U.S. patent application number 13/368256 was filed with the patent office on 2013-02-14 for surgical snare with electrosurgical tip and method of use.
This patent application is currently assigned to TransEnterix, Inc.. The applicant listed for this patent is William L. Athas, Thomas B. Miller, Robert E. Welt. Invention is credited to William L. Athas, Thomas B. Miller, Robert E. Welt.
Application Number | 20130041372 13/368256 |
Document ID | / |
Family ID | 43823774 |
Filed Date | 2013-02-14 |
United States Patent
Application |
20130041372 |
Kind Code |
A1 |
Welt; Robert E. ; et
al. |
February 14, 2013 |
Surgical Snare with Electrosurgical Tip and Method of Use
Abstract
A medical device includes a tissue dissector and a snare loop on
a common shaft. At least the distal tip of the snare loop is
energizable to function as an electrosurgical element for tissue
dissection. In use the snare loop is partially extended from the
shaft to expose the electrosurgical element for electrosurgical
dissection, and the snare loop is fully extended from the shaft to
deploy the snare loop for retrieval and positioning of an implant
such as a gastric banding device. The snare loop may be deployed
through a pair of jaws also mounted on the shaft for use in tissue
dissection.
Inventors: |
Welt; Robert E.; (Wake
Forest, NC) ; Athas; William L.; (Chapel Hill,
NC) ; Miller; Thomas B.; (Perkiomenville,
PA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Welt; Robert E.
Athas; William L.
Miller; Thomas B. |
Wake Forest
Chapel Hill
Perkiomenville |
NC
NC
PA |
US
US
US |
|
|
Assignee: |
TransEnterix, Inc.
|
Family ID: |
43823774 |
Appl. No.: |
13/368256 |
Filed: |
February 7, 2012 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
12469071 |
May 20, 2009 |
8246617 |
|
|
13368256 |
|
|
|
|
12209586 |
Sep 12, 2008 |
|
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12469071 |
|
|
|
|
60971900 |
Sep 12, 2007 |
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Current U.S.
Class: |
606/45 ;
606/113 |
Current CPC
Class: |
A61B 2018/00214
20130101; A61B 2017/003 20130101; A61B 2017/320048 20130101; A61B
2018/1407 20130101; A61B 2017/00353 20130101; A61B 2017/3447
20130101; A61B 18/1482 20130101; A61B 2017/320056 20130101; A61B
18/1477 20130101; A61B 17/295 20130101; A61B 2017/3445 20130101;
A61B 2018/00494 20130101; A61B 18/14 20130101; A61B 17/32056
20130101; A61B 2018/141 20130101; A61B 17/3421 20130101; A61B
2017/320044 20130101; A61F 5/0089 20130101; A61B 2017/00349
20130101; A61B 2018/144 20130101 |
Class at
Publication: |
606/45 ;
606/113 |
International
Class: |
A61B 18/18 20060101
A61B018/18; A61B 17/32 20060101 A61B017/32 |
Claims
1. A medical instrument comprising: a shaft having a distal
portion; a pair of jaws on the distal portion of the shaft; and a
snare extendable from the distal portion of the shaft.
2. The medical instrument of claim 1, wherein the snare is
extendable to an extended position in which a portion of the snare
extends distal to the jaws.
3. The medical instrument of claim 2 wherein when the snare is in
the extended position a portion of the snare extends longitudinally
through the jaws.
4. The medical instrument of claim 2 wherein when the snare is in
the extended position a portion of the snare extends between the
jaws.
5. The medical instrument of claim 4, wherein the jaws are moveable
between an open position and a closed positions and wherein the
jaws in the closed position define a passage, and wherein a portion
of the snare extends through the passage to a position distal to
the jaws when the snare is in the extended position and the jaws
are in the closed position.
6. The medical instrument of claim 1, wherein the snare includes a
snare loop and a distal tip on the snare loop, and wherein the
snare includes a first extended position in which the distal tip is
positioned distal to the jaws, and a second extended position in
which the snare loop is positioned distal to the jaws.
7. The medical instrument of claim 6, wherein the distal tip
includes an electrically conductive element electrically
connectable to a source of radiofrequency energy.
