Liquid jet-powered surgical instruments

• US 6,511,493 B1
• Filed: 01/10/2000
• Issued: 01/28/2003
• Est. Priority Date: 01/10/2000
• Status: Expired due to Fees

• Current Assignee: HydroCision, Inc., Hydrocislon Incorporated
• Original Assignee: HydroCision, Inc.
• Inventors: Moutafis, Timothy E., Staid, Kevin, Freeman, Donald C. Jr.
• Primary Examiner(s): TRUONG, KEVIN THAO
• Application Number:
  US09/480,500
• Time in Patent Office: 1,114 Days
• Field of Search: 606/167, 606/170, 606/181, 606/159, 606/190, 606/172, 604/22
• US Class Current: 606/167
• CPC Class Codes: A61B 17/3203 Fluid jet cutting instruments
• 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 2017/00553 using a turbine

Abstract

The present invention provides a series of devices useful for surgical procedures utilizing rotatable components for grinding, cutting, ablating, polishing, drilling, screwing, etc., tissues of the body of a patient. The invention includes, in one aspect, a series of devices comprising surgical instruments including rotatable shafts, and surgical components drivable by the shafts that can be utilized for contact with tissue in a surgical operating field. Some preferred surgical instruments provided by the invention utilize a liquid jet-driven rotor mechanism for driving rotation of the rotatable shaft. Some preferred instruments provided by the invention include both a liquid jet-driven rotor mechanism and a nozzle at the distal end of the instrument for forming a liquid cutting jet for cutting or ablating tissue of a patient. Such instruments can include a liquid flow directing valve therein that includes a pressure-tight sealing component comprising a sealing element that is constructed and arranged to be slidably moveable within a cylinder of the valve. The invention provides methods for utilizing the inventive surgical instruments in surgical procedures involving both cutting or ablating tissue of a patient with a liquid cutting jet and grinding, cutting, or ablating tissue with a rotating surface of a surgical instrument.

Claims

1. A device comprising:

a surgical instrument having a distal end adapted to perform a surgical procedure on a patient and a proximal end adapted to be controllable by an operator, the instrument including;

a rotatable shaft;

a surgical component drivable by the shaft, constructed and arranged for contact with tissue in a surgical operating field;

a liquid jet-driven rotatable rotor, drivingly coupled to the rotatable shaft, when the instrument is in operation, such that rotation of the liquid jet-driven rotatable rotor causes a corresponding rotation of the rotatable shaft, where

the liquid jet-driven rotatable rotor is maintained in a surrounding gaseous environment while being rotatably driven by at least one liquid jet during operation, so that essentially no part of the rotor is submerged in liquid.

2. The device as in claim 1, wherein the proximal end of the instrument includes a body.

3. The device as in claim 2, wherein the rotatable shaft extends from the body of the instrument towards the distal end of the instrument.

4. The device as in claim 3, wherein the surgical component is positioned at a distal end of the rotatable shaft.

5. The device as in claim 3, wherein the liquid jet-driven rotor is positioned within the body of the instrument and is drivingly coupled to a proximal end of the rotatable shaft, when the instrument is in operation.

6. The device as in claim 2, further comprising:

a pressure lumen having sufficient burst strength to conduct a high pressure liquid towards the distal end of the instrument, the pressure lumen including at least one nozzle providing a jet opening and being shaped to form a liquid cutting jet as a liquid at high pressure flows therethrough.

7. The device as in claim 6, further comprising:

a liquid-jet target locatable opposite the jet opening at a predetermined distance therefrom to receive the liquid cutting jet when the instrument is in operation.

8. The device as in claim 6, further comprising:

an evacuation lumen, including a jet-receiving opening locatable opposite the jet opening at a predetermined distance therefrom to receive the liquid cutting jet when the instrument is in operation.

9. The device as in claim 8, wherein the evacuation lumen is shaped and positionable to enable evacuation of essentially all of the liquid comprising the liquid cutting jet from the jet-receiving opening to a proximal end of the evacuation lumen without the need for an external source of suction coupled in fluid communication with the evacuation lumen.

