U.S. patent application number 14/204670 was filed with the patent office on 2014-09-18 for apparatus for tissue dissection with suction ring.
This patent application is currently assigned to Boston Scientific Scimed, Inc.. The applicant listed for this patent is Boston Scientific Scimed, Inc.. Invention is credited to Daniel LANG, Samuel RAYBIN, Paul SMITH, Naroun SUON.
Application Number | 20140275769 14/204670 |
Document ID | / |
Family ID | 50721868 |
Filed Date | 2014-09-18 |
United States Patent
Application |
20140275769 |
Kind Code |
A1 |
RAYBIN; Samuel ; et
al. |
September 18, 2014 |
APPARATUS FOR TISSUE DISSECTION WITH SUCTION RING
Abstract
A medical device may include a housing. The housing may include
an outer wall, an inner wall spaced from the outer wall, and a
cavity defined by the outer wall and the inner wall. The distal end
of the outer wall may be disposed proximally from the distal end of
the inner wall. The housing may further define a passageway
therethrough. The cavity may be in fluid communication with a port
configured to adjust pressure within the cavity.
Inventors: |
RAYBIN; Samuel;
(Marlborough, MA) ; SMITH; Paul; (Smithfield,
RI) ; SUON; Naroun; (Lawrence, MA) ; LANG;
Daniel; (North Attleboro, MA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Boston Scientific Scimed, Inc. |
Maple Grove |
MN |
US |
|
|
Assignee: |
Boston Scientific Scimed,
Inc.
Maple Grove
MN
|
Family ID: |
50721868 |
Appl. No.: |
14/204670 |
Filed: |
March 11, 2014 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
61798690 |
Mar 15, 2013 |
|
|
|
61777988 |
Mar 12, 2013 |
|
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Current U.S.
Class: |
600/104 ;
606/113 |
Current CPC
Class: |
A61B 1/00137 20130101;
A61B 2017/00269 20130101; A61B 17/30 20130101; A61B 2017/308
20130101; A61B 17/32056 20130101; A61B 1/00094 20130101; A61B
1/00101 20130101; A61B 17/00234 20130101; A61B 2017/00296 20130101;
A61B 17/320016 20130101; A61B 2017/306 20130101 |
Class at
Publication: |
600/104 ;
606/113 |
International
Class: |
A61B 17/32 20060101
A61B017/32 |
Claims
1. A medical device, comprising: a housing including an outer wall,
an inner wall spaced from the outer wall, and a cavity defined by
the outer wall and the inner wall, wherein the distal end of the
outer wall is disposed proximally from the distal end of the inner
wall, the housing further defines a passageway therethrough, and
the cavity is in fluid communication with a port configured to
adjust pressure within the cavity.
2. The medical device of claim 1, further comprising a plurality a
depth limiters disposed in the cavity, wherein the plurality of
depth limiters extend from one of the inner or outer walls.
3. The medical device of claim 1, further comprising an element
capable of resecting tissue provided external to the inner
wall.
4. The medical device of claim 3, wherein the element capable of
resecting tissue is a snare.
5. The medical device of claim 1, wherein the inner wall includes
at least one ledge projecting into the passageway for limiting a
travel of the elongate member.
6. The medical device of claim 1, wherein the housing defines an
opening having at least one straight edge.
7. The medical device of claim 8, wherein the housing defines an
opening having a plurality of straight edges.
8. The medical device of claim 1, wherein the inner wall is
adjustable relative to the outer wall.
9. The medical device of claim 1, wherein the elongate member
includes an endoscope including at least one imaging device.
10. The medical device of claim 1, wherein the housing includes a
sheath extending proximally therefrom, and wherein the sheath
includes a lumen configured to receive an endoscopic cutting
device.
11. The medical device of claim 1, wherein a distal end of the
outer wall is curved towards the inner wall.
12. An endoscopic mucosal resection device, comprising: an elongate
member including a proximal end, a distal end, and a lumen
extending therebetween; a housing operably coupled and movable
relative to the distal end of the elongate member, the housing
including an outer wall, an inner wall spaced from the outer wall,
and a cavity defined by the outer wall and the inner wall, wherein
the distal end of the outer wall is disposed proximally from the
distal end of the inner wall, the housing further defines a
passageway therethrough, and a proximal portion of the passageway
is configured to receive the elongate member therein; and a cutting
device.
