U.S. patent application number 15/025168 was filed with the patent office on 2016-08-18 for tissue incision device and method.
The applicant listed for this patent is RELEASE MEDICAL, INC.. Invention is credited to Treg Brown, Nathaniel Cohen, Robert Fernandez, Steven S. Golden.
Application Number | 20160235431 15/025168 |
Document ID | / |
Family ID | 52744541 |
Filed Date | 2016-08-18 |
United States Patent
Application |
20160235431 |
Kind Code |
A1 |
Brown; Treg ; et
al. |
August 18, 2016 |
TISSUE INCISION DEVICE AND METHOD
Abstract
A minimally invasive tissue incision system for creating joint
capsulotomies and releasing/incising various tendon and fibrous
band structures. The system contains a penetrating needle which is
retractable so as to expose a cutting element, and which may be
used as a penetrating needle to pierce the skin and other soft
tissue structures. The cutting element provided within the
penetrating needle may be used to incise subsequent tissue
structures after the initial penetration. The system facilitates
such procedures by providing the cutting element with the confines
of the needle which provides safe introduction of the cutting
element directly to the site via the needle.
Inventors: |
Brown; Treg; (Carbondale,
IL) ; Golden; Steven S.; (Menlo Park, CA) ;
Fernandez; Robert; (Campbell, CA) ; Cohen;
Nathaniel; (Los Gatos, CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
RELEASE MEDICAL, INC. |
Campbell |
CA |
US |
|
|
Family ID: |
52744541 |
Appl. No.: |
15/025168 |
Filed: |
September 26, 2014 |
PCT Filed: |
September 26, 2014 |
PCT NO: |
PCT/US14/57857 |
371 Date: |
March 25, 2016 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
61883861 |
Sep 27, 2013 |
|
|
|
61912439 |
Dec 5, 2013 |
|
|
|
Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 17/3421 20130101;
A61B 18/1233 20130101; A61B 10/0275 20130101; A61B 2018/00601
20130101; A61B 18/148 20130101; A61B 2017/320004 20130101; A61B
17/3472 20130101; A61B 2218/002 20130101; A61B 18/1477 20130101;
A61B 2017/320008 20130101; A61B 17/320016 20130101; A61B 17/32002
20130101; A61B 17/3496 20130101 |
International
Class: |
A61B 17/32 20060101
A61B017/32; A61B 17/34 20060101 A61B017/34; A61B 18/14 20060101
A61B018/14 |
Claims
1. A method of incising tissue in medical procedure comprising:
inserting a needle through the skin and subcutaneous tissue layers
of a human or animal, positioning the needle tip near a secondary
tissue structure to be incised, retracting the needle to expose a
cutting element, and manipulating the cutting element to incise the
tissue structure.
2. The method of claim 1 where in the incised tissue structure is a
joint capsule.
3. The method of claim 1 wherein the incised tissue structure is a
ligament or fibrous band of tissue.
4. The method of claim 1 wherein the initial needle penetration
does not require a skin incision with another instrument.
5. The method of claim 1 wherein the retraction of the needle
utilizes a spring element.
6. The method of claim 1, wherein the cutting element is slidably
received within the needle, and retracting the needle comprises
movement of the needle proximally relative to the cutting
element.
7.-11. (canceled)
12. A device for incising tissue in the human body, comprising: a
tissue-penetrating needle, the needle comprising a distal end, and
a lumen extending along a length of the needle, a cutting element
slidingly received within the lumen needle, and a mechanism for
moving the needle relative to the cutting element.
13. The device of claim 12 wherein the cutting element is arranged
such that it extends orthogonally to the axis of the needle.
14. The device of claim 12 wherein the cutting element has multiple
cutting edges.
15. The device of claim 12 wherein the cutting element has
serrations.
16. The device of claim 12 wherein the needle moves linearly along
the length of an axis of the cutting element.
17. The device of claim 12 wherein the needle moves rotationally
relative to the cutting element.
18. The device of claim 12 wherein the cutting element is mounted
to a stylet.
19. The device of claim 18 wherein the stylet is designed to
occlude the lumen of the needle.
20. The device of claim 12 further comprising an injector for
injecting fluids through the lumen of the needle.
21. The device of claim 12 further comprising an electrosurgical
generator connected to the device.
22. The device of claim 12 further comprising a nerve stimulation
generator and monitoring device connected to the needle.
23.-28. (canceled)
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims priority from and the benefit of
U.S. Patent Application No. 61/883,861, titled "TISSUE INCISION
APPARATUS AND METHOD" filed Sep. 27, 2013 (Attorney Docket No.
96077-889592 (000110US)), and U.S. Patent Application No.
61/912,439, titled "TISSUE INCISION DEVICE" filed Dec. 5, 2013
(Attorney Docket No. 96077-894996 (000120US)).
BACKGROUND
[0002] There is an ever-increasing demand for more minimally
invasive surgical techniques. The lower morbidity seen in
percutaneous, endoscopic and arthroscopic surgery makes these
techniques very appealing to both patients and physicians. These
technologically advanced procedures include many forms of tissue
incision at all points during the procedure. Procedures such as
arthroscopic rotator cuff and labral repair, hip arthroscopy, and
knee and elbow arthroscopy utilize incisions at the both the skin
level and deeper-lying tissue structures. Other procedures, known
generally known as "release" procedures utilize a skin incision as
well as a subsequent incision in a fibrous band of tissue in order
to "release" the fibrous band of tissue or allow it more freedom to
move. These procedures are commonly performed by a physician in an
open setting, but increasingly performed in an arthroscopic (i.e.,
with use of a tiny camera) setting and even performed
percutaneously with only a needle penetration at the skin level.
These percutaneous procedures typically require some type of visual
guidance, such as endoscopy or ultrasound in order to reduce risk
and assure good results. Such procedures may include plantar fascia
release, carpal tunnel release, or illeotibial band release.
[0003] Because most of these procedures involve the extremities
(hands, feet, arms, etc.), it is desirable to make the smallest
possible incision at the skin level to minimize soft tissue damage
and scarring as well as speed the healing process. This presents a
great challenge regarding the size of the instrumentation used and
size of the visualization systems. Typically these procedures
require multiple instruments which are often switched-out with
other instruments to perform the wide variety of functions. As in
the case of arthroscopic joint procedures, the fibrous capsule
surrounding the joint must be penetrated and opened (called a
capsulotomy). This is currently done via a series of steps starting
with a small gage needle (e.g., a spinal needle). Fluoroscopy is
used to visualize the needle placement into the joint space. The
needle must then be withdrawn and a scalpel blade inserted,
sometimes blind, to further open the capsule. It can be problematic
to achieve the same path through the tissue with the secondary
blade, resulting in unnecessary tissue damage and procedure time. A
guide pin is often used and devices such as Sluss US2011/0087250
are designed with a secondary lumen to slide over the guide pin and
subsequently cut tissue but this presents the logistical issue of
multiple exchanges, which adds time and complexity to the
procedure. Other devices such as McCormack U.S. Pat. No. 8,753,364
are specifically designed to cut ligaments (e.g. carpal ligament)
in a minimally invasive fashion using a serrated saw-type
instrument, but do not allow for direct penetration of the skin and
underlying tissue via an integral needle
[0004] Currently a solution does not exist which provides cutting
capability within a small bore hypodermic needle.
