Endoscope and method for vein removal

Abstract

An endoscope for use in harvesting blood vessels includes a scope body of the type having a lumen extending longitudinally therethrough which itself has a proximal and a distal end. The endoscope includes means for viewing an area adjacent the distal end of the lumen, and the lumen has a lateral dimension of a size sufficient to accommodate the blood vessel being harvested and at least one tool for use in harvesting the blood vessel. A first end of the blood vessel section to be harvested is exposed through an incision in the patient's body. A dissecting tool and a gripping tool are inserted through the lumen of the endoscope and used to dissect the blood vessel away from the surrounding connective tissue of the patient's body, using the viewing means of the endoscope to view this dissection in process within the patient's body. Additional tools are provided for use through the lumen of the endoscope to remove body fluids and coagulate bleeding tissue, and to sever side branches from the blood vessel to be harvested, as well as to sever a distal end of the blood vessel to be harvested when a desired length of blood vessel has been dissected. Only a single small incision in the patient's body is necessary to harvest a relatively long length of blood vessel in a precise and controlled manner through endoscopic vision using the inventive endoscope and its related tools. .Iadd.The questions raised in reexamination request No. 90/004,301, filed Jul. 12, 1996, have been considered and the results thereof are reflected in this reissue patent which constitutes the reexamination certificate required by 35 U.S.C. 307 as provided in 37 CFR 1.570(e). .Iaddend.

What is claimed: 
     
       1. A method of harvesting a section of a vessel from a patient's body as living tissue for use in a different environment of the patient's body comprising: providing an endoscope of the type having a scope body with a lumen extending longitudinally therethrough, with the lumen having a proximal end and a distal end, and means for viewing an area adjacent the distal end of the lumen, the lumen having a lateral dimension of size sufficient to accommodate the vessel and a tool for use in harvesting the vessel;   exposing a first end of the vessel section to be harvested through an incision in the patient's body;   gripping the first end with a gripping tool that has been inserted through the lumen of the endoscope; and   dissecting the vessel away from surrounding connective tissue of the patient's body with a dissecting tool inserted through the lumen of the endoscope, using the viewing means to view the dissection in process.Iadd.;   cutting the vessel at proximal and distal ends of the vessel section; and   removing the vessel section from the patient's body, the steps of exposing, gripping, dissecting, cutting and removing being performed in a manner that minimizes damage to the endothelium of the vessel.Iaddend..   
     
     
       2. The method of harvesting a vessel according to claim 1, including: advancing the endoscope and the dissecting tool along the vessel until a side branch of the vessel is encountered.   
     
     
       3. The method of harvesting a vessel according to claim 2, including: applying a ligation member to the branch and cutting the branch between the vessel and the ligation member with a ligating-cutting tool inserted through the lumen.   
     
     
       4. The method of harvesting a vessel according to claim 3, including: repeating the advancing and applying steps until the endoscope is fully inserted or a desired length of the vessel is reached.   
     
     
       5. The method of harvesting a vessel according to claim 1, including: controlling bleeding as necessary with a bleeding control tool inserted through the lumen.   
     
     
       6. The method of harvesting a vessel according to claim 1, including: ligating and cutting the distal end of the vessel with a transecting tool inserted through the lumen, allowing a segment of the vessel to be removed without making a second incision in the patient's body.   
     
     
       7. The method of harvesting a vessel according to claim 1, including: making a second incision in the patient's body spaced from the first incision;   exposing that portion of the vessel which has been dissected from surrounding tissue of the patient's body through the second incision in the patient's body;   gripping the exposed portion of the vessel which has been dissected and that has been inserted through the lumen of the endoscope;   advancing the endoscope over the vessel and into the patient's body through the second incision; and   continuing to dissect the vessel away from surrounding connective tissue of the patient's body with a dissecting tool inserted through the lumen of the endoscope, using the viewing means to view the continued dissection in process.   
     
     
       8. A method of removing a section of a vessel from a patient's body for use in a different environment comprising: providing an endoscope of the type having a scope body with a lumen extending longitudinally therethrough, with the lumen having a proximal end and a distal end, and means for viewing an area adjacent to the distal end of the lumen, the lumen having a lateral dimension of size sufficient to accommodate that section of the vessel which is being removed and a tool for use in removing the section of the vessel;   exposing a portion of the section of the vessel to be removed through an incision in the patient's body;   gripping the exposed portion with a gripping tool that has been inserted through the lumen of the endoscope; and   dissecting the section of the vessel which is being removed from the patient's body with a dissecting tool also inserted through the lumen of the endoscope, using the viewing means to view the dissection process.Iadd.;   cutting the vessel at proximal and distal ends of the vessel section; and   removing the vessel section from the patient's body, the steps of exposing, gripping, dissecting, cutting and removing being performed in a manner that minimizes damage to the endothelium of the vessel.Iaddend..   
     
