Resectoscopic Device And Method

• US 20070244353A1
• Filed: 04/13/2006
• Published: 10/18/2007
• Est. Priority Date: 04/13/2006
• Status: Active Grant

• Current Assignee: Dane Larsen
• Original Assignee: Dane Larsen
• Inventors: Larsen, Dane
• Granted Patent: US 7,794,393 B2
• Time in Patent Office: Days
• US Class Current: 600/105
• CPC Class Codes: A61B 1/12 with cooling or rinsing arrangements
• CPC Class Codes: A61B 1/126 provided with means for cleaning in-use
• CPC Class Codes: A61B 1/307 for the urinary organs, e.g. urethroscopes, cystoscopes
• CPC Class Codes: A61B 18/18 by applying electromagnetic radiation, e.g. microwaves radiation therapy A61N5/00

Abstract

A surgical instrument has a channel dimensioned to receive a viewing instrument and enable the viewing instrument to be moved to or from a position near an optically transparent portion of a blunt, enclosed distal end of a shaft to provide unobstructed viewing through the distal end, and a position to the proximal side of an enclosed working area to provide viewing of the enclosed working area. A surgical instrument also or alternatively has a fluid routing switch within a shaft which can selectively connect a fluid infusion channel to at least one fluid export pore or a return channel. A method involves moving a viewing instrument to or from a position near an optically transparent portion of a blunt, enclosed distal shaft end and a proximal side of an enclosed working area. A method also or alternatively involves changing a position of a fluid routing switch within the shaft.

Claims

1. A surgical instrument comprising:

a shaft having a proximal end and a blunt, enclosed distal end, the blunt, enclosed distal end being optically transparent over at least a portion of its area, the shaft further comprising

a longitudinally extending fluid infusion channel,

a side wall having an opening therein defining an enclosed working area within which resection can occur,

a longitudinally extending return channel coupling the working area to a connection for a tissue collection cavity,

a viewing instrument channel dimensioned to receive a viewing instrument inserted from the proximal end and being positioned so as to enable the inserted viewing instrument to be moved to or from

i) a position near the portion of the blunt, enclosed distal end that is optically transparent to provide unobstructed viewing through the blunt, enclosed distal end, and

ii) a position to the proximal side of the enclosed working area to provide viewing of the enclosed working area, and

at least one pore through which fluid passing from the proximal end of the shaft towards the blunt, enclosed distal end via the fluid infusion channel can exit the shaft.

2. The surgical instrument of claim 1 further comprising:

a switch, within the shaft, coupled to each of the fluid infusion channel, pore and return channel.

3. The surgical instrument of claim 2 wherein the switch comprises one of a pivoting switch or a sliding switch.

4. The surgical instrument of claim 1 wherein the optically transparent portion comprises:

a membrane, a plate, a lens, or a surface of the shaft.

5. The surgical instrument of claim 4 wherein the membrane, plate, lens or surface of the shaft includes an in-shaft surface configured as a mirror image of an end surface of a viewing instrument to facilitate abutting of the end surface against the in-shaft surface.

6. The surgical instrument of claim 1 wherein the optically transparent portion comprises:

a hole.

7. The surgical instrument of claim 1 further comprising:

a handle, having a tissue receiving cavity therein, coupled to the return channel.

8. The surgical instrument of claim 1 further comprising:

a reflective surface within the shaft and located relative to the viewing instrument channel so as to provide a viewing instrument within the viewing instrument channel with a view that is different from a view that can be obtained by the viewing instrument alone.

9. The surgical instrument of claim 1 further comprising:

a trolley, located near the proximal end, and configured to movably constrain the viewing instrument such that movement of the trolley will cause the inserted viewing instrument to be moved between the position near the portion of the blunt, enclosed distal end and the position to the proximate side of the enclosed working area.

10. The surgical instrument of claim 1 further comprising:

at least one auxiliary channel within the shaft.

11. The surgical instrument of claim 10 wherein the auxiliary channel extends from near the proximal end to the working area.

12. The surgical instrument of claim 10 wherein the auxiliary channel extends from near the proximal end to the blunt, enclosed distal end.

13. The surgical instrument of claim 1 further comprising:

a cutting member within the shaft.

14. The surgical instrument of claim 13 wherein the cutting member comprises at least one of:

a wire loop, a blade, a scissor, a shutter or a harmonically vibrated cutter.

15. The surgical instrument of claim 13 wherein the cutting member is moveable solely within the working area.

16. The surgical instrument of claim 13 further comprising:

a cutting member home position and wherein the cutting member is normally biased to the home position.

17. The surgical instrument of claim 16 wherein the cutting member home position is to the distal side of the working area.

18. The surgical instrument of claim 16 wherein the cutting member home position is to the proximal side of the working area.

19. The surgical instrument of claim 1 wherein:

the opening in the side wall defining the enclosed working area comprises a closed geometric shape.

20. The surgical instrument of claim 19 wherein the closed geometric shape is one of a circle, a quadralateral or an ovoid.

39. A resectoscope comprising:

the surgical instrument of one of claims 1, 21, 27, 31, 37 or 38 interconnected to

i) a handle having a tissue receiving cavity, and

ii) a cutting member.

40. A kit comprising:

the surgical instrument of one of claims 1, 21, 27, 31, 37 or 38 packaged in sterile form.

41. The kit of claim 40 further comprising:

a handle having a tissue receiving cavity therewithin.

42. The kit of claim 40 wherein the shaft is a single use shaft.

43. The kit of claim 40 further comprising:

a cutting member dimensioned for placement within the working area to effect tissue resection therewithin.

