U.S. patent application number 11/048277 was filed with the patent office on 2005-06-23 for apparatus and method for resecting and removing selected body tissue from a site inside a patient.
Invention is credited to Barry, Robert Lawrence, DeVore, Lauri J..
Application Number | 20050137591 11/048277 |
Document ID | / |
Family ID | 29418823 |
Filed Date | 2005-06-23 |
United States Patent
Application |
20050137591 |
Kind Code |
A1 |
Barry, Robert Lawrence ; et
al. |
June 23, 2005 |
Apparatus and method for resecting and removing selected body
tissue from a site inside a patient
Abstract
An electrosurgery device according to an embodiment of the
invention captures a lymph nodule and resects it. The lymph node is
captured with a vacuum and resected it with an electrode, which
minimizes bleeding and limits the potentially malignant node from
coming into contact with surround tissue as it is resected and
removed. This limits the potential for inadvertent cancer spread.
An electrosurgery device according to an embodiment of the
invention also allows several lymph nodes to be resected in a
single procedure, each lymph node being easily indexed according to
its nodal station and stored in a manner that limits the potential
for cross-contamination. An electrosurgery device according to an
embodiment of the invention further provides a collector for
individually receiving resected lymph nodes. The collector may be
easily detached and sent to pathology without interrupting
resection of other lymph nodes.
Inventors: |
Barry, Robert Lawrence;
(Kirkland, WA) ; DeVore, Lauri J.; (Seattle,
WA) |
Correspondence
Address: |
KNOBBE MARTENS OLSON & BEAR LLP
2040 MAIN STREET
FOURTEENTH FLOOR
IRVINE
CA
92614
US
|
Family ID: |
29418823 |
Appl. No.: |
11/048277 |
Filed: |
February 1, 2005 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11048277 |
Feb 1, 2005 |
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10146444 |
May 14, 2002 |
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6852108 |
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Current U.S.
Class: |
606/45 ;
606/48 |
Current CPC
Class: |
A61B 18/1482 20130101;
A61B 10/0283 20130101; A61B 2017/00809 20130101; A61B 2018/1412
20130101; A61B 17/32056 20130101; A61B 2018/1407 20130101; A61B
10/02 20130101; A61B 2018/00541 20130101; A61B 2018/00029 20130101;
A61B 2018/00601 20130101; A61B 2017/306 20130101 |
Class at
Publication: |
606/045 ;
606/048 |
International
Class: |
A61B 018/14 |
Claims
What is claimed is:
1. A device for resecting selected body tissue from other body
tissue at a site inside a patient and removing the selected body
tissue, comprising: an electrosurgery device having an electrode
that cuts through tissue to resect the selected body tissue from
the other body tissue; a tubular member having a vacuum lumen that
draws the selected body tissue into proximity with the electrode to
permit the electrode to resect the selected body tissue from the
other body tissue; and a collector that receives the resected body
tissue.
2. The device of claim 1, further comprising a compliant port
through which the selected body tissue is drawn, and that maintains
a seal with the selected body tissue.
3. The device of claim 2, wherein the compliant port comprises a
flexible material carried on the tubular member and having an
opening that maintains a seal with the other body tissue when the
selected body tissue has been resected.
4. The device of claim 1, wherein the collector receives resection
byproducts.
5. The device of claim 1, wherein the collector is in vacuum
communication with the lumen.
6. The device of claim 1, wherein the vacuum lumen further draws
the resected body tissue into the collector.
7. The device of claim 1, wherein the electrode is an active
electrode of an electrosurgery system.
8. The device of claim 1, wherein the electrode forms an RF
blade.
9. The device of claim 1, wherein the electrode forms an RF
loop.
10. The device of claim 1, wherein the electrode is a bipolar
device.
11. The device of claim 1, wherein the collector includes at least
one collection chamber.
12. The device of claim 1, wherein the collector comprises a
plurality of collection chambers, each of which is selectively
communicable with the vacuum lumen.
13. The device of claim 12, wherein a collection chamber has a
reference marking.
14. The device of claim 1, wherein the collector can be disengaged
from the device after receiving the resected body tissue.
