US20030083656A1 - Tissue separator assembly and method - Google Patents
Tissue separator assembly and method Download PDFInfo
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- US20030083656A1 US20030083656A1 US10/045,657 US4565701A US2003083656A1 US 20030083656 A1 US20030083656 A1 US 20030083656A1 US 4565701 A US4565701 A US 4565701A US 2003083656 A1 US2003083656 A1 US 2003083656A1
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- tissue
- assembly
- distal
- shaft
- separator element
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/148—Probes or electrodes therefor having a short, rigid shaft for accessing the inner body transcutaneously, e.g. for neurosurgery or arthroscopy
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00831—Material properties
- A61B2017/00867—Material properties shape memory effect
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B2017/1205—Introduction devices
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B2017/22051—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
- A61B2017/22061—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation for spreading elements apart
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- A—HUMAN NECESSITIES
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- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
- A61B2017/2212—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions having a closed distal end, e.g. a loop
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- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
- A61B2017/2215—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions having an open distal end
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00214—Expandable means emitting energy, e.g. by elements carried thereon
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/00601—Cutting
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1475—Electrodes retractable in or deployable from a housing
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
- A61B2090/3904—Markers, e.g. radio-opaque or breast lesions markers specially adapted for marking specified tissue
- A61B2090/3908—Soft tissue, e.g. breast tissue
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/02—Devices for expanding tissue, e.g. skin tissue
Definitions
- tissue separator assembly including the proximal end assembly, typically a handle, and catheter assembly extending from the proximal end assembly.
- the catheter assembly includes a shaft and an elongate tissue separator element, a distal part of which is movable between a retracted state and an outwardly extending, operational state.
- the proximal end assembly includes a first driver coupled to the tissue separator element and constructed to (1) to move the tissue separator element from the retracted state to the operational state, and (2) automatically rotate the tissue separator element about the axis, whereby a tissue section is separable from the surrounding tissue by the moving tissue separator element.
- tissue separator assembly including the proximal end assembly, typically a handle, and catheter assembly extending from the proximal end assembly.
- the catheter assembly includes a shaft and an elongate tissue separator element, a distal part of which is movable between a retracted state and an outwardly bowed, operational state.
- An energy source is selectively coupled to the tissue separator element.
- the proximal end assembly includes a first driver coupled to the tissue separator element and constructed to (1) to move the tissue separator element from the retracted state to the operational state, and (2) automatically rotate the tissue separator element about the axis, whereby a tissue section is separable from the surrounding tissue by the moving tissue separator element.
- the catheter assembly also includes a tissue holding element at the distal portion of the shaft movable from a retracted condition to an extended, tissue engaging condition so to help secure a separated tissue section to the catheter assembly.
- the catheter assembly further includes a tubular braided element at the distal portion of the shaft movable to a radially expanded state so to surround the tissue separator element and any separated tissue section.
- the proximal end assembly also includes a second driver coupled to the holding element and to the tubular braided element. The second driver is constructed to move the holding element to the extended, tissue engaging condition and move the tubular braided element to the distal, radially expanded state.
- tissue separator assembly including the proximal end assembly, typically a handle, and catheter assembly extending from the proximal end assembly.
- the catheter assembly includes a shaft and a movable tissue separator element.
- the proximal end assembly includes a first driver coupled to the tissue separator element and constructed to drive the tissue separator element through tissue to separate a tissue section from surrounding tissue.
- the catheter assembly also includes a tissue holding element at the distal portion of the shaft movable from a retracted condition to an extended, tissue engaging condition so to help secure a separated tissue section to the catheter assembly.
- the catheter assembly further includes a tubular braided element at the distal portion of the shaft movable to a radially expanded state so to surround the tissue separator element and any separated tissue section.
- the proximal end assembly also includes a second driver coupled to the holding element and to the tubular braided element. The second driver is constructed to move the holding element to the extended, tissue engaging condition and move the tubular braided element to the distal, radially expanded state.
- a further aspect of the invention is directed to a method for creating a tissue section within surrounding tissue.
- the method includes positioning a distal end of a catheter assembly at a target location within a patient.
- An elongate tissue separator element, at the distal end of the catheter assembly, is moved to an outwardly extending, operational state.
- the separator element is automatically rotated about the axis, following at least the start of the separator element moving step, so to separate a tissue section from surrounding tissue.
- the method may also include moving a tissue holding element, located at the distal end of the catheter assembly, from a retracted condition to an extended, tissue engaging condition. Further, the method may include surrounding the separated tissue section with a tubular braided element.
- a still further aspect of the invention is directed to a method for creating a tissue section within surrounding tissue.
- the method includes positioning a distal end of the catheter assembly at a target location within a breast of a patient.
- An elongate tissue separator element, at the distal end of the catheter assembly is moved to a radially extended, outwardly bowed, operational state. Energy is supplied to the separator element.
- the separator element is automatically rotated about the axis, following at least the start of the separator element moving step, so to separate a tissue section from surrounding tissue.
- a tissue holding element, located at the distal end of the catheter assembly is moved from a retracted condition to an extended, tissue engaging condition.
- the separated tissue section is surrounded by a tubular braided element by moving the tubular braided element, located at the distal end of the catheter assembly, from a proximal, radially contracted state to a distal, radially expanded state following the automatically rotating step.
- FIG. 1 is a partially schematic overall view of a tissue separator assembly made according to the invention with portions of the handle removed for clarity;
- FIG. 1A is a simplified cross-sectional view taken along line 1 A- 1 A of FIG. 1 showing the engagement of a pin within a slot in the lead nut mounted to the lead screw;
- FIG. 2 is schematic view of portions of the drive elements of the assembly of FIG. 1;
- FIG. 3 is a simplified cross-sectional view of the catheter assembly taken along line 3 - 3 of FIG. 1;
- FIG. 4 is an oblique view of the housing half of FIG. 1 together with the drive screw, drive nut and an L-shaped actuator connected to and movable with the drive nut;
- FIGS. 5 and 6 show the handle and catheter assembly of FIG. 1 after the actuator has moved from the position of FIG. 1 and the actuator extension has pushed the separator wire pusher screw in a distal direction causing the separator wire to move radially outwardly;
- FIG. 7 is a simplified the end view of the block and the pusher screw just after the pusher screw has exited the slot in the block showing the off-vertical orientation of the pusher screw;
- FIG. 8 illustrates the proximal end of the lead screw, which is visible from outside the housing, and a rotary position indicator marked thereon corresponding to the position of the separator wire in FIG. 10;
- FIGS. 9 and 10 illustrate the structure of FIGS. 5 and 6 after the drive screw has moved the actuator distally causing the lead nut to rotate the lead screw, catheter shaft and separator wire therewith about 540 degrees to create a separated tissue section;
- FIGS. 11 and 12 illustrate the manual actuation of tissue section holding elements
- FIG. 13 is a simplified view of certain of the components of FIG. 12;
- FIG. 14 is a cross-sectional view of the catheter taken along line 14 - 14 of FIG. 13;
- FIGS. 15 and 16 illustrate the manual actuation of a tubular braided element to surround the separated tissue section
- FIG. 17 is a simplified view of certain of the components of FIG. 16.
