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Patentes

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Número de publicaciónUS20020029055 A1
Tipo de publicaciónSolicitud
Número de solicitudUS 09/872,526
Fecha de publicación7 Mar 2002
Fecha de presentación1 Jun 2001
Fecha de prioridad28 Jun 1990
También publicado comoUS5269785, US5403317, US5577517, US5694951, US5935131, US6174313, US6468289, US6543455, US6592531, US6607534, US6652532, US6719803, US6835198, US7134437, US7896880, US20020045903, US20020055755, US20020082631, US20020091403, US20020091406, US20020099401, US20030009147, US20030009172, US20030009237
Número de publicación09872526, 872526, US 2002/0029055 A1, US 2002/029055 A1, US 20020029055 A1, US 20020029055A1, US 2002029055 A1, US 2002029055A1, US-A1-20020029055, US-A1-2002029055, US2002/0029055A1, US2002/029055A1, US20020029055 A1, US20020029055A1, US2002029055 A1, US2002029055A1
InventoresPeter Bonutti
Cesionario originalBonutti Peter M.
Exportar citaBiBTeX, EndNote, RefMan
Enlaces externos: USPTO, Cesión de USPTO, Espacenet
Apparatus and method for tissue removal
US 20020029055 A1
Resumen
Percutaneous tissue removal apparatus comprises a flexible drill shaft, a cutting tip mounted on the shaft for placement adjacent a tissue mass for cutting the tissue, means for transmitting motion to the shaft to move the cutting tip against the tissue to cut tissue fragments from the tissue, and means for removing the tissue fragments along the shaft by suction to a location outside the tissue mass while cutting. The apparatus may include means for collecting one or more selected components of the harvested tissue fragments for implantation of the fragments preferably into the body of the patient from whom they were removed. Where the tissue to be cut is bone, a cutting tip is preferably made of a polymeric material which is softer than the cortical portion of the bone, although the cutting tip may be made of a ceramic or a composite material. A second flexible shaft may be provided either within or about the flexible drill shaft. The harvested tissue fragments may be implanted in the donor patient's body.
Imágenes(6)
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Reclamaciones(35)
I claim:
1. Tissue removal apparatus comprising:
a flexible drill shaft;
a cutting tip mounted on said shaft for cutting tissue;
means for transmitting motion to said shaft to move said cutting tip against the tissue to cut tissue fragments from the tissue; and
means for removing the tissue fragments along said shaft by suction to a location outside the body while cutting.
2. An apparatus as defined in claim 1 including means for collecting one or more selected components of the removed tissue fragments for implantation of the fragments into the body of the patient from whom they were removed.
3. An apparatus as defined in claim 1 wherein said drill shaft comprises a polymeric or composite material.
4. An apparatus as defined in claim 1 wherein said cutting tip comprises a polymeric or composite material with hardness specific to tissue application.
5. An apparatus as defined in claim 2 wherein said cutting tip is made of a composite or ceramic material.
6. An apparatus as defined in claim 1 wherein said flexible drill includes surface means defining a suction passage extending axially along said drill shaft through which said bone fragments are removed, said suction passage having a smooth polymeric surface to reduce friction.
7. An apparatus as defined in claim 1 further including guide means for controlling the location of said cutting tip within the tissue.
8. An apparatus as defined in claim 7 wherein said guide means comprises a guide rod extending within said flexible cutting shaft to allow said shaft to advance into a space.
9. An apparatus as defined in claim 8 wherein said guide means is selectively rigidifiable.
10. An apparatus as defined in claim 1 including means for injecting fluid to a location adjacent said cutting tip including surface means defining a fluid injection passage extending axially along said flexible shaft.
11. An apparatus as defined in claim 1 wherein said flexible drill shaft is hollow and comprising a non-moving flexible sleeve extending generally coaxially about said flexible drill shaft.
12. An apparatus as defined in claim 11 including an axially extending suction passage between said flexible drill shaft and said flexible sleeve and through which the tissue fragments are removed.
13. An apparatus as defined in claim 1 wherein said flexible drill shaft is solid and comprising a flexible sleeve extending generally coaxially about said flexible drill shaft and movable with said flexible drill shaft when said flexible drill shaft is moved to cut tissue.
14. An apparatus as defined in claim 1 comprising a formable sleeve extending generally coaxially with said flexible drill shaft.
15. An apparatus as defined in claim 1 comprising a disposable liner sleeve at least partially defining a suction passage for the harvested tissue fragments.
16. Tissue removal apparatus comprising:
a flexible shaft;
a cutting tip mounted on said shaft for placement within a tissue mass;
means for transmitting rotary or oscillatory motion to said shaft to move said cutting tip against the tissue to cut tissue fragments from the tissue mass;
means for removing the tissue fragments along said shaft by suction to a location outside the body while cutting; and
means for collecting one or more selected components of the removed tissue fragments for implantation of the fragments into the body of the patient from whom they were removed.
17. An apparatus as defined in claim 16 wherein said means for collecting comprises a trap or a filter or a strainer.
18. An apparatus as defined in claim 16 wherein said flexible shaft includes surface means defining an axially extending suction passage along said flexible shaft through which said tissue fragments are removed, said suction passage having a smooth polymeric surface to reduce friction of the removed tissue fragments.
19. Tissue removal apparatus comprising:
a flexible hollow drill shaft;
a cutting tip mounted on said shaft;
means for transmitting rotary or oscillatory motion to said drill shaft to move said cutting tip within a tissue mass to cut tissue fragments from the tissue mass;
means for removing the tissue fragments along said shaft by suction to a location outside the body while cutting; and
guide means for controlling the location of said cutting tip within the tissue mass.
20. An apparatus as defined in claim 19 wherein said guide means comprises a guide rod extending within said flexible drill shaft.
21. An apparatus as defined in claim 19 wherein said guide means comprises a hollow guide sleeve outside said flexible drill shaft.
22. An apparatus as defined in claim 19 wherein said guide means is selectively rigidifiable.
23. An apparatus as defined in claim 19 comprising a second flexible shaft extending generally coaxially with said flexible drill shaft and movable with said flexible drill shaft when said flexible drill shaft is moved to cut tissue.
24. An apparatus as defined in claim 19 comprising a formable sleeve extending generally coaxially about said flexible drill shaft.
25. Tissue removal apparatus comprising:
a flexible shaft for insertion inside a tissue mass;
a cutting tip mounted on said shaft for cutting the tissue;
means for transmitting motion to said shaft to move said cutting tip against the tissue to cut tissue fragments from the tissue mass;
guide means for controlling the location of said cutting tip within the tissue mass;
means for removing the tissue fragments along said shaft by suction to a location outside the body while cutting; and
means for collecting one or more selected components of the harvested tissue fragments for implantation of the fragments into the body of the patient from whom they were removed.
26. A method comprising the steps of:
placing within a tissue mass a flexible shaft having mounted thereon a cutting tip for cutting the tissue mass;
transmitting motion to said shaft to move said cutting tip against the tissue to cut tissue fragments from the tissue mass; and
removing the tissue fragments along the shaft by suction to a location outside the tissue mass while cutting the tissue.
27. A method as defined in claim 26 further including the step of controlling the location of said cutting tip within the tissue mass with a guide rod.
28. A method as defined in claim 26 including the step of cutting bone with a cutting tip which is harder than cancellous bone.
29. A method as defined in claim 26 further including the step of collecting one or more selected components of the removed tissue fragments for implantation into the body of the patient from whom they were removed.
30. A method as defined in claim 29 further including the step of controlling the location of said cutting tip within the tissue mass with a guide rod.
31. A method of grafting human tissue comprising the steps of obtaining a quantity of tissue fragments suitable for grafting, compressing the tissue fragments into a plug suitable for implantation, and securing the compressed tissue fragments in the graft location with a retainer.
32. A method as defined in claim 31 wherein the retainer is a biodegradable mesh or sac.
33. A method as defined in claim 31 wherein the retainer is a mass of solidified flowable polymeric material.
34. A method as defined in claim 33 wherein the polymeric material is a biodegradable material.
35. Tissue removal apparatus comprising a rotatable flexible drill shaft and a rotary cutting tip attached to said shaft for placement adjacent or within a tissue mass for cutting the tissue, said rotary cutting tip having first and second adjacent cutting edges spaced apart in the direction of rotation including a leading edge for grabbing the tissue to be cut and a trailing edge for cutting the tissue.
Descripción
    BACKGROUND OF THE INVENTION
  • [0001]
    1. Technical Field
  • [0002]
    The present invention relates to the field of tissue removal and tissue grafting. More particularly, t he present invention relates to an apparatus and method for the percutaneous cutting and removal of selected portions of tissue from a patient and the possible harvesting and implantation of the tissue portion in the donor.
  • [0003]
    2. Description of the Prior Art
  • [0004]
    There are various known methods and apparatus for the cutting and removal of tissue fragments from a human. Each of these, however, suffers from one or more deficiencies.