     
       9. The method of removing a section of a vessel according to claim 8, and further including: removing the section of the vessel through the lumen of the endoscope.   
     
     
       10. The method of removing a section of a vessel according to claim 8, and further including: advancing the endoscope and the dissecting tool along the vessel until a branch of the vessel is encountered.   
     
     
       11. The method of removing a section of a vessel according to claim 10, and further including: applying a ligation member to the vessel branch and cutting the branch with a ligating-cutting tool inserted through the lumen.   
     
     
       12. The method of removing a section of a vessel according to claim 11, and further including: repeating the advancing and applying steps until the endoscope is fully inserted or the desired amount of the vessel is dissected.   
     
     
       13. The method of removing a section of a vessel according to claim 8, and further including: controlling bleeding as necessary with a bleeding control tool inserted through the lumen. .Iadd.   
     
     
       14.  The method of claim 1 further comprising re-using the vessel section as a fluid conduit in another part of the patient's body. .Iaddend..Iadd.15. The method of claim 8 further comprising re-using the vessel section as a fluid conduit in a human body. .Iaddend..Iadd.16. A method of harvesting a section of a vessel from a patient's body for use in a different environment comprising: making an incision over a first end of the vessel section to be harvested, the length of the incision being sufficient to accommodate at least one tool used in harvesting the vessel section but being substantially smaller than the length of the vessel section;   exposing the first end of the vessel section through the incision;   dissecting the vessel away from surrounding tissue of the patient's body until a desired length of vessel which exceeds the length of the incision has been dissected free from surrounding tissue;   severing the vessel at proximal and distal ends of the vessel section with at least one tool inserted through the incision; and   removing the vessel section through the incision, the steps of making an incision, exposing, dissecting, severing, and removing being performed in a manner that minimizes damage to the endothelium of the vessel. .Iaddend..Iadd.17. The method of harvesting a vessel according to claim 16, including:   applying a ligation member to the vessel in a position distal to the distal end of the vessel section. .Iaddend..Iadd.18. The method of harvesting a vessel according to claim 16, including;   controlling bleeding as necessary. .Iaddend..Iadd.19. The method of harvesting a vessel according to claim 16, including:   applying a ligation member to a side branch of the vessel; and   severing the side branch of the vessel between the ligation member and the   
     
     
        vessel. .Iaddend..Iadd.20.  The method of claim 16 further comprising re-using the vessel section as a fluid conduit in a human body. .Iaddend..Iadd.21. The method of claim 16 further comprising re-using the vessel section as a fluid conduit in another part of the patient's body. .Iaddend..Iadd.22. A method of harvesting a section of a vessel from a patient's body for use in a different environment comprising: making an incision in the patient's body over a first end of the vessel section to be harvested, the length of the incision being sufficient to accommodate at least one tool used in harvesting the vessel section but being substantially smaller than the length of the vessel section;   exposing the first end of the vessel section to be harvested through the incision in the patient's body;   dissecting the vessel away from surrounding tissue of the patient's body; and   viewing the dissection of the vessel with a viewing device inserted through the incision;   severing the vessel at proximal and distal ends of the vessel section; and   removing the vessel section from the patient's body, the steps of making an incision, exposing, dissecting, viewing, severing and removing being performed in a manner that minimizes damage to the endothelium of the vessel. .Iaddend..Iadd.23. The method of harvesting a vessel according to claim 22, including:   applying a ligation member to a side branch of the vessel; and   severing the side branch between the vessel and the ligation member. .Iaddend..Iadd.24. The method of harvesting a vessel according to claim 23, including;   repeating the dissecting step until a desired length of the vessel section has been dissected. .Iaddend..Iadd.25. The method of harvesting a vessel according to claim 24, including:   severing the distal end of the vessel section; and   removing the vessel section through the incision. .Iaddend..Iadd.26. The method of harvesting a vessel according to claim 22, including;   repeating the dissecting step until a desired length of the vessel section   
     
