Tissue resecting system

• US 20060047185A1
• Filed: 08/27/2004
• Published: 03/02/2006
• Est. Priority Date: 08/27/2004
• Status: Active Grant

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Smith & Nephew Incorporated (Smith & Nephew PLC)
• Inventors: Hedstrom, Petter, Newell, Christopher R., Shener, Cemal, Krause, Kenneth W.
• Granted Patent: US 8,062,214 B2
• Time in Patent Office: Days
• US Class Current: 600/156
• CPC Class Codes: A61B 1/00068 Valve switch arrangements
• CPC Class Codes: A61B 1/015 Control of fluid supply or evacuation
• CPC Class Codes: A61B 1/018 for receiving instruments
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• 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 17/3421 Cannulas
• CPC Class Codes: A61B 17/3498 Valves therefor, e.g. flapper valves, slide valves haemostasis valves A61M39/06; check valves A61M39/24
• CPC Class Codes: A61B 2017/0225 flexible, e.g. fabrics, meshes, or membranes
• CPC Class Codes: A61B 2017/320024 Morcellators, e.g. having a hollow cutting tube with an annular cutter for morcellating and removing tissue
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments

Abstract

A surgical system includes a first instrument defining a first channel and a second instrument receivable by the first channel. The second instrument defines a second channel. A valve coupled to the first instrument controls fluid flow through the first channel, such that impedance of fluid flow through the first channel is substantially the same without the second instrument received in the first channel and with the first channel partially blocked by the second instrument. In another aspect, a surgical apparatus includes an outer member and an inner member received within the outer member to define a first channel therebetween. The inner member houses an optical lens and defines a second channel for receiving a surgical instrument. The first and second channels are configured such that a pump having an inflow rate of up to about 0.7 L/min connected to the second channel can maintain fluid pressure inside an organ.

Claims

1. A surgical system comprising:

a first instrument defining a fluid flow channel;

a second instrument receivable by the first instrument fluid flow channel; and

a valve coupled to the first instrument and configured to control fluid flow through the first instrument channel, wherein the valve is configured such that impedance of fluid flow through the first instrument channel is substantially the same without the second instrument received in the first instrument channel and with the first instrument channel partially blocked by the second instrument such that the first instrument channel is limited to a region between the first and second instruments.

2. The system of claim 1 wherein the first instrument includes an outer member and an inner member, the inner member defining the first instrument channel therethrough, the inner member being received within the outer member, and the outer member and the inner member defining a second fluid flow channel therebetween.

3. The system of claim 2 wherein the second instrument includes a tube defining a second instrument channel therethrough, the tube partially blocking the first instrument fluid flow channel when received therein.

4. The system of claim 3 wherein the second fluid flow channel has a cross-sectional area of about 0.0083 to about 0.0249 square inches, the first instrument fluid flow channel has a cross-sectional area of about 0.0053 to about 0.0159 square inches, and the second instrument channel has a cross-sectional area of about 0.0042 to about 0.013 square inches.

5. The system of claim 4 wherein the second fluid flow channel has a cross-sectional area of about 0.0166 square inches, the first instrument fluid flow channel has a cross-sectional area of about 0.0106 square inches, and the second instrument channel has a cross-sectional area of about 0.0085 square inches.

6. The system of claim 1 wherein the valve comprises a housing and a body within the housing, the body defining an opening therein and being moveable relative to the housing between a first position in which the opening and the first instrument channel define a first fluid flow path having a first impedance and a second position in which the opening is arranged to receive the second instrument therethrough such that the opening and the first instrument channel define a second fluid flow path that has a second impedance substantially equal to the first impedance.

7. The system of claim 1 further comprising a pump, the first instrument configured to connect to the pump such that the pump infuses fluid through the first instrument channel.

8. The system of claim 7 wherein the pump is programmed to infuse fluid through the first instrument channel to maintain a substantially constant pressure of between about 60 mm Hg and about 120 mm Hg inside a distensible organ.

9. The system of claim 7 further comprising a sensor coupled to the pump to sense a flow impedance at a given flow rate and a controller coupled to the sensor and the pump to compare the flow impedance to a predetermined flow impedance for the given flow rate to verify the identity of the first and second instruments.

10. The system of claim 1 wherein the second instrument has a channel in fluid communication with a source of suction and further comprising a regulator interposed between the second instrument channel and the source of suction to regulate an amount of suction applied through the second instrument channel.

11. A surgical system comprising:

a first instrument defining a fluid flow channel;

a second instrument receivable by the first instrument fluid flow channel; and

means for maintaining a substantially constant impedance of fluid flow through the first instrument channel with and without the second instrument received in the first instrument channel.

12. A method comprising:

(a) positioning a valve coupled to a first instrument in a first position;

(b) introducing fluid to a distensible organ through the valve with the valve in the first position and through a channel in the first instrument;

(c) positioning the valve in a second position;

(d) introducing a second instrument through the valve with the valve in the second position and through the first instrument channel; and

(e) introducing fluid to the distensible organ through the valve with the valve in the second position and through a region of the first instrument channel located between the first and second instruments,

wherein the impedance of fluid flow in steps (b) and (e) is substantially the same.

13. The method of claim 12 further comprising maintaining substantially constant fluid pressure within the distensible organ with and without the second instrument received in the first instrument channel.

