WO2005027740A1

WO2005027740A1 - Surgical instrument

Info

Publication number: WO2005027740A1
Application number: PCT/NZ2004/000229
Authority: WO
Inventors: Garry Heynen
Original assignee: Garry Heynen
Priority date: 2003-09-23
Filing date: 2004-09-23
Publication date: 2005-03-31

Abstract

A surgical suction, illumination and irrigation apparatus to extract a fluid and/or to supply a fluid during a surgical procedure comprising a fluid passageway (7) defined by a lighting ducting member (30). The ducting member (30) is formed of a lighting ducting transparent or translucent material that surrounds the thus defined fluid passageway (7) and is able to receive, duct and emit light from a source (15) to the operative end (3) of the surgical apparatus to illuminate the fluid and/or tissue of the surgical site.

Description

SURGICAL INSTRUMENT

FIELD OF THE INVENTION The present invention relates to a surgical instrument in particular those used for suction, illumination and irrigation in surgical procedures, whether handheld or otherwise.

BACKGROUND OF THE INVENTION The nature of surgical procedures is that they often require the removal of fluids and particles and illumination inside the surgical site. In particular, during revision hip replacement and knee replacement surgery, illumination is often required along with suction and irrigation to gain visualisation of the internal anatomy of the shaft of a long bone with a view towards removal of debris including cement, metal and membrane. Illumination is provided by the ambient lighting of the operating theatre and also more specifically by special overhead theatre operating lights. In many situations where the surgical site is shallow or sufficiently open such ambient and overhead lighting is sufficient. However increasingly surgical procedures are either deep within the ^"body cavity or have only a minimal incision (such as "key hole" or minimally invasive surgery) and thus ambient or external light is not sufficient. Procedures involving only small incisions such as spinal surgery, minimally invasive joint replacement surgery, neuro-surgery and any other surgical procedure where a small incision is utilised, light therefore can not gain access to the depths of the wound which is often obscured by the surgeon's hands. In the past surgeons have relied on head lights and focused external lighting which still has the problem of the surgeon's hands obscuring the wound while operating. There exists combined suction, illumination and irrigation sources such as Yankauer type suction instruments with a handle and (optionally extended) tip putting the three elements in close proximity to the surgical site (shown in Figure 1). However such instruments have the two or three functions in separate conduits down the instrument. The instrument thus is bulky for a given diameter of suction bore, light source and optionally irrigant channel. Furthermore present sources (and subsequent conduit down the instrument) of illumination tend to be heat generating thus introducing undesirable heat into the surgical site. Due to the trade off between external instrument bulk and internal bore diameter(s) the suction bore may be smaller than is ultimately desirable. Depending upon the nature of the material being suctioned and with the addition of heat the bore can become blocked. Blocking of such sterile units is a requirement for throwing away and replacement. Such a relatively complex item is thus relatively expensive given the fabrication, materials and controls present; even in a disposable unit. Advantages are therefore gained if the overall external size of the unit, i.e. that part in the body, can be minimised whilst the internal bore diameter(s) for suction and/or irrigation can be maximised. Such an advantage can be realised by the combination of two or more such functions into a single unit. It is therefore an object of the invention to provide a surgical instrument which at least goes some way to overcoming the disadvantages of the prior art, or which combines the functions of at least suction and illumination, and/or irrigation, and/or maximises the internal bore diameter for the given external instrument diameter or at least provides the public with a useful choice.

