CIRURGICAL INSTRUMENTS

专利摘要:
surgical instruments, systems and methods of use a surgical instrument (10, 100) includes a support body (22, 122), a joining element, an arm, and a working end (14, 114), the support body (22, 122) has an upper portion, a distal end (24, 124), a proximal end and a lower portion. the joining element is pivotally mounted on an extreme distal portion (24, 124) of the support body (22, 122) to allow positioning of a proximal portion of an arm (12, 112) extending distally from the joining element (30, 130). the joining element (30, 130) is also configured to at least partially limit movement of the proximal portion of the arm (12, 112) to a plane. the work end (30, 130) is mounted on an extreme distal portion of the arm. the surgical instrument (10,100) can be configured as a heart stabilizer or a heart positioner. the joining element (30, 130) can be additionally configured as a slotted sphere (36, 136), a disc element (34, 134) or a combination thereof.
公开号:BR112012032039B1
申请号:R112012032039-4
申请日:2011-06-14
公开日:2020-12-15
发明作者:Andrew Serowski；Juan I. Perez；Kumar Jambunathan；Kyle Klein；Kristopher Yee
申请人:Maquet Cardiovascular Llc；
IPC主号:

专利说明:

REMISSIVE REFERENCE TO RELATED ORDERS
This application claims priority to provisional US patent application serial number 61 / 354,516, entitled “Surgical instruments, systems and methods of use” that was filed on June 14, 2010 and US patent application serial number 13 / 160,445, entitled “Surgical instruments, systems and methods of use” filed on June 14, 2011, the contents of which are incorporated here as a reference in full. FIELD OF THE INVENTION
The present invention relates generally to surgical instruments, and more particularly to surgical instruments useful for engaging surfaces of an organ, including organ stabilizing instruments and organ positioning instruments and their related components. BACKGROUND OF THE INVENTION
Diseases of the cardiovascular system affect millions of people annually and are a leading cause of death worldwide. The cost to society of such diseases is enormous both in terms of the number of lives lost and in terms of the costs associated with treating patients using traditional surgical techniques. A particularly prevalent form of cardiovascular disease is a reduction in the blood supply that leads to the heart caused by atherosclerosis or another condition that creates a restriction in blood flow at a critical point in the vasculature that supplies blood to the heart.
One option for treating such a blockage or restriction in the blood flow it supplies to the heart is a procedure known as a coronary artery bypass graft (CABG) surgery, more commonly known as a "heart bypass" operation. In the CABG procedure, the surgeon "deflects" the obstruction to recover adequate blood flow to the heart by attaching an available source vessel to the obstructed target coronary artery or removing a portion of a vein or artery from another part of the body, to use as a graft and installing the graft between a point in a source vessel and a point in a target artery.
To restore an adequate blood supply to the heart, the CABG procedure requires that a fluid connection be established between two vessels. This procedure is known as an "anastomosis." Typically, a source vessel, such as a source artery with an unobstructed blood flow, that is, the left or right internal mammary artery (IMA) or a bypass graft having an end sewn to an unobstructed blood source such as the aorta, it is sewn into a target closed coronary artery, such as the left anterior descending artery (LAD) or another vessel that provides blood flow to the heart muscles.
Although the CABG procedure has become relatively common, the procedure itself is long and traumatic and can damage the heart, cardiovascular system, brain and blood cells, as well as activate plasma cascade systems. In a conventional CABG procedure, the surgeon makes an incision down the center of the chest, cuts through the sternum, performs several other procedures necessary to connect the patient to a heart-lung bypass machine, stops the blood flow to the heart and then for the heart to beat to complete the bypass. Traumatic and longer surgical procedures are needed, in part, to connect the patient to a cardiopulmonary bypass machine (CPB) to continue the circulation of oxygenated blood to the rest of the body while the bypass is completed.
In recent years, an increasing number of surgeons have started performing CABG procedures using specially developed surgical techniques so that the CABG procedure could be performed while the heart is still beating. In such procedures, there is no need for any form of cardiopulmonary bypass, and no need to stop the heart. As a result, these beating heart procedures are much less invasive and carry a lower risk of postoperative neurological complications. In certain situations, the CABG full-beating heart procedure can be performed through a small number, typically one or two, of comparatively small incisions in the chest, further reducing the risk of postoperative injury complications.
When CABG procedures are performed on a beating heart, a surgical stabilizing instrument is typically used to stabilize the heart tissue in the area of the anastomosis. Several surgical stabilizing instruments are available today. Typically, the surgical stabilizing instrument will have some form of fixation mechanism that allows it to be fixed to the sternum retractor, so that it is kept fixed in relation to the tissue to be stabilized. A disadvantage of currently available stabilizing instruments is that they tend to extend very far through the open chest cavity and can obstruct the surgeon's hand movements in some cases. In addition, the arm and attachment mechanism also extend above the surface of the retractor and can also form an obstruction.
There is a continuing need for surgical stabilizing instruments having a lower profile and which can be extended into the chest cavity in a configuration that causes less obstruction for the surgeon who operates.
When an anastomosis must be performed in a surgical target area that is not readily accessible by the surgeon (for example, one or more arteries of interest are located in the lateral or posterior aspects of the heart, making access to such arteries difficult), the heart is typically repositioned by hand, by the surgeon or assistant to the surgeon, or more commonly, by attaching an organ positioning instrument to the heart, to reposition and maintain the heart in a displaced position through the organ positioning instrument.
Various organ positioning instruments are available today. Typically, the organ positioner will have some form of fixation mechanism that allows it to be attached to the sternum retractor, so that it can be supported by the sternum retractor while holding the organ in the displaced position.
A disadvantage of currently available organ positioning instruments is that they tend to extend too far through the open chest cavity and may obstruct the surgeon's hand movements in some cases, and may prevent visualization of some areas in the surgical field.
There is a continuing need for organ positioning instruments that can be extended into the chest cavity in a configuration that causes less obstruction for the surgeon who operates.
The present invention addresses these needs as well as providing additional improved aspects that will become apparent after reading the detailed description below. BRIEF DESCRIPTION OF THE INVENTION
A surgical instrument according to an exemplary embodiment of the present invention comprises: a support body having an upper portion, a distal end, a proximal end and a lower portion; a joining element pivotally mounted on an extreme distal portion of the support body to allow positioning of a proximal portion of an arm extending distally from the joining element, the joining element configured to at least partially limit the movement of the proximal portion of the arm to a plane; and a working end mounted on an extreme distal portion of the arm.
According to an example embodiment, the junction element comprises a first junction element and a second junction element, wherein the first junction element confines movement of the proximal portion of the arm to yaw, and the second junction element confines movement from the proximal portion, from the arm to heaving.
According to an example embodiment, the joining element pivotally mounted on the extreme distal portion of the support body is a disc element.
According to an example embodiment, the joining element further comprises a slotted sphere.
According to an example embodiment, the joining element is a disc element, and the slotted sphere is connected to the disc element.
According to an example embodiment, further comprising an actuator rotatably mounted to the support body towards the proximal end of the support body, and a cable extending from the actuator through the support body, joint element, slotted sphere and arm, the driver and the cable being configured to change an arm state from a flexible state to a rigid state by moving the trigger in a first direction, and from the rigid state to the flexible state by moving the driver is a second direction opposite to first direction.
According to an example modality, the movement of the trigger involves rotation, the first direction is a first direction of rotation, and the second direction is a counter-rotational direction.
According to an example embodiment, the slotted ball element forms a joint with a proximal end of the arm.
According to an example embodiment, the upper and lower surfaces of the disc element extend substantially parallel to the upper portion of the support body, and in which the slotted sphere is able to pivot to an angularly downward position from a plane parallel to the upper and lower surfaces of the disc element.
According to an example embodiment, the instrument further comprising a vacuum tube in fluid communication with the working end, and the working end is configured to fix reversibly to the outer surface of a human's heart.
According to an example modality, the instrument further comprises an actuator rotatably mounted to the support body at the proximal end of the support body, the actuator being configured to change a state of the arm from a flexible state to a rigid state by rotating the actuator in a first rotational direction, and from the rigid state to the flexible state by rotating the actuator in a counter-rotational direction.
According to an example modality, the instrument further comprises a suction tube in fluid communication with the working end, and a clamp configured to temporarily receive and retain the suction tube to keep the suction tube in a low profile with the instrument, in which the arm is formed with or connected to the support body, the driver, or both the support body and the driver.
According to an example embodiment, the actuator comprises a plurality of fins with one of the clips formed on one or more of the fins.
According to an example embodiment, the instrument is an organ stabilizer and the working end comprises at least one contact element configured to be exerted against a tissue surface to stabilize the tissue surface.
According to an example embodiment, the instrument is an organ positioner and the working end comprises a suction element defining a vacuum space therein, in which the suction element is configured to receive the apex of a human heart. instrument is additionally configured to exert sufficient suction force on the heart to move the heart when the suction element is placed against the heart, a negative pressure of 250 mm of Mercury is applied in the vacuum space to engage the suction element with the heart , and the suction element is moved.
According to an example embodiment, the lower portion comprises an assembly mechanism configured to reversibly secure the instrument to a fixed object.
According to an example embodiment, the mounting mechanism is fixed to a surface of a sternum retractor, the sternum retractor comprising a sternum retractor blade mounted on or integral with the sternum retractor, on which the arm is capable to be oriented downwards to make contact with an internal surface of a sternum retractor blade without requiring movement of the actuator with respect to the mounting body.
According to an example embodiment, the assembly mechanism comprises a fixed jaw and a movable jaw; and wherein a mounting mechanism driver is pivotally mounted at the bottom and at least partially above the movable jaw, the mounting mechanism driver being configured to move the movable jaw from an unlocked position to a locked position and vice versa .
According to an example embodiment, the mounting mechanism driver is configured to move the movable jaw towards the locked position when the mounting mechanism driver is pulled in a proximal direction.
According to an example embodiment, the assembly mechanism comprises a fixed jaw which is unitarily formed with the main body, and a movable jaw movably engaged with the main body.
According to an example embodiment, the instrument comprises a cam mounted above a lower surface of the movable jaw and below the mounting mechanism driver, the cam connected to the mounting mechanism driver to be actuated to lock or unlock the movable jaw .
According to an example embodiment, the mounting mechanism comprises a mounting mechanism driver, the mounting mechanism driver including oscillating switches with cams configured to attach to the fixed object.
According to an example embodiment, the instrument is a stabilizer and the working end comprises a pair of contact elements and / or a blowing / mist forming device incorporated in at least one of the contact elements.
According to an example modality, the instrument is a stabilizer configured for a blower / mist forming device to be attached to it. The instrument is a stabilizer and the working end comprises a pair of contact elements and a support for connecting the contact elements to the arm, where the support is pivotally connected to the contact elements.
According to an example embodiment, the contact elements individually comprise a clamp at an extreme portion close thereto, the clamps configured to form a pressure fit with the support elements.
According to an example modality, the instrument is a stabilizer and the working end comprises a pair of contact elements, the contact elements each having a relatively thicker cross-sectional dimension on an outer edge of it and a dimension in relatively thin cross section at an inner edge of it.
According to an example embodiment, the arm comprises an intermediate link which is adjustable by a user to adjust a portion of the distal arm of the intermediate link and the working element to assume a flexible configuration in a first configuration, and to assume a rigid configuration in a second configuration, while allowing a portion of the arm near the intermediate connection to remain flexible during both the first configuration and the second configuration.
According to an example embodiment, the arm comprises an intermediate link which is adjustable by a user to adjust a portion of the arm close to the intermediate link to assume a flexible configuration in a first configuration, and to assume a rigid configuration in a second configuration, while allowing a portion of the arm away from the intermediate connection and the working end to remain flexible during both the first configuration and the second configuration.
According to an example modality, the instrument further comprises a motor configured to operate the driver, and a second driver, located distally from the driver and the motor, electrically connected to the motor, and configured to drive the motor to drive the driver to increase or decrease stiffness in the arm and a connection between the arm and the working end.
According to an example embodiment, the upper portion is smooth and comprises a flat portion with no obstructions in it, and in which the upper surface provides a surgeon's hand rest, which can be used to help stabilize the surgeon's hand. surgeon.
According to an exemplary embodiment, ridges or teeth provided around at least a portion of a perimeter of the disc element.
According to an example embodiment, the instrument comprises a cable extending through the disc element, at least a portion of the arm, and at least a portion of the support body, wherein the disc element comprises a slot formed therein, the slit being curved to facilitate flexing and clamping the cable against it when the disc element was pivoted, thereby helping to eliminate or reduce variations in at least one of the cable length and cable tension at different angular positions of the disc element in relation to the support body.
According to an example embodiment, the disk element comprises a slot formed therein, the slot being curved to facilitate flexing and tightening the cable against it when the disk element was pivoted, thereby helping to eliminate or reduce variations by minus one of the cable length and cable tension at different angular positions of the disc element in relation to the support body.
According to an example modality, the instrument further comprises a driver pivotally mounted to the support body at the proximal end of the support body and a cable extending from the driver through the support body, disc element, slotted sphere and arm , the driver and cable being configured to change an arm state from a flexible state to a rigid state by rotating the driver in a first rotational direction, and from the rigid state to a flexible state by rotating the driver in a counterrotational direction.
According to an example embodiment, the instrument comprises a vessel in fluid communication with the vacuum tube, the vessel having an opening for connecting the vessel in fluid communication with a vacuum source, the vessel configured to retain fluid in it .
According to an example embodiment, the instrument comprises a filter in fluid communication with the opening of the container, the filter configured to be connected to a vacuum source and to filter materials in effluent particles from the container.
According to an example embodiment, the container has at least one substantially flat side.
According to an example embodiment, the instrument comprises a strip connected to the container and adapted to suspend the container in a vertical orientation in which the opening for connecting the container with a vacuum source is higher than a connection that forms the communication of fluid from the container with the vacuum tube.
According to an example embodiment, a surface of the container is misted up to inhibit glare from there.
Surgical instrument, according to an exemplary embodiment of the present invention, comprises: a support body, an arm and a tool; the support body configured for use with a retractor, a lower surface of the support body facing the retractor when assembled, a front edge of the support body extending at an angle to the bottom surface; the arm pivotally connected at a proximal end of the arm through the extreme joint to the front edge of the support body; the tool connected to a distal end of the arm; the arm configured to be movable between a plurality of positions relative to the support body and to be temporarily lockable in those positions.
According to an example embodiment, the joint is configured in such a way that a proximal portion of the arm extending from or adjacent to the support body is pivotable to the support body and temporarily lockable in a position substantially perpendicular to the support body.
According to an example embodiment, the joint is configured in such a way that a proximal portion of the arm extending from and adjacent to the support body is movable from a left distal region of the support body to a right distal region of the support body and vice versa.
A surgical instrument according to an exemplary embodiment of the present invention comprises a support body, an arm, a tool and a tube; the support body configured to mount on a retractor or an operating table; the arm pivotally connected at an end proximal to the support body; the tool connected to a distal end of the arm; the arm configured to be movable between a plurality of positions in relation to the support body and to be temporarily lockable in those positions; a distal end of the tube connected to or adjacent to a distal end of the arm; and the support body configured to removably retain the tube.
According to an example embodiment, the support body includes a recess dimensioned to receive and removably retain the tube.
According to an example embodiment, the support body includes a clip sized to receive and removably retain the tube.
According to an example modality, the support body further comprising a rotary mounted actuator on the surgical instrument, the actuator being configured to change a state of the arm from a flexible state to a rigid state by rotating the actuator in a first rotational direction, and from the rigid state to the flexible state by rotating the actuator in a counter-rotational direction; and the driver configured to removably retain the tube.
An example method of operating a surgical instrument in accordance with the present invention comprises the steps of securing an instrument support body to a fixed object so that the support body is not movable with respect to the fixed object; adjusting an orientation of an arm extending from a distal end of the support body; and rotating a pivotally mounted actuator at a proximal end of the support body, thereby fixing the orientation of the arm with respect to the support body in a rigid configuration.
According to an example embodiment, a tensioning cable extends through at least portions of the near half of the arm and the supporting body and connects with the driver, and the rotation of the driver increases tension in the cable.
According to an example embodiment, the fixed object is a sternum retractor and the arm contacts an internal surface of the sternum retractor in the rigid configuration.
According to an example modality, the instrument is a surgical stabilizer.
According to an example modality, the instrument is a surgical stabilizer for beating heart surgery, or an organ positioner for beating heart surgery.
A surgical instrument according to an exemplary embodiment of the present invention comprises: a support body, an arm, and a tool; the support body configured to support a retractor, a lower surface of the support body facing the retractor when assembled, a front edge of the support body extending at an angle to the bottom surface; the arm pivotally connected at a proximal end of the arm through the joint to or along the front edge of the support body; the tool connected to a distal end of the arm; the arm configured to be movable between a plurality of positions in relation to the support body and to be temporarily lockable in those positions; and the joint configured in such a way that a proximal portion of the arm extending from and adjacent to the support body is pivotable to and temporarily lockable in a position substantially perpendicular to the support body along portions of the front edge.
According to an example embodiment, the surgical instrument further comprises a universal connector configured to connect the support body to any of a plurality of retractors of different sizes.
According to an example embodiment, the gasket includes a disc element.
According to an example embodiment, the joint includes a slotted ball.
A surgical instrument in accordance with an exemplary embodiment of the present invention comprises: a pivotally mounted driver on the support body at the proximal end of the support body and a cable extending from the driver through the support body, disk element, sphere with slot and arm, and the driver and cable are configured to change an arm state from a flexible state to a rigid state by rotating the driver in a first rotational direction, and from the rigid state to a flexible state by rotating the driver in a counter-rotational direction.
According to an example embodiment, a tube is provided in fluid communication with the tool.
According to an example embodiment, a tube is provided in fluid communication with the tool, and the driver includes a clamp configured to receive and temporarily retain the tube to keep the tube in a low profile arrangement with the instrument.
According to an example embodiment, the support body includes a recess dimensioned to receive and removably retain the tube.
According to an example embodiment, the instrument is a stabilizer and the tool comprises at least one contact element configured to be exerted against a fabric surface to stabilize the fabric surface.
According to an example embodiment, the instrument is a positioner and the tool comprises a suction element defining a vacuum space therein, in which the suction element is configured to exert sufficient suction force on an organ to move the organ when the suction element is placed against the organ, negative pressure is applied to the vacuum space to engage the suction element with the organ and the suction element is moved.
According to an example modality, the instrument includes; a cable extending through the disc element, at least a portion of the arm and at least a portion of the support body, wherein the disc element comprises a slot formed therein, the slot being curved to facilitate flexing and tightening the cable against the same when the disk element has been pivoted, thereby helping to eliminate or reduce variations in at least one of cable length and cable tension at different angular positions of the disk element with respect to the support body.
According to an example embodiment, a driver is pivotally mounted to the support body at the proximal end of the support body and a cable extends from the driver through the support body, disc element, slotted sphere and arm.
According to an example modality, the driver and the cable are configured to change a state of the arm from a flexible state to a rigid state by rotation of the driver in a first rotational direction, and from the rigid state to the flexible state by rotation of the trigger in a counter-rotational direction.
According to an example embodiment, a container is provided in fluid communication with the tube, the container having an opening for connecting the fluid communication container with a vacuum source, the container configured to retain fluid therein.
According to an example embodiment, a filter is in fluid communication with the opening of the container, and the filter is configured to be connected to the vacuum source and to filter material in effluent particles from the container.
According to an example embodiment, a strip is connected to the container and adapted to hang the container in a vertical orientation in which the opening for connecting the container with a vacuum source is higher than a connection that forms fluid communication. the container with the vacuum tube.
According to an example embodiment, a surgical instrument is provided that includes a support body, an arm, a tool, and a tube; the support body configured to support on a retractor or an operating table; the arm pivotally connected at an end proximal to the support body; the tool connected to a distal end of the arm; the arm configured to be movable between a plurality of positions in relation to the support body and to be temporarily lockable in those positions; a distal end of the tube connected to or adjacent to a distal end of the arm; and the support body configured to removably retain the tube.
A surgical instrument according to an exemplary embodiment of the present invention comprises: a support body having an upper portion, a distal end, a proximal end and a lower portion; a plurality of support body claws formed by or connected to the lower portion; a joining element engaged with an arm, the arm extending distally from the joining element and ending with a working end mounted on an extreme distal portion of the arm, the joining element pivotally mounted on an extreme distal portion of the support body; where the arm through the positioning of the junction element is able to be positioned towards the distal left or right regions of the support body without interfering with the space located above the support body claws and immediately dorsal the upper body part. Support.
According to an example embodiment, the joining element is capable of being positioned with limited movement of at least a portion of the joining element with respect to a plane horizontally aligned with respect to the upper portion of the support body.
According to an example embodiment, the working end is configured for attachment to the surface of a heart, the working end also including a stabilizing element for engaging one or both sides of a coronary artery, or a positioning element capable of receiving the apex of the heart.
A surgical instrument according to an exemplary embodiment of the present invention comprises: a flexible arm comprising a distal end, a proximal end, and a plurality of joining elements located therebetween so that at least a portion of contiguous joining elements can forming articulation joints; a working end configured to engage a surface of a human's heart, where the working end is connected to the distal end of the flexible arm; and a support body joint forming a support body angle between the proximal end of the flexible arm, and a support body, a minimum support body angle being a maximum of 120 degrees, where a reference angle is defined in 180 degrees between any two untensioned joint joints.
According to an example embodiment, the minimum support body angle is greater than 105 degrees.
According to an example embodiment, the support body joint is comprised of a horizontal joint and a vertical joint, wherein the horizontal joint is configured for controlled plane translation or pivot along a foreground that is substantially horizontal, and the vertical joint is configured for generally flat translation or pivot along a second plane that is substantially perpendicular to the first plane.
A surgical instrument according to an exemplary embodiment of the present invention comprises: a flexible arm comprising a distal end, a proximal end, and a plurality of joining elements located therebetween so that at least a portion of contiguous joining elements can forming articulation joints, the articulation joints capable of establishing a plurality of arm joint angles each having a minimum obtainable angle value, the sine angle defined as 180 degrees between any two un-tensioned articulation joints; a working end configured to engage a surface of a human's heart, where the working end is connected to the distal end of the flexible arm; and a support body joint forming a support body angle between the proximal end of the flexible arm and a support body, a minimum support body angle being an angle substantially less than a smaller of the minimum angle values obtainable.
A surgical instrument according to an exemplary embodiment of the present invention comprises: a support body having an upper portion, a distal end, a proximal end and a lower portion and connected to a joining element; a support body claw formed by or connected to the lower portion; the joining element engaged in a proximal portion of an arm extending distally from the joining element and ending with a working end, the joining element being pivotally mounted on an extreme distal portion of the supporting body; wherein the joining element prohibits a proximal portion of the arm from extending above the upper portion of the support body.
A surgical instrument according to an exemplary embodiment of the present invention comprises: a support body having an upper surface, a distal end, a proximal end and a lower portion; a joining element including a pivotally mounted disc element at an extreme distal portion of the support body; an arm extending distally from the disk element; and a working end mounted on an extreme distal portion of the arm.
According to an example embodiment, the joining element forms a joint with a proximal end of the arm. joining element includes a slotted sphere.
According to an example embodiment, the slotted sphere is fixed to the disk element.
According to an example modality, the instrument includes a pivotally mounted actuator on the support body at the proximal end of the support body and a cable extending from the actuator through the support body, disc element, slotted sphere and arm, and the driver and cable are configured to change an arm state from a flexible state to a rigid state by rotating the driver in a first rotational direction, and from the rigid state to a flexible state by rotating the driver in a counterrotational direction.
According to an example embodiment, the slotted sphere forms a joint with a proximal end of the arm.
According to an example embodiment, the upper and lower surfaces of the disc element extend substantially parallel to the upper surface of the support body, and the sphere extends angled downwards from a plane parallel to the upper and lower surfaces.
According to an example embodiment, a vacuum tube is provided in fluid communication with the working end.
According to an example embodiment, a driver is pivotally mounted on the support body at the proximal end of the support body. The driver is configured to change an arm state from a flexible state to a rigid state by rotating the driver in a first rotational direction, and from the rigid state to a flexible state by rotating the driver in a counterrotational direction.
According to an example embodiment, a suction tube is provided in fluid communication with the working end, and the driver includes a clamp configured to receive and temporarily retain the suction tube to keep the suction tube in a low profile. with the instrument.
According to an example embodiment, the actuator comprises a plurality of fins with one of the clips formed on each of the fins.
According to an example embodiment, the instrument is a stabilizer and the working end comprises at least one contact element configured to be exerted against a tissue surface to stabilize the tissue surface.
