US20140228872A1 - Tissue severing devices with sliding support and methods - Google Patents
Tissue severing devices with sliding support and methods Download PDFInfo
- Publication number
- US20140228872A1 US20140228872A1 US14/082,201 US201314082201A US2014228872A1 US 20140228872 A1 US20140228872 A1 US 20140228872A1 US 201314082201 A US201314082201 A US 201314082201A US 2014228872 A1 US2014228872 A1 US 2014228872A1
- Authority
- US
- United States
- Prior art keywords
- distal end
- cutting element
- inner member
- tube member
- operable
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
Links
- DEDZSLCZHWTGOR-UHFFFAOYSA-N CCCC1CCCCC1 Chemical compound CCCC1CCCCC1 DEDZSLCZHWTGOR-UHFFFAOYSA-N 0.000 description 1
Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/3205—Excision instruments
- A61B17/32056—Surgical snare instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
- A61B17/32002—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments
-
- 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
- A61B17/22004—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 using mechanical vibrations, e.g. ultrasonic shock waves
- A61B17/22012—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 using mechanical vibrations, e.g. ultrasonic shock waves in direct contact with, or very close to, the obstruction or concrement
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/003—Steerable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
- A61B17/32002—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments
- A61B2017/320024—Morcellators, e.g. having a hollow cutting tube with an annular cutter for morcellating and removing tissue
-
- 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
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00559—Female reproductive organs
-
- 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
- A61B2018/00595—Cauterization
-
- 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
- A61B2018/00994—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body combining two or more different kinds of non-mechanical energy or combining one or more non-mechanical energies with ultrasound
-
- 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
- A61B2018/1405—Electrodes having a specific shape
- A61B2018/1407—Loop
- A61B2018/141—Snare
Definitions
- the present invention is related generally to the field of medical devices. More particularly, the present invention involves devices and methods that enable accurate dissection of tissue such as associated with a patient undergoing surgery.
- Morcellators are devices that morcellate or cut tissue into smaller pieces to allow for easier removal through small surgical access sites. Morcellators that require a pushing or downward traction operation to cut the tissue present a danger of over extension into tissue that is not to be injured. By way of example, but not limited thereto, in a laparoscopic subtotal hysterectomy, one way of minimizing the danger of this over extension is to amputate the body of the uterus from the cervix prior to morcellation. The amputation of the uterus presents an added risk of injury to other organs, such as the rectum and bowel, as they lie behind the uterus and are difficult to see during uterus amputation.
- amputation is commonly performed using electrocautery or harmonic scalpel which may cause lateral spread of heat or other energy and can inadvertently cause a burn to the bowel or bladder that may not be realized until days after surgery. Further, amputation of the uterus requires the use of one surgical instrument to amputate the uterus and another surgical instrument to morcellate the uterus with their associated cost and complexity of use.
- Some known laparoscopic supracervical hysterectomy instruments utilize graspers that pull tissue into a spinning tubular blade or the spinning blade is pushed into the tissue. These types of instruments have their limitations and dangers associated with their use, such as, but not limited to, the exposed sharp blade possibly injuring surrounding tissue not intended to be morcellated, discharge of the tissue in a spinning tool, and the difficulty and dangers of placing downward traction into the target tissue.
- a tissue severing device comprises a handle, a tube member, and inner member, and a cutting element.
- the tube member includes an elongated tube having a tube member proximal end extending into the handle and a tube member distal end opposite the tube member proximal end.
- the tube member defines a tube member lumen that extends through the tube member proximal end to the tube member distal end and defining a tube member axis.
- the inner member includes an elongated body having an inner member proximal end extending through the tube member lumen and into the handle and an inner member distal end opposite the inner member proximal end. The inner member is operable to be received within the tube member lumen.
- the cutting element includes a cutting element proximal end and a cutting element distal end opposite the cutting element proximal end.
- the cutting element proximal end extends into the inner member distal end.
- the cutting element distal end extends from the inner member distal end.
- the tube member distal end is operable to move distally over and receive the inner member distal end and the inner member distal end therein.
- the tube member distal end is operable to move in a proximal direction to expose the cutting element distal end.
- the handle further comprises an engagement means in operable engagement with the tube member proximal end operable to permit the tube member to be moved proximally and distally over the inner member.
- the tissue severing device is operable to present the cutting element distal end at an angle to the tube member axis when the tube member distal end is withdrawn from the cutting element distal end and at least a portion of the inner member distal end.
- At least a portion of the inner member distal end is biased to form a curve of a predetermined angle with respect to the tube member axis when the tube member distal end is withdrawn from at least a portion of the inner member distal end, and is elastically deformable operable to extend under the urging engagement of the tube member distal end when advanced over the inner member distal end.
- the tissue severing device further comprises a supporting means operable to support the inner member distal end in a curved position when the inner member distal end is at least partially exposed by the withdrawal of the tube member distal end.
- the supporting means comprises a fixed support ribbon.
- the fixed support ribbon comprises an elongated body including a fixed support ribbon proximal end and a fixed support ribbon distal end opposite the fixed support ribbon proximal end.
- the fixed support ribbon proximal end is coupled to the tube member distal end within the tube member lumen and the fixed support ribbon distal end is coupled to the inner member distal end.
- the tube member distal end is operable to advance over and receive the inner member distal end, the cutting element distal end, and the fixed support ribbon.
- the fixed support ribbon has a length that is operable to pull the inner member distal end into a curve with respect to the tube member axis when the tube member distal end is moved in a proximal direction and to substantially retain that curve when tissue is severed by the cutting element distal end.
- the inner member distal end is biased to a substantially straight orientation along the tube member axis.
- the fixed support ribbon is operable to provide a pulling force necessary to flex the inner member distal end into a curve as well as provide support to prevent the inner member distal end from significantly extending toward the tube member axis when the cutting element distal end is pulled through tissue to be severed.
- the tissue severing device further comprises a slidable support ribbon operable for supporting the inner member distal end in a curved position when the inner member distal end is at least partially exposed by the withdrawal of the tube member distal end.
- the slidable support ribbon comprises an elongated body including a slidable support ribbon proximal end and a slidable support ribbon distal end opposite the slidable support ribbon proximal end.
- the slidable support ribbon proximal end extends through the tube member lumen from about the tube member proximal end to about the tube member distal end and adjacent the inner member.
- the slidable support ribbon distal end is positioned adjacent the inner member distal end and the cutting element distal end.
- the tissue severing device further comprises an engagement ring coupled to the inner member distal end.
- the slidable support ribbon distal end and the inner member distal end are slidingly coupled by cooperative engagement of the inner member distal end and the engagement ring.
- the slidable support ribbon distal end comprises a substantially uniform width body portion and a flared portion at about the inner member distal end, wherein the flared portion has a width that is larger than the body portion.
- the engagement ring comprising a shape of a partial loop coupled to the inner member distal end transverse to an inner member axis.
- the engagement ring is operable to slidingly receive the body portion of the slidable support ribbon distal end and is undersized so as to not be able to receive the flared portion therethrough.
- the flared portion is operable as a catch such that there is no further axial movement of the slidable support ribbon distal end relative to the engagement ring when the flared portion engages the engagement ring.
- the engagement of the flare portion with the engagement ring is operable to provide a means for pulling the inner member distal end proximally and thus flex the inner member distal end to present the cutting element distal end to an angle to the tube member axis.
- the engagement ring is operable to be slidingly received within the tube member lumen.
- the cutting element comprises an elongated member that forms a contiguous element that defines a loop at the cutting element distal end and two ends at the cutting element proximal end.
- the cutting element distal end comprises a substantially elastic material such that the cutting element distal end comprises a diameter somewhat larger than the inner diameter of the tube member lumen.
- the cutting element distal end substantially elastically deforms and is slidingly received within the tube member lumen and when the tube member distal end is advanced in the proximal direction, the cutting element distal end exits the tube member lumen and substantially elastically expands therefrom.
- the tissue severing device further comprises an energy source coupled to the cutting element and operable to assist the cutting element proximal end in cutting and severing tissue.
- the energy source is housed within the handle.
- the inner member further comprises at least one inner member lumen extending through the inner member proximal end and the inner member distal end.
- the cutting element comprises an elongated member that forms a contiguous element that defines a loop at the cutting element distal end and two ends at the cutting element proximal end. The cutting element proximal end extends through the inner member lumen to the handle and the two ends of the cutting element proximal end are coupled to the energy source.
- the tissue severing device further comprises an engagement means operable for moving the tube member proximally and distally over the inner member.
- FIGS. 1A and 1B are perspective views of embodiments of tissue severing devices comprising a handle, a tube member, an inner member, and a cutting element;
- FIG. 2A is a side view of the device distal end showing the cutting element distal end extending from the tube member distal end of an embodiment of the tissue severing device of FIG. 1A ;
- FIG. 2B is a side view of the device distal end showing the inner member distal end and the cutting element distal end extending from the tube member distal end of an embodiment of the tissue severing device of FIG. 1A ;
- FIG. 3 is a side cut-away view of the device distal end showing the tube member distal end extending over and containing the inner member distal end and the cutting element distal end of an embodiment of the tissue severing device of FIG. 1A ;
- FIGS. 4A-4C are side views of the device distal end showing a progression of position of the inner member distal end in accordance with embodiment
- FIGS. 5A and 5B are side cut-away views of the device distal end showing an embodiment of a supporting means comprising a fixed support ribbon of an embodiment of the tissue severing device of FIG. 1B ;
- FIGS. 6A-6C are side views of the device distal end showing a progression of positions of the inner member distal end, in accordance with an embodiment
- FIG. 7A is a side, partial cut-away view of a tissue severing device 10 in accordance with an embodiment
- FIGS. 7B-7C are perspective and top views, respectively, of the device distal end showing a slidable support ribbon as another embodiment of a supporting means operable for supporting the inner member distal end in a curved position when the inner member distal end is at least partially exposed by the withdrawal of the tube member distal end;
- FIG. 7D is a perspective view of a device distal end comprising a slidable support ribbon and a plurality of engagement rings, in accordance with another embodiment
- FIG. 8 is a cross-sectional view of the inner member distal end, a portion of the body portion of the slidable support ribbon distal end, and an engagement ring, in accordance with an embodiment
- FIGS. 9A-9D are side views of an embodiment of a mechanism for controlling the movement of the slidable support ribbon under the influence of the movement of the tube member;
- FIGS. 10A and 10B are perspective and side views, respectively, of a distal end of another embodiment of a slidable support ribbon
- FIGS. 11A-11C are top, perspective, and top views, respectively, of the device distal end with the slidable support ribbon, in accordance with an embodiment
- FIG. 12 is a side view of a cutting element engagement element comprising a U-shaped flange, in accordance with an embodiment
- FIG. 13 is a side, partial cut-away view of an inner member, in accordance with an embodiment
- FIG. 14 is a top view of the device distal end showing a bifurcated inner member distal end, in accordance with the embodiment of FIG. 13 ;
- FIG. 15 is a top, partial cut-away view of the device distal end showing the inner member distal end, in accordance with another embodiment
- FIG. 16 is a side view of the device distal end showing a slidable support ribbon wherein the slidable support ribbon distal end is fixedly coupled to the inner member distal end, in accordance with an embodiment
- FIG. 17 is a side cross-sectional view of an embodiment of a cutting element proximal end and an inner member distal end that are operable for removable coupling engagement therebetween;
- FIG. 18 is a partial cut-away view of an embodiment of a cutting element and an inner member, in accordance with an embodiment
- FIG. 19A is a top view of an embodiment of a cutting element, in accordance with an embodiment
- FIG. 19B is a perspective view of an embodiment of a cutting element, in accordance with an embodiment
- FIGS. 19C and 19D are top views, expanded and compresses, respectively, of an embodiment of a cutting element, in accordance with an embodiment
- FIG. 19E is a top view showing an embodiment of a cutting element, in accordance with an embodiment
- FIG. 19F is a top view showing another embodiment of a cutting element, in accordance with an embodiment.
- FIG. 20 is a side partial cut-away view of the device distal end wherein the cutting element distal end has a bias to an angle beta to the tube member axis, in accordance with an embodiment
- FIG. 21 is a side cut-away view of a tissue severing device in accordance with an embodiment
- FIG. 22 is a side view of the distal region of an embodiment of the tissue severing device as presented to tissue, in accordance with an embodiment
- FIG. 23 is a side view of the distal region of an embodiment of the tissue severing device as cutting through tissue, in accordance with an embodiment
- FIG. 24 is a side view of the distal region of an embodiment of the tissue severing device as presented to tissue, in accordance with an embodiment
- FIG. 25 is a perspective view of a device distal end including an inner member distal end that is operable to allow for articulation, in accordance with an embodiment
- FIG. 26 is a perspective view of a device distal end including another inner member distal end that is operable to allow for articulation, in accordance with an embodiment.
- Tissue severing devices as provided in embodiments herein are operable to be inserted through small surgical openings, such as, but not limited to, being inserted through a trocar sleeve at a laparoscopic port site and advanced to tissue to be severed or morcellated.
- the tissue severing device is operable to directly sever or morcellate tissue within a patient's body.
- FIGS. 1A and 1B are perspective views of tissue severing devices 10 comprising a handle 50 , a tube member 20 , an inner member 30 , and a cutting element 40 , in accordance with two embodiments.
- the tube member 20 comprises an elongated relatively stiff tube having a tube member proximal end 22 extending into the handle 50 and a tube member distal end 24 opposite the tube member proximal end 22 .
- the tube member 20 defines a tube member lumen 26 that extends through the tube member proximal end 22 to the tube member distal end 24 defining a tube member axis X.
- the inner member 30 comprises an elongated body having an inner member proximal end 32 (hidden from view) extending through the tube member lumen 26 and into the handle 50 and an inner member distal end 34 opposite the inner member proximal end 32 .
- the inner member 30 is operable to be received within the tube member lumen 26 .
- the cutting element 40 comprises a cutting element proximal end 42 (hidden from view) that enters the inner member distal end 34 , shown in FIG. 18 , and a cutting element distal end 44 opposite the cutting element proximal end 42 .
- the cutting element distal end 44 extends from the inner member distal end 34 .
- the tissue severing device 10 includes a device proximal end 14 that generally includes the handle 50 and a device distal end 16 that generally includes the tube member distal end 24 , the inner member distal end 34 , and the cutting element distal end 44 .
- FIG. 2A is a side view of the device distal end 16 showing the cutting element distal end 44 extending from the tube member distal end 24 .
- FIG. 2B is a side view of the device distal end 16 showing the inner member distal end 34 and the cutting element distal end 44 extending from the tube member distal end 24 .
- FIG. 3 is a side cut-away view of the device distal end 16 showing the tube member distal end 24 extending over and containing the inner member distal end 34 and the cutting element distal end 44 .
- the tube member distal end 24 is operable to move in a distal direction (away from the handle 50 ) over and with the tube lumen 26 operable to receive the inner member distal end 34 and the cutting element distal end 44 therein, as shown in FIG.
- the tube member distal end 24 is also operable to move in a proximal direction (toward the handle 50 ) to expose the cutting element distal end 44 , as shown in FIG. 2A , and, in other embodiments, also expose at least a portion of the inner member distal end 34 , as shown in FIGS. 1A , 1 B and 2 B, so as to present the cutting element distal end 44 to tissue to be cut or severed.
- the tube member proximal end 22 includes an engagement means in cooperative engagement with the handle 50 operable to permit the tube member 20 to be moved proximally and distally over the inner member 30 . It is anticipated that there are many engagement means that may be used to provide the function for permitting the movement of the tube member 20 proximally and distally over the inner member 30 , some of which are described below.
- the tube member 20 may comprise any suitable material, including, but not limited to, stainless steel, plastic, PTFE, polymer, and composite materials.
- the interior and/or exterior surfaces of the inner member 30 and tube member 20 may be coated with a low friction material such as, but not limited to, PTFE, Teflon®, polyvinylidene fluoride, polyethylene, or another polymeric material to facilitate movement of the tube member 20 with respect to the inner member 30 and cutting element distal end 44 .
- the tissue severing device 10 is operable to present the cutting element distal end 44 extending from the tube member distal end 24 substantially parallel with the tube member axis X, as shown in FIG. 2A .
- the tube member distal end 24 is operable to move proximately such that the cutting element distal end 44 is exposed so as to be available for use to cut or sever tissue.
- the inner member 30 may be relatively stiff so as to support the cutting element 40 from deflecting during use to cut or sever tissue.
- the tissue severing device 10 is operable to present the cutting element distal end 44 at an angle alpha to the tube member axis X when the tube member distal end 24 is withdrawn from the cutting element distal end 44 and at least a portion of the inner member distal end 34 , as shown in FIG. 2B .
- the inner member distal end 34 is operable to curve away from and form an angle alpha with the tube member axis X when the inner member distal end 34 is exposed by the withdrawal of the tube member distal end 24 therefrom.
- FIGS. 4A-4C are side views of the device distal end 16 showing a progression of position of the inner member distal end 34 .
- the angle alpha becomes progressively larger to a final predetermined angle alpha.
- the predetermined angle alpha may be any angle to the tube member axis X.
- the predetermined angle alpha may be up to and including 90 degrees to the tube member axis X.
- the tube member distal end 22 by being moved proximally or distally, may be used, among other things, to control the angle alpha of the cutting element distal end 44 and the cutting depth into the tissue as the tissue is being cut or severed.
- At least a portion of the inner member distal end 34 is biased to form a curve of a predetermined angle alpha when the tube member distal end 24 is withdrawn from over the inner member distal end 34 .
- the means for providing the bias that affects the curve in the inner member distal end 34 may include one or a combination of the elastic properties of the tube member distal end 24 and a support means, as further described below.
- the at least a portion of the inner member distal end 34 that is elastically biased to form a curve of a predetermined angle alpha is elastically deformable so as to extend (straighten) under the urging engagement of the tube member distal end 24 advancing distally over the inner member distal end 34 .
- the inner member distal end 34 and the cutting element distal end 44 are operatively stiff so as to prevent substantial extension or deflection of either or both of the inner member distal end 34 and the cutting element distal end 44 toward the tube member axis X under the forces encountered when the cutting element distal end 44 penetrates, cuts, and/or severs tissue, but not so stiff so as to prevent the extension of the inner member distal end 34 and the cutting element distal end 44 under the force of the tube member distal end 24 moving distally thereover.
- the at least a portion of the inner member distal end 34 comprises any suitable material or assembly so as to be elastically deformable as well as either biased to be substantially straight or biased to form a curve of a predetermined angle alpha.
- suitable materials include, but are not limited to, heat-set and cold-formed stainless steel and alloys thereof, super-elastic shape memory alloys including nickel-titanium alloys, preferentially-braided tubing and sleeves, and heat set or cold formed polymer and composite materials, among others, in forms such as, but not limited to, wires, ribbons, rods, sleeves, and tubes.
- Such apparatus to affect articulation may include, but not limited to, one or more pivots, joints, extensible tubing, and rigid segments coupled by flexible or elastic interconnects. Embodiments representative of examples of such apparatus are provided in the discussion of FIGS. 25 and 26 .
- the inner member 30 and the tube member 20 may comprise more than one material along the length of or at different portions of the inner member 30 and tube member 20 suitable for a particular purpose.
- the inner member distal end 34 may be elastically deformable wherein the inner member proximal end 32 may be relatively stiffer as compared with the inner member distal end 34 .
- the tissue severing device 10 further comprises a support means.
- the support means may be used to the advantage of guiding tissue to be severed into the cutting element distal end 44 and controlling the depth of the cut, regardless of the support means' contribution to establishing the curve of the inner member distal end 34 or controlling extension of the inner member distal end 34 toward the tube member axis X while the cutting element distal end 44 is pulled through tissue to be severed.
- the tissue severing device 10 further comprises supporting means for supporting the inner member distal end 34 in a curved position when the inner member distal end 34 is at least partially exposed by the withdrawal of the tube member distal end 24 therefrom.
- the supporting means may be used in combination with or in lieu of any bias to a predetermined curvature that may be present in the inner member distal end 34 as described above.