- FIGS. 1 and 2 illustrate a tissue separator assembly 10 used to separate target tissue from surrounding tissue, typically within a patient's breast. The removal of target tissue may be for diagnostic or therapeutic purposes.
- the assembly 10 includes a catheter assembly 12 extending from a handle 14 . Introduction of catheter assembly 12 into the patient, typically through the skin, is preferably aided by the use of, for example, a trocar or an RF tip to provide a suitable path through the tissue.
- a stepper motor 16 is connected to handle 14 by a drive drive cable 18 and a drive cable connector 20 mounted to the handle housing 22 . Note that in the figures only one-half of handle housing 22 is shown; the other housing half is substantially similar.
- RF energy is supplied to catheter assembly 12 from an RF source 24 , along drive cable 18 and to the interior of handle 14 .
- a controller 26 controls the operation of stepper motor 16 as well as RF source 24 , such as speed of operation and energy level. Controller 26 also receives appropriate feedback signals from handle 14 and catheter assembly 12 , such as tissue temperature, resistance force signals, rotary orientation, and so forth.
- Drive cable 18 is connected to and rotates a drive screw 28 rotatably mounted within handle 14 at a fixed axial location by drive screw supports 30 , 32 .
- a drive nut 34 is threadably mounted to drive screw 28 .
- An L-shaped actuator 36 is secured to drive nut 34 .
- Actuator 36 see FIG. 4, includes a generally horizontal base portion 38 and a generally vertical upright portion 40 sized and configured to move within handle 14 parallel to the axis of drive screw 28 . Therefore, rotation of drive screw 28 by stepper motor 16 causes actuator 36 to slide within housing 22 from the initial position of FIG. 1 to the position of FIG. 10. Reverse and reciprocating movement is also possible.
- Catheter assembly 12 includes in introducer sheath 42 mounted to and extending from housing 22 .
- Catheter assembly 12 also includes an actuator tube 43 , discussed below with reference to FIGS. 14 - 17 , passing through sheath 42 and a shaft 44 passing through tube 43 .
- Shaft 44 has a distal portion 46 extending distally of the distal end 48 of sheath 42 and a proximal portion 50 extending into the interior of handle 14 .
- Proximal portion 50 is secured to and rotates with a lead screw 52 .
- shaft 44 rotates with lead screw 52 .
- Lead screw 52 is mounted within housing 22 in a manner so that it can rotate but not move axially within housing 22 .
- a tissue separator device 54 extends along shaft 44 and has a separator wire portion 56 secured to the distal end 58 of shaft 44 .
- the separator wire 56 is positioned externally of distal portion 46 .
- the majority of tissue separator device 54 is in the form of a wire and extends through an axial bore 60 formed in shaft 44 .
- the separator device 54 has a radially extending pusher screw 62 at its proximal end.
- the proximal end of shaft 44 has an axially extending slot 64 , see FIG. 2, through which pusher screw 62 extends. Accordingly, pushing pusher screw 62 distally, that is to the left in the figures, causes tissue separator wire 56 to move outwardly from its radially contracted condition of FIG.
- wire 56 is supplied with RF energy from RF source 24 .
- Other applications of energy such as mechanical reciprocation or mechanical vibration, can also be used.
- the axial movement of pusher screw 62 is caused by the axial movement of actuator 36 .
- Actuator 36 has an extension 66 extending distally from upright portion 40 .
- Extension 66 has a downwardly formed distal end 68 aligned with pusher screw 62 .
- the initial axial movement of actuator 40 caused by the rotation of drive screw 28 by stepper motor 16 , closes a small gap 70 (see FIG. 2) between distal end 68 and pusher screw 62 . This small gap permits the initiation of an electrosurgical arc prior to the outwardly radial movement of separator wire 56 .
- Continued distal movement of actuator 36 moves pusher screw 62 distally causing separator wire 56 to bow outwardly to the position of FIGS. 5 and 6.
- FIGS. 5 and 6 show the use of a support block 72 , which is a part of housing 22 , to support the distal end of lead screw 52 and the proximal end of shaft 44 .
- Support block 72 has an axially extending slot 74 , see FIGS. 5 and 7, which initially houses pusher screw 62 .
- pusher screw 62 exits slot 74 and the distal end 68 of extension 66 , which has a chamfered face, causes pusher screw 62 , along with shaft 44 , to begin rotating to the off-vertical position of FIG. 7.
- upright portion 40 of actuator 36 closes gap 73 (see FIG.
- Assembly 10 is configured so that shaft 44 rotates about 540 degrees to ensure a tissue section 80 is completely separated from the surrounding tissue by the passage of separator wire 56 through the tissue.
- the radial position of separator wire 56 can be easily determined by looking at the proximal end 82 of lead screw 52 , which is exposed through housing 22 . See FIG. 8.
- Proximal end 82 has a rotary position indicator 84 formed thereon corresponding to the rotary position of separator wire 56 .
- Assembly 10 also includes a T-pusher device 86 having a pair of pusher tabs 88 extending laterally outwardly from slots formed in housing 22 . See FIGS. 11 - 13 . After shaft 44 has completed its rotation, the user begins pushing tabs 88 distally. This causes an extension 90 of device 86 to rotate a flipper cam 92 about a pivot pin 94 ; flipper cam 92 is connected to the proximal ends of a pair of tissue section holding elements 96 . Holding elements 96 are in the form of wires passing through axial bores 98 formed in shaft 44 as shown in FIG. 3.
