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WO2025240259A1 - Systèmes et procédés de prélèvement de vaisseaux sanguins - Google Patents

Systèmes et procédés de prélèvement de vaisseaux sanguins

Info

Publication number
WO2025240259A1
WO2025240259A1 PCT/US2025/028654 US2025028654W WO2025240259A1 WO 2025240259 A1 WO2025240259 A1 WO 2025240259A1 US 2025028654 W US2025028654 W US 2025028654W WO 2025240259 A1 WO2025240259 A1 WO 2025240259A1
Authority
WO
WIPO (PCT)
Prior art keywords
vessel
distal end
jaws
actuator handle
jaw
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Pending
Application number
PCT/US2025/028654
Other languages
English (en)
Inventor
Tatsunori Fujii
Randal J. Kadykowski
Zachary A. Coon
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Terumo Cardiovascular Systems Corp
Original Assignee
Terumo Cardiovascular Systems Corp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Terumo Cardiovascular Systems Corp filed Critical Terumo Cardiovascular Systems Corp
Publication of WO2025240259A1 publication Critical patent/WO2025240259A1/fr
Pending legal-status Critical Current
Anticipated expiration legal-status Critical

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00008—Vein tendon strippers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/295—Forceps for use in minimally invasive surgery combined with cutting implements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00831—Material properties
    • A61B2017/00902—Material properties transparent or translucent
    • A61B2017/00907—Material properties transparent or translucent for light
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/361—Image-producing devices, e.g. surgical cameras

Definitions

  • This document relates to systems for dissecting/harvesting blood vessels from a subject's body (e.g., a leg or arm) and methods for the use of such systems.
  • a subject's body e.g., a leg or arm
  • this document relates to a multifunctional all-in-one blood vessel harvesting system that includes, for example, a tissue dissector, video camera sensor, vessel positioner, vessel cautery' device, vessel cutting device, and user controls that are all integrated into a single device.
  • a blood vessel or vessel section such as an artery or vein
  • CABG coronary' artery' bypass grafting
  • a blood vessel or vessel section such as an artery or vein
  • is “harvested” i.e.. removed
  • the blood vessel is used to form a bypass between an arterial blood source and the coronary artery' that is to be bypassed.
  • the preferred sources for the vessel to be used as the bypass graft are the saphenous veins in the legs and the radial artery in the arms.
  • Endoscopic surgical procedures for harvesting a section of a vein (e.g., the saphenous vein) subcutaneously have been developed in order to avoid disadvantages and potential complications of harvesting through a continuous incision.
  • One such minimally -invasive technique employs a small incision for locating the desired vein and for introducing one or more endoscopic harvesting devices.
  • Primary dissection occurs by introduction of a dissecting instrument through the incision to create a working space and separate the vein from the surrounding tissue.
  • a cutting instrument is introduced into the working space to sever the blood vessel from the connective tissue and side branches of the blood vessel.
  • the branches may be cauterized using the cutting instrument.
  • the endoscopic entry site is located near the midpoint of the vessel being harvested, with dissection and cutting of branches proceeding in both directions along the vessel from the entry site.
  • a second small incision, or stab wound is made at one end thereof and the blood vessel section is ligated.
  • a third small incision is made at the other end of the blood vessel section which is then ligated, thereby allowing the desired section to be completely removed through the first incision.
  • only the first two incisions may be necessary if the length of the endoscopic device is sufficient to obtain the desired length of the blood vessel while working in only one direction along the vessel from the entry point.
  • the conventional dissector tool typically comprises a longitudinal stainless steel or plastic rod with a tip at one end and an operator handle at the other.
  • the tip is tapered to a blunt end and is made of transparent plastic.
  • An endoscope including an optical cable is inserted through the hollow handle and hollow rod to abut the tip to allow for endoscopic viewing during dissection.
  • the dissection proceeds along the perimeter of the vein being harvested to separate it from the surrounding tissue and to expose the side branches of the vein so that they can be severed with the cutting tool.
  • an insufflation gas such as carbon dioxide is introduced to the subcutaneous space surrounding the blood vessel to improve visualization of the tissue structures within the operative tunnel being created around the vessel.
  • the ability of the tunnel to be inflated is facilitated in part by the use of a trocar at the entry site to provide a partial seal around the endoscopic instrument. Since there is not a 100% trocar seal by design, a continuous supply of the insufflation gas is provided through the endoscopic instrument to be expelled distally at its tip.
  • the conventional blood vessel harvesting system includes multiple separate devices including, but not limited to, a dissector tool, and endoscope, and a blood vessel harvester cautery and cutting tool.
  • This document describes systems for dissecting/harvesting blood vessels from a subject’s body (e.g., a leg or arm) and methods for the use of such systems.
  • a subject’s body e.g., a leg or arm
  • multifunctional all-in-one blood vessel harvesting systems can include, for example, a tissue dissector, video camera sensor, vessel positioner, vessel cautery’ device, vessel cutting device, and user controls that are all integrated into a single device.
  • the pointed tip is laterally offset from the central longitudinal axis of the main shaft.
  • Such a vessel harvesting apparatus for removing a blood vessel from a patient may optionally include one or more of the following features.
  • the apparatus may also include a vessel positioner that is selectively extendable and retractable relative to the tissue dissector member by manipulation of a control mechanism on the actuator handle. A distal end portion of the vessel positioner may be extendable distally beyond the tissue dissector member and retractable proximally of the tissue dissector member.
  • the tissue dissector member may include a transparent portion.
  • the apparatus may also include an image sensor positioned to capture images distal of the tissue dissector member through the transparent portion of the tissue dissector member.
  • the tissue dissector member comprises a transparent cone member.
  • the apparatus may also include a selectively extendable vessel cutting blade.
  • the vessel cautery tool may also include an elongate shaft construct that is coupled to the actuator handle, and/or a jaw structure attached at a distal end portion of the elongate shaft construct.
  • the cauterization electrodes are attached to the jaw structure.
  • the main shaft may define a first lumen.
  • the vessel cautery tool may be slidably disposed in the first lumen.
  • the vessel cautery tool is retractable so that the jaw structure is fully within the first lumen.
  • the vessel cautery’ tool may be extendable so that the jaw structure is positioned distally of the tissue dissector member.
  • the vessel cautery tool is rotatable within the first lumen.
  • the first lumen may be offset from the central longitudinal axis of the main shaft.
  • this disclosure is directed to a vessel cautery' tool that includes an elongate shaft construct defining a longitudinal axis, and ajaw structure coupled to a distal end portion of the shaft construct.
  • the jaw structure includes a first jaw pivotably coupled at the distal end portion of the shaft construct; a second jaw pivotably coupled at the distal end portion of the shaft construct; a first electrode coupled to the first jaw, wherein a distal end of the first electrode terminates proximally of a distal end portion of the first jaw; a second electrode coupled to the second jaw, wherein a distal end of the second electrode terminates proximally of a distal end portion of the second jaw; and a cutting blade that is distally extendable and proximally retractable along the first and second jaws.
  • the jaw structure is selectively reconfigurable between an open configuration and a closed configuration. When the jaw structure is in the closed configuration, the distal end portions of the first and second jaws make contact with each other while the first and second electrodes are spaced apart from each other.
  • Such a vessel cautery tool may optionally include one or more of the following features.
  • the cutting blade travels distally and proximally within grooves defined by the first and second electrodes.
  • the cutting blade may travel distally and proximally within grooves defined by the first and second jaws.
  • a leading distal end of the cutting blade may extend across the longitudinal axis and at an angle that is not perpendicular thereto. The angle of the leading distal end of the cutting blade may be slanted away from an interface between the distal end portions of the first and second jaws when the jaw structure is in the closed configuration.
  • this disclosure is directed to a device for dissecting a blood vessel from a patient.