- FIGS. 5A and 5B are side cut-away views of the device distal end 16 showing an embodiment of a supporting means comprising a fixed support ribbon 60 , also shown in the embodiment of FIG. 1B .
- the fixed support ribbon 60 comprises an elongated body including a fixed support ribbon proximal end 62 and a fixed support ribbon distal end 64 opposite the fixed support ribbon proximal end 62 .
- the fixed support ribbon proximal end 62 is coupled to the tube member distal end 24 within the tube member lumen 26 and the fixed support ribbon distal end 64 is coupled to the inner member distal end 34 .
- the tube member distal end 24 is operable to advance over and receive the inner member distal end 34 , the cutting element distal end 44 , and the fixed support ribbon 60 , as shown in FIG. 5A .
- the tube member distal end 34 may be moved in the proximal direction so as to withdraw from the cutting element distal end 44 , the inner member distal end 34 , and a portion of the fixed support ribbon 60 , as shown in FIG. 5B .
- the fixed support ribbon 60 has a length that is operable to pull the inner member distal end 34 into a curve and to substantially retain that curve as tissue is severed by the cutting element distal end 44 .
- FIGS. 6A-4C are side views of the device distal end 16 showing a progression of positions of the inner member distal end 34 .
- the fixed support ribbon 60 is generally slack and does not exhibit a significant force on the inner member distal end 34 .
- the tube member distal end 24 is moved proximally (toward the handle as shown in FIG.
- the fixed support ribbon 60 becomes taught and begins to exert a pulling force on the inner member distal end 34 which bends the inner member distal end 34 to an angle alpha to the tube member axis X dependent on the distance that the tube member distal end 24 has moved proximally, as shown in FIGS. 6B and 6C .
- the fixed support ribbon proximal end 62 moves distally with the tube member distal end 24 allowing the inner member distal end 34 to extend toward the tube member axis X.
- the fixed support ribbon 60 in combination with the tube member distal end 24 provides support to prevent the inner member distal end 34 from extending significantly toward the tube member axis X when the cutting element distal end 44 is pulled through tissue to be severed which may present forces that may overcome the curve bias of the inner member distal end 34 were it not for the fixed support ribbon 60 .
- the fixed support ribbon 60 assists in controlling the depth of cut of the cutting element distal end 44 by impinging on and guiding the tissue into the cutting element distal end 44 , as will be discussed further below.
- the fixed support ribbon 60 is operable to control the depth of cut into the tissue by the cutting element distal end 44 .
- the fixed support ribbon 60 slides along the tissue edge substantially preventing the cutting element distal end 44 from sinking into the tissue to a depth greater than the length of the cutting element distal end 44 .
- the fixed support ribbon 60 in combination with the tube member distal end 24 provides the pulling force necessary to bend the inner member distal end 34 into a curve as well as provide support to prevent the inner member distal end 34 from significantly extending toward the tube member axis X when the cutting element distal end 44 is pulled through tissue to be severed. Additionally, the fixed support ribbon 60 assists in controlling the depth of cut of the cutting element distal end 44 by guiding the tissue to be severed into the cutting element distal end 44 , as will be discussed further below.
- the tube member distal end 24 by being moved proximally or distally, in combination with the fixed support ribbon 60 , may be used, among other things, to control the angle alpha of the cutting element distal end 44 and the cutting depth into the tissue as the tissue is being cut or severed.
- FIG. 7A is a side, partial cut-away view of a tissue severing device 10 and FIGS. 7B-7C are perspective and top views, respectively, of the device distal end 16 showing a slidable support ribbon 160 as another embodiment of a supporting means operable for supporting the inner member distal end 34 in a curved position when the inner member distal end 34 is at least partially exposed by the withdrawal of the tube member distal end 24 .
- the slidable support ribbon 160 may be used in combination with or in lieu of any bias to a predetermined curvature that may be present in the inner member distal end 34 .
- the slidable support ribbon 160 comprises an elongated body including a slidable support ribbon proximal end 162 and a slidable support ribbon distal end 164 opposite the slidable support ribbon proximal end 162 .
- the slidable support ribbon proximal end 162 extends through the tube member lumen 26 from about the tube member proximal end 22 to the tube member distal end 24 and adjacent the inner member 30 .
- the slidable support ribbon distal end 164 is positioned adjacent the inner member distal end 34 and the cutting element distal end 44 and is operably engaged therewith as detailed below.
- the slidable support ribbon proximal end 162 is positioned generally adjacent the handle 50 and may be operably engaged by the user or elements of the tissue severing device 10 as detailed below.
- the slidable support ribbon distal end 164 is operable to support the inner member distal end 34 into a curved shape when the tube member distal end 24 is withdrawn therefrom.
- the slidable support ribbon 160 is operable to substantially prevent the inner member distal end 34 from extending toward the tube member axis X when the cutting element distal end 44 is pulled through tissue to be severed.
- the slidable support ribbon 160 is also operable to, among other things, control the depth of cut into the tissue by guiding the tissue toward the cutting element distal end 44 .
- the slidable support ribbon distal end 164 is also operable to, among other things, protect the tube member lumen 26 from being damaged by a sharp edge 45 of the cutting element distal end 44 by acting as a barrier therebetween.
- the slidable support ribbon distal end 164 comprises a relatively flat profile so as to cover at least a portion of the cutting element distal end 44 when the slidable support ribbon distal end 164 is extended there over.
- the slidable support ribbon distal end 164 is operable to extend between a sharp edge 45 , shown in FIG. 7C , of the cutting element distal end 44 and a portion of the tube member lumen 26 when the tube member distal end 24 is extended over the cutting element distal end 44 .
- the slidable support ribbon distal end 164 is operable to withdraw from adjacent the sharp edge 45 of the cutting element distal end 44 when the tube member distal end 24 is withdrawn from over the cutting element distal end 44 .
- the slidable support ribbon distal end 164 is operable to begin withdrawing proximally from being adjacent the cutting element distal end 44 as the cutting element distal end 44 begins to be exposed by the withdrawing tube member distal end 24 .
- the slidable support ribbon distal end 164 is exposed substantially concurrently with the exposure of the inner member distal end 34 by the tube member distal end 24 .
- the slidable support ribbon distal end 164 is not adjacent the portion of the cutting element distal end 44 that is exposed by the withdrawing tube member distal end 24 such that the cutting element distal end 44 may begin severing tissue immediately upon withdrawal of the tube member distal end 24 .
- the slidable support ribbon distal end 164 is operable to at least partially be adjacent the cutting element distal end 44 as the cutting element distal end 44 and the slidable support ribbon distal end 164 are exposed by the withdrawing tube member distal end 24 .
- the slidable support ribbon distal end 164 is withdrawn from adjacent the cutting element distal end 44 after the cutting element distal end 44 is at least substantially exposed by the withdrawing tube member distal end 24 .
- the slidable support ribbon distal end 164 may come between at least a portion of the sharp edge 45 of the cutting element distal end 44 and adjacent tissue near which it is placed. The user may withdraw the slidable support ribbon distal end 164 into the tube member lumen 26 in which the cutting element distal end 44 may then sever tissue.
- the slidable support ribbon distal end 164 is withdrawn from adjacent the cutting element distal end 44 and operably engages the inner member distal end 34 so as to provide at least one of the following functions, including, but not limited to, support the inner member distal end 34 into an arc shape, to substantially prevent the inner member distal end 34 from extending toward the tube member axis X while the cutting element distal end 44 is pulled through tissue to be severed, and control the depth of cut into the tissue by guiding the tissue toward the cutting element distal end 44 .
- the slidable support ribbon 160 is operable to control the depth of cut into the tissue by the cutting element distal end 44 . During use, the slidable support ribbon 160 slides along the tissue edge substantially preventing the cutting element distal end 44 from sinking into the tissue to a depth greater than the length of the cutting element distal end 44 .
- the slidable support ribbon distal end 164 and the tube member distal end 24 are operably engaged to provide the desired functions.
- the slidable support ribbon distal end 164 is slidingly coupled to the inner member distal end 34 .
- the user may pull the slidable support ribbon proximal end 162 in the proximal direction so as to withdraw the slidable support ribbon proximal end 162 from adjacent the cutting element distal end 44 and bend the inner member distal end 34 into a desired arc to present the cutting element distal end 44 to the tissue at an angle alpha to the tube member axis X.
- the user may control the slidable support ribbon proximal end 162 in a desired position by pulling or pushing the slidable support ribbon proximal end 162 .
- the slidable support ribbon distal end 164 and the inner member distal end 34 are slidingly coupled by cooperative engagement of the inner member distal end 34 and an engagement ring 168 coupled to the inner member distal end 34 .
- the slidable support ribbon distal end 164 comprises a substantially uniform width body portion 165 and a flared portion 167 at the slidable support ribbon distal end 164 , wherein the flared portion 167 has a width that is larger than the body portion 165 .
- the engagement ring 168 comprises a shape of a partial loop and is coupled to the inner member distal end 34 transverse to an inner member axis X 2 .
- the engagement ring 168 is operable to slidingly receive the body portion 165 of the slidable support ribbon distal end 164 but is undersized so as to not be able to receive the flared portion 167 therethrough.
- the flared portion 167 thus, functions as a catch such that there is no further axial movement of the slidable support ribbon distal end 164 relative to the engagement ring 168 when the flared portion 167 engages the engagement ring 168 .
- the engagement of the flare portion 167 with the engagement ring 168 provides a means for pulling the inner member distal end 34 proximally and thus flex the inner member distal end 34 into a desired arc to present the cutting element distal end 44 at an angle alpha to the tube member axis X.
- FIG. 7D is a perspective view of the device distal end 16 comprising a slidable support ribbon 160 and a plurality of engagement rings 168 a , 168 b in accordance with another embodiment.
- the plurality of engagement rings 168 a , 168 b are operable to support the slidable support ribbon 160 in conformance with the curved position of the inner member distal end 34 when the inner member distal end 34 is at least partially exposed by the withdrawal of the tube member distal end 24 .
- FIG. 8 is a cross-sectional view of the inner member distal end 34 , a portion of the body portion 165 of the slidable support ribbon distal end 164 , and an embodiment of the engagement ring 168 .
- the engagement ring 168 comprises a proximal edge 163 that is sloped facing proximally so as to guide the tube member distal end 24 over the engagement ring 168 .
- the engagement ring 168 is operable to slidingly receive the body portion 165 of the slidable support ribbon distal end 164 .
- the engagement ring 168 comprises an inner surface 161 that has a convex shape facing distally so as to assist in guiding the body portion 165 of the slidable support ribbon distal end 164 between the engagement ring 168 and the inner member distal end 34 . This may be particularly advantageous when the slidable support ribbon distal end 164 is caused to flex at an angle so as to pull and/or support the inner member distal end 34 at an angle to the tube member axis X.
- the pullback of the slidable support ribbon 160 in the proximal direction so as to bend the inner member distal end 34 into a desired curve to present the cutting element distal end 44 at an angle alpha to the tube member axis X, and visa versa may be done in a manual operation by the user or an automatic operation by the tissue cutting device 10 .
- the slidable support ribbon 160 is manually controlled, the slidable support ribbon proximal end 162 is operable to be manipulated by the user.
- the slidable support ribbon proximal end 162 extends from the handle 50 such that the slidable support ribbon proximal end 162 may be grasped by the user.
- the slidable support ribbon proximal end 162 and the handle 50 may also comprise an engagement element such that the slidable support ribbon proximal end 162 may be releasably coupled to the handle 50 when the slidable support ribbon 160 is extended or retracted to a desired position.
- the engagement element allows for temporarily fixating the position of the slidable support ribbon proximal end 162 .
- a ratchet 150 may be operably engaged between the slidable support ribbon proximal end 162 and the handle 50 .
- the ratchet 150 allows for motion in the proximal direction while preventing motion in the distal direction until controlled release.
- a ratchet 150 may comprise many devices, such as, but not limited to, a pair of racks with intermeshing teeth, and a toothed gear and pawl.
- the movement of the slidable support ribbon 160 may also be controlled by an electrical device, such as, but not limited to, an electric motor.
- an electrical device such as, but not limited to, an electric motor.
- the slidable support ribbon proximal end 162 is engaged with a motor that is automatically or manually controlled operable to move the slidable support ribbon 160 proximally and distally.
- the slidable support ribbon proximal end 162 is operable to be manipulated by an interaction of elements of the tissue severing device 10 .
- the slidable support ribbon proximal end 162 is cooperatively engaged with the tube member proximal end 22 such that when the tube member proximal end 22 is moved axially, the slidable support ribbon 160 may be moved axially as well. It is anticipated that there are many apparatus that may affect cooperation between the slidable support ribbon proximal end 162 and the tube member proximal end 22 .
- FIGS. 9A-9D are side views of an embodiment of a mechanism for controlling the movement of the slidable support ribbon 160 under the influence of the movement of the tube member 20 .
- the slidable support ribbon proximal end 162 further comprises a snare 166 extending at an angle from the slidable support ribbon proximal end 162 operable to catch a tube member proximal edge 21 of the tube member proximal end 22 .
- FIG. 9A shows a simplified view of the tube member 20 in the distal position wherein the cutting element 40 is contained within the tube member lumen 26 .
- the snare 166 is spaced a predetermined distance from the tube member proximal edge 21 .
- the predetermined distance may be substantially the same as the length of the cutting element 40 such that when the tube member distal end 24 has retracted from the cutting element distal end 44 , the tube member proximal edge 21 may engage the snare 166 , as shown in FIG. 9B .
- the tube member proximal edge 21 engages the snare 166 so as to pull the slidable support ribbon 160 in the proximal direction and thus move the slidable support ribbon distal end 164 from adjacent the cutting element distal end 44 , as shown in FIG. 9C .
- the slidable support ribbon 160 is moved further in the proximal direction and thus the slidable support ribbon distal end 164 engages the inner member distal end 34 so as to support the cutting element distal end 44 at an angle alpha to the tube member axis X.
- the slidable support ribbon distal end 164 may be coupled to a biasing element 265 such that the slidable support ribbon 160 is urged to move in the distal direction when the tube member 20 is moved in the distal direction.
- FIGS. 10A and 10B are perspective and side views, respectively, of a distal end 1164 of another embodiment of a slidable support ribbon 1160 .
- the slidable support ribbon 1160 is an embodiment of a supporting means that is operable for supporting the inner member distal end 34 in a curved position when the inner member distal end 34 is at least partially exposed by the withdrawal of the tube member distal end 24 and operable to support the cutting element distal end 44 in an open position.
- the slidable support ribbon 1160 may be used in combination with or in lieu of any bias to a predetermined curvature, including straight, that may be present in the inner member distal end 34 .
- the slidable support ribbon 1160 comprises an elongated body including a slidable support ribbon proximal end 162 , a slidable support ribbon distal end 1164 opposite the slidable support ribbon proximal end 162 , and a ribbon body portion 1161 therebetween.
- the slidable support ribbon distal end 1164 comprises a cutting element engagement element 1170 operable to engage the cutting element portions 144 a , 144 b of the cutting element distal end 44 about the inner member distal end 34 as shown in FIGS. 11B-11C and discussed below.
- the cutting element engagement element 1170 comprises a flange 1168 depending at about a 90 degree angle from the ribbon body portion 1161 .
- the flange 1168 is operable to be received within the loop formed by the cutting element distal end 44 .
- FIGS. 11A-11C are top, perspective, and top views, respectively, of the device distal end 16 with the slidable support ribbon 1160 in accordance with an embodiment.
- the slidable support ribbon distal end 1164 is positioned adjacent the inner member distal end 34 and the cutting element distal end 44 and is operably engaged therewith as detailed below.
- the slidable support ribbon 1160 may be moved proximally such that the flange 1168 engages the cutting element portions 144 a , 144 b of the cutting element distal end 44 assisting in spreading apart the cutting element portions 144 a , 144 b and thus assisting in opening and stabilizing the loop formed by the cutting element distal end 44 .
- the flange 1168 helps to stabilize, or hold-open, the cutting element distal end 44 during subsequent tissue severing.
- the flared portion 167 of the slidable support ribbon distal end 1164 engages the engagement ring 168 reducing any further traction on the cutting element distal end 44 by the flange 1168 .
- the slidable support ribbon distal end 1164 is also operable to support the inner member distal end 34 into a curved shape at an angle alpha to the tube member axis X when the tube member distal end 24 is withdrawn therefrom.
- the slidable support ribbon 1160 is operable to substantially prevent the inner member distal end 34 from extending toward the tube member axis X when the cutting element distal end 44 is pulled through tissue to be severed.
- the slidable support ribbon 1160 is also operable to, among other things, control the depth of cut into the tissue by guiding the tissue toward the cutting element distal end 44 .
- the slidable support ribbon distal end 1164 is slidingly coupled to the inner member distal end 34 by an engagement ring 168 .
- the slidable engagement of the slidable support ribbon 1160 of FIGS. 11A-11C is substantially the same as the slidable engagement of the embodiments of FIGS. 7A-7C .
- the slidable support ribbon distal end 1164 is flared so as to engage the engagement ring 168 so as to position the cutting element distal end 44 as described above and shown in FIG. 11B .
- the slidable support ribbon distal end 1164 is flared also so as to provide a broader flange 1168 so as to more greatly engage and spread apart the cutting element portions 144 a , 144 b of the cutting element distal end 44 .
- FIG. 12 is a side view of a cutting element engagement element 1170 comprising a U-shaped flange 1169 operable to engage and substantially wrap around the cutting element portions 144 a , 144 b of the cutting element distal end 44 .
- the U-shaped flange 1169 is operable to contain a portion of the cutting element portions 144 a , 144 b therein so as to prevent the cutting element portions 144 a , 144 b from slipping from the engagement of the U-shaped flange 1169 .
- direct contact of the cutting element engagement element 1170 with the cutting element portions 144 a , 144 b may not be suitable for every purpose.
- direct contact may reduce freedom of movement of the cutting element distal end 44 when energized by an energy source as discussed below.
- direct contact may cause electrical conductivity issues when the cutting element distal end 44 is energized by an electrical source such as in electrocautery.
- FIG. 13 is a side, partial cut-away view of an inner member 30 further comprising two inner member lumens 36 a,b that are substantially parallel and that extend from the inner member proximal end 32 to the inner member distal end 34 therethrough, in accordance with an embodiment.
- the inner member distal end 34 further comprises a slit 135 between the two inner member lumens 36 a,b , that extends from the inner member distal end 34 to a predetermined distance proximally operable to produce a bifurcation of the inner member distal end 34 defining two branch portions 234 a,b each containing one of the two inner member lumens 36 a,b .
- the two inner member lumens 36 a,b are operable such that each of the cutting element portions 144 a , 144 b of the cutting element distal end 44 may be received and extend into one of the two inner member lumens 36 a,b.
- FIG. 14 is a top view of the device distal end 16 showing a bifurcated inner member distal end 34 in accordance with the embodiment of FIG. 13 .
- the inner member distal end 34 is bifurcated along the slit 135 , the bifurcation being formed under the urging engagement of one or more of the spring bias of the cutting element 44 and the cutting element engagement element 1170 of the slidable support ribbon distal end 1164 .
- the cutting element engagement element 1170 engages the two branch portions 234 a,b of the inner member distal end 34 about the cutting element portions 144 a , 144 b of the cutting element distal end 44 effectively creating and/or supporting the bifurcation of the inner member distal end 34 .
- the cutting element engagement element 1170 engages the two branch portions 234 a,b as shown in FIG. 14 rather than the cutting element portions 144 a , 144 b themselves as shown in FIG. 11B .
- FIG. 15 is a top, partial cut-away view of the device distal end 16 showing the inner member distal end 34 , in accordance with another embodiment.
- the tissue severing device 10 further comprises two cutting element sleeves 230 a,b .
- Each cutting element sleeve 230 a,b comprises an elongated body having a cutting element sleeve proximal end 232 a,b extending through the inner member lumen 36 and into the handle 50 and a cutting element sleeve distal end 234 a,b opposite the cutting element sleeve proximal end 232 a,b .
