U.S. patent application number 10/659703 was filed with the patent office on 2004-04-22 for surgical instrument.
This patent application is currently assigned to Gyrus Medical Limited. Invention is credited to Batchelor, Kester J., Ebbutt, Julian M..
Application Number | 20040078037 10/659703 |
Document ID | / |
Family ID | 27256166 |
Filed Date | 2004-04-22 |
United States Patent
Application |
20040078037 |
Kind Code |
A1 |
Batchelor, Kester J. ; et
al. |
April 22, 2004 |
Surgical instrument
Abstract
A surgical instrument comprising an elongate hollow probe (1)
having first and second apertures (4 and 5) at its distal end
portion. An elongate drive shaft is disposed within the probe (1)
and is mounted for rotation about its longitudinal axis within the
probe. A cutting tool (2, 34) is located at the distal end of the
drive shaft, and is positioned adjacent to the first aperture (4).
A bipolar electrosurgical device (3) is located at the distal end
of the probe (1) in the region of the second aperture (5). The
electrosurgical device includes an active electrode (13) and a
return electrode (11) separate and insulated therefrom. A motor (6)
is provided for rotating the drive shaft; and suction means is
provided for selectively providing a source of suction at either
the first aperture (4) or the second aperture (5).
Inventors: |
Batchelor, Kester J.;
(Newport, GB) ; Ebbutt, Julian M.; (Cardiff,
GB) |
Correspondence
Address: |
NIXON & VANDERHYE, PC
1100 N GLEBE ROAD
8TH FLOOR
ARLINGTON
VA
22201-4714
US
|
Assignee: |
Gyrus Medical Limited
Cardiff
GB
|
Family ID: |
27256166 |
Appl. No.: |
10/659703 |
Filed: |
September 11, 2003 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
10659703 |
Sep 11, 2003 |
|
|
|
10139638 |
May 7, 2002 |
|
|
|
60305097 |
Jul 16, 2001 |
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Current U.S.
Class: |
606/48 ;
606/50 |
Current CPC
Class: |
A61B 2218/007 20130101;
A61B 2018/00208 20130101; A61B 2017/00973 20130101; A61B 2018/126
20130101; A61B 17/32002 20130101; A61B 18/148 20130101 |
Class at
Publication: |
606/048 ;
606/050 |
International
Class: |
A61B 018/14 |
Foreign Application Data
Date |
Code |
Application Number |
May 10, 2001 |
GB |
0111463.6 |
Claims
1. A surgical instrument comprising an elongate hollow probe having
an apertured region at its distal end portion, an elongate drive
shaft disposed within the probe and mounted for rotation about its
longitudinal axis within the probe, a cutting tool located at the
distal end of the drive shaft and positioned adjacent to the
aperture region, an electrosurgical device located at the distal
end of the probe, a motor for rotating the drive shaft and suction
means for providing a source of suction at the apertured region for
evacuating tissue debris removed by either the cutting tool or the
electrosurgical device.
2. A surgical instrument as claimed in claim 1, wherein the
electrosurgical device is a bipolar electrosurgical device
including at least one active electrode, at least one return
electrode and an insulator for spacing and insulating the or each
return electrode with respect to the or each active electrode.
3. A surgical instrument as claimed in claim 1 or claim 2, wherein
the apertured region is constituted by first and second apertures,
the cutting tool being positioned to enable tissue to be cut by
cutting means provided on the cutting tool the cutting means being
engageable with tissue through the first aperture, and the second
aperture being positioned in the region of the electrosurgical
device.
4. A surgical instrument as claimed in claim 3, wherein the second
aperture is positioned adjacent to the electrosurgical device.
5. A surgical instrument as claimed in claim 3 or claim 4, further
comprising means for selectively blocking communication between the
first aperture and the suction means to allow the suction means to
operate principally through the second aperture.
6. A surgical instrument as claimed in any one of claims 3 to 5,
wherein the drive shaft is hollow, the cutting tool is hollow and
contiguous therewith, and the distal end portion of the cutting
tool is formed with a cut-out through which tissue debris can be
evacuated when the cutout is in alignment with the first
aperture.