According to an example embodiment, the instrument is a positioner and the working end comprises a suction element defining a vacuum space therein, in which the suction element is configured to exert sufficient suction force on an organ to move the organ when the suction element is placed against the organ, a negative pressure is applied in the vacuum space to engage the suction element with the organ, and the suction element is moved.
According to an example embodiment, the lower portion comprises an assembly mechanism configured to secure the instrument to a fixed object.
According to an example embodiment, the mounting mechanism is fixed to a blade of a sternum retractor and the arm is oriented downwards and in contact with an internal surface of the sternum retractor blade.
According to an example embodiment, the assembly mechanism comprises a fixed jaw and a movable jaw; and a mounting mechanism driver is pivotally mounted in the lower portion above the movable jaw. The mounting mechanism driver is configured to move the movable jaw from an unlocked position to a locked position and vice versa.
According to an example embodiment, the mounting mechanism driver is configured to move the movable jaw towards the locked position when the mounting mechanism driver is pulled in a proximal direction.
According to an example embodiment, a cam is mounted above a lower surface of the movable jaw and below the mounting mechanism driver. The cam is connected to the mounting mechanism driver to be actuated to lock or unlock the movable jaw.
According to an example embodiment, the mounting mechanism comprises a mounting mechanism driver, and the mounting mechanism driver includes oscillating switches with cams configured to attach to the fixed object on the opposite side of the fixed object.
According to an example embodiment, the instrument is a stabilizer and the working end comprises a pair of contact elements and a blower / mist forming device incorporated in at least one of the contact elements.
According to an example modality, the instrument is a stabilizer and the working end comprises a pair of contact elements and the stabilizer is configured for a fogger / blower device to be attached to it.
According to an example embodiment, the instrument is a stabilizer and the working end comprises a pair of contact elements and supports connecting the contact elements to the arm, in which the supports are pivotally connected to the contact elements.
According to an example embodiment, the contact elements comprise each clamp in an extreme portion close to it, and the clamps are configured to form a pressure fit with the support elements.
According to an example embodiment, the instrument is a stabilizer and the working end comprises a pair of contact elements. The contact elements individually have a relatively thicker cross-sectional dimension on an outer edge of them and a relatively thinner cross-sectional dimension on an inner edge of them.
According to an example embodiment, the arm comprises an intermediate link which is adjustable by the user to adjust a portion of the distal arm of the intermediate link and the working element to assume a flexible configuration in a first configuration, and to assume a rigid configuration in a second configuration, while allowing a portion of the arm close to the intermediate connection to remain flexible during the first configuration and the second configuration.
According to an example embodiment, the arm comprises an intermediate link that is adjustable by a user to adjust a portion of the arm next to the intermediate link to assume a flexible configuration in a first configuration, and to assume a rigid configuration in a second configuration, while allowing a portion of the arm away from the intermediate connection and the working end to remain flexible during both the first configuration and the second configuration.
According to an example modality, a motor is configured to operate the driver, and a second driver is provided. The second driver is located distally from the driver and the engine, and is electrically connected to the engine, and configured to drive the engine to drive the driver to increase or decrease rigidity in the arm and a connection between the arm and the working end. The upper surface of the support body is smooth and flat with no obstructions in it, and the upper surface provides a rest for a surgeon's hand, which can be used to help stabilize the surgeon's hand.
According to an example embodiment, ratchet ridges or teeth are provided around at least a portion of a perimeter of the disk element.
According to an example embodiment, the instrument includes a cable extending through the disc element, at least a portion of the arm and at least a portion of the support body, wherein the disc element comprises a slot formed therein, the slit being curved to facilitate flexing and clamping the cable against it when the disc element was pivoted, thereby helping to eliminate or reduce variations in at least one of the cable length and cable tension at different angular positions of the disc element in relation to the support body.
According to an example embodiment, the disk element comprises a slot formed therein, the slot being curved to facilitate flexing and tightening the cable against it when the disk element was pivoted, thereby helping to eliminate or reduce variations at least one of the cable length and cable tension at different angular positions of the disc element in relation to the support body.
According to an example embodiment, a driver is rotatably mounted to the support body at the proximal end of the support body and a cable extends from the driver through the support body, disc element, ball and arm. The driver and cable are configured to change an arm state from a flexible state to a rigid state by rotating the driver in a first rotational direction, and from a rigid state to a flexible state by rotating the driver in a counterrotational direction.
According to an example embodiment, the vacuum / suction tube comprises a color-coded connector at a proximal end thereof, the connector configured to be connected to a vacuum source or another vacuum line in fluid communication with a source vacuum.
According to an example embodiment, a container is provided in fluid communication with the suction / vacuum tube, the container having an opening for connecting the fluid communication container with a vacuum source, the container configured to retain fluid in the same.
According to an example embodiment, a filter is in fluid communication with the opening of the container, and the filter is configured to be connected to the vacuum source and to filter particulate materials from the effluent from the container.
According to an example embodiment, the container has at least one substantially flat side. it is connected to the container and adapted to hang the container in a vertical orientation in which the opening for connecting the container with a vacuum source is higher than a connection forming the fluid communication between the container and the vacuum tube.
According to an example embodiment, a surface of the container is misted up to inhibit glare reflection from there.
In another aspect of the present invention, a method of operating a surgical instrument is provided including: securing an instrument support body to a fixed object so that the support body is not movable with respect to the fixed object; adjusting an orientation of an arm extending from a distal end of the support body; and rotating a pivotally mounted actuator at a proximal end of the support body, thereby fixing the orientation of the arm in a rigid configuration.
According to an example embodiment, a tensioning cable extends through the arm and the support body and connects with the driver, and the rotation of the driver increases tension in the cable.
According to an example modality, the fixed object is a sternum retractor and the arm contacts an internal surface of the sternum retractor in the rigid configuration.
According to an example modality, the instrument is a surgical stabilizer. instrument is an organ positioner.
In another aspect of the present invention, a surgical system is provided that includes: a surgical retractor having at least one rail adapted to mount surgical instruments thereon; a positioner comprising: a first body having an upper surface, a first distal end, a first proximal end and a first lower portion, wherein the first lower portion comprises a first mounting mechanism configured to secure the positioner on at least one rail, wherein the first assembly mechanism comprises a first fixed jaw and a first movable jaw; and wherein a first mounting mechanism driver is pivotally mounted in the first lower portion above the first movable jaw, the first mounting mechanism driver being configured to move the first movable jaw from an unlocked position to a locked position and vice versa, where the first mounting mechanism driver is configured to move the first movable jaw towards the locked position when the first mounting mechanism driver is pulled in a proximal direction, where a first cam is mounted above a lower surface of the first movable claw and below the first mounting mechanism driver, the first cam connected to the first mounting mechanism driver to be operated to lock or unlock the movable claw, where the first upper surface is smooth and substantially flat with no obstructions in it , and where the first upper surface provides a rest for the surgeon's hand, which can be used to help stabilize the surgeon's hand; a first joining element including a first pivotally mounted disk element at an extreme distal portion of the first support body and a first slotted sphere attached to the first disk element; a first arm extending distally from the first joint, the first joining element forming a joint with a proximal end of the first arm; a suction element defining a vacuum space therein, where the suction element is configured to exert sufficient suction force on an organ to move the organ when the suction element is placed against the organ, negative pressure is applied to the vacuum space to engage the suction element with the organ, and the suction element is moved; a first driver pivotally mounted on the first support body at the proximal end of the first support body and a first cable extending from the first driver through the first support body, first disc element, first slotted sphere and first arm, the first driver and first cable being configured to change a state of the first arm from a flexible state to a rigid state by rotating the first driver in a first rotational direction, and from a rigid state to a flexible state by rotating the first driver in one direction counterrotational, in which the first disk element comprises a first slot formed in it, the first slot being curved to facilitate flexing and tightening of the cable against it when the first disk element was pivoted, thereby helping to eliminate or reduce variations by minus one of the first cable length and first cable tension in different ring positions d the first disk element in relation to the first support body; and a first vacuum tube in fluid communication with the suction element, wherein the first driver comprises a clamp configured to receive and temporarily retain the first suction tube to maintain the first suction tube in a low profile with the positioner; the first trigger comprises a plurality of first alerts with one of the clamps formed on each of the fins, and the first vacuum tube comprises a first color-coded connector at a proximal end thereof, the first color-coded connector configured for be connected to a vacuum source or other vacuum line in fluid communication with a vacuum source; a first container in fluid communication with the first vacuum tube through the first color-coded connector, the first container having a first open to connect the first container in fluid communication with the first vacuum source, the first container configured to hold fluid therein, where the first container has at least one substantially flat side, and where a surface of the first container is fogged up to inhibit glare reflection from there; a first strip connected to the first container and adapted to hang the first container in a vertical orientation in which the first opening to connect the first, container with the first vacuum source is higher than a first connection forming the fluid communication of the first container with the first vacuum tube; a first filter in fluid communication with the first opening of the first container, the first filter configured to be connected to the first vacuum source and to filter particulate materials from the effluent from the first container; a stabilizer comprising: a second body having an upper surface, a second distal end, a second proximal end and a second lower portion, the second lower portion comprising a second mounting mechanism configured to secure the stabilizer to at least one rail, wherein the second mounting mechanism comprises a second fixed jaw and a second movable jaw; and wherein the second mounting mechanism driver is pivotally mounted on the second lower portion above the second movable jaw, the second mounting mechanism driver being configured to move the second movable jaw from an unlocked position to a locked position, and vice versa, in which the second mounting mechanism driver is configured to move the second movable jaw towards the locked position when the second mounting mechanism driver is pulled in a proximal direction in which a second cam is mounted above a surface bottom of the second movable claw and below the second mounting mechanism driver, the second cam connected to the second mounting mechanism driver to be actuated to lock or unlock the movable claw, where the second upper surface is smooth and substantially flat without obstructions in it, and where the second upper surface provides a rest for a surgeon's hand, which can be used to help stabilize the surgeon's hand; a second joining element including a second disc element pivotally mounted on a distal end portion of the second support body and a second slotted sphere attached to the second disc element; a second arm extending distally from the second joint, the second joining element forming a joint with a proximal end of the second arm; a pair of contact elements configured to be exerted against a tissue surface of the organ to stabilize the tissue surface and at least one of the contact elements configured to attach a blower / fog-forming device to it or having a blower / device mist builder incorporated in it; a second driver pivotally mounted to the second support body at the proximal end of the second support body and a second cable extending from the second driver through the second support body, the second disc element, second slotted sphere and second arm, the second driver and second cable being configured to change a state of the second arm from a flexible state to a rigid state by pressing the second driver in a second rotational direction, and from the rigid state to a flexible state by rotating the second driver in one direction counterrotational, in which the second disk element comprises a second slot formed in it, the second slot being curved to facilitate flexing and tightening the cable against it when the second disk element has been pivoted, thereby helping to eliminate or reduce variations in at least one of the second cable length and second cable tension at different angular positions than the second disk in relation to the second support body; and a second vacuum tube in fluid communication with the suction element, wherein the second driver comprises a clamp configured to receive and temporarily retain the second suction tube to maintain the second suction tube in a low profile with the stabilizer; wherein the second driver comprises a plurality of second alerts with one of the clips formed on each of the fins, and the second vacuum tube comprises a second color-coded connector at a proximal end thereof, the second color-coded connector configured to be connected to a vacuum source or other vacuum line in fluid communication with a vacuum source; a second container in fluid communication with the second vacuum tube through the second color-coded connector, the second container having a second opening for connecting the second container in fluid communication with the second vacuum source, the second container configured to hold fluid therein, where the second container has at least one substantially flat side, and where a surface of the second container is misted up to inhibit glare reflection thereafter; a second strip connected to the second container and adapted to hang the second container in a vertical orientation in which the second opening for connecting the second container with the second vacuum source is higher than a second connection forming the fluid communication of the second container with the second vacuum tube; and a second filter in fluid communication with the second opening of the second container, the second filter configured to be connected to the second vacuum source and to filter particulate materials from the effluent of the second container.
In another aspect of the present invention, a surgical instrument is provided that includes a support body, an arm, a joint, and a tool; the support body configured to mount on a retractor, a lower surface of the support body facing the retractor when assembled, a front edge of the support body extending at an angle to the bottom surface; the arm pivotally connected at a proximal end through the joint to the front edge of the support body; the tool connected to a distal end of the arm; the arm configured to be movable between a plurality of positions in relation to the support body and to be temporarily lockable in those positions; and the joint configured in such a way that a proximal portion of the arm extending from and adjacent to the support body is pivotal to and temporarily lockable in a position substantially perpendicular to the support body.
According to an example embodiment, the surgical instrument further comprises a universal connector configured to connect the support body to any of a plurality of retractors of different sizes.
According to an example embodiment, the gasket includes a disc element.
According to an example embodiment, the joint includes a slotted sphere.
According to an example modality, the instrument includes a driver pivotally mounted to the support body at the proximal end of the support body and a cable extending from the driver through the support body, disc element, slotted sphere and arm, and the driver and cable are configured to change an arm state from a flexible state to a rigid state by rotating the driver in a first rotational direction, and from the rigid state to a flexible state by rotating the driver in a counter-rotational direction .
According to an example embodiment, a tube is provided in fluid communication with the tool.
According to an example embodiment, a tube is provided in fluid communication with the tool, and the driver includes a clamp configured to receive and temporarily retain the tube to keep the tube in a low profile with the instrument.
According to an example embodiment, the support body includes a recess dimensioned to receive and removably retain the tube.
According to an example embodiment, the instrument is a stabilizer and the tool comprises at least one contact element configured to be exerted against a fabric surface to stabilize the fabric surface.
According to an example modality, the instrument is a positioner and the tool comprises a suction element that defines a vacuum space therein, in which the suction element is configured to exert sufficient suction force on an organ to move the organ when the suction element is placed against the organ, negative pressure is applied in the vacuum space to engage the suction element with the organ, and the suction element is moved.
According to an example embodiment, the instrument includes a cable extending through the disc element, at least a portion of the arm and at least a portion of the support body, wherein the disc element comprises a slot formed therein, the slit being curved to facilitate flexing and clamping the cable against it when the disc element was pivoted, thereby helping to eliminate or reduce variations in at least one of cable length and cable tension at different angular positions of the disc element in relation to the support body.
According to an example embodiment, a driver is rotatably mounted to the support body at the proximal end of the support body and a cable extends from the driver through the support body, disc element, ball and arm. The driver and cable are configured to change an arm state from a flexible state to a rigid state by rotating the driver in a first rotational direction, and from a rigid state to a flexible state by rotating the driver in a counterrotational direction.
According to an example embodiment, a container is provided in fluid communication with the tube, the container having an opening for connecting the fluid communication container with a vacuum source, the container configured to retain fluid therein.
According to an example embodiment, a filter is in fluid communication with the opening of the container, and the filter is configured to be connected to a vacuum source and to filter particulate materials from the container effluent.
According to an example embodiment, a strip is connected to the container and adapted to hang the container in a vertical orientation in which the opening for connecting the container to a vacuum source is higher than a connection that forms fluid communication. the container with the vacuum tube.
In another aspect of the present invention, a surgical instrument is provided that includes a support body, an arm, a tool and a tube; the support body configured to mount on a retractor or an operating table; the arm pivotally connected at a proximal end, to the support body; the tool connected to a distal end of the arm; the arm configured to be movable between a plurality of positions in relation to the support body and to be temporarily lockable in those positions; a distal end of the tube connected to or adjacent to a distal end of the arm; and the support body configured to removably retain the tube.
According to an example embodiment, the support body includes a recess dimensioned to receive and removably retain the tube.
According to an example embodiment, the support body includes a clip sized to receive and removably retain the tube.
According to an example embodiment, the support body additionally includes a pivotally mounted actuator on the surgical instrument, the actuator being configured to change a state of the arm from a flexible state to a rigid state by rotating the actuator in a first direction rotational, and from the rigid state to the flexible state by rotating the actuator in a counter-rotational direction; and the driver configured to removably retain the tube.
According to an example embodiment, the arm is pivotally connected to the support body by means of a joint.
According to an example embodiment, the gasket includes a disc element.
According to an example embodiment, the joint includes a slotted sphere.
According to an example modality, the tube is supplied in fluid communication with the tool.
According to an example embodiment, the actuator includes a clamp configured to receive and temporarily retain the tube to keep the tube in a low profile with the instrument.
According to an example embodiment, the instrument is a stabilizer and the tool comprises at least one contact element configured to be exerted against a fabric surface to stabilize the fabric surface.
According to an example modality, the instrument is a positioner and the tool comprises a suction element that defines a vacuum space therein, in which the suction element is configured to exert sufficient suction force on an organ to move the organ when the suction element is placed against the organ, negative pressure is applied in the vacuum space to engage the suction element with the organ, and the suction element is moved.
According to an example embodiment, the instrument includes a cable extending through the disc element, at least a portion of the arm and at least a portion of the support body, wherein the disc element comprises a slot formed therein, the slot being curved to facilitate flexing and tightening the cable against it when the disk element has been pivoted, thereby helping to eliminate or reduce variations in at least one of cable length and cable tension at different angular positions of the disk element with respect to to the support body.
According to an example embodiment, a driver is rotatably mounted to the support body at the proximal end of the support body and a cable extends from the driver through the support body, disc element, ball and arm. The driver and cable are configured to change an arm state from a flexible state to a rigid state by rotating the driver in a first rotational direction, and from a rigid state to a flexible state by rotating the driver in a counterrotational direction.
According to an example embodiment, a container is provided in fluid communication with the tube, the container having an opening for connecting the fluid communication container with a vacuum source, the container configured to retain fluid therein.
According to an example embodiment, a filter is in fluid communication with the opening of the container, and the filter is configured to be connected to the vacuum source and to filter particulate materials from the effluent from the container.
According to an example embodiment, a strip is connected to the container and adapted to hang the container in a vertical orientation in which the opening for connecting the container with a vacuum source is higher than a connection forming the fluid communication of the container with the tube.
These and other features of the invention will become apparent to those skilled in the art after reading the details of the instruments and methods as described more fully below. BRIEF DESCRIPTION OF THE FIGURES
Figure 1 illustrates a surgical instrument configured as a surgical stabilizing instrument according to an embodiment of the present invention.
Figure 2 illustrates the ability of a joint element, according to the present invention, to provide an arm with the ability to be positioned very close to the internal surface of a sternum retractor, in relation to the capacity of a stabilizing arm of the prior art. .
Figure 3 is a perspective view of a surgical stabilizing instrument according to an embodiment of the present invention.
Figure 4 is an exploded view of the stabilizing instrument in Figure 3.
Figure 5 is a longitudinal section view showing a joint element that includes an articulated joint which is formed by a pivotally disc element mounted on a mounting mechanism according to one embodiment of the present invention.
Figure 6 illustrates pivoting action provided by the articulated joint shown in figure 5.
The figure! 7 illustrates a disk element which is provided with slits through a proximal portion thereof, according to an embodiment of the present invention.
Figure 8 is a top view of a slit in a longitudinal, partial section view taken in a plane at right angles to the plane along which the partial section view of Figure 5 is taken.
Figure 9 illustrates an alternative embodiment of a joining element according to the present invention, in which a sphere is rotationally mounted on a disk element.
Figure 10 shows an alternative embodiment to the sphere shown in Figure 9, according to the present invention.
Figure 11 shows a configuration in which the actuator (not shown) is actuated to propel the support body against the disc to thereby lock the angular position of the disc in relation to the body, according to an embodiment of the present invention.
Fig. 12 is a sectional view of the modality of Fig. 11, but it also shows the driver.
Figure 13A illustrates a side view of an arrangement in which corrugated retainers are provided to which a ball can fit, according to an embodiment of the present invention.
Figure 13B shows a top section view taken along line A-A of figure 13A.
Figure 14 illustrates a joining element and mounting mechanism in which a socket or slot is provided in the support body and a sphere (or alternatively disk element) is provided with a characteristic (ferrule, spike or finger) that slides in one fit or notch as the disc element pivots in relation to the support body, according to an embodiment of the present invention.
Figure 15 shows a sphere having a three-slot configuration according to an embodiment of the present invention.
Figures 16A-16C illustrate a joining element in which a sphere is provided with a slot and is rotationally mounted at the distal end of a support body, according to an embodiment of the present invention.
Figure 17 shows a device in which both the arm and the driver are angularly movable in relation to the mounting mechanism according to an embodiment of the present invention.
Figure 18 illustrates an arrangement in which a slotted sphere has been integrated into a support body according to an embodiment of the present invention.
Figure 19 illustrates a joining element similar to the embodiment of figures 16A-16C, but where the sphere is provided with an opening as a direct hole that defines a path through the sphere according to an embodiment of the present invention.
Figure 20A illustrates a surgical instrument configured as a stabilizing instrument in which the pivoting action of the arm and working end in relation to a fixed portion of the mounting mechanism is provided by a rotationally mounted tower on top of the mounting mechanism. according to an embodiment of the present invention.
Figure 20B is a partial longitudinal section view of the device of Figure 20A.
Figure 20C illustrates that the actuator lever can be operated at many different angles to tighten the cable.
Figure 21 illustrates a joining element that uses a tower, but where the tower is formed with a disk and ball element according to an embodiment of the present invention.
Figure 22 shows a surgical instrument configured as an organ positioning instrument according to an embodiment of the present invention.
Figure 23 is a detailed view of the instrument in Figure 22.
Figure 24 shows two surgical instruments, a first configured as a positioned instrument and a second configured as a stabilizing instrument, both mounted on the tracks of a sternum retractor according to an embodiment of the present invention.
Figure 25 is a partial longitudinal section view of the device of Figure 22.
Figure 26 is a top view of a slit in a longitudinal, partial section view taken at an angle at right angles to the plane along which the partial section view of Figure 25 is taken.
Figure 27 is a partial view showing details of an assembly mechanism according to an embodiment of the present invention.
Figure 28A shows a driver pulled back in the locked and aerodynamic position with the mounting mechanism according to an embodiment of the present invention.
Figure 28B illustrates the driver of figure 28A in the unlocked configuration according to an embodiment of the present invention.
Figure 28C is a cross-sectional view of figure 28A taken along line 28C-28C.
Figurei, 28D is a cross-sectional view of Figure 28B taken along line 28D-28D.
Figures 29A-29B show a side view and an external view, respectively, of a driver according to an embodiment of the present invention.
Figure 29C illustrates a surgical instrument configured as a stabilizing instrument with a support body configured to removably retain a tube, in accordance with an embodiment of the present invention.
Figures 30A-30B show a side view and an extreme view, respectively, of a driver according to another embodiment of the present invention.
Figure 31A is a perspective view of a container according to an embodiment of the present invention.
Figure 31B is a longitudinal sectional view of the container of Figure 31A taken along line 31B-31B.
Figure 31C is a longitudinal sectional view of the container of Figure 31A taken along line 31C-31C.
Fig. 31D illustrates a strip provided with a container according to an embodiment of the present invention.
Figure 32 illustrates the use of a stabilizing instrument and a positioning instrument, each with a container according to an embodiment of the present invention.
Figures 33A-33B show an alternative mounting mechanism driver according to an embodiment of the present invention.
Figures 34A-34B illustrate alternative aspects that can be provided with a working end of a stabilizing instrument according to various embodiments of the present invention.
Fig. 35 illustrates a modification whereby contact elements are tapered from a thicker dimension on the outer edges of the same, to a thinner dimension on the inner edges (16 ') of the same according to an embodiment of the present invention.
Fig. 36 illustrates an embodiment of a device having an alternative arm in which an intermediate connection is provided which is adjustable by a user to adjust the tension on the cable distally from it in accordance with an embodiment of the present invention.
Fig. 37 illustrates an embodiment of a device having an alternative actuation mechanism according to an embodiment of the present invention. DETAILED DESCRIPTION OF THE INVENTION
Before the present instruments and methods are described, it is to be understood that the present invention is not limited to the specific described modalities, as these can of course vary. It should also be understood that the terminology used here is for the purpose of describing specific modalities only, and is not intended to be limiting, since the scope of the present invention will be limited only by the appended claims.
Where a range of values is provided, it is understood that each intervening value, up to the tenth of the unit of the lower limit unless the context clearly determines otherwise, between the upper and lower limits of that range, is also specifically revealed. Each minor range between any mentioned value or intermediate value in ■ a mentioned range and any other mentioned or intermediate value in that mentioned range is covered by the invention. The upper and lower limits of that lower range can be independently included or excluded in the range, and each range where any, none or both of the limits are included in the lower ranges is also covered in the invention, subject to any limit specifically excluded in the mentioned range. Where the mentioned range includes one or both of the limits, ranges excluding either or both of those included limits are also included in the invention.
Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by a person of ordinary skill in the art to which the present invention belongs. Although any methods and materials similar or equivalent to those described herein can be used in the practice or testing of the present invention, the preferred methods and materials are now described. All publications mentioned here are incorporated by reference to reveal and describe the methods and / or materials with respect to which the publications are cited.
It should be noted that as used herein and in the appended claims, the terms "lock" or "lock" will mean limiting or rendering immovable or mobile with difficulty.
It should be noted that as used herein and in the appended claims, the singular forms "one", "one", and "o, a" include referents in the plural unless the context clearly determines otherwise. Thus, for example, reference to "a contact element" includes a plurality of such contact elements and reference to "the device" includes reference to one or more devices and equivalents thereof known to those skilled in the art and so on. .
The publications discussed here are provided solely for your disclosure prior to the filing date of this application. Nothing herein should be construed as an admission that the present invention is not entitled to predate such publication by virtue of a previous invention. In addition, the publication dates provided may differ from the actual publication dates which may need to be independently confirmed.
Although the instruments described here are described for use on the heart, it is noted that these instruments are not limited to use on the heart, but can be used for surgical procedures on other organs or tissues, such as to position and / or stabilize other organs or tissues. .
Figure 1 shows a surgical instrument configured as a stabilizing instrument (10) according to an embodiment of the present invention. The stabilizer instrument (10) includes a mounting mechanism (20) configured to mount the stabilizer instrument (10) on a relatively fixed object, such as a sternum retractor, operating table, etc. In figure 1, the stabilizing instrument (10) is mounted on a rail (202) of a sternum retractor (200). The sternum retractor is shown to be used in an open chest procedure in which an opening (2) was made to expose the patient's heart (4) (1).
The stabilizing instrument (10) further includes an arm (12) pivotally connected to and extending distally from a distal end (24) of the support body (22). The upper surface 26 of the support body (22) has a low profile and is preferably smooth so as not to trap sutures, surgical gloves or any other object susceptible to being attached to an uneven surface. In addition, this smooth surface can be used by the surgeon to rest the hand or finger, assist in steadying the hand during suturing, for example. As the arm (10) extends from the distal end (24) of the support body (22) not from the upper surface (26) as in many instruments of the prior art, it provides a lower profile, in relation to the height of the chest ( 2) the patient's (1) and 'sternum' retractor (200). This makes the instrument less of an obstruction (compared to stabilizing instruments of the prior art where the arm is attached to the top of the fixation mechanism) for the surgeon or anyone trying to access the surgical workspace (3).
The stabilizing instrument (10) also includes a working end (14) mounted on an extreme distal portion of the arm (12). The working end (14) of the stabilizing instrument (10) includes at least one contact element (16). A pair of contact elements (16) is provided: in the mode shown in figure 1.
Contact elements (16) are configured and sized to contact the tissue surface in a surgical target area to stabilize the tissue and facilitate the performance of a surgical procedure. For example, in figure 1, the contact elements are shaped, configured and sized to contact the surface of the heart (4) on opposite sides of a coronary artery in which an anastomosis must be performed.
Contact elements (16) can be configured to engage fabric mechanically (which optionally can include contact surfaces that increase friction), by applying suction or combinations thereof. There are many different modalities of contact elements that can be employed in a surgical stabilizer according to the modalities of the present invention. Additional examples of such contact elements and details thereof can be found in US patents 5,727,569; 5,875,782; 5,894,842; 5,906,607; 5,957,835; 5,976,069; 6,032,672; 6,036,641; 6,050,266; 6,120,436; 6,213,941; 6,231,506; 6,283,912; 6,290,644; 6,315,717; 6,331,158; 6,346,077; 6,375,611; 6,394,951; 6,406,424; 6,511,416; 6,626,830; 6,652,454; 6,656,113; 6,673,013; 6,685,632; 6,701,930; 6,743,169; 6,758,808; 6,849,044; 6,852,075; 6,893,391; 7,056,287; 7,220,228; 7,238,155; 7,326,177; 7,335,158; 7,485,090; 7,497,824; and 7,503,891, each of which is hereby incorporated in full, as a reference to it.
The support body (22) is configured and dimensioned so that the distal end (24) thereof is substantially laterally flush with an internal surface (2001) of the sternum retractor (200), particularly with an internal surface of the arm / laminate (204) of the sternum retractor. Alternatively, the distal end (24) may extend slightly beyond the inner surface (200i) or end slightly close to the inner surface (200i). In any case, when the stabilizing instrument is attached to the rail (202) as shown in. 1, the distal end (24) of the support body (20) does not extend substantially into the surgical workspace (3), and thus forms much less of an obstruction than currently available surgical stabilizers. In addition, the joining element (30) that joins the arm (12) provides the arm (12) with the ability to be positioned very close to the inner surface (200i) in relation to the capacity of a stabilizing arm of the prior art (1012 ) of the prior art stabilizer (1000), as shown in figure 2. This also reduces the amount of obstruction created by the stabilizer (10) and particularly the stabilizer arm (12). The joining element (30) even allows the arm (12) to be oriented in contact with the internal surface (200i). Yet additionally, the. the joining element (20) is configured in such a way that a portion of the arm (12) extending from and immediately adjacent to the joining element (30) is pivotal to and temporarily lockable in a position substantially perpendicular to the support body (22 ), as illustrated in figure 2. Specifically, as shown in figure 2, the closest connection (44) to the arm (12) can be positioned substantially perpendicular (that is, at an angle of approximately 80 degrees to approximately 90 degrees) to the support body (22).
The junction element (30) is pivotally mounted to the support body (22) at the extreme distal portion thereof, so that the arm (12), which is joined to the distal end of the junction element (30) extends from the distal end (24) of the support body (22). Figure 3 is a perspective view of a surgical stabilizing instrument (10) according to an embodiment of the present invention. The working end (14) is mounted at the distal end of the arm (12) through a joint (56) (socket and ball joint in the form shown in figure 3) as described in more detail in previous patents incorporated by reference above.
The arm (12) comprises a plurality of hinge connections (40) that allow the arm (12) to be flexible in a first configuration, but which can be compressed to make the arm (12) substantially rigid in a second configuration. In the embodiment shown in figure 3, the connections (40) include alternating ball joints (42) and biconcave discs (44). The spheres (42) are made of a plastic having a hardness that is less than the hardness of the material (typically, plastic) from which the disks (44) are made. This allows the disks (44) to become embedded in the spheres (42) during compression of the applied components by applying tension to the tensioning element extending through them, thereby increasing the rigidity of the arm by the grip imposed by the incorporation disks. Additional details and examples of suitable arms are described in US patent 6,506,149, which is hereby incorporated herein in its entirety, by reference to it. Alternatively, connections (40) may include (but alternatives are not limited to 10 such examples) a series of spherical joints, a series of joints having a convex side and a concave side, or any of the other modalities described in US patent 6,506,149 , or any of the modalities described in US patent 6,758,808, for example.
Each connection (40) includes a central channel (40c) through it that can be tapered at both ends to allow a cable (46) (see the detailed view in figure (4)) to pass through it smoothly and easily (and improve rigidity in the rigid state of the arm). The cable (46) 20 extends through connections (40), joint element (30), support body (22) and connects closely to a drive mechanism (50) and connects distally to a mechanism configured to lock or unlock the gasket (56). The most distal hinge element (43) at the distal end of the arm (12) includes a cavity (43c) that opens at the distal end of the hinge element (43) and is adapted to at least partially cover the distal end of the stabilizer arm (12) and is married to the most distal articulation element (43) through the coupling elements ((58), (47) and (60)), in combination with the tensioning cable (46) that extends through the stabilizer.
The socket element (56s) includes an opening (56p), which is sized to freely receive the ball portion (56b) to which the working end (14) is attached. The socket element (56s) also includes a slot (561) dimensioned to receive the rod (56t), allowing it to slide freely in the slot (561) while at the same time preventing the ball portion (56b) from passing through the same. A close opening is provided in the socket element (56s) and sized to receive at least a portion of the coupling elements (58), (47) and (60)
The coupling element (60) can be a socket cover which is received at the next opening. The socket cap (60) includes a cap or base portion (shown and described in more detail in US patent 6,758,808) to abut the ball portion (56b) and hold it in position on the socket element (56s). In the example shown, the lid portion has a substantially flat bottom surface with a circular opening sized to offset against the sphericity of the sphere portion (56b). Of course, other configurations of the bottom surface are considered to perform the same function, for example, the ability to apply force against the ball portion (56b) and maintain the ball portion in the socket element (56s), while also allowing the sphere portion rotates. In addition, after increased application of force, the cap portion has the ability to lock the ball portion (56s) and prevent it from rotating.
The outer surface of the socket cover (60) is substantially cylindrical and adapted to slide and rotate to fit in the cavity of the coupling element (56s) introduced through the opening near it. This allows rotation of the working end (14) about the longitudinal geometric axis of the maneuverable arm (12) when the stabilizer (10) is in a non-rigid state. The proximal portion of the socket cover (60) includes drive surfaces adapted to abut against the most distal hinge element (43) and transmit force against the ball portion (56b) when the cable is tensioned. After full tension release on the stabilizer cable (46) (10), the socket element (56s) can be pulled in a direction away from the most distal hinge element (43) by a sufficient distance to allow the sphere (56b) is extracted through the opening (56p), for example, to change the assembly by replacing the existing working end (14) with a different one. In this way, a change can be made between the working ends (14) to choose a different design or configuration, or even change to one that operates on a different principle. For example, a change in a mechanical contact element, which operates by applying physical pressure against the beating heart tissue, can be replaced by a negative pressure contact element, which engages the heart by vacuum. In this regard, any of the contact elements described here could be exchanged for operation on the stabilizer (10) described. In addition, other known contact elements could be used or adapted for use by those of ordinary skill in the art.
The socket cover (60) also includes open or recessed portions sized to receive the arms of the coupling element (58). The recessed portions are continuous over the length of the socket cover (60) and are also defined along the perimeter of the cover portion. In this way, the arms of the coupling element (58) interlock with the socket cover and are continuous with the outer perimeter of the same to form a cylindrical surface to rotate against the socket element (56s). The inner surface of the socket element (56s) is recessed near the proximal end to form an annular notch that extends around the inner circumference of the close end portion and is under a ferrule formed in this way. After assembly, points that extend outward from the coupling element arms (58) at the distal ends of the arms, engage the notch and are prevented from being removed from the socket element (56s) by the ferrule. As the ferrule and the notch extend around the total internal circumference of the socket element (56s), the coupling element (58) is free to rotate with the socket cover (60) in an unlocked configuration of the stabilizer (10). The outer ends of the tips are preferably chamfered or beveled to facilitate the insertion of the coupling element (58) into the socket element (56s).
A cable fitting is provided as part of the coupling assembly and includes a coupling element / stop portion in the enlarged ball shape or other shape (47) that has a backing surface adapted to abut against the coupling element (58) to apply a force to it when the cable is pulled up against it.
The proximal end of the cable (46) is connected to the drive mechanism which is configured to increase or decrease the tension in the cable (466) by stretching the extreme end near the cable (46) closely or by moving it distally from the body support (22), respectively. The voltage increase and decrease is triggered by a trigger (52), like the button shown in figures 3-4. Additional details on the operation of the mechanism (50) and alternative modalities of such a mechanism can be found, for example, in US patent 6,758,808 and other patents incorporated by reference above. The present invention is not intended to be limited to the mechanism (50) shown in figure (4), since other mechanisms that provide the same function can be replaced.
In the embodiment shown in figures 3-4, the working end (14) includes openings (16s) through the contact surfaces of the contact elements (16) that are configured to apply suction (negative pressure) to the surface of the fabric to be stabilized , to make the contact surfaces engage the fabric. The openings (16s) are in fluid communication with the vacuum tube (62), which is configured, at its proximal end, to be connected in fluid communication with a negative pressure source. A connector (64) provided at the proximal end of the vacuum tube (62) can be color-coded (for example, color-coded blue, or some other distinct color), so that users can readily visually distinguish that vacuum tube from other vacuum tubes that may be used during the procedure (such as a vacuum tube for a positioner, discussed in more detail below). This can be important when different vacuum tubes require different vacuum characteristics, such as the magnitude of the negative pressure, for example, as it helps to prevent erroneous attachment of a vacuum tube to the wrong vacuum source. Color coding the luer or tubing is an inexpensive way to distinguish the tube.
The joint element (30) includes an articulated joint (32) which is formed by a disc element (34) pivotally mounted to the mounting mechanism (20) as shown in figure 3 and in the longitudinal, partial section view of figure 5 The pivoting action provided by an articulated joint (32) allows the stabilizing arm (12) to be pivoted out of the way so that the arm does not protrude excessively into the surgical workspace (3). As shown in figure 6, the arm can be pivoted towards the right or left of the distal end (24) of the support body (22), by the pivot disc element (34) in relation to the support body (22), so that the arm (12) approaches or even contacts the inner surface of the retractor (200i) and the arm can thus be adjusted 'to follow along the perimeter of the surgical workspace (3). The pivoting action can be obtained along a single plane coexisting with the disk element (34). Additionally, the pivoting action can occur without movement of the drive mechanism (50) in relation to the support body (22).
The disk element (34) is provided with slits (34s) through a proximal portion thereof, forming close upper and lower disk surfaces (34p) where the slot (34s) typically sweeps through at least 120 degrees from the periphery of the disc element (34), more typically at least approximately 150 degrees as shown in figure 7, and extends to the center of the disc element (34). The slot (34s) allows the cable (46) to be tensioned while maintaining (i.e., without changing or affecting) the rotational position of the disc element (34) in relation to the support body (22). The pivot point in the center of the disc element (34) allows the disc element (34) to maintain its angular position when tensioning the cable (46).
As shown in the embodiment of figure 8, which provides a top view of the slit (34s) in a longitudinal, partial section view taken in a plane at right angles to the plane along which the partial section view of figure 5 is taken , the disc element (34) rotates in a circular slot without a pin. The pivoting action is caused by sliding along matched circular surfaces of the disc element (34) and circular crack. The disk element (34) is held in place by friction and an interference fit with the circular slot (22s) formed at the distal end (24) of the support body (22). The radius of the disc element (34) is slightly greater than the radius of curvature of the slot (22s). When the cable (46) is tensioned, the disc element (34) is pulled into a seat formed by the circular slot (22s). Chamfers (34r) formed by removing corners at the upper and lower circular edges of the disc element (34) (see figure 5) can be provided to facilitate seating of the disc element (34). When the cable (466) is not tensioned, the disk element (34) is retained at the distal end of the support body by the arm (12), the distal end of the support body (24) and cable (466). The curvature (34c) at the distal ends of the slot facilitates flexing and tightening of the cable against them when the disc element (34) was pivoted, and helps to eliminate or reduce variations in cable length / tension at different angular positions from the disk (34). Preferably, the disc element is metal like stainless steel, and the ball (36) is plastic and snapped onto the disc element (34). The ball element (36), like the other balls on the arm, is softer than the disc element (44) with which it interfaces, so that the disc element (44) bites the ball (36) to help provide additional rigidity to the arm (12) when the arm (12) is in a locked configuration.
Additionally, the joining element (30) includes a sphere (36) that extends from a distal end of the disk element (34) as shown in figure 7. The sphere (36) is dimensioned to cooperate with a close concave surface of the connection (44), thereby allowing the type of socket and sphere, three-dimensional articulation of the connection (and therefore the arm (12) and working end (14)) in relation to the sphere (36). The ball (36) can also be slotted (36s) to further facilitate or optionally control the downward angle of the arm (12) in relation to the support body (22) thereby facilitating the positioning of the arm downwards and following the outline of the retractor and perimeter of the surgical opening as illustrated in figure 6. The slit (36s) can be provided with a curvature (36c) at the proximal end of it, as shown in figure 5. The curvature (36c) at the proximal end of the slit (36s) facilitates flexing and tightening the cable against it when the arm (12) has been pivoted down in relation to the ball (36) / disc element (34), and helps to eliminate or reduce variations in cable length / tension in angular positions different from the arm (12). In addition, a lubricating sleeve (46s) (such as one made of polytetrafluoroethylene) or lubricating coating can be provided over the cable (46) to help facilitate sliding and reduce friction, as shown in figure 8.
Figure 9 illustrates an alternative embodiment of the joining element (30) in which the ball (36) is rotationally mounted on the disc element (34). Optionally, retainers or ratchet teeth (48) can be provided to allow a ratchet-like adjustment of the rotational position of the ball (36) with respect to the disc element (34).
Figure 10 illustrates another alternative modality of the sphere (36) in which the sphere (36) is provided with two intersecting slits (36sl, 36s2) formed perpendicular to each other. Alternatively, three or more intersecting slots (36s) can be provided. Like the previous embodiments, the ball (36) can be attached to the disc element (34) or can be rotationally mounted on the disc element (34). Optionally, retainers or ratchet teeth (48) can be provided to allow a ratchet-like adjustment of the rotational position of the ball (36) with respect to the disc element (34).
Figure 11 shows a mode in which the driver (not shown) is actuated to drive the disc (34) against the support body (22) to thereby lock the angular position of the disc (34) in relation to the body (22) . In addition, the ball (36) is tilted downwards in relation to the plane of the disc orientation (34), that is, see the angle (39). It is noted that any of the other spheres (36) described above as well as below can alternatively be positioned in an orientation inclined downwards with respect to the disc plane (34).
Figure 12 is a sectional view of the embodiment of figure 11, but which additionally shows a driver (52). As the driver (52) is pressed (by turning against the screw mechanism inside) against the body (22) it pushes the disc (34) against the body (22) and at the same time, pulls the balls (36) , (42) and disc / connection elements (44) together, tightening the arm (12) and gasket between the disc (34) and housing (22).
Figures 13A-13B illustrate a side view and an upper section view taken along line AA of figure 13A, where the support body (22) is provided in its distal end portion with a plurality of undulations or retainers distributed horizontally and radially (54) each configured and dimensioned to receive a sphere closer (42) to the arm (12) or (1012). After applying tension through the cable (46), it pulls the closest ball (42) for locking engagement with the receptacle / ripple / retainer (54) in which it is positioned. The additional application of tension locks the arm (12), (1012) as already described. After removing tension from the cable (46) and sufficiently lengthening / loosening the cable (46), the nearest ball (42) can be manually dislodged from its current position in one of the corrugations (54) and moved to a desired location received by another of the undulations (54), as indicated in hidden lines in figure 13B. In this way, the closest sphere (42) can be positioned (and then locked) on any of the undulations, thereby providing the ability to tilt the arm (12), (1012) in the horizontal plane with respect to the longitudinal geometric axis of the body support (22), as illustrated by the angle (57) in figure 13B.
Figure (4) illustrates a modality of the joining element (30) and mounting mechanism (20) in which a socket or slot (66) is provided in the support and ball body (36) (or alternatively disc element (24) )) has an aspect (ferrule, ear or finger) (68) that slides in the groove or notch (66) as the disc element (34) pivots in relation to the support body (22).
After locking the joining element (30), the arm (12) and the working element (.14) by pulling the cable (46) using the actuator (52), the aspect 68 abuts against the upper surface of the slot (66) , which prevents the disc element (34) from lifting. The pin (35) is shown in figure 14 and is the aspect around which the disc element pivots. A spring (70) is provided in the slot (70s). The spring (70) has sufficient elastic force to separate the 'proximal end of the disc element (34) from contact with the support body (22) when tension is released on the cable (46).
Figure 15 illustrates a modality of the sphere (36) having a configuration of three slits in which the slits (36al, 36s2 and 36s3) join to form a Y shape.
Figures 16A-16B illustrate an embodiment of a joining element (30) in which a sphere (36) is provided with a slot (36s) and is rotationally mounted at the distal end of the support body (22). In this way, the junction element (30) provides functionality similar to the junction elements (30) described above which include the disk element (34) and sphere (36). The functionality is; similar in that the sphere (36) can be rotated ii i: j I (see the curved arrows in figure 16B), which then allows horizontal rotation or pivoting action of the arm (12) when the slot (36s) is horizontally oriented as in figure 16C.
Figure 17 shows an embodiment in which both the arm (12) and the driver (52) are angularly movable in relation to the mounting mechanisms (20). In this regard, a gasket 72 is provided to allow at least downward angling of the trigger button (52) in relation to the mounting mechanism (20). Any of the joining elements (30) described here can be provided to allow an angle of the arm (12) in relation to the mounting mechanism. By allowing angular movement of the actuator, this allows the user to move the actuator (52) to cause less of an obstruction for the surgeon or other personnel trying to access the surgical space (3). It is also less likely to grab sutures or other equipment when moved down as shown in figure 17.
Figure 18 illustrates a modality in which the slotted sphere (36) has been integrated into the support body (22). This reduces the partial count required for fabrication, but may not be as efficient in maintaining the relative pivotal position of the arm (12) in relation to the support body (22) when the cable (46) is tightened. Optionally, ripples (74) can be provided in the slit portion (36s) of the ball (36) to reduce the tendency of the cable (46) to straighten the arm (12) with respect to the body (22) as tension is applied .
Figure 19 illustrates a modality of a joining element (30) similar to the modality of figures 16A-16C, but where the sphere (36) is provided with an opening (36p) as a direct hole that defines a path through the sphere ( 36) that guides the cable (46) from an orientation substantially aligned with the longitudinal geometric axis of the body (22) at the end (36pl), to an orientation forming an angle with respect to the longitudinal geometric axis of the body (22) at the end ( 36p2). In the example shown, the angle is approximately ninety degrees. However, this angle can vary and can be selected from a range of approximately seventy-five degrees to approximately one hundred and thirty-five degrees, more typically from a range of approximately eighty degrees to approximately one hundred and ten degrees. A cross pin (37), such as a stainless steel pin, can be provided to help support the guide path of (36p) and help reduce wear. The pin (37) provides the location on which the cable flexes. The pin (37) is provided as a metal component to withstand high drag forces (frictional) when the cable (46) is pulled at high bending stresses (36p). The pin (37) is crossed through the component (36), as by pressure fitting and / or the use of adhesive or other fixation means. The ball (36) is additionally provided with a slot (36s) and is rotationally mounted on the distal end of the support body (22). In this way, the junction element (30) provides functionality similar to the junction elements (30) previously described which include disc element (34) and sphere (36). The functionality is similar in that the ball (36) can be rotated, which then allows changes in the angular position of the arm (12) in relation to the horizontal plane. In addition, a curved tube molded by rigid insertion can be provided around the cable to prevent or reduce wear of the components as the tube provides less frictional resistance than the cable as it slides against the other components.
Figure 20A illustrates a modality of a stabilizing instrument in which the pivoting action of the arm (12) and the working extremity in relation to a fixed portion of the mounting mechanism (20) is provided by a tower (30t) rotationally mounted on top of the mounting mechanism (20). The driver (52 ') in this embodiment comprises a lever that is configured with a cam mechanism for fast tensioning (and also quick tension release) of the cable (46). The contact elements (16) of the working portion (14) are supported by intermediate lengths by axes (17) used to support the contact elements (16) and connect them to the arm (12) through the axis (17) 'and a ball joint mechanism as previously described. The intermediate connection of the axes (17) to the contact elements (16) places stabilization points closer to the target surgical site to be stabilized.
Figure 20B is a partial longitudinal section view of the device (10) of figure 20A showing the cable path (46) through the mounting mechanism (20) and tower (30t). As the cable extends upwards through the center (34c) of the tower (30t), this allows the tower to maintain its rotational position in relation to the support mechanism (20) during tightening. Figure 20C illustrates that the actuator lever (52 ') can be operated at many different angles to tighten the cable (46).
Figure 21 illustrates a joining element that uses a tower (30t), but where the tower (30t) is formed with a disk element (34) and sphere (36). The disk element (34) is provided with slots (34s) and the ball (36) is slotted (36s). The tower (30t) interfaces with the distal end of the support body (22), and is provided with retainers (34d) for different incremental rotations of the tower (30t) in relation to the support body (2 | 2) and that help to maintain the current angular position of the tower (30t) in relation to the support body (22). A pivot element (34p) such as a fastener or the like is inserted into the slot (28s) of the fixing bracket (28) that allows the tower (30t) to rotate in relation to the fixing bracket (28) and support body (22 ), and also allows the cable (46) to pull the tower (30t) to contact the distal surface (24) of the support body (22) and compress against it to prevent rotation of the tower (30t) in relation to the body support (22).
Figure 22 shows a surgical instrument configured as an organ positioning instrument (100) according to an embodiment of the present invention. The positioning instrument (100) includes a mounting mechanism (120) configured to mount the positioning instrument (100) on a relatively fixed object, such as a sternum retractor, operating table, etc. In figure 24, the positioning instrument (100) is mounted on a rail (202) of a sternum retractor (200).
The positioning instrument (100) further includes an arm (112) pivotally connected to and extending distally from a distal end (124) of the support body (122). The upper surface (126) of the support body (122) is smooth so as not to trap sutures, surgical gloves or any other object liable to be attached to an uneven surface. In addition, this smooth surface can be used by the surgeon to rest a hand or finger, assist in steadying the hand during suturing or another procedure step, for example. As the arm (112) extends from the distal end (124) of the support body (122) and not from the upper surface (126), it provides a lower profile, in relation to the height of the opening (2) of the patient's chest (1) and sternum retractor (200) than a design where the arm extends from a top of the support body. This makes the instrument less of an obstruction (compared to stabilizing instruments of the prior art where the arm is attached to the top of the fixation mechanism) for the surgeon or anyone trying to access the surgical workspace (3).
The positioning instrument (100) further includes a working end (114) mounted on a distal end portion of the arm (112). The working end (114) of the positioning instrument (100) includes at least one contact element (116). A single contact element (116) is provided in the mode shown in figure 22, although multiple contact elements (116) may alternatively be provided. A flexible joint (118) is provided to mount the contact element (116) on a rigid structure while still allowing a limited range of movement for the contact element (116). The contact element (116) is a suction element that is configured to attach to an organ and engage the organ by applying negative pressure through the suction element, with sufficient strength to move the engaged organ and maintain it in an orientation displaced. In one embodiment, this includes maintaining the apex of the heart in an elevated, suspended orientation. The suction element (116) of figures 22-23 includes a cup (151), a hollow shaft (153) securely attached to the cup (151), and connection (157) (to attach a suction line (162) to the axis (153)). The axis (153) is oriented with its geometric axis parallel to the central longitudinal axis of the cup (151). The forming seal (252) is mounted on the distal surface of the cup (151). The seal (252) forms a seal with the heart (or other organ) when vacuum is applied through the body (151) and the seal (252) is placed in contact with the organ. Optionally, a filter (155), such as a foam, mesh or similar filter, can be adapted in the cup (151) (by friction fitting, molding and / or adhesive or other mechanical or chemical means, for example) to prevent the organ tissue is aspirated substantially into the inner area of the cup (151). The concave inner surface of the cup (151) can optionally additionally be coated with soft and absorbent material (preferably non-woven rayon or viscose cloth, but alternatively another material such as gauze or a material of a type currently used in neuro-sponges). The absorbent material is preferably capable of absorbing enough blood and / or other body fluid to significantly improve the traction between the cup and organ, and preferably also works (together with the filter (155), if present) to diffuse the suction exerted by the limb (151) in the organ.