[0005] The following references may be relevant to this
technology:
TABLE-US-00001 Agee 5,306,284 Abidin 5,275,606 Aikins 4,491,132
Assell 7,799,032 Auchter 8,256,331 Auchter 8,256,330 Al-Laban
6,224,574 Bartlett 5,441,502 Battenfield 5,730,749 Berberich
8,088,136 Bleich 7,553,307 Brown 5,323,765 Capuano 4,790,312 Chow
5,029,573 Chow 5,356,419 Conlon 8,328,836 Deal 2008/0091196
DiMatteo 5,334,214 Duperier 2012/0221032 Eaton 5,234,436 Eaton
5,312,413 Flatland 8,485,988 Flynn 8,377,086 Freiberg 6,270,501
Garcia 2003/0097079 Ginsberg 3,347,232 Gonzales 6,974,476 Green
5,569,283 Heppler 2004/0181246 Heppler 2012/0226299 Huang
2012/0029542 Kermode 5,769,865 Kilburn-Peterson 2014/0031865
Kilburn-Peterson 8,523,903 Lee 8,257,379 Liu CN201211201 McClure
3,007,471 McKormack 8,348,966 McKormack 2013/0110146 Menon
5,273,024 Mesa 5,254,128 Mirza 5,366,465 Mohizea 8,403,863 Muto
2012/0232571 Muto 2009/0157110 Newman 2002/0143352 Nobis
2007/0250057 Ochiai 2012/0157999 Oretorp 4,444,184 Park
2009/0312782 Pierce 5,620,454 Pilo WO 96/35380 Putnam 5,334,214
Rehnke 7,780,690 Rehnke 2011/0046652 Rubinstein 5,462,062 Sartor
8,460,289 Seipel 2011/0087260 Sergio 6,685,717 Shaolian 7,641,658
Sluss 2011/0087258 Strickland 6,179,852 Strickland 8,273,098 Suzuki
6,068,603 Urata 4,642,090 Weiss 6,019,774 Weiss 2009/0048620
Wellborn 7,918,784 Wijay 2012/0239070
BRIEF SUMMARY
[0006] The following presents a simplified summary of some
embodiments of the invention in order to provide a basic
understanding of the invention. This summary is not an extensive
overview of the invention. It is not intended to identify
key/critical elements of the invention or to delineate the scope of
the invention. Its sole purpose is to present some embodiments of
the invention in a simplified form as a prelude to the more
detailed description that is presented later.
[0007] Embodiments proposed herein solve the above issues by
providing a minimally invasive tissue incision system (referred to
at points herein as a "needle-knife") having a tissue cutting
mechanism within a penetrating needle. The penetrating needle is
used to initiate a procedure. With such a device, a capsulotomy may
be created without the need for withdrawing the needle, thus
reducing the risk associated with bladed instrument exchanges.
[0008] In release-type procedures, a fibrous tissue band generally
requires incising in order to restore some functionality. While
sometimes performed arthroscopically (with a camera), these
procedures are also performed with the use of ultrasound guidance.
Ultrasound guidance provides the advantage of not requiring a
camera (and associated cannula) to be inserted into the working
space since the ultrasound probe resides outside the patient. In
these procedures, ultrasound is used to visualize the needle
penetration to the desired location. A cutting or debriding tool
may then directly placed or inserted via the needle lumen to incise
the fibrous tissue band. In accordance with embodiments described
herein, the proposed needle-knife facilitates such procedures by
providing the cutting element within the confines of the needle,
which provides safe introduction of the cutting element directly to
the site via the needle.
[0009] An issue encountered during laparoscopic surgery is the need
for an additional cutting instrument in the field without adding an
additional laparoscopic port. Adding a laparoscopic port can be
costly and take more time. More importantly however, adding an
additional port is more invasive, typically requiring a skin
incision of between 5 mm and 12 mm. In accordance with embodiments
described herein, when the needle-knife is used instead of adding
another laparoscopic port, it may be possible to avoid an
additional incision since only the needle (2 mm diameter)
penetration is required. The necessity of stitching another
incision closed at the end of the procedure is also avoided.
[0010] The minimally invasive tissue incision system in accordance
with embodiments herein may be used as a penetrating needle to
pierce the skin and other soft tissue structures. A cutting
mechanism is provided within the penetrating needle which may be
used to incise subsequent tissue structures after the initial
penetration.
[0011] In embodiments, the cutting element may be disposed at the
end of a stylet coaxially disposed within the lumen of the needle.
The cutting element/stylet is slideable within the needle and may
be completely removable from the primary needle assembly so as to
allow other instruments or fluids to be passed down the lumen of
the needle. A luer fitting is preferably situated at the proximal
end of the device to facilitate connection of the stylet and/or
ancillary devices. The penetrating needle, being coaxially
slideable about the stylet/cutting element, may be configured with
a slider so as to facilitate retraction of the needle relative to
the stylet/cutting element. Said retraction of the needle exposes
the cutting element at the distal tip of the needle thus allowing
tissue to be incised via movement of the entire assembly. The
needle may be further configured with a spring mechanism so as to
facilitate the needle's retraction relative to the stylet/cutting
element.
[0012] In embodiments, the stylet may be configured such that the
distal most portion occludes the distal lumen of the needle so as
to prevent tissue or other debris from becoming lodged within the
needle lumen. In this configuration, the cutting element is
situated just proximal of the occluding portion, which is
preferably a relatively thin section, like a plate.
[0013] In further embodiments, the penetrating needle may have a
window situated just proximal to the distal needle tip. Coaxially
and rotatably situated within the penetrating needle is a second,
inner tubular structure with a window opposite that of the window
on the needle. The stylet/cutting element resides within the inner
tubular structure. When the window on the inner tube is rotated to
align with the window on the outer needle, the cutting element is
exposed, thus allowing tissue to be incised via movement of the
entire assembly. The inner tubular structure may be configured with
a rotator knob at the proximal end so as to facilitate rotation of
the tube to align the windows and expose the cutting element.
[0014] In embodiments, the proximal end of the device may be
configured as a slender hub, similar to that of a typical spinal
needle. This configuration facilitates fingertip control. In other
embodiments, the proximal end of the device may be configured into
a larger handle, meant to be grasped or gripped in the palm of the
hand.
