U.S. patent application number 11/929940 was filed with the patent office on 2008-03-06 for surgical endoscopic cutting device and method for its use.
This patent application is currently assigned to SMITH & NEPHEW, INC.. Invention is credited to Mark Hans Emanuel.
Application Number | 20080058588 11/929940 |
Document ID | / |
Family ID | 19765613 |
Filed Date | 2008-03-06 |
United States Patent
Application |
20080058588 |
Kind Code |
A1 |
Emanuel; Mark Hans |
March 6, 2008 |
SURGICAL ENDOSCOPIC CUTTING DEVICE AND METHOD FOR ITS USE
Abstract
A surgical endoscopic cuffing device includes cutting elements
fitted in a protective tube. The device has an inlet for fluid, a
discharge outlet for tissue and fluid, and a further outlet that
discharges most of the fluid.
Inventors: |
Emanuel; Mark Hans;
(Bloemendaal, NL) |
Correspondence
Address: |
FISH & RICHARDSON P.C.;SMITH & NEPHEW, INC.
150 Minuteman Road
Andover
MA
01810
US
|
Assignee: |
SMITH & NEPHEW, INC.
1450 Brooks Road
Memphis
TN
38116
|
Family ID: |
19765613 |
Appl. No.: |
11/929940 |
Filed: |
October 30, 2007 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
11780759 |
Jul 20, 2007 |
|
|
|
11929940 |
Oct 30, 2007 |
|
|
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09486977 |
Mar 6, 2000 |
7249602 |
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11780759 |
Jul 20, 2007 |
|
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Current U.S.
Class: |
600/104 ;
128/898; 606/170 |
Current CPC
Class: |
A61B 1/12 20130101; A61B
2017/4216 20130101; A61B 17/32002 20130101; A61B 17/42 20130101;
A61B 90/361 20160201; A61B 17/320016 20130101; A61B 1/018 20130101;
A61B 90/30 20160201; A61B 2217/005 20130101; A61B 2217/007
20130101 |
Class at
Publication: |
600/104 ;
128/898; 606/170 |
International
Class: |
A61B 1/00 20060101
A61B001/00; A61B 17/32 20060101 A61B017/32 |
Foreign Application Data
Date |
Code |
Application Number |
Sep 4, 1998 |
NL |
PCT/NL98/00504 |
Sep 4, 1997 |
NL |
1006944 |
Claims
1. A method comprising: inserting a cutter into a lumen of an
endoscope through a valve of the endoscope, the lumen having a
longitudinal axis extending from the valve to a distal end portion
of the endoscope, and inserting the endoscope into a distensible
organ.
2. The method of claim 1 further comprising introducing a fluid
into the organ.
3. The method of claim 2 further comprising introducing the fluid
through the endoscope.
4. The method of claim 1 further comprising cutting tissue with the
cutter.
5. The method of claim 1 further comprising discharging fluid and
cut tissue through the cutter.
6. The method of claim 1 further comprising providing a tube
defining a lumen for receiving the endoscope.
7. The method of claim 6 further comprising discharging fluid
through the tube.
8. The method of claim 1 wherein the cutter is inserted after the
endoscope is inserted.
9. The method of claim 1 further comprising controlling pressure
within the distensible organ.
10. The method of claim 1 wherein the valve comprises a shut-off
valve.
11. The method of claim 1 wherein the endoscope comprises a viewing
channel configured to enable a user to view an interior of the
distensible organ.
12. The method of claim 11 wherein the endoscope further comprises
a lens at an end of the viewing channel.
13. The method of claim 12 further comprising a camera coupled to
the viewing channel for viewing the interior of the distensible
organ.
14. A method comprising: inserting a cutter into a distensible
organ through a shut-off valve of an endoscope, the shut-off valve
defining an opening for receiving the cutter, the opening being
aligned with a longitudinal axis of the endoscope.
15. The method of claim 14 further comprising introducing a fluid
into the organ.
16. The method of claim 15 further comprising introducing the fluid
through the endoscope.
17. The method of claim 14 further comprising cutting tissue with
the cutter.
18. The method of claim 14 further comprising discharging fluid and
cut tissue through the cutter.
19. The method of claim 14 further comprising providing a tube
defining a lumen for receiving the endoscope.
20. The method of claim 19 further comprising discharging fluid
through the tube.
21. The method of claim 14 further comprising controlling pressure
within the distensible organ.
22. The method of claim 11 wherein the endoscope comprises a
viewing channel configured to enable a user to view an interior of
the distensible organ.