     
        has been dissected. .Iaddend..Iadd.27.  The method of harvesting a vessel according to claim 26, including: severing the distal end of the vessel section; and   removing the vessel section through the incision. .Iaddend..Iadd.28. The method of harvesting a vessel according to claim 22, including:   controlling bleeding as necessary. .Iaddend..Iadd.29. The method of claim 20 further comprising re-using the vessel section as a fluid conduit in a human body. .Iaddend..Iadd.30. The method of claim 22 further comprising re-using the vessel section as a fluid conduit in another part of the patient's body. .Iaddend..Iadd.31. A method of harvesting a section of a vessel from a patient's body for use in a different environment comprising:   providing a device having an elongated body, the body having a lumen extending longitudinally therethrough, the lumen having a proximal end and a distal end and having a lateral dimension of size sufficient to accommodate the vessel and a tool for use in harvesting the vessel;   exposing a first end of the vessel section to be harvested through an incision in the patient's body;   gripping the first end with a gripping tool that has been inserted through the lumen of the elongated body;   dissecting the vessel away from surrounding tissue of the patient's body with a dissecting tool inserted through the incision; and   viewing the dissection of the vessel from an area adjacent the distal end of the lumen of the elongated body;   severing the vessel at proximal and distal ends of the vessel section; and   removing the vessel section from the patient's body, the steps of exposing, gripping, dissecting, viewing, severing and removing being performed in a manner that minimizes damage to the endothelium of the vessel. .Iaddend..Iadd.32. The method of harvesting a vessel according to claim 31, including:   advancing the elongated body and the dissecting tool along the vessel until   
     
     
        a side branch of the vessel is encountered. .Iaddend..Iadd.33.  The method of harvesting a vessel according to claim 32, including: applying a ligation member to the branch and cutting the branch between the vessel and the ligation member with a ligating-cutting tool inserted through the lumen. .Iaddend..Iadd.34. The method of harvesting a vessel according to claim 33, including:   repeating the advancing and applying steps until the elongated body is fully inserted or a desired length of the vessel is reached. .Iaddend..Iadd.35. The method of harvesting a vessel according to claim 31, including:   controlling bleeding as necessary with a bleeding control tube inserted through the lumen. .Iaddend..Iadd.36. The method of harvesting a vessel according to claim 31, including:   ligating and cutting the distal end of the vessel with a transecting tool inserted through the lumen, allowing the vessel section to be removed without making a second incision in the patient's body. .Iaddend..Iadd.37. The method of harvesting a vessel according to claim 31, including:   making a second incision in the patient's body spaced from the first incision;   exposing that portion of the vessel which has been dissected from surrounding tissue of the patient's body through the second incision in the patient's body;   gripping the exposed portion of the vessel which has been dissected with a gripping tool that has been inserted through the lumen of the elongated body;   advancing the elongated body over the vessel and into the patient's body through the second incision; and   continuing to dissect the vessel away from surrounding tissue of the patient's body with a dissecting tool inserted through the second   
     
     
        incision. .Iaddend..Iadd.38.  The method of claim 31 further comprising re-using the vessel section as a fluid conduit in a human body. .Iaddend..Iadd.39. The method of claim 3 further comprising re-using the vessel section as a fluid conduit in another part of the patient's body. .Iaddend..Iadd.40. A method of harvesting a section of a vessel from a patient's body for use in a different environment comprising: making an incision over a first end of the vessel section to be harvested, the length of the incision being sufficient to accommodate at least one tool used in harvesting the vessel section but being substantially smaller than the length of the vessel section;   exposing the first end of the vessel section through the incision;   dissecting the vessel away from surrounding tissue of the patient's body with a dissecting tool inserted through the incision until a desired length of vessel which exceeds the length of the incision has been dissected free from surrounding tissue;   viewing the dissection of the vessel with a viewing device inserted through the incision;   severing the vessel at proximal and distal ends of the vessel; and   removing the vessel section from the patient's body, the steps of making an incision, exposing, dissecting, viewing, severing, and removing being performed in a manner that minimizes damage to the endothelium of the vessel. .Iaddend..Iadd.41. The method of claim 40 further comprising re-using the vessel section as a fluid conduit in a human body. .Iaddend..Iadd.42. The method of claim 40 further comprising re-using the vessel section as a fluid conduit in another part of the patient's body. .Iaddend..Iadd.43. The method of harvesting a vessel according to claim 40, including:   applying a ligation member to the vessel in a position distal to the distal end of the vessel section. .Iaddend..Iadd.44. The method of harvesting a vessel according to claim 40, including;   controlling bleeding as necessary. .Iaddend..Iadd.45. The method of harvesting a vessel according to claim 40, including:   litigating a branch of the vessel; and   severing the branch of the vessel between the ligation and the vessel.   
     