- holding elements 96 are preformed hook wires 100 , preferably made of a shape memory material such as nitinol, which pass through openings formed in distal portion 46 of shaft 44 and engage separated tissue section 80 to help secure tissue section 80 to distal portion 46 of shaft 44 .
- a shape memory material such as nitinol
- Device 86 includes a distal end 102 connected to the proximal end of actuator tube 43 .
- the movement of device 86 causes tube 43 to move distally within introducer sheath 42 .
- a tubular braided element 104 see FIGS. 14 - 17 , secured to the distal end of actuator tube 43 , is still fully housed within sheath 42 .
- Further distal movement of device 86 causes tubular braided element 104 to extend outwardly past distal end 48 of sheath 42 to the position of FIGS. 15 - 17 .
- tubular braided element 104 The purpose of tubular braided element 104 is to surround separated tissue section 80 by passing along the dissection plane between the separated tissue section and the surrounding tissue.
- the open outer end 106 of element 104 naturally expands radially as it is pushed axially through the tissue.
- shaft 44 has an outwardly tapered guide surface 108 , formed on a guide element 110 , positioned adjacent to distal end 48 of introducer shaft 42 .
- Guide element 110 has a slot in its proximal surface into which the proximal end of separator wire 56 passes when in the radially expanded condition of FIG. 9; this helps to keep separator wire 56 from folding over during rotation.
- outer end 106 of tubular braided element 104 could include a drawstring or other type of closure element.
- the separated tissue section 80 now substantially enclosed within tubular braided element 104 and secured to distal portion 46 of shaft 44 by hook wires 100 , may be removed from the patient.
- separated tissue section 80 retains most if not all of its physical integrity once removed from the patient. Also, the use of tubular braided element 104 , especially when it is sealed or otherwise impermeable to the passage of material, helps to reduce the possibility of seeding diseased tissue along the tissue tract during removal of separated tissue section 80 .
- a target tissue localization device such as disclosed in U.S. Pat. No. 6,179,860, may be incorporated into assembly 10 ; such a localization device would be deployed, as indicated by dashed lines 112 in FIG. 1 and localization device actuator shaft 114 in FIG. 18, after placement of distal portion 46 of shaft 44 at the target site and would be used to help stabilize the assembly and also help contain, in conjunction with a tubular braided element 104 , separated tissue section 80 .
- Lead screw 52 could be hollow to permit actuator shaft 114 , or other medical devices, to pass therethrough and into a lumen within shaft 44 .
- stepper motor 16 drive screw 28 and drive nut 34
- other driving mechanisms such as spring driven drivers with appropriately configured escape mechanisms and/or movement damping devices, could be used.
- shaft 44 does not begin to rotate until after separator wire 56 has reached its fully radially extended state. In some situations it may be desired to begin rotating shaft 44 before and/or during the outward movement of separator wire 56 .
Abstract
A tissue separator assembly includes a proximal end assembly, typically a handle, and a catheter assembly, including a shaft and a tissue separator movable between a retracted state and an outwardly extending, operational state. An energy source may be selectively coupled to the tissue separator element. The tissue separator element may be moved to the operational state and then automatically rotated to separate a tissue section from the surrounding tissue. A tissue holding element may be used to help secure a separated tissue section to the catheter assembly. A tubular braided element may be used to surround the tissue separator element and any separated tissue section.
Description
- This application claims the benefit of U.S. Provisional Patent Application No. 60/246,413 filed Nov. 7, 2000 and entitled Tissue Therapy and/or Removal Apparatus and Methods for Use. See also: (1) U.S. Pat. No. 6,179,860 issued Jan. 30, 2001 and entitled Target Tissue Localization Device And Method, (2) International Publication No. WO 00/10471 published Mar. 2, 2000 and entitled Target Tissue Localization Device And Method, (3) U.S. Pat. No. 6,221,006 issued Apr. 24, 2001 and entitled Entrapping Apparatus And Method For Use, (4) International Publication No. WO 99/39648 published Aug. 12, 1999 and entitled Entrapping Apparatus And Method For Use, (5) U.S. patent application Ser. No. 09/588,278 filed Jun. 5, 2000 and entitled Tissue Removal Methods And this Apparatus, and (6) International Publication No. WO 00/74561 published Dec. 14, 2000 and entitled Tissue Removal Methods And Apparatus.
- The M. D. Anderson Cancer Center in Houston, Texas predicts that cancer will become the leading cause of death in the United States by the year 2002. Cancer presently results in over one thousand five hundred deaths every day in the United States (550,000 deaths every year). Therapy modalities for cancer are plentiful and continued to be researched with vigor. Still, the preferred treatment continues to be physical removal of the cancer. When applicable, surgical removal is preferred (breast, colon, brain, lung, kidney, etc.). Open, excisional, surgical removal is often extremely invasive so that efforts to remove cancerous tissue in less invasive ways continue, but have not yet been perfected.
- The only cure for cancer continues to be the early diagnosis and subsequent early treatment. As cancer therapies continue at earlier stages of diagnosis, the cancerous tissue being operated on is also smaller. Early removal of the smaller cancers demand new techniques for removal and obliteration of these less invasive cancers.
- There are a variety of techniques that attempt to accomplish less invasive cancer therapy, but so far without sufficiently improved results. For example, the ABBI system from U.S. Surgical Corporation and the Site Select system from ImaGyn Corporation, attempt to accomplish less invasive cancer therapy. However, conventional techniques require more than Minimally Invasive Surgery (MIS) techniques in that they require a large core (that is more than about 15 mm diameter) incision. Additionally, the Mammotome system from Johnson and Johnson and MIBB system from U.S. Surgical Corporation also require large core (over about 4 mm diameter) access to accomplish biopsy.
- A recent convention held by the American Society of Surgical Oncologists on Mar. 13, 2000 reported that conventional stereotactic core biopsy (SCB) procedures fall short in providing definitive answers to detail precise surgical regimens after this SCB type vacuum assisted biopsy, especially with ductile carcinoma in situ (DCIS). Apparently these percutaneous systems damage “normal” tissue cells so that it is difficult to determine if the cells are “normal damaged” cells or early pre-cancerous (e.g. Atypical Ductal Hyerplasia (ADH)) cells.
