Method for prostatic tissue resection

• US 5,527,331 A
• Filed: 09/15/1995
• Issued: 06/18/1996
• Est. Priority Date: 10/13/1993
• Status: Expired due to Fees

• Current Assignee: FemRx, Inc. (Johnson & Johnson)
• Original Assignee: FemRx, Inc. (Johnson & Johnson)
• Inventors: Kresch, Arnold J., Alden, Donald L.
• Primary Examiner(s): Pellegrino, Stephen C.
• Assistant Examiner(s): Lewis, William
• Application Number:
  US08/529,144
• Time in Patent Office: 277 Days
• Field of Search: 606/1, 606/13-15, 606/159, 606/170, 606/171, 606/167, 606/180, 606/37, 606/46, 128/3, 128/4, 128/6, 128/751-755, 128/898, 604/22, 604/24 AA
• US Class Current: 606/170
• CPC Class Codes: A61B 10/02 Instruments for taking cell samples or for biopsy A61B10/0038 and A61B10/0045 take precedence; needle locating or guiding means A61B17/3403; samplers for enzymology or microbiology C12M1/26; sampling or preparing biological specimens G01N33/48
• CPC Class Codes: A61B 17/32002 with continuously rotating, oscillating or reciprocating cutting instruments
• CPC Class Codes: A61B 18/14 Probes or electrodes therefor
• CPC Class Codes: A61B 18/1482 having a long rigid shaft for accessing the inner body transcutaneously in minimal invasive surgery, e.g. laparoscopy
• CPC Class Codes: A61B 18/1485 having a short rigid shaft for accessing the inner body through natural openings
• CPC Class Codes: A61B 18/1487 Trocar-like, i.e. devices producing an enlarged transcutaneous opening
• CPC Class Codes: A61B 2017/00106 ultrasonic
• CPC Class Codes: A61B 2017/4216 Operations on uterus, e.g. endometrium
• CPC Class Codes: A61B 2018/00208 actively driven, e.g. by a motor
• CPC Class Codes: A61B 2018/00559 Female reproductive organs
• CPC Class Codes: A61B 2018/1253 monopolar
• CPC Class Codes: A61B 2018/1472 for use with liquid electrolyte, e.g. virtual electrodes
• CPC Class Codes: A61B 2018/1861 with an instrument inserted into a body lumen or cavity, e.g. a catheter
• CPC Class Codes: A61B 2090/062 penetration depth
• CPC Class Codes: A61B 2090/064 for measuring force, pressure or mechanical tension
• CPC Class Codes: A61B 2090/306 using optical fibres
• CPC Class Codes: A61B 2090/378 using ultrasound
• CPC Class Codes: A61B 2090/3784 both receiver and transmitter being in the instrument or receiver being also transmitter
• CPC Class Codes: A61B 2217/005 with suction drainage system
• CPC Class Codes: A61B 2217/007 with irrigation system
• CPC Class Codes: A61M 1/84 : Drainage tubes; Aspiration tips for negative pressure wound therapy A61M1/90; for surgical cutting instruments A61B17/32
• CPC Class Codes: A61M 1/85 : with gas or fluid supply means, e.g. for supplying rinsing fluids or anticoagulants for negative pressure wound therapy A61M1/92, A61M1/94; combined with tracheal tubes A61M16/0463; dental instruments with combined rinsing and aspirating A61C17/0208

Abstract

A tissue resection device for preferred use in an organ inflated with non-conductive optically transparent fluid under pressure is disclosed. The instrument includes a rigid shaft having a proximal end, a distal end, and defining a perfusion lumen extending therebetween. At its distal end, the shaft is provided with a rounded blunt end having an elongate aperture exposing the lumen near the distal end. A drive tube is rotatably disposed within the shaft lumen and has a proximal end, a distal end, and a drive tube aspiration lumen extending therebetween. A cutting head is mounted on the distal end of the drive tube and has a laterally disposed cutting edge which can resection either by conventional cutting or electrocautery. This laterally disposed cutting edge is communicated to an internal passage between the cutting edge and the aspiration lumen of the drive tube so that tissue severed as the cutting head is rotated may be drawn directly into the aspiration lumen. A housing attached to the proximal end of the shaft. Preferably, a DC motor in the housing is connected to rotate the drive tube and thus the laterally disposed cutting head. Connection is provided on the housing for connecting the perfusion shaft lumen to a perfusion source and the aspiration lumen to an aspiration source. Preferably, an optic fiber provides an optical view of surgery while a proximally mounted and laterally exposed ultrasound transducer is disposed with a solid angle of interrogation including the surgical site.

Claims

1. A method for resecting prostatic tissue, said method comprising:

providing a probe defining a lumen and having a distal end open at an elongate slot;

providing a rotatable cutting head having laterally disposed cutting edges relative to an axis along the lumen of the probe, the cutting head having a dimension sufficient to fit into and through said lumen of said probe, said cutting head having means for directing tissue resected by said cutting edges into said lumen;

providing a tube attached to said rotatable cutting head so that said cutting head is disposed at said elongate aperture;

inserting said probe within a urethra with said elongate slot confronted to a surgical site;

rotating the tube to rotate said cutting head in contact with prostatic tissue to be resected;

perfusing the surgical site with perfusion fluid and aspirating the surgical site through said lumen to draw resected prostatic tissue from said surgical site; and

applying radio frequency energy to the cutting head as it is rotated at a frequency selected to enhance cutting.

2. A method as in claim 1, including the step of applying radio frequency energy to the cutting head at a frequency selected to enhance coagulation.

