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| United States Patent | 3,844,272 |
| Banko | October 29, 1974 |
SURGICAL INSTRUMENTS
Abstract
Surgical instrument for taking tissue specimens in which a pair of coaxial tubular members are provided which are formed to have a tissue specimen receiving or flow compartment or provisions for holding the tissue. Each of the tubular members has a cutting or a holding edge and suction is provided through the instrument for drawing the specimen into the tissue receiving or tissue flow compartment. Movement of one of the tubular members relative to the other causes the tissue specimen to be cut and placed in the compartment or to be just cut and held in place.
| Inventors: | Banko; Anton (Bronx, NY) |
| Appl. No.: | 05/241,019 |
| Filed: | April 4, 1972 |
| Application Number | Filing Date | Patent Number | Issue Date | ||
| 799476 | Feb., 1969 | 3732858 | |||
| 762286 | Sep., 1968 | 3528425 | |||
| Current U.S. Class: | 600/566 ; 604/22; 606/170 |
| Current International Class: | A61B 17/32 (20060101); A61F 9/007 (20060101); A61B 10/00 (20060101); A61B 17/30 (20060101); A61B 18/02 (20060101); A61B 18/14 (20060101); A61B 18/00 (20060101); A61B 19/00 (20060101); A61B 17/00 (20060101); A61M 3/02 (20060101); A61M 3/00 (20060101); A61b 005/00 () |
| Field of Search: | 128/2R,2B,305,276,303.1 |
| 3173414 | March 1965 | Guillant |
| 3526219 | September 1970 | Balamuth |
| 3606878 | September 1971 | Kellogg |
| 3614953 | October 1971 | Moss |
Attorney, Agent or Firm:
CROSS-REFERENCE TO RELATED APPLICATION
This application is a continuation-in-part of applicant's copending application Ser. No. 799,476, filed Feb. 14, 1969 and now U.S. Pat. No. 3,732,858, which is in turn a continuation-in-part of the then copending application Ser. No. 762,286, filed Sept. 16, 1968 and now U.S. Pat. No. 3,528,425. All of said applications are assigned to the assignee of the subject application.
What is claimed is:
1. A surgical instrument comprising a first tubular member having a first active cutting means thereon, a second tubular member having a second active cutting means thereon, said first and second tubular members being concentric with each other, means for rotating said first and second members relative to each other to bring said first and second active means into an active relationship to cut an object, said second active means including a pocket formed at the end of said second active means having a cutting edge formed around at least a portion thereof, said first member having a portion of its first active means formed of a shape complementary to the pocket formed on said second member and including a cutting edge formed around at least a portion thereof, and means for applying suction including a first passage formed in said second member adapted to receive suction from a source, at least one opening in said second member through a wall thereof into its pocket, and a second passage between said first and second members to provide communication between said first passage and said opening.
2. An instrument as in claim 1 further comprising means for supplying irrigation fluid to exit from said instrument at a location adjacent said first and second active means.
3. An instrument as in claim 1 further comprising means for limiting the rotation of said first and second members relative to each other.
4. An instrument as in claim 1 wherein the leading end of said first member is pointed.
5. A surgical instrument comprising a first tubular member having a first active cutting means thereon, a second tubular member having a second active cutting means thereon, said first and second tubular members being concentric with each other, means for rotating said first and second members relative to each other to bring said first and second active means into an active relationship to cut an object, said second active means including a pocket formed at the end of said second means having a cutting edge formed around at least a portion thereof, said first member having a portion of its first active means formed of a shape complementary to the pocket formed on said second member and including a cutting edge formed around at least a portion thereof, and means for applying suction including a first passage formed in said second member adapted to receive suction from a source, said first passage having an exit directly into its said pocket.
6. An instrument as in claim 5 wherein said second member includes means at an end thereof for attaching a syringe to said second member.
7. An instrument as in claim 6 further comprising means for limiting the rotation of said first and second members relative to each other.
8. A surgical instrument comprising a first tubular member having a first active cutting means thereon, a second tubular member having a second active cutting means thereon which is located within said first member and movable relative thereto to bring said first and second active means into an active cutting relationship, means for applying suction pressure through said second member to said instrument to draw material into the area occupied by said second active member when in said active relationship, and means for supplying irrigation fluid to exit from said instrument at a location adjacent said first and second active means, said supplying means including a third tubular member concentric with said first member and defining a passage through which the irrigation fluid is supplied.
9. An instrument as in claim 8 wherein said third tubular member is formed with an exit passage through which the irrigation fluid leaves the instrument.
