U.S. patent application number 15/666784 was filed with the patent office on 2019-02-07 for surgical instruments for engaging tissue to stabilize tissue and facilitate tissue manipulation.
The applicant listed for this patent is COVIDIEN LP. Invention is credited to AMARSINH D. JADHAV, RAJAT R. ROKDE, YOGESH K. VIKHARANKAR.
Application Number | 20190038314 15/666784 |
Document ID | / |
Family ID | 65231294 |
Filed Date | 2019-02-07 |
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United States Patent
Application |
20190038314 |
Kind Code |
A1 |
JADHAV; AMARSINH D. ; et
al. |
February 7, 2019 |
SURGICAL INSTRUMENTS FOR ENGAGING TISSUE TO STABILIZE TISSUE AND
FACILITATE TISSUE MANIPULATION
Abstract
A surgical instrument includes a stationary shaft defining a
conduit and a movable shaft slidably disposed therein. A surgical
tool extends distally from the movable shaft and a cup extends
distally from the stationary shaft. The cup includes a body
defining one or more channels, an annular rim disposed at the
distal end portion thereof and defining a plurality of apertures
each in fluid communication with one of the channels, and a cap
disposed at the proximal end portion of the body and defining a
lumen fluidly coupling the one or more channels with the conduit. A
central aperture of the cap slidably receives the surgical tool
and/or the movable shaft as the movable shaft slides from a
retracted position, wherein the surgical tool is disposed
proximally of the distal end portion of the cup, and an extended
position, wherein the surgical tool extends through and distally
from the cup.
Inventors: |
JADHAV; AMARSINH D.;
(KARNATAKA, IN) ; ROKDE; RAJAT R.; (PUNE, IN)
; VIKHARANKAR; YOGESH K.; (NASHIK, IN) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
COVIDIEN LP |
MANSFIELD |
MA |
US |
|
|
Family ID: |
65231294 |
Appl. No.: |
15/666784 |
Filed: |
August 2, 2017 |
Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 17/4241 20130101;
A61B 1/00066 20130101; A61B 2017/308 20130101; A61B 17/0206
20130101; A61B 2017/2901 20130101; A61B 17/3417 20130101 |
International
Class: |
A61B 17/42 20060101
A61B017/42; A61B 1/00 20060101 A61B001/00; A61B 17/34 20060101
A61B017/34 |
Claims
1. A surgical instrument, comprising: a shaft assembly including a
stationary shaft and a movable shaft slidably disposed within the
stationary shaft, the stationary shaft defining a conduit extending
therethrough; a surgical tool extending distally from a distal end
portion of the movable shaft; a cup extending distally from a
distal end portion of the stationary shaft, the cup including: a
body including a proximal end portion and a distal end portion, the
body defining one or more channels extending from the proximal end
portion to the distal end portion thereof; an annular rim disposed
at the distal end portion of the body, the annular rim defining a
plurality of apertures therethrough, each aperture disposed in
fluid communication with one of the one or more channels; and a cap
disposed at the proximal end portion of the body, the cap defining
a lumen fluidly coupling the channels with the conduit, the cap
defining a central aperture configured to slidably receive at least
one of the surgical tool or the movable shaft therethrough, wherein
the movable shaft is slidable relative to the stationary shaft from
a retracted position, wherein the surgical tool is disposed
proximally of the distal end portion of the cup, and an extended
position, wherein the surgical tool extends through and distally
from the cup.
2. The surgical instrument of claim 1, wherein the surgical tool is
a tissue-engaging implement.
3. The surgical instrument of claim 2, wherein the tissue-engaging
implement is a screw.
4. The surgical instrument of claim 3, wherein the screw defines a
corkscrew-shaped configuration.
5. The surgical instrument of claim 1, wherein the plurality of
apertures is equally-spaced about a circumference of the annular
rim of the cup.
6. The surgical instrument of claim 1, further including a
compliant annular ring disposed about the annular rim of the cup,
wherein the plurality of apertures extends through the compliant
annular rim.
7. The surgical instrument of claim 1, wherein the movable shaft is
rotatable relative to the stationary shaft to rotate the surgical
tool relative to the cup.
