Polypectomy snare instrument

• US 6,235,026 B1
• Filed: 08/06/1999
• Issued: 05/22/2001
• Est. Priority Date: 08/06/1999
• Status: Expired due to Term

• Current Assignee: Boston Scientific Scimed, Inc. (Boston Scientific Corporation)
• Original Assignee: Scimed Life Systems Incorporated (Boston Scientific Corporation)
• Inventors: Smith, Kevin W.
• Primary Examiner(s): PEFFLEY, MICHAEL F
• Application Number:
  US09/369,724
• Time in Patent Office: 655 Days
• Field of Search: 606/41, 606/45-52, 606/110-113
• US Class Current: 606/46
• CPC Class Codes: A61B 17/221 Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions surgical snare instruments A61B17/32056
• CPC Class Codes: A61B 17/2909 Handles
• CPC Class Codes: A61B 17/32056 Surgical snare instruments for removing or smashing calculi A61B2017/2212; tonsillotomes A61B17/26
• CPC Class Codes: A61B 18/14 Probes or electrodes therefor
• 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 2017/00469 for insertion of instruments, e.g. guide wire, optical fibre
• CPC Class Codes: A61B 2017/2212 having a closed distal end, e.g. a loop
• CPC Class Codes: A61B 2017/2929 with a head rotatable about the longitudinal axis of the shaft
• CPC Class Codes: A61B 2017/293 with means preventing relative rotation between the shaft and the actuating rod
• CPC Class Codes: A61B 2018/00196 reciprocating lengthwise
• CPC Class Codes: A61B 2018/0091 Handpieces of the surgical instrument or device
• CPC Class Codes: A61B 2018/1407 Loop
• CPC Class Codes: A61B 2018/141 Snare
• CPC Class Codes: A61B 2018/1861 with an instrument inserted into a body lumen or cavity, e.g. a catheter

Abstract

A surgical snare instrument according to several embodiments includes a first handle capable of controlling the rotational position of the snare, and a second handle adapted to control the opening and closing of the snare and cauterization. The first handle serves as a grippable element on the sheath and contains a system which rotates the shaft, and consequently the snare, so that when the physician grips the first handle, the physician is capable of steering the snare by operating the first handle. In addition, the physician is also capable of positioning the entire sheath relative to the endoscope by sliding the sheath into and out of the working channel of the endoscope. The proximal handle is operable by an assistant and permits longitudinal movement of the shaft and cautery application. According to other embodiments, the snare instrument is provided with a mount which enables the snare instrument to be adjustably fixed relative to an endoscope handle. Additionally, an embodiment is also provided in which a single handle provides a physician with a system which advances and retracts the sheath of the snare instrument relative to the endoscope, a system which opens and closes the snare, and a system which rotates the shaft and the snare to position the snare over a polyp.

Claims

1. A surgical instrument for insertion through an endoscope having a handle and a working channel, said surgical instrument comprising:

a) an elongate flexible tubular sheath having a proximal and distal ends;

b) a flexible shaft extending through and axially movable relative to the sheath, said sheath having proximal and distal ends;

c) an end effector coupled to or formed at said distal end of said shaft;

d) a first means coupled to said shaft for rotating said shaft relative to said sheath wherein said first means is a first handle including a first member and including a second member provided with a bore, said second member being axially rotatable relative to said first member, said first member having a distal end fixedly coupled to said proximal end of said sheath and a proximal end coupled to said distal end of said tubular member, said shaft extending through said bore, and said second member having means for engaging said shaft such that rotation of said second member relative to first member causes rotation of said shaft relative to said sheath;

e) a second means for longitudinally moving said shaft relative to said tubular sheath; and

f) a tubular member coupling said first and second means together.

2. A Surgical instrument according to claim 1, wherein:

said end effector is a snare.

3. A surgical instrument according to claim 1, wherein:

said tubular member is flexible.

4. A surgical instrument according to claim 1, wherein:

said first means is located distal said second means.

5. A surgical instrument according to claim 1, wherein:

said shaft includes a key portion provided with a non-circular cross section, and said means for engaging said shaft is a non-circular cross section of said bore of said second member adapted to engage said key portion.

6. A surgical instrument according to claim 5, wherein:

said second member is provided with a tubular portion which extends at least partially into said proximal and distal ends of said first member, said tubular portion having said bore with said non-circular cross section.

7. A surgical instrument according to claim 6, wherein:

said tubular portion of said second member extends beyond said proximal and distal ends of said first member.

8. A surgical instrument according to claim 1,

wherein said second means for longitudinally moving said shaft relative to said sheath includes a first member having a throughbore and a distal end coupled to said proximal end of said tubular member, and a second member coupled to said shaft and movable relative to said first member to cause said shaft to move longitudinally relative to said sheath.

9. A surgical instrument according to claim 8, wherein:

said second member is longitudinally slidable relative to said first member.