The conformation seal (252) is preferably made of biocompatible foam having some open cells (to control a slow flow of air through the seal (252)), and some have closed cells (including those that define a "coating" on the distal surface seal (252), which is the surface designed to contact the organ). The size and ratio of> open cells to closed cells> guide the rate at which air moves through the seal (252), to retain and continue to retain suction (with the seal liner (252) engaged against an organ or tissue) with a given amount of vacuum applied in (151). As noted, the coating is especially smooth so that upon contacting the surface of the organ / tissue, it forms a seal with the same that is air tight and does not leak to reduce the amount of vacuum applied.
The flexible joint (118) is attached to the distal end of the arm (112). This connection can be formed in the same way as described above with respect to components (43), (47), (58), (60) and (56s) above in the stabilizer mode of figures 3-4. Alternative connections can be replaced as described in the patents that have been incorporated above. Other alternative connections, as well as alternative suction elements that can be replaced can be found in US patents: 6,019,722; 6,338,712; 6,361,493; 6,390,976; 6,506,149; 6,610,008; 6,730,020; 6,969,349; 6,705,988; 6,726,622; 6,743,170; 6,899,670; 7,179,224; 7,195,591; 7,226,409; 7,377,895; 7,404,792; 7,476,196; 7,476,199; and 7,479,104, each of which is hereby incorporated into the entirety by reference to the same.
The arm (112) can be made in the same way as the arm (12) discussed above, although the elements (140) and (142) may have smaller cross-section dimensions than corresponding elements (40) and (42). Alternatively, “any arm that has a flexible configuration, and that can be driven to a rigid configuration can be used, including any arms described in any of the patents incorporated by reference here. The mounting mechanism (120) is provided to secure the positioner (100) to a stationary object, such as a sternum retractor or other fixed object.
The fork (165) is fixed to the ball (56b) via an upright or is integrally made with the ball (56b) and upright. The ball (56b) is free to rotate in relation to the socket (56s) when the cable (46) is released from tension and the arm (112) is in a flexible state. This freedom to rotate is three-dimensional freedom provided by a ball and socket arrangement. The roller (164) is rotationally mounted between the tips of the form (165) and is free to rotate with respect to them. The roller (164) defines a central channel (164c), and the axis (153) of the contact element (114) extends through the channel (164c) as shown in figure 22. Preferably, the spring (156) is positioned around of the axis (153) between the connection (157). and the roller (164). The spring (156) is compressed by force. exercised by connection (157) and roller (164).
During beating heart surgery, the positioner (100) of figure 22 works as follows. The working portion (114) is securely attached by suction exerted through the suction line (162), connection (157), shaft (153) and cup (151) to the surface of the beating heart, thereby engaging the portion (114) so that the cup (151) moves as a unit with the beating heart. The weight of the heart causes the shaft (153) (and the entire cup (151)) and roller (164) to rotate as a unit relative to the fork (165). As the shaft (153) and roller (164) rotate as described with respect to the fork (165), the fork (165) typically also rotates with respect to the socket (56s). In some implementations, the device is implemented in such a way that the rotation of the fork (165) in relation to the socket (56s) occurs only during gross manipulation of the suction element (151) (with the heart coupled by suction to the suction element). In addition, as the shaft (153) and cup (151) oscillate, substantially vertically as a unit with the surface of the beating heart, the shaft (153) slides (through the central channel (164c) of the roller (164) ) in relation to the roller (164) (since the vertical position of the roller (164) is fixed by the fork (165)).
The spring (156) dampens the oscillating movement of the shaft (153) in relation to the roller (164), in the following way. As the shaft (153) slides vertically downwards relative to the roller (164), the spring (156) is compressed (converting some of the kinetic energy of the shaft (153) into potential energy). Then, as the shaft (153) slides vertically upwards in relation to the roller (164), the spring (156) relaxes (stretches) back to its equilibrium position (helping to pull the surface of the heart upwards since some of the potential energy stored in the spring is converted into axis kinetic energy (153)). Optionally, the fork (165) can include a pivot lock (not shown, see US patent 6.506.149, figure (30) and description) that can be manually rotated between two positions: a first position in which it does not prevent that the shaft (153) rotates in relation to the roller (164); and a second position (locking) in which it prevents translation of the shaft (153) in relation to the roller (164).
The support body (122) is configured and dimensioned so that the distal end (124) thereof is substantially flush with an internal surface (200i) of the sternum retractor (200), particularly with an internal surface of the arm / blade ( 204) of the sternum retractor. Alternatively, the distal end (124) may extend slightly beyond / into the inner surface (200i) or terminate slightly before / outside the inner surface (200i). In any case, when the positioning instrument (100) is attached to the rail (202) as shown in figure 24, the distal end (124) of the support body (20) does not extend substantially into the surgical workspace (3) , and thus forms much less of an obstruction than currently available surgical stabilizers. In addition, the joining element (130) that joins the arm (112) provides the arm (112) with the ability to be positioned very close to the internal surface (200i). This mode, both the stabilizer instrument (10) and the positioning instrument (100) as described here, can be oriented so that the arms (12) and (112), respectively, follow along the perimeter of the workspace , thereby greatly increasing the amount of unobstructed working space (3) available to the surgeon, as shown in figure 24. The joining element (130) even allows the arm (112) to be oriented in contact with the inner surface (200i). In particular, the positioning angles of the support body are possible due to the pivoting action of the joining element (130) (or the ball (36) with the slot (36s)). These angles created by pivoting the joining element (130) are substantially smaller than the angles created by alternating ball joints (142). "
The joining element (130) is pivotally mounted on the support body (122) at the distal end portion thereof, so that the arm (112), which is joined to the distal end of the joining element (130), extends the from the distal end (124) of the support body (122). The arm (112) comprises a plurality of hinge connections (140) which allow the arm (112) to be flexible in a first configuration, but which can be compressed to make the arm (112) substantially rigid in a second configuration. In the embodiment shown in figures 22-23, connections (140) include alternating ball joints (142) and biconcave discs (144), as described in more detail in US patent 6,506,149. Alternatively, connections (140) may include (but alternatives are not limited to these examples) a series of spherical joints, a series of joints having a convex side and a concave side, or any of the other modalities described in US patent 6,506,149 , or any of the modalities described in US patent 6,758,808, for example.
Each connection (140) includes a central channel through it that can be tapered at both ends to allow a cable (4 6) (see the detailed view in figure 23) to pass through it smoothly and easily (and to improve rigidity in the rigid state of the arm). The cable (46) extends through the connections (140), joint element (130), support body (122) and connects closely with a drive mechanism (50) and connects distally with a mechanism configured to lock or unlock the gasket (56). The most distal hinge element (43) at the distal end of the arm (112) includes a cavity that opens towards the distal end of the hinge element (43) and is adapted to at least partially receive coupling elements ((58), ( 47) and (60)). A socket element (56s) covers the distal end of the positioning arm (112) and is mated to the most distal hinge element (43) through the coupling elements ((58), (47) and (60)), in combination with the tensioning cable (46) that extends through the positioner.
The proximal end of the cable (46) is connected to a drive mechanism that is configured to increase or decrease the tension on the cable (46) by stretching the extreme end near the cable (466) closely or moving it distally in relation to the support body (122), respectively. The voltage increase and decrease is triggered by the actuator (152), like the button shown in figures 22-23. Additional details on the operation of the mechanism (50) and alternative modalities of such a mechanism can be found, for example, in US patent 6,758,808 and other patents incorporated by reference above. The present invention is not intended to be limited to the mechanism (50) shown in figure 23, since other mechanisms that provide the same function can be replaced.
In the embodiment shown in figures 22-23, the working end (114) includes a suction cup (151) that is configured to apply suction (negative pressure) to the surface of the fabric to be positioned or manipulated, to make the cup (151) engage the fabric. The suction cup (151) is in fluid communication with a vacuum tube (162), which is configured, at its proximal end, to be connected in fluid communication with a negative pressure source. A connector (164) provided at the proximal end of the vacuum tube (162) can be color-coded (for example, color-coded yellow, or some other distinct color), so that users can readily visually distinguish that vacuum tube ( 162) of the vacuum tube (62) or other vacuum tubes that may be used during the procedure. This is important to distinguish, since the magnitude of negative pressure used for the positioner (100) can differ significantly from the magnitude of negative pressure applied through the stabilizer (10).
The joint element (130) includes an articulated joint or pivot (132) that is formed by a disc element (134) pivotally mounted on the mounting mechanism (120) as shown in figure 22 and in the longitudinal, partial section view of the figure 25. The pivoting action provided by the articulated joint (132) allows the stabilizing arm (112) to be pivoted out of the way so that the arm does not protrude into the surgical workspace, (3). As shown in figure 25, the arm (112) can be pivoted, pivoting the disk element (134) in relation to the support body (122), so that the arm (112) approaches or even contacts the internal surface of the retractor (200i) and the arm (112) can thus be adjusted to follow along the perimeter contour of the surgical workspace (3).
The disk element (134) is provided with slits (134s) through a proximal portion thereof, where the slot (134s) typically sweeps through at least approximately 120 degrees from the periphery of the disk element (134), most typically at least approximately 150 degrees as shown in figure (26), and extends to the center of the disc element (134). The slot (134s) allows the cable (46) to be tensioned while maintaining the articulated position of the disc element (134) in relation to the support body (122).
Figure (26) provides a top view of the slot (134s) in a partial longitudinal section view taken in a plane at right angles to the plane along which the partial section view of Figure 25 is taken. The curvature (34c) at the distal ends of the slot facilitates the flexing and tightening of the cable (466) against it when the disc element (134) has been pivoted, and helps to eliminate or reduce variations in cable length / tension in positions different angles from the disc element (134).
In addition, the joining element (130) includes a sphere (136) extending from a distal end of the disc element (134) as shown in figures 25- (26). The ball (136) is dimensioned to cooperate with a close concave surface of the connection (144), thereby allowing the three-dimensional articulation, sphere type and connection socket (and therefore the arm (112) and working end (114)) in relation to the sphere (136). The ball (136) can also be provided with slots (136s) to further facilitate the downward angling of the arm (112) in relation to the support body (122), thereby facilitating the positioning of the arm downwards and following the contour of the retractor and perimeter of the surgical opening as illustrated in figure 24. The slit (136s) can be provided with a curvature at its proximal end. The curvature at the proximal end of the slot (136s) facilitates flexing and tightening of the cable against it when the arm (112) has been pivoted down in relation to the ball (136) / disc element (134), and helps to eliminate or reduce variations in cable length / tension at different angles of the arm (112). In addition, a lubricating sleeve (46s) (such as one made of polytetrafluoroethylene) or lubricating coating can be provided over the cable (46) to help facilitate sliding and reduce friction.
Other variations of the sphere (136) can be provided, including, but not limited to, variations of the sphere (36) described above. Similarly, alternative embodiments of the disc element (134) can be provided as alternative embodiments of the disc element (34) described above.
Figure 27 is a partial view showing details of an assembly mechanism (20) according to an embodiment of the present invention. Although these details are described in relation to the mounting mechanism (20) for a stabilizing instrument (10) (shown, for example, in figures 3-4), it is noted that the details apply equally to a mounting mechanism (120 ) for a positioning instrument according to an embodiment of the present invention (shown, for example, in figures 22-23), since the same mechanism can be used.
Unlike conventional locking mechanisms that use a lever and a cam to move a movable claw from a clamping mechanism in relation to a fixed claw to fix the mechanism to a fixed object, where the lever is coplanar with the bottom surface of the movable claw or the lower surface of the lever is below the upper surface of the movable claw, the actuator of the mounting mechanism (for example, lever or similar) (80) of the embodiment of the present invention shown in figure 27 is slidably mounted on the support body (22) (or (122)) so that the entire mounting mechanism driver (80) is positioned above the upper surface (82u) of the movable jaw (82) and the working mechanism is incorporated into the housing and jaw. This arrangement elevates the actuator (80) above the patient's skin when the mounting mechanism (20) is being attached to a sternum retractor, for example, thereby greatly reducing the chances of tightening the patient's skin on the actuator mechanism as required that the actuator (80) is activated, either to fix the mechanism to the retractor or to remove it from there. In addition, the mechanism of action of meat is hidden in the movable jaw (82), so that there is no risk of trapping or grabbing the patient's tissue during use. Also, the mechanism is designed to allow a lower profile for mounting, compared to current devices, and therefore the stabilizer or positioner is less obstructive to the surgical field and adjacent areas used by the surgeon. Some components of the mounting mechanism (20) are formed of metal to further reduce the profile of the mounting mechanism. For example, the lever portion (80a) of the driver, cam (81) (figure 28C) and optionally, the lever grip portion (80b) of the driver are made of metal to provide a more compact configuration of the mounting mechanism in comparison with prior art designs that make one or more of these polymer components.
In addition, unlike conventional mounting mechanisms in which the actuator lever is rotated distally to secure the mechanism to a retractor, the actuator (80) of the present invention is pulled in close proximity (ie towards the user) to secure or lock the mounting mechanism (20) (or (120)) on a retractor. Ergonomically, this makes it easier for the user to lock an instrument (100) or (10) in a sternum retractor as the close rotation is easier to perform and can be generally done with one hand, where both hands are often required to fix a mechanism that requires distal rotation of the lever to fix the mechanism, since it is easy to hold the body (22) and pull, using one hand, but difficult to hold the body and push, using the same hand. In addition, in conventional mechanisms, the lever extends outward from the mounting mechanism and extends along the track of the retractor when the mechanism is attached to it, thereby preventing another instrument from being mounted close to that mechanism. In the present invention, however, the driver (80) is pulled back in the locked position and aerodynamically with the mounting mechanism (20), (120), see figure 28A. This allows the placement of another instrument much closer to the mounting mechanism (20), (120) on the retractor track, in relation to what is allowed by currently available mechanisms.
Figure 28B illustrates the actuator (80) in the unlocked configuration, which allows initial placement of the mounting mechanism on the fixed object, such as a sternum retractor, or removal of the mounting mechanism from the fixed object. Figure 28C is a cross-sectional view of figure 28A taken along line 28C-28C, and showing the mounting mechanism (20), (120) in the locked configuration. The movable claw (82) is propelled towards the fixed claw (84) by a bias element (88), such as a spiral spring, or other bias element. Therefore, when the mounting mechanism (20), (120) is placed on the rail (202), the rail (202) is contacted on opposite sides by claws (84), (82), as proposed for that position by the propensity element (88). By pulling the driver (80) closely, a cam (81) connected to the driver (80) is rotated and pulls an internal jaw component (82a) on the movable jaw (82) upwards to engage the teeth of the internal jaw component ( 82c) against the upper teeth (84c), thereby locking the movable jaw (82) in relation to the fixed jaw (84) and locking the mounting mechanism (20), (120) in a position fixed against the rail (202) . Thus, the mechanism (20), (120) holds the instrument (10), (1000) fixedly to the rail (202), helping to prevent movement of the arm or surgical instrument.
Figure 28D is a cross-sectional view of figure 28B taken along line 28D-28D, and showing the mounting mechanism (20), (120) in the unlocked and locked configuration. movable claw retracted so that the mounting mechanism (20), (120) can be removed from the rail (202) (or to facilitate placing the mounting mechanism (20), (120) on the rail before securing and locking the same). By pushing the driver (80) distally, the cam (81) rotates in reverse, thereby removing the teeth (82c) from contact with the teeth (84c) and allowing the movable jaw (82) to move away from the fixed jaw (84 ), as well as rail (202), and providing sufficient clearance between the two claws (82), (84) in relation to the rail (202) to allow the mounting mechanism (20), (120) to be lifted off the rail ( 202.). The pushing movement of the actuator (80) requires less effort by the user to unlock and remove the instrument from the surgical site. Additional details on the operation of the cam in relation to the movable grapple can be found in US patent 6,685,632. A spring (88) is provided that tends the movable jaw (82) towards the fixed jaw (84). To first place the claws (82), (84) on the rail (202), the user pulls back on the claw (82) while holding the fixed portion of the mechanism (20), (120) (claw (84) or other fixed portion) to separate the claws. After the jaws have moved away from the upper rail flanges, the jaw (82) can be released, and the spring (88) moves the jaw (82) towards the jaws (84) to place the jaws in lateral contact with the rail (202).
Figures 29A-29B show a side view and an end view, respectively, of a driver (52). The driver (52) is provided with a clamp (52c) provided on at least one of the fins (52f) of the same. In the mode shown, a clamp (52c) is formed on each of the fins (52f). Alternatively, only one or two of the fins (52f) could be provided with clamps (52c). Each clamp (52c) is configured to receive and temporarily or reversibly hold the suction tube (62) to help keep the suction tube in a low profile as it runs along the profile of the instrument (10) / arm (12) , for example, see figure 3. The opening (52o) of the clamp (52c) has a distance through which is slightly smaller than the outside diameter of the tube (62). Therefore, the tube (62) has to be tightened or deformed to insert it through the opening (52o) of the clamp (52c).
Alternatively, or in addition to temporarily retaining the tube (62) in the clamp (52c), the tube can be temporarily retained in the recess (22c) provided in the support body (22), as shown in figure 29C. The recess (22c) is configured to receive and temporarily retain the suction tube (62) to help keep the suction tube in a low profile as it runs along the profile of the instrument (10) / arm (12), for example For example, see figure 29C. The opening of the recess (22c) has a distance through which is slightly less than the outside diameter of the tube (62). Therefore, the tube (62) has to be tightened or deformed to insert it through the opening of the recess (22c) so that it is retained in the recess (22c) after insertion in that place, until a force is applied to pull the even back out of the recess (22c).
Preferably, the tube (62) is a reinforced, flexible, soft tube. However, the inside (52b) of the main body of the clamp (52c) has an internal diameter only slightly smaller than the outside diameter of the tube (62), in order to hold the tube (62) while maintaining relatively non-substantial constriction. Therefore, the tube (62) is held in position in the space (52b) by the soft grip and opening (52o) of the clamp (52c) prevents the tubing (62) from escaping from the clamp during use of the instrument, as operator intervention it is required to remove the tube again so that it can be repositioned in the opening (52o).
Figures 30A-30B show a side view and an extreme view, respectively, of the driver (152). The driver (152) is provided with a clamp (152c) provided on at least one of the fins (152f) of the same. In the mode shown, a clamp (152c) is formed on each of the fins (152f). Alternatively, a smaller number or just one of the fins (152f) could be provided with a clamp (152c). Each clamp (152c) is configured to receive and temporarily retain the suction tube (162) to help keep the suction tube (162) in a low profile as it follows along the profile of the instrument (100) / arm ( 112), for example, see figure 22. The opening (152o) of the clamp (152c) has a distance through which is slightly less than the outside diameter of the tube (162). Therefore, the tube (162) has to be tightened or deformed to insert it through the opening (152o) of the clamp (152c). However, the inside (152b) of the main body of the clamp (152c) has an internal diameter slightly smaller than the outside diameter of the tube (162), in order to hold the tube (162), while not overtightening the tube (162 ). Therefore, the tube (162) is held in position in the space (152b) by the soft grip and the opening (152o) of the clip (152c) prevents the tubing (162) from escaping from the clip while using the instrument, since the operator intervention is necessary to remove the tube so that it can be repositioned in the opening (152o).
Alternatively, or in addition to temporarily retaining the tube (62) on the clamp (152c), the tube can be temporarily retained in a recess provided in the support body (122). The recess in the support body (122) can be configured in the same way as the recess (22c) shown in figure 29C and described above, and is configured to receive and temporarily retain the suction tube (62) to help maintain the tube suction in a low profile as it follows along the profile of the instrument (100) / arm (112). It is further observed that the support body (122) can be constructed to be equal to the support body (22).
31A is a perspective view of a container (300) that is configured to be placed in line, in fluid communication with the vacuum line (62) or (162), between the device (10) or (100) and the vacuum source. As vacuum is applied from the vacuum source (402) or (404) (see figure 32), the suction applied to the patient's tissues (1) not only performs the desired engagement of the working ends (14), (114) with the target tissues, but also tends to pull fluids and particulate materials up through the vacuum tubes (62), (162). These fluids and particulate materials are drawn in through the piping (302) (see figure 31B). A closed end cap (304) is provided over the proximal end of the tube (302). The inner diameter of the cap (304) is significantly larger than the outer diameter of the tube (302) in order to form an annular gap (306) between them. As fluids and particulate materials leave the proximal end of the tube (302), they impact the closed end of the cap (304) or simply (in the case of heavier materials) flow over the sides of the tubes (302) as a source . In any case, most of the liquids contained in the fluids, as well as larger, heavier particulate materials, precipitate out of the fluid flow and are contained by the container (300) and retained in the lower extreme portion of the container (300) by gravity, since the container is oriented vertically during use (for example, see figure 32). In addition, the lid (304) prevents spillage and splash of materials in particles and fluids on the side walls of the container (300), thereby avoiding soiling the walls that would otherwise obstruct the view of the content and level of the content. The lighter fluids, such as gases, and potentially some materials in smaller particles remain in the flow, out through the piping (308), see figure 31C.
A filter (320) is supplied in line, in fluid communication with the container (300), between the container (300) and the vacuum source (402) or (404), see figure 32. Thus, in contrast of some conventional containers, the filter (320) is not supplied inside the container (300), however it is upstream of it. This prevents the filter (320) from being saturated by liquids accumulating in the container, and also makes it possible to change the filter (320) without having to change the container (300), or to change or empty the container (300) without having to change the filter (320). The filter (320) is configured to retain particulate materials that were not contained by the container (300).
The container (300) is preferably provided with at least one substantially flat side which facilitates the assembly of the container (300) along a wall, for example. In the embodiment shown in figures 31A-31D, the container (300) has four substantially flat sides and is substantially square in cross section. However, other shapes in cross section, including, but not limited to triangular, semicircular or semioval, can be replaced. The outer surface of the container is also preferably provided with a fogged finish in order to minimize glare that could otherwise be reflected from the bright lighting of the operating room. Not only does this prevent glare as a distraction, but it also makes it easy to view the contents of the container (300), so that it can be monitored to ensure that it does not fill before changing it.
31D shows a strip (310) which can also be provided with the container (300). The strip (310) is attached to the container (300) and is configured to hang the container from any stationary projection (330) (see figure 32) in the operating room in order to keep the container (300) hanging in the orientation desired vertical (see figure 32) so that the outlet (308) is higher than the inlet (302) and the container (300) is oriented substantially vertically.
Turning now to figures 33A-33B, an alternative mounting mechanism driver (80 ') is described. The driver (80 ') is shown to be used with the instrument (10) of figure 20A. However, any of the other instruments (10), (100) described here could be modified to use this alternate mounting mechanism driver, (80 '). Oscillating switches (86) with meat (86c) interface with the rail (202) and apply compressive forces against it, when rotated (see curved arrows in figure 33B), thereby securely holding the support body and instrument (10) , (100) to the rail (202).
Figures 34A-34B illustrate alternative aspects that can be provided with a working end (14) of a stabilizing instrument according to various embodiments of the present invention. The contact elements (16) and supports therefor can be configured to provide a blower / mist forming device (15) integrated with the contact elements as shown, so that nozzles or openings of the blower / fog forming device are directed towards inside, between the contact elements (16) on which they are mounted, so that they direct the mist towards the surgical target located between the contact elements (16). Alternatively, the stabilizing instrument can be configured for a blower / mist forming device to be attached to it. The working end can be configured for a blower / mist forming device to be attached to it.
Additionally or alternatively, the supports (17) can be configured to pivot in relation to contact elements (16), as indicated by the arrows in figure 34A. The contact elements (16) can also be provided with clamps (19) at their distal ends configured to form a pressure fit with the support elements (17), in order to keep the working end in a very low profile where both the contact elements and the supports extend substantially aligned in the same plane. Figure 35 illustrates a modification whereby contact elements (16) are tapered from a thicker dimension on the outer edges of the same, to a thinner dimension on the inner edges (16 ') of the same. Other modifications that can be made include, but are not limited to: mounting one or more cameras on the contact elements (16) that can be connected to a monitor for viewing, and / or providing an arm (12, 112) that is flexible in a first configuration and after applying vacuum to it, it is made rigid in a second configuration. Fig. 36 illustrates a device modality (10) having an alternative arm (12 ') in which an intermediate connection (45) is provided which is adjustable by a user to adjust the tension in the cable distally therefrom. This aspect can therefore be used to tighten / lock the working end (14) and distal connections of the connection (45), while still allowing connections close to the connection (45) to remain flexible. In this way, the user could fix an initial "rough" or coarse positioning of the working end (14) by tightening the distal connections using the connection (45) as described, and then fine positioning can be accomplished by making additional fine adjustments to the positioning for manipulating the connections close to the connection (45). After obtaining satisfactory fine adjustments for positioning, the rest of the connections can then be locked using the actuator (52). In addition, the connection (45) can be configured to tighten the connections close to the same while allowing the distal connections of the same to remain loose / flexible. In an alternative embodiment, a second cable along the cable (46) is provided that connects to the connection (45) distally, passes through the connections close to the connection (45) and connects to the support body (22). It is observed that although the modifications described with respect to figure 36 are shown with respect to a stabilizing instrument (10), that any and all such modifications can also be applied to a positioning instrument (100). Fig. 37 illustrates an embodiment of the device (10) having an alternate drive mechanism (52), (52 '), (53). In these embodiments, the driver (52) can be operated in the same way as described above with respect to figures 3-4. Alternatively, a motor (53) is provided that can be driven by the driver (52 '), for example, a push button or other switch electrically connected via the arm (12) and support body (22) to the motor (53) , to drive the actuator (52) to increase or decrease the tension in the cable (466). In this way, the actuator (52 ') allows a user to tighten / lock the working end (14) and arm (12) from the extreme distal portion of the instrument, for example, while the hand (s) of the instrument user is (are) in the vicinity of the extreme distal portion of the instrument (10) to position the working end (14) as desired. It is observed that although the modifications described in relation to figure 37 are shown with respect to a stabilizing instrument (10) that the driver (52 ') and motor (53) can be similarly implemented in a positioning instrument (100) of the same way to control the trigger (152).
Although the present invention has been described with reference to its specific modalities, it should be understood by those skilled in the art that various changes can be made and equivalents can be replaced without departing from the true spirit and scope of the invention. In addition, many modifications can be made to adapt a specific situation, material, composition of matter, process, step or process steps, to the objective, spirit and scope of the present invention. All of these changes are intended to be within the scope of the claims appended hereto.