15. The device of claim 1, wherein the collector can be disengaged
from the device after receiving the resected body tissue and
another collector may be engaged with the device to receive another
resected body tissue.
16. The device of claim 1, wherein the tubular member is curved at
its distal tip.
17. A device for resecting selected body tissue from other body
tissue at a site inside a patient and removing the selected body
tissue, comprising: an electrosurgery device having an electrode
that cuts through tissue to resect the selected body tissue from
the other body tissue; a tubular member having a vacuum lumen that
draws the selected body tissue into proximity with the electrode to
permit the electrode to resect the selected body tissue from the
other body tissue; a compliant port carried on the tubular member
through which the selected body tissue is drawn, and that maintains
a seal with the selected body tissue; and a collector having a
plurality of collection chambers, each collection chamber being
selectively communicable with the vacuum lumen to receive the
resected body tissue.
18. A method of resecting selected body tissue from other body
tissue at a site inside a patient and removing the selected body
tissue, comprising the steps of: disposing a tubular member having
a lumen adjacent to the selected body tissue; creating a vacuum
inside the lumen to draw the selected body tissue inside the lumen;
drawing the selected body tissue inside the lumen with a vacuum;
cutting through tissue to resect the selected body tissue from the
other body tissue with an electrosurgery device; and collecting the
resected body tissue in a collector.
19. The method of claim 18, including the further step of
aspirating the selected body tissue from the patient out of another
end of the lumen.
20. The method of claim 18, including the further step of drawing
the selected body tissue with the vacuum through a compliant port
that maintains a seal with the selected body tissue.
21. The method of claim 20, wherein the compliant port further
comprises a flexible material carried on the tubular member and
having an opening maintaining a vacuum against the other body
tissue.
22. The method of claim 18, wherein the step of collecting the
resected body tissue includes the further step of collecting
resection byproducts.
23. A device for resecting selected body tissue from other body
tissue at a site inside a patient and removing the selected body
tissue, comprising: electrosurgery means for resecting the selected
body tissue from the other body tissue; vacuum directing means for
drawing the selected body tissue into proximity with the
electrosurgery means to permit the electrosurgery means to resect
the selected body tissue from the other body tissue; and collection
means for receiving the resected body tissue
Description
RELATED APPLICATIONS
[0001] The present application is a continuation of U.S.
application Ser. No. 10/146,444, filed May 14, 2002, the entire
contents of which is incorporated herein by reference.
FIELD OF THE INVENTION
[0002] The present invention is generally directed to an apparatus
and method for resecting body tissue from a site within a patient
and removing it from the patient. The present invention is more
particularly directed to an electrosurgery apparatus for capturing,
resecting, removing, and indexing selected body tissue, such as
lymph nodes or other tissue.
BACKGROUND
[0003] One important step in the treatment of pulmonary cancer is
resecting bronchial lymph nodes. Mediastinoscopy is one frequently
employed procedure to resect lymph nodes in the thorax and
bronchial system. An incision is made in the sternal or jugular
notch at the base of the neck, and a tubular instrument called a
mediastinoscope is inserted in the incision, placed between the
trachea and the sternum, and directed into the chest cavity. The
mediastinoscope permits direct visualization of the lymph nodes
located in the paratracheal and parabronchial areas. The size of
the instrument is large enough to allow the insertion of shearing
and grabbing tools to resect regional lymph nodes. Once removed,
the resected lymph nodes are sent to pathology for analysis.
[0004] The procedure for bronchial lymph node visualization and
resection through the mediastinoscope has problems. For example,
the procedure is limited to taking one lymph node at a time. Since
a plurality of lymph nodes are generally required to be resected,
the procedure can be relatively long. In addition, the
instrumentation to grab and resect the lymph node may cause
problems. For example, surgeons generally utilize long instruments
such as ring forceps to suspend the target lymph node to be
resected and removed. Such instruments can result in potential
squeezing and damage to lymph nodes that may contain cancer cells,
thus causing bleeding and releasing potentially hazardous
byproducts such as tissue, blood, and cells into the chest cavity.
