CA2210523A1 - Surgical instrument - Google Patents
Surgical instrumentInfo
- Publication number
- CA2210523A1 CA2210523A1 CA002210523A CA2210523A CA2210523A1 CA 2210523 A1 CA2210523 A1 CA 2210523A1 CA 002210523 A CA002210523 A CA 002210523A CA 2210523 A CA2210523 A CA 2210523A CA 2210523 A1 CA2210523 A1 CA 2210523A1
- Authority
- CA
- Canada
- Prior art keywords
- instrument
- tube
- window
- base
- shield
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
- A61B17/32002—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/003—Steerable
- A61B2017/00318—Steering mechanisms
- A61B2017/00331—Steering mechanisms with preformed bends
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/3209—Incision instruments
- A61B17/3211—Surgical scalpels, knives; Accessories therefor
- A61B2017/32113—Surgical scalpels, knives; Accessories therefor with extendable or retractable guard or blade
Abstract
A surgical instrument (10) includes a support member that extends distally from a base (20), carrying at a distal region a window (31) defining an opening. A surgical tool (12) at least partially disposed in the distal region is movable with respect to the window (31) to cut tissue extending through the opening. A shield (26) also at least partially disposed in the distal region is movable with respect to the window (31) to at least partially cover the opening.
Description
SURG~C~I INSTI7.UMENT
This invention relates to surgical instrumentsl and in particular to powered arthroscopic surgical instruments.
Powerl3d arth,~s _~ic surgical instrurnents typically include a rigid, slc-lion~ry outer tube within which a rigid inner tube is rOtdt-J
by a motor. A cutting implement, such as a blade or abrading burr, is disposet on the distal end of the inner tube. Tissue or bone is 10 ~Yrc~s~ to the cutting implement through an Gpenirl~ in the distal end of the outer tube, and tissue or bone r,ay",~, IL:a cut by the rotating blade or burr are drawn thro~h the interior of the inner tube along with i"i~ g fluid by the use of suction applied at the pr~,~i" ,al end of the instrurnent. Examples of such sur~ical 15 instruments are described in ~J.S. Patent Nos 4,2031444, 4,274,414, 4~834,729, and 4,842,578, all of which are assigned to the present assignee Some arthrosco~ic surgical instruments are linear, that is, ZO straight between their proximal and distal ends. Others are curved to rdcilita~ positioning the cutting i",ple".t:"l against tissue to be cut without requiring that the instrument be rernoved from the body and reinserted through an ~dr1itional puncture In a curved instrument, a region of the inner tube is flexible to enable the inner tube to accept 25 the curvature imposed by the outer tube while lldnsrl,iLli, ,~ the torque ~pplied by the motor to the blade.
The cutting implernent ~ ros~ at the distal end of instruments of the prior art have tended to lack ~ alilit~ in their 30 control with the e~cision of tissue being ~all or nothing" event. In certain circumstances, the cutting of tissue may necessit~te careful and delicate use of the cutting i.I~p~e,~ t. In other circumstances, a CA 022l0523 l997-07-24 W O96/25103 PCTrUS96/01920 more aggressive approach may be needed. Instruments of the prior art tend to la~k this versatility and thus the ~ucoP~-s of an operation may lie more in the skill of the surgeon to control the cutting implement than might otherwise be desired.
It is an object of the pr~ser,l invention to overcome, or at least alleviate, this proble,...
Accordingly, there is provided a surgical instrument 10 comprising a base, a suppor~ member extending distally frorn said base and carrying at a distal region a window defining an openirlg, a surgical tool a~ least partially disposed in said distal region and movable to cut tissue eAb,.Jing through said opening 15 characterised by the fact that said support r..ei ,.ber is provided with a shield at least partially ~icposed in said distal region and movable with respect to said window to at least partially cover said opening.
One general aspect of the invention is a surgical instrument in 20 which a movable shield can be positioned to at least partially cover the distal opening in a support, I ,e, . ~L ~r Another general aspect of the invention is a method for using the surgical instrument. In still another general ~spe~t the support ,.,~"l~e:r has a pair of openings in its distal end. either of which can be seleetively covered by the 25 movable shield.
Among other advd"~as~es, the invention allows the user to partially or completely cover the Gpe~ l9 by moving the shield, thereby preventing at least some tissue frorn entering into the 30 instrument through the opening and being cut by the surgical tool.
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WO 96t25103 PCT/US96/01920 As a result, the cutting action of the surgical tool can be reduced or s~'~ by appro~,.i..Le positioning of the shield.
Moreover, v~lhere the surgical instrument has a pair of openings at its distal end, the invention allows the user to partially or completely cover one of the oper.i- I95 by moving the shield, thereby preventing at least some tissue from entering into the instrument through that op~r,i"~ and being cut by the surgical tool. As a result, by a~l,,upriate positioning of the shield, the user can select be~vccn 10 windows that have, for example, different cutting configurations and different rot..liGnal ol ier.l; Itions.
For il.ald,-ce, one window can be configured for more dyy,essive cuKing than the other. The preferred degree of cutting 15 can thus be Lhose~ l by moving the shield to cover the opening of the ~i.ld~,v: having the ur,Jasired cutting ~,lldr~.;~istics. Moreover, the windows may be locAt~l at different ~utdlio"al .Jrit:~lldtiuns around the distal region of the support rllel"ber. l hus, even if their cutting char~Leri~tics are idenlicdl, the w;nclo~rs ~.an be selectively covered 20 and uncovered to ~Jldrl9e the di,~clion of eutting of the instrument.
Preferred embodirnents include the following features.
In a particularly useful embodiment, an act~ting member 25 (e.g., a tube Go~Yi~lly disposed ol~tside the support rllelllbar) e~ ls distally from the base, and transmits a lot.~iG~ ~al force applied at a proximal end to move the shield, which is attached to a distal end of the actuating member. The ~ru~i,,Idl end of the ~ctll~ti-lg ~ ."~cr is rigidly secured to a knob ~ dtably mounted to a 30 stationary portion of the base The knob may be selectively rotated to a plurality of discrete posiliGns with r~s~e~l to the base. allowing W O 96/25103 PCTrUS96/01920 the shield to be positioned to a corresponding plurality of discrete rotational o.ientdlions. 8ec~ ce the ~ t~ tirl9 member is rotatably coupled to the base, the openings may be selectively covered and uncovered while the instrurnent remains in situ within the patient.
A drive member (e.g., a tube dispose~l coaxially within the support member) c~ nl~s distally from the base, and transmits a rotational force applied at a ,uro~ al end to move at least a portion of the surgical tool, a cutting implement attached to a distal end of 10 the drive member. As the drive mernber rotates, the edges of the cutting implement move toward and closely past the edges of the windows. A hollow p:~c~ge in the tubular drive member is adapted to receive suction at its proximal end, transporting body material cut by the cutting imp!e,..,~nL away from a surgical site while the 15 instrument remains in situ for further cutting.
The support member (e.g., a tube) couples to the base in a manner that allows it to slide axially with ,~:spe~ to the ba-~e. During assembly, the support tube is inserted into the ~otl~tor tube, and 20 the A~tu~tor tube is atta~hed to the base. When the drive tube is then inserted into the support tube, the outer surface of the distal tip of the drive tube bears against the inner surface of the distal tip of the support tube Because the support tube can slide axially with respect to the base, this forces the supporl tube distally until the 25 outer surface of the distal tip of the support tube bears agai"st the inner surface of the distal tip of the aoh~tnr tube. Thus, when ass~i"bl~d, there is little or no gap ~ JJccn the distal tips of the various tubes This reduces the amount of severed tissue, fluid, and other ",atl::,ial that would othe~ise pass into the annular regions 30 separating the three tubes.
In all~:nlate embodiments of the present invention, the support tube is bent, and an actuating .,lel.,ber extending distally from the base is relatively flexible at least in the bend region, allowing the actuating member to transmit force through the bend S region to move the shield For ioatance, the ~ ting member (e.g., a tube r~ispos~-i outside the support r~mLt r) and the drive tube may both be relieved with a series of axially sp~ed slots in the region of the bend. This arrangement provides the actuating and drive tubes with the requisite transverse flexibility to accommodate 10 the bend, and the n~cess~ry torsional ~tirr"ess to rotate the shield and the cutting implement, r~ ctively RF!r~llsf~ it is bent, the instrument may be used to operate on surgical areas that would otherwise be difficultto reach with a sllaiyl,t-shafted instrurrent.
In other embodiments, a relatively rigid sheath is dispo~e~l co:~Yi-"y with, and is axially s~ with respec~ to, the bent support "-~n,~:r, which is relatively d~ru.-"a~le at least in the bend region.
By sliding the rigid sheath fore and aft along the support m t:."L:r to selectiYely cover and uncover the bend region, a surgeon may 20 ~ ,ye the angle of offset provided by the bend region, all while the instrument f~",ains in sity within the patient.
Other features and advantages of the invention will ~e~o",e apparent from the r~ L ~J;n9 de'~ s~ iun, and from the daims ~ig. 1 is a top view of a surgical instrument.
