Surgical support structure

Abstract

This document discusses, among other things, a system for translocating a multilayer patch. The system includes a support structure having a contact surface for bonding to the patch. The support structure has a shape configured to support the patch following separation of the patch from a surrounding tissue.

1 . A system for translocating a multilayer patch of choroid, Bruch's membrane, and retinal pigment epithelium (RPE), the system comprising:
 a support structure having a contact surface for bonding to the patch, the support structure having a shape configured to support the patch following separation of the patch from a surrounding tissue.   
   
   
       2 . The system of  claim 1  further including a tool configured to engage the support structure. 
   
   
       3 . The system of  claim 1  further including a cannula having at least one lumen, wherein the lumen is configured to pass the support structure. 
   
   
       4 . The system of  claim 1  wherein the support structure includes at least one ring shaped member. 
   
   
       5 . The system of  claim 1  wherein the support structure is configured to permanently bond to the patch. 
   
   
       6 . The system of  claim 1  wherein the support structure is configured for removal following translocation of the patch. 
   
   
       7 . A system comprising:
 a support structure having a tissue contact surface configured to bond to a tissue and configured to maintain a fixed shape of the tissue after separation of the tissue from a membrane.   
   
   
       8 . The system of  claim 7  wherein the support structure has a circular configuration. 
   
   
       9 . The system of  claim 7  wherein the support structure includes a first member and a second member, each member of which is adapted to engage with the other. 
   
   
       10 . The system of  claim 9  wherein the first member includes a tongue and the second member includes a groove. 
   
   
       11 . The system of  claim 7  wherein the support structure includes at least one ring. 
   
   
       12 . The system of  claim 11  wherein the at least one ring is endless. 
   
   
       13 . The system of  claim 11  wherein the at least one ring contacts two opposing surfaces of the membrane. 
   
   
       14 . The system of  claim 7  wherein the support structure includes at least one of stainless steel, nitinol, a polymer, a shape memory material, a superelastic material, and a bioerodable material. 
   
   
       15 . The system of  claim 7  wherein the support structure includes at least one of a textured surface and a porous surface. 
   
   
       16 . The system of  claim 7  wherein the support structure includes a coated surface. 
   
   
       17 . The system of  claim 16  wherein the coated surface includes a drug eluting surface. 
   
   
       18 . The system of  claim 7  wherein a portion of the support structure has a cross section corresponding to at least one of a circle, a rectangle, and an oval. 
   
   
       19 . The system of  claim 7  wherein the support structure includes a first member and a second member, and further wherein the tissue contact surface includes a first surface on the first member and a second surface on the second member. 
   
   
       20 . The system of  claim 19  wherein the first member is coupled to the second member by a joint. 
   
   
       21 . The system of  claim 20  wherein the joint includes at least one of a portion of a helix, a hinge, and a flexible linkage. 
   
   
       22 . The system of  claim 7  wherein a first element of the support structure is configured for placement in at least one of a suprachoroidal space of an eye and on a retinal pigment epithelium (RPE) surface of the eye. 
   
   
       23 . The system of  claim 7  further including a manipulator configured to couple with the support structure. 
   
   
       24 . The system of  claim 23  wherein the manipulator includes one or more electrically conductive nodes and wherein the support structure includes one or more corresponding nodes. 
   
   
       25 . The system of  claim 23  wherein the manipulator includes a pair of forceps. 
   
   
       26 . The system of  claim 25  wherein the pair of forceps are adapted for delivering radio frequency (RF) energy. 
   
   
       27 . The system of  claim 25  wherein the pair of forceps is configured to provide bipolar energy. 
   
   
       28 . The system of  claim 25  wherein the pair of forceps includes clamping faces configured to exert a position dependent clamping force. 
   
   
       29 . The system of  claim 23  wherein the support structure includes at least one feature configured to engage a portion of the manipulator. 
   
   
       30 . The system of  claim 29  wherein the feature includes at least one of a tab, a cavity, a graduated section, a ball-shaped element, a t-slot element, a hole, a spring, and a deflectable portion. 
   
   
       31 . The system of  claim 29  wherein the feature allows exertion of a torque on the support structure. 
   
   
       32 . The system of  claim 29  wherein the feature is configured to couple with a radio frequency (RF) energy source. 
   
   
       33 . The system of  claim 7  further including a cannula configured to pass the support structure. 
   
   
       34 . The system of  claim 33  wherein the cannula includes a curved lumen. 
   
   
       35 . The system of  claim 33  wherein the cannula has at least two lumens. 
   
   
       36 . The system of  claim 33  wherein the cannula includes at least two pushrods in contact with the reinforcement structure. 
   
   
       37 . The system of  claim 7  wherein the support structure includes a mesh. 
   
   
       38 . The system of  claim 37  wherein the support structure includes a first portion and a second portion and wherein the mesh is disposed on the first portion. 
   
   
       39 . The system of  claim 7  wherein the support structure is configured for placement on a single side of the membrane. 
   
   
       40 . The system of  claim 7  wherein the support structure includes a first portion configured for placement on a first surface of the membrane and a second portion configured for placement on a second surface of the membrane. 
   
   
       41 . The system of  claim 40  wherein a tissue contacting surface of the first portion includes at least two conductors separated by an insulator. 
   
   
       42 . The system of  claim 41  wherein the at least two conductors includes concentric metal conductors. 
   
   
       43 . A method comprising:
 affixing a first support structure on a target of a membrane; and   separating the target from the membrane by manipulating the first support structure.   
   