7. A surgical instrument as claimed in claim 5 or claim 6, wherein
the blocking means is provided by the cutting tool being configured
in such a manner that a portion thereof effectively blocks the
first aperture when the cutting tool is in a predetermined
rotational position.
8. A surgical instrument as claimed in claim 7, wherein an outer
surface of the hollow cutting tool constitutes the means for
effectively blocking the first aperture when the cutting tool is in
said predetermined position.
9. A surgical instrument as claimed in claim 7 or claim 8, further
comprising means for selectively positioning the cutting tool
automatically in said predetermined position.
10. A surgical instrument as claimed in claim 5, wherein the
blocking means comprises a baffle operable to block effectively the
first aperture.
11. A surgical instrument as claimed in claim 10, wherein the
baffle is located on the exterior of the probe.
12. A surgical instrument as claimed in claim 10, where the baffle
is located on the interior of the probe.
13. A surgical instrument as claimed in any one of claims 10 to 11,
wherein the baffle is movable between a first position, in which it
effectively blocks the first aperture, and a second position in
which it is clear of the first aperture.
14. A surgical instrument as claimed in claim 13, wherein the
baffle is rotatable about the longitudinal axis of the probe
between the first and second positions.
15. A surgical instrument as claimed in any one of claims 10 to 14,
wherein the baffle is manually movable between its first and second
positions.
16. A surgical instrument as claimed in any one of claims 10 to 14,
wherein a motor is provided to move the baffle between its first
and second positions.
17. A surgical instrument as claimed in any one of claims 3 to 5,
wherein the cutting tool is provided with an abrasive outer
surface, the distal end portion of the probe being spaced from the
abrasive outer surface to define an inlet through which tissue
debris can pass.
18. A surgical instrument as claimed in claim 17 when appendant to
claim 5, wherein the cutting tool is selectively movable
longitudinally of the probe in order to provide the means for
blocking communication between the first aperture and the suction
means.
19. A surgical instrument as claimed in any preceding claim,
wherein there is a single active electrode, and a single return
electrode, and the active electrode, the insulator and the return
electrode are formed with contiguous apertures in alignment with
the second aperture.
20. A surgical instrument as claimed in any of claims 1 to 4,
wherein the drive shaft is solid and of a diameter less than that
of the hollow probe so as to define a channel between the drive
shaft and the hollow probe, tissue debris being removable via the
channel.
Description
[0001] This invention relates to a surgical instrument, and in
particular to a surgical instrument that can use mechanical energy
and/or electrical energy to treat tissue.
[0002] Known mechanical surgical instruments include simple
scalpels which are used for cutting soft tissue, rotatable shavers
which are also used for removing soft tissue, and rotatable burrs
which are used for cutting harder tissue such as bone.
[0003] Known electrosurgical instruments include monopolar and
bipolar devices, both of which are used primarily for treating or
cauterising soft tissue. A monopolar electrosurgical device
includes a single active electrode and a return electrode. The
return electrode being positioned in use, remotely from the active
electrode, usually on the patient's skin. A bipolar electrosurgical
instrument has both active and return electrodes located in close
proximity, usually within the one device. Electrical energy passes
from the active electrode to the return electrode via tissue being
treated, and possibly via an electroconductive fluid surrounding
the tip of the instrument. Both monopolar and bipolar
electrosurgical instruments are limited by their inability to
remove hard tissue such as bone, as they are less efficient and
relatively slow in removing such hard tissue.
[0004] Typically, therefore, if a surgeon needs to remove hard and
soft tissues from the same surgical site, and/or to cauterise
and/or to ablate tissue, different surgical instruments would need
to be used. For example, an electrosurgical instrument could be
used to cut soft tissue, in which case a mechanical instrument
(such as a burr) would be needed to cut hard tissue such as bone.