10. A surgical instrument according to claim 1, wherein:

said shaft comprises a first element extending from said end effector to a location proximal said first means, and a second element extending from said location to said second member of said second means, said first and second elements being freely axially rotatable relative to each other.

11. A surgical instrument according to claim 10, wherein:

said first and second elements are coupled by a swivel joint.

12. A surgical instrument according to claim 10, wherein

said first element of said shaft is camber-free.

13. A surgical instrument according to claim 1, wherein:

said shaft is freely axially rotatable relative to said second means.

14. A surgical instrument according to claim 13, wherein:

said shaft is camber-free.

15. A surgical instrument according to claim 1, further comprising:

g) a first stiffening sleeve, wherein said sheath is coupled to said first means and said stiffening sleeve is provided over a portion of said sheath at or adjacent a coupling of said sheath to said first means.

16. A surgical instrument according to claim 15, further comprising:

h) a second stiffening sleeve provided over a portion of said tubular member at or adjacent a coupling of said tubular member to said first means.

17. A surgical instrument according to claim 1, further comprising:

g) means for providing a cautery current to said shaft.

18. A surgical instrument according to claim 1, further comprising:

g) mounting means for mounting said first means relative to the handle of the endoscope such that said sheath of said surgical instrument extends through the working channel of the endoscope.

19. A surgical instrument according to claim 17, wherein:

said mounting means is adapted to adjustably fix said distal end of said sheath relative to a distal end of the endoscope.

20. A surgical instrument for insertion through an endoscope having a handle and a working channel, said surgical instrument comprising:

a) a elongate flexible tubular sheath having proximal and distal ends;

b) a flexible shaft extending through and axially movable relative to the sheath, said shaft having proximal and distal ends;

c) an end effector coupled to or formed at said distal end of said shaft, said end effector capable of being positioned in open and closed positions; and

d) a handle including coupling means for coupling said handle to the endoscope handle, and further including,

i) first means for longitudinally moving said sheath relative said working channel of the endoscope,

ii) second means for longitudinally moving said shaft relative to said sheath such that said end effector is movable between open and closed positions determined by relative positions of said sheath and said shaft, and

iii) third means for axially rotating said shaft relative to said sheath.

21. A surgical instrument according to claim 20, wherein:

said end effector is a snare.

22. A surgical instrument according to claim 20, wherein:

said shaft is freely axially rotatable relative to said second means.

23. A surgical instrument according to claim 20, wherein:

said shaft includes a key portion provided with a non-circular cross section, and said third means includes means for engaging said key portion.

24. A surgical instrument according to claim 20, wherein:

said third means i s located distal said second means, and said shaft comprises a first element extending from said end effector to a location proximal said third means, and a second element extending from said location to said second means, said first and second elements being freely axially rotatable relative to each other.

25. A-surgical instrument according to claim 24, wherein:

said first and second elements are coupled by a swivel joint.

26. A surgical instrument according to claim 24, wherein

said first element of said shaft is camber-free.

27. A surgical instrument according to claim 20, wherein:

said shaft is freely axially rotatable relative to said third means.

28. A surgical instrument according to claim 27, wherein:

said shaft is camber-free.

29. A surgical instrument according to claim 20, further comprising:

e) means for providing a cautery current to said shaft.

30. A surgical instrument for insertion through an endoscope having a handle and a working channel, said surgical instrument comprising:

a) a elongate flexible tubular sheath having proximal and distal ends;

b) a flexible shaft extending through and axially movable relative to the sheath, said shaft having proximal and distal ends;

c) an end effector coupled to or formed at said distal end of said shaft;

d) a first means for rotating said shaft relative to said sheath;

e) a second means for longitudinally moving said shaft relative to said sheath; and

f) a means for fixedly coupling said surgical instrument relative to the handle of the endoscope, said means for fixedly coupling includes a first portion couplable to the endoscope and a second portion coupled to said sheath and longitudinally adjustably fixable relative to said first portion, such that said sheath may be longitudinally adjusted relative to the working channel.

31. A surgical instrument according to claim 30, wherein:

said end effector is a snare.

32. A surgical instrument according to claim 30, wherein:

said shaft is freely axially rotatable relative to said second means.

33. A surgical instrument according to claim 30, wherein:

said shaft includes a key portion provided with a non-circular cross section, and said first means includes means for engaging said key portion.

34. A surgical instrument according to claim 30, wherein:

said first means is located distal said second means, and said shaft comprises a first element extending from said end effector to a location proximal said first means, and a second element extending from said location to said second means, said first and second elements being freely axially rotatable relative to each other.

35. A surgical instrument according to claim 34, wherein:

said first and second elements are coupled by a swivel joint.

36. A surgical instrument according to claim 34, wherein

said first element of said shaft is camber-free.

37. A surgical instrument according to claim 30, wherein:

said shaft is freely axially rotatable relative to said second means.

38. A surgical instrument according to claim 37, wherein:

said shaft is camber-free.

39. A surgical instrument according to claim 30, further comprising:

e) means for providing a cautery current to said shaft.