10. An instrument as in claim 8 wherein said second tubular member is formed with a second opening at the end thereof adjacent which said second active cutting means are located, and first opening formed in the wall of said first member to direct the irrigation fluid into said second member when the same is moved to a position where its second opening is aligned in fluid flow communication with the first opening in said first member.
11. An instrument as in claim 8 wherein said first and second tubular members each have their respective ends formed with openings having arcuate shaped cutting surfaces, said first and second tubular members being rotatable relative to each other.
12. An instrument as in claim 8 wherein said first and second tubular members each have their respective ends formed with openings having flat shaped cutting surfaces, said first and second members being rotatable relative to each other.
13. An instrument as in claim 11 wherein said third tubular member is formed with an exit passage through which the irrigation fluid leaves the instrument.
14. An instrument as in claim 12 wherein said third tubular member is formed with an exit passage through which the irrigation fluid leaves the instrument.
15. An instrument as in claim 11 wherein said second member is formed with a second opening at the end thereof adjacent which said second active means are located, and first opening formed in the wall of said first member to direct the irrigation fluid into said second member when the same is moved to a position where its second opening is aligned in fluid flow communication with the first opening in said first member.
16. An instrument as in claim 12 wherein said second member is formed with a second opening at the end thereof adjacent which said second active means are located, and first opening formed in the wall of said first member to direct the irrigation fluid into said second member when the same is moved to a position where its second opening is aligned in fluid flow communication with the first opening in said first member.
17. An instrument comprising first and second tubular members, said second member being located within said first member and being movable relative thereto, at least one means at an end of said second member to perform an operative function, and means for applying suction pressure through said second tubular member to exit through said second member at a location adjacent said one means to perform an operative function.
18. An instrument as in claim 17 wherein said first and second members are formed with a passage therebetween through which irrigation fluid can be supplied, and an exit port for said irrigation fluid in said first member.
19. An instrument as in claim 8 wherein said first and second tubular members each have an opening therein, the suction pressure exiting the instrument when said two openings are aligned, and an opening in said third tubular member through which the irrigation fluid exits.
20. An instrument as in claim 19 wherein said openings of said first and second members have cutting surfaces which are said first and second active means respectively, said first and second members being rotatable relative to each other.
21. An instrument as in claim 20 wherein said openings of said first and second members are located spaced away from the front end of the instrument.
In the foregoing patent applications various forms of instruments are disclosed and claimed which are adapted for the cutting, holding and removal of tissue from the body. The present invention also relates to instruments of the same general type. More specifically, the subject application includes instruments adopted for cutting tissue members as bands and membranes in the eye and instruments which are adopted for holding and working tissue members, in the manner of forceps. In addition the invention also relates to instruments of the type wherein a tissue sample of a portion of the body of an animal or a human being may readily be taken.
The preferred embodiments of the instruments of the present invention are provided with a suction arrangement wherein the tissue is drawn into the active portion of the instrument for cutting, holding or removing the tissue material. Further these instruments are constructed so that the relative displacement of the holding or cutting surfaces with respect to each other may be easily controlled so that a predetermined amount of tissue can be held, cut or removed at any one time.
In accordance with the invention, surgical type instruments are provided having first and second tubular coaxial members. Each of the members has a holding or cutting edge which cooperates with the holding or cutting edge of the other member. In the preferred embodiment of the invention for removal of a tissue specimen, the two members have an opening adjacent the respective cutting edges and the openings can be aligned to provide access to a tissue receiving compartment, all or a portion of which is formed in one of the members. The instrument is also provided with a manually or mechanically operated suction system which communicates with the tissue receiving compartment of one of the members so that the tissue specimen can be drawn into the compartment. Once the desired quantity of tissue is present in the compartment, the two members are rotated relative to each other so that the respective cutting edges thereon coact to cut off the specimen and place it into the compartment. In another embodiment of the invention, one of the members has an opening into a tissue receiving compartment which is surrounded by a cutting edge. The other members is axially slidable and has a cutting edge which cuts off the specimen to be taken.
Embodiments of the instruments of the present invention are also preferably provided with an arrangement to limit the relative rotation of the two tubular members so that the user can readily tell when the tissue receiving compartment of the instrument is open, to receive a tissue specimen, and closed with the specimen cut off and held in the compartment.
The instruments of the present invention also have the capability of moving one of the tubular members longitudinally, relative to the other member, to control the size of the opening into the tissue receiving compartment and thereby the size of the specimen to be cut. Further, various types of instruments are disclosed which have the capability of providing suction as well as irrigation into the area being worked upon. An arrangement for ejecting the severed tissue is also provided.
