Note: Descriptions are shown in the official language in which they were submitted.
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DISPOSABLE LAVAGE
Back~round and Summary of the Invention
The present invention relates to handheld
lavages and more particularly to tha provision of
handheld lavages which may be held securely in one hand
and provide irrigation, aspiration, or other therapeutic
functions.
Many surgical procedures require instruments
capable of cauterizing, slicing, cutting, or otherwise
dissecting bodily tissue. However, use of such
instruments generally results in the production of blood
and other tissue debris in the area of operation of the
instrument, obscuring the view of the surgeon and making
further cutting or cauterization dangerous. Washing the
blood or tissue debris from the area of operation by
irrigation with a saline solution, or removing
disassociated tissue with an aspiration devi~e are two
methods commonly employed by surgeons to clear blood and
tissue debris from the operating area. Typically,
cutting or cauterizing tissue is accomplished with one
instrument, followed by aspiration or irrigation of the
cut or cauterized area with a second instrument. The
surgeon alternates between use of the two instruments
until the operation is complete.
An exarnple of an instrument that provides both
irrigation an~ aspiration is described in U.S. Patent
4,53,957 to Williams et al. A cylindrical tube that
acts as a handle conducts fluid through its interior to
peripheral outlets in an outer irrigation cannula. Fluid
or tissue is removed from the cutting site through an
aspiration cannula extending completely through the
handle. However, use of this type of instrument can be
cumbersome in many surgical operations, because it either
requires additional persons to manipulate the
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aspiration/irrigation device, or its use must be
frequertly alternated with the cutting or cauterizing
device.
To alleviate the requirement for multiple
instruments, it is known to provide combination
irrigators/scalpels. For example, U.S. Patent 4,642,090
to ~trata describes a hollow scalpel handle through which
~luid can flow to wash the cutting edge of a scalpel
blade affixed to the scalpel handle. Although this
device provides limited irrigation, the surgeon is unable
to aspirate bodily tissue cut by the scalpel. In
addition, the fixed position of the scalpel blade greatly
limits the type of operation for which this device is
suited. Generally, only well exposed tissues such as the
eye can be operated on using this device. Insertion of
the protruding scalpel through narrow incisions or bodily
cavities risks damaging healthy tissue by inadvertent
cutting.
Accordingly, to alleviate problems associated
with surgical devices known in the prior art, it is an
object of the present invention to provide a lavage
having a fluid passageway through which irrigation fluid
can pass to a desired surgical operating site, and
through which tissue debris derived from the operating
site can be removed by aspiration.
Another object of the present invention is to
provide a lavage having a cutting or cauterizing tip that
is not exposed until the tip is positioned at the desired
operating site.
Yet another object of the present invention is
to provide a handheld, disposable lavage with an
irrigation/aspiration cannula and a separate tool for
cutting, grasping or cauterizing that fits inside the
irrigation/aspiration cannula.
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Another object of the present invention is to
provide a handheld, disposable lavage with an
irrigation/aspiration cannula and a separate tool for
cutting, grasping or cauterizing over which a shield that
can be reversibly retracted and extended from the
irrigation/aspiration cannula to fit over the tool.
Still another object of the present invention
is to provide a lavage having ~n irrigation/aspiration
cannula through whiçh liquid or solid movement is
controlled by a rotary valve positioned in an attached
valve body configured to be held in one hand with the
thumb of that one hand acting to open or close the valve
as desired.
Yet another object of the present invention is
to provide a lavage having an irrigation/aspiration
cannula through which extended objects can be introduced
by passing through a breachable seal attached to a
conduit piece in fluid communication with the
irrigation/aspiration cannula.
Another object of the present invention is to
provide a lavage having an irrigation/aspiration cannula
coupled to a standard conduit piece having an attached
breachable seal through which extended objects or fluids
can be introducecl, and through which liquid or solid
movement is controlled by a valve positioned in an
attached valve body that is configured to be held in one
hand with the-~humb of that one hand acting to open or
close the valve as desired.
An additional object of the present invention
is to provide a conduit piece having a longitudinally
extending passageway in fluid communication with a
longitudinally extending cannula so that streams of fluid
or extended objects can be introduced into the cannula
through the longitudinally extending passageway without
suffering substantial deflection.
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In accordance with the foregoing objectives, a
surgical device that includes a longitudinally extending
cannula formed to define an interior channel is provided.
A knife is positioned within the interior channel of the
cannula to cut or dissect desired tissue during ~urgical
procedures. The knife has a first cutting edge extending
at an angle relative to the longitudinal axis of cannula
and can be provided with a second cutting edge that
extends substantially parallel to ~he longitudinal axis
of cannula. When the knife is provided with the second
cutting edge, the cannula is for~ed to define a notch
that at least partially exposes the second cutting edge
of the knife to enable a surgeon to cut tissue.
In a preferred embodiment, a first cannula
formed to define a first interior channel is provided. A
second cannula is positioned substantially within the
first interior channel of the first cannula and acts to
define a second interior channel. A conduit piece
defining a first passageway in fluid communication with
the first interior channel of the first cannula, a second
passageway connected in fluid communication with the
second cannula, and a third passageway connected in fluid
communication with the first interior channel of the
first cannula, is connected to the first cannula. The
second passageway can be sealed with a breachable seal
means that per~its piercing insertion of tools or other
surgical instruments. The entire device can be manually
held using an elongated valve body coupled to the
conduit piece and shaped to have a manually grippable
longitudinally extending body. This longitudinally
extending body defines a fourth passageway extending
longitudinally therethrough which is connected in fluid
communication to the third passageway of the conduit
piece, with fluid flow within said fourth passageway
being controlled by a manua~ly operable rotary valve.
In preferred embodiments the cannula is
attached to a conduit piece defining first, second, and
third passageways in fluid communication with the
interior channel of the cannula. The conduit piece can
also be attached to a valve body that is shaped to have a
manually grippable longitudinally extending body. In
such embodiments the valve body defines a fourth
passageway extending therethrough in fluid co~munication
with the third passageway of the conduit piece.
