WO1993005719A1 - Instrument de coupe microchirurgical - Google Patents

Instrument de coupe microchirurgical Download PDF

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Publication number
WO1993005719A1
WO1993005719A1 PCT/US1992/007954 US9207954W WO9305719A1 WO 1993005719 A1 WO1993005719 A1 WO 1993005719A1 US 9207954 W US9207954 W US 9207954W WO 9305719 A1 WO9305719 A1 WO 9305719A1
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WO
WIPO (PCT)
Prior art keywords
cutting
armature
actuator
tube
assembly
Prior art date
Application number
PCT/US1992/007954
Other languages
English (en)
Inventor
Thomas Ying-Ching Lo
Franklin Tao
Tolentino Escorcio
Original Assignee
Visionary Medical, 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
Priority claimed from US07/764,518 external-priority patent/US5275607A/en
Application filed by Visionary Medical, Inc. filed Critical Visionary Medical, Inc.
Publication of WO1993005719A1 publication Critical patent/WO1993005719A1/fr

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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
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/00736—Instruments for removal of intra-ocular material or intra-ocular injection, e.g. cataract instruments
    • A61F9/00745—Instruments for removal of intra-ocular material or intra-ocular injection, e.g. cataract instruments using mechanical vibrations, e.g. ultrasonic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/00736—Instruments for removal of intra-ocular material or intra-ocular injection, e.g. cataract instruments
    • A61F9/00763—Instruments for removal of intra-ocular material or intra-ocular injection, e.g. cataract instruments with rotating or reciprocating cutting elements, e.g. concentric cutting needles
    • 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
    • A61B17/3201—Scissors
    • 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
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • A61B2017/320093—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw additional movable means performing cutting operation
    • 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
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • A61B2017/320094—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw additional movable means performing clamping operation

