Methods and systems for minimally invasive endoscopic surgeries

摘要

The present invention provides systems and methods for minimally invasive endoscopic surgical procedures. In certain embodiments, the surgical procedures include harvesting of a deep basilic or cephalic vein for creation of a brachial-basilic or brachial-cephalic AV fistula, with simultaneous transpositioning, harvesting of a deep basilic or cephalic vein for transposition of an existing brachial-basilic or brachial-cephalic AV fistula, and ligating and excising an aneurysmal radial-cephalic, brachial-cephalic, or brachial-basilic AV fistula from the upper or lower arm.

主权项

1. A method of performing a minimally invasive endoscopic vein superficialization and arteriovenous (AV) fistula creation in an upper extremity, the method comprising:
creating a first incision of about 2 cm at a distal site; introducing a cannula through the first incision, the cannula having a handle at a proximal end and a shaft extending from the handle to a distal end, the shaft having a length of about 20 cm to about 26 cm and configured to receive an endoscope therein, identifying an artery and a vein, the identified vein having a distal and proximal end, the proximal distal end being in close proximity to the first incision; inserting the endoscope through the cannula, the endoscope having a distal end with a dissector tip attached thereto; isolating branches of the vein by passing the endoscopic tip of the endoscope over the vein, starting at the distal end of the vein and advancing toward the proximal end thereof; cauterizing and bisecting the vein branches using a bipolar device inserted through the cannula; creating a second incision of about 1 cm at a proximal site; pulling the vein out through the second incision; flushing the vein; tying off the vein branches; creating a superficial subcutaneous tunnel through subcutaneous tissue by passing the endoscope configured with a dissector tip above adipose tissue starting at the first incision and advancing proximally the adipose tissue to the second incision, withdrawing the endoscope with the dissector tip from the superficial subcutaneous tunnel and replacing the endoscope with the dissector tip with an endoscopic device, the an endoscopic device including the cannula; an endoscope and the bipolar device attachment; advancing the endoscope device through the superficial subcutaneous tunnel from the first incision to the second incisions; attaching the harvested/transposed vein to a selected at least one of the endoscope and the bipolar device attachment without the use of clips; withdrawing through the superficial subcutaneous tunnel the selected at least one of the endoscope and the bipolar device attachment and the attached harvested/transposed vein from the second incision site to the first incision site of the superficial path; creating the AV fistula with the harvested/transposed vein; assessing for thrill; and closing the incisions.