  • [0005]
    U.S. Pat. No. 4,832,683 shows an instrument for ultrasonic cutting of bones, with irrigation or suction. However, there is no suction while cutting, no removal of the cut bone or tissue, and no flexibility in the instrument.
  • [0006]
    U.S. Pat. No. 4,265,231 shows apparatus f or drilling a curved hole having a flexible shaft confined in a rigid tubular sheath, but which shows no removal of cut bone or tissue.
  • [0007]
    U.S. Pat. No. 4,541,423 shows apparatus for drilling a curved hole having a flexible shaft confined in a semirigid tubular sheath, but which shows no removal of cut bone or tissue.
  • [0008]
    U.S. Pat. No. 4,589,414 shows a surgical cutting instrument with a reciprocatory cutting motion, but which has no removal of cut bone or tissue, and no flexibility in the instrument.
  • [0009]
    U.S. Pat. No. 4,603,694 shows a rotating arthroscopic shaver with suction, but which is not flexible and which has no removal of cut bone or tissue.
  • [0010]
    U.S. Pat. No. 4,751,922 shows a flexible medullary reamer with a plastic shaft and a guide rod, but which has no suction and no removal of the cut bone or tissue.
  • [0011]
    U.S. Pat. Nos. 4,798,213, 4,649,918, and 4,142,517 show various apparatus for bone coring.
  • SUMMARY OF THE INVENTION
  • [0012]
    The present invention is a percutaneous tissue removal apparatus including a flexible drill shaft and means for transmitting motion to the shaft. A cutting tip is mounted on the shaft to cut tissue fragments from the tissue. The tissue fragments are removed by suction along the flexible drill shaft to a location outside the body while cutting. One or more selected components of the removed tissue fragments may be collected for implantation, preferably into the body of the patient from whom they were removed. Because the drill shaft is flexible, the surgeon can guide the cutting tip into various locations within the tissue from a small (percutaneous) incision. The surgeon can cut around arcs or angles, rather than only being able to go in a straight line, to reach any desired location, and to avoid vital tissue which would otherwise be in the cutting path. For example, when removing unwanted tissue inside a knee joint the drill shaft can deform, and is therefore less likely to damage normal tissue or joint surfaces. None of these functions is possible with a straight line system.
  • GENERAL DESCRIPTION OF THE INVENTION
  • [0013]
    The present invention is a percutaneous tissue removal device and method. In the preferred embodiments described below, the apparatus and method are illustrated as used for removal of bone tissue, but such description is for illustrative purposes only. The invention is not limited to the removal of bone tissue and may be used for removal of cartilage, muscle, fetal tissue, etc. It may be used to break up and remove kidney stones, in the gall bladder for a stone or tumor, in the stomach, in the colon to remove a polyp or tumor, etc. It can reach spaces not currently available with the straight line systems currently available.
  • [0014]
    A percutaneous tissue removal apparatus in accordance with the present invention includes a flexible drill shaft for insertion inside a tissue. A cutting tip is mounted on the drill shaft for cutting the tissue. Either rotating motion or reciprocating motion is transmitted to the drill shaft to move the cutting tip against the tissue to cut tissue fragments from the tissue. While cutting, the tissue fragments are removed by suction to a location outside the body. The drill shaft and cutting tip are small enough to be usable percutaneously. They may also be used for endoscopic, arthroscopic or fiberoptic or open surgery.
  • [0015]
    Because the drill shaft is flexible, the surgeon can guide the cutting tip into various locations within the tissue from one percutaneous incision. The surgeon can cut around arcs or angles, rather than only being able to go in a straight line, to reach any desired location, and to avoid vital tissue which would otherwise be in the cutting path. The flexible drill shaft also allows the surgeon when working inside a bone, for example, to keep the cutting tip away from the harder outer cortical bone and to remove only the softer inner cancellous bone. None of these features is available with the current straight line cutting devices.
  • [0016]
    The drill shaft may be made of metal, of polymeric material to reduce friction, or of a composite material. Extensive use of polymers in the drill shaft, its housing if provided, and the cutting tip area reduces friction substantially, thus requiring less energy and generating less heat within the tissue. The drill shaft is drivable by hand (for improved feel) or by motor, at variable speeds based on the need for the tissue removed.
  • [0017]
    To provide for the collection of the tissue fragments to be harvested, the removal apparatus has an axially extending suction passage along the drill shaft through which the tissue fragments are removed. The suction passage has a smooth lining to keep the tissue fragments or graft material contained and to reduce friction of the harvested tissue fragments. This lining may be the inside diameter of the flexible drill shaft itself, or may be a separate liner sleeve which can be removed and disposed of when it becomes unsanitary or clogged, without having to remove the drill shaft and cutting tip. Alternatively, if a separate guide sleeve or guide rod is used the suction passage may be formed between the drill shaft and the guide sleeve or guide rod. In such a case, the drill shaft may be solid rather than hollow.
  • [0018]
    The cutting tip is made of a material which is harder than the material to be cut. The cutting tip may be slightly larger in diameter than the drill shaft. The cutting tip may be made of a polymeric material or a composite material. Alternatively, the cutting tip may be made of a ceramic material. The cutting tip is separable from the drill shaft, and several different cutting tips may be provided in varying hardnesses, so that the surgeon can selectively remove various portions of tissue as desired.
  • [0019]
    By virtue of its flexibility, the flexible drill shaft, when removing bone tissue, may stay within the cortical confines of the bone. Alternatively, it may work with a guide device to control the location of the cutting tip within the bone. The guide means may be a guide rod extending within the flexible drill shaft, or a hollow guide sleeve outside the flexible drill shaft. The guide rod or guide sleeve may be rigid in a particular shape, to fit a particular application; or it may be bendable into a particular shape which it will hold; or it may be selectively rigidifiable into a particular shape in situ. The guide means may include structure for positioning the tip of the flexible drill shaft. The guide means may also be inserted into a separate flexible tube system to guide it to a specific location, then removed, allowing the flexible drill to be inserted.
  • [0020]
    Fluid may be injected through the flexible drill shaft to a location adjacent the cutting tip to increase the efficiency of the tissue removal and to limit thermal necrosis. Alternatively, a fluid injection passage may extend axially along the flexible drill shaft, the drill shaft. Alternatively, fluid may be injected through the suction passage, alternating with the suction. The fluid injection may be constant or it may be pulsatile in nature. If fluid injection is used, centrifuging of the harvested material may be performed.
  • [0021]
    Means for collecting one or more selected components of the harvested tissue fragments may include a known trap or filter connected to the outlet of the suction passage. Removed tissue may be centrifuged to separate its components. Thus, the tissue fragments are not merely removed from the body and may be harvested for implantation of the fragments, preferably into the body of the patient from whom they were removed. In order to maintain the sterility of the tissue removed, the entire suction apparatus including the suction passage and the trap or filter is sterilized, and, if necessary, is disposable.
  • [0022]
    With the present invention all work is done by going percutaneously through the skin to a specific tissue area to minimize the damage to skin, muscle, and bone. For example, when removing bone tissue, trauma is limited to a small opening in the hard outer structural cortical bone, limiting postoperative bleeding from the bone which is difficult to stop, because the small operative hole can easily be plugged after the grafting procedure is completed, preventing postoperative bleeding into soft tissue. There is only intraosseous bleeding, so that fewer complications, and less pain, are likely to arise. The operation does not create stress risers which would weaken the bone. Thus, the present invention provides a safe and efficient way to collect and reuse a patient's own tissue.
  • [0023]
    Human tissue grafting works best using the patient's own tissue as donor material. Therefore, the harvested tissue may be implanted in the donor's own body for grafting. To implant one or more selected components of harvested bone fragments, for example, a cannula is inserted through the skin and muscle to the area of the bone where the graft is to be placed. A drill or curette is then used to remove a portion of the outer cortical bone. A curette or probe is inserted through the cannula to clear out the area where the graft is to be placed, either in open surgery or through X-ray guidance in percutaneous surgery. The harvested tissue fragments may be packed or compressed into a plug of tissue graft material, of a specific shape, with or without blood or fibrin for adhesion. Or, a retaining material such as a biodegradable mesh may be used to hold the graft material together as a unit. The graft material and its retaining material are then inserted at the graft location in the bone. Alternatively, the graft material is inserted and then sealed in place with a mass of formable polymeric material inserted over the graft material to hold the graft together in position.