BRIEF DESCRIPTION OF THE INVENTION In a first aspect the present invention may be said to broadly consist in an apparatus adapted to extract a fluid and/or to supply a fluid during a surgical procedure comprising or including, a fluid passageway defining member having an inlet end having at least one inlet and an outlet end having at least one outlet, and a lighting ducting member, or members, adapted to receive, duct and emit light to an or the other end, inlet or outlet, thereby to illuminate the fluid and/or tissue of the surgical site. In one embodiment the fluid passageway defining member and the lighting ducting member, or members, is one and the same unitary member i.e. the member is formed of a light transparent and or translucent material and that material surrounds the thus defined fluid passageway. Preferably said unitary member is formed from a plastics material e.g. a suitable plastic material such as an acrylic plastics material with a light transmissivity rating of 90% or higher. Preferably said plastics material is extruded. Preferably the end from which the light emits is the operative end and the lighting is received at the non-operative end i.e. that end more proximal to the surgeon during a surgical procedure. In one embodiment of the present invention the fluid passageway is adapted by suction to remove fluid and/or solid matter from the surgical site whilst the surgical site is being illuminated by the light ducting member(s). In another embodiment the fluid passageway may provide a fluid to be supplied into the surgical site whilst the light ducting member illuminates that surgical site. In some forms of the present invention multiple fluid passageways may be provided so that there might be both a supply of fluid into the surgical site whilst there can also be a removal of fluid(s) and/or solid matter from the surgical site. Such multiple fluid passageways need not be co-axial but can be if desired. Preferably said unitary member is connected or connectable to a housing containing connections for said illumination, and/or suction and/or fluid provision. Preferably said unitary member is selectively disengageable from said housing. Preferably said housing is in the form of a handle. Preferably the control of suction and/or fluid is via a user control means, for example a trigger. Preferably any one of said suction, and/or said illumination, and/or said fluid is supplied from either a source internal of said housing or external of said housing. In a second aspect the present invention consists in a surgical instrument comprising or including a hollow member with at least one bore therethrough having an operative end and a non operative end around which periphery of said hollow member there is a light transmissive material towards at least the operative end which transmits light at or near the operative end of said hollow member, when connected to an illumination source, and said hollow member is capable of supplying suction and/or a fluid at or near the operative end of said hollow member, when connected to a source of suction and/or vacuum. Preferably said hollow member is defined by said light transmissive material to form a unitary member. Preferably said unitary member is connected or connectable to a housing containing connections for said illumination, and/or suction and/or fluid provision. Preferably said housing has a handle or grippable means at or towards their non-operative end. Preferably said hollow member is divided into two or more bores. Preferably at least one bore is connected to a source of vacuum at its non- operative end, producing suction at its operative end. Preferably said other of two bores is connectable to a source of fluid at its non-operative end to provide irrigation at its operative end. Preferably said handle has controls thereon for selection and control of suction and/or irrigation. Preferably said light transmissive material is an acrylic plastic with a light transmissivity rating of 90% or higher. Preferably said hollow member is circular in cross-section. Preferably said light transmissive material towards said operative end is circular in cross-section. Alternatively a portion of said light transmissive material may be crescent shaped or of other cross-section. Alternatively said light transmissive material may stop clear of the operative end of said hollow member. Preferably said handle or grippable means has connections for suction, illumination and optionally irrigation sources. Preferably said hollow member is constructed of said acrylic material which transmits light from said light source to said operative end of said hollow member. Preferably said unitary member is selectively disengageable from said housing. Preferably said housing is in the form of a handle. Preferably said controls are in the form of a trigger. Preferably any one of said suction, and/or said illumination, and/or said fluid is supplied from either a source internal of said housing or external of said housing. A surgical instrument as herein described with reference to any one of Figures 2 through 9. An apparatus as herein described with reference to any one of Figures 2 through 9. As used herein the term "and/or" means "and" or "or", or where the context allows both. As used herein the term "(s)" following a noun means the plural and/or singular form of that noun. As used herein the term "bore" is also construed to mean the conduit of any hollow conduit or tubular member, or the hollow conduit or tubular member itself, being able to communicate a fluid, and/or vacuum. To those skilled in the art to which the invention relates, many changes in construction and widely differing embodiments and applications of the invention will suggest themselves without departing from the scope of the invention as defined in the appended claims. The disclosures and the descriptions herein are purely illustrative and are not intended to be in any sense limiting. BRIEF DESCRIPTION OF THE DRAWINGS A preferred embodiment of the present invention is shown in the accompanying drawings, Figure 1 is a perspective view of two surgical instruments of the prior art, Figure 2 shows a number of perspective views of further operative end configurations of the surgical instrument, Figure 3 is side view of the surgical instrument of the present invention with illumination, suction and/or irrigation connections attached at the non- operative end, Figure 4 is a close-up view of the operative end of the surgical instrument of Figure 2, Figure 5 shows a close up view of the operative end of the surgical instrument and in particular a dual bore arrangement, Figure 6 shows a further embodiment of the surgical instrument having an external light source input with a trigger system to choose between irrigation down or suction up the conduit, Figure 7 shows a similar embodiment to that of Figure 6 with the exception that the light source and pump are self contained within the surgical implement, Figure 8 shows a variation of the surgical instrument whereby the main conduit is utilised for illumination and suction at a separate conduit for irrigation is provided, and, Figure 9 shows a surgical instrument in partial cross section having a housing and a removable unitary member.

