WO2003013367A2

WO2003013367A2 - Vascular harvesting tool and methods

Info

Publication number: WO2003013367A2
Application number: PCT/US2002/025504
Authority: WO
Inventors: James E. Jervis
Original assignee: General Surgical Innovations Inc.
Priority date: 2001-08-10
Filing date: 2002-08-09
Publication date: 2003-02-20
Also published as: WO2003013367A3

Abstract

The present disclosure is directed to devices for harvesting blood vessels from the body and to methods of using the devices of the present disclosure to perform the blood vessel harvesting. The vessel harvesting tools include first and second vessel engaging members configured and adapted to engage the vessel. The first engaging member and the second engaging member are axially and rotatably adjustable with respect to one another. The method of harvesting includes providing a vessel harvesting tool having first and second vessel engaging members, creating a working space proximate to an elongate body structure to be harvested, manipulating the vessel harvesting tool to place the elongate body structure between the first and the second vessel engaging members and axially manipulating the first engaging member with respect to the second engaging member to separate the elongate body structure from surrounding tissue.

Description

VASCULAR HARVESTING TOOL AND METHODS

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application claims priority of U.S. Provisional Patent Application Serial No. 60/311,334 filed August 10, 2001, the entire contents of which are incorporated by reference.

BACKGROUND

1. Technical Field

The present disclosure relates to methods and devices for endoscopic surgery, and more particularly to methods and devices for endoscopic harvesting of body structures.

2. Background

Numerous surgical procedures have been developed to replace or bypass arteries that have become blocked by disease. Aortocoronary bypass surgery is perhaps the most important of these surgical procedures. The coronary arteries supply blood to the heart. As a result of aging and disease, coronary arteries may become blocked by plaque deposits, stenosis, or cholesterol. In some instances, these blockages can be treated with ar herectomy, angioplasty or stent placement, and coronary bypass surgery is not required. Coronary bypass surgery is required when these other methods of treatment cannot be used or have failed to clear the blocked artery. In coronary bypass surgery, a blood vessel is harvested from elsewhere in the body and grafted into place between the aorta and the coronary artery beyond the point of blockage.

The coronary bypass surgery requires a length of blood vessel or artery for the graft. It is preferred to use a blood vessel taken from the patient undergoing the bypass surgery. The patient is a ready source of suitable blood vessels that will not be rejected by the body after transplantation and grafting onto the aorta and coronary artery. The saphenous vein in the leg is the best substitute for small arteries such as the coronary arteries, and it is the preferred blood vessel for use in coronary bypass surgery. This is because the saphenous vein is typically 3 to 5 mm in diameter, i.e., about the same size as the coronary arteries. Also, the venous system of the legs is sufficiently redundant so that, after removal of the saphenous vein, other blood vessels that remain in the leg are adequate to provide return blood flow. The cephalic vein in the arm is an alternative that is sometimes used.

Previously an operation to harvest the saphenous vein required the surgeon to make an incision into the leg in order to gain access to the saphenous vein and then proceed to cut the vein from the leg. In order to expose the vein, the surgeon made a series of incisions generally from the groin to the knee or the ankle leaving one or more skin bridges along the line of the incisions. It was recommended that handling of the saphenous vein be kept to a minimum while the saphenous vein was removed from the surrounding connective tissue. After exposing the saphenous vein, the surgeon grasped the saphenous vein with his fingers while stripping off the surrounding tissues with dissecting scissors or other scraping instruments. The surgeon would use his fingers and/or blunt dissection tools to pull and lift (or mobilize) the vein from the surrounding tissue. The saphenous vein was mobilized or pulled as far as possible through each incision. To reach under the skin bridges, the surgeon lifted the skin with retractors and dug the saphenous vein free. While stripping the vein, the surgeon would encounter the various tributary blood vessels that feed into the saphenous vein. These tributaries needed to be ligated and divided. To divide and ligate the tributaries that lay under the skin bridges, the surgeon needed to cut one end of the saphenous vein and pull it under the skin bridge to gently pull the saphenous vein out from under the skin bridge until the tributary was sufficiently exposed so that it could be ligated and divided. In certain instances surgeons made one continuous incision from the groin to the knee and/or ankle. The surgeon proceeds to pull and lift the saphenous vein from the surrounding tissue and when the saphenous vein was completely mobilized, the surgeon cut the proximal and distal ends of the saphenous vein and removed it from the leg. After removal, the saphenous vein was prepared for implantation into the graft site, and the long incisions made in the leg are stitched closed. The procedure described above can be used to harvest blood vessels for a femoral popliteal bypass, in which an occluded femoral artery is bypassed from above the occlusion to the popliteal artery above or below the knee. The procedure can also be used to harvest blood vessels for the revascularization of the superior mesenteric artery that supplies blood to the abdominal cavity and intestines. In this case, the harvested blood vessel is inserted between the distal end of the aorta and patent (unblocked) section of the mesenteric artery. For bypass grafts of the lower popliteal branches in the calf, the procedure can be used to harvest the umbilical blood vessel. The harvested blood vessel can also be used for a blood vessel loop in the arm (for dialysis) between the cephalic vein and brachial artery. The procedures may be used also to harvest blood vessels for femoral-tibial, femora-peroneal, aorto-femoral, and iliac-femoral bypass operations and any other bypass operation. As can be seen from the description above, the harvesting operation is very traumatic in its own right and the long incisions created in the leg can be slow to heal and very painful.

