Tissue slitting methods and systems
View Patent ↗Methods and systems for separating an object, such as a lead, from formed tissue are provided. Specifically, a tissue slitting device is configured to engage patient formed tissue at a slitting engagement point. While the object is subjected to a first traction force, the tissue slitting device is caused to move further into the engaged tissue and slit the tissue past the point of engagement. The slitting device causes the tissue to separate along an axial direction of the length of the formed tissue and releases at least some of the force containing the object. The methods and systems are well suited for use in cardiac pacing or defibrillator lead explant procedures.
1. A method for separating an implanted object in a patient from a tissue growth surrounding at least a portion of a circumference of the implanted object, the method comprising:
providing a tissue slitting apparatus comprising a flexible shaft, wherein the flexible shaft has a proximal end, a distal end including a wedge shape that defines a knife-edge at a distal leading edge of the most distal portion of the tissue slitting apparatus, wherein the wedge shape is stationary with respect to the flexible shaft and tapers outwardly proceeding proximally from the knife-edge, and an internal lumen extending between the proximal end and the distal end, the knife-edge including at least one point coincident with the internal lumen;
slitting the tissue growth along its length at only a first radial position relative to the implanted object with the knife-edge of the flexible shaft and simultaneously parting the tissue along the wedge shape of the flexible shaft; and
thereafter removing the implanted object from the tissue growth.
2. The method of claim 1 , wherein the distal end of the flexible shaft comprises a fluid conveying device, and wherein the slitting and thereafter removing steps comprise the sub-steps:
attaching a mechanical traction device to the implanted object;
inserting the mechanical traction device into the tissue slitting apparatus;
applying a mechanical traction force to the mechanical traction device;
indexing the tissue slitting apparatus to an engagement area of the tissue growth in contact with the implanted object;
moving the fluid conveying device adjacent to the tissue growth; and
activating the fluid conveying device, such that a section of the tissue growth is ablated and separated from the implanted object at least at the engagement area with pressurized fluid directed via the fluid conveying device.
3. The method of claim 2 , wherein the fluid conveying device slits a first, but not a second, portion of the tissue growth around the circumference of the implanted object and wherein prior to indexing the tissue slitting apparatus to the engagement area, the method further comprises:
orienting the fluid conveying device to slit tissue along a free length of the tissue growth aligned with the first radial position relative to the implanted object and where the tissue growth is free from attachment to a portion of vasculature of the patient.
4. The method of claim 3 , wherein orienting the fluid conveying device further comprises:
aligning the fluid conveying device along an area of the free length of the tissue growth wherein a thickness of a first section of the tissue growth surrounding the implanted object is less than a thickness of a second section of the tissue growth surrounding the implanted object, and wherein the second section of the tissue growth is attached to the vasculature of the patient.
5. The method of claim 2 , further comprising:
determining whether the tissue growth is completely separated along a length of the tissue growth surrounding the implanted object; and
moving the fluid conveying device further into the tissue growth to ablate and separate any tissue growth determined to remain along the length of the tissue growth surrounding the implanted object.
6. The method of claim 1 , wherein the slitting step comprises slitting about a partial periphery of an internal diameter of the tissue growth adjacent to and at least substantially surrounding the implanted object at any point along the implanted object.
7. The method of claim 1 , further comprising:
attaching a mechanical traction device to the implanted object;
inserting the mechanical traction device into the internal lumen of the tissue slitting apparatus;
applying a mechanical traction force to the mechanical traction device; and
indexing the tissue slitting apparatus to an engagement area of the tissue growth in contact with the implanted object;
thereafter performing the slitting and removing steps.
8. The method of claim 7 , wherein the knife-edge slits a first, but not a second, portion of the tissue growth around the circumference of the implanted object and wherein prior to indexing the tissue slitting apparatus to the engagement area, the method further comprises:
orienting the knife-edge to slit tissue along a free length of the tissue growth aligned with the first radial position relative to the implanted object and where the tissue growth is free from attachment to a portion of vasculature of the patient.
9. The method of claim 8 , wherein orienting the knife-edge further comprises:
aligning the knife-edge along an area of the free length of the tissue growth wherein a thickness of a first section of the tissue growth surrounding the implanted object is less than a thickness of a second section of the tissue growth surrounding the implanted object, and wherein the second section of the tissue growth is attached to the vasculature of the patient.