Method and apparatus for transurethral resection of the prostate

• US 6,156,049 A
• Filed: 02/10/1999
• Issued: 12/05/2000
• 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: Hmelar, Mike, Thompson, David P., Connors, Kevin, Lovato, Paul H., Zinner, Russell Alex, Gollnick, David Alan
• Primary Examiner(s): Buiz, Michael
• Assistant Examiner(s): LEWIS, WILLIAM W
• Application Number:
  US09/248,739
• Time in Patent Office: 664 Days
• Field of Search: 606/1, 606/167, 606/170, 606/171, 606/180, 604/22, 600/564
• 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 and an aperture with opposing cutting edges formed adjacent to its distal end. The inner probe tube is slidably disposed inside an outer probe tube, and moves relative thereto in a longitudinal reciprocating manner. The outer probe tube has an open distal end and another aperture with opposing cutting edges. During each reciprocating movement cycle, the apertures pass each other twice, and the inner probe tube aperture passes beyond the outer probe tube'"'"'s open distal end once, where two cutting actions occur between the apertures'"'"' cutting edges when they pass each other, and a third cutting action occurs when a cutting edge of the inner probe tube aperture passes the outer probe tube'"'"'s distal end. Target tissue that is cut by the cutting actions is then aspirated out of the patient'"'"'s body through the aspiration channel.

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 in a sidewall thereof adjacent to an open 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 in a sidewall thereof adjacent to a distal end of said inner probe tube, said inner probe tube is slidably disposed inside said first interior channel and movable in a reciprocating longitudinal direction parallel to said longitudinal axis and between a first position where said first and second apertures at least partially overlap each other and a second position where said second aperture is extended at least partially beyond the open distal end and out of said outer probe tube, a proximate end of said inner probe tube being connectable to a vacuum source; and

said first aperture having a first cutting edge and said second aperture having second and third opposing cutting edges, wherein said first and second cutting edges pass each other when said inner probe tube moves from said first position to said second position, and said third cutting edge and said open distal end passing each other when said inner probe tube moves from said second position to said first position;

wherein during operation;

a portion of the targeted tissue is drawn into said first and second apertures by aspiration caused by a vacuum in said aspiration channel from the vacuum source when said inner probe tube is in said first position, and 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, and

another portion of the targeted tissue is drawn into said second aperture by the vacuum when said inner probe tube is in said second position, and is cut by said third cutting edge and open distal end passing each other when said inner probe tube moves from said second position to said first position,

the cut portions of targeted tissue being drawn into and through said aspiration channel.

2. The morcellation device as recited in claim 1, wherein said first and second cutting edges are non-parallel to each other.

3. The morcellation device as recited in claim 1, wherein at least one of said first, second, and third cutting edges is arc shaped.

4. The morcellation device as recited in claim 2, wherein at least one of said first and second cutting edges is non-linearly shaped to provide a varying cutting action as said inner tube moves from said first position to said second position.

5. The morcellation device as recited in claim 1, 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.

6. The morcellation device as recited in claim 5, 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.

7. The morcellation device as recited in claim 5, wherein said motor assembly has a telescope port for inserting a telescope parallel to said inner and outer probe tubes.

8. The morcellation device as recited in claim 7, 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.

9. The morcellation device as recited in claim 5, 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.

10. The morcellation device as recited in claim 1, wherein said outer probe tube is tapered down in diameter adjacent said distal end of said outer probe tube.

11. The morcellation device as recited in claim 1, wherein:

the first aperture has a fourth cutting edge opposing the first cutting edge, and

the inner probe tube is movable to a proximal position at which the entire second aperture is located proximal to said first aperture, such that during the operation, still yet another portion of the targeted tissue is drawn into said first and second apertures by aspiration caused by a vacuum in said aspiration channel from the vacuum source when said inner probe tube is in said first position, and is cut by said third and fourth cutting edges passing each other when said inner probe tube moves from said first position to said proximal position.