Endoscopic surgical techniques for operations such as gall bladder removal and hernia repair have become common. In an endoscopic surgical technique the surgeon performing such a technique makes a few small incisions in the patient and inserts long tools, including forceps, scissors, and staplers through the incision deep into the body. Viewing the tools through an endoscopic laparoscope, or a video display from the endoscope, the surgeon can perform all the cutting and suturing operations necessary for a wide variety of operations. The procedures are also referred to as laparoscopic surgery, minimally invasive surgery, or video-assisted surgery. References to endoscopic surgery and endoscopes below are intended to encompass all these fields, and all operations described below with reference to endoscopes, can also be accomplished with laparoscopes, gastroscopes, and any other imaging devices which may be conveniently used. Minimally invasive procedures for blood vessel removal have been proposed in

U.S. Pat. No. 5,373,840 to Knighton. Knighton discloses a method of cutting the saphenous vein at one end, grasping the one end of the blood vessel with graspers or forceps and sliding a ring over the saphenous vein while holding it. Knighton uses a dissecting tool with an annular cutting ring, and requires that the saphenous vein be overrun or progressively surrounded with the dissecting tool and the endoscope, so that after the endoscope has been inserted as far as it will go, the entire dissected portion of the saphenous vein has been pulled in the lumen of the endoscope. As shown in FIGS. 1 and 10 of Knighton, the method requires deployment of the forceps inside the annular dissection loop, and it requires deployment of the loop and graspers inside the endoscope lumen. The saphenous vein must be cut and grasped by the forceps before it can be dissected by the dissecting ring. Consequently, this method also results in a high degree of trauma to the patient.

Thus, it is an object of the present disclosure to provide methods and devices for harvesting blood vessels with a less traumatic operation than the operations presently used to harvest blood vessels.

SUMMARY

The present disclosure is directed to devices for harvesting blood vessels from the body. The present disclosure is also directed to methods of using the devices of the present disclosure to perform the blood vessel harvesting.

In accordance with one aspect of the present disclosure, a vessel harvesting tool for harvesting a vessel from a body, includes a first vessel engaging member configured and adapted to engage the vessel and a second vessel engaging member configured and adapted to engage the vessel. The first engaging member and the second engaging member are axially and rotatably adjustable with respect to one another.

In one embodiment, the first vessel engaging member includes an elongate rod defining a longitudinal axis and a first hook formed at a distal end thereof. The first hook preferably is angularly oriented and, more preferably, substantially orthogonally oriented with respect to the elongate rod. Further, the second vessel engaging member includes a tubular body having a lumen extending therethrough and a second hook provided at a distal end of the tubular body. The second hook is preferably angularly oriented and, more preferably, substantially orthogonally oriented with respect to the tubular body. The lumen is configured and dimensioned to slidably and rotatably receive the elongate rod of the first engaging member therein.

The first hook defines a first opening and the second hook defines a second opening. The hooks are preferably oriented in such a manner as to define a channel which runs from one hook to the other when, in a distal end view of the tool, a distal end of the first hook is seen to overlap a distal end of the second hook. Thus, while in the overlapped position the first and the second hooks surround the vessel. In another embodiment, the vessel harvesting tool further includes a handle operatively coupled near a proximal end of the tubular body. The elongate rod is preferably spring biased in a first position wherein the first hook is in close proximity to the second hook. It is contemplated that the vessel harvesting tool includes a first hook actuating tab positioned near a proximal end of the elongate rod. Actuation of the tab preferably approximates the first hook to the second hook.

In another embodiment, it is contemplated that the second vessel engaging member includes a tubular body having a pair of graspers operatively coupled to a distal end thereof. The graspers are configured and adapted to be approximated toward one another to grasp the vessel therebetween. The elongate rod is preferably slidably and rotatably coupled to an outer surface of the tubular body.