- A study presented by Dr. Ollila et al. from the University of North Carolina, Chapel Hill, demonstrated that histology and pathology is compromised using these conventional techniques because of the damage done to the removed tissue specimens. Hence, for many reasons, including the fact that DCIS is becoming more detectable and hence more prevalent in breast cancer diagnosis in the U.S., there is a growing need to improve upon conventional vacuum assisted core biopsy systems.
- One aspect of the invention is directed to a tissue separator assembly including the proximal end assembly, typically a handle, and catheter assembly extending from the proximal end assembly. The catheter assembly includes a shaft and an elongate tissue separator element, a distal part of which is movable between a retracted state and an outwardly extending, operational state. The proximal end assembly includes a first driver coupled to the tissue separator element and constructed to (1) to move the tissue separator element from the retracted state to the operational state, and (2) automatically rotate the tissue separator element about the axis, whereby a tissue section is separable from the surrounding tissue by the moving tissue separator element.
- Another aspect of the invention is directed to a tissue separator assembly including the proximal end assembly, typically a handle, and catheter assembly extending from the proximal end assembly. The catheter assembly includes a shaft and an elongate tissue separator element, a distal part of which is movable between a retracted state and an outwardly bowed, operational state. An energy source is selectively coupled to the tissue separator element. The proximal end assembly includes a first driver coupled to the tissue separator element and constructed to (1) to move the tissue separator element from the retracted state to the operational state, and (2) automatically rotate the tissue separator element about the axis, whereby a tissue section is separable from the surrounding tissue by the moving tissue separator element. The catheter assembly also includes a tissue holding element at the distal portion of the shaft movable from a retracted condition to an extended, tissue engaging condition so to help secure a separated tissue section to the catheter assembly. The catheter assembly further includes a tubular braided element at the distal portion of the shaft movable to a radially expanded state so to surround the tissue separator element and any separated tissue section. The proximal end assembly also includes a second driver coupled to the holding element and to the tubular braided element. The second driver is constructed to move the holding element to the extended, tissue engaging condition and move the tubular braided element to the distal, radially expanded state.
- Another aspect of the invention is directed to a tissue separator assembly including the proximal end assembly, typically a handle, and catheter assembly extending from the proximal end assembly. The catheter assembly includes a shaft and a movable tissue separator element. The proximal end assembly includes a first driver coupled to the tissue separator element and constructed to drive the tissue separator element through tissue to separate a tissue section from surrounding tissue. The catheter assembly also includes a tissue holding element at the distal portion of the shaft movable from a retracted condition to an extended, tissue engaging condition so to help secure a separated tissue section to the catheter assembly. The catheter assembly further includes a tubular braided element at the distal portion of the shaft movable to a radially expanded state so to surround the tissue separator element and any separated tissue section. The proximal end assembly also includes a second driver coupled to the holding element and to the tubular braided element. The second driver is constructed to move the holding element to the extended, tissue engaging condition and move the tubular braided element to the distal, radially expanded state.
- A further aspect of the invention is directed to a method for creating a tissue section within surrounding tissue. The method includes positioning a distal end of a catheter assembly at a target location within a patient. An elongate tissue separator element, at the distal end of the catheter assembly, is moved to an outwardly extending, operational state. The separator element is automatically rotated about the axis, following at least the start of the separator element moving step, so to separate a tissue section from surrounding tissue. The method may also include moving a tissue holding element, located at the distal end of the catheter assembly, from a retracted condition to an extended, tissue engaging condition. Further, the method may include surrounding the separated tissue section with a tubular braided element.
- A still further aspect of the invention is directed to a method for creating a tissue section within surrounding tissue. The method includes positioning a distal end of the catheter assembly at a target location within a breast of a patient. An elongate tissue separator element, at the distal end of the catheter assembly, is moved to a radially extended, outwardly bowed, operational state. Energy is supplied to the separator element. The separator element is automatically rotated about the axis, following at least the start of the separator element moving step, so to separate a tissue section from surrounding tissue. A tissue holding element, located at the distal end of the catheter assembly, is moved from a retracted condition to an extended, tissue engaging condition. The separated tissue section is surrounded by a tubular braided element by moving the tubular braided element, located at the distal end of the catheter assembly, from a proximal, radially contracted state to a distal, radially expanded state following the automatically rotating step.
- Other features and advantages of the invention will appear from the following description in which the preferred embodiments have been set forth in detail in conjunction with the accompanying drawings.
- FIG. 1 is a partially schematic overall view of a tissue separator assembly made according to the invention with portions of the handle removed for clarity;
- FIG. 1A is a simplified cross-sectional view taken along line1A-1A of FIG. 1 showing the engagement of a pin within a slot in the lead nut mounted to the lead screw;
- FIG. 2 is schematic view of portions of the drive elements of the assembly of FIG. 1;
- FIG. 3 is a simplified cross-sectional view of the catheter assembly taken along line3-3 of FIG. 1;
- FIG. 4 is an oblique view of the housing half of FIG. 1 together with the drive screw, drive nut and an L-shaped actuator connected to and movable with the drive nut;
- FIGS. 5 and 6 show the handle and catheter assembly of FIG. 1 after the actuator has moved from the position of FIG. 1 and the actuator extension has pushed the separator wire pusher screw in a distal direction causing the separator wire to move radially outwardly;
- FIG. 7 is a simplified the end view of the block and the pusher screw just after the pusher screw has exited the slot in the block showing the off-vertical orientation of the pusher screw;
- FIG. 8 illustrates the proximal end of the lead screw, which is visible from outside the housing, and a rotary position indicator marked thereon corresponding to the position of the separator wire in FIG. 10;
- FIGS. 9 and 10 illustrate the structure of FIGS. 5 and 6 after the drive screw has moved the actuator distally causing the lead nut to rotate the lead screw, catheter shaft and separator wire therewith about 540 degrees to create a separated tissue section;
- FIGS. 11 and 12 illustrate the manual actuation of tissue section holding elements;
- FIG. 13 is a simplified view of certain of the components of FIG. 12;
- FIG. 14 is a cross-sectional view of the catheter taken along line14-14 of FIG. 13;
- FIGS. 15 and 16 illustrate the manual actuation of a tubular braided element to surround the separated tissue section; and
- FIG. 17 is a simplified view of certain of the components of FIG. 16.
