US20030199809A1 - Methods, systems, and kits for implanting articles - Google Patents

Abstract

Methods, systems, and kits for subcutaneously implanting articles, such as drug inserts and reservoirs. The methods rely on percutaneously forming a tissue tract and radially dilating the tract to a diameter which permits introduction of the article. By fully expanding the lumenal diameter of the tissue tract prior to introduction of the article, damage to the article resulting from passage through a partially expanded tissue tract can be avoided. In the exemplary embodiment, a radially expandable sleeve is first percutaneously introduced to the subcutaneous target site. An assembly of a cannula and dilator is then passed through the sleeve, effecting radial expansion. The dilator is removed and the article is then introduced through a lumen of the cannula.

Description

CROSS-REFERENCES TO RELATED APPLICATIONS
• The present application is a continuation of, and claims the benefit of priority from U.S. application Ser. No. 09/112,102 filed Jul. 8, 1998, the full disclosure of which is incorporated herein by reference.[0001]
BACKGROUND OF THE INVENTION
• 1. Field of the Invention[0002]
• The present invention relates generally to medical methods, apparatus, and kits. More particularly, the present invention relates to methods, systems, and kits for percutaneously delivering implantable articles, such as subcutaneous drug inserts, to solid tissue locations.[0003]
• Implantable articles are useful for a wide variety of medical purposes. Of particular interest to the present invention, drug inserts and controlled release reservoirs may be subcutaneously implanted in order to release a drug or other biologically active substance over time. Usually, the insert or reservoir will be implanted intramuscularly or intraperitoneally by first forming an incision which permits the article to be implanted at the target site. Often, a large bore needle or cannula is used to inject the insert or reservoir to the target location. Such devices, however, often result in coring of the tissue, and subsequent injection of the drug insert pushes against such cored tissue, rendering placement difficult. While such problems have been at least partly overcome by the use of trocar/cannula assemblies where the trocar cuts through tissue, the use of relatively large diameter trocars is traumatic to the patient and can leave scarring.[0004]
• An improvement over the use of large diameter needles and trocars is proposed in U.S. Pat. No. 5,304,119. The '119 patent teaches use of a tapered cannula having a pair of opposed tines overs its distal end. The tines meet together in a “duck bill” fashion and may be advanced through solid tissue with reduced trauma to the patient. After initial placement of the cannula, a drug insert may be advanced axially through the device, forcing the opposed tines to open and permitting placement of the insert at the desired target location. While workable and an improvement over prior delivery systems, reliance on passage of the drug insert to open the opposed tines can be problematic. In particular, the mechanical action can physically damage the drug insert prior to its delivery to the tissue target site.[0005]
• For these reasons, it would be desirable to provide improved methods, systems, and kits for delivering implantable articles, such as drug inserts and controlled release reservoirs, to solid tissue locations. In particular, it would be desirable to provide for percutaneous delivery of such articles in a manner which is both minimally traumatic to the patient and minimally damaging to the article. At least some these objectives will be met by the invention described hereinafter.[0006]
• 2. Description of the Background Art[0007]
• A device and method for injecting implants are described in U.S. Pat. No. 5,304,119, discussed in more detail above. Radially expanding dilators of a type suitable for use in the methods of the present invention are described in U.S. Pat. Nos. 5,183,464 and 5,431,676, and are commercially available under the tradename STEP from InnerDyne, Inc., Sunnyvale, Calif., assignee of the present application. Other pertinent patents include U.S. Pat. Nos. 5,674,240; 5,484,403; 5,403,278; 5,201,756; 4,899,729; 4,716,901; and 3,788,318.[0008]
BRIEF SUMMARY OF THE INVENTION
• According to the present invention, improved methods, systems, and kits are provided for implanting articles in solid tissue. The articles will usually be intended for drug delivery, typically being drug delivery inserts or reservoirs intended for controlled release of the drugs, but could also be intended for other purposes such as the delivery of brachytherapy seeds, pacemakers and other stimulatory devices and leads, pumps, transducers and other diagnostic and monitoring devices, sensors, and the like. The methods and systems of the present invention are characterized by the formation and radial expansion of a tissue tract from the surface of a patient's skin to a target site beneath the skin, typically within solid tissue (e.g., muscle), beneath the peritoneum, (i.e., the retroperitoneum), or the like. The tissue tract is radially expanded, preferably, to a substantially constant lumen diameter over its entire length, with the expansion occurring prior to introduction of the drug insert or other article. Radial expansion of the tissue tract is generally less traumatic to the patient than use of a large bore coring needle or large diameter trocar, and full expansion of the tissue tract prior to introduction of the article avoids the risk of damage to the article which can occur with systems such as that described in U.S. Pat. No. 5,304,119, where the article itself mechanically opens a path as it is advanced.[0009]
