Apparatus and method for subcutaneous electrode insertion
Devices and methods for electrode implantation. A first embodiment includes an electrode insertion tool adapted to tunnel through tissue and attach, at its distal end, to a lead, such that the lead may be pulled into the tunneled space as the electrode insertion tool is removed. Additional embodiments include methods for inserting electrode/lead assemblies, including a method wherein an insertion tool is first used to tunnel through tissue, then to pull an electrode/lead into the tunneled space. In a further embodiment the insertion tool is next used, with a splittable sheath disposed thereon, to create an additional path into tissue, after which the insertion tool is removed, leaving the sheath in place; a lead is inserted to the sheath, and, finally, the splittable sheath is removed over the lead.
1. A method of implanting an implantable defibrillator including a canister and a lead electrode assembly into a patient, the lead electrode assembly having proximal and distal ends, the method comprising:
making an axillary incision near the left axilla of the patient and a xiphoid incision near the xiphoid of the patient;
bluntly dissecting a pocket at the axillary incision for receiving the canister;
advancing a first introducer tool having proximal and distal ends through the xiphoid incision toward the axillary incision to create a first subcutaneous tunnel, wherein the first introducer tool is curved to match patient anatomy between the xiphoid incision and the axillary incision;
accessing the distal end of the first introducer tool via the axillary incision and securing the distal end of the lead electrode assembly to the distal end of the first introducer tool;
withdrawing the first introducer tool through the xiphoid incision such that a portion of the lead electrode assembly is pulled through the axillary incision and into the first subcutaneous tunnel, until the first introducer tool fully exits the first subcutaneous tunnel and the distal end of the lead electrode assembly extends through the xiphoid incision while the proximal end of the lead electrode assembly remains outside of the first subcutaneous tunnel;
inserting a second introducer tool, the second introducer tool being straight relative to the first introducer tool, through the xiphoid incision and toward the head of the patient along the sternum to create a second subcutaneous tunnel;
removing the second introducer tool via the xiphoid incision; and
inserting the distal end of the lead electrode assembly into the second subcutaneous tunnel.
2. The method of claim 1 wherein:
during the step of inserting the second introducer tool, a splittable sheath is provided on the second introducer tool;
during the step of removing the second introducer tool, the splittable sheath is kept in place in the second subcutaneous tunnel; and
the lead electrode assembly is inserted into the second subcutaneous tunnel by insertion into the splittable sheath.
3. The method of claim 2 further comprising removing the splittable sheath by splitting the sheath along a line of weakness after the lead electrode assembly is inserted into the second subcutaneous tunnel.
4. The method of claim 3 further comprising:
inserting the canister into the pocket; and
closing the axillary and xiphoid incisions after the canister and lead electrode assembly are inserted.
5. The method of claim 1 further comprising:
inserting the canister into the pocket; and
closing the axillary and xiphoid incisions after the canister and lead electrode assembly are inserted.