Methods and devices for tissue removal

• US 6,032,673 A
• Filed: 08/15/1997
• Issued: 03/07/2000
• Est. Priority Date: 10/13/1994
• Status: Expired due to Term

• Current Assignee: Ethicon Incorporated (Johnson & Johnson)
• Original Assignee: FemRx, Inc. (Johnson & Johnson)
• Inventors: Kresch, Arnold J., Alden, Donald L., Christian, Jeffrey J., Savage, George M.
• Primary Examiner(s): PEFFLEY, MICHAEL F
• Application Number:
  US08/912,259
• Time in Patent Office: 935 Days
• Field of Search: 606/41, 606/42, 606/45-50, 128/898, 604/21, 604/22, 600/105, 600/135
• US Class Current: 128/898
• CPC Class Codes: A61B 17/32 Surgical cutting instruments A61B18/042 takes precedence; suture cutters A61B17/0467; instruments for ligaturing or cutting A61B17/128; instruments for rupturing the amniotic membrane A61B17/4208; specially adapted knives for eye surgery A61F9/0133
• CPC Class Codes: A61B 18/1485 having a short rigid shaft for accessing the inner body through natural openings
• CPC Class Codes: A61B 18/149 bow shaped or with rotatable body at cantilever end, e.g. for resectoscopes, or coagulating rollers
• 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 2018/00559 Female reproductive organs
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/00601 Cutting
• CPC Class Codes: A61B 2018/00738 Depth, e.g. depth of ablation
• CPC Class Codes: A61B 2018/00982 combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
• CPC Class Codes: A61B 2018/1253 monopolar
• CPC Class Codes: A61B 2018/1407 Loop
• 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 2090/3614 using optical fibre
• CPC Class Codes: A61B 2090/3782 transmitter or receiver in catheter or minimal invasive instrument
• CPC Class Codes: A61B 2218/002 Irrigation
• CPC Class Codes: A61B 2218/007 Aspiration

Abstract

The present invention provides a tissue resection device comprising a handle housing having a fluid infusion lumen. A shaft is reciprocatably mounted to the housing, the shaft having an aperture adjacent to a distal end and a fluid and tissue aspiration lumen extending from the aperture to a proximal end of the shaft. A cutting member is disposed adjacent to the aperture to sever tissue as the shaft is reciprocated, and an imaging mechanism on the housing is oriented toward the cutting member, thereby allowing the attending surgeon to optically direct the removal of body cavity tissue. A chopping mechanism is disposed within the lumen of the shaft to reduce the size of tissues passing through the lumen.

Claims

1. A method for resecting tissue from the uterus, the method comprising:

removing tissue from the uterus by applying a cutter or radio frequency to the tissue, wherein the tissue is removed in elongate strips;

viewing depth of tissue resection in the uterus while removing the tissue;

chopping the removed strips of tissue into morsels within the uterus; and

evacuating the removed tissue from the uterus.

2. A method as claimed in claim 1, wherein the chopping step further comprises shearing the removed tissue between adjacent edges of a chopping mechanism.

3. A method as claimed in claim 2, further comprising rotating one of the adjacent edges.

4. A method for resecting tissue from a uterus, the method comprising:

removing tissue from the uterus by applying a cutter to the tissue, wherein the tissue is removed in elongate strips by manipulating a shaft of a probe to reciprocate an electrosurgical cutting wire of the probe through the tissue adjacent the shaft, the electrosurgical cutting wire protruding radially from the shaft;

viewing depth of tissue resection in the uterus while removing the tissue;

reducing the size of the tissue strips; and

evacuating the removed tissue from the uterus.

5. A method for resecting tissue as claimed in claim 4, wherein the electrosurgical cutting wire defines a curve protruding from the shaft, and wherein the reciprocation of the curved wire passes the curve through the tissue so as to remove the elongate strips of tissue.

6. A method for resecting tissue from a surgical site of an internal body cavity, the method comprising:

cutting strips of tissue from the surgical site by axially translating an electrosurgical cutting member of a probe;

aspirating fluid from the surgical site into an aperture on a shaft of the probe so that the strips of tissue enter the aperture; and

chopping the strips of tissue into morsels as they enter the aperture and evacuating the morsels through the shaft of the probe.

7. A method as claimed in claim 6, further comprising flowing irrigation fluid over an imaging mechanism and toward the cutting member while optically imaging the tissue and cutting member through the imaging mechanism, and also while cutting the strips of tissue by advancing the cutting member toward the imaging mechanism.

8. A method for resecting tissue from the uterus, the method comprising:

removing tissue from the uterus by applying radio frequency energy to the tissue, wherein the tissue is removed in elongate strips by manipulating a shaft of a probe to reciprocate an electrosurgical cutting wire of the probe through the tissue adjacent the shaft, the electrosurgical cutting wire protruding radially from the shaft;

viewing depth of, tissue resection in the uterus while removing the tissue;

reducing the size of the tissue strips; and

evacuating the removed tissue from the uterus.

9. A method for resecting tissue as claimed in claim 8, wherein the electrosurgical cutting wire defines a curve protruding from the shaft, and wherein the reciprocation of the curved wire passes the curve through the tissue so as to remove the elongate strips of tissue.