In a further embodiment, the second vessel engaging member includes a tubular body having a pair of arms slidably and rotatably received within the tubular body and a grasper formed at a distal end of each arm. Each arm is preferably independently manipulatable in order to approximate the graspers toward one another. In this embodiment, each arm may be configured to have an increasing thickness in a distal direction. Accordingly, the distal ends of the arms are biased away from one another when exposed from the tubular body and are approximated toward one another when moved proximally into the tubular body. In another embodiment, the vessel harvesting tool includes an elongate body having a hook member rotatably coupled to the elongate body, preferably near a distal end of the elongate body. The elongate body defines a longitudinal axis. Preferably, the hook member is pivotable about an axis substantially orthogonal to the longitudinal axis. In an alternative embodiment, the vessel harvesting tool includes a tubular body having a hook member rotatably coupled thereto. The hook member includes a sprocket provided on a proximal end thereof, which sprocket is disposed within the tubular body. The vessel harvesting tool further includes a shaft slidably received within the tubular body. The shaft including a plurality of teeth formed near a distal end thereof, the plurality of teeth being configured and dimensioned to engage the sprocket of the hook member. According to the present embodiment, axial movement of the shaft within the tubular body causes rotation of the hook member. In an alternative embodiment, the vessel harvesting tool includes a first body member, a second body member operatively coupled to the first body member, wherein the first body member and the second body member are axially slidable relative to one another and a hook member having a proximal portion disposed between the first and second body members. According to the present embodiment, axial movement of the first body member relative to the second body member causes the hook member to rotate. Each of the first and second members include a respective recess having a toothed track formed therein and wherein the proximal end of the hook member includes a toothed sprocket configured and adapted to engage the toothed tracks. The present disclosure also provides for a method of harvesting a section of a blood vessel from a body. The method of harvesting includes providing a vessel harvesting tool. The vessel harvesting tool includes a first vessel engaging member configured and adapted to engage the vessel and a second vessel engaging member configured and adapted to engage the vessel. The first engaging member and the second engaging member are preferably axially and rotatably adjustable with respect to one another. The method further includes the steps of creating a working space proximate to an elongate body structure to be harvested, manipulating the vessel harvesting tool to place the elongate body structure within and between the first and the second vessel engaging members and axially manipulating the first engaging member with respect to the second engaging member to separate the elongate body structure from surrounding tissue.

In a further method, preferably the first and the second engaging members each respectively have a hook member provided near a distal end thereof. Each hook member is oriented to substantially surround the elongate body structure. Accordingly, relative axial movement of the hooks with respect to one another separates the elongate body structure from the surrounding tissue.

In another method, the first engaging member includes an elongate rod having a hook member formed at a distal end thereof, wherein the hook member is substantially orthogonally oriented with respect to the elongate rod. The second engaging member includes a tubular body having a hook at the distal end thereof, and one or both of the respective hooks are moved axially relative to each other to harvest the elongate body structure. The tubular body preferably has a pair of graspers operatively associated therewith. The graspers are configured and adapted to be approximated toward one another for grasping the elongate body vessel. Accordingly, the hook member separates the elongate body vessel from the surrounding tissue by moving axially along the elongate body vessel as the pair of graspers grasp the elongate body vessel therebetween.

Other objects and features of the present disclosure will become apparent from consideration of the following description taken in conjunction with the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings which constitute part of this specification, illustrate embodiments of the disclosure and, together with the general description given above, and the detailed description of the embodiments given below, serve to explain the principles of the present disclosure.

FIG. 1 is a schematic view of a leg illustrating the incisions necessary in a method for harvesting a body vessel, such as a saphenous vein, using the methods and devices presented herein;

FIG. 2 is a perspective view, with portions broken away, of a distal end of a vessel harvesting tool, in accordance with an embodiment of the present disclosure, including first and second hooks;

FIG. 3 is an end view of the vessel harvesting tool of FIG. 2;

FIG. 4 is a side elevational view, with portions broken away, of a vessel harvesting tool, in accordance with another embodiment of the present disclosure, including a handle and a trigger portion;

FIG. 5 is a side elevational view, with portions broken away, illustrating an alternative embodiment of the vessel harvesting tool of FIG. 4;

FIG. 6 is a plan view of a vessel harvesting tool, with portions broken away, in accordance with a further embodiment of the present disclosure, including a hook and a distal grasper;

FIG. 7 is a perspective view, with portions broken away, of the vessel harvesting tool of FIG. 6; FIG. 8 is a perspective view, with portions broken away, of a vessel harvesting tool, in accordance with another embodiment of the present disclosure, including a distal hook and a grasper;

FIG. 9 is a top plan view, with portions broken away, of the vessel harvesting tool of FIG. 8;

FIG. 10 is a plan view of a vessel harvesting tool, with portions broken away, in accordance with another embodiment of the present disclosure, including a reversible hook;

FIG. 11 is an end view of the vessel harvesting tool of FIG. 10; and FIG. 12 is an enlarged plan view, with portions broken away, of an alternative embodiment of a vessel harvesting tool.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

Preferred embodiments of the presently disclosed blood vessel harvesting device will now be described in detail with reference to the drawing figures wherein like reference numerals identify similar or identical elements. In the drawings and in the description which follows, the term "proximal", as is traditional will refer to the end of the surgical device or instrument of the present disclosure which is closest to the operator, while the term "distal" will refer to the end of the device which is furthest from the operator.