  • [0024]
    A method of percutaneous tissue removal in accordance with the present invention includes the steps of placing within a tissue mass a flexible drill shaft having mounted thereon a cutting tip for cutting the tissue; transmitting motion to the drill shaft to move the cutting tip against the tissue to cut tissue fragments from the tissue; and removing the tissue fragments by suction to a location outside the tissue mass while cutting the tissue. The method may further include the step of controlling the location of the cutting tip within the tissue with a guide rod, the step of collecting one or more selected components of the harvested tissue fragments, and/or the step of implanting the fragments into the body of the patient from whom they were removed.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • [0025]
    Further features of the present invention will become apparent to those skilled in the art to which the present invention relates from reading the following specification with reference to the accompanying drawings, in which:
  • [0026]
    [0026]FIG. 1 is a schematic view of a tissue removal system in accordance with the present invention and including a flexible drill;
  • [0027]
    [0027]FIG. 2 is a schematic view of a hand-powered flexible drill for use in the system of FIG. 1;
  • [0028]
    [0028]FIG. 3 is a schematic view of a portion of a hollow flexible drive shaft for the flexible drill;
  • [0029]
    [0029]FIG. 4 is a schematic view similar to FIG. 3 and showing a guide rod inside the hollow flexible drive shaft;
  • [0030]
    [0030]FIG. 5 illustrates a portion of a flexible drill including a hollow flexible inner cutting shaft within a flexible outer sleeve and a suction passage between the two shafts;
  • [0031]
    [0031]FIG. 6 is a view similar to FIG. 5 with a suction passage within the inner shaft;
  • [0032]
    [0032]FIG. 7 illustrates a portion of a flexible drill including a solid flexible inner cutting shaft within a flexible outer sleeve and a suction passage between the two shafts;
  • [0033]
    [0033]FIG. 8 illustrates a portion of a flexible drill including a solid formable inner guide rod within a flexible outer cutting sleeve and a suction passage between;
  • [0034]
    [0034]FIG. 9 illustrates a portion of a flexible drill including a hollow flexible inner cutting shaft within a solid formable outer sleeve and a suction passage between;
  • [0035]
    [0035]FIG. 10 is a view similar to FIG. 9 with a suction passage within the inner shaft;
  • [0036]
    [0036]FIG. 11 illustrates a portion of a flexible drill including a solid flexible inner cutting shaft within a solid formable outer sleeve and a suction passage between;
  • [0037]
    [0037]FIG. 12 illustrates a portion of a flexible drill including a relatively flexible portion between two relatively rigid portions;
  • [0038]
    [0038]FIG. 13 illustrates the use of a liner sleeve in a suction passage;
  • [0039]
    [0039]FIG. 14 is a view illustrating a number of different cutting tips usable with the flexible drill;
  • [0040]
    [0040]FIGS. 15 and 16 are schematic views illustrating the provision of a plurality of separately inflatable bladders as a guide mechanism for a flexible structure and the operation of a guidance system for locating the tip of the flexible structure;
  • [0041]
    [0041]FIGS. 17 and 17A are schematic views illustrating the forming of harvested tissue fragments into a compressed plug suitable for implantation;
  • [0042]
    [0042]FIG. 18 is a schematic view illustrating the implantation of harvested bone fragments using a polymeric mesh as a retainer; and
  • [0043]
    [0043]FIGS. 19 and 19A are schematic views illustrating the implantation of harvested tissue fragments using a formable polymeric sealant as a retainer.
  • DESCRIPTION OF PREFERRED EMBODIMENTS
  • [0044]
    The present invention is described herein with reference to a percutaneous bone removal and harvesting apparatus and method. It should be understood that the present invention is not limited to the removal of bone tissue, but is useful in the removal of any hard or soft tissue in the body such as excess, unwanted, or tumorous tissue or tissue used for reimplantation or grating.
  • [0045]
    A percutaneous bone removal apparatus 10 (FIG. 1) in accordance with the present invention includes a flexible drill 12. The flexible drill 12 has a flexible shaft 14 and a cutting tip 16 at the distal end of the shaft 14. The proximal end of the flexible shaft 14 is connected by a housing 18 to a motor or other power source 20 to provide rotational motion or reciprocating motion in a manner known in the art. Alternatively, the drill 12 may have an angled drive, such as 90° drive or any angle, with the motor drive connected at an angle to the longitudinal extent of the suction and cutting apparatus.
  • [0046]
    Control means indicated schematically at 21 may include one or more switches or valves to turn on or off the suction, irrigation, and motor drive. control A fluid injection source 22 is connected by a fluid injection line 24 to the housing 18 of the flexible drill 12. A suction source 26 acts through a trap or filter or strainer 28 and a suction line 30 to provide suction capabilities for the flexible drill 12.
  • [0047]
    [0047]FIG. 2 illustrates a flexible drill 12 a in which the housing 18 a is connected to a hand controller 20 a. The hand controller 20 a allows the surgeon to operate the flexible drill 12 a by hand, imparting either rotational or reciprocating movement to the flexible shaft 14 a and cutting tip 16 a.
  • [0048]
    [0048]FIG. 3 illustrates a portion of a basic version of a flexible drill having a cutting tip 16 mounted on a flexible drive shaft 31. The drive shaft 31 has an outer surface 32 and an inner surface 34 defining a longitudinally extending suction passage 36. The cutting tip 16 has a cutting edge 40 and an opening 38 through which tissue fragments cut by the cutting tip 16 may be aspirated. The tissue fragments are drawn through the suction passage 36 in the flexible drive shaft 31 and thence into the suction line 30 (FIG. 1) for collection in the trap or filter or strainer 28.
  • [0049]
    [0049]FIG. 4 illustrates the use of a pre-inserted guide rod 42 with a flexible drill of the present invention. The guide rod 42 extends through the suction passage 36 of the flexible drive shaft 31. The guide rod 42 may be any suitable structure including a K-wire or other known device. The cutting tip 16 may have a centrally located opening in its distal end to allow insertion of the flexible drill over the guide rod 42. The guide rod 42 is first placed in the body, then the flexible drill is inserted over the guide rod 42 and guided to the location from which tissue is to be harvested.
  • [0050]
    [0050]FIG. 5 illustrates an embodiment of a flexible drill having an outer sleeve 44 circumscribing a flexible drill shaft 41. The flexible outer sleeve 44 may be formed of a metal or composite material or may be formed of a polymeric material which may be the same as or different from the material of the flexible inner cutting shaft 31. The outer sleeve 44 is fixed (non-moving) to minimize tissue damage. A suction passage 46 is defined between the outer surface of the flexible inner shaft 31 to which the cutting tip is attached, and the inner surface of the flexible outer sleeve 44. Alternatively, as shown in FIG. 6, a suction passage 48 may be defined within the flexible inner cutting shaft 50. In this case, the outer surface of the flexible inner shaft 50 is preferably, as illustrated in FIG. 6, in close proximity to the inner surface of the outer sleeve 44 to increase stability. The use of polymeric materials for both the inner shaft 50 and the outer sleeve 44 provides for reduced friction between the sleeve 44 and the shaft 50 for ease of operation and reduced heat generation.
  • [0051]
    [0051]FIG. 7 illustrates an alternate embodiment of the apparatus of FIG. 5 in which the flexible inner cutting shaft 52 is formed as a solid shaft rather than a hollow shaft. The harvested tissue fragments travel through the suction passage 46 between the inner shaft 52 and the outer sleeve 44.
  • [0052]
    [0052]FIG. 8 illustrates apparatus similar to FIG. 7 in which a fixed (non-moving) inner shaft 54 is made of a solid, formable, material and the cutting tip is mounted on a flexible rotating outer sleeve 56. Suction is drawn through a suction passage 58 between the shaft 54 and the sleeve 56. The inner shaft 54 is made from a semi-rigid material which is bendable to a desired curvature, at the use site, to select the curvature of the hole to be drilled, and which is rigid enough to retain that curvature in use while the drill shaft 56 rotates around it. Such material is disclosed in U.S. Pat. No. 4,541,423, the disclosure of which is incorporated herein by reference.
  • [0053]
    [0053]FIGS. 9, 10 and 11 illustrate embodiments of the flexible drill of the present invention in which a flexible inner cutting shaft, which may be hollow or solid, is disposed within a non-moving formable outer sleeve. The formable outer sleeve 60 is made of a semi-rigid bendable shape retaining material as described above with reference to FIG. 8. In FIG. 9, a hollow flexible inner cutting shaft 62 is disposed within the outer sleeve 60 and defines therebetween a suction passage 64. In FIG. 10, a hollow flexible inner cutting shaft 66 is disposed in close proximity to and within the outer sleeve 60, with a suction passage 68 formed within the flexible inner cutting shaft 66. In FIG. 11, a solid flexible inner cutting shaft 70 is disposed within the outer sleeve 60, defining therebetween a suction passage 72.
  • [0054]
    [0054]FIG. 12 illustrates a portion of a flexible drill shaft 80 in accordance with the present invention in which a pair of relatively rigid drill portions 82 and 84 are joined by a relatively flexible drill portion 86. The relatively rigid drill portion 82 includes an outer sleeve 88, an inner shaft 90, and a suction passage 92 therebetween. The relatively rigid drill portion 84 includes an outer sleeve 94 like the outer sleeve 88, an inner shaft 96 like the inner shaft 90, and a suction passage 98 therebetween. The drill portion 86 includes a relatively flexible inner shaft portion 100 disposed within a relatively flexible outer sleeve portion 102, defining therebetween a suction passage 104. The relatively flexible inner shaft portion 100 connects the relatively rigid inner shaft portions 90 and 96. The relatively flexible outer sleeve portion 102 connects the relatively rigid outer sleeve portions 88 and 94. The suction passage 104 in the relatively flexible drill shaft portion 86 connects the suction passages 92 and 98. Either the inner shaft or the outer sleeve of the flexible drill 80 may have a cutting tip mounted thereon. Thus, with a flexible drill shaft made in this manner, it is not necessary that the entire drill shaft be made of flexible materials, but rather “joints” such as are formed by the relatively flexible portion 86 may be placed along the longitudinal extent of a relatively rigid drill shaft as desired.
