U.S. patent application number 13/159356 was filed with the patent office on 2012-03-22 for tubular cutter device and methods for cutting and removing strips of tissue from the body of a patient.
This patent application is currently assigned to NEOMEDIX CORPORATION. Invention is credited to Soheila Mirhashemi, Michael Mittelstein, John T. Sorensen.
Application Number | 20120071908 13/159356 |
Document ID | / |
Family ID | 41264227 |
Filed Date | 2012-03-22 |
United States Patent
Application |
20120071908 |
Kind Code |
A1 |
Sorensen; John T. ; et
al. |
March 22, 2012 |
TUBULAR CUTTER DEVICE AND METHODS FOR CUTTING AND REMOVING STRIPS
OF TISSUE FROM THE BODY OF A PATIENT
Abstract
Methods and devices for cutting strips of tissue from masses of
tissue inside or outside of the bodies of human or animal subjects.
The device generally comprises a) an elongate cutting tube that has
a distal end and a lumen that opens through an opening in the
distal end and b) first and second cutting edges formed on
generally opposite edges of the distal end of the cutting tube and
separated by a distance D. The device is advanced through tissue to
cut a strip of tissue of approximate width W. Width W is
approximately equal to distance D.
Inventors: |
Sorensen; John T.; (Ladera
Ranch, CA) ; Mittelstein; Michael; (Laguna Niguel,
CA) ; Mirhashemi; Soheila; (Laguna Niguel,
CA) |
Assignee: |
NEOMEDIX CORPORATION
Tustin
CA
|
Family ID: |
41264227 |
Appl. No.: |
13/159356 |
Filed: |
June 13, 2011 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10560267 |
May 11, 2006 |
7959641 |
|
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PCT/US2004/018488 |
Jun 10, 2004 |
|
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13159356 |
|
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|
60477258 |
Jun 10, 2003 |
|
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Current U.S.
Class: |
606/170 |
Current CPC
Class: |
A61F 9/00781 20130101;
A61B 2017/320064 20130101; A61B 2018/00083 20130101; A61B 2018/1497
20130101; A61F 9/0079 20130101; A61F 9/007 20130101; A61B 18/1482
20130101; A61B 17/320016 20130101; A61F 9/00736 20130101 |
Class at
Publication: |
606/170 |
International
Class: |
A61B 17/32 20060101
A61B017/32 |
Claims
1. A device for cutting a strip of tissue of approximate width W
from a mass of tissue, said device comprising: an elongate cutting
tube having a distal end and a lumen that opens through an opening
in the distal end; first and second cutting edges being formed on
generally opposite edges of the distal end of the cutting tube said
first and second cutting edges being separated by a distance D;
said cutting tube being advanceable through tissue such that the
first and second cutting edges will cut a strip of tissue having
approximate width W, said approximate width W being approximately
equal to the distance D between the first and second cutting
edges.
2. A device according to claim 1 wherein the cutting tube comprises
a stainless steel hypodermic tubing.
3. A device according to claim 1 further comprising at least one
protruding tip formed on the distal end of the cutting tube.
4. A device according to claim 2 wherein the protruding tip is
tapered.
5. A device according to claim 2 wherein the protruding tip is
sufficiently blunt to be substantially a traumatic.
6. A device according to claim 1 wherein the first and second
cutting edges are located on opposite lateral sides of the distal
end of the cutting tube.
7. A device according to claim 4 wherein the first and second
cutting edges are located on opposite lateral sides of the distal
end of the cutting tube and the protruding tip is located on the
bottom of the distal end of the cutting tube.
8. A device according to claim 7 further comprising a blunt edge
located at the top of the distal end of the cutting tube.
9. A device according to claim 1 wherein there is a single bend or
curve formed in the cutting tube.
10. A device according to claim 9 wherein there is a single bend of
approximately 20 degrees to approximately 90 degrees formed in the
cutting tube.
11. A device according to claim 10 wherein the bend is
approximately 90 degrees.
