CA2393608A1 - Surgical instruments with integrated electrocautery - Google Patents

Surgical instruments with integrated electrocautery Download PDF

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Publication number
CA2393608A1
CA2393608A1 CA002393608A CA2393608A CA2393608A1 CA 2393608 A1 CA2393608 A1 CA 2393608A1 CA 002393608 A CA002393608 A CA 002393608A CA 2393608 A CA2393608 A CA 2393608A CA 2393608 A1 CA2393608 A1 CA 2393608A1
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CA
Canada
Prior art keywords
lumen
instrument
surgical
liquid
distal end
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
CA002393608A
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French (fr)
Other versions
CA2393608C (en
Inventor
Timothy E. Moutafis
Donald C. Freeman, Jr.
Kevin Staid
Andy H. Levine
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Hydrocision Inc
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Individual
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Filing date
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Publication of CA2393608A1 publication Critical patent/CA2393608A1/en
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Publication of CA2393608C publication Critical patent/CA2393608C/en
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Expired - Lifetime legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3203—Fluid jet cutting instruments
    • A61B17/32037—Fluid jet cutting instruments for removing obstructions from inner organs or blood vessels, e.g. for atherectomy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A61B17/320758—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions with a rotating cutting instrument, e.g. motor driven
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1485—Probes or electrodes therefor having a short rigid shaft for accessing the inner body through natural openings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
    • A61B2017/00553—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated using a turbine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3203—Fluid jet cutting instruments
    • A61B2017/32032—Fluid jet cutting instruments using cavitation of the fluid
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3205—Excision instruments
    • A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
    • A61B17/320758—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions with a rotating cutting instrument, e.g. motor driven
    • A61B2017/320775—Morcellators, impeller or propeller like means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00184—Moving parts
    • A61B2018/00202—Moving parts rotating
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00607—Coagulation and cutting with the same instrument

Abstract

The invention includes a series of surgical instruments (1000) providing at least one electrode (1002) for performing electrocautery, and provides a method for cutting and cauterizing tissue with a surgical instrument. The invention involves a method for detecting the location of a bleeding vessel in a liquid-filled, visually monitored surgical field of a patient and for electrocauterizing the vessel to stop the bleeding before visualization of t he surgical field is compromised. Surgical instruments according to the inventi on also include operable components (118) for forming a liquid cutting jet for cutting or ablating tissue of a patient and/or for providing a rotating, tissue contacting component (122) for cutting, grinding, ablating, etc. tiss ue during a surgical procedure. Some surgical instruments include one or more liquid conducting lumen (118, 120) therein for transporting and/or removing a liquid from a surgical operating field, which lumen, in some cases, are selectively coated with a layer of an electrically insulating material so th at certain, selected, uncoated regions of an external surface of the lumen can act as an electrocautery electrode of the instrument.

Claims (45)