23. The method of claim 22 wherein the endoscope further comprises
a lens at an end of the viewing channel.
24. The method of claim 22 further comprising a camera coupled to
the viewing channel for viewing the interior of the distensible
organ.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a divisional application of and claims
priority to U.S. application Ser. No. 11/780,759, filed on Jul. 20,
2007, which is a continuation application of and claims priority to
U.S. application Ser. No. 09/486,977, filed on Mar. 6, 2000.
FIELD OF THE INVENTION
[0002] The present invention relates to a surgical endoscopic
cutting device.
BACKGROUND OF THE INVENTION
[0003] Surgical cutting devices are generally known and used for
the removal of hard and/or soft tissue, such as in the vicinity of
the knee joint. Such cutting devices are used in, for example, a
joint cavity, where they can be guided endoscopically by separately
inserting a viewing device having a light source and an observation
portion. Such operations are successfully used in organs and joints
lying not too deep underneath the skin.
[0004] When operations are being carried out on organs lying
deeper, other techniques are currently used. If, for example,
tissue has to be removed from the uterus, prostate, or urinary
bladder, such as mucous membrane or other tissues, it was customary
until now to use a so-called "loop." This is a loop-shaped cutting
wire which is brought to a first potential, while the wall of the
uterus is brought to a second, different potential. Tissue is
removed by moving the loop along the uterus wall. In order to be
able to carry out such an operation, it is necessary to dilate the
uterus. Dilation is carried out by introducing a fluid. In order to
maintain the effect of the potential difference, a non-conducting
fluid is used, for example a 5% sorbitol solution. Because wounds
are caused during the treatment described above, a good part of
this fluid is resorbed into the patient's bloodstream (by way of
the uterus). This can lead to highly dangerous electrolyte
displacements. It has been found that the tissue can be removed
more easily by working with a high-frequency monopolar electric
current, but there is a risk of high-frequency electric current
leading to internal and external burns. The loop is generally
fitted on an endoscope and moved back and forth along the uterus
wall with the endoscope. The tissue cut off during this treatment
has to be removed from the uterus, which considerably extends the
duration of the operation. Furthermore, the doctor has to check
that all detached material actually has been removed.
[0005] This means that such operations are very time-consuming and
require the surgeon to repeatedly move the device back and forth.
This is tiring and consequently difficult to learn. Moreover, the
patient has to be monitored continually during the operation, in
order to prevent the undesirable phenomena described above. It is
not uncommon for such an operation to be broken off because the
patient's life is endangered by the side effects.
[0006] On the other hand, it is desirable to be able to carry out
such operations instead of simply performing a hysterectomy.
[0007] WO 96/11638 discloses a cutter including a hollow stem and a
cutting head accommodated inside a rigid housing. This rigid
housing likewise contains a viewing channel with the necessary
optics. U.S. Pat. No. 5,195,541 describes a laparoscopic discectomy
apparatus. For a laparoscopic method it is essential to inflate the
related cavity using gas. The gas feed is discontinuous and has no
effect on viewing of the operation site.
[0008] Fluid is introduced by way of a space between the stem and
the rigid housing and discharged together with the detached tissue
through the hollow stem of the cutter.
[0009] This device could be satisfactory for the removal of tissues
from certain body cavities, such as from the bladder. However, in
the case of other body cavities, it is necessary to "blow up" the
cavity before treatment can be carried out. An example of this is
the uterus, in which it is important that the amount of enlargement
of the organ be accurately controlled. The irregular discharge of
fluid through the hollow stem of the cutter, caused partly by the
irregular release of tissue, means that it cannot be guaranteed
that the pressure inside the cavity is accurately controlled.
[0010] Such a device is consequently not very suitable for use in
the treatment of such a cavity.
SUMMARY OF THE INVENTION
[0011] The object of the present invention is to provide a device
which can perform such a treatment.
[0012] According to the invention, a further outlet channel is
provided, the function of which is independent of whether or not
detached tissue has been released. In other words, a regular
discharge of fluid can occur through this further outlet channel.
Since only a minor part of the fluid is now discharged through the
outlet, in which there are detached pieces of tissue, the pressure
inside the body cavity can be regulated and controlled accurately.
This makes it possible to remove undesired tissue from cavities
such as the uterus. The applicability of the removal of tissues by
cutting is consequently considerably increased.
