pericardial space.
  • BACKGROUND OF THE INVENTION
  • [0002]
    The pericardium is a multi-layer membranous fibro serous sac that surrounds the heart. An inner layer of the pericardium, known as the serous pericardium, is adjacent to the outer layer of the heart, also known as the epicardium. An outer layer of the pericardium is known as the fibrous pericardium. Between the fibrous pericardium and serous pericardium is a space known as the pericardial space. The term “pericardium” is often used, however, to refer only to the fibrous pericardium. Similarly, the term “pericardial space” is often used to refer generally to the space between the fibrous pericardium and the heart.
  • [0003]
    Certain surgical or other procedures on the heart require access to the pericardial space through the pericardium. Known approaches for accessing the pericardium and heart from outside the body include sternotomy and sub-xyphoid approaches. One such surgical procedure that requires access to the pericardial space is the delivery of cardiac support devices. Cardiac support devices are structures, sometimes referred to as jackets, that surround all or portions of a diseased heart. These devices are intended to treat chronic heart failure or other cardiac disease, which may be associated valvular dysfunction, by constraining expansion of the heart. They can be delivered and implanted using conventional cardiothoracic surgical techniques or minimally invasive surgical procedures. Devices of these types and associated delivery tools and methods are shown, for example, in the following U.S. patents, all of which are incorporated herein by reference in their entirety.
  • [0000]
    Inventor Name Patent/Publication No.
    Alferness 5,702,343
    Alferness et al. 6,123,662
    Vanden Hoek et al. 6,293,906
    Alferness et al. 6,482,146
    Lau et al. 6,702,732
    Walsh et al. 6,902,522
    Girard et al. 6,951,534
  • [0004]
    Tools and methods for accessing the pericardial space and for introducing other instruments and therapeutic devices such as cardiac support devices into that space are also known. Examples of tools and methods of these types are shown in the following U.S. patents and published applications, all of which are incorporated herein by reference in their entirety.
  • [0000]
    Inventor Name Patent/Publication No.
    Grabek 5,931,810
    Schmidt 5,972,013
    Schmidt et al. 6,206,004
    Lau et al. 2005/0055032
    Lau et al. 2005/0102010
  • [0005]
    Cardiac support devices of the type described above are typically delivered through an incision in the pericardium near the apex of the heart. Visualizing the heart and mounting the devices through the incision can involve moving the incision and manipulating the pericardium. In the course of these procedures the pericardium can sometimes interfere with the delivery of the device.
  • [0006]
    There is, therefore, a continuing need for improved devices and methods for managing the pericardium during intra-pericardial procedures. Devices and methods that can enhance cardiac support device delivery procedures would be especially desirable.
  • SUMMARY OF THE INVENTION
  • [0007]
    The present invention is an improved device for managing a patient's pericardium during intra-pericardial procedures. The efficiency of procedures such as the delivery of cardiac support devices can be greatly enhanced by the device.
  • [0008]
    One embodiment of the invention is a tool including a tubular body having a diameter and first and second ends. A lip on one or both of the first and second ends of the body is extendable with respect to the body between a retracted state and an expanded state. In the expanded state the lip extends from and has a diameter greater than the diameter of the body. In some embodiments the body and lip are formed from a single piece of flexible and lubricious material. Other embodiments of the tool are formed from a plurality of strips of lubricious material.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • [0009]
    FIG. 1A is an isometric view of a pericardium management tool in accordance with one embodiment of the present invention in a retracted state.
  • [0010]
    FIG. 1B is an isometric view of the pericardium management tool shown in FIG. 1A in an expanded state.
  • [0011]
    FIGS. 2A-2C are illustrations of the pericardium management tool shown in FIG. 1A being inserted into and deployed within a patient's pericardial space.
  • [0012]
    FIG. 3 is an isometric view of a device for inserting and deploying the pericardium management tool shown in FIG. 1A.
  • [0013]
    FIG. 4 is a top view of the deployment device shown in FIG. 3.
  • [0014]
    FIG. 5 is an isometric view, taken from the side, showing the pericardium management tool of FIG. 1A on the deployment device of FIG. 3, with the internal end of the tool and device inserted into and deployed with the pericardial space.
  • [0015]
    FIG. 6 is an isometric view of the deployed tool and device shown in FIG. 5.
  • [0016]
    FIG. 7 is an isometric view of a pericardium management tool in accordance with another embodiment of the invention.
  • [0017]
    FIGS. 8A-8C are illustrations of the pericardium management tool shown in FIG. 7 being inserted into and deployed within a patient's pericardial space.
  • [0018]
    FIG. 9 is a top view of the deployed pericardium management tool shown in FIG. 7.
  • [0019]
    FIGS. 10A and 10B are top views of a pericardium retractor in accordance with another embodiment of the invention in closed and open states, respectively.
  • [0020]
    FIGS. 11A and 11B are detailed isometric views of the blades of the retractor shown in FIGS. 10A and 10B in the closed and open states, respectively.
  • [0021]
    FIGS. 12A and 12B are illustrations of the retractor shown in FIGS. 10A and 10B being inserted into and opened within a patient's pericardial space.
  • [0022]
    FIG. 13 is a top view of a pericardium retractor in accordance with another embodiment of the invention inserted into and opened within a pericardial space.
  • [0023]
    FIG. 14 is a side view of the retractor shown in FIG. 13 within the pericardial space.
  • [0024]
    FIG. 15 is a side view of a pericardium management tool in accordance with another embodiment of the invention deployed within an incision through a patient's pericardium.
  • [0025]
    FIG. 16 is an illustration of a plurality of flexible members that can be assembled to form the tool shown in FIG. 15.
  • [0026]
    FIG. 17 is a sectional view of an alternative version of one of the flexible members shown in FIG. 16.
  • [0027]
    FIG. 18 is a sectional view of another alternative version of one of the flexible members shown in FIG. 16.
  • [0028]
    FIG. 19 is a side view of yet another alternative version of one of the flexible members shown in FIG. 16.
  • DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
  • [0029]
    FIGS. 1A and 1B are illustrations of a pericardium management tool 10 in accordance with one embodiment of the invention. As shown, the tool 10 is a flexible member having a tubular body 12 with a first or external end 14 and a second or internal end 16. A barrier portion 18 of the body 12 between the ends 14 and 16 has a diameter DBP. A lip 20 on the external end 14 of the body 12 has a diameter DEL that is greater than the diameter DBP of the barrier portion 18. An extendable lip 22 on the internal end 16 of the body 12 is expandable with respect to the body between a first or retracted state shown in FIG. 1A and a second or expanded state shown in FIG. 1B. In the retracted state shown in FIG. 1A, the extendable lip 22 has a diameter DIL1 that can be greater than, less than or equal to the diameter DBP of the barrier portion 18. In the embodiment shown, the extendable lip structure 22 has a diameter DIL1 in its retracted state that is slightly larger than the diameter DBP of the barrier portion 18. In the expanded state shown in FIG. 1B, the extendable lip structure 22 has a diameter DIL2 that is greater than the diameter DBP of the barrier portion 18.
  • [0030]
    In the embodiment shown in FIGS. 1A and 1B, the entire body 12 is formed from flexible (i.e., compliant) material such as fabric manufactured of expanded PTFE threads. Material of this type is commercially available as Gore-Tex fabric from W.L. Gore. Some embodiments of the invention are formed from material that is also expandable, although other embodiments of the invention are constructed from material that is not expandable. Materials of this type can also be elastic, although other embodiments of the invention are constructed from material that is not elastic. Another characteristic of material of this type is that it has a relatively low coefficient of friction, and therefore has relatively low friction surfaces. Still other embodiments of the invention are formed from other materials (e.g., Dacron) having a lubricious coating.
  • [0031]
    In the embodiment of pericardium management tool 10 shown in FIGS. 1A and 1B, the lip 20 on the external end 14 of body 12 is fixed in size. The lip 20 can, for example, be formed by stretching the fabric around a hoop (not visible) of wire or other elongated material to form a tubular pocket 23, and forming a hem in the fabric to retain the hoop inside the tubular pocket. As shown in FIGS. 1A and 1B, in this embodiment of the tool 10, the diameter of the body 12 continuously increases between the diameter DBP of the barrier portion 18 and the diameter DEL of the external lip 20.
  • [0032]
    The extendable lip 22 is moved between its retracted and expanded states in this embodiment by a flexible elongated element such as wire 24 that is inserted into and withdrawn from a tubular pocket 26 in the internal end 16 of the body 12. Pocket 26 can be formed by folding and hemming the fabric on the end 16 of the body 12. By forcing the wire 24 in a direction generally parallel to its length into the pocket 26 through a hole (not shown), the wire is be formed into a hoop of increasing circumference and diameter that stretches the fabric of the body 12 to expand the lip 22. The lip 22 is retracted by withdrawing the wire 24 from the pocket 26.
  • [0033]
    FIGS. 2A-2C illustrate a method for operating and deploying the tool 10 to manage a patient's pericardium 30 and provide access to heart 32. The pericardium 30 is accessed from a desired location through the patient's skin 31. An incision 34 is then made through the pericardium 30 to provide access to the pericardial space 36 surrounding heart 32. As shown in FIG. 2A, the internal end 16 of the body 12 is inserted through the skin 31 and incision 34, and positioned within the pericardial space 36. The lip 20 on the external end 14 of the body 12 will remain on the outside of the pericardium 30, and typically on the outside of the patient's skin 31.
  • [0034]
    The expansion of lip 22 can then be initiated by forcing the wire 24 into the pocket 26 as shown in FIG. 2B. As the wire 24 is fed into the pocket 26 the circumference and diameter of the lip 22 will expand with respect to the barrier portion 18 and draw the internal end 16 of the body 12 closer to the interior surface of pericardium 30. This expansion operation continues until the lip 22 is in its expanded state shown in FIG. 2C. When the tool 10 is deployed with the lip 22 in the expanded state, the barrier portion 18 of the body 12 forms a tubular structure around and against the exposed edges of the pericardium 30 and skin 31. The lip 22 also extends beyond the edges of the incision 34 and forces the fabric of the lip and body 12 to be positioned on or adjacent to the interior surfaces of the pericardium 30 around the incision. The lip 22 thereby covers or lines the inside surface of the pericardium 30 around the incision 34. Similarly, this deployment causes the external lip 20 to be located on or least adjacent to the external surface of the patient's skin 31, with the fabric of the external lip and body 12 extending beyond and around the opening over the external surface of the skin to form a cover or lining.
  • [0035]
    Tool 10 can be efficiently inserted and deployed. The deployed tool 10 surrounds the incision 34 in the pericardium 30 and provides a low-friction access port to the pericardial space 36. Since the edges of the pericardium 30 at the incision 34 are covered and protected, they will not interfere with surgical or other procedures being performed through the deployed tool 10. The deployed tool 10 also engages the pericardium 30 around the incision 34 to such a degree that the tool can be manipulated to lift, shift or otherwise move the location of the barrier portion 18, and therefore the access port, as desired during the surgical procedure. The surgeon can thereby effectively enhance his or her visualization of and access to the pericardial space 36 without interference from the edges of the pericardium 30. The characteristics of the tool 10 also enable the device to continually resize and conform to changes in the shape or size of the incision 34 that might be caused during the surgical procedure.
  • [0036]
    Upon completion of the surgical or other procedure the tool 10 can be removed from the incision 34. This removal can be facilitated by returning the lip 22 on the internal end 16 to its retracted state (e.g., by withdrawing the wire 24). The above described advantages of the tool 10 are thereby achieved by a device that can be efficiently removed following the completion of the procedure.