10. The device as in claim 8, wherein the body of the surgical instrument includes a liquid flow directing valve therein having an inlet in fluid communication with a source of high pressure liquid, a first outlet in fluid communication with the pressure lumen having sufficient burst strength to conduct a high pressure liquid towards the distal end of the instrument, and a second outlet in fluid communication with a second pressure lumen configured to conduct a high pressure liquid towards the liquid jet-driven rotor.

11. The device as in claim 2, further comprising:

a pressure lumen having a proximal end, and a distal end that is contained within the body of the instrument, the pressure lumen having sufficient burst strength to conduct a high pressure liquid, the distal end of the pressure lumen including a nozzle therein that is shaped to form a liquid jet as a liquid at high pressure flows therethrough, where

the nozzle is positioned within the body of the instrument so that the liquid rotor-driving jet emanating therefrom impacts a surface of the liquid jet-driven rotatable rotor, thereby imparting rotational motion to the rotor, such that there is essentially no change in hydrostatic pressure of the liquid comprising the liquid rotor-driving jet while in contact with the rotor, when the instrument is in operation.

12. The device as in claim 1, wherein the component constructed and arranged for contact with tissue in a surgical operating field comprises a grinding burr.

13. The device as in claim 12, wherein the burr comprises a fluted burr.

14. The device as in claim 12, wherein the burr comprises a diamond burr.

15. The device as in claim 12, further comprising:

a sheath having a proximal end and a distal end, the sheath surrounding at least a portion of the rotatable shaft.

16. The device as in claim 15, wherein the proximal end of the sheath is in fluid communication with an external source of suction to enable evacuation of tissue fragments and debris from a region of the surgical operating field surrounding the burr.

17. The device as in claim 15, wherein the rotatable shaft is constructed and arranged to generate an evacuation force tending to drive liquid and debris from the distal end of the sheath towards the proximal end of the sheath.

18. The device as in claim 17, wherein the rotatable shaft includes an impeller thereon, the impeller being disposed within the sheath, when the instrument is in operation.

19. The device as in claim 17, wherein the rotatable shaft has a helically grooved channel disposed on at least a portion of an outer surface of the shaft, the channel being disposed within the sheath, when the instrument is in operation.

20. The device as in claim 17, wherein the rotatable shaft is hollow along at least a portion of its length and includes a scoop shaped aperture, the aperture providing fluid communication between an environment surrounding the shaft and a channel defined by a hollow center of the shaft and shaped and positioned to drive liquid and debris through the channel towards the proximal end of the surgical instrument.

21. The device as in claim 1, wherein the surgical operating field comprises the joint capsule of a patient.

22. The device as in claim 1, wherein the liquid jet-driven rotor is contained within a housing, which housing is in fluid communication with a source of suction able to remove liquid from the housing during operation of the instrument.

23. The device as in claim 1, wherein the rotatable shaft has a longitudinal axis defining an axis of rotation of the shaft and the rotatable rotor rotates about an axis of rotation that is essentially perpendicular to the axis of rotation of the rotatable shaft, when the instrument is in operation.

24. The device as in claim 1, wherein the rotatable shaft has a longitudinal axis defining an axis of rotation of the shaft and the rotatable rotor rotates about an axis of rotation at a first rotational speed and the rotatable shaft rotates about the longitudinal axis defining an axis of rotation of the shaft at a second rotational speed that is different from the first rotational speed, when the instrument is in operation.

25. The device as in claim 1, wherein the rotatable rotor comprises a saw-tooth rotor.

26. A device comprising:

a surgical instrument having a distal end adapted to perform a surgical procedure on a patient and a proximal end adapted to be controllable by an operator, the instrument including;

a pressure lumen having sufficient burst strength to conduct a high pressure liquid towards the distal end of the instrument, the pressure lumen including at least one nozzle providing a jet opening and being shaped to form a liquid cutting jet as a liquid at high pressure flows therethrough; and

a rotatable shaft;

a surgical component drivable by the shaft, constructed and arranged for contact with tissue in a surgical operating field.

