US20030204188A1 - Tissue separating and localizing catheter assembly - Google Patents
Tissue separating and localizing catheter assembly Download PDFInfo
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- US20030204188A1 US20030204188A1 US10/374,584 US37458403A US2003204188A1 US 20030204188 A1 US20030204188 A1 US 20030204188A1 US 37458403 A US37458403 A US 37458403A US 2003204188 A1 US2003204188 A1 US 2003204188A1
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- A—HUMAN NECESSITIES
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- 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
- A61B18/148—Probes or electrodes therefor having a short, rigid shaft for accessing the inner body transcutaneously, e.g. for neurosurgery or arthroscopy
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
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- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
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- A61B2090/3908—Soft tissue, e.g. breast tissue
Definitions
- a first aspect of the invention is directed to a tissue-separating catheter assembly comprising a rotatable shaft having a distal shaft portion, a tissue separator device extending along the shaft and having an expandable distal separator part at the distal shaft portion, a radially-expandable localization device at the distal shaft portion, and an expandable tubular element movable so its outer end may be generally axially aligned with the localization device.
- a tissue section separated from surrounding tissue by the tissue separator device may be capturable by the localization device and the tubular element to aid removal of the separated tissue section from a patient.
- a second aspect of the invention is directed to a method for separating and capturing a tissue section from surrounding tissue of a patient.
- a localization device is directed along a tissue track to a position distal of a target site.
- the localization device is changed from a first, radially-contracted state to a second, radially-expanded state.
- a tissue section at the target site is separated from surrounding tissue.
- An expandable tubular element is pushed over the separated tissue section until its outer end is generally aligned with the localization device, thereby effectively capturing the separated tissue section.
- FIG. 1 is a partially schematic overall view of a tissue separator assembly made according to the invention with portions of the handle removed for clarity;
- FIG. 1A is a simplified cross-sectional view taken along line 1 A- 1 A of FIG. 1 showing the engagement of a pin within a slot in the lead nut mounted to the lead screw;
- FIG. 2 is schematic view of portions of the drive elements of the assembly of FIG. 1;
- FIG. 3 is a simplified cross-sectional view of the catheter assembly taken along line 3 - 3 of FIG. 1;
- FIG. 4 is an oblique view of the housing half of FIG. 1 together with the drive screw, drive nut and an L-shaped actuator connected to and movable with the drive nut;
- FIGS. 5 and 6 show the handle and catheter assembly of FIG. 1 after the actuator has moved from the position of FIG. 1 and the actuator extension has pushed the separator wire pusher screw in a distal direction causing the separator wire to move radially outwardly;
- FIG. 7 is a simplified the end view of the block and the pusher screw just after the pusher screw has exited the slot in the block showing the off-vertical orientation of the pusher screw;
- FIG. 8 illustrates the proximal end of the lead screw, which is visible from outside the housing, and a rotary position indicator marked thereon corresponding to the position of the separator wire in FIG. 10;
- FIGS. 9 and 10 illustrate the structure of FIGS. 5 and 6 after the drive screw has moved the actuator distally causing the lead nut to rotate the lead screw, catheter shaft and separator wire therewith about 540 degrees to create a separated tissue section;
- FIGS. 11 and 12 illustrate the manual actuation of tissue section holding elements
- FIG. 13 is a simplified view of certain of the components of FIG. 12;
- FIG. 14 is a cross-sectional view of the catheter taken along line 14 - 14 of FIG. 13;
- FIGS. 15 and 16 illustrate the manual actuation of a tubular braided element to surround the separated tissue section
- FIG. 17 is a simplified view of certain of the components of FIG. 16;
- FIG. 18 is enlarged side view of the distal end of an alternative embodiment of the catheter assembly of FIG. 1;
- FIG. 19 is a side view of a modified embodiment of the distal end of the catheter assembly of FIG. 18;
- FIG. 20 is a schematic illustration showing the difference in size between the separated tissue sections of the embodiments of FIGS. 18 and 19;
- FIG. 21 is an enlarged top view taken along line 21 - 21 of FIG. 18;
- FIG. 22 is an enlarged cross-sectional view taken along the line 22 - 22 of FIG. 21;
- FIG. 23 is a cross-sectional view taken along line 23 - 23 of FIG. 18;
- FIGS. 24 A- 24 H are simplified side views of different embodiments of the guide element/transition surface of FIG. 18;
- FIG. 25 is an overall view of the distal end of the catheter assembly of FIG. 18 illustrating a hook wire/tissue holding element in a deployed condition
- FIG. 26 is a cross-sectional view of a portion of the shaft of FIG. 25;
- FIG. 27 is a somewhat simplified cross-sectional view of the structure of FIG. 25 with the separator wire portion in a radially retracted state;
- FIG. 27A is a somewhat simplified cross-sectional view of the structure of FIG. 25 with the separator wire portion in a radially extended state;
- FIG. 28 illustrates a further embodiment of the invention of FIG. 18 including three separator wire portions, one of which is shown in the operational state;
- FIG. 29A is a simplified end view of the structure of FIG. 28 suggesting three equally-spaced separator wire portions, each in their retracted states;
- FIG. 29B is a view similar to FIG. 29A but with one separator wire portion in an operational state
- FIG. 30 is a simplified schematic illustration of a tissue-penetrating assembly
- FIG. 31 is an overall view of a tissue localizing and separating assembly made according to the invention including a tissue separator assembly, a coupler and a tissue localization assembly, the localization device of the tissue localization assembly being in an expanded condition at a target site within a patient;
- FIG. 32 is an enlarged view of a portion of the assembly of FIG. 31 illustrating a loop at the distal end of the coupler being engaged with the proximal end of the tissue localization assembly;
- FIGS. 33 and 34 illustrate the distal end of the coupler and the proximal end of the tissue localization assembly of FIG. 31 joined to one another;
- FIG. 35 illustrates the distal movement of the tissue separator assembly causing the joined ends of FIGS. 33 and 34 to be moved into the catheter assembly thereby docking the tissue localization assembly to the tissue separator assembly;
- FIGS. 35 A- 35 C are simplified drawings showing the movement of an indicator tube, secured to the elongate coupler, through an opening in the proximal end of the handle;
- FIG. 36 is an enlarged view of the distal portion of the assembly of FIG. 35 after the separator wire portion has been radially expanded and rotated and after the hook wire has been deployed to engage the separated tissue section;
- FIG. 37 illustrates the assembly of FIG. 36 after the catheter assembly sleeve has been moved proximally a short distance to expose the distal end of the tubular braided element
- FIG. 38 is a somewhat idealized illustration of the movement of the tubular braided element in a distal direction within a patient with the tubular braided element initially generally following the outline of the separated tissue section and its outer end generally axially aligned with the localization device;
- FIG. 39 illustrates the assembly of FIG. 38 after having been removed from the patient with the outer end of the tubular braided element returned to its relaxed state
- FIG. 40 illustrates the shape of a tubular braided material after it has been stretched over a cylindrical mandrel having an enlarged central portion
- FIG. 41 illustrates the structure of FIG. 40 after one end of the mandrel and the tubular braided material has been dipped into a silicone compound
- FIG. 42 illustrates the open mesh end of the dipped tubular braided material, after the silicone has been cured and removed from the mandrel, being pulled back into the dipped end to create a tubular braided element;
- FIG. 43 illustrates the resulting tubular braided element being mounted to the distal end of the actuator tube
- FIG. 44 shows the proximal end of the tubular braided element being secured to the distal end of the actuator tube by a length of heat shrink tubing
- FIG. 45 illustrates the tubular braided element secured to the actuator tube.
- FIGS. 1 and 2 illustrate a tissue separator assembly 10 used to separate target tissue from surrounding tissue, typically within a patient's breast. The removal of target tissue may be for diagnostic or therapeutic purposes.
- the assembly 10 includes a catheter assembly 12 extending from a handle 14 . Introduction of catheter assembly 12 into the patient, typically through the skin, is preferably aided by the use of, for example, a trocar or an RF tip to provide a suitable path through the tissue.
- a stepper motor 16 is connected to handle 14 by a drive cable 18 and a drive cable connector 20 mounted to the handle housing 22 . Note that in the Figs. only one-half of handle housing 22 is shown; the other housing half is substantially similar.
- RF energy is supplied to catheter assembly 12 from an RF source 24 , along drive cable 18 and to the interior of handle 14 .
- a controller 26 controls the operation of stepper motor 16 as well as RF source 24 , such as speed of operation and energy level. Controller 26 also receives appropriate feedback signals from handle 14 and catheter assembly 12 , such as tissue temperature, resistance force signals, tissue impedance, rotary orientation, and so forth.
- Drive cable 18 is connected to and rotates a drive screw 28 rotatably mounted within handle 14 at a fixed axial location by drive screw supports 30 , 32 .
- a drive nut 34 is threadably mounted to drive screw 28 .
- An L-shaped actuator 36 is secured to drive nut 34 .
- Actuator 36 see FIG. 4, includes a generally horizontal base portion 38 and a generally vertical upright portion 40 sized and configured to move within handle 14 parallel to the axis of drive screw 28 . Therefore, rotation of drive screw 28 by stepper motor 16 causes actuator 36 to slide within housing 22 from the initial position of FIG. 1 to the position of FIG. 10. Reverse and reciprocating movement is also possible.
- Catheter assembly 12 includes in introducer sheath 42 mounted to and extending from housing 22 .
- Catheter assembly 12 also includes an actuator tube 43 , discussed below with reference to FIGS. 14 - 17 , passing through sheath 42 and a shaft 44 passing through tube 43 .
- Shaft 44 has a distal portion 46 extending distally of the distal end 48 of sheath 42 and a proximal portion 50 extending into the interior of handle 14 .
- Proximal portion 50 is secured to and rotates with a lead screw 52 .
- shaft 44 rotates with lead screw 52 .
- Lead screw 52 is mounted within housing 22 in a manner so that it can rotate but not move axially within housing 22 .
- a tissue separator device 54 extends along shaft 44 and has a separator wire portion 56 secured to the distal end 58 of shaft 44 .
- the separator wire 56 is positioned externally of distal portion 46 .
- the majority of tissue separator device 54 is in the form of a wire and extends through an axial bore 60 formed in shaft 44 .
- the separator device 54 has a radially extending pusher screw 62 at its proximal end.
- the proximal end of shaft 44 has an axially extending slot 64 , see FIG. 2, through which pusher screw 62 extends. Accordingly, pushing pusher screw 62 distally, that is to the left in the Figs., causes tissue separator wire 56 to move outwardly from its radially contracted condition of FIG.
- wire 56 is supplied with RF energy from RF source 24 .
- Other applications of energy such as mechanical reciprocation or mechanical vibration, can also be used.
- the axial movement of pusher screw 62 is caused by the axial movement of actuator 36 .
- Actuator 36 has an extension 66 extending distally from upright portion 40 .
- Extension 66 has a downwardly formed distal end 68 aligned with pusher screw 62 .
- the initial axial movement of actuator 40 caused by the rotation of drive screw 28 by stepper motor 16 , closes a small gap 70 (see FIG. 2) between distal end 68 and pusher screw 62 . This small gap permits the initiation of an electrosurgical arc prior to the outwardly radial movement of separator wire 56 .
- Continued distal movement of actuator 36 moves pusher screw 62 distally causing separator wire 56 to bow outwardly to the position of FIGS. 5 and 6.
- FIGS. 5 and 6 show the use of a support block 72 , which is a part of housing 22 , to support the distal end of lead screw 52 and the proximal end of shaft 44 .
- Support block 72 has an axially extending slot 74 , see FIGS. 5 and 7, which initially houses pusher screw 62 .
- pusher screw 62 exits slot 74 and the distal end 68 of extension 66 , which has a chamfered face, causes pusher screw 62 , along with shaft 44 , to begin rotating to the off-vertical position of FIG. 7.
- upright portion 40 of actuator 36 closes gap 73 (see FIG.
- Assembly 10 is configured so that shaft 44 rotates about 540 degrees to ensure a tissue section 80 is completely separated from the surrounding tissue by the passage of separator wire 56 through the tissue.
- the radial position of separator wire 56 can be easily determined by looking at the proximal end 82 of lead screw 52 , which is exposed through housing 22 . See FIG. 8.
- Proximal end 82 has a rotary position indicator 84 formed thereon corresponding to the rotary position of separator wire 56 .
- Assembly 10 also includes a T-pusher device 86 having a pair of pusher tabs 88 extending laterally outwardly from slots formed in housing 22 . See FIGS. 11 - 13 . After shaft 44 has completed its rotation, the user begins pushing tabs 88 distally. This causes an extension 90 of device 86 to rotate a flipper cam 92 about a pivot pin 94 ; flipper cam 92 is connected to the proximal ends of a pair of tissue section holding elements 96 . Holding elements 96 are in the form of wires passing through axial bores 98 formed in shaft 44 as shown in FIG. 3.
- holding elements 96 are preformed hook wires 100 , preferably made of a shape memory material such as Nitinol, which pass through openings formed in distal portion 46 of shaft 44 and engage separated tissue section 80 to help secure tissue section 80 to distal portion 46 of shaft 44 .
- shape memory material such as Nitinol
- Device 86 includes a distal end 102 connected to the proximal end of actuator tube 43 .
- the movement of device 86 causes tube 43 to move distally within introducer sheath 42 .
- a tubular braided element 104 see FIGS. 14 - 17 , secured to the distal end of actuator tube 43 , is still fully housed within sheath 42 .
- Further distal movement of device 86 causes tubular braided element 104 to extend outwardly past distal end 48 of sheath 42 to the position of FIGS. 15 - 17 .
- tubular braided element 104 The purpose of tubular braided element 104 is to surround separated tissue section 80 by passing along the dissection plane between the separated tissue section and the surrounding tissue.
- the open outer end 106 of element 104 naturally expands radially as it is pushed axially through the tissue.
- shaft 44 has an outwardly tapered guide surface 108 , formed on a guide element 110 , positioned adjacent to distal end 48 of introducer shaft 42 .
- the proper radial expansion of element 104 may also be aided by the shape that element 104 takes when in its relaxed state. See, for example, the discussion of tubular braided element 104 with regard to FIGS. 40 - 45 .
- Guide element 110 has a slot in its proximal surface into which the proximal end of separator wire 56 passes when in the radially expanded condition of FIG. 9; this helps to keep separator wire 56 from folding over during rotation.
- outer end 106 of tubular braided element 104 could include a drawstring or other type of closure element. The separated tissue section 80 , now substantially enclosed within tubular braided element 104 and secured to distal portion 46 of shaft 44 by hook wires 100 , may be removed from the patient.
- separated tissue section 80 retains most if not all of its physical integrity once removed from the patient. Also, the use of tubular braided element 104 , especially when it is sealed or otherwise impermeable to the passage of material, helps to reduce the possibility of seeding diseased tissue along the tissue track during removal of separated tissue section 80 .
- FIGS. 18 - 29 B illustrate further embodiments of the invention with like reference numerals referring to like elements.
- FIG. 18 is an enlarged side view of the distal end 120 of alternative embodiment of the catheter assembly 12 of FIG. 1.
- separator wire portion 56 is seen to include a distal end 122 .