The methods and devices presented herein take advantage of laparoscopic procedures to lessen the trauma of blood vessel harvesting operations. Instead of making an incision along or over the entire length, or essentially the entire length of the blood vessel to be harvested, the method according to the present disclosure may be conducted with only a few small incisions. All that is needed is a working space large enough to allow the surgeon to use the device of the present disclosure and view the operation through an appropriate viewing scope.

Referring initially to FIGS. 2 and 3, a vessel harvesting tool, in accordance with the principles of the present disclosure, is shown generally as reference numeral 70. As shown in FIG. 2 vessel harvesting tool 70 includes a long slender shaft or rod 76 of preferably sufficiently stiff material, e.g., wire, defining a longitudinal axis and an angularly, here transversely, oriented first hook 80 affixed to a distal end of rod 76. Rod 76 is maintained within and is coaxial with a tube 72 and is configured to both slide relative to and preferably also rotate within tube 72. Affixed to a distal end of tube 72 is a transversely oriented second hook 90 similarly configured and dimensioned as first hook 80. First hook 80 is preferably rotatable with respect to second hook 90 in order to facilitate insertion of a saphenous vein 74 or other structure in a channel 82 (see FIG. 3) defined by first hook 80 and second hook 90 when, in an end view, first hook 80 and second hook 90 circumferentially overlap one another.

As shown in FIG. 3, hooks 80, 90 may be configured such that first hook 80 extends clockwise from rod 76 and second hook 90 extends counterclockwise from tube 72, or vice versa, so that hooks 80, 90 are in opposing relationship to one another. Such a configuration ensures that, once hooks 80, 90 are rotated toward one another to place a vessel or other body structure within channel 82 formed by hooks 80 or 90 and hooks 80, 90 are sufficiently axially close to one another, the vessel will be prevented from inadvertently falling out during harvesting. Each hook 80, 90 occupies an arc or radial segment of about 180° to 270° so that saphenous vein 74 can pass into and will lie inside channel 82 when engaged by hooks 80, 90. The diameter of channel 82 defined by hooks 80, 90 is slightly larger than the diameter of saphenous vein 74, so that hooks 80, 90 can be easily slipped under and along saphenous vein 74.

It is contemplated that shaft 76 can also have an offset or crooked segment (not shown) located distally of the distal end of tube 72 which acts to set off first hook 80 with respect to an axis established by tube 72. Both the transverse first hook 80 and transverse second hook 90 need not be but preferably are generally orthogonal to the longitudinal axes of shaft 76 and tube 72, respectively. Thus, although hooks 80, 90 are shown generally orthogonal to the axis of tube 72 and/or shaft 76, hooks 80, 90 need not be exactly orthogonal, and need only be offset to a degree sufficient to allow it to engage and encompass saphenous vein 74 upon a respective rotation toward saphenous vein 74.

Rod 76 and/or tube 72 can be made of stainless steel, titanium, plastic, or other biocompatible material including composite materials such as, e.g., nitinol. FIG. 4 shows a vessel harvesting tool 70 including an ergonomic proximal handle 62 affixed to a proximal end of tube 72. Tube 72 includes a lumen sized to accommodate rod 76, wherein first hook 80 is affixed to the distal end of rod 76 and second hook 90 is affixed to the distal end of tube 72. Rod 76 is preferably coaxially positioned within tube 72 and passes therethrough. Rod 76 has proximal and distal portions extending beyond tube 72. However, it is envisioned that rod 76 need not be coaxial with tube 72. For example, rod 76 may, be disposed next to tube 72. In such a configuration, an endoscope lumen may be provided in tube 72 for viewing the harvesting procedure.

As seen in FIG. 4, a thumb-tab 64 is provided at the proximal end of rod 76. Thumb-tab 64 is configured and adapted to be actuated to axially and/or rotationally separate first hook 80 relative to second hook 90. The proximal portion of rod 76 can include a compression spring 66 such that first hook 80 and second hook 90 are biased toward one another when released by the operator. In the configuration of FIG. 4, moving actuating thumb-tab 64 distally causes first hook 80 to move linearly distally away from second hook 90, while release of thumb-tab 64 causes first hook 80 to move linearly proximally closer to second hook 90, as indicated by double headed arrow "A". FIG. 5 shows an alternate configuration of handle 62 having a trigger assembly

68, in accordance with the present disclosure. Trigger assembly 68 includes a finger- tab 69 operatively coupled to rod 76, a guide rod 73 which is operatively coupled to finger-tab 69 and extends through handle 62, and a compression spring 66 positioned such that first hook 80 and second hook 90 are biased apart when trigger assembly 68 is released by the operator. In the configuration of FIG. 5, actuation of trigger assembly 68 causes first hook 80 to move linearly proximally closer relative to second hook 90 while release of trigger assembly 68 causes first hook 80 to move linearly away from second hook 90, as indicated by double headed arrow "A" in FIG. 5.