13. The medical device of claim 12, wherein the cavity is in fluid
communication with a port configured to adjust pressure within the
cavity.
14. The medical device of claim 12, wherein the cutting device is
provided external to the inner wall.
15. The medical device of claim 12, wherein the inner wall includes
at least one ledge projecting into the passageway for limiting
travel of the elongate member.
16. The medical device of claim 12, wherein the inner wall is
adjustable relative to the outer wall.
17. The medical device of claim 12, further including at least one
depth limiter disposed in the cavity and extending from one of the
inner or outer walls.
18. The medical device of claim 12, wherein the housing includes a
sheath extending proximally therefrom, the sheath including a lumen
for receiving a portion of the cutting device.
19. A method of resecting tissue from within a patient, comprising:
advancing an endoscopic mucosal resection device to a target
location within the patient, the endoscopic mucosal resection
device comprising: a housing operably coupled and movable relative
to the distal end of an elongate member, the housing including an
outer wall, an inner wall spaced from the outer wall, and a cavity
defined by the outer wall and the inner wall, wherein the housing
further defines a passageway therethrough, a proximal portion of
the passageway being configured to receive the elongate member
therein; disposing a distal end of the housing adjacent a tissue
wall; applying suction to the cavity to draw at least one layer of
the tissue wall into the cavity; and resecting a portion of tissue
drawn into the cavity.
20. The method of claim 19, wherein a distal end of the outer wall
is disposed proximally of a distal end of the inner wall.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims the benefit of priority from U.S.
Provisional Application No. 61/777,988, filed on Mar. 12, 2013, and
U.S. Provisional Application No. 61/798,690, filed on Mar. 15,
2013, each of which is incorporated by reference herein in its
entirety.
DESCRIPTION OF THE INVENTION
[0002] 1. Field of the Disclosure
[0003] The present disclosure generally relates to a medical
instrument, and more particularly to an apparatus for tissue
resection.
[0004] 2. Background
[0005] A wide variety of medical techniques and instruments have
been developed for diagnosis and/or treatment within a patient's
body, such as the gastrointestinal (GI) tract. For example,
endoscopic mucosal resection (EMR) is a minimally invasive
technique used for removing, e.g., malignant/non-malignant lesions
and/or otherwise unwanted tissue. Endoscopic medical procedures,
for example EMR, may excise sessile adenomas (i.e., tumors attached
to a bodily surface) in an anatomical lumen. Such procedures often
require the dissection of one tissue plane while leaving an
underlying tissue plane intact. When performing these procedures,
it is desirable to cleanly cut and retrieve a uniform tissue sample
of sufficient size, particularly where a pathology study of the
sample might be necessary. In addition, it is desirable for the
resection to leave clean margins at the treatment site in order to
minimize any further disruption of the surrounding anatomy.
[0006] If the adenoma is flat against a lumen wall, however,
excising the adenoma can be difficult. In such cases, one of
several techniques may be used to raise the flat adenoma so that it
may be excised appropriately without harming underlying tissue
layers. For instance, forceps can be used to raise the flat
adenoma. Also, injections of a solution into, e.g., the submucosal
or an underlying tissue layer can create a space or opening under
the tissue, creating a buffer zone. The space lifts the flat
adenoma above the underlying tissue to facilitate removal, and
minimizes mechanical or electrocautery damage to the deeper tissue
layers.
[0007] These conventional techniques and instruments, however, have
many disadvantages and/or limitations. For example, perforation is
a key concern as it poses a serious safety risk the patient. The
present disclosure is described to overcome one or more of the
above limitations and/or other shortcomings in the art.
SUMMARY OF THE DISCLOSURE
[0008] The present disclosure relates to a embodiments of apparatus
and methods for tissue resection, which may reduce the risk of
perforating underlying tissue layers by, e.g., lifting and
separating the mucosa from the muscularis, around the perimeter of
the lesion or other unwanted tissue.
[0009] In one embodiment, a medical device may include a housing.
The housing may include an outer wall, an inner wall spaced from
the outer wall, and a cavity defined by the outer wall and the
inner wall. The distal end of the outer wall may be disposed
proximally from the distal end of the inner wall. The housing may
further define a passageway therethrough. The cavity may be in
fluid communication with a port configured to adjust pressure
within the cavity.
