Minimally invasive methods and apparatus for target-tissue excision

Abstract

Methods and apparatus are provided to facilitate the minimally invasive removal of tissue and to facilitate the direct approach to anesthetizing a body wall of a patient. A pull-type cutting device also is disclosed to introduce an opening into the body wall to provide access for intra-chest surgical interventions, for example a minimally invasive biopsy technique as also described for excising target tissue from within a patient, including a nodule from within the patient's lung.

1 - 11 . (canceled) 
     
     
         12 . A method of excising a nodule within a lung of a patient, comprising anchoring a catch wire from the nodule, tensioning the catch wire through a tissue tract extending between the nodule and an opening in a body wall, dilating the tissue tract via inflation of a dilation catheter within said tract that extends through a pleura surrounding the lung and into the lung up to the nodule, and advancing an excision device along the catch wire to excise the target tissue against a counterforce applied by tensioning the catch wire. 
     
     
         13 . The method of  claim 12 , the dilation catheter being inserted into the tissue tract over and along the catch wire and advanced toward the nodule against a counterforce supplied by tensioning the catch wire. 
     
     
         14 . The method of  claim 13 , the excision device comprising a hollow sleeve having a circumferential cutting edge, and advancing the excision device until the nodule is disposed within the excision device, and thereafter withdrawing the excision device. 
     
     
         15 . The method of  claim 14 , further comprising simultaneously withdrawing the catch wire and the excision device until they emerge from the opening in the body wall, the catch wire being anchored from the nodule via a tissue anchor engaged against the nodule at a side opposite the body-wall opening. 
     
     
         16 . The method of  claim 13 , further comprising, after the tissue tract is dilated, inserting a fixed-diameter sleeve over the inflated dilation catheter to provide a fixed-diameter passageway along the tissue tract, thereafter deflating and withdrawing the inflation catheter from the tissue tract, and thereafter inserting therein an excision device up to the nodule, the excision device comprising a hollow sleeve having a circumferential cutting edge, and advancing the excision device until the nodule is disposed within the excision device. 
     
     
         17 . A method of excising target tissue, comprising:
 tensioning a catch wire from a proximal end thereof located adjacent a target tissue within a patient;   dilating a tissue tract between a body wall of the patient and the target tissue via inflation of a dilation catheter extending therebetween;   inserting an excision device through the dilated tissue tract and over the inflated dilation catheter; and   advancing the excision device along the catch wire and toward the target tissue against a counterforce applied by tensioning the catch wire, thereby making a slice in tissue surrounding the target tissue via a cutting edge of the excision device and advancing the excision device over the target tissue through the slice until the target tissue is located within the excision device.   
     
     
         18 . The method of  claim 17 , further comprising withdrawing the tissue anchor, the excision device and the dilation catheter in tandem until the target tissue arrives outside a body of the patient. 
     
     
         19 . A method of excising target tissue, comprising:
 tensioning a catch wire from a proximal end thereof located adjacent a target tissue within a patient;   dilating a tissue tract between a body wall of the patient and the target tissue via inflation of a dilation catheter extending therebetween;   inserting an excision device through the dilated tissue tract via a channel at the center of the inflated dilation catheter; and   advancing the excision device along the catch wire toward the target tissue against a counterforce applied by tensioning the catch wire, thereby making a slice in tissue surrounding the target tissue via a cutting edge of the excision device and advancing the excision device over the target tissue through the slice until the target tissue is located within the excision device.   
     
     
         20 . The method of  claim 12 , further comprising inserting the excision device over the inflated dilation catheter and advancing the excision device toward the target tissue against the counterforce, making a slice in tissue surrounding the target tissue via a cutting edge of the excision device and advancing the excision device over the target tissue through the slice until the target tissue is located within the excision device. 
     
     
         21 . The method of  claim 19 , further comprising withdrawing the tissue anchor, the excision device and the dilation catheter in tandem until the target tissue arrives outside a body of the patient. 
     
     
         22 . The method of  claim 12 , further comprising inserting the excision device through a channel at the center of the inflated dilation catheter and advancing the excision device toward the target tissue against the counterforce, making a slice in tissue surrounding the target tissue via a cutting edge of the excision device and advancing the excision device over the target tissue through the slice until the target tissue is located within the excision device. 
     
     
         23 - 37 . (canceled) 
     
     
         38 . An apparatus configured to excise target tissue, the apparatus comprising:
 a catch wire tensionable from a proximal end thereof from a target tissue within a patient;   a dilation catheter configured to be inflatable to dilate a tissue tract between a chest wall of the patient and the target tissue;   an excision device configured such that in use it can be advanced along the catch wire and over the inflated dilation catheter against a counterforce applied by tensioning the catch wire, to make a slice in tissue surrounding the target tissue via a cutting edge of the excision device, and to advance over the target tissue through the slice until the target tissue is located within the excision device.