21. A surgical instrument comprising:

a shaft having a proximal end and a blunt, enclosed distal end, the blunt, enclosed distal end being optically transparent over at least a portion of its area, the shaft further comprising

a longitudinally extending fluid infusion channel,

a side wall having

i) a resection port therein, near the distal end, defining an enclosed working area within which tissue can be resected, and

ii) at least one fluid export pore,

a longitudinally extending return channel coupling the working area to the proximal end dimensioned for passage of the resected tissue from the working area to the proximal end, and

a movable fluid routing switch within the shaft and near the distal end which, when in a first position, will cause fluid traveling within the fluid infusion channel from the proximal end to the distal end to exit the shaft via the at least one fluid export pore and, when in a second position, will cause fluid traveling within the fluid infusion channel from the proximal end to the distal end to be routed within the shaft near the distal end so that it will pass through the working area and along the return channel towards the proximal end.

22. The surgical instrument of claim 21 wherein the movable fluid routing switch comprises a pivotable switch

23. The surgical instrument of claim 21 wherein the movable fluid routing switch comprises a reed switch.

24. The surgical instrument of claim 23 wherein the reed switch comprises at least one hole through which the fluid traveling within the fluid infusion channel can pass.

25. The surgical instrument of claim 21 further comprising:

a reflective surface proximate to the switch that is inclined relative to a longitudinal axis of the shaft.

26. The surgical instrument of claim 21 wherein the movable fluid routing switch is configured for actuation by one of a viewing instrument or a cutting member.

27. A surgical instrument comprising:

a shaft having a proximal end and a blunt, enclosed distal end, the shaft further comprising

a fluid infusion channel,

a return channel dimensioned for passage of resected tissue from a working area within the shaft near the distal end towards the proximal end,

at least one fluid export pore, and

a fluid routing switch within the shaft, near the distal end, which can selectively connect the fluid infusion channel to at least one of the at least one fluid export pore or the return channel.

28. The surgical instrument of claim 27 wherein the fluid routing switch comprises a pivotable switch

29. The surgical instrument of claim 27 wherein the fluid routing switch comprises a reed switch.

30. The surgical instrument of claim 27 further comprising:

a reflective surface near the fluid routing switch that is inclined relative to a longitudinal axis of the shaft.

31. A surgical instrument comprising:

a shaft having a proximal end and a blunt, enclosed distal end, the blunt, enclosed distal end being optically transparent over at least a portion of its area,

a scope having a viewing end that is moveable within the shaft between a first position and a second position such that

i) when in the first position within the shaft, the viewing end will be on a distal side of a working area within which resection can occur and proximate to the optically transparent portion of the distal end and provide an unobstructed view external to the blunt, enclosed distal end; and

ii) when in the second position within the shaft, the viewing end will be on a proximal side of the working area and provide a view of the working area.

32. The surgical instrument of claim 31 further comprising:

a trolley.

33. The surgical instrument of claim 32 wherein the trolley comprises at least two pits, each configured to receive an orientation pin of the scope.

34. The surgical instrument of claim 31 wherein the viewing end of the scope comprises a beveled surface.

35. The surgical instrument of claim 34 wherein the portion of the optically transparent area comprises a section having a bevel that is configured for mating with the beveled surface.

36. The surgical instrument of claim 31 further comprising a fluid routing switch configured for actuation by the scope when the scope is in the first position.

37. A surgical instrument comprising:

a shaft having a proximal end, a working area defined by a port in a sidewall of the shaft, at least one fluid export port, and a blunt, enclosed distal end having an optically transparent portion;

at least two fluid conveying channels within the shaft; and

a switch within the shaft configured to selectively modify a connection from between one of the fluid conveying channels and the at least one fluid export port, to between the one of the fluid conveying channels and another of the fluid conveying channels.

38. A surgical instrument comprising:

a longitudinal shaft including

a) an enclosed, blunt distal tip;

b) an internal fluid flow path; and

c) an externalizable fluid flow path,

a working area, defined by an opening in a side of the longitudinal shaft, located within the internal fluid flow path, and

a switch, coupled to the internal fluid flow path and the externalizable fluid flow path which will control infusion fluid flow into the internal fluid flow path and the externalizable fluid flow path.

44. A method comprising:

a) inserting a shaft of a surgical instrument, having a blunt, enclosed distal end, into a body cavity while viewing the insertion through the blunt, enclosed distal end via a viewing element end positioned to the distal side of a working area near an optically transparent portion of the distal end;

b) establishing a fluid path extending from near a proximal end of the shaft, through at least a portion of the shaft, to an export pore;

c) withdrawing the viewing element end to a proximal side of the working area;

d) moving the shaft so that tissue to be resected is within the working area;

e) establishing, within the shaft, a fluid circulation path that will direct fluid along a path from the proximal side of the working area towards the distal side of the working area without passing through the working area, then from the distal side of the working area to the proximal side of the working area by passing through the working area; and

f) resecting the tissue within the working area such that, once the tissue is resected, fluid in the fluid circulation path passing through the working area from the distal to the proximal side will convey the resected tissue away from the working area.

45. The method of claim 44 wherein step “

d)”

occurs one of concurrent with, before or after step “

e)”

.

46. The method of claim 45 wherein, following “

f)”

the method comprises;

discarding at least the shaft.

47. The method of claim 45 wherein, following “

f)”

the method comprises;

sterilizing at least the shaft.

48. The method of claim 45 further comprising:

establishing, for a period of time, a rate of fluid flow through the export pore.

49. The method of claim 48 wherein, while the fluid circulation rate is established, the method further comprises:

establishing a fluid flow rate within at least a portion of the fluid circulation path that is at least double what the rate of fluid flow was through the export pore following “

b)”

.

