5 6
Aspiration flow is controlled by an aspiration valve 32, so Ser. No. 08/705,228, filed Aug. 29, 1996. (Attorney Docket
that the distension pressure may be maintained indepen- No. 16944-001110) also incorporated by reference, a switch
dently from flow. Electrosurgical connector wires 34 and a (not shown) optionally allows application of electrosurgical
flex drive input 36 provide external electrical and mechani- power to be directed to a roller mounted distally of the
cal power. An optical image eyepiece 38 is removably 5 aperture (not shown). Irrigation flow is directed distally over
attached to housing 24 to optically direct the resection the scope through the sheath, and the aspiration flow returns
procedure. Optionally, an ultrasound transceiver may be proximally (with the severed tissue fragments) through the
mounted on the distal end of the probe. Such a distal lumen of the cooperating tubular cutters, as more fully
ultrasound transducer may optionally comprise a one- or described in co-pending U.S. patent application Ser. No.
two-dimensional phased array to allow scanning of the 10 08/542,289, the full disclosure of which is herein incorpo
resection tissue independent of any mechanical movement rated by reference.
of the transducer or probe. Referring to FIG. 3, an exemplary method for using
Referring now to FIG. 2, a resection system 40 utilizes the resection probe 10 typically comprises transcervically intro
input and output connectors on the housing of probe 10, during sheath 22 into the uterus U. Such insertion is
together with standard stand-alone surgical system 15 facilitated by use of an obturator. Manipulation of the probe
components, to minimize cost, weight, and fatigue when is facilitated by limiting the sheath to a maximum of about
using probe 10 in a resection procedure. An irrigation supply 27 Fr (about 9 mm in diameter). Once the sheath is properly
41 is connected to irrigation port 28 to provide a continuous positioned, the obturator is removed and the cutting member
flow of irrigation fluid during resection. Preferably, irriga- 18 and scope 20 are inserted through the sheath and proxi
tion supply 41 comprises a standard irrigation supply bag 20 mal housing 24 is attached to sheath coupling 50.
suspended above the surgical site to provide a constant The probe is manipulated from the proximal housing 24
pressure gravity feed, allowing distension pressure to be usmg articulation handle 26. The surgeon inserts the fingers
varied simply by changing the height of the irrigation of one hand tlirough finger handle 70, and inserts the thumb
supply. Alternatively, a valve or controlled flow pump may 0f foe same hand through thumb ring 72. Preferably, the
be used to supply irrigation fluid. 25 fingers are held stationary while the thumb ring extends the
In the exemplary embodiment, aspiration, mechanical shaft and cutting member distally from the sheath. Thumb
rotation, and electrosurgical potential are coupled to the ring 72 is biased toward the proximal direction, so that
shaft through a disposable cartridge 25 on shaft housing 24, removal of strips of tissue typically takes place under the
the disposable cartridge reciprocating with the shaft as assistance of biasing spring 73.
shown. This disposable cartridge structure facilitates 30 Removal of fibroid tissue from the uterus U begins with
replacement of the cutting wire/shaft assembly (including the cutting member 18 extended distally from the sheath 22
the inner and outer tubes of the chopping mechanism) which and energized with RF power, as described above. As
would otherwise limit probe life. Fluid which leaves aspi- illustrated in FIG. 3, the shaft is generally aligned with the
ration removal port 30 is directed through a filter canister 42 tissue to be removed so that proximally actuating thumb ring
and then to an aspiration sump 44. Filter 42 removes the 72 draws electrosurgical cutting surface 18 through fibroid
solid tissue fragments from the aspiration fluid for analysis. and/or endometrial tissue. The procedure is directed using
Sump 44 is preferably connected to a standard vacuum SCOpe 20. preferably while the scope and sheath are held
supply line to promote the withdrawal of aspiration fluid substantially motionless using finger handle 70. Performing
through the probe. Aspiration vacuum control is conve- each cut towards the viewing scope helps to avoid inadvert
niently provided by aspiration valve 32 (see FIG. 1). ently perforating uterus U.
Mechanical power is supplied to flex drive input 36 by In an alternative embodiment of the method of the present
drive motor 48. Drive motor 48 preferably rotates at least in invention, the surgeon may manipulate the thumb ring
the range between 500 and 1500 rpm, and typically allows relative to the finger handle to bring the cutting surface 18
for rotation in either direction, or oscillating rotation back 45 to a preferred viewing distance from scope 20. and then
and forth. The morcellator generally shears tissue translate the shaft and housing assemblies together proxi
mechanically, without electrosurgical potential, although mally. This provides a longer cutting stroke for cutting
such potential may be advantageous for some embodiments surface 18, and decreases the time required for the resection
of tubular surgical cutters. procedure.
The morcellator promotes aspiration of larger tissue frag- 50 As the electrosurgical cutting surface 18 moves
ments without clogging the aspiration flow path. The size of proximally, rolling elements 19 generally roll against the
the morcellator can be reduced by breaking up tissue frag- fibroid or endometrial tissue. These rolling elements fan
ments with round or star shaped rollers 19, as more fully outward radially, so that multiple separate fibroid tissue
explained in co-pending U.S. patent application Ser. No. segments are detached from the uterus by each stroke of the
08/705,229, filed Aug. 29, 1996 (Attorney Docket No. 55 cutting member. Therefore, the detached tissue segments are
16944-001210). the full disclosure of which is incorporated each smaller than an equivalent single strip of severed tissue,
by reference. Often times, such rollers will be used to and are significantly easier to draw into the morcellator for
vaporize a significant amount of the resected tissue, as extraction. The cutting member can thus have an increased
described in co-pending U.S. patent application Ser. No. axial projection area, i.e., can remove a greater volume of
08/732,033. filed Oct. 16, 1996 (Attorney Docket No. ^ tissue with each stroke, without overwhelming the morcel
16944-000170), the full disclosure of which is also incor- lator. Those of skill in the art will appreciate that such
porated by reference. Nonetheless, the presence of the methods and devices will have many advantageous
morcellator is generally advantageous to aspirate tissue applications, including for the removal of selected thoracic
fragments which are released. tissues, particularly lung tissue, tissues of the bladder, and
Controlled electrosurgical power is supplied through elec- 65 tissues of the prostate,
trosurgical wires 34 to the cutting member by power unit 46. Referring now to FIGS. 4 and 5, the chopping action of
As is more fully described in co-pending U.S. application the tubular surgical cutters provided by rotating inner tube