- Distal end 122 terminates at a ball-type element 124 (see FIG. 22) housed within a cavity 126 defined within distal portion 46 of shaft 44 at the tip 136 of the distal portion to form a pivot joint 128 .
- the provision of pivot joint 128 permits distal end 122 to effectively pivot freely as separator wire portion 56 is moved between the operational and retracted states.
- FIG. 20 illustrates the increased volume of separated tissue section 80 A resulting from the embodiment of FIG. 18 to the reduced volume, separated tissue section 80 B from the embodiment of FIG. 19.
- the volume of separated tissue section 80 A has been calculated to be about 50 percent greater than the volume of separated tissue section 80 B for the same distance of travel of tissue separator device 54 .
- Distal portion 46 of shaft 44 includes guide element 110 which acts as a transition surface 110 .
- Transition surface 110 is a distally-facing surface extending radially outwardly and proximally, that is longitudinally away from the tip 136 of distal portion 46 .
- a series of spaced-apart, first, proximal energizable tissue separator elements 130 are positioned along transition surface 110 .
- FIG. 23 is a cross-sectional view taken along line 23 - 23 of FIG. 18 and illustrates the electrical connection of elements 130 to metallic tube 132 .
- FIGS. 24 A- 24 H illustrate alternative embodiments of first elements 130 .
- Elements 130 A have extended longitudinal lengths, as compared with the essentially circular elements 130 of FIGS. 18 and 23. It is believed that the extended lengths of element 130 A may be useful for reducing the penetration force needed for placement at the target site.
- the FIG. 24A embodiment is the presently preferred embodiment.
- Element 130 B comprises a circumferentially continuous or substantially circumferentially continuous element. The circumferentially extending element 130 B may also be useful for reducing the required penetration force.
- Elements 130 C are similar to elements 130 but are located at peripheral region 140 of transition surface 110 .
- Elements 130 D and 130 E, shown in FIGS. 24D and 24E, are generally V-shaped and serpentine-shaped variations.
- FIGS. 24F and 24G extend along substantially the entire lengths of distal portion 46 in straight and spiral configurations, respectively.
- FIG. 24H illustrates a further embodiment of elements 130 H with elements 130 H extending radially outwardly from distal portion 46 ; elements 130 H may be retractable and may have shapes other than the pointed, triangular shape illustrated. While elements 130 are typically formed from metal wires or similar structure, elements 130 may also be painted, plated or otherwise deposited on the surface of distal portion 46 . A combination of two or more of the arrangements of element 130 may be useful in appropriate circumstances. While presently all of elements 130 are supplied with equal energy levels, different energy levels may be supplied. Also, the energy levels supplied may be varied over time or according to the resistance to the passage of separator wire portion 56 through the tissue. Also, energy to elements 130 may be turned on as needed at the discretion of the user.
- Distal portion 46 is hollow and contains an electrically conductive, metallic tube 132 defining an opening 134 at the tip 136 of distal portion 46 .
- the outer, annular edge of tube 132 acts as a second, distal energizable tissue separator element 138 .
- Both first element 130 and second element 138 are selectively coupleable to one or more appropriate energy sources to aid movement of distal portion 46 through tissue to the target site.
- FIGS. 25 and 26 illustrate the hook wires 100 , which act as tissue holding elements, extending through openings 142 formed within distal portion 46 of shaft 44 .
- Hook wires 100 are preferably sized, positioned and shaped to engage separated tissue section 80 at about its center of mass. While two hook wires 100 are shown in this embodiment, a greater or lesser number may also be used. Also, hook wires 100 having different sizes and shapes may be used. Hook wires 100 may also be located at different axial positions and may be energizable to aid movement through tissue.
- FIGS. 25, 27 and 27 A illustrate the passage of separator wire portion 56 through proximal and distal channels 146 , 148 formed in distal shaft portion 46 .
- Distal portion 46 defines a base surface 150 extending along the bottoms of channels 146 and 148 and extending between channels 146 and 148 .
- Separator wire portion 56 lies against base surface 150 when in a retracted state.
- the central portion 152 of base surface 150 is convex so that when separator wire portion 56 is in the retracted state, a central portion of wire portion 56 lies along a convex line, that is a line that bows slightly outwardly. Therefore when tissue separator device 54 is moved distally, separator wire portion 56 is predisposed to move radially outwardly in the desired manner.
- the amount of force needed to be applied to device 54 may also be reduced by the use of convex central portion 152 .
- FIG. 28 illustrates a further alternative embodiment to the embodiment of FIG. 18 comprising three separator wire portions 56 , as opposed to one in FIG. 18, one wire portion 56 being shown in an operational state and the other two wire portions 56 in retracted states and adjacent base surfaces 150 .
- FIG. 29B Another difference from the embodiment of FIG. 18 is that the function of first, proximal energizable tissue separator elements 130 has been replaced by energizing the three separator wire portions 56 when the device is directed through tissue to a target site with wire portions 56 in retracted states.
- FIG. 29A Once at the target site the physician may decide to move one, two or all three of separator wire portions 56 from the retracted state to the operational state depending on various factors, such as the characteristics of the tissue and the number of pieces tissue section 80 is to be divided into.
- Distal portion 46 in the embodiment of FIGS. 18 - 29 B, comprises a proximal element 154 , a body portion 156 and tip 136 , tip 136 acting as an end cap.
- FIG. 27 illustrates the interengagement of elements 154 , 156 and 136 .
- Elements 154 , 156 and 136 are configured to promote simple assembly. Assembly may take place by simply stacking each element in order over central tube 132 , the parts being held in place distally by the flared end 138 of the tube.
- Elements 154 , 156 and 136 are preferably electrically non-conductive.
- Elements 154 and 156 are typically made from the medical grade ceramic material, such as Al 2 O 3 or zirconia, while tip 136 is typically made from a medical grade polymer, such as PEEK or polyimide.
- the amount of force required for the passage of a needle, or other tissue-penetrating element, such as distal portion 46 of shaft 44 , through tissue often changes because the tissue characteristics often changes between the point of entry and the target site. If the tissue-penetrating element must pass through a hard or otherwise difficult-to-penetrate tissue region, the amount of force needed to penetrate the hard tissue region may be sufficiently great to, for example, cause the tissue-penetrating element to buckle. Even if the tissue-penetrating element has sufficient columnar strength to resist buckling, the amount of force required may be sufficient to cause the tissue to be deformed making it difficult to position the tip of the tissue-penetrating element at the target site.
- the amount of force needed to do so may tend to cause the tip of the tissue-penetrating element to be inserted much farther than desired causing unintended tissue trauma and possibly injuring adjacent organs.
- FIG. 30 illustrates, in schematic form, a tissue-penetrating assembly 160 comprising broadly a tissue-penetrating subassembly 162 coupled to a tissue-energizing circuit 164 and a force-sensitive switch 166 operably coupled to the tissue-penetrating subassembly.
- the subassembly 162 comprises a handle assembly 168 , or other support assembly, including a handle 170 , a handle extension 172 extending rigidly from handle 170 , and a needle clamp 172 mounted to handle 170 at a pivot 176 .
- Subassembly 162 also includes a needle 178 , or other tissue-penetrating device, secured to and extending from needle clamp 174 .
- Needle 178 includes a needle shaft 180 covered by electrical installation 182 along most of its length. Electrical installation 182 helps to concentrate the tissue-penetrating energy at the tip 184 of needle 178 , tip 184 having a tissue-separating surface 185 .
- Force-sensitive switch 166 includes a compression spring 186 captured between needle clamp 174 and handle extension 172 .
- Assembly 160 also includes an arming switch 188 mounted to handle 170 , switch 188 including an arm 190 mounted to handle 170 at a pivot 192 .
- Switch 188 also includes an arming compression spring 194 captured between arm 190 and handle extension 172 .
- the use of arming switch 188 helps to enhance the safety of assembly 160 by helping to prevent the inadvertent connection of needle 178 to RF generator 200 .
- Circuit 164 includes a pair of leads 196 , 198 electrically connected to needle clamp 174 , and thus needle tip 184 , and to arm 190 through pivots 176 , 192 , respectively.
- Circuit 164 also comprises an RF generator 200 , from which leads 196 , 198 extend, and a return cable 202 coupling generator 200 to a return pad 204 .
- An electrical conductor 206 is mounted to handle extension 172 and has electrical contact surfaces 208 , 210 positioned opposite the corresponding surfaces of needle shaft 180 and arm 190 .
- An arming button 212 is mounted to arm 190 to permit the user to arm assembly 116 by pressing on arming button 212 to cause arm 190 to contact surface 210 .
- RF generator 200 can supply energy to surface 185 at tip 184 permitting needle 178 to pass through hard tissue 216 without excessive force.
- tip 184 has passed through hard tissue layer 216 , the force on needle 178 decreases to permit spring 186 to separate needle shaft 180 from contact surface 208 so to stop supplying RF energy to tissue separator surface 185 .
- Tissue-penetrating assembly 160 can be used to aid the insertion of a simple needle into tissue.
- the tissue-penetrating invention also can be incorporated into other devices including tissue-penetrating elements, such as the embodiments discussed above including shaft 44 and a target tissue localization device disclosed in U.S. Pat. No. 6,179,860.
- FIGS. 31 - 39 illustrate further aspects of the invention in which tissue separator assembly 10 is combined with an elongated coupler 220 and a tissue localization assembly 222 to arrive at a tissue localizing and separating assembly 224 .
- Tissue localization assembly 222 may be of the type disclosed in U.S. Pat. No. 6,179,860. Assembly 222 is shown deployed within a patient 226 with localization device to 112 in a radially expanded, deployed condition. Assembly 222 includes a sheath 228 (see FIG. 32) within which a pull wire 230 is slidably housed. The relative axial movement of sheath 228 and pull wire 230 causes localization device 112 to radially expand and radially contract. The proximal end 232 of pull wire 230 is a recurved end 232 (see FIGS. 32, 34) for engagement by coupler 220 as discussed below.
- Coupler 220 is a flexible wire having a coupler loop 234 at its distal end and an enlarged proximal end 236 .
- Coupler 220 passes through shaft 44 (see FIGS. 2, 32) of catheter assembly 12 .
- Coupler loop 234 is used to join coupler 220 to the recurved end 232 of pull wire 230 ; this is shown in FIGS. 31 - 34 .
- tissue separator assembly 10 is moved distally along coupler 220 , while the user grasps end 236 to maintain tension on the tissue localization assembly 220 , causing the joined ends 232 , 234 to pass into shaft 44 thus docking tissue localization assembly 222 to tissue separator assembly 10 .
- tissue localization assembly 222 becomes at least temporarily locked or fixed to tissue separator assembly 10 to prevent the inadvertent relative axial movement between localization device 112 and assembly 10 .
- other locking mechanisms such as a spring finger carried by assembly 220 and engageable with handle 14 , can also be used to lock assemblies 10 , 222 to one another.
- FIG. 36 is an enlarged view of the distal portion of assembly 224 of FIG. 35 after separator wire portion 56 has been radially expanded and rotated, to create a separated tissue section 80 , and after hook wire 100 has been deployed to engage the separated tissue section 80 . It has been found to be desirable to leave a space, indicated generally as distance 238 , between localization device 112 and separated tissue section 80 .
- FIG. 37 illustrates the assembly of FIG. 36 after introducer sheath 42 has been moved proximally a short distance to expose outer end 106 of tubular braided element 104 .
- FIG. 38 is a somewhat generalized illustration of the movement of tubular braided element 104 in a distal direction within patient 226 with the tubular braided element initially generally following the outline of separated tissue section 80 and outer end 106 generally axially aligned with localization device 112 .
- the movement of outer end 106 of tubular braided element 104 will generally following the path indicated until it reaches position 240 . Following position 240 , the path outer end 106 takes will largely depend on the physical characteristics of the tissue through which is passing. However, the path illustrated is typical.
- Separated tissue section 80 is then removed from patient 226 by simultaneously pulling the entire assembly shown in FIG.
- tubular braided element 104 has a tendency to elongate axially to a reduced diameter, more cylindrical form thus reducing potential tissue trauma along the tissue track and through the access opening at the beginning of the tissue track.
- FIG. 39 illustrates the assembly of FIG. 38 after having been removed from patient 226 with outer end 106 of tubular braided element 104 returned to its relaxed state and tissue specimen 80 retained by tubular braided element 104 and localization device 112 .
- tubular braided element 104 when in a relaxed state, has a generally trumpet shape with outer end 106 flaring outwardly. It has been found that this trumpet shape helps to guide tubular braided element 104 around separated tissue section 80 , especially during its initial movement from introducer sheath 42 .
- FIGS. 40 - 45 illustrate a preferred method of making tubular braided element 104 .
- Tubular braided element 104 is sized according to the size of the tissue specimen being removed so that the number of elements, sizes and other specifications discussed below may be varied according to a particular circumstance.
- FIG. 40 illustrates the shape of a length of tubular braided material 244 after it has been stretched over a cylindrical mandrel (not shown) having an enlarged (20.5 mm diameter by 50 mm long) central portion in this embodiment. Material 244 , prior to being stretched over the mandrel, is supplied in a continuous length and cut to size for the mandrel and a starting diameter of ⁇ fraction (5/16) ⁇ ′′ or ⁇ 8 mm.
- Material 244 is made of monofilament polyester fibers having a diameter of 0.10 inch (0.25 mm)
- the braid consists of 56 monofilaments and is made on 56 carrier braider.
- the braid when formed in continuous lengths, maintains an approximate ⁇ fraction (5/16) ⁇ ′′ (8 mm) internal diameter.
- the braid angle is held fixed during the braiding operation, and was chosen for this application because a small shortening in axial length results in a rapid change in diameter.
- the enlarged central portion of the mandrel corresponds to the shape of tubular braided material 244 , that is it is cylindrical with generally hemispherical ends.
- FIG. 41 illustrates the structure of FIG.
- FIGS. 40 illustrates tubular braided element 104 being mounted to the distal end of actuator tube 43 .
- Dual-wall tubular braided element 104 has an outer wall 256 substantially completely covered with silicone web 246 , and inner wall 258 at least substantially free of the silicone web material, an an open outer end 106 covered with silicone web 246 .
- Silicone web 246 serves at least two functions. It helps maintain the trumpet shape of tubular braided element 104 in its relaxed state while permitting the tubular braided element to radially expand and radially contract from the trumpet shape. It also helps to prevent passage of tissue through tubular braided element 104 during removal of separated tissue section 80 . This helps to prevent contamination along the tissue track during tissue removal procedures. While tubular braided element 104 could be made as a single layer, that is without open mesh end 250 being pulled back into the structure, it has been found that doing so helps to maintain a softer leading edge at outer end 106 of tubular braided element 104 .
- the general trumpet shape shown in FIGS. 43 - 45 occurs as a natural result of the forming process illustrated and described.
- braided element 104 comprises a tubular sleeve of braided polyester (PET—polyethylene terephthalate) monofilament folded over itself to form a smooth end.
- PET polyethylene terephthalate
- the open weave construction allows it to enlarge to several times its original diameter.
- the outer braided layer is coated with silicone.
