US20150005578A1 - Method and devices for minimally invasive arthroscopic procedures - Google Patents
Method and devices for minimally invasive arthroscopic procedures Download PDFInfo
- Publication number
- US20150005578A1 US20150005578A1 US14/224,897 US201414224897A US2015005578A1 US 20150005578 A1 US20150005578 A1 US 20150005578A1 US 201414224897 A US201414224897 A US 201414224897A US 2015005578 A1 US2015005578 A1 US 2015005578A1
- Authority
- US
- United States
- Prior art keywords
- flexible
- distal end
- operable
- body member
- end segment
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
Links
- UQSPFNNKZPPRDE-FIGJELIWSA-N CC1/C=C\C(C(C=C2)=C(C=C3)/C2=C2/C4=CC24)=CC/C3=C\C1 Chemical compound CC1/C=C\C(C(C=C2)=C(C=C3)/C2=C2/C4=CC24)=CC/C3=C\C1 UQSPFNNKZPPRDE-FIGJELIWSA-N 0.000 description 1
Images
Classifications
-
- A61B19/22—
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/005—Flexible endoscopes
- A61B1/0051—Flexible endoscopes with controlled bending of insertion part
- A61B1/0055—Constructional details of insertion parts, e.g. vertebral elements
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00147—Holding or positioning arrangements
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/04—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances
- A61B1/05—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances characterised by the image sensor, e.g. camera, being in the distal end portion
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/313—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes
- A61B1/317—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes for bones or joints, e.g. osteoscopes, arthroscopes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B17/295—Forceps for use in minimally invasive surgery combined with cutting implements
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/70—Manipulators specially adapted for use in surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/70—Manipulators specially adapted for use in surgery
- A61B34/71—Manipulators operated by drive cable mechanisms
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00163—Optical arrangements
- A61B1/00165—Optical arrangements with light-conductive means, e.g. fibre optics
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1482—Probes or electrodes therefor having a long rigid shaft for accessing the inner body transcutaneously in minimal invasive surgery, e.g. laparoscopy
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/003—Steerable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/003—Steerable
- A61B2017/00318—Steering mechanisms
- A61B2017/00331—Steering mechanisms with preformed bends
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00831—Material properties
- A61B2017/00867—Material properties shape memory effect
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2901—Details of shaft
- A61B2017/2902—Details of shaft characterized by features of the actuating rod
- A61B2017/2903—Details of shaft characterized by features of the actuating rod transferring rotary motion
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2901—Details of shaft
- A61B2017/2904—Details of shaft curved, but rigid
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2901—Details of shaft
- A61B2017/2905—Details of shaft flexible
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2901—Details of shaft
- A61B2017/2906—Multiple forceps
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B17/2909—Handles
- A61B2017/291—Handles the position of the handle being adjustable with respect to the shaft
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2931—Details of heads or jaws with releasable head
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2948—Sealing means, e.g. for sealing the interior from fluid entry
-
- A61B2019/2242—
Abstract
A surgical device is provided, the device having a tubular outer body member with a handle at its proximal end and a flexible distal end segment extending from its distal end. The surgical device also has an operable end extending from the distal end of the flexible distal end segment. The device is configured for selectively causing the flexible end segment to bend to adopt a desired curvature and for selectively rotating the operable end relative to the flexible distal end segment about an axis of the flexible distal end segment.
Description
- The present application is a continuation-in-part of U.S. patent application Ser. No. 12/119,799, filed on May 13, 2008, which is a continuation of U.S. patent application Ser. No. 11/643,740, filed Dec. 20, 2006, which claims the benefit of U.S. provisional application 60/752,284, filed Dec. 20, 2005, each of which is incorporated herein by reference in its entirety.
- The present invention relates generally to devices and methods for performing arthroscopic procedures, particularly arthroscopic procedures on the hip, including arthroscopic diagnostic and surgical procedures.
- Access to the knee and shoulder capsules during arthroscopic surgery is typically made through opposing portals often called the operative portal and the visualization portal. The arthroscope is typically inserted through the visualization portal, while the medical device is inserted through the operative portal. The visualization portal can be readily interchanged with the operative portal to provide an enhanced view of and access to internal capsular structures.
- The hip is complex and difficult to access using arthroscopic techniques.
FIGS. 1 and 2 illustrate the basic anatomy of the hip. For the sake of simplification, the figures do not show the surrounding synovial membrane, the femor ligament complex, the tough adductor muscle structure, varying layers of fat, and other tissue, which all compound the difficulty in accessing the joint capsule. There are also many delicate structures surrounding the joint that are not shown in the figures, i.e., the anterior femoral neurovascular bundle, the lateral femoral cutaneous nerve, the lateral femoral circumflex artery and the sciatic nerve, among others. Damage to these structures is permanent and irreparable - Typically, access to the hip joint for minimally invasive arthroscopic surgery is through two cannulas positioned in the posterolateral and anterolateral positions that are located 1-2 cm above (superior) and 1-2 cm on each side of the landmark greater trocanter, as shown in
FIG. 3 . Typically, the arthroscope is in the posterolateral position and the operative device (e.g. forceps, dissector, scissors, scalpel, punch, probe, powered shaver, manual graspers, electrocautery wand, etc.) is in the anterolateral position. It is common to interchange these positions to improve visualization and/or access to the target site. - Despite the ability to interchange positions, parts of the distended surfaces of the hip joint can not be fully visualized.
FIG. 3 shows this “No See” zone. The portions of the hip not accessible by straight and rigid operative instruments is even larger. For example, if the target site is in a region that is hidden on the far side of the femoral head, a third portal must often be established in the anterior position. Such an added portal considerably increases the risk of the procedure because the proximity of the lateral femoral cutaneous nerve, the lateral femoral circumflex artery, and the femoral neurovascular bundle. Access via the opposite, posterior side of the joint, i.e. the gluteal region, is not a viable option nor is the medial approach from the groin. - Roughly half of the distended hip joint is not accessible through the normal, accepted, portal placement positions. While the situation can be relieved somewhat through the use of 70 degree scopes and physically prying the cannulas into a contrived position, the access problem remains a significant hurdle to the performance of arthroscopic procedures on the hip.
- The invention generally relates to devices and methods for performing arthroscopic procedures, particularly arthroscopic procedures on the hip. The devices and methods provide visualization and access to regions of the spherically-shaped hip joint that are inaccessible with the current technology of arthroscopic instrumentation.
- The devices and methods can suitably be used to perform arthroscopic procedures not only on the hip, but also on other parts of the body that require flexible access, such as the knee and shoulder. The devices and methods are not limited to arthroscopy, and can further be used in endoscopic and laparoscopic procedures as well as open surgery.
- In one aspect, the invention generally relates to a device for arthroscopic medical procedures and comprises a handle at a proximal end, an operable portion at a distal end, a body member extending between the handle and the operable end, the body member comprising an outer rigid member and an inner member slidably housed within outer rigid member, the inner member having flexibility along at least a portion of its length. As the inner member is retracted within outer rigid member, the inner member takes on the profile of the outer rigid member, and wherein as the inner member is extended outside the outer rigid member, the inner member takes on a curved profile.
- In another aspect, the invention generally relates to an arthroscopic medical device for use in performing a medical procedure at a site within a patient comprising a handle for positioning outside of the patient, a body member extending from the handle, wherein at least a portion of the body member is inserted within the patient, the body member comprising an outer member having a position fixed relative to the handle and an inner member slidably and rotatably housed within outer member and having flexibility along at least a portion of its length, a rotation mechanism that causes inner member to rotate relative to outer member, an extension mechanism that causes inner member to extend outside of and retract within outer member and an operable end removably mounted on the inner member. The inner member has a distal end that takes on a predetermined arcuate path.
- In another aspect, the invention generally relates to a device for arthroscopic medical procedures comprising a handle, a rigid outer tube extending from the handle, and a pre-bent flexible inner tube slidably received within the outer tube. The inner tube is disposed so as to advance out of the outer tube in an arcuate shaped path and so as to rotate about the linear axis of the rigid tube and/or the arcuate axis of the advancing flexible tube. The inner tube has an operable end at its distal end in the form of a visualization device, an electrical manipulation device, and/or a mechanical manipulation device.
- In another aspect, the invention generally relates to a device for diagnostic or surgical procedures comprising a handle at a proximal end; an elongate body member extending from the handle, the elongate body member having a proximal end and a distal end; a flexible, steerable distal end segment extending from the distal end of the elongate body member; an operable end rotatably mounted to the distal end segment; a manipulation mechanism at the proximal end of the device for manipulating the distal end segment and rotating the operable end; wherein the device provides the following independent degrees of freedom including: linear translation along the linear axis of the elongated body member, rotation about the linear axis of the elongated body member, curvilinear bending of the flexible end segment to provide the flexible end segment with an arcuate axis, and rotation of the operable end about the arcuate axis of the flexible end segment.
- In another aspect, the invention generally relates to a device for diagnostic or surgical procedures comprising a handle at a proximal end; an operable end at a distal end; an outer rigid or semi-rigid body member fixed relative to the handle; an inner body member slidably housed and rotatably positioned within the outer body member, the inner body member having flexibility along at least a portion of its length; and an pre-formed element, rotatably fixed to the handle and slidably fixed within the inner body member, the pre-formed element defining a bend radius; wherein as the inner body member is retracted within outer body member, the inner body member takes on the profile of the outer member, and wherein as the inner body member is extended outside the outer body member, the inner body member takes on a curved profile proportional to the bend radius of the pre-formed element, the curved profile providing the inner body member with an arcuate axis, and wherein the operable end is rotatable about the arcuate axis of the inner member.
- In another aspect, the invention generally relates to a device for diagnostic or surgical procedures comprising a handle at a proximal end; an operable end rotatably mounted at a distal end; a rigid or semi-rigid elongate body member fixed relative to the handle and interconnected with the operable portion via a flexible distal portion; flexion control means for bending the flexible distal portion; one or more pairs of cables interconnecting the flexion control means and the flexible distal portion, wherein manipulation of flexion control means places a tensile force on one or more cables and causes the flexible distal portion to bend proportionally to the tensile force, wherein bending of the flexible distal portion provides the flexible distal portion with an arcuate axis; and rotation control means in connection with the operable portion for rotating the operative end about the arcuate axis of the flexible distal segment.
- In another aspect, the invention generally relates to a device for diagnostic or surgical procedures comprising a handle; a rigid or semi-rigid tubular body member extending from the handle and having a proximal end and a distal end; and a flexible, steerable, distal end segment with an operable end rotatably mounted to the distal end of the body member, the operable end in the form of a visualization device, an electrical tissue manipulation device, and/or a mechanical tissue manipulation device.
- Embodiments according to these aspects of the invention can include the following features. The device can be designed for use in medical procedures on the hip, for example, arthroscopic procedures on the hip, and the inner body member or the flexible distal segment/distal end segment takes on a curved profile having a bend radius corresponding to the curvature of the femoral head. In some embodiments, the bend radius can be approximately 25 mm. The device can be designed for use in medical procedures on the knee or shoulder, and the inner member can take on a curved profile having a bend radius less than 25 mm. In some embodiments, the bend radius can be approximately 12 mm. The device can be for use in medical procedures on the elbow, wrist, or intraverterbral spaces, and the inner member can take on a curved profile having a bend radius less than 12 mm. In some embodiments, the bed radius can range from about 1 mm to about 5 mm. The device can be for use in general abdominal laparoscopy, and the inner member can take on a curved profile having a bend radius ranging from about 25 mm to about 50 mm. The inner and outer members can have a cylindrical shape with a circular cross-section. The inner and outer members can be fabricated of a lightweight and strong bio-compatible material. The material can be selected from surgical grade stainless steel, anodized aluminum, and polymeric materials and composites. The operable end of the device can be in the form of gaspers, scissors, forceps, scalpels, punches, probes, dissectors, mono polar cautery, bi-polar ablation/cautery, CCD cameras and lens. The operable end can include a pair of arms, jaws, or elements movable with relation to each other, and the device can further include an actuation mechanism at its proximal end. The actuation mechanism can comprises a trigger, ring, or one or more actuating buttons on the handle. The actuation mechanism can comprise finger and thumb holes movable with relation to each other. The body member can be hollow and house apparatus that connects the actuation mechanism to the operable end. The apparatus that connects the actuation mechanism to the operable end can include one or more cables or push/pull rods in connection with a cam. The apparatus that connects the actuation mechanism to the operable end can include one or more push/pull rods in connection with a rack having ridges along at least a portion of its length, a pinion having ridges that mate with the ridges on the rack, the pinion being in connection with the actuation mechanism. The actuation mechanism can be provided such that actuation rotates the rack, which, in turn, moves the pinion proximally or distally relative to the device, which, in turn, pushes and pulls the push/pull rods, which, in turn, opens and closes the pair of arms, jaws, or elements movable with relation to each other. The device can further comprise a spring that pre-loads the actuation mechanism and causes the pinion to move. A pre-curved member can be embedded within the inner member along at least a portion of the length of the inner member, such that, as the inner member is extended outside the outer rigid member, the inner member takes the profile of the pre-curved member. The pre-curved member can be formed of a shape memory material, such as nitinol. The inner member can include one or more articulating knuckle members and, as the inner member is extended outside the outer rigid member, the inner member can bend at the one or more articulating knuckle members to take on a curved profile. A shape memory material, such as nitinol, pre-formed into a curved profile, can be embedded along at least a portion of the length of the inner member such that, as the inner member is extended outside the outer member, the inner member takes on the pre-formed curved profile of the shape memory material. At least a portion of the inner member can be formed of a shape memory material, such as nitinol, pre-formed into a desired curved profile such that, as the inner member is extended outside the outer rigid member, the inner member takes on the pre-formed curved profile. The device can further comprise a curvilinear actuation mechanism in connection with the inner member for controlling advancement of the inner member outside of the outer member. The device can include an actuating rod slidably disposed within the handle. The actuating rod can have a distal end in connection with the inner member and a proximal end extending outside the handle, such that movement of the actuating rod in a proximal direction pulls the inner member within the outer member, and movement of the actuating rod in a distal direction pushes the inner member outside of the outer member. The operable end can be rotatable about the longitudinal axis of the device. The inner member can be rotatable within outer member, thereby providing rotation of the operable end. The operable end can be rotatably mounted to the inner member. The device can provide visualization and access to the entire site via two portals, without interchanging access portals or providing access through additional portals. The device can have any combination of the following five degrees of freedom, which are described in more detail herein: “curvilinear bending” of a distal portion of the device, “rotation about the linear axis of the elongate body member”, “rotation of the operable end”, “operable end motion”, and “rectilinear extension”. The device can further comprise a curvilinear actuation assembly for movement of the inner member relative to the outer member. The operable end can be removable and interchangeable. The inner member can be removable and interchangeable. The operable end can comprise a camera and the device can further includes an LED illumination source in connection with one or more fiber optics extending through inner member and in connection with the camera. The operable end can further includes a lens system and the one or more fiber optics can comprise a fiber optic bundle, and the camera and lens system can be mounted at the distal end of the inner member and are surrounded by the fiber optic bundle. The LED illumination source can be mounted on a carrier slidably and rotatably disposed within housing and in connection with the inner member. The fiber optic bundle can be potted. The operable end can comprise an RF electrode electrically insulated from the inner member and/or the outer member and the handle. The RF electrode can comprise opposing electrodes for bi-polar and ablative applications or a single electrode for mono-polar applications at a single potential. The operable end can be in the form of a pair of jaws that, when disposed in a closed position, overlap each other to resect or punch tissue positioned between the pair of jaws. The operable end can be in the form of a powered blade with suction, and the device can further includes an actuation mechanism at its proximal end. The actuation mechanism can comprises a flexible drive shaft that can be in connection with an external motor powered unit Thus, tissue and other material can be pulled into the operable end using suction and the tissue and other material can be resected and withdrawn through the device using the blade, in combination with suction (e.g. by connecting the device to a vacuum source). The entire device or one or more portions of the device, such as the inner member, elongate member, and/or operable end, can be disposable. The entire device or one or more parts of the device can be reusable.
