WO1998024372A1 - Appareil et procedes adaptes a la chirurgie par voie percutanee - Google Patents

Appareil et procedes adaptes a la chirurgie par voie percutanee Download PDF

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Publication number
WO1998024372A1
WO1998024372A1 PCT/US1997/021558 US9721558W WO9824372A1 WO 1998024372 A1 WO1998024372 A1 WO 1998024372A1 US 9721558 W US9721558 W US 9721558W WO 9824372 A1 WO9824372 A1 WO 9824372A1
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WO
WIPO (PCT)
Prior art keywords
cutting head
disposed
catheter shaft
catheter
end effector
Prior art date
Application number
PCT/US1997/021558
Other languages
English (en)
Inventor
Vahid Saadat
Original Assignee
Angiotrax, Inc.
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Priority claimed from US08/863,877 external-priority patent/US5910150A/en
Application filed by Angiotrax, Inc. filed Critical Angiotrax, Inc.
Priority to EP97951467A priority Critical patent/EP1011460A4/fr
Priority to AU55101/98A priority patent/AU5510198A/en
Priority to CA002273149A priority patent/CA2273149A1/fr
Priority to JP52564498A priority patent/JP2001505460A/ja
Publication of WO1998024372A1 publication Critical patent/WO1998024372A1/fr

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    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • 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
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    • 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
    • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
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    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A61B2017/00247—Making holes in the wall of the heart, e.g. laser Myocardial revascularization
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    • A61B2017/22072—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other
    • A61B2017/22074—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other the instrument being only slidable in a channel, e.g. advancing optical fibre through a channel
    • A61B2017/22077—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other the instrument being only slidable in a channel, e.g. advancing optical fibre through a channel with a part piercing the tissue
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    • A61B2018/00214—Expandable means emitting energy, e.g. by elements carried thereon
    • A61B2018/00267—Expandable means emitting energy, e.g. by elements carried thereon having a basket shaped structure
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    • A61B2018/00273—Anchoring means for temporary attachment of a device to tissue
    • A61B2018/00279—Anchoring means for temporary attachment of a device to tissue deployable
    • A—HUMAN NECESSITIES
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    • A61B2018/00291—Anchoring means for temporary attachment of a device to tissue using suction
    • A—HUMAN NECESSITIES
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    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00351—Heart
    • A61B2018/00392—Transmyocardial revascularisation
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    • 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
    • A61B2018/1405—Electrodes having a specific shape
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    • A61B2018/1861—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves with an instrument inserted into a body lumen or cavity, e.g. a catheter
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Definitions

