U.S. patent application number 12/593461 was filed with the patent office on 2010-08-12 for ultrasonic cutting tool.
Invention is credited to Michael John Radley Young, Stephen Michael Radley Young.
Application Number | 20100204721 12/593461 |
Document ID | / |
Family ID | 34430509 |
Filed Date | 2010-08-12 |
United States Patent
Application |
20100204721 |
Kind Code |
A1 |
Young; Michael John Radley ;
et al. |
August 12, 2010 |
ULTRASONIC CUTTING TOOL
Abstract
The ultrasonic surgical tool has an elongate waveguide (1)
operatively connected or connectable at a proximal end to a source
of ultrasonic vibrations. At a distal end, an operative element
comprises a radially-extending ridge (2) defined between a
substantially parallel pair of grooves (4) extending longitudinally
of the waveguide (1). The operative element is curved in a plane
transverse to that of the ridge (2). This arrangement is
ergonomically superior and allows a surgeon to work for longer and
with improved control. It also allows a clear visualisation of the
operative elements of the tool and the target tissue.
Inventors: |
Young; Michael John Radley;
(South Devon, GB) ; Young; Stephen Michael Radley;
(South Devon, GB) |
Correspondence
Address: |
CARTER, DELUCA, FARRELL & SCHMIDT, LLP
445 BROAD HOLLOW ROAD, SUITE 420
MELVILLE
NY
11747
US
|
Family ID: |
34430509 |
Appl. No.: |
12/593461 |
Filed: |
February 28, 2006 |
PCT Filed: |
February 28, 2006 |
PCT NO: |
PCT/GB2006/000697 |
371 Date: |
April 15, 2010 |
Current U.S.
Class: |
606/169 |
Current CPC
Class: |
A61B 2017/320075
20170801; A61B 2017/00526 20130101; A61B 17/320068 20130101; A61B
17/32002 20130101; A61B 2017/320069 20170801 |
Class at
Publication: |
606/169 |
International
Class: |
A61B 17/32 20060101
A61B017/32 |
Foreign Application Data
Date |
Code |
Application Number |
Mar 3, 2005 |
GB |
0504321.1 |
Claims
1-10. (canceled)
11. An ultrasonic surgical tool comprising: elongate waveguide
means, a source of torsional mode ultrasonic vibrations operatively
connected or connectable to a proximal end of said waveguide means,
and an operative element adjacent a generally cylindrical distal
end of said waveguide means and comprising a radially-extending
ridge means defined between a substantially parallel pair of groove
means extending longitudinally of the waveguide means from a distal
end thereof, said operative element being curved in a plane
transverse to that of the ridge means.
12. A tool as claimed in claim 11, wherein the operative element is
curved in a plane substantially perpendicular to that of the ridge
means.
13. A tool as claimed in claim 11, wherein the operative element is
tapered towards its distal end.
14. A tool as claimed in claim 11, wherein the operative element
has a substantially blunt distal tip.
15. A tool as claimed in claim 11, wherein the operative element
comprises two convergent faces extending transversely to the plane
of curvature of the operative element, preferably with a first said
convergent face is concavely curved and a second said convergent
face convexly curved.
16. A tool as claimed in claim 15, wherein the ridge means extends
in a plane generally bisecting those of the convergent faces, and
the first concave convergent face converges towards the plane of
the ridge means more gradually than does the second convex
convergent face.
17. A tool as claimed in claim 11, wherein the operative element
further comprises a jaw member controllably moveable pivotally into
and out of engagement with the ridge means.
18. A tool as claimed in claim 17, wherein the jaw member or its
contact surface is curved correspondingly with the ridge means.
19. A tool as claimed in claim 11, further comprising means whereby
the operative element may be selectably rotated about a
longitudinal axis of the waveguide means so as to be presented to a
desired element of tissue on which to act.