- the braided element In its undeployed state, the braided element was designed to fit inside a 6 mm sheath. Some of the Nitinol prototypes that were fabricated seemed to have adequate strength and stiffness, and fit within a 6 mm sheath. However, because of other factors discussed below, a PET braid presently preferred over a Nitinol braid.
- Braid angle, number of filaments, and filament material stiffness and diameter are the main determinants. Axial orientation, greater number and stiffer filaments all combine for greater columnar strength.
- the presently preferred material for braided element 104 is 0.010′′ (0.25 mm) diameter monofilament. The number of monofilaments in the braid was chosen to optimize the mechanical properties of braided element 104 . Increasing the number of filaments will create the opposite effect—the columnar strength will be reduced thus increasing the chance of buckling. Fewer filaments creates an increase in spacing between the filaments as the braided element expands from retracted to deployed. If the spacing becomes too large, the coating may tear.
- a braided element constructed with a more axially oriented braid angle will take up much more length in the retracted state and therefore require a greater amount of travel to deploy.
- the number of filaments was chosen to optimize braided element strength, spacing between filaments, and amount of deployment travel.
- the distal end of the braided element that is the end that first comes into contact with the tissue, be smooth. It was discovered at a braided element with jagged or sharp edge may get caught in the tissue and fail to slide into the cut tissue interface around the separated tissue section.
- various methods of terminating the lose wires were explored, such as soldering, brazing, or bonding balls at the wire ends, or folding each single wire over. These methods were not very successful.
- the balls to be atraumatic they need to be of considerable size.
- the balls or folded-over ends increase the diameter of the retracted braided element, making it difficult to fit inside a sheath.
- the shape of the braided element also affects its functionality. Braided element prototypes of many different shapes were tested, such as “bullet”, “cone”, and “bell” or “trumpet” profiles of varying diameters.
- a desirable characteristic of braided element 104 is that the braided element flares open as it is initially deployed, so that it is predisposed to expand around the biopsy sample rather than push the sample further into the cavity.
- the shape of braided element 104 has been optimized to maximize the amount that it flares open during deployment.
- the braided element is currently coated with a two-component silicone elastomer. Some polyurethane coatings were investigated also, but did not perform as well as silicone coatings during preliminary testing. The silicone coating was chosen because of its high tear strength and elasticity. From the retracted state to the fully deployed state, the diameter of braided element 104 may expand as much as 300%. The braided element may have a snare at the distal end to aid in capturing the sample.
- lead screw 52 could be hollow to permit actuator shaft 114 , or other medical devices, to pass therethrough and into a lumen within shaft 44 .
- base surface 150 is shown to have a smoothly curving shape, surface 150 may have other shapes, such as a discontinuous surface shape, a flat surface shape with one or more projections providing the desired bow in the separator wire portion 56 , or a combination thereof.
- Braided element 104 may be made of other materials and by other processes than those disclosed.
Abstract
Description
- This application is a continuation-in-part of U.S. patent application Ser. No. 10/045,657 filed Nov. 7, 2001 and entitled Tissue Separator Assembly And Method. This application is related to the following two patent applications filed on the same date as this application: Tissue Separating Catheter Assembly And Method, attorney Docket No. ARTM 1016-1; Tissue Localizing And Separating Assembly, attorney Docket No. 1019-1. See also: (1) U.S. Pat. No. 6,179,860 issued Jan. 30, 2001 and entitled Target Tissue Localization Device And Method, (2) International Publication No. WO 00/10471 published Mar. 2, 2000 and entitled Target Tissue Localization Device And Method, (3) U.S. Pat. No. 6,221,006 issued Apr. 24, 2001 and entitled Entrapping Apparatus And Method For Use, (4) International Publication No. WO 99/39648 published Aug. 12, 1999 and entitled Entrapping Apparatus And Method For Use, (5) U.S. patent application Ser. No. 09/588,278 filed Jun. 5, 2000 and entitled Tissue Removal Methods And Apparatus, (6) International Publication No. WO 00/74561 published Dec. 14, 2000 and entitled Tissue Removal Methods And Apparatus; (7) U.S. patent application Ser. No. 09/844,661 filed Apr. 27, 2001 and entitled Intraoperative Tissue Treatment Methods.
- Cancer presently results in over one thousand five hundred deaths every day in the United States (550,000 deaths every year). Therapy modalities for cancer are plentiful and continued to be researched with vigor. Still, the preferred treatment continues to be physical removal of the cancer. When applicable, surgical removal is preferred (breast, colon, brain, lung, kidney, etc.). Open, excisional, surgical removal is often extremely invasive so that efforts to remove cancerous tissue in less invasive ways continue, but have not yet been perfected.
- The only cure for cancer continues to be the early diagnosis and subsequent early treatment. As cancer therapies continue at earlier stages of diagnosis, the cancerous tissue being operated on is also smaller. Early removal of the smaller cancers demand new techniques for removal and obliteration of these less invasive cancers.
- There is a variety of techniques that attempt to accomplish less invasive cancer therapy, but so far without sufficiently improved results. For example, the ABBI system from U.S. Surgical Corporation and the Site Select system from ImaGyn Corporation, attempt to accomplish less invasive cancer therapy. However, conventional techniques, in contrast with Minimally Invasive Surgery (MIS) techniques, require a large core (that is more than about 15 mm diameter) incision. Additionally, the Mammotome system from Johnson and Johnson and MIBB system from U.S. Surgical Corporation also require large core (over about 4 mm diameter) access to accomplish biopsy.
- A convention held by the American Society of Surgical Oncologists on Mar. 13, 2000 reported that conventional stereotactic core biopsy (SCB) procedures fall short in providing definitive answers to detail precise surgical regimens after this SCB type vacuum assisted biopsy, especially with ductile carcinoma in situ (DCIS). Apparently these percutaneous systems damage “normal” tissue cells so that it is difficult to determine if the cells are “normal damaged” cells or early pre-cancerous (e.g. Atypical Ductal Hyerplasia (ADH)) cells.
- A study presented by Dr. Ollila et al. from the University of North Carolina, Chapel Hill, demonstrated that histology and pathology is compromised using these conventional techniques because of the damage done to the removed tissue specimens. Hence, for many reasons, including the fact that DCIS is becoming more detectable and hence more prevalent in breast cancer diagnosis in the U.S., there is a growing need to improve upon conventional vacuum assisted core biopsy systems.
- A first aspect of the invention is directed to a tissue-separating catheter assembly comprising a rotatable shaft having a distal shaft portion, a tissue separator device extending along the shaft and having an expandable distal separator part at the distal shaft portion, a radially-expandable localization device at the distal shaft portion, and an expandable tubular element movable so its outer end may be generally axially aligned with the localization device. A tissue section separated from surrounding tissue by the tissue separator device may be capturable by the localization device and the tubular element to aid removal of the separated tissue section from a patient.
- A second aspect of the invention is directed to a method for separating and capturing a tissue section from surrounding tissue of a patient. A localization device is directed along a tissue track to a position distal of a target site. The localization device is changed from a first, radially-contracted state to a second, radially-expanded state. A tissue section at the target site is separated from surrounding tissue. An expandable tubular element is pushed over the separated tissue section until its outer end is generally aligned with the localization device, thereby effectively capturing the separated tissue section.
- Other features and advantages of the invention will appear from the following description in which the preferred embodiments have been set forth in detail in conjunction with the accompanying drawings.
- FIG. 1 is a partially schematic overall view of a tissue separator assembly made according to the invention with portions of the handle removed for clarity;
- FIG. 1A is a simplified cross-sectional view taken along line1A-1A of FIG. 1 showing the engagement of a pin within a slot in the lead nut mounted to the lead screw;
- FIG. 2 is schematic view of portions of the drive elements of the assembly of FIG. 1;
- FIG. 3 is a simplified cross-sectional view of the catheter assembly taken along line3-3 of FIG. 1;
- FIG. 4 is an oblique view of the housing half of FIG. 1 together with the drive screw, drive nut and an L-shaped actuator connected to and movable with the drive nut;
- FIGS. 5 and 6 show the handle and catheter assembly of FIG. 1 after the actuator has moved from the position of FIG. 1 and the actuator extension has pushed the separator wire pusher screw in a distal direction causing the separator wire to move radially outwardly;
- FIG. 7 is a simplified the end view of the block and the pusher screw just after the pusher screw has exited the slot in the block showing the off-vertical orientation of the pusher screw;
- FIG. 8 illustrates the proximal end of the lead screw, which is visible from outside the housing, and a rotary position indicator marked thereon corresponding to the position of the separator wire in FIG. 10;
- FIGS. 9 and 10 illustrate the structure of FIGS. 5 and 6 after the drive screw has moved the actuator distally causing the lead nut to rotate the lead screw, catheter shaft and separator wire therewith about 540 degrees to create a separated tissue section;
- FIGS. 11 and 12 illustrate the manual actuation of tissue section holding elements;
- FIG. 13 is a simplified view of certain of the components of FIG. 12;
- FIG. 14 is a cross-sectional view of the catheter taken along line14-14 of FIG. 13;
- FIGS. 15 and 16 illustrate the manual actuation of a tubular braided element to surround the separated tissue section;
- FIG. 17 is a simplified view of certain of the components of FIG. 16;
- FIG. 18 is enlarged side view of the distal end of an alternative embodiment of the catheter assembly of FIG. 1;
- FIG. 19 is a side view of a modified embodiment of the distal end of the catheter assembly of FIG. 18;
- FIG. 20 is a schematic illustration showing the difference in size between the separated tissue sections of the embodiments of FIGS. 18 and 19;
- FIG. 21 is an enlarged top view taken along line21-21 of FIG. 18;
- FIG. 22 is an enlarged cross-sectional view taken along the line22-22 of FIG. 21;
- FIG. 23 is a cross-sectional view taken along line23-23 of FIG. 18;
- FIGS.24A-24H are simplified side views of different embodiments of the guide element/transition surface of FIG. 18;
- FIG. 25 is an overall view of the distal end of the catheter assembly of FIG. 18 illustrating a hook wire/tissue holding element in a deployed condition;
- FIG. 26 is a cross-sectional view of a portion of the shaft of FIG. 25;
- FIG. 27 is a somewhat simplified cross-sectional view of the structure of FIG. 25 with the separator wire portion in a radially retracted state;
- FIG. 27A is a somewhat simplified cross-sectional view of the structure of FIG. 25 with the separator wire portion in a radially extended state;
- FIG. 28 illustrates a further embodiment of the invention of FIG. 18 including three separator wire portions, one of which is shown in the operational state; and
- FIG. 29A is a simplified end view of the structure of FIG. 28 suggesting three equally-spaced separator wire portions, each in their retracted states;
- FIG. 29B is a view similar to FIG. 29A but with one separator wire portion in an operational state;
- FIG. 30 is a simplified schematic illustration of a tissue-penetrating assembly;
- FIG. 31 is an overall view of a tissue localizing and separating assembly made according to the invention including a tissue separator assembly, a coupler and a tissue localization assembly, the localization device of the tissue localization assembly being in an expanded condition at a target site within a patient;
- FIG. 32 is an enlarged view of a portion of the assembly of FIG. 31 illustrating a loop at the distal end of the coupler being engaged with the proximal end of the tissue localization assembly;
- FIGS. 33 and 34 illustrate the distal end of the coupler and the proximal end of the tissue localization assembly of FIG. 31 joined to one another;
- FIG. 35 illustrates the distal movement of the tissue separator assembly causing the joined ends of FIGS. 33 and 34 to be moved into the catheter assembly thereby docking the tissue localization assembly to the tissue separator assembly;
- FIGS.35A-35C are simplified drawings showing the movement of an indicator tube, secured to the elongate coupler, through an opening in the proximal end of the handle;
- FIG. 36 is an enlarged view of the distal portion of the assembly of FIG. 35 after the separator wire portion has been radially expanded and rotated and after the hook wire has been deployed to engage the separated tissue section;
- FIG. 37 illustrates the assembly of FIG. 36 after the catheter assembly sleeve has been moved proximally a short distance to expose the distal end of the tubular braided element;
- FIG. 38 is a somewhat idealized illustration of the movement of the tubular braided element in a distal direction within a patient with the tubular braided element initially generally following the outline of the separated tissue section and its outer end generally axially aligned with the localization device;
- FIG. 39 illustrates the assembly of FIG. 38 after having been removed from the patient with the outer end of the tubular braided element returned to its relaxed state;
- FIG. 40 illustrates the shape of a tubular braided material after it has been stretched over a cylindrical mandrel having an enlarged central portion;
- FIG. 41 illustrates the structure of FIG. 40 after one end of the mandrel and the tubular braided material has been dipped into a silicone compound;
- FIG. 42 illustrates the open mesh end of the dipped tubular braided material, after the silicone has been cured and removed from the mandrel, being pulled back into the dipped end to create a tubular braided element;
- FIG. 43 illustrates the resulting tubular braided element being mounted to the distal end of the actuator tube;
- FIG. 44 shows the proximal end of the tubular braided element being secured to the distal end of the actuator tube by a length of heat shrink tubing; and
- FIG. 45 illustrates the tubular braided element secured to the actuator tube.
