U.S. patent application number 10/924954 was filed with the patent office on 2005-11-24 for surgical instrument.
This patent application is currently assigned to Gyrus Medical Limited. Invention is credited to Amoah, Francis, Ebbutt, Julian Mark, Goble, Colin Charles Owen, Hall, Matthew Richard, Marshall, Mark George, Varney, Kelvin John.
Application Number | 20050261676 10/924954 |
Document ID | / |
Family ID | 32607661 |
Filed Date | 2005-11-24 |
United States Patent
Application |
20050261676 |
Kind Code |
A1 |
Hall, Matthew Richard ; et
al. |
November 24, 2005 |
Surgical instrument
Abstract
A device for morcellating tissue within a body cavity of a
patient comprises a stationary tube having a distal end portion,
and a bipolar electrosurgical electrode assembly located at the
distal end of the tube. The electrosurgical electrode assembly
comprises first and second electrodes separated by an insulation
member, the bipolar electrosurgical electrode assembly extending
around the circumference of the distal edge of the tube. When an
electrosurgical cutting voltage is applied to the electrode
assembly, and relative movement is initiated between the tube and
the tissue, a core of severed tissue is formed within the tube such
that it can be removed from the body cavity of the patient. A
tissue-pulling device such as a jaw assembly can be employed to
pull tissue against the distal end of the tube.
Inventors: |
Hall, Matthew Richard;
(Reading, GB) ; Marshall, Mark George; (Berkshire,
GB) ; Goble, Colin Charles Owen; (Oxfordshire,
GB) ; Amoah, Francis; (Cardiff, GB) ; Varney,
Kelvin John; (Monmouthsire, GB) ; Ebbutt, Julian
Mark; (Cardiff, GB) |
Correspondence
Address: |
NIXON & VANDERHYE, PC
901 NORTH GLEBE ROAD, 11TH FLOOR
ARLINGTON
VA
22203
US
|
Assignee: |
Gyrus Medical Limited
Cardiff
GB
|
Family ID: |
32607661 |
Appl. No.: |
10/924954 |
Filed: |
August 25, 2004 |
Current U.S.
Class: |
606/48 |
Current CPC
Class: |
A61B 17/29 20130101;
A61B 2017/4216 20130101; A61B 17/320016 20130101; A61B 18/1442
20130101; A61B 2018/1412 20130101; A61B 17/32053 20130101; A61B
18/1485 20130101; A61B 2017/320775 20130101 |
Class at
Publication: |
606/048 |
International
Class: |
A61B 018/14 |
Foreign Application Data
Date |
Code |
Application Number |
May 20, 2004 |
GB |
0411270.2 |
Claims
What is claimed is:
1. In combination, a device for morcellating tissue within a body
cavity of a patient and a tissue-pulling device, the morcellating
device comprising a stationary tube having a distal end portion,
the tissue-pulling device being locatable within the tube, the
combination including a bipolar electrosurgical electrode assembly
including first and second electrodes, the first electrode being
located at the distal end of the tube, such that, when an
electrosurgical cutting voltage is applied to the electrode
assembly the tissue-pulling device can be moved to pull tissue
against the distal end of the tube to form a core of severed tissue
within the tube, and further moved in order to remove the severed
tissue from the body cavity of the patient.
2. A combination according to claim 1, wherein the first electrode
extends around the circumference of the distal edge of the
tube.
3. A combination according to claim 2, wherein the first electrode
extends completely around the circumference of the stationary
tube.
4. A combination according to claim 1, wherein the second electrode
is located at the distal end of the tube, and is separated from the
first electrode by an insulation member.
5. A combination according to claim 4, wherein the tube constitutes
the second electrode.
6. A combination according to claim 4, wherein the first electrode
comprises a conductive track present on the insulation member.
7. A combination according to claim 6, wherein the conductive track
is printed on to the insulating member.
8. A combination according to claim 1, wherein the second electrode
is located on, or constituted by, the tissue-pulling device.
9. A combination according to claim 1, wherein the tissue-pulling
device is longitudinally movable with respect to the tube.