[0013] The further outlet channel described above is formed by an
insertion tube fitted around the endoscopic device. This insertion
tube serves to clear a space for the endoscopic device. For this
purpose, the front side of the insertion tube can be provided with
an insertion mandrel, which is removed after the positioning of the
insertion tube and replaced by the endoscopic device described
above. In this case the further outlet channel can be defined
between the endoscopic device and the insertion tube.
[0014] In the case of such a construction it is desirable for a
coupler to be present to provide a coupling between the rigid
housing and the insertion tube described above.
[0015] Discharge of the tissue material which has been detached can
be achieved either by making the stem on which the cutting elements
are fitted hollow, or by fitting a protective tube around the
cutter. Such a protective tube can also be used without the space
between protective tube and stem serving as an outlet channel. This
means that the cutter can be designed as a separate unit which can
be coupled to the rigid housing, which has advantages in particular
for purposes of sterilization. Namely, the device can then be
detached in a simple way.
[0016] For the removal of tissue from a uterus it is essential for
the rigid housing to have a length which is sufficient to reach all
tissue parts, i.e. a length of at least 30 cm.
[0017] The observation part of the device described above includes
a light channel in the housing, provided near one end with a lens
and near the other end with an observation mechanism. The latter
can include an eyepiece or a connection for a camera so that the
surgeon can carry out the operation using a monitor and others can
possibly look at the same time.
[0018] The cutting elements described above can include any cutting
element known in the prior art. In other words, a cutting head with
cutting faces can be used, but it is also possible to use
constructions with teeth, meshing with the protective tube or
otherwise. In the latter instance, the protective tube is
preferably provided with a lateral opening through which a part of
the cutting elements extends so that on each revolution, part of
the tissue is removed and can be discharged directly through the
interior of the drive/discharge tube of the cutter.
[0019] The invention also relates to a method for the removal of
uterus tissue in which the device described above is used. In other
words, a machining operation is now applied with the use of a
physiological fluid which can be electrically conducting without
any problem, while at the same time the removed tissue is sucked
out. It is, of course, possible to suck out the tissue at a later
stage. The machining operation is carried out by a rotating
action.
[0020] According to a further embodiment of the method, an outlet
and a further outlet are present, and the pressure inside the body
cavity is regulated by metering the quantity of fluid which moves
through the further outlet. The insertion of the surgical
endoscopic cutting device is preferably carried out in the manner
described above using an insertion mandrel and insertion tube.
BRIEF DESCRIPTION OF DRAWINGS
[0021] The invention will be explained in greater detail below with
reference to an exemplary embodiment shown in the drawings, in
which:
[0022] FIG. 1 shows the endoscopic cutting device according to the
invention in the assembled state, in side view and partially in
section;
[0023] FIG. 1a shows the viewing/receiving part of the cutting
device of FIG. 1 in section along the line Ia-Ia;
[0024] FIG. 2 shows a side and partially cut-away view of the
viewing/receiving part of the cutting device of FIG. 1;
[0025] FIG. 3 shows a partially cut-away perspective view of the
device of FIG. 1, with the insertion end enlarged;
[0026] FIG. 4 shows a partially sectional side view of the cutter
of the cutting device of FIG. 3;
[0027] FIG. 5 shows a variant of the cutter shown in FIG. 4;
and
[0028] FIG. 6 shows an insertion mandrel according to the
invention.
DETAILED DESCRIPTION
[0029] The endoscopic cutting device according to the invention is
indicated in its entirety by 1 in FIG. 1. It comprises a
viewing/receiving part 3, which is shown in FIG. 2, a cutting part
2, which is shown in greater detail in FIGS. 4 and 5, and an
insertion mandrel, which is shown in FIG. 6.
[0030] With reference to FIG. 2, it can be seen that the
viewing/receiving part 3, is composed of an outer tube 4 in which a
main channel 5 and viewing channel 6 are defined. Viewing channel 6
ends at one side in a lens 13 and at the other side in a viewing
tube 7, on which an eyepiece or camera connection is placed. A
connection 8 for a light source is also present, for connection to
a fibre optics bundle which provides for lighting at the end of
lens 13. Near the control end, tube 4 is provided with a fluid
inlet 9 connected to a hose 12, for adding a physiological salt
solution.
[0031] A shut-off valve is indicated by 10.
[0032] The length of the actual outer tube 4, is indicated by A and
is more than 30 cm.