- In another aspect, the invention generally relates to a medical device kit, comprising one or more of the components set forth herein. The one or more devices can be packaged in sterile condition.
- In another aspect, the invention generally relates to a method for performing minimally invasive hip arthroscopic surgical procedures comprising (a) providing a device comprising a handle at a proximal end, an operable portion at a distal end, a body member extending between the handle and the operable end, the body member comprising an outer rigid member, and an inner member slidably housed within outer rigid member, the inner member having flexibility along at least a portion of its length, wherein as the inner member is retracted within outer rigid member, the inner member takes on the profile of the outer rigid member, and wherein as the inner member is extended outside the outer rigid member, the inner member takes on a curved profile, (b) disposing the inner member in a retracted position within the outer rigid member, (c) inserting the body member into the body and into the hip capsule, (d) extending the inner member outside the outer rigid member, (e) allowing the inner member to take on a curved profile, (f) performing the procedure, (g) withdrawing the inner member within the outer member, and (h) removing the body member from the body. The operable end can be further rotatable about the arcuate axis of the curved inner member.
- In another aspect, the invention generally relates to a method of performing hip arthroscopy comprising providing a first portal in the posterolateral position and second portal in the anterolateral position; inserting a first device in the anterolateral position, the first device comprising a handle at a proximal end, an operable portion comprising a visualization device at a distal end, a body member extending between the handle and the operable end, the body member comprising an outer rigid member and an inner member slidably housed within outer rigid member, the inner member having flexibility along at least a portion of its length; inserting a second device in the posterolateral position, the second device comprising a handle at a proximal end, an operable portion comprising a operative device at a distal end, a body member extending between the handle and the operable end, the body member comprising an outer rigid member and an inner member slidably housed within outer rigid member, the inner member having flexibility along at least a portion of its length; and extending the inner member of the first device and second device outside of the outer member and allowing the inner member or the first and/or second device to take on an arcuate shaped path concentric with the radii of the femor head and acetabulum of the hip joint.
- In another aspect, the invention generally relates to a method of performing minimally invasive diagnostic and surgical procedures on the hip comprising (a) providing a visualization and/or an operable device(s) comprising a handle at a proximal end; an operable end at a distal end; a rigid or semi rigid elongate body member extending between the handle and the operable end; a distal flexible end segment that rotatably connects the operable end to the elongate body member; the handle comprising control means to precisely maneuver the operable end by iteratively adjusting each of the following degrees of freedom: linear translation of the operable end into the hip joint capsule; rotation about the linear axis of the elongated body member; curvilinear bending of the distal flexible end segment; and rotation about an axis of a bend in the distal end segment; (b) disposing the flexible end segment into a straight configuration; (c) inserting the distal end of the device into the body and into the hip capsule; (d) linearly translating the operable end into the capsule; (e) iteratively adjusting the curvilinear bend radius of the distal flexible end segment while translating the operable end toward the operative target; (f) performing the procedure; (g) disposing the end segment into a straight configuration; and (h) removing the device from the capsule.
- In another aspect, the invention generally relates to a method of performing arthroscopic procedures comprising providing a first portal in the posterolateral position and second portal in the anterolateral position; inserting a first device in the anterolateral position, the first device comprising a handle at a proximal end, an operable end comprising a visualization device at a distal end, a body member extending between the handle and the operable end, and an end segment connecting the operable end to the body member and capable of being iterively manipulated to translate, bend, and rotate to achieve a desired position at the target site and to achieve a desired field of view; and inserting a second device in the posterolateral position, the second device comprising a handle at a proximal end, an operable end comprising an electrical manipulation device or a mechanical manipulation device at a distal end, a body member extending between the handle and the operable end, and an end segment connecting the operable end to the body member and capable of being iterively manipulated to translate, bend, and rotate to achieve a desire position at the target site and to actuate to achieve the desired surgical outcome.
- A particular aspect of the invention provides a device for diagnostic or surgical procedures. The device comprises a tubular outer body member having a proximal end and a distal end and having a handle attached to the proximal end of the outer body member. A flexible distal end segment extends from the distal end of the outer body member. This flexible distal end segment has an axial end segment passage formed through it. The device further comprises a rotation control member comprising an extension tube portion rotatably disposed within the outer body member and a flexible drive shaft portion. The flexible drive shaft portion is attached to and extends distally from a distal end of the extension tube portion for rotation therewith. At least a portion of the flexible drive shaft portion is rotatably and slidably disposed within the axial end segment passage so as to take on a profile of the flexible distal end segment. The device also comprises an operable end attached at a distal end of the flexible drive shaft portion for rotation therewith. The flexible drive shaft is selectively rotatable to establish a desired rotational orientation of the operable end. The flexible distal end segment may comprise an exterior flexible member attached to the distal end of the outer body member and an interior flexible member. The exterior flexible member may have an exterior member axial passage formed therethrough. The interior flexible member has proximal and distal ends and defines the axial end segment passage. At least a portion of the interior flexible member is disposed within the exterior flexible member so as to take on a profile of the exterior flexible member.
- Methods in accordance with these aspects can further include the following features. The method can include rotating the inner member of the first and/or second device about the longitudinal axis of the outer member, and/or rotating the operable end about the arcuate axis of the curved elongate body member/inner body member. The operable end includes a pair of arms, jaws, or one or more movable elements, and the handle further comprises control means to actuate the movement of the one or more movable elements, and the method further comprises performing the procedure by actuating the operable end to manipulate tissue and other target sites within the hip joint capsule.
- A particular aspect of the invention provides a method of performing a surgical procedure within a confined body cavity of a patient using a surgical device. The surgical device has a tubular outer body member with a handle at its proximal end and a flexible distal end segment extending from its distal end. The surgical device also has an operable end extending from the distal end of the flexible distal end segment. The surgical device is configured for selectively causing the flexible end segment to bend to adopt a desired curvature and for selectively rotating the operable end relative to the flexible distal end segment about an axis of the flexible distal end segment. The method comprises placing the flexible end segment into a straight configuration and inserting the operable end and at least a portion of the flexible end segment into the body cavity. The method further comprises linearly translating the operable end to a desired location within the body cavity. The method still further comprises adjusting the curvature of the flexible end segment to establish an engagement angle of the operable end relative to the outer body of the device and rotating the operable end about an axis of the flexible end segment to establish a desired operable end rotational angle. The method also comprises operating the operable end to perform a surgical function with respect to a target tissue within the body cavity.
- Other aspects and advantages of the invention will become apparent from the following description, taken in conjunction with the accompanying drawings, illustrating the principles of the invention by way of example only.
- The foregoing and other objects, features, and advantages of the present invention, as well as the invention itself, will be more fully understood from the following description of various embodiments, when read together with the accompanying drawings, in which:
-
FIG. 1 shows a cross sectional anterior view of a distended right hip joint. -
FIG. 2A shows a posterior view of the right hip joint. -
FIG. 2B shows an anterior view of a right hip joint with various ligaments shown. -
FIG. 2C shows the structures surrounding the right hip joint. -
FIG. 2D shows a cross-sectional posterior view of the right hip joint. -
FIG. 3 shows access to the hip joint using 70.degree. arthroscopes and rigid operative tools. -
FIG. 4 shows access to the hip joint using an embodiment of the present invention. -
FIG. 5A shows a side view of a device in accordance with one embodiment of the present invention, wherein the distal end is in an extended curvilinear position, and a finger actuated trigger is provided. -
FIG. 5B shows a side view of a device in accordance with another embodiment of the present invention, wherein the distal end is in an extended curvilinear position, and a thumb actuated ring is provided. -
FIGS. 6A , 6B, 6C and 6D show one embodiment wherein the “curvilinear bending motion” degree of freedom is provided. -
FIGS. 7A , 7B, 7C and 7D show the “rotation of the operable end” degree of freedom of one embodiment of the invention. -
FIGS. 8A , 8B, 8C and 8D show the “rotation about the linear axis of the elongate body member” degree of freedom of one embodiment of the invention. -
FIG. 9 shows “rectilinear extension” of the distal end degree of freedom of one embodiment of the invention with the device inserted in the hip joint capsule. -
FIG. 10 shows an embodiment of an actuating handle as it can be used to extend an inner tube out of an outer tube and provide curvilinear motion of the inner tube and distal end. -
FIG. 11 shows an embodiment of the body member with a distal end in a curved and extended position. -
FIG. 12 shows a cross-sectional view of one embodiment of the handle, wherein the trigger is actuated to provide the distal end in a retracted position. -
FIG. 13 shows a cross-sectional view of one embodiment of the handle, wherein the handle is actuated to provide the distal end in an extended position. -
FIG. 14 shows a cross-sectional view of one embodiment of the device, wherein the trigger is actuated to provide the distal end in a retracted position. -
FIG. 15 shows a cross-section view of one alternate embodiment of the handle which uses a thumb-actuated trigger/ring. -
FIG. 16 shows an embodiment of a handle used for electrocautery applications. -
FIG. 17A shows side view of a device in accordance with another embodiment of the present invention, wherein a flexible distal end segment is provided, and wherein the. -
FIG. 17B shows a detailed cross-sectional view of the handle, the flexible distal end segment, and the elongate body member of the device shown inFIG. 17A . -
FIG. 18A shows a side view of a device in accordance with another embodiment of the present invention having a flexible distal end segment, wherein an actuation means is in a position that moves the flexible distal end segment forward. -
FIG. 18B shows side view of the handle ofFIG. 18A with the actuation means is in a position that moves the flexible distal end segment backwards. -
FIG. 19A shows a side cross-sectional detailed view of the handle ofFIG. 18A . -
FIG. 19B shows a side cross-sectional detailed view of the handle ofFIG. 18B . -
FIG. 20 shows a side cross-sectional detailed view of a distal portion of the device ofFIG. 18A . -
FIG. 21 shows schematically, rotation of the operable end and distal end segment ofFIG. 18A . -
FIG. 22 shows a side view of a device in accordance with another embodiment of the present invention having a flexible distal end segment formed of vertebrae. -
FIG. 23 shows a side cross-sectional detailed view of one embodiment of the handle ofFIG. 22 . -
FIG. 24 shows a cross-sectional detailed view of a distal portion of the device ofFIG. 22 . -
FIG. 24A shows a side cross-sectional view of the operable end of the device ofFIG. 22 . -
FIG. 25A shows schematically, rotation of the operable end relative to the distal end segment ofFIG. 22 . -
FIG. 25B shows a side view of one embodiment of the distal end segment ofFIG. 22 in a straight position. -
FIG. 25C shows a side view of another embodiment of the operable end ofFIG. 22 . -
FIG. 25D shows a side view of the operable end ofFIG. 25C in the form of overlapping jaws in an open and closed position. -
FIG. 26 shows a side view of a device in accordance with another embodiment of the present invention having a flexible distal end segment formed of vertebrae. -
FIGS. 27A , 27B and 27C show side detailed views of the operable end of the device ofFIG. 26 . -
FIGS. 28A and 28B show detailed views of one embodiment of the distal end segment ofFIG. 26 in a straight position. -
FIG. 29 shows a side cross-sectional detailed view of one embodiment of the handle ofFIG. 26 . -
FIG. 30 shows a cross-sectional detailed view of a distal portion of the device ofFIG. 26 . -
FIG. 31 shows views of the distal end and operable end of another embodiment of the invention. -
FIGS. 32A and 32B show side cross-sectional views of a portion of a surgical device according to an embodiment of the invention. -
FIGS. 33A and 33B show side cross-sectional views of a portion of a surgical device according to an embodiment of the invention. - The devices and methods of the invention are primarily illustrated and described herein by means of devices which have been adapted for use in performing arthroscopic procedures on the hip. The devices and methods provide access to the internal portions of the distended hip capsule during arthroscopic procedures that are presently not accessible using currently available arthroscopic instruments. The devices and methods can suitably be used to perform arthroscopic procedures not only on the hip, but also on other parts of the body, such as the knee and shoulder. The devices are particularly suitable for performing procedures on parts of the body that require flexible access. The devices and methods are not limited to arthroscopy, and can further be used in endoscopic and laparoscopic procedures as well as open surgeries. The devices can be in the general form of any conventional diagnostic or operative instrument including, but not limited to, gaspers, scissors, forceps, scalpels, punches, probes, dissectors, mono polar cautery, bi-polar ablation/cautery, CCD camera and lens. Thus, the disclosure to follow should be construed as illustrative rather than in a limiting sense.