• In a first aspect, a method according to the present invention comprises percutaneously inserting a radially expandable sleeve so that a distal end of the sleeve lies adjacent to a target site in solid tissue. An assembly comprising a cannula and a dilator is then introduced through the radially expandable sleeve, where the cannula and dilator have a diameter which is larger than an initial diameter of the sleeve so that the sleeve is radially expanded as the assembly is advanced distally through a lumen of the sleeve. Usually, the dilator will have a tapered or pointed distal end which facilitates advancement through the sleeve and which can extend beyond the distal end of the sleeve to penetrate the solid tissue and create a potential space for receiving the article to be implanted.[0010]
• After the cannula/dilator assembly has been fully advanced within the sleeve, the dilator is removed from the cannula, leaving the cannula in place to maintain an open lumen having a diameter which is significantly greater than the initial lumen diameter of the sleeve. Usually, the lumenal diameter of the cannula will be in the range from 2 mm to 20 mm, preferably from 3 mm to 12 mm, most typically from 3 mm to 5 mm, while the initial lumen diameter of the sleeve will be less than 1 mm. After the dilator has been removed from the cannula, the article is advanced distally through the cannula lumen and beyond the distal end of the cannula so that it enters into the tissue where it is to be implanted. Conveniently, the article can be advanced using the same dilator which was originally used to advance the assembly of the cannula and dilator. Alternatively, a separate pusher rod or other element may be provided for insertion, advancement, and implantation of the article.[0011]
• Usually, the percutaneous sleeve inserting step will comprise advancing an assembly of the sleeve and a needle directly into the tissue. The needle will usually be a small diameter, non-coring needle having a sharpened distal tip which extends distally of the sleeve to facilitate advancement of the assembly through the tissue. The needle may then be withdrawn proximally from the sleeve, leaving the sleeve in place to receive introduction of the assembly of the cannula and dilator in a subsequent step. In the exemplary embodiment, the expandable sleeve comprises a tubular braid formed from a mesh of non-elastic filaments which axially shorten as they are radially expanded.[0012]
• The article will preferably be a drug delivery implant or controlled and sustained release reservoir. The article may be used for delivering a wide variety of drugs of the type which are suitable for subcutaneous intramuscular implantation, such as contraceptives, hormonal replacement, e.g. estrogen, progesterone, testostoronen, and the like.[0013]
• In a second aspect, the method of the present invention comprises radially expanding a tissue tract to form a lumen having a substantially constant diameter over its entire length. The article to be implanted is then advanced distally through the lumen after the lumen has been substantially completely expanded. In this way, patient trauma is reduced while the risk of damage to the implanted article is minimized.[0014]
• The present invention further comprises kits including a radially expandable sleeve, a cannula, and a dilator. The kit will further comprise instructions for use setting forth any of the methods described above. The kit usually will further comprise a container for holding the various kit components together, typically being a pouch, tray, box, tube, or the like. The kit components will usually be sterilized and maintained sterilely within the packaging, where sterilization can be effected by conventional means, such as radiation, exposure to ethyleneoxide, or the like. Optionally, the kit may further comprise the article to be implanted, typically being a pharmaceutical implant or reservoir.[0015]
• The present invention still further comprises systems including both a radially expandable sleeve and a drug delivery article. The radially expandable sleeve will be expandable from a narrow diameter configuration which can be percutaneously introduced to the patient with lessened patient trauma and which will be radially expandable to a large diameter configuration in order to provide a non-collapsible lumen. The drug delivery article will have peripheral dimensions which permit it to be delivered through the non-collapsible lumen of the sleeve after radial expansion. The lumen of the sleeve will be capable of remaining fully open to its large diameter configuration even in the absence of the article so that the article may be passed through the lumen without the need for the article to help open the lumen. Usually, the radially expandable sleeve will be opened using an assembly of a cannula and a dilator as generally described above.[0016]
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 illustrates a radially expandable sleeve and a needle having a sharpened distal tip which may be received in a lumen of the sleeve to be used in the methods of the present invention.[0017]