  • [0037]
    Pericardial management tools in accordance with the invention and having features and advantages such as those described above in connection with tool 10 can take other forms. By way of example, and not shown, in other embodiments of the invention the barrier portion 18 and lip 20 on external end 14 can be formed of rigid materials such as polymers. The lip 20 on the external end 14 need not be fixed, but instead can have structures such as those of the lip 22 on the internal end 16 that can be moved between retracted and expanded states. The extendable lip 22 can also be formed from different materials, including rigid materials, and different structures and methods can be used to move the lip between its retracted and expanded states. In still other embodiments, the tool includes a low friction material coating (e.g., in solid or liquid form) on the interior surfaces of the body 12 or at least on the barrier portion 18. The entire tool 10, or just portions, can be constructed from any suitable material such as, for example, fabrics, metals, polymers or biologic materials. The exterior surface of the tool 10 near the lips 20 and/or 22 can also include adhesive elements or coatings, or other tissue-engaging structures or material, that will facilitate the attachment of the lips to the adjacent tissue when the device is deployed. Although the tubular body 12 has a circular cross section in the illustrated embodiment, other embodiments (not shown) have other cross sectional shapes.
  • [0038]
    FIGS. 3 and 4 are illustrations of a deployment device 50 that can be used to insert and deploy the pericardium management tool 10. As shown, deployment device 50 has a handle 52 with a pair of guide members 54 extending from one end. The guide members 54 are tubes and have fingers 56 on the ends opposite the handle 52 that extend in a direction back toward and generally parallel to the handle. The wire 24 that is used to deploy the tool 10 (not shown in FIGS. 3 or 4) extends through the guide members 54 and out the ends of the fingers 56. The portion of the wire 24 extending from the fingers 56 forms a hoop that is located in the extendable lip 22 of the tool 10 when the tool is mounted on the deployment device 50, thereby supporting the tool during its use. The ends of the wire 24 extending from the ends of the guide members 54 mounted to the handle 52 are connected to a slide 60. Slide 60 is movably mounted to the handle 52, and in the embodiment shown is mounted to a slot 62 for movement along the length of the handle. The circumference and diameter of the hoop in the wire 24 can be expanded and retracted by moving the slide 60 toward and away from the end of the handle 52 with the guide members 54, respectively.
  • [0039]
    FIGS. 5 and 6 are illustrations of the pericardium management tool 10 mounted to the deployment device 50. A cover 64 of flexible fabric encloses the portions of the deployment device 50 between the slide 60 and end portion of handle 52. The internal end 16 and extendable lip 22 of the tool 10 (not visible in FIGS. 5 and 6) are positioned through an incision 34 into mammalian pericardium 30 in these figures. The slide 60 has been actuated (e.g., by the surgeon's thumb) to drive the extendable lip 22 to its expanded state. In FIG. 6 the pericardial space 36 and heart 32 are visible through the opening in the body 12.
  • [0040]
    FIG. 7 is an illustration of a pericardium management tool 110 in accordance with another embodiment of the invention. As shown, tool 110 includes a hoop 170 and a body 112 formed by a plurality of flexible members such as material strips 172. The material strips 172 can be formed of any of the materials of the body 12 of tool 10 described above. In one embodiment, for example, strips 172 are formed of relatively low friction and flexible material such as PTFE. The strips 172 extend from the hoop at spaced apart locations and can be formed of relatively thin sheet material. Hoop 170 can be an elongated metal or polymer member (e.g., wire). Material strips 172 can be attached to the hoop 170 by wrapping the ends of the strips around the hoop and securing the ends to the hoop or adjacent portions of the strips (e.g., by a sewn hem or adhesive). The end 114 of tool 110 at which the material strips 172 are attached to the hoop 170 is an exterior end of the tool, while the free ends of the strips are at an internal end 116 of the tool.
  • [0041]
    FIGS. 8A-8C and 9 illustrate a method for operating and deploying the tool 110 to manage a patient's pericardium 130 and provide access to heart 132. The pericardium 130 is accessed from a desired location through the patient's skin 131. An incision 134 is then made through the pericardium 130 to provide access to the pericardial space 136 surrounding heart 132. As shown in FIG. 8A, the portions of material strips 172 on the internal end 116 of the body 112 are inserted through the skin 131 and incision 134, and positioned within the pericardial space 136. The body 112 of the device 10 is in a retracted state during this insertion step. The hoop 170 on the external end 114 of the body 112 functions as a lip 120 and remains on the outside of the pericardium 130, and typically on the outside of the patient's skin 131.
  • [0042]
    The body 112 of tool 110 is then expanded within the pericardial space 136 by radially extending the free ends of the material strips 172 in a fanned arrangement under the pericardium 130. The portions of the material strips 172 on the internal end 116 of the body 112 are thereby expanded in diameter and circumference with respect to the diameter and circumference of a barrier portion 118 that engages the edges of the pericardium 130 at the incision 134. These steps can be done by hand (e.g., by the surgeon using his or her fingers to tuck the material strips 172 under the pericardium 130) or with the assistance of instruments. The portions of the material strips 172 on the ends 116 of the body 112 form a lip 122 under the pericardium 130. This expansion operation continues until the lip 122 is in its expanded state shown in FIG. 8C.
  • [0043]
    As perhaps best shown in FIGS. 8C and 9, when the tool 110 is deployed with the lip 122 in the expanded state, the portions of the material strips 172 at barrier portion 118 are positioned closely adjacent to one another and form a tubular structure against the exposed edges of the pericardium 130 and skin 131. In the illustrated embodiment the portions of the material strips 172 at barrier portion 118 are located immediately adjacent to one another. In other embodiments (not shown) the strips 172 can overlap one another, or be spaced from one other, at barrier portion 118.
  • [0044]
    The lip 122 extends beyond and around the edges of the incision 134 and forces the material strips 172 to be positioned on or adjacent to the interior surfaces of the pericardium 130 around the incision, thereby lining the pericardium around the incision. When deployed, the illustrated embodiment of tool 110 has gaps in the lip 122 between the material strips 172. However substantial portions of the pericardium 130 around the incision 134 are still lined by the lip 122 (e.g., sufficient portions to reduce or prevent the pericardium from interfering with the surgical procedure). Following this deployment operation the external lip 120 will typically be located on or at least adjacent to the external surface of the patient's skin 131, with the material of strips 172 at the lip 120 and body 112 extending beyond and around the opening over the external surface of the skin.