8. The medical instrument of claim 5, wherein: the shaft includes a
lumen; the medical instrument further includes a guide tube
extending through the lumen, the guide tube including a distal
portion disposed between the jaws and a spreading element on the
distal portion; the guide tube is longitudinally slidable relative
to the shaft between a distal position and a proximal position,
wherein when the guide tube in the proximal position positions the
spreading element into contact with opposed contact surfaces on the
jaws, and thereby positions the jaws in the opened position.
9. The medical instrument of claim 1, wherein the medical
instrument includes an electrically conductive element electrically
connectable to a source of radiofrequency energy, the element
extendable from the distal portion of the shaft.
10. The medical instrument of claim 9, wherein the electrically
conductive element is extendable through the jaws.
11. The medical instrument of claim 9 wherein the electrically
conductive element is a distal portion of the snare.
12. A medical instrument comprising: an elongate tube having a
lumen; a snare comprising a loop and a distal tip on the loop,
wherein the snare is extendable from the distal portion of the tube
from a retracted position in which the loop is contained within the
tube, to a first extended position in which the distal tip extends
distally from the tube, and a second extended position in which the
loop extends distally from the tube; wherein at least a portion of
the loop has an electrically conductive portion electrically
connectable to a source of radiofrequency energy.
13. The medical instrument of claim 12 wherein the electrically
conductive portion includes the distal tip.
14. The medical instrument of claim 13, wherein the portion of the
loop proximal to the distal tip has a non-conductive surface.
15. The medical instrument of claim 13, wherein the snare comprise
a wire, and wherein at the distal tip the wire is formed into a
generally v-shaped element.
Description
RELATED APPLICATIONS
[0001] This application is a continuation of U.S. application Ser.
No. 12/469,071, filed May 20, 2009, which is a continuation in part
of U.S. application Ser. No. 12/209,586, filed Sep. 12, 2008, which
claims the benefit of U.S. Provisional Application No. 60/971,900,
filed Sep. 12, 2007.
TECHNICAL FIELD OF THE INVENTION
[0002] The present invention relates to the field of systems for
performing surgical procedures through minimally invasive access
ports.
BACKGROUND
[0003] Co-pending U.S. application Ser. No. 12/209,586, filed Sep.
12, 2008 and incorporated herein by reference, describes procedures
and devices useful for implanting a gastric banding device (e.g.
lap band or Swedish lap band) using a minimally invasive
technique.
[0004] In accordance with the of the disclosed implantation
procedures, one of more dissection instruments is passed through
single port or laparoscopic access devices and used to dissect a
tunnel around the posterior side of the stomach, through the
fascia/connective tissues surrounding the proximal stomach and
lower esophagus. A snare is advanced through the tunnel and
positioned with the shaft of the snare device extending through the
tunnel and with the loop of the snare accessible from or near the
anterior side of the stomach. A portion of the gastric band is
passed through the open snare loop and the snare loop is closed to
engage the gastric band. Tension is applied to the snare to
withdraw the snare back around the posterior side of the stomach
and then anteriorly in order to draw the gastric band around the
posterior side of the stomach. The gastric band is closed around
the stomach.
[0005] The prior application describes a combination dissection and
snare device particularly beneficial for carrying out the
procedure. That device is disclosed as having an elongate shaft
having a pre-curved distal end and an optional dissection balloon
positioned on the shaft. A monopolar RF dissection wire is
positioned within the shaft and has a conductive tip or electrode
extendable from the shaft when needed to electrosurgically dissect
or penetrate tissue. A snare loop is also extendable from and
retractable into the distal end of the shaft. That device
simplifies implantation of a gastric banding device in that it
allows the dissection step(s) and the step of engaging the implant
to be carried out with a single device. In particular, the device
is advanced into the abdominal cavity, and manipulated using RF
and/or blunt dissection to form an appropriate path through the
connective tissue. As the device is advanced to the posterior side
of the stomach, the curvature of the device carries the distal end
of the device into a more anterior position. The snare is deployed
from the device. The gastric band is passed into the cavity,
captured using the snare, and drawn around the posterior side of
the stomach using the snare.
[0006] The present application describes an improvement to the
combination dissection device and snare disclosed in the prior
application.
BRIEF DESCRIPTION OF THE DRAWINGS
[0007] FIG. 1 is a perspective view of the electrosurgical
dissector and snare device.
[0008] FIG. 2A is a perspective view of the jaw tip of the device
of FIG. 1.
[0009] FIG. 2B is a longitudinal cross-section view of the jaw tip
of FIG. 2.