- Each of the two cutting element sleeves 230 a,b further comprises a sleeve lumen 236 a,b that extends from the cutting element sleeve proximal end 232 a,b to the cutting element sleeve distal end 234 a,b therethrough.
- the cutting element portions 144 a , 144 b of the cutting element distal end 44 are operable to be received within the sleeve lumen 236 a,b.
- the two cutting element sleeves 230 a,b spread apart from each other under the urging engagement of one or more of the spring bias of the cutting element 44 and the cutting element engagement element 1170 of the slidable support ribbon distal end 1164 .
- the cutting element engagement element 1170 engages the two cutting element sleeve distal ends 234 a,b about the cutting element portions 144 a , 144 b of the cutting element distal end 44 effectively assisting in spreading apart the cutting element portions 144 a , 144 b and thus opening or making more circular the loop formed by the cutting element distal end 44 , the two cutting element sleeves 230 a,b preventing direct contact between the cutting element engagement element 1170 and the cutting element portions 144 a , 144 b.
- FIG. 16 is a side view of the device distal end 16 showing a slidable support ribbon 2160 wherein the sliding support ribbon distal end 164 is fixedly coupled to the inner member distal end 34 , in accordance with an embodiment.
- the user may pull the sliding support ribbon proximal end 162 in the proximal direction so as to flex the inner member distal end 34 into a desired curve to present the cutting element distal end 44 at an angle alpha to the tube member axis X.
- the user may control the sliding support ribbon distal end 164 in a desired position by pulling or pushing a snare 166 at the sliding support ribbon proximal end 162 .
- the slidable support ribbon 2160 may also be moved proximally and distally by the apparatus presented for the other embodiments herein or by apparatus known in the art.
- the cutting element 40 is operable for cutting and severing tissue.
- the cutting element 40 comprises a cutting element proximal end 42 that engages the inner member 30 and a cutting element distal end 44 , at least a portion of which is used to cut and sever tissue.
- embodiments of the cutting element proximal end 42 are anticipated. In general, embodiments of the cutting element proximal end 42 are anticipated that either couple with the inner member distal end 34 or pass through the inner member 30 to couple with other elements within the handle 50 . It is appreciated that there are many coupling elements that may be used to provide fixed or removable coupling between the inner member distal end 34 and the cutting element proximal end 42 .
- FIG. 17 is a side cross-sectional view of an embodiment wherein the cutting element proximal end 42 and the inner member distal end 34 are operable for removable coupling engagement therebetween.
- the cutting element proximal end 42 comprises a mating element 37 and the inner member distal end 34 comprises a receiving element 35 .
- the mating element 37 and the receiving element 35 are operable for removable coupling therebetween, wherein the mating element 37 is received and coupled to the receiving element 35 .
- a plurality of cutting elements 40 may be provided, each suitable for a particular purpose such that one cutting element 40 may be interchanged on the inner member distal end 34 with another cutting element 40 of a same or different configuration.
- cutting elements 40 of differing sizes and shapes may be provided suitable for a particular purpose.
- a replacement cutting element 40 may replace the first.
- a cutting element 40 is provided that comprises a cutting element proximal end 42 that passes through the inner member 30 and is operable for coupling with elements within the handle 50 .
- FIG. 18 is a side, cut-away view of an inner member 30 further comprising at least one inner member lumen 36 that extends from the inner member proximal end 32 to the inner member distal end 34 therethrough.
- the cutting element 40 comprises an elongated member that forms a contiguous element that defines a loop 46 at the cutting element distal end 44 and two ends 48 at the cutting element proximal end 42 .
- the cutting element 40 is a wire.
- the cutting element 40 is a ribbon, that is, a flat-sided elongated member that defines a loop 46 at the cutting element distal end 44 with the two ends 48 of the ribbon forming the cutting element proximal end 42 .
- the cutting element proximal end 42 is operable to be received within the inner member lumen 36 and extend from the inner member proximal end 32 suitable for a particular purpose discussed below.
- the cutting element distal end 44 comprises a blade that is operable for cutting and severing tissue.
- the cutting element distal end 44 comprises a loop 46 , such as, but not limited to a loop of wire and ribbon. At least a portion of the cutting element distal end 44 comprises one or more sharp portions 45 that are suitable for severing tissue.
- FIG. 18 shows an embodiment of a cutting element distal end 44 , in accordance with an embodiment.
- the cutting element distal end 44 comprises a wire in the form of a loop 46 including a sharp edge 45 that is preferentially sharp so as to cut tissue.
- the sharp edge 45 is operable such that it may cut into adjacent tissue as it is released by the tube member distal end 24 and as the tissue severing device 10 is pulled proximally toward the user.
- FIG. 19A is a top view showing an embodiment of a cutting element 40 a , in accordance with an embodiment.
- the cutting element distal end 44 comprises a ribbon in the form of a loop 46 including a sharp edge 45 that is preferentially sharp so as to cut tissue.
- a broad surface 41 of the cutting element 40 a is generally parallel to a plane defined by the loop 46 so as to present the sharp edge 45 also generally parallel with the plane defined by the loop 46 .
- FIG. 19B is a perspective view showing an embodiment of a cutting element 40 b , in accordance with an embodiment.
- the cutting element distal end 44 comprises a ribbon in the form of a loop 46 including a sharp edge 45 that is preferentially sharp so as to cut tissue, and a dull edge 47 that is not sharp relative to the sharp edge 45 , such that it may not cut tissue.
- a broad surface 41 of the cutting element 40 b is generally perpendicular to a plane defined by the loop 46 so as to present the sharp edge 45 also generally perpendicular with the plane defined by the loop 46 .
- the sharp edge 45 is operable to cut into adjacent tissue as it is released by the tube member distal end 24 , as shown in FIG. 11B , and as the tissue severing device 10 is pulled proximally toward the user.
- the sharp edge 45 is presented on the edge of the cutting element distal end 44 that faces proximally when it is released by the tube member distal end 24 .
- the sharp edge 45 may comprise serrations so as to assist in severing tissue.
- the cutting element distal end 44 is operable to fit within the tube member lumen 26 without elastic deformation of the cutting element distal end 44 .
- the cutting element distal end 44 comprises a substantially elastic material such that the loop 46 may have a diameter somewhat larger than the inner diameter of the tube member lumen 26 .
- the cutting element distal end 44 is operable to substantially elastically deform and be slidingly received within the tube member lumen 26 as shown in FIG. 5A .
- the cutting element distal end 44 is operable to exit the tube member lumen 26 and substantially elastically expand therefrom.
- the cutting element distal end 44 is in the form of a substantially oval loop 46 when released from the tube member lumen 26 .
- the loop 46 is operable to be biased to open up when the tube member distal end 24 is withdrawn therefrom.
- the cutting element distal end 44 is operable to elastically deform under the impinging force of the tube member distal end 24 into a substantially closed or pinched-down oval shape so as to enter the tube member lumen 26 .
- the loop 46 of the cutting element distal end 44 may have a diameter of about 12 mm, wherein the tube member may have an inner diameter of about 5 mm.
- the cutting element 40 may be constructed from many typed of materials, such as, but not limited to, stainless steel and shape-memory metals or metal alloys such as, but not limited to, nickel-titanium alloy.
- the cutting element distal end 44 is substantially uniformly elastically deformable. In accordance with other embodiments, the cutting element distal end 44 comprises one or more elastic regions operable to provide elastic deformation of the cutting element distal end 44 .
- FIGS. 19C and 19D are top views showing an embodiment of a cutting element 40 c , in accordance with an embodiment.
- the cutting element distal end 44 comprises a ribbon in the form of a loop 46 comprising two stainless steel portions 141 coupled together by a super-elastic nickel-titanium alloy portion 241 , wherein the nickel-titanium portion 241 provides a significant portion of the elasticity of the cutting element distal end 44 to a collapsed shape as shown in FIG. 19C and the stainless steel portions 141 providing generally the bias to the expanded shape as shown in FIG. 19D .
- FIG. 19E is a top view showing an embodiment of a cutting element 40 e , in accordance with an embodiment.
- the cutting element distal end 44 comprises a ribbon defining a crease 341 across the width of the ribbon.
- the crease 341 is operable to allow for preferential bending to assist in compressing the cutting element distal end 44 into an elongated loop for the cutting element distal end 44 to be received within the tube member lumen 26 .
- FIG. 19F is a top view showing another embodiment of a cutting element 40 f , in accordance with an embodiment.
- the cutting element distal end 44 comprises a ribbon defining a necked-down portion 441 .
- the necked-down portion 441 is operable to allow for preferential bending to assist in compressing the cutting element distal end 44 into an elongated loop for the cutting element distal end 44 to be received within the tube member lumen 26 .
- FIG. 20 is a side partial cut-away view of the device distal end 16 wherein the cutting element distal end 44 has a bias to an angle beta to the tube member axis X, in accordance with an embodiment.
- the bias of the cutting element distal end 44 is operable such that the sharp edge 45 is presented to tissue when the device distal end 16 is placed along side and adjacent to tissue to be severed as will be discussed below.
- the tissue may begin to be severed prior to the emergence of the inner member distal end 34 from the tube member distal end 24 .
- the inner member 30 and thus the cutting element 40 may be operable to be assembled in the tube member lumen 36 such that the cutting element distal end 44 may be retained at one or more predetermined angles with respect to the handle 50 .
- the cutting element distal end 44 may be operable to be assembled to extend from the tube member distal end 24 at one of four directions, such as up, right, down, or left, as viewed along the tube member axis X from the handle 50 .
- FIG. 21 is a side partial cut-away view of a tissue severing device 10 comprising an energy source 90 , in accordance with an embodiment.
- the cutting element proximal end 42 comprises two ends 48 , such as shown in the embodiment of FIG. 18 .
- the cutting element proximal end 42 extends through the inner member lumen 36 to the handle 50 .
- the two ends 48 of the cutting element proximal end 42 are coupled to the energy source 90 operable to assist in severing tissue.
- the energy source 90 may employ one or more energy modes that are operable to assist in cutting and severing tissue, such as, but not limited to, mechanical, radio frequency, thermal, ultrasonic, and any other suitable energy.
- the energy source 90 is a radio frequency energy source 90
- the cutting element 40 may function as a component of a monopolar or a bipolar system.
- the radio frequency energy source 90 may be operable as an electrocautery instrument so as to provide, among other things, coagulation of small bleeding vessels that may be encountered during the severing process.
- the two ends 48 of the cutting element proximal end 42 are coupled to an energy source 90 that is mechanical in operation.
- the energy source 90 is an ultrasonic source that is operable to impart a vibratory action to the cutting element distal end 44 to assist in severing the tissue.
- the energy source 90 is a mechanical oscillator that is operable to rapidly and alternatively pull on the two ends 48 of the cutting element proximal end 42 so as to impart a sawing motion to the cutting element distal end 44 to assist in severing the tissue.
- the energy source 90 is a mechanical oscillator, such as, but not limited to, a motor, that is operable to rapidly and alternatively push-pull on the two ends 48 of the cutting element proximal end 42 so as to provide a rapid in and out movement of the cutting element distal end 44 to assist in severing tissue.
- the inner member lumen 36 comprises a track that is operable to guide the movement of the cutting element distal end 44 which is coupled to a trolley that is adapted to couple with the track.
- the energy source 90 is a thermal source that is operable to heat the cutting element distal end 44 to assist in severing the tissue.
- the cutting element distal end 44 may be energized with energy by coupling the energy source 90 to the inner member proximal end 32 .
- the energy from the energy source 90 is communicated to the cutting element distal end 44 via the inner member 30 .
- many energy sources may be used to communicate energy to the cutting element distal end 44 via the inner member 30 .
- a mechanical energy source may be particularly effective.
- the inner member proximal end 32 is coupled to a mechanical oscillator that is operable to rapidly push-pull on the inner member proximal end 32 so as to impart motion to the cutting element distal end 44 to assist in severing the tissue.
- the energy source 90 is an ultrasonic source that is operable to impart a vibratory action to the inner member 30 that is communicated to the cutting element distal end 44 to assist in severing tissue.
- the energy source 90 is a variable speed drive operable to induce oscillatory motion to the cutting element distal end 44 either directly or via the inner member 30 .
- the drive includes a motor 92 , a transmission 93 , and a switch 94 .
- the switch 94 comprises a first contact 95 housed in the handle 50 adjacent a button contact 96 .
- the switch 94 When the button contact 96 is in an initial position, the switch 94 represents an open electrical circuit. Thus, no current is supplied to the motor 92 , and the cutting element distal end 44 is stationary.
- the motor 92 is electrically connected to power via the switch 94 and a control 99 when the button contact 96 is in the inward most position so as to make electric coupling with the first contact 95 , as will be described more fully hereafter.
- the control 99 includes a rotary pot 97 operable to allow a user to control the power available to the motor 92 and, thus, the speed of the cutting element distal end 44 .
- the button contact 96 nests within a track (not shown) defined by the handle 50 .
- a button return spring (not shown), which may be mounted between the button contact 96 and a portion of the handle 50 , biases the button contact 96 in an outward position away from the first contact 95 and out of electrical communication therewith.
- the transmission 93 is operable to convert rotational motion from the motor 92 to an oscillatory motion that is communicated to the cutting element distal end 44 by coupling the transmission 93 to either the cutting element proximal end 42 or the inner member proximal end 32 .
- the tissue cutting device 10 further comprises an engagement means 70 being operable for moving the tube member 20 proximally and distally over the inner member 30 . It is anticipated that there are many engagement means 70 that may be used to provide the function for moving the tube member 20 proximally and distally, including unpowered, powered, manual and automatic means, some of which will be described further below.
- the handle 50 comprises the engagement means 70 as a slidable engagement element
- the tube member 20 is operable to be moved proximally and distally over the inner member 30 by a user grasping the tube member 20 and sliding the tube member 20 through the slidable engagement element within the handle 50 .
- the tissue severing device 10 further comprises an engagement means 70 in the form of a tube member moving element 170 operable to engage the tube member proximal end 22 for moving the tube member 20 proximally and distally over the inner member 30 .
- the tube member moving element 170 that is operable for axially moving the tube member 20 includes a rack 56 and pinion 57 .
- the rack 56 comprises a plurality of spaced notches or grooves located at the tube member proximal end 22 .
- the rack 56 may be an integral feature of the tube member 20 or an element that is coupled to the tube member proximal end 22 .
- the pinion 57 comprises an engagement wheel having teeth that operably engage the spaced notches of the rack 56 . In operation, when the pinion 57 is rotated in a clockwise direction, the rack 56 is engaged to advance the tube member 20 axially in a proximal direction. When the pinion 57 is rotated in the opposite direction, the rack 56 is engaged to move the tube member 20 axially in a distal direction.
- a tube member moving element 170 for axially moving the tube member 20 relative to the inner member 30 and cutting element 40 may be provided by many known means, such as, but not limited to a rack and pinion drive system wherein the pinion comprises helical threads and is operable by rotating the pinion along the tube member axis X, such as shown in the embodiment of FIGS. 1A and 1B .
- Other linear actuators may also be used, suitable for a particular purpose. It is appreciated that the tube member moving element 170 may be electrically and manually operated.
- the tube member moving element 170 for axially moving the tube member 20 relative to the inner member 30 and cutting element 40 may be operably coupled to the energy source 90 for energizing the cutting element distal end 44 .
- the energy source 90 for energizing the cutting element distal end 44 is activated only when the tube member 20 has been moved proximally by a predetermined amount. Such a configuration may prevent the activation of the energy source 90 prior to the withdrawal of the cutting element distal end 44 from the cutting element distal end 44 .
- the tube member 20 may include one or more accessory lumens such as, but not limited to, for suction, irrigation, inflation.
- Gas, liquid, or a combination thereof from an external source may be administered through a communications lumen 225 , shown in FIG. 21 , and coupled to the tube member lumen 26 at the tube member proximal end 22 .
- an aqueous solution may be employed for irrigation purposes or a local anesthetic, such as lidocaine, may be administered through the tube member lumen 26 so as to exit the tube member distal end 24 .
- the tube member lumen 26 may be operatively connected to an external vacuum source.
- the external vacuum source may provide suction to, for example, but not limited to, remove from the patient, fluids, such as, but not limited to, blood, irrigation fluid or smoke generated during use of the cutting element 40 or other device.
- the cutting element 40 and inner member 30 are first contained within the tube member lumen 26 of the tube member 20 .
- the tube member distal end 24 may be passed through a trocar sleeve that has been placed within a patient and placed along side and adjacent to tissue 80 to be severed as shown in FIG. 22 .
- FIG. 22 is a side view of the device distal end 16 placed along side tissue 80 to be severed.
- the tube member 20 is moved axially proximally so as to withdraw from and expose the cutting element distal end 44 and the inner member distal end 34 .
- the cutting element distal end 44 is operable to impinge and cut into the adjacent tissue 80 substantially laterally or laterally and proximally (toward the handle 50 ) so as to create an arc-shaped cut 86 into the tissue 80 , as shown in FIG. 22 .
- the handle 50 is pulled proximally so as to pull the extended cutting element distal end 44 through the tissue 80 , severing the tissue 80 , with the severed tissue 85 extruding through the loop 46 of the cutting element distal end 44 , as shown in FIG. 23 .
- the support ribbon 60 substantially prevents the inner shaft distal end 34 from extending distally toward the tube member axis X during the cutting operation as well as prevents the cutting element distal end 44 from cutting too deeply.
- the support ribbon 60 guides the tissue 80 into the loop 46 of the cutting element distal end 44 and therefore limits the depth of the cut 86 . Were the cutting element distal end 44 to cut too deeply, the cutting element distal end 44 may get stuck during the cutting operation. Severed tissue 85 may be removed from the patient by another device.
- Additional severing operations may be performed by moving the exposed cutting element distal end 44 to another portion of tissue 80 to be severed and impinging the cutting element distal end 44 into the tissue 80 .
- the tube member 20 may thereafter be moved distally so as to advance over the inner member distal end 34 and the cutting element distal end 44 .
- the tube member distal end 24 is again placed along side tissue 80 to be severed and the process is repeated.
- the angle of the cutting element distal end 44 to the tissue 80 may be changed by the selective positioning of the tube member distal end 24 with respect to the cutting element distal end 44 or the inner member distal end 34 .
- the user may adjust the angle of the cutting element distal end 44 at any time during the cutting operation so as to control the cutting operation.
- less tissue 80 may be severed by reducing the exposure of the cutting element distal end 44 .
- the initiation of the cutting operation may be done at first by limiting the exposure of the cutting element distal end 44 and subsequently increasing the exposure of the cutting element distal end 44 as the tissue severing device 10 is pulled proximally during the cutting operation.
- the cutting element distal end 44 may be operable to impinge and cut into the adjacent tissue 80 substantially laterally or combination laterally and proximally (toward the handle 50 ) so as to create an arc-shaped cut 86 into the tissue 80 , the cutting element distal end 44 may be placed and the cut initiated closer to vital organs and tissue that is to remain unsevered.
- the uterus may be morcellated while the uterus is still attached to the cervix.
- the lateral cutting action of the embodiments of the tissue severing device 10 greatly reduce the risk of injuring adjacent tissue and organs as compared with uterus amputation procedures, particularly for those embodiments of the tissue severing device 10 that do not incorporate heat in the cutting operation. Further, since no amputation of the uterus prior to morcellation is required, only one device, the tissue severing device 10 , is required for both the separation of the uterus from the cervix and morcellating the uterus for removal, reducing the cost and complexity of the surgery.
- tissue severing device 10 presents a significant improvement over prior art devices, as, among other things, downward (distal) traction is not employed and uterus amputation and the corresponding amputation surgical device is not required.
- the tube member 20 may be moved distally so as to advance over the inner member distal end 34 and the cutting element distal end 44 so as to prevent the cutting element distal end 44 from injuring the patient while resting in the patient.
- the tube member distal end 24 is moved proximately so as to withdraw from the cutting element distal end 44 and the inner member distal end 34 .
- the cutting element distal end 44 is placed beyond a leading edge 82 of the tissue 80 with the sharp portion 45 of the cutting element distal end 44 placed adjacent tissue 80 to be severed, as shown in FIG. 24 .