~n one preferred embodiment, the second
passageway is configured to lie in substantially coaxial
relationship to the first passageway. Fluid under high
pressure is forced through the second passageway and into
the interior channel of the first or second cannula. This
high pressure fluid can be used to efficiently dissect,
cut, separate or move tissue. Alternatively, the second
cannula can be formed to have an inner diameter
s~fficiently large to allow passage of an optic fiber
capable of conveying a laser beam for laser cauterization
of bodily tissue. In other embodiments of the invention
the inner diameter of the second cannula is selected to
allow insertion, passage through, and withdrawal of
surgical instrw~ents such as pincers, biopsy needles,
probes, or graspers. Electrically insulated leads
passing through an electrically insulated second cannula
can be used f~r electrical cauterization in yet another
preferred embodiment.
In other preferred embodiments a surgical
instrument such as a knife, scissors, pincers, needles or
probes can be mounted to either the first cannula or a
rod situated at least partially within the first cannula.
In certain embodimPnts, it is possible to provide a
mechanism for retracting the surgical instrument from
first cannula so that the instrument is shielded by the
3~ first cannula as the lavage is moved to or away from an
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operating site. When access to the surgical instrument
is desired, an extension mechanism can b~ enabled to move
the surgical instrument from it shielded position in the
cannula to its normal operating position. For example, a
cutting knife can be mounted on a movable rod
substantially positioned with the first interior channel
of the first cannula. The rod and the cutting knife
mounted thereupon can be moved outward from a first
position within the first interior channel of the first
cannula by engaging an extending mean~ for extending the
cutting knife from the first position within the first
interior channel of the first cannula to a second
position extending at least partially from the first
interior channel. The cutting knife can be retracted by
way of a retracting means for retracting the cutting
knife from the second position extending out from the
first interior channel back to the first position within
the first 'nterior channel of the first cannula.
The surgical instrument can also be permanently
mounted so that it remains immobile relative to the first
cannula. For example, the cutting knife having a
cutting edge can be permanently mounted to the first
cannula so that its cutting edge extends outward into the
first interior channel of the first cannula. The cannula
is formed to define a notch or slot that at least
partially expo~es the cutting edge of the cutting knife.
The cutting knife remains at least partially shielded by
a shielding portion of the cannula adjacent to the notch
defined within the first cannula.
In another preferred embodiment the surgical
instrument is permanently ~ounted and shielding action is
provided by a movable shield. For example, a surgical
instrument such as the cutting knife can be mounted to
first cannula so that the cutting edge protrudes from the
first cannula. A shield, configured to be movable within
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the first interior channel of the first cannula, can be
extended to shield the cutting edge of the cuttin~ knife.
This shield can also be retracted to expose the
instrument when use of the instrument is desired. In
certain embodiments, movement of the ~hield is only
enabled upon release of a lock mechanism.
One advantage of the precent invention is
provided by the conjunction of a 6urgical instrument and
means for providing irrigation/aspiration on the same
handheld assembly. A surgeon can cut bodily tissue and
simultaneously wash away blood flow resulting from the
cut. The amount of saline irrigation that needs to be
~upplied can be determined and supplied by the surgeon
himself, without necessarily requiring the assistance of
other personnel. The time required for a surgical
procedure can be diminished, and the need for auxiliary
personnel to operate separate irrigation or aspiration
devices can be eliminated.
Another advantage of the present invention is a
consequence of the modular construction of the individual
components of the disposable lavage. A standard conduit
piece having a plurality of passageways extending
therethrough can be fitted with a second cannula disposed
within the first interior channel of the first cannula
and attached in ~Eluid communication with th~ conduit
piece, an exte~sion and retraction mechanism for
extending or retracting a shi~ld movable in the first
interior channel of the first cannula, an extension and
retraction mechanism for extending or retracting a
surgical instrument movable in the first interior channel
of the first cannula, a valve body having a passageway in
fluid communication with the passageways of the conduit
piece and wherein a rotary valve is positioned to control
aspiration/irrigation, a breachable seal element having a
membrane that can be pierced by a needle to inject fluids
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into the first cannula, or any combination of the
preceding components as well as other components that can
also be conjoined to form the lavage as~embly. Each of
these components can be inexpensively produced and
mounted to the conduit piece, allowing a lavage unit to
be disposable. This greatly reduces the problems
associated with cleaning and sterilization associated
with instruments designed for reuse.
OthPr objects, features and advantages of the
present invention will become apparent with reference to
the following drawings and description of certain
embodiments of the invention.
