AU2014221219B2 - Endoscopic ultrasound fine needle aspiration device - Google Patents

Abstract

-13 Described herein is a handle for an endoscopic medical device. The device comprises an elongated body extending from a proximal end to a distal end. The elongated body has a distal segment, a central segment, a proximal segment rotatably coupled to the distal segment, and a lumen extending longitudinally therethrough from the proximal end to the distal end and configured to receive the endoscopic medical device therethrough. The distal segment is configured to non-rotatably couple to the endoscopic medical device. The lumen is rotatable relative to the central segment and the distal segment so that rotation of the proximal segment causes a rotation of the lumen and the endoscopic medical device without applying torque to the endoscopic medical device. 0o O Ni o-

Description

- 1 Endoscopic Ultrasound Fine Needle Aspiration Device Inventors: Brian Tinkham, Robert DeVries, Michal Weisman, Shawn Ryan and Daniel Bacon Priority Claim [0001] The application claims the priority to the U.S. Provisional Application Serial No. 61/380,471, entitled "Endoscopic Ultrasound Fine Needle Aspiration Device" filed September 7, 2010. The specification of the above-identified application is incorporated herewith by reference. Background [0002] Any discussion of the prior art throughout the specification should in no way be considered as an admission that such prior art is widely known or forms part of common general knowledge in the field. [0003] A biopsy may be performed with Endoscopic Ultrasound Fine Needle Aspiration ("EUS-FNA") devices to obtain cells or small samples of tissue from, for example, the breast or liver for cytology studies, endoscopy or oncology. As understood by those skilled in the art, biopsy needles enable the capture of samples to facilitate diagnosis and treatment. These biopsy needles are generally connected at their proximal ends to handles including actuation mechanisms. Currently available handles are typically formed as two or more overlapping substantially cylindrical elements with a first element attached to an endoscope and a second larger diameter element overlapping a proximal portion of the first element being used to advance the needle to a target site in a living body. Presently available handles and actuation mechanisms offer insufficient ergonomics and further require that the entire handle be rotated to rotate the needle attached thereto. Summary of the Invention [0004] Unless the context clearly requires otherwise, throughout the description and the claims, the words "comprise", "comprising", and the like are to be construed in an inclusive sense as opposed to an exclusive or exhaustive sense; that is to say, in the sense of "including, but not limited to".

-2 [0005] It is an object of the present invention to overcome or ameliorate at least one of the disadvantages of the prior art, or to provide a useful alternative. [0006] According to a first aspect, there is provided a handle for a medical device, comprising: a proximal segment defining a proximal lumen extending longitudinally therethrough, the proximal lumen being sized and shaped to receive an endoscopic medical device therein; a medial segment received within a distal portion of the proximal segment, the medial segment having an outer diameter smaller than an inner diameter of the proximal segment and defining a medial lumen extending therethrough open to the proximal lumen; and a distal segment received within a distal portion of the medial segment and defining a distal lumen extending therethrough open to the medial lumen, the distal segment having an outer diameter smaller than an inner diameter of the medial segment, wherein the medial segment includes a first movement limiting mechanism configured to limit advancement and retraction of an endoscope attached to a distal end of the distal segment and wherein the medial segment includes a second movement limiting mechanism limiting movement of an endoscopic medical device inserted through the proximal, medial and distal lumens along an axis of the distal lumen and the medial segment includes a second movement limiting mechanism configured to limit advancement and retraction of an endoscope attached to a distal end of the distal body portion. [0007] According to a second aspect, there is provided a method for performing a target procedure in a living body, comprising the steps of: attaching a proximal end of a needle device to an endoscope, the needle device comprising an elongated body having a proximal body portion, a central body portion and a distal body portion and a lumen extending through the elongated body portion, wherein a distal end of the needle device is configured to engage a proximal end of an endoscope; inserting a needle through the needle device; and rotating the proximal body portion to cause a rotation of the lumen and the needle, wherein the lumen is rotatable relative to the central body portion and the -3 distal body portion so that rotation of the lumen does not apply torque to the endoscope. [0008] According to a third aspect, there is provided a method for performing a procedure in a living body, comprising the steps of: attaching a proximal end of an endoscopic medical device handle to an endoscope, the handle comprising an elongated body having a proximal body portion, a central body portion and a distal body portion and a lumen extending through the elongated body portion, wherein a distal end of the handle is configured to engage a proximal end of an endoscope; inserting an endoscopic medical device through the handle; and rotating the proximal body portion to rotate the lumen and the endoscopic medical device, the lumen being rotatable relative to the central body portion and the distal body portion so that rotation of the lumen does not apply torque to the endoscope. [0009] According to a fourth aspect, there is provided a telescoping handle for a medical device, comprising: a proximal segment defining a proximal lumen extending longitudinally therethrough, the proximal lumen being sized and shaped to receive an endoscopic medical device therein; a medial segment received within a distal portion of the proximal segment, the medial segment having an outer diameter smaller than an inner diameter of the proximal segment and defining a medial lumen extending therethrough open to the proximal lumen; and a distal segment received within a distal portion of the medial segment and defining a distal lumen extending therethrough open to the medial lumen, the distal segment having an outer diameter smaller than an inner diameter of the medial segment, wherein the medial segment is telescopically movable into and out of the proximal segment and wherein the distal segment is telescopically movable into and out of the medial segment and wherein proximal and distal movement of the medial and distal segments is not translated to an endoscopic medical device received within the proximal, medial and distal lumens.

