Method and apparatus for transurethral resection of the prostate

• US 6,024,751 A
• Filed: 04/11/1997
• Issued: 02/15/2000
• Est. Priority Date: 04/11/1997
• Status: Expired due to Term

• Current Assignee: Lumenis Limited (Boston Scientific Corporation)
• Original Assignee: Coherent Inc (Coherent Corp.)
• Inventors: Lovato, Paul H., Zinner, Russell Alex, Gollnick, David Alan, Thompson, David P., Connors, Kevin, Hmelar, Michael
• Primary Examiner(s): Buiz, Michael
• Assistant Examiner(s): Lewis, William
• Application Number:
  US08/837,003
• Time in Patent Office: 1,040 Days
• Field of Search: 606/1, 606/167, 606/170, 606/171, 606/180, 604/22
• US Class Current: 606/170
• CPC Class Codes: A61B 1/015 Control of fluid supply or evacuation
• CPC Class Codes: A61B 17/32002 with continuously rotating, oscillating or reciprocating cutting instruments
• CPC Class Codes: A61B 18/201 with beam delivery through a hollow tube, e.g. forming an articulated arm through a flexible conduit A61B18/22; Hand-pieces therefor
• CPC Class Codes: A61B 2017/00274 Prostate operation, e.g. prostatectomy, turp, bhp treatment
• CPC Class Codes: A61B 2017/00685 Archimedes screw
• CPC Class Codes: A61B 2017/320028 with reciprocating movements
• CPC Class Codes: A61B 2018/00547 Prostate
• CPC Class Codes: A61B 2217/005 with suction drainage system

Abstract

A method and apparatus for transurethral resection of the prostate, which includes inserting a transurethral incisional device through the patient'"'"'s urethra, incising off at least one piece of targeted prostatic tissue using the incisional device, inserting a morcellation probe through the patient'"'"'s urethra, morcellating the excised piece of targeted prostatic tissue with the morcellation probe, and aspirating the morcellated prostatic tissue through the morcellation probe and out of the patient.

The morcellation probe of the present invention includes an elongated inner probe tube that defines an aspiration channel therein. The inner probe tube is slidably disposed inside an outer probe tube. The outer probe tube has a first aperture with a first cutting edge for cutting tissue. The inner probe tube has a second aperture or a spiral shaped groove defining a second cutting edge that moves relative to the first cutting edge to cut tissue drawn through the first aperture. The second aperture or groove are in communication with the aspiration channel. A tissue manipulation port can be formed in either the outer or inner probe tubes to overlap with the inner or outer probe tube apertures or the groove to provide continuous aspiration adjacent the first aperture if/when the first aperture is sealed by the inner probe tube.

Claims

1. A morcellation device for morcellating and removing targeted body tissue from within a patient, comprising:

an elongated outer probe tube defining a first interior channel therein and having a first aperture formed adjacent to a closed distal end of said outer probe tube;

an elongated inner probe tube defining an aspiration channel therein and having a longitudinal axis and a second aperture formed adjacent to a distal end of said inner probe tube, said inner probe tube being slidably disposed inside said first interior channel, a proximate end of said inner probe tube being connectable to a vacuum source, said inner probe tube movable relative to said outer probe tube between a first position where said first and second apertures at least partially overlap each other, and a second position where said first and second apertures do not overlap each other;

a tissue manipulation port formed in one of said outer probe tube adjacent said first aperture and said inner probe tube adjacent said second aperture, such that said tissue manipulation port at least partially overlaps one of said first and second apertures when said inner probe tube is in said second position; and

said first aperture has a first cutting edge and said second aperture has a second cutting edge, said first and second cutting edges passing each other when said inner probe tube moves from said first position to said second position;

wherein during operation, aspiration caused by a vacuum in said aspiration channel from the vacuum source manipulates the targeted tissue to said first aperture and draws a portion of the targeted tissue into said first and second apertures when said inner probe tube is in said first position, and the portion of targeted tissue is cut by said first and second cutting edges passing each other when said inner probe tube moves from said first position to said second position, the cut portion of targeted tissue being drawn into and through said aspiration channel, the tissue manipulation port providing suction from the aspiration channel to hold the target tissue in position while said inner probe tube is in said second position.

2. The morcellation device as recited in claim 1, wherein when said outer probe tube is in said first position, said tissue manipulation port does not overlap the one of said first and second apertures.

3. The morcellation device as recited in claim 2, wherein, during said movement of said inner probe tube from said first position to said second position, the overlapping of said tissue manipulation port with the one of said first and second apertures begins before said first and second apertures cease overlapping each other, to provide continuous manipulation of the target tissue position as said inner probe tube moves from said first to said second positions.

