WO1999030622A2

WO1999030622A2 - Low profile endoscopic surgical instruments

Info

Publication number: WO1999030622A2
Application number: PCT/US1998/026622
Authority: WO
Inventors: Jim Kermode; Wade Keller
Original assignee: Surgical Insight, Inc.
Priority date: 1997-12-17
Filing date: 1998-12-14
Publication date: 1999-06-24
Also published as: WO1999030622A9; AU1726999A

Abstract

Disclosed are low profile instruments with independently movable coaxial tubes, the relative movement of which results in actuation of distal end effectors for surgical use. The instruments have a central operating channel for receiving additional instruments.

Description

LOW PROFILE ENDOSCOPIC SURGICAL

INSTRUMENTS

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation-in-part of, and claims benefit from, co- pending United States provisional patent application serial no. 60/069,958, filed December 17, 1997, the contents of which are incorporated herein by reference.

BACKGROUND OF THE INVENTION 1. Field of the Invention

This invention relates generally to surgical instruments, and more particularly to low-profile instruments and operational techniques, the instruments having a central working channel for receiving other instruments such as a video endoscope.

2. Description of the Prior Art A recent trend in surgery h.as been to minimize the size of the access portal required to perform a surgical procedure. This has led to the development of many specialized surgical instruments and even a dedicated surgical field, endoscopy. Surgical entry portals have now become small enough that the surgeon can no longer directly visualize the instruments or operational site. Surgeons are thus increasingly relying on remote imaging, such as imaging provided by fluoroscopy or fiber optics, to observe the operational site. For general surgical procedures, laparoscopy, in which a video endoscope is placed through one portal and the surgical instrumentation through another, has become a common practice. While this permits procedures to be performed through small access portals, it fails to provide vital sensory feedback to the surgeon. Remote viewing of the operational site often makes it difficult for surgeons to use their natural, innate abilities to locate and manipulate structures .and instruments. Surgeons are often required to develop "triangulation" skills wherein they must learn how their instruments move and react relative to the endoscope rather than relative to their hands, eyes or the instrument itself. This remote viewing also requires a free space between the endoscope and the instrument such that the instrument and operative site remain in view. Commonly, this is achieved by inflating and distending the operative region with C0₂ gas. This practice may have its own complications as the C0₂ applies pressure to the intern^ organs and slowly dissolves into the patient's bloodstream. In the case of highly restricted spaces, there may not be enough space to allow for both the imaging and operative instruments. Small spaces are a particular problem since the instrumentation in current use are simply downsized versions of traditional devices. What is needed is instrumentation which is specifically designed to aid in remote imaging of the operative field, to .allow access through small portals, and to facilitate the perform.ance of a wide variety of surgical procedures.

Some attempt has been made to combine imaging with instrumentation. This has primarily been accomplished by simply bundling together an existing instrument .and .an existing imaging means.

One such instrument is that disclosed in U.S. Patents Nos. 5,667,472 and 5,667,473 to Finn et al. and U.S. Patent No. 5,667,478 to McFarlin et al. The device disclosed in these patents is simply a flexible fiber optic endoscope applied to the body of a standard surgical instrument. The instrument disclosed in these patents contains few simple features intended to reduce the overall size of the instrument, but the patents disclose nothing that is specifically directed toward optimizing the performance of the imaging and operative combination.

Another such instrument is that described in U.S. Patent No. 4,962,770 to Agee, which consists of a highly specialized knife and endoscope for use in dividing the transverse carpal ligament. This instrument coordinates the performance of the imaging and operative functions, but the resultant combination is quite l.arge, thus requiring a large access portal for use.

Accordingly, while devices exist that provide an enhanced view for the surgeon .and that allow access to the operative site through small portals, devices which optimally allow for both features simultaneously do not exist. The current instrumentation is further limited in that it does not easily accommodate other stand.ard surgical accessories. In fact, many of the current instruments are so specialized that their utility is limited.