- FIGS. 1 and 2 illustrate a
tissue separator assembly 10 used to separate target tissue from surrounding tissue, typically within a patient's breast. The removal of target tissue may be for diagnostic or therapeutic purposes. Theassembly 10 includes acatheter assembly 12 extending from ahandle 14. Introduction ofcatheter assembly 12 into the patient, typically through the skin, is preferably aided by the use of, for example, a trocar or an RF tip to provide a suitable path through the tissue. Astepper motor 16 is connected to handle 14 by adrive cable 18 and adrive cable connector 20 mounted to thehandle housing 22. Note that in the Figs. only one-half ofhandle housing 22 is shown; the other housing half is substantially similar. RF energy is supplied tocatheter assembly 12 from anRF source 24, alongdrive cable 18 and to the interior ofhandle 14. Acontroller 26 controls the operation ofstepper motor 16 as well asRF source 24, such as speed of operation and energy level.Controller 26 also receives appropriate feedback signals fromhandle 14 andcatheter assembly 12, such as tissue temperature, resistance force signals, tissue impedance, rotary orientation, and so forth. -
Drive cable 18 is connected to and rotates adrive screw 28 rotatably mounted withinhandle 14 at a fixed axial location by drive screw supports 30, 32. Adrive nut 34 is threadably mounted to drivescrew 28. An L-shapedactuator 36 is secured to drivenut 34.Actuator 36, see FIG. 4, includes a generallyhorizontal base portion 38 and a generallyvertical upright portion 40 sized and configured to move withinhandle 14 parallel to the axis ofdrive screw 28. Therefore, rotation ofdrive screw 28 bystepper motor 16 causes actuator 36 to slide withinhousing 22 from the initial position of FIG. 1 to the position of FIG. 10. Reverse and reciprocating movement is also possible. -
Catheter assembly 12 includes inintroducer sheath 42 mounted to and extending fromhousing 22.Catheter assembly 12 also includes anactuator tube 43, discussed below with reference to FIGS. 14-17, passing throughsheath 42 and ashaft 44 passing throughtube 43. See FIG. 3.Shaft 44 has adistal portion 46 extending distally of thedistal end 48 ofsheath 42 and aproximal portion 50 extending into the interior ofhandle 14.Proximal portion 50 is secured to and rotates with alead screw 52. Accordingly,shaft 44 rotates withlead screw 52. Leadscrew 52 is mounted withinhousing 22 in a manner so that it can rotate but not move axially withinhousing 22. Atissue separator device 54 extends alongshaft 44 and has aseparator wire portion 56 secured to the distal end 58 ofshaft 44. Theseparator wire 56 is positioned externally ofdistal portion 46. The majority oftissue separator device 54 is in the form of a wire and extends through anaxial bore 60 formed inshaft 44. Theseparator device 54 has a radially extendingpusher screw 62 at its proximal end. The proximal end ofshaft 44 has an axially extendingslot 64, see FIG. 2, through which pusher screw 62 extends. Accordingly, pushingpusher screw 62 distally, that is to the left in the Figs., causestissue separator wire 56 to move outwardly from its radially contracted condition of FIG. 1 to its radially extended condition of FIGS. 5 and 6. This radially outwardly movement is typically accomplished at the target site within the patient, typically a patient's breast. To aid movement of separator wire through the tissue,wire 56 is supplied with RF energy fromRF source 24. Other applications of energy, such as mechanical reciprocation or mechanical vibration, can also be used. - The axial movement of
pusher screw 62 is caused by the axial movement ofactuator 36.Actuator 36 has anextension 66 extending distally fromupright portion 40.Extension 66 has a downwardly formeddistal end 68 aligned withpusher screw 62. The initial axial movement ofactuator 40, caused by the rotation ofdrive screw 28 bystepper motor 16, closes a small gap 70 (see FIG. 2) betweendistal end 68 andpusher screw 62. This small gap permits the initiation of an electrosurgical arc prior to the outwardly radial movement ofseparator wire 56. Continued distal movement ofactuator 36 moves pusher screw 62 distally causingseparator wire 56 to bow outwardly to the position of FIGS. 5 and 6. FIGS. 5 and 6 (but not FIG. 1) show the use of asupport block 72, which is a part ofhousing 22, to support the distal end oflead screw 52 and the proximal end ofshaft 44.Support block 72 has an axially extendingslot 74, see FIGS. 5 and 7, which initially housespusher screw 62. At thetime separator wire 56 is fully extended,pusher screw 62exits slot 74 and thedistal end 68 ofextension 66, which has a chamfered face, causespusher screw 62, along withshaft 44, to begin rotating to the off-vertical position of FIG. 7. At the same timeupright portion 40 ofactuator 36 closes gap 73 (see FIG. 2) and contacts alead nut 75 threadably mounted onlead screw 52. Ananti-rotation pin 76 extends fromupright portion 40 ofactuator 36 and is housed within aU-shaped slot 78 formed inlead nut 74, see FIG. 1A, to preventlead nut 74 from rotating aroundlead screw 52 aslead nut 74 it is moved axially byactuator 36. Instead, the axial movement ofactuator 36 causes leadscrew 52 to rotate thus rotatingshaft 44.Assembly 10 is configured so thatshaft 44 rotates about 540 degrees to ensure atissue section 80 is completely separated from the surrounding tissue by the passage ofseparator wire 56 through the tissue. The radial position ofseparator wire 56 can be easily determined by looking at theproximal end 82 oflead screw 52, which is exposed throughhousing 22. See FIG. 8.Proximal end 82 has arotary position indicator 84 formed thereon corresponding to the rotary position ofseparator wire 56. - The above-described sequence of events, according to this disclosed embodiment, proceeds automatically once initiated by a user. Of course operation of the device, including one or more of extension of
separator wire 56, rotation ofshaft 44 and energizingwire 56, can be terminated manually or automatically based on, for example, an unexpected resistance to the rotation ofshaft 44. -
Assembly 10 also includes a T-pusher device 86 having a pair ofpusher tabs 88 extending laterally outwardly from slots formed inhousing 22. See FIGS. 11-13. Aftershaft 44 has completed its rotation, the user begins pushingtabs 88 distally. This causes anextension 90 ofdevice 86 to rotate aflipper cam 92 about apivot pin 94;flipper cam 92 is connected to the proximal ends of a pair of tissuesection holding elements 96. Holdingelements 96 are in the form of wires passing throughaxial bores 98 formed inshaft 44 as shown in FIG. 3. The distal ends of holdingelements 96 are preformedhook wires 100, preferably made of a shape memory material such as Nitinol, which pass through openings formed indistal portion 46 ofshaft 44 and engage separatedtissue section 80 to helpsecure tissue section 80 todistal portion 46 ofshaft 44. -
Device 86 includes adistal end 102 connected to the proximal end ofactuator tube 43. Thus, the movement ofdevice 86 causestube 43 to move distally withinintroducer sheath 42. At this point, that is withhook wires 100 deployed as an FIGS. 11-13, atubular braided element 104, see FIGS. 14-17, secured to the distal end ofactuator tube 43, is still fully housed withinsheath 42. Further distal movement ofdevice 86 causes tubular braidedelement 104 to extend outwardly pastdistal end 48 ofsheath 42 to the position of FIGS. 15-17. The purpose oftubular braided element 104 is to surround separatedtissue section 80 by passing along the dissection plane between the separated tissue section and the surrounding tissue. The openouter end 106 ofelement 104 naturally expands radially as it is pushed axially through the tissue. To aid the proper initial radial expansion ofelement 104,shaft 44 has an outwardlytapered guide surface 108, formed on aguide element 110, positioned adjacent todistal end 48 ofintroducer shaft 42. The proper radial expansion ofelement 104 may also be aided by the shape thatelement 104 takes when in its relaxed state. See, for example, the discussion oftubular braided element 104 with regard to FIGS. 40-45.Guide element 110 has a slot in its proximal surface into which the proximal end ofseparator wire 56 passes when in the radially expanded condition of FIG. 9; this helps to keepseparator wire 56 from folding over during rotation. If desired,outer end 106 oftubular braided element 104 could include a drawstring or other type of closure element. The separatedtissue section 80, now substantially enclosed withintubular braided element 104 and secured todistal portion 46 ofshaft 44 byhook wires 100, may be removed from the patient. - With the present invention separated
tissue section 80 retains most if not all of its physical integrity once removed from the patient. Also, the use oftubular braided element 104, especially when it is sealed or otherwise impermeable to the passage of material, helps to reduce the possibility of seeding diseased tissue along the tissue track during removal of separatedtissue section 80. - FIGS.18-29B illustrate further embodiments of the invention with like reference numerals referring to like elements. FIG. 18 is an enlarged side view of the distal end 120 of alternative embodiment of the
catheter assembly 12 of FIG. 1. Referring now also to FIGS. 21, 22 and 27,separator wire portion 56 is seen to include adistal end 122.Distal end 122 terminates at a ball-type element 124 (see FIG. 22) housed within acavity 126 defined withindistal portion 46 ofshaft 44 at thetip 136 of the distal portion to form apivot joint 128. The provision of pivot joint 128 permitsdistal end 122 to effectively pivot freely asseparator wire portion 56 is moved between the operational and retracted states. In addition to reducing stresses and improving the fatigue characteristics ofdistal end 122 ofseparator wire portion 56, the use of pivot joint 128 helps to increase the volume of the separated tissue section removed from the patient for the same distance of travel oftissue separator device 54. This increase in volume may be appreciated by comparing the embodiments of FIGS. 18 and 19. In the FIG. 19 embodiment, thedistal end 122 ofseparator wire portion 56 is rigidly or otherwise non-pivotally secured todistal portion 46 ofshaft 44. FIG. 20 illustrates the increased volume of separatedtissue section 80A resulting from the embodiment of FIG. 18 to the reduced volume, separatedtissue section 80B from the embodiment of FIG. 19. In this example the volume of separatedtissue section 80A has been calculated to be about 50 percent greater than the volume of separatedtissue section 80B for the same distance of travel oftissue separator device 54. -
Distal portion 46 ofshaft 44 includesguide element 110 which acts as atransition surface 110.Transition surface 110 is a distally-facing surface extending radially outwardly and proximally, that is longitudinally away from thetip 136 ofdistal portion 46. A series of spaced-apart, first, proximal energizabletissue separator elements 130 are positioned alongtransition surface 110. FIG. 23 is a cross-sectional view taken along line 23-23 of FIG. 18 and illustrates the electrical connection ofelements 130 tometallic tube 132. - FIGS.24A-24H illustrate alternative embodiments of
first elements 130.Elements 130A have extended longitudinal lengths, as compared with the essentiallycircular elements 130 of FIGS. 18 and 23. It is believed that the extended lengths ofelement 130A may be useful for reducing the penetration force needed for placement at the target site. The FIG. 24A embodiment is the presently preferred embodiment. Element 130B comprises a circumferentially continuous or substantially circumferentially continuous element. The circumferentially extending element 130B may also be useful for reducing the required penetration force.Elements 130C are similar toelements 130 but are located atperipheral region 140 oftransition surface 110. Elements 130D and 130E, shown in FIGS. 24D and 24E, are generally V-shaped and serpentine-shaped variations.Elements 130F and 130G, shown in FIGS. 24F and 24G, extend along substantially the entire lengths ofdistal portion 46 in straight and spiral configurations, respectively. FIG. 24H illustrates a further embodiment of elements 130H with elements 130H extending radially outwardly fromdistal portion 46; elements 130H may be retractable and may have shapes other than the pointed, triangular shape illustrated. Whileelements 130 are typically formed from metal wires or similar structure,elements 130 may also be painted, plated or otherwise deposited on the surface ofdistal portion 46. A combination of two or more of the arrangements ofelement 130 may be useful in appropriate circumstances. While presently all ofelements 130 are supplied with equal energy levels, different energy levels may be supplied. Also, the energy levels supplied may be varied over time or according to the resistance to the passage ofseparator wire portion 56 through the tissue. Also, energy toelements 130 may be turned on as needed at the discretion of the user. -
Distal portion 46 is hollow and contains an electrically conductive,metallic tube 132 defining anopening 134 at thetip 136 ofdistal portion 46. The outer, annular edge oftube 132 acts as a second, distal energizabletissue separator element 138. Bothfirst element 130 andsecond element 138 are selectively coupleable to one or more appropriate energy sources to aid movement ofdistal portion 46 through tissue to the target site. - FIGS. 25 and 26 illustrate the
hook wires 100, which act as tissue holding elements, extending throughopenings 142 formed withindistal portion 46 ofshaft 44.Hook wires 100 are preferably sized, positioned and shaped to engage separatedtissue section 80 at about its center of mass. While twohook wires 100 are shown in this embodiment, a greater or lesser number may also be used. Also, hookwires 100 having different sizes and shapes may be used.Hook wires 100 may also be located at different axial positions and may be energizable to aid movement through tissue. - FIGS. 25, 27 and27A illustrate the passage of
separator wire portion 56 through proximal anddistal channels distal shaft portion 46.Distal portion 46 defines abase surface 150 extending along the bottoms ofchannels channels Separator wire portion 56 lies againstbase surface 150 when in a retracted state. As shown best in FIGS. 27 and 27A, thecentral portion 152 ofbase surface 150 is convex so that whenseparator wire portion 56 is in the retracted state, a central portion ofwire portion 56 lies along a convex line, that is a line that bows slightly outwardly. Therefore whentissue separator device 54 is moved distally,separator wire portion 56 is predisposed to move radially outwardly in the desired manner. The amount of force needed to be applied todevice 54 may also be reduced by the use of convexcentral portion 152. - FIG. 28 illustrates a further alternative embodiment to the embodiment of FIG. 18 comprising three
separator wire portions 56, as opposed to one in FIG. 18, onewire portion 56 being shown in an operational state and the other twowire portions 56 in retracted states and adjacent base surfaces 150. This is suggested in FIG. 29B. Another difference from the embodiment of FIG. 18 is that the function of first, proximal energizabletissue separator elements 130 has been replaced by energizing the threeseparator wire portions 56 when the device is directed through tissue to a target site withwire portions 56 in retracted states. This is suggested in FIG. 29A. Once at the target site the physician may decide to move one, two or all three ofseparator wire portions 56 from the retracted state to the operational state depending on various factors, such as the characteristics of the tissue and the number ofpieces tissue section 80 is to be divided into. -
Distal portion 46, in the embodiment of FIGS. 18-29B, comprises aproximal element 154, a body portion 156 andtip 136,tip 136 acting as an end cap. FIG. 27 illustrates the interengagement ofelements Elements central tube 132, the parts being held in place distally by the flaredend 138 of the tube.Elements Elements 154 and 156 are typically made from the medical grade ceramic material, such as Al2O3 or zirconia, whiletip 136 is typically made from a medical grade polymer, such as PEEK or polyimide. - The amount of force required for the passage of a needle, or other tissue-penetrating element, such as
distal portion 46 ofshaft 44, through tissue often changes because the tissue characteristics often changes between the point of entry and the target site. If the tissue-penetrating element must pass through a hard or otherwise difficult-to-penetrate tissue region, the amount of force needed to penetrate the hard tissue region may be sufficiently great to, for example, cause the tissue-penetrating element to buckle. Even if the tissue-penetrating element has sufficient columnar strength to resist buckling, the amount of force required may be sufficient to cause the tissue to be deformed making it difficult to position the tip of the tissue-penetrating element at the target site. Also, once the tip has passed through the difficult-to-penetrate tissue region, the amount of force needed to do so may tend to cause the tip of the tissue-penetrating element to be inserted much farther than desired causing unintended tissue trauma and possibly injuring adjacent organs. - FIG. 30 illustrates, in schematic form, a tissue-penetrating