10. A combination according to claim 9, wherein the tissue-pulling
device comprises a pair of jaw members movable between open and
closed positions.
11. A combination according to claim 10, wherein the jaw members
are mounted on a rod extending though the tube.
12. A combination according to claim 1, wherein the tissue-pulling
device comprises a screw member rotatable with respect to the
tube.
13. A combination according to claim 1, wherein the stationary tube
has an end face which is angled with respect to the longitudinal
axis of the tube.
14. A combination according to claim 13, wherein the end face of
the tube is at an angle of between 30 and 60 degrees to the
longitudinal axis of the tube.
15. A combination according to claim 14, wherein the end face of
the tube is at an angle of 45 degrees to the longitudinal axis of
the tube.
16. A method of laparoscopically removing a uterus, the method
comprising the steps of: a) dissecting the body of the uterus from
the stump of the uterus, b) laparoscopically inserting a
morcellating device comprising a stationary tube having a distal
end portion, and a tissue-pulling device located within the tube,
the morcellating device and/or the tissue-pulling device including
a bipolar electrosurgical electrode assembly, the electrosurgical
assembly comprising first and second electrodes, at least one of
the electrodes being located at the distal end of the tube, c)
grasping tissue with the tissue-pulling device and pulling it
against the distal end of the tube, d) energising the bipolar
electrode assembly with an electrosurgical cutting voltage, e)
continuing to pull the tissue with the tissue-pulling device so
that a core of tissue is formed within the tube, and f) withdrawing
the core of tissue from the tube.
17. A device for morcellating tissue within a body cavity of a
patient, the device comprising a stationary tube having a distal
end portion, and a bipolar electrosurgical electrode assembly
located at the distal end of the tube, the electrosurgical assembly
comprising first and second electrodes separated by an insulating
member, the bipolar electrosurgical electrode assembly extending
around the circumference of the distal edge of the tube, such that,
when an electrosurgical cutting voltage is applied to the electrode
assembly and relative movement is initiated between the tube and
the tissue, a core of severed tissue is formed within the tube such
that it can be removed from the body cavity of the patient.
Description
BACKGROUND OF THE INVENTION
[0001] This invention relates to a bipolar electrosurgical
instrument for use in the bulk removal of tissue, as in a
laparoscopic hysterectomy.
[0002] In a laparoscopic hysterectomy, the body of the uterus is
resected from the stump or fundus, and then removed from the
operative site. To enable the uterus to be removed through a
limited surgical opening, it is desirable to morcellate it into
relatively smaller pieces of tissue, which are easier to remove.
The present invention relates to an instrument and method for
morcellating and removing a uterus.
[0003] U.S. Pat. Nos. 5,957,884, 6,007,512 and 6,036,681 are
examples of morcellating devices in which an element carrying an
electrode is rotated in order to cause the morcellation of tissue.
This rotation of the electrode necessitates a mechanical drive
arrangement, which increases the complexity of the instrument. The
present invention seeks to provide a simpler and hence more
reliable arrangement for the bulk removal of tissue.
SUMMARY OF THE INVENTION
[0004] Accordingly, there is provided a combination of a device for
morcellating tissue within a body cavity of a patient and a
tissue-pulling device, the morcellating device comprising a
stationary tube having a distal end portion, the tissue-pulling
device being locatable within the tube, the combination including a
bipolar electrosurgical electrode assembly including first and
second electrodes, the first electrode being located at the distal
end of the tube, such that, when an electrosurgical cutting voltage
is applied to the electrode assembly, the tissue-pulling device can
be moved to pull tissue against the distal end of the tube to form
a core of severed tissue within the tube, and further moved in
order to remove the severed tissue from the body cavity of the
patient.
[0005] Conveniently, the electrosurgical electrode assembly extends
around the circumference of the distal edge of the tube, preferably
completely around the circumferential edge.