SUMMARY OF THE INVENTION One of the objects of the present invention is to provide new and improved assemblies of surgical instruments for use in minimally invasive surgical procedures, particularly those procedures where it is advantageous to have a single entry portal for the instrumentation and the vision system. It is another object of the present invention to provide very low profile surgical instruments optimized for use in confined spaces. These and other objects and advantages are achieved by constructing the surgical instrument as a plurality of tubular members coaxially arranged, in which the diameter of the outermost tubular member is less than 10 mm while the innermost tubul.ar member forms a central (axial) lumen whose internal diameter is sufficiently large to accommodate any of various types of secondary instruments such as an imaging instrument. At least two of the tubular members are movable relative to each other, and one or both of the two has an end effector at its distal end, the end effector being a functional device that can be actuated to perform a function such as cutting, clamping, abrading, or any other corrective, therapeutic, or manipulative action at the distal end of the instrument. By virtue of the manner in which the end effectors and tubular members are constructed and joined together, actuation of the end effector(s) is achieved by moving one of the two or more tubular members relative to the other. This results in either the individual action of a single end effector or the coaction of two end effectors. As explained in detail below, various types of action and directions of movement can be achieved by appropriate construction and joinder of the parts. Further features of the surgical instrument are apertures appropriately positioned at the distal ends of the tubul.ar members to permit the use and functioning of the secondary instrument that is inserted through the lumen of the innermost tubular member by providing access of the secondary instrument (e.g., the imaging instrument) to the regions surrounding the distal end of the surgical instrument. The proximal end of the surgical instrument is fitted with means for inserting the imaging device or other secondary instrument through the lumen for access to the surrounding regions through the apertures.

DESCRIPTION OF THE DRAWINGS

FIGURE LEGEND: 20 Outer tube

21 Distal end of outer tube

22 Proximal end of outer tube

23 Inner tube

24 Distal end of inner tube 25 Proximal end of inner tube

26 Endoscope

27 Tissue elevator

28 Cutting edge 29 Actuator pivot pin

30 Outer tube end effector

31 Clamp Surface

32 Actuator pin

33 Actuator slot

34 Window opening

35 Abrasive surface

36 Handle shell half

37 Spring

38 Spring no load position

39 Spring pre-load position

40 Clamping Knob

41 Trigger

42 Trigger pivot pin

43 Gear

44 Rack

45 Inner tube end effector

46 Blade

47 Intermediate tube

48 Intermediate tube end effector

49 Solder joint

50 Positive lead

51 Ground lead

52 Strain relief

53 Electrical cable

54 Working channel

Figure 1A is a distal detail view of the tip of a device made in accordance with the present invention. The tip consists of the distal end of an inner tube 24 which is rotatably located within the distal end of outer tube 21. The interior of the distal end of inner tube 24 defines a working channel 54 which may slidably or rotatably receive other instruments. The distal end of inner tube 24 is further fitted with an end effector 45 containing a clamping surface 31. The distal end of the outer tube 21 is fitted with an end effector 30 which contains a cutting edge 28. Relative motion of the tubes 24 and 21 results in relative motion of the end effectors 45 and 30. Figure IB is an end view of the tip shown in Figure 1A. This view shows the end effectors 30 .and 45 in a first position where cutting edge 28 may strike end effector 45 thus forming a scissors.

Figure 1C is the same end view as Figure IB. This view however shows the end effectors 30 and 45 in a second position where the clamping surfaces 31 may cooperate to form a clamp.

Figure 2 is a distal detail view of the tip of a device made in accordance with the present invention. Relative motion of the distal ends of inner tube 24 .and outer tube 21 results in the movement of actuator pins 32 in actuator slots 33. This motion further results in the movement of blades 46 with cutting edges 28 in a direction substantially perpendicular to the axis of the motion of the distal ends of inner tube 24 .and outer tube 21. The interior of the distal end of inner tube 24 further defines a working channel 54 which may slidably or rotatably receive other instruments.

Figure 3 is a distal detail view of the tip of a device made in accordance with the present invention. Relative motion of the distal ends of inner tube 24 and outer tube 21 results in the movement of actuator pins 32 in actuator slots 33, about pivot pin 29. This motion further results in blades 46 with cutting edges 28, rotating towards or away from the axis of the motion of the distal ends of inner tube 24 and outer tube 21. The interior of the distal end of inner tube 24 further defines a working channel 54 which may slidably or rotatably receive other instruments.

Figure 4 is a distal detail view of the tip of a device made in accordance with the present invention. Oscillatory, axial motion of the distal end of inner tube 24 relative to the distal end of outer tube 21 results in the oscillatory axial motion of end effector 45. End effector 45 is fitted with a blade 46 with a serrated cutting edge 28. The interior of the distal end of inner tube 24 further defines a working channel 54 which may slidably or rotatably receive other instruments.