-4 [00010] According to a fifth aspect, there is provided a handle for an endoscopic medical device comprising: an elongated body extending from a proximal end to a distal end, the elongated body having a distal segment, a central segment, a proximal segment rotatably coupled to the distal segment, and a lumen extending longitudinally therethrough from the proximal end to the distal end and configured to receive the endoscopic medical device therethrough, the distal segment configured to non-rotatably couple to the endoscopic medical device, wherein the lumen is rotatable relative to the central segment and the distal segment so that rotation of the proximal segment causes a rotation of the lumen and the endoscopic medical device without applying torque to the endoscopic medical device. Brief Description of the Drawings [00011] Embodiments of the invention will now be described, by way of example only, with reference to the accompanying drawings in which: Fig. 1 is a first perspective view of a device according to a first embodiment of the invention; Fig. 2 is a second perspective view of the device of Fig. 1; Fig. 3 is a partial cross-sectional view of the device of Fig. 1; Fig. 4 is a perspective view of the device of Fig. 1 in a first operative configuration; and Fig. 5 is a perspective view of the device of Fig. 1 in a second operative configuration. Detailed Description [00012] The present invention relates to handle for an apparatus for obtaining tissue samples and, more particularly relates to FNA devices. The handles according to the invention may be used in substantially all procedures employing FNA devices further increasing the efficacy of FNA procedures by improving handling of the device via an ergonomic design and also by permitting rotational movement of the endoscope without the need to rotate the entire shaft of the device. Specifically, presently available devices require that the entire endoscope or the entire handle be rotated in order to affect a rotation of the needle at a target site in the body. The exemplary system and method according to the -5 present invention allows for a selective rotation of only a needle of an FNA device without rotating the entire handle, as will be described in greater detail hereinafter. [00013] Devices and methods according to the present invention comprise an FNA device including an ergonomic handle controlling rotation of an FNA device inserted through the device, the handle being connected to an adjustment portion controlling proximal-distal movement of the FNA needle inserted through the FNA device and through an endoscope attached to a distal portion of the device, the endoscope being configured for insertion into a living body in an operative configuration. Specifically, embodiments of the present invention are directed to a handle configured to control rotation of the FNA needle inserted therethrough while bypassing the need to rotate the entire endoscope, as is customary with presently available devices. It is noted that the use of the term distal herein refers to a direction away from a user and toward a target tissue treatment area and the term proximal refers to a direction approaching a user of the device (e.g., a physician) with a proximal portion of the device remaining external to the patient as an endoscope attached to the distal portion is inserted into the body. [00014] As shown in Figs. 1-5, an FNA actuation device 100 according to an exemplary embodiment of the present invention comprises an elongated body having a proximal handle portion 102, a central portion 104, a distal portion 106 and an attachment portion 108 located at a distal end thereof, the attachment portion 108 permitting attachment with an endoscope or other device for insertion into a living body in an operative configuration. In an exemplary embodiment, components of the device 100 may be formed of any combination of a polymer, metal or other known material, as known to those of skill in the art. An exemplary material of the device 100 is selected so that, when attached to an endoscope, the elements are permitted to rotate without breaking or cracking, as will be described in greater detail later on. A lumen 110 extends through the device 100 from a proximal end 112 to a distal end 114. The lumen 110 may be substantially circular in cross section and may be configured to receive a needle, stylet or another medical device therethrough (e.g., electrodes, knives, pincers, etc.), as those skilled in the art will understand. The needle or other medical device may be configured to reflect ultrasound signals, such as for example, an endoscopic ultrasound ("EUS") needle, as those skilled in the art will understand. It is noted, however, that other cross-sectional shapes of the lumen 110 are also envisioned. Inner walls of a portion of the lumen 110 extending through the proximal handle portion 102 comprise radial abutments or a treated surface (not shown) to -6 permit a frictional or mechanical engagement with an outer wall of a needle 103 to be inserted therethrough. The needle 103 may also comprise an abutment, a recess or a treated surface to permit such an engagement. Thus, when inserted through the lumen 110, the needle 103 may be moved proximally and distally relative to the proximal handle portion 102 by application of a sufficient proximally or distally directed force to a proximal end of the needle but may be prevented from being rotated relative thereto. Rotation of the needle 103 can only be facilitated by a rotation of the proximal handle portion 102. Alternatively, as will be understood by those skilled in the art, the shapes of any portion of the needle, stylet or other medical device and a corresponding portion the lumen 110 may be keyed to one another to prevent relative rotation therebetween. The lumen 110 also extends through the central portion 104 and distal portion 106 but is not rotatably fixed thereto. That is, the lumen 110 is rotatable relative to the central portion 104 and the distal portion 106. Specifically, as shown in Fig. 3, the central portion 104 and distal portion 106 comprise a telescoping internal channel 138 configured with first, second and third sections 140, 142, 144 configured to be retractable into one another upon retraction of one or both of the central and distal portions 104, 106. The lumen 110 extends through the telescoping internal channel 138 and is slidable relative thereto so that retraction and expansion of the telescoping internal channel 138 does not cause proximal or distal movement of the lumen 110. Thus, proximal retraction of the distal portion 106 causes the distal portion 106 to be withdrawn into the central portion 106 and retraction of at least the third section 144 into the second section 142. Similarly, when the central portion 104 is retracted into the proximal handle portion 102, as will be discussed in