Fig. 2 is a sectional side view of the surgical instrument, taken along line Z-2 of Fig. 1 Fig. 3 is a side view of the surgical instrument, taken along 30 line 3-3 of Fig. 1 Fig. 4 is a cross-s~l;tiGnal side vjew of a distal region of the surgica1 instrument.
Fig. 5 is a perspective view of a distal region of the i"ler",ediate tube of the surgical instrument.
Figs. 6 and 7 are top and side views, respectively, of the distal region of the inter",~id~ tube of the surgical instrument.
Fig. 8 is a sectional view of the distal region of the intermediate tube of the surgical instrument, taken along line 8-8 of Fig. 7.
Fig. 9 is an end view of the distal region of the intermediate tube of the surgical instrument, taken alon~ line 9-9 of Fig. 7.
Figs. 10, 11, and 12 show inner, i"k,r",~:diate, and outer tubes, respectively, o~ the surgical instrument.
Fig. 13 is a sectional view of a ratchet mechanism of the 1~ surgical instrument, taken along line 13-13 of Fig. 1.
Fig. 14 sho~vs the surgical instrument in use.
Fig. 15 shows another embodiment of a surgical instrument.
Fig. 16 shows another e",boJi~nent of a surgical instrument.
As shown in Figs. 1, 2, and 3, a surs3iGal instrument 10 suitable for pe,rur-,-ing, e.g., closed, arthroscopic surSery on the knee with a surgical tool 12, includes an inter,l,ediate tube 14 within which a rotating innertube 16 is c~Yi~~y di~po5ed. In turn, intermediate tube 14 is a~Yi~ly disposed within a rotatable outer 25 tube 18. Tubes 14, 16, and 18 extend distallyfrom a base 20.
Referring also to Fig. 4, a distal region of outer tube 1~ is partially cut away to form an aperture 22, which extends to the longitudinal axis 24 of instrument 10. The remaining, solid portion of 30 the distal region of outer tube 18 co" ",, ises a shield 26. As outer tube 18 is rotated relative to i"l~,r"~diate tube 14, shield 26 Wo 96/25103 PCT/US96/01920 altemately covers and uncovers an incisor window 28 and a synovator ~indow 30 locatPd on oF,posil~: sides o~ a window dSS~ y 31 carried at the distal end of i"l~r" lediate tube 14.
As shown in Figs ~-9, the edges 32 of incisor window 28 are sha, ~ e. Iell and serrated, and the edges 34 of synovator windo~v 30 are sharpened and smooth. Referring to Fig. 4, a window 35 fc~(".ed by the sharpened, smooth edges 37 of a cutting impiement 36 carried at the distai end of inner tube 16 is periodically ex~,osed 10 through incisor window 28 and synovator ~r~ o~l/ 30 as inner tube 16 rotates. Thus, tissue entering through either incisor window 28 or synovator v~indow 30 (dq,en~Jing on the ,~Jtdtional oric' ,Ldtion of shield 26) can extend into the interior of inner tube 16. As inner tube 16 rotabs, edges 37 o~ cutting implement 36 move toward and 15 closely past edges 32, 34 of W;l~vrs 28, 30 in ~J;.Id~N asse,.~61y 31, severing the tissue projecting It.orell,r~ugh. Together, cuffing implernent 36 and window ass~",bly 31 cu"-prise sursical tool 12.
Inner tube 16 is made from metal or other rigid material, such 20 as stainless steel As shown in Fig. 10, the distal end 40 of inner tube 16 supports cutting il "plel l .ent 36 (made frorn, for example, stainless steel and attached to tube 16 by uI~hli, ,~ or brazing).
Cutting implement 36 is sized to provide a close-running fit with the inner portion of w;, ,du~ assembly 31 for t:r~ jF .l cutting. The 25 o~ui"g defined by window 35 in i-l,ple~ nt 36 is an extension of a central pz~5s~3~e 46 in inner tube 16 that runs the entire length of tube 16.
rlu~i",al region 48 of innertube 16 is rigidly mounted to a 30 drive shaft 50 that rotates within base 20, sho~vn also in Fig. 2.
Centra1 p~ss ~e 46 te,l"i,lates in a vacuum source opening 5Z In =
CA 022l0523 l997-07-24 W O96/25103 PCTrUS96/01920 drive shaft 50. The pr~Ai",dl end 54 of drive shaft 50 fits into a handpiece 110 (~ig. 14) which includes a motor 112 for lvl~Ling drive shaft 50 and inner tube 16 with respect to both interrnediate tube 14 and outertube 18. One l::AdlJ~ e of such a handpiece is ~escribed in U.S. Patent No. 4 705 038 e"ti~l~ "Surgical System for Powered Instruments", and assigned to the present assignee which is incorporated by reference. Opening 52 i~ coupled to a vacuum source 114 (Fig 14) during operation to remove severed tissue and irrigating fluid from the surgical site via p~c5~9~ 46 in a 10 manner des. ~ ed in debil below.
.
Fig. 11 shows illlellrl~.liaLt: t~be 14 which is also made ~rom a rigid material such as stainless steel or other metal. Distal end 56 of in~e""adiate tube 14 supports wi.ld~JJv assembly 31 (made from~
15 for C~dn~ E, stainless steel and attached to tube 14 by welding or brazing). The inner and outer~ ",e:le,~ o~window assembly 31 are substantially equal to the inner and outer di~rll~L~ of tube 14.
Intermediate tube 14 is hollow along its entire length to 20 provide a pass~ge 60 that receives inner h~be 16 and outting i" ~lo .,enl 36 which exten-l~ to the partially closed distal end 62 of window assembly 31 The openings defined by windows 28 30 in window assel"bly 31 are u ~t~nsions of ~ J~ 60. The inner diameter of i,.te""ediate tube 14 is only slightly larger than the outer 25 diameter of inner tube 16 ~e.g. by appru~i--,ately 0.002 inches or 0.051 mm) This allows inner tube 16 to ratate freely but helps minimize wobbling of tube 16 to keep sharp cutting edges 37 of cutting implement 36 and edges 32, 34 of v~lindo~vs 28 30 closely aligned.
W O96/2S103 PCTnUS96/01920 The proximal end 63 of intermediate tube 16 is rigidly mounted to a coupling 64 loc~ted within a cavity 66 of a hub 68 of base 20, shown also in Fig. 2. Cavity 66 includes an axially extending keyway 70 sized and lc~c.lled to recei~e a key 74 on 5 coupling 64. Thus, although coupling 64 can move axially with respect to hub 68, key 74 prevents coupling 64 from rotating.
Cavity 66 in hub 68 communicates with p~ss~ge 60, and is configured to receive drive shaft 50. During as~c:,,,l,ly,after outer 10 tube 18 has been attached to hub 68 in the manner desc, iLe~
below, innertube 16 is in~ d through hub 68 into p~s~ 60 of inter",adiate tube 14. When the distal tip 78 of cutting implement 36 (Fig. 10) contacts the inner surface of the distal tip 62 of window assembly 31, coupling 64 and intermediate tube 14 are forced 15 distally, until the outer surface of distal tip 62 contacts the inner surface of the partially closed distal tip 80 of oubr tube 18. Thus~
because inter",~Jiale~ tube 14 can slide axially with respect to hub 68, the gap between the distal tips of inl~rlll~cliate tube 14 and outer tube 18, as well as the gap between the distal tips of inner tube 16 20 and i"~r,~ Jidte tube 14, are essentially zero. This reduces the amount of severed tissue, fluid, and other Illate~ that would othe~ise pass into the annular regions separating tubes 14, 16, 18.
With inner tube 16 i"~l "e ', a pliable fitting 82 retains drive shaft ~0 within hub 68. Fitting 82 provides a fluid-ti3ht seal when base 20 is 25 il,s~,led into handpiece 110.
- Outer tube 18, shown in Fig 12, is also made from a rigid material such as stainless steel or other metal. Aperture 22 is - .Jefi"~d by SlllU~tjl, unsharpened edges 84 of tube 18. Edges 84 30 extend, parallel to axis 24, from a point p~uxi, llal of distal tip 80 to distal tip 80. Aperture ~2 is an extension of a central r~cs~~ 88 in outer tube 18 that runs the entire length of tùbe 18.
Pruxi",al region 90 of outer tube 18 is rigidly mounted to a 5 knob 92 that rotatably couples to hub 68 of base 20. As shown in Fig. 11, a pair of fingers 9C extends distally from base 68, parallel to axis 24, and a raised shoulder region 96 encircles base 68 immediately proximal of the point where flngers 94 attach to base 68. When i,-~",l~diate tube 14 is inserted into r~ss~ge 88 of outer 10 tube 18 and knob 92 and base 20 are forced toge~h~r, a mating shoulder 98 on the inner surface of the proximal end of knob 92 engage~ shoulder 96, as shown in Fig. 2, preventing knob 92 and base 68 from separating longitudinally.
As shown in Fig 13, fingers 94 are quasi-pentagonal in cross-15 section. VVith knob 92 installed, the radial outermost point 100 of each finge~ 94 rests in an a mating apex 102 on the inner surface of knob 92. Apexes 102 are ~r,~,ed by the intersection of adjacent arcuate sur~aces 104 of a wall 106 of knob 92. Fingers 94 and arcuate surFaces 104 eoaGt to allow the relative l~tdliCil ,al orientation 20 be~ween knob 92 and hub 68 to be changed~ in a ratchet-like r~sl,ion, in LliSCIel~, 180~ steps. In particular, outertube 18, knob 92, and fingers 94 are oriented so that incisor window 28 is fully Govered by shield 26 vvhen knob 92 is rotated to one step, and synovator window 30 is fully covered by shield 26 when knob 92 is 25 rotated to the other step.
