Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B10/00—Instruments for taking body samples for diagnostic purposes; Other methods or instruments for diagnosis, e.g. for vaccination diagnosis, sex determination or ovulation-period determination; Throat striking implements
  • A61B10/02—Instruments for taking cell samples or for biopsy
  • A61B10/0233—Pointed or sharp biopsy instruments
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
  • A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B10/00—Instruments for taking body samples for diagnostic purposes; Other methods or instruments for diagnosis, e.g. for vaccination diagnosis, sex determination or ovulation-period determination; Throat striking implements
  • A61B10/0096—Casings for storing test samples
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B50/00—Containers, covers, furniture or holders specially adapted for surgical or diagnostic appliances or instruments, e.g. sterile covers
  • A61B50/30—Containers specially adapted for packaging, protecting, dispensing, collecting or disposing of surgical or diagnostic appliances or instruments
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B50/00—Containers, covers, furniture or holders specially adapted for surgical or diagnostic appliances or instruments, e.g. sterile covers
  • A61B50/30—Containers specially adapted for packaging, protecting, dispensing, collecting or disposing of surgical or diagnostic appliances or instruments
  • A61B50/31—Carrying cases or bags, e.g. doctors' bags
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B10/00—Instruments for taking body samples for diagnostic purposes; Other methods or instruments for diagnosis, e.g. for vaccination diagnosis, sex determination or ovulation-period determination; Throat striking implements
  • A61B10/02—Instruments for taking cell samples or for biopsy
  • A61B2010/0225—Instruments for taking cell samples or for biopsy for taking multiple samples
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B10/00—Instruments for taking body samples for diagnostic purposes; Other methods or instruments for diagnosis, e.g. for vaccination diagnosis, sex determination or ovulation-period determination; Throat striking implements
  • A61B10/02—Instruments for taking cell samples or for biopsy
  • A61B10/04—Endoscopic instruments, e.g. catheter-type instruments
  • A61B2010/045—Needles
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
  • A61B2017/00292—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
  • A61B2017/00296—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means mounted on an endoscope
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
  • A61B2017/00292—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
  • A61B2017/00336—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means with a protective sleeve, e.g. retractable or slidable
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B2017/00477—Coupling
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B2017/00681—Aspects not otherwise provided for
  • A61B2017/00734—Aspects not otherwise provided for battery operated
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B2017/00831—Material properties
  • A61B2017/0084—Material properties low friction
  • A61B2017/00849—Material properties low friction with respect to tissue, e.g. hollow organs
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/02—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by cooling, e.g. cryogenic techniques
  • A61B2018/0231—Characteristics of handpieces or probes
  • A61B2018/0237—Characteristics of handpieces or probes with a thermoelectric element in the probe for cooling purposes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/02—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by cooling, e.g. cryogenic techniques
  • A61B2018/0231—Characteristics of handpieces or probes
  • A61B2018/0237—Characteristics of handpieces or probes with a thermoelectric element in the probe for cooling purposes
  • A61B2018/0243—Characteristics of handpieces or probes with a thermoelectric element in the probe for cooling purposes cooling of the hot side of the junction, e.g. heat sink
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B50/00—Containers, covers, furniture or holders specially adapted for surgical or diagnostic appliances or instruments, e.g. sterile covers
  • A61B2050/001—Temperature-modifying means
  • A61B2050/0014—Cooling means

Definitions

• the present invention relates to a medical device for sampling biological material (eg. tissue or liquid- such as a diseased tissue, tissue that is suspected of being diseased and/or blood) and an assembly (eg. a transportation device) for housing the device.
• biological material eg. tissue or liquid- such as a diseased tissue, tissue that is suspected of being diseased and/or blood
• assembly eg. a transportation device
• biopsy specimens are an important procedure used for the diagnosis and prognosis of patients with cancerous tumours, pre-malignant conditions, and other diseases and disorders.
• the physician uses mammography, x-ray, ultrasound imaging or MRI to investigate suspicious circumstances, and a biopsy is performed to provide material for histopathology, immunohistopathology molecular histopathology, gene expression analysis and genetic testing.
• the biopsy specimen will help determine whether the cells are diseased, the type of disease that exists, the likely rate of progression, the chance of recurrence and what treatment should be used to treat the disease.
• Collection of the correct type of sample and a sample with intact nucleic acid and protein fractions is important for an accurate prognosis and/or diagnosis since the choice of treatment that is applied, and the outcome for the patient depends, in part, upon it.
• the choice of sample, the maintenance of its in vivo state and its collection is one of the most important procedure in the treatment of diseases - such as cancer.
• the biopsy may be performed by an open technique which is an invasive surgical procedure using a scalpel and involving direct vision of the target area, but is more likely to be a subcutaneous biopsy, done with a needle-like instrument through a relatively small incision, remotely or with the aid of an imaging device, and may be either a fine needle aspiration or a core biopsy. Alternatively, the entire tumour may be excised.
• tumours such as breast, cervical, lung, kidney, pancreatic or prostate cancer.
• Another common application is collection of bowel biopsies.
• Freezing the tissue sample at the site of the tumour or source of the biopsy sample would be even more advantageous because the frozen material is rigid and can be drawn to the end of the cannula with the minimum of tissue disruption.
• biopsy samples are capable of precisely identifying the cancer type species, probability of recurrence, and also in many cases the likely response from the range of drugs available for chemotherapy.