  • [0055]
    [0055]FIG. 13 illustrates how a disposable single-use liner sleeve 110 may be used in a flexible drill of the present invention. The liner sleeve 110 shown in FIG. 13 is located within an outer sleeve 112 and is shown about a guide rod or guide wire 114. Suction is drawn through a passage 116 within the liner sleeve 110. The disposable single-use liner sleeve 110 provides an absolutely sterile environment through which harvested tissue fragments may pass. The inner surface 118 of the liner sleeve 110 is extremely smooth in order to facilitate passage of the harvested tissue fragments therethrough. It should be understood that a liner sleeve like the liner sleeve 110 may be used with any suitable flexible drill shaft configuration in accordance with the present invention, and not merely with the configuration shown in FIG. 13.
  • [0056]
    [0056]FIG. 14 illustrates several different cutting tips which may be attached in a known manner to a flexible drill shaft in accordance with the present invention. The technology for the cutting tips is not specific to the present invention, but rather the cutting tips may be designed in accordance with known principles.
  • [0057]
    The cutting tip 120 (FIG. 14) has a cutting edge 122 at least partially defining an opening 123 through which suction is drawn. The cutting tip 124 includes a plurality of cutting edges 126 defining a plurality of suction openings 128 disposed along the outer circumferential portion of the cutting tip 124. The cutting tip 130 is similar to the cutting tip 124 but includes cutting edges 126 a and suction openings 128 a which extend to the end of the cutting tip 130. Furthermore, the cutting tip 130 is blunt rather than sharp, to avoid perforation of tissue, such as bones.
  • [0058]
    The cutting tip 132 has a spiral cutting edge 134 defining a spiral suction opening 136. The cutting tip 138 has at least one longitudinally extending cutting edge 140 at least partially defining a longitudinally extending suction opening 142. The cutting tip 143 is formed as a burr with fluted cutting edges 144 and suction openings 145, and is especially suited for shaving operations such as removal of bone spurs, etc. The cutting tip 146 has twin cutting edges 147 and 148 and a suction opening 149. The cutting edges 157 and 148 can be configured with the leading edge to grab the tissue and the trailing edge to cut the tissue.
  • [0059]
    The configuration of a cutting tip for use in accordance with the present invention is a design choice within the skill of the art. The goals to be met are proper cutting and suction capabilities, controllability and shape so as to avoid unwanted damage to areas of tissue not to be cut. For example, when removing the softer cancellous portion of bone, the cutting tip may be made of a material which is harder than the cancellous material of the bone but softer than the cortical portion of the bone to avoid damage thereto. Metal may be useful, and suitable polymers are also readily available. Ceramic materials and composites are also suitable. Also, the cutting tip may be arranged as a rotating flexible shaft within a fixed flexible outer shaft, with a cutting edge on the rotating shaft to cut tissue off against the fixed edge. In such a case, the apparatus may be advantageously configured with one shaft being metal and the other polymeric, to minimize friction and heat buildup.
  • [0060]
    [0060]FIGS. 15 and 16 illustrate an alternate guidance system for positioning a flexible drill shaft 150 and its associated cutting tip. Disposed within the sleeve 150 is a guidance mechanism 152 including a plurality of inflatable elements spaced serially. The inflatable elements, when inflated, rigidify and become straight, while when in the deflated condition they are soft and flexible and may be curved or bent. Thus, as seen in FIG. 15, both the inflatable elements designated 154 and the inflatable elements 156 are curved. In FIG. 16, the inflatable elements 154 have rigidified and straightened, while the inflatable elements 156 remain in their curved position. The inflatable elements may also be accordion shaped, expanding in length as they are inflated. The mechanism 152 may be augmented with a known cable guidance system.
  • [0061]
    By selectively and individually controlling the rigidification of any or all of the inflatable elements of the mechanism 152, the inflatable mechanism 152 and its associated outer sleeve 150 may be selectively formed into almost any desired shape or position. Suitable control and valving apparatus is provided for controlling the inflation of the inflatable elements. Such apparatus may be, when only a few elements are present, a simple mechanical valving apparatus. When more elements are present, or more sophisticated or complex control thereof is desired, a microprocessor may be used to control the inflation of each segment. Separate inflation and deflation lines can be used, or one line can, by alternating valving, serve both functions. In such case, the control signals may be multiplexed down the structure via electric wire, optical fiber, or radio control, for example.
  • [0062]
    At the distal end of the mechanism 152 is a tip guidance mechanism 160 including a plurality of inflatable members 162. The inflatable members 162 when in a deflated condition are flexible and relatively straight. When inflated, as shown in FIG. 16, the members 162 assume a preformed shape which may be curved or straight and which is illustrated herein as a curved shape, bending radially outwardly to engage the surface of adjacent tissue 164 and curve the end of the device into an appropriate position. The members 162 may be constructed, using known principles, to assume any desired shape. By controlling the positioning of one or more of the elements 162, the tip portion 168 of the guidance mechanism 152 may be selectively placed in any position relative to the tissue 164, thus positioning the end of the sleeve 150. The air bladder guidance system as described may be used in conjunction with a flexible tube separate from the flexible drill shaft, order to guide the flexible tube to a specific location and position it there, thereafter removing the guidance system and allowing a flexible drill to be inserted.
  • [0063]
    Means for collecting one or more selected components of the harvested tissue fragments includes a mechanism 28 (FIG. 1) which may be a known trap or filter connected to the outlet of the suction passage 30. Removed tissue may also be centrifuged if necessary or desired, keeping the components such as bone, cells, and blood and discarding fluid. These components and connections, and their uses, are well known in the art and thus are not described herein in greater detail. The harvested tissue fragments are not merely removed from the body of the patient, but are also collected in the structure 28 and thus harvested or saved for later implantation of the fragments, preferably into the body of the patient from whom they were removed. Such harvesting and implantation are desirable because human tissue grafting works best using the patient's own tissue as donor material.
  • [0064]
    In preparing the harvested graft material for implantation, the tissue fragments alone are spun or compressed (see FIG. 17) to form them into the desired shape. When the tissue is harvested, blood and blood clots are often drawn along with the tissue fragments. The blood component fibrin is a sticky clotting component, and can be used to aid in holding the tissue fragments together for implantation. Thus, the blood can be is separated from the tissue fragments and then spun to separate the fibrin for use with the tissue fragments. Alternatively, the entire mass of tissue fragments and blood is compressed into a specific shape to form the mass into a specific, appropriate shape for implantation into the body.
  • [0065]
    The surgeon can also place other substances into the graft material to be implanted, such as other tissue graft material, collagen, antibiotics, or ceramic hydroxyapatite or tricalcium phosphate to aid in bone ingrowth. In such a case, when the blood or fibrin is used also, the graft has the adhesive qualities of the blood or fibrin and the biological properties of the bone (or other) tissue, along with the appropriate medical properties of any other material included.
  • [0066]
    Harvested tissue fragments before implantation are preferably packed or compressed into a plug of tissue graft material. Alternatively, the tissue fragments may be left in a more loose state, or only certain selected cells, components, or tissue fragments are used. Any suitable means of packing or compressing fragments may be used. FIG. 17 illustrates schematically a simple apparatus for doing so. As viewed in FIG. 17, the harvested tissue pieces 170 are placed into a form or mold 172 and then compressed by a movable compressor 174 to form a plug 176 of a desired shape or size. Unwanted fluid drains out through one or more fluid outlets 178, while the graft, cells, fibrin, and blood clot tissues remain within the form 172.
  • [0067]
    To implant one or more selected components of the harvested tissue fragments, for example in grafting bone tissue onto a bone, a cannula 180 is inserted through the skin 182 and muscle 184 to the area of the bone 186 where the graft is to be placed. A curette or probe is then inserted through the cannula 182 to clear out the area 188 where the graft is to be placed.
  • [0068]
    The harvested tissue fragments are compacted or compressed into a plug 190 of tissue graft material. A retaining material such as a known biodegradable or other polymeric mesh 192 is then used to hold the graft material 190 together as a unit. The retaining material may also be a sac of biodegradable material used to hold the graft material. The sac can be closed by a clamp or by crimping or heat sealing. The graft material 190 and its retaining material 192 are then inserted into the graft area of the bone. The cannula 180 may then be removed. Alternatively, the tissue graft material may be held in place by a mass of biodegradable or other polymeric material used as a sealant for the opening in the bone 186. The graft material can be compressed or spun into a specific shape. Thus, if an implant is needed to fit a specific shape of bone defect, the graft material can be formed in the shape needed and packed directly into the bone gap.
