Surgical instrument for endoscopic and general surgery

• US 5,827,323 A
• Filed: 10/04/1996
• Issued: 10/27/1998
• Est. Priority Date: 07/21/1993
• Status: Expired due to Term

• Current Assignee: Charles H. Klieman
• Original Assignee: Charles H. Klieman
• Inventors: Stiggelbout, John M., Klieman, Charles H.
• Primary Examiner(s): Thaler, Michael H.
• Application Number:
  US08/729,683
• Time in Patent Office: 753 Days
• Field of Search: 606/205-208, 606/174, 606/170, 606/51, 606/52, 128/751, 600/564
• US Class Current: 606/205
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/2909 Handles
• 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 17/3201 Scissors for biopsy A61B10/02
• CPC Class Codes: A61B 18/1442 Probes having pivoting end effectors, e.g. forceps
• CPC Class Codes: A61B 2017/00398 using powered actuators, e.g. stepper motors, solenoids
• CPC Class Codes: A61B 2017/0046 with a releasable handle; with handle and operating part separable for prosthetic joint-implanting tools A61F2/4603
• CPC Class Codes: A61B 2017/2923 Toothed members, e.g. rack and pinion
• CPC Class Codes: A61B 2017/2926 Details of heads or jaws
• CPC Class Codes: A61B 2017/2927 the angular position of the head being adjustable with respect to the shaft
• CPC Class Codes: A61B 2017/2929 with a head rotatable about the longitudinal axis of the shaft
• CPC Class Codes: A61B 2017/2931 with releasable head
• CPC Class Codes: A61B 2017/2932 Transmission of forces to jaw members
• CPC Class Codes: A61B 2017/2937 with flexible part
• CPC Class Codes: A61B 2017/2938 Independently actuatable jaw members, e.g. two actuating rods
• CPC Class Codes: A61B 2017/2939 Details of linkages or pivot points
• CPC Class Codes: A61B 2017/2943 Toothed members, e.g. rack and pinion
• CPC Class Codes: A61B 2017/2945 Curved jaws
• CPC Class Codes: A61B 2017/2946 Locking means
• CPC Class Codes: A61B 2018/1432 curved
• CPC Class Codes: A61B 2034/742 : Joysticks
• CPC Class Codes: A61B 2090/3614 : using optical fibre
• CPC Class Codes: A61B 2217/005 : with suction drainage system

Abstract

An endoscopic surgical instrument with manual controls and single-handed design has a tubular barrel with a handle at its proximal end and an end effector at its distal end. A linkage extends through the tubular barrel and connects the handle with the end effector. The handle has a stationary finger loop, in fixed alignment with the longitudinal axis of the tubular barrel, and is designed to receive a middle finger. The handle also includes a thumb lever, a fingerwheel control and a rotate control. The thumb lever, operated by the thumb of the hand gripping the finger loop, actuates the end effector; the fingerwheel control, operated by the index finger of the hand gripping the finger loop, pivots the end effector; and the rotate control, which is also actuated by the same index finger, rotates the tubular barrel and attached end effector. The endoscopic surgical instrument may also be configured to include electrocautery capability, an integrated endoscope, and irrigation and aspiration capabilities is also disclosed.

Claims

1. A surgical instrument for use in endoscopy comprising:

a tubular barrel with no joints and having a proximal end and a distal end;

an end effector comprising a first working piece and a second working piece, each working piece being pivotally attached directly to the distal end of the tubular barrel, the two working pieces forming an operating angle therebetween;

a handle attached to the proximal end of the tubular barrel, the handle comprising;

an elongated stationary portion permanently fixed in alignment with the longitudinal axis of the tubular barrel, the stationary portion having a grip portion that is grippable by a single hand, wherein the stationary portion has a longitudinal axis that extends at an angle relative to the longitudinal axis of the tubular barrel;

a manually operated actuating control; and

a manually operated pivot control, the actuating and pivot controls being operable by the same hand which grips the grip portion; and

linkage extending through the tubular barrel, the linkage operably connecting the actuating control and the pivot control to the first and second end effector working pieces, wherein

in response to the actuating control being operated, the linkage acts on the end effector to alter the operating angle; and

in response to the pivot control being operated, the linkage acts upon both the first and second end effector working pieces to pivot the end effector working pieces simultaneously and in the same direction while maintaining a substantially constant operating angle.