- Cutting of the tissue 80 is affected by pulling proximally on the tissue severing device.
- articulation apparatus operable to allow for articulation of the inner member distal end 34 may be provided by many apparatus, such as, but not limited to, nested ring sections, sliding corrugated sections, pivots, movable joints, and extensible tubing, such as, but not limited to, bellows-type tubing.
- means for providing control of, movement of, and/or a bias to the segments into a predetermined configuration may be provided by many apparatus, such as, but not limited to, elastic elements, such as, but not limited to, springs and spine members, and mechanical elements, such as, but not limited to, a slidable support ribbon 165 and pull-wires and rods.
- FIG. 25 is a perspective view of a device distal end 16 including an inner member distal end 34 that is operable to allow for articulation, in accordance with an embodiment. At least a portion of the inner member distal end 34 comprises two or more segments 34 a , 34 b that are interconnected by a bellows joint 37 supported by one or more spine members 39 .
- the one or more spine members 39 may be operable to provide a predetermined bias on the segments 34 a , 34 b , so as to present the inner member distal end 34 in a straight or curved configuration suitable for a particular purposes.
- FIG. 26 is a perspective view of a device distal end 16 including another inner member distal end 34 that is operable to allow for articulation, in accordance with an embodiment.
- At least a portion of the inner member distal end 34 comprises two or more segments 34 a , 34 b that are interconnected by a pivot joint 37 .
- the movement of the pivot joint 37 may be controlled, at least in part, by the engagement of the slidable support ribbon 165 with the engagement ring 168 so as to present the inner member distal end 34 in a straight or curved configuration.
- the pivot joint 37 is located between the inner member proximal end 32 and the engagement ring 168 .
- the tube member distal end 24 may have a tube flare portion 29 to guide the engagement of the slidable support ribbon 165 and/or the inner member distal end 34 as shown in FIG. 25 .
- the tube flare portion 29 is operable to provide a smooth bend radius for the components that may engage it.
- the slidable support ribbon 165 and the inner member distal end 34 lie substantially parallel with each other within the tube member distal end 24 .
- the cutting element distal end 44 expands into an open position.
- the cutting element engagement element 1170 engages the cutting element portions 144 a , 144 b of the cutting element distal end 44 to stabilize, or hold-open, the cutting element distal end 44 during subsequent tissue severing.
- the flared portion 167 of the slidable support ribbon distal end 164 engages the engagement ring 168 reducing any further traction on the cutting element distal end 44 by the cutting element engagement element 1170 .
- the crease 1141 preferentially bends so as to reduce engagement of the slidable support ribbon distal end 164 on the tube member distal end 24 .
Abstract
Tissue severing devices and methods are provided operable to be inserted through small surgical openings and advanced to tissue to be severed. The tissue severing device includes a cutting element that extends from a tube member during use. A slidable support ribbon is operable to support the cutting element at an angle to an axis of the tube member.
Description
- This application is a continuation of and claims priority to U.S. patent application Ser. No. 13/495,023, now U.S. Pat. No. 8,585,727, which is a continuation of and claimed priority to PCT patent application Serial Number PCT/US10/24210, filed Feb. 14, 2010, entitled TISSUE SEVERING DEVICES AND METHODS, incorporated herein in its entirety by reference.
- The present invention is related generally to the field of medical devices. More particularly, the present invention involves devices and methods that enable accurate dissection of tissue such as associated with a patient undergoing surgery.
- During surgical procedures and, more particularly, tissue removal procedures, it is desirable to limit the size of the entry incision to minimize the trauma experienced by the patient. In the past, efforts to minimize entry incision size have generally been limited due to the size of the tissue to be removed and the need for access to the tissue.
- However, in modern surgery access to the tissue cite is provided by inserting one or more trocar and cannula. Thereafter, one or more laparoscopes are used to view the tissue to be removed, and additional port sites are used to gain access to the tissue to sever it from tissue which is to remain. However, the entry incision must still be sized to allow removal of the severed tissue and, therefore, the reduction in entry incision size is rather limited even in more modern or recently developed surgical procedures.
- Morcellators are devices that morcellate or cut tissue into smaller pieces to allow for easier removal through small surgical access sites. Morcellators that require a pushing or downward traction operation to cut the tissue present a danger of over extension into tissue that is not to be injured. By way of example, but not limited thereto, in a laparoscopic subtotal hysterectomy, one way of minimizing the danger of this over extension is to amputate the body of the uterus from the cervix prior to morcellation. The amputation of the uterus presents an added risk of injury to other organs, such as the rectum and bowel, as they lie behind the uterus and are difficult to see during uterus amputation. Also, amputation is commonly performed using electrocautery or harmonic scalpel which may cause lateral spread of heat or other energy and can inadvertently cause a burn to the bowel or bladder that may not be realized until days after surgery. Further, amputation of the uterus requires the use of one surgical instrument to amputate the uterus and another surgical instrument to morcellate the uterus with their associated cost and complexity of use.
- Some known laparoscopic supracervical hysterectomy instruments utilize graspers that pull tissue into a spinning tubular blade or the spinning blade is pushed into the tissue. These types of instruments have their limitations and dangers associated with their use, such as, but not limited to, the exposed sharp blade possibly injuring surrounding tissue not intended to be morcellated, discharge of the tissue in a spinning tool, and the difficulty and dangers of placing downward traction into the target tissue.
- There exists a need in the art for surgical devices and methods that allow for more effective tissue severing and morcellating and which allow for morcellation without the need to first amputate the tissue.
- In accordance with an embodiment, a tissue severing device comprises a handle, a tube member, and inner member, and a cutting element. The tube member includes an elongated tube having a tube member proximal end extending into the handle and a tube member distal end opposite the tube member proximal end. The tube member defines a tube member lumen that extends through the tube member proximal end to the tube member distal end and defining a tube member axis. The inner member includes an elongated body having an inner member proximal end extending through the tube member lumen and into the handle and an inner member distal end opposite the inner member proximal end. The inner member is operable to be received within the tube member lumen. The cutting element includes a cutting element proximal end and a cutting element distal end opposite the cutting element proximal end. The cutting element proximal end extends into the inner member distal end. The cutting element distal end extends from the inner member distal end. The tube member distal end is operable to move distally over and receive the inner member distal end and the inner member distal end therein. The tube member distal end is operable to move in a proximal direction to expose the cutting element distal end.
- In accordance with another embodiment, the handle further comprises an engagement means in operable engagement with the tube member proximal end operable to permit the tube member to be moved proximally and distally over the inner member.
- In accordance with another embodiment, the tissue severing device is operable to present the cutting element distal end at an angle to the tube member axis when the tube member distal end is withdrawn from the cutting element distal end and at least a portion of the inner member distal end.
- In accordance with another embodiment, at least a portion of the inner member distal end is biased to form a curve of a predetermined angle with respect to the tube member axis when the tube member distal end is withdrawn from at least a portion of the inner member distal end, and is elastically deformable operable to extend under the urging engagement of the tube member distal end when advanced over the inner member distal end.
- In accordance with another embodiment, the tissue severing device further comprises a supporting means operable to support the inner member distal end in a curved position when the inner member distal end is at least partially exposed by the withdrawal of the tube member distal end.
- In accordance with another embodiment, the supporting means comprises a fixed support ribbon. The fixed support ribbon comprises an elongated body including a fixed support ribbon proximal end and a fixed support ribbon distal end opposite the fixed support ribbon proximal end. The fixed support ribbon proximal end is coupled to the tube member distal end within the tube member lumen and the fixed support ribbon distal end is coupled to the inner member distal end. The tube member distal end is operable to advance over and receive the inner member distal end, the cutting element distal end, and the fixed support ribbon. The fixed support ribbon has a length that is operable to pull the inner member distal end into a curve with respect to the tube member axis when the tube member distal end is moved in a proximal direction and to substantially retain that curve when tissue is severed by the cutting element distal end.
- In accordance with another embodiment, the inner member distal end is biased to a substantially straight orientation along the tube member axis. The fixed support ribbon is operable to provide a pulling force necessary to flex the inner member distal end into a curve as well as provide support to prevent the inner member distal end from significantly extending toward the tube member axis when the cutting element distal end is pulled through tissue to be severed.
- In accordance with another embodiment, the tissue severing device further comprises a slidable support ribbon operable for supporting the inner member distal end in a curved position when the inner member distal end is at least partially exposed by the withdrawal of the tube member distal end. The slidable support ribbon comprises an elongated body including a slidable support ribbon proximal end and a slidable support ribbon distal end opposite the slidable support ribbon proximal end. The slidable support ribbon proximal end extends through the tube member lumen from about the tube member proximal end to about the tube member distal end and adjacent the inner member. The slidable support ribbon distal end is positioned adjacent the inner member distal end and the cutting element distal end.
- In accordance with another embodiment, the tissue severing device further comprises an engagement ring coupled to the inner member distal end. The slidable support ribbon distal end and the inner member distal end are slidingly coupled by cooperative engagement of the inner member distal end and the engagement ring. The slidable support ribbon distal end comprises a substantially uniform width body portion and a flared portion at about the inner member distal end, wherein the flared portion has a width that is larger than the body portion. The engagement ring comprising a shape of a partial loop coupled to the inner member distal end transverse to an inner member axis. The engagement ring is operable to slidingly receive the body portion of the slidable support ribbon distal end and is undersized so as to not be able to receive the flared portion therethrough. The flared portion is operable as a catch such that there is no further axial movement of the slidable support ribbon distal end relative to the engagement ring when the flared portion engages the engagement ring. The engagement of the flare portion with the engagement ring is operable to provide a means for pulling the inner member distal end proximally and thus flex the inner member distal end to present the cutting element distal end to an angle to the tube member axis. The engagement ring is operable to be slidingly received within the tube member lumen.
- In accordance with another embodiment, the cutting element comprises an elongated member that forms a contiguous element that defines a loop at the cutting element distal end and two ends at the cutting element proximal end.
- In accordance with another embodiment, the cutting element distal end comprises a substantially elastic material such that the cutting element distal end comprises a diameter somewhat larger than the inner diameter of the tube member lumen. When the tube member distal end is advanced in the distal direction, the cutting element distal end substantially elastically deforms and is slidingly received within the tube member lumen and when the tube member distal end is advanced in the proximal direction, the cutting element distal end exits the tube member lumen and substantially elastically expands therefrom.
- In accordance with another embodiment, the tissue severing device further comprises an energy source coupled to the cutting element and operable to assist the cutting element proximal end in cutting and severing tissue.
- In accordance with another embodiment, the energy source is housed within the handle. The inner member further comprises at least one inner member lumen extending through the inner member proximal end and the inner member distal end. The cutting element comprises an elongated member that forms a contiguous element that defines a loop at the cutting element distal end and two ends at the cutting element proximal end. The cutting element proximal end extends through the inner member lumen to the handle and the two ends of the cutting element proximal end are coupled to the energy source.
- In accordance with another embodiment, the tissue severing device further comprises an engagement means operable for moving the tube member proximally and distally over the inner member.
- Embodiments are illustrated by way of example and not by way of limitation in the figures of the accompanying drawings, in which like references may indicate similar elements throughout the various figures unless otherwise specified.
-
FIGS. 1A and 1B are perspective views of embodiments of tissue severing devices comprising a handle, a tube member, an inner member, and a cutting element; -
FIG. 2A is a side view of the device distal end showing the cutting element distal end extending from the tube member distal end of an embodiment of the tissue severing device ofFIG. 1A ; -
FIG. 2B is a side view of the device distal end showing the inner member distal end and the cutting element distal end extending from the tube member distal end of an embodiment of the tissue severing device ofFIG. 1A ; -
FIG. 3 is a side cut-away view of the device distal end showing the tube member distal end extending over and containing the inner member distal end and the cutting element distal end of an embodiment of the tissue severing device ofFIG. 1A ; -
FIGS. 4A-4C are side views of the device distal end showing a progression of position of the inner member distal end in accordance with embodiment; -
FIGS. 5A and 5B are side cut-away views of the device distal end showing an embodiment of a supporting means comprising a fixed support ribbon of an embodiment of the tissue severing device ofFIG. 1B ; -
FIGS. 6A-6C are side views of the device distal end showing a progression of positions of the inner member distal end, in accordance with an embodiment; -
FIG. 7A is a side, partial cut-away view of atissue severing device 10 in accordance with an embodiment; -
FIGS. 7B-7C are perspective and top views, respectively, of the device distal end showing a slidable support ribbon as another embodiment of a supporting means operable for supporting the inner member distal end in a curved position when the inner member distal end is at least partially exposed by the withdrawal of the tube member distal end; -
FIG. 7D is a perspective view of a device distal end comprising a slidable support ribbon and a plurality of engagement rings, in accordance with another embodiment; -
FIG. 8 is a cross-sectional view of the inner member distal end, a portion of the body portion of the slidable support ribbon distal end, and an engagement ring, in accordance with an embodiment; -
FIGS. 9A-9D are side views of an embodiment of a mechanism for controlling the movement of the slidable support ribbon under the influence of the movement of the tube member; -
FIGS. 10A and 10B are perspective and side views, respectively, of a distal end of another embodiment of a slidable support ribbon; -
FIGS. 11A-11C are top, perspective, and top views, respectively, of the device distal end with the slidable support ribbon, in accordance with an embodiment; -
FIG. 12 is a side view of a cutting element engagement element comprising a U-shaped flange, in accordance with an embodiment; -
FIG. 13 is a side, partial cut-away view of an inner member, in accordance with an embodiment; -
FIG. 14 is a top view of the device distal end showing a bifurcated inner member distal end, in accordance with the embodiment ofFIG. 13 ; -
FIG. 15 is a top, partial cut-away view of the device distal end showing the inner member distal end, in accordance with another embodiment; -
FIG. 16 is a side view of the device distal end showing a slidable support ribbon wherein the slidable support ribbon distal end is fixedly coupled to the inner member distal end, in accordance with an embodiment; -
FIG. 17 is a side cross-sectional view of an embodiment of a cutting element proximal end and an inner member distal end that are operable for removable coupling engagement therebetween; -
FIG. 18 is a partial cut-away view of an embodiment of a cutting element and an inner member, in accordance with an embodiment; -
FIG. 19A is a top view of an embodiment of a cutting element, in accordance with an embodiment; -
FIG. 19B is a perspective view of an embodiment of a cutting element, in accordance with an embodiment; -
FIGS. 19C and 19D are top views, expanded and compresses, respectively, of an embodiment of a cutting element, in accordance with an embodiment; -
FIG. 19E is a top view showing an embodiment of a cutting element, in accordance with an embodiment; -
FIG. 19F is a top view showing another embodiment of a cutting element, in accordance with an embodiment; -
FIG. 20 is a side partial cut-away view of the device distal end wherein the cutting element distal end has a bias to an angle beta to the tube member axis, in accordance with an embodiment; -
FIG. 21 is a side cut-away view of a tissue severing device in accordance with an embodiment; -
FIG. 22 is a side view of the distal region of an embodiment of the tissue severing device as presented to tissue, in accordance with an embodiment; -
FIG. 23 is a side view of the distal region of an embodiment of the tissue severing device as cutting through tissue, in accordance with an embodiment; -
FIG. 24 is a side view of the distal region of an embodiment of the tissue severing device as presented to tissue, in accordance with an embodiment -
FIG. 25 is a perspective view of a device distal end including an inner member distal end that is operable to allow for articulation, in accordance with an embodiment; and -
FIG. 26 is a perspective view of a device distal end including another inner member distal end that is operable to allow for articulation, in accordance with an embodiment. - In the following description, embodiments of apparatus and methods will be disclosed. For purposes of explanation, specific numbers, materials, and/or configurations are set forth in order to provide a thorough understanding of the embodiments. However, it will also be apparent to those skilled in the art that the embodiments may be practiced without one or more of the specific details, or with other approaches, materials, components, etc. In other instances, well-known structures, materials, and/or operations are not shown and/or described in detail to avoid obscuring the embodiments. Accordingly, in some instances, features are omitted and/or simplified in order to not obscure the disclosed embodiments. Furthermore, it is understood that the embodiments shown in the figures are illustrative representations and are not necessarily drawn to scale.
- Reference throughout this specification to “one embodiment” or “an embodiment” means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment of claimed subject matter. Thus, the appearances of the phrase “in one embodiment” or “an embodiment” in various places throughout this specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in one or more embodiments.
- Reference will now be made to embodiments illustrated in the drawings and specific language which will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended. Alterations and further modifications of the illustrated embodiments and further applications of the principles of the invention, as would normally occur to one skilled in the art to which the invention relates, are also within the scope of the invention.
- Tissue severing devices as provided in embodiments herein are operable to be inserted through small surgical openings, such as, but not limited to, being inserted through a trocar sleeve at a laparoscopic port site and advanced to tissue to be severed or morcellated. The tissue severing device is operable to directly sever or morcellate tissue within a patient's body.