8. The surgical instrument of claim 1, wherein the stationary shaft
defines an inlet opening at a proximal end portion thereof, the
inlet opening disposed in fluid communication with the conduit and
adapted to connect to a pump.
9. A surgical system, comprising: a pump; and a surgical
instrument, including: a shaft assembly including a stationary
shaft and a movable shaft slidably disposed within the stationary
shaft, the stationary shaft defining a conduit extending
therethrough, a proximal end portion of the conduit fluidly coupled
to the pump; a surgical tool extending distally from a distal end
portion of the movable shaft; a cup extending distally from a
distal end portion of the stationary shaft, the cup including: a
body including a proximal end portion and a distal end portion, the
body defining one or more channels extending from the proximal end
portion to the distal end portion thereof; an annular rim disposed
at the distal end portion of the body, the annular rim defining a
plurality of apertures therethrough, each aperture disposed in
fluid communication with one of the one or more channels; and a cap
disposed at the proximal end portion of the body, the cap defining
a lumen fluidly coupling the channels with the conduit, the cap
defining a central aperture configured to slidably receive at least
one of the surgical tool or the movable shaft therethrough,
wherein, upon activation of the pump, suction is established
through the conduit, the lumen, the one or more channels, and the
apertures.
10. The system of claim 9, wherein the movable shaft is slidable
relative to the stationary shaft from a retracted position, wherein
the surgical tool is disposed proximally of the distal end portion
of the cup, and an extended position, wherein the surgical tool
extends through and distally from the cup.
11. The system of claim 9, wherein the surgical tool is a
tissue-engaging implement.
12. The system of claim 11, wherein the tissue-engaging implement
is a screw defining a corkscrew-shaped configuration.
13. The system of claim 9, further comprising a connector fluidly
coupling the pump with the proximal end portion of the conduit.
14. The system of claim 9, further including a compliant annular
ring disposed about the annular rim of the cup, wherein the
plurality of apertures extends through the compliant annular
rim.
15. The system of claim 9, wherein the movable shaft is rotatable
relative to the stationary shaft to rotate the surgical tool
relative to the cup.
16. A method, comprising: positioning a cup against a target area
of the tissue; applying suction to the cup to suction the target
area of tissue against the cup, thereby stabilizing the target area
of tissue; and advancing a surgical tool through an interior of the
cup and into engagement with the target area of tissue.
17. The method of claim 16, wherein the surgical tool is advanced
and rotated into engagement with the target area of tissue.
18. The method of claim 16, further including maneuvering the
surgical tool to manipulate the target area of tissue.
19. The method of claim 18, further including cutting the target
area of tissue.
Description
TECHNICAL FIELD
[0001] The present disclosure generally relates to surgical
instruments, and more particularly, to surgical instruments for
engaging tissue, such as, for example, uterine tissue, to stabilize
tissue and facilitate manipulation of the tissue.
BACKGROUND
[0002] Certain surgical procedures are performed to remove uterine
tissue, such as hysterectomies, fibroidectomies, myomectomies, and
the like. One or more of these procedures can be performed
laparoscopically by passing surgical instrument(s) down a cannula
so that a distal working end of the surgical instrument(s) can be
positioned within an internal surgical site, while operated from a
proximal manipulator of the surgical instrument(s). In these
instances, a surgical instrument inserted through an abdominal
cannula may be utilized to engage a uterus, uterine fibroids (known
as leiomyomas), or other tissue to enable manipulation of the
tissue relative to a moving cutting tool, such as a morcellator,
operating within the internal surgical site.
[0003] To stabilize the uterus or other tissue during a procedure,
for example, the clinician may employ mechanical graspers or a
screw. However, due to the slippery nature of uterine tissue and
its size and bulky shape, the clinician may be required to make
several attempts to reposition the mechanical graspers and/or screw
in order to secure the uterus or other tissue in position. Thus,
although mechanical graspers and screws are effective, they may be
improved.
SUMMARY
[0004] As used herein, the term "distal" refers to the portion that
is being described that is further from a user, while the term
"proximal" refers to the portion that is being described that is
closer to a user. Further, to the extent consistent, any of the
aspects described herein may be used in conjunction with any of the
other aspects described herein.