[0015] In additional embodiments, a method of performing a joint
capsulotomy is disclosed. The method involves the acts of: 1.)
inserting the needle-knife into the joint space; 2.) retracting the
needle component of the needle-knife a specified distance so as to
expose a cutting element; and 3.) completing the capsulotomy with
the cutting element of the needle-knife. Further acts of the method
may include: 4.) removing the stylet/cutting element from the
needle-knife and inserting a guide wire/pin through the lumen of
the needle to facilitate insertion of other instrumentation.
[0016] In other embodiments, methods for performing various
"release" procedures are disclosed. These methods involve the acts
of: 1.) percutaneous insertion of the needle-knife into the region
containing fibrous band to be released; 2.) retracting the needle
component to expose the cutting blade; 3.) using the exposed blade
to incise the fibrous band thus providing "release;" and 4.)
extending the needle (reverse of act 2) to cover or sheath the
cutting blade and removing the assemble from the tissue.
[0017] For a more comprehensive understanding of the nature and
advantages of the present invention, reference should be made to
the ensuing detailed description and accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
[0018] FIG. 1 is a perspective view of a needle-knife device with a
needle extended in a neutral state.
[0019] FIG. 2 is a perspective view of the needle-knife device of
FIG. 1 with the needle retracted, exposing a cutting element;
[0020] FIG. 3 is a perspective view of the needle-knife device of
FIG. 1 with a stylet/cutting element/hub assembly removed from a
needle/housing assembly;
[0021] FIG. 4 is a perspective view another embodiment of a
needle-knife device with windows in a needle and inner tube to
expose a cutting element;
[0022] FIG. 5 is a close up view of the distal portion of the
embodiment of FIG. 4;
[0023] FIG. 6 is a perspective view of a cutting element for a
needle-knife device in accordance with embodiments;
[0024] FIG. 7 is a perspective view of another embodiment of a
cutting element for a needle-knife device, with the cutting element
having dual cutting edges;
[0025] FIG. 8 is a perspective view of yet another embodiment of a
cutting element for a needle-knife device, with the cutting element
having a cruciform multi-cutting edge configuration;
[0026] FIG. 9 is a perspective view of still another embodiment of
a cutting element for a needle-knife device, with a cutting element
having a lumen-occluding element at the distal end;
[0027] FIG. 10 is a diagrammatic representation of a partial
section view of a human joint structure with a needle-knife device
being used to create a capsulotomy in the human joint structure
with a needle in a neutral state in accordance with
embodiments;
[0028] FIG. 11 is a diagrammatic representation of a partial
section view of the human joint structure of FIG. 10, with the
needle-knife device of FIG. 10, being used to create a capsulotomy
in the human joint structure with the needle in a retracted
position in accordance with embodiments;
[0029] FIG. 12 is a diagrammatic representation of a partial
section view of a body structure, with a needle-knife device being
used to incise a ligament or fibrous tissue band in the body
structure in accordance with embodiments; and
[0030] FIG. 13 is a diagrammatic representation of a partial
section view of a body structure, with a needle-knife device being
used to incise a ligament or fibrous tissue band in the body
structure in accordance with embodiments.
[0031] FIG. 14 is a perspective view of a distal end of a needle
knife device having a conical stylet configured for tissue
remodeling.
[0032] FIG. 15 is a perspective view of a distal end of another
embodiment of a needle knife device having a stylet configured for
tissue remodeling.
[0033] FIG. 16 is a perspective view of a distal end of another
embodiment of a needle knife device having a spherical-tipped
stylet configured for tissue remodeling.
[0034] FIG. 17 is a perspective view of a distal end of another
embodiment of a needle knife device having tubular stylet
configured for tissue remodeling.
[0035] FIG. 18 is a perspective view of a distal end of another
embodiment of a needle knife device having a rounded tip blunt
stylet configured for blunt tissue dissection.
[0036] FIG. 19 is a perspective view of a distal end of another
embodiment of a needle knife device having a drill-bit stylet
configured for drilling holes in tissue.
[0037] FIG. 20 is a perspective view of a distal end of another
embodiment of a needle knife device having a flat-sided stylet
configured for tissue remodeling.
[0038] FIG. 21 is a perspective view of an embodiment of a needle
knife device having an automatically retracting needle with a small
handle for fingertip control.
[0039] FIG. 22 is a perspective view of the needle knife device of
FIG. 21 shown with a needle retracted.
[0040] FIG. 23 is a magnified cross section view of the needle
knife device of FIGS. 21 and 22.
[0041] FIG. 24 is a hidden line perspective view of the distal tip
of an embodiment of a needle knife device having a lumen-occluding
element.
[0042] FIG. 25 is a hidden-line perspective view of a distal tip of
an embodiment of a needle knife device having a lumen-occluding
element integral with a stylet/cutting blade.
[0043] FIG. 26 is a perspective view of a distal tip of an
embodiment of a needle knife device having a lumen-occluding
element integral with a stylet/cutting blade with a needle in a
retracted position.
[0044] FIG. 27 is a perspective view of an embodiment of a needle
knife device enhanced for manufacturability and ergonomics and
having a needle-locking feature.
[0045] FIG. 28 is a front, perspective view of the needle knife
device of FIG. 27.
[0046] FIG. 29 is a partial cut-away perspective view of a needle
knife device with a needle-locking feature and a biasing
member.
[0047] FIG. 30 is a perspective view of an embodiment of a needle
knife device configured to connect to an electrosurgical
generator.
DETAILED DESCRIPTION
[0048] In the following description, various embodiments of the
present invention will be described. For purposes of explanation,
specific configurations and details are set forth in order to
provide a thorough understanding of the embodiments. However, it
will also be apparent to one skilled in the art that the present
invention may be practiced without the specific details.
Furthermore, well-known features may be omitted or simplified in
order not to obscure the embodiment being described.
[0049] Embodiments proposed herein provide a minimally invasive
tissue incision system (referred to at points herein as a
"needle-knife") having a tissue cutting mechanism or other
structure within a penetrating needle. The penetrating needle is
used to initiate a procedure, and the cutting mechanism or other
structure is available in the penetrated opening of the entered
tissue. The needle-knife disclosed herein has a broad application
in orthopedic surgery as well as general laparoscopic surgery.
Procedures supported by devices disclosed herein include: creation
of joint capsulotomies in arthroscopic procedures of the hip and
shoulder; tenotomy in the shoulder, including the rotator cuff
tendon for partial thickness rotator cuff repairs; tenotomy in the
biceps tendon for biceps tenodesis procedures; incision of the
transverse humeral ligament; tenotomies of the hip include the
psoas tendon; and tenotomy of the extensor carpiradialis brevis
tendon to treat lateral epicondylitis of the elbow as well as
tentotomy of the medial flexor wad for medial epicondylitis.