-
FIGS. 1A and 1B are perspective views oftissue severing devices 10 comprising ahandle 50, atube member 20, aninner member 30, and a cuttingelement 40, in accordance with two embodiments. Thetube member 20 comprises an elongated relatively stiff tube having a tube memberproximal end 22 extending into thehandle 50 and a tube memberdistal end 24 opposite the tube memberproximal end 22. Thetube member 20 defines atube member lumen 26 that extends through the tube memberproximal end 22 to the tube memberdistal end 24 defining a tube member axis X. Theinner member 30 comprises an elongated body having an inner member proximal end 32 (hidden from view) extending through thetube member lumen 26 and into thehandle 50 and an inner memberdistal end 34 opposite the inner memberproximal end 32. Theinner member 30 is operable to be received within thetube member lumen 26. - The cutting
element 40 comprises a cutting element proximal end 42 (hidden from view) that enters the inner memberdistal end 34, shown inFIG. 18 , and a cutting elementdistal end 44 opposite the cutting elementproximal end 42. The cutting elementdistal end 44 extends from the inner memberdistal end 34. - The
tissue severing device 10 includes a deviceproximal end 14 that generally includes thehandle 50 and a devicedistal end 16 that generally includes the tube memberdistal end 24, the inner memberdistal end 34, and the cutting elementdistal end 44. -
FIG. 2A is a side view of the devicedistal end 16 showing the cutting elementdistal end 44 extending from the tube memberdistal end 24.FIG. 2B is a side view of the devicedistal end 16 showing the inner memberdistal end 34 and the cutting elementdistal end 44 extending from the tube memberdistal end 24.FIG. 3 is a side cut-away view of the devicedistal end 16 showing the tube memberdistal end 24 extending over and containing the inner memberdistal end 34 and the cutting elementdistal end 44. The tube memberdistal end 24 is operable to move in a distal direction (away from the handle 50) over and with thetube lumen 26 operable to receive the inner memberdistal end 34 and the cutting elementdistal end 44 therein, as shown inFIG. 3 . The tube memberdistal end 24 is also operable to move in a proximal direction (toward the handle 50) to expose the cutting elementdistal end 44, as shown inFIG. 2A , and, in other embodiments, also expose at least a portion of the inner memberdistal end 34, as shown inFIGS. 1A , 1B and 2B, so as to present the cutting elementdistal end 44 to tissue to be cut or severed. - Referring again to
FIGS. 1A and 1B , in accordance with an embodiment, the tube memberproximal end 22 includes an engagement means in cooperative engagement with thehandle 50 operable to permit thetube member 20 to be moved proximally and distally over theinner member 30. It is anticipated that there are many engagement means that may be used to provide the function for permitting the movement of thetube member 20 proximally and distally over theinner member 30, some of which are described below. - The
tube member 20 may comprise any suitable material, including, but not limited to, stainless steel, plastic, PTFE, polymer, and composite materials. In addition, the interior and/or exterior surfaces of theinner member 30 andtube member 20 may be coated with a low friction material such as, but not limited to, PTFE, Teflon®, polyvinylidene fluoride, polyethylene, or another polymeric material to facilitate movement of thetube member 20 with respect to theinner member 30 and cutting elementdistal end 44. - In accordance with an embodiment, the
tissue severing device 10 is operable to present the cutting elementdistal end 44 extending from the tube memberdistal end 24 substantially parallel with the tube member axis X, as shown inFIG. 2A . The tube memberdistal end 24 is operable to move proximately such that the cutting elementdistal end 44 is exposed so as to be available for use to cut or sever tissue. In accordance with an embodiment, theinner member 30 may be relatively stiff so as to support the cuttingelement 40 from deflecting during use to cut or sever tissue. - In accordance with another embodiment, the
tissue severing device 10 is operable to present the cutting elementdistal end 44 at an angle alpha to the tube member axis X when the tube memberdistal end 24 is withdrawn from the cutting elementdistal end 44 and at least a portion of the inner memberdistal end 34, as shown inFIG. 2B . In accordance with an embodiment, the inner memberdistal end 34 is operable to curve away from and form an angle alpha with the tube member axis X when the inner memberdistal end 34 is exposed by the withdrawal of the tube memberdistal end 24 therefrom.FIGS. 4A-4C are side views of the devicedistal end 16 showing a progression of position of the inner memberdistal end 34. As the tube memberdistal end 24 withdraws from the inner memberdistal end 34, the angle alpha becomes progressively larger to a final predetermined angle alpha. In accordance with embodiments, the predetermined angle alpha may be any angle to the tube member axis X. In accordance with an embodiment, the predetermined angle alpha may be up to and including 90 degrees to the tube member axis X. - The tube member
distal end 22, by being moved proximally or distally, may be used, among other things, to control the angle alpha of the cutting elementdistal end 44 and the cutting depth into the tissue as the tissue is being cut or severed. - In accordance with an embodiment, at least a portion of the inner member
distal end 34 is biased to form a curve of a predetermined angle alpha when the tube memberdistal end 24 is withdrawn from over the inner memberdistal end 34. The means for providing the bias that affects the curve in the inner memberdistal end 34 may include one or a combination of the elastic properties of the tube memberdistal end 24 and a support means, as further described below. - In accordance with an embodiment, the at least a portion of the inner member
distal end 34 that is elastically biased to form a curve of a predetermined angle alpha is elastically deformable so as to extend (straighten) under the urging engagement of the tube memberdistal end 24 advancing distally over the inner memberdistal end 34. The inner memberdistal end 34 and the cutting elementdistal end 44 are operatively stiff so as to prevent substantial extension or deflection of either or both of the inner memberdistal end 34 and the cutting elementdistal end 44 toward the tube member axis X under the forces encountered when the cutting elementdistal end 44 penetrates, cuts, and/or severs tissue, but not so stiff so as to prevent the extension of the inner memberdistal end 34 and the cutting elementdistal end 44 under the force of the tube memberdistal end 24 moving distally thereover. - In accordance with embodiments, the at least a portion of the inner member
distal end 34 comprises any suitable material or assembly so as to be elastically deformable as well as either biased to be substantially straight or biased to form a curve of a predetermined angle alpha. Suitable materials include, but are not limited to, heat-set and cold-formed stainless steel and alloys thereof, super-elastic shape memory alloys including nickel-titanium alloys, preferentially-braided tubing and sleeves, and heat set or cold formed polymer and composite materials, among others, in forms such as, but not limited to, wires, ribbons, rods, sleeves, and tubes. - It is appreciated that there may be many apparatus that may be utilized to affect articulation of the inner member
distal end 34. Such apparatus to affect articulation may include, but not limited to, one or more pivots, joints, extensible tubing, and rigid segments coupled by flexible or elastic interconnects. Embodiments representative of examples of such apparatus are provided in the discussion ofFIGS. 25 and 26 . - It is understood that the
inner member 30 and thetube member 20 may comprise more than one material along the length of or at different portions of theinner member 30 andtube member 20 suitable for a particular purpose. By way of example, the inner memberdistal end 34 may be elastically deformable wherein the inner memberproximal end 32 may be relatively stiffer as compared with the inner memberdistal end 34. - In accordance with other embodiments, and as an alternative to relying entirely on the elastic properties of the inner member
distal end 34 to affect the suitable balance of stiffness for the particular purpose as described above, thetissue severing device 10 further comprises a support means. As also provided below, the support means may be used to the advantage of guiding tissue to be severed into the cutting elementdistal end 44 and controlling the depth of the cut, regardless of the support means' contribution to establishing the curve of the inner memberdistal end 34 or controlling extension of the inner memberdistal end 34 toward the tube member axis X while the cutting elementdistal end 44 is pulled through tissue to be severed. - In accordance with embodiments of the
tissue severing device 10, thetissue severing device 10 further comprises supporting means for supporting the inner memberdistal end 34 in a curved position when the inner memberdistal end 34 is at least partially exposed by the withdrawal of the tube memberdistal end 24 therefrom. The supporting means may be used in combination with or in lieu of any bias to a predetermined curvature that may be present in the inner memberdistal end 34 as described above. -
FIGS. 5A and 5B are side cut-away views of the devicedistal end 16 showing an embodiment of a supporting means comprising a fixedsupport ribbon 60, also shown in the embodiment ofFIG. 1B . The fixedsupport ribbon 60 comprises an elongated body including a fixed support ribbonproximal end 62 and a fixed support ribbondistal end 64 opposite the fixed support ribbonproximal end 62. The fixed support ribbonproximal end 62 is coupled to the tube memberdistal end 24 within thetube member lumen 26 and the fixed support ribbondistal end 64 is coupled to the inner memberdistal end 34. - The tube member
distal end 24 is operable to advance over and receive the inner memberdistal end 34, the cutting elementdistal end 44, and the fixedsupport ribbon 60, as shown inFIG. 5A . The tube memberdistal end 34 may be moved in the proximal direction so as to withdraw from the cutting elementdistal end 44, the inner memberdistal end 34, and a portion of the fixedsupport ribbon 60, as shown inFIG. 5B . The fixedsupport ribbon 60 has a length that is operable to pull the inner memberdistal end 34 into a curve and to substantially retain that curve as tissue is severed by the cutting elementdistal end 44. -
FIGS. 6A-4C are side views of the devicedistal end 16 showing a progression of positions of the inner memberdistal end 34. When the tube memberdistal end 24 covers the cutting elementdistal end 44, as shown inFIG. 6A , the fixedsupport ribbon 60 is generally slack and does not exhibit a significant force on the inner memberdistal end 34. As the tube memberdistal end 24 is moved proximally (toward the handle as shown inFIG. 1B ), and moving the fixed support ribbonproximal end 62 proximally, exposing at least a portion of the inner memberdistal end 34, the fixedsupport ribbon 60 becomes taught and begins to exert a pulling force on the inner memberdistal end 34 which bends the inner memberdistal end 34 to an angle alpha to the tube member axis X dependent on the distance that the tube memberdistal end 24 has moved proximally, as shown inFIGS. 6B and 6C . - As the tube member
distal end 24 is moved distally to progressively cover the inner memberdistal end 34, the fixed support ribbonproximal end 62 moves distally with the tube memberdistal end 24 allowing the inner memberdistal end 34 to extend toward the tube member axis X. In an embodiment wherein the inner memberdistal end 34 has a curve bias, that is, is biased to a predetermined curve, the fixedsupport ribbon 60 in combination with the tube memberdistal end 24 provides support to prevent the inner memberdistal end 34 from extending significantly toward the tube member axis X when the cutting elementdistal end 44 is pulled through tissue to be severed which may present forces that may overcome the curve bias of the inner memberdistal end 34 were it not for the fixedsupport ribbon 60. In addition, or in the alternative, the fixedsupport ribbon 60 assists in controlling the depth of cut of the cutting elementdistal end 44 by impinging on and guiding the tissue into the cutting elementdistal end 44, as will be discussed further below. - The fixed
support ribbon 60 is operable to control the depth of cut into the tissue by the cutting elementdistal end 44. During use, the fixedsupport ribbon 60 slides along the tissue edge substantially preventing the cutting elementdistal end 44 from sinking into the tissue to a depth greater than the length of the cutting elementdistal end 44. - In an embodiment wherein the inner member
distal end 34 has a straight bias, that is, is biased to a substantially straight orientation along the tube member axis X, the fixedsupport ribbon 60 in combination with the tube memberdistal end 24 provides the pulling force necessary to bend the inner memberdistal end 34 into a curve as well as provide support to prevent the inner memberdistal end 34 from significantly extending toward the tube member axis X when the cutting elementdistal end 44 is pulled through tissue to be severed. Additionally, the fixedsupport ribbon 60 assists in controlling the depth of cut of the cutting elementdistal end 44 by guiding the tissue to be severed into the cutting elementdistal end 44, as will be discussed further below. - The tube member
distal end 24, by being moved proximally or distally, in combination with the fixedsupport ribbon 60, may be used, among other things, to control the angle alpha of the cutting elementdistal end 44 and the cutting depth into the tissue as the tissue is being cut or severed. -
FIG. 7A is a side, partial cut-away view of atissue severing device 10 andFIGS. 7B-7C are perspective and top views, respectively, of the devicedistal end 16 showing aslidable support ribbon 160 as another embodiment of a supporting means operable for supporting the inner memberdistal end 34 in a curved position when the inner memberdistal end 34 is at least partially exposed by the withdrawal of the tube memberdistal end 24. Theslidable support ribbon 160 may be used in combination with or in lieu of any bias to a predetermined curvature that may be present in the inner memberdistal end 34. - The
slidable support ribbon 160 comprises an elongated body including a slidable support ribbonproximal end 162 and a slidable support ribbondistal end 164 opposite the slidable support ribbonproximal end 162. The slidable support ribbonproximal end 162 extends through thetube member lumen 26 from about the tube memberproximal end 22 to the tube memberdistal end 24 and adjacent theinner member 30. The slidable support ribbondistal end 164 is positioned adjacent the inner memberdistal end 34 and the cutting elementdistal end 44 and is operably engaged therewith as detailed below. - The slidable support ribbon
proximal end 162 is positioned generally adjacent thehandle 50 and may be operably engaged by the user or elements of thetissue severing device 10 as detailed below. - In accordance with an embodiment, the slidable support ribbon
distal end 164 is operable to support the inner memberdistal end 34 into a curved shape when the tube memberdistal end 24 is withdrawn therefrom. Theslidable support ribbon 160 is operable to substantially prevent the inner memberdistal end 34 from extending toward the tube member axis X when the cutting elementdistal end 44 is pulled through tissue to be severed. Theslidable support ribbon 160 is also operable to, among other things, control the depth of cut into the tissue by guiding the tissue toward the cutting elementdistal end 44. - In another embodiment, the slidable support ribbon
distal end 164 is also operable to, among other things, protect thetube member lumen 26 from being damaged by asharp edge 45 of the cutting elementdistal end 44 by acting as a barrier therebetween. In accordance with an embodiment, the slidable support ribbondistal end 164 comprises a relatively flat profile so as to cover at least a portion of the cutting elementdistal end 44 when the slidable support ribbondistal end 164 is extended there over. The slidable support ribbondistal end 164 is operable to extend between asharp edge 45, shown inFIG. 7C , of the cutting elementdistal end 44 and a portion of thetube member lumen 26 when the tube memberdistal end 24 is extended over the cutting elementdistal end 44. The slidable support ribbondistal end 164 is operable to withdraw from adjacent thesharp edge 45 of the cutting elementdistal end 44 when the tube memberdistal end 24 is withdrawn from over the cutting elementdistal end 44. - In accordance with an embodiment, the slidable support ribbon
distal end 164 is operable to begin withdrawing proximally from being adjacent the cutting elementdistal end 44 as the cutting elementdistal end 44 begins to be exposed by the withdrawing tube memberdistal end 24. In this embodiment, the slidable support ribbondistal end 164 is exposed substantially concurrently with the exposure of the inner memberdistal end 34 by the tube memberdistal end 24. In other words, the slidable support ribbondistal end 164 is not adjacent the portion of the cutting elementdistal end 44 that is exposed by the withdrawing tube memberdistal end 24 such that the cutting elementdistal end 44 may begin severing tissue immediately upon withdrawal of the tube memberdistal end 24. - In accordance with another embodiment, the slidable support ribbon
distal end 164 is operable to at least partially be adjacent the cutting elementdistal end 44 as the cutting elementdistal end 44 and the slidable support ribbondistal end 164 are exposed by the withdrawing tube memberdistal end 24. In this embodiment, the slidable support ribbondistal end 164 is withdrawn from adjacent the cutting elementdistal end 44 after the cutting elementdistal end 44 is at least substantially exposed by the withdrawing tube memberdistal end 24. The slidable support ribbondistal end 164 may come between at least a portion of thesharp edge 45 of the cutting elementdistal end 44 and adjacent tissue near which it is placed. The user may withdraw the slidable support ribbondistal end 164 into thetube member lumen 26 in which the cutting elementdistal end 44 may then sever tissue. - In another embodiment, as the tube member
distal end 24 is further withdrawn so as to expose a portion of the inner memberdistal end 34, the slidable support ribbondistal end 164 is withdrawn from adjacent the cutting elementdistal end 44 and operably engages the inner memberdistal end 34 so as to provide at least one of the following functions, including, but not limited to, support the inner memberdistal end 34 into an arc shape, to substantially prevent the inner memberdistal end 34 from extending toward the tube member axis X while the cutting elementdistal end 44 is pulled through tissue to be severed, and control the depth of cut into the tissue by guiding the tissue toward the cutting elementdistal end 44. - The
slidable support ribbon 160 is operable to control the depth of cut into the tissue by the cutting elementdistal end 44. During use, theslidable support ribbon 160 slides along the tissue edge substantially preventing the cutting elementdistal end 44 from sinking into the tissue to a depth greater than the length of the cutting elementdistal end 44. - As discussed above, the slidable support ribbon
distal end 164 and the tube memberdistal end 24 are operably engaged to provide the desired functions. In accordance with the embodiments ofFIGS. 7A-7C , the slidable support ribbondistal end 164 is slidingly coupled to the inner memberdistal end 34. As the inner memberdistal end 34 is exposed by the withdrawing tube memberdistal end 24, the user may pull the slidable support ribbonproximal end 162 in the proximal direction so as to withdraw the slidable support ribbonproximal end 162 from adjacent the cutting elementdistal end 44 and bend the inner memberdistal end 34 into a desired arc to present the cutting elementdistal end 44 to the tissue at an angle alpha to the tube member axis X. The user may control the slidable support ribbonproximal end 162 in a desired position by pulling or pushing the slidable support ribbonproximal end 162. - In accordance with an embodiment, the slidable support ribbon
distal end 164 and the inner memberdistal end 34 are slidingly coupled by cooperative engagement of the inner memberdistal end 34 and anengagement ring 168 coupled to the inner memberdistal end 34. The slidable support ribbondistal end 164 comprises a substantially uniformwidth body portion 165 and a flaredportion 167 at the slidable support ribbondistal end 164, wherein the flaredportion 167 has a width that is larger than thebody portion 165. - The
engagement ring 168 comprises a shape of a partial loop and is coupled to the inner memberdistal end 34 transverse to an inner member axis X2. Theengagement ring 168 is operable to slidingly receive thebody portion 165 of the slidable support ribbondistal end 164 but is undersized so as to not be able to receive the flaredportion 167 therethrough. The flaredportion 167, thus, functions as a catch such that there is no further axial movement of the slidable support ribbondistal end 164 relative to theengagement ring 168 when the flaredportion 167 engages theengagement ring 168. Therefore, the engagement of theflare portion 167 with theengagement ring 168 provides a means for pulling the inner memberdistal end 34 proximally and thus flex the inner memberdistal end 34 into a desired arc to present the cutting elementdistal end 44 at an angle alpha to the tube member axis X. -
FIG. 7D is a perspective view of the devicedistal end 16 comprising aslidable support ribbon 160 and a plurality ofengagement rings engagement rings slidable support ribbon 160 in conformance with the curved position of the inner memberdistal end 34 when the inner memberdistal end 34 is at least partially exposed by the withdrawal of the tube memberdistal end 24. - The
engagement ring 168 is operable to be slidingly received within thetube member lumen 26.FIG. 8 is a cross-sectional view of the inner memberdistal end 34, a portion of thebody portion 165 of the slidable support ribbondistal end 164, and an embodiment of theengagement ring 168. To assist in guiding the tube memberdistal end 24 over theengagement ring 168 so as to contain theengagement ring 168, theengagement ring 168 comprises aproximal edge 163 that is sloped facing proximally so as to guide the tube memberdistal end 24 over theengagement ring 168. - The
engagement ring 168 is operable to slidingly receive thebody portion 165 of the slidable support ribbondistal end 164. In accordance with an embodiment, theengagement ring 168 comprises aninner surface 161 that has a convex shape facing distally so as to assist in guiding thebody portion 165 of the slidable support ribbondistal end 164 between theengagement ring 168 and the inner memberdistal end 34. This may be particularly advantageous when the slidable support ribbondistal end 164 is caused to flex at an angle so as to pull and/or support the inner memberdistal end 34 at an angle to the tube member axis X. - In accordance with an embodiment, the pullback of the
slidable support ribbon 160 in the proximal direction so as to bend the inner memberdistal end 34 into a desired curve to present the cutting elementdistal end 44 at an angle alpha to the tube member axis X, and visa versa, may be done in a manual operation by the user or an automatic operation by thetissue cutting device 10. In accordance with an embodiment wherein theslidable support ribbon 160 is manually controlled, the slidable support ribbonproximal end 162 is operable to be manipulated by the user. In accordance with an embodiment, as shown inFIG. 7A , the slidable support ribbonproximal end 162 extends from thehandle 50 such that the slidable support ribbonproximal end 162 may be grasped by the user. The slidable support ribbonproximal end 162 and thehandle 50 may also comprise an engagement element such that the slidable support ribbonproximal end 162 may be releasably coupled to thehandle 50 when theslidable support ribbon 160 is extended or retracted to a desired position. The engagement element allows for temporarily fixating the position of the slidable support ribbonproximal end 162. - It is anticipated that there are many suitable engagement elements that provide the function for releasably coupling the slidable support ribbon
proximal end 162 to thehandle 50. In an embodiment of an engagement element, by way of example only and not limited thereto, as shown inFIG. 7A , aratchet 150 may be operably engaged between the slidable support ribbonproximal end 162 and thehandle 50. Theratchet 150 allows for motion in the proximal direction while preventing motion in the distal direction until controlled release. As is known in the art, aratchet 150 may comprise many devices, such as, but not limited to, a pair of racks with intermeshing teeth, and a toothed gear and pawl. - It is appreciated that the movement of the