A preferred method of the present disclosure will now be described with reference to FIGS. 1-5 and in the context of a saphenous vein harvesting procedure. First, the surgeon creates a working space under the skin and over the saphenous vein using known laparoscopic techniques. The surgeon makes several small incisions (i.e., cut downs) 12, 13 and 14 to expose saphenous vein 74. As seen in FIG. 1, a distal incision 12 near the knee and a proximal incision 13 near the groin are preferred and if the entire length of saphenous vein 74 is to be harvested, an additional incision 14 can be made close to the ankle. Saphenous vein 74 can be seen through incisions 12-14. It will be apparent from the description that the use of three or four incisions used to harvest the entire saphenous vein are merely a matter of convenience, and those particularly skilled in laparoscopic procedures may require fewer incisions or more incisions as required.

After making the necessary incisions, the surgeon preferably inserts a blunt tunneling tool (not shown) into one incision and pushes it along saphenous vein 74 towards another incision. The tunneling creates a tunnel or channel running along saphenous vein 74. The tunnel may be expanded by insertion of the balloon described herein, which can be inflated to expand or propagate the tunnel further along saphenous vein 74. U.S. Pat. No. 5,899,913, the disclosure of which is incorporated herein by reference in its entirety, describes suitable methods and devices for creating and expanding a working space proximate a body structure to be harvested, such as saphenous vein 74.

When the tunnel is of sufficient size, the incisions may be sealed with a trocar 37. Trocar 37 is used to insert the various tools used in the procedure. One trocar 37 is used to inject or infuse carbon dioxide (CO₂) or other gas (or liquid) into the tunnel in a procedure known as insufflation, which pressurizes the tunnel and keeps it open and expanded to make it easier to see inside the tunnel and easier to insert and manipulate an endoscope and instruments into the tunnel. Insufflation is accomplished with techniques generally known to endoscopic and laparoscopic surgeons. The insufflation creates an inflated space under the skin. An endoscope or laparoscope may also be inserted into trocar 37. The endoscope permits the surgeon to view the tunnel, including saphenous vein 74 and connective tissue. The endoscope fits tightly into trocar 37 so as to create a seal between the endoscope and the trocar, thus helping to maintain the pressure of the CO₂. Other systems for dissection and retraction are shown in US. Pat. No. 6,228,024, U.S. Pat. No. 6,068,039 and U.S. Pat, No. 6,196,968, the disclosures of which are incorporated herein by reference in their entireties.

Preferably while the working space is insufflated or otherwise retracted, vessel harvesting tool 70 is inserted through trocar 37 and operated to dissect and strip saphenous vein 74 and mobilize it. As described above, the incision may optionally be made at the knee, as indicated by incision 12 of FIG. 1 or the ankle, or may be made at both the knee and the ankle so that the balloon dissecting devices and vessel harvesting devices can be used to dissect the saphenous vein first in the thigh and then in the calf, or vice-versa.

With reference to FIG. 2, a method of the present disclosure is shown wherein vessel harvesting tool 70 has been rotated by the surgeon so that first hook 80 is slipped under and around saphenous vein 74. Similarly, second hook 90 is counter-rotated and slipped under and around saphenous vein 74 so that saphenous vein 74 lies within channel 82 created by first hook 80 and second hook 90. The surgeon may then pull vessel harvesting tool 70 while operating thumb-tab 64 (see FIG. 4) to advance first hook 80 distally to provide countertraction to saphenous vein 74 and to facilitate stripping of saphenous vein 74 from the vessel bed and free of connective tissue. The surgeon may also rotate vessel harvesting tool 70 to aid in freeing or dissecting saphenous vein 74 from the connective tissue. When a side branch 71 is encountered by first hook 80 or second hook 90, movement of hooks 80 or 90 will be blocked by side branch 71. Moreover, hooks 80, 90 can be used to expose side branch 71 for ligation and division from saphenous vein 74. After the entirety of the desired length of saphenous vein 74 has been separated from the connective tissue and as explained, the appropriate branches 71 have been ligated and truncated, saphenous vein 74 can be grasped with laparoscopic grippers and pulled from the leg through groin incision 13, knee incision 12 or ankle incision 14. Vessel harvesting tool 70 may also be manipulated to lift or mobilize saphenous vein 74 from the vessel bed in which it lies. Vessel harvesting tool 70 can be pushed and pulled as necessary to separate or dissect the connective tissue from saphenous vein 74 with counter-traction being provided by first hook 80.