-
FIGS. 5-16 illustrate various embodiments and views of a medical device 100 according to the invention. The medical device 100 has aproximal end 102, adistal end 104 defining anoperable end 105 of the device, and anelongate body member 106 extending therebetween. As used herein, “elongate” generally refers to a member or element that is long in proportion to width, “proximal” generally refers to a position or direction that corresponds to the user, and “distal” generally refers to a position or direction that corresponds to the patient. - The
elongate body member 106 is shown having a generally cylindrical shape with a circular cross-section. However, this shall not be construed as limiting thebody member 106 to such as shape, as it is within the scope of the present invention for other geometric shapes to be used for theelongate body member 106. In an exemplary embodiment, thebody member 106 includes a smooth outer surface. Theelongate body member 106 is also shown having a straight, rigid shape along a substantial portion of its length. However, this shall not be construed as limiting thebody member 106 to such as shape, as it is within the scope of the present invention for other geometric shapes to be used for theelongate body member 106. For example, a flexibleelongate body member 106 will have important utility in certain applications, especially as they relate to endoscopic requirements into any of the long, tortuous, cavities of the body commonly encountered especially in ENT and colorectal procedures. - The
elongate body member 106 can be fabricated from any bio-compatible material known to those skilled in the art for use in fabricating medical instruments. The material can be lightweight and strong and can include, for example, surgical grade stainless steel, anodized aluminum, and polymeric materials and composites. The dimensions of the device 100 can vary depending on the type of procedure performed and can be readily determined by one of skill in the art. In general, the length and thickness of the device is in accordance with conventional medical devices. - The
proximal end 102 can include ahandle 103 that is grasped by a user, and can be adapted to assist the user in securely gripping and manipulating the device 100. For example, thehandle 103 can include a rubber coating, grooves or similar finger grip configuration (e.g., surface preparations or artifacts), and the like. - The
distal end 104 defines anoperable end 105 of the device and can be in the form of conventional surgical and diagnostic medical device operable ends. For example, theoperable end 105 can be in the form of gaspers, scissors, forceps, scalpels, punches, probes, dissectors, mono polar cautery, bi-polar ablation/cautery, CCD camera and lens. The general design of theoperable end 105 can be in accordance with conventional operable ends. - In embodiments wherein the
operable end 105 is in the form of a scalpel, probe, or similar static end that does not require actuation, theproximal end 102 can include asimple handle 103, much like that found on, for example, a conventional scalpel. - In embodiments wherein the
operable end 105 is in the form of, for example, grasper or scissors, which include a pair of arms, jaws or other elements that are movable in relation to each other, the device includes an actuation mechanism (e.g. 112, 113) in connection with theoperable end 105 and configured and arranged to move the arms, jaws or elements of theoperable end 105. In one embodiment, thehandle 103 is an actuating handle that, when manipulated, moves the arms, jaws or other elements. Such actuating handles are well known and, thus, thepresent handle 103 can be in accordance with conventional actuating handles. In one embodiment, the handle includes a trigger 112 (FIG. 5A ) or a ring 113 (FIG. 5B ) engaged by a finger or thumb of the user. Manipulation of thetrigger 112 orring 113, for example, pressing thetrigger 112 orring 113 towards thehandle 103, causes the arms, jaws, or other elements to open or close. In another embodiment, thehandle 103 can be similar to the handle of scissors or the like, with finger and thumb holes that can be opened and closed to open and close/relax the arms, jaws, or other elements. In other embodiments, one or more actuating buttons (not shown) are provided that opens and closes the arms, jaws, or other elements when pressed. - In embodiments wherein the
operable end 105 has arms, jaws, or elements are controllable by an actuation mechanism, thebody member 106 can be hollow and house apparatus that connects the actuation mechanism to theoperable end 105. Manipulation of the actuation mechanism causes the apparatus to open and close the arms, jaws, or other elements. For example, thehollow body member 106 can house one or more cables or push/pull rods (not shown) in connection with a cam (not shown) to open and close arms, jaws or similar movable or grasping mechanisms. - The
operable end 105 of the device, including, graspers, punches, scissors, RF ablative electrode/s, or CCD cameras with directional lenses, can be controllable in five degrees of freedom by actuating mechanisms. In some embodiments, fewer than five degrees of freedom can be provided as desired. - One degree of freedom is called “curvilinear bending” of a distal portion of the device. With this degree of freedom, the
elongate body member 106 provides curvilinear bending motion about its longitudinal axis, which allows for the smooth bending into a desired arcuate shape. In one embodiment, at least a portion of theelongate body member 106 is flexible (e.g. distalflexible portion 214 inFIGS. 18A and 20 ; distalflexible portion 314 inFIGS. 22 and 24 ; distal flexible portion 414 inFIG. 26 ; and distal flexible portion 515 inFIG. 17A ) and so as to provide the curvilinear bending motion. In one embodiment, the curvilinear bending motion is controllable at theproximal end 102 of the device. For example, the device can include ahandle 103 ordistal end 102 having a curvilinear bending actuation mechanism (not shown) that causes thebody member 106 to curve and/or controls the amount of curve of the body member. The degree of bending is independent of the other degrees of freedom (e.g. rotation) and the actuation ofoperable end 105. - In one embodiment, for example, as shown in
FIGS. 6A-8D , curvilinear bending motion can be provided by forming theelongate body member 106 of at least two concentric body members including a relatively rigidouter body member 120 and aninner body member 122 having flexibility along at least a portion of its length. The inner andouter body members outer body members FIGS. 5A and 5B , theouter body member 120 is fixed to and extends from thehandle 103, while the innertubular member 122 is slidably disposed within theouter body member 120. The innertubular member 122 distal end forms thedistal end 104 of the elongate body member. The inner tubular member can further be received within at least a portion of thehandle 103 as shown inFIG. 5A . When theinner body member 122 is housed within the outer body member, it takes on the shape of the outer body member. As theinner body member 122 is advanced outside of theouter body member 120, the inner body member is allowed to take on a curved profile due to its flexibility. The curvilinear bending motion can be about a radius as shown in the figures. - In some embodiments, the
inner body member 122 can be pre-bent into a fixed radius form so as to control the bend radius of theinner body member 122 as it extends outside of theouter body member 120. In this aspect, the degree of bend can further be controlled by the amount by which theinner body member 122 is extended outside of theouter body member 120. Thus, for example, the degree of bending of theinner body member 122 can be iteratively adjusted with changes in the linear extension of theinner body member 122 outside of theouter body member 120 by the user, e.g. as theoperative end 105 is translated into the joint capsule. - In some embodiments, a pre-bent member, such as a pre-bent member or wire (not shown), or similar form shown as
pre-formed tube 219 inFIG. 20 , is positioned along or embedded within theinner body member 122 along at least a portion of its length. When theinner body member 122 is housed within theouter body member 120 as shown inFIG. 6A , theinner body member 122 and the pre-bent member take on the shape of theouter body member 120. As theinner body member 122 is extended outside theouter body member 120, theinner body member 122 takes on the curvilinear shape of the pre-bent member or wire. - In another embodiment, the
distal end 104 is in connection with the innertubular member 122 via one or more articulatingknuckle members 124, configured as shown inFIGS. 6A-D . When theinner body member 122 is within theouter body member 120, theinner body member 122 takes on the configuration of the outer body member 120 (straight) as shown inFIG. 6A . As theinner body member 122 is extended outside of the outer body member, it is allowed to bend at the one or more articulatingknuckle member 124 to take on a curved profile. - In other embodiments, a shape memory material is embedded in or positioned along at least a portion of the
inner body member 122. The shape memory material is formed into a desired curved profile and embedded withininner body member 122, which is flexible along at least a portion of its length. When unconstrained, the shape memory, and, thus, theinner body member 122, take on the pre-formed curved shape. Thus, when theinner body member 122 is retracted within theouter body member 120, it takes on the shape of theouter body member 120. As theinner body member 122 is extended outside theouter body member 120, theinner body member 122 takes on the shape of the shape memory material. In other embodiments, rather than embed a shape memory material within theinner body member 122, at least a portion of theinner body member 122 is formed of a shape memory material and pre-formed into a desired curved profile. - In another embodiment, the
inner body member 122 is flexible along at least a portion of its length and its bending is controlled or articulated with a system of embedded steering cables (such as thesteering cables 301 shown inFIGS. 23 and 24 , and thesteering cables 421 shown inFIG. 29 ). The degree of bend in theinner body member 122 is controlled, for example, by tensioning one of an opposing pair of cables (not shown), that causes theinner member 122 to bend proportionally to the pull force on the cables. For example, as shown inFIGS. 23 and 29 , a rotational device orcam 310/411 is in connection with the pair of cables such that manipulation of therotational device 310/411 results in tension on the cables and bending of theinner body member 122. The degree of bending can be iteratively adjusted by the user as theoperable end 105 is translated into the joint capsule. - Advancement of the
inner body member 122 outside of the outer body member can be controlled by a curvilinear actuation mechanism in connection with theinner body member 122. In one embodiment, for example, as shown inFIGS. 13 and 14 , theinner body member 122 extends from thedistal end 104 to thehandle 103. Theinner body member 122 can be received within at least a portion of the handle, and is in connection with aslidable housing 130. In one embodiment,slidable housing 130 has aproximal end 127 and adistal end 129.Proximal end 127 is positioned outside of thehandle 103 as shown inFIGS. 13 and 14 , whiledistal end 129 is fixed to theinner body member 122. Theslidable housing 130 is slidably received within the handle between an extended position, shown in the bottom view ofFIG. 5A , and a retracted position, shown in the top view ofFIG. 5A . When theslidable housing 130 is extended, it pushes theinner body member 122 in a distal direction and out of theouter body member 120. When theslidable housing 130 is retracted, it pulls the inner body member in a proximal direction and inside of theouter body member 120. The distal end of theslidable housing 130 can be directly in connection with theinner body member 122 or indirectly connected to theinner body member 122, for example, via aconnection mechanism 131 as shown inFIGS. 13 and 14 . In some embodiments, a ring or similar mechanism can be positioned at theproximal end 127 ofslidable housing 130 to facilitate movement of theslidable housing 130 relative to handle 103. - In another embodiment, the
slidable housing 130 can be in connection with one or more actuating triggers or buttons (not shown) at the distal end of the handle such that pushing the button(s) or trigger(s) causes theinner body member 122 to extend or withdraw relative to the outer body member 120 (e.g. via an actuating rod 123). - The device can be designed to bend at a radius that provides enhanced access to the site of the procedure. For embodiments wherein the device is adapted for use in hip procedures, the bend radius can correspond to the curvature of the femoral head. For example, the device can bend at approximately a 25 mm radius, which corresponds to the curvature of the femoral head. When the device designed for use in capsules smaller than the hip, such as the knee and the shoulder, the bend radius can be smaller to accommodate the size of the capsule. In one embodiment, the device is designed for use on the knee and shoulder, and the device bends at approximately a 12 mm radius. When the device is designed for use in capsules smaller than the knee and shoulder, such as the elbow, wrist, and intraverterbral spaces, the bend radius can be smaller in size to accommodate the capsule. For example, the bend radius for the elbow, wrist, and intraverterbral spaces can be as small as few mm. Outside the field of arthroscopy, for example, general abdominal laparoscopy for laparoscopic colosysectomy or appendectomy, the curvature would be larger, for example, the bend radius can be as large as a 50 mm.
- Another degree of freedom, called “rotation about the linear axis of the elongate body member”, provides rotation of the
elongate body member 106, for example, as shown inFIGS. 8A-D . This rotation also moves theoperable end 105 in a broad circular path as shown. This degree of freedom can simply be provided by rotation of the entire device 100, for example, by holding and rotating the handle. - Another degree of freedom is shown in
FIGS. 7A-D , and is called “rotation of the operable end”. This degree of freedom allows for the smooth rotation of theoperable end 105 about the arcuate axis of the curvedinner member 122. For example, aninner body member 122 can be rotatably and slidably disposed withinouter body member 120. In one embodiment, theinner body member 122 is in connection with theslidable housing 130 that also rotates. Theproximal end 127 of the slidable/rotatable housing 130 extends outside of thehandle 103, as discussed above, and can be rotated relative to handle 103. As the slidable/rotatable housing 130 is rotated, theinner body member 122 also rotates. Theinner member 122 can, thus, rotate about its arcuate axis irrespective of the extent or radius of the bend or degree of jaw actuation. This rotation can also be transferred to thedistal end 104 rotatably mounted to the device. - Another degree of freedom is called “operable end motion”. In those embodiments where the
operable end 105 consists of a pair of intermating elements, e.g. graspers, punches, scissors, or the like, an actuating mechanism causes the movable elements to open and close one relative to the other. This allows the surgeon to grasp, resect or otherwise mechanically manipulate the target surgical tissue. The actuation is independent of the degree of extension, bending, or rotation. This motion can be controlled by the position of the actuation mechanism (e.g. trigger 112, ring 113) on thehandle 103, which works in connection with apparatus (e.g. cable(s) or push/pull rods) to open or close arms, jaws, or other elements. For electronic applications, wherein thedistal end 104 is in the form of a cautery tool or a camera or the like, the actuation mechanism (e.g. trigger 112, ring 113) can switch power to the cautery electrodes or electronically control one variable on the camera. - Another degree of freedom is called “rectilinear extension” of the
distal end 104, and is illustrated schematically inFIG. 9 . This degree of freedom allows the user to precisely control the degree of linear insertion of theoperable end 105 into the hip joint capsule. This insertion impacts the depth of insertion and the depth of thedistal end 104. Rectilinear extension can be irrespective of the bend radius, arcuate rotation, or jaw actuation. - The combination of the plurality of degrees of freedom allows visualization and access to the entire hip joint. Such visualization and access can be provided without interchanging access portals. The degrees of freedom can be controlled by one or more of the actuating mechanisms described herein. In some embodiments, these degrees of freedom can be operable by a single hand holding the device.