[0010] FIG. 3 is a perspective view of the distal end of the
device, with the jaw tip removed.
[0011] FIG. 4A is similar to FIG. 3 but includes the jaw tip.
[0012] FIG. 4B is a perspective view of the distal end of the
device showing the jaws flexed into the opened position.
[0013] FIG. 5A is similar to FIG. 4 but shows the snare fully
extended.
[0014] FIG. 5B is similar to FIG. 5A but shows the snare partially
extended.
[0015] FIG. 5C is a close-up view of the partially extended
snare.
[0016] FIG. 6 is a perspective view of the snare removed from the
snare guide tube and shaft;
[0017] FIG. 7A is a partially exploded view of the handle in which
one shell section of the handle housing is not shown.
[0018] FIG. 7B is a side elevation of the contents of the handle
without the housing.
[0019] FIG. 8 is similar to FIG. 7B but shows one shell section of
the housing.
[0020] FIGS. 9A-9G are a sequence of drawings schematically
illustrating use of the device for implantation of a gastric
banding device.
DETAILED DESCRIPTION
[0021] FIG. 1 shows an embodiment of a combination electrosurgical
dissector and snare device 10. Dissector and snare device 10 has a
handle 12 and an elongate shaft 14 having a pre-curved distal
section 15. The shaft is preferably rigid or semi-rigid so as to
allow it to approximately retain its shape during use, although in
alternative embodiment flexible shafts may be used.
[0022] A jaw tip 16 is positioned at the distal end of the shaft
14. Referring to FIG. 2A, in one embodiment, the jaw tip 16 is a
tubular element having integrally formed first and second jaw
members 18a, 18b extending from a tubular coupling 20. The single
piece construction of the jaw tip biases the jaw members 18a, 18b
in the closed position shown in FIG. 2A. Each jaw member has a pair
of teeth 19 extending towards the opposed jaw member. When in the
closed position, the jaw members 18a, 18b define a distal gap or
passage 22 at their distal ends.
[0023] Referring to FIG. 2B, the jaw tip 16 includes a cylindrical
lumen 24 aligned with the passage 22. Walls defining the lumen 24
having longitudinally-extending edges 26 between the jaw members
18a, 18b. The edges 26 define a space between the jaw members 18a,
18b. Due to the varying contour of the edges 26, the space has a
broad distal section 28a and a narrow section 28b proximal to the
distal section 28a.
[0024] The distal end of the shaft 14, with the jaw tip 16 removed,
is shown in FIG. 3. A snare guide tube 30 extends through the lumen
of the shaft 14. A distal element 32 is positioned at the tip of
the guide tube 30 and has an opening 34 aligned with the lumen of
the snare guide tube 30. In the illustrated embodiment, the distal
element 32 is a spherical bead, the surface of which, as shown in
FIG. 4A, extends into the broad distal section 28a of the space
between the jaw members 18a, 18b. The opening 34 in the distal
element 32 is aligned with the distal passage 22 defined by the
jaws in the closed position.
[0025] Referring to FIG. 7A the proximal end of the snare guide
tube 30 is coupled to a piston 35 disposed within the handle 12. As
will be discussed in detail below, the piston 35 is longitudinally
moveable within the handle to a retracted position to withdraw the
snare guide tube 30 and thus its distal element 32 in a proximal
direction. When the distal element is moved proximally, it cams the
jaws to the open position shown in FIG. 4B as it moves from within
the broad distal section 28a to the narrow section 28b of the space
defined by the edges 26. As shown, the jaw members 18a, 18b flex at
flex regions 33 when they are moved to the open position. When the
distal element is returned to a more distal position within the
broad section 28a, it moves out of contact with the edges 26,
allowing the spring bias of the jaw members 18a, 18b to return them
to the closed position.
[0026] A snare 36 is disposed within the snare guide tube 30. The
snare 36 is formed of a wire strand formed into a loop 38. FIG. 5A
shows the snare 36 in a fully deployed position in which the loop
38 is fully extended from the guide tube 30. A v-shaped tip section
40 is positioned at the distal end of the loop 38. The snare is
advanceable from the fully retracted position shown in FIG. 4A in
which the snare loop is fully contained within the snare guide tube
30, to a partially extended position shown in FIG. 5B in which the
tip section 40 extends from the snare guide tube 30. When the snare
loop is in the partially extended position, the portions of the
wire loop just proximal to the "v" may extend in parallel contact
with one another as shown in FIG. 5C. The snare loop is further
advanceable to the fully deployed position shown in FIG. 5A. The
snare 36 is formed of an electrically conductive wire so that the
tip can function as an RF dissection wire. The snare 36 may be
conductive only at the tip 40, with the remainder of the loop 38
covered by insulative material, or the entire loop 40 (including
the tip 40) may be conductive.
