U.S. patent application number 14/619982 was filed with the patent office on 2015-06-04 for reciprocating rotary arthroscopic surgical instrument.
The applicant listed for this patent is Smith & Nephew, Inc.. Invention is credited to Roger R. Cassidy, JR., Peter M. Cesarini, Karen Drucker, Rafal Jezierski.
Application Number | 20150150576 14/619982 |
Document ID | / |
Family ID | 25530108 |
Filed Date | 2015-06-04 |
United States Patent
Application |
20150150576 |
Kind Code |
A1 |
Cesarini; Peter M. ; et
al. |
June 4, 2015 |
RECIPROCATING ROTARY ARTHROSCOPIC SURGICAL INSTRUMENT
Abstract
A surgical instrument includes a cutting member with an
implement for cutting tissue, and a drive coupled to the cutting
member to simultaneously rotate and translate the cutting member in
response to a force applied to the drive. A method of cutting
tissue includes positioning an outer member such that tissue is
located within the outer member, engaging the tissue with an inner
member, and simultaneously rotating and translating the inner
member to cut the tissue. A tangential cutting force is applied to
the tissue with the inner member to mechanically cut the tissue.
The inner member is mechanically driven to undergo simultaneous
rotation and translation.
Inventors: |
Cesarini; Peter M.;
(Londonderry, NH) ; Drucker; Karen; (Stoneham,
MA) ; Jezierski; Rafal; (Boston, MA) ;
Cassidy, JR.; Roger R.; (Methuen, MA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Smith & Nephew, Inc. |
Memphis |
TN |
US |
|
|
Family ID: |
25530108 |
Appl. No.: |
14/619982 |
Filed: |
February 11, 2015 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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14161234 |
Jan 22, 2014 |
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14619982 |
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13051257 |
Mar 18, 2011 |
8663264 |
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14161234 |
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11734674 |
Apr 12, 2007 |
7922737 |
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13051257 |
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09983810 |
Oct 26, 2001 |
7226459 |
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11734674 |
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Current U.S.
Class: |
606/171 |
Current CPC
Class: |
A61B 17/320758 20130101;
A61B 18/148 20130101; A61B 2017/320032 20130101; A61B 17/32002
20130101; A61B 2017/320028 20130101; A61B 17/320016 20130101; A61B
2017/2913 20130101; A61B 2217/005 20130101 |
International
Class: |
A61B 17/32 20060101
A61B017/32 |
Claims
1. (canceled)
2. A surgical instrument, comprising: a cutting member having a
cutting edge and being configured to rotate about a longitudinal
axis and linearly advance generally along the longitudinal axis; an
outer tubular member, the cutting member being received within the
outer tubular member, the outer tubular member including a cutting
window disposed proximate to a tip of the outer tubular member, the
cutting window having a proximal end and distal end separated by a
first length along the longitudinal axis; a drive coupled to the
cutting member, the drive including a drive member having a helical
groove, the helical groove having a second length along the
longitudinal axis that is longer than the first length such that
(i) the drive is configured to rotate, linearly advance, and
reciprocate the cutting member in response to a rotational force
applied to the drive in a single direction and (ii) advance the
cutting edge beyond the distal end of the cutting window.
3. The surgical instrument of claim 2, wherein cutting member is
configured to be placed tangentially against targeted tissue such
that the cutting edge of the cutting member is configured to shear
the targeted tissue.
4. The surgical instrument of claim 3, wherein the cutting member
shears the targeted tissue during simultaneous rotation and linear
advancing of the cutting member towards the distal end of the
cutting window.
5. The surgical instrument of claim 4, wherein the cutting member
is configured to not cut tissue during reciprocation of the cutting
member.
6. The surgical instrument of claim 2, wherein the cutting member
is configured to cut tissue only during simultaneous rotation and
linear advancing of the cutting member and not during simultaneous
rotation and reciprocation of the cutting member.
7. The surgical instrument of claim 2, wherein drive member is
directly coupled to the cutting member.
8. The surgical instrument of claim 2, wherein the drive further
includes a translation piece.