50. The method of claim 48 wherein, while the fluid circulation rate is established, the method further comprises:

establishing a fluid flow rate within at least a portion of the fluid circulation path that is at least triple what the rate of fluid flow was through the export pore following “

b)”

.

51. The method of claim 45 further comprising:

causing the fluid in at least a portion of the fluid circulation path to flow at a rate of at least 4 liters/min.

52. The method of claim 45 wherein, following “

a)”

the method further comprises;

cauterizing tissue within the body cavity without withdrawing the blunt, enclosed distal end from the body cavity.

53. The method of claim 45 wherein, following “

a)”

the method further comprises;

deploying a device in the body cavity via an auxiliary channel within the shaft.

54. A method comprising:

viewing insertion of a shaft, having a blunt, enclosed distal end, into a body cavity through the blunt distal end via an optical element located proximate to the distal end;

causing a fluid flowing along the shaft from a proximal end to a distal end to exit the shaft through at least one export pore;

changing a switch setting such that the fluid flowing in the proximal to distal direction will bypass a working area and, once past the working area will flow in the distal to proximal direction and pass through the working area; and

causing a discrete piece of tissue to enter the working area so that it will be conveyed in the distal to proximal direction by the flow of the fluid.

55. The method of claim 54 further comprising:

causing the fluid to flow through the working area at a rate in excess of 4 liters/min.

56. The method of claim 54 wherein the changing the switch setting comprises:

moving one of a viewing instrument or a cutting member.

57. The method of claim 54 further comprising:

providing a tissue collector near the proximal end of the shaft that will receive and retain the discrete piece of tissue.

58. The method of claim 54 wherein the causing the discrete piece of tissue to enter the working area comprises:

moving a cutting element in a proximal to distal direction.

59. The method of claim 54 wherein the causing the discrete piece of tissue to enter the working area comprises:

moving a cutting element in a distal to proximal direction.

60. The method of claim 54 wherein, if the discrete piece of tissue becomes caught on a cutting member, the method comprises:

moving at least one of the cutting member or a viewing instrument relative to each other to dislodge the discrete piece of tissue.

61. The method of claim 54 wherein, if the discrete piece of tissue becomes caught on a cutting member, the method comprises:

moving the cutting member within the flowing fluid.

62. The method of claim 54 wherein, if the discrete piece of tissue becomes caught on a cutting member, the method comprises:

inserting an object through an auxiliary channel in the shaft into the working area in order to use the object to dislodge the discrete piece of tissue without withdrawing any of a cutting member, viewing instrument or a section of the shaft containing the working area from the body cavity.

63. The method of claim 54 wherein, if the discrete piece of tissue becomes caught on a cutting member, the method comprises:

returning the cutting member to a home position in order to dislodge the discrete piece of tissue.

64. A method comprising:

providing a switch in a shaft for an instrument that can be used to resect tissue within a body cavity, the shaft having a proximal end and a distal end;

defining a first position for the switch which will cause fluid flowing in a channel in a proximal to distal direction to exit the shaft through at least one export pore located near the distal end; and

defining a second position for the switch, which will cause fluid flowing in the channel in the proximal to distal direction to remain within the shaft and be directed so as to pass through a working area where resection can occur to cause a piece of resected tissue to move in a distal to proximal direction within the shaft.

65. The method of claim 64 further comprising:

defining at least one position between the first and second positions wherein at least some of the fluid flowing in the channel in the proximal to distal direction will exit the shaft through the at least one export pore and other of the fluid flowing in the channel in the proximal to distal direction will remain within the shaft and be directed so as to pass through the working area and cause the piece of resected tissue to move in the distal to proximal direction within the shaft.

66. A method comprising:

defining, in a shaft for a resectoscope having a blunt, enclosed distal end including an optically transparent area, a first location for a viewing instrument, the first location being to the distal side of a working area but proximate to the optically transparent area and the working area being defined by an opening in the shaft having a closed geometric shape that is located to the proximal side of the enclosed distal end in a perimeter surface of the shaft, so that, when the viewing instrument is in the first position, a user using the viewing instrument will be able to see an area external to and longitudinally removed from the distal end of the shaft via the optically transparent area;

defining, in the shaft, a second location for the viewing instrument, to the proximal side of the working area, such that, when the viewing instrument is in the second position the user will be able to see resectable tissue of a body cavity that is located within the working area; and

defining the placement of the first position relative to the second position such that, the viewing instrument can be moved back and forth between the first position to the second position concurrent with export of tissue within the body cavity.

67. A neurosurgical instrument comprising:

a shaft, dimensioned for insertion through a cranial burr-hole, having a proximal end and a blunt, enclosed distal end, the blunt, enclosed distal end being optically transparent over at least a portion of its area, the shaft further comprising

a longitudinally extending fluid infusion channel,

a side wall having an opening therein through which fluid-induced intracranial pressure caused during insertion of the shaft can be relieved, the opening further defining an enclosed working area within which resection can occur,

a longitudinally extending return channel coupling the working area to a connection for a tissue collection cavity,

a viewing instrument channel dimensioned to receive a viewing instrument inserted from the proximal end and being positioned so as to enable the inserted viewing instrument to be moved to or from

i) a position near the portion of the blunt, enclosed distal end that is optically transparent to provide unobstructed viewing of intracranial tissue through the blunt, enclosed distal end, and

ii) a position to the proximate side of the enclosed working area to provide viewing of the enclosed working area, and

at least one pore through which fluid passing from the proximal end of the shaft towards the blunt, enclosed distal end via the fluid infusion channel can periodically exit the shaft.

68. The neurosurgical instrument of claim 67 wherein:

a portion of a body of the shaft is curved.