Saphenous vein 74 has a number of tributary veins (i.e., branches 71) that carry venous blood into it. These tributaries must be tied off and cut off from saphenous vein 74 before saphenous vein 74 can be removed. In medical terms, these tributaries must be ligated and divided or transected. These tributary veins can be readily identified with vessel harvesting tool 70 because the surgeon will feel the resistance while pulling and will not be able to pull hooks 80, 90 through a tributary vein. When a tributary vein is encountered, the surgeon can use standard endoscopic and laparoscopic tools to close the tributaries and cut them from saphenous vein 74. Turning now to FIG. 6, an alternate vessel harvesting tool, in accordance with the present disclosure, is shown generally as 100. Vessel harvesting tool 100 includes a tube 110 having a pair of graspers 114 disposed on a distal end thereof. Vessel harvesting tool 100 can include a proximal handle (not shown) having a trigger configured and adapted to actuate graspers 114. Vessel harvesting tool 100 further includes a hook dissector 112 disposed on a distal end of shaft 113. Hook dissector 112 and shaft 113 are preferably configured similarly to first hook 80 and shaft 76 described in connection with FIGS. 2-5 above. Although shaft 113 may be parallel to tube 110, tube 110 may also be provided with a lumen in which shaft 113 is disposed so that shaft 113 is coaxial with tube 110.

Tube 110 and/or shaft 113 are adapted such that shaft 113 is axially slidable relative to tube 110 and is also preferably axially rotatable to facilitate sliding and rotating of hook 112 around a vessel or other body structure. For example, one or more retaining tabs 131 can be provided on the outer surface of tube 110 (see FIG. 7) to maintain shaft 113 in slidably parallel orientation with respect to tube 110. Preferably, shaft 113 includes a proximal actuator (not shown) that can be manipulated by the operator to advance, retract and/or rotate hook 112 to dissect a body structure free of surrounding connective tissue. This may include a simple finger ring or a trigger that is actuated by the operator. Also, tube 110 may include a proximal actuator, i.e., a trigger (not shown) that opens and closes graspers 114. The structures of various actuators suitable for these applications are well known in the art. Each grasper 114 may further include juxtaposed gnurled gripping inner surfaces 116 in order to prevent slippage of saphenous vein 74.

Other features may be included with vessel harvesting tool 100 in order to facilitate its operation. For example, as shown in FIG. 6, tube 110 may include an endoscope channel 117 having a distal lens 115 for viewing the harvesting operation. Endoscope channel 117 may also have a slot (not shown) along the underside of the tube to allow the endoscope to be partially withdrawn in order to view the operation of hook 112 during harvesting of saphenous vein 74 using a downwardly facing lens 115a, as shown in FIG. 7. In an alternative embodiment, as seen in FIG. 7, vessel harvesting tool 100 includes a pair of arms 122 slidably and rotatably received within tube 110. Each arm 122 terminates in a grasper 114 formed at a distal end thereof. With reference to FIG. 7, a method of use is shown wherein vessel harvesting tool 100 is shown harvesting saphenous vein 74. Graspers 114 securely hold saphenous vein 74 while hook 112 is used to strip and free saphenous vein 74 of connective tissue. Particularly, hook 112 is pulled proximally to provide counter-traction to graspers 114 and to strip saphenous vein 74 free.

FIGS. 8-9 show an alternate configuration of a vessel harvesting tool generally designated as 200. Vessel harvesting tool 200 includes a tubular body 220 defining a lumen therein, a pair of arms 222 slidably and rotatably received within the lumen of tubular body 220 and a harvesting hook 212 having a shaft 230 operatively coupled to the outer surface of tubular body 220 in such a manner as to permit slidable and rotatable movement of hook 212 relative to tubular body 220. Each arm 222 terminates in a grasper 224. Particularly, as shown in FIG. 9, arms 222 are configured to have an increasing thickness "t" in the distal direction. Moreover, arms 222 are made from a shape memory alloy that allows them to spring apart as graspers 224 are moved distally as indicated by double headed arrow "B" with respect to the distal opening of tubular body 220. Conversely, when arms 222 are retracted proximally in a direction opposite to the direction indicated by arrow "B" into tubular body 220, the increasing thickness "t" of arms 222 causes the edge of the distal opening of tubular body 220 to contact and press against arms 222, forcing graspers 224 together. In this manner, graspers 224 can securely grasp a vessel (i.e., the saphenous vein) therebetween merely by firmly retracting arms 222 proximally into tubular body 220.

