Endoscopic heart surgery method

Abstract

It is an object to provide an endoscopic heart surgery method with which it is possible to observe an endoscopic image with a stable field of view in the pericardial space. Provided is an endoscopic heart surgery method including an inserting step of inserting an inserted portion of an endoscope into a body from the subxiphoid area and inserting the inserted portion into the pericardial space by penetrating the pericardium in the vicinity of the heart apex; a moving step of advancing the inserted portion toward the base of the heart so that the inserted portion passes through the vicinity of the roof of the pericardial space and is moved toward the heart apex to a treated area in the pericardial space; and an observing step of observing the treated area with the endoscope.

1 . An endoscopic heart surgery method comprising:
 an inserting step of inserting an inserted portion of an endoscope into a body from the subxiphoid area and inserting the inserted portion into the pericardial space by penetrating the pericardium in the vicinity of the heart apex;   a moving step of advancing the inserted portion toward the base of the heart so that the inserted portion passes through the vicinity of the roof of the pericardial space and is moved toward the heart apex to a treated area in the pericardial space; and   an observing step of observing the treated area with the endoscope.   
     
     
         2 . An endoscopic heart surgery method according to  claim 1 , wherein the moving step includes a rotating step of passing the inserted portion through the vicinity of the roof of the pericardial space while rotating the inserted portion in a circumferential direction thereof. 
     
     
         3 . An endoscopic heart surgery method according to  claim 1 , wherein the moving step includes a bending step of passing the inserted portion through the vicinity of the roof of the pericardial space while bending a bending portion provided at the inserted portion. 
     
     
         4 . An endoscopic heart surgery method according to  claim 2 , wherein
 in the rotating step, the inserted portion is rotated clockwise, and   in the observing step, the right atrium, the right ventricle, the right coronary artery, the right coronary vein, the right atrial appendage, the heart apex, or the anterior interventricular groove is observed.   
     
     
         5 . An endoscopic heart surgery method according to  claim 2 , wherein
 in the rotating step, the inserted portion is rotated counterclockwise, and   in the observing step, the left atrium, the left ventricle, the left coronary artery, the left coronary vein, the coronary sinus, the left atrial appendage, the heart apex, or the posterior interventricular groove is observed.   
     
     
         6 . An endoscopic heart surgery method according to  claim 1 , wherein the inserting step and the moving step are performed under radiography. 
     
     
         7 . An endoscopic heart surgery method according to  claim 1 , wherein, in the inserting step, the pericardium is penetrated with the inserted portion by the Seldinger method. 
     
     
         8 . An endoscopic heart surgery method according to  claim 1 , further comprising a space ensuring step of ensuring a space between the pericardium and the surface of the heart prior to the observing step by injecting a fluid into the pericardial space via a channel in the inserted portion. 
     
     
         9 . An endoscopic heart surgery method according to  claim 1 , further comprising a posture changing step of changing the posture of the patient before the observing step so that the distal end of the inserted portion is disposed above the heart in the pericardial space. 
     
     
         10 . An endoscopic heart surgery method according to  claim 9 , wherein the posture changing step is performed before the inserting step. 
     
     
         11 . An endoscopic heart surgery method according to  claim 9 , wherein the posture changing step is performed concurrently with the moving step. 
     
     
         12 . An endoscopic heart surgery method according to  claim 8 , further comprising a posture changing step of changing the posture of the patient after the space ensuring step so that the distal end of the inserted portion is disposed above the heart in the pericardial space. 
     
     
         13 . An endoscopic heart surgery method according to  claim 1 , further comprising an orientation confirming step of confirming the orientation of the inserted portion by observing an organ that is outside and adjacent to the pericardium transparently through the pericardium. 
     
     
         14 . An endoscopic heart surgery method according to  claim 1 , further comprising an orientation confirming step of confirming the orientation of the inserted portion by injecting a liquid into the pericardial space and observing the position of the surface of the liquid. 
     
     
         15 . An endoscopic heart surgery method according to  claim 1 , further comprising a pulsation suppressing step of suppressing the pulsation of the heart prior to the observing step by projecting a device toward the heart from a channel of the inserted portion and abutting the device against the heart. 
     
     
         16 . An endoscopic heart surgery method according to  claim 1 , further comprising a pulsation suppressing step of suppressing the pulsation of the heart prior to the observing step by abutting against the heart a device that is inserted into the pericardial space by penetrating the pericardium at a position different from that of the endoscope. 
     
     
         17 . An endoscopic heart surgery method according to  claim 1 , wherein an oblique-viewing endoscope or a lateral-viewing endoscope is used as the endoscope. 
     
     
         18 . An endoscopic heart surgery method according to  claim 1 , wherein an endoscope having a viewing angle wider than or equal to 120° is used as the endoscope. 
     
     
         19 . An endoscopic heart surgery method according to  claim 1 , wherein an endoscope with an outer diameter less than or equal to 6 mm is used as the endoscope.