Procedures related to the knee suitable for the device may be
patella or quadriceps tenodesis, and illeotibial band release and
incision of the lateral patellar retinaculum. The needle-knife
device may be suitable for performing percutaneous plantar fascia
release in the foot and lengthening of the Achilles tendon in the
ankle area. In the leg, anterior and lateral compartment
fasciotomies may be performed with the device. The device would
have application for carpal tunnel syndrome to percutaneously
release the carpal ligament. A1 pulley release for treatment of
trigger finger condition is another application. This is intended
to be a partial list demonstrating some non-limiting examples of
the wide range of applications in orthopedic surgery for the
technologies disclosed herein.
[0050] Applications outside of orthopedic surgery include use as an
additional blade for laparoscopic surgery without the need for
adding an additional port. Procedures such as laparoscopic
cholecystectomy and hernia repair may encounter a need for another
cutting blade in the field. Because this device is a needle, it may
introduce a cutting blade to the field percutaneously. This would
save time and money in the procedure.
[0051] Referring now to the drawings, in which like reference
numerals represent like parts throughout the several views, FIG. 1
is a perspective view a needle-knife device 100 with a cutting
member 102 (FIG. 3) sheathed within a penetrating needle 104. This
position represents an initial state in which the device 100 would
be manipulated to penetrate the needle 104 through animal or human
skin and into underlying tissue. The penetrating needle 104 is
shown fixedly attached at the proximal end to a slider 106 which is
linearly slideable within a housing 108. In embodiments the slider
106 may be rotationally slideable as well, so as to lock into a
secondary slot(s) (not shown in FIG. 1) which may extend from a
primary slot 110 within the housing 108. Movement of the slider 106
directly translates to movement of the needle 104. This figure
shows a simple friction slider, however other embodiments may
employ a spring mechanism to facilitate movement of the slider and
associated needle. Alternate embodiments may use a mechanism other
than a slider to facilitate movement of the needle. An example of
such a mechanism would be a thumb wheel mounted within the housing
108 and having gear teeth so as to mesh with teeth or grooves on
the proximal end of the needle 104 such that rotation of said thumb
wheel drives the needle backward and forward. Another example of
such a mechanism is a trigger mechanism which may be used in
combination with a housing that takes a pistol grip form.
[0052] In operation, the user grips the needle-knife device 100 at
the housing 108 and penetrates the skin and underlying tissue with
the distal tip 112 of the needle 104. Once the needle 104 is in the
desired position as evidenced by visualization (ultrasound,
endoscopic, or otherwise) or palpation, the user activates the
slider 106 by moving the slider to a more proximal position, thus
retracting the needle 104 relative a cutting element 102 (best
shown in FIG. 3) so as to expose the cutting element. With the
cutting element 102 exposed, the user manipulates the device as
necessary so that the cutting element can cut tissue structures as
desired.
[0053] FIG. 2 shows the needle-knife device 100 with the needle 104
in a retracted state. In this state the cutting element 102 is
exposed from the distal tip 112 of the needle. The slider 106 is in
the fully retracted position. In embodiments, a detent mechanism
may be employed between the slider and the housing 108 so as to
allow selective partial retraction of the needle 104. In the
embodiment shown, friction can be provided between the components
to allow for infinite selective retraction. The cutting member 102
is disposed at the end of a stylet 114 (shown in FIG. 3). The
stylet 114 can be composed of a rod, tube, or other shaped
elongated member which is attached to a hub 116 at the proximal
end. The stylet 114 is mounted in the housing 108 (shown in FIG.
3). With the cutting member exposed, tissue or structures may be
incised by manipulating the device.
[0054] Referring now to FIG. 3, the stylet 114 is shown completely
removed from the housing 108. At the proximal end of the stylet
114, a hub 116 is shown fixedly attached. This hub 116 contains
features which allows the hub to be removably attached to the
housing 108. In this exemplary embodiment, the hub 116 utilizes an
internal thread with a male luer 118. This male luer mates to a
boss 120 on the housing 108 containing a female luer and external
threads 122. Other attachment means may be employed such as snaps,
however the use of standard luer fittings has the added benefit of
allowing the attachment of syringes and other medical apparatus for
other purposes. The stylet remains attached to the housing during
normal operation. At points in the medical procedure it may become
necessary to remove the stylet so as to place a guide pin through
the lumen of the needle or inject fluids to the surgical site. The
stylet is simply removed by twisting the hub 116 and pulling it
(and stylet) away from the housing 108. In embodiments an internal
seal such as an o-ring may be used to create a fluid-tight seal
between the internal surface of the housing 108 and the external
surface of the needle 104 in order to prevent injectable fluids
like drugs from escaping the device.
[0055] In another embodiment of the stylet, the hub 116 may be
configured on its proximal end to accept an electrosurgical
connector. This would give the distal end of the stylet/cutting
element capability to cut, coagulate, seal, desiccate, or fulgurate
tissue with the use of an electrosurgical generator. Further
details are provided in embodiments described later in this
application.
[0056] FIG. 4 shows another embodiment of a needle-knife device 200
which utilizes a window 222 in a penetrating needle 204 situated
just proximal to the distal needle tip 212. A rotator knob 206
attached to the proximal end of the penetrating needle 204 and
rides within a circumferential slot 210 in the housing 208 and
facilitates rotation of the needle to align the window opening 222
with the cutting element 202 (shown in FIG. 5) so as to expose the
cutting element. This view shows the window in the "closed"
position, wherein the back side (opposite the cutting element) of
the stylet obscures the window opening 222. The stylet of this
embodiment is designed such that its outer diameter is very close
to the inner diameter of the needle, creating a flush closure of
the needle window. In other embodiments, a twist knob attached to
the needle 204 and axially aligned and rotatably connected to the
housing may facilitate rotation of the needle. Alternatively, the
stylet 214 may be rotatable within the needle 204. In embodiments,
another inner tube situated coaxially and rotatably within the
needle and having its own window may be utilized to cover and
expose the underlying cutting element.
[0057] FIG. 5 is a close up view of the distal end of the window
needle-knife device of FIG. 4. Coaxially and rotatably situated
within the penetrating needle 204 is a stylet 214 with cutting
element 202. In this view the needle is shown rotated 180 degrees
from its position in FIG. 4, which aligns the window 222 to expose
the underlying cutting element 202. The stylet 214 can be rotated
so that the cutting element 202 is exposed through the window 222
or not. With the underlying cutting element 202 exposed, tissue may
be incised as in the other embodiments via manipulation of the
entire assembly.
[0058] The cutting element 102 and/or 202 may generally be any
sharp blade configuration, and can be straight, curved, angled
and/or serrated. The cutting element 202 extends orthogonally from
the axis of the stylet 214. FIG. 6 shows an embodiment of the
cutting element 102 as used with the needle-knife embodiment of
FIGS. 1-3. This cutting element is similar to a sharp pointed
scalpel blade. The primary cutting edge 103 of the blade is
positioned orthogonally to the axis of the stylet 114. The sharp
point 105 may provide added utility in piercing tissue structures.