27. The device as in claim 26, wherein the rotatable shaft extends from the proximal end of the instrument towards the distal end of the instrument.

28. The device as in claim 27, wherein the surgical component is positioned at a distal end of the rotatable shaft.

29. The device as in claim 26, further comprising:

a liquid-jet target locatable opposite the jet opening at a predetermined distance therefrom to receive the liquid cutting jet when the instrument is in operation.

30. The device as in claim 26, further comprising:

an evacuation lumen, including a jet-receiving opening locatable opposite the jet opening at a predetermined distance therefrom to receive a liquid cutting jet when the instrument is in operation.

31. The device as in claim 30, wherein the high pressure liquid is supplied to the jet opening when the instrument is in operation at a pressure of at least 500 psig.

32. The device as in claim 31, wherein the high pressure liquid is supplied to the jet opening when the instrument is in operation at a pressure of at least 5,000 psig.

33. The device as in claim 32, wherein the high pressure liquid is supplied to the jet opening when the instrument is in operation at a pressure of at least 15,000 psig.

34. The device as in claim 33, wherein the high pressure liquid is supplied to the jet opening when the instrument is in operation at a pressure of at least 30,000 psig.

35. The device as in claim 34, wherein the high pressure liquid is supplied to the jet opening when the instrument is in operation at a pressure of at least 50,000 psig.

36. The device as in claim 30, wherein the evacuation lumen is shaped and positionable to enable evacuation of essentially all of the liquid comprising the liquid cutting jet from the jet-receiving opening to a proximal end of the evacuation lumen without the need for an external source of suction coupled in fluid communication with the evacuation lumen.

37. The device as in claim 30, wherein the component constructed and arranged for contact with tissue in a surgical operating field comprises a grinding burr.

38. The device as in claim 37, further comprising:

a sheath having a proximal end and a distal end, the sheath surrounding at least a portion of the rotatable shaft.

39. The device as in claim 38, wherein at least a portion the pressure lumen including at least one nozzle providing a jet opening and being shaped to form a liquid cutting jet as a liquid at high pressure flows therethrough and the evacuation lumen including a jet-receiving opening locatable opposite the jet opening at a predetermined distance therefrom to receive a liquid cutting jet are surrounded by the sheath.

40. The device as in claim 38, wherein essentially the entirety of the pressure lumen including at least one nozzle providing a jet opening and being shaped to form a liquid cutting jet as a liquid at high pressure flows therethrough and the evacuation lumen including a jet-receiving opening locatable opposite the jet opening at a predetermined distance therefrom to receive a liquid cutting jet are positioned external to the sheath.

41. The device as in claim 38, wherein the proximal end of the sheath is in fluid communication with an external source of suction to enable evacuation of tissue fragments and debris from a region of the surgical operating field surrounding the burr.

42. The device as in claim 38, wherein the rotatable shaft is constructed and arranged to generate an evacuation force tending to drive liquid and debris from the distal end of the sheath towards the proximal end of the sheath.

43. The device as in claim 26, wherein the surgical operating field comprises a joint capsule of a patient.

44. The device as in claim 26, further comprising:

a body of the surgical instrument;

a rotatable rotor positioned within the body of the instrument and drivingly coupled to the rotatable shaft, when the instrument is in operation, such that rotation of the rotatable rotor causes a corresponding rotation of the rotatable shaft;

a second pressure lumen having a proximal end, and a distal end that is contained within the body of the instrument, the second pressure lumen having sufficient burst strength to conduct a high pressure liquid, the distal end of the second pressure lumen including a nozzle therein that is shaped to form a liquid jet as a liquid at high pressure flows therethrough, where

the nozzle of the second pressure lumen is positioned within the body of the instrument so that the liquid jet emanating therefrom impacts a surface of the rotatable rotor, thereby imparting rotational motion to the rotor, such that there is essentially no change in hydrostatic pressure of the liquid comprising the liquid jet while in contact with the rotor, when the instrument is in operation.

45. The device as in claim 44, wherein the rotatable rotor comprises a saw-tooth rotor.

46. The device as in claim 44, wherein the rotatable shaft has a longitudinal axis defining an axis of rotation of the shaft and the rotatable rotor rotates about an axis of rotation that is essentially perpendicular to the axis of rotation of the rotatable shaft, when the instrument is in operation.