• gene chip arrays eg. Affymetrix, Illumina, Agilent, TmBioscience, Biochip Innovations and SiMEMS arrays
• microarrays sometimes called microarrays or lab-on-a-chip capable of probing the DNA/RNA/Protein, and their signatures, associated with the cancerous material.
• the act of cutting tissue during the biopsy sampling process causes undue damage to the cellular structure which reduces the precision of traditional histopathology and can introduce spurious artefacts which lead to doubts and mistakes at the microscopic examination.
• removal of frozen tissue is beneficial in optimizing the histopathology examination.
• the situation of the traditional methods is worsened by the fact that specimens are often frozen to enable them to be cut into thin slices on a microtome, and this additional freezing action introduces further damage and the introduction of spurious artefacts to the sample.
• Even in the traditional methods there are benefits in collecting frozen material and maintaining it in a frozen state until the point at which it can be paraffin embedded, microtome prepared and examined.
• RNA & DNA nucleic acid content
• the sample is put in an RNase inhibitor solution to protect the RNA from degrading.
• RNase inhibitor degrades the protein content of the sample, thus making traditional histopathological investigation impossible. No simple method exists for keeping the nucleic acid and protein content of the sample intact from excision, through transportation to testing.
• II is the Peltier coefficient IIAB of the entire couple
• HA and HB are the coefficients of each material.
• the conductors are attempting to return to an equilibrium position that existed before the current was applied by absorbing energy at one connection and releasing it at the other.
• Individual couples can be connected in series to enhance the effect, and since the length of electrical connection is not critical, the cryogenic tips can be very small indeed.
• the present invention relates to improvements in medical devices for sampling biological material.
• the Peltier effect has been widely adopted throughout industry for heat engines and portable refrigerators but has only rarely been miniaturised to, for example, cool printed circuit boards.
• the present inventors believe that the Peltier effect has not hitherto been considered or incorporated into biopsy instrumentation as described herein.
• the materials used to generate the couple have not previously been considered as forming part of the actual physical assembly of the device itself.
• the need for maintaining a frozen sample from collection through to transportation and actual testing for analysis has not widely been realised and hitherto no such facility exists for providing the specimens required to optimise the analysis procedures.
• thermoelectric or Peltier couple hi the absence of a current, this couple can act as a thermocouple, a physical property which in one embodiment the apparatus uses as a temperature sensing and controlling system. In another embodiment the probe temperature is measured by electrical demand placed upon the circuit.
• Cryogenic application may be made by one or more Peltier couples or by a semiconductor array or cascade of several arrays, as described herein. By this means samples may be frozen locally and removed without degradation of one or more of its components - such as RNA, DNA and/or protein.
• the frozen sample may be transferred to a modularly designed transport system incorporating its own power supply or its own external supply input so that the probe continues to receive its refrigerating power, whereby the integrity of the frozen sample may be preserved virtually indefinitely without degradation.
• the present invention addresses the need to transport samples - such as biopsy, blood and other samples - in a frozen state, rather than in either an RNase solution (to prevent RNA degradation) or Formalin (to prevent protein degradation).
• Formalin degrades nucleic acid, thus preventing analyses of the DNA & RNA and RNase solutions degrade proteins, thus preventing analysis of the proteomic status of the sample.
• the biopsy probe incorporates a Perkins tube and the tube itself then becomes an integral part of the transport system to ensure continued cryogenic conditions for the specimen.
• a medical device for sampling biological material comprising; (i) an elongate housing; (ii) a probe for sampling the biological material mounted (eg. slideably mounted) within the elongate housing; and (iii) a current supply electrically coupled to the probe or the elongate housing; wherein said elongate housing and said probe are made from materials having different Peltier potentials such that supply of current from the current supply generates a Peltier effect between said elongate housing and said probe.
• a method for sampling biological material in vitro or in vivo comprising the use of the medical device described herein.
• an assembly for housing a medical device comprising an outer casing, an insulating liner and a current supply having a receptacle within the assembly for receiving the medical device, wherein the receptacle comprises materials having different Peltier potentials such that supply of current from the current supply generates a Peltier effect between said receptacle and said medical device.
• the receptacle comprises materials having different Peltier potentials such that supply of current from the current supply generates a Peltier effect between said receptacle and said medical device.
• a Perkins tube enabling the cryogenic probe to be elongate.
• a combination comprising the medical device and the assembly described herein.
• a method for transporting a medical device comprising the use of the assembly described herein which may or may not incorporate a Perkins tube as an integral part of the transport mechanism.
• a seventh aspect there is provided the use of the assembly described herein for transporting a medical device.
• said device comprises a plurality of Peltier couples to form a Peltier couple array or a cascade of Peltier couple arrays.
• the temperature of said elongate housing or a portion thereof is reduced to about 0 0 C or less when current is applied to the elongate housing.
• the temperature of the distal end of said elongate housing is reduced.
• the temperature of said probe or a portion thereof is reduced to about 0 0 C or less when current is applied to the probe.
• the temperature of the distal end of said probe is reduced. In some embodiments, the temperature of the distal end of said probe is reduced such that the sampled biological material is held at around minus 20 degrees Celsius or lower.
• the distal end of said elongate housing and/or probe is removable.
• the distal end of said elongate housing has a cutting edge suitable for inserting through tissue.
• said probe is selected from the group consisting of a trocar, scissors, forceps, 'Cobra' forceps, grasping forceps, bullet forceps, bipolar forceps and ball or spatula instruments or a combination of at least two thereof.