Multiple cutting elements may be positioned side-by-side in the
orientation shown here to provide additional cutting capability. In
such a side-by-side arrangement, the cutting elements may be
powered from an internal or external source so as to alternately
reciprocate, thus providing enhanced cutting capability in certain
media. In all embodiments, the cutting element(s) may be a separate
component(s) that is affixed to the stylet or the cutting element
and the stylet may be fabricated from a single piece of steel or
other suitable material. All cutting elements disclosed herein may
be utilized with either the open end needle-knife embodiments
(e.g., FIG. 3) or the window needle-knife embodiments (e.g., FIG.
5).
[0059] FIG. 7 shows another embodiment of a cutting element 302
with a rounded tip 304. The cutting edge of the member is continued
around the tip to create at least a partial cutting edge 305 on the
back side of the blade. This may provide the added utility of
cutting in the opposite direction without having to rotate the
device 180 degrees. It is understood that a sharp tip may be
combined with a double-edged cutting element just as a rounded tip
may have only one sharp cutting surface.
[0060] FIG. 8 shows another embodiment of a cutting element 303
with a cruciform blade configuration. This configuration has a flat
blade 306 with a second flat blade 307 crossing it in the center at
90 degrees. This type of blade arrangement may provide advantages
for penetrating a tissue structure.
[0061] The embodiments of FIGS. 6-8 show cutting elements that do
not occlude the lumen of the penetrating needle. In alternate
embodiments, it may be advantageous for the tip of a cutting member
to occlude the lumen of the penetrating needle so as to prevent
tissue from clogging the needle lumen. For example, FIG. 9 is an
embodiment of a cutting element 310 that has a flat surface 314 at
the distal end of the cutting element 312. This flat surface 314 is
shaped and angled so as to match the bevel of the outer needle. In
embodiments, multiple cutting elements, such as the cutting element
312, may be arranged side-by-side behind the flat surface 314 so as
to make multiple incisions simultaneously in tissue. Additionally,
in the embodiment shown in FIG. 9, the surface 314 which occludes
the lumen of the penetrating needle is flat, however in other
embodiments the surface may take other shapes, such as rounded,
bullet-shaped or pointed.
[0062] Turning now to FIG. 10, a needle-knife device 500 is shown
which may be used to create a capsulotomy in joint tissue. The
needle-knife device may be substantially the same as any of the
embodiments previously disclosed herein. In FIG. 10, a body joint
is shown in cross section. The two bones 402 comprising the joint
are shown, with a fibrous joint capsule 404 present. A skin layer
406 is represented with other soft tissue 408 residing between the
joint capsule and the skin. The penetrating needle 502 of the
needle-knife device 500 is shown penetrating through the skin layer
406, the other soft tissue 408, and into the joint capsule 404 such
that the distal needle tip 503 is positioned just inside the joint
capsule 404. The slider 504 on the device 500 is in its distal most
position. In use, appropriate positioning of the needle in the
joint space would be confirmed at this point by the user with
endoscopic visualization or fluoroscopy or some other visualization
system.
[0063] FIG. 11 shows a further step in the capsulotomy sequence of
the same joint space as FIG. 10. After insertion of the penetrating
needle 502 into the joint capsule 404, the penetrating needle 502
may be refracted by moving the slider 504 toward the proximal end
of the handle. By retracting the needle 502, the cutting element
506 is exposed, residing in the same position in the joint that the
needle tip 503 previously resided. At this point, the device may be
manipulated so as to force the cutting element laterally to cut
joint capsule tissue, thereby enlarging the incision in the capsule
and creating space for the placement and maneuvering of subsequent
instruments. Once the cutting is completed, the slider may be
advanced distally to its original position, thus resheathing the
cutting element for atraumatic withdrawal.
[0064] FIGS. 10 and 11 are intended as generic representations of a
typical joint structure and may represent the shoulder joint,
elbow, knee, or hip joints. Other joint structures such as the
spine may also benefit from the similar use of the needle-knife
device disclosed herein.
[0065] FIGS. 12 and 13 are simplified generic representations of a
body structure shown in cross section. This body structure could
represent a hand or foot, leg or arm. The body structure has
fibrous band or ligament 604 (shown in section) running through it
below the skin level at 602. These figures show how a needle-knife
device substantially the same as disclosed herein may be used to
incise a fibrous band or ligament structure for medical purposes as
may be done in "release" or other procedures. Typical procedures of
this type include, but are not limited to plantar fascia release,
carpal tunnel release, Achilles lengthening, illeotibial band
release and compartment release.
[0066] FIG. 12 shows the penetrating needle 606 of said
needle-knife device having been penetrated into the anatomical
space surrounding a fibrous band or ligament 604. Ideally the
needle 606 may be placed across the breadth of the band/ligament
604 such that the tip 607 is positioned under the distal side of
the band/ligament 604. The needle 606 may then be retracted a
specified distance as described previously, thus exposing the
cutting element 608 as shown in FIG. 13. By manipulating the
needle-knife device so as to push the cutting member 608 into and
across the band/ligament 604, the band ligament is incised. A
single incision with the cutting member may be sufficient, or
depending upon the surgical procedure, multiple passes of the
cutting member may be required to sufficiently incise the tissue.
Any of the embodiments of the invention disclosed herein may be
used for this type of medical procedure.
[0067] Surgical applications discussed thus far have been generally
orthopedic in nature, however the scope of use of embodiments
herein is not limited to only to orthopedics. Any surgical
procedure requiring incision or modification of an internal tissue
structure may benefit from the use of the needle knife device.
Particularly, the needle-knife device can be particularly useful in
minimally invasive procedures where a secondary visualization
source (e.g. scope camera, x-ray, or ultrasound) is used. Examples
of other procedures may include, but are not limited to, cardiac
surgery, neurosurgery, gynecological, gastrointestinal or general
laparoscopic surgery. Variations on the embodiments disclosed
herein may enhance the usefulness for specific surgical
applications. For example, the typical length of the needle of the
embodiments disclosed herein for arthroscopic procedures might be
in the range of 0.5 to 5 inches (except for hip arthroscopy which
is about 8 inches). However, for general laparoscopic surgery, a
significantly longer needle may be useful (6-14 inches) in order to
reach the surgical site.
[0068] Further, depending on the visualization method used for the
surgical procedure, variations of the embodiments disclosed herein
may enhance visualization of the device. For example, certain
surface modifications, treatments, or coatings may be applied to
the needle, blade and/or stylet to enhance their visibility when
used with ultrasound guidance. Such treatments may include but are
not limited to dimpling, blasting and coating so as to alter the
component's interaction with the ultrasound waves, making it more
readily visible.
