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 having a distal end structure operative to engage the target anatomical structure, the distal end structure adapted to extend beyond said second end to perform a surgical intervention on the target anatomic structure and the passageway is sized and configured to allow retraction of the distal end structure within said passageway before and after the surgical intervention; and   an internal joint, said internal joint being contained generally within said passageway and coupled to said access cannula, 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 said access cannula is adapted to traverse said anatomic barrier and communicate 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 said first open end is adapted to be adjacent the point of insertion and said second open end is adapted to be adjacent the anatomic barrier to provide said passageway between the point of entry and the anatomic barrier, said surgical instrument adapted to extend extracorporeally beyond said first open end when said surgical instrument is coupled to said internal joint, said surgical instrument adapted to be 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 adapted to provide 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 for introduction 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 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, each of said surgical instruments having a distal end structure operative to engage the target anatomic structure, each of the distal end structures adapted to extend beyond said second end to perform a surgical intervention on the target anatomic structure and the passageway is sized and configured to allow retraction of the distal end structures within said passageway before and after the surgical intervention; and   an internal joint, said internal joint being contained generally within said passageway and coupled to said access cannula, 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 at least one coupled surgical instrument relative to said access cannula when said at least one surgical instrument is coupled thereto;   wherein, in use, said access cannula is adapted to traverse said anatomic barrier and communicate 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.   
     
     
         19 . The surgical device of  claim 18 , 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. 
     
     
         20 . The surgical device of  claim 18 , further comprising a cannula-to-barrier interface, wherein said access cannula is rotatably connectable with the anatomic barrier through said cannula-to-barrier interface. 
     
     
         21 . The surgical device of  claim 18 , wherein said access cannula is provided with a seal member across said passageway, said seal member adapted to provide a seal between the intra-cavity and extra-cavity regions, and wherein, in use, said cooperating surgical instruments extend across said seal member. 
     
     
         22 . The surgical device of  claim 18 , 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. 
     
     
         23 . 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 extending between said first and second open ends, said access cannula configured and sized to displace and maintain body tissue laterally away from said passageway, said passageway configured and sized to receive therein a first and a second surgical instrument each having a distal end structure operative to engage the target anatomical structure, each of the distal end structures adapted to extend beyond said second end to perform a surgical intervention on the target anatomic structure and the passageway is sized and configured to allow retraction of each of the distal end structures within said passageway before and after the surgical intervention;   a first internal joint, said first internal joint being contained generally within said passageway and coupled to said access cannula, said first internal joint configured to couple with a portion of said first surgical instrument and provide at least one motion degree of freedom of said first surgical instrument relative to said access cannula when said first surgical instrument is coupled thereto;   a second internal joint, said second internal joint being contained generally within said passageway and coupled to said access cannula, said second internal joint configured to couple with a portion of said second surgical instrument and provide at least one motion degree of freedom of said second surgical instrument relative to said access cannula when said second surgical instrument is coupled thereto; and   wherein said access cannula is adapted to traverse said anatomic barrier and communicate said extra-cavity region with said intra-cavity region thereby allowing said first and second surgical instruments to cooperate and perform said surgical intervention on the target anatomic structure while said surgical instruments is are coupled to said first and second internal joints, respectively.