Cutting apparatus having articulable tip

• US 5,972,012 A
• Filed: 02/19/1998
• Issued: 10/26/1999
• Est. Priority Date: 10/17/1997
• Status: Expired due to Term

• Current Assignee: Advanced Cardiovascular Systems Incorporated (Abbott Laboratories)
• Original Assignee: Angiotrax, Inc.
• Inventors: Saadat, Vahid, Ream, John H.
• Primary Examiner(s): Buiz, Michael
• Assistant Examiner(s): LEWIS, WILLIAM W
• Application Number:
  US09/027,828
• Time in Patent Office: 614 Days
• Field of Search: 606/1, 606/167, 606/170, 606/171, 606/18, 604/22, 600/564-568
• US Class Current: 606/170
• CPC Class Codes: A61B 17/32002 with continuously rotating, oscillating or reciprocating cutting instruments
• CPC Class Codes: A61B 17/3207 Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions A61B17/32037 takes precedence; endoscopic cutting instruments A61B17/320016
• CPC Class Codes: A61B 17/320758 with a rotating cutting instrument, e.g. motor driven A61B17/320725, A61B17/32075 and A61B17/320783 take precedence; for removing intra-ocular material A61F9/00763; endoscopic rotatable cutting instruments A61B17/32002
• CPC Class Codes: A61B 17/3478 Endoscopic needles, e.g. for infusion biopsy needles A61B10/0233; catheters with injection needles A61M25/0067
• CPC Class Codes: A61B 18/148 having a short, rigid shaft for accessing the inner body transcutaneously, e.g. for neurosurgery or arthroscopy
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 2017/00022 Sensing or detecting at the treatment site
• CPC Class Codes: A61B 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/00398 using powered actuators, e.g. stepper motors, solenoids
• CPC Class Codes: A61B 2017/00685 Archimedes screw
• CPC Class Codes: A61B 2017/00703 correcting for movement of heart, e.g. ECG-triggered
• CPC Class Codes: A61B 2017/22077 with a part piercing the tissue A61B2017/22044 takes precedence
• CPC Class Codes: A61B 2017/2927 the angular position of the head being adjustable with respect to the shaft
• CPC Class Codes: A61B 2017/308 with suction cups
• CPC Class Codes: A61B 2017/320028 with reciprocating movements
• CPC Class Codes: A61B 2017/320084 Irrigation sleeves
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments
• CPC Class Codes: A61B 2017/3488 Fixation to inner organ or inner body tissue
• CPC Class Codes: A61B 2018/00196 : reciprocating lengthwise
• CPC Class Codes: A61B 2018/00208 : actively driven, e.g. by a motor
• CPC Class Codes: A61B 2018/00267 : having a basket shaped structure
• CPC Class Codes: A61B 2018/00279 : deployable
• CPC Class Codes: A61B 2018/00291 : using suction
• CPC Class Codes: A61B 2018/00392 : Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/00738 : Depth, e.g. depth of ablation
• CPC Class Codes: A61B 2018/00761 : Duration
• CPC Class Codes: A61B 2018/00839 : Bioelectrical parameters, e.g. ECG, EEG
• CPC Class Codes: A61B 2018/00916 : with means for switching or controlling the main function of the instrument or device
• CPC Class Codes: A61B 2018/124 : switching the output to different electrodes, e.g. sequentially
• CPC Class Codes: A61B 2018/1435 : Spiral
• CPC Class Codes: A61B 2018/1437 : whereby the windings of the spiral touch each other such as to create a continuous surface
• CPC Class Codes: A61B 2018/1861 : with an instrument inserted into a body lumen or cavity, e.g. a catheter
• CPC Class Codes: A61B 2090/064 : for measuring force, pressure or mechanical tension
• CPC Class Codes: A61B 2090/3782 : transmitter or receiver in catheter or minimal invasive instrument
• CPC Class Codes: A61B 2090/3784 : both receiver and transmitter being in the instrument or receiver being also transmitter
• CPC Class Codes: A61B 2218/002 : Irrigation
• CPC Class Codes: A61B 2218/007 : Aspiration
• CPC Class Codes: A61B 34/20 : Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 90/37 : Surgical systems with images on a monitor during operation

Abstract

Apparatus and methods for intraoperatively performing surgery to create transmural channels in tissue, for example, as in transmyocardial revascularization, are provided using apparatus having an end region containing a mechanical cutting head and means for articulating the end-region to access hard-to-reach portions of the anatomy. The handpiece is coupled by a disposable cable to a controller that houses a vacuum pump and mechanisms for driving the cutting head. The cutting head is adapted to cooperate with the vacuum pump to evacuate tissue severed during the channel forming process.