2. The surgical instrument according to claim 1, wherein the actuating control comprises a trigger lever, wherein movement of the trigger lever in a first direction decreases the operating angle between the first and second end effector pieces and movement of the trigger lever in an opposite direction increases the operating angle between the first and second end effector pieces.

3. The surgical instrument according to claim 2, wherein:

the grip portion of the handle is designed to be gripped by at least a middle finger; and

the trigger lever is designed to be operated by a thumb.

4. The surgical instrument according to claim 3, wherein:

the grip portion comprises a finger loop for receiving at least a middle finger; and

the trigger lever comprises a thumb loop for receiving a thumb.

5. The surgical instrument according to claim 3, wherein the pivot control is operated by an index finger.

6. The surgical instrument according to claim 5, wherein the pivot control is a fingerwheel roller disposed on the stationary portion of the handle, wherein rotation of the fingerwheel roller in a first direction pivots the first and second end effector pieces away from a longitudinally extended position and rotation of the fingerwheel roller in an opposite direction pivots the first and second end effector pieces toward the longitudinally extended position.

7. The surgical instrument according to claim 5, wherein the pivot control is a second lever attached to the stationary portion of the handle, wherein pivoting the second lever in a first direction pivots the first and second end effector pieces away from a longitudinally extended position and pivoting the second lever in an opposite direction pivots the first and second end effector pieces toward the longitudinally extended position.

8. The surgical instrument according to claim 7, wherein the second lever has a pivot axis that is approximately orthogonal to a longitudinal axis of the tubular barrel.

9. The surgical instrument according to claim 8, wherein the second lever comprises a finger loop for receiving an index finger for operating the second lever.

10. The surgical instrument according to claim 7, wherein the second lever has a pivot axis that is approximately parallel to a longitudinal axis of the tubular barrel.

11. The surgical instrument according to claim 10, wherein the second lever comprises a finger loop for receiving an index finger for operating the second lever.

12. The surgical instrument according to claim 5, wherein the handle further comprises a manually operated rotate control for rotating the tubular barrel and attached end effector, the rotate control being independent of the actuating control and the pivot control and further being operable by the same index finger that operates the pivot control.

13. The surgical instrument according to claim 12, wherein the rotate control comprises a rotatable knob, the knob being rotatably affixed to the tubular barrel so that it rotates with the knob.

14. The surgical instrument according to claim 12, wherein the handle further comprises a manually operated means for locking the trigger lever to prevent it from moving in the direction which increases the operating angle between the first and second end effector pieces, the locking means designed to be operated by the same index finger that operates the pivot control.

15. The surgical instrument according to claim 14, wherein the locking means comprises:

a lock-and-release lever associated with the handle, the lock-and-release lever being manually pivotable into a locked position and a released position;

a ratchet bar disposed partially within the handle and pivotable about a pin, the ratchet bar having a first arm operably connected to the lock-and-release lever and a second arm having at its distal end a rack for engaging a mating catch attached to the trigger lever; and

a spring for biasing the ratchet bar in a pivotal direction such that the rack of the second arm is biased toward the mating catch of the trigger lever, wherein, when the lock-and-release lever is in the released position the lock-and-release lever biases the ratchet bar in a pivotal direction against the bias of the spring and holds the rack of the second arm away from the mating catch, and when the lock-and-release lever is in the locked position the lever does not bias the ratchet bar and the bias of the spring causes the rack of the second arm to engage the mating catch of the trigger lever.