47. The device as in claim 46, wherein the rotatable rotor rotates about an axis of rotation at a first rotational speed and the rotatable shaft rotates about the axis of rotation of the shaft at a second rotational speed that is different from the first rotational speed, when the instrument is in operation.

48. A device comprising:

a surgical instrument having a distal end adapted to perform a surgical procedure on a patient and a proximal adapted to be controllable by an operator, the instrument including;

a rotatable shaft;

a surgical component drivable by the shaft, constructed and arranged for contact with tissue in a surgical operating field;

a rotatable rotor, drivingly coupled to the rotatable shaft, when the instrument is in operation, such that rotation of the rotatable rotor causes a corresponding rotation of the rotatable shaft;

a pressure lumen having a proximal end, and a distal end, the pressure lumen having sufficient burst strength to conduct a high pressure liquid, the distal end of the pressure lumen including a nozzle therein that is shaped to form a liquid jet as a liquid at high pressure flows therethrough, where

the nozzle is positioned so that at least a portion of the liquid jet emanating therefrom impacts a surface of the rotatable rotor, thereby imparting rotational motion to the rotor, such that there is essentially no change in hydrostatic pressure of the liquid comprising the liquid jet while in contact with the rotor, when the instrument is in operation.

49. The device as in claim 48, wherein the proximal end of the instrument includes a body.

50. The device as in claim 49, wherein the rotatable shaft extends from the body of the instrument towards the distal end of the instrument.

51. The device as in claim 50, wherein the rotatable rotor is positioned within the body of the instrument and is drivingly coupled to a proximal end of the rotatable shaft, when the instrument is in operation.

52. The device as in claim 49, wherein the distal end of the pressure lumen and the nozzle are positioned within the body of the instrument.

53. The device as in claim 48, wherein the nozzle is positioned so that essentially the entirety of the liquid jet emanating therefrom impacts a surface of the rotatable rotor.

54. The device as in claim 48, further comprising:

a second pressure lumen having sufficient burst strength to conduct a high pressure liquid towards the distal end of the instrument, the second pressure lumen including at least one nozzle providing a jet opening and being shaped to form a liquid cutting jet as a liquid at high pressure flows therethrough.

55. The device as in claim 54, further comprising:

a liquid-jet target locatable opposite the jet opening of the second pressure lumen at a predetermined distance therefrom to receive the liquid cutting jet when the instrument is in operation.

56. The device as in claim 54, further comprising:

an evacuation lumen, including a jet-receiving opening locatable opposite the jet opening of the second pressure lumen at a predetermined distance therefrom to receive the liquid cutting jet when the instrument is in operation.

57. The device as in claim 56, wherein the evacuation lumen is shaped and positionable to enable evacuation of essentially all of the liquid comprising the liquid cutting jet from the jet-receiving opening to a proximal end of the evacuation lumen without the need for an external source of suction coupled in fluid communication with the evacuation lumen.

58. The device as in claim 54, wherein the surgical instrument includes a liquid flow directing valve having an inlet in fluid communication with a source of high pressure liquid, a first outlet in fluid communication with the pressure lumen configured to conduct a high pressure liquid towards the rotatable rotor, and a second outlet in fluid communication with the second pressure lumen having sufficient burst strength to conduct a high pressure liquid towards the distal end of the instrument.

59. The device as in claim 48, further comprising a surgical component drivable by the rotatable shaft, constructed and arranged for contact with tissue in a surgical operating field.

60. The device as in claim 59, wherein the component constructed and arranged for contact with tissue in a surgical operating field comprises a grinding burr.