assembly 160 comprising broadly a tissue-penetratingsubassembly 162 coupled to a tissue-energizing circuit 164 and a force-sensitive switch 166 operably coupled to the tissue-penetrating subassembly. Thesubassembly 162 comprises ahandle assembly 168, or other support assembly, including ahandle 170, ahandle extension 172 extending rigidly fromhandle 170, and aneedle clamp 172 mounted to handle 170 at apivot 176. Subassembly 162 also includes aneedle 178, or other tissue-penetrating device, secured to and extending from needle clamp 174.Needle 178 includes aneedle shaft 180 covered byelectrical installation 182 along most of its length.Electrical installation 182 helps to concentrate the tissue-penetrating energy at thetip 184 ofneedle 178,tip 184 having a tissue-separatingsurface 185. - Force-sensitive switch166 includes a
compression spring 186 captured between needle clamp 174 and handleextension 172.Assembly 160 also includes an armingswitch 188 mounted to handle 170, switch 188 including anarm 190 mounted to handle 170 at apivot 192. Switch 188 also includes an armingcompression spring 194 captured betweenarm 190 and handleextension 172. The use of armingswitch 188 helps to enhance the safety ofassembly 160 by helping to prevent the inadvertent connection ofneedle 178 toRF generator 200. Circuit 164 includes a pair ofleads needle tip 184, and toarm 190 throughpivots RF generator 200, from which leads 196, 198 extend, and areturn cable 202coupling generator 200 to a return pad 204. An electrical conductor 206 is mounted to handleextension 172 and has electrical contact surfaces 208, 210 positioned opposite the corresponding surfaces ofneedle shaft 180 andarm 190. Anarming button 212 is mounted toarm 190 to permit the user to arm assembly 116 by pressing onarming button 212 to causearm 190 to contactsurface 210. With the device now armed,needle 178 is directed into tissue, exemplified by three layers of tissue, including soft tissue layers 214 and 218 and hard or otherwise difficult-to-penetrate tissue layer 216. Upon encountering hard tissue layer 216, the force needed to penetrate tissue layer 216 is sufficient to compressspring 186 and causeneedle shaft 180 to contactelectrical contact surface 208 thus completing the circuit toRF generator 200. At thispoint RF generator 200 can supply energy to surface 185 attip 184 permittingneedle 178 to pass through hard tissue 216 without excessive force. Oncetip 184 has passed through hard tissue layer 216, the force onneedle 178 decreases to permitspring 186 toseparate needle shaft 180 fromcontact surface 208 so to stop supplying RF energy totissue separator surface 185. - Tissue-penetrating
assembly 160 can be used to aid the insertion of a simple needle into tissue. However, the tissue-penetrating invention also can be incorporated into other devices including tissue-penetrating elements, such as the embodiments discussed above includingshaft 44 and a target tissue localization device disclosed in U.S. Pat. No. 6,179,860. - FIGS.31-39 illustrate further aspects of the invention in which
tissue separator assembly 10 is combined with anelongated coupler 220 and atissue localization assembly 222 to arrive at a tissue localizing and separatingassembly 224.Tissue localization assembly 222 may be of the type disclosed in U.S. Pat. No. 6,179,860.Assembly 222 is shown deployed within apatient 226 with localization device to 112 in a radially expanded, deployed condition.Assembly 222 includes a sheath 228 (see FIG. 32) within which apull wire 230 is slidably housed. The relative axial movement ofsheath 228 and pullwire 230 causeslocalization device 112 to radially expand and radially contract. Theproximal end 232 ofpull wire 230 is a recurved end 232 (see FIGS. 32, 34) for engagement bycoupler 220 as discussed below. -
Coupler 220 is a flexible wire having acoupler loop 234 at its distal end and an enlargedproximal end 236.Coupler 220 passes through shaft 44 (see FIGS. 2, 32) ofcatheter assembly 12.Coupler loop 234 is used to joincoupler 220 to therecurved end 232 ofpull wire 230; this is shown in FIGS. 31-34. After being so joined,tissue separator assembly 10 is moved distally alongcoupler 220, while the user graspsend 236 to maintain tension on thetissue localization assembly 220, causing the joined ends 232, 234 to pass intoshaft 44 thus dockingtissue localization assembly 222 totissue separator assembly 10. Continued distal movement ofassembly 10 causescatheter assembly 12 to enterpatient 226 and pass along the tissue track created bytissue localization assembly 222 untiltip 136 ofdistal portion 46 ofshaft 44 is properly positioned relative tolocalization device 112. Proper positioning is visually indicated to the user by a length oftube 233, typically colored red and affixed tocoupler 220, becoming exposed after exiting the proximal end opening 235 ofhandle 14 as shown in FIGS. 35A-35C. When properly positioned, see FIG. 35C, alocking spring clip 237, located onhandle 14 adjacent toproximal end opening 235, springs back from its biased position of FIG. 35B to its unbiased position of FIGS. 35A and 35C to preventtube 237 from inadvertently reenteringhandle 14. When so positioned,tissue localization assembly 222 becomes at least temporarily locked or fixed totissue separator assembly 10 to prevent the inadvertent relative axial movement betweenlocalization device 112 andassembly 10. Of course other locking mechanisms, such as a spring finger carried byassembly 220 and engageable withhandle 14, can also be used to lockassemblies - FIG. 36 is an enlarged view of the distal portion of
assembly 224 of FIG. 35 afterseparator wire portion 56 has been radially expanded and rotated, to create a separatedtissue section 80, and afterhook wire 100 has been deployed to engage the separatedtissue section 80. It has been found to be desirable to leave a space, indicated generally asdistance 238, betweenlocalization device 112 and separatedtissue section 80. FIG. 37 illustrates the assembly of FIG. 36 afterintroducer sheath 42 has been moved proximally a short distance to exposeouter end 106 oftubular braided element 104. FIG. 38 is a somewhat generalized illustration of the movement oftubular braided element 104 in a distal direction withinpatient 226 with the tubular braided element initially generally following the outline of separatedtissue section 80 andouter end 106 generally axially aligned withlocalization device 112. It should be noted that the movement ofouter end 106 oftubular braided element 104 will generally following the path indicated until it reachesposition 240. Followingposition 240, the pathouter end 106 takes will largely depend on the physical characteristics of the tissue through which is passing. However, the path illustrated is typical.Separated tissue section 80 is then removed frompatient 226 by simultaneously pulling the entire assembly shown in FIG. 38, including separatedtissue section 80 captured bytubular braided element 104 andlocalization device 112, secured bycoupler 220, back along the tissue track. During this movementtubular braided element 104 has a tendency to elongate axially to a reduced diameter, more cylindrical form thus reducing potential tissue trauma along the tissue track and through the access opening at the beginning of the tissue track. - FIG. 39 illustrates the assembly of FIG. 38 after having been removed from
patient 226 withouter end 106 oftubular braided element 104 returned to its relaxed state andtissue specimen 80 retained bytubular braided element 104 andlocalization device 112. As suggested in FIG. 39,tubular braided element 104, when in a relaxed state, has a generally trumpet shape withouter end 106 flaring outwardly. It has been found that this trumpet shape helps to guidetubular braided element 104 around separatedtissue section 80, especially during its initial movement fromintroducer sheath 42. - FIGS.40-45 illustrate a preferred method of making
tubular braided element 104.Tubular braided element 104 is sized according to the size of the tissue specimen being removed so that the number of elements, sizes and other specifications discussed below may be varied according to a particular circumstance. FIG. 40 illustrates the shape of a length of tubularbraided material 244 after it has been stretched over a cylindrical mandrel (not shown) having an enlarged (20.5 mm diameter by 50 mm long) central portion in this embodiment.Material 244, prior to being stretched over the mandrel, is supplied in a continuous length and cut to size for the mandrel and a starting diameter of {fraction (5/16)}″ or ˜8 mm.Material 244 is made of monofilament polyester fibers having a diameter of 0.10 inch (0.25 mm) The braid consists of 56 monofilaments and is made on 56 carrier braider. The braid, when formed in continuous lengths, maintains an approximate {fraction (5/16)}″ (8 mm) internal diameter. The braid angle is held fixed during the braiding operation, and was chosen for this application because a small shortening in axial length results in a rapid change in diameter. The enlarged central portion of the mandrel corresponds to the shape of tubularbraided material 244, that is it is cylindrical with generally hemispherical ends. FIG. 41 illustrates the structure of FIG. 40 after one end of the mandrel and tubularbraided material 244 has been dipped into a silicone compound. The dipped structure is then cured, typically in an oven, to create a silicone film orweb 246 covering one end of tubularbraided material 244. After curing, the dipped, curedstructure 248 is removed from the mandrel by being pulled over the mandrel from left to right in FIG. 41. FIG. 42 illustrates theopen mesh end 250 of the dipped, curedstructure 248 being pulled back into the dipped end to create the dual-wall tubular braidedelement 104 shown in FIG. 43. FIG. 43 illustratestubular braided element 104 being mounted to the distal end ofactuator tube 43. FIGS. 44 and 45 show the proximal end oftubular braided element 104 being secured to the distal end ofactuator tube 43 by a length ofheat shrink tubing 252 and an adhesive to create a tissue-surroundingassembly 254. Dual-wall tubular braidedelement 104 has anouter wall 256 substantially completely covered withsilicone web 246, andinner wall 258 at least substantially free of the silicone web material, an an openouter end 106 covered withsilicone web 246. -
Silicone web 246 serves at least two functions. It helps maintain the trumpet shape oftubular braided element 104 in its relaxed state while permitting the tubular braided element to radially expand and radially contract from the trumpet shape. It also helps to prevent passage of tissue throughtubular braided element 104 during removal of separatedtissue section 80. This helps to prevent contamination along the tissue track during tissue removal procedures. Whiletubular braided element 104 could be made as a single layer, that is withoutopen mesh end 250 being pulled back into the structure, it has been found that doing so helps to maintain a softer leading edge atouter end 106 oftubular braided element 104. The general trumpet shape shown in FIGS. 43-45 occurs as a natural result of the forming process illustrated and described. - The following discussion of the development of the current embodiment of
braided element 104 may be useful in appreciating its various features and advantages. The presently preferred embodiment ofbraided element 104 comprises a tubular sleeve of braided polyester (PET—polyethylene terephthalate) monofilament folded over itself to form a smooth end. The open weave construction allows it to enlarge to several times its original diameter. The outer braided layer is coated with silicone. - Early braided element prototypes consisted of Nitinol braided tubing. The wire diameter, braid angle and number of wires that comprise the braid were explored. These properties affect the strength of the braided element. The braided element must have enough stiffness and columnar strength to overcome the forces acting against it as it is deployed in the tissue. However, if it is too rigid, it may push the separated tissue section further into the cut cavity. Non-braided forms were also considered, such as Nitinol wire placed axially along the lengths of the axis, supported by coating or other rigid members. The combination of wire diameter, braid angle, and number of wires also affects the retracted properties of the braided element. In its undeployed state, the braided element was designed to fit inside a 6 mm sheath. Some of the Nitinol prototypes that were fabricated seemed to have adequate strength and stiffness, and fit within a 6 mm sheath. However, because of other factors discussed below, a PET braid presently preferred over a Nitinol braid.
- There are several factors that interact to effect columnar strength. Braid angle, number of filaments, and filament material stiffness and diameter are the main determinants. Axial orientation, greater number and stiffer filaments all combine for greater columnar strength. The presently preferred material for
braided element 104 is 0.010″ (0.25 mm) diameter monofilament. The number of monofilaments in the braid was chosen to optimize the mechanical properties ofbraided element 104. Increasing the number of filaments will create the opposite effect—the columnar strength will be reduced thus increasing the chance of buckling. Fewer filaments creates an increase in spacing between the filaments as the braided element expands from retracted to deployed. If the spacing becomes too large, the coating may tear. Also, a braided element constructed with a more axially oriented braid angle will take up much more length in the retracted state and therefore require a greater amount of travel to deploy. The number of filaments was chosen to optimize braided element strength, spacing between filaments, and amount of deployment travel. - It is presently preferred that the distal end of the braided element, that is the end that first comes into contact with the tissue, be smooth. It was discovered at a braided element with jagged or sharp edge may get caught in the tissue and fail to slide into the cut tissue interface around the separated tissue section. For the Nitinol braid, various methods of terminating the lose wires were explored, such as soldering, brazing, or bonding balls at the wire ends, or folding each single wire over. These methods were not very successful. For the balls to be atraumatic, they need to be of considerable size. The balls or folded-over ends increase the diameter of the retracted braided element, making it difficult to fit inside a sheath. This led to concepts of ‘roll-over’ and ‘double layer’ braided elements. For both concepts, the tubular braid is folded over itself to form a two-layered braided element with folded-over, smooth ends. For a ‘double layer’ braided element, the two layers are bonded together at the proximal end. The two-layered Nitinol braided elements that were prototyped showed promising characteristics. However the folded-over ends provided too much bulge and made it difficult or impossible to retract into a 6 mm diameter sheath. The PET braid, on the other hand, forms a nice crease when the braid is folded over, and is easily retracted into the sheath. For deployment, the outer layer is pushed forward and allowed to slide over the inner layer. This embodiment has potential but is not the presently preferred embodiment.
- The shape of the braided element also affects its functionality. Braided element prototypes of many different shapes were tested, such as “bullet”, “cone”, and “bell” or “trumpet” profiles of varying diameters. A desirable characteristic of
braided element 104 is that the braided element flares open as it is initially deployed, so that it is predisposed to expand around the biopsy sample rather than push the sample further into the cavity. The shape ofbraided element 104 has been optimized to maximize the amount that it flares open during deployment. - The braided element is currently coated with a two-component silicone elastomer. Some polyurethane coatings were investigated also, but did not perform as well as silicone coatings during preliminary testing. The silicone coating was chosen because of its high tear strength and elasticity. From the retracted state to the fully deployed state, the diameter of braided
element 104 may expand as much as 300%. The braided element may have a snare at the distal end to aid in capturing the sample. - Modification and variation can be made to the disclosed embodiments without departing from the subject of the invention as defined in the following claims. For example,
lead screw 52 could be hollow to permitactuator shaft 114, or other medical devices, to pass therethrough and into a lumen withinshaft 44. Whilebase surface 150 is shown to have a smoothly curving shape,surface 150 may have other shapes, such as a discontinuous surface shape, a flat surface shape with one or more projections providing the desired bow in theseparator wire portion 56, or a combination thereof.Braided element 104 may be made of other materials and by other processes than those disclosed. - Any and all patents, patent applications and printed publications referred to above are hereby incorporated by reference.