9. The surgical instrument of claim 8, wherein the translation
piece is disposed in the helical groove of the drive member such
that rotation of the drive member causes the cutting member to
linearly advance.
10. The surgical instrument of claim 2, wherein the helical groove
makes at least two revolutions around the drive member and is
configured to cause the cutting member to linearly advance in a
first direction, directly from a first location to a second
location, along an axis of the cutting member while the drive
member completes at least two full rotations.
11. The surgical instrument of claim 2, wherein the helical groove
comprises a left-hand threaded helical channel and a right-hand
threaded helical channel, the left-hand threaded helical channel
and the right-hand threaded helical channel being blended together
at their ends to form a continuous groove such that there is a
smooth transition from the left-hand threaded helical channel to
the right-hand threaded helical channel.
Description
CROSS REFERENCE TO RELATED APPLICATION
[0001] This application is a continuation of U.S. patent
application Ser. No. 11/734,674, filed Apr. 12, 2007, now allowed,
which is a continuation of U.S. application Ser. No. 09/983,810,
filed Oct. 26, 2001, now U.S. Pat. No. 7,226,459. The prior
applications are incorporated herein by reference in their
entirety.
TECHNICAL HELD
[0002] This invention relates to rotary cutting surgical
instruments, and more particularly, to a reciprocating rotary
surgical instrument for cutting semi-rigid tissue.
BACKGROUND
[0003] Conventional arthroscopic surgical instruments generally
include an outer tube and an inner member that rotates or
translates axially within the outer tube. The outer tube and inner
member may interact to create shear forces that cut tissue. This
type of cutting is generally used to cut soft tissue, such as
muscle, ligaments, and tendons.
SUMMARY
[0004] In one aspect, a surgical instrument includes a cutting
member with an implement for cutting tissue, and a drive coupled to
the cutting member to simultaneously rotate and translate the
cutting member in response to a force applied to the drive.
[0005] One or more of the following features may be included in the
surgical instrument. The drive is configured such that the cutting
member reciprocates. The drive includes a drive member attached to
the cutting member. The drive member includes a helical groove. The
drive includes a translation piece disposed in the groove such that
rotary driving of the drive member results in simultaneous
reciprocation of the drive member relative to the translation
piece.
[0006] In the illustrated embodiment, the drive includes an inner
drive hub coupled to the drive member. The inner drive hub defines
a slot and the drive member includes a key received in the slot
rotary coupling the drive member to the inner drive hub such that
the drive member rotates with the inner drive hub while being free
to translate relative to the inner drive hub. The helical groove
includes a left-hand threaded helical channel. The helical groove
includes a right-hand threaded helical channel. The cutting member
is attached to the drive member to move rotatably and axially with
the member.
[0007] The implement is a chamfered cutting edge at a distal end of
the cutting member. The chamfered edge is a straight cutting edge.
Alternatively, the chamfered edge is an angled cutting edge.
[0008] The instrument includes an outer tubular member. The cutting
member is received within the outer member. The outer member
includes a cutting window disposed proximate to a tip of the outer
member. The cutting window is an opening in the outer member
exposing the cutting member to tissue. The cutting window has a
U-shaped proximal end and a saddle-shaped distal end. The
saddle-shaped distal end of the cutting window includes a hook.
[0009] The translation piece includes a follower received within
the groove and a sealing cap over the follower. The follower is
free to swivel relative to the sealing cap. The follower has an
arched bridge shape. The translation piece is coupled to the drive
member such that the translation piece is disposed in the helical
groove and swivels to follow the helical groove as the drive member
rotates.
[0010] In another aspect, a method of cutting tissue includes
positioning an outer member such that tissue is located within the
outer member, engaging the tissue with an inner member received
within the outer member, and simultaneously rotating and
translating the inner member to cut the tissue. One or more of the
following features may be included. The translating is
reciprocating. The outer member is oriented tangentially to the
tissue.
[0011] In another aspect, a method of cutting tissue includes
providing a surgical instrument having an outer member and an inner
member received within the outer member for movement relative to
the outer member, and applying a tangential cutting force to the
tissue with the inner member to mechanically cut the tissue.