  • [0045]
    Pericardium management tool 110 can be efficiently inserted and deployed to surround the incision and provide a low-friction access port to the pericardial space 136. FIG. 9, for example, shows how the deployed tool 110 provides access to the pericardial space 136 and heart 132. The tool 110 can be removed from the incision 134 following the completion of the surgical procedure by returning the lip 122 to its retracted state and pulling the body 112 out of the incision. The functions and associated advantages provided by pericardium management tool 110 are the same or similar to those of tool 10 described above.
  • [0046]
    Pericardium management tools in accordance with the invention having features and advantages such as those described above in connection with tool 110 can take other forms. By way of example, and not shown, in other embodiments if the invention the portions of the strips 172 (e.g., flexible members) that are positioned on the outside and/or the inside of the pericardium 130 can be formed of rigid material, and the portions of the strips forming the barrier portion 118 can be formed of flexible material or have hinge structures that enable the ends to be fanned out within the pericardial space 136. Malleable metals or other material or structures can be added to the material strips 172 at the barrier portion 118 to cause the strips to retain their expanded state positions. The strips need not be formed of low friction material, but can instead be formed of other materials and have a coating of low friction material on at least those portions forming the interior surface of barrier portion 118. The material strips 172 can also be curved or otherwise shaped to reduce or eliminate the size of the gaps between the strips at the lips 120 and/or 122 when the tool 110 is deployed. Adhesive or other structures (e.g., hook and loop fasteners) on the material strips (e.g., on the edges) can be used to secure the strips to one another. Other features of the tool 10 described above can also be incorporated into tool 110.
  • [0047]
    A retractor 200 in accordance with another embodiment of the invention is shown in FIGS. 10A and 10B. Retractor 200 includes a handle 202, a pair of blades 204 and an actuating member 208. Blades 204 are shown in greater detail in FIGS. 11A and 11B. The retractor 200 and blades 204 are shown in a closed or retracted position in FIGS. 10A and 11A with the blades located adjacent to one another, and in an open or extended position in FIGS. 10B and 11B with the blades spaced apart from one another.
  • [0048]
    Blades 204 each have an upright wall portion 210 and a lip 212 extending from the wall portion. Wall portions 210 have a convex surface in the embodiment shown. Similarly, in the embodiment shown the lips 212 have a convex outer edge. In other embodiments of the invention the wall portions 210 and the outer edges of the lips 212 have other shapes (e.g., are flat or straight).
  • [0049]
    Handle 202 is an elongated member in the embodiment shown and has a proximal end 214 and a distal end 216. One of the blades 204 (i.e., a fixed blade) is mounted to the distal end 216 of the handle 202 with the lip 212 facing the proximal end 214. An elongated member such as shaft 215 can mount the fixed blade 204 to the handle 202. Actuating member 208 includes a U-shaped arm 217 with a proximal end 218 movably mounted to the handle 202 and a distal end 220 mounted to the other blade 204 (i.e., the movable blade). The blade 204 is mounted to the distal end 220 of arm 217 with the lip 212 of the blade facing away from the distal end 216 of the handle 202. In the embodiment shown, the proximal end 218 of arm 217 is slidably mounted to a slot 222 in the handle 202 by an a slide 224.
  • [0050]
    The operation of retractor 200 can be described with reference to FIGS. 10A, 10B, 11A, 11B, 12A and 12B. The pericardium 230 is accessed from a desired location through the patient's skin 231. An incision 234 is then made through the pericardium 230 to provide access to the pericardial space 236. With the handle 202 and actuating member 208 manipulated so the blades 204 are in the closed position shown in FIGS. 10A and 11A, the blades are inserted through the incision 234 to position the lips 212 within the pericardial space 236 as shown in FIG. 12A. The actuating member 208 is then actuated to move the blades 204 to the open position shown in FIGS. 10B and 11B. This expansion of the blades 204 will cause the wall portions 210 of the blades to engage the exposed edges of the pericardium 230, and the lips 212 to extend beyond the edges of the incision over the inside surface of the pericardium 230. The incision 234 is thereby spread apart, and the edges of the pericardium 230 at the incision engaged, to provide access to the pericardial space 236 and heart 232. A releasable clamp mechanism (not shown) on the handle can be used to retain the retractor 200 in the open position during surgical procedures. Upon completion of the surgical procedure the retractor 200 can be returned to its closed position and withdrawn from the incision 234.
  • [0051]
    Retractor 200 can be efficiently operated. The retractor 200 provides functions and advantages that are the same or similar to those described above in connection with tool 10. Retractor 200 can be used alone to access the pericardial space 236. Alternatively, tools such as 10 and 110 described above can be used in connection with the retractor 200 by inserting them into the opening created by the retractor.
  • [0052]
    FIGS. 13 and 14 are illustrations of a retractor 300 in accordance with another embodiment of the invention. In these figures the retractor 300 is shown in an open state with the blades 304 within the pericardium 330 of a mammal, exposing the pericardial space 336 and heart 332. In the embodiment shown, the actuating mechanism and handle of retractor 300 formed by a hand-held clamp mechanism 303 having a pair of arms 305 pivotally connected by a hinge 307. A releasable locking mechanism 311 is connected to the hand-engaging sections 313 of the arms 305. The blades 304 are mounted directly to the arms 305. The edges of the lips 312 are generally linear, and the wall portions 310 are generally planar. Other than these differences, retractor 300 can be substantially the same or similar to retractor 200 described above, and functions in manner that is substantially the same or similar to that of retractor 200.
  • [0053]
    FIG. 15 is an illustration of a pericardium management tool 410 in accordance with another embodiment of the invention. Tool 410 is formed from a plurality of individual material strips 472 such as those shown in FIG. 16. Material strips 472 can be formed from any of the materials and/or structures of material strips 172 of tool 110 described above (e.g., low friction and flexible materials), and have an external end 414 and an internal end 416. In the embodiment shown, the material strips 472 are elongated members having concave side edges 475. Adhesive 473 is located on at least one side of the material strips 472 adjacent to at least one of the edges.