  • the present invention relates to apparatus and methods for performing surgery on an interior wall of a hollow-body organ such as the heart, or within the brain cavities and the like. More particularly, the present invention provides a device that enables a clinician to perform surgery on an interior wall of a hollow-body organ at a selected angle relative to a longitudinal axis of the device, and is especially well-suited for boring channels in the myocardium.
  • a leading cause of death in the United States today is coronary artery disease, in which atherosclerotic plaque causes blockages in the coronary arteries, resulting in ischemia of the heart (i.e., inadequate blood flow to the myocardium) .
  • the disease manifests itself as chest pain or angina. In 1996, approximately 7 million people suffered from angina in the United States.
  • Coronary artery bypass grafting (CABG)
  • CABG Coronary artery bypass grafting
  • CABG Coronary artery bypass grafting
  • Such surgery creates significant trauma to the patient, requires long recuperation times, and causes a great deal of morbidity and mortality.
  • experience has shown that the bypass vessel or graft becomes obstructed with time, requiring further surgery.
  • PTCA percutaneous transluminal coronary angioplasty
  • atherectomy involves using an end effector, such as a mechanical cutting device (or laser) to cut (or ablate) a passage through the blockage.
  • an end effector such as a mechanical cutting device (or laser) to cut (or ablate) a passage through the blockage.
  • Such methods have drawbacks, however, ranging from re-blockage of dilated vessels with angioplasty to catastrophic rupture or dissection of the vessel during atherectomy.
  • these methods may only be used for that fraction of the patient population where the blockages are few and are easily accessible. Neither technique is suitable for the treatment of diffuse atherosclerosis.
  • the catheter includes a plurality of control lines for directing the tip of the catheter.
  • the patent states that because the myocardium is more easily traversed than the epicardium, the clinician may judge the depth of the channel by sensing the pressure applied to the proximal end of the catheter. The patent does not address the problem of cardiac tamponade that might result if the clinician inadvertently perforates the heart wall, nor how ablated tissue is prevented from embolizing blood vessels.
  • Aita et al rely on fluoroscopic methods to determine the location of the distal end of the catheter.
  • U.S. Patent No. 5,380,316 to Aita et al describes an intraoperative laser-based system for performing TMR.
  • U.S. Patent No. 5,591,159 to Taheri describes a mechanical apparatus for performing TMR involving a catheter having an end effector formed from a plurality of spring-loaded needles.
  • the catheter first is positioned percutaneously within the left ventricle.
  • a plunger is then released so that the needles are thrust into the endocardium.
  • the needles form small channels that extend into the myocardium as they are withdrawn.
  • the patent suggests that the needles may be withdrawn and advanced repetitively at different locations under fluoroscopic guidance. The patent does not appear to address how tissue is ejected from the needles between the tissue-cutting steps.
  • TMR percutaneous surgery
  • precise control desirably should, in the context of TMR, include the capability to reliably control the depth of channel formed in the myocardium by the end effector. It would also be desirable to control the location of the end region of the device within the ventricle both with respect to features of the ventricular walls and in relation to other channels formed by the device. In addition, such precise control preferably should include the capability to stabilize the end region of the device within the organ, for example, to counteract reaction forces created by the actuation of the end effector during treatment.
  • U.S. Patent Nos. 5,389,073 and 5,330,466 to Imran describe steerable catheters;
  • U.S. Patent No. 5,415,166 to Imran describes a device for endocardial mapping;
  • U.S. Patent No. 4,813,930 to Elliott describes a radially extendable member for stabilizing an angioplasty catheter within a vessel;
  • U.S. Patent No. 5,354,310 describes an expandable wire mesh and graft for stabilizing an aneurysm;
  • U.S. Patent No. 5,358,472 and 5,358,485 to Vance et al . describe atherectomy cutters that provide for aspiration of severed material.
  • Apparatus constructed in accordance with the present invention comprises a catheter having a longitudinal axis and an end region movable to a series of positions along the longitudinal axis.
  • the end region may be selectively moved to a position at an angle relative to the longitudinal axis of the catheter, including a substantially orthogonal position.
  • the catheter includes means for stabilizing a distal region of the apparatus within a hollow-body organ, and for counteracting reaction forces developed during actuation of an end effector.
  • the catheter also includes means for aspirating tissue cut or ablated from the treatment site by the end effector.
  • the catheter in a preferred embodiment of the apparatus of the invention, includes a catheter shaft and a guide member disposed for longitudinal sliding movement within a groove of the catheter shaft.
