EP0556335A1 - Instrument chirurgical servant a enlever des matieres - Google Patents

Instrument chirurgical servant a enlever des matieres

Info

Publication number
EP0556335A1
EP0556335A1 EP92902009A EP92902009A EP0556335A1 EP 0556335 A1 EP0556335 A1 EP 0556335A1 EP 92902009 A EP92902009 A EP 92902009A EP 92902009 A EP92902009 A EP 92902009A EP 0556335 A1 EP0556335 A1 EP 0556335A1
Authority
EP
European Patent Office
Prior art keywords
surgical instrument
cutter
drive
distal
proximal
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP92902009A
Other languages
German (de)
English (en)
Other versions
EP0556335A4 (en
Inventor
Arthur H. Hamlin
John A. Snapp
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Bowen & Co Inc
Original Assignee
Bowen & Co Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Bowen & Co Inc filed Critical Bowen & Co Inc
Publication of EP0556335A1 publication Critical patent/EP0556335A1/fr
Publication of EP0556335A4 publication Critical patent/EP0556335A4/en
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • A61B17/32002—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft
    • A61B2017/2904—Details of shaft curved, but rigid

Definitions

  • the invention relates to surgical instruments of the type which have heretofore found principal use in endoscopic, and especially arthroscopic, surgical 5 procedures.
  • Such instruments, and specifically meniscus cutters utilized in shoulder, knee and other surgical procedures, have been considered less than completely acceptable in large part because of technical problems associated with the positioning of the meniscal tissue
  • the instrument includes a continuous outer tubular member which extends the length of the instrument and is bent during anufacture to achieve a predetermined angle.
  • An elaborate flexible transmission system which extends through the outer tube comprises a composite, spirally- wound tube consisting of an inner spiral, a middle spiral and an outer spiral.
  • the arrangement of multiple spiral tubes, which are spot-welded, are each alternately spiraled relative to adjacent spirals to enable rotation of the transmission tube in opposite directions. It can be appreciated that the mechanical complexity of this device renders it unduly expensive to manufacture and therefore procure, and subjects the instrument to an increased likelihood of failure.
  • Such an instrument should be structurally stable, incorporate a positive drive for both clockwise and counterclockwise rotational movement of a cutter device, include minimal suction channel disruption, be easily sterilizable, and inexpensive in both material cost and assembly procedures to thereby enable its use as an economically feasible disposable item.
  • the angular orientation of the cutter head is achieved by the " provision of a hollow connector elbow between a linear outer tube and a linear cutter head sheath that are respectively mounted to the angularly oriented legs of the elbow.
  • Instruments of different angles are easily manufactured by the use of appropriately angled and rigid preformed elbows, with the remainder of the components being standardized, that are of the same or substantially similar construction regardless of the angle of the elbow.
  • the cutter includes a hollow cutter shaft with a generally laterally directed mouth at the distal end thereof having blade edges which, upon rotation of the cutter shaft, cooperate with blade edges in a window laterally defined through the cutter sheath to provide a compound cutting action that is applicable for use in removing tissue or other material from the body of a patient.
  • the terms "cutter” and “cutting” and respective derivatives thereof encompass various apparatus and processes for effecting as slicing, shaving and abrading by which body material is to be separated from a material source upon progressive advancement of the cutter device of the subject application thereagainst.
  • the proximal end of the cutter shaft is provided with a plurality of equally spaced, rearwardly directed gear teeth that are positioned peripherally about and within the end portion of the shaft as a continuation of the inner and outer peripheries of the shaft to define a driven gear.
  • the driven gear is located at the angle of the elbow and is in meshed driving engagement with a similarly formed gear on the distal end of an elongate hollow drive shaft. It is preferred that the angle defined by the connector elbow be between about 180 degrees (wherein the legs are in linear alignment) and approximately 90 degrees (where the legs are generally at right angles to each other) .
  • the depth and shape of the drive and driven gear teeth are such as to ensure a positive driving mesh at any of the desired angles within the aforementioned range.
  • the preferred angle that is the angle considered to be most practical for standard arthroscopic surgery, is approximately 165 degrees.