[0006] U.S. Pat. No. 5,304,124 describes an instrument for removing
a myoma from the uterus of a patient, the device utilising a
cauterising element at the end of a tubular member. This
cauterising element is described as being a wire loop, or a
"Bovie-type component". As this device is for the removal of a
myoma (leaving the remainder of the uterus intact), the cauterising
element will reduce the bleeding from the remainder of the uterus,
which will still be vascularly connected to the patient. In
contrast, the present invention provides a bipolar electrosurgical
device, more suited to the bulk removal of tissue from a uterus
which has been resected and will no longer have a vascular
supply.
[0007] The second electrode of the bipolar assembly is preferably
also located at the distal end of the tube, and separated from the
first electrode by an insulation member. Conveniently, the tube
itself constitutes the second electrode, and the first electrode
may be a conductive track present on the insulation member, for
example by the printing of the track on the insulation member.
[0008] The second electrode is alternatively or additionally
located on, or constituted by, the tissue-pulling device. If the
second electrode is located on the tube, and there is no electrical
connection between the second electrode and the tissue-pulling
device, there will possibly be a situation in which tissue being
pulled into the tube is in contact with the first electrode but not
the second. Under these circumstances, the electrosurgical cutting
of the tissue will not be effected until the tissue is pulled far
enough so as to contact the second electrode. By placing the second
electrode on the tissue-pulling device, or, if the second electrode
is located on or constituted by the tube, by making the second
electrode in electrical communication with the tissue-pulling
device, the cutting of tissue will be effected by a bipolar
electrode assembly constituted between the tissue-pulling device
and the first electrode.
[0009] By providing both the second electrode on the tube, and
making the tissue-pulling device effective as the second electrode,
each will act as the second electrode at different times. When the
tissue is first presented to the tube, the tissue-pulling device
will act as the second electrode. Subsequently, as the tissue is
pulled into the tube, the bipolar cutting will occur between the
first electrode and the second electrode located on the tube. This
arrangement ensures that, as the first tissue contact with the tube
is established, the bipolar electrode assembly is capable of firing
up successfully, and yet continues to be effective as more and more
tissue is pulled into the tube.
[0010] Thus, it will be seen that the bipolar electrode assembly is
constituted either by having two electrodes in the distal region of
the tube, or one electrode in the distal region of the tube and the
other on the tissue-pulling device, or both. Either of these
arrangements constitute "bipolar" electrode assemblies, even if the
tissue-pulling device constitutes one of the electrodes. A bipolar
electrode assembly has at least two electrodes, manoeuvrable in the
immediate region of the surgical site. This is in contrast to
monopolar or "Bovie type" arrangements, in which an immovable
return pad is attached to the patient at a point somewhat removed
from the surgical site.
[0011] The tissue-pulling device is preferably longitudinally
movable with respect to the tube. By the use of a pulling device,
the tube can be maintained stationary and tissue pulled into the
end of the tube. There is, therefore, no need to advance the tube
or otherwise move it into the tissue to be removed, as with many of
the prior art devices.
[0012] The tissue-pulling device is preferably a pair of jaw
members movable between open and closed positions, the jaw members
conveniently being mounted on a rod extending through the tube. The
jaws can be closed around tissue, grasping it firmly, and the rod
retracted within the tube to cause the tissue to be severed by the
electrosurgical electrode assembly at the distal end of the
tube.
[0013] Alternatively, the tissue-pulling device comprises a screw
member rotatable with respect to the tube. Rotation of the screw
member has the effect of pulling tissue into the tube. The tube
preferably has an end face which is angled with respect to the
longitudinal axis of the tube, conveniently at an angle of between
30 and 60 degrees to the longitudinal axis, and typically at 45
degrees thereto. This angled end face helps to ensure that the
initial contact between the tissue and the electrode assembly is a
point contact, thereby assisting with the firing-up of the
electrode assembly into a cutting or vaporisation mode and ensuring
effective separation of the tissue.