- In one embodiment, the degrees of freedom are provided by an actuating mechanism shown in
FIGS. 5A , 5B, 10 and 11. Theelongate body member 106 is interconnected with aproximal end 102 handle assembly, which is housed withinhandle 103. Thebody member 106 includes anouter body member 120, aninner body member 122, an articulatingknuckle 124, and anoperable end 105.Inner body member 122 is received withinouter body member 120 and is interconnected with theslidable housing 130. Theouter body member 120 is disposed about theinner body member 122 and is attached to the handle 103 (not shown) using conventional fastening means, such as a collett-like fastener or the like (e.g. as shown inFIGS. 5A and 5B ). Thebody member 106, which is formed of the inner andouter body members FIG. 11 . An articulatingknuckle 124 is positioned at the distal end of theinner body member 122 for connection to theoperable end 105 either directly or indirectly. Ajaw actuating rack 138 is located within theslidable housing 130. Therack 138 has ridges 140 along at least a portion of its length. Apinion 132 having ridges 142 that mate with ridges 140 on therack 138 is positioned on therack 138, and is in connection with an actuation mechanism 112 (which can be, for example, a trigger or ring or similar actuation mechanisms for engagement and manipulation by a finger or thumb). When the actuation mechanism 112 (e.g. trigger or ring) is manipulated (e.g. pulled), therack 138 slides within thehousing 130 which, in turn, pulls on the actuating rod 123 (FIG. 13 ) to actuate the operable end 105 (e.g. open and close the jaws). Thepinion 132 can be pushed sideways so as to disengage the pinion ridges 142 from the rack ridges 140, and free therack 138 to be extended or retracted smoothly. For example, a three-spoked hub 151,thumbring 152, or similar mechanism, can be positioned in connection with therack 138 for extending or retracting therack 138 distally or proximally. Motion of therack 138 in a distal or proximal direction causes theinner body member 122, which is directly or indirectly in connection with therack 138, to move. Such motion is defined as “rectilinear extension”. Once the appropriate extension is achieved, thehousing 130 can be locked in place by sliding thelocking pin 170 to engage the slidable/rotatable housing 130. With thelocking pin 170 engaged or not, theinner body member 122 can also be rotated with respect to the longitudinal axis of the device to further position thedistal end 104 andoperable end 105 as desired. This rotation is referred to above as the “rotation of the operable end”. If desired, theouter body member 120 and thehandle 103, which are fixed together (e.g. via a collett on a tapered lock), can rotate or move into and away from the hip joint capsule. These are referred to “rotation about the linear axis of the elongate body member” and “rectilinear extension” respectively. When theoperable end 105 is positioned using these degrees of freedom, thetrigger 112 can be used to manipulate thepinion 132 to move therack 138 forward and backward relative to thehousing 130, which pushes and pulls the push/pull rod assembly 136, which, in turn, opens and closes the grasping jaws or other movable elements on the operable end 108 (“operable end motion”). For example,FIG. 12 shows thetrigger 112 in a forward position withhousing 130 retracted, whileFIG. 13 shows thetrigger 112 in a backward position withhousing 130 in an extended position. - The
rack 138,housing 130,pinion 132, and other elements can be enclosed in a proximal end portion of the device, such as thehandle 103, for example, as shown inFIGS. 12 and 13 . Thehandle 103 can be ergonomically shaped for comfort and access to the actuation triggers, rings, and other mechanisms by either the right or left hand. Thehandle 103 and its connection to theouter body member 120 is designed to withstand the manipulation and “prying” forces often employed to position the device. Thetrigger 112 is shown in both the retracted (FIG. 13 ) and extended (FIG. 12 ) positions. In some embodiments, therack 138 has a spring (not shown) for spring loading, so as to pre-load thetrigger 112 and allows therack 138 to rotate with thehousing 130.FIG. 14 shows another cross section view of this embodiment of the actuating handle, with theinner body member 122 retracted withinouter body member 120. - In another embodiment, illustrated in
FIGS. 18-21 , the device is provided with a fixed-radius, pre-formed curvabledistal end segment 214. The device 200 shown inFIG. 18 has a proximal end defining ahandle 203, adistal end 204 defining anoperable end 205 of the device 200, and anelongate body member 206 extending therebetween. Theoperable end 205 is rotatable, as shown, for example, inFIG. 21 . - By combining one or more of the degrees of freedom discussed herein, precise positioning of the
operable end 205 within the hip capsule can be achieved. Rectilinear extension can be achieved by the user holding the device by thehandle 203 and simply moving the device by the handle in and out of the hip capsule. The user can further rotate the device about the linear axis of theelongate body member 206 by holding onto and rotating thehandle 203. Motion about these two degrees of freedom can allow the user to begin to approach the coarse position within the hip capsule as desired. Further precise positioning of the device can be provided by providing curvilinear bending of thedistal end segment 214 of theelongate body member 206 along its longitudinal axis into a desired arcuate shape. Such curvilinear bending can be achieved, for example, by any of the mechanisms described herein (e.g. wherein the device is provided with a fixed-radius, pre-formed curvable end segment, by advancement and withdrawal of thedistal end segment 214 within and outside of an outer rigid member). Theoperable end 205 can further be positioned by rotation of theoperable end 205 about the arcuate axis of thecurved body member 206 as described herein. In those embodiments wherein theoperable end 205 consists of a pair of intermating elements, e.g. graspers, punches, scissors, or the like, operable end motion/actuation can further position theoperable end 205 as desired within the hip capsule. - One embodiment of a control means 210 for providing iterative rectilinear extension and curvilinear bending is illustrated in
FIGS. 18A-B and 19A-B. The control means can be positioned, as shown, in thehandle 203, or elsewhere in or along the device. For example, twoknurled knobs knob 211 forward (e.g. as shown inFIGS. 18A and 19A ), thereby causing the actuation means to slide forward and, in turn, to move forward thedistal end segment 214. The user can further use, for example, the forefinger, to pull back theknob 212 like a trigger which, in turn, pulls thedistal end segment 214 backwards (e.g. as shown inFIGS. 18B and 19B ). - As shown in
FIGS. 19 and 20 , aninner tube 213 connects the control means 210 to thedistal end segment 214 via anadapter 215. Theinner tube 213 is slidably and rotatably positioned within at least a portion of anouter body member 220. Theouter body member 220 is fixed relative to thehandle 203. Theouter body member 220 may be rigid or semi-rigid. A preformedmember 219 can be positioned within thedistal end segment 214 and is rotationally constrained to rotate with thehandle 203 and is slidably constrained to slide with thedistal end segment 214. Advancement of theinner tube 213 beyond the distal end of theouter body member 220 can be controlled by the control means 210. For example, theinner tube 213 can extend from the distal end of theouter body member 220 to the control means 210. In one embodiment, theinner tube 213 is received within at least a portion of theouter member 220, and is in connection with the control means 210. The control means 210 is slidably received within thehandle 203 between an extended position (shown inFIGS. 18A and 19A ), and a retracted position (shown inFIGS. 18B and 19B ). When the preformedmember 219 is within theouter body member 220, thepre-formed member 219 is constrained in the same shape (e.g. straight or other shape) as theouter body member 220. When the control means 210 is extended, it pushes theinner tube 213 and preformedmember 219 in a distal direction and out of theouter body member 220. When the control means 210 is retracted, it pulls theinner tube 213 and preformedmember 219 in a proximal direction and inside of theouter body member 220. - Curvilinear bending can further be provided as illustrated in
FIGS. 18A and 20 . Control means for curvilinear bending can, for example, be positioned within thehandle 203. Ahub 232 can be rotatably positioned in connection with the control means 210 in manner that causes thehub 232 to translate and rotate with the control means 210. The curvilinear bending, in this embodiment, can be controlled by the degree of extension of the preformedmember 219 from within theouter body member 220. The curvilinear shape of the distalflexible end 214 can be controlled by the pre-formed shape of the preformedmember 219. The preformedmember 219 can, in some embodiments, be made from nitinol or spring temper stainless steel for limited flexural loading. In its unstressed state, the preformedmember 219 can be formed into a radius that is best suited for the intended purpose. For the hip capsule, this is generally about 25 mm, although, different users of the device may have preferences for smaller or larger radii. In this embodiment, the preformedmember 219 can be made from tubular material that provides the flexibledistal end 214 with adequate structural support, in some instances stiff structural support, and which can further provide cannulated access (e.g. for an actuation wire/cable). For smaller radii, the preformedmember 219 can be provided with a flat ribbon cross section. The dimensions can be chosen to meet the requirements of the design. These design aspects can include a reasonable force to withdraw the preformedmember 219 back into theouter body member 220 and the stiffness and structural support that it provides to the flexibledistal end 214. The preformedmember 219 can be fixed to a collar at each end (230, 231) to provide a bearing surface over which the flexibledistal end 214 can rotate. For example, thecollar 230 can be fixed to the preformedmember 219. Aslider assembly 233 can be designed and disposed so as to translate with the control means 210 but not rotate. Theslider assembly 233 can be provided so as to restrain the preformedmember 219 in the plane of thehandle 203 and to prevent it from rotating when theoperable end 205 is rotated about its arcuate axis. - This control means 210, which includes the two
knobs tube 213, theadapter 215, the flexibledistal end 214, thehub 232, and theoperable end 205, all translate as a single element along the axis of a fixed preformed shape of preformedmember 219. When the knob(s) is moved forward, the whole assembly moves forward. Similarly, when the motion of the knobs are reversed, the entire assembly translates back into theouter body member 220. - Rotation of the
operable end 205 of the device can be provided by rotation control means which can also be positioned at thedistal end 204, such as in thehandle 203 as shown, for example, inFIGS. 18A-B and 19A-B. In some embodiments, the control means 210, which provides extension and bending as described above, can also provide rotation. In one embodiment, one or more of the knurled knobs 211 and 212 rotate with respect to the handle 203 (e.g. for convenience, theknobs knob 211 and forefinger rotation of knob 212). The preformedelement 221 and preformedmember 219 can be constrained so as to remain fixed with thehandle 203 as one or more of theknobs inner tube 213 can be secured to control means 210 so as to move with the control means 210. Thus, when the control means 210 moves distally/proximally, theinner tube 213, likewise, moves distally/proximally. Theinner tube 213 is in connection with the flexibledistal end segment 214, for example, via anadapter 215. Theflexible end segment 213 is, in turn, in connection with thehub 232 of theoperable end 205. This mechanism, which includes theknobs inner tube 213,adapter 215, flexibledistal end 214,hub 232, andoperable end 205 can be disposed so as to rotate as a single element about preformedelement 219. For example,FIG. 20 illustrates one position of theoperable end 205, whileFIG. 21 shows another position of theoperable end 205 after rotation of one ormore knobs - The
operable end 205 can be in the form of movable portions, e.g. two parts such asjaws jaws actuating thumb ring 238 such that thejaws thumb ring 238 is moved forward and open when thethumb ring 238 is moved backward (or vice versa). - Another device embodiment shown in
FIG. 5B , positions the user's hand in a position common to that used to hold graspers and punches. A thumb ring 151 (FIG. 5B ) or similar manipulation element (e.g. three-spoked hub 152,FIGS. 5A and 10 ) be used to linearly translate theoperable end 105. Theoperable end 105 can be actuated (e.g. actuation of jaws) by moving thering 113 shown inFIG. 5B . This configuration can utilize arack 138 andpinion 132 mechanism as shown inFIG. 10 to effect the translation, arcuate rotation, and operable end actuation of the device. Arelease member 117 can be provided to release therack 138 from the pinion 132 (e.g. using forefinger). Thus, for example, thethumb ring 151 can be used to translate the slidable/rotatable housing 130 (e.g. as shown inFIGS. 5A , 5B, 12, and 13) and theinner body member 122, while theknob 161 can be manipulated to rotate the slidable/rotatable housing 130 and theinner body member 122, and thetrigger 113 can be manipulated to translate therack 138 which actuates the operable end (e.g. opens and closes jaws). A lockingmember 162 can be used to lock the slidable/rotatable housing 130 in place, while arelease member 117 can be used to engage/disengage thepinion 132. - Another embodiment of the device shown in
FIG. 5A positions the user's hand in a position common to gripping a pistol. In this configuration, the thumb can be used to manipulate a three-spoked hub 151 (or other type of manipulation device) to effect linear translation and bending of theinner body member 122. Further, rotation of the three-spoked hub 151 can provide rotation of theoperable end 105 as shown in the bottom figure of 5A. The forefinger can be used to actuate the operable end (e.g. jaws) using thetrigger 112. This configuration can utilize arack 138 andpinion 132 mechanism as shown inFIG. 10 . Arelease member 117 can be provided to release therack 138 from the pinion 132 (e.g. using forefinger). A locking means 169 can further be provided to lock the slidablerotatable housing 130 into a particular position. - In another embodiment, illustrated in
FIGS. 22-26 , the device is provided with a variable radius curvabledistal end segment 314. Thedevice 300 shown inFIG. 22 has aproximal end 302 defining a handle 303, a distal end 304 defining anoperable end 305 of thedevice 300, and anelongate body member 306 extending therebetween. Theoperable end 305 is rotatable, as shown, for example, inFIG. 25 . In the illustrated embodiment, theoperable end 305 includes alower jaw member 342 to which anupper jaw member 344 is pivotably attached. As will be discussed in more detail hereafter, thelower jaw member 342 may be connected to aflexible drive shaft 341 that may be selectively rotated within the curvabledistal end segment 314, thereby causing theoperable end 305 to rotate relative to thedistal end segment 314 about its arcuate axis. - By combining one or more of the degrees of freedom discussed herein, precise positioning of the
operable end 305 within the hip capsule can be achieved. Rectilinear extension can be achieved by the user holding the device by the handle 303 and simply moving and guiding the device by the handle in and out of the hip capsule. The user can further rotate the device about the linear axis of theelongate body member 306 by holding onto and rotating the handle 303. Motion about these two degrees of freedom can allow the user to begin to approach the coarse position within the hip capsule as desired. Further precise positioning of the device can be provided by providing curvilinear bending of adistal end segment 314 of theelongate body member 306 about its longitudinal axis into a desired arcuate shape. - In this embodiment, curvilinear bending of the
distal end segment 314 is an iterative process of extending and bending. The control means for curvilinear bending of thedistal end segment 314 can be positioned at the distal end, for example, in the handle 303. One or more pairs of tensioningcables 301, for example, as shown inFIG. 23 terminate at a thumbwheel-like or cam-likerotational device 310. As therotational device 310 is rotated, one of the pairedtensioning cables 301 is put into tension. A tensioning means 311 is positioned to keep non-tensioned cables in sufficient tension to retain its position in the handle 303, i.e. securely positioned overguides 324 that can be provided for proper actuation. A locking means 312 can be provided against therotational device 310 to secure the rotational position of therotational device 310 and subsequently secure the degree of bending of the distalflexible portion 314. - The pairs of tensioning
cables 301 terminate distally at adistal portion 315 of thedistal end segment 314 as shown, for example, inFIG. 24 . The distalflexible portion 314 is shown as comprising of a series ofvertebrae 331 interconnected by aintegral web 332, which is in the form of a beam-like member that interconnects thevertebrae 331. In some embodiments as shown in the figures, the entire distal flexible portion, including thevertebrae 331 andweb 332, is a single molded part. In other embodiments, while generally more expensive, thedistal end segment 314 can be formed of a plurality of vertebrae individually formed and strung together, and relying on a pivoting hinge-like arrangement between the vertebra to provide the bending shape. By using an interconnectingweb 332, the resulting bend will be in accordance with the classic predictions of any beam subjected to moment forces on each end. This distributes the stress over the length of the beam (and, here, the length of the distal end segment 314) and relieves any point of localized stress that would result if the vertebrae were hinged together at points. Thevertebrae 331 can be generally cylindrical in shape, as shown, or of any other geometric shape. The principal of operation is that as one of the pairedcables 301 is put into tension, thevertebrae 331 on that side compress as the interconnectingweb 332 bends. The degree of bending is proportional to the stress in thecables 301. Thedistal end segment 314 can be fabricated of any conventional materials used in forming surgical devices and, for example, can be fabricated of a polymeric resin with mechanical properties that allow repeated bending stress in the elastic limit of the molded material. - The
distal end segment 314 may also comprise a substantially non-bendableproximal portion 308. At least a portion of thisproximal portion 308 may be disposed within and fixedly attached to the distal end of theelongate body member 306 as shown inFIG. 24 . - The position of the
operable end 305 can further be refined by rotating theoperable end 305 about it's arcuate axis as shown, for example, inFIG. 25A . Rotation control means 350 can be mounted in thehandle 302 as shown, for example, inFIG. 23 . Arotation extension tube 340 is secured in the rotation control means 350 in a manner that causes it to rotate as arotational wheel 351 is rotated. Aflexible drive shaft 341, which can be hollow, as shown inFIG. 24 , is in connection with theextension tube 340 in a manner that causes it to rotate about its arcuate axis as therotational wheel 351 is rotated. In turn, as best seen inFIG. 24A in which the upper jaw andactuation wire 370 are omitted for clarity, the bearingface 343 of thelower jaw 342 is secured to thedrive shaft 341 by bearingface extension 345 in a manner that causes it to rotate as thedrive shaft 341 and therotation wheel 351 rotate. This causes the entireoperable end 305 to rotate relative to thedistal-most vertebra 315 when therotational wheel 351 is rotated. Theproximal portion 308 and thevertebrae 331 of thedistal end segment 314 may be formed withlongitudinal passages flexible drive shaft 341 may be passed to connect theoperable end 305 to the rotation control means 350. A spring-loadedpawl 353 can further be provided so as to secure the rotational position of theoperable end 305 once the desired position has been achieved. The rotation control means 350 may also be spring-loaded 352 in a manner that keeps the bearingface 343 of thelower jaw 342 in contact with the distal portion end of thedistal-most vertebra 315 ofdistal end segment 314. - One type of actuation means in the form of an
actuating trigger 371 for controlling the movement of theoperable end 305 is shown inFIGS. 22 and 23 . Theactuating trigger 371 can use a cam shapedsurface 372 to control the shape of awire 370 and to provide support when thewire 370 is in compression. A proximal end of thewire 370 is fixed to the cam shapedsurface 372 in a manner that causes thewire 370 to be put into tension when thetrigger 371 is pulled and into compression when thetrigger 371 is pushed forward. Thewire 370 is fixed at its distal end in theoperable end 305, as shown inFIG. 24 , in a manner that causes theoperable end 305 to actuate when thetrigger 371 is pushed and pulled (e.g. forjaws 380/381 to close when thetrigger 371 is pulled and open when thetrigger 371 is pushed forward or vice versa, as shown inFIGS. 25C and 25D ). As noted above, theflexible drive shaft 341 may be formed as a tube to provide a passage for thewire 370 through thedistal end segment 314. - In one embodiment, the
operable end 305 is in the form of grasping jaws, as shown inFIGS. 25A , 21, and 11. InFIG. 25A , theoperable end 305 includes upper andlower jaws operable end 305 is in the form of overlappingjaws FIGS. 25C and 25D . These overlappingjaws FIGS. 25C and 25D can be in accordance with any of those set forth herein. However, the edges of thejaws FIG. 25D in a manner that causes the sharpened edge of one jaw to contact and slide along the face of the mating jaw. Referring toFIG. 25D , the sharpened edge of one jaw, which can be, for example, afixed jaw 380, is designed to contact with and slide along the ground face of the other jaw, for example, amoveable jaw 381, as themovable jaw 381 is closed against it. Similarly, the sharpened edge of themovable jaw 381 can be designed to come into contact with and slide along the ground face of the fixedjaw 380 as themovable jaw 381 is closed against the fixedjaw 380. To enable this contact, the edge of themovable jaw 381 can be ground or formed to a slight taper, the leading edge of which just clears the leading edge of the fixedjaw 380 and moves closer to it as the jaws are closed. The closing movement of the jaws continues until contact is made between the jaws in the manner described. In some embodiments, if desired, bothjaws - Because the distended hip joint capsule is typically filled with circulating saline at a slight pressure, the pressurized saline will leak from any open path in the device. Thus, these open paths should be sealed. For example, the leak path around the actuating wire can be sealed, for example, with an embedded
silicone element 390. The leak path around therotation extension tube 340 andtension cables 301 can also sealed, for example, with an embeddedsilicon element 391. The leak path around theelongate body member 306 can be sealed using conventional seals used in conventional cannulas. Other conventional sealing techniques and materials can also be used. - The basic handle type and actuation mechanism(s) can vary, based on the curvilinear/bending motion, rotational motion, and linear actuation/rectilinear extension principles disclosed above as well as the specifics of the operable ends as discussed herein. The handles can be reusable and sterilizable. The operable ends can be single-use sterile disposable devices, or reusable and sterilizable. The entire device can also be reusable and sterilizable or can be a single-use sterile disposable device.