3. A method as in claim 1, including the steps of reversing the rotation of the cutting head while the radio frequency energy is applied to cauterize with said cutting head.

4. A method as in claim 1, further comprising optically viewing the prostatic tissue to be resected while contacting with the cutting head.

5. A method as in claim 1, further comprising

providing a sound transducer on said cutting head;

and,

ultrasonically viewing the prostatic tissue through said sound transducer to determine depth of prostatic tissue to be resected.

6. A method as in claim 1, further comprising the steps of:

aspirating a perfusion fluid from said surgical site through a tube attached to said cutting head.

7. A method as in claim 1, including the steps of:

perfusing said surgical site through said probe.

8. A method of inserting for surgery a resectoscope for operating on prostatic tissue at a surgical site in a perfused urethra of a human comprising the steps of:

providing a probe having a distal and proximal end and defining a lumen therebetween, said distal end of said probe including an elongate slot adjacent a blunt end;

providing an obturator for occupying said probe at said slot for enabling insertion of said probe to said urethra in said human;

placing said obturator in said probe from said proximal end to occupy said elongate slot and inserting said probe to said urethra in said human body;

withdrawing said obturator from said probe through the proximal end of said inserted probe;

perfusing said urethra with fluid through said lumen in said probe;

providing a rotatable member having a cutting head mounted on the distal end thereof and a proximal end adapted to be rotated, said cutting head and rotating member having a dimension less than the lumen of said probe;

inserting said cutting head and said rotating member to said lumen at said proximal end of said probe to protrude said cutting head from said probe at said slot at said distal end of said probe;

providing an optical fiber for visualizing said cutting head;

inserting said fiber along said lumen to visualize said cutting head in said probe at said slot at said distal end of said probe; and

,

rotating said cutting head from said rotatable member at the distal end of said probe during said visualization for operating at said surgical site.

9. A method of inserting for surgery a resectoscope according to claim 8 further comprising:

providing a lumen in said rotatable member between the distal end of said member adjacent said cutting head and the proximal end of said member; and

,

aspirating said perfused surgical site through said lumen in said rotatable member.

10. A method of inserting for surgery a resectoscope according to claim 8 further comprising:

perfusing said cavity with a substantially non-conductive fluid;

providing an electrical path in said rotatable member to said cutting head; and

,

supplying electrical energy sufficient for cautery to said cutting head.

11. A method of inserting for surgery a resectoscope according to claim 8 and further including:

providing an acoustical transducer in said cutting head having sufficient dimension to fit within said lumen of said probe from said proximal end to said distal end; and

,

sending and receiving sound at said acoustical transducer during said rotation of said cutting head for acoustical examination of said surgical site.

12. A method for resecting prostatic tissue from the urethra, the method comprising:

removing prostatic tissue from the urethra by applying a cutter or radio frequency to the prostatic tissue;

viewing depth of tissue resection in the urethra while removing the prostatic tissue; and

evacuating the removed prostatic tissue from the urethra.

15. A method as in claim 12, wherein the removing step comprises translating a cutting member through prostatic tissue to form a strip of tissue.

16. A method as in claim 15, wherein the evacuating step comprises chopping the strip of tissue into morsels and aspirating the morsels from the urethra.

17. A method as in claim 16, wherein the cutting member is translated longitudinally within the urethra.

18. A method as in claim 17, wherein the chopping step comprises rotating a cutting head having a laterally disposed cutting edge.

13. A method for resecting prostatic tissue, said method comprising:

providing a probe defining a lumen and having a distal end open at an elongate slot;

providing a rotatable cutting head having laterally disposed cutting edges relative to an axis along the lumen of the probe, the cutting head having a dimension sufficient to fit into and through said lumen of said probe, said cutting head having means for directing tissue resected by said cutting edges into said lumen;

providing a tube attached to said rotatable cutting head so that said cutting head is disposed at said elongate aperture;

inserting said probe within a urethra with said elongate slot confronted to a surgical site;

rotating the tube to rotate said cutting head in contact with prostatic tissue to be resected;

perfusing the surgical site with perfusion fluid and aspirating the surgical site through said lumen to draw resected tissue from said surgical site; and

applying radio frequency energy to the cutting head at a frequency selected to enhance coagulation.

14. A method for resecting prostatic tissue, said method comprising:

providing a probe defining a lumen and having a distal end open at an elongate slot;

providing a rotatable cutting head having laterally disposed cutting edges relative to an axis along the lumen of the probe, the cutting head having a dimension sufficient to fit into and through said lumen of said probe, said cutting head having means for directing tissue resected by said cutting edges into said lumen;

providing a tube attached to said rotatable cutting head so that said cutting head is disposed at said elongate aperture;

inserting said probe within a urethra with said elongate slot confronted to a surgical site;

rotating the tube to rotate said cutting head in contact with prostatic tissue to be resected;

perfusing the surgical site with perfusion fluid and aspirating the surgical site through said lumen to draw resected tissue from said surgical site; and

optically viewing the tissue to be resected while contacting with the cutting head.

19. A method for resecting prostatic tissue from the urethra, the method comprising:

removing prostatic tissue from the urethra by longitudinally translating an electrosurgical cutting member through the prostatic tissue to form a strip of tissue, the cutting member being disposed on a probe;

monitoring depth of tissue resection from the probe while removing the prostatic tissue; and

evacuating the removed prostatic tissue by rotating a cutting head of the probe to chop the strip of tissue into morsels and aspirating the morsels from the urethra through a lumen of the probe.

20. A method as in claim 19, further comprising directing the strips of tissue toward the cutting head with an at least partially electrically conductive structure, and electrically energizing the structure for electrocautery.