As knob 92 is rotated with l~s,.,. _L to hub 68, outerrnost points 100 move across arcuate surfaces 104, initially forcing fingers 94 radially inward. When ou~erl,lost points 100 move past the 30 recpective midpoints of surFaces 104, the elastic energy stored in the ~ rl-c~l flexible fingers 94 forces the fingers radially ou~Nard W O96/25103 PCTrUS96/01920 until the relative rotational Orierlt~liGn beh~ n knob 92 and hub 68 has changed by 180~, and fingers 98 rest in the c",posite apex 102.
Thus, fingers 94 positively urge oul~lr.,Ost points 100 into each ~ssor;~t~d apex as it is encountered, thereby giving the surgeon S kinesthetic feerlh~rk as to the amount by which outer tube 1~ has been rotated, and also helping to avoid z~ccidPntal rotation o~ outer tube 18 with ~~spo_L to w;, Idu)~S 28, 30. Nloreover, a pair o~
dia~ ,ally opposed bulges 108 on the c: uter sur~ace of knob 92 are oriented adjacent to, and at the same circl~mferential loc~lio" as, 1 o ar~xes 102. Bulges 108 thus make knob 92 easier to grasp, and further indicate to the surgeon when knob 92 has been rotated a sumcient degree. Together, fingers 94 and knob 92 conlprise a ratchet asse,"Lly.
1~ Ref~. ,i"~ also to Fig 14, in operation, surgical instrument 10 is inserted into the distal end of a hanrlrieGe 110. Outer tube 18 is then introduced as shown through a punc~ure wound 120 into the knee joint 122, below the ,uat~ Light is prl ,e-~cl into the joint via a second puncture 124 using a fiber optic light source 126, and a 20 visual image of the s~rgical site is retumed through a separate optical path to a television camera 128. The image is d~li.r~red by camera 128 onto a television screen 130 ~or viewing by the surgeon.
(Alternatively, the surgeon can view the image using an e~ or the image can be r~or-Jed.) The surgeon ~ t s surgical tool 12 by activating motor 112, which receives Gp~ tiny F,ult,l,~ial and current from power supply 116. Motor 112 engages and rotates drive shaft 50, thereby applying rotdlional force to inner tube 16 and lutali~l~ tube 16 with 30 ,t:~pe~t to tubes 14, 18. The surgeon controls ruldliulldl speed and direction (either unidi, t:~lional or oscillatory) using foot swi~ches Wo 96/25103 PCT/US96/01920 116a, 116b, which control the magnitu~e and polarity of operating potential and current provided by power supply 116 to motor 112.
Motor 1 12 is capable of rot~li"~ inner tube 16 over a wide range of speeds, e g., between about 100 rpm and 5000 rpm, and can deliver 5 a torque of up to 25 oz. inches (0 177 Nm).
Dir~trtnt types of surgical instruments such as instrurnent 10 have rotational and torsional limits. To prevent the surgeon from inadvertently operdli"g instrument 10 at dangerously high speeds 10 and torques, instrument 10 identifies to sensors (not shown) in handpiece 110 what type of instrument it is, and the speed of and torsion applied by motor 112 is co"lr_~lc-~ so that these limits are not .qY~eede~. (This control technique is described in the . . ,antioned U.S. Patent No. 4,705,038.) During the surgical proced-lre, the body joint is dist~n~d vvith fluid intro~ ed through a third puncture wound 132 frorn a fluid source 134. The fluid i"i~les the site and renders tissue 136 (which is, e.g., synovial tissue) mobile so that it floats and can be 20 ~lispl~ ed (similar to the movement of scawccd in water).
The surgeon progressively cuts away synovial tissue 136 by movlng surgical instrument 10 frorn side to side and in the axial direction using handpiece 110 (while viewing television screen 130).
25 For instance, if incisor window Z8 is exposed to the joint tissue (that is, if synovator window 30 is f~llly covered by shield 26), instrument 10 will cut tissue ayyr~ssively, h~ç~nce of the conhguration o~
serrated edges 32. I~ during the procedure the sur~3eon desires instea~ to cut tissue less aggressively, the ,~r~:s~r.l invention allows 30 him to do so simply by holding knob 92 fixed, and lul~lilly handpi~ 110 (and thus hub 68) until incisor window 28 is fully Wo 96/25103 PCT/US96/01920 vered by shield 26. Thls e~oses the l~ss-aggresshre. smooth-ed~ed synovator window 30. The ratchet mechanism provides the surgeon with Icinesth~lic feedback, indicating when th~ handpiccc 110 I)as been rotated the requisite 1~Qn. (Alternatively, handpiece 110 can be held fixed and knob 92 rotated. Because incisorwindow 28 is located on the opposite side of window as~embly 31 T'rom synoYator window 3~, in order to resume cu/;ting the same tissuc as before, the ~urgeon would then rot3te instrumcnt 10 180~ 3bout 8Xi6 24.) The 3urgeon cun change the ,utcllional orienlation of 6hield 26 with respect to windows 28, 30 at any time. For example, innQr tube 16 c~n be driven by motor 112 or may b6 stationary while the eurgeon rotates shield 26. T~e surgQon can resume more aggressivo tissue-cu';ting at any time simply by rotatlng knot~ 92 nr 1~ handpiece 110 in eitherdi,~c~;on.
Tissue fra~men~s and other ~ody material cut by surgical tool 12 are wlthdrawn from the surgical site along with irrigatiûll fluid via central passage 46 of inner tube 1~ (Fiys. 2, 10) in response to Z0 suction applied by vacuum source 114.
Other embodiments ~re within the scope of the following claims.
For example, although surgical inr~trument 10 is straight between it~ proximal and distal and~, a surgical instrurnent 210 embodying the teachings d;s~l~ced herein could instead include a bend region 212, as shown in Fi~. 15. ~end re~lon 212. whlch is di~po.c~d sli~htly proximal ot the dlstal end 214 of outer tube 21~, an~ularly o~tsets surgical tool 218 frorTI a generally straight axis 220 of surgioal instrurnent 210. Bend region 212 ena~les surgical in~trument 210 to opsrate on sur~ical areas that are difficult to reach with a straight-shafted instrument.
In order to rota~e a shield 222 at a dlstal region of outer tube 5 216 to selectlvely coYer and uncover an incisor window 224 and a synovator wlndow (not shown) located Dn ~Jpo5;~e sides of an assembly carried at the distai end of a bent, rigid intermediate tube 22~, wter tube 21~ is flexible at least in bGnd region 212. The inner tube (not shown) i5 likc,/~isc flexible at lea~t in bend region 212, 10 allowing it to transmit torque through bend region 212 to operate surgic~l tool 218. ~Itern~tively, the inter"led;~l~ and inncr tube6 may be flexible, and the outer tub~ may be rigid. In thi6 latter embodiment, interrnediate tube 226 i6 rota~ed to 6electively cover ~nd uncover the inci60r and 6ynovator window~, and outcr tube 216 16 (and thu6 al60 shiald 222) remains ~t~tionary. Similar flexible tube arrang~m0nts are disclosed in copending app' ~ on serial no.
08/2û0,662, filed on Febr iary 23, 1994, which is a continuation-ln-part of ~pp'ic ~ ~ on serial no. 08/011,3~4, filed on January 29. 1993, which are both assi~ned to the present as~iignee and i,,~.un~o,d~ed 20 hereln by re~erence In their entirety.
Various tube configurations exhibit the requi3ite flexibility ot least in the bend reQion to be employed in surgiccl instrument 210.
For instance, a region of an otherwise rigid tubc or tube6 may be Z5 r~l,ev~ with a series of sxisliy spaccd, circumferentially extending 3iot9 228 (only slots 228 in o~ter tube 216 shown in Fig. 15).
Slotting a rotatable tube for flexibility and torque t.dns",ission is de6cribed in IJ,S~ P~hnt No. 5,152,744, assigned to the present assignee and incorporated herein by reference in its entlrety~ To 30 prevent tissue fra~ments or other body materlal frorn catching on Dr passin~ throu~h the slots In the inner tube. the slots can be covered Wo 96/25103 PCT/US96101920 - with a pliable nlaterial ~uch as silicone R~V or a heat-shrinkable polymeric sheath (not shown).
The flexible regicn or regions can instead be comprised of a 5 series of discrete. interengaging segrnents as di~Glosed in copendinQ application serial no. 03/228 083 filet on April 15 1994 whioh is as~igned to the pre~nt ~3s;gnee snd incorporated herein by reference in its entirety. Alternatively, the tube~ can be con~prised, at lea~t in the bend region of a flexible or elar,~v"~r;c 10 m~tcrial, such as rubber, pla6tic, or other polymer.
Inter",ediiat~ tube 226 is comprised of a material (e.g.