12. 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 in a sidewall thereof adjacent to an open 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 in a sidewall thereof adjacent to a distal end of said inner probe tube, said second aperture having opposing third and fourth cutting edges, wherein;

said inner probe tube is slidably disposed inside said first interior channel and movable relative to said outer probe tube in a reciprocating longitudinal direction parallel to said longitudinal axis between a proximal position and a distal position,

said first and second apertures at least partially overlap each other when said inner probe tube is in a medial position that is in-between the proximal and distal positions, and do not overlap each other when said inner probe tube is in said proximal position,

said second aperture is extended at least partially beyond the open distal end and out of said outer probe tube when said inner probe tube is in said distal position, and

a proximate end of said inner probe tube is connectable to a vacuum source;

wherein during operation;

a portion of the targeted tissue is drawn into said first and second apertures by aspiration caused by a vacuum in said aspiration channel from the vacuum source when said inner probe tube is in said medial position, and is cut by said first and third cutting edges passing each other when said inner probe tube moves from said medial position to said distal position,

another portion of the targeted tissue is drawn into said second aperture by the vacuum when said inner probe tube is in said distal position, and is cut by said fourth cutting edge and open distal end passing each other when said inner probe tube moves from said distal position toward said proximal position, and

a further portion of the targeted tissue is drawn into said first and second apertures when said inner probe tube is in said medial position, and is cut by said second and fourth cutting edges passing each other when said inner probe tube moves from said medial position to said proximal position;

the cut portions of targeted tissue being drawn into and through said aspiration channel.

13. The morcellation device as recited in claim 12, wherein said first and third cutting edges are non-parallel to each other.

14. The morcellation device as recited in claim 12, wherein said second and fourth cutting edges are non-parallel to each other.

15. The morcellation device as recited in claim 12, wherein at least one of said first, second, third and fourth cutting edges is arc shaped.

16. The morcellation device as recited in claim 12, 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 from said medial position to one of said proximal and distal positions.

17. The morcellation device as recited in claim 12, 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 direction relative to said outer probe tube.

18. The morcellation device as recited in claim 17, 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 direction, said pin is disengageable from said inner probe tube for removal of said inner probe tube from said morcellation device.

19. The morcellation device as recited in claim 17, wherein said motor assembly has a telescope port for inserting a telescope parallel to said inner and outer probe tubes.

20. The morcellation device as recited in claim 19, 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.

21. The morcellation device as recited in claim 17, 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.

22. The morcellation device as recited in claim 12, wherein said outer probe tube is tapered down in diameter adjacent said distal end of said outer probe tube.

23. 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;

wherein the morcellation probe comprises;

an elongated outer probe tube defining a first interior channel therein and having a first aperture formed in a sidewall thereof adjacent to an open 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 in a sidewall thereof adjacent to a distal end of said inner probe tube, said second aperture having opposing third and fourth cutting edges, wherein;

said inner probe tube is slidably disposed inside said first interior channel and movable relative to said outer probe tube in a reciprocating longitudinal direction parallel to said longitudinal axis between a proximal position and a distal position,

said first and second apertures at least partially overlap each other when said inner probe tube is in said medial position and do not overlap each other when said inner probe tube is in said proximal position,

said second aperture is extended at least partially beyond the open distal end and out of said outer probe tube when said inner probe tube is in said distal position, and

a proximate end of said inner probe tube is connectable to a vacuum source;

wherein during operation;

a portion of the excised piece of targeted prostatic tissue is drawn into said first and second apertures by aspiration caused by a vacuum in said aspiration channel from the vacuum source when said inner probe tube is in said medial position, and is cut by said first and third cutting edges passing each other when said inner probe tube moves from said medial position to said distal position,

another portion of the excised piece of targeted prostatic tissue is drawn into said second aperture by the vacuum when said inner probe tube is in said distal position, and is cut by said fourth cutting edge and open distal end passing each other when said inner probe tube moves from said distal position toward said proximal position, and

a further portion of the excised piece of targeted prostatic tissue is drawn into said first and second apertures when said inner probe tube is in said medial position, and is cut by said second and fourth cutting edges passing each other when said inner probe tube moves from said medial position to said proximal position;

the cut portions of targeted prostatic tissue being drawn into and through said aspiration channel.

24. The method of claim 23, 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.

25. The method of claim 24, 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.

26. The method of claim 24, wherein the incisional device includes an electrosurgical cutting loop for performing the incising step.

27. The method of claim 24, 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.

28. The method of claim 27, 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.

29. The method of claim 23, wherein said incising step and said morcellating step are performed substantially simultaneously.