greater detail later on, the outer wall of the central portion 104 slides into a cavity 136 within the proximal handle portion 102. The lumen 110 is slidable relative to the telescoping internal channel 138 so that proximal retraction of the central portion 104 and distal portion 106 does not proximally retract the needle 103 but rather, permits a greater portion of the needle 103 to be exposed at a distal end of the device 100, as shown in Fig. 4. The telescoping internal channel 138 further comprises a lip 146 formed at a proximal end thereof to permit frictional engagement of the telescoping internal channel 138 with an abutment 148 preventing removal of the central portion 104 from the proximal handle portion 102. The lumen 110 extends proximally from the proximal handle portion 102 by a predetermined distance and comprises an opening 118 opening into the lumen 110 to permit insertion of the needle or other device therethrough. [00015] The proximal handle portion 102 may be substantially cylindrical in shape and may be formed with an outer diameter greater than that of both the central portion 104 and -7 the distal portion 106. It is further noted that the proximal handle portion 102 may also be formed with a non-circular cross-sectional shape without deviating from the scope of the present invention. The proximal handle portion 102 may be formed with a taper so that its diameter increases toward a central portion thereof with proximal and distal ends of the proximal handle portion 102 having a smaller diameter than that of the central portion. The proximal handle portion 102 further comprises an ergonomic groove 116 formed adjacent a distal end thereof to aid in gripping and manipulation thereof. It is noted that although only a single groove 116 is shown, the proximal handle portion 102 may be formed with any number and variety of grooves or abutments configured to aid in ergonomic handling without deviating from the scope of the present invention. The proximal handle portion 102 may also have a soft grip coating (e.g., thermoplastic elastomer) or another surface modification or coating to aid in handling. [00016] The central portion 104 extends distally from the proximal handle portion 102 by a predetermined distance and also has a substantially circular cross-section. A diameter of the central portion 104 in this embodiment may be approximately 13 - 25 mm. The central portion 104, although securely connected to the proximal handle portion 102, remains rotatable relative thereto. That is, rotation of the proximal handle portion 102 and the lumen 110 does not result in a rotation of the central portion 104. In one embodiment of the invention, the proximal handle portion 102 comprises a radial groove (not shown) formed on an inner wall of a distal rim thereof configured to rotatably engage a radial abutment formed on an outer wall of a proximal rim of the central portion 104. Alternatively, any connection may be forged between the proximal handle portion 102 and the central portion 104 without deviating from the scope of the present invention. [00017] The central portion 104 further comprises a first mechanism 120 and a second mechanism 122 configured to selectively limit a proximal-distal movement of the distal portion 106 relative to the central portion 104 and movement of the central portion 104 relative to the proximal handle portion 102. Specifically, the first mechanism 120 may be formed as a ring 124 extending around a portion of an outer surface of the central portion 104. The ring 124 may be secured to the central portion 104 and may be held in place by a friction fit or any other suitable attachment means known in the art. In an exemplary embodiment, the ring 124 of the first mechanism 120 may be permanently secured to a distal end of the central portion 104. The ring 124 includes a pair of slots 126 extending substantially perpendicular to a longitudinal axis of the central portion 104 and having a -8 length smaller than a circumference of the ring 124. The slots 126 are configured to permit the device to be locked in a desired configuration. Specifically, a profile of an inner surface of the ring 124 adjacent to the outer surface of the distal portion 106 is non-circular (e.g., elliptical) while a knob 128 of the mechanism 120 includes one or more arms (not shown) which extend from a part of the knob 128 which is located between the ring 124 and the outer surface of the distal portion 106. The arms are sized so that, when the knob 128 is rotated to a first orientation, the arms are located within a space formed between a larger diameter portion of the non-circular inner surface of the ring 124 and the distal portion 106 so that the ring 124 is loosely held around the distal portion 106. Rotation of the knob 128 to a second orientation (e.g., by 90E relative to the first orientation) moves the arms into a smaller space between a reduced diameter portion of the non-circular inner surface of the ring 124 and the distal portion 106 so that the ring 124 is pressed tightly against the distal portion 106 locking the positions of the distal portion 106 and the central portion 104. [00018] The distal portion 106 is sized and shaped to be slidably received within the central actuating portion 104 and telescopically extendable therefrom. When the distal portion 106 is manually moved to a desired position (i.e., using markings 107 formed on an outer wall thereof as a guide), the first mechanism 120 is tightened to apply a torque to the distal portion 106 to lock a position thereof. The distal portion 106 also comprises a distal opening 130 through which the distal end 114 of the lumen 110 exits the device 100. [00019] The second mechanism 122 provided over the central portion 104 is formed substantially similarly to the first mechanism 120 but comprises a ring 132 slidable along a length thereof to permit advancement of the central portion 104 into and out of the proximal handle portion 102. Thus, the second mechanism 122 may be positioned over a target portion of the central portion 104 using markings 105 as a guide and tightened to lock a position thereof. In this manner, the second mechanism 122 can be positioned so that only a portion of the central portion 104 located proximally of the second mechanism 122 is retracted into the proximal handle portion 102, as shown in Fig. 4. For example, when the window 123 is positioned over the "8" marker at a distal-most position of the central portion 104, substantially the entire length of the central portion 104 can be withdrawn proximally into the proximal handle portion 102, as shown in Fig. 4. Similarly, when the second mechanism 122 is moved to a proximal-most position along the central portion 104 (i.e., so that a window 123 is positioned over a "0" marker), the central portion 104 is prevented from being retracted into the proximal handle portion 102.