The insertion and removal of different surgical instruments through
an incision to a surgical site does, however, complicate and
lengthen a surgical operation as compared with using a single
surgical instrument, as well as adding to the overall costs of
instruments needed. To overcome this disadvantage, it is known to
use a surgical instrument which includes a mechanical element, such
as a rotary shaver or burr, and an electrosurgical instrument such
as a monopolar or bipolar device. A known instrument of this type
is described in U.S. Pat. No. 5,904,681, which describes an
instrument having a shaver or bus, rotatably mounted within an
outer sleeve, and a bipolar electrosurgical device mounted at the
end of the outer sleeve and adjacent to an apertured end portion
thereof through which the rotary shaver or burr acts on hard tissue
such as bone. The interior of the sleeve is connected to a source
of suction, so that tissue particles removed by the shaver or burr
can be removed from the vicinity of the surgical site. The
disadvantage of this type of instrument is that tissue debris
removed by the electrosurgical device cannot be removed from the
vicinity of the surgical site via the sleeve interior by the source
of suction provided for removing tissue particles cut by the rotary
shaver or burr.
[0005] The aim of the invention is to provide a surgical instrument
that can cut through both soft and hard tissues using mechanical
and electrosurgical devices, and reliably remove tissue particles
and debris produced by both the mechanical and electrosurgical
means.
[0006] The present invention provides a surgical instrument
comprising an elongate hollow probe having an apertured region at
its distal end portion, an elongate drive shaft disposed within the
probe and mounted for rotation about its longitudinal axis within
the probe, a cutting tool located at the distal end of the drive
shaft and positioned adjacent to the apertured region, an
electrosurgical device located at the distal end of the probe
adjacent to the apertured region, a motor for rotating the drive
shaft, and suction means for providing a source of suction at the
apertured region for evacuating tissue debris removed by either the
cutting tool or the electrosurgical device.
[0007] Advantageously, the electrosurgical device is a bipolar
electrosurgical device including at least one active electrode, at
least one rerun electrode and an insulator for spacing and
insulating the or each return electrode with respect to the or each
active electrode.
[0008] In a preferred embodiment, the apertured region is
constituted by first and second apertures, the cutting tool being
positioned to enable tissue to be cut by cutting means provided on
the cutting tool, the cutting means being engageable with tissue
through the first aperture, and the second aperture being
positioned in the region of the electrosurgical device, preferably
adjacent thereto.
[0009] In a preferred embodiment the instrument further comprises
means for selectively blocking communication between the first
aperture and the suction means to allow the suction means to
operate principally through the second aperture. In one embodiment,
the drive shaft is hollow, the cutting tool is hollow and
contiguous therewith and the distal end portion of the cutting tool
is formed with a cut-out through which tissue debris can be
evacuate when the cut-out is in alignment with the first aperture.
Alternatively, the drive shaft is solid and of a diameter less than
that of the hollow probe so as to defuse a channel between the
drive shaft and the hollow probe, tissue debris being removable via
the channel.
[0010] Advantageously, the blocking means is provided by the
cutting tool being configured in such a manner that a portion
thereof effectively blocks the first aperture when the cutting tool
is in a predetermined rotational position. Preferably, an outer
surface of the hollow cutting tool constitutes the means for
effectively blocking the first aperture when the cutting tool is in
said predetermined position. In one preferred arrangement, the
instrument further comprises means for selectively positioning the
cutting tool automatically in said predetermined position.
[0011] Alternatively, the blocking means comprises a baffle
operable to block effectively the first aperture. The baffle may be
located on the interior or the exterior of the probe, and is
preferably movable between a first position, in which it
effectively blocks the first aperture, and a second position in
which it is clear of the first aperture. In one arrangement, the
baffle is rotatable about the longitudinal axis of the probe
between the first and second positions. The baffle may be manually
movable between its first and second positions, or alternatively a
motor is provided to move the baffle between its first and second
positions.
[0012] Alternatively, the cutting tool is provided with an abrasive
outer surface, the distal end portion of the probe being spaced
from the abrasive outer surface to define an inlet through which
tissue debris can pass.
[0013] Conveniently, there is a single active electrode, and a
single return electrode, and the active electrode, the insulator
and the return electrode are formed with contiguous apertures in
alignment with the second aperture.