DETAILED DESCRIPTION OF THE INVENTION With reference to Figures 1 through 9 the present invention will now be described. The prior art instruments 6 typically have separate conduits for each source (e.g two or three separate conduits), down their length, one each for illumination 8, suction bore 10 (constructed from metal) and (optionally) irrigation 12. Since each of these has separate conduits down the length of the instrument a compromise must be reached between the size of each conduit versus the external size of the instrument. One embodiment of the present invention comprises a surgical instrument 1 with a housing 29 and a unitary member 30. The housing having a handle or grippable portion 2 at a non-operative end 5, operative in this context refers to the end of the instrument directed to the operation site (i.e. that directed away from the surgeon). The handle has vacuum 13, illumination 15 and optionally irrigation (not shown) links joining the handle at vacuum 19, illumination 21 and irrigation (not shown) connections. The handle is so contoured in the preferred embodiment that it is easy to hold or grip by a user under surgical conditions and also manoeuvre. A contoured region 4 on either side of the portion 2 facilitate easy gripping by a user or engagement with other equipment. Optionally at least the contoured region 4 or other regions of the handle 2 may have soft or deformable areas to aid gripping. Other configurations of the instrument as a grippable handle are shown in Figures 6 and 7. The combination bore 7 and illumination periphery 9 (as an illuminating bore tube 20 or unitary member 30) has illumination connection 21 at or towards its non operative end 5. The illumination connection 21 can be connected to an external illumination source (not shown) via the illumination link 15 or may have an internal illumination source 22 comprising part of the handle or grippable portion 2. The illumination source whether internal or external is preferably of a non heat creating variety such as that derived from light emitting diode(s) (LED) or similar light sources known in the art. Other light sources may also be utilised where temperature sensitivity is not crucial. A vacuum and/or irrigation connection 19 and 23 enters the handle from an external source of vacuum and irrigation via vacuum and irrigation links 13 and 17. In the two particular embodiments shown there is connection for both vacuum (i.e. suction) and irrigation fluid to travel down (in the case of irrigation fluid) and up (in the case of such) the bore 7. The selection between suction or irrigation is achieved by a control 24 which in one preferred embodiment is a trigger on the handle 2 of the instrument. Simple valving systems known in the art are actable by the control 24 to select between vacuum and/or irrigation. A further embodiment of the surgical instrument has an internal vacuum source 26 and an internal irritant pump 28. These may be powered by either an internal battery pack or via an external power connection 25. If the power supply is internal it may be in the form of a replaceable or a chargeable battery. When there is an internal irrigant pump 28 there will still be an external irrigation - connection 23 via an irrigation link 17. An internal supply of irrigant is also considered to be within the scope of the present invention. From the handle 2 an extending member 16 terminates at the operative end 3 of the surgical instrument. The operative end 3 has in relative close proximity a bore 7 from a hollow member which passes from the handle 2 and source connections thereof, down through the extending member 16. The bore is capable of transmitting the suction from the vacuum source up through the bore and irrigation fluid from the irrigation source, down the bore. The suction can remove fluid(s), particles and irrigant etc. from the surgical site. Typically in the preferred embodiment the bore is substantially circular in cross-section. However in other embodiments the cross-section may be different, and or changing along its length to suit the application. Such embodiments will be discussed shortly. Substantially about the bore extends an acrylic light transmissive material, thus forming a unitary member 30 of light transmissive material substantially defining the bore. The light transmissive material can for example be an acrylic plastic, with a light transmissivity rating of 90% or higher. One example is an acrylic plastic with elasticisers such as but not limited to that marketed under the brand name Oroglas (SG-7) by Atoglas, a high tensile acrylic plastic with light transmissivity of 91% or greater. A tough high tensile plastic material is desirable for surgical environments where impact is likely to occur, such as use with osteotomes and the like. A high tensile material may not be required for surgical environments where no impact is likely and as such lower toughness materials with higher transmissivity are also included and may be used, such as that marketed under the brand CM207 with a transmissivity of 94%. The forming of the unitary member may be by extrusion, moulding or other known methods of plastics forming in the industry. In some applications other transmissive materials may be used, such as for example, but not limited to glass, if the surgical environment is applicable. The connection 21 of the light illumination line 15 to the handle 2 transmits light into and down the acrylic extrusion forming the illumination periphery 9 at the operative end. The cutting and/or shaping of the termination, at or near to the operative end 3, of the illumination periphery, affects and controls the output of the light transmitted to the operative end 3. The unitary member 30 may be removable from the housing 29 such as the handle 2. In such instances this will allow for in surgery, pre-surgery or post surgery replacement of the unitary member 30 should it become blocked or not be sterile. In this way the flexibility is retained should the tube become blocked whilst keeping the cost down on of any replacement parts. Such replacement is achievable either by push fit into an O ring type connection 31, threaded connection, or other air or fluid type connection in the art. The connection itself need not be in the handle 2 but may be anywhere down the length of the unitary member 30. In the preferred embodiment the suction bore and illumination periphery are combined as one. The illumination periphery is formed from a hollow extruded, machined, moulded or otherwise manufactured acrylic plastic tubular member. The hollow of the tubular member also being used for the bore 7. The illumination periphery and thus performs the dual function of illumination and suction path into the one member. Optionally also irrigant may be passed down the bore or may be supplied from a separate conduit. The illumination periphery as discussed may be of circular cross-section. However other shapes are also preferable. Figure 4 and to some extent Figure 2 show a crescent shaped cross-section about the bore 7. This gives strong side focus of the light and more intense lighting of the surgical area. Other configurations may have the combined bore 7 and resulting illumination periphery 9 as an oval section as shown in the first of Figures 2C, alternatively the bore maybe circular and the illumination periphery maybe oval such as the second depiction in Figure 2C or any other geometric shape may be utilised such as a triangular illumination periphery around a circular bore as shown in the third depiction of 2 C. Any desired illumination periphery and combination with any desired bore shape is considered to be within the extent of the invention, and the important aspect is the combination of the bore 7 and illumination periphery 9 as the one component. The light transmitted down the light conducting element projecting from the operative end 3 into the operative field. The operative end 3 may have an elongate. lumen 18 to extend the bore 7 past the termination of the illumination periphery 9. The lumen may be as a result of an integral extension of the illumination periphery or the addition of an extension (metal, plastic or otherwise) during manufacture of the surgical instrument. A further embodiment or adoption of the present invention has the bore 7 and illumination periphery 9 as an integral unit as described, with bore 7 further being divided into two or more conduits, 7A and 7B by a bore divider. Such division of the bore allows one sub-bore, e.g. 7A to be used for suction whilst the other sub-bore e.g. 7B can be used for irrigation. This will, of course, result in a smaller than the previous single channel suction bore. However the resulting two channels will still convey the external size internal bore size advantage discussed; but just to a lesser extent. The bore divider 20 may be so positioned that the irrigation bore may be markedly smaller than the suction bore, as shown. Since the irrigation is a fluid with generally no particles then a small irrigation channel is still acceptable whilst the comparatively larger suction bore can handle the particles and fluid required of a suction bore. A further embodiment of the illumination bore tube 20 is shown in