1. 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 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;
a rotatable shaft;
a surgical component drivable by the shaft, constructed and arranged for contact with tissue in a surgical operating field; and at least one electrocautery electrode.
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 1, wherein at least one electrocautery electrode is positioned at the distal end of the instrument.
6. The device as in claim 2, further comprising:
a liquid jet-driven rotatable rotor, positioned within the body of the instrument, the rotor being drivingly coupled to a proximal end of 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.
7. The device as in claim 2, 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.
8. The device as in claim 7, 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.
9. The device as in claim 7, wherein at least one electrocautery electrode comprises a portion of an external surface of at least one of the pressure lumen and the evacuation lumen.
10. The device as in claim 9, wherein the surgical instrument includes at least two electrocautery electrodes operable in a bipolar mode, with each electrode being positioned at the distal end of the surgical instrument.
11. The device as in claim 10, wherein the evacuation lumen is connected in electrical communication with a positive terminal of an external power supply, and wherein the pressure lumen is connected in electrical communication with a source of ground potential.
12. The device as in claim 11, wherein the evacuation lumen has an outer surface that is electrically insulated and includes a first region near the distal end of the lumen that is not electrically insulated and that forms an electrocautery electrode and a second region located within the body of the instrument that is not electrically insulated and forms an electrical contact with the positive terminal of an external power supply.
13. 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; and at least one electrocautery electrode.
14. 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;
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;
a first electrocautery electrode comprising at least a portion of an external surface of the pressure lumen; and a second electrocautery electrode comprising at least a portion of an external surface of the evacuation lumen.
15. The device as in claim 14, Wherein the external surface of the pressure lumen is coated with an essentially continuous layer of electrical insulation and includes an uncoated region at a distal end of the pressure lumen, which region forms the first electrocautery electrode.
16. The device as in claim 14, wherein the external surface of the evacuation lumen is electrically conductive except in a region at a distal end of the evacuation lumen, which region is coated with an essentially continuous layer of electrical insulation.
17. The device as in claim 14, wherein the pressure lumen is connected in electrical communication with a positive terminal of an external power supply, and wherein the evacuation lumen is connected in electrical communication with a source of ground potential.
18. The device as in claim 14, 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.
19. The device as in claim 18, wherein at least one of the pressure lumen and the evacuation lumen is movable relative to the other.
20. The device as in claim 19, wherein movement of at least one of the pressure lumen and the evacuation lumen causes a change in the predetermined distance, the change in the predetermined distance causing a corresponding change in a length of the liquid cutting jet when the instrument is in operation.
21. The device as in claim 20, wherein the movement comprises a rotational movement.
22. The device as in claim 21, wherein the movement is controllable by manipulating at least a part of the proximal end of the surgical instrument.
23. 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 first lumen constructed of an electrically conducting material providing a first liquid passageway between the distal end and the proximal end of the instrument; and a second lumen constructed of an electrically conducting material providing a second liquid passageway between the distal end and the proximal end of the instrument, the first lumen being connectable in electrical communication with a first electrical potential, and having an external surface, at at least the distal end of the instrument, which is inserted into a surgical field of a patient when the instrument is utilized for a surgical procedure, that is coated with an essentially continuous layer of electrical insulation and includes an uninsulated region at a distal end of the first lumen, which region at a distal end of the first lumen forms a first electrocautery electrode, and the second lumen being connectable in electrical communication with a second electrical potential different from the first electrical potential, and having an external surface, at at least the distal end of the instrument, which is inserted into a surgical field of a patient when the instrument is utilized for a surgical procedure, that is electrically conductive, forming a second electrocautery electrode, except in a region at a distal end of the second lumen, which region at a distal end of the second lumen is coated with an essentially continuous layer of electrical insulation
24. The device as in claim 23, wherein the first electrical potential is provided by a positive terminal of an external power supply and the second electrical potential is provided by a source of ground potential, so that the first electrocautery electrode acts as a positive electrocautery electrode and the second electrocautery electrode acts as a ground electrocautery electrode, when the instrument is in operation.
25. The device as in claim 23, wherein at least one layer of electrical insulation is formed from poly(vinylidene fluoride) shrink-wrap tubing.
26. The device as in claim 25, wherein the thickness of the layers of electrical insulation is between about 0.004 inch and between about 0.006 inch.
27. The device as in claim 23, wherein the distal end of the second lumen is insulated from a distal-most end of the lumen to a distance, measured proximally from the distal-most end, of about 0.2 inch.