[0014] The invention will now be described in greater detail, by
way of example, with reference to the drawings, in which:--
[0015] FIG. 1 is a schematic diagram of a surgical system
incorporating a surgical instrument constructed in accordance with
the invention;
[0016] FIG. 2 is a side view, partly in section of the distal end
of a surgical instrument constructed in accordance with the
invention;
[0017] FIG. 3 is a side view, partly in section of an alternative
embodiment of a surgical instrument constructed in accordance with
the invention; and
[0018] FIGS. 4a and 4b are side views, partly in section, of
another alternative embodiment of a surgical instrument constructed
in accordance with the invention;
[0019] Referring to the drawings, FIG. 1 shows an electrosurgical
system which includes a controller/generator 8 and a handpiece 41
having a detachable surgical probe shown generally at 42. The probe
42 includes both a rotatable cutting element 43, driven by a motor,
shown schematically at 6, within the handpiece 41, and a bipolar
electrosurgical device shown generally at 3. Power signals for both
the motor 6 and the electrosurgical device 3 are supplied to the
handpiece 41 from an output socket 45 on the controller/generator
8, via a connector cord 46. Activation of the controller/generator
8 may be performed by means of a footswitch 47, coupled to the
controller/generator by means of a connector cord 48. A source of
suction 7 is also provided coupled to the handpiece by a cord
49.
[0020] FIG. 2 shows the distal end of the surgical probe 42 which
has a generally cylindrical outer tube 1, a mechanical shaver 2
rotatably mounted within the outer tube, and the bipolar
electrosurgical device 3 fixed to an external surface of the tube.
The tube 1 is made of a conductive metal such as stainless steel,
and its external surface is substantially coated with an insulating
material such as an insulating polymer sheath. The extreme distal
end portion of the tube 1 is formed with a cutout 4 through which
the distal end portion of the shaver 2 protrudes. The shaver 2 is
rotatable, relative to the tube 1, by the motor 6 which is a
brushless dc motor. The shaver 2 is generally hollow, and the
suction pump 7 applies suction to the interior of the shaver, and
hence to the region surrounding the cut-out 4.
[0021] The bipolar electrosurgical device 3 comprises a return
electrode 11 which is secured to the outer tube 1 and mounted on a
spacing element 12, and an active (tissue treatment) electrode 13
spaced from the return electrode by a ceramic insulator 14.
Contiguous apertures 5 in the tube 1, the return electrode 11, the
insulator 14 and the tissue treatment electrode 13 constitute a
passage leading from the interior of the tube 1 to the region
adjacent to the tissue treatment electrode. Through the apertures
5, suction can be applied to the region surrounding the tissue
treatment electrode 13. The electrosurgical controller/generator 8
supplies radio frequency (RF) power to the bipolar electrosurgical
device. Electrical current passing to the tissue treatment
electrode 13 via a lead 71.
[0022] The surgical instrument described above is intended for
athroscopic use, that is to say for operations on joints such as
shoulders or knees. It will be appreciated, however, that the
surgical instrument could be used at any surgical site located
within the body of a patient where surgery is to be performed.
Moreover, the surgical instrument is primarily intended for use
with an endoscope which allows a surgeon to view a surgical site.
In such a case, the surgical instrument is inserted through a first
incision, and the endoscope is inserted through a second incision.
The distal ends of both the endoscope and the surgical instrument
are positioned adjacent to the surgical site, and the surgeon can
view the surgical site on a monitor attached to the endoscope.
[0023] In use, once the endoscope and surgical instrument have been
positioned adjacent to the surgical site, the dc motor 6 is turned
on to power the rotatable shaver 2, which can then be used to
remove tissue from the surgical site. Any tissue or debris removed
in this mechanical surgical procedure is exacted from the region of
the surgical site via the cut-out 4 in the tube 1, and the interior
of the shaver by the suction pump 7.
[0024] When the surgeon has finished using the shaver 2, he can use
the electrosurgical device 3 to ablate or desiccate soft tissue at
the site, or to cauterise adjacent blood vessels. In order to do
this, the controller/generator 8 switches off the dc motor 6, and
electrosurgical power is provided to the electrosurgical device 3.
The electrosurgical device 3 can ablate, desiccate or cauterise at
the surgical site. Any tissue removed during such an operation, can
be removed by the suction pump 7 via the apertures 5 and the
interior of the shaver 2.