权利要求:
Claims (11)
[0001]
1. Surgical instrument, characterized by the fact that it comprises: a support body (22, 122) having an upper portion, a distal extremity, a proximal extremity and a lower portion; wherein the lower portion comprises an assembly mechanism (20, 120) configured to reversibly attach the surgical instrument to a retractor system; a driver (52, 52 ', 152) mounted to the support body in a region of the proximal end of the support body; a joining element (30, 130) pivotally mounted on a portion of the distal end of the support body to allow the positioning of the proximal portion of an arm (12, 112) extending distally from the joining element of a distal region left of the support body to a right distal region of the support body and vice versa without causing movement of the actuator, in which the joining element comprises: a first joining element (34, 134) configured to limit yaw movement, and a second joining element (36, 136) configured to limit pitching movement; a working end (14, 114) mounted on a portion of the distal end of the arm; and a cable (46) that extends from the driver through the support body of the joining element and the arm; wherein the joint element mounted on the support body is configured to at least partially limit the movement of the proximal portion of the arm in a plane, where the arm (12, 112) comprises a plurality of articulation connections (40, 140) that allow the arm to remain in a flexible state and can be compressed to place the arm in a rigid state, where a proximal arm connection immediately adjacent to the joint element is pivotable to a position substantially perpendicular with respect to the supporting body , wherein the substantially perpendicular position is a position in which the proximal connection is at an angle of 80 degrees to 90 degrees in relation to the support body; where a driver is pivotally mounted to the support body at the proximal end of the support body, where the driver and cable are configured to change a state of the arm from the flexible state to the rigid state by rotating the driver in a first rotational direction , and from the rigid state to the flexible state by rotation of the actuator in a second rotational direction opposite to the first direction, in which the rotation of the actuator in the first rotational direction increases the tension in the cable, thus fixing the orientation of the arm in relation to the body of support in the rigid state.
[0002]
2. Instrument according to claim 1, characterized by the fact that the first joining element is a disc element (34, 134) that is received within a cavity of the support body, and the second joining element is a slotted sphere (36, 136) connected to the disk element.
[0003]
3. Instrument, according to claim 2, characterized by the fact that the upper and lower surfaces of the disk element (34, 134) are parallel to the upper portion of the support body, and in which the proximal portion of the arm is coupled to slotted sphere (36, 136) and capable of pivoting to a position in which the proximal portion of the arm is at an angle of 80 degrees to 90 degrees with respect to the upper and lower surfaces of the disc element.
[0004]
4. Instrument according to claim 2, characterized by the fact that the slotted ball element (36, 136) forms a joint with a proximal end of the arm.
[0005]
5. Instrument according to any one of claims 1 to 4, characterized by the fact that it further comprises a vacuum tube (62, 162) in fluid communication with the working end, and the working end is configured to clamp reversible shape to the outer surface of a human's heart.
[0006]
6. Instrument according to any one of claims 1 to 4, characterized by the fact that the instrument is an organ stabilizer (10) and the working end comprises at least one contact element (16) configured to be exercised against an fabric surface to stabilize the fabric surface.
[0007]
7. Instrument according to any one of claims 1 to 5, characterized by the fact that the instrument is an organ positioner (100) and the working end comprises a suction element (116) defining a vacuum space therein, wherein the suction element is configured to receive the apex of a human heart.
[0008]
8. Instrument according to any one of claims 1 to 5 or 7, characterized by the fact that it further comprises a suction tube (62, 162) in fluid communication with the working end, and a clamp (52c, 152c) configured to temporarily receive and retain the suction tube to keep the suction tube in a low profile with the instrument, where the clamp is formed with or connected to the support body, the driver, or both the support body and the driver .
[0009]
9. Instrument according to any one of claims 1 to 8, characterized by the fact that the arm comprises an intermediate connection (45) arranged between a distal portion of the arm and a proximal portion of the arm, the intermediate connection is capable of adjusting a the distal and proximal portions of the arm to assume a flexible configuration in a first configuration, and to assume a rigid configuration in a second configuration, while allowing a portion of the proximal arm of the intermediate connection to remain flexible during both the first configuration and the second configuration, and wherein the actuator is able to adjust the proximal or distal portion of the arm which is not capable of being adjusted by the intermediate connection.
[0010]
10. Instrument according to any one of claims 1 to 9, characterized by the fact that a portion of the joint element limits the movement of the proximal portion of the arm to a single plane when the joint element is removably mounted to the body of Support.
[0011]
11. Instrument according to any one of claims 1 to 10, characterized by the fact that the upper portion of the support body extending from a central portion of the body to a distal end portion is smooth and comprises a flat portion without obstructions in the same.

