U.S. patent application number 14/090305 was filed with the patent office on 2015-05-28 for systems and methods for a surgical tissue manipulator.
The applicant listed for this patent is Novartis AG. Invention is credited to Philipp Schaller.
Application Number | 20150148838 14/090305 |
Document ID | / |
Family ID | 53183262 |
Filed Date | 2015-05-28 |
United States Patent
Application |
20150148838 |
Kind Code |
A1 |
Schaller; Philipp |
May 28, 2015 |
Systems and Methods for a Surgical Tissue Manipulator
Abstract
An apparatus for manipulating tissue during a procedure
performed within an eye of a patient is disclosed herein. The
apparatus includes a hand-held controller and an elongate member
configured to be inserted into the eye of the patient. The elongate
member has a proximal end and a distal end, with the proximal end
of the elongate member being coupled to the hand-held controller.
The elongate member also has a lumen extending through the length
of the elongate member. The apparatus further includes a plurality
of flexible grasping fibers extending through at least a portion of
the lumen and beyond the distal end thereof. The grasping fibers
are adjustable by the hand-held controller to advance or retract
relative to the elongate member by altering a distance between
distal ends of the grasping fibers and the distal end of the
elongate member.
Inventors: |
Schaller; Philipp; (Stein am
Rhein, CH) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Novartis AG |
Basel |
|
CH |
|
|
Family ID: |
53183262 |
Appl. No.: |
14/090305 |
Filed: |
November 26, 2013 |
Current U.S.
Class: |
606/207 |
Current CPC
Class: |
A61B 34/70 20160201;
A61F 9/00727 20130101 |
Class at
Publication: |
606/207 |
International
Class: |
A61B 19/00 20060101
A61B019/00 |
Claims
1. An apparatus for manipulating tissue during a procedure
performed within an eye of a patient, the apparatus comprising: a
controller; an elongate member configured to be inserted into the
eye and having a proximal end and a distal end, the proximal end of
the elongate member being coupled to the controller, a lumen
extending through a length of the elongate member; and a plurality
of flexible grasping fibers extending through at least a portion of
the lumen and beyond the distal end thereof, the grasping fibers
being adjustable by the controller to advance or retract relative
to the elongate member by altering a distance between distal ends
of the grasping fibers and the distal end of the elongate
member.
2. The apparatus of claim 1, further comprising a slide block
coupled to a proximal end of each grasping fiber of the plurality
of grasping fibers.
3. The apparatus of claim 2, wherein the elongate member is
configured to move relative to the slide block.
4. The apparatus of claim 1, wherein the grasping fibers are
configured to grasp tissue when the distance between the distal
ends of the grasping fibers and the distal end of the elongate
member is decreased.
5. The apparatus of claim 1, wherein the elongate member moves
relative to the grasping fibers to open and close the plurality of
grasping fibers.
6. The apparatus of claim 1, wherein the elongate member has an
outer diameter ranging from about 0.4 millimeters to about 0.9
millimeters.
7. The apparatus of claim 1, wherein each grasping fiber of the
plurality of grasping fibers has a diameter of about 0.01
millimeters to about 0.1 millimeters.
8. The apparatus of claim 1, wherein at least some of the plurality
of grasping fibers have hooked ends or textured ends.
9. The apparatus of claim 1, wherein the plurality of grasping
fibers are formed with a curve proximate a distal end of each of
the plurality of grasping fibers.
10. The apparatus of claim 1, wherein the controller is configured
to move the elongate member relative the plurality of grasping
fibers when the controller is activated by an operator.
11. A minimally invasive apparatus for manipulating tissue in an
eye of a patient, comprising: an elongate member configured to be
inserted through a minimally invasive surgical opening in the eye
of the patient, the elongate member having a proximal end, a distal
end, and a lumen extending through a length of the elongate member
from the proximal end to the distal end; a hand-held controller
coupled to the proximal end of the elongate member; and a plurality
of grasping fibers extending through at least a portion of the
lumen and beyond the distal end thereof, the grasping fibers being
adjustable by the hand-held controller to advance or retract
relative to the elongate member by altering a distance between
distal ends of the grasping fibers and the distal end of the
elongate member.