  • the guide member includes an end region including an end effector maneuverable between a transit position wherein the end region lies parallel to a longitudinal axis of the catheter to a working position wherein the end region and end effector are oriented at an angle relative to the longitudinal axis, including a substantially orthogonal position.
  • the end effector preferably includes a mechanical cutting element configured to allow severed tissue to be aspirated to the proximal end of the catheter, and may optionally include an RF electrode for cauterizing the treatment site .
  • the catheter shaft which may additionally include adjustable outwardly projecting stabilization members, provides a stable platform to counteract reaction forces generated when the end effector contacts the wall of the hollow-body organ.
  • Methods of using the apparatus of the present invention to perform surgery, such as transmyocardial revascularization, are also provided.
  • FIG. 1 is a view of a first illustrative embodiment of apparatus constructed in accordance with the present invention
  • FIG. 2 is a perspective view of the distal region and end effector of the apparatus of FIG. 1;
  • FIGS. 3A and 3B are, respectively, a perspective view and side view of stabilization members disposed on the distal region of the apparatus of FIG. 1;
  • FIG. 4 is sectional view of an illustrative end effector constructed in accordance with the present invention.
  • FIGS. 5A and 5B are, respectively, side and perspective views of an illustrative handle assembly for controlling and actuating the apparatus of the present invention
  • FIGS. 6A-6C are views showing deployment of the apparatus of FIG. 1 in a patient's left ventricle to perform TMR;
  • FIG. 7 is a perspective view of the distal region of an alternative embodiment of apparatus constructed in accordance with the present invention.
  • FIG. 8 is a perspective view of the distal region of the apparatus of the present invention showing an alternative embodiment of the stabilization members
  • the present invention therefore offers a device having a directable end region and end effector for performing surgery that provides a degree of control heretofore unattainable. While the invention is described hereinafter as particularly useful in the emerging field of transmyocardial revascularization, apparatus constructed in accordance with the present invention may be advantageously used in performing surgery on other hollow-body organs, such as the intestines, blood vessels or the brain cavities. In addition, while the present invention is described herein in the context of a mechanical cutting system, the control and stabilization apparatus of the present invention may be advantageously used with other types of cutting elements, such as lasers, cryogenic cutters or radio-frequency ablation devices.
  • Guide member 22 includes a lumen, as described hereinafter, through which tissue may be evacuated from a treatment site by suction. Accordingly, guide member 22 may also be formed from a loosely wound spring reinforced with a soft elastomeric coating.
  • the elastomeric coating advantageously serves the following functions: it provides sealing along the length of the guide member required to maintain adequate suction through the lumen; it prevents collapse of the lumen in the presence of applied suction; it resists kinking of the coils of the spring; and it also enables the guide member to be bent to relatively tight radii.
  • Reinforced tubing suitable for use as guide member 22 is available from Adam Spence Corporation, Wall, New Jersey.
  • end region 25 of guide member 22 is movable from a transit position lying parallel to the longitudinal axis of catheter shaft 21 to a working position wherein end region 25 is articulated to a position substantially orthogonal to the longitudinal axis of the catheter shaft.
  • end region 25 may be constructed to enable it to be locked in position at any angle that may be desired for a given application.
  • stabilization members 27 project outwardly from apertures 37 on either side of catheter shaft 21 in distal region 23.
  • stabilization members 27 comprise four circumferentially-oriented hoops formed of flexible wires 27a-27d.
  • wires 27a- 27d comprise a continuous coil having its distal end affixed to catheter shaft 21 and its proximal end connected to handle assembly 26 via push wire 38. The turns of the coil are slidably disposed in lumens within catheter shaft 21 that interconnect apertures 37 on either side of the catheter shaft.
  • wires 27a-27d may be moved from a retracted position in which they are retracted against distal region 23 of catheter shaft 21 to an expanded position in which they engage a wall of the organ and urge end region 25 into engagement with an opposing wall of the organ, thereby stabilizing catheter shaft 21 against rotation.
  • Stabilization members 27 may be constructed of any suitable elastic material, including stainless steel, spring steel, nickel-titanium alloys, and a variety of plastics. A nickel-titanium alloy is preferred where wires 27a-27d comprise a continuous coil, as in FIG. 3B. In the contracted mode, catheter shaft 21 and guide member 22 have a relatively small profile, for example, 2-3 mm.
  • stabilization members 27 Upon actuation of the control means in handle assembly 26, wires 27a-27d expand out as shown in FIG. 3B to form a basket shape that spans and conforms to the lumen of the organ or vessel.