Definitions

  • This invention relates to a surgical cutting device for cutting tissue, such as ocular tissue.
  • Surgical cutting devices such as for use in cutting ocular tissue, are widely employed in surgical procedures in which fine tissue cutting is to be achieved.
  • actuation of one blade end against the other is through the transfer of movement to the movable blade by depression of a single level extending from the handle (Southerland-Grieshaber) or by squeezing two opposing platforms on opposing sides of the handle.
  • the movable blade moves through an excursion of 60 to 70 mils (0.060 to 0.070 inch) from the fully open to the fully closed portion during actuation.
  • actuation is achieved by pressurizing a piston with a compressed gas source into a chamber within the handle, which causes the piston to move forward against a spring, moving one blade against the other, closing the blades. Opening the blades is accomplished by movement in the opposite direction through energy stored in the spring, as the gas within the piston chamber is released.
  • Control of the gas pressure release to the piston is accomplished by depression of a foot pedal by the surgeon. Scissor actuation is thus accomplished via footpedal control rather than via finger control, allowing the surgeon to hold the instrument steady without inducing any unnecessary tremor or motion to the blades due to finger movement.
  • Motor drivers of either rotary or linear solenoid style activate scissor closure by controlled transfer of the motor energy to the movable blade.
  • One commercially available cutting -tool is an automated, solenoid-style microscissprs that has a nondetachable pair of cutting blades extending from the end of a tubular needle, with the outer blade end being fixed and the inner blade end being reciprocated between an open and closed position with respect to the fixed blade.
  • the blade excursion is again 60 to 70 mils (0.060 to 0.070 inch) and travels at a rate of 1000 mm/sec from the open to the closed position.
  • the moving blade cuts in about 5 milliseconds and remains shut for about 15 milliseconds before automatically returning to the open position.
  • the device operates to produce a series of repetitive ⁇ cuts or oscillations at a rate of one to five strokes per second, with each stroke traveling at 1000 mm/sec.
  • the tissue is torn or inefficiently cut, due to tendency of the tissue to be pushed away from the cutting regions of the blades at relatively low scissor speeds.
  • ultrasonic probe to cut or macerate tissue by vibration at ultrasonic frequencies, typically between about 30 and 80 kHz.
  • ultrasonic frequencies typically between about 30 and 80 kHz.
  • ultrasonic probe is a very effective heat transfer device, and can cause thermal damage to the surrounding tissues. It is also generally difficult to control the area and degree of cutting and thus not widely used in microsurgeries except for cataract removal procedures.
  • the present invention includes a icrosurgical cutting device for cutting tissue, such as ocular tissue.
  • the device includes a handle-like body for gripping by the surgeon during the cutting operation, a linear actuator carried in the handle body, and having an armature which is movable axially, under the influence of a voltage applied to the actuator, between a fully extended and a fully retracted position, and structure for clamping a microsurgical cutting tool to the actuator's armature, for movement therewith between such extended and retracted positions, typically between about 50-100 mils.
  • a controller circuit in the device is designed to drive the armature in one of the following selectable modes:
  • the circuit controller is effective, in either the proportional mode or oscillatory mode, to supply a high-frequency voltage signal, in the range-between about 50-1,000 Hz, to the actuator, to produce a superimposed vibrational component whose amplitude is substantially less, than that of total excursion distance of the armature between its fully retracted and fully extended positions.
  • the cutting tool used in the device may be part of a tool assembly that includes an outer sleeve having an axial bore, an inner sleeve, a portion of which is mounted within the axial bore of the outer sleeve for limited axial movement with respect thereto, and a cutting tool having a proximal end secured to the inner sleeve and a distal cutting end.
  • the clamping structure in the device includes a first clamping structure carried on the handle-like body for receiving the outer sleeve in clamping engagement therewith, and a second clamping structure carried on the armature for receiving the inner sleeve in clamping engagement therewith.
  • the first and second clamping structures may include annular clamps for releasably engaging the outer surfaces of the tool assembly's outer and inner sleeves, respectively.
  • the invention in another aspect, includes a -cool assembly for use with a cutting device of the ⁇ ype described.
  • the assembly includes an outer sleeve having an axial bore, an inner sleeve, a portion of which is mounte within the axial bore for limited axial movement with respect thereto, and a cutting tool having a proximal end secured to the inner sleeve and a distal cutting end.
  • the outer and inner sleeves may have recessed portions adapted to receive first and second clamping structures in the cutting device releasably therewith, respectively.
  • the tool assembly is designed for tissue cutting by a scissors action.
  • the assembly further includes a tube attached to the outer sleeve, and a fixed- position blade mounted in the tube, where the cutting tool is movable within the tube, as the actuator is moved between its fully extended and fully retracted positions, to positions at which the cutting end of the cutting tool is open and closed with respect to the fixed-position blade.
  • the assembly is designed for- tissue removal.
  • the assembly further includes a tube attached to the outer sleeve and defining an axially extending opening adjacent the tube's distal end, where the cutting end of the cutting tool is designed to move within the tube, adjacent this opening, and the assembly is adapted for use with a cutting device designed to exert a vacuum within the tube.
  • the assembly is designed for tissue fragmentation, ' and the cutting tool includes-a tube having a bladed ' end.
  • Fig. 1 is a sectional view of an microsurgical cutting device constructed according to one embodiment of the invention