[0005] A surgical instrument provided in accordance with aspects of
the present disclosure includes a shaft assembly, a surgical tool,
and a cup. The shaft assembly includes a stationary shaft and a
movable shaft slidably disposed within the stationary shaft. The
stationary shaft defines a conduit extending therethrough. The
surgical tool extends distally from a distal end portion of the
movable shaft. The cup extends distally from a distal end portion
of the stationary shaft. The cup includes a body, an annular rim,
and a cap. The body includes a proximal end portion and a distal
end portion and defines one or more channels extending from the
proximal end portion to the distal end portion thereof. The annular
rim is disposed at the distal end portion of the body and defines a
plurality of apertures therethrough, each of which is disposed in
fluid communication with one of the channels. The cap is disposed
at the proximal end portion of the body and defines a lumen fluidly
coupling the channels with the conduit and a central aperture
configured to slidably receive the surgical tool and/or the movable
shaft. The movable shaft is slidable relative to the stationary
shaft from a retracted position, wherein the surgical tool is
disposed proximally of the distal end portion of the cup, and an
extended position, wherein the surgical tool extends through and
distally from the cup.
[0006] In an aspect of the present disclosure, the surgical tool is
a tissue-engaging implement. The tissue-engaging implement may be a
screw and, more specifically, may be a screw defining a
corkscrew-shaped configuration.
[0007] In another aspect of the present disclosure, the plurality
of apertures is equally-spaced about a circumference of the annular
rim of the cup.
[0008] In still another aspect of the present disclosure, a
compliant annular ring is disposed about the annular rim of the
cup. In such aspects, the plurality of apertures extends through
the compliant annular rim.
[0009] In yet another aspect of the present disclosure, the movable
shaft is rotatable relative to the stationary shaft to rotate the
surgical tool relative to the cup.
[0010] In still yet another aspect of the present disclosure, the
stationary shaft defines an inlet opening at a proximal end portion
thereof. The inlet opening is disposed in fluid communication with
the conduit and adapted to connect to a pump.
[0011] A surgical system provided in accordance with aspects of the
present disclosure includes a pump and a surgical instrument. The
surgical instrument includes a shaft assembly, a surgical tool, and
a cup. The shaft assembly includes a stationary shaft and a movable
shaft slidably disposed within the stationary shaft. The stationary
shaft defines a conduit extending therethrough having a proximal
end portion fluidly coupled to the pump. The surgical tool extends
distally from a distal end portion of the movable shaft. The cup
extends distally from a distal end portion of the stationary shaft.
The cup includes a body, an annular rim, and a cap. The body
includes a proximal end portion and a distal end portion and
defines one or more channels extending from the proximal end
portion to the distal end portion thereof. The annular rim is
disposed at the distal end portion of the body and defines a
plurality of apertures therethrough, each of which is disposed in
fluid communication with one of the channels. The cap is disposed
at the proximal end portion of the body and defines a lumen fluidly
coupling the channels with the conduit and a central aperture
configured to slidably receive the surgical tool and/or the movable
shaft. Upon activation of the pump, suction is established through
the conduit, the lumen, the one or more channels, and the
apertures.
[0012] In an aspect of the present disclosure, the movable shaft is
slidable relative to the stationary shaft from a retracted
position, wherein the surgical tool is disposed proximally of the
distal end portion of the cup, and an extended position, wherein
the surgical tool extends through and distally from the cup.
[0013] In another aspect of the present disclosure, the surgical
tool is a tissue-engaging implement. The tissue-engaging implement
may be a screw and, more specifically, may be a screw defining a
corkscrew-shaped configuration.
[0014] In yet another aspect of the present disclosure, the system
further includes a connector fluidly coupling the pump with the
proximal end portion of the conduit.
[0015] In still another aspect of the present disclosure, a
compliant annular ring is disposed about the annular rim of the cup
including the plurality of apertures extending therethrough.
[0016] In still yet another aspect of the present disclosure, the
movable shaft is rotatable relative to the stationary shaft to
rotate the surgical tool relative to the cup.
[0017] A method provided in accordance with aspects of the present
disclosure includes positioning a cup against a target area of the
tissue, applying suction to the cup to suction the target area of
tissue against the cup, thereby stabilizing the target area of
tissue, and advancing a surgical tool through an interior of the
cup and into engagement with the target area of tissue.