61. The device as in claim 48, wherein the surgical operating field comprises the joint capsule of a patient.

62. The device as in claim 48, wherein the liquid at high pressure is supplied to the nozzle at at least 1000 psig.

63. The device as in claim 62, wherein the liquid at high pressure is supplied to the nozzle at at least 5000 psig.

64. The device as in claim 63, wherein the liquid at high pressure is supplied to the nozzle at at least 8000 psig.

65. The device as in claim 64, wherein the liquid at high pressure is supplied to the nozzle at at least 15,000 psig.

66. The device as in claim 65, wherein the liquid at high pressure is supplied to the nozzle at at least 30,000 psig.

67. The device as in claim 48, wherein the nozzle has a region of minimum cross-sectional diameter having a predetermined length, the ratio of the predetermined length to the minimum cross-sectional diameter being not less than about four.

68. The device as in claim 67, wherein the ratio of the predetermined length to the minimum cross-sectional diameter is not less than about six.

69. The device as in claim 68, wherein the ratio of the predetermined length to the minimum cross-sectional diameter is not less than about ten.

70. The device as in claim 48, wherein the nozzle is positioned so that the liquid jet emanating therefrom traverses a gas-filled gap before impacting a surface of the rotatable rotor when the instrument is in operation.

71. The device as in claim 70, wherein essentially no portion of the rotatable rotor is submerged in a liquid when the instrument is in operation.

72. The device as in claim 48, wherein the liquid jet is directed towards a surface of the rotatable rotor at a non-zero angle thereto.

73. The device as in claim 72, wherein the liquid jet is directed towards the surface of the rotatable rotor essentially perpendicularly thereto.

74. The device as in claim 72, wherein the surface of the rotatable rotor upon which the liquid jet impacts is essentially planar.

75. The device as in claim 74, wherein the rotatable rotor comprises a saw-tooth rotor.

76. The device as in claim 48, wherein the liquid jet is directed towards a surface of the rotatable rotor essentially tangentially thereto.

77. The device of claim 76, wherein the surface of the rotatable rotor upon which the liquid jet impacts is smoothly curved.

78. The device as in claim 77, wherein the rotatable rotor comprises a curved-vane rotor.

79. The device as in claim 77, wherein the rotatable rotor comprises a Terry rotor.

80. The device as in claim 48, further comprising:

an evacuation lumen, including a jet-receiving opening to receive at least a portion of the liquid jet after it impacts a surface of the rotatable rotor, when the instrument is in operation.

81. The device of claim 80, wherein the evacuation lumen is shaped and positionable to enable evacuation of essentially all of the liquid comprising the liquid jet impacting a surface of the rotatable rotor from the jet-receiving opening to a proximal end of the evacuation lumen without the need for an external source of suction coupled in fluid communication with the evacuation lumen.

82. A device comprising:

a surgical instrument having a distal end adapted to perform a surgical procedure on a patient and a proximal end adapted to be controllable by an operator, the instrument including;

a rotatable shaft having a longitudinal axis defining an axis of rotation of the shaft;

a surgical component drivable by the shaft, constructed and arranged for contact with tissue in a surgical operating field;

a liquid jet-driven rotatable rotor, drivingly coupled to the rotatable shaft, when the instrument is in operation, such that rotation of the liquid jet-driven rotatable rotor causes a corresponding rotation of the rotatable shaft, where

the rotatable rotor rotates about an axis of rotation that is essentially perpendicular to the axis of rotation of the rotatable shaft, when the instrument is in operation.

83. The device as in claim 82, wherein the rotatable rotor rotates about its axis of rotation at a first rotational speed and the rotatable shaft rotates its axis of rotation at a second rotational speed that is different from the first rotational speed, when the instrument is in operation.

84. The device as in claim 82, wherein the rotatable rotor comprises a saw-tooth rotor.

85. The device as in claim 82, wherein the rotatable rotor comprises a curved-vane rotor.

86. The device as in claim 82, wherein the rotatable rotor comprises a Terry rotor.

87. A device comprising:

a surgical instrument having a distal end adapted to perform a surgical procedure on a patient and a proximal end adapted to be controllable by an operator, the instrument including;

a rotatable shaft having a longitudinal axis defining an axis of rotation of the shaft;

a surgical component drivable by the shaft, constructed and arranged for contact with tissue in a surgical operating field;

a liquid jet-driven rotatable rotor, drivingly coupled to the rotatable shaft, when the instrument is in operation, such that rotation of the liquid jet-driven rotatable rotor causes a corresponding rotation of the rotatable shaft, where

the rotatable rotor rotates about an axis of rotation at a first rotational speed and the rotatable shaft rotates about the longitudinal axis defining an axis of rotation of the shaft at a second rotational speed that is different from the first rotational speed, when the instrument is in operation.