12. The apparatus of claim 11, wherein the elongate member is
coupled to the hand-held controller configured to control
displacement of the elongate member relative to the plurality of
grasping fibers.
13. The apparatus of claim 11, wherein the elongate member is a
metal tube.
14. The apparatus of claim 11, wherein the plurality of grasping
fibers is formed from plastic, glass, silicone, metal or a
composite.
15. The apparatus of claim 11, wherein the plurality of grasping
fibers comprises a first set of grasping fibers and a second set of
grasping fibers.
16. The apparatus of claim 15, wherein the first set of grasping
fibers and the second set of grasping fibers are biased to curve in
opposite directions when the apparatus is an open state.
17. A method of positioning retinal tissue that has detached from a
back surface of an eye of a patient, the method comprising: making
an incision in the eye; inserting a retinal manipulator into the
eye through the incision, the retinal manipulator having two
pluralities of grasping fibers at a distal end thereof; grasping a
portion of the retinal tissue that is detached from the back
surface of the eye between the two pluralities of grasping fibers;
and maneuvering the retinal tissue by maneuvering the grasped
portion with the retinal manipulator.
18. The method of claim 17, wherein the retinal manipulator
comprises a tube having the two pluralities of grasping fibers
positioned therein, the two pluralities of fibers being biased to
extend in different directions.
19. The method of claim 18, further comprising adjusting a
stiffness of the plurality of grasping fibers by positioning the
tube relative to the two pluralities of grasping fibers.
20. The method of claim 17, further comprising fully retracting the
two pluralities of fibers into a tube prior to inserting the
retinal manipulator into the eye through the incision.
Description
BACKGROUND
[0001] The present disclosure relates to systems and methods as
used to manipulate delicate tissue during surgical procedures, and
more particularly, to the manipulation of retinal tissue during an
ophthalmic surgical procedure.
[0002] Among the many conditions that can afflict a patient's eye
are retinal detachment and/or tearing. A detached retina is a
condition in which the retina of an eye, which is normally attached
at the back of the eye, peels away from the back of the eye. This
can cause vision problems including blindness. In order to reattach
the retina, surgery may be required. During a procedure, the retina
may be manipulated back into position against the back of the eye.
However, retinal tissues are easily damaged during manipulation.
Current approaches to manipulate and reposition a detached retina
include grasping, squeezing, and manipulating the retina with
internal limiting membrane (ILM) forceps. However, this approach
may concentrate excessive pressure on the retinal tissues. Other
approaches, such as the use of backflush soft tip instruments do
not provide the ability to grasp tissue. Thus, the current
approaches may cause additional damage to the detached retina
during the reattachment process due to the high surface pressure of
such forceps.
[0003] Therefore, there remains a need for an improved systems and
methods for manipulating retinal tissue. The present disclosure is
directed to addressing one or more of the deficiencies in the prior
art.
SUMMARY
[0004] In one exemplary aspect, the present disclosure is directed
to an apparatus for manipulating tissue during a procedure
performed within an eye of a patient. The apparatus includes a
hand-held controller and an elongate member configured to be
inserted into the eye. The elongate member has a proximal end and a
distal end, with the proximal end of the elongate member being
coupled to the hand-held controller. The elongate member also has a
lumen extending through the length of the elongate member. The
apparatus further includes a plurality of flexible grasping fibers
extending through at least a portion of the lumen and beyond the
distal end thereof. The grasping fibers are adjustable by the
controller to advance or retract relative to the elongate member by
altering a distance between distal ends of the grasping fibers and
the distal end of the elongate member.
[0005] In another exemplary aspect, the present disclosure is
directed to an apparatus for manipulating tissue in an eye of a
patient. The apparatus is inserted with minimal invasiveness into
the patient and includes an elongate member configured to be
inserted through a minimally invasive surgical opening in the eye
of the patient. The elongate member has a proximal end, a distal
end, and a lumen extending through the length of the elongate
member. The apparatus further includes a hand-held controller
coupled to the proximal end and a plurality of grasping fibers
extending through at least a portion of the lumen and beyond the
distal end thereof. The plurality of grasping fibers is adjustable
by the hand-held controller to grasp a portion of the tissue by
altering a distance between distal ends of the grasping fibers and
the distal end of the elongate member.