69. The neurosurgical instrument of claim 67 wherein:

a portion of a body of the shaft is flexible.

70. A neurosurgical instrument comprising:

a shaft, dimensioned for insertion through a cranial burr-hole, and having a proximal end and a blunt, enclosed distal end, the shaft further comprising

a fluid infusion channel,

a return channel dimensioned for drainage of fluid introduced into the cranium during insertion of the shaft and passage of resected tissue from a working area within the shaft near the distal end towards the proximal end,

at least one fluid export pore, and

a fluid routing switch within the shaft, near the distal end, which can selectively connect the fluid infusion channel to the at least one fluid export pore during incremental advancement of the instrument between the burr-hole and an area where tissue resection would occur or to the return channel to export the resected tissue from the working area.

71. A neurosurgical instrument comprising:

a shaft, dimensioned for insertion through a cranial burr-hole, and having a proximal end and a blunt, enclosed distal end, the blunt, enclosed distal end being optically transparent over at least a portion of its area,

a scope having a viewing end that is moveable within the shaft between a first position and a second position such that

i) when in the first position within the shaft, the viewing end will be on a distal side of a working area within which resection can occur and proximate to the optically transparent portion of the distal end to provide an unobstructed view of cranial tissue that is external to the blunt, enclosed distal end; and

ii) when in the second position within the shaft, the viewing end will be on a proximal side of the working area and provide a view of the working area.

72. A neurosurgical method comprising:

a) inserting a shaft of a neurosurgical instrument, having a blunt, enclosed distal end, through a burr-hole in a cranium while viewing the insertion through the blunt, enclosed distal end via a viewing element end positioned to the distal side of a working area near an optically transparent portion of the distal end;

b) establishing a fluid path extending from near a proximal end of the shaft, through at least a portion of the shaft, to an export pore;

c) briefly infusing a small amount of fluid into the cranium;

d) incrementally advancing the distal end within the cranium to a resection site;

e) withdrawing the viewing element end to a proximal side of the working area;

f) moving the shaft so that tissue at the resection site that is to be resected is within the working area;

g) establishing, within the shaft, a fluid circulation path that will direct fluid along a path from the proximal side of the working area towards the distal side of the working area without passing through the working area, then from the distal side of the working area to the proximal side of the working area and passing through the working area; and

h) resecting the tissue within the working area such that, once the tissue is resected, fluid in the fluid circulation path passing through the working area from the distal to the proximal side will convey the resected tissue away from the working area and towards the proximal end of the shaft.

73. A spinal microdiscectomy instrument comprising:

a shaft, dimensioned for insertion through a paraspinal incision, having a proximal end and a blunt, enclosed distal end, the blunt, enclosed distal end being optically transparent over at least a portion of its area, the shaft further comprising

a longitudinally extending fluid infusion channel,

a side wall having an opening therein defining an enclosed working area within which tissue resection can occur,

a longitudinally extending return channel coupling the working area to a connection for a tissue collection cavity,

a viewing instrument channel dimensioned to receive a viewing instrument inserted from the proximal end and being positioned so as to enable the inserted viewing instrument to be moved to or from

i) a position near the portion of the blunt, enclosed distal end that is optically transparent to provide unobstructed viewing of spinal disc tissue through the blunt, enclosed distal end, and

ii) a position to the proximate side of the enclosed working area to provide viewing of spinal disc tissue that will be resected within the enclosed working area.

74. A spinal microdiscectomy instrument comprising:

a shaft, dimensioned for insertion through a paraspinal incision, and having a proximal end and a blunt, enclosed distal end, the shaft further comprising

a fluid infusion channel,

a return channel dimensioned for passage of resected spinal disc tissue from a working area within the shaft near the distal end towards the proximal end,

at least one fluid export pore, and

a fluid routing switch within the shaft, near the distal end, which can selectively connect the fluid infusion channel to the at least one fluid export pore or to the return channel to export the resected spinal disc tissue from the working area.

75. A spinal microdiscectomy instrument comprising:

a shaft, dimensioned for insertion through a paraspinal incision and having a proximal end and a blunt, enclosed distal end, the blunt, enclosed distal end being optically transparent over at least a portion of its area,

a scope having a viewing end that is moveable within the shaft between a first position and a second position such that

i) when in the first position within the shaft, the viewing end will be on a distal side of a working area within which resection can occur and proximate to the optically transparent portion of the distal end to provide an unobstructed view of spinal disc tissue external to the blunt, enclosed distal end; and

ii) when in the second position within the shaft, the viewing end will be on a proximal side of the working area and provide a view of spinal disc tissue within the working area.

76. A method of performing a surgical procedure on spinal disc tissue comprising:

a) inserting a shaft of an instrument, having a blunt, enclosed distal end, through a paraspinal incision while viewing the insertion through the blunt, enclosed distal end via a viewing element end positioned to the distal side of a working area near an optically transparent portion of the distal end;

b) establishing a fluid path extending from near a proximal end of the shaft, through at least a portion of the shaft, to an export pore to create a minimally inflated cavity;

c) withdrawing the viewing element end to a proximal side of the working area;

d) moving the shaft so that tissue to be resected is within the working area;

g) establishing, within the shaft, a fluid circulation path that will direct fluid along a path from the proximal side of the working area towards the distal side of the working area without passing through the working area, then from the distal side of the working area to the proximal side of the working area and passing through the working area; and

h) resecting the tissue within the working area such that, once the tissue is resected, fluid in the fluid circulation path passing through the working area from the distal to the proximal side will convey the resected tissue away from the working area and towards the proximal end of the shaft.