16. The surgical instrument according to claim 5, wherein the handle further comprises a manually operated means for locking the trigger lever to prevent it from moving in the direction which increases the operating angle between the first and second end effector pieces, the locking means designed to be operated by the same index finger that operates the pivot control.

17. The surgical instrument according to claim 16, wherein the locking means comprises:

a lock-and-release lever associated with the handle, the lock-and-release lever being manually pivotable into a locked position and a released position;

a ratchet bar disposed partially within the handle and pivotable about a pin, the ratchet bar having a first arm operably connected to the lock-and-release lever and a second arm having at its distal end a rack for engaging a mating catch attached to the trigger lever; and

a spring for biasing the ratchet bar in a pivotal direction such that the rack of the second arm is biased toward the mating catch of the trigger lever, wherein, when the lock-and-release lever is in the released position the lock-and-release lever biases the ratchet bar in a pivotal direction against the bias of the spring and holds the rack of the second arm away from the mating catch, and when the lock-and-release lever is in the locked position the lever does not bias the ratchet bar and the bias of the spring causes the rack of the second arm to engage the mating catch of the trigger lever.

18. The surgical instrument according to claim 2, wherein the handle further comprises a manually operated means for locking the trigger lever to prevent it from moving in the direction which increases the operating angle between the first and second end effector pieces.

19. The surgical instrument according to claim 18, wherein the locking means is designed to be operated by the same hand that grips the grip portion of the handle.

20. The surgical instrument according to claim 19, wherein the locking means comprises:

a lock-and-release lever associated with the handle, the lock-and-release lever being manually pivotable into a locked position and a released position;

a ratchet bar disposed partially within the handle and pivotable about a pin, the ratchet bar having a first arm operably connected to the lock-and-release lever and a second arm having at its distal end a rack for engaging a mating catch attached to the trigger lever; and

a spring for biasing the ratchet bar in a pivotal direction such that the rack of the second arm is biased toward the mating catch of the trigger lever, wherein, when the lock-and-release lever is in the released position the lock-and-release lever biases the ratchet bar in a pivotal direction against the bias of the spring and holds the rack of the second arm away from the mating catch, and when the lock-and-release lever is in the locked position the lever does not bias the ratchet bar and the bias of the spring causes the rack of the second arm to engage the mating catch of the trigger lever.

21. The surgical instrument according to claim 1, wherein the pivot control is a fingerwheel roller disposed on the stationary portion of the handle, wherein rotation of the fingerwheel roller in a first direction pivots the first and second end effector pieces away from a longitudinally extended position and rotation of the fingerwheel roller in an opposite direction pivots the first and second end effector pieces toward the longitudinally extended position.

22. The surgical instrument according to claim 21, wherein the fingerwheel roller includes a spring and detent mechanism for providing tactile feedback of the fingerwheel roller being rotated.

23. The surgical instrument according to claim 21, wherein the fingerwheel roller has an axis of rotation approximately orthoganol to a longitudinal axis of the tubular barrel.

24. The surgical instrument according to claim 1, wherein the handle further comprises a manually operated rotate control for rotating the tubular barrel and attached end effector, the rotate control being independent of the actuating control and the pivot control and further being operable by the same hand which grips the grip portion of the handle.

25. The surgical instrument according to claim 24 wherein the rotate control comprises a rotatable knob, the knob being rotatably affixed to the tubular barrel so that it rotates with the knob.

26. The surgical instrument according to claim 25, wherein the rotatable knob includes a spring and detent mechanism for providing tactile feedback of the rotatable knob being rotated.

27. The surgical instrument according to claim 24, wherein:

the grip portion of the handle is designed to be gripped by at least a middle finger;

the actuating control comprises a trigger lever designed to be operated by a thumb;

the pivot control is designed to be operated by an index finger; and

the rotate control is designed to be operated by the same index finger that operates the pivot control.