It is therefore an object of the present invention to provide instruments for taking tissue specimens.
A further object is to provide an instrument for taking tissue specimens in which suction can be provided via the instrument to draw the specimen to be taken into a tissue receiving compartment.
Another object is to provide surgical instruments for taking tissue specimens which can provide both suction and irrigation to the area of the tissue being operated upon.
Still a further object is to provide surgical instruments for taking tissue specimens in which a stop arrangement is provided for two members which are movable relative to each other so that the user can readily tell when the instrument is in a position to receive a specimen and when it is closed with the specimen trapped therein.
Other objects and advantages of the present invention will become more apparent upon reference to the following specification and annexed drawings, in which:
FIG. 1 is a perspective view of a preferred embodiment of the invention for removing a tissue sample;
FIG. 2 is a plan view of the instrument of FIG. 1 shown partly broken away and partly in cross-section;
FIG. 3 is a cross-sectional view of the instrument of FIGS. 1 and 2 taken along lines 3--3 of FIG. 2;
FIG. 4 is an enlarged fragmentary view of the tip of the instrument in cross section of the instrument of FIG. 1;
FIG. 5 is a cross-sectional view taken along 5--5 of FIG. 4;
FIG. 6 is a view similar to FIG. 4 showing the operative end of the instrument in the closed position;
FIG. 7 is a cross-sectional view of FIG. 6 taken along lines 7--7;
FIG. 8 is a fragmentary view of a portion of the instrument of FIGS. 1 and 2 showing an alternative type of arrangement for providing axial motion of a portion of the instrument;
FIG. 9 is a plan view, partly broken away and party in cross-section, of another embodiment of the subject invention;
FIGS. 10 and 11 are cross-sectional views of the instrument of FIG. 9 taken respectively along lines 10--10 and 11--11;
FIG. 12 is a fragmentary view of the front portion of another embodiment of the invention taken in cross-section;
FIGS. 13 and 14 are fragmentary views of the front portion of still a further embodiment of the invention, shown in cross-section, and showing respectively the open and closed positions of the instrument;
FIGS. 12A and 13A are views corresponding to FIGS. 12 and 13 showing further embodiments of the invention;
FIGS. 15 and 16 are fragmentary views of the front portion of yet a further embodiment of the invention, showing respectively the open and closed positions of the instrument, in cross-section;
FIGS. 17A and 17B show a plan view and an enlarged fragmentary view, both partly in section, of another instrument and its front portion, respectively;
FIGS. 18A and 18B are side and cross-sectional views of the front portion of another embodiment of instrument;
FIG. 19 is a plan view, partially in section, of the front portions of another form of instrument;
FIGS. 20A-20E are various views of a type to instrument constructed as a scissors;
FIGS. 21A and 21B are a plan view, in cross-section, and a front view of a type of instrument constructed as a forceps;
FIGS. 21A-21C are various views of a type of instrument constructed as a knife.
FIGS. 1-8 show a preferred embodiment of the instrument of the present invention for taking a tissue sample from the body of an animal or a human being. The instrument 10 includes a first tubular member 12 which extends substantially the entire length of the instrument and whose terminal (distal) operative end 12a is coaxial with a second tubular member 19. Member 12 has an internal fluid flow passage 13. A conduit 14 is shown attached to the proximal end of the tubular member 12 in communication with the flow passage 13. The conduit 14 is in turn connected to a suitable apparatus (not shown) for applying suction.
An intermediate portion of the first tubular member 12 passes through a hollow housing 16 of generally cylindrical shape which has a tapered down front section 17. An intermediate distal portion of first tubular member 12 undergoes a reduction in diameter within housing 16 to form the operative portion 12a. Similarly, the second tubular member 19 is a reduced diameter extension of housing 16.
The open end of housing 16 remote from second tubular member 19 has screw threads 21 thereon to accept a cap 23 which seals off the housing. An O-ring 24 is held against the end wall of the cap 23 and a collet 27 which is fastened to the tubular member 12. This seals the opening 28 in the cap end wall. A stop pin 31 projects axially from the collet 27 toward the front of the instrument within the housing 16 to engage an upstandin stop lug 35 mounted on the internal wall of housing upstanding
A knob 40 having a central bore through which first tubular member 12 passes is held to the member 12 by a set screw 42. The knob may have a knurled outer surface to provide better gripping action. Rotation of the knob 40 turns the tubular member 12 and its extension 12a relative to the member 19. The rotation of tubular member 12 is limited by the stop pin 31 engaging the stop lug 35.