77. An instrument for use in thoracic surgery comprising:

an articulable shaft dimensioned for insertion into the pleural space and having a proximal end and a blunt, enclosed distal end, the blunt, enclosed distal end being optically transparent over at least a portion of its area, the shaft further comprising

a longitudinally extending fluid infusion channel,

a side wall having an opening therein defining an enclosed working area within which tissue resection can occur,

a longitudinally extending return channel coupling the working area to a connection for a tissue collection cavity,

a viewing instrument channel dimensioned to receive a viewing instrument inserted from the proximal end and being positioned so as to enable the inserted viewing instrument to be moved to or from

i) a position near the portion of the blunt, enclosed distal end that is optically transparent to provide unobstructed viewing of tissue within the pleural space through the blunt, enclosed distal end, and

ii) a position to the proximate side of the enclosed working area to provide viewing of tissue that will be resected within the enclosed working area.

78. The instrument of claim 77 further comprising:

a longitudinally extending auxiliary channel, coupled to an auxiliary port, the auxiliary port extending the auxiliary channel to a position external to the distal end, through which fluid external to the shaft can be drawn into the shaft by vacuum applied to the auxiliary channel.

79. The instrument of claim 77 wherein:

a portion of the shaft containing the blunt, enclosed distal end is configured for axial rotation.

80. An instrument for use in thoracic surgery comprising:

an ariculable shaft, dimensioned for insertion through a chest tube into a pleural space, the shaft having a proximal end and a blunt, enclosed distal end, the shaft further comprising

a fluid infusion channel,

a return channel dimensioned for passage of resected tissue from a working area within the shaft near the distal end towards the proximal end,

at least one fluid export pore, and

a fluid routing switch within the shaft, near the distal end, which can selectively connect the fluid infusion channel to the at least one fluid export pore to allow tissue rinsing or to the return channel to export the resected tissue from the working area out of the pleural space.

81. An instrument for use in thoracic surgery comprising:

an articulable shaft, dimensioned for insertion through a chest tube into a pleural space, and having a proximal end and a blunt, enclosed distal end, the blunt, enclosed distal end being optically transparent over at least a portion of its area,

an auxiliary channel within the shaft through which fluid external to the shaft can be drawn into the shaft by application of a vacuum to the auxiliary channel;

a scope having a viewing end that is moveable within the shaft between a first position and a second position such that

i) when in the first position within the shaft, the viewing end will be on a distal side of a working area within which resection can occur and proximate to the optically transparent portion of the distal end to provide an unobstructed view of tissue external to the blunt, enclosed distal end within a pleural space; and

ii) when in the second position within the shaft, the viewing end will be on a proximal side of the working area and provide a view of the working area.

82. A method of performing a thoracic surgical procedure comprising:

a) inserting an articulable shaft of an instrument, having a blunt, enclosed distal end, into the chest cavity while viewing the insertion through the blunt, enclosed distal end via a viewing element end positioned to the distal side of a working area near an optically transparent portion of the distal end;

b) articulating the shaft in order to target tissue for resection;

c) withdrawing the viewing element end to a proximal side of the working area;

d) moving the shaft so that tissue to be resected is within the working area;

e) establishing, within the shaft, a fluid circulation path that will direct fluid along a path from the proximal side of the working area towards the distal side of the working area without passing through the working area, then from the distal side of the working area to the proximal side of the working area and passing through the working area; and

f) resecting the tissue within the working area such that, once the tissue is resected, fluid in the fluid circulation path passing through the working area from the distal to the proximal side will convey the resected tissue away from the working area and out of the chest cavity.

83. An instrument for use in pulmonologic surgery comprising:

a shaft, dimensioned for insertion into one of a human laryngeal, tracheal or bronchial passage, the shaft having a proximal end and a blunt, enclosed distal end, the blunt, enclosed distal end being optically transparent over at least a portion of its area, the shaft further comprising

a longitudinally extending fluid infusion channel,

a side wall having an opening therein defining an enclosed working area within which resection can occur,

a longitudinally extending return channel coupling the working area to a connection for a tissue collection cavity,

an auxiliary channel coupled to an opening in a surface of the shaft through which fluid can be moved from external to the shaft into the shaft by application of a vacuum to the auxiliary channel;

a viewing instrument channel dimensioned to receive a viewing instrument inserted from the proximal end and being positioned so as to enable the inserted viewing instrument to be moved to or from

i) a position near the portion of the blunt, enclosed distal end that is optically transparent to provide unobstructed viewing through the blunt, enclosed distal end, and

ii) a position to the proximate side of the enclosed working area to provide viewing of the enclosed working area.

84. The instrument of claim 83 wherein:

the working area is within a first portion of the shaft,

the shaft comprises a second portion located between the first portion and the proximal end, and

the second portion is flexible.

85. An instrument for use in pulmonologic surgery comprising:

a shaft, dimensioned for insertion into one of a human laryngeal, tracheal or bronchial passage, the shaft having a proximal end and a blunt, enclosed distal end, the shaft further comprising

an auxiliary channel through which fluid can be moved from external to the shaft into the shaft by application of a vacuum to the auxiliary channel,

a fluid infusion channel,

a return channel dimensioned for passage of resected tissue from a working area within the shaft near the distal end towards the proximal end; and

a fluid routing switch within the shaft, near the distal end, which can selectively connect the fluid infusion channel to the return channel to facilitate fluid driven export of the resected tissue from the working area.

