U.S. patent application number 15/951915 was filed with the patent office on 2018-08-16 for small gauge instruments for micro surgery.
The applicant listed for this patent is CYGNUS LP. Invention is credited to Fouad Mansour.
Application Number | 20180228651 15/951915 |
Document ID | / |
Family ID | 54700428 |
Filed Date | 2018-08-16 |
United States Patent
Application |
20180228651 |
Kind Code |
A1 |
Mansour; Fouad |
August 16, 2018 |
SMALL GAUGE INSTRUMENTS FOR MICRO SURGERY
Abstract
A surgical system combines a cannula and an instrument in a
manner that allows small gauge instruments to be used effectively,
with little or no bending with respect to the manipulating proximal
side of the instrument. Such design overcomes the shortcomings of
prior art, and applies to various microsurgical procedures,
including ophthalmology, allowing the use of smaller
endo-photocoagulation probes, illumination probes, combination
probes, vitrectors, scissors, manipulators, picks, diathermy, and
others. By using smaller gauge, patient recovery is expected to be
faster.
Inventors: |
Mansour; Fouad; (Sandy
Springs, GA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
CYGNUS LP |
Roswell |
GA |
US |
|
|
Family ID: |
54700428 |
Appl. No.: |
15/951915 |
Filed: |
April 12, 2018 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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14639663 |
Mar 5, 2015 |
9949876 |
|
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15951915 |
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61948329 |
Mar 5, 2014 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61F 9/00736 20130101;
A61B 17/3421 20130101; A61B 2017/347 20130101; A61B 17/3462
20130101; A61F 9/00821 20130101; A61B 2017/3443 20130101; A61B
2017/00477 20130101; A61B 2017/00305 20130101 |
International
Class: |
A61F 9/008 20060101
A61F009/008; A61B 17/34 20060101 A61B017/34; A61F 9/007 20060101
A61F009/007 |
Claims
1. A surgical instrument comprising: a handle; a sleeve attached to
the handle and adapted to selectively anchor with a base of a
cannula after the cannula is inserted into and held at an entry
site of an eye during a micro-surgical procedure, wherein the
sleeve is surrounded by an inner circumferential surface of the
base of the cannula when anchored with the base of the cannula; and
an elongate functioning member extending from the handle and
associated with the sleeve, wherein the functioning member is
adapted to be inserted through the cannula during the
micro-surgical procedure.
2. The surgical instrument of claim 1, further comprising the
cannula configured with the base, wherein the cannula is adapted to
be inserted into and held at the entry site of the eye during the
micro-surgical procedure.
3. The surgical instrument of claim 2, wherein the base of the
cannula is configured with an inner diameter larger than an inner
diameter of a remainder of the cannula.
4. The surgical instrument of claim 3, wherein the inner diameter
of the base of the cannula is larger than an inner diameter of the
entry site of the eye.
5. The surgical instrument of claim 1, wherein the functioning
member is further adapted to be inserted through the cannula after
the cannula is inserted into and held at the entry site of the eye
during the micro-surgical procedure.
6. The surgical instrument of claim 1, wherein the functioning
member is further adapted to be inserted through the cannula before
the cannula is anchored with the base of the cannula.
7. The surgical instrument of claim 1, wherein the sleeve and the
cannula, when anchored, at least partially reduce bending of the
functioning member during manipulation of the surgical
instrument.
8. The surgical instrument of claim 1, wherein the sleeve is
further adapted to additionally anchor with the base of the cannula
via an outer circumferential surface of the base of the cannula
such that a portion of the sleeve surrounds the outer
circumferential surface of the base of the cannula when the sleeve
is anchored with the base of the cannula.
9. The surgical instrument of claim 1, wherein the functioning
member is at least partially disposed within the sleeve.
10. The surgical instrument of claim 1, further comprising: a
mechanical mechanism extending at least partially external to the
handle and connected, within the handle, to the functioning member,
the mechanical mechanism adapted to advance or retract the
functioning member through the cannula during the micro-surgical
procedure.
11. The surgical instrument of claim 1, wherein the numerical value
of the gauge of the sleeve is 20 gauge or less.
12. A method of anchoring a surgical instrument to a cannula for
use during a micro-surgical procedure, the method comprising:
inserting the cannula into an entry site of an eye during the
micro-surgical procedure, wherein the cannula is held at the entry
site of the eye during the micro-surgical procedure; responsive to
inserting the cannula into the entry site of the eye during the
micro-surgical procedure, anchoring a sleeve attached to a handle
of the surgical instrument to a base of the cannula, wherein the
sleeve is surrounded by an inner circumferential surface of the
base of the cannula when anchored with the base of the cannula; and
inserting a functioning member, wherein the functioning member
extends from the handle and is associated with the sleeve, through
the cannula to effectuate the micro-surgical procedure.