Turning now to FIG. 10, an alternative vessel harvesting tool is shown generally as 300. Vessel harvesting tool 300 includes a tubular body 302 defining a longitudinal axis "X" having a reversible left-hand/right-hand hook 304 disposed on a distal end thereof. Hook 304 includes a toothed sprocket 306 that engages teeth 308 provided on an inner shaft 310. Inner shaft 310 is axially slidable within tubular body 302 and causes hook 304 to rotate about a central axis "Y" axis (see FIG. 11) of sprocket 306. Preferably, central axis "Y" is orthogonally oriented with respect to the longitudinal "X" axis. Vessel harvesting tool 300 also includes a proximal actuator (not shown) to manipulate inner shaft 310 in a proximal and/or a distal direction, indicated by double headed arrow "C", to vary the orientation of hook 304 from a right-hand to a left-hand configuration. Vessel harvesting tool 300 may be particularly desirable when encountering side-branches as, depending on the vessel geometry, side-branches are more easily manipulated with a particular orientation of hook 304. Thus, the angular disposition of hook 304 relative to tubular body 302 may be easily altered depending on the geometry of the vessel or body structure harvested.

FIG. 11 shows an end view of vessel harvesting tool 300 illustrating the left- hand (dashed lines) and right-hand configuration (solid line) of hook 304 of FIG. 10.

FIG. 12 is an enlarged view of an alternate reversible left-hand/right-hand vessel harvesting tool shown generally as 350. Vessel harvesting tool 350 includes a first member 352 and a second member 354 wherein first and second members 352, 354 are axially slidable relative to each other. First and second members 352, 354 include respective recesses 356a, 356b having respective toothed tracks 362a, 362b. Disposed between recesses 356a, 356b of first and second members 352, 354 is a hook 358, wherein hook 358 includes a toothed sprocket 360 configured and adapted to engage tracks 362a and 362b. Thus, when first and second members 352, 354 are slid relative to each other, toothed tracks 362a, 362b engage sprocket 360 and cause hook 358 to rotate from a left-hand to a right-hand configuration or vice versa.

The devices and methods described above have been developed in the field of blood vessel harvesting and vascular surgery. It is, however, readily apparent that the devices and methods may be used for dissecting and mobilizing other elongate organs of the body. Various arteries, veins, and blood vessels must be dissected and mobilized for other operations, such as popliteal bypass, or a dialysis vein loop. In these operations, a blood vessel must be harvested, and the sites at which the blood vessel will be attached or amostosized must also be uncovered. The methods described herein may be applied to harvesting blood vessels, veins, or arteries other than saphenous vein 74, and may be employed for harvesting blood vessels for transplant into any area of the body. Where appropriate, the devices and methods may be used during open surgery to facilitate the removal of blood vessels, veins, or arteries, in which case the working space is provided by the normal open surgery techniques. While the preferred embodiments of the devices and methods have been described herein, they are merely illustrative of the principles of the invention. Other embodiments and configurations may be devised without departing from the spirit of the inventions and the scope of the appended claims.

Claims

WHAT IS CLAIMED IS:

1. A vessel harvesting tool for harvesting vessels from a body, comprising: a first vessel engaging member configured and adapted to engage a vessel; and a second vessel engaging member configured and adapted to engage the vessel, wherein the first engaging member and the second engaging member are axially and rotatably adjustable with respect to one another.

2. The vessel harvesting tool according to claim 1, wherein the first vessel engaging member includes an elongate rod defining a longitudinal axis and a first hook formed at a distal end thereof, the first hook being angularly oriented with respect to the elongate rod.

3. The vessel harvesting tool according to claim 2, wherein the first hook is substantially orthogonally oriented with respect to the elongate rod.

4. The vessel harvesting tool according to claim 2, wherein the second vessel engaging member includes a tubular body having a lumen extending therethrough and a second hook provided at a distal end of the tubular body, the second hook being angularly oriented with respect to the tubular body, the lumen being configured and dimensioned to slidably and rotatably receive the elongate rod of the first engaging member therein.

5. The vessel harvesting tool according to claim 4, wherein the second hook is substantially orthogonally oriented with respect to the tubular body.

6. The vessel harvesting tool according to claim 4, wherein the first hook defines a first opening and the second hook defines a second opening, wherein the hooks are oriented to define a channel running from one hook to the other when, in a distal end view of the tool, a distal end of the first hook is seen to overlap a distal end of the second hook, and wherein in the overlapped position the first and the second hooks surround the vessel.

7. The vessel harvesting tool according to claim 6, wherein the vessel harvesting tool further comprises: a handle operatively coupled near a proximal end of the tubular body, wherein the elongate rod is spring biased in a first position wherein the first hook is in close proximity to the second hook.

8. The vessel harvesting tool according to claim 7, wherein the vessel harvesting tool includes a first hook actuating tab positioned near a proximal end of the elongate rod, wherein actuation of the tab approximates the first hook to the second hook.

9. The vessel harvesting tool according to claim 2, wherein the second vessel engaging member includes a tubular body having a pair of graspers operatively coupled to a distal end thereof, wherein the graspers are configured and adapted to be approximated toward one another to grasp the vessel therebetween.