- FIGS. 1 and 2 illustrate a
tissue separator assembly 10 used to separate target tissue from surrounding tissue, typically within a patient's breast. The removal of target tissue may be for diagnostic or therapeutic purposes. Theassembly 10 includes acatheter assembly 12 extending from ahandle 14. Introduction ofcatheter assembly 12 into the patient, typically through the skin, is preferably aided by the use of, for example, a trocar or an RF tip to provide a suitable path through the tissue. Astepper motor 16 is connected to handle 14 by adrive drive cable 18 and adrive cable connector 20 mounted to thehandle housing 22. Note that in the figures only one-half ofhandle housing 22 is shown; the other housing half is substantially similar. RF energy is supplied tocatheter assembly 12 from anRF source 24, alongdrive cable 18 and to the interior ofhandle 14. Acontroller 26 controls the operation ofstepper motor 16 as well asRF source 24, such as speed of operation and energy level.Controller 26 also receives appropriate feedback signals fromhandle 14 andcatheter assembly 12, such as tissue temperature, resistance force signals, rotary orientation, and so forth. -
Drive cable 18 is connected to and rotates adrive screw 28 rotatably mounted withinhandle 14 at a fixed axial location by drive screw supports 30, 32. Adrive nut 34 is threadably mounted to drivescrew 28. An L-shapedactuator 36 is secured to drivenut 34.Actuator 36, see FIG. 4, includes a generallyhorizontal base portion 38 and a generallyvertical upright portion 40 sized and configured to move withinhandle 14 parallel to the axis ofdrive screw 28. Therefore, rotation ofdrive screw 28 bystepper motor 16 causes actuator 36 to slide withinhousing 22 from the initial position of FIG. 1 to the position of FIG. 10. Reverse and reciprocating movement is also possible. -
Catheter assembly 12 includes inintroducer sheath 42 mounted to and extending fromhousing 22.Catheter assembly 12 also includes anactuator tube 43, discussed below with reference to FIGS. 14-17, passing throughsheath 42 and ashaft 44 passing throughtube 43. See FIG. 3.Shaft 44 has adistal portion 46 extending distally of thedistal end 48 ofsheath 42 and aproximal portion 50 extending into the interior ofhandle 14.Proximal portion 50 is secured to and rotates with alead screw 52. Accordingly,shaft 44 rotates withlead screw 52. Leadscrew 52 is mounted withinhousing 22 in a manner so that it can rotate but not move axially withinhousing 22. Atissue separator device 54 extends alongshaft 44 and has aseparator wire portion 56 secured to the distal end 58 ofshaft 44. Theseparator wire 56 is positioned externally ofdistal portion 46. The majority oftissue separator device 54 is in the form of a wire and extends through anaxial bore 60 formed inshaft 44. Theseparator device 54 has a radially extendingpusher screw 62 at its proximal end. The proximal end ofshaft 44 has an axially extendingslot 64, see FIG. 2, through which pusher screw 62 extends. Accordingly, pushingpusher screw 62 distally, that is to the left in the figures, causestissue separator wire 56 to move outwardly from its radially contracted condition of FIG. 1 to its radially extended condition of FIGS. 5 and 6. This radially outwardly movement is typically accomplished at the target site within the patient, typically a patient's breast. To aid movement of separator wire through the tissue,wire 56 is supplied with RF energy fromRF source 24. Other applications of energy, such as mechanical reciprocation or mechanical vibration, can also be used. - The axial movement of
pusher screw 62 is caused by the axial movement ofactuator 36.Actuator 36 has anextension 66 extending distally fromupright portion 40.Extension 66 has a downwardly formeddistal end 68 aligned withpusher screw 62. The initial axial movement ofactuator 40, caused by the rotation ofdrive screw 28 bystepper motor 16, closes a small gap 70 (see FIG. 2) betweendistal end 68 andpusher screw 62. This small gap permits the initiation of an electrosurgical arc prior to the outwardly radial movement ofseparator wire 56. Continued distal movement ofactuator 36 moves pusher screw 62 distally causingseparator wire 56 to bow outwardly to the position of FIGS. 5 and 6. FIGS. 5 and 6 (but not FIG. 1) show the use of asupport block 72, which is a part ofhousing 22, to support the distal end oflead screw 52 and the proximal end ofshaft 44.Support block 72 has an axially extendingslot 74, see FIGS. 5 and 7, which initially housespusher screw 62. At thetime support wire 56 is fully extended,pusher screw 62exits slot 74 and thedistal end 68 ofextension 66, which has a chamfered face, causespusher screw 62, along withshaft 44, to begin rotating to the off-vertical position of FIG. 7. At the same timeupright portion 40 ofactuator 36 closes gap 73 (see FIG. 2) and contacts alead nut 75 threadably mounted onlead screw 52. Ananti-rotation pin 76 extends fromupright portion 40 ofactuator 36 and is housed within aU-shaped slot 78 formed inlead nut 74, see FIG. 1A, to preventlead nut 74 from rotating aroundlead screw 52 aslead nut 74 it is moved axially byactuator 36. Instead, the axial movement ofactuator 36 causes leadscrew 52 to rotate thus rotatingshaft 44.Assembly 10 is configured so thatshaft 44 rotates about 540 degrees to ensure atissue section 80 is completely separated from the surrounding tissue by the passage ofseparator wire 56 through the tissue. The radial position ofseparator wire 56 can be easily determined by looking at theproximal end 82 oflead screw 52, which is exposed throughhousing 22. See FIG. 8.Proximal end 82 has arotary position indicator 84 formed thereon corresponding to the rotary position ofseparator wire 56. - The above described sequence of events, according to this disclosed embodiment, proceeds automatically once initiated by a user. Of course operation of the device, including one or more of extension of
separator wire 56, rotation ofshaft 44 and energizingwire 56, can be terminated manually or automatically based on, for example, an unexpected resistance to the rotation ofshaft 44. With the disclosed embodiment the following events proceed manually; however, the assembly could be designed so that any or all of the following could be accomplished automatically. -
Assembly 10 also includes a T-pusher device 86 having a pair ofpusher tabs 88 extending laterally outwardly from slots formed inhousing 22. See FIGS. 11-13. Aftershaft 44 has completed its rotation, the user begins pushingtabs 88 distally. This causes anextension 90 ofdevice 86 to rotate aflipper cam 92 about apivot pin 94;flipper cam 92 is connected to the proximal ends of a pair of tissuesection holding elements 96. Holdingelements 96 are in the form of wires passing throughaxial bores 98 formed inshaft 44 as shown in FIG. 3. The distal ends of holdingelements 96 are preformedhook wires 100, preferably made of a shape memory material such as nitinol, which pass through openings formed indistal portion 46 ofshaft 44 and engage separatedtissue section 80 to helpsecure tissue section 80 todistal portion 46 ofshaft 44. -
