Pursestring suture retractor and method of use

Abstract

Systems, devices, and methods for endoscopically retracting a target tissue. The device includes a first shaft and a second shaft slidably coupled thereto. An internal member extends in a transverse direction from the first shaft and is configured for advancement through a penetration in the target tissue to atraumatically engage a distal surface of the target tissue after being advanced therethrough. A pair of external members extend from the second shaft generally parallel to the transverse direction. The external members are spaced apart and are configured to atraumatically engage a proximal surface of the target tissue when the internal member is moved longitudinally relative to the external members. The internal member applies traction to the target tissue when retracted past the pair of external members, which apply counter-traction to the target tissue on opposing lateral sides of the internal member, to re-shape the target tissue and enable subsequent suture placement.

What is claimed is: 
     
         1 . An endoscopic tissue retraction device, comprising:
 a first shaft;   a second shaft slidably coupled to the first shaft and longitudinally movable relative thereto;   an internal member coupled to the first shaft so as to extend therefrom in a transverse direction, the internal member being configured for advancement through a penetration in a target tissue of a patient and having a proximally-facing surface configured to atraumatically engage a distal surface of the target tissue after being advanced therethrough; and   a pair of external members each coupled to the second shaft so as to extend therefrom generally parallel to the transverse direction, the external members being spaced apart and each having a distally-facing surface configured to atraumatically engage a proximal surface of the target tissue,   wherein the internal member is movable longitudinally relative to the external members between a distal position and a proximal position along a plane extending between the external members, the internal member being configured to apply traction to the target tissue when retracted from the distal position towards and past the pair of external members to the proximal position, and   wherein the pair of external members are configured to apply counter-traction to the target tissue on opposing lateral sides of the internal member, whereby the target tissue is re-shaped so as to have a pair of laterally facing surfaces each extending between the internal member and one of the external members.   
     
     
         2 . The device of  claim 1 , wherein the first shaft is rigid. 
     
     
         3 . The device of  claim 1 , wherein the second shaft is rigid. 
     
     
         4 . The device of  claim 1 , wherein the second shaft is configured to be inserted into a working channel of a surgical instrument, an endoscope, a mediastinoscope, or a suprasternal access device placed through an opening in the body of the body of the patient. 
     
     
         5 . The device of  claim 1 , wherein the first shaft is slidably disposed within at least a portion of the second shaft. 
     
     
         6 . The device of  claim 1 , wherein the target tissue is a wall of a heart of the patient. 
     
     
         7 . The device of  claim 6 , wherein the internal member is configured to apply traction to the target tissue while the heart is beating. 
     
     
         8 . The device of  claim 1 , wherein the internal member is configured to be movable from a longitudinal configuration to a transverse configuration, and wherein the internal member is configured to engage the distal surface of the target tissue when in the transverse configuration, and further comprising a rigid element coupled to the internal member and configured to apply force to the internal member to maintain the internal member in the longitudinal configuration when compressed, wherein tensioning of the rigid element moves the rigid elements at least a first distance and removes the force applied to the internal member to actuate the internal member from the longitudinal configuration to the transverse configuration, wherein the first distance is within a range of about 1 mm to about 20 mm. 
     
     
         9 . The device of  claim 1 , wherein the internal member is configured to be movable from a longitudinal configuration to a transverse configuration, and wherein the internal member is configured to engage the distal surface of the target tissue when in the transverse configuration, and further comprising a locking mechanism coupled to the internal member and configured to maintain the internal member in the longitudinal configuration, wherein disengaging the internal member from the locking mechanism actuates the internal member from the longitudinal configuration to the transverse configuration. 
     
     
         10 . The device of  claim 1 , wherein a distal tip of the internal member is tapered to sharpened to facilitate advancement through the target tissue. 
     
     
         11 . The device of  claim 1 , wherein the internal member comprises a guidewire lumen configured to slidably receive a guidewire therethrough. 
     
     
         12 . The device of  claim 11 , wherein the internal member comprises an elastomeric seal disposed within the guidewire lumen and configured to seal the target tissue and prevent fluid flow through the guidewire lumen. 
     
     
         13 . The device of  claim 1 , wherein the pair of external members are moveable from a longitudinal configuration to a transverse configuration, and wherein the pair of external members are configured to engage the proximal surface of the target tissue when in the transverse configuration. 
     
     
         14 . The device of  claim 13 , wherein the pair of external members are configured to be rotated from the longitudinal configuration to the transverse configuration. 
     
     
         15 . The device of  claim 14 , further comprising at least two rigid elements coupled to the pair of external members, respectively, and configured to apply force to the pair of external members to maintain the pair of external members in the longitudinal configuration when compressed, wherein tension of the at least two rigid elements moves the at least two rigid elements at least a first distance and removes the force applied to the pair of external members to actuate the pair of external members from the longitudinal configuration to the transverse configuration, wherein the first distance is within a range of about 1 mm to about 20 mm. 
     
     
         16 . The device of  claim 1 , wherein the first shaft comprises a suction lumen configured to remove blood or bodily fluids from the target tissue. 
     
     
         17 . A surgical system, comprising:
 the device of  claim 1 ;   one or more sutures; and   a curved needle coupled to the one or more sutures and configured to place the one or more sutures in the target tissue when the internal member applies traction to the target tissue.   
     
     
         18 . A surgical system, comprising:
 the device of  claim 1 ; and   a visualization device comprising a mediastinoscope, a camera coupled to a distal portion of the endoscopic tissue retraction device, an optical channel in the endoscopic tissue retraction device, or an endoscope.