Minimally Invasive Endoscopic Vessel Harvesting
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Solution Overview
Problem
Traditional open surgical techniques for vascular access and fasciotomy procedures result in long incisions, scarring, increased risk of infection, pain, poor wound healing, and functional impairment, particularly in patients requiring arteriovenous fistulas for dialysis.
Innovation Solution
Development of minimally invasive endoscopic surgical methods and systems for arteriovenous fistula creation, transposition, ligation, and excision, as well as fasciotomy, utilizing a blunt tip trocar, endoscope, harvesting cannula, bisector/bipolar device, and suction device to minimize tissue damage and scarring, and facilitate precise procedures through smaller incisions.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If traditional open surgical techniques are used for arteriovenous fistula creation and fasciotomy, then the surgical procedure can be completed with established methods, but the patient experiences long incisions, disfiguring scars, increased infection risk, pain, poor wound healing, and functional impairment
Solution Approach 1:
The surgical procedure is divided into multiple small incisions (typically 3-5 incisions of 0.5-2 cm each) rather than one large incision. Each incision serves a specific function: one for the endoscope, one for the harvesting cannula, and additional small incisions for vessel manipulation. This segmentation allows the surgeon to perform complex vascular surgery while minimizing visible scarring and tissue damage.
Solution Approach 2:
The patent transitions from traditional two-dimensional open surgery to three-dimensional endoscopic visualization. The endoscope provides magnified 3D views of the surgical field, allowing precise manipulation of vessels through small incisions. This dimensional change enables complex vascular anastomosis and fistula creation without requiring large incisions, thereby reducing scarring and improving cosmetic outcomes.
2Ease of manufacture
If traditional open surgical techniques are used, then the procedure can be performed with standard instrumentation, but the patient suffers from high risk of infections, bleeding, and painful surgical sites
Solution Approach 1:
The procedure uses multiple small puncture sites instead of large incisions, which significantly reduces the surface area exposed to bacteria and the risk of surgical site infections. The small incisions also minimize blood loss and reduce postoperative pain, while still allowing access to deep vascular structures through the use of long, thin endoscopic instruments.
Solution Approach 2:
The endoscope acts as an intermediary tool that allows the surgeon to visualize and manipulate vessels through small incisions. The endoscopic system includes a camera, light source, and magnifying lenses that provide enhanced visualization of the surgical field, enabling precise dissection and anastomosis without requiring large exposure incisions, thereby reducing infection risk and trauma.
3Reliability
If traditional open surgical techniques are used for arteriovenous fistula creation, then the fistula can be created with established methods, but the patient requires subsequent transposition surgery and experiences disfiguring scars at long incision sites
Solution Approach 1:
The procedure creates the arteriovenous fistula through multiple small incisions distributed along the limb rather than one long incision. The incisions are placed at intervals to allow endoscopic access to the vessels at different depths and locations. This segmented approach creates minimal scarring that is distributed and much less noticeable than a single long scar, while still achieving reliable fistula creation.
Solution Approach 2:
The endoscopic approach allows the surgeon to work in the third dimension by inserting instruments at various angles and depths through small incisions. The magnified endoscopic view enables precise dissection and anastomosis of vessels that would otherwise require large incisions for direct visualization. This dimensional approach allows fistula creation with minimal cosmetic impact.
4Object-affected harmful factors
If minimally invasive endoscopic methods are used, then scarring is reduced and wound healing is improved, but the surgical procedure requires specialized instrumentation and increased precision
Solution Approach 1:
The endoscopic system uses a standardized set of multi-functional instruments that can perform multiple surgical tasks. The harvesting cannula, for example, can be used for vessel dissection, isolation, and harvesting. The endoscope itself serves multiple functions: visualization, illumination, and providing a working channel for instrument passage. This universality reduces the need for numerous specialized tools while achieving minimally invasive benefits.
Solution Approach 2:
The endoscope serves as an intermediary system that bridges the gap between small external incisions and the deep vascular structures. The endoscopic tower includes a camera, light source, magnifying lenses, and image processing system that together provide enhanced visualization. This intermediary system compensates for the limited exposure through small incisions, allowing complex vascular surgery with minimal scarring despite the increased complexity of the instrumentation.
Applied Scientific Principles
This section explains which scientific principles are used to turn an abstract innovation direction into a practical engineering solution.
Function Achieved in This Case
The minimally invasive approach reduces scarring, pain, infection risk, and promotes faster recovery with improved precision and reduced blood loss, eliminating the need for multiple surgeries and minimizing tissue damage.
Implementation Method 1
an endoscopic suction device sized to fit into and extend to the distal end of the cannula to provide suction at the cannula distal end to remove debris
Implementation Method 2
The bisector/bipolar device or attachment may be used to cut and cauterize branches of the blood vessel while under endoscopic visualization
Data Source
AI summary
Methods and systems are provided for harvesting at least a portion of a blood vessel, such as the radial artery in the upper extremity and the saphenous vein in the lower extremity. In certain embodiments, an endoscopic surgical system includes a blunt tip trocar (BTT) for insertion into an incision in the extremity, a cannula for insertion through the BTT, a bisector/bipolar device, and an endoscope. The endoscope may have a dissection tip at its distal end for dissecting tissue from the blood vessel and, with the tip removed, may provide a visual field at its distal end. The endoscope is sized to fit into the cannula and provides visualization of the blood vessel during bisection with the bisector/bipolar device.