  • the device includes: an actuator handle; a main shaft extending from the actuator handle and defining a central longitudinal axis; a tissue dissector member at a distal end of the main shaft and comprising a pointed tip; a vessel cautery tool comprising one or more cauterization electrodes; and a vessel positioner that is distally extendable and proximally retractable.
  • a vessel contact member at a distal end of the vessel positioner is located laterally between the tissue dissector member and the vessel cautery tool when the vessel positioner is proximally retracted.
  • the tissue dissector member is located laterally betw een the vessel contact member and the vessel cautery tool when the vessel positioner is distally extended.
  • the vessel contact member may include one or more flexible arms that are naturally curved to configure the vessel contact member to move laterally away from the central longitudinal axis as the vessel positioner is being distally extended.
  • the one or more flexible arms may include two shape-set nitinol wire members.
  • the tissue dissector member may be positioned between the two shape-set nitinol wire members when the vessel positioner is distally extended.
  • this disclosure is directed to a device for dissecting a blood vessel from a patient.
  • the device includes: a main shaft defining a lumen and a central longitudinal axis; a tissue dissector member at a distal end of the main shaft; a vessel cautery tool; and an actuator handle assembly.
  • the vessel cautery tool includes: a shaft slidably disposed in the lumen; a pair of jaws pivotably coupled to a distal end portion of the shaft; one or more cauterization electrodes coupled to the jaws; and a cutting blade that is slidably translatable along the pair of jaws.
  • the actuator handle includes a first portion coupled to a proximal end of the main shaft, and a second portion coupled to a proximal end of the shaft of the vessel cautery tool.
  • the actuator handle assembly includes user-operable controls for: (i) opening and closing the pair of jaws, (ii) energizing the one or more cauterization electrodes, and (iii) translating the cutting blade.
  • the user-operable controls for opening and closing the pair of jaws comprises a first member that is movably coupled to the second portion of the actuator handle assembly.
  • the first member defines an opening having a central axis that extends longitudinally.
  • Such a device for dissecting a blood vessel from a patient may optionally include one or more of the following features.
  • the first and second portions of the actuator handle assembly may be translatable in relation to each other.
  • the device may also include a vessel positioner.
  • the first portion of the actuator handle assembly may include a sliding actuator for translating the vessel positioner proximally and distally of the tissue dissector member.
  • the user-operable controls for opening and closing the pair of jaws may include a second member that is mov ably- coupled to the second portion of the actuator handle assembly.
  • the second member may define an opening having a central axis that extends transversely across the central longitudinal axis.
  • the opening defined by the first member may be smaller than the opening defined by the second member.
  • the second portion of the actuator handle assembly may include the user-operable control for energizing the one or more cauterization electrodes.
  • the user-operable control for energizing the one or more cauterization electrodes may be located on the second portion of the actuator handle assembly so that a thumb of a user can actuate the user-operable control for energizing the one or more cauterization electrodes while extending through the opening of the first member.
  • this disclosure is directed to a device for dissecting a blood vessel from a patient.
  • the device includes: an actuator handle; a main shaft extending from the actuator handle and defining a central longitudinal axis; a tissue dissector member at a distal end of the main shaft and comprising a pointed tip; and a vessel cautery tool comprising two jaws and one or more cauterization electrodes.
  • the actuator handle includes: a first portion, and a second portion comprising a distal portion and a proximal portion that are rotatably coupled to each other. The first portion is longitudinally slidable along the distal portion.
  • the proximal portion may include a first member and a second member that are manually actuatable to open and/or close the two jaws.
  • the proximal portion may also include an actuatable control by which the one or more cauterization electrodes can be energized. Rotation of the proximal portion relative to the distal portion may cause rotation of the vessel cautery tool relative to the main shaft. In some embodiments, longitudinal sliding of the first portion along the distal portion extends and/or retracts the vessel cautery tool relative to the main shaft.
  • a blood vessel harvesting procedure can be fully performed in a single pass using the all-in-one blood vessel harvesting systems described herein.
  • conventional blood vessel harvesting systems include multiple separate components and therefore require multiple passes. Accordingly, blood vessel harvesting procedures can be performed more efficiently and. in some cases, at a potentially lower clinical cost using the all-in-one blood vessel harvesting systems described herein.
  • the all-in-one blood vessel harvesting systems described herein have enhanced user controls and visualization capabilities. Accordingly, blood vessel harvesting procedures can be performed with more accuracy and efficacy.
  • blood vessel harvesting procedures can be advantageously performed in a minimally invasive fashion. Such minimally invasive techniques can reduce recovery times, patient discomfort, and treatment costs.
  • FIG. 1 is an external view of a saphenous vein being harvested from a leg.
  • FIG. 2 is a side view of a prior art dissector unit.
  • FIG. 3 is a side view of a prior art harvest ng unit.
  • FIG. 4 is a plan view of a prior art blunt dissector with an endoscope and a trocar.
  • FIG. 5 is a partial cross-sectional view of the dissection of a blood vessel.
  • FIG. 6 schematically shows a prior art harvesting unit in greater detail.
  • FIG. 7 is a perspective view of an example all-in-one blood vessel harvesting system in accordance with some embodiments.
  • FIG. 8 is an expanded view of a first configuration of a distal end portion of the all-in-one blood vessel harvesting system of FIG. 7.
  • FIG. 9 is an expanded view of a second configuration of the distal end portion of the all-in-one blood vessel harvesting system of FIG. 7.
  • FIG. 10 is a side view of the shaft and tissue dissector of the all-in-one blood vessel harvesting system of FIG. 7.
  • FIG. 11 is an expanded view of the distal end portion of FIG. 10.
  • FIG. 12 is an end view of the distal end portion of FIG. 10.
  • FIG. 13 is another side view of the distal end portion of FIG. 10.
  • FIG. 14 is a top view of FIG. 13.
  • FIG. 15 is transparent side view of the distal end portion of FIG. 10.
  • FIG. 16 is a schematic side view of an example vessel cautery tool with a jaw structure in an open configuration.
  • FIG. 17 shows the vessel cautery tool of FIG. 16 with the jaw structure in a closed configuration.
  • FIG. 18 is a perspective view of the vessel cautery tool of FIG. 16 with the jaw structure in a closed configuration and the cutting blade being actuated.
  • FIG. 19 is a longitudinal cross-sectional view of the arrangement of FIG. 18.
  • FIG. 20 is a view like FIG. 19 but with the cutting blade fully extended.
  • FIG. 21 is a schematic perspective view of another example jaw structure with the jaws in a closed configuration.
  • FIG. 22 is another view of the arrangement of FIG. 21.
  • FIG. 23 is a side view of the working end portion of an example vessel harvesting system with a vessel positioner in an extended position and a retracted position.
  • FIG. 24 is a perspective view of a distal end portion of an example vessel positioner.
  • FIG. 25 is a perspective view of an example actuator handle assembly used with some vessel harvesting systems described herein.
  • FIG. 26 is a perspective view of another example actuator handle assembly used with some vessel harvesting systems described herein.
  • FIG. 27 is a side view of the actuator handle assembly of FIG. 26.
  • FIG. 28 is a perspective view of another example actuator handle assembly used with some vessel harvesting systems described herein.
  • FIG. 29 is another perspective view of the actuator handle assembly of FIG. 28. in a second configuration.
  • This document describes systems for dissecting/harvesting blood vessels from a subject’s body (e.g., a leg or arm) and methods for the use of such systems.
  • a subject e.g., a leg or arm
  • multifunctional all-in-one blood vessel harvesting systems can include, for example, a tissue dissector, video camera sensor, vessel positioner, vessel cautery device, vessel harvesting device, and user controls that are all integrated into a single disposable device.
  • a patient 10 has a saphenous vein 11 within a lower limb 12 (e.g., leg).
  • An incision 13 is made directly above vein 11, and tissue is peeled back from incision 13 to access the vein. Endoscopic instruments are inserted through incision 13 to separate vein 11 from connective tissue and then to cauterize and sever side branches that extend from vein 11.