[0069] Up to this point embodiments disclosed herein have focused
on a cutting stylet within the needle structure. Further
embodiments include a stylet configured at the distal end to
perform functions other than cutting, as with a sharp blade. Such
functions may include but are not limited to scraping, gouging,
debriding, fenestrating, roughening, skiving, filing, or sanding.
Said functions may generally be employed in an effort to remodel
the tissue for clinical benefit. The stylet of the present
invention may be configured to perform any one or more of these
tasks, and may further be removable as previously disclosed. This
removability lends itself to creation of a system, wherein
different stylets with different configurations and different
functions may be inserted into the needle to perform a more complex
task and interchanged with other stylets to perform a new task as
the clinical situation may dictate. This interchanging may be
accomplished without ever moving the needle from a specific
anatomical site.
[0070] Turning back to the figures, FIG. 14 shows an embodiment
similar in structure to prior embodiments with a penetrating needle
104 and removable stylet 702. The distal tip of the stylet 702 is a
conical shape and has a roughened surface. FIG. 15 shows a similar
configuration, but the stylet has a knurled surface 703. The
stylets 702 and 703 with the roughened surfaces can be used for
debriding of bone or other hard tissue so as to remodel the tissue
structure. As with prior embodiments, the conical roughened tip may
reside behind the cutting edge of the needle during needle
penetration, then exposed as the needle is retracted in preparation
for tissue remodeling. The stylet/assembly may then be rotated or
reciprocated so as to remodel the tissue. While the distal portion
of the stylet of these embodiments is shown in a conical, tapered
configuration, other embodiments have a straight, non-tapered tip
or a reverse-tapered tip.
[0071] FIG. 16 shows a similar embodiment wherein the distal stylet
tip is spherical in shape and contains cuts 704, such as
indentations or grooves, in a spiral formation about the spherical
stylet tip. With such a configuration, the stylet may be rotated
either manually or by a powered source so as to remove small
amounts of surface tissue (i.e., via the cuts 704) in an effort to
remodel the tissue.
[0072] A stylet may also be composed of a tubular member 706 with
an open end 707 as shown in FIG. 17. Such a stylet may be used to
gouge or scrape bone or other hard tissue so as to remodel the
tissue. With a tubular stylet as disclosed herein, a suction source
may be attached at the proximal end and suction applied through the
tube to remove small pieces of loose tissue debris as it is
released from the main body of tissue. Additionally, openings 708
in the sidewall of the tubular stylet may allow for debriding or
scraping of bone or tissue at an alternate angle of approach.
[0073] In some situations it may be desirable to have a stylet tip
that may simply act as a blunt tissue dissector. FIG. 18 shows an
embodiment of a device with such a blunt, rounded stylet tip 710.
In this embodiment the rounded stylet tip may reside beyond the
distal tip 112 of the penetrating needle 104 so as to provide blunt
dissection only. At any point during the clinical procedure, the
rounded tip stylet 712 may be removed and replaced with other
stylets as disclosed herein to perform alternate functions as the
procedure or the patient anatomy may demand.
[0074] In some clinical situations, it may be desired to drill
holes in the bone, as in the case of treating lateral epicondylitis
in the elbow. FIG. 19 shows an embodiment of the device with a
stylet 714 that is configured as a drill bit. When the needle 104
is retracted, the drill bit portion of the stylet is exposed beyond
the distal tip 112 of the needle and a hole may be drilled in the
tissue by rotating the stylet from the proximal end. As in previous
embodiments, the stylet may be rotated manually or attached to a
powered driver source.
[0075] FIG. 20 shows another embodiment wherein the distal stylet
tip 716 has flat sides. The flat sides have a knurled or roughened
surface 718 that can be used to remodel the tissue as necessary for
the clinical situation. The distal tip 716 may have one or multiple
flat surfaces.
[0076] Prior embodiments of the proximal end of the device
disclosed herein show a housing or hand piece designed to be
gripped in the palm or by a majority of the hand as is typical of
many surgical hand pieces. FIG. 21 is an embodiment of a
needle-knife device 800 with a smaller housing 804 at the proximal
end that is designed to be held and manipulated with the
fingertips. As with prior embodiments, a penetrating needle 802 is
present and shown in the extended position with a bladed stylet
disposed inside the needle lumen. The stylet is fixedly attached at
the proximal end to a hub 806. The stylet/hub assembly is removable
and replaceable with other stylets of similar form and in a manner
as disclosed in prior embodiments. The penetrating needle 802 is
fixedly attached to a shuttle 808 (FIG. 22). This shuttle 808 is
slidably disposed within the housing 804 so as to move the
penetrating needle in the axial directions. The shuttle 808 of this
embodiment has a distal tip 810 and a proximal tip 812 (FIG. 23). A
compression spring 803 is utilized to retract the penetrating
needle 802 and expose the cutting blade or other structure at the
distal end of the stylet. The intent is to provide needle
retraction with a very limited finger movement, as in pushing a
button with a fingertip. In a latched position, the shuttle 808 is
pressed distally, against the bias of the spring 803, until a back
edge 818 of the distal shuttle end 810 latches behind a front edge
816 of the housing 804. The internal compression spring 803 applies
a force in the proximal direction against the shuttle 808 so that
when the distal tip 810 of the shuttle is pushed inward toward the
needle by a technician's finger, the shuttle "unlatches" and is
free to move proximally under the force of the compression
spring.
[0077] FIG. 22 shows the same device 800 with the penetrating
needle 802 in the retracted state so as to expose a cutting blade
814. The proximal tip 812 of the shuttle 808 is shown in displaced
position as forced there by the compression spring.
[0078] In FIG. 23, the compression spring 803 is shown within the
housing at full extension and pushing the shuttle 808 to its
proximal position. The penetrating needle 802 is shown fixedly
attached to the shuttle 808, such that movement of the shuttle in
the axial direction produces retraction and extension of the needle
802 relative to the stylet with cutting blade 814. The proximal end
of the stylet with cutting blade 814 is fixedly attached to the hub
806. When the proximal tip 812 of the shuttle 808 is pushed
distally by the operator, the shuttle 808 with attached penetrating
needle 802 moves axially forward within the housing 804 and
compresses the spring 803 until a back edge 818 of a distal tip 810
of the shuttle catches on the front edge 816 of an opening 820 in
the housing 804. At this point, the spring 803 is compressed and
the penetrating needle 802 is extended forward so as to cover the
cutting blade, putting the mechanism into a "cocked" state. When
the operator wishes to retract the needle 802 to expose the cutting
blade, the distal tip 810 of the shuttle 808 is pressed inward
toward the needle, thus dissociating the back edge 818 of the
shuttle from the front edge 816 of the opening 820 in the housing
804. This allows the spring force to push the shuttle 808 and
associated needle 802 proximally to uncover the cutting blade. A
front edge 805 of the proximal shuttle end 812 catches on a back
edge 807 of the housing 804 preventing forward movement of the
needle. This may be of particular use when friction created by skin
and other tissue around the needle is great enough so as dislodge
the needle inadvertently.