Claims

1. Apparatus for use with a first vacuum source to form a channel in tissue, the apparatus comprising:

a handpiece having;

a body,

a shaft coupled to the body, the shaft having a lumen, a longitudinal axis and an articulation region;

a cutting head having a bore coupled to the first vacuum source, a first position wherein the cutting head extends from within the lumen to form a channel in the tissue, tissue severed by the cutting head being aspirated through the bore by the first vacuum source, and a second position wherein the cutting head is retracted within the lumen; and

means for articulating the articulation region to dispose the cutting head at an angle relative to the longitudinal axis of the shaft.

2. The apparatus as defined in claim 1 wherein the apparatus further comprises:

a controller housing a linear motor; and

a cable coupling the linear motor to the cutting head to move the cutting head between the first and second positions.

3. The apparatus as defined in claim 1 wherein the first vacuum source is housed within the controller.

4. The apparatus as defined in claim 1 further comprising a rotary motor disposed within the controller and coupled by the cable to the cutting head to rotate the cutting head.

5. The apparatus as defined in claim 4 wherein the handpiece further comprises a control panel having buttons that cause activation of the linear and rotary motors.

6. The apparatus as defined in claim 4 wherein the cable comprises a drive cable and the apparatus further comprises a coupling that transmits rotary motion and longitudinal motion from the rotary and linear motors, respectively, to the drive cable.

7. The apparatus as defined in claim 6 wherein the handpiece further comprises a spool coupled between the drive cable and the cutting head, the spool including struts defining apertures that permit tissue aspirated through the bore of the cutting head to pass to a tissue filter.

8. The apparatus as defined in claim 1 wherein the cutting head, in the first position, also experiences motion selected from the group consisting of reciprocatory motion, angular motion or vibrational motion.

9. The apparatus as defined in claim 1 wherein the apparatus further comprises means for stabilizing the cutting head in contact with the tissue.

10. The apparatus as defined in claim 9 wherein the means for stabilizing comprises a suction cup disposed on the shaft near the cutting head and means for inducing suction through the suction cup.

11. The apparatus as defined in claim 10 wherein the first vacuum source provides a first level of suction to the cutting head and the means for inducing suction through the suction cup comprises a second vacuum source that provides a second level of suction, the second level of suction lower than the first level of suction.

12. The apparatus as defined in claim 1 wherein the handpiece is discarded after a single use.

13. The apparatus as defined in claim 1 wherein the handpiece further comprises a drive tube coupled between the drive cable and the cutting head, the drive tube comprising:

a rigid proximal portion;

a rigid distal portion; and

a flexible drive coupling disposed between the rigid proximal portion and the rigid distal portion.

14. The apparatus as defined in claim 1 further comprising means for advancing the cutting head at high speed in a distal direction.

15. The apparatus as defined in claim 1 further comprising means, disposed on the shaft, for viewing the cutting head when the articulation region is articulated.

16. Apparatus for forming a channel in tissue, the apparatus comprising:

a controller housing a linear motor and a first vacuum source;

a handpiece comprising;

a body,

a shaft coupled to the body, the shaft having a lumen, a longitudinal axis, and an articulation region;

a cutting head having a bore coupled to the first vacuum source, a first position wherein the cutting head extends from within the lumen to form a channel in the tissue, tissue severed by the cutting head being aspirated through the bore by the first vacuum source, and a second position wherein the cutting head is retracted within the lumen; and

means for articulating the articulation region; and

a cable coupling the linear motor and vacuum source, the linear motor causing the cutting head to move the cutting head between the first and second positions.

17. The apparatus as defined in claim 16 further comprising a rotary motor housed within the controller and coupled by the cable to the cutting head to rotate the cutting head.

18. The apparatus as defined in claim 17 wherein the cable comprises a drive cable and the apparatus further comprises a coupling that transmits rotary motion and longitudinal motion from the rotary and linear motors, respectively, to the drive cable.

19. The apparatus as defined in claim 18 wherein the handpiece further comprises a spool coupled between the drive cable and the cutting head, the spool including struts defining apertures that permit tissue aspirated through the bore of the cutting head to pass to a tissue filter.

20. The apparatus as defined in claim 16 wherein the cutting head, in the first position, also experiences motion selected from the group consisting of reciprocatory motion, angular motion or vibrational motion.

21. The apparatus as defined in claim 16 further comprising means for stabilizing the cutting head in contact with the tissue.

22. The apparatus as defined in claim 21 wherein the means for stabilizing comprises a suction cup disposed on the shaft near the cutting head and a second vacuum source housed in the controller that induces suction through the suction cup.

23. The apparatus as defined in claim 16 wherein the handpiece and cable are discarded after a single use.

24. The apparatus as defined in claim 18 wherein the handpiece further comprises a drive tube coupled between the drive cable and the cutting head, the drive tube comprising:

a rigid proximal portion;

a rigid distal portion; and

a flexible drive coupling disposed between the rigid proximal portion and the rigid distal portion.

25. The apparatus as defined in claim 16 further comprising means for advancing the cutting head at high speed in a distal direction.

26. The apparatus as defined in claim 16 further comprising means, disposed on the shaft, for viewing the cutting head when the articulation region is articulated.