  • [0054]
    Tool 410 is deployed by inserting the material strips 472 individually into an incision 434 in the pericardium 430. Internal ends 416 are then tucked under the internal surface of the pericardium 430, and the external ends 414 are bent over the outside of the pericardium 430 or body. Adjacent side edges 475 of the material strips 472 can be joined together. In the embodiment shown in FIGS. 15 and 16, for example, the side edges 475 are overlapped and secured together by the adhesive 473. When deployed, the tool 410 has a tubular body 412 with a barrier portion 418 that engages and surrounds the edge of the pericardium 430 at the incision 434. The internal ends 416 of the material strips 472 are extended from retracted positions to form an extendable lip 422 that lines the interior surface of the pericardium 430 around the incision 434. The external ends 414 form a lip 420 on the outside surface of the pericardium 430 or body.
  • [0055]
    Pericardium management tool 410 can be efficiently inserted and deployed to surround the incision 434 and provide a low-friction access port to the pericardial space 436. The tool 410 can be removed from the incision 434 following the completion of the intra-pericardial procedure by pulling the body 412 out of the incision. The functions and advantages provided by pericardial management tool 410 are the same or similar to those of tools 10 and 110 described above.
  • [0056]
    Pericardium management tools in accordance with the invention having features and advantages such as those described above in connection with tool 410 can take other forms. By way of example, FIG. 17 illustrates a cross section of a material strip 472′ having an arcuate cross section. The actuate cross section of material strip 472′ provides the strip with beam strength, and enhances the its ability to be deployed as part of the tool. FIG. 18 illustrates the external end 414″ of a material strip 472″. As shown, the end 414 includes an engagement structure such as pocket 481″ that can be engaged by an instrument or other tool during the deployment of the tool. FIG. 19 illustrates a material strip 472′″ having a tissue-engaging structure such as adhesive strip 485′″ on its external end 414′″ and a malleable material strip 483′″ adjacent the barrier portion 418′″. Adhesive strip 485′″ can be used to enhance the engagement of the end 414′″ with the pericardium (not shown) when deployed as part of the tool in the manner described above. Malleable material strip 483′″ can help the material strip 472′″ retain its shape when deployed as part of the tool, yet allow the material strip to be returned to other shapes during the removal of the tool. Of course the features of the material strips shown in FIGS. 17-19 can be combined with one another and with the features of the material strips 472 described above. Similarly, features of the tools 10 and 110 described above can be incorporated into material strips 472 and tool 410. Other structures such as snaps, magnets or hook and loop fasteners can be used as alternatives to the adhesive 473 to secure the material strips 472 to one another. The material strips 472 can have side edges with straight or other shape profiles, and need not be configured to engage adjacent material strips along their entire lengths. A plurality of the material strips 472 can be distributed together as a kit for assembling the tool. For example, in one embodiment (not shown) a plurality of the material strips 472 are packaged together as a kit for this purpose.
  • [0057]
    Although the present invention has been described with reference to preferred embodiments, those skilled in the art will recognize that changes can be made in form and detail without departing from the spirit and scope of the invention. For example, although not shown, tools and methods in accordance with the invention can be incorporated into delivery tools for cardiac support devices.
Citas de patentes
Patente citada Fecha de presentación Fecha de publicación Solicitante Título
US1965542 *24 Nov 19333 Jul 1934Jr William ColvinFabric
US2278926 *15 Feb 19417 Abr 1942Metal Textile CorpKnitted metallic fabric for belting and other uses
US2376442 *7 Jul 194322 May 1945Hugo MehlerTubular netting
US2992550 *13 May 195918 Jul 1961Hagin Frith & SonsKnitted mesh
US3384530 *23 Jul 196521 May 1968Plastic Textile Access LtdExtruded plastic net, method of making the same and sack made of said net
US3452742 *29 Jun 19661 Jul 1969Us Catheter & Instr CorpControlled vascular curvable spring guide
US3587567 *20 Dic 196828 Jun 1971Schiff Peter PaulMechanical ventricular assistance assembly
US3732662 *30 Jul 197115 May 1973Paxton FMethod of forming, filling, closing and labelling tubular netting bags
US4196534 *27 Oct 19778 Abr 1980Toshitsune ShibamotoPlastic net bag and label
US4428375 *16 Feb 198231 Ene 1984Ellman Barry RSurgical bag for splenorrhaphy
US4567900 *4 Jun 19844 Feb 1986Moore J PaulInternal deployable defibrillator electrode
US4637377 *20 Sep 198520 Ene 1987Loop Floyd DPillow or support member for surgical use
US4821723 *27 Feb 198718 Abr 1989Intermedics Inc.Biphasic waveforms for defibrillation
US4827932 *27 Feb 19879 May 1989Intermedics Inc.Implantable defibrillation electrodes
US4834707 *16 Sep 198730 May 1989Evans Phillip HVenting apparatus and method for cardiovascular pumping application