~tainlo~s ~teel or other metal ceramiG or pla~tic) sufficiently ri~id to retain the sllape and orient;~"ion of bend re~ion 212 durln~ normal 1~ surgical use of instnlment ~1û. Althou~h bend reglon 212 Is often pr~fo,.,led durin~ manufacture ~e.g. by moldlng in~ "~diate tube 226 to the deslre~ shape or by bending it around a mandrel). if Illter"l~ e tube 22~ is c-,"".,ised at least in the bend region of a plasticly deformable material, bend region 212 can alternatively or 20 additionally be p~ ,haped or reshaped by the surgeon prior to or during the procedure to best rnatch the contour3 ~nd chor~cteristics of the ~urgical site.
Anothcr cmbodiment of the precent inv~ntion ~urgical 26 instrument 310, i~ ~hown in Fig. 16. A bend region 312 in sur~ical in~trument 310 is provided by a curved intermedi~te tube 314 and an inner tube 316 and an outer tube 318 of the instrument are flexible at least in bend re~ion 312. (Alternatlvely. similar to the alternative embodlment descrlbed above in conneclion with Fig. ~5 30 outertu~e 318 could be curved and intemlediate tube 314 could be flexible at least in bend region 312.) A window ~ssembly 320 W O96/25103 PCTrUS96/01920 camed at th~ dictal end of Inter"l~dlate tube 314 has opposit~ly disposed inclsor and synovator v.~ d-J.~ 322. 324, witilin which a cuttlng Implement (not shown) disj~osed at the distal end of Innertube 31~ rotates A shield 326 carried at the distal end of outer 5 tube 3t8 can be rotated to selectively cover either of windows.322, 324.
Similar to the instrurnent dis~losed in U.S. Patent No.
5,282,821, incorporated herein by raf~rence in its entirety, int~r-"cdiate tube 314 of ~urgicai inctrumant 310 is resilient, and a 10 straight, rigid cheath 328 i~ dispo~cd co~xially outside outer tube 318. Sheath 328 i~ axially slidable with respect to outer tube 318 and in its rest position (shown in Fig. 16) the distal end ~f sheath 328 ter",i"ales at a point just pr~ f bend re~ion 312. 511dlng sheath 328 distally (i.e., in the dil~LLion indlcated by arrow 330) ~ver 15 bend region 312 causes intermedlate tube 314 to straighten out.
decreasin~ the an~le ot offset provided by bend region 312. Slidin~
sheath 328 pru~l",ally 13ack to its rest posilion allows bend region 312 to recover its prerormed curvature. Thus, the angle of offset of tile ciistal region 332 of instrument 310 with respect to the proximQI
20 region 334 of the instrument can be selectivcly changed while the instrument ~",~;"c ~ihl within the pstient.
Other types of sur~ic31 toolc, CUch a~ abr~ders, may be ernployed with any of curgical instruments 10. 210, 310. Moreover, 25 the surgical tool may be removably connected to the distal end of the inner tube, allowing just the ~ur~ical tool to be replaced should It b~come worn or dama~ed, as disclosed In U.S. Patent No.
~,32û,~3~, assigned to the present assignee and incorporated herein ~y re~erence In its entirety. Als~, the sur~ic~l tool and the 30 inner tube need nc~t be comprised of the same material. Rather, the ~urgical tool will cften i~e comprised of a hard material well-suited to -W O96/25103 PCTrUS96/01920 - cutting, v,/h_reas the inner tube m~y be COI ~ l~ri5~ lead of a more compliant mat~rial (at least in the bend region) for tral~s."illi"y torque throu~h the bend region.
In addition, the inner, int~r",~Ji~te, and outer l-,el.,Le,~ need not bê tubes, but Gould instead be, e.~., solid ~le~lber~ or cables.
Moreover, the ~,ro~ ,al end of the outer member can be coupled to a source of ..lt~tior,al power, such as a motor (not shown), ~
the shield to be either power-rotated or manually actuated. Fùrther, 10 the interrllcJi~l~ tube of the instrument may be provided with more or fewer windows, and the ui"dow confisu,alio"s may be tc~ilolLd to dirLr~, .l cutting sr.~ i.,nO. For in~tance, in some applications it may be u~eful to provide a sin~le large window, and to ~/ary thê size of ths Y,~;.l '~w opening by partially covering it with the shield. In 15 such an arpliG~tion, it might be desirable to remove the ratchet mechanism to allow knob 92 to rotate ~.lloothly with ~ l to hub 68, or to modify the ratchet mechanism to rotate in smaller ..,ental ~têp~i.
In ~ iti~", the shield need not be attached to a member thst tA~ends from the base. Rather, the shield may be a cap mounted on the distal end of the inter~l,Gdiate tube. In such a construction, the instrument would have to be .~it~.dr -.v., from the joint space in order to select a Ji~,_r.. n ~vindow ~or cuttin3. Also, the shield need 25 not rotate, but could be configured il.~ I to slide along the intermediate tube to selec~ively cover and uncover eith~r or both of - the v~i~ Ido~/,'S, The inner "~e,~ ~ber could likewise translate axially to operate the distal tip surgical tool.
While the invention has been dcscriL~d in terms of surgical 30 instruments for s,li-ruscut ~, the invention may also be used with wo 96/25103 PCT/US96/o1s20 other types of instruments, for example, in3truments con~i~ured for other kind~ of endoscopic procedures and ~or biopsy epplicdlions.
This invention relates to surgical instrumentsl and in particular to powered arthroscopic surgical instruments.
Powerl3d arth,~s _~ic surgical instrurnents typically include a rigid, slc-lion~ry outer tube within which a rigid inner tube is rOtdt-J
by a motor. A cutting implement, such as a blade or abrading burr, is disposet on the distal end of the inner tube. Tissue or bone is 10 ~Yrc~s~ to the cutting implement through an Gpenirl~ in the distal end of the outer tube, and tissue or bone r,ay",~, IL:a cut by the rotating blade or burr are drawn thro~h the interior of the inner tube along with i"i~ g fluid by the use of suction applied at the pr~,~i" ,al end of the instrurnent. Examples of such sur~ical 15 instruments are described in ~J.S. Patent Nos 4,2031444, 4,274,414, 4~834,729, and 4,842,578, all of which are assigned to the present assignee Some arthrosco~ic surgical instruments are linear, that is, ZO straight between their proximal and distal ends. Others are curved to rdcilita~ positioning the cutting i",ple".t:"l against tissue to be cut without requiring that the instrument be rernoved from the body and reinserted through an ~dr1itional puncture In a curved instrument, a region of the inner tube is flexible to enable the inner tube to accept 25 the curvature imposed by the outer tube while lldnsrl,iLli, ,~ the torque ~pplied by the motor to the blade.
The cutting implernent ~ ros~ at the distal end of instruments of the prior art have tended to lack ~ alilit~ in their 30 control with the e~cision of tissue being ~all or nothing" event. In certain circumstances, the cutting of tissue may necessit~te careful and delicate use of the cutting i.I~p~e,~ t. In other circumstances, a CA 022l0523 l997-07-24 W O96/25103 PCTrUS96/01920 more aggressive approach may be needed. Instruments of the prior art tend to la~k this versatility and thus the ~ucoP~-s of an operation may lie more in the skill of the surgeon to control the cutting implement than might otherwise be desired.
It is an object of the pr~ser,l invention to overcome, or at least alleviate, this proble,...
Accordingly, there is provided a surgical instrument 10 comprising a base, a suppor~ member extending distally frorn said base and carrying at a distal region a window defining an openirlg, a surgical tool a~ least partially disposed in said distal region and movable to cut tissue eAb,.Jing through said opening 15 characterised by the fact that said support r..ei ,.ber is provided with a shield at least partially ~icposed in said distal region and movable with respect to said window to at least partially cover said opening.
One general aspect of the invention is a surgical instrument in 20 which a movable shield can be positioned to at least partially cover the distal opening in a support, I ,e, . ~L ~r Another general aspect of the invention is a method for using the surgical instrument. In still another general ~spe~t the support ,.,~"l~e:r has a pair of openings in its distal end. either of which can be seleetively covered by the 25 movable shield.
Among other advd"~as~es, the invention allows the user to partially or completely cover the Gpe~ l9 by moving the shield, thereby preventing at least some tissue frorn entering into the 30 instrument through the opening and being cut by the surgical tool.
.
WO 96t25103 PCT/US96/01920 As a result, the cutting action of the surgical tool can be reduced or s~'~ by appro~,.i..Le positioning of the shield.
Moreover, v~lhere the surgical instrument has a pair of openings at its distal end, the invention allows the user to partially or completely cover one of the oper.i- I95 by moving the shield, thereby preventing at least some tissue from entering into the instrument through that op~r,i"~ and being cut by the surgical tool. As a result, by a~l,,upriate positioning of the shield, the user can select be~vccn 10 windows that have, for example, different cutting configurations and different rot..liGnal ol ier.l; Itions.
For il.ald,-ce, one window can be configured for more dyy,essive cuKing than the other. The preferred degree of cutting 15 can thus be Lhose~ l by moving the shield to cover the opening of the ~i.ld~,v: having the ur,Jasired cutting ~,lldr~.;~istics. Moreover, the windows may be locAt~l at different ~utdlio"al .Jrit:~lldtiuns around the distal region of the support rllel"ber. l hus, even if their cutting char~Leri~tics are idenlicdl, the w;nclo~rs ~.an be selectively covered 20 and uncovered to ~Jldrl9e the di,~clion of eutting of the instrument.