[0018] In an aspect of the present disclosure, the surgical tool is
advanced and rotated into engagement with the target area of
tissue.
[0019] In another aspect of the present disclosure, the method
further includes maneuvering the surgical tool to manipulate the
target area of tissue.
[0020] In another aspect of the present disclosure, the method
further includes cutting the target area of tissue.
BRIEF DESCRIPTION OF THE DRAWINGS
[0021] The above and other aspects and features of the present
disclosure will become more apparent in light of the following
detailed description when taken in conjunction with the
accompanying drawings, in which:
[0022] FIG. 1 is a front, perspective view of a surgical instrument
provided in accordance with aspects of the present disclosure;
[0023] FIG. 2 is an enlarged, front, perspective view of a cup of
the surgical instrument of FIG. 1;
[0024] FIG. 3 is an end view of the cup of FIG. 2 with the annular
ring removed therefrom;
[0025] FIG. 4 is a longitudinal, cross-sectional view of the
surgical instrument of FIG. 1, shown operably coupled to a
pump;
[0026] FIG. 5 is a rear, perspective view of the surgical
instrument of FIG. 1, shown operably coupled to a pump; and
[0027] FIGS. 6 and 7 are perspective views of the surgical
instrument of FIG. 1 in use engaging tissue to stabilize tissue and
facilitate manipulation of tissue.
DETAILED DESCRIPTION
[0028] Surgical instruments configured to engage tissue to
stabilize tissue and facilitate manipulation of tissue are
provided, each generally including a shaft assembly having a
movable member with a distal end portion including a screw
extending distally therefrom and a stationary member defining a
vacuum conduit, and a cup having a cap through which the movable
member is slidably disposed and to which the stationary member is
coupled. A vacuum pump may be coupled to the stationary member to
provide suction to the cup via the vacuum conduit. In use, the
surgical instrument is maneuvered such that the cup is disposed
about a target area of tissue. The vacuum pump is then turned on to
suction the target area to the cup, thereby stabilizing the target
area to enable advancement of the movable member distally towards
the target area to engage the target area with the screw. In
embodiments, the movable member may be simultaneously advanced and
rotate to thereby rotate the screw into engagement with the target
area. Fluid, debris, and/or other biological matter may be
collected within the cup and carried away via the suction. These
and other aspects and features of the present disclosure are
detailed below.
[0029] With reference now to FIGS. 1-4, a surgical instrument
provided in accordance with the present disclosure and configured
to engage tissue to stabilize tissue and facilitate manipulation of
tissue is shown generally identified by reference numeral 100.
Surgical instrument 100 includes a shaft assembly 102, a screw 104
extending distally from the shaft assembly 102, and a cup 106
having a central opening 108 through which the shaft assembly 102
extends. To permit the cup 106 to be suctioned against a surface of
tissue, a rim portion 110 of the cup 106 includes one or more
suction holes 112 communicating with radial apertures 116 in a cap
118 covering the central opening 108 of the cup 106 and the radial
apertures 116 communicate, via channel(s) 121 and annular lumen
142, with a vacuum lumen 120 that extends through at least a
portion of the shaft assembly 102 to a proximal end portion 122 of
shaft assembly 102 that is configured to couple to a vacuum pump
114 via a pump connection 180 (see FIG. 4).
[0030] The cup 106 is generally dome-shaped with the central
opening 108 formed in the apex of the dome. In embodiments, the cup
106 is made of a durable, biocompatible plastic or polymer and may
be transparent or semi-transparent. Other suitable materials
configured to maintain structural integrity the cup 106 when
pressurized are also contemplated.
[0031] The cup 106 is made up of a body 109 having an outer surface
126 and an inner surface 128 that defines an interior cavity 130.
The body 109 includes one or more channels 121 formed between the
outer and inner surfaces 126, 128, which extend from the rim
portion 110 of the cup 106 to the central opening 108 of the cup
106. The one or more channels 121 terminate at the rim portion 110
at corresponding suction holes 112. Although the outer and inner
surfaces 126, 128 are illustrated as being smooth such that the
presence of the channel(s) 121 is not immediately visibly
detectable, it will be appreciated that the outer surface 126
and/or inner surface 128 of the cup 106 may alternatively include
ridges beneath which the channel(s) 121 are located. Further,
although suction holes 112 are illustrated as generally circular,
other suitable configurations, e.g., slotted, elongated,
rectangular, etc., are also contemplated. Additionally, although
distinct channels 121 are illustrated, it is also contemplated that
one or more channels 121 be formed via a hollow or partially hollow
(with or without partitions) body 109 of the cup 106.