28. The surgical instrument according to claim 27, wherein:

the grip portion of the handle comprises a finger loop for receiving at least a middle finger;

the actuating control comprises a thumb loop for receiving a thumb;

the pivot control comprises a fingerwheel roller disposed on the stationary portion of the handle, wherein rotation of the fingerwheel roller by the index finger in a first direction pivots the first and second end effector pieces away from a longitudinally extended position and rotation of the fingerwheel roller by the index finger in an opposite direction pivots the first and second end effector pieces toward the longitudinally extended position; and

the rotate control comprises a rotatable knob, the knob being rotatably affixed to the tubular barrel so that it rotates with the knob.

29. The surgical instrument according to claim 24, wherein the pivot control further comprises a mechanical force multiplier operably connecting the force of rotation from the fingerwheel roller to the translation of the tubular barrel.

30. The surgical instrument according to claim 29, wherein the mechanical force multiplier comprises gears and pinions.

31. The surgical instrument according to claim 30, wherein the proximal portion of the tubular barrel further comprises a cylindrical rack, the cylindrical rack operably coupled to the gears and pinions of the force multiplier such that rotation of the fingerwheel roller causes a force to be applied to the cylindrical rack resulting in axial translation of the tubular barrel, while rotation of the tubular barrel by the rotate control does not cause axial translation of the tubular barrel.

32. The surgical instrument according to claim 1, wherein:

the handle further comprises a plug for connecting the surgical instrument to a source of electrical current;

the handle further comprises an electrically conductive path connecting the plug to the linkage extending through the tubular barrel;

the linkage and the end effector are made from electrically conductive material, wherein electrical current is provided to an area of interest near the end effector.

33. The surgical instrument according to claim 32, wherein the tubular barrel is not electrically conductive.

34. A surgical instrument for use in endoscopy comprising:

a tubular barrel having a proximal end and a distal end;

an end effector comprising a first working piece and a second working piece, each piece being pivotally attached directly to the distal end of the tubular barrel, the two end effector pieces forming an operating angle therebetween;

a linkage extending through the tubular barrel, the linkage comprising;

a first elongated member operably connected to the first end effector working piece so that relative translational movement between the first elongated member and the tubular barrel causes the first end effector working piece to pivot; and

a second elongated member operably connected to the second end effector working piece so that relative translational movement between the second elongated member and the tubular barrel causes the second end effector working piece to pivot; and

a handle attached to the proximal end of the tubular barrel, the handle comprising;

an elongated stationary piece permanently fixed in alignment with the longitudinal axis of the tubular barrel, the stationary portion having a grip portion that is grippable by a single hand, wherein the stationary piece has a longitudinal axis that extends at an angle relative to the longitudinal axis of the tubular barrel;

a manually operated actuation control for causing relative translational movement between the first elongated member and the tubular barrel, thereby causing the first end effector working piece to pivot thereby effecting a change in the operating angle; and

a manually operated pivot control for causing relative translational movement between the tubular barrel and both the first and second elongated members without significant relative translational movement between the first and second elongated members, thereby causing the first and second end effector pieces to pivot simultaneously and in the same direction while maintaining a substantially constant operating angle, the actuation and pivot controls being operable by the same hand which grips the grip portion of the handle.

35. The surgical instrument according to claim 34, wherein the actuating control comprises a trigger lever operably connected to the first elongated member and pivotable relative to the stationary piece of the handle, wherein pivotal movement of the trigger lever in a first pivotal direction translates the first elongated member in a first translational direction thus pivoting the first end effector working piece to decrease the operating angle, and wherein pivotal movement of the trigger lever in an opposite pivotal direction translates the first elongated member in a direction opposite the first translational direction thus pivoting the first end effector working piece to increase the operating angle.

36. The surgical instrument according to claim 34, wherein:

the tubular barrel is axially translatable along its longitudinal axis and relative to the stationary piece of the handle; and

the pivot control translates the tubular barrel relative to the stationary piece of the handle while the first and second elongated members are held translationally stationary relative to the stationary piece of the handle, thereby achieving the relative translational movement between the tubular barrel and both the first and second elongated members without significant relative translational movement between the first and second elongated members.