Preferred embodirnents include the following features.
In a particularly useful embodiment, an act~ting member 25 (e.g., a tube Go~Yi~lly disposed ol~tside the support rllelllbar) e~ ls distally from the base, and transmits a lot.~iG~ ~al force applied at a proximal end to move the shield, which is attached to a distal end of the actuating member. The ~ru~i,,Idl end of the ~ctll~ti-lg ~ ."~cr is rigidly secured to a knob ~ dtably mounted to a 30 stationary portion of the base The knob may be selectively rotated to a plurality of discrete posiliGns with r~s~e~l to the base. allowing W O 96/25103 PCTrUS96/01920 the shield to be positioned to a corresponding plurality of discrete rotational o.ientdlions. 8ec~ ce the ~ t~ tirl9 member is rotatably coupled to the base, the openings may be selectively covered and uncovered while the instrurnent remains in situ within the patient.
A drive member (e.g., a tube dispose~l coaxially within the support member) c~ nl~s distally from the base, and transmits a rotational force applied at a ,uro~ al end to move at least a portion of the surgical tool, a cutting implement attached to a distal end of 10 the drive member. As the drive mernber rotates, the edges of the cutting implement move toward and closely past the edges of the windows. A hollow p:~c~ge in the tubular drive member is adapted to receive suction at its proximal end, transporting body material cut by the cutting imp!e,..,~nL away from a surgical site while the 15 instrument remains in situ for further cutting.
The support member (e.g., a tube) couples to the base in a manner that allows it to slide axially with ,~:spe~ to the ba-~e. During assembly, the support tube is inserted into the ~otl~tor tube, and 20 the A~tu~tor tube is atta~hed to the base. When the drive tube is then inserted into the support tube, the outer surface of the distal tip of the drive tube bears against the inner surface of the distal tip of the support tube Because the support tube can slide axially with respect to the base, this forces the supporl tube distally until the 25 outer surface of the distal tip of the support tube bears agai"st the inner surface of the distal tip of the aoh~tnr tube. Thus, when ass~i"bl~d, there is little or no gap ~ JJccn the distal tips of the various tubes This reduces the amount of severed tissue, fluid, and other ",atl::,ial that would othe~ise pass into the annular regions 30 separating the three tubes.
In all~:nlate embodiments of the present invention, the support tube is bent, and an actuating .,lel.,ber extending distally from the base is relatively flexible at least in the bend region, allowing the actuating member to transmit force through the bend S region to move the shield For ioatance, the ~ ting member (e.g., a tube r~ispos~-i outside the support r~mLt r) and the drive tube may both be relieved with a series of axially sp~ed slots in the region of the bend. This arrangement provides the actuating and drive tubes with the requisite transverse flexibility to accommodate 10 the bend, and the n~cess~ry torsional ~tirr"ess to rotate the shield and the cutting implement, r~ ctively RF!r~llsf~ it is bent, the instrument may be used to operate on surgical areas that would otherwise be difficultto reach with a sllaiyl,t-shafted instrurrent.
In other embodiments, a relatively rigid sheath is dispo~e~l co:~Yi-"y with, and is axially s~ with respec~ to, the bent support "-~n,~:r, which is relatively d~ru.-"a~le at least in the bend region.
By sliding the rigid sheath fore and aft along the support m t:."L:r to selectiYely cover and uncover the bend region, a surgeon may 20 ~ ,ye the angle of offset provided by the bend region, all while the instrument f~",ains in sity within the patient.
Other features and advantages of the invention will ~e~o",e apparent from the r~ L ~J;n9 de'~ s~ iun, and from the daims ~ig. 1 is a top view of a surgical instrument.
Fig. 2 is a sectional side view of the surgical instrument, taken along line Z-2 of Fig. 1 Fig. 3 is a side view of the surgical instrument, taken along 30 line 3-3 of Fig. 1 Fig. 4 is a cross-s~l;tiGnal side vjew of a distal region of the surgica1 instrument.
Fig. 5 is a perspective view of a distal region of the i"ler",ediate tube of the surgical instrument.
Figs. 6 and 7 are top and side views, respectively, of the distal region of the inter",~id~ tube of the surgical instrument.
Fig. 8 is a sectional view of the distal region of the intermediate tube of the surgical instrument, taken along line 8-8 of Fig. 7.
Fig. 9 is an end view of the distal region of the intermediate tube of the surgical instrument, taken alon~ line 9-9 of Fig. 7.
Figs. 10, 11, and 12 show inner, i"k,r",~:diate, and outer tubes, respectively, o~ the surgical instrument.
Fig. 13 is a sectional view of a ratchet mechanism of the 1~ surgical instrument, taken along line 13-13 of Fig. 1.
Fig. 14 sho~vs the surgical instrument in use.
Fig. 15 shows another embodiment of a surgical instrument.
Fig. 16 shows another e",boJi~nent of a surgical instrument.
As shown in Figs. 1, 2, and 3, a surs3iGal instrument 10 suitable for pe,rur-,-ing, e.g., closed, arthroscopic surSery on the knee with a surgical tool 12, includes an inter,l,ediate tube 14 within which a rotating innertube 16 is c~Yi~~y di~po5ed. In turn, intermediate tube 14 is a~Yi~ly disposed within a rotatable outer 25 tube 18. Tubes 14, 16, and 18 extend distallyfrom a base 20.
Referring also to Fig. 4, a distal region of outer tube 1~ is partially cut away to form an aperture 22, which extends to the longitudinal axis 24 of instrument 10. The remaining, solid portion of 30 the distal region of outer tube 18 co" ",, ises a shield 26. As outer tube 18 is rotated relative to i"l~,r"~diate tube 14, shield 26 Wo 96/25103 PCT/US96/01920 altemately covers and uncovers an incisor window 28 and a synovator ~indow 30 locatPd on oF,posil~: sides o~ a window dSS~ y 31 carried at the distal end of i"l~r" lediate tube 14.
As shown in Figs ~-9, the edges 32 of incisor window 28 are sha, ~ e. Iell and serrated, and the edges 34 of synovator windo~v 30 are sharpened and smooth. Referring to Fig. 4, a window 35 fc~(".ed by the sharpened, smooth edges 37 of a cutting impiement 36 carried at the distai end of inner tube 16 is periodically ex~,osed 10 through incisor window 28 and synovator ~r~ o~l/ 30 as inner tube 16 rotates. Thus, tissue entering through either incisor window 28 or synovator v~indow 30 (dq,en~Jing on the ,~Jtdtional oric' ,Ldtion of shield 26) can extend into the interior of inner tube 16. As inner tube 16 rotabs, edges 37 o~ cutting implement 36 move toward and 15 closely past edges 32, 34 of W;l~vrs 28, 30 in ~J;.Id~N asse,.~61y 31, severing the tissue projecting It.orell,r~ugh. Together, cuffing implernent 36 and window ass~",bly 31 cu"-prise sursical tool 12.
Inner tube 16 is made from metal or other rigid material, such 20 as stainless steel As shown in Fig. 10, the distal end 40 of inner tube 16 supports cutting il "plel l .ent 36 (made frorn, for example, stainless steel and attached to tube 16 by uI~hli, ,~ or brazing).
Cutting implement 36 is sized to provide a close-running fit with the inner portion of w;, ,du~ assembly 31 for t:r~ jF .l cutting. The 25 o~ui"g defined by window 35 in i-l,ple~ nt 36 is an extension of a central pz~5s~3~e 46 in inner tube 16 that runs the entire length of tube 16.
rlu~i",al region 48 of innertube 16 is rigidly mounted to a 30 drive shaft 50 that rotates within base 20, sho~vn also in Fig. 2.
Centra1 p~ss ~e 46 te,l"i,lates in a vacuum source opening 5Z In =
CA 022l0523 l997-07-24 W O96/25103 PCTrUS96/01920 drive shaft 50. The pr~Ai",dl end 54 of drive shaft 50 fits into a handpiece 110 (~ig. 14) which includes a motor 112 for lvl~Ling drive shaft 50 and inner tube 16 with respect to both interrnediate tube 14 and outertube 18. One l::AdlJ~ e of such a handpiece is ~escribed in U.S. Patent No. 4 705 038 e"ti~l~ "Surgical System for Powered Instruments", and assigned to the present assignee which is incorporated by reference. Opening 52 i~ coupled to a vacuum source 114 (Fig 14) during operation to remove severed tissue and irrigating fluid from the surgical site via p~c5~9~ 46 in a 10 manner des. ~ ed in debil below.
.
Fig. 11 shows illlellrl~.liaLt: t~be 14 which is also made ~rom a rigid material such as stainless steel or other metal. Distal end 56 of in~e""adiate tube 14 supports wi.ld~JJv assembly 31 (made from~
15 for C~dn~ E, stainless steel and attached to tube 14 by welding or brazing). The inner and outer~ ",e:le,~ o~window assembly 31 are substantially equal to the inner and outer di~rll~L~ of tube 14.