Obviously, this is a condition to be avoided. Removing these
hazardous byproducts from the patient is a problem. Another problem
stems from the very narrow working channel and the close proximity
of vulnerable structures such as arteries and the heart.
Traditional biopsy and resection devices may impact the adjacent
structures. The number of samples generally taken causes a storage
problem and a cross-contamination problem. With present procedures
and devices, each sample is individually removed and indexed
according to its nodal station before being sent to pathology. This
requires time and effort.
[0005] Hence, there is a need in the art for an improved apparatus
and method for resecting a selected body tissue, such as bronchial
and thoracic lymph nodes. More particularly, there is such a need
for a device and method for quickly and efficiently capturing
bronchial and thoracic lymph nodes, resecting them without causing
bleeding or spilling byproducts into the patient, and indexing
them. The present invention addresses that need.
SUMMARY OF THE INVENTION
[0006] The present invention provides a device for resecting
selected body tissue from other body tissue at a site inside a
patient and removing the selected body tissue. The device includes
an electrosurgery device having an electrode that cuts through
tissue to resect the selected body tissue from the other body
tissue, a tubular member having a vacuum lumen that draws the
selected body tissue into proximity with the electrode to permit
the electrode to resect the selected body tissue from the other
body tissue, and a collector that receives the resected body
tissue. The device may further include a compliant port through
which the selected body tissue is drawn, and that maintains a seal
with the selected body tissue. The compliant port may include a
flexible material carried on the tubular member and having an
opening maintaining a vacuum against the other body tissue and
resection byproducts when the selected body tissue has been
resected. The collector may also receive resection byproducts. The
collector may be in vacuum communication with the lumen. The vacuum
lumen may draw the resected body tissue into the collector. The
electrode may be an active electrode of an electrosurgery system.
The electrode may form an RF blade, and may form an RF loop. The
electrode may be a bipolar device. The electrode may be a monopolar
device. The collector may include at least one collection chamber.
The collector may comprise a plurality of collection chambers, each
of which is selectively communicable with the vacuum lumen. The
collection chamber may have reference markings. The collector may
be disengaged from the device after receiving the resected body
tissue. The collector may be disengaged from the device after
receiving the resected body tissue and another collector may be
engaged with the device to receive another resected body tissue.
The tubular member may be curved at its distal tip. The distal tip
may be shaped to accommodate a particular anatomy.
[0007] The present invention further provides a device for
resecting selected body tissue from other body tissue at a site
inside a patient and removing the selected body tissue. The device
resecting selected body tissue includes an electrosurgery device
having an electrode that cuts through tissue to resect the selected
body tissue from the other body tissue, a tubular member having a
vacuum lumen that draws the selected body tissue into proximity
with the electrode to permit the electrode to resect the selected
body tissue from the other body tissue, a compliant port carried on
the tubular member through which the selected body tissue is drawn,
and that maintains a seal with the selected body tissue, and a
collector having a plurality of collection chambers, each of which
is selectively communicable with the vacuum lumen to receive the
resected body tissue.
[0008] The present invention still further provides a method of
resecting selected body tissue from other body tissue at a site
inside a patient and removing the selected body tissue. The method
includes the steps of disposing a tubular member having a lumen
adjacent to the selected body tissue, creating a vacuum inside the
lumen to draw the selected body tissue inside the lumen, drawing
the selected body tissue inside the lumen with a vacuum, cutting
through tissue to resect the selected body tissue from the other
body tissue with an electrosurgery device, and collecting the
resected body tissue in a collector. The method may include the
further step of aspirating the selected body tissue from the
patient out of another end of the lumen. The method may include the
further step of drawing the selected body tissue with the vacuum
through a compliant port that maintains a seal with the selected
body tissue. The compliant port may include a flexible material
carried on the tubular member and having an opening maintaining a
vacuum against the other body tissue. The step of collecting the
resected body tissue may include the further step of collecting
resection byproducts.
[0009] The present invention further includes a device for
resecting selected body tissue from other body tissue at a site
inside a patient and removing the selected body tissue. The device
includes electrosurgery means for resecting the selected body
tissue from the other body tissue, vacuum directing means for
drawing the selected body tissue into proximity with the
electrosurgery means to permit the electrosurgery means to resect
the selected body tissue from the other body tissue, and collection
means for receiving the resected body tissue.