[0012] In another aspect, a method of cutting tissue includes
applying a tangential cutting force to tissue with a member, and
mechanically driving the member to undergo simultaneous rotation
and translation. The method may include that the translation is
reciprocation.
[0013] The cutting edge of conventional arthroscopic surgical
instruments, such as rotary shears, have difficulty initiating a
cut into semi-rigid tissue tend to bounce away from the tissue.
Toothed edge geometry somewhat ameliorates this problem because the
"teeth" attempt to pierce the tissue to initiate a cut. However,
the efficiency of using "teeth" is limited and the limitations are
more evident when cutting large volumes of semi-rigid tissue, such
as meniscus or intrauterine fibroid tissue. The simultaneous
rotating and reciprocating inner member of the surgical instrument
of the invention overcomes these difficulties. The tangential
approach to the tissue in the method of the invention limits the
tendency of the instrument to bounce away from the tissue. In
particular, the instrument and method provide a higher resection
rate to shorten procedure length, during, e.g., fibroid and polyp
resection.
[0014] The details of one or more implementations are set forth in
the accompanying drawings and the description below. Other features
will be apparent from the description and drawings, and from the
claims.
DESCRIPTION OF DRAWINGS
[0015] FIG. 1A is a side view and 1B is a cross-sectional view
taken along 1B-1B in FIG. 1A of a reciprocating rotary surgical
instrument.
[0016] FIG. 2A is a top view, FIG. 2B is a cross-sectional view
taken along 2B-2B in FIG. 2A, FIG. 2C is a distal end view, and
FIG. 2D is a proximal end view of the inner drive hub of the
reciprocating rotary surgical instrument of FIG. 1.
[0017] FIG. 3A is a top view, FIG. 3B is a side view, FIG. 3C is a
cross-sectional view taken along 3C-3C in FIG. 3A, and FIG. 3D is a
proximal end view of the helical member of the reciprocating rotary
surgical instrument of FIG. 1.
[0018] FIG. 4A is a top view, FIG. 4B is a cross-sectional view
taken along 4B-4B in FIG. 4A, and FIG. 4C is a distal end of the
outer hub of the reciprocating rotary surgical instrument of
[0019] FIG. 5A is an exploded view, FIG. 5B is a partial cutaway
view, and FIGS. 5C and 5D are side views of the translation piece
and the helical member of the surgical instrument of FIG. 1.
[0020] FIG. 6A is a side view, FIG. 6B is a cross-sectional view
taken along 6B-6B in FIG. 6A, and FIG. 6C is a top view of the
follower of the translation piece of the reciprocating rotary
surgical instrument of FIG. 1.
[0021] FIG. 7A is a top view and FIG. 7B is a cross-sectional view
taken along 7B-7B of FIG. 7A of the cap for the follower of the
translation piece of the reciprocating rotary surgical instrument
of FIG. 1.
[0022] FIG. 8A is a top view and FIG. 8B is a side view of the
outer member of the reciprocating rotary surgical instrument of
FIG. 1.
[0023] FIG. 9 is a side view of the inner member of the
reciprocating rotary surgical instrument of FIG. 1.
[0024] FIG. 10 illustrates a reciprocating rotary surgical
instrument of FIG. 1 in use to cut tissue.
[0025] FIG. 11 is a side view of an alternate implementation of the
inner member o reciprocating surgical instrument.
[0026] Like reference symbols in the various drawings indicate like
elements.
DETAILED DESCRIPTION
[0027] As shown in FIGS. 1A and 1B, a cutting device 100 includes a
driving end 110 and a cutting end 190. The driving end 110 is
located at the proximal end of the cutting device 100. The cutting
end 190 is located at the distal end of the cutting device 100. At
the driving end 110, there is an inner drive hub 130 with a drive
coupler 120, and an outer hub 140. The drive coupler 120 mounts
into a rotary driver (not shown), which turns the drive coupler 120
causing a helical member 150 and the inner drive hub 130 to rotate.
For instance, the rotary driver is Dyonics Power Handpiece, No.