  • stabilization members 27 comprise a single coil, as in FIG. 3B, they may be actuated by a single control means.
  • each of stabilization members 27 may be individually adjusted to conform to the shape of the cavity of the hollow- body organ.
  • Stabilization members 27 may alternatively be oriented parallel to the longitudinal axis of apparatus 20, as described hereinafter with respect to FIG. 8.
  • guide member 22 Orientation of end region 25 of guide member 22 is accomplished by control wire 46, which is slidingly disposed in lumen 47 of guide member 22.
  • guide member 22 preferably comprises a spring material with spaces in-between the coils to allow it to bend when control wire 46 is retracted in a proximal direction.
  • guide member 22 may be constructed of polyimide coated over a braided steel tube and includes slits on the inside of bend region 36 so that end region 25 bends in the direction of the slits when control wire 46 is retracted in a proximal direction.
  • helical blade 43 may be extended to the proximal end of guide member 22.
  • the helical structure will function as an Archimedes screw, so that rotation of the helix pushes severed tissue along the length of the lumen to the proximal end.
  • Applicant expects that high speed rotation of cutting head 41 will generate frictional heating of the tissue surrounding the cutting head, thereby causing coagulation of the tissue with minimal thermal damage to the surrounding tissue.
  • tubular member 42 of cutting head 41 may comprise an electrically conductive material and be electrically coupled to the optional radio-frequency generator circuitry in controller 29 to provide coagulation of the edges of a channel formed in the tissue by cutting head 41.
  • tubular element 42 serves as the electrode in a monopolar coagulation arrangement.
  • a second electrode (not shown) may be formed on the working end spaced apart from the cutting head 41, so that tubular member 42 serves as one electrode of a bipolar coagulation arrangement. Applicant expects that the sealing action produced by RF coagulation, if provided, will simulate the lesions produced by a laser.
  • Micromorcellator 40 of FIG. 4 may be manufactured, for example, using spring bowden in which the end has been fused with heat to form tubular element 42 and then sharpened to allow it to cut tissue.
  • Blade 43 is inserted into tubular element 42 and bonded to, immediately or a short distance behind, the tip of the sharpened tubular element 42.
  • Tubular member 42 formed thereby may be conductive, or alternatively, a wire may be used to carry RF energy from the RF source to tubular element 42 for providing coagulation, if desired.
  • Upper portion 52 includes indicator 57a that may be selectively aligned with indicators 57b, so that the channels formed by end effector 40 are positioned at a series of spaced-apart locations.
  • Cable 28 extends from upper portion 52 and connects the working end of apparatus 20 to controller 29.
  • Upper portion 52 also includes button 58 which may be moved in slot 59 to control the articulation of end region 25 of guide member 22, and depth control lever 60 disposed in slot 61.
  • Depth control lever 60 is moved within slot 61 to control reciprocation of cutting head 41 from end region 25.
  • Slot 61 has a length so that when button 60 is moved to fully extend cutting head 41 from guide member 22, a proximal portion of tubular member 42 remains within guide member 22.
  • a user-adjustable limit bar (not shown) may be provided in slot 61 to select the maximum extension of cutting head 41 desired for a particular application.
  • RF button 62 also may be provided to control activation of the optional RF circuitry of controller 29 to coagulate tissue surrounding the channel formed by micromorcellator 40.
  • RF button also could take the form of a microswitch located within slot 61 of handle assembly 50, so as to provide automatic activation of the RF coagulation feature for a short period of time when depth control lever 60 is advanced to contact the user-adjustable limit bar.
  • handle assembly 50 provides for longitudinal movement of end region 25 with respect to catheter shaft 21 via relative movement between upper portion 52 and lower portion 51 (using knob 53) ; provides selective deployment of stabilization members 27 via button 55; selective orientation of end region 25 via button 58; control over the depth of the channels formed by end effector 40 via depth control lever 60; and, optionally, activation of an RF coagulation feature via button 62.
  • Previously known imaging techniques such as ultrasound, MRI scan, CT scan, or fluoroscopy, may be used to verify the location of the distal region 23 within the heart.
  • means may be provided in distal region 23 for emitting an ultrasonic signal which is detectable using an ultrasound imaging system outside of the patient.
  • a piezo-electric transducer may be affixed to the tip of the catheter and tuned to a frequency of a color Doppler ultrasound imaging system so as to appear as a bright orange or yellow spot on the display of the ultrasound system.
  • Yet another way to detect the location of distal region 23 is by pinpointing the delay time of an EKG signal at the point of detection, using an electrode disposed in distal region 23. By looking at the morphology as well as the temporal characteristics of the EKG signal, the vertical position of the catheter within the heart chamber may be determined.