As shown best in FIGS. 4 and 6, the flow passage 13 in first tubular member 12 terminates at a solid end wall 46. Ahead of the wall, the distal end of member 12 is formed with a generally cup-shaped member 48 which forms a portion of a tissue specimen receiving compartment. The upper edge of the cup 48 is formed with a cutting edge 49 completely therearound. This edge is sharp all around compartment 48 with the exception of the rear portion adjacent the tubular member 12a. As seen in FIGS. 5 and 7, the cup 48 has an interior surface which is substantially semi-cylindrical in shape. The leading end wall 48a is tapered outwardly somewhat while the trailing end wall 49b is tapered inwardly somewhat. The lower portion of the wall of cup 48 is and an is formed with one or more flow passages 51. The two interior side walls of the compartments are straight and tangent to the curved bottom wall. This facilitates the removal of tissue from the compartment.
The front end of second tubular member 19 is solid and is tapered to have a needle point 55. This permits the active end of the instrument to be inserted directly into the body from which the specimen is being taken. To the rear of the needle point 55 a hollow tubular pocket portion 19a (see FIG. 6) of member 19 is of generally semi-cylindrical shape which is complementary overall to the outer surface of cup 48 of the tubular member 12. This permits cup 48 to be rotated within the pocket 19a.
The upper edge of portion 19a (FIG. 7) of second tubular member 19 is also sharpened to provide a cutting edge 59, as shown in FIGS. 5 and 7. Cutting edge 49 is on the outside of cup 48 while edge 59 is on the inside of pocket 19a. Consequently, when the two edges oppose each other, a cutting action can take place. The upper cutting edges 49 and 50 of cup 48 and the member 19a can be substantially flush when the member 12 is rotated to have cup 48 in the open position shown in FIG. 4.
A space 62 is provided between the lower wall of the cup 48, which contains the passages 51, and the lower wall of section 19a of member 19. It should be understood that only one opening 51 can be used. The space 62 extends the length of cup 48 to a pocket 51 close to the front end of section 19a, adjacent the inner end of needle 55. A flow passage 15 is formed in the wall of tubular member 12a to the rear of the solid end 46. Passage 15 communicates with the through flow passage 13 of member 12 and the space 62 between cup 48 and section 19a of tubular member 19. As can be seen, a complete flow passage is provided from the suction or pressure line 14 through the passage 13 of tubular member 12, the opening 15, the elongated passage 62 and then through the openings 51 into the cup 48.
In operation of the instrument of FIGS. 1-8, the needle end 55 is inserted through the skin of the subject into the appropriate tissue from which the sample is to be taken. The instrument is inserted in its closed position. This prevents tissue particles from collecting in compartment 48 during penetration. When in place, member 12 is rotated to the open position shown in FIGS. 4 and 5. Suction is then applied through the conduit 14 which aids in drawing the tissue to be sampled into the cup 48 through the flow passage 62 previously described. Any blood or other liquid in the area from which tissue is being sampled is aspirated through the passages 51 and out of the instrument through the path 62, 15, 13 and 14. Once the tissue is in the cup the operator rotates the tubular member 12 by turning the knob 40. The leading cutting edge 49 of cup 48, depending upon the direction of rotation of member 12, cooperates with the cutting edge 59 on section 19a and cuts off the tissue sample as the member is rotated. Completion of the rotation of member 12 to the position shown in FIGS. 6 and 7 causes the tissue specimen to be cut off completely and separated from the rest of the anatomy.
As shown in FIGS. 6 and 7, with the instrument in the closed position a compartment is formed between the cup 48 and section 19a of the member 19. The tissue sample is completely contained within the compartment. At this time, the needle in its closed position is withdrawn from the subject. The tissue specimen is removed from the instrument by first rotating member 12 to open the compartment. Gas or liquid under pressure is then applied through the conduit 14. This can be from any source, for example, by attaching a filled syringe to the fine end of conduit 14. After the fluid from the syringe is ejected to move the tissue out of the compartment, the syringe can be disconnected from the conduit so that the instrument can again be used to collect a tissue specimen. The syringe also can apply suction pressure.
The stop pin 31 is preferably located with respect to stop lug 35 so that the compartment will be fully opened when member 12 is rotated up against a stop in one direction and fully closed when rotated up against the stop in the other direction.