US4840626 *29 Sep 198620 Jun 1989Johnson & Johnson Patient Care, Inc.Heparin-containing adhesion prevention barrier and process
US4932972 *26 Abr 198812 Jun 1990Richards Medical CompanyProsthetic ligament
US4936857 *15 Feb 198826 Jun 1990Kulik Yaroslav PProsthetic pericardium
US4995857 *7 Abr 198926 Feb 1991Arnold John RLeft ventricular assist device and method for temporary and permanent procedures
US5087243 *18 Jun 199011 Feb 1992Boaz AvitallMyocardial iontophoresis
US5131905 *16 Jul 199021 Jul 1992Grooters Ronald KExternal cardiac assist device
US5186711 *28 May 199116 Feb 1993Albert Einstein College Of Medicine Of Yeshiva UniversityHemostasis apparatus and method
US5188813 *17 Mar 199223 Feb 1993Johnson Matthey Public Limited CompanyMetal fabrics
US5192314 *12 Dic 19919 Mar 1993Daskalakis Michael KSynthetic intraventricular implants and method of inserting
US5207725 *12 Sep 19914 May 1993Pinkerton Linda LSoap holder
US5279539 *17 Ago 199218 Ene 1994Ethicon, Inc.Drawstring surgical pouch and method of use for preventing ovarian adhesions
US5290217 *10 Oct 19911 Mar 1994Earl K. SipesMethod and apparatus for hernia repair
US5383840 *28 Jul 199224 Ene 1995Vascor, Inc.Biocompatible ventricular assist and arrhythmia control device including cardiac compression band-stay-pad assembly
US5385156 *27 Ago 199331 Ene 1995Rose Health Care SystemsDiagnostic and treatment method for cardiac rupture and apparatus for performing the same
US5405360 *22 Jul 199311 Abr 1995United States Surgical CorporationResilient arm mesh deployer
US5409703 *24 Jun 199325 Abr 1995Carrington Laboratories, Inc.Dried hydrogel from hydrophilic-hygroscopic polymer
US5507779 *12 Abr 199416 Abr 1996Ventritex, Inc.Cardiac insulation for defibrillation
US5522790 *14 Mar 19944 Jun 1996Origin Medsystems, Inc.Retraction apparatus and methods for endoscopic surgery
US5524633 *1 Oct 199311 Jun 1996Advanced Surgical, Inc.Self-deploying isolation bag
US5593441 *7 Jun 199514 Ene 1997C. R. Bard, Inc.Method for limiting the incidence of postoperative adhesions
US5603337 *5 Dic 199418 Feb 1997Jarvik; RobertTwo-stage cardiomyoplasty
US5611515 *5 Abr 199318 Mar 1997Boston Scientic CorporationBladder neck suspension procedure
US5713954 *13 Jun 19953 Feb 1998Abiomed R&D, Inc.Extra cardiac ventricular assist device
US5735290 *28 Jul 19947 Abr 1998Heartport, Inc.Methods and systems for performing thoracoscopic coronary bypass and other procedures
US5766216 *30 May 199616 Jun 1998Gangal; Hanamraddi T.Band applicator for appendicular and meso-appendicular stumps
US6045497 *29 Jul 19984 Abr 2000Myocor, Inc.Heart wall tension reduction apparatus and method
US6050936 *2 Ene 199718 Abr 2000Myocor, Inc.Heart wall tension reduction apparatus
US6059715 *4 Ene 19999 May 2000Myocor, Inc.Heart wall tension reduction apparatus
US6076013 *14 Ene 199913 Jun 2000Brennan; Edward F.Apparatus and methods for treating congestive heart failure
US6077214 *29 Jul 199820 Jun 2000Myocor, Inc.Stress reduction apparatus and method
US6077218 *23 Sep 199720 Jun 2000Acorn Cardiovascular, Inc.Cardiac reinforcement device
US6169922 *18 Nov 19982 Ene 2001Acorn Cardiovascular, Inc.Defibrillating cardiac jacket with interwoven electrode grids
US6174279 *21 Sep 199916 Ene 2001Acorn Cardiovascular, Inc.Cardiac constraint with tension indicator
US6179791 *21 Sep 199930 Ene 2001Acorn Cardiovascular, Inc.Device for heart measurement
US6193648 *21 Sep 199927 Feb 2001Acorn Cardiovascular, Inc.Cardiac constraint with draw string tensioning
US6205747 *18 Sep 199827 Mar 2001Rosalina Paniagua OlaecheaProcess for closing nets for fruits and the like and net closed by means of said process
US6206004 *6 Dic 199627 Mar 2001Comedicus IncorporatedTreatment method via the pericardial space
US6224540 *13 Feb 19981 May 2001Abiomed, Inc.Passive girdle for heart ventricle for therapeutic aid to patients having ventricular dilatation
US6230714 *18 Nov 199815 May 2001Acorn Cardiovascular, Inc.Cardiac constraint with prior venus occlusion methods
US6241654 *7 Jul 19995 Jun 2001Acorn Cardiovasculr, Inc.Cardiac reinforcement devices and methods
US6360749 *8 Oct 199926 Mar 2002Swaminathan JayaramanModification of properties and geometry of heart tissue to influence heart function
US6370429 *31 Jul 20009 Abr 2002Acorn Cardiovascular, Inc.Defibrillating cardiac constraint
US6375608 *25 Oct 200023 Abr 2002Acorn Cardiovascular, Inc.Cardiac reinforcement device
US6402680 *27 Abr 200111 Jun 2002Myocor, Inc.Stress reduction apparatus and method
US6508756 *30 Dic 199821 Ene 2003Abiomed, Inc.Passive cardiac assistance device
US6517570 *21 Jul 199711 Feb 2003Gore Enterprise Holdings, Inc.Exterior supported self-expanding stent-graft
US6537203 *4 May 200025 Mar 2003Acorn Cardiovascular, Inc.Cardiac disease treatment and device
US6541678 *21 Mar 20011 Abr 2003Brennen Medical, Inc.Immunostimulating coating for surgical devices
US6544168 *25 Feb 20028 Abr 2003Acorn Cardiovascular, Inc.Cardiac reinforcement device
US6564094 *22 Dic 200013 May 2003Acorn Cardiovascular, Inc.Cardiac disease treatment and device
US6567699 *30 Ene 200220 May 2003Acorn Cardiovascular, Inc.Defibrillating cardiac constraint
US6569082 *8 Feb 200127 May 2003Origin Medsystems, Inc.Apparatus and methods for cardiac restraint
US6572533 *17 Ago 20003 Jun 2003Acorn Cardiovascular, Inc.Cardiac disease treatment and device
US6579226 *3 Ago 200117 Jun 2003Acorn Cardiovascular, Inc.Delivery of cardiac constraint jacket
