Steerable sphincterotome and methods for cannulation, papillotomy and sphincterotomy

• US 20020095168A1
• Filed: 01/18/2001
• Published: 07/18/2002
• Est. Priority Date: 01/18/2001
• Status: Active Grant

• Current Assignee: Boston Scientific Scimed (Boston Scientific Corporation)
• Original Assignee: Scimed Life Systems Incorporated (Boston Scientific Corporation)
• Inventors: Chin, Yem, Griego, John A.
• Granted Patent: US 6,579,300 B2
• Time in Patent Office: Days
• US Class Current: 606/167
• CPC Class Codes: A61B 17/320016 Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes A61B10/0233, A61B17/29, A61B17/3207 take precedence
• CPC Class Codes: A61B 17/32056 Surgical snare instruments for removing or smashing calculi A61B2017/2212; tonsillotomes A61B17/26
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/320032 Details of the rotating or oscillating shaft, e.g. using a flexible shaft
• CPC Class Codes: A61B 2018/00166 Multiple lumina
• CPC Class Codes: A61B 2018/00553 Sphincter
• CPC Class Codes: A61B 2018/00601 Cutting
• CPC Class Codes: A61B 2018/1407 Loop
• CPC Class Codes: A61B 2018/1437 whereby the windings of the spiral touch each other such as to create a continuous surface
• CPC Class Codes: A61B 2018/144 Wire
• CPC Class Codes: A61B 2018/1861 with an instrument inserted into a body lumen or cavity, e.g. a catheter

Abstract

The present invention relates to methodology of and apparatus for accurately positioning devices for performing endoscopic cannulation, papillotomy and sphincterotomy and similar procedures. The sphincterotome with a steerable or adjustable distal segment of the present invention allows the physician to control the position of the distal tip of the device independently of the endoscope and adjust for inconsistencies in the device and the anatomy. According to one embodiment of the present invention, a threaded portion of a cable assembly cooperates with a torque transmission element and a cog to enable the operator to rotate a cutting wire into a desired position relative to the catheter. Alternate embodiments allow the operator to fix the depth of a needle knife while allowing, if desired, accurate rotational positioning of the associated catheter. Threaded stabilizing elements, pivot elements and a steering wire may be used together or individually to accomplish these features. Presently available products that may be modified according to the present invention include, but are not limited to, Boston Scientific Sphincterotomes and Needle Knives.

Claims

1. In an endoscopic catheter having a distally located tissue cutting device in a first lumen thereof, the improvement for orienting the cutting device which comprises:

providing said catheter with a second lumen having a reciprocating cable therein, said second lumen having a fixed member therein for imparting rotary motion to said cable when reciprocated therethrough; and

reciprocation of said cable causing rotation of at least a distal portion of said catheter to orient said cutting device.

2. Catheter of claim 1 wherein said cable has spiral threads on an outer circumference thereof.

3. Catheter of claim 2 wherein said fixed member includes a spiral thread on an inner circumference thereof.

4. Catheter of claim 1 wherein said cutting device is a sphincterotome.

5. Catheter of claim 1 wherein said cutting device is a papillotome.

6. Catheter of claim 1 wherein said cutting device operates in response to energy from an rf heating source.

7. Catheter of claim 1 wherein said distal portion of said catheter is curved and the cutting device is a needle knife.

8. In an endoscopic catheter having a distally located tissue cutting device in a first lumen thereof, the improvement for orienting the cutting device which comprises:

providing said catheter with a second lumen having a reciprocating cable therein, said second lumen having fixed member therein for imparting rotary motion to said cable when reciprocated therethrough;

said cable having a sliding member attached thereto distally of said fixed member; and

reciprocation of said cable causing rotation of said sliding member and at least a distal portion of said catheter to orient said cutting device.

9. Catheter of claim 8 wherein said second lumen is non-round in cross section.

10. Catheter of claim 8 wherein said second lumen is square in cross section.

11. Catheter of claim 10 where said sliding member is square in cross section.

12. Catheter of claim 8 wherein said cable has spiral threads on an outer circumference thereof.

13. Catheter of claim 12 wherein said fixed member includes a spiral thread on an inner circumference thereof.

14. Catheter of claim 8 wherein the distal portion of said catheter is curved and the cutting device is a needle knife.

15. Catheter of claim 8 wherein said cutting device is a sphincterotome.

16. Catheter of claim 8 wherein said cutting device is a papillotome.

18. Method of claim 17 wherein said cable has spiral threads on an outer circumference thereof.

19. The device of claim 18 wherein said fixed member includes a spiral thread on an inner circumference thereof.

20. Method of claim 17 wherein said cutting device is a sphincterotome.

21. Method of claim 17 wherein said cutting device is a papillotome.

22. Method of claim 17 wherein said cutting device operates in response to energy from an rf heating source.

23. Method of claim 17 wherein the distal portion of said catheter is curved and the cutting device is a needle knife.

25. Method of claim 24 wherein said second lumen is non-round in cross section.

26. Method of claim 25 wherein said second lumen is square in cross section.

27. Method of claim 25 wherein said sliding member is square in cross section.

28. Method of claim 24 wherein said cable has spiral threads on an outer circumference thereof.

29. Method of claim 28 wherein said fixed member includes a spiral thread on an inner circumference thereof.

30. Method of claim 24 wherein said distal portion of said catheter is curved and the cutting device is a needle knife.

17. Method for orientating a tissue cutting device located in a distal portion of a first lumen of an endoscopic catheter which comprises:

providing said catheter with a second lumen having a reciprocating cable therein, said second lumen having a fixed member therein for imparting rotary motion to said cable when reciprocated therethrough; and

reciprocating said cable to cause rotation of at least a distal portion of said catheter thereby orienting said cutting device.