  • a second incision or stab wound 14 is created at a second position on limb 12 so that a second end of vein 11 can be severed. Vein 11 is then extracted through one of the incisions.
  • the entry point and/or second incision or stab wound can be placed at various locations along vein 11 as shown at 15, for example.
  • FIG. 1 illustrates the leg 12 as an example vessel harv esting site
  • the use of the vessel harv esting systems described herein are not limited to use in the leg 12.
  • the vessel harvesting systems described herein can be used to harvest a vessel from an arm of the patient 10.
  • the uses of the vessel harvesting systems described herein are not limited to use in the leg 12.
  • Dissector unit 16 can be used for endoscopic dissection of a saphenous vein or other vessel by insertion through an initial incision and then pressing a dissector tip 17 into the fat along the direction of the vessel to separate it from adjacent tissue.
  • Dissector unit 16 has a handle 18 connected to a longitudinal rod 19 having dissector tip 17 at its distal end.
  • a receiver 20 at the end of handle 18 receives an endoscope and optical cable (not shown) for extending through rod 19 to dissector tip 17.
  • the dissector tip 17 can be at least partially transparent to allow visualization of the vessel and surrounding tissue.
  • An insufflation tube 21 passes through handle 12 and is part of an insufflation gas channel extending to a release hole in or near tip 17. Tube 21 is connected to a source of CO2 or other insufflation gas for filling and expanding the cavity adjacent the vessel as it is being formed.
  • the insufflation provides enhanced endoscopic visibility of the vessel and surrounding tissues during the harvesting procedure.
  • a harvester cutting unit 22 as shown in FIG. 3 is used subcutaneously to grasp the vessel being dissected and to cauterize/sever any branches or connective tissue connecting to the vessel.
  • Harvester 22 has a handle 23 connected to an elongated sleeve member 24 and an endoscope receiver 25.
  • V -keeper 26 At the distal end of sleeve 24 are a vessel keeper (V -keeper) 26 for retaining the vessel being dissected and a vessel cutter (V-cutter) 27 for cauterizing/sev ering branches.
  • V-keeper 26 is manipulated by V-keeper buttons 28 on handle 23.
  • V-cutter 27 is extended or retracted by manipulating a V-cutter extender button 29 on handle 23.
  • An insufflator tube 30 is adapted to be connected to an insufflation gas source to deliver the gas to the distal end of sleeve 24 via a gas channel extending between handle 23 at the proximal end and a release hole at the distal end.
  • An integrated bipolar cord 31 connects to a source of high frequency voltage, and includes conductors for supplying the voltage to electrodes on V-cutter 27 for cauterizing and cutting the branches and connective tissue.
  • FIG. 4 shows another conventional vessel harvesting system which includes an endoscope unit 30 to perform observation in a patient's body, a dissector unit 31 to dissect a blood vessel in the body, and a trocar 32 to help insert the endoscope 30 and dissector apparatus 31 into the body.
  • An optical system is shown as a rigid endoscope 30 and includes an elongated rod-like inserting portion 33. The proximal end of inserting portion 33 connects to an end adapter 34 to transmit an endoscopic image.
  • a light guide port 35 projects from end adapter 34 to connect to a light guide cable which supplies illumination light to endoscope 30.
  • the optical system can employ a camera and LED light source installed at the distal end of endoscope 30 connected via electrical cables to power and a video processor.
  • Dissector unit 31 includes a tubular main body portion 36 comprising a hollow longitudinal rod within which endoscope 30 is to be inserted. Endoscope 30 is inserted or removed from longitudinal rod 36 through a handle portion 37.
  • the material of longitudinal rod 36 material is selected from fluoropolymers, which are well known materials.
  • the outer surface of longitudinal rod 36 comprises polytetrafluoroethylene (PTFE). The use of a fluoropolymer reduces the friction caused by moving rod 36 through connective tissue, thereby reducing the force required to perform a dissection.
  • a blunt dissector tip 38 is disposed at the distal end of longitudinal rod 36.
  • Tip 38 has a conical shape and comprises a transparent synthetic resin material to facilitate viewing through tip 38 using endoscope 30.
  • Trocar 32 includes a body 39 to guide dissector unit 31 into the incision site.
  • An aperture seal 40 is located on the surface of the proximal end of body 39. Aperture seal 40 allows dissector unit 31 to be inserted in body 39 of trocar 32 in one fluid forward motion.
  • the outer surface of trocar body 39 includes a projection to engage with living tissue and a holding portion 41 to hold the body 39 onto the living tissue (e.g., the patient's skin).
  • FIG. 5 is cross-sectional view showing a dissector unit 42 inserted subcutaneously within a lower limb 43 via a trocar 44 from a skin incision in the direction of the inguinal region, for example. Since the inserting direction of dissector 10 is along the direction of a blood vessel 45 being dissected, the operator gradually inserts the dissector so as to dissect peripheral tissue 46 from blood vessel 45 while viewing the endoscope image.
  • An insufflation gas (e.g., carbon dioxide) may be fed via a tube 47 from a regulated insufflation gas source 48.
  • An insufflation unit such as the UHI-3 High Flow Insufflation Unit, available from Olympus Medical Systems Corporation, can be used.
  • the CO2 gas inflates the area between the dissected tissue and the blood vessel to create an open tunnel 49. Therefore, the field of view of the endoscope is opened wide by gas inflation so that visualization of the internal tissue structures is improved.
  • a cutter unit is inserted through trocar 44 and tunnel 49 is insufflated in the same manner.
  • An example conventional cutter unit 50 as shown in FIG. 6 can be used.
  • An insufflation tube 51 can be connected to the same gas source.
  • Cutter unit 50 is also connected to an electrical bipolar source via electrical cable 52 for cauterization and/or cutting of blood vessels (such as vessels that branch off from the main vessel being harvested).
  • FIG. 7 illustrates an all-in-one vessel harvesting device 100 in accordance with some example embodiments described herein.
  • the harvesting device 100 is a device for dissecting/harvesting a blood vessel from a patient in a minimally-invasive manner. In some cases, the harvesting device 100 is used to dissect/harvest and remove a blood vessel from a leg of the patient, or from an arm of the patient.
  • the vessel harvesting device 100 includes the functionalities of the dissector unit 16 (FIG. 2), the harvester cutting unit 22 (FIG. 4), the endoscope unit 30 (FIG. 4), plus other features, in a single vessel harvesting device 100. Accordingly, the procedure for dissecting/harvesting the blood vessel from the patient can be performed in a more efficient manner as compared to conventional prior art systems, because all the required functionality is present in the depicted single vessel harvesting device 100.
  • the vessel harvesting device 100 includes, broadly speaking, an actuator handle assembly 110, a main shaft 120, and a distal working end portion 130.
  • the main shaft 120 extends distally from the actuator handle assembly 110.
  • the main shaft 120 defines a central longitudinal axis 121 (e.g.. see FIGs. 10—15).
  • the working end portion 130 is at a distal end of the main shaft 120.
  • the working end portion 130 and a distal portion of the main shaft 120 are inserted through an incision (e.g., see incisions 13, 14, and 15 in FIG. 1) and are then utilized within the body of the patient.
  • the actuator handle assembly 110 remains external to the patient. Using the actuator handle assembly 110, a clinician operator can manipulate, control, and operate the main shaft 120 and the working end portion 130 to perform the vessel dissection/harvesting procedure.
  • a complete system for harvesting blood vessels typically includes various other equipment in addition to the depicted example vessel harvesting device 100.
  • a complete system may include, but is not limited to, a video system (e.g., including an image processing system and one or more display monitors), an electrocauterization energy source and control system, an insufflation gas supply and control system, and various other medical devices and systems that can be used to support/perform such vessel harvesting procedures.