[0006] In another exemplary aspect, the present disclosure is
directed to a method of positioning retinal tissue that has
detached from a back surface of an eye of a patient. The method
includes steps of making an incision in the eye and inserting a
retinal manipulator into the eye through the incision. The retinal
manipulator has two pluralities of grasping fibers at a distal end
thereof. The method further includes grasping a portion of the
retinal tissue that is detached from the back surface of the eye
between the two pluralities of grasping fibers and of maneuvering
the retinal tissue by maneuvering the grasped portion with the
retinal manipulator.
[0007] It is to be understood that both the foregoing general
description and the following drawings and detailed description are
exemplary and explanatory in nature and are intended to provide an
understanding of the present disclosure without limiting the scope
of the present disclosure. In that regard, additional aspects,
features, and advantages of the present disclosure will be apparent
to one skilled in the art from the following.
BRIEF DESCRIPTION OF THE DRAWINGS
[0008] The accompanying drawings illustrate embodiments of the
devices and methods disclosed herein and together with the
description, serve to explain the principles of the present
disclosure.
[0009] FIG. 1 is a cross-sectional illustration of a retinal
manipulator, according to exemplary aspects of the present
disclosure, inserted into an eye.
[0010] FIG. 2A is a cross-sectional illustration of a retinal
manipulator in a closed state according to exemplary aspects of the
present disclosure.
[0011] FIG. 2B is an end view of the retinal manipulator
illustrated in FIG. 2A.
[0012] FIG. 2C is a cross-sectional illustration of the retinal
manipulator of FIGS. 2A and 2B in an open state according to
exemplary aspects of the present disclosure.
[0013] FIG. 2D is an end view of the retinal manipulator as
illustrated in FIG. 2C.
[0014] FIG. 3A is a cross-sectional illustration of an open-state
retinal manipulator in contact with retinal tissue according to
exemplary aspects of the present disclosure.
[0015] FIG. 3B is a cross-sectional illustration of a
grasping-state retinal manipulator in contact with retinal tissue
according to exemplary aspects of the present disclosure.
[0016] FIG. 3C is a cross-sectional illustration of a
grasping-state retinal manipulator in contact with a loose end of
retinal tissue according to exemplary aspects of the present
disclosure.
[0017] FIG. 4A is a cross-sectional illustration of an alternative
retinal manipulator in a closed state according to exemplary
aspects of the present disclosure.
[0018] FIG. 4B is an end view of the alternative retinal
manipulator illustrated in FIG. 4A.
[0019] FIG. 4C is a cross-sectional illustration of the alternative
retinal manipulator of FIGS. 4A and 4B in an open state according
to exemplary aspects of the present disclosure.
[0020] FIG. 4D is an end view of the retinal manipulator as
illustrated in 4C.
[0021] FIG. 5A is a cross-sectional illustration of the alternative
retinal manipulator of FIGS. 4A-D in contact with retinal tissue
according to exemplary aspects of the present disclosure.
[0022] FIG. 5B is a cross-sectional illustration of the retinal
manipulator of FIG. 5A in a grasping state according to exemplary
aspects of the present disclosure.
[0023] FIG. 6 is a cross-sectional illustration of a portion of a
retinal manipulator according to exemplary aspects of the present
disclosure.
[0024] FIG. 7 is a side-view illustration of a plurality of
exemplary distal ends of a grasping fiber according to exemplary
aspects of the present disclosure.
[0025] FIG. 8 is a flowchart of a method of positioning retinal
tissue that has detached from a back surface of an eye according to
exemplary aspects of the present disclosure.
[0026] These figures are better understood by reference to the
following Detailed Description.