Brief Descrition of the Drawinqs
Fig.1 is a perspective view of a disposable
lavage having a central cannula through which an optic
fiber capable of transmitting a laser beam can be
inserted;
Fig. 2 is a side sectional view of the
disposable lavage shown in Fig. 1, showing insertion of
the optic fiber through a breachable seal;
Fig. 3 is a cross sectional view along lines 3-3 of
of the device shown in Fig. 2, showing the central
cannula and the outer tube;
Fig. 4 is a partial side sectional view of
another embodiment of a disposable lavage constructed
without a central cannula;
Fig. 5 is a perspective view of a disposable
lavage tip having a permanently mounted cutting knife,
with the knife being accessible only in the notch region
and the cannula providing a partial shield;
Fig. 6 is a cross sectional view taken along
line 6-6 showing the mounted cutting knife;
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g
Fig. 7 is a ide sectional view of a disposable
lavage having a retractible knife connected to a thumb
actuated button which is depressed to extend the knife;
Fig. 8 shows the device of Fig. 7 with the
knife extended from the outer tube and the button in a
depressed position;
Fig. 9 is a side sectional view showing an
alternative embodiment of the button having a thumb
actuated indicator/catch for holding the knife in an
extended position;
Fig. 10 shows the device of Fig. 9 with the
indicator/catch engaged to hold the knife in an extended
position and provide tactile indication that the knife is
in the extended position;
Fig. ll is a partial side view, cutaway to show
a device having a fixed cutting knife and a retractible
shiel~ for the knife;
Fig. 12 is a perspective v..ew of the
retractible shield shown in Fig. 11, with the shield
being positioned to partially expose the knife;
Fig. 13 is an exploded view of a dual lock
mechanism that can be threaded onto the conduit piece and
is suitable for holding the shield in a predetermined
position relative to the knife until both a first lock
element and a sec:ond lock element are disabled;
Fig,~14 is a closeup side view of the dual lock
mechanism in a released position to permit movement of
the shield;
Fig. 15 is view of the dual lock mechanism of
Fig. 14 in a locked position;
Fig. 16 is a transverse sectional view through
the single passage valve shown in Fig. 1;
Fig. 17 is a perspective view with portions
broken away of a modification of the valve in Fig. 16
wherein a duel input and a single output is illustrated;
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Fig. 18 is a perspective view of an end portion
of a disposable lavage having a cannula with the second
cannula positioned adjacent a shield for high pressure
fluid cutting;
Fig. 19 is a side elevation of Fig. 18 with
portions broken away to show the cutting region;
Fig. 20 is a partial ~ide view of a tip of a
cannula into which a notch is cut. The longitudinal axis
of the cannula is indicated;
Fig. 21 is a partial cutaway side view of the
cannula illustrated in Fig. 20, with the added feature of
a fixed knife having a first cutting edge extending
perpendicular to the longitudinal axis of the cannula and
a second cutting edge extending substantially parallel
the longitudinal axis of the cannula;
Fig. 22 is a partial side view of a cannula
having a sloping cut at its tip to expose a curved knife
that presents a continuous cutting edge having a first
portion extending substantially parallel to the
longitudinal axis of the cannula and a second portion
extending substantially along an angle relative to the
longitudinal axis of the cannula;
Fig. 23 is a partial cutaway side view of a
cannula having a first cutting edge extending
perpendicular to the longitudinal axis of the cannula;
Fig.~24 iæ a partial top view of the cannula
shown in Fig. 23;
Fig. 25 is a partial cutaway view of a cannula
having a fixed knife positioned in its interior channel.
The knife has a first cutting edqe extending
perpendicular to the longitudinal axis of the cannula and
a second cutting edge extending substantially parallel
the longitudinal axis of the cannula. The second cutting
edge can be shielded by a movable shield positioned for
movement within the interior channel of the sannula;
2 ~ i i 3 ,!3~
Fig. 26 is a partial view of a disposable
lavage having a cannula equipped with threads to be
removably attached to a manually grippable valve body via
a conduit piece fitted with a threaded lock;
Fig. 27 illustrates an alternative mbodiment
in which flexible tubing is connected to the conduit
piece and manually grippable valve body shown in Fig. 26;
Fig. 28 illustrates a rigid cannula coupled to
the conduit piece illustrated in Figs. 27 and 26 by way
of a flexible inter~ediary tube.
Fig. 29 is a partial cutaway ~ide view of a
cannula having a cutting edge extending parallel to the
longitudinal axis of the cannula;
Fig. 30 is a view of a cannula tip assembly
~efining a cutting region for cutting tissue and a curved
forward shield for redirecting a cutting agent (indicated
by arrows) passing from the second cannula through the
cutting region.
Fig. 31 is a partial cutaway view of a cannula
having both a fixed knife and a second ~annula positioned
in its interior channel; and
Fig. 3:2 is a view along section 32-32 of Fig.
31 indicating the relative position of the second cannula
and the fixed kn:ife.
Detailed Desc~iption of the nrawinq~
As illustrated in Figs. 1-3, a disposable
lavage 10 has a first cannula 12 generally extending
along an axis 9 and defining a irst channel 13 situated
in fluid communication with a conduit piece 20. The
first cannula 12 is attached to the conduit piece 20 at
its attachment end 15~ The first cannula 12 is
positioned to longitu~inally extend outward from the
conduit piece 20 to terminate at a tip 16. A plurality
of aperture~ 14 are de~ined by the first cannula 12 near
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the tip 16. The first cannula 12 is generally formed to
have a tubular shape, and is constructed from inexpensive
and rigid materials such as stainless ~teel or relatively
rigid engineering-grade plastics such as polycarbonates.
As shown in the Eectional view of Fig. 2, the
conduit piece 20 is for~ed to linearly extending define a
first passageway 30 having first passageway walls 31, a
linearly extending second passageway 32 having second
passageway walls 33, and a third passageway 34 having
third passageway walls 35. ~he first, second and third
passageways 30, 32, and 34 are generally tubular cavities
that intersect each other and through which fluid can
flow. The passageways 30, 32, and 34 intersect each
other at a branch 36 that is centrally positioned in the
conduit piece 20. In the embodiment illustrated in Fig.
2, the first cannula 12 has its attachment end 15
inserted into the first passageway 30 to extend as far as
the branch 36. The attachment end 15 is fixed in place
by an adhesive (not shown) that holds the attachment end
15 in close contact with the first passageway walls 31.
Of course, permanent attachment of the attachment end 15
of the first cannula 12 to the conduit piece 20 can also
be provided by other means that can include friction
couplings, locking tabs ~not shown) that reciprocally
engage the attac,hment end 15 to the conduit piece 20,
nipples or threalds extending from the conduit piece 20
(not shown) over which the attachment end 15 can be
coupled to the conduit piece 20, or any other mean- for
providing a secure connection between the conduit piece
20 and the first cannula 12.
Although metals such as stainless steel can be
used to form the conduit piece 20, it is often
advantageous to reduce costs and increase reliability by
molding the conduit piece 20 as one piece. Rigid
thermoset plastics such as polycarbonate or polyethylene
2 ~3
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are preferred molding plastics. The low cost of molded
plastics allows the conduit piece to be disposable,
eliminating costly maintenance and ~terilization
procedures associated with manufacture of non-disposable
conduits. Construction of the conduit piece 20 from
plastics rather than metals also has the advantage of
permitting the conduit piece 20 to be formed completely
or partially transparent, allowing an operator to
visually determine if one of the passageways 30, 32, or
34 is completely or partially blocked by solid material.