  • the vessel harvesting device 100 system can include a gyrosensor as described in U.S. Patent Application 17/498,891 filed on October 12, 2021, which is hereby incorporated by reference in its entirety.
  • the working end portion 130 can include, but is not limited to, a shaft transition portion 140, a tissue dissector member 150, a vessel positioner 160, and a vessel cautery 7 tool 170.
  • the shaft transition portion 140 extends from the distal end of the main shaft 120.
  • the tissue dissector member 150 extends from a distal end of the shaft transition portion 140.
  • the vessel positioner 160 is selectively extendable (e g., as shown in FIG. 8) and retractable (e g., as shown in FIG. 9) relative to the tissue dissector member 150 and the shaft transition portion 140.
  • the vessel cautery tool 170 is also selectively extendable (e.g., as shown in FIG.
  • the vessel cautery tool 170 is not visible because it is fully retracted into a lumen 122 that is defined by the shaft transition portion 140 and the main shaft 120.
  • the tissue dissector member 150 comprises a pointed tip that a clinician can use to effectuate tissue dissection by movement of the main shaft 120 by manipulation of the actuator handle assembly 110.
  • the tissue dissector member 150 is conical.
  • tissue dissector member 150 can have a transparent portion (or can be entirely transparent) to facilitate a clinician’s visualization of areas around and beyond the distal working end portion 130 during the dissection and other steps of the vessel harvesting procedure.
  • the tissue dissector member 150 comprises a transparent cone member with a pointed tip.
  • the pointed tip is laterally offset from the central longitudinal axis 121 of the main shaft 120 (e.g., see FIG. 10, etc.).
  • the vessel positioner 160 can be used by the clinician to move and/or control the positions of vessels during the vessel harvesting procedure.
  • the vessel positioner 160 (when extended) can be placed in contact with the main vessel to be harvested while the vessel cautery' tool 170 is used to cauterize and cut a branch vessel that extends laterally from the main vessel.
  • the vessel positioner 160 is used to establish the position the main vessel (and its branch vessels) and to stabilize/control the main vessel while a branch is being isolated, cauterized, and/or cut.
  • the vessel positioner 160 includes a vessel contact member 162 that is attached to the distal ends of two elongate flexible arm members 164.
  • the vessel contact member 162 has a concave surface that defines a groove that can releasably receive/contain a blood vessel w hen the vessel positioner 160 is extended.
  • the concave surface also allow s the vessel contact member 162 to closely fit against, and meld with, the transition portion 140 when the vessel positioner 160 is retracted. Accordingly, the vessel positioner 160 is out of the way when the working end portion 130 is being used for tissue dissection (e.g., while the vessel positioner 160 is retracted as shown in FIG. 9).
  • the longitudinal and lateral position and orientation of the vessel positioner 160 can be controlled by the clinician operator of the vessel harvesting device 100.
  • the vessel positioner 160 can be selectively longitudinally extended and retracted by the clinician by manipulating an actuation member at the actuator handle assembly 110. When retracted (as shown in FIG. 9), the distal end portion of the vessel positioner 160 is closely nested with the transition portion 140.
  • the vessel positioner 160 can be extended distally beyond the pointed tip of the tissue dissector member 150 (as shown in FIG. 8).
  • the flexible arm members 164 of the vessel positioner 160 have a natural curve that laterally moves the position of the vessel contact member 162 toward the pointed tip of the tissue dissector member 150, or even below the pointed tip of the tissue dissector member 150 (i.e., wherein “below” means in the lateral direction opposite of the vessel cautery' tool 170).
  • the flexible arm members 164 are made of a super elastic shape memory material such as. but not limited to, nitinol (a metal alloy comprising nickel and titanium). As the vessel positioner 160 is being extended, the natural curves of the flexible arm members 164 exhibit themselves and the vessel contact member 1 2 thereby moves laterally (as well as distally).
  • the working end portion 130 of the vessel harvesting device 100 also includes the vessel cautery tool 170 that includes a jaw structure 172.
  • the vessel cautery tool 170 can be used to cauterize and/or cut blood vessels (such as branch vessels extending from a main vessel being harvested).
  • Examples of the vessel cautery tool 170 and the jaw structure 172 are provided in references such as, but not limited to, PCT publication WO2023/204231 having a priority date of April 21, 2022; PCT publication WO2023/204232 having a priority date of April 21, 2022; and PCT publication WO2023/204233 having a priority date of April 21, 2022; which are hereby incorporated by reference in their entireties and for all purposes.
  • the vessel cautery tool 170 includes the jaw structure 172 that is pivotably coupled to a distal end portion of an elongate shaft construct 174.
  • a proximal end portion of the elongate shaft construct 174 is coupled to the actuator handle assembly 110. Accordingly, a clinician operator can operate the functions of the vessel cautery tool 170 by manipulating various control actuators/mechanisms of the actuator handle assembly 110.
  • the vessel cautery tool 170 has multiple functions that are controllable by the clinician.
  • the jaw structure 172 of the vessel cautery tool 170 can be selectively extended (e.g., extended distally beyond the pointed tip of the tissue dissector member 150 as shown in FIG. 8) and retracted (e.g.. fully within the lumen 122 as shown in FIG. 9).
  • the vessel cautery tool 170 is slidably disposed within the lumen 122 that is defined by the shaft transition portion 140 and the main shaft 120. While FIGs.
  • the longitudinal position of the distal end portion of the vessel cautery tool 170 is infinitely adjustable by the clinician to any longitudinal position desired by the clinician (up to a distal travel limit and proximally to completely within the lumen 122 that is defined by the shaft transition portion 140 and the main shaft 120).
  • the vessel cautery tool 170 is also selectively rotatable about its longitudinal axis.
  • the vessel cautery tool 170. being slidably disposed within the lumen 122. is thereby 7 axially rotatable relative to the main shaft 120.
  • the clinician can use this functionality 7 to manually rotate the vessel cautery 7 tool 170, as desired by the clinician, to position/orient the jaws of the jaw structure 172 to capture blood vessels, for example.
  • the vessel cautery tool 170 also has a grasping functionality 7 . That is, the two jaws of the jaw 7 structure 172 can be selectively opened and closed by the clinician using various control actuators/mechanisms of the actuator handle assembly 110. For example, a clinician can operate the jaw structure 172 to capture a blood vessel within the jaw structure 172 by closing the jaw structure 172 on the blood vessel.
  • the vessel cautery tool 170 also has a cauterization functionality. Accordingly, the jaws of the jaw structure 172 can have one or more cauterization electrodes mounted thereon. The clinician operator can selectively energize the one or more cauterization electrodes to cauterize a blood vessel that is captured within the jaws.
  • the vessel cautery 7 tool 170 also has a blood vessel cutting functionality 7 .
  • the vessel cautery 7 tool 170 can include a selectively extendable/actuatable cutting blade or other type of tissue cutting mechanism. Accordingly, a clinician can use the various control actuators/mechanisms of the actuator handle assembly 110 to cut a blood vessel that is captured within the jaw structure 172 (e.g., after the cauterization of the blood vessel has occurred).
  • the vessel harvesting device 100 also includes the actuator handle assembly 110.
  • the actuator handle assembly 110 includes various actuators and functionalities that a clinician can use to control the working end portion 130 of the vessel harvesting device 100 during a blood vessel harvesting procedure.
  • Such actuators can be any type of. or combinations of, slidable, rotatable, pivotable, twistable, and the like.
  • Such actuators can be mechanical, electro-mechanical, electrical, and the like.
  • a clinician can operate the actuator handle assembly 110 to initiate and perform actions such as, but not limited to, manipulating the tissue dissector member 150 to dissect tissue, extending and positioning the vessel positioner 160 to capture and stabilize a blood vessel, extending the vessel cautery tool 170, opening the jaws of the jaw structure 172, closing the jaws of the jaw structure 172 to capture a blood vessel, locking the jaws of the jaw structure 172 in a closed position, cauterizing a blood vessel, and cutting a blood vessel.
