Medical material removal method and associated instrumentation

• US 5,928,218 A
• Filed: 05/24/1996
• Issued: 07/27/1999
• Est. Priority Date: 12/16/1994
• Status: Expired due to Term

• Current Assignee: Gary A. Gelbfish
• Original Assignee: Gary A. Gelbfish
• Inventors: Gelbfish, Gary A.
• Primary Examiner(s): McDermott, Corrine
• Assistant Examiner(s): RODRIGUEZ, CRIS LOIREN
• Application Number:
  US08/653,514
• Time in Patent Office: 1,159 Days
• Field of Search: 604/21, 604/22, 604/28, 604/30, 604/49, 604/52, 604/93, 604/164, 604/246, 604/256, 604/264, 604/268, 604/280, 604/53, 604/96, 604/540, 606/167, 606/170, 606/171, 606/159, 600/564, 600/568
• US Class Current: 604/540
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/22 Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for dilators A61M29/00
• CPC Class Codes: A61B 17/320783 through side-hole, e.g. sliding or rotating cutter inside catheter
• CPC Class Codes: A61B 17/3417 Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating syringe needles A61M5/32; dilators A61M29/00
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/00473 Distal part, e.g. tip or head A61B2017/00464 takes precedence
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61B 2217/005 with suction drainage system
• CPC Class Codes: A61B 2217/007 with irrigation system
• 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 minimally invasive medical device comprises a tubular member with a large-diameter distal end portion and a smaller-diameter proximal portion. A clot-intake port is disposed in the distal end portion of the tubular member, while a cutter element is movably disposed in the distal end portion for severing material sucked in through the intake port and for temporarily closing the intake port during an extraction of the severed material from the device. A hollow drive rod extends through the tubular member to the cutter element for shifting the cutter element, while an outlet port is disposed in the tubular member proximally of the intake port and distally of the proximal portion of the tubular member. The tubular member extends through a catheter so that the intake port is disposed outside the catheter and the outlet port is disposed inside the catheter. The maximum transverse dimension of the proximal portion of the tubular member is substantially narrower than the lumen of the catheter, thereby providing flexibility to the combination of catheter and tubular drive element. A wire valve in the distal end portion of the tubular member is closed to block irrigation fluid from leaving an irrigation outlet in the drive rod while a mass is sucked into the tubular member through the intake port and is opened to permit flow of fluid when a severed mass is being sucked in a proximal direction through the catheter. A balloon at the distal end of the tubular member is inflated via irrigation fluid regulated by a valve operated according to the position of the cutter element.

Claims

1. A minimally invasive medical method, comprising:

providing a catheter, a tubular member and a drive rod, said catheter having a distal end section and a suction port, said tubular member having a distal end portion provided with an intake port and further having a outlet port, said drive rod being disposed in said tubular member and having a distal end provided with a cutter element having a cutting edge;

inserting said distal end section of said catheter into a patient;

inserting said tubular member into said catheter so that said intake port is disposed outside said catheter and said outlet port is disposed inside said catheter;

shifting said drive rod in said tubular member so that said cutter element moves to open said intake port;

applying suction to said catheter to pull material from the patient through said intake port into said distal end portion of said tubular member;

shifting said drive rod to move said cutting edge of said cutter element past said intake port to thereby sever the material pulled into said distal end portion of said tubular member;

by an application of suction force, drawing the severed material in a proximal direction from said distal end portion of said tubular member, through said outlet port and along said catheter, outside of said proximal portion of said tubular member, to said suction port of said catheter; and

during the drawing of the severed material, feeding fluid into said tubular member upstream of said severed material to facilitate the drawing of the severed material.

2. The method defined in claim 1 wherein said drive rod has an irrigation port and wherein said drive rod is hollow, the feeding of said fluid to said tubular member including delivering said fluid through said drive rod to said irrigation port.

3. The method defined in claim 2, further comprising closing said irrigation port during the pulling of material through said intake port into said distal end portion of said tubular member, also comprising opening said irrigation outlet after the severing of the pulled-in material by said cutting edge.