Device 86 includes adistal end 102 connected to the proximal end ofactuator tube 43. Thus, the movement ofdevice 86 causestube 43 to move distally withinintroducer sheath 42. At this point, that is withhook wires 100 deployed as an FIGS. 11-13, atubular braided element 104, see FIGS. 14-17, secured to the distal end ofactuator tube 43, is still fully housed withinsheath 42. Further distal movement ofdevice 86 causes tubular braidedelement 104 to extend outwardly pastdistal end 48 ofsheath 42 to the position of FIGS. 15-17. The purpose oftubular braided element 104 is to surround separatedtissue section 80 by passing along the dissection plane between the separated tissue section and the surrounding tissue. The openouter end 106 ofelement 104 naturally expands radially as it is pushed axially through the tissue. To aid the proper initial radial expansion ofelement 104,shaft 44 has an outwardlytapered guide surface 108, formed on aguide element 110, positioned adjacent todistal end 48 ofintroducer shaft 42.Guide element 110 has a slot in its proximal surface into which the proximal end ofseparator wire 56 passes when in the radially expanded condition of FIG. 9; this helps to keepseparator wire 56 from folding over during rotation. If desired,outer end 106 oftubular braided element 104 could include a drawstring or other type of closure element. The separatedtissue section 80, now substantially enclosed withintubular braided element 104 and secured todistal portion 46 ofshaft 44 byhook wires 100, may be removed from the patient. - With the present invention separated
tissue section 80 retains most if not all of its physical integrity once removed from the patient. Also, the use oftubular braided element 104, especially when it is sealed or otherwise impermeable to the passage of material, helps to reduce the possibility of seeding diseased tissue along the tissue tract during removal of separatedtissue section 80. - Modification and variation can be made to be disclosed embodiments without departing from the subject of the invention as defined in the following claims. For example, a target tissue localization device, such as disclosed in U.S. Pat. No. 6,179,860, may be incorporated into
assembly 10; such a localization device would be deployed, as indicated by dashedlines 112 in FIG. 1 and localizationdevice actuator shaft 114 in FIG. 18, after placement ofdistal portion 46 ofshaft 44 at the target site and would be used to help stabilize the assembly and also help contain, in conjunction with atubular braided element 104, separatedtissue section 80. Leadscrew 52 could be hollow to permitactuator shaft 114, or other medical devices, to pass therethrough and into a lumen withinshaft 44. Instead ofstepper motor 16,drive screw 28 and drivenut 34, other driving mechanisms, such as spring driven drivers with appropriately configured escape mechanisms and/or movement damping devices, could be used. In thepreferred embodiment shaft 44 does not begin to rotate until afterseparator wire 56 has reached its fully radially extended state. In some situations it may be desired to begin rotatingshaft 44 before and/or during the outward movement ofseparator wire 56. - Any and all patents, patent applications and printed publications referred to above are hereby incorporated by reference.
Claims (61)
1. A tissue separator assembly comprising:
a proximal end assembly;
a catheter assembly, extending from the proximal end assembly, comprising:
a shaft having a distal portion and defining an axis at the distal portion; and
an elongate tissue separator element having a proximal part and a distal part, the distal part connected to the distal portion of the shaft and movable between a retracted state, adjacent to the distal portion, and an outwardly extending, operational state; and
the proximal end assembly comprising a first driver, operably coupled to the tissue separator element, constructed to (1) move the tissue separator element from the retracted state to the operational state, and (2) automatically rotate the tissue separator element about the axis, whereby a tissue section is separable from surrounding tissue by the moving tissue separator element.
2. The assembly according to claim 1 wherein the first driver is constructed to automatically rotate the tissue separator element after the tissue separator element is in the operational state.
3. The assembly according to claim 1 wherein first driver automatically rotates the shaft and the tissue separator element therewith about the axis.
4. The assembly according to claim 1 wherein the shaft has at least one longitudinally extending bore.
5. The assembly according to claim 1 wherein the catheter assembly comprises a hollow introducer sheath housing the shaft.
6. The assembly according to claim 1 wherein the distal part of the tissue separator element comprises a wire.
7. The assembly according to claim 1 wherein the distal part of the tissue separator element bows outwardly when in the operational state.
8. The assembly according to claim 1 further comprising an energy source selectively coupled to the tissue separator element.
9. The assembly according to claim 8 wherein the energy source comprises an RF generator.
10. The assembly according to claim 1 wherein the first driver comprises an actuator movable along a path from a first position, to a second position and to a third position, said actuator comprising a first part engageable with the proximal part of the tissue separator element as the actuator moves between the first and second positions so to move the distal part of the tissue separator element from the retracted state to the operational state.
11. They assembly according to claim 10 wherein the first driver comprises a lead screw rotationally coupled to the shaft so rotation of the lead screw causes the shaft to rotate.
12. The assembly according to claim 11 wherein the lead screw comprises a rotary position indicator.
13. The assembly according to claim 12 wherein the lead screw has a proximal end and the proximal end the comprises said indicator.
14. The assembly according to claim 11 wherein the first driver comprises a lead nut rotationally mounted to the lead screw, said lead nut and lead screw configured so that axial movement of the lead nut causes rotational movement of the lead screw and the shaft therewith.
15. The assembly according to claim 14 wherein the actuator comprises a second part engageable with the lead nut as the actuator moves from the second position to the third position thereby causing the lead screw and the shaft and tissue separator element therewith to rotate.
16. The assembly according to claim 1 wherein the catheter assembly comprises a tissue section holding element at the distal portion of the shaft, said holding element movable from a retracted condition to an extended, tissue engaging condition so to help secure a separated tissue section to the catheter assembly.
17. The assembly according to claim 16 wherein the tissue section holding element comprises at least one wire having a pre-curved distal end.
18. The assembly according to claim 16 wherein the proximal end assembly comprises a second driver, operably coupled to the holding element, constructed to move the holding element from the retracted condition to the extended, tissue engaging condition.