[0079] FIG. 24 is another embodiment wherein the penetrating needle
830 contains a lumen-occluding element 832 shown in partially
hidden lines. The inclusion of a lumen-occluding element in the
device may be necessary to prevent tissue from entering the lumen
of the needle 830 upon penetration through the tissue. The
lumen-occluding element 832 may have a slot 834 which allows
extension of a cutting blade when the cutting needle 830 is
retracted. The slot 834 may be rectangular, square, round, or any
other shape that may be required to allow for passage of a cutting
blade or other tissue-remodeling element. The lumen-occluding
element is generally fixedly attached to the penetrating needle and
may be very short like a wafer or may extend a significant distance
down the lumen of the needle to the extent that it may extend the
full length of the penetrating needle. The lumen-occluding element
may be preferably manufactured from plastics or metals commonly
used in medical devices. Other materials such as ceramics or foams
may also be suitable.
[0080] A lumen-occluding element may also be integrated with the
stylet/or cutting blade. FIGS. 25 and 26 illustrate such an
embodiment. In FIG. 25, the lumen-occluding element 840 is
integrated with the stylet/cutting blade 842 and is shown in hidden
lines within the lumen of the penetrating needle 844. FIG. 26 shows
the penetrating needle 844 retracted to expose the cutting blade
842 with a lumen-occluding element 840 at the distal tip. In this
embodiment, the lumen-occluding element 840 is a disc-shaped
element. In other embodiments, the lumen-occluding element may be
any shape which partially or substantially occludes the lumen of
the penetrating needle such as spherical or multi-faceted shapes
such as rectangular or hexagonal. The lumen-occluding element is
preferably manufactured from metals or plastics commonly used for
medical devices. It may be formed integrally with the cutting blade
from the same piece of raw material or may be fabricated separately
and attached to the cutting blade via a friction fit, adhesive,
snap fit, welding or other assembly mechanism.
[0081] FIGS. 27-29 show an embodiment of the present invention
substantially the same as the embodiments of FIGS. 1-3, but refined
for ease-of-use and manufacturability. Contours on the underside of
the handle provide a place for the user's fingers to grip and
strategically placed ridges 906 provide better traction for the
user to manipulate the device. The slider 902 which manipulates the
needle 908 is shown in the forward position thus covering the
cutting blade 910. Also provided in FIGS. 27-29 is a locking
feature which helps to prevent needle retraction when penetrating
the skin or other tissues. A locking feature to prevent needle
movement may take many forms. Shown here is a bayonet-style lock,
wherein the slider 902, when advanced fully forward, is secondarily
moved to the side (in an axial fashion) and into a slot which
prevents backwards movement and subsequent retraction of the
needle. In FIG. 27, the slider 902 is shown in the locked position
and thus rests off-center from the rest of the handle.
[0082] FIG. 28 shows a front view of the device in the locked mode,
where the slider 902 can be clearly seen in a position offset from
the center of the handle. In use, the operator would manually move
the slider 902 back to the center position and thus out of the
locking slot prior to retracting the slider to subsequently retract
the needle and expose the cutting blade.
[0083] FIG. 29 shows a partial cut-away view of the needle knife
device with a locking mechanism. The slider and needle are shown in
the "unlocked" and retracted position. In this embodiment, a
biasing member 912 is shown which is designed to facilitate
movement the slider 902 sideways into a locking slot as the use
user pushes the slider forward to extend the needle 908 over the
cutting blade 910. In embodiments, the biasing member may be a
separate component that is attached to the handle or may be
manufactured as parts of the handle itself. In yet other
embodiments, no biasing mechanism may be present, thus requiring
the user to manually push the slider 902 into the bayonet slot.
Other mechanisms may be employed to prevent proximal movement of
the needle and slider such as a button-like protrusion on the
slider which protrudes through a hole or slot in the handle and
must be actively disengaged by the user in order to allow movement
of the slider and needle. Another example of such a mechanism would
be a pull tab or break-away tab which provides a physical block
preventing the slider from moving proximally and may be manually
removed by the operator. Such locking mechanisms are designed with
sufficient strength so as to prevent proximal needle movement when
piercing the skin or other soft tissues.
[0084] As disclosed in prior embodiments, cutting and coagulation
of certain tissues may be achieved or enhanced by application of
energy though the blade/stylet and/or needle. One example of said
energy would radiofrequency electrical energy or RF. RF is common
in the surgical setting and RF generators are found in nearly all
surgical suites. FIG. 30 shows an embodiment of the needle knife
device configured for use with an RF generator 930. The needle
knife device is configured with one or more standard RF receptacles
(male or female) for connection to the RF generator 930. The plug
is internally connected to the blade/stylet through the cap 934
such that electrical energy may be delivered to the cutting blade
or other functional instrument at the end of the stylet. The use of
electrical current with the device may require additional features
for effectiveness such as insulation along the length of the stylet
or needle so as to prevent dispersion of the current to surrounding
tissues and concentrate it at the un-insulated distal tip. Any
other design aspects typically found in electrosurgical instruments
which enhance safety or effectiveness may be applied to the needle
knife device in a similar manner. Other examples of energy that may
be applied through the needle knife device include, but are not
limited to, ultrasonic vibration and thermal energy.
[0085] In embodiments, the invention disclosed herein may be
configured to work with nerve monitoring equipment. Certain
procedures may be carried out in the vicinity of critical
neurological structures (e.g. the ulnar nerve in the wrist/hand)
making it important know the location of the tip of the needle
knife device with respect to such a structure. In a similar manner
as configured for electrical generation, the proximal end of the
stylet may be configured to accept neural monitoring connections.
Alternately, a specific stylet with a nerve-sensing probe at the
distal tip may be inserted into the needle knife device as
described herein and connected to nerve monitoring equipment. Once
the proximity to the nerve is verified with said probe, that
nerve-sensing stylet may be remove and replaced with a cutting
stylet.
[0086] The needle-knife device shown in FIGS. 1-30, is preferably
constructed using materials and methods typically used to construct
handheld surgical instruments. Such materials for the hand piece
may be but not limited to metals such as stainless steel or
aluminum, or plastics such as ABS, polycarbonate, polyethylene,
polysulfone, acetal or other suitable thermoplastics. The
penetrating needle described herein may be constructed from
suitable metals as a typical hypodermic needle. Stainless steel,
nitinol or other metals may be appropriate. The cutting member of
the invention disclosed herein is preferably stainless steel or
carbon steel but other metals may be appropriate such as nitinol,
or aluminum. Ceramics and plastics may even be utilized as to the
extent of their ability to hold an appropriately sharp edge. The
cutting member may have a smooth edge or may be serrated so as to
better incise certain tissues. The elongated rod or stylet
disclosed herein that connects the cutting member to the hub or
housing may be made of any suitable metal or plastic. For example,
if some flexibility or curvature were required over the length of
the needle, then the needle and/or stylet may be composed of
nitinol or other shape memory or flexible alloy so as to allow a
greater degree of flexibility and/or curvature.