[0010] In another embodiment, an endoscopic mucosal resection
device may include an elongate member. The elongate member may
include a proximal end, a distal end, and a lumen extending
therebetween. The device may also include a housing operably
coupled and movable relative to the distal end of the elongate
member. The housing may include an outer wall, an inner wall spaced
from the outer wall, and a cavity defined by the outer wall and the
inner wall. The distal end of the outer wall may be disposed
proximally from the distal end of the inner wall. The housing may
further define a passageway therethrough. A proximal portion of the
passageway may be configured to receive the elongate member
therein. The device may also include a cutting device.
[0011] In a further embodiment, a method of resecting tissue from
within a patient may include advancing an endoscopic mucosal
resection device to a target location within the patient. The
endoscopic mucosal resection device may include a housing operably
coupled and movable relative to the distal end of an elongate
member. The housing may include an outer wall, an inner wall spaced
from the outer wall, and a cavity defined by the outer wall and the
inner wall. The housing may further define a passageway
therethrough. A proximal portion of the passageway may be
configured to receive the elongate member therein. The method may
also include disposing a distal end of the housing adjacent a
tissue wall. The method may also include applying suction to the
cavity to draw at least one layer of the tissue wall into the
cavity. The method may also include resecting a portion of tissue
drawn into the cavity.
[0012] Other aspects and features of the disclosure will be evident
from reading the following detailed description of the preferred
embodiments, which are intended to illustrate, not limit, the
disclosure.
BRIEF DESCRIPTION OF THE DRAWINGS
[0013] The present disclosure is further described in the detailed
description which follows, in reference to the drawings, by way of
non-limiting examples of preferred embodiments of the present
disclosure, in which like characters represent like elements
throughout the several views of the drawings.
[0014] FIG. 1 illustrates a perspective view of an exemplary tissue
resection apparatus according to an embodiment of the present
disclosure.
[0015] FIG. 2 is a cross-sectional view of the exemplary tissue
resection apparatus of FIG. 1.
[0016] FIG. 3 is a cross-sectional view of the exemplary tissue
resection apparatus including an endoscope therein and in
cooperating with tissue, according to an embodiment of the present
disclosure.
[0017] FIG. 4 is a schematic view of an exemplary tissue resection
apparatus in combination with a suitable cutting device, in
accordance with another embodiment of the present disclosure.
[0018] FIG. 5 is a cross-sectional view of an exemplary tissue
resecting apparatus, according to a further aspect of the present
disclosure.
[0019] FIG. 6A is a top view of the apparatus of FIG. 5.
[0020] FIG. 6B is a bottom view of the apparatus of FIG. 5.
[0021] FIGS. 7A-7B depict an alternate embodiment of an apparatus
in accordance with a further embodiment of the present
disclosure.
[0022] FIG. 8 depicts a further embodiment of an apparatus in
accordance with the present disclosure.
[0023] FIGS. 9A-9C depict exemplary structures to facilitate
separating a first tissue layer from a second tissue layer, in
accordance with the present disclosure.
DETAILED DESCRIPTION OF THE EMBODIMENTS
[0024] Reference will now be made in detail to the exemplary
embodiments of the disclosure illustrated in the accompanying
drawings. Wherever possible, the same reference numbers will be
used throughout the drawings to refer to the same or like
parts.
[0025] The present disclosure relates to an apparatus for
endoscopic treatment, which may reduce the risk of perforating an
underlying tissue layer, e.g., by lifting and separating the tissue
layer intended for resection from the underlying layer, which is
not intended for the resection. FIG. 1 and FIG. 2 illustrate an
exemplary tissue resection apparatus 1, according to an embodiment
of the present disclosure. As shown, the apparatus may include a
housing 3 having an outer wall 5 and an inner wall 7 disposed
within the housing 3. The inner wall 7 is surrounded by the outer
wall 5 and separated by a specific distance so that there is a
cavity 11 or a hollow gap (referred hereinafter as the "cavity")
formed between the outer wall 5 and the inner wall 7. In one
embodiment, the cavity 11 may be substantially annular or
completely annular, extending completely about chamber 13. The
distal end of the housing 3 is opened so that the housing 3 is
adapted to be placed against a surface of tissue. The housing 3
further includes a connection to a suction source, for example the
port 9, for applying suction in the cavity 11 to draw tissue into
the cavity 11.