19. The assembly according to claim 1 wherein the catheter assembly comprises a tubular braided element at the distal portion of the shaft movable longitudinally and radially between a proximal, radially contracted state and a distal, radially expanded state with said tubular braided element surrounding the tissue separator element and any separated tissue section when in the distal, radially expanded state.
20. They assembly according to claim 19 wherein the shaft comprises an outwardly flaring guide surface to help guide the tubular braided element along a tissue dissection between a separated tissue section and surrounding tissue as the tubular braided element moves from the proximal, radially contracted state to the distal, radially expanded state.
21. The assembly according to claim 19 wherein the proximal end assembly comprises a second driver, operably coupled to the tubular braided element, constructed to move the tubular braided element from the proximal, radially contracted state to the distal, radially expanded state.
22. The assembly according to claim 1 wherein the catheter assembly comprises:
a tissue section holding element at the distal portion of the shaft, said holding element movable from a retracted condition to an extended, tissue engaging condition so to help secure a separated tissue section to the catheter assembly; and
a tubular braided element at the distal portion of the shaft movable longitudinally and radially between a proximal, radially contracted state and a distal, radially expanded state with said tubular braided element surrounding the tissue separator element and any separated tissue section when in the distal, radially expanded state.
23. The assembly according to claim 27 wherein the proximal end assembly comprises a second driver, operably coupled to the holding element and to the tubular braided element, constructed to:
move the holding element from the retracted condition to the extended, tissue engaging condition and;
move the tubular braided element from the proximal, radially contracted state to the distal, radially expanded state.
24. The assembly according to claim 23 wherein the second driver is a manually operated driver.
25. A tissue separator assembly comprising:
a proximal end assembly;
a catheter assembly, extending from the proximal end assembly, comprising:
a shaft having a distal portion and defining an axis at the distal portion; and
an elongate tissue separator element having a proximal part and a distal part, the distal part connected to the distal portion of the shaft and movable between a retracted state, adjacent to the distal portion, and an outwardly bowed, operational state;
an energy source selectively coupled to the tissue separator element;
the proximal end assembly comprising a first driver, operably coupled to the tissue separator element, constructed to (1) move the tissue separator element from the retracted state to the operational state, and thereafter (2) automatically rotate the tissue separator element about the axis, whereby a tissue section is separable from surrounding tissue by the moving tissue separator element;
the catheter assembly comprising:
a tissue section holding element at the distal portion of the shaft, said holding element movable from a retracted condition to an extended, tissue engaging condition so to help secure a separated tissue section to the catheter assembly;
a tubular braided element at the distal portion of the shaft movable longitudinally and radially between a proximal, radially contracted state and a distal, radially expanded state with said tubular braided element surrounding the tissue separator element and any separated tissue section when in the distal, radially expanded state; and
the proximal end assembly comprising a second driver, operably coupled to the holding element and to the tubular braided element, constructed to:
move the holding element from the retracted condition to the extended, tissue engaging condition; and
move the tubular braided element from the proximal, radially contracted state to the distal, radially expanded state.
26. The assembly according to claim 25 wherein:
the first driver comprises an actuator movable along a path from a first position, to a second position and to a third position, said actuator comprising a first part engageable with the proximal part of the tissue separator element as the actuator moves between the first and second positions so to move the distal part of the tissue separator element from the retracted state to the operational state;
the first driver comprises a lead screw rotationally coupled to the shaft so rotation of the lead screw causes the shaft to rotate;
the first driver comprises a lead nut rotationally mounted to the lead screw, said lead nut and lead screw configured so that axial movement of the lead nut causes rotational movement of the lead screw; and
the actuator comprises a second part engageable with the lead nut as the actuator moves from the second position to the third position thereby causing the lead screw and the shaft and tissue separator element therewith to rotate.
27. A tissue separator assembly comprising:
a proximal end assembly;
a catheter assembly, extending from the proximal end assembly, comprising:
a shaft having a distal portion and defining an axis at the distal portion; and
tissue separator means, at the distal portion of the shaft and movable between a retracted state and an extended, operational state, for passing through and separating tissue;
the proximal end assembly comprising means for (1) moving the tissue separator means from the retracted state to the extended, operational state, and (2) automatically rotating the tissue separator element about the axis, whereby a tissue section is separable from surrounding tissue.
28. The assembly according to claim 27 wherein the catheter assembly comprises means for helping to secure a separated tissue section to the catheter assembly.
29. The assembly according to claim 27 wherein the catheter assembly comprises means for selectively enveloping the distal portion of the shaft, the tissue separator means and any separated tissue section.
30. A tissue separator assembly comprising:
a proximal end assembly;
a catheter assembly, extending from the proximal end assembly, comprising:
a shaft having a distal portion and defining an axis at the distal portion; and
a movable tissue separator element at the distal portion of the shaft;
the proximal end assembly comprising a first driver, operably coupled to the tissue separator element, constructed to drive the tissue separator element through tissue to separate a tissue section from surrounding tissue;
the catheter assembly comprising:
a tissue section holding element at the distal portion of the shaft, said holding element movable from a retracted condition to an extended, tissue engaging condition so to help secure a separated tissue section to the catheter assembly;
a tubular braided element at the distal portion of the shaft movable longitudinally and radially between a proximal, radially contracted state and a distal, radially expanded state with said tubular braided element surrounding the tissue separator element and any separated tissue section when in the distal, radially expanded state; and
the proximal end assembly comprising a second driver, operably coupled to the holding element and to the tubular braided element, constructed to:
move the holding element from the retracted condition to the extended, tissue engaging condition; and
move the tubular braided element from the proximal, radially contracted state to the distal, radially expanded state.
31. The assembly according to claim 30 wherein the first driver is constructed to automatically rotate the shaft and the tissue separator element therewith about the axis after the tissue separator element is in the operational state.
32. The assembly according to claim 30 wherein the shaft has at least one longitudinally extending bore.
33. The assembly according to claim 30 wherein the catheter assembly comprises a hollow introducer sheath housing the shaft.
34. The assembly according to claim 30 wherein the distal part of the tissue separator element comprises a wire.
35. The assembly according to claim 30 further comprising an energy source selectively coupled to the tissue separator element.
36. The assembly according to claim 35 wherein the energy source comprises an RF generator.
37. The assembly according to claim 30 wherein the first driver comprises an actuator movable along a path from a first position, to a second position and to a third position, said actuator comprising a first part engageable with the proximal part of the tissue separator element as the actuator moves between the first and second positions so to move the distal part of the tissue separator element from the retracted state to the operational state.