slidable support ribbon 160 may also be controlled by an electrical device, such as, but not limited to, an electric motor. In accordance with an embodiment, the slidable support ribbonproximal end 162 is engaged with a motor that is automatically or manually controlled operable to move theslidable support ribbon 160 proximally and distally. - In accordance with an embodiment wherein the
slidable support ribbon 160 is automatically controlled by thetissue severing device 10, the slidable support ribbonproximal end 162 is operable to be manipulated by an interaction of elements of thetissue severing device 10. - In accordance with an embodiment wherein the
slidable support ribbon 160 is automatically controlled, the slidable support ribbonproximal end 162 is cooperatively engaged with the tube memberproximal end 22 such that when the tube memberproximal end 22 is moved axially, theslidable support ribbon 160 may be moved axially as well. It is anticipated that there are many apparatus that may affect cooperation between the slidable support ribbonproximal end 162 and the tube memberproximal end 22. -
FIGS. 9A-9D are side views of an embodiment of a mechanism for controlling the movement of theslidable support ribbon 160 under the influence of the movement of thetube member 20. The slidable support ribbonproximal end 162 further comprises asnare 166 extending at an angle from the slidable support ribbonproximal end 162 operable to catch a tube memberproximal edge 21 of the tube memberproximal end 22. -
FIG. 9A shows a simplified view of thetube member 20 in the distal position wherein the cuttingelement 40 is contained within thetube member lumen 26. Thesnare 166 is spaced a predetermined distance from the tube memberproximal edge 21. The predetermined distance may be substantially the same as the length of the cuttingelement 40 such that when the tube memberdistal end 24 has retracted from the cutting elementdistal end 44, the tube memberproximal edge 21 may engage thesnare 166, as shown inFIG. 9B . As thetube member 20 is moved further in the proximal direction, the tube memberproximal edge 21 engages thesnare 166 so as to pull theslidable support ribbon 160 in the proximal direction and thus move the slidable support ribbondistal end 164 from adjacent the cutting elementdistal end 44, as shown inFIG. 9C . As thetube member 20 is moved further in the proximal direction, theslidable support ribbon 160 is moved further in the proximal direction and thus the slidable support ribbondistal end 164 engages the inner memberdistal end 34 so as to support the cutting elementdistal end 44 at an angle alpha to the tube member axis X. In accordance with an embodiment, the slidable support ribbondistal end 164 may be coupled to abiasing element 265 such that theslidable support ribbon 160 is urged to move in the distal direction when thetube member 20 is moved in the distal direction. -
FIGS. 10A and 10B are perspective and side views, respectively, of adistal end 1164 of another embodiment of aslidable support ribbon 1160. Theslidable support ribbon 1160 is an embodiment of a supporting means that is operable for supporting the inner memberdistal end 34 in a curved position when the inner memberdistal end 34 is at least partially exposed by the withdrawal of the tube memberdistal end 24 and operable to support the cutting elementdistal end 44 in an open position. Theslidable support ribbon 1160 may be used in combination with or in lieu of any bias to a predetermined curvature, including straight, that may be present in the inner memberdistal end 34. - The
slidable support ribbon 1160 comprises an elongated body including a slidable support ribbonproximal end 162, a slidable support ribbondistal end 1164 opposite the slidable support ribbonproximal end 162, and aribbon body portion 1161 therebetween. The slidable support ribbondistal end 1164 comprises a cuttingelement engagement element 1170 operable to engage the cuttingelement portions distal end 44 about the inner memberdistal end 34 as shown inFIGS. 11B-11C and discussed below. In accordance with the embodiment ofFIGS. 10A-10B , the cuttingelement engagement element 1170 comprises aflange 1168 depending at about a 90 degree angle from theribbon body portion 1161. Theflange 1168 is operable to be received within the loop formed by the cutting elementdistal end 44. - Substantially similar to the embodiment of the
slidable support ribbon 160 ofFIG. 7A , the slidable support ribbonproximal end 162 of theslidable support ribbon 1160 extends through thetube member lumen 26 from about the tube memberproximal end 22 to the tube memberdistal end 24 and adjacent theinner member 30.FIGS. 11A-11C are top, perspective, and top views, respectively, of the devicedistal end 16 with theslidable support ribbon 1160 in accordance with an embodiment. The slidable support ribbondistal end 1164 is positioned adjacent the inner memberdistal end 34 and the cutting elementdistal end 44 and is operably engaged therewith as detailed below. - As shown in
FIG. 11A , when the cutting elementdistal end 44 is positioned within the tube memberdistal end 24, theflange 1168 of the slidable support ribbondistal end 1164 is positioned within the loop formed by the cutting elementdistal end 44 and does not substantially engage the cutting elementdistal end 44. As shown inFIGS. 11B-11C , when the cutting elementdistal end 44 is exposed by the withdrawal of the tube memberdistal end 24, theslidable support ribbon 1160 may be moved proximally such that theflange 1168 engages the cuttingelement portions distal end 44 assisting in spreading apart the cuttingelement portions distal end 44. Theflange 1168 helps to stabilize, or hold-open, the cutting elementdistal end 44 during subsequent tissue severing. The flaredportion 167 of the slidable support ribbondistal end 1164 engages theengagement ring 168 reducing any further traction on the cutting elementdistal end 44 by theflange 1168. - The slidable support ribbon
distal end 1164 is also operable to support the inner memberdistal end 34 into a curved shape at an angle alpha to the tube member axis X when the tube memberdistal end 24 is withdrawn therefrom. Theslidable support ribbon 1160 is operable to substantially prevent the inner memberdistal end 34 from extending toward the tube member axis X when the cutting elementdistal end 44 is pulled through tissue to be severed. Theslidable support ribbon 1160 is also operable to, among other things, control the depth of cut into the tissue by guiding the tissue toward the cutting elementdistal end 44. - Substantially similar to the embodiment of
FIG. 7A , the slidable support ribbondistal end 1164 is slidingly coupled to the inner memberdistal end 34 by anengagement ring 168. The slidable engagement of theslidable support ribbon 1160 ofFIGS. 11A-11C is substantially the same as the slidable engagement of the embodiments ofFIGS. 7A-7C . In accordance with an embodiment, the slidable support ribbondistal end 1164 is flared so as to engage theengagement ring 168 so as to position the cutting elementdistal end 44 as described above and shown inFIG. 11B . The slidable support ribbondistal end 1164 is flared also so as to provide abroader flange 1168 so as to more greatly engage and spread apart the cuttingelement portions distal end 44. - It is appreciated that the cutting
element engagement element 1170 of the slidable support ribbondistal end 1164 that is operable to engage the cuttingelement portions distal end 44 may have a shape suitable for a particular purpose.FIG. 12 is a side view of a cuttingelement engagement element 1170 comprising aU-shaped flange 1169 operable to engage and substantially wrap around the cuttingelement portions distal end 44. TheU-shaped flange 1169 is operable to contain a portion of the cuttingelement portions cutting element portions U-shaped flange 1169. - It is appreciated that direct contact of the cutting
element engagement element 1170 with the cuttingelement portions distal end 44 when energized by an energy source as discussed below. By way of another example, but not limited thereto, direct contact may cause electrical conductivity issues when the cutting elementdistal end 44 is energized by an electrical source such as in electrocautery. It is appreciated that there are many ways to prevent the direct contact between the cuttingelement engagement element 1170 and the cuttingelement portions element engagement element 1170 is moved proximally so as to assist in spreading apart the cuttingelement portions distal end 44. -
FIG. 13 is a side, partial cut-away view of aninner member 30 further comprising twoinner member lumens 36 a,b that are substantially parallel and that extend from the inner memberproximal end 32 to the inner memberdistal end 34 therethrough, in accordance with an embodiment. The inner memberdistal end 34 further comprises aslit 135 between the twoinner member lumens 36 a,b, that extends from the inner memberdistal end 34 to a predetermined distance proximally operable to produce a bifurcation of the inner memberdistal end 34 defining twobranch portions 234 a,b each containing one of the twoinner member lumens 36 a,b. The twoinner member lumens 36 a,b are operable such that each of the cuttingelement portions distal end 44 may be received and extend into one of the twoinner member lumens 36 a,b. -
FIG. 14 is a top view of the devicedistal end 16 showing a bifurcated inner memberdistal end 34 in accordance with the embodiment ofFIG. 13 . The inner memberdistal end 34 is bifurcated along theslit 135, the bifurcation being formed under the urging engagement of one or more of the spring bias of the cuttingelement 44 and the cuttingelement engagement element 1170 of the slidable support ribbondistal end 1164. In the case of the cuttingelement engagement element 1170, the cuttingelement engagement element 1170 engages the twobranch portions 234 a,b of the inner memberdistal end 34 about the cuttingelement portions distal end 44 effectively creating and/or supporting the bifurcation of the inner memberdistal end 34. The cuttingelement engagement element 1170 engages the twobranch portions 234 a,b as shown inFIG. 14 rather than the cuttingelement portions FIG. 11B . -
FIG. 15 is a top, partial cut-away view of the devicedistal end 16 showing the inner memberdistal end 34, in accordance with another embodiment. Thetissue severing device 10 further comprises two cuttingelement sleeves 230 a,b. Each cuttingelement sleeve 230 a,b comprises an elongated body having a cutting element sleeveproximal end 232 a,b extending through theinner member lumen 36 and into thehandle 50 and a cutting element sleevedistal end 234 a,b opposite the cutting element sleeveproximal end 232 a,b. Each of the two cuttingelement sleeves 230 a,b further comprises a sleeve lumen 236 a,b that extends from the cutting element sleeveproximal end 232 a,b to the cutting element sleevedistal end 234 a,b therethrough. The cuttingelement portions distal end 44 are operable to be received within the sleeve lumen 236 a,b. - The two
cutting element sleeves 230 a,b spread apart from each other under the urging engagement of one or more of the spring bias of the cuttingelement 44 and the cuttingelement engagement element 1170 of the slidable support ribbondistal end 1164. In the case of the cuttingelement engagement element 1170, the cuttingelement engagement element 1170 engages the two cutting element sleeve distal ends 234 a,b about the cuttingelement portions distal end 44 effectively assisting in spreading apart the cuttingelement portions distal end 44, the two cuttingelement sleeves 230 a,b preventing direct contact between the cuttingelement engagement element 1170 and the cuttingelement portions -
FIG. 16 is a side view of the devicedistal end 16 showing aslidable support ribbon 2160 wherein the sliding support ribbondistal end 164 is fixedly coupled to the inner memberdistal end 34, in accordance with an embodiment. When the inner memberdistal end 34 is exposed by the withdrawing tube memberdistal end 24, the user may pull the sliding support ribbonproximal end 162 in the proximal direction so as to flex the inner memberdistal end 34 into a desired curve to present the cutting elementdistal end 44 at an angle alpha to the tube member axis X. The user may control the sliding support ribbondistal end 164 in a desired position by pulling or pushing asnare 166 at the sliding support ribbonproximal end 162. It is appreciated that theslidable support ribbon 2160 may also be moved proximally and distally by the apparatus presented for the other embodiments herein or by apparatus known in the art. - As previously discussed, the cutting
element 40 is operable for cutting and severing tissue. The cuttingelement 40 comprises a cutting elementproximal end 42 that engages theinner member 30 and a cutting elementdistal end 44, at least a portion of which is used to cut and sever tissue. - Various embodiments of the cutting element
proximal end 42 are anticipated. In general, embodiments of the cutting elementproximal end 42 are anticipated that either couple with the inner memberdistal end 34 or pass through theinner member 30 to couple with other elements within thehandle 50. It is appreciated that there are many coupling elements that may be used to provide fixed or removable coupling between the inner memberdistal end 34 and the cutting elementproximal end 42. - In accordance with an embodiment, a cutting
element 40 is provided that may be removably coupled with the inner memberdistal end 34.FIG. 17 is a side cross-sectional view of an embodiment wherein the cutting elementproximal end 42 and the inner memberdistal end 34 are operable for removable coupling engagement therebetween. The cutting elementproximal end 42 comprises amating element 37 and the inner memberdistal end 34 comprises a receivingelement 35. Themating element 37 and the receivingelement 35 are operable for removable coupling therebetween, wherein themating element 37 is received and coupled to the receivingelement 35. - In accordance with an embodiment, a plurality of cutting
elements 40 may be provided, each suitable for a particular purpose such that one cuttingelement 40 may be interchanged on the inner memberdistal end 34 with another cuttingelement 40 of a same or different configuration. By way of example, cuttingelements 40 of differing sizes and shapes may be provided suitable for a particular purpose. Further, as the cuttingelement 40 becomes dull, areplacement cutting element 40 may replace the first. - In accordance with other embodiments, a cutting
element 40 is provided that comprises a cutting elementproximal end 42 that passes through theinner member 30 and is operable for coupling with elements within thehandle 50.FIG. 18 is a side, cut-away view of aninner member 30 further comprising at least oneinner member lumen 36 that extends from the inner memberproximal end 32 to the inner memberdistal end 34 therethrough. In accordance with the embodiment ofFIG. 18 , the cuttingelement 40 comprises an elongated member that forms a contiguous element that defines aloop 46 at the cutting elementdistal end 44 and two ends 48 at the cutting elementproximal end 42. In accordance with an embodiment, the cuttingelement 40 is a wire. In another embodiment, the cuttingelement 40 is a ribbon, that is, a flat-sided elongated member that defines aloop 46 at the cutting elementdistal end 44 with the two ends 48 of the ribbon forming the cutting elementproximal end 42. The cutting elementproximal end 42 is operable to be received within theinner member lumen 36 and extend from the inner memberproximal end 32 suitable for a particular purpose discussed below. - Various embodiments of the cutting element
distal end 44 are anticipated. In accordance with an embodiment, the cutting elementdistal end 44 comprises a blade that is operable for cutting and severing tissue. In accordance with other embodiments, the cutting elementdistal end 44 comprises aloop 46, such as, but not limited to a loop of wire and ribbon. At least a portion of the cutting elementdistal end 44 comprises one or moresharp portions 45 that are suitable for severing tissue.FIG. 18 shows an embodiment of a cutting elementdistal end 44, in accordance with an embodiment. The cutting elementdistal end 44 comprises a wire in the form of aloop 46 including asharp edge 45 that is preferentially sharp so as to cut tissue. Thesharp edge 45 is operable such that it may cut into adjacent tissue as it is released by the tube memberdistal end 24 and as thetissue severing device 10 is pulled proximally toward the user. -
FIG. 19A is a top view showing an embodiment of a cuttingelement 40 a, in accordance with an embodiment. The cutting elementdistal end 44 comprises a ribbon in the form of aloop 46 including asharp edge 45 that is preferentially sharp so as to cut tissue. Abroad surface 41 of the cuttingelement 40 a is generally parallel to a plane defined by theloop 46 so as to present thesharp edge 45 also generally parallel with the plane defined by theloop 46. -
FIG. 19B is a perspective view showing an embodiment of a cuttingelement 40 b, in accordance with an embodiment. The cutting elementdistal end 44 comprises a ribbon in the form of aloop 46 including asharp edge 45 that is preferentially sharp so as to cut tissue, and adull edge 47 that is not sharp relative to thesharp edge 45, such that it may not cut tissue. Abroad surface 41 of the cuttingelement 40 b is generally perpendicular to a plane defined by theloop 46 so as to present thesharp edge 45 also generally perpendicular with the plane defined by theloop 46. - The
sharp edge 45 is operable to cut into adjacent tissue as it is released by the tube memberdistal end 24, as shown inFIG. 11B , and as thetissue severing device 10 is pulled proximally toward the user. Thesharp edge 45 is presented on the edge of the cutting elementdistal end 44 that faces proximally when it is released by the tube memberdistal end 24. In other embodiments, thesharp edge 45 may comprise serrations so as to assist in severing tissue. - Various sizes and configurations of embodiments of the cutting element
distal end 44 are anticipated. In the embodiment ofFIG. 3 , the cutting elementdistal end 44 is operable to fit within thetube member lumen 26 without elastic deformation of the cutting elementdistal end 44. - In the embodiment of
FIGS. 5A-5B , the cutting elementdistal end 44 comprises a substantially elastic material such that theloop 46 may have a diameter somewhat larger than the inner diameter of thetube member lumen 26. When the tube memberdistal end 24 is advanced in the distal direction, the cutting elementdistal end 44 is operable to substantially elastically deform and be slidingly received within thetube member lumen 26 as shown inFIG. 5A . When the tube memberdistal end 24 is advanced in the proximal direction, the cutting elementdistal end 44 is operable to exit thetube member lumen 26 and substantially elastically expand therefrom. In accordance with an embodiment, the cutting elementdistal end 44 is in the form of a substantiallyoval loop 46 when released from thetube member lumen 26. Theloop 46 is operable to be biased to open up when the tube memberdistal end 24 is withdrawn therefrom. When thetube member 20 is advanced over the cutting elementdistal end 44, the cutting elementdistal end 44 is operable to elastically deform under the impinging force of the tube memberdistal end 24 into a substantially closed or pinched-down oval shape so as to enter thetube member lumen 26. In accordance with an embodiment, and by way of example and not limited thereto, theloop 46 of the cutting elementdistal end 44 may have a diameter of about 12 mm, wherein the tube member may have an inner diameter of about 5 mm. - It is appreciated that the cutting
element 40 may be constructed from many typed of materials, such as, but not limited to, stainless steel and shape-memory metals or metal alloys such as, but not limited to, nickel-titanium alloy. - In accordance with an embodiment, the cutting element
distal end 44 is substantially uniformly elastically deformable. In accordance with other embodiments, the cutting elementdistal end 44 comprises one or more elastic regions operable to provide elastic deformation of the cutting elementdistal end 44. - In accordance with an embodiment, the cutting element
distal end 44 is formed as a single element. In accordance with another embodiment, the cutting elementdistal end 44 may be formed by integrating or joining separate components comprising one or more materials, at least some of which have elastic properties.FIGS. 19C and 19D are top views showing an embodiment of a cuttingelement 40 c, in accordance with an embodiment. The cutting elementdistal end 44 comprises a ribbon in the form of aloop 46 comprising twostainless steel portions 141 coupled together by a super-elastic nickel-titanium alloy portion 241, wherein the nickel-titanium portion 241 provides a significant portion of the elasticity of the cutting elementdistal end 44 to a collapsed shape as shown inFIG. 19C and thestainless steel portions 141 providing generally the bias to the expanded shape as shown inFIG. 19D . - It is also appreciated that the cutting
element 40 may be constructed with geometric features that assist in forming a loop at the cutting elementdistal end 44.FIG. 19E is a top view showing an embodiment of a cuttingelement 40 e, in accordance with an embodiment. The cutting elementdistal end 44 comprises a ribbon defining acrease 341 across the width of the ribbon. Thecrease 341 is operable to allow for preferential bending to assist in compressing the cutting elementdistal end 44 into an elongated loop for the cutting elementdistal end 44 to be received within thetube member lumen 26. -
FIG. 19F is a top view showing another embodiment of a cuttingelement 40 f, in accordance with an embodiment. The cutting elementdistal end 44 comprises a ribbon defining a necked-downportion 441. The necked-downportion 441 is operable to allow for preferential bending to assist in compressing the cutting elementdistal end 44 into an elongated loop for the cutting elementdistal end 44 to be received within thetube member lumen 26. -
FIG. 20 is a side partial cut-away view of the devicedistal end 16 wherein the cutting elementdistal end 44 has a bias to an angle beta to the tube member axis X, in accordance with an embodiment. The bias of the cutting elementdistal end 44 is operable such that thesharp edge 45 is presented to tissue when the devicedistal end 16 is placed along side and adjacent to tissue to be severed as will be discussed below. In accordance with this embodiment, the tissue may begin to be severed prior to the emergence of the inner memberdistal end 34 from the tube memberdistal end 24. - In accordance with an embodiment, the
inner member 30 and thus the cuttingelement 40 may be operable to be assembled in thetube member lumen 36 such that the cutting elementdistal end 44 may be retained at one or more predetermined angles with respect to thehandle 50. By way of example, in accordance with an embodiment, the cutting elementdistal end 44 may be operable to be assembled to extend from the tube memberdistal end 24 at one of four directions, such as up, right, down, or left, as viewed along the tube member axis X from thehandle 50. - In accordance with embodiments of the
tissue cutting device 10, an energy source is provided to assist the cutting elementproximal end 44 in cutting and severing tissue.FIG. 21 is a side partial cut-away view of atissue severing device 10 comprising anenergy source 90, in accordance with an embodiment. The cutting elementproximal end 42 comprises two ends 48, such as shown in the embodiment ofFIG. 18 . The cutting elementproximal end 42 extends through theinner member lumen 36 to thehandle 50. Within thehandle 50, the two ends 48 of the cutting elementproximal end 42 are coupled to theenergy source 90 operable to assist in severing tissue. It is appreciated that theenergy source 90 may employ one or more energy modes that are operable to assist in cutting and severing tissue, such as, but not limited to, mechanical, radio frequency, thermal, ultrasonic, and any other suitable energy. - In accordance with an embodiment, the
energy source 90 is a radiofrequency energy source 90, and the cuttingelement 40 may function as a component of a monopolar or a bipolar system. The radiofrequency energy source 90 may be operable as an electrocautery instrument so as to provide, among other things, coagulation of small bleeding vessels that may be encountered during the severing process. - In accordance with another embodiment, the two ends 48 of the cutting element