[0014] The invention also extends to a method of laparoscopically
removing a uterus, the method comprising the steps of:
[0015] a) dissecting the body of the uterus from the stump of the
uterus,
[0016] b) laparoscopically inserting a morcellating device
comprising a stationary tube having a distal end portion, and a
tissue-pulling device located within the tube, the morcellating
device and/or the tissue-pulling device including a bipolar
electrosurgical electrode assembly, the electrosurgical assembly
comprising first and second electrodes, at least one of the
electrodes being located at the distal end of the tube,
[0017] c) grasping tissue with the tissue-pulling device and
pulling it against the distal end of the tube,
[0018] d) energising the bipolar electrode assembly with an
electrosurgical cutting voltage,
[0019] e) continuing to pull the tissue with the tissue-pulling
device so that a core of tissue is formed within the tube, and
[0020] f) withdrawing the core of tissue from the tube.
[0021] Finally, the invention also extends to a device for
morcellating tissue within a body cavity of a patient, the device
comprising a stationary tube having a distal end portion, and a
bipolar electrosurgical electrode assembly located at the distal
end of the tube, the electrosurgical assembly comprising first and
second electrodes separated by an insulating member, the bipolar
electrosurgical electrode assembly extending around the
circumference of the distal edge of the tube, such that, when an
electrosurgical cutting voltage is applied to the electrode
assembly and relative movement is initiated between the tube and
the tissue, a core of severed tissue is formed within the tube such
that it can be removed from the body cavity of the patient.
BRIEF DESCRIPTION OF THE DRAWINGS
[0022] The invention will now be described in more detail, by way
of example only, with reference to the accompanying drawings, in
which:
[0023] FIG. 1 is a schematic side view, partly in section, of a
morcellating system in accordance with the present invention,
[0024] FIG. 2 is a schematic sectional view of a part of the system
of FIG. 1,
[0025] FIG. 3 is a schematic sectional view of an alternative
embodiment of the part of FIG. 2, and
[0026] FIG. 4 is a schematic sectional view of an alternative
embodiment of morcellating system in accordance with the present
invention.
DESCRIPTION OF PREFERRED EMBODIMENTS
[0027] Referring to FIG. 1, a morcellating system comprises a
morcellating device shown generally at 1, a tissue-pulling device
shown generally at 2, and an electrosurgical generator 3. The
generator 3 is connected to the morcellating device 1 by means of
cable 4, and to the tissue-pulling device 2 by means of cable 5.
The generator 3 is controlled by means of a footswitch 6.
[0028] As shown in FIGS. 1 and 2, the morcellating device 1
comprises a handle 7 and a cylindrical tube 8. The cylindrical tube
8 is hollow, and defines a lumen 9 therein. The proximal end 10 of
the tube 8 extends from the handle 7 as shown at 11, and the distal
end 12 of the tube is provided with an electrosurgical electrode
assembly 13. The electrosurgical electrode assembly 13 comprises an
active tissue-cutting electrode 14, and an insulating member 15,
both extending around the circumference of the tube 8. The
insulating member 15 separates the electrode 14 from the remainder
of the tube 8, which acts as a return electrode 16.
[0029] The tube 8 is connected to one pole of the generator 3, via
the cable 4 and a connector 17. The active electrode 14 extends
around the entire circumference of the tube 8, and is connected to
the other pole of the generator 3, via the cable 4, the connector
17 and additional wiring (not shown). In this way, the electrodes
14 and 16 constitute a bipolar electrode assembly, which, when
energised by the generator 3, is capable of cutting tissue coming
into contact with the distal end 12 of the tube 8.
[0030] The tissue-pulling device 2 comprises a tubular shaft 18, at
the proximal end of which is a scissors-type handle mechanism 19,
having a first handle 20 and a second handle 21. The second handle
21 is pivotable with respect to the first, about a pivot pin 22.
Pivoting of the second handle 21 causes longitudinal movement of a
push rod 23 extending through the shaft 18 to the distal end
thereof.