  • tissue severed by cutting head 41 is suctioned into lumen 44 and aspirated to the proximal end of apparatus 20 via the vacuum source of controller 29.
  • the depth of channel 207 which is proportional to the movement of depth control lever 60 in slot 61, may be predetermined using conventional ultrasound techniques, MRI scanning, or other suitable methods.
  • tissue severed from the ventricular wall is aspirated through lumen 44 of guide member 22, thereby reducing the risk of embolization of the severed material.
  • suction through lumen 44 will assist in stabilizing the micromorcellator, and tend to draw tissue into the cutting head.
  • the foregoing methods enable a matrix of channels to be formed illustratively in the left ventricular wall. It will of course be understood that the same steps may be performed in mirror image to stabilize the apparatus against the left ventricular wall while actuating the end effector to produce a series of channels in the septal region.
  • the formation of such channels in the endocardium or septal region enables oxygenated blood in the left ventricle to flow directly into the myocardium and thus nourish and oxygenate the muscle. It is believed that these channels may be drilled anywhere on the walls of the heart chamber, including the septum, apex and left ventricular wall, and the above-described apparatus provides this capability.
  • Wires 71 and 72 in cooperation with a distally-directed axial force exerted on the handle assembly by the clinician, serve to anchor the catheter against a lateral wall of the left ventricle, while catheter shaft 74 and guide member 79 are advanced along the dual-rail.
  • apparatus 70 may include flexurally weaker locations along its length to aid in positioning distal region 74 within the left ventricle.
  • the position of end region 75 and end effector 81 may be determined relative to the apex of the heart. This position information may be sampled using suitable analog to digital circuitry, and displayed on a display unit to aid the physician in determining where to place the channels in the heart wall.
  • FIGS. 8 and 9A-9C a first alternative embodiment of the stabilization members of the present invention are described.
  • Apparatus 90 includes catheter shaft 21 including barbs 33 and guide member 22 including end region 25.
  • Stabilization members 91a- 91d project from proximal apertures 92 and distal apertures 93, and comprise individual longitudinally- oriented flexible wires. Wires 91a-91d enter lumens in catheter shaft 21 through apertures 92 and extend proximally to handle assembly 26.
  • Each of wires 91a- 91d preferably has a respective button (similar to button 55 in FIGS.
  • wires 91a-91d of the embodiment of FIG. 8 may be moved from a retracted position in which they are retracted against distal region 23 of catheter shaft 21 to an expanded position in which they engage a wall of the organ and urge end region 25 into engagement with an opposing wall of the organ, thus stabilizing catheter shaft 21 against rotation.
  • each of stabilization members 91 preferably may be selectively extended a different amount, therefore causing distal region 23 to rotate about its longitudinal axis.
  • wire 91a is extended from distal region 23 a greater distance, causing a larger bow in wire 91a, while wire 91d is extended a smaller distance, causing a smaller bow therein. Consequently, if each of wires 91a-91d contacts a wall of the organ, catheter shaft 23 will have a tendency to rotate in a counterclockwise direction (viewed from the distal end) . Conversely, reversing the extensions of wires 91a and 91d, as in FIG. 9C, will cause rotation in the opposite direction. It is therefore seen that by individually controlling the extension of the stabilization members 91, the position of the catheter with respect to an interior lateral wall of the hollow- body organ can be controlled.
  • Apparatus 100 includes catheter shaft 101 and guide member 102. Except for stabilization members 103, which in FIG. 10 comprise horizontal inflatable ribs, apparatus 100 is similar to apparatus 20 of FIG. 1.
  • guide member 102 moves relative to catheter shaft 101 to enable the clinician to form a series of vertically aligned channels in the myocardium. Once a line of channels has been formed, the catheter must be moved laterally to a new location and the procedure repeated until the desired number of channels has been achieved.
  • One expedient for doing so for example, applicable to the apparatus of FIG. 7, is to withdraw the catheter slightly, rotate it and reposition it at a different location on the left ventricular wall.
  • the stabilization arrangement of FIG. 10 instead facilitates lateral movement by deflating ribs 103, rotating catheter shaft 21, and then re-inflating ribs 103.
  • stabilization members 103 when inflated, provide a degree of hoop strength that ensures proper contact of the distal face of end region 106 with the wall of the hollow-body organ or vessel at all times. Once a vertical row of channels has been formed, stabilization members 103 are deflated by the clinician and end region 106 is moved to a new lateral position. The stabilization members are fully re- inflated and another vertical row of channels is formed, as discussed hereinabove.