20. An ultrasonic surgical tool comprising: elongate waveguide
means, a source of torsional mode ultrasonic vibrations operatively
connected or connectable to a proximal end of said waveguide means,
an operative element adjacent a generally cylindrical distal end of
said waveguide means and comprising a radially-extending ridge
means defined between a substantially parallel pair of groove means
extending longitudinally of the waveguide means from a distal end
thereof, said operative element being curved in a plane transverse
to that of the ridge means, and a controllably pivotable
non-vibrated jaw mechanism comprising a jaw member with a curvature
corresponding with that of the ridge means, the jaw member being
operable to be brought down into contact with an upper surface of
the ridge means and to trap tissue to be cut and coagulated
therebetween.
Description
[0001] The present invention relates to an ultrasonic surgical
tool, such as an ultrasonic laparoscopic tool for cutting soft body
tissues. More particularly, but not exclusively, it relates to such
a tool having an operative tip that is profiled to improve the
ergonomics of its use.
[0002] Ultrasonically-vibrated cutting tools have proven of major
benefit for surgery, particularly laparoscopic surgery (so-called
"keyhole" surgery). An elongate, narrow surgical tool, usually
together with a fibre-optic endoscope viewing system, is introduced
through a small incision into a patient's body and directed to an
exact region of tissue requiring surgery. In more complex
procedures, further tools may be introduced, by way of further
incisions, then directed to the same site, although this is avoided
wherever possible. In any case, a basic aim of laparoscopic surgery
is to minimise the size and number of incisions (or "ports") made
into the patient's body.
[0003] The constraints inherent in working with long, narrow tools
in a confined space under remote viewing (for example on a monitor
screen) mean that ergonomic design of laparoscopic tools is of
paramount importance.
[0004] Ultrasonically-vibratable tools bring significant benefits
in such minimally invasive procedures, as they may be selectably
energised so as to cut only target tissues, and they may easily be
adapted to cauterise tissue as they cut. Thus, blood vessels may be
both severed and sealed in one operation, for example,
significantly reducing bleeding. Such haemostatic cutting is of
particular benefit in laparoscopic surgery, where visibility is at
a premium.
[0005] Torsional-mode ultrasonic vibrations have proven
particularly effective, since they may be transmitted efficiently
and precisely into selected target tissues with minimal extraneous
leakage of ultrasonic energy, whereas the alternative
longitudinal-mode (or compression-wave) ultrasonic vibrations may
lead to undesirable propagation of energy longitudinally out of a
distal end of a tool into adjacent (non-target) tissues.
[0006] A conventional ultrasonically-vibratable laparoscopic tool,
whether torsional-mode or longitundinal-mode, comprises an
operative element or elements extending longitudinally from a
distal end of an elongate waveguide. A surgeon manipulates the tool
by grasping a handgrip mounted adjacent the proximal end of the
waveguide, which extends through a restricted port into a patient's
body. The operative elements are thus ideally positioned to be
employed on tissues substantially directly in line with the axis of
the waveguide. However, to work on tissue located to one side of
the axis of the waveguide, the surgeon must partially withdraw and
realign the tool, constrained by the dimensions of the port and at
all times manipulating the tool by its proximal end. The continual
repositioning required in a complex procedure may rapidly lead to
fatigue on the part of the surgeon. There is hence a need for an
ergonomically superior tool that allows the surgeon to work for
longer and with improved control.
[0007] As mentioned above, another important ergonomic issue in
laparoscopy is clear visualisation of the operative elements of the
tool and the target tissue. An endoscope viewing system is inserted
through a further incision, but this may arrive at the target
tissue at such an acute angle to the tool that three dimensional
visualisation is difficult.
[0008] It is hence an object of the present invention to provide an
ultrasonic cutting and/or coagulating tool that obviates the above
disadvantages and allows a user to conduct laparoscopic surgery
more conveniently and with improved control.
[0009] According to the present invention, there is provided an
ultrasonic surgical tool comprising elongate waveguide means
operatively connected or connectable at a proximal end to a source
of ultrasonic vibrations and provided adjacent a
generally-cylindrical distal end with an operative element
comprising a radially-extending ridge means defined between a
substantially parallel pair of groove means extending
longitudinally of the waveguide from a distal end thereof, said
operative element being curved in a plane transverse to that of the
ridge means.
