Diaphragm Entry for Posterior Thoracic Access

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Solution Overview

Problem

Conventional surgical techniques for accessing the thoracic cavity, such as median sternotomy, thoracotomy, and subxyphoid techniques, lack sufficient visibility and access to the posterior regions of the heart and lungs, leading to inconsistent electrode contact during thermal ablation procedures and increased risk of complications like esophageal fistulas due to inadequate precision in tissue coagulation.

Innovation Solution

The development of a diaphragm entry method and device that creates a temporary cavity between organs using an elongate member with expandable members, allowing for direct visualization and manipulation of posterior thoracic structures, enabling precise coagulation and minimizing tissue dissection.

Engineering Contradictions & Design Principles

VSEngineering Contradiction Analysis

1Area of stationary object

If conventional surgical techniques (median sternotomy, thoracotomy, subxyphoid techniques) are used to access the thoracic cavity, then access to the heart and lungs is achieved, but visibility and access to posterior regions of the heart and lungs are insufficient

Engineering Contradiction:

Improveaccess to posterior thoracic structuresVSAvoidvisibility of posterior heart and lungs

Core Design Contradiction:

Area of stationary objectVSEase of operation

Solution Approach 1:

The patent employs retrograde access by approaching the thoracic cavity from the abdominal side through the diaphragm, reversing the conventional anterior or lateral approaches. This inversion allows direct visualization and access to posterior thoracic structures including the posterior heart surface and pulmonary veins, which are difficult to reach through traditional chest wall incisions.

Inventive Principle:

Principle #13The other way round (Inversion)

Solution Approach 2:

The diaphragm serves as an intermediary structure that provides a natural pathway from the abdominal cavity to the thoracic cavity. By accessing through the diaphragm rather than directly through the chest wall, the procedure achieves posterior thoracic access while avoiding the need for large incisions and muscle cutting associated with conventional approaches.

Inventive Principle:

Principle #24Intermediary (Mediator)

2Area of stationary object

If the heart is significantly rotated or lifted during median sternotomy to visualize posterior surface, then posterior heart visibility is improved, but hemodynamic issues occur

Engineering Contradiction:

Improvevisibility of posterior heart surfaceVSAvoidhemodynamic stability

Core Design Contradiction:

Area of stationary objectVSReliability

Solution Approach 1:

Instead of manipulating the heart to achieve visibility from the front, the approach is inverted by accessing the heart from behind through the diaphragm. This eliminates the need for significant heart rotation or lifting, maintaining hemodynamic stability while providing direct visualization of the posterior heart surface.

Inventive Principle:

Principle #13The other way round (Inversion)

3Stability of the object's composition

If large diameter metal wires are used to close median sternotomy, then chest stability is achieved during healing, but patient mobility and recovery are significantly restricted

Engineering Contradiction:

Improvechest wall stabilityVSAvoidpatient mobility during recovery

Core Design Contradiction:

Stability of the object's compositionVSEase of operation

Solution Approach 1:

The patent extracts the need for sternotomy and its associated wire closure by using an alternative access route through the diaphragm. This eliminates the creation of a large midline chest incision, thereby avoiding the mobility restrictions and prolonged recovery associated with sternotomy wire closure while still achieving the necessary surgical access.

Inventive Principle:

Principle #2Taking out (Extraction)

4Area of stationary object

If thoracotomy is performed to access the thoracic cavity, then access to heart and lungs is achieved, but muscle cutting causes significant pain during rehabilitation

Engineering Contradiction:

Improveaccess to thoracic cavityVSAvoidpain during rehabilitation

Core Design Contradiction:

Area of stationary objectVSObject-affected harmful factors

Solution Approach 1:

The diaphragm acts as an intermediary that provides access to the thoracic cavity without requiring cutting through the chest wall muscles. By routing the surgical approach through the diaphragm from the abdominal side, the procedure achieves thoracic access while avoiding the muscle cutting and associated rehabilitation pain of conventional thoracotomy.

Inventive Principle:

Principle #24Intermediary (Mediator)

5Ease of operation

If endoscopes are used during thoracotomy to improve visualization, then some access to posterior regions is achieved, but access remains limited and organs cannot be easily lifted or rotated

Engineering Contradiction:

Improvevisualization of posterior regionsVSAvoidaccess to posterior heart and lungs

Core Design Contradiction:

Ease of operationVSArea of stationary object

Solution Approach 1:

Rather than using endoscopes to try to visualize posterior structures from an anterior approach, the technique inverts the approach by directly accessing the posterior thoracic structures from behind through the diaphragm. This provides both visualization and manual access to manipulate organs without the limitations of endoscopic visualization through small incisions.

Inventive Principle:

Principle #13The other way round (Inversion)

Data Source

PatentUS11690646B2Diaphragm entry for posterior surgical access

Publication Date: 2023.07.04 ATRICURE INC

AI summary

Methods and devices described herein facilitate improved treatment of body organs.