10. The vessel harvesting tool according to claim 9, wherein the elongate rod is slidably and rotatably coupled to an outer surface of the tubular body.

11. The vessel harvesting tool according to claim 2, wherein the second vessel engaging member includes a tubular body having a pair of arms slidably and rotatbly received within the tubular body and a grasper formed at a distal end of each arm, wherein each arm is independently manipulatable in order to approximate the graspers toward one another.

12. The vessel harvesting tool according to claim 11, wherein each arm is configured to have an increasing thickness in a distal direction, wherein the distal end of the arms are biased away from one another when exposed from the tubular body and wherein the distal end of the arms approximate toward one another when the arms are moved proximally into the tubular body.

13. A vessel harvesting tool for harvesting a vessel from a body, comprising: an elongate body having a hook member rotatably coupled to the elongate body, the elongate body defining a longitudinal axis, and the hook member being pivotable about an axis substantially orthogonal to the longitudinal axis.

14. The vessel harvesting tool according to claim 13, wherein the hook member is rotatably coupled near a distal end of the elongate body.

15. The vessel harvesting tool according to claim 14, wherein the vessel harvesting tool comprises: a tubular body having a hook member rotatably coupled thereto, wherein the hook member includes a sprocket provided on a proximal end thereof and disposed within the tubular body; and a shaft slidably received within the tubular body, the shaft including a plurality of teeth formed near a distal end thereof, the plurality of teeth being configured and dimensioned to engage the sprocket of the hook member, wherein axial movement of the shaft within the tubular body causes the hook member to rotate.

16. The vessel harvesting tool according to claim 13, wherein the vessel harvesting tool comprises: a first body member; a second body member operatively coupled to the first body member, wherein the first body member and the second body member are axially slidable relative to one another; and a hook member having a proximal portion disposed between the first and second body members, wherein axial movement of the first body member relative to the second body member causes the hook member to rotate.

17. The vessel harvesting tool according to claim 16, wherein each of the first and second members include a respective recess having a toothed track formed therein and wherein the proximal end of the hook member includes a toothed sprocket configured and adapted to engage the toothed tracks.

18. A method of harvesting an elongate body structure comprising: providing a vessel harvesting tool, the vessel harvesting tool including: a first vessel engaging member configured and adapted to engage the vessel; and a second vessel engaging member configured and adapted to engage the vessel, wherein the first engaging member and the second engaging member are axially and rotatably adjustable with respect to one another; creating a working space proximate to an elongate body structure to be harvested; manipulating the vessel harvesting tool to place the elongate body structure within and between the first and the second vessel engaging members; and axially manipulating the first engaging member with respect to the second engaging member to separate the elongate body structure from surrounding tissue.

19. The method according to claim 18, wherein the first and the second engaging members each respectively have a hook member provided near a distal end thereof, wherein each hook member is oriented to substantially surround the elongate body structure, and wherein relative axial movement of the hooks with respect to one another separates the elongate body structure from the surrounding tissue.

20. The method according to claim 18, wherein the first engaging member includes an elongate rod having a hook member formed at a distal end thereof, the hook member being substantially orthogonally oriented with respect to the elongate rod, and wherein the second engaging member includes a tubular body having a hook at the distal end thereof, and one or both of the respective hooks is or are moved axially relative to each other to harvest the elongate body structure.

21. The method according to claim 20, the tubular body includes a pair of graspers operatively associated therewith, wherein the graspers are configured and adapted to be approximated toward one another for grasping the elongate body vessel, and wherein the hook member separates the elongate body vessel from the surrounding tissue by moving axially along the elongate body vessel as the pair of graspers grasp the elongate body vessel therebetween.

22. A vessel harvesting tool for harvesting vessels from a body, comprising: a first vessel engaging member including an elongate rod defining a longitudinal axis and a first hook provided at a distal end of the elongate rod, wherein the first hook is angularly oriented with respect to the elongate rod; a second vessel engaging member including a tubular body having a lumen extending therethrough and a second hook provided at a distal end thereof, wherein the second hook is angularly oriented with respect to the tubular body, the tubular body being configured and adapted to slidably and rotatably retain the elongate rod therein, wherein the first hook defines a first opening and the second hook defines a second opening, wherein the hooks are oriented to define a channel running from one hook to the other when, in a distal end view of the tool, a distal end of the first hook is seen to overlap a distal end of the second hook, and wherein in the overlapped position the first and the second hook surround the vessel; and a handle operatively coupled near a proximal end of the tubular body, wherein the elongate rod is spring biased in a first position wherein the first hook is in close proximity to the second hook.

23. The vessel harvesting tool according to claim 22, wherein the vessel harvesting tool includes a first hook actuating tab positioned near a proximal end of the elongate rod, wherein actuation of the first hook actuating tab axially displaces the first hook with respect to the second hook.