Intermediate tube 14 is hollow along its entire length to 20 provide a pass~ge 60 that receives inner h~be 16 and outting i" ~lo .,enl 36 which exten-l~ to the partially closed distal end 62 of window assembly 31 The openings defined by windows 28 30 in window assel"bly 31 are u ~t~nsions of ~ J~ 60. The inner diameter of i,.te""ediate tube 14 is only slightly larger than the outer 25 diameter of inner tube 16 ~e.g. by appru~i--,ately 0.002 inches or 0.051 mm) This allows inner tube 16 to ratate freely but helps minimize wobbling of tube 16 to keep sharp cutting edges 37 of cutting implement 36 and edges 32, 34 of v~lindo~vs 28 30 closely aligned.
W O96/2S103 PCTnUS96/01920 The proximal end 63 of intermediate tube 16 is rigidly mounted to a coupling 64 loc~ted within a cavity 66 of a hub 68 of base 20, shown also in Fig. 2. Cavity 66 includes an axially extending keyway 70 sized and lc~c.lled to recei~e a key 74 on 5 coupling 64. Thus, although coupling 64 can move axially with respect to hub 68, key 74 prevents coupling 64 from rotating.
Cavity 66 in hub 68 communicates with p~ss~ge 60, and is configured to receive drive shaft 50. During as~c:,,,l,ly,after outer 10 tube 18 has been attached to hub 68 in the manner desc, iLe~
below, innertube 16 is in~ d through hub 68 into p~s~ 60 of inter",adiate tube 14. When the distal tip 78 of cutting implement 36 (Fig. 10) contacts the inner surface of the distal tip 62 of window assembly 31, coupling 64 and intermediate tube 14 are forced 15 distally, until the outer surface of distal tip 62 contacts the inner surface of the partially closed distal tip 80 of oubr tube 18. Thus~
because inter",~Jiale~ tube 14 can slide axially with respect to hub 68, the gap between the distal tips of inl~rlll~cliate tube 14 and outer tube 18, as well as the gap between the distal tips of inner tube 16 20 and i"~r,~ Jidte tube 14, are essentially zero. This reduces the amount of severed tissue, fluid, and other Illate~ that would othe~ise pass into the annular regions separating tubes 14, 16, 18.
With inner tube 16 i"~l "e ', a pliable fitting 82 retains drive shaft ~0 within hub 68. Fitting 82 provides a fluid-ti3ht seal when base 20 is 25 il,s~,led into handpiece 110.
- Outer tube 18, shown in Fig 12, is also made from a rigid material such as stainless steel or other metal. Aperture 22 is - .Jefi"~d by SlllU~tjl, unsharpened edges 84 of tube 18. Edges 84 30 extend, parallel to axis 24, from a point p~uxi, llal of distal tip 80 to distal tip 80. Aperture ~2 is an extension of a central r~cs~~ 88 in outer tube 18 that runs the entire length of tùbe 18.
Pruxi",al region 90 of outer tube 18 is rigidly mounted to a 5 knob 92 that rotatably couples to hub 68 of base 20. As shown in Fig. 11, a pair of fingers 9C extends distally from base 68, parallel to axis 24, and a raised shoulder region 96 encircles base 68 immediately proximal of the point where flngers 94 attach to base 68. When i,-~",l~diate tube 14 is inserted into r~ss~ge 88 of outer 10 tube 18 and knob 92 and base 20 are forced toge~h~r, a mating shoulder 98 on the inner surface of the proximal end of knob 92 engage~ shoulder 96, as shown in Fig. 2, preventing knob 92 and base 68 from separating longitudinally.
As shown in Fig 13, fingers 94 are quasi-pentagonal in cross-15 section. VVith knob 92 installed, the radial outermost point 100 of each finge~ 94 rests in an a mating apex 102 on the inner surface of knob 92. Apexes 102 are ~r,~,ed by the intersection of adjacent arcuate sur~aces 104 of a wall 106 of knob 92. Fingers 94 and arcuate surFaces 104 eoaGt to allow the relative l~tdliCil ,al orientation 20 be~ween knob 92 and hub 68 to be changed~ in a ratchet-like r~sl,ion, in LliSCIel~, 180~ steps. In particular, outertube 18, knob 92, and fingers 94 are oriented so that incisor window 28 is fully Govered by shield 26 vvhen knob 92 is rotated to one step, and synovator window 30 is fully covered by shield 26 when knob 92 is 25 rotated to the other step.
As knob 92 is rotated with l~s,.,. _L to hub 68, outerrnost points 100 move across arcuate surfaces 104, initially forcing fingers 94 radially inward. When ou~erl,lost points 100 move past the 30 recpective midpoints of surFaces 104, the elastic energy stored in the ~ rl-c~l flexible fingers 94 forces the fingers radially ou~Nard W O96/25103 PCTrUS96/01920 until the relative rotational Orierlt~liGn beh~ n knob 92 and hub 68 has changed by 180~, and fingers 98 rest in the c",posite apex 102.
Thus, fingers 94 positively urge oul~lr.,Ost points 100 into each ~ssor;~t~d apex as it is encountered, thereby giving the surgeon S kinesthetic feerlh~rk as to the amount by which outer tube 1~ has been rotated, and also helping to avoid z~ccidPntal rotation o~ outer tube 18 with ~~spo_L to w;, Idu)~S 28, 30. Nloreover, a pair o~
dia~ ,ally opposed bulges 108 on the c: uter sur~ace of knob 92 are oriented adjacent to, and at the same circl~mferential loc~lio" as, 1 o ar~xes 102. Bulges 108 thus make knob 92 easier to grasp, and further indicate to the surgeon when knob 92 has been rotated a sumcient degree. Together, fingers 94 and knob 92 conlprise a ratchet asse,"Lly.
1~ Ref~. ,i"~ also to Fig 14, in operation, surgical instrument 10 is inserted into the distal end of a hanrlrieGe 110. Outer tube 18 is then introduced as shown through a punc~ure wound 120 into the knee joint 122, below the ,uat~ Light is prl ,e-~cl into the joint via a second puncture 124 using a fiber optic light source 126, and a 20 visual image of the s~rgical site is retumed through a separate optical path to a television camera 128. The image is d~li.r~red by camera 128 onto a television screen 130 ~or viewing by the surgeon.
(Alternatively, the surgeon can view the image using an e~ or the image can be r~or-Jed.) The surgeon ~ t s surgical tool 12 by activating motor 112, which receives Gp~ tiny F,ult,l,~ial and current from power supply 116. Motor 112 engages and rotates drive shaft 50, thereby applying rotdlional force to inner tube 16 and lutali~l~ tube 16 with 30 ,t:~pe~t to tubes 14, 18. The surgeon controls ruldliulldl speed and direction (either unidi, t:~lional or oscillatory) using foot swi~ches Wo 96/25103 PCT/US96/01920 116a, 116b, which control the magnitu~e and polarity of operating potential and current provided by power supply 116 to motor 112.
Motor 1 12 is capable of rot~li"~ inner tube 16 over a wide range of speeds, e g., between about 100 rpm and 5000 rpm, and can deliver 5 a torque of up to 25 oz. inches (0 177 Nm).
Dir~trtnt types of surgical instruments such as instrurnent 10 have rotational and torsional limits. To prevent the surgeon from inadvertently operdli"g instrument 10 at dangerously high speeds 10 and torques, instrument 10 identifies to sensors (not shown) in handpiece 110 what type of instrument it is, and the speed of and torsion applied by motor 112 is co"lr_~lc-~ so that these limits are not .qY~eede~. (This control technique is described in the . . ,antioned U.S. Patent No. 4,705,038.) During the surgical proced-lre, the body joint is dist~n~d vvith fluid intro~ ed through a third puncture wound 132 frorn a fluid source 134. The fluid i"i~les the site and renders tissue 136 (which is, e.g., synovial tissue) mobile so that it floats and can be 20 ~lispl~ ed (similar to the movement of scawccd in water).
The surgeon progressively cuts away synovial tissue 136 by movlng surgical instrument 10 frorn side to side and in the axial direction using handpiece 110 (while viewing television screen 130).
25 For instance, if incisor window Z8 is exposed to the joint tissue (that is, if synovator window 30 is f~llly covered by shield 26), instrument 10 will cut tissue ayyr~ssively, h~ç~nce of the conhguration o~
serrated edges 32. I~ during the procedure the sur~3eon desires instea~ to cut tissue less aggressively, the ,~r~:s~r.l invention allows 30 him to do so simply by holding knob 92 fixed, and lul~lilly handpi~ 110 (and thus hub 68) until incisor window 28 is fully Wo 96/25103 PCT/US96/01920 vered by shield 26. Thls e~oses the l~ss-aggresshre. smooth-ed~ed synovator window 30. The ratchet mechanism provides the surgeon with Icinesth~lic feedback, indicating when th~ handpiccc 110 I)as been rotated the requisite 1~Qn. (Alternatively, handpiece 110 can be held fixed and knob 92 rotated. Because incisorwindow 28 is located on the opposite side of window as~embly 31 T'rom synoYator window 3~, in order to resume cu/;ting the same tissuc as before, the ~urgeon would then rot3te instrumcnt 10 180~ 3bout 8Xi6 24.) The 3urgeon cun change the ,utcllional orienlation of 6hield 26 with respect to windows 28, 30 at any time. For example, innQr tube 16 c~n be driven by motor 112 or may b6 stationary while the eurgeon rotates shield 26. T~e surgQon can resume more aggressivo tissue-cu';ting at any time simply by rotatlng knot~ 92 nr 1~ handpiece 110 in eitherdi,~c~;on.