• said elongate housing is a cannula.
• said probe comprises one or more hollow lumens.
• the hollow lumens are spaced around the circumference of said probe.
• the probe is moveable by a handle accessible on the outside of the device.
• the probe is or comprises a Perkins tube.
• said elongate housing comprises one or more of the components selected from the group consisting of: a fibre optic, a camera connection, video cabling, power transmission cabling, a fluid path, a gas path, a vacuum path, a local cauterising or ablating pad or path and a local dosing facility for one or more pharmaceutical products, one or more biochips, one or more nanochips or one or more biosensors or a combination of two or more of said components.
• said method comprises the steps of: (a) locating the medical device adjacent to the biological material to be sampled; (b) activating the Peltier couple on the medical device; (c) engaging the probe of the medical device with the biological material; (d) retracting the biological material contained in the probe into the elongate housing of the medical device; and (e) withdrawing the medical device from the sample.
• the Peltier couple on the medical device is activated after the probe of the medical device has been engaged with the biological material.
• the method comprises the step of: (f) detaching the probe comprising the sample from the medical device.
• the method comprises the step of: (g) extracting said sample from said probe for analysis, wherein said sample is extracted either before or after said probe containing the sample is detached from the medical device.
• said medical device receives stabilising resistance.
• said probe is engaged with the sample for a period of time that is long enough for said sample to be partially or entirely frozen.
• multiple samples are collected consecutively from the same sample.
• the receptacle within the assembly receives the probe that is detached from the medical device.
• the probe may be or may comprise a Perkins tube for transmitting cryogenic temperatures generated within the receptacle.
• the method comprises inserting the medical device into the receptacle of the assembly.
• the method comprises detaching the probe from the medical device and inserting the probe into the receptacle of the assembly.
• the probe may be or may incorporate a Perkins tube, as described herein.
• the transport system may incorporate the said Perkins tube.
• the present invention has a number of advantages. These advantages will be apparent in the following description.
• the present invention is advantageous because the integrity of the sample can be maintained since the sample can be frozen from collection through to actual testing.
• the present invention is advantageous because the sample may be protected from any risk of contamination from surrounding tissue or material (eg. potentially diseased cellular tissue or material) at the site of biopsy since the sample can be withdrawn (eg. retracted) into the elongate housing before the device is removed.
• tissue or material eg. potentially diseased cellular tissue or material
• the present invention is advantageous because the distal end of the mechanical device may be disposed of or sterilised once the sample has been dealt with, thereby providing a great advantage in the treatment and sterilisation of such equipment especially with heightened concerns over transmissible diseases - such as CJD - notwithstanding the possibility of inadvertently transferring diseased cells themselves.
• the present invention is advantageous because the mechanical device may be miniaturised. Such miniaturisation allows much greater flexibility for biopsy sampling and may minimise trauma to the subject.
• the present invention is advantageous because the system accommodates the sample from excision right through to laboratory testing without risk of thawing or contamination; conditions which cannot be bettered for a number of advanced diagnostic processes.
• the present invention is advantageous because the system incorporates inexpensive disposable collectors which avoid the costs and delays of sterilisation and cleaning with associated risks of contaminating the sample and spreading disease.
• Figure 1 is an overall view of one embodiment of the medical device constructed in accordance with the principles of the present invention.
• Figure 2 illustrates the typical detail of one embodiment of the distal end of the elongate housing of the medical device.
• Figure 3 illustrates one embodiment of the elongate housing of the medical device in use with a trocar biopsy needle in place within a sample.
• Figure 4 illustrates one embodiment of the medical device inserted into a sample and placed adjacent to a tumour or non-malignant growth with the tip of the trocar 16 adjacent to the site for sampling.
• Figure 5 illustrates one embodiment of the medical device in sample collection mode.
• Figure 6 illustrates one embodiment of the medical device being retracted with the trocar withdrawn into the elongate housing and containing the biopsy sample.
• Figure 7 illustrates another embodiment of the medical device of the present invention whereby repeat sampling from different areas within the region may be collected consecutively without having to relocate and reengage the sample with the elongate housing.
• Figure 8 illustrates one embodiment of the trocar including a plurality of coring lumens opening at the distal end of the trocar.
• Figure 9 illustrates one embodiment of the trocar being transferred to its transport box.
• Figure 10 illustrates one embodiment of the detail of the trocar receptacle.
• FIG 11 shows one embodiment of the tip which is threaded so that it is in intimate thermal contact with the remainder of the probe.
• Figure 12 shows one embodiment of a typical arrangement for a battery powered instrument according to the present invention.
• Figure 13 shows one embodiment of the elongate housing comprising a probe with an optional hollow tip.
• Figure 14 shows one embodiment of the elongate housing and the probe comprising a cryogenic tip.
• Figure 15 shows one embodiment for the insertion of the tip of the probe and Peltier device using a cam operated by handle.
• the medical device described herein can be used for sampling or biopsying any biological material that can be frozen.
• the biological material may be liquid or tissue (eg. soft tissue).
• tissue eg. soft tissue
• tissue include, but are not limited to, breast tissue, liver tissue, pancreas tissue, brain tissue, polyps tissue, kidney tissue and lymph node tissue.
• the biological material may be from a mammal - such as a human or an animal.
• the biological material may be tumorous tissue.
• tumorous tissue is meant herein any abnormal tissue including tumour or cancerous tissue.