[0010] These and various other features as well as advantages which
characterize the present invention will be apparent from a reading
of the following detailed description and a review of the
associated drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
[0011] The features of the present invention which are believed to
be novel are set forth with particularity in the appended claims.
The invention, together with further objects and advantages
thereof, may best be understood by making reference to the
following description taken in conjunction with the accompanying
drawings, in the several figures of which like referenced numerals
identify identical elements, and wherein:
[0012] FIG. 1 illustrates a person's neck, collarbones, and
respiratory system;
[0013] FIG. 2 illustrates several of the lymph nodes of the
respiratory system;
[0014] FIG. 3 illustrates a monopolar electrosurgery system
suitable for use with an electrosurgery device to resect body
tissue at a site within a patient, in accordance with the present
invention;
[0015] FIG. 4 is a perspective view of an electrosurgery device, in
accordance with the present invention;
[0016] FIG. 5 is a partial longitudinal section view of the distal
tip of the tubular member of the electrosurgery device of FIG. 4,
according to an embodiment of the invention;
[0017] FIG. 6 illustrates an electrosurgery device inserted through
an incision in the sternal notch and into a thorax, in accordance
with the invention;
[0018] FIG. 7 illustrates a step in resecting a lymph node where
the distal tip of the tubular member is adjacent to a lymph node
for resection, in accordance with the present invention;
[0019] FIG. 8 illustrates an intermediate step where a lymph node
has been drawn in proximity to the compliant port by the vacuum
draw;
[0020] FIG. 9 illustrates an intermediate step where the lymph node
has been drawn substantially through the compliant port and into
the resection lumen;
[0021] FIG. 10 illustrates an intermediate step where the electrode
has been partially deployed and moved centrally;
[0022] FIG. 11 illustrates an intermediate step where the electrode
has cut through tissue to resect the lymph node from other body
tissue;
[0023] FIG. 12 illustrates a step where the vacuum draws the
resected lymph node into a lumen to aspirate it from the
patient;
[0024] FIG. 13 is a side, partial longitudinal section view
illustrating a distal tip of an electrical surgery device having a
lasso-shaped active electrode, in accordance with an embodiment of
the present invention;
[0025] FIG. 14 illustrates the lasso-shaped active electrode loop
of FIG. 13 cinched around a perimeter of the lymph node;
[0026] FIG. 15 is a side, partial longitudinal section view
illustrating a distal tip of an electrical surgery device having a
loop-shaped bipolar electrode, in accordance with an embodiment of
the present invention;
[0027] FIG. 16 illustrates an oval distal tip according to an
embodiment of the invention;
[0028] FIG. 17 illustrates a distal tip geometry designed to
accommodate the trachea according to an embodiment of the
invention;
[0029] FIG. 18 illustrates an asymmetrical distal tip geometry
according to an embodiment of the invention; and
[0030] FIG. 19 illustrates a conical distal tip geometry according
to an embodiment of the invention.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
[0031] In the following detailed description of exemplary
embodiments of the invention, reference is made to the accompanying
drawings that form a part hereof. The detailed description and the
drawings illustrate specific exemplary embodiments by which the
invention may be practiced. These embodiments are described in
sufficient detail to enable those skilled in the art to practice
the invention. It is understood that other embodiments may be
utilized, and other changes may be made, without departing from the
spirit or scope of the present invention. The following detailed
description is therefore not to be taken in a limiting sense, and
the scope of the present invention is defined only by the appended
claims.
[0032] Throughout the specification and claims, the following terms
take the meanings explicitly associated herein unless the context
clearly dictates otherwise. The meaning of "a", "an", and "the"
include plural references. The meaning of "in" includes "in" and
"on." Referring to the drawings, like numbers indicated like parts
throughout the views. Additionally, a reference to the singular
includes a reference to the plural unless otherwise stated or
inconsistent with the disclosure herein.