  • the outer tube and elbow preferably present a smooth, continuous inner bearing surface that cooperate with smooth exterior bearing surfaces defined by the exterior surfaces of the drive shaft and cutter shaft along the lengths thereof for rotational support of the drive shaft and cutter shaft within the outer tube and cutter sheath without separate bearing means.
  • the gear- joined drive shaft and cutter shaft define a smooth continuous interior material-withdrawing passage interrupted only at the meshing gears and adapted, through the meshing gears, for positive rotation in both clockwise and counterclockwise directions.
  • the outer tube and cutter sheath respectively telescopically engage the two legs of the connector elbow and are permanently fixed thereto, preferably by welding. However, other suitable securing means can be provided.
  • both the drive shaft and the cutter shaft When assembled, both the drive shaft and the cutter shaft, while freely rotatable, can be supported along substantially the full lengths thereof or by one or more bearing sections and are precluded from longitudinal shifting within the outer tube and cutter sheath.
  • Figure 1 is a schematic illustration of a prior art instrument illustrating the difficulty in accessing posterior meniscus material with a straight shaft;
  • Figure 2 is a schematic illustration similar to Figure 1 illustrating the angled instrument of the present invention
  • Figure 3 is an enlarged side elevational view of the forward angled portion of the instrument
  • Figure 4 is a longitudinal cross-sectional view through the structure of Figure 3;
  • Figure 5 is a view of the cutter end of Figure 4 with the cutter shaft rotated 90 degrees and presented partially in elevation;
  • Figure 6 is an enlarged sectional detail illustrating the positioning means for the drive shaft;
  • Figure 7 is a cross-sectional view similar to
  • Figure 8 is an exploded perspective view of the components of the instrument.
  • Figures 9-12 are perspective views of various alternative cutter head arrangements.
  • FIG 2 in the same or substantially similar surgical environment as shown in Figure 1, illustrates the surgical instrument 12 of the present invention in which provision is made for accessing angularly offset areas such as the channel 11a in a manner not possible with the conventional straight instrument 10 of Figure 1.
  • the instrument 12 comprises an elongate linear or straight shank 14 with an angularly-directed cutter head or operating end portion 16 at the distal end thereof.
  • the proximal end of the shank 14 is associated, in a conventional manner, with a vacuum or suction source as schematically shown at 18, and a drive motor 20.
  • a drive motor means can be provided for a manual driving of the cutter head 16.
  • the shank 14 comprises a hollow cylindrical outer tube 22 having a smooth surfaced bore 24 therethrough which, along substantially the full length thereof, defines a continuous bearing surface.
  • the distal or forward end portion of the outer tube 22 is counterbored to define an annular recess 26 terminating in an annular, radially inwardly extending and forwardly directed shoulder 28, as shown in Figure 6.
  • the angle of the instrument, or more particularly the cutter head 16 with respect to the tube 22, is defined by a connector elbow 30, as shown more clearly in Figure 3.
  • the elbow 30 is of rigid hollow tubular construction and, in accord with the specific area to be accessed by the instrument, can be configured so as to provide any of a range of angles "a" that are between approximately 90 degrees and approximately 180 degrees.
  • most surgical sites to which the subject invention is concerned can be accessed by cutter heads oriented at anywhere from a range of about 105 degrees (Fig. 7) to about 165 degrees (Fig. 4) .
  • the connector elbow 30, with its angularly related elongate proximal and distal legs 32 and 34 thereof and the angle juncture therebetween, is provided with smooth inner and outer surfaces defining, when assembled to the outer tube 22, smooth continuations of the inner and outer surfaces of the tube 22.
  • the proximal leg 32 is exteriorly recessed about the proximal end thereof to define an elongated exterior recess 36 which complements the counterbore 26 of the outer tube 22 for telescopic reception and nesting, therein.
  • the proximal edge 38 of the proximal elbow leg 32 terminates slightly forward of the shoulder 28 of the counterbore 26, defining therewith an annular recess or groove 40.
  • the engagement of the recessed proximal end portion of the elbow leg 32 within the counterbored distal end portion of the outer tube 22 is rigidified, preferably by welding, and is such as to provide for substantially continuous outer and inner surfaces, with the exception of the annular recess 40, as described above.
  • the distal end portion of the distal leg 34 of the connector elbow is similarly externally recessed to define an elongated annular recess 44.
  • An elongate cutter sheath 46 of a thickness corresponding to the depth of the recess 44, has the proximal end thereof received within the recess 44 along the length of the recess to define a smooth exterior surface continuation of the distal leg 34.