• the device may also be used for sampling other material where preservation of DNA and/or RNA and/or protein is important - such as kidney, liver, prostate, brain, uterine fibroids, animals, foodstuffs, genetically modified organisms, deceased bodies, animals, scenes of crimes material, blood or a component thereof and the like.
• the sample may be a liquid - such as blood or a component thereof. Accordingly, the present invention can be used for taking blood samples and in one embodiment, is particularly suited to transporting thrombophilia screens. Blood samples for some tests, such as thrombophilia and applications where the nucleic acid ⁇ eg. RNA) within the blood samples is tested, require the samples to be frozen when transported.
• the Peltier effect is the creation of a heat difference from an electric voltage. It occurs when a current is passed through two dissimilar metals that are connected to each other at a Peltier couple (eg. a Peltier junction). The current drives a transfer of heat from one junction to the other: one junction cools down while the other heats up. Accordingly, the Peltier couple can be used as a Peltier cooler to bring about localised cooling of the medical device or a portion thereof. Since Peltier discovered the thermoelectric exchange between temperature and current, it has been realised with the onset of semiconductor technology that certain materials possess enhanced thermoelectric properties.
• bismuth telluride which is a quaternary alloy consisting of tellurium busmuth, antimony and selenium, doped and processed to yield oriented polycrystalline semiconductors with anosotropic thermoelectric properties.
• Such devices are commercially available from a number of sources for example from Copernica Ltd, Unit 5, Wates Way, Banbury, Oxfordshire, 0X16 3TS, UK
• the maximum efficiency achievable from such a system is currently about 67 0 C for a 'no load' situation, ie. the device is not extracting heat from an open system. Accordingly, with a normal healthy mammalian body temperature of 37 0 C there is the possibility to cool mammalian tissue to about -30 °C if the energy of conversion of tissue from its normal state to a refrigerated state is ignored.
• the Peltier effect occurs at the position where two materials having different Peltier potentials meet.
• the cold zone will radiate out from this position typically depending on the time that the instrument is switched on and the degree of insulating provided to the device.
• the elongate housing and the probe of the mechanical device are made from materials each having different Peltier potentials (eg. dissimilar materials) such that entire portions (eg. the whole) of the elongate housing and/or entire portions (eg. the whole) of the probe may be reduced in temperature (eg. to a temperature that is less than or equal to about 0 0 C). Accordingly, the Peltier effect can be used to bring about freezing.
• materials each having different Peltier potentials eg. dissimilar materials
• the device is configured such that the probe or portions thereof is reduced in temperature as compared to the elongate housing. According to this configuration, it will be necessary to insulate those portions of the elongate housing and/or the probe for which the temperature is not to be reduced. This may be achieved using various methods that are known in the art - such as using a thermally insulated coating as described herein. Alternatively or in addition, it is possible to use some of the heat from the Peltier couple to warm up those portions of the mechanical device that do not need to be cooled. Alternatively or in addition, it is possible for the heat to be removed by means of an additional metal component - such as a metal rod attached to the device.
• an additional metal component such as a metal rod attached to the device.
• the device incorporates a thermally conductively connected area around the hot Peltier couple suitable for dissipating heat generated by the Peltier junction, which provides optimum efficiency.
• the large thermal differences which may occur between the different parts of the device may necessitate removal of the heat which may be dissipated by a heat sink or a fan and the like.
• the heat may be dissipated through the device - such as through the handle of the device.
• the distal end of the probe eg. the tip
• the distal end of the probe is reduced in temperature such that in use an amount of sample can be extracted and protected by retracting the cooled (eg. frozen) distal end of the probe into the elongate housing.
• the Peltier effect is generated at the distal end of the probe.
• this embodiment of the present invention is particularly advantageous because, for example, it is possible to maintain the sample in a frozen state and also prevent contamination of the sample as it is withdrawn.
• the device is a miniaturised device in which the Peltier couple is very close to the distal end of the probe.
• the device comprises a Peltier array or cascade of Peltier arrays.
• the probe and/or the elongate housing may comprise a Peltier array comprising or consisting of a semiconductor thermoelectric array (eg. bismuth telluride or equivalent) within or surrounding the probe or within or surrounding the elongate housing such that applying current to the array produces a temperature differential between one side of the array and the other side.
• a semiconductor thermoelectric array eg. bismuth telluride or equivalent
• the arrays may be stacked together in a cascade to give exceptionally high rates of cooling. Such an approach is desirable to maximise the area of sampling and minimise the time needed for freezing to occur during the biopsy sampling stage.
• the elongate housing and/or the probe comprises an electrically insulated annulus having a different Peltier potential to said elongate housing and/or probe.
• the elongate housing and/or the probe consists of one material with an annulus made of a second material, suitably, at or close to the distal end of the elongate housing and/or the probe.
• Each of the materials has a different Peltier potential.
• Two suitable materials for manufacture are nickel and chrome.
• the annulus is electrically insulated from the elongate housing and/or the probe such that a small electric potential passes between them to generate a Peltier effect.
• the elongate housing comprises an electrically insulated annulus having a different Peltier potential to the rest of the elongate housing. Accordingly, the elongate housing consists of one material with the annulus being made of a second material, suitably, at or close to the distal end of the elongate housing.
• the elongate housing and/or the probe operate as a cryogenic probe by virtue of the Peltier effect which requires a power source which can be remotely powered or can be operated by batteries - such as rechargeable batteries.