  • [0069]
    The bone graft material may also be implanted in the loose condition as described above. The bone graft material 194, if loose, can be inserted through a funnel 196 and a sleeve 198 located within the cannula 180, to the area 188 to be grafted. It is then packed in place as desired using a suitable instrument. Next, an injector 200 is used to inject a mass of flowable biodegradable or other polymeric material 202 for use as a sealant to seal the bone graft material 194 in position. The use of a flowable biodegradable material is preferable in that it allows the surgeon to form in situ a custom shaped sealant plug to seal the opening in the tissue graft area, which will eventually resorb as new tissue grows into its place.
  • [0070]
    The apparatus may include, as noted above, fluid injection means 22 and 24 for injecting fluid through the flexible drill to a location adjacent the cutting tip to aid in cutting and removal of the harvested tissue fragments. For example, in the drill shaft structure illustrated in FIG. 5, fluid may be injected through a fluid injection passage 204 within the flexible inner cutting shaft 31, while suction is drawn in the opposite direction through the suction passage 46. Alternatively, the suction may be intermittently discontinued and fluid may be injected through the suction passage, alternating with the suction. The fluid injection may be constant or it may be pulsatile in nature.
  • [0071]
    The present invention thus provides a method of percutaneous tissue removal which includes the steps of placing adjacent to a tissue mass a flexible drill shaft 14 having mounted thereon a cutting tip 16 for cutting the tissue; transmitting motion to the drill shaft 14 to move the cutting tip 16 against the tissue to cut tissue fragments from the tissue; and removing the tissue fragments by suction to a location outside the tissue mass while cutting the tissue. The method may further include the step of controlling the location of the cutting tip within the tissue with a guide mechanism, the step of collecting one or more selected components of the harvested tissue fragments, and/or the step of implanting the fragments into the body of the patient from whom they were removed.
  • [0072]
    From the above description of the invention, those skilled in the art will perceive improvements, changes and modifications. Such improvements, changes and modifications within the skill of the art are intended to be covered by the appended claims.
Citas de patentes
Patente citada Fecha de presentación Fecha de publicación Solicitante Título
US1959615 *27 Abr 193222 May 1934Derrah Robert VFruit squeezer
US2433815 *13 Sep 193530 Dic 1947Nicephore Laforge Pierre CharlApparatus for pressing fruit
US2724326 *10 Oct 195222 Nov 1955Long Oliver ROrange juice extractor
US2955530 *24 Mar 195911 Oct 1960Sebastian C GaetaTissue press
US3048522 *4 Ago 19597 Ago 1962Millot LabProcess for separating endocellular components and a composition produced thereby
US3108357 *20 Jun 196229 Oct 1963William J LiebigCompound absorbable prosthetic implants, fabrics and yarns therefor
US3224434 *6 Nov 196221 Dic 1965Waldemar Medical Res FoundatioCell collector
US3469003 *1 Abr 196623 Sep 1969Haver Lockhart Lab IncInjectable reconstituted collagen fluid adjuvant for vaccines and other drugs
US3514791 *25 Jul 19672 Jun 1970Charles H SparksTissue grafts
US3593709 *28 Oct 196820 Jul 1971William X HalloranAngular compression plate for bone fractures
US3606878 *4 Oct 196821 Sep 1971Howard B Kellogg JrNeedle instrument for extracting biopsy sections
US3613497 *10 Abr 196919 Oct 1971U S Expansion Bolt CoExpansion anchor
US3618605 *12 Nov 19699 Nov 1971Glassman Jacob ACatamenial tampon
US3655306 *19 Ene 197011 Abr 1972Donald Nixon RossApparatus for molding heart valves
US3670732 *11 May 197020 Jun 1972Ralph R RobinsonVacuum curette
US3777743 *29 Sep 197211 Dic 1973Kendall & CoEndometrial sampler
US3804089 *8 Jun 197116 Abr 1974H BridgmanVacuum cannula apparatus
US3812855 *15 Dic 197128 May 1974Surgical Design CorpSystem for controlling fluid and suction pressure
US3846846 *26 Sep 197312 Nov 1974Fischer ArturHip joint prosthesis
US3874264 *16 Feb 19731 Abr 1975Constantine D PolosAnchor bolt assembly
US3939835 *3 Jul 197424 Feb 1976Henry BridgmanMedical aspiration system vacuum level indicator
US3945375 *30 Abr 197323 Mar 1976Surgical Design CorporationRotatable surgical instrument
US4210580 *19 Jun 19791 Jul 1980David AmraniProcess for separation and isolation of AHF and fibronectin from blood plasma
US4245653 *2 Ene 197920 Ene 1981Kenneth WeaverMethod and apparatus for obtaining specimens of endometrial tissue
US4274414 *21 Feb 197923 Jun 1981Dyonics, Inc.Surgical instrument
US4373535 *17 Ago 198115 Feb 1983Martell Michael DVenting, self-stopping, aspirating syringe
US4445509 *4 Feb 19821 May 1984Auth David CMethod and apparatus for removal of enclosed abnormal deposits
US4573448 *5 Oct 19834 Mar 1986Pilling Co.Method for decompressing herniated intervertebral discs
US4598698 *17 Ene 19858 Jul 1986Warner-Lambert Technologies, Inc.Diagnostic device
US4646736 *25 Jul 19863 Mar 1987E. R. Squibb & Sons, Inc.Transluminal thrombectomy apparatus
US4646738 *5 Dic 19853 Mar 1987Concept, Inc.Rotary surgical tool
US4696667 *20 Mar 198629 Sep 1987Helmut MaschIntravascular catheter and method
US4706659 *5 Dic 198417 Nov 1987Regents Of The University Of MichiganFlexible connecting shaft for intramedullary reamer
US4747405 *16 Sep 198631 May 1988Vaser, Inc.Angioplasty catheter
US4750488 *27 Feb 198714 Jun 1988Sonomed Technology, Inc.Vibration apparatus preferably for endoscopic ultrasonic aspirator
US4756708 *2 Jun 198712 Jul 1988Vas-Cath IncorporatedBiopsy catheter
US4785825 *4 Feb 198822 Nov 1988Humboldt--Universitaet zu BerlinSafety biopsy forceps
US4790819 *24 Ago 198713 Dic 1988American Cyanamid CompanyFibrin clot delivery device and method
US4828563 *13 Ago 19879 May 1989Dr. Muller-Lierheim AgImplant
US4863472 *2 Sep 19875 Sep 1989Biocon OyBone graft implant
US4883666 *29 Abr 198728 Nov 1989Massachusetts Institute Of TechnologyControlled drug delivery system for treatment of neural disorders
US4892552 *8 Sep 19869 Ene 1990Ainsworth Robert DOrthopedic device
US4899729 *3 Ago 198813 Feb 1990Gill Steven SExpansible cannula
US4902296 *29 Oct 198720 Feb 1990The University Of Virginia Alumni Patents FoundationUse of demineralized bone matrix in the repair of segmental defects
US4932973 *21 Abr 198812 Jun 1990El GendlerCartilage and bone induction by artificially perforated organic bone matrix
US4936848 *22 Sep 198926 Jun 1990Bagby George WImplant for vertebrae
US5015247 *13 Jun 198814 May 1991Michelson Gary KThreaded spinal implant
US5027827 *28 Mar 19902 Jul 1991Cody Michael PVacuum biopsy apparatus
US5047040 *16 Feb 198910 Sep 1991Devices For Vascular Intervention, Inc.Atherectomy device and method
US5057120 *28 Dic 198815 Oct 1991Farcot Jean ChristianApparatus for the performance of an angioplasty of long duration
US5059193 *19 Abr 199022 Oct 1991Spine-Tech, Inc.Expandable spinal implant and surgical method
US5127419 *2 Jul 19917 Jul 1992Antoine KaldanyBiopsy instrument with slotted driving member
US5152744 *27 Dic 19906 Oct 1992Smith & Nephew DyonicsSurgical instrument
US5152776 *15 Nov 19916 Oct 1992Cordis CorporationBalloon inflation device
US5167239 *30 May 19911 Dic 1992Endomedix CorporationAnchorable guidewire
US5185001 *18 Ene 19909 Feb 1993The Research Foundation Of State University Of New YorkMethod of preparing autologous plasma fibrin and application apparatus therefor
