Methods, apparatus, and systems for tissue dissection and modification

• US 8,968,302 B2
• Filed: 02/05/2013
• Issued: 03/03/2015
• Est. Priority Date: 12/31/2012
• Status: Active Grant

• Current Assignee: TDM SurgiTech, Inc.
• Original Assignee: TDM SurgiTech, Inc.
• Inventors: Weber, Paul Joseph
• Primary Examiner(s): Wieland, Robert N
• Application Number:
  US13/760,042
• Publication Number:
  US 20140188111A1
• Time in Patent Office: 756 Days
• Field of Search: 606/45
• US Class Current: 606/45
• CPC Class Codes: A61B 18/082 Probes or electrodes therefor
• CPC Class Codes: A61B 18/14 Probes or electrodes therefor
• CPC Class Codes: A61B 18/1402 Probes for open surgery
• CPC Class Codes: A61B 18/148 having a short, rigid shaft for accessing the inner body transcutaneously, e.g. for neurosurgery or arthroscopy
• CPC Class Codes: A61B 18/1482 having a long rigid shaft for accessing the inner body transcutaneously in minimal invasive surgery, e.g. laparoscopy
• 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 18/1815 using microwaves
• 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 2017/00106 ultrasonic
• CPC Class Codes: A61B 2017/00221 with wireless transmission of data, e.g. by infrared radiation or radiowaves
• CPC Class Codes: A61B 2018/00023 closed, i.e. without wound contact by the fluid
• CPC Class Codes: A61B 2018/00303 active, e.g. with a motor creating vibrations
• CPC Class Codes: A61B 2018/00589 Coagulation
• CPC Class Codes: A61B 2018/00601 Cutting
• CPC Class Codes: A61B 2018/00619 Welding
• CPC Class Codes: A61B 2018/00642 with feedback, i.e. closed loop control
• CPC Class Codes: A61B 2018/0066 without feedback, i.e. open loop control
• CPC Class Codes: A61B 2018/00666 using a threshold value
• CPC Class Codes: A61B 2018/00708 switching the power on or off
• CPC Class Codes: A61B 2018/00714 Temperature
• CPC Class Codes: A61B 2018/0072 : Current
• CPC Class Codes: A61B 2018/00761 : Duration
• CPC Class Codes: A61B 2018/00791 : Temperature
• CPC Class Codes: A61B 2018/00797 : measured by multiple temperature sensors
• CPC Class Codes: A61B 2018/00815 : measured by a thermistor
• CPC Class Codes: A61B 2018/00821 : measured by a thermocouple
• CPC Class Codes: A61B 2018/00863 : Fluid flow
• CPC Class Codes: A61B 2018/00875 : Resistance or impedance
• CPC Class Codes: A61B 2018/00898 : Alarms or notifications created in response to an abnormal condition
• 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 2018/1807 : using light other than laser radiation
• CPC Class Codes: A61B 2018/2211 : Plurality of fibres
• CPC Class Codes: A61B 2090/3945 : Active visible markers, e.g. light emitting diodes
• CPC Class Codes: A61B 2218/002 : Irrigation
• CPC Class Codes: A61B 2218/007 : Aspiration
• CPC Class Codes: A61B 34/30 : Surgical robots
• CPC Class Codes: A61B 90/98 : using electromagnetic means, e.g. transponders
• CPC Class Codes: A61N 2007/0047 : interstitial
• CPC Class Codes: A61N 7/00 : Ultrasound therapy lithotripsy A61B17/22, A61B17/225; massage using supersonic vibration A61H23/00 ; using ultrasound for introducing media into the body A61M37/0092

Abstract

Methods, apparatus and systems for tissue dissection and modification are disclosed herein. A method for tissue dissection and modification may comprise inserting a tissue dissecting and modifying wand (TDM) through an incision in a patient'"'"'s body. The TDM may comprise a tip having a plurality of protrusions with lysing segments positioned between the protrusions to dissect and/or modify tissue. The TDM may also comprise an energy window positioned on top of the TDM that is configured to deliver energy to modify tissues. After separating tissue using the lysing segment(s) to define a target region, the energy window may be activated and moved around within the target region to modify tissues. In some implementations, the energy window may be activated prior to and/or during dissection of the tissue such that the tissue is separated while tissue is modified within the target region.