  • balloons 114a-114c may be selectively inflated via inflation lumens (not shown) in catheter shaft 111 to stabilize apparatus 110 within a hollow-body organ, and to rotate catheter shaft 111 (and end region 113) in a manner similar to that described above with respect to FIGS. 9A-9C.
  • Micromorcellator 120 is disposed within guide member 121 that includes slits in bend region 122 and control wire 123 disposed in lumen 124. End region 125 of guide member 121 is articulated to a position about 90 degrees from the longitudinal axis of the catheter shaft by retracting control wire 123 in a proximal direction, as described hereinabove.
  • Micromorcellator 120 comprises cutting head 126 affixed to a distal end of drive cable 127 and disposed in telescoping tubular member 128.
  • Drive cable 127 is disposed in internal lumen 129 of end region 125, and couples cutting element 126 to the motor of controller 29.
  • cutting head 126 includes tubular region 130 and a plurality of angled teeth 131 disposed from its interior wall.
  • Frustoconical portion 132 joins tubular region 130 to drive cable hub 133.
  • Frustoconical portion 132 has openings 134 through which tissue severed by teeth 131 within tubular region 130 exit into lumen 129 of guide member 121.
  • Tubular region includes sharp beveled edge 135 and flange 136 disposed on its exterior surface.
  • flange 136 is slidingly engaged between steps 137 and 138 of telescoping member 128.
  • Telescoping member 128 also includes flange 139 that abuts against stops 140 when the telescoping member is moved to its distal-most position.
  • Cutting head 126 is reciprocated within lumen 129 of guide member 121 by an axial force applied to drive cable 127 (drive cable 127 is relatively stiff to accomplish this force transmission) .
  • drive cable 127 is pushed in the distal direction (e.g., by the clinician actuating the depth control lever of the handle assembly)
  • cutting head 126 is displaced distally.
  • flange 136 is journaled between steps 137 and 138 of telescoping member 128, the telescoping member is advanced (and retracted) along with the cutting head. Accordingly, telescoping member enables cutting head 126 to be extended a distance equal to several times the length of the cutting head while using a centrally disposed drive cable.
  • cutting head 126 provides the capability to further divide the severed tissue after it is cut from the organ or vessel wall by teeth 131.
  • Teeth 131 preferably are sharp slanted blades mounted on the interior wall of tubular member 130. Teeth 131 are arranged so that they urge the severed tissue in a proximal direction when cutting head 126 is rotated, in conjunction with action of the negative pressure in lumen 129 and forward movement of the cutting head.
  • the tissue exits tubular region 130 by passing through windows 134, the tissue is further finely divided by the arms of frustoconical region 132 that connect tubular region 130 to drive cable hub 133. Because cutting head 126 is rotated at high speeds, for example 100 to 10,000 rpm, the severed tissue is finely divided by region 132, enhancing the ease with which the tissue may be aspirated through lumen 129.
  • a micromorcellator constructed in accordance with the present invention may optionally include two or more stationary blades 141 (one shown in FIG. 13B) , which are preferably fixed to the interior of telescoping member 128 or guide member 121. Tissue exiting windows 134 of cutting head 126 impinge upon stationary blades 141, which further finely divide the tissue. Applicant expects that such further morcellation of the severed tissue will enhance the ability to aspirate the tissue from lumen 129.
  • cutting head 150 comprises tubular member 151 having sharpened beveled edge 152 and lumen 153.
  • Cutting head 150 is similar to cutting head 41 of FIG. 4 (except that blade 43 is omitted) and is attached to the drive rod in a similar fashion.
  • cutting head 155 includes frustoconical tubular member 156 having sharpened edge 157 and lumen 158.
  • Lumen 158 increases in diameter in the distal to proximal directions, so that tissue severed by edge 157 is less likely to become lodged in the lumen.
  • Cutting head 155 is attached to the drive rod in the same manner as, and is operated in a similar manner to, cutting head 41 of FIG. 4.
  • FIG. 14C depicts cutting head 160, which is a variation of cutting head 150, and includes raised thread 164 that projects from the interior wall of lumen 163 of tubular member 161. It is contemplated that the helix of thread 164 should be oriented so that the thread pushes severed tissue in the proximal direction when cutting head is rotated to cut tissue. As will be understood, thread 164 may be equally advantageously employed with cutting head 155 of FIG. 14B.
  • FIG. 14D depicts cutting head 165 comprising tubular member 166, as described with respect to FIG. 14A above, and propeller-like blade 167.
  • Blade 167 includes sharpened edges 168 for severing tissue drawn into tubular member 166, for example, by suction or forward motion of the tubular member.
  • Blade 167 includes nose cone 169, and is mounted on drive cable 170, like the cutting head of FIGS. 13.
  • Cutting head 175 comprises tubular member 176 (similar to that of FIG. 14A) carrying band-type blade 177. Blade 177 projects from the distal endface of tubular member 176, and includes a band or ribbon having sharpened lead edges 177. Cutting head 175 is attached to a drive rod in the same manner as, and operated in a similar manner to, cutting head 41 of FIG. 4.