US5190541 *17 Oct 19902 Mar 1993Boston Scientific CorporationSurgical instrument and method
US5226877 *23 Jun 198913 Jul 1993Epstein Gordon HMethod and apparatus for preparing fibrinogen adhesive from whole blood
US5236456 *17 Ene 199117 Ago 1993Osteotech, Inc.Osteogenic composition and implant containing same
US5285795 *12 Sep 199115 Feb 1994Surgical Dynamics, Inc.Percutaneous discectomy system having a bendable discectomy probe and a steerable cannula
US5372138 *9 Dic 199213 Dic 1994Boston Scientific CorporationAcousting imaging catheters and the like
US5443443 *17 Ago 199322 Ago 1995Surgical Systems & Instruments, Inc.Atherectomy system
US5593425 *30 May 199514 Ene 1997Peter M. BonuttiSurgical devices assembled using heat bonable materials
US5694951 *9 Ago 19969 Dic 1997Bonutti; Peter M.Method for tissue removal and transplantation
US5713853 *7 Jun 19953 Feb 1998Interventional Innovations CorporationMethods for treating thrombosis
US5833692 *10 Abr 199610 Nov 1998Smith & Nephew, Inc.Surgical instrument
US5868749 *31 Ene 19979 Feb 1999Reed; Thomas M.Fixation devices
US5968048 *22 Jul 199619 Oct 1999Howmedica GmbhBore head for boring bone channels
US6261295 *4 Oct 199917 Jul 2001Cortek, Inc.Cutting jig and guide for tome apparatus for spinal implant
US6312438 *1 Feb 20006 Nov 2001Medtronic Xomed, Inc.Rotary bur instruments having bur tips with aspiration passages
US6325806 *31 Ene 20004 Dic 2001Biomedical Enterprises, Inc.Materials collection system and uses thereof
US6358252 *2 Ago 200019 Mar 2002Ira L. ShapiraApparatus for extracting bone marrow
US6409764 *3 Dic 199825 Jun 2002Charles F. WhiteMethods and articles for regenerating bone or peridontal tissue
USRE38018 *7 Mar 20014 Mar 2003Medtronic Xomed, Inc.Angled rotary tissue cutting instrument and method of fabricating the same
Citada por
Patente citante Fecha de presentación Fecha de publicación Solicitante Título
US678353321 Nov 200131 Ago 2004Sythes Ag ChurAttachable/detachable reaming head for surgical reamer
US685233021 Dic 20008 Feb 2005Depuy Mitek, Inc.Reinforced foam implants with enhanced integrity for soft tissue repair and regeneration
US688442816 Dic 200226 Abr 2005Depuy Mitek, Inc.Use of reinforced foam implants with enhanced integrity for soft tissue repair and regeneration
US711510015 Nov 20023 Oct 2006Ethicon, Inc.Tissue biopsy and processing device
US761147311 Sep 20033 Nov 2009Ethicon, Inc.Tissue extraction and maceration device
US779440828 Mar 200314 Sep 2010Ethicon, Inc.Tissue collection device and methods
US782470125 Feb 20032 Nov 2010Ethicon, Inc.Biocompatible scaffold for ligament or tendon repair
US787529629 Nov 200725 Ene 2011Depuy Mitek, Inc.Conformable tissue repair implant capable of injection delivery
US79014615 Dic 20038 Mar 2011Ethicon, Inc.Viable tissue repair implants and methods of use
US799808629 Sep 200916 Ago 2011Depuy Mitek, Inc.Tissue extraction and maceration device
US801686728 Oct 200413 Sep 2011Depuy Mitek, Inc.Graft fixation device and method
US803400327 Mar 200811 Oct 2011Depuy Mitek, Inc.Tissue extraction and collection device
US813768620 Abr 200420 Mar 2012Depuy Mitek, Inc.Nonwoven tissue scaffold
US813770229 Dic 201020 Mar 2012Depuy Mitek, Inc.Conformable tissue repair implant capable of injection delivery
US816354920 Dic 200624 Abr 2012Zimmer Orthobiologics, Inc.Method of obtaining viable small tissue particles and use for tissue repair
US821112515 Ago 20083 Jul 2012Ethicon Endo-Surgery, Inc.Sterile appliance delivery device for endoscopic procedures
US822178029 Jun 200617 Jul 2012Depuy Mitek, Inc.Nonwoven tissue scaffold
US822671530 Jun 200324 Jul 2012Depuy Mitek, Inc.Scaffold for connective tissue repair
US824120429 Ago 200814 Ago 2012Ethicon Endo-Surgery, Inc.Articulating end cap
US825205730 Ene 200928 Ago 2012Ethicon Endo-Surgery, Inc.Surgical access device
US826256314 Jul 200811 Sep 2012Ethicon Endo-Surgery, Inc.Endoscopic translumenal articulatable steerable overtube
US826265521 Nov 200711 Sep 2012Ethicon Endo-Surgery, Inc.Bipolar forceps
US826268010 Mar 200811 Sep 2012Ethicon Endo-Surgery, Inc.Anastomotic device
US8337394 *1 Oct 200825 Dic 2012Ethicon Endo-Surgery, Inc.Overtube with expandable tip
US835348717 Dic 200915 Ene 2013Ethicon Endo-Surgery, Inc.User interface support devices for endoscopic surgical instruments
US836106612 Ene 200929 Ene 2013Ethicon Endo-Surgery, Inc.Electrical ablation devices
US836111227 Jun 200829 Ene 2013Ethicon Endo-Surgery, Inc.Surgical suture arrangement
US84039265 Jun 200826 Mar 2013Ethicon Endo-Surgery, Inc.Manually articulating devices
US84092003 Sep 20082 Abr 2013Ethicon Endo-Surgery, Inc.Surgical grasping device
US842550525 Ago 201123 Abr 2013Ethicon Endo-Surgery, Inc.Electroporation ablation apparatus, system, and method
US844953827 Ene 201028 May 2013Ethicon Endo-Surgery, Inc.Electroporation ablation apparatus, system, and method
US844956115 Feb 200728 May 2013Depuy Mitek, LlcGraft fixation device combination
US848065731 Oct 20079 Jul 2013Ethicon Endo-Surgery, Inc.Detachable distal overtube section and methods for forming a sealable opening in the wall of an organ
US848075728 Ago 20069 Jul 2013Zimmer, Inc.Implants and methods for repair, replacement and treatment of disease
US849657417 Dic 200930 Jul 2013Ethicon Endo-Surgery, Inc.Selectively positionable camera for surgical guide tube assembly
US849697027 Feb 201230 Jul 2013Depuy Mitek, LlcConformable tissue repair implant capable of injection delivery
US849712123 Mar 201230 Jul 2013Zimmer Orthobiologics, Inc.Method of obtaining viable small tissue particles and use for tissue repair
US850656418 Dic 200913 Ago 2013Ethicon Endo-Surgery, Inc.Surgical instrument comprising an electrode
US851843315 Dic 201127 Ago 2013Zimmer, Inc.Method of treating an osteochondral defect
US852426815 Dic 20113 Sep 2013Zimmer, Inc.Cadaveric allogenic human juvenile cartilage implant
US852956325 Ago 200810 Sep 2013Ethicon Endo-Surgery, Inc.Electrical ablation devices
US856254215 Jul 201022 Oct 2013Depuy Mitek, LlcTissue collection device and methods
US856841025 Abr 200829 Oct 2013Ethicon Endo-Surgery, Inc.Electrical ablation surgical instruments
US857989721 Nov 200712 Nov 2013Ethicon Endo-Surgery, Inc.Bipolar forceps
US858561028 Jun 201119 Nov 2013Depuy Mitek, LlcTissue extraction and maceration device
US86086525 Nov 200917 Dic 2013Ethicon Endo-Surgery, Inc.Vaginal entry surgical devices, kit, system, and method
US863706621 Sep 201028 Ene 2014Depuy Mitek, LlcBiocompatible scaffold for ligament or tendon repair
US8641775 *1 Feb 20114 Feb 2014Depuy Mitek, LlcViable tissue repair implants and methods of use
US865250722 Dic 201018 Feb 2014Zimmer, Inc.Juvenile cartilage composition
US865788120 Abr 200425 Feb 2014Depuy Mitek, LlcMeniscal repair scaffold
US867292115 Mar 200718 Mar 2014Karl Storz Gmbh & Co. KgFlexible hollow shaft for a medical instrument
US867900330 May 200825 Mar 2014Ethicon Endo-Surgery, Inc.Surgical device and endoscope including same
US869125916 Nov 20058 Abr 2014Depuy Mitek, LlcReinforced foam implants with enhanced integrity for soft tissue repair and regeneration
US874743910 Jul 200610 Jun 2014P Tech, LlcMethod of using ultrasonic vibration to secure body tissue with fastening element
US876516523 Ago 20101 Jul 2014Zimmer, Inc.Particulate cartilage system
US877126030 May 20088 Jul 2014Ethicon Endo-Surgery, Inc.Actuating and articulating surgical device
US87730017 Jun 20138 Jul 2014Ethicon Endo-Surgery, Inc.Rotating transducer mount for ultrasonic surgical instruments