  • the sheath 46 projects beyond the distal end of the distal elbow leg 34 and terminates in a retaining end 48 laterally directed at least partially across the forward or distal end of the cutter sheath 46.
  • the cutter sheath includes at, or immediately adjacent the distal end thereof, a cutter window 50 with blade edges.
  • the window 50 opens either completely or partially laterally along at least a portion of the linear extent of the cutter sheath 46.
  • an elongate hollow cutter shaft 52 with a proximal portion coextensive with the distal leg 34 and having a smooth exterior surface 54 in bearing engagement with the inner surface of leg 34 along the length thereof.
  • the distal end portion 56 of the cutter shaft 52 is configured so as to be radially thicker than the proximal portion thereof and defines an exterior, rearwardly-directed annular shoulder 58 which bears against the leading edge of the distal leg 34 of the elbow 30.
  • the exterior of the distal end portion 56 of the cutter shaft 52 is, for the linear extent of the sheath 46 forward of the leg 34 and to the retaining end 48, in bearing engagement with the inner surface of the sheath 46.
  • the bore 60 which extends substantially axially through the cutter shaft 52 is of a smooth surface and exhibits a constant diameter that terminates in an end wall 62 having an exterior surface bearing against the retaining end 48 of the sheath 46.
  • a cutter comprising a mouth 64 with peripheral cutting edges, that is formed through the cutter shaft 52 immediately rearward of the distal end 62 thereof and generally laterally directed to cooperate with the sheath window 50, and more particularly the cutting edges 65 defined thereabout.
  • At least one, and preferably both, of the cutter mouth and sheath window edges is formed from suitably sharpened, and optionally hardened surgical grade stainless steel. The cooperation provides for a shearing action as the cutter shaft 52 is rotated, either clockwise or counterclockwise, within the operating end portion 16 of the instrument.
  • the preferred rotational rate of operation is from about 100 rpm to about 7,000 rpm, in accordance with such factors as surgeon preference, cutter head configuration, the type of drive motor 20 used with the instrument 12, and the type of surgery and location of the surgical site.
  • the instrument 12 is used with a drive motor 20 that is controllable to provide a range of cutter blade rotational rates that can be controlled by the user.
  • the cutter sheath 46 is preferably rigidly joined at the telescopic overlap with the recessed distal end portion of the elbow leg 34 by conventional securing means such as welding.
  • the cutter shaft 52 while freely rotatable within the cutter sheath 46 and elbow leg 34 and in stable bearing engagement along at least substantially the full length thereof, is retained against longitudinal movement or shifting by and between the retaining end 48 of the sheath 46 and the shoulder 58 on the cutter shaft 52 which engages the leading or distal end of the elbow leg 34.
  • the cutter shaft 52 is preferably configured so as to be gear driven with a driven gear 66 integrally defined at the proximal end of the shaft 52, located at the angle of the elbow connector 30, by a plurality of gear teeth 68 cut or otherwise formed directly in the proximal end portion of the cutter shaft 52, whereby the formed teeth 68 are provided with inner and outer surfaces which define smooth continuations of the respective inner and outer surfaces of the cutter shaft 52.
  • Rotatable driving of the cutter shaft 52 is effected by an elongate hollow drive shaft 70 that is longitudinally received within, and coextensive with, the outer tube 22 and the linearly-aligned proximal leg 32 of the connector 30.
  • the outer surface 72 of the drive shaft 70 defines a smooth bearing surface in engagement with the inner surface 24 of the outer tube 22 and the inner surface of the proximal elbow leg 32 along the full length thereof.
  • This outer surface 72 includes an annular groove 74 that is radially aligned with the groove 40 and forms therewith a closed channel which encircles the drive shaft 70.
  • This closed channel receives a steel wire retainer ring 76 which extends into both grooves 40 and 74, substantially completely filling the annular channel defined thereby.
  • the retainer ring 76 retains the drive shaft 70 against longitudinal movement relative to the outer tube 22, while allowing for rotation of the drive shaft 72 within the outer tube with the shaft supported and stabilized during rotation by the substantially full length engaged bearing surfaces 24 and 72.
  • the distal end portion of the drive shaft 70 has a drive gear 78 formed thereat which complements the driven gear 68 formed on the proximal end of the cutter shaft 52 and similarly includes a series of equally spaced peripheral gear teeth 80, the opposed surfaces of which form smooth continuations of the inner surface or bore of the drive shaft 70 and the outer bearing surface 72 thereof.