Figure 8 whereby the main bore 7 exists within an illumination periphery 9 and there is external to this a supplementary bore 27. In the preferred embodiment the bore 7 is for suction and the supplementary bore 27 is for the supply of irrigant. The tube of this embodiment is either fittable to a handle 2 or is its own integral surgical device. Such an illuminating bore tube 20 may also be of the replaceable variety as previously described.

Claims

CLAIMS:

1. An apparatus adapted to extract a fluid and/or to supply a fluid during a surgical procedure comprising or including, a fluid passageway defining member having an inlet end having at least one inlet and an outlet end having at least one outlet, and a lighting ducting member, or members, adapted to receive, duct and emit light to an or the other end, inlet or outlet, thereby to illuminate the fluid and/or tissue of the surgical site.

2. An apparatus as claimed in claim 1 wherein the fluid passageway defining member and the lighting ducting member, or members, is one and the same unitary member i.e. the member is formed of a light transparent and or translucent material and that material surrounds the thus defined fluid passageway.

3. An apparatus as claimed in claim 2 wherein said unitary member is formed from a plastics material e.g. a suitable plastic material such as an acrylic plastics material with a light transmissivity rating of 90% or higher.

4. An apparatus as claimed in any one of claims 1 to 3 wherein the end from which the light emits is the operative end and the lighting is received at the non- operative end i.e. that end more proximal to the surgeon during a surgical procedure.