10. A method for resecting tissue from a patient'"'"'s internal body structure, comprising:

directing an electrosurgical member of a probe into the tissue by positioning a shaft of the probe adjacent the tissue so that the electrosurgical member protrudes from the shaft into the tissue;

translating the electrosurgical member through the tissue to electrosurgically remove the tissue from the internal body structure;

chopping the removed tissue into smaller morsels; and

evacuating the morsels from the patient.

11. The method of claim 10, further comprising ultrasonically measuring the depth of tissue to be removed.

12. The method of claim 10, further comprising optically visualizing the internal body structure while removing the tissue.

13. The method of claim 10, further comprising cauterizing bleeding tissue on the internal body structure.

14. A method for resecting tissue from a patient'"'"'s internal body structure, comprising:

directing an electrosurgical member of a probe into the tissue by positioning a shaft of the probe adjacent the tissue so that the electrosurgical member protrudes from the shaft into the tissue;

translating the electrosurgical member through the tissue to electrosurgically remove the tissue from the internal body structure;

chopping the removed tissue into smaller morsels; and

evacuating the morsels from the patient;

wherein electrosurgical member is a wire, and wherein the wire is translated to remove the tissue in elongate strips.

15. A method for resecting tissue from a patient'"'"'s internal body structure, comprising:

directing an electrosurgical member of a probe into the tissue by positioning a shaft of the probe adjacent the tissue so that the electrosurgical member protrudes from the shaft into the tissue;

translating the electrosurgical member through the tissue to electrosurgically remove the tissue from the internal body structure;

chopping the removed tissue into smaller morsels by rotating a sharpened blade in the internal body structure to shear the removed tissue between the sharpened blade and an adjacent surface; and

evacuating the morsels from the patient.

16. A method for resecting tissue from a body structure, said method comprising:

providing a probe having a proximal end, a distal end, a lumen extending therebetween, and an aperture exposing the lumen near the distal end;

providing an electrosurgical wire near the distal end of the probe, the electrosurgical wire defining a curve protruding from the probe;

providing a drive member rotatably disposed within the probe lumen and having a proximal end and a distal end;

providing a rotatable cutting member at the distal end of the drive member with the cutting member being accessible through the aperture;

positioning said probe at a surgical site near the body structure;

translating the electrosurgical wire along tissue at the surgical site to resect tissue within the curve from the body structure; and

rotating the cutting member to chop the removed tissue into smaller morsels.

17. The method of claim 16, further comprising aspirating the morsels from the body structure through the probe lumen.

18. The method of claim 16, further comprising ultrasonically viewing depth of tissue to be removed.

19. A method for resecting tissue from a body structure, said method comprising:

providing a probe having a proximal end, a distal end, a lumen extending therebetween, and an aperture exposing the lumen near the distal end;

providing an electrosurgical wire near the distal end of the probe;

providing a drive member rotatably disposed within the probe lumen and having a proximal end and a distal end;

providing a rotatable cutting member at the distal end of the drive member with the cutting member being accessible through the aperture;

positioning said probe at a surgical site near the body structure;

translating the electrosurgical wire along tissue at the surgical site to resect tissue from the body structure;

rotating the cutting member to chop the removed tissue into smaller morsels; and

providing an electrically conductive element on the probe, providing current to the electrically conductive element, and placing the electrically conductive element against bleeding tissue on the body structure to effect cauterization.

20. A method for extracting tissue from a uterus, the method comprising:

removing tissue from the uterus by applying a radio frequency to the tissue with an electrosurgical element of a probe so that a portion of the removed tissue is vaporized;

viewing depth of tissue removed from the uterus while removing the tissue by optically imaging the tissue with a scope of the probe; and

evacuating tissue removed from the uterus while removing the tissue by aspirating the removed tissue through an aspiration lumen of the probe;

wherein irrigation fluid flows from adjacent the scope toward the electrosurgical element, and wherein the aspirating step maintains image clarity by drawing removed tissue from adjacent the electrosurgical element away from the scope.

21. A method as claimed in claim 20, wherein a majority of removed tissue is vaporized, and wherein the morcellating step avoids clogging of an aspiration lumen.

22. A method for extracting tissue from a uterus, the method comprising:

removing tissue from the uterus by applying a radio frequency to the tissue with an electrosurgical element of a probe and translating the element through uterine tissue while the element is energized with the radio frequency so that a portion of the removed tissue is vaporized and a portion of uterine tissue is severed;

viewing depth of tissue removed from the uterus while removing the tissue by optically imaging the tissue with a scope of the probe; and

evacuating tissue removed from the uterus by morcellating the severed tissue and aspirating the removed tissue through an aspiration lumen of the probe;

wherein irrigation fluid flows from adjacent the scope toward the electrosurgical element, and wherein the aspirating step maintains image clarity by drawing removed tissue from adjacent the electrosurgical element away from the scope.

23. A method as claimed in claim 22, wherein a majority of the removed tissue is vaporized, and wherein the morcellating step avoids clogging of an aspiration lumen.

24. A method for resecting tissue from a surgical site of an internal body cavity comprising:

directing an electrosurgical member of a probe into the tissue by positioning a shaft of the probe adjacent the tissue so that the electrosurgical member protrudes from the shaft into the tissue;

translating the electrosurgical member through the tissue to electrosurgically remove the tissue from the internal body cavity thereby exposing a severed tissue area within the body cavity;

cauterizing the severed tissue area; and

evacuating the removed tissue from the body cavity.