DETAILED DESCRIPTION
[0027] For the purposes of promoting an understanding of the
principles of the present disclosure, reference will now be made to
the embodiments illustrated in the drawings and specific language
will be used to describe them. It will nevertheless be understood
that no limitation of the scope of the present disclosure is
intended. Any alterations and further modifications to the
described devices, instruments, methods, and any further
application of the principles of the present disclosure are fully
contemplated as would normally occur to one skilled in the art to
which the present disclosure relates. In particular, it is fully
contemplated that the features, components, and/or steps described
with respect to one embodiment may be combined with the features,
components, and/or steps described with respect to other
embodiments of the present disclosure. For simplicity, in some
instances the same reference numbers are used throughout the
drawings to refer to the same or like parts.
[0028] The present disclosure relates generally to systems and
methods of manipulating delicate tissue such as retinal tissue,
particularly when the tissue is accessed during a minimally
invasive procedure. In some aspects, in order to handle the retinal
tissue in a suitably gentle manner, the grasping pressure on the
tissue is distributed across more than two or three surfaces. As
disclosed herein, a plurality of fingers or fibers is controlled to
provide such a distributed surface for safer grasping of the retina
of a patient. While the example of retinal manipulation is used
throughout this disclosure, the systems and methods may be applied
for the manipulation of other delicate tissues.
[0029] FIG. 1 is a cross-sectional illustration of an eye 100
having a retinal manipulator 120 inserted therein according to
exemplary aspects of the present disclosure. A number of features
of the eye 100 are illustrated herein. The eye 100 includes a
sclera 102 that is coupled to a retinal membrane or retina 104 by a
choroid (not illustrated in FIG. 1). The choroid includes
connective tissue to attach the retina 104 to the inside wall of
the sclera 102 at the back of the eye 100 and to provide oxygen and
nourishment to the outer layers of the retina 104. The retina 102
contains photo-activated cells that transmit signals over an optic
nerve 106 to a brain. A cornea 108 permits light to enter the eye
100, the light being focused by a lens 110.
[0030] As illustrated, the eye 100 includes a pronounced detachment
area 112 in which the retina 104 is detached from the back, inner
wall of the sclera 102. Fluid or vitreous humor may fill an area
between the detached portion of the retina 104 and the sclera 102.
To treat the detachment 112, the detached portion of the retina 104
may be repositioned against the sclera 104. As part of this
process, a vitrectomy procedure may be performed to remove vitreous
humor from the vitreous chamber 114 of the eye 100. After the
retina 104 is properly positioned, it may be reattached naturally
over a period of time.
[0031] Properly repositioning the retina 104 against the sclera 102
may be done by manually grasping the retina 104 and moving it into
the desired position. The retinal manipulator 120 is an apparatus
configured to distribute a grasping force over a larger surface
area so that additional damage to the retina 104 may be avoided
during the effort to reposition it. The retinal manipulator 120 is
introduced into the vitreous chamber 114 through an opening in the
sclera 102 provided by a trocar cannula 122. A distal portion 124
of the manipulator 120 includes a plurality of fingers or grasping
fibers 126 that may be used to securely grasp the retina 104 for
precise positioning. The plurality of grasping fibers 126 may
provide a distributed contact area by which to grasp the retina
104. This may prevent damage that can be caused when small contact
surfaces are used that cause high surface pressure that is
difficult to control, such as may be the case with conventional
forceps. A proximal end of the manipulator 120 includes a hand-held
controller 130. The hand-held controller is configured to provide
for manual or automatic control of the distal portion 124 of the
retinal manipulator. Further detail regarding the manipulator 120
is included below.
[0032] FIG. 2A is a cross-sectional illustration of a retinal
manipulator 120 such as that described in FIG. 1. Only a distal
portion of the manipulator 120 is depicted in FIG. 2A. The
manipulator 120 includes an elongate member illustrated as a tube
202 that contains a plurality of grasping fibers 204 in a lumen
extending at least part way through the tube 202. The tube 202
includes a distal end 206 and a proximal end (not depicted). The
tube 202 and the grasping fibers 204 may not be fixed together.