13. The method of claim 12, wherein the base of the cannula is
configured with an inner diameter larger than an inner diameter of
a remainder of the cannula.
14. The method of claim 12, wherein the sleeve is additionally
anchored to the base of the cannula via an outer circumferential
surface of the base of the cannula such that a portion of the
sleeve surrounds the outer circumferential surface of the base of
the cannula when the sleeve is anchored with the base of the
cannula.
15. The method of claim 12, wherein the functioning member is
inserted through the cannula prior to inserting the cannula into
the entry site of the eye.
16. The method of claim 12, further comprising: manipulating a
mechanical mechanism extending at least partially external to the
handle and connected, within the handle, to the functioning member
to advance or retract the functioning member through the
cannula.
17. A surgical instrument comprising: a handle; a sleeve attached
to the handle and adapted to selectively anchor with a base of a
cannula after the cannula is inserted into and held at an entry
site of an eye during a micro-surgical procedure, wherein the
sleeve is surrounded by an inner circumferential surface of the
base of the cannula when anchored with the base of the cannula; and
an elongate functioning member associated with the sleeve, wherein
the functioning member is adapted for selective longitudinal
movement relative to the sleeve, and wherein the functioning member
is further adapted to be selectively inserted through the cannula
during the micro-surgical procedure.
18. The surgical instrument of claim 17, further comprising the
cannula configured with the base, wherein the cannula is adapted to
be inserted into and held at the entry site of the eye during the
micro-surgical procedure.
19. The surgical instrument of claim 18, wherein the base of the
cannula is configured with an inner diameter larger than an inner
diameter of a remainder of the cannula.
20. The surgical instrument of claim 19, wherein the functioning
member is further adapted for selective longitudinal movement
within the sleeve.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a divisional of, and claims priority to,
co-pending U.S. application Ser. No. 14/639,663, filed Mar. 5,
2015, which claims priority to U.S. Provisional Patent Application
Ser. No. 61/948,329, filed Mar. 5, 2014, entitled "Small Gauge
Instruments for Micro Surgery," the disclosures of which are
incorporated by reference herein as though set forth in their
entireties.
TECHNICAL FIELD
[0002] The subject matter of the present invention relates,
generally, to reducing the size of instruments that are used in
micro surgery; thus, reducing the trauma and recovery time for the
patient. In retina surgery, this includes, but is not limited to,
laser probes for endo-photocoagulation, illumination probes used in
the vitreous, vitrectors, instruments (knives, scissors,
manipulators, picks, and the like), multi-function probes,
diathermy, and the like. In other applications, electrodes for
sensing and/or delivering energy are included.
BACKGROUND
[0003] In the field of endo-photocoagulation laser treatment at the
retina during eye surgery, it is desirable to reduce the size of
the entry site in order to have less trauma and recovery time for
the patient.
[0004] Most often, and as in other fields is medical surgery, a
trocar system is used, whereby a cannula is inserted at the entry
site with the assistance of a puncturing device/instrument. Once
the cannula is in place, the puncturing device/instrument is
withdrawn and the cannula serves as an opening that allows one or
more device to enter through the cannula and into the surgical site
where it is needed.
[0005] As the industry has moved toward smaller diameters
(typically, 27 gauge, 25 gauge, and 23 gauge, as opposed to the
larger, 20 gauge), such current systems prove to have engineering
limitations, as the small gauge instruments tend to flex at the
entry point when the direction of the instrument (generally via a
hand held instrument base) is changed in order to target other
areas in the general proximity.
[0006] As the outside diameter of the cannula is always larger than
the outside diameter of the device to be inserted therethrough, it
is important to note that a 25 gauge instrument will use close to
23.5 gauge cannula, and a 23 gauge instrument will use close to
21.5 gauge cannula.
[0007] In practice, with the 23 gauge system, the entry wound
diameter is reduced by about 15%, and for the 25 gauge system, it
is reduced by about 33%, in comparison with the 20 gauge
system.
[0008] With the 25 gauge system, the flexibility of the instruments
reached an upper limit that not all surgeons are comfortable with,
opting instead for the larger 23 gauge system.
[0009] As for the 27 gauge system, the flexibility is reduced by
using a reinforcing sleeve that stays close to the cannula entry,
using the physics of a cantilever, where rigidity is the strongest
at the base (or lateral movement is the lowest) compared to the
distal end, as in the case of U.S. patent application Ser. No.
11/268,928.
[0010] Such size and technique provides very little control over
changing the direction of the instrument and is used only in very
simple operation where the target area is very small.
[0011] Hence, a new approach is needed in order to use smaller
gauge instruments, increasing the level of manipulation by the
surgeon, with the least amount of sacrifice in performance.