US6582355 *4 May 200024 Jun 2003Acorn Cardiovascular, Inc.Cardiac disease treatment method
US6673009 *8 Nov 20006 Ene 2004Acorn Cardiovascular, Inc.Adjustment clamp
US6682474 *10 Sep 200127 Ene 2004Paracor Surgical, Inc.Expandable cardiac harness for treating congestive heart failure
US6682475 *11 Jun 200227 Ene 2004Acorn Cardiovascular, Inc.Tension indicator for cardiac support device and method therefore
US6682476 *23 Oct 200227 Ene 2004Acorn Cardiovascular, Inc.Cardiac disease treatment and device
US6689048 *23 Ago 200210 Feb 2004Acorn Cardiovascular, Inc.Delivery of cardiac constraint jacket
US6695769 *25 Sep 200124 Feb 2004The Foundry, Inc.Passive ventricular support devices and methods of using them
US6702732 *8 Ago 20009 Mar 2004Paracor Surgical, Inc.Expandable cardiac harness for treating congestive heart failure
US6723041 *10 Sep 200220 Abr 2004Lilip LauDevice for treating heart failure
US6723044 *14 Mar 200220 Abr 2004Apple Medical CorporationAbdominal retractor
US6730016 *12 Jun 20004 May 2004Acorn Cardiovascular, Inc.Cardiac disease treatment and device
US6755779 *1 Dic 200029 Jun 2004Acorn Cardiovascular, Inc.Apparatus and method for delivery of cardiac constraint jacket
US6881185 *28 Ene 200419 Abr 2005Acorn Cardiovascular, Inc.Delivery of cardiac constraint jacket
US6893392 *13 Feb 200317 May 2005Acorn Cardiovascular, Inc.Cardiac reinforcement device
US6902522 *12 Jun 20007 Jun 2005Acorn Cardiovascular, Inc.Cardiac disease treatment and device
US6902524 *17 Nov 20037 Jun 2005Acorn Cardiovascular, Inc.Cardiac disease treatment and device
US6908426 *12 Ago 200321 Jun 2005Acorn Cardiovascular, Inc.Cardiac disease treatment and device
US7033319 *20 Abr 200425 Abr 2006Apple Medical CorporationAbdominal retractor
US7060023 *25 Sep 200113 Jun 2006The Foundry Inc.Pericardium reinforcing devices and methods of using them
US7163507 *23 Sep 200316 Ene 2007Acorn Cardiovascular, Inc.Cardiac reinforcement device
US7189203 *17 Nov 200313 Mar 2007Paracor Medical, Inc.Cardiac harness delivery device and method
US7235042 *16 Sep 200326 Jun 2007Acorn Cardiovascular, Inc.Apparatus and method for applying cardiac support device
US20020019580 *10 Sep 200114 Feb 2002Lilip LauExpandable cardiac harness for treating congestive heart failure
US20040059181 *23 Sep 200325 Mar 2004Acorn Cardiovascular, Inc.Cardiac reinforcement device
US20050033109 *30 Abr 200410 Feb 2005Lilip LauHeart failure treatment device and method
US20050059854 *16 Sep 200317 Mar 2005Acorn Cardiovascular, Inc.Apparatus and method for applying cardiac support device
US20050059855 *27 Oct 200417 Mar 2005Lilip LauCardiac harness delivery device and method
US20050059865 *17 Sep 200317 Mar 2005Applied Medical Resources CorporationSurgical instrument access device
US20050090707 *23 Nov 200428 Abr 2005Lilip LauCardiac harness delivery device and method
US20060009831 *29 Jul 200512 Ene 2006Lilip LauCardiac harness having leadless electrodes for pacing and sensing therapy
Citada por
Patente citante Fecha de presentación Fecha de publicación Solicitante Título
US82572518 Abr 20094 Sep 2012Ethicon Endo-Surgery, Inc.Methods and devices for providing access into a body cavity
US825725211 Jun 20104 Sep 2012Tyco Healthcare Group LpElongated seal anchor for use in surgical procedures
US825725411 Dic 20094 Sep 2012Tyco Healthcare Group LpLaparoscopic instrument and trocar systems for trans-umbilical laparoscopic surgery
US83176908 Mar 201027 Nov 2012Covidien LpFoam port and introducer assembly
US83231848 Mar 20104 Dic 2012Covidien LpSurgical access port and associated introducer mechanism
US839401811 Dic 200912 Mar 2013Covidien LpLaparoscopic instrument and trocar systems for transumbilical laparoscopic surgery
US84144878 Feb 20119 Abr 2013Applied Medical Resources CorporationCircular surgical retractor
US846027113 May 201011 Jun 2013Covidien LpLaparoscopic instrument and cannula assembly and related surgical method
US85509921 Sep 20118 Oct 2013Covidien LpTwo-part access assembly
US856264126 Sep 200722 Oct 2013Covidien LpLaparoscopic instruments
US865216011 Dic 200918 Feb 2014Covidien LpLaparoscopic instrument and trocar systems for trans-umbilical laparoscopic surgery
US865216111 Dic 200918 Feb 2014Covidien LpLaparoscopic instrument and trocar systems for trans-umbilical laparoscopic surgery
US8663271 *3 Ago 20074 Mar 2014Northgate Technologies, Inc.In-dwelling port for access into a body
US869076612 Feb 20138 Abr 2014Covidien LpLaparoscopic instrument and trocar systems and related surgical method
US871874620 Jun 20086 May 2014Mardil, Inc.Pericardial space imaging for cardiac support device implantation
US872810912 Feb 201320 May 2014Covidien LpLaparoscopic instrument and trocar systems and related surgical method
US87532676 Dic 201117 Jun 2014Covidien LpAccess assembly insertion device
US87582369 May 201224 Jun 2014Applied Medical Resources CorporationWound retractor
US876464527 Feb 20131 Jul 2014Covidien LpSurgical access device and wound protector
US876464815 Mar 20131 Jul 2014Covidien LpLaparoscopic instrument and trocar systems and related surgical method
US876476531 Ago 20091 Jul 2014Covidien LpLaparoscopic instrument and related surgical method
US88646591 Sep 201121 Oct 2014Covidien LpSeal anchor for use in surgical procedures
US8888695 *27 Mar 200818 Nov 2014Covidien LpLaparoscopic port assembly
US894498730 Sep 20103 Feb 2015Adjucor UgCardiac assistance device and method for the control thereof