Rather, the tube 202 may slide away from or toward the exposed
distal ends of the plurality of grasping fibers 204. The relative
positioning of the distal end 206 of the tube 202 and the distal
ends of the grasping fibers 204 may adjust the stiffness of the
grasping fibers 204 and their position and orientation within the
eye of a patient. FIG. 2A illustrates the manipulator 120 in a
"closed" state. In some embodiments, the tube 202 may be about 1.5
inches in length.
[0033] FIG. 2B is an end view of the retinal manipulator 120
illustrated in FIG. 2A. In the illustrated embodiment of FIG. 2B,
the tube 202 has a generally circular cross-section and the
grasping fibers 204 similarly have circular cross-sections. In some
embodiments, other cross-sections may be used. For example, the
tube 202 may have an elliptical cross-section.
[0034] FIG. 2C is a cross-sectional illustration of the retinal
manipulator of FIGS. 2A and 2B in an "open" state according to
exemplary aspects of the present disclosure. Unlike in FIGS. 2A and
2B, the manipulator 120 as illustrated in FIG. 2B is in an open
state, such that the distal ends of all the grasping fibers 204 are
not compressed together. Each of the grasping fibers is formed with
a desired curvature, such that when no force is applied to a
grasping fiber, it exhibits a curved shape or is biased in a curved
shape. That is, its natural shape absent deforming forces is a
curved shape. However, when a force is applied to a grasping fiber,
such as by drawing it into a confined volume, the limits of the
volume may temporarily straighten the grasping fiber. The grasping
fibers 204 are formed such that there is a curved portion at the
distal ends of the fibers 204. When the curved portions at the
distal ends of the grasping fibers 204 are draw into the tube 202,
the fibers 204 are forced into a straight configuration. The curved
portions of the grasping fibers 204 are resilient or elastic such
that the tendency to curve is not eliminated by temporary
positioning of the grasping fibers 204 within the confinement of
the tube 202.
[0035] The grasping fibers 204 include two groups of fibers 204: an
"up" group 204A and a "down" group 204B. As illustrated, the
grasping fibers in the up group 204A are predisposed or preformed
to curve upwards when in their natural shape, while the grasping
fibers in the down group 204B are preformed to curve downwards when
in their natural shape. Thus, the up group 204A and the down group
204B are configured to curve away from each other in opposing
directions. In some aspects, this may be achieved by a difference
in arrangement of the grasping fibers 204 as will be discussed in
more detail below, rather than a difference in fabrication.
[0036] The relative positioning of the tube 202 and the grasping
fibers 204 may determine whether the manipulator 120 is in an open
state or a closed state. A hand-held controller, such as the
hand-held controller 130 of FIG. 1, may be provided to control the
relative positioning as desired. As the distal end 206 of the tube
202 comes closer to the distal ends of the grasping fibers 204, the
manipulator 120 enters a closed state. As the distal ends of the
grasping fibers 204 and the tube 202 move apart, the manipulator
assumes an open state due to the opposite curve directions of the
up group 204A and the down group 204B.
[0037] FIG. 2D is an end view of the retinal manipulator
illustrated in FIGS. 2A, 2B, and 2C. As depicted, in FIG. 2D, the
manipulator 120 is in an open state. When the manipulator 120 is in
an open state, it may be used to grasp delicate tissue as
illustrated in FIGS. 3A and 3B.
[0038] FIG. 3A is a cross-sectional illustration of the retinal
manipulator 120 of FIGS. 2A-D in contact with retinal tissue 302
according to exemplary aspects of the present disclosure. During a
procedure requiring retinal manipulation, the distal end of the
manipulator 120 is carefully maneuvered into contact with the
tissue 302, which has detached from the sclera as described above
in FIG. 1. As illustrated in FIG. 3A, the manipulator 120 is in an
open state, such that the up group 204A and the down group 204B of
the grasping fibers 204 are separated by a separation distance D1
of about 0.2 millimeters to about 1 millimeter.
[0039] FIG. 3B illustrates the retinal manipulator 120 in a
grasping state. When the manipulator 120 is desirably positioned in
contact with the tissue 302, the tube 202 of the manipulator 120 is
moved forward (i.e., distally) relative to the grasping fibers 204.