Tissue fra~men~s and other ~ody material cut by surgical tool 12 are wlthdrawn from the surgical site along with irrigatiûll fluid via central passage 46 of inner tube 1~ (Fiys. 2, 10) in response to Z0 suction applied by vacuum source 114.
Other embodiments ~re within the scope of the following claims.
For example, although surgical inr~trument 10 is straight between it~ proximal and distal and~, a surgical instrurnent 210 embodying the teachings d;s~l~ced herein could instead include a bend region 212, as shown in Fi~. 15. ~end re~lon 212. whlch is di~po.c~d sli~htly proximal ot the dlstal end 214 of outer tube 21~, an~ularly o~tsets surgical tool 218 frorTI a generally straight axis 220 of surgioal instrurnent 210. Bend region 212 ena~les surgical in~trument 210 to opsrate on sur~ical areas that are difficult to reach with a straight-shafted instrument.
In order to rota~e a shield 222 at a dlstal region of outer tube 5 216 to selectlvely coYer and uncover an incisor window 224 and a synovator wlndow (not shown) located Dn ~Jpo5;~e sides of an assembly carried at the distai end of a bent, rigid intermediate tube 22~, wter tube 21~ is flexible at least in bGnd region 212. The inner tube (not shown) i5 likc,/~isc flexible at lea~t in bend region 212, 10 allowing it to transmit torque through bend region 212 to operate surgic~l tool 218. ~Itern~tively, the inter"led;~l~ and inncr tube6 may be flexible, and the outer tub~ may be rigid. In thi6 latter embodiment, interrnediate tube 226 i6 rota~ed to 6electively cover ~nd uncover the inci60r and 6ynovator window~, and outcr tube 216 16 (and thu6 al60 shiald 222) remains ~t~tionary. Similar flexible tube arrang~m0nts are disclosed in copending app' ~ on serial no.
08/2û0,662, filed on Febr iary 23, 1994, which is a continuation-ln-part of ~pp'ic ~ ~ on serial no. 08/011,3~4, filed on January 29. 1993, which are both assi~ned to the present as~iignee and i,,~.un~o,d~ed 20 hereln by re~erence In their entirety.
Various tube configurations exhibit the requi3ite flexibility ot least in the bend reQion to be employed in surgiccl instrument 210.
For instance, a region of an otherwise rigid tubc or tube6 may be Z5 r~l,ev~ with a series of sxisliy spaccd, circumferentially extending 3iot9 228 (only slots 228 in o~ter tube 216 shown in Fig. 15).
Slotting a rotatable tube for flexibility and torque t.dns",ission is de6cribed in IJ,S~ P~hnt No. 5,152,744, assigned to the present assignee and incorporated herein by reference in its entlrety~ To 30 prevent tissue fra~ments or other body materlal frorn catching on Dr passin~ throu~h the slots In the inner tube. the slots can be covered Wo 96/25103 PCT/US96101920 - with a pliable nlaterial ~uch as silicone R~V or a heat-shrinkable polymeric sheath (not shown).
The flexible regicn or regions can instead be comprised of a 5 series of discrete. interengaging segrnents as di~Glosed in copendinQ application serial no. 03/228 083 filet on April 15 1994 whioh is as~igned to the pre~nt ~3s;gnee snd incorporated herein by reference in its entirety. Alternatively, the tube~ can be con~prised, at lea~t in the bend region of a flexible or elar,~v"~r;c 10 m~tcrial, such as rubber, pla6tic, or other polymer.
Inter",ediiat~ tube 226 is comprised of a material (e.g.
~tainlo~s ~teel or other metal ceramiG or pla~tic) sufficiently ri~id to retain the sllape and orient;~"ion of bend re~ion 212 durln~ normal 1~ surgical use of instnlment ~1û. Althou~h bend reglon 212 Is often pr~fo,.,led durin~ manufacture ~e.g. by moldlng in~ "~diate tube 226 to the deslre~ shape or by bending it around a mandrel). if Illter"l~ e tube 22~ is c-,"".,ised at least in the bend region of a plasticly deformable material, bend region 212 can alternatively or 20 additionally be p~ ,haped or reshaped by the surgeon prior to or during the procedure to best rnatch the contour3 ~nd chor~cteristics of the ~urgical site.
Anothcr cmbodiment of the precent inv~ntion ~urgical 26 instrument 310, i~ ~hown in Fig. 16. A bend region 312 in sur~ical in~trument 310 is provided by a curved intermedi~te tube 314 and an inner tube 316 and an outer tube 318 of the instrument are flexible at least in bend re~ion 312. (Alternatlvely. similar to the alternative embodlment descrlbed above in conneclion with Fig. ~5 30 outertu~e 318 could be curved and intemlediate tube 314 could be flexible at least in bend region 312.) A window ~ssembly 320 W O96/25103 PCTrUS96/01920 camed at th~ dictal end of Inter"l~dlate tube 314 has opposit~ly disposed inclsor and synovator v.~ d-J.~ 322. 324, witilin which a cuttlng Implement (not shown) disj~osed at the distal end of Innertube 31~ rotates A shield 326 carried at the distal end of outer 5 tube 3t8 can be rotated to selectively cover either of windows.322, 324.
Similar to the instrurnent dis~losed in U.S. Patent No.
5,282,821, incorporated herein by raf~rence in its entirety, int~r-"cdiate tube 314 of ~urgicai inctrumant 310 is resilient, and a 10 straight, rigid cheath 328 i~ dispo~cd co~xially outside outer tube 318. Sheath 328 i~ axially slidable with respect to outer tube 318 and in its rest position (shown in Fig. 16) the distal end ~f sheath 328 ter",i"ales at a point just pr~ f bend re~ion 312. 511dlng sheath 328 distally (i.e., in the dil~LLion indlcated by arrow 330) ~ver 15 bend region 312 causes intermedlate tube 314 to straighten out.
decreasin~ the an~le ot offset provided by bend region 312. Slidin~
sheath 328 pru~l",ally 13ack to its rest posilion allows bend region 312 to recover its prerormed curvature. Thus, the angle of offset of tile ciistal region 332 of instrument 310 with respect to the proximQI
20 region 334 of the instrument can be selectivcly changed while the instrument ~",~;"c ~ihl within the pstient.
Other types of sur~ic31 toolc, CUch a~ abr~ders, may be ernployed with any of curgical instruments 10. 210, 310. Moreover, 25 the surgical tool may be removably connected to the distal end of the inner tube, allowing just the ~ur~ical tool to be replaced should It b~come worn or dama~ed, as disclosed In U.S. Patent No.
~,32û,~3~, assigned to the present assignee and incorporated herein ~y re~erence In its entirety. Als~, the sur~ic~l tool and the 30 inner tube need nc~t be comprised of the same material. Rather, the ~urgical tool will cften i~e comprised of a hard material well-suited to -W O96/25103 PCTrUS96/01920 - cutting, v,/h_reas the inner tube m~y be COI ~ l~ri5~ lead of a more compliant mat~rial (at least in the bend region) for tral~s."illi"y torque throu~h the bend region.
In addition, the inner, int~r",~Ji~te, and outer l-,el.,Le,~ need not bê tubes, but Gould instead be, e.~., solid ~le~lber~ or cables.
Moreover, the ~,ro~ ,al end of the outer member can be coupled to a source of ..lt~tior,al power, such as a motor (not shown), ~
the shield to be either power-rotated or manually actuated. Fùrther, 10 the interrllcJi~l~ tube of the instrument may be provided with more or fewer windows, and the ui"dow confisu,alio"s may be tc~ilolLd to dirLr~, .l cutting sr.~ i.,nO. For in~tance, in some applications it may be u~eful to provide a sin~le large window, and to ~/ary thê size of ths Y,~;.l '~w opening by partially covering it with the shield. In 15 such an arpliG~tion, it might be desirable to remove the ratchet mechanism to allow knob 92 to rotate ~.lloothly with ~ l to hub 68, or to modify the ratchet mechanism to rotate in smaller ..,ental ~têp~i.
In ~ iti~", the shield need not be attached to a member thst tA~ends from the base. Rather, the shield may be a cap mounted on the distal end of the inter~l,Gdiate tube. In such a construction, the instrument would have to be .~it~.dr -.v., from the joint space in order to select a Ji~,_r.. n ~vindow ~or cuttin3. Also, the shield need 25 not rotate, but could be configured il.~ I to slide along the intermediate tube to selec~ively cover and uncover eith~r or both of - the v~i~ Ido~/,'S, The inner "~e,~ ~ber could likewise translate axially to operate the distal tip surgical tool.
While the invention has been dcscriL~d in terms of surgical 30 instruments for s,li-ruscut ~, the invention may also be used with wo 96/25103 PCT/US96/o1s20 other types of instruments, for example, in3truments con~i~ured for other kind~ of endoscopic procedures and ~or biopsy epplicdlions.