- In some embodiments, the device provides RF electrocautery. In such embodiments, the handle of the device can provide the curvilinear/bending motion, rotational motion, operable end motion, and linear actuation/rectilinear extension principles disclosed above as well as power leads for interconnection with an RF power generator. The device can further be provided with the appropriate types and positions of electrical insulative materials. Such materials can be housed in the elongate body member of the device and/or the handle. A schematic of an RF handle is shown in
FIG. 16 . The basic features of the device can be the same as those provided for graspers, scalpels, dissectors, and other operable ends. The device will further include power wires within the device (e.g. inside the flexible inner body member) electrically interconnected with apower connector 99, as well as the appropriate insulative measures (e.g. between the inner and outer body members). In some embodiments, the RF operable end is in the form of a mono-polar tip, which has no moving parts. In other embodiments, the RF operable end is in the form of a bi-polar tip, which includes a pair of movable electrode (jaws). In bi-polar applications, the opposing jaws generally are electrically insulated from each other. The basic handle type and actuation mechanism(s) for RF devices can vary similar to those provided for graspers, scalpels, dissectors, and other devices described herein. Such variations can be based on the curvilinear/bending motion, arcuate rotation, and linear actuation principles disclosed above as well as the specifics of the operable ends as discussed herein. The handles can be reusable and sterilizable. The operable ends can be single-use sterile disposable devices, or reusable and sterilizable. The entire device can also be reusable and sterilizable or can be a single-use sterile disposable device. - Further, interchangeable operable ends in the form of a multiplicity of electrocautery tips can be provided to make available the numerous shaped electrodes that are used by surgeons. For example, mono-polar tips have no moving parts can be provided as well as bi-polar tips which include a pair of movable electrode (jaws). In one embodiment, the device is in the form of a mono-polar device and the handle can be devoid of an operable end actuation mechanism discussed above
- In other embodiments, the device provides visualization of the entire capsule via a camera positioned as an operable end in combination with any of the basic embodiments described herein. Any conventional camera mechanism and associated components can be used. In one embodiment, shown in
FIGS. 17A and B, the camera is anelectronic CCD device 532 positioned within a mountingcylinder 533. Distal to the CCD are thelenses 534 that function to shape the image fed to the camera. Included among thelenses 534 is an angled lens that that shifts the field of view to something off axis of the camera (e.g. 30.degree. off axis). This is useful to provide the surgeon with a more direct image of the surgical target. Surrounding the CCD is a bundling offiber optics 531 that are potted into arc-shaped areas formed between theround mounting cylinder 533 and aCCD chip 532. Thesefiber optics 531 transfer light from the distal end of the device (e.g. handle 510) to the camera tip, and are angled to be normal to the distal lens face. Thesignal wire bundle 506 and thefiber optic 531 can be co-located within therotation tube 503 that extends though theouter tube 520 to thehandle 510. - A
rotation tube 503 is fixed to arotation knob 505 in thehandle 510 and a light-focusingenclosure 502. As theknob 505 is rotated, thelight focusing enclosure 502 and therotation tube 503 are likewise rotated, which, in turn, rotates anadapter 535 at the distal end of the distalflexible portion 530. The mountingcylinder 533 and all of the camera components mounted therein, are rotatable with theadapter 535. - The
fiber optics 531 are terminated at the focus of the light-focusingenclosure 502. Thefiber optics 531 are potted together and polished to provide a mirror smooth surface to receive and transfer the light emitted from a multiplicity of LEDlight sources 507. This light is focused onto the fiber optics face and is reflected through the fibers to the distal end of thecamera lens system 534. The CCDsignal wire bundle 506 passes through thelight focusing enclosure 502 and is coiled into a service loop to take up the twisting of thewire bundle 506. - As in the other embodiments described herein, a thumb-rotation wheel or similar mechanism can be used in connection with a pair of opposing cables to put one of the cables in tension and to relax the opposing cable. The tension causes the flexible
distal end portion 530 to bend in proportion to the force applied to the cables. - The entire assembly is sterilizable, for example, by steam autoclave or sterile soak solutions.
- In another embodiment, the expensive CCD camera is replaced by a low-cost digital camera chip available using CMOS technology, the general features of which may be in accordance with conventional CMOS technology. This, combined with a low-cost LED illumination source and the other low-cost molded plastic components, position the camera to be disposable device and delivered sterile to the customer using EtO sterilization methods.
- In another embodiment, the camera is reusable. For example, the camera can be reusable for a limited number of times and is referred to as a “reposable” device that is sterilized each time through the use of a sterile soaking solution.
- In another embodiment, illustrated in
FIGS. 26-31 , the device is provided with a variable radius curvable end segment 414. Thedevice 400 shown inFIG. 26 has a proximal end defining ahandle 403, a distal end defining anoperable end 405 of thedevice 400, and anelongate body member 406 extending therebetween. Theoperable end 405 is rotatable and can provide suction, as shown, for example, inFIGS. 27A-27C . In some embodiments, theoperable end 405 is in the form of a powered instrument blade. - An external rotational drive force may be connected to the device with coupler onto a bearing
shaft 417 and a vacuum source can be connected viavacuum port 415. The handle 405 houses the control means for the degrees of freedom of the tip (three degrees provided by curvilinear bending of the distal flexible portion 414, rotation of theoperable end 405, and rotation about the axis of the device).Tension steering cables 421 can be provided in thehandle 403 to control the bend radius of the flexible portion 414. The flexible portion 414 can be in accordance with any of the embodiments described above, for example, it can be in the form of a single piece injection molded plastic made from materials chosen for the their bending fatigue resistance properties, e.g. urethane, nylon, santoprene, elastomers and the like. The design can include a series ofvertebra 422 interconnected by beam-shaped webs as described herein. In other embodiments, the device can include a series of discreet vertebrae strung together over thecables 421. As the tension in one of thecables 421 increases, the vertebral geometries surrounding that cable move closer together, thereby placing the beam-shapedweb 424 in a state of bending. The stress is distributed linearly over the distance between the neutral axis and the thickness of the beam. This improves the fatigue life of the beam-shapedwebs 424, by avoiding the stress riser point loads that are common with a hinged geometry as opposed to a bending geometry. The molded piece can further contain anaxial hole 426 through which a flexible drive tube 431 (FIG. 30 ) can be placed for the purpose of rotating the operable end, as well as holes (not shown for each tensioning cable 421). - An embodiment of the control means is shown in
FIG. 29 . Thesteering cables 421 are routed around strategically positioned bearing rods and terminated on the circumference of a rotational wheel 411 (which can be conveniently positioned for rotation by the thumb or forefinger). As therotational wheel 411 is rotated, one of the pair ofsteering cables 421 is placed into tension. The other cable is slackened to extend over its elongated distance. Arotation knob 412 can be disposed so as to rotate (e.g. in bearing saddles 413) and can be conveniently disposed for rotation by a finger (e.g. forefinger) or the thumb. Arotation tube 431 can be anchored securely within therotation knob 412, such that when theknob 412 is rotated, thetube 431 rotates as well. At the distal end of the device, this rotation translates into the rotation of theoperable end 405. Thetube 431 can be terminated at the proximal end of the device in a sealedhousing 432 with seals 433 (e.g. o-ring seals). Theseals 433 are provided to hold the vacuum in avacuum chamber 444, without preventing rotation. Thevacuum chamber 444 is interconnected with an external vacuum source through a flexible hose positioned over thevacuum port 415. A flexiblerotational actuating cable 416 is terminated at the proximal end in the bearingshaft 417. The bearing shaft rotates in ashaft seal 418 which holds the vacuum of thevacuum chamber 444. Thevacuum chamber 444 pulls fluid and resected tissue from theoperable end 405, through therotation tube 431, and out of the device through thevacuum port 415. To prevent the tissue from plugging the rotation tube pathway, a flexiblerotational actuating cable 416 can be designed and disposed to rotate in a random, non-linear pattern to disrupt any tissue coagulation. This random, non-linear pattern can be kept unstable by varying the tension in thecables 421. For example, theactuating cable 416 can rotate within the limits of straight on the center line with high tension or in contact with the walls of therotation tube 431 with low tension or even slight compression. - The flexible
rotational actuating cable 416 is terminated distally in the cylindrical-shapedrotatable resecting piece 424 of theoperable end 405 as shown inFIG. 30 . Thispiece 424 rotates freely within a fixedresecting piece 423. Mating resecting pieces can be provided in a manner that cause tissue to be pulled by vacuum or suction through a window formed in theoperable end 405 and into the cavity formed by therotating piece 424 as shown, for example, inFIGS. 27A-27C . The tissue is resected as it is entrapped between sharpened edges of therotating piece 424 and the sharpened edges of the fixedpiece 423. Therotation tube 431 is terminated distally into the fixedpiece 423 in a manner that allows it to rotate about its arcuate axis, thereby exposing the rotating cutting window or windows only to the target surgical tissue as shown inFIGS. 27A-27C . - Another embodiment is shown in
FIG. 31 . In this embodiment, the device is distally terminated in aburr 605 that is designed primarily for bone resection. Removal of the debris can be provided with or without suction as described herein. - The above embodiments address the need for a surgical instrument with a flexible tip that offers multiple degrees of freedom at its operable end to facilitate maneuverability and access. The various embodiments can make use of a variety of implements at the operable end, many of which require application of a significant compressive load at the instrument tip. The curvature of the flexible end segments of these instruments is generally controlled by tensioning cables or rods. In order for these systems to be effective in the application of a compressive load, the operable end must no be significantly deflected when the compressive force is applied. For example, if the end segment is bent to a 45 degree angle and a compressive load is applied during a punching operation, the force will tend to compress the end segment into a shorter length. This deflection may prohibit the force from being delivered to the tissue and no punching is accomplished.
