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JP-7854894-B2 - Endoscopic vascular sampling using temperature control and augmented reality displays

JP7854894B2JP 7854894 B2JP7854894 B2JP 7854894B2JP-7854894-B2

Inventors

  • ジョゼフ・マーク・ジェリック
  • 坪内 猛
  • ランダル・ジェームズ・カディコフスキ
  • 藤井 達徳

Assignees

  • テルモ カーディオバスキュラー システムズ コーポレイション

Dates

Publication Date
20260507
Application Date
20220810
Priority Date
20210811

Claims (15)

  1. A vascular sampling system, An elongated sampling instrument for insertion into the body along the pathway of a target vessel, wherein the target vessel is connected to at least one side branch, and the sampling instrument has a cutter for applying thermal energy to sever and cauterize the side branch; An endoscope camera installed on the sampling device captures a visible light image from the distal tip of the sampling device within the dissection tunnel surrounding the target blood vessel, A thermal camera installed in the sampling device captures a thermogram that matches the visible light image in order to characterize the temperature present on each surface within the dissection tunnel, An image processor that represents a video stream including the visible light image, and an overlay display that depicts the temperature present on at least some of the surfaces when the thermal energy is applied, A vascular sampling system comprising a display that presents the video stream and the overlaid display to the user.
  2. The system according to claim 1, wherein the superimposed display includes a colored display portion having multiple colors corresponding to each temperature class.
  3. The system according to claim 1, wherein the image processor identifies the target vessel and the side branches, and the overlay display depicts the temperature present in at least a portion of the target vessel and at least a portion of the side branches.
  4. The system according to claim 3, wherein the image processor identifies the target vessel and its side branches using image analysis.
  5. The system according to claim 1, wherein the image processor identifies the target vessel and the side branches, and the image processor represents a cutting indicator for guiding the cutter to a suitable location for cutting the identified side branches in order to limit the thermal load applied to the target vessel.
  6. The system according to claim 5, wherein the cutting indicator includes a marker that points to a spatial location on the side branch.
  7. The system according to claim 5, wherein the cutting indicator includes a highlight region superimposed on the location of the preferred location in the visible light image.
  8. The system according to claim 5, wherein the cutting indicator includes a guide indicator corresponding to the direction of movement of the cutter to reach the preferred location.
  9. The system according to claim 5, wherein the cutting indicator includes a flag having a stop (no-go) state when the cutter is not in the preferred location and a continue (go) state when the cutter is in the preferred location.
  10. The system according to claim 5, wherein the image processor identifies the preferred location for detaching the identified side branch, so that the distance from the preferred location to the target vessel maintains the heating of the target vessel below a thermal threshold.
  11. The system according to claim 1, wherein the image processor accumulates the thermal exposure received by the target blood vessel, and the image processor displays a parameter display indicator corresponding to the accumulated thermal exposure.
  12. The system according to claim 11, wherein the image processor displays a warning indicator when the accumulated heat exposure exceeds a damage threshold.
  13. The system according to claim 1, wherein the image processor identifies the target vessel and the side branches, and the image processor represents a diameter indicator according to the estimated diameter of the side branches.
  14. The system according to claim 1, wherein the image processor identifies the target vessel and the side branches, the image processor determines a target energy for detaching the side branches according to the estimated diameter of the side branches, and the image processor represents an energy indicator according to the target energy.
  15. The system according to claim 1, wherein the display comprises an augmented reality display worn by the user.

Description

Cross-referencing of related applications is not applicable. Not applicable to research funded by the federal government. The present invention generally relates to devices and methods for endoscopic harvesting of blood vessels within a patient's limb, using thermal energy applied to cut and cauterize tissue and collateral branches, and more particularly to achieving temperature control within an endoscopic vessel harvesting system that may have an augmented reality device worn by the person performing the harvesting procedure. In connection with coronary artery bypass grafting (CABG), a blood vessel or vascular section, such as an artery or vein, is "harvested" (i.e., removed) from its natural location within the patient's body for use elsewhere in the body. In CABG, for example, this vessel is used to form a bypass between the arterial blood source and the coronary artery to be rerouted. Suitable sources for vessels to be used as bypass grafts include, in particular, the saphenous vein in the leg and the radial artery in the arm. To avoid the disadvantages and potential complications of harvesting via serial incisions, endoscopic surgical techniques have been developed for subcutaneous harvesting of venous sections (e.g., saphenous vein). One such minimally invasive technique employs a small incision to locate the desired vessel and introduce one or more endoscopic harvesting devices. Initial dissection is performed by introducing dissection instruments through the incision to create working space and separate the vessel from the surrounding tissue. Cutting instruments are then introduced into the working space to separate the vessel from the connective tissue and its collateral branches. The collateral branches can be cut and cauterized using the cutting instruments. In one typical procedure, the endoscopic entry point is located near the midpoint of the vessel to be harvested, where dissection and cutting of the branch advance bidirectionally along the vessel from the entry point. A second small incision or puncture wound is made at one end of the desired section of the vessel, and this section is ligated. A third small incision is then made at the other end of the ligated section, allowing for complete removal of this desired section through the first incision. Alternatively, if the length of the endoscopic device is sufficient to obtain the desired length of vessel while working in only one direction along the vessel from the entry point, only the first two incisions may be necessary. An example of a commercially available product for performing the endoscopic venous sampling described above is the VirtuoSaph Plus™ endoscopic vascular sampling system from Terumo Cardiovascular Systems Corporation, Ann Arbor, Michigan. This type of endoscopic vascular sampling system is also described in U.S. Patents 7,331,971 and 8,048,100, as well as U.S. Patent Publications 2010/0292533 and 2012/0035606, which are incorporated herein by reference in their entirety. Dissection tools typically consist of a longitudinal rod made of stainless steel or plastic, comprising a tip at one end and a surgeon's handle at the other. The rod may have a PTFE coating to reduce sliding resistance. The tip tapers to a non-sharp end and is made of clear plastic. Dissection progresses along the outer circumference of the harvested vessel to separate it from the surrounding tissue and expose its side branches, so that the vessel can be cut using a cutting tool. In the VirtuoSaph® Plus system, the cutting tool for cutting and cauterizing branches has the form of a V-cutter, where the V-shaped tip is extendable from the distal end of the unit to guide the branch to be cut into a longitudinal slit. An electrode adjacent to the slit is electrically excited with a high-frequency voltage to cauterize and coagulate the branch (e.g., bipolar electrosurgical energy). Furthermore, a V-keeper extends from the distal end to capture the vascular tissue and guide the tool along it. An internal endoscopic view is provided to the user via an optical system having a camera and video display. The camera may be installed inside the distal tip of the collection device. Alternatively, a lens and optical fiber mounted inside the collection device can transmit images to a camera located at the remote end of an optical fiber outside the collection device or located inside the device's handle. The view is illuminated by a light source, such as an LED, installed at the tip of the collection device (dissection instrument or cutter), or by a remote source that inputs light into an optical fiber extending through the collection device to emit light from the tip. U.S. Patent No. 7,331,971U.S. Patent No. 8,048,100U.S. Patent Application Publication No. 2010/0292533U.S. Patent Application Publication No. 2012/0035606 This is an external view showing the saphenous vein taken from the leg.This is a side view showing a conventional anatomical instrument unit.This is a si