12. A device according to claim 1 wherein there are a plurality of
bends or curves formed in the cutting tube.
13. A device according to claim 12 wherein there are a plurality of
bends of approximately 20 degrees to approximately 90 degrees each
formed in the cutting tube.
14. A device according to claim 12 wherein there is a first bend of
approximately 90 degrees and a second bend of approximately 90
degrees, formed in the tube.
15. A device according to claim 1 further comprising a source of
negative pressure connected to the lumen of the cutting tube so as
to aspirate fluid or matter through the lumen of the tube.
16. A device according to claim 1 wherein the device further
comprises a second lumen.
17. A device according to claim 16 wherein one of the lumens is
connected to a source of fluid such that fluid may be infused
therethrough and the other of said lumens is connected to a source
of negative pressure such that fluid or matter may be aspirated
therethrough.
18. A device according to claim 1 wherein at least one of the
cutting edges is heated such that it will cauterize as it cuts.
19. A device according to claim 1 further comprising apparatus for
severing the strip of tissue when the strip of tissue has reached a
desired length.
20. A device according to claim 19 wherein the apparatus for
severing the strip of tissue comprises at least one electrode
which, when energized, will sever the strip of tissue.
21. A device according to claim 1 wherein the device further
comprises: a second tube that has a lumen and a distal end; wherein
the cutting tube extends through the lumen of the outer tube with a
distal portion of the cutting tube extending out of and beyond the
distal end of the outer tube.
22. A device according to claim 21 wherein: the outer diameter of
the cutting tube is smaller than the inner diameter of the second
tube such that fluid may flow through the lumen of the second tube;
and at least one aperture is formed in the second tube to permit
fluid to pass into or out of the lumen of the second tube.
Description
RELATED APPLICATIONS
[0001] This application is a division of copending U.S. patent
application Ser. No. 10/560,267 filed May 11, 2006, which is a 35
U.S.C. .sctn.371 national stage of PCT International Patent
Application No. PCT/US2004/018488 filed Jun. 10, 2004, which claims
priority to U.S. Provisional Patent Application No. 60/477,258
filed on Jun. 10, 2003, the entire disclosure of each such prior
application being expressly incorporated herein by reference.
BACKGROUND OF THE INVENTION
[0002] There are numerous medical and surgical procedures in which
it is desirable to cut and remove a strip of tissue of controlled
width from the body of a human or veterinary patient. For example,
it may sometimes be desirable to form an incision of a controlled
width (e.g., an incision that is wider than an incision made by a
typical scalpel or cutting blade) in the skin, mucous membrane,
tumor, organ or other tissue or a human or animal. Also, it may
sometimes desirable to remove a strip or quantity of tissue from
the body of a human or animal for use as a biopsy specimen, for
chemical/biological analysis, for retention or archival of DNA
identification purposes, etc. Also, some surgical procedures
require removal of a strip of tissue of a known width from an
anatomical location within the body of a patient.
[0003] One surgical procedure wherein a strip of tissue of a known
width is removed from an anatomical location within the body of a
patient is an ophthalmological procedure used to treat glaucoma.
This ophthalmological procedure is sometimes referred to as a
goniectomy. In a goniectomy procedure, a device that is operative
to cut or ablate a strip of tissue of approximately 2-10 mm in
length and about 50-200 .mu.m in width is inserted into the
anterior chamber of the eye and used to remove a full thickness
strip of tissue from the trabecular meshwork. The trabecular
meshwork is a loosely organized, porous network of tissue that
overlies a collecting canal known as Schlemm's canal. A fluid,
known as aqueous humor, is continually produced in the anterior
chamber of the eye. In normal individuals, aqueous humor flows
through the trabecular meshwork, into Shlemm's Canal and out of the
eye through a series of ducts. In patients who suffer from
glaucoma, the drainage of aqueous humor from the eye may be
impaired by elevated flow resistance through the trabecular
meshwork, thereby resulting in an increase in intraocular pressure.