[0010] The operative element may be curved in a plane substantially
perpendicular to that of the ridge means.
[0011] Preferably, the operative element is tapered towards its
distal end.
[0012] Advantageously, the operative element comprises two
convergent faces extending transversely to the plane of curvature
of the operative element.
[0013] A first said convergent face may thus be concavely curved
and a second said convergent face convexly curved.
[0014] The operative element may comprise a substantially blunt
distal tip.
[0015] Preferably, the ridge means extends in a plane generally
bisecting those of the convergent faces.
[0016] Advantageously, the first, concave convergent face converges
towards the plane of the ridge means more gradually than does the
second, convex convergent face.
[0017] The operative element thus comprises more material between
the plane of the ridge means and the concave convergent face than
between the plane of the ridge means and the convex convergent
face.
[0018] Preferably, the ridge means forms a cutting edge of the
operative element.
[0019] Advantageously, the operative element comprises a jaw member
controllably pivotably moveable into and out of engagement with the
ridge means.
[0020] The jaw member may be curved correspondingly with the ridge
means.
[0021] The jaw member may comprise a contact surface so formed as
to be cooperable with the ridge means.
[0022] In a preferred embodiment, the tool comprises a source of
torsional mode ultrasonic vibrations.
[0023] The tool preferably comprises means whereby the operative
element may be selectably rotated about a longitudinal axis of the
waveguide so as to be presented to a desired element of tissue on
which to act.
[0024] An embodiment of the present invention will now be more
particularly described, by way of example and with reference to the
accompanying drawings, in which:
[0025] FIG. 1 is a plan view from above of a tip of an ultrasonic
tool embodying the present invention, at a first stage of its
production;
[0026] FIG. 2 is a cross-sectional view of the tip of the tool
shown in FIG. 1, taken along the line II-II;
[0027] FIG. 3 is a plan view from above of the tip of the tool
shown in FIG. 1, at a second stage of its production;
[0028] FIG. 4 is a cross-sectional view of the tip of the tool
shown in FIG. 3, taken along the line IV-IV;
[0029] FIG. 5 is a plan view from above of the tip of the tool
shown in FIG. 1, at a last stage of its production; and
[0030] FIG. 6 is a distal end elevation of the tip of the tool
shown in FIG. 5.
[0031] Referring now to the Figures, and to FIGS. 1 and 2 in
particular, a narrow elongate cylindrical waveguide 1 comprises a
hard, corrosion resistant material, ideally titanium or an alloy
thereof. FIG. 1 shows the waveguide 1 after a first stage of the
production of a tool tip thereon. Two parallel grooves 4 extend
longitudinally of the waveguide 1 from its distal end 3, defining
between them an upstanding rib 2. The grooves 4 blend into the
cylindrical surface of the waveguide 1 at their proximal ends 6,
and deepen towards the distal end 3 of the waveguide 1. The
upstanding rib 2 extends in parallel to a longitudinal axis 9 of
the waveguide 1. (For the purposes of this description, the rib 2
will be taken as a top of the waveguide 1, and a plane extending
through the rib 2 and the longitudinal axis 9 is thus considered to
be a vertical plane).
[0032] In a second stage of the production of the tip of the tool,
the result of which is shown in FIGS. 3 and 4, the distal end 3 of
the waveguide 1 is tapered by machining a pair of vertically
extending flats 11, 12 into it. The flats 11, 12 converge towards
the distal end 3, but if prolonged would only meet beyond it. They
thus leave a narrow, flat distal tip 8, which is wider than the rib
2.
[0033] The flats 11, 12 begin each level with the other at their
proximal ends, but extend at slightly different angles, a first
flat 11 extending at a lesser angle to the rib 2 than a second flat
12. As a result, the tip 8 is asymmetric, slightly more material
remaining to a side of the rib 2 adjacent the first flat 11 than to
a side of the rib 2 adjacent the second flat 12.
[0034] In cross-section (FIG. 4), the waveguide 1 now begins to
take the form of a blade with a first 14 and a second 15 face
formed by the respective flats 11, 12.