• the cooling effect may be transferred from the tip of the device to a remote area of tissue being sampled by adding to the tip of the device an extension - such as the super-conducting system of Perkins tube manufactured by CRS Engineering Ltd, Willowbum Industrial Estate, Alnwick, Northumberland, United Kingdom.
• an extension - such as the super-conducting system of Perkins tube manufactured by CRS Engineering Ltd, Willowbum Industrial Estate, Alnwick, Northumberland, United Kingdom.
• the current from the power source is delivered to the input of the Peltier device or cascade of Peltier devices.
• the apparatus advantageously has the facility to withdraw the sample back into the elongate housing.
• the apparatus or a detachable portion thereof comprising the frozen sample may then be inserted into an appropriate receptacle - such as an insulated container - in order to maintain it in the frozen state for analysis and/or transportation without substantial deterioration of the specimen.
• the portion of the medical device comprising the frozen sample is detachable such that only that portion of the device comprising the sample needs to be used for subsequent analysis and/or transportation.
• the mechanical device, aside from the detachable portion of the device comprising the sample is reusable.
• the detachable portion of the device comprising the sample is disposable or sterilisable.
• the medical device as described herein comprises an elongate housing.
• the elongate housing may be a flexible or a rigid elongate housing.
• the elongate housing is flexible and/or articulate and/or steerable.
• the elongate housing is hollow and so it can house the probe.
• the elongate housing extends from a handle assembly, which is attached to the proximal end of the elongate housing.
• the elongate housing may be provided at its proximal end with a connector to an external electric current source having a plurality of insulated conducting wire sets for providing current and optionally, temperature sensing equipment.
• the elongate housing or a portion thereof comprises an optical coating on the exterior surface or within the bore of the elongate housing that reduces reflection or glare.
• the elongate housing or a portion thereof comprises an electrically insulated coating and/or a thermally insulated coating.
• the coating is silicone, PTFE or Teflon.
• this coating exists on any surface which comes into contact with the sample. In some embodiments, this coating exists on any surface which comes into contact with the sample other than the probe.
• the coating may be treated with one or more agents in order to reduce the risk of contamination of the device.
• the device is treated with an antibacterial agent - such as polymer comprising Microban ® (Talon House, Presley Way, Crownhill, Milton Keynes, MK8 OES, United Kingdom).
• the distal end of the elongate housing (eg. the tip) may be configured for easy insertion or cutting into biological material.
• the sharpness of the distal end may be suitable for insertion and the elongate housing may be generally smooth with an optional hydrophilic surface coating.
• the elongate housing may even comprise at its distal end one or more coring lumens that open at the distal end of the elongate housing.
• the coring lumens may be spaced around the circumference of the distal end of the elongate housing.
• this may provide for multiple sampling locations.
• the coring lumens may be spaced evenly or unevenly around the circumference of the distal end of the elongate housing.
• the distal end of said elongate housing has a cutting edge suitable for inserting through biological material.
• the elongate housing may be a cylindrical, oval or other suitable configuration with optional side or end openings.
• the cutting edge on the elongate housing bores a hollow annular portion of biological material as the probe retracts into the lumen of the elongate housing bringing with it adherent frozen biological material, thereby minimising contamination to the surrounding area.
• the outer diameter of the elongate housing may be less than 5 mm, less than 2 mm or smaller.
• the elongate housing may be several inches in length or longer suitable for the intended applications.
• the elongate housing is wide enough to carry or contain one or more additional components that are of use in obtaining a sample.
• the additional components may include, but are not limited to, one or more fibre optics, one or more camera connections, one or more video cablings, one or more power transmission cablings, one or more fluid paths, one or more gas paths, one or more vacuum paths, one or more local cauterising or ablating pads or paths and/or one or more local dosing facilities for one or more pharmaceutical products.
• the distal end of the elongate housing comprises an electrically insulated portion that is manufactured from a material that has a different Peltier coefficient to said elongate housing.
• the elongate housing is a flexible tube - such as a cannula (eg. an intravenous cannula).
• Cannulae are typically made with a probe - such as a trocar - contained therein.
• probe refers to any probe that is suitable for the sampling or biopsying biological material
• the probe may be a trocar, scissors, forceps, 'Cobra' forceps, grasping forceps, bullet forceps, bipolar forceps and ball or spatula instruments and the like.
• the probe is mounted within the elongate housing such that in use it can be extended and retracted.
• the probe is slideably mounted.
• the probe is slideably mounted longitudinally.
• at least a portion of the probe is contained within the elongate housing.
• the probe may be extended from the elongate housing in use such that at least a portion of said probe will extrude from the distal end (eg. the tip) of the elongate housing.
• said probe when the probe is withdrawn or retracted, said probe will not or substantially will not extrude from the distal end of the elongate housing.
• the distal end of the probe will be at least substantially flush with the distal end of the elongate housing.
• the probe is a trocar.
• the mechanical device comprises a cannula and a trocar.
• the probe may be heated.
• the probe may be or may comprise or consist of a Perkins tube.
• the Perkins tube may be detachable from the device.
• a hermetic tube, or 'Perkins tube' is a heat transfer mechanism that can transport large quantities of heat with a very small difference in temperature between the hotter and colder interfaces.
• 'Perkins tube' Inside a Perkins tube, fluid at the hot interface turns to vapour and the vapour naturally flows and condenses on the cold interface. The liquid falls or is moved by capillary action back to the hot interface to evaporate again and repeat the cycle.