The third passageway 34 of the conduit piece 20
is placed in fluid communication with a valving mechanism
40 that is best shown in pexspective view in Figs. 1 and
16. The valving mechanism 40 extend generally along axis
7 that lies at a non-parallel angle e relative to the
axis 9 of the cannula 12 includes a valve body 42 that is
formed to define a neck 45 through which a fourth
passageway 43 is situated in fluid communication with the
third passageway 34. The conduit piece 20 is joined to
the valve body 42 by insertion of the neck 45 into the
third passageway 34 for frictional or adhesive coupling
of the passageway wall 35 to the neck 45.
The valve body 42 is also configured to be
manually grippable for ease of operation. The valve body
42 is formed to provide a forward bottom portion 44
shaped to be ~ripped by the index finger of one hand and
a rearward bottom portion 46 shaped to be gripped by the
middle finger and, depending upon the size of the hand,
by the fourth finger of the hand, with a depending
central portion 48 between the forward and rearward
portions 44, 46. It will be appreciated from the
sectional view of Fig. 1 and Fig. 16 that the recessed
portions 44, 46 are smoothly transversely recessed for
gripping comfort while the depending central portion 48
is smoothly rounded to fit be~ween the index and middle
s~
fingers. It will further be appreciated that, in this
~escription and in the appended claims, statements such
as "engaged by the index finger" and "engaged by the
middle finger" are intended to indicate the general shape
and size of an adult's hand relative to the valve
mechanism 40 and that the valve body 42 is proportioned
and shaped to be held generally by the index and middle
fingers pressing the body against the palm of the hand,
leaving the thumb free for movement to control the
mechanism.
The valve body 42 is further provided with a
nipple 52 to which a fluid line 54 i~ attached. The
fluid line 54 can be used to provide fluids to the fourth
passageway 43 or to provide a passage through which
fluids and solids can be withdrawn from the fourth
passageway 43 by a vacuum (vacuum generating apparatus or
fluid supply apparatus not shown~. If desired, the valve
body 42 may have, for instance, one, two or even three or
more fluid lines connected in fluid communication with
the fourth passageway 43 (Fig. 17, described hereinafter,
hows a dual fluid line assembly).
The valve body 42 is molded to provide a
cylindrical opening 50 extending transversely through the
valve body and illustratively, just above the central
body portion 48 which is held between the index and
middle fingers~ of the hand. This cylindrical opening 50
is positioned to intercept the fourth passageway 43
extending through the valve body 42 as best seen in Fig.
2. A cylindrical, molded plastic, one-piece rotor 60 is
snugly and slidably rotatahly insert~d in the cylindrical
opening 50 to block the fourth passageway 43 except when
the rotor 60 is in its passageway opening position as
shown in Fig. 16.
The valve body 42 may preferably be molded from
a rigid material such as a polycarbonate plastic while
) sJ r j i
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rotor 60 may preferably be molded from a softer plastic
such as a polypropylene, nylon or teflon~ The closeness
of the snug fit of the rotor 60 in the cylindrical
opening 50 and the nature of the material from which the
valve body 42 and rotor 60 are molded will determine the
pressure capacity of the valving mechanism. It will be
appreciated that a very snug rotor 60 fit in the
cylindrical opening 50 will accommodate high pressure.
The rotor 60 is provided with a peripherally extending
thumb engaging arm 62 integrally molded thereon. The
thumb engaging arm 62 extends generally parallel to and
above the rotor 60. This engaging portion 62 may be
serrated as indicated at 66 to provide a gripping surface
for the thumb.
In FigO 2, the illustrative rotor 60 is formed
to define a passag~way 64 which is substantially in
alignment with the fourth passageway 43. When the rotor
60 is rotated by movement of the thumb engaging arm 62,
however, the passageway 43 will be blocked by the rotor
60. This is illustrated in Fig. 1, in which the engaging
arm 62, initially in a forward position with the
passageway 64 in substantial alignment and in fluid
communication wit:h the fourth passageway 43 is reversibly
moved to a closecl position in which the fourth passageway
is blocked by the rotor 60. In the closed position there
is no fluid co~mication between fluid lines and the
third passageway 34 of the conduit piece 20.
The present invention, therefore, provides a
two piece, disposable, plastic stopcock handle-valve or
valving mechanism which can be held and operated by
either hand. The axis of this valvin~ mechanism extends
at an angle relative to the axis of a cannula to which it
is attached via a conduit piece. The body of the
handle-valve has a contoured bottom surface that fits
into enough of the palm side of either hand of the
6 ~
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operator, starting with the index finger, to permit the
operator to both operate the handle-valve and direct its
motion. Importantly, for control purposes, the thumb
engages an actuating means which is preferably disposed
axially and longitudinally just above the rotor of the
valve, and this actuating or engaging portion may be
integrally molded with the rotor. For control purposes,
the arm 62 connected to the rotor 60 should have a
moment-arm of approximately one inch and a stroke of
approximately three-fourths inch, a comfortable span for
either an adult female or male hand. The top extension
of the thumb engaging portion may be serrated to
facilitate its movement ~y the thumb and the bottom or
other surfaces of the valve body may be serrated at
convenient locations to provide a convenient and
comfortable grip. The valve body 42 and the rotor 60 are
assembled with a slight intèrference ~it to provide a
good seal between the body and the rotor 60 without
requiring extreme pressure in excess of that which is
comfortable for an adult female or male to move by thumb
action.