The goniectomy procedure can restore normal drainage of aqueous
humor from the eye by removing a full thickness segment of the
trabecular meshwork, thus allowing the aqueous humor to drain
through the open area from which the strip of trabecular meshwork
has been removed. The goniectomy procedure and certain prior art
instruments useable to perform such procedure are described in U.S.
patent application Ser. No. 10/052,473 published as No.
2002/011608A1 (Baerveldt), the entirety of which is expressly
incorporated herein by reference.
[0004] At present there remains a need in the art for the
development of simple, inexpensive and accurate instruments useable
to perform the goniectomy procedure as well as other procedures
where it is desired to remove a strip of tissue from a larger mass
of tissue.
SUMMARY OF THE INVENTION
[0005] The present invention provides a device for cutting a strip
of tissue of approximate width W from a mass of tissue. The device
generally comprises a) an elongate cutting tube that has a distal
end and a lumen that opens through an opening in the distal end and
b) first and second cutting edges formed on generally opposite
edges of the distal end of the cutting tube and separated by a
distance D. The cutting tube is advanceable through tissue such
that the first and second cutting edges will cut a strip of tissue
having approximate width W, wherein the approximate width W is
approximately equal to the distance D between the first and second
cutting edges. In some embodiments, the strip of tissue may be
aspirated or otherwise removed through the lumen of the cutter
tube. In some embodiments, the device may include apparatus useable
to sever (e.g., transversely cut or transect) the strip of tissue
when the strip of tissue has reached a desired length.
[0006] Further in accordance with the invention there is provided a
method for cutting a strip of tissue of width W from a tissue mass.
This method generally comprises the steps of a) providing a device
that comprises i) an elongate cutting tube that has a distal end
and a lumen that opens through an opening in the distal end and ii)
first and second cutting edges formed on generally opposite edges
of the distal end of the cutting tube and separated by a distance D
that is approximately equal to the width W of the strip of tissue
to be cut; and b) advancing the distal end of the cutting tube
through the mass of tissue such that the first and second cutting
edges cut a strip of tissue of approximate width W. Further aspects
and elements of the invention will be understood by those of skill
in the art upon reading the detailed description of specific
examples set forth herebelow.
BRIEF DESCRIPTION OF THE DRAWINGS
[0007] FIG. 1 is a perspective view of a system incorporating a
needle cutting device of the present invention.
[0008] FIG. 2 is an enlarged perspective view of section 2 of FIG.
1.
[0009] FIGS. 3A-3D show various steps in a method for manufacturing
a needle cutter of the present invention.
[0010] FIG. 4 is a side view of a distal portion of a needle cutter
device of the present invention being used to cut a strip of tissue
of approximate width W.
[0011] FIG. 5 is a perspective view of the distal portion of a
needle cuter device of the present invention incorporating
apparatus for severing a strip of tissue cut by the needle cutter
device after the strip of tissue has reached a desired length.
[0012] FIG. 6 is a side view of the distal portion of another
embodiment of a needle cutter device of the present invention
having a plurality of curves or bends formed in the cutting
tube.
DETAILED DESCRIPTION
[0013] The following detailed description, and the drawings to
which it refers, are provided for the purpose of describing and
illustrating certain preferred embodiments or examples of the
invention only, and no attempt has been made to exhaustively
describe all possible embodiments or examples of the invention.
Thus, the following detailed description and the accompanying
drawings shall not be construed to limit, in any way, the scope of
the claims recited in this patent application and any patent(s)
issuing therefrom.
[0014] One example of a needle cutter device 10 of the present
invention is shown in FIGS. 1-4. This needle cutter device 10
generally comprises an elongate cutting tube 14 that has a distal
end and a lumen 27 that opens through an opening in the distal end.