• Perkins tubes can generally produce around eighty times more heat transfer than an equivalent copper rod, but hitherto as far as the inventor can ascertain have not been used for transfer of low temperatures, only hot temperatures.
• the internal thermal transfer fluid is often water or mercury for such applications, but experiments in cryogenic applications have revealed to us that alcohol, and even liquid helium serve admirably. Efficiency of cryogenic temperature transfer depends on the quantity of fluid contained within the Perkins tube and its internal pressure at a given temperature.
• a suitable transfer fluid is a coolant - such as pure methanol (methyl alcohol).
• Perkins tubes may be of stainless steel, nickel steel, titanium, and substantially ceramic-coated steel, for example.
• the Perkins tubes may even be a flexible Perkins tubes that may have benefit in remote access to previously difficult-to-reach body parts such as bowel cavities. Using such a device permits application of the present invention to even remote parts of the body.
• the Perkins tube is constructed with an internal coolant - such as methanol or the like.
• the Perkins tube is insulated substantially over its length with an insulating sheath material - such as high purity silica, syntactic polyurethane, or the like. This concentrates the cryogenic application at the tip of the Perkins tube, which may or may not be retractable.
• an insulating sheath material such as high purity silica, syntactic polyurethane, or the like. This concentrates the cryogenic application at the tip of the Perkins tube, which may or may not be retractable.
• the mechanical device is positioned at or close to the site of the biological material to be sampled or biopsied (eg. adjacent to the biological material - such as tissue) to be sampled - such as a potential tumour - by a range of techniques that are well known in the art. Such techniques include, but are not limited to, x-ray, ultrasound, or computer aided tomography.
• the Peltier effect on the medical device is then activated, which in one embodiment is by the use of a switch or other means.
• the probe of the medical device is then contacted or engaged with the sample in order to obtain the sample or biopsy.
• the sample contained in the probe is then retracted or withdrawn into the elongate housing of the medical device; and the medical device removed from the subject.
• the sample may then be transferred for analysis.
• the sample may be transferred to a near-patient microarray analysis system for rapid diagnosis, or the sample may be transferred to the transport system for despatch to the laboratory. This is accomplished in one embodiment by switching on the transport container and inserting the sample or the disposable tip containing the sample into the pre-cooled receptacle, or in another embodiment by transferring the Perkins tube into the pre- cooled holder within the transport system.
• FIG. 1 to 15 there are shown embodiments of the medical device (eg. the surgical apparatus) described herein.
• the medical device eg. the surgical apparatus
• a cannula 12 contains a trocar 15 which may be extended and retracted as desired using the outer hand grip 20.
• This grip may be located in one position automatically by application of a ratchet 22.
• the whole trocar assembly is capable of rotation via the grip 28.
• the cannula optimally carries fibre optic illumination, camera connections, video, power transmission cabling and any other ancillary requirement associated with biopsy samplers such as fluid and gas paths, vacuum path, local cauterizing or ablating pads or paths, local dosing facility with pharmaceutical products and Biochip or nanochip for in vivo diagnostics.
• the end of the cannula 12 consisting of parent material 33 having Peltier coefficient I A and incorporating a ring of material 38 having Peltier coefficient I B electrically connected to the power supply.
• the end of the cannula has a cutting edge suitable for inserting through biological material and is typically manufactured from material capable of being identified by imaging techniques adopted in surgery. Shown in this view are fibre optic light 40, camera exit point 44, vacuum point 46 and ancillary connection suitable for video 48.
• the cannula 12 can be flexible, articulated and steerable and can be configured to both pierce biological material and also be manoeuvrable within biological material.
• Suitable materials for cannula 12 and trocar 15 include, but are not limited to, stainless steel, nickel and nickel alloys, chromel, chromium and its alloys, aluminium and its alloys, shape memory alloys such as nickel titanium alloys, polyesters, polyethylenes, polyurethanes, Pebax ® , polyimides, nylons, copolymers thereof and other metals and medical plastics known to those skilled in the art.
• the manoeuvrable parts and operational parts can be made of an acceptable biological material such as TeflonTM (polytetrafluoroethylene (PTFE) or expanded polytetrafiuoroethylene (ePTFE)), carbon fiber, metal or metal composite for maximum strength with minimal wall thickness.
• TeflonTM polytetrafluoroethylene (PTFE) or expanded polytetrafiuoroethylene (ePTFE)
• carbon fiber metal or metal composite for maximum strength with minimal wall thickness.
• cannula 12 can be coated 13 with a lubricious coating or film which reduces the friction (and hence trauma) of cannula with hepatic, pulmonary, bone and other biological material.
• the cannula 12 may also have a coating 14 designed to insulate electrically and/or thermally as required.
• Such coatings can include but are not limited to silicones, PTFE (including Teflon ® ) and other coatings known in the art.
• cannula 12 and trocar 15 can have an optical coating 52 on their exterior surface or within the bore that is configured to reduce reflection or glare from their respective surfaces that may interfere with the sampling process.
• Optical coating 52 can be any non-reflective, glare resistant coating known in the art or can be a surface treatment such as anodization.
• all or portions of the apparatus 1 including cannula 12 and trocar 15 can be constructed of materials known in the art that are optimized and/or compatible with radiation sterilizations (e.g. Gamma or E-beam). In related embodiments, all or portions of apparatus 1 can be configured to be sterilized by plasma sterilization by systems.