14. The method of claim 13, wherein maintaining comprises suctioning fluid from the distensible organ through the second instrument.

15. The method of claim 14, further comprising regulating a pump coupled to the valve for introducing fluid through the valve.

16. A valve comprising:

a housing; and

a body within the housing, the body defining an opening therein, the body being moveable relative to the housing between a first position in which the opening and the housing define a first fluid flow path having a first impedance and a second position in which the opening is arranged to receive a surgical instrument therein, the opening being configured such that with the surgical instrument received therein, the opening and the housing define a second fluid flow path that has a second impedance substantially equal to the first impedance.

17. The valve of claim 16 wherein the opening includes a throughbore through the body for receiving the surgical instrument.

18. The valve of claim 17 wherein the opening further includes a second bore having a first open end and a second closed end in the body.

19. The valve of claim 18 wherein the second bore is arranged substantially orthogonal to the throughbore.

20. The valve of claim 18 wherein the second bore intersects the throughbore.

21. The valve of claim 20 wherein the housing defines an inlet and an outlet.

22. The valve of claim 21 wherein when the body is in the first position, the throughbore is partially aligned with the inlet and the first fluid flow path is from the inlet, through the throughbore, and then through the second bore to the outlet.

23. The valve of claim 21 wherein when the body is in the second position, the second bore is aligned with the inlet and the second fluid flow path is from the inlet, through the second bore, and then through the throughbore to the outlet.

24. A method of regulating inflow through a valve comprising:

positioning the valve in a first position wherein the valve has a first impedance;

positioning the valve in a second position; and

introducing a surgical instrument through the valve in the second position wherein a combination of the surgical instrument and the valve has a second impedance substantially equal to the first impedance.

25. An apparatus for surgery comprising:

an outer member, and

an inner member received within the outer member, the outer member and the inner member defining a first channel therebetween, the inner member housing an optical lens and defining a second channel for receiving a surgical instrument, the first and second channels being configured such that a pump having an inflow rate of up to about 0.7 L/min connected to the second channel can maintain fluid pressure inside an organ.

26. The apparatus of claim 25 further comprising a pump coupled to the second channel to introduce fluid through the second channel at an inflow rate up to about 0.7 L/min.

27. The apparatus of claim 25 wherein the outer member defines a plurality of holes in fluid communication with the first channel.

28. The apparatus of claim 27 wherein the plurality of holes is positioned in a distal portion of the outer member.

29. The apparatus of claim 25 wherein the second channel has a D-shaped cross-section.

30. The apparatus of claim 25 wherein the first channel has a cross-sectional area of about 0.0053 to about 0.0159 square inches and the second channel has a cross-sectional area of about 0.0083 to about 0.0249 square inches for receiving the surgical instrument having a suction channel with a cross-sectional area of about 0.0042 to about 0.013 square inches.

31. The apparatus of claim 30 wherein the first channel has a cross-sectional area of about 0.0166 square inches and the second channel has a cross-sectional area of about 0.0106 square inches for receiving the surgical instrument having a suction channel with a cross-sectional area of about 0.0085 square inches.

32. The apparatus of claim 25 further comprising a valve coupled to the inner member for regulating inflow through the second channel such that the valve and the second channel have a first impedance equal to a second impedance when the surgical instrument is received in the second channel.

33. A fluid management system comprising:

a pump configured for coupling to an endoscope to infuse fluid through the endoscope at a given flow rate;

a sensor coupled to the pump that senses a flow impedance through the endoscope at the given flow rate;

a controller coupled to the sensor and programmed to compare the flow impedance to a predetermined flow impedance for the given flow rate to verify the identity of the endoscope and a surgical instrument received therein.

34. The fluid management system of claim 33 wherein the sensor comprises a pressure transducer.

35. The fluid management system of claim 33 further comprising a circuit coupled to the controller and the pump for disabling the pump if the identity of the surgical instrument and endoscope is not verified.

36. The fluid management system of claim 33 wherein the controller is programmed to compare flow impedances to predetermined flow impedances at multiple flow rates.

37. A fluid management system comprising:

means for infusing fluid through an endoscope at a flow rate;

means for measuring a flow impedance through the endoscope at the flow rate; and

means for comparing the flow impedance to a predetermined flow impedance to verify the identity of the endoscope and a surgical instrument received therein.

38. A method comprising:

programming a pump with data on a predetermined flow impedance for an endoscope and surgical instrument assembly for a given flow rate;

activating the pump to infuse fluid through the endoscope and surgical instrument assembly at the given flow rate;

sensing a flow impedance through the assembly; and

comparing the sensed flow impedance to the predetermined flow impedance.

39. The method of claim 38 further comprising disabling the pump if the flow impedance is not within a threshold value of the predetermined flow impedance.

40. A method comprising:

infusing fluid into a distensible organ; and

maintaining a substantially constant fluid pressure inside the distensible organ between about 60 mm Hg and about 120 mm Hg.

41. A system comprising:

an endoscope defining a channel therethrough;

a surgical instrument received within the endoscope channel, the surgical instrument defining a channel therein for connection with a source of suction; and

a regulator coupled to the surgical instrument channel between the instrument channel and the source of suction to regulate an amount of suction applied through the instrument channel.

42. The system of claim 41 wherein the regulator is configured to maintain the suction pressure below a threshold value.

43. The system of claim 42 wherein the threshold value is about 200 mm Hg.