Claims

1. A method for removing fibrous tissue in a patient using a tissue dissecting and

modifying wand, the method comprising the steps of:

creating an incision into a patient'"'"'s skin;

inserting a tissue dissecting and modifying wand into the incision, wherein the tissue dissecting and modifying wand comprises;

a shaft;

a tip positioned at a distal end of the shaft, wherein the tip comprises a plurality of protrusions; and

at least one lysing segment positioned between at least two adjacent protrusions among the plurality of protrusions;

passing the tissue dissecting and modifying wand through tissue to create a path to a target fibrous tissue;

positioning the tissue dissecting and modifying wand adjacent to the target fibrous tissue within the patient; and

removing the target fibrous tissue using the tissue dissecting and modifying wand.

2. The method of claim 1, wherein the step of passing the tissue dissecting and modifying wand through tissue to create a path to a target fibrous tissue comprises passing the tissue dissecting and modifying wand through tissue in a fanning motion to create least a portion of the path the path to the target fibrous tissue.

3. The method of claim 1, wherein the step of passing the tissue dissecting and modifying wand through tissue to create a path to a target fibrous tissue comprises activating the at least one lysing segment to apply energy to the tissue defining the path.

4. The method of claim 3, wherein the step of passing the tissue dissecting and modifying wand through tissue to create a path to a target fibrous tissue comprises activating the at least one lysing segment to apply electrical energy to the tissue defining the path.

5. The method of claim 1, wherein the tissue dissecting and modifying wand further comprises an energy window, wherein the energy window is configured to deliver energy to tissue adjacent to the energy window during operations with the tissue dissecting and modifying wand.

6. The method of claim 5, wherein the step of passing the tissue dissecting and modifying wand through tissue to create a path to a target fibrous tissue comprises activating the energy window to at least one of reduce bleeding within the path and induce fibrosis within tissues defining the path.

7. The method of claim 1, wherein the tissue dissecting and modifying wand further comprises:

a second plurality of protrusions positioned along the tip; and

at least one lysing segment positioned between at least two adjacent protrusions in the second plurality of protrusions, wherein the plurality of protrusions is positioned to at least substantially extend in a first direction, and wherein the second plurality of protrusions is positioned to at least substantially extend in a second direction distinct from the first direction.

8. The method of claim 7, wherein the first direction is at least substantially perpendicular to the second direction.

9. The method of claim 7, wherein the first direction extends at an acute angle relative to the second direction.

10. The method of claim 7, further comprising a third plurality of protrusions positioned on the tip, wherein the third plurality of protrusions is positioned to at least substantially extend in a third direction distinct from the first and second directions.

11. The method of claim 10, wherein the first direction extends at least substantially along a longitudinal axis of the tissue dissecting and modifying wand, wherein the second direction is at least substantially perpendicular to the first direction, and wherein the third direction extends at an acute angle relative to both the first and second directions.

12. The method of claim 1, wherein the step of removing the target fibrous tissue from an organ using the tissue dissecting and modifying wand comprises removing the target fibrous tissue from at least one of a muscle, lung, heart, gastrointestinal, and gallbladder tissue.

13. The method of claim 1, wherein the step of passing the tissue dissecting and modifying wand through tissue to create a path to a target fibrous tissue comprises applying at least one fluid to the tissue defining the path while creating the path.

14. A method for repairing herniated tissue in a patient using a tissue dissecting and

modifying wand, the method comprising the steps of:

creating an incision into a patient'"'"'s skin;

inserting a tissue dissecting and modifying wand into the incision, wherein the tissue dissecting and modifying wand comprises;

a shaft;

a tip positioned at a distal end of the shaft, wherein the tip comprises a plurality of protrusions; and

at least one lysing segment positioned between at least two adjacent protrusions among the plurality of protrusions;

passing the tissue dissecting and modifying wand through tissue to create a path to a target herniated tissue;

positioning the tissue dissecting and modifying wand adjacent to the target herniated tissue within the patient; and

removing the target herniated tissue using the tissue dissecting and modifying wand.

15. The method of claim 14, wherein the step of passing the tissue dissecting and modifying wand through tissue to create a path to a target herniated tissue comprises passing the tissue dissecting and modifying wand through tissue in a fanning motion to create least a portion of the path the path to the target herniated tissue.

16. The method of claim 14, wherein the step of passing the tissue dissecting and modifying wand through tissue to create a path to a target herniated tissue comprises activating the at least one lysing segment to apply energy to the tissue defining the path.