  • actions such as, but not limited to, manipulating the tissue dissector member 150 to dissect tissue, extending and positioning the vessel positioner 160 to capture and stabilize a blood vessel, extending the vessel cautery tool 170, opening the jaws of the jaw structure 172, closing the jaws of the jaw structure 172 to capture a blood vessel, locking the jaws of the jaw structure 172 in a closed position, cauterizing a blood vessel, and cutting a blood vessel.
  • the vessel harvesting device 100 can be used by a clinician in the following manner to perform a vessel harvesting procedure that includes the steps of: (1) dissecting blood vessels from adipose tissue using the tissue dissector member 150, (2) capturing and stabilizing the position of a blood vessel using the vessel positioner 160, (3) extending the vessel cautery tool 170 and opening the jaws of the vessel cautery tool 170 around a blood vessel, (4) closing/compressing the jaws of the vessel cautery tool 170 on/around the blood vessel, (4) locking the jaws in the closed position on/around the blood vessel, (5) cauterizing the blood vessel with the jaws in the locked arrangement, and (6) cutting the blood vessel using the vessel cautery tool 170 and with the jaws in the locked arrangement. All of the foregoing actions can be performed while visualized by the clinician using the imaging functionality of the vessel harvesting device 100.
  • FIGs. 10-12 illustrate the longitudinal axes of the main shaft 120. the lumen 122, and the conical tissue dissector member 150. These three axes are separated from each other.
  • the central longitudinal axis of the main shaft 120 is axis 121.
  • the central longitudinal axis of the lumen 122 is axis 123.
  • the central longitudinal axis of the tissue dissector member 150 is axis 151.
  • the axis 151 extends through the pointed tip of the tissue dissector member 150.
  • the central longitudinal axis 121 of the main shaft 120 is located between: (i) the central longitudinal axis 123 of the lumen 122 and (ii) the central longitudinal axis 151 of the tissue dissector member 150.
  • the central longitudinal axis 123 of the lumen 122 is laterally offset from the central longitudinal axis 121 of the main shaft 120, and the central longitudinal axis 151 of the tissue dissector member 150 is laterally offset from the central longitudinal axis 121.
  • the lateral offset of the lumen 122 relative to the central longitudinal axis 121 of the main shaft 120 means that the lumen 122 that slidably contains the vessel cautery' tool 170 is not centralized in/along the main shaft 120.
  • the lateral offset of the central longitudinal axis 151 of the tissue dissector member 150 means that the conical tissue dissector member 150 (including its pointed tip) is not centralized with the main shaft 120. That is significant in that the pointed tip of the conical tissue dissector member 150, being useful for tissue dissection, is not centered in relation to the main shaft 120.
  • the conical tissue dissector member 150 being at least partially transparent, is used for endoscopic visualization, the in vivo view of the working end portion 130 of the vessel harvesting device 100 is laterally offset relative to the central longitudinal axis 121 of the main shaft 120.
  • FIG. 13 further illustrates the lateral offset of the tissue dissector member 150 as facilitated by the shape of the shaft transition portion 140. That is, the shaft transition portion 140 extends from the distal end of the main shaft 120 at an angle al relative to the central longitudinal axis 121 of the main shaft 120. In some embodiments, the angle al is in a range of about 10° to 40°, or about 20° to 50°, or about 30° to 60°, or about 20° to 30°, without limitation.
  • FIG. 14 illustrates that the shaft transition portion 140 and the tissue dissector member 150 have distally reducing diameters as compared to the main shaft 120, terminating at the pointed tip of the tissue dissector member 150. Said another way, the transition portion 140 and the tissue dissector member 150 neck dow n in diameter from the main shaft 120 to the pointed tip of the tissue dissector member 150.
  • An angle a2 is defined between: (i) a line extending between the pointed tip of the tissue dissector member 150 and the outer diameter at the junction betw een the shaft transition portion 140 and (ii) the main shaft 120 (or the central longitudinal axis 121 of the main shaft 120).
  • the angle a2 is in a range of about 10° to 40°, or about 20° to 30°, or about 20° to 40°. or about 10° to 30°, or about 10° to 20°, or about 5° to 20°, without limitation.
  • FIG. 15 transparently illustrates the main shaft 120, the transition portion 140, and the tissue dissector member 150.
  • an image sensor 180 is positioned within the transition portion 140.
  • the image sensor 180 is pointed/aimed distally toward the tissue dissector member 150.
  • the image sensor 180 is positioned to capture images that are distal of the tissue dissector member 150 by viewing the images through the transparent portion(s) of the tissue dissector member 150. Accordingly, in this illustration it can be readily seen that the axis 151 (which is also the central axis of the image sensor 180 in this embodiment) is offset from the central longitudinal axis 121 of the main shaft 120.
  • the image sensor 180 is a high-resolution solid state image sensor such as a charge-coupled device (CCDs) image sensor or a complementary metal oxide semiconductor (CMOS) image sensor.
  • CCDs charge-coupled device
  • CMOS complementary metal oxide semiconductor
  • one or more visible light emitters are included as part of the image sensor 180 or near to the image sensor 180.
  • multiple light emitting diodes (“LEDs”) are positioned around the outer periphery of the image sensor 180.
  • FIGs. 16-20 schematically illustrate an example jaw structure 172 of the vessel cautery 7 tool 170.
  • the jaw structure 172 includes a first jaw 172a and a second jaw 172b (collectively “jaws 172a/b”) that are movably coupled to the distal end portion of the elongate shaft construct 174 of the vessel cautery tool 170.
  • the jaws 172a/b are pivotably coupled to the distal end portion of the elongate shaft construct 174 at a pivot point 171.
  • a clinician user can selectively open the jaw structure 172 (e.g., as shown in FIG. 16) and selectively close/compress the jaw structure 172 (e.g.. as shown in FIGs. 17-20) by actuating one or more control devices at/on the actuator handle assembly 110 (FIG. 7).
  • the jaw structure 172 can include cautery 7 electrodes for cauterizing blood vessels captured between the jaws 172a/b.
  • a first electrode 173a is coupled to the first jaw 172a
  • a second electrode 173b is coupled to the second jaw 172b.
  • the clinician user can then activate the vessel cauterization process by actuation of a button or switch at/on the actuator handle assembly 110, and thermal energy will be generated between the electrodes 173a/b in order to cauterize blood vessels that are positioned there between (e.g., as depicted in FIG. 17).
  • the portions of the jaws 172a/b to which the electrodes 173a/b are attached are electrically insulative.
  • the jaw structure 172 also includes ajaw interface between the jaws 172a/b at a distal end portion 176 of the jaw structure 172.
  • the distal end portion 176 of the jaw structure 172 is where electrically insulative distal end portions of the jaws 172a/b make contact with each other when the jaws 172a/b are closed and/or compressed.
  • the distal end portion 176 is configured so that when the jaws 172a/b are in the closed arrangement, the electrodes 173a/b are spaced apart from each other. That is, because of the distal end portion 176 of the jaw structure 172, the electrodes 173a/b do not contact each other, even when the jaws 172a/b are closed.
  • the electrically insulative distal end portion 176 of the jaws 172a/b is free of the electrodes 173a/b.
  • the distal end of each electrode 173a/b terminates proximally of the distal end portion 176 of the jaw structure 172. Accordingly, when the jaws 172a/b are closed, the electrically insulative distal end portion(s) 176 of the jaws 172a/b make contact with each other, but the electrodes 173a/b are spaced apart from each other.
  • the jaw interface between the jaws 172a/b at the distal end portion 176 of the jaw structure 172 is laterally offset from the longitudinal axis of the elongate shaft construct 174 of the vessel cautery tool 170.
  • the jaw interface between the jaws 172a/b at the distal end portion 176 is also laterally offset from the space between the electrodes 173a/b when the jaws 172a/b are in the closed arrangement.