[0025] The surgical instrument described above can, therefore, be
used for both mechanical and electrosurgical operation, so a single
instrument can be used for both types of surgery, thereby avoiding
the need to use two different instruments for surgery involving
treatment of both hard and soft tissue. Moreover, the provision of
the apertures 4 and 5 in the distal end of the tube 1 and the
tissue treatment electrode 13 respectively ensures that suction can
be applied to the regions of mechanical and electrosurgical tissue
treatment to facilitate the removal of surgically-removed tissue
debris.
[0026] As the cut-out 4 is considerably larger in area than the
apertures 5, suction power in the region of the tissue treatment
electrode 13 will be substantially reduced during electrosurgery
unless the cut-out 4 is blocked off. It is important, therefore,
when the dc motor 6 is turned off and the electrosurgical power is
supplied to the device 3, that the shaver 2 is positioned within
the tube 1 so as to completely block the cut-out 4. This can be
accomplished by shaping the distal end portion of the shaver 2 so
as to block the cut-out 4 when the shaver is in the "RF mode"
position shown in FIG. 2, and by controlling the motor 6 to bring
the shaver to the RF mode position when an appropriate signal is
provided by the controller/generator 8.
[0027] FIG. 3 shows the distal end of a modified form of the
surgical instrument of FIG. 2. This surgical instrument is similar
to that of FIG. 2, and so like reference numerals will be used for
like parts, and only the modifications will be described in detail.
The basic difference between the surgical instrument of FIG. 3 and
that of FIG. 2 is that this surgical device includes a mechanical
burr 32 in place of the mechanical shaver 2. The burr 32 has a
hollow central stem 33 which is rotatably mounted within the outer
tube 1, and a solid cutting head 34 having an abrasive outer
surface. The cutting head 34 extends through the cut-out 4 in a
distal end portion of the tube 1 so that, in use, the abrasive
outer surface can contact hard tissue or bone for mechanical
removal thereof. The distal end of the tube 1 protrudes from the
distal end of the cutting head 34 to define therewith an inlet 35
through which tissue debris can pass. The inlet 35 communicates
with a passageway 73 between the stem 33 and the outer tube 1, so
that the suction pump 7 can provide suction to the inlet 35.
[0028] An annular valve seat 60 is located on the inner surface of
the outer tube 1, at a position corresponding with the transition
from the stem 33 to the cutting head 34, and just distal of the
apertures 5. In its rotating position (shown in FIG. 3), the burr
32 is spaced longitudinally from the valve seat 60 such that there
is an annular aperture 61 between the stem 33 and the outer tube 1
allowing communication between the inlet 35 and the passageway 73.
In this way, suction is delivered to the inlet 35. However, when it
is desired to use the electrosurgical device 3, the burr 32 is
moved longitudinally in the outer tube 1 so that the cutting head
34 contacts the valve seat 60, closing the annular aperture 61. Now
there is no communication between the inlet and the passageway 73,
and the suction is delivered to the apertures 5 in the region of
the electrosurgical device 3. In this way, suction is provided to
whichever of the two devices (the cutting head d4 or the
electrosurgical device 3) is being used at any particular time.
[0029] FIGS. 4a and 4b show a modified version of the surgical
instrument, in which the stem 33 of the burr 32 is hollow and in
communication with the suction pump 7. The stem 33 has an aperture
74 at its distal end to allow communication between the hollow
interior of the stem and the cut-out 4. The instrument also has a
curved baffle 36 at its distal end portion, the baffle being shaped
to cover the inlet 35. The baffle 36 is rotatable between a first
position, shown in FIG. 4a, and a second position, shown in FIG.
4b. In the first position, the baffle blocks the inlet 35, so that
suction from the pump 7 is supplied through apertures 5 to the
region of the electrosurgical device 3. In the second position, the
baffle 36 is clear of the inlet 35, allowing suction to be supplied
through the hollow interior of the stem 3i to the region of the
abrasive cutting head 34 of the burr 32. As before suction is
provided to whichever of the two devices (the cutting head 34 or
the electrosurgical device 3) is being used at any particular
time.
* * * * *