Methods and apparatus for transesophageal microaccess surgery

Abstract

The current invention describes methods of transesophageal access to the neck and thorax to perform surgical interventions on structures outside the esophagus in both the cervical and the thoracic cavity. It describes a liner device made of a complete or partial tubular structure, or a flat plate, the liner having means to facilitate creation of a side opening, which may include a valve. The liner with its side opening form a port structure inside the esophageal lumen. The port structure allows elongated surgical devices to pass through a perforation across the full thickness of the esophageal wall to outside location, in a controlled way. The elongated surgical devices can be diagnostic scopes, therapeutic scopes, manual elongated surgical devices, robotic arms or the like. After being deployed outside the esophagus, the surgical devices can access structures outside the esophagus, in the neck and thorax in 360 degrees of freedom around the esophageal circumference. These structures can be bony, cartilaginous, spinal, vascular, soft tissue, deep tissues, lymph nodal, cardiac, pulmonary, tracheal, nervous, muscular or diaphragmatic, skin and subcutaneous tissues of the neck, skin and subcutaneous tissues of the anterior chest wall, skin and subcutaneous tissues of the skin of the back, and skin and layers of the breast.

1 - 41 . (canceled) 
     
     
         42 . A liner for isolating esophageal lumen tissue from contact with fluids, the liner comprising:
 a first open end;   a second distal end;   a longitudinal wall between the first open end and the second distal end, wherein at least a portion of the longitudinal wall is configured to be applied to the esophageal tissue to attach to the tissue on an inside the esophageal lumen; and   an opening portion in the at least the portion of the longitudinal wall constructed and arranged to:
 pass a distal portion of a surgical device through the at least the portion of the longitudinal wall and through the esophageal tissue, and 
 maintain a fluid impermeable seal of the opening in esophageal lumen. 
   
     
     
         43 . The liner according to  claim 42 , wherein the opening portion is configured for penetration to create a complete or partial opening, and wherein the opening portion preserves sterility and enables surgical devices to go through the liner and the esophageal wall at the opening portion after the liner and the esophageal wall have been penetrated to create an opening at the opening portion. 
     
     
         44 . The liner according to  claim 42 , wherein the liner is a barrier and the opening portion comprises a complete opening in the longitudinal wall to allow surgical devices to go through the liner and the esophageal wall to enable operations on a target outside the esophageal wall. 
     
     
         45 . The liner according to  claim 44 , where the liner has a pre-formed location for creation of a hole to allow for passage through the liner. 
     
     
         46 . The liner according to  claim 45 , wherein a valve communicates with the hole, wherein the valve mechanism can be operated during a procedure affecting at least one of the esophageal tissue, and other tissue accessible through the hole. 
     
     
         47 . The liner according to  claim 42 , wherein liner has a closed second end. 
     
     
         48 . The liner according to  claim 42 , wherein the liner is affixed to the esophageal tissue by at least one attachment device. 
     
     
         49 . The liner according to  claim 48 , wherein the attachment device comprises at least one of a vacuum seal, a mechanical seal, an inflation balloon, a weld, a suture, an adhesives, and mechanical devices. 
     
     
         50 . The liner according to  claim 42 , wherein the first open end, the second distal end and the longitudinal wall comprise at least a portion of a tubular structure. 
     
     
         51 . The liner according to  claim 42 , further comprising a side opening mechanism disposed in the longitudinal wall. 
     
     
         52 . The liner according to  claim 42 , further comprising an attachment component configured to mate with a deployment device, in which the deployment device is configured to pass through a patient's mouth and advance to at least the distal esophagus, and wherein the attachment component is configured to release a connection between the attachment component and the deployment device once the liner is positioned. 
     
     
         53 . The liner according to  claim 42 , wherein the liner is a barrier and comprises a complete or partial opening to allow devices to go through the esophageal wall to a target outside the esophageal wall after the liner and the esophageal wall have been penetrated to create an opening. 
     
     
         54 . The liner according to  claim 42 , wherein the material of the liner is constructed and arranged to be degradable in vivo, and wherein the liner is configured to remain in place post surgical procedure and during a recovery period. 
     
     
         55 . The liner according to  claim 42 , wherein the liner includes at least a first layer and a second layer. 
     
     
         56 . The liner according to  claim 55 , wherein either one or both of the first layer and the second layer include an opening, wherein the liner in constructed and arranged such that the opening in either one or both of the first layer and the second layer is covered by the other layer. 
     
     
         57 . The liner according to  claim 55 , wherein the first layer and the second layer are moveable at least in part with respect to each other to provide access to an opening through the liner. 
     
     
         58 . The liner according to  claim 55 , wherein the first and second layer include an opening through their respective layer, wherein the first and second layers are configurable in a closed position wherein the openings are covered by the first and second layers, and an open position where the openings are aligned to enable a surgical device to pass through the liner and the esophageal wall. 
     
     
         59 . The liner according to  claim 42 , wherein the liner isolates a partial or full perforation in the wall of the esophagus, wherein the isolation of the perforated portion of the wall prevents contamination of the perforation site by covering it, and wherein the liner device is one of a generally planar device and a device that is fully or partially tubular. 
     
     
         60 . The liner of  claim 59 , wherein the liner further comprises a sheath extending from the first open end to a mouth of the patient. 
     
     
         61 . The liner of  claim 42 , wherein the liner in configured for pre-placement at a tissue site in the esophagus before perforation of the esophagus. 
     
     
         62 . The liner of  claim 42 , wherein the liner is configured to permit fluid flow through the esophagus while maintaining isolation of any esophageal opening. 
     
     
         63 . The liner of  claim 62 , wherein the liner is further configured to maintain isolation of any esophageal opening until healing of the opening in the esophageal tissue prevents infection post surgical procedure.