- In general, there is a trade-off between maneuverability (i.e., flexibility and controllability) and the ability to withstand a compressive load without significant deflection. The
device 700 illustrated inFIGS. 32A and 32B overcomes this problem by providing an additional flexible member in the end segment of the instrument. The additional flexible member is structured so as to prevent the shortening of the end segment due to compressive loading. The device of this embodiment has a handle at its proximal end (not shown) to which is attached anelongate body member 706 to which is attached a curvabledistal end segment 714 terminating at anoperable end 705. Theoperable end 705 may comprise any of the previously discussed implements and may be rotatable relative to thecurvable end segment 714. In the embodiment ofFIGS. 32A and 32B , theoperable end 705 comprises upper and lower grasping or cutting jaws similar to those ofFIGS. 25A and 25C , For simplicity, only the lower jaw member is 742 is illustrated inFIGS. 32A and 32B . As in previous embodiments, the operation of the jaws of theoperable end 705 may be controlled through the use of a cable (not shown) attached to the lower jaw and threaded back through the center of thecurvable end segment 714 and theelongate body member 706. - The
curvable end segment 714 of thedevice 700 includes an exteriorflexible member 730 configured for flexibility and maneuverability and an interiorflexible member 780 configured to prevent shortening and consequent deflection of thecurvable end segment 714 when a compressive load is applied. The exteriorflexible member 730 is attached to the distal end of theelongate member 706 in a manner similar to that of the end segments of the previous embodiments. The exteriorflexible member 730 has a central passage formed therethrough. As discussed in more detail hereafter, this passage is sized and configured to accommodate a flexible rotationcontrol drive shaft 708 and the interiorflexible member 780. The exteriorflexible member 730 may be further configured with one or more passages through which may be disposed tensioningcables 701 for controlling the bending of the exteriorflexible member 730, and any cables required for operating theoperable end 705. - Like the entire distal flexible portion of the previous embodiments, the exterior
flexible member 730 may be formed as a plurality ofvertebrae 731 interconnected by web members 732. Thevertebrae 731 and web members 732 may be integrally formed as a single molded part. Alternatively, the exteriorflexible member 730 may be formed from a plurality of vertebrae individually formed and pivotably attached to one another by hinges. As before, the interconnecting web 732 produces bending in accordance with the classic predictions of any beam subjected to moment forces on each end. This distributes the stress over the length of the beam (and, here, the length of the exterior flexible member 730) and relieves any point of localized stress that would result if thevertebrae 731 were hinged together at points. Thevertebrae 731 can be generally cylindrical in shape, as shown, or of any other geometric shape. - As in previous embodiments a pair of
tensioning cables 701 are attached to diametrically opposed points adjacent the distal end of the exteriorflexible member 730. In the illustrated embodiment thetensioning cables 701 are attached to thedistal-most vertebra 715. When a tension force is applied to one of the tension cables 701 (or if bothcables 701 are under tension, when the tension force in onecable 701 than in the other cable 701), thevertebrae 731 are caused to compress on the side of the tensionedcable 701, thereby causing the interconnecting webs 732 to bend. The degree of bending is proportional to the differential tensile stress in thecables 701. Any of the previously discussed control and locking mechanisms for establishing and maintaining the tension force in the cables 701 (and thus a desired bending profile) may be used in conjunction with the device of this embodiment. - The
device 700 includes arotation control member 704 that is attached at its distal end to theoperable end 705 and that is operably connected at its proximal end to a rotation control mechanism in the handle. The rotation control mechanism may be similar to the rotation control means discussed in connection with previous embodiments. Therotation control member 704 has anextension tube portion 707 rotatably disposed within theelongate body tube 706 and a flexibledrive shaft portion 708 disposed through the central passage of the exteriorflexible member 730. The flexibledrive shaft portion 708 extends distally from the distal end of theextension tube portion 707. Theextension tube portion 707 and the flexibledrive shaft portion 708 each define a central passage that, together, form a rotation control member passage 709 that extends from the proximal end to the distal end of therotation control member 704 to provide a passage for any cables required to operate theoperable end 705. It will be understood that theextension tube portion 707 and the flexibledrive shaft portion 708 may be formed as separate members that are permanently attached to one another or may be integrally formed as a single structure. - The flexible
drive shaft portion 708 is fixedly attached to theoperable end 705. It can therefore be seen that selective rotation of therotation control member 704 will produce a rotation of theoperable end 705 about the axis of the flexibledrive shaft portion 708. When the flexibledrive shaft portion 708 is straight, this axis is a linear axis and when the flexibledrive shaft portion 708 is bent, this axis is an arcuate axis. - The interior
flexible member 780 is formed as a spring-like member having a plurality ofcoils 781. The interiorflexible member 780 is configured for slidable disposition within the central passage of the exteriorflexible member 730 and with its own central passage for slidable and rotational disposition therethrough of the flexibledrive shaft portion 708 of therotation control member 704. - The interior
flexible member 780 is sized and positioned so that when the exteriorflexible member 730 is bent, the interiorflexible member 780 is also bent and conforms to the arc established by the inner passage of the exteriorflexible member 730. This, in turn, will cause the flexibledrive shaft portion 708 of therotational control member 704 to bend, conforming to the central passage of the interiorflexible member 780. The interiorflexible member 780 is further configured so that when it is bent, itsdistal end 782 engages a proximal surface of theoperable end 705 and itsproximal end 784 engages a distal surface of theextension tube portion 707 of therotational control member 704. - The interior
flexible member 780 is further configured so that when theflexible end segment 714 is in a straight, unbent configuration, thecoils 781 are in a relaxed state in which there is no space betweenadjacent coils 781, As best seen inFIG. 32B , the interiorflexible member 780 is also configured so that when it is bent, a radially inward (with respect to the arc established by the bend) portion of eachcoil 781 remains in contact with a radially inward portion of eachadjacent coil 781, At the same time, a space is introduced between a radially outward portion of eachcoil 781 and a radially outward portion of eachadjacent coil 781. In a particular embodiment, thecoils 781 are substantially rectangular as illustrated inFIGS. 32A and 32B . - It can be seen that by maintaining contact between the
coils 781 along their radially inward portions, a compression load may be transmitted from theoperable end 705 through thecoils 781 to theextension tube portion 707 of therotational control member 704. - In operation, the
tensioning cables 701 are used to bend the exteriorflexible member 730 to take on a desired curvature. The size and configuration of theexterior member vertebrae 731 provides leverage so that the curvable end segment may be selectively curved with relatively little force on thetensioning cables 701. The slidably disposed interiorflexible member 780 is forced to adopt a conforming curvature. - The
device 700 ofFIGS. 32A and 32B provides a combination of flexibility, maneuverability and resistance to deflection when a compressive load is applied at the operable end. As noted above, any of the previously described operable end implements may be used with this embodiment. The nested disposition of the twoflexible members device 700 in some applications. As with any bending member, each of theflexible member flexible member 730 is such that its NF is essentially along the arcuate axis through its center. The configuration of the interiorflexible member 780, however, is such that its NF is through its radially inward contacting portions. As a result, the NF of the interiorflexible member 780 defines a shorter radius arc than does the NF of the exteriorflexible member 730. Because their actual lengths remain unchanged when the distal end segment is curved, the difference in arc radius causes the interiorflexible member 780 to protrude from the distal end of the exteriorflexible member 730, thus potentially compromising the integrity of thedevice 700. The effect is illustrated by a comparison of the position of theoperable end 705 relative to the distal end of the exteriorflexible member 730 in the uncurved configuration ofFIG. 32A and in the curved configuration ofFIG. 32B . As shown inFIG. 32A , theoperable end 705 and the distal end of the interiorflexible member 780 extending some distance outward from the distal end of the exteriorflexible member 730. - This effect may be countered as illustrated by the
device 800 according to another embodiment of the invention, which is illustrated inFIGS. 33A and 33B . Thedevice 800 is similar to thedevice 700 in most respects. It has a handle at its proximal end (not shown) to which is attached anelongate body member 806 to which is attached a curvabledistal end segment 814 terminating at anoperable end 805. Theoperable end 805 may comprise any of the previously discussed implements and may be rotatable relative to thecurvable end segment 814. As shown inFIGS. 33A and 33B , theoperable end 805 may comprises upper and lower grasping or cutting jaws similar to those ofFIGS. 25A and 25C , For simplicity, only the lower jaw member is 842 is illustrated inFIGS. 33A and 33B . As in previous embodiments, the operation of the jaws of theoperable end 805 may be controlled through the use of a cable (not shown) attached to the lower jaw and threaded back through the center of thecurvable end segment 814 and theelongate member 806. - As in the previous embodiment, the
curvable end segment 814 of thedevice 800 is formed from two flexible members: an exteriorflexible member 830 and an interiorflexible member 880 configured to prevent deflection of thecurvable end segment 814 when a compressive load is applied. The exteriorflexible member 830 is attached to the distal end of theelongate member 806 in a manner similar to that of the end segments of the previous embodiments. The exteriorflexible member 830 has a central passage formed therethrough. This passage is sized and configured to accommodate a flexible rotationcontrol drive shaft 808 and the interiorflexible member 880. The exteriorflexible member 830 may also be configured with one or more passages through which may be disposed tensioningcables 801 for controlling the bending of the exteriorflexible member 830 and any cables required for operating theoperable end 805. - The exterior
flexible member 830 may be formed as a plurality ofvertebrae 831 interconnected by web members 832. Thevertebrae 831 and web members 832 may be integrally formed as a single molded part. Alternatively, the exteriorflexible member 830 may be formed from a plurality of vertebrae individually formed and pivotably attached to one another by hinges. As before, the interconnecting web 832 produces bending in accordance with the classic predictions of any beam subjected to moment forces on each end. Thevertebrae 831 can be generally cylindrical in shape, as shown, or of any other geometric shape. - As in previous embodiments a pair of
tensioning cables 801 are attached to diametrically opposed points adjacent the distal end of the exteriorflexible member 830. In the illustrated embodiment thetensioning cables 801 are attached to thedistal-most vertebra 815. When a tension force is applied to one of the tension cables 801 (or if bothcables 801 are under tension, when the tension force in onecable 801 than in the other cable 801), thevertebrae 831 are caused to compress on the side of the tensionedcable 801, thereby causing the interconnecting webs 832 to bend. The degree of bending is proportional to the differential tensile stress in thecables 801. Any of the previously discussed control and locking mechanisms for establishing and maintaining the tension force in the cables 801 (and thus a desired bending profile) may be used in conjunction with the device of this embodiment. - The
device 800 includes arotation control member 804 that is attached at its distal end to theoperable end 805 and that is operably connected at its proximal end to a rotation control mechanism in the handle. The rotation control mechanism may be similar to the rotation control means discussed in connection with previous embodiments. Therotation control member 804 is similar to that of the previous embodiment, having anextension tube portion 807 rotatably disposed within theelongate body tube 806 and a flexibledrive shaft portion 808 disposed through the central passage of the exteriorflexible member 830. Theextension tube portion 807 and the flexibledrive shaft portion 808 each define a central passage that, together, form a rotation control member passage 809 that extends from the proximal end to the distal end of therotation control member 804. As before, the flexibledrive shaft portion 808 may be formed as separate members that are permanently attached to one another or may be integrally formed as a single structure. - The flexible
drive shaft portion 808 is fixedly attached to theoperable end 805. It can therefore be seen that selective rotation of therotation control member 804 will produce a rotation of theoperable end 805 about the axis of the flexibledrive shaft portion 808. When the flexibledrive shaft portion 808 is straight, this axis is a linear axis and when the flexibledrive shaft portion 808 is bent, this axis is an arcuate axis. - The interior
flexible member 880 is substantially similar to the interriorflexible member 780 of the previous embodiment. The interiorflexible member 880 is sized and positioned so that when the exteriorflexible member 830 is bent, the interiorflexible member 880 is also bent and conforms to the arc established by the inner passage of the exteriorflexible member 830. This, in turn, will cause the flexibledrive shaft portion 808 of therotational control member 804 to bend, conforming to the central passage of the interiorflexible member 880. The interiorflexible member 880 is further configured so that when it is bent, itsdistal end 882 engages a proximal surface of theoperable end 805 and itsproximal end 884 engages a distal surface of theextension tube portion 807 of therotational control member 804. - The interior
flexible member 880 is further configured so that when theflexible end segment 814 is in a straight, unbent configuration, thecoils 881 are in a relaxed state in which there is no space betweenadjacent coils 881, As best seen inFIG. 33B , the interiorflexible member 880 is also configured so that when it is bent, a radially inward (with respect to the arc established by the bend) portion of eachcoil 881 remains in contact with a radially inward portion of eachadjacent coil 881, At the same time, a space is introduced between a radially outward portion of eachcoil 881 and a radially outward portion of eachadjacent coil 881. In a particular embodiment, thecoils 881 are substantially rectangular as illustrated inFIGS. 33A and 33B . - As in the previous embodiment, the
tensioning cables 801 are used to bend the exteriorflexible member 830 to take on a desired curvature. The size and configuration of theexterior member vertebrae 831 provides leverage so that the curvable end segment may be selectively curved with relatively little force on thetensioning cables 801. The slidably disposed interiorflexible member 880 is forced to adopt a conforming curvature. - To prevent the protrusion of the interior
flexible member 880 from the distal end of the exteriorflexible member 830, thedevice 800 incorporates abiasing mechanism 890 that serves to bias therotation control member 807 toward the proximal end of the elongateouter member 806. Therotation control member 807 transfers this biasing force to theoperable end 805 to assure that when theflexible end segment 814 is bent, theoperable end 805 stays in contact with the distal end of the exteriorflexible member 830, As in the previous embodiment, the difference in NF between the two flexible members when theflexible end segment 814 is bent results in an excess length of the interiorflexible member 880. As a result of the biasing force, however, theproximal end 884 of the interiorflexible member 880 is forced to move in the proximal direction so that the excess length is drawn into theelongate body member 806. - In the embodiment illustrated in
FIGS. 33A and 33B , thebiasing mechanism 890 includes a helical spring 892 disposed circumferentially around therotation control member 807 within the interior of the elongateouter member 806. Therotation control member 807 is formed with an inwardly extendingtab 894 or other stopping mechanism that engages the distal end of the spring 892. Therotation control member 807 is formed with an outwardly extendingcircumferential flange 896 or other structure for engaging the proximal end of the spring 892. As shown inFIG. 33A , when thedistal end segment 814 is in an uncurved configuration, the spring 892 is in a relatively compressed state. As shown inFIG. 33B , when thedistal end segment 814 is curved, the effective length of the interiorflexible member 880 is greater than the effective length of the exterior flexible member. However, the biasing force of the spring 892 acting on therotation control member 807 keeps theoperable end 805 in contact with the exteriorflexible member 830 and causes the interiorflexible member 880 to be withdrawn in the proximal direction. - It will be understood that the
biasing mechanism 890 is not limited to use in conjunction with the vertebrate flexible members of the illustrated embodiment, but could be used in conjunction with any elongate surgical instrument embodiment of the invention that has a curvable end segment with two nested flexible members having different neutral fiber lengths when the curvable end segment is curved. - Thus, alternate embodiments can be contrived as required by the customer. The handles can be reusable and sterilizable. The operable ends can be single-use sterile disposable elements, or they can be reusable and sterilizable. If desired, the entire device can be disposable.
- For each of the various types of devices and operable ends, individual devices can be provided. In other embodiments, one or more devices can be provided with a variety of interchangeable operable ends. Thus, for example, a single base device can be provided with interchangeable operable ends ranging from the various stationary operable ends (e.g. scalpel), movable operable ends (e.g. scissors, dissectors, clamps), RF operable ends, and visualization operable ends. In such embodiments, the base device can include at least the handle portion of the device including the various actuation mechanisms for actuating operable end arms or jaws, actuating RF electrodes, and actuating the cameras. These actuation mechanisms can be used as applicable to each operable ends and can be enabled/disabled based on the operable end attached to the device. The base device can further include an elongate body member, in the form of an inner and outer body member or not, with the interchangeable portion being the distal, operable end. Thus, in such embodiments, the base device would be provided with a plurality of operable ends that can be removably and interchangeably attached to the elongate body member/inner body member. In other embodiments, the base device includes the handle and the outer body member, with the interchangeable portion being the inner body member having the operable end attached thereto. In such embodiments, the base device would be provided with a plurality of inner body members, each having a different operable end attached thereto. Further, each inner body member could be provided with the appropriate actuation mechanism where required (e.g. electrical and insulation mechanisms housed therein). In other embodiments, the base device includes the handle, with the elongate body member/inner and outer body member being the interchangeable portion. In such embodiments, the base device would be provided with a plurality of elongate body members/inner and outer body members having different operable ends attached thereto.
- Further, interchangeable operable ends in the form of a multiplicity of electrocautery tips can be provided to make available the numerous shaped electrodes that are used by surgeons. For example, mono-polar tips have no moving parts can be provided as well as bi-polar tips which include a pair of movable electrode (jaws). In one embodiment, the device is in the form of a mono-polar device and the handle can be devoid of an operable end actuation mechanism discussed above.
- In each of these embodiments, the interchangeable portion(s) are provided with a connection mechanism that mates with a connection mechanism on the base device. Conventional connection mechanisms that can provide repeat connection and removal between the removable interchangeable elements can be used in these embodiments (e.g. mating threaded portions and mating tabs and grooves).
- In some embodiments, a single device is provided with a handle for performing grasping, cutting, etc. and electrocautery and, as such, a single handle can be provided for both types of procedures. A separate device can be provided for visualization. As such, the surgeon can use one handle for visualization and one handle for tissue manipulation and ablation.
- For all of the embodiments, all or portions of the device can be reusable or disposed of. In some embodiments, removable and interchangeable distal ends, inner/outer body member(s), and/or elongate body members that can be reused or disposed of as desired.
- Methods of the present invention comprise performing arthroscopic procedures using the present devices so as to visualize and access to the entire joint without switching cannulated access portals. These methods are performed with devices that flexibly move within the site of the procedure by use of a distended joint and a curvilinear segment. The devices are capable of being extended into the joint and curving at a radius required to visualize and access to the entire distended capsule volume and eliminates any “no see” zones. The devices also obviate the requirement that the devices be interchanged into more than one access portal to allow for the visualization of the entire joint. In one embodiment, the device is adapted for hip procedures and is adapted for extension into the hip joint approximately 3 inches and curving at a radius approximately equal to that of the femoral head.