     
        .Iaddend..Iadd.46.  The method of harvesting a vessel according to claim 40 including maintaining the lumen of the vessel clear of any tools and other objects used in the harvesting procedure. .Iaddend..Iadd.47. The method of harvesting a vessel according to claim 40 including making a second incision in the patient's body spaced from the first incision, the second incision being substantially smaller than the length of the vessel section, and wherein the vessel section is removed through the second 
     
     
        incision. .Iaddend..Iadd.48.  A method of harvesting a section of a vessel from a patient's body for use in a different environment comprising: making an incision over a first end of the vessel section to be harvested, the length of the incision being sufficient to accommodate at least one tool used in harvesting the vessel section but being substantially smaller than the length of the vessel section;   exposing the first end of the vessel section through the incision;   dissecting the vessel away from surrounding tissue of the patient's body until a desired length of vessel which exceeds the length of the incision has been dissected free from surrounding tissue;   severing the vessel at proximal and distal ends of the vessel section with at least one tool inserted through the incision;   removing the vessel section through the incision; and   re-using the vessel section as a fluid conduit in a human body.   
     
     
        .Iaddend..Iadd.49.  A method of harvesting a section of a vessel from a patient's body for use in a different environment comprising: making an incision in the patient's body over a first end of the vessel section to be harvested, the length of the incision being sufficient to accommodate at least one tool used in harvesting the vessel section but being substantially smaller than the length of the vessel section;   exposing the first end of the vessel section to be harvested through the incision in the patient's body;   dissecting the vessel away from surrounding tissue of the patient's body; and   viewing the dissection of the vessel with a viewing device inserted through the incision;   severing the vessel at proximal and distal ends of the vessel section;   removing the vessel section from the patient's body; and   re-using the vessel section as a fluid conduit in a human body. .Iaddend..Iadd.50. A method of harvesting a section of a vessel from a patient's body for use in a different environment comprising:   providing a device having an elongated body, the body having a lumen extending longitudinally therethrough, the lumen having a proximal end and a distal end and having a lateral dimension of size sufficient to accommodate the vessel and a tool for use in harvesting the vessel;   exposing a first end of the vessel section to be harvested through an incision in the patient's body;   gripping the first end with a gripping tool that has been inserted through the lumen of the elongated body;   dissecting the vessel away from surrounding tissue of the patient's body with a dissecting tool inserted through the incision; and   viewing the dissection of the vessel from an area adjacent the distal end of the lumen of the elongated body;   severing the vessel at proximal and distal ends of the vessel section;   removing the vessel section from the patient's body; and   re-using the vessel section as a fluid conduit in a human body.   
     
     
        .Iaddend..Iadd.51.  A method of harvesting a section of a vessel from a patient's body for use in a different environment comprising: making an incision over a first end of the vessel section to be harvested, the length of the incision being sufficient to accommodate at least one tool used in harvesting the vessel section but being substantially smaller than the length of the vessel section;   exposing the first end of the vessel section through the incision;   dissecting the vessel away from surrounding tissue of the patient's body with a dissecting tool inserted through the incision until a desired length of vessel which exceeds the length of the incision has been dissected free from surrounding tissue;   viewing the dissection of the vessel with a viewing device inserted through the incision;   severing the vessel at proximal and distal ends of the vessel;   removing the vessel section from the patient's body; and   re-using the vessel section as a fluid conduit in a human body.   
     
     
        .Iaddend..Iadd.52.  A method of re-using a section of a vessel from a patient's body in the patient's body comprising: making an incision over a first end of the vessel section, the length of the incision being sufficient to accommodate at least one tool used in the method but being substantially smaller than the length of the vessel section;   exposing the first end of the vessel section through the incision;   dissecting the vessel away from surrounding tissue of the patient's body with a tool inserted through the incision until a desired length of vessel which exceeds the length of the incision has been dissected free from surrounding tissue;   severing the first end of the vessel section with a tool inserted through the incision; and   re-using the vessel section as a fluid conduit in the patient's body. .Iaddend.