-9 [00020] The attachment portion 108 has a greater diameter than the distal portion 106 and comprises internal threading 134 engaging a threaded outer wall of a proximal end of an endoscope (not shown). The distal end 114 of the lumen 110 may be configured so that, when the attachment portion 108 may be coupled to an endoscope, the lumen 110 aligns with and engages a working channel extending through the endoscope (not shown). Specifically, a proximal end of the endoscope (not shown) may be received within the attachment portion 108 and the attachment portion 108 may be rotated to lockingly engage the threads of the endoscope. In one embodiment, only the attachment portion 108 may be rotated to threadedly engage the endoscope (not shown). In another embodiment, the attachment portion 108 may not be rotatable relative to the distal portion 106 so that, in order to threadedly engage the endoscope, the entire distal portion 106 must be rotated. In another embodiment of the invention, the attachment portion 108 may be configured to permit a luer lock connection with the endoscope. [00021] In accordance with an exemplary method of the present application, an endoscope may be attached to the attachment portion 108. The central and distal portions 104, 106 are then manipulated to a desired orientation and the first and second mechanisms 120, 122 are tightened to lock the device 100 in the desired configuration. That is, the distal portion 106 may be extended to a length selected such that, when the needle 103 may be inserted into the lumen 110 and through the endoscope, the needle be movable between a first position in which a distal end of the needle may be located within the endoscope lumen (e.g., substantially adjacent a distal end thereof) and a deployed position in which the needle projects distally beyond a distal end of the endoscope by a desired distance. The needle 103 may then be inserted through the FNA device 100 into the working channel of the endoscope until the proximal end of the needle may be locked in position at a proximal end of the device 100. At this point, the device 100 may be configured so that the needle 103 is in the first position with the distal tip thereof received within the endoscope. In addition, at this point, a stylet is preferably placed in a closed configuration in which it seals a distal opening of the needle as the needle is inserted through non-targeted tissue to the target tissue site. The endoscope is then guided to a target location within the body in a conventional manner and a physician or other user determines (e.g., under visual observation via the endoscope) whether a tissue penetrating distal tip of the needle 103 is in a desired orientation relative to target tissue to be sampled. If not, the physician may rotate the proximal handle portion 102 by a desired angle with the rotation being translated only to the lumen 110 and the needle 103 located therein while the central portion 104, distal portion 106 and the entire length of -10 the endoscope remain substantially unaffected by the rotation. The physician freely rotates the needle 103 by any desired angle until the desired orientation is achieved. The needle 103 may then be moved distally out of the endoscope to extend distally therefrom by the desired distance under the guidance of an imaging device, as those skilled in the art will understand. At this point the stylet is also moved to a tissue receiving configuration in which the distal opening of the needle 103 is open to receive tissue. It is further noted that the needle 103 may subsequently be rotated at any point during the target procedure as deemed necessary by the physician. [00022] The present invention has been described with reference to specific exemplary embodiments. Those skilled in the art will understand that various modifications and changes may be made to the embodiments. The specifications are, therefore, to be regarded in an illustrative rather than a restrictive sense.