类似技术:

---

公开号 | 公开日 | 专利标题

---

BR112012032039B1|2020-12-15|CIRURGICAL INSTRUMENTS

---

EP0908138B1|2004-01-07|Surgical tissue stabilization device having remotely actuated feet

---

CA2249494C|2007-01-09|A tissue stabilization device for use during surgery

---

EP0908139B1|2003-12-10|A tissue stabilization device for use during surgery

---

US6007486A|1999-12-28|Tissue stabilization device for use during surgery having a segmented shaft

---

ES2227691T3|2005-04-01|SURGICAL HOLDING DEVICES.

---

US7294104B2|2007-11-13|Surgical instrument holder

---

US6364833B1|2002-04-02|Irrigator for use with surgical retractor and tissue stabilization device and methods related thereto

---

AU3121701A|2001-08-07|Apparatus and methods for cardiac surgery

---

BR122020016721B1|2021-12-07|SURGICAL INSTRUMENTS

同族专利:

---

公开号 | 公开日

---

US20190357895A1|2019-11-28|

---

JP2018015636A|2018-02-01|

---

BR112012032039A2|2016-11-08|

---

EP3741306A3|2021-07-21|

---

US20210236107A1|2021-08-05|

---

EP3187119A1|2017-07-05|

---

JP6239792B2|2017-11-29|

---

WO2011159733A1|2011-12-22|

---

EP2579785A1|2013-04-17|

---

EP2579785B1|2016-11-16|

---

US9655605B2|2017-05-23|

---

JP2017094139A|2017-06-01|

---

US20170238917A1|2017-08-24|

---

AU2011268433A1|2013-01-10|

---

EP3741306A2|2020-11-25|

---

US20120157788A1|2012-06-21|

---

US10398422B2|2019-09-03|

---

AU2015230712B2|2017-06-15|

---

JP2013545493A|2013-12-26|

---

AU2015230712A1|2015-11-05|

---

JP2020157042A|2020-10-01|

---

JP6715401B2|2020-07-01|

---

EP3187119B1|2020-07-15|

引用文献:

---

公开号 | 申请日 | 公开日 | 申请人 | 专利标题

---

---

US1706500A|1927-08-01|1929-03-26|Henry J Smith|Surgical retractor|

---

US2082782A|1935-10-03|1937-06-08|Alfred G Allen|Vacuum tenaculum|

---

US2296793A|1942-02-02|1942-09-22|Harry M Kirschbaum|Surgical retractor|

---

US2450194A|1946-07-22|1948-09-28|Glaser Mark Albert|Adjustable retractor|

---

GB623897A|1947-04-03|1949-05-25|Fridolin Fluck|Improved apparatus for treating the body|

---

US2693795A|1950-09-09|1954-11-09|Herman R Grieshaber|Surgical retractor|

---

US2863444A|1956-08-21|1958-12-09|Winsten Joseph|Liver retractor for cholecystectomies|

---

NL106631C|1960-02-04|1963-11-15|Pieter Johannes Meijs|SUPPORT AND LOCKING DEVICE, IN PARTICULAR FOR A TIMER|

---

US3361133A|1965-07-22|1968-01-02|Canadian Patents Dev|Vacuum artery clamp|

---

US3392722A|1965-07-29|1968-07-16|Roger L. Jorgensen|Post-operative surgical valve|

---

US3466079A|1965-09-08|1969-09-09|Western Electric Co|Pressurized fluid pickup device|

---

GB1251833A|1968-02-26|1971-11-03|

---

US3683926A|1970-07-09|1972-08-15|Dainippon Pharmaceutical Co|Tube for connecting blood vessels|

---

US3720433A|1970-09-29|1973-03-13|Us Navy|Manipulator apparatus for gripping submerged objects|

---

GB1376747A|1971-02-11|1974-12-11|Molins Ltd|Monitoring devices|

---

US3807406A|1971-06-25|1974-04-30|Bio Medicus Inc|Instrument surgical with suction device|

---

US3783873A|1971-09-16|1974-01-08|H Jacobs|Weighted surgical clamp having foldable prop|

---

US3858926A|1973-07-23|1975-01-07|Ludger Ottenhues|Vacuum lifting device|

---

US3882885A|1973-07-25|1975-05-13|Continental Oil Co|Method of handling a large diameter slurry hose system|

---

US3916909A|1973-08-01|1975-11-04|Bio Medicus Inc|Suction surgical instrument of the forceps type|

---

US4048987A|1973-08-06|1977-09-20|James Kevin Hurson|Surgical acid|

---

US3882855A|1973-11-12|1975-05-13|Heyer Schulte Corp|Retractor for soft tissue for example brain tissue|

---

US3858578A|1974-01-21|1975-01-07|Pravel Wilson & Matthews|Surgical retaining device|

---

US4049002A|1975-07-18|1977-09-20|Bio-Medicus, Inc.|Fluid conveying surgical instrument|

---

US3912317A|1974-07-10|1975-10-14|Shiroyama Kogyo Kk|Vacuum suction type manipulator|

---

GB1526933A|1974-09-13|1978-10-04|Johnson Matthey Co Ltd|Vacuum head for handling transfers|

---

US4096864A|1975-03-26|1978-06-27|Bio-Medicus, Inc.|Fluid carrying surgical instrument of the forceps type|

---

US4047532A|1975-04-21|1977-09-13|Phillips Jack L|Vacuum forcep and method of using same|

---

US3983863A|1975-06-02|1976-10-05|American Hospital Supply Corporation|Heart support for coronary artery surgery|

---

DE2527706A1|1975-06-21|1976-12-30|Hanfried Dr Med Weigand|DEVICE FOR THE INTRODUCTION OF CONTRAST AGENTS INTO AN ARTIFICIAL INTESTINAL OUTLET|

---

US4049000A|1975-08-01|1977-09-20|Williams Robert W|Suction retraction instrument|

---

GB1530332A|1976-03-13|1978-10-25|Vinten Ltd|Balanced portable pedestals|

---

US4052980A|1976-06-10|1977-10-11|Guenter A. Grams|Triaxial fiberoptic soft tissue retractor|

---

US4168708A|1977-04-20|1979-09-25|Medical Engineering Corp.|Blood vessel occlusion means suitable for use in anastomosis|

---

US4108178A|1977-04-28|1978-08-22|Progessive Machine Products, Inc.|Pinch valve syringe|

---

US4226228A|1978-11-02|1980-10-07|Shin Hee J|Multiple joint retractor with light|

---

US4217890A|1978-11-03|1980-08-19|Owens Milton L|Surgical sling for positioning a harvested kidney during surgical reattachment|

---

JPS6114822B2|1978-11-09|1986-04-21|Olympus Optical Co|

---

US4230119A|1978-12-01|1980-10-28|Medical Engineering Corp.|Micro-hemostat|

---

US4300541A|1979-02-09|1981-11-17|Kermit Burgin|Speculum lens structure|

---

US4306561A|1979-11-05|1981-12-22|Ocean Trading Co., Ltd.|Holding apparatus for repairing severed nerves and method of using the same|

---

SU1088712A1|1979-11-14|1984-04-30|Всесоюзный научно-исследовательский и испытательный институт медицинской техники|Apparatus for circular suture of blood vessels|

---

US4428368A|1980-09-29|1984-01-31|Masakatsu Torii|Massage device|

---

US4421107A|1980-10-15|1983-12-20|Estes Roger Q|Surgical retractor elements and assembly|

---

US4368736A|1980-11-17|1983-01-18|Kaster Robert L|Anastomotic fitting|

---

US4366819A|1980-11-17|1983-01-04|Kaster Robert L|Anastomotic fitting|

---

US4346711A|1981-01-16|1982-08-31|Sherwood Medical Industries Inc.|Body fluid collection device with disposable liner|

---

US4688570A|1981-03-09|1987-08-25|The Regents Of The University Of California|Ophthalmologic surgical instrument|

---

US5245705A|1981-10-02|1993-09-14|Hughes Aircraft Company|Functional addressing method and apparatus for a multiplexed data bus|

---

US4483339A|1982-01-29|1984-11-20|Rolando Gillis|Vascular surgery roll|

---

US4434791A|1982-03-15|1984-03-06|Humboldt Products Corp.|Surgical retractor array system|

---

US4457300A|1982-06-07|1984-07-03|Ohio Medical Instrument Co., Inc.|Surgical retractor|

---

US4492229A|1982-09-03|1985-01-08|Grunwald Ronald P|Suture guide holder|

---

US4461284A|1982-09-30|1984-07-24|Fackler Martin L|Surgical retaining device|

---

US4428815A|1983-04-28|1984-01-31|Western Electric Co., Inc.|Vacuum-type article holder and methods of supportively retaining articles|

---

US4747395A|1983-08-24|1988-05-31|Brief L Paul|Surgical retractor for bone surgery|

---

SE454941B|1983-10-28|1988-06-13|Astra Tech Ab|ELECTROD, VACUUM FIXED SOFT, AND AN ELECTROD PLATE FOR AN ELECTROD, INTENDED FOR EX ECG SURFACES|

---

US4718418A|1983-11-17|1988-01-12|Lri L.P.|Apparatus for ophthalmological surgery|

---

US4841967A|1984-01-30|1989-06-27|Chang Ming Z|Positioning device for percutaneous needle insertion|

---

US4597382A|1984-03-16|1986-07-01|Perez Jr Raul|Medical speculum and procedure|

---

US4627421A|1984-08-03|1986-12-09|Symbas Panagiotis N|Sternal retractor|

---

EP0191043A1|1984-08-10|1986-08-20|World Products Pty. Limited|Device for manipulative treatments|

---

US4949707A|1984-11-08|1990-08-21|Minnesota Scientific, Inc.|Retractor apparatus|

---

US4617916A|1984-11-08|1986-10-21|Minnesota Scientific, Inc.|Retractor apparatus|

---

US5169761A|1984-12-11|1992-12-08|California Biotechnology Inc.|Dna encoding and expression systems for alveolar surfactant proteins|

---

US4941872A|1985-01-22|1990-07-17|C. R. Bard, Inc.|Control handle for surgical irrigation and suction device|

---

USD293470S|1985-03-14|1987-12-29|Adler David T|Combined adjustable positioner and holder for surgical instruments|

---

US4673161A|1985-03-27|1987-06-16|Sherwood Medical Company|Tube clamping device|

---

SE8502048D0|1985-04-26|1985-04-26|Astra Tech Ab|VACUUM FIXED HALLS FOR MEDICAL USE|

---

US4637377A|1985-09-20|1987-01-20|Loop Floyd D|Pillow or support member for surgical use|

---

US4955896A|1985-09-27|1990-09-11|Freeman Jerre M|Universal medical forcep tool|

---

USRE34150E|1985-11-12|1992-12-29|Kapp Surgical Instrument, Inc.|Cardiovascular and thoracic retractor|

---

US4726356A|1985-11-12|1988-02-23|Kapp Surgical Instrument, Inc.|Cardiovascular and thoracic retractor|

---

IL80661A|1985-11-29|1991-07-18|Jaquet Orthopedie|Device for positioning and securing a part having circular regions|

---

DE3609133C2|1986-03-19|1988-03-17|Glatt Gmbh, 7851 Binzen, De|

---

US4708510A|1986-04-17|1987-11-24|Mcconnell Bernard E|Ball joint coupling|

---

SE454942B|1986-05-22|1988-06-13|Astra Tech Ab|HEART HELP DEVICE FOR INOPERATION IN BROSTHALAN|

---

FR2599238B1|1986-05-28|1988-08-19|Delacroix Chevalier Sa|STERNAL RETRACTOR.|

---

US4767404A|1986-07-14|1988-08-30|R & S Associates Co.|Surgical suction device having a perforated sleeve|

---

JPS6339770A|1986-08-01|1988-02-20|Kiyoshi Takahashi|Vacuum forceps made of total fluorocarbon resin|

---

SE447012B|1986-09-10|1986-10-20|Goran Ewerlof|DEVICE FOR CONTROL AND REGULATION OF A FLOWING FLUID|

---

US4754746A|1986-09-25|1988-07-05|Cox Kenneth L|Self-retaining metatarsal spreader|

---

US4747394A|1986-10-08|1988-05-31|Watanabe Orthopedic Systems, Inc.|Spinal retractor|

---

DE3778477D1|1986-10-14|1992-05-27|Zedlani Pty Ltd|DEVICE FOR TREATING URINE INCONTINENCE.|

---

JPS6387831U|1986-11-26|1988-06-08|

---

US4702230A|1986-12-08|1987-10-27|Pilling Co.|Adapter for surgical retractor|

---

US5323789A|1986-12-18|1994-06-28|Minnesota Mining And Manufacturing Company|Anastomosis preparation technique with easily insertable member|

---

US5098369A|1987-02-27|1992-03-24|Vascor, Inc.|Biocompatible ventricular assist and arrhythmia control device including cardiac compression pad and compression assembly|

---

US4925443A|1987-02-27|1990-05-15|Heilman Marlin S|Biocompatible ventricular assist and arrhythmia control device|

---

US4863133A|1987-05-26|1989-09-05|Leonard Medical|Arm device for adjustable positioning of a medical instrument or the like|

---

US4827926A|1987-06-30|1989-05-09|Carol Mark P|Flexible support arm for medical instruments|

---

US4803984A|1987-07-06|1989-02-14|Montefiore Hospital Association Of Western Pennsylvania|Method for performing small vessel anastomosis|

---

US4808163A|1987-07-29|1989-02-28|Laub Glenn W|Percutaneous venous cannula for cardiopulmonary bypass|

---

IT1222456B|1987-08-06|1990-09-05|Enzo Scaglia|SUCTION CUP LIFT|

---

US4787662A|1987-08-28|1988-11-29|Hewlett-Packard Company|Vacuum driven gripping tool|

---

US4852552A|1987-09-03|1989-08-01|Pilling Co.|Sternal retractor|

---

US5080088A|1987-11-09|1992-01-14|Minnesota Scientific, Inc.|Flexible retractor|

---

US4884559A|1987-12-04|1989-12-05|Collins Jason H|Surgical speculum|

---

US4854318A|1987-12-18|1989-08-08|Scanlan International|Blood vessel holder and method of using in anastomosis|

---

DE3801666A1|1988-01-21|1989-07-27|Masa Maschinenfabrik Olga Koss|ELASTIC SUCTION PLATE FOR SENSITIVE OBJECTS|

---

US5180392A|1988-02-01|1993-01-19|Einar Skeie|Anastomotic device|

---

US4865019A|1988-02-25|1989-09-12|Phillips Steven J|Retractor apparatus for use in harvesting mammary arteries during heart by-pass surgery|

---

US4857042A|1988-03-16|1989-08-15|Sherwood Medical Company|Body fluid collection device|

---

US5052373A|1988-07-29|1991-10-01|Michelson Gary K|Spinal retractor|

---

SE8802904D0|1988-08-16|1988-08-16|Mogens Bugge|DR MOGENS BUGGE'S MAMMARIA HAKE|

---

US4892526A|1988-08-18|1990-01-09|Reese H William|Surgical irrigation apparatus|

---

US5011469A|1988-08-29|1991-04-30|Shiley, Inc.|Peripheral cardiopulmonary bypass and coronary reperfusion system|

---

US4971037A|1988-09-19|1990-11-20|Pilling Co.|Surgical retractor support|

---

US4962758A|1988-11-23|1990-10-16|Jeffrey Lasner|Vibratory device for releasing air bubbles trapped in the heart muscle|

---

US5152777A|1989-01-25|1992-10-06|Uresil Corporation|Device and method for providing protection from emboli and preventing occulsion of blood vessels|

---

US5192289A|1989-03-09|1993-03-09|Avatar Design And Development, Inc.|Anastomosis stent and stent selection system|

---

US4991578A|1989-04-04|1991-02-12|Siemens-Pacesetter, Inc.|Method and system for implanting self-anchoring epicardial defibrillation electrodes|

---

US4989587A|1989-04-26|1991-02-05|Farley Daniel K|Sternal retractor|

---

US4993862A|1989-08-16|1991-02-19|Pilling Company|Clamp assembly for surgical retractor support|

---

US5632746A|1989-08-16|1997-05-27|Medtronic, Inc.|Device or apparatus for manipulating matter|

---

US5167223A|1989-09-08|1992-12-01|Tibor Koros|Heart valve retractor and sternum spreader surgical instrument|

---

US5034001A|1989-09-08|1991-07-23|Advanced Cardiovascular Systems, Inc.|Method of repairing a damaged blood vessel with an expandable cage catheter|

---

US5019086A|1989-09-12|1991-05-28|Neward Theodore C|Manipulable vacuum extractor for childbirth and method of using the same|

---

US5009660A|1989-09-15|1991-04-23|Visx, Incorporated|Gas purging, eye fixation hand piece|

---

US4973300A|1989-09-22|1990-11-27|Pioneering Technologies, Inc.|Cardiac sling for circumflex coronary artery surgery|

---

EP0422887B1|1989-10-13|1996-12-11|Kabushiki Kaisha Machida Seisakusho|Bending device|

---

US4949927A|1989-10-17|1990-08-21|John Madocks|Articulable column|

---

US5203769A|1989-11-06|1993-04-20|Mectra Labs, Inc.|Medical device valving mechanism|

---

US5139517A|1989-11-08|1992-08-18|Corral David F|Orthotopic intraventricular heart pump|

---

US5102853A|1989-11-22|1992-04-07|Ford Motor Company|Three-way catalyst for automotive emission control|

---

US5036868A|1990-01-29|1991-08-06|Unilink Inc.|Anastomosis preparation technique|

---

US5328471A|1990-02-26|1994-07-12|Endoluminal Therapeutics, Inc.|Method and apparatus for treatment of focal disease in hollow tubular organs and other tissue lumens|

---

US5053041A|1990-03-12|1991-10-01|Ansari Shapoor S|Vessel holder|

---

US5107852A|1990-04-02|1992-04-28|W. L. Gore & Associates, Inc.|Catheter guidewire device having a covering of fluoropolymer tape|

---

US5071407A|1990-04-12|1991-12-10|Schneider Inc.|Radially expandable fixation member|

---

US5242399A|1990-04-25|1993-09-07|Advanced Cardiovascular Systems, Inc.|Method and system for stent delivery|

---

US5037428A|1990-06-21|1991-08-06|Applied Medical Technology, Inc.|Vessel approximation and alignment device|

---

EP0466632B1|1990-07-13|1995-11-02|Javier Botet Del Castillo|Protective instrument for suturing|

---

US5131905A|1990-07-16|1992-07-21|Grooters Ronald K|External cardiac assist device|

---

US5087247A|1990-08-28|1992-02-11|Cardiovascular Designs, Inc.|Balloon perfusion catheter|