[0027] As most easily viewed in FIG. 6, the snare 36 includes two
parallel proximal end sections 42a, 42b of the snare wire. The end
sections 42a, 42b are connected to a snare conductor 43 by
soldering, using a short piece of tubing 47 to cover and complete
the joint. Referring now to FIGS. 7A and 7B, the snare conductor 43
extends through the snare guide tube 30, around a pin 44, and is
coupled to a slider 46. The slider 46 includes first and second
pins 48a, 48b, each of which is connected to the snare conductor
43. As shown in FIG. 8, the ends of each pin 48a, 48b are slidably
disposed in slots 50 in opposite sides of the handle housing (one
side of which is shown). A head 52 on the slider 46 is slidably
positioned within slots 53 parallel to the slots 50.
[0028] An upper-surface of the head includes a sawtooth pattern of
ridges 55a. Corresponding ridges 55b are formed in the slots 53
such that the ridges 55a, 55b engage one another to maintain the
longitudinal position of the slider 46 within the slots 53.
[0029] The snare conductor 43 extends from the second pin 48b of
the slider 46, around another pin 56 and a series of pulleys 58,
60, 62 and is coupled to a proximal side of the piston 35. Pulley
58 is supported by a bracket mounted to a compression spring 66.
The compression spring 66 is seated within a slot 68 (FIG. 7A) in
the handle 12.
[0030] The snare conductor 43 is electrically coupled to an energy
source such as a monopolar RF source 45 (FIG. 1). FIG. 7B shows
that in the illustrated embodiment, a conductor 59 is coupled to
one of the pins 56 with which the snare conductor 43 is in contact,
so that the pin 56 electrically couples the snare conductor 43 to
conductor 59.
[0031] A pair of jaw actuation cables 70 is connected to me piston
35. The cables 70 extend around a pin and are connected to spool 72
connected to a grip 74. The spool 72 is pivotally mounted within
the handle 12 by a pin 76.
[0032] Referring again to FIG. 1, a preferred handle housing is
comprised of shell halves 78a, 78b which, when assembled, leaved an
exposed cutout 80. The cutout 80 is covered by a cover 82 having
flexible end sections 84 that extend into the cutout 80. The cover
82 includes a button 86 disposed between the end sections 84. The
button 86 is coupled to a standoff 87 (FIG. 7A) that extends
towards the button 86 from the head 52 of slider 46 (FIG. 8). The
sawtooth ridges 55b in the handle 12 (described with reference to
FIG. 8) contact the head 52 on opposite sides of the standoff 87.
Pressing the button 86 towards the cutout 80 depresses the head 52
to move the ridges 55a of the head out of engagement with the
ridges 55b in the handle. Sliding the button 86 distally after
disengaging the ridges 55a, 55b slides the slider 46 distally
within the handle. When the button slides 86, its flexible end
sections 84 slide within slots 85 (FIG. 8) in the housing.
[0033] Operation of the device 10 will next be described. A user
will typically hold the device with his/her palm against the handle
12, his/her index finger extending through the grip 74, and his/her
thumb on the button 86. To open the jaws 18a, 18b, the user
squeezes the grip 74 towards the handle 12, causing the grip 74 and
spool 72 to pivot relative to the pin 76 and to thus apply tension
to the jaw actuation cables 70. The actuation cables 70 pull the
piston 35 in a proximal direction and in doing so they withdraw the
snare guide tube 30 proximally. The distal element 32 on the snare
guide tube 30 spreads the jaws apart by camming the jaws into the
open position by acting on the edges 26 as described above.
Releasing the grip 74 causes the jaws to return to the open
position under their own spring bias.