37. The surgical instrument according to claim 36, wherein the pivot control comprises a fingerwheel roller disposed on the stationary piece of the handle and operably connected to the tubular barrel, wherein rotation of the fingerwheel roller in a first rotational direction translates the tubular barrel relative to the handle in a first translational direction thus pivoting the end effector working pieces away from a longitudinally extended position, and wherein rotation of the fingerwheel roller in an opposite rotational direction translates the tubular barrel relative to the handle in a direction opposite the first translational direction thus pivoting the end effector working pieces toward the longitudinally extended position.

38. The surgical instrument according to claim 37, wherein the pivot control further comprises a mechanical force multiplier operably connecting the force of rotation from the fingerwheel roller to the translation of the tubular barrel.

39. The surgical instrument according to claim 38, wherein the mechanical force multiplier comprises gears and pinions.

40. The surgical instrument according to claim 39, wherein the proximal portion of the tubular barrel further comprises a cylindrical rack, the cylindrical rack operably coupled to the gears and pinions of the force multiplier such that rotation of the fingerwheel roller causes a force to be applied to the cylindrical rack resulting in translation of the tubular barrel.

41. The surgical instrument according to claim 37, wherein the fingerwheel roller has an axis of rotation approximately orthoganol to the longitudinal axis of the tubular barrel.

42. The surgical instrument according to claim 36, wherein the pivot control is a pivot control lever attached to the stationary piece of the handle and operably connected to the tubular barrel, wherein pivoting the pivot control lever in a first pivotal direction translates the tubular barrel relative to the handle in a first translational direction thus pivoting the end effector working pieces away from a longitudinally extended position, and wherein pivoting the pivot control lever in an opposite pivotal direction translates the tubular barrel relative to the handle in a direction opposite the first translational direction thus pivoting the end effector working pieces toward the longitudinally extended position.

43. The surgical instrument according to claim 42, wherein the pivot control lever comprises a finger loop for receiving an index finger for operating the pivot control lever, and wherein the pivot control lever has a pivot axis that is approximately normal to the longitudinal axis of the tubular barrel.

44. The surgical instrument according to claim 42, wherein the pivot control lever comprises a finger loop for receiving an index finger for operating the pivot control lever, and wherein the pivot control lever has a pivot axis that is approximately parallel to the longitudinal axis of the tubular barrel.

45. The surgical instrument according to claim 36, wherein:

the grip portion of the handle is designed to be gripped by at least a middle finger;

the actuating control comprises a thumb lever operably connected to the first elongated member and pivotable relative to the stationary piece of the handle, wherein pivotal movement of the thumb lever in a first pivotal direction translates the first elongated member in a first translational direction thus pivoting the first end effector working piece to decrease the operating angle, and wherein pivotal movement of the thumb lever in an opposite pivotal direction translates the first elongated member in a direction opposite the first translational direction thus pivoting the first end effector working piece to increase the operating angle;

the pivot control comprises a fingerwheel roller disposed on the stationary piece of the handle and operable by an index finger, the fingerwheel roller being operably connected to the tubular barrel, wherein rotation of the fingerwheel roller in a first rotational direction translates the tubular barrel relative to the handle in a first translational direction thus pivoting the end effector working pieces away from a longitudinally extended position, and wherein rotation of the fingerwheel roller in an opposite rotational direction translates the tubular barrel relative to the handle in a direction opposite the first translational direction thus pivoting the end effector working pieces toward the longitudinally extended position;

the handle further comprises a rotatable knob disposed around a proximal end of the tubular barrel and rotatable by the same index finger that operates the fingerwheel roller, the rotatable knob being rotatably affixed to the tubular barrel so that the tubular barrel and attached end effector rotate about a longitudinal axis of the tubular barrel as the knob is rotated.