- During use, the handle or proximal end is positioned outside the body. At least the distal portion of the body member is positioned inside the joint capsule, for example, as shown in
FIG. 9 . In one embodiment, two incisions are made and a cannula is inserted through each incisions to provide access to the joint capsule. The elongate body member of one device having a visualization mechanism at its distal end is inserted through one cannula. The elongate body member of another device having an operable end (e.g. scissors, dissector, forceps, punch, etc) is inserted through the other cannula. The elongate body member of one or more of the devices are extended and provided in a curved profile to enhance access to the various parts of the joint. In one embodiment, the body member is provided as an inner and outer body member, and, once the outer body member is positioned within the joint capsule, the inner body member is extended outside of the outer body member and provided in a curved profile. The procedure is performed and the devices withdrawn through the cannula after they are returned to a straight profile. Such procedures can be used in any type of arthroscopic surgery, such as the hip. - In another aspect, the invention generally relates to a method for performing minimally invasive hip arthroscopic surgical procedures by providing a device comprising a handle at a proximal end, a flexible or curvable portion at the distal end, and an elongate body member extending therebetween. An operable end is further rotatably mounted at the distal end. The bend radius of the flexible or curvable portion can be controlled, for example, in two ways: (1) a fixed-radius curvable device having an inner member with an embedded pre-formed shape, pre-formed to the desire radius, can be slidably extended from its location within an outer body member until the desired protruding radius is achieved through the actuation of a mechanism within the handle, and (2) a variable radius device having a system of steering cables (or cable) embedded in an articulating flexible or curvable distal end segment can be tensioned by rotation of a cam-like actuator located in the handle to achieve the desired bend radius. In each case, the user can iteratively adjust the extension and the degree of bending to accurately position the operable end in the joint capsule. The method further comprises (i) positioning the flexible or curvable distal portion into a straight configuration either by retracting the pre-formed end segment into the straight outer member, or tensioning the system of opposing steering cables until the flexible or curvable distal end segment is straight; (ii) inserting the straight elongate member into the hip capsule; (iii) iteratively adjusting the degree of extension and the bend radius to position the operable end in the desired arcuate position through the manipulation of control mechanisms in the handle; (iv) iteratively adjusting the degree of rotation about the linear axis of the elongated body member; (v) adjusting the rotational position of the operable end about it's arcuate axis to the desired rotational orientation using control mechanisms in the handle; (vi) performing the intended procedure by actuating the operable end by, for example, tensioning a cable to the desired effect through the manipulation of control mechanisms in the handle; (vii) re-establishing the straight configuration of the flexible or curvable distal end segment and re-positioning the operable end into its closed position as required; and (viii) removing the device from the body.
- The above-described method is particularly effective for devices that have a relatively long, flexible end segment and in devices having controls that are soft and iterative in nature for precise maneuverability. In many applications, however, devices with shorter, more robust, flexible tips may be desirable. Such devices may, for example, have a bending limit at or below 90 degrees. With such devices, a method of deployment other than the above-described iterative method may be preferable. This method may be employed using a sequence of “set-and forget” bending and rotation adjustments. More specifically, the surgeon may adjust the degree of bending for best access to the target tissue and then lock it in place. The surgeon may also selectively rotate the operable end of the device (e.g., grasping or cutting jaws) to the best angle of approach to the target tissue and then lock that in place. This will position the jaws (or other implement) of the operable end to punch or grasp or otherwise manipulate the target tissue in the desired way.
- In a hip arthroscopy procedure, a typical sequence for using a steerable instrument with an operable end at the distal end of a curvable end segment in a method according to the invention would thus include the following sequence:
-
- (a) Placing the flexible end segment into a straight configuration;
- (b) Inserting the distal end of the device into the body and into the distended capsule;
- (c) Linearly translating the operable end into the capsule;
- (d) Adjusting the degree of bend of the flexible end segment and locking the position;
- (e) Adjusting the angle of rotation of the operable or visualization end and locking the position;
- (f) If necessary, making minor adjustments in position by translating and or rotating the handle of the device to allow engagement or visualization of the target tissue;
- (g) Performing the procedure; i.e. grasping, resecting, ablating, or otherwise surgically manipulating the target tissue or establishing a clear visual image of the target surgical area within the capsule;
Upon completion of the procedure, the device may be returned to its straight configuration and withdrawn. It will be understood that variations in the sequence may be made without departing from the spirit and scope of the invention. For example, the order in which the bending and rotation positions are established may be reversed.
- Any of these methods can be expanded to include the interaction of two devices as describe herein by (i) providing a first portal in the posterolateral position and second portal in the anterolateral position; (ii) inserting a first device in the anterolateral position, the first device comprising a handle at a proximal end, an operable end comprising a visualization device at a distal end, a body member extending, and an operable end capable of being iterively manipulated to translate, bend, rotate to achieve the desired position in the capsule and to actuate as required to achieve the desired field of view; (iii) inserting a second device in the posterolateral position, the second device comprising a handle at a proximal end, an operable end comprising a operative device at a distal end, a body member extending therebetween, and an operable end capable of being iteratively manipulated to translate, bend, and rotate to achieve the desire position ion the capsule and to actuate as required to achieve the desired surgical outcome
- Methods in accordance with these aspects can further include multiple operative devices. For example. After the visualization portal has been set up, it could be necessary to use one operative device to resect tissue (e.g. a punch), a second operative device to remove tissue and loose bodies, a third device to cauterize any remaining bleeding sites, etc.
- The present invention also includes kits (not shown) that comprise one or more devices in accordance with the invention, that can be packaged in sterile condition. Such kits also may include one or more interchangeable distal ends, operable ends, body members (elongate body member, inner body member, outer body member) for use with the devices, and/or written instructions for use of the device(s) and/or the equipment. In some embodiments, the kit also can also include flexible and/or rigid access cannulas that are sealed against the saline distension pressure within the joint capsule and inserted using “safe access” trocars, mechanical flexation device(s) that mechanically distends the hip joint laterally as well as longitudinally along the line of action coincident with the center line of the femoral neck, and fluid management systems to control the flow and pressure of the saline in the hip capsule.
- In one embodiment, the kit includes some combination of the following equipment: a curvilinear visualization device, a curvilinear instrument capable of mechanically manipulating tissue, such as a grasper, a punch, scissors, a clamp, a retractor, a powered instrument blade, a bone resection tool, or the like, and a curvilinear instrument capable of electrically manipulating tissue, such as a monopolar or bi-polar cautery, or the like. The visualization device, mechanical manipulating device and electrical manipulating device can be provided as two or more proximal ends or handles together with interchangeable body members having thereon a variety of visualization, mechanical, and electrical elements. In another embodiment, the visualization device, mechanical manipulating device and electrical manipulating device can be provided as two or more proximal ends or handles with attached body members together with interchangeable inner tubular members having thereon a variety of visualization, mechanical, and electrical elements. In another embodiment, the visualization device, mechanical manipulating device and electrical manipulating device can be provided as two or more proximal ends or handles with attached body members together with interchangeable distal operable ends in the form of a variety of visualization, mechanical and electrical operable elements. Thus, the desired visualization, mechanical or electrical device can be provided simply by interchanging the body member, tubular member or operable end.
- The foregoing description of the invention is merely illustrative thereof, and it is understood that variations and modifications can be effected without departing from the scope or spirit of the invention as set forth in the following claims. For example, the curvilinear approach for the precise delivery of a multiplicity of operable ends has great utility beyond hip applications described herein, (e.g. knee and shoulder arthroscopy, as well as smaller joint arthroscopy). The smaller diameters of the device (e.g. approximately 3.5 mm for graspers and RF probes and approximately 4.0 mm for cameras) as well as the flexibility of each device also make it useful for other applications that require delicate visualization and tissue manipulation, including, but not limited to, laparoscopic cholecystectomies, appendectomies, hernia repair, bariatric gastric by-pass, and certain thoracic and spinal procedures
Claims (21)
1. A device for diagnostic or surgical procedures comprising:
a tubular outer body member having a proximal end and a distal end;
a handle attached to the proximal end of the outer body member;
a flexible distal end segment extending from the distal end of the outer body member, the flexible distal end segment having an axial end segment passage formed therethrough;
a rotation control member comprising:
an extension tube portion rotatably disposed within the outer body member and
a flexible drive shaft portion attached to and extending distally from a distal end of the extension tube portion for rotation therewith, at least a portion of the flexible drive shaft portion being rotatably and slidably disposed within the axial end segment passage so as to take on a profile of the flexible distal end segment; and
an operable end attached at a distal end of the flexible drive shaft portion for rotation therewith, the flexible drive shaft being selectively rotatable to establish a desired rotational orientation of the operable end.
2. The device of claim 1 wherein the flexible distal end segment comprises a plurality of vertebrae.
3. The device of claim 2 wherein the plurality of vertebrae are interconnected by an integral web.
4. The device of claim 3 wherein the vertebrae and web are integrally formed as a single member.
5. The device of claim 1 wherein the extension tube portion is operably connected to a rotation control mechanism housed in the handle, the rotation control mechanism being configured to allow selective rotation of the extension tube portion, the flexible drive shaft portion and the operable end while the flexible distal end segment remains fixed.
6. The device of claim 1 further comprising:
first and second cables disposed so that a first portion of each cable is disposed within the outer body member and a second portion of each cable is disposed within the flexible distal end segment, each cable having a distal end attached to an attachment point of the flexible distal end segment on its outer surface adjacent its distal end, the attachment points of the first and second cables being diametrically opposed so that when tensile forces are applied to one or both of the cables, a difference in the tensile force applied to the two cables causes the flexible distal end segment to bend.
7. The device of claim 1 further comprising:
bending means attached to the flexible distal end segment for selectively bending the flexible distal end segment to a desired bending profile.
8. The device of claim 7 further comprising:
profile locking means for locking the flexible distal end segment in the desired bending profile.
9. The device of claim 1 further comprising:
wherein the flexible distal end segment comprises
an exterior flexible member attached to the distal end of the outer body member, the exterior flexible member having an exterior member axial passage formed therethrough, and
an interior flexible member having proximal and distal ends and defining the axial end segment passage, at least a portion of the interior flexible member being disposed within the exterior flexible member so as to take on a profile of the exterior flexible member,
10. The device of claim 9 wherein the interior flexible member is configured so that when the flexible distal end segment is bent, the distal end of the interior flexible member engages a surface of the operable end and the proximal end of the interior flexible member engages a surface of the rotation control member.
11. The device of claim 10 wherein the interior flexible member is further configured to transmit a compression load from the operable end to the rotation control member when the operable end is operated.
12. The device of claim 10 further comprising:
a biasing arrangement including a spring in engagement with the rotation control member and the tubular outer body member to bias the rotation control member in a proximal direction relative to the tubular outer body member.
13. The device of claim 9 wherein the interior flexible member is a flat coil spring.
14. The device of claim 13 wherein the biasing arrangement and the rotation control member are sized and configured so as to cause the operable end to maintain engagement with the distal end of the exterior flexible member through a predetermined range of flexible end segment bending profiles.
15. The device of claim 9 wherein the exterior flexible member comprises a plurality of vertebrae.
16. The device of claim 9 further comprising:
first and second cables disposed so that a first portion of each cable is disposed within the outer body member and a second portion of each cable is disposed within the flexible distal end segment, each cable having a distal end attached to an attachment point of the exterior flexible member on its outer surface adjacent its distal end, the attachment points of the first and second cables being diametrically opposed so that when tensile forces are applied to one or both of the cables, a difference in the tensile force applied to the two cables causes the exterior flexible member to bend.
17. A method of performing a surgical procedure within a confined body cavity of a patient using a surgical device having a tubular outer body member with a handle at its proximal end and a flexible distal end segment extending from its distal end and having an operable end extending from the distal end of the flexible distal end segment, the device being configured for selectively causing the flexible end segment to bend to adopt a desired curvature, and for selectively rotating the operable end relative to the flexible distal end segment about an axis of the flexible distal end segment, the method comprising:
placing the flexible end segment into a straight configuration;
inserting the operable end and at least a portion of the flexible end segment into the body cavity;
linearly translating the operable end to a desired location within the body cavity;
adjusting the curvature of the flexible end segment to establish an engagement angle of the operable end relative to the outer body of the device;
rotating the operable end about an axis of the flexible end segment to establish a desired operable end rotational angle; and
operating the operable end to perform a surgical function with respect to a target tissue within the body cavity.
18. A method according to claim 17 wherein the surgical function is selected from the set consisting of viewing, imaging, grasping, resecting, ablating, and manipulating the target tissue.
19. A method according to claim 17 further comprising:
rotating the surgical device about an axis of the outer body member.
20. A method according to claim 17 further comprising:
returning the flexible end segment to the straight configuration; and
withdrawing the operable end at the at least a portion of the flexible end segment from the body cavity.
