Surgical apparatus and method for performing transabdominal cardiac surgery

Abstract

The invention provides a surgical apparatus and method for performing less-invasive, closed chest cardiac surgery through a transabdominal approach, without cardiopulmonary bypass. In a preferred embodiment, the invention provides a heart manipulator and a coronary stabilizer which are deployed through an access cannula and secured relative to a stationary support through a surgical arm. Heart manipulator and coronary stabilizer cooperate together to enable access to all the coronary artery territories of the heart through a single access cannula. Also provided is a diaphragm tissue retractor.

1 . A surgical device for accessing a target anatomic structure of a patient body, the patient body including an internal body cavity, the internal body cavity containing the target anatomic structure and defining a peripheral internal cavity wall, the peripheral internal cavity wall including an anatomic barrier, the anatomic barrier separating an intra-cavity region defined by the peripheral internal cavity wall and an extra-cavity region being external to the intra-cavity region, said surgical device comprising: 
 an access cannula, said access cannula extending between a first open end and a second open end and including a passageway between said first and second open ends, said passageway configured and sized to receive therein a surgical instrument to perform a surgical intervention on the target anatomic structure; and    an internal joint, said internal joint being contained generally within said passageway, said internal joint configured to couple with a portion of said surgical instrument and provide at least one motion degree of freedom of said surgical instrument relative to said access cannula when said surgical instrument is coupled thereto;    wherein, in use, said access cannula traverses said anatomic barrier and communicates said extra-cavity region with said intra-cavity region thereby allowing said surgical instrument to perform said surgical intervention on the target anatomic structure while said surgical instrument is coupled to said internal joint.    
   
   
       2 . The surgical device of  claim 1 , wherein the patient body includes an external body surface, the external body surface defining a point of insertion for said surgical device, and wherein, in use, said first open end is adjacent the point of insertion and said second open end is adjacent the anatomic barrier to provide said passageway between the point of entry and the anatomic barrier, said surgical instrument extending extracorporeally beyond said first open end when said surgical instrument is coupled to said internal joint, said surgical instrument being extracorporeally operable relative to said motion degree of freedom.  
   
   
       3 . The surgical device of  claim 2 , wherein said internal joint provides two motion degrees of freedom of said surgical instrument relative to said access cannula when said surgical instrument is coupled thereto.  
   
   
       4 . The surgical device of  claim 2 , wherein said internal joint provides three motion degrees of freedom of said surgical instrument relative to said access cannula when said surgical instrument is coupled thereto.  
   
   
       5 . The surgical device of  claim 2 , wherein said internal joint provides four motion degrees of freedom of said surgical instrument relative to said access cannula when said surgical instrument is coupled thereto.  
   
   
       6 . The surgical device of  claim 1 , wherein said internal joint includes an internal joint locking member to lock said surgical instrument in a fixed spatial relationship relative to said access cannula.  
   
   
       7 . The surgical device of  claim 6 , wherein said surgical device further comprises a surgical platform, said access cannula being connected to said surgical platform through an external joint, said external joint providing at least one motion degree of freedom between said access cannula and said surgical platform.  
   
   
       8 . The surgical device of  claim 7 , wherein said external joint includes an external joint locking member to lock said access cannula in a fixed spatial relationship relative to said surgical platform.  
   
   
       9 . The surgical device of  claim 1 , wherein said surgical device further comprises a surgical platform, said access cannula being connected to said surgical platform through an external joint, said external joint providing at least one motion degree of freedom between said access cannula and said surgical platform.  
   
   
       10 . The surgical device of  claim 9 , wherein said external joint includes an external joint locking member to lock said access cannula in a fixed spatial relationship relative to said surgical platform.  
   
   
       11 . The surgical device of  claim 1 , wherein said access cannula is configured to be connectable to a surgical robot.  
   
   
       12 . The surgical device of  claim 1 , wherein said access cannula is provided with a seal member across said passageway, said seal member providing a seal between the intra-cavity and extra-cavity regions, and wherein, in use, said surgical instrument extends across said seal member when said surgical instrument is coupled to said internal joint.  
   
   
       13 . The surgical device of  claim 1 , wherein said access cannula is partitioned with an access lumen, said access lumen providing, in use, fluid communication between a first portion of said access cannula located upstream of the anatomic barrier to a second portion of said access cannula located downstream of the anatomic barrier, said access lumen being configured and sized to receive a surgical aid to facilitate the surgical intervention on the target anatomic structure.  
   
   
       14 . The surgical device of  claim 13 , wherein said surgical aid is a surgical gas introduced into the intra-cavity region through said access lumen.  
   
   
       15 . The surgical device of  claim 1 , wherein the internal body cavity is a thoracic cavity, the internal cavity peripheral wall comprises an internal ribcage surface and a diaphragm, the target anatomic structure is a mediastinum tissue located within the thoracic cavity, and said surgical instrument includes a tissue manipulator configured and sized to engage the mediastinum tissue within the intra-cavity region and, in use, position the mediastinum tissue relative to said access cannula.  
   