• FIG 3 there is shown one embodiment of the cannula in use with a trocar biopsy needle 15 in place within the lumen.
• the trocar 15 has a sharp distal tip 16 which can pierce the tumour 2.
• the distal tip is shaped with a coring edge to collect biological material within the lumen 17 of the needle. Suction may be applied to the cannula lumen through the vacuum hose 57 and connection 59, thus drawing the tumor to the distal edge of the cannula and securely holding it in place.
• FIG. 4 there is shown a further embodiment of the device 1 inserted into biological material (such as tissue eg. breast tissue) and placed adjacent to a tumor or non-malignant growth with the tip of the trocar 16 adjacent to the site for sampling.
• Switch 60 activates the Peltier couple causing rapid freezing of the Peltier Type I B zone 38 local to the collection site. In some embodiments, this switches on a light 61 identifying that the Peltier cooling is taking place, reverting to a flashing light once adequate cryogenic temperature has been reached.
• Trocar 16 freezes by thermal conduction from cannula 12. Cannula coating 14 reduces loss of cooling power to surrounding biological material.
• FIG. 5 there is shown a further embodiment of the device in sample collection mode whereby hand grip 20 has been activated to extend the refrigerated trocar 15 out into tumour or non-malignant tissue being sampled, having received stabilizing resistance by suction from the vacuum attached to the cannula 12.
• a small core of biological material 19 has been forced into the lumen of the trocar needle 15.
• the rate of advancement is dependent on the rate of freezing of the biological material and whether or not the surgeon requires the sample to be taken whilst frozen, or simply frozen at the point of extraction from its surrounding biological material.
• FIG 6 there is shown another embodiment of the device in which it is retracted with the trocar 15 withdrawn into the cannula lumen 12 and containing the biopsy sample.
• the sample is protected by the cannula 12 so that it will not contaminate surrounding biological material as the device is withdrawn.
• the needle may now be removed and the core of biological material (eg. tumor tissue) extracted and analyzed for the presence of cancer cells.
• Figure 7 shows another embodiment whereby repeat sampling from different areas within the region may be collected consecutively without having to relocate and reengage the tumor with the cannula 12.
• the trocar 15 has an extended hollow lumen 18 so that consecutive areas may be penetrated, the previous solid, frozen sample 19 being pushed further into the trocar lumen 18 to allow for further sampling. After all necessary biopsies have been taken, some or all of the sample may be analyzed for the presence of cancer cells or other undesirable entities.
• FIG 8 shows another embodiment of the invention in which a trocar comprises several coring lumens 20 opening at the distal end of the trocar 15.
• the coring lumens are spaced around the circumference of the trocar, and allow for multiple sampling locations. It may be used in place of the single trocar as illustrated in Fig. 1. By providing suction to one or more of the lumens, the tumour is secured to the trocar for sampling.
• Figure 11 shows one embodiment of the tip 66 which is threaded 68 so that it is in intimate thermal contact with the remainder of the trocar 67 and may be removed or replaced as necessary.
• An alternative embodiment is that this connection is made further down the trocar so that the Peltier cooler is removed along with the Trocar tip and this provides for cooling to continue once the tip has been placed in the transport box and receives its own power supply.
• FIG. 12 an embodiment of the arrangement for a battery powered instrument is shown comprising an elongate housing 31 and handle 38 which houses a power source (preferably a battery, more preferably, a rechargeable battery) 39 held in place by a spring 40 which provides electrical contact to the elongate housing at ground voltage (earth).
• a power source preferably a battery, more preferably, a rechargeable battery
• An electrical cable runs to the end of the probe thus providing positive voltage from the battery to the probe to generate the Peltier effect in the Peltier device shown here as a Peltier cascade 32.
• power is turned on or off with switch 37.
• the probe 33 moves in and out of the area to be sampled using handle 34 pushed against spring 35.
• Figure 13 shows an embodiment of the elongate housing 5 housing a probe 8 with an optional hollow tip.
• the Peltier cooler comprises elements 19 sandwiched between plates 26 forming in this case a cascade. The number of elements is optional depending on the extent of cooling required and the diameter of the trocar which depends on the
• Figure 14 shows another embodiment of the elongate housing 3 and the probe comprising a tip 6 which is the cryogenic end and 11 which is the hot end.
• the trocar tip 6 may optionally comprise a hollow section 14 for specimen collection.
• Spacers 28 and 29 may be used to locate the probe in the elongated body.
• Spacer 28 is insulating (for example plastic - such as nylon) and spacer 29 is electrically conducting and/or thermally insulating (such as conductive plastic).
• Placing a positive electrical charge on the probe 11 via an electrical cable or other means passes current through the Peltier device causing the tip 6 to cool and the remainder 11 to absorb the heat which is dissipated.
• spacers 29 are electrically conducting the current passes through the circuit completed by the elongate housing and probe.
• An alternative embodiment for passing this current is to attach electrical cables to the positive and negative side of the Peltier device.
• Figure 15 shows an embodiment for the insertion of the tip of the probe 56 and Peltier device 55 using a cam 51 operated by handle 52 against the end of the trocar 54 held against spring 53.
• the mechanical device comprises a handle assembly (eg. a detachable handle assembly) at one end - suitably the proximal end of the elongate housing.
• a handle assembly eg. a detachable handle assembly
• the elongate housing extends from the handle assembly. In some embodiments, the probe is extended and/or retracted using a grip contained in the handle assembly.
• the handle assembly comprises at least one switch to activate the Peltier couple causing rapid freezing of the electrically insulated portion.