[0035] In the final stage of production, the result of which is
shown in FIGS. 5 and 6, a distal portion of the waveguide 1 is bent
round a vertically extending mandrel, so that the first face 14
adopts a concave profile 17 and the second face 15 adopts a
slightly shallower convex profile 18. As a result, the rib 2 is
also curved, and the tip 8 is deflected outwardly, away from the
axis 9 of the waveguide 1, until it extends beyond a cylindrical
volume extending distally from a distal extremity of the waveguide
1.
[0036] The waveguide tip shown in FIG. 5 forms the cutting blade of
an ultrasonically-vibratable laparoscopic surgical tool. The
waveguide 1 is connected at its proximal end to a generator of
torsional-mode ultrasonic vibrations and to a handgrip graspable by
a surgeon, and is provided along almost its entire length with a
sleeve to isolate tissue through which it passes from ultrasonic
vibrations transmitted along the waveguide 1. The rib 2, and in
particular regions of the grooves 4 immediately flanking the rib 2
will best transmit ultrasonic energy into tissue contacted by the
waveguide 1.
[0037] The tapering of the waveguide 1 towards the distal tip 8
produces a tool with a much finer dissecting profile than would an
equivalent untapered distal end 3 of a waveguide 1. The tapering
also facilitates the step of bending the waveguide 1 around the
mandrel. One further benefit is that the taper towards the distal
tip 8, which is now significantly displaced from the
longitudinal/torsional axis 9, reduces the moment of inertia of the
tip 8. This reduces any tendency to generate unwanted unbalanced
transverse vibrational modes adjacent the distal tip 8. As can be
seen from FIG. 6, the distal tip 8 is pared down to a minimum
consistent with supporting the rib 2. Were it much narrower, it
might risk physically cutting into tissue as it is introduced into
the body, whereas an ideal laparoscopic tool is functionally blunt
until the moment that it is activated.
[0038] The shape of the tool shown allows it to be used as a very
delicate probe or dissector until a distal portion of the rib 2 is
brought into contact with the tissue to be treated, and is
ultrasonically vibrated, at which point it becomes a very precise
cutting/coagulating tool.
[0039] The shape is of particular advantage over existing tools
when the waveguide 1 is made rotatable about the axis 9, for
example using an arrangement such as that disclosed in our
copending UK Patent Application No. 0500937.8. This allows the
distal tip 8 to be applied to tissue all around the end 3 of the
waveguide 1, by simply "dialling" a desired angular alignment of
the distal tip 8, then for example sliding it under an adjacent
vessel, and ultrasonically activating it to make the required
cut.
[0040] A conventional operative tip of an ultrasonic laparoscopic
tool extends longitudinally from the distal end of the waveguide,
and so can only easily act on tissue directly in front of the tool.
The surgeon would then have to realign the entire elongate tool,
constrained by the size of the incision through which it passes, to
work on selected tissue that is not directly in the initial path of
the tool. The form of tip 8 shown gives the surgeon a far greater
radius of action without needing to reposition the whole tool, a
significant ergonomic improvement.
[0041] The distal tip 8 profile shown is also usable with a
controllably pivotable non-vibrated jaw mechanism, of the form used
in conventional linearly-arranged tools. This comprises a jaw
member (not shown) with a curvature corresponding with that of the
rib 2, which would be brought down into contact with an upper
surface of the rib 2 to trap tissue to be cut and coagulated
therebetween. Optionally, a contact surface of the jaw member would
be so profiled as to cooperate with the cross-sectional profile of
the rib 2 and at least the flanking regions of the grooves 4 when
it closes.
[0042] The distal tip 8 profile shown is of particular benefit in
procedures such as a cholecystectomy on the gall bladder, in which
curved cutting planes are preferred over simple flat cuts.
[0043] Clearly, with the distal tip 8 displaced outwardly from the
waveguide 1, it is also easier to see in the field of view of a
conventionally positioned endoscope viewer. This improved
visibility aids the surgeon in carrying out swift and accurate
procedures.
* * * * *