Figure 5 is a distal detail view of the tip of a device made in accordance with the present invention. Relative motion of the distal ends of inner tube 24 and outer tube 21 results in the movement of actuator pin 32 in actuator slot 33, about pivot pin 29 located on outer tube end effector 30. This motion further results in a first blade 46 with cutting edge 28, rotating towards or away from the axis of the motion of the distal ends of inner tube 24 and outer tube 21 and a second blade 46 with a cutting edge 28, in the manner of a scissors. The interior of the distal end of inner tube 24 further defines a working channel 54 which may slidably or rotatably receive other instruments. Figure 6 is a distal detail view of the tip of a device made in accordance with the present invention. Axial motion of the distal end of inner tube 24 relative to the distal end of outer tube 21 results in the axial motion of inner tube end effector 45 relative to outer tube end effector 30. Both end effectors are fitted with blades 46 having cutting edges 28 and may cooperate as scissors as a result of said axial motion. The interior of the distal end of inner tube 24 further defines a working channel 54 which may slidably or rotatably receive other instruments. Figure 7 is a distal detail view of the tip of a device made in accordance with the present invention. Relative motion of the distal ends of inner tube 24 .and outer tube 21, .and their associated end effectors 45 and 30 respectively, results in the movement of actuator pin 32 in actuator slot 33, about pivot pin 29. This motion further results in a first blade 46 with cutting edge 28, rotating towards or away from the axis of the motion of the distal ends of inner tube 24 and outer tube 21. This first blade 46 and cutting edge 28 also rotates towards and away from a second blade 46 with a cutting edge 28 in the manner of a scissors. The interior of the distal end of inner tube 24 further defines a working channel 54 which may slidably or rotatably receive other instruments. Figure 8 is a distal detail view of the tip of a device made in accordance with the present invention. Rotary motion of the distal end of inner tube 24 relative to the distal end of outer tube 21 results in the rotary motion of end effector 45. End effector 45 is fitted with an abrasive surface 35 .and a window opening 34. The interior of the distal end of inner tube 24 further defines a working channel 54 which may slidably or rotatably receive other instruments. In the case where the other instrument is an imaging system, the rotary motion of window 34 on end effector 45 results in a substantially unobstructed view of the operative environment.

Figure 9 is a distal detail view of the tip of a device made in accordance with the present invention. Rotary motion of the distal end of inner tube 24 relative to the distal end of outer tube 21 results in the rotary motion of end effector 45. End effector 45 is fitted with a circular blade 46 with a serrated circular cutting edge 28 .and a window opening 34. The interior of the distal end of inner tube 24 further defines a working channel 54 which may slidably or rotatably receive other instruments. In the case where the other instrument is an imaging system, the rotary motion of window 34 on end effector 45 results in a substantially unobstructed view of the operative environment.

Figure 10 is a distal detail view of the tip of a device made in accordance with the present invention. Rotary motion of the distal end of inner tube 24 relative to the distal end of outer tube 21 results in the rotary motion of inner tube end effector 45 relative to outer tube end effector 30. Both end effectors are fitted with blades 46 having cutting edges 28 and may cooperate as scissors as a result of said rotary motion. The interior of the distal end of inner tube 24 further defines a working channel 54 which may slidably or rotatably receive other instruments.

Figure 11 is a distal detail view of the tip of a device made in accordance with the present invention. Relative motion of the distal ends of inner tube 24 and outer tube 21 results in the movement of end effectors 45 and 30 respectively, which further results in the movement of actuator pins 32 in actuator slots 33, about pivot pin 29. This motion also results in blades 46 with cutting edges 28, rotating towards or away from the axis of the motion of the distal ends of inner tube 24 and outer tube 21 such that they cooperate as a scissors. The interior of the distal end of inner tube 24 further defines a working channel 54 which may slidably or rotatably receive other instruments.