17. The method of claim 16, wherein the step of passing the tissue dissecting and modifying wand through tissue to create a path to a target herniated tissue comprises activating the at least one lysing segment to apply electrical energy to the tissue defining the path.

18. The method of claim 14, wherein the tissue dissecting and modifying wand further comprises an energy window, wherein the energy window is configured to deliver energy to tissue adjacent to the energy window during operations with the tissue dissecting and modifying wand.

19. The method of claim 18, wherein the step of passing the tissue dissecting and modifying wand through tissue to create a path to a target herniated tissue comprises activating the energy window to at least one of reduce bleeding within the path and induce fibrosis within tissues defining the path.

20. The method of claim 14, wherein the tissue dissecting and modifying wand further comprises:

a second plurality of protrusions positioned along the tip; and

at least one lysing segment positioned between at least two adjacent protrusions in the second plurality of protrusions, wherein the plurality of protrusions is positioned to at least substantially extend in a first direction, and wherein the second plurality of protrusions is positioned to at least substantially extend in a second direction distinct from the first direction.

21. The method of claim 20, wherein the first direction is at least substantially perpendicular to the second direction.

22. The method of claim 20, wherein the first direction extends at an acute angle relative to the second direction.

23. The method of claim 20, further comprising a third plurality of protrusions positioned on the tip, wherein the third plurality of protrusions is positioned to at least substantially extend in a third direction distinct from the first and second directions.

24. The method of claim 23, wherein the first direction extends at least substantially along a longitudinal axis of the tissue dissecting and modifying wand, wherein the second direction is at least substantially perpendicular to the first direction, and wherein the third direction extends at an acute angle relative to both the first and second directions.

25. The method of claim 14, wherein the step of repairing herniated tissue using the tissue dissecting and modifying wand comprises repairing herniated tissue from at least one of a muscle, gastrointestinal, and genitourinary tissue.

26. The method of claim 14, wherein the step of passing the tissue dissecting and modifying wand through tissue to create a path to a target herniated tissue comprises applying at least one fluid to the tissue defining the path while creating the path.

27. The method of claim 14, wherein the step of repairing herniated tissue using the tissue dissecting and modifying wand comprises separating at least one of herniated and tissues adjacent to the herniated tissue.

28. The method of claim 14, wherein the step of repairing herniated tissue using the tissue dissecting and modifying wand comprises inducing fibrosis to at least one of herniated and tissues adjacent to the herniated tissue.

29. A method for accessing a portion of the Central Nervous System in a patient using a tissue dissecting and modifying wand, the method comprising the steps of:

creating an incision into a patient'"'"'s skin;

inserting a tissue dissecting and modifying wand into the incision, wherein the tissue dissecting and modifying wand comprises;

a shaft;

a tip positioned at a distal end of the shaft, wherein the tip comprises a plurality of protrusions; and

at least one lysing segment positioned between at least two adjacent protrusions among the plurality of protrusions;

passing the tissue dissecting and modifying wand through tissue to create a path to a target portion of the Central Nervous System; and

positioning the tissue dissecting and modifying wand adjacent to the target portion of the Central Nervous System within the patient.

30. The method of claim 29, wherein the step of passing the tissue dissecting and modifying wand through tissue to create a path to a target portion of the Central Nervous System comprises passing the tissue dissecting and modifying wand through tissue in a fanning motion to create at least a portion of the path to the target portion of the Central Nervous System.

31. The method of claim 29, wherein the step of passing the tissue dissecting and modifying wand through tissue to create a path to a target portion of the Central Nervous System comprises activating the at least one lysing segment to apply energy to the tissue defining the path.

32. The method of claim 31, wherein the step of passing the tissue dissecting and modifying wand through tissue to create a path to a target portion of the Central Nervous System comprises activating the at least one lysing segment to apply electrical energy to the tissue defining the path.

33. The method of claim 29, wherein the tissue dissecting and modifying wand further comprises an energy window, wherein the energy window is configured to deliver energy to tissue adjacent to the energy window during operations with the tissue dissecting and modifying wand.

34. The method of claim 33, wherein the step of passing the tissue dissecting and modifying wand through tissue to create a path to a target portion of the Central Nervous System comprises activating the energy window to reduce bleeding within the path.