As the tube 202 moves toward the distal ends of the grasping fibers
204, the tube 202 forces the up group 204A and the down group 204B
closer together. In some embodiments, the grasping fibers may be
moved proximally toward a proximal end of the tube 202. As the
grasping fibers 204 are forced together by the tube 202, the
separation distance decreases as indicated by a smaller separation
distance D2 in FIG. 3B. A section 304 of the tissue 302 is pinched
or grasped between the up group 204A and the down group 204B, such
that manipulation of the tissue 302 may be accomplished by
maneuvering the manipulator 120.
[0040] FIG. 3C also illustrates the retinal manipulator 120 in a
grasping state. FIG. 3C is similar to FIG. 3B in many respects, but
illustrates a different way in which the manipulator 120 may be
used to manipulate the tissue 302. Rather than grasping a section
304 of the tissue 302, the manipulator 120 may be used to grasp and
manipulate a loose end 306 of the tissue 302. The loose end 306 may
be caused by a torn retina. The flexible grasping fibers 204 of the
manipulator 120 may allow a surgeon to grasp the loose end 306
without damaging the tissue 302.
[0041] The grasping state may be achieved when the tube 202 is at a
closest point to the distal ends of the grasping fibers 204, or may
be achieved in a position between a fully closed state and a fully
open state. The grasping fibers 204 may be flexible so that, even
when the manipulator is in a fully closed position a separation
distance D2 is present. This may prevent the section 304 of tissue
302 from being damaged by the manipulator 120 when in a grasping
state. As illustrated, the grasping fibers 204 are formed from a
polymer material, such as polyurethane, nylons, and polypropylene.
In other embodiments the grasping fibers 204 are formed from other
polymers, glass, silicone, metal, a composite, or another suitable
material. Each individual fiber of the grasping fibers 204 may have
an outer diameter ranging from about 0.01 millimeters to about 0.1
millimeters. In general, the higher the elastic modulus of the
material used, the smaller cross-section of the fibers may be. As
illustrated in FIG. 3B, the grasping fibers 204 distribute the
force exerted by the manipulator 120. As depicted, not all of the
fibers 204 are in contact with the tissue 302. However, the fibers
204 may fan out horizontally in response to each other and to the
exerted force as the grasping state is achieved, further increasing
the contact area.
[0042] The stiffness of the grasping fibers may be predictably
altered by varying the distance the grasping fibers extend beyond
the distal end of the tube 202. For example, when the grasping
fibers are fully extended as illustrated in FIG. 3A, the fibers may
be at their most flexible, least stiff configuration. In such an
open or extended state, the manipulator 120 may be suitable for
delicate tasks such as smoothing or flattening wrinkles from the
retinal tissue 302 with minimal adverse impact. Thus, a surgeon may
use the manipulator 120 both to grasp the tissue 302 for larger
scale repositioning of a detached portion of the tissue 302 and for
finer scale smoothing of the tissue 302 once it has been placed
back into contact with the back of the eye.
[0043] FIGS. 4A, 4B, 4C, and 4D illustrate an additional embodiment
of a manipulator that may be used as the retinal manipulator 120 of
FIG. 1. FIG. 4A is a cross-sectional view of a distal portion of a
delicate tissue manipulator 400. The manipulator 400 is similar in
many respects to the manipulator 120 described above, and includes
an elongate member or tube 402 and a plurality of grasping fingers
404. The tube 402 includes a distal end 406 and a proximal end (not
depicted). In the illustrated embodiment, the tube 402 is a metal
tube that has an outer diameter ranging from about 0.4 millimeters
to about 0.9 millimeters. The grasping fibers 404 are configured in
two concentric rings of fibers: a ring of inner fibers 404A and a
ring of outer fibers 404B. Both the inner fibers 404A and the outer
fibers 404B extend through a lumen 408 running through the tube
402. FIG. 4A illustrates the manipulator 400 in a closed state such
that it may not be used for grasping tissue. In some embodiments,
when the manipulator 400 is in a closed state, the grasping fibers
404 may be fully retracted within the tube 402. The grasping fibers
404 may be fully retracted when inserted into the eye. FIG. 4B also
illustrates the manipulator 400 in a closed state, but from an end
view perspective.