[0026] In some embodiments, the space surrounded by the inner wall
7 may be hollow, forming a hollow chamber 13, as depicted in FIG.
2. As will be described in further detail below, the housing 3 may
include a proximal opening 15, providing access to the hollow
chamber 13, so that an elongated tubular member (not shown in FIG.
2) can be inserted into the hollow chamber 13.
[0027] FIG. 3 illustrates a cross-sectional view of the apparatus 1
being placed against a tissue layer "L". When the apparatus is
placed against the surface of targeted tissue layer "L", the
suction applied from the suction source (not shown) via the port 9
draws in the targeted tissue "L" into the cavity 11, thereby
forming a ridge of tissue, as illustrated in FIG. 3. In one
embodiment, port 9 may be in fluid communication with cavity 11, so
that a vacuum applied to portion 9 may be realized throughout
cavity 11. As shown in FIG. 1, e.g., port 9 may be offset relative
to a longitudinal axis of housing 3 such that cavity 13 (discussed
below) may receive tubular member 17 therein. A portion of port 9
may be configured to extend away from a proximal end of housing 3.
The raised ridge of tissue drawn into the cavity 11 may facilitate
snaring or other resection methods. The cavity 11 may be preferably
narrow so that the non-targeted sub tissue layer (e.g., tissue
layer "SL") is excluded from being drawn up into the cavity,
thereby reducing the risk of perforating the SL tissue layer.
[0028] In some embodiments, the housing 3 may include a
substantially cylindrical shape. In such a case, a continuous
circular cavity will be formed between the outer wall 5 and the
inner wall 7, and the tissue drawn into the cavity 11 will form a
circumferential ridge of tissue surrounding a substantially flat
tissue surface in the middle, as illustrated in FIG. 3. However, it
should be noted that the housing 3 can be in any shape suitable for
forming the cavity 11 for drawing tissue therein. For example,
housing 3 may include a square or rectangular configuration shown
in, e.g., FIGS. 7A, 7B, and 8. More particularly, housing 3 defines
an opening having at least one straight edge to facilitate removal
of tissue via a tessellation technique.
[0029] As briefly described above, the apparatus 1 may include a
hollow chamber 13 for accommodating an elongated tubular member
(e.g., tubular member 17). In an aspect, the apparatus 1 may be
configured as an endoscopic cap, and the elongated tubular member
17 may be an endoscope with various endoscope functionalities,
including visualization, illumination, flushing, irrigation,
suction, and the like, and using a variety of tools through its
working channels (not shown). Those of ordinary skill in the art
will understand that tubular member 17 may include any suitable
introduction sheath known in the art.
[0030] In some embodiments, one or more internal working channels
may be included inside the tubular member 17 for receiving
endoscopic instruments, such as an optical scope or as an
aspiration path connected to the suction source. It should be noted
that the internal working channels may have non-circular
cross-sectional shapes, and may be in any shapes depending on the
types of endoscopic instrument and/or application of the working
channel(s). Further, the tubular member 17 may include a number of
additional lumens for receiving control wires, which may extend
from various control sources (e.g., actuation handle, knobs,
steering controls, etc.) disposed at the proximal end of tubular
member 17 through the tubular member 17.
[0031] An external shape and dimension of the tubular member 17 may
be substantially the same as the hollow chamber 13. In some
embodiments, the dimension (e.g., width) of the tubular member 17
may be slightly larger than the size of the hollow chamber 13 in
order to facilitate a tight fitting of the tubular member 17 into
the hollow chamber 13. In such cases, the surroundings of the
proximal opening of the hollow chamber 13 and/or the inner wall 7
may be made of a flexible material that is elastically deformable
to accommodate the larger tubular member 17 into the hollow chamber
13. In some embodiments, the tubular member 17 may be made of a
flexible material that is elastically deformable, so that the
tubular member 15 can be snuggly fitted into the hollow chamber 13.