88. The device as in claim 87, wherein the rotatable rotor comprises a saw-tooth rotor.

89. The device as in claim 87, wherein the rotatable rotor comprises a curved-vane rotor.

90. The device as in claim 87, wherein the rotatable rotor comprises a Terry rotor.

91. The device as in claim 87, wherein the rotatable rotor is drivingly coupled to the rotatable shaft by a gear reduction mechanism.

92. The device as in claim 91, wherein the first rotational speed exceeds the second rotational speed by at least a factor of about 2.

93. The device as in claim 92, wherein the first rotational speed exceeds the second rotational speed by at least a factor of about 5.

94. The device as in claim 93, wherein the first rotational speed exceeds the second rotational speed by at least a factor of about 10.

95. The device as in claim 94, wherein the first rotational speed exceeds the second rotational speed by at least a factor of about 20.

96. The device as in claim 95, wherein the first rotational speed exceeds the second rotational speed by at least a factor of about 30.

97. The device as in claim 87, wherein the diameter of the rotatable rotor is at least about 0.5 inch.

98. The device as in claim 97, wherein the diameter of the rotatable rotor is at least about 1 inch.

99. The device as in claim 98, wherein the diameter of the rotatable rotor is at least about 2 inches.

100. The device as in claim 99, wherein the diameter of the rotatable rotor is at least about 5 inches.

101. The device as in claim 100, wherein the diameter of the rotatable rotor is at least about 10 inches.

102. The device as in claim 87, wherein the first rotational speed of the rotatable rotor is at least about 16,000 RPM.

103. The device as in claim 102, wherein the first rotational speed of the rotatable rotor is at least about 65,000 RPM.

104. The device as in claim 103, wherein the first rotational speed of the rotatable rotor is at least about 130,000 RPM.

105. The device as in claim 104, wherein the first rotational speed of the rotatable rotor is at least about 250,000 RPM.

106. The device as in claim 105, wherein the first rotational speed of the rotatable rotor is at least about 500,000 RPM.

107. A device comprising:

a surgical instrument having a distal end adapted to perform a surgical procedure on a patient and a proximal end adapted to be controllable by an operator, the instrument including;

a rotatable shaft;

a surgical component drivable by the shaft, constructed and arranged for contact with tissue in a surgical operating field;

a liquid jet-driven rotatable saw-tooth rotor, drivingly coupled to the rotatable shaft, when the instrument is in operation, such that rotation of the liquid jet-driven rotatable saw-tooth rotor causes a corresponding rotation of the rotatable shaft.

108. The device as in claim 107, wherein the rotatable saw-tooth rotor has a diameter between about 0.5 inch and about 10 inches.

109. The device as in claim 108, wherein the rotatable saw-tooth rotor has a diameter about 1 inch.

110. The device as in claim 107, wherein the rotatable saw-tooth rotor contains between about 10 and about 200 teeth.

111. The device as in claim 110, wherein the rotatable saw-tooth rotor contains about 80 teeth.

112. The device as in claim 107, wherein the rotatable saw-tooth rotor includes a plurality of liquid jet-impacting surfaces, each of which impacting surfaces is oriented essentially perpendicularly to at least one liquid jet impacting thereon at at least one rotational position of the rotatable rotor.

113. The device as in claim 112, wherein when the rotor is in a rotational position such that an impacting surface is oriented essentially perpendicularly to the liquid jet impacting thereon, essentially the entirety of the liquid jet impacts on the impacting surface of the rotor.

114. The device as in claim 113, wherein each of the liquid jet-impacting surfaces of the rotor is oriented essentially perpendicularly with respect to a line tangent to a circle circumscribed by the outermost perimeter of the rotor as it rotates about an axis of rotation.