First and second cutting edges 20, 22 are formed on generally
opposite edges of the distal end of the cutting tube 14. These
first and second cutting edges 20, 22 are separated by a distance
D, as shown in the distal end view of FIG. 3B. In the particular
example shown in the drawings, the first and second cutting edges
20, 22 are located on opposite lateral sides of the distal end of
the cutting tube 14 and a blunt, protruding tip 24 is located on
the bottom of the distal end of the cutting tube. Also, a blunt
edge 26 is located at the top of the distal end of the cutting tube
14. Thus, only the lateral cutting edges 20, 22 are sharp and
intended to cut tissue. The blunt, protruding tip 24 can, in some
applications, be configured and used to facilitate insertion of the
device 10 to its intended location and/or the blunt protruding tip
24 may be placed in an anatomical or man made grove or channel
(e.g., Schlemm's Canal of the eye) such that it will then advance
through the channel or groove and guide the advancement and
positioning of the remainder of the device 10.
[0015] One or more bends or curves may optionally be formed in the
cutting tube 14 to facilitate its use for its intended purpose. For
example, in the embodiment of the device 10 shown in FIG. 2, a
single bend 17 of approximately 90 degrees is formed near the
distal end of the cutting tube 14. In the embodiment of the device
10b shown in FIG. 6, two separate bends of approximately 90 degrees
each are formed at spaced apart locations on the cutting tube 14,
thereby giving the cutting tube 14 a generally U shaped
configuration. It will be appreciated that any number of bends or
curves, in any direction and of any severity may be formed in the
cutting tube 14 to facilitate its use in specific procedures or to
enable it to be inserted through tortuous anatomical channels of
the body. In most cases, the degree of curvature in embodiments
where a single bend or curve is formed will be between
approximately 30 and approximately 90 degrees and in embodiments
where more than one bend or curve are formed in the cutting tube 14
each such bend or curve will typically be between approximately 15
to approximately 90 degrees.
[0016] As shown in FIG. 4, when the cutting tube 14 is advanced
through tissue, distal end first, the first and second cutting
edges 20, 22 will cut a strip ST of tissue having approximate width
W, such approximate width W being approximately equal to the
distance D between the first and second cutting edges 20, 22. The
severed strip ST of tissue will enter the lumen 27 of the cutting
tube 14 as the device advances. Negative pressure may be applied to
lumen 27 to aspirate the strip ST of tissue and/or fluid and/or
other matter through lumen 27.
[0017] The device 10 may optionally include a second lumen. Such
second lumen may be used for infusion of fluid through the device
10 or for other purposes. In the embodiment shown in FIGS. 1 and 2,
the device 10 comprises an outer tube 16 in addition to the cutting
tube 14. The cutting tube 14 is of smaller diameter than the outer
tube 16 and the cutting tube 14 may extend through the lumen 19 of
the outer tube 16 such that a distal portion of the cutting tube 14
extends out of and beyond the distal end of the outer tube 16, as
may be seen in FIG. 2. The distal end of the outer tube 16 is
tapered and in close approximation with the outer surface of the
cutting tube 14. Fluid may be infused through the lumen 19 of the
outer tube 16, through the space between the outer surface of the
cutting tube 14 and the inner surface of the outer tube 16. Fluid
that is infused through the lumen 19 of the outer tube 16 may flow
out of one or more apertures 11 formed near the distal end of the
outer tube.
[0018] In some embodiments, the device 10 may be equipped with
severing apparatus for severing (e.g., transversely cutting or
transecting) the strip ST of tissue to fully excise or detach the
strip ST of tissue from the remaining tissue mass and/or from the
body of a human or animal subject. Such severing apparatus may
comprise any suitable type of tissue cutter such as a blade,
scissor, guillotine, electrode(s), laser, energy emitting tissue
cutter, mechanical tissue cutter, etc. FIG. 5 shows an example of
an embodiment of the device 10a wherein monopolar or bipolar
electrode(s) 40 are located on the distal end of the cutting tube
14. When it is desired to sever the strip ST of tissue, the
electrode(s) is/are energized with sufficient energy to sever the
strip ST, thereby disconnecting the strip ST from the remaining
tissue mass and/or the body of the human or animal subject.