[0033] Briefly stated, an electrosurgery device according to an
embodiment of the invention described captures a lymph nodule and
resects it. The lymph node is captured with a vacuum and resected
with an electrode, which minimizes bleeding and limits the
potentially malignant node from coming into contact with
surrounding tissue as it is resected and removed. This limits the
potential for inadvertent cancer spread. An electrosurgery device
according to an embodiment of the invention also allows several
lymph nodes to be resected in a single procedure, each lymph node
being easily indexed according to its nodal station and stored in a
manner that limits the potential for cross-contamination. An
electrosurgery device according to an embodiment of the invention
further provides a collector for individually receiving resected
lymph nodes. The collector may be easily detached and sent to
pathology without interrupting resection of other lymph nodes.
[0034] FIG. 1 illustrates a person's neck, collarbones, and
respiratory system. The respiratory system 20 resides within the
thorax 22 that occupies a space defined by the chest wall 24 and
the diaphragm 26.
[0035] The respiratory system 20 includes the trachea 28, the left
mainstem bronchus 30, the right mainstem bronchus 32, which then
further divides into bronchial branches and sub-branches. The
respiratory system 20 further includes left lung lobes 52 and 54
and right lung lobes 56, 58, and 60. Each bronchial branch and
sub-branch communicates with a respective different portion of a
lung lobe, either the entire lung lobe or a portion thereof.
[0036] The right clavicle 21 and the left clavicle 23 join at the
top of the sternum 25 (only the top portion of sternum 25 is shown
for clarity) and lie anteriorly to the trachea 28. A sternal or
jugular notch 27 is formed in the sternum 25 and at the base of the
neck.
[0037] FIG. 2 illustrates several of the lymph nodes of the
respiratory system. The nodes have been classified into regional
nodal stations for lung cancer staging, and the stations are used
to index biopsied or resected lymph nodes. FIG. 2 illustrates right
and left upper paratracheal nodes 71r and 711 (indexed as stations
2R and 2L); right and left lower paratracheal nodes 73r and 731
(indexed as stations 4R and 4L); right and left tracheobronchial
angle nodes 75r and 751 (indexed as stations 10R and 10L); right
and left interlobar nodes 77r and 771 (indexed as stations 11R and
11L); and subcarinal node 79 (indexed as station 7). Typically,
several lymph nodes may be located at one station. Additional nodes
and stations were omitted from FIG. 2 for clarity.
[0038] FIG. 3 illustrates a monopolar electrosurgery system
suitable for use with an electrosurgery device to resect body
tissue at a site within a patient, in accordance with the present
invention. Electrosurgery system 80 includes an aspiration pump 81,
an electrosurgery RF generator 82, a ground electrode 84, a ground
electrode coupler 85, a foot control unit 86, a foot control unit
coupler 87, an aspiration coupler 88, an electrosurgery coupler 89,
and an electrosurgery device 90 including a tubular member 92. The
depiction of a monopolar electrosurgery system in FIG. 3 is not
intended to limit the practice of the present invention to only
monopolar devices. In an alternative embodiment of the invention, a
bipolar electrosurgery system may be used, eliminating the need for
ground electrode 84 and ground electrode coupler 85.
[0039] Electrosurgery RF generator 82 is coupled to ground
electrode 84 by ground electrode coupler 85, to foot control unit
86 by foot control unit coupler 87, and to electrosurgery device 90
by electrosurgery coupler 89. Electrosurgery device 90 includes an
active electrode (not shown) and tubular member 92. Aspiration pump
81 is coupled to electrosurgery device 90 and to tubular member 92
by aspiration coupler 88.
[0040] In operation, electrosurgery RF generator 82 supplies a
source of electrical current, typically in the radio frequency
range, to the active electrode of electrosurgery device 90 and
ground electrode 84 (which is sometimes known as a dispersive
electrode). The current forms an electrical arc ahead of the active
electrode and volatizes the tissues, separating them as if they
were cut. Ground electrode 84 provides a large surface for patient
electrical contact, and is placed in electrical contact with the
patient. The active electrode directs the current flow into the
tissue of the patient, and ground electrode 84 directs current flow
from the patient to electrosurgery generator. The current waveform
supplied by electrosurgery RF generator 82 may vary in strength and
frequency, and it may be pulsed. The RF energy may be modulated in
a sinusoidal or square waveform. It may also be mixed mode or
combination thereof. The particular electrosurgery current waveform
is selected to accomplish the objectives of the procedure being
performed. The surgeon may use foot control unit 86 to control
electrosurgery RF generator 82 or a hand controlled switch on
electrosurgery device 90.