  • Fig. 2 is a sectional view of a portion of the handpiece of the device of Fig. l with its linear actuator removed;
  • Fig. 3 is a sectional view of the linear actuator of the device shown in Fig. l;
  • Fig. 4 is a sectional view showing one of the clamping structures in the Fig. 1 device;
  • Fig. 5 is a sectional view taken along line 5-5 in Fig. 4;
  • Fig. 6 is an exploded view of a cutting tool assembly designed for use with the device of the invention;
  • Fig. 7 is an enlarged side view of the outer sleeve in the Fig. 6 assembly
  • Fig. 8 is a sectional view taken on line 8-8 of Fig. 7;
  • Fig. 9 is an enlarged sectional view of the coupling structure by which the armature shaft in the cutting device is coupled to the cutting tool in the coupling assembly;
  • Figs. 10A, 10B, and IOC illustrate the relative positions of the cutting tool assembly blades in their fully open, partially open, and closed positions, respectively;
  • Figs. 11A and 11B show the positions of the armature in the cutting device at retracted and extended positions, respectively;
  • Fig. 12 is a schematic circuit diagram of a controller circuit in the device.
  • Figs. 13 shows the relationship between voltage level applied to the linear actuator, in a proportional mode, and position of relative positions of cutting blades seen in Figures 10A-10C;
  • Figure 14 show signals which can be supplied by the controller circuit in an oscillatory mode with a square- wave output (solid line left) , an oscillatory mode with a sine wave output (dotted line left) , and a square-wave output with a high-frequency vibrational component (solid line right) ;
  • Figure 15 is a side sectional view of a tool assembly sed with the cutting device of the invention for tissue removal.
  • Figure 16 is a side sectional view of a tool assembly used with the cutting device of the invention for tissue fragmentation.
  • a microsurgical cutting device 20 constructed according to one embodiment of the invention.
  • the device generally includes a handpiece 22 having a handle-type body 24, a linear actuator 26 housed within the body, and a controlling circuit (described below with respect to Fig. 12) , by which the linear actuator can be driven in one of a number of selectable modes.
  • the cutting device is designed for use with a detachable tool assembly, to be described below.
  • the linear actuator or motor in the device is a linear voltage-to-displace ent transducer. It is of low mass and low reluctance so that it may perform the functions of driving a cutting tool in its various modes of operation to be described below. Through the use of rare earth magnets of low mass, the motor may be operated to oscillate a cutting tool at oscillatory frequencies preferably between 1-20 Hz and vibrational frequencies preferably between 50- 1,000 Hz.
  • the low mass of the armature of the actuator 26 is advantageous in achieving movement at these velocities.
  • Actuator 26 includes an armature 28 which is mounted for axial movement within the body.
  • armature 28 includes a shaft 30 which is mounted for reciprocating axial movement in bearings 32, 34 mounted in end plates 36, 38, respectively, in the actuator.
  • a plurality of magnets such as magnets 40, 42, 44, which are separated by spacers, such as spacer 46 between adjacent pairs of magnets 40, 42.
  • the magnets are preferably made of rare earth magnetic materials that will retain their magnetic strength even after being subjected to high temperatures common in steam autoclave sterilization.
  • One such magnetic material used in a constructed embodiment of the invention is Neodymium Iron Boron (NdFeB) .
  • This material may be magnetized to provide a strong magnetic ield for a given weight and has the capacity to retain its magnetization over time and when heated to high temperatures during steam autoclaving for sterilizatio .
  • the magnets are polarized with axially spaced poles arranged with their respective fluxes in opposition.
  • the confronting faces of the adjacent magnets such as adjacent magnets 40, 42, have the same polarity (either N or S polarity) . Therefore the four magnets in the armature would have the pole orientation NS-SN-NS-SN, or SN-NS-SN- NS.
  • the magnets in the assembly are secured against axial movement on shaft 30 by resilient C-rings, such as ring 48, received in annular grooves in the shaft.
  • spacers such as spacer 50, which provide high permeability flux paths, as do the internal spacers, such as spacer 46.
  • the spacers in the armature are preferably made of Hi-Mu80 material which is a commercially available high permeability material.
  • a pair of springs or Belleville washers 52, 54 Disposed between C-ring 48 and end plate 36 at the forward side of armature in Fig. 3 is a pair of springs or Belleville washers 52, 54, which are carried or. the armature shaft.
  • These washers act to bias the armature to a retracted "at rest" position shown in Figs. 1 and 3.
  • the washers are compressed against the end plate as the armature shaft moves forwardly in its mounting bearings;.
  • the washers tend to reduce the shock or bouncing that would therwise occur at the extremity of travel of the armature and also provide a rest position of the armature when the motor is not energized.
  • a coil bobbin 56 which supports five spaced coils, such as coils 58, 60, 62.
  • the coils are displaced axially with respect to the magnets, such that each coil is aligned with one of the spacers, such as coil 60 aligned with spacer 46 (The armature in Fig. 3 is in a fully retracted position, where the armature is shifted toward the right in the figure with respect to the coil bobbin. In an intermediate armature position, the coils. are symetrically aligned, in an axial direction, with the associated spacers in the armature) ,
  • a casing 59 Surrounding and supporting the coils is a casing 59, which is also made of a high permeability material such as Hi-Mu80. End plates 36, 38 and the coil bobbin are retained within the casing by E-rings, such as E-ring 64 (Fig. 1) , which are received within annual grooves in the ends of casing to restrain the parts form axial displacement.
  • E-rings such as E-ring 64 (Fig. 1)
  • the coils are connected in circuit so that adjacent coils carry current in opposite directions.
  • the current would be clockwise in one coil and counter-clockwise in the immediately adjacent coils.