  • the distal end portion 176 of the second jaw 172b extends across the longitudinal axis of the elongate shaft construct 174, while the distal end portion 176 of the first jaw 172a does not cross the longitudinal axis of the elongate shaft construct 174.
  • the jaw structure 172 can also include a means for cutting blood vessels (e.g., after cauterization).
  • the jaw structure 172 includes a cutting blade 175.
  • the clinician user can then activate the vessel cutting process by actuation of a button or switch at/on the actuator handle assembly 110, and the cutting blade 175 will translate distally to cut a blood vessel positioned between the jaws 172a/b.
  • the cutting blade 175 translates along/within longitudinal grooves defined by the electrodes 173a/b and/or the jaws 172a/b when activated to cut a vessel positioned between the jaws 172a/b.
  • the leading distal end of the cutting blade 175 is sharpened and angled (at anon-perpendicular angle relative to the central longitudinal axis of the elongate shaft construct 174).
  • the leading distal end of the cutting blade 175 is angled toward the second jaw 172b and away from the first jaw 172a.
  • Such an angle of the leading distal end of the cutting blade 175 tends to drive the blood vessel away from the interface between the jaws 172a/b during the cutting process. Said another way, the vessel being cut will not be forced toward the interface between the jaws 172a/b when the leading distal end of the cutting blade 175 makes contact with the blood vessel.
  • the vessel being cut will be forced away from the interface when the leading distal end of the cutting blade 175 makes contact with the blood vessel.
  • This arrangement can help ensure an effective and repeatable vessel cutting process during the vessel harvesting procedure because the vessels being cut will be prevented from being forced into the interface between the jaws 172a/b during the cutting.
  • FIGs. 21 and 22 illustrate another example jaw structure 172' of the vessel cautery tool 170.
  • the jaw structure 172' includes a first jaw- 172a' and a second jaw 172b' (collectively “jaws 172a7b'”) that are movably coupled to the distal end portion of the elongate shaft construct 174 of the vessel cautery tool 170.
  • the jaw s 172a7b' are pivotably coupled to the distal end portion of the elongate shaft construct 174 at a pivot point 171 (e.g., as shown in FIG. 16).
  • a clinician user can selectively open the jaw structure 172' and selectively close/compress the jaw structure 172' (e.g., as shown in FIGs. 21-22) by actuating one or more control devices at/on the actuator handle assembly 110 (FIG. 7).
  • the jaw structure 172' can include cautery electrodes for cauterizing blood vessels captured betw een the jaw s 172a7b'.
  • a first electrode 173a' is coupled to the first jaw 172a'
  • a second electrode 173b' is coupled to the second jaw 172b'.
  • the clinician user can then activate the vessel cauterization process byactuation of a button or switch at/on the actuator handle assembly 110, and thermal energy will be generated between the electrodes 173a7b' in order to cauterize blood vessels that are positioned there between.
  • the portions of the jaws 172a7b' to which the electrodes 173a7b’ are attached are electrically insulative.
  • the jaw structure 172’ also includes ajaw interface between the jaws 172a7b' at a distal end portion 176' of the jaw structure 172.
  • the distal end portion 176' of the jaw structure 172 is where electrically insulative distal end portions of the jaws 172a7b' make contact with each other when the jaws 172a7b' are closed and/or compressed.
  • the distal end portion 176' is configured so that when the jaws 172a7b' are in the closed arrangement, the electrodes 173a7b' are spaced apart from each other. That is, because of the distal end portion 176' of the jaw structure 172', the electrodes 173a7b' do not contact each other, even when the jaws 172a7b' are closed.
  • the second jaw 172b' includes one or more posts (two posts in the depicted embodiment) that extend toward the first jaw 172a' and make contact at ajaw interface area.
  • the post(s) of the electrically insulative distal end portion 176' of the jaws 172a7b' is/are free of the electrodes 173a7b'.
  • the distal end portion of each electrode 173a'/b' extends laterally within or along the side(s) of the post(s) of the electrically insulative distal end portion 176'. Accordingly, when the jaws 172a7b' are closed, the electrically insulative distal end portion(s) 176' of the jaws 172a7b' make contact with each other, but the electrodes 173a7b' are spaced apart from each other.
  • the jaw interface between the jaw s 172a7b' at the distal end portion 176' of the jaw structure 172' is laterally offset from the longitudinal axis of the elongate shaft construct 174 of the vessel cautery tool 170.
  • the jaw interface between the jaws 172a7b' at the distal end portion 176' is also laterally offset from the space between the electrodes 173a7b' when the jaws 172a7b' are in the closed arrangement.
  • the post(s) at the distal end portion 176' of the second jaw 7 172b' extend(s) across the longitudinal axis of the elongate shaft construct 174. while the distal end portion 176' of the first jaw 172a' does not cross the longitudinal axis of the elongate shaft construct 174.
  • the jaw 7 structure 172' can also include a means for cutting blood vessels (e.g., after cauterization).
  • the jaw structure 17'2 includes a cutting blade 175'.
  • the clinician user can then activate the vessel cutting process by actuation of a button or switch at/on the actuator handle assembly 110, and the cutting blade 175' will translate distally to cut a blood vessel positioned between the jaws 172a7b'.
  • the cutting blade 175' translates along/within longitudinal grooves defined by the electrodes 173a'/b' and/or the jaws 172a7b' when activated to cut a vessel positioned between the jaws 172a7b'.
  • the leading distal end of the cutting blade 175' is sharpened and angled (at anon-perpendicular angle relative to the central longitudinal axis of the elongate shaft construct 174).
  • the leading distal end of the cutting blade 175' is angled toward the second jaw 172b' and away from the first jaw 172a'.
  • Such an angle of the leading distal end of the cutting blade 175' tends to drive the blood vessel away from the interface between the jaws 172a'/b' during the cutting process. Said another way, the vessel being cut will not be forced toward the interface between the jaws 172a7b' when the leading distal end of the cutting blade 175' makes contact with the blood vessel.
  • the vessel being cut will be forced away from the interface when the leading distal end of the cutting blade 175' makes contact with the blood vessel.
  • This arrangement can help ensure an effective and repeatable vessel cutting process during the vessel harvesting procedure because the vessels being cut will be prevented from being forced into the interface between the jaws 172a7b' during the cutting.
  • the working end portion 130 of the harvesting device 100 can include the vessel positioner 160.
  • the vessel positioner 160 is selectively extendable (e.g., as shown in FIG. 8) and retractable (e.g., as shown in FIG. 9) relative to the tissue dissector member 150 and the shaft transition portion 140.
  • the vessel positioner 160 can be used by the clinician to move and/or control the positions of vessels during the vessel harvesting procedure.
  • the vessel positioner 160 (when extended) can be placed in contact with the main vessel to be harvested while the vessel cautery tool 170 is used to cauterize and cut a branch vessel that extends laterally from the main vessel.
  • the vessel positioner 160 is used to establish the position the main vessel (and its branch vessels) and to stabilize/control the main vessel while a branch is being isolated, cauterized, and/or cut.
  • the vessel positioner 160 includes a vessel contact member 162 that is attached to the distal ends of two elongate flexible arm members 164.
  • FIG. 23 shows the vessel positioner 160 in its retracted position in which the vessel contact member 162 is nested with the transition portion 140 near the center of the distal working end 130 and shows the extended vessel positioner 160 in broken lines.
  • the flexible arm members 164 have a naturally curved shape that moves the vessel contact member 162 laterally on the other side of the tissue dissector member 150 when the vessel positioner 160 is distally extended.
  • the vessel contact member 162 has a concave surface that defines a groove that can releasably receive/contain a blood vessel 11 when the vessel positioner 160 is distally extended.
  • the concave surface also allows the vessel contact member 162 to closely fit against, and nest with, the transition portion 140 when the vessel positioner 160 is retracted. Accordingly, the vessel positioner 160 is out of the way when the working end portion 130 is being used for tissue dissection (e.g., while the vessel positioner 160 is retracted).