725355. The inner drive hub 130 with the drive coupler 120 is, for
example, a component of Smith & Nephew disposable arthroscopic
surgical instrument, No. 7205306. The helical member 150 is located
within the inner drive hub 120 and the outer hub 140. The helical
member 150 and a translation piece 145 are coupled together such
that rotation of the helical member 150 causes linear translation
of the helical member 150, as described further below.
[0028] The cutting device 100 includes an elongated inner member
185 and an elongated outer member 186, as shown in FIG. 1B. The
inner member 185 is tubular with a hollow interior 184. The inner
member 185 is fixed to the helical member 150 for axial and rotary
motion therewith.
[0029] The outer member 186 is also tubular with a hollow interior
187. The inner member 185 is received inside the outer member 186.
The outer member 186 is fixed to the outer hub 140 and does not
move. The outer member 186 includes a tip 188, which is blunt,
i.e., the corners are rounded. At the cutting end 190, the outer
member 186 defines a cutting window 170 through a wall 186a of the
outer member 186.
[0030] Referring to FIGS. 2A-2D, the inner drive hub 130 includes
the drive coupler 120, a lumen 136, an aspiration opening 132, and
a slot 134. The drive coupler 120 extends from the proximal end of
the inner drive hub 130 and mounts in the rotary driver. Debris
from the cutting end 190 of the cutting device 100 is aspirated
through the aspiration opening 132. The slot 134 is disposed in a
wall 131 of the inner drive hub 130. The slot 134 is like a track
along one side of the inner drive hub 130. The slot 134 of the
inner drive hub 130 is coupled with a key 152 of the helical member
150 (see FIG. 4B) so that rotation of the inner drive hub 130
causes the helical member 1150 to rotate while allowing the helical
member 150 to move axially relative to the inner drive hub 130,
e.g., the key 152 axially slides along the slot 134.
[0031] Referring to FIGS. 3A-3D, the helical member 150 of the
cutting device 100 is formed of a lubricious material in a tubular
shape with a through lumen 159. The inner member 185 is disposed
within the helical member 150 and fixed therein, for example, by
epoxy, injection-molded, or over-molded plastic.
[0032] The helical member 150 includes the key 152 and two helical
channels 156, 158 disposed thereon. As shown in FIG. 3B, the key
152 is shaped like a fin and is located at the proximal end of the
helical member 150. The key 152 mates with the slot 134 of the
inner drive hub 130.
[0033] The two helical channels 156, 158 are disposed on a distal
portion of the exterior surface of the helical member 150. One
helical channel 156 is right-hand threaded; the other helical
channel 158 is left-hand threaded. The pitch of the helical
channels may be different or the same. The length of the distal
portion of the helical member 150 with helical channels 156, 158 is
longer than the length of the cutting window 170. The helical
channels 156, 158 are smoothly blended together at their ends to
form a continuous groove so that there is a smooth transition from
one helical channel to the other helical channel at each end of the
distal portion of the helical member 150.
[0034] The helical member 150 and the inner drive hub 130 are
mechanically driven by the rotary driver. The helical member 150
also moves in an axial direction, e.g., reciprocates, as a result
of the interaction of the translation piece 145 with the helical
channels 156, 158, as described below.
[0035] Referring to FIGS. 4A-4C, the outer hub 140 of the cutting
device 100 is formed of hard plastic and does not move. An example
of an outer hub is a component of Smith & Nephew disposable
arthroscopic surgical instrument, No. 7205306, modified with a
cutout 144 for receiving the translation piece 145. The cutout 144
is disposed within a wall of the outer hub 140, for example,
centrally, as in FIG. 4B, and aligned with the helical member. The
translation piece 145 is located in the cutout 144 of the outer hub
140.
[0036] As shown in FIG. 1B, the outer member 186 is disposed within
the outer hub 140 and fixed therein by a coupling 144 using, for
example, epoxy, glue, insert molding, or spin-welding.
[0037] Referring to FIG. 5A, the translation piece 145 includes a
follower 145a and a cap 145b. Having the two helical channels 156,
158 in conjunction with the slot/key 134, 152 coupling of the inner
drive hub 130 and the helical member 150, the rotary driver only
needs to rotate in one direction and does not require reversal of
the rotational direction upon the translation piece 145 reaching
the end of one of the helical channels 156, 158.