  • the magnetic flux path provided by the spacers, such as spacer 46, along with the casing results in the flux from each magnet passing through one coil going outwardly and through an adjacent coil coming inwardly.
  • the forces produced by the currents through the coils are additive and displace the armature in proportion to the magnitude of the applied voltage;
  • the actuator is held within housing or body 24 by annular shouldered rings, such as ring 66, as best seen in Fig. l.
  • body 24 is formed by a cylindrical member 68.
  • This member has an open end 70 through which the actuator is assembled. This end is closed a cap 72 which has an opening " through which a power cord 74 extends for supplying current to the actuator coils.
  • An O-ring seal 76 is positioned between cap 72 and member 68 to seal the motor enclosure against the entrance of moisture.
  • the forward end of member 68 is formed with an annular wall 71 that defines an opening 73 through which the forward end of the actuator shaft extends.
  • a flexible boot 75 which has an outer flange 75a, which is clamped between wall 71 and shoulder ring 66.
  • the boot is in sealed engagement with a coupling member 78, as shown in Fig. 1.
  • the boot permits the shaft to reciprocate axially while sealing the actuator against moisture and contaminants.
  • the forward end of the cutting tool includes a pair of clamp structures, or means, 78, 79 for clamping in a cutting tool assembly designed for releasable attachment to the cutting device.
  • a pair of clamp structures or means, 78, 79 for clamping in a cutting tool assembly designed for releasable attachment to the cutting device.
  • the assembly generally includes an outer sleeve 82 (Fig. 6-8) having an axial bore 84 (Fig.
  • the outer surface of sleeve 82 is formed with a series of annular grooves, such as grooves 94, which facilitate grasping the assembly 24 to withdraw it from engagement with the handpiece 22.
  • the proximal end of the sleeve (the right end in Figs. 7 and 8) has a smaller-diameter outer surface region in which is formed an annular groove 96 for use in engaging clamping structure in the cutting device, as will be described.
  • the inner bore of sleeve 82 includes a smaller diameter distal region 84a, and a larger-diameter proximal region 84b in which inner sleeve 86 is slidably received.
  • a pin 98 carried in an central part of the larger bore region serves to limit reciprocal motion of the inner sleeve within this bore region, as seen below.
  • a tube 100 (Fig. 6) is received, e.g., by press fitting, in the proximal bore region of sleeve 84.
  • One- exemplary tube is a 20 gauge stainless steel needle having a length of about 2.5 cm, and an inner diameter of about 26 mils.
  • the tube supports a fixed-position cutting blade 102 which is carried at the distal end of a shaft 104 which itself is attached, as by welding, to the inner wall of the tube.
  • Sleeve 86 includes a bore 106 which receives and in which is attached the proximal end of tool 88, for axial movement therewith.
  • a notch 10-8 which provides clearance for pin 91 in the assembly. The notch serves to limit the excursion of the inner sleeve within bore 84b between an extended position at which the right end wall of the notch in Fig. 6 contacts the pin, and a retracted position at which the left end wall of the notch in the figure makes contact with the pin.
  • Also formed in the outer surface of sleeve 86 is a groove 110 for use in engaging clamping structure in the cutting device, as will be described.
  • sleeve 86 In the assembly, movement of sleeve 86 between its extended and retracted positions moves- blade or blade end 90 back and forth with respect to fixed-position blade 102, as illustrated in Figs. 10A-10C, which show the relative positions of the blades at a fully extended, closed or cutting position (10A) , a partially open position (10B) , and a fully retracted, open position (IOC) .
  • the detachable cutting assembly has been described with respect to a scissors-type instrument with relatively moving blades, it will be appreciated that the assembly cutting tool(s) may be designed for performing a variety of microsurgical functions. Embodiments of a cutting assembly designed for use in tissue removal and tissue fragmentation are described below with respect to Figs. 15 and 16, respectively.
  • the clamping structures are part of an assembly 112 which is mounted on an annular extension 114 of body 24, for axial shifting with respect thereto.
  • Assembly 112 includes a unitary ring structure 116 composed of three cylindrical members 118, 120, 122 having the cross- sectional shapes shown in Fig. 2 and threaded or press fitted together.
  • Member 122 slides within a cavity 124 formed in extension 114, and member 120 slides within a cavity 126 formed within a cap 128 which serves to hold assembly 122 within body 24.
  • a spring 130 interposed between a ridge 132 on the cap and a radial lip 134 in member 120 serves to bias the assembly tov/ard the left in Fig. 2.
  • member 118 has three angularly spaced, radial channels, such as channel 136, each of which contains a ball, such as ball 138-, which can move radially within the channel.
  • the balls are confined in the channels by a cap 140 which fits over member 118 as seen in Fig. 2, and is axially slidable thereon.
  • the cap is biased towards the stop position shown in Fig. 2 by a spring 142.
  • the cap has an annular step 144 which allows the balls in member 118 to move outwardly in a radial direction, when the cap is moved inwardly on member 118, to a position where the cap contacts lip 134 on member 120.
  • Member 118, cap .
  • FIG. 9 shows details of • ' aboye.-described coupling member 77 and the forward end of shaft 30 which is coupled thereto.
  • the coupling member is composed of a coupling sleeve 146, a proximal region of which is rigidly attached to the shaft in the armature, as by press fitting, and a distal region of which is adapted to receive a portion of inner sleeve 86 of the tool assembly, as shown.
  • one or more O-rings such as O-ring 148 are placed in the sleeve at the position shown, and forced into place against an annular lip 150 in the sleeve by a sleeve-like coupler 154 which is press fitted into the distal region of sleeve 148 as shown.
  • the opposite end of coupler 154 is press fitted into a cap 156 which houses a C-ring 158 adapted to releasably engage groove 110 in the inner sleeve of the tool assembly, when such is forced into the cylindrical cavity formed by the coupling member.