Figure 12 is a distal detail view of the tip of a device made in accordance with the present invention. Oscillatory, rotary motion of the distal end of inner tube 24 relative to the distal end of outer tube 21 results in the oscillatory rotary motion of end effector 45. End effector 45 is fitted with a semi-circular blade 46 with a semi-circular cutting edge 28 and window opening 34. The interior of the distal end of inner tube 24 further defines a working channel 54 which may slidably or rotatably receive other instruments. In the case where the other instrument is an imaging system, the oscillatory, rotary motion of the window opening 34 results in a substantially unobstructed view of the operative environment. Figure 13 is a distal detail view of the tip of a device made in accordance with the present invention. Relative motion of the distal ends of inner tube 24 and outer tube 21 results in the movement of actuator pins 32 in actuator slots 33, about pivot pin 29. This motion further results in blades 46 with cutting edges 28, rotating towards or away from the axis of the motion of the distal ends of inner tube 24 and outer tube 21. The distal end of inner tube 24 contains an end effector 45 which may protect the cutting edges 28 from surrounding structures when the blades 46 are aligned with the axis of the distal ends of actuator tubes 24 and 21. The interior of the distal end of inner tube 24 further defines a working channel 54 which may slidably or rotatably receive other instruments. Figure 14 is a distal detail view of the tip of a device made in accordance with the present invention. Relative motion of the distal ends of inner tube 24 and outer tube 21, .and their associated end effectors 45 and 30 respectively, results in the movement of actuator pin 32 in actuator slot 33, about pivot pin 29. This motion further results in clamping surfaces 31 rotating towards or away from the axis of the motion of the distal ends of inner tube 24 and outer tube 21 in the manner of a hemostat.

Alternatively and independently, relative motion of the distal ends of intermediate tube 47 and outer tube 21, and their associated end effectors 48 .and 30 respectively, results in the movement of actuator pin 32 in actuator slot 33, about pivot pin 29. This motion further results in a first blade 46 with cutting edge 28, rotating towards or away from the axis of the motion of the distal ends of intermediate tube 47 and outer tube 21. This first blade also rotates towards and away from a second blade 46 with cutting edge 28 thereby forming a scissors. The interior of the distal end of inner tube 24 further defines a working channel 54 which may slidably or rotatably receive other instruments.

Figure 15 is a distal detail view of the tip of a device made in accordance with the present invention. Relative motion of inner tube 23, outer tube 20 and intermediate tube 47, and their associated end effectors 45, 30 .and 48 respectively, results in end effectors 45 .and 30 acting upon blades 46. This motion results in blades 46 with cutting edges 28 rotating towards and away from one another about pivot pins 29 in the manner of a scissors. The interior of the inner tube 23 further defines a working channel 54 which may slidably or rotatably receive other instruments.

Figure 16 is a distal detail view of the tip of a device made in accordance with the present invention. Relative motion of the distal ends of inner tube 24 and outer tube 21, and their associated end effectors 45 and 30 respectively, results in the movement of actuator pin 32 in actuator slot 33, about pivot pin 29. This motion further results in the motion of tissue elevator 27. The interior of the distal end of inner tube 24 further defines a working channel 54 which may slidably or rotatably receive other instruments. In this view, working channel 54 is fitted with and endoscopic viewing device 26.

Figure 17 is a cross-sectional view of a linear actuating handle device made in accordance with the present invention. Rotary motion of trigger 41 about pivot pin 42 imparts a linear motion to actuator pin 32, secured to the proximal end 22 of outer tube 20, via actuator slot 33. This further results in the relative linear motion of outer tube 20 relative to inner tube 23. It is understood that the inner and outer tubes 23 and 20 respectively would be connected to a tip configuration in accordance with the present invention. The motion of trigger 41 is influenced by spring 37 which may be in a neutral position 38 or one of two pre-load positions 39. The pre-load positions 39 result in the trigger coming to rest at one or another extreme of travel. The handle 36 is further fitted with a clamping knob 40 which may be used to secure an instrument within the working channel 54.

Figure 18 is a cross-sectional view of a rotary actuating handle device made in accordance with the present invention. Rotary motion of trigger 41 about pivot pin 42 imparts a linear motion to actuator pin 32, secured to rack 44, via actuator slot 33. This linear motion of rack 44 then causes rotary motion of gear 43, secured to the proximal end 22 of outer tube 20. It is understood that the inner and outer tubes 23 and 20 respectively would be connected to a tip configuration in accordance with the disclosed invention. The motion of trigger 41 is influenced by spring 37 which may be in a neutral position 38 or one of two pre-load positions 39. The pre-load positions 39 result in the trigger coming to rest at one or another extreme of travel. The handle 36 is further fitted with a clamping knob 40 which may be used to secure an instrument within the working channel 54. An alternative to the clamping knob is a Touhy-Borst type valve. Such valves are obtainable from Medical Disposables International, West Conshohocken, Pennsylvania, USA. The handle 36 shown is fitted with .an electrically insulating intermediate tube 47 which electrically isolates inner tube 23 from outer tube 20. Thus, attaching wires 50 and 51 at solder joints 49 allows a current to be carried between inner tube 23 and outer tube 20 via a tip as disclosed in this invention. In this manner, a current can be passed across the end effectors of the surgical instrument through biological material situated between the end effectors. This can be used for resistive heating of the material, cauterization o f the material, or vaporization of the material. The wires 50 and 51 are connected to a standard surgical generator (such as those available from Valley Laboratories, Boulder Creek, Colorado, USA) via cable 53 which exits the handle through strain relief 52.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