The instrument shown in FIGS. 1-7 is shown as having only rotating motion, the amount of rotation being limited by the position of stops 31a and 31b. In FIG. 8, an arrangement is shown for providing axial reciprocating motion for the inner tubular member 12. Here, the collet 27 on member 12 is moved further into housing 16 and a coil spring 25 is located between the end of the collect to contact a washer 25a adjacent the O-ring 24. As should be apparent, tubular member 12 can be moved backwards toward the housing cap 23 against the force of spring 25. As this takes place the cup 48 moves further into the outer tube 19, thereby reducing the area available or tissue to be drawn into the cup and be cut off. By using this arrangement, the size of the tissue sample can be readily controlled. Upon release of the inner tubular member 12 against the force of the spring 65, it is moved back to its full open position shown in FIG. 4. The two members are rotated relative to one another to cut off the tissue specimen after the size of compartment has been established. As should be apparent, a solenoid (electrically operated) arrangement can be substituted for spring 25.
FIGS. 9 through 16 show further embodiments of the invention for taking tissue samples and/or for performing tissue removal. Referring first to FIGS. 9-14, an inner tubular member 112 passes through a hollow housing 114 whose end has a cap 116 thereon. Member 112 is hollow so that suction can be applied from a suitable source (not shown). A knob 117 is attached by spokes 118 to inner tubular member 112. The spokes 118 serve as a stop for rotation of member 112 against conduit 128 which passes through knob 117 and provides irrigation fluid to the instrument. If desired, an arrangement such as shown in FIG. 8, and in FIGS. 15 and 16 to be described below, can be provided in housing 114 so that the inner tubular member 112 can be reciprocated forward and backward.
The distal end of inner tubular member 112 has a reduced diameter end portion 112a which is coaxial with an passes through a concentric central tube 120 which is attached to the end of the housing. Tube 120 serves as an alignment and bearing surface for the inner tubular member 112a.
An outer tube 122 surrounds the central tube 120 and is concentric therewith. Outer tube 122 is attached to the left end of housing 114 in flow communication with an annular fluid flow chamber 126 formed in the housing. A fluid flow passage 124 is provided between the central tube 120 and the outer tube 122 which is in communication with annular flow passage 126 formed in housing 114. Conduit 128 for the irrigation fluid passes through knob 117 and the housing 114. The end of conduit 128 is at the flow chamber 126 at the front end of housing 114.
The fluid from conduit 128 goes from the flow chamber 126 in the housing to the passage 124. Two different arrangements for the exit of the irrigation fluid are shown respectively in FIGS. 12-12A and FIGS. 13, 13A, 14.
In both the embodiments of FIG. 12 and FIGS. 13-14, the central tubular member 112 has an arcuate opening 113. The edges surrounding the opening 113 are sharpened to provide a cutting surface. Similarly, the central tube 120 has an opening 121 of a shape complementary to that of opening 113. The edge surrounding opening 121 is also sharpened to provide a cutting surface.
The embodiments of FIGS. 12A and 13A correspond, respectively, to those of FIGS. 12 and 13. Here, however, opening 113a is straight. This configuration provides a flat area which can be rested against a desired part of the work area to seal it off. Maximum suction can therefore be applied. The embodiments of FIGS. 12, 13 and 14, due to the use of the curved surface 113 would have some leakage in the area of the curve.
In each of the embodiments of FIGS. 12, 12A, 13, 13A, and 14, the distal end 120a of the central tubular member 120 is shown rounded. Therefore, the instruments of these embodiments are not self-penetrating, as is the instrument of FIGS. 1-8, and a preliminary incision has to be made. The inner wall of the distal end 120a has an obtuse angle at point 120b with the wall of the tubular member 120. The front end of the inner tubular member 112a is of a complementary shape. The leading edge of opening 113 and 113a of each of these instruments preferably starts above the center line (longitudinal central axis of the inner member 112.)
Considering now the arrangements for providing the fluid flow, and referring first to FIGS. 12 and 12A the distal end of the outer tubular member 122 is fastened at 123 to the central tubular member 120 to close off the flow passage 124 for the irrigation fluid at the end of the instrument. One or more openings 130 are provided in the outer tubular member 122 through which the irrigation fluid can exit from passage 124 into the area being worked upon.
As in the case of the embodiment of FIGS. 1-8, suction applied to the inner tube 112 through the opening 113 draws the tissue specimen into the opening. Rotation of the inner tube 112 relative to the center tube 120 causes the two cutting edges of inner and central members 112 and 120 to mate and cut the specimen. It is then drawn into tubular member 112. After the member 112 is rotated to cut the specimen, the suction force can be turned off and the cut specimen held in the hollow portion of inner member 112. The instrument can then be withdrawn from the incision. As an alternative to this, the suction force can be left on and the cut tissue specimen drawn through the suction line. A trap (not shown) can be placed in the suction line to accept and hold the specimen as it comes from tubular member 112 through the suction conduit. Where continuous removal of a portion of tissue is to take place, inner tubular member 112 can alternately be rotated between its open and closed positions. In this case, the suction force is left on to provide for continuous removal of the cut tissue from the opening 113 of member 112.