   
       44 . The method of  claim 43  further comprising positioning the target at a destination site of the membrane. 
   
   
       45 . The method of  claim 44  further comprising affixing the target at the destination site. 
   
   
       46 . The method of  claim 43  further comprising placing a second support structure on a second surface of the membrane. 
   
   
       47 . The method of  claim 46  wherein placing the second support structure includes orienting the first support structure and the second support structure in a predetermined alignment. 
   
   
       48 . The method of  claim 43  wherein separating includes at least one of coagulating, ablating, and forming an incision. 
   
   
       49 . The method of  claim 43  wherein affixing the first support structure includes transitioning a superelastic material from a first configuration to a second configuration during introduction into the eye. 
   
   
       50 . The method of  claim 43  wherein affixing the first support structure includes transitioning a shape memory material from a first configuration to a second configuration. 
   
   
       51 . The method of  claim 43  wherein affixing includes manipulating a linear element within a guide. 
   
   
       52 . The method of  claim 43  wherein affixing includes bonding the first support structure to the membrane. 
   
   
       53 . The method of  claim 52  wherein bonding includes applying energy. 
   
   
       54 . The method of  claim 53  wherein applying energy includes applying at least one of radio frequency energy, thermal energy, optical energy, and electrical energy. 
   
   
       55 . A system comprising:
 a guide having a central lumen;   an internal member disposed in the central lumen; and   a pair of split rings coupled to the internal member wherein each split ring is held in parallel alignment.   
   
   
       56 . The system of  claim 55  wherein the pair of split rings includes nitinol. 
   
   
       57 . The system of  claim 55  wherein the internal member includes a first linear wire and a second linear wire and further wherein each of the first linear wire and the second linear wire is coupled to one each of the pair of split rings. 
   
   
       58 . A method comprising:
 bonding tissue to a support structure, the tissue supported by a membrane;   separating the bonded tissue from the membrane; and   manipulating the support structure to reposition the bonded tissue.   
   
   
       59 . The method of  claim 58  wherein bonding includes forming a chemical bond. 
   
   
       60 . The method of  claim 59  wherein forming a chemical bond includes using an adhesive. 
   
   
       61 . The method of  claim 58  further including selectively disbonding the support structure. 
   
   
       62 . The method of  claim 61  wherein selectively disbonding includes at least one of bioeroding and laser ablating. 
   
   
       63 . The method of  claims 58  wherein manipulating includes engaging a feature of the support structure. 
   
   
       64 . The method of  claim 58  wherein manipulating includes exerting a torque on the support structure. 
   
   
       65 . The method of  claim 58  wherein bonding includes applying radio frequency (RF) energy. 
   
   
       66 . The method of  claim 58  wherein bonding includes coupling with a surgical tool. 
   
   
       67 . The method of  claim 58  wherein bonding includes applying RF energy at each of a plurality of features of the support structure. 
   
   
       68 . The method of  claim 58  wherein separating includes at least one of coagulating and forming an incision. 
   
   
       69 . A system comprising:
 a cannula configured to pass through a tissue wall, the cannula having at least one lumen; and   a support structure disposed for passage through the lumen, wherein the support structure is configured to change shape upon ejection from the lumen and is configured to bond to a membrane.   
   
   
       70 . The system of  claim 69  wherein the support structure is configured to bond to two surfaces of the membrane. 
   
   
       71 . The system of  claim 69  wherein the at least one lumen is curved. 
   
   
       72 . The system of  claim 69  wherein the support structure includes a ring. 
   
   
       73 . The system of  claim 72  wherein the ring is separable from a pushrod, and wherein a portion of the pushrod is configured for passage through the lumen. 
   
   
       74 . The system of  claim 72  further comprising a pushrod configured for passage through the lumen and wherein the ring is in contact with the pushrod. 
   
   
       75 . The system of  claim 72  wherein a portion of the ring has a cross section corresponding to at least one of a circle, a rectangle, and an oval. 
   
   
       76 . The system of  claim 69  wherein the support structure includes at least one of a shape memory material and a superelastic material. 
   
   
       77 . The system of  claim 69  wherein the support structure includes a split ring. 
   
   
       78 . The system of  claim 69  wherein the support structure includes two ring members in parallel alignment. 
   
   
       79 . The system of  claim 69  wherein the support structure includes an electrical conductor. 
   
   
       80 . The system of  claim 79  wherein an electric current in the support structure causes the support structure to bond to the membrane. 
   
   
       81 . The system of  claim 69  wherein a first portion of the support structure is configured to bond to a first surface of the membrane and a second portion of the support structure is configured to bond to an opposing surface of the membrane. 
   
   
       82 . A system for translocating a multilayer patch of choroid, Bruch's membrane, and retinal pigment epithelium (RPE) the system comprising:
 support means having a contact surface for bonding to the patch, the support means having a shape configured to support the patch following separation of the patch from a surrounding tissue.   
   
   
       83 . The system of  claim 82  further including an engaging means to couple with the support means. 
   
   
       84 . The system of  claim 82  further including a passing means having a lumen, wherein the lumen is configured to pass the support means. 
   
   
       85 . The system of  claim 82  wherein the support means includes at least one ring shaped member. 
   
   
       86 . The system of  claim 82  wherein the support means is configured to permanently bond to the patch. 
   
   
       87 . The system of  claim 82  wherein the support means is configured for removal following translocation of the patch.