---

JP2524586Y2|1990-09-06|1997-02-05|エスエムシー株式会社|Suction pad|

---

US5125395A|1990-09-12|1992-06-30|Adair Edwin Lloyd|Deflectable sheath for optical catheter|

---

US5449372A|1990-10-09|1995-09-12|Scimed Lifesystems, Inc.|Temporary stent and methods for use and manufacture|

---

US5098396A|1990-10-19|1992-03-24|Taylor Ellis R|Valve for an intravascular catheter device|

---

FR2668696B1|1990-11-06|1993-02-19|Ethnor|ENDOSCOPIC SURGICAL INSTRUMENT FOR TISSUE ENTRY.|

---

US5119804A|1990-11-19|1992-06-09|Anstadt George L|Heart massage apparatus|

---

US5159921A|1990-11-27|1992-11-03|Hoover Rocklin L|Surgical retractor|

---

US5300087A|1991-03-22|1994-04-05|Knoepfler Dennis J|Multiple purpose forceps|

---

US5133724A|1991-04-04|1992-07-28|Pilling Co.|Abdominal aortic clamp|

---

NZ272209A|1991-05-01|2001-02-23|Univ Columbia|Myocardial revascularisation of the heart by a laser|

---

US5370134A|1991-05-29|1994-12-06|Orgin Medsystems, Inc.|Method and apparatus for body structure manipulation and dissection|

---

US5520610A|1991-05-31|1996-05-28|Giglio; Steven R.|Self retaining retractor|

---

US6029671A|1991-07-16|2000-02-29|Heartport, Inc.|System and methods for performing endovascular procedures|

---

US5199419A|1991-08-05|1993-04-06|United States Surgical Corporation|Surgical retractor|

---

US5150706A|1991-08-15|1992-09-29|Cox James L|Cooling net for cardiac or transplant surgery|

---

US5171254A|1991-11-19|1992-12-15|Sher Neal A|Eye fixation device|

---

US5707362A|1992-04-15|1998-01-13|Yoon; Inbae|Penetrating instrument having an expandable anchoring portion for triggering protrusion of a safety member and/or retraction of a penetrating member|

---

GB9201214D0|1992-01-21|1992-03-11|Mcmahon Michael J|Surgical retractors|

---

US5348259A|1992-02-10|1994-09-20|Massachusetts Institute Of Technology|Flexible, articulable column|

---

US5339801A|1992-03-12|1994-08-23|Uresil Corporation|Surgical retractor and surgical method|

---

US5268640A|1992-04-02|1993-12-07|Toshiba America Mri, Inc.|Method and apparatus for the formation of a plurality of NMR images, each having a different characteristic, of the same slice, in a single sequence|

---

US5368566A|1992-04-29|1994-11-29|Cardiovascular Dynamics, Inc.|Delivery and temporary stent catheter having a reinforced perfusion lumen|

---

US5293863A|1992-05-08|1994-03-15|Loma Linda University Medical Center|Bladed endoscopic retractor|

---

US5311131A|1992-05-15|1994-05-10|Board Of Regents Of The University Of Washington|Magnetic resonance imaging using pattern recognition|

---

US5372147A|1992-06-16|1994-12-13|Origin Medsystems, Inc.|Peritoneal distension robotic arm|

---

US5336252A|1992-06-22|1994-08-09|Cohen Donald M|System and method for implanting cardiac electrical leads|

---

US5437266A|1992-07-02|1995-08-01|Mcpherson; William|Coil screw surgical retractor|

---

US5290082A|1992-07-06|1994-03-01|Palmer Harold D|Battery operated hand held vacuum handling device|

---

US5383840A|1992-07-28|1995-01-24|Vascor, Inc.|Biocompatible ventricular assist and arrhythmia control device including cardiac compression band-stay-pad assembly|

---

US5336170A|1992-07-29|1994-08-09|Research Medical, Inc.|Surgical site visualization wand|

---

US5318013A|1992-11-06|1994-06-07|Wilk Peter J|Surgical clamping assembly and associated method|

---

WO1994003142A1|1992-07-30|1994-02-17|Temple University - Of The Commonwealth System Of Higher Education|Direct manual cardiac compression device and method of use thereof|

---

US5256132A|1992-08-17|1993-10-26|Snyders Robert V|Cardiac assist envelope for endoscopic application|

---

US5242386A|1992-08-27|1993-09-07|Sontech Limited|Echographic suction cannula|

---

US5287861A|1992-10-30|1994-02-22|Wilk Peter J|Coronary artery by-pass method and associated catheter|

---

US5382756A|1993-01-22|1995-01-17|Dagan; Gideon B.|Encapsulation closure for cables|

---

US5403280A|1993-02-16|1995-04-04|Wang; James C.|Inflatable perfusion catheter|

---

US5452733A|1993-02-22|1995-09-26|Stanford Surgical Technologies, Inc.|Methods for performing thoracoscopic coronary artery bypass|

---

US5571215A|1993-02-22|1996-11-05|Heartport, Inc.|Devices and methods for intracardiac procedures|

---

US5799661A|1993-02-22|1998-09-01|Heartport, Inc.|Devices and methods for port-access multivessel coronary artery bypass surgery|

---

US5569274A|1993-02-22|1996-10-29|Heartport, Inc.|Endoscopic vascular clamping system and method|

---

US6010531A|1993-02-22|2000-01-04|Heartport, Inc.|Less-invasive devices and methods for cardiac valve surgery|

---

US6494211B1|1993-02-22|2002-12-17|Hearport, Inc.|Device and methods for port-access multivessel coronary artery bypass surgery|

---

US5735290A|1993-02-22|1998-04-07|Heartport, Inc.|Methods and systems for performing thoracoscopic coronary bypass and other procedures|

---

US5713951A|1993-02-22|1998-02-03|Heartport, Inc.|Thoracoscopic valve prosthesis delivery device|

---

US6478029B1|1993-02-22|2002-11-12|Hearport, Inc.|Devices and methods for port-access multivessel coronary artery bypass surgery|

---

US5613937A|1993-02-22|1997-03-25|Heartport, Inc.|Method of retracting heart tissue in closed-chest heart surgery using endo-scopic retraction|

---

US5425705A|1993-02-22|1995-06-20|Stanford Surgical Technologies, Inc.|Thoracoscopic devices and methods for arresting the heart|

---

US5797960A|1993-02-22|1998-08-25|Stevens; John H.|Method and apparatus for thoracoscopic intracardiac procedures|

---

US5423737A|1993-05-27|1995-06-13|New Dimensions In Medicine, Inc.|Transparent hydrogel wound dressing with release tab|

---

US5498256A|1993-05-28|1996-03-12|Snowden-Pencer, Inc.|Surgical instrument handle|

---

US5363841A|1993-07-02|1994-11-15|Coker Wesley L|Retractor for spinal surgery|

---

US5513827A|1993-07-26|1996-05-07|Karlin Technology, Inc.|Gooseneck surgical instrument holder|

---

JPH0758191A|1993-08-13|1995-03-03|Toshiba Corp|Wafer stage device|

---

US5395333A|1993-09-01|1995-03-07|Scimed Life Systems, Inc.|Multi-lobed support balloon catheter with perfusion|

---

US5437651A|1993-09-01|1995-08-01|Research Medical, Inc.|Medical suction apparatus|

---

US5957832A|1993-10-08|1999-09-28|Heartport, Inc.|Stereoscopic percutaneous visualization system|

---

US5512038A|1993-11-15|1996-04-30|O'neal; Darrell D.|Spinal retractor apparatus having a curved blade|

---

US5397307A|1993-12-07|1995-03-14|Schneider Inc.|Drug delivery PTCA catheter and method for drug delivery|

---

JP2580836Y2|1993-12-16|1998-09-17|繁 風間|Heart conversion device|

---

DK145593A|1993-12-23|1995-06-24|Joergen A Rygaard|Surgical double instrument for performing connection mlm. arteries |

---

US5772583A|1994-01-21|1998-06-30|Wright; John T. M.|Sternal retractor with attachments for mitral & tricuspid valve repair|

---

US5514076A|1994-01-27|1996-05-07|Flexmedics Corporation|Surgical retractor|

---

US5453078A|1994-03-04|1995-09-26|Merocel Corporation|Endoscopic wedge and organ positioner|

---

US5417709A|1994-04-12|1995-05-23|Symbiosis Corporation|Endoscopic instrument with end effectors forming suction and/or irrigation lumens|

---

US5484412A|1994-04-19|1996-01-16|Pierpont; Brien E.|Angioplasty method and means for performing angioplasty|

---

US5512037A|1994-05-12|1996-04-30|United States Surgical Corporation|Percutaneous surgical retractor|

---

US5522819A|1994-05-12|1996-06-04|Target Therapeutics, Inc.|Dual coil medical retrieval device|

---

US5846219A|1994-05-26|1998-12-08|Vancaillie; Thierry G.|Variable backflow suction-hydraulic curet|

---

US5480425A|1994-06-09|1996-01-02|Carbomedics, Inc.|Integrated heart valve rotator and holder|

---

US5558665A|1994-06-24|1996-09-24|Archimedes Surgical, Inc.|Surgical instrument and method for intraluminal retraction of an anatomic structure|

---

US5547458A|1994-07-11|1996-08-20|Ethicon, Inc.|T-shaped abdominal wall lift with telescoping member|

---

US5503617A|1994-07-19|1996-04-02|Jako; Geza J.|Retractor and method for direct access endoscopic surgery|

---

US5738627A|1994-08-18|1998-04-14|Duke University|Bi-ventricular cardiac assist device|

---

US5807243A|1994-08-31|1998-09-15|Heartport, Inc.|Method for isolating a surgical site|

---

US5820373A|1995-08-29|1998-10-13|Koichi Okano|Cleaning device for periodontal pocket|

---

US5803902A|1994-10-06|1998-09-08|United States Surgical Corporation|Surgical retractor|

---

US5522882A|1994-10-21|1996-06-04|Impra, Inc.|Method and apparatus for balloon expandable stent-graft delivery|

---

US5489280A|1994-10-31|1996-02-06|Zimmer, Inc.|Surgical preparation solution applicator|

---

US5830214A|1994-11-08|1998-11-03|Heartport, Inc.|Fluid-evacuating electrosurgical device|

---

US5795291A|1994-11-10|1998-08-18|Koros; Tibor|Cervical retractor system|

---

US5529571A|1995-01-17|1996-06-25|Daniel; Elie C.|Surgical retractor/compressor|

---

US5607446A|1995-01-31|1997-03-04|Beehler; Cecil C.|Pupil dilator|

---

US6110187A|1995-02-24|2000-08-29|Heartport, Inc.|Device and method for minimizing heart displacements during a beating heart surgical procedure|

---

US5888247A|1995-04-10|1999-03-30|Cardiothoracic Systems, Inc|Method for coronary artery bypass|

---

US5722935A|1995-05-05|1998-03-03|Minnesota Scientific, Inc.|Laparoscopic retractor having a plurality of blades extending laterally from a handle|

---

US5616117A|1995-08-03|1997-04-01|Ohio Medical Instrument Company, Inc.|Self locking surgical retractor|

---

EP0985934B1|1995-08-28|2004-10-20|Shin-Etsu Chemical Co., Ltd.|Opposed magnet-type magnetic circuit assembly with permanent magnets|

---

US5836311A|1995-09-20|1998-11-17|Medtronic, Inc.|Method and apparatus for temporarily immobilizing a local area of tissue|

---

US7445594B1|1995-09-20|2008-11-04|Medtronic, Inc.|Method and apparatus for temporarily immobilizing a local area of tissue|

---

US5667480A|1995-10-20|1997-09-16|Ethicon Endo-Surgery, Inc.|Method and devices for endoscopic vessel harvesting|

---

US5755660A|1995-10-31|1998-05-26|Tyagi; Narendra S.|Combination surgical retractor, light source, spreader, and suction apparatus|

---

GB9522313D0|1995-11-01|1996-01-03|Squibb Bristol Myers Co|Use of an adhesive composition in the manufacture of a wound dressing|

---

US6425901B1|1995-12-07|2002-07-30|Loma Linda University Medical Center|Vascular wound closure system|

---

US5645560A|1995-12-15|1997-07-08|Cardiovascular Dynamics, Inc.|Fixed focal balloon for interactive angioplasty and stent implantation|

---

IT1284331B1|1996-01-23|1998-05-18|Sergio Gentilli|SUCTION SUCTION ATRAUMATIC TOOL FOR HANDLING OF PARENCHIMATOSIS ORGANS AND CABLES FOR LAPAROSCOPY AND ENDOSCOPY.|

---

US5813410A|1996-02-01|1998-09-29|Levin; John M.|Internal body pump and systems employing same|

---

US5782746A|1996-02-15|1998-07-21|Wright; John T. M.|Local cardiac immobilization surgical device|

---

US5913876A|1996-02-20|1999-06-22|Cardiothoracic Systems, Inc.|Method and apparatus for using vagus nerve stimulation in surgery|

---

US6852075B1|1996-02-20|2005-02-08|Cardiothoracic Systems, Inc.|Surgical devices for imposing a negative pressure to stabilize cardiac tissue during surgery|

---

CA2197614C|1996-02-20|2002-07-02|Charles S. Taylor|Surgical instruments and procedures for stabilizing the beating heart during coronary artery bypass graft surgery|

---

US5894843A|1996-02-20|1999-04-20|Cardiothoracic Systems, Inc.|Surgical method for stabilizing the beating heart during coronary artery bypass graft surgery|

---

US5651378A|1996-02-20|1997-07-29|Cardiothoracic Systems, Inc.|Method of using vagal nerve stimulation in surgery|

---

US5976171A|1996-02-20|1999-11-02|Cardiothoracic Systems, Inc.|Access platform for internal mammary dissection|

---

US5727569A|1996-02-20|1998-03-17|Cardiothoracic Systems, Inc.|Surgical devices for imposing a negative pressure to fix the position of cardiac tissue during surgery|

---

US6290644B1|1996-02-20|2001-09-18|Cardiothoracic Systems, Inc.|Surgical instruments and procedures for stabilizing a localized portion of a beating heart|

---

CA2198036C|1996-02-20|2000-12-05|Charles S. Taylor|Access platform for internal mammary dissection|

---

US6685632B1|1999-05-04|2004-02-03|Cardiothoracic Systems, Inc.|Surgical instruments for accessing and stabilizing a localized portion of a beating heart|

---

US5730757A|1996-02-20|1998-03-24|Cardiothoracic Systems, Inc.|Access platform for internal mammary dissection|

---

US5769870A|1996-02-20|1998-06-23|Cardiothoracic Systems, Inc.|Perfusion device for maintaining blood flow in a vessel while isolating an anastomosis|

---

US6814700B1|1996-03-04|2004-11-09|Heartport, Inc.|Soft tissue retractor and method for providing surgical access|

---

US6033641A|1996-04-18|2000-03-07|University Of Pittsburgh Of The Comonwealth System Of Higher Education|Catalyst for purifying the exhaust gas from the combustion in an engine or gas turbines and method of making and using the same|

---

US5947896A|1996-04-26|1999-09-07|United States Surgical Corporation|Heart stabilizer apparatus and method for use|

---

US5967973A|1996-04-26|1999-10-19|United States Surgical|Surgical retractor and method of surgery|

---

US6132370A|1996-04-26|2000-10-17|Genzyme Corporation|Retractor-mounted coronary stabilizer|

---

US5976080A|1996-09-20|1999-11-02|United States Surgical|Surgical apparatus and method|

---

WO1997040738A1|1996-04-26|1997-11-06|Genzyme Corporation|Coronary stabilizing retractor|

---

US6152874A|1996-04-26|2000-11-28|Genzyme Corporation|Adjustable multi-purpose coronary stabilizing retractor|

---

CA2211305A1|1996-07-25|1998-01-25|Jose A. Navia|Epicardial immobilization device|

---

US5899627A|1996-09-12|1999-05-04|Minnesota Scientific, Inc.|Clamp for retractor support|

---

US5846187A|1996-09-13|1998-12-08|Genzyme Corporation|Redo sternotomy retractor|

---

US5875782A|1996-11-14|1999-03-02|Cardiothoracic Systems, Inc.|Methods and devices for minimally invasive coronary artery revascularization on a beating heart without cardiopulmonary bypass|

---

US5921979A|1996-12-18|1999-07-13|Guidant Corporation|Apparatus and method for tissue and organ stabilization|

---

US6322500B1|1996-12-23|2001-11-27|University Of Massachusetts|Minimally invasive surgical apparatus|

---

GB9700384D0|1997-01-10|1997-02-26|Morton Lee R|Exercise apparatus|

---

US5865731A|1997-01-25|1999-02-02|Lenox-Maclaren|Surgical retractor having variable position retractor blades|

---

US5891017A|1997-01-31|1999-04-06|Baxter Research Medical, Inc.|Surgical stabilizer and method for isolating and immobilizing cardiac tissue|

---

US5882299A|1997-01-31|1999-03-16|Minnesota Scientific, Inc.|Device and procedure for minimally invasive coronary anastomosis|

---

US6231585B1|1997-11-20|2001-05-15|Medivas, Llc|Device for stabilizing a treatment site and method of use|

---

JP3036686B2|1997-02-27|2000-04-24|政夫 高橋|Hemostatic holding device for vascular anastomosis used for coronary artery bypass surgery|

---

US5885271A|1997-03-14|1999-03-23|Millennium Cardiac Strategies, Inc.|Device for regional immobilization of a compliant body|

---

US6900592B2|1997-03-18|2005-05-31|The Trustees Of The Stevens Institute Of Technology|Method and apparatus for stabilizing of the glow plasma discharges|

---

US5906602A|1997-03-27|1999-05-25|The Procter & Gamble Company|Shaped absorbent cores comprising multiple pieces of absorbent material and method for making same|

---

US5967972A|1997-03-28|1999-10-19|Kapp Surgical Instrument, Inc.|Minimally invasive surgical retractor and method of operation|

---

US6458079B1|1997-04-25|2002-10-01|Beth Israel Deaconess Medical Center|Surgical retractor and method of use|

---

US6033362A|1997-04-25|2000-03-07|Beth Israel Deaconess Medical Center|Surgical retractor and method of use|

---

DE29707567U1|1997-04-29|1997-07-03|Riess Andreas G|Arrangement for the local immobilization of a beating heart|

---

US5846193A|1997-05-01|1998-12-08|Wright; John T. M.|Midcab retractor|

---

US5984867A|1997-05-02|1999-11-16|Heartport, Inc.|Surgical retractor and method of retracting|

---

AU7175398A|1997-05-02|1998-11-27|Medtronic, Inc.|Adjustable supporting bracket having plural ball and socket joints|

---

US6030340A|1997-12-19|2000-02-29|United States Surgical|Surgical retractor|

---

US6190311B1|1997-05-02|2001-02-20|Cardiothoracic Systems, Inc.|Retractor and instrument platform for a less invasive cardiovascular surgical procedure|

---

DE29708050U1|1997-05-07|1997-07-17|Riess Andreas|Arrangement for the local immobilization of a beating heart|

---

US5957835A|1997-05-16|1999-09-28|Guidant Corporation|Apparatus and method for cardiac stabilization and arterial occlusion|

---

US6015427A|1997-07-07|2000-01-18|Eclipse Surgical Technologies, Inc.|Heart stabilizer with controllable stay suture and cutting element|

---

US5876332A|1997-07-24|1999-03-02|Genzyme Corporation|Surgical support member|

---

AU8907098A|1997-08-13|1999-03-08|Lenox-Maclaren|Device and method for localized heart motion dampening at a cardiac surgical site|

---

CA2216893A1|1997-08-27|1999-02-27|Raymond Cartier|Sternum retractor for performing bypass surgery on a beating heart|

---

US6102854A|1997-08-27|2000-08-15|Coroneo Inc.|Sternum retractor for performing bypass surgery on a beating heart|

---

US6019722A|1997-09-17|2000-02-01|Guidant Corporation|Device to permit offpump beating heart coronary bypass surgery|

---

US6969349B1|1997-09-17|2005-11-29|Origin Medsystem, Inc.|Device to permit offpump beating heart coronary bypass surgery|

---

US6338712B2|1997-09-17|2002-01-15|Origin Medsystems, Inc.|Device to permit offpump beating heart coronary bypass surgery|

---

US6390976B1|1997-09-17|2002-05-21|Origin Medsystems, Inc.|System to permit offpump beating heart coronary bypass surgery|

---

US5944658A|1997-09-23|1999-08-31|Koros; Tibor B.|Lumbar spinal fusion retractor and distractor system|

---

AU9664398A|1997-09-26|1999-04-23|Alliance Medical Technologies, Inc.|Stabilizer|

---

US6013027A|1997-10-07|2000-01-11|Ethicon Endo-Surgery, Inc.|Method for using a tissue stabilization device during surgery|

---

US5865730A|1997-10-07|1999-02-02|Ethicon Endo-Surgery, Inc.|Tissue stabilization device for use during surgery having remotely actuated feet|

---

US6193652B1|1997-10-07|2001-02-27|Ethicon Endo-Surgery, Inc.|Tissue stabilization device for use during surgery having spherical curved feet|