  • This releasable engagement couples the inner sleeve of the tool assembly to shaft 30 in the armature, for reciprocal motion therewith during operation of the cutting device.
  • the coupling member, O-rings, and C-ring collectively form the clamping structure or means 78 in the cutting device.
  • Fig. 12 is a schematic view of the circuit controller, or circuit means, 160 used in driving the linear actuator in the device in one of a variety of selectable modes.
  • the device generally includes a potentiometer switch 162, typically in the form of a foot switch.
  • Switch 162 includes, in addition to the potentiometer, a two-position switch 165 at one end of travel, which will turn on a solid-state CMOS analog switch 166, such as an
  • Switch 165 also enables a selected waveform or combination of waveforms to reach a class-B power amplifier 168 which drives the coil in the linear actuator.
  • a second two-position switch 170 at the other end of travel of switch 162 is used in providing a positive DC voltage 164 to the actuator, to fully close the cutting blades in the tool assembly, as described below.
  • a mode selector 171 in the circuit includes four switches 174, 176, 178, 192 which are preferably CMOS switches driven by simple logic gates determined by the operating mode selected.
  • the output of the switches is connected to a summing amplifier 180, which is a conventional inverting operational amplifier, such as an amplifier TL084 supplied by Texas Instruments.
  • switch 192 When switch 170 in the potentiometer switch is activated, switch 192 will close, with switches 174, 176, 178 open, such that a positive DC voltage 164 only will be applied to switch 166, to fully close the blades.
  • the switch 170 is needed only with a scissors type tool assembly, so that regardless of which mode is selected, the surgeon will have a means to close the blades fully before introducing the cutting blades into the surgical site.
  • Amplifier 168 includes a pnp (TIP-127) and an npn
  • TIP-127 Darlington pair, and an inverting op amp, and is of conventional design, with appropriate feedback and compensation network for the inductive load of a motor to ensure stability.
  • An oscillator 182 in the circuit is preferably a function generator such as an ICL8038 generator supplied by Harris Semiconductor.
  • the oscillator provides square, sinusoidal, or triangular waveforms.
  • the output frequency is adjustable by a potentiometer 184.to achieve a selected output frequency, preferably between 1-20 Hz, and more preferably between 1-10 Hz.
  • a higher-frequency oscillator, referred to herein as vibrator 186 may be a function generator or simply an op amp with positive feedback which oscillates with a square wave output.
  • the vibrator can be preset to output a selected square-wave frequency, preferably between 50- 1,000, e.g. , 500 Hz.
  • a monostable multivibrator 188 in the circuit is a digital IC, e.g., 74HC123 multivibrator that is activated when the foot pedal is fully released (activating switch 165) . At that moment, a negative pulse is generated to' push the shaft of the motor back, to ensure that the two cutting blades will be fully open at their rest positions.
  • a cutting tool assembly such as assembly 80 to the device.
  • the assembly is inserted into the clamping structure, as indicated in Figs. 11A and 11B, with cap 140 moved rearwardly against spring 142 to allow the balls in clamping structure 79 to move radially outwardly within radial step 144.
  • cap 140 is released, to lock the balls into a -position of positive engagement with groove 96.
  • a proportional or linear mode the movable blade in the tool assembly is moved away from an intermediate position selectively according to the setting of a user-controlled foot switch, identified as switch 162 in Fig. 12.
  • the circuit controller is set to engage switch 176, connecting the output of switch 162 with the coils in actuator 26.
  • the voltage level produced in switch 162, as the potentiometer in the switch is moved in either direction away from a 0 volt output is shown in Fig. 13.
  • the actuator At the 0-volt position of the switch, the actuator is in a position intermediate the two positions shown in Fig. 11A and 11B. At this position, blades 90, 108 in the attached tool assembly are in an intermediate position, somewhat more open than that shown in Fig. 10B. Assuming the total allowed excursion of the armature is between 50- 100 mils, this distance between blades at this midpoint is between about 25-50 mils.
  • the armature As the foot-switch potentiometer is moved to output a negative voltage, the armature is moved proportionately toward its retracted position, moving blade 90 rearwardly with respect to fixed-position blade 102. It is appreciated that the extent of relative movement of the blades can be finely controlled in this manner, allowing the user to position the blades and hold the positioned blades at a selected position until further foot switch movement is made.
  • the foot switch is operated to bring the potentiometer to its most-negative output position, shown in Fig. 13
  • the armature As the foot switch is operated to bring the potentiometer to its most-negative output position, shown in Fig. 13, the armature is moved to its fully retracted position, shown in Fig. 11A, at which the blades are in their fully open position, shown in Fig.
  • the device is set, through switch 178, to connect oscillator 182 in the circuit with actuator 26.
  • the circuit controller is further set to a selected frequency, typically between 1-20 Hz, and a desired wave output.
  • Fig. 14 shows the waveforms of a sine wave output (dotted lines) or square-wave output (solid lines) .
  • One advantage of the sine wave output is that the armature approaches its fully extended and fully retracted positions gradually, and therefore with substantially smoother action.
  • the amplitude of the signal is preferably greater than that required to move the armature between its fully extended and fully retracted positions, typically 50-100 mils. However, a lower- amplitude signal will result in a smaller excursion of the armature away from its "at rest" position.
  • the circuit controller can also be set to provide a relatively high frequency vibrational component superimposed on the linear or slow-frequency oscillatory movement. This is done- by connecting switch 174 in combination with either switch 176 (for linear mode) or switch 178 (for oscillatory mode) .