[0019] In some embodiments of the device 10, the cutting edges 20,
22 may be heated such that they will cauterize as the cut. As those
of skill in the art will appreciate, such heating of the cutting
edges 20, 22 may be accomplished by placement of electrode(s) near
the cutting edges 20, 22 such that, when the electrode(s) is/are
energized, the cutting edges 20, 22 will become heated to a
temperature suitable for the desired cauterization function.
[0020] The needle cutter device 10 of the present invention may
optionally be used as part of a system 12, as shown in FIG. 1. The
basic components of the system 12 comprise an aspiration pump
module 74 and a source of irrigation fluid 72, mounted on a
surgical roller cart 70. Control of the console functions during
procedures may be accomplished by an aspiration foot pedal 78 which
controls an aspiration pump 74 and variation in the height of the
source of infusion fluid 72 to change the gravity fed pressure or
flow rate of infusion fluid through the device. A pinch valve, or
other means, may also be incorporated in the console to control
flow of the irrigation fluid to the needle cutter device 10. In
embodiments that include apparatus (e.g., electrode(s)) for heating
the cutting edges 20, 22 and/or for severing the strip ST of tissue
(FIG. 5), the system 11 may additionally comprise an electrical
current source, such as an electrosurgical generator 76 and
electrosurgical foot pedal 80 which controls the electrosurgical
generator to deliver desired amount(s) of energy to the
electrode(s) or other electrical elements (e.g., resistance
heater(s), etc.) on the device 10. As an option, all of the basic
control functions of system 12 may be integrated into a single
footpedal to facilitate use.
[0021] The device 10 may be provided as a pre-sterilized,
single-use disposable probe or tip that is attachable to a standard
surgical irrigation/aspiration handpiece such as that commercially
available as The Rhein I/A Tip System from Rhein Medical, Inc.,
Tampa, Fla. After the device 10 has been attached to the handpiece,
it may be connected to any or all of the electrosurgical generator
module 76, aspiration pump module 74 and the source of irrigation
fluid 72, as shown. Thus, the device 10 may be fully equipped for
irrigation, aspiration, and electrosurgical capabilities, as
described herein.
[0022] FIGS. 3A-3D show an example of a method for manufacturing
the cutting tube 14 from standard tubing (e.g., stainless steel
hypodermic tubing). Initially, the distal end of a tube is cut to
form the lateral cutting edges 20, 22, the protruding tip 24 and
the blunt top edge 26. Thereafter, if it is desired to have one or
more bends or curves in the cutting tube 14, angular cut out(s) 30
may be formed in the tube 14, as shown in FIG. 3C. Thereafter, the
tube 14 is bent to bring the edges of each angular cut out 30 into
apposition and weld, adhesive or other joining techniques are used
to weld or join the opposed edges of the cut outs together, thereby
forming the desired bend(s) or curve(s) in the cutting tube 14.
Likewise, if it is desired to have one or more bends or curves in
the cutting tube 14, the tube 14 may be directly bent to form said
curves or bends without the use of angular cut outs(s) 30. It may
be appreciated that the use of angular cut-out(s) 30 allow a tube
10 of a given diameter to incorporate a curve or angle in a more
compact form than is possible by bending tubing 10 of a given
diameter to said curve or angle without kinking or damaging tube
10.
[0023] The device 10 and system 12 are useable to perform a variety
of procedures wherein it is desired to form an incision or opening
of a desired width or to remove, from a mass of tissue, a strip ST
of tissue of a desired width.
[0024] One particular procedure that may be performed to treat
glaucoma, using the device 10 and system 12 of the present
invention, is a goniectomy. As explained herein a goniectomy
procedure is an ab interno surgical procedure wherein a sector of
the trabecular meshwork is removed from the eye of the patient to
facilitate drainage of aqueous humor from the anterior chamber of
the eye through Schlemm's Canal and the associated collector
channels, thereby relieving elevated intraocular pressure.
[0025] To perform a goniectomy procedure using the device 10, first
a small incision is made in the cornea at about 3 o'clock in the
left eye, or at about 9 o'clock in the right eye. A 1.5 mm slit
knife may be used to make this incision.