US877964813 Ago 201215 Jul 2014Ethicon Endo-Surgery, Inc.Ultrasonic device for cutting and coagulating with stepped output
US878486322 Dic 201022 Jul 2014Zimmer, Inc.Particulate cadaveric allogenic cartilage system
US88083293 Abr 201219 Ago 2014Bonutti Skeletal Innovations LlcApparatus and method for securing a portion of a body
US881490231 Jul 200626 Ago 2014Bonutti Skeletal Innovations LlcMethod of securing body tissue
US883491422 Dic 201016 Sep 2014Zimmer, Inc.Treatment methods using a particulate cadaveric allogenic juvenile cartilage particles
US884568717 Sep 201330 Sep 2014Bonutti Skeletal Innovations LlcAnchor for securing a suture
US88456996 Mar 201230 Sep 2014Bonutti Skeletal Innovations LlcMethod of securing tissue
US887078824 Jun 201128 Oct 2014Depuy Mitek, LlcTissue extraction and collection device
US88950458 May 201225 Nov 2014Depuy Mitek, LlcMethod of preparation of bioabsorbable porous reinforced tissue implants and implants thereof
US89060354 Jun 20089 Dic 2014Ethicon Endo-Surgery, Inc.Endoscopic drop off bag
US89398974 Feb 201127 Ene 2015Ethicon Endo-Surgery, Inc.Methods for closing a gastrotomy
US895127211 Feb 201010 Feb 2015Ethicon Endo-Surgery, Inc.Seal arrangements for ultrasonically powered surgical instruments
US898619917 Feb 201224 Mar 2015Ethicon Endo-Surgery, Inc.Apparatus and methods for cleaning the lens of an endoscope
US900519829 Ene 201014 Abr 2015Ethicon Endo-Surgery, Inc.Surgical instrument comprising an electrode
US90114314 Sep 201221 Abr 2015Ethicon Endo-Surgery, Inc.Electrical ablation devices
US902848318 Dic 200912 May 2015Ethicon Endo-Surgery, Inc.Surgical instrument comprising an electrode
US904998715 Mar 20129 Jun 2015Ethicon Endo-Surgery, Inc.Hand held surgical device for manipulating an internal magnet assembly within a patient
US90667471 Nov 201330 Jun 2015Ethicon Endo-Surgery, Inc.Ultrasonic surgical instrument blades
US90786623 Jul 201214 Jul 2015Ethicon Endo-Surgery, Inc.Endoscopic cap electrode and method for using the same
US9089344 *4 Jun 201428 Jul 2015Medtronic Xomed, Inc.Rotary cutting tool with improved cutting and reduced clogging on soft tissue and thin bone
US909536722 Oct 20124 Ago 2015Ethicon Endo-Surgery, Inc.Flexible harmonic waveguides/blades for surgical instruments
US9107689 *15 Jul 201318 Ago 2015Ethicon Endo-Surgery, Inc.Dual purpose surgical instrument for cutting and coagulating tissue
US913831815 Dic 201122 Sep 2015Zimmer, Inc.Apparatus for forming an implant
US919871429 Jun 20121 Dic 2015Ethicon Endo-Surgery, Inc.Haptic feedback devices for surgical robot
US92113628 Jun 201215 Dic 2015Depuy Mitek, LlcScaffold for connective tissue repair
US922052620 Mar 201229 Dic 2015Ethicon Endo-Surgery, Inc.Rotational coupling device for surgical instrument with flexible actuators
US922052728 Jul 201429 Dic 2015Ethicon Endo-Surgery, LlcSurgical instruments
US922676615 Mar 20135 Ene 2016Ethicon Endo-Surgery, Inc.Serial communication protocol for medical device
US922676729 Jun 20125 Ene 2016Ethicon Endo-Surgery, Inc.Closed feedback control for electrosurgical device
US922677230 Ene 20095 Ene 2016Ethicon Endo-Surgery, Inc.Surgical device
US92329796 Feb 201312 Ene 2016Ethicon Endo-Surgery, Inc.Robotically controlled surgical instrument
US923324118 Ene 201212 Ene 2016Ethicon Endo-Surgery, Inc.Electrical ablation devices and methods
US923792115 Mar 201319 Ene 2016Ethicon Endo-Surgery, Inc.Devices and techniques for cutting and coagulating tissue
US923795726 Feb 201419 Ene 2016Globus Medical, Inc.Low profile plate
US924172815 Mar 201326 Ene 2016Ethicon Endo-Surgery, Inc.Surgical instrument with multiple clamping mechanisms
US924173115 Mar 201326 Ene 2016Ethicon Endo-Surgery, Inc.Rotatable electrical connection for ultrasonic surgical instruments
US925416928 Feb 20119 Feb 2016Ethicon Endo-Surgery, Inc.Electrical ablation devices and methods
US925923411 Feb 201016 Feb 2016Ethicon Endo-Surgery, LlcUltrasonic surgical instruments with rotatable blade and hollow sheath arrangements
US927795715 Ago 20128 Mar 2016Ethicon Endo-Surgery, Inc.Electrosurgical devices and methods
US928304529 Jun 201215 Mar 2016Ethicon Endo-Surgery, LlcSurgical instruments with fluid management system
US931462028 Feb 201119 Abr 2016Ethicon Endo-Surgery, Inc.Electrical ablation devices and methods
US932678829 Jun 20123 May 2016Ethicon Endo-Surgery, LlcLockout mechanism for use with robotic electrosurgical device
US933928918 Jun 201517 May 2016Ehticon Endo-Surgery, LLCUltrasonic surgical instrument blades
US935175429 Jun 201231 May 2016Ethicon Endo-Surgery, LlcUltrasonic surgical instruments with distally positioned jaw assemblies
US93581271 Feb 20127 Jun 2016Globus Medical, Inc.Intervertebral fusion implant
US936434326 Dic 201314 Jun 2016Globus Medical, Inc.Intervertebral fusion implant
US93752689 May 201328 Jun 2016Ethicon Endo-Surgery, Inc.Electroporation ablation apparatus, system, and method
US939303729 Jun 201219 Jul 2016Ethicon Endo-Surgery, LlcSurgical instruments with articulating shafts
US940273814 Feb 20132 Ago 2016Globus Medical, Inc.Devices and methods for correcting vertebral misalignment
US940862229 Jun 20129 Ago 2016Ethicon Endo-Surgery, LlcSurgical instruments with articulating shafts
US941485325 Mar 201316 Ago 2016Ethicon Endo-Surgery, LlcUltrasonic end effectors with increased active length
US942724910 May 201330 Ago 2016Ethicon Endo-Surgery, LlcRotatable cutting implements with friction reducing material for ultrasonic surgical instruments
US942725514 May 201230 Ago 2016Ethicon Endo-Surgery, Inc.Apparatus for introducing a steerable camera assembly into a patient
US943966815 Mar 201313 Sep 2016Ethicon Endo-Surgery, LlcSwitch arrangements for ultrasonic surgical instruments
US943966928 Mar 201313 Sep 2016Ethicon Endo-Surgery, LlcUltrasonic surgical instruments
US944583221 Jun 201320 Sep 2016Ethicon Endo-Surgery, LlcSurgical instruments
US9446230 *4 Sep 201420 Sep 2016Advanced Bionics AgCochlear implant electrode array and method for inserting the same into a human cochlea
US94982456 May 201422 Nov 2016Ethicon Endo-Surgery, LlcUltrasonic surgical instruments
US95044833 Jul 201229 Nov 2016Ethicon Endo-Surgery, LlcSurgical instruments
US950485520 Mar 201529 Nov 2016Ethicon Surgery, LLCDevices and techniques for cutting and coagulating tissue
US951085011 Nov 20136 Dic 2016Ethicon Endo-Surgery, LlcUltrasonic surgical instruments
US951117122 Nov 20106 Dic 2016Depuy Mitek, LlcBiocompatible scaffolds with tissue fragments
US95266309 Dic 201527 Dic 2016Globus Medical, Inc.Low profile plate
US953910923 Oct 201510 Ene 2017Globus Medical, Inc.Low profile plate
US954529030 Jul 201217 Ene 2017Ethicon Endo-Surgery, Inc.Needle probe guide
US95726232 Ago 201221 Feb 2017Ethicon Endo-Surgery, Inc.Reusable electrode and disposable sheath
US958576514 Feb 20137 Mar 2017Globus Medical, IncDevices and methods for correcting vertebral misalignment
US9597091 *13 May 201321 Mar 2017Empire Technology Development LlcArticulated bone drill and tap
US961593613 Mar 201411 Abr 2017Globus Medical, Inc.Intervertebral fusion implant
US962323728 Sep 201518 Abr 2017Ethicon Endo-Surgery, LlcSurgical generator for ultrasonic and electrosurgical devices
US9636131 *26 Feb 20142 May 2017Stryker CorporationSurgical tool arrangement and surgical cutting accessory for use therewith
US963613510 Nov 20142 May 2017Ethicon Endo-Surgery, LlcUltrasonic surgical instruments
US964264412 Mar 20159 May 2017Ethicon Endo-Surgery, LlcSurgical instruments
US96491266 Ene 201516 May 2017Ethicon Endo-Surgery, LlcSeal arrangements for ultrasonically powered surgical instruments