[0033] FIG. 4 shows details of the cutter or the cutting part 2,
which is composed of a protective tube 16 inside of which a
drive/suction tube 17 is fitted. Near the working end, tube 17 is
provided with teeth 19 which mesh with teeth 18 provided in an
opening 26 in the end part of protective tube 16. Near the other
end, drive/suction tube 17 is provided with a coupling 20, which
can be connected at one end to a rotating drive motor 21, not shown
in detail, and at the other end is provided with an opening 22
through which fluid and removed material can be discharged by way
of suction tube 17 to the discharge hose 23. A pressure regulator
can be present in this discharge hose 23, which is connected to a
vacuum source.
[0034] In FIG. 1 the insertion part is indicated by 27. This
insertion part is composed of an insertion tube 28 which is
provided with openings 29 at one end and near the other end, the
insertion part 27 is provided with a bayonet connection 30 and an
outlet 31. Insertion tube 28 is designed in such a way that tube 4
can be fitted therein, as shown in FIGS. 1 and 3, while it is also
possible to fit insertion mandrel 40, provided with stem 41 and
mandrel 42, in insertion tube 28
[0035] The construction described above has an inlet 38 for fluid.
Inlet 38 extends to channel 14 (FIG. 1a), i.e. the space bounded
between the outer tube 4 and the protective tube 16 and 36,
respectively from FIG. 4 or 5. A shut-off valve 39, which is
connected to channel 14, is present, while the further outlet is
indicated by 31. A discharge hose 23 for tissue and fluid is shown.
During the removal of tissue, with a substantially continuous
supply of fluid through inlet 38, some of the fluid will be
discharged through outlet 23. This relatively small amount will be
mixed with a mixture released during the cutting operation. Most of
the fluid will be discharged through the further outlet 31. This
discharge is unimpeded and occurs through openings 29. Pressure
variations occurring due to the presence or absence of removed
tissue in channel 17 (FIG. 4) have little or no influence on the
pressure inside the body cavity owing to the presence of the
further outlet 31.
[0036] If the device is to be inserted into, for example, a uterus,
insertion mandrel 40 will first be inserted, with shut-off valve 39
open, into insertion tube 28 with bayonet 30. This assembly is then
placed in the uterus in a relatively simple manner due to the shape
of mandrel 42. Mandrel 42 is then removed by manipulating stem 41,
and the construction shown in FIG. 2 is placed in tube 28.
Connection is made here to bayonet 30. The cutting action can then
begin after the uterus has been dilated by the introduction of
fluid. This fluid can be a physiological flushing and distension
fluid, such as a physiological salt solution (NaCl 0.9%). In the
event of the (unavoidable) resorption of the physiological fluid
into the blood, electrolyte displacement, with fatal consequences
for the patient, will not occur. Owing to the absence of electrical
current, the burns described above are also ruled out.
[0037] By switching on motor 21, tube 17 is set in rotation and
teeth 19 move regularly along cutting edge 18 of protective tube 16
which remains stationary. While they are moving along each other
and picking up tissue material between them, a cutting, detaching
action on the tissue material is occurring. The cut, detached
material is removed through the interior of tube 17 and outlet
23.
[0038] The appropriate area of the uterus can be treated by moving
parts 18 and 19 along the uterus wall or along tissue to be
removed, which can be observed through viewing tube 7 by supplying
light through connection 8.
[0039] Through the use of a continuous flow system, a constantly
clear view is obtained for the observer even if blood and/or mucous
is/are in the mixture. Moreover, the pressure can be maintained as
low as possible, in order to prevent intravasation.
[0040] FIG. 5 shows a variant of the end of the cutter. The cutter
or cutting part are indicated in their entirety by 32. The
protective tube is indicated by 36 and is beveled near the end. The
drive/suction tube is indicated by 37 and provided with a cutting
head near the end. In this embodiment, there is either no
interaction between cutting head 35 and protective tube 36, or head
35 and tube 36 interact near the edge of tube 36, which is adapted
for that purpose by grinding.
[0041] It is understood that such cutting elements can be designed
in any way known in the prior art.
[0042] These and further modifications are considered to lie within
the scope of the present application, to be immediately obvious to
the person skilled in the art after reading the description, and to
lie within the scope of the appended claims. For instance, it is
possible to effect the supply of working fluid and the discharge of
cleaning material in another way, i.e., to arrange the interior of
housing 4 slightly differently. Furthermore, the method described
above can be used for the removal of other tissue material, such as
prostate tissue through the urethra, or for the removal of tissue
from the wall of the urinary bladder.
* * * * *