Claims (5)
Priority Applications (7)
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US10/374,584 US20030204188A1 (en) | 2001-11-07 | 2003-02-25 | Tissue separating and localizing catheter assembly |
EP04713706A EP1604359A4 (en) | 2003-02-25 | 2004-02-23 | Tissue separating and localizing catheter assembly |
AU2004216253A AU2004216253B2 (en) | 2003-02-25 | 2004-02-23 | Tissue separating and localizing catheter assembly |
JP2006503747A JP2006518642A (en) | 2003-02-25 | 2004-02-23 | Catheter assembly for tissue separation and placement |
PCT/US2004/005070 WO2004075946A2 (en) | 2003-02-25 | 2004-02-23 | Tissue separating and localizing catheter assembly |
US11/434,632 US7846159B2 (en) | 2000-11-07 | 2006-05-15 | Tissue separating and localizing catheter assembly |
US13/865,611 US9211130B2 (en) | 2000-06-05 | 2013-04-18 | Tissue separating catheter assembly and method |
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US10/374,584 US20030204188A1 (en) | 2001-11-07 | 2003-02-25 | Tissue separating and localizing catheter assembly |
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Cited By (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20080039884A1 (en) * | 2006-08-10 | 2008-02-14 | Nohilly Martin J | Morcellator with detachable handle |
US8298243B2 (en) | 2007-07-30 | 2012-10-30 | Tyco Healthcare Group Lp | Combination wire electrode and tube electrode polypectomy device |
US8328803B2 (en) | 2008-01-31 | 2012-12-11 | Covidien Lp | Polyp removal device and method of use |
US10813685B2 (en) | 2014-09-25 | 2020-10-27 | Covidien Lp | Single-handed operable surgical instrument including loop electrode with integrated pad electrode |
US11185215B2 (en) * | 2017-08-07 | 2021-11-30 | Boston Scientific Scimed, Inc. | Medical systems, devices, and related methods |
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Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
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US7621930B2 (en) | 2006-01-20 | 2009-11-24 | Ethicon Endo-Surgery, Inc. | Ultrasound medical instrument having a medical ultrasonic blade |
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US20090204005A1 (en) * | 2008-02-07 | 2009-08-13 | Broncus Technologies, Inc. | Puncture resistant catheter for sensing vessels and for creating passages in tissue |
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US11090104B2 (en) | 2009-10-09 | 2021-08-17 | Cilag Gmbh International | Surgical generator for ultrasonic and electrosurgical devices |
US10172669B2 (en) | 2009-10-09 | 2019-01-08 | Ethicon Llc | Surgical instrument comprising an energy trigger lockout |
US8956349B2 (en) | 2009-10-09 | 2015-02-17 | Ethicon Endo-Surgery, Inc. | Surgical generator for ultrasonic and electrosurgical devices |
US10441345B2 (en) | 2009-10-09 | 2019-10-15 | Ethicon Llc | Surgical generator for ultrasonic and electrosurgical devices |
US8469981B2 (en) | 2010-02-11 | 2013-06-25 | Ethicon Endo-Surgery, Inc. | Rotatable cutting implement arrangements for ultrasonic surgical instruments |
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US8951272B2 (en) | 2010-02-11 | 2015-02-10 | Ethicon Endo-Surgery, Inc. | Seal arrangements for ultrasonically powered surgical instruments |
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US9005199B2 (en) | 2010-06-10 | 2015-04-14 | Ethicon Endo-Surgery, Inc. | Heat management configurations for controlling heat dissipation from electrosurgical instruments |
US8613383B2 (en) | 2010-07-14 | 2013-12-24 | Ethicon Endo-Surgery, Inc. | Surgical instruments with electrodes |
US8795327B2 (en) | 2010-07-22 | 2014-08-05 | Ethicon Endo-Surgery, Inc. | Electrosurgical instrument with separate closure and cutting members |
US9192431B2 (en) | 2010-07-23 | 2015-11-24 | Ethicon Endo-Surgery, Inc. | Electrosurgical cutting and sealing instrument |
US9011437B2 (en) | 2010-07-23 | 2015-04-21 | Ethicon Endo-Surgery, Inc. | Electrosurgical cutting and sealing instrument |
US8702704B2 (en) | 2010-07-23 | 2014-04-22 | Ethicon Endo-Surgery, Inc. | Electrosurgical cutting and sealing instrument |
US8979843B2 (en) * | 2010-07-23 | 2015-03-17 | Ethicon Endo-Surgery, Inc. | Electrosurgical cutting and sealing instrument |
US8979844B2 (en) | 2010-07-23 | 2015-03-17 | Ethicon Endo-Surgery, Inc. | Electrosurgical cutting and sealing instrument |
US8979890B2 (en) | 2010-10-01 | 2015-03-17 | Ethicon Endo-Surgery, Inc. | Surgical instrument with jaw member |
US9375255B2 (en) | 2010-11-05 | 2016-06-28 | Ethicon Endo-Surgery, Llc | Surgical instrument handpiece with resiliently biased coupling to modular shaft and end effector |
US10085792B2 (en) | 2010-11-05 | 2018-10-02 | Ethicon Llc | Surgical instrument with motorized attachment feature |
US9017851B2 (en) | 2010-11-05 | 2015-04-28 | Ethicon Endo-Surgery, Inc. | Sterile housing for non-sterile medical device component |
US9526921B2 (en) | 2010-11-05 | 2016-12-27 | Ethicon Endo-Surgery, Llc | User feedback through end effector of surgical instrument |
US10959769B2 (en) | 2010-11-05 | 2021-03-30 | Ethicon Llc | Surgical instrument with slip ring assembly to power ultrasonic transducer |
US9161803B2 (en) * | 2010-11-05 | 2015-10-20 | Ethicon Endo-Surgery, Inc. | Motor driven electrosurgical device with mechanical and electrical feedback |
US10660695B2 (en) | 2010-11-05 | 2020-05-26 | Ethicon Llc | Sterile medical instrument charging device |
US9421062B2 (en) | 2010-11-05 | 2016-08-23 | Ethicon Endo-Surgery, Llc | Surgical instrument shaft with resiliently biased coupling to handpiece |
US9011471B2 (en) | 2010-11-05 | 2015-04-21 | Ethicon Endo-Surgery, Inc. | Surgical instrument with pivoting coupling to modular shaft and end effector |
US9381058B2 (en) | 2010-11-05 | 2016-07-05 | Ethicon Endo-Surgery, Llc | Recharge system for medical devices |
US9510895B2 (en) | 2010-11-05 | 2016-12-06 | Ethicon Endo-Surgery, Llc | Surgical instrument with modular shaft and end effector |
US9782215B2 (en) | 2010-11-05 | 2017-10-10 | Ethicon Endo-Surgery, Llc | Surgical instrument with ultrasonic transducer having integral switches |
US20120116265A1 (en) | 2010-11-05 | 2012-05-10 | Houser Kevin L | Surgical instrument with charging devices |
US20120116381A1 (en) | 2010-11-05 | 2012-05-10 | Houser Kevin L | Surgical instrument with charging station and wireless communication |
US9000720B2 (en) | 2010-11-05 | 2015-04-07 | Ethicon Endo-Surgery, Inc. | Medical device packaging with charging interface |
US9017849B2 (en) | 2010-11-05 | 2015-04-28 | Ethicon Endo-Surgery, Inc. | Power source management for medical device |
US10881448B2 (en) | 2010-11-05 | 2021-01-05 | Ethicon Llc | Cam driven coupling between ultrasonic transducer and waveguide in surgical instrument |
US9247986B2 (en) | 2010-11-05 | 2016-02-02 | Ethicon Endo-Surgery, Llc | Surgical instrument with ultrasonic transducer having integral switches |
US9649150B2 (en) | 2010-11-05 | 2017-05-16 | Ethicon Endo-Surgery, Llc | Selective activation of electronic components in medical device |
US9597143B2 (en) | 2010-11-05 | 2017-03-21 | Ethicon Endo-Surgery, Llc | Sterile medical instrument charging device |
US9072523B2 (en) | 2010-11-05 | 2015-07-07 | Ethicon Endo-Surgery, Inc. | Medical device with feature for sterile acceptance of non-sterile reusable component |
US9782214B2 (en) | 2010-11-05 | 2017-10-10 | Ethicon Llc | Surgical instrument with sensor and powered control |
US9039720B2 (en) | 2010-11-05 | 2015-05-26 | Ethicon Endo-Surgery, Inc. | Surgical instrument with ratcheting rotatable shaft |
US9089338B2 (en) | 2010-11-05 | 2015-07-28 | Ethicon Endo-Surgery, Inc. | Medical device packaging with window for insertion of reusable component |
US9259265B2 (en) | 2011-07-22 | 2016-02-16 | Ethicon Endo-Surgery, Llc | Surgical instruments for tensioning tissue |
US9044243B2 (en) | 2011-08-30 | 2015-06-02 | Ethcon Endo-Surgery, Inc. | Surgical cutting and fastening device with descendible second trigger arrangement |
US9333025B2 (en) | 2011-10-24 | 2016-05-10 | Ethicon Endo-Surgery, Llc | Battery initialization clip |
EP2811932B1 (en) | 2012-02-10 | 2019-06-26 | Ethicon LLC | Robotically controlled surgical instrument |
US9439668B2 (en) | 2012-04-09 | 2016-09-13 | Ethicon Endo-Surgery, Llc | Switch arrangements for ultrasonic surgical instruments |
US20140005705A1 (en) | 2012-06-29 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Surgical instruments with articulating shafts |
US20140005640A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Surgical end effector jaw and electrode configurations |
US20140005702A1 (en) | 2012-06-29 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments with distally positioned transducers |
US9326788B2 (en) | 2012-06-29 | 2016-05-03 | Ethicon Endo-Surgery, Llc | Lockout mechanism for use with robotic electrosurgical device |
US9226767B2 (en) | 2012-06-29 | 2016-01-05 | Ethicon Endo-Surgery, Inc. | Closed feedback control for electrosurgical device |
US9408622B2 (en) | 2012-06-29 | 2016-08-09 | Ethicon Endo-Surgery, Llc | Surgical instruments with articulating shafts |
US9393037B2 (en) | 2012-06-29 | 2016-07-19 | Ethicon Endo-Surgery, Llc | Surgical instruments with articulating shafts |
US9198714B2 (en) | 2012-06-29 | 2015-12-01 | Ethicon Endo-Surgery, Inc. | Haptic feedback devices for surgical robot |
US9820768B2 (en) | 2012-06-29 | 2017-11-21 | Ethicon Llc | Ultrasonic surgical instruments with control mechanisms |
US9351754B2 (en) | 2012-06-29 | 2016-05-31 | Ethicon Endo-Surgery, Llc | Ultrasonic surgical instruments with distally positioned jaw assemblies |
US20140052120A1 (en) * | 2012-08-17 | 2014-02-20 | Medtronic Ablation Frontiers Llc | Electrophysiology catheter design |
BR112015007010B1 (en) | 2012-09-28 | 2022-05-31 | Ethicon Endo-Surgery, Inc | end actuator |
US9095367B2 (en) | 2012-10-22 | 2015-08-04 | Ethicon Endo-Surgery, Inc. | Flexible harmonic waveguides/blades for surgical instruments |
US20140135804A1 (en) | 2012-11-15 | 2014-05-15 | Ethicon Endo-Surgery, Inc. | Ultrasonic and electrosurgical devices |
US10226273B2 (en) | 2013-03-14 | 2019-03-12 | Ethicon Llc | Mechanical fasteners for use with surgical energy devices |
US9295514B2 (en) | 2013-08-30 | 2016-03-29 | Ethicon Endo-Surgery, Llc | Surgical devices with close quarter articulation features |
US9814514B2 (en) | 2013-09-13 | 2017-11-14 | Ethicon Llc | Electrosurgical (RF) medical instruments for cutting and coagulating tissue |
US9861428B2 (en) | 2013-09-16 | 2018-01-09 | Ethicon Llc | Integrated systems for electrosurgical steam or smoke control |
US9526565B2 (en) | 2013-11-08 | 2016-12-27 | Ethicon Endo-Surgery, Llc | Electrosurgical devices |
US9265926B2 (en) | 2013-11-08 | 2016-02-23 | Ethicon Endo-Surgery, Llc | Electrosurgical devices |
GB2521229A (en) | 2013-12-16 | 2015-06-17 | Ethicon Endo Surgery Inc | Medical device |
GB2521228A (en) | 2013-12-16 | 2015-06-17 | Ethicon Endo Surgery Inc | Medical device |
US9795436B2 (en) | 2014-01-07 | 2017-10-24 | Ethicon Llc | Harvesting energy from a surgical generator |
US9408660B2 (en) | 2014-01-17 | 2016-08-09 | Ethicon Endo-Surgery, Llc | Device trigger dampening mechanism |
US9554854B2 (en) | 2014-03-18 | 2017-01-31 | Ethicon Endo-Surgery, Llc | Detecting short circuits in electrosurgical medical devices |
US10092310B2 (en) | 2014-03-27 | 2018-10-09 | Ethicon Llc | Electrosurgical devices |
US10463421B2 (en) | 2014-03-27 | 2019-11-05 | Ethicon Llc | Two stage trigger, clamp and cut bipolar vessel sealer |
US10524852B1 (en) | 2014-03-28 | 2020-01-07 | Ethicon Llc | Distal sealing end effector with spacers |
US9737355B2 (en) | 2014-03-31 | 2017-08-22 | Ethicon Llc | Controlling impedance rise in electrosurgical medical devices |
US9913680B2 (en) | 2014-04-15 | 2018-03-13 | Ethicon Llc | Software algorithms for electrosurgical instruments |
US9757186B2 (en) | 2014-04-17 | 2017-09-12 | Ethicon Llc | Device status feedback for bipolar tissue spacer |
US9700333B2 (en) | 2014-06-30 | 2017-07-11 | Ethicon Llc | Surgical instrument with variable tissue compression |
US10285724B2 (en) | 2014-07-31 | 2019-05-14 | Ethicon Llc | Actuation mechanisms and load adjustment assemblies for surgical instruments |
US9877776B2 (en) | 2014-08-25 | 2018-01-30 | Ethicon Llc | Simultaneous I-beam and spring driven cam jaw closure mechanism |
US10194976B2 (en) | 2014-08-25 | 2019-02-05 | Ethicon Llc | Lockout disabling mechanism |
US10194972B2 (en) | 2014-08-26 | 2019-02-05 | Ethicon Llc | Managing tissue treatment |
US10136938B2 (en) | 2014-10-29 | 2018-11-27 | Ethicon Llc | Electrosurgical instrument with sensor |
US10639092B2 (en) | 2014-12-08 | 2020-05-05 | Ethicon Llc | Electrode configurations for surgical instruments |
US9848937B2 (en) | 2014-12-22 | 2017-12-26 | Ethicon Llc | End effector with detectable configurations |
US10092348B2 (en) | 2014-12-22 | 2018-10-09 | Ethicon Llc | RF tissue sealer, shear grip, trigger lock mechanism and energy activation |
US10159524B2 (en) | 2014-12-22 | 2018-12-25 | Ethicon Llc | High power battery powered RF amplifier topology |
US10111699B2 (en) | 2014-12-22 | 2018-10-30 | Ethicon Llc | RF tissue sealer, shear grip, trigger lock mechanism and energy activation |
US10245095B2 (en) | 2015-02-06 | 2019-04-02 | Ethicon Llc | Electrosurgical instrument with rotation and articulation mechanisms |
US10321950B2 (en) | 2015-03-17 | 2019-06-18 | Ethicon Llc | Managing tissue treatment |
US10342602B2 (en) | 2015-03-17 | 2019-07-09 | Ethicon Llc | Managing tissue treatment |
US10595929B2 (en) | 2015-03-24 | 2020-03-24 | Ethicon Llc | Surgical instruments with firing system overload protection mechanisms |
US10314638B2 (en) | 2015-04-07 | 2019-06-11 | Ethicon Llc | Articulating radio frequency (RF) tissue seal with articulating state sensing |