FIGS. 13, 13A and 14 show another type of flow arrangement in which a passage, or passages, 140 for the irrigation fluid has been shifted from the outer tube 122 to the central tube 120. These passages are located to direct the fluid into the opening 113 or 113a. In the open position of the instrument, shown in FIG. 13, the irrigation fluid has no exit since passage 140 is closed by the bottom of the inner tubular member 112. As in the case of the instrument of FIG. 12, the tissue is drawn into the inner tube 112 through opening 113 or 113a by the suction force. The inner tube 112 is then rotated to the closed position to cut off the specimen. As shown in FIG. 14, at this time the irrigation fluid can exit through passage 140 into the inner tubular member 112 to aid in washing the tissue specimen back up through the suction conduit provided by the tube 112.
FIGS. 15 and 16 show a further embodiment of the invention which is in some respects similar to that of FIG. 12. Here, the irrigation passage 130 is formed in the outer tube 122 and the outer tube is permanently attached at 123 to the end of the central tube 120. In this case, the end 120a of the tube 120 is curved upwardly at 120b to form a cutting edge 120c at the front end of the opening 121a. The shape of the openings of the embodiment of FIGS. 15-16 are suitable for a side cutting operation while those of FIGS. 12-14 are more suitable for front cutting. This is so because the front portion 120a of the central tubular member is FIGS. 12-14 has a part removed to provide entrance from the front of the instrument into opening 113. In FIGS. 15-16, the front 120a is left substantially intact. In FIGS. 15 and 16, the exit passage 130 for the irrigation fluid is in the outer member 122 opposite the cutting surfaces. It is formed as close to the end of the tip as possible.
In FIGS. 15-16, the front end of the inner tube 112 is provided with a cutting end 112b. The tube 112 can be reciprocated forward and backward for example, in the manner shown for example in the embodiment of FIG. 8. As should be apparent, as the inner tube 112 is slid forward the cutting edge 112b cuts the tissue specimen. The cut is completed by a shearing action with an inwardly facing cutting edge 120c on the front 120a of central tubular member 120a. This is shown in FIG. 16. The instrument can be withdrawn from the body with the central member 112 in the position shown in FIG. 16. The cut specimen can be removed from central member 112 when the instrument is outside of the body. As an alternative to this, the suction force can be left on to withdraw the specimen. As in the case with the embodiments of FIGS. 12-14, this can provide repeated removal of tissue. A solenoid can be used to provide the reciprocating action to achieve the cutting.
FIGS. 17A and 17B show a modified form of the instrument of FIGS. 1-8. The instrument includes an outer tube 200 having a pointed end 201. Tube 200 has its end remote from point 201 fastened into a forward outer housing section 203a. An inner tube 204 is rotatable within the outer tube 200. Inner tube 204 includes a passage 205 which extends for its length and terminates in a restricted outlet end 207 which opens into the interior of a pocket or cup 208 formed at the end of the inner tube. Pocket 208 is of the same general shape as pocket 48 of FIG. 4 and has a cutting edge 210 formed on its upper edge in the same general manner as the cutting edge 49 of FIGS. 1-8. The end portion of outer tube 200 is formed of a complementary shape to pocket 208 of tube 204 which has a cutting edge (not shown) formed therearound in a manner similar to the cutting edge 59 of FIGS. 1-8. Thus, upon rotation of the inner tube 204 relative to outer tube 200, a tissue specimen may be cut off and placed in the pocket 208. The suction pressure or irrigation fluid is supplied directly from the end 207 of passage 205 into pocket 208 in a direction along the longitudinal axis of the instrument.
The inner tube 204 passes through the forward outer housing section 203a and a forward inner housing section 211a whose forward end is threaded to section 203a. An O-ring 203c seals off the two members. The end of tube 204 opposite the pocket 208 terminates in an enlarged fixture 214 with a threaded outer surface 215. Fixture 214 is designed to accept and hold an end of a hypodermic type syringe 220 which has the usual outer cylinder 221 and inner piston 223 with thumb actuator 224 at its near end. The forward end of the syringe has a reduced diameter opening 225 which is internally thread to mate with threads 215 of fixture 214 to hold the syringe to the instrument.
