Surgical apparatus and method for performing transabdominal cardiac surgery

Abstract

The invention provides a surgical apparatus and method for performing less-invasive, closed chest cardiac surgery through a transabdominal approach, without cardiopulmonary bypass. In a preferred embodiment, the invention provides a heart manipulator and a coronary stabilizer which are deployed through an access cannula and secured relative to a stationary support through a surgical arm. Heart manipulator and coronary stabilizer cooperate together to enable access to all the coronary artery territories of the heart through a single access cannula. Also provided is a diaphragm tissue retractor.

Description

[0001] This application is a continuation of application Ser. No. 10 / 243,764, filed Sep. 16, 2002 (pending), which is a continuation of application Ser. No. 09 / 488,557, filed Jan. 21, 2000 (now U.S. Pat. No. 6,478,028), the disclosures of which are hereby incorporated by reference herein.FIELD OF THE INVENTION [0002] The present invention relates generally to a surgical apparatus and method for performing less-invasive surgical procedures, and more specifically, to a surgical apparatus and method for performing a surgical procedure on the beating heart, such as stabilizing a portion of a beating heart during a coronary artery revascularization, wherein said surgical procedure is performed through a percutaneous transabdominal approach. BACKGROUND OF THE INVENTION [0003] Cardiac surgery, and more specifically traditional coronary artery bypass graft (CABG) surgery, has been performed since the 1970's on a regular basis with the advent of the cardiopulmonary machine. In traditional CA...

AI Technical Summary

Benefits of technology

[0026] Another aspect of the invention describes a surgical method in which the surgical apparatus may be used to perform coronary artery revascularization on the beating heart through an access cannula inserted through a transabdominal approach. This surgical method avoids the ECC and is less invasive for the patient. This surgical method also avoids the need for cutting the patient's ribcage, or spreading apart ribcage or removing part of patient's rib in order to access the patient's heart such as is the case with conventional CABG surgery or beating heart surgery performed through a sternotomy, thoracotomy, or other like incisions.

Problems solved by technology

However, there are two main invasive aspects associated to traditional CABG—the sternotomy incision and the ECC.

In addition to being one of the most invasive aspects of traditional CABG, ECC is also responsible for a large percentage of the initial procedure cost of traditional CABG.

If ECC-related complications develop, ECC is also responsible for the post-operative costs incurred to treat these complications.

A median sternotomy, although less clinically-invasive than ECC, has the perception of being more invasive due to the surgical scaring that results from the surgery.

A full median sternotomy may result in a temporary disturbance in the respiratory mechanism, an increased risk of operative shock or dehiscence, and re-operation surgery from bleeding complications.

Moreover, prolonged exposure to air of the exposed mediastinum may lead to hypothermia, infection or compromise of the neuro-endocrine response.

Patients with severe chronic obstructive pulmonary disease (COPD), severe emphysema or severe pulmonary insufficiency are therefore at a higher risk of developing complications when exposed to a sternotomy incision.

Performing port access surgery remotely through a number of small ports tends to be difficult, at times leading to unwanted tissue dissection that requires the conversion to a full sternotomy in order to complete the surgical procedure.

However, unlike other organ surgeries, gall bladder for instance, the beating motion of the heart tends to complicate the surgical intervention.

Moreover, the MIDCAB thoracotomy incision to access the beating heart has been discovered to be more painful and less tolerated by patients than originally anticipated, especially in younger patients.

In some patients, verticalization of a beating heart is not well tolerated and may lead to hemodynamic instability during the surgical procedure.

However, the high incidence of restenosis associated with PTCA, and its generally low endorsement in the treatment of triple vessel disease does not make this procedure suitable to the majority of cardiac surgery patients that require coronary artery revascularization.

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