86. A surgical method comprising:

a) inserting a shaft of an instrument, having a blunt, enclosed distal end into one of a tracheal or bronchial passage of a human while viewing the insertion through the blunt, enclosed distal end via a viewing element end positioned to the distal side of a working area near an optically transparent portion of the distal end;

b) visually locating tissue to be resected;

c) withdrawing the viewing element end to a proximal side of the working area;

d) moving the shaft so that at least a portion of the tissue to be resected is within the working area;

e) viewing the portion via the withdrawn viewing element end;

f) establishing, within the shaft, a fluid circulation path that will direct fluid along a path from the proximal side of the working area towards the distal side of the working area without passing through the working area, then from the distal side of the working area to the proximal side of the working area and passing through the working area; and

h) resecting the tissue within the working area such that, once the tissue is resected, the fluid in the fluid circulation path passing through the working area from the distal to the proximal side will convey the resected tissue away from the working area and towards the proximal end of the shaft.

87. The method of claim 86, wherein, following “

a)”

the method further comprises;

applying a vacuum to a channel within the shaft to facilitate movement of a substance from external to the shaft into a passage within the shaft.

88. The method of claim 86, wherein the fluid circulation path comprises a fluid infusion channel, the method further comprising:

introducing an oxygenated fluid into a fluid infusion channel.

89. An instrument for use in gastrointestinal surgery comprising:

a shaft, dimensioned for insertion into a section of the gastrointestinal tract of a human, the shaft having a proximal end and a blunt, enclosed distal end, the blunt, enclosed distal end being optically transparent over at least a portion of its area, the shaft further comprising

a longitudinally extending fluid infusion channel,

a side wall having an opening therein defining an enclosed working area within which resection can occur,

a longitudinally extending return channel coupling the working area to a connection for a tissue collection cavity,

at least one fluid export pore selectively connectable to the fluid infusion channel;

a viewing instrument channel dimensioned to receive a viewing instrument inserted from the proximal end and being positioned so as to enable the inserted viewing instrument to be moved to or from

i) a position near the portion of the blunt, enclosed distal end that is optically transparent to provide unobstructed viewing through the blunt, enclosed distal end, and

ii) a position to the proximate side of the enclosed working area to provide viewing of the enclosed working area.

90. The instrument of claim 89 wherein:

the working area and blunt, enclosed distal end are within a first portion of the shaft,

the shaft comprises a second portion located between the first portion and the proximal end, and

the second portion is flexible.

91. An instrument for use in gastrointestinal surgery comprising:

a shaft, dimensioned for insertion into a portion of the gastrointestinal tract of a human, the shaft having a proximal end and a blunt, enclosed distal end, the shaft further comprising

a fluid infusion channel,

a return channel dimensioned for passage of resected tissue from a working area within the shaft near the distal end towards the proximal end; and

a fluid routing switch within the shaft, near the distal end, which can selectively connect the fluid infusion channel to the return channel to facilitate fluid driven export of the resected tissue from the working area.

92. A gastrointestinal surgical method comprising:

a) inserting a shaft of an instrument, having a blunt, enclosed distal end into a portion of the gastrointestinal tract of a human while viewing the insertion through the blunt, enclosed distal end via a viewing element end positioned to the distal side of a working area near an optically transparent portion of the distal end;

b) visually locating tissue that is to be resected;

c) withdrawing the viewing element end to a proximal side of the working area;

d) moving the shaft so that at least some of the tissue to be resected is within the working area;

e) viewing the at least some tissue via the withdrawn viewing element end;

f) establishing, within the shaft, a fluid circulation path that will direct fluid along a path from the proximal side of the working area towards the distal side of the working area without passing through the working area, then from the distal side of the working area to the proximal side of the working area and passing through the working area; and

h) resecting the tissue within the working area such that, once the tissue is resected, the fluid in the fluid circulation path passing through the working area from the distal to the proximal side will convey the resected tissue away from the working area and towards the proximal end of the shaft.

93. The method of claim 92, wherein, following “

a)”

the method further comprises;

coupling a fluid infusion channel to a fluid export pore to direct a flow of fluid from the fluid infusion channel to a location external to the shaft via the fluid export pore.

94. A gynecological instrument comprising:

a shaft, dimensioned for insertion through the cervix into the uterus, the shaft having a proximal end and a blunt, enclosed distal end, the blunt, enclosed distal end being optically transparent over at least a portion of its area, the shaft further comprising

a longitudinally extending fluid infusion channel,

a side wall having an opening therein defining an enclosed working area within which resection can occur,

a longitudinally extending return channel coupling the working area to a connection for a tissue collection cavity,

a viewing instrument channel dimensioned to receive a viewing instrument inserted from the proximal end and being positioned so as to enable the inserted viewing instrument to be moved to or from

i) a position near the portion of the blunt, enclosed distal end that is optically transparent to provide unobstructed viewing through the blunt, enclosed distal end, and

ii) a position to the proximate side of the enclosed working area to provide viewing of the enclosed working area, and

at least one pore through which fluid passing from the proximal end of the shaft towards the blunt, enclosed distal end via the fluid infusion channel can exit the shaft to inflate the uterine cavity.

95. The gynecological instrument of claim 94 wherein:

the shaft is at least 14 cm long.

96. The gynecological instrument of claim 94 further comprising:

an auxiliary channel through which a ureteral stent can be deployed.

97. The gynecological instrument of claim 94 further comprising:

an auxiliary channel through which a tubal occlusion device for sterilization can be deployed.

98. A gynecological surgical instrument comprising:

a shaft, dimensioned for insertion into the uterus via the cervix, and having a proximal end and a blunt, enclosed distal end, the shaft further comprising

a fluid infusion channel,

a return channel dimensioned for passage of resected tissue from a working area within the shaft near the distal end towards the proximal end,

at least one fluid export pore, and

a fluid routing switch within the shaft, near the distal end, which can be moved to connect the fluid infusion channel to the at least one fluid export pore to inflate the uterus and to connect the fluid infusion channel to the return channel to export the resected tissue from the working area.