38. They assembly according to claim 37 wherein the first driver comprises a lead screw rotationally coupled to the shaft so rotation of the lead screw causes the shaft to rotate.
39. The assembly according to claim 38 wherein the lead screw comprises a rotary position indicator.
40. The assembly according to claim 39 wherein the lead screw has a proximal end and the proximal end the comprises said indicator.
41. The assembly according to claim 38 wherein the first driver comprises a lead nut rotationally mounted to the lead screw, said lead nut and lead screw configured so that axial movement of the lead nut causes rotational movement of the lead screw and the shaft therewith.
42. The assembly according to claim 41 wherein the actuator comprises a second part engageable with the lead nut as the actuator moves from the second position to the third position thereby causing the lead screw and the shaft and tissue separator element therewith to rotate.
43. The assembly according to claim 30 wherein the tissue section holding element comprises at least one wire having a pre-curved distal end.
44. They assembly according to claim 30 wherein the shaft comprises an outwardly flaring guide surface to help guide the tubular braided element along a tissue dissection between a separated tissue section and surrounding tissue as the tubular braided element moves from the proximal, radially contracted state to the distal, radially expanded state.
45. The assembly according to claim 30 wherein the second driver is a manually operated driver.
46. A tissue separator assembly comprising:
a proximal end assembly;
a catheter assembly, extending from the proximal end assembly, comprising tissue separator means for passing through and separating tissue;
the proximal end assembly comprising a first driving means for driving the tissue separator means through tissue to separate a tissue section from surrounding tissue;
the catheter assembly comprising;
tissue puncturing means for helping to secure a separated tissue section to the catheter assembly; and
means for surrounding the tissue separator means and any separated tissue section; and
the proximal end assembly comprising a second driving means for:
driving the tissue puncturing means into a separated tissue section; and
driving the surrounding means.
47. A method for creating a tissue section within surrounding tissue comprising:
positioning a distal end of a catheter assembly at a target location within a patient, the catheter assembly defining an axis;
moving an elongate tissue separator element, at the distal end of the catheter assembly, from a radially retracted state to an outwardly extending, operational state; and
automatically, following at least the start of the separator element moving step, rotating the separator element about the axis to separate a tissue section from surrounding tissue.
48. The method of according to claim 47 further comprising supplying energy to the separator element.
49. The method of according to claim the 48 wherein the energy supplying step comprises supplying RF energy to the separator element.
50. The method of according to claim 47 wherein the automatically rotating step begins after the separator element has reached the operational state.
51. The method according to claim 47 wherein the automatically rotating step is carried out by rotating the separator element about 540° about the axis.
52. The method according to claim 47 further comprising moving a tissue holding element, located at the distal end of the catheter assembly, from a retracted condition to an extended, tissue engaging condition.
53. The method according to claim 52 wherein the tissue holding element moving step is carried out following the automatically rotating step.
54. The method according to claim 52 wherein the tissue holding element moving step is carried out using at least one wire having a pre-curved distal end.
55. The method according to claim 47 further comprising surrounding the separated tissue section with a tubular braided element by moving the tubular braided element, located at the distal end of the catheter assembly, from a proximal, radially contracted state to a distal, radially expanded state following the automatically rotating step.
56. A method for creating a tissue section within surrounding breast tissue of a patient comprising:
positioning a distal end of a catheter assembly at a target location within the breast of a patient, the catheter assembly defining an axis;
moving an elongate tissue separator element, at the distal end of the catheter assembly, from a radially retracted state to a radially extended, outwardly bowed, operational state;
supplying energy to the separator element;
automatically, following the separator element moving step, rotating the separator element about the axis to separate a tissue section from surrounding tissue;
moving a tissue holding element, located at the distal end of the catheter assembly, from a retracted condition to an extended, tissue engaging condition; and
surrounding the separated tissue section with the tubular braided element by moving the tubular braided element, located at the distal end of the catheter assembly, from a proximal, radially contracted state to a distal, radially expanded state following the automatically rotating step.
57. The method of according to claim the 56 wherein the energy supplying step comprises supplying RF energy to the separator element.
58. The method of according to claim 56 wherein the automatically rotating step begins after the separator element has reached the operational state.
59. The method according to claim 56 wherein the automatically rotating step is carried out by rotating the separator element about 540° about the axis.
60. The method according to claim 56 wherein the tissue holding element moving step is carried out following the automatically rotating step.
61. The method according to claim 56 wherein the tissue holding element moving step is carried out using at least one wire having a pre-curved distal end.
Priority Applications (4)
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US10/045,657 US20030083656A1 (en) | 2000-11-07 | 2001-11-07 | Tissue separator assembly and method |
US10/374,584 US20030204188A1 (en) | 2001-11-07 | 2003-02-25 | Tissue separating and localizing catheter assembly |
US11/434,632 US7846159B2 (en) | 2000-11-07 | 2006-05-15 | Tissue separating and localizing catheter assembly |
US13/865,611 US9211130B2 (en) | 2000-06-05 | 2013-04-18 | Tissue separating catheter assembly and method |
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US24641300P | 2000-11-07 | 2000-11-07 | |
US10/045,657 US20030083656A1 (en) | 2000-11-07 | 2001-11-07 | Tissue separator assembly and method |
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US10/374,584 Continuation-In-Part US20030204188A1 (en) | 2000-06-05 | 2003-02-25 | Tissue separating and localizing catheter assembly |
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US10/212,467 Expired - Fee Related US7150712B2 (en) | 2000-11-07 | 2002-08-05 | Target tissue localization assembly and method |
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US8795332B2 (en) | 2002-09-30 | 2014-08-05 | Ethicon, Inc. | Barbed sutures |
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Also Published As
Publication number | Publication date |
---|---|
WO2002076281A3 (en) | 2003-06-19 |
WO2002064012A3 (en) | 2003-01-09 |
EP1341435A2 (en) | 2003-09-10 |
US20040049224A1 (en) | 2004-03-11 |
WO2002076281A2 (en) | 2002-10-03 |
US7150712B2 (en) | 2006-12-19 |
JP4180382B2 (en) | 2008-11-12 |
EP1341435A4 (en) | 2005-08-17 |
JP2004529689A (en) | 2004-09-30 |
WO2002064012A2 (en) | 2002-08-22 |
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