  • Fig. 14 show a square wave oscillatory-mode output having a superimposed square-wave component produced by vibrator 186. Because of the relatively high-frequency of the superimposed component, the inertia of the armature will confine it to undergo a vibrational excursion which is substantially less than the total excursion between fully extended and retracted positions. Typically, the small displacement vibration excursion is from 1-3 mils, compared with a total excursion of 50 mils or more. The extent of vibrational excursion can be increased by reducing vibrational frequency or increasing vibration-signal amplitude.
  • switch 162 is designed to operate a switch 165 at one extreme position of the foot pedal in the switch.
  • switch 165 When switch 165 is depressed it will direct the selected voltage signal to the power amp when depressed.
  • the switch When released, the switch will activate switch 166 to the position shown in Fig. 12, causing multi ⁇ vibrator 188 to deliver a short negative pulse to amplifier 168 and actuator 26.
  • the purpose of this negative pulse is to cause the movable blade to be displaced to an open position at the end of the surgical procedure and thereafter be returned to the closed position by the positive DC signal.
  • sleeve 82 and its attached fixed-position blade 102 is also moved rearwardly, ultimately to a position where the two blades are overlapping.
  • the tool assembly disclosed includes a detachable assembly having relatively reciprocable scissors blades. It is contemplated that the device can also be used with a variety of other tool assemblies for use in tissue removal, tissue fragmentation, and other specialized microsurgical operations.
  • Fig. 15 shows a tool assembly 192 having inner and outer sleeves 194, 196, respectively, which have substantially the same construction as sleeves 86, 82, respectively.
  • a tube 198 in the assembly is rigidly attached to sleeve 196, and defines an inner bore 200 and adjacent its distal end, an axially extending opening 202.
  • a needle-like tube 204 rigidly attached to and extending through sleeve 194 in the assembly has a bladed distal end 206 designed to move back and forth across opening 202 when sleeve 194 , is moved between fully retracted and extended positions with respect to sleeve 196, producing a cutting action of tissue disposed adjacent the opening.
  • the assembly is preferably designed for use with a cutting device of the type described above, but additionally providing a vacuum source communicating with the coupling member in the device, and therefore also communicating with the open proximal end of tube 204, during a tissue removal operation.
  • the suction in the tube acts to draw tissue into opening 202, when tube 204 is in a retracted position. As the bladed tube is then extended past the opening, tissue is sliced away, then drawn into tube 204 at the next retraction position.
  • Fig. 16 shows a tool assembly 206 having inner and outer sleeves 208, 210, respectively, these sleeves having substantially the same construction as sleeves 86, 82, respectively.
  • a tube 212 in the assembly extends slidably through a bore 214 in sleeve 210 and extends through and is rigidly attached, as by press fitting, within a bore 216 in sleeve 208..
  • the tube has a bladed distal end 218.
  • the assembly is preferably designed for use with a cutting device of the type described above, but also additionally providing a vacuum source communicating with the coupling member in the device, and therefore also communicating with the open proximal end of tube 212, during a tissue removal operation.
  • the suction in the tube acts to draw tissue into opening the bladed opening of the tube, as the tube is move by oscillation, or a combination of oscillation and vibration, to fragment tissue at a microsurgical site.
  • the present invention includes a cutting tool assembly of the type illustrated by assemblies 80, 192, and 206, for use with a microsurgical tool having a handle body of the type described above.
  • the assembly generally includes an outer sleeve having an axial bore, an inner sleeve, a portion of which is mounted within the axial bore of the outer sleeve for limited axial movement with respect thereto, and a cutting tool having a proximal end secured to the inner sleeve and a distal cutting end.
  • the assembly is disposable after a single use, and is removed for disposal simply by releasing cap 140 in the cutting device to release clamping structure 79, then forcibly pulling the inner sleeve in the assembly out of its C-ring attachment by clamping structure 78.
  • Assembly 80 which is designed for tissue cutting .by a scissors action, further includes a tube attached to the outer sleeve, a fixed-position blade mounted in this tube, and the cutting tool is movable within the tube, as the actuator is moved between its fully retracted and extended positions, to positions at which the cutting end of the cutting tool is open and closed with respect to the fixed- position blade, respectively.
  • Assembly 192 which is designed for use in tissue removal, further includes a tube attached to the outer sleeve and defining an axially extending opening adjacent the tube's distal end.
  • the cutting end of the cutting tool is designed to move within the tube, adjacent this opening.
  • the assembly is preferably adapted for use with a cutting device designed to exert a vacuum within the bladed tube.
  • the cutting tool includes a tube having a bladed end.
  • the cutting device is designed for controlled-position linear or oscillatory motion of cutting blade.
  • the linear mode allows a surgeon to set blade distances precisely for particular types of cutting operations, and to cut with a controlled cutting motion, as though the surgeon had direct manual control of two bladed elements.
  • the linear operation can be coupled with a vibrational mode to effect vibration-type cutting at a selected blade-distance setting.
  • the full-excursion blade motion can be coupled with a vibrational mode to effect snipping, a vibrational cutting action.
  • the cutting tool assembly of the invention is releasably coupled to the cutting device by a pair of clamping structures which allow the two sleeves in the assembly to be positively clamped, during a cutting operation, but also easily released after use.
  • the assemblies may be disposable to avoid problems of contamination and infection, or damaging the blades during cleaning.