[0034] The features for retracting the snare guide tube 30 to open
the jaws and for deploying the snare operate cooperatively to
maintain the longitudinal alignment of the snare loop 38 and the
snare guide tube 30. In particular, when the piston 35 is moved
proximally to retract the snare guide tube 30, it pulls the distal
end of the snare cable 43 (i.e. the portion anchored to the piston
35 near pulley 62) proximally, applying tension to the slider 46
and thus the portion of the snare cable 43 that extends into the
snare guide tube 30, to retract the snare 36 by a corresponding
amount. This avoids inadvertent exposure of the snare loop 38 when
the jaws are opened. The bracket 64 and spring 66 act as a
tensioning system to aid in maintaining the position of the snare
loop 38 relative to the jaws 18a, 18b.
[0035] To extend the snare loop 38, the user presses button 86
using his or her thumb. The button 86 presses downwardly against
the head 52 of the slider 46, releasing the engagement between the
sawtooth ridges 55a, 55b. Once released, the slider 46 is free to
slide longitudinally within the handle. The user advances the
button 86 to slide the slider 46 in a distal direction, thus
pushing the snare loop 38 from the distal end of the snare guide
tube 30. Because of the passage 22 in the jaw tip, the snare loop
38 can be advanced whether the jaws are closed or open. It should
be noted that the jaw tip 16 is preferably formed of material that
is not electrically conductive so as to prevent conduction of RF
energy from the snare to the jaws.
[0036] The user may advance the snare loop 38 by a first amount to
expose only the tip 40 (FIG. 5B), of s/he may advance the snare
loop 38 by a greater amount to fully deploy the snare (FIG. 5A).
The user can engage the snare loop 38 in an extended position by
releasing pressure against the button 86, allowing the sawtooth
ridges of the head 52 to re-engage with the corresponding ridges in
the handle.
[0037] When it is time to retract the snare loop 38, the user
applies downward pressure to the button 86 to disengage the ridges
55a, 55b and s/he then retracts the button 86 proximally to return
the slider to its original position.
[0038] In a typical procedure, the device 10 is advanced through a
single port or laparoscopic access device into the abdominal cavity
and advanced towards the stomach. The snare loop 38 is advanced to
the position shown in FIG. 5B, exposing the tip 40. The snare loop
38 is energized by activating the RE energy source 45 (e.g. by
depressing a foot pedal). The tip 40 is advanced around the
posterior side of the stomach, electrosurgically forming a tunnel T
through the fascia, connective tissue and/or other tissue posterior
to the stomach as shown in FIG. 9A. The user may begin the
electrosurgical step adjacent to the lesser curvature LC of the
stomach and continue formation of the tunnel under the stomach to
the greater curvature GC, or the electrosurgical step may be at the
greater curvature and work towards the lesser curvature.
[0039] The electrosurgically formed tunnel T is expanded using the
dissecting jaws 18a, 18b as shown in FIG. 9B. This step may be
performed during the electrosurgical step, with the jaws being
opened and closed behind the energized tip 40 as the tip 40 forms
the tunnel through the tissue. Alternatively, or in addition to
using the jaws during electrosurgical dissection, the distal end of
the device may be retracted back through runnel and the used at
that time (during retraction and/or subsequent re-advancement of
the device within the tunnel) to increase the size of the tunnel
using known dissection techniques. Use of the jaws for dissection
can involve opening the jaws to separate tissue layers on opposite
sides of the jaws
[0040] The curvature of the distal section 15 aids in directing the
operative tip around the stomach and into a more anterior position
(FIG. 9C) appropriate for full deployment of the snare for
retrieving the gastric band G. Once the tunnel has been dissected
to an appropriate size, the snare is moved to the fully deployed
position of FIG. 5A, and a portion of a gastric banding device is
placed within the loop of the snare. The snare is withdrawn
somewhat to cinch the loop against the gastric banding device. The
device 10 is withdrawn, passing again around the posterior side of
the stomach, thus drawing the engaged end of the gastric banding
device with it. The banding device is closed into a loop and
retained in place using known techniques. The dissector and snare
device 10 is removed from the body cavity, leaving the banding
device implanted around the stomach.
[0041] It should be recognized that a number of Variations of the
above-identified embodiments will be obvious to one of ordinary
skill in the art in view of the foregoing description. Accordingly,
the invention is not to be limited by those specific embodiments
and methods of the present invention shown and described herein.
Rather, the scope of the invention is to be defined by the claims
and their equivalents.
[0042] Any and all applications referred to herein, including for
purposes of priority, are hereby incorporated herein by
reference.
* * * * *