  • the gear teeth 68 and 80 mesh at the angle joinder of the legs of the elbow 30 and are configured to provide for a positive driving mesh regardless of the angle of the elbow within the contemplated range of the invention.
  • the adaptability of the meshing of the gear teeth will be appreciated from a comparison of the structures depicted Figures 4 and 7.
  • proximal end of the drive shaft 70 and the proximal end of the outer tube 22 are joined, in the manner of a conventional surgical cutting instrument, with both motor means 20 for effecting a driving of the drive shaft 70 and appropriate suction generating apparatus 18 for obtaining vacuum positioning of material to be cut by the surgical instrument 12 and removal of cut material through the aligned bores in the drive shaft and cutter shaft.
  • elbows are standardized, thus facilitating assembly and through the use of preformed elbows assuring a consistent uniformity.
  • the individual components are rigid elements which, with regard to the outer components including the outer tube 22, elbow 30 and cutter sheath 46, are rigidly fixed, as by welding, to rotatably receive the drive components therein and therethrough.
  • the inner and outer components themselves provide for full length engaged bearing surfaces without additional bearing means, and can be configured from a wide range of surgical grade materials such as stainless steel, plastics, or a combination of stainless steel and plastic. Alternatively, one or more bearing sections can be provided along the respective inner and outer components.
  • the drive shaft and cutter shaft are in direct driving engagement through integral gear teeth formed at the adjacent ends thereof.
  • the engaged gear teeth are operable through a range of fixed angular orientations and are equally effective for both clockwise and counterclockwise driving engagement.
  • both the sheath window and cutter shaft mouth can be provided with a generally oval configuration with continuously curving surfaces as shown in Figure 9.
  • the sheath window as shown in Figure 10 can be configured with a multitude of apertures 90 of reduced dimension that are oval or circular in configuration and which cooperate with an underlying cutter shaft opening which, upon rotation of the cutter shaft, sweeps by each of the individual windows to achieve a shaving effect as opposed to a broader cutting effect achieved by the cutter head of Figures 5 and 9.
  • the edge surface 65 of the sheath window 50 is provided with a serrated surface along its opposed edges that are aligned with the longitudinal axis of the cutter head so as to provide a plurality of opposed teeth 92 which, together with the rotary action of the cutter element, facilitate a broader cutting effect that is generally comparable, or even greater, than that provided by the arrangement depicted in Figure 9.
  • the cutter head can be in the form of an abrader 64• rotatably received within the cutter window 50.
  • the distal end 96 of the abrader 64* extends beyond the open; distal end 98 of the cutter window 50 to permit for the abrading of body material such as bone or cartilage upon axial or laterial extension, or any combination thereof, of the abrader 64* against the material to be removed.
  • body material such as bone or cartilage upon axial or laterial extension, or any combination thereof
  • the angle of the cutter head is determined by the fixed angle elbow with the material to be acted on drawn into the cutter head as a part of the cutting procedure, and upon being severed, effectively evacuated through the smooth bores of the aligned cutter and drive shafts.
  • the surgical instrument of the invention has, in Figure 2, been illustrated as used in the performance of an arthroscopic procedure on a knee, the instrument has substantially broader applications.
  • the angled instrument of the subject invention is particularly applicable for use in shoulder surgery for, among other of a wide variety of surgical applications, abrading the scapula neck inferior.
  • the instrument will have practical applications in a wide range of surgical procedures other than arthroscopic procedures, such as conventional (open) surgery as well as microsurgical procedures upon appropriate scaling of the respective components of the surgical instrument.
  • the described instrument is unique in its solution of the vexing problem of obtaining access to areas normally difficult to reach with conventional, i.e., straight, instruments and doing so in a manner which minimizes trauma to the surgical site as compared to that experienced in conventional procedures requiring multiple instruments or instruments of complex construction.
  • the principals of the invention and in particular the rigid connector elbow and full length rigid shafts with direct bearing surfaces, can be utilized in conjunction with a variety of different forms of cutters, drive means and suction apparatus, all of which are to be regarded as falling within the scope of the invention as set forth in the foregoing detailed description and accompanying patent claims.