99. A gynecological instrument comprising:

a shaft, dimensioned for insertion through the cervix into the uterus, and having a proximal end and a blunt, enclosed distal end, the blunt, enclosed distal end being optically transparent over at least a portion of its area,

a scope having a viewing end that is moveable within the shaft between a first position and a second position such that

i) when in the first position within the shaft, the viewing end will be on a distal side of a working area within which resection can occur and proximate to the optically transparent portion of the distal end to provide an unobstructed view of tissue external to the blunt, enclosed distal end; and

ii) when in the second position within the shaft, the viewing end will be on a proximal side of the working area and provide a view of the working area.

100. A gynecological method comprising:

a) inserting a shaft of an instrument, having a blunt, enclosed distal end, into the uterus via the cervix while viewing the insertion through the blunt, enclosed distal end via a viewing element end positioned to the distal side of a working area within the shaft near an optically transparent portion of the distal end;

b) establishing a fluid path extending from near a proximal end of the shaft, through at least a portion of the shaft, to an export pore;

c) inflating the uterus;

d) withdrawing the viewing element end to a proximal side of the working area;

e) moving the shaft so that tissue to be resected is within the working area;

f) establishing, within the shaft, a fluid circulation path that will direct fluid along a path from the proximal side of the working area towards the distal side of the working area without passing through the working area, then from the distal side of the working area to the proximal side of the working area and passing through the working area; and

g) resecting the tissue within the working area such that, once the tissue is resected, fluid in the fluid circulation path passing through the working area from the distal to the proximal side will convey the resected tissue away from the working area and towards the proximal end of the shaft.

101. The method of claim 100 further comprising:

identifying a cervical polyp during the inserting;

causing the cervical polyp to enter the working area; and

resecting the cervical polyp while it is within the working area.

102. A urological instrument comprising:

a shaft, dimensioned for insertion into the urethra, the shaft having a proximal end and a blunt, enclosed distal end, the blunt, enclosed distal end being optically transparent over at least a portion of its area, the shaft further comprising

a longitudinally extending fluid infusion channel,

a side wall having an opening therein defining an enclosed working area within which resection of tissue from within the urinary tract can occur,

a longitudinally extending return channel coupling the working area to a connection for a tissue collection cavity,

a viewing instrument channel dimensioned to receive a viewing instrument inserted from the proximal end and being positioned so as to enable the inserted viewing instrument to be moved to or from

i) a position near the portion of the blunt, enclosed distal end that is optically transparent to provide unobstructed viewing through the blunt, enclosed distal end, and

ii) a position to the proximate side of the enclosed working area to provide viewing of the enclosed working area, and

at least one pore through which fluid passing from the proximal end of the shaft towards the blunt, enclosed distal end via the fluid infusion channel can exit the shaft.

103. The urological instrument of claim 102 further comprising:

an auxiliary channel through which a catheter can be deployed.

104. A urological surgical instrument comprising:

a shaft, dimensioned for insertion into the urethra, and having a proximal end and a blunt, enclosed distal end, the shaft further comprising

a fluid infusion channel,

a return channel dimensioned for passage of tissue, resected from within the urinary tract, from a working area within the shaft near the distal end towards the proximal end,

at least one fluid export pore, and

a fluid routing switch within the shaft, near the distal end, which can be moved to connect the fluid infusion channel to the at least one fluid export pore and to connect the fluid infusion channel to the return channel to form a fluid circuit within the shaft.

105. A urological instrument comprising:

a shaft, dimensioned for insertion into the urethra, and having a proximal end and a blunt, enclosed distal end, the blunt, enclosed distal end being optically transparent over at least a portion of its area,

a scope having a viewing end that is moveable within the shaft between a first position and a second position such that

i) when in the first position within the shaft, the viewing end will be on a distal side of a working area within which resection can occur and proximate to the optically transparent portion of the distal end to provide an unobstructed view of tissue external to the blunt, enclosed distal end; and

ii) when in the second position within the shaft, the viewing end will be on a proximal side of the working area and provide a view of the working area.

106. A urological method comprising:

a) inserting a shaft of an instrument, having a blunt, enclosed distal end, into a portion of the urinary tract while viewing the insertion through the blunt, enclosed distal end via a viewing element end positioned to the distal side of a working area within the shaft near an optically transparent portion of the distal end;

b) establishing a fluid path extending from near a proximal end of the shaft, through at least a portion of the shaft, to an export pore;

c) withdrawing the viewing element end to a proximal side of the working area;

d) moving the shaft so that tissue to be resected is within the working area;

e) establishing, within the shaft, a fluid circulation path that will direct fluid along a path from the proximal side of the working area towards the distal side of the working area without passing through the working area, then from the distal side of the working area to the proximal side of the working area and passing through the working area; and

f) resecting the tissue within the working area such that, once the tissue is resected, fluid in the fluid circulation path passing through the working area from the distal to the proximal side will convey the resected tissue away from the working area and towards the proximal end of the shaft.

107. A surgical instrument comprising:

a shaft, dimensioned for insertion into one of a facial, sinus or nasal cavity, the shaft having a proximal end and a blunt, enclosed distal end, the blunt, enclosed distal end being optically transparent over at least a portion of its area, the shaft further comprising

a longitudinally extending fluid infusion channel,

a side wall having an opening therein defining an enclosed working area within which resection of tissue from the cavity can occur,

a longitudinally extending return channel coupling the working area to a connection for a tissue collection cavity,

a viewing instrument channel dimensioned to receive a viewing instrument inserted from the proximal end and being positioned so as to enable the inserted viewing instrument to be moved to or from

i) a position near the portion of the blunt, enclosed distal end that is optically transparent to provide unobstructed viewing through the blunt, enclosed distal end, and

ii) a position to the proximate side of the enclosed working area to provide viewing of the enclosed working area, and

at least one pore through which fluid passing from the proximal end of the shaft towards the blunt, enclosed distal end via the fluid infusion channel can exit the shaft.