A preferred embodiment of a tip of the present invention may consist of coaxial tubes of 304 stainless steel. The inner tube may have an inner diameter (ID) of about 2 mm and a wall thickness of about 0.2 mm. This ID is sufficient to .allow passage of a commercially available endoscope such as the MINI-SITE available from United States Surgical Corporation, Norwalk, Connecticut, USA. This inner tube may reside within .an outer tube with .an ID of about 2.5 mm and a wall thickness of about 0.2 mm. The proximal ends of each of these tubes may then be attached to a handle mechanism which allows for rotary motion of the tubes. The distal ends of these tubes may have silver soldered or insert molded to their ends blades of 300 or 400 series stainless steel. These blades may be arranged to act as scissors when the tubes are rotated.

Another embodiment of a tip of the present invention may consist of coaxial tubes of 304 stainless steel. The inner tube may have an ID of about 2 mm and a wall thickness of about 0.2 mm. This ID is sufficient to allow passage of a commercially available endoscope such as the MINI-SITE referred to above. This inner tube may reside within an outer tube with .an ID of about 2.5 mm and a wall thickness of about 0.2 mm. The proximal ends of each of these tubes may then be attached to a handle mechanism which allows for rotary motion of the tubes. To the distal ends of the tubes may be silver soldered or insert molded a bars about 0.5 mm square and 10 mm long. The bar on the inner tube would be oriented such that opposite faces of the bar lay parallel to a radii of the inner tube. The bar on the outer tube may have one face parallel to a radius of the outer tube .and a vertex from another pair of faces oriented to strike the face of the bar on the inner tube. This vertex may then be sharpened such that the striking action results in the vertex .and face acting as shears. This action would be the result of relative rotation of the tubes in a first direction. Relative rotation of the tubes in a second direction may result in the faces from the inner and outer bar coming together in the form of a clamp. There may also be a further tube of polyimide located in between the inner and outer tubes. This inner tube may have an ID of about 2.5 mm wall thickness of about 0.01 mm. The location of this polyimide tube may allow for an electrical current to be conducted through the inner and outer tubes. The current path may then be completed when the bars come into contact with one another.

A further embodiment of a tip of the present invention may consist of coaxial tubes of 304 stainless steel. The inner tube may have an ID of about 2.5 mm and a wall thickness of about 0.1 mm. This ID is sufficient to allow passage of a commercially available endoscope such as the NEONATE cystoscope available from Storz Instrument Co., St. Louis, Missouri, USA. The inner tube may reside within an outer tube with an ID of about 2.8 mm and a wall thickness of about 0.1 mm. The proximal ends of each of these tubes may then be attached to a handle mechanism which allows for relative axial motion of the tubes. The distal end of the inner tube may have silver soldered or insert molded to its end a clamping jaw surface with a pivot. The pivot may be configured to mate with a pivot hole of a blade. The blade may be made by electrochemically etching the blade shape, a pivot hole and an actuating slot. Such blades are commercially available from suppliers such as Specialty Blades Inc., Staunton, Virginia, USA. The distal end of the outer tube may have silver soldered or insert molded to its end a small structure with a second pin which may mate with the actuating slot on the blade. Thus relative axial motion of the tubes may result in the blade moving towards and away from the clamping surface in the manner of a scissors.

Another embodiment of a tip of the present invention may consist of coaxial, plastic tubes such as those available from Polygon Company, Walkerton, Indiana, USA. The inner tube may have an ID of about 1.9 mm and a wall thickness of about 0.1 mm. This ID is sufficient to allow passage of a commercially available, flexible endoscope such as those from Claras Medical Systems, Inc., Minneapolis, Minnesota, USA. The inner tube may reside within an outer tube with an ID of about 2.2 mm and a wall thickness of about 0.1 mm. The proximal ends of each of these tubes may then be attached to a handle mechanism which allows for relative axial motion of the tubes. The distal end of the inner tube may have glued or insert molded to its end a pivot pin. The pivot pin may be configured to mate with a pivot hole of a pair of blades. Each blade may be made by electrochemically etching the blade shape, a pivot hole and an actuating slot. Such blades are commercially available from suppliers such as Specialty Blades Inc. The distal end of the outer tube may have glued or insert molded to its end a small stracture with a pair of pins configured such that each pin mates with an actuating slot on one of the blades. Thus, relative axial motion of the tubes may result in the blades moving towards and away from the axis of the tubes in the manner of a scissors.