5. An apparatus as claimed in any one of claims 1 to 4 wherein the fluid passageway is adapted by suction to remove fluid and/or solid matter from the surgical site whilst the surgical site is being illuminated by the light ducting member(s).

6. An apparatus as claimed in any one of claims 1 to 5 wherein the fluid passageway may provide a fluid to be supplied into the surgical site whilst the light ducting member illuminates that surgical site.

7. An apparatus as claimed in any one of claims 1 to 6 wherein multiple fluid passageways may be provided so that there might be both a supply of fluid into the surgical site whilst there can also be a removal of fluid(s) and/or solid matter from the surgical site.

8. An apparatus as claimed in claim 7 wherein said multiple fluid passageways need not be co-axial but can be if desired.

9. An apparatus as claimed in any one of claims 2 to 8 wherein said unitary member is connected or connectable to a housing containing connections for said illumination, and/or suction and/or fluid provision.

10. An apparatus as claimed in claim 9 wherein said unitary member is selectively disengageable from said housing.

11. An apparatus as claimed in claim 9 or 10 wherein said housing is in the form of a handle.

12. An apparatus as claimed in any one of claims 6 to 11 wherein the control of suction and/or fluid is via a user control means, for example a trigger.

13. An apparatus as claimed in any one of claims 6 to 12 wherein any one of said suction, and/or said illumination, and/or said fluid is supplied from either a source internal of said housing or external of said housing.

14. A surgical instrument comprising or including a hollow member with at least one bore therethrough having an operative end and a non operative end around which periphery of said hollow member there is a light transmissive material towards at least the operative end which transmits light at or near the operative end of said hollow member, when connected to an illumination source, and said hollow member is capable of supplying suction and/or a fluid at or near the operative end of said hollow member, when connected to a source of suction and/or vacuum.

15. A surgical instrument as claimed in claim 14 wherein the hollow member is defined by said light transmissive material to form a unitary member.

16. A surgical instrument as claimed in claim 15 wherein said unitary member is connected or connectable to a housing containing connections for said illumination, and/or suction and/or fluid provision.

17. A surgical instrument as claimed in claim 16 wherein said housing has a handle or grippable means at or towards their non-operative end.

18. A surgical instrument as claimed in any one of claims 14 to 17 wherein said hollow member is divided into two or more bores.

19. A surgical instrument as claimed in any one of claims 14 to 18 wherein at least one bore is connected to a source of vacuum at its non-operative end, producing suction at its operative end.

20. A surgical instrument as claimed in any one of claims 14 to 19 wherein said other of two bores is connectable to a source of fluid at its non-operative end to provide irrigation at its operative end.

21. A surgical instrument as claimed in any one of claims 17 to 20 wherein said handle has controls thereon for selection and control of suction and/or irrigation.

22. A surgical instrument as claimed in any one of claims 14 to 21 wherein said light transmissive material is an acrylic plastic with a light transmissivity rating of 90% or higher.

23. A surgical instrument as claimed in any one of claims 14 to 22 wherein said hollow member is circular in cross-section.

24. A surgical instrument as claimed in any one of claims 14 to 23 wherein said light transmissive material towards said operative end is circular in cross- section.

25. A surgical instrument as claimed in any one of claims 14 to 24 wherein a portion of said light transmissive material may be crescent shaped or of other cross-section.

26. A surgical instrument as claimed in any one of claims 14 to 25 wherein said light transmissive material may stop clear 'of the operative end of said hollow member.

27. A surgical instrument as claimed in any one of claims 17 to 26 wherein said handle or grippable means has connections for suction, illumination and optionally irrigation sources.

28. A surgical instrument as claimed in any one of claims 14 to 27 wherein said hollow member is constructed of said acrylic material which transmits light from said light source to said operative end of said hollow member.

29. An apparatus as claimed in any one of claims 15 to 28 wherein said unitary member is selectively disengageable from said housing.

30. An apparatus as claimed in any one of claims 17 to 29 wherein said housing is in the form of a handle.

31. An apparatus as claimed in any one of claims 21 to 30 wherein said controls are in the form of a trigger.

32. An apparatus as claimed in any one of claims 14 to 31 wherein any one of said, suction, and/or said illumination, and/or said fluid is supplied from either a source internal of said housing or external of said housing.

33. A surgical instrument as herein described with reference to any one of Figures 2 through 9.

34. An apparatus as herein described with reference to any one of Figures 2 through 9.