US10117702B2 (en) | 2015-04-10 | 2018-11-06 | Ethicon Llc | Surgical generator systems and related methods |
US10130410B2 (en) | 2015-04-17 | 2018-11-20 | Ethicon Llc | Electrosurgical instrument including a cutting member decouplable from a cutting member trigger |
US9872725B2 (en) | 2015-04-29 | 2018-01-23 | Ethicon Llc | RF tissue sealer with mode selection |
US11020140B2 (en) | 2015-06-17 | 2021-06-01 | Cilag Gmbh International | Ultrasonic surgical blade for use with ultrasonic surgical instruments |
US10034704B2 (en) | 2015-06-30 | 2018-07-31 | Ethicon Llc | Surgical instrument with user adaptable algorithms |
US10898256B2 (en) | 2015-06-30 | 2021-01-26 | Ethicon Llc | Surgical system with user adaptable techniques based on tissue impedance |
US11051873B2 (en) | 2015-06-30 | 2021-07-06 | Cilag Gmbh International | Surgical system with user adaptable techniques employing multiple energy modalities based on tissue parameters |
US11129669B2 (en) | 2015-06-30 | 2021-09-28 | Cilag Gmbh International | Surgical system with user adaptable techniques based on tissue type |
US10357303B2 (en) | 2015-06-30 | 2019-07-23 | Ethicon Llc | Translatable outer tube for sealing using shielded lap chole dissector |
US11141213B2 (en) | 2015-06-30 | 2021-10-12 | Cilag Gmbh International | Surgical instrument with user adaptable techniques |
US10154852B2 (en) | 2015-07-01 | 2018-12-18 | Ethicon Llc | Ultrasonic surgical blade with improved cutting and coagulation features |
US10687884B2 (en) | 2015-09-30 | 2020-06-23 | Ethicon Llc | Circuits for supplying isolated direct current (DC) voltage to surgical instruments |
US10595930B2 (en) | 2015-10-16 | 2020-03-24 | Ethicon Llc | Electrode wiping surgical device |
US10959771B2 (en) | 2015-10-16 | 2021-03-30 | Ethicon Llc | Suction and irrigation sealing grasper |
US10179022B2 (en) | 2015-12-30 | 2019-01-15 | Ethicon Llc | Jaw position impedance limiter for electrosurgical instrument |
US10959806B2 (en) | 2015-12-30 | 2021-03-30 | Ethicon Llc | Energized medical device with reusable handle |
US10575892B2 (en) | 2015-12-31 | 2020-03-03 | Ethicon Llc | Adapter for electrical surgical instruments |
US10709469B2 (en) | 2016-01-15 | 2020-07-14 | Ethicon Llc | Modular battery powered handheld surgical instrument with energy conservation techniques |
US11229471B2 (en) | 2016-01-15 | 2022-01-25 | Cilag Gmbh International | Modular battery powered handheld surgical instrument with selective application of energy based on tissue characterization |
US11129670B2 (en) | 2016-01-15 | 2021-09-28 | Cilag Gmbh International | Modular battery powered handheld surgical instrument with selective application of energy based on button displacement, intensity, or local tissue characterization |
US10716615B2 (en) | 2016-01-15 | 2020-07-21 | Ethicon Llc | Modular battery powered handheld surgical instrument with curved end effectors having asymmetric engagement between jaw and blade |
US10555769B2 (en) | 2016-02-22 | 2020-02-11 | Ethicon Llc | Flexible circuits for electrosurgical instrument |
US10646269B2 (en) | 2016-04-29 | 2020-05-12 | Ethicon Llc | Non-linear jaw gap for electrosurgical instruments |
US10485607B2 (en) | 2016-04-29 | 2019-11-26 | Ethicon Llc | Jaw structure with distal closure for electrosurgical instruments |
US10702329B2 (en) | 2016-04-29 | 2020-07-07 | Ethicon Llc | Jaw structure with distal post for electrosurgical instruments |
US10987156B2 (en) | 2016-04-29 | 2021-04-27 | Ethicon Llc | Electrosurgical instrument with electrically conductive gap setting member and electrically insulative tissue engaging members |
US10856934B2 (en) | 2016-04-29 | 2020-12-08 | Ethicon Llc | Electrosurgical instrument with electrically conductive gap setting and tissue engaging members |
US10456193B2 (en) | 2016-05-03 | 2019-10-29 | Ethicon Llc | Medical device with a bilateral jaw configuration for nerve stimulation |
US10245064B2 (en) | 2016-07-12 | 2019-04-02 | Ethicon Llc | Ultrasonic surgical instrument with piezoelectric central lumen transducer |
US10893883B2 (en) | 2016-07-13 | 2021-01-19 | Ethicon Llc | Ultrasonic assembly for use with ultrasonic surgical instruments |
US10842522B2 (en) | 2016-07-15 | 2020-11-24 | Ethicon Llc | Ultrasonic surgical instruments having offset blades |
US10376305B2 (en) | 2016-08-05 | 2019-08-13 | Ethicon Llc | Methods and systems for advanced harmonic energy |
US10285723B2 (en) | 2016-08-09 | 2019-05-14 | Ethicon Llc | Ultrasonic surgical blade with improved heel portion |
USD847990S1 (en) | 2016-08-16 | 2019-05-07 | Ethicon Llc | Surgical instrument |
US10952759B2 (en) | 2016-08-25 | 2021-03-23 | Ethicon Llc | Tissue loading of a surgical instrument |
US10828056B2 (en) | 2016-08-25 | 2020-11-10 | Ethicon Llc | Ultrasonic transducer to waveguide acoustic coupling, connections, and configurations |
US10751117B2 (en) | 2016-09-23 | 2020-08-25 | Ethicon Llc | Electrosurgical instrument with fluid diverter |
US10603064B2 (en) | 2016-11-28 | 2020-03-31 | Ethicon Llc | Ultrasonic transducer |
US11266430B2 (en) | 2016-11-29 | 2022-03-08 | Cilag Gmbh International | End effector control and calibration |
US11033325B2 (en) | 2017-02-16 | 2021-06-15 | Cilag Gmbh International | Electrosurgical instrument with telescoping suction port and debris cleaner |
US10799284B2 (en) | 2017-03-15 | 2020-10-13 | Ethicon Llc | Electrosurgical instrument with textured jaws |
US11497546B2 (en) | 2017-03-31 | 2022-11-15 | Cilag Gmbh International | Area ratios of patterned coatings on RF electrodes to reduce sticking |
US10603117B2 (en) | 2017-06-28 | 2020-03-31 | Ethicon Llc | Articulation state detection mechanisms |
US10820920B2 (en) | 2017-07-05 | 2020-11-03 | Ethicon Llc | Reusable ultrasonic medical devices and methods of their use |
US11033323B2 (en) | 2017-09-29 | 2021-06-15 | Cilag Gmbh International | Systems and methods for managing fluid and suction in electrosurgical systems |
US11484358B2 (en) | 2017-09-29 | 2022-11-01 | Cilag Gmbh International | Flexible electrosurgical instrument |
US11490951B2 (en) | 2017-09-29 | 2022-11-08 | Cilag Gmbh International | Saline contact with electrodes |
US11547468B2 (en) | 2019-06-27 | 2023-01-10 | Cilag Gmbh International | Robotic surgical system with safety and cooperative sensing control |
US11607278B2 (en) | 2019-06-27 | 2023-03-21 | Cilag Gmbh International | Cooperative robotic surgical systems |
US11413102B2 (en) | 2019-06-27 | 2022-08-16 | Cilag Gmbh International | Multi-access port for surgical robotic systems |
US11723729B2 (en) | 2019-06-27 | 2023-08-15 | Cilag Gmbh International | Robotic surgical assembly coupling safety mechanisms |
US11612445B2 (en) | 2019-06-27 | 2023-03-28 | Cilag Gmbh International | Cooperative operation of robotic arms |
US20210196359A1 (en) | 2019-12-30 | 2021-07-01 | Ethicon Llc | Electrosurgical instruments with electrodes having energy focusing features |
US11944366B2 (en) | 2019-12-30 | 2024-04-02 | Cilag Gmbh International | Asymmetric segmented ultrasonic support pad for cooperative engagement with a movable RF electrode |
US11786291B2 (en) | 2019-12-30 | 2023-10-17 | Cilag Gmbh International | Deflectable support of RF energy electrode with respect to opposing ultrasonic blade |
US11911063B2 (en) | 2019-12-30 | 2024-02-27 | Cilag Gmbh International | Techniques for detecting ultrasonic blade to electrode contact and reducing power to ultrasonic blade |
US11950797B2 (en) | 2019-12-30 | 2024-04-09 | Cilag Gmbh International | Deflectable electrode with higher distal bias relative to proximal bias |
US11452525B2 (en) | 2019-12-30 | 2022-09-27 | Cilag Gmbh International | Surgical instrument comprising an adjustment system |
US20210196344A1 (en) | 2019-12-30 | 2021-07-01 | Ethicon Llc | Surgical system communication pathways |
US11937863B2 (en) | 2019-12-30 | 2024-03-26 | Cilag Gmbh International | Deflectable electrode with variable compression bias along the length of the deflectable electrode |
US11779387B2 (en) | 2019-12-30 | 2023-10-10 | Cilag Gmbh International | Clamp arm jaw to minimize tissue sticking and improve tissue control |
US11696776B2 (en) | 2019-12-30 | 2023-07-11 | Cilag Gmbh International | Articulatable surgical instrument |
US11660089B2 (en) | 2019-12-30 | 2023-05-30 | Cilag Gmbh International | Surgical instrument comprising a sensing system |
US11779329B2 (en) | 2019-12-30 | 2023-10-10 | Cilag Gmbh International | Surgical instrument comprising a flex circuit including a sensor system |
US20210196349A1 (en) | 2019-12-30 | 2021-07-01 | Ethicon Llc | Electrosurgical instrument with flexible wiring assemblies |
US20210196363A1 (en) | 2019-12-30 | 2021-07-01 | Ethicon Llc | Electrosurgical instrument with electrodes operable in bipolar and monopolar modes |
US11812957B2 (en) | 2019-12-30 | 2023-11-14 | Cilag Gmbh International | Surgical instrument comprising a signal interference resolution system |
US11684412B2 (en) | 2019-12-30 | 2023-06-27 | Cilag Gmbh International | Surgical instrument with rotatable and articulatable surgical end effector |
US11931026B2 (en) | 2021-06-30 | 2024-03-19 | Cilag Gmbh International | Staple cartridge replacement |
US11957342B2 (en) | 2021-11-01 | 2024-04-16 | Cilag Gmbh International | Devices, systems, and methods for detecting tissue and foreign objects during a surgical operation |
Citations (51)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3557794A (en) * | 1968-07-30 | 1971-01-26 | Us Air Force | Arterial dilation device |
US3910279A (en) * | 1973-06-20 | 1975-10-07 | Olympus Optical Co | Electrosurgical instrument |
US3996938A (en) * | 1975-07-10 | 1976-12-14 | Clark Iii William T | Expanding mesh catheter |
US4611594A (en) * | 1984-04-11 | 1986-09-16 | Northwestern University | Medical instrument for containment and removal of calculi |
US4638802A (en) * | 1984-09-21 | 1987-01-27 | Olympus Optical Co., Ltd. | High frequency instrument for incision and excision |
US4997435A (en) * | 1989-09-25 | 1991-03-05 | Methodist Hospital Of Indiana Inc. | Percutaneous catheter with encapsulating receptacle |
US5007908A (en) * | 1989-09-29 | 1991-04-16 | Everest Medical Corporation | Electrosurgical instrument having needle cutting electrode and spot-coag electrode |
US5031634A (en) * | 1990-01-19 | 1991-07-16 | Beth Israel Hospital Assoc., Inc. | Adjustable biopsy needle-guide device |
US5100423A (en) * | 1990-08-21 | 1992-03-31 | Medical Engineering & Development Institute, Inc. | Ablation catheter |
US5102415A (en) * | 1989-09-06 | 1992-04-07 | Guenther Rolf W | Apparatus for removing blood clots from arteries and veins |
US5176687A (en) * | 1991-05-10 | 1993-01-05 | Hasson Harrith M | Disposable pouch container for isolation and retrieval of tissues removed at laparoscopy |
US5190561A (en) * | 1991-01-23 | 1993-03-02 | Surgical Innovations, Inc. | Tissue and organ extractor |
US5370647A (en) * | 1991-01-23 | 1994-12-06 | Surgical Innovations, Inc. | Tissue and organ extractor |
US5370660A (en) * | 1993-11-01 | 1994-12-06 | Cordis Corporation | Apparatus and method for delivering a vessel plug into the body of a patient |
US5415656A (en) * | 1993-09-28 | 1995-05-16 | American Medical Systems, Inc. | Electrosurgical apparatus |
US5709697A (en) * | 1995-11-22 | 1998-01-20 | United States Surgical Corporation | Apparatus and method for removing tissue |
US5728133A (en) * | 1996-07-09 | 1998-03-17 | Cardiologics, L.L.C. | Anchoring device and method for sealing percutaneous punctures in vessels |
US5794626A (en) * | 1994-08-18 | 1998-08-18 | Kieturakis; Maciej J. | Excisional stereotactic apparatus |
US5795308A (en) * | 1995-03-09 | 1998-08-18 | Russin; Lincoln D. | Apparatus for coaxial breast biopsy |
US5796045A (en) * | 1996-01-10 | 1998-08-18 | Gremco S.A. | Braided sheath sleeve for threading over at least one elongate element to be protected, and a method of manufacturing such a sleeve |
US5928159A (en) * | 1995-03-03 | 1999-07-27 | Neothermia Corporation | Apparatus and method for characterization and treatment of tumors |
US5928260A (en) * | 1997-07-10 | 1999-07-27 | Scimed Life Systems, Inc. | Removable occlusion system for aneurysm neck |
US5947964A (en) * | 1995-03-03 | 1999-09-07 | Neothermia Corporation | Methods and apparatus for therapeutic cauterization of predetermined volumes of biological tissue |
US5989265A (en) * | 1995-03-08 | 1999-11-23 | Bouquet De La Joliniere; Jean Henri | Device for pinpointing suspect lesions of the breast and apparatus for positioning it |
US6022362A (en) * | 1998-09-03 | 2000-02-08 | Rubicor Medical, Inc. | Excisional biopsy devices and methods |
US6051008A (en) * | 1996-12-02 | 2000-04-18 | Angiotrax, Inc. | Apparatus having stabilization members for percutaneously performing surgery and methods of use |
US6053876A (en) * | 1999-06-09 | 2000-04-25 | Fisher; John | Apparatus and method for marking non-palpable lesions |
US6106524A (en) * | 1995-03-03 | 2000-08-22 | Neothermia Corporation | Methods and apparatus for therapeutic cauterization of predetermined volumes of biological tissue |
US6136014A (en) * | 1998-09-01 | 2000-10-24 | Vivant Medical, Inc. | Percutaneous tissue removal device |
US6179860B1 (en) * | 1998-08-19 | 2001-01-30 | Artemis Medical, Inc. | Target tissue localization device and method |
US6221006B1 (en) * | 1998-02-10 | 2001-04-24 | Artemis Medical Inc. | Entrapping apparatus and method for use |
US6258115B1 (en) * | 1997-04-23 | 2001-07-10 | Artemis Medical, Inc. | Bifurcated stent and distal protection system |
US6258083B1 (en) * | 1996-03-29 | 2001-07-10 | Eclipse Surgical Technologies, Inc. | Viewing surgical scope for minimally invasive procedures |
US6261241B1 (en) * | 1998-03-03 | 2001-07-17 | Senorx, Inc. | Electrosurgical biopsy device and method |
