Surgery – Instruments – Suture retaining means
Reexamination Certificate
1998-06-05
2001-01-16
Buiz, Michael (Department: 3731)
Surgery
Instruments
Suture retaining means
C606S233000, C606S144000
Reexamination Certificate
active
06174323
ABSTRACT:
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention relates to a method and assembly for reducing the volume of a lung and, more particularly, to a mechanical lung volume reduction assembly having cords and anchors that pull on portions of a lung to compress the volume of a portion of the lung.
2. Brief Description of the Related Art
The lungs deliver oxygen to the body and remove carbon dioxide. Healthy lung tissue includes a multitude of air passageways which lead to respiratory bronchiole within the lung. These airways eventually lead to small sacs called alveoli, where the oxygen and carbon dioxide are exchanged through the ultra-thin walls of the alveoli. This occurs deep within the lungs, in an area which is accessed by a network of airways, consisting of a series of branching tubes which become narrower, shorter, and more numerous as they penetrate deeper into the lungs. As shown in
FIG. 1
, tiny air sacks called alveoli
1
surround both alveolar ducts
2
and respiratory bronchiole
3
throughout the lung. The alveoli are small, polyhedral recesses composed of a fibrillated connective tissue and surrounded by a few involuntary muscular and elastic fibers. These alveoli
1
inflate and deflate with air when we breath. The alveoli are generally grouped together in a tightly packed configuration called an alveolar sac. The thin walls of the alveoli
1
perform gas exchange as we inhale and exhale.
During inhalation, as the diaphragm contracts and the ribs are raised, a vacuum is created in the chest, and air is drawn into the lungs. As the diaphragm relaxes, normal lungs act like a stretched balloon and rebound to the normal relaxed state, forcing air out of the lungs. The elasticity of the lungs is maintained by the supportive structure of the alveoli. This network of alveoli provides strength to the airway walls, as well as elasticity to the lungs, both of which contribute to the lung's ability to function effectively.
Patients with pulmonary disease have reduced lung capacity and efficiency due to the breakdown of lung tissue. This often is caused by smoking. In cases of severe chronic pulmonary disease, such as emphysema, lung tissue is destroyed, reducing the strength of the airways. This reduction and strength of the airway walls allows the walls to become “floppy” thereby losing their ability to remain open during exhalation. In the lungs of an emphysema patient, illustrated in
FIG. 2
, the walls between adjacent alveoli within the alveolar sac deteriorate. This wall deterioration is accelerated by the chemicals in smoke which affect the production of mucus in the lungs. Although the break down of the walls of the alveoli in the lungs occurs over time even in a healthy patient, this deterioration is greatly accelerated in a smoker causing the smoker's lungs to have multiple large spaces
4
with few connecting walls in the place of the much smaller and more dense alveoli spaces
1
in healthy lung tissue.
A cross section of a diseased emphysematous lung will look like Swiss cheese due to the deterioration of the alveoli walls which leaves large spaces in the tissue. In contrast, healthy lung tissue when seen in cross section has no noticeable holes because of the small size of the alveoli. When many of the walls of the alveoli
1
have deteriorated as shown in
FIG. 2
, the lung has larger open spaces
4
and a larger overall volume, but has less wall tissue to achieve gas exchange.
In this diseased state, the patient suffers from the inability to get the air out of their lungs due to the collapse of the airways during exhalation. Heavily diseased areas of the lung become overinflated. Within the confines of the chest cavity, this overinflation restricts the in-flow of fresh air and the proper function of healthier tissue, resulting in significant breathlessness. Thus, the emphysema patient must take in a greater volume of air to achieve the same amount of gas exchange. When severe emphysema patients take in as much air as their chest cavity can accommodate, they still have insufficient gas exchange because their chest is full of non-functional air filling large cavities in the lungs. Emphysema patients will often look barrel-chested and their shoulders will elevate as they strain to make room for their overinflated lungs to work.
In severe emphysema cases, lung volume reduction surgery (LVRS) is performed to improve lung efficiency of the patient and allow the patient to regain mobility. In lung volume reduction surgery, a more diseased portion of an emphysematous lung having a large amount of alveolar wall deterioration is surgically removed. LVRS is performed by opening the chest cavity, retracting the ribs, stapling off, and removing the more diseased portion of the lung. This allows the remaining healthier lung tissue to inflate more fully and take greater advantage of the body's ability to inhale and exhale. Since there is more air and more gas exchange in the healthier portion of the lung, lung efficiency is improved.
Lung volume reduction surgery is an extremely invasive procedure requiring the surgical opening of the chest cavity and removal of lung tissue. This surgery has substantial risks of serious post-operative complications, such as pneumothorax, and requires an extended convalescence.
Accordingly, it is desirable to achieve the benefits of improved air exchange for emphysema patients provided by LVRS without invasive open chest surgery and the associated complications.
SUMMARY OF THE INVENTION
The present invention relates to a minimally invasive system for reducing the volume of an emphysematous or otherwise unhealthy lung without the drawbacks of conventional LVRS.
In accordance with one aspect of the present invention, a method is described for reducing the volume of a lung. The method includes the steps of anchoring at a first position in the lung a first anchor, anchoring at a second position in the lung a second anchor, where the first position is distant from the second position, reducing the distance between the anchored first anchor and the anchored second anchor to decrease a volume of the lung, and preventing the reduced distance from substantially increasing.
In accordance with an additional aspect of the present invention, a method is described for reducing the volume of a lung. The method includes the steps of anchoring in a portion of a lung an anchor having a cord attached thereto, and pulling the cord to cause the anchor to pull on the portion of the lung to decrease the volume of the lung.
In accordance with a further aspect of the invention an assembly for reducing the volume of a lung is described. The assembly includes a first cord, and a first anchor for anchoring to a first portion of the lung. The first cord is attached to the first anchor. The assembly further includes a second cord, and a second anchor for anchoring to a second portion of the lung. The second cord is attached to the second anchor. The assembly also includes a delivery device for delivering the first anchor to the first portion of the lung and for delivering the second anchor to the second portion of the lung, and a connection device for connecting the first cord to the second cord within the lung.
In accordance with an additional aspect of the invention an assembly for reducing the volume of a lung is described. The assembly includes a first anchor for anchoring to a first portion of the bronchial passageways of the lung, and a second anchor for anchoring to a second portion of the bronchial passageways of the lung. The assembly also includes a connection device for positioning in the lung, a first cord connecting the first anchor to the connection device, and a second cord connecting the second anchor to the connection device, the connection device preventing the first cord and the second cord from moving relative to the connection device in a direction away from the connection device.
In accordance with another aspect of the invention an assembly for reducing the volume of a lung is described. The assembly inclu
Biggs Michael J.
Davenport James M.
Loomas Bryan
Broncus Technologies, Inc.
Buiz Michael
Morrison & Foerster / LLP
Ngo Lien
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