Methods and devices to decrease tissue trauma during surgery

Abstract

Methods and devices are disclosed to reduce the tissue trauma that occurs when a physician retracts or otherwise deforms a patient's tissues for surgery or other medical procedures. In one part, methods and devices are disclosed for cooling the tissue around the incision. In another part, methods and devices are disclosed that elute drugs into the tissues of the tissue margin. In another part, methods and devices are disclosed to engage tissues during retraction to cushion, to sense tissue state, and to modulate tissue state.

What is claimed is: 
     
         1 . A device for delivering fluid to incised tissues surrounding a trocar, comprising:
 a hollow body configured to engage both the trocar and the incised tissues surrounding the trocar, the hollow body further comprising:   a fluid reservoir configured to contain at least one fluid;   a double-walled, hollow sleeve associated with the fluid reservoir, the double-walled, hollow sleeve further comprising:
 a first, inner wall adapted to engage the trocar, and 
 a second, outer, tissue-facing wall that is fluid-permeable and configured to engage the incised tissues surrounding the trocar; 
 a means configured to introduce the at least one fluid into the fluid reservoir; 
 a means configured to generate flow of the fluid from the second, outer, tissue-facing wall to the incised tissues surrounding the trocar. 
   
     
     
         2 . The device of  claim 1 , wherein the second, outer, tissue-facing comprises at least one perforation. 
     
     
         3 . The device of  claim 1 , wherein the means configured to introduce the fluid into the fluid reservoir comprises a self-sealing rubber membrane easily pierced by a hypodermic syringe. 
     
     
         4 . The device of  claim 1 , wherein the at least one fluid includes a first fluid and a second fluid, where the first fluid is a liquid substantially occupying the majority of the fluid reservoir and filling the double-walled, hollow sleeve, and where the second fluid is a gas. 
     
     
         5 . The device of  claim 4 , wherein the first fluid is physiological saline mixed with a pharmacological agent, and where the second fluid is air. 
     
     
         6 . The device of  claim 4 , wherein pressurization of the gas drives flow of the first liquid across the second, outer tissue-facing wall and into the incised tissues surrounding the trocar. 
     
     
         7 . The device of  claim 6 , wherein the gas is pressurized by a finger-actuated piston communicating with the fluid reservoir, wherein the pressure of the first fluid is controlled. 
     
     
         8 . The device of  claim 2 , wherein the at least one perforation is so small that transport from the fluid reservoir to the incised tissues surrounding the trocar is by diffusion. 
     
     
         9 . The device of  claim 1 , wherein the hollow body is substantially annular. 
     
     
         10 . The device of  claim 1 , wherein the device is formed as part of the trocar. 
     
     
         11 . The device of  claim 1 , wherein the device is configured to slide on to the trocar. 
     
     
         12 . The device of  claim 1 , wherein the second, outer tissue-facing wall comprises a membrane. 
     
     
         13 . The device of  claim 1 , wherein the second, outer tissue-facing wall is perforated with a frit fill. 
     
     
         14 . The device of  claim 1 , wherein the second, outer tissue-facing wall is nano-perforated. 
     
     
         15 . The device of  claim 1 , wherein the second, outer tissue-facing wall is controllably permeable. 
     
     
         16 . The device of  claim 15 , wherein the second, outer tissue-facing wall has a permeability that is controlled via direct pressure of the fluid. 
     
     
         17 . The device of  claim 15 , wherein the second, outer tissue-facing wall has a permeability that is controlled via pressure of a second working fluid, which may be a gas. 
     
     
         18 . The device of  claim 15 , wherein the device has a permeability that is electronically controllable. 
     
     
         19 . The device of  claim 15 , wherein the device has a permeability that may be electronically addressable in either time or space, or both time and space. 
     
     
         20 . The device of  claim 15 , wherein the device has a permeability that is differentially controllable. 
     
     
         21 . The device of  claim 1 , wherein more than one type of fluid is introduced into the reservoir.