Vessel harvesting retractor with dissection element

#This invention relates to surgical devices and methods for dissecting around elongated tissue structures. In particular, this invention relates to devices and methods for dissecting around a blood vessel such as a saphenous vein during an endoscopic vessel harvesting procedure.

#Endoscopic vein harvesting (EVH), particularly of the greater saphenous vein in the leg, is a surgical procedure for obtaining a graft vessel for a coronary artery bypass graft (CABG) procedure. A physician's assistant (PA) typically performs the EVH on one or both legs of the patient while a cardiac surgeon operates on the patient's chest in preparation for the grafts. Performing the EVH in a timely manner is important so that the PA can present the prepped vessel to the surgeon by the time the surgeon is ready to attach the graft vessel to the heart. The EVH procedure learning curve and additional time required to harvest a blood vessel using minimally invasive techniques continue to be issues for the rapid adoption of the procedure. The present invention improves the ease of use and decreases the time required to harvest a vessel. Specifically, this invention reduces the number of instrument exchanges through the surgical incision in the patient.

#Several investigators have proposed devices and methods for performing EVH, as disclosed in the patents cited. For example, U.S. Pat. No. 5,928,138 (“Method and Devices for Endoscopic Vessel Harvesting”, assigned to Ethicon Endo-Surgery, Inc., and issued on Jul. 27, 1999) discloses an optical dissector having a concave working head. A commercial version of this optical dissector is called the ClearGlide subcutaneous retractor and is available from Ethicon, Inc., Somerville, N.J. The ClearGlide is currently one of the main products available today for performing EVH, and provides good access and visibility to the surgical site along the greater saphenous vein.

#FIG. 1 is a perspective view of a preferred implementation of a surgical instrument of the present invention, used for dissecting and harvesting a vein;

#FIG. 2 is a front view of a spoon retractor of the surgical instrument of FIG. 1, the spoon retractor having a flexible arm as a dissecting element in an extended position;

#FIG. 3 is a side sectional view of the spoon retractor shown in FIG. 2 taken along line 3-3;

#A surgical instrument for endoscopic dissection of vessels for CABG surgery as known in the art generally comprises a concave working head, a shaft, and a handle. The instrument is typically fitted with an endoscope inserted through a handle and the shaft so that an operator may view into a working space created by concave working head.

#In operation the surgeon introduces the concave working head and a portion of shaft through a surgical incision and manipulates surgical instrument alongside the saphenous vein in order to free the vein from surrounding tissues and to isolate side branches of the vein that must be ligated prior to removal of the vein from the patient's leg.

#The concave working head may be made from a clear plastic so that the operator may visualize tissue structures adjacent to it as well as inside the working space. U.S. Pat. No. 5,928,138 also discloses how surgical instrument may be used with other surgical instruments for dissecting and harvesting a vein. The present invention reduces the time required to perform the EVH procedure (and subsequent trauma to tissue) due to fewer exchanges of these additional instruments into incision.