Still further types of construction of the various tubes are the use of a coil spring or a wire braided tube as one or more of the tubes. An additional embodiment of a surgical instrument of the present invention may consist of coaxial tubes of which one or more is flexible. Flexibility can be achieved by the use of nickel-titanium alloy in its superelastic state as a material of construction. For example, an outer tube may be constructed of 304 stainless steel, and an inner tube of nickel-tit.anium alloy in its superel.astic state. The inner tube may have an ID of about 2.0 mm and a wall thickness of about 0.2 mm. This ID is sufficient to allow passage of a commercially available endoscope such as the MINI-SITE referred to above. The inner tube may reside within an outer tube with an ID of about 2.5 mm and a wall thickness of about 0.2 mm. This outer tube may be bent about its axis in a radius of about 30 mm. The proximal ends of each of these tubes may then be attached to a handle mechanism which allows for relative axial motion of the tubes. The distal end of the inner tube may have silver soldered or insert molded to its end a clamping jaw surface with a pivot. The pivot may be configured to mate with a pivot hole of a blade. The blade may be made by electrochemically etching the blade shape, a pivot hole and an actuating slot. Such blades are commercially available from suppliers such as Specialty Blades Inc. The distal end of the outer tube may have silver soldered or insert molded to its end a small stracture with a second pin which may mate with the actuating slot on the blade. Thus relative axial motion of the tubes may result in the blade moving towards and away from the cl.amping surface in the manner of a scissors.

A preferred embodiment of a handle of the present invention may consist of a pistol grip. The grip may be made in two halves, each molded from a thermoplastic such as ABS. The halves may be configured to receive the coaxial tubes which comprise the tips of the disclosed invention. The grip may also contain a trigger, simil.arly molded of ABS plastic, which rotates about a pivot within the grip. The trigger may also be attached to a linkage which converts the rotary motion of the trigger to relative linear motion of the coaxial tubes. The linkage may further have fitted a spring which may predispose the linkage to reside at a neutral position or perhaps a position at one extreme of the linkage's full travel. The grip may have a lock which engages the linkage thereby preventing motion of the tubes. This lock may engage the linkage at any of several positions. The grip may have an additional locking nut on the proximal end of the grip, aligned with coaxial tubes. This nut may be configured to constrict its ID .and thus secure items placed into the coaxial tubes. In the case where remote imaging is desired, a flexible endoscope, such as those available from Claras Medical Systems, Inc., may be secured to the grip with the locking nut. Use of the flexible endoscope allows the weight and bulk of the endoscopic camera and light cable to be located distant from the grip thus enhancing the maneuverability of the grip.

Another embodiment of a handle of the present invention may consist of a screw driver type grip. The grip may be made in two halves, each molded from a thermoplastic such as polycarbonate. The halves may be configured to receive the coaxial tubes which comprise the tips of the disclosed invention. The grip may also contain an actuating trigger, similarly molded of polycarbonate plastic, which slides within a slot within the grip. The trigger may also be attached to a linkage which converts the linear motion of the trigger to relative rotary motion of the coaxial tubes. The linkage may further have fitted a spring which may predispose the linkage to reside at a neutral position or perhaps a position at one extreme of the linkage's full travel. The grip may also have a lock which engages the linkage thereby preventing motion of the tubes. This lock may engage the linkage at any of several positions. The grip may have an additional locking nut on the proximal end of the grip, aligned with coaxial tubes. This nut may be configured to constrict its ID and thus secure items placed into the coaxial tubes. In the case where remote imaging is desired, an endoscope, such as the MINI-SITE referred to above may be secured to the grip with the locking nut.