21. A method according to claim 17 wherein the body cavity is a hip capsule of the patient.
Priority Applications (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US14/224,897 US20150005578A1 (en) | 2005-12-20 | 2014-03-25 | Method and devices for minimally invasive arthroscopic procedures |
US14/534,757 US9962168B2 (en) | 2005-12-20 | 2014-11-06 | Method and apparatus for performing minimally invasive arthroscopic procedures |
US15/973,800 US10702285B2 (en) | 2005-12-20 | 2018-05-08 | Method and apparatus for performing minimally invasive arthroscopic procedures |
Applications Claiming Priority (5)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US75228405P | 2005-12-20 | 2005-12-20 | |
US11/643,740 US20070179340A1 (en) | 2005-12-20 | 2006-12-20 | Method and devices for minimally invasive arthroscopic procedures |
US12/119,799 US20080221392A1 (en) | 2005-12-20 | 2008-05-13 | Method and Devices for Minimally Invasive Arthroscopic Procedures |
US12/399,471 US8679097B2 (en) | 2005-12-20 | 2009-03-06 | Method and devices for minimally invasive arthroscopic procedures |
US14/224,897 US20150005578A1 (en) | 2005-12-20 | 2014-03-25 | Method and devices for minimally invasive arthroscopic procedures |
Related Parent Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US12/399,471 Continuation US8679097B2 (en) | 2005-12-20 | 2009-03-06 | Method and devices for minimally invasive arthroscopic procedures |
Related Child Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US14/534,757 Continuation-In-Part US9962168B2 (en) | 2005-12-20 | 2014-11-06 | Method and apparatus for performing minimally invasive arthroscopic procedures |
Publications (1)
Publication Number | Publication Date |
---|---|
US20150005578A1 true US20150005578A1 (en) | 2015-01-01 |
Family
ID=40799304
Family Applications (2)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US12/399,471 Active 2029-10-11 US8679097B2 (en) | 2005-12-20 | 2009-03-06 | Method and devices for minimally invasive arthroscopic procedures |
US14/224,897 Abandoned US20150005578A1 (en) | 2005-12-20 | 2014-03-25 | Method and devices for minimally invasive arthroscopic procedures |
Family Applications Before (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
US12/399,471 Active 2029-10-11 US8679097B2 (en) | 2005-12-20 | 2009-03-06 | Method and devices for minimally invasive arthroscopic procedures |
Country Status (1)
Country | Link |
---|---|
US (2) | US8679097B2 (en) |
Cited By (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US10463535B2 (en) | 2014-09-17 | 2019-11-05 | Carl Zeiss Meditec Cataract Technology Inc. | Devices and methods for the removal of lenticular tissue |
US10478334B2 (en) | 2014-09-17 | 2019-11-19 | Carl Zeiss Meditec Cataract Technology Inc. | Devices and methods for cutting lenticular tissue |
US10932951B2 (en) | 2017-12-14 | 2021-03-02 | Carl Zeiss Meditec Cataract Technology Inc. | Devices and methods for ocular surgery |
US11413188B2 (en) | 2016-10-26 | 2022-08-16 | Carl Zeiss Meditec Cataract Technology Inc. | Devices and methods for cutting a lens in an eye |
US11452501B2 (en) * | 2015-03-02 | 2022-09-27 | Koninklijke Philips N.V. | Variable configuration bending neck for an articulating ultrasound probe |
US11723802B2 (en) | 2016-01-30 | 2023-08-15 | Carl Zeiss Meditec Cataract Technology Inc. | Devices and methods for ocular surgery |
Families Citing this family (30)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
AU2009257304A1 (en) * | 2008-06-13 | 2009-12-17 | Pivot Medical, Inc. | Methods and apparatus for joint distraction |
CA2772523A1 (en) * | 2009-07-29 | 2011-02-03 | Transenterix, Inc. | Deflectable instrument ports |
US8920309B2 (en) * | 2010-03-12 | 2014-12-30 | Microline Surgical, Inc. | Picture in picture clip applier video system |
WO2011151828A2 (en) * | 2010-06-01 | 2011-12-08 | T.A.G. Medical Devices - Agriculture Cooperative Ltd. | Surgical implement particularly useful for knee reconstruction surgery |
JP5781398B2 (en) * | 2011-08-26 | 2015-09-24 | テルモ株式会社 | Membrane tissue transfer device and membrane tissue transfer method |
US9211134B2 (en) | 2012-04-09 | 2015-12-15 | Carefusion 2200, Inc. | Wrist assembly for articulating laparoscopic surgical instruments |
US9566080B2 (en) * | 2012-04-12 | 2017-02-14 | Olympus Corporation | Grasping treatment device |
US20140012075A1 (en) * | 2012-07-09 | 2014-01-09 | Gyrus Acmi, Inc., D.B.A. Olympus Surgical Technologies America | Sinus endoscope |
GB2508905A (en) * | 2012-12-14 | 2014-06-18 | Gyrus Medical Ltd | Endoscopic instrument with bypass lead |
WO2014113428A1 (en) | 2013-01-16 | 2014-07-24 | Teleflex Medical Incorporated | Rigid and flexible laparoscopic tool shafts and methods using same |
US9492060B2 (en) * | 2013-03-15 | 2016-11-15 | DePuy Synthes Products, Inc. | White balance and fixed pattern noise frame calibration using distal cap |
US10300286B2 (en) * | 2013-09-27 | 2019-05-28 | Medtronic, Inc. | Tools and assemblies thereof for implantable medical devices |
IL231054A (en) * | 2014-02-20 | 2015-07-30 | Tzony Siegal | Apparatus for advancement along a predetermined curved trajectory and a method for operation thereof |
US10105126B2 (en) * | 2014-04-09 | 2018-10-23 | Lsi Solutions, Inc. | Self-articulating joint for a minimally invasive surgical apparatus |
JP6305316B2 (en) * | 2014-11-07 | 2018-04-04 | オリンパス株式会社 | Endoscope |
CN105759418B (en) * | 2014-12-19 | 2019-06-28 | 深圳市锐丽视科技有限公司 | Flexible number endoscope |
US11457987B2 (en) * | 2015-05-15 | 2022-10-04 | The Johns Hopkins University | Manipulator device and therapeutic and diagnostic methods |
US11504104B2 (en) | 2015-10-20 | 2022-11-22 | Lumendi Ltd. | Medical instruments for performing minimally-invasive procedures |
US11446081B2 (en) | 2015-10-20 | 2022-09-20 | Lumedi Ltd. | Medical instruments for performing minimally-invasive procedures |
KR20180072744A (en) | 2015-10-20 | 2018-06-29 | 루멘디 엘티디. | Medical devices for performing minimally invasive procedures |
US11363944B2 (en) * | 2016-02-12 | 2022-06-21 | Stryker Corporation | Surgical instrument with steerable camera |
KR102252846B1 (en) * | 2016-03-01 | 2021-05-17 | 쿡 메디컬 테크놀러지스 엘엘씨 | Flexible endoscopic support system |
KR102354214B1 (en) | 2016-03-01 | 2022-01-20 | 쿡 메디컬 테크놀러지스 엘엘씨 | Deflecting endoscope accessory channels |
US10143823B2 (en) | 2016-04-29 | 2018-12-04 | Medtronic, Inc. | Interventional medical systems and improved assemblies thereof and associated methods of use |
US10736702B2 (en) * | 2016-08-16 | 2020-08-11 | Ethicon Llc | Activating and rotating surgical end effectors |
FR3077479A1 (en) * | 2017-12-13 | 2019-08-09 | Antoine Poirier | DEVICE FOR ARTIFICIAL INSEMINATION, VARIAL AND UTERINE OBSERVATIONS AND SAMPLES OF LIVESTOCK ANIMALS |
US11559191B2 (en) | 2018-10-29 | 2023-01-24 | G.I. View Ltd. | Insertion unit for medical instruments and an intubation system thereof |
US10646104B1 (en) * | 2018-10-29 | 2020-05-12 | G.I. View Ltd. | Disposable endoscope |
AU2020321811B2 (en) * | 2019-07-29 | 2023-07-27 | Boston Scientific Scimed, Inc. | Tissue clipping device |
KR102354491B1 (en) * | 2021-07-13 | 2022-01-24 | 주식회사 딥큐어 | Electrode apparatus for blocking or controlling nerve inside body |
Family Cites Families (47)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5152744A (en) * | 1990-02-07 | 1992-10-06 | Smith & Nephew Dyonics | Surgical instrument |
US5439478A (en) * | 1990-05-10 | 1995-08-08 | Symbiosis Corporation | Steerable flexible microsurgical instrument with rotatable clevis |
US5507297A (en) * | 1991-04-04 | 1996-04-16 | Symbiosis Corporation | Endoscopic instruments having detachable proximal handle and distal portions |
US5411514A (en) * | 1992-09-30 | 1995-05-02 | Linvatec Corporation | Bendable variable angle rotating shaver |
US5593416A (en) * | 1993-01-26 | 1997-01-14 | Donahue; John R. | Method of using flexible surgical instrument |
EP0613661B1 (en) * | 1993-01-29 | 1998-04-15 | Smith & Nephew, Inc. | Rotatable curved instrument |
US5306245A (en) * | 1993-02-23 | 1994-04-26 | Advanced Surgical Inc. | Articulating device |
US5643294A (en) * | 1993-03-01 | 1997-07-01 | United States Surgical Corporation | Surgical apparatus having an increased range of operability |
US5318528A (en) * | 1993-04-13 | 1994-06-07 | Advanced Surgical Inc. | Steerable surgical devices |
US5454827A (en) * | 1994-05-24 | 1995-10-03 | Aust; Gilbert M. | Surgical instrument |
US5766196A (en) * | 1994-06-06 | 1998-06-16 | Tnco, Inc. | Surgical instrument with steerable distal end |
US5609601A (en) * | 1994-09-23 | 1997-03-11 | United States Surgical Corporation | Endoscopic surgical apparatus with rotation lock |
US5618293A (en) * | 1995-06-06 | 1997-04-08 | Smith & Nephews Dyonics, Inc. | Surgical instrument |
US5797959A (en) * | 1995-09-21 | 1998-08-25 | United States Surgical Corporation | Surgical apparatus with articulating jaw structure |
US6620155B2 (en) * | 1996-07-16 | 2003-09-16 | Arthrocare Corp. | System and methods for electrosurgical tissue contraction within the spine |
US5938678A (en) * | 1997-06-11 | 1999-08-17 | Endius Incorporated | Surgical instrument |
US5899914A (en) * | 1997-06-11 | 1999-05-04 | Endius Incorporated | Surgical instrument |
US7090683B2 (en) * | 1998-02-24 | 2006-08-15 | Hansen Medical, Inc. | Flexible instrument |
US20020095175A1 (en) * | 1998-02-24 | 2002-07-18 | Brock David L. | Flexible instrument |
US7169141B2 (en) * | 1998-02-24 | 2007-01-30 | Hansen Medical, Inc. | Surgical instrument |
US6352503B1 (en) * | 1998-07-17 | 2002-03-05 | Olympus Optical Co., Ltd. | Endoscopic surgery apparatus |
US6228023B1 (en) * | 1999-02-17 | 2001-05-08 | Abiomed, Inc. | Tissue pick and method for use in minimally invasive surgical procedures |
US6464711B1 (en) * | 1999-03-19 | 2002-10-15 | Medtronic Xomed, Inc. | Articulating mechanism for steerable surgical cutting instruments |
EP1055397B1 (en) * | 1999-04-29 | 2001-05-23 | Karl Storz GmbH & Co. KG | Medical instrument for preparing tissue |
US6375635B1 (en) * | 1999-05-18 | 2002-04-23 | Hydrocision, Inc. | Fluid jet surgical instruments |
US7637905B2 (en) * | 2003-01-15 | 2009-12-29 | Usgi Medical, Inc. | Endoluminal tool deployment system |
US6533749B1 (en) * | 1999-09-24 | 2003-03-18 | Medtronic Xomed, Inc. | Angled rotary tissue cutting instrument with flexible inner member |
US6423059B1 (en) * | 1999-11-16 | 2002-07-23 | Sulzer Medica Usa Inc. | Radio frequency ablation apparatus with remotely articulating and self-locking electrode wand |
US6428539B1 (en) * | 2000-03-09 | 2002-08-06 | Origin Medsystems, Inc. | Apparatus and method for minimally invasive surgery using rotational cutting tool |
US6743239B1 (en) * | 2000-05-25 | 2004-06-01 | St. Jude Medical, Inc. | Devices with a bendable tip for medical procedures |
US6569105B1 (en) * | 2000-09-14 | 2003-05-27 | Syntheon, Llc | Rotatable and deflectable biopsy forceps |
US6656195B2 (en) * | 2000-09-22 | 2003-12-02 | Medtronic Xomed, Inc. | Flexible inner tubular members and rotary tissue cutting instruments having flexible inner tubular members |
US20020087151A1 (en) * | 2000-12-29 | 2002-07-04 | Afx, Inc. | Tissue ablation apparatus with a sliding ablation instrument and method |
US20030135204A1 (en) * | 2001-02-15 | 2003-07-17 | Endo Via Medical, Inc. | Robotically controlled medical instrument with a flexible section |
US6695772B1 (en) * | 2001-11-26 | 2004-02-24 | Visionary Biomedical, Inc. | Small diameter cannula devices, systems and methods |
US6645218B1 (en) * | 2002-08-05 | 2003-11-11 | Endius Incorporated | Surgical instrument |
US8118732B2 (en) * | 2003-04-01 | 2012-02-21 | Boston Scientific Scimed, Inc. | Force feedback control system for video endoscope |
US7090637B2 (en) * | 2003-05-23 | 2006-08-15 | Novare Surgical Systems, Inc. | Articulating mechanism for remote manipulation of a surgical or diagnostic tool |
US20050043682A1 (en) * | 2003-08-22 | 2005-02-24 | Cannuflow Incorporated | Flexible inflow/outflow cannula and flexible instrument port |
US7147650B2 (en) * | 2003-10-30 | 2006-12-12 | Woojin Lee | Surgical instrument |
US7338513B2 (en) * | 2003-10-30 | 2008-03-04 | Cambridge Endoscopic Devices, Inc. | Surgical instrument |
US7585300B2 (en) * | 2003-12-19 | 2009-09-08 | Spinascope, Inc. | Dissecting high speed burr for spinal surgery |
US20050197623A1 (en) * | 2004-02-17 | 2005-09-08 | Leeflang Stephen A. | Variable steerable catheters and methods for using them |
US20050209622A1 (en) * | 2004-03-03 | 2005-09-22 | Scimed Life Systems, Inc. | Tissue removal probe with irrigation and aspiration ports |
EP1727578A4 (en) | 2004-03-10 | 2009-01-07 | Rxtrocar Ltd | Trocar-cannula complex, cannula and method for delivering biologically active agents during minimally invasive surgery |
JP2005296412A (en) | 2004-04-13 | 2005-10-27 | Olympus Corp | Endoscopic treatment apparatus |
WO2007075989A2 (en) | 2005-12-20 | 2007-07-05 | Orthodynamix Llc | Method and devices for minimally invasive arthroscopic procedures |
-
2009
- 2009-03-06 US US12/399,471 patent/US8679097B2/en active Active
-
2014
- 2014-03-25 US US14/224,897 patent/US20150005578A1/en not_active Abandoned
Cited By (10)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US10463535B2 (en) | 2014-09-17 | 2019-11-05 | Carl Zeiss Meditec Cataract Technology Inc. | Devices and methods for the removal of lenticular tissue |
US10463536B2 (en) | 2014-09-17 | 2019-11-05 | Carl Zeiss Meditec Cataract Technology Inc. | Devices and methods for the removal of lenticular tissue |
US10478334B2 (en) | 2014-09-17 | 2019-11-19 | Carl Zeiss Meditec Cataract Technology Inc. | Devices and methods for cutting lenticular tissue |
US10517758B1 (en) | 2014-09-17 | 2019-12-31 | Carl Zeiss Meditec Cataract Technology Inc. | Devices and methods for the removal of lenticular tissue |
US11723803B2 (en) | 2014-09-17 | 2023-08-15 | Carl Zeiss Meditec Cataract Technology Inc. | Devices and methods for the removal of lenticular tissue |
US11813142B2 (en) | 2014-09-17 | 2023-11-14 | Carl Zeiss Meditec Cataract Technology Inc. | Devices and methods for cutting lenticular tissue |
US11452501B2 (en) * | 2015-03-02 | 2022-09-27 | Koninklijke Philips N.V. | Variable configuration bending neck for an articulating ultrasound probe |
US11723802B2 (en) | 2016-01-30 | 2023-08-15 | Carl Zeiss Meditec Cataract Technology Inc. | Devices and methods for ocular surgery |
US11413188B2 (en) | 2016-10-26 | 2022-08-16 | Carl Zeiss Meditec Cataract Technology Inc. | Devices and methods for cutting a lens in an eye |
US10932951B2 (en) | 2017-12-14 | 2021-03-02 | Carl Zeiss Meditec Cataract Technology Inc. | Devices and methods for ocular surgery |
Also Published As
Publication number | Publication date |
---|---|
US8679097B2 (en) | 2014-03-25 |
US20090171159A1 (en) | 2009-07-02 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
US8679097B2 (en) | Method and devices for minimally invasive arthroscopic procedures | |
US20080221392A1 (en) | Method and Devices for Minimally Invasive Arthroscopic Procedures | |
EP0920280B1 (en) | Fingertip-mounted minimally invasive surgical instruments | |
US10143454B2 (en) | Loader for exchanging end effectors in vivo | |
US9962168B2 (en) | Method and apparatus for performing minimally invasive arthroscopic procedures | |
EP2763615B1 (en) | Laparoscopic instrument with attachable energy end effector | |
AU742708B2 (en) | Systems, methods, and instruments for minimally invasive surgery | |
US6165184A (en) | Systems methods and instruments for minimally invasive surgery | |
AU2011305616B2 (en) | Laparoscopic instrument with attachable end effector | |
US20120259325A1 (en) | Laparoscopic Instrument with Attachable Energy End Effector | |
WO1998048687A2 (en) | Surgical instrument with rotatably mounted offset end effector and method of using the same | |
US20120078291A1 (en) | Laparoscopic instrument with attachable end effector | |
EP2485632A1 (en) | Laparoscopic instrument with attachable end effector | |
US10702285B2 (en) | Method and apparatus for performing minimally invasive arthroscopic procedures | |
AU1601399A (en) | Surgical instrument with rotatably mounted offset end effector and method of using the same |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
STCB | Information on status: application discontinuation |
Free format text: ABANDONED -- FAILURE TO RESPOND TO AN OFFICE ACTION |