[0032] In embodiments, an annular ring 138 is disposed over the rim
portion 110 of the cup 106 to cover the distally-facing surface and
inner and outer edges of the rim portion 110 of the cup 106. The
annular ring 138 may define apertures that communicate with
apertures or other openings defined within the rim portion 110 to
define suction holes 112 therethrough. The annular ring 138 may be
formed of a compliant material, such as rubber, a foam, a polymeric
material, or the like, and may be adhered with an adhesive or
molded over the rim portion 110 of the cup 106.
[0033] Continuing with reference to FIGS. 1-4, as noted above, the
plurality of channels 121 extending through the body 109 of the cup
106 terminate at the central opening 108. The cap 118 is disposed
about the outer surface 126 of the cup 106 at the apex thereof and,
more particularly, over the central opening 108. The cap 118
defines radial apertures 116 that align with corresponding outlets
of the one or more channels 121. The radial apertures 116 provide
communication with an annular lumen 142 formed in the cap 118, and
the annular lumen 142 communicates with the vacuum lumen 120 that
extends through at least a portion of the shaft assembly 102, as
described in detail below. The cap 118 further includes a central
aperture 144 within which a portion of the shaft assembly 102 is
slidably disposed. Although not specifically depicted, in other
embodiments, the cap 118 is disposed on the inner surface 128 of
the cup 106 within the interior cavity 130 defined by the body 109
of the cup 106.
[0034] The shaft assembly 102 includes a movable member 150 and a
stationary member 152. The movable member 150 extends through a
main lumen 154 formed through the stationary member 152 and has a
length that is greater than that of the stationary member 152. In
particular, the movable member 150 is configured to have a middle
portion that is the length of the stationary member, a distal end
portion 156 that extends distally from the stationary member 152
and through the central opening 108 of the cup 106 at least
partially through the interior cavity 130 of the cup 106, and a
proximal end portion 158 that extends from the stationary member
152 in a proximal direction a length that is sufficient to enable
manipulation of the movable member 150 relative to the stationary
member 152 to advance the distal end portion 156 of the movable
member 150 into tissue a desired distance.
[0035] In embodiments, the distal end portion 156 of the movable
member 150 includes the screw 104. The screw 104 is made of
stainless steel or another biocompatible material capable of
maintaining structural integrity when inserted into tissue and is
spiral or corkscrew shaped. The screw is engaged to the distal end
portion 156 of the movable member 150 and extends distally
therefrom. The screw 104 has a tip 160 that is sharp in order to
more easily puncture tissue when the screw 104 is rotated in a
particular direction. In other embodiments, the tip 160 is
blunt.
[0036] The proximal end portion 158 of the movable member 150
extends proximally out of the main lumen 154 of the stationary
member 152, as noted above, so as to provide a handle portion 162
for manipulation, e.g., translation and/or rotation, by a user. The
handle portion 162 may include a textured surface, knob, or other
mechanical feature to improve the user's grasp of the movable
member 150. In embodiments, the movable member 150 slidably
contacts the interior surface of the stationary member 152 that
defines the main lumen 154. In other embodiments, a small annular
gap is maintained between the movable member 150 and the surface of
the stationary member 152 in any suitable fashion, e.g., via
washers, bearings, etc.
[0037] The stationary member 152 is configured to maintain its
stiffness throughout the entirety of a surgical procedure. As
illustrated in FIG. 4, a distal end portion 164 of the stationary
member 152 extends through the central aperture 144 of the cap 118.
The stationary member 152 may be either temporarily or permanently
coupled to the cap 118. An annular opening 166 is formed in the
distal end portion 164 of the stationary member 152 and is aligned
with the annular lumen 142 of the cap 118. In other embodiments, a
plurality of annular openings is included in the distal end portion
164, each annular opening being aligned with the annular lumen 142.