Another embodiment of a valve body having dual
fluid line input/output is shown in Fig. 17. A valve
body 42a is connlected to fluid lines 54a and 54b. These
fluid lines 54a and 54b can alternatively be used to
provide fluid~ to a fourth passageway 43a (for example
through line ~4a) or to provide a passage through which
fluids and solids can be withdrawn from the fourth
passageway ~3a by a vacuum (for example through line 54b;
vacuum generating apparatus or fluid supply apparatus not
shown). The valve body 42a is molded to provide a
cylindrical opening 50a extending transversely through
the valve body 42a. This cylindric~l opening 50a is
positioned to intercept the fourth passageway 43a in the
valve body 42a. A cylindrical, molded plastic, one-piece
~ ~3~ JZ3g
rotor 60a is snugly and slidably rotatably inserted in
the cylindrical opening 50a to block the fourth
passageway 43a except when the rotor 60a i8 in one of its
two passageway opening positions such that a passageway
64a is in fluid communication between fluid lines 54a and
passageway 43a, or alternatively such that passageway 64b
i8 in fluid communication between fluid lines 54~ and
43Z~. Coupling of the valve body 42a to a conduit piece
20 and cannula 12 gives a surgeon the ability to rapidly
alternate between irrigation and aspiration of a ~urgical
site by simply rotating the rotor 60a to the appropriate
position for introduction or withdrawal of fluids.
Introduction or withdrawal of f luids does not
necessarily have to be accomplished solely through the
15 fluid line 54 (or 54a or 54b) by way of the fourth
passageway 43 (or 43a) and the third passageway 34. As
shown in Figs. 2 and 4, fluids and solids can be
withdrawn from or introduced to pass through the first
passageway 30 defined in the conduit piece 20 by way of
2C the second passageway 32. The second passageway 32 is
defined by the second passageway walls 33 of the conduit
piece 20 and is configured to lie in substantially
coaxial relationship to the first passageway 30. This
geometry permits longitudinally extending objects
introduced through the second passageway 32 to easily
pass into the the first passageway 30 wit~out substantial
deformation o~ bending. Also, as best shown in Fig. 4,
the alignment of the first and second passageways 30 and
32 permits longitudinally extending streams of fluid
under high pressure to be introduced through the second
passageway 32 to pass through the first passageway 30,
and from that passageway 32 into the first cannula 12.
Such fluid would not be substantially slowed or
redirected during its passage, and could accordingly be
~ ~ 5 ~
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utilized to provide a stream of water capable of cutting
or moving bodily tissue as desired.
The second passageway 32 can also accomodate a
second cannula 70 defining a ~econd channel 73 with which
the second passageway 32 is connected in fluid
communication (best shown in Fig. 2). The second cannula
70 is attached to the conduit piece 20 at its attachment
end 75. The second cannula 70 is positioned to
longitudinally extend outward from the conduit piece 20
to terminate at a tip 76. The second cannula 70 is
dimensioned to fit within the first cannula 12, and like
the first cannula 12 i6 generally formed to have a
tubular shape. The position of the second cannula 70
relative to the fir~t cannula 12 is again indicated in
cross section in Fig. 3. The tip 76 can also be arranged
to float within the first cannula 12, to be held in fixed
attachment to the first cannula 12 by an adhesive or spot
welding, or can be arranged to lie concentrically within
the first cannula 12. Like the first cannula 12, the
second cannula 70 can also be constructed from
inexpensive and rigid materials such as stainless steel
or relatively rigid engineering-grade plastics such as
polycarbonates.
In the embodiment illustrated in Fig. 2, the
second cannula 70 has its attachment ~nd 75 inserted to
extend through both the first passageway 30 and the
branch 36 partially into the second passageway ~2, where
it is fixed in place by an adhesive (not shown) that
holds the attachment end 75 in close contact with the
second passageway walls 33O Permanent attachment of the
attachment end 75 of the second cannula 70 to the conduit
piece 20 can also be provided by other means that can
include frictive couplings, locking tabs (not shown) that
reciprocally engage the attachment end 75 to the conduit
piece 20, nipples or screw threads extending from he
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conduit piece 20 (not shown) over which the attachment
end 75 can be coupled to the conduit piece 20, or any
other means ~or providing a secure connection between the
conduit piece 20 and the second cannula 70.
Fluid flow into or out of the cPcond passageway
32 can be controlled by a æeal 80 that blocks the second
passageway 32. In the embodiment shown in Figs. 1 and 2
the seal 80 includes a me~brane 82 conformably stretched
to fit over a seal body 84. The membrane 82 can be
composed of an elastomeric material that permits
pierceable entry of objects and still provides sealing
action to limit backflow of fluid out of the second
passageway 32. The seal body 84 is formed to have
threads 85 capable of engaging corresponding threads 86
formed in the conduit piece 20 to provide screw lockable
engagement between the seal 80 and the conduit piece 20.
Objects contemplated for insertion into the second
passageway 32 through the seal 80 include but are not
limited to hypodermic needles, auxiliary cannula,
surgical instruments such as scissors, pincers, gra~pers,
or probes, optical fibers to assist in illuminating or
imaging a dimly lit or visually inaccessible surgical
site, or as shown in Fig. 1 and 2 an optical fiber 90
coupled to laser 92. The optical fiber 90 could be used
to deliver to a desired area the coherent laser energy
produced by the :Laser 92 to cauterize selected bodily
tissue. In the disclosed embodiment, control of the
optic fiber 90 is enhanced because the fiber 90 is
tightly held in a desired position by the second cannula
70.
In addition to its uses as an instrument
conduit, the second cannula 70 can be used to channel
high pressure fluids to an operating site ~not shown).
This is best seen in the embodiment of the invention
35 illustrated in Figs. 18 and 19. In Figs. 18 and 19, a
~ ~ t) ~
-20-
second cannula 470 (similar to the second cannula 70) can
be configured to operate in conjunction with a high
pressure fluid source (not shown) to provide tissue
cutting action. The second cannula ~70 i8 positioned
within a cavity 413 defined by a first cannula 412, and
is held in place by fixed attachment to the conduit piece
20. The first cannula 412 is for~ed to have a terminal
shield 419 that is positioned to intercept and dissipate
high pressure fluid streaming from the channel 473 of the
~econd cannula 470. In operation, tissue (not shown) can
be placed in a cutting region 480 located between the
terminal shield 41~ and the channel 473 of the second
cannula 470. High pressure fluid (flow direction
indicated by arrows in Fig. 19) moving at high velocities
in the cutting region 480 will slice tissue as desired.
