Surgery – Specula – Retractor
Reexamination Certificate
1999-02-17
2001-05-08
Smith, Jeffrey A. (Department: 3732)
Surgery
Specula
Retractor
C600S206000, C600S217000, C606S001000
Reexamination Certificate
active
06228023
ABSTRACT:
BACKGROUND OF THE INVENTION
1. Field of the Invention
This invention relates generally to medical devices for use during surgery and, more particularly, to tissue picks for use in endoscopic, laparoscopic, or other minimally invasive surgeries.
2. Related Art
Tissue picks are commonly used by surgeons, for example, to lift tissue such as peritoneum, pleura, endocardium, organ capsules, skin, or any other tissue, hereafter referred to as target tissue, during invasive surgical procedures. Tissue picks are also commonly used when separating fine target tissue from an underlying area such as an artery which is not to be cut.
A conventional tissue pick is formed of a rigid material in the shape of a relatively short rod-like device having a handle end attached to a tissue grasping end. The tissue grasping end includes a double-pronged tip. To use a conventional tissue pick, during surgery, a surgeon orients and manipulates the tissue pick such that the double-pronged tip grasps the target tissue. The surgeon then moves the tissue pick, together with the target tissue, to a desired location. A second surgeon or other medical assistant then manually holds the tissue pick in the desired location while the surgical procedure is performed.
With the advent of less invasive surgeries, such as laparoscopic, thoracoscopic or endoscopic surgeries, the use of conventional tissue picks is limited primarily due to the relatively short length and rigidity of the instrument. However, the need to lift or move a target tissue during minimally invasive surgery remains. Generally, in such invasive surgeries, the body cavity area where the surgery is to occur is generally filled with a gas, typically carbon dioxide, to inflate the cavity to about six inches or so, thereby separating the outer tissue layers from the surgical field. A plurality of laparoscopic trocars are inserted through the outer tissue layers so as to extend into the inflated body cavity. One trocar may be used to receive a small fiber optic video camera or other video device. Other trocars may receive the surgical instruments required to perform the intended surgery.
Tedious surgical procedures have been developed to move the target tissue during minimally invasive laparoscopic surgery. Common to such procedures is the creation of a small incision at a location remote from the laparoscopic trocar. This small incision must extend through the many layers of outer tissue before reaching the inflated body cavity. A surgical needle and suture is then manipulated through the small incision into the body cavity. With a pair of graspers through the same or another incision, the needle is grasped and pushed through the target tissue. The needle is then released and subsequently grasped on the other side of the target tissue with the graspers and pulled back out through the incision. The suture is then anchored in some well-known manner, and the target tissue is retracted or moved into position. Alternatively, a separate trocar can be placed for a grasper or other instrument.
The inventors of the present invention have recognized certain disadvantages with the above approaches. For example, the area of the body where the relatively large incision is made for insertion of either the tissue pick or needle and suture is traumatized. Also, because the needle and suture pierce through the target tissue, it too is traumatized. After the surgery is complete, each layer of tissue through which the incision was made must be sutured and, therefore, is further traumatized. In addition, the method described above with sutures can be time consuming and tedious.
Another disadvantage arises during use of a conventional tissue pick in minimally-invasive surgeries. For example, in order to effectively grasp the target tissue, the tissue pick must be substantially orthogonal to the surface of the target tissue so that the tissue grasping end of the tissue pick can embed into the target tissue. This is sometimes difficult if not impossible to achieve, given the restricted surgical field.
SUMMARY OF THE INVENTION
The present invention is a minimally invasive tissue pick and associated methodology for manipulating tissue during minimally invasive procedures that overcomes the above and other disadvantages of conventional techniques. The present invention includes a tissue pick adapted for passage through a lumen that is inserted through the body of a patient undergoing a minimally invasive surgical procedure. A proximal end of the tissue pick, which extends outside the patient's body, may be manipulated by the surgeon so as to effect actuation of the tissue grasping device at a distal end of the tissue pick within the patient's body. Once manipulated so as to grasp the target tissue, the tissue grasping device remains attached to the target tissue, enabling the surgeon to move the tissue into a desired position.
The tissue pick may be configured to articulate the tissue grasping device relative to the tissue pick so as to position the tissue grasping device at an angle relative to the surface of the target tissue, thus facilitating grasping of the target tissue. This substantially eliminates the need to relocate the lumen and, subsequently, the tissue pick. The tissue pick may also include at least one locking mechanism to secure the tissue pick in a desired orientation. This frees the surgeon to more readily perform the intended surgical procedure.
In one aspect of the present invention, a tissue pick is disclosed. The tissue pick includes an elongated member having a proximal end and a distal end. The distal end is adapted to be inserted through a lumen. A tissue grasping member disposed at the distal end of the elongated member is adapted to be manipulated by controlling the proximal end of the elongated member to automatically grasp the tissue. Thus, an advantage of the present invention is that a less traumatic procedure for moving target tissue is provided, which may result in reduced risk of infection.
In another aspect, the tissue pick includes an outer tube adapted to be inserted through the lumen. The elongated member is disposed within the outer tube. In one embodiment, the elongated member defines a longitudinal axis and the tissue grasping member is rotatable about the longitudinal axis relative to the outer tube. In another aspect, the tissue pick includes a lock for locking the rotation of the grasping member, thereby reducing the need for additional surgical hands or additional surgical instruments. In still another aspect, the tissue pick includes a knob attached to the proximal end of the elongated member for facilitating rotation of the grasping member. In yet another aspect, the tissue pick includes a lock for locking longitudinal displacement of the tissue pick relative to the lumen, thereby further reducing the need for additional surgical hands or additional surgical instruments.
In still another aspect, the tissue pick includes a helix for imparting rotation of the tissue grasping member. The helix is formed on either the elongated member or the tissue grasping member. A cam follower cooperates with the helix and is adapted for linear movement relative to the helix. In one embodiment of the invention, the helix and the cam follower are disposed adjacent to the proximal end. In another embodiment, the helix and the cam follower are disposed adjacent to the distal end.
In yet another embodiment, the tissue grasping member includes at least two helically formed opposing prongs. The prongs grasp an outer portion of tissue upon rotation of the grasping member. In still another embodiment, the tissue grasping member includes at least two spring loaded arc-shaped opposing prongs cooperating with a housing. The tissue grasping member is adapted to be positioned in an extended position, wherein the prongs are disposed in an unbiased opened position substantially outside of the housing, and in a retracted position, wherein the prongs are disposed in a biased closed position substantially inside of the housing.
In an alternative embodimen
Stewart Robert B.
Zaslavsky Ella
Abiomed, Inc.
Samuels, Gauthier & Stevens, LLP.
Smith Jeffrey A.
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