4. The morcellation device as recited in claim 3, wherein said inner probe tube rotates about its longitudinal axis relative to said outer probe tube between said first and second positions.

5. The morcellation device as recited in claim 3, wherein said inner probe tube is movable relative to said outer probe tube in a reciprocating longitudinal movement between said first and second positions in a direction parallel to said longitudinal axis of said inner probe tube.

6. The morcellation device as recited in claim 3, wherein said tissue manipulation port is formed continuously with the other of said one of said first and second apertures.

7. The morcellation device as recited in claim 3, wherein said first and second cutting edges are non-parallel to each other.

8. The morcellation device as recited in claim 3, wherein at least one of said first and second cutting edges is arc shaped.

9. The morcellation device as recited in claim 3, wherein said first and second cutting edges are non-linearly shaped to provide a varying cutting action as said inner tube moves from said first position to said second position.

10. The morcellation device as recited in claim 5, further comprising:

a motor assembly having a motor, said motor assembly connected to a proximate end of said outer probe tube, said motor connected to said inner probe tube for driving said inner probe tube in said reciprocating longitudinal movement relative to said outer probe tube.

11. The morcellation device as recited in claim 10, further comprising:

a cam attached to said motor;

a pin engaged with said cam and removably engaged with said inner probe tube, wherein said motor rotates said cam which in turn drives said pin in a reciprocating movement, said pin is disengageable from said inner probe tube for removal of said inner probe tube from said morcellation device.

12. The morcellation device as recited in claim 10, wherein said motor assembly has a telescope port for inserting a telescope parallel to said inner and outer probe tubes.

13. The morcellation device as recited in claim 12, further comprising:

an irrigation fluid source that provides irrigation fluid into an irrigation line; and

an outer sheath tube defining an irrigation channel in fluid communication with an irrigation port connected to said irrigation line, said outer sheath tube surrounding said telescope and said outer probe tube with an open end adjacent to said outer probe tube distal end for directing the irrigation fluid thereto.

14. The morcellation device as recited in claim 10, further comprising:

a footswitch connected to said motor and connectable to the vacuum source for controlling said motor and the vacuum source, wherein when said footswitch is slightly depressed, the vacuum source is activated to create a low level vacuum in said aspiration channel, and when said footswitch is depressed to a mid-position said motor is activated to drive said inner probe tube in said movement relative to said outer probe tube, wherein as said footswitch is gradually depressed beyond said mid-position, said motor and vacuum source are controlled to gradually increase the motor speed and aspiration channel vacuum.

15. The morcellation device as recited in claim 3, wherein said outer probe tube is tapered down in diameter adjacent said distal end of said outer probe tube.

16. The morcellation device as recited in claim 3, further comprising:

a first fluid port formed in said inner probe tube adjacent said distal end thereof;

a second fluid port formed in said outer probe tube adjacent said distal end thereof, wherein said first and second fluid ports are alternately overlapping and not overlapping each other during said movement of said inner probe tube between said first and second positions for supplying fluid into said aspiration channel when said distal end of said outer tube is positioned in a fluid environment, said first and second fluid ports positioned sufficiently away from said first and second apertures to not manipulate the position of the targeted tissue engaged therewith.

17. A morcellation device for morcellating and removing targeted body tissue from within a patient, comprising:

an elongated outer probe tube defining a first interior channel therein and having a first aperture formed adjacent to a closed distal end of said outer probe tube, said first aperture having opposing first and second cutting edges;

an elongated inner probe tube defining an aspiration channel therein and having a longitudinal axis and a second aperture formed adjacent to a distal end of said inner probe tube, said second aperture having opposing third and fourth cutting edges, said inner probe tube being slidably disposed inside said first interior channel, a proximate end of said inner probe tube being connectable to a vacuum source, said inner probe tube being movable relative to said outer probe tube between a first position, a second position, and a medial position which is between said first and second positions, said first and second apertures at least partially overlap each other when said inner probe tube is in said medial position, said first and second apertures not overlapping each other when said inner probe tube is in either of said first and second positions;

a first tissue manipulation port, formed adjacent to one of said first and third cutting edges, that overlaps with one of said first and second apertures when said inner probe tube is in said first position; and

a second tissue manipulation port, formed adjacent to one of said second and fourth cutting edges, that overlaps with one of said first and second apertures when said inner probe tube is in said second position;

wherein during operation, aspiration caused by a vacuum in said aspiration channel from the vacuum source manipulates the targeted tissue to said first aperture and draws a portion of the targeted tissue into said first and second apertures when said inner probe tube is in said medial position, and the portion of targeted tissue is cut by said first and third cutting edges passing each other when inner tube moves from said medial position to said first position and by said second and fourth cutting edges passing each other when said inner tube moves from said medial position to said second position, the cut targeted tissue being drawn into and through said aspiration channel, said first and second tissue manipulation ports providing suction from the aspiration channel to hold the target tissue in position while said inner probe tube is in said first and second positions.