In certain embodiments of the invention a knife
100 such as indicated in Figs. 5 and 6 can be mounted at
a tip 116 of the cannula 110. Access to the cutting edge
102 of the knife 100 is permitted by forming the tip 116
with a notch 104 that partially exposes the cutting edge
102. The remainder of the tip 116 acts as a partial
shield 120 that redirects tissue as the tip 116 is moved
through a body (not shown).
A knif~e 200 can also be mounted to a movable
element 202 situated within the cannula 12 such as shown
in Figs. 7 through 10. As shown in Fig. 7 the knife 200
normally rests in a home position within the cannula 12.
A trigger button 204 can be pushed inward, causing the
rod 202 and connected knife 200 to extend out of the
cannula 12. The rod 202 and attached knife remain in the
extended position until the button 204 is redepressed.
Alternative assemblies providing locking
extension of the knife 200 from the cannula 12 are shown
in Figs~ 9 and 10. A flexible lever 220 is shown in its
home position in Fig. 9. When a trigger button 214 is
a ~ 8
-21-
inwardly depressed, the flexible lever 220 moves outward.
Retraction of the knife 200 is prevented because the
lever 220 engages a catch 230 that prevents reverse
motion of the lever 220 and the attached rod 202. Release
of the catch 230 by inwardly pushing the lever 220 to
clear the catch 230 enables the retraction of the knife
200.
As shown in Figs. 11 through 15, a shield 300
can be alternately extended or retracted from the cannula
12 to respectively cover or uncover a knife 200 mounted
to the cannula 12. The knife 200 is mounted to the
cannula 12 so that it protrudes from the tip 16 of the
cannula 12 in a position suitable for surgical
operations. As best shown in Fig. 12, the shield 300 is
split to form a channel 302 which slide~ over the
permanently mounted knife 200. In the illustrated
embodiment the shield 300 is concentrically arranged
within the cannula 12, and is .Cormed to have a generally
tubular shape with a circular cross section and an outer
diameter slightly smaller than an inner diameter of the
cannula 12. It is contemplated that a shield can also be
formed to have arcuate, elliptical, polygonal or other
type cross section as desired.
In the embodiment shown in Figs. 11-15 the
extension and retraction of the shield 300 is facilitated
by the use of a dual lock assembly 310 that holds the
shield in a d~sired position relative to the knife 200.
The dual lock assembly 310 is threadingly attached to the
conduit piece 20 so that it lies substantially colinear
to the longitudinally extending cannula 12. The dual
lock assembly 310 is best seen in the exploded
perspective view of Fig. 13, which respectively
illustrates from left to right a rod 315 that couples the
dual lock assembly 310 to the æhield 300, a housing 320,
a first lock element 330, and a second lock element 340.
~ a ~ J ~
The housing 320 is formed to have a housing
cavity 321 that extends therethrough. Threads 317 are
defined in the housing 320 to allow threaded engagement
with the conduit piece 20. In sther embodiments (not
shown), locking tabs and adhesive or frictional couplings
can also be used to join the housing 320 of the dual lock
assembly 310 to the conduit piece 24. The housing 320 is
also formed to have a "D'~-shaped aperture 311 ~generally
indicated in Figs. 11, 14-15) allowing access to the
cavity 321. The housing 320 is also formed to have a
land 322. The land 322 is a generally flattened region
of the housing 320 through which a latch channel 326 is
defined to extend. The latch channel 326 communicates
with a plurality of side channels 324 formed in the
housing 320 to extend perpendicular to the latch channel
326. Between each pair of side channels 324 the housing
320 acts to form stops 325. It will be appreciated that
these channels 324 and 326 can be cut or formed during
mold casting of the housing 320 as desired.
The first lock element 330 includes a plug 332,
a flexible arm 333, a tongue 334, and a button 336 having
a shield retraction pad 338 and a shield extension pad
339. As best shown in Figs. 11, 14, and 15, the plug 332
can slidably reciprocate in the cavity 321 of the housing
25 320. The plug 332 interconnects the rod 315 and the
combination of the flexible arm 333 and the button 336.
When the dual lock assembly 310 is fully assembled, the
button 336 can be positioned to slidably move along the
land 322 of the housing 320, pulling (or pushing, as
30 appropriate) the plug 332 and the connected rod 315.
The second lock element 3~0 includes a shaft
341 connected to a handle 346. The shaft 341 has a flat
land 342 and a curved land 344, giving it a generally
"D"-shaped cross section that is dimensioned to fit
through the "D"-shaped aper~ure 311 opening into the
3 8
-23-
housing 320. Because of this "D"-shape, the shaft 341
cannot rotate relative to the housing 320. Situated
opposite the handle 346, an end 343 of the haft 341 is
formed to define cross cutting channels 348 and 349. As
best seen in Figs. 11 and 14-15, the end 343 of the shaft
341 has a qenerally circular cross ~ection (with a
channel 349 passing through it) and i8 dimensioned to
conformably ride in the cavity 3~1 in the housing 320.
Because of the flattened land 342, the remainder of the
shaft 341 does not completely fill the cavity 321.
When the dual lock assembly 310 is assembled
and positioned so that the first lock element 330 and the
second lock element 340 are fully engaged in locking
position (as seen in Fig. 15), it is impossible to either
extend or retract the shield 300. If either the shield
retraction pad 338 or the shield extension pad 339 is
downwardly pushed, the consequent downward movement of
the flexible arm 333 is stopped as the tongue 334
contacts the land 342 of the shaft 341. As a result,
longitudinal movement of the first locking element 330 is
inhibited because the tongue 334 engages stops 325 formed
in the housing 320.