US896140731 Ago 200924 Feb 2015Covidien LpSurgical port assembly
US896824710 Jun 20133 Mar 2015Covidien LpLaparoscopic instrument and cannula assembly and related surgical method
US901147415 Mar 201321 Abr 2015Covidien LpLaparoscopic instrument and trocar systems and related surgical method
US90172491 Mar 201328 Abr 2015Covidien LpSurgical access assembly and method of use therefor
US90172516 May 201428 Abr 2015Covidien LpAccess assembly insertion device
US911395120 Feb 201225 Ago 2015Covidien LpSeal anchor for use in surgical procedures
US911395220 Abr 201525 Ago 2015Covidien LpSurgical access assembly and method of use therefor
US91491781 Mar 20136 Oct 2015Covidien LpSurgical access assembly and method of use therefor
US9220824 *15 Mar 201329 Dic 2015AdjuCor GmbHImplanting cardiac devices
US924169719 Jun 201426 Ene 2016Applied Medical Resources CorporationWound retractor
US9271639 *31 Ene 20131 Mar 2016Covidien LpSurgical introducer and access port assembly
US930797519 Jun 201412 Abr 2016Applied Medical Resources CorporationWound retractor
US931426721 Nov 201419 Abr 2016Covidien LpLaparoscopic port assembly
US934587021 Ene 201424 May 2016Northgate Technologies Inc.In-dwelling port for access into a body
US943343519 Ene 20156 Sep 2016Covidien LpLaparoscopic instrument and cannula assembly and related surgical method
US945198025 Jul 201327 Sep 2016Covidien LpHand access device
US9463007 *22 Ene 201311 Oct 2016Covidien LpAdjustable height port including retention elements
US948619716 Sep 20138 Nov 2016Covidien LpTwo-part access assembly
US949219519 Ene 201515 Nov 2016Covidien LpSurgical port assembly
US952199613 Jul 201220 Dic 2016Cook Medical Technologies LlcSurgical retractor device
US952652120 Ago 201527 Dic 2016Covidien LpSurgical access assembly and method of use therefor
US953280115 Sep 20143 Ene 2017Covidien LpSeal anchor for use in surgical procedures
US953902723 Mar 201510 Ene 2017Covidien LpLaparoscopic instrument and trocar systems and related surgical method
US95610244 Feb 20157 Feb 2017Applied Medical Resources CorporationWound retractor
US95725954 Mar 201521 Feb 2017Northgate Technologies Inc.In-dwelling port for access into a body
US96491028 Jul 201516 May 2017Applied Medical Resources CorporationWound retractor with split hoops
US970701121 Jul 201518 Jul 2017Covidien LpAttachments for use with a surgical access device
US20080255519 *27 Mar 200816 Oct 2008Pnavel Systems, Inc.Laparoscopic port assembly
US20080319255 *20 Jun 200825 Dic 2008Acorn Cardiovascular, Inc.Pericardial space imaging for cardiac support device implantation
US20100057121 *31 Ago 20094 Mar 2010Gregory PiskunLaparoscopic instrument and related surgical method
US20100130824 *11 Dic 200927 May 2010Gregory PiskunLaparoscopic instrument and trocar systems for trans-umbilical laparoscopic surgery
US20100137691 *11 Dic 20093 Jun 2010Gregory PiskunLaparoscopic instrument and trocar systems for trans-umbilical laparoscopic surgery
US20100305407 *2 Jun 20102 Dic 2010Farley Daniel KMalleable Port Retractor
US20110130633 *8 Feb 20112 Jun 2011Applied Medical Resources CorporationCircular surgical retractor
US20110172495 *23 Mar 201114 Jul 2011Armstrong David NSurgical retractor
US20130225931 *31 Ene 201329 Ago 2013Covidien LpSurgical introducer and access port assembly
US20130225933 *22 Ene 201329 Ago 2013Covidien LpAdjustable height port including retention elements
US20140194670 *15 Mar 201310 Jul 2014Stephen Manuel WildhirtImplanting cardiac devices
USD71203331 Jul 201326 Ago 2014Covidien LpSeal anchor for use in surgical procedures
USD71203431 Jul 201326 Ago 2014Covidien LpSeal anchor for use in surgical procedures
USD7369215 Jun 201418 Ago 2015Covidien LpSeal anchor for use in surgical procedures
USD7385005 Jun 20148 Sep 2015Covidien LpSeal anchor for use in surgical procedures
CN101849848A *31 Mar 20106 Oct 2010伊西康内外科公司Access devices
CN101856247A *8 Abr 201013 Oct 2010伊西康内外科公司Methods and devices for providing access into body cavity
DE102013200153A1 *8 Ene 201310 Jul 2014AdjuCor GmbHDevice for supporting pumping function of heart in human body, has pericardial closure for sealing break-through membrane and provided with first and second closure elements, which are provided with two disk shaped sealing lips
EP2238925A1 *30 Mar 201013 Oct 2010Tyco Healthcare Group LPSurgical access port and associated introducer mechanism
EP2238933A1 *8 Abr 201013 Oct 2010Ethicon Endo-Surgery, Inc.Methods and devices for providing access into a body cavity
EP2502588A1 *22 Mar 201226 Sep 2012Tyco Healthcare Group LPWound protector including pocket for reusable distal ring
EP2630927A3 *22 Feb 201320 Ago 2014Covidien LPAdjustable height port including retention elements
WO2012154845A1 *9 May 201215 Nov 2012Applied Medical Resources CorporationWound retractor
Clasificaciones
Clasificación de EE.UU.600/208, 600/222
Clasificación internacionalA61B1/32
Clasificación cooperativaA61B2017/0237, A61B17/2833, A61B2017/00849, A61B17/02, A61B17/3439, A61B17/3423, A61B17/0206
Clasificación europeaA61B17/02A, A61B17/34G4A, A61B17/02
Eventos legales
FechaCódigoEventoDescripción
12 Sep 2006ASAssignment
Owner name: ACORN CARDIOVASCULAR, INC., MINNESOTA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:PIGNATO, PAUL ANDREW;HJELLE, AARON J.;WALSH, ROBERT G.;AND OTHERS;REEL/FRAME:018236/0644;SIGNING DATES FROM 20060726 TO 20060824