The vacuum lumen 120 extends from the radial annular opening 166 to
one or more vacuum pump inlet openings 172 formed at the proximal
end portion 122 of the stationary member 152. In embodiments, with
additional reference to FIG. 5, a pump connection 180 is coupled to
the one or more inlet openings 172. In other embodiment, two pump
connections 180, 180a (shown in phantom) are coupled to
corresponding ones of the inlet openings 172.
[0038] With reference to FIGS. 6 and 7, in conjunction with FIGS.
1-4, during a surgical procedure, the surgical instrument 100 is
navigated to a target area of tissue with the movable member 150 of
the shaft assembly 102 disposed in a retracted position, wherein
the screw 104 is disposed within the main lumen 154 of the
stationary member 152 or protruding minimally therefrom into (but
not beyond) the internal cavity 130 of the cup 106.
[0039] Once disposed in a desired position, the annular ring 138
disposed on the rim portion 110 of the cup 106 is urged against the
surface of the target area of tissue 600, and the vacuum pump 114
is activated to a powered on condition. As a result, suction is
created through the vacuum lumen 120 of the stationary member 152
of the shaft assembly 104, the annular lumen 142 of the cap 118,
the channels 121 of the cup 106, and the suction holes 112 defined
through rim portion 110 of the cup 106 and the annular ring 138 to
cause the cup 106 to be suctioned to the target area of tissue 600.
In this manner, the cup 106 stabilizes the target area of tissue
600.
[0040] With the surgical instrument 100 suctioned to the target
area of tissue 600, the proximal end portion 158 of the movable
member 150 is urged distally relative to the stationary member 152
to advance the distal end portion 156 of the movable member 150
and, thus, screw 104 into the target area of tissue 600. In
embodiments, the proximal end portion 158 of the movable member 150
is rotated relative to the stationary member 152 in a direction
corresponding to the corkscrew shape of the screw 104 during the
distal advancement of the movable member 150 to permit the screw
104 to engage and embed within the target area of tissue 600. By
using the suction provided by cup 106, engagement of the screw 104
within the target area of tissue 600 is more easily, accurately,
and securely achieved.
[0041] The suction provided by cup 106 also enables fluid, debris,
and/or other biological matter to be suctioned into the cup 106 and
carried away via the suction path detailed above. This may be
accomplished before suctioning the cup 106 to the target area of
tissue 600, after suctioning the cup 106 to the target area of
tissue 600, and/or while the cup 106 is suctioned to the target
area of tissue 600. Additional apertures communicated with the
suction path may be provided on the interior surface 128 of the
body 109 of the cup 106, the exterior surface 126 of the body 109
of the cup 106, and/or on another portion of the cup 106 for these
purposes.
[0042] Once screw 104 is engaged within the target area of tissue
600, shaft assembly 102 may be maneuvered to manipulate the target
area of tissue 600 to a desired orientation and/or position such
as, for example, to facilitate cutting, e.g., morcellating, the
target area of tissue 600. Alternatively, stationary member 152 and
cup 106 may be withdrawn proximally about movable member 150 such
that movable member 150 may be maneuvered to manipulate the target
area of tissue 600 to a desired orientation and/or position.
[0043] The embodiments disclosed herein are examples of the
disclosure and may be embodied in various forms. For instance,
although certain embodiments herein are described as separate
embodiments, each of the embodiments herein may be combined with
one or more of the other embodiments herein. Specific structural
and functional details disclosed herein are not to be interpreted
as limiting, but as a basis for the claims and as a representative
basis for teaching one skilled in the art to variously employ the
present disclosure in virtually any appropriately detailed
structure Like reference numerals may refer to similar or identical
elements throughout the description of the figures.
[0044] It should be understood that the foregoing description is
only illustrative of the present disclosure. Various alternatives
and modifications can be devised by those skilled in the art
without departing from the disclosure. Accordingly, the present
disclosure is intended to embrace all such alternatives,
modifications and variances. The embodiments described with
reference to the attached drawing figures are presented only to
demonstrate certain examples of the disclosure. Other elements,
steps, methods, and techniques that are insubstantially different
from those described above and/or in the appended claims are also
intended to be within the scope of the disclosure.
* * * * *