As shown in Fig. 14, to unlock the first lock
element 330 for leither extension or retraction of the
shield 300 requi:res that the handle 346 of the second
lock element 3~40 be pulled outward from the housing 320
far enough so that the tongue 334 appended to the
flexible arm 333 is situated over the channel 348. As
indicated in Fig. 14, the positioning of the second lock
element 340 in this disabled condition is indicated by
the exposure of a red color 345 on the shaft 341. When
the red color 345 is visible, either the second locking
element 340 is not in a position to prevent unlocking of
the fir~t locking element 330 or the cutting knife 200 is
completely or partially exposed, or both.
g ~
After the second locking element 340 has been
disabled, the first locking element 330 can be moved to
either a position suitable for extending or retracting
the shield 300 simply by downwardly pushing either the
shield retraction pad 338 or the shield extension pad 339
in the direction of the arrow. The flexible arm 333
flexes downward as the button 336 i8 depressed, forcing
the tongue 334 into the channel 348. The shield can be
retracted to fully or partially expose the knife 200 by
applying sufficient downward force to the retraction tab
338 of the button 336 to keep the tongue 334 in the
channel 348 and by simultaneously pressing the button 336
in the direction of the handle 346. After the shield 300
has been retracted a desired amount, the button 336 is
released, allowing the flexible arm 333 to move back to
its nor~al resting position and placing the tongue 334 in
a locked position between the stops 325, su~h as shown
for example in Fig. 15. ~y reversing this procedure the
shield 300 can be moved to more fully or completely cover
20 the knife 200. Extending the shield 300 requires
applying sufficient downward force to the extension tab
339 of the button 336 to keep the tongue 334 in the
channel 348 and simultaneously pressing the button 336 in
the direction of the conduit piece 20. After the shield
25 300 has been extended a desired amount, the button 336 is
released, allowing the flexible arm 333 to move back to
its normal re5~ing position and placing the tongue 334 in
a locked position between the stops 325, such as shown
for example in Fig. 11.
Figs. 20 through 25 illustrate several other
embodiments of the invention that enable a surgeon to cut
bodily tissue. As shown in Figs. 20 and 21 a cannula 500
having a longitudinally extending axis 501 is formed to
define an interior channel 503. The interior channel 503
is accessible through both a notch 504 and a front
3 8
opening 506 defined at a tip 502 of the cannula 500. As
shown in Fig. 21, a knife 510 can be positioned within
interior channel 503 and fixedly attached to the cannula
500.
The knife 510 is provided with a ~irst cutting
edge 512 that extends along an axis 513 that lies at an
angle a relative to the longitudinally extending axis 501
of the cannula 500. In Fig. 21, ~his angle a is about 90
degrees, 60 that th~ first cutting edge 512 extends
essentially perpendicular to the axis 501 of the cannula
500. In this orientation, the first cutting edge 512 can
cut body tissue that enters the interior channel 503 of
the cannula 500 through the front opening 506 in the tip
502 of cannula 500. Such body tissue (not illustrated)
can be encouraged to enter the front opening 506 as a
result of pushing the tip 502 of the cannula 500 into
body tissue, or alternatively can be drawn into the front
opening 506 by drawing a vacuum in the interior channel
503. The application of the vacuum can be controlled in
the manner previously described in connection with Figs.
1-3.
The knife 510 is also provided with a second
cutting edge 514 that is exposed for cutting by the notch
504 defined in the tip 502 of the cannula 500. This
second cutting edge S14 2xtends along an axis 515 that
lies -~ubstantially parallel to the longitudinally
extending axis 531 of the cannula 500. Similar to the
embodiment of the invention shown in Figs. 5 and 6, the
cannula 500 acts to at least partially shield the second
cutting edge 514 as the tip 502 of the cannula 500 is
moved through body tissue.
Another embodiment of the invention is
presented in Fig. 22, which illustrates a cannula 520
that extends along a longitudinally extending axis 521
and is formed to have an interior channel 523. The
~.~J~
-26-
interior channel 523 is accessible through a front
opening 526 defined by a sloping cut S24 through a tip
522 of the cannula 520. As shown in Fig. 22, a knife 530
can be positioned at least partially within the interior
channel 523 and fixedly attached to the cannula 520 at
its tip 522.
The knife 530 i~ provided with a curved,
continuous cutting edge 531 suitable for per~orming
surgical operations. Although the cutting edge 531
presents a continuously changing angle relative to the
longitudinal axis 521 of the cannula 520, utilization of
the knife 530 during surgical operations would generally
involve two different cutting actions. A first cutting
edge 532 that extends along an axis 533 substantially
lies at an angle b relative to the longitudinally
extending axis 521 of the cannula 520. This angled
orientation allows a surgeon to cut body tissue as the
cannula 520 is moved forward along its longitudinal axis
521. Alternatively, body tissue (not shown) can be drawn
into the front opening 526 by drawing a vacuum in the
interior channel 523. The application of the vacuum can
be controlled in the manner previously described in
connection with Figs. 1-3 and Fig. 21.
The ~utting ed~e 531 of the knife 530 also has
a second cutting edge 534 substantially extending along
an axis 535 th~at lies parallel to the longitudinally
extending axis 521 of the cannula 520. The second
cutting edge 534 is used to cut body tissue situated in
parallel relation to the axis 521 of the cannula 520. In
addition, the cannula 520 acts to at least partially
shield the cutting edge 531 as the tip 522 of the cannula
500 is moved in certain directions through body tissue.
As shown in Figs. 23 and 24 a cannula 540
having a longitudinally extending axis 541 is formed to
define an interior channel 543. The interior channel 543
2G~ i8
is accessible through a front opening 546 defined at a
tip 542 of the cannula 540. A knife 550 can be
positioned within interior channel 543 and fixedly
attached to the tip 542 of the cannula 540.
The knife 550 i provided with a first cutting
edge 552 that extends along an axis 553 that lies at an
angle c relative to the longitudinally extending axis 541
of the cannula 540. In the illustrated Figures 23 and
24, the angle c i6 about 90 degrees, so that the first
cuttinq edge 552 extends essentially perpendicular to the
axis 541 of the cannula 540. Functioning in a manner
similar to the embodiments shown in Figs. 21 and 22, in
this orientation the first cutting edge 552 can cut body
tissue that enters the interior channel 543 of the
cannula 540 through the front opening 54~ in the tip 542
of cannula 540. Such body tissue ~not illustrated) can
be encouraged to enter the front opening 546 as a result
of pushing the tip 542 of the cannula 500 into bod~
tissue, or alternatively can be drawn into the front
opening 546 by drawing a vacuum in the interior channel
543. The application of the vacuum can be controlled in
the manner previously described in connection with Figs.