In addition, one or more ledges or ridges 19 may be formed on an
interior wall of the hollow chamber 13 to prevent the tubular
member 17 from passing through the entire hollow chamber 13. A
position of ledges or ridges 19 along inner wall 7 may be varied as
desired to alter a position of tubular member 17 relative to
housing 3. Also, in some other embodiments, the apparatus 1 may be
configured so that the elongated tubular member 17 can pass
completely through the hollow chamber 13, which will allow for
extension and retraction of the apparatus 1 relative to the tubular
member 17 (e.g., endoscope). In such embodiments, therefore, ledges
or ridges 19 may be excluded.
[0032] FIG. 4 illustrates an exemplary embodiment of the apparatus
1 equipped with a snare 21. Those of ordinary skill in the art will
understand that any suitable cutting device may be used in
conjunction with apparatus 1. As shown, snare 21 can be opened and
preloaded around the exterior of the apparatus 1 prior to drawing
in the tissue. When the tissue layer ("L") is drawn into the cavity
11 as shown in FIG. 2, the snare 21 can be closed around the base
of the raised circumferential ridge of the drawn up tissue for
resection. In this example, the tubular member 17 may be surrounded
by a sheath 23, which may contain at least one auxiliary working
channel 25. The sheath 23 may include a flexible tubular member
extending proximally away from a proximal end of the housing 3.
Auxiliary working channel 25 may include a lumen in the
aforementioned sheath 23 or another tubular member operably coupled
to the sheath 23. For instance, the auxiliary working channel 25
may accommodate the snare 21. It should be appreciated that the
sheath 23 may include a plurality of auxiliary working channels 25
for various other functionalities. For example, one of the working
channels may function as the aspiration path between the port 9 and
the suction source (not shown). Additional auxiliary working
channels may be included in the sheath 23 to accommodate various
other instruments and functionalities. Although the apparatus 1 and
the tubular member 17 have been described in the context of an
endoscope cap with a snare, it is contemplated that the tubular
member 17 also may be any other medical device, such as a catheter
or guiding tube that includes any number of the features and
characteristics disclosed herein. Further, various tissue
dissection/resection tools may be also used in conjunction with the
apparatus 1 for tissue resection or other endoscopic treatment.
[0033] FIG. 5 illustrates additional details of the apparatus 1.
The distal end portion of the outer wall 5 may be rounded and bent
towards the inner wall 7 at a predetermined angle. This angle may
promote drawing in the tissue positioned underneath the hollow
chamber 13 (i.e., the tissue layer "L" surrounded by the most
distal end/tip 27 of the inner wall 7) so that tissue underneath
the hollow chamber 13 becomes taut as illustrated by the arrows in
FIG. 3.
[0034] In some embodiments, the distal most end/tip 27 of the inner
wall 7 is substantially co-planar with the distal most end/tip 29
of the outer wall 5. In other embodiments, however, the tip 27 of
the inner wall 7 may be recessed towards the proximal end of the
housing 3 relative to the tip 29 of the outer wall 5 as shown in
FIG. 5. In other words, the tip 29 of the outer wall 5 is extended
closer to the surface of the tissue layer ("L") than the tip 27 of
the inner wall 7. In this configuration, the hollow chamber 13 may
not be completely isolated from the suction applied via the port 9
by the inner wall 7. Accordingly, when the suction is applied from
the suction source, the tissue layer ("L") enclosed within the tip
29 of the outer wall 5 may be drawn up (i.e., lifted) to the level
of the tip 27 of the inner wall 7 initially. When the tissue layer
("L") contacts the tip 27 of the recessed inner wall 7, a seal may
be formed so that the cavity 11 is isolated from the hollow chamber
13. In other words, the recessed inner wall 7 elevates the tissue
layer ("L") approximately equal to the vertical distance ("D1"
shown in FIG. 5) between the tip 29 of the outer wall 5 and the tip
27 of the inner wall 7.
[0035] Once the tissue layer "L", which is enclosed within the
housing 3, is elevated and the hollow chamber 13 is isolated from
the suction applied via the port 9, the tissue layer "L" may be
further drawn into the cavity 11 to form a ridge of tissue
surrounding the substantially flat tissue underneath the hollow
chamber 13. It is contemplated that the elevation of tissue within
the housing 3 can prevent the snare 21 from snagging on the inner
wall 7 during resection procedure, e.g.