[0041] Tubular member 92 has a vacuum lumen for drawing selected
body tissue into proximity to the active electrode, and for
aspirating the resected tissue from the patient. Tubular member 92
carries the active electrode. Electrosurgery device 90 is
configured to be carried in a conduit or catheter of an endoscope,
such as a mediastinoscope, or alternatively may be used separately
in conjunction with an endoscope or other viewing device.
[0042] FIG. 4 is a perspective view of electrosurgery device 90, in
accordance with the present invention. FIG. 5 is a partial
longitudinal section view of the distal tip 99 of the tubular
member 92 of the electrosurgery device 90 of FIG. 4, in accordance
with the present invention. Electrosurgery device 90 includes a
body 98, a tubular member 92, a handle 93, an activation device 94,
and a collector 96 having chambers 97a-97f. Tubular member 92
includes a distal tip 99, an electrode 100, an electrode lumen 102,
a primary vacuum lumen 104, a secondary vacuum lumen 106, a
compliant port 110, and a resection lumen 115.
[0043] Body 98 carries tubular member 92, handle 93, activation
device 94, and collector 96. Aspiration coupler 88 and
electrosurgery coupler 89 are coupled to electrosurgery device 90
at handle 93 in a preferred embodiment. Aspiration coupler 88 is in
vacuum communication with collector 96, and lumens 102 and 104.
Collector 96 is in vacuum communication with lumens 102 and 104.
Collector 96 can be disengaged from body 98, and another collector
96 can be engaged with body 98 without electrosurgery device 90
being removed from a patient. Collector 96 may have a plurality of
selectable chambers, each chamber being selectively communicable
with vacuum lumens 102 and 104. In a preferred embodiment,
collector 96 has six chambers, 97a-97f, and is arranged much like a
cylinder on a six-shot revolver, with collector 96 being rotatable
to select a chamber, and removable and replaceable. Chambers
97a-97f are indexed or reference marked corresponding to the lymph
node stations likely to be encountered. For example, collector 96
is reference marked for the upper and lower paratracheal nodes,
stations 2R, 2L, 4R and 4L, in the embodiment illustrated.
[0044] Electrode 100 is carried in lumen 102 of tubular member 92,
is exposed to resection lumen 115, and is coupled to the
electrosurgery generator by electrode coupler 89. In a preferred
embodiment, electrode 100 is an active electrode in the shape of a
blade, and consisting of radio frequency surgical materials
suitable for cutting through tissue, including resecting selected
tissue such as lymph nodes from other body tissue. In an
alternative embodiment, electrode 100 may be sharpened. The
electrode may be maneuverable. Electrode 100 may be carried
substantially within lumen 102 until needed, and then extended for
use.
[0045] Activation device 94 is a trigger-like device used to extend
electrode 100 for cutting and to retract it. FIGS. 10 and 11
illustrate extension of electrode 100 for cutting.
[0046] Tubular member 92 may be made of any material suitable for
surgical use. When the electrosurgery device 90 is a bi-polar
device, the tubular member 90 may be any material suitable for
surgical use and for forming a return electrode. One end is coupled
to body 98, and the other end including distal tip 99 is arranged
for insertion into an incision in the sternal notch and down into
the thorax. While illustrated as round in FIG. 5, distal tip 99 can
be any cross-sectional shape suitable for the purpose of
electrosurgery device 90. FIGS. 16-19 illustrate alternative shaped
embodiments of the distal tip 99. In an alternative embodiment, the
distal tip 99 may be arranged for insertion through an incision in
another part of the body. For example, lymph nodes at stations 7,
8, and 9 of FIG. 2 can only be reached by entry between certain
ribs. While distal tip 99 is illustrated as lying in a single plane
perpendicular to the longitudinal axis of tubular member 92, it may
be formed at another angle and/or in multiple planes to facilitate
access to lymph nodes. In an alternative embodiment, distal tip 99
may have a bend or curve to facilitate access to lymph nodes.