• FIG. 2 illustrates a dilator and cannula which may be formed into an assembly and used in the methods of the present invention.[0018]
• FIGS.[0019]3-10 illustrate the method of the present invention for subcutaneously implanting an article.
• FIG. 11 illustrates a kit constructed in accordance with the principles of the present invention.[0020]
DESCRIPTION OF THE SPECIFIC EMBODIMENTS
• Referring to FIG. 1, a radially[0021]expandable sleeve10 andneedle12 which may be used in the methods and systems of the present invention are illustrated. Thesleeve10 comprises atubular sheath14 having aproximal end16 and adistal end18. Theproximal end16 is tapered radially outward in the proximal direction and secured to ahandle20. An aperture (not shown) in the handle is aligned with the expanded diameter of theproximal end16 and includes abayonet fitting22 aligned with the aperture. Thetubular sheath14 may comprise any material which is capable of receiving the assembly of the cannula and dilator to effect radial expansion of the sheath, as described in more detail hereinafter. In the exemplary embodiment, the sheath comprises an inelastic braid covered by an elastic membrane, as generally described in U.S. Pat. No. 5,431,676, the full disclosure of which is incorporated herein by reference. Suitableexpandable sleeves10 may be obtained commercially from InnerDyne, Inc., Sunnyvale, Calif., as part of the STEP system.
• The[0022]needle12 may comprise a simplesolid core rod24 having a sharpeneddistal tip26. Alternatively, the needle may be cannulated to confirm placement by aspiration or drop tests and/or to facilitate over-the-wire placement. The diameter of the needle will typically be in the range from 1 mm to 2 mm, and advancement of the needle through tissue will generally not result in coring of the tissue. When theneedle12 is placed in the lumen ofsleeve10, the sharpenedtip26 will extend out of the distal end of the sleeve, typically by distance in the range from 1 mm to 3 mm.
• The methods and the systems of the present invention will further utilized an assembly of a[0023]cannula30 anddilator40, as illustrated in FIG. 2. Thecannula30 comprises a rigid, thin-walled tubular member32 having adistal end34 and aproximal end36. Ahandle38 having an aperture aligned with a lumen of thetubular member32 is attached to the proximal end of the tubular member. Thedilator40 comprises asolid core shaft42 having a tapereddistal end44 and ahandle46 at its proximal end. The dilator may be removably inserted into the lumen ofcannula30 so that the tapered distal end of the dilator extends distally beyonddistal end34 of the cannula. The lumenal diameter of the cannula will typically be within the ranges set forth above.
• Referring now to FIGS.[0024]3-10, a method according to the present invention for delivering a drug insert60 (FIG. 7) will be described. Initially, the assembly ofsleeve10 andneedle12 will be percutaneously introduced to a target site TS beneath the patient's skin S (FIG. 3). After reaching the target site TS, theneedle12 is withdrawn in the proximal direction, as shown byarrow62 in FIG. 4. After fully withdrawing theneedle12, the assembly ofcannula30 anddilator40 may be introduced through the inner lumen of theexpandable sleeve10, as shown in FIG. 5. Thetapered end44 of thedilator40 will extend into the tissue at the target site TS. Thedilator40 may then be withdrawn in the proximal direction, indicated byarrow64 in FIG. 6, leaving thecannula30 in place within the radially expandedsleeve10. An opening or potential space O is thus created at thedistal end34 of thecannula30 after thedilator40 is withdrawn. The length of the opening will depend on the distance by which thedilator40 has advanced into the tissue, typically being from 1 mm to 30 mm, usually from 5 mm to 15 mm, depending on the size of the article to be delivered. Alternatively, the opening O could be formed by partially withdrawing the distal end of thecannula30 prior to insertion of the article to be implanted. Thedrug insert60 or other article may then be introduced distally through the lumen of thecannula30 in the direction ofarrow66, as shown in FIG. 7. Conveniently, thedilator40 may be used to push theinsert60 so that it extends into the potential space0, as also shown in FIG. 8.
• After the[0025]insert60 is fully implanted, as shown in FIG. 8, thedilator40 may be withdrawn, followed by withdrawal of thecannula30 in the direction ofarrow70, as shown in FIG. 9. As thecannula30 is proximally withdrawn, thesleeve10 will collapse, allowing thesleeve10 to be readily withdrawn in the direction of arrow72, as shown in FIG. 10. Collapse of the sleeve lessens trauma to the patient.
• Kits according to the present invention will comprise at least some of the components thereof packaged together with instructions for[0026]use80, as shown in FIG. 11. For example, the assembly of radiallyexpandable sleeve10 andneedle12 may be packaged together with the assembly ofcannula30 anddilator40 in apouch82, or other conventional container, such as tray, tube, box, or the like. The instructions foruse80 will set forth any of the methods described above for percutaneously introducing an article beneath a patient's skin for subcutaneous implantation.
• While the above is a complete description of the preferred embodiments of the invention, various alternatives, modifications, and equivalents may be used. Therefore, the above description should not be taken as limiting the scope of the invention which is defined by the appended claims.[0027]