[0031] At the distal end of the shaft 18 is a jaw assembly 24, with
a first jaw member 25 and a second jaw member 26 movable between
open and closed positions by the movement of the push rod 23. The
tissue-pulling device 2 is manually translatable in a longitudinal
manner within the lumen 9 of the morcellating device 1, with
slidable guide members 27 supporting the shaft 18 of the
tissue-pulling device within the tube 8. The jaw members 25 and 26
are electrically connected to the shaft 18, and the shaft 18 is
electrically connected, via the lead 5 and the connector 28, with
the generator 3. The shaft 18 is connected to the same pole of the
generator 3 as the return electrode 16, constituted by the tube
8.
[0032] The operation of the morcellating system is as follows. The
tube 8 of the morcellating device 1 is inserted into the body of a
patient, typically through a trocar (not shown), and brought into
position adjacent to the tissue to be removed (typically a resected
uterus in the case of a laparoscopic hysterectomy). The
tissue-pulling device 2 is then inserted through the lumen 9 of the
morcellating device 1. The handle 21 is operated to open the jaw
assembly 24, and the tissue-pulling device 2 is manoeuvred so that
tissue from the uterus is located between the jaw members 25 and
26. The handle 21 is then operated to close the jaw assembly 24,
grasping tissue therein.
[0033] The surgeon operates the footswitch 6 to operate the
generator 3 so that an electrosurgical cutting voltage is supplied
between the tissue-cutting electrode 14 and the return electrode
16. As mentioned previously, the push rod 23 and the jaw assembly
24 are also electrically connected to the same pole of the
generator 3 as the tube 8, and so both the tube and the jaw
assembly constitute the return electrode 16. With tissue firmly
grasped in the jaw assembly 24, the device 2 is slowly withdrawn
from the tube 8, pulling the tissue against the distal end of the
tube and the tissue-cutting electrode 14. As the tissue contacts
the tissue-cutting electrode 14, it is vaporised, allowing the
device 2 to be withdrawn further into the tube 8. In this way, a
cylindrical core of tissue is formed in the tube 8, the tissue
being withdrawn though the proximal end 10 of the morcellating
device 1 (which remains outside the body of the patient) for
disposal.
[0034] The tissue-pulling device 2 can then be re-inserted into the
tube 8 such that a further core of tissue can be removed from the
body of the patient. By repeating this process, large quantities of
tissue can be removed from the patient in a relatively short time,
such that the entire uterus can be removed, if necessary, while
still employing a laparoscopic approach.
[0035] FIG. 3 shows an alternative embodiment of the tube 8, in
which the distal end 12 of the tube has an angled end as shown at
33. This angled end, which typically lies at an angle of 45 degrees
to the longitudinal axis of the tube, helps to provide an initial
point of contact between the tissue-cutting electrode 14 and the
tissue being drawn into the tube 8. This assists in ensuring
effective electrosurgical cutting of the tissue.
[0036] FIG. 4 shows the tube 8 of an alternative embodiment of the
morcellating device 1, in which the tissue-pulling device is
constituted by a screw-member 29. The screw-member 29 is rotatably
driven at its proximal end by means of a motor 30, and has a sharp
tip 31 at its distal end. The tip 31 of the screw-member 29 engages
tissue, and the rotation of the screw-member causes the tissue to
be pulled against the distal end of the tube 8, where it is
vaporised by the electrosurgical electrode assembly 13 as
previously described. Tissue travels up the tube 8 under the action
of the rotation of the screw-member 29, until it exits from the
proximal end 10 of the tube, to be removed from the screw-member by
a stripping element 32. This arrangement has the advantage that the
extraction of tissue can be effected on an almost continuous basis,
without the need for the removal and re-insertion of the
tissue-pulling device of FIGS. 1 and 2.
[0037] Those skilled in the art will appreciate that, in addition
to the jaw device and screw-member described above, other means for
pulling tissue into the tube 8 can be envisaged. The bipolar
electrosurgical assembly 13 will be capable of cutting tissue
pulled into contact therewith, by any suitable means.
[0038] Although the present invention has been described in terms
of a particular embodiment and process, it is not intended that the
invention be limited to that embodiment. Modifications of the
embodiment and process within the spirit of the invention will be
apparent to those skilled in the art. The scope of the invention is
defined by the claims that follow.
* * * * *