Tubular member 92 includes lumen 102 for delivery of electrode 100.
Tubular member 92 also includes primary vacuum lumen 104 and
secondary vacuum lumen 106 providing vacuum draws 105 and 107 in
the resection lumen 115. In an alternative embodiment, a plurality
of secondary vacuum lumens 106 may be provided. In another
alternative embodiment, electrosurgery system 80 includes a system
providing a saline solution to electrosurgery device 90, and
tubular member 99 includes a lumen that provides the saline
solution to assist in RF cautery and for cooling.
[0047] The compliant port 110 includes the opening 112 and is
carried on the distal tip 99. The complaint port 110 may be made
from a flexible material such as silicone. The opening 112 is
flexible to allow a wide range of lymph node sizes to be drawn
through, while maintaining a vacuum seal against the lymph node.
The vacuum draws 105 and 107 provide the vacuum draw 113 through
the opening 112.
[0048] FIG. 6 illustrates an electrosurgery device inserted through
an incision in the sternal notch and into a thorax, in accordance
with the present invention. FIG. 6 depicts the tubular member 92 of
electrosurgery device 90 inserted through an incision at the
sternal notch 27 just above the sternum 25. The procedure for
placing the tubular member 92 involves anesthetizing the patent,
making an incision at the sternal notch 27 just above the sternum
25, and inserting tubular member 92 through the incision and
between the trachea 28 and the top of the sternum 25. Tubular
member 92 is advanced to where its distal tip 99 is adjacent to
lymph node 711 or any other selected lymph node. Electrosurgery
device 90 may be incorporated into another device that provides
viewing of the selected lymph nodes, or may be accompanied in use
by a viewing device.
[0049] FIGS. 7-12 illustrate several steps in resecting a lymph
node, in accordance with the present invention. FIG. 7 illustrates
the distal tip 99 of tubular member 92 adjacent to lymph node 711
for resection. Vacuum draw 113 creates a vacuum drawing lymph node
711 toward opening 112 in compliant port 110. Vacuum draw 113 may
be used to gently tease the lymph node 711 out from adjacent
tissues, and move it toward opening 112.
[0050] FIG. 8 illustrates lymph node 711 having been drawn in
proximity to compliant port 110 by vacuum draw 113. FIG. 9
illustrates lymph node 711 having been drawn substantially through
compliant port 110 by vacuum draw 113 (not shown) and by vacuum
draws 105 and 107, into resection lumen 115. In this position,
lymph node 711 is in proximity with electrode 100, permitting it to
be resected. Compliant port 110 and opening 112 maintain a seal
with lymph node 711, causing a vacuum in resection lumen 115. FIG.
10 illustrates electrode 100 having been partially deployed toward
lymph node 711 and moved centrally. Electrode 100 may be deployed
by squeezing the activation device 94 of FIG. 4. FIG. 11
illustrates electrode 100 having been fully deployed and activated
to cut through tissue at a location near opening 112 to resect
lymph node 711 from other body tissue 118. Activation of the
electrode may be by further squeezing the activation device or by
using foot control unit 86 of FIG. 2. Vacuum draws 105 and 107
continue to maintain a vacuum in resection lumen 115 against the
seal with lymph node 711 provided by compliant port 110 and opening
112. Using an electrosurgery device such as electrode 100 minimizes
bleeding and release potentially hazardous tissue, blood, and cells
(hereafter referred to as "resection byproducts 117"). If any
resection byproducts 117 are created, the vacuum maintained in
resection lumen 115 retains the byproducts 117, and limits any
escape into the chest cavity. Until vacuum draws 105 and 107 are
reduced to release other body tissue 118 from opening 112, the
vacuum is maintained in resection lumen 115.
[0051] FIG. 12 illustrates vacuum draw 105 pulling resected lymph
node 711 into lumen 104 to aspirate resected lymph node 711 from
the patient. After lymph node 711 is resected as illustrated in
FIG. 11, vacuum draw 105 pulls resected lymph node 711 into lumen
104 and aspirates it from the patient and into the collector.