Claims (20)

What is claimed is:

1. A method for implanting an article in solid tissue, said method comprising:

percutaneously inserting a radially expandable sleeve so that a distal end thereof lies adjacent to a target site in solid tissue;

introducing an assembly of a cannula and dilator through the radially expandable sleeve, wherein the diameter of the sleeve is expanded;

removing the dilator from the cannula to leave an open lumen to the tissue target site; and

advancing the article through the cannula lumen and into the tissue target site.

2. A method as inclaim 1, wherein the sleeve inserting step comprises advancing an assembly of the sleeve and a needle into the tissue, wherein a sharpened distal tip of the needle is disposed distally of the sleeve to advance through the tissue first.

3. A method as inclaim 1, wherein the expandable sleeve comprises a tubular braid formed of a mesh of non-elastic filaments which axially shorten as they are expanded.

4. A method as inclaim 1, wherein the assembly introducing step comprises penetrating a tapered distal end of the dilator into the tissue disposed distally of the distal end of the sleeve in order to create an opening in the solid tissue to receive the article.

5. A method as inclaim 1, wherein the cannula lumen has a diameter in the range from 2 mm to 20 mm.

6. A method as inclaim 1, wherein the inserting step comprises introducing the sleeve intramuscularly or subcutaneously.

7. A method as inclaim 6, wherein the article is an implant which releases a drug selected from the group consisting of estrogen, progesterone, and testosterone.

8. An improved method for implanting an article into solid tissue, said method being of the type wherein a tissue tract is formed and dilated to permit advancement of the article, wherein the improvement comprises:

radially expanding the tissue tract to form a lumen having a substantially constant diameter; and

advancing the article through the lumen after the lumen has been substantially completely expanded.

9. An improved method as inclaim 8, wherein the radial expanding step comprises:

percutaneously inserting a radially expandable sleeve so that a distal end thereof lies adjacent to a target site in solid tissue;

introducing an assembly of a cannula and dilator through the radially expandable sleeve, wherein the sleeve is radially expanded; and

removing the dilator from the cannula to leave the substantially constant diameter lumen to the target site.

10. A method as inclaim 9, wherein the sleeve inserting step comprises advancing an assembly of the sleeve and a needle into the tissue, wherein a sharpened distal tip of the needle is disposed distally of the sleeve to advance through the tissue first.

11. A method as inclaim 9, wherein the expandable sleeve comprises a tubular braid formed of a mesh of non-elastic filaments which axially shorten as they are expanded.

12. A method as inclaim 9, wherein the assembly introducing step comprises penetrating a tapered distal end of the dilator into the tissue disposed distally of the distal end of the sleeve in order to create an opening in the solid tissue to receive the article.

13. A method as inclaim 9, wherein the cannula lumen has a diameter in the range from 2 mm to 20 mm.

14. A method as inclaim 9, wherein the inserting step comprises introducing the sleeve intramuscularly or subcutaneously.

15. A method as inclaim 14, wherein the article is an implant which releases a drug selected from the group consisting of estrogen, progesterone, and testosterone.

16. A kit comprising:

a radially expandable sleeve;

a cannula;

a dilator; and

instructions for use according to the method ofclaim 1.

17. A kit as inclaim 16, further comprising an article to be implanted.

18. A kit as inclaim 17, wherein the article comprises a pharmaceutical implant.

19. A system for implanting a drug delivery article in a patient, said system comprising:

a radially expandable sleeve, said sleeve being expandable from a narrow diameter configuration to a large diameter configuration and providing a non-collapsible lumen; and

a drug delivery article having peripheral dimensions which permit it to be delivered through the non-collapsible lumen, wherein the lumen can remain fully open to its large diameter configuration in the absence of the article therein.

20. A system as inclaim 19, further comprising an assembly of a cannula and a dilator removably received in a lumen of the cannula, wherein the assembly is configured to be advanced through the sleeve to radially expand the sleeve and wherein the dilator can be removed from the cannula to leave the non-collapsible lumen through the sleeve.

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