   
       16 . The surgical device of  claim 15 , wherein said internal joint provides at least two motion degrees of freedom of said tissue manipulator relative to said access cannula, said internal joint also having an internal joint locking member to lock said tissue manipulator in a fixed spatial relationship relative to said access cannula.  
   
   
       17 . The surgical device of  claim 16 , wherein said surgical device further comprises a surgical platform, said access cannula connected to said surgical platform through an external joint, said external joint providing at least one motion degree of freedom between said access cannula and said surgical platform, said external joint having an external joint locking member to lock said access cannula in a fixed spatial relationship relative to said surgical platform.  
   
   
       18 . A surgical device for performing a surgical intervention on a patient heart, the patient heart located within a thoracic cavity of a patient body, the thoracic cavity defining a thoracic peripheral wall, the thoracic peripheral wall including a diaphragm, the diaphragm separating an intra-thoracic region defined by the thoracic peripheral wall and an extra-thoracic region being external to the intra-thoracic region, said surgical device comprising: 
 a heart manipulator, said heart manipulator configured and sized to engage a portion of the patient's heart and to position the patient's heart within the intra-thoracic cavity; and    an access cannula, said access cannula extending between a first open end and a second open end and providing a passageway between said first and second open ends, said passageway configured and sized to receive therein at least a portion of said heart manipulator;    wherein, in use, said access cannula traverses the diaphragm and communicates the extra-thoracic region with the intra-thoracic region thereby allowing said heart manipulator to position the patient heart while the access cannula is engaged with the diaphragm and said heart manipulator is engaged with the engaged portion of the patient heart.    
   
   
       19 . The surgical device of  claim 18 , wherein the patient has an external body surface including an abdominal point of insertion for said surgical device, and wherein, in use, said first open end is adjacent the abdominal point of insertion and said second open end is adjacent the diaphragm to provide said passageway between the abdominal point of entry and the diaphragm, said heart manipulator extending trans-abdominally within said passageway between a manipulator first end located extracorporeally beyond said access cannula first open end and a manipulator second end located intra-thoracically beyond said access cannula second open end, said manipulator second end configured to engage the engaged portion of the patient heart.  
   
   
       20 . The surgical device of  claim 19 , wherein the surgical device further comprises an internal joint, said internal joint being contained generally within said passageway, said internal joint configured to couple with a portion of said heart manipulator and provide at least one motion degree of freedom of said heart manipulator relative to said access cannula when said heart manipulator is coupled thereto, and wherein, in use, said surgical intervention on the target anatomic structure occurs while said heart manipulator is coupled to said internal joint.  
   
   
       21 . The surgical device of  claim 19 , wherein said heart manipulator includes at least one negative pressure suction port configured for engaging said engaged portion of the patient's heart.  
   
   
       22 . The surgical device of  claim 19 , wherein said heart manipulator includes a non-flowing suction cup configured for engaging said engaged portion of the patient's heart.  
   
   
       23 . The surgical device of  claim 18 , wherein said heart manipulator is a pericardium manipulating device configured and sized to manipulate a pericardium tissue portion of the patient heart.  
   
   
       24 . A surgical device for performing a surgical intervention on a target anatomic structure of a patient body, the patient body including an internal body cavity, the internal body cavity containing the target anatomic structure and defining a peripheral internal cavity wall, the internal cavity wall including an anatomic barrier, the anatomic barrier separating an intra-cavity region defined by the peripheral internal cavity wall and an extra-cavity region external to the intra-cavity region, said surgical device comprising: 
 an access cannula, said access cannula extending between a first open end and a second open end and providing a passageway between said first and second open ends, said passageway configured and sized to receive therein two cooperating surgical instruments to perform the surgical intervention on the target anatomic structure; and    an internal joint, said internal joint being contained generally within said passageway, said internal joint being configured to couple with at least one of said two cooperating surgical instruments, said internal joint providing at least one motion degree of freedom of said coupled surgical instrument relative to said access cannula when said surgical instrument is coupled thereto;    wherein, in use, said access cannula traverses said anatomic barrier and communicates said extra-cavity region with said intra-cavity region thereby allowing said cooperating surgical instruments to perform said surgical intervention on the target anatomic structure while at least one of said surgical instruments is coupled to said internal joint.    
   
   
       25 . The surgical device of  claim 24 , wherein said access cannula includes two cannulated portions, each of said two cooperating surgical instruments sized and configured to be housed within one of said cannulated portions.  
   
   
       26 . The surgical device of  claim 24 , further comprising a cannula-to-barrier interface, wherein said access cannula is rotatably connectable with the anatomic barrier through said cannula-to-barrier interface.  
   
   
       27 . The surgical device of  claim 24 , wherein said access cannula is provided with a seal member across said passageway, said seal member providing a seal between the intra-cavity and extra-cavity regions, and wherein, in use, said cooperating surgical instruments extend across said seal member.  
   
   
       28 . The surgical device of  claim 24 , wherein said cooperating surgical instruments include a heart manipulator and a heart stabilizer, said heart manipulator configured and sized to engage a first portion of the patient heart and position the heart within a thoracic cavity, and said heart stabilizer is configured and sized to locally immobilize a second portion of the patient heart.