US6277083B1 (en) * | 1999-12-27 | 2001-08-21 | Neothermia Corporation | Minimally invasive intact recovery of tissue |
US6280450B1 (en) * | 1997-07-24 | 2001-08-28 | Rex Medical, Lp | Breast surgery method and apparatus |
US6287304B1 (en) * | 1999-10-15 | 2001-09-11 | Neothermia Corporation | Interstitial cauterization of tissue volumes with electrosurgically deployed electrodes |
US6312429B1 (en) * | 1998-09-01 | 2001-11-06 | Senorx, Inc. | Electrosurgical lesion location device |
US6312428B1 (en) * | 1995-03-03 | 2001-11-06 | Neothermia Corporation | Methods and apparatus for therapeutic cauterization of predetermined volumes of biological tissue |
US6331166B1 (en) * | 1998-03-03 | 2001-12-18 | Senorx, Inc. | Breast biopsy system and method |
US20020007130A1 (en) * | 1998-03-03 | 2002-01-17 | Senorx, Inc. | Methods and apparatus for securing medical instruments to desired locations in a patients body |
US6344026B1 (en) * | 1998-04-08 | 2002-02-05 | Senorx, Inc. | Tissue specimen encapsulation device and method thereof |
USD457628S1 (en) * | 2001-07-12 | 2002-05-21 | Neothermia Corporation | Electrosurgical instrument handle |
USD457960S1 (en) * | 2001-07-12 | 2002-05-28 | Neothermia Corporation | Electrosurgical instrument handle |
US6432103B1 (en) * | 1995-06-07 | 2002-08-13 | Arthrocare Corporation | System for electrosurgical treatment of submucosal tissue |
US6440147B1 (en) * | 1998-09-03 | 2002-08-27 | Rubicor Medical, Inc. | Excisional biopsy devices and methods |
US6471659B2 (en) * | 1999-12-27 | 2002-10-29 | Neothermia Corporation | Minimally invasive intact recovery of tissue |
US6514248B1 (en) * | 1999-10-15 | 2003-02-04 | Neothermia Corporation | Accurate cutting about and into tissue volumes with electrosurgically deployed electrodes |
US6620157B1 (en) * | 2000-12-28 | 2003-09-16 | Senorx, Inc. | High frequency power source |
US6626903B2 (en) * | 1997-07-24 | 2003-09-30 | Rex Medical, L.P. | Surgical biopsy device |
US7916667B2 (en) * | 2007-06-29 | 2011-03-29 | Alcatel-Lucent Usa Inc. | Method for detecting RF link imbalances in a wireless communications network |
Family Cites Families (25)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3460539A (en) | 1967-03-10 | 1969-08-12 | James E Anhalt Sr | Cautery tip |
WO1986004226A1 (en) * | 1985-01-25 | 1986-07-31 | Kharkovsky Nauchno-Issledovatelsky Institut Obsche | Electrosurgical instrument |
US5282484A (en) | 1989-08-18 | 1994-02-01 | Endovascular Instruments, Inc. | Method for performing a partial atherectomy |
US5030201A (en) | 1989-11-24 | 1991-07-09 | Aubrey Palestrant | Expandable atherectomy catheter device |
US5599347A (en) * | 1991-02-13 | 1997-02-04 | Applied Medical Resources Corporation | Surgical trocar with cutoff circuit |
US5275610A (en) | 1991-05-13 | 1994-01-04 | Cook Incorporated | Surgical retractors and method of use |
US5419767A (en) * | 1992-01-07 | 1995-05-30 | Thapliyal And Eggers Partners | Methods and apparatus for advancing catheters through severely occluded body lumens |
US5224945A (en) | 1992-01-13 | 1993-07-06 | Interventional Technologies, Inc. | Compressible/expandable atherectomy cutter |
US5281218A (en) * | 1992-06-05 | 1994-01-25 | Cardiac Pathways Corporation | Catheter having needle electrode for radiofrequency ablation |
US5417697A (en) | 1993-07-07 | 1995-05-23 | Wilk; Peter J. | Polyp retrieval assembly with cauterization loop and suction web |
GB9314640D0 (en) | 1993-07-15 | 1993-08-25 | Salim Aws S M | Tunnellimg catheter |
US6059734A (en) | 1995-01-06 | 2000-05-09 | Yoon; Inbae | Methods of collecting tissue at obstructed anatomical sites |
CA2248260C (en) | 1996-03-05 | 2010-11-16 | Michael D. Laufer | Vascular catheter-based system for heating tissue |
DE19610461C2 (en) | 1996-03-16 | 1999-02-11 | Osypka Peter | Catheter with an insertion tube |
DE19706751A1 (en) | 1996-03-27 | 1997-10-02 | Valleylab Inc | Electrosurgical device for removing tissue in body areas |
US5746753A (en) * | 1996-05-13 | 1998-05-05 | Boston Scientific Corporation | Needle grasping apparatus |
US6530923B1 (en) | 1998-02-10 | 2003-03-11 | Artemis Medical, Inc. | Tissue removal methods and apparatus |
US6602204B2 (en) | 1998-02-10 | 2003-08-05 | Artemis Medical, Inc | Intraoperative tissue treatment methods |
US5997533A (en) * | 1998-01-30 | 1999-12-07 | Ethicon Endo-Surgery, Inc. | RF pressure activated instrument |
KR100286837B1 (en) * | 1998-07-15 | 2001-05-02 | 구자홍 | Resonator of a rotary compressor |
JP2003517346A (en) | 1999-06-04 | 2003-05-27 | アーテミス・メディカル・インコーポレイテッド | Tissue removal method and device |
US7534242B2 (en) | 2003-02-25 | 2009-05-19 | Artemis Medical, Inc. | Tissue separating catheter assembly and method |
US6994677B1 (en) | 2003-02-25 | 2006-02-07 | Artemis Medical, Inc. | Tissue localizing and separating assembly |
WO2002005717A1 (en) | 2000-07-18 | 2002-01-24 | Senorx, Inc. | Apparatus and method for tissue capture |
WO2002064012A2 (en) * | 2000-11-07 | 2002-08-22 | Artemis Medical, Inc. | Target tissue localization assembly and method |
-
2003
- 2003-02-25 US US10/374,584 patent/US20030204188A1/en not_active Abandoned
-
2004
- 2004-02-23 JP JP2006503747A patent/JP2006518642A/en active Pending
- 2004-02-23 WO PCT/US2004/005070 patent/WO2004075946A2/en active Application Filing
- 2004-02-23 AU AU2004216253A patent/AU2004216253B2/en not_active Ceased
- 2004-02-23 EP EP04713706A patent/EP1604359A4/en not_active Withdrawn
-
2006
- 2006-05-15 US US11/434,632 patent/US7846159B2/en active Active
Patent Citations (52)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3557794A (en) * | 1968-07-30 | 1971-01-26 | Us Air Force | Arterial dilation device |
US3910279A (en) * | 1973-06-20 | 1975-10-07 | Olympus Optical Co | Electrosurgical instrument |
US3996938A (en) * | 1975-07-10 | 1976-12-14 | Clark Iii William T | Expanding mesh catheter |
US4611594A (en) * | 1984-04-11 | 1986-09-16 | Northwestern University | Medical instrument for containment and removal of calculi |
US4638802A (en) * | 1984-09-21 | 1987-01-27 | Olympus Optical Co., Ltd. | High frequency instrument for incision and excision |
US5102415A (en) * | 1989-09-06 | 1992-04-07 | Guenther Rolf W | Apparatus for removing blood clots from arteries and veins |
US4997435A (en) * | 1989-09-25 | 1991-03-05 | Methodist Hospital Of Indiana Inc. | Percutaneous catheter with encapsulating receptacle |
US5007908A (en) * | 1989-09-29 | 1991-04-16 | Everest Medical Corporation | Electrosurgical instrument having needle cutting electrode and spot-coag electrode |
US5031634A (en) * | 1990-01-19 | 1991-07-16 | Beth Israel Hospital Assoc., Inc. | Adjustable biopsy needle-guide device |
US5100423A (en) * | 1990-08-21 | 1992-03-31 | Medical Engineering & Development Institute, Inc. | Ablation catheter |
US5370647A (en) * | 1991-01-23 | 1994-12-06 | Surgical Innovations, Inc. | Tissue and organ extractor |
US5190561A (en) * | 1991-01-23 | 1993-03-02 | Surgical Innovations, Inc. | Tissue and organ extractor |
US5176687A (en) * | 1991-05-10 | 1993-01-05 | Hasson Harrith M | Disposable pouch container for isolation and retrieval of tissues removed at laparoscopy |
US5415656A (en) * | 1993-09-28 | 1995-05-16 | American Medical Systems, Inc. | Electrosurgical apparatus |
US5370660A (en) * | 1993-11-01 | 1994-12-06 | Cordis Corporation | Apparatus and method for delivering a vessel plug into the body of a patient |
US5794626A (en) * | 1994-08-18 | 1998-08-18 | Kieturakis; Maciej J. | Excisional stereotactic apparatus |
US6106524A (en) * | 1995-03-03 | 2000-08-22 | Neothermia Corporation | Methods and apparatus for therapeutic cauterization of predetermined volumes of biological tissue |
US6312428B1 (en) * | 1995-03-03 | 2001-11-06 | Neothermia Corporation | Methods and apparatus for therapeutic cauterization of predetermined volumes of biological tissue |
US5928159A (en) * | 1995-03-03 | 1999-07-27 | Neothermia Corporation | Apparatus and method for characterization and treatment of tumors |
US5947964A (en) * | 1995-03-03 | 1999-09-07 | Neothermia Corporation | Methods and apparatus for therapeutic cauterization of predetermined volumes of biological tissue |
US5989265A (en) * | 1995-03-08 | 1999-11-23 | Bouquet De La Joliniere; Jean Henri | Device for pinpointing suspect lesions of the breast and apparatus for positioning it |
US5795308A (en) * | 1995-03-09 | 1998-08-18 | Russin; Lincoln D. | Apparatus for coaxial breast biopsy |
US6432103B1 (en) * | 1995-06-07 | 2002-08-13 | Arthrocare Corporation | System for electrosurgical treatment of submucosal tissue |
US5709697A (en) * | 1995-11-22 | 1998-01-20 | United States Surgical Corporation | Apparatus and method for removing tissue |
US5796045A (en) * | 1996-01-10 | 1998-08-18 | Gremco S.A. | Braided sheath sleeve for threading over at least one elongate element to be protected, and a method of manufacturing such a sleeve |
US6258083B1 (en) * | 1996-03-29 | 2001-07-10 | Eclipse Surgical Technologies, Inc. | Viewing surgical scope for minimally invasive procedures |
US5728133A (en) * | 1996-07-09 | 1998-03-17 | Cardiologics, L.L.C. | Anchoring device and method for sealing percutaneous punctures in vessels |
US6051008A (en) * | 1996-12-02 | 2000-04-18 | Angiotrax, Inc. | Apparatus having stabilization members for percutaneously performing surgery and methods of use |
US6258115B1 (en) * | 1997-04-23 | 2001-07-10 | Artemis Medical, Inc. | Bifurcated stent and distal protection system |
US5928260A (en) * | 1997-07-10 | 1999-07-27 | Scimed Life Systems, Inc. | Removable occlusion system for aneurysm neck |
US6626903B2 (en) * | 1997-07-24 | 2003-09-30 | Rex Medical, L.P. | Surgical biopsy device |
US6280450B1 (en) * | 1997-07-24 | 2001-08-28 | Rex Medical, Lp | Breast surgery method and apparatus |
US6221006B1 (en) * | 1998-02-10 | 2001-04-24 | Artemis Medical Inc. | Entrapping apparatus and method for use |
US6331166B1 (en) * | 1998-03-03 | 2001-12-18 | Senorx, Inc. | Breast biopsy system and method |
US6261241B1 (en) * | 1998-03-03 | 2001-07-17 | Senorx, Inc. | Electrosurgical biopsy device and method |
US6540693B2 (en) * | 1998-03-03 | 2003-04-01 | Senorx, Inc. | Methods and apparatus for securing medical instruments to desired locations in a patients body |
US20020007130A1 (en) * | 1998-03-03 | 2002-01-17 | Senorx, Inc. | Methods and apparatus for securing medical instruments to desired locations in a patients body |
US6344026B1 (en) * | 1998-04-08 | 2002-02-05 | Senorx, Inc. | Tissue specimen encapsulation device and method thereof |
US6179860B1 (en) * | 1998-08-19 | 2001-01-30 | Artemis Medical, Inc. | Target tissue localization device and method |
US6136014A (en) * | 1998-09-01 | 2000-10-24 | Vivant Medical, Inc. | Percutaneous tissue removal device |
US6312429B1 (en) * | 1998-09-01 | 2001-11-06 | Senorx, Inc. | Electrosurgical lesion location device |
US6022362A (en) * | 1998-09-03 | 2000-02-08 | Rubicor Medical, Inc. | Excisional biopsy devices and methods |
US6440147B1 (en) * | 1998-09-03 | 2002-08-27 | Rubicor Medical, Inc. | Excisional biopsy devices and methods |
US6053876A (en) * | 1999-06-09 | 2000-04-25 | Fisher; John | Apparatus and method for marking non-palpable lesions |
US6287304B1 (en) * | 1999-10-15 | 2001-09-11 | Neothermia Corporation | Interstitial cauterization of tissue volumes with electrosurgically deployed electrodes |
US6514248B1 (en) * | 1999-10-15 | 2003-02-04 | Neothermia Corporation | Accurate cutting about and into tissue volumes with electrosurgically deployed electrodes |
US6277083B1 (en) * | 1999-12-27 | 2001-08-21 | Neothermia Corporation | Minimally invasive intact recovery of tissue |
US6471659B2 (en) * | 1999-12-27 | 2002-10-29 | Neothermia Corporation | Minimally invasive intact recovery of tissue |
US6620157B1 (en) * | 2000-12-28 | 2003-09-16 | Senorx, Inc. | High frequency power source |
USD457960S1 (en) * | 2001-07-12 | 2002-05-28 | Neothermia Corporation | Electrosurgical instrument handle |
USD457628S1 (en) * | 2001-07-12 | 2002-05-21 | Neothermia Corporation | Electrosurgical instrument handle |
US7916667B2 (en) * | 2007-06-29 | 2011-03-29 | Alcatel-Lucent Usa Inc. | Method for detecting RF link imbalances in a wireless communications network |
Cited By (9)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20080039884A1 (en) * | 2006-08-10 | 2008-02-14 | Nohilly Martin J | Morcellator with detachable handle |
US8100928B2 (en) * | 2006-08-10 | 2012-01-24 | Ethicon, Inc. | Morcellator with detachable handle |
US8298243B2 (en) | 2007-07-30 | 2012-10-30 | Tyco Healthcare Group Lp | Combination wire electrode and tube electrode polypectomy device |
US8328803B2 (en) | 2008-01-31 | 2012-12-11 | Covidien Lp | Polyp removal device and method of use |
USRE46063E1 (en) | 2008-01-31 | 2016-07-12 | Covidien Lp | Polyp removal device and method of use |
US9918771B2 (en) | 2008-01-31 | 2018-03-20 | Covidien Lp | Polyp removal device and method of use |
US10959767B2 (en) | 2008-01-31 | 2021-03-30 | Covidien Lp | Polyp removal device and method of use |
US10813685B2 (en) | 2014-09-25 | 2020-10-27 | Covidien Lp | Single-handed operable surgical instrument including loop electrode with integrated pad electrode |
US11185215B2 (en) * | 2017-08-07 | 2021-11-30 | Boston Scientific Scimed, Inc. | Medical systems, devices, and related methods |
Also Published As
Publication number | Publication date |
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US7846159B2 (en) | 2010-12-07 |
EP1604359A4 (en) | 2008-10-15 |
WO2004075946A3 (en) | 2005-06-23 |
WO2004075946A2 (en) | 2004-09-10 |
US20060293654A1 (en) | 2006-12-28 |
EP1604359A2 (en) | 2005-12-14 |
AU2004216253A1 (en) | 2004-09-10 |
JP2006518642A (en) | 2006-08-17 |
AU2004216253B2 (en) | 2009-10-01 |
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