proximal end 42 are coupled to anenergy source 90 that is mechanical in operation. In accordance with an embodiment, theenergy source 90 is an ultrasonic source that is operable to impart a vibratory action to the cutting elementdistal end 44 to assist in severing the tissue. In another embodiment, theenergy source 90 is a mechanical oscillator that is operable to rapidly and alternatively pull on the two ends 48 of the cutting elementproximal end 42 so as to impart a sawing motion to the cutting elementdistal end 44 to assist in severing the tissue. - In another embodiment, the
energy source 90 is a mechanical oscillator, such as, but not limited to, a motor, that is operable to rapidly and alternatively push-pull on the two ends 48 of the cutting elementproximal end 42 so as to provide a rapid in and out movement of the cutting elementdistal end 44 to assist in severing tissue. In accordance with another embodiment, theinner member lumen 36 comprises a track that is operable to guide the movement of the cutting elementdistal end 44 which is coupled to a trolley that is adapted to couple with the track. - In yet another embodiment, the
energy source 90 is a thermal source that is operable to heat the cutting elementdistal end 44 to assist in severing the tissue. - In accordance with embodiments wherein the cutting element
proximal end 42 couples with the inner memberdistal end 34, the cutting elementdistal end 44 may be energized with energy by coupling theenergy source 90 to the inner memberproximal end 32. The energy from theenergy source 90 is communicated to the cutting elementdistal end 44 via theinner member 30. It is appreciated that many energy sources may be used to communicate energy to the cutting elementdistal end 44 via theinner member 30. It is also appreciated that a mechanical energy source may be particularly effective. In accordance with an embodiment, the inner memberproximal end 32 is coupled to a mechanical oscillator that is operable to rapidly push-pull on the inner memberproximal end 32 so as to impart motion to the cutting elementdistal end 44 to assist in severing the tissue. In accordance with an embodiment, theenergy source 90 is an ultrasonic source that is operable to impart a vibratory action to theinner member 30 that is communicated to the cutting elementdistal end 44 to assist in severing tissue. - In accordance with and embodiment, by way of example, the
energy source 90 is a variable speed drive operable to induce oscillatory motion to the cutting elementdistal end 44 either directly or via theinner member 30. Referring again toFIG. 21 , the drive includes amotor 92, atransmission 93, and aswitch 94. Theswitch 94 comprises afirst contact 95 housed in thehandle 50 adjacent abutton contact 96. - When the
button contact 96 is in an initial position, theswitch 94 represents an open electrical circuit. Thus, no current is supplied to themotor 92, and the cutting elementdistal end 44 is stationary. Themotor 92 is electrically connected to power via theswitch 94 and acontrol 99 when thebutton contact 96 is in the inward most position so as to make electric coupling with thefirst contact 95, as will be described more fully hereafter. - The
control 99 includes arotary pot 97 operable to allow a user to control the power available to themotor 92 and, thus, the speed of the cutting elementdistal end 44. Appropriate lengths ofelectrical conductors 91 electrically interconnect thecontrol 99, the switch, 94, and themotor 92. - The
button contact 96 nests within a track (not shown) defined by thehandle 50. A button return spring (not shown), which may be mounted between thebutton contact 96 and a portion of thehandle 50, biases thebutton contact 96 in an outward position away from thefirst contact 95 and out of electrical communication therewith. Thetransmission 93 is operable to convert rotational motion from themotor 92 to an oscillatory motion that is communicated to the cutting elementdistal end 44 by coupling thetransmission 93 to either the cutting elementproximal end 42 or the inner memberproximal end 32. - In accordance with embodiments of the
tissue cutting device 10, and referring toFIGS. 1A and 1B , thetissue cutting device 10 further comprises an engagement means 70 being operable for moving thetube member 20 proximally and distally over theinner member 30. It is anticipated that there are many engagement means 70 that may be used to provide the function for moving thetube member 20 proximally and distally, including unpowered, powered, manual and automatic means, some of which will be described further below. In accordance with an embodiment, wherein thehandle 50 comprises the engagement means 70 as a slidable engagement element, and thetube member 20 is operable to be moved proximally and distally over theinner member 30 by a user grasping thetube member 20 and sliding thetube member 20 through the slidable engagement element within thehandle 50. - The
tissue severing device 10, shown inFIGS. 1 and 21 , further comprises an engagement means 70 in the form of a tubemember moving element 170 operable to engage the tube memberproximal end 22 for moving thetube member 20 proximally and distally over theinner member 30. In accordance with an embodiment as shown inFIG. 21 , the tubemember moving element 170 that is operable for axially moving thetube member 20 includes arack 56 andpinion 57. It is understood that there are many rack and pinion configurations in the art suitable for a particular purpose. For example, but not limited thereto, in accordance with an embodiment, therack 56 comprises a plurality of spaced notches or grooves located at the tube memberproximal end 22. Therack 56 may be an integral feature of thetube member 20 or an element that is coupled to the tube memberproximal end 22. Thepinion 57 comprises an engagement wheel having teeth that operably engage the spaced notches of therack 56. In operation, when thepinion 57 is rotated in a clockwise direction, therack 56 is engaged to advance thetube member 20 axially in a proximal direction. When thepinion 57 is rotated in the opposite direction, therack 56 is engaged to move thetube member 20 axially in a distal direction. - A tube
member moving element 170 for axially moving thetube member 20 relative to theinner member 30 and cuttingelement 40 may be provided by many known means, such as, but not limited to a rack and pinion drive system wherein the pinion comprises helical threads and is operable by rotating the pinion along the tube member axis X, such as shown in the embodiment ofFIGS. 1A and 1B . Other linear actuators may also be used, suitable for a particular purpose. It is appreciated that the tubemember moving element 170 may be electrically and manually operated. - It is appreciated that the tube
member moving element 170 for axially moving thetube member 20 relative to theinner member 30 and cuttingelement 40 may be operably coupled to theenergy source 90 for energizing the cutting elementdistal end 44. By way of example, but not limited thereto, in accordance with an embodiment, theenergy source 90 for energizing the cutting elementdistal end 44 is activated only when thetube member 20 has been moved proximally by a predetermined amount. Such a configuration may prevent the activation of theenergy source 90 prior to the withdrawal of the cutting elementdistal end 44 from the cutting elementdistal end 44. - It is appreciated that other elements may be incorporated into the
tissue severing device 10. By way of example, but not limited thereto, thetube member 20 may include one or more accessory lumens such as, but not limited to, for suction, irrigation, inflation. Gas, liquid, or a combination thereof from an external source may be administered through acommunications lumen 225, shown inFIG. 21 , and coupled to thetube member lumen 26 at the tube memberproximal end 22. For example, but not limited thereto, an aqueous solution may be employed for irrigation purposes or a local anesthetic, such as lidocaine, may be administered through thetube member lumen 26 so as to exit the tube memberdistal end 24. In addition, thetube member lumen 26 may be operatively connected to an external vacuum source. The external vacuum source may provide suction to, for example, but not limited to, remove from the patient, fluids, such as, but not limited to, blood, irrigation fluid or smoke generated during use of the cuttingelement 40 or other device. - In using the
tissue severing device 10 of an embodiment shown inFIG. 21 , the cuttingelement 40 andinner member 30 are first contained within thetube member lumen 26 of thetube member 20. The tube memberdistal end 24 may be passed through a trocar sleeve that has been placed within a patient and placed along side and adjacent totissue 80 to be severed as shown inFIG. 22 .FIG. 22 is a side view of the devicedistal end 16 placed alongside tissue 80 to be severed. Thetube member 20 is moved axially proximally so as to withdraw from and expose the cutting elementdistal end 44 and the inner memberdistal end 34. The cutting elementdistal end 44 is operable to impinge and cut into theadjacent tissue 80 substantially laterally or laterally and proximally (toward the handle 50) so as to create an arc-shapedcut 86 into thetissue 80, as shown inFIG. 22 . Once the cuttingelement 40 is exposed the desired amount, thehandle 50, as shown inFIG. 1B , is pulled proximally so as to pull the extended cutting elementdistal end 44 through thetissue 80, severing thetissue 80, with the severedtissue 85 extruding through theloop 46 of the cutting elementdistal end 44, as shown inFIG. 23 . - The
support ribbon 60 substantially prevents the inner shaftdistal end 34 from extending distally toward the tube member axis X during the cutting operation as well as prevents the cutting elementdistal end 44 from cutting too deeply. Thesupport ribbon 60 guides thetissue 80 into theloop 46 of the cutting elementdistal end 44 and therefore limits the depth of thecut 86. Were the cutting elementdistal end 44 to cut too deeply, the cutting elementdistal end 44 may get stuck during the cutting operation.Severed tissue 85 may be removed from the patient by another device. - Additional severing operations may be performed by moving the exposed cutting element
distal end 44 to another portion oftissue 80 to be severed and impinging the cutting elementdistal end 44 into thetissue 80. Alternatively, after each cutting operation, thetube member 20 may thereafter be moved distally so as to advance over the inner memberdistal end 34 and the cutting elementdistal end 44. The tube memberdistal end 24 is again placed alongside tissue 80 to be severed and the process is repeated. - It is appreciated that the angle of the cutting element
distal end 44 to thetissue 80 may be changed by the selective positioning of the tube memberdistal end 24 with respect to the cutting elementdistal end 44 or the inner memberdistal end 34. The user may adjust the angle of the cutting elementdistal end 44 at any time during the cutting operation so as to control the cutting operation. By way of example, but not limited thereto,less tissue 80 may be severed by reducing the exposure of the cutting elementdistal end 44. By way of another non-limiting example, the initiation of the cutting operation may be done at first by limiting the exposure of the cutting elementdistal end 44 and subsequently increasing the exposure of the cutting elementdistal end 44 as thetissue severing device 10 is pulled proximally during the cutting operation. - It is appreciated that by virtue of the cutting element
distal end 44 being operable to impinge and cut into theadjacent tissue 80 substantially laterally or combination laterally and proximally (toward the handle 50) so as to create an arc-shapedcut 86 into thetissue 80, the cutting elementdistal end 44 may be placed and the cut initiated closer to vital organs and tissue that is to remain unsevered. In embodiments of thetissue severing device 10 disclosed herein, the uterus may be morcellated while the uterus is still attached to the cervix. The lateral cutting action of the embodiments of thetissue severing device 10 greatly reduce the risk of injuring adjacent tissue and organs as compared with uterus amputation procedures, particularly for those embodiments of thetissue severing device 10 that do not incorporate heat in the cutting operation. Further, since no amputation of the uterus prior to morcellation is required, only one device, thetissue severing device 10, is required for both the separation of the uterus from the cervix and morcellating the uterus for removal, reducing the cost and complexity of the surgery. It is evident that embodiments of thetissue severing device 10 disclosed herein presents a significant improvement over prior art devices, as, among other things, downward (distal) traction is not employed and uterus amputation and the corresponding amputation surgical device is not required. - It may be necessary for the surgeon to rest the device
distal end 16 in the patient while other operations are performed. Thetube member 20 may be moved distally so as to advance over the inner memberdistal end 34 and the cutting elementdistal end 44 so as to prevent the cutting elementdistal end 44 from injuring the patient while resting in the patient. - In accordance with another method of using the
tissue severing device 10, the tube memberdistal end 24 is moved proximately so as to withdraw from the cutting elementdistal end 44 and the inner memberdistal end 34. The cutting elementdistal end 44 is placed beyond a leadingedge 82 of thetissue 80 with thesharp portion 45 of the cutting elementdistal end 44 placedadjacent tissue 80 to be severed, as shown inFIG. 24 . Cutting of thetissue 80 is affected by pulling proximally on the tissue severing device. - Referring again to the ability of the inner member
distal end 34 to deform or flex from a substantially straight configuration to a curved or angled configuration, it is appreciated that articulation apparatus operable to allow for articulation of the inner memberdistal end 34 may be provided by many apparatus, such as, but not limited to, nested ring sections, sliding corrugated sections, pivots, movable joints, and extensible tubing, such as, but not limited to, bellows-type tubing. It is also appreciated that means for providing control of, movement of, and/or a bias to the segments into a predetermined configuration, such as substantially straight or to form a curve of a predetermined angle, may be provided by many apparatus, such as, but not limited to, elastic elements, such as, but not limited to, springs and spine members, and mechanical elements, such as, but not limited to, aslidable support ribbon 165 and pull-wires and rods. -
FIG. 25 is a perspective view of a devicedistal end 16 including an inner memberdistal end 34 that is operable to allow for articulation, in accordance with an embodiment. At least a portion of the inner memberdistal end 34 comprises two ormore segments more spine members 39. The one ormore spine members 39 may be operable to provide a predetermined bias on thesegments distal end 34 in a straight or curved configuration suitable for a particular purposes. -
FIG. 26 is a perspective view of a devicedistal end 16 including another inner memberdistal end 34 that is operable to allow for articulation, in accordance with an embodiment. At least a portion of the inner memberdistal end 34 comprises two ormore segments slidable support ribbon 165 with theengagement ring 168 so as to present the inner memberdistal end 34 in a straight or curved configuration. The pivot joint 37 is located between the inner memberproximal end 32 and theengagement ring 168. - It is appreciated that the tube member
distal end 24 may have atube flare portion 29 to guide the engagement of theslidable support ribbon 165 and/or the inner memberdistal end 34 as shown inFIG. 25 . Thetube flare portion 29 is operable to provide a smooth bend radius for the components that may engage it. - In operation, when the tube member
distal end 24 is advanced over the cutting elementdistal end 44, theslidable support ribbon 165 and the inner memberdistal end 34 lie substantially parallel with each other within the tube memberdistal end 24. As the tube memberdistal end 24 is withdrawn, the cutting elementdistal end 44 expands into an open position. As the tube memberdistal end 24 is further withdrawn, the cuttingelement engagement element 1170 engages the cuttingelement portions distal end 44 to stabilize, or hold-open, the cutting elementdistal end 44 during subsequent tissue severing. The flaredportion 167 of the slidable support ribbondistal end 164 engages theengagement ring 168 reducing any further traction on the cutting elementdistal end 44 by the cuttingelement engagement element 1170. The crease 1141 preferentially bends so as to reduce engagement of the slidable support ribbondistal end 164 on the tube memberdistal end 24. - While the invention has been described in connection with specific embodiments thereof, it will be understood that it is capable of further modification, and this application is intended to cover any variations, uses, or adaptations of the invention following, in general, the principles of the invention and including such departures from the present disclosure as come within known or customary practice in the art to which the invention pertains and as may be applied to the essential features hereinbefore set forth, and as fall within the scope of the invention and the limits of the appended claims.
Claims (31)
1-27. (canceled)
28. A tissue severing device comprising:
a handle;
a tube member including an elongated tube having a tube member proximal end extending into the handle and a tube member distal end opposite the tube member proximal end, the tube member defining a tube member lumen that extends through the tube member proximal end to the tube member distal end and defining a tube member axis;
an inner member including an elongated body having an inner member proximal end extending through the tube member lumen and into the handle and an inner member distal end opposite the inner member proximal end, the inner member being operable to be received within the tube member lumen;
a cutting element including a cutting element proximal end and a cutting element distal end opposite the cutting element proximal end, the cutting element proximal end extending into the inner member distal end, the cutting element distal end extending from the inner member distal end,
the tube member distal end being operable to move distally over and receive the inner member distal end and the inner member distal end therein, and the tube member distal end being operable to move in a proximal direction to expose the cutting element distal end; and
a slidable support ribbon operable for supporting the inner member distal end in a curved position when the inner member distal end is at least partially exposed by the withdrawal of the tube member distal end, the slidable support ribbon comprising an elongated body including a slidable support ribbon proximal end and a slidable support ribbon distal end opposite the slidable support ribbon proximal end, the slidable support ribbon proximal end extending through the tube member lumen from about the tube member proximal end to about the tube member distal end and adjacent the inner member, the slidable support ribbon distal end positioned adjacent the inner member distal end and the cutting element distal end.
29. The tissue severing device of claim 28 , wherein the slidable support ribbon proximal end is positioned generally adjacent the handle and may be operably engaged by a user.
30. The tissue severing device of claim 28 , wherein the slidable support ribbon distal end is operable to support the inner member distal end into a curved shape when the tube member distal end is withdrawn therefrom, the slidable support ribbon being operable to substantially prevent the inner member distal end from extending toward the tube member axis when the cutting element distal end is pulled through tissue to be severed.
31-35. (canceled)
36. The tissue severing device of claim 30 , wherein the slidable support ribbon distal end is operably coupled to the tube member so as to begin withdrawing proximally from being adjacent the cutting element distal end as the cutting element distal end begins to be exposed by the withdrawing tube member distal end, the slidable support ribbon distal end operable to be exposed substantially concurrently with the exposure of the inner member distal end by the tube member distal end.
37. (canceled)
38. The tissue severing device of claim 30 , wherein the tube member distal end is operable to be withdrawn so as to expose a portion of the inner member distal end, the slidable support ribbon distal end is operable to be withdrawn from adjacent the cutting element distal end and operably engage the inner member distal end so as to support the inner member distal end into an angle to the tube member axis.
39. The tissue severing device of claim 30 , wherein the slidable support ribbon distal end is slidingly coupled to the inner member distal end, wherein when the inner member distal end is exposed by withdrawing the tube member distal end, a user may pull the slidable support ribbon proximal end in the proximal direction so as to withdraw the slidable support ribbon distal end from adjacent the cutting element distal end and flex the inner member distal end into a desired angle to the tube member axis.
40. The tissue severing device of claim 30 , further comprising an engagement ring coupled to the inner member distal end, the slidable support ribbon distal end and the inner member distal end are slidingly coupled by cooperative engagement of the inner member distal end and the engagement ring, the slidable support ribbon distal end comprising a substantially uniform width body portion and a flared portion at about the inner member distal end, wherein the flared portion has a width that is larger than the body portion, the engagement ring comprising a shape of a partial loop coupled to the inner member distal end transverse to an inner member axis, the engagement ring being operable to slidingly receive the body portion of the slidable support ribbon distal end and is undersized so as to not be able to receive the flared portion therethrough, the flared portion operable as a catch such that there is no further axial movement of the slidable support ribbon distal end relative to the engagement ring when the flared portion engages the engagement ring, wherein the engagement of the flare portion with the engagement ring is operable to provide a means for pulling the inner member distal end proximally and thus flex the inner member distal end to present the cutting element distal end to an angle to the tube member axis, wherein the engagement ring being operable to be slidingly received within the tube member lumen.
41-42. (canceled)
43. The tissue severing device of claim 40 , wherein the slidable support ribbon distal end further comprises a cutting element engagement element operable to engage the cutting element distal end about the inner member distal end, operable to open and stabilize the cutting element distal end when the cutting element engagement element engages the cutting element distal end about the about the inner member distal end.
44-46. (canceled)
47. The tissue severing device of claim 28 , wherein the slidable support ribbon proximal end is cooperatively engaged with the tube member proximal end such that when the tube member proximal end is moved axially, the slidable support ribbon is operable to be moved axially as well.
48. The tissue severing device of claim 28 , wherein the slidable support ribbon proximal end further comprising a snare extending at an angle from the slidable support ribbon proximal end operable to engage the tube member proximal end such that when the tube member proximal end is moved axially, the slidable support ribbon is operable to be moved axially.
49. The tissue severing device of claim 43 , wherein the cutting element engagement element is a flange extending at an acute angle from the slidable support ribbon distal end and extending into the loop formed by the cutting element distal end when adjacent thereto.
50. (canceled)
51. The tissue severing device of claim 28 , wherein the cutting element comprises a cutting element proximal end and a cutting element distal end opposite the cutting element proximal end, the cutting element proximal end and the inner member distal end removably coupled therebetween, the cutting element distal end including at least a portion operable to cut and sever tissue.
52. (canceled)
53. The tissue severing device of claim 28 , wherein the cutting element distal end defines a loop, at least a portion of the cutting element distal end including one or more sharp portions that are suitable for severing tissue.
54. The tissue severing device of claim 53 , wherein the loop is operable to be biased to expand when the tube member distal end is withdrawn therefrom, and wherein the cutting element distal end being elastically deformed under the impinging force of the tube member distal end so as to enter and be contained by the tube member lumen when the tube member is advanced over the cutting element distal end.