SUMMARY
[0012] In recognition of the above-described problems, a solution
is herein proposed. With the decrease in instrument sizes,
stiffening of the instruments becomes more challenging, with the
current state of the art. It becomes more convenient that the
instrument relies primarily on the rigidity of the cannula itself,
by anchoring the instrument to the cannula.
[0013] As the cannula is typically around 4 mm long, bending it is
not practically possible, even at smaller sizes.
[0014] The advantage of such new approach allows for smaller
cannulas and, thus, smaller instruments to be inserted through such
cannulas, while maintaining similar control that is comparable to
larger size instruments when restricted to the current state of the
art.
[0015] As an illustration, a 34 gauge tube can fit a 100 micron
laser fiber, and such a tube can go through a 30 gauge cannula;
thus, reducing the entry wound diameter by about 66% when compared
to 20 gauge cannulas, 60% when compared to 23 gauge cannulas, and
50% when compared to 25 gauge cannulas, and still with minimal
compromise to the effectiveness and maneuvering offered by the 20
gauge system that is restricted to the current state of the
art.
[0016] In a first embodiment, the cannula is geometrically similar
to what is currently used, while the instrument mates at the base
of the cannula, at the external surface of the cannula entry
point.
[0017] In such arrangement, the instrument diameter connecting to
the cannula is chosen so that it has a diameter that resists
flexing, allowing the cannula to change direction independently of
the instrument flexibility. Such instrument size would be typically
20 gauge or larger. Once the instrument is engaged at the base of
the cannula, the functioning (and smaller) part of the instrument
passes through the cannula and into the surgical spot.
[0018] In some cases, the functioning part of the instrument may
enter through the cannula prior to mating the instrument and
cannula.
[0019] However, having a short instrument length allows for smaller
instrument size, as the flexing would diminish. In case of longer
instruments, a larger instrument size may be needed.
[0020] As the instrument is manipulated laterally at its handle,
the attached large gauge part of the instrument connecting to the
cannula moves into the desired position, and if needed, the
functioning part of the instrument is allowed to move in and out of
the surgical spot using secondary manipulation at the
instrument.
[0021] In a second embodiment, the cannula is geometrically similar
to what is currently used, with the difference being that the
instrument mates at the base of the cannula at the internal surface
of the cannula entry point.
[0022] In a third embodiment, the cannula is geometrically similar
to what is currently used, with the difference being that the
instrument mates at the base of the cannula at the internal and
external surfaces of the cannula entry point.
[0023] These and other features and advantages of the various
embodiments of devices and related systems, as set forth within the
present disclosure, will become more apparent to those of ordinary
skill in the art after reading the following Detailed Description
of Illustrative Embodiments and the Claims in light of the
accompanying drawing Figures.
BRIEF DESCRIPTION OF THE DRAWINGS
[0024] Accordingly, the within disclosure will be best understood
through consideration of, and with reference to, the following
drawing Figures, viewed in conjunction with the Detailed
Description of Illustrative Embodiments referring thereto, in which
like reference numbers throughout the various Figures designate
like structure, and in which:
[0025] FIG. 1A illustrates a representative of the traditional
design, prior art in a straight position;
[0026] FIG. 1B illustrates a representative of the traditional
design, prior art in a flexed position;
[0027] FIG. 1C illustrates a representative of the sleeve
reinforced design, prior art in a straight position;
[0028] FIG. 1D illustrates a representative of the sleeve
reinforced design, prior art in a flexed position;
[0029] FIG. 2A illustrates the first embodiment of the present
invention in the straight position;
[0030] FIG. 2B illustrates the first embodiment of the present
invention in the flexed position;
[0031] FIG. 2C illustrates the second embodiment of the present
invention in the straight position;
[0032] FIG. 2D illustrates the second embodiment of the present
invention in the flexed position;
[0033] FIG. 2E illustrates the third embodiment of the present
invention in the straight position;
[0034] FIG. 2F illustrates the third embodiment of the present
invention in the flexed position;
[0035] FIG. 3A illustrates deployment (when needed) of the
functioning part of the instrument for the first embodiment of the
present invention;
[0036] FIG. 3B illustrates the retraction (when needed) of the
functioning part of the instrument for the first embodiment (past
the cannula) of the present invention;
[0037] FIG. 3C illustrates an optional retraction (when needed) of
the functioning part of the instrument for the first embodiment
(within and including the edges of the cannula) of the present
invention;
[0038] FIG. 3D illustrates another optional retraction (when
needed) of the functioning part of the instrument for the first
embodiment (not reaching the cannula) of the present invention;
[0039] FIG. 4A illustrates deployment (when needed) of the
functioning part of the instrument for the second embodiment of the
present invention;
[0040] FIG. 4B illustrates the retraction (when needed) of the
functioning part of the instrument for the second embodiment (past
the cannula) of the present invention;
[0041] FIG. 4C illustrates an optional retraction (when needed) of
the functioning part of the instrument for the second embodiment
(within and including the edges of the cannula) of the present
invention;
[0042] FIG. 4D illustrates another optional retraction (when
needed) of the functioning part of the instrument for the second
embodiment (not reaching the cannula) of the present invention;
[0043] FIG. 5A illustrates deployment (when needed) of the
functioning part of the instrument for the third embodiment of the
present invention;
[0044] FIG. 5B illustrates the retraction (when needed) of the
functioning part of the instrument for the third embodiment (past
the cannula) of the present invention;
[0045] FIG. 5C illustrates an optional retraction (when needed) of
the functioning part of the instrument for the third embodiment
(within and including the edges of the cannula) of the present
invention; and
[0046] FIG. 5D illustrates another optional retraction (when
needed) of the functioning part of the instrument for the third
embodiment (not reaching the cannula) of the present invention.
DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS
[0047] In describing the several embodiments illustrated in the
Figures, specific terminology is employed for the sake of clarity.
The invention, however, is not intended to be limited to the
specific terminology so selected, and it is to be understood that
each specific element includes all technical equivalents that
operate in a similar manner to accomplish a similar purpose.
Additionally, in the Figures, like reference numerals shall be used
to designate corresponding parts throughout the several
Figures.
[0048] As illustrated in FIGS. 1A-1B, a representative, prior art
shows the typical functioning of an instrument through a
cannula.
[0049] In order to target an adjacent area, the instrument is
manipulated by changing the angle. The smaller the instrument, the
more flexing is observed.
[0050] Depending on the instrument, a certain flexing cannot be
exceeded without compromising its function.
[0051] The smaller diameters clearly show an increasing challenge
to effectively use the instrument
[0052] As illustrated in FIGS. 1C-1D, representative illustrations
of the prior art show the typical functioning of an instrument
through a cannula, using a sleeve reinforcement to limit the
flexing.
[0053] As in FIGS. 1A-1B, flexing is still occurring between the
base of the cannula and the instrument.
[0054] In this design, flexing is reduced; thus, allowing the use
of smaller instruments.
[0055] Such a design has its limitation, as smaller instruments
will bend sharply at the base of the cannula, risking catastrophic
failure, including but not limited to instrument failure or
breakage of a fiber optic caused by excessive bending.
[0056] Turning now to a discussion of the inventive aspects of the
present disclosure, and as illustrated in FIGS. 2A-2B, a large
sleeve 12 surrounds and mates with the base 22 of the cannula 20 on
the outside.
[0057] Manipulating the handle 14 of the instrument 10 causes the
short cannula 20 to reshape the entry location, without any stress
or bending on the functioning part 18 of the instrument 10.
[0058] As illustrated in FIGS. 2C-2D, a large sleeve 12 is inserted
and mates with the base 22 of the cannula 20 on the inside.
[0059] Manipulating the instrument 10 causes the short cannula 20
to reshape the entry location, without any stress or bending on the
functioning part 18 of the instrument 10.
[0060] As illustrated in FIGS. 2E-2F, a large sleeve 12 surrounds
the wall of the base 22 of the cannula 20 and mates with the base
22 of the cannula 20 on the inside and outside.
[0061] Manipulating the instrument 10 causes the short cannula to
reshape the entry location, without any stress or bending on the
functioning part 18 of the instrument 10.
[0062] As illustrated in FIGS. 3A-3D, the functioning part 18 of
the instrument 10 can be deployed using a mechanical mechanism 30
that advances it into the desired surgical position. In the fully
retracted position, the tip of the functioning part 18 of the
instrument 10 may be beyond the distal end of the cannula 20,
within the cannula 20, or prior to the proximal part of the cannula
20. These illustrations pertain to a first embodiment.
[0063] As illustrated in FIGS. 4A-4D, the functioning part 18 of
the instrument 10 can be deployed using a mechanical mechanism 30
that advances it into the desired surgical position. In the fully
retracted position, the tip of the functioning part 18 of the
instrument 10 may be beyond the distal end of the cannula 20,
within the cannula 20, or prior to the proximal part of the cannula
20. These illustrations pertain to a second embodiment.
[0064] As illustrated in FIGS. 5A-5D, the functioning part 18 of
the instrument 10 can be deployed using a mechanical mechanism 30
that advances it into the desired surgical position. In the fully
retracted position, the tip of the functioning part 18 of the
instrument 10 may be beyond the distal end of the cannula 20,
within the cannula 20, or prior to the proximal part of the cannula
20. These illustrations pertain to the third embodiment.
[0065] Having, thus, described exemplary embodiments of the subject
matter of the present disclosure, it is noted that the within
disclosures are exemplary only and that various other alternatives,
adaptations, and modifications may be made within the scope and
spirit of the present invention. Accordingly, the present subject
matter is not limited to the specific embodiments as illustrated
herein, but is only limited by the following claims.
* * * * *