[0036] Further, in some embodiments, a distal tip 27 of inner wall
7 may be longer than tip 29 of outer wall 5. For example, with
reference to FIG. 8, apparatus 80 may include an outer wall 82 and
an inner wall 84. Inner wall 84 may be configured to extend
distally further than outer wall 82 to ensure proper suction on the
targeted tissue is maintained. In other embodiments, however, the
distal ends of both inner and outer walls 82 and 84 may be flush
with one another.
[0037] In some embodiments, the hollow chamber 13 may be provided
with its own aspiration port 31 to provide negative/positive
pressure in the hollow chamber 13. For example, negative pressure
may be applied to draw tissue into the disclosed apparatus. In the
embodiments where positive pressure is applied, the positive
pressure may be used to expel tissue lodged in the disclosed
apparatus or otherwise in contact with the disclosed apparatus. In
such embodiments, a tubular member 15 may include an internal or an
auxiliary working channel (not shown) providing an aspiration path
for the hollow chamber 13. In some embodiments, one or both of
ports 9 and 31 may be used to introduce, e.g., irrigation or
insufflation, to a location within a patient's body.
[0038] In some embodiments, the length of the inner wall 7 (e.g.,
the vertical length "D2") may be adjustable, such that the tip 27
of the inner wall 7 may be extended and/or retracted in distal and
proximal directions relative to wall 5. It is contemplated that the
adjustable inner wall 7 enables controlling the amount of elevation
of the tissue required for creating the seal (e.g., isolating the
hollow chamber 13 from the port 9), at which point the tissue will
be drawn into the cavity 11 to form the ridge of tissue. Adjusting
inner wall 7 may also allow sufficiently separating tissue layers
so that an underlying tissue is not perforated during a resection
procedure. When it is not necessary to elevate the tissue prior to
forming the ridge of tissue, the inner wall 7 may be extended in
the distal direction so that the tip 27 of the inner wall 7 is
substantially co-planar with the tip 29 of the outer wall 5,
thereby creating instant isolation of the hollow chamber 13 from
the suction applied via the port 9. Those of ordinary skill in the
art will readily recognize that outer wall 5 may be also configured
to be adjustable in substantially the same manner as inner wall
7.
[0039] Various types of mechanisms and configurations may be
employed in implementing the adjustable inner wall 7 or outer wall
5. For the purposes of efficiency, the adjustable mechanisms will
be only described relative to inner wall 7, however those of
ordinary skill will understand that the same principles may be
applied to outer wall 5. In an exemplary embodiment, the inner wall
7 may include a plurality of telescoping segments 33 that are
arranged to slide, e.g., in and out relative to one another, as
depicted in FIG. 5. In this example, the elongated tubular member
15 may be used in exerting the force necessary for extending and/or
retracting the telescoping segments 33. For instance, the elongated
member 15 may include one or more grooves that may selectively
couple with one or more of ridges 19 or may abut a fixed portion of
the inner wall 7, such that the vertical length ("D2") of the inner
wall 7 may be controlled by pushing in and/or pulling out the
tubular member 15. In some other embodiments, some portion of the
inner wall 7 may be formed as a screw thread, a helical ridge, a
spiral groove and/or appropriate gearing mechanisms, such that the
distance between the tip 27 of the inner wall 7 and the tip 29 of
the outer wall 5 is adjusted by applying rotational force to move
the inner wall 7 in the proximal or distal directions relative to
outer wall 5. For example, a portion of an external wall of the
elongated tubular member 15 may include a screw thread
corresponding to a screw thread on the inner wall 7, so that
rotational force applied to the tubular member 15 facilitates
moving the inner wall 7 relative outer wall 5. In some other
embodiments, other control means that are operable via the working
channel and/or the lumen may be used in implementing the adjustable
inner wall 7. Such other control means may include, e.g., an
electric motor disposed in the housing 3 or the tubular member 15
controlled via the control lines extending through the lumen in the
tubular member 15.
[0040] The size (e.g., a width or volume) of the resected tissue
may be controlled by the amount of tissue drawn into the cavity 11.