[0044] FIGS. 4C and 4D illustrate the manipulator 400 in an open
state such that it can be used to grasp delicate tissue. The
grasping fingers 404, both in inner fibers 404A and the outer
fibers 404B, are configured such that as the distal end 406 of the
tube 402 moves away from distal ends of the fibers 404, each fiber
moves away from a central axis of the tube 402. This may be better
understood with reference to FIG. 4D. As illustrated in the end
view of FIG. 4D, in the open state, the inner fibers 404A and the
outer fibers 404B form circles expanding away from a central axis
of the tube 402. The manipulator 404 may be able to
circumferentially grasp a portion of delicate tissue by which to
manipulate the tissue. The manipulator 120 may provide a
comparatively more bilateral grasp on the tissue.
[0045] FIGS. 5A and 5B illustrate the manipulator 400 in use. In
FIG. 5A, the manipulator is carefully positioned proximate a tissue
502, such as retinal tissue, in an open state, such that a
separation distance D3 is opened and available to grasp a section
504 of the tissue 502. As the distal end 406 of the tube 402 is
moved closer to the distal ends of the fibers 404, the tube 402
forces the fibers 404 closer together, decreasing the separation
distance D3, and grasping the section 504 as illustrated in FIG.
5B. In the grasping state, the manipulator 400 includes a
separation distance D4 between the distal ends of the grasping
fibers 404. As described above, the manipulator 400 grasps
circumferentially, such that the view of FIG. 5B may be
substantially the same from any perspective orthogonal to a central
axis of the tube 402. As described open in connection with the
manipulator 120 in FIGS. 3A and 3B, the manipulator 400 may be used
to reposition the tissue 502 in the open (or extended) state and in
the grasping state.
[0046] FIG. 6 is a cross-sectional illustration of a portion of a
manipulator 600. The manipulator 600 is similar to the manipulator
120 and the manipulator 400 described above. However, the distal
portion of the manipulator 600 is not illustrated in FIG. 6, rather
a more central portion of the manipulator 600 is presented. The
manipulator 600 includes a tube 602, which is similar to the tubes
202 and 402 and has a lumen 604 extending therethrough. Proximal
ends of a plurality grasping fibers 606 are coupled to a slide
block 608 so that the grasping fibers 606 may be moved together as
a single group. In turn, the slide block 608 is coupled to an
attachment line 610 that connects with a controller, such as the
hand-held controller 130 of FIG. 1.
[0047] The controller may be a squeeze-type controller that can
allow a surgeon or technician using the manipulator 600 (or the
manipulators 120 and/or 400) to squeeze the controller to
transition from an open state to a closed state or to a grasping
state having tissue secured by the grasping fibers 606 of the
manipulator 600. As such, in some embodiments, the controller 130
also serves as the handle to the manipulator. Alternatively, the
controller may be a slide-type controller that permits a surgeon to
control the state of the controller by manipulating a sliding
mechanism. As such, the controller may act as a piston or plunger
that advances the slide block 608, causing the grasping fibers to
project relative to the distal end of the tube. In some
embodiments, the attachment line 610 fixes the grasping fibers in
place while the controller is configured to move the tube 602
relative to the grasping fibers. Other controls, both manual, and
automated, are contemplated. Some embodiments include biasing
members, such as spring-actuators, that bias the manipulator 600 to
a position placing the manipulator in an open state.
[0048] The slide block 608 may be formed from plastic, metal, a
composite, or other material, and may be insertably or abuttingly
coupled with the grasping fibers 606. All of the grasping fibers
606 may be formed so that they curve when not constrained by the
tube 602. By selectively arranging and coupling the grasping fibers
606 to the slide block, a desired open state may be achieved. For
example, if a first group of fibers is inserted so that they bend
up when not constrained and a second group of fibers is inserted so
that they bend down when not constrained, the manipulator 600 may
have an open state similar to that depicted in FIGS. 2C and 2D.