Abstract

On décrit un appareil (20) et des procédés qui permettent d'effectuer un acte chirurgical à l'intérieur d'un organe corporel creux. On utilise un cathéter (28) qui comporte un axe longitudinal et une partie terminale dotée d'un effecteur terminal (25), ladite partie terminale étant mobile et pouvant adopter une série de positions le long de l'axe longitudinal ainsi qu'une orientation sélectionnée par rapport à l'axe longitudinal. Le cathéter (28) comprend des éléments (27) qui servent à stabiliser la partie terminale de l'appareil à l'intérieur d'un organe corporel creux et à contrebalancer les forces de réaction qui se créent pendant la mise en oeuvre de l'effecteur terminal (25). Ce dernier (25) coupe les tissus et aspire depuis un site de traitement les tissus coupés.
PCT/US1997/021558 1996-12-02 1997-11-25 Appareil et procedes adaptes a la chirurgie par voie percutanee WO1998024372A1 (fr)

Priority Applications (4)

Application Number Priority Date Filing Date Title
EP97951467A EP1011460A4 (fr) 1996-12-02 1997-11-25 Appareil et procedes adaptes a la chirurgie par voie percutanee
AU55101/98A AU5510198A (en) 1996-12-02 1997-11-25 Apparatus and methods for percutaneously performing surgery
CA002273149A CA2273149A1 (fr) 1996-12-02 1997-11-25 Appareil et procedes adaptes a la chirurgie par voie percutanee
JP52564498A JP2001505460A (ja) 1996-12-02 1997-11-25 手術を経皮的に実施するための装置および方法

Applications Claiming Priority (6)

Application Number Priority Date Filing Date Title
US3219696P 1996-12-02 1996-12-02
US08/863,925 1997-05-27
US08/863,877 US5910150A (en) 1996-12-02 1997-05-27 Apparatus for performing surgery
US08/863,877 1997-05-27
US60/032,196 1997-05-27
US08/863,925 US5941893A (en) 1996-12-02 1997-05-27 Apparatus for transluminally performing surgery

Publications (1)

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WO1998024372A1 true WO1998024372A1 (fr) 1998-06-11

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EP (1) EP1011460A4 (fr)
JP (1) JP2001505460A (fr)
AU (1) AU5510198A (fr)
CA (1) CA2273149A1 (fr)
WO (1) WO1998024372A1 (fr)

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EP1011460A1 (fr) 2000-06-28
AU5510198A (en) 1998-06-29

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