  • the vessel contact member 162 is a concave member that is coupled/attached to the flexible arm members 164. In some embodiments, no such additional vessel contact member 162 is included. Rather, the flexible arm members 164 simply extend along a U-shaped path at the distal end of the vessel positioner 1 0.
  • the longitudinal (proximal/distal) and lateral position and orientation of the vessel positioner 160 can be controlled by the clinician operator of the vessel harvesting device 100.
  • the vessel positioner 160 can be selectively longitudinally extended and retracted by the clinician by manipulating an actuation member at/on the actuator handle assembly 110. When retracted, the distal end portion of the vessel positioner 160 is closely mated with the transition portion 140 near the centerline of the working end portion 130.
  • the vessel positioner 160 can be extended by the clinician user distally beyond the pointed tip of the tissue dissector member 150 (as shown in broken lines in FIG. 23).
  • the flexible arm members 164 of the vessel positioner 160 have a natural curve that laterally moves the location of the vessel contact member 162 toward the pointed tip of the tissue dissector member 150, or even below the pointed tip of the tissue dissector member 150 (i.e., wherein “below” means in the lateral direction opposite of the vessel cautery tool 170). In that position, the vessel 11 is held a safe distance away from the cautery electrodes of the vessel cautery tool 170 so that the risk of thermal damage to the vessel 11 is minimized.
  • the flexible arm members 164 are made of a shape-set super elastic shape memory material such as, but not limited to, nitinol (a metal alloy comprising nickel and titanium). As the vessel positioner 160 is being extended, the natural curves of the flexible arm members 164 exhibit themselves and the vessel contact member 162 thereby moves laterally (as well as distally). The tissue dissector member 150 is between the two flexible arm members 164 when the vessel positioner 160 is extended.
  • nitinol a metal alloy comprising nickel and titanium
  • the vessel harvesting device 100 includes the actuator handle assembly 110 that is operable by a clinician-user.
  • the actuator handle assembly 110 includes a first portion 111 and a second portion 115.
  • the first portion 111 is positioned distally of the second portion 115.
  • the first portion 111 is coupled to a proximal end of the main shaft 120.
  • the second portion 1 15 is coupled to a proximal end of the elongate shaft construct 174 of the vessel cautery tool 170.
  • the elongate shaft construct 174 of the vessel cautery tool 170 is slidably disposed in the lumen 122 defined by the main shaft 120 and the shaft transition portion 140. Accordingly, the first portion 111 and the second portion 115 of the actuator handle assembly 110 are slidably translatable relative to each other. In other words, a clinician-user can distally extend the jaw structure 172 of the vessel cautery tool 170 out of the lumen 122 (e.g., as shown in FIG. 8) by pushing the second portion 115 of the actuator handle assembly 110 distally in relation to the first portion 111 of the actuator handle assembly 110.
  • a clinician-user can proximally retract the jaw structure 172 of the vessel cautery tool 170 back toward and/or fully into the lumen 122 (e.g., as shown in FIG. 9) by pulling the second portion 115 of the actuator handle assembly 110 proximally in relation to the first portion 111 of the actuator handle assembly 110.
  • the elongate shaft construct 174 of the vessel cautery tool 170 is slidably disposed in the lumen 122 defined by the main shaft 120 and the shaft transition portion 140, the first portion 1 11 and the second portion 115 of the actuator handle assembly 110 are rotatable relative to each other about the longitudinal axis 123 of the lumen 122 (see FIGs. 11 and 12). Accordingly, the clinician-user can rotate the jaw structure 172 of the vessel cautery tool 170 by rotating the second portion 115 of the actuator handle assembly 110 in relation to the first portion 11 1 of the actuator handle assembly 110.
  • the first portion 111 of the actuator handle assembly 110 can include one or more actuator buttons, switches, slides, and the like that a clinician-user can manually operate in order to perform various functions of the vessel harvesting device 100.
  • the first portion 11 1 of the actuator handle assembly 110 includes a slidable actuator 112 by which a clinician-user can translate the vessel positioner 160 relative to the main shaft 120, i.e., to extend the vessel contact member 162 distally of the tissue dissector member 150 (e.g.. as shown in FIG. 8) and to retract the vessel contact member 162 proximally of the tissue dissector member 150 (e.g., as shown in FIG. 9).
  • the second portion 115 of the actuator handle assembly 110 can also include one or more actuator buttons, switches, slides, and the like that a clinician-user can manually operate in order to perform various functions of the vessel harvesting device 100.
  • the second portion 1 15 includes a first member 116 and a second member 117 that are actuatable by the clinician-user to open and close the jaws of the jaw structure 172.
  • the clinicianoperator can place his/her fingers in one of the first member 116 or the second member 117 and place his/her thumb in the other of the first member 116 or the second member 117.
  • the clinician-operator can then open and close the jaws of the jaw structure 172 by manually moving the first member 116 and the second member 117 laterally away from the centerline of the second portion 115 of the actuator handle assembly 110, similar to the motion to actuate a pair of scissors.
  • the second portion 115 of the actuator handle assembly 110 also includes a slidable actuator 118.
  • the slidable actuator 118 is multifunctional in response to the position it is slid to along the second portion 115 of the actuator handle assembly 110.
  • the slidable actuator 118 can be slid by the clinician-user to a first position to compress and lock the jaws of the jaw structure 172 in the closed position. Then, in some embodiments the slidable actuator 118 can be slid by the clinician-user to a second position to energize the cauterization electrodes on the jaws of the jaw structure 172.
  • an interlock is included in the design that prevents energization of the cauterization electrodes unless the jaws of the jaw structure 172 are closed/compressed and locked in that position.
  • the slidable actuator 118 can be slid by the clinician-user to a third position to distally extend the cutting blade of the jaw structure 172 (e.g., see the cutting blade 175 of the jaw structure 172 show n in FIGs. 16-20).
  • the mechanisms to actuate the locking of the jaws, the cauterization, and the cutting can be separate actuators.
  • the mechanisms to actuate the locking of the jaws and to energize the cauterization can be on the same actuator (e.g., the slidable actuator 118), and the mechanism to actuate the cutting can be a separate actuator. Any combination or separation of such mechanisms is possible and envisioned by this disclosure.
  • FIGs. 26 and 27 illustrate another example second portion 115' of the actuator handle assembly 110.
  • the components having reference numbers corresponding to those of the second portion 115 as described above can be the same. How ever, the second portion 115' is different from the second portion 115 at least because the first member 116' is different than first member 116.
  • the first member 116' defines a thumb/ finger receiving area that defines an axis 113 that extends longitudinally (e.g., in a direction like that of the central longitudinal axis 121).
  • the second member 1 17 defines a thumb/finger receiving area that defines an axis 114 that extends transversely across the central longitudinal axis 121.
  • the clinician-user may find it convenient, efficient, and ergonomic to position her/his thumb in/through the first member 116' (e.g., as depicted in FIG. 27) and to position two or more of her/his other fingers in/through the second member 117.
  • the clinician-operator can then move the first member 116' and the second member 117 away from the central longitudinal axis 121 to open the jaws of the jaw structure 172, and so on.
  • the clinician-user By extending a thumb through the first member 116' (with its axis 113 extending longitudinally) can enable the clinician-user to use her/his thumb to actuate other mechanisms on the second portion 115' of the actuator handle assembly 110.
  • the clinician-user may be able to use her/his thumb to actuate the slidable actuator 118 while her/his thumb is also engaged with the first member 116'. This arrangement can thereby facilitate single-handed operation of the second portion 115' of the actuator handle assembly 110.
  • FIGs. 28 and 29 illustrate another example actuator handle assembly 210.