1-3.
Another embodimen~ of the invention is
illustrated in Fig. 25. A cannula 560 having a
longitudinally extending axis 561 is formed to define an
interior channel 563. The interior channel 563 is
accessible through both a notch 564 and a front opening
566 defined at a tip 562 of the cannula 560. As shown in
Fig. 25, a knife 570 can be positioned within interior
channel 563 and fixedly attached to the cannula 560.
The knife 570 is provided with a first cutting
edge 572 that extends along an axis 573 that lies at an
angle d relative to the longitudinally extending axis 561
of the cannula 5~0. Similar to the embodiment shown in
2f3'~
-28-
Fig. 21, the first cutting edge S72 extends essentially
perpendicular to the axis 561 of the cannula 560. A
second cutting edge 574 is exposed for cutting by the
notch 564 defined in the tip 562 of the cannula 560. This
second cutting edge 574 extends along an axis 575 that
lies substantially parallel to the longitudinally
extending axis 561 of the cannula 560. This ~econd
cutting edge 574 can be shielded by ~oving a shield 578
positioned with the interior channel 563 to a position in
the tip 562 that covers the notch 564 and second cutting
edge 574. In the embodiment shown, the shield 578 is
constructed to form a generally tubular cannula having an
outer diameter less than the inner diameter of the
cannula 560. Movement of the shield 578 between the two
positions can be enabled by a mechanism such as shown in
Figs. 11 through 15.
Fig. 29 illustrates another embodiment of the
invention. A cannula 580 having a longitudinally
extending axis 581 is formed to define an interior
channel 583. The interior channel 583 is accessible
through a notch 584 defined in a tip 582 of the cannula
580. A knife 590 can be positioned within interior
channel 583 and fixedly attached to the cannula 580.
The knife 590 is provided with a cutting edge
594 that is exposed for cutting by the notch 584. This
cutting edge 594 extends along an axis 595 that lies
substantially~arallel to the longitudinally extending
axis 581 of the cannula 580.
Fig. 30 illustrates another embodiment of the
invention that does not require placement of a knife for
cutting action. Instead, a cutting region 605 is defined
within an interior channel 603 of a tip 602 of a cannula
600 longitudinally extending along an axis 601. The
cutting region 605 linearly extends essentially parallel
to the axis 601 between a tip 614 of a second cannula 610
-29-
situated in the interior channel 603 and a terminal
shield 609 attached ~o the cannula 600. In action,
particles, liquid, electric current, or radiation such as
provi~ed by infrared, visible, or ultraviolet laser
(particle, liquid, electric current, and radiative paths
are indicated by arrows 612) travel through an interior
channel 611 of the second cannula 610, pass through the
cutting region 605 to cut, cauterize, sear or otherwise
transfer energy to body ti~sue (not shown) maneuvered to
a position within the cutting region 605. The particles,
liquid, or radiation can be absorbed (or in the case of
electric current conducted to ground) by the terminal
shield or backscattered (as indicated by arrows 613).
Removal of particles or liquid from the interior channel
603 can be accomplished through application of a vacuum
to suck material out of the interior channel 603.
Radiation or electric current can of course be
respectively absorbed or conducted to an appropriate
ground. Absorption or dissipation of radiation can be
enhanced by providing the terminal shield 609 with
absorptive, non-reflective coatings as desired.
Application and control of an applied vacuum for removal
of liquid or particulate matter from the cutting region
605 is discussed with reference to Figs. 1-3.
Another embodiment of the invention is
illustrated i~ Figs. 31 and 32. In this embodiment a
cannula 700 havinq a longitudinally extending axis 701 is
formed to define an interior channel 703. Extending
longitudinally through the interior channel 703 along
30 axis 731 is a second cannula 730 formed to define a
second interior channel 732. The second interior channel
732 is configured to allow passage of surgical
instruments, optic fibers, liquid, or other desired
materials (not shown).
2#~ 38
-30-
The interior channel 703 of the cannula 700 is
accessible through both a not~h 704 and a front opening
706 defined at a tip 702 of the cannula 700. As shown in
Fig. 31 and 32, a knife 710 can be pQsitioned within
interior channel 703 and fixedly attached to the cannula
700~ The knife 710 is provided with a first cutting
edge 712 that extends along an axis 713 that lies
perpendicular relative to the longitudinally extending
axis 701 of the cannula 700. Similar to the embodiment
of the invention illustrated in Fig. 21, in this
orientation, the first cutting edge 712 can cut body
tissue that enters the interior channel 703 of the
cannula 700 through the front opening 706 in the tip 702
of cannula 700.
The knife 710 is also provided with a second
cutting edge 714 that is exposed for cutting by the notch
704 defined in the tip 702 of the cannula 700. This
second cutting edge 714 extends along an axis 715 that
lies substantially parallel to the longitudinally
20 extending axis 701 of the cannula 700. Similar to the
embodiment of the invention shown in Figs. 5 and 6, the
cannula 700 acts to at least partially shield the second
cutting edge 714 as the tip 702 of the cannula 700 is
moved through body tissue.
Permanent attachment of a cannula to a conduit
piece is not required for operation of the present
invention. As shown in Fig. 26, the cannula 500 can be
attached to the conduit piece 20 by coupling a male
threaded unit 610 and a female threaded unit 620 to form
30 a mating unit 600 that connects the conduit piece 20, the
cannula 500, and valve body 40 in fluid communication. It
is also possible to couple non-rigid conduits to the
conduit piece 20, such as illustrated in Figs~ 27 and 28.
In those Figures, a flexible tube 630 is attached to the
male thrPaded unit 610 to allow connection to the female
2~f ~i38
threaded unit 620. The flexible tube 630 can be formed
to have any desired length, and can b~ constructed from
any convenient flexible plastic material. In addition,
as shown in Fig. 28, such a flexible tube 630 can be
further equipped with a 6econd mating unit 640 to allow
connection of (for example) a rigid cannula 500.