28. The device as in claim 24, wherein the total surface area of the distal end of the instrument which is inserted into a surgical field and which is maintained at ground potential exceeds the total surface area of the positive electrocautery electrode formed on the first lumen by at least a factor of about 2.
29. The device as in claim 28, wherein the total surface area of the distal end of the instrument which is inserted into a surgical field and which is maintained at ground potential exceeds the total surface area of the positive electrocautery electrode formed on the first lumen by at least a factor of about 5.
30. The device as in claim 29, wherein the total surface area of the distal end of the instrument which is inserted into a surgical field and which is maintained at ground potential exceeds the total surface area of the positive electrocautery electrode formed on the first lumen by at least a factor of about 10.
31. The device as in claim 24, wherein the positive electrocautery electrode formed on the first lumen has a total surface area of about 0.2 cm2.
32. The device as in claim 24, wherein the total surface area of the ground electrocautery electrode formed on the second lumen is sufficient to prevent boiling of any liquid contained in the surgical field of the patient, when the instrument is in operation.
33. The device as in claim 32, wherein the ground electrocautery electrode formed on the second lumen has a total surface area of at least about 2 cm2.
34. A method comprising:
inserting a surgical instrument into a surgical field of a patient;
creating a liquid cutting jet with the surgical instrument;
cutting or ablating a selected tissue of the patient with the liquid cutting jet;
applying an electrical signal to at least one electrode of the surgical instrument; and cauterizing a tissue of the patient.
35. The method as in claim 34, further comprising after the creating step, the step of:
directing the liquid cutting jet towards a jet-receiving opening in an evacuation lumen of the surgical instrument.
36. The method as in claim 35, wherein at least one electrode comprises a distal surface of at least one of a pressure lumen and the evacuation lumen of the surgical instrument.
37. The method as in claim 36, wherein in the applying step, a bipolar electrical signal is applied to two electrodes of the surgical instrument.
38. The method as in claim 34, further comprising the steps of:
rotating a rotatable component of the surgical instrument;
contacting a rotating surface of the rotatable component with a second selected tissue;
and grinding, cutting, or abrading the second selected tissue with the rotating surface.
39. The method as in claim 34, wherein the creating step is performed independently of the cauterizing step.
40. The method as in claim 34, wherein the creating step and the cauterizing step are performed concurrently.
41. A method for detecting the location of a bleeding vessel in a liquid-filled, visually monitored surgical field of a patient and for electrocauterizing the vessel to stop the bleeding before visualization of the surgical field is compromised, the method comprising:
inserting a surgical instrument into the surgical field of a patient;
controllably evacuating a portion of the liquid from the surgical field with an evacuation lumen of the surgical instrument;
visualizing a trail of blood originating at the bleeding vessel and flowing towards and into the evacuation lumen of the surgical instrument;
moving the surgical instrument within the surgical field along the trail of blood towards the bleeding vessel;
placing at least one electrode surface of the surgical instrument in proximity to the bleeding vessel; and applying an electrical signal to the electrode to electrocauterize the bleeding vessel to stop bleeding therefrom.
42. The method as in claim 41, Wherein the controllably evacuating step comprises:
creating a liquid jet with the surgical instrument;
directing the liquid jet towards a jet-receiving opening in an evacuation lumen of the surgical instrument; and removing liquid comprising the liquid jet without applying a source of external suction in fluid communication with the evacuation lumen.
43. The method as in claim 41, wherein the surgical field is visually monitored with an endoscopic probe.
44. The method as in claim 41, wherein in the placing step, two electrode surfaces of the surgical instrument are placed in proximity to the bleeding vessel, and wherein in the applying step, a bipolar electrical signal is applied to the electrodes to electrocauterize the bleeding vessel to stop bleeding therefrom.
45. The method as in claim 44, wherein a portion of an external surface of a pressure lumen of the surgical instrument comprises a first electrode surface and a portion of an external surface of the evacuation lumen of the surgical instrument comprises a second electrode surface.
CA2393608A 2000-01-10 2001-01-10 Surgical instruments with integrated electrocautery Expired - Lifetime CA2393608C (en)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
US09/480,762 2000-01-10
US09/480,762 US6451017B1 (en) 2000-01-10 2000-01-10 Surgical instruments with integrated electrocautery
PCT/US2001/000766 WO2001050965A2 (en) 2000-01-10 2001-01-10 Surgical instruments with integrated electrocautery

Publications (2)

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CA2393608A1 true CA2393608A1 (en) 2001-07-19
CA2393608C CA2393608C (en) 2010-04-20

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CA2393608A Expired - Lifetime CA2393608C (en) 2000-01-10 2001-01-10 Surgical instruments with integrated electrocautery

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US (3) US6451017B1 (en)
EP (1) EP1246576B1 (en)
JP (1) JP2003519525A (en)
AT (1) ATE472295T1 (en)
AU (1) AU780721B2 (en)
CA (1) CA2393608C (en)
DE (1) DE60142463D1 (en)
WO (1) WO2001050965A2 (en)

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AU780721B2 (en) 2005-04-14
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CA2393608C (en) 2010-04-20
US6899712B2 (en) 2005-05-31
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WO2001050965A9 (en) 2002-12-27
EP1246576A2 (en) 2002-10-09
US6451017B1 (en) 2002-09-17
AU2779401A (en) 2001-07-24
EP1246576B1 (en) 2010-06-30

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