Landscapes

  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

Instrument chirurgical pourvu d'une tige d'entraînement (70) allongée traversant de manière rotative et entrant en appui direct avec le passage interne lisse d'un tube externe (22). Un coude de raccordement rigide 930) dont les branches (32, 34) sont à des angles prédéterminés permet d'orienter de manière angulaire une tige de coupe (52) par rapport à la tige d'entraînement, les tiges entrant en un engagement d'entraînement par l'intermédiaire de dents d'engrenage (68, 80) placées sur des extrémités adjacentes des tiges et en-deçà des bords périphériques des tiges. L'extrémité avant de la tige de coupe comprend une ouverture (64) orientée latéralement, pourvue de tranchants qui coopèrent avec une fenêtre (50) latéralement ménagée dans le fourreau externe de l'instrument.
EP19920902009 1990-11-09 1991-11-08 Surgical instrument for material removal Withdrawn EP0556335A4 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US61127890A 1990-11-09 1990-11-09
US611278 1996-03-19

Publications (2)

Publication Number Publication Date
EP0556335A1 true EP0556335A1 (fr) 1993-08-25
EP0556335A4 EP0556335A4 (en) 1994-07-13

Family

ID=24448390

Family Applications (1)

Application Number Title Priority Date Filing Date
EP19920902009 Withdrawn EP0556335A4 (en) 1990-11-09 1991-11-08 Surgical instrument for material removal

Country Status (4)

Country Link
EP (1) EP0556335A4 (fr)
JP (1) JPH06503238A (fr)
CA (1) CA2095821A1 (fr)
WO (1) WO1992008416A1 (fr)

Families Citing this family (13)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
ES2118742T3 (es) * 1990-10-19 1998-10-01 Smith & Nephew Inc Dispositivo quirurgico.
US5411514A (en) * 1992-09-30 1995-05-02 Linvatec Corporation Bendable variable angle rotating shaver
DE4323756A1 (de) * 1993-07-15 1995-01-19 Wolf Gmbh Richard Chirurgisches Instrument zum Abtragen von Gewebe
US5423844A (en) * 1993-10-22 1995-06-13 Promex, Inc. Rotary surgical cutting instrument
DE69517463T2 (de) * 1994-04-15 2001-03-08 Smith & Nephew Inc Gekrümmtes chirurgisches Instrument mit segmentiertem Innenelement
DE4422426C2 (de) * 1994-06-28 1998-02-26 Kurt Eberle Kg Chirurgisches Instrument zum Entfernen von Gewebe oder Knorpel
US5676012A (en) * 1995-12-05 1997-10-14 Spectrum Manufacturing, Inc. Process for forming endoscopic shaver blade from elongate tube
BE1010290A3 (nl) * 1996-05-10 1998-05-05 Saturnus Ag Weefsel-morcellator.
US5792167A (en) * 1996-09-13 1998-08-11 Stryker Corporation Surgical irrigation pump and tool system
US5741287A (en) * 1996-11-01 1998-04-21 Femrx, Inc. Surgical tubular cutter having a tapering cutting chamber
US7641667B2 (en) * 2002-01-29 2010-01-05 Smith & Nephew, Inc. Tissue cutting instrument
US7244263B2 (en) 2002-04-09 2007-07-17 Stryker Corporation Surgical instrument
US9445825B2 (en) 2011-02-10 2016-09-20 Wright Medical Technology, Inc. Expandable surgical device

Family Cites Families (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US1677337A (en) * 1924-09-27 1928-07-17 Thomas E Grove Antrum drill
US4646738A (en) * 1985-12-05 1987-03-03 Concept, Inc. Rotary surgical tool

Non-Patent Citations (2)

* Cited by examiner, † Cited by third party
Title
No further relevant documents disclosed *
See also references of WO9208416A1 *

Also Published As

Publication number Publication date
CA2095821A1 (fr) 1992-05-10
EP0556335A4 (en) 1994-07-13
JPH06503238A (ja) 1994-04-14
WO1992008416A1 (fr) 1992-05-29

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