The forward inner housing section 211a has a rear collar section 211b coupled to it by a threaded engagement. The rear section 211b has a central opening into which the forward end of fixture 214 extends. A rear outer housing section 203b, which forms a cup, has a set screw 217 passing radially therethrough to engage and hold the fixture 214 of the inner tube 204. A washer 218 is attached to inner tube 204 and a spring 218a is located between the washer and the forward shoulder of inner housing section 211b. This arrangement stabilizes tube 204.
The rear outer housing section 203b is rotatable relative to the inner housing sections 211a, 211b. Thus, when it is turned, the engagement between set screw 217 and fixture 214 causes the inner tube 204 to rotate relative to outer tube 200 and produce the cutting action of pocket 208. A stop (not shown) in the form of contacting lugs on the rear inner and outer housing sections 211b and 203b can be used to limit the rotation.
Piston 223 has an operative end 227 of rubber or like material which forms a seal with the inner surface of cylinder 221 to eject fluid out of syringe 220 into the passage 204 of inner tube 204. Alternatively, moving piston 220 out of the cylinder creates a suction pressure in passage 205. The syringe 220 can be filled with fluid by unscrewing from the remainder of the assembly. If desired, a flexible tube can be interposed between the fixture 214 and the syringe end 225 so that the syringe can be located remote from the needle itself.
FIGS. 18A and 18B show a further embodiment of the invention which in some respects is similar to the embodiments shown in FIGS. 9-16. Here, a tube 250 is formed with inner and outer section to define an intermediate hollow passage 251. Passage 251 terminates in an exit port 254 through which irrigation fluid can be ejected into the area being worked upon. The end section 250a of the outer tube 250 forward of port 254 tapers inwardly to a blunt end 257.
Outer tube 250 has an opening 255 formed in wall section 250a. This opening can be for example, of circular, elliptical, or elongated, shape. The lower edge surrounding the periphery of the opening is preferably sharpened to provide a cutting surface.
An inner tube 260 of generally complementary shape to the outer tube 250 is provided which is rotatable relative to the outer tube, for example, by an arrangement such as is shown in FIG. 9. Inner tube 260 defines an interior suction passage 261 and has an opening 262 in its forward wall section 260a which is of the same shape as opening 255. The opening 255 preferably has a cutting edge (not shown) around the periphery of its upper surface. The front end of the inner tube 260 can be left open since passage 261 has a dead end against the end 257 of the outer tube. The taper of the forward ends of both tubes 250 and 260 provide a tight fit for the two tubes for cutting purposes and a self-sharpening action as the two tubes are rotated relative to each other. The preferred minimum angle of taper is about 10.degree. total included angle.
In operation of the instrument of FIG. 18, irrigation fluid is supplied to the passage 251 in the outer wall 250 and exits through port 254. Suction pressure is applied through inner tube passage 261.
With the two tubes 250 and 260 rotated to a position whereby the opening 255 is closed by the bottom portion of the inner tube 260, the irrigation fluid from port 254 is supplied to the working area. When the tissue is to be cut, the flow of irrigation fluid can, if desired, be stopped or left on. To make the cut, the inner tube 260 is rotated relative to the outer tube 250 so that the openings 255 and 262 are aligned. The suction in passage 261 draws the tissue through the two openings 255, 262 into the passage 261. Upon rotation of inner tube 260 to close the opening 255, the tissue in the opening will be cut by the sharpened cutting surfaces surrounding the two openings. The tissue cut off can be removed through the passage 261.
FIG. 19 shows a modification of the instrument FIG. 19. The same reference numbers are used for the same parts. In FIG. 19, instead of using an inner tube 250 with an opening aligning with the opening 255 in the outer tube 250, a drill 270 is provided having a head end 272 of a shape complementary to the tapered outer tube section 250a. Drill 272 has a cutting edge 273 which upon rotation of the drill mates with the cutting edge on the lower surface of the opening 255.
Upon application of suction through a passage 275 defined by the interior wall of outer tube 250, suction is applied to the working area through the opening 255. The sample is sucked into opening 255 and is continuously cut off as the drill 270 rotates. The cut off tissue is removed from the instrument through passage 275. As should be apparent, the instrument of FIG. 19 has advantages in that it provides for a continuous cutting of the sample.
In the embodiments shown in FIGS. 18A-18B and 19, the inner tube 260 of FIGS. 18A-18B and the drill 270 of FIG. 19 can be rotated either manually or by an automatic device, for example, a motor (not shown).