46. The surgical instrument according to claim 45, wherein the handle further comprises a manually operated means for locking the thumb lever to prevent it from pivoting in the opposite pivotal direction to increase the operating angle.

47. The surgical instrument according to claim 46, wherein the locking means comprises:

a lock-and-release lever associated with the handle, the lock-and-release lever being manually pivotable into a locked position and a released position by the same index finger that operates the fingerwheel roller and the rotatable knob;

a ratchet bar pivotable about a pin connected to the stationary piece of the handle, the ratchet bar having a first arm operably connected to the lock-and-release lever and a second arm having at its distal end a rack for engaging a mating catch attached to the thumb lever; and

a spring for biasing the ratchet bar in a pivotal direction such that the rack of the second arm is biased toward the mating catch of the thumb lever, wherein, when the lock-and-release lever is in the released position the lock-and-release lever biases the ratchet bar in a pivotal direction against the bias of the spring and holds the rack of the second arm away from the mating catch, and when the lock-and-release lever is in the locked position the lock-and-release lever does not bias the ratchet bar and the bias of the spring causes the rack of the second arm to engage the mating catch of the thumb lever, preventing it from pivoting in the opposite pivotal direction.

48. The surgical instrument according to claim 34, wherein the handle further comprises a manually operated rotate control for rotating the tubular barrel and attached end effector about a longitudinal axis of the tubular barrel, the rotate control being operable by the same hand which grips the grip portion of the handle.

49. The surgical instrument according to claim 48, wherein the rotate control comprises a rotatable knob disposed around a proximal end of the tubular barrel, the rotatable knob being rotatably affixed to the tubular barrel so that the tubular barrel and attached end effector rotate as the knob is rotated.

50. The surgical instrument according to claim 49, wherein:

the tubular barrel is axially translatable along its longitudinal axis and relative to the stationary piece of the handle;

the pivot control translates the tubular barrel relative to the stationary piece of the handle while the first and second elongated members are held translationally stationary relative to the stationary piece of the handle, thereby achieving the relative translational movement between the tubular barrel and both the first and second elongated members without significant relative translational movement between the first and second elongated members; and

the rotatable knob is rotatably affixed to the tubular barrel by a pin extending internal of the rotatable knob and through a longitudinally extending slot in each side of the tubular barrel, the longitudinally extending slots in the tubular barrel allowing the tubular barrel to be translated axially relative to the stationary piece of the handle.

51. The surgical instrument according to claim 50, wherein:

the actuating control comprises a trigger lever pivotable relative to the stationary piece of the handle, the trigger lever being connected to the first elongated member by a ball-and-socket arrangement, wherein pivotal movement of the trigger lever in a first pivotal direction translates the first elongated member in a first translational direction thus pivoting the first end effector working piece to decrease the operating angle, and wherein pivotal movement of the trigger lever in an opposite pivotal direction translates the first elongated member in a direction opposite the first translational direction thus pivoting the first end effector working piece to increase the operating angle;

the first elongated member extending through the tubular barrel on one side of the pin extending through the tubular barrel, the pin forcing the first elongated member to be rotated inside the tubular barrel as the tubular barrel is rotated by the rotatable knob, the ball and socket connection between the first elongated member and the trigger lever permitting the rotational movement of the first elongated member despite the connection of the first elongated member to the trigger lever.

52. The surgical instrument according to claim 51, wherein the second elongated member is affixed at its proximal end to the pin extending through the tubular barrel thereby causing the first elongated member to be rotated with the tubular barrel as the tubular barrel is rotated by the rotatable knob and the first elongated member to be held translationally stationary relative to the stationary piece of the handle.

53. The surgical apparatus of claim 49, wherein the handle, actuation control, pivot control and rotate control are molded of plastic and are electrically non-conductive.

54. The surgical apparatus of claim 34, wherein the first and second elongated members are fabricated from lengths of shaped metallic wire.