Alternatively, the grasping fibers may be inserted into the slide
block 608 so that the manipulator 600 has an open state similar to
that depicted in FIGS. 4C and 4D. To maintain orientation within
the tube 602, the slide block 608 may be cylindrically shaped with
an outer diameter that approximates an inner diameter of the tube
602.
[0049] The attachment line 610 may rigidly couple the slide block
608 to the controller so that the slide block 608 may be
selectively moved forward and backward along a portion of the lumen
604. Additionally, using a manipulator as described herein may
entail using the controller to move the tube 602 relative to the
slide block 608 affixed to a rigid attachment line 610. While the
attachment line 610 is depicted as having a smaller outer diameter
than that of the slide block 608, in some embodiments the outer
diameter of the attachment line 610 may substantially conform to an
inner diameter of the tube 602.
[0050] FIG. 7 is a side-view illustration of a plurality of
exemplary distal ends of individual grasping fibers. The distal
ends depicted in FIG. 7 may be present on the grasping fibers
described above in connection with manipulators 120, 400, and 600.
An exemplary grasping fiber 702 includes a distal end that is
straight. An exemplary grasping fiber 704 has a rounded distal end.
An exemplary grasping fiber 706 includes a textured area 708 at its
distal end. The textured area 708 may provide more adhesion when
grasping delicate tissues. FIG. 7 also includes an exemplary
grasping fiber 710 that includes a hook 712 at its distal end.
While the grasping fibers of a manipulator may be formed from a
variety of materials, fibers like the grasping fiber 710 may be
more easily formed from plastic than glass or metal. Combinations
of the features of grasping fibers 702, 704, 706, and 710 may be
used as well to decrease the pressure needed to securely manipulate
delicate tissues. In some embodiments of a manipulator as described
herein may include more than one type of grasping fiber.
[0051] FIG. 8 is a flowchart of a method 800 of positioning retinal
tissue that has detached from a back surface of an eye of a
patient. As illustrated in FIG. 8, the method 800 includes a
plurality of enumerated steps. Embodiments of the method 800 may
include additional steps before, after, and in between the
enumerated steps. Method 800 begins in step 802 in which a surgeon
makes an incision in the eye, such as the eye 100 of FIG. 1 and
performs any needed surgical processes, such as a vitrectomy
process. In step 804, the surgeon inserts a retinal manipulator
into the eye of the patient through the incision. The retinal
manipulator inserted in step 804 may be similar in shape and
function to the manipulator 120 of FIGS. 1, 2A-D, and 3A-B or the
manipulator 400 of FIGS. 4A-D and 5A-B. Before inserting the
manipulator into the eye, the surgeon may fully retract the
plurality of grasping fibers into the tube of the manipulator as
described above.
[0052] In step 806, the surgeon grasps a portion of the detached
retinal tissue using the plurality of grasping fibers as included
in the manipulator 120 or the manipulator 400. In step 808, the
surgeon maneuvers the retinal tissue into a desired position by
maneuvering a proximal end of the retinal manipulator. This may
largely alter the general position of the retinal tissue. The
surgeon may additionally use the plurality of grasping fibers in an
extended or open state, thereby making the grasping fibers less
stiff, to smooth wrinkles from the retinal tissue or otherwise
provide finer scale positioning.
[0053] The systems and methods disclosed herein may be used to
reposition delicate tissues, such as retinal tissue, within a
patient. This may result in more desirable positioning and also may
result in less damage to the tissue resulting from the
repositioning process. A single apparatus may be used for larger
scale movements and finer scale movements of the tissue. This may
improve the efficiency and efficacy of procedures performed with
these systems and methods.
[0054] Persons of ordinary skill in the art will appreciate that
the embodiments encompassed by the present disclosure are not
limited to the particular exemplary embodiments described above. In
that regard, although illustrative embodiments have been shown and
described, a wide range of modification, change, combination, and
substitution is contemplated in the foregoing disclosure. It is
understood that such variations may be made to the foregoing
without departing from the scope of the present disclosure.
Accordingly, it is appropriate that the appended claims be
construed broadly and in a manner consistent with the present
disclosure.
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