US96754672 Nov 201213 Jun 2017Globus Medical, Inc.Intervertebral fusion implant
US96819591 Jun 201520 Jun 2017Globus Medical, Inc.Low profile plate
US970033920 May 200911 Jul 2017Ethicon Endo-Surgery, Inc.Coupling arrangements and methods for attaching tools to ultrasonic surgical instruments
US97003432 Nov 201511 Jul 2017Ethicon Endo-Surgery, LlcDevices and techniques for cutting and coagulating tissue
US970700412 Mar 201518 Jul 2017Ethicon LlcSurgical instruments
US970702720 May 201118 Jul 2017Ethicon Endo-Surgery, LlcMedical device
US97135074 Ene 201625 Jul 2017Ethicon Endo-Surgery, LlcClosed feedback control for electrosurgical device
US972411815 Mar 20138 Ago 2017Ethicon Endo-Surgery, LlcTechniques for cutting and coagulating tissue for ultrasonic surgical instruments
US973732623 Oct 201522 Ago 2017Ethicon Endo-Surgery, LlcHaptic feedback devices for surgical robot
US97439479 Dic 201529 Ago 2017Ethicon Endo-Surgery, LlcEnd effector with a clamp arm assembly and blade
US97440492 Mar 201529 Ago 2017DePuy Synthes Products, Inc.Low profile intervertebral implant
US20020119177 *21 Dic 200029 Ago 2002Bowman Steven M.Reinforced foam implants with enhanced integrity for soft tissue repair and regeneration
US20020127265 *14 Dic 200112 Sep 2002Bowman Steven M.Use of reinforced foam implants with enhanced integrity for soft tissue repair and regeneration
US20030097133 *21 Nov 200122 May 2003Green James M.Attachable/detachable reaming head for surgical reamer
US20030147935 *16 Dic 20027 Ago 2003Ethicon, Inc.Use of reinforced foam implants with enhanced integrity for soft tissue repair and regeneration
US20030193104 *10 Jun 200316 Oct 2003Melican Mora CarolynneReinforced tissue implants and methods of manufacture and use
US20040078077 *25 Feb 200322 Abr 2004Francois BinetteBiocompatible scaffold for ligament or tendon repair
US20040078090 *25 Feb 200322 Abr 2004Francois BinetteBiocompatible scaffolds with tissue fragments
US20040097829 *15 Nov 200220 May 2004Mcrury Ian D.Tissue biopsy and processing device
US20040193071 *28 Mar 200330 Sep 2004Ethicon, Inc.Tissue collection device and methods
US20040267362 *30 Jun 200330 Dic 2004Julia HwangScaffold for connective tissue repair
US20050059905 *11 Sep 200317 Mar 2005Robert BoockTissue extraction and maceration device
US20050113937 *26 Nov 200326 May 2005Francois BinetteConformable tissue repair implant capable of injection delivery
US20050177249 *9 Feb 200411 Ago 2005Kladakis Stephanie M.Scaffolds with viable tissue
US20050232967 *20 Abr 200420 Oct 2005Kladakis Stephanie MNonwoven tissue scaffold
US20050234549 *20 Abr 200420 Oct 2005Kladakis Stephanie MMeniscal repair scaffold
US20060067967 *16 Nov 200530 Mar 2006Depuy Mitek, Inc.Reinforced foam implants with enhanced integrity for soft tissue repair and regeneration
US20070031470 *29 Jun 20068 Feb 2007Depuy Mitek, Inc.Nonwoven tissue scaffold
US20070162055 *15 Feb 200712 Jul 2007Bowman Steven MGraft fixation device combination
US20070219539 *15 Mar 200720 Sep 2007Andreas EfingerFlexible Hollow Shaft For A Medical Instrument
US20080153157 *20 Dic 200626 Jun 2008Zimmer Orthobiologics, Inc.Method of obtaining viable small tissue particles and use for tissue repair
US20080234715 *27 Mar 200825 Sep 2008Depuy Mitek, Inc.Tissue Extraction and Collection Device
US20090112062 *31 Oct 200730 Abr 2009Bakos Gregory JDetachable distal overtube section and methods for forming a sealable opening in the wall of an organ
US20090131932 *21 Nov 200721 May 2009Vakharia Omar JBipolar forceps having a cutting element
US20090227828 *10 Mar 200810 Sep 2009Ethicon Endo-Surgery, Inc.Anastomotic device
US20090299143 *30 May 20083 Dic 2009Conlon Sean PActuating and articulating surgical device
US20100022915 *29 Sep 200928 Ene 2010Depuy Mitek, Inc.Tissue extraction and maceration device
US20100042045 *15 Ago 200818 Feb 2010Ethicon Endo-Surgery, Inc.Sterile appliance delivery device for endoscopic procedures
US20100049190 *25 Ago 200825 Feb 2010Ethicon Endo-Surgery, Inc.Electrical ablation devices
US20100056862 *3 Sep 20084 Mar 2010Ethicon Endo-Surgery, Inc.Access needle for natural orifice translumenal endoscopic surgery
US20100081877 *1 Oct 20081 Abr 2010Ethicon Endo-Surgery, Inc.Overtube with expandable tip
US20100198005 *30 Ene 20095 Ago 2010Ethicon Endo-Surgery, Inc.Surgical access device
US20100198149 *30 Ene 20095 Ago 2010Ethicon Endo-Surgery, Inc.Surgical device
US20100249700 *27 Mar 200930 Sep 2010Ethicon Endo-Surgery, Inc.Surgical instruments for in vivo assembly
US20100257850 *20 Nov 200814 Oct 2010Hino Motors Ltd.Exhaust emission control device
US20100280406 *15 Jul 20104 Nov 2010Ethicon, Inc.Tissue Collection Device and Methods
US20100331774 *15 Ago 200830 Dic 2010Ethicon Endo-Surgery, Inc.Sterile appliance delivery device for endoscopic procedures
US20110009963 *21 Sep 201013 Ene 2011Depuy Mitek, Inc.Biocompatible scaffold for ligament or tendon repair
US20110091517 *22 Nov 201021 Abr 2011Depuy Mitek, Inc.Biocompatible scaffolds with tissue fragments
US20110097381 *29 Dic 201028 Abr 2011Depuy Mitek, Inc.Conformable tissue repair implant capable of injection delivery
US20110105850 *5 Nov 20095 May 2011Ethicon Endo-Surgery, Inc.Vaginal entry surgical devices, kit, system, and method
US20110124964 *4 Feb 201126 May 2011Ethicon Endo-Surgery, Inc.Methods for closing a gastrotomy
US20110152609 *17 Dic 200923 Jun 2011Ethicon Endo-Surgery, Inc.User interface support devices for endoscopic surgical instruments
US20110177134 *1 Feb 201121 Jul 2011Depuy Mitek, Inc.Viable Tissue Repair Implants and Methods of Use
US20110190659 *29 Ene 20104 Ago 2011Ethicon Endo-Surgery, Inc.Surgical instrument comprising an electrode
US20110196398 *11 Feb 201011 Ago 2011Ethicon Endo-Surgery, Inc.Seal arrangements for ultrasonically powered surgical instruments
US20140277041 *26 Feb 201418 Sep 2014Kevin ManleySurgical tool arrangement and surgical cutting accessory for use therewith
US20140288560 *4 Jun 201425 Sep 2014Medtronic Xomed, Inc.Rotary cutting tool with improved cutting and reduced clogging on soft tissue and thin bone
US20140336653 *13 May 201313 Nov 2014Empire Technology Development LlcArticulated bone drill and tap
US20150351789 *17 Ago 201510 Dic 2015Ethicon Endo-Surgery, Inc.Dual purpose surgical instrument for cutting and coagulating tissue
EP1534149A1 *25 Jun 20031 Jun 2005Hee-Young Kangnam Plastic Sugery LeeFacial bone contouring device using hollowed rasp provided with non-plugging holes formed through cutting plane
EP1534149A4 *25 Jun 200323 Sep 2009Lee Hee Young Kangnam PlasticFacial bone contouring device using hollowed rasp provided with non-plugging holes formed through cutting plane
EP1834595A2 *13 Mar 200719 Sep 2007Karl Storz GmbH & Co. KGFlexible quill shaft for a medical instrument
EP1834595A3 *13 Mar 200731 Oct 2007Karl Storz GmbH & Co. KGFlexible quill shaft for a medical instrument
EP2294992A1 *27 Mar 200916 Mar 2011DePuy Mitek, Inc.Tissue extraction and collection device
WO2010130304A1 *20 Feb 201018 Nov 2010Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V.Automated separation of fatty tissue
WO2012016334A1 *2 Ago 20119 Feb 2012Adam HackingDevices for adapting bone
Clasificaciones
Clasificación de EE.UU.606/170
Clasificación internacionalA61M1/00, A61B17/32, A61B10/02, A61B10/00, A61B17/00, A61B17/16
Clasificación cooperativaA61B2017/00831, A61B2217/007, A61B17/1615, A61B2217/005, A61B17/1635, A61B17/1631, A61B17/32002, A61B2017/00969, A61B10/025, A61M1/0056
Clasificación europeaA61B17/32E2, A61B17/16G, A61B10/02P4
Eventos legales
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