Accordingly, in some embodiments, the apparatus 1 may further
include a number of depth limiters 35 disposed within the cavity 11
to adjust and/or control the amount of tissue drawn into the cavity
11, as shown in FIGS. 5, 6A and 6B. The depth limiters 35 may
include a plurality of blocks, panels, or other suitable structures
that extend between the outer wall 5 and the inner wall 7 at a
specific depth (e.g., "D3" shown in FIG. 5) within and around the
cavity 11. The plurality of depth limiters 35 may be arranged
relative to each other in such a way that a plurality of gaps 37 is
formed between every two adjacent depth limiters 35. The size of
each gap 37 formed between the depth limiters 35 should be
sufficient to maintain the air-flow necessary for drawing tissue
into the cavity 11 while preventing the tissue from passing through
the gap 37. The size of the gaps 37 formed between each of the
depth limiters 35 may vary depending on the type of tissues and/or
the type of resection procedures.
[0041] In some embodiments, the depth of the vertical distance
("D3") of the depth limiters relative to the tip 29 of the outer
wall 5 may be adjustable. By way of an example, some portion of the
inner wall 7 may include one or more slots for receiving the depth
limiters 35, so that the depth limiter 35 can be moved distally or
proximally within the cavity 11. Similarly, the depth limiters may
extend from or be received in an inner surface of outer wall 5. One
of the internal or the auxiliary working channels may be used for
extending a control mechanism for moving depth limiters 35 within
the cavity 11. The control mechanism may be a rotatable rod or a
cable configured to push and pull the depth limiters 35 along the
cavity 11. In some other embodiments, the depth limiters 35 may
utilize a screw thread, a helical ridge, a spiral grove and/or
other suitable mechanisms configured for adjusting the position of
depth limiters 35. The control mechanism may also be an electrical
motor disposed in the housing 3 or the tubular member 15, providing
sufficient force to move the depth limiters 35 as desired.
[0042] Further, the plurality of depth limiters 35 may be formed as
a single piece structure in order to simplify the control mechanism
for adjusting the depth limiter 35. Alternatively, each depth
limiter 35 may be separately adjustable by providing an independent
control mechanism for each depth limiter 35. This configuration may
allow for more precise control over the amount of tissue being
drawn into the cavity 11 as each of the depth limiters 35 around
the cavity 11 may be adjusted to be at differing depths. It should
be appreciated that various other control mechanisms and
configurations may be used in implementing the adjustable depth
limiters 35.
[0043] In some embodiments, the disclosed apparatus may include
suitable cutting and/or ligating instruments. For example, as shown
in FIG. 7B, the device 70 may be provided with a cutting tool 72
disposed about a periphery of opening 74. Cutting tool 72 may
include any suitable tool known in the art. For example, in one
embodiment, cutting tool 72 may include a snare, which may or may
not include electro-cautery capabilities. Further, cutting tool 72
may include a ligating band or shuttling wire in some embodiments.
Further, although the depicted embodiment illustrates that cutting
tool 72 is disposed adjacent outer wall 76, those of ordinary skill
in the art will understand that cutting tool 72 may be disposed
adjacent inner wall 78.
[0044] FIGS. 9A-9C depict embodiments of an alternative apparatus
in accordance with the present disclosure. For example, as shown in
FIG. 9A, inner wall 90 may be longer than outer wall 94. Together
inner wall 90 and outer wall 94 may define a groove 96 therebetween
for receiving tissue. A cutting tool 98 (as discussed above) may be
disposed adjacent outer wall 94. A distal end of inner wall 90 may
be angled away from outer wall 94. Further, an outer, distal edge
of outer wall 94 may include a bevel or chamfer. Groove 96 may
include a generally rectangular cross-sectional configuration.
[0045] With reference to FIG. 9B, e.g., a distal end of inner wall
90 may be substantially planar. However, outer wall 94 may include
a configuration that angles outer wall 94 toward inner wall 90.
Turning now to FIG. 9C, inner wall 96 may include a first portion
96a movably coupled to a second portion 96b. First portion 96a may
be configured to move reciprocally in the directions of arrow 100.
Second portion 96b may be configured to transition between a first
configuration and a second configuration, wherein in the second
configuration, the second portion 96b is configured to trap tissue
between second portion 96b and an inner surface of outer wall
94.
[0046] It should be understood that this disclosure is, in many
respects, only illustrative. Changes may be made in details,
particularly in matters of shape, size, length, and arrangement of
components without exceeding the scope of the present disclosure.
Thus, the present disclosure is intended to cover alternatives,
modifications, and equivalents, which may be included within the
spirit and scope of the present disclosure as defined by the
claims.
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