108. The surgical instrument of claim 107 further comprising:

an auxiliary channel through which the facial cavity can be aspirated.

109. The surgical instrument of claim 107 wherein the facial cavity is at least one of:

a nasal cavity or a sinus.

110. A surgical instrument comprising:

a shaft, dimensioned for insertion into a facial cavity, and having a proximal end and a blunt, enclosed distal end, the shaft further comprising

a fluid infusion channel,

a return channel dimensioned for passage of tissue, resected from within the facial cavity, from a working area within the shaft near the distal end towards the proximal end,

at least one fluid export pore, and

a fluid routing switch within the shaft, near the distal end, which can be moved to connect the fluid infusion channel to the at least one fluid export pore to provide irrigation of the facial cavity and to connect the fluid infusion channel to the return channel to export the resected tissue from the working area.

111. A surgical instrument comprising:

a shaft, dimensioned for insertion into a facial cavity, having a proximal end and a blunt, enclosed distal end, the blunt, enclosed distal end being optically transparent over at least a portion of its area,

a scope having a viewing end that is moveable within the shaft between a first position and a second position such that

i) when in the first position within the shaft, the viewing end will be on a distal side of a working area within which resection can occur and proximate to the optically transparent portion of the distal end to provide an unobstructed view of tissue within the facial cavity external to the blunt, enclosed distal end; and

ii) when in the second position within the shaft, the viewing end will be on a proximal side of the working area and provide a view of the working area.

112. A surgical method comprising:

a) inserting a shaft of an instrument, having a blunt, enclosed distal end, into a facial cavity while viewing the insertion through the blunt, enclosed distal end via a viewing element end positioned to the distal side of a working area within the shaft and near an optically transparent portion of the distal end;

b) withdrawing the viewing element end to a proximal side of the working area;

c) moving the shaft so that tissue to be resected from the facial cavity is within the working area;

d) establishing, within the shaft, a fluid circulation path that will direct fluid along a path from the proximal side of the working area towards the distal side of the working area without passing through the working area, then from the distal side of the working area to the proximal side of the working area and passing through the working area;

e) resecting the tissue within the working area such that, once the tissue is resected, fluid in the fluid circulation path passing through the working area from the distal to the proximal side will convey the resected tissue away from the working area and towards the proximal end of the shaft.

113. The surgical method of claim 112, further comprising:

establishing a fluid path extending from near a proximal end of the shaft, through at least a portion of the shaft, to an export pore; and

irrigating at least a portion of the facial cavity.

114. An instrument for use in proctological surgery comprising:

an elongated shaft, dimensioned for insertion into the body via the anus, having a proximal end and a blunt, enclosed distal end, the blunt, enclosed distal end being optically transparent over at least a portion of its area, the shaft further comprising

a longitudinally extending fluid infusion channel,

a side wall having an opening therein defining an enclosed working area within which resection can occur,

a longitudinally extending return channel coupling the working area to a connection for a tissue collection cavity,

at least one fluid export pore selectively connectable to the fluid infusion channel;

a viewing instrument channel dimensioned to receive a viewing instrument inserted from the proximal end and being positioned so as to enable the inserted viewing instrument to be moved to or from

i) a position near the portion of the blunt, enclosed distal end that is optically transparent to provide unobstructed viewing through the blunt, enclosed distal end, and

ii) a position to the proximate side of the enclosed working area to provide viewing of the enclosed working area.

115. The instrument of claim 114 wherein:

the working area and blunt, enclosed distal end are within a first portion of the elongated shaft,

the elongated shaft comprises a second portion located between the first portion and the proximal end, and

the second portion is flexible.

116. An instrument for use in proctological surgery comprising:

a shaft, dimensioned for insertion into a body via the anus, the shaft having a proximal end and a blunt, enclosed distal end, the shaft further comprising

a fluid infusion channel,

a return channel dimensioned for passage of resected tissue from a working area within the shaft near the distal end towards the proximal end; and

a fluid routing switch within the shaft, near the distal end, which can selectively connect the fluid infusion channel to the return channel to facilitate fluid driven export of the resected tissue from the working area.

117. A proctological surgical method comprising:

a) inserting a shaft of an instrument, having a blunt, enclosed distal end into a human via the anus while viewing the insertion through the blunt, enclosed distal end via a viewing element end positioned to the distal side of a working area near an optically transparent portion of the distal end;

b) visually locating tissue to be resected from within at least one of the rectum or colon;

c) withdrawing the viewing element end to a proximal side of the working area;

d) moving the shaft so that at least some of the tissue to be resected is within the working area;

e) viewing the at least some tissue via the withdrawn viewing element end;

f) establishing, within the shaft, a fluid circulation path that will direct fluid along a path from the proximal side of the working area towards the distal side of the working area without passing through the working area, then from the distal side of the working area to the proximal side of the working area and passing through the working area; and

h) resecting the tissue within the working area such that, once the tissue is resected, the fluid in the fluid circulation path passing through the working area from the distal to the proximal side will convey the resected tissue away from the working area and towards the proximal end of the shaft.

118. The method of claim 117, wherein, following “

a)”

the method further comprises;

coupling a fluid infusion channel to a fluid export pore to direct a flow of fluid from the fluid infusion channel to a location external to the shaft via the fluid export pore.