4. The method defined in claim 3 wherein a valve is disposed in said distal end portion of said tubular member and wherein the closing and opening of said irrigation port are effectuated by operating said valve.

5. A minimally invasive medical method comprising:

providing a tubular member, said tubular member having a distal end portion provided with an intake port and a valve, said tubular member having a cutter element disposed inside said tubular member, said cutter element having a cutting edge;

inserting said tubular member into a patient;

applying suction to said tubular member to draw material from the patient into said tubular member through said intake port;

shifting said cutter element in said tubular member so that said cutting edge of said cutter element moves past said intake port to sever the drawn-in material;

applying suction to said tubular member to draw the severed material in a proximal direction through said tubular member; and

operating said valve (a) to prevent flow of an irrigation fluid into said tubular member during application of suction to draw said material into said tubular member through said intake port and (b) to enable a feeding of said irrigation fluid into said tubular member upstream of said severed material during application of suction to draw said severed material through said tubular member.

6. The method defined in claim 5 wherein the shifting of said cutter element includes shifting a drive rod extending into said tubular member to said cutter element, said drive rod having a lumen and an irrigation outlet communicating with said lumen at a distal end thereof, further comprising feeding said irrigation fluid to said tubular member upstream of severed material via said lumen and said irrigation outlet.

7. A minimally invasive medical method comprising:

providing a tubular member, said tubular member having a distal end portion provided with an intake port and a one-way valve, a balloon being disposed on said tubular member, said tubular member having a cutter element disposed inside said tubular member, said cutter element having a cutting edge;

inserting said tubular member into a vascular component of a patient;

feeding a pressurization fluid to said distal end portion of said tubular member and from said distal end portion through said one-way valve to said balloon;

inflating said balloon in said vascular component by virtue of said feeding of said pressurization fluid;

after inflation of said balloon, exerting tension on said tubular member to pull said balloon through the patient;

applying suction to said tubular member to draw material from the patient into said tubular member through said intake port;

shifting said cutter element in said tubular member so that said cutting edge of said cutter element moves past said intake port to sever the drawn-in material;

applying suction to said tubular member to draw the severed clot material in a proximal direction through said tubular member; and

subsequent to pulling of said balloon through said vascular component, shifting said cutter element in a distal direction to open said one-way valve and deflate said balloon.

8. A method for removing material from inside a patient, comprising:

providing a tubular member having a suction port and a distal end portion provided with an intake port;

inserting a portion of said tubular member through a skin surface of a patient and into an internal structure of the patient so that said suction port is located outside of the patient and said intake port is located in said internal structure;

upon completion of said inserting, applying suction to said tubular member via said suction port to thereby draw material in said internal structure towards said intake port;

upon a drawing of said material at least partially into said tubular member through said intake port, severing a portion of said material inside said tubular member;

upon the severing of said portion of said material, maintaining said intake port in a closed configuration;

by virtue of the closure of said intake port, generating a pressure gradient across the severed portion of said material inside said tubular member to move said severed portion along said tubular member to said suction port,

the generating of said pressure gradient including applying suction to said tubular member via said suction port,

the generating of said pressure gradient also including feeding fluid to said tubular member on a side of said severed portion opposite said suction port, thereby relieving negative pressure generated in said tubular member between said severed portion and said intake port owing to motion of said severed portion in response to suction from said suction port.

9. The method defined in claim 8 wherein said tubular member is provided internally with a drive rod and a cutter element, said a drive rod having a distal end connected to said cutter element, said drive rod being eccentrically disposed substantially inside said tubular member, the severing of said portion of material being implement by moving said drive rod to shift said cutter element, an irrigation port being disposed in said drive rod, the feeding of fluid to said tubular member including feeding said fluid through said drive rod to said irrigation port.

10. The method defined in claim 8 wherein the tubular member is provided with a movable or shiftable cutter element having a cutting edge, the severing of said portion of said material including shifting said cutter element so that said cutting edge moves past said intake port, the closing of said intake port including blocking said intake port with said cutter element.