A further embodiment of a handle of the present invention may consist of a pistol grip. The grip may be made in two halves, each molded from a thermoplastic such as ABS. The halves may be configured to receive the coaxial tubes which comprise the tips of the disclosed invention. The grip may also contain a DC motor such as that available from Micro Mo Electronics, Inc., Clearwater, Florida, USA. The motor may also be attached to a linkage which translates the rotary motion of the motor to relative motion of the coaxial tubes, the relative motion being either axial, rotational, or oscillatory either in the axial or rotational directions. The motor may be connected to a speed control, such as a potentiometer, within the grip. The potentiometer may be accessible to the operator, thereby .allowing speed control of the motor. The speed control may also be connected to a commercially available DC power source, external to the grip. The grip may also have a locking nut on the proximo end of the grip, aligned with coaxial tubes. This nut may be configured to constrict its ID and thus secure items placed into the coaxial tubes. In the case where remote imaging is desired, a flexible endoscope, such as those available from Claras Medical Systems, Inc., may be secured to the grip with the locking nut. Use of the flexible endoscope allows the weight and bulk of the endoscopic camera and light cable to be located distant from the grip thus enhancing the maneuverability of the grip. The endoscopic camera may also be connected to a video imaging system. The video imaging system may contain image stabilization means to prevent the endoscopic image from becoming blurred as a result of the action of the motor.

In the further practice of this invention, two or more surgical instruments in accordance with the invention can be used simultaneously, each with an endoscope passing through its lumen. Images from the two endoscopes can be viewed simultaneously on two or more monitors or on a single monitor with a video image splitter.

The foregoing description focuses on the use of an imaging device as the secondary instrument that passes through the lumen of the innermost tubul.ar member. Imaging devices are but one example of such secondary instruments. Other ex.amples are needles, or the use of the lumen to provide aspiration, irrigation, or both. Aspiration and/or irrigation may be achieved by the use of media such as a gas or a liquid. The lumen can also be used as a channel to remove material from the surgical site surrounding the distal end of the tubul.ar members. When the lumen is used for imaging, the imaging device inserted through the lumen can be an optical fiber, an endoscope or any other type of imaging component among those known in the art. Endoscopes may range in diameter from about 0.5 to about 10 mm. When an endoscope is used, an image stabilization component is preferably included as well. Such components are well known to those skilled in the construction and/or use of endoscopes.

While this invention has been described fully .and completely, it should be understood that within the scope of the appended claims, the invention may be practiced otherwise than as specifically described.

Claims

WHAT IS CLAIMED IS:

1. An elongate tubular surgical instrument, said instrument comprising: a plurality of tubul.ar members each having proximal and distal ends and sharing a common axis, the outermost of said plurality of tubular members having an outer diameter of less than 10 mm and the innermost forming a lumen sufficiently l.arge to accommodate an imaging instrument, said plurality of tubular members comprising first and second tubul.ar members each having end effectors at the distal ends thereof, said first and second tubular members being movable relative to each other in a manner that causes said end effectors to coactively operate on solid matter in contact with the exterior of said instrument apertures at the distal ends of said first and second tubular members to permit access to surrounding areas for imaging, and means for inserting an imaging device through said lumen for imaging through said apertures.

2. A surgical instrument in accordance with claim 1 further comprising an imaging device passing through said lumen to said distal ends of said tubul.ar members.

3. A surgical instrument in accordance with claim 2 in which said imaging device is an optical fiber.

4. A surgical instrument in accordance with claim 2 in which said imaging device is an endoscope.

5. A surgical instrument in accordance with claim 4 in which said endoscope is 0.5 mm to 10 mm in diameter.

6. A surgical instrument in accordance with claim 1 further comprising a lock at said proximal ends of said tubular members for restricting movement of said tubular members.

7. A surgical instrument in accordance with claim 1 further comprising cl.amp means at said proximal ends of said tubular members for securably attaching said imaging device.

8. A surgical instrument in accordance with claim 1 in which said end effectors are electrodes electrically insulated from each other.

9. A surgical instrument in accordance with claim 1 in which one of said tubular members is flexible.

10. A surgical instrument in accordance with claim 1 in which one of said tubular members is made of nickel titanium alloy.

11. A surgical instrument in accordance with claim 1 in which one of said tubular members is a coil spring.

12. An elongate tubular surgical instrument, said instrument comprising: a plurality of tubul.ar members of circular cross section each having proximal and distal ends and sharing a common axis, the outermost of said plurality of tubular members having an outer diameter less than 10 mm and the innermost forming a lumen sufficiently large to accommodate an imaging instrument, said plurality comprising first and second tubular members that are independently movable, an effector member movably attached to the distal end of said second tubular member, an actuator pin affixed to said first tubular member and extending through a slot-shaped opening in said effector member, said slot-shaped opening being not parallel to said common axis such that axial movement of said first tubular member relative to said second tubular member causes said pin to travel along the length of said slot and thereby cause movement of said effector member relative to said second tubular member in a functional manner, and means for inserting an imaging device through said lumen for imaging through said apertures.