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

Abstract

L'invention décrit un intrument de coupe microchirurgical (20) servant à couper un tissu, tel qu'un tissu oculaire. L'instrument comprend un élément sous forme de manche (24), un organe actionneur linéaire (26) situé à l'intérieur dudit élément (24), afin de déplacer un induit (28) entre des positions repliée et déployée, sur une course située entre 50 et 100 millièmes de pouces environ, ainsi qu'un circuit pouvant exciter l'organe actionneur (26) selon un mode proportionnel ou un mode à oscillations lentes. Le dispositif est conçu pour s'accoupler avec un ensemble de bistouris (8), de préférence, un ensemble jetable, par l'intermédiaire d'une structure à deux pinces (78, 79) maintenant une partie de l'ensemble (80) en position fixe et reliant un bistouri (88) dudit ensemble à l'induit de l'organe actionneur.
PCT/US1992/007954 1991-09-23 1992-09-21 Instrument de coupe microchirurgical WO1993005719A1 (fr)

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US764,518 1991-09-23
US07/764,518 US5275607A (en) 1991-09-23 1991-09-23 Intraocular surgical scissors
US89642692A 1992-06-10 1992-06-10
US896,426 1992-06-10

Publications (1)

Publication Number Publication Date
WO1993005719A1 true WO1993005719A1 (fr) 1993-04-01

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Cited By (16)

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US5823199A (en) * 1992-11-25 1998-10-20 Scimed Life Systems, Inc. In vivo mechanical energy source
WO2001068016A3 (fr) * 2000-03-11 2002-07-25 Univ Johns Hopkins Procedes de chirurgie oculaire sans suture et instruments de mise en oeuvre de ces procedes
EP2314233A1 (fr) * 2001-08-08 2011-04-27 Stryker Corporation Système d'outil chirurgical avec une fixation intermédiaire située entre la pièce à main et un accessoire ou un implant, la fixation pouvant transmettre l'énergie de la pièce à main à l'accessoire ou à l'implant et signaux de données de l'accessoire ou de l'implant vers la pièce à main
US8277418B2 (en) 2009-12-23 2012-10-02 Alcon Research, Ltd. Ophthalmic valved trocar cannula
US8343106B2 (en) 2009-12-23 2013-01-01 Alcon Research, Ltd. Ophthalmic valved trocar vent
WO2014085387A1 (fr) * 2012-11-29 2014-06-05 Microfabrica Inc. Micro-dispositifs de débridement et procédés de résection de tissu
US8795278B2 (en) 2008-06-23 2014-08-05 Microfabrica Inc. Selective tissue removal tool for use in medical applications and methods for making and using
EP2839799A1 (fr) * 2009-04-23 2015-02-25 Orthosonics Limited Instrument amélioré de résection osseuse
US8968346B2 (en) 2008-06-23 2015-03-03 Microfabrica Inc. Miniature shredding tool for use in medical applications and methods for making
US9290854B2 (en) 2013-07-16 2016-03-22 Microfabrica Inc. Counterfeiting deterrent and security devices, systems and methods
US9451977B2 (en) 2008-06-23 2016-09-27 Microfabrica Inc. MEMS micro debrider devices and methods of tissue removal
US9486360B2 (en) 2013-12-05 2016-11-08 Novartis Ag Dual electromagnetic coil vitrectomy probe
US10251782B2 (en) 2014-10-29 2019-04-09 Novartis Ag Vitrectomy probe with a counterbalanced electromagnetic drive
US10492822B2 (en) 2009-08-18 2019-12-03 Microfabrica Inc. Concentric cutting devices for use in minimally invasive medical procedures
US10676836B2 (en) 2003-06-27 2020-06-09 Microfabrica Inc. Electrochemical fabrication methods incorporating dielectric materials and/or using dielectric substrates
US10939934B2 (en) 2008-06-23 2021-03-09 Microfabrica Inc. Miniature shredding tools for use in medical applications, methods for making, and procedures for using

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US4210146A (en) * 1978-06-01 1980-07-01 Anton Banko Surgical instrument with flexible blade
SU835436A1 (ru) * 1979-07-16 1981-06-07 Предприятие П/Я В-8657 Ультразвуковой хирургический инструмент
US4428748A (en) * 1980-04-09 1984-01-31 Peyman Gholam A Combined ultrasonic emulsifier and mechanical cutter for surgery
US4877026A (en) * 1988-07-22 1989-10-31 Microline Inc. Surgical apparatus