24. Method for orientating a tissue cutting device located in a distal portion of a first lumen of an endoscopic catheter which comprises:

providing said catheter with a second lumen having a reciprocating cable therein, said second lumen having a fixed member therein for imparting rotary motion to said cable when reciprocated therethrough and a sliding member attached to said cable distally of said fixed member; and

reciprocating said cable to cause rotation of said sliding member and at least a distal portion of said catheter to orient said cutting device.

31. In an endoscopic catheter having a cable actuated needle knife in a lumen thereof, said needle knife being deployable from a distal end of said catheter, the improvement for substantially preventing movement of said needle knife after deployment which comprises a distally positioned fixed stabilizing element in said lumen internally engaging said needle knife cable to prevent such movement.

32. Catheter of claim 31 wherein said needle knife cable includes a spiral thread on an outer circumference thereof.

33. Catheter of claim 32 wherein said fixed stabilizing element includes a spiral thread on an inner circumference thereof.

34. Catheter of claim 33 further comprising a pivot element included within said needle knife cable.

35. Catheter of claim 34 wherein said pivot element is proximal of said fixed stabilizing element.

36. Catheter of claim 35 wherein said needle knife cable includes a spiral thread on an outer circumference thereof.

37. Catheter of claim 36 wherein said fixed stabilizing element includes a spiral thread on an inner circumference thereof.

39. Catheter of claim 38 wherein said reciprocating cable has spiral threads on an outer circumference thereof.

40. Catheter of claim 39 wherein said fixed member includes a spiral thread on an inner circumference thereof.

41. Catheter of claim 38 wherein said needle knife operates in response to energy from an rf heating source.

42. Catheter of claim 38 wherein said distal portion of said catheter is curved.

43. Catheter of claim 38 wherein said needle knife cable includes a spiral thread on an outer circumference thereof.

44. Catheter of claim 43 wherein said fixed stabilizing element includes a spiral thread on an inner circumference thereof.

45. Catheter of claim 38 further comprising a pivot element included within said needle knife cable.

46. Catheter of claim 45 wherein said pivot element is proximal of said stabilizing element.

47. Catheter of claim 46 wherein said needle knife cable includes a spiral thread on an outer circumference thereof.

48. Catheter of claim 47 wherein said fixed stabilizing element includes a spiral thread on an inner circumference thereof.

50. Catheter of claim 49 wherein said second lumen is non-round in cross section.

51. Catheter of claim 50 wherein said second lumen is square in cross section.

52. Catheter of claim 51 wherein said sliding member is square in cross section.

53. Catheter of claim 49 wherein said cable has spiral threads on an outer circumference thereof.

54. Catheter of claim 53 wherein said fixed member includes a spiral thread on an inner circumference thereof.

55. Catheter of claim 49 wherein said needle knife operates in response to energy from an rf heating source.

56. Catheter of claim 49 wherein said distal portion of said needle knife is curved.

57. Catheter of claim 49 wherein said needle knife cable includes a spiral thread on an outer circumference thereof.

58. Catheter of claim 57 wherein said fixed stabilizing element includes a spiral thread on an inner circumference thereof.

59. Catheter of claim 49 further comprising a pivot element included within said needle knife cable.

60. Catheter of claim 59 wherein said pivot element is proximal of said fixed stabilizing element.

61. Catheter of claim 60 wherein said needle knife cable includes a spiral thread on an outer circumference thereof.

62. Catheter of claim 61 wherein said fixed stabilizing element includes a spiral thread on an inner circumference thereof.

38. In an endoscopic catheter having a cable actuated needle knife in a first lumen thereof, said needle knife being deployable from a distal end of said catheter, the improvement for orienting the cutting device and for substantially preventing movement of said needle knife after deployment which comprises:

providing said catheter with a second lumen having a reciprocating cable therein, said second lumen having a fixed member therein for imparting rotary motion to said cable when reciprocated therethrough;

reciprocation of said cable causing rotation of at least a distal portion of said catheter to orient said cutting device, and

providing a distally positioned fixed stabilizing element in said first lumen internally engaging said needle knife cable to prevent such movement.

49. In an endoscopic catheter having a cable actuated needle knife in a first lumen thereof, said needle knife being deployable from a distal end of said catheter, the improvement for orienting the cutting device and for substantially preventing movement of said needle knife after deployment which comprises:

providing said catheter with a second lumen having a reciprocating cable therein, said second lumen having a fixed member therein for imparting rotary motion to said cable when reciprocated therethrough;

said cable having a sliding member attached thereto distally of said fixed member;

reciprocation of said cable causing rotation of said sliding member and at least a distal portion of said catheter to orient said cutting device, and

providing a distally positioned fixed stabilizing element in said first lumen internally engaging said needle knife cable to prevent such movement.