Vessel Harvesting

Abstract

Apparatus and method for harvesting selected vessels in the body of a patient include manual manipulation of a rigid dissecting endoscope and the reconfiguration thereof to facilitate tissue dissection and tissue dilation in the formation of an anatomical space about the vessel within which side-branch vessels may be manipulated in preparation for severance and removal of the vessel from the anatomical space.

1 . Apparatus for selective positioning over a portion of the length of an endoscope for selectively performing tissue manipulation in the body of a patient, the apparatus comprising:
 an elongated cannula having distal and proximal ends and having an inner bore therebetween of diameter sized to slidably and rotatably receive an endoscope therein;   a surgical effector device disposed near the distal end of the cannula for rotation with the cannula about an endoscope received therein and disposed for selective movement relative to the distal end of the cannula; and   a control member supported by the cannula near the proximal end thereof and linked to the surgical effector device for selective actuation thereof to manipulate tissue near the distal end of the cannula within a field of view of an endoscope disposed therein in response to manual actuation of the control member.   
   
   
       2 . Apparatus as in  claim 1  including a handle structure attached to the cannula near the proximal end thereof and supporting the control member thereon for movement relative to the cannula and handle structure linked through the cannula to the surgical effector device. 
   
   
       3 . Apparatus as in  claim 2  in which the handle structure is substantially aligned with the cannula in eccentric spaced orientation thereto. 
   
   
       4 . Apparatus as in  claim 1  including a vessel retractor as the surgical effector device supported by the cannula for slidable deployment and retraction relative to the distal end of the cannula in response to actuation of the control member supported on the handle structure and linked through the cannula to the vessel retractor. 
   
   
       5 . Apparatus as in  claim 4  in which the vessel retractor is mounted for movement relative to the distal end of the cannula for displacing a tissue structure laterally relative to the elongated cannula in response to actuation of the control member. 
   
   
       6 . Apparatus as in  claim 5  in which the vessel retractor includes a vessel-confining structure disposed forward of the distal end of the cannula for retaining a vessel as a tissue structure during lateral displacement thereof in response to manual manipulation of the control member linked to the vessel retractor. 
   
   
       7 . Apparatus as in  claim 5  in which the vessel-confining structure of the vessel retractor includes a generally inverted C-shaped recess disposed between a pair of axially-extending supports. 
   
   
       8 . Apparatus as in  claim 7  in which the inverted C-shaped recess is substantially aligned with the elongated cannula and is configured to overlay a distal end of an endoscope disposed within the cannula. 
   
   
       9 . Apparatus as in  claim 7  in which the pair of axially-extending supports for the vessel retractor are substantially parallel aligned within the cannula and are resiliently biased laterally away from alignment with the elongated cannula for laterally displacing the vessel retractor in response to axial extension thereof distally of the distal end of the cannula. 
   
   
       10 . Apparatus as in  claim 9  in which a proximal edge of the vessel retractor between the pair of supports includes a substantially V-shaped recess. 
   
   
       11 . Apparatus as in  claim 9  in which each of the pair of supports includes an inward recess located at adjacent positions along the supports near the vessel retractor. 
   
   
       12 . Apparatus as in  claim 9  in which one of the pair of supports is configured as a tube for passing a fluid therethrough to the distal end of the cannula. 
   
   
       13 . Apparatus as in  claim 8  in which one of the pair of supports is configured as a tube having a distal opening oriented toward a distal end of an endoscope disposed within the cannula. 
   
   
       14 . Apparatus according to  claim 1  comprising:
 a plurality of surgical effector devices supported by the cannula near the distal end thereof, each for different manipulations of tissue;   a plurality of control members supported by the cannula near the proximal end thereof, each linked to a respective one of the plurality of surgical effector devices for selective actuation thereof to manipulate tissue differently near the distal end of the cannula in response to manual actuation of the respective control member.   
   
   
       15 . Apparatus as in  claim 14  in which one of the surgical effector devices includes a cutting device capable of cutting tissue near the distal end of the cannula in response to manual actuation of the control member near the proximal end of the cannula; and
 another of the surgical effector devices includes a vessel retractor configured to engage a vessel for the displacement thereof laterally relative to the distal end of the cannula in operable position slidably extended forward of the distal end of the cannula.   
   
   
       16 . Apparatus as in  claim 15  in which the retractor is deployed with the cutting device to displace a vessel laterally relative to the distal end of the cannula in the operable positions of the retractor and cutting device forward of the distal end of the cannula. 
   
   
       17 . A method of dissecting a vessel within the body of a patient using an endoscope with an overlying cannula supporting a surgical effector device, the method comprising:
 forming an incision to expose the vessel;   advancing the cannula through the incision and along the course of the vessel to bluntly dissect tissue therefrom for forming an anatomical space about the vessel and exposing side-branch vessels thereof under visualization through an endoscope disposed within the cannula;   manipulating with the surgical effector device supported by the cannula any side-branch vessels exposed within the anatomical space along the course of the vessel under visualization through the endoscope; and   severing the vessel for use as a bypass conduit.   
   
   
       18 . The method according to  claim 17  including deploying from the distal end of the overlying cannula a vessel retractor as the surgical effector device for selectively laterally displacing the vessel during severing of side branches therefrom under visualization through the endoscope. 
   
   
       19 . The method according to  claim 17  including selectively rotating the overlying cannula about the endoscope to position the surgical effortor device for severing side-branch vessels under visualization within the field of view of the endoscope. 
   
   
       20 . A kit of surgical apparatus for performing surgical procedures, the kit comprising:
 an elongated cannula having a bore therethrough between distal and proximal ends thereof for slidably and rotatably receiving an endoscope therein, the cannula supporting a number of surgical utilization devices including a vessel retractor near the distal end of the cannula for selective manipulation in response to a corresponding number of control means supported near the proximal end of the cannula and linked to corresponding surgical utilization devices; and,   a container enclosing the cannula to form an hermetic seal thereabout and maintain a sterile environment therein about the cannula.