  • This actuator handle assembly 210 can be substituted for the actuator handle assembly 1 10 described above. Accordingly, the actuator handle assembly 210 can be used by a clinician-user to operate an all-in-one blood vessel harvesting system during a vessel harvesting procedure. That is, a clinician-user can control and manipulate the actuator handle assembly 210 to operate and/or actuate all aspects of the distal working end portion 130 (see FIGs. 7-9), such as the tissue dissector member 150, the vessel positioner 160, and the vessel cautery tool 170 (with its jaw structure 172, including cauterization and vessel cutting).
  • the actuator handle assembly 210 includes a first portion 211 and a second portion 213. Further, the second portion 213 is made up of two portions: (i) a distal portion 214 and (ii) a proximal portion 215.
  • the first portion 211 is manually translatable along the distal portion 214 of the second portion 213 as indicated by the longitudinally-extending arrow T. Accordingly, it can be said that the overall length of the actuator handle assembly 210 can be adjusted, like a telescope, between a longer configuration (as shown in FIG. 28) and a shorter configuration (as shown in FIG. 29).
  • the vessel cautery tool 170 is withdrawn or retracted within the lumen 122 of the main shaft 120 (e.g., as shown in FIG. 9).
  • the vessel cautery tool 170 distally extends out from the lumen 122 of the main shaft 120 (e.g., as show n in FIG. 8). Said another w ay, by longitudinally telescoping or sliding the first portion 211 along the distal portion 214 of the second portion 213. the clinician-user can extend and/or retract the vessel cautery tool 170 at the distal working end portion 130.
  • the first portion 211 of the actuator handle assembly 210 is keyed to the distal portion 214 of the second portion 213. Accordingly, while the first portion 211 can be translated along the distal portion 214 of the second portion 213. the first portion 211 is not rotatable relative to the distal portion 214 of the second portion 213.
  • the distal portion 214 of the second portion 213 is rotatably coupled to the proximal portion 215 of the second portion 213 at a rotary joint 216. Accordingly, the proximal portion 215 of the second portion 213 is manually rotatable relative to the distal portion 214 of the second portion 213 as indicated by the arcuate arrow R.
  • the clinician-user can rotate the elongate shaft construct 174 and the vessel cautery tool 170 about the central longitudinal axis 123 of the lumen 122. This rotation can be performed in both the longer configuration of FIG. 28 and in the shorter configuration of FIG. 29.
  • the distal portion 214 of the second portion 213 adds strength to the actuator handle assembly 210 and prevents the proximal portion 215 of the second portion 213 from dangling and possibly bending about the elongate shaft construct 174 where it inserts into the first portion 211 of the actuator handle assembly 210.
  • This also gives the appearance and functionality of one overall handle 210 as opposed to two handles (e.g., as shown in FIGs. 25-27).
  • This design of the actuator handle assembly 210 also prevents pinching of gloves between handles of the two-part, non-center section design as shown in FIGs. 25-27.
  • the actuator handle assembly 210 includes a slidable actuator 212 by which a clinician-user can translate the vessel positioner 160 relative to the main shaft 120, i.e.. to extend the vessel contact member 162 distally of the tissue dissector member 150 (e g., as shown in FIG. 8) and to retract the vessel contact member 162 proximally of the tissue dissector member 150 (e.g., as show n in FIG. 9).
  • the actuator handle assembly 210 also includes a multifunctional actuator 219 (e.g., like the slidable actuator 118 described above).
  • the clinician-user can actuate the multifunctional actuator 219 to perform functions such as jaw locking, vessel cauterization, and vessel cutting, for example.
  • the actuator handle assembly 210 also includes a first member 217 and a second member 218. By manipulating the first member 217 and the second member 218 in a scissors-like manner, a clinician-user can open and/or close the jaws of the jaw structure 172.
  • the first member 217 defines a thumb/finger receiving area with an axis that extends longitudinally (e.g., in a direction like that of the central longitudinal axis 121).
  • the second member 218 defines a thumb/finger receiving area with an axis that extends transversely across the central longitudinal axis 121.
  • the clinician-user may find it convenient, efficient, and ergonomic to position her/his thumb in/through the first member 217 (e.g., as depicted in FIG. 27 for first member 116') and to position two or more of her/his other fingers in/through the second member 218.
  • the clinician-operator can then move the first member 217 and the second member 218 away from the central longitudinal axis 121 to open the jaws of the jaw structure 172, and so on.
  • the clinician-user By extending a thumb through the first member 217 (with its axis extending longitudinally) the clinician-user is enabled to use her/his thumb to actuate other mechanisms on the second portion 213 of the actuator handle assembly 210.
  • the clinician-user may be able to use her/his thumb to actuate the multifunctional actuator 219 while her/his thumb is also engaged with the first member 217. This arrangement can thereby facilitate single-handed operation of the second portion 213 of the actuator handle assembly 210.

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  • Surgery (AREA)
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  • Veterinary Medicine (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
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  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Orthopedic Medicine & Surgery (AREA)
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  • Surgical Instruments (AREA)

Abstract

En lien avec le pontage coronarien (PAC), un vaisseau sanguin ou une section de vaisseau, tel qu'une artère ou une veine, est "prélevé" (c'est-à-dire disséqué et retiré) de son emplacement naturel dans le corps d'un patient pour l'utiliser ailleurs dans le corps. Des systèmes de dispositif médical peuvent être utilisés pour prélever des vaisseaux sanguins à partir du corps d'un sujet (par exemple, à partir d'une jambe ou d'un bras) d'une manière minimalement invasive. Par exemple, ce document décrit des systèmes multifonctionnels de prélèvement de vaisseau sanguin tout-en-un qui peuvent comprendre, par exemple, un dissecteur tissulaire, un capteur de caméra vidéo, un positionneur de vaisseau, un dispositif de cautérisation de vaisseau, un dispositif de coupe de vaisseau et des commandes d'utilisateur qui sont tous intégrés en un seul dispositif.
PCT/US2025/028654 2024-05-14 2025-05-09 Systèmes et procédés de prélèvement de vaisseaux sanguins Pending WO2025240259A1 (fr)

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Application Number Priority Date Filing Date Title
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US63/647,103 2024-05-14

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WO2025240259A1 true WO2025240259A1 (fr) 2025-11-20

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Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6162173A (en) * 1998-06-22 2000-12-19 Origin Medsystems, Inc. Device and method for remote vessel ligation
US20050154257A1 (en) * 2003-10-31 2005-07-14 Olympus Corporation Living-body tissue removing apparatus
US20090062795A1 (en) * 2007-08-31 2009-03-05 Ethicon Endo-Surgery, Inc. Electrical ablation surgical instruments
US20180280084A1 (en) * 2017-03-30 2018-10-04 Creo Medical Limited Electrosurgical instrument
US20200345408A1 (en) * 2019-05-01 2020-11-05 Saphena Medical, Inc. Unitary endoscopic vessel harvesting devices with a visual cue to identify orientation of cutting elements
US11432839B2 (en) * 2018-01-12 2022-09-06 Maquet Cardiovascular Llc Vessel harvesting apparatus and method

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6162173A (en) * 1998-06-22 2000-12-19 Origin Medsystems, Inc. Device and method for remote vessel ligation
US20050154257A1 (en) * 2003-10-31 2005-07-14 Olympus Corporation Living-body tissue removing apparatus
US20090062795A1 (en) * 2007-08-31 2009-03-05 Ethicon Endo-Surgery, Inc. Electrical ablation surgical instruments
US20180280084A1 (en) * 2017-03-30 2018-10-04 Creo Medical Limited Electrosurgical instrument
US11432839B2 (en) * 2018-01-12 2022-09-06 Maquet Cardiovascular Llc Vessel harvesting apparatus and method
US20200345408A1 (en) * 2019-05-01 2020-11-05 Saphena Medical, Inc. Unitary endoscopic vessel harvesting devices with a visual cue to identify orientation of cutting elements

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