13. A surgical instrument in accordance with claim 12 in which said effector member is pivotally attached to said second tubular member such that axial movement of said first tubular member relative to said second tubul.ar member causes said effector member to pivot relative to said second tubular member.

14. A surgical instrument in accordance with claim 12 in which said effector member has a cutting edge, and said movement of said effector member extends said cutting edge away from said common axis.

15. A surgical instrument in accordance with claim 12 in which said effector member has a first cutting edge, and said movement of said effector member brings said first cutting edge into engagement with a second cutting edge on said surgical instrument in a scissors-type cutting action.

16. A surgical instrument in accordance with claim 12 comprising first and second such effector members, each with cutting edges and each movably attached to said distal end of said second tubular member and each containing a slot-shaped opemng not parallel to said common axis to receive an actuator pin attached to said first tubul.ar member, such that axial movement of said first tubular member causes said first and second effector members to engage in a scissors-type cutting action.

17. A surgical instrument in accordance with claim 12 in which said effector member has a clamping surface, and said movement of said effector member causes said clamping surface to engage in a clamping action.

18. A surgical instrument in accordance with claim 12 comprising first and second effector members, each movably attached to said distal end of said second tubular member and each containing a slot-shaped opening not parallel to said common axis to receive an actuator pin attached to said first tubular member, such that axial movement of said first tubular member causes said first and second effector members to move in opposing directions.

19. An elongate tubular surgical instrument, said instrument comprising: a plurality of tubul.ar members of circular cross section each having proximal and distal ends and sharing a common axis, the outermost of said plurality of tubular members having a diameter less than 10 mm and the innermost forming a lumen sufficiently large to accommodate an imaging instrument, said plurality of tubular members comprising first and second tubular members that are independently rotatable about said common axis, said first and second tubular members having opposing first and second cutting edges, respectively, and apertures at their distal ends, said cutting edges arranged to coact with each other to effect cutting upon rotation of one of said first and second tubular members relative to the other while permitting access through said apertures to surrounding areas for imaging, and means for inserting an imaging device through said lumen for imaging through said apertures.

20. A surgical instrument in accordance with claim 19 in which said first and second tubule members each further contain a clamping surface capable of being placed in clamping relation by rotation of one of said first and second tubular members relative to the other, and rotation in a first direction causes said cutting edges to coact while rotation in a second direction places said clamping surfaces in clamping relation.

21. An elongate, tubular surgical instrument, said instrument comprising: a plurality of tubul.ar members of circular cross section each having proximal and distal ends and sharing a common axis, the outermost of said plurality of tubular members having an outer diameter of less than 10 mm and the innermost forming a lumen sufficiently l.arge to accommodate an imaging instrument, said plurality of tubular members comprising first and second tubular members that are independently movable along said common axis, said first and second tubular members each having cutting edges and apertures at their distal ends, said cutting edges arranged to coact with each other to effect cutting upon axial movement of one of said first and second tubul.ar members relative to the other while permitting access through said apertures to surrounding areas for imaging, and means for inserting an imaging device through said lumen for imaging through said apertures.

22. An elongate, tubular surgical instrument, said instrument comprising: a plurality of tubular members of circular crosssection each having proximal and distal ends and sharing a common axis, the outermost of said plurality of tubular members having a diameter of less than 10 mm and the innermost forming a lumen sufficiently large to accommodate an imaging instrument, said plurality of tubular members comprising first and second tubular members that are independently rotatable along said common axis, said first and second tubular members each having apertures at their distal ends and one of said first and second tubular members having an abrasive element at its distal end, said abrasive element arranged to abrade solid matter contacting the exterior of said instrument upon movement of one of said first and second tubular members relative to the other while permitting access through said apertures to surrounding areas for imaging, and means for inserting an imaging device through said lumen for imaging through said apertures.

23. A surgical instrument in accordance with claim 22 in which said abrasive element is arranged to abrade solid matter contacting the exterior of said instrument upon axial movement of one or said first and second tubular members relative to the other.

24. A surgical instrument in accordance with claim 22 in which said abrasive element is arranged to abrade solid matter contacting the exterior of said instrument upon rotational movement of one or said first and second tubular members relative to the other.

25. A surgical instrument in accordance with claim 22 in which said abrasive element is a serrated blade.

26. A surgical instrument in accordance with claim 22 in which said abrasive element is a knurled surface.