[0038] Referring to FIGS. 6A-6C, the follower 145a includes a
cylindrical head 145a1 and two legs 145a2. As shown in FIGS. 5B-5D,
the legs 145a2 form an arch and rest in the channels of the double
helix 156, 158 formed in the distal portion of the exterior surface
of the helical member 150. The arch of the legs 145a2 is
dimensionally related to the diameter described by the helical
channels 156, 158 of the helical member 150.
[0039] Referring particularly to FIGS. 5C and 5D, as the helical
member 150 and the inner drive hub 130 are mechanically driven by
the rotary driver (not shown), the follower 145a follows the
helical channels 156, 158, swiveling as the follower 145a smoothly
transitions from helical channel to helical channel 156,158 at the
ends of the distal portion of the helical member 150 having the
helical channels 156, 158. The coupling of the follower 145a to the
helical channels 156, 158 causes the helical member 150 to also
translate. Thus, the inner member 185 simultaneously rotates and
reciprocates to cut the tissue.
[0040] Referring to FIGS. 7A and 7B, the cap 145b of the
translation piece 145 covers the follower 145a to provide a seal to
allow sufficient suction to remove aspirated debris. Also, the cap
145b is a separate piece from the follower 145a in order to allow
the follower 145b to swivel.
[0041] As shown in FIGS. 8A and 89, the outer member cutting window
170 has a generally oblong shape. The proximal end 172 of the
cutting window 170 is U-shaped and the distal end 173 has a saddle
shape that forms a hook 174. The distal end 173 is chamfered to
provide a sharp edge. The hook 174 pierces the targeted tissue to
hold the tissue as the inner member 185 cuts. Also, the shape of
the cutting window 170 eliminates galling between the inner and
outer members 185, 186, and dulling of the cutting edge of the
inner member 185.
[0042] The cutting window 170 is disposed proximate to the tip 188
of the outer member 186. The cutting window 170 exposes the inner
member 185 over a length
[0043] FIG. 9 shows that the inner member 185 is generally tubular
with hollow interior 187. Aspiration of debris occurs through the
hollow interior 187 of the inner member 185, and through the lumen
of the helical member to the aspiration opening 132 of the inner
drive hub 130. The distal end 183 of the inner member 185 is
chamfered to a sharp edge 187 for cutting. The inner member 185
simultaneously rotates about its axis and translates along its axis
to cut tissue. The cutting surface of the distal end 183 of the
inner member 185 shears the tissue. For example, referring to 10,
the cutting device 100 is placed tangentially against the targeted
tissue such that the cutting window 170 exposes the inner member
185 to the tissue. As the inner member 185 rotates and translates,
as shown by the arrows, the tissue within the cutting window
catches on the hook 174 to initiate the cut and then the cutting
edge 183 of the inner member 185 shears the tissue as the inner
member 185 advances to cut the tissue. The cut is completed as the
cutting edge 183 of the inner member 185 advances beyond the hook
174 of the cutting window 170 within the outer member 186.
[0044] FIG. 11 shows an alternative implementation of the inner
member. The distal end 283 of the inner member 285 may be angled to
a chamfered point so that the cut in the targeted tissue is
initiated on one side and then extends across the width of the
tissue. Similarly, when the cutting device is placed tangentially
against the targeted tissue, the rotating and translating inner
member 285 shears the tissue to be cut.
[0045] A number of implementations have been described.
Nevertheless, it will be understood that various modifications may
be made. For example, instead of a double helical channel, the
helical member may include a single helical channel with a
retractable follower and spring, or possibly, attraction and
repelling forces of magnets or a solenoid could enable the rotating
and reciprocating movements. Also, alternatively, the inner and
outer members may have a cross-sectional shape other than circular.
Additionally, the shape of the hook of the outer member may be
modified in order to improve grasping of the tissue or grasping a
larger volume of tissue. Accordingly, other implementations are
within the scope of the following claims.
* * * * *