• the handle assembly may comprise at least one switch to deactivate the Peltier couple.
• the Peltier couple may be activated and deactivated using the same switch.
• the same (or a different) switch may activate one or more of the Peltier couples in the cascade to provide background cooling, or a coarse temperature control or a 'boost' setting.
• activation of the Peltier couple switches on a light identifying that the Peltier cooling is taking place.
• the device incorporates a timer for optimum collection of the right size of biological material.
• a light switches to a flashing light once the desired cryogenic temperature has been reached.
• the handle assembly may also comprise at least a switch control arrangement to control the electrical current and/or the current flow direction and/or impedance measurement and/or temperature sensing, and/or other operating conditions.
• the handle assembly further incorporates an electronic control circuit for maintaining a constant cryogenic temperature for the probe.
• the electronic control circuit may monitor the Peltier effect through the amount of current drawn.
• the electronic control circuit may monitor the Peltier effect by using the material couple as the principle of a thermocouple.
• an assembly for housing a medical device comprising an outer casing, an insulating liner and a current supply having a receptacle within the assembly for receiving the medical device, wherein the receptacle comprises materials having different Peltier potentials such that supply of current from the current supply generates a Peltier effect between said receptacle and said medical device.
• the probe detachable from the medical device and so in one embodiment the probe is transferred to the assembly rather than the entire medical device.
• Figure 9 illustrates one embodiment of the assembly in which the trocar is transferred to its transport box 101, comprising a rigid transport outer case 111 and an insulating liner 112 and lid 113 having a collecting device within the box consisting of a trocar receptor 116 assembled from a Peltier couple manufactured from parent material 119 having Peltier coefficient I A and incorporating a Peltier couple of material 120 having
• Peltier coefficient I B electrically connected to the power supply.
• Power supply 135 provides electrical current and control circuit 142 provides facility to maintain a constant temperature at the trocar.
• FIG 10 shows another embodiment of the trocar receptor 116, comprising parent material 1 19 having Peltier coefficient I A and incorporating material 120 having Peltier coefficient I B electrically connected to the power supply.
• TRANSPORT DEVICE Samples which must be transported have to remain frozen for the duration of the journey and any time they are waiting to be analysed.
• this is accomplished by removing the sample, or a disposable biopsy sampling tip containing the sample and placing it in a receptacle in an insulated container powered by electricity and containing Peltier coolers controlled by a temperature programmer and powered by rechargeable batteries and/or a mains/12 volt direct current - such as from a vehicle battery.
• the container receptacle houses the Perkins tube complete with sample and the Perkins tube is removed from the biopsy sampler and is placed in its receptacle in the transport container.
• the transport container is also fitted with a sealable lid, high-grade insulation, carrying handle, integral power and power controller, thermocouple or other temperature sensor.
• the transport container is also fitted with a compensating power system for optimal temperature stability may be included.
• the transport container is also fitted with a rechargeable or 'dry' battery power supply, mains power, 12 volt or 6 volt vehicle battery power provision.
• the transport container is also fitted with a record facility for sample details.
• the transport container is also fitted with a RFID or other location and tracking system.
• the transport container is also fitted with a temperature alarm. In another embodiment, the transport container is also fitted with an automatic telecommunications notification facility.
• the transport container is also fitted with a transport approval for biohazard samples (for example IATA, ROGS or others).
• biohazard samples for example IATA, ROGS or others.
• the transport container is also fitted with any additional 'intelligent' systems that may be required by individual authorities.
• the medical device and the assembly may be supplied in the form a kit.
• the kit may comprise one or more detachable probes.
• a set of instructions will also typically be included in the kit.
• a biopsy/tissue/other material sampling apparatus for maintaining sample integrity and minimising sample contamination, the apparatus comprising:
• a collection device including an elongate housing, the collection device being manoeuvrable in tissue and trackable via imaging techniques, optimally made from materials having two Peltier effects; and/or
• a probe suitable for collecting a sample which optionally in one embodiment consists of two materials having different Peltier potentials; and/or means for passing a current to or through the elongate housing, and/or
• the probe is selected from the group consisting of scissors, forceps, 'Cobra' forceps, grasping forceps, bullet forceps, bipolar forceps, ball or spatula type instruments or any variation thereof, including any probe for capture.
• the mechanical device further comprises resources configured to distinguish between normal and abnormal samples, wherein the abnormal sample may include at least one of abnormally mutated tissue, abnormally dividing tissue, cancerous tissue, metastatic tissue, immortal tissue, or hypoxic tissue.
• the abnormal sample may include at least one of abnormally mutated tissue, abnormally dividing tissue, cancerous tissue, metastatic tissue, immortal tissue, or hypoxic tissue.
• the mechanical device further comprises a tissue/biopsy/sample and treatment apparatus for detecting and treating tumours, the apparatus comprising an elongate housing which is sent complete to the laboratory whilst maintained in a cryogenic state, with or without prior detachment of the trocar or probe from that part of the instrument.
• the mechanical device further incorporates an electronic control circuit capable of maintaining a constant cryogenic temperature at the trocar, probe, scissors, forceps, 'Cobra' forceps, grasping forceps, bullet forceps, bipolar forceps, ball or spatula type instruments or any variation thereof, including any probe for capture, by monitoring the Peltier effect through current drawn or by using the material couple as the principle of a thermocouple.
• the probe is disposable or sterilisable.

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