Vacuum draw 107 maintains the vacuum in resection lumen 115
providing a backup vacuum draw in case resected lymph node 711
obstructs or reduces vacuum draw 105 while it is being aspirated.
Vacuum draw 107 may also aspirate any resection byproducts 117 from
the resection lumen 115. Lumens 104 and 102 are both in vacuum
communication with the collector 96 of FIG. 4. The resected lymph
node 711 is drawn through lumen 104 by vacuum draw 105 into the
collector. Any resection byproducts 117 are also drawn into the
collector through lumens 104 and 106. In an embodiment where
collector 96 includes a plurality of collection chambers, resected
lymph node 711 and any resection byproducts 117 are drawn into a
selected collection chamber. In the embodiment where the collection
chambers are indexed, the chamber with reference mark 2L would be
selected. The collector may be quickly indexed by rotation to
another chamber. As described in conjunction with FIG. 4, the
collector may be disengaged from the electrosurgery device after
receiving the resected lymph node 711, and another collector may be
engaged to receive other resected body tissue without removing the
electrosurgery device from the patient. The electrosurgery device
according to an embodiment of the invention allows a lymph node to
be captured and to be resected with a single device.
[0052] FIGS. 13 and 14 are side, partial longitudinal section views
illustrating a distal tip 99 of an electrical surgery device having
a lasso-shaped active electrode 120, in accordance with an
embodiment of the present invention. A lasso-shaped active
electrode 120 may be used in an alternative embodiment of the
present invention to resect a lymph node. FIG. 13 illustrates
lasso-shaped active electrode 120 arranged to form a loop 122 that
may be cinched around a perimeter of lymph node 711. Lymph node 711
is drawn into resection lumen 115 in the manner described in FIGS.
7-9. FIG. 14 illustrates loop 122 having been cinched around a
perimeter of lymph node 711 by retraction of electrode 120. The
retraction may be controlled by squeezing the activation device 94
of FIG. 4. Electrode 120 is activated to cut through tissue to
resect lymph node 711 from other body tissue. Activation of the
electrode may be by further squeezing the activation device, or by
foot control unit 86 of FIG. 2. Lymph node 711 is aspirated from
the patent in the manner described in FIG. 12. In an alternative
embodiment, active electrode 120 may be a rigid loop that is
retracted against a portion perimeter of lymph node 711 and
activated to cut through the lymph node 711.
[0053] FIG. 15 is a side, partial longitudinal section view
illustrating a distal tip 99 of an electrical surgery device having
a loop-shaped bipolar electrode 130, in accordance with an
embodiment of the present invention. Bipolar electrode 130 includes
insulation 132 and electrode 134. Insulation 132 electrically
isolates bipolar electrode 130 from the electrosurgery device.
Electrode 134 is formed into a loop 122 to snare lymph node 711 and
perform the cutting. The bipolar electrode 130 is operated by an
electrosurgery system substantially similar to the system
illustrated in FIG. 3, except no ground electrode is required. The
operation of loop-shaped bipolar electrode 130 is similar to the
operation of electrode 120 described in conjunction with FIGS. 13
and 14.
[0054] FIGS. 16-19 are perspective views illustrating alternative
shapes of the distal tip 99 according to an embodiment of the
invention. The distal tip 99 can be any shape, can lie in a single
or in multiple planes, and can be at any angle to the longitudinal
member 92 suitable for the intended use of the electrosurgery
device. FIG. 16 illustrates an oval distal tip 99a. FIG. 17
illustrates a distal tip 99b having a geometry designed to
accommodate the trachea. FIG. 18 illustrates a distal tip 99c
having an asymmetrical geometry. FIG. 19 illustrates distal tip 99d
having a conical geometry.
[0055] Although the present invention has been described in
considerable detail with reference to certain preferred
embodiments, other embodiments are possible. Therefore, the spirit
or scope of the appended claims should not be limited to the
description of the embodiments contained herein. It is intended
that the invention resides in the claims hereinafter appended.
* * * * *