[0087] Other variations are within the spirit of the present
invention. Thus, while the invention is susceptible to various
modifications and alternative constructions, certain illustrated
embodiments thereof are shown in the drawings and have been
described above in detail. It should be understood, however, that
there is no intention to limit the invention to the specific form
or forms disclosed, but on the contrary, the intention is to cover
all modifications, alternative constructions, and equivalents
falling within the spirit and scope of the invention, as defined in
the appended claims.
[0088] The use of the terms "a" and "an" and "the" and similar
referents in the context of describing the invention (especially in
the context of the following claims) are to be construed to cover
both the singular and the plural, unless otherwise indicated herein
or clearly contradicted by context. The terms "comprising,"
"having," "including," and "containing" are to be construed as
open-ended terms (i.e., meaning "including, but not limited to,")
unless otherwise noted. The term "connected" is to be construed as
partly or wholly contained within, attached to, or joined together,
even if there is something intervening. Recitation of ranges of
values herein are merely intended to serve as a shorthand method of
referring individually to each separate value falling within the
range, unless otherwise indicated herein, and each separate value
is incorporated into the specification as if it were individually
recited herein. All methods described herein can be performed in
any suitable order unless otherwise indicated herein or otherwise
clearly contradicted by context. The use of any and all examples,
or exemplary language (e.g., "such as") provided herein, is
intended merely to better illuminate embodiments of the invention
and does not pose a limitation on the scope of the invention unless
otherwise claimed. No language in the specification should be
construed as indicating any non-claimed element as essential to the
practice of the invention.
[0089] Preferred embodiments of this invention are described
herein, including the best mode known to the inventors for carrying
out the invention. Variations of those preferred embodiments may
become apparent to those of ordinary skill in the art upon reading
the foregoing description. The inventors expect skilled artisans to
employ such variations as appropriate, and the inventors intend for
the invention to be practiced otherwise than as specifically
described herein. Accordingly, this invention includes all
modifications and equivalents of the subject matter recited in the
claims appended hereto as permitted by applicable law. Moreover,
any combination of the above-described elements in all possible
variations thereof is encompassed by the invention unless otherwise
indicated herein or otherwise clearly contradicted by context.
[0090] All references, including publications, patent applications,
and patents, cited herein are hereby incorporated by reference to
the same extent as if each reference were individually and
specifically indicated to be incorporated by reference and were set
forth in its entirety herein.
[0091] Embodiments of the disclosure can be described in view of
the following clauses:
1. A method of incising tissue in medical procedure comprising:
inserting a needle through the skin and subcutaneous tissue layers
of a human or animal, positioning the needle tip near a secondary
tissue structure to be incised, retracting the needle to expose a
cutting element, and manipulating the cutting element to incise the
tissue structure. 2. The method of claim 1 where in the incised
tissue structure is a joint capsule. 3. The method of claim 1
wherein the incised tissue structure is a ligament or fibrous band
of tissue. 4. The method of claim 1 where in the initial needle
penetration does not require a skin incision with another
instrument. 5. The method of claim 1 wherein the retraction of the
needle utilizes a spring. 6. The method of claim 1, wherein the
cutting element is slidably received within the needle, and
retracting the needle comprises movement of the needle proximally
relative to the cutting element. 7. A method of incising tissue in
medical procedure comprising: inserting a needle through the skin
and subcutaneous tissue layers of a human or animal, the needle
comprising a distal end, a lumen extending along a length of the
needle, a window on a side of the lumen exposing a portion of the
lumen, and a cutting element mounted in the lumen, positioning the
distal tip of the needle near a secondary tissue structure to be
incised, exposing the cutting element through the window, and
manipulating the cutting element to incise the tissue structure. 8.
The method of claim 7 wherein the cutting element is exposed
through the window by rotating of the needle relative to the
cutting element. 9. The method of claim 8 wherein the window is
uncovered by rotating the cutting element. 10. The method of claim
8 wherein the window is uncovered by rotating the needle. 11. The
method of claim 7 wherein the window is uncovered by rotating an
inner tube residing coaxially within the needle. 12. A device for
incising tissue in the human body, comprising: a tissue-penetrating
needle, the needle comprising a distal end, and a lumen extending
along a length of the needle, a cutting element slidingly received
within the lumen needle, and a mechanism for moving the needle
relative to the cutting element. 13. The device of claim 12 wherein
the cutting element is arranged such that it extends orthogonally
to the axis of the needle. 14. The device of claim 12 wherein the
cutting element has multiple cutting edges. 15. The device of claim
12 wherein the cutting element has serrations. 16. The device of
claim 12 wherein the needle moves linearly along the length of an
axis of the cutting element. 17. The device of claim 12 wherein the
needle moves rotationally relative to the cutting element. 18. The
device of claim 12 wherein the cutting element is mounted to a
stylet. 19. The device of claim 18 wherein the stylet is designed
to occlude the lumen of the needle. 20. The device of claim 12
further comprising an injector for injecting fluids through the
lumen of the needle. 21. The device of claim 12 further comprising
an electrosurgical generator connected to the device. 22. The
device of claim 12 further comprising a nerve stimulation generator
and monitoring device connected to the needle. 23. A system for
remodeling tissue in the human body, comprising: a
tissue-penetrating needle the needle comprising a distal end, a
lumen extending along a length of the needle; a first stylet
configured to fit within the lumen of the needle, said first stylet
having a first distal stylet tip configured to remodel tissue in a
first manner; a second stylet configured to fit within the lumen of
the needle, said second stylet having a second distal stylet tip
configured to remodel tissue in a second manner; and a mechanism
for moving the needle relative to the first stylet or the second
stylet when the respective stylet is within the lumen between a
first position where the distal tip of the respective stylet is at
least partly received within the lumen and a second position where
the distal stylet tip of the respective lumen is more exposed out
of the lumen. 24. A system of claim 23 wherein one of the stylets
is configured with at least one cutting edge. 25. A system of claim
23 wherein one of the stylets is configured with a blunt or rounded
tip. 26. A system of claim 23 wherein one of the stylets is
configured to drill a hole in tissue. 27. A system of claim 23
wherein one of the stylets is configured with a roughened or
knurled surface. 28. A system of claim 23 wherein the one of the
stylets is tubular in nature with the distal tip configured so as
to gouge or skive tissue.
* * * * *