[0026] The device 10 is attached to the source of irrigation fluid
72 (e.g., basic balanced salt solution) such that irrigation fluid
will flow through lumen 19 of the outer tube 16 and out of outflow
aperture 11. The device 10 is then inserted through the incision
and into the anterior chamber of the eye (with irrigation flowing).
In some cases, during the insertion of the device 10, the source of
irrigation fluid 72 may initially connected to the device such that
the irrigation fluid will flow through the lumen 27 of the cutter
tube 14. In this manner, irrigation fluid will begin to infuse into
the anterior chamber of the eye as soon as the distal end of the
cutter tube 14 has entered the anterior chamber, rather than being
delayed until the larger outer tube 16 and aperture 11 have been
advanced through the incision and into the anterior chamber. By
this alternative approach, irrigation fluid may be caused to flow
out of the distal end of the cutter tube 14 as the device 10 is
being inserted, thereby spreading or opening the incision by
hydraulic force while in addition increasing the fluid pressure in
the anterior chamber. Such spreading or opening of the incision may
facilitate advancement of the larger diameter outer tube 16 through
the incision. Pressurizing the fluid in the anterior chamber causes
the anterior chamber to deepen and may facilitate maneuvering of
device 10 within the anterior chamber. In cases where this
alternative approach is used, the source of infusion fluid 72 may
be disconnected from lumen 27 of the cutter tube 14 after the
device 10 has been inserted into the anterior chamber and,
thereafter, the infusion fluid source 72 may be reconnected to
lumen 19 of outer tube 16 such that infusion fluid will flow out of
aperture 11. Negative pressure (e.g., via aspiration pump module
74) may then be applied to lumen 27 of the cutter tube 14 so as to
aspirate fluid and debris through lumen 27 as shown in FIG. 4. The
vertical height of the infusion fluid source 72 may be adjusted to
provide sufficient gravity feed of infusion fluid to make up for
the volume of fluid or matter being aspirated from the anterior
chamber through lumen 27, thereby
maintaining the desired pressure of fluid within the anterior
chamber during the procedure.
[0027] A lens device (e.g., Ocular Swan-Jacob Autoclavable
Gonioprism, Model OSJAG, Ocular Instruments Inc., Bellevue, Wash.)
may be positioned on the anterior aspect of the eye to enable the
physician to clearly visualize the angle of the eye where the
segment of trabecular meshwork is to be removed. Under direct
visualization, the device 10 is advanced until the distal tip of
the cutter tube 14 is positioned adjacent to the trabecular
meshwork at the location where the strip ST is to be removed.
Thereafter, the protruding tip 24 is advanced through the
trabecular meshwork and into Schlemm's Canal.
[0028] The device 10 is then advanced along Schlemm's Canal,
thereby causing the cutting edges 20, 22 to cut a strip of the
trabecular meshwork, thereby creating an opening through which
aqueous humor may drain from the anterior chamber of the eye.
[0029] After a strip of tissue of the desired length (e.g., about
2-10 mm) has been cut by the lateral cutting edges 20, 22, any
optional tissue severing apparatus (e.g., electrode(s) 40 may be
used (if present) to transect or sever the strip ST of tissue
thereby disconnecting it from the patient's body and allowing it to
be aspirated or drawn into or through lumen 27.
[0030] Thereafter, the aspiration is stopped, the device 10 is
removed from the eye, and the infusion is stopped.
[0031] Following completion of the surgery, aqueous humor will
drain from the anterior chamber through the opening that was
created by removal of the strip of tissue from the trabecular
meshwork TM.
[0032] Although the invention has been described above with respect
to certain embodiments and examples, it is to be appreciated that
such embodiments and examples are non-limiting and are not
purported to define all embodiments and examples of the invention.
Indeed, those of skill in the art will recognize that various
modifications may be made to the above-described embodiments and
examples without departing from the intended spirit and scope of
the invention and it is intended that all such modifications be
included within the scope of the following claims.
* * * * *