FIGS. 20A-20E show a scissors type of instrument for cutting tissue. An elongated outer tube 280 is provided as a support for the remainder of the instrument. An inner tubular member 285 extends through the length of housing 280 and is adapted at one end 286 to receive suction pressure. The other end of tube 285 is supported within an outer tubular guide 290 which is fastened to an end wall 281 of the housing 280. A conduit 292 which extends through housing 280 has a discharge end 293 in the housing end wall 281. The discharge end 293 communicates with the space between the outer surface of the inner tube 285 and the inner surface of guide tube 290 to define a passage 294 so that fluid applied through conduit 292 can exit through a port 296 adjacent the end of the guide tube into the work area. FIGS. 20A-20E show the end of the inner tube 285 supported by the interior wall of guide 290 and the passage 294 with exit port 296.
The end 286 of inner tube 285 has a knob 298 fastened thereon which backs up against a spring 302 located between the knob and the end wall of housing 280. The knob permits the inner tube 285 to be rotated relative to the guide tube 290. Spring 302 insures that if there is a slight reciprocation of members 285 and 290 relative to each other, that the two will be aligned when knob 298 is released.
The cutting end of the instrument includes a first curved cutting member 310 which is formed partially around the end of tube 285. The two curved cutting members 310 and 320 have respective inclined edges 311 and 321 on each side thereof. When viewed from the side, such as in FIGS. 20B and 20C, the edges form a negative angle with respect to each other, that is, the opening between the opposing edges of the cutting members 310 and 320 increases from the front to the rear of the instrument. The negative angle is used so that the tissue being cut will not squeeze out as the two members 285 and 290 are rotated relative to each other. As shown in FIGS. 20D and 20E, the radius of the circle on which the cutting edge 311 is located is smaller than the one on which the cutting edge 321 is located and are such that the cutting edge 321 can move within the edge 311 to provide a scissors type shearing action. FIGS. 20D and 20E show front views of slightly different forms of cutting surfaces.
FIGS. 21A and 21B show an instrument similar to that of FIGS. 20A-20E. The housing and the irrigation and suction arrangements are the same as are the other portions of the instrument. The only difference between the instruments of FIG. 20 and FIG. 21 is that the operative ends of the two members 285 and 290 are not formed with cutting members. Instead, inner tube 285 has an arcuately shaped gripping member 335 formed thereon with flat surface 336 on each side thereof. Similarly guide 290 has an arcuate gripping member 340 with a flat surface 341 on each side thereof.
The opposing surfaces 336 and 341 of members 335 and 340 define the same type of negative angle as in FIG. 20. However, the radii of the members 335 and 340 are the same so that when the members 280 and 285 are rotated relative to each other, the tissue, or other material, is held between the two surfaces 336 and 341. As should be apparent, the application of suction through the inner tube 285 aids in having the tissue held between the two gripping members 335 and 340.
FIGS. 22A-22C show a type of knife with provisions for providing both irrigation fluid and suction pressure. A housing 360 has a rear end on which a rotatable cap 362 is held by a set screw 364 which rides in a groove 365. A threaded bushing 366 is fastened to an inner tubular member 370. A conduit 372 for applying suction pressure to the central passage 371 of tube 370 is attached to an end of tube 370 outside of housing 360. Cap 362 has threads 366a which rotate on the threads of bushing 366. A pin 374 is fastened to the tube 370 and extends through a slot 375 in the wall of housing 360. The end 361 of housing 360 remote from cap 362 has a guide tube 380 attached thereto. The guide tube is formed of two conctcutive tubular members 380a and 380b to define a hollow interior to provide a passage 381 for irrigation fluid which exits through a port 383 near the end of tube 380. Tube 380 is closed off by a nipple 385. The irrigation fluid is supplied via a conduit 387 which passes through end 361 of housing 360 to communicate with passage 381.
The end of inner tube 370 which is remote from conduit 372 passes through and is guided by the interior walls of the innermost tubular section 380b of the guide tube 380. A knife blade 390 of any desired shape and having a cutting edge 392 is mounted on the end of tube 370 leaving the front of the tube partially open for suction pressure to be available through the passage 371.
In the operation of the instrument of FIGS. 22A-22B the irrigation fluid flowing through port 283 clears the work area. The suction from passage 371 draws the member to be cut into the active area of the knife. The knife is moved with a to-and-fro motion by turning cap 362 which rotates around fixed bushing 366 causing the knife to move. Pin 374 provides a stop in each direction. Pieces of the material cut are removed through the passage 371 by the suction pressure.
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