55. (canceled)
56. The tissue severing device of claim 28 , wherein the inner member further comprises at least one inner member lumen extending through the inner member proximal end and the inner member distal end, the cutting element proximal end extending through the inner member lumen and coupled within the handle.
57. The tissue severing device of claim 56 , wherein the cutting element comprises a ribbon defining a flat-sided elongated member that defines a loop at the cutting element distal end and two ends forming the cutting element proximal end, the cutting element proximal end received within the inner member lumen and extending from the inner member proximal end.
58. The tissue severing device of claim 28 , wherein the cutting element distal end has a bias to form an angle to the tube member axis.
59. The tissue severing device of claim 28 , further comprising an energy source coupled to the cutting element and operable to assist the cutting element proximal end in cutting and severing tissue.
60-63. (canceled)
64. The tissue severing device of claim 59 , wherein the energy source is a mechanical oscillator that is operable to rapidly and alternatively pull on the two ends of the cutting element proximal end so as to impart a sawing motion to the cutting element distal end.
65-66. (canceled)
67. The tissue severing device of claim 28 , wherein the inner member proximal end is coupled to a mechanical oscillator that is operable to rapidly push-pull on the inner member proximal end so as to impart motion to the cutting element distal end.
68-118. (canceled)
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US14/082,201 US20140228872A1 (en) | 2010-02-14 | 2013-11-18 | Tissue severing devices with sliding support and methods |
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
PCT/US2010/024210 WO2011099983A1 (en) | 2010-02-14 | 2010-02-14 | Tissue severing devices and methods |
US13/495,023 US8585727B2 (en) | 2010-02-14 | 2012-06-13 | Tissue severing devices and methods |
US14/082,201 US20140228872A1 (en) | 2010-02-14 | 2013-11-18 | Tissue severing devices with sliding support and methods |
Related Parent Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US13/495,023 Continuation US8585727B2 (en) | 2010-02-14 | 2012-06-13 | Tissue severing devices and methods |
Publications (1)
Publication Number | Publication Date |
---|---|
US20140228872A1 true US20140228872A1 (en) | 2014-08-14 |
Family
ID=47519334
Family Applications (2)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US13/495,023 Expired - Fee Related US8585727B2 (en) | 2010-02-14 | 2012-06-13 | Tissue severing devices and methods |
US14/082,201 Abandoned US20140228872A1 (en) | 2010-02-14 | 2013-11-18 | Tissue severing devices with sliding support and methods |
Family Applications Before (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US13/495,023 Expired - Fee Related US8585727B2 (en) | 2010-02-14 | 2012-06-13 | Tissue severing devices and methods |
Country Status (1)
Country | Link |
---|---|
US (2) | US8585727B2 (en) |
Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2017019653A1 (en) * | 2015-07-27 | 2017-02-02 | Boston Scientific Scimed, Inc | Devices for manipulating tissue and related methods |
Families Citing this family (88)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US10835307B2 (en) | 2001-06-12 | 2020-11-17 | Ethicon Llc | Modular battery powered handheld surgical instrument containing elongated multi-layered shaft |
US11134978B2 (en) | 2016-01-15 | 2021-10-05 | Cilag Gmbh International | Modular battery powered handheld surgical instrument with self-diagnosing control switches for reusable handle assembly |
US9089360B2 (en) | 2008-08-06 | 2015-07-28 | Ethicon Endo-Surgery, Inc. | Devices and techniques for cutting and coagulating tissue |
US8663220B2 (en) | 2009-07-15 | 2014-03-04 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
JP5538795B2 (en) * | 2009-09-28 | 2014-07-02 | Ntn株式会社 | Remote control type actuator |
US10441345B2 (en) | 2009-10-09 | 2019-10-15 | Ethicon Llc | Surgical generator for ultrasonic and electrosurgical devices |
US11090104B2 (en) | 2009-10-09 | 2021-08-17 | Cilag Gmbh International | Surgical generator for ultrasonic and electrosurgical devices |
US8986302B2 (en) | 2009-10-09 | 2015-03-24 | Ethicon Endo-Surgery, Inc. | Surgical generator for ultrasonic and electrosurgical devices |
US8469981B2 (en) | 2010-02-11 | 2013-06-25 | Ethicon Endo-Surgery, Inc. | Rotatable cutting implement arrangements for ultrasonic surgical instruments |
US8585727B2 (en) * | 2010-02-14 | 2013-11-19 | Oscar R. Polo | Tissue severing devices and methods |
US8795327B2 (en) | 2010-07-22 | 2014-08-05 | Ethicon Endo-Surgery, Inc. | Electrosurgical instrument with separate closure and cutting members |
US9192431B2 (en) | 2010-07-23 | 2015-11-24 | Ethicon Endo-Surgery, Inc. | Electrosurgical cutting and sealing instrument |
US20120265175A1 (en) * | 2011-04-14 | 2012-10-18 | Medtronic Xomed, Inc. | Malleable instrument for laparoscopic procedures |
US9259265B2 (en) | 2011-07-22 | 2016-02-16 | Ethicon Endo-Surgery, Llc | Surgical instruments for tensioning tissue |
US10039597B2 (en) * | 2011-10-31 | 2018-08-07 | Boston Scientific Scimed, Inc. | Surgical cutting instrument and related methods |
WO2013119545A1 (en) | 2012-02-10 | 2013-08-15 | Ethicon-Endo Surgery, Inc. | Robotically controlled surgical instrument |
US9439668B2 (en) | 2012-04-09 | 2016-09-13 | Ethicon Endo-Surgery, Llc | Switch arrangements for ultrasonic surgical instruments |
US20140005705A1 (en) | 2012-06-29 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Surgical instruments with articulating shafts |
US9198714B2 (en) | 2012-06-29 | 2015-12-01 | Ethicon Endo-Surgery, Inc. | Haptic feedback devices for surgical robot |
US9393037B2 (en) * | 2012-06-29 | 2016-07-19 | Ethicon Endo-Surgery, Llc | Surgical instruments with articulating shafts |
US20140005702A1 (en) | 2012-06-29 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments with distally positioned transducers |
US9351754B2 (en) | 2012-06-29 | 2016-05-31 | Ethicon Endo-Surgery, Llc | Ultrasonic surgical instruments with distally positioned jaw assemblies |
US9326788B2 (en) | 2012-06-29 | 2016-05-03 | Ethicon Endo-Surgery, Llc | Lockout mechanism for use with robotic electrosurgical device |
US9226767B2 (en) | 2012-06-29 | 2016-01-05 | Ethicon Endo-Surgery, Inc. | Closed feedback control for electrosurgical device |
US9408622B2 (en) | 2012-06-29 | 2016-08-09 | Ethicon Endo-Surgery, Llc | Surgical instruments with articulating shafts |
BR112015007010B1 (en) | 2012-09-28 | 2022-05-31 | Ethicon Endo-Surgery, Inc | end actuator |
US9095367B2 (en) | 2012-10-22 | 2015-08-04 | Ethicon Endo-Surgery, Inc. | Flexible harmonic waveguides/blades for surgical instruments |
US20140135804A1 (en) | 2012-11-15 | 2014-05-15 | Ethicon Endo-Surgery, Inc. | Ultrasonic and electrosurgical devices |
US20160175038A1 (en) * | 2013-03-14 | 2016-06-23 | John R. Zider | Surgical Devices |
US20140378988A1 (en) * | 2013-06-20 | 2014-12-25 | Boston Scientific Scimed, Inc. | Supported retrieval device and related methods of use |
US9814514B2 (en) | 2013-09-13 | 2017-11-14 | Ethicon Llc | Electrosurgical (RF) medical instruments for cutting and coagulating tissue |
US9265926B2 (en) | 2013-11-08 | 2016-02-23 | Ethicon Endo-Surgery, Llc | Electrosurgical devices |
GB2521228A (en) | 2013-12-16 | 2015-06-17 | Ethicon Endo Surgery Inc | Medical device |
US9795436B2 (en) | 2014-01-07 | 2017-10-24 | Ethicon Llc | Harvesting energy from a surgical generator |
US9554854B2 (en) | 2014-03-18 | 2017-01-31 | Ethicon Endo-Surgery, Llc | Detecting short circuits in electrosurgical medical devices |
US10463421B2 (en) | 2014-03-27 | 2019-11-05 | Ethicon Llc | Two stage trigger, clamp and cut bipolar vessel sealer |
US10092310B2 (en) | 2014-03-27 | 2018-10-09 | Ethicon Llc | Electrosurgical devices |
US9737355B2 (en) | 2014-03-31 | 2017-08-22 | Ethicon Llc | Controlling impedance rise in electrosurgical medical devices |
US9913680B2 (en) | 2014-04-15 | 2018-03-13 | Ethicon Llc | Software algorithms for electrosurgical instruments |
US9603616B2 (en) | 2014-04-17 | 2017-03-28 | Covidien Lp | Vibrating surgical instruments for blunt dissection and methods for use thereof |
US9597105B2 (en) * | 2014-04-17 | 2017-03-21 | Covidien Lp | Vibrating surgical instruments for blunt dissection |
US10285724B2 (en) | 2014-07-31 | 2019-05-14 | Ethicon Llc | Actuation mechanisms and load adjustment assemblies for surgical instruments |
US9055967B1 (en) * | 2014-11-07 | 2015-06-16 | Oscar R Polo | Tissue severing device having dual reciprocating looped blades and methods of use |
US10639092B2 (en) | 2014-12-08 | 2020-05-05 | Ethicon Llc | Electrode configurations for surgical instruments |
US10245095B2 (en) | 2015-02-06 | 2019-04-02 | Ethicon Llc | Electrosurgical instrument with rotation and articulation mechanisms |
US10321950B2 (en) | 2015-03-17 | 2019-06-18 | Ethicon Llc | Managing tissue treatment |
US10342602B2 (en) | 2015-03-17 | 2019-07-09 | Ethicon Llc | Managing tissue treatment |
US10595929B2 (en) | 2015-03-24 | 2020-03-24 | Ethicon Llc | Surgical instruments with firing system overload protection mechanisms |
US10765470B2 (en) | 2015-06-30 | 2020-09-08 | Ethicon Llc | Surgical system with user adaptable techniques employing simultaneous energy modalities based on tissue parameters |
US10034704B2 (en) | 2015-06-30 | 2018-07-31 | Ethicon Llc | Surgical instrument with user adaptable algorithms |
US11051873B2 (en) | 2015-06-30 | 2021-07-06 | Cilag Gmbh International | Surgical system with user adaptable techniques employing multiple energy modalities based on tissue parameters |
US11129669B2 (en) | 2015-06-30 | 2021-09-28 | Cilag Gmbh International | Surgical system with user adaptable techniques based on tissue type |
US10898256B2 (en) | 2015-06-30 | 2021-01-26 | Ethicon Llc | Surgical system with user adaptable techniques based on tissue impedance |
US10751108B2 (en) | 2015-09-30 | 2020-08-25 | Ethicon Llc | Protection techniques for generator for digitally generating electrosurgical and ultrasonic electrical signal waveforms |
US10595930B2 (en) | 2015-10-16 | 2020-03-24 | Ethicon Llc | Electrode wiping surgical device |
DE202015008447U1 (en) | 2015-12-08 | 2016-03-31 | Oscar R. Polo | Device for separating tissue with two oscillating loop blades |
US9364253B1 (en) * | 2015-12-11 | 2016-06-14 | Oscar R Polo | Tissue severing device having dual reciprocating looped blades and methods of use |
US10179022B2 (en) | 2015-12-30 | 2019-01-15 | Ethicon Llc | Jaw position impedance limiter for electrosurgical instrument |
US10575892B2 (en) | 2015-12-31 | 2020-03-03 | Ethicon Llc | Adapter for electrical surgical instruments |
US11229471B2 (en) | 2016-01-15 | 2022-01-25 | Cilag Gmbh International | Modular battery powered handheld surgical instrument with selective application of energy based on tissue characterization |
US11129670B2 (en) | 2016-01-15 | 2021-09-28 | Cilag Gmbh International | Modular battery powered handheld surgical instrument with selective application of energy based on button displacement, intensity, or local tissue characterization |
US10716615B2 (en) | 2016-01-15 | 2020-07-21 | Ethicon Llc | Modular battery powered handheld surgical instrument with curved end effectors having asymmetric engagement between jaw and blade |
US10555769B2 (en) | 2016-02-22 | 2020-02-11 | Ethicon Llc | Flexible circuits for electrosurgical instrument |
WO2017189442A1 (en) | 2016-04-25 | 2017-11-02 | Claria Medical, Inc. | Systems and methods for tissue capture and removal |
US10485607B2 (en) | 2016-04-29 | 2019-11-26 | Ethicon Llc | Jaw structure with distal closure for electrosurgical instruments |
US10646269B2 (en) | 2016-04-29 | 2020-05-12 | Ethicon Llc | Non-linear jaw gap for electrosurgical instruments |
US10702329B2 (en) | 2016-04-29 | 2020-07-07 | Ethicon Llc | Jaw structure with distal post for electrosurgical instruments |
US10456193B2 (en) | 2016-05-03 | 2019-10-29 | Ethicon Llc | Medical device with a bilateral jaw configuration for nerve stimulation |
US10376305B2 (en) | 2016-08-05 | 2019-08-13 | Ethicon Llc | Methods and systems for advanced harmonic energy |
US11266430B2 (en) | 2016-11-29 | 2022-03-08 | Cilag Gmbh International | End effector control and calibration |
US11090145B2 (en) * | 2017-07-06 | 2021-08-17 | Park Surgical Innovations, Llc | Device for delivering grafts at a surgical site and method |
WO2019212864A1 (en) * | 2018-05-03 | 2019-11-07 | New World Medical, Inc. | Apparatus and method for cataract extraction |
US11937863B2 (en) | 2019-12-30 | 2024-03-26 | Cilag Gmbh International | Deflectable electrode with variable compression bias along the length of the deflectable electrode |
US11911063B2 (en) | 2019-12-30 | 2024-02-27 | Cilag Gmbh International | Techniques for detecting ultrasonic blade to electrode contact and reducing power to ultrasonic blade |
US11452525B2 (en) | 2019-12-30 | 2022-09-27 | Cilag Gmbh International | Surgical instrument comprising an adjustment system |
US11684412B2 (en) | 2019-12-30 | 2023-06-27 | Cilag Gmbh International | Surgical instrument with rotatable and articulatable surgical end effector |
US11696776B2 (en) | 2019-12-30 | 2023-07-11 | Cilag Gmbh International | Articulatable surgical instrument |
US11944366B2 (en) | 2019-12-30 | 2024-04-02 | Cilag Gmbh International | Asymmetric segmented ultrasonic support pad for cooperative engagement with a movable RF electrode |
US20210196362A1 (en) | 2019-12-30 | 2021-07-01 | Ethicon Llc | Electrosurgical end effectors with thermally insulative and thermally conductive portions |
US11779329B2 (en) | 2019-12-30 | 2023-10-10 | Cilag Gmbh International | Surgical instrument comprising a flex circuit including a sensor system |
US11759251B2 (en) | 2019-12-30 | 2023-09-19 | Cilag Gmbh International | Control program adaptation based on device status and user input |
US20210196363A1 (en) | 2019-12-30 | 2021-07-01 | Ethicon Llc | Electrosurgical instrument with electrodes operable in bipolar and monopolar modes |
US11812957B2 (en) | 2019-12-30 | 2023-11-14 | Cilag Gmbh International | Surgical instrument comprising a signal interference resolution system |
US11660089B2 (en) | 2019-12-30 | 2023-05-30 | Cilag Gmbh International | Surgical instrument comprising a sensing system |
US11779387B2 (en) | 2019-12-30 | 2023-10-10 | Cilag Gmbh International | Clamp arm jaw to minimize tissue sticking and improve tissue control |
US20210196357A1 (en) | 2019-12-30 | 2021-07-01 | Ethicon Llc | Electrosurgical instrument with asynchronous energizing electrodes |
US11786291B2 (en) | 2019-12-30 | 2023-10-17 | Cilag Gmbh International | Deflectable support of RF energy electrode with respect to opposing ultrasonic blade |
US11950797B2 (en) | 2019-12-30 | 2024-04-09 | Cilag Gmbh International | Deflectable electrode with higher distal bias relative to proximal bias |
Citations (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5607446A (en) * | 1995-01-31 | 1997-03-04 | Beehler; Cecil C. | Pupil dilator |
US20100082019A1 (en) * | 2007-01-19 | 2010-04-01 | Joseph Neev | Devices and methods for generation of subsurface microdisruptions for biomedical applications |
US8585727B2 (en) * | 2010-02-14 | 2013-11-19 | Oscar R. Polo | Tissue severing devices and methods |
Family Cites Families (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4574803A (en) | 1979-01-19 | 1986-03-11 | Karl Storz | Tissue cutter |
DE19747149C2 (en) | 1997-10-24 | 2000-02-10 | Harald G W Kuebler | Surgical cutting instrument |
US6464711B1 (en) | 1999-03-19 | 2002-10-15 | Medtronic Xomed, Inc. | Articulating mechanism for steerable surgical cutting instruments |
US7488322B2 (en) | 2004-02-11 | 2009-02-10 | Medtronic, Inc. | High speed surgical cutting instrument |
WO2008124650A1 (en) * | 2007-04-06 | 2008-10-16 | Interlace Medical, Inc. | Method, system and device for tissue removal |
-
2012
- 2012-06-13 US US13/495,023 patent/US8585727B2/en not_active Expired - Fee Related
-
2013
- 2013-11-18 US US14/082,201 patent/US20140228872A1/en not_active Abandoned
Patent Citations (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5607446A (en) * | 1995-01-31 | 1997-03-04 | Beehler; Cecil C. | Pupil dilator |
US20100082019A1 (en) * | 2007-01-19 | 2010-04-01 | Joseph Neev | Devices and methods for generation of subsurface microdisruptions for biomedical applications |
US8585727B2 (en) * | 2010-02-14 | 2013-11-19 | Oscar R. Polo | Tissue severing devices and methods |
Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2017019653A1 (en) * | 2015-07-27 | 2017-02-02 | Boston Scientific Scimed, Inc | Devices for manipulating tissue and related methods |
US10512477B2 (en) | 2015-07-27 | 2019-12-24 | Boston Scientific Scimed, Inc. | Devices for manipulating tissue and related methods |
Also Published As
Publication number | Publication date |
---|---|
US8585727B2 (en) | 2013-11-19 |
US20130018402A1 (en) | 2013-01-17 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US8585727B2 (en) | Tissue severing devices and methods | |
CN110141181B (en) | Apparatus, system, and method for obtaining tissue samples using biopsy tools | |
JP4510001B2 (en) | Driving force transmission along a bending instrument | |
JP4982699B2 (en) | Biopsy forceps | |
AU653531B2 (en) | Surgical cutting instrument | |
US5755730A (en) | Device for use in cutting threads | |
EP3868314A1 (en) | Surgical cutting instrument with distal suction capability | |
JPH11226024A (en) | Treating implement for endoscope | |
US9872600B2 (en) | Tissue resection bander and related methods of use | |
EP0619986A1 (en) | Longitudinal reciprocating incisor | |
EP2862526A1 (en) | Methods and devices for cutting tissue | |
US10342565B2 (en) | Surgical system with expandable shield | |
US20130211415A1 (en) | Steerable tissue manipulation medical devices and related methods of use | |
JP2016524943A (en) | Supported collection devices and related methods of use | |
CA2934767C (en) | Tissue severing device having dual reciprocating looped blades and methods of use | |
US9055967B1 (en) | Tissue severing device having dual reciprocating looped blades and methods of use | |
US8226671B2 (en) | Methods and devices for providing direction to surgical tools | |
WO2011099983A1 (en) | Tissue severing devices and methods | |
EP3829465B1 (en) | Surgical cutting tool | |
JP4827879B2 (en) | Endoscope | |
CN220109809U (en) | Cold cutting snare | |
US20220257222A1 (en) | System for Endoscopic Biopsy And Debulking | |
US20140276814A1 (en) | Tissue resection device and related methods of use |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
STCB | Information on status: application discontinuation |
Free format text: ABANDONED -- FAILURE TO PAY ISSUE FEE |