Claims (14)

1. A handle for an endoscopic medical device comprising: an elongated body extending from a proximal end to a distal end, the elongated body having a distal segment, a central segment, a proximal segment rotatably coupled to the distal segment, and a lumen extending longitudinally therethrough from the proximal end to the distal end and configured to receive the endoscopic medical device therethrough, the distal segment configured to non-rotatably couple to the endoscopic medical device, wherein the lumen is rotatable relative to the central segment and the distal segment so that rotation of the proximal segment causes a rotation of the lumen and the endoscopic medical device without applying torque to the endoscopic medical device.

2. The handle of claim 1, wherein the endoscopic medical device is a needle.

3. The handle of claim 2, wherein the needle is an endoscopic ultrasound needle.

4. The handle of any one of the preceding claims, further comprising an actuating mechanism position on the central segment, the actuating mechanism configured to affect proximal and distal movement of the distal segment relative to the central segment.

5. The handle of any one of the preceding claims, wherein an outer diameter of the medial segment is smaller than an inner diameter of the proximal segment.

6. The handle of any one of claims 1 to 4, wherein an outer diameter of the distal segment is smaller than an inner diameter of the medial segment.

7. The handle of any one of the preceding claims, wherein the medial segment includes a first movement limiting mechanism configured to limit advancement and retraction of the endoscopic medical device.

8. The handle of claim 7, wherein the first movement limiting mechanism locks a position of the distal segment relative to the medial segment.

9. The handle of claim 7 or claim 8, wherein the medial segment includes a second movement limiting mechanism configured to limit movement of the endoscopic medical device. -12

10. The handle of claim 9, wherein the second movement limiting mechanism is slidably positioned over a target portion of the medial segment so that only a portion of the medial segment located proximally thereof is retractable into the proximal segment.

11. The handle of any one of the preceding claims, wherein the distal segment threadedly engages the endoscopic medical device.

12. The handle of claim 11, wherein the distal segment engages the endoscopic medical device via a luer lock.

13. The handle of any one of the preceding claims, wherein a proximal portion of the lumen is keyed to a shape of the endoscopic medical device.

14. The handle of claim 7, wherein the first movement limiting mechanism is moveable between a first configuration and a second configuration, the first configuration configured to permit the distal segment to move longitudinally through the medial segment to adjust a length of the handle to a desired length, and the second configuration configured to lock the medial and distal segments relative to one another to maintain the desired length of the handle.