---

US6007486A|1997-10-07|1999-12-28|Ethicon Endo-Surgery, Inc.|Tissue stabilization device for use during surgery having a segmented shaft|

---

US5984864A|1997-10-07|1999-11-16|Ethicon Endo-Surgery, Inc.|Tissue stabilization device for use during surgery|

---

US5879291A|1997-10-08|1999-03-09|Ethicon Endo-Surgery, Inc.|Device used with a surgical retractor to elevate body parts|

---

US6015382A|1997-10-16|2000-01-18|General Surgical Innovations, Inc.|Inflatable manipulator for organ positioning during surgery and method of use|

---

FR2770124B1|1997-10-23|1999-12-10|Materiel Orthopedique En Abreg|SURGICAL INSTRUMENTATION FOR SHRINKAGE AND SPREADING OF SOFT TISSUES AND VESSELS FOR AN ANTERIOR APPROACH OF THE RACHIS|

---

US5957423A|1997-11-05|1999-09-28|Kronner; Richard F.|Low profile scope holder|

---

US6033425A|1997-11-12|2000-03-07|Genzyme Corporation|Lifting rib retractor|

---

US6200263B1|1998-01-23|2001-03-13|United States Surgical Corporation|Surgical instrument holder|

---

AU2332699A|1998-01-23|1999-08-09|United States Surgical Corporation|Surgical instrument|

---

US5846194A|1998-01-23|1998-12-08|Ethicon Endo-Surgery, Inc.|Surgical retraction apparatus|

---

US7137949B2|2001-07-13|2006-11-21|United States Surgical Corporation|Surgical instrument|

---

USD421803S|1998-03-07|2000-03-21|Koros Tibor B|Retractor for coronary artery bypass surgery|

---

US6251065B1|1998-03-17|2001-06-26|Gary S. Kochamba|Methods and apparatus for stabilizing tissue|

---

EP1063951B1|1998-03-17|2009-09-16|Gary S. Kochamba|Apparatus for stabilizing tissue|

---

US6113534A|1998-03-19|2000-09-05|Koros; Tibor B.|Adjustable heart surface stabilizer|

---

AUPP294698A0|1998-04-15|1998-05-07|Gray, Bruce|Removable ball joint|

---

US5928139A|1998-04-24|1999-07-27|Koros; Tibor B.|Retractor with adjustable length blades and light pipe guides|

---

US6199556B1|1998-05-01|2001-03-13|Cardiothoracic Systems, Inc.|Xyphoid access for cardiac surgical procedures|

---

US6210323B1|1998-05-05|2001-04-03|The University Of British Columbia|Surgical arm and tissue stabilizer|

---

CA2232795A1|1998-05-22|1999-11-22|Coroneo Inc.|Manipulation and adjustment of surgical instruments|

---

US5908382A|1998-07-08|1999-06-01|Koros; Tibor B.|Minimally invasive retractor for internal mammary artery harvesting|

---

US6224545B1|1998-07-24|2001-05-01|Core Surgical, Inc.|Surgical retractor and method for use|

---

US6063021A|1998-07-31|2000-05-16|Pilling Weck Incorporated|Stabilizer for surgery|

---

US5894842A|1998-08-11|1999-04-20|Long Island Jewish Medical Center|Pessary for treating vaginal prolapse|

---

EP1105048A1|1998-08-17|2001-06-13|Coroneo Inc.|Pericardium retraction device for positioning a beating heart|

---

WO2000015119A2|1998-09-15|2000-03-23|Medtronic, Inc.|Method and apparatus for temporarily immobilizing a local area of tissue|

---

US5984865A|1998-09-15|1999-11-16|Thompson Surgical Instruments, Inc.|Surgical retractor having locking interchangeable blades|

---

US6007523A|1998-09-28|1999-12-28|Embol-X, Inc.|Suction support and method of use|

---

US6468265B1|1998-11-20|2002-10-22|Intuitive Surgical, Inc.|Performing cardiac surgery without cardioplegia|

---

US6398726B1|1998-11-20|2002-06-04|Intuitive Surgical, Inc.|Stabilizer for robotic beating-heart surgery|

---

US6066160A|1998-11-23|2000-05-23|Quickie Llc|Passive knotless suture terminator for use in minimally invasive surgery and to facilitate standard tissue securing|

---

US6099468A|1999-01-15|2000-08-08|Kapp Surgical Instrument, Inc.|Retractor for partial sternotomy|

---

US6364833B1|1999-01-24|2002-04-02|Genzyme Corpforation|Irrigator for use with surgical retractor and tissue stabilization device and methods related thereto|

---

US6348036B1|1999-01-24|2002-02-19|Genzyme Corporation|Surgical retractor and tissue stabilization device|

---

US6168577B1|1999-01-25|2001-01-02|Cardiothoracic Systems, Inc.|Directed stream blower for clearing a surgical site|

---

US6196963B1|1999-03-02|2001-03-06|Medtronic Ave, Inc.|Brachytherapy device assembly and method of use|

---

US6042539A|1999-03-26|2000-03-28|Ethicon Endo-Surgery, Inc.|Vacuum-actuated tissue-lifting device and method|

---

EP1185193A4|2000-01-27|2004-09-15|Heartport Inc|Apparatus and methods for cardiac surgery|

---

US6994669B1|1999-04-15|2006-02-07|Heartport, Inc.|Apparatus and method for cardiac surgery|

---

US6331157B2|1999-04-15|2001-12-18|Heartport, Inc.|Apparatus and methods for off-pump cardiac surgery|

---

US6283912B1|1999-05-04|2001-09-04|Cardiothoracic Systems, Inc.|Surgical retractor platform blade apparatus|

---

US6231506B1|1999-05-04|2001-05-15|Cardiothoracic Systems, Inc.|Method and apparatus for creating a working opening through an incision|

---

US6626830B1|1999-05-04|2003-09-30|Cardiothoracic Systems, Inc.|Methods and devices for improved tissue stabilization|

---

US6258023B1|1999-07-08|2001-07-10|Chase Medical, Inc.|Device and method for isolating a surface of a beating heart during surgery|

---

US6511416B1|1999-08-03|2003-01-28|Cardiothoracic Systems, Inc.|Tissue stabilizer and methods of use|

---

US6338738B1|1999-08-31|2002-01-15|Edwards Lifesciences Corp.|Device and method for stabilizing cardiac tissue|

---

US6506149B2|1999-09-07|2003-01-14|Origin Medsystems, Inc.|Organ manipulator having suction member supported with freedom to move relative to its support|

---

US6406424B1|1999-09-16|2002-06-18|Williamson, Iv Warren P.|Tissue stabilizer having an articulating lift element|

---

US6936001B1|1999-10-01|2005-08-30|Computer Motion, Inc.|Heart stabilizer|

---

US6475142B1|1999-11-12|2002-11-05|Genzyme Corporation|Curved stabilization arm for use with surgical retractor and tissue stabilization device and methods related thereto|

---

US6375611B1|2000-01-07|2002-04-23|Origin Medsystems, Inc.|Organ stabilizer|

---

EP1248577A2|2000-01-10|2002-10-16|Medivas, LLC|Flexible stabilizer arm for forcibly holding an object against a surface|

---

WO2001058362A1|2000-02-11|2001-08-16|Endoscopic Technologies, Inc.|Tissue stabilizer|

---

US6602183B1|2000-07-24|2003-08-05|Inpulse Dynamics Nv|Enhanced suction-based cardiac mechanical stabilizer|

---

US6503245B2|2000-10-11|2003-01-07|Medcanica, Inc.|Method of performing port off-pump beating heart coronary artery bypass surgery|

---

AU2002316360A1|2001-06-27|2003-03-03|Popcab, Llc|System for port off-pump coronary artery bypass surgery|

---

US6592573B2|2000-10-11|2003-07-15|Popcab, Llc|Through-port heart stabilization system|

---

EP2441395A3|2000-11-28|2014-06-18|Intuitive Surgical Operations, Inc.|Endoscope beating-heart stabilizer and vessel occlusion fastener|

---

US6447443B1|2001-01-13|2002-09-10|Medtronic, Inc.|Method for organ positioning and stabilization|

---

US6758808B2|2001-01-24|2004-07-06|Cardiothoracic System, Inc.|Surgical instruments for stabilizing a localized portion of a beating heart|

---

US20030195482A1|2001-02-02|2003-10-16|Schultz Joseph P.|Pneumatic medical system|

---

US6589166B2|2001-02-16|2003-07-08|Ethicon, Inc.|Cardiac stabilizer device having multiplexed vacuum ports and method of stabilizing a beating heart|

---

US6807439B2|2001-04-03|2004-10-19|Medtronic, Inc.|System and method for detecting dislodgement of an implantable medical device|

---

US7338441B2|2001-09-06|2008-03-04|Houser Russell A|Superelastic/shape memory tissue stabilizers and surgical instruments|

---

US20030083555A1|2001-10-29|2003-05-01|Scott Hunt|Segmented arm support system and method for stabilizing tissue|

---

US7182731B2|2002-01-23|2007-02-27|Genesee Biomedical, Inc.|Support arm for cardiac surgery|

---

US6866628B2|2002-04-11|2005-03-15|Medtronic, Inc.|Apparatus for temporarily engaging body tissue|

---

US6800058B2|2002-04-26|2004-10-05|Medtronic, Inc.|System, method and apparatus for regulating vacuum supplied to surgical tools|

---

US6758809B2|2002-06-06|2004-07-06|Medtronic, Inc.|Surgical tool for engagement of body tissue|

---

US6790177B2|2002-06-27|2004-09-14|Boss Instruments, Ltd.|Surgical retractor apparatus|

---

US20040002625A1|2002-06-27|2004-01-01|Timothy Dietz|Apparatus and methods for cardiac surgery|

---

US7191683B2|2002-10-15|2007-03-20|Boss Instruments, Ltd., Inc.|Swivel retractor blade assembly|

---

DE10300125A1|2003-01-07|2004-07-15|Bayer Ag|Process for the preparation of nitrodiphenylamines|

---

US7637905B2|2003-01-15|2009-12-29|Usgi Medical, Inc.|Endoluminal tool deployment system|

---

ES2327628T3|2003-03-13|2009-11-02|Medtronic, Inc.|APPARATUS FOR TEMPORARILY CLAMPING OF BODY FABRIC.|

---

US7591783B2|2003-04-01|2009-09-22|Boston Scientific Scimed, Inc.|Articulation joint for video endoscope|

---

US7241264B2|2003-06-30|2007-07-10|Ethicon, Inc.|Variable-pitch cam mechanism for tension devices|

---

US7479104B2|2003-07-08|2009-01-20|Maquet Cardiovascular, Llc|Organ manipulator apparatus|

---

JP4274073B2|2003-08-08|2009-06-03|住友ベークライト株式会社|Coronary artery bypass surgery instrument|

---

US20060200005A1|2003-09-17|2006-09-07|Levahn Intellectual Property Holding Company, Llc|Low profile, handle-in-between surgical scissors clamp|

---

US7125379B2|2003-09-19|2006-10-24|Minnesota Scientific, Inc.|Surgical support arm docking apparatus|

---

US7753844B2|2003-10-17|2010-07-13|Minnesota Scientific, Inc.|Articulated retractor blade holder|

---

US7179224B2|2003-12-30|2007-02-20|Cardiothoracic Systems, Inc.|Organ manipulator and positioner and methods of using the same|

---

US7399272B2|2004-03-24|2008-07-15|Medtronic, Inc.|Methods and apparatus providing suction-assisted tissue engagement|

---

US20060270909A1|2005-05-25|2006-11-30|Davis John W|Surgical instruments and methods for use in reduced-access surgical sites|

---

US8083664B2|2005-05-25|2011-12-27|Maquet Cardiovascular Llc|Surgical stabilizers and methods for use in reduced-access surgical sites|

---

US7794387B2|2006-04-26|2010-09-14|Medtronic, Inc.|Methods and devices for stabilizing tissue|

---

US8597182B2|2006-04-28|2013-12-03|Intuitive Surgical Operations, Inc.|Robotic endoscopic retractor for use in minimally invasive surgery|

---

US20080071145A1|2006-09-19|2008-03-20|Levahn Intellectual Property Holding Company, Llc|Support Clamp For Retractor Bar Stock Of Generally Rectangular Cross-Section|

---

GB0712764D0|2007-07-02|2007-08-08|Smith & Nephew|Carrying Bag|

---

GB0800835D0|2008-01-17|2008-02-27|Cardioprec Ltd|Retractor|

---

US20090254187A1|2008-04-07|2009-10-08|Minnesota Scientific, Inc.|Tightenable Surgical Retractor Joint|

---

EP2218404B1|2009-02-13|2018-09-05|Fondazione Istituto Italiano Di Tecnologia|A surgical lift device to assist in surgical access through skin, tissue and organs|

---

JP5415925B2|2009-03-02|2014-02-12|オリンパス株式会社|Endoscope|

---

US20100317925A1|2009-06-12|2010-12-16|Banchieri Michael J|Suction-assisted tissue stabilizers|

---

US8696556B2|2009-07-28|2014-04-15|Endoscopic Technologies, Inc.|Tissue retractors with fluid evacuation/infusion and/or light emission capability|

---

US8876712B2|2009-07-29|2014-11-04|Edwards Lifesciences Corporation|Intracardiac sheath stabilizer|

---

US8469032B2|2009-08-17|2013-06-25|Timothy J. Farnum|Airway positioning device|

---

WO2011069036A1|2009-12-03|2011-06-09|Thompson Surgical Instruments, Inc.|Posterior lumbar retractor system|

---

US8480574B2|2010-04-29|2013-07-09|Empire Technology Development Llc|Flexible dam and retractor|

---

AU2011268433A1|2010-06-14|2013-01-10|Maquet Cardiovascular Llc|Surgical instruments, systems and methods of use|

---

US9486296B2|2010-07-08|2016-11-08|Warsaw Orthopedic, Inc.|Surgical assembly with flexible arm|

---

US8460172B2|2010-07-29|2013-06-11|Medtronic, Inc.|Tissue stabilizing device and methods including a self-expandable head-link assembly|

---

US9220485B2|2010-08-28|2015-12-29|Endochoice, Inc.|Tissue collection and separation device|

---

US8852079B2|2012-02-27|2014-10-07|Medtronic, Inc.|Valve assembly with shape memory member|

---

US8231528B1|2012-03-13|2012-07-31|Globus Medical, Inc.|System and method for retracting body tissue|DE10154163A1|2001-11-03|2003-05-22|Advanced Med Tech|Device for straightening and stabilizing the spine|

---

US8979931B2|2006-12-08|2015-03-17|DePuy Synthes Products, LLC|Nucleus replacement device and method|

---

US9022998B2|2010-02-26|2015-05-05|Maquet Cardiovascular Llc|Blower instrument, apparatus and methods of using|

---

AU2011268433A1|2010-06-14|2013-01-10|Maquet Cardiovascular Llc|Surgical instruments, systems and methods of use|

---

US9622779B2|2011-10-27|2017-04-18|DePuy Synthes Products, Inc.|Method and devices for a sub-splenius / supra-levator scapulae surgical access technique|

---

US9265490B2|2012-04-16|2016-02-23|DePuy Synthes Products, Inc.|Detachable dilator blade|

---

US9629523B2|2012-06-27|2017-04-25|Camplex, Inc.|Binocular viewing assembly for a surgical visualization system|

---

US9642606B2|2012-06-27|2017-05-09|Camplex, Inc.|Surgical visualization system|

---

EP2907125B1|2012-09-26|2017-08-02|Applied Medical Resources Corporation|Surgical training model for laparoscopic procedures|

---

US9480855B2|2012-09-26|2016-11-01|DePuy Synthes Products, Inc.|NIR/red light for lateral neuroprotection|

---

US20140106328A1|2012-10-17|2014-04-17|The Cleveland Clinic Foundation|Surgical training apparatus|

---

DE102012219727A1|2012-10-29|2014-04-30|Aesculap Ag|Atrium retractor|

---

US9070306B2|2012-11-02|2015-06-30|Digital Surgicals Pte. Ltd.|Apparatus, method and system for microsurgical suture training|

---

DE102013102628A1|2013-03-14|2014-10-02|Aesculap Ag|Surgical device for stabilizing or immobilizing moving tissue|

---

JP6456924B2|2013-04-30|2019-01-23|シーダーズ−サイナイ メディカル センター|Fixation device and method for medical procedures|

---

EP2999414B1|2013-05-21|2018-08-08|Camplex, Inc.|Surgical visualization systems|

---

JP6521982B2|2013-09-20|2019-05-29|キャンプレックス インコーポレイテッド|Surgical visualization system and display|

---

US10881286B2|2013-09-20|2021-01-05|Camplex, Inc.|Medical apparatus for use with a surgical tubular retractor|

---

WO2015060611A1|2013-10-23|2015-04-30|진화메디칼 주식회사|Stabilizer for heart operation|

---

DE202013105202U1|2013-11-18|2013-11-26|Fehling Instruments Gmbh & Co. Kg|Spreader, especially for cranial surgery|

---

US10478364B2|2014-03-10|2019-11-19|Stryker Corporation|Limb positioning system|

---

DE102014104179A1|2014-03-26|2015-10-01|Aesculap Ag|Control for safe assembly and disassembly of two functional units of a multi-part medical device|

---

EP3190998A4|2014-07-28|2018-03-28|Bioceptive, Inc.|Device and methods for manipulating a uterus or other bodily tissue|

---

US9980737B2|2014-08-04|2018-05-29|Medos International Sarl|Flexible transport auger|

---

US10111712B2|2014-09-09|2018-10-30|Medos International Sarl|Proximal-end securement of a minimally invasive working channel|

---

US9924979B2|2014-09-09|2018-03-27|Medos International Sarl|Proximal-end securement of a minimally invasive working channel|

---

US10264959B2|2014-09-09|2019-04-23|Medos International Sarl|Proximal-end securement of a minimally invasive working channel|

---

EP3212271B1|2014-10-29|2022-03-16|Cedars-Sinai Medical Center|Apparatuses and systems for controlled delivery of therapeutics and related substances|

---

US10702353B2|2014-12-05|2020-07-07|Camplex, Inc.|Surgical visualizations systems and displays|

---

US9951904B2|2015-03-24|2018-04-24|Stryker Corporation|Rotatable seat clamps for rail clamp|

---

WO2016154589A1|2015-03-25|2016-09-29|Camplex, Inc.|Surgical visualization systems and displays|

---

US10786264B2|2015-03-31|2020-09-29|Medos International Sarl|Percutaneous disc clearing device|

---

US10149672B2|2015-06-30|2018-12-11|Emory University|Devices and methods for stabilizing tissue|

---

US10987129B2|2015-09-04|2021-04-27|Medos International Sarl|Multi-shield spinal access system|

---

WO2017091704A1|2015-11-25|2017-06-01|Camplex, Inc.|Surgical visualization systems and displays|

---

CN107896483B|2016-01-29|2020-07-31|法尔扎姆·法拉曼德|Minimally invasive heart stabilizer|

---

US10299838B2|2016-02-05|2019-05-28|Medos International Sarl|Method and instruments for interbody fusion and posterior fixation through a single incision|

---

US20210128269A1|2017-02-02|2021-05-06|University Of Pittsburgh - Of The Commonwealth System Of Higher Education|Adjustable retaining arm system|

---

US10918455B2|2017-05-08|2021-02-16|Camplex, Inc.|Variable light source|

---

JP6462040B2|2017-05-23|2019-01-30|住友ベークライト株式会社|Coronary artery bypass surgery treatment instrument and treatment instrument parts|

---

US20200197037A1|2017-05-23|2020-06-25|Sumitomo Bakelite Co., Ltd.|Coronary artery bypass surgery treatment tool, treatment tool part, medical connector, and medical device|

---

US11013530B2|2019-03-08|2021-05-25|Medos International Sarl|Surface features for device retention|

---

US11241252B2|2019-03-22|2022-02-08|Medos International Sarl|Skin foundation access portal|

---

US11129727B2|2019-03-29|2021-09-28|Medos International Sari|Inflatable non-distracting intervertebral implants and related methods|

法律状态:
2018-03-27| B15K| Others concerning applications: alteration of classification|Ipc: A61B 17/02 (2006.01), A61B 90/50 (2016.01), A61B 9 |

---

2018-12-26| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|

---

2019-09-10| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

---

2020-05-19| B07A| Technical examination (opinion): publication of technical examination (opinion) [chapter 7.1 patent gazette]|

---

2020-08-25| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

---

2020-12-15| B16A| Patent or certificate of addition of invention granted|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 14/06/2011, OBSERVADAS AS CONDICOES LEGAIS. |

优先权:

---

申请号 | 申请日 | 专利标题

---

US35451610P| true| 2010-06-14|2010-06-14|

---

US61/354,516|2010-06-14|

---

US13/160,445|US9655605B2|2010-06-14|2011-06-14|Surgical instruments, systems and methods of use|

---

PCT/US2011/040399|WO2011159733A1|2010-06-14|2011-06-14|Surgical instruments, systems and methods of use|

---

US13/160,445|2011-06-14|

---