35. The method of claim 29, wherein the tissue dissecting and modifying wand further comprises:

a second plurality of protrusions positioned along the tip; and

at least one lysing segment positioned between at least two adjacent protrusions in the second plurality of protrusions, wherein the plurality of protrusions is positioned to at least substantially extend in a first direction, and wherein the second plurality of protrusions is positioned to at least substantially extend in a second direction distinct from the first direction.

36. The method of claim 35, wherein the first direction is at least substantially perpendicular to the second direction.

37. The method of claim 35, wherein the first direction extends at an acute angle relative to the second direction.

38. The method of claim 35, further comprising a third plurality of protrusions positioned on the tip, wherein the third plurality of protrusions is positioned to at least substantially extend in a third direction distinct from the first and second directions.

39. The method of claim 38, wherein the first direction extends at least substantially along a longitudinal axis of the tissue dissecting and modifying wand, wherein the second direction is at least substantially perpendicular to the first direction, and wherein the third direction extends at an acute angle relative to both the first and second directions.

40. The method of claim 29, wherein the target portion of the Central Nervous System comprises a portion of the patient'"'"'s brain.

41. The method of claim 29, wherein the step of passing the tissue dissecting and modifying wand through tissue to create a path to a target portion of the Central Nervous System comprises applying at least one fluid to the tissue defining the path while creating the path.

42. A method for removing tissue from a nerve in a patient using a tissue dissecting and modifying wand, the method comprising the steps of:

creating an incision into a patient'"'"'s skin;

inserting a tissue dissecting and modifying wand into the incision, wherein the tissue dissecting and modifying wand comprises;

a shaft;

a tip positioned at a distal end of the shaft, wherein the tip comprises a plurality of protrusions; and

at least one lysing segment positioned between at least two adjacent protrusions among the plurality of protrusions;

passing the tissue dissecting and modifying wand through tissue to create a path to a target tissue from a nerve;

positioning the tissue dissecting and modifying wand adjacent to the target tissue from a nerve within the patient; and

removing the target tissue from a nerve using the tissue dissecting and modifying wand.

43. The method of claim 42, wherein the step of passing the tissue dissecting and modifying wand through tissue to create a path to a target tissue from a nerve comprises passing the tissue dissecting and modifying wand through tissue in a fanning motion to create least a portion of the path the path to the target tissue from a nerve.

44. The method of claim 42, wherein the step of passing the tissue dissecting and modifying wand through tissue to create a path to a target tissue from a nerve comprises activating the at least one lysing segment to apply energy to the tissue defining the path.

45. The method of claim 44, wherein the step of passing the tissue dissecting and modifying wand through tissue to create a path to a target tissue from a nerve comprises activating the at least one lysing segment to apply electrical energy to the tissue defining the path.

46. The method of claim 42, wherein the tissue dissecting and modifying wand further comprises an energy window, wherein the energy window is configured to deliver energy to tissue adjacent to the energy window during operations with the tissue dissecting and modifying wand.

47. The method of claim 46, wherein the step of passing the tissue dissecting and modifying wand through tissue to create a path to a target tissue from a nerve comprises activating the energy window to at least one of reduce bleeding within the path and induce fibrosis within tissues defining the path.

48. The method of claim 42, wherein the tissue dissecting and modifying wand further comprises:

a second plurality of protrusions positioned along the tip; and

at least one lysing segment positioned between at least two adjacent protrusions in the second plurality of protrusions, wherein the plurality of protrusions is positioned to at least substantially extend in a first direction, and wherein the second plurality of protrusions is positioned to at least substantially extend in a second direction distinct from the first direction.

49. The method of claim 48, wherein the first direction is at least substantially perpendicular to the second direction.

50. The method of claim 48, wherein the first direction extends at an acute angle relative to the second direction.

51. The method of claim 48, further comprising a third plurality of protrusions positioned on the tip, wherein the third plurality of protrusions is positioned to at least substantially extend in a third direction distinct from the first and second directions.

52. The method of claim 51, wherein the first direction extends at least substantially along a longitudinal axis of the tissue dissecting and modifying wand, wherein the second direction is at least substantially perpendicular to the first direction, and wherein the third direction extends at an acute angle relative to both the first and second directions.

53. The method of claim 42, wherein the step of passing the tissue dissecting and modifying wand through tissue to create a path to a target tissue from a nerve comprises applying at least one fluid to the tissue defining the path while creating the path.