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Publication number Priority date Publication date Assignee Title
US4200106A (en) * 1977-10-11 1980-04-29 Dinkelkamp Henry T Fixed arc cyclic ophthalmic surgical instrument
US4210146A (en) * 1978-06-01 1980-07-01 Anton Banko Surgical instrument with flexible blade
SU835436A1 (ru) * 1979-07-16 1981-06-07 Предприятие П/Я В-8657 Ультразвуковой хирургический инструмент
US4428748A (en) * 1980-04-09 1984-01-31 Peyman Gholam A Combined ultrasonic emulsifier and mechanical cutter for surgery
US4877026A (en) * 1988-07-22 1989-10-31 Microline Inc. Surgical apparatus

Cited By (26)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6089235A (en) * 1992-11-25 2000-07-18 Scimed Life Systems, Inc. Method of using an in vivo mechanical energy source
US5823199A (en) * 1992-11-25 1998-10-20 Scimed Life Systems, Inc. In vivo mechanical energy source
WO2001068016A3 (fr) * 2000-03-11 2002-07-25 Univ Johns Hopkins Procedes de chirurgie oculaire sans suture et instruments de mise en oeuvre de ces procedes
US7077848B1 (en) 2000-03-11 2006-07-18 John Hopkins University Sutureless occular surgical methods and instruments for use in such methods
US9707026B2 (en) 2001-08-08 2017-07-18 Stryker Corporation Surgical tool system including a navigation unit that receives information about implant the system is to implant and that responds to the received information
EP2314233A1 (fr) * 2001-08-08 2011-04-27 Stryker Corporation Système d'outil chirurgical avec une fixation intermédiaire située entre la pièce à main et un accessoire ou un implant, la fixation pouvant transmettre l'énergie de la pièce à main à l'accessoire ou à l'implant et signaux de données de l'accessoire ou de l'implant vers la pièce à main
US8035487B2 (en) 2001-08-08 2011-10-11 Stryker Corporation Method for assembling, identifying and controlling a powered surgical tool assembly assembled from multiple components
US10676836B2 (en) 2003-06-27 2020-06-09 Microfabrica Inc. Electrochemical fabrication methods incorporating dielectric materials and/or using dielectric substrates
US10939934B2 (en) 2008-06-23 2021-03-09 Microfabrica Inc. Miniature shredding tools for use in medical applications, methods for making, and procedures for using
US8795278B2 (en) 2008-06-23 2014-08-05 Microfabrica Inc. Selective tissue removal tool for use in medical applications and methods for making and using
US8968346B2 (en) 2008-06-23 2015-03-03 Microfabrica Inc. Miniature shredding tool for use in medical applications and methods for making
US10064644B2 (en) 2008-06-23 2018-09-04 Microfabrica Inc. Selective tissue removal tool for use in medical applications and methods for making and using
US9451977B2 (en) 2008-06-23 2016-09-27 Microfabrica Inc. MEMS micro debrider devices and methods of tissue removal
US9907564B2 (en) 2008-06-23 2018-03-06 Microfabrica Inc. Miniature shredding tool for use in medical applications and methods for making
EP2839799A1 (fr) * 2009-04-23 2015-02-25 Orthosonics Limited Instrument amélioré de résection osseuse
US10492822B2 (en) 2009-08-18 2019-12-03 Microfabrica Inc. Concentric cutting devices for use in minimally invasive medical procedures
US8277418B2 (en) 2009-12-23 2012-10-02 Alcon Research, Ltd. Ophthalmic valved trocar cannula
US8679064B2 (en) 2009-12-23 2014-03-25 Alcon Research, Ltd. Ophthalmic valved trocar cannula
US8343106B2 (en) 2009-12-23 2013-01-01 Alcon Research, Ltd. Ophthalmic valved trocar vent
US9814484B2 (en) 2012-11-29 2017-11-14 Microfabrica Inc. Micro debrider devices and methods of tissue removal
WO2014085387A1 (fr) * 2012-11-29 2014-06-05 Microfabrica Inc. Micro-dispositifs de débridement et procédés de résection de tissu
US9567682B2 (en) 2013-07-16 2017-02-14 Microfabrica Inc. Counterfeiting deterrent and security devices, systems, and methods
US9290854B2 (en) 2013-07-16 2016-03-22 Microfabrica Inc. Counterfeiting deterrent and security devices, systems and methods
US10801119B2 (en) 2013-07-16 2020-10-13 Microfabrica Inc. Counterfeiting deterrent and security devices, systems, and methods
US9486360B2 (en) 2013-12-05 2016-11-08 Novartis Ag Dual electromagnetic coil vitrectomy probe
US10251782B2 (en) 2014-10-29 2019-04-09 Novartis Ag Vitrectomy probe with a counterbalanced electromagnetic drive

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