Claims (28)
1. A surgical instrument comprising:
a base;
a support member extending distally from said base and carrying at a distal region a window defining and opening;
a surgical tool at least partially disposed in said distal region and movable to cut tissue extending through said opening characterised by the fact that said support member is provided with a shield at least partially disposed in said distal region and movable with respect to said window to at least partially cover said opening.
a base;
a support member extending distally from said base and carrying at a distal region a window defining and opening;
a surgical tool at least partially disposed in said distal region and movable to cut tissue extending through said opening characterised by the fact that said support member is provided with a shield at least partially disposed in said distal region and movable with respect to said window to at least partially cover said opening.
2. The instrument of claim 1 further comprising a second window defining a second opening carried at said distal region of said support member.
3. The instrument of claim 2 wherein said shield is movable to selectively cover one of said opening and said second opening.
4. The instrument of claim 1 further comprising an actuating member extending distally from said base for transmitting a force applied at a proximal end of said actuating member to move said shield.
5. The instrument of claim 4 wherein said shield is attached to a distal end of said actuating member.
6. The instrument of claim 4 wherein said actuating member comprises a tube.
7. The instrument of claim 4 wherein said proximal end of said actuating member is rigidly secured to a knob rotatably mounted to a stationary portion of said base.
8. The instrument of claim 7 wherein said knob is mounted to said stationary portion so that said knob can be selectively rotated to a plurality of discrete positions with respect to said stationary portion thereby to allow said shield to be selectively positioned to a corresponding plurality of discrete rotational orientations.
9. The instrument of claim 1 wherein said support member is axially slidable with respect to said base.
10. The instrument of claim 1 wherein said support member comprises a tube.
11. The instrument of claim 1 wherein said window is defined in an assembly attached to a distal end of said support member.
12. The instrument of claim 1 further comprising a drive member extending distally from said base for transmitting a force applied at a proximal end of said drive member to move at least a portion of said surgical tool.
13. The instrument of claim 12 wherein said surgical tool comprises a cutting implement attached to a distal end of said drive member.
14. The instrument of claim 13 wherein edges of said cutting implement move toward and closely past edges of said window in response to said force transmitted by said drive member.
15. The instrument of claim 14 wherein said cutting implement rotates with respect to said window in response to a rotational force transmitted by said drive member.
16. The instrument of claim 12 wherein said drive member comprises a tube.
17. The instrument of claim 15 wherein said drive member is hollow and is adapted to receive suction at its proximal end and to transport body material cut by said cutting implement away from a surgical site while the instrument remains in situ for further cutting.
18. The instrument of claim 1 further comprising a bend region in said support member.
19. The instrument of claim 18 further comprising an actuating member extending distally from said base for transmitting a force applied at a proximal end of said actuating member through said bend region to move said shield, wherein said actuacting member is relatively flexible at least in said bend region.
20, The instrument of claim 19 wherein said actuating member is a tube disposed outside said support member, and wherein said tube is relieved with a series of axially spaced slots in the area of said bend region to render said tube relatively flexible.
21. The instrument of claim 18 wherein said support member is relatively deformable at least in said bend region.
22. The instrument of claim 21 further comprising a rigid sheath disposed coaxially with and axially slidable with respect to said support member.
23. A surgical instrument comprising:
a base;
a support member extending distally from said base and carrying at a distal region a first window and a second window defining respective first and second openings;
a surgical tool at least partially disposed in said distal region and movable to cut tissue extending through said openings; and a shield at least partially disposed in said distal region and movable with respect to said window to selectively cover one of said openings.
a base;
a support member extending distally from said base and carrying at a distal region a first window and a second window defining respective first and second openings;
a surgical tool at least partially disposed in said distal region and movable to cut tissue extending through said openings; and a shield at least partially disposed in said distal region and movable with respect to said window to selectively cover one of said openings.
24. The instrument of claim 23 wherein said shield is movable to at least partially cover one of said openings.
25. The instrument of claim 23 wherein said first window is configured for more aggressive cutting than said second window.
26. A surgical instrument comprising:
a base;
a first tube extending distally from said base and carrying at a distal region a first window and a second window defining respective first and second openings;
a second tube disposed coaxially within said first tube and rotatably mounted with respect to said base, said second tube carrying a surgical tool in said distal region to out tissue extending through said opening when said second tube is rotated with respect to said first tube; and a third tube disposed coaxially outside said first tube and rotatably coupled to said base, said third tube carrying a shield in said distal region to selectively cover one of said openings when said third tube is rotated with respect to said first tube.
a base;
a first tube extending distally from said base and carrying at a distal region a first window and a second window defining respective first and second openings;
a second tube disposed coaxially within said first tube and rotatably mounted with respect to said base, said second tube carrying a surgical tool in said distal region to out tissue extending through said opening when said second tube is rotated with respect to said first tube; and a third tube disposed coaxially outside said first tube and rotatably coupled to said base, said third tube carrying a shield in said distal region to selectively cover one of said openings when said third tube is rotated with respect to said first tube.
27. A method of surgery for a joint space comprising:
introducing into said joint from outside said joint via a puncture wound in the flesh:
a first conduit for introducing fluid from a fluid source, a visualization instrument, and a surgical instrument comprising:
a base;
a support member extending distally from said base and carrying at a distal region a window defining an opening;
a surgical tool at least partially disposed in said distal region and movable to cut tissue extending through said opening;
and a shield at least partially disposed in said distal region and movable with respect to said window to at least partially cover said opening;
introducing fluid through said first conduit into said joint to distend said joint and to provided a clear field for viewing through said visualisation instrument, positioning said visualization instrument to enable observation of the area of said joint to be surgically treated, and on the basis of said visual observation, positioning said surgical instrument adjacent to said area of said joint and applying a force at a proximal end of said surgical device to operate said surgical tool to cut degenerated cartilage and synovial tissue of the joint exposed to said implement through said opening.
introducing into said joint from outside said joint via a puncture wound in the flesh:
a first conduit for introducing fluid from a fluid source, a visualization instrument, and a surgical instrument comprising:
a base;
a support member extending distally from said base and carrying at a distal region a window defining an opening;
a surgical tool at least partially disposed in said distal region and movable to cut tissue extending through said opening;
and a shield at least partially disposed in said distal region and movable with respect to said window to at least partially cover said opening;
introducing fluid through said first conduit into said joint to distend said joint and to provided a clear field for viewing through said visualisation instrument, positioning said visualization instrument to enable observation of the area of said joint to be surgically treated, and on the basis of said visual observation, positioning said surgical instrument adjacent to said area of said joint and applying a force at a proximal end of said surgical device to operate said surgical tool to cut degenerated cartilage and synovial tissue of the joint exposed to said implement through said opening.
28. The method of claim 27 further comprising the step of moving said shield with respect to said window to cover said opening.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US08/388,992 US5601583A (en) | 1995-02-15 | 1995-02-15 | Surgical instrument |
| US08/388,992 | 1995-02-15 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA2210523A1 true CA2210523A1 (en) | 1996-08-22 |
Family
ID=23536402
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA002210523A Abandoned CA2210523A1 (en) | 1995-02-15 | 1996-02-15 | Surgical instrument |
Country Status (8)
| Country | Link |
|---|---|
| US (1) | US5601583A (en) |
| EP (1) | EP0809466B1 (en) |
| JP (1) | JP3767903B2 (en) |
| AT (1) | ATE345737T1 (en) |
| AU (1) | AU690435B2 (en) |
| CA (1) | CA2210523A1 (en) |
| DE (1) | DE69636717T2 (en) |
| WO (1) | WO1996025103A1 (en) |
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-
1995
- 1995-02-15 US US08/388,992 patent/US5601583A/en not_active Expired - Lifetime
-
1996
- 1996-02-15 DE DE69636717T patent/DE69636717T2/en not_active Expired - Lifetime
- 1996-02-15 CA CA002210523A patent/CA2210523A1/en not_active Abandoned
- 1996-02-15 AU AU49791/96A patent/AU690435B2/en not_active Ceased
- 1996-02-15 AT AT96906402T patent/ATE345737T1/en not_active IP Right Cessation
- 1996-02-15 EP EP96906402A patent/EP0809466B1/en not_active Expired - Lifetime
- 1996-02-15 WO PCT/US1996/001920 patent/WO1996025103A1/en active IP Right Grant
- 1996-02-15 JP JP52508196A patent/JP3767903B2/en not_active Expired - Fee Related
Also Published As
| Publication number | Publication date |
|---|---|
| AU690435B2 (en) | 1998-04-23 |
| US5601583A (en) | 1997-02-11 |
| EP0809466B1 (en) | 2006-11-22 |
| DE69636717T2 (en) | 2007-10-18 |
| EP0809466A4 (en) | 2001-11-21 |
| JPH11504533A (en) | 1999-04-27 |
| EP0809466A1 (en) | 1997-12-03 |
| DE69636717D1 (en) | 2007-01-04 |
| WO1996025103A1 (en) | 1996-08-22 |
| ATE345737T1 (en) | 2006-12-15 |
| AU4979196A (en) | 1996-09-04 |
| JP3767903B2 (en) | 2006-04-19 |
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Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| EEER | Examination request | ||
| FZDE | Discontinued |