18. The morcellation device of claim 17, wherein:

said first tissue manipulation port does not overlap with the one of said first and second apertures when said inner probe tube is in said second position; and

said second tissue manipulation port does not overlap with the one of said first and second apertures when said inner probe tube is in said first position.

19. The morcellation device of claim 18, wherein:

during said movement of said inner probe tube from said medial position to said first position, said overlapping of said first tissue manipulation port with the one of said first and second apertures begins before said first and second apertures cease overlapping each other, and

during said movement of said inner probe tube from said medial position to said second position, said overlapping of said second tissue manipulation port with the one of said first and second apertures begins before said first and second apertures cease overlapping each other, wherein continuous manipulation of the target tissue position is provided as the inner probe tube travels from said first position to said second position.

20. The morcellation device as recited in claim 19, wherein said inner probe tube rotates about its longitudinal axis relative to said outer probe tube between said first and second positions.

21. The morcellation device as recited in claim 20, wherein said inner probe oscillates between said first and second positions thereby passing through said medial position twice during each of said oscillations.

22. The morcellation device as recited in claim 19, wherein said inner probe tube is movable relative to said outer probe tube in a reciprocating longitudinal movement between said first and second positions in a direction parallel to said longitudinal axis of said inner probe tube.

23. The morcellation device as recited in claim 19, wherein said first tissue manipulation port is formed continuously with the one of said first and third cutting edges, and said second tissue manipulation port is formed continuously with the one of said second and fourth cutting edges.

24. The morcellation device as recited in claim 19, wherein said first and third cutting edges are non-parallel to each other, and said second and fourth cutting edges are non-parallel to each other.

25. The morcellation device as recited in claim 19, wherein at least one of said first, second, third and fourth cutting edges is arc shaped.

26. The morcellation device as recited in claim 19, wherein at least one of said first, second, third and fourth cutting edges is non-linearly shaped to provide a varying cutting action as said inner tube moves away from said medial position.

27. The morcellation device as recited in claim 22, further comprising:

a motor assembly having a motor, said motor assembly connected to a proximate end of said outer probe tube, said motor connected to said inner probe tube for driving said inner probe tube in said reciprocating longitudinal movement relative to said outer probe tube.

28. The morcellation device as recited in claim 27, further comprising:

a cam attached to said motor;

a pin engaged with said cam and removably engaged with said inner probe tube, wherein said motor rotates said cam which in turn drives said pin in a reciprocating movement, said pin is disengageable from said inner probe tube for removal of said inner probe tube from said morcellation device.

29. The morcellation device as recited in claim 27, wherein said motor assembly has a telescope port for inserting a telescope parallel to the inner and outer probe tubes.

30. The morcellation device as recited in claim 29, further comprising:

an irrigation fluid source that provides irrigation fluid into an irrigation line; and

an outer sheath tube defining an irrigation channel in fluid communication with an irrigation port connected to said irrigation line, said outer sheath tube surrounding said telescope and said outer probe tube with an open end adjacent to said outer probe tube distal end for directing the irrigation fluid thereto.

31. The morcellation device as recited in claim 27, further comprising:

a footswitch connected to said motor and connectable to the vacuum source for controlling said motor and the vacuum source, wherein when said footswitch is slightly depressed, the vacuum source is activated to create a low level vacuum in said aspiration channel, and when said footswitch is depressed to a mid-position said motor is activated to drive said inner probe tube in said movement relative to said outer probe tube, wherein as said footswitch is gradually depressed beyond said mid-position, said motor and vacuum source are controlled to gradually increase the motor speed and aspiration channel vacuum.

32. The morcellation device as recited in claim 19, wherein said outer probe tube is tapered down in diameter adjacent said distal end of said outer probe tube.

33. The morcellation device as recited in claim 19, further comprising:

a first fluid port formed in said inner probe tube adjacent said distal end thereof;

a second fluid port formed in said outer probe tube adjacent said distal end thereof, wherein said first and second fluid ports are alternately overlapping and not overlapping each other during said movement of said inner probe tube between said first and second positions for supplying fluid into said aspiration channel when said distal end of said outer tube is positioned in a fluid environment, said first and second fluid ports positioned sufficiently away from said first and second apertures to not manipulate the position of the targeted tissue engaged therewith.

34. A morcellation device for morcellating and removing targeted body tissue from within a patient, comprising:

an elongated outer probe tube defining a first interior channel therein and having a first aperture formed adjacent to a closed distal end of said outer probe tube;

an elongated inner probe tube defining an aspiration channel therein and having a longitudinal axis and an outer surface, a spiral shaped groove is formed in said outer surface, an aspiration port in communication with said aspiration channel is formed in said groove, said inner probe tube being slidably disposed inside said first interior channel and rotatable about its longitudinal axis relative to said outer probe tube, a proximate end of said inner probe tube being connectable to a vacuum source;

said first aperture has a first cutting edge and said groove defining a spiral shaped second cutting edge, said first and second cutting edges passing each other when said inner probe rotates relative to said outer probe tube;

wherein during operation, aspiration caused by a vacuum in said aspiration channel from the vacuum source manipulates the targeted tissue to said first aperture and draws a portion of the targeted tissue into said first aperture and said groove, and the portion of targeted tissue is cut by said first and second cutting edges passing each other when said inner probe tube is rotated relative to said outer probe tube, the cut portion of targeted tissue being drawn along said groove, through said aspiration port and through said aspiration channel.

35. The morcellation device as recited in claim 34, wherein at least a portion of said groove is exposed to said first aperture throughout an entire revolution of said inner probe tube relative to said outer probe tube.

36. The morcellation device as recited in claim 35, wherein said first and second cutting edges are non-parallel to each other.

37. The morcellation device as recited in claim 35, wherein said first cutting edge is arc shaped.

38. The morcellation device as recited in claim 35, wherein said first cutting edge is non-linearly shaped to provide a varying cutting action as said inner tube is rotated.

39. The morcellation device as recited in claim 35, wherein said outer probe tube is tapered down in diameter adjacent said distal end of said outer probe tube.

40. A method for transurethral removal of targeted prostatic tissue from within a patient, comprising the steps of:

inserting a transurethral incisional device through the patient'"'"'s urethra;

incising off at least one piece of targeted prostatic tissue using the incisional device;

inserting a morcellation probe through the patient'"'"'s urethra;

morcellating the excised piece of targeted prostatic tissue with the morcellation probe; and

aspirating the morcellated prostatic tissue through the morcellation probe and out of the patient.

41. The method of claim 40, further comprising the step of:

pushing the excised piece of targeted prostatic tissue into the bladder of the patient before the morcellation step, wherein said morcellation step is performed by said morcellation probe inside the patient'"'"'s bladder.

42. The method of claim 41, further comprising the steps of:

retrieving the excised piece of targeted prostatic tissue within the patient'"'"'s bladder with the morcellation probe; and

positioning the retrieved piece of prostatic tissue away from the walls of the patient'"'"'s bladder before the morcellating step.

43. The method of claim 41, wherein the incisional device includes an electrosurgical cutting loop for performing the incising step.

44. The method of claim 41, wherein the incisional device includes an optical fiber having an input end connected to a laser system that generates an optical output and an output end for delivering the optical output through the patient'"'"'s urethra to the targeted prostatic tissue, wherein said incising step is performed by said optical output exiting said output end.

45. The method of claim 44, wherein said laser system is one of an erbium laser system, a holmium laser system, an Nd:

Yag laser system and a KTP laser system.

46. The method of claim 40, wherein said morcellation probe includes:

an elongated outer probe tube defining a first interior channel therein and having a first aperture formed adjacent to a closed distal end of said outer probe tube;

an elongated inner probe tube defining an aspiration channel therein and having a second aperture formed adjacent to a distal end of said inner probe tube, said inner probe tube being slidably disposed inside said first interior channel, a proximate end of said inner probe tube being connectable to a vacuum source, said inner probe tube movable relative to said outer probe tube between a first position where said first and second apertures at least partially overlap each other, and a second position where said first and second apertures do not overlap each other;

a tissue manipulation port formed in one of said outer probe tube adjacent said first aperture and said inner probe tube adjacent said second aperture, such that said tissue manipulation port at least partially overlaps one of said first and second apertures when said inner probe tube is in said second position; and

said first aperture has a first cutting edge and said second aperture has a second cutting edge, said first and second cutting edges passing each other when said inner probe tube moves from said first position to said second position;

wherein during operation, aspiration caused by a vacuum in said aspiration channel from the vacuum source manipulates the targeted tissue to said first aperture and draws a portion of the targeted tissue into said first and second apertures when said inner probe tube is in said first position, and the portion of targeted tissue is cut by said first and second cutting edges passing each other when said inner probe tube moves from said first position to said second position, the cut portion of targeted tissue being drawn into and through said aspiration channel, the tissue manipulation port providing suction from the aspiration channel to hold